RESUMEN
Rationale: Obstructive sleep apnea (OSA)-induced endothelial cell (EC) dysfunction contributes to OSA-related cardiovascular sequelae. The mechanistic basis of endothelial impairment by OSA is unclear. Objectives: The goals of this study were to identify the mechanism of OSA-induced EC dysfunction and explore the potential therapies for OSA-accelerated cardiovascular disease. Methods: The experimental methods include data mining, bioinformatics, EC functional analyses, OSA mouse models, and assessment of OSA human subjects. Measurements and Main Results: Using mined microRNA sequencing data, we found that microRNA 210 (miR-210) conferred the greatest induction by intermittent hypoxia in ECs. Consistently, the serum concentration of miR-210 was higher in individuals with OSA from two independent cohorts. Importantly, miR-210 concentration was positively correlated with the apnea-hypopnea index. RNA sequencing data collected from ECs transfected with miR-210 or treated with OSA serum showed a set of genes commonly altered by miR-210 and OSA serum, which are largely involved in mitochondrion-related pathways. ECs transfected with miR-210 or treated with OSA serum showed reduced [Formula: see text]o2 rate, mitochondrial membrane potential, and DNA abundance. Mechanistically, intermittent hypoxia-induced SREBP2 (sterol regulatory element-binding protein 2) bound to the promoter region of miR-210, which in turn inhibited the iron-sulfur cluster assembly enzyme and led to mitochondrial dysfunction. Moreover, the SREBP2 inhibitor betulin alleviated intermittent hypoxia-increased systolic blood pressure in the OSA mouse model. Conclusions: These results identify an axis involving SREBP2, miR-210, and mitochondrial dysfunction, representing a new mechanistic link between OSA and EC dysfunction that may have important implications for treating and preventing OSA-related cardiovascular sequelae.
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Enfermedades Cardiovasculares , MicroARNs , Apnea Obstructiva del Sueño , Enfermedades Vasculares , Animales , Ratones , Humanos , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/genética , Hipoxia/genética , MicroARNs/genéticaRESUMEN
BACKGROUND: The aim of this retrospective study was to construct and clinically apply a nomogram for cancer-specific survival (CSS) in patients diagnosed with base-of-tongue squamous cell carcinoma (BOTSCC) to predict their survival prognosis. METHODS: We collected 8448 patients diagnosed with BOTSCC during 2004-2015 from the Surveillance, Epidemiology, and End Results (SEER) database and divided 30% and 70% of them into validation and training cohorts, respectively. We utilized backward stepwise regression in the Cox model to select variables. Predictive variables were subsequently identified from the variables selected above by using multivariate Cox regression. The new survival model was compared with the American Joint Committee on Cancer (AJCC) prognosis model using the following variables: calibration curve, time-dependent area under the receiver operating characteristic curve (AUC), concordance index (C-index), integrated discrimination improvement (IDI), decision-curve analysis (DCA), and net reclassification improvement (NRI). RESULTS: A nomogram was established for predicting the CSS probability in patients with BOTSCC. Factors including sex, race, age at diagnosis, marital status, radiotherapy status, chemotherapy status, TNM AJCC stage, surgery status, tumor size, and months from diagnosis to treatment were selected through multivariate Cox regression as independent predictors of CSS. Calibration plots indicated that the model we established had satisfactory calibration ability. The AUC, C-index, IDI, DCA, and NRI results illustrated that the nomogram performed explicit prognoses more accurately than did the AJCC system alone. CONCLUSION: We identified the relevant factors affecting the survival of BOTSCC patients and analyzed the data on patients suffering from BOTSCC in the SEER database. These factors were used to construct a new nomogram to give clinical staff a more-visual prediction model for the 3-, 5-, and 8-year probabilities of CSS for patients newly diagnosed with BOTSCC, thereby aiding clinical decision making.
