scholarly journals INFLUENCE OF THE ANESTHESIA METHOD ON THE OUTCOMES OF CARDIAC SURGERY OF DIFFERENT COMPLEXITY IN CHILDREN

2017 ◽  
Vol 11 (4) ◽  
pp. 226-232
Author(s):  
Lyaylya Z. Biktasheva ◽  
I. N Menshugin ◽  
V. A Mazurok ◽  
A. E Bautin
Keyword(s):  
Heart Failure ◽  
Mechanical Ventilation ◽  
Postoperative Complications ◽  
Epidural Anesthesia ◽  
Perioperative Period ◽  
Significant Positive Effect ◽  
Early Activation ◽  
The Mean ◽  
Positive Effect ◽  
A Current

The Aristotle score: a complexity-adjusted method to evaluate surgical results. For an assessment of dynamics of quality of the provided cardio-surgical help, comparison of a perioperative case rate and a mortality depending on the degree of surgical risk at cardiac interventions the Aristotle score is used. Thoracic epidural anesthesia (TEA) in comparison with high-opioids intravenous anesthesia (IVA) contributes to hemodynamics stability and early activation of patients. Objective: To analyze a current of the perioperative period at cardiac interventions in children with various categories of complexity of surgical intervention on «Aristotle score» depending on a type of anesthesia. Materials and methods. The 139 children with congenital heart diseases (CHD) underwent surgical correction. Patients were treated in Federal State Budgetary Institution of the Russian Ministry of Health (Penza), and «Almazov National medical research Centre» from 2008 to 2017 yrs. Patients (139 people, the mean age M (SD) of 7.6 (5.6) months of life) were divided into groups according to the categories of operational complexity presented in the Aristotle score. The group 1 consisted of 85 (61.2%) patients underwent interventions of second category of complexity, the group 2 consisted of 49 (39.8%) patients underwent interventions of 3 and 4 categories of complexity. Results. In cardiosurgical operations of the 2nd category of the Aristotle scale complexity a significant positive effect of TEA on the perioperative period was revealed in the form of a decrease in the severity of intraoperative heart failure and the level of glycaemia, the total number of postoperative complications and the time of patients’ staying on mechanical ventilation, as well as the duration of ICU stay and the decrease thrombocytopenia severity and frequency. In operations of grade 3 and 4, in which the duration of extracorporeal circulation was greater, the use of TEA did not have a significant positive effect on the incidence of postoperative complications, but after epidural anesthesia the mean duration of the patients’ stay on the mechanical ventilation and in the ICU was also significantly less. Apparently, the result is a consequence of a lesser severity of heart failure and early activation of patients by excluding the use of opioids, which have a depressing effect on the central nervous system, cardiac, respiratory and other systems. It can also be assumed that the administration of local anesthetics within 24 hours after the operation maintained sympatholytic and antiarrhythmic effects, and also prevented the complications development as a result of effective analgesia. Sufficiently convincing evidence of high antinociceptive activity of TEA is the possibility of safe extubation of patients in both the 2-d and 3-d categories of surgical complexity demonstrated in our study already in the operating room. Conclusion. Use of high TEA as a component of the combined anesthesia at surgical correction of CHD in young children has positive impact on a current of the perioperative period in the form of decrease in severity of heart and respiratory failure, duration of respiratory support, early activation and reduction of ICU stay.

Abstract 15938: B-type Natriuretic Peptide Levels Do Not Predict the Need for Mechanical Ventilation in Hospitalized Patients With COVID-19

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Daniel perry ◽  
Tariq U Azam ◽  
Husam Shadid ◽  
Michael Pan ◽  
Hannah Berlin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Natriuretic Peptide ◽  
Chart Review ◽  
Prospective Observational Study ◽  
Clinical Laboratory ◽  
Multivariable Analysis ◽  
The Mean ◽  
Intracardiac Pressure

