Institution
Federal University of São Paulo
Education•São Paulo, Brazil•
About: Federal University of São Paulo is a education organization based out in São Paulo, Brazil. It is known for research contribution in the topics: Population & Transplantation. The organization has 27971 authors who have published 49365 publications receiving 935536 citations. The organization is also known as: Universidade Federal de São Paulo & Universidade Federal de Sao Paulo.
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TL;DR: NPPV, especially CPAP, in addition to standard medical care is an effective and safe intervention for the treatment of adult patients with acute cardiogenic pulmonary edema.
Abstract: Background
This is an update of a systematic review previously published in 2008 about non-invasive positive pressure ventilation (NPPV). NPPV has been widely used to alleviate signs and symptoms of respiratory distress due to cardiogenic pulmonary oedema. NPPV prevents alveolar collapse and helps redistribute intra-alveolar fluid, improving pulmonary compliance and reducing the pressure of breathing.
Objectives
To determine the effectiveness and safety of NPPV in the treatment of adult patients with cardiogenic pulmonary oedema in its acute stage.
Search methods
We searched the following databases on 20 April 2011: CENTRAL and DARE, (The Cochrane Library, Issue 2 of 4, 2011); MEDLINE (Ovid, 1950 to April 2011); EMBASE (Ovid, 1980 to April 2011); CINAHL (1982 to April 2011); and LILACS (1982 to April 2011). We also reviewed reference lists of included studies and contacted experts and equipment manufacturers. We did not apply language restrictions.
Selection criteria
We selected blinded or unblinded randomised or quasi-randomised clinical trials, reporting on adult patients with acute or acute-on-chronic cardiogenic pulmonary oedema and where NPPV (continuous positive airway pressure (CPAP) or bilevel NPPV) plus standard medical care was compared with standard medical care alone.
Data collection and analysis
Two authors independently selected articles and abstracted data using a standardised data collection form. We evaluated study quality with emphasis on allocation concealment, sequence generation allocation, losses to follow-up, outcome assessors, selective outcome reporting and adherence to the intention-to-treat principle.
Main results
We included 32 studies (2916 participants), of generally low or uncertain risk of bias. Compared with standard medical care, NPPV significantly reduced hospital mortality (RR 0.66, 95% CI 0.48 to 0.89) and endotracheal intubation (RR 0.52, 95% CI 0.36 to 0.75). We found no difference in hospital length of stay with NPPV; however, intensive care unit stay was reduced by 1 day (WMD -0.89 days, 95% CI -1.33 to -0.45). Compared with standard medical care, we did not observe significant increases in the incidence of acute myocardial infarction with NPPV during its application (RR 1.24, 95% CI 0.79 to 1.95) or after (RR 0.70, 95% CI 0.11 to 4.26). We identified fewer adverse events with NPPV use (in particular progressive respiratory distress and neurological failure (coma)) when compared with standard medical care.
Authors' conclusions
NPPV in addition to standard medical care is an effective and safe intervention for the treatment of adult patients with acute cardiogenic pulmonary oedema. The evidence to date on the potential benefit of NPPV in reducing mortality is entirely derived from small-trials and further large-scale trials are needed.
334 citations
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Université libre de Bruxelles1, University College London2, University of Barcelona3, Federal University of São Paulo4, St. Michael's Hospital5, The George Institute for Global Health6, University of Genoa7, University of Turin8, University of Indonesia9, Claude Bernard University Lyon 110, Peking Union Medical College Hospital11, Ghent University Hospital12, Medanta13, Utrecht University14, Outcomes Research Consortium15, Wake Forest University16, Washington University in St. Louis17, University of Pittsburgh18
TL;DR: In a worldwide sample of patients admitted to ICUs in September 2017, the prevalence of suspected or proven infection was high, with a substantial risk of in-hospital mortality, and ICU-acquired infection was independently associated with higher risk of mortality.
Abstract: Importance Infection is frequent among patients in the intensive care unit (ICU). Contemporary information about the types of infections, causative pathogens, and outcomes can aid the development of policies for prevention, diagnosis, treatment, and resource allocation and may assist in the design of interventional studies. Objective To provide information about the prevalence and outcomes of infection and the available resources in ICUs worldwide. Design, Setting, and Participants Observational 24-hour point prevalence study with longitudinal follow-up at 1150 centers in 88 countries. All adult patients (aged ≥18 years) treated at a participating ICU during a 24-hour period commencing at 08:00 on September 13, 2017, were included. The final follow-up date was November 13, 2017. Exposures Infection diagnosis and receipt of antibiotics. Main Outcomes and Measures Prevalence of infection and antibiotic exposure (cross-sectional design) and all-cause in-hospital mortality (longitudinal design). Results Among 15 202 included patients (mean age, 61.1 years [SD, 17.3 years]; 9181 were men [60.4%]), infection data were available for 15 165 (99.8%); 8135 (54%) had suspected or proven infection, including 1760 (22%) with ICU-acquired infection. A total of 10 640 patients (70%) received at least 1 antibiotic. The proportion of patients with suspected or proven infection ranged from 43% (141/328) in Australasia to 60% (1892/3150) in Asia and the Middle East. Among the 8135 patients with suspected or proven infection, 5259 (65%) had at least 1 positive microbiological culture; gram-negative microorganisms were identified in 67% of these patients (n = 3540), gram-positive microorganisms in 37% (n = 1946), and fungal microorganisms in 16% (n = 864). The in-hospital mortality rate was 30% (2404/7936) in patients with suspected or proven infection. In a multilevel analysis, ICU-acquired infection was independently associated with higher risk of mortality compared with community-acquired infection (odds ratio [OR], 1.32 [95% CI, 1.10-1.60];P = .003). Among antibiotic-resistant microorganisms, infection with vancomycin-resistantEnterococcus(OR, 2.41 [95% CI, 1.43-4.06];P = .001),Klebsiellaresistant to β-lactam antibiotics, including third-generation cephalosporins and carbapenems (OR, 1.29 [95% CI, 1.02-1.63];P = .03), or carbapenem-resistantAcinetobacterspecies (OR, 1.40 [95% CI, 1.08-1.81];P = .01) was independently associated with a higher risk of death vs infection with another microorganism. Conclusions and Relevance In a worldwide sample of patients admitted to ICUs in September 2017, the prevalence of suspected or proven infection was high, with a substantial risk of in-hospital mortality.
