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  • 文章类型: Journal Article
    在第一次描述主动脉瓣阻塞近300年后,经导管主动脉瓣植入术(TAVI)经过不到20年的随机临床试验(RCT),才成为主动脉瓣狭窄患者公认的治疗策略.最近出版物的高密度使得人们很容易忽视导致这一程序发展的历史。了解诊断或治疗技术的发展可以改善批判性推理,防止重复的错误,为未来的研究铺平了道路,并为该主题提供了深刻的见解。然而,它不应该掩盖最近发表的RCT的发现,这仍然是临床实践的支柱。在这份时间表审查中,作者旨在回顾TAVI的发展,将主动脉瓣狭窄的病理生理学和TAVI的初始概念与临床试验路线图相结合,从而推广了TAVI程序。
    Nearly 300 years after the first description of aortic valve obstruction, it has taken less than two decades of randomized clinical trials (RCTs) for transcatheter aortic valve implantation (TAVI) to become a recognized strategy for patients with aortic stenosis. The high density of recent publications makes it easy to ignore the history that led to the development of this procedure. Knowing the evolution of a diagnostic or therapeutic technique improves critical reasoning, prevents repeated mistakes, paves the way for future research and contributes to an insightful perspective on the subject. Nevertheless, it should not overshadow the findings of recently published RCTs, which still are the mainstay of clinical practice. In this timeline review, the authors aim to recap the development of TAVI, combining the pathophysiology of aortic stenosis and the initial concept of TAVI with the roadmap of clinical trials that led to the generalization of the TAVI procedure.
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  • 文章类型: Journal Article
    不对称基底间隔肥大存在于10%的血流动力学显着主动脉瓣狭窄的患者中。从外科医生的角度来看,它代表了一个难题,因为它可能与主动脉瓣置换术(AVR)后的短期和长期结果欠佳有关,但也会增加手术矫正时不必要的并发症。为了深入了解在这种情况下同时行间隔肌切除术的有效性和安全性,我们使用Pubmed界面对Medline从成立到2020年11月进行了文献综述。只有五项低证据回顾性分析,包括总共<200例接受AVR并伴随间隔肌切除术的患者,在文献中发现。总之,常规子宫切除术,在AVR期间在超声心动图上怀疑或直接可视化的不对称间隔肥大的情况下,看起来是个安全的程序,所有作者报告并发症发生率低或无并发症。总的来说,这种情况下的肌切除术与左心室重塑替代(LVM;LVM指数;LVM/身高)和舒张功能(E/E')的超声心动图检查结果有关,提示对血液动力学结果有一定益处。然而,血流动力学改善在多大程度上完全归因于肌切除术尚不确定,是的,这种改善的临床意义,据报道,短期和中期生存率相似。
    Asymmetric basal septal hypertrophy is present in 10% of patients with hemodynamic significant aortic valve stenosis. From the surgeon\'s standpoint, it represents a dilemma as it may be implicated in suboptimal short and long-term results after aortic valve replacement (AVR), but also heighten unwarranted complications at the time of surgical correction. To provide insight about the usefulness and safety of concomitant septal myectomy in this setting, we performed a literature review searching Medline from its inception to November 2020 using the Pubmed interface. Only five low evidence retrospective analyses, comprising a total of <200 patients undergoing AVR with concomitant septal myectomy, were found in the literature. In summary, routine myectomy, in the presence of suspected or directly visualized asymmetric septal hypertrophy on echocardiogram during AVR, seems to be a safe procedure, with all authors reporting a low rate or absence of complications. Overall, myectomy in this setting is associated with superior echocardiographic results concerning surrogates of LV remodelling (LVM; LVM index; LVM/height) and diastolic function (E/E\'), suggesting some benefit for hemodynamic outcomes. However, to what extent hemodynamic improvement is exclusively attributable to myectomy is uncertain, as is, the clinical significance of such an improvement, with similar short and mid-term survival rates being reported.
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  • 文章类型: Case Reports
    BACKGROUND: Anaphylaxis is a constant perioperative concern due to the exposure to several agents capable of inducing hypersensitivity reactions. Patent blue V (PBV), also known as Sulfan Blue, a synthetic dye used in sentinel node research in breast surgery, is responsible for 0.6% of reported anaphylactic conditions. We present a case of a 49-year-old female patient who underwent left breast tumorectomy with sentinel lymph node staging using PBV and experienced an anaphylactic reaction.
