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Precise Harmful toxins for the treatment Prostate Cancer.
OBJECTIVE To evaluate aortic disease progression and reintervention after an initial thoracic aortic dissection in pathogenic variant carriers. METHODS Of 175 participants diagnosed with thoracic aortic dissection, 31 had a pathogenic variant (pathogenic group) across 6 genes (COL3A1, FBN1, LOX, PRKG1, SMAD3, TGFBR2) identified by whole exome sequencing. Those with benign or normal variants (benign/normal group, n = 144) comprised the control group. Clinical data were collected through medical record review (1985-2018) and supplemented with the National Death Index database (December 2018). RESULTS The entire cohort (n = 175) consisted of 108 type A aortic dissections and 67 type B aortic dissections, similarly distributed between groups. The pathogenic group was significantly younger (43 vs 56 years, P less then .0001) and had significantly more aortic root replacements and similar extents of arch replacement at initial type A aortic dissection repair. The median follow-up time was 7.5 (4.6-12) years. After initial treatment, the pathogenic group required significantly more aortic reinterventions (median 1 vs 0, P less then .0001) and mean cumulative aortic reinterventions for each patient (10 years 1 vs 0.5, P = .029). Both incidence rate (12%/year vs 1.2%/year, P = .0001) and cumulative incidence of reinterventions (9 years 70% vs 6%, P less then .0001) for the preserved native aortic root were significantly higher in the pathogenic group, but were similar for the preserved native aortic arch and distal aorta between groups. Ten-year survival was similar in the pathogenic and benign/normal groups (92% vs 85%). CONCLUSIONS Aggressive aortic root replacement and similar arch management should be considered in pathogenic variant carriers at initial type A aortic dissection repair compared with benign/normal variant carriers. INTRODUCTION AND OBJECTIVES Magnesium sulfate has been used in anesthesia because it has relevant clinical features such as analgesia, autonomic response control and muscle relaxation. Using the agent to establish adequate conditions for tracheal intubation remains controversial. The aim of the study was to compare the effectiveness of magnesium sulfate and rocuronium for rapid sequence tracheal intubation in adults. METHODS Double blind, randomized, unicentric, prospective study assessed 68 patients, ASA 1 or 2, over 18 years, scheduled for appendectomy under general anesthesia. Patients were divided into two groups. GM patients received 50 mg.kg-1magnesium sulfate and GR patients, 1 mg.kg-1 rocuronium immediately before anesthesia induction. Arterial Blood Pressure (BP) and Heart Rate (HR) were measured in both groups at five times related to the administration of the drugs studied. The primary variable was the clinical status of tracheal intubation. TRIAL REGISTRY RBR-4xr92k. RESULTS GM was associated with no significant hemodynamic parameter change after injection. GM showed 85% (29/34) poor intubation clinical status, 15% (5/34) good, and 0% excellent ( less then 0.0001). CONCLUSION Magnesium sulfate did not provide adequate clinical status when compared to rocuronium at a dose of 50 mg.kg-1 for rapid sequence intubation in adult patients. BACKGROUND AND OBJECTIVES Poor monitoring of tracheal tube cuff pressure may result in patient complications. The objective method of using a manometer is recommended to keep safe cuff pressure values (20-30 cm H2O). However, as manometers are not readily available, anesthesiologists use subjective methods. We aimed to assess appropriateness of a subjective method for attaining cuff pressure and the expertise level of manometer handling among anesthesiology staff and residents in a university teaching hospital. METHODS Prospective observational study, recruiting participants that performed tracheal intubation and the subjective method for tube cuff inflation. Patients with difficult airway, larynx and trachea anatomic abnormality and emergency procedures were not included. Up to 60 minutes after tracheal intubation, an investigator registered the cuff pressure using an aneroid manometer (AMBU®) connected to the tube pilot balloon. RESULTS Forty-seven anesthesiologists were included in the study - 24 residents and 23 staff. Mean (SD) and medians (IQR) measured in cm H2O were, respectively, 52.5 (27.1) and 50 (30-70). We registered 83% of measurements outside the recommended pressure range, with no difference between specialists and residents. The level of expertise with the objective method was also similar in both groups. Pressure adjustments were performed in 76.6% of cases. CONCLUSION The subjective method for inflating the tracheal tube cuff resulted in a high rate of inadequate cuff pressures, with no difference in performance between anesthesiology specialists and residents. Patients with hereditary predisposition to digestive cancer are at high risk of neoplasia and management in expert centers is recommended. The PRED-IdF network was thus created in 2009, with the support of the French National Cancer Institute (INCa), covering Paris and its suburbs, including five teaching hospitals and two oncology-dedicated institutes. The aim of this network is to offer optimized cancer screening programs based on expert recommendations to patients with hereditary predisposition. Any patient with suspicion of hereditary colorectal syndrome can be referred to the PRED-IdF network. The missions of this network include the establishment of a personalized screening program (PSP), coordination of PSP, expertise/recourse for difficult cases and research. Since 2009, 3384 patients have been included. We genetically identified 1925 patients with Lynch syndrome and 539 with familial adenomatous polyposis (FAP) (including both APC and MUTYH