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[PMID]:29505518
[Au] Autor:Zhang S; Huang Q; Xu B; Ma J; Cao G; Pei F
[Ad] Endereço:Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
[Ti] Título:Effectiveness and safety of an optimized blood management program in total hip and knee arthroplasty: A large, single-center, retrospective study.
[So] Source:Medicine (Baltimore);97(1):e9429, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Little has been published on blood management in total hip and knee arthroplasty (THA and TKA, respectively) patients focusing on both hematopoiesis and hemostasis. Our aim was to explore the effectiveness and safety of an optimized blood management program in THA and TKA patients in a large, single-center, retrospective study.We retrospectively reviewed consecutive primary unilateral THA and TKA patients' data at our institution through the National Health Database. They were divided into 3 groups according to an optimized blood management program: group A-combined use of intravenous and topical tranexamic acid (TXA); group B-use of recombinant human erythropoietin (rHuEPO) and iron supplements in addition to treatments in group A; group C-use of additional multiple boluses of TXA in addition to treatments in group B. The primary outcomes were hemoglobin (Hb) drop and calculated total blood loss (TBL). Other outcome measurements such as transfusion rate, postoperative length of stay (PLOS), venous thromboembolism (VTE), and mortality were also compared.From 2014 to 2016, a total of 1907 unilateral THA (986 in group A, 745 in group B, and 176 in group C) and 1505 unilateral TKA (795 in group A, 556 in group B, and 154 in group C) procedures were conducted at our institution. The Hb drop, calculated TBL, and PLOS in group C were significantly lower than those in groups A and B for THA and TKA patients. The transfusion rate in group C was also significantly less than in groups A and B for THA patients, while it was similar in groups A and B for TKA patients. No patients in group C received a transfusion. A significant difference was not detected in the incidence of deep vein thrombosis. No episode of symptomatic pulmonary embolism or all-cause mortality occurred within 30 days postoperatively.The current retrospective study suggests that for patients receiving primary unilateral THA or TKA, multiple boluses of intravenous TXA combined with topical TXA, rHuEPO, and iron supplements can reduce the calculated TBL, Hb drop, transfusion rate, and PLOS without increasing the incidence of VTE or mortality.
[Mh] Termos MeSH primário: Anemia/tratamento farmacológico
Antifibrinolíticos/administração & dosagem
Perda Sanguínea Cirúrgica/prevenção & controle
Eritropoetina/uso terapêutico
Ferro/uso terapêutico
Oligoelementos/uso terapêutico
Ácido Tranexâmico/administração & dosagem
[Mh] Termos MeSH secundário: Administração Intravenosa
Administração Tópica
Adulto
Idoso
Anemia/etiologia
Artroplastia de Quadril/efeitos adversos
Artroplastia do Joelho/efeitos adversos
Feminino
Seres Humanos
Masculino
Meia-Idade
Proteínas Recombinantes/uso terapêutico
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antifibrinolytic Agents); 0 (Recombinant Proteins); 0 (Trace Elements); 11096-26-7 (Erythropoietin); 6T84R30KC1 (Tranexamic Acid); E1UOL152H7 (Iron)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180306
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009429


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[PMID]:29489645
[Au] Autor:Xiong J; Li H; Li X; Wang L; Zhao P; Meng D; Wei ZX; Tian T
[Ad] Endereço:The First Affiliated Hospital of Henan University of Traditional Chinese Medicine.
[Ti] Título:Electroacupuncture for postoperative pain management after total knee arthroplasty: Protocol for a systematic review and meta-analysis.
