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PURPOSE: This study examines long-term benefit on functional outcomes and quality of life after selective dorsal rhizotomy (SDR) in children with spastic diplegia in Hong Kong. METHOD: This is a case control study. Individuals with spastic diplegia who were at 6 to 12 years post-SDR were recruited. Age, gender, cognition, and Gross Motor Function Classification System level-matched individuals with spastic diplegia who had not undergone SDR were recruited as controls. Outcome measures included physical level, functional level, physiological level, and quality of life. All data were compared by independent t-test. RESULTS: Individuals post-SDR (n = 15) demonstrated a significantly better range of ankle dorsiflexion in knee extension by - 5.7 ± 10.9° than the control group (n = 12). No other significant differences were observed. CONCLUSION: SDR is a safe, one-off procedure and provides long-term reduction in spasticity with no major complications. With the heterogeneity, we did not demonstrate between-group differences in long-term functional outcomes.
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Paralisia Cerebral , Rizotomia , Criança , Humanos , Rizotomia/métodos , Estudos Retrospectivos , Estudos de Casos e Controles , Paralisia Cerebral/complicações , Qualidade de Vida , Espasticidade Muscular/cirurgia , Espasticidade Muscular/etiologia , Resultado do TratamentoRESUMO
Surgery and anaesthesia subject the brain to considerable stress in the peri-operative period. This may be caused by potentially neurotoxic anaesthetic drugs, impaired cerebral perfusion and reperfusion injury related to surgery or thromboembolic events. Patient monitoring using electroencephalogram and cerebral oximetry can assist in optimising depth of anaesthesia and assessment of cerebral metabolic activity. However, research findings have been contradictory as to whether these monitors can help ameliorate peri-operative neurocognitive complications. In this narrative review, we will discuss recent evidence in the use of electroencephalography and cerebral oximetry and the underlying scientific principles. It is important to appreciate the raw electroencephalographic changes under anaesthesia and those associated with ageing, in order to interpret depth of anaesthesia indices correctly. Cerebral oximetry is useful not only for the detection of cerebral desaturation but also to identify those patients who are particularly vulnerable to injury, for better risk stratification. An algorithm-based approach may be most effective in managing the episodes of cerebral desaturation.
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Anestesia/métodos , Circulação Cerebrovascular/fisiologia , Eletroencefalografia/métodos , Monitorização Intraoperatória/métodos , Oximetria/métodos , Assistência Perioperatória/métodos , Anestesia/normas , Encéfalo/efeitos dos fármacos , Encéfalo/fisiologia , Circulação Cerebrovascular/efeitos dos fármacos , Eletroencefalografia/normas , Humanos , Monitorização Intraoperatória/normas , Oximetria/normas , Assistência Perioperatória/normas , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controleRESUMO
Patients with Parkinson's disease are at higher risk of peri-operative medical and surgical complications. Multidisciplinary management, early recognition of potential complications, specialised care of medications and intra-operative protection of the vulnerable brain are all important aspects of the peri-operative management of patients with Parkinson's disease. Advances in continuous dopaminergic treatment, development of a peri-operative Parkinson's disease pathway and application of telemedicine are starting to play a role in improving peri-operative care. Management of patients with advanced Parkinson's disease is also evolving, with potential for incorporation of integrated care and changes in the anaesthetic management for deep brain stimulation surgery. There are new methods for localisation of target nuclei and increasing insight on the effects of anaesthetic drugs on microelectrode recordings and clinical outcomes. Parkinson's disease is a progressive disease, but management is improving with better peri-operative care for patients.
