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1.
Aesthet Surg J ; 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38963821

RESUMO

BACKGROUND: Over the past decade, the use of poly-4-hydroxybutyrate (P4HB) in aesthetic breast surgery has grown in popularity. Published data on long-term outcomes, however, is scarce. OBJECTIVES: The purpose of this study was to assess long-term outcomes when using P4HB in various aesthetic breast procedures. METHODS: A retrospective review of all patients undergoing breast procedures with P4HB performed by the senior author (WPA) between July 2012 and March 2022. All patients with greater than one year of follow-up were evaluated, including demographics, surgical indications, complications, secondary procedures, and patient satisfaction. A Kruskal-Wallis test was performed to assess the stability of satisfaction over time. RESULTS: A total of 248 patients were evaluated. The mean follow-up length was 2.9 years (range, 1-9.3y). The most common surgical indication was breast ptosis, which comprised 68 percent (n=167) of patients. The overall complication rate was 8.0 percent (n=20), with an unplanned reoperation rate of 2.8 percent (n=7). Across the entire study population, the mean satisfaction score was 3.42 out of 4. When satisfaction scores were compared to follow-up length, Kruskal-Wallis test demonstrated no statistical differences (H = 18.2, p = 0.89, df = 2), suggesting stability of satisfaction over time. CONCLUSIONS: This study presents the senior author's entire experience with P4HB across a wide range of aesthetic breast procedures. With an average follow-up length of almost 3 years, P4HB appears to be both a safe and effective tool to support soft tissue in aesthetic breast surgery. Further, high patient satisfaction appears stable.

2.
ACS Appl Mater Interfaces ; 16(15): 18686-18692, 2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38573309

RESUMO

Redox flow batteries (RFBs) are membrane-separated rechargeable flow cells with redox electrolytes, offering the potential for large-scale energy storage and supporting renewable energy grids. Yet, creating a cost-effective, high-performance RFB system is challenging. In this work, we investigate an Fe/Mn RFB alkaline system based on the [(TEA)Fe-O-Fe(TEA)]3-/4- and MnO4-/2- redox couples with a theoretical cell voltage of ∼1.43 V. This combination has not been systematically studied previously, but it can lead to a very low-cost and sustainable materials for high energy storage. Constant current cycling tests were performed at ±41 mA cm-2 between 20% and 80% SOC over 800 h (400 cycles) with an apparent Coulombic efficiency (CE) approaching 100%, while the voltage efficiency (VE) gradually decreased from ∼75.3% to ∼61.4% due to increasing internal resistances. The voltage efficiency loss can be mitigated through a periodic acid treatment to remove MnO2 deposits from the separator.

3.
Commun Biol ; 7(1): 6, 2024 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-38168632

RESUMO

Mouse is the mammalian model of choice to study human health and disease due to its size, ease of breeding and the natural occurrence of conditions mimicking human pathology. Here we design and validate multiple reaction monitoring mass spectrometry (MRM-MS) assays for quantitation of 2118 unique proteins in 20 murine tissues and organs. We provide open access to technical aspects of these assays to enable their implementation in other laboratories, and demonstrate their suitability for proteomic profiling in mice by measuring normal protein abundances in tissues from three mouse strains: C57BL/6NCrl, NOD/SCID, and BALB/cAnNCrl. Sex- and strain-specific differences in protein abundances are identified and described, and the measured values are freely accessible via our MouseQuaPro database: http://mousequapro.proteincentre.com . Together, this large library of quantitative MRM-MS assays established in mice and the measured baseline protein abundances represent an important resource for research involving mouse models.


