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INTRODUCTION: The objective was to assess the effectiveness and safety of a bioabsorbable mesh at the time of closure of a midline laparotomy for IH prevention. MATERIALS AND METHODS: A multicenter, randomized clinical trial including patients undergoing abdominal surgical procedures through a midline laparotomy incision was designed. In the group of mesh (n = 167) the incision was closed using a continuous polydioxanone suture (PDS) plus a bioabsorbable mesh. In the control group (n = 165) a continuous PDS single layer suture was only used. Patients were randomly assigned (1:1) to the two groups. The primary outcome was the incidence of IH at 6, 12 and 24 months. Assessment of IH was done using a CT scan. RESULTS: At 6 months, the rates of IH were 15.2% and 24.8% in the experimental and control groups, respectively (relative risk [RR] 0.66, 95% confidence interval [CI] 0.38-0.98, P = 0.042). At 12 months, the rate of IH continued to be significantly lower in the experimental group (21.4% vs. 33.1%, P = 0.033), but at 24 months, there were no significant differences between the study groups with a follow-up rate of only 37.5%. The number needed to treat (NNT) was 11 and 9 at 6 and 12 months, respectively. CONCLUSION: The bioabsorbable mesh significantly prevented IH during the first year. Not reliable conclusions can be drawn across the second year. This may suggest that the any of the closing technique assessed in this study would have a "palliative" transient effect for preventing IH in the long-term.
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Técnicas de Fechamento de Ferimentos Abdominais , Hérnia Incisional , Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Implantes Absorvíveis , Herniorrafia/efeitos adversos , Humanos , Hérnia Incisional/epidemiologia , Hérnia Incisional/etiologia , Hérnia Incisional/prevenção & controle , Laparotomia/efeitos adversos , Polidioxanona , Telas Cirúrgicas/efeitos adversosRESUMO
BACKGROUND: The prognostic value of sarcopenic obesity in gastric cancer surgery remains debated. We aimed to evaluate the impact on outcomes of body composition and sarcopenic obesity after gastrectomy for gastric cancer. METHODS: A retrospective review of prospectively maintained database of patients undergoing gastrectomy for gastric cancer from 2010 to 2017 was performed. Skeletal muscle mass and visceral adipose tissue were evaluated by preoperative computed tomography to define sarcopenia and obesity. Patients were classified in body composition groups according to the presence or absence of sarcopenia and obesity. Prognostic factors for survival were assessed by multivariate Cox analysis. RESULTS: Of the 198 patients undergoing gastrectomy for gastric cancer, 90 (45.4%) patients were sarcopenic, 130 (67.7%) obese, and in the subclassification for body composition categories: 33 (17%) nonsarcopenic nonobesity, 75 (38%) non sarcopenic obesity, 35 (17%) sarcopenic nonobesity, and 55 (28%) sarcopenic obesity. No category of body composition was a predictor of postoperative complications and worse overall and disease-free survival outcomes. Multivariable analysis identified ASA III classification, preoperative weight loss > 10%, postoperative surgical re-intervention, and advanced tumor stage as independent prognostic factors for overall survival, and patients aged 75 years or older, preoperative weight loss > 10%, elevated netrophil-lymphocyte ratio, and advanced tumor stage as independent prognostic factors for disease-free survival. CONCLUSIONS: Sarcopenia, obesity, and sarcopenic obesity were not associated with worse outcomes after gastric cancer surgery.
