The Romanian chapter of the European Society of Regional Anesthesia and Pain Therapy (ESRA) reached to the seventh edition. More information is available at arar.medevents.ro. The meeting was held in Cluj-Napoca, and gathered together 65 lecturers from 15 countries. 430 delegates registered for the meeting for both on-site and on-line versions. The participants had the opportunity to present the results of their own scientific work in the dedicated posted sessions. The organizing committee hopes that soon this session will become a launching pad for the young researchers who will increase their numbers in studying both regional anesthesia and pain treatment. The collaboration with Signa-Vitae journal honor us, and we hope we will increase it with mutual benefits. Below are some of the nominated abstracts and lectures.
{"title":"Abstracts of the 7th edition of “National Congress of the Romanian Association of Regional Anesthesia and Pain Therapy (ARAR)”","authors":"","doi":"10.22514/sv.2023.094","DOIUrl":"https://doi.org/10.22514/sv.2023.094","url":null,"abstract":"The Romanian chapter of the European Society of Regional Anesthesia and Pain Therapy (ESRA) reached to the seventh edition. More information is available at arar.medevents.ro. The meeting was held in Cluj-Napoca, and gathered together 65 lecturers from 15 countries. 430 delegates registered for the meeting for both on-site and on-line versions. The participants had the opportunity to present the results of their own scientific work in the dedicated posted sessions. The organizing committee hopes that soon this session will become a launching pad for the young researchers who will increase their numbers in studying both regional anesthesia and pain treatment. The collaboration with Signa-Vitae journal honor us, and we hope we will increase it with mutual benefits. Below are some of the nominated abstracts and lectures.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135496330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study explores the applicability of general anesthesia with a laryngeal mask airway in painless bronchoscopy and its impact on the sense of comfort and satisfaction. Using the random number table method, we divided 101 elderly patients with respiratory disease who underwent bronchoscopy into two groups, with one group receiving intravenous general anesthesia (IVGA) and the other group receiving laryngeal mask airway general anesthesia (LMAGA). Their vital signs, including heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2), were compared and we also examined their perioperative adverse effects and assessed the sense of comfort and satisfaction. There were no significant differences in vital signs, including HR, MAP and SpO2, between the two groups before anesthesia (T0). However, at T1 and T2, the HR of patients in the LMAGA group was significantly lower than that of the IVGA group. Additionally, the MAP and SpO2 levels in the LMAGA group were significantly higher than those in the IVGA group. The LMAGA group also demonstrated significantly shorter surgical duration and faster recovery from anesthesia than the IVGA group. Furthermore, the LMAGA group exhibited a significantly lower incidence of adverse effects and a notable increase in comfort and satisfaction compared to the IVGA group. LMAGA demonstrates a significant anesthetic effect in painless bronchoscopy, effectively improving the patient’s vital signs, reducing the duration of the operation and anesthetic recovery time, lowering the occurrence of perioperative adverse reactions, and enhancing the overall sense of comfort and satisfaction.
