The Journal of international medical research
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Review Case Reports
Septic shock after liver transplantation successfully treated with endotoxin and cytokine adsorption continuous renal replacement therapy: a case report and literature review.
Endotoxins and cytokines play an important role in multiple organ failure pathogenesis in patients with severe Gram-negative bacterial infection. We present a clinical case where an oXiris hemofilter was used for continuous renal replacement therapy (CRRT) treatment in a patient with septic shock after liver transplantation. A 35-year-old man with a 20-year history of hepatitis B presented with jaundice, loss of appetite, and decreased urine output. ⋯ Procalcitonin, endotoxin, and the inflammatory factors interleukin (IL)-6 and IL-10 also decreased gradually. The patient's liver and kidney functions were completely restored. Our experience suggests that oXiris CRRT combined with antibacterial therapy is an effective treatment for septic shock after liver transplantation.
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Meta Analysis
Steroid use after cardiac arrest is associated with favourable outcomes: a systematic review and meta-analysis.
The effect of steroid use on outcomes in patients with cardiac arrest (CA) remains controversial. We systematically reviewed the literature to investigate whether steroid use after CA increased the return of spontaneous circulation (ROSC) rate and survival to discharge in patients with CA. ⋯ Current evidence indicates that steroid use after CA could increase ROSC and survival to discharge in patients with CA. However, high-quality and adequately powered RCTs are warranted.
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Previous studies comparing surgical pleth index (SPI)-guided and conventional analgesia have shown differing results. Therefore, we compared the intraoperative opioid requirement, extubation time, postoperative pain scores, and perioperative adverse events between these two modalities. ⋯ Compared with conventional analgesia, SPI-guided analgesia can reduce intraoperative opioid consumption and facilitate extubation. Moreover, no intergroup difference was observed in the degree of postoperative pain or incidence of perioperative adverse events.
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Back pain is a common clinical symptom. Degeneration of intervertebral discs is one of the most important factors leading to back pain, namely, discogenic back pain. However, at present, the understanding of lumbar intervertebral discs causing back pain is confined to biomechanical and histological studies. ⋯ Therefore, study of neural mechanisms that are involved in progression of discogenic back pain will provide additional assistance for treatment of its symptoms. We review the anatomical structure of intervertebral discs and the related neural mechanisms involved in discogenic back pain. We also discuss the current view of neural mechanisms underlying discogenic back pain.
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Review Comparative Study
Cerebral monitoring of anaesthesia on reducing cognitive dysfunction and postoperative delirium: a systematic review.
Objective To assess the efficacy of cerebrally monitoring the depth of anaesthesia in reducing postoperative cognitive dysfunction and postoperative delirium (POD). Methods MEDLINE, EMBASE, and Cochrane Library databases were searched following PRISMA statement guidelines. We included randomized clinical trials (RCTs) comparing electroencephalogram-based and routine care-guided titration of anaesthesia in a systematic review. ⋯ There was no significant difference between BIS- and AEP-based titration of anaesthesia in reducing the risk of POD. Extensive heterogeneity for cardiac and thoracic surgery was identified in the study population, and significant publication bias was found among the POD results. Conclusions BIS- and AEP-guided anaesthesia are associated with significantly reduced risk of POD and long-term cognitive dysfunction.