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Endocrine Journal Mar 2023Obesity is a major complication in children with 21-hydroxylase deficiency (21-OHD). There is evidence to show that higher body mass index (BMI) during infancy and early...
Obesity is a major complication in children with 21-hydroxylase deficiency (21-OHD). There is evidence to show that higher body mass index (BMI) during infancy and early childhood is associated with an increased risk for the subsequent development of obesity in the general population; however, limited information is currently available on this issue in 21-OHD patients. Additionally, despite the frequent use of supraphysiological dosages of hydrocortisone in 21-OHD, the association between BMI and hydrocortisone dosage during these periods remains largely unclear; therefore, we retrospectively investigated BMI at approximately 1 and 3 years old and its association with hydrocortisone dosage in 56 children with 21-OHD. The median BMI-standard deviation score (SDS) was 0.28 (Interquartile range [IQR]: -0.53 to 1.09) and 0.39 (IQR: -0.44 to 1.14) at approximately 1 and 3 years old, respectively, and no association was observed between hydrocortisone dosage and BMI-SDS at either time-point; however, multivariate analysis revealed that hydrocortisone dosage at approximately 1 year old was positively associated with changes in BMI (β = 0.57, p = 0.013) and BMI-SDS (β = 0.59, p = 0.011) between approximately 1 and 3 years old after adjustment for age, sex, and changes in hydrocortisone dosage during the same period. The average dosage of hydrocortisone between approximately 6 months and 1 year old also showed similar results. These results indicate that a higher dosage of hydrocortisone during late infancy is associated with a higher BMI at approximately 3 years old, which may lead to the development of obesity later in life in children with 21-OHD.
Topics: Child; Humans; Child, Preschool; Infant; Hydrocortisone; Body Mass Index; Retrospective Studies; Body Height; Obesity
PubMed: 36504089
DOI: 10.1507/endocrj.EJ22-0466 -
Minerva Anestesiologica Apr 2024Opioid-free anesthesia (OFA) represents an innovative approach that prioritizes patient safety, reduces the risks associated with opioid use, and seeks to enhance... (Review)
Review
Opioid-free anesthesia (OFA) represents an innovative approach that prioritizes patient safety, reduces the risks associated with opioid use, and seeks to enhance recovery. Few descriptions regarding the practical and implementation aspects exist. This review serves as a practical guide on OFA teaching and application. We briefly discuss the historical use of opioids in anesthesia, side effects and their consequences. We discuss pedagogical avenues and challenges, as well as implementation of OFA in less experienced settings. Opioid use in anesthesia originally coexisted with OFA. During the last decades, the advent of multimodal analgesia has resulted in decreased opioid dosages both before and after surgery. Recently, OFA increased in popularity, supported by meta-analyses, due to reduced nausea and vomiting, with a potential, even if limited, impact on pain. OFA, as part of rational prescribing, may contribute to a more patient-centered approach. Different strategies for OFA implementation coexist. Educational aspects, leadership, guidelines, local guidance, and training are all important. We propose a framework for OFA implementation with concrete options, including patient preparation, choice of OFA pharmacological agents (according to type of surgery and patient), and postoperative care. Whilst opioids still have an important place in pain management, they have brought harms that we cannot ignore. Evidence for using opioid-sparing and OFA techniques continues to emerge and there is a need to personalize more approaches. In this review, we provide evidence-based, relatively simple methods that can be used in implementing and delivering OFA.