Assuntos
Proteínas , Proteômica , Humanos , Animais , Camundongos , Proteômica/métodos , Camundongos Endogâmicos NOD , Camundongos SCID , Camundongos Endogâmicos C57BL , Proteínas/análise , Mamíferos
4.
Aesthet Surg J ; 44(1): 1-8, 2023 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-37409963

RESUMO

BACKGROUND: In 2001, Elkwood and Matarasso published an American Society of Plastic Surgeons (ASPS) member survey detailing brow lift practice patterns. Interval changes in practice patterns have not been studied. OBJECTIVES: The previous survey was revised to elucidate current trends in brow lift surgery. METHODS: A 34-question descriptive survey was distributed to a random group of 2360 ASPS members. Results were compared to the 2001 survey. RESULTS: A total of 257 responses were collected (11% response rate; ± 6% margin of error at 95% CI). The most frequent technique for the correction of brow ptosis in both surveys was the endoscopic approach. The use of hardware fixation has increased in endoscopic brow lifting, whereas the use of cortical tunnels has decreased. Although coronal brow lifting has decreased in frequency, hairline and isolated temporal lift have increased. Neuromodulators have replaced resurfacing techniques as the most common nonsurgical adjunct. Frequent use of neuromodulators has risen from 11.2% to 88.5%. Nearly 30% of current surgeons feel that neuromodulators have replaced formal brow lifting procedures to a significant degree. CONCLUSIONS: In comparing the 2001 and current ASPS member survey there has been a clear transition to less invasive procedures over time. Although the endoscopic approach was the most popular means of forehead correction in both surveys, coronal brow lifting has decreased in frequency and the hairline and temporal approaches have increased. Neurotoxins have replaced laser resurfacing and chemical peeling methods as an adjunct, and in some cases replaced the invasive procedure entirely. Possible explanations for these findings will be discussed.


Assuntos
Procedimentos de Cirurgia Plástica , Ritidoplastia , Humanos , Ritidoplastia/métodos , Endoscopia/métodos , Neurotoxinas , Testa/cirurgia , Neurotransmissores , Sobrancelhas
7.
ACS Appl Mater Interfaces ; 15(1): 1148-1156, 2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36563037

RESUMO

Nonflammable eutectic solvents show great potential to enhance the concentrations of the redox-active materials and the cell voltages for redox flow batteries (RFBs). Herein, we report a promising redox-active eutectic electrolyte (1.5 M total redox species) with viologen and ferrocene derivatives where both of the redox reactions are reversible with a maximum open-circuit voltage of 1.35 V and an energy density of 15.1 Wh L-1, which is relevant to large-scale energy storage. The charge-discharge (from 75 to 25% state of charge) characteristics in a flow cell (0.15 M negolyte and 0.3 M posolyte) showed that it can be cycled with consistent discharge capacity for 12 h (19 cycles), beyond which pressure-driven crossover between the posolyte and negolyte reservoirs leads to capacity decay. This study points to promising new directions toward eutectic electrolyte development for RFBs where we demonstrate increasing the polarity, functionalizing the redox molecules, and separating redox intermediates to prevent undesired side reactions can make improvements in operating cell voltage, energy density, and cyclability.

8.
Plast Reconstr Surg ; 151(1): 158e-166e, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36576831

RESUMO

BACKGROUND: Previous studies have compared various attributes of independent and integrated resident applicants and identified criteria for a successful match outcome. Few studies have directly examined the relative desirability of various surgical and nonsurgical specialties from the resident's perspective. To address this, the authors analyzed plastic surgery resident applicants and available positions from 2010 through 2018 and compared these data alongside four surgical and five nonsurgical specialties. METHODS: In this cross-sectional, retrospective review from the San Francisco Match and National Resident Matching Program, year, number of applicants, available positions, and specialty (integrated or independent plastic, general, or orthopedic surgery; neurosurgery; otolaryngology; anesthesiology; emergency, family, or internal medicine; and pediatrics) were examined. RESULTS: From 2010 through 2018, the number of integrated positions increased by 142%, whereas the number of integrated applicants increased only by 14.5%. The number of available independent positions decreased by 32.6%, whereas the number of independent applicants decreased by 43.9%. All surgical subspecialties demonstrated a decrease in applicants relative to positions (range 9.9% to 24.8%). Unlike the surgical specialties, the nonsurgical fields increased both their number of positions (14% to 57.2%) and number of applicants (2.2% to 44.1%). In particular, applicants to emergency, family, and internal medicine increased dramatically (17% to 44.1%). CONCLUSIONS: Applicants to plastic surgery and other surgical residencies changed minimally. The nonsurgical specialties showed a significant increase in the number of applicants, suggesting increasing interest in the nonsurgical fields. Contributing factors may include medical school pressures, lifestyle concerns, and experience with various specialties during medical school. Means of enhancing medical student exposure to plastic surgery are suggested.


