scholarly journals Perioperative glucocorticoid administration for prevention of systemic organ failure in patients undergoing esophageal resection for esophageal carcinoma

2006 ◽  
Vol 124 (2) ◽  
pp. 112-115 ◽  
Author(s):  
Antônio Marcos Raimondi ◽  
Hélio Penna Guimarães ◽  
José Luiz Gomes do Amaral ◽  
Patrícia Helena Rocha Leal
Keyword(s):  
Postoperative Complications ◽  
Esophageal Carcinoma ◽  
Weighted Mean Difference ◽  
Postoperative Mortality ◽  
Analysis Data ◽  
Esophageal Resection ◽  
Cochrane Library ◽  
Trial Quality ◽  
Glucocorticoid Administration ◽  
The Difference

CONTEXT AND OBJECTIVE: Preoperative glucocorticoid administration has been proposed for reducing postoperative morbidity. This is not widely used before esophageal resection because of incomplete knowledge regarding its effectiveness. The aim here was to assess the effects of preoperative glucocorticoid administration in adults undergoing esophageal resection for esophageal carcinoma. SEARCH STRATEGY: Studies were identified by searching the Cochrane Controlled Trials Register, MEDLINE, EMBASE, Cancer Lit, SCIELO and Cochrane Library, and by manual searching from relevant articles. The last search for clinical trials for this systematic review was performed in December 2004. SELECTION CRITERIA: This review included randomized studies of patients with potentially resectable carcinomas of the esophagus that compared preoperative glucocorticoid administration with placebo. DATA COLLECTION AND ANALYSIS: Data were extracted by the same reviewers, and the trial quality was assessed using Jadad scoring. Relative risk and weighted mean difference with 95% confidence limits were used to assess the significance of the difference between the treatment arms. RESULTS: Four randomized trials involving 146 patients were found. There were no differences in postoperative mortality, sepsis, anastomotic leakage, hepatic and renal failure between the glucocorticoid and placebo groups. There were fewer postoperative respiratory complications (p = 0.005) and multiple postoperative complications (p = 0.004) and lower postoperative plasma interleukin-6 levels (p = 0.00001) with preoperative glucocorticoid administration. There was a higher postoperative PaO2/FiO2 ratio (p = 0.0001) with preoperative glucocorticoid administration. CONCLUSION: Prophylactic administration of glucocorticoids is associated with decreased postoperative complications.

Esophageal resection in elderly esophageal carcinoma patients: improvement in postoperative complications

2001 ◽  
Vol 71 (2) ◽  
pp. 414-418 ◽  
Author(s):  
Shoichi Kinugasa ◽  
Mitsuo Tachibana ◽  
Hiroshi Yoshimura ◽  
Dipok Kumar Dhar ◽  
Muneaki Shibakita ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Esophageal Carcinoma ◽  
Esophageal Resection

PENGAKUAN CALABAI: SEBUAH ANALISIS INTERTEKSTUAL NOVEL PASUNG JIWA KARYA OKKY MADASARI DAN NOVEL CALABAI KARYA PEPI AL-BAYQUNIE

Jurnal KATA ◽  
2018 ◽  
Vol 2 (1) ◽  
pp. 50
Author(s):  
Krisna Aji Kusuma ◽  
Herman J Waluyo ◽  
Nugraheni Eko Wardani
Keyword(s):  
Content Analysis ◽  
Analysis Data ◽  
Qualitative Approach ◽  
The Novel ◽  
Research Results ◽  
Self Actualization ◽  
Similarities And Differences ◽  
The Difference ◽  
Descriptive Qualitative

