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Goal-directed resuscitation therapy in high-risk patients undergoing cardiac surgery (GRICS study): a randomized controlled trial - preliminary results. Crit Care 2013. [PMCID: PMC3642541 DOI: 10.1186/cc12131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Red cell distribution width predicts cardiovascular complications after high-risk surgery. Crit Care 2013. [PMCID: PMC3642824 DOI: 10.1186/cc12170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Cost implication of antibiotic-associated diarrhoea and the financial impact of probiotic use in its prevention. Crit Care 2013. [PMCID: PMC3643174 DOI: 10.1186/cc12021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Vasopressin Versus Norepinephrine for the Management of Shock After Cardiac Surgery (VaNCS study): a randomized controlled trial. Crit Care 2013. [PMCID: PMC3642574 DOI: 10.1186/cc12160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Treatment-related cardiac complications associated with goal-directed therapy in high-risk surgical patients: a meta-analysis. Crit Care 2013. [PMCID: PMC3642484 DOI: 10.1186/cc12133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Transfusion Requirements in Surgical Oncology Patients (TRISOP): a randomized, controlled trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013. [PMCID: PMC3642659 DOI: 10.1186/cc12302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. Br J Anaesth 2013; 110:510-7. [PMID: 23447502 DOI: 10.1093/bja/aet020] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Perioperative mortality after cardiac surgery has decreased in recent years although postoperative morbidity is still significant. Although there is evidence that perioperative goal-directed haemodynamic therapy (GDT) may reduce surgical mortality and morbidity in non-cardiac surgical patients, the data are less clear after cardiac surgery. The objective of this review is to perform a meta-analysis on the effects of perioperative GDT on mortality, morbidity, and length of hospital stay in cardiac surgical patients. METHODS We conducted a systematic review using Medline, EMBASE, and the Cochrane Controlled Clinical Trials Register. Additional sources were sought from experts. The inclusion criteria were randomized controlled trials, mortality reported as an outcome, pre-emptive haemodynamic intervention, and cardiac surgical population. Included studies were examined in full and subjected to quantifiable analysis, subgroup analysis, and sensitivity analysis where possible. Data synthesis was obtained by using odds ratio (OR) and mean difference (MD) for continuous data with 95% confidence interval (CI) utilizing a random-effects model. RESULTS From 4986 potential studies, 5 met all the inclusion criteria (699 patients). The quantitative analysis showed that the use of GDT reduced the postoperative complication rate (OR 0.33, 95% CI 0.15-0.73; P=0,006) and hospital length of stay (MD -2.44, 95% CI -4.03 to -0.84; P=0,003). There was no significant reduction in mortality. CONCLUSION The use of pre-emptive GDT in cardiac surgery reduces morbidity and hospital length of stay.
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Oxygen delivery index during goal-directed therapy predicts complications and hospital length of stay in patients undergoing high-risk surgery. Crit Care 2012. [PMCID: PMC3363892 DOI: 10.1186/cc11081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Raised serum cardiac troponin I concentrations predict hospital mortality in intensive care unit patients. Br J Anaesth 2012; 109:219-24. [PMID: 22617093 DOI: 10.1093/bja/aes141] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recent work suggests that increased plasma concentrations of cardiac troponin I (cTnI) are common in critically ill patients and are associated with poor outcome. We measured the frequency of increased plasma cTnI concentrations during patients' stay in a mixed medical/surgical intensive care unit (ICU) and compared our findings with hospital mortality. METHODS Basic details, organ support, and hospital mortality were recorded for all patients treated in ICU during a 6 month period. cTnI concentrations were sampled daily for all patients, using 0.04 µg litre(-1) as the upper limit of normal, and 0.12 µg litre(-1) as an additional stratification point. RESULTS Of 663 patients, 54% were male, with a mean (sd) age of 60 (18) yr, 65% were surgical patients, and the median Acute Physiology and Chronic Ill Health II (APACHE II) score was 15 (inter-quartile range 12-20). Increased cTnI concentrations were found in 345 patients (52%) while in ICU. One hundred and twenty patients (18%) died in hospital. cTnI concentration >0.04 µg litre(-1) was associated with reduced odds of hospital survival, independent of age, medical admission, unplanned admission, APACHE II score, mechanical ventilation, and haemofiltration (adjusted odds ratio 0.25, 95% confidence interval 0.08-0.75, P=0.014). Stratification by the degree of cTnI increase revealed an incremental trend towards a lower odds of hospital survival, including for patients with 'minor' elevations of cTnI (0.05-0.12 µg litre(-1)). CONCLUSIONS Increased serum cTnI concentrations during ICU stay independently predicts hospital mortality, even when the threshold is low. We found a trend towards an association between 'minor' elevations in cTnI and higher in-hospital mortality.
