Medicine
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Observational Study
Prospective clinical observational study evaluating gender-associated differences of preoperative pain intensity.
Previous studies reported conflicting results concerning different pain perceptions of men and women. Recent research found higher pain levels in men after major surgery, contrasted by women after minor procedures. This trial investigates differences in self-reported preoperative pain intensity between genders before surgery. ⋯ This large clinical study observed significantly higher preoperative pain intensity in female surgical patients. This gender difference was larger in the elderly potentially contradicting the current hypothesis of a primary sex-hormone derived effect. The observed variability in specific patient subgroups may help to explain heterogeneous findings of previous studies.
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Despite gaining popularity, venovenous extracorporeal membrane oxygenation (VV-ECMO) remains a controversial therapy for acute respiratory failure (ARF) in adult patients due to its equivocal survival benefits. The study was aimed at identifying the preinterventional prognostic predictors of hospital mortality in adult VV-ECMO patients and developing a practical mortality prediction score to facilitate clinical decision-making. This retrospective study included 116 adult patients who received VV-ECMO for severe ARF in a tertiary referral center, from 2007 to 2015. ⋯ Duration of MV, severity of organ dysfunction, and immunocompromised status were important preinterventional prognostic predictors for adult VV-ECMO. The 3 prognostic predictors could also constitute a practical prognosticating tool in patients requiring this advanced respiratory support. Physicians in ECMO institutions are encouraged to perform external validations of this prognosticating tool and make contributions to score optimization.
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During abdominal surgery, the use of protective ventilation with a low tidal volume, positive expiratory pressure (PEEP) and recruitment maneuvers (RMs) may limit the applicability of dynamic preload indices. The objective of the present study was to establish whether or not the variation in stroke volume (SV) during an RM could predict fluid responsiveness. We prospectively included patients receiving protective ventilation (tidal volume: 6 mL kg, PEEP: 5-7 cmH2O; RMs). ⋯ A ΔrecSV value more than 16% predicted fluid responsiveness with an area under the receiver-operating characteristic curve (AU) of 0.95 (95% confidence interval [CI]: 0.91-0.99; P < 0.0001) and a narrow gray zone between 15% and 17%. The area under the curve values for ΔrecPP and ΔrespSV were, respectively, 0.81 (95%CI: 0.7-0.91; P = 0.0001) and 0.80 (95%CI: 0.70-0.94; P < 0.0001). ΔrespPP did not predict fluid responsiveness. During abdominal surgery with protective ventilation, a ΔrecSV value more than 16% accurately predicted fluid responsiveness and had a narrow gray zone (between 15% and 17%). ΔrecPP and ΔrespSV (but not ΔrespPP) were also predictive.
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Comparative Study Observational Study
The feasibility of CT lung volume as a surrogate marker of donor-recipient size matching in lung transplantation.
Donor-recipient size matching in lung transplantation (LTx) by computed tomography lung volume (CTvol) may be a reasonable approach because size matching is an anatomical issue. The purpose of this study is to evaluate the feasibility of CTvol as a surrogate marker of size matching in LTx by comparing CTvol and predicted total lung capacity (pTLC) to reference total lung capacity (TLC) values. From January to December 2014, data from 400 patients who underwent plethysmography, pulmonary function testing (PFT), and chest computed tomography scans were reviewed retrospectively. ⋯ CTvol showed similar or better correlation with TLC compared to the pTLC in normal participants and patients with obstructive or restrictive pulmonary diseases. CTvol showed a smaller error rate in patients with restrictive disease. The results suggest that CTvol may be a feasible method for size matching in LTx.
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Comparative Study
Comparison of the prognostic values of the 2010 WHO classification, AJCC 7th edition, and ENETS classification of gastric neuroendocrine tumors.
The ability of the European Neuroendocrine Tumor Society (ENETS) system, 2010 World Health Organization (WHO) grading system, and American Joint Committee on Cancer (AJCC) staging system to predict survival after gastric neuroendocrine tumor (NET) resection has not yet been validated. We retrospectively evaluated 175 gastric NETs from 1996 to 2014. WHO grade 3 (G3) patients (n = 66) had a lower survival rate than grade 1 (G1) (n = 39) or grade 2 (G2) (n = 13) patients, with similar high survival rates for G1 and G2 patients. ⋯ Our findings strongly suggested that the WHO and ENETS classification systems have shown a low prognostic value. The AJCC TNM system showed a low prognostic value for well-differentiated NETs (G1 or G2). In contrast, the AJCC TNM system had a high prognostic value for G3 or mixed tumors.