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1.
Nurse Educ Today ; 144: 106395, 2024 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-39288478

RESUMEN

BACKGROUND: College students are amid a mental health crisis with campuses seeing the highest rates of mental health disorders in over a decade. College nursing students stand out as particularly affected, experiencing elevated levels of anxiety, stress, and depression compared to the general student population. At the forefront of addressing this issue are college faculty, especially nursing faculty, who play a unique role in identifying and referring students with mental health needs due to their close interactions in smaller teaching-learning settings such as clinicals, simulations, and one-on-one validations. AIM: This study evaluated the perceived competency, knowledge, engagement, and fear levels of nursing faculty in supporting the mental health of Bachelor of Science in Nursing students. Additionally, the study explored whether faculty members with prior MH training differed in these levels. METHODS: Survey data from 63 faculty members employed across six prominent nursing schools in the southeast region of the United States, all offering Bachelor of Science in Nursing programs, were analyzed. Employing a cross-sectional design, the study utilized the "College Mental Health Perceived Competency Scale" (CMHPCS) to assess faculty's competence, knowledge, engagement and fear in supporting student mental health. RESULTS: Among the 63 participants, significant differences were observed in engagement levels between nursing faculty with and without prior mental health training (p < .012). Overall, the surveyed nursing faculty demonstrated high levels of competence, engagement and knowledge and low levels of fear in supporting the nursing student's mental health. CONCLUSION: The results prompt recommendations for future research aimed at developing a comprehensive approach to equip nursing faculty with effective mental health training and interventions. Such efforts seek to empower student nurses with the tools necessary to support their own mental health, enabling them to competently care for patients and communities.

2.
Cancer Lett ; 599: 217108, 2024 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-38986735

RESUMEN

Cancer remains the leading cause of death worldwide with approved oncology drugs continuing to have heterogenous patient responses and accompanied adverse effects (AEs) that limits effectiveness. Here, we examined >100 FDA-approved oncology drugs in the context of stemness using a surrogate model of transformed human pluripotent cancer stem cells (CSCs) vs. healthy stem cells (hSCs) capable of distinguishing abnormal self-renewal and differentiation. Although a proportion of these drugs had no effects (inactive), a larger portion affected CSCs (active), and a unique subset preferentially affected CSCs over hSCs (selective). Single cell gene expression and protein profiling of each drug's FDA recognized target provided a molecular correlation of responses in CSCs vs. hSCs. Uniquely, drugs selective for CSCs demonstrated clinical efficacy, measured by overall survival, and reduced AEs. Our findings reveal that while unintentional, half of anticancer drugs are active against CSCs and associated with improved clinical outcomes. Based on these findings, we suggest ability to target CSC targeting should be included as a property of early onco-therapeutic development.


Asunto(s)
Antineoplásicos , Aprobación de Drogas , Células Madre Neoplásicas , Humanos , Células Madre Neoplásicas/efectos de los fármacos , Células Madre Neoplásicas/patología , Células Madre Neoplásicas/metabolismo , Antineoplásicos/farmacología , United States Food and Drug Administration , Estados Unidos , Neoplasias/tratamiento farmacológico , Neoplasias/patología , Neoplasias/genética , Línea Celular Tumoral , Diferenciación Celular/efectos de los fármacos
3.
bioRxiv ; 2024 May 25.
Artículo en Inglés | MEDLINE | ID: mdl-38826464