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Efficacy of functional hemodynamic parameters in predicting fluid responsiveness with pulse power analysis in surgical patients. Minerva Anestesiol 2012; 78:527-533. [PMID: 22534733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND In this study we quantify the ability of dynamic cardiovascular parameters measured by the PulseCO™ algorithm of the LiDCO™plus monitor to predict the response to a fluid challenge in post-operative patients. METHODS Surgical patients, admitted to the Intensive Care Unit from the operating theatre were monitored with the LiDCO™plus system. A number of static and dynamic cardiovascular measurements were recorded before and after a fluid challenge. Receiver Operator Characteristic (ROC) curve analysis was used to identify the baseline values, with optimum sensitivity and specificity, to predict responsiveness to a fluid challenge. RESULTS Thirty-one patients were enrolled, and received protocol-based fluid challenges. Twelve (38%) responded by demonstrating an increase in stroke volume of >15%. Heart rate (HR) and central venous pressure (CVP) were not statistically different between responders and non-responders. Mean arterial pressure (mAP), systolic pressure variation (SPV), pulse pressure variation (PPV) and stroke volume variation (SVV) were statistically different between responders and non-responders. Parameters with a ROC area under the curve (AUC) significantly >0.5 included SPV 0.70 (0.52-0.88) P=0.046, PPV 0.87 (0.76-0.99) P<0.0002 and SVV 0.84 (0.71-0.96) P=0.0005. The best cut-off values (sensitivity and specificity) to predict fluid were SPV >9 mmHg (73%, 76%), PPV >13% (83%, 74%) and SVV >12.5% (75%, 83%). ROC analysis did not show the AUC to be significantly >0.5 for HR, mAP and CVP CONCLUSION: Dynamic indices measured by PulseCO™ (LiDCO) have a high sensitivity and specificity in predicting fluid responsiveness in sedated and mechanically ventilated patients. A cut-off value for PPV of 13% is the most sensitive and specific indicator of fluid responsiveness.
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Economic evaluation of early-goal directed therapy for high-risk surgical patients. Crit Care 2012. [PMCID: PMC3363616 DOI: 10.1186/cc10805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Goal-directed hemodynamic resuscitation in high-risk patients undergoing cardiac surgery: a randomized controlled trial - preliminary data (GRICCS STUDY). Crit Care 2012. [PMCID: PMC3363615 DOI: 10.1186/cc10804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Delayed discharges revisited: impact of a liaison post on patients' transition from ICU to ward care. Crit Care 2012. [PMCID: PMC3363931 DOI: 10.1186/cc11120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cost-effectiveness analysis of two thromboprophylactic strategies following major surgery. Crit Care 2012. [PMCID: PMC3363840 DOI: 10.1186/cc11029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Frank-Starling and Guyton together at bedside during a fluid challenge. Crit Care 2012. [PMCID: PMC3363656 DOI: 10.1186/cc10845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Admission lactate and outcome after high-risk surgery. Crit Care 2012. [PMCID: PMC3363679 DOI: 10.1186/cc10868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Prediction of fluid responsiveness in intensive care (PREFERENCE study): fluid challenge versus passive leg raising in high-risk surgical patients. Crit Care 2012. [PMCID: PMC3363657 DOI: 10.1186/cc10846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM). Intensive Care Med 2012; 38:598-605. [DOI: 10.1007/s00134-011-2462-3] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022]
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Abstract
The aim of this study was to determine if severity assessment tools (general severity of illness and community-acquired pneumonia specific scores) can be used to guide decisions for patients admitted to the intensive care unit (ICU) due to pandemic influenza A pneumonia. A prospective, observational, multicentre study included 265 patients with a mean age of 42 (±16.1) years and an ICU mortality of 31.7%. On admission to the ICU, the mean pneumonia severity index (PSI) score was 103.2 ± 43.2 points, the CURB-65 score was 1.7 ± 1.1 points and the PIRO-CAP score was 3.2 ± 1.5 points. None of the scores had a good predictive ability: area under the ROC for PSI, 0.72 (95% CI, 0.65-0.78); CURB-65, 0.67 (95% CI, 0.59-0.74); and PIRO-CAP, 0.64 (95% CI, 0.56-0.71). The PSI score (OR, 1.022 (1.009-1.034), p 0.001) was independently associated with ICU mortality; however, none of the three scores, when used at ICU admission, were able to reliably detect a low-risk group of patients. Low risk for mortality was identified in 27.5% of patients using PIRO-CAP, but above 40% when using PSI (I-III) or CURB65 (<2). Observed mortality was 13.7%, 13.5% and 19.4%, respectively. Pneumonia-specific scores undervalued severity and should not be used as instruments to guide decisions in the ICU.
