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1.
Anaesthesia ; 74(6): 751-757, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30933322

RESUMO

The TotaltrackTM is a new video laryngeal mask, which combines a supraglottic airway with a videolaryngoscope. We evaluated the performance of this device in an observational study in 300 adult patients. The Totaltrack was inserted at the first attempt and the glottis seen in all cases. In 249 patients (83%; 95%CI 78.7-87.3%) the glottis was seen at the first attempt. Adequate ventilation and tracheal intubation were achieved in all patients. The median time to visualisation of vocal cords, to confirmation of ventilation and to successful tracheal intubation was 5 s, 13 s and 24 s, respectively. Nineteen patients (6.3%; 95%CI 3.55-9.05%) suffered minor complications, such as mucosal lesion or blood staining. The Totaltrack appears effective for airway management.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Máscaras Laríngeas , Gravação de Videoteipe/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Manuseio das Vias Aéreas/métodos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
2.
Public Health ; 158: 47-54, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29547759

RESUMO

OBJECTIVE: ST-segment elevation myocardial infarction (STEMI) has an important economic burden that poised the urgent need to evaluate its catastrophic medical expense. This study evaluates the first 5 years of the national health initiative called Popular Insurance (PI) at the National Institute of Cardiology in Mexico. STUDY DESIGN: Retrospective data analysis. METHODS: STEMI patients with (n=317) and without (n=260) PI were selected. Analysed variables included socio-economical context, management care, cost evaluation and three outcomes (mortality, hospital readmission and therapeutic adherence). Descriptive statistical analyses, Kaplan-Meier survival and Support Vector Machine models were used accordingly. RESULTS: Treatment costs were higher for PI-covered individuals (P=0.022) and only 1.89% of them remained in debt, in contrast to 16.15% of those without PI. Statistically significant differences were found in relation to days in hospital wards (P<0.001), imaging studies (P<0.001) and surgical materials (P=0.04). Survival analysis (P=0.44) and therapeutic adherence (P=0.38) showed no differences. Hospital readmission was predicted with an 81.97% accuracy. The most important predictive variables included were stent type, number of days at the coronary care unit and hospital wards. CONCLUSIONS: The PI has proven to be a successful program where no differences were found in terms of health care and survival, whereas it provides timely financial support for families facing catastrophic health challenging events.


Assuntos
Doença Catastrófica/economia , Gastos em Saúde/estatística & dados numéricos , Infarto do Miocárdio/economia , Programas Nacionais de Saúde , Doença Catastrófica/terapia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos
3.
World J Urol ; 35(12): 1891-1897, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28836063

RESUMO

PURPOSE: Because the prognostic impact of the clinical and pathological features on cancer-specific survival (CSS) and overall survival (OS) in patients with papillary renal cell carcinoma (papRCC) is still controversial, we want to assess the impact of clinicopathological features, including Fuhrman grade and age, on survival in surgically treated papRCC patients in a large multi-institutional series. METHODS: We established a comprehensive multi-institutional database of surgically treated papRCC patients. Histopathological data collected from 2189 patients with papRCC after radical nephrectomy or nephron-sparing surgery were pooled from 18 centres in Europe and North America. OS and CSS probabilities were estimated using the Kaplan-Meier method. Multivariable competing risks analyses were used to assess the impact of Fuhrman grade (FG1-FG4) and age groups (<50 years, 50-75 years, >75 years) on cancer-specific mortality (CSM). RESULTS: CSS and OS rates for patients were 89 and 81% at 3 years, 86 and 75% at 5 years and 78 and 41% at 10 years after surgery, respectively. CSM differed significantly between FG 3 (hazard ratio [HR] 4.22, 95% confidence interval [CI] 2.17-8.22; p < 0.001) and FG 4 (HR 8.93, 95% CI 4.25-18.79; p < 0.001) in comparison to FG 1. CSM was significantly worse in patients aged >75 (HR 2.85, 95% CI 2.06-3.95; p < 0.001) compared to <50 years. CONCLUSIONS: FG is a strong prognostic factor for CSS in papRCC patients. In addition, patients older than 75 have worse CSM than patients younger than 50 years. These findings should be considered for clinical decision making.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Nefrectomia , Medição de Risco/métodos , Idoso , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Europa (Continente)/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/diagnóstico , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Mortalidade , Gradação de Tumores , Estadiamento de Neoplasias , Nefrectomia/efeitos adversos , Nefrectomia/métodos , América do Norte/epidemiologia , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos
4.
Genet Mol Res ; 14(1): 2929-39, 2015 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-25867443

