-
McMahan Dillon heeft een update geplaatst 6 dagen, 8 uren geleden
BACKGROUND There are few studies on the use of a mechanical chest compression (meCC) device during transport in patients with out-of-hospital cardiac arrest (OHCA). OBJECTIVE The aim of our study was to compare the performance of an meCC device with that of manual chest compression during transport after OHCA. METHODS This study used data from the national cardiac arrest registry of patients with OHCA of presumed cardiac etiology. The primary exposure was the use of an meCC device by an Emergency Medical Services provider while transporting a patient to the emergency department. The primary endpoint was good cerebral performance category at discharge. We compared survival and neurologic outcomes between an meCC device group and a manual chest compression group. We also performed an interaction analysis to assess changes in study outcomes of meCC device use by the initial electrocardiogram (ECG) and transport time interval (TTI). RESULTS Among 30,021 adult patients after OHCA with presumed cardiac etiology, an meCC device was used in 2357 (7.6%). After adjustment for possible confounders, there were no significant differences with respect to good neurologic recovery in the outcomes of patients who were treated with an meCC device and those who received manual chest compression (adjusted odds ratio [AOR] 0.66; 95% confidence interval [CI] 0.43-1.02) and survival to discharge (AOR 0.83; 95% CI 0.64-1.06). In the interaction model, the AOR of the meCC device study outcome did not interact with the initial ECG and TTI. CONCLUSIONS The meCC device did not show better study outcomes than manual compression. During tumor development, tissue necrosis appears as a natural phenomenon directly associated with an increase in tumor size. The aim of this study was to assess the use of ultrasound (US) for predicting natural tumor necrosis in a rat liver implant model of colorectal cancer. To achieve this goal, we sought to establish a correlation between US-measured tumor volume, serum enzyme levels and histopathological findings, particularly those regarding necrosis phenomena in liver implants. Under US guidance, CC531 colorectal cancer cells were injected into the left liver lobe of WAG/RijHsd rats. Twenty-eight days after cell inoculation, tumor volume was measured by US, and rats were sacrificed to obtain samples of tumor tissue as well as blood serum. In hematoxylin and eosin-stained tumor samples, the percentage of tumor that was necrotic was estimated. The association between percentage tumor necrosis and US-measured tumor volume was assessed by univariate logistic regression analysis, and a linear regression equation was obtained. Serum enzyme levels did not differ significantly between tumor-bearing and tumor-free rats. Tumor implants appeared as well-defined hyper-echoic regions with a mean volume of 0.61 ± 0.39 mL and tumor necrosis percentage of 8.6 ± 7.7%. Linear regression analysis revealed a very strong relationship (Pearson correlation coefficient r = 0.911) between US-measured tumor volume and tumor necrosis percentage; the regression equation was tumor necrosis percentage = 21 × US-measured tumor volume (in mL) – 3.1. The study found US to be a useful tool in animal-based trials. Selleckchem GSK 2837808A Tumors inside the liver (ranging in volume from 0.24-1.37 mL) can be observed by US, and moreover, US-measured tumor volume on day 28 can be used to estimate tumor necrosis occurring as the natural evolution of tumor implants. OBJECTIVES Coagulation function dynamically changes during cardiac surgery and is normalized after surgery. The authors investigated changes of coagulation function during cardiac surgery and after mimicked salvaged blood transfusion (SBT), and determined background risk factors for coagulation dysfunction by thromboelastmetry including maximum clot firmness of fibrinogen assay (FIBTEM-MCF primary variable). DESIGN Prospective observational study with ex vivo laboratory experiment. SETTING University hospital. PARTICIPANTS Consecutive 65 adult elective cardiac surgery patients being scheduled to use cell salvage technique. INTERVENTIONS Arterial blood sampling (preoperative after anesthesia induction, and postoperative after reversal of heparin), and ex vivo dilution of postoperative blood with salvaged blood (7.4% 2.5 mL + 0.2 mL and 18.5% 2.2 mL + 0.5 mL). MEASUREMENTS AND MAIN RESULTS Thromboelastometry was performed for the preoperative blood sample, and postoperative blood samples mixed with different amount of the salvaged blood. Preoperative FIBTEM-MCF significantly decreased after cardiac surgery (16.5 [95% confidence interval (15.4-17.6)] mm to 9.5 [8.4-10.6] mm, p less then 0.0001). In vitro 7.4% and 18.5% salvaged blood addition dose-dependently reduced FIBTEM-MCF (9.1 [95% confidence interval (8.0-10.1)] mm, 7.9 [6.8-9.0] mm, respectively, p less then 0.0001). Preoperative FIBTEM-MCF and changes of FIBTEM-MCF during cardiac surgery were independent risk factors for development of the FIBTEM-MCF 8 mm or less after in vitro salvaged blood addition. Furthermore, residual heparin within salvaged blood was indicated by significant increase of intrinsic assay-clotting time/ heparin assay-clotting time after 18.5% in vitro salvaged blood addition (p less then 0.0001). CONCLUSIONS Salvaged blood transfusion of more than 18.5% whole blood volume may impair coagulation function particularly in patients with lower FIBTEM-MCF before and after cardiac surgery. OBJECTIVES The aim of the present study was to prevent cross-infection in the operating room during emergency procedures for patients with confirmed or suspected 2019 novel coronavirus (2019-nCoV) by following anesthesia management protocols, and to document clinical- and anesthesia-related characteristics of these patients. DESIGN This was a retrospective, multicenter clinical study. SETTING This study used a multicenter dataset from 4 hospitals in Wuhan, China. PARTICIPANTS Patients and health care providers with confirmed or suspected 2019-nCoV from January 23 to 31, 2020, at the Wuhan Union Hospital, the Wuhan Children’s Hospital, The Central Hospital of Wuhan, and the Wuhan Fourth Hospital in Wuhan, China. INTERVENTIONS Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in 4 hospitals in Wuhan. MEASUREMENTS AND MAIN RESULTS Cross-infection in the operating rooms of the 4 hospitals was effectively reduced by implementing the new measures and procedures.