RESUMO
The English SARS-CoV-2 epidemic has been affected by the emergence of new viral variants such as B.1.177, Alpha and Delta, and changing restrictions. We used statistical models and the agent-based model Covasim, in June 2021, to estimate B.1.177 to be 20% more transmissible than the wild type, Alpha to be 50-80% more transmissible than B.1.177 and Delta to be 65-90% more transmissible than Alpha. Using these estimates in Covasim (calibrated 1 September 2020 to 20 June 2021), in June 2021, we found that due to the high transmissibility of Delta, resurgence in infections driven by the Delta variant would not be prevented, but would be strongly reduced by delaying the relaxation of restrictions by one month and with continued vaccination. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.
Assuntos
COVID-19 , SARS-CoV-2 , Humanos , Modelos Estatísticos , SARS-CoV-2/genética , Análise de SistemasRESUMO
This study evaluated the effects of a microbial feed supplement (MFS; Galaxis, Ascus Biosciences Inc.) comprising 2 native rumen microbes on performance parameters in mid-lactation dairy cows. Forty-six lactating primiparous and multiparous Holstein cows [629 ± 62 kg of body weight, mean ± standard deviation (SD); parity 1.64 ± 0.49; 119 ± 38 days in milk; 45.11 ± 3.81 and 52.73 ± 4.77 kg/d of milk yield for primiparous and multiparous, respectively] were enrolled in a study containing 3 experimental periods (P). During all periods, enrolled cows were fed the same base total mixed ration (TMR) ad libitum once daily. During P1 (7 d), baseline data were obtained for covariate analysis. At the beginning of P2 (60 d), cows were assigned to 1 of 2 dietary treatment groups in a randomized complete block design to balance for milk yield (MY), parity, and days in milk: (1) a control diet (CON; base TMR; n = 23), or (2) a control diet supplemented with 5 g/d of MFS (MFS; n = 23). Sample size was determined based on previous, unpublished results involving this MFS; a 3-kg difference between groups with a SD of 3.5 kg could be detected with sufficient power (0.81) using a total sample size of 46 cows. Treatment was top-dressed and hand-mixed into the top one-third of the TMR. During P3 (7 d), no treatment was administered, and all cows were fed the base TMR. When analyzing all cows in the data set, MFS had little to no effect on performance. However, modeling revealed that the fixed effect of covariate milk production level had a significant effect on the response of MY and ECM, and further investigation of the data revealed that treatment effectiveness in P2 correlated with milk production during P1. Cows were retrospectively categorized into 2 milk production groups (MPG) balanced for parity: MPG1 (i.e., <53 kg/d of ECM during P1; n = 34) or MPG2 (i.e., ≥53 kg/d of ECM during P1; n = 12). Energy-corrected milk was increased by 4.4% in MFS-administered MPG1 cows compared with CON cows during P2. Although there were no significant effects of MFS on production variables for MPG2 cows, MY tended to be decreased by 3.9% in MFS-administered cows compared with CON cows. Further investigation is needed to understand production level response differences and the effect of supplemented native rumen microbes on animal health and productivity.
RESUMO
The aim of the present study was to evaluate the efficacy of topical versus combined (intravenous + topical) tranexamic acid (TXA) to reduce perioperative blood loss after uncemented primary total hip arthroplasty (THA). Seventy-five patients were randomized in three comparable experimental groups: 1) topical TXA (3 g in 50 ml of saline solution); 2) intravenous + topical TXA (3 g topical + 2 g in 100 ml of saline solution intravenously); 3) controls. Pre- and post-operative hemoglobin (Hb) levels and hematocrit (Hct) values along with the rate of blood transfusion in the 3 groups were compared. The intravenous + topical TXA group demonstrated higher Hb levels and Hct values at postoperative day one (Hb = p <0.05, Hct = p <0.001), postoperative day three (Hb = p <0.05, Hct = p <0.001), and discharge (Hct = p <0.01) compared to the control group. The intravenous + topical group had a lower transfusion rate compared to the control group (0% vs 20%, p = 0.014). With the numbers available, no difference in postoperative Hb level and transfusion rate emerged between topical TXA and control group.