RESUMEN

RNA virus induced excessive inflammation and impaired antiviral interferon (IFN-I) responses are associated with severe disease. This innate immune response, also referred to as 'dysregulated immunity,' is caused by viral single-stranded RNA (ssRNA) and double-stranded-RNA (dsRNA) mediated exuberant inflammation and viral protein-induced IFN antagonism. However, key host factors and the underlying mechanism driving viral RNA-mediated dysregulated immunity are poorly defined. Here, using viral ssRNA and dsRNA mimics, which activate toll-like receptor 7 (TLR7) and TLR3, respectively, we evaluated the role of viral RNAs in causing dysregulated immunity. We show that murine bone marrow-derived macrophages (BMDMs) stimulated with TLR3 and TLR7 agonists induce differential inflammatory and antiviral cytokine response. TLR7 activation triggered a robust inflammatory cytokine/chemokine induction compared to TLR3 activation, whereas TLR3 stimulation induced significantly increased IFN/IFN stimulated gene (ISG) response relative to TLR7 activation. To define the mechanistic basis for dysregulated immunity, we examined cell-surface and endosomal TLR levels and downstream mitogen-activated protein kinase (MAPK) and nuclear factor kappa B (NF-kB) activation. We identified a significantly higher cell-surface and endosomal TLR7 expression compared to TLR3, which further correlated with early and robust MAPK (pERK1/2 and p-P38) and NF-kB activation in TLR7-stimulated macrophages. Furthermore, blocking EKR1/2, p38, and NF-kB activity reduced TLR3/7-induced inflammatory cytokine/chemokine levels, whereas only ERK1/2 inhibition enhanced viral RNA-mimic-induced IFN/ISG responses. Collectively, our results illustrate that high cell surface and endosomal TLR7 expression and robust ERK1/2 activation drive viral ssRNA mimic-induced excessive inflammatory and reduced IFN/ISG responses, and blocking ERK1/2 activity would mitigate viral-RNA/TLR-induced dysregulated immunity.

4.
Nurs Educ Perspect ; 2024 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-38595187

RESUMEN

ABSTRACT: The COVID-19 pandemic and subsequent vaccine hesitancy highlighted the need for additional learning experiences for nursing students to address person-centered care and communication. This project aimed to employ a three-step service-learning experience consisting of town hall meetings, motivational interviewing training, and rural health fairs to address vaccine hesitancy in communities surrounding the college. Evaluation of the project revealed satisfaction and increased confidence among participating nursing students.

5.
Cell Rep Med ; 5(4): 101485, 2024 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-38582086

RESUMEN

Despite most acute myeloid leukemia (AML) patients entering remission following chemotherapy, outcomes remain poor due to surviving leukemic cells that contribute to relapse. The nature of these enduring cells is poorly understood. Here, through temporal single-cell transcriptomic characterization of AML hierarchical regeneration in response to chemotherapy, we reveal a cell population: AML regeneration enriched cells (RECs). RECs are defined by CD74/CD68 expression, and although derived from leukemic stem cells (LSCs), are devoid of stem/progenitor capacity. Based on REC in situ proximity to CD34-expressing cells identified using spatial transcriptomics on AML patient bone marrow samples, RECs demonstrate the ability to augment or reduce leukemic regeneration in vivo based on transfusion or depletion, respectively. Furthermore, RECs are prognostic for patient survival as well as predictive of treatment failure in AML cohorts. Our study reveals RECs as a previously unknown functional catalyst of LSC-driven regeneration contributing to the non-canonical framework of AML regeneration.


Asunto(s)
Perfilación de la Expresión Génica , Leucemia Mieloide Aguda , Humanos , Pronóstico , Leucemia Mieloide Aguda/tratamiento farmacológico , Células Madre/metabolismo
6.
Cell Rep Med ; 4(7): 101108, 2023 07 18.
Artículo en Inglés | MEDLINE | ID: mdl-37433297

RESUMEN

We systematically investigate functional and molecular measures of stemness in patients with acute myeloid leukemia (AML) using a cohort of 121 individuals. We confirm that the presence of leukemic stem cells (LSCs) detected through in vivo xenograft transplantation is associated with poor survival. However, the measurement of leukemic progenitor cells (LPCs) through in vitro colony-forming assays provides an even stronger predictor of overall and event-free survival. LPCs not only capture patient-specific mutations but also retain serial re-plating ability, demonstrating their biological relevance. Notably, LPC content represents an independent prognostic factor in multivariate analyses including clinical guidelines of risk stratification. Our findings suggest that LPCs provide a robust functional measure of AML, enabling quantitative and rapid assessment of a wide range of patients. This highlights the potential of LPCs as a valuable prognostic factor in AML management.