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Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias Laríngeas , Neoplasias de la Lengua , Humanos , Pronóstico , Nomogramas , Carcinoma de Células Escamosas/terapia , Estudios Retrospectivos , Neoplasias de la Lengua/terapia , Carcinoma de Células Escamosas de Cabeza y Cuello , Lengua , Programa de VERFRESUMEN
We investigated clinical information underneath the beat-to-beat fluctuation of the arterial blood pressure (ABP) waveform morphology. We proposed the Dynamical Diffusion Map algorithm (DDMap) to quantify the variability of morphology. The underlying physiology could be the compensatory mechanisms involving complex interactions between various physiological mechanisms to regulate the cardiovascular system. As a liver transplant surgery contains distinct periods, we investigated its clinical behavior in different surgical steps. Our study used DDmap algorithm, based on unsupervised manifold learning, to obtain a quantitative index for the beat-to-beat variability of morphology. We examined the correlation between the variability of ABP morphology and disease acuity as indicated by Model for End-Stage Liver Disease (MELD) scores, the postoperative laboratory data, and 4 early allograft failure (EAF) scores. Among the 85 enrolled patients, the variability of morphology obtained during the presurgical phase was best correlated with MELD-Na scores. The neohepatic phase variability of morphology was associated with EAF scores as well as postoperative bilirubin levels, international normalized ratio, aspartate aminotransferase levels, and platelet count. Furthermore, variability of morphology presents more associations with the above clinical conditions than the common BP measures and their BP variability indices. The variability of morphology obtained during the presurgical phase is indicative of patient acuity, whereas those during the neohepatic phase are indicative of short-term surgical outcomes.
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Enfermedad Hepática en Estado Terminal , Trasplante de Hígado , Humanos , Presión Arterial , Enfermedad Hepática en Estado Terminal/cirugía , Bilirrubina , Índice de Severidad de la Enfermedad , Presión Sanguínea , Estudios RetrospectivosRESUMEN
Bariatric surgery reduces body weight, enhances metabolic and diabetic control, and improves outcomes on obesity-related comorbidities. However, the mechanisms mediating this protection against cardiovascular diseases remain unclear. We investigated the effect of sleeve gastrectomy (SG) on vascular protection in response to shear stress-induced atherosclerosis using an overweighted and carotid artery ligation mouse model. Eight-week-old male wild-type mice (C57BL/6J) were fed a high-fat diet (HFD) for two weeks to induce weight gain and dysmetabolism. SG was performed in HFD-fed mice. Two weeks after the SG procedure, partial carotid-artery ligation was performed to promote disturbed flow-induced atherosclerosis. Compared with the control mice, HFD-fed wild-type mice exhibited increased body weight, total cholesterol level, hemoglobin A1c, and enhanced insulin resistance; SG significantly reversed these adverse effects. As expected, HFD-fed mice exhibited greater neointimal hyperplasia and atherosclerotic plaques than the control group, and the SG procedure attenuated HFD-promoted ligation-induced neointimal hyperplasia and arterial elastin fragmentation. Besides, HFD promoted ligation-induced macrophage infiltration, matrix metalloproteinase-9 expression, upregulation of inflammatory cytokines, and increased vascular endothelial growth factor secretion. SG significantly reduced the above-mentioned effects. Moreover, HFD restriction partially reversed the intimal hyperplasia caused by carotid artery ligation; however, this protective effect was significantly lower than that observed in SG-operated mice. Our study demonstrated that HFD deteriorates shear stress-induced atherosclerosis and SG mitigates vascular remodeling, and this protective effect was not comparable in HFD restriction group. These findings provide a rationale for using bariatric surgery to counter atherosclerosis in morbid obesity.
