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[PMID]:28455405
[Au] Autor:Li Kam Wa ME; Taraborrelli P; Hayat S; Lim PB
[Ad] Endereço:Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK.
[Ti] Título:Respiration driven excessive sinus tachycardia treated with clonidine.
[So] Source:BMJ Case Rep;2017, 2017 Apr 28.
[Is] ISSN:1757-790X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:A 26-year-old man presented to our syncope service with debilitating daily palpitations, shortness of breath, presyncope and syncope following a severe viral respiratory illness 4 years previously. Mobitz type II block had previously been identified, leading to a permanent pacemaker and no further episodes of frank syncope. Transthoracic echocardiography, electophysiological study and repeated urine metanepherines were normal. His palpitations and presyncope were reproducible on deep inspiration, coughing, isometric hand exercise and passive leg raises. We demonstrated rapid increases in heart rate with no change in morphology on his 12 lead ECG. His symptoms were resistant to fludrocortisone, flecainide, ß blockers and ivabradine. Initiation of clonidine in combination with ivabradine led to rapid resolution of his symptoms. We suggest that an excessive respiratory sinus arrhythmia was responsible for his symptoms and achieved an excellent response with the centrally acting sympatholytic clonidine, where previous peripherally acting treatments had failed.
[Mh] Termos MeSH primário: Inalação/fisiologia
Síncope/fisiopatologia
Taquicardia Sinusal/complicações
[Mh] Termos MeSH secundário: Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico
Adulto
Benzazepinas/administração & dosagem
Benzazepinas/uso terapêutico
Fármacos Cardiovasculares/administração & dosagem
Fármacos Cardiovasculares/uso terapêutico
Clonidina/administração & dosagem
Clonidina/uso terapêutico
Tosse/complicações
Tosse/etiologia
Quimioterapia Combinada/métodos
Dispneia/diagnóstico
Dispneia/etiologia
Ecocardiografia/métodos
Eletrocardiografia/métodos
Seres Humanos
Masculino
Síncope/etiologia
Taquicardia/etiologia
Taquicardia/fisiopatologia
Taquicardia Sinusal/diagnóstico por imagem
Taquicardia Sinusal/tratamento farmacológico
Taquicardia Sinusal/fisiopatologia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenergic alpha-2 Receptor Agonists); 0 (Benzazepines); 0 (Cardiovascular Agents); 3H48L0LPZQ (ivabradine); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:29329328
[Au] Autor:Baille G; Perez T; Devos D; Deken V; Defebvre L; Moreau C
[Ad] Endereço:Department of Neurology and Movement Disorders, Lille University Medical Center, Lille, France.
[Ti] Título:Early occurrence of inspiratory muscle weakness in Parkinson's disease.
[So] Source:PLoS One;13(1):e0190400, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: In Parkinson's disease (PD), respiratory insufficiency (including functional and muscle disorders) can impact dysarthria and swallowing. Most studies of this topic have been performed retrospectively in populations of patients with advanced PD. The objective of the present study was to characterize lung function (under off-drug conditions) in early-stage PD patients at baseline and then again two years later. METHODS: Forty-one early-stage PD patients (mean ± SD age: 61.7 ± 7.7; mean ± SD disease duration: 1.9 ± 1.7 years) were prospectively enrolled and compared with 36 age-matched healthy controls. Neurological evaluations and pulmonary function testing were performed in the off-drug condition at the inclusion visit and then two years later. RESULTS: Pulmonary function testing did not reveal any restrictive or obstructive disorders; at baseline, inspiratory muscle weakness was the only abnormality observed in the PD group (in 53.7% of the patients, vs. 25% in controls; p = 0.0105). The PD patients had a lower mean maximal inspiratory mouth pressure than controls and a lower sniff nasal inspiratory pressure. Two years after the initiation of chronic treatment with antiparkinsonian medications, the maximal inspiratory mouth pressure and the sniff nasal inspiratory pressure tended to be higher. Lastly, overall motor outcomes were not significantly worse in patients with inspiratory muscle weakness than in patients without inspiratory muscle weakness. CONCLUSION: Inspiratory muscle weakness seems to be common in patients with early-stage PD, and was seen to be stable over a two-year period. Additional long-term follow-up studies are required to specify the impact of this new feature of PD.