Asunto(s)
Leucemia Mieloide Aguda , Humanos , Pronóstico , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/genética
7.
Clin Endocrinol (Oxf) ; 98(2): 177-189, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36263687

RESUMEN

OBJECTIVE: The objective of this study was to evaluate the role of adrenal venous sampling (AVS) in guiding the management of patients with corticotropin (ACTH)-independent glucocorticoid secretory autonomy and bilateral adrenal masses. DESIGN AND PATIENTS: A cohort with 25 patients underwent AVS and surgical management. MEASUREMENTS: Cortisol was measured from the adrenal veins (AVs) and inferior vena cava (IVC). AV/IVC cortisol ratio and cortisol lateralization ratio (CLR) (dominant AV cortisol concentration divided by the nondominant AV cortisol concentration) were calculated. Posthoc receiver-operating characteristic curves were generated to determine the specificity of revised AV/IVC cortisol ratio and CLR in differentiating unilateral from bilateral disease. RESULTS: Patients underwent unilateral (n = 21) or bilateral (n = 4) adrenalectomy. The mean AV/IVC cortisol ratio for unilateral adrenalectomy was 12.1 ± 9.6 (dominant) and 4.7 ± 3.8 (contralateral) with a mean CLR of 3.6 ± 3.5. The mean AV/IVC cortisol ratio for bilateral adrenalectomy was 7.5 ± 2.1, with a mean CLR of 1.1 ± 0.6. At a mean follow-up of 22 months, one patient who underwent unilateral adrenalectomy for the predicted bilateral disease developed recurrent mild autonomous cortisol secretion. Posthoc analyses demonstrated a specificity of 95%-100% for unilateral disease with AV/IVC cortisol ratio >9 for one side, <2.0 for the opposite side and a CLR > 2.3. The specificity was 80%-90% for bilateral disease with AV/IVC cortisol ratio >5.1 bilaterally and a CLR < 1.1. CONCLUSIONS: Among patients with bilateral adrenal masses and ACTH-independent autonomous cortisol secretion, AVS can distinguish between unilateral and bilateral disease with high specificity and may guide surgical management.


Asunto(s)
Enfermedades de las Glándulas Suprarrenales , Hiperaldosteronismo , Humanos , Hidrocortisona , Glándulas Suprarrenales/irrigación sanguínea , Adrenalectomía , Hormona Adrenocorticotrópica , Hiperaldosteronismo/cirugía , Estudios Retrospectivos , Aldosterona
8.
Nurs Forum ; 57(6): 1567-1570, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36081324

RESUMEN

Healthcare professionals have battled physically, mentally, and emotionally overwhelming workforce pressures for years. The COVID-19 pandemic exacerbated this burnout substantially since its onset in 2020. Recently implemented federal initiatives aim to assist in the development of moral resiliency against a morally distressing workplace environment. But is this enough? Meeting the immediate need for substantial mental health resources in the healthcare field is essential and will be a long-lasting endeavor.


Asunto(s)
Agotamiento Profesional , COVID-19 , Humanos , Pandemias , Salud Mental , Personal de Salud/psicología , Agotamiento Profesional/etiología , Agotamiento Profesional/psicología , Actitud del Personal de Salud
9.
J Deaf Stud Deaf Educ ; 27(3): 245-261, 2022 08 06.
Artículo en Inglés | MEDLINE | ID: mdl-35791669

RESUMEN

Research literature and community narratives both emphasize the importance of self-determination in the lives of deaf youth. This paper describes the development, initial validation, and potential applications of a translated measure of self-determination for deaf youth, the SDI:SR ASL Translation (SDI:SR ASL). A sample of 3,309 young people who completed the SDI:SR, of whom 392 were deaf, was used in this validation study. Results provide preliminary support for the use of SDI:SR ASL with deaf youth. Findings also indicate that deaf youth who take the SDI:SR ASL score more similarly to youth without disabilities taking the SDI:SR than youth with disabilities. The SDI:SR ASL can be an important tool for researchers and practitioners to better understand self-determination among deaf youth and facilitate continued development of self-determination skills.


Asunto(s)
Personas con Deficiencia Auditiva , Lengua de Signos , Adolescente , Humanos , Estudiantes , Traducción , Estados Unidos
10.
SAGE Open Nurs ; 8: 23779608221082962, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35284635