mutations), representing 72.8% of the PRED-IdF cohort. The PRED-IdF is also an important promotor of research in the field. We recently demonstrated the beneficial impact of the network in terms of colorectal cancer occurrence in patients with Lynch syndrome. Moreover, the PRED-IdF is involved in many studies ranging from basic science collaborations to randomized controlled trials. The long-term objective is to offer to all patients a personalized medical approach. Virtual clinics have been proposed as a method of reducing costs and improving services in the National Health Service (NHS). The aim of this research was to assess the attitudes of clinicians and patients towards virtual consultations in a department of oral and maxillofacial surgery (OMFS). Patients and clinicians at conventional OMFS adult outpatient clinics were prospectively interviewed using a structured questionnaire. Variables recorded included type of consultation, overall attitude, time travelled, and mode of transport. ML348 Patients' notes were assessed retrospectively to check if examinations had been done. A total of 146 patients (100%) completed the surveys, and 108 of them (74%) were amenable to having virtual consultations in the future. Such appointments may have been suitable for 19 patients who did not have examinations. Chi squared analysis showed no relation between type of appointment and preference for a virtual consultation (p=0.087). To introduce a virtual consultation system in our department and to assess its efficacy once implemented, further development and research are required. Crown All rights reserved.OBJECTIVE To identify the health needs of the patient and family facing the perspectives of discharge, health care, and adaptation to the new reality at home. METHODS This was a quantitative and qualitative, exploratory, descriptive study conducted at a reference hospital for liver transplantation. The participants were patients undergoing liver transplant in this hospital unit from 2011 to June 2019. A semistructured interview script was used for data collection, and data were analyzed according to guidelines proposed for content analysis. RESULTS Twenty patients participated, with a mean age of 40.2 years; 76% were men. The interview data enabled the development of 3 categories daily health care, warning signs, and adaptation to the new health care routine. The data obtained from the categories showed that the main health needs include difficulties in blood glucose management, insulin administration, the importance of awareness of the warning signs, and obtaining support from the health care team to deal with food restrictions and high doses of medication. CONCLUSION The health needs are focused on identifying strategies to develop daily care, in addition to seeking better strategies to adapt to the new reality. The study showed the need for individualized discharge planning by the health care team, based on the health needs of each patient. OBJECTIVE To develop a radial basis function (RBF) neural network and investigate its performance in the estimation of glomerular filtration rate (GFR) for patients with chronic kidney disease. METHODS A total of 651 patients with chronic kidney disease were enrolled in this study. The GFR measured by 99mTc-DTPA renal dynamic imaging was used as the standard GFR. The RBF neural network model was established and the performance prediction GFR value was verified. It was found that the RBF neural network could better evaluate the GFR of patients with chronic kidney disease stage 2-5, which is superior to the Modification of Diet in Renal Disease equation. CONCLUSIONS The RBF neural network evaluated GFR significantly for patients with chronic kidney disease stages 2-5, and it showed no difference with the 99mTc-DTPA renal dynamic imaging method, and it can be used for estimated GFR evaluation. OBJECTIVE This article analyzes the effectiveness of a super-accelerated immunization schedule against hepatitis B in patients who have received a liver transplantation. METHODS This is a quantitative and retrospective study based on secondary data of medical records from 177 patients who have received a liver transplantation at the Hospital de Base in São José do Rio Preto, São Paulo State, Brazil, between 1998 and 2016. RESULTS From the total number of participants, 72.89% were male, 39.55% had a cirrhosis diagnosis with associated causes, 23.16% had hepatocellular carcinoma, 53.11% were classified according to Child-Turcotte-Pugh C score, 58.76% had the hepatitis C virus, 97.18% had received an unconventional immunization schedule, and seroconversion was 36.63% among those with an unconventional schedule. The fact that the patient had the hepatitis C virus was statistically significant considering the lack of protection of the vaccine against the hepatitis B virus; their chances were 5 times higher of not seroconverting at the end of the immunization schedule. CONCLUSION The need for high immediate protection in a short term may justify using unconventional immunization schedules in patients who make it to the transplantation waiting list without any previous immunization. Primary central nervous system tumors can be the cause of brain death. Not all of them contraindicate the donation of organs and tissues for transplant. A survey of cases was carried out in our country in which it was observed that the number of brain deaths caused by primary tumors was low, of the order of 2%, with an ẋ (media) of 3 by year, which would increase the potential for donation. Medical records, an anatomopathologic study, and a detailed physical examination will be fundamental when applying the donor selection criteria. Nuclear magnetic resonance in expert hands has a sensitivity of 96% to catalog the benignity or malignancy of this type of tumors.
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