RESUMO

We studied the interethnic variation of the MMP-9 microsatellite in the Mestizo and Amerindian populations using blood samples collected from 435 healthy unrelated individuals from the Central Valley of Mexico. DNA samples were genotyped using the -90 (CA)12-27 repeat near the MMP transcriptional start site using capillary electrophoresis. Our data were compared with those from African, Asian, and European populations (N = 729). Both Mestizo and Amerindian populations were in Hardy-Weinberg equilibrium (P ≥ 0.05). However, strong genetic heterogeneity was found within the Mestizo population (94%, P ≤ 0.0001), which exhibited the highest frequency of Amerindian, African, and European alleles. Likewise, Amerindians showed 6.7% variation among populations (P ≤ 0.0001), suggesting a genetic substructure potentially associated with linguistic affiliations. These findings were corroborated with principal component and population differentiation analyses, which showed relative proximity among the Mestizos and their historical parental populations: Asian (FST ≥ 0.05), European (FST ≥ 0.09), and African (FST ≥ 0.02). Nevertheless, important differences were found between Mestizo and Nahuas (P ≤ 0.0001), and between Mestizo and Me'Phaas (P ≤ 0.0001). These findings highlight the importance of determining local-specific patterns to establish the population variability of MMP-9 and other polymorphic markers. Validation of candidate markers is critical to identifying risk factors; however, this depends on knowledge of population genetic variation, which increases the possibility of finding true causative variants. We also show that dissimilar ethnic backgrounds might lead to spurious associations. Our study provides useful considerations for greater accuracy and robustness in future genetic association studies.


Assuntos
População Negra/genética , Variação Genética , Indígenas Norte-Americanos/genética , Metaloproteinase 9 da Matriz/genética , Repetições de Microssatélites/genética , População Branca/genética , Alelos , Análise de Variância , Frequência do Gene , Genética Populacional/métodos , Genótipo , Geografia , Humanos , Desequilíbrio de Ligação , México , Análise de Componente Principal , Análise de Sequência de DNA
5.
Artigo em Inglês | MEDLINE | ID: mdl-39243814

RESUMO

The main objectives of the pre-anaesthesia consultation are to establish the patient's anaesthesia and surgical risk, evaluate and optimize their health status, provide the patient with information and preoperative recommendations, and fulfil the legally established bureaucratic obligations. The incorporation of information technologies - e-Health - has maximised the efficiency of pre-anaesthesia assessments and provided patients with an added benefit. The SEDAR Task Force has developed a digital framework as an alternative to the conventional pre-anaesthesia assessment process, and has put forward a series of policies and technical recommendations for the incorporation of different types of pre-anaesthesia teleconsultation services in hospital anaesthesiology departments. We also put forward an evaluation tool that includes several quality indicators on which to base continuous improvements in healthcare.

6.
Artigo em Inglês | MEDLINE | ID: mdl-38825182

RESUMO

PURPOSE: To demonstrate the utility of machine learning models for predicting difficult airways using clinical and ultrasound parameters. METHODS: This is a prospective non-consecutive cohort of patients undergoing elective surgery. We collected as predictor variables age, sex, BMI, OSA, Mallampatti, thyromental distance, bite test, cervical circumference, cervical ultrasound measurements, and Cormack-Lehanne class after laryngoscopy. We univariate analyzed the relationship of the predictor variables with the Cormack-Lehanne class to design machine learning models by applying the random forest technique with each predictor variable separately and in combination. We found each design's AUC-ROC, sensitivity, specificity, and positive and negative predictive values. RESULTS: We recruited 400 patients. Cormack-Lehanne patients≥III had higher age, BMI, cervical circumference, Mallampati class membership≥III, and bite test≥II and their ultrasound measurements were significantly higher. Machine learning models based on physical examination obtained better AUC-ROC values than ultrasound measurements but without reaching statistical significance. The combination of physical variables that we call the "Classic Model" achieved the highest AUC-ROC value among all the models [0.75 (0.67-0.83)], this difference being statistically significant compared to the rest of the ultrasound models. CONCLUSIONS: The use of machine learning models for diagnosing VAD is a real possibility, although it is still in a very preliminary stage of development. CLINICAL REGISTRY: ClinicalTrials.gov: NCT04816435.

7.
Rev Esp Anestesiol Reanim (Engl Ed) ; 71(3): 171-206, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38340791

RESUMO

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.