RESUMEN

Background: Childhood overweight and obesity continues to be a major public health concern, especially in minority, low-income, and rural populations. In order to develop health promotion interventions aimed at reducing obesity rates, there is a need to identify which populations have the highest rates of obesity and the risk factors associated with these high rates. Methods: Data collected from low-income, preschool children and their parents in an urban community and a rural community in Alabama were analyzed and compared. Body Mass Index (BMI) was collected during school based health screenings, and information regarding parent's BMI and child's consumption of sugar-sweetened beverages (SSBs) were collected by parent report. Results: Of the 363 children screened, 12.8% (15.2% rural and 11.9% urban) were considered overweight, and 15.8% (20.2% rural and 14.2% urban) of the sample was classified as obese. Rates of overweight and obesity for mothers were 27.6% (25.3% rural and 28.4% urban) and 48% (56.3% rural and 44.8% urban) respectively and 39.6% (53.3% rural and 34.4% urban) and 34.6% (28.3% rural and 36.9% urban) for fathers. Parents reported their child consumed 3.82 SSBs per day. Overall, mother's BMI, father's BMI and sugar-sweetened beverage consumption was positively associated with child's BMI. However, there were no significant interactions between the rural and urban groups. Conclusion: Rates of overweight and obesity remain high in low-income, predominantly minority preschool children and their parents in two communities in Alabama. Consumption of SSBs, mother's BMI, and father's BMI are three factors impacting the weight status of low-income preschool children. These factors are significant in both rural and urban children.

12.
Cell Calcium ; 101: 102499, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34839223

RESUMEN

Bitter taste receptors (T2Rs) localize to airway motile cilia and initiate innate immune responses in retaliation to bacterial quorum sensing molecules. Activation of cilia T2Rs leads to calcium-driven NO production that increases cilia beating and directly kills bacteria. Several diseases, including chronic rhinosinusitis, COPD, and cystic fibrosis, are characterized by loss of motile cilia and/or squamous metaplasia. To understand T2R function within the altered landscape of airway disease, we studied T2Rs in non-ciliated airway cell lines and primary cells. Several T2Rs localize to the nucleus in de-differentiated cells that typically localize to cilia in differentiated cells. As cilia and nuclear import utilize shared proteins, some T2Rs may target to the nucleus in the absence of motile cilia. T2R agonists selectively elevated nuclear and mitochondrial calcium through a G-protein-coupled receptor phospholipase C mechanism. Additionally, T2R agonists decreased nuclear cAMP, increased nitric oxide, and increased cGMP, consistent with T2R signaling. Furthermore, exposure to T2R agonists led to nuclear calcium-induced mitochondrial depolarization and caspase activation. T2R agonists induced apoptosis in primary bronchial and nasal cells differentiated at air-liquid interface but then induced to a squamous phenotype by apical submersion. Air-exposed well-differentiated cells did not die. This may be a last-resort defense against bacterial infection. However, it may also increase susceptibility of de-differentiated or remodeled epithelia to damage by bacterial metabolites. Moreover, the T2R-activated apoptosis pathway occurs in airway cancer cells. T2Rs may thus contribute to microbiome-tumor cell crosstalk in airway cancers. Targeting T2Rs may be useful for activating cancer cell apoptosis while sparing surrounding tissue.


Asunto(s)
Apoptosis , Calcio , Células Epiteliales/citología , Receptores Acoplados a Proteínas G/agonistas , Bronquios , Humanos
13.
Biomedicines ; 9(11)2021 Oct 27.
Artículo en Inglés | MEDLINE | ID: mdl-34829779

RESUMEN

Visceral obesity may be a driving factor in nonalcoholic fatty liver disease (NAFLD) development. Previous studies have shown that the omega-3 polyunsaturated fatty acid, eicosapentaenoic acid (EPA), ameliorates obesity in high-fat (HF) fed male, C57Bl/6 mice at thermoneutral conditions, independent of uncoupling protein 1 (UCP1). Our goals herein were to investigate sex-dependent mechanisms of EPA in the livers of wild type (WT) and UCP1 knockout (KO) male and female mice fed a HF diet (45% kcal fat; WT-HF, KO-HF) with or without supplementation of 36 g/kg EPA (WT-EPA, KO-EPA). KO significantly increased body weight in males, with no significant reductions with EPA in the WT or KO groups. In females, there were no significant differences in body weight among KO groups and no effects of EPA. In males, liver TGs were significantly higher in the KO-HF group and reduced with EPA, which was not observed in females. Accordingly, gene and protein markers of mitochondrial oxidation, peroxisomal biogenesis and oxidation, as well as metabolic futile cycles were sex-dependently impacted by KO and EPA supplementation. These findings suggest a genotypic difference in response to dietary EPA supplementation on the livers of male and female mice with diet-induced obesity and housed at thermoneutrality.

