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  1. Article ; Online: C1-esterase inhibitor for short-term prophylaxis in a patient with hereditary angioedema with normal C1 inhibitor function.

    Yu, Savio K H / Callum, Jeannie / Alam, Asim

    Journal of clinical anesthesia

    2016  Volume 35, Page(s) 488–491

    Abstract: Hereditary angioedema with normal C1-esterase inhibitor (HAE-nC1INH) perioperative is a rare condition which could have potential disastrous ramifications for the anesthesiologist in the perioperative period. However, there is limited evidence and/or ... ...

    Abstract Hereditary angioedema with normal C1-esterase inhibitor (HAE-nC1INH) perioperative is a rare condition which could have potential disastrous ramifications for the anesthesiologist in the perioperative period. However, there is limited evidence and/or guidelines on the optimal way to manage these patients. We present the case of a patient with HAE-nC1INH who was successfully managed in the perioperative period with plasma derived C1-esterase inhibitor (pdC1INH). A 29-year-old woman with a diagnosis of HAE-nC1INH presented to the preoperative consultation in preparation for an upcoming total thyroidectomy. She had a 14-year history of ongoing lip and facial edema sometimes necessitating emergency department visitation. Close consultation with her immunologist, transfusion medicine specialists, and anesthesia care providers allowed for a preoperative plan to provide the patient adequate prophylaxis. Both pdC1INH and tranexamic acid were given preoperatively. The patient underwent surgery with no complications. A multidisciplinary team of clinical immunologists, transfusion medicine specialists, and anesthesiologists facilitated the successful perioperative management of a patient with HAE-nC1INH; pdC1INH may a suitable prophylactic perioperative therapy for this rare patient population.
    MeSH term(s) Adult ; Angioedemas, Hereditary/complications ; Angioedemas, Hereditary/surgery ; Antifibrinolytic Agents/therapeutic use ; Complement C1 Inactivator Proteins/physiology ; Complement C1 Inhibitor Protein/therapeutic use ; Complement Inactivating Agents/therapeutic use ; Female ; Humans ; Postoperative Complications/prevention & control ; Preoperative Care/methods ; Thyroidectomy ; Tranexamic Acid/therapeutic use
    Chemical Substances Antifibrinolytic Agents ; Complement C1 Inactivator Proteins ; Complement C1 Inhibitor Protein ; Complement Inactivating Agents ; SERPING1 protein, human ; Tranexamic Acid (6T84R30KC1)
    Language English
    Publishing date 2016-12
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1011618-7
    ISSN 1873-4529 ; 0952-8180
    ISSN (online) 1873-4529
    ISSN 0952-8180
    DOI 10.1016/j.jclinane.2016.08.042
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2622: Show issues Location:
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  2. Article ; Online: A systematic review of medication safety outcomes related to drug interaction software.

    Wong, Kevin / Yu, Savio K H / Holbrook, Anne

    Journal of population therapeutics and clinical pharmacology = Journal de la therapeutique des populations et de la pharmacologie clinique

    2010  Volume 17, Issue 2, Page(s) e243–55

    Abstract: Background: Adverse drug events (ADEs) represent an important problem for hospital and primary care. Software that detects potential adverse drug interactions has been widely implemented in an effort to reduce the rate of ADEs. However, the impact of ... ...

    Abstract Background: Adverse drug events (ADEs) represent an important problem for hospital and primary care. Software that detects potential adverse drug interactions has been widely implemented in an effort to reduce the rate of ADEs. However, the impact of drug interaction detection software (DIS) on patient safety outcomes remains unknown.
    Objectives: To systematically review the literature on DIS in preventing adverse drug events and determine the effectiveness and cost-effectiveness of DIS.
    Methods: A literature search of MEDLINE, EMBASE, CINAHL, IPA and Healthstar, using terms "Computer, Software or Decision Support" combined with "Drug Interactions, Drug Errors or Drug Monitoring" sought English language, post-1990 prospective studies that examined drug interaction (drug-drug) software as an intervention and adverse drug interactions as an outcome. Relevant studies were analyzed using a Bayesian meta-analysis approach.
    Results: Of 5848 citations, only four studies met our inclusion criteria. Most of the excluded studies were not prospective or measured only prescriber attitudes, implementation success or changes in workflow. No study examined the impact of drug interaction software exclusively, rather as a component of decision support software. A Bayesian meta-analysis of these studies showed no significant difference in event rate between intervention and control groups (relative risk 0.66, 95% CI 0.33 to 1.18). The posterior median I-squared was 52%.
    Conclusion: No good quality studies address the specific benefits and harms or cost-effectiveness of drug interaction software on medication safety or clinical outcomes. The evidence at present does not support a benefit for these systems or support any policy to widely disseminate their use.
    MeSH term(s) Animals ; Drug Interactions ; Drug-Related Side Effects and Adverse Reactions/economics ; Drug-Related Side Effects and Adverse Reactions/prevention & control ; Humans ; Software/standards ; Treatment Outcome
    Language English
    Publishing date 2010-07-06
    Publishing country Australia
    Document type Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
    ISSN 2561-8741
    ISSN (online) 2561-8741
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: The safety of perioperative esmolol: a systematic review and meta-analysis of randomized controlled trials.