<p><em>This study aims to describe the intertextuality relationship between the novel Pasung Jiwa by Okky Madasari and Calabai by Pepi Al-Bayqunie. The type of research is descriptive qualitative approach using content analysis. Data are collected by inventorying events that are similarities and differences, specifications on the characters, settings, plots, and themes of both text. The research results indicate that there are similar themes on the two novels, the theme of self actualization in addition with the theme of family and friendship. The same characterization are also used by both author, masculine figures with feminine soul characters. The difference between the two novels lies on the plot and setting. Pasung Jiwa uses progressive plot and Calabai uses a flash-back plot.. Okky Madasari takes Java Island as the background in the novel Pasung Jiwa, while the novel Calabai, Pepi Al-Bayqunie using the setting of Sulawesi Island. The basis of the similarity of theme and characterization supported by the similirity of events in the story shows the existence of intertextual relationship between the two novels. As a previously published work, the novel Pasung Jiwa by Okky Madasari is a hipogram and novel Calabai by Pepi A-Bayqunie as a transformational text. On the theme and characterization, the transformation of Calabai forward the hypogram, while in the plot and setting deviates his hypogram, Pasung Jiwa.</em></p><p>Penelitian ini bertujuan untuk mendeskripsikan hubungan intertekstualitas antara novel Pasung Jiwa karya Okky Madasari dan novel Calabai karya Pepi Al-Bayqunie. Jenis penelitian ini adalah deskriptif kualitatif dengan pendekatan konten analisis. Data dikumpulkan dengan menginventariskan peristiwa yang merupakan persamaan dan perbedaan, spesifikasi pada tokoh, latar, alur, dan tema dari kedua teks. Hasil penelitian ini menunjukkan bahwa terdapat kesamaan tema pada kedua novel, yaitu tema aktualisasi diri, ditambah dengan tema keluarga dan persahabatan. Penokohan yang sama juga digunakan oleh kedua penulis, yaitu tokoh maskulin dengan karakter jiwa feminin. Perbedaan kedua novel terletak pada alur dan latar. Pasung Jiwa menggunakan alur maju dan Calabai menggunakan alur campuran. Latar dalam novel Pasung Jiwa, Okky Madasari mengambil latar Pulau Jawa, sedangkan novel Calabai, Pepi Al-Bayqunie menggunakan latar Pulau Sulawesi. Dasar kesamaan tema dan penokohan didukung kesamaan peristiwa-peristiwa dalam cerita menunjukkan adanya hubungan intertekstual antara kedua novel. Sebagai karya yang terbit terlebih dahulu menjadikan novel Pasung Jiwa karya Okky Madasari adalah hipogram dan novel Calabai karya Pepi Al-Bayqunie sebagai teks transformasi. Pada tema dan penokohan, transformasi Calabai meneruskan hipogram, sedangkan pada alur dan latar menyimpangi hipogramnya, Pasung Jiwa.</p>

scholarly journals Regional differences in mortality rates during the COVID-19 epidemic in Italy

2020 ◽  
pp. 1-22
Author(s):  
Danila Azzolina ◽  
Giulia Lorenzoni ◽  
Luciano Silvestri ◽  
Ilaria Prosepe ◽  
Paola Berchialla ◽  
...  
Keyword(s):  
Regional Differences ◽  
Southern Italy ◽  
Meta Analysis ◽  
Analysis Data ◽  
Mortality Rates ◽  
Northern Italy ◽  
Admission Rates ◽  
Considerable Impact ◽  
The Difference ◽  
Disease Diffusion

Abstract Objective The COVID-19 outbreak started in Italy on February 20th, 2020, and has resulted in many deaths and intensive care unit (ICU) admissions. This study aimed to illustrate the epidemic COVID-19 growth pattern in Italy by considering the regional differences in disease diffusion during the first three months of the epidemic. Study design and methods Official COVID-19 data were obtained from the Italian Civil Protection Department of the Council of Ministers Presidency. The mortality and ICU admission rates per 100 000 inhabitants were calculated at the regional level and summarized via a Bayesian multilevel meta-analysis. Data were retrieved until April 21st, 2020. Results The highest cumulative mortality rates per 100 000 inhabitants were observed in northern Italy, particularly in Lombardia (85.3, 95% credibility intervals [CI] 75.7–94.7). The difference in the mortality rates between northern and southern Italy increased over time, reaching a difference of 67.72 (95% CI = 66–67) cases on April 2nd. Conclusions Northern Italy showed higher and increasing mortality rates during the first three months of the epidemic. The uncontrolled virus circulation preceding the infection spreading in southern Italy had a considerable impact on system burnout. This experience demonstrates that preparedness against the pandemic is of crucial importance to contain its disruptive effects.

scholarly journals Effects of Dexmedetomidine as an Analgesic Adjuvant for Surgery of Femur Fracture: A Systematic Review and Meta-Analysis

Pharmacology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Shan Deng ◽  
Yonghao Yu
Keyword(s):  
Femur Fracture ◽  
Meta Analysis ◽  
Sensory Block ◽  
Cochrane Library ◽  
Rescue Analgesia ◽  
Block Level ◽  
Block Time ◽  
Sedation Scores ◽  
The Difference ◽  
The Cochrane Library

