• 【坐位式手术中有斜肌间神经阻滞的结果:单中心系列。】 复制标题 收藏 收藏
    DOI:10.1097/AAP.0b013e318277a2eb 复制DOI
    作者列表:Rohrbaugh M,Kentor ML,Orebaugh SL,Williams B
    BACKGROUND & AIMS: BACKGROUND:Several case reports have raised serious concerns about the safety of shoulder surgery in the beach-chair position, related to global cerebral hypoperfusion. We summarize our experiences with 15,014 cases of shoulder arthroscopy over an 11-year period. Our primary aim was to evaluate the incidence of intraoperative or immediate postoperative neurologic events and secondarily to relate other perioperative complications. METHODS:We searched our online deidentified departmental quality improvement and patient safety database for adverse outcomes associated with arthroscopic shoulder surgery performed in the beach-chair position for the 11-year period between April 2001 and November 2011, as well as our hospital-system database and a statewide database. This was compared with the total number of such cases, available from our department billing database. RESULTS:The total rate of adverse events was 0.37%. Neurologic abnormalities suggestive of acute cerebral ischemia or hemorrhage did not occur in the immediate perioperative period. One new neurologic deficit was reported, secondary to ischemic stroke, which occurred 24 hours after the surgery. The most frequent complications detected were unplanned return to care (0.067%), local anesthetic systemic toxicity (0.053%), and airway compromise requiring unplanned intubation (0.033%). Complications were infrequent and did not vary in incidence over the course of the study. CONCLUSIONS:This retrospective study suggests that intraoperative or immediate postoperative stroke is rare when surgery is conducted in beach-chair position in conjunction with regional anesthesia, propofol sedation, and spontaneous respiration via natural airway.
    背景与目标: 背景:几例病例报告引起了人们对与全脑低灌注相关的沙滩椅位置肩部手术安全性的严重关注。我们总结了我们在11年中共15014例肩关节镜检查的经验。我们的主要目的是评估术中或术后立即发生的神经系统事件的发生率,其次是与其他围手术期并发症相关。
    方法:我们在2001年4月至2011年11月的11年期间,通过在线不确定的部门质量改善和患者安全数据库,搜索了在沙滩椅位置进行的关节镜肩部手术相关的不良结局,以及医院系统数据库和全州数据库。将其与此类案件的总数进行比较,可从我们的部门账单数据库中获得该数目。
    结果:不良反应总发生率为0.37%。围手术期未发生提示急性脑缺血或出血的神经系统异常。据报道,缺血性中风继发于术后24小时,出现了一种新的神经功能缺损。发现的最常见并发症是计划外恢复治疗(0.067%),局麻药全身毒性(0.053%)和需要计划外插管的气道损害(0.033%)。在研究过程中,并发症很少见,发生率也没有变化。
    结论:这项回顾性研究表明,当在沙滩椅位置进行手术并结合区域麻醉,丙泊酚镇静和通过自然呼吸道自发呼吸时,很少发生术中或术后中风。
  • 【羊膜移植在急性史蒂芬-约翰逊综合征和毒性表皮坏死溶解治疗中的适应症和结局:病例对照研究。】 复制标题 收藏 收藏
    DOI:10.1097/ICO.0b013e31823d02a8 复制DOI
    作者列表:Hsu M,Jayaram A,Verner R,Lin A,Bouchard C
    BACKGROUND & AIMS: PURPOSE:To evaluate the indications and outcomes of amniotic membrane transplantation (AMT) performed within the first 2 weeks of presentation in the management of patients with acute Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). METHODS:A retrospective chart review from January 1998 to May 2011 identified 128 SJS/TEN patients admitted to Loyola University Medical Center Burn intensive care unit. The degree of initial ocular surface inflammation was graded as mild, moderate, or severe within the first 2 weeks of admission. Patients were managed either medically or with amniotic membrane (AM). Outcomes were graded as good [best-corrected visual acuity (BCVA)>20/40], fair (BCVA 20/40 to 20/200 or with ocular surface discomfort, requiring contact lens or reconstructive surgeries), or poor (BCVA<20/200). RESULTS:Of the 182 eyes (91 patients) with documented inpatient eye examinations, 108 eyes (59.4%) had mild or no initial ocular involvement, 37 eyes (20.3%) had moderate, and 37 eyes (20.3%) had severe inflammation. Of the 29 patients (58 eyes) with greater than 1 month of follow-up, 17 patients (33 eyes) were treated with medical management and 13 patients (25 eyes) were treated with early AM. One of the 23 eyes with moderate or severe presentation treated with early AMT (4.3%) resulted in a poor outcome within 3 months compared with 8 of 23 eyes (34.8%) that were medically managed (P=0.022). CONCLUSIONS:We present the first case-control study of the use of AM in the management of acute SJS/TEN. Early use of AMT prevents severe vision loss in SJS/TEN patients with initial moderate or severe ocular surface inflammation.