[Mh] Termos MeSH primário: Debilidade Muscular/fisiopatologia
Doença de Parkinson/fisiopatologia
Músculos Respiratórios/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Inalação
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180113
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190400


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[PMID]:29267988
[Au] Autor:Rietberg MB; Veerbeek JM; Gosselink R; Kwakkel G; van Wegen EE
[Ad] Endereço:Department of Rehabilitation Medicine, Amsterdan Movement Sciences, MS Center Amsterdam, VU University Medical Center, De Boelelaan 1118, Amsterdam, Netherlands, 1007 MB.
[Ti] Título:Respiratory muscle training for multiple sclerosis.
[So] Source:Cochrane Database Syst Rev;12:CD009424, 2017 Dec 21.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Multiple sclerosis (MS) is a chronic disease of the central nervous system, affecting approximately 2.5 million people worldwide. People with MS may experience limitations in muscular strength and endurance - including the respiratory muscles, affecting functional performance and exercise capacity. Respiratory muscle weakness can also lead to diminished performance on coughing, which may result in (aspiration) pneumonia or even acute ventilatory failure, complications that frequently cause death in MS. Training of the respiratory muscles might improve respiratory function and cough efficacy. OBJECTIVES: To assess the effects of respiratory muscle training versus any other type of training or no training for respiratory muscle function, pulmonary function and clinical outcomes in people with MS. SEARCH METHODS: We searched the Trials Register of the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group (3 February 2017), which contains trials from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, LILACS and the trial registry databases ClinicalTrials.gov and WHO International Clinical Trials Registry Platform. Two authors independently screened records yielded by the search, handsearched reference lists of review articles and primary studies, checked trial registers for protocols, and contacted experts in the field to identify further published or unpublished trials. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that investigated the efficacy of respiratory muscle training versus any control in people with MS. DATA COLLECTION AND ANALYSIS: One reviewer extracted study characteristics and study data from included RCTs, and two other reviewers independently cross-checked all extracted data. Two review authors independently assessed risk of bias with the Cochrane 'Risk of bias' assessment tool. When at least two RCTs provided data for the same type of outcome, we performed meta-analyses. We assessed the certainty of the evidence according to the GRADE approach. MAIN RESULTS: We included six RCTs, comprising 195 participants with MS. Two RCTs investigated inspiratory muscle training with a threshold device; three RCTs, expiratory muscle training with a threshold device; and one RCT, regular breathing exercises. Eighteen participants (˜ 10%) dropped out; trials reported no serious adverse events.We pooled and analyzed data of 5 trials (N=137) for both inspiratory and expiratory muscle training, using a fixed-effect model for all but one outcome. Compared to no active control, meta-analysis showed that inspiratory muscle training resulted in no significant difference in maximal inspiratory pressure (mean difference (MD) 6.50 cmH O, 95% confidence interval (CI) -7.39 to 20.38, P = 0.36, I = 0%) or maximal expiratory pressure (MD -8.22 cmH O, 95% CI -26.20 to 9.77, P = 0.37, I = 0%), but there was a significant benefit on the predicted maximal inspiratory pressure (MD 20.92 cmH O, 95% CI 6.03 to 35.81, P = 0.006, I = 18%). Meta-analysis with a random-effects model failed to show a significant difference in predicted maximal expiratory pressure (MD 5.86 cmH O, 95% CI -10.63 to 22.35, P = 0.49, I = 55%). These studies did not report outcomes for health-related quality of life.Three RCTS compared expiratory muscle training versus no active control or sham training. Under a fixed-effect model, meta-analysis failed to show a significant difference between groups with regard to maximal expiratory pressure (MD 8.33 cmH O, 95% CI -0.93 to 17.59, P = 0.18, I = 42%) or maximal inspiratory pressure (MD 3.54 cmH O, 95% CI -5.04 to 12.12, P = 0.42, I = 41%). One trial assessed quality of life, finding no differences between groups.For all predetermined secondary outcomes, such as forced expiratory volume, forced vital capacity and peak flow pooling was not possible. However, two trials on inspiratory muscle training assessed fatigue using the Fatigue Severity Scale (range of scores 0-56 ), finding no difference between groups (MD, -0.28 points, 95% CI-0.95 to 0.39, P = 0.42, I = 0%). Due to the low number of studies included, we could not perform cumulative meta-analysis or subgroup analyses. It was not possible to perform a meta-analysis for adverse events, no serious adverse were mentioned in any of the included trials.The quality of evidence was low for all outcomes because of limitations in design and implementation as well as imprecision of results. AUTHORS' CONCLUSIONS: This review provides low-quality evidence that resistive inspiratory muscle training with a resistive threshold device is moderately effective postintervention for improving predicted maximal inspiratory pressure in people with mild to moderate MS, whereas expiratory muscle training showed no significant effects. The sustainability of the favourable effect of inspiratory muscle training is unclear, as is the impact of the observed effects on quality of life.