Assuntos
Artroplastia de Quadril , Administração Tópica , Antifibrinolíticos , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Ácido TranexâmicoRESUMO
Patients with ulcerative colitis (UC) using marijuana have been reported to experience symptomatic benefit. Cannabidivarin (CBDV) is a safe non-psychoactive phytocannabinoid able to activate and desensitize TRPA1, a member of the TRP channels superfamily, which plays a pivotal role in intestinal inflammation. Here, we have investigated the potential intestinal anti-inflammatory effect of CBDV in mice and in biopsies from pediatric patients with active UC. Colonic inflammation was induced in mice by dinitrobenzenesulfonic acid (DNBS). The effect of orally administered CBDV on macroscopic and microscopic damage, inflammatory parameters (i.e. myeloperoxidase activity, intestinal permeability and cytokine production) and faecal microbiota composition, was evaluated 3 days after DNBS administration. TRPA1 expression was studied by RT-PCR in inflamed colons of mice as well as in mucosal colonic biopsies of children with active UC, whose response to incubation with CBDV was also investigated. CBDV attenuates, in a TRPA1-antagonist sensitive manner, DNBS-induced signs of inflammation including neutrophil infiltration, intestinal permeability, and cytokine (i.e. IL-1ß, IL-6 and the chemokine MCP-1) production. CBDV also alters the dysregulation of gut microbiota associated to colitis. Finally, CBDV lessens cytokine expression in colonic biopsies from pediatric patients with ulcerative colitis, a condition in which TRPA1 was up-regulated. Our preclinical study shows that CBDV exerts intestinal anti-inflammatory effects in mice via TRPA1, and in children with active UC. Since CBDV has a favorable safety profile in humans, it may be considered for possible clinical trials in patients with UC.
Assuntos
Anti-Inflamatórios/uso terapêutico , Canabinoides/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Citocinas/análise , Inflamação/tratamento farmacológico , Animais , Criança , Colite Ulcerativa/genética , Colite Ulcerativa/patologia , Humanos , Inflamação/genética , Inflamação/patologia , Intestinos/efeitos dos fármacos , Intestinos/patologia , Masculino , Camundongos , Canal de Cátion TRPA1/genética , Regulação para Cima/efeitos dos fármacosRESUMO
BACKGROUND: Endocannabinoid anandamide (AEA) inhibits intestinal motility and visceral pain, but it may also be proalgesic through transient receptor potential vanilloid-1 (TRPV1). AEA is degraded by fatty acid amide hydrolase (FAAH). This study explored whether dual inhibition of FAAH and TRPV1 reduces diarrhea and abdominal pain. METHODS: Immunostaining was performed on myenteric plexus of the mouse colon. The effects of the dual FAAH/TRPV1 inhibitor AA-5-HT on electrically induced contractility, excitatory junction potential (EJP) and fast (f) and slow (s) inhibitory junction potentials (IJP) in the mouse colon, colonic propulsion and visceromotor response (VMR) to rectal distension were studied. The colonic levels of endocannabinoids and fatty acid amides were measured. KEY RESULTS: CB1-positive neurons exhibited TRPV1; only some TRPV1 positive neurons did not express CB1. CB1 and FAAH did not colocalize. AA-5-HT (100 nM-10 µM) decreased colonic contractility by ~60%; this effect was abolished by TRPV1 antagonist 5'-IRTX, but not by CB1 antagonist, SR141716. AA-5-HT (1 µM-10 µM) inhibited EJP by ~30% and IJPs by ~50%. The effects of AA-5-HT on junction potentials were reversed by SR141716 and 5`-IRTX. AA-5-HT (20 mg/kg; i.p.) inhibited colonic propulsion by ~30%; SR141716 but not 5`-IRTX reversed this effect. AA-5-HT decreased VMR by ~50%-60%; these effects were not blocked by SR141716 or 5`-IRTX. AA-5-HT increased AEA in the colon. CONCLUSIONS AND INFERENCES: The effects of AA-5-HT on visceral sensation and colonic motility are differentially mediated by CB1, TRPV1 and non-CB1/TRPV1 mechanisms, possibly reflecting the distinct neuromodulatory roles of endocannabinoid and endovanilloid FAAH substrates in the mouse intestine.