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Aterosclerosis , Obesidad Mórbida , Ratones , Masculino , Animales , Pérdida de Peso/fisiología , Dieta Alta en Grasa/efectos adversos , Hiperplasia , Factor A de Crecimiento Endotelial Vascular , Ratones Endogámicos C57BL , Obesidad Mórbida/cirugía , Gastrectomía/métodos , Aterosclerosis/etiologíaRESUMEN
Pulsatile shear (PS) and oscillatory shear (OS) elicit distinct mechanotransduction signals that maintain endothelial homeostasis or induce endothelial dysfunction, respectively. A subset of microRNAs (miRs) in vascular endothelial cells (ECs) are differentially regulated by PS and OS, but the regulation of the miR processing and its implications in EC biology by shear stress are poorly understood. From a systematic in silico analysis for RNA binding proteins that regulate miR processing, we found that nucleolin (NCL) is a major regulator of miR processing in response to OS and essential for the maturation of miR-93 and miR-484 that target mRNAs encoding Krüppel-like factor 2 (KLF2) and endothelial nitric oxide synthase (eNOS). Additionally, anti-miR-93 and anti-miR-484 restore KLF2 and eNOS expression and NO bioavailability in ECs under OS. Analysis of posttranslational modifications of NCL identified that serine 328 (S328) phosphorylation by AMP-activated protein kinase (AMPK) was a major PS-activated event. AMPK phosphorylation of NCL sequesters it in the nucleus, thereby inhibiting miR-93 and miR-484 processing and their subsequent targeting of KLF2 and eNOS mRNA. Elevated levels of miR-93 and miR-484 were found in sera collected from individuals afflicted with coronary artery disease in two cohorts. These findings provide translational relevance of the AMPK-NCL-miR-93/miR-484 axis in miRNA processing in EC health and coronary artery disease.
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Enfermedad de la Arteria Coronaria/genética , Mecanotransducción Celular/genética , MicroARNs/metabolismo , Fosfoproteínas/metabolismo , Proteínas de Unión al ARN/metabolismo , Proteínas Quinasas Activadas por AMP/genética , Proteínas Quinasas Activadas por AMP/metabolismo , Adulto , Anciano , Animales , Estudios de Casos y Controles , Células Cultivadas , Biología Computacional , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/patología , Células Endoteliales/patología , Endotelio Vascular/citología , Endotelio Vascular/patología , Femenino , Técnicas de Silenciamiento del Gen , Humanos , Factores de Transcripción de Tipo Kruppel/genética , Masculino , Ratones , MicroARNs/antagonistas & inhibidores , MicroARNs/sangre , Persona de Mediana Edad , Óxido Nítrico Sintasa de Tipo III/genética , Fosforilación , Procesamiento Proteico-Postraduccional , Procesamiento Postranscripcional del ARN , Serina/metabolismo , Estrés Mecánico , NucleolinaRESUMEN
The pathophysiology of sepsis involves inflammation and hypercoagulability, which lead to microvascular thrombosis and compromised organ perfusion. Dipeptidyl peptidase (DPP)-4 inhibitors, e.g., linagliptin, are commonly used anti-diabetic drugs known to exert anti-inflammatory effects. However, whether these drugs confer an anti-thrombotic effect that preserves organ perfusion in sepsis remains to be investigated. In the present study, human umbilical vein endothelial cells (HUVECs) were treated with linagliptin to examine its anti-inflammatory and anti-thrombotic effects under tumor necrosis factor (TNF)-α treatment. To validate findings from in vitro experiments and provide in vivo evidence for the identified mechanism, a mouse model of lipopolysaccharide (LPS)-induced systemic inflammatory response syndrome was used, and pulmonary microcirculatory thrombosis was measured. In TNF-α-treated HUVECs and LPS-injected mice, linagliptin suppressed expressions of interleukin-1ß (IL-1ß) and intercellular adhesion molecule 1 (ICAM-1) via a nuclear factor-κB (NF-κB)-dependent pathway. Linagliptin attenuated tissue factor expression via the Akt/endothelial nitric oxide synthase pathway. In LPS-injected mice, linagliptin pretreatment significantly reduced thrombosis in the pulmonary microcirculation. These anti-inflammatory and anti-thrombotic effects were independent of blood glucose level. Together the present results suggest that linagliptin exerts protective effects against endothelial inflammation and microvascular thrombosis in a mouse model of sepsis.