[Mh] Termos MeSH primário: Exercícios Respiratórios/métodos
Esclerose Múltipla/complicações
[Mh] Termos MeSH secundário: Tosse/fisiopatologia
Expiração/fisiologia
Seres Humanos
Inalação/fisiologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Músculos Respiratórios
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD009424.pub2


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[PMID]:27773445
[Au] Autor:Lens E; Gurney-Champion OJ; Tekelenburg DR; van Kesteren Z; Parkes MJ; van Tienhoven G; Nederveen AJ; van der Horst A; Bel A
[Ad] Endereço:Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, The Netherlands. Electronic address: e.lens@amc.uva.nl.
[Ti] Título:Abdominal organ motion during inhalation and exhalation breath-holds: pancreatic motion at different lung volumes compared.
[So] Source:Radiother Oncol;121(2):268-275, 2016 11.
[Is] ISSN:1879-0887
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Contrary to what is commonly assumed, organs continue to move during breath-holding. We investigated the influence of lung volume on motion magnitude during breath-holding and changes in velocity over the duration of breath-holding. MATERIALS AND METHODS: Sixteen healthy subjects performed 60-second inhalation breath-holds in room-air, with lung volumes of ∼100% and ∼70% of the inspiratory capacity, and exhalation breath-holds, with lung volumes of ∼30% and ∼0% of the inspiratory capacity. During breath-holding, we obtained dynamic single-slice magnetic-resonance images with a time-resolution of 0.6s. We used 2-dimensional image correlation to obtain the diaphragmatic and pancreatic velocity and displacement during breath-holding. RESULTS: Organ velocity was largest in the inferior-superior direction and was greatest during the first 10s of breath-holding, with diaphragm velocities of 0.41mm/s, 0.29mm/s, 0.16mm/s and 0.15mm/s during BH , BH , BH and BH , respectively. Organ motion magnitudes were larger during inhalation breath-holds (diaphragm moved 9.8 and 9.0mm during BH and BH , respectively) than during exhalation breath-holds (5.6 and 4.3mm during BH and BH , respectively). CONCLUSION: Using exhalation breath-holds rather than inhalation breath-holds and delaying irradiation until after the first 10s of breath-holding may be advantageous for irradiation of abdominal tumors.
[Mh] Termos MeSH primário: Suspensão da Respiração
Inalação/fisiologia
Pulmão/fisiologia
Movimento/fisiologia
Pâncreas/fisiologia
[Mh] Termos MeSH secundário: Adulto
Diafragma/diagnóstico por imagem
Diafragma/fisiologia
Expiração/fisiologia
Feminino
Seres Humanos
Pulmão/diagnóstico por imagem
Medidas de Volume Pulmonar/métodos
Imagem por Ressonância Magnética/métodos
Masculino
Pâncreas/diagnóstico por imagem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180119
[Lr] Data última revisão:
180119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29254775
[Au] Autor:Poulsen PR; Eley J; Langner U; Simone CB; Langen K
[Ad] Endereço:Department of Oncology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: per.poulsen@rm.dk.
[Ti] Título:Efficient Interplay Effect Mitigation for Proton Pencil Beam Scanning by Spot-Adapted Layered Repainting Evenly Spread out Over the Full Breathing Cycle.