Assuntos
Internato e Residência , Procedimentos de Cirurgia Plástica , Cirurgia Plástica , Humanos , Criança , Estados Unidos , Educação de Pós-Graduação em Medicina , Cirurgia Plástica/educação , Estudos Transversais
9.
Artigo em Inglês | MEDLINE | ID: mdl-35589375

RESUMO

INTRODUCTION: Selecting the ideal contact to apply subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease is time-consuming and reliant on clinical expertise. The aim of this cohort study was to assess whether neuronal signals (beta oscillations and evoked resonant neural activity (ERNA)), and the anatomical location of electrodes, can predict the contacts selected by long-term, expert-clinician programming of STN-DBS. METHODS: We evaluated 92 hemispheres of 47 patients with Parkinson's disease receiving chronic monopolar and bipolar STN-DBS. At each contact, beta oscillations and ERNA were recorded intraoperatively, and anatomical locations were assessed. How these factors, alone and in combination, predicted the contacts clinically selected for chronic deep brain stimulation at 6 months postoperatively was evaluated using a simple-ranking method and machine learning algorithms. RESULTS: The probability that each factor individually predicted the clinician-chosen contact was as follows: ERNA 80%, anatomy 67%, beta oscillations 50%. ERNA performed significantly better than anatomy and beta oscillations. Combining neuronal signal and anatomical data did not improve predictive performance. CONCLUSION: This work supports the development of probability-based algorithms using neuronal signals and anatomical data to assist programming of deep brain stimulation.

10.
Rev Sci Instrum ; 93(4): 043005, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35489939

RESUMO

A field programmable gate array (FPGA)-based timing and trigger control system has been developed for the Dynamic Compression Sector (DCS) user facility located at the Advanced Photon Source (APS) at Argonne National Laboratory. The DCS is a first-of-its-kind capability dedicated to dynamic compression science. All components of the DCS laser shock station-x-ray choppers, single-shot shutter, internal laser triggers, and shot diagnostics-must be synchronized with respect to the arrival of x rays in the hutch. An FPGA synchronized to the APS storage ring radio frequency clock (352 MHz) generates trigger signals for each stage of the laser and x-ray shutter system with low jitter. The developed FPGA-based control system was the first system used to control the laser and the shutter system since its commissioning, and it has been developing since then to improve the timing jitter. The system is composed of a Zynq FPGA, a debug card, line drivers, and a power supply. The delay and offsets of the trigger signals can be adjusted by using a user-friendly graphical user interface with high precision. The details of the system architecture, timing requirements, firmware, and software implementation along with the performance evaluation are presented in this paper. The system offers low timing jitter (15.5 ps rms) with respect to the APS 352 MHz clock, suitable for the 100 ps (FWHM) x-ray bunch duration at the APS.

11.
Plast Reconstr Surg ; 149(6): 1096e-1105e, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35383689

RESUMO

BACKGROUND: In 2000, Matarasso et al. performed a survey of American Society of Plastic Surgeons members' face lift practice patterns. Since that publication, the aesthetic marketplace has changed dramatically, as have ancillary face lift techniques. In an attempt to detail these changes, we repeated that original survey, adding questions to address more recent technical issues and advances. The goal of this report was to define current face lift practice patterns, compare current patterns to the previous ones, and define recent advances. METHODS: A 38-question survey assessing face lift techniques, perioperative management, complications, and concomitant procedures was electronically distributed to a random cohort of American Society of Plastic Surgeons members. Data were recorded and statistically analyzed utilizing the Pearson chi-square test. RESULTS: A total of 251 forms were returned and analyzed. Details of demographics, face lift techniques, ancillary procedures, perioperative care, and complications are presented. Current results were compared to the previously published society member practice patterns delineated in the 2000 Plastic and Reconstructive Surgery publication. CONCLUSIONS: The basic approach of American Society of Plastic Surgeons members to the face lift operation has not changed dramatically over the past 20 years. The development of operative adjuncts, however, has been positive, including fat grafting techniques, concomitant use of skin resurfacing, and means of minimizing blood loss with tranexamic acid. In certain instances, respondents do not follow evidence-based guidelines for perioperative care. Finally, common complications of practicing members appear to coincide with published retrospective reviews.