Introduction: B-type natriuretic peptide (BNP) is widely used as a biomarker of heart failure and typically rises in response to increased intracardiac pressure. BNP levels have been measured in patients with coronavirus disease 2019 (COVID-19) to assess the cardiovascular contribution to respiratory failure and guide diuresis. Whether BNP levels do predict the need for mechanical ventilation (MV) is however unknown. Methods: The Michigan Medicine Covid-19 Cohort (M 2 C 2 ) is an ongoing prospective observational study in which detailed clinical, laboratory and outcomes data were collected from chart review of consecutive adult patients hospitalized for COVID-19. Patients who were positive for SARS-CoV-2 infection but without symptoms of COVID-19 were not included in this cohort. We identified 495 patients admitted between March 1 st and May 1 st for COVID-19, of whom 290 (58.6%) had BNP levels measured during their hospitalization. We examined the association between BNP and the need for MV during their hospitalization. Results: Among the 290 patients evaluated, the mean age was 62 (SD 15), 169 (58.3%) were male, 135 (46.6%) were blacks, and 61 (21.0%) had pre-existing heart failure. The median BNP level was 50 pg/ml, and 104 (35.9%) of patients had a BNP level > 100 pg/ml. A total of 130 (44.8%) required MV during their hospitalization. The median BNP level in patients who required MV was 63 pg/ml (IQR 25-171), compared to 46 pg /ml (IQR 17-187) in patients who did not, P=0.23. In multivariable analysis adjusting for age, gender, race, pre-existing heart failure, and serum creatinine on admission, BNP>100 pg/ml was not associated with the need for MV. Conclusions: In patients hospitalized for COVID-19, BNP levels were not associated with the need for MV, suggesting that the cardiovascular contribution to respiratory failure in these patients is likely minor compared to the inflammatory response or direct impact of the virus.

scholarly journals Knowledge Spillover and R&D in Manufacturing Enterprises

2021 ◽  
Vol 3 (6) ◽  
Author(s):  
Ting Yang ◽  
Bing Gao ◽  
Kejin Xie
Keyword(s):  
Knowledge Spillovers ◽  
Spillover Effect ◽  
Manufacturing Industries ◽  
Significant Positive Effect ◽  
Factor Productivity ◽  
Manufacturing Enterprises ◽  
City Regions ◽  
The Mean ◽  
Interaction Term ◽  
Positive Effect

Based on the database of Chinese industrial industries, a model is constructed to empirically analyze the interaction between knowledge spillovers and R&D in manufacturing industries; the mean productivity values of county and city regions have a significant positive effect on firms' R&D, which gradually decreases; an interaction term between the number of neighboring firms and the average total factor productivity of industries in different regional scopes is added, and the greater the number of neighboring firms in the neighborhood, the greater the spillover effect on research and development. In order to increase the innovation input of companies, they need to be given the space to fully exchange ideas.

scholarly journals Risk assessment of cardial complications in patients with concomitant ischemic heart disease using different regimens of intraoperative fluid therapy

2020 ◽  
pp. 50-51
Author(s):  
Ya.V. Morozova
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Postoperative Complications ◽  
Fluid Therapy ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Enzyme Linked Immunosorbent Assay ◽  
Hemodynamic Parameters ◽  
Normal Limits ◽  
Significant Correction

Objective. To investigate the incidence of postoperative cardiac complications when performing advanced surgical interventions for cancer in patients with concomitant coronary heart disease (CHD) using two different regimens of intraoperative fluid therapy. Materials and methods. The study included 89 patients who underwent advanced surgery under general anesthesia. The division of patients into two groups was performed depending on the chosen way of intraoperative fluid therapy: the first (n=45) with a restrictive regimen (7.0±0.2 ml/kg/h), the second (n=44) – with a liberal (13.9±0,6 ml/kg/h). Groups of patients had no differences in anthropometric data, the volume of surgery, anesthesia. Intraoperatively, continuous monitoring of routine hemodynamic parameters (blood pressure, heart rate) and electrocardiography (ECG), quantitative assessment of biomarkers of myocardial damage (TnI, NTproBNP) by enzyme-linked immunosorbent assay in three stages (before surgery, immediately after and in the early postoperative period 18-24 h) of operation. Results and discussion. None of the patients had critical incidents during anesthesia, some of them had postoperative complications that did not require significant correction, but only more careful monitoring. In all patients of both groups, stable hemodynamic parameters were observed in the perioperative period, which was ensured by the adequacy of anesthesia, fluid therapy and the use of maintenance doses of sympathomimetics (phenylephrine) if necessary. In the 1st group 8 patients (17.8 %) needed support with sympathomimetics, in the 2nd – 3 patients (6.8 %). The study of the dynamics of cardiac biomarkers revealed a slight increase in cardiac troponin I in both groups, which was within the upper limit of normal. A more significant increase in troponin levels (so-called myocardial injury) was found in 5 patients (11.1 %) of the 1st group and in 6 patients (13.6 %) of the 2nd group in the postoperative stage. In the study of the concentration of natriuretic peptide found a more significant increase in patients of group 2 in the postoperative period, but these values were within normal limits. Manifestations of heart failure decompensation were not found in either patient in either group. According to ECG monitoring, no ischemic changes were found in any of the patients, benign arrhythmias were detected in 5 patients (11.1 %) of the 1st group and in 7 patients (15.9 %) of the 2nd group. Signs of acute renal injury were not found in either patient of either group, all had sufficient diuresis and blood creatinine levels within normal limits in the perioperative period. According to the statistical indicators of stay in the intensive care unit and in the hospital, the patients of both groups did not differ from each other. Thus, the study found no significant differences in the frequency of postoperative complications in patients with concomitant CHD when using relatively restrictive and liberal regimens of perioperative infusion therapy. The key point in the management of these patients is, in our opinion, the desire for “zero” balance by the end of the 1st day of the postoperative period and beyond. The main tools of the anesthesiologist are careful accounting of the injected fluid and its losses. This tactic may allow the use of a more liberal infusion regimen if necessary in patients without signs of heart failure. Conclusions. Relatively restrictive and liberal regimens of perioperative fluid therapy can be safely used in patients with concomitant CHD without signs of heart failure, provided adequate monitoring and management within the “zero” fluid balance.