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A prospective study into the use of NT-proBNP measurements in critically ill patients. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/09563070410001703923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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P5-07-01: Novel Alternative Splice Variants of HER2 in Invasive Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-07-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The Human Epidermal Growth Factor Receptor 2 (HER2) is an oncogene expressed in 25–30% of invasive breast cancers. HER2 shares extensive homology with other members of the HER family (HER1, HER3 and HER4), and is constitutively active as an homo- and heterodimer. The HER2 gene encodes an 185kDa transmembrane protein with tyrosine kinase activity. Gene amplification or protein expression of HER2 is a predictor of poor clinical outcome and decreased survival in women with breast cancer, and also indicates a favourable response to Trastuzumab (Herceptin) therapy, or a combinational therapy comprising Herceptin plus chemotherapy. However, resistance to Trastuzumab remains the case in approximately 50% of HER2 amplified/overexpressing tumours. Understanding the molecular mechanisms of Trastuzumab resistance and identifying more effective therapies, is critical in the treatment of patients whose breast cancers express this aggressive disease phenotype. In this study, it is postulated that the abnormal generation of mRNA splice variants may be responsible for the continued tumour growth and progression.
Aims: The aim of this study is to increase our understanding of the role of HER-2 splice variants in the development and progression of breast cancer. This will inform the development of more sophisticated and effective therapies that target specific HER-2 isoforms, rather than Herceptin, which targets just the generic wild type HER-2 protein. Materials and Methods: The entire coding region of HER-2 cDNA was PCR amplified using 12 sets of HER-2 specific primers in HER-2 positive cell lines (SKOV-3, SKBR-3, MDA-MB-453 and MDA-MB-361).
Results: RT-PCR results showed multiple bands in various regions of the HER2 mRNA. Sequencing of these bands revealed novel alternative splice variants with deletions in exons 13 and 18 of the HER2 gene expressed in addition to the wild type HER2. Bioinformatic analysis of the deletions revealed a cassette exon deletion in exon 13, and a loss of 42 base pairs in the 3’ end of exon 18 compared to the full length HER2. Both the full length HER2 sequence and the sequence containing the deletions were translated using the ExPASy Translate Tool. This revealed an in-frame deletion of 14 amino acids and revealed a novel splice isoform with a deletion in the HER2 protein which encompasses the entire ATP binding pocket. This was determined by analysis using UniProtKB to identify the composition of amino acids for each domain of HER2. Discussion: Our studies have identified novel splice variants in the tyrosine-kinase domain of the HER-2 gene using HER-2 positive cell lines. The loss of an ATP binding site in the HER2 gene may lead to a less active HER2 isoform which may play a significant role in prognosis. Current work is being carried out to study the regulation of these splice variants and to study the role of splice factors ASF/SF2 and SRPK1 in the regulation of HER2 splicing, and to elucidate any significant changes in the HER2 signalling pathways. In addition, the expression of these isoforms are currently being investigated in tissues from formalin fixed, paraffin embedded and frozen breast tumours.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-07-01.