    METHODS: We conducted a literature search through PubMed for case reports, case series, reviews, and systematic reviews since 2005 with the keywords \"anaphylaxis\" and \"patent blue\". We then included articles found in these publications\' reference sections.
    RESULTS: We found 12 relevant publications regarding this topic. The main findings are summarized, with information regarding the clinical presentation, management, and investigation protocol. Hypotension is the most common clinical manifestation. The presentation is usually delayed when compared with anaphylaxis from other agents, and cutaneous manifestations are occasionally absent. Patients may have had previous exposure to the dye, used also as a food, clothes and drug colorant.
    CONCLUSIONS: The diagnosis of anaphylaxis in patients under sedation or general anesthesia may be difficult due to particularities of the perioperative context. According to the published literature, the presentation of the reaction is similar in most cases and a heightened clinical sense is key to address the situation appropriately. Finding the agent responsible for the allergic reaction is of paramount importance to prevent future episodes.
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  • 文章类型: Journal Article
    尽管越来越多的证据支持对败血症患者的外周灌注进行监测,尚未进行系统评价以探讨外周组织微循环中评估的灌注不良与死亡率之间的相关性.对最重要的数据库进行了搜索,以查找直到2018年2月发表的文章,这些文章使用不同的关键词符合本研究的标准:败血症,死亡率,预后,微循环和外周灌注。纳入标准是评估外周灌注/微循环与脓毒症死亡率之间相关性的研究。采用的排除标准是:审查文章,动物/临床前研究,元分析,摘要,国会年鉴,社论,信件,病例报告,重复和没有摘要和/或没有文本的文章。在选择的26篇文章中,使用至少一种公认的监测外周灌注的方法评估了2465例脓毒症患者。该综述显示了一个异质性危重患者组,死亡率在3%至71%之间(中位数=37%[28%-43%])。最常用的测量方法是近红外光谱(NIRS)(7篇)和侧流暗场(SDF)成像(5篇)。研究最多的血管床是舌下/颊微循环(8篇),其次是指尖(4篇)。大多数研究(23篇文章)证明了外周灌注不良与死亡率之间的明确关系。总之,外周非生命器官灌注不足/微循环异常的诊断与死亡率增加相关.然而,必须进行更多的研究来验证这种关联是否可以被视为脓毒症患者的重力标志或器官衰竭的触发因素.
    Although increasing evidence supports the monitoring of peripheral perfusion in septic patients, no systematic review has been undertaken to explore the strength of association between poor perfusion assessed in microcirculation of peripheral tissues and mortality. A search of the most important databases was carried out to find articles published until February 2018 that met the criteria of this study using different keywords: sepsis, mortality, prognosis, microcirculation and peripheral perfusion. The inclusion criteria were studies that assessed association between peripheral perfusion/microcirculation and mortality in sepsis. The exclusion criteria adopted were: review articles, animal/pre-clinical studies, meta-analyzes, abstracts, annals of congress, editorials, letters, case-reports, duplicate and articles that did not present abstracts and/or had no text. In the 26 articles were chosen in which 2465 patients with sepsis were evaluated using at least one recognized method for monitoring peripheral perfusion. The review demonstrated a heterogeneous critically ill group with a mortality-rate between 3% and 71% (median=37% [28%-43%]). The most commonly used methods for measurement were Near-Infrared Spectroscopy (NIRS) (7 articles) and Sidestream Dark-Field (SDF) imaging (5 articles). The vascular bed most studied was the sublingual/buccal microcirculation (8 articles), followed by fingertip (4 articles). The majority of the studies (23 articles) demonstrated a clear relationship between poor peripheral perfusion and mortality. In conclusion, the diagnosis of hypoperfusion/microcirculatory abnormalities in peripheral non-vital organs was associated with increased mortality. However, additional studies must be undertaken to verify if this association can be considered a marker of the gravity or a trigger factor for organ failure in sepsis.
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  • 文章类型: Comparative Study
    BACKGROUND: Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may lead to outcomes of aspiration pneumonia, ranging from hospitalization to death. This assessment proposes a non-invasive, acoustic-based method to differentiate between individuals with and without signals of penetration and aspiration.
    OBJECTIVE: This systematic review evaluated the diagnostic validity of different methods for assessment of swallowing sounds, when compared to videofluroscopy swallowing study to detect oropharyngeal dysphagia.
