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R K Ryu J D Durham J Krysl R Shrestha R Shrestha G T Everson J Stephens I Kam M Wachs D A Kumpe 《Journal of vascular and interventional radiology : JVIR》1999,10(6):799-805
PURPOSE: To investigate the role of transjugular intrahepatic portosystemic shunt (TIPS) as a bridge to transplantation for patients with Budd-Chiari syndrome (BCS). MATERIALS AND METHODS: Eight patients (five women, three men) with a mean age of 49.8 years (range, 20-61 years) were diagnosed with BCS by means of computed tomography, hepatic venography, and liver biopsy. One patient had acute liver failure, with subacute or chronic failure in seven. TIPS placement was attempted in all eight patients. Clinical follow-up and portograms were obtained in all patients until death or transplantation. RESULTS: TIPS placement was completed in seven of eight patients (87.5%). During the follow-up period, TIPS occlusion occurred in four patients. TIPS revision in this patient, although successful, was complicated by hemorrhage and multiorgan failure, and the patient died. Assisted patency rate, excluding the technical failure, was 100%. Mean follow-up in the six survivors with TIPS was 342 days (range, 19-660 days). All six survivors had complete resolution of their ascites. Albumin levels improved an average of 0.43 g/dL (range, 0.3-1.4 g/dL). Bilirubin levels improved in five of six patients (83%), decreasing by an average of 5.6 mg/dL (range, 3.0-15.2 mg/dL). Of the six survivors, three underwent elective liver transplantation, one is awaiting transplantation, and one has been removed from the transplantation list because of clinical improvement. One patient was a candidate for transplantation but declined to be put on the list. CONCLUSION: Hepatic synthetic dysfunction improves markedly after TIPS placement in patients with BCS. Significant improvement in ascites can also occur. TIPS can be an effective bridge to transplantation for patients with BCS. 相似文献
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Simon Braithwaite Jonny Coppel Lucy Everson Jessica Kearney Lucy Gibson Rahul Chodhari 《The Journal of asthma》2013,50(10):1077-1078
AbstractObjective: To assess the efficacy of inhaled, repeat doses (28 days) of the glucocorticoid agonist GW870086, which has been designed to inhibit gene transrepression of the glucocorticoid receptor while preserving its transactivation. Methods: This was a randomised, placebo-controlled, two-way crossover study, approved by the independent ethics committees of the study centres. Subjects with FEV1 40–85% of the predicted normal value (n?=?36) received GW870086 (1?mg, once-daily) and placebo. Results: No significant change from baseline in forced expiratory volume in one second (FEV1) was seen following administration of GW8780086 1?mg relative to placebo; mean FEV1 (day 28), relative to placebo, was (95% confidence intervals [CI]) ?0.077?L (?0.192, 0.038). A moderate positive placebo response was observed on Days 14 and 28: Mean FEV1 (95% CI) was 0.115?L (0.040, 0.189) and 0.115?L (0.019, 0.212), respectively. The placebo response was more notable in treatment period 1 and was larger than the response to GW870086 1?mg on day 28, irrespective of period. Peak expiratory flow rate results were consistent with FEV1 and no difference was seen between the GW870086 and placebo for rescue medication usage. Conclusion: This total lack of effect suggests that repeat-dose GW8700861?mg has suboptimal efficacy in mild to moderate asthma. 相似文献
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Z Toossi J R Sedor M A Mettler B Everson T Young O D Ratnoff 《Proceedings of the National Academy of Sciences of the United States of America》1992,89(24):11969-11972
The results reported here indicate that activated species of Hageman factor (HF, factor XII), a protein that mediates blood clotting, fibrinolysis, and activation of the complement cascade, induce elaboration of interleukin 1 (IL-1) by human monocytes. Augmentation of IL-1 production in mononuclear cell cultures was observed when HF was present along with lipopolysaccharide (LPS) but was not observed with HF alone. Furthermore, antiserum to HF abrogated the enhancement of IL-1 in cultures containing HF and LPS. Total IL-1 activity, which represents secreted and cell-associated IL-1, was enhanced in LPS-stimulated mononuclear cultures by HF. In the absence of LPS, the initial activation product of HF, HFa, which contains the serine protease enzyme activity and the surface-binding domains of the protein, induced IL-1 beta protein and mRNA. In the presence of LPS, the enzymatic moiety (HFf), which is also contained in HF and HFa, amplified IL-1 production. Induction and amplification of monocyte IL-1 by HF provides further evidence for establishing a role for HF in the acute-phase reaction and the cellular immune response. 相似文献
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Information discontinuity between hospitals and skilled nursing facilities (SNFs) is a critical barrier to safe and effective transitions. To engage effectively in information sharing, SNFs need structural health information exchange (HIE) capabilities but also HIE design and workflows that result in electronic information actually being accessible and usable at the point of care. We use nationally representative SNF data to identify key facility characteristics, and characteristics of the facility’s top hospital referral partner, that are associated with likelihood of SNFs having access to electronic information sharing tools. Controlling for those capabilities, we then assess the extent to which those same characteristics influence the extent to which the SNF reports usable information received electronically that is actually available at the point of care. We conducted pooled, cross-sectional survey data analyses. We identified our sample of SNFs through the Office of the National Coordinator SNF Health IT Survey (2016-2017). From this survey, we generated our SNF HIE capability metric (ability to electronically query for or receive patient information from outside sources) as well as our key study outcome—whether SNFs report usable electronic information from outside sources available at the point of care. Organizational SNF characteristics were pulled from the SK&A Nursing Home datafile as well as the CMS Nursing Home Public Use file. We matched each SNF to the hospital responsible for sending the highest percent of their referrals using Medicare referral pattern data and used these same data to calculate a measure of SNF referral relationship concentration. We then, for each partner hospital, used the American Hospital Association (AHA) IT Supplement to identify general and SNF-specific HIE capabilities. We use linear probability models to estimate the association between relevant organizational characteristics (of the SNF and partner hospital) and both HIE outcomes: (1) SNF HIE capabilities and (2) SNF self-reported availability of usable and accessible outside information at the point of care (controlling for HIE capabilities). Nationally representative sample of skilled nursing facilities (N = 1,189). Controlling for the presence of an EHR, SNFs are more likely to electronically query for or receive information from outside sources if they are large (+10.3%, top tertile compared to bottom; P = .004), if they are part of a large chain (+11.7%, member of 70+ nursing home chain, compared to standalone; P = .001), and if their partnering hospital reports having a health information portal (+7.5%; P = .049). Adjusting for SNF HIE capabilities, SNFs have a higher probability of usable electronic information available at the point of care if their top partner hospital reports participation in a community HIO (+7.6%; P = .018). Hospital information portals increase SNF access to HIE infrastructure, but community-level HIOs increase the likelihood that SNFs actually have accessible, usable electronic information from hospitals at the point of care. Community HIOs appear to play a critical role in SNFs having usable, timely access to outside sources of health information. HIOs have significant opportunity to bolster their value proposition through greater engagement with SNFs and other postacute providers on supporting their informational needs and transitional care processes with hospitals. Office of the National Coordinator for Health IT. 相似文献
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