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Sarcopenia , Neoplasias Gástricas , Composição Corporal , Estudos de Coortes , Humanos , Músculo Esquelético/patologia , Obesidade/complicações , Obesidade/patologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/diagnóstico , Sarcopenia/diagnóstico por imagem , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgiaRESUMO
BACKGROUND: Because of the increasing life expectancy in our society, aging-related neurodegenerative disorders are one of the main issues in global health. Most of these diseases are characterized by the deposition of misfolded proteins and a progressive cognitive decline. Among these diseases, Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are the most common types of degenerative dementia. Although both show specific features, an important neuropathological and clinical overlap between them hampers their correct diagnosis. In this work, we identified molecular biomarkers aiming to improve the misdiagnosis between both diseases. METHODS: Plasma extracellular vesicles (EVs) -from DLB, AD and healthy controls- were isolated using size-exclusion chromatography (SEC) and characterized by flow cytometry, Nanoparticle Tracking Analysis (NTA) and cryo-electron microscopy. Next Generation Sequencing (NGS) and related bibliographic search was performed and a selected group of EV-associated microRNAs (miRNAs) was analysed by qPCR. RESULTS: Results uncovered two miRNAs (hsa-miR-451a and hsa-miR-21-5p) significantly down-regulated in AD samples respect to DLB patients, and a set of four miRNAs (hsa-miR-23a-3p, hsa-miR-126-3p, hsa-let-7i-5p, and hsa-miR-151a-3p) significantly decreased in AD respect to controls. The two miRNAs showing decreased expression in AD in comparison to DLB provided area under the curve (AUC) values of 0.9 in ROC curve analysis, thus suggesting their possible use as biomarkers to discriminate between both diseases. Target gene analysis of these miRNAs using prediction online tools showed accumulation of phosphorylation enzymes, presence of proteasome-related proteins and genes involved in cell death among others. CONCLUSION: Our data suggest that plasma-EV associated miRNAs may reflect a differential profile for a given dementia-related disorder which, once validated in larger cohorts of patients, could help to improve the differential diagnosis of DLB versus AD.
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BACKGROUND: Kidney transplantation (KTx) is the best therapeutic approach for chronic kidney diseases leading to irreversible kidney failure. Considering the origin of the graft, several studies have reported differences between living (LD) and deceased donors (DD) in graft and patient survival. These differences seem to be related to multiple factors including, donor age and time of cold ischemia among others. Many of transplanted organs come from old-aged DDs, in which pre-transplant biopsy is recommended. However, kidney biopsy has several limitations, and there is a need to develop alternatives to assess the status of a kidney before transplantation. As the analysis of urinary extracellular vesicles (uEVs) rendered promising results as non-invasive biomarkers of kidney-related pathologies, this pilot study aimed to investigate whether profiling uEVs of LDs and DDs may be of help to assess the quality of the kidney before nephrectomy. METHODS: uEVs from 5 living donors and 7 deceased donors were isolated by size-exclusion chromatography, and their protein and miRNA content were analysed by liquid chromatography followed by mass spectrometry and next generation sequencing, respectively. Then, hierarchical clustering and venn diagrams were done with Perseus software and InteractiVenn tool. Specific EVs data bases were also used for Gene Ontology analysis. RESULTS: Next generation sequencing revealed that uEVs from DDs contained less miRNAs than LDs, but most of the DD-expressed miRNAs were shared with LDs (96%). Only miR-326 (targeting the apoptotic-related Bcl2) was found significantly over-represented in LD. Focusing on the protein content, we detected a low intra-group correlation in both types of donors. Despite these differences, hierarchical clustering of either miRNA or protein data could not identify a differential profile between LDs and DDs. Of note, 90% of transplanted patients had a functional graft after a year from KTx. CONCLUSIONS: In this pilot study we found that, in normo-functional grafts, minor differences in uEVs profile could not discriminate between LDs and DDs.