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Editorial: Pulmonary artery catheters - to use or not to use; that is the question? ACTA ACUST UNITED AC 2011. [DOI: 10.3109/tcic.11.3.117.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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75
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Reply to Petros et al.: Early steriod therapy for patients with H1N1 influenza A virus infection. Intensive Care Med 2011. [DOI: 10.1007/s00134-011-2290-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Epidemiology and outcome following post-surgical admission to critical care. Intensive Care Med 2011; 37:1466-72. [PMID: 21732168 DOI: 10.1007/s00134-011-2299-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 06/02/2011] [Indexed: 01/13/2023]
Abstract
PURPOSE To describe the factors related to outcome in patients admitted to the intensive care unit (ICU) after major surgery at a national level (in Austria). METHODS Analysis of a prospectively collected database of ICU admissions over an 11-year period. Factors associated with mortality and how this changed with time were explored using logistic multilevel modelling. RESULTS A total of 88,504 surgical patients had a mean ICU length of stay of 6.5 days and total hospital stay of 31.3 days. They had an ICU mortality of 7.6% and a hospital mortality of 11.8%. Factors associated with hospital mortality included age (odds ratio (OR) 1.42 per 10 years of age), urgency of operation (2.02 for emergency when compared to elective), SAPS II score (OR 1.09), reason for admission being a medical cause and the specific nature of the surgery itself: thoracic (OR 1.81), cardiovascular (OR 1.25), trauma (OR 1.22) or gastrointestinal surgery (OR 1.71). In addition patients who had pre-existing chronic renal (OR 1.40), respiratory (OR 1.20) or cardiac failure (OR 1.29), cirrhosis (OR 2.50), alcoholism (OR 1.42), acute kidney injury (OR 1.88) and/or non-metastatic cancer (OR 1.20) were associated with higher hospital mortality than patients without this co-morbidity. There was a reduction in the OR for death over the whole 11-year period. This improved outcome remained valid even after adjusting for the identified risk factors for mortality (OR per year 0.96). CONCLUSIONS This study has shown the high level of demand for critical care for this patient group and an improving rate of survival.
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Delta central venous pressure and dynamic indices of preload in postsurgical ICU patients. Crit Care 2011. [PMCID: PMC3061679 DOI: 10.1186/cc9469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Dynamic indices of preload in postcardiac surgery patients by pulse power analysis. Crit Care 2011. [PMCID: PMC3061684 DOI: 10.1186/cc9474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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80
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Factors and consequences associated with a delay in the discharge process of patients from an adult critical care unit. Crit Care 2011. [PMCID: PMC3068392 DOI: 10.1186/cc9883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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81
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Accuracy of stroke volume variation as a predictor of volume responsiveness in patients with raised intra-abdominal pressure. Crit Care 2011. [PMCID: PMC3061698 DOI: 10.1186/cc9488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Comparison of breast cancer in Indonesia and Malaysia--a clinico-pathological study between Dharmais Cancer Centre Jakarta and University Malaya Medical Centre, Kuala Lumpur. Asian Pac J Cancer Prev 2011; 12:2943-2946. [PMID: 22393968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION The age standardised incidence rate (ASR) of breast cancer in Malaysia which is a high middle- income country is similar to Indonesia, a low middle-income country. (Globocan 2008) It is however unknown whether the presentation of breast cancer differs between these two countries. OBJECTIVE We compared the stage, age at presentation, and pathological characteristics of breast cancer between two tertiary hospitals in Indonesia and Malaysia; Dharmais Cancer Centre (DCC), which is the national cancer referral centre in Indonesia, and University Malaya Medical Centre (UMMC), which is an academic hospital with established breast oncology services in Kuala Lumpur. One thousand, one hundred and fourteen consecutive women (477 in UMMC: 637 in DCC) who were newly diagnosed with breast cancer between January and December, 2010 were included. Patient's age, TNM stage at presentation, and pathological characteristics were compared. Estrogen receptor (ER) and progesterone receptor (PR) were considered positive if 10% or greater of invasive cell nuclei were stained while HER2 was considered positive with an immunohistochemistry staining intensity of 3+ . Logistic regression analyses were performed to identify differences. RESULTS Median age at diagnosis was 52 years in UMMC and 47 years in DCC, whereby patients in DCC were more likely to be very young at diagnosis (aged < 35 years) compared to their counterparts in UMMC (Odds ratio (OR): 2.09; 95%CI: 1.32-3.31). Approximately one third of patients in UMMC presented with TNM stage III or IV, compared to 63% in DCC. Patients in DCC were three times more likely to present with metastatic breast cancer compared to patients in UMMC (OR: 3.01; 95% CI: 2.02-4.48). The percentage of low grade tumours in DCC was higher than in UMMC (28% vs 11% respectively), and the difference persisted even after multivariate adjustment. Although the frequency of ER and PR positivity appeared to be higher in UMMC (65% and 55% respectively) compared to DCC (48% and 40% respectively), these differences were not statistically significant following adjustment for age, stage, HER2 status and grade. The frequency of HER2 positivity was 45% in DCC compared to 26% in UMMC, and remained significantly higher even after multivariate adjustment (multivariate OR:1.76; 95%CI:1.25-2.47, in DCC compared to UMMC). The proportion of triple negative breast cancer was however similar in the two centres (19% in UMMC vs 21% in DCC). CONCLUSION Indonesian women with breast cancer seem to present at a younger age and at later stages compared to Malaysian women. Their tumors were more likely to be of low grade and HER2 positive, even after adjustment for other factors, while hormone receptor positivity proved similar in the two groups. The higher HER2 positivity rate in Indonesian patients warrants further study.
