BACKGROUND Sedation is commonly performed for the endoscopic submucosal dissection(ESD)of early gastric cancer.Severe hypoxemia occasionally occurs due to the respiratory depression during sedation.AIM To establish pr...BACKGROUND Sedation is commonly performed for the endoscopic submucosal dissection(ESD)of early gastric cancer.Severe hypoxemia occasionally occurs due to the respiratory depression during sedation.AIM To establish predictive models for respiratory depression during sedation for ESD.METHODS Thirty-five adult patients undergoing sedation using propofol and pentazocine for gastric ESDs participated in this prospective observational study.Preoperatively,a portable sleep monitor and STOP questionnaires,which are the established screening tools for sleep apnea syndrome,were utilized.Respiration during sedation was assessed by a standard polysomnography technique including the pulse oximeter,nasal pressure sensor,nasal thermistor sensor,and chest and abdominal respiratory motion sensors.The apnea-hypopnea index(AHI)was obtained using a preoperative portable sleep monitor and polysomnography during ESD.A predictive model for the AHI during sedation was developed using either the preoperative AHI or STOP questionnaire score.RESULTS All ESDs were completed successfully and without complications.Seventeen patients(49%)had a preoperative AHI greater than 5/h.The intraoperative AHI was significantly greater than the preoperative AHI(12.8±7.6 events/h vs 9.35±11.0 events/h,P=0.049).Among the potential predictive variables,age,body mass index,STOP questionnaire score,and preoperative AHI were significantly correlated with AHI during sedation.Multiple linear regression analysis determined either STOP questionnaire score or preoperative AHI as independent predictors for intraoperative AHI≥30/h(area under the curve[AUC]:0.707 and 0.833,respectively)and AHI between 15 and 30/h(AUC:0.761 and 0.778,respectively).CONCLUSION The cost-effective STOP questionnaire shows performance for predicting abnormal breathing during sedation for ESD that was equivalent to that of preoperative portable sleep monitoring.展开更多
Background: the quality of life (QoL) of patients with pancreatic ductal adenocarcinoma (PDAC), with its limited survival, can be affected by chemotherapy-induced toxicity. The main objective was to evaluate the effec...Background: the quality of life (QoL) of patients with pancreatic ductal adenocarcinoma (PDAC), with its limited survival, can be affected by chemotherapy-induced toxicity. The main objective was to evaluate the effect of introducing ocoxin oral solution (OOS) in combination with standard therapy on quality of life. Methods: Thirty patients were enrolled in an exploratory, prospective, single-centre clinical trial in the oncology department of “Hermanos Ameijeiras” University Hospital in Havana, Cuba. Quality of life was measured using the EORTC QLQ-C30 questionnaire and toxicity was assessed using the NCI-CTC-AE classification version 5.0. Results: There was stability in the scores over time for overall QoL and the functional scale criteria, while in terms of symptoms, fatigue, pain and loss of appetite were reduced. No grade 3 - 4 adverse events (AEs) were recorded, and only 14.9% of toxicities were classified as grade 2, and these were considered to be unrelated to OOS. Biochemical and nutritional parameters were normalised at 12 months compared to the baseline values. Conclusions: This clinical study is the first report of the use of OOS in patients with advanced pancreatic cancer, and demonstrates that it is able to maintain optimal quality of life with reduced severity of toxicity during and after combination treatment with gemcitabine-based chemotherapy.展开更多
The study was conducted to investigate the impact of different levels of feed on the adaptive capability based on physiological, blood biochemical, endocrine and molecular mechanisms in growing Osmanabadi kids. The pr...The study was conducted to investigate the impact of different levels of feed on the adaptive capability based on physiological, blood biochemical, endocrine and molecular mechanisms in growing Osmanabadi kids. The primary objective of the study was to identify if HSP70 and HSP90 can be a nutritional stress marker for goat. The study was conducted for a period of two months. The animals were randomly divided into three groups as GI （n = 6; ad libitum feeding）, GII （n = 6; 20% less than ad libitum） and GIII （n = 6; 40% less than ad libitum）. The animals were fed with feed consisting of 50% roughage and 50% concentrate. Blood collection was carried out at fortnightly intervals. Body weights were recorded at weekly interval. Physiological responses, biochemical responses, plasma tri-iodo-thyronine （T3）, thyroxin （＇1＂4） and cortisol were recorded at fortnightly interval. At the end of study period, only GI and Gill animals were slaughtered and different organs were collected for histopathological studies as well as for hepatic HSP70 and HSP90 mRNA transcript expression. Body weight recorded showed significant （P 〈 0.01） differences between the groups. Physiological responses showed significant （P 〈 0.01） variation among the groups. Among the biochemical parameters, plasma glucose and total plasma protein and globulin showed significant （P 〈 0.01） differences between the groups. Plasma