Journal of the Chinese Medical Association : JCMA
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Low central venous pressure (CVP) produced by fluid restriction has been applied to liver transplant recipients in order to decrease blood loss. However, CVP is not reliable for monitoring intravascular volume and ventricular filling. In addition, doubts remain over the association between fluid restriction and acute kidney injury (AKI). We tested the utility of stroke volume variation (SVV), derived from the FloTrac/Vigileo system, as a decision-making tool in fluid management. We examined the differences in fluid administration, urine output, postoperative AKI, and 30-day and 1-year survival rates between liver transplant recipients with fluid management guided by SVV and CVP. ⋯ The outcomes of living donor liver transplant patients who had fluid therapy guided by an SVV less than 10% were similar to those of patients who were given fluids to reach a CVP of 10 mmHg. Our findings suggest that the two measures of vascular filling are similar in liver transplant recipients with demographic characteristics similar to those of our patients.
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The association between genetic polymorphisms of ADRβ2, IL-4, and ADAM3 and asthma remains undetermined. Furthermore, it is not clear as to whether these three gene polymorphisms combined produce a correlative increase in asthmatic risk. ⋯ Genetic polymorphism in the IL-4 promoter, ADRβ2, and ADAM33 is associated with asthma. Furthermore, ADAM33 genetic polymorphism modifies the phenotype of asthma in atopy and hyperresponsiveness. Asthma is a complex polygenic disease, and combinations of polymorphisms of various genes have an additive effect on the risk of asthma.
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Cirrhosis is associated with hyperdynamic circulation, which consists of peripheral vasodilatation and increased cardiac output. Peripheral vasodilatation is central to hyperdynamic circulation and portal hypertension in cirrhosis. However, those mechanisms underlying hyperdynamic circulation remain elusive, and are not fully understood. ⋯ Clinically, these patients present with sodium fluid retention, and strain often unmasks the presence of latent heart failure. No specific treatment can yet be recommended, but caution should be used with respect to procedures that may stress the heart such as shunt implantation and liver transplantation. Ultimately, additional research will be necessary to more accurately describe the prevalence, impact, and morbidity and survival rates for CCM, and to identify potential treatments.