{"title":"he application value of laryngeal mask airway general anesthesia in painless bronchoscopy and its influence on the sense of comfort and satisfaction","authors":"","doi":"10.22514/sv.2023.103","DOIUrl":"https://doi.org/10.22514/sv.2023.103","url":null,"abstract":"This study explores the applicability of general anesthesia with a laryngeal mask airway in painless bronchoscopy and its impact on the sense of comfort and satisfaction. Using the random number table method, we divided 101 elderly patients with respiratory disease who underwent bronchoscopy into two groups, with one group receiving intravenous general anesthesia (IVGA) and the other group receiving laryngeal mask airway general anesthesia (LMAGA). Their vital signs, including heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2), were compared and we also examined their perioperative adverse effects and assessed the sense of comfort and satisfaction. There were no significant differences in vital signs, including HR, MAP and SpO2, between the two groups before anesthesia (T0). However, at T1 and T2, the HR of patients in the LMAGA group was significantly lower than that of the IVGA group. Additionally, the MAP and SpO2 levels in the LMAGA group were significantly higher than those in the IVGA group. The LMAGA group also demonstrated significantly shorter surgical duration and faster recovery from anesthesia than the IVGA group. Furthermore, the LMAGA group exhibited a significantly lower incidence of adverse effects and a notable increase in comfort and satisfaction compared to the IVGA group. LMAGA demonstrates a significant anesthetic effect in painless bronchoscopy, effectively improving the patient’s vital signs, reducing the duration of the operation and anesthetic recovery time, lowering the occurrence of perioperative adverse reactions, and enhancing the overall sense of comfort and satisfaction.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135508336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diagnostic errors are a relevant health-care problem. Although medical history taking is usually the first step in patients’ assessment there are only limited data on the association of its quality and diagnostic accuracy. Accordingly, this prospective randomized simulator-based single-blind trial aimed to investigate the effects of initial cues and history taking skills on diagnostic accuracy. 198 medical students (135 females) were given the task to assess a patient presenting with simulated acute pulmonary embolism. Participants were randomized to six versions of the scenario differing only in the initial cues, i.e., in the reply of the patient to the initial question about the reason for his visit. In three of six versions, initial cues were restricted to thoracic symptoms (chest pain, dyspnoea, or combination of both). In the remaining three versions, initial cues consisted of thoracic and extra-thoracic (leg pain, immobilization) symptoms. The primary outcome was diagnostic accuracy. The number of initial cues was unrelated to diagnostic accuracy. However, the combination of extra-thoracic and thoracic cues resulted in a higher diagnostic accuracy than thoracic cues only (52/96 vs. 35/102, p = 0.006). In multivariate regression, the number of questions asked from the categories “risk factors of pulmonary embolism” (regression coefficient 0.15, p < 0.001) and “dyspnea” (regression coefficient 0.12, p < 0.001) predicted diagnostic accuracy. Moreover, questions relating to “immobilization” (regression coefficient 0.42, p < 0.001), “onset of dyspnea” (regression coefficient 0.23, p = 0.003), and “modifying factors of chest pain” (regression coefficient 0.20, p = 0.04) independently predicted diagnostic accuracy. Interestingly, more systematic history taking was associated with lower diagnostic accuracy (regression coefficient −0.27, p < 0.001). The present trial demonstrates that during history taking cues initially revealed by the patient, kind and category of questions asked during the interview, and the interview’s structural systematics affect diagnostic accuracy.
{"title":"Effects of the quality of medical history taking on diagnostic accuracy","authors":"","doi":"10.22514/sv.2023.081","DOIUrl":"https://doi.org/10.22514/sv.2023.081","url":null,"abstract":"Diagnostic errors are a relevant health-care problem. Although medical history taking is usually the first step in patients’ assessment there are only limited data on the association of its quality and diagnostic accuracy. Accordingly, this prospective randomized simulator-based single-blind trial aimed to investigate the effects of initial cues and history taking skills on diagnostic accuracy. 198 medical students (135 females) were given the task to assess a patient presenting with simulated acute pulmonary embolism. Participants were randomized to six versions of the scenario differing only in the initial cues, i.e., in the reply of the patient to the initial question about the reason for his visit. In three of six versions, initial cues were restricted to thoracic symptoms (chest pain, dyspnoea, or combination of both). In the remaining three versions, initial cues consisted of thoracic and extra-thoracic (leg pain, immobilization) symptoms. The primary outcome was diagnostic accuracy. The number of initial cues was unrelated to diagnostic accuracy. However, the combination of extra-thoracic and thoracic cues resulted in a higher diagnostic accuracy than thoracic cues only (52/96 vs. 35/102, p = 0.006). In multivariate regression, the number of questions asked from the categories “risk factors of pulmonary embolism” (regression coefficient 0.15, p < 0.001) and “dyspnea” (regression coefficient 0.12, p < 0.001) predicted diagnostic accuracy. Moreover, questions relating to “immobilization” (regression coefficient 0.42, p < 0.001), “onset of dyspnea” (regression coefficient 0.23, p = 0.003), and “modifying factors of chest pain” (regression coefficient 0.20, p = 0.04) independently predicted diagnostic accuracy. Interestingly, more systematic history taking was associated with lower diagnostic accuracy (regression coefficient −0.27, p < 0.001). The present trial demonstrates that during history taking cues initially revealed by the patient, kind and category of questions asked during the interview, and the interview’s structural systematics affect diagnostic accuracy.