    背景与目标: 目的:评估在急性史蒂文斯-约翰逊综合征(SJS)和中毒性表皮坏死溶解症(TEN)患者治疗的前两周内进行羊膜移植(AMT)的适应症和结果。
    方法:回顾性调查1998年1月至2011年5月的病历,确定了128名SJS / TEN患者,他们被洛约拉大学医学中心烧伤重症监护室收治。在入院的前两周内,初期眼表炎症的程度分为轻度,中度或重度。患者接受药物治疗或羊膜(AM)治疗。结果分为好[最佳矫正视力(BCVA)> 20/40],一般(BCVA 20/40至20/200或眼表不适,需要隐形眼镜或重建手术)或较差(BCVA <20) / 200)。
    结果:在有住院眼科检查的182眼(91例患者)中,有108眼(59.4%)有轻度或无初次眼部受累,有37眼(20.3%)为中度,有37眼(20.3%)有严重的炎症。在随访时间超过1个月的29例患者(58眼)中,有17例患者(33眼)接受了药物治疗,有13例患者(25眼)接受了早期AM治疗。接受早期AMT治疗的23眼中度或重度表现之一(4.3%)在3个月内导致不良结局,相比之下,接受药物治疗的23眼中有8眼(34.8%)(P = 0.022)。
    结论:我们提出了在急性SJS / TEN治疗中使用AM的首例病例对照研究。早期使用AMT可防止SJS / TEN患有初期中度或严重眼表炎症的患者严重视力下降。
  • 【成人严重烧伤后影响心理,社会和健康结局的因素:队列研究方案。】 复制标题 收藏 收藏
    DOI:10.1136/bmjopen-2017-017545 复制DOI
    作者列表:Druery M,Newcombe PA,Cameron CM,Lipman J
    BACKGROUND & AIMS: INTRODUCTION:The goal of burn care is that 'the quality of the outcome must be worth the pain of survival'. More research is needed to understand how best to deliver care for patients with burns to achieve this aim. Loss of independence, function as well as loss of income for patients with burns and carers cause a significant burden at both individual and societal levels. Much is being done to advance knowledge in the clinical care field; however, there has been a paucity of research exploring psychosocial outcomes. This paper describes the study background and methods, as implemented in an Australian cohort study of psychosocial outcomes after major burn injuries. METHODS AND ANALYSIS:In this inception cohort study, a target sample of 230 participants, aged 18 years or over, admitted to a single statewide burns centre with a burn injury are identified by hospital staff for inclusion. Baseline survey data are collected either in person or by telephone within 28 days of the injury and participants then followed up with telephone interviews at 3, 6 and 12 months postburn. Injury and burns treatment information is collected from medical records. Social support is measured as a predictor variable using the Multidimensional Scale of Perceived Social Support. Outcome data are collected via standardised measures in the domains of Quality of Life (SF-12, EQ-5D, BSHS-B), depression (PHQ-9), post-traumatic stress disorder (PCL-C, PAS), community integration (CIQ-R) and Quality-Adjusted Life Years (EQ-5D). Additional survey questions measure life satisfaction, return to work and public services utilisation at 12 months postinjury. Data analysis methods will include analysis of variance, Pearson correlation and hierarchical multiple regression analyses. ETHICS AND DISSEMINATION:Hospital-based and University of Queensland Human Research Ethics Committees have approved the protocol. Results from the study will be disseminated at national and international conferences, in peer-reviewed journals and in a doctoral thesis. TRIAL REGISTRATION NUMBER:Australia New Zealand Clinical Trials Registry (ACTRN12616000828426). Retrospectively registered on 23 June 2016; pre-results.
    背景与目标: 简介:烧伤护理的目标是“结果的质量必须值得生存之苦”。需要更多的研究来了解如何最好地为烧伤患者提供护理以实现该目标。烧伤和照顾者患者失去独立性,功能以及收入损失,在个人和社会层面都造成了沉重的负担。为了提高临床护理领域的知识水平,正在做很多工作。然而,很少有研究探讨社会心理结果。本文描述了一项研究背景和方法,该方法在澳大利亚严重烧伤后心理社会结局队列研究中实施。
    方法和分析:在这项队列研究中,由医院工作人员确定了230名年龄在18岁或以上,被纳入一个州范围内烧伤中心的烧伤中心的参与者的目标样本。基线调查数据在受伤后28天内亲自或通过电话收集,参与者在烧伤后3、6和12个月进行电话访谈。受伤和烧伤的治疗信息是从医疗记录中收集的。使用“感知社会支持的多维量表”将社会支持作为预测变量进行衡量。通过生活质量(SF-12,EQ-5D,BSHS-B),抑郁症(PHQ-9),创伤后应激障碍(PCL-C,PAS),社区整合等领域的标准化措施收集结果数据(CIQ-R)和质量调整寿命年(EQ-5D)。额外的调查问题可衡量受伤后12个月的生活满意度,重返工作岗位和使用公共服务的情况。数据分析方法将包括方差分析,Pearson相关性和分层多元回归分析。
    道德与传播:医院和昆士兰大学人类研究伦理委员会已批准该协议。该研究的结果将在国家和国际会议,同行评审期刊和博士学位论文中进行传播。
    试验注册号:澳大利亚新西兰临床试验注册(ACTRN12616000828426)。追溯注册于2016年6月23日;结果。
  • 【声门上癌的经皮激光外科手术与抢救性激光显微外科手术的功能和肿瘤学结局。】 复制标题 收藏 收藏
    DOI:10.1177/000348941212101007 复制DOI
    作者列表:Hutcheson KA,Jantharapattana K,Barringer DA,Lewin JS,Holsinger FC
    BACKGROUND & AIMS: OBJECTIVES:We evaluated the functional and oncological outcomes of transoral laser microsurgery (TLM) in patients with previously untreated supraglottic carcinoma compared with the outcomes in salvage cases after radiation-based treatment. METHODS:We conducted a retrospective case-control study at a single academic tertiary care institution. The functional outcomes were stratified by prior irradiation and were assessed at baseline, less than 1 week after operation, and at last follow-up. RESULTS:Five patients underwent TLM for previously untreated disease, and 5 previously irradiated patients underwent salvage TLM for local failure. No patient required tracheostomy. There was no local recurrence after TLM as primary therapy, and none of those patients required radiotherapy. One salvage patient developed local recurrence. The duration of feeding tube dependence (p = 0.049) and the rates of chronic aspiration (more than 1 month after operation; p = 0.048) were significantly higher in the salvage TLM cases than in the previously untreated cases. The median scores on the PSS-HN Understandability of Speech were 75 ("usually understandable") in the salvage group and 100 ("always understandable") in the previously untreated group. CONCLUSIONS:Both local control and function were better in the previously untreated patients than in the salvage patients. Our findings provide support for the use of TLM as a primary treatment modality for selected supraglottic carcinomas, but also suggest a potential for functional recovery in both previously untreated and salvage cases.
