Hansonkonradsen2831
Ventilator-associated pneumonia (VAP) is related with high mortality, duration of mechanical ventilation and costs. Recent studies have questioned the safety and effectiveness of oral chlorhexidine to prevent VAP. #link# We sought to verify whether the adverse effects of this substance outweigh its benefits. We searched several databases and selected studies that investigated the use of oral chlorhexidine and its impact on mortality. No association between oral chlorhexidine and lower VAP rates was found on meta-analyses of double-blind randomized trials, however significant increase in mortality was reported. It is speculated that chlorhexidine can cause damage to several organic sectors and cytotoxicity. Although it still can be beneficial in specific settings, robust evidence to recommend its routine application for all mechanically ventilated patients is lacking; therefore, given the possibility of harm, it would be better to follow the principle of non-maleficence until more studies becomes available.Transition metal dichalcogenides (TMDCs), such as MoS2 and WS2, have attracted much attention in biosensing and bioimaging due to its excellent stability, biocompatibility, high specific surface area, and wide varieties. In this review, we overviewed the application of TMDCs in biosensing and bioimaging. Firstly, the synthesis methods and surface functionalization methods of TMDCs were summarized. Secondly, according to the working mechanism, we classified and gave a detailed account of the latest research progress of TMDC-based biosensing for the detection of the enzyme, DNA, and other biological molecules. Then, we outlined the recent progress of applying TMDCs in bio-imaging, including fluorescence, X-ray computed tomographic, magnetic response imaging, photographic and multimodal imaging, respectively. Finally, we discussed the future challenges and development direction of the application of TMDCs in medical diagnosis. Also, we put forward our view on the opportunity of TMDCs in the big data of modern medical diagnosis.Observational studies on dietary or circulating magnesium and risk of cardiovascular disease (CVD) in Chronic Kidney Disease (CKD) stage 1-4 have reported no-to-modest inverse associations. 24 h Urinary magnesium concentration (24 h UMg), an indicator of intestinal magnesium absorption, may provide better insight into the connection of CKD progression. We examined 3179 participants aged 18-74 years with CKD stage 1-4 in the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) study, a prospective population-based cohort study. Data were analysed using Spearman rank-order correlation coefficients for all comparisons. ML 210 performed a time-to-event analysis of the data using the Kaplan-Meier survival model, Cox proportional hazard model and competing risk Fine and Gray subdistribution hazard model. During a median follow-up of 4.19 years (interquartile range, 3.43-5.09 years), when modelling end-stage renal disease (ESRD), CVD and death, 24 h UMg was associated with risk of CVD (HR, 1.612 (95% CI, 1.056-2.460)), while no significant association with ESRD and death endpoints could be detected. 24 h UMg risk variants display a modest association with CVD in CKD stage 1-4 patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03041987. link2 Registered January 1, 2012. (retrospectively registered) (https//www.clinicaltrials.gov/ct2/show/NCT03041987?term=Chinese+Cohort+Study+of+Chronic+Kidney+Disease+%28C-STRIDE%29&rank=1).
Coronavirus disease 2019 (COVID-19) may associate with clinical manifestations, ranging from alterations in smell and taste to severe respiratory distress requiring intensive care, that might associate with weight loss and malnutrition. We aimed to assess the incidence of unintentional weight loss and malnutrition in COVID-19 survivors.
In this post-hoc analysis of a prospective observational cohort study, we enrolled all adult (age ≥18 years) patients with a confirmed diagnosis of COVID-19 who had been discharged home from either a medical ward or the Emergency Department of San Raffaele University Hospital, and were re-evaluated after remission at the Outpatient COVID-19 Follow-Up Clinic of the same Institution from April 7, 2020, to May 11, 2020. Demographic, anthropometric, clinical and biochemical parameters upon admission were prospectively collected. At follow-up, anthropometrics, the mini nutritional assessment screening and a visual analogue scale for appetite were assessed.
A total of 213 patidisease, and after clinical remission. CLINICALTRIALS.
NCT04318366.
NCT04318366.
To review antibiotic stewardship strategies for neonatal intensive care units (NICU) in the areas of management of surgical site infections, perioperative prophylaxis and culture negative late onset sepsis.
Review of local microbiology, stratification of surgical procedures by risk of contamination of the surgical site, and adherence to evidence-based principles of perioperative antibiotic administration (targeted therapy, effective dosing, appropriate timing and limiting duration post-operatively) can help to minimize unnecessary antibiotic use for neonatal surgery. Creating a late onset sepsis case definition, appropriate collection and interpretation of blood cultures, and instituting antibiotic time-outs can minimize the overuse of antibiotics for culture negative sepsis.
Effective implementation of these antimicrobial stewardship strategies in the NICU can reduce unnecessary antimicrobial use and limit the emergence of resistant pathogens.
Effective implementation of these antimicrobial stewardship strategies in the NICU can reduce unnecessary antimicrobial use and limit the emergence of resistant pathogens.