14.
Front Microbiol ; 12: 624618, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33854487

RESUMEN

The tumor microenvironment is characterized by anomalous vascularization, hypoxia, and acidity at the core of solid tumors that culminates in concentrated necrosis and immune system dysregulation among other effects. While this environment presents several challenges for the development of oncotherapeutics that deliver their activity via the enhanced permeability and retention (EPR) effect of the leaky blood vessels around a tumor, oncolytic bacteria, or a class of bacteria with a noted capacity to lyse solid tumors, are attracted to the very environment found at the center of solid tumors that confounds other therapeutics. It is this capacity that allows for a potent, active penetration from the tumor margins into the core, and subsequent colonization to facilitate lysis and immune reactivation. Clostridium novyi in particular has recently shown great promise in preclinical and clinical trials when administered directly to the tumor. These studies indicate that C. novyi is uniquely poised to effectively accomplish the long sought after "holy grail" of oncotherapeutics: selective tumor localization via intravenous delivery. This study reports the development of efficient methods that facilitate experimental work and therapeutic translation of C. novyi including the ability to work with this obligate micro-anaerobe on the benchtop. Additionally, this study seeks to utilize this newfound experimental flexibility to address several gaps in the current knowledge regarding the efficacy of CRIPSR/Cas9-mediated gene insertion in this species to further develop this oncolytic bacteria and the genetic customization of bacteria in general.

15.
Future Microbiol ; 16: 341-368, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33754804

RESUMEN

The development of a 'smart' drug capable of distinguishing tumor from host cells has been sought for centuries, but the microenvironment of solid tumors continues to confound therapeutics. Solid tumors present several challenges for current oncotherapeutics, including aberrant vascularization, hypoxia, necrosis, abnormally high pH and local immune suppression. While traditional chemotherapeutics are limited by such an environment, oncolytic microbes are drawn to it - having an innate ability to selectively infect, colonize and eradicate solid tumors. Development of an oncolytic species would represent a shift in the cancer therapeutic paradigm, with ramifications reaching from the medical into the socio-economic. Modern genetic engineering techniques could be implemented to customize 'Frankenstein' bacteria with advantageous characteristics from several species.


Lay abstract Side effects of chemotherapeutics are thought to often be a reflection of our inability to target these toxic substances to only cancer cells; hence, scientists have spent centuries searching for alternative treatments that would confine their actions to tumor cells, sparing healthy tissue. Unfortunately, the dense nature of tumor tissue along with altered blood vessels, that lead to diminished tumor tissue oxygenation, altered tissue pH and cellular metabolic inactivity or even cell death have proven challenging. Importantly, these barriers have contributed to local and even sometimes systemic suppression of the patient's immune system that can allow the tumor to grow and progress unchecked. While most non-cancer cells are inhibited by the local tumor environment, certain microbes, including some bacteria and viruses, are drawn to it, possessing a natural ability to selectively infect, colonize and eradicate solid tumors. These microbes may also restore the patient's immune balance. However, use of these microbes is not without its own problems; nevertheless, modern genetic engineering techniques could be implemented to develop customized, safe, effective bacteria with advantageous characteristics. The development and clinical translation of cancer-fighting bacteria would represent a shift in cancer therapeutics and would have ramifications that reach beyond medical efficacy into the realm of socioeconomics. This review seeks to marry the current field of oncolytic bacteria with the expanding field of modern bacterial genetic engineering techniques in prospect of such a therapeutic.


Asunto(s)
Bacterias , Terapia Biológica , Ingeniería Genética , Neoplasias/terapia , Animales , Bacterias/clasificación , Bacterias/genética , Fenómenos Fisiológicos Bacterianos , Genoma Bacteriano/genética , Interacciones Microbiota-Huesped , Humanos , Neoplasias/microbiología , Microambiente Tumoral
16.
Adv Nutr ; 12(1): 102-114, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-32761179