scholarly journals COVID-19 complicating perioperative management of LVAD implantation: a case report and systematic review

2021 ◽  
Author(s):  
Deborah Belfort ◽  
Bruno Biselli ◽  
Monica Ávila ◽  
Maria Tereza Lira ◽  
Filomena Galas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Severe Pneumonia ◽  
Perioperative Period ◽  
Left Ventricular ◽  
High Risk Population ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
The Mean ◽  
Worse Prognosis

The coronavirus 2019 disease (COVID-19) affected 125 million people worldwide and caused 2.7 million deaths. Some comorbidities are associated with worse prognosis and left ventricular assist device (LVAD) recipients are probably part of this high-risk population. We report a 31-year-old male patient who developed COVID-19 during LVAD implantation. His postoperative period was complicated by severe pneumonia and mechanical ventilation leading to right ventricular failure (RVF) and inotrope necessity. He experienced multiple complications, but eventually recovered. We present a systematic review of LVAD recipients and COVID-19. Among 14 patients, the mean age was 62.7 years, 78.5% were male. Five patients (35.7%) required mechanical ventilation and 3 patients (21.4%) died. Two patients (14.2%) had thromboembolic events. This case and systematic review suggest LVAD recipients are at particular risk of unfavorable outcomes and they may be more susceptible to RVF in the setting of COVID-19, particularly during perioperative period.

scholarly journals The Effect of Guided Question Technique on Students’ Writing Ability in Descriptive Text

2019 ◽  
Vol 3 (2) ◽  
pp. 216-229
Author(s):  
Rizka Indriani ◽  
Zahrida . ◽  
Mei Hardiah
Keyword(s):  
Experimental Design ◽  
Control Group ◽  
Significant Positive Effect ◽  
Writing Ability ◽  
Post Test ◽  
Quasi Experimental ◽  
The Mean ◽  
Writing Tests ◽  
Positive Effect ◽  
Experimental Group

The objective of this research is to find out whether or not there is a significant effect using guided question technique on students’ writing ability in descriptive text. This research is a quasi experimental design. The population of this research is the seventh grade students at SMPN 3 Kota Bengkulu. The sample in this research are about 60 students divided into 2 classes, VII 2 consists of 30 students as the experimental group and VII 3 that consist of 30 students as the control group. The treatment is given only for the experimental group. The data are collected by using two writing tests: pre-test and post-test. The result of the research showed the mean score of experimental group (31.34) was higher than mean score of control group (23.35). This indicated that the guided question technique could give a significant positive effect to the students’ writing ability in descriptive text.