    Yu, Savio K H / Tait, Gordon / Karkouti, Keyvan / Wijeysundera, Duminda / McCluskey, Stuart / Beattie, W Scott

    Anesthesia and analgesia

    2011  Volume 112, Issue 2, Page(s) 267–281

    Abstract: Background: Although β blockers have been found to decrease perioperative myocardial infarction (MI), β-blocker-mediated hypotension is associated with postoperative stroke and mortality. In this systematic review we assessed the safety and efficacy of ... ...

    Abstract Background: Although β blockers have been found to decrease perioperative myocardial infarction (MI), β-blocker-mediated hypotension is associated with postoperative stroke and mortality. In this systematic review we assessed the safety and efficacy of the β1-specific, adrenergic receptor antagonist esmolol in noncardiac surgery. Safety was assessed by analyzing the incidence of postoperative hypotension and bradycardia, and efficacy was assessed by analyzing the incidence of myocardial ischemia.
    Methods: We searched electronic databases for randomized placebo-controlled trials of the perioperative use of esmolol in noncardiac surgery. We abstracted data on design, demographics, hemodynamic changes (planned or unplanned), myocardial ischemia, and MI. Heterogeneity was assessed via meta-regression.
    Results: Our search identified 67 trials, which were well matched for study characteristics. The quality of the studies was limited by small sample size and poorly defined allocation concealment. Overall, the analysis demonstrates an increased incidence of unplanned hypotension (OR 2.13; 95% confidence interval [CI], 1.48 to 3.04), which was found to be dose related (R(2) = 0.408). An increased incidence of significant bradycardia was not demonstrated (OR 1.18; 95% CI, 0.69 to 2.02). Dose titration was shown to influence both the change in arterial blood pressure and heart rate. In comparison with placebo, esmolol decreased the frequency of myocardial ischemia in the 7 evaluating studies (OR 0.17; 95% CI, 0.02 to 0.45). We did not assess the effects of esmolol on the incidence of MI or stroke because the incidence of these events was too infrequent in the retrieved studies.
    Conclusion: This review suggests that titration of esmolol to a hemodynamic end point can be safe and effective. Safety data from studies in higher-risk patients are needed to establish a perioperative safety and efficacy profile of esmolol.
    MeSH term(s) Adrenergic beta-1 Receptor Antagonists/administration & dosage ; Adrenergic beta-1 Receptor Antagonists/adverse effects ; Blood Pressure/drug effects ; Bradycardia/chemically induced ; Bradycardia/physiopathology ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Evidence-Based Medicine ; Heart Rate/drug effects ; Humans ; Hypotension/chemically induced ; Hypotension/physiopathology ; Myocardial Ischemia/etiology ; Myocardial Ischemia/physiopathology ; Myocardial Ischemia/prevention & control ; Perioperative Care ; Postoperative Complications/etiology ; Postoperative Complications/physiopathology ; Postoperative Complications/prevention & control ; Propanolamines/administration & dosage ; Propanolamines/adverse effects ; Randomized Controlled Trials as Topic ; Risk Assessment ; Risk Factors ; Treatment Outcome
    Chemical Substances Adrenergic beta-1 Receptor Antagonists ; Propanolamines ; esmolol (MDY902UXSR)
    Language English
    Publishing date 2011-02
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Review
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ANE.0b013e3182025af7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Uk I Zs.78: Show issues Location:
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    Zs.MO 149: Show issues

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  4. Article: Targeted therapy for intractable cancer on the basis of molecular profiles: An open-label, phase II basket trial (Long March Pathway).