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Anestesia/métodos , Gerenciamento Clínico , Monitorização Intraoperatória/métodos , Doença de Parkinson/terapia , Assistência Perioperatória/métodos , Anestesia/efeitos adversos , Anestesia/normas , Dopaminérgicos/uso terapêutico , Humanos , Monitorização Intraoperatória/normas , Doença de Parkinson/diagnósticoRESUMO
BACKGROUND: When cell-free DNA (cfDNA) testing is used as a secondary screening tool following combined first-trimester screening (cFTS), cFTS is used to estimate the prior risk for chromosome abnormalities. This study aimed to assess the factors that are associated with common and atypical abnormalities following cFTS, including cFTS risk, advanced maternal age, increased nuchal translucency (NT) ≥3.5 mm, and abnormal levels of serum markers. METHODS: We reviewed a historical cohort of 1855 Chinese women carrying singleton pregnancies with a positive cFTS [at a threshold of 1:250 for trisomy (T) 21 or 1:180 for T18] in one public hospital over a five-year period. All chromosome abnormalities were confirmed by invasive prenatal diagnosis (IPD) with karyotyping, with or without array comparative genomic hybridization. Using multivariable binary logistic regression analysis, we determined the parameters that were associated with common and atypical abnormalities. RESULTS: Overall, the prevalence of common and atypical abnormalities was 6.2 and 1.2%, respectively, and the prevalence increased with the risk of T21 by cFTS. In pregnancies with a risk of T21 > 1 in 100, a high risk of both T21 and T18, an increased NT, or a pregnancy-associated plasma A (PAPP-A) level < 0.2 multiple of medians (MoM), the prevalence of common abnormalities was 12.2, 64.7, 25.5 and 33.8%, respectively, while that of atypical abnormalities was 1.6, 3.9, 4.2, and 7.4%, respectively. In the multivariable binary logistic regression analysis, out of these four factors, only two (increased NT and PAPP_A < 0.2 MoM) were significant predictors of common and atypical abnormalities, respectively. Of all positive cFTS pregnancies, 50.4% did not have any of these four factors, and the prevalence of common and atypical abnormalities was 1.1 and 0.6%, respectively. There were three atypical abnormalities, all of which were mosaicism, and they were detected among women with IPD alone. The ages of these women were ≥ 35 years. All three pregnancies were continued after proper counseling. After giving birth, only one child had mild abnormalities, while the other two were phenotypically normal. CONCLUSIONS: Our study identified factors associated with common and atypical abnormalities after cFTS. These factors can be used to estimate the prior risk for these abnormalities to help with post-cFTS counseling in terms of choosing between cfDNA testing and IPD.
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Aberrações Cromossômicas/embriologia , Transtornos Cromossômicos/diagnóstico , Testes Genéticos/estatística & dados numéricos , Testes para Triagem do Soro Materno/estatística & dados numéricos , Primeiro Trimestre da Gravidez/sangue , Adulto , Povo Asiático/genética , Biomarcadores/sangue , Ácidos Nucleicos Livres/análise , China/epidemiologia , Transtornos Cromossômicos/embriologia , Transtornos Cromossômicos/epidemiologia , Hibridização Genômica Comparativa , Feminino , Testes Genéticos/métodos , Humanos , Cariotipagem , Modelos Logísticos , Idade Materna , Testes para Triagem do Soro Materno/métodos , Medição da Translucência Nucal , Gravidez , Proteína Plasmática A Associada à Gravidez/análise , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
Dietary patterns may interfere with the efficacy of herbal intervention. Our results demonstrated the protective effects of Salvia miltiorrhiza aqueous extract (SMA) on bone metabolism were influenced by levels of dietary fat and sucrose in ovariectomized (OVX) rats through its actions on attenuating lipid deposition and oxidative stress in rats. INTRODUCTION: Salvia miltiorrhiza (SM), also known as Danshen, has been tested as an osteoporosis treatment in a series of small, short human trials that generally report improvements in bone property. However, dietary patterns may interfere with the effects of herbal intervention. We hypothesized that dietary fat and sucrose levels could influence the effects of SM supplementation on bone in estrogen-deficient animals. METHODS: Six-month-old Sprague-Dawley sham or OVX rats were fed either a low-saturated fat-sucrose (LFS, a diet that was similar in composition to normal rat chow) or a high-fat-sucrose (HFS) diet and OVX rats were treated (8 rats/group) with SM aqueous extract (SMA, 600 mg/kg/day), 17ß-estradiol (1 mg/kg/day), or vehicle for 12 weeks. RESULTS: SMA significantly improved bone properties as revealed by the increase in trabecular bone mineral density and decrease in trabecular separation at proximal metaphysis of the tibia (PT) in HFS-fed OVX rats, but not in LFS-fed OVX rats. SMA greatly reduced lipid deposition and malondialdehyde levels, improved the activities of superoxide dismutase, catalase, and glutathione peroxidase in the livers of HFS-fed OVX rats. SMA could directly improve the proliferation and differentiation in vitro in an H2O2-induced preosteoblast cell model by attenuating cellular reactive oxygen species levels. CONCLUSIONS: The protective effects of SMA on bone metabolism were influenced by dietary fat and sucrose levels in OVX rats. The ability of SMA to reduce bone loss in HFS-fed OVX rats was associated with the attenuation of lipid deposition and oxidative stress levels.