RESUMEN

The influence of diet on the gut microbiota is an emerging research area with significant impact on human health and disease. However, the effects of beef, the most consumed red meat in the United States, on gut microbial profile are not well studied. Following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols, the objective of this systematic review was to conduct a rigorous and thorough review of the current scientific literature regarding the effects of beef protein and the resulting bioactivity of beef protein and amino acids on the gut microbiota, with the goal of identifying gaps in the literature and guiding future research priorities. Utilizing MEDLINE Complete, PubMed, ScienceDirect, Scopus, and Google Scholar databases, we conducted searches including terms and combinations of the following: animal protein, amino acid, beef, bioactive compounds, diet, health, microbiome, peptide, processed beef, and protein. We identified 131 articles, from which 15 were included in our review. The effects of beef on mouse and rat models were mostly consistent for the bacterial phylum level. Short-term (1-4-wk) beef intakes had little to no effect on microbial profiles in humans. Most studies utilized high beef feeding (240-380 g/d), and no study examined recommended amounts of protein [∼3.71 oz/d (105 g/d) meats, poultry, and eggs, or ∼26 oz/week (737 g/wk) from these food sources] according to US dietary guidelines. Additionally, the majority of animal and human studies with adverse findings examined the impact of beef in the context of a diet high in fat or sugar. In conclusion, an extensive gap exists in the literature regarding beef and the microbiota. More studies are necessary to elucidate the role of the microbiota following the consumption of beef, especially in interaction with other dietary compounds, and how beef preparation, processing, and cooking methods differentially influence the biological effects of beef on human health.


Asunto(s)
Microbioma Gastrointestinal , Animales , Bovinos , Dieta , Huevos , Humanos , Carne , Ratones , Prevotella , Ratas
17.
Curr Probl Diagn Radiol ; 50(5): 623-628, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32561153

RESUMEN

PURPOSE: To compare vascular plugs to coil embolization of the proximal splenic artery and evaluate differences in radiation exposure to the patients. METHODS: An electronic literature search was performed for relevant studies from January 2000 to July 2018 that compared the efficacy of vascular plugs vs coils in splenic artery embolization. Only studies that investigated coil or vascular plug use, without combination with other embolic agents, were included. Meta-analysis was performed using a fixed effects model approach with the inverse variance-weighted average method to determine pooled differences in time to vessel occlusion, procedure time, fluoroscopy time, total number of devices used, and radiation exposure. Heterogeneity was assessed using the I square statistic. Pooled outcomes were compared, and quality assessments were evaluated using the Newcastle Ottawa Scale. RESULTS: Eight studies met inclusion criteria. 81 patients were embolized with vascular plugs and 52 patients with coils only. The most common indication for splenic artery embolization was trauma. Time to vessel occlusion was shorter in the vascular plug group by 7.11 minutes (P = 0.003). Fluoroscopy time was shorter by 13.82 minutes in the vascular plug cohort, and these patients received less radiation (-439 mGy) compared to the coil group (P = 0.006 and P = 0.02, respectively). The number of devices was significantly fewer in the vascular plug group (-3.54; P < 0.001). Procedure time was not statistically significant. CONCLUSION: Our data supports the vascular plug is superior to coils for embolization of the proximal splenic artery with respect to occlusion time, fluoroscopy time, patient radiation exposure, and number occlusive devices used.


Asunto(s)
Embolización Terapéutica , Exposición a la Radiación , Humanos , Estudios Retrospectivos , Bazo , Arteria Esplénica/diagnóstico por imagen , Resultado del Tratamiento
18.
Cardiovasc Intervent Radiol ; 43(5): 706-713, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32103305

RESUMEN

PURPOSE: To evaluate the comparative outcome and cost of vascular plugs versus coils for internal iliac artery embolization prior to endovascular aortic aneurysm repair. METHOD: A search was performed for internal iliac artery embolization studies in adult patients from January 2005 to July 2018. Inclusion criteria included embolization of unilateral or bilateral IIAs with either coils or plug(s) prior to endovascular aortic repair. Meta-analysis was performed using a fixed effects model with the inverse variance-weighted average method to determine pooled differences in surgical time, fluoroscopy time, radiation exposure, number of devices used, cost of devices, and post-embolization buttock claudication. Heterogeneity was assessed using the Chi-square statistic. Pooled outcomes were compared, and quality assessments were evaluated using the Newcastle-Ottawa scale. RESULT: Six studies met inclusion criteria. One hundred and eighty-one patients were included in the study, of which 87 were in the plug group and 94 in the coil group. Vascular plug use led to 35.32 min shorter surgery time (p < 0.001), 15.64 min less fluoroscopy time (p < 0.001), 157,599 mGy/cm2 less radiation (p < 0.001), and 5.88 fewer occlusive devices (p < 0.001) than the use of coils alone. The estimated total cost of occlusion devices was $575.45 USD lower in the plug cohort (p < 0.001). The development of buttock claudication 12 months after EVAR was 11% less likely in the plug cohort but was not statistically significant (p = 0.71). CONCLUSION: The vascular plug appears to be superior to coils in embolization of the internal iliac artery due to shorter surgical time, fluoroscopy time, radiation exposure, and total cost of occlusive devices.