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A prospective study of the accuracy and precision of continuous cardiac output monitoring devices as compared to intermittent thermodilution. Minerva Anestesiol 2010; 76:1010-1017. [PMID: 20634793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Pulse pressure (PP) analysis from a radial arterial line is available with the LiDCO plus monitor (LiDCO, Cambridge, UK) and FloTrac/Vigileo (Edwards Lifesciences, Irvine, CA, USA). The aim of this study was to investigate the agreement of continuous PP analysis against intermittent thermodilution (ITD) using the pulmonary artery catheter (PAC). METHODS This was a six-hour study in 29 patients monitored with a PAC. All measurements were referenced against CO measured from the average of four ITD curves from the PAC. The LiDCO plus was calibrated with a lithium dilution (PulseCOLi) and with ITD (PulseCOITD) at baseline. Measurements from Vigileo software 1.03 (APCO), LiDCO plus (PulseCOLi and PulseCOITD), CCO and ITD were taken every hour for the next six hours. The bias and precision between the two devices were calculated as well as the percentage error (PE) of agreement between the tested device and the reference. The coefficient of variation (CV) of the tested device was then derived. RESULTS The average bias, PE and coefficient of variation for CCO vs. ITD of the tested device were 0.3 L/min, 28% and 13%, respectively; for APCO vs. ITD the calculations were -1.1 L/min, 55% and 27%; for PulseCOLi Cardiac output Blood pressure Thermodilution. ITD they were 0.5 L/min, 40% and 19%; and for PulseCOITD vs. ITD they were 0.2 L/min, -31% and 15%. CONCLUSION APCO (Vigileo software 1.03) and PulseCOLi showed a moderate agreement with the PAC. When PulseCO was calibrated with ITD (PulseCOITD) it showed excellent agreement, demonstrating that PulseCO performs well against ITD when the calibration process is optimally performed.
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Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection. Intensive Care Med 2010; 37:272-83. [PMID: 21107529 PMCID: PMC7079858 DOI: 10.1007/s00134-010-2078-z] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 08/24/2010] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial. METHODS Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry. RESULTS Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, p < 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1-4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, p < 0.01; OR 3.8, CI 2.1-7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7-2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0-4.8, p < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed. CONCLUSIONS Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections.
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Patient safety in anesthesia. Minerva Anestesiol 2010; 76:753-757. [PMID: 20820154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Medical mistakes have been identified as resulting from a breakdown in one or more of five major areas: equipment performance, communication, staffing levels, complex environments and workloads. Because many of these areas relate directly to the practice of anesthesiology, they can contribute significantly to the safety and quality of the use of anesthesia. The specialty of anesthesia has embraced a culture of safety, resulting in many beneficial improvements for patients. The avoidance of error has led to improved outcomes, with a decrease in directly attributable rates of morbidity and mortality. Despite these improved rates, there are still areas that can be improved. This paper describes the background of these issues, discusses areas where performance has improved and identifies the areas in which there is room for further improvement.