Patients who undergo surgery of femur fracture suffer the excruciating pain. Dexmedetomidine (DEX) is a unique α2-adrenergic receptor agonist with sedative and analgesic properties, whose efficacy and safety are still unclear for surgery of femur fracture. Randomized controlled trials comparing the effects of addition of DEX to general or local anesthesia in surgery of femur fracture were searched from MEDLINE, EMBASE, and the Cochrane Library database. Patients who received DEX infusion had a significant longer time to rescue analgesia compared with those without DEX coadministration. DEX treatment seemed to reduce the visual analog score; however, the significance did not reach any statistical difference. DEX as an analgesic adjuvant did not reduce the onset of sensory block time, shorten the time to achieve maximum sensory block level, and provide a longer duration of sensory block. The difference in mean sedation scores between 2 groups was not statistically significant. As for adverse effects, DEX therapy significantly increased the rate of hypotension. In conclusion, dexmedetomidine as a local anesthetic adjuvant in femur fracture surgery had a longer duration of rescue analgesia. However, the incidence of hypotension was markedly increased in these patients. It was worth noting that the evidence was of low to moderate quality.

scholarly journals Comparison of clinical efficacy and safety between dexmedetomidine and propofol among patients undergoing gastrointestinal endoscopy: a meta-analysis

2021 ◽  
Vol 49 (7) ◽  
pp. 030006052110327
Author(s):  
Weihua Liu ◽  
Wenli Yu ◽  
Hongli Yu ◽  
Mingwei Sheng
Keyword(s):  
Clinical Efficacy ◽  
Lower Risk ◽  
Gastrointestinal Endoscopy ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Similar Efficacy ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Inclusion Criteria ◽  
Weighted Mean

Objective To compare the clinical efficacy and safety of dexmedetomidine and propofol in patients who underwent gastrointestinal endoscopy. Methods Relevant studies comparing dexmedetomidine and propofol among patients who underwent gastrointestinal endoscopy were retrieved from databases such as PubMed, Embase, and Cochrane Library. Results Seven relevant studies (dexmedetomidine group, n = 238; propofol group, n = 239) met the inclusion criteria. There were no significant differences in the induction time (weighted mean difference [WMD] = 3.46, 95% confidence interval [CI] = −0.95–7.88, I2 = 99%) and recovery time (WMD = 2.74, 95% CI = −2.72–8.19, I2 = 98%). Subgroup analysis revealed no significant differences in the risks of hypotension (risk ratio [RR] = 0.56, 95% CI = 0.25–1.22) and nausea and vomiting (RR = 1.00, 95% CI = 0.46–2.22) between the drugs, whereas dexmedetomidine carried a lower risk of hypoxia (RR = 0.26, 95% CI = 0.11–0.63) and higher risk of bradycardia (RR = 3.01, 95% CI = 1.38–6.54). Conclusions Dexmedetomidine had similar efficacy and safety profiles as propofol in patients undergoing gastrointestinal endoscopy.

scholarly journals The diagnostic value of EBV-DNA and EBV-related antibodies detection for nasopharyngeal carcinoma: a meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Weixing Liu ◽  
Gui Chen ◽  
Xin Gong ◽  
Yingqi Wang ◽  
Yaoming Zheng ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Test Performance ◽  
Meta Analysis ◽  
Diagnostic Value ◽  
Cochrane Library ◽  
Control Group ◽  
Summary Receiver Operating Characteristic ◽  
Ebv Dna ◽  
The Difference ◽  
Sensitivity Specificity