333 citations
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TL;DR: This review will examine both the principles and outcomes of techniques to prevent collagen hydrolysis in dentin-resin interfaces, and shows that enzyme inhibition is a promising approach to improve hybrid layer preservation and bond strength durability.
332 citations
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St George’s University Hospitals NHS Foundation Trust1, Ohio State University2, King's College London3, Université libre de Bruxelles4, Tata Memorial Hospital5, Peking Union Medical College Hospital6, New York University7, University of Barcelona8, University of Queensland9, Federal University of São Paulo10, University of Kansas11, Sultanah Aminah Hospital12, Brown University13
TL;DR: Patients whose care included compliance with all of the evidence-based bundle metrics had a 40 % reduction in the odds of dying in hospital with the 3-h bundle and 36 % for the 6-h bundles.
Abstract: Despite evidence demonstrating the value of performance initiatives, marked differences remain between hospitals in the delivery of care for patients with sepsis. The aims of this study were to improve our understanding of how compliance with the 3-h and 6-h Surviving Sepsis Campaign (SSC) bundles are used in different geographic areas, and how this relates to outcome. This was a global, prospective, observational, quality improvement study of compliance with the SSC bundles in patients with either severe sepsis or septic shock. A total of 1794 patients from 62 countries were enrolled in the study with either severe sepsis or septic shock. Overall compliance with all the 3-h bundle metrics was 19 %. This was associated with lower hospital mortality than non-compliance (20 vs. 31 %, p < 0.001). Overall compliance with all the 6-h bundle metrics was 36 %. This was associated with lower hospital mortality than non-compliance (22 vs. 32 %, p < 0.001). After adjusting the crude mortality differences for ICU admission, sepsis status (severe sepsis or septic shock), location of diagnosis, APACHE II score and country, compliance remained independently associated with improvements in hospital mortality for both the 3-h bundle (OR = 0.64 (95 % CI 0.47−0.87), p = 0.004)) and 6-h bundle (OR = 0.71 (95 % CI 0.56−0.90), p = 0.005)). Compliance with all of the evidence-based bundle metrics was not high. Patients whose care included compliance with all of these metrics had a 40 % reduction in the odds of dying in hospital with the 3-h bundle and 36 % for the 6-h bundle.
330 citations
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Case Western Reserve University1, National Institutes of Health2, University Hospitals of Cleveland3, University of Toronto4, University of São Paulo5, East Tennessee State University6, University of Tübingen7, Washington University in St. Louis8, Federal University of São Paulo9, Columbia University10, Riyadh Military Hospital11
TL;DR: The CACP protein, which has previously been identified as both 'megakaryocyte stimulating factor precursor' and 'superficial zone protein', contains domains that have homology to somatomedin B, heparin-binding proteins, mucins and haemopexins, and the similarity of CACP sequence to that of other protein families and the expression in non-skeletal tissues suggest it may have diverse biological activities.
Abstract: Altered growth and function of synoviocytes, the intimal cells which line joint cavities and tendon sheaths, occur in a number of skeletal diseases. Hyperplasia of synoviocytes is found in both rheumatoid arthritis and osteoarthritis, despite differences in the underlying aetiologies of the two disorders. We have studied the autosomal recessive disorder camptodactyly-arthropathy-coxa vara-pericarditis syndrome (CACP; MIM 208250) to identify biological pathways that lead to synoviocyte hyperplasia, the principal pathological feature of this syndrome. Using a positional-candidate approach, we identified mutations in a gene (CACP) encoding a secreted proteoglycan as the cause of CACP. The CACP protein, which has previously been identified as both 'megakaryocyte stimulating factor precursor' and 'superficial zone protein', contains domains that have homology to somatomedin B, heparin-binding proteins, mucins and haemopexins. In addition to expression in joint synovium and cartilage, CACP is expressed in non-skeletal tissues including liver and pericardium. The similarity of CACP sequence to that of other protein families and the expression of CACP in non-skeletal tissues suggest it may have diverse biological activities.
330 citations
Authors
Showing all 28240 results
Name | H-index | Papers | Citations |
---|---|---|---|
Majid Ezzati | 133 | 443 | 137171 |
Christian Guilleminault | 133 | 897 | 68844 |
Jean Rivier | 133 | 769 | 73919 |
Myron M. Levine | 123 | 789 | 60865 |
Werner Seeger | 114 | 1113 | 57464 |
Katherine L. Tucker | 106 | 683 | 39404 |
Michael Bader | 103 | 735 | 37525 |
Paulo A. Lotufo | 89 | 622 | 100527 |
Fernando Q. Cunha | 88 | 682 | 31501 |
Paul R. Sanberg | 87 | 635 | 29745 |
Harold A. Chapman | 87 | 191 | 26617 |
Ricardo T. Gazzinelli | 86 | 340 | 28233 |
Carlito B. Lebrilla | 86 | 495 | 25415 |
Roger S. McIntyre | 85 | 807 | 32040 |
Sergio Tufik | 85 | 1424 | 35174 |