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Dieta Hiperlipídica , Gorduras na Dieta/farmacologia , Sacarose Alimentar/farmacologia , Medicamentos de Ervas Chinesas/uso terapêutico , Osteoporose Pós-Menopausa/prevenção & controle , Fitoterapia/métodos , Fenômenos Fisiológicos da Nutrição Animal , Animais , Peso Corporal/efeitos dos fármacos , Sacarose Alimentar/administração & dosagem , Avaliação Pré-Clínica de Medicamentos/métodos , Medicamentos de Ervas Chinesas/farmacologia , Ácidos Graxos/administração & dosagem , Ácidos Graxos/farmacologia , Feminino , Humanos , Metabolismo dos Lipídeos/efeitos dos fármacos , Fígado/metabolismo , Tamanho do Órgão/efeitos dos fármacos , Ovariectomia , Estresse Oxidativo/efeitos dos fármacos , Ratos Sprague-Dawley , Salvia miltiorrhiza , Útero/patologiaRESUMO
BACKGROUND: Rehabilitation is widely advocated and provided as a standard of care for patients with total knee arthroplasty (TKA) but its effects on intermediate- to longer-term physical function is unclear. Also unknown is the relationship between the number of rehabilitation sessions attended and functional outcomes. METHODS: We conducted a prospective cohort study of 1540 patients who had undergone TKA and were referred for rehabilitation. Physical function was indexed by the Short-Form 36 (SF-36) physical function score at 6 months post-TKA. We used multivariable linear regression to assess the association between rehabilitation attendance and Month-6 physical function. Among patients who attended rehabilitation, multivariable linear regression was used to examine the dose-response association between the number of sessions attended and Month-6 physical function. RESULTS: Of the 1540 patients, 68 patients did not attend rehabilitation, 86 patients attended one session, and 1386 patients attended two or more sessions. Adjusted for the propensity to attend rehabilitation, rehabilitation attendance was independently associated with better Month-6 SF-36 physical function (point estimate, 5.0 points; 95% CI, 0.5-9.5; P = 0.028 compared with patients with no rehabilitation). Among patients who attended rehabilitation, attending five sessions was associated with a 3.6-point increase in SF-36 scores (95% CI, 0.8-6.5; P = 0.01) relative to patients who attended one session. CONCLUSIONS: Rehabilitation attendance post-TKA is associated with an increase in self-report physical function. Among patients who attended rehabilitation, a modest dose-response relationship was observed between the number of sessions and functional outcomes.
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Atividades Cotidianas , Artroplastia do Joelho/reabilitação , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Idoso , Estudos de Coortes , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Singapura , Resultado do TratamentoRESUMO
OBJECTIVE: Little is known about how static standing balance changes post total knee arthroplasty (TKA). The primary aim of this study was to examine the sensitivity to change and redundancy of center of pressure (COP) variables post-TKA. The secondary aim was to compare the sensitivity of these measures to standard clinical assessments of one repetition maximum knee extension strength and fast pace gait speed. DESIGN: 466 participants performed instrumented double-limb standing balance tests with eyes open at 4 and 12 weeks post-TKA. Measures of COP standard deviation, amplitude, root mean square (RMS), path length, detrended fluctuation analysis (DFA) and signal frequency content for the medial-lateral (ML) and anterior-posterior (AP) axes were examined. RESULTS: Significant decreases in total path length, ML variables related to sway velocity and AP signal complexity and frequency were observed. Inter-session Cohen's d effect size (ES) revealed the strongest effect was for high velocity ML path length, with a 12% decrease in this rapid sway. This variable, along with AP mean instantaneous frequency and AP DFA, were the only ones significantly different with effect sizes >0.20 and non-redundant (Spearman's rho <0.75). The ES of COP-derived variables (maximum = 0.45) were lower than gait speed (1.40) and knee extensor strength (1.54). CONCLUSION: Increased high velocity ML sway is present at four compared to 12 weeks post-TKA. This augmented rapid sway may provide increased challenges to the postural control system at a time coinciding with reduced strength levels, which could have implications for physical function during activities of daily living.