To determine whether the extraperitoneal approach for paraaortic staging lymphadenectomy results in a lower rate of surgical complications compared to the transperitoneal approach, without compromising oncological outcomes.
Prospective randomized multicenter study of patients with early endometrial or ovarian cancer undergoing paraaortic lymphadenectomy in 2010-2019. Patients were randomized to minimally invasive surgery (laparoscopy or robotic-assisted) using an extraperitoneal or a transperitoneal approach. The primary end point measure was a composite outcome that included developing one or more of the following surgical complications bleeding during paraaortic lymphadenectomy ≥500 mL, any intraoperative complication related to paraaortic lymphadenectomy, severe postoperative complication (Dindo ≥ IIIA), impossibility to complete the procedure, or conversion to laparotomy.
There were 103 patients in the extraperitoneal group and 100 in the transperitoneal group. Differences in the composite outcome (the number of aortic nodes retrieved was higher. The decision to use one or another laparoscopic route is a matter of the surgeon preference. Trial registration ClinicalTrials.gov.identifier NCT02676726.Uterine serous carcinoma (USC) is an aggressive subtype of endometrial cancer. Multimodality treatment with surgery, radiotherapy, and chemotherapy is commonly used, given its propensity for extrauterine spread, distant recurrences, and poor prognosis. However, the use of molecularly-based therapy is expanding. Here, we review key molecular features of USC, discuss current management, and assess the landscape of novel therapies and combinations.
Our objective was to investigate whether trial evidence showing that neoadjuvant chemotherapy is non inferior to primary surgery for the primary treatment of advanced ovarian cancer could be extrapolated to groups of patients that were not included in the trials.
Using a detailed retrospective cohort of all patients managed through a single tertiary hospital we carried out a propensity score analysis, principal component analysis, and cox proportional hazard analysis to compare survival in matched cohorts.
A propensity score analysis showed that for at least 41% of all patients with advanced high-grade serous cancer neoadjuvant chemotherapy is non inferior to primary surgery (median survival primary surgery 38months, neoadjuvant chemotherapy 35months. P=0.39). However, principal component analysis, supported by cox modelling, suggests that for some subgroups, including patients with subdiaphragmatic nodal disease, primary surgery may be associated with improved survival (HR 0.11, CI 0.026-0.48).
We have shown that the findings of previous trials can be extrapolated to a wider population and that statistical modelling can be used to identify groups or patients who benefit from specific modalities of treatment.
We have shown that the findings of previous trials can be extrapolated to a wider population and that statistical modelling can be used to identify groups or patients who benefit from specific modalities of treatment.
Supervised Machine Learning techniques have shown significant potential in medical image analysis. link3 However, the training data that need to be collected for these techniques in the field of MRI 1) may not be available, 2) may be available but the size is small, 3) may be available but not representative and 4) may be available but with weak labels. The aim of this study was to overcome these limitations through advanced MR simulations on a realistic computer model of human anatomy without using a real MRI scanner, without scanning patients and without having personnel and the associated expenses.
The 4D-XCAT model was used with the coreMRI simulation platform for generating artificial short-axis MR-images for training a neural-network to automatic delineate the LV endocardium and epicardium. Its performance was assessed on real MR-images acquired from eight healthy volunteers. The neural-network was also trained on real MR-images from a publicly available dataset and its performance was assessed on the samg to use specialized personnel, such as technologists and radiologists.
This paper proposes a new and highly efficient implementation of 3D+t groupwise registration based on the free-form deformation paradigm.
Deformation is posed as a cascade of 1D convolutions, achieving great reduction in execution time for evaluation of transformations and gradients.
The proposed method has been applied to 4D cardiac MRI and 4D thoracic CT monomodal datasets. Results show an average runtime reduction above 90%, both in CPU and GPU executions, compared with the classical tensor product formulation.
Our implementation, although fully developed for the metric sum of squared differences, can be extended to other metrics and its adaptation to multiresolution strategies is straightforward. Therefore, it can be extremely useful to speed up image registration procedures in different applications where high dimensional data are involved.
Our implementation, although fully developed for the metric sum of squared differences, can be extended to other metrics and its adaptation to multiresolution strategies is straightforward. Therefore, it can be extremely useful to speed up image registration procedures in different applications where high dimensional data are involved.
Narcolepsy is the second most common sleep disorder. It is characterised by excessive daytime sleepiness together with other symptoms such as cataplexy, sleep paralysis, and hallucinations. The pathophysiology and treatment of this disease, together with its associated syndromes, can severely interfere with anaesthesia.
Due to the lack of quality evidence on which to base a high grade of recommendation for anaesthesia in these patients, we performed a non-systematic, narrative review of the literature in Pubmed. We used the descriptors narcolepsy, anesthesia, surgery, perioperative, opioid, obstructive, apnea and sleep both individually and with AND and OR connectors.
The recommendation to avoid opioids and the stability of opioid-free anaesthesia (OFA) make this approach an option to consider in these patients. We describe a case in which it was used safely.
The recommendation to avoid opioids and the stability of opioid-free anaesthesia (OFA) make this approach an option to consider in these patients.