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135311275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sepsis-induced acute kidney injury is associated with inflammatory dysregulations within the kidney. This study aimed to explore the renal protective effect of hispidulin on suppressing the apoptosis rate, and inhibiting reactive oxygen species production and inflammatory response after cecal puncture (CLP) operation. In order to gain a deeper understanding of the relationship between sepsis and acute kidney injury, the CLP induced kidney injury animal model was established. The automated biochemical analyzer was used to measure the kidney function related biomarkers including serum cystatin C (ScysC), blood urea nitrogen (BUN), and serum creatinine (Scr). The pathological changes of damaged kidney tissues were detected by hematoxylin and eosin (H&E) staining. The expression of inflammatory cytokines including tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and interleukin 6 (IL-6) were detected by their corresponding test kits and Real-Time Quantitative Reverse Transcription PCR (qRT-PCR). The level of reactive oxygen species production-related protein including myeloperoxidase (MPO), glutathione (GSH), superoxide dismutase (SOD), and malondialdehyde (MDA) in kidney tissue from each group were quantized using Enzyme-linked immunosorbent assay (ELISA). The protein expression was measured using western blot and the apoptotic rate of kidney tissue was measured by terminal deoxynucleotidyl transferase Deoxyuridine Triphosphate (dUTP) nick end labeling (TUNEL) assay. Our results revealed that hispidulin has the protective ability in sepsis-induced acute kidney injury. The potential mechanism of hispidulin on sepsis-induced cell apoptosis, oxidative stress and inflammatory response was also investigated. Finally, our results highlighted that hispidulin exerted a protective effects on CLP-induced acute kidney injury by suppressing the protein kinase B (AKT) and Nuclear factor kappa B (NF-κB) signaling pathways. In summary, the current study provided a piece of novel evidence, that hispidulin can be explored as a potential drug in CLP-induced acute kidney injury by examining its effects on suppressed the oxidative stress, inflammatory responses, and apoptosis in kidney tissue.
{"title":"Hispidulin protective impact on sepsis induced acute kidney injury is mediated by regulation of AKT and NF-κB pathway","authors":"","doi":"10.22514/sv.2023.109","DOIUrl":"https://doi.org/10.22514/sv.2023.109","url":null,"abstract":"Sepsis-induced acute kidney injury is associated with inflammatory dysregulations within the kidney. This study aimed to explore the renal protective effect of hispidulin on suppressing the apoptosis rate, and inhibiting reactive oxygen species production and inflammatory response after cecal puncture (CLP) operation. In order to gain a deeper understanding of the relationship between sepsis and acute kidney injury, the CLP induced kidney injury animal model was established. The automated biochemical analyzer was used to measure the kidney function related biomarkers including serum cystatin C (ScysC), blood urea nitrogen (BUN), and serum creatinine (Scr). The pathological changes of damaged kidney tissues were detected by hematoxylin and eosin (H&E) staining. The expression of inflammatory cytokines including tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and interleukin 6 (IL-6) were detected by their corresponding test kits and Real-Time Quantitative Reverse Transcription PCR (qRT-PCR). The level of reactive oxygen species production-related protein including myeloperoxidase (MPO), glutathione (GSH), superoxide dismutase (SOD), and malondialdehyde (MDA) in kidney tissue from each group were quantized using Enzyme-linked immunosorbent assay (ELISA). The protein expression was measured using western blot and the apoptotic rate of kidney tissue was measured by terminal deoxynucleotidyl transferase Deoxyuridine Triphosphate (dUTP) nick end labeling (TUNEL) assay. Our results revealed that hispidulin has the protective ability in sepsis-induced acute kidney injury. The potential mechanism of hispidulin on sepsis-induced cell apoptosis, oxidative stress and inflammatory response was also investigated. Finally, our results highlighted that hispidulin exerted a protective effects on CLP-induced acute kidney injury by suppressing the protein kinase B (AKT) and Nuclear factor kappa B (NF-κB) signaling pathways. In summary, the current study provided a piece of novel evidence, that hispidulin can be explored as a potential drug in CLP-induced acute kidney injury by examining its effects on suppressed the oxidative stress, inflammatory responses, and apoptosis in kidney tissue.