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1.
HLA ; 103(6): e15572, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38923242

RESUMEN

This study investigates kidney transplant outcomes in highly sensitised patients after implementing a delisting strategy aimed at enabling transplantation despite preformed donor-specific antibodies (preDSA), with the goal of reducing acute antibody-mediated rejection (aAMR) risk. Fifty-three sensitised recipients underwent kidney transplant after delisting prohibited HLA antigens, focusing initially in low MFI antibodies (<5000), except for anti-HLA-DQ. If insufficient, higher MFI antibodies were permitted, especially for those without an immunogenic eplet pattern assigned. Delisting of Complement-fixing antibodies (C1q+) was consistently avoided. Comparison cohorts included 53 sensitised recipients without DSA (SwoDSA) and 53 non-sensitised (NS). The average waiting time prior to delisting was 4.4 ± 1.8 years, with a reduction in cPRA from 99.7 ± 0.5 to 98.1 ± 0.7, followed by transplantation within 7.2 ± 8.0 months (analysed in 34 patients). Rejection rates were similar among preDSA, SwoDSA, and NS groups (16%, 8%, and 11%, respectively; p = 0.46). However, aAMR was higher in the preDSA group (12%, 4%, and 2%, respectively; p = 0.073), only presented in recipients with DSA of MFI >5000. The highest MFI DSA were against HLA-DP (Median: 10796 MFI), with 50% of preDSA aAMR cases due to anti-DP antibodies (n = 3). Graft survival rates at 1 and 5 years in preDSA group were 94%, and 67%, comparable to SwoDSA (94%, and 70%; p = 0.69), being significantly higher in the NS group (p = 0.002). The five-year recipient survival rate was 89%, comparable to SwoDSA and NS groups (p = 0.79). A delisting strategy enables safe kidney transplant in highly sensitised patients with preDSA, with a slight increase in aAMR and comparable graft and patient survivals to non-DSA cohorts.


Asunto(s)
Rechazo de Injerto , Supervivencia de Injerto , Antígenos HLA , Isoanticuerpos , Trasplante de Riñón , Donantes de Tejidos , Humanos , Rechazo de Injerto/inmunología , Masculino , Antígenos HLA/inmunología , Persona de Mediana Edad , Femenino , Isoanticuerpos/sangre , Isoanticuerpos/inmunología , Adulto , Prueba de Histocompatibilidad/métodos , Medicina de Precisión/métodos , Anciano
3.
Cell Rep ; 42(11): 113337, 2023 11 28.
Artículo en Inglés | MEDLINE | ID: mdl-37883232

RESUMEN

Intraflagellar transport (IFT) trains, built around IFT-A and IFT-B complexes, are carried by opposing motors to import and export ciliary cargo. While transported by kinesin-2 on anterograde IFT trains, the dynein-2 motor adopts an autoinhibitory conformation until it needs to be activated at the ciliary tip to power retrograde IFT. Growing evidence has linked the IFT-A complex to retrograde IFT; however, its roles in this process remain unknown. Here, we use CRISPR-Cas9-mediated genome editing to disable the dynein-2 autoinhibition mechanism in Caenorhabditis elegans and assess its impact on IFT with high-resolution live imaging and photobleaching analyses. Remarkably, this dynein-2 "hot-wiring" approach reignites retrograde motility inside IFT-A-deficient cilia without triggering tug-of-war events. In addition to providing functional evidence that multiple mechanisms maintain dynein-2 inhibited during anterograde IFT, our data establish key roles for IFT-A in mediating motor-train coupling during IFT turnaround, promoting retrograde IFT initiation, and modulating dynein-2 retrograde motility.


