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1.
Zhonghua Yi Xue Za Zhi ; 104(35): 3334-3341, 2024 Sep 10.
Artículo en Chino | MEDLINE | ID: mdl-39266498

RESUMEN

Objective: To investigate the safety and efficacy of a varicose vein sealant kit in the treatment of great saphenous vein dysfunction. Methods: It was a randomized controlled trial. A total of 180 patients with great saphenous vein dysfunction were enrolled prospectively, and scheduled for surgical treatment in 9 hospitals, including the Second Affiliated Hospital of Naval Medical University, Shanghai Oriental Hospital Affiliated to Tongji University, Xuanwu Hospital Capital Medical University, the First Hospital of Hebei Medical University, Ganzhou People's Hospital, Shanxi Bethune Hospital, the Second Affiliated Hospital of Zhejiang University School of Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, and Zhongshan Hospital Affiliated to Xiamen University, from June to October 2022. Using a random number table method, the subjects were divided into an experimental group and a control group, with 90 cases in each group. The patients of experimental group received treatment with varicose vein sealant kit, while the patients of control group received radiofrequency ablation. The main outcome measure was the complete closure rate of the great saphenous vein in both groups of patients 3 months after surgery. The secondary outcome measures were the complete closure rate of the great saphenous vein in both groups of patients immediately after surgery and 6 months after surgery, the operation time for closing the main trunk of the great saphenous vein, pain score, venous clinical severity score (VCSS), Aberdeen varicose veins questionnaire (AVVQ) at different times before and after surgery, and the incidence of complications in both groups of patients. The non inferiority threshold for the two treatment methods is set at "-10.00%". Results: A total of 177 patients were ultimately enrolled. There were 89 cases in the experimental group, including 38 males and 51 females, with a median age [M (Q1, Q3)] of 59.7(49.6, 66.7) years, and 88 cases in the control group, including 30 males and 58 females, with a median age of 57.2(46.9, 65.9) years. A total of 174 patients completed a 3-month follow-up, and 167 patients completed a 6-month follow-up. The closure time of the main saphenous vein in the experimental group was (22.1±11.1) min, which was longer than the control group, which was (18.7±9.8) min (P=0.031). The complete closure rate of the great saphenous vein immediately after surgery in both the experimental group and the control group was 100%. The complete closure rates of the great saphenous vein at 3 months after surgery were 98.8% (85/86) and 98.9% (87/88), respectively. The lower limit of the 95%CI for the difference between the two groups was -3.19%, which was greater than the non-inferiority threshold of -10.00% (non-inferiority P<0.001). The complete closure rates of the great saphenous vein at 6 months after surgery were 97.6% (81/83) and 100% (84/84), the lower limit of the 95%CI for the difference between the two groups was -5.71%, which was greater than the non-inferiority threshold of -10.00% (non-inferiority P<0.001). The immediate pain scores after complete anesthesia awakening of the experimental group and the control group were both 1.0 (0, 2.0), with no statistically significant difference (P=0.365). The incidence of bruising in the experimental group and the control group one week after surgery was 61.2% (52/85) and 67.1% (57/85), respectively, with no statistically significant difference (P=0.181). There was no statistically significant difference in VCSS and AVVQ scores between groups before surgery and at 1, 3, and 6 months after surgery (all P>0.05). There was no statistically significant difference in the incidence of complications such as deep vein thrombosis, phlebitis, pain, and subcutaneous hematoma in the lower limbs 3 months after surgery (all P>0.05). Conclusion: The varicose vein sealant kit is safe and effective in treating great saphenous vein dysfunction, and can achieve a complete closure rate of great saphenous vein that is not inferior to traditional radiofrequency ablation.


Asunto(s)
Vena Safena , Várices , Insuficiencia Venosa , Humanos , Vena Safena/cirugía , Várices/cirugía , Insuficiencia Venosa/cirugía , Resultado del Tratamiento , Estudios Prospectivos , Masculino , Femenino , Persona de Mediana Edad , Ablación por Catéter/métodos
2.
Zhonghua Yu Fang Yi Xue Za Zhi ; 57(12): 2117-2121, 2023 Dec 06.
Artículo en Chino | MEDLINE | ID: mdl-38186164