[So] Source:Medicine (Baltimore);97(9):e0014, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Total knee arthroplasty (TKA) is one of the most common joint replacement surgeries in the United States. Postoperative pain is still a major complication after TKA. Electroacupuncture (EA) has been commonly used in clinical practice for pain after TKA, but its effects and safety remain uncertain. This protocol is described for a systematic review to investigate the beneficial effects and safety of EA for postoperative pain after TKA. METHODS: Randomized controlled trials (RCTs) related to EA treatment of pain after TKA will be collected from 3 databases of English literature, namely PubMed, Embase, and Cochrane Library, and 4 databases of Chinese literatures, namely CBM, CNKI, VIP and Wanfang database. The retrieved trials will be those published from the time when the respective databases were built to January 2018. The therapeutic effects according to the change from baseline in the amount of pain measured by the visual analogue scale (VAS) or numerical rating scale, will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed. RESULTS: This systematic review and meta-analysis will provide a high-quality synthesis of current evidence of EA for pain after TKA. CONCLUSION: The conclusion of our systematic review will provide evidence to judge whether EA is an effective intervention for patient with postoperative pain after TKA. PROSPERO REGISTRATION NUMBER: PROSPERO CRD 42018082407.
[Mh] Termos MeSH primário: Artroplastia do Joelho/efeitos adversos
Eletroacupuntura
Dor Pós-Operatória/terapia
[Mh] Termos MeSH secundário: Seres Humanos
Manejo da Dor/métodos
Projetos de Pesquisa
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000010014


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[PMID]:29341066
[Au] Autor:Yu Y; Zhang K; Zhang L; Zong H; Meng L; Han R
[Ad] Endereço:Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No.6 Tiantan Xili, Beijing, China, 100050.
[Ti] Título:Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults.
[So] Source:Cochrane Database Syst Rev;1:CD010947, 2018 Jan 17.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Various techniques have been employed for the early detection of perioperative cerebral ischaemia and hypoxia. Cerebral near-infrared spectroscopy (NIRS) is increasingly used in this clinical scenario to monitor brain oxygenation. However, it is unknown whether perioperative cerebral NIRS monitoring and the subsequent treatment strategies are of benefit to patients. OBJECTIVES: To assess the effects of perioperative cerebral NIRS monitoring and corresponding treatment strategies in adults and children, compared with blinded or no cerebral oxygenation monitoring, or cerebral oxygenation monitoring based on non-NIRS technologies, on the detection of cerebral oxygen desaturation events (CDEs), neurological outcomes, non-neurological outcomes and socioeconomic impact (including cost of hospitalization and length of hospital stay). SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 12), Embase (1974 to 20 December 2016) and MEDLINE (PubMed) (1975 to 20 December 2016). We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing studies on 20 December 2016. We updated this search in November 2017, but these results have not yet been incorporated in the review. We imposed no language restriction. SELECTION CRITERIA: We included all relevant randomized controlled trials (RCTs) dealing with the use of cerebral NIRS in the perioperative setting (during the operation and within 72 hours after the operation), including the operating room, the postanaesthesia care unit and the intensive care unit. DATA COLLECTION AND ANALYSIS: Two authors independently selected studies, assessed risk of bias and extracted data. For binary outcomes, we calculated the risk ratio (RR) and its 95% confidence interval (CI). For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. As we expected clinical and methodological heterogeneity between studies, we employed a random-effects model for analyses and we examined the data for heterogeneity (I statistic). We created a 'Summary of findings' table using GRADEpro. MAIN RESULTS: We included 15 studies in the review, comprising a total of 1822 adult participants. There are 12 studies awaiting classification, and eight ongoing studies.None of the 15 included studies considered the paediatric population. Four studies were conducted in the abdominal and orthopaedic surgery setting (lumbar spine, or knee and hip replacement), one study in the carotid endarterectomy