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Artroplastia do Joelho/efeitos adversos , Equilíbrio Postural , Idoso , Feminino , Marcha , Humanos , Articulação do Joelho/fisiopatologia , Locomoção , Masculino , Recuperação de Função Fisiológica , Fatores de TempoRESUMO
There has been a growing interest in using intraoperative neuromonitoring to reduce the incidence of stroke and paralysis in major vascular interventions. Electroencephalography, various neurophysiological evoked potential measurements, transcranial Doppler, and near-infrared spectroscopy are some of the modalities currently used to detect neural injuries. A good understanding of these modalities and their interactions with anaesthesia is important to maximize their value and to allow meaningful interpretation of their results. In view of the inter-individual differences in anatomy, physiological reserves, and severity of pathological processes, neuromonitoring may be a valuable method to evaluate the well-being of the nervous system during and after surgical interventions. In this review, we summarize some of their applications, efficacies, and drawbacks in major carotid and aortic surgeries.
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Monitorização Intraoperatória , Procedimentos Cirúrgicos Vasculares , Anestesia Geral , Aorta/cirurgia , Encéfalo/fisiopatologia , Eletroencefalografia , Potenciais Evocados , Humanos , Espectroscopia de Luz Próxima ao Infravermelho , Medula Espinal/fisiopatologia , Ultrassonografia Doppler TranscranianaRESUMO
INTRODUCTION: Colorectal endoscopic submucosal dissection is not a widely adopted procedure due to its technical difficulties. This study aimed to share the experience in setting up this novel procedure and to report the learning curve for such a procedure at a low-volume district hospital in Hong Kong. METHODS: This case series comprised 71 colorectal endoscopic submucosal dissections that were performed by a single endoscopist without experience in gastric or colorectal endoscopic submucosal dissection. Lesion characteristics, procedure time per unit area of tumour, en-bloc resection rate, R0 resection rate, complications, and length of stay were recorded prospectively. Results were compared for two consecutive periods to study the learning curve. RESULTS: Overall, 41 (57.7%) tumours were located in the right colon, 21 (29.6%) in the left colon, and nine (12.7%) in the rectum. The median tumour area was 4 cm(2) (range, 0.25-16 cm(2)). The median operating time was 105 (range, 47-342) minutes. The median procedure time per unit area of tumour was 24.9 min/cm(2). There was one instance of intra-operative bleeding that required conversion to laparoscopic colectomy. There was no postoperative haemorrhage. The overall perforation rate was 15.5%, in which one required conversion to laparoscopic colectomy. The overall morbidity rate was 16.9% and there was no mortality. The median hospital stay was 1 day (range, 0-11 days). The overall en-bloc resection rate and R0 resection rate was 81.2% and 58.0%, respectively. Comparison of the two study periods revealed that procedure time per unit area of tumour decreased significantly from 31.5 min/cm(2) to 21.5 min/cm(2) (P=0.032). The en-bloc resection rate improved from 78.8% to 83.3% (P=0.15). The R0 resection rate improved significantly from 39.4% to 75.0% (P<0.01). CONCLUSION: Untutored colorectal endoscopic submucosal dissection is feasible with acceptable clinical outcomes at a low-volume district hospital in Hong Kong.