RESUMEN

Objective: To analyze the immunological characteristics and antibody changes of patients infected with the Omicron BA.1 and evaluate the possibility of secondary infection. Methods: A total of 104 patients infected with Omicron BA.1 in the Jinnan District of Tianjin from January 8 to February 2, 2022, were included in the study. The control group and case group were matched 1∶1 based on age, sex and vaccination status. Serum was collected from the case group and control group at 3, 6 and 9 months after infection. The serum levels of interleukin4 (IL-4), IL-5 and interferon-gamma (IFN-γ), as well as the positive rates of IgG, IgG1 and IgG2, were detected by ELISA. Results: The highest concentration of IFN-γ in the case group at 6 months after infection was 145.4 pg/ml, followed by a decrease in concentration. The concentrations of IL-4 and IL-5 began to decrease at 6 months after infection (all P<0.001). There was no significant difference in the IgG2 positive rate between the case group and the control group at 6 months after BA.1 infection. However, at 9 months, there was a significant decrease compared to the control group (P=0.003). The ratio of IFN-γ/IL4 at 3 months after infection in the case group was lower than that in the control group (P<0.001). There was no significant difference in the ratio between the case group and the control group at 9 months after infection. Conclusion: The cellular immune function has been impaired at 3 months after infection with BA.1, and the specific cellular immune and humoral immune functions decrease significantly after 6 months, and the risk of secondary infection increases.


Asunto(s)
Coinfección , Inmunidad Humoral , Adulto , Humanos , Interleucina-4 , Interleucina-5 , Inmunoglobulina G , Interferón gamma
3.
Animal ; 15(7): 100254, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34090092

RESUMEN

Although the skeletal muscle is one of the main sites of metabolism, little is known about the molecular mechanisms involving its response to nutrition stress. The aim of the study was to screen the transcriptome of sheep muscle to identify the metabolism-related genes under nutrition deprivation stress. Ten healthy adult female Small-tailed Han sheep with similar age and weight were randomly divided into a normal group and fasted group. After 3 days, three sheep were randomly selected from each group and the semitendinosus samples were subjected to RNA-sequencing (RNA-seq) and a series of analyses and function annotations. Compared with the normal group, 391 differentially expressed genes (DEGs) were identified in the fasted group that had obvious weight loss, including 278 down-regulated and 113 up-regulated genes. Gene Ontology enrichment annotation classified 228 DEGs in the metabolic process, 11 of which were new genes and only Sheep_newGene_4578 had been annotated by Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway. The results of Clusters of Orthologous Groups annotation indicated that 11, 9, and 4 DEGs were respectively classified in lipid transport and metabolism, amino acid transport and metabolism, and carbohydrate transport and metabolism. In addition, KEGG enrichment analysis showed that there were not only pathways which were directly related to metabolisms such as protein digestion and absorption pathway, fatty acid metabolism pathway, and biosynthesis pathway of unsaturated fatty acids, but also PI3K-AKT pathway, AMPK pathway, MAPK pathway, and FoxO pathway which were important to metabolism among the top 20 pathways with the lowest significant Q value. The MCODE analysis of protein-protein interaction revealed that two identified subnetworks with top score were closely associated with metabolism. The correlation analysis showed that the mRNA levels of most of DEGs that might be related in the two subnetworks were significantly correlated respectively, and the mRNA levels of most of 10 metabolism-related DEGs including Sheep_newGene_4578 were significantly correlated. Finally, 16 random and 10 metabolism-related DEGs were chosen for confirmation by quantitative real-time PCR, demonstrating the same expression change as determined by RNA-seq. In conclusion, multiple interrelated metabolism-related DEGs in skeletal muscle contributed to the response of sheep to nutritional deprivation stress.


Asunto(s)
Perfilación de la Expresión Génica , Fosfatidilinositol 3-Quinasas , Animales , Femenino , Perfilación de la Expresión Génica/veterinaria , Músculo Esquelético , ARN , Ovinos , Transcriptoma
4.
Trials ; 22(1): 228, 2021 Mar 23.
Artículo en Inglés | MEDLINE | ID: mdl-33757568

RESUMEN

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by coughing, the production of excess sputum, and dyspnea. Patients with excessively thick sputum may have frequent attacks or develop more serious disease. The guidelines recommend airway clearance for patients with excessive sputum who are hospitalized with COPD. The active cycle of breathing technique is the most common non-pharmacological airway clearance technique used by physiotherapists. However, the effectiveness of the technique is not always guaranteed. Active cycle of breathing techniques require the initial dilution of the sputum, usually by inhalation drugs, which may have limited effects. Recent studies have found that phonophoresis decreases inflammation, suggesting the potential of the combined usage of active cycle of breathing techniques and phonophoresis. Therefore, the aim of this study is to explore the effectiveness and safety of combining active cycle of breathing technique and phonophoresis in treating COPD patients. METHODS AND ANALYSIS: We propose a single-blind randomized controlled trial using 75 hospitalized patients diagnosed with COPD with excessive sputum production. The patients will be divided into three groups. The intervention group will receive active cycle of breathing techniques combined with phonophoresis. The two comparison groups will be treated with active cycle of breathing techniques and phonophoresis, respectively. The program will be implemented daily for 1 week. The primary outcomes will be changes in sputum viscosity and production, lung function, and pulse oximetry. Secondary outcomes include the assessment of COPD and anxiety, measured by the COPD Assessment Test scale and the Anxiety Inventory for Respiratory Disease, respectively; self-satisfaction; the degree of cooperation; and the length of hospital stay. All outcome measures, with the exception of sputum production and additional secondary outcomes, will be assessed at the commencement of the study and after 1 week's intervention. Analysis of variance will be used to investigate differences between the groups, and a p-value of less than 0.05 (two-tailed) will be considered statistically significant. DISCUSSION: This study introduces a combination of active cycle of breathing techniques and phonophoresis to explore the impact of these interventions on patients hospitalized with COPD. If this combined intervention is shown to be effective, it may prove to be a better treatment for patients with COPD. TRIAL REGISTRATION: The trial was registered prospectively on the Chinese Clinical Trial Registry on 24 December 2019.ClinicalTrials.gov ChiCTR1900028506 . Registered on December 2019.