Topics: Humans; Analgesics, Opioid; Anesthesia; Anesthesiology
PubMed: 38482635
DOI: 10.23736/S0375-9393.23.17824-2 -
Internal and Emergency Medicine Aug 2021We conducted an observational cohort study in adult patients consecutively admitted for the respiratory illness Covid-19 to our hub hospital from March 9 to April 7,... (Observational Study)
Observational Study
We conducted an observational cohort study in adult patients consecutively admitted for the respiratory illness Covid-19 to our hub hospital from March 9 to April 7, 2020. The high observed rate of venous thromboembolism prompted us to increase the prophylactic doses of enoxaparin from 40 mg daily up to 1 mg/kg twice daily in patients admitted to intensive care units (ICU), 0.7 mg/kg twice daily in high-intensity of care wards and 1 mg/kg daily in low-intensity of care wards. Patients on high enoxaparin doses were compared to those who received prophylaxis with the standard dosage. Efficacy endpoints were mortality, clinical deterioration, and the occurrence of venous thromboembolism, safety endpoint was the occurrence of major bleeding. Of 278 patients with Covid-19, 127 received prophylaxis with high enoxaparin doses and 151 with standard dosage. At 21 days, the incidence rate of death and clinical deterioration were lower in patients on higher doses than in those on the standard dosage (hazard ratio 0.39, 95% confidence interval 0.23-0.62), and the incidence of venous thromboembolism was also lower (hazard ratio 0.52, 95% confidence interval 0.26-1.05). Major bleeding occurred in four of 127 patients (3.1%) on the high enoxaparin dosage. In conclusion, in the cohort of patients with Covid-19 treated with high enoxaparin dosages we observed a 60% reduction of mortality and clinical deterioration and a 50% reduction of venous thromboembolism compared to standard dosage prophylaxis. However, 3% of patients on high enoxaparin dosages had non-fatal major bleeding.
Topics: Aged; Body Mass Index; COVID-19; Cohort Studies; Enoxaparin; Female; Heparin, Low-Molecular-Weight; Hospitalization; Humans; Male; Middle Aged; Pre-Exposure Prophylaxis; Venous Thromboembolism; COVID-19 Drug Treatment
PubMed: 33389568
DOI: 10.1007/s11739-020-02585-9 -
Iranian Journal of Medical Sciences Jan 2021Since the emergence of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic, an increasing number of reports and studies have tried to warn the... (Review)
Review
Since the emergence of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic, an increasing number of reports and studies have tried to warn the medical community about the thrombotic complications of coronavirus disease 2019 (COVID-19). It is suggested that the hyperinflammatory response and endothelial injury, especially in patients with severe disease, lead to a hypercoagulable state. Sudden deaths occurring in some patients also point to fulminant arrhythmias and massive pulmonary embolism (PE). Several expert panels have published recommendations regarding the prophylaxis and treatment of such complications. Nonetheless, there are limited high-quality studies for evidence-based decision-making, and most of these recommendations have arisen from descriptive studies, and optimal anticoagulant agents and dosages are yet to be designated. The coagulopathy persists after the acute phase of the illness, and some panels recommend the continuation of deep vein thrombosis prophylaxis for several days after regaining the normal daily activities by the patient. Here, we review the incidence and possible mechanisms of thrombotic complications, and present a summary of the considerations for the prophylaxis and treatment of such complications in the adult population.
Topics: Anticoagulants; COVID-19; Humans; Incidence; Platelet Aggregation Inhibitors; Risk Factors; Thrombophilia; Venous Thromboembolism
PubMed: 33487787
DOI: 10.30476/ijms.2020.87233.1730 -
International Journal of Molecular... Mar 2020Deep dermal defects can result from burns, necrotizing fasciitis and severe soft tissue trauma. Physiological scar restriction during wound healing becomes increasingly... (Review)
Review
Deep dermal defects can result from burns, necrotizing fasciitis and severe soft tissue trauma. Physiological scar restriction during wound healing becomes increasingly relevant in proportion to the affected area. This massively restricts the general mobility of patients. External mechanical influences (activity or immobilization in everyday life) can lead to the formation of marked scar strands and adhesions. Overloading results in a renewed inflammatory reaction and thus in further restriction. Appropriate mechanical stimuli can have a positive influence on the scar tissue. "Use determines function," and even minimal external forces are sufficient to cause functional alignment (mechanotransduction). The first and second remarkable increases in connective tissue resistance (R1 and R2) seem to be relevant clinical indications of adequate dosage in the proliferation and remodulation phase, making it possible to counteract potential overdosage in deep dermal defects. The current state of research does not allow a direct transfer to the clinical treatment of large scars. However, the continuous clinical implementation of study results with regard to the mechanosensitivity of isolated fibroblasts, and the constant adaptation of manual techniques, has nevertheless created an evidence-base for manual scar therapy. The manual dosages are adapted to tissue physiology and to respective wound healing phases. Clinical observations show improved mobility of the affected regions and fewer relapses into the inflammatory phase due to mechanical overload.