Assuntos
Procedimentos de Cirurgia Plástica , Ritidoplastia , Cirurgiões , Cirurgia Plástica , Humanos , Padrões de Prática Médica , Estudos Retrospectivos , Ritidoplastia/métodos , Inquéritos e Questionários , Estados Unidos
12.
Aesthet Surg J ; 42(9): 971-977, 2022 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-35350068

RESUMO

BACKGROUND: Tranexamic acid (TXA) has rapidly gained popularity in aesthetic surgery. Previous reports have suggested that TXA provides a dry surgical field and significantly reduces operating time during facelift surgery. OBJECTIVES: The aim of this study was to build upon earlier findings by providing a large cohort matched alongside historic controls and more clearly document time saved when performing facelift surgery. METHODS: A retrospective, single-surgeon case-control study was undertaken between July 2016 and October 2021. All patients underwent facelift surgery alone or in combination with fat transfer and perioral chemical peel. All patients received subcutaneous infiltration of 0.5% lidocaine/1:200,000 epinephrine with or without 1 or 2 mg/mL TXA. Patient demographics, TXA dose, surgical time, and minor and major complications were examined. RESULTS: In total 145 consecutive patients were identified: 73 in Group 1 (no-TXA) and 72 in Group 2 (TXA). No differences in terms of gender distribution (P = 0.75), age (P = 0.54), BMI (P = 0.18), frequency of secondary rhytidectomy (P = 0.08), rate of ancillary lipografting (P = 0.44), TXA dose (P = 0.238), and minor complication rate (P = 0.56) were observed. However, mean surgical time in the no-TXA group was 21 minutes longer than in the TXA group (P = 0.016). Six patients (8%) in the no-TXA group experienced minor complications vs 8 patients (11%) in the TXA group. No patients experienced major complications. CONCLUSIONS: Although previous studies have highlighted the potential benefits of TXA in aesthetic surgery, most of the data remain subjective and non-validated. This report adds to the objective body of evidence supporting TXA in facial aesthetic surgery by documenting time saved in the operating room without additional surgical morbidity.


Assuntos
Antifibrinolíticos , Ritidoplastia , Ácido Tranexâmico , Antifibrinolíticos/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Estudos de Casos e Controles , Humanos , Salas Cirúrgicas , Estudos Retrospectivos , Ritidoplastia/efeitos adversos , Ácido Tranexâmico/efeitos adversos
13.
Brain Commun ; 4(1): fcac003, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35169708

RESUMO

Selecting the ideal contact to apply subthalamic nucleus deep brain stimulation in Parkinson's disease can be an arduous process, with outcomes highly dependent on clinician expertise. This study aims to assess whether neuronal signals recorded intraoperatively in awake patients, and the anatomical location of contacts, can assist programming. In a cohort of 14 patients with Parkinson's disease, implanted with subthalamic nucleus deep brain stimulation, the four contacts on each lead in the 28 hemispheres were ranked according to proximity to a nominated ideal anatomical location and power of the following neuronal signals: evoked resonant neural activity, beta oscillations and high-frequency oscillations. We assessed how these rankings predicted, on each lead: (i) the motor benefit from deep brain stimulation applied through each contact and (ii) the 'ideal' contact to apply deep brain stimulation. The ranking of contacts according to each factor predicted motor benefit from subthalamic nucleus deep brain stimulation, as follows: evoked resonant neural activity; r 2 = 0.50, Akaike information criterion 1039.9, beta; r 2 = 0.50, Akaike information criterion 1041.6, high-frequency oscillations; r 2 = 0.44, Akaike information criterion 1057.2 and anatomy; r 2 = 0.49, Akaike information criterion 1048.0. Combining evoked resonant neural activity, beta and high-frequency oscillations ranking data yielded the strongest predictive model (r 2 = 0.61, Akaike information criterion 1021.5). The 'ideal' contact (yielding maximal benefit) was ranked first according to each factor in the following proportion of hemispheres; evoked resonant neural activity 18/28, beta 17/28, anatomy 16/28, high-frequency oscillations 7/28. Across hemispheres, the maximal available deep brain stimulation benefit did not differ from that yielded by contacts chosen by clinicians for chronic therapy or contacts ranked first according to evoked resonant neural activity. Evoked resonant neural activity, beta oscillations and anatomy similarly predicted how motor benefit from subthalamic nucleus deep brain stimulation varied across contacts on each lead. This could assist programming by providing a probability ranking of contacts akin to a 'monopolar survey'. However, these factors identified the 'ideal' contact in only a proportion of hemispheres. More advanced signal processing and anatomical techniques may be needed for the full automation of contact selection.