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135560007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Altered mental status (AMS) describes an undifferentiated presentation of disorders of mentation. It represents a common problem for prehospital and hospital providers and may be found in 5% to 10% of patients admitted to the Emergency Department (ED). Psychomotor Agitation (PMA), a state of motor restlessness and mental tension associated with a variety of psychiatric conditions, is one of the most frequent manifestations of AMS. In this observational retrospective study we included all the patients who presented PMA, treated by the out-of-hospital Emergency Medical System (EMS), and transported to the ED of the University Hospital of Udine, Italy. The objectives were to determine the incidence of patients with PMA treated by EMS in the area of investigation, the evaluation of pharmacologically treated patients considering the most commonly administered drugs, the intubation rate, the fraction of inspired oxygen (FiO2) needs, the length of hospital stay (LOHS), the adverse drug reactions (ADRs), and the excited delirium syndrome (ExDS). From January 2017 to December 2018, 319 patients were enrolled. The prevalence of PMA was 2.5% and 0.5% were the cases of PMA managed by the EMS. The predominant drugs used for sedation were midazolam (19.75%) and ketamine (9.09%), alone or in association; patients with consistent PMA required more than one sedative. Statistically significant differences were found in FiO2 supplementation for ketamine-sedated psychiatric patients and midazolam-sedated psychiatric patients with chronic home therapy, in the LOHS >24 hours (h), with a longer stay in case of midazolam and ketamine use, and in LOHS and FiO2 supplementation due to polypharmacy administration with more than one sedative drug. PMA is a frequent and widespread phenomenon and in the prehospital setting requires rapid assessment and management. Therapeutical strategies with benzodiazepines, ketamine, and rarely associations of drugs are safe, do not increase hypoxia and intubation rate.
{"title":"Prehospital drugs for sedation in psychomotor agitation, friends or foes? An observational retrospective study","authors":"","doi":"10.22514/sv.2023.110","DOIUrl":"https://doi.org/10.22514/sv.2023.110","url":null,"abstract":"Altered mental status (AMS) describes an undifferentiated presentation of disorders of mentation. It represents a common problem for prehospital and hospital providers and may be found in 5% to 10% of patients admitted to the Emergency Department (ED). Psychomotor Agitation (PMA), a state of motor restlessness and mental tension associated with a variety of psychiatric conditions, is one of the most frequent manifestations of AMS. In this observational retrospective study we included all the patients who presented PMA, treated by the out-of-hospital Emergency Medical System (EMS), and transported to the ED of the University Hospital of Udine, Italy. The objectives were to determine the incidence of patients with PMA treated by EMS in the area of investigation, the evaluation of pharmacologically treated patients considering the most commonly administered drugs, the intubation rate, the fraction of inspired oxygen (FiO2) needs, the length of hospital stay (LOHS), the adverse drug reactions (ADRs), and the excited delirium syndrome (ExDS). From January 2017 to December 2018, 319 patients were enrolled. The prevalence of PMA was 2.5% and 0.5% were the cases of PMA managed by the EMS. The predominant drugs used for sedation were midazolam (19.75%) and ketamine (9.09%), alone or in association; patients with consistent PMA required more than one sedative. Statistically significant differences were found in FiO2 supplementation for ketamine-sedated psychiatric patients and midazolam-sedated psychiatric patients with chronic home therapy, in the LOHS >24 hours (h), with a longer stay in case of midazolam and ketamine use, and in LOHS and FiO2 supplementation due to polypharmacy administration with more than one sedative drug. PMA is a frequent and widespread phenomenon and in the prehospital setting requires rapid assessment and management. Therapeutical strategies with benzodiazepines, ketamine, and rarely associations of drugs are safe, do not increase hypoxia and intubation rate.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135560012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A prevalent cerebrovascular disease like the acute cerebral infarction is caused by cerebral thrombosis or arteriosclerosis that can result in ischemic necrosis of brain tissues. Treatment drugs of higher efficiency are required to be developed for acute cerebral infarction. Physalin A (PA) is a major compound from Physalis alkekengi L. and has pharmacological properties. However, the neuroprotective effects of PA are less reported and the mechanism remains unclear. The acute cerebral infarction cell model was constructed by treating PC12 cells with oxygen-glucose deprivation/reoxygenation (OGD/R). The impacts of PA on cell viability were determined by performing 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) and lactate dehydrogenase (LDH) releasing assays. Immunoblot and Enzyme-linked Immunosorbent assay (ELISA) were conducted to examine PA effects on inflammation. PA effects on pyroptosis were detected by performing immunoblot and immunostaining. Moreover, immunoblot was further conducted to confirm the mechanism. In this study, the survival and inhibition of the pyroptosis of OGD/R-induced PC12 cells were regulated by PA. Furthermore, PA suppressed the inflammation. PA inhibited mitogen-activated protein kinase (MAPK) pathway activation, and the activation of MAPK pathway reversed the neuroprotective effect of PA. Therefore, PA exerts neuroprotective effects by suppressing OGD/R-induced cellular pyroptosis and inflammatory responses in nerve cells.