setting, and the remaining 10 studies in the aortic or cardiac surgery setting. The main sources of bias in the included studies related to potential conflict of interest from industry sponsorship, unclear blinding status or missing participant data.Two studies with 312 participants considered postoperative neurological injury, however no pooled effect estimate could be calculated due to discordant direction of effect between studies (low-quality evidence). One study (N = 126) in participants undergoing major abdominal surgery reported that 4/66 participants experienced neurological injury with blinded monitoring versus 0/56 in the active monitoring group. A second study (N = 195) in participants having coronary artery bypass surgery reported that 1/96 participants experienced neurological injury in the blinded monitoring group compared with 4/94 participants in the active monitoring group.We are uncertain whether active cerebral NIRS monitoring has an important effect on the risk of postoperative stroke because of the low number of events and wide confidence interval (RR 0.25, 95% CI 0.03 to 2.20; 2 studies, 240 participants; low-quality evidence).We are uncertain whether active cerebral NIRS monitoring has an important effect on postoperative delirium because of the wide confidence interval (RR 0.63, 95% CI 0.27 to 1.45; 1 study, 190 participants; low-quality evidence).Two studies with 126 participants showed that active cerebral NIRS monitoring may reduce the incidence of mild postoperative cognitive dysfunction (POCD) as defined by the original studies at one week after surgery (RR 0.53, 95% CI 0.30 to 0.95, I = 49%, low-quality evidence).Based on six studies with 962 participants, there was moderate-quality evidence that active cerebral oxygenation monitoring probably does not decrease the occurrence of POCD (decline in cognitive function) at one week after surgery (RR 0.62, 95% CI 0.37 to 1.04, I = 80%). The different type of monitoring equipment in one study could potentially be the cause of the heterogeneity.We are uncertain whether active cerebral NIRS monitoring has an important effect on intraoperative mortality or postoperative mortality because of the low number of events and wide confidence interval (RR 0.63, 95% CI 0.08 to 5.03, I = 0%; 3 studies, 390 participants; low-quality evidence). There was no evidence to determine whether routine use of NIRS-based cerebral oxygenation monitoring causes adverse effects. AUTHORS' CONCLUSIONS: The effects of perioperative active cerebral NIRS monitoring of brain oxygenation in adults for reducing the occurrence of short-term, mild POCD are uncertain due to the low quality of the evidence. There is uncertainty as to whether active cerebral NIRS monitoring has an important effect on postoperative stroke, delirium or death because of the low number of events and wide confidence intervals. The conclusions of this review may change when the eight ongoing studies are published and the 12 studies awaiting assessment are classified. More RCTs performed in the paediatric population and high-risk patients undergoing non-cardiac surgery (e.g. neurosurgery, carotid endarterectomy and other surgery) are needed.
[Mh] Termos MeSH primário: Encéfalo/metabolismo
Hipóxia-Isquemia Encefálica/diagnóstico
Consumo de Oxigênio/fisiologia
Espectroscopia de Luz Próxima ao Infravermelho
[Mh] Termos MeSH secundário: Abdome/cirurgia
Adulto
Artroplastia de Quadril
Artroplastia do Joelho
Criança
Transtornos Cognitivos/prevenção & controle
Seres Humanos
Vértebras Lombares/cirurgia
Monitorização Intraoperatória
Complicações Pós-Operatórias/prevenção & controle
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180118
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD010947.pub2


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Registro de Ensaios Clínicos
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[PMID]:29466159
[Au] Autor:Anderson DR; Dunbar M; Murnaghan J; Kahn SR; Gross P; Forsythe M; Pelet S; Fisher W; Belzile E; Dolan S; Crowther M; Bohm E; MacDonald SJ; Gofton W; Kim P; Zukor D; Pleasance S; Andreou P; Doucette S; Theriault C; Abianui A; Carrier M; Kovacs MJ; Rodger MA; Coyle D; Wells PS; Vendittoli PA
[Ad] Endereço:From the Departments of Medicine (D.R.A.), Surgery (M.D.), and Community Health and Epidemiology (P.A.), Dalhousie University, and the Nova Scotia Health Authority (S. Pleasance, S. Doucette, C.T., A.A.), Halifax, the Department of Surgery, University of Toronto, Toronto (J.M.), the Departments of M
[Ti] Título:Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty.