T3 （P 〈 0.01）, T4 （P 〈 0.01） and cortisol （P 〈 0.05） also differed significantly between the groups. The relative hepatic HSP70 mRNA transcript expression was significantly （P 〈 0.05） higher in Gill （2.8 fold） as compared to GI （1 fold） kids. Similar result was obtained for hepatic HSP90 mRNA transcript expression. From the results, it can be concluded that Osmanabadi kids possessed the ability to alter their adaptive mechanisms to maintain homeostasis. Further, the study revealed the significance of providing the optimum nutrition for these animals to adapt to existing environmental conditions. The study also established that respiration rate （RR）, rectal temperature （RT）, T3, T4 and cortisol are considered as nutritional stress markers for goat. Further, the results revealed that probably this is the first study to establish the nutritional stress impact on heat shock protein （HSP） expression in goats. The study identified both HSP70 and HSP90 to be the ideal molecular markers for feed deficit in goats.展开更多
BACKGROUND Due to development of an immune-dysregulated phenotype,advanced liver disease in all forms predisposes patients to sepsis acquisition,including by opportunistic pathogens such as fungi.Little data exists on...BACKGROUND Due to development of an immune-dysregulated phenotype,advanced liver disease in all forms predisposes patients to sepsis acquisition,including by opportunistic pathogens such as fungi.Little data exists on fungal infection within a medical intensive liver unit(MILU),particularly in relation to acute on chronic liver failure.AIM To investigate the impact of fungal infections among critically ill patients with advanced liver disease,and compare outcomes to those of patients with bacterial infections.METHODS From our prospective registry of MILU patients from 2018-2022,we included 27 patients with culture-positive fungal infections and 183 with bacterial infections.We compared outcomes between patients admitted to the MILU with fungal infections to bacterial counterparts.Data was extracted through chart review.RESULTS All fungal infections were due to Candida species,and were most frequently blood isolates.Mortality among patients with fungal infections was significantly worse relative to the bacterial cohort(93%vs 52%,P<0.001).The majority of the fungal cohort developed grade 2 or 3 acute on chronic liver failure(ACLF)(90%vs 64%,P=0.02).Patients in the fungal cohort had increased use of vasopressors(96%vs 70%,P=0.04),mechanical ventilation(96%vs 65%,P<0.001),and dialysis due to acute kidney injury(78%vs 52%,P=0.014).On MILU admission,the fungal cohort had significantly higher Acute Physiology and Chronic Health Evaluation(108 vs 91,P=0.003),Acute Physiology Score(86 vs 65,P=0.003),and Model for End-Stage Liver Disease-Sodium scores(86 vs 65,P=0.041).There was no significant difference in the rate of central line use preceding culture(52%vs 40%,P=0.2).Patients with fungal infection had higher rate of transplant hold placement,and lower rates of transplant;however,differences did not achieve statistical significance.CONCLUSION Mortality was worse among patients with fungal infections,likely attributable to severe ACLF development.Prospective studies examining empiric antifungals in severe ACLF and associations between fungal infections and transplant outcomes are critical.展开更多
基金Supported by Japan Society for the Promotion of Science KAKENHI,No.15K09056.
文摘BACKGROUND Sedation is commonly performed for the endoscopic submucosal dissection(ESD)of early gastric cancer.Severe hypoxemia occasionally occurs due to the respiratory depression during sedation.AIM To establish predictive models for respiratory depression during sedation for ESD.METHODS Thirty-five adult patients undergoing sedation using propofol and pentazocine for gastric ESDs participated in this prospective observational study.Preoperatively,a portable sleep monitor and STOP questionnaires,which are the established screening tools for sleep apnea syndrome,were utilized.Respiration during sedation was assessed by a standard polysomnography technique including the pulse oximeter,nasal pressure sensor,nasal thermistor sensor,and chest and abdominal respiratory motion sensors.The apnea-hypopnea index(AHI)was obtained using a preoperative portable sleep monitor and polysomnography during ESD.A predictive model for the AHI during sedation was developed using either the preoperative AHI or STOP questionnaire score.RESULTS All ESDs were completed successfully and without complications.Seventeen patients(49%)had a preoperative AHI greater than 5/h.The intraoperative AHI was significantly greater than the preoperative AHI(12.8±7.6 events/h vs 9.35±11.0 events/h,P=0.049).Among the potential predictive variables,age,body mass index,STOP questionnaire score,and preoperative AHI were significantly correlated with AHI during sedation.Multiple linear regression analysis determined either STOP questionnaire score or preoperative AHI as independent predictors for intraoperative AHI≥30/h(area under the curve[AUC]:0.707 and 0.833,respectively)and AHI between 15 and 30/h(AUC:0.761 and 0.778,respectively).CONCLUSION The cost-effective STOP questionnaire shows performance for predicting abnormal breathing during sedation for ESD that was equivalent to that of preoperative portable sleep monitoring.