Asunto(s)
Proteínas de Caenorhabditis elegans , Dineínas , Animales , Dineínas/metabolismo , Transporte Biológico , Cilios/metabolismo , Caenorhabditis elegans/metabolismo , Proteínas de Caenorhabditis elegans/metabolismo , Flagelos/metabolismo
5.
J Cell Biol ; 221(1)2022 01 03.
Artículo en Inglés | MEDLINE | ID: mdl-34739033

RESUMEN

The dynein-2 motor complex drives retrograde intraflagellar transport (IFT), playing a pivotal role in the assembly and functions of cilia. However, the mechanisms that regulate dynein-2 motility remain poorly understood. Here, we identify the Caenorhabditis elegans WDR60 homologue, WDR-60, and dissect the roles of this intermediate chain using genome editing and live imaging of endogenous dynein-2/IFT components. We find that loss of WDR-60 impairs dynein-2 recruitment to cilia and its incorporation onto anterograde IFT trains, reducing retrograde motor availability at the ciliary tip. Consistent with this, we show that fewer dynein-2 motors power WDR-60-deficient retrograde IFT trains, which move at reduced velocities and fail to exit cilia, accumulating on the distal side of the transition zone. Remarkably, disrupting the transition zone's NPHP module almost fully restores ciliary exit of underpowered retrograde trains in wdr-60 mutants. This work establishes WDR-60 as a major contributor to IFT, and the NPHP module as a roadblock to dynein-2 passage through the transition zone.


Asunto(s)
Proteínas de Caenorhabditis elegans/metabolismo , Caenorhabditis elegans/metabolismo , Cilios/metabolismo , Proteínas del Citoesqueleto/metabolismo , Dineínas/metabolismo , Flagelos/metabolismo , Animales , Proteínas de Caenorhabditis elegans/química , Proteínas del Citoesqueleto/química , Dineínas/química , Proteínas Fluorescentes Verdes/metabolismo , Cinética , Mutación/genética , Dominios Proteicos , Células Receptoras Sensoriales/metabolismo
7.
MicroPubl Biol ; 20212021 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-33997658

RESUMEN

Cilia are microtubule-based organelles that carry out a wide range of critical functions throughout the development of higher animals. Regardless of their type, all cilia rely on a motor-driven, bidirectional transport system known as intraflagellar transport (IFT). Of the many components of the IFT machinery, IFT20 is one of the smallest subunits. Nevertheless, IFT20 has been shown to play critical roles in the assembly of several types of mammalian cilia. Here we show that the IFT20 homolog in Caenorhabditis elegans, IFT-20, is also important for correct cilium assembly in sensory neurons. Strikingly, however, we find that IFT-20-deficient animals are able to assemble short, vestigial cilia. In spite of this, we show that practically all IFT-20-deficient animals fail to respond to environmental cues that are normally detected by cilia to modulate their behavior. Altogether, our results indicate that IFT-20 is critical for both the correct assembly and function of cilia in C. elegans.

8.
Int J Mol Sci ; 22(1)2020 Dec 28.
Artículo en Inglés | MEDLINE | ID: mdl-33379360

RESUMEN

Mucopolysaccharidosis type IVA (MPS IVA) is a lysosomal storage disease caused by mutations in the N-acetylgalactosamine-6-sulfatase (GALNS) gene. Skeletal dysplasia and the related clinical features of MPS IVA are caused by disruption of the cartilage and its extracellular matrix, leading to a growth imbalance. Enzyme replacement therapy (ERT) with recombinant human GALNS has yielded positive results in activity of daily living and endurance tests. However, no data have demonstrated improvements in bone lesions and bone grow thin MPS IVA after ERT, and there is no correlation between therapeutic efficacy and urine levels of keratan sulfate, which accumulates in MPS IVA patients. Using qualitative and quantitative proteomics approaches, we analyzed leukocyte samples from healthy controls (n = 6) and from untreated (n = 5) and ERT-treated (n = 8, sampled before and after treatment) MPS IVA patients to identify potential biomarkers of disease. Out of 690 proteins identified in leukocytes, we selected a group of proteins that were dysregulated in MPS IVA patients with ERT. From these, we identified four potential protein biomarkers, all of which may influence bone and cartilage metabolism: lactotransferrin, coronin 1A, neutral alpha-glucosidase AB, and vitronectin. Further studies of cartilage and bone alterations in MPS IVA will be required to verify the validity of these proteins as potential biomarkers of MPS IVA.