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Inhibidores de la Dipeptidil-Peptidasa IV , Sepsis , Trombosis , Animales , Dipeptidil Peptidasa 4 , Inhibidores de la Dipeptidil-Peptidasa IV/farmacología , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Dipeptidil-Peptidasas y Tripeptidil-Peptidasas , Modelos Animales de Enfermedad , Células Endoteliales de la Vena Umbilical Humana , Humanos , Hipoglucemiantes/farmacología , Inflamación/tratamiento farmacológico , Linagliptina/farmacología , Linagliptina/uso terapéutico , Lipopolisacáridos/farmacología , Ratones , Microcirculación , Sepsis/complicaciones , Sepsis/tratamiento farmacológico , Trombosis/tratamiento farmacológico , Trombosis/etiología , Factor de Necrosis Tumoral alfa/farmacologíaRESUMEN
BACKGROUND: Cardiovascular waveforms contain information for clinical diagnosis. By learning and organizing the subtle change of waveform morphology from large amounts of raw waveform data, unsupervised manifold learning helps delineate a high-dimensional structure and display it as a novel 3-dimensional (3D) image. We hypothesize that the shape of this structure conveys clinically relevant inner dynamics information. METHODS: To validate this hypothesis, we investigate the electrocardiography (ECG) waveform for ischemic heart disease and arterial blood pressure (ABP) waveform in dynamic vasoactive episodes. We model each beat or pulse to be a point lying on a manifold-like a surface-and use the diffusion map (DMap) to establish the relationship among those pulses. The output of the DMap is converted to a 3D image for visualization. For ECG datasets, first we analyzed the non-ST-elevation ECG waveform distribution from unstable angina to healthy control in the 3D image, and we investigated intraoperative ST-elevation ECG waveforms to show the dynamic ECG waveform changes. For ABP datasets, we analyzed waveforms collected under endotracheal intubation and administration of vasodilator. To quantify the dynamic separation, we applied the support vector machine (SVM) analysis and reported the total accuracy and macro-F1 score. We further performed the trajectory analysis and derived the moving direction of successive beats (or pulses) as vectors in the high-dimensional space. RESULTS: For the non-ST-elevation ECG, a hierarchical tree structure comprising consecutive ECG waveforms spanning from unstable angina to healthy control is presented in the 3D image (accuracy = 97.6%, macro-F1 = 96.1%). The DMap helps quantify and visualize the evolving direction of intraoperative ST-elevation myocardial episode in a 1-hour period (accuracy = 97.58%, macro-F1 = 96.06%). The ABP waveform analysis of Nicardipine administration shows interindividual difference (accuracy = 95.01%, macro-F1 = 96.9%) and their common directions from intraindividual moving trajectories. The dynamic change of the ABP waveform during endotracheal intubation shows a loop-like trajectory structure, which can be further divided using the manifold learning knowledge obtained from Nicardipine. CONCLUSIONS: The DMap and the generated 3D image of ECG or ABP waveforms provides clinically relevant inner dynamics information. It provides clues of acute coronary syndrome diagnosis, shows clinical course in myocardial ischemic episode, and reveals underneath physiological mechanism under stress or vasodilators.