Assuntos
Manuseio das Vias Aéreas , Humanos , Manuseio das Vias Aéreas/normas , Manuseio das Vias Aéreas/métodos , Medicina de Emergência/normas , Adulto , Intubação Intratraqueal
8.
Rev Esp Anestesiol Reanim (Engl Ed) ; 71(3): 207-247, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38340790

RESUMO

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.


Assuntos
Manuseio das Vias Aéreas , Humanos , Manuseio das Vias Aéreas/normas , Manuseio das Vias Aéreas/métodos , Medicina de Emergência/normas , Adulto , Intubação Intratraqueal
9.
Curr Mol Pharmacol ; 14(4): 570-578, 2021 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-32744980

RESUMO

BACKGROUND: Valproic acid (VPA) is an HDAC inhibitor (HDACI) with an anticancer activity, but is hepatotoxic. N-(2-hydroxyphenyl)-2-propylpentanamide (o-OH-VPA) is a VPA aryl derivative designed in silico as a selective inhibitor of HDAC8 with biological properties against HeLa, rhabdomyosarcoma and breast cancer cell cultures. OBJECTIVE: We studied the epigenetic mechanism of o-OH-VPA as an HDACI and evaluated whether it was toxic to normal cells. METHODS: HeLa cells and primary human fibroblasts were used for this study as carcinogenic and normal cells, respectively. Cell survival was evaluated by MTT assay, whereas viability and doubling time were determined by the Trypan-blue method. HDAC activity was tested using the colorimetric HDAC activity assay. The expression of p21 was analyzed by PCR and HDAC8 expression was also evaluated by real-time PCR. Cell cycle and caspase-3 activity were analyzed by flow cytometry and caspase-3 colorimetric assay, respectively. RESULTS: o-OH-VPA (IC50 = 0.1 mM) was fifty-eight times more effective than VPA (IC50 = 5.8 mM) to reduce HeLa cell survival. Furthermore, o-OH-VPA increased the doubling time of HeLa cells by 33% with respect to the control. o-OH-VPA acted as HDACI in HeLa cells without affecting the HDAC8 expression, arresting the cell cycle of HeLa cells in the G0/G1 phase due to the increase in p21 expression with the inhibition of caspase-3 activity without exhibiting toxicity toward normal cells. CONCLUSION: Our results revealed that o-OH-VPA is an HDACI with a selective effect against HeLa cells but without the known toxicity exerted by most pan-HDACIs on normal cells.


Assuntos
Epigênese Genética , Ácido Valproico , Amidas , Linhagem Celular Tumoral , Células HeLa , Histona Desacetilases/metabolismo , Humanos , Pentanos , Proteínas Repressoras/metabolismo , Ácido Valproico/farmacologia
11.
Actas Dermosifiliogr ; 101(4): 341-8, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20487690

RESUMO

BACKGROUND: Melanoma is a malignant neoplasm with high metastatic disease risk and elevated mortality. Incidence of melanoma varies according to geographic region and genetic BACKGROUND: Epidemiological studies indicate that acral melanoma (AM) is among the most common melanomas in the Mexican population. While extensive studies have identified genes associated with melanoma, little is known about the genes involved in the pathogenesis of AM. OBJECTIVE: To compare the gene expression patterns between primary melanoma and normal skin. METHODS: We used 10 samples of fresh acral melanomas and normal skin for the study of differential gene expression and 22 samples of melanoma for in situ hybridization. RESULTS: We first identified a gene that was present in a sample of AM and absent in normal skin. DNA sequencing of this differentially expressed gene revealed that it corresponded to ABCB5, a gene recently implicated in the regulation of progenitor cell fusion. Furthermore, we detected ABCB5 expression in other melanoma specimens by RT-PCR. We showed that nine out of ten melanomas were positive for ABCB5 while only one melanoma and normal skin samples were negative. All ABCB5 expressing melanomas had variable gene expression according to in situ hybridization studies, suggesting that the ABCB5 gene may be differentially regulated by individual melanomas. CONCLUSIONS: The ABCB5 gene may be related to the properties of chemoresistance and aggressiveness of melanoma. The high expression found in samples of acral melanoma may provide more insight on the pathogenesis of this common type of melanoma in the Mexican population, frequently associated with poor prognosis.