    背景与目标: 目的:我们评估了先前未经治疗的声门上癌患者经口激光显微外科手术(TLM)的功能和肿瘤学结果,与基于放射治疗的抢救病例的结果相比。
    方法:我们在一家单一的三级学术机构中进行了一项回顾性病例对照研究。功能结局通过事先照射进行分层,并在基线,手术后不到1周和最后一次随访时进行评估。
    结果:5例接受过TLM的患者先前未接受过治疗,而5例接受过放射线的患者则接受了TLM进行局部衰竭治疗。没有患者需要气管切开术。 TLM作为主要疗法后没有局部复发,而且这些患者均不需要放疗。一名抢救患者出现局部复发。抢救性TLM病例的进食管依赖性持续时间(p = 0.049)和慢性误吸率(术后1个月以上; p = 0.048)显着高于先前未治疗的病例。挽救组的PSS-HN语音可理解性中位数为75(“通常可理解”),以前未治疗的组为100(“始终可理解”)。
    结论:先前未治疗的患者的局部控制和功能均优于抢救患者。我们的发现为TLM作为选定的声门上癌的主要治疗手段提供了支持,但也暗示了先前未治疗和挽救病例的功能恢复潜力。
  • 【中度至复杂先天性心脏病或肺动脉高压的产妇的围产期结局和麻醉管理*。】 复制标题 收藏 收藏
    DOI:10.1111/anae.12058 复制DOI
    作者列表:Maxwell BG,El-Sayed YY,Riley ET,Carvalho B
    BACKGROUND & AIMS: :We performed a retrospective cohort analysis of pregnancies among women with moderate to complex congenital heart disease or pulmonary hypertension over a 12-year period, resulting in a cohort of 107 cases in 65 women. Neuraxial analgesia or anaesthesia was provided in 84%, 89% and 95% of spontaneous vaginal, operative vaginal and caesarean deliveries, respectively. The caesarean delivery rate was 43% compared to our institution average of 27% over the same period (p = 0.02), and 38% had operative vaginal deliveries compared to a 10.5% institution rate (p < 0.01). Invasive monitoring was used in 28% of all deliveries. There were one maternal and two neonatal deaths. This study provides detailed anaesthetic and peripartum management of women with congenital heart disease, a patient population in whom evidence-based practice and data are largely lacking. We observed a predominance of neuraxial anaesthetic techniques, increased caesarean and operative delivery rates, and favourable maternal and neonatal outcomes. Multicentre studies and registries to compare anaesthetic and obstetric management strategies further and delineate risk factors for adverse outcomes are required.
    背景与目标: :我们对12年来中度至复杂性先天性心脏病或肺动脉高压妇女的妊娠进行了回顾性队列研究,得出65例妇女的107例队列。自发性阴道,手术阴道和剖腹产分别有84%,89%和95%提供神经镇痛或麻醉作用。剖腹产率为43%,而同期我们机构的平均分娩率为27%(p = 0.02),而手术阴道分娩率为38%,而机构分娩率为10.5%(p <0.01)。在所有分娩中有28%使用了侵入式监测。有1例孕产妇死亡和2例新生儿死亡。这项研究为患有先天性心脏病的妇女提供了详细的麻醉和围产期治疗方法,该病患者中大量缺乏循证医学实践和数据。我们观察到神经麻醉技术占优势,剖腹产和手术分娩率增加,孕产妇和新生儿预后良好。需要进行多中心研究和登记,以进一步比较麻醉和产科管理策略,并描述不良后果的危险因素。
  • 【小儿悬挂和绞窄损伤:临床因素和预后的10年回顾性描述。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Davies D,Lang M,Watts R
    BACKGROUND & AIMS: OBJECTIVE:To identify early clinical factors that are correlated with death or severe disability in paediatric patients who have sustained an injury by hanging or strangulation. METHODS:A retrospective review of all patient records from January 1, 1997, to September 30, 2007, was conducted. Patient records were identified by International Classification of Diseases and Related Health Problems, Tenth Revision, Canada diagnostic codes for asphyxia, strangulation, hypoxic-ischemic encephalopathy, hanging, hypoxemia, hypoxia or anoxia. RESULTS:A total of 109 records were identified. Of these, 41 met the inclusion criteria for the study. Of 19 (46%) children who were pulse-less and received cardiopulmonary resuscitation, 16 died and the survivors were severely disabled. Of the 22 (54%) children who were found with a pulse, 18 made a full recovery. CONCLUSIONS:Children who are pulseless at discovery for hanging injuries are at high risk of death or severe disability. Early clinical and neurophysiological indicators should be applied systematically to best guide clinicians and parents in their decision making.