[So] Source:Int J Radiat Oncol Biol Phys;100(1):226-234, 2018 Jan 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To develop and implement a practical repainting method for efficient interplay effect mitigation in proton pencil beam scanning (PBS). METHODS AND MATERIALS: A new flexible repainting scheme with spot-adapted numbers of repainting evenly spread out over the whole breathing cycle (assumed to be 4 seconds) was developed. Twelve fields from 5 thoracic and upper abdominal PBS plans were delivered 3 times using the new repainting scheme to an ion chamber array on a motion stage. One time was static and 2 used 4-second, 3-cm peak-to-peak sinusoidal motion with delivery started at maximum inhalation and maximum exhalation. For comparison, all dose measurements were repeated with no repainting and with 8 repaintings. For each motion experiment, the 3%/3-mm gamma pass rate was calculated using the motion-convolved static dose as the reference. Simulations were first validated with the experiments and then used to extend the study to 0- to 5-cm motion magnitude, 2- to 6-second motion periods, patient-measured liver tumor motion, and 1- to 6-fraction treatments. The effect of the proposed method was evaluated for the 5 clinical cases using 4-dimensional (4D) dose reconstruction in the planning 4D computed tomography scan. The target homogeneity index, HI = (D - D )/D , of a single-fraction delivery is reported, where D and D is the dose delivered to 2% and 98% of the target, respectively, and D is the mean dose. RESULTS: The gamma pass rates were 59.6% ± 9.7% with no repainting, 76.5% ± 10.8% with 8 repaintings, and 92.4% ± 3.8% with the new repainting scheme. Simulations reproduced the experimental gamma pass rates with a 1.3% root-mean-square error and demonstrated largely improved gamma pass rates with the new repainting scheme for all investigated motion scenarios. One- and two-fraction deliveries with the new repainting scheme had gamma pass rates similar to those of 3-4 and 6-fraction deliveries with 8 repaintings. The mean HI for the 5 clinical cases was 14.2% with no repainting, 13.7% with 8 repaintings, 12.0% with the new repainting scheme, and 11.6% for the 4D dose without interplay effects. CONCLUSIONS: A novel repainting strategy for efficient interplay effect mitigation was proposed, implemented, and shown to outperform conventional repainting in experiments, simulations, and dose reconstructions. This strategy could allow for safe and more optimal clinical delivery of thoracic and abdominal proton PBS and better facilitate hypofractionated and stereotactic treatments.
[Mh] Termos MeSH primário: Neoplasias/radioterapia
Movimentos dos Órgãos
Terapia com Prótons/métodos
Respiração
[Mh] Termos MeSH secundário: Neoplasias Brônquicas/radioterapia
Carcinoma Pulmonar de Células não Pequenas/radioterapia
Carcinoma de Células Renais/radioterapia
Expiração
Tomografia Computadorizada Quadridimensional/métodos
Seres Humanos
Inalação
Neoplasias Renais/radioterapia
Neoplasias Hepáticas/radioterapia
Neoplasias Pulmonares/radioterapia
Neoplasias Pancreáticas/radioterapia
Planejamento da Radioterapia Assistida por Computador/métodos
Software
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE


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[PMID]:28922226
[Au] Autor:Larsen MHH; Ekeloef S; Kokotovic D; Schou-Pedersen AM; Lykkesfeldt J; Gögenür I
[Ad] Endereço:From the *Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege, Denmark; and †Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
[Ti] Título:Effect of High Inspiratory Oxygen Fraction on Endothelial Function in Healthy Volunteers: A Randomized Controlled Crossover Pilot Study.
[So] Source:Anesth Analg;125(5):1793-1796, 2017 Nov.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:It has been suggested that high inspiratory oxygen concentrations during anesthesia may be associated with higher postoperative mortality due to endothelial dysfunction. A randomized controlled crossover study was conducted with 25 healthy male volunteers. They inhaled an oxygen concentration of 30% and 80%. The endothelial function was assessed using noninvasive digital pulse amplitude tonometry (EndoPAT) supported by endothelial biomarkers. The difference in endothelial function between the 2 treatments was 0.05 (95% confidence interval, -0.36 to 0.27; P = .77). Endothelial biomarkers were unaffected. Inhalation of a high oxygen fraction in healthy volunteers did not result in a significant reduction of endothelial function.
