Medicine
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Observational Study
Urine Output During Cardiopulmonary Bypass Predicts Acute Kidney Injury After Cardiac Surgery: A Single-Center Retrospective Analysis.
Urine output is closely associated with renal function and has been used as a diagnostic criterion for acute kidney injury (AKI). However, urine output during cardiopulmonary bypass (CPB) has never been identified as a predictor of postoperative AKI. Considering altered renal homeostasis during CPB, we made a comprehensible approach to CPB urine output and evaluated its predictability for AKI. ⋯ In a multivariate logistic regression to find predictors for AKI in entire patients, CPB urine output did not show statistical significance. After separating patients into subgroups with CPB urine output below and over 4 mL/kg/h, it was identified as an independent predictor for AKI with the odds ratio of 0.43 (confidence interval 0.30-0.61) and 1.11 (confidence interval 1.02-1.20), respectively. The amount of urine output during CPB with careful analysis may serve as a simple and feasible method to predict the development of AKI after cardiac surgery at an early time point.
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Observational Study
Effects of the Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Vein Cross-Sectional Area in Children With Simple Congenital Heart Defects.
Catheterization of the internal jugular vein (IJV) remains difficult in pediatric populations. Increasing the cross-sectional area (CSA) of the IJV facilitates cannulation and decreases complications. We aimed to evaluate the Trendelenburg position and the levels of positive end-expiratory pressure (PEEP) at which the maximum increase of CSA of the IJV occurred in children undergoing cardiac surgery. ⋯ The Trendelenburg tilt alone increased the CSA by 19.0%, and combining the 10° Trendelenburg with a 10 cm H2O PEEP resulted in the largest IJV CSA increase (33.3%) compared with the supine position with no PEEP. Meanwhile, vital signs remained relatively steady during the experiment. The application of the Trendelenburg position and a 10 cm H2O PEEP thus significantly increases the CSA of the right IJV, perhaps improving the chances of successful cannulation in pediatric patients with simple congenital heart defects.
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Multicenter Study
Adverse Drug Reactions Causing Admission to Medical Wards: A Cross-Sectional Survey at 4 Hospitals in South Africa.
Limited data exist on the burden of serious adverse drug reactions (ADRs) in sub-Saharan Africa, which has high HIV and tuberculosis prevalence. We determined the proportion of adult admissions attributable to ADRs at 4 hospitals in South Africa. We characterized drugs implicated in, risk factors for, and the preventability of ADR-related admissions. ⋯ In our survey, approximately 1 in 12 admissions was because of an ADR. The range of ADRs and implicated drugs reflect South Africa's high HIV and tuberculosis burden. Identification and management of these ADRs should be considered in HIV and tuberculosis care and treatment programs and should be emphasized in health care worker training programmes.
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Randomized Controlled Trial
Effects of Postoperative Pain Management on Immune Function After Laparoscopic Resection of Colorectal Cancer: A Randomized Study.
There has been a rising interest in the possible association between perioperative opioid use and postoperative outcomes in cancer patients. Continuous surgical wound infiltration with local anesthetics is a nonopioid analgesic technique that can be used as a postoperative pain management alternative to opioid-based intravenous patient-controlled analgesia (IV PCA). The aim of this study was to compare the effects of an opioid-based analgesic regimen versus a local anesthetic wound infiltration-based analgesic regimen on immune modulation and short-term cancer recurrence or metastasis in patients undergoing laparoscopic resection of colorectal cancer. ⋯ Postoperative inflammatory responses were also similar between the groups. When compared with ropivacaine wound infiltration-based analgesia, fentanyl-based analgesia did not further decrease NKCC or affect short-term cancer recurrence or metastasis. Thus, a fentanyl-based analgesic regimen and a ropivacaine wound infiltration-based analgesic regimen can both be used for postoperative pain management in laparoscopic resection of colorectal cancer.
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Observational Study
The Association Between Peptic Ulcer Disease and Ischemic Stroke: A Population-Based Longitudinal Study.
Stroke is a common cause of death worldwide, but about 30% of ischemic stroke (IS) patients have no identifiable contributing risk factors. Because peptic ulcer disease (PUD) and vascular events share some common risk factors, we conducted a population-based study to evaluate the association between PUD and IS. We followed up a representative sample of 1 million residents of Taiwan using the National Health Insurance Research Database from 1997 to 2011. ⋯ Other independent risk factors included male sex, older age, lower income, and co-morbidity of hypertension, diabetes mellitus (DM), and heart disease. PUD is a risk factor for IS, independent of conventional risk factors such as male sex, older age, lower income, and co-morbidity of hypertension, DM, and heart disease. Prevention strategies taking into account PUD should be developed and evaluated.