[So] Source:N Engl J Med;378(8):699-707, 2018 02 22.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Clinical trials and meta-analyses have suggested that aspirin may be effective for the prevention of venous thromboembolism (proximal deep-vein thrombosis or pulmonary embolism) after total hip or total knee arthroplasty, but comparisons with direct oral anticoagulants are lacking for prophylaxis beyond hospital discharge. METHODS: We performed a multicenter, double-blind, randomized, controlled trial involving patients who were undergoing total hip or knee arthroplasty. All the patients received once-daily oral rivaroxaban (10 mg) until postoperative day 5 and then were randomly assigned to continue rivaroxaban or switch to aspirin (81 mg daily) for an additional 9 days after total knee arthroplasty or for 30 days after total hip arthroplasty. Patients were followed for 90 days for symptomatic venous thromboembolism (the primary effectiveness outcome) and bleeding complications, including major or clinically relevant nonmajor bleeding (the primary safety outcome). RESULTS: A total of 3424 patients (1804 undergoing total hip arthroplasty and 1620 undergoing total knee arthroplasty) were enrolled in the trial. Venous thromboembolism occurred in 11 of 1707 patients (0.64%) in the aspirin group and in 12 of 1717 patients (0.70%) in the rivaroxaban group (difference, 0.06 percentage points; 95% confidence interval [CI], -0.55 to 0.66; P<0.001 for noninferiority and P=0.84 for superiority). Major bleeding complications occurred in 8 patients (0.47%) in the aspirin group and in 5 (0.29%) in the rivaroxaban group (difference, 0.18 percentage points; 95% CI, -0.65 to 0.29; P=0.42). Clinically important bleeding occurred in 22 patients (1.29%) in the aspirin group and in 17 (0.99%) in the rivaroxaban group (difference, 0.30 percentage points; 95% CI, -1.07 to 0.47; P=0.43). CONCLUSIONS: Among patients who received 5 days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT01720108 .).
[Mh] Termos MeSH primário: Artroplastia de Quadril
Artroplastia do Joelho
Aspirina/uso terapêutico
Inibidores do Fator Xa/uso terapêutico
Inibidores da Agregação de Plaquetas/uso terapêutico
Complicações Pós-Operatórias/prevenção & controle
Rivaroxabana/uso terapêutico
Tromboembolia Venosa/prevenção & controle
[Mh] Termos MeSH secundário: Idoso
Aspirina/efeitos adversos
Método Duplo-Cego
Inibidores do Fator Xa/efeitos adversos
Hemorragia/induzido quimicamente
Seres Humanos
Masculino
Meia-Idade
Inibidores da Agregação de Plaquetas/efeitos adversos
Fatores de Risco
Rivaroxabana/efeitos adversos
[Pt] Tipo de publicação:EQUIVALENCE TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Factor Xa Inhibitors); 0 (Platelet Aggregation Inhibitors); 9NDF7JZ4M3 (Rivaroxaban); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1712746


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[PMID]:29390376
[Au] Autor:Han SB; Kyung HS; Seo IW; Shin YS
[Ad] Endereço:Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul.
[Ti] Título:Better clinical outcomes after unicompartmental knee arthroplasty when comparing with high tibial osteotomy.
[So] Source:Medicine (Baltimore);96(50):e9268, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are well-established treatments for medial knee osteoarthritis (OA). However, it is unclear whether HTO or UKA leads to better clinical outcomes and lower complication rates. This meta-analysis compared the clinical outcomes and complications of HTO and UKA in patients with medial knee OA. METHODS: All studies comparing the functional outcome, postoperative pain, revision rate to total knee arthroplasty (TKA), postoperative complications, postoperative velocity, and postoperative range of motion (ROM) as assessed with various measurement tools in patients with medial knee OA treated with HTO or UKA were included. RESULTS: Sixteen studies were included in the meta-analysis. The proportion of patients who underwent revision to TKA (OR 1.56, 95% CI: 0.61-3.98; P = .35) did not differ significantly between HTO and UKA. In contrast, functional outcome (OR 0.47, 95% CI: 0.24 to 0.95; P = .04), postoperative pain (OR 0.28, 95% CI: 0.12 to 0.62; P = .002), postoperative complications (OR 2.48, 95% CI: 1.26 to 4.90; P = .009), postoperative velocity (95% CI: -0.11 to -0.00; P = .03), and postoperative ROM (95% CI: 2.02 to 15.23; P = .01) were significantly different between the 2 groups. CONCLUSIONS: There were no significant differences in the revision rate to TKA between HTO and UKA. However, results from subgroup analyses suggested that opening-wedge HTO resulted in a lower revision rate to TKA than did UKA, whereas closing-wedge HTO resulted in a higher revision rate to TKA than did UKA. In addition, UKA resulted in significantly better functional outcomes and postoperative velocity, along with less postoperative pain, fewer postoperative complications, and lower postoperative ROM. Based on the findings of current meta-analysis, UKA appears to be as efficacious and safe as HTO in the treatment of medial knee OA.