    背景与目标: 目的:确定与因悬挂或绞死而受伤的小儿患者的死亡或严重残疾有关的早期临床因素。
    方法:对1997年1月1日至2007年9月30日的所有患者记录进行回顾性回顾。通过国际疾病分类和相关健康问题分类(第十次修订版,加拿大)对窒息,窒息,缺氧缺血性脑病,悬挂,低氧血症,缺氧或缺氧的诊断代码确定了患者的记录。
    结果:共鉴定到109条记录。其中有41个符合研究的纳入标准。在无脉搏并接受心肺复苏的19名儿童中(46%),有16人死亡,幸存者严重残疾。在发现有脉搏的22名儿童中(54%),其中18名完全康复。
    结论:发现悬吊伤害而无脉搏的儿童极有可能导致死亡或严重残疾。应系统地应用早期临床和神经生理指标,以最好地指导临床医生和父母进行决策。
  • 【内镜超声引导与常规透壁技术在引流胰腺假性囊肿方面具有可比的治疗效果。】 复制标题 收藏 收藏
    DOI:10.1097/MEG.0b013e32835871eb 复制DOI
    作者列表:Panamonta N,Ngamruengphong S,Kijsirichareanchai K,Nugent K,Rakvit A
    BACKGROUND & AIMS: :We carried out the first meta-analysis comparing the technical success and clinical outcomes of endoscopic ultrasound-guided drainage (EUD) and conventional transmural drainage (CTD) for pancreatic pseudocysts. We searched PubMed, Embase, Scopus, and the Cochrane library to identify relevant prospective trials. The technical success rate, short-term (4-6 weeks) success, and long-term (at 6 months) success in symptoms and the radiologic resolution of pseudocysts, complication rates, and death rates were compared. Two eligible randomized-controlled trials and two prospective studies including 229 patients were retrieved. The technical success rate was significantly higher for EUD than for CTD [risk ratio (RR)=12.38, 95% confidence interval (CI): 1.39-110.22]. When CTD failed because of the nonbulging nature of pseudocysts, a crossover was carried out to EUD (n=18), which was successfully performed in all these cases. All patients with portal hypertension and bleeding tendency were subjected to EUD to avoid severe complications. EUD was not superior to CTD in terms of short-term success (RR=1.03, 95% CI: 0.95-1.11) or long-term success (RR=0.98, 95% CI: 0.76-1.25). The overall complications were similar in both groups (RR=0.98, 95% CI: 0.52-1.86). The most common complications were bleeding and infection. There were two deaths from bleeding after CTD. The short-term and long-term treatment success of both methods is comparable only if proper drainage modality is selected in specific clinical situations. For bulging pseudocysts, either EUD or CTD can be selected whereas EUD is the treatment of choice for nonbulging pseudocysts, portal hypertension, or coagulopathy.
    背景与目标: :我们进行了首次荟萃分析,比较了胰腺假性囊肿的内镜超声引导引流术(EUD)和常规透壁引流术(CTD)的技术成功率和临床结果。我们搜索了PubMed,Embase,Scopus和Cochrane库,以确定相关的前瞻性试验。比较了技术成功率,短期(4-6周)成功率和长期(6个月时)症状的成功率以及假性囊肿的放射学分辨率,并发症发生率和死亡率。检索了两项合格的随机对照试验和两项前瞻性研究,其中包括229例患者。 EUD的技术成功率显着高于CTD [风险比(RR)= 12.38,95%置信区间(CI):1.39-110.22]。当CTD由于假性囊肿的非膨隆性而失败时,便与EUD进行了交叉(n = 18),在所有这些情况下均成功进行了交叉。所有患有门静脉高压症和出血倾向的患者均应接受EUD治疗,以避免严重的并发症。就短期成功率(RR = 1.03,95%CI:0.95-1.11)或长期成功率(RR = 0.98,95%CI:0.76-1.25)而言,EUD并不优于CTD。两组的总并发症相似(RR = 0.98,95%CI:0.52-1.86)。最常见的并发症是出血和感染。 CTD后有两人因出血死亡。仅当在特定的临床情况下选择了适当的引流方式时,这两种方法的短期和长期治疗成功率才具有可比性。对于隆起的假性囊肿,可以选择EUD或CTD,而EUD是不隆起的假性囊肿,门脉高压或凝血病的治疗选择。
  • 【小儿克罗恩病患者手术后的长期结局。】 复制标题 收藏 收藏
    DOI:10.1097/MPG.0b013e318279871c 复制DOI
    作者列表:Piekkala M,Pakarinen M,Ashorn M,Rintala R,Kolho KL
    BACKGROUND & AIMS: OBJECTIVE:Of pediatric patients with Crohn disease, 20% to 30% undergo surgery within 10 years. Although disease relapses and reoperations are common, long-term functional outcomes and quality of life (QoL) are unclear. METHODS:In 2010, we reviewed the hospital records of all pediatric patients with CD who had undergone intestinal resections during childhood in 2 major tertiary care hospitals between 1985 and 2008 and mailed out questionnaires that asked about health outcomes and QoL. We compared the QoL of the patients and a group of matched controls randomly chosen from the Population Register Centre. RESULTS:In total, 36 children had undergone bowel resection a median of 10 years earlier and had at least 2 years of follow-up. Disease activation (verified at endoscopy) requiring medical or surgical treatment occurred in 94% (median 1.8 years after primary resection). At least 1 surgical complication occurred in 77%, and 54% underwent re-resection. The patients reported a median stool frequency of 3 stools during the day and zero at night, with 33% being totally continent. Overall, 96% were completely or moderately satisfied with the outcome of the surgery. The QoL was comparable between the patients and controls, but school or work absences diminished the QoL of the patients. CONCLUSIONS:Surgery for pediatric-onset CD is risky even under expert care. Disease relapses and bowel re-resections are common during the first decade after primary surgery. In the long term, however, bowel function is acceptable and the QoL is comparable between patients and their peers.