14.
J Neurosurg ; : 1-10, 2021 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-34891136

RESUMO

OBJECTIVE: Deep brain stimulation (DBS) surgery is commonly performed with the patient awake to facilitate assessments of electrode positioning. However, awake neurosurgery can be a barrier to patients receiving DBS. Electrode implantation can be performed with the patient under general anesthesia (GA) using intraoperative imaging, although such techniques are not widely available. Electrophysiological features can also aid in the identification of target neural regions and provide functional evidence of electrode placement. Here we assess the presence and positional variation under GA of spontaneous beta and high-frequency oscillation (HFO) activity, and evoked resonant neural activity (ERNA), a novel evoked response localized to the subthalamic nucleus. METHODS: ERNA, beta, and HFO were intraoperatively recorded from DBS leads comprising four individual electrodes immediately after bilateral awake implantation into the subthalamic nucleus of 21 patients with Parkinson's disease (42 hemispheres) and after subsequent GA induction deep enough to perform pulse generator implantation. The main anesthetic agent was either propofol (10 patients) or sevoflurane (11 patients). RESULTS: GA reduced the amplitude of ERNA, beta, and HFO activity (p < 0.001); however, ERNA amplitudes remained large in comparison to spontaneous local field potentials. Notably, a moderately strong correlation between awake ERNA amplitude and electrode distance to an "ideal" therapeutic target within dorsal STN was preserved under GA (awake: ρ = -0.73, adjusted p value [padj] < 0.001; GA: ρ = -0.69, padj < 0.001). In contrast, correlations were diminished under GA for beta (awake: ρ = -0.45, padj < 0.001; GA: ρ = -0.13, padj = 0.12) and HFO (awake: ρ = -0.69, padj < 0.001; GA: ρ = -0.33, padj < 0.001). The largest ERNA occurred at the same electrode (awake vs GA) for 35/42 hemispheres (83.3%) and corresponded closely to the electrode selected by the clinician for chronic therapy at 12 months (awake ERNA 77.5%, GA ERNA 82.5%). The largest beta amplitude occurred at the same electrode (awake vs GA) for only 17/42 (40.5%) hemispheres and 21/42 (50%) for HFO. The electrode measuring the largest awake beta and HFO amplitudes corresponded to the electrode selected by the clinician for chronic therapy at 12 months in 60% and 70% of hemispheres, respectively. However, this correspondence diminished substantially under GA (beta 20%, HFO 35%). CONCLUSIONS: ERNA is a robust electrophysiological signal localized to the dorsal subthalamic nucleus subregion that is largely preserved under GA, indicating it could feasibly guide electrode implantation, either alone or in complementary use with existing methods.

