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42 papers 0 to 25 followers
https://www.readbyqxmd.com/read/27898215/randomized-trial-of-pleural-fluid-drainage-frequency-in-patients-with-malignant-pleural-effusions-the-asap-trial
#1
Momen M Wahidi, Chakravarthy Reddy, Lonny Yarmus, David Feller-Kopman, Ali Musani, R Wesley Shepherd, Hans Lee, Rabih Bechara, Carla Lamb, Scott Shofer, Kamran Mahmood, Gaetane Michaud, Jonathan Puchalski, Samaan Rafeq, Stephen M Cattaneo, John Mullon, Steven Leh, Martin Mayse, Samantha M Thomas, Bercedis Peterson, Richard W Light
RATIONALE: Patients with malignant pleural effusions have significant dyspnea and shortened life expectancy. Indwelling pleural catheters (IPC) allow patients to drain pleural fluid at home and can lead to auto-pleurodesis. The optimal drainage frequency to achieve auto-pleurodesis and freedom from catheter has not been determined. OBJECTIVE: To determine whether an aggressive daily drainage strategy is superior to the current standard every other day drainage of pleural fluid in achieving auto-pleurodesis...
November 29, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27888549/microscope-assisted-hepatic-artery-reconstruction-in-adult-living-donor-liver-transplantation-a-review-of-325-consecutive-cases-in-a-single-center
#2
Chen-Fang Lee, Johnny Chuieng Yi Lu, Ahmed Zidan, Ching-Song Lee, Tsung-Han Wu, Kun-Ming Chan, Wei-Chen Lee
BACKGROUND: Despite the technical and medical improvements in the recent years, hepatic artery thrombosis (HAT) remains a devastating complication after living donor liver transplantation (LDLT). We described our surgical techniques and monitoring protocols for hepatic artery reconstruction. We reported one of the lowest incidence rates of HAT in the literature. METHODS: Between 2008 and 2015, a total of 325 LDLTs performed at our institute were retrospectively analyzed...
November 26, 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/27861290/pathophysiological-trends-during-withdrawal-of-life-support-implications-for-organ-donation-after-circulatory-death
#3
Arjun Iyer, Hong Chee Chew, Ling Gao, Jeanette Villanueva, Mark Hicks, Aoife Doyle, Gayathri Kumarasinghe, Andrew Jabbour, Paul Cassius Jansz, Michael P Feneley, Richard P Harvey, Robert M Graham, Kumud K Dhital, Peter S Macdonald
BACKGROUND: Donation after circulatory death (DCD) provides an alternative pathway to deceased organ transplantation. Although clinical DCD lung, liver, and kidney transplantation are well established, transplantation of hearts retrieved from DCD donors has reached clinical translation only recently. Progress has been limited by concern regarding the viability of DCD hearts. The aim of this study was to document the pathophysiological changes that occur in the heart and circulation during withdrawal of life (WLS) support...
December 2016: Transplantation
https://www.readbyqxmd.com/read/27853353/update-on-sepsis-associated-acute-kidney-injury-emerging-targeted-therapies
#4
REVIEW
James F Doyle, Lui G Forni
Sepsis-associated acute kidney injury (SA-AKI) is an independent predictor of increased mortality and morbidity. It is essential that further advances in the treatment of sepsis should prioritize targeted therapies in SA-AKI in order to improve these bleak outcomes. As yet, a unique therapy that effectively reduces the impact of acute kidney injury has not been demonstrated. However, the emergence of novel targeted therapies, perhaps in combination, has the possibility of significantly reducing the long-term sequelae of an episode of SA-AKI...
2016: Biologics: Targets & Therapy
https://www.readbyqxmd.com/read/27884765/efficacy-of-clarithromycin-naproxen-oseltamivir-combination-in-the-treatment-of-patients-hospitalized-for-influenza-a-h3n2-infection-an-open-label-randomized-controlled-phase-2b-3-trial
#5
Ivan Fn Hung, Kelvin Kw To, Jasper Fw Chan, Vincent Cc Cheng, Kevin Sh Liu, Anthony Tam, Tuen-Ching Chan, Anna Jinxia Zhang, Patrick Li, Tin-Lun Wong, Ricky Zhang, Michael Ks Cheung, William Leung, Johnson Yn Lau, Manson Fok, Honglin Chen, Kwok-Hung Chan, Kwok-Yung Yuen
BACKGROUND: Influenza causes excessive hospitalizations and deaths. Single agent treatment with oseltamivir in severe influenza might be insufficient. The study assessed the efficacy and safety of oseltamivir-clarithromycin-naproxen combination for treatment of serious influenza. METHODS: From February to April 2015, we conducted a prospective open-label randomized-controlled trial. Adult patients hospitalized for A(H3N2) influenza were randomly assigned to a 2-day combination of clarithromycin 500mg, naproxen 200mg and oseltamivir 75mg twice daily, followed by 3 days of oseltamivir; or oseltamivir 75mg twice daily without placebos for 5 days as control (1:1)...