Asunto(s)
Biomarcadores/metabolismo , Mucopolisacaridosis IV/metabolismo , Proteómica , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Preescolar , Regulación hacia Abajo , Terapia de Reemplazo Enzimático , Femenino , Humanos , Lactante , Leucocitos/metabolismo , Masculino , Mucopolisacaridosis IV/terapia , Mapas de Interacción de Proteínas , Adulto Joven
9.
Revista Digital de Postgrado ; 9(2): 214, ago. 2020.
Artículo en Español | LILACS, LIVECS | ID: biblio-1103446

RESUMEN

El término Origen Temprano de las Enfermedades del Adulto explica la aparición temprana de las condiciones anormales cardiovasculares y metabólicas en la vida adulta, mayor riesgo de morbilidad y muerte asociados a factores ambientales, especialmente nutricionales, que actúan en las primeras etapas de la vida. Estas respuestas programadas dependen de la naturaleza del estímulo o noxa, del tiempo de exposición y del momento de ocurrencia de la noxa, pudiendo un solo genotipo original varios fenotipos y estarían condicionadas por criterios críticos en los cuales se desarrollarían cambios a largo plazo pudiendo ser reversibles o no. La Programación Fetal explica que respuestas adaptativas embrionarias y fetales en un ambiente subóptimo genera consecuencias adversas permanentes. La desnutrición, así como la sobrenutrición fetal aumenta el riesgo de desarrollar alteraciones en el peso y composición corporal fetal, y posteriormente obesidad, síndrome metabólico, incremento en la adiposidad, alteración en el metabolismo de la glucosa y / o insulina, alteración del metabolismo lipídico, alteraciones hepáticas y de las cifras tensionales. La impronta genómica es esencial para el desarrollo y defectos en la misma puede originar alteraciones de la identidad parental transmisibles a las siguientes generaciones. Esta programación fetal puede ser explicada por la epigenética, definida como la serie de alteraciones hereditarias de la expresión genética a través de modificaciones del ADN y las histonas centrales sin cambios en la secuencia de ADN. Estas modificaciones epigenéticas alteran la estructura y condensación de la cromatina, afectando la expresión del genotipo y fenotipo. Este artículo desarrolla los aspectos involucrados en la Programación Fetal y los posibles mecanismos sobre la misma(AU)


The term Early Origin of Adult Diseases explains the early onset of abnormal cardiovascular and metabolic conditions in adult life, increased risk of morbidity and death associated with environmental factors, especially nutritional factors, that act in the early stages of life. These programmed responses depend on the nature of the stimulus or noxa, the time of exposure and the moment of occurrence of the noxa, with a single original genotype being able to have several phenotypes and would be conditioned by critical criteria in which long-term changes could develop, reversibles or not. Fetal Programming explains that embryonic and fetal adaptive responses in a suboptimal environment generate permanent adverse consequences. Fetal malnutrition as overnutrition increases the risk of developing alterations in fetal body weight and composition, and subsequently obesity, metabolic syndrome, increased adiposity, impaired glucose and / or insulin metabolism, impaired lipid metabolism, liver disorders and altered blood pressure. The genomic imprint is essential for development and defects in it can cause alterations of the parental identity and are transmitted to the following generations. This fetal programming can be explained by epigenetics, defined as the series of inherited alterations of genetic expression through modifications of DNA and central histones without changes in the DNA sequence. These epigenetic modifications alter the structure and condensation of chromatin, affecting the expression of the genotype and phenotype. This article develops the aspects involved in Fetal Programming and the possible mechanisms on it(AU)


Asunto(s)
Humanos , Trastornos Nutricionales en el Feto , Desarrollo Fetal , Noxas , Enfermedades Nutricionales y Metabólicas , Composición Corporal , Hipotálamo/anatomía & histología , Errores Innatos del Metabolismo
10.
Obes Surg ; 30(9): 3514-3521, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32314255

