RESUMEN
OBJECTIVE: Our study objective was to evaluate changes in ETT tube depth throughout the initial intubation course in very and extremely preterm infants in order to evaluate the risk of outgrowing an endotracheal tube (ETT). METHODS: This was a retrospective cohort study of preterm infants born at <32 weeks of gestation who were admitted to the NICU between 2012 and 2021 and required intubation for mechanical ventilation. Infants who were intubated only for surfactant administration and those with airway malformations were excluded. Descriptive statistics were used to define the range of ETT depths at the time of extubation, stratified by gestational age (<28 weeks vs 28-32 weeks of gestation). Relative ETT depth was defined as the final depth minus the initial depth. RESULTS: Out of 496 infants, 140 patients met all criteria for inclusion. Descriptive analysis of extubation depths across the populations demonstrated median relative ETT depth of 0 cm for the 28-32-week gestational age group, and -0.25 cm for the <28-week gestational age group. The 95th percentile for both gestational age groups was a relative depth of 0.5 cm and the 99th percentile was 1.0-1.5 cm. CONCLUSION: The results of our study suggest that the vast majority of patients in the NICU are unlikely to "outgrow" ETT tube length which should be taken into account when deciding where to trim the ETT in order to minimize airway resistance.
Asunto(s)
Edad Gestacional , Recien Nacido Extremadamente Prematuro , Intubación Intratraqueal , Humanos , Intubación Intratraqueal/métodos , Intubación Intratraqueal/instrumentación , Recién Nacido , Estudios Retrospectivos , Femenino , Masculino , Extubación Traqueal/métodos , Extubación Traqueal/estadística & datos numéricos , Unidades de Cuidado Intensivo Neonatal , Respiración Artificial/métodos , Respiración Artificial/instrumentación , Recien Nacido PrematuroRESUMEN
Marijuana generally refers to the dried mixture of leaves and flowers of the cannabis plant, and the term cannabis is a commonly used to refer to products derived from the Cannabis sativa L. plant. There has been an increasing interest in the potential medicinal use of cannabis to treat a variety of diseases and conditions. This review will provide the latest evidence regarding the medical risks and potential therapeutic benefits of cannabis in managing patients with sleep disorders or those with other medical conditions who commonly suffer with sleep disturbance as an associated comorbidity. Published data regarding the effects of cannabis compounds on sleep in the general population, as well as in patients with insomnia, chronic pain, posttraumatic stress disorder, and other neurological conditions, will be presented. Current trends for marijuana use and its effects on the economy and the implications that those trends and effects have on future research into medical cannabis are also presented.
Asunto(s)
Marihuana Medicinal/uso terapéutico , Enfermedades del Sistema Nervioso/tratamiento farmacológico , Trastornos del Sueño-Vigilia/tratamiento farmacológico , HumanosRESUMEN
BACKGROUND: Despite improvements in cancer management, most pancreatic cancers are still diagnosed at an advanced stage. We have recently identified promoter DNA methylation of the genes ADAMTS1 and BNC1 as potential blood biomarkers of pancreas cancer. In this study, we validate this biomarker panel in peripheral cell-free tumor DNA of patients with pancreatic cancer. RESULTS: Sensitivity and specificity for each gene are as follows: ADAMTS1 87.2% and 95.8% (AUC = 0.91; 95% CI 0.71-0.86) and BNC1 64.1% and 93.7% (AUC = 0.79; 95% CI 0.63-0.78). When using methylation of either gene as a combination panel, sensitivity increases to 97.3% and specificity to 91.6% (AUC = 0.95; 95% CI 0.77-0.90). Adding pre-operative CA 19-9 values to the combined two-gene methylation panel did not improve sensitivity. Methylation of ADAMTS1 was found to be positive in 87.5% (7/8) of stage I, 77.8% (7/9) of stage IIA, and 90% (18/20) of stage IIB disease. Similarly, BNC1 was positive in 62.5% (5/8) of stage I patients, 55.6% (5/9) of stage IIA, and 65% (13/20) of patients with stage IIB disease. The two-gene panel (ADAMTS1 and/or BNC1) was positive in 100% (8/8) of stage I, 88.9% (8/9) of stage IIA, and 100% (20/20) of stage IIB disease. The sensitivity and specificity of the two-gene panel for localized pancreatic cancer (stages I and II), where the cancer is eligible for surgical resection with curative potential, was 94.8% and 91.6% respectively. Additionally, the two-gene panel exhibited an AUC of 0.95 (95% CI 0.90-0.98) compared to 57.1% for CA 19-9 alone. CONCLUSION: The methylation status of ADAMTS1 and BNC1 in cfDNA shows promise for detecting pancreatic cancer during the early stages when curative resection of the tumor is still possible. This minimally invasive blood-based biomarker panel could be used as a promising tool for diagnosis and screening in a select subset of high-risk populations.