    METHODS: Articles in which the primary objective was to evaluate the accuracy of swallowing sounds were searched in five electronic databases with no language or time limitations. Accuracy measurements described in the studies were transformed to construct receiver operating characteristic curves and forest plots with the aid of Review Manager v. 5.2 (The Nordic Cochrane Centre, Copenhagen, Denmark). The methodology of the selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies-2.
    RESULTS: The final electronic search revealed 554 records, however only 3 studies met the inclusion criteria. The accuracy values (area under the curve) were 0.94 for microphone, 0.80 for doppler, and 0.60 for stethoscope.
    CONCLUSIONS: Based on limited evidence and low methodological quality because few studies were included, with a small sample size, from all index testes found for this systematic review, doppler showed excellent diagnostic accuracy for the discrimination of swallowing sounds, whereas microphone-reported good accuracy discrimination of swallowing sounds of dysphagic patients and stethoscope showed best screening test.
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  • 文章类型: Journal Article
    OBJECTIVE: To review the association between intimate partner violence and breastfeeding practices in the literature.
    METHODS: The search was carried out in five databases, including MEDLINE, LILACS, SCOPUS, PsycoINFO, and Science Direct. The search strategy was carried out in February 2017. The authors included original studies with observational design, which investigated forms of intimate partner violence (including emotional, physical, and/or sexual) and breastfeeding practices. The quality of the studies was assessed based on the bias susceptibility through criteria specifically developed for this review.
    METHODS: The study included 12 original articles (10 cross-sectional, one case-control, and one cohort study) carried out in different countries. The forms of intimate partner violence observed were emotional, physical, and/or sexual. Breastfeeding was investigated by different tools and only assessed children between 2 days and 6 months of life. Of the 12 studies included in this review, eight found a lower breastfeeding intention, breastfeeding initiation, and exclusive breastfeeding during the first six months of the child\'s life, and a higher likelihood of early termination of exclusive breastfeeding among women living at home where violence was present. The quality varied between the studies and six were classified as having low bias susceptibility based on the assessed items.
    CONCLUSIONS: Intimate partner violence is associated with inadequate breastfeeding practices of children aged 2 days to 6 months of life.
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  • 文章类型: Journal Article
    OBJECTIVE: Synthesize the information about the factors associated with maintenance of breastfeeding for 12 months or more.
    METHODS: A systematic review was conducted in the Pubmed/Medline, Scielo, and Lilacs databases, including articles published in Portuguese or English since 2004 on the factors associated with breastfeeding maintenance for at least 12 months; review articles and those with qualitative design were excluded. The factors were organized into four levels, according to the chronological proximity to the outcome: distal, distal intermediate, proximal intermediate, and proximal; nationality and place/area of residence were considered contextual factors.
    METHODS: 1174 articles were identified, of which 19 were included in this review, comprising seven cohort studies and 12 cross-sectional studies. A total of 39 of the 75 assessed factors were associated with the outcome at least once. The factors with the highest percentages of associations with maintenance of breastfeeding for 12 months or more, considering the number of times they were tested were: children whose parents are the caregivers (100%), none type of maternal exposure to smoke (54%), children and/or parents are immigrants/foreigners (50%), live in urban areas (42.9%), older maternal age (40%), married women (37.5%), higher level of maternal education (31.3%), greater parity (30.8%), and lower income (30%).
    CONCLUSIONS: The maintenance of breastfeeding for 12 months or more is associated with multiple factors, emphasizing the contextual factors and those related to some maternal sociodemographic characteristics. Associations differ in effect and magnitude between the different populations studied.
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  • 文章类型: Journal Article
    The present study aimed to update the literature review on the prevalence of fibromyalgia published in 2006. A bibliographical survey was carried out from 2005 to 2014 in the MEDLINE, Web of Science, Embase, LILACS and SciELO databases and 3274 records were identified. Five researchers selected the studies, following the inclusion criteria: studies that obtained the prevalence of fibromyalgia. Fibromyalgia studies in associated diseases were excluded. When screening by title and abstract, 2073 irrelevant articles were excluded. The full texts of 210 articles were evaluated for eligibility and this review included 39 studies, described in 41 articles. The selected studies were grouped into four categories: (A) prevalence of fibromyalgia in the general population; (B) prevalence of fibromyalgia in women; (C) prevalence of fibromyalgia in rural and urban areas; (D) prevalence of fibromyalgia in special populations. The literature shows values of fibromyalgia prevalence in the general population between 0.2 and 6.6%, in women between 2.4 and 6.8%, in urban areas between 0.7 and 11.4%, in rural areas between 0.1 and 5.2%, and in special populations values between 0.6 and 15%. This literature review update shows a significant increase in fibromyalgia prevalence studies in the world. The new 2010 American College of Rheumatology criteria have not been widely used yet and the COPCORD (Community-oriented program for control of Rheumatic Diseases) methodology has increased the quality of studies on the prevalence of rheumatic diseases in general.