急性脑梗死是一种常见的脑血管疾病，由脑血栓形成或动脉硬化引起，可导致脑组织缺血性坏死。急性脑梗死需要开发更有效的治疗药物。Physalin A (PA)是Physalis alkekengi L.的主要化合物，具有药理作用。然而，PA的神经保护作用报道较少，其机制尚不清楚。采用氧糖剥夺/再氧化(OGD/R)处理PC12细胞，建立急性脑梗死细胞模型。采用3-(4,5-二甲基-2-噻唑基)-2,5-二苯基-2- h -溴化四唑(MTT)和乳酸脱氢酶(LDH)释放法测定PA对细胞活力的影响。采用免疫印迹和酶联免疫吸附试验(ELISA)检测PA对炎症的影响。采用免疫印迹和免疫染色法检测PA对焦亡的影响。免疫印迹法进一步证实其作用机制。在本研究中，PA可调节OGD/ r诱导的PC12细胞的存活和对凋亡的抑制作用。此外，PA对炎症有抑制作用。PA抑制丝裂原活化蛋白激酶(MAPK)通路的激活，MAPK通路的激活逆转了PA的神经保护作用。因此，PA通过抑制OGD/ r诱导的神经细胞焦亡和炎症反应发挥神经保护作用。
{"title":"Physalin A exerts neuroprotective effects: inhibition of OGD/R-induced cellular pyroptosis and inflammatory responses in nerve cells","authors":"","doi":"10.22514/sv.2023.111","DOIUrl":"https://doi.org/10.22514/sv.2023.111","url":null,"abstract":"A prevalent cerebrovascular disease like the acute cerebral infarction is caused by cerebral thrombosis or arteriosclerosis that can result in ischemic necrosis of brain tissues. Treatment drugs of higher efficiency are required to be developed for acute cerebral infarction. Physalin A (PA) is a major compound from Physalis alkekengi L. and has pharmacological properties. However, the neuroprotective effects of PA are less reported and the mechanism remains unclear. The acute cerebral infarction cell model was constructed by treating PC12 cells with oxygen-glucose deprivation/reoxygenation (OGD/R). The impacts of PA on cell viability were determined by performing 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) and lactate dehydrogenase (LDH) releasing assays. Immunoblot and Enzyme-linked Immunosorbent assay (ELISA) were conducted to examine PA effects on inflammation. PA effects on pyroptosis were detected by performing immunoblot and immunostaining. Moreover, immunoblot was further conducted to confirm the mechanism. In this study, the survival and inhibition of the pyroptosis of OGD/R-induced PC12 cells were regulated by PA. Furthermore, PA suppressed the inflammation. PA inhibited mitogen-activated protein kinase (MAPK) pathway activation, and the activation of MAPK pathway reversed the neuroprotective effect of PA. Therefore, PA exerts neuroprotective effects by suppressing OGD/R-induced cellular pyroptosis and inflammatory responses in nerve cells.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135559599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity is the civilizational disease of our era, and often leads to comorbidity, hypertension, diabetes and obstructive sleep apnea. Contemporary non-surgical treatment for obesity is frequently inefficient, resulting in the increased prominence of surgical procedures, specifically, laparoscopic sleeve gastrectomy (LSG). In our case report, we present a case in which LSG was not feasible in reference to the traditional surgical technique due to severe hiatal hernia (HH), which inexplicably went undetected during preoperative examinations, however, with the help of intraoperative gastroscopy, the problem was effectively solved. The patient, a middle-aged Caucasian male, underwent removal of a gastric band due to gastric band migration, and was presented for LSG due to repeated weight gain. During the operation, the insertion of the bougie proved unsuccessful after several attempts. Through intraoperative gastroscopy, a severe HH was discovered. The endoscope was inserted into the compromised passageway leading into the stomach, effectively substituting the role of bougie used in the traditional surgical procedure. Unexpected difficulty or inability to insert a bougie is rare in consideration of LSG, however, in this case, surgery could not have been performed in the conventional manner. During intraoperative gastroscopy, the gastroscope is inserted into the stomach using visual control, and effectively substitutes the bougie function. The likelihood of rare, yet severe, life-threatening complications from the insertion of a bougie is reduced and surgery can be performed in the traditional sense. We have no knowledge of cases in which a HH prevents the conventional surgical technique. However, in extreme cases in which the traditional non-surgical technique and other types of surgery are deemed unsuitable, intraoperative gastroscopy provides a simple and safe solution.