Asunto(s)
Fonoforesis , Enfermedad Pulmonar Obstructiva Crónica , Disnea , Humanos , Pulmón , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Método Simple Ciego
6.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(5): 648-652, 2020 May 10.
Artículo en Chino | MEDLINE | ID: mdl-32162858

RESUMEN

Objective: To investigate and analysis the epidemiological characteristics of a cluster epidemic of COIVD-19 in a collective workplace in Tianjin, evduate the prevention and control measures based on limited evidence and experience in early period of COVID-19 epidemic. Methods: Descriptive research method was used to describe the distribution and other epidemiological characteristics of the cluster cases of COVID-19. Results: Since the onset of the first index case on January 15, ten confirmed COVID-19 cases had occurred in the workplace, and the epidemic had spread from the workplace to 4 families, infecting 7 family members. The median age of 17 cases was 55 (19-79) years. All the 10 employee cases were males, and in the family cases, 3 were males and 4 were females. Of the employee cases, 8 worked in CW workshop and 2 worked in administrative office building. The median exposure-onset interval of all the cases was 4 days, and the median exposure-onset interval was 4.5 days in the employee cases and 4 days in the family cases. The median onset-medical care seeking interval was 4 days in the non-isolated cases, 2.5 days in the cases with home isolation after onset, and 0.5 day in the cases with home isolation before onset. Conclusions: The clustering of COVID-19 cases was observed in this workplace in Tianjin, which affected 4 families. In the early stage of the epidemic, accurate and rapid blocking and control measures can completely prevent the large-scale spread of COVID-19.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Epidemias , Neumonía Viral/epidemiología , Lugar de Trabajo , Adulto , Anciano , COVID-19 , China/epidemiología , Análisis por Conglomerados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias
7.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 53(12): 904-908, 2018 Dec 07.
Artículo en Chino | MEDLINE | ID: mdl-30585001

RESUMEN

Objective: To study the shift of oVEMP frequency tuning of unilateral Meniere's disease, by analyzing oVEMP of air-conducted tone bursts in various frequencies. Methods: From May 2016 to October 2017, 33 patients with unilateral Meniere's from Aerospace Center Hospital were tested for oVEMP in 500 Hz and 1 000 Hz air-conducted tone bursts respectively, and 20 healthy subjects(40 ears), matched for age and sex, were used as healthy control. The amplitudes of the N1-P1 wave and the frequency amplitude ratios of 500/1 000 Hz in affected ears, unaffected ears and normal ears were compared; and receiver operating characteristic curve was analyzed for frequency amplitude ratios of 500/1 000 Hz. Results: By the 500 Hz tone-burst stimulus, the provocation rates of the oVEMP were 84.9%(28/33), 93.9%(31/33) and 97.5%(39/40) in affected ears, contralateral ears and the ears of normal controls, respectively. By the stimulus of 1 000 Hz tone-burst, the provocation rates of the oVEMP were 81.8%(27/33), 87.9%(29/33) and 82.5% (33/40) in affected ears, contralateral ears and normal control ears, respectively. Amplitudes of N1-P1 waveforms in 500 Hz air-conducted tone bursts in affected ears were under normal control ears and contralateral ears. There was significant difference between affected ears and healthy control ears (P<0.05). Amplitudes of N1-P1 waveforms in contralateral ears were also significantly smaller than those in normal control ears (P<0.05). There were no significant differences in amplitudes of N1-P1 waveforms between affected ears, contralateral ears and normal control ears in 1 000 Hz tone bursts stimulus(P>0.05). Frequency amplitude ratios of 500/1 000 Hz in affected ears were significantly under contralateral and normal control ears (P<0.05). According to ROC, the frequency amplitude ratio critical value of frequency tuning was set as 1.17, the positive rate of frequency tuning shift in affected ears was 54.5%(18/33) and significantly higher than in contralateral ears(18.2%, 6/33, χ(2)=9.429, P=0.002) and normal control ears (7.5%, 3/40, χ(2)=19.530, P=0.000). In contrast, there was no significant difference in the incidence of frequency tuning shift between contralateral ears and normal ears(χ(2)=1.909, P=0.167). Conclusions: Frequency tuning oVEMP with Meniere's disease will be changed.Frequency tuning of oVEMP with Meniere's disease shifts from low frequency region to high frequency region in comparison with healthy people. Frequency amplitude ratio is helpful for diagnosis of Meniere's disease.