Assuntos
Amidoidrolases/metabolismo , Motilidade Gastrointestinal/fisiologia , Plexo Mientérico/metabolismo , Canais de Cátion TRPV/metabolismo , Dor Visceral/metabolismo , Animais , Ácidos Araquidônicos/farmacologia , Motilidade Gastrointestinal/efeitos dos fármacos , Masculino , Camundongos , Plexo Mientérico/efeitos dos fármacos , Serotonina/análogos & derivados , Serotonina/farmacologiaRESUMO
Endometriosis is a benign condition described as the presence of endometrial- like tissue found outside the uterine cavity. Hepatic endometriosis is one of the rarest localization of extrapelvic endometriosis, only 22 cases have been reported in the literature. The preoperative diagnosis of hepatic endometriosis is rather difficult because in about the half of the patient affected they had no history of endometriosis. Moreover radiological images reveal no characteristic findings for hepatic endometriosis. It is often described as cystic mass with or without solid component, difficult to distinguish from hepatic abscess, hematoma, cystoadenoma or malignant neoplasia. We report a case of a 27-year-old female with a large cystic mass involving the left lobe of the liver. The patient underwent laparoscopic exploration and converted to laparotomy for resection of giant hepatic endometriosis.
Assuntos
Cistos/patologia , Endometriose/complicações , Endometriose/patologia , Hepatopatias/patologia , Adulto , Cistos/etiologia , Cistos/cirurgia , Diagnóstico Diferencial , Endometriose/cirurgia , Feminino , Hepatectomia/métodos , Humanos , Hepatopatias/cirurgia , Resultado do TratamentoRESUMO
AIM: The aim of this paper was to assess the origin and course variations of vessels forming the renal vascular pedicle. METHODS: The IRB approved study retrospectively evaluated 921 consecutive patients (503 females, 418 males; mean age, 54 years), who underwent multidetector computed tomographic (MDCT) of the abdomen for various purposes at our Department of Radiology, between January 2012 and December 2013. Multiplanar and volumetric reformations were performed in all cases. For each set of images, the locations of renal artery origins and renal venous drainage, such as all renal vessels variations, including division variations and presence of extrarenal vessels, were investigated. RESULTS: The tract of the aorta between the upper margin of L1 and the lower margin of L2 originated 96% of main renal arteries and 72% of extra renal arteries. The most common location for renal artery origin was the L1- L2 intervertebral disc level. Sixty-nine percent of patients showed a single renal artery, with multiple arteries in 31%, bilateral multiple arteries in 11%, and early division in 6% of cases. Additional renal arteries were detected on the right side in 5% and on the left side in 12% of cases. With regard to the venous drainage, 89.8% of patients showed a single renal vein, with multiple vein in 10.2%, while 23.8% showed a retro-aortic course of the renal vein. CONCLUSION: Renal arteries and veins variations of origin and course are not infrequent. Extrarenal vessels may compromise renal surgery. The awareness of any possible renovascular anomaly is crucial in case of a non-invasive diagnostic search for renal artery stenosis, and when renal surgery related to renal arteries is performed, such as in case of interventional radiological procedures, urological and vascular operations, and renal transplantation.
Assuntos
Angiografia , Rim/irrigação sanguínea , Tomografia Computadorizada Multidetectores , Artéria Renal/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
The Minimally Invasive Surgery (MIS) paradigm is well established in modern surgical procedures. Although MIS is successful from the patient's viewpoint, the use of rigid instruments inserted through small skin incisions leads to dexterity constraints and loss of degree of motion. Robotics has been introduced as support for augmenting dexterity during interventions, restoring hand-eye coordination and providing tools with enhanced degrees of motion. However, surgical robots have high costs and large footprint, pushing the research towards the development of modular robots to be used in Naturally Orifice Trans-luminal Endoscopic Surgery (NOTES) procedures. The main need of having simple and cheap tools able to be interchanged during the surgical procedure became crucial. In this paper an innovative modular end-effector based on a compliant soft actuation system able to provide up to 5.78 N gripping forces is presented.
Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Fenômenos Biomecânicos , Desenho de Equipamento , Força da Mão , Humanos , Imageamento Tridimensional , Cirurgia Endoscópica por Orifício Natural/instrumentaçãoRESUMO
Large duplication of the short arm of chromosome 5 is a rare condition normally associated to severe phenotype anomalies including heart and brain malformations. We report a prenatal case of a large 5p duplication with sub-telomeric deletion in a foetus with very mild phenotypic abnormalities. Foetal ultrasonographic examination at 22 weeks of gestation showed short femur, clubfeet, pielectasy, and facial dysmorphisms. Chromosome investigations revealed an inverted duplication of the short arm of chromosome 5 from 5p13.1 to 5p15.33 and a 800 kb deletion at 5pter. The absence of severe anomalies such as cardiac and cerebral defects, observed so far in all large 5p duplications, and the comparison to previous cases described both in literature and in DECIPHER database suggest that the critical region for the severe phenotype in 5p duplication syndrome might be smaller than that previously described, excluding half of the 5p13 band. This might help in prenatal genetic counselling.