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Colo/lesões , Colonoscopia/métodos , Ressecção Endoscópica de Mucosa/métodos , Curva de Aprendizado , Idoso , Idoso de 80 Anos ou mais , Colectomia/métodos , Colo/cirurgia , Colonoscopia/efeitos adversos , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Feminino , Hong Kong , Hospitais de Distrito , Hospitais com Baixo Volume de Atendimentos , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologiaRESUMO
INTRODUCTION: In Hong Kong, universal combined first-trimester screening for Down's syndrome was started as a 'free service' in July 2010. Non-invasive prenatal testing was available as a self-financed item in August 2011. This study aimed to determine whether the introduction of non-invasive prenatal testing as a contingent approach influenced the indications for invasive prenatal diagnosis and the consequent prenatal detection of Down's syndrome. METHODS: This historical cohort study was conducted at the Prenatal Diagnosis Clinic of Queen Elizabeth Hospital in Hong Kong. We compared the indications for invasive prenatal diagnosis and prenatal detection of Down's syndrome in singleton pregnancies 1 year before and 2 years following the availability of non-invasive prenatal testing as a contingent test after a positive aneuploidy test. All pregnant women who attended our hospital for counselling about universal Down's syndrome screening between August 2010 and July 2013 were recruited. RESULTS: A total of 16 098 women were counselled. After the introduction of non-invasive prenatal testing, the invasive prenatal diagnosis rate for a positive aneuploidy screening reduced from 77.7% in 2010-11 to 68.8% in 2012-13. The new combined conventional plus non-invasive prenatal testing strategy was associated with a lower false-positive rate (6.9% in 2010-11 vs 5.2% in 2011-12 and 4.9% in 2012-13). There was no significant increase in invasive prenatal diagnosis for structural anomalies over the years. There was no significant trend in the overall prenatal detection rate of Down's syndrome (100% 1 year before vs 89.1% 2 years after introduction of non-invasive prenatal testing). Four (2.6%) of 156 women who underwent non-invasive prenatal testing for a screen-positive result had a high-risk result for trisomy 21, which was subsequently confirmed by invasive prenatal diagnosis. There were no false-negative cases. CONCLUSION: The introduction of non-invasive prenatal testing as a contingent approach reduced the invasive prenatal diagnosis rate for a positive aneuploidy screening without affecting the invasive prenatal diagnosis rate for structural anomalies or the overall detection rate of fetal Down's syndrome.
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Aneuploidia , Biomarcadores/sangue , Síndrome de Down/diagnóstico , Síndrome de Down/epidemiologia , Programas de Rastreamento/métodos , Diagnóstico Pré-Natal/estatística & dados numéricos , Adulto , Estudos de Coortes , Reações Falso-Positivas , Feminino , Hong Kong/epidemiologia , Humanos , Idade Materna , Gravidez , Primeiro Trimestre da Gravidez , Diagnóstico Pré-Natal/tendênciasRESUMO
Hydrops fetalis is commonly due to Hb Bart's (γ4) disease in South East Asia. Here, we report an unusual case of hydrops fetalis due to congenital dyserythropoietic anemia (CDA) associated with compound heterozygosity for Krüppel-like factor 1 (KLF1) gene mutations. Fetal cardiomegaly was first detected on routine mid-trimester scan in a pregnant woman with normal mean corpuscular volume (MCV) and Rhesus positive status. The fetus subsequently developed hydrops fetalis, and cordocentesis showed severe fetal anemia with a hemoglobin (Hb) level of 3.4 g/dL. Common causes of fetal anemia including Hb Bart's disease, parvovirus infection, and red cell antibodies were excluded. In view of the marked increase in erythroblasts at various stages of erythropoiesis, the diagnosis of CDA was suspected. We screened the couple for previously reported KLF1 gene mutations, showing that the mother was heterozygous for the c.525_526insCGGCGCC, p.Gly176Argfs*179 mutation, and her husband heterozygous for c.1012C>A, p.Pro338Thr mutation. The fetus was a compound heterozygote for these two KLF1 mutations. After counseling, repeated intrauterine transfusions were given at 27, 29, and 34 weeks' gestation; the hydrops fetalis was resolved. The baby was delivered at 34 weeks' gestation and required monthly blood transfusions but was otherwise thriving. Bone marrow aspiration at 10 months of age showed the features of ineffective erythropoiesis, compatible with CDA. In conclusion, hydrops fetalis can rarely be due to CDA associated with a compound heterozygous mutation for KLF1 gene mutations, and be managed by repeated intrauterine transfusions. Our present report adds to the wide clinical spectrum of KLF1 mutations.