Asunto(s)
Enfermedad de Meniere/fisiopatología , Potenciales Vestibulares Miogénicos Evocados/fisiología , Estudios de Casos y Controles , Humanos , Enfermedad de Meniere/diagnóstico , Curva ROC , Vestíbulo del Laberinto
8.
Bratisl Lek Listy ; 118(10): 609-612, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29198128

RESUMEN

BACKGROUND: Pro-protein processing mechanism plays an important role in neuron injury. OBJECTIVE: To study the protein convertase 1 (PC1) mediated processing mechanism, the ischemic cellular or tissue proPC1/PC1 or proCgA/CgA (pro-chromogranin A) was analyzed. METHODS: NS20Y differentiated cells were stressed by 0-6 h of oxygen and glucose deprivation (OGD) in glucose-free DMEM and an anaerobic jar environment. Ischemic C57BL/J mouse model was established by performing 60-min of middle cerebral artery occlusion (MCAO) operation and subsequent 4 or 24-h reperfusion. The TUNEL, immunochemistry, and Western blot methods were used to detect protein expression in ischemic cells or tissues. RESULTS: The OGD or MCAO stress caused substantial cell death in a dose-dependent manner (p < 0.05 or 0.01). With the increasing OGD dose, proPC1 and PC1 proteins gradually increased (p < 0.05 or 0.01) whereas proCgA and CgA proteins decreased (p < 0.05). In vivo the proPC1 and PC1 expressions presented with a peak at 4-h and then decreased at 24-h reperfusion (p < 0.05 or 0.01). The tissue proCgA and CgA proteins decreased with the increasing reperfusion time (p < 0.05). CONCLUSIONS: The results suggest that the increasing PC1 expression promoted the transformation of proCgA into CgA or smaller peptides, i.e. Pancreastatin or Secretoneurin, and the PC1 mediated processing plays a critical role (Fig. 4, Ref. 15).


Asunto(s)
Muerte Celular , Cromogranina A/metabolismo , Infarto de la Arteria Cerebral Media/metabolismo , Neuronas/metabolismo , Proproteína Convertasa 1/metabolismo , Animales , Western Blotting , Isquemia Encefálica/metabolismo , Diferenciación Celular , Hipoxia de la Célula , Glucosa , Etiquetado Corte-Fin in Situ , Ratones , Ratones Endogámicos C57BL , Neuropéptidos/metabolismo , Secretogranina II/metabolismo
10.
Eur Rev Med Pharmacol Sci ; 21(9): 2167-2171, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-28537667

RESUMEN

OBJECTIVE: We conducted this study to analyze the mechanism behind the high coagulation state induced by circulating plasma microparticle tissue factor (MP-TF) in patients with breast cancer. PATIENTS AND METHODS: 87 cases of breast cancer patients (10 cases of TNM stage I, 16 cases of II, 32 cases of III, 29 cases of IV; 8 cases of pathological type in situ carcinoma, 15 cases of ductal carcinoma, 64 cases of invasive cancer) were used as the observation group and 20 cases of benign breast lesions were used as the control group to compare MP-TF levels of plasma and coagulation parameters including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and D-dimer body (D-D) level and NF-κB signaling pathway index including P50, p65, TAK1 and IκBα levels. RESULTS: The plasma MP-TF level in the observation group was significantly higher than that in control group, and the level of MP-TF in the observation group increased with an increase in depth of TNM stage and tumor invasion; differences were statistically significant (p<0.05). In the observation group, the plasma PT and APTT were shortened, and the levels of FIB and D-D were increased; the differences were statistically significant (p<0.05). In the observation group, the levels of P50, p65, TAK1, IκBαin circulating blood were higher than those in control group; the differences were statistically significant (p<0.05). After the Pearson test, the plasma levels of MP-TF in patients with breast cancer were negatively correlated with PT and APTT, and positively correlated with FIB, D-D values and the levels of p50, p65, TAK1 and IκBα (4 p<0.05). CONCLUSIONS: MP-TF can lead to high blood coagulation in patients with breast cancer through the activation of NF-κB signaling pathway, which may become a new target for the intervention of the disease.