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  • 文章类型: Journal Article
    背景:颌骨坏死可由辐射引起,用于放射治疗恶性肿瘤,或用于骨重塑和抗血管生成的药物,如二膦酸盐。这些情况可能与触发因素有关,例如感染,创伤和血管减少。颌骨坏死患者的治疗需要谨慎,因为没有单独和明确的特定治疗方法。然而,可以以相关的方式采用不同的治疗方式来控制和稳定病变。
    目的:回顾有关颌骨坏死的病因和治疗的最新知识,无线电诱导和药物相关,旨在提高寻求改善患者生活质量的专业人员的知识。
    方法:PubMed中的文献综述以及在选定文章的参考列表中手动搜索相关出版物。1983年至2017年的英文文章,以评估颌骨坏死为主要目标,进行了选择和分析。
    结果:感染,创伤和血管减少对颌骨坏死有触发作用。预防和/或稳定措施可以与治疗方式结合使用,以适当地管理颌骨患者的骨坏死。
    结论:根据现有文献选择合适的治疗方法治疗颌骨坏死是一个合理的决定,可以帮助制定适当的治疗计划。
    BACKGROUND: Osteonecrosis of the jaws can result either from radiation, used in radiotherapy for treatment of malignant tumors, or medications used for bone remodeling and anti-angiogenesis such as bisphosphonates. These conditions can be associated with triggering factors such as infection, trauma and decreased vascularity. The management of patients with osteonecrosis of the jaws requires caution since there is no specific treatment that acts isolated and decidedly. However, different treatment modalities can be employed in an associated manner to control and stabilize lesions.
    OBJECTIVE: To review the current knowledge on etiology and management of osteonecrosis of the jaws, both radio-induced and medication-related, aiming to improve knowledge of professionals seeking to improve the quality of life of their patients.
    METHODS: Literature review in PubMed as well as manual search for relevant publications in reference list of selected articles. Articles in English ranging from 1983 to 2017, which assessed osteonecrosis of the jaws as main objective, were selected and analyzed.
    RESULTS: Infections, traumas and decreased vascularity have a triggering role for osteonecrosis of the jaws. Prophylactic and/or stabilizing measures can be employed in association with therapeutic modalities to properly manage osteonecrosis of the jaws patients.
    CONCLUSIONS: Selecting an appropriate therapy for osteonecrosis of the jaws management based on current literature is a rational decision that can help lead to a proper treatment plan.
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  • 文章类型: Journal Article
    OBJECTIVE: To define the antecedents, consequents, and attributes of spiritual coping.
    METHODS: Rodgers\' evolutionary model for concept analysis was used to guide an integrative literature review of qualitative research.
    RESULTS: Six qualitative articles were included and elements that define and contextualize the concept were identified.
    CONCLUSIONS: Three new nursing diagnoses are proposed, based on qualitative findings.
    CONCLUSIONS: These new diagnoses should be submitted to clinical validation in different cultural and religious backgrounds, but the inclusion in the taxonomy highlights a holistic perspective concerning the spiritual dimension of patients\' responses in life and health transitions, and so, bringing the approach to spirituality into nursing practice.
    UNASSIGNED: Definir os antecedentes, os consequentes e os atributos de coping espiritual. MÉTODOS: Modelo evolucionário de análise de conceitos de Beth Rodgers baseado numa revisão integrativa de literatura de pesquisa qualitativa.
    UNASSIGNED: Seis pesquisas qualitativas foram incluídas e os elementos que definem e contextualizam o conceito foram identificados. CONCLUSÕES: São propostos três novos diagnósticos de enfermagem, baseados na evidência de estudos qualitativos. IMPLICAÇÕES PARA A PRÁTICA: Estes novos diagnósticos devem ser submetidos a estudos de validação clínica em diferentes contextos culturais e religiosos, e quando incluídos na taxonomia estarão a enfatizar uma perspectiva holística das respostas dos pacientes relacionada à dimensão espiritual e, assim, promovendo a inclusão da espiritualidade na prática clínica.
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