[Mh] Termos MeSH primário: Endotélio Vascular/efeitos dos fármacos
Antebraço/irrigação sanguínea
Inalação
Oxigenoterapia
Oxigênio/administração & dosagem
Vasodilatação/efeitos dos fármacos
[Mh] Termos MeSH secundário: Administração por Inalação
Adolescente
Adulto
Biomarcadores/sangue
Estudos Cross-Over
Dinamarca
Endotélio Vascular/metabolismo
Endotélio Vascular/fisiopatologia
Voluntários Saudáveis
Seres Humanos
Hiperemia/fisiopatologia
Masculino
Manometria
Projetos Piloto
Valor Preditivo dos Testes
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Biomarkers); S88TT14065 (Oxygen)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170919
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002357


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[PMID]:28911510
[Au] Autor:Debaty G; Labarere J; Frascone RJ; Wayne MA; Swor RA; Mahoney BD; Domeier RM; Olinger ML; O'Neil BJ; Yannopoulos D; Aufderheide TP; Lurie KG
[Ad] Endereço:University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble, France; Department of Emergency Medicine, University Hospital of Grenoble Alps, Grenoble, France. Electronic address: gdebaty@gmail.com.
[Ti] Título:Long-Term Prognostic Value of Gasping During Out-of-Hospital Cardiac Arrest.
[So] Source:J Am Coll Cardiol;70(12):1467-1476, 2017 Sep 19.
[Is] ISSN:1558-3597
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Gasping is a natural reflex that enhances oxygenation and circulation during cardiopulmonary resuscitation (CPR). OBJECTIVES: This study sought to assess the relationship between gasping during out-of-hospital cardiac arrest and 1-year survival with favorable neurological outcomes. METHODS: The authors prospectively collected incidence of gasping on all evaluable subjects in a multicenter, randomized, controlled, National Institutes of Health-funded out-of-hospital cardiac arrest clinical trial from August 2007 to July 2009. The association between gasping and 1-year survival with favorable neurological function, defined as a Cerebral Performance Category (CPC) score ≤2 was estimated using multivariable logistic regression. RESULTS: The rates of 1-year survival with a CPC score of ≤2 were 5.4% (98 of 1,827) overall, and 20% (36 of 177) and 3.7% (61 of 1,643) for individuals with and without spontaneous gasping or agonal respiration during CPR, respectively. In multivariable analysis, 1-year survival with CPC ≤2 was independently associated with younger age (odds ratio [OR] for 1 SD increment 0.57; 95% confidence interval [CI]: 0.43 to 0.76), gasping during CPR (OR: 3.94; 95% CI: 2.09 to 7.44), shockable initial recorded rhythm (OR: 16.50; 95% CI: 7.40 to 36.81), shorter CPR duration (OR: 0.31; 95% CI: 0.19 to 0.51), lower epinephrine dosage (OR: 0.47; 95% CI: 0.25 to 0.87), and pulmonary edema (OR: 3.41; 95% CI: 1.53 to 7.60). Gasping combined with a shockable initial recorded rhythm had a 57-fold higher OR (95% CI: 23.49 to 136.92) of 1-year survival with CPC ≤2 versus no gasping and no shockable rhythm. CONCLUSIONS: Gasping during CPR was independently associated with increased 1-year survival with CPC ≤2, regardless of the first recorded rhythm. These findings underscore the importance of not terminating resuscitation prematurely in gasping patients and the need to routinely recognize, monitor, and record data on gasping in all future cardiac arrest trials and registries.
[Mh] Termos MeSH primário: Inalação
Parada Cardíaca Extra-Hospitalar/mortalidade
Parada Cardíaca Extra-Hospitalar/fisiopatologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Parada Cardíaca Extra-Hospitalar/complicações
Prognóstico
Estudos Prospectivos
Taxa de Sobrevida
Taquicardia Ventricular/complicações
Fatores de Tempo
Fibrilação Ventricular/complicações
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE


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[PMID]:28857907
[Au] Autor:Jozwiak M; Depret F; Teboul JL; Alphonsine JE; Lai C; Richard C; Monnet X
[Ad] Endereço:1Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, Le Kremlin-Bicêtre, France. 2Inserm UMR S_999, Univ Paris-Sud, Le Kremlin-Bicêtre, France.
[Ti] Título:Predicting Fluid Responsiveness in Critically Ill Patients by Using Combined End-Expiratory and End-Inspiratory Occlusions With Echocardiography.