Asunto(s)
Coagulación Sanguínea , Neoplasias de la Mama/sangre , Tromboplastina/análisis , Adulto , Anciano , Neoplasias de la Mama/patología , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial , Tiempo de Protrombina
11.
Eur Rev Med Pharmacol Sci ; 19(5): 772-83, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25807429

RESUMEN

OBJECTIVE: Chronic Ang II stimulation is linked to cardiac remodeling characterized by fibrosis and cardiac hypertrophy. However, the underlying cellular mechanisms involved are not yet fully known. Here, we studied the molecular mechanisms underlying the chronic effect of Ang II on cardiac hypertrophy, fibrosis, and autophagy. MATERIALS AND METHODS: The role of class I PI3-kinase in these actions of Ang II was studied using lentiviral vector-mediated expression of a dominant negative form of PI3-kinase subunit p85α (Lv-DNp85) in the heart. Ang II was infused subcutaneously for 4 weeks on rats using osmotic pumps. Cardiac hypertrophy, fibrosis, reactive oxygen species (ROS), and autophagy were examined in four groups of rats (Ang II+Lv-DNp85, Ang II+Lv-GFP, Saline+Lv-DNp85, Saline+Lv-GFP). RESULTS: Chronic infusion of Ang II induced severe cardiac hypertrophy and perivascular fibrosis in the heart. These effects were associated with a significant reduction in LC3 II and elevation in ROS levels, suggesting marked impairment of cardiac autophagy and increased generation of ROS. Cardiac transduction of Lv-DNp85 significantly attenuated Ang II-induced impairment of autophagy and elevation of ROS, as well as Ang II-induced cardiac hypertrophy and perivascular fibrosis. To study the cellular mechanisms underlying those actions of Ang II, phosphorylated Akt and mTOR were measured in hearts from these rats. Ang II increased phosphorylation of Akt and mTOR; and cardiac transduction of Lv-DNp85 significantly abolished Ang II-induced phosphorylation of Akt and mTOR, a signaling pathway inhibiting autophagy. CONCLUSIONS: These results demonstrate that class I PI3-kinase, via activation of the Akt-mTOR pathway, is involved in Ang II-induced impairment of autophagy, elevation of ROS, cardiac hypertrophy, and fibrosis, suggesting a novel target for cardiac protection.


Asunto(s)
Angiotensina II/administración & dosificación , Cardiomegalia/inducido químicamente , Fosfatidilinositol 3-Quinasas/metabolismo , Inhibidores de las Quinasa Fosfoinosítidos-3 , Angiotensina II/efectos adversos , Animales , Autofagia/efectos de los fármacos , Cardiomegalia/enzimología , Cardiomegalia/patología , Fibrosis/inducido químicamente , Fibrosis/enzimología , Fibrosis/patología , Masculino , Fosforilación , Ratas , Ratas Sprague-Dawley , Especies Reactivas de Oxígeno/metabolismo , Transducción de Señal
12.
Eur Rev Med Pharmacol Sci ; 17(19): 2644-53, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24142613

RESUMEN

AIM: The objective of this study is to examine effects of extracts from cooked lentils on angiotensin II (Ang II)-induced hypertension, cardiac hypertrophy and fibrosis in normotensive rats. MATERIALS AND METHODS: Animals were divided into four groups (n=5 each group): control group, Ang II group, Ang II plus cooked lentil extract (Ang II+CLE) group, and Ang II plus raw lentil extract (Ang II+RLE) group. The telemetry blood pressure transducers were implanted into all rats. A telemetry BP probe was positioned intra-abdominally and secured to the ventral abdominal muscle with the catheter inserted into the lower abdominal aorta. Heart wall thickness, cross-sectional area of cardiomyocytes, diameter of the arterial cross-sections, and perivascular fibrosis in heart and kidney were measured. The surface area of positive-staining cardiomyocytes was analyzed using image analysis software. Reactive oxygen species (ROS) generation was determined using an oxidant-sensitive fluorogenic probe. RESULTS: Rats that received cooked or raw lentil extracts (oral administration, 8 weeks) show significantly attenuated Ang II-induced elevation in blood pressure, cardiac hypertrophy, perivascular fibrosis. Results demonstrated that pretreatment of cardiomyocytes with cooked or raw lentil extract significantly attenuated the Ang II-induced increase in the size of cells (16.0±1.7% and 21.2±2.9%, respectively, n=5, p < 0.05), and cooked or raw lentil extracts also attenuated the Ang II-induced increase in the reactive oxygen species levels in cardiomyocytes (19.8±2.2% & 26.6±3.1%, respectively, n=5, p < 0.05). CONCLUSIONS: This study showed that extracts from cooked lentils could prevent Ang II-induced elevation in blood pressure, cardiac hypertrophy, small arterial remodeling and perivascular fibrosis, and heating process does not have any significant affect on these protective effects.