    背景与目标: 目的:患有克罗恩病的小儿患者中,有20%至30%在10年内接受手术。尽管疾病复发和再次手术很普遍,但长期功能结局和生活质量(QoL)尚不清楚。
    方法:2010年,我们回顾了1985年至2008年间两家主要三级医院的所有CD患儿在小儿时期进行过肠切除的小儿CD的医院记录,并寄出了有关健康结局和QoL的问卷。我们比较了患者和从人口登记中心随机选择的一组配对对照的生活质量。
    结果:总共有36名儿童接受了肠切除术,中位值是10年前,并且至少接受了2年的随访。 94%(初次切除后中位数为1.8年)发生了需要药物或手术治疗的疾病激活(在内窥镜检查中验证)。 77%的患者至少发生了1例手术并发症,而54%的患者接受了再次切除。患者报告白天大便次数中位数为3次,晚上为零,其中33%完全为大洲。总体而言,有96%的人对手术的结果完全满意或中度满意。患者和对照组之间的QoL相当,但是因学校缺勤或缺勤而降低了患者的QoL。
    结论:即使在专家的护理下,小儿发作性CD的手术也是有风险的。在初次手术后的头十年,疾病复发和肠切除很常见。但是,从长期来看,肠功能是可以接受的,患者与同伴之间的QoL相当。
  • 【在金黄色葡萄球菌菌血症的结局预测中验证疾病评分系统的严重性。】 复制标题 收藏 收藏
    DOI:10.1097/MAJ.0b013e31826767f0 复制DOI
    作者列表:Sharma M,Szpunar S,Khatib R
    BACKGROUND & AIMS: BACKGROUND:Severity of illness scores are helpful in predicting mortality; however, no standardized scoring system has been validated in patients with Staphylococcus aureus bacteremia (SAB). The modified Rapid Emergency Medicine Score (REMS), the CURB-65 (confusion, urea, respiratory rate, blood pressure and age 65) and the Charlson weighted index of comorbidity (CWIC) were compared in predicting outcomes at the onset of SAB. METHODS:All adult inpatients with SAB from July 15, 2008, to December 31, 2009, were prospectively assessed. The 3 scoring systems were applied: REMS, CURB-65 and CWIC. The end points were attributable and overall mortality. RESULTS:A total of 241 patients with SAB were reviewed during the study period. The all-cause mortality rate was 22.8% and attributable mortality 14.1%. Patients who died had higher mean CURB-65 score and REMS than those who lived, whereas the difference in the CWIC score was not significant. Two logistic regression models based on CURB-65 score or REMS, after controlling for CWIC, revealed that both scores were independent predictors of mortality, with an odds ratio of 3.38 (P < 0.0001) and 1.45 (P < 0.0001) for CURB-65 and REMS, respectively. Receiver operating characteristic analysis revealed that a cutoff point of 3.0 (CURB-65) and 6.0 (REMS) provided the highest sensitivity and specificity. The area under the curves for all-cause mortality were 0.832 and 0.806, and for attributable mortality 0.845 and 0.819, for CURB-65 and REMS, respectively. CONCLUSIONS:REMS and CURB-65 scores outperformed CWIC as predictors of mortality in SAB and may be effective in predicting the severity of illness at the onset of bacteremia.
    背景与目标: 背景:疾病评分的高低有助于预测死亡率。但是,尚无标准的评分系统在金黄色葡萄球菌菌血症(SAB)患者中得到验证。在预测SAB发作的结果时,比较了修改后的快速急诊医学评分(REMS),CURB-65(精神错乱,尿素,呼吸频率,血压和65岁)和Charlson合并症加权指数(CWIC)。
    方法:对2008年7月15日至2009年12月31日期间所有成人SAB住院患者进行前瞻性评估。应用了3种评分系统:REMS,CURB-65和CWIC。终点归因于总死亡率。
    结果:在研究期间,共对241名SAB患者进行了回顾。全因死亡率为22.8%,归因死亡率为14.1%。死亡患者的CURB-65平均得分和REMS均高于活着的患者,而CWIC得分的差异并不显着。在控制了CWIC之后,基于CURB-65得分或REMS的两个逻辑回归模型显示,两个得分都是死亡率的独立预测因子,CURB-65的优势比为3.38(P <0.0001)和1.45(P <0.0001)。和REMS分别。接收器工作特性分析显示,临界点3.0(CURB-65)和6.0(REMS)提供了最高的灵敏度和特异性。对于CURB-65和REMS,全因死亡率的曲线下面积分别为0.832和0.806,归因死亡率分别为0.845和0.819。
    结论:REMS和CURB-65得分优于CWIC作为SAB死亡率的预测指标,可能有效地预测菌血症发作时疾病的严重程度。
  • 【马凡氏综合症妇女的出生特征,妊娠的产科和新生儿结局-一项全国队列研究和病例对照研究。】 复制标题 收藏 收藏
    DOI:10.1016/j.ejogrb.2017.05.026 复制DOI
    作者列表:Kernell K,Sydsjö G,Bladh M,Josefsson A
    BACKGROUND & AIMS: OBJECTIVE:The aim was to investigate birth characteristics, obstetric and neonatal outcomes of the first childbirth in women with Marfan syndrome by use of Swedish national registers since pregnancy-related outcomes in women with Marfan syndrome have only been sparsely investigated. STUDY DESIGN:In this national population-based cohort study and matched case-control study of Swedish women born 1973-1993, women with Marfan syndrome (n=273) were compared to women without the condition (n=1 017 265). The study population was followed until 2013. A total of 364 553 mother-firstborn-offspring pairs were analyzed. Sixty-one women with Marfan syndrome became mothers. Women with Marfan syndrome were also compared to 543 healthy controls. RESULTS:Women with Marfan syndrome were more often born preterm (p<0.001), small-for-gestational age (p<0.001), and delivered by cesarean section (p=0.001). Women with Marfan syndrome had no increased risk of giving birth by cesarean section (p=0.079). No increased neonatal risks in their children were found. Women with Marfan syndrome were less likely to give birth than those without (p<0.001). There were no maternal deaths. CONCLUSIONS:Women with Marfan syndrome were more likely to be born preterm, SGA and by cesarean section. These increased risks of preterm birth and SGA babies were not found in connection with their own first childbirth. Pregnancies with known fetal Marfan syndrome have to be carefully monitored. The results are important for obstetricians giving preconception counseling and treating women with Marfan syndrome. Further studies are needed to evaluate risks during pregnancy and long-term effects of pregnancy on the cardiovascular status of women with Marfan syndrome.