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Vesículas Extracelulares/genética , Vesículas Extracelulares/metabolismo , Perfilação da Expressão Gênica/métodos , Rim/fisiologia , Doadores Vivos , Idoso , Biomarcadores/urina , Feminino , Humanos , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Projetos Piloto , Doadores de TecidosRESUMO
AIM: Although the oncological adequacy of laparoscopic rectal resection (LR) appears equivalent to open resection (OR), its benefit is controversial in the elderly. The aim of this study was to investigate the influence of LR on morbidity and mortality in octogenarians. METHOD: This was a retrospective analysis of all patients who underwent rectal surgery for cancer between 2003 and 2013 in a teaching hospital. The primary aim of the study was to assess the influence of surgical approach on mortality and morbidity of rectal resection in patients ≥ 80 years old. Regression analysis was performed to control the effect of covariables on the clinical outcome. RESULTS: Of 408 patients 203 were in the LR group and 205 in the OR group including 303 (74.3%) less than 80 years and 105 (25.7%) over 80 years. The mortality was lower in the LR group compared with the OR group for patients under 80 years (0% vs 4.6%; P = 0.049) and no different in the over 80 group (11.5% vs 9.4%; P = 0.859). In younger patients, the OR group showed longer hospital stay (9 vs 7 days; P < 0.001) and more complications (44.1% vs 29.8%; P = 0.042). Medical complications were more frequent in LR group than OR group octogenarians (40.4% vs 20.8%; P = 0.009) as well as grade C anastomotic leakage (13.8 vs 10.7; P = 0.041). CONCLUSION: LR for rectal cancer showed clinical advantages in patients under 80 years and was as safe as OR in patients over 80 years, although the advantages of laparoscopic surgery were lost in the elderly group due to a higher rate of medical complications. OR may be an option in elderly patients with important comorbidities.
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Fatores Etários , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Morbidade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Hernia repair is one of the most common operations in general surgery, and its associated complications typically relate to infections, among others. The loading of antibiotics to surgical meshes to deliver them locally in the abdominal hernia repair site can be one way to manage infections associated with surgical implants. However, the amount of drug loaded is restricted by the low wettability of polypropylene (PP). In this work, plasma has been used to tailor the surface properties of PP meshes to obtain high loading of ampicillin while conserving the desired biological properties of the unmodified samples and conferring them with antibacterial activity. It was demonstrated that the new surface chemistry and improved wettability led to 3-fold higher antibiotic loading. Subsequently, a PEG-like dry coating was deposited from tetraglyme with low-pressure plasma which allowed maintaining the high drug loading and kept cell properties such as chemotaxis, adhesion and morphology to the same levels as the untreated ones which have shown long-standing clinical success.
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Antibacterianos/administração & dosagem , Polimerização , Polipropilenos , Telas Cirúrgicas , Animais , Linhagem Celular , Humanos , Camundongos , Microscopia Eletrônica de Varredura , Propriedades de SuperfícieRESUMO
Sperm deep freezing procedures for ram semen have considerable variations regarding the steps being employed for cooling, freezing, and addition of cryoprotectants. In this work, we evaluated the effects of the addition of glycerol and/or the disaccharides sucrose and trehalose to hypertonic diluents either before or after cooling from 30 °C to 5 °C in Merino Australian ram semen cryopreservation. Using optical and transmission electron microscopy techniques, we assessed that glycerol was beneficial to the cooling process independently of its addition at 30 °C or 5 °C in terms of sperm membrane integrity in different regions of the plasma membrane (acrosomal region, 14.5% higher integrity; postacrosomal region, 8.0% higher integrity [P < 0.01]; hypoosmotic swelling test [HOST], 10.8% higher integrity [P < 0.001]). Disaccharides were necessary for a better cryopreservation in liquid nitrogen, and the best procedure was their addition after cooling at 5 °C (12% higher sperm motility [P < 0.001]; 8% higher acrosome integrity, [P < 0.05]; 9.5% higher plasma membrane integrity assessed by HOST [P < 0.001]). Trehalose showed a greater preservation cryoprotectant capacity than sucrose, as indicated by sperm motility after thawing (8.1% greater [P < 0.01]) and by the integrity of the intermediate piece (20% greater [P < 0.05]). From these results, we conclude that the best procedure for ram semen cryopreservation in hypertonic disaccharide-containing diluents is the addition of glycerol and trehalose after the cooling process, at 5 °C.