Asunto(s)
Angiotensina II/farmacología , Cardiomegalia/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Lens (Planta) , Extractos Vegetales/uso terapéutico , Animales , Masculino , Miocitos Cardíacos/metabolismo , Estrés Oxidativo/efectos de los fármacos , Fitoterapia , Ratas , Ratas Sprague-Dawley , Remodelación Ventricular/efectos de los fármacos
13.
Can J Surg ; 56(3): 180-6, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23484469

RESUMEN

BACKGROUND: Research has demonstrated equivalent patient safety outcomes for various cardiac procedures when the primary surgeon was a supervised trainee. However, cardiac surgery cases have become more complex, and the Canadian cardiac surgery education model has undergone some changes. We sought to compare patient safety and efficiency of aortic valve replacement (AVR) between Canadian patients treated by senior cardiac trainees and those treated by certified cardiac surgeons. METHODS: We completed a single-centre, case-matched, prospectively collected and retrospectively analyzed study of AVR. Patients were matched between trainees and consultants for age, sex, New York Heart Association and Canadian Cardiovascular Society status, urgency of operation and diabetes status. RESULTS: We analyzed 1102 procedures: 624 isolated AVRs and 478 AVRs with coronary artery bypass graft (CABG). For isolated AVR, there was no significant difference in 30-d mortality (p = 0.13) or in major adverse events (p = 0.38) between the groups. In the AVR+CABG group, there was no significant difference in 30-day mortality (p = 0.10) or in the rates of major adverse events (p = 0.37) between the groups. Secondary outcomes (hospital and intensive care unit lengths of stay, valve size and type) did not differ significantly between the groups for isolated AVR or AVR+CABG. CONCLUSION: Despite a higher-risk patient population and changes in the cardiac surgery training model, it appears that outcomes are not negatively affected when a senior trainee acts as the primary surgeon in cases of AVR.


CONTEXTE: La recherche a fait état de résultats équivalents au plan de la sécurité des patients lors de diverses interventions cardiaques lorsque le chirurgien principal était un résident supervisé. Toutefois, la chirurgie cardiaque se complexifie et le modèle de formation canadien en chirurgie cardiaque a subi quelques transformations. Nous avons voulu comparer la sécurité de patients canadiens et l'efficience du remplacement de la valvule aortique (RVA) selon que les patients étaient traités par des résidents séniors en chirurgie cardiaque ou par des chirurgiens certifiés. MÉTHODES: Nous avons procédé à une collecte prospective de cas assortis, dans 1 seul centre, puis à une analyse rétrospective des cas de RVA. Les patients ont été répartis entre résidents et experts et assortis selon l'âge, le sexe, la classification de la NYHA (New York Heart Association) et de la Société canadienne de cardiologie, le caractère urgent de l'intervention et le statut à l'égard du diabète. RÉSULTANTS: Nous avons analysé 1102 interventions : 624 RVA isolés et 478 RVA avec pontage aorto-coronarien (PAC). Dans les cas de RVA isolés, on n'a noté aucune différence significative pour ce qui est de la mortalité à 30 jours (p = 0,13) ou des effets indésirables majeurs (p = 0,38) entre les groupes. Pour ce qui est du groupe RVA+PAC, on n'a noté aucune différence significative quant à la mortalité à 30 jours (p = 0,10) ou quant aux taux d'effets indésirables majeurs (p = 0,37) entre les groupes. Les paramètres secondaires (durée du séjour à l'hôpital et à l'unité des soins intensifs, taille et type de valvule) n'ont pas été significativement différents entre les groupes qu'il s'agisse de RVA isolé ou de RVA+PAC. CONCLUSIONS: Malgré une population de patients à risque plus élevé et les transformations apportées au modèle de formation en chirurgie cardiaque, il semble que les résultats ne soient pas affectés négativement lorsqu'un résident sénior agit à titre de chirurgien principal dans les cas de RVA.


Asunto(s)
Válvula Aórtica , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/educación , Internado y Residencia/organización & administración , Cirugía Torácica/educación , Anciano , Canadá , Competencia Clínica , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/educación , Puente de Arteria Coronaria/mortalidad , Femenino , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/mortalidad , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Seguridad del Paciente , Estudios Retrospectivos , Resultado del Tratamiento
14.
Ann Thorac Surg ; 72(3): 782-7, 2001 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-11565658