Assuntos
Cromossomos Humanos Par 5/genética , Feto/anormalidades , Duplicação Gênica , Deleção de Sequência , Anormalidades Múltiplas/genética , Feminino , Humanos , Fenótipo , Gravidez , Ultrassonografia Pré-NatalRESUMO
Bacillus Calmette-Guerin (BCG) has failed to efficaciously control the worldwide spread of the disease. New vaccine development targets virulence antigens of Mycobacterium tuberculosis that are deleted in Mycobacterium bovis BCG. Immunization with ESAT-6 and CFP10 provides protection against M. tuberculosis in a murine infection model. Further, previous studies have shown that calreticulin increases the cell-mediated immune responses to antigens. Therefore, to test whether calreticulin enhances the immune response against M. tuberculosis antigens, we fused ESAT-6 to calreticulin and constructed a recombinant replication-deficient adenovirus to express the resulting fusion protein (AdCRT-ESAT-6). The adjuvant effect of calreticulin was assayed by measuring cytokine responses specific to ESAT-6. Recombinant adenovirus expressing the fusion protein produced higher levels of interferon-γ and tumour necrosis factor-α in response to ESAT-6. This immune response was not improved by the addition of CFP-10 to the CRT-ESAT-6 fusion protein (AdCRT-ESAT-6-CFP10). Mice immunized with these recombinant adenoviruses did not decrease the mycobacterial burden after low-dose aerosol infection with M. tuberculosis. We conclude that calreticulin can be used as an adjuvant to enhance the immune response against mycobacterial antigens, but it is not enough to protect against tuberculosis.
Assuntos
Antígenos de Bactérias/biossíntese , Proteínas de Bactérias/biossíntese , Calreticulina/biossíntese , Mycobacterium tuberculosis/imunologia , Tuberculose/imunologia , Tuberculose/prevenção & controle , Adenoviridae/genética , Adenoviridae/metabolismo , Animais , Antígenos de Bactérias/genética , Antígenos de Bactérias/imunologia , Proteínas de Bactérias/genética , Proteínas de Bactérias/imunologia , Calreticulina/genética , Calreticulina/imunologia , Contagem de Colônia Microbiana , Feminino , Vetores Genéticos/genética , Vetores Genéticos/metabolismo , Interferon gama/imunologia , Pulmão/microbiologia , Camundongos , Camundongos Endogâmicos C57BL , Proteínas Recombinantes de Fusão/administração & dosagem , Proteínas Recombinantes de Fusão/biossíntese , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/imunologia , Organismos Livres de Patógenos Específicos , Baço/microbiologia , Fator de Necrose Tumoral alfa/imunologiaRESUMO
AIM: Plant cannabinoids, like Δ(9)-tetrahydrocannabinol (THC) and cannabidiol (CBD), activate/desensitize thermosensitive transient receptor potential (TRP) channels of vanilloid type-1 or -2 (TRPV1 or TRPV2). We investigated whether cannabinoids also activate/desensitize two other 'thermo-TRP's', the TRP channels of vanilloid type-3 or -4 (TRPV3 or TRPV4), and if the TRPV-inactive cannabichromene (CBC) modifies the expression of TRPV1-4 channels in the gastrointestinal tract. METHODS: TRP activity was assessed by evaluating elevation of [Ca(2+)](i) in rat recombinant TRPV3- and TRPV4-expressing HEK-293 cells. TRP channel mRNA expression was measured by quantitative RT-PCR in the jejunum and ileum of mice treated with vehicle or the pro-inflammatory agent croton oil. RESULTS: (i) CBD and tetrahydrocannabivarin (THCV) stimulated TRPV3-mediated [Ca(2+)](i) with high efficacy (50-70% of the effect of ionomycin) and potency (EC(50â¼) 3.7 µm), whereas cannabigerovarin (CBGV) and cannabigerolic acid (CBGA) were significantly more efficacious at desensitizing this channel to the action of carvacrol than at activating it; (ii) cannabidivarin and THCV stimulated TRPV4-mediated [Ca(2+)](i) with moderate-high efficacy (30-60% of the effect of ionomycin) and potency (EC(50) 0.9-6.4 µm), whereas CBGA, CBGV, cannabinol and cannabigerol were significantly more efficacious at desensitizing this channel to the action of 4-α-phorbol 12,13-didecanoate (4α-PDD) than at activating it; (iii) CBC reduced TRPV1ß, TRPV3 and TRPV4 mRNA in the jejunum, and TRPV3 and TRPV4 mRNA in the ileum of croton oil-treated mice. CONCLUSIONS: Cannabinoids can affect both the activity and the expression of TRPV1-4 channels, with various potential therapeutic applications, including in the gastrointestinal tract.