文摘Background: the quality of life (QoL) of patients with pancreatic ductal adenocarcinoma (PDAC), with its limited survival, can be affected by chemotherapy-induced toxicity. The main objective was to evaluate the effect of introducing ocoxin oral solution (OOS) in combination with standard therapy on quality of life. Methods: Thirty patients were enrolled in an exploratory, prospective, single-centre clinical trial in the oncology department of “Hermanos Ameijeiras” University Hospital in Havana, Cuba. Quality of life was measured using the EORTC QLQ-C30 questionnaire and toxicity was assessed using the NCI-CTC-AE classification version 5.0. Results: There was stability in the scores over time for overall QoL and the functional scale criteria, while in terms of symptoms, fatigue, pain and loss of appetite were reduced. No grade 3 - 4 adverse events (AEs) were recorded, and only 14.9% of toxicities were classified as grade 2, and these were considered to be unrelated to OOS. Biochemical and nutritional parameters were normalised at 12 months compared to the baseline values. Conclusions: This clinical study is the first report of the use of OOS in patients with advanced pancreatic cancer, and demonstrates that it is able to maintain optimal quality of life with reduced severity of toxicity during and after combination treatment with gemcitabine-based chemotherapy.
文摘The study was conducted to investigate the impact of different levels of feed on the adaptive capability based on physiological, blood biochemical, endocrine and molecular mechanisms in growing Osmanabadi kids. The primary objective of the study was to identify if HSP70 and HSP90 can be a nutritional stress marker for goat. The study was conducted for a period of two months. The animals were randomly divided into three groups as GI （n = 6; ad libitum feeding）, GII （n = 6; 20% less than ad libitum） and GIII （n = 6; 40% less than ad libitum）. The animals were fed with feed consisting of 50% roughage and 50% concentrate. Blood collection was carried out at fortnightly intervals. Body weights were recorded at weekly interval. Physiological responses, biochemical responses, plasma tri-iodo-thyronine （T3）, thyroxin （＇1＂4） and cortisol were recorded at fortnightly interval. At the end of study period, only GI and Gill animals were slaughtered and different organs were collected for histopathological studies as well as for hepatic HSP70 and HSP90 mRNA transcript expression. Body weight recorded showed significant （P 〈 0.01） differences between the groups. Physiological responses showed significant （P 〈 0.01） variation among the groups. Among the biochemical parameters, plasma glucose and total plasma protein and globulin showed significant （P 〈 0.01） differences between the groups. Plasma T3 （P 〈 0.01）, T4 （P 〈 0.01） and cortisol （P 〈 0.05） also differed significantly between the groups. The relative hepatic HSP70 mRNA transcript expression was significantly （P 〈 0.05） higher in Gill （2.8 fold） as compared to GI （1 fold） kids. Similar result was obtained for hepatic HSP90 mRNA transcript expression. From the results, it can be concluded that Osmanabadi kids possessed the ability to alter their adaptive mechanisms to maintain homeostasis. Further, the study revealed the significance of providing the optimum nutrition for these animals to adapt to existing environmental conditions. The study also established that respiration rate （RR）, rectal temperature （RT）, T3, T4 and cortisol are considered as nutritional stress markers for goat. Further, the results revealed that probably this is the first study to establish the nutritional stress impact on heat shock protein （HSP） expression in goats. The study identified both HSP70 and HSP90 to be the ideal molecular markers for feed deficit in goats.
文摘BACKGROUND Due to development of an immune-dysregulated phenotype,advanced liver disease in all forms predisposes patients to sepsis acquisition,including by opportunistic pathogens such as fungi.Little data exists on fungal infection within a medical intensive liver unit(MILU),particularly in relation to acute on chronic liver failure.AIM To investigate the impact of fungal infections among critically ill patients with advanced liver disease,and compare outcomes to those of patients with bacterial infections.METHODS From our prospective registry of MILU patients from 2018-2022,we included 27 patients with culture-positive fungal infections and 183 with bacterial infections.We compared outcomes between patients admitted to the MILU with fungal infections to bacterial counterparts.Data was extracted through chart review.RESULTS All fungal infections were due to Candida species,and were most frequently blood isolates.Mortality among patients with fungal infections was significantly worse relative to the bacterial cohort(93%vs 52%,P<0.001).The majority of the fungal cohort developed grade 2 or 3 acute on chronic liver failure(ACLF)(90%vs 64%,P=0.02).Patients in the fungal cohort had increased use of vasopressors(96%vs 70%,P=0.04),mechanical ventilation(96%vs 65%,P<0.001),and dialysis due to acute kidney injury(78%vs 52%,P=0.014).On MILU admission,the fungal cohort had significantly higher Acute Physiology and Chronic Health Evaluation(108 vs 91,P=0.003),Acute Physiology Score(86 vs 65,P=0.003),and Model for End-Stage Liver Disease-Sodium scores(86 vs 65,P=0.041).There was no significant difference in the rate of central line use preceding culture(52%vs 40%,P=0.2).Patients with fungal infection had higher rate of transplant hold placement,and lower rates of transplant;however,differences did not achieve statistical significance.CONCLUSION Mortality was worse among patients with fungal infections,likely attributable to severe ACLF development.Prospective studies examining empiric antifungals in severe ACLF and associations between fungal infections and transplant outcomes are critical.