RESUMEN

PURPOSE: Bariatric surgery generates a large weight loss. It is considered a successful surgery when 50% of the excess weight loss is reached. However, this measure does not include some variables that may have a direct impact on a patient's health, such as fat-free mass (FFM) or bone mass. Therefore, the aim of this study is to evaluate body composition and bone mass in patients undergoing one-anastomosis gastric bypass (OAGB). METHODS: A prospective observational study was performed in patients undergoing OAGB. Body composition and bone mass were evaluated by bioelectrical impedance analysis at baseline (1 day prior to surgery), at 6 and 12 months after surgery. RESULTS: A total of 94 patients (67% females and 33% males) were included in the study. The excess BMI loss at 6 and 12 months after surgery was 97.9 ± 20.1% and 110.2 ± 30.5% respectively. The FFM showed a reduction of 6.6 ± 4.8 kg (p < 0.01) 6 months after surgery and of 7.9 ± 4.9 kg (p < 0.01) at 12 months, meaning a decrease of 10.5 ± 7.3% and a 12.9 ± 6.6% respectively. The bone mass decrease was 10.1 ± 6.9% (p < 0.01) and 12.9 ± 6.5% (p < 0.01) at 12 months after OAGB. CONCLUSIONS: OAGB obtains a relevant weight loss in patients with morbid obesity, mainly, due to fat mass reductions. However, this procedure also provokes FFM and bone mass decreases, especially in females, but not significantly greater than other restrictive or mixed procedures.


Asunto(s)
Cirugía Bariátrica , Derivación Gástrica , Obesidad Mórbida , Composición Corporal , Femenino , Humanos , Masculino , Obesidad Mórbida/cirugía , Pérdida de Peso
11.
World J Surg ; 44(3): 855-862, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31641833

RESUMEN

BACKGROUND: Ideal jejunal and ileal lengths in bariatric/metabolic procedures to be left in alimentary continuity still remain unclear. We aimed to evaluate different lengths of biliopancreatic limb (BPL) and common limb (CL) performed in a series of patients submitted to OAGB, and correlate them with weight loss and nutritional deficits. PATIENTS AND METHODS: A prospective observational study of 350 consecutive morbidly obese patients undergoing OAGB was performed. BPL and CL lengths were determined intraoperatively; BPL/TBL and CL/TBL ratios were then calculated. Anthropometric variables, remission of comorbidities and specific supplementation needs were recorded at 1, 2 and 5 years after surgery. RESULTS: Three hundred patients were included for final analysis. BPL length and BPL/TBL ratio directly correlated with Units of BMI lost (UBMIL). Conversely, CL length and CL/TBL ratio showed an inverse correlation with UBMIL. Establishing a BMI ≤ 25 kg/m2 as ideal, the most accurate AUC, to predict achieving an ideal BMI at 1, 2 and 5 years after surgery, was obtained for the CL/TBL ratio, followed by the CL length at 1, 2 and 5 years. An ideal range was established between 0.40 and 0.43 for the CL/TBL ratio, and 200 to 220 cm for the CL length. Among these ranges, there were no cases of protein or calorie malnutrition. CONCLUSION: TBL measurement is essential to obtain optimal outcomes after OAGB, both in terms of excellent weight loss and remission/improvement of comorbidities, as well as with a low risk of nutritional deficiencies. The CL/TBL ratio, followed by CL length, are the most accurate parameters to predict a 5-year postoperative BMI ≤ 25 kg/m2.


Asunto(s)
Anastomosis Quirúrgica/métodos , Derivación Gástrica/métodos , Desnutrición/epidemiología , Obesidad Mórbida/cirugía , Pérdida de Peso , Adulto , Comorbilidad , Femenino , Humanos , Intestino Delgado/cirugía , Masculino , Persona de Mediana Edad , Estudios Prospectivos
12.
Int J Mol Sci ; 20(18)2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31540344

RESUMEN

Morquio A syndrome, or mucopolysaccharidosis type IVA (MPS IVA), is a lysosomal storage disease due to mutations in the N-acetylgalactosamine-6-sulfatase (GALNS) gene. Systemic skeletal dysplasia and the related clinical features of MPS IVA are due to disruption of cartilage and its extracellular matrix, leading to an imbalance of growth. Enzyme replacement therapy (ERT) with recombinant human GALNS, alpha elosulfase, provides a systemic treatment. However, this therapy has a limited impact on skeletal dysplasia because the infused enzyme cannot penetrate cartilage and bone. Therefore, an alternative therapeutic approach to reach the cartilage is an unmet challenge. We have developed a new drug delivery system based on a nanostructure lipid carrier with the capacity to immobilize enzymes used for ERT and to target the lysosomes. This study aimed to assess the effect of the encapsulated enzyme in this new delivery system, using in vitro proteomic technology. We found a greater internalization of the enzyme carried by nanoparticles inside the cells and an improvement of cellular protein routes previously impaired by the disease, compared with conventional ERT. This is the first qualitative and quantitative proteomic assay that demonstrates the advantages of a new delivery system to improve the MPS IVA ERT.