November 21, 2016: Chest
https://www.readbyqxmd.com/read/27653443/is-universal-antifungal-prophylaxis-mandatory-in-adults-after-lung-transplantation-a-review-and-meta-analysis-of-observational-studies
#6
REVIEW
Kevin Pilarczyk, Nils Haake, Jens Heckmann, Henning Carstens, Assad Haneya, Jochen Cremer, Heinz Jakob, Nikolaus Pizanis, Markus Kamler
BACKGROUND: Lung transplant (LTX) recipients are at high risk of invasive Aspergillus infections (IAI). However, no randomized-controlled trials (RCT) or international guidelines on antifungal prophylaxis (AFP) in the LTX population exist. METHODS: A meta-analysis was performed to determine whether AFP reduces the rate of IAI after LTX. A total of six eligible observational studies (five with no prophylaxis, one with targeted prophylaxis, three studies including heart/lung transplantation) with a total of 748 patients were included...
December 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/26975498/effect-of-postextubation-high-flow-nasal-cannula-vs-conventional-oxygen-therapy-on-reintubation-in-low-risk-patients-a-randomized-clinical-trial
#7
RANDOMIZED CONTROLLED TRIAL
Gonzalo Hernández, Concepción Vaquero, Paloma González, Carles Subira, Fernando Frutos-Vivar, Gemma Rialp, Cesar Laborda, Laura Colinas, Rafael Cuena, Rafael Fernández
IMPORTANCE: Studies of mechanically ventilated critically ill patients that combine populations that are at high and low risk for reintubation suggest that conditioned high-flow nasal cannula oxygen therapy after extubation improves oxygenation compared with conventional oxygen therapy. However, conclusive data about reintubation are lacking. OBJECTIVE: To determine whether high-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy for preventing reintubation in mechanically ventilated patients at low risk for reintubation...
April 5, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27744739/the-role-of-exercise-in-a-weight-loss-program-on-clinical-control-in-obese-adults-with-asthma-a-rct
#8
Patricia D Freitas, Palmira G Ferreira, Aline G Silva, Rafael Stelmach, Regina M Carvalho-Pinto, Frederico L A Fernandes, Marcio C Mancini, Maria N Sato, Milton A Martins, Celso R F Carvalho
RATIONALE: Clinical control is difficult to achieve in obese patients with asthma. Bariatric surgery has been recommended for weight-loss and to improve asthma control; however, the benefits of nonsurgical interventions have been poorly investigated. OBJECTIVE: To examine the effect of exercise training in a weight-loss program on asthma control, quality of life, inflammatory biomarkers and lung function. METHODS: Fifty-five obese patients with asthma were randomly assigned to either a weight-loss program + exercise (WL+E group, n=28) or a weight-loss program + sham (WL+S group, n=27) group, where the weight-loss program included nutrition (caloric restriction) and psychological therapies...
July 19, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27876591/cystic-fibrosis-and-the-nervous-system
#9
REVIEW
Leah R Reznikov
Cystic Fibrosis (CF) is a life-shortening autosomal recessive disorder caused by mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR). CFTR is an anion channel that conducts bicarbonate and chloride across cell membranes. While defective anion transport across epithelial cells is accepted as the basic defect in CF, many of the features observed in people with CF and organs affected in CF are modulated by the nervous system. This is of interest because CFTR expression has been reported in both the peripheral and central nervous systems, and it is well known that the transport of anions, such as chloride, greatly modulates neuronal excitability...
November 19, 2016: Chest
https://www.readbyqxmd.com/read/27876592/sirs-qsofa-and-organ-dysfunction-insights-from-a-prospective-database-of-emergency-department-patients-with-infection
#10
Julian M Williams, Jaimi H Greenslade, Juliet V McKenzie, Kevin Chu, Anthony Ft Brown, Jeffrey Lipman
OBJECTIVE: A proposed revision of sepsis definitions has abandoned SIRS, defined organ dysfunction as an increase in total SOFA score of ≥2, and conceived "qSOFA" as a bedside indicator of organ dysfunction. We aimed to (1) determine the prognostic impact of SIRS, (2) compare diagnostic accuracy of SIRS and qSOFA for organ dysfunction, and (3) compare standard (Sepsis-2) and revised (Sepsis-3) definitions for organ dysfunction in emergency department patients with infection. METHODS: Consecutive ED patients admitted with presumed infection were prospectively enrolled over three years...