Assuntos
Canabinoides/farmacologia , Gastroenteropatias/metabolismo , Intestino Delgado/metabolismo , Canais de Cátion TRPV/metabolismo , Animais , Cálcio/metabolismo , Canabidiol/química , Canabidiol/farmacologia , Canabinoides/química , Dronabinol/química , Dronabinol/farmacologia , Gastroenteropatias/induzido quimicamente , Células HEK293 , Humanos , Inflamação/induzido quimicamente , Inflamação/metabolismo , Camundongos , Ratos , Canais de Cátion TRPV/genéticaRESUMO
BACKGROUND: Functional dyspepsia (FD) is a highly prevalent gastrointestinal disorder characterized by alterations in gastric motility. Yarrow (Achillea millefolium L., Fam Asteraceae) preparations are traditional remedies used to treat dyspeptic complaints. Herein, we investigated the effect of a standardized dry water extract obtained from A. millefolium flowering tops (AME) on gastric motility. METHODS: The effect of AME on motility was evaluated on the resting tone of the isolated gastric antrum and on gastric emptying in vivo (phenol red meal method) both in control mice and in the model of cancer chemotherapy (cisplatin)-induced gastric abnormalities. KEY RESULTS: The AME contracted mouse and human gastric strips and this action was unaffected by hexamethonium and tetrodotoxin, but strongly reduced by atropine. Among various chemical ingredients in yarrow, choline, but not the flavonoids rutin and apigenin, mimicked the action of AME. Furthermore, AME deprived of choline did not exert a contractile effect. In vivo, AME stimulated gastric emptying both in control and in cisplatin-treated mice, being more active in pathological states. CONCLUSIONS & INFERENCES: It is concluded that (i) AME exerts a direct spasmogenic effect on gastric antrum; (ii) choline is the chemical ingredient responsible of such effect; (iii) the prokinetic effect of AME observed in vivo could provide the pharmacological basis underlying its traditional use in the treatment of dyspepsia.
Assuntos
Achillea , Motilidade Gastrointestinal/efeitos dos fármacos , Extratos Vegetais/farmacologia , Estômago/efeitos dos fármacos , Animais , Esvaziamento Gástrico/efeitos dos fármacos , Humanos , Masculino , Camundongos , Contração Muscular/efeitos dos fármacosRESUMO
BACKGROUND: Bromelain (BR) is a cysteine protease with inhibitory effects on intestinal secretion and inflammation. However, its effects on intestinal motility are largely unexplored. Thus, we investigated the effect of this plant-derived compound on intestinal contractility and transit in mice. METHODS: Contractility in vitro was evaluated by stimulating the mouse isolated ileum, in an organ bath, with acetylcholine, barium chloride, or electrical field stimulation. Motility in vivo was measured by evaluating the distribution of an orally administered fluorescent marker along the small intestine. Transit was also evaluated in pathophysiologic states induced by the pro-inflammatory compound croton oil or by the diabetogenic agent streptozotocin. KEY RESULTS: Bromelain inhibited the contractions induced by different spasmogenic compounds in the mouse ileum with similar potency. The antispasmodic effect was reduced or counteracted by the proteolytic enzyme inhibitor, gabexate (15 × 10(-6) mol L(-1) ), protease-activated receptor-2 (PAR-2) antagonist, N(1) -3-methylbutyryl-N(4) -6-aminohexanoyl-piperazine (10(-4) mol L(-1) ), phospholipase C (PLC) inhibitor, neomycin (3 × 10(-3) mol L(-1) ), and phosphodiesterase 4 (PDE4) inhibitor, rolipram (10(-6) mol L(-1) ). In vivo, BR preferentially inhibited motility in pathophysiologic states in a PAR-2-antagonist-sensitive manner. CONCLUSIONS & INFERENCES: Our data suggest that BR inhibits intestinal motility - preferentially in pathophysiologic conditions - with a mechanism possibly involving membrane PAR-2 and PLC and PDE4 as intracellular signals. Bromelain could be a lead compound for the development of new drugs, able to normalize the intestinal motility in inflammation and diabetes.