Asunto(s)
Condroitinsulfatasas/administración & dosificación , Sistemas de Liberación de Medicamentos , Liposomas/química , Mucopolisacaridosis IV/tratamiento farmacológico , Adulto , Células Cultivadas , Condroitinsulfatasas/farmacocinética , Terapia de Reemplazo Enzimático/métodos , Femenino , Humanos , Lípidos/química , Masculino , Nanoestructuras/química , Proteómica , Adulto Joven
13.
Nutr Hosp ; 36(1): 238-241, 2019 03 07.
Artículo en Inglés | MEDLINE | ID: mdl-30834767

RESUMEN

Introduction: Malabsorptive bariatric techniques are associated with nutritional deficiencies. However, when patients do not respond to supplemental intensive treatments they should be closely followed because they can hide other pathological conditions. We present the case of a 47-year-old man with morbid obesity (body mass index [BMI]: 48 kg/m2) who underwent bariatric surgery. In 2016, he presented severe pneumonia and hospitalization at the Intensive Unit Care was required. After this episode, his nutritional state impaired, presenting 6-7 diarrhea/steatorrhea events per-day and requiring several hospitalizations due to the persistence of severe hypoproteinemia. He was given parenteral high-protein associated with low-fat oral diet. He presented a temporary biochemical improvement, but the hypoproteinemia recurred. Finally, tests revealed the presence of Tropheryma whipplei as protein-losing enteropathy. Whipple's disease (WD) is a rare cause of diarrhea and malnutrition, and these symptoms can be confused with the postoperative status of malabsorptive bariatric techniques. WD requires early diagnosis with prolonged antibiotic treatment to avoid severe complications.


Introducción: Las técnicas bariátricas malabsortivas suelen asociarse a deficiencias nutricionales. Sin embargo, cuando los pacientes no responden a tratamientos intensivos suplementarios, deben valorarse otras condiciones patológicas. Presentamos el caso de un hombre de 47 años, obeso mórbido (índice de masa corporal [IMC]: 48 kg/m2) sometido a cirugía bariátrica, que dos años más tarde presentó neumonía severa, por lo que requirió ingreso en la Unidad de Cuidados Intensivos. Posteriormente, el estado nutricional se deterioró, presentando 6-7 episodios de diarrea-esteatorrea/día y requiriendo varias hospitalizaciones por hipoproteinemia severa. Recibió infusión parenteral rica en proteínas asociada con una dieta baja en grasas y presentó mejoría analítica temporal. Finalmente, las pruebas revelaron la presencia de Tropheryma whipplei, una bacteria que genera enteropatía pierde-proteínas. La enfermedad de Whipple (EW) es una causa poco común de diarrea y malnutrición. Estos síntomas pueden confundirse con el posoperatorio de técnicas bariátricas malabsortivas. La EW requiere un diagnóstico precoz con un tratamiento antibiótico prolongado para evitar complicaciones graves.


Asunto(s)
Cirugía Bariátrica , Síndromes de Malabsorción/complicaciones , Desnutrición/complicaciones , Complicaciones Posoperatorias/fisiopatología , Enfermedad de Whipple/etiología , Antibacterianos/uso terapéutico , Dieta con Restricción de Grasas , Proteínas en la Dieta/uso terapéutico , Femenino , Humanos , Síndromes de Malabsorción/etiología , Desnutrición/etiología , Persona de Mediana Edad , Estado Nutricional , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/etiología , Tropheryma , Enfermedad de Whipple/dietoterapia , Enfermedad de Whipple/microbiología
14.
Foods ; 8(12)2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31888256