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Criopreservação/veterinária , Glicerol/farmacologia , Preservação do Sêmen/veterinária , Ovinos/fisiologia , Sacarose/farmacologia , Trealose/farmacologia , Animais , Criopreservação/métodos , Crioprotetores/química , Crioprotetores/farmacologia , Congelamento , Glicerol/química , Masculino , Preservação do Sêmen/métodos , Sacarose/química , Trealose/químicaRESUMO
In Northern Patagonia, Argentina, the ovine mating season starts on March 15, which is the time when rams are submitted to summer temperatures. This study assessed the adaptability of 12 Australian Merino rams, six unshorn and six shorn, half of which were treated in a heat chamber for five days (09.00 hours to 17.00 hours) that gradually reached 40 °C. In an attempt to quantify the effects of heat stress on sperm head morphology, ellipticity was analyzed to establish the relationship between the distributions of subpopulations, light hours, temperature and humidity. Ellipticity was measured on 9224 sperm heads that were obtained over 12 weeks starting in the summer time. Four sperm head subpopulations (S) were identified by comparison with a sperm head population of ejaculates obtained in the late breeding season without the effect of heat stress (S1 = heads with ellipticity ≥ 2.00; S2 = sperm head with range of ellipticity between 1.80 and 1.99; S3 = sperm head with range of ellipticity from 1.60 to 1.79; and S4 = sperm head with range of ellipticity from 1.30 to 1.59). The variable sperm head ellipticity for each ejaculate was expressed as the means and frequencies of subpopulation. The results demonstrate changes in ram sperm head ellipticity in different conditions (control/treated, unshorn/shorn) throughout the experiment (P < 0.05). Treated shorn rams had a higher mean ellipticity and frequency of elliptical heads (mean ellipticity value = 2.06 and S1 frequency = 76.35%), peaking in the seventh week posttreatment (on the basis of the action of heat stress on seminiferous tubules). According to this study, unshorn rams were better adapted to heat stress than the shorn ones.
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Ovinos/fisiologia , Espermatozoides/citologia , Estresse Fisiológico/fisiologia , Animais , Argentina , Masculino , Análise do Sêmen/veterinária , Espermatozoides/fisiologiaRESUMO
Small bowel diverticula are rare formations and some are prone to complications such as lower gastrointestinal bleeding. We report the case of a patient with hemorrhagic shock following upper gastrointestinal bleeding. A 39-year-old patient was admitted to the unit for recurrent bleeding. The patient received transfusions and selective arteriography was performed which reported bleeding at the level of the ileocolic artery. Laparatomy was performed and blood was found at the entire colon and small intestine up to 40 cm of Treitz angle where multiple diverticula were visualized. Bowel resection was performed. Although duodeno-jejunal diverticula are rare, a special attention should be paid to this clinical entity as it can be a cause of recurrent upper gastrointestinal bleeding.