[So] Source:Crit Care Med;45(11):e1131-e1138, 2017 Nov.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: First, we aimed at assessing whether fluid responsiveness is predicted by the effects of an end-expiratory occlusion on the velocity-time integral of the left ventricular outflow tract. Second, we investigated whether adding the effects of an end-inspiratory occlusion and of an end-expiratory occlusion on velocity-time integral can predict fluid responsiveness with similar reliability than end-expiratory occlusion alone but with a higher threshold, which might be more compatible with the precision of echocardiography. DESIGN: Diagnostic study. SETTING: Medical ICU. PATIENTS: Thirty mechanically ventilated patients in whom fluid administration was planned. INTERVENTIONS: A 15-second end-expiratory occlusion and end-inspiratory occlusion, separated by 1 minute, followed by a 500-mL saline administration. MEASUREMENTS AND MAIN RESULTS: Pulse contour analysis-derived cardiac index and velocity-time integral were measured during the last 5 seconds of 15-second end-inspiratory occlusion and end-expiratory occlusion and after fluid administration. End-expiratory occlusion increased velocity-time integral more in responders than in nonresponders to fluid administration (11% ± 5% vs 3% ± 1%, respectively; p < 0.0001), and end-inspiratory occlusion decreased velocity-time integral more in responders than in nonresponders (12% ± 5% vs 5% ± 2%, respectively; p = 0.0002). When adding the absolute values of changes in velocity-time integral observed during both occlusions, velocity-time integral changed by 23% ± 9% in responders and by 8% ± 3% in nonresponders. Fluid responsiveness was predicted by the end-expiratory occlusion-induced change in velocity-time integral with an area under the receiver operating characteristic curve of 0.938 (0.785-0.989) and a threshold value of 5%. Fluid responsiveness was predicted by the sum of absolute values of changes in velocity-time integral during both occlusions with a similar reliability (area under the receiver operating characteristic curve = 0.973 [0.838-1.000]) but with a threshold of 13%. Both sensitivity and specificity were 93% (68-100%). CONCLUSIONS: If consecutive end-inspiratory occlusion and end-expiratory occlusion change velocity-time integral is greater than or equal to 13% in total, fluid responsiveness is accurately predicted. This threshold is more compatible with the precision of echocardiography than that obtained by end-expiratory occlusion alone.
[Mh] Termos MeSH primário: Ecocardiografia/métodos
Expiração/fisiologia
Hidratação/métodos
Inalação/fisiologia
Respiração Artificial/métodos
[Mh] Termos MeSH secundário: Idoso
Estado Terminal
Feminino
Hemodinâmica
Seres Humanos
Unidades de Terapia Intensiva
Masculino
Meia-Idade
Estudos Prospectivos
Reprodutibilidade dos Testes
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170901
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002704


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[PMID]:28784319
[Au] Autor:Moser JB; Mak SM; McNulty WH; Padley S; Nair A; Shah PL; Devaraj A
[Ad] Endereço:Department of Radiology, St George's Hospital NHS Foundation Trust, London, UK.
[Ti] Título:The influence of inspiratory effort and emphysema on pulmonary nodule volumetry reproducibility.
[So] Source:Clin Radiol;72(11):925-929, 2017 Nov.
[Is] ISSN:1365-229X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: To evaluate the impact of inspiratory effort and emphysema on reproducibility of pulmonary nodule volumetry. MATERIALS AND METHODS: Eighty-eight nodules in 24 patients with emphysema were studied retrospectively. All patients had undergone volumetric inspiratory and end-expiratory thoracic computed tomography (CT) for consideration of bronchoscopic lung volume reduction. Inspiratory and expiratory nodule volumes were measured using commercially available software. Local emphysema extent was established by analysing a segmentation area extended circumferentially around each nodule (quantified as percent of lung with density of -950 HU or less). Lung volumes were established using the same software. Differences in inspiratory and expiratory nodule volumes were illustrated using the Bland-Altman test. The influences of percentage reduction in lung volume at expiration, local emphysema extent, and nodule size on nodule volume variability were tested with multiple linear regression. RESULTS: The majority of nodules (59/88 [67%]) showed an increased volume at expiration. Mean difference in nodule volume between expiration and inspiration was +7.5% (95% confidence interval: -24.1, 39.1%). No relationships were demonstrated between nodule volume variability and emphysema extent, degree of expiration, or nodule size. CONCLUSION: Expiration causes a modest increase in volumetry-derived nodule volumes; however, the effect is unpredictable. Local emphysema extent had no significant effect on volume variability in the present cohort.