RESUMEN

Cronobacter sakazakii is an opportunistic pathogen that is associated with outbreaks of neonatal necrotizing enterocolitis, septicaemia, and meningitis. Reconstituted powdered infant formulae is the most common vehicle of infection. The aim of the present study is to gain insight into the physiological states of C. sakazakii cells using flow cytometry to detect the compromised cells, which are viable but non-culturable using plate-based methods, and to evaluate the impact of milk heat treatments on those populations. Dead-cell suspensions as well as heat-treated and non-heat-treated cell suspensions were used. After 60 or 65 °C treatments, the number of compromised cells increased as a result of cells with compromised membranes shifting from the heat-treated suspension. These temperatures were not effective at killing all bacteria but were effective at compromising their membranes. Thus, mild heat treatments are not enough to guarantee the safety of powered infant formulae. Flow cytometry was capable of detecting C. sakazakii's compromised cells that cannot be detected with classical plate count methods; thus, it could be used as a screening test to decrease the risk derived from the presence of pathogenic viable but non-culturable cells in this food that is intended for newborns' nutrition.

15.
Eur J Clin Microbiol Infect Dis ; 37(4): 643-649, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29280085

RESUMEN

The aim of this work was to ascertain the usefulness of a new commercially-available single-assay chemiluminescence test (CHT) for the diagnosis of human tularemia (Tularaemia VIRCLIA IgG + IgM monotest, Vircell, Santa Fe, Granada, Spain). A total of 773 sera from 773 patients including 364 initial sera from patients with diagnosed tularemia, patients with suspected tularemia not confirmed (100), healthy people (152), patients with serology positive to Brucella (97), patients diagnosed with other infectious diseases (30), and patients diagnosed with autoimmune diseases (30) were included. All sera were tested by CHT, "in-house" microagglutination test (MAT), immunochromatographic test (ICT) (Virapid Tularaemia, Vircell, Santa Fe Granada, Spain), and "in-house" ELISA IgG, and ELISA IgM. Of the total initial sera, 334 (sensitivity 91.8%) were positive in the CHT, 332 (sensitivity 91.2%) in the MAT, 330 (sensitivity 90.7%) in the ICT, and 328 (sensitivity 90.1%) in the ELISA IgG and ELISA IgM tests. The specificity of the CHT was 96.7%; of the MAT, 100%; of the ICT, 98.7%; and of the ELISA IgG and ELISA IgM, 97.4%. In the group of patients with serology positive to Brucella, at least 12.4% of sera were positive in tularemia tests (12.4% in ELISA IgM, 13.4% in MAT, 14.4% in ICT, and 15.5% in CHT and ELISA IgG). In conclusion, CHT presents a sensitivity and specificity in early diagnosis of human tularemia, similar to MAT, ICT, and ELISA IgG and ELISA IgM. Its single assay design allows lower costs, especially in areas of low endemicity or inter-epidemic periods.


Asunto(s)
Anticuerpos Antibacterianos/sangre , Francisella tularensis/inmunología , Inmunoensayo/métodos , Mediciones Luminiscentes/métodos , Pruebas Serológicas/métodos , Tularemia/diagnóstico , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Inmunoensayo/economía , Inmunoensayo/estadística & datos numéricos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Mediciones Luminiscentes/economía , Mediciones Luminiscentes/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pruebas Serológicas/economía , Pruebas Serológicas/estadística & datos numéricos , Tularemia/microbiología
16.
Minerva Cardioangiol ; 64(2): 101-13, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26977768

