Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 3 de 3
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Med Sci Monit ; 27: e933082, 2021 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-34937854

RESUMO

BACKGROUND Moderate sedation for endoscopic intervention has become common and offers increased safety and comfort. Patients with cirrhosis are sicker and at increased risk for complications related to sedation. However, postoperative complications associated with moderate sedation and their risk factors have not been adequately studied in this population. MATERIAL AND METHODS This retrospective study included cirrhotic patients who underwent endoscopic procedures with moderate sedation and were admitted to the First Affiliated Hospital, Zhejiang University School of Medicine, between January 1, 2015, and December 31, 2019. A mixed-effects multivariate logistic regression model determined odds ratios between variables and complications, adjusting for potential confounders. The model was validated with 51 patients admitted from August 28, 2020, to October 12, 2020, at 3 hospitals. RESULTS Among 232 cirrhotic patients, complications were recorded for 40 patients (17.2%). These patients had a significantly longer hospital length of stay (P<0.05), and postprocedural complications (35/40; 87.5%) were the most common type of complication. Moderate sedation-associated postoperative complications were significantly associated with portal hypertension history (odds ratio [OR] 2.201; 95% confidence interval [CI] 0.903, 5.364) and the procedure being performed in the evening (OR 1.971; 95% CI 0.946, 4.106). The area under the receiver-operating characteristic curve was 0.627 (95% CI, 0.534 to 0.719, P=0.012) in the validated subgroup, and the predicted accordance rate was 70%. CONCLUSIONS Moderate sedation-associated postoperative complications were relatively high among cirrhotic patients undergoing endoscopic procedures. Complications were associated with sicker patients who underwent endoscopic procedures in the evening, suggesting the potential need for more intensive care of perioperative management in this population, including anesthesia monitoring.


Assuntos
Sedação Consciente/efeitos adversos , Endoscopia do Sistema Digestório/efeitos adversos , Cirrose Hepática/complicações , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia do Sistema Digestório/métodos , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Prevalência , Estudos Retrospectivos , Adulto Jovem
2.
Ann Palliat Med ; 10(2): 1285-1295, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33040550

RESUMO

BACKGROUND: Endoscopic submucosal dissection (ESD) under general anesthesia in left lateral position may lead to transient impairment of pulmonary function. We used electrical impedance tomography (EIT), an increasingly implied non-invasive instrument for bedside real-time monitoring regional changes in ventilation, to assess the changes of regional lung aeration and ventilation in patients undergoing ESD. METHODS: Twenty-two patients scheduled for elective ESD under mechanical ventilation in left lateral position were studied. We acquired 2-min EIT records at four time points: (M1) baseline, before induction of anesthesia, (M2) after the start of mechanical ventilation and before surgery, (M3) after surgery and before extubation, and (M4) after extubation and before leaving operation room, respectively. To quantify regional changes in lung ventilation, we calculated the ventilation proportion of left and right lung regions. Possible changes in lung aeration were detected by changes in end-expiratory lung impedance (EELI). Global inhomogeneity index (GI) was also analyzed. RESULTS: After tracheal intubation in the left lateral position, left lung showed a lower ventilation proportion (M1, 49.6% vs. M2, 36.2% P<0.05), a reduction in EELI {∆EELI -87 [-809; 253]} and a higher GI index value (M1, 0.29±0.09 vs. M2, 0.41±0.12, P<0.05), while right lung showed a higher ventilation proportion (M1, 50.4% vs. M2, 63.8%, P<0.05) and an increase in EELI {∆EELI 161 [-952; 1,905]}. During ESD operation, no changes in either regional ventilation distribution or GI index were observed. After extubation, the GI values in right and left lung were both returned to the level before anesthesia. CONCLUSIONS: In patients with left lateral position undergoing ESD, left lung was characterized by decreased ventilation and more inhomogeneity while right lung was opposite after intubation. ESD procedure with carbon dioxide insufflation did not lead to significant changes in either regional ventilation or homogeneity. And the change of lung inhomogeneity during ESD procedure is transient.


Assuntos
Respiração Artificial , Tomografia , Anestesia Geral , Impedância Elétrica , Humanos , Pulmão/diagnóstico por imagem
3.
ACS Infect Dis ; 3(5): 349-359, 2017 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-28215073

RESUMO

In 2013, the Centers for Disease Control highlighted Clostridium difficile as an urgent threat for antibiotic-resistant infections, in part due to the emergence of highly virulent fluoroquinolone-resistant strains. Limited therapeutic options currently exist, many of which result in disease relapse. We sought to identify molecules specifically targeting C. difficile in high-throughput screens of our diversity-oriented synthesis compound collection. We identified two scaffolds with apparently novel mechanisms of action that selectively target C. difficile while having little to no activity against other intestinal anaerobes; preliminary evidence suggests that compounds from one of these scaffolds target the glutamate racemase. In vivo efficacy data suggest that both compound series may provide lead optimization candidates.


Assuntos
Isomerases de Aminoácido/antagonistas & inibidores , Antibacterianos/farmacologia , Proteínas de Bactérias/antagonistas & inibidores , Clostridioides difficile/efeitos dos fármacos , Enterocolite Pseudomembranosa/tratamento farmacológico , Compostos Heterocíclicos com 2 Anéis/farmacologia , Compostos de Fenilureia/farmacologia , Pirróis/farmacologia , Quinolinas/farmacologia , Isomerases de Aminoácido/genética , Isomerases de Aminoácido/metabolismo , Animais , Antibacterianos/síntese química , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Clostridioides difficile/enzimologia , Clostridioides difficile/genética , Clostridioides difficile/crescimento & desenvolvimento , Desenho de Fármacos , Enterocolite Pseudomembranosa/microbiologia , Enterocolite Pseudomembranosa/mortalidade , Enterocolite Pseudomembranosa/patologia , Feminino , Expressão Gênica , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/crescimento & desenvolvimento , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/crescimento & desenvolvimento , Compostos Heterocíclicos com 2 Anéis/síntese química , Camundongos , Camundongos Endogâmicos C57BL , Testes de Sensibilidade Microbiana , Compostos de Fenilureia/síntese química , Pirróis/síntese química , Quinolinas/síntese química , Especificidade da Espécie , Relação Estrutura-Atividade , Análise de Sobrevida
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...