Articles: function.
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Anesthesia and analgesia · Apr 2014
Comparative StudyIntraoperative three-dimensional versus two-dimensional echocardiography for left ventricular assessment.
Three-dimensional (3D) transesophageal echocardiography (TEE) technology is now widely used intraoperatively in cardiac surgery. Left ventricular (LV) measurements with 3D transthoracic echocardiography correlate better with cardiac magnetic resonance measurements compared with traditional two-dimensional (2D) transthoracic echocardiography. In this study, we compared intraoperative 3D TEE against 2D TEE regarding quantitative indices of LV function. ⋯ Intraoperative 3D TEE quantification of LV global function, image acquisition time, and reproducibility was not statistically different when compared with 2D TEE. It was however associated with calculation of larger LV volumes and a longer analysis time. Nevertheless, the 3-zone error grid analysis of the LV indexed volumes showed that the difference between 3D and 2D measurements does not affect the LV classification as normal, mildly to moderately dilated, or severely dilated.
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In the perioperative period, acute heart failure can result from a variety of conditions, and treatment may vary considerably depending on its mechanism. This review aims to provide conceptual framework by selectively presenting recent knowledge and advances in acute heart failure therapies including drugs (inotropes, diuretics) and devices (mechanical assistance, biventricular pacing, ultrafiltration). ⋯ Poor data exist in the perioperative setting concerning acute heart failure therapies. Large trials are needed to support the use of levosimendan, mechanical assistance, utrafiltration and biventricular pacing in the perioperative setting. The prognostic role of natriuretic peptides was confirmed in the perioperative period.
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Semin Respir Crit Care Med · Apr 2014
ReviewBiomarkers in connective tissue disease-associated interstitial lung disease.
This article reviews major biomarkers in serum and bronchoalveolar lavage fluid (BALF) with respect to their diagnostic and prognostic value in connective tissue disease-associated interstitial lung disease (CTD-ILD). In some CTD such as systemic sclerosis (SSc), the incidence of ILD is up to two-third of patients, and currently ILD represents the leading cause of death in SSc. Because of the extremely variable incidence and outcome of ILD in CTD, progress in the discovery and validation of biomarkers for diagnosis, prognosis, patients' subtyping, response to treatment, or as surrogate endpoints in clinical trials is extremely important. ⋯ Besides autoantibodies, an increase in serum or BALF of a biomarker of pulmonary origin may be able to predict or reflect the development of fibrosis, the impairment of lung function, and ideally also the prognosis. Promising biomarkers are lung epithelium-derived proteins such as KL-6 (Krebs von den Lungen-6), SP-D (surfactant protein-D), SP-A (surfactant protein-A), YKL-40 (chitinase-3-like protein 1 [CHI3L1] or cytokines such as CCL18 [chemokine (C-C) motif ligand 18]). In the future, genetic/epigenetic markers, such as human leukocyte antigen (HLA) haplotypes, single nucleotide polymorphisms, and micro-RNA, may help to identify subtypes of patients with different needs of management and treatment strategies.
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Anesthesia and analgesia · Apr 2014
Dexamethasone produces dose-dependent inhibition of sugammadex reversal in in vitro innervated primary human muscle cells.
Corticosteroids are frequently used during anesthesia to provide substitution therapy in patients with adrenal insufficiency, as a first-line treatment of several life-threatening conditions, to prevent postoperative nausea and vomiting, and as a component of multimodal analgesia. For these last 2 indications, dexamethasone is most frequently used. Due to the structural resemblance between aminosteroid muscle relaxants and dexamethasone, concerns have been raised about possible corticosteroid inhibition in the reversal of neuromuscular block by sugammadex. We thus investigated the influence of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular block, which could be relevant in certain clinical situations. ⋯ This is the first report in which the effects of rocuronium and sugammadex interactions with dexamethasone have been studied in a highly accessible in vitro experimental model of functionally innervated human muscle cells. Sugammadex reverses rocuronium-induced neuromuscular block; however, concomitant addition of high dexamethasone concentrations diminishes the efficiency of sugammadex. Further studies are required to determine the clinical relevance of these interactions.
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Semin Respir Crit Care Med · Apr 2014
ReviewPulmonary manifestations of systemic lupus erythematosus.
Systemic lupus erythematosus (SLE) is a systemic inflammatory disease, characterized serologically by an autoantibody response to nucleic antigens, and clinically by injury and/or malfunction in any organ system. During their disease course, up to 50% of SLE patients will develop lung disease. ⋯ Two major themes inform our understanding of SLE-associated pulmonary manifestations: first, the presence of specific autoantibodies correlates with the presence of certain pulmonary manifestations and second, vascular injury marks a common pathophysiologic thread among the various SLE-related lung diseases. This review will focus on the clinical presentation, pathogenesis, pathology, management, and prognosis of these SLE-associated lung conditions.