Estimasi Pengaruh Faktor Internal Bank dan Stabilitas Makroekonomi terhadap Profitabilitas dengan Mediasi Rasio Pembiayaan Bermasalah di PT Bank Muamalat Indonesia

2020 ◽  
Vol 3 (2) ◽  
pp. 93-108
Author(s):  
Annisa Siti Fathonah ◽  
Dadang Hermawan
Keyword(s):  
Secondary Data ◽  
Financial Statements ◽  
Significant Positive Effect ◽  
Return On Assets ◽  
Internal Factors ◽  
Macroeconomic Factors ◽  
Operating Income ◽  
Significant Negative Effect ◽  
Negative Effect ◽  
Positive Effect

This study aims to determine and analyze how much influence the bank's internal factors such as Equity, Operational Costs per Operating Income (BOPO), Financing Deposit to Ratio (FDR), Non Performing Financing (NPF) as a mediator and external or macroeconomic factors namely inflation and Gross Domestic Product (GDP) on profitability represented by Return on Assets (ROA) at Bank Muamalat Indonesia for the period 2008-2018. The data used in this research are secondary data obtained from the publication of quarterly financial statements from 2008 to quarter 2 of 2018. The method that used in this research is path analysis with SPSS 20.0 as the analytical tool. The results of the study partially test the hypothesis (t-test), in substructure I shows that the capital variable has a significant negative effect on NPF, BOPO and inflation has a significant positive effect on NPF, FDR and GDP do not significantly influence NPF at Bank Muamalat Indonesia. In substructure II partially, Capital, BOPO, significant negative effect on ROA, FDR and NPF has a significant positive effect on ROA, Inflation and GDP does not significantly influence ROA while simultaneously significantly influencing ROA. Based on the sobel test, capital has a significant effect on ROA through NPF, BOPO has a significant effect on ROA through NPF, FDR has a significant effect on ROA through NPF, Inflation has a significant effect on ROA through NPF, while GDP has no significant effect on ROA through NPF.

Kredit Bermasalah sebagai Pemoderasi Pengaruh Tingkat Penyaluran Kredit terhadap Profitabilitas

2020 ◽  
Vol 5 (1) ◽  
pp. 52
Author(s):  
Sukirno Sukirno
Keyword(s):  
Research Method ◽  
Quantitative Research ◽  
Stock Exchange ◽  
Survey Methods ◽  
Analytical Tool ◽  
Significant Positive Effect ◽  
Purposive Sampling ◽  
The Relationship ◽  
Positive Effect

Abstract This study aims to empirically challenge the moderation of Non-Performing Loans to the effect of Credit Distribution Rates on Profitability. The population of 81 bank companies listed on the Indonesia Stock Exchange in the period 2014-2018 and which met the criteria of the research sample (purposive sampling) were 22 companies. The research method uses survey methods with quantitative research approaches, the analytical tool used is moderation regression. This study concludes that the level of credit distribution has a significant positive effect on profitability and the existence of the problem loan variable is proven to be a moderating variable that weakens the relationship between the level of credit distribution and profitability.    

Consumption Emotions and Consumer Values among Turkish Consumers during the COVID-19 Pandemic

2020 ◽  
Vol 8 (2) ◽  
pp. 135-160
Author(s):  
Nevin Karabiyik Yerden
Keyword(s):  
Questionnaire Survey ◽  
Sampling Method ◽  
Significant Positive Effect ◽  
Consumption Emotions ◽  
The World ◽  
Consumer Values ◽  
Convenience Sampling ◽  
Business Structures ◽  
Consumer Lifestyles ◽  
Positive Effect

The COVID 19 pandemic created economic havoc around the world. Along with healthcare challenges, the pandemic has also been changing consumer lifestyles. It affects business structures and service delivery too. This article draws on an investigation of the effect of consumption emotions of Turkish consumers on consumer values during the COVID 19 Pandemic. A convenience sampling method was adopted in the study and a questionnaire survey was administered to collect 390 consumer cases. The results show that the consumption emotions of Turkish consumers during the COVID 19 Pandemichad a significant positive effect on consumer values. It was found that Turkish consumers were to feel anxiety, calmness and hope more often than not during the pandemic.