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Anemia Diseritropoética Congênita/diagnóstico , Anemia Diseritropoética Congênita/genética , Heterozigoto , Hidropisia Fetal/genética , Fatores de Transcrição Kruppel-Like/genética , Mutação , Adulto , Anemia Diseritropoética Congênita/etiologia , Anemia Diseritropoética Congênita/terapia , Transfusão de Sangue Intrauterina , Exame de Medula Óssea , Cordocentese , Feminino , Humanos , Hidropisia Fetal/diagnóstico , Hidropisia Fetal/etiologia , Hidropisia Fetal/terapia , Lactente , Masculino , Gravidez , Diagnóstico Pré-NatalRESUMO
Trafficking of lung dendritic cells (DCs) to the draining lymph node (dLN) is a crucial step for the initiation of T cell responses upon pathogen challenge. However, little is known about the factors that regulate lung DC migration to the dLN. In this study, using a model of influenza infection, we demonstrate that complement component C3 is critically required for efficient emigration of DCs from the lung to the dLN. C3 deficiency affect lung DC-mediated viral antigen transport to the dLN, resulting in severely compromised priming of virus-specific T cell responses. Consequently, C3-deficient mice lack effector T cell response in the lungs that affected viral clearance and survival. We further show that direct signaling by C3a and C5a through C3aR and C5aR respectively expressed on lung DCs is required for their efficient trafficking. However, among lung DCs, only CD103(+) DCs make a significant contribution to lung C5a levels and exclusively produce high levels of C3 and C5 during influenza infection. Collectively, our findings show that complement has a profound impact on immune regulation by controlling tissue DC trafficking and highlights a potential utility for complement as an adjuvant in novel vaccine strategies.
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Antígenos CD/metabolismo , Complemento C3/metabolismo , Complemento C5a/metabolismo , Células Dendríticas/metabolismo , Cadeias alfa de Integrinas/metabolismo , Pulmão/metabolismo , Infecções por Orthomyxoviridae/metabolismo , Animais , Antígenos Virais , Movimento Celular , Complemento C3/deficiência , Células Dendríticas/virologia , Pulmão/virologia , Camundongos , Camundongos Knockout , Infecções por Orthomyxoviridae/mortalidade , Infecções por Orthomyxoviridae/virologia , Receptor da Anafilatoxina C5a/metabolismo , Receptores de Complemento/metabolismo , Transdução de Sinais , Taxa de Sobrevida , Linfócitos T/metabolismo , Carga Viral , VírusRESUMO
BACKGROUND: Mesenchymal stem cells are proposed to facilitate repair of organ injuries. The aim of this study was to investigate whether local injection of mesenchymal stem cells could accelerate healing of sutured gastric perforations. METHODS: Sutured gastric perforations in rats were treated either with local injection of mesenchymal stem cells (injected MSC group) or by topically spraying with fibrin glue containing mesenchymal stem cells (sprayed MSC group). Controls were treated by local injection of saline or topical spray of fibrin glue without mesenchymal stem cells. Healing of sutured gastric perforations was assessed on days 3, 5 and 7. RESULTS: Local injection of mesenchymal stem cells significantly promoted the healing of gastric perforations, with the highest pneumatic bursting pressure (mean(s.e.m.) 112·3(30·2) mmHg on day 5 versus 71·2(17·4) mmHg in saline controls; P = 0·001), minimal wound adhesions, and lowest incidence of wound dehiscence (3, 6, 5 and 1 animal on day 5 in control, fibrin, sprayed MSC and injected MSC groups respectively; n = 10 per group) and abdominal abscess (2, 2, 1 and no animals respectively on day 5). Histological examination showed that gastric perforations in the injected MSC group displayed reduced inflammation, and increased granulation and re-epithelialization. Sutured gastric perforations in the injected MSC group showed decreased expression of interleukin 6, and increased expression of transforming growth factor ß1 and epithelial proliferating cell nuclear antigen, compared with the other groups. CONCLUSION: Local injection of mesenchymal stem cells was more effective than topical application, and enhanced the healing of sutured gastric perforations by an anti-inflammatory process, enhanced cellular proliferation and earlier onset of granulation. Surgical relevance Abnormal healing of gastric perforation may cause morbidity and increase the risk of death. Adipose tissue-derived mesenchymal stem cells have been found to promote the healing of organ injuries through cellular differentiation and secretion of cytokines that stimulate cellular proliferation and angiogenesis, and suppress inflammation. This study explored the therapeutic potential of such mesenchymal stem cells for promotion of the healing of sutured gastric perforations. Mesenchymal stem cells delivered by local injection significantly enhanced the healing of gastric perforations with reduced severity of wound adhesion, and a decreased incidence of wound dehiscence and abdominal abscess. The increased expression of transforming growth factor ß1, proliferating cell nuclear antigen and reduced level of interleukin 6 provide evidence for enhancement of the healing process. Engrafted mesenchymal stem cells expressed α-smooth muscle actin as a marker of myofibroblasts. This preclinical study indicates that local injection of allogeneic adipose tissue-derived mesenchymal stem cells may have a potential therapeutic role in enhancing the healing of peptic ulcer disease and prevention of ulcer-related complications.