Abstract Background Numerous individual studies have investigated the diagnostic value of EBV-DNA, EA-IgA, VCA-IgA, EBNA1-IgA and Rta-IgG detection for nasopharyngeal carcinoma (NPC), but the conclusions remain controversial. This meta-analysis aimed to determine the value of EBV-DNA, EA-IgA, VCA-IgA, EBNA1-IgA and Rta-IgG detection in the diagnosis of NPC. Methods PROSPERO registration number: CRD42019145532. PubMed, EMBASE, Cochrane Library, and Chinese data libraries (Wanfang, CNKI, and CBM) were searched up to January 2019. The pooled sensitivity, specificity, and positive likelihood, negative likelihood, and diagnostic odds ratios were conducted in this meta-analysis. Summary receiver operating characteristic curves evaluated the test-performance global summary. Publication bias was examined by Deek’s funnel plot asymmetry test. Results Forty-seven studies with 8382 NPC patients (NPC group) and 15,089 individuals without NPC (Control group) were included in this meta-analysis. The sensitivity, specificity, positive likelihood (+ LR), negative likelihood (-LR), DOR and AUC of EBV-DNA in diagnosis of NPC were: 0.76 (95% CI 0.73–0.77), 0.96 (95% CI 0.95–0.97), 14.66 (95% CI 9.97–21.55), 0.19 (95% CI 0.13–0.28), 84 (95% CI 50.45–139.88), 0.96 (SE: 0.001), and 0.55 (95% CI 0.54–0.57), 0.96 (95% CI 0.96–0.97), 12.91 (95% CI 9.55–17.45), 0.35 (95% CI 0.29–0.43), 39.57 (95% CI 26.44–59.23), 0.94 (SE: 0.002) for the EA-IgA, and 0.85 (95% CI 0.84–0.85), 0.89 (95% CI 0.88–0.89), 6.73 (95% CI5.38–8.43), 0.17 (95% CI 0.12–0.23), 43.03 (95% CI 31.51–58.76), 0.93 (SE: 0.007) for the VCA-IgA, and 0.86 (95% CI 0.85–0.88), 0.87 (95% CI 0.88–0.90), 7.55 (95% CI 5.79–9.87), 0.16 (95% CI 0.13–0.19), 50.95 (95% CI 34.35–75.57), 0.94 (SE: 0.008) for the EBNA1-IgA, and 0.70 (95% CI 0.69–0.71), 0.94 (95% CI 0.94–0.95), 9.84 (95% CI 8.40–11.54), 0.25 (95% CI 0.21–0.31), 40.59 (95% CI 32.09–51.35), 0.95 (SE: 0.005) for the Rta-IgG. The EBV-DNA had larger AUC compared with other EBV-based antibodies (P < 0.05), while the difference between EA-IgA, VCA-IgA, EBNA1-IgA and Rta-IgG was not statistically significant (P > 0.05). Conclusions EBV-DNA, VCA-IgA, EBNA1-IgA and Rta-IgG detection have high accuracy in early diagnosis NPC. In addition, EBV-DNA detection has the higher diagnosis accuracy in NPC. On the other hand, EA-IgA is suitable for the diagnosis but not NPC screening.

Outcomes of Surgical and Nonsurgical Treatment for Colorectal Cancer in Nonagenarian Patients

2021 ◽  
pp. 000313482199506
Author(s):  
Youngbae Jeon ◽  
Kyoung-Won Han ◽  
Won-Suk Lee ◽  
Jeong-Heum Baek
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Postoperative Mortality ◽  
Nonsurgical Treatment ◽  
Perioperative Outcomes ◽  
Rank Test ◽  
Kaplan Meier ◽  
Number Of Patients

Purpose This study is aimed to evaluate the clinical outcomes of surgical treatment for nonagenarian patients with colorectal cancer. Methods This retrospective single-center study included patients diagnosed with colorectal cancer at the age of ≥90 years between 2004 and 2018. Patient demographics were compared between the operation and nonoperation groups (NOG). Perioperative outcomes, histopathological outcomes, and postoperative complications were evaluated. Overall survival was analyzed using Kaplan-Meier methods and log-rank test. Results A total of 31 patients were included (16 men and 15 women), and the median age was 91 (range: 90‐96) years. The number of patients who underwent surgery and who received nonoperative management was 20 and 11, respectively. No statistical differences in baseline demographics were observed between both groups. None of these patients were treated with perioperative chemotherapy or radiotherapy. Surgery comprised 18 (90.0%) colectomies and 2 (10.0%) transanal excisions. Short-term (≤30 days) and long-term (31‐90 days) postoperative complications occurred in 7 (35.0%) and 4 (20.0%) patients, respectively. No complications needed reoperation, such as anastomosis leakage or bleeding. No postoperative mortality occurred within 30 days: 90-day postoperative mortality occurred in two patients (10.0%), respectively. The median overall survival of the operation group was 31.6 (95% confidence interval: 26.7‐36.5) and that of NOG was 12.5 months (95% CI: 2.4‐22.6) ( P = 0.012). Conclusion Surgical treatment can be considered in carefully selected nonagenarian patients with colorectal cancer in terms of acceptable postoperative morbidity, with better overall survival than the nonsurgical treatment.