{"title":"Intraoperative gastroscopy during laparoscopic sleeve gastrectomy after gastric band surgery with unrecognized hiatal hernia—a case report","authors":"","doi":"10.22514/sv.2023.093","DOIUrl":"https://doi.org/10.22514/sv.2023.093","url":null,"abstract":"Obesity is the civilizational disease of our era, and often leads to comorbidity, hypertension, diabetes and obstructive sleep apnea. Contemporary non-surgical treatment for obesity is frequently inefficient, resulting in the increased prominence of surgical procedures, specifically, laparoscopic sleeve gastrectomy (LSG). In our case report, we present a case in which LSG was not feasible in reference to the traditional surgical technique due to severe hiatal hernia (HH), which inexplicably went undetected during preoperative examinations, however, with the help of intraoperative gastroscopy, the problem was effectively solved. The patient, a middle-aged Caucasian male, underwent removal of a gastric band due to gastric band migration, and was presented for LSG due to repeated weight gain. During the operation, the insertion of the bougie proved unsuccessful after several attempts. Through intraoperative gastroscopy, a severe HH was discovered. The endoscope was inserted into the compromised passageway leading into the stomach, effectively substituting the role of bougie used in the traditional surgical procedure. Unexpected difficulty or inability to insert a bougie is rare in consideration of LSG, however, in this case, surgery could not have been performed in the conventional manner. During intraoperative gastroscopy, the gastroscope is inserted into the stomach using visual control, and effectively substitutes the bougie function. The likelihood of rare, yet severe, life-threatening complications from the insertion of a bougie is reduced and surgery can be performed in the traditional sense. We have no knowledge of cases in which a HH prevents the conventional surgical technique. However, in extreme cases in which the traditional non-surgical technique and other types of surgery are deemed unsuitable, intraoperative gastroscopy provides a simple and safe solution.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135355681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The delayed prediction of high-flow nasal cannula (HFNC) failure is associated with poor prognosis in patients with acute respiratory failure (ARF) treated with HFNCs. This study aimed to identify the early predictors for requiring mechanical ventilation (MV) in ARF patients treated with HFNCs. This was a single-center retrospective observational study based on ARF patients older than 18 years, treated with HFNC, and had chest computed tomography (CT) scans performed in the emergency department (ED) of a tertiary hospital between July 2018 and June 2020. The demographic and laboratory data were collected, and the cross-sectional area (CSA) of the diaphragmatic crus was measured on the chest CT scan. Two hundred and twenty-nine patients with ARF (92 females and 137 males) were treated with HFNCs during the study period and included in this study. Twenty-five female patients (27.17%) and 32 male patients (23.36%) required subsequent intubation and MV and were categorized as HFNC failures. Their respiratory rate-oxygenation (ROX) indexes were acquired at two hours, and the average CSA of the diaphragmatic crura was integrated to analyze the predictive power, which showed good predictive accuracy in both gender groups (area under the receiver operating characteristic curves (AUROC) for females, 0.778, and males, 0.782). The optimal ROC curve cutoff point for the average CSA of the diaphragmatic crus was estimated to be 1.48 cm2 in female patients and 1.64 cm2 in male patients. Altogether, these results indicated that the CSA measurement of the diaphragmatic crus on CT in ARF patients might help predict the risk of HFNC failure.