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Bases de Datos Factuales , Electrocardiografía/métodos , Frecuencia Cardíaca/fisiología , Imagenología Tridimensional/métodos , Aprendizaje Automático no Supervisado , Análisis de Ondículas , Humanos , Procesamiento de Señales Asistido por ComputadorRESUMEN
Toll-like receptor-mediated NF-κB activation is a major innate immune reaction of vascular endothelial cells (ECs) in response to prooxidative and proinflammatory stimuli. We identified that TNF-α receptor-associated factor-interacting protein with a forkhead-associated domain (TIFA) is a regulator of priming (signal 1) and activating (signal 2) signals of nucleotide oligomerization domain-like receptor family pyrin domain-containing protein 3 (NLRP3) inflammasome in ECs. Oxidative and inflammatory stresses such as atheroprone flow and hyperlipidemia induce and activate TIFA in vitro and in vivo. For the priming of signal 1, sterol regulatory element-binding protein 2 transactivates TIFA, which in turn induces NF-κB activation and augments the transcription of NLRP3 inflammasome components. For the activation of signal 2, Akt is involved in TIFA Thr9 phosphorylation, which is essential for TIFA-TIFA homophilic oligomerization. Thr9 phosphorylation-dependent TIFA oligomerization facilitates the higher-order assembly of NLRP3 inflammasome, as indicated by the interaction between TIFA and caspase-1 in the activated ECs. Our results suggest that TIFA is a crucial mediator in the endothelial innate immune response by potentiating and amplifying NLRP3 inflammasome via augmenting signals 1 and 2.
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Proteínas Adaptadoras Transductoras de Señales/metabolismo , Inflamasomas/metabolismo , Proteína con Dominio Pirina 3 de la Familia NLR/metabolismo , Animales , Apolipoproteínas E/genética , Endotelio/metabolismo , Células HEK293 , Células Endoteliales de la Vena Umbilical Humana , Humanos , Inmunidad Innata , Inflamación , Pulmón/metabolismo , Masculino , Ratones , Ratones Transgénicos , FN-kappa B/metabolismo , Estrés Oxidativo , Fosforilación , Interferencia de ARN , Transducción de Señal/efectos de los fármacos , Proteína 2 de Unión a Elementos Reguladores de Esteroles/metabolismo , Transcripción GenéticaRESUMEN
BACKGROUND: Human gut microbiome has an essential role in human health and disease. Although the major dominant microbiota within individuals have been reported, the change of gut microbiome caused by external factors, such as antibiotic use and bowel cleansing, remains unclear. We conducted this study to investigate the change of gut microbiome in overweight male adults after bowel preparation, where none of the participants had been diagnosed with any systemic diseases. METHODS: A total of 20 overweight, male Taiwanese adults were recruited, and all participants were omnivorous. The participants provided fecal samples and blood samples at three time points: prior to bowel preparation, 7 days after colonoscopy, and 28 days after colonoscopy. The microbiota composition in fecal samples was analyzed using 16S ribosome RNA gene amplicon sequencing. RESULTS: Our results demonstrated that the relative abundance of the most dominant bacteria hardly changed from prior to bowel preparation to 28 days after colonoscopy. Using the ratio of Prevotella to the sum of Prevotella and Bacteroides in the fecal samples at baseline, the participants were separated into two groups. The fecal samples of the Type 1 group was Bacteroides-dominant, and that of the Type 2 group was Prevotella-dominant with a noticeable presence Bacteroides. Bulleidia appears more in the Type 1 fecal samples, while Akkermensia appears more in the Type 2 fecal samples. Of each type, the gut microbial diversity differed slightly among the three collection times. Additionally, the Type 2 fecal microbiota was temporarily susceptible to bowel cleansing. Predictive functional analysis of microbial community reveals that their activities for the mineral absorption metabolism and arachidonic acid metabolism differed significantly between the two types. Depending on their fecal type, the variance of triglycerides and C-reactive protein also differed between the two types of participants. CONCLUSIONS: Depending upon the fecal type, the microbial diversity and the predictive functional modules of microbial community differed significantly after bowel preparation. In addition, blood biochemical markers presented somewhat associated with fecal type. Therefore, our results might provide some insights as to how knowledge of the microbial community could be used to promote health through personalized clinical treatment.
