Peripherally inserted central catheters inserted with current best practices have low deep vein thrombosis and central line-associated bloodstream infection risk compared with centrally inserted central catheters: A contemporary meta-analysis.
- 作者列表："Schears GJ","Ferko N","Syed I","Arpino JM","Alsbrooks K
BACKGROUND:Peripherally inserted central catheters and centrally inserted central catheters have numerous benefits but can be associated with risks. This meta-analysis compared central catheters for relevant clinical outcomes using recent studies more likely to coincide with practice guidelines. METHODS:Several databases, Ovid MEDLINE, Embase, and EBM Reviews were searched for articles (2006-2018) that compared central catheters. Analyses were limited to peer-reviewed studies comparing peripherally inserted central catheters to centrally inserted central catheters for deep vein thrombosis and/or central line-associated bloodstream infections. Subgroup, sensitivity analyses, and patient-reported measures were included. Risk ratios, incidence rate ratios, and weighted event risks were reported. Study quality assessment was conducted using Newcastle-Ottawa and Cochrane Risk of Bias scales. RESULTS:Of 4609 screened abstracts, 31 studies were included in these meta-analyses. Across studies, peripherally inserted central catheters were protective for central line-associated bloodstream infection (incidence rate ratio = 0.52, 95% confidence interval: 0.30-0.92), with consistent results across subgroups. Peripherally inserted central catheters were associated with an increased risk of deep vein thrombosis (risk ratio = 2.08, 95% confidence interval: 1.47-2.94); however, smaller diameter and single-lumen peripherally inserted central catheters were no longer associated with increased risk. The absolute risk of deep vein thrombosis was calculated to 2.3% and 3.9% for smaller diameter peripherally inserted central catheters and centrally inserted central catheters, respectively. On average, peripherally inserted central catheter patients had 11.6 more catheter days than centrally inserted central catheter patients (p = 0.064). Patient outcomes favored peripherally inserted central catheters. CONCLUSION:When adhering to best practices, this study demonstrated that concerns related to peripherally inserted central catheters and deep vein thrombosis risk are minimized. Dramatic changes to clinical practice over the last 10 years have helped to address past issues with central catheters and complication risk. Given the lower rate of complications when following current guidelines, clinicians should prioritize central line choice based on patient therapeutic needs, rather than fear of complications. Future research should continue to consider contemporary literature over antiquated data, such that it recognizes the implications of best practices in modern central catheterization.
背景: 经外周静脉置入中心静脉导管和经中心静脉置入中心静脉导管有许多好处，但也可能存在风险。这项荟萃分析比较了中央导管的相关临床结果，使用最近的研究更可能与实践指南一致。 方法: 在几个数据库中，Ovid MEDLINE、Embase和EBM评论中检索了比较中心导管的文章 (2006-2018)。分析仅限于同行评审研究，比较外周静脉置入中心静脉导管与中心静脉置入中心静脉导管对深静脉血栓和/或中心静脉导管相关血流感染的影响。包括亚组、敏感性分析和患者报告的措施。报告了风险比、发病率比率和加权事件风险。使用纽卡斯尔-渥太华和Cochrane偏倚风险量表进行研究质量评估。 结果: 在4609篇筛选的摘要中，31篇研究被纳入这些荟萃分析。在整个研究中，经外周静脉置入中心静脉导管对中心静脉导管相关血流感染具有保护作用 (发病率比率 = 0.52，95% 置信区间: 0.30-0.92)，各亚组的结果一致。经外周置入中心静脉导管与深静脉血栓形成风险增加相关 (风险率 = 2.08，95% 置信区间: 1.47-2.94); 然而，较小直径和单腔经外周置入中心静脉导管不再与风险增加相关。对于较小直径的经外周穿刺中心静脉导管和经中央穿刺中心静脉导管，深静脉血栓形成的绝对风险分别为2.3% 和3.9%。平均而言，经外周静脉置入中心静脉导管患者的置管天数比经中心静脉置入中心静脉导管患者多11.6 (p = 0.064)。患者结局倾向于经外周置入中心静脉导管。 结论: 当坚持最佳实践时，本研究表明，与外周静脉置入中心静脉导管和深静脉血栓风险相关的担忧被最小化。过去10年临床实践的巨大变化有助于解决过去中心导管和并发症风险的问题。鉴于遵循当前指南时并发症发生率较低，临床医生应根据患者的治疗需求优先选择中心线，而不是担心并发症。未来的研究应继续考虑当代文献对过时数据的影响，以便认识到现代中心导管插入术最佳实践的影响。