Assuntos
Ananas/enzimologia , Bromelaínas/farmacologia , Motilidade Gastrointestinal/efeitos dos fármacos , Trânsito Gastrointestinal/efeitos dos fármacos , Acetilcolina/farmacologia , Animais , Compostos de Bário/farmacologia , Bromelaínas/metabolismo , Células CACO-2 , Cloretos/farmacologia , Agonistas Colinérgicos/farmacologia , Óleo de Cróton/farmacologia , Diabetes Mellitus Experimental/fisiopatologia , Estimulação Elétrica , Inibidores Enzimáticos/metabolismo , Inibidores Enzimáticos/farmacologia , Humanos , Ileíte/induzido quimicamente , Ileíte/fisiopatologia , Masculino , Camundongos , Contração Muscular/efeitos dos fármacos , Peptídeos/metabolismo , Receptor PAR-1/antagonistas & inibidores , Receptor PAR-2/antagonistas & inibidoresRESUMO
AIM: Peripheral arterial disease (PAD) is a chronic figure suitable to be treated at the II stage to prevent the extreme developments both of the critical limb ischemia and the amputation, as well. The aim of this study was to establish a rehabilitation program (pharmacological and physical) focused not only on the improvement of the flow but also on the metabolic rebalancing in the claudicant limb. METHODS: The study enrolled 222 patients, (125 non-diabetics and 97 diabetics): 54 II A and 168 II B stage; 172 patients (131 II B and 41 II A; 104 non-diabetics and 68 diabetics) were submitted to iv. L-propionil carnytine (Lpc) and physical training on treadmill or exercise bike and 50 patients to iv. therapy alone. Instrumental (Rheoscreen, Oximetry, ABI, walking distance measurement) and clinical checks (questionnaire - Appendix 1) were performed at days: T0, T45,T 90,T180, T230 and during the follow up stated at T 90,T180,T360 from T 230 (end of DH). RESULTS: A significant increasing of the walking distance has been reached in the group undergoing the rehabilitation program. Treadmill: non-diabetics +261.48% at 0% and +122.53% at slope 10% (T230) further increasing to +502.31% at 0% and +289.42% at slope 10% (T360); diabetics: + 158.49% at T0 and + 98.26% at slope 10% (T230) further increased to +287.74% at 0% and +197.39% at 10% (T360) in comparison with the group which had only iv. Lpc : non-diabetics +141.63% at 0% and +104.08% at slope 10% (T230) further increased to +202.064% at 0% and +155.10% at slope 10% (T360); diabetics: +109.124% at T0 and +100% at slop 10% (T230) further increased to +171.08% at 0% and +140% at 10% (T360) . Exercise bike: non-diabetics: +170.27% at T230 in comparison T0 increased to +305.4% at T360; diabetics: +166.66 at T230 reaching +288.88% at T 360. CONCLUSION: Our rehabilitative program gives not only good results at the end of the treatment but mainly stable, with the chance to reach further improving of both walking distance and quality of life, particularly in those patients which observe constantly the physical training.
Assuntos
Doença Arterial Periférica/reabilitação , Idoso , Cardiotônicos/uso terapêutico , Carnitina/análogos & derivados , Carnitina/uso terapêutico , Protocolos Clínicos , Terapia Combinada , Diabetes Mellitus Tipo 2/complicações , Terapia por Exercício , Extremidades/irrigação sanguínea , Feminino , Seguimentos , Humanos , Isquemia/complicações , Isquemia/reabilitação , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/tratamento farmacológico , Doença Arterial Periférica/terapia , Fluxo Sanguíneo Regional/fisiologia , Caminhada/fisiologiaRESUMO
AIM: Adherence to evidence based guidelines, assessed by measuring key indicators, allows to detect, evaluate and improve quality of care. Since 2004 in Carlo Poma Hospital, following the introduction of a network for ST-elevation myocardial infarction (STEMI) management, the authors carried out a clinical database in order to measure quality of care in STEMI patients. MATERIALS AND METHODS: A real time upgradable database was developed, to assess clinical practice in myocardial infarction management. The authors evaluated prevalence and control of risk factors, pharmacological therapies and interventional procedures, pathways and delays to care. RESULTS: From 1 February 2004 to 31 January 2008, 1,714 consecutive patients with myocardial infarction were admitted in the Intensive Care Unit (ICU). Primary percutaneous coronary intervention (PCI) was performed in 85% of STEMI patients. Door to balloon time was greater than 90 min in only 17% of patients, of whom 88% coming from emergency department and 12% transferred by 118. CONCLUSION: In the authors' experience quality indicators proved useful in the management of myocardial infarction. Implementation of 118 and improvement of pre-hospital diagnosis in setting of local network can reduce time to treatment.
Assuntos
Sistemas de Gerenciamento de Base de Dados , Bases de Dados Factuais , Infarto do Miocárdio/terapia , Qualidade da Assistência à Saúde/normas , Idoso , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Controle de Qualidade , Indicadores de Qualidade em Assistência à SaúdeRESUMO
In order to calculate the cardiovascular risk in patients with chronic renal failure (CRF), we retrospectively analyzed 1482 acute myocardial infarctions (AMIs) treated in the ICU at C. Poma General Hospital, Mantua, Italy, from 1 December 2004 to 31 July 2007. Of these patients, 133 suffered from CRF at hospital admission (eGFR <40 mL/min/1.73 m2 body surface and/or serum creatinine >2 mg/dL). During hospitalization for AMI, the CRF-affected patients showed a 2.7 times higher relative risk of mortality than patients without CRF (Yates chi square 14.46; p = 0.0001432). The evaluated comorbidities (hypertension, type 2 diabetes, supra-aortic vascular stenosis >70%, previous PTCA, COPD, previous AMI, previous coronary artery bypass and chronic obliterative peripheral arteriopathy) increased the relative risk of death 1.2- to 3.76-fold in those affected. In accord with recent evidence in the international literature, our results point to the importance of early assessment of CRF for the prognosis of patients with AMI.
Assuntos
Falência Renal Crônica/mortalidade , Infarto do Miocárdio/mortalidade , Idoso , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Itália/epidemiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/epidemiologia , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de SobrevidaRESUMO
Shifts in ectomycorrhizal (ECM) community structure were examined across an experimental hydrologic gradient on containerized seedlings of two oak species, Quercus montana and Quercus palustris, inoculated from a homogenate of roots from mature oak trees. At the end of one growing season, seedlings were harvested, roots were sorted by morphotype, and proportional colonization of each type was determined. DNA was subsequently extracted from individual root tips for polymerase chain reaction, restriction fragment length polymorphism, and rDNA sequencing of the ITS1/5.8S/ITS2 region to determine identities of fungal morphotypes. Twelve distinct molecular types were identified. Analysis of similarity showed that ECM fungal assemblages shifted significantly in composition across the soil moisture gradient. Taxa within the genus Tuber and the family Thelephoraceae were largely responsible for the changes in fungal assemblages. There were also significant differences in ECM community assemblages between the two oak host species. These results demonstrate that the structure of ECM fungal communities depends on both the abiotic and biotic environments and can shift with changes in soil moisture as well as host plant, even within the same genus.
Assuntos
Biodiversidade , Fungos/classificação , Fungos/isolamento & purificação , Micorrizas/crescimento & desenvolvimento , Quercus/microbiologia , Análise por Conglomerados , Impressões Digitais de DNA , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Fungos/genética , Genótipo , Maryland , Dados de Sequência Molecular , Filogenia , Raízes de Plantas/microbiologia , Polimorfismo de Fragmento de Restrição , Plântula/microbiologia , Análise de Sequência de DNARESUMO
The purpose of this study was to evaluate the consequences of different choices of acquisition parameters on the actual image noise and on the patient dose with an automatic tube current modulation system. The CT investigated was a GE Lightspeed 16-slice and an anthropomorphic phantom was used to simulate the patient. Several acquisitions were made varying noise index (NI), kilovoltage and pitch values. Tube current values were compared for the different acquisitions. Patient dose was evaluated in terms of volumetric computed tomography dose index (CTDI(vol)) and also as effective dose. The noise actually present in the images was analyzed by a region of interest analysis considering representatively phantom sections in the regions of the shoulders, of the lungs and of the abdomen. The obtained results generally evidenced a good agreement between the noise index and the measured noise for the abdomen sections, whereas for the shoulders and the lungs sections the measured noise was respectively greater and lower of the NI. Varying the kV the automatic current modulation system provided images with a substantially constancy of the actual noise and of the patient dose. An increase of the pitch generally decreased the patient dose, whereas the noise was slightly greater for the lowest pitch and almost constant for the other pitch values. This study outlines some important relationships between an automatic tube current modulation system and other CT acquisition parameters, providing useful informations for the choice requested by radiologists in the task of optimization of the CT acquisition protocols. Unless there are other considerations in place, pixel pitches below 1.375 should be avoided, and kVp settings can be changed with no real impact on dose or image noise.