RESUMEN

BACKGROUND: To determine the clinical risk factors predictive of the 5-year mortality in patients with low cardiac output syndrome (LCOS) after cardiac surgery. In addition, to assess the influence of inflammation and myocardial dysfunction severity, as measured by C-reactive protein (CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, on outcome. METHODS: We studied 30 patients who underwent cardiac surgery and developed postoperative LCOS requiring inotropic support for longer than 48 hours after intensive care unit (ICU) admission. All patients received a 24-hour infusion of levosimendan after study enrolment. We measured the following at baseline, 24 h, 48 h and 7 days: clinical data, serum NT-proBNP and serum CRP levels. Patients were followed-up at 5 years for death by any cause. A risk-adjusted Cox proportional hazards regression model was used for statistical analysis. Hazard ratios and their 95% confidence intervals (CI) are presented. RESULTS: The 5-year mortality was 36.6% (n.=11). The predictors of 5-year mortality were the presence of dilated cardiomyopathy (HR=36.909; 95% CI: 1.901-716.747; P=0.017), a higher central venous pressure (CVP) at 48 hours (HR=2.686; 95% CI: 1.383-5.214; P=0.004), and lower CRP levels on day 7 (HR=0.963; 95% CI: 0.933-0.994; P=0.021). NT-proBNP levels showed a trend to higher initial levels in survivors without statistical significance, but were not associated with 5-year mortality. CONCLUSIONS: The presence of dilated cardiomyopathy, elevated CVP at 48 h and reduced CRP levels on day 7 predicted 5-year mortality in patients who developed postoperative LCOS after cardiac surgery. NT-proBNP levels in the first postoperative week were not predictors of long-term outcomes.


Asunto(s)
Gasto Cardíaco Bajo/tratamiento farmacológico , Procedimientos Quirúrgicos Cardíacos/métodos , Cardiotónicos/uso terapéutico , Hidrazonas/uso terapéutico , Piridazinas/uso terapéutico , Anciano , Proteína C-Reactiva/metabolismo , Gasto Cardíaco Bajo/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/metabolismo , Fragmentos de Péptidos/metabolismo , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Simendán , Factores de Tiempo , Resultado del Tratamiento
17.
Rev. colomb. cardiol ; 23(2): 152.e1-152.e3, mar.-abr, 2016. tab
Artículo en Español | LILACS, COLNAL | ID: lil-791266

RESUMEN

El uso de la radioterapia ha contribuido a mejorar la supervivencia de pacientes con diversos tumores malignos relacionados con la región torácica. No obstante, la irradiación cardíaca a una dosis suficientemente alta puede dañar prácticamente cualquier componente del mismo, incluyendo el sistema de conducción. Se describe el caso de un paciente que desarrolló bloqueo auriculoventricular completo, más de veinte años después de recibir radioterapia supradiafragmática para el tratamiento de un linfoma de Hodgkin.


The use of radiotherapy has contributed to improving the survival in patients with diverse malignancies related to the thoracic region. Nevertheless, cardiac radiation in sufficiently high dose can damage virtually any of its components, including the conduction system. We describe the case of a patient who developed a complete atrioventricular block more than twenty years after receiving supradiaphragmatic radiotherapy for Hodgkin lymphoma.


Asunto(s)
Humanos , Masculino , Adulto , Bloqueo Cardíaco , Nodo Atrioventricular , Relojes Biológicos , Neoplasias
18.
Rheumatol Int ; 34(11): 1607-12, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24728027

RESUMEN

Fibromyalgia (FM) syndrome is a disabling clinical condition of unknown cause, and only symptomatic treatment with limited benefit is available. Gluten sensitivity that does not fulfill the diagnostic criteria for celiac disease (CD) is increasingly recognized as a frequent and treatable condition with a wide spectrum of manifestations that overlap with the manifestations of FM, including chronic musculoskeletal pain, asthenia, and irritable bowel syndrome. The aim of this report was to describe 20 selected patients with FM without CD who improved when placed on a gluten-free diet. An anti-transglutaminase assay, duodenal biopsy, and HLA typing were performed in all cases. CD was ruled out by negative anti-transglutaminase assay results and absence of villous atrophy in the duodenal biopsy. All patients had intraepithelial lymphocytosis without villous atrophy. Clinical response was defined as achieving at least one of the following scenarios: remission of FM pain criteria, return to work, return to normal life, or the discontinuation of opioids. The mean follow-up period was 16 months (range 5-31). This observation supports the hypothesis that non-celiac gluten sensitivity may be an underlying cause of FM syndrome.