METHODS::The ATP binding-cassette superfamily corresponds the mostly transmembrane transporters family found in humans. These proteins actively transport endogenous and exogenous substrates through biological membranes in body tissues, so they have an important role in the regulation of many physiological functions necessary for human homeostasis, as well as in response regulation to several pharmacological substrates. The development of multidrug resistance has become one of the main troubles in conventional chemotherapy in different illnesses including cancer, being the increased efflux of antineoplastic drugs the main reason for this multidrug resistance, with a key role of the ABC superfamily. Likely, the interindividual variability in the pharmacological response among patients is well known, and may be due to intrinsically factors of the disease, genetic and environmental ones. Thus, the understanding of this variability, especially the genetic variability associated with the efficacy and toxicity of drugs, can provide a safer and more effective pharmacological treatment, so ABC genes are considered as important regulators due to their relationship with the reduction in pharmacological response. In this review, updated information about transporters belonging to this superfamily was collected, the possible role of these transporters in cancer, the role of genetic variability in their genes, as well as some therapeutic tools that have been tried to raise against main transporters associated with chemoresistance in cancer.
METHODS:BACKGROUND:Cholinergic neurotransmission regulates neuroinflammation in Parkinson disease (PD). RESEARCH DESIGN AND METHODS:The authors conducted a delayed-start study of donepezil for cognitive decline in non-demented PD patients. The study consisted of a 96-week randomized placebo-controlled double-blind phase 1, followed by a 24-week donepezil extension phase 2. The primary outcome measure was a change in the Mini-Mental State Examination (MMSE) at week 120. RESULTS:A total of 98 patients were randomly allocated to the early-start (donepezil-to-donepezil) and delayed-start (placebo-to-donepezil) groups. Mean (SD) of the baseline MMSE was 27.6 (2.0) and 28.0 (2.1), respectively. MMSE change at week 120 was better in the early-start group than in the delayed-start group, but the difference was not significant. The MMSE declined in apolipoprotein ε4 carriers, but not in non-carriers, and the factor interaction (intervention × ε4 genotype) was highly significant (P < 0.001). Analyzed with the interaction, the difference was significant (group difference 1.95 [0.33 to 3.57], P = 0.018). The MMSE decline slope in phase 1 was significantly better in the early-start group than in the delayed-start group (P = 0.048). CONCLUSIONS:Cognitive function deteriorated in ε4 carriers, but not in non-carriers, and early-start donepezil may postpone cognitive decline in the former.
METHODS::Since the discovery of dental pulp stem cells, a lot of teams have expressed an interest in dental pulp regeneration. Many approaches, experimental models and biological explorations have been developed, each including the use of stem cells and scaffolds with the final goal being clinical application in humans. In this review, the authors' objective was to compare the experimental models and strategies used for the development of biomaterials for tissue engineering of dental pulp with stem cells. Electronic queries were conducted on PubMed using the following terms: pulp regeneration, scaffold, stem cells, tissue engineering and biomaterial. The extracted data included the following information: the strategy envisaged, the type of stem cells, the experimental models, the exploration or analysis methods, the cytotoxicity or viability or proliferation cellular tests, the tests of scaffold antibacterial properties and take into account the vascularization of the regenerated dental pulp. From the 71 selected articles, 59% focused on the "cell-transplantation" strategy, 82% used in vitro experimentation, 58% in vivo animal models and only one described an in vivo in situ human clinical study. 87% used dental pulp stem cells. A majority of the studies reported histology (75%) and immunohistochemistry explorations (66%). 73% mentioned the use of cytotoxicity, proliferation or viability tests. 48% took vascularization into account but only 6% studied the antibacterial properties of the scaffolds. This article gives an overview of the methods used to regenerate dental pulp from stem cells and should help researchers create the best development strategies for research in this field.