Assuntos
Transportadores de Cassetes de Ligação de ATP/genética , Regulação Neoplásica da Expressão Gênica , Melanoma/genética , Neoplasias Cutâneas/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32564884

RESUMO

BACKGROUND: Rapid sequence induction (RSI) in adults has undergone changes in recent years due to pharmacological and technological advances. The objective of this survey was to evaluate current practice among Spanish anesthesiologists. METHODS: A 31-item questionnaire regarding RSI practice was sent to anesthesiologists working in Spanish public hospitals. Differences in responses according to the type of hospital or experience of the respondent were compared for all data using the chi-square and Fisher's exact test. RESULTS: Approximately 15.89% of Spanish anesthesiologists participated in the survey (1002 questionnaires). The results show considerable heterogeneity in most aspects of RSI. Less than 20% of respondents administer sodium citrate. Sixty-four percent place a nasogastric tube in patients with intestinal obstruction. Gastric residue is assessed by ultrasound in 6% of cases. Only 25% of respondents measure ETO2 to check the effectiveness of preoxygenation, and 22% use nasal oxygen insufflation with nasal prongs or THRIVE. Sixty two percent of respondents apply cricoid pressure, but only 50% release the pressure when encountering intubation difficulty. Up to 40% of respondents reported cases of aspiration despite applying cricoid pressure. Propofol was the most commonly used hypnotic (97.6%), but there was no clear preference in the choice of neuromuscular relaxant (suxamethonium versus rocuronium ratio of approximately 1:1). Only 44% of respondents calculated the dose of sugammadex that would be required for emergency reversal of rocuronium. CONCLUSIONS: The survey showed significant variation in RSI practice, similar to that of other countries. Quality prospective studies are needed to standardize clinical practice.


Assuntos
Anestesiologia , Padrões de Prática Médica , Indução e Intubação de Sequência Rápida/normas , Pesquisas sobre Atenção à Saúde , Humanos , Espanha
13.
J Steroid Biochem Mol Biol ; 113(1-2): 46-51, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19073256

RESUMO

The OPG/RANKL/RANK system is important in the balance between bone formation and resorption. We used primary human osteoblasts (hOBs) cells to examine the impact of 17-beta-estradiol (E2) or/and 1,25-dihydroxyvitamin D (1,25D) in OPG/RANKL system in 28 post-menopausal (PM) women; (a) with hip fracture (OP) or (b) with osteoarthritis (OA). The hOB from OP patients proliferated slower during the first stage, than the OA women (31.5+/-2.6 and 21.4+/-1.3 days, respectively, p<0.05). The OP group secreted significantly higher OPG protein levels than the OA women (10.1+/-2.6 and 4.4+/-0.8pmol/L, respectively, p<0.05). The 1,25D and 1,25D+E2 induce an increase in RANKL and RANKL/OPG mRNA expression in OP patients above 200% (p<0.05). HOBs from the osteoporotic hip initially proliferate slower but after reaching the first cellular confluence, the proliferation rate is equal in both groups. Furthermore, hOBs from hips with OP present a higher protein secretion of OPG, and higher RANKL and RANKL/OPG expression ratio in response to 1,25D and 1,25D+E2, than hOBs from OA women. All this could suggest that the greater bone loss that characterizes OP patients can be mediated due to differences in the secretion and expression of the RANKL/OPG system in response to different stimuli.


Assuntos
Fraturas do Quadril/patologia , Osteoartrite/patologia , Osteoblastos/metabolismo , Osteoporose/patologia , Osteoprotegerina/metabolismo , Pós-Menopausa/metabolismo , Ligante RANK/metabolismo , Idoso , Idoso de 80 Anos ou mais , Células Cultivadas , Estradiol/farmacologia , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Fraturas do Quadril/complicações , Fraturas do Quadril/metabolismo , Humanos , Osteoartrite/metabolismo , Osteoblastos/efeitos dos fármacos , Osteoblastos/patologia , Osteoporose/complicações , Osteoporose/metabolismo , Osteoprotegerina/genética , Pós-Menopausa/efeitos dos fármacos , Ligante RANK/genética , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Vitamina D/análogos & derivados , Vitamina D/farmacologia
15.
Rev Esp Anestesiol Reanim ; 56(7): 417-24, 2009.
Artigo em Espanhol | MEDLINE | ID: mdl-19856688

