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  • 1
    In: Acta Anaesthesiologica Scandinavica, Wiley, Vol. 66, No. 3 ( 2022-03), p. 375-385
    Abstract: Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and is associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non‐ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients. Method We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy. Results A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with 24%–100% of doctors from sites responding. Most ICUs (80%) did not have a local guideline for the management of acute AF. The preferred first‐line strategy for the management of hemodynamically stable patients with acute AF was observation (95% of respondents), rhythm control (3%), or rate control (2%). For hemodynamically unstable patients, the preferred strategy was observation (48%), rhythm control (48%), or rate control (4%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta‐blockers other than sotalol, and magnesium in that order. A total of 67% preferred using anticoagulant therapy in ICU patients with AF, among whom 61% preferred therapeutic dose anticoagulants and 39% prophylactic dose anticoagulants. Conclusion This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.
    Type of Medium: Online Resource
    ISSN: 0001-5172 , 1399-6576
    URL: Issue
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2004319-3
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  • 2
    In: European Journal of Heart Failure, Wiley, Vol. 19, No. S2 ( 2017-05), p. 97-103
    Abstract: Ventricular septal rupture ( VSR ) became a rare mechanical complication of myocardial infarction in the era of percutaneous coronary interventions but is associated with extreme mortality in patients who present with cardiogenic shock ( CS ). Promising outcomes have been reported with the use of circulatory support allowing haemodynamic stabilization, followed by delayed repair. Therefore, we analysed our experience with an early use of Veno‐Arterial Extracorporeal Membrane Oxygenation (V‐A ECMO ) for postinfarction VSR . Methods and results We conducted a retrospective search of institutional database for patients presenting with postinfarction VSR from January 2007 to June 2016. Data from 31 consecutive patients (mean age 69.5 ± 9.1 years) who were admitted to hospital were analysed. Seven out of 31 patients with VSR who were in refractory CS received V‐A ECMO support preoperatively. ECMO improved end‐organ perfusion with decreased lactate levels 24 hours after implantation (7.9 mmol/L vs. 1.6 mmol/L, p = 0.01), normalized arterial pH (7.25 vs. 7.40, p 〈 0.04), improved mean arterial pressure (64 mmHg vs. 83 mmHg , p 〈 0.01) and lowered heart rate (115/min vs. 68/min, p 〈 0.01). Mean duration of ECMO support was 12 days, 5 out of 7 patients underwent surgical repair, 4 were weaned from ECMO , 3 survived 30 days and 2 survived more than 1 year. The most frequent complication (5 patients) and the cause of death (3 patients) was bleeding. Conclusions Our experience suggests that early V‐A ECMO in patients with VSR and refractory CS might prevent irreversible multiorgan failure by improved end‐organ perfusion. Bleeding complications remain an important limitation of this approach.
    Type of Medium: Online Resource
    ISSN: 1388-9842 , 1879-0844
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 1500332-2
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  • 3
    In: Head & Neck, Wiley, Vol. 42, No. 3 ( 2020-03), p. 498-512
    Abstract: The aim was to collate and contrast patient concerns from a range of different head and neck cancer follow‐up clinics around the world. Also, we sought to explore the relationship, if any, between responses to the patient concerns inventory (PCI) and overall quality of life (QOL). Methods Nineteen units participated with intention of including 100 patients per site as close to a consecutive series as possible in order to minimize selection bias. Results There were 2136 patients with a median total number of PCI items selected of 5 (2‐10). “Fear of the cancer returning” (39%) and “dry mouth” (37%) were most common. Twenty‐five percent (524) reported less than good QOL. Conclusion There was considerable variation between units in the number of items selected and in overall QOL, even after allowing for case‐mix variables. There was a strong progressive association between the number of PCI items and QOL.
    Type of Medium: Online Resource
    ISSN: 1043-3074 , 1097-0347
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2001440-5
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  • 4
    In: The Journal of Physiology, Wiley, Vol. 593, No. 10 ( 2015-05-15), p. 2279-2293
    Abstract: NMDA receptors (NMDARs) are tetrameric cation channels permeable to calcium; they mediate excitatory synaptic transmission in the CNS and their excessive activation can lead to neurodegeneration. Although these receptors are in direct contact with plasma membrane, lipid–NMDAR interactions are little understood. Using cultured rat cerebellar granule cells, we show that acute and chronic pretreatments resulting in cell cholesterol depletion profoundly diminish NMDAR responses and increase NMDAR desensitization, and also that cholesterol enrichment potentiates NMDAR responses; however, cholesterol manipulation has no effect on the amplitude of AMPA/kainate receptor responses. Diminution of NMDAR responses by cholesterol depletion is the result of a reduction of the ion channel open probability, whereas the increase in receptor desensitization is the result of an increase in the rate constant of entry into the desensitized state. These results demonstrate the physiological role of membrane lipids in the modulation of NMDAR activity. Abstract NMDA receptors (NMDARs) are glutamate‐gated ion channels that mediate excitatory neurotransmission in the CNS. Although these receptors are in direct contact with plasma membrane, lipid–NMDAR interactions are little understood. In the present study, we aimed at characterizing the effect of cholesterol on the ionotropic glutamate receptors. Whole‐cell current responses induced by fast application of NMDA in cultured rat cerebellar granule cells (CGCs) were almost abolished (reduced to 3%) and the relative degree of receptor desensitization was increased (by seven‐fold) after acute cholesterol depletion by methyl‐β‐cyclodextrin. Both of these effects were fully reversible by cholesterol repletion. By contrast, the responses mediated by AMPA/kainate receptors were not affected by cholesterol depletion. Similar results were obtained in CGCs after chronic inhibition of cholesterol biosynthesis by simvastatin and acute enzymatic cholesterol degradation to 4‐cholesten‐3‐one by cholesterol oxidase. Fluorescence anisotropy measurements showed that membrane fluidity increased after methyl‐β‐cyclodextrin pretreatment. However, no change in fluidity was observed after cholesterol enzymatic degradation, suggesting that the effect of cholesterol on NMDARs is not mediated by changes in membrane fluidity. Our data show that diminution of NMDAR responses by cholesterol depletion is the result of a reduction of the open probability, whereas the increase in receptor desensitization is the result of an increase in the rate constant of entry into the desensitized state. Surface NMDAR population, agonist affinity, single‐channel conductance and open time were not altered in cholesterol‐depleted CGCs. The results of our experiments show that cholesterol is a strong endogenous modulator of NMDARs.
    Type of Medium: Online Resource
    ISSN: 0022-3751 , 1469-7793
    URL: Issue
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 1475290-6
    SSG: 12
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