[Mh] Termos MeSH primário: Artroplastia do Joelho/métodos
Osteoartrite do Joelho/cirurgia
Osteotomia/métodos
Tíbia/cirurgia
[Mh] Termos MeSH secundário: Seres Humanos
Amplitude de Movimento Articular
Reoperação
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009268


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[PMID]:29466152
[Au] Autor:Garcia D
[Ad] Endereço:From the Department of Medicine, University of Washington, Seattle.
[Ti] Título:Hybrid Strategy to Prevent Venous Thromboembolism after Joint Arthroplasty.
[So] Source:N Engl J Med;378(8):762-763, 2018 02 22.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Artroplastia do Joelho
Tromboembolia Venosa
[Mh] Termos MeSH secundário: Anticoagulantes
Artroplastia de Quadril
Seres Humanos
Complicações Pós-Operatórias
Trombose Venosa
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Nm] Nome de substância:
0 (Anticoagulants)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMe1716534


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[PMID]:28462424
[Au] Autor:Marra MA; Andersen MS; Damsgaard M; Koopman BFJM; Janssen D; Verdonschot N
[Ad] Endereço:Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, P. O. Box 9101, Nijmegen 6500 HB, The Netherlands e-mail: Marco.Marra@radboudumc.nl.
[Ti] Título:Evaluation of a Surrogate Contact Model in Force-Dependent Kinematic Simulations of Total Knee Replacement.
[So] Source:J Biomech Eng;139(8), 2017 Aug 01.
[Is] ISSN:1528-8951
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Knowing the forces in the human body is of great clinical interest and musculoskeletal (MS) models are the most commonly used tool to estimate them in vivo. Unfortunately, the process of computing muscle, joint contact, and ligament forces simultaneously is computationally highly demanding. The goal of this study was to develop a fast surrogate model of the tibiofemoral (TF) contact in a total knee replacement (TKR) model and apply it to force-dependent kinematic (FDK) simulations of activities of daily living (ADLs). Multiple domains were populated with sample points from the reference TKR contact model, based on reference simulations and design-of-experiments. Artificial neural networks (ANN) learned the relationship between TF pose and loads from the medial and lateral sides of the TKR implant. Normal and right-turn gait, rising-from-a-chair, and a squat were simulated using both surrogate and reference contact models. Compared to the reference contact model, the surrogate contact model predicted TF forces with a root-mean-square error (RMSE) lower than 10 N and TF moments lower than 0.3 N·m over all simulated activities. Secondary knee kinematics were predicted with RMSE lower than 0.2 mm and 0.2 deg. Simulations that used the surrogate contact model ran on average three times faster than those using the reference model, allowing the simulation of a full gait cycle in 4.5 min. This modeling approach proved fast and accurate enough to perform extensive parametric analyses, such as simulating subject-specific variations and surgical-related factors in TKR.
[Mh] Termos MeSH primário: Artroplastia do Joelho
Fenômenos Mecânicos
Modelos Biológicos
[Mh] Termos MeSH secundário: Atividades Cotidianas
Fenômenos Biomecânicos
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1115/1.4036605


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[PMID]:29254318
[Au] Autor:Vicenti G; Pesce V; Bizzoca D; Nappi V; Palmiotto F; Carrozzo M; Moretti B
[Ad] Endereço:School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy.
[Ti] Título:Perioperative plasmatic presepsin levels in patients undergoing total hip or knee replacement: a preliminary study.
[So] Source:J Biol Regul Homeost Agents;31(4):1081-1086, 2017 Oct-Dec.