    背景与目标: 目的:由于仅对马凡氏综合征妇女的妊娠相关结局进行了稀疏调查,因此目的是通过瑞典国家登记簿调查马凡氏综合征妇女的首次生育的​​出生特征,产科和新生儿结局。
    研究设计:在这项基于全国人群的队列研究和匹配的病例对照研究中,对1973年至1993年出生的瑞典妇女进行了比较,将患有马凡氏综合症(n = 273)的妇女与未患此病的妇女(n = 1 017 265)进行了比较。研究人群一直追踪到2013年。共分析了364 553对母亲-第一胎-后代。六十一名患有马凡氏综合症的妇女成为母亲。还比较了患有马凡氏综合症的女性和543名健康对照者。
    结果:马凡氏综合征的妇女更早产(p <0.001),小胎龄(p <0.001),并通过剖宫产分娩(p = 0.001)。患有马凡氏综合症的妇女通过剖宫产术分娩的风险没有增加(p = 0.079)。没有发现孩子的新生儿患病风险增加。患有马凡氏综合症的妇女比没有马芬综合症的妇女分娩的可能性更低(p <0.001)。没有孕产妇死亡。
    结论:马凡氏综合征的女性更可能早产,SGA和剖宫产。未发现早产和SGA婴儿的这些增加的风险与他们的初生有关。患有已知胎儿马凡氏综合征的孕妇必须进行仔细监测。这些结果对于产科医生进行孕前咨询和治疗患有马凡氏综合症的妇女非常重要。需要进一步的研究来评估妊娠期间的风险以及妊娠对马凡氏综合症女性心血管状况的长期影响。
  • 【阿霉素扩张型心肌病的心脏移植生存结果。】 复制标题 收藏 收藏
    DOI:10.1016/j.amjcard.2012.10.048 复制DOI
    作者列表:Lenneman AJ,Wang L,Wigger M,Frangoul H,Harrell FE,Silverstein C,Sawyer DB,Lenneman CG
    BACKGROUND & AIMS: :In 2015, there will be an estimated 11.3 million cancer survivors. With an increasing population of cancer survivors, it is imperative to understand the treatment options available and outcomes for chemotherapy-related cardiomyopathy. Anthracycline-based chemotherapy causes heart failure in approximately 5% of patients. Orthotopic heart transplantation (OHT) is an option for cancer survivors in complete remission who develop end-stage heart failure. We examined retrospective OHT data collected from the United Network of Organ Sharing from 1987 to 2011. The primary aim was to characterize the survival in patients with either the primary diagnosis of "dilated cardiomyopathy: Adriamycin" (DCA) versus "all other" causes of cardiomyopathy. The secondary aim was to define the differences in the primary cause of death and to describe the temporal relationship of DCA OHT. The United Network of Organ Sharing database identified 453 OHTs for the diagnosis of DCA and 51,312 OHTs for all other causes of cardiomyopathy. The DCA group was significantly younger with a greater percentage of women. After adjusting for age, gender, and history of malignancy, the 10-year survival curves showed that patients with DCA have an improved survival compared to those with all other causes of cardiomyopathy (hazard ratio 1.28, p = 0.026). No difference was found in the primary cause of death between the 2 groups. A statistically significant increasing temporal trend was seen in the number of OHTs for the diagnosis DCA. In conclusion, patients who undergo OHT for DCA have favorable 10-year survival, making OHT a good therapeutic option for end-stage heart failure due to anthracyclines. Additionally, no increased risk of cancer-related deaths was found in the DCA group, demonstrating that recurrent malignancy does not affect long-term survival. The temporal trends demonstrated that DCA remains a significant problem for cancer survivors.
    背景与目标: :2015年,估计将有1,130万癌症幸存者。随着癌症幸存者人数的增加,必须了解可用的治疗方案和化疗相关性心肌病的预后。基于蒽环类的化学疗法在大约5%的患者中引起心力衰竭。原位心脏移植(OHT)是完全缓解并发展为晚期心力衰竭的癌症幸存者的一种选择。我们检查了从1987年至2011年从器官共享联合网络收集的回顾性OHT数据。主要目的是鉴定患有“扩张型心肌病:阿霉素”(DCA)与“其他所有”原因的原发性诊断的患者的生存情况。心肌病。第二个目的是确定主要死亡原因的差异,并描述DCA OHT的时间关系。器官共享网络联合会确定了用于诊断DCA的453个OHT,以及所有其他引起心肌病的原因的51,312个OHT。 DCA组明显年轻,女性比例更高。在对年龄,性别和恶性肿瘤病史进行调整后,10年生存曲线显示DCA患者的生存率比所有其他原因的心肌病患者高(危险比1.28,p = 0.026)。两组之间的主要死亡原因均未发现差异。诊断DCA的OHT数量出现了统计上显着增加的时间趋势。总之,接受OHT进行DCA治疗的患者具有良好的10年生存期,这使OHT成为治疗因蒽环类药物所致晚期心力衰竭的良好治疗选择。此外,在DCA组中未发现与癌症相关的死亡风险增加,表明复发性恶性肿瘤不会影响长期生存。时间趋势表明,DCA对于癌症幸存者仍然是一个重大问题。
  • 【出生时间是否可以预测围产期不良结果?坦桑尼亚在资源贫乏地区进行的基于医院的横断面研究。】 复制标题 收藏 收藏
    DOI:10.1186/s12884-017-1358-9 复制DOI
    作者列表:Mgaya A,Hinju J,Kidanto H
    BACKGROUND & AIMS: BACKGROUND:Inconsistent evidence of a higher risk of adverse perinatal outcomes during off-hours compared to office hours necessitated a search for clear evidence of an association between time of birth and adverse perinatal outcomes. METHODS:A cross-sectional study conducted at a tertiary referral hospital compared perinatal outcomes across three working shifts over 24 h. A checklist and a questionnaire were used to record parturients' socio-demographic and obstetric characteristics, mode of delivery and perinatal outcomes, including 5th minute Apgar score, and early neonatal mortality. Risks of adverse outcomes included maternal age, parity, referral