    Jiao, Xiao-Dong / Qin, Bao-Dong / Wang, Zhan / Liu, Ke / Wu, Ying / Ling, Yan / Qin, Wen-Xing / Wang, Miao-Miao / Yuan, Ling-Yan / Barreto, Savio George / Kim, Anthony W / Mak, Kimberley / Li, Hao / Xu, Yuan-Yuan / Qiu, Xiao-Ming / Wu, Min / Jin, Min / Xu, Li-Chao / Zhong, Yi /
    Yang, Hui / Chen, Xue-Qin / Zeng, Yu / Shi, Jun / Zhu, Wen-Yu / Ding, Qing-Qing / Jia, Wei / Liu, Su-Fen / Zhou, Jun-Jing / Shen, Hong / Yao, Shi-Hua / Guo, Zhao-Ji / Li, Ting / Zhou, Pei-Juan / Dong, Xue-Wei / Lu, Wen-Feng / Coleman, Robert L / Akce, Mehmet / Akladios, Chérif / Puccetti, Francesco / Zang, Yuan-Sheng

    Frontiers in oncology

    2023  Volume 13, Page(s) 860711

    Abstract: Purpose: We evaluated he effects of molecular guided-targeted therapy for intractable cancer. Also, the epidemiology of druggable gene alterations in Chinese population was investigated.: Materials and methods: The Long March Pathway (ClinicalTrials ... ...

    Abstract Purpose: We evaluated he effects of molecular guided-targeted therapy for intractable cancer. Also, the epidemiology of druggable gene alterations in Chinese population was investigated.
    Materials and methods: The Long March Pathway (ClinicalTrials.gov identifier: NCT03239015) is a non-randomized, open-label, phase II trial consisting of several basket studies examining the molecular profiles of intractable cancers in the Chinese population. The trial aimed to 1) evaluate the efficacy of targeted therapy for intractable cancer and 2) identify the molecular epidemiology of the tier II gene alterations among Chinese pan-cancer patients.
    Results: In the first stage, molecular profiles of 520 intractable pan-cancer patients were identified, and 115 patients were identified to have tier II gene alterations. Then, 27 of these 115 patients received targeted therapy based on molecular profiles. The overall response rate (ORR) was 29.6% (8/27), and the disease control rate (DCR) was 44.4% (12/27). The median duration of response (DOR) was 4.80 months (95% CI, 3.33-27.2), and median progression-free survival (PFS) was 4.67 months (95% CI, 2.33-9.50). In the second stage, molecular epidemiology of 17,841 Chinese pan-cancer patients demonstrated that the frequency of tier II gene alterations across cancer types is 17.7%. Bladder cancer had the most tier-II alterations (26.1%), followed by breast cancer (22.4%), and non-small cell lung cancer (NSCLC; 20.2%).
    Conclusion: The Long March Pathway trial demonstrated a significant clinical benefit for intractable cancer from molecular-guided targeted therapy in the Chinese population. The frequency of tier II gene alterations across cancer types supports the feasibility of molecular-guided targeted therapy under basket trials.
    Language English
    Publishing date 2023-02-23
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2649216-7
    ISSN 2234-943X
    ISSN 2234-943X
    DOI 10.3389/fonc.2023.860711
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  5. Article ; Online: Prognostic Significance of Grade Discrepancy Between Primary Tumor and Venous Thrombus in Nonmetastatic Clear-cell Renal Cell Carcinoma: Analysis of the REMEMBER Registry and Implications for Adjuvant Therapy.