RESUMO

OBJECTIVE: To assess the quality of postoperative analgesia provided by intravenous administration of paracetamol and ketorolac plus morphine in bolus doses with or without continuous infusion of local anesthetic into the surgical wound after abdominal hysterectomy. Patient satisfaction was included among the outcomes assessed. MATERIAL AND METHODS: Prospective pilot study in ASA 1-2 patients randomized to 2 groups: women in the subcutaneous catheter group received intravenous analgesics plus a continuous infusion (2 mL/h) of 0.25% bupivacaine whereas women in the control group received only the intravenous analgesics. The outcome measures were pain intensity assessed on a verbal numerical scale at rest and with movement, morphine requirements in the first 48 hours after surgery, and complications related to the drugs used or the technique. RESULTS: Twenty-six patients were enrolled; 10 were randomized to the catheter group and 16 to the control group. Statistically significant between-group differences in pain both at rest and with movement were found while the women were in the postoperative recovery unit. Postoperative pain with movement was also significantly different at 24 hours (P<.004) and 48 hours (P<.02). Similarly, mean (SD) morphine requirements in the recovery unit were significantly greater in the control group, at 8 (2.27) mg, compared with 3.20 (1.79) mg in the catheter group (P<.002). Walking began earlier in the catheter group. No differences were found in the incidences of complications. CONCLUSIONS: Postoperative pain is effectively relieved by continuous infusion of local anesthetic into the surgical wound after abdominal hysterectomy. This technique provides good analgesia with less morphine consumption and scarce adverse effects. Patient satisfaction and the sense of receiving quality pain management are high.


Assuntos
Anestésicos Locais/administração & dosagem , Histerectomia , Dor Pós-Operatória/prevenção & controle , Adulto , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Infusões Intralesionais , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos
16.
Rev Esp Anestesiol Reanim (Engl Ed) ; 66(2): 104-112, 2019 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30293813

RESUMO

Healthcare is in constant transformation. Health systems should focus on improving efficiency to meet a growing demand for high-quality, low-cost health care. The operating room is one of the biggest sources of revenue and one of the largest areas of expense. Therefore, operating room management is a critical key to success. The aim of this article is to analyze the current principles of organization, optimization and clinical management of the operating room and its impact on the quality and safety of care.


Assuntos
Eficiência Organizacional , Salas Cirúrgicas/organização & administração , Duração da Cirurgia , Qualidade da Assistência à Saúde , Emergências , Salas Cirúrgicas/estatística & dados numéricos , Fatores de Tempo
17.
Transl Oncol ; 12(1): 24-35, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30265974

RESUMO

Epithelial cells lining the intestinal mucosa constitute a selective-semipermeable barrier acting as first line of defense in the organism. The number of those cells remains constant during physiological conditions, but disruption of epithelial cell homeostasis has been observed in several pathologies. During colitis, epithelial cell proliferation decreases and cell death augments. The mechanism responsible for these changes remains unknown. Here, we show that the pro-inflammatory cytokine IFNγ contributes to the inhibition of epithelial cell proliferation in intestinal epithelial cells (IECs) by inducing the activation of mTORC1. Activation of mTORC1 in response to IFNγ was detected in IECs present along the crypt axis and in colonic macrophages. mTORC1 inhibition enhances cell proliferation, increases DNA damage in IEC. In macrophages, mTORC1 inhibition strongly reduces the expression of pro-inflammatory markers. As a consequence, mTORC1 inhibition exacerbated disease activity, increased mucosal damage, enhanced ulceration, augmented cell infiltration, decreased survival and stimulated tumor formation in a model of colorectal cancer CRC associated to colitis. Thus, our findings suggest that mTORC1 signaling downstream of IFNγ prevents epithelial DNA damage and cancer development during colitis.

18.
Rev. esp. anestesiol. reanim ; 71(3): 172-206, 20240301. tab
Artigo em Inglês | BIGG | ID: biblio-1563293

RESUMO

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.


Assuntos
Humanos , Máscaras Laríngeas , Manuseio das Vias Aéreas/normas , Intubação Intratraqueal , Traqueostomia/reabilitação , Sedação Consciente
20.
Rev Esp Anestesiol Reanim (Engl Ed) ; 65(1): 41-48, 2018 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29031661

RESUMO

The difficult airway constitutes a continuous challenge for anesthesiologists. Guidelines and algorithms are key to preserving patient safety, by recommending specific plans and strategies that address predicted or unexpected difficult airway. However, there are currently no "gold standard" algorithms or universally accepted standards. The aim of this article is to present a synthesis of the recommendations of the main guidelines and difficult airway algorithms.


Assuntos
Manuseio das Vias Aéreas/normas , Manuseio das Vias Aéreas/métodos , Algoritmos , Anestesia Geral , Humanos , Intubação Intratraqueal , Guias de Prática Clínica como Assunto
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