Topics: Animals; Biomarkers; Burns; Cicatrix; Cicatrix, Hypertrophic; Connective Tissue; Dermis; Disease Management; Fibroblasts; Humans; Mechanotransduction, Cellular; Musculoskeletal Manipulations; Wound Healing
PubMed: 32192136
DOI: 10.3390/ijms21062055 -
Advanced Science (Weinheim,... Jan 2022A high-throughput non-viral intracellular delivery platform is introduced for the transfection of large cargos with dosage-control. This platform, termed...
A high-throughput non-viral intracellular delivery platform is introduced for the transfection of large cargos with dosage-control. This platform, termed Acoustic-Electric Shear Orbiting Poration (AESOP), optimizes the delivery of intended cargo sizes with poration of the cell membranes via mechanical shear followed by the modulated expansion of these nanopores via electric field. Furthermore, AESOP utilizes acoustic microstreaming vortices wherein up to millions of cells are trapped and mixed uniformly with exogenous cargos, enabling the delivery of cargos into cells with targeted dosages. Intracellular delivery of a wide range of molecule sizes (<1 kDa to 2 MDa) with high efficiency (>90%), cell viability (>80%), and uniform dosages (<60% coefficient of variation (CV)) simultaneously into 1 million cells min per single chip is demonstrated. AESOP is successfully applied to two gene editing applications that require the delivery of large plasmids: i) enhanced green fluorescent protein (eGFP) plasmid (6.1 kbp) transfection, and ii) clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9-mediated gene knockout using a 9.3 kbp plasmid DNA encoding Cas9 protein and single guide RNA (sgRNA). Compared to alternative platforms, this platform offers dosage-controlled intracellular delivery of large plasmids simultaneously to large populations of cells while maintaining cell viability at comparable delivery efficiencies.
Topics: Acoustics; Cell Line, Tumor; Gene Editing; Gene Transfer Techniques; Humans
PubMed: 34716688
DOI: 10.1002/advs.202102021 -
Advanced Science (Weinheim,... Feb 2021Optical-resolution photoacoustic microscopy (OR-PAM) is an excellent modality for in vivo biomedical imaging as it noninvasively provides high-resolution morphologic and...
Optical-resolution photoacoustic microscopy (OR-PAM) is an excellent modality for in vivo biomedical imaging as it noninvasively provides high-resolution morphologic and functional information without the need for exogenous contrast agents. However, the high excitation laser dosage, limited imaging speed, and imperfect image quality still hinder the use of OR-PAM in clinical applications. The laser dosage, imaging speed, and image quality are mutually restrained by each other, and thus far, no methods have been proposed to resolve this challenge. Here, a deep learning method called the multitask residual dense network is proposed to overcome this challenge. This method utilizes an innovative strategy of integrating multisupervised learning, dual-channel sample collection, and a reasonable weight distribution. The proposed deep learning method is combined with an application-targeted modified OR-PAM system. Superior images under ultralow laser dosage (32-fold reduced dosage) are obtained for the first time in this study. Using this new technique, a high-quality, high-speed OR-PAM system that meets clinical requirements is now conceivable.
PubMed: 33552869
DOI: 10.1002/advs.202003097 -
Computational Intelligence and... 2022In traditional Chinese medicine (TCM), drug dosage is an important part of the prescription. Different doses of the same drug can have varying curative effects. Doctors... (Review)
Review
In traditional Chinese medicine (TCM), drug dosage is an important part of the prescription. Different doses of the same drug can have varying curative effects. Doctors must determine the drug combination and dosage in clinical practice based on the patient's symptoms and treatment efficacy. Existing studies on the prescription pattern of TCM on the treatment of osteoporosis only analyze the frequency that a certain drug combination is used, without considering the treatment efficacy or drug dosage. As a result, we searched for and recorded existing literature on randomized controlled trials of TCM treatment of osteoporosis, calculated weights based on the treatment efficacy of the prescriptions used in the randomized controlled trials, and created the TCM weighted transaction database. Then, a new multilevel Top- weighted association rule algorithm is proposed to obtain effective prescription patterns that include drug dosages, which can assist doctors in clinical practice in choosing a combination of drugs to form a prescription with good curative effects.