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Heces/microbiología , Microbioma Gastrointestinal , Sobrepeso/microbiología , Adulto , Biodiversidad , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
CKD is an independent risk factor for cardiovascular disease (CVD). The accumulation of uremic toxins in CKD induces oxidative stress and endothelial dysfunction. MicroRNA-92a (miR-92a) is induced by oxidative stress in endothelial cells (ECs) and involved in angiogenesis and atherosclerosis. We investigated a role for oxidative stress-responsive miR-92a in CKD. Our study of patients at three clinical sites showed increased serum miR-92a level with decreased kidney function. In cultured ECs, human CKD serum or uremic toxins (such as indoxyl sulfate), compared with non-CKD serum, induced the levels of miR-92a and suppressed the expression of miR-92a targets, including key endothelial-protective molecules. The antioxidant N-acetylcysteine inhibited these vasculopathic properties. In rats, adenine-induced CKD associated with increased levels of miR-92a in aortas, serum, and CD144+ endothelial microparticles. Furthermore, CD144+ microparticles from human uremic serum contained more miR-92a than those from control serum. Additional analysis showed a positive correlation between serum levels of miR-92a and indoxyl sulfate in a cohort of patients with ESRD undergoing hemodialysis. Collectively, our findings suggest that the uremic toxins accumulated in CKD can upregulate miR-92a in ECs, which impairs EC function and predisposes patients to CVD.
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Células Endoteliales/fisiología , MicroARNs/fisiología , Insuficiencia Renal Crónica/fisiopatología , Animales , Femenino , Humanos , Masculino , MicroARNs/sangre , Persona de Mediana Edad , Ratas , Ratas Wistar , Insuficiencia Renal Crónica/sangreRESUMEN
Aims: Trimethylamine-N-oxide (TMAO) is a metabolite generated from dietary choline, betaine, and l-carnitine, after their oxidization in the liver. TMAO has been identified as a novel independent risk factor for atherosclerosis through the induction of vascular inflammation. However, the effect of TMAO on neointimal formation in response to vascular injury remains unclear. Results: This study was conducted using a murine model of acutely disturbed flow-induced atherosclerosis induced by partial carotid artery ligation. 3,3-Dimethyl-1-butanol (DMB) was used to reduce TMAO concentrations. Wild-type mice were divided into four groups [regular diet, high-TMAO diet, high-choline diet, and high-choline diet+DMB] to investigate the effects of TMAO elevation and its inhibition by DMB. Mice fed high-TMAO and high-choline diets had significantly enhanced neointimal hyperplasia and advanced plaques, elevated arterial elastin fragmentation, increased macrophage infiltration and inflammatory cytokine secretion, and enhanced activation of nuclear factor (NF)-κB, the NLRP3 inflammasome, and endoplasmic reticulum (ER) stress relative to the control group. Mice fed high-choline diets with DMB treatment exhibited attenuated flow-induced atherosclerosis, inflammasome expression, ER stress, and reactive oxygen species expression. Human aortic smooth muscle cells (HASMCs) were used to investigate the mechanism of TMAO-induced injury. The HASMCs were treated with TMAO with or without an ER stress inhibitor to determine whether inhibition of ER stress modulates the TMAO-induced inflammatory response. Innovation: This study demonstrates that TMAO regulates vascular remodeling via ER stress. Conclusion: Our findings demonstrate that TMAO elevation promotes disturbed flow-induced atherosclerosis and that DMB administration mitigates vascular remodeling, suggesting a rationale for a TMAO-targeted strategy for the treatment of atherosclerosis. Antioxid. Redox Signal. 38, 215-233.