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Procedimentos Cirúrgicos do Sistema Digestório , Divertículo/cirurgia , Hemorragia Gastrointestinal/cirurgia , Doenças do Jejuno/cirurgia , Choque Hemorrágico/cirurgia , Adulto , Transfusão de Sangue , Diagnóstico Diferencial , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Divertículo/complicações , Hemorragia Gastrointestinal/etiologia , Hemostasia Cirúrgica , Humanos , Doenças do Jejuno/complicações , Laparotomia , Masculino , Choque Hemorrágico/etiologia , Resultado do TratamentoRESUMO
INTRODUCTION: The interviews and interactions with patients are part of everyday health care provider. However, there is sometimes a difficulty in communication, linked to several factors. For this reason, the use of images to illustrate the medical conditions in the outpatient clinic can improve patient communication. We report our initial experience with the use of images to manage the quality of care to surigcal patients. METHODOLOGY: He used a computer to show pictures of the following conditions: surgery for an inguinal hernia, cholelithiasis, cholecystitis and the choledocholithiasis and finally thyroid pathology. Were randomized two groups of patients. Each of the affected patients in any stage of the disease, they explained their problems. In one of the groups also showed the patient was using the current image and continued to give appropriate explanations related to pathology. Thereafter, patients in both groups filled in an anonymous questionnaire in which they responded to what degree it was considered useful this methodology, and degree of satisfaction received outpatient treatment with or without the deployment of images by computer. We have analyzed the average time expected and made a visit. RESULTS: 187 patients will be visited in the consultations over a period of 8 months. In 83 patients have been using images to give the explanations in external consultations. Of these, 24 patients suffering from thyroid, 24 hernias or incisional hernias and 35 patients with biliary tract pathology. Patients in the group were shown images of conditions have responded mostly be very satisfied with the use of images while the explanations are given on the patient's illness. Also, over 80% of patients report being satisfied with this system. The visiting time was not lengthened. DISCUSSION: Despite the existence of different variables that can influence patient satisfaction, use of images to illustrate surgical diseases to patients improves communication and flow of the explanations of the physician. CONCLUSIONS: The relationship doctor-patient communication is the key event in an outpatient setting. It determines a good overall result of the clinical interview. The use of images in an outpatient improves communication between patients and doctors. Moreover, the degree of satisfaction is high and the degree of understanding of the disease. It seems useful to incorporate in our outpatient clinic.
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Assistência Ambulatorial/normas , Comunicação , Computadores , Pacientes Ambulatoriais , Médicos , Qualidade da Assistência à Saúde/normas , Encaminhamento e Consulta/normas , Colecistite/cirurgia , Coledocolitíase/cirurgia , Colelitíase/cirurgia , Hérnia Inguinal/cirurgia , Humanos , Satisfação do Paciente , Relações Médico-Paciente , Inquéritos e Questionários , Doenças da Glândula Tireoide/cirurgiaRESUMO
Examination of the type and frequency of damage to the head of spermatozoa using electron microscopy can be used to evaluate the quality of differently treated sperm. This report describes a systematic approach based on 29 morphological categories of sperm heads assessed from discrete regions in raw, chilled and frozen-thawed spermatozoa. Injury occurred principally at the plasma membrane and could be present or absent in all regions. In the anterior segment, when the plasma membrane is present, it can be intact, dilated, very dilated, disrupted, or contain vesicles characteristic of acrosomal reaction-like capacitation changes. When the plasma membrane is absent, the acrosome may be intact, exhibit a complete loss of contents, or retain some contents of the apical ridge and present a very dilated outer acrosomal membrane. The plasma membrane in the equatorial segment and the boundary between regions can be intact, dilated, very dilated or disrupted. The post-acrosomal plasma membrane is classified as intact, dilated or very dilated, whereas the dense lamina is intact, dilated or fragmented. The morphology of the heads most frequently observed in chilled spermatozoa consists of anterior and equatorial segments with a dilated, or dilated and disrupted plasma membrane; a boundary between regions with an intact and dilated plasma membrane; and a post-acrosomal region with an intact plasma membrane and dense lamina, both dilated. In frozen-thawed spermatozoa, the morphology of the heads is more frequently characterised by no plasma membrane and an acrosome showing complete or some loss of contents in the apical ridge and very dilated outer acrosomal membrane, presenting mostly dilated and fragmented dense lamina in the post-acrosomal region. These findings are consistent with the conclusion that the freezing process produces an increase in the degree of damage to the cells when they are subjected to increasing degrees of cold shock. There are still difficulties in developing a good diluent and process for preserving the plasma membrane in ram spermatozoa. This systematisation, using different categories, allows characterisation of multiple transmission electron microscopy images. Thus, the different changes observed due to cryopreservation may be correlated.