Effect of Probiotic Consumption on Immune Response in Athletes: A Meta-analysis

2021 ◽  
Author(s):  
Rahele Tavakoly ◽  
Amir Hadi ◽  
Nahid Rafie ◽  
Behrouz Talaei ◽  
Wolfgang Marx ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Monocyte Count ◽  
Randomized Controlled ◽  
Immunological Markers ◽  
Online Databases ◽  
Immunological Effects

AbstractThe possible effect of probiotic interventions on immunological markers in athletes is inconclusive. Therefore, to synthesize and quantitatively analyze the existing evidence on this topic, systematic literature searches of online databases PubMed, Scopus, Cochrane Library, and ISI Web of Sciences was carried out up to February 2021 to find all randomized controlled trials (RCTs) concerning the immunological effects of probiotics in athletes. In the random-effects model, weighted mean difference (WMD) and 95% confidence interval (CI) explained the net effect. The authors assessed the likelihood of publication bias via Egger’s and Begg’s statistics. A total of 13 RCTs (836 participants) were retrieved. Probiotic consumption reduced lymphocyte T cytotoxic count significantly (WMD=−0.08 cells×109/L; 95% CI: −0.15 to −0.01; p=0.022) with evidence of moderate heterogeneity (I 2=59.1%, p=0.044) and monocyte count when intervention duration was ≤ 4 weeks (WMD=−0.08 cells×109/L; 95% CI: −0.16 to −0.001; I 2=0.0%). Furthermore, leukocyte count was significantly elevated (WMD=0.48 cells×109/L; 95% CI: 0.02 to 0.93; I 2=0.0%) when multi-strain probiotics were used. Probiotic supplements may improve immunological markers, including lymphocyte T cytotoxic, monocyte, and leukocyte in athletes. Further randomized controlled trials using diverse strains of probiotics and consistent outcome measures are necessary to allow for evidence-based recommendations.

scholarly journals LYMPHOCYTE COUNT AND PLATELET VOLUME PREDICTS POSTOPERATIVE COMPLICATIONS IN ESOPHAGECTOMY FOR CANCER: A COHORT STUDY

2019 ◽  
Vol 56 (4) ◽  
pp. 377-385 ◽  
Author(s):  
Francisco TUSTUMI ◽  
Flávio Roberto TAKEDA ◽  
Antonio Adolfo Guerra Soares BRANDÃO ◽  
Rubens Antonio Aissar SALLUM ◽  
Ulysses RIBEIRO JUNIOR ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Count ◽  
Univariate Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Postoperative Mortality ◽  
Platelet Volume ◽  
Curative Intent ◽  
Trimodal Therapy ◽  
Esophagectomy For Cancer ◽  
Cellular Components

ABSTRACT BACKGROUND: Biomarkers from routine complete blood count are known predictive factors of long-term outcomes in cancer patients. The value of these biomarkers in the setting of trimodal therapy for esophageal cancer in predicting early postoperative outcomes is not studied. OBJECTIVE: The present study evaluated the value of cellular blood components changes during neoadjuvant chemoradiotherapy followed by curative intent esophagectomy for cancer in predicting postoperative mortality and morbidity. METHODS: A cohort of 149 consecutive patients that underwent chemoradiotherapy using platinum- and taxane-based regimens followed by esophagectomy was analyzed. Cellular components of blood collected before neoadjuvant therapy (period A) and before surgery (period B) were assessed for postoperative mortality and complications. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of blood count variables. RESULTS: Postoperative morbidity was present in 46% of the patients. On multiple regression analysis platelet volume (B) (OR: 1.53; 95% CI: 1.2-2.33) was an independent predictor of general complications. Severe postoperative surgical complications were present in 17% of the patients. On multiple regression analysis, lymphocyte decrease between B-A periods (OR: 0.992; 95% CI: 0.990-0.997) was related to higher risk for severe complications. Cervical anastomotic leakage was present in 25.6% of the patients. On univariate analysis eosinophil count in A and B periods was related to cervical anastomotic leakage. For this outcome, multivariate joint model could not identify independent risk variables of cellular components of blood. The 30-day mortality rate was 7.4%. On univariate analysis, platelet count in period B was associated to higher risk for mortality. The multivariate joint model could not accurately predict mortality due to the few number of patients in the mortality group. CONCLUSION: This is the first study to assess the relationship between peripheral blood count variables changes during neoadjuvant chemoradiotherapy using a platinum- and taxane-based regimen followed by curative intent esophagectomy for cancer in predicting postoperative complications. The platelet volume prior to surgery is related to postoperative complications and the lymphocyte count change prior to surgery predicts severe postoperative complications in the setting of trimodal therapy for esophageal cancer.

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