15.
Scand J Immunol ; 94(5): e13098, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34940993

RESUMO

Costimulatory and coinhibitory mechanisms appear to be involved throughout immune responses to control their specificity and level. Many mechanisms operate; therefore, various theoretical models should be considered complementary rather than competing. One such coinhibitory model, pictured in 1971, involves the crosslinking of antigen receptors with inhibitory Fc receptors by antigen/antibody complexes. This model was prompted by observations that the Fc portion of antibody was required for potent suppression of immune responses by antibody. The signal via the antigen receptor wakes up T or B cells, providing specificity, while costimulators and coinhibitors stimulate or inhibit these awoken cells. The recent observations that administration of monoclonal anti-SARS-CoV-2 spike antibodies in early COVID-19 patients inhibits the induction of clinically damaging autoimmune antibodies suggest they may provide negative Fc signals that are blocked in COVID-19 patients. Furthermore, the reduced ability of SARS-CoV-2 antigen to localize to germinal centres in COVID-19 patients also suggests a block in binding of the Fc of antibody bound to antigen on FcγRIIb of follicular dendritic cells. The distinction between self and foreign is made not only at the beginning of immune responses but also throughout, and involves multiple mechanisms and models. There are past beginnings (history of models) and current and future beginnings for solving serious clinical problems (such as COVID-19) and different types of models used for understanding the complexities of fundamental immunology.


Assuntos
COVID-19/imunologia , Modelos Imunológicos , Receptores Fc/metabolismo , SARS-CoV-2/fisiologia , Animais , Anticorpos Antivirais/metabolismo , Complexo Antígeno-Anticorpo/metabolismo , Autoanticorpos/metabolismo , Humanos , Terapia de Imunossupressão
16.
Aesthet Surg J Open Forum ; 3(1): ojab007, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34212140

RESUMO

This article provides a review of available evidence with regard to short-term complications in facelift surgery. The article reviews both the most common complications and less common, but well-described ones. The goal is to offer objective means to minimize postoperative complications and a guide for treatment when they occur.

17.
J Phys Chem Lett ; 12(22): 5286-5293, 2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34061531

RESUMO

Detonation nanodiamond (DND) is known to form aggregates that significantly reduce their unique nanoscale properties and require postprocessing to separate. How and when DND aggregates is an important question that has not been answered experimentally and could provide the foundation for approaches to limit aggregation. To answer this question, time-resolved small-angle X-ray scattering was performed during the detonation of high-explosives that are expected to condense particulates in the diamond, graphite, and liquid regions of the carbon phase diagram. DND aggregation into low fractal dimension structures could be observed as early as 0.1 µs, along with a separate scattering population also observed from an explosive that produces primarily graphitic products. A counterexample is the case of a high-explosive that produces nano-onions, where no hierarchical scattering was observed for at least 10 µs behind the detonation front. These results suggest that DND aggregation occurs on time scales comparable to particle formation.

18.
Ann Vasc Surg ; 74: 258-263, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33549772

RESUMO

BACKGROUND: Transcatheter aortic valve implantation (TAVI) procedures have revolutionized the treatment of aortic stenosis. However, due to large sheaths, improperly deployed closure devices, and the comorbidities and challenges innate to this population, vascular access complications can be devastating. The objective of this study is to evaluate vascular access complications in one of the largest TAVI sites in North America. METHODS: This was a retrospective single center review between January 2014 and December 2018 of vascular access complications necessitating operative intervention by vascular surgery. Patient demographics and preoperative comorbidities were collected. Type of vascular access complication, types of repair, closure device used, and postoperative outcomes were analyzed. RESULTS: A total of 37 cases out of a total of 985 TAVI procedures were identified. TAVI was carried out in the operating suite (70%) or the catheterization lab (30%). Consults to vascular surgery were requested intraoperatively (60%), immediately postoperative (14%), later in the day of the TAVI (20%), and on postoperative day 1 (6%). The location of injury included common femoral artery (49%), superficial femoral artery (11%) and external iliac artery (41%), with some cases injuring multiple vessels. Closure devices were found in the subcutaneous tissue (26%), anterior wall (37%), posterior wall (11%), intra-arterial (11%), closing the anterior to the posterior wall (16%), and in the inguinal ligament (5%). Injuries included tears (11%), dissections (38%), and vessel rupture (19%). The majority of repairs were done primarily (64%), with patch (28%) and bypass (8%) less frequently. Four patients died perioperatively (11%), 2 from hemorrhage, 1 from cardiac arrest, and 1 from progressive respiratory disease. CONCLUSIONS: Access complications during TAVI procedures predispose complex patients to increased risk of morbidity and mortality. Careful patient selection, proper access techniques, and performing high risk patients in the operating suite with vascular surgery are fundamental in minimizing complications.