[Is] ISSN:0393-974X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:Presepsin (sCD14-ST) is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in the diagnosis and management of periprosthetic joint infections (PJI). The aim of this study is to define the normal perioperative plasmatic levels of presepsin in patients undergoing primary cementless total hip replacement (THR) or primary cemented total knee replacement (TKR). For this purpose, 50 patients (19 male, 31 female, mean age= 64.04±8.88) were recruited. The patients were divided into two groups: Group A patients underwent cementless THR, whereas Group B patients underwent cemented TKR. On recruitment, anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score (HHS) for Group A patients and Knee Society Score (KSS) for Group B patients, drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS), C-reactive protein (CRP) and procalcitonin (PCT) 24 hours before arthroplasty (T0) and at 24 (T1), 48 (T2), 72 (T3) and 96 (T4) hours postoperatively. Body temperature (θ) was recorded every six hours in the time lapse T0-T4. Presepsin plasmatic concentration was comparable at baseline in both groups. After surgery, however, a significant increase of presepsin was observed in Group A, whereas in Group B no significant changes of presepsin were recorded. A comparable trend of this biomarker was found in the two groups, i.e. presepsin increased from T0 to T3, when it reached its maximum value, and its decrease started at T4. Finally, presepsin resulted more accurate than CRP in the evaluation of perioperative inflammatory response in patients undergoing THR or TKR. These data will be helpful in defining a reference interval for presepsin in patients with prosthetic joint implants, and a cut-off of this biomarker for the diagnosis of PJI.
[Mh] Termos MeSH primário: Artroplastia de Quadril
Artroplastia do Joelho
Receptores de Lipopolissacarídeos/sangue
Osteoartrite do Quadril/sangue
Osteoartrite do Joelho/sangue
Fragmentos de Peptídeos/sangue
Sepse/sangue
[Mh] Termos MeSH secundário: Idoso
Biomarcadores/sangue
Proteína C-Reativa/metabolismo
Calcitonina/sangue
Feminino
Seres Humanos
Masculino
Meia-Idade
Osteoartrite do Quadril/complicações
Osteoartrite do Quadril/diagnóstico
Osteoartrite do Quadril/cirurgia
Osteoartrite do Joelho/complicações
Osteoartrite do Joelho/diagnóstico
Osteoartrite do Joelho/cirurgia
Período Perioperatório
Dados Preliminares
Sepse/complicações
Sepse/diagnóstico
Sepse/cirurgia
Índice de Gravidade de Doença
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Lipopolysaccharide Receptors); 0 (Peptide Fragments); 0 (presepsin protein, human); 9007-12-9 (Calcitonin); 9007-41-4 (C-Reactive Protein)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE


  9 / 18195 MEDLINE  
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[PMID]:29390496
[Au] Autor:Lu K; Xu M; Li W; Wang K; Wang D
[Ad] Endereço:Department of Joint Surgery, Liaocheng Clinical College of Taishan Medical University.
[Ti] Título:A study on dynamic monitoring, components, and risk factors of embolism during total knee arthroplasty.
[So] Source:Medicine (Baltimore);96(51):e9303, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Fat embolism is a common complication of orthopedic surgery. However, the exact component and risk factor responsible for this complication remains unelucidated. This study aimed to detect the origin of the pulmonary embolus and identify relevant risk factors of pulmonary embolism in total knee replacement. METHODS: A total of 40 osteoarthritis patients who underwent primary unilateral TKA were recruited into this study. Transesophageal echocardiography (TEE) was utilized to dynamically monitor the embolism. Pulmonary arterial pressure was recorded and biopsies were obtained from the medullary cavity during surgery. RESULTS: After tourniquet release, the arterial embolism was observed by TEE to have a peak signal at 30 seconds when pulmonary arterial pressure was increased by 25% to 40% (P = .002). The pathology study of the embolism revealed its bone marrow origin. Total embolus quantity was positively correlated with age (P = .021), body mass index (BMI, P = .041), and fat content of the bone marrow (P = .003). Logistic regression analysis revealed that the fat content of the marrow (OR: 1.432, 95% CI: 1.335-1.592), age (OR: 1.632, 95% CI: 1.445-1.832), and BMI (OR: 1.231, 95% CI: 1.032-1.381) were risk factors for pulmonary hypertension. CONCLUSION: This study revealed that the embolus detected in the right atrium was derived from bone marrow tissues, and this led to pulmonary arterial pressure fluctuations after tourniquet release. Therefore, elderly patients who have high BMI or bone marrow fat content are at high-risk for pulmonary fat embolism during TKA.