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Transplante de Células-Tronco Mesenquimais/métodos , Cicatrização/fisiologia , Tecido Adiposo/citologia , Tecido Adiposo/transplante , Administração Tópica , Animais , Diferenciação Celular/fisiologia , Ciclo-Oxigenase 2/metabolismo , Modelos Animais de Doenças , Feminino , Adesivo Tecidual de Fibrina/administração & dosagem , Gastrite/metabolismo , Injeções , Perfuração Intestinal/patologia , Perfuração Intestinal/terapia , Células-Tronco Mesenquimais/citologia , Pressão , Ratos Sprague-Dawley , Gastropatias/patologia , Gastropatias/terapia , Deiscência da Ferida Operatória , Técnicas de Sutura , Adesivos Teciduais/administração & dosagem , Fator de Crescimento Transformador beta1/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismoRESUMO
OBJECTIVE: The aim of this study is to enhance the understanding of frequent blood donors' characteristics and devise strategies to achieve an optimal blood inventory. BACKGROUND: Apart from donor recruitment and retention, an effective way to increase blood supply is to increase the donation frequency among donors. Understanding the characteristics of frequent donors will be helpful to impact their future donation pattern, which would in turn achieve a stable and adequate blood inventory to meet the changing demands of the society. METHODS AND MATERIALS: Demographic information of blood donors for each donation in Hong Kong (HK) was routinely collected and stored in the database of Hong Kong Red Cross Blood Transfusion Service. Logistic regression models (by gender group) with interaction effects were constructed to analyse the differences in the likelihood of being frequent donors and the associations with their demographic characteristics. RESULTS: A total of 158,666 blood donors in 2010 gave 227,634 donations during the study. In general, male donors were more likely to be frequent donors. Logistic regression models further identified the characteristics of frequent donors in HK: older, blood type Rh D-ve and repeat donors, although their extent of impact was different for different gender group. CONCLUSION: To achieve an optimal blood inventory to meet the challenge of ageing in the society, donors who donate less often should be targeted to increase their donation frequency. More efforts in promotion should be made to recruit those non-donors to join the blood donation pool and motivate 'targeted' existing donors in the population to participate blood donation more regularly.
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Doadores de Sangue , Bases de Dados Factuais , Demografia , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
OBJECTIVES: To investigate how the introduction of noninvasive prenatal testing (NIPT) influenced women's testing choices following a positive Down syndrome screening. METHODS: A retrospective study was conducted to compare differences in the uptake rates of invasive prenatal diagnosis (IPD) or no testing in one public hospital 1 year before (pre-NIPT) and 1 and 2 years after the introduction of NIPT in private in August 2011 using descriptive analysis and a χ² test. Conventional screening was funded publicly, but NIPT was not. Multivariable binary logistic regression was used to determine factors affecting choices. RESULTS: In pre-NIPT and in years 1 and 2 after the introduction of NIPT, 306, 362 and 401 women who screened positive were seen, respectively. In year 1 and year 2, 12.6 and 26.7% of them underwent NIPT while IPD was decreased by 16.3 and 25.6%, respectively (p < 0.001). Both chorionic villus sampling and amniocentesis decreased in year 1, but only the former in year 2. However, the rate of declining further testing was similar before and after NIPT (p = 0.213). In multivariable analysis, first trimester screening, nulliparity and working women were significant predictors of accepting NIPT, while only nulliparity was a predictor of declining IPD (OR = 0.61). CONCLUSIONS: Introduction of NIPT resulted in a significant decrease in IPD for 2 consecutive years..