Assuntos
Estenose da Valva Aórtica/cirurgia , Cateterismo Periférico/efeitos adversos , Técnicas Hemostáticas/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/cirurgia , Idoso , Idoso de 80 Anos ou mais , Colúmbia Britânica , Cateterismo Periférico/instrumentação , Tomada de Decisão Clínica , Feminino , Próteses Valvulares Cardíacas , Técnicas Hemostáticas/instrumentação , Humanos , Masculino , Seleção de Pacientes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/instrumentação , Resultado do Tratamento , Dispositivos de Acesso Vascular , Dispositivos de Oclusão Vascular , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
19.
Ann Surg Open ; 2(1): e049, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37638251

RESUMO

Objectives: To determine the association of preoperative mood symptoms and postoperative adverse outcomes; to explore sex-specific differences. Background: Depression and anxiety can increase postoperative mortality. Psychological stress is associated with a chronic inflammatory response unfavorable to postsurgical healing. Methods: Prospective cohort study. Patients were recruited from surgical preadmission clinics at a university hospital. Preoperative depression and anxiety were measured via the Beck Depression and Beck Anxiety Inventories (BDI-II and BAI). Our primary outcome was a composite of postoperative complications, extended length of stay (ELOS) and early readmission. Associated variables included demographics, preoperative pain, pain tolerance/catastrophizing, coping mechanisms, postoperative pain, and opioid use. We adjusted for age, comorbidities, and surgical specialty. Results: Of 1061 recruited patients (ten surgical specialties, 2015-2020), 455 males and 486 females had preoperative and postoperative data available. Mean age was 62.9 (range 20.2-96.2). At baseline, 9.3% of patients had moderate or severe depression; 7.4% had moderate or severe anxiety. Females were more likely to be moderately or severely depressed (11% vs 7%, P = 0.036) and moderately or severely anxious (9% vs 6%, P = 0.034). Females had significantly fewer reported comorbidities and lower American Society of Anesthesiologists category (P < 0.001). Increasing BDI-II and BAI scores significantly increased likelihood of postoperative complications, ELOS, and/or hospital readmission in females (adjusted odds ratio [aOR] = 2.57 for BDI-II 1-19 vs 0, P = 0.041; aOR = 4.48 for BDI-II > 19 vs 0, P = 0.008; aOR = 1.54 for BAI ≤ 6 vs >6, P = 0.038) but not in males. Mood symptoms did not influence postoperative pain or opioid use. Conclusion: Preoperative depression and anxiety negatively impact surgical outcomes in female patients undergoing major surgery.

20.
J Proteome Res ; 20(1): 305-316, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33151080

RESUMO

We investigated the effect of homogenization strategy and protein precipitation on downstream protein quantitation using multiple reaction monitoring mass spectrometry (MRM-MS). Our objective was to develop a workflow capable of processing disparate tissue types with high throughput, minimal variability, and maximum purity. Similar abundances of endogenous proteins were measured in nine different mouse tissues regardless of the homogenization method used; however, protein precipitation had strong positive effects on several targets. The best throughput was achieved by lyophilizing tissues to dryness, followed by homogenization via bead-beating without sample buffer. Finally, the effect of tissue perfusion prior to dissection and collection was explored in 20 mouse tissues. MRM-MS showed decreased abundances of blood-related proteins in perfused tissues; however, complete removal was not achieved. Concentrations of nonblood proteins were largely unchanged, although significantly higher variances were observed for proteins from the perfused lung, indicating that perfusion may not be suitable for this organ. We present a simple yet effective tissue processing workflow consisting of harvest of fresh nonperfused tissue, novel lyophilization and homogenization by bead-beating, and protein precipitation. This workflow can be applied to a range of mouse tissues with the advantages of simplicity, minimal manual manipulation of samples, use of commonly available equipment, and high sample quality.


Assuntos
Proteínas Sanguíneas , Proteômica , Animais , Espectrometria de Massas , Camundongos , Fluxo de Trabalho
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