    Wu, Zhenjie / Chen, Hui / Chen, Qi / Ge, Silun / Yu, Nengwang / Campi, Riccardo / Gómez Rivas, Juan / Autorino, Riccardo / Rouprêt, Morgan / Psutka, Sarah P / Mehrazin, Reza / Porpiglia, Francesco / Bensalah, Karim / Black, Peter C / Mir, Maria C / Minervini, Andrea / Djaladat, Hooman / Margulis, Vitaly / Bertolo, Riccardo /
    Caliò, Anna / Carbonara, Umberto / Amparore, Daniele / Borregales, Leonardo D / Ciccarese, Chiara / Diana, Pietro / Erdem, Selcuk / Marandino, Laura / Marchioni, Michele / Muselaers, Constantijn H J / Palumbo, Carlotta / Pavan, Nicola / Pecoraro, Angela / Roussel, Eduard / Warren, Hannah / Pandolfo, Savio Domenico / Chen, Rui / Zhou, Wenquan / Zhai, Wei / He, Miaoxia / Li, Yaoming / Han, Bo / Wan, Jie / Zeng, Xing / Yan, Junan / Fu, Yao / Ji, Changwei / Fan, Xiang / Zhang, Guangyuan / Zhao, Cheng / Jing, Taile / Wang, Anbang / Feng, Chenchen / Zhao, Hongwei / Sun, Di / Wang, Liang / Tai, Sheng / Zhang, Cheng / Chen, Shaohao / Liu, Yixun / Xu, Zhipeng / Wang, Haifeng / Gao, Jinli / Wang, Fubo / Cheng, Jiwen / Miao, He / Rao, Qiu / Wang, Jianning / Xu, Ning / Wang, Gongxian / Liang, Chaozhao / Liu, Zhiyu / Xia, Dan / Jiang, Jun / Zu, Xiongbing / Chen, Ming / Guo, Hongqian / Qin, Weijun / Wang, Zhe / Xue, Wei / Shi, Benkang / Zhou, Xiaojun / Wang, Shaogang / Zheng, Junhua / Ge, Jingping / Feng, Xiang / Li, Minming / Chen, Cheng / Qu, Le / Wang, Linhui

    European urology oncology

    2023  Volume 7, Issue 1, Page(s) 112–121

    Abstract: Background: Further stratification of the risk of recurrence of clear-cell renal cell carcinoma (ccRCC) with venous tumor thrombus (VTT) will facilitate selection of candidates for adjuvant therapy.: Objective: To assess the impact of tumor grade ... ...

    Abstract Background: Further stratification of the risk of recurrence of clear-cell renal cell carcinoma (ccRCC) with venous tumor thrombus (VTT) will facilitate selection of candidates for adjuvant therapy.
    Objective: To assess the impact of tumor grade discrepancy (GD) between the primary tumor (PT) and VTT in nonmetastatic ccRCC on disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS).
    Design, setting, and participants: This was a retrospective analysis of a multi-institutional nationwide data set for patients with pT3N0M0 ccRCC who underwent radical nephrectomy and thrombectomy.
    Outcomes measurements and statistical analysis: Pathology slides were centrally reviewed. GD, a bidirectional variable (upgrading or downgrading), was numerically defined as the VTT grade minus the PT grade. Multivariable models were built to predict DFS, OS, and CSS.
    Results and limitations: We analyzed data for 604 patients with median follow-up of 42 mo (excluding events). Tumor GD between VTT and PT was observed for 47% (285/604) of the patients and was an independent risk factor with incremental value in predicting the outcomes of interest (all p < 0.05). Incorporation of tumor GD significantly improved the performance of the ECOG-ACRIN 2805 (ASSURE) model. A GD-based model (PT grade, GD, pT stage, PT sarcomatoid features, fat invasion, and VTT consistency) had a c index of 0.72 for DFS. The hazard ratios were 8.0 for GD = +2 (p < 0.001), 1.9 for GD = +1 (p < 0.001), 0.57 for GD = -1 (p = 0.001), and 0.22 for GD = -2 (p = 0.003) versus GD = 0 as the reference. According to model-converted risk scores, DFS, OS, and CSS significantly differed between subgroups with low, intermediate, and high risk (all p < 0.001).
    Conclusions: Routine reporting of VTT upgrading or downgrading in relation to the PT and use of our GD-based nomograms can facilitate more informed treatment decisions by tailoring strategies to an individual patient's risk of progression.
    Patient summary: We developed a tool to improve patient counseling and guide decision-making on other therapies in addition to surgery for patients with the clear-cell type of kidney cancer and tumor invasion of a vein.
    MeSH term(s) Humans ; Carcinoma, Renal Cell/surgery ; Carcinoma, Renal Cell/pathology ; Prognosis ; Retrospective Studies ; Neoplasm Invasiveness/pathology ; Kidney Neoplasms/surgery ; Thrombosis/pathology ; Thrombosis/surgery ; Registries
    Language English
    Publishing date 2023-07-18
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2588-9311
    ISSN (online) 2588-9311
    DOI 10.1016/j.euo.2023.06.006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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