Asunto(s)
Dieta Sin Gluten , Fibromialgia/dietoterapia , Hipersensibilidad a los Alimentos/dietoterapia , Glútenes/efectos adversos , Adulto , Anciano , Biopsia , Duodeno/patología , Femenino , Fibromialgia/diagnóstico , Fibromialgia/etiología , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/etiología , Humanos , Linfocitosis/diagnóstico , Linfocitosis/dietoterapia , Linfocitosis/etiología , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Inducción de Remisión , Estudios Retrospectivos , Factores de Riesgo , España , Factores de Tiempo , Resultado del Tratamiento
19.
Arch. venez. pueric. pediatr ; 76(3): 109-116, sep. 2013. tab
Artículo en Español | LILACS | ID: lil-707287

RESUMEN

La nutrición del recién nacido prematuro o de bajo peso constituye un desafío para el pediatra y el neonatólogo desde el nacimiento y hasta bien avanzada la infancia. Uno de los mayores retos es mantener una ganancia de peso similar al crecimiento fetal hasta que el neonato alcance las 40 semanas de edad postconcepcional, y luego lograr un crecimiento que garantice eventualmente, una talla acorde a la edad cronológica, adecuada mineralización ósea y un óptimo neurodesarrollo. Todas estas metas se pueden alcanzar con el inicio precoz de la alimentación enteral, incluso nutrición trófica, en aquellos neonatos difíciles de alimentar y sin contraindicación de la vía oral; así como con el empleo de leche humana, la suplementación y/o fortificación cuando los requerimientos sean mayores y/o la ganancia de peso sea insuficiente, y el adecuado seguimiento de las variables antropométricas y bioquímicas que evidencian un crecimiento saludable.


The nutrition of the premature or low birth weight newborn is a challenge for the pediatrician and neonatologist from birth and up to advanced childhood. One of the biggest challenges is to keep a weight gain similar to fetal growth until the neonate achieves 40 weeks of postconcepcional age, and subsequently achieve a growth rate that guarantees, eventually, the goal of a length according to chronological age, proper bone mineralization and an optimal neurodevelopment. All these goals can be reached with the early commencement of enteral feeding, even with trophic nutrition in those hard-to-feed infants without contraindication to eat; the use of human milk, supplementation or fortification when the requirements are higher, and/or weight gain is too low and with the appropriate follow-up of the anthropometric and biochemical measurements that evidence a healthy growth.

20.
J AOAC Int ; 95(5): 1291-310, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-23175959

RESUMEN

Due to the extensive use of organochlorine pesticides (OCPs) for agricultural purposes and their high persistence and low biodegradability, they have become an important group of contaminants. Detection and quantification of pesticide residues in food, particularly fruits and vegetables, is of growing concern for producers, consumers, and governments. The most widely used pretreatment for the extraction of pesticides in plants is based on solvent extraction liquid-solid extraction (LSE). LSE can be carried out using Soxhlet, shake-flask, homogenization, sonication, and, more recently, microwave-assisted extraction, pressurized liquid extraction, and supercritical fluid extraction. Furthermore, new analytical procedures using the extraction with sorbents, such as solid-phase microextraction, stir bar sorptive extraction, and matrix solid-phase dispersion, have also been used. On the other hand, a wide range of cleanup methods (liquid-liquid extraction, solid-phase extraction, gel permeation chromatography, and dispersive solid-phase extraction; and chromatographic techniques with electron capture detector and mass spectrometry detector; and HPLC with a ultraviolet detector are reported in the literature. This article reviews the applicability, advantages, and disadvantages of various sample preparation techniques (traditional and new techniques) for the analysis of OCPs in different plants and plant materials. It covers more than 15 years of published methods in which pesticide residues have been determined in a wide range of vegetation samples (fruits, horticultural samples, medicinal plants, tree leaves, etc.) by the use of chromatographic techniques after various sample preparation steps. A great number of applications in different plant material are provided. To the best of the authors' knowledge, previously published reviews have not covered as wide and exhaustive range of vegetation matrixes as presented here. A summary of pesticide levels cited in the literature is included.


Asunto(s)
Hidrocarburos Clorados/química , Residuos de Plaguicidas/química , Plaguicidas/química , Plantas/química , Técnicas de Química Analítica , Monitoreo del Ambiente
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