[Mh] Termos MeSH primário: Artroplastia do Joelho/efeitos adversos
Embolia Gordurosa/diagnóstico por imagem
Átrios do Coração/diagnóstico por imagem
Monitorização Intraoperatória
[Mh] Termos MeSH secundário: Tecido Adiposo/patologia
Fatores Etários
Pressão Sanguínea
Índice de Massa Corporal
Medula Óssea/patologia
Ecocardiografia Transesofagiana
Embolia Gordurosa/etiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Osteoartrite do Joelho/cirurgia
Complicações Pós-Operatórias
Fatores de Risco
Torniquetes
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009303


  10 / 18195 MEDLINE  
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[PMID]:29381914
[Au] Autor:Wang Z; Zheng J; Zhao Y; Xiang Y; Chen X; Zhao F; Jin Y
[Ad] Endereço:Department of Orthopaedics, Henan Provincial People's Hospital.
[Ti] Título:Preoperative bathing with chlorhexidine reduces the incidence of surgical site infections after total knee arthroplasty: A meta-analysis.
[So] Source:Medicine (Baltimore);96(47):e8321, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Surgical site infection is a devastating postoperative complication, and the occurrence ranges from 1% to 2% after total knee arthroplasty (TKA). The efficacy of the preoperative use of chlorhexidine for reducing infection has been debated. This meta-analysis aimed to examine the efficacy of the use of chlorhexidine to prevent surgical site infections after TKA. METHODS: In February 2017, a systematic literature review was conducted using the following electronic databases: PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and the Google database. Data from randomized controlled trials (RCTs) and retrospective comparative study (RCS) that compared the use of chlorhexidine versus control washes to prep patients for TKA were retrieved. The primary endpoint was to compare the total incidence of infection with and without the use of chlorhexidine. The secondary outcomes were the incidence of infection in low-risk category patients, moderate-risk category patients, and high-risk category patients. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects modeling when necessary. RESULTS: Four clinical trials that included 8787 patients (chlorhexidine group: n = 2615, control group: n = 6172) were ultimately included in the meta-analysis. Chlorhexidine was associated with a reduced total incidence of infection, corresponding to a reduction of 1.69% [risk ratio (RR) = 0.22; 95% confidence interval (95% CI) = 0.12-0.40; P = .000]. Similarly, chlorhexidine was associated with a reduction in the incidence of infection among patients in the moderate-risk category (RR, 0.18; 95% CI, 0.05-0.63; P = .007) and the high-risk category (RR, 0.13; 95% CI, 0.03-0.67; P = .014). There was no significant difference between the incidence of infection in low-risk category patients with chlorhexidine use compared with the use of control washes (RR, 0.60; 95% CI, 0.22-1.60; P = .330). CONCLUSION: The preoperative use of chlorhexidine could reduce the total incidence of infection and the incidence of infection in moderate-risk and high-risk category patients. The overall evidence and the number of included studies was limited; thus, a greater number of high-quality RCTs is still needed to further identify the effects of chlorhexidine on reducing the incidence of infection after TKA.
[Mh] Termos MeSH primário: Anti-Infecciosos Locais/administração & dosagem
Artroplastia do Joelho/métodos
Banhos/métodos
Clorexidina/administração & dosagem
Infecção da Ferida Cirúrgica/prevenção & controle
[Mh] Termos MeSH secundário: Seres Humanos
Cuidados Pré-Operatórios
Estudos Retrospectivos
Fatores de Risco
Autocuidado
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (Anti-Infective Agents, Local); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008321



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