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Membrana Celular/ultraestrutura , Criopreservação , Cabeça do Espermatozoide/ultraestrutura , Animais , Membrana Celular/efeitos dos fármacos , Crioprotetores/farmacologia , Congelamento , Processamento de Imagem Assistida por Computador , Masculino , Microscopia Eletrônica de Transmissão , Carneiro Doméstico , Cabeça do Espermatozoide/efeitos dos fármacosRESUMO
CONTEXT: One salient feature of autoimmune thyroid disease is the inappropriate expression of human leukocyte antigen (HLA) class II molecules by thyroid follicular cells. Metallothioneins (MT) are small proteins induced by tissue stress that can contribute to restoring homeostasis of tissue inflammation and have been found to be increased in a transcriptomic analysis of Graves' disease (GD) glands. METHODOLOGY: To assess the role of MT in the pathogenesis of GD, we analyzed MT-I and -II expression and distribution in GD-affected thyroid glands (n = 14) compared with other thyroid diseases (n = 20) and normal thyroid glands (n = 5). Two-color indirect immunofluorescence and semiquantitative morphometry were applied. The relationship between MT and HLA class II expression was analyzed by their degree of colocalization in GD sections, and in vitro induction kinetics and expression of these molecules on the HT93 thyroid cell line were compared by quantitative RT-PCR and flow cytometry using interferon-γ and zinc as stimuli. RESULTS: MT were clearly overexpressed in nine of 14 GD glands. MT expression distribution in GD was almost reciprocal to that of HLA class II. In vitro analysis of MT and HLA class II demonstrated that MT is induced more slowly and at a lower level than HLA. Moreover, the main MT inducer, zinc, reduces interferon-γ-induced class II expression. CONCLUSIONS: These findings show that MT and HLA class II play very different roles in the autoimmune process by affecting the thyroid gland, thereby pointing to the possible role of MT as a marker of cell stress and homeostasis restoration in GD.
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Doença de Graves/genética , Metalotioneína/genética , Glândula Tireoide/metabolismo , Adolescente , Adulto , Idoso , Células Cultivadas , Estudos de Coortes , Feminino , Regulação da Expressão Gênica , Doença de Graves/metabolismo , Doença de Graves/patologia , Humanos , Masculino , Metalotioneína/metabolismo , Pessoa de Meia-Idade , Estresse Fisiológico/genética , Estresse Fisiológico/fisiologia , Glândula Tireoide/patologia , Regulação para Cima/genética , Adulto JovemRESUMO
The presence of an intrauterine device (IUD) within the colon is rare. Complications have been reported with IUDs among which uterine perforation. Translocation of IUDs to the uterine cavity, to the bladder and also through the wall of the bowel, and sigmoid colon has been reported. We believe there may be a case that surgeons should know the result of despite being a priori gynaecological complication. This paper reports on a case of colon perforation by an IUD.
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INTRODUCTION: Since early nineties, laparoscopic cholecystectomy has become gold standard for cholecystectomy. Also, a high tendency of minimizing surgical trauma encourages the use of new approaches in laparoscopic surgery. A novel approach such as Single incision laparoscopic surgery (SILS) cholecystectomy has been describes. CASE REPORT: We report on a case of a 33-year-old female patient scheduled for elective laparoscopic cholecystectomy due to symptomatic ultrasonography verified cholelithiasis. A single 2.5-cm long semicircular infraumbilical skin incision was used. Pneumoperitoneum was established alter introduction of the predesigned trocar. Antegrade cholecystectomy was performed without stay suture placement. Postoperative course was uneventful. DISCUSSION: This article reports the authors' method of performing SILS cholecystectomy. SILS approach is feasible with new standard devices from the industry that offers slightly modified instruments for standard laparoscopic cholecystectomy. CONCLUSION: Single-incision laparoscopic surgery is a feasible way to perform cholecystectomy. A learning-curve is required and further work in the form of randomized controlled trials is needed to investigate the advantages of this new technique.