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Aterosclerosis , Inflamasomas , Animales , Humanos , Ratones , Aterosclerosis/tratamiento farmacológico , Aterosclerosis/etiología , Arterias Carótidas/metabolismo , Colina/metabolismo , Modelos Animales de Enfermedad , Inflamasomas/metabolismo , FN-kappa B/metabolismo , Estrés Oxidativo , Remodelación VascularRESUMEN
BACKGROUND: Liver transplantation (LT) is being increasingly performed for alcohol-related liver disease (ALD). It is unclear whether the increasing frequency of LTs in ALD patients has a negative impact on deceased-donor (DDLT) allocation and whether the current policy of 6 months of abstinence before transplantation effectively prevents recidivism after transplantation or improves long-term outcomes. METHODS: A total of 506 adult LT recipients, including 97 ALD patients, were enrolled. The outcomes of ALD patients were compared with those of non-ALD patients. The 97 ALD patients were further divided into group A (6-month abstinence) and group N (nonabstinence) based on the pretransplant alcohol withdrawal period. The incidence of relapsed drinking and the long-term outcomes were compared between the two groups. RESULTS: The prevalence of LT for ALD significantly increased after 2016 (27.0% vs 14.0%; p < 0.01), but the frequency of DDLT for ALD remained unchanged (22.6% vs 34.1%, p = 0.210). After a median follow-up of 56.9 months, patient survival was comparable between the ALD and non-ALD patients (1, 3, and 5 years posttransplant: 87.6%, 84.3%, and 79.5% vs 82.8%, 76.6%, and 72.2%, respectively; p = 0.396). The results were consistent irrespective of the transplant type and disease severity. In ALD patients, 22 of the 70 (31.4%) patients reported relapsed drinking after transplantation, and the prevalence in group A had a higher tendency than that in group N (38.3% vs 17.4%, p = 0.077). Six months of abstinence or nonabstinence did not result in a survival difference, and de novo malignancies were the leading cause of late patient death in ALD patients. CONCLUSION: LT achieves favorable outcomes for ALD patients. Six months of abstinence pretransplant did not predict the risk of recidivism after transplantation. The high incidence of de novo malignancies in these patients warrants a more comprehensive physical evaluation and better lifestyle modifications to improve long-term outcomes.
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Alcoholismo , Hepatopatías Alcohólicas , Trasplante de Hígado , Síndrome de Abstinencia a Sustancias , Adulto , Humanos , Hepatopatías Alcohólicas/cirugía , Hepatopatías Alcohólicas/epidemiología , RecurrenciaRESUMEN
Plasma-containing products are given during the pre-anhepatic stage of liver transplant surgery to correct abnormal thromboelastogram (TEG) values and prevent blood loss due to coagulation defects. However, evidence suggests that abnormal TEG results do not always predict bleeding. We questioned what effect using higher TEG values to initiate treatment would have on blood loss. A single transfusion protocol was used for all patients who underwent liver transplantation between 2007 and 2010. Thirty-eight patients received coagulation products when standard TEG cutoff values were exceeded, whereas another 39 patients received coagulation products when the TEG values were 35% greater than normal. The results of postoperative coagulation tests for total blood loss and the use of blood products were compared for the 2 groups. When the critical TEG values for transfusion were higher, significantly fewer units of fresh frozen plasma (5.58 ± 6.49 versus 11.53 ± 6.66 U) and pheresis platelets (1.84 ± 1.33 versus 3.55 ± 1.43 U) were used. There were no differences in blood loss or postoperative blood product use. In conclusion, the use of higher critical TEG values to initiate the transfusion of plasma-containing products is not associated with increased blood loss. Further testing is necessary to identify what TEG value predicts bleeding due to a deficit in coagulation factors.