status and mode of delivery, and were assessed for their association with time of delivery and prevalence of fresh stillbirth as a proxy for poor perinatal outcome at a significance level of p = 0.05. RESULTS:Off-hour deliveries were nearly twice as likely to occur during the night shift (odds ratio (OR), 1.62; 95% confidence interval (CI), 1.50-1.72), but were unlikely during the evening shift (OR, 0.58; 95% CI, 0.45-0.71) (all p < 0.001). Neonatal distress (O.R, 1.48, 95% CI; 1.07-2.04, p = 0.02), early neonatal deaths (OR, 1.70; 95% CI, 1.07-2.72, p = 0.03) and fresh stillbirths (OR, 1.95; 95% CI, 1.31-2.90, p = 0.001) were more significantly associated with deliveries occurring during night shifts compared to evening and morning shifts. However, fresh stillbirths occurring during the night shift were independently associated with antenatal admission from clinics or wards, referral from another hospital, and abnormal breech delivery (OR 1.9; 95% CI, 1.3-2.9, p = 0.001, for fresh stillbirths; OR, 5.0; 95% CI 1.7-8.3, p < 0.001, for antenatal admission; OR, 95% CI, 1.1-2.9, p < 0.001, for referral form another hospital; and OR 1.6; 95% CI 1.02-2.6, p = 0.004, for abnormal breech deliveries). CONCLUSION:Off-hours deliveries, particularly during the night shift, were significantly associated with higher proportions of adverse perinatal outcomes, including low Apgar score, early neonatal death and fresh stillbirth, compared to morning and evening shifts. Labour room admissions from antenatal wards, referrals from another hospital and abnormal breech delivery were independent risk factors for poor perinatal outcome, particularly fresh stillbirths.
    背景与目标: 背景:与办公时间相比,非工作时间不利于围产期结局的风险的证据不一致,因此有必要寻找明确的证据来证明出生时间与不良围产期结局之间的关联。
    方法:在一家三级转诊医院进行的横断面研究比较了24小时内三个工作班次的围产期结局。使用检查表和调查表记录产妇的社会人口统计学和产科特征,分娩方式和围产期结局,包括第5分钟的Apgar评分和新生儿早期死亡率。不良结局的风险包括产妇年龄,胎次,转诊状况和分娩方式,并评估了它们与分娩时间和新鲜死产的发生率之间的关联,以作为围产期预后不良的指标,其显着性水平为p = 0.05。
    结果:夜班期间的下班时间交付几率几乎翻倍(几率(OR)为1.62; 95%置信区间(CI)为1.50-1.72),但在晚班期间则不太可能出现(OR为0.58) ; 95%CI,0.45-0.71)(所有p <0.001)。新生儿窘迫(OR,1.48,95%CI; 1.07-2.04,p = 0.02),早期新生儿死亡(OR,1.70; 95%CI,1.07-2.72,p = 0.03)和新鲜死产(OR,1.95; 95% CI,1.31-2.90,p = 0.001)与夜班和早班相比,与夜班期间的分娩更显着相关。但是,夜班期间发生的新鲜死产与从诊所或病房的产前入院,从另一家医院转诊以及异常的臀位分娩独立相关(OR 1.9;新鲜死产的95%CI,1.3-2.9,p = 0.001;或者; 5.0; 95%CI 1.7-8.3,p <0.001(对于产前入院);或95%CI,1.1-2.9,p <0.001,对于从另一家医院转诊;或OR 1.6; 95%CI 1.02-2.6,p = 0.004,用于异常臀位)。
    结论:与早班和晚班相比,非工作时间的分娩,特别是在夜班期间,与较高的围产期不良后果显着相关,包括低的Apgar评分,早期的新生儿死亡和新鲜的死产。从产前病房分娩,从另一家医院转诊以及异常的臀位分娩是围产期预后不良(尤其是新鲜死产)的独立危险因素。
  • 【血液透析患者的踝臂指数随时间下降和心血管结局。】 复制标题 收藏 收藏
    DOI:10.1097/MAJ.0b013e31825141bf 复制DOI
    作者列表:Chen SC,Chang JM,Liu WC,Huang JC,Chen YY,Yang TK,Su HM,Chen HC
    BACKGROUND & AIMS: INTRODUCTION:Abnormal ankle-brachial index (ABI) is associated with increased morbidity and mortality in hemodialysis patients. However, whether the decrease in ABI over time carries the prognostic value is unknown. The aim of this study was to assess whether the decrease in ABI over time was a good predictor of poor cardiovascular (CV) prognosis in hemodialysis patients. METHODS:This study enrolled 234 routine hemodialysis patients and 173 patients completed the follow-up. The ABI was measured by an ABI-form device at baseline and at the first year follow-up. The ΔABI was defined as ABI measured at the first year follow-up minus ABI measured at baseline. Progressors of ABI were defined as patients with ΔABI < -0.3. CV events were defined as CV death, hospitalization for unstable angina, nonfatal myocardial infarction, hospitalization for arrhythmia, hospitalization for congestive heart failure and stroke. RESULTS:The follow-up period was 37.8 ± 11.1 months. In the multivariate analysis, progressors of ABI (hazard ratio, 2.71; 95% confidence interval, 1.10-6.68, P = 0.03), decreased albumin and increased high-sensitivity C-reactive protein were associated with increased CV events. CONCLUSIONS:This longitudinal study showed ΔABI < -0.3 was independently associated with an increase in CV events. Hence, a great decrease in ABI over time might be a useful indicator of poor CV prognosis in hemodialysis patients.