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Colecistectomia Laparoscópica/métodos , Colelitíase/cirurgia , Adulto , Colelitíase/diagnóstico , Feminino , Humanos , Satisfação do Paciente , Resultado do TratamentoRESUMO
Uterine lipomas are very uncommon with symptoms that are similar to leiomyomas. Their diagnosis is always histological although some radiological methods may suggest their existence prior to surgery. They are sometimes associated with endometrial pathology, but there are no previous reported cases related to ovarian thecoma. Their prognosis is excellent. Clinical, radiological, morphologic, and immunohistochemical findings are shown which correspond to uterine lipoma associated with endometrial polyps and ovarian thecoma.
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Autoimmune thyroid diseases (AITD) are considered as prototypic organ-specific autoimmune diseases, yet their underlying aetiology remains poorly understood. Among the various pathophysiological mechanisms considered, a failure of central tolerance has received little attention. Here we present evidence in favour of dysregulated thymic function playing a role in AITD. Flow-cytometric analyses conducted in peripheral blood lymphocytes from 58 AITD patients and 48 age- and-sex-matched controls showed that AITD patients have significantly higher blood levels of CD4(+)CD45RA(+), CD4(+)CD31(+) and CD4/CD8 double-positive T lymphocytes, all markers of recent thymic emigrants (RTE). In addition, the alpha-signal joint T cell receptor excision circles (TRECs) content (a molecular marker of RTEs) was higher in the group of AITD patients older than 35 years than in age-matched controls. This was independent from peripheral T cell expansion as assessed by relative telomere length. Comparisons of TREC levels in peripheral blood lymphocytes and intrathyroidal lymphocytes in paired samples showed higher levels within the thyroid during the initial 30 months of the disease, indicating an influx of RTE into the thyroid during the initial stages of AITD. Additionally, a lack of correlation between TREC levels and forkhead box P3 expression suggests that the intrathyroidal RTE are not natural regulatory T cells. These results uncover a hitherto unknown correlation between altered thymic T cell export, the composition of intrathyroidal T cells and autoimmune pathology.
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Doenças Autoimunes/imunologia , Linfócitos T/metabolismo , Timo/imunologia , Doenças da Glândula Tireoide/imunologia , Adulto , Fatores Etários , Idoso , Doenças Autoimunes/sangue , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Citometria de Fluxo , Humanos , Masculino , Pessoa de Meia-Idade , Tolerância a Antígenos Próprios , Espanha , Linfócitos T/imunologia , Telômero/patologia , Timo/fisiopatologia , Doenças da Glândula Tireoide/sangue , Adulto JovemRESUMO
INTRODUCTION: Although parenteral nutrition is a vital method of delivery essential nutrients in patients with malnutrition associated to gastro-intestinal insufficiency, its inappropriate use can increase the risk of complications and incur unnecessary expenses. OBJECTIVE: Our goal was to evaluate the influence of both, the presence of the Nutritional Support Unit and the implementing clinical practice guidelines on post-operative nutritional status, complications and length of stay among patients undergoing elective colorectal cancer surgery. METHODS: Prospective and observational study: Three period times were included-the year during the guidelines elaboration (A), and the first (B) and the second year (C) after their implementation. All patients submitted to elective colorectal cancer surgery at least 18 years of age were included (A: n=297; B: n=103, and C: n=149). WE ANALYSED: Nutritional status (NS) on admission to hospital and at discharge, use of post-operative parenteral nutrition (PPN), incidence of post-operative complications (PC), number of days of nil by mouth following surgery (NPO), and hospital length of stay (LOS). RESULTS: Although the prevalence of malnutrition on admission was low, an increment was observed during the hospitalisation time. However, only in the first period time, the increment was significantly different (A: from 8.4% to 19.5%, p<0.001; B: from 3.9% to 8.7%, and C: from 4.7% to 6.7%). Globally, the use of PPN decreased (A: 79.1%, B: 47.0%, and C: 12.8%; p<0.001). This behaviour was mainly observed in well-nourished patients (use of PPN in well nourished, A: 79.3%, B: 44.4%, and C: 11.3%; p<0.001). Significant differences were observed in the global incidence of PC (A: 27.9%, B: 28.2%, and C: 8.1%, p<0.001). Furthermore, PC was higher in well-nourished patients with PPN versus without PPN, with significant differences in B and C periods (A: 29.3% vs. 25.0%; B: 38.6% vs. 18.8%, p=0.004; C: 31.3% vs. 4.8%, p=0.003). The NPO was higher in patients without PPN in period A (7 d vs. 5 d, p<0.001) and higher in those with PPN in period C (8 d vs. 6 d, p=0.035). All in all, LOS decreased significantly during the study period time (A: 16 d, B: 13 d, and C: 11 d, p<0.001). CONCLUSION: The presence of Nutritional Support Unit and clinical practice guidelines for colorectal cancer management and treatment, optimised the use of hospital resources, namely unnecessary use of parenteral nutrition, reduction along with decrease in number of complications and length of hospital stay.