Topics: Databases, Factual; Drugs, Chinese Herbal; Humans; Medicine, Chinese Traditional; Osteoporosis; Prescriptions
PubMed: 35665295
DOI: 10.1155/2022/5466011 -
Interactive Cardiovascular and Thoracic... Apr 2021A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does routine topical antimicrobial administration... (Review)
Review
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does routine topical antimicrobial administration prevent sternal wound infection (SWI) after cardiac surgery? Altogether >238 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Several different antimicrobial agents, dosages and application protocols were found in the literature. Regarding topical vancomycin use, a meta-analysis by Kowalewski et al. demonstrated a 76% risk reduction in any SWI. Collagen-gentamicin sponge application was associated with a 38% risk reduction in SWI in another meta-analysis by Kowalewski et al., which included 4 randomized control trials and >23 000 patients. Lower evidence observational studies found benefit in the use of different regimes, including: combination of vancomycin paste and subcutaneous gentamycin; combined cefazoline and gentamicin spray; isolated cefazolin; bacitracin ointment; and rifampicin irrigation. We conclude that, in light of the body of evidence available, topical antibiotic application prevents SWI, including both superficial and deep SWI. The strongest evidence, derived from 2 meta-analyses, is related to the use of gentamicin-collagen sponges and topical vancomycin. Heterogeneity throughout studies regarding antibiotic agents, dosages, application protocols and SWI definition makes providing general recommendations challenging.
Topics: Administration, Topical; Anti-Infective Agents; Cardiac Surgical Procedures; Gentamicins; Humans; Meta-Analysis as Topic; Sternotomy; Sternum; Surgical Wound Infection; Treatment Outcome; Vancomycin
PubMed: 33346346
DOI: 10.1093/icvts/ivaa292 -
Influence of Fiber Type and Dosage on Tensile Property of Asphalt Mixture Using Direct Tensile Test.Materials (Basel, Switzerland) Jan 2023In engineering practice, fiber addition is a frequently used method to improve the tensile property of asphalt mixture. However, the optimum fiber type and dosage have...
In engineering practice, fiber addition is a frequently used method to improve the tensile property of asphalt mixture. However, the optimum fiber type and dosage have not been determined by direct tensile tests. In this paper, monotonic tensile tests were conducted on three kinds of stone mastic asphalt (SMA13) mixtures, that is, granular-lignin-fiber-reinforced SMA (GFSMA), flocculent-lignin-fiber-reinforced SMA (FFSMA), and basalt-fiber-reinforced SMA (BFSMA) at different fiber dosages to probe the influence of fiber dosage on their tensile mechanical indexes (tensile strength, ultimate strain, elastic modulus, and strain energy density) and to determine the optimum dosage of each kind of fiber. The results showed that with the elevation of fiber dosage, the tensile strength, elastic modulus, and strain energy density of all three kinds of asphalt mixtures increased first and then decreased, while the ultimate strain increased constantly. The optimum dosage was 0.50 wt%, 0.45 wt%, and 0.50 wt% for granular lignin fiber, flocculent lignin fiber, and basalt fiber, respectively. On this basis, strain-controlled direct tensile fatigue tests were conducted on the three kinds of asphalt mixtures at the corresponding optimum fiber dosage. The results indicated that asphalt mixture reinforced with 0.50 wt% granular lignin fiber exhibited ideal direct tensile fatigue performance with respect to fatigue life and accumulative dissipated energy. Therefore, granular lignin fiber is recommended as the favorable fiber type, and its optimum dosage is 0.50 wt%. Moreover, scanning electron microscopy (SEM) demonstrated that the essence of the impact of fiber dosage and type on the tensile property of SMA is whether the reinforcement effect on the mixture matrix outweighs the negative effect of the defects between fiber and mixture matrix, or whether the reverse applies.
PubMed: 36676561
DOI: 10.3390/ma16020822