{"title":"Prediction of high-flow nasal cannula failure in patients with acute respiratory failure by measuring the cross-sectional area of the diaphragmatic crus and ROX index","authors":"","doi":"10.22514/sv.2023.084","DOIUrl":"https://doi.org/10.22514/sv.2023.084","url":null,"abstract":"The delayed prediction of high-flow nasal cannula (HFNC) failure is associated with poor prognosis in patients with acute respiratory failure (ARF) treated with HFNCs. This study aimed to identify the early predictors for requiring mechanical ventilation (MV) in ARF patients treated with HFNCs. This was a single-center retrospective observational study based on ARF patients older than 18 years, treated with HFNC, and had chest computed tomography (CT) scans performed in the emergency department (ED) of a tertiary hospital between July 2018 and June 2020. The demographic and laboratory data were collected, and the cross-sectional area (CSA) of the diaphragmatic crus was measured on the chest CT scan. Two hundred and twenty-nine patients with ARF (92 females and 137 males) were treated with HFNCs during the study period and included in this study. Twenty-five female patients (27.17%) and 32 male patients (23.36%) required subsequent intubation and MV and were categorized as HFNC failures. Their respiratory rate-oxygenation (ROX) indexes were acquired at two hours, and the average CSA of the diaphragmatic crura was integrated to analyze the predictive power, which showed good predictive accuracy in both gender groups (area under the receiver operating characteristic curves (AUROC) for females, 0.778, and males, 0.782). The optimal ROC curve cutoff point for the average CSA of the diaphragmatic crus was estimated to be 1.48 cm2 in female patients and 1.64 cm2 in male patients. Altogether, these results indicated that the CSA measurement of the diaphragmatic crus on CT in ARF patients might help predict the risk of HFNC failure.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135355683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Epidemics of infectious diseases, such as the coronavirus disease 2019 (COVID-19) pandemic, have various psychiatric effects. These psychiatric problems are affected not only by the fear of infectious diseases, but also by economic and social changes following the epidemic. The aim of this study was to investigate the effect of COVID-19 pandemic on their suicide attempts through face-to-face interview records of suicide attempt patients who came to the emergency department (ED). This single-center, retrospective observational study was conducted with suicide attempt patients who visited ED from February 2020 to January 2021, who underwent a face-to-face interview with a psychiatrist. The patients were classified as a COVID-19 related group if they clearly mentioned a causal relationship between the COVID-19 pandemic and suicide attempts in the interview record, and a non-related group if they did not. A total of 502 patients were included, of which 90 were classified as a COVID-19 related group. As a result of comparing the demographic characteristics between the two groups, there were more patients who were employers by occupation and patients without a psychiatric history in the COVID-19 related group compared to the non-related group. There were various differences in motives for suicide attempt between the two groups, and unemployment, financial difficulty, and loneliness were statistically significantly higher in the COVID-19 related group than in the non-related group. The number of COVID-19 related groups increased toward the late period, but there was no statistically significant difference in suicide attempt motives. In conclusion, the COVID-19 pandemic has had a variety of effects on suicide attempt patients and also affects suicide attempts in patients with no psychiatric history. As motives for suicide attempts by the COVID-19 related group, unemployment, financial difficulty, and loneliness showed statistically significant results.