[Mh] Termos MeSH primário: Inalação/fisiologia
Nódulos Pulmonares Múltiplos/diagnóstico por imagem
Nódulos Pulmonares Múltiplos/patologia
Enfisema Pulmonar/patologia
Tomografia Computadorizada por Raios X
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Pulmão/diagnóstico por imagem
Pulmão/patologia
Masculino
Meia-Idade
Nódulos Pulmonares Múltiplos/complicações
Enfisema Pulmonar/complicações
Reprodutibilidade dos Testes
Testes de Função Respiratória
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170809
[St] Status:MEDLINE


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[PMID]:28693885
[Au] Autor:Rosenberg YJ; Mao L; Jiang X; Lees J; Zhang L; Radic Z; Taylor P
[Ad] Endereço:PlantVax Inc, Rockville, MD 20850, USA. Electronic address: yjr@plantvax.com.
[Ti] Título:Post-exposure treatment with the oxime RS194B rapidly reverses early and advanced symptoms in macaques exposed to sarin vapor.
[So] Source:Chem Biol Interact;274:50-57, 2017 Aug 25.
[Is] ISSN:1872-7786
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:Organophosphate (OP) nerve agents and pesticides trigger a common mechanism of neurotoxicity resulting from critical targeting and inhibition of acetylcholinesterases (AChE) in central and peripheral synapses in the cholinergic nervous system. Therapeutic countermeasures have thus focused on either administering an oxime post-exposure, that can rapidly reactivate OP-inhibited AChE, or by preventing OP poisoning through administering pre-exposure treatments that scavenge OPs before they inhibit their physiological AChE targets. While several pyridinium aldoxime antidotes are currently approved, their utility is impaired due to their inability to cross the blood-brain barrier (BBB) efficiently. The present study utilized a macaque (Ma) model to demonstrate the efficacy of a novel zwitterionic and centrally acting oxime RS194B to reactivate sarin- and paraoxon-inhibited macaque AChE and butyrylcholinesterase (BChE) in vitro and to further assess the capacity of RS194B to effect a reversal of clinical symptoms following sarin inhalation in vivo. In vitro, oxime reactivation of MaAChE and MaBChE was shown to be comparable to their human orthologs, while the macaque studies indicated that IM administration of 62.5 mg/kg of RS194B and 0.28 mg/kg atropine after continuous exposure to 49.6 µg/kg sarin vapor, rapidly reactivated the inhibited AChE and BChE in blood and reversed both early and advanced clinical symptoms of sarin-induced toxicity following pulmonary exposure within 1 h. The rapid cessation of autonomic and central symptoms, including convulsions, observed in macaques bodes well for the use of RS194B as an intra- or post-exposure human treatment and validates the macaque model in generating efficacy and toxicology data required for approval under the FDA Animal rule.
[Mh] Termos MeSH primário: Acetamidas/farmacologia
Reativadores da Colinesterase/farmacologia
Oximas/farmacologia
[Mh] Termos MeSH secundário: Acetamidas/administração & dosagem
Acetamidas/química
Acetilcolinesterase/sangue
Acetilcolinesterase/química
Acetilcolinesterase/genética
Acetilcolinesterase/metabolismo
Animais
Butirilcolinesterase/sangue
Butirilcolinesterase/química
Butirilcolinesterase/genética
Butirilcolinesterase/metabolismo
Substâncias para a Guerra Química/toxicidade
Reativadores da Colinesterase/administração & dosagem
Reativadores da Colinesterase/química
Gases/química
Inalação
Macaca/metabolismo
Modelos Animais
Oximas/administração & dosagem
Oximas/química
Paraoxon/toxicidade
Proteínas Recombinantes/biossíntese
Proteínas Recombinantes/química
Proteínas Recombinantes/isolamento & purificação
Sarina/toxicidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Acetamides); 0 (Chemical Warfare Agents); 0 (Cholinesterase Reactivators); 0 (Gases); 0 (Oximes); 0 (RS194B); 0 (Recombinant Proteins); B4XG72QGFM (Sarin); EC 3.1.1.7 (Acetylcholinesterase); EC 3.1.1.8 (Butyrylcholinesterase); Q9CX8P80JW (Paraoxon)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170712
[St] Status:MEDLINE



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