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C-reactive protein as a predictor of outcome after discharge from the intensive care: a prospective observational study. Br J Anaesth 2010; 105:318-25. [PMID: 20630889 DOI: 10.1093/bja/aeq171] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Recent studies have found plasma C-reactive protein (CRP) to be a predictor of outcome after discharge from the intensive care unit (ICU). To assess the generalizability of this finding, we assessed the value of CRP on the day of ICU discharge as a predictor of unplanned ICU readmission and unexpected death within 2 weeks. Plasma albumin and white cell count at discharge were also considered as markers associated with ongoing inflammation. METHODS This was a single-centre observational study involving a medical-surgical ICU in a university teaching hospital. Data were prospectively collected from 1487 admissions involving 1401 patients over a 12 month period. Patients' admission details and APACHE II score were collected in addition to plasma CRP, white cell count, and albumin values from the day of discharge from ICU. We assessed the difference in these variables between patients who were readmitted, who died unexpectedly, and those who did not. RESULTS We found that 9.9% of patients discharged were either readmitted (7.0%) or died unexpectedly (2.9%). Patients who were readmitted had a lower plasma albumin concentration [20 (16, 24) vs 22 (19, 27), P<0.001] and a higher admission APACHE II score [median (inter-quartile range, IQR) 16.5 (13, 21) vs 15 (12, 18), P=0.02]. Patients who died unexpectedly on the ward were older [mean (sd): 76 (12) vs 59 (19), P<0.001] and had a higher APACHE II score [21 (17.25, 26) vs 15 (12, 18), P<0.001]. There was not a statistically significant difference in CRP concentration between patients who either required ICU readmissions or died unexpectedly on the ward and those who did not. CONCLUSIONS In a mixed medical-surgical intensive care, plasma CRP measured at the day of discharge from intensive care is not a predictor of readmissions or deaths.
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Does stroke volume increase after a fluid challenge? A study on the management of patients undergoing major head and neck free flap surgery: preliminary data. Crit Care 2010. [PMCID: PMC2934350 DOI: 10.1186/cc8351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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88
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NICOM vs LiDCO™ plus during changes in cardiac output in critically ill patients. Crit Care 2010. [PMCID: PMC2934558 DOI: 10.1186/cc8332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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89
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90
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Fighting for freedom. Br Dent J 2009; 207:409. [DOI: 10.1038/sj.bdj.2009.968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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91
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Modelling the impact of an influenza A/H1N1 pandemic on critical care demand from early pathogenicity data: the case for sentinel reporting. Anaesthesia 2009; 64:937-41. [PMID: 19645759 DOI: 10.1111/j.1365-2044.2009.06070.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Projected critical care demand for pandemic influenza H1N1 in England was estimated in this study. The effect of varying hospital admission rates under statistical uncertainty was examined. Early in a pandemic, uncertainty in epidemiological parameters leads to a wide range of credible scenarios, with projected demand ranging from insignificant to overwhelming. However, even small changes to input assumptions make the major incident scenario increasingly likely. Before any cases are admitted to hospital, 95% confidence limit on admission rates led to a range in predicted peak critical care bed occupancy of between 0% and 37% of total critical care bed capacity, half of these cases requiring ventilatory support. For hospital admission rates above 0.25%, critical care bed availability would be exceeded. Further, only 10% of critical care beds in England are in specialist paediatric units, but best estimates suggest that 30% of patients requiring critical care will be children. Paediatric intensive care facilities are likely to be quickly exhausted and suggest that older children should be managed in adult critical care units to allow resource optimisation. Crucially this study highlights the need for sentinel reporting and real-time modelling to guide rational decision making.
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92
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Goal-directed Hemodynamic Therapy for Surgical Patients. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-77383-4_59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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93
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Fluid responsiveness in patients following major surgery. Crit Care 2009. [PMCID: PMC4084100 DOI: 10.1186/cc7378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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94
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Intraoperative central venous oxygen saturation and patient outcome in patients undergoing major abdominal surgery. Crit Care 2009. [PMCID: PMC4084114 DOI: 10.1186/cc7392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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95
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Raised C-reactive protein on ICU discharge is not associated with subsequent poor outcome. Crit Care 2009. [PMCID: PMC4084277 DOI: 10.1186/cc7555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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96
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Transpulmonary lithium dilution technique: time to recalibration and calibration drift. Crit Care 2009. [PMCID: PMC4084104 DOI: 10.1186/cc7382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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97
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The oestrogen receptor-negative/progesterone receptor-positive breast tumour: a biological entity or a technical artefact? J Clin Pathol 2008; 62:95-6. [DOI: 10.1136/jcp.2008.060723] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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98
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Plasma C-reactive protein and albumin as predictors of readmission to intensive care. Crit Care 2008. [PMCID: PMC4088545 DOI: 10.1186/cc6395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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99
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From Arterial Pressure to Cardiac Output. Intensive Care Med 2008. [DOI: 10.1007/978-0-387-77383-4_55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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100
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Tissue oxygen saturation does not correlate with the oxygen delivery index during major abdominal surgery. Crit Care 2008. [PMCID: PMC4088439 DOI: 10.1186/cc6289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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