The American journal of the medical sciences
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Long-term use of ketamine results in ketamine-associated urinary dysfunction (KAUD), which is characterized by frequent micturition, urgent urination, urine pain, hematuria, dysuria and urge incontinence. This study aims to examine the effect of ketamine on the urothelium and investigate the underlying mechanisms responsible for KAUD. ⋯ These results suggest that the mitochondrial pathway of apoptosis in bladder epithelium may contribute to KAUD.
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The FloTrac®/Vigileo device uses arterial pressure waveform analysis to calculate stroke volume and cardiac output; it does not require calibration against an independent measurement of cardiac output. Consequently, it provides a method to determine hemodynamic status, changes in the clinical course and responses to therapeutic interventions in patients who have arterial catheters in place. These devices perform relatively well in stable patients undergoing surgery and having an acceptable percentage error in differences between the FloTrac® device and invasive monitoring using pulmonary catheters. ⋯ There is a moderate correlation with changes in cardiac output after fluid administration, but a poor correlation with changes in cardiac output after increases or decreases in norepinephrine administration. The bias between measurements increases as the systemic vascular resistance decreases. Consequently, cardiac output measurements using the FloTrac® device are not accurate enough for use in patients with septic shock, advanced liver disease and other medical conditions associated with decreased vascular tone.
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The aim of this study was to evaluate the prognostic value of B-type natriuretic peptide (BNP) in combination with the sequential organ failure assessment (SOFA) score in patients with septic shock at the time of emergency department (ED). ⋯ The combination of SOFA with BNP at the time of ED presentation may provide superior prognostic accuracy to the patients with septic shock. However, further studies need to validate the prognostic usefulness of SOFA with BNP.
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A paradoxical association between cholesterol level and clinical outcome has been suggested, yet never previously established, in patients with chronic obstructive pulmonary disease (COPD). ⋯ Low cholesterol levels are significantly associated with increased mortality after AECOPD. Nonetheless, as statin treatment was associated with reduced mortality over the entire range of cholesterol levels, its use should be considered in all COPD patients.