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Povo Asiático/etnologia , Síndrome de Down/diagnóstico , Síndrome de Down/etnologia , Diagnóstico Pré-Natal/tendências , Adulto , Amniocentese/métodos , Amniocentese/tendências , Amostra da Vilosidade Coriônica/métodos , Amostra da Vilosidade Coriônica/tendências , Estudos de Coortes , Feminino , Humanos , Gravidez , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/tendênciasRESUMO
The authors present 2 unusual cases of haemoglobin (Hb) Bart's hydrops fetalis and highlight the problem of a screening system for α-thalassaemia which focuses on maternal and paternal mean corpuscular volume (MCV) alone. Normal paternal MCV may not preclude fetal Hb Bart's disease because of the rare occurrence of maternal uniparental disomy or non-paternity. During a mid-trimester anomaly scan, with fetal cardiomegaly or hydrops in a woman with low MCV but normal paternal MCV, obstetricians should remain alert for fetal Hb Bart's disease. This is very important and relevant for national screening systems in South-East Asia, where a routine mid-trimester scan may not be available. A routine mid-trimester anomaly scan should therefore be implemented and in high prevalence areas, sonographers should be sensitive to the cardio-thoracic ratio even if screening shows that pregnancy is unlikely to be at risk.
Assuntos
Hidropisia Fetal/genética , Paternidade , Dissomia Uniparental , Adulto , Índices de Eritrócitos , Feminino , Hemoglobinas Anormais/genética , Humanos , Hidropisia Fetal/diagnóstico por imagem , Gravidez , Diagnóstico Pré-Natal , Ultrassonografia , Talassemia alfa/sangue , Talassemia alfa/genéticaRESUMO
BACKGROUND: Maintenance of an effective pool of regular donors is important for protecting public health. In planning the development of blood donation services, motivation for repeat donation would need to be considered in context of the location of blood donation centres in the community. STUDY DESIGN AND METHODS: Donors giving blood in January 2012 were invited to participate in a cross-sectional study by completing an anonymous online questionnaire. Residence and work/school locations were collected together with demographics and donation histories. Motivated donors were compared with less motivated ones in terms of their timing of blood donation and the spatial relationship with the donor centres. RESULTS: A total of 3744 questionnaires were completed, representing a response rate of 16.4%. Weekday centre donors were less likely to have returned for blood donation within a year [odds ratio (OR) = 0.79, 95% confidence interval (CI) = 0.65-0.96] and intend to donate in the following 6 months (OR = 0.69, 95% CI = 0.49-0.97). Living further away from the donor centres gave a higher OR for giving blood during weekdays among motivated centre donors, but such association was absent among less motivated centre donors. Regardless of the level of donors' motivation for blood donation, fewer weekday donations were made if the distance between location of school or workplace and donor centre increased. CONCLUSION: Blood donation behaviour was associated with both the accessibility of donor centres and daily commuting patterns of the residents. Motivated centre donors were making more donations, regardless of the distance.
Assuntos
Atividades Cotidianas , Doadores de Sangue , Motivação , Inquéritos e Questionários , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: The use of computed tomography (CT) in healthcare institutions has increased rapidly in recent years. The Singapore Health Services (SingHealth) cluster of healthcare institutions has taken the first step in establishing a local cluster-wide CT Diagnostic Reference Levels (DRL) in Singapore. CT dose data from each institution were collected through two primary dosimetry metrics: volume CT dose index (CTDIvol measured in mGy) and dose-length product (DLP measured in mGy.cm). METHODS: Data from 19 CT scanners in seven institutions under one of Singapore healthcare cluster were retrospectively collected and analysed. The five common adult CT examinations analysed were CT Brain (non-contrast enhanced), CT Chest (IV contrast enhanced), CT Kidney-Ureter-Bladder (CT KUB, non-contrast enhanced), CT Pulmonary Angiogram (CT PA, IV contrast enhanced) and CT Abdomen-Pelvis (CT AP, IV contrast enhanced, single phase). Median CTDIvol and DLP values for the five CT examinations from each institution were derived, with the cluster DRLs determined as the 75th percentile of the distribution of the institution median dose values. RESULTS: A total of 2413 dose data points were collected over a six-month period from June to November 2020. The cluster CT DRLs for the five CT examinations were determined to be 47 mGy and 820 mGy.cm for CT Brain, 5.4 mGy and 225 mGy.cm for CT Chest, 6.7 mGy and 248 mGy.cm for CT PA, 4.6 mGy and 190 mGy.cm for CT KUB and 6.9 mGy and 349 mGy.cm for CT AP. CONCLUSION: The establishment of the cluster CT DRLs provided individual institutions with a better understanding if their CT doses are unusually high or low, while emphasising that these DRLs are not meant as hard dose limits or constraints to follow strictly.