RESUMEN

BACKGROUND: To select the site of a target vessel for distal anastomosis surgeons use different approaches. Some try to place the graft as close to the stenosis as possible, whereas others routinely anastomose the graft onto the distal portion. In this latter case the proximal portion and its tributaries are perfused from the graft in a retrograde rather than an antegrade fashion. The aim of this study was to investigate the effect of local hemodynamics associated with the different location of distal anastomoses on flow patterns in the proximal native artery and its branches. METHODS: Computational fluid dynamic and in vitro model studies were carried out in a control model composed of a straight tube (host) with a 45E side branch and models in which the proximal end of the host had various degrees of stenosis; a 45E end-to-side "graft" anastomosis was introduced either proximal (upstream) or distal (downstream) to the branch. RESULTS: Placing the graft proximal to the branch largely preserved the flow patterns that were seen in the control model. Placing the graft distal to the branch, however, introduced an extensive region of relatively stagnant flow in the native vessel near the branch. Such regions are known to promote thrombus formation that could ultimately lead to occlusion of the retrograde portion of the host vessel. CONCLUSIONS: This study suggests that, although often less convenient surgically, long-term outcome of coronary artery bypass grafting may be improved by placing grafts in the most proximal portion of the native vessel, as close to the occlusion or stenosis as possible for better preservation of a proximal artery and its branches.


Asunto(s)
Circulación Coronaria , Anastomosis Interna Mamario-Coronaria/métodos , Velocidad del Flujo Sanguíneo , Constricción , Vasos Coronarios/patología , Hemorreología , Humanos , Modelos Cardiovasculares , Modelos Estructurales , Flujo Pulsátil
15.
Ann Thorac Surg ; 72(2): 625-7, 2001 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-11515920

RESUMEN

The incidental finding of malignant internal thoracic lymph nodes while mobilizing the internal thoracic artery (ITA) for coronary bypass grafting has not to our knowledge been previously reported. The cases of 3 male patients who underwent surgery between January 1990 and January 1993 and in whom malignant lymph nodes were found in the ITA pedicle are reviewed. One individual was found to have metastatic carcinoma of the breast, whereas the other 2 were discovered to have previously undiagnosed lymphomas. After undergoing further relevant investigation and treatment, all 3 patients remain free of recurrent disease 6.8 to 9.8 years after their original cardiac surgery. Primary or metastatic malignancy may be encountered in the course of ITA mobilization for grafting. Abnormally enlarged internal thoracic lymph nodes should be sent for pathologic examination.


Asunto(s)
Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Complicaciones Intraoperatorias/patología , Metástasis Linfática/patología , Arterias Mamarias/trasplante , Anciano , Biopsia , Neoplasias de la Mama Masculina/patología , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/secundario , Humanos , Leucemia Linfocítica Crónica de Células B/patología , Escisión del Ganglio Linfático , Linfoma de Células del Manto/patología , Masculino , Arterias Mamarias/patología , Persona de Mediana Edad , Timo/patología
16.
Genetics ; 143(2): 961-72, 1996 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-8725242

RESUMEN

Wolbachia are cytoplasmically inherited bacteria responsible for reproductive incompatibility in a wide range of insects. There has been little exploration, however, of within species Wolbachia polymorphisms and their effects on compatibility. Here we show that some strains of the parasitic wasp Nasonia vitripennis are infected with two distinct bacterial strains (A and B) whereas others are singly infected (A or B). Double and single infections are confirmed by both PCR amplification and Southern analysis of genomic DNA. Furthermore, it is shown that prolonged larval diapause (the overwintering stage of the wasp) of a double-infected strain can lead to stochastic loss of one or both bacterial strains. After diapause of a double-infected line, sublines were produced with AB, A only, B only or no Wolbachia. A and B sublines are bidirectionally incompatible, whereas males from AB lines are unidirectionally incompatible with females of A and B sublines. Results therefore show rapid development of bidirectional incompatibility within a species due to segregation of associated symbiotic bacteria.


Asunto(s)
Infecciones por Rickettsia/genética , Rickettsia/genética , Avispas/microbiología , Animales , Reacción en Cadena de la Polimerasa
17.
Proc Biol Sci ; 261(1360): 55-63, 1995 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-7644549

RESUMEN

Wolbachia are cytoplasmically inherited bacteria found in reproductive tissues of many arthropod species. These bacteria are associated with reproductive alterations in their hosts, including parthenogenesis, reproductive incompatibility and feminization. A fine-scale phylogenetic analysis was done using DNA sequences from ftsZ, a rapidly evolving bacterial cell-cycle gene. ftsZ sequences were determined for 38 different Wolbachia strains from 31 different species of insects and one isopod. The following results were found: (i) there are two major division of Wolbachia (A and B) which diverged 58-67 millions years before present based upon synonymous substitution rates; (ii) a general concordance is found between the ftsZ and 16S rDNA phylogenies, indicating that these represent bacterial strain (rather than simply gene) phylogenies; however, a possible example of recombination between A and B division bacteria may have occurred in the feminizing Wolbachia present in an isopod; (iii) extensive horizontal transmission of Wolbachia has occurred between insect taxa, including different insect orders; one strain in particular (designated Adm) shows extensive recent horizontal transmission; (iv) there is an association between the Wolbachia found in a parasitic wasp (Nasonia) and its fly host (Protocalliphora), suggesting exchange of bacteria between these species; (v) parthenogenesis induction has evolved several times among the Wolbachia; and (vi) some insects harbour infections with more than one Wolbachia strain, even within individual insects.