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Neoplasias Colorretais/terapia , Estado Nutricional , Avaliação de Processos e Resultados em Cuidados de Saúde , Nutrição Parenteral/métodos , Complicações Pós-Operatórias/epidemiologia , Guias de Prática Clínica como Assunto , Adulto , Idoso , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral/efeitos adversos , Período Pós-Operatório , Resultado do TratamentoRESUMO
In this second review on chemokines, we focus on the polymorphisms and alternative splicings and on their consequences in disease. Because chemokines are key mediators in the pathogenesis of inflammatory, autoimmune, vascular and neoplastic disorders, a large number of studies attempting to relate particular polymorphisms of chemokines to given diseases have already been conducted, sometimes with contradictory results. Reviewing the published data, it becomes evident that some chemokine genes that are polymorphic have alleles that are found repeatedly, associated with disease of different aetiologies but sharing some aspects of pathogenesis. Among CXC chemokines, single nucleotide polymorphisms (SNPs) in the CXCL8 and CXCL12 genes stand out, as they have alleles associated with many diseases such as asthma and human immunodeficiency virus (HIV), respectively. Of CC chemokines, the stronger associations occur among alleles from SNPs in CCL2 and CCL5 genes and a number of inflammatory conditions. To understand how chemokines contribute to disease it is also necessary to take into account all the isoforms resulting from differential splicing. The first part of this review deals with polymorphisms and the second with the diversity of molecular species derived from each chemokine gene due to alternative splicing phenomena. The number of molecular species and the level of expression of each of them for every chemokine and for each functionally related group of chemokines reaches a complexity that requires new modelling algorithms akin to those proposed in systems biology approaches.
Assuntos
Processamento Alternativo , Quimiocinas/genética , Predisposição Genética para Doença , Polimorfismo Genético , Quimiocinas CC/genética , Quimiocinas CXC/genética , HumanosRESUMO
BACKGROUND: We assessed the usefulness of a short postal questionnaire and selective clinical examination combined with repeat mailing and telephone reminders for quality assessment in hernia surgery. METHODS: All patients (n = 1153) who underwent tension-free hernioplasty through an open preperitoneal approach between 1999 and 2003 received a six-item questionnaire with a covering letter and a stamped addressed envelope. Nonresponders received two successive new questionnaires and a telephone call. RESULTS: A total of 841 (72.9%) patients returned questionnaires after three reminders (512 after the first mailing, 205 after the second, and 124 after the third). Positive questionnaire answers were documented for 152 (18.1%) of repairs and negative answers for 689 (81.9%). Of the 152 patients who answered "yes" to either of the questions regarding recurrence and/or current pain, 91 declined clinical appointments, 24 could not be contacted by phone, and 37 underwent physical examination. Of the 312 patients who did not return the questionnaire, eight had died, 124 did not want to be visited, and 180 could not be located. The recurrence rate was 2.7% and the chronic pain rate 5.9%. CONCLUSIONS: Repeat mailing was a useful strategy to improve response to self-administered postal questionnaires on hernia surgery quality assessment. However, contacting the group that responded with positive questionnaire answers was a poorly effective way to encourage subjects to come for a physical examination.