    背景与目标: 简介:踝臂指数异常(ABI)与血液透析患者的发病率和死亡率增加相关。但是,随着时间的推移,ABI的降低是否具有预后价值尚不清楚。这项研究的目的是评估ABI随时间的下降是否是血液透析患者不良心血管(CV)预后的良好预测指标。
    方法:本研究招募了234例常规血液透析患者,其中173例患者完成了随访。在基线和第一年随访时,通过ABI形式的设备对ABI进行测量。 ΔABI定义为在第一年随访中测得的ABI减去在基线时测得的ABI。 ABI的进展者定义为ΔABI<-0.3的患者。 CV事件的定义为CV死亡,不稳定型心绞痛的住院治疗,非致命性心肌梗死,心律不齐的住院治疗,充血性心力衰竭和中风的住院治疗。
    结果:随访时间为37.8±11.1个月。在多变量分析中,ABI的进展(危险比,2.71; 95%置信区间,1.10-6.68,P = 0.03),白蛋白降低和高敏感性C反应蛋白升高与CV事件增加相关。
    结论:这项纵向研究表明ΔABI<-0.3与CV事件的增加独立相关。因此,随着时间的推移,ABI的大幅下降可能是血液透析患者CV预后不良的有用指标。
  • 【有没有“正确”的方法可以使患者从呼吸机上断奶? Randolph等人的一项重要评估:机械呼吸机断奶方案对婴幼儿呼吸道结局的影响:一项随机对照试验(JAMA 2002; 288:2561-25】 复制标题 收藏 收藏
    DOI:10.1097/01.PCC.0000244403.86349.09 复制DOI
    作者列表:Twite MD
    BACKGROUND & AIMS: OBJECTIVE:To review the findings and discuss the implications of mechanical ventilator weaning protocols in children. DESIGN:A critical appraisal of Randolph et al. Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: A randomized controlled trial. JAMA 2002;288:2561-2568, and literature review. FINDINGS:There was no difference in ventilator weaning times between children randomized to a ventilator weaning protocol (pressure support, volume support, or no protocol). However, the study did show that increased sedative use during the first 24 hrs of weaning (the only time during which these data were collected) was an important predictor of weaning duration (p < .001) and weaning failure (p = .04). CONCLUSIONS:The majority of children are weaned from mechanical ventilation over a short period of time. Weaning protocols may not shorten this brief duration of weaning but may have other advantages such as improved collaboration between healthcare team members. Future research into the effects of sedation on weaning from mechanical ventilation is needed in children.
    背景与目标: 目的:回顾研究结果并讨论机械呼吸机断奶方案对儿童的影响。
    设计:Randolph等人的重要评估。机械呼吸机断奶方案对婴幼儿呼吸系统结局的影响:一项随机对照试验。 JAMA 2002; 288:2561-2568,以及文献综述。
    结果:随机分配到呼吸机断奶方案(压力支持,容量支持或无协议)的儿童之间的呼吸机断奶时间没有差异。但是,该研究确实表明,在断奶的前24小时(收集这些数据的唯一时间)内镇静剂使用的增加是断奶持续时间(p <.001)和断奶失败(p = .04)的重要预测指标。 。
    结论:大多数儿童在短时间内断奶了机械通气。断奶协议可能不会缩短这段短暂的断奶时间,但可能具有其他优势,例如改善医疗团队成员之间的协作。儿童需要镇静剂对机械通气对断奶的影响的未来研究。
  • 【恒河猴从出生到成年的肺泡数量增加,但大小没有增加。】 复制标题 收藏 收藏
    DOI:10.1152/ajplung.00467.2006 复制DOI
    作者列表:Hyde DM,Blozis SA,Avdalovic MV,Putney LF,Dettorre R,Quesenberry NJ,Singh P,Tyler NK
    BACKGROUND & AIMS: :Postnatal developmental stages of lung parenchyma in rhesus monkeys is about one-third that of humans. Alveoli in humans are reported to be formed up to 8 yr of age. We used design-based stereological methods to estimate the number of alveoli (N(alv)) in male and female rhesus monkeys over the first 7 yr of life. Twenty-six rhesus monkeys (13 males ranging in age from 4 to 1,920 days and lung volumes from 41.7 to 602 cm(3), 13 females ranging in age from 22 to 2,675 days and lung volumes from 43.5 to 380 cm(3)) were necropsied and lungs fixed, isotropically oriented, fractionated, sampled, embedded, and sectioned for alveolar counting. Parenchymal, alveolar, alveolar duct core air, and interalveolar septal tissue volumes increased rapidly during the first 2 yr with slowed growth from 2 to 7 yr. The rate of change was greater in males than females. N(alv) also showed consistent growth throughout the study, with increases in N(alv) best predicted by increases in lung volume. However, mean alveolar volume showed little relationship with age, lung volume, or body weight but was larger in females and showed a greater size distribution than in males. Alveoli increase in number but not volume throughout postnatal development in rhesus monkeys.
    背景与目标: :恒河猴的肺实质的产后发育阶段约为人类的三分之一。据报道,人类肺泡的形成年龄高达8岁。我们使用基于设计的立体方法来估计生命的前7年中雄性和雌性恒河猴的肺泡(N(alv))数量。 26只猕猴(13只雄性,年龄从4到1,920天不等,肺活量从41.7到602 cm(3),13只雌性,年龄从22到2,675天不等,肺活量从43.5到380 cm(3))进行尸检并固定肺,各向同性,分馏,取样,包埋和切片,以进行肺泡计数。在最初的2年中,实质,肺泡,肺泡导管核心空气和肺泡间隔组织的体积迅速增加,而从2到7年的生长缓慢。男性的变化率大于女性。在整个研究过程中,N(alv)也显示出一致的增长,其中N(alv)的增加最好通过肺体积的增加来预测。但是,平均肺泡容量与年龄,肺活量或体重关系不大,但女性比男性更大,并且大小分布比男性更大。在猕猴的整个产后发育过程中,肺泡的数量增加,但体积没有增加。

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