Asunto(s)
Artrópodos/microbiología , Filogenia , Rickettsiaceae/genética , Animales , Secuencia de Bases , Clonación Molecular , Cartilla de ADN , Datos de Secuencia Molecular , Reacción en Cadena de la Polimerasa , Rickettsiaceae/clasificación , Rickettsiaceae/patogenicidad
18.
Ann Thorac Surg ; 58(5): 1368-72; discussion 1372-3, 1994 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-7979661

RESUMEN

Previous investigations from our institution using an isolated human cardiomyocyte model concluded that glucose supplementation of University of Wisconsin solution (UWS) was beneficial with respect to adenine nucleotide and protein recovery. We wished to confirm these results using an isolated heart model. Rodent hearts were frozen in liquid nitrogen (control) or flushed and stored in UWS for 8 hours at 0 degrees C or UWS supplemented with 10, 20, or 30 mmol/L glucose. Experimental hearts were assessed at end-storage or after 45 minutes of reperfusion on a Langendorff apparatus. Adenine nucleotides were assessed by high performance liquid chromatography. In parallel experiments, ventricular function was assessed before and after storage in Langendorff-perfused hearts instrumented with a left ventricular balloon. Glucose supplementation was associated with greater poststorage (20 and 30 mmol/L glucose) and postreperfusion (10, 20, and 30 mmol/L glucose) adenosine triphosphate levels than unmodified UWS. Developed pressure (expressed as a percentage of control values) was increased with 10 mmol/L glucose (75.2% +/- 7.9%, mean +/- standard deviation) compared with unmodified UWS (64.6% +/- 6.6%; p < 0.05). Coronary flow was greater with 10 (72.6% +/- 10.7%) or 20 mmol/L (71.2% +/- 12.5%) versus 0 mmol/L glucose (58.6% +/- 12.1%, p < 0.05). The data support previous in vitro findings and suggest that the addition of 10 mmol/L glucose to UWS is associated with enhanced recovery after prolonged hypothermic storage.


Asunto(s)
Glucosa , Trasplante de Corazón , Soluciones Preservantes de Órganos , Preservación de Órganos , Nucleótidos de Adenina/metabolismo , Adenosina , Alopurinol , Animales , Circulación Coronaria , Glutatión , Hipoxantina , Hipoxantinas/metabolismo , Técnicas In Vitro , Inosina/metabolismo , Inosina Monofosfato/metabolismo , Insulina , Miocardio/metabolismo , Rafinosa , Ratas , Ratas Sprague-Dawley , Función Ventricular
19.
Appl Opt ; 30(10): 1274-8, 1991 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-20582138

RESUMEN

An automated measurement method for 360 degrees surface topography of 3-D diffuse objects is presented. The method is based on the simple principle of triangulation with structured illumination. The geometric specifications of the structured light module used in the system are analyzed on a computer. Using an advantageous data acquisition schedule, high data acquisition rates and measuring accuracy can be achieved. The system comprises a structured lighting projector, a 2-D detector array, and a microcomputer for control and processing. Experimental results for 3-D objects are offered.

20.
Zhonghua Zhong Liu Za Zhi ; 12(1): 15-7, 1990 Jan.
Artículo en Chino | MEDLINE | ID: mdl-2364864

RESUMEN

G-banding and high resolution chromosome banding techniques were used in studying a human lung adenocarcinoma cell line LGC-7910. One hundred cells were counted at Passage 150. Ten, twelve and ten cells were analyzed at Passages 150, 173 and 183, respectively. The model number of chromosome in this cell line was 67-69. A number of marker chromosomes related to complex chromosomal rearrangement was observed. The analysis of chromosomes at the different passages showed a stability during subculture of the cell line. It was found that the cell line had partial deletion of the short arm on chromosome 7 (with breakpoint at 7p15.3-p13), rearrangement of the arm on chromosome 1 (with breakpoint at 1p13.1) and increase in chromosome 7 number. The results suggested that such chromosome alteration be related to the expression of activated oncogenes during carcinogenesis.


Asunto(s)
Adenocarcinoma/genética , Deleción Cromosómica , Cromosomas Humanos Par 7 , Neoplasias Pulmonares/genética , Adenocarcinoma/patología , Bandeo Cromosómico , Marcadores Genéticos , Humanos , Neoplasias Pulmonares/patología , Células Tumorales Cultivadas
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