November 19, 2016: Chest
https://www.readbyqxmd.com/read/27629776/antiplatelet-versus-anticoagulation-treatment-for-patients-with-heart-failure-in-sinus-rhythm
#11
Eduard Shantsila, Gregory Yh Lip
BACKGROUND: Morbidity in patients with chronic heart failure is high, and this predisposes them to thrombotic complications, including stroke and thromboembolism, which in turn contribute to high mortality. Oral anticoagulants (e.g. warfarin) and antiplatelet agents (e.g. aspirin) are the principle oral antithrombotic agents. Many heart failure patients with sinus rhythm take aspirin because coronary artery disease is the leading cause of heart failure. Oral anticoagulants have become a standard in the management of heart failure with atrial fibrillation...
September 15, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27617709/sugar-industry-and-coronary-heart-disease-research-a-historical-analysis-of-internal-industry-documents
#12
Cristin E Kearns, Laura A Schmidt, Stanton A Glantz
Early warning signals of the coronary heart disease (CHD) risk of sugar (sucrose) emerged in the 1950s. We examined Sugar Research Foundation (SRF) internal documents, historical reports, and statements relevant to early debates about the dietary causes of CHD and assembled findings chronologically into a narrative case study. The SRF sponsored its first CHD research project in 1965, a literature review published in the New England Journal of Medicine, which singled out fat and cholesterol as the dietary causes of CHD and downplayed evidence that sucrose consumption was also a risk factor...
November 1, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27673305/time-to-treatment-with-endovascular-thrombectomy-and-outcomes-from-ischemic-stroke-a-meta-analysis
#13
Jeffrey L Saver, Mayank Goyal, Aad van der Lugt, Bijoy K Menon, Charles B L M Majoie, Diederik W Dippel, Bruce C Campbell, Raul G Nogueira, Andrew M Demchuk, Alejandro Tomasello, Pere Cardona, Thomas G Devlin, Donald F Frei, Richard du Mesnil de Rochemont, Olvert A Berkhemer, Tudor G Jovin, Adnan H Siddiqui, Wim H van Zwam, Stephen M Davis, Carlos Castaño, Biggya L Sapkota, Puck S Fransen, Carlos Molina, Robert J van Oostenbrugge, Ángel Chamorro, Hester Lingsma, Frank L Silver, Geoffrey A Donnan, Ashfaq Shuaib, Scott Brown, Bruce Stouch, Peter J Mitchell, Antoni Davalos, Yvo B W E M Roos, Michael D Hill
IMPORTANCE: Endovascular thrombectomy with second-generation devices is beneficial for patients with ischemic stroke due to intracranial large-vessel occlusions. Delineation of the association of treatment time with outcomes would help to guide implementation. OBJECTIVE: To characterize the period in which endovascular thrombectomy is associated with benefit, and the extent to which treatment delay is related to functional outcomes, mortality, and symptomatic intracranial hemorrhage...
September 27, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27567896/severe-community-acquired-pneumonia-timely-management-measures-in-the-first-24-hours
#14
REVIEW
Jason Phua, Nathan C Dean, Qi Guo, Win Sen Kuan, Hui Fang Lim, Tow Keang Lim
Mortality rates for severe community-acquired pneumonia (CAP) range from 17 to 48 % in published studies.In this review, we searched PubMed for relevant papers published between 1981 and June 2016 and relevant files. We explored how early and aggressive management measures, implemented within 24 hours of recognition of severe CAP and carried out both in the emergency department and in the ICU, decrease mortality in severe CAP.These measures begin with the use of severity assessment tools and the application of care bundles via clinical decision support tools...
August 28, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/19467755/australasian-resuscitation-of-sepsis-evaluation-arise-a-multi-centre-prospective-inception-cohort-study
#15
MULTICENTER STUDY
Sandra L Peake, Michael Bailey, Rinaldo Bellomo, Peter A Cameron, Anthony Cross, Anthony Delaney, Simon Finfer, Alisa Higgins, Daryl A Jones, John A Myburgh, Gillian A Syres, Steven A R Webb, Patricia Williams
AIM: Determine current resuscitation practices and outcomes in patients presenting to the emergency department (ED) with sepsis and hypoperfusion or septic shock in Australia and New Zealand (ANZ). METHODS: Three-month prospective, multi-centre, observational study of all adult patients with sepsis and hypoperfusion or septic shock in the ED of 32 ANZ tertiary-referral, metropolitan and rural hospitals. RESULTS: 324 patients were enrolled (mean [SD] age 63...