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Pérdida de Sangre Quirúrgica/prevención & control , Transfusión Sanguínea , Fallo Renal Crónico/cirugía , Trasplante de Hígado , Tromboelastografía/métodos , Adulto , Coagulación Sanguínea , Factores de Coagulación Sanguínea , Pruebas de Coagulación Sanguínea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Plasma , Transfusión de Plaquetas , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Tromboelastografía/normasRESUMEN
Retrograde arterial flush (RGAF) of liver grafts, which prevents arterial intima injuries in living donor liver transplantation (LDLT), seemed to reduce post-transplantational cholestasis by our preliminary study. The aim of this study was to further confirm this effect of RGAF of grafts in LDLT by a prospective randomized study. The enrolled cases were randomly divided into two groups, RGAF (portal flush plus RGAF) and non-RGAF (portal flush only). The outcome measures included intra-operative hemodynamic changes, one-month post-transplantational liver function tests and acute cellular rejection, vascular and biliary complications, the length of postoperative hospital stay, and graft and patient survivals. The significant findings of results were lower postoperative serum bilirubin in the RGAF group until three wk after transplantation (days 1, 3, 7, 14, and 21 serum total bilirubin, mg/dL: 5.82±5.46, 3.95±4.28, 4.87±5.01, 3.62±5.32, and 3.63±6.91 vs. 8.41±5.49, 7.47±5.61, 10.0±10.1, 9.06±11.6, and 6.02±9.84, respectively, in RGAF and non-RGAF, p=0.017, 0.002, 0.014, 0.011, 0.109) and shorter postoperative hospital stay in the RGAF group (31.1±17.6 vs. 44.8±32.3 d, respectively, in RGAF and non-RGAF, p=0.035). In conclusion, the RGAF of liver grafts on a back table may ameliorate postoperative functional cholestasis in LDLT, which possibly reduces postoperative hospital stay.
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Colestasis/prevención & control , Arteria Hepática , Trasplante de Hígado/efectos adversos , Donadores Vivos , Perfusión , Adulto , Presión Sanguínea , Colestasis/etiología , Femenino , Humanos , Circulación Hepática , Masculino , Persona de Mediana Edad , Soluciones Preservantes de Órganos/administración & dosificación , Soluciones Preservantes de Órganos/efectos adversos , Sistema PortaRESUMEN
A new freshwater goby of Rhinogobius Gill, 1859, were collected from the Minjiang river basin, Fujian Province, PR China. The new goby, Rhinogobius lianchengensis n. sp. can be well distinguished from other congeneric species by the following combination of features: second dorsal fin I/8; anal fin I/6-7; pectoral fin modally 16-17; longitudinal scale rows 33-34; predorsal scales 0-3; vertebral count 27; and specific coloration pattern: scale pocket of lateral body with distal brown to blackish brown mark; cheek deep brown on dorsal half with 7-8 somewhat parallel oblique deep brown bars after the vertical stripe on snout in male; opercle brown to yellowish brown with net-like deep brown marks in both sexes; branchiostegal membrane bright yellow background with 16-19 deep red or brownish red spots in male; first dorsal fin with a black mark in male; pectoral fin base with a median patch of blackish spots surrounding with some irregularly large brown marks; and caudal fin yellow with 3-4 vertical rows of deep brown spots. A diagnostic key to all nominal Rhinogobius species from Fujian Province, PR China is provided.
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Perciformes , Ríos , Femenino , Masculino , Animales , Peces , Branquias , ChinaRESUMEN
A new freshwater rhinogoby has been collected and surveyed from northern Taiwan. The new species, Rhinogobius yangminshanensis n. sp. with fluvial life history can be well distinguished from other congeners by the following combination of features: (1) fin rays: second dorsal fin rays I/9; anal fin rays I/8; pectoral fin rays modally 16; (2) squamation: longitudinal scale series 28-30 (modally 29); perdorsal scales 9-10 (modally 9); (4) vertebral count 27; (5) rear edge of mouth: merely extending to vertical of anterior margin of pupil in male and (6) specific colouration: lateral side with 6-7 longitudinal rows of bright orange to orange red spots in male which general size about 1/2 of pupil diameter. Cheek and opercle with 24-35 orange spots in male. Branchiostegal membrane with many minute orange spots in male. Caudal fin with distally orange zone in male with about 3 vertical rows of orange or orange red spots. First dorsal fin with broad orange band on distally 1/3 area. A middