RESUMO
Organ donors are sources of physiologically healthy organs and tissues for life-saving transplantation, and have been recently used for human immunology studies which are typically confined to the sampling of peripheral blood. Donors comprise a diverse population with different causes of death and clinical outcomes during hospitalization, and the effects of such variations on immune parameters in blood and tissues are not known. We present here a coordinate analysis of innate and adaptive immune components in blood, lymphoid (bone marrow, spleen, lymph nodes), and mucosal (lungs, intestines) sites from a population of brain-dead organ donors (2 months-93 years; n = 291) across eight clinical parameters. Overall, the blood of donors exhibited similar monocyte and lymphocyte content and low serum levels of pro-inflammatory cytokines as healthy controls; however, donor blood had increased neutrophils and serum levels of IL-8, IL-6, and MCP-1 which varied with cause of death. In tissues, the frequency and composition of monocytes, neutrophils, B lymphocytes and T cell subsets in lymphoid or mucosal sites did not vary with clinical state, and was similar in donors independent of the extent of clinical complications. Our results reveal that organ donors maintain tissue homeostasis, and are a valuable resource for fundamental studies in human immunology.
Assuntos
Morte Encefálica/imunologia , Linfócitos/imunologia , Células Mieloides/imunologia , Transplante de Órgãos , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Morte Encefálica/patologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Citocinas/sangue , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prognóstico , Subpopulações de Linfócitos T/imunologia , Adulto JovemRESUMO
The initiation factor 4E for eukaryotic translation (eIF4E) binds the messenger RNA 5'-cap structure and is important in the regulation of protein synthesis. Mammalian eIF4E activity is inhibited when the initiation factor binds to the translational repressors, the 4E-binding proteins (4E-BPS). Here we show that the Drosophila melanogaster 4E-BP (d4E-BP) is a downstream target of the phosphatidylinositol-3-OH kinase (PI(3)K) signal-transduction cascade, which affects the interaction of d4E-BP with eIF4E. Ectopic expression of a highly active d4E-BP mutant in wing-imaginal discs causes a reduction of wing size, brought about by a decrease in cell size and number. A marked reduction in cell size was also observed in post-mitotic cells. Expression of d4E-BP in the eye and wing together with PI(3)K or dAkt1, the serine/threonine kinase downstream of PI(3)K, resulted in suppression of the growth phenotype elicited by these kinases. Our results support a role for d4E-BP as an effector of cell growth.
Assuntos
Proteínas de Transporte/fisiologia , Drosophila melanogaster/metabolismo , Fosfatidilinositol 3-Quinases/fisiologia , Fosfoproteínas/fisiologia , Transdução de Sinais/fisiologia , Sequência de Aminoácidos , Animais , Proteínas de Transporte/química , Proteínas de Transporte/genética , Divisão Celular/fisiologia , Clonagem Molecular , Proteínas de Drosophila , Drosophila melanogaster/citologia , Drosophila melanogaster/enzimologia , Peptídeos e Proteínas de Sinalização Intracelular , Dados de Sequência Molecular , Fatores de Iniciação de Peptídeos , Fosfoproteínas/química , Fosfoproteínas/genética , Biossíntese de Proteínas , Homologia de Sequência de AminoácidosRESUMO
An efficient electrochemiluminescent (ECL) single-use sensor for H(2)O(2) is presented based on an electropolymerized film prepared on screen-printed gold electrode (gold SPE). A study of the copolymerization of luminol in the presence of different monomers was carried out. The polymeric films were grown potentiodynamically with a potential interval between -0.2 and 1.0 V in 0.2 M H(2)SO(4) and were characterized by their electrochemical, electrochemiluminescent, and superficial features. The polymer with the most efficient growth and ECL emission was poly(luminol-3,3',5,5'-tetramethylbenzidine) at 1:5 ratio. These prepared SPE cells present good mechanical and photoemissive properties. A semi-logarithmic linearization shows a noticeable four decade-width concentration range with a limit of detection (LOD) of 2.6 × 10(-9) M and a precision of 10.2% (n = 5; as relative standard deviation, RSD) in the medium range level. The described SPE ECL sensors will be useful for the determination of oxidase substrates in ECL single-use biosensors.
RESUMO
An electrochemiluminescence-based disposable biosensor for lactate is characterized. The lactate recognition system is based on lactate oxidase (LOx) and the transduction system consists of luminol. All the needed reagents, luminol, LOx, BSA, electrolyte and buffer have been immobilized by a Methocel membrane placed on the working electrode of the screen-printed electrochemical cell. The measurement of the electrochemiluminescence (ECL) is made possible via a photocounting head when 50 microl of sample is placed into the screen-printed cell with a circular container containing the disposable sensing membrane. The compositions of the membrane and reaction conditions have been optimized to obtain adequate sensitivity. The disposable biosensor responds to lactate after 20 s when two 1 s pulses at 0.5 V are applied to obtain the analytical parameter, the ECL initial rate. The linearized double logarithmic dependence for lactate shows a dynamic range from 10(-5) to 5 x 10(-4) M with a detection limit of 5 x 10(-6) M and a sensor-to-sensor repeatability, as relative standard deviation, RSD, of 3.30% at the medium level of the range. The ECL disposable biosensor was applied to the analysis of lactate in human saliva as an alternative procedure for obtaining the lactate level in a non-invasive way. Interferences coming from components of saliva were studied and eliminated in a simple way that was easy to handle. The procedure was validated for use in human saliva, comparing the results against an enzymatic reference procedure. The proposed method is quick, inexpensive, selective and sensitive and uses conventional ECL instrumentation.
Assuntos
Técnicas Biossensoriais/métodos , Equipamentos Descartáveis , Lactatos/análise , Saliva/química , Animais , Técnicas Biossensoriais/instrumentação , Soluções Tampão , Bovinos , Eletroquímica , Eletrodos , Eletrólitos/química , Grafite/química , Humanos , Peróxido de Hidrogênio/metabolismo , Concentração de Íons de Hidrogênio , Indicadores e Reagentes/química , Lactatos/metabolismo , Medições Luminescentes , Luminol/química , Membranas Artificiais , Metanol/química , Oxigenases de Função Mista/metabolismo , Oxirredução , Soroalbumina Bovina/química , TemperaturaRESUMO
We determined the effect of water and nitrogen intake on nitrogenous waste composition in the nectarivorous Pallas's long-tongued bat Glossophaga soricina (Phyllostomidae) to test the hypothesis that bats reduce excretion of urea nitrogen and increase the excretion of ammonia nitrogen as nitrogen intake decreases and water intake decreases. Because changes in urine nitrogen composition are expected only in animals whose natural diets are low in nitrogen and high in water content, we also measured maintenance nitrogen requirements (MNR). We hypothesized that, similar to other plant-eating vertebrates, nectarivorous bats have low MNR. Our nitrogen excretion hypothesis was partly proved correct. There was an increase in the proportion of N excreted as ammonia and a decrease in the proportion excreted as urea in low-nitrogen diets. The proportion of N excreted as ammonia and urea was independent of water intake. Most individuals were ureotelic (n = 28), and only a few were ureo-ammonotelic (n = 3) or ammonotelic (n = 2). According to our nitrogen requirement hypothesis, apparent MNR (60 mg kg(-0.75) d(-1)) and truly digestible MNR (54 mg N kg(-0.75) d(-1)) were low. A decrease in urea excretion in low-nitrogen diets may result from urea recycling from liver to the gut functioning as a nitrogen salvage system in nectarivorous bats. This mechanism probably contributes to the low MNR found in Pallas's long-tongued bats.
Assuntos
Amônia/urina , Quirópteros/metabolismo , Quirópteros/urina , Nitrogênio/metabolismo , Ureia/urina , Amônia/análise , Animais , Ureia/análise , Água/metabolismoRESUMO
BACKGROUND: In patients with a low clinical probability of pulmonary embolism (PE) and a nondiagnostic lung scan, the prevalence of PE is theoretically very low. We assessed the safety and usefulness of this association for ruling out PE. METHODS: We analyzed data from 2 consecutive cohort management studies performed in 2 university hospitals (Geneva University Hospital, Geneva, Switzerland, and Hospital Saint-Luc, Montreal, Quebec), which enrolled 1034 consecutive patients who came to the emergency department with clinically suspected PE. All patients were submitted to a sequential diagnostic protocol of lung scan, D-dimer testing, lower-limb venous compression ultrasonography (US), and pulmonary angiography in case of inconclusive results of noninvasive workup. RESULTS: The prevalence of PE was 27.6%. Empirical assessment was accurate for identifying patients with a low likelihood of PE (8.2% prevalence of PE in the low clinical probability category). One hundred eighty patients had a low clinical probability of PE and a nondiagnostic lung scan. Among these patients, US showed deep vein thrombosis in 5. Hence, PE could be ruled out by a low clinical probability, a nondiagnostic lung scan, and a normal US in 175 patients (21.5%). The 3-month thromboembolic risk in these patients was low (1.7%; 95% confidence interval, 0.4%-4.9%). CONCLUSIONS: Anticoagulant treatment could be safely withheld in patients with a low clinical probability of PE and a nondiagnostic lung scan, provided that the US is normal. This combination of findings avoided pulmonary angiography in 21.5% of patients with suspected PE in this series.
Assuntos
Embolia Pulmonar/diagnóstico , Adulto , Idoso , Angiografia , Gasometria , Estudos de Coortes , Diagnóstico Diferencial , Eletrocardiografia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico , Valor Preditivo dos Testes , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico por imagem , Risco , Fatores de Risco , Suíça , UltrassonografiaRESUMO
Chylothorax is an unusual manifestation of tuberculous disease. Anecdotal cases of chylothorax due to Mycobacterium tuberculosis have been reported in the literature. We describe a case of tuberculous chylothorax and review the previously published cases. None of these cases was diagnosed by the application of polymerase chain reaction in pleural effusion. This test applied to different specimens has shown high specificity and sensitivity; for this reason, the routine use of this test, on pleural effusion, could be very useful, quick, and few aggressive in the diagnosis of tuberculous chylothorax, especially when chest X-ray is normal.
Assuntos
Quilotórax/etiologia , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Quilotórax/microbiologia , DNA Bacteriano/isolamento & purificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/etiologia , Derrame Pleural/microbiologia , Reação em Cadeia da Polimerase , Sensibilidade e Especificidade , Ducto Torácico/patologia , Tuberculose dos Linfonodos/complicações , Tuberculose dos Linfonodos/diagnóstico , Tuberculose Pleural/complicações , Tuberculose Pleural/diagnóstico , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/microbiologiaRESUMO
BACKGROUND: Post-thrombotic syndrome (PTS) is a frequent chronic complication of deep vein thrombosis (DVT). OBJECTIVE: In the BioSOX study, we investigated whether inflammation markers predict the risk of PTS after DVT. METHODS: We measured C-reactive protein (CRP), ICAM-1, interleukin (IL)-6, and IL-10, at baseline, and 1 month and 6 months after a first proximal DVT, among 803 participants in the SOX trial. Participants were prospectively followed for 24 months for development of PTS. RESULTS: Median CRP levels at 1 month, ICAM-1 levels at baseline, 1 month and 6 months, IL-6 levels at 1 month and 6 months and IL-10 levels at 6 months were higher in patients who developed PTS than in those who did not. Multivariable regression with the median as a cutoff showed risk ratios (RRs) for PTS of 1.23 (95% confidence interval [CI] 1.05-1.45) and 1.25 (95% CI 1.05-1.48) for ICAM-1 at 1 month and 6 months, respectively, and 1.27 (95% CI 1.07-1.51) for IL-10 at 6 months. Quartile-based analysis demonstrated a dose-response association between ICAM-1 and PTS. ICAM-1 and IL-10 were also associated with PTS severity. Analysis of biomarker trajectories after DVT demonstrated an association between the highest-trajectory group of ICAM-1 and PTS. CONCLUSIONS: In this prospective study, ICAM-1 over time was most consistently associated with the risk of PTS. Further study is required to confirm these findings and assess their potential clinical relevance.
Assuntos
Mediadores da Inflamação/sangue , Molécula 1 de Adesão Intercelular/sangue , Síndrome Pós-Trombótica/etiologia , Trombose Venosa/sangue , Adulto , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Canadá , Distribuição de Qui-Quadrado , Feminino , Seguimentos , Humanos , Interleucina-10/sangue , Interleucina-6/sangue , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Síndrome Pós-Trombótica/diagnóstico , Síndrome Pós-Trombótica/prevenção & controle , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Meias de Compressão , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Trombose Venosa/complicações , Trombose Venosa/diagnóstico , Trombose Venosa/terapiaRESUMO
The distribution of serotoninergic neurons in the nervous system of the scale worm Harmothoe imbricata was visualized in the anterior half of the body by the peroxidase-antiperoxidase (PAP) immunohistochemical method with a specific antiserotonin antibody. Immunoreactive neuronal somata were localized in discrete ganglion cell masses of the dorsally situated cerebral ganglion and in segmental ganglia of the ventral nerve cord. They also make up the majority of neurons present in the parapodial ganglia. Large and small varicose fibers stained in the neuropile of all the above-mentioned ganglia but also in interganglionic connectives and segmental nerves. On the basis of soma size and location and of fiber distribution, the reactive neurons were identified as primarily interneuronal with a few motoneurons and presumptive afferent neurons. The presence of a motor component was substantiated by observations of several reactive varicose fibers spread over longitudinal muscle layers of the trunk. In addition, neurites of the subepidermal nerve plexus and enterochromaffinlike cells of the gut epithelium reacted with the serotonin antibody. It is concluded that serotoninergic pathways are ubiquitous elements in the organization of the central and peripheral nervous system of this polychaete. The significance of these findings in relation to other annelid groups and to the physiological role of serotonin is discussed.
Assuntos
Sistema Nervoso/análise , Poliquetos/análise , Serotonina/análise , Animais , Imuno-Histoquímica , Sistema Nervoso/citologiaRESUMO
Pulmonary embolism (PE) may encompass a wide spectrum of severity. To determine whether clinical findings, D-dimer (DD) concentration, and deep vein thrombosis (DVT) shown by lower-limb venous compression ultrasonography (US) might predict the scintigraphic extent of PE, we studied 104 hemodynamically stable consecutive outpatients with acute PE diagnosed by a high-probability ventilation-perfusion lung scan. Scintigraphic extent of PE was classified into three categories: perfusion defects corresponding to <30%, 30-50%, or >50% of the total lung area. Median respiratory and heart rates were found to be significantly related to the extent of PE. Higher median alveolar-arterial oxygen difference values were observed as the proportion of lung perfusion defects increased (>50% vs. <30%, 6.3 vs. 3.6 kPa, P <.0001). Median plasma DD concentration was 7950 microg/L in patients with >50% perfusion defects compared to 2731 microg/L in those with <30% defects (P = .0001). DD levels above 4000 microg/L were associated to more extensive perfusion defects (>50% vs. <30% defects, OR 30; 95% CI 5.8-155). Finally, a proximal DVT was more likely among patients with larger perfusion defects (>50% vs. <30% defects, OR 4.5; 95% CI 1.5-13.6). In conclusion, clinical signs such as tachypnea and tachycardia, alveolar-arterial oxygen difference, plasma DD concentration, and presence of DVT on US are predictors of a larger PE, as assessed by the extent of perfusion defects on high probability lung scans.
Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Embolia Pulmonar/diagnóstico , Trombose Venosa/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Prognóstico , Estudos Prospectivos , Embolia Pulmonar/etiologia , Embolia Pulmonar/patologia , Testes de Função Respiratória , Fatores de Risco , Ultrassonografia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico , Relação Ventilação-PerfusãoRESUMO
To examine the range of momentary fluctuations of intraocular pressure caused by vascular pulsations in 42 glaucomatous and 18 normal eyes, we obtained consecutive intraocular pressure measurements at hourly intervals with a noncontact air tonometer. Glaucomatous eyes had a significantly (P less than .001) greater range of intraocular pressure measurements on consecutive readings than normal eyes (4.4 +/- 1.4 mm Hg vs 2.7 +/- 0.7 mm Hg). The frequency of consecutive intraocular pressure readings exceeding a spread of 4 mm Hg was significantly increased in glaucomatous eyes. The range of intraocular pressure measurements was greater even in those glaucomatous eyes with mean intraocular pressures within the normal range. There was a positive correlation between mean intraocular pressure and mean range in glaucomatous eyes, but not in normal eyes. In both glaucomatous and normal eyes, there was no significant correlation between age and mean range.
Assuntos
Glaucoma de Ângulo Aberto/fisiopatologia , Pressão Intraocular , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Plasma D-dimer, a highly sensitive marker of venous thromboembolism, was measured using an enzyme-linked immunosorbent assay pre-operatively, on the third postoperative day, and at the time of phlebography in 118 patients undergoing elective total knee arthroplasty. Deep venous thrombosis (DVT) was detected using systematic bilateral phlebography between the eighth and 12th postoperative day in 47 (39.8%) patients. D-dimer plasma concentrations did not differ between patients who had DVT and those who had no DVT, either pre-operatively (n = 118, P = 0.63) or at the time of phlebography (n = 111, P = 0.70). On the third postoperative day, D-dimer concentration was significantly higher (P < 0.01) in the patients who had DVT (median 3270 microg/l, range 1156-9996, n = 47) than in those who did not (2287 microg/l, 685-7062, n = 64). However, receiver operating characteristics curve analysis did not provide any useful cutoff values that would allow individual diagnoses to be made. In conclusion, the results of the present study suggest that plasma measurement of D-dimer concentration is of no value for predicting, diagnosing or ruling out DVT in patients undergoing total knee arthroplasty.
Assuntos
Artroplastia do Joelho , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Complicações Pós-Operatórias/diagnóstico , Tromboflebite/diagnóstico , Biomarcadores/sangue , Intervalos de Confiança , Ensaio de Imunoadsorção Enzimática , Humanos , Flebografia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/prevenção & controle , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Tromboflebite/sangue , Tromboflebite/prevenção & controleRESUMO
Fibrin monomer (FM) is a highly sensitive marker of venous thromboembolism and can be used to rule out deep venous thrombosis (DVT) and/or pulmonary embolism in symptomatic outpatients. The aim of the study was to investigate the usefulness of serial fibrin monomer determinations to predict or rule out DVT after total knee arthroplasty in asymptomatic patients. One hundred and thirty consecutive patients underwent total knee replacement. Blood samples were obtained in 104 of them the day before, at days 1, 3, 6 after surgery and at the day of phlebography. Phlebography was performed in all these patients between days 8 and 12 after surgery. There were 44 DVT (44/104, 42%). As compared with the patients without DVT, FM mean levels were 2 and 1.5 times higher in the DVT group at day 3 (P < 0.001) and day 6 (P < 0.01), respectively. However, no useful cut-off values for DVT prediction or exclusion could be determined due to the scattering of the values. Therefore, despite differences between patients with or without DVT, serial FM determinations are of no value for predicting or ruling out DVT in individual patients undergoing total knee arthroplasty.
Assuntos
Artroplastia do Joelho , Fibrina/análise , Tromboflebite/diagnóstico , Artroplastia do Joelho/efeitos adversos , Biomarcadores , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Valor Preditivo dos Testes , Tromboflebite/sangueRESUMO
The optimal regime of antithrombotic prophylaxis for patients undergoing total knee arthroplasty (TKA) has not been established. Many surgeons employ intermittent pneumatic compression while others use low-molecular-weight heparins (LMWH) which were primarily developed for total hip arthroplasty. We compared the efficacy and safety of these two techniques in a randomised study with blinded assessment of the endpoint by phlebography. We randomised 130 patients, scheduled for elective TKA, to receive one daily subcutaneous injection of nadroparin calcium (dosage adapted to body-weight) or continuous intermittent pneumatic compression of the foot by means of the arteriovenous impulse system. A total of 108 patients (60 in the LMWH group and 48 in the mechanical prophylaxis group) had phlebography eight to 12 days after surgery. Of the 47 with deep-vein thrombosis, 16 had received LMWH (26.7%, 95% CI 16.1 to 39.7) and 31, mechanical prophylaxis (64.6%, 95% CI 49.5 to 77.8). The difference between the two groups was highly significant (p < 0.001). Only one patient in the LMWH group had severe bleeding. We conclude that one daily subcutaneous injection of calcium nadroparin in a fixed, weight-adjusted dosage scheme is superior to intermittent pneumatic compression of the foot for thromboprophylaxis after TKA. The LMWH scheme was also safe.
Assuntos
Anticoagulantes/uso terapêutico , Artroplastia do Joelho , Nadroparina/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Trombose Venosa/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
The present work recorded frequencies of five poses (left profile, half-left profile, full-face view, half-right profile, and right profile) by examining 4,180 single-subject portraits of various media. Statistically significant differences were found between the incidence of half-left and half-right profiles. These differences found across media, authorship, and five centuries of portrait work are consistent with right-hemisphere activation models in attentional bias and perception of emotion.
Assuntos
Dominância Cerebral , Emoções , Expressão Facial , Pinturas , Reconhecimento Visual de Modelos , Adulto , Feminino , Humanos , MasculinoRESUMO
During 1987-1996, 39 of 720 patients hospitalized (most for severe schizophrenia) were diagnosed as having active pulmonary tuberculosis (5.4%, 975 per 105 per year). In 1992-1993, after a cluster of 5 cases was found, all patients were screened by PPD skin test and chest X-ray and 16 more cases were identified. Diagnosis was confirmed bacteriologically in only 10 of them but there were typical radiological findings in the others. 39 were treated with a multi-drug regimen. In addition, 333 exposed patients and 21% who had converted their skin tests were given isoniazid preventive therapy. A small increase in levels of liver enzymes was common, but significant abnormality (over 4 times the upper limit of normal) was found in only 7 patients, in whom therapy was therefore stopped or changed. During a follow-up period of 4 years, 2 more developed tuberculosis and 33 converted their PPD reactivity status. We conclude that an outbreak of tuberculosis in a psychiatric hospital can be controlled with a relatively low rate of side-effects by using systematic diagnostic and therapeutic measures. However, single step screening is not sufficient. Routine screening of all new patients, a high index of suspicion and contact investigation are needed.
Assuntos
Surtos de Doenças , Hospitais Psiquiátricos , Tuberculose Pulmonar/epidemiologia , Antituberculosos/uso terapêutico , Quimioterapia Combinada , Seguimentos , Humanos , Incidência , Isoniazida/uso terapêutico , Israel , Pirazinamida/uso terapêutico , Recidiva , Rifampina/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/prevenção & controleRESUMO
Acute deep venous thrombosis (DVT) causes leg pain. Elastic compression stockings (ECS) have potential to relieve DVT-related leg pain by diminishing the diameter of distended veins and increasing venous blood flow. It was our objective to determine whether ECS reduce leg pain in patients with acute DVT. We performed a secondary analysis of the SOX Trial, a multicentre randomised placebo controlled trial of active ECS versus placebo ECS to prevent the post-thrombotic syndrome.The study was performed in 24 hospital centres in Canada and the U.S. and included 803 patients with a first episode of acute proximal DVT. Patients were randomised to receive active ECS (knee length, 30-40 mm Hg graduated pressure) or placebo ECS (manufactured to look identical to active ECS, but lacking therapeutic compression). Study outcome was leg pain severity assessed on an 11-point numerical pain rating scale (0, no pain; 10, worst possible pain) at baseline, 14, 30 and 60 days after randomisation. Mean age was 55 years and 60% were male. In active ECS patients (n=409), mean (SD) pain severity at baseline and at 60 days were 5.18 (3.29) and 1.39 (2.19), respectively, and in placebo ECS patients (n=394) were 5.38 (3.29) and 1.13 (1.86), respectively. There were no significant differences in pain scores between groups at any assessment point, and no evidence for subgroup interaction by age, sex or anatomical extent of DVT. Results were similar in an analysis restricted to patients who reported wearing stockings every day. In conclusion, ECS do not reduce leg pain in patients with acute proximal DVT.
Assuntos
Dor Aguda/terapia , Extremidade Inferior/irrigação sanguínea , Meias de Compressão , Trombose Venosa/terapia , Dor Aguda/diagnóstico , Dor Aguda/etiologia , Adulto , Idoso , Canadá , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Síndrome Pós-Trombótica/etiologia , Síndrome Pós-Trombótica/prevenção & controle , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Trombose Venosa/complicações , Trombose Venosa/diagnósticoRESUMO
An electrochemiluminescent cholesterol disposable biosensor has been prepared by the formation of assembled layers on gold screen-printed cells. The detection layer is based on the electro-formation of new luminol copolymers with different synthesized biotinylated pyrroles prepared by click-chemistry, offering a new transduction layer with new electroluminescent properties on biosensors. The electrochemiluminescence (ECL) luminol copolymers are electroformed by cyclic voltammetry (five cycles) at pH 7.0 uses a10(-3)M biotinylated pyrrole-luminol ratio of 1:10 in PBS buffer. With respect to the recognition layer, cholesterol oxidase was biotinylated by incubation with biotin vinyl sulfone, and immobilized on the copolymer by avidin-biotin interaction. The analytical signal of the biosensor is the ECL enzymatic initial rate working in chronoamperometric mode at 0.5V excitation potential with 10s between pulses at pH 9.5. The disposable device offers a cholesterol linear range from 1.5×10(-5)M to 8.0×10(-4)M with a limit of detection of 1.47×10(-5)M and accuracy of 7.9% for 9.0×10(-5)M and 14.1% for 2.0×10(-4)M, (n=5). Satisfactory results were obtained for cholesterol determination in serum samples compared to a reference procedure.
Assuntos
Técnicas Biossensoriais , Colesterol/sangue , Técnicas Eletroquímicas , Medições Luminescentes , Polímeros/química , Avidina/química , Biotina/química , Química Click , Humanos , Concentração de Íons de Hidrogênio , Luminol/química , Modelos Moleculares , Estrutura Molecular , Polímeros/síntese química , Pirróis/síntese química , Pirróis/química , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Few studies have evaluated the long-term economic consequences of deep vein thrombosis (DVT). None of them have incorporated prospectively collected clinical data to ensure accurate identification of incident cases of DVT and DVT-related health outcomes of interest, such as post-thrombotic syndrome (PTS). OBJECTIVES: To prospectively quantify medical and non-medical resource use and costs related to DVT during 2 years following diagnosis, and to identify clinical determinants of costs. METHODS: Three hundred and fifty-five consecutive patients with acute DVT were recruited at seven Canadian hospital centers. Resource use and cost information were retrieved from three sources: weekly patient-completed cost diaries, nurse-completed case report forms, and the Quebec provincial administrative healthcare database (RAMQ). RESULTS: The rate of DVT-related hospitalization was 3.5 per 100 patient-years (95% confidence interval [CI] 2.2-4.9). Patients reported a mean (standard deviation) of 15.0 (14.5) physician visits and 0.7 (1.2) other healthcare professional visits. The average cost of DVT was $5180 (95% CI $4344-6017) in Canadian dollars, with 51.6% of costs being attributable to non-medical resource use. Multivariate analysis identified four independent predictors of costs: concomitant pulmonary embolism (relative increase in cost [RIC] 3.16; 95% CI 2.18-4.58), unprovoked DVT (RIC 1.65; 95% CI 1.28-2.13), development of PTS during follow-up (RIC 1.35; 95% CI 1.05-1.74), and management of DVT in the inpatient setting (RIC 1.79; 95% CI 1.33-2.40). CONCLUSIONS: The economic burden of DVT is substantial. The use of measures to prevent the occurrence of PTS and favoring outpatient care of DVT has the potential to diminish costs.
Assuntos
Efeitos Psicossociais da Doença , Trombose Venosa/economia , Adulto , Idoso , Canadá , Feminino , Alocação de Recursos para a Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
A poly(luminol-3,3',5,5'-tetramethylbenzidine) copolymer manufactured by electropolymerization on screen-printed gold electrodes greatly improves the electrochemiluminescence of hydrogen peroxide. Cholesterol oxidase was immobilized on the surface of a poly(luminol-3,3',5,5'-tetramethylbenzidine) screen-printed cell modified with chitosan to prepare an ECL biosensor for cholesterol. Working under the optimized conditions, the linear dynamic range of cholesterol was 2.4 × 10(-5)-1.0 × 10(-3)M with a limit of detection of 7.3 × 10(-6)M and a precision of 10.3% (5.0 × 10(-4)M, n=5) expressed as relative standard deviation. This biosensor was applied to the determination of total cholesterol in serum samples obtaining satisfactory results with respect to the reference procedure. This cholesterol biosensor offers an alternative analytical method with low cost and high speed.