Asunto(s)
Análisis Costo-Beneficio/métodos , Análisis Costo-Beneficio/estadística & datos numéricos , Embolización Terapéutica/economía , Embolización Terapéutica/instrumentación , Aneurisma Ilíaco/economía , Aneurisma Ilíaco/terapia , Anciano , Estudios de Cohortes , Análisis Costo-Beneficio/economía , Embolización Terapéutica/métodos , Femenino , Humanos , Arteria Ilíaca , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
19.
mBio ; 10(6)2019 12 24.
Artículo en Inglés | MEDLINE | ID: mdl-31874913

RESUMEN

Staphylococcus aureus is an important pathogen responsible for nosocomial and community-acquired infections in humans, and methicillin-resistant S. aureus (MRSA) infections have continued to increase despite widespread preventative measures. S. aureus can colonize the female vaginal tract, and reports have suggested an increase in MRSA infections in pregnant and postpartum women as well as outbreaks in newborn nurseries. Currently, little is known about specific factors that promote MRSA vaginal colonization and subsequent infection. To study S. aureus colonization of the female reproductive tract in a mammalian system, we developed a mouse model of S. aureus vaginal carriage and demonstrated that both hospital-associated and community-associated MRSA isolates can colonize the murine vaginal tract. Immunohistochemical analysis revealed an increase in neutrophils in the vaginal lumen during MRSA colonization. Additionally, we observed that a mutant lacking fibrinogen binding adhesins exhibited decreased persistence within the mouse vagina. To further identify novel factors that promote vaginal colonization, we performed RNA sequencing to determine the transcriptome of MRSA growing in vivo during vaginal carriage at 5 h, 1 day, and 3 days postinoculation. Over 25% of the bacterial genes were differentially regulated at all time points during colonization compared to laboratory cultures. The most highly induced genes were those involved in iron acquisition, including the Isd system and siderophore transport systems. Mutants deficient in these pathways did not persist as well during in vivo colonization. These results reveal that fibrinogen binding and the capacity to overcome host nutritional limitation are important determinants of MRSA vaginal colonization.IMPORTANCEStaphylococcus aureus is an opportunistic pathogen able to cause a wide variety of infections in humans. Recent reports have suggested an increasing prevalence of MRSA in pregnant and postpartum women, coinciding with the increased incidence of MRSA infections in neonatal intensive care units (NICUs) and newborn nurseries. Vertical transmission from mothers to infants at delivery is a likely route of MRSA acquisition by the newborn; however, essentially nothing is known about host and bacterial factors that influence MRSA carriage in the vagina. Here, we established a mouse model of vaginal colonization and observed that multiple MRSA strains can persist in the vaginal tract. Additionally, we determined that MRSA interactions with fibrinogen and iron uptake can promote vaginal persistence. This study is the first to identify molecular mechanisms which govern vaginal colonization by MRSA, the critical initial step preceding infection and neonatal transmission.


Asunto(s)
Interacciones Microbiota-Huesped , Staphylococcus aureus Resistente a Meticilina/fisiología , Vagina/microbiología , Adhesinas Bacterianas/genética , Adhesinas Bacterianas/metabolismo , Animales , Modelos Animales de Enfermedad , Femenino , Fibrinógeno/metabolismo , Perfilación de la Expresión Génica , Hierro/metabolismo , Staphylococcus aureus Resistente a Meticilina/genética , Staphylococcus aureus Resistente a Meticilina/patogenicidad , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Mutación , Neutrófilos/inmunología , Análisis de Secuencia de ARN , Vagina/inmunología , Factores de Virulencia/genética
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