July 2009: Resuscitation
https://www.readbyqxmd.com/read/19762075/efficacy-and-economic-assessment-of-conventional-ventilatory-support-versus-extracorporeal-membrane-oxygenation-for-severe-adult-respiratory-failure-cesar-a-multicentre-randomised-controlled-trial
#16
RANDOMIZED CONTROLLED TRIAL
Giles J Peek, Miranda Mugford, Ravindranath Tiruvoipati, Andrew Wilson, Elizabeth Allen, Mariamma M Thalanany, Clare L Hibbert, Ann Truesdale, Felicity Clemens, Nicola Cooper, Richard K Firmin, Diana Elbourne
BACKGROUND: Severe acute respiratory failure in adults causes high mortality despite improvements in ventilation techniques and other treatments (eg, steroids, prone positioning, bronchoscopy, and inhaled nitric oxide). We aimed to delineate the safety, clinical efficacy, and cost-effectiveness of extracorporeal membrane oxygenation (ECMO) compared with conventional ventilation support. METHODS: In this UK-based multicentre trial, we used an independent central randomisation service to randomly assign 180 adults in a 1:1 ratio to receive continued conventional management or referral to consideration for treatment by ECMO...
October 17, 2009: Lancet
https://www.readbyqxmd.com/read/19907042/revascularization-versus-medical-therapy-for-renal-artery-stenosis
#17
RANDOMIZED CONTROLLED TRIAL
Keith Wheatley, Natalie Ives, Richard Gray, Philip A Kalra, Jonathan G Moss, Colin Baigent, Susan Carr, Nicholas Chalmers, David Eadington, George Hamilton, Graham Lipkin, Anthony Nicholson, John Scoble
BACKGROUND: Percutaneous revascularization of the renal arteries improves patency in atherosclerotic renovascular disease, yet evidence of a clinical benefit is limited. METHODS: In a randomized, unblinded trial, we assigned 806 patients with atherosclerotic renovascular disease either to undergo revascularization in addition to receiving medical therapy or to receive medical therapy alone. The primary outcome was renal function, as measured by the reciprocal of the serum creatinine level (a measure that has a linear relationship with creatinine clearance)...
November 12, 2009: New England Journal of Medicine
https://www.readbyqxmd.com/read/26466050/contrasting-male-and-female-trends-in-tobacco-attributed-mortality-in-china-evidence-from-successive-nationwide-prospective-cohort-studies
#18
REVIEW
Zhengming Chen, Richard Peto, Maigeng Zhou, Andri Iona, Margaret Smith, Ling Yang, Yu Guo, Yiping Chen, Zheng Bian, Garry Lancaster, Paul Sherliker, Shutao Pang, Hao Wang, Hua Su, Ming Wu, Xianping Wu, Junshi Chen, Rory Collins, Liming Li
BACKGROUND: Chinese men now smoke more than a third of the world's cigarettes, following a large increase in urban then rural usage. Conversely, Chinese women now smoke far less than in previous generations. We assess the oppositely changing effects of tobacco on male and female mortality. METHODS: Two nationwide prospective studies 15 years apart recruited 220,000 men in about 1991 at ages 40-79 years (first study) and 210,000 men and 300,000 women in about 2006 at ages 35-74 years (second study), with follow-up during 1991-99 (mid-year 1995) and 2006-14 (mid-year 2010), respectively...
October 10, 2015: Lancet
https://www.readbyqxmd.com/read/26436207/remote-ischemic-preconditioning-and-outcomes-of-cardiac-surgery
#19
RANDOMIZED CONTROLLED TRIAL
Derek J Hausenloy, Luciano Candilio, Richard Evans, Cono Ariti, David P Jenkins, Shyam Kolvekar, Rosemary Knight, Gudrun Kunst, Christopher Laing, Jennifer Nicholas, John Pepper, Steven Robertson, Maria Xenou, Tim Clayton, Derek M Yellon
BACKGROUND: Whether remote ischemic preconditioning (transient ischemia and reperfusion of the arm) can improve clinical outcomes in patients undergoing coronary-artery bypass graft (CABG) surgery is not known. We investigated this question in a randomized trial. METHODS: We conducted a multicenter, sham-controlled trial involving adults at increased surgical risk who were undergoing on-pump CABG (with or without valve surgery) with blood cardioplegia. After anesthesia induction and before surgical incision, patients were randomly assigned to remote ischemic preconditioning (four 5-minute inflations and deflations of a standard blood-pressure cuff on the upper arm) or sham conditioning (control group)...
October 8, 2015: New England Journal of Medicine
https://www.readbyqxmd.com/read/27203510/high-flow-oxygen-therapy-and-other-inhaled-therapies-in-intensive-care-units
#20
REVIEW
Sean D Levy, Jehan W Alladina, Kathryn A Hibbert, R Scott Harris, Ednan K Bajwa, Dean R Hess
In this Series paper, we review the current evidence for the use of high-flow oxygen therapy, inhaled gases, and aerosols in the care of critically ill patients. The available evidence supports the use of high-flow nasal cannulae for selected patients with acute hypoxaemic respiratory failure. Heliox might prevent intubation or improve gas flow in mechanically ventilated patients with severe asthma. Additionally, it might improve the delivery of aerosolised bronchodilators in obstructive lung disease in general...
April 30, 2016: Lancet
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