{"title":"Impact of COVID-19 on suicidal attempts identified by face-to-face interviews","authors":"","doi":"10.22514/sv.2023.088","DOIUrl":"https://doi.org/10.22514/sv.2023.088","url":null,"abstract":"Epidemics of infectious diseases, such as the coronavirus disease 2019 (COVID-19) pandemic, have various psychiatric effects. These psychiatric problems are affected not only by the fear of infectious diseases, but also by economic and social changes following the epidemic. The aim of this study was to investigate the effect of COVID-19 pandemic on their suicide attempts through face-to-face interview records of suicide attempt patients who came to the emergency department (ED). This single-center, retrospective observational study was conducted with suicide attempt patients who visited ED from February 2020 to January 2021, who underwent a face-to-face interview with a psychiatrist. The patients were classified as a COVID-19 related group if they clearly mentioned a causal relationship between the COVID-19 pandemic and suicide attempts in the interview record, and a non-related group if they did not. A total of 502 patients were included, of which 90 were classified as a COVID-19 related group. As a result of comparing the demographic characteristics between the two groups, there were more patients who were employers by occupation and patients without a psychiatric history in the COVID-19 related group compared to the non-related group. There were various differences in motives for suicide attempt between the two groups, and unemployment, financial difficulty, and loneliness were statistically significantly higher in the COVID-19 related group than in the non-related group. The number of COVID-19 related groups increased toward the late period, but there was no statistically significant difference in suicide attempt motives. In conclusion, the COVID-19 pandemic has had a variety of effects on suicide attempt patients and also affects suicide attempts in patients with no psychiatric history. As motives for suicide attempts by the COVID-19 related group, unemployment, financial difficulty, and loneliness showed statistically significant results.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135357802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To develop an XGBoost model to predict the occurrence of acute lung injury (ALI) in patients with acute pancreatitis (AP). Using the case database of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1231 cases suffering from AP were screened, and after 137 variables were identified, the clinical characteristics of the samples were statistically analyzed, and the data were randomly divided into a training set (75%) to build the XGBoost model and a test set (25%) for validation. Finally, the performance of the model was evaluated based on accuracy, specificity, sensitivity, and subject characteristics working characteristic curves. The model performance is also compared with that of three other commonly used machine learning algorithms (support vector machine (SVM), logistic regression, and random forest). The age and laboratory tests of patients with AP combined with ALI differed from those of patients without combined acute lung injury. The area under the receiver operating characteristic (ROC) curve of the test set after model evaluation was 0.9534, the specificity was 0.7333, and the sensitivity was 0.7857, with arterial partial pressure of oxygen, bile acid, aspartate transaminase, urea nitrogen, and arterial blood pH as its most important influencing factors. In this study, the XGBoost model has advantages compared with other three machine learning algorithms. The XGBoost model has potential in the application of predicting acute lung injury after acute pancreatitis.
{"title":"XGBoost model predicts acute lung injury after acute pancreatitis","authors":"","doi":"10.22514/sv.2023.087","DOIUrl":"https://doi.org/10.22514/sv.2023.087","url":null,"abstract":"To develop an XGBoost model to predict the occurrence of acute lung injury (ALI) in patients with acute pancreatitis (AP). Using the case database of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1231 cases suffering from AP were screened, and after 137 variables were identified, the clinical characteristics of the samples were statistically analyzed, and the data were randomly divided into a training set (75%) to build the XGBoost model and a test set (25%) for validation. Finally, the performance of the model was evaluated based on accuracy, specificity, sensitivity, and subject characteristics working characteristic curves. The model performance is also compared with that of three other commonly used machine learning algorithms (support vector machine (SVM), logistic regression, and random forest). The age and laboratory tests of patients with AP combined with ALI differed from those of patients without combined acute lung injury. The area under the receiver operating characteristic (ROC) curve of the test set after model evaluation was 0.9534, the specificity was 0.7333, and the sensitivity was 0.7857, with arterial partial pressure of oxygen, bile acid, aspartate transaminase, urea nitrogen, and arterial blood pH as its most important influencing factors. In this study, the XGBoost model has advantages compared with other three machine learning algorithms. The XGBoost model has potential in the application of predicting acute lung injury after acute pancreatitis.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135357947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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