Direct Myocardial Implantation of Human Fetal Stem Cells in Heart Failure Patients: Long-term Results

2010 ◽  
Vol 13 (1) ◽  
pp. 31 ◽  
Author(s):  
Federico Benetti ◽  
Ernesto Pe�herrera ◽  
Teodoro Maldonado ◽  
Yan Duarte Vera ◽  
Valvanur Subramanian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Cardiac Function ◽  
Nyha Class ◽  
Left Ventricular ◽  
Long Term Results ◽  
Walk Test ◽  
The Mean ◽  
6 Minute Walk Test ◽  
Minute Walk

Background: End-stage heart failure (HF) is refractory to current standard medical therapy, and the number of donor hearts is insufficient to meet the demand for transplantation. Recent studies suggest autologous stem cell therapy may regenerate cardiomyocytes, stimulate neovascularization, and improve cardiac function and clinical status. Although human fetal-derived stem cells (HFDSCs) have been studied for the treatment of a variety of conditions, no clinical studies have been reported to date on their use in treating HF. We sought to determine the efficacy and safety of HFDSC treatment in HF patients.Methods and Results: Direct myocardial transplantation of HFDSCs by open-chest surgical procedure was performed in 10 patients with HF due to nonischemic, nonchagasic dilated cardiomyopathy. Before and after the procedure, and with no changes in their preoperative doses of medications (digoxin, furosemide, spironolactone, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, betablockers), patients were assessed for New York Heart Association (NYHA) class, performance in the exercise tolerance test (ETT), ejection fraction (EF), left ventricular end-diastolic dimension (LVEDD) via transthoracic echocardiography, performance in the 6-minute walk test, and performance in the Minnesota congestive HF test. All 10 patients survived the operation. One patient had a stroke 3 days after the procedure, and although she later recovered, she was unable to perform the follow-up tests. Another male patient experienced pericardial effusion 3 weeks after the procedure. Although it resolved spontaneously, the patient abandoned his control tests and died 5 months after the procedure. An autopsy of the myocardium suggested that new young cells were present in the cardiomyocyte mix. At 40 months, the mean (SD) NYHA class decreased from 3.4 0.5 to 1.33 0.5 (P = .001); the mean EF increased 31%, from 26.6% 4% to 34.8% 7.2% (P = .005); and the mean ETT increased 291.3%, from 4.25 minutes to 16.63 minutes (128.9% increase in metabolic equivalents, from 2.46 to 5.63) (P < .0001); the mean LVEDD decreased 15%, from 6.85 0.6 cm to 5.80 0.58 cm (P < .001); mean performance in the 6-minute walk test increased by 43.2%, from 251 113.1 seconds to 360 0 seconds (P = .01); the mean distance increased 64.4%, from 284.4 144.9 m to 468.2 89.8 m (P = .004); and the mean result in the Minnesota test decreased from 71 27.3 to 6 5.9 (P < .001).Conclusion: Although these initial findings suggest direct myocardial implantation of HFDSCs is feasible and improves cardiac function in HF patients at 40 months, more clinical research is required to confirm these observations.

Effect of Compensation and Work Environment on Employee Performance with Employee Job Satisfaction as an Intervening Variable

2018 ◽  
Vol 9 (03) ◽  
pp. 20553-20562
Author(s):  
Putu Ayu Diah Juliarti ◽  
Anak Agung Putu Agung ◽  
I Nengah Sudja
Keyword(s):  
Job Satisfaction ◽  
Work Environment ◽  
High Performance ◽  
Employee Performance ◽  
Statistical Tests ◽  
Path Coefficient ◽  
Significant Positive Effect ◽  
Organizational Goals ◽  
Record Keeping ◽  
Positive Effect

An employee who has a high performance and better able to support the achievement of the goals and objectives set by the company. Employees can work well if you have a high performance that can produce good work anyway. With the high- performance that employees, is expected to achieve organizational goals. This study examines the effect of compensation and work environment on employee performance with job satisfaction to be intervening variable. Data on compensation, work environment, job satisfaction, and employee performance obtained through observation, record keeping and questioner with respondents. The data obtained are then analyzed using Partial Least Squares (PLS). Statistical tests results showed  (1) the compensation proved significant positive effect on job satisfaction the path coefficient of 0.434 and T-Stats for 4.880, (2) work environment proved to be a significant positive effect on job satisfaction the path coefficient of 0.434 and T-Stats for 4.074, (3) job satisfaction proved to be a significant positive effect on employee performance the path coefficient of 0.264 and T-Stats for 2.458, (4) compensation proved positive and significant effect employee performance the path coefficient of 0.242 and T-Stats for 2.912, (5) work environment proved positive and significant effect employee performance the path coefficient of 0.378 and T-Stats for 3.343. Based on test results obtained statistical results of all variables positive and signicant impact.

Sign in / Sign up

Export Citation Format

Share Document