Assuntos
Carga Corporal (Radioterapia) , Doses de Radiação , Intensificação de Imagem Radiográfica/instrumentação , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/instrumentação , Tomografia Computadorizada por Raios X/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Imagens de Fantasmas , Radiometria , Raios XRESUMO
The plant Cannabis has been known for centuries to be beneficial in a variety of gastrointestinal diseases, including emesis, diarrhea, inflammatory bowel disease and intestinal pain. delta9-tetrahydrocannabinol, the main psychotropic component of Cannabis, acts via at least two types of cannabinoid receptors, named CB1 and CB2 receptors. CB1 receptors are located primarily on central and peripheral neurons (including the enteric nervous system) where they modulate neurotransmitter release, whereas CB2 receptors are concerned with immune function, inflammation and pain. The discovery of endogenous ligands [i.e. anandamide and 2-arachidonoyl glycerol (2-AG)] for these receptors indicates the presence of a functional endogenous cannabinoid system in the gastrointestinal tract. Anatomical and functional evidence suggests the presence of CB1 receptors in the myenteric plexus, which are associated with cholinergic neurons in a variety of species, including in humans. Activation of prejunctional CB1 receptors reduces excitatory enteric transmission (mainly cholinergic transmission) in different regions of the gastrointestinal tract. Consistently, in vivo studies have shown that cannabinoids reduce gastrointestinal transit in rodents through activation of CB1, but not CB2, receptors. However, in pathophysiological states, both CB1 and CB2 receptors could reduce the increase of intestinal motility induced by inflammatory stimuli. Cannabinoids also reduce gastrointestinal motility in randomized clinical trials. Overall, modulation of the gut endogenous cannabinoid system may provide a useful therapeutic target for disorders of gastrointestinal motility.
Assuntos
Canabinoides/farmacologia , Motilidade Gastrointestinal/efeitos dos fármacos , Receptores de Canabinoides/efeitos dos fármacos , Animais , Cannabis/química , Gastroenteropatias/tratamento farmacológico , Humanos , Síndrome do Intestino Irritável/tratamento farmacológico , Síndrome do Intestino Irritável/fisiopatologia , Transmissão Sináptica/efeitos dos fármacosRESUMO
UNLABELLED: Radon, the second cause of lung cancer after smoking, is a natural, radioactive gas, which originates from the soil and pollutes indoor air, especially in closed or underground spaces. Italian legislation recommends an action level of 500 Bq/m3 per year for occupational exposure in underground premises. OBJECTIVES: Since banks usually use various underground premises (archives, safe-deposit room), a study was made of the radon levels on such premises with the aim of identifying useful monitoring strategies. METHODS: 134 branches of a major Italian banking group were examined using 1817 nuclear track dosimeters at ground level and underground level premises. The branches were located in 7 Italian regions in the north (Piedmont, Lombardy, Veneto), centre (Lazio) and south (Campania, Apulia, Sicily). Information on measurement points was recorded in a technical sheet and statistical analysis was carried out. RESULTS: Annual underground measurements gave an average concentration of 157 Bq/m3, with 5.1% for 400 < C < 500 Bq/m3 and 2.9%for C > 500 Bq/m3. Seasonal variability was reflected in a significant decrease in concentrations between winter and spring (delta(mean)% = -47.3%) and good stability between autumn and winter (delta(mean)% = 3%); moreover quarterly concentrations account for 85% of the variability of the corresponding annual level. A multiple linear regression model (R2 = 0.33) indicated geographic location as the principal factor in radon accumulation, followed by underground level, humidity, use, lack of windows, heating and natural ventilation, and direct contact of at least one wall with ground rock; whereas the safe-deposit room structure seems to protect from radon accumulation. Moreover, the ground level measurement results were significantly associated with the corresponding underground average concentrations (p < 0.001). CONCLUSIONS: The results could be a useful tool in planning a monitoring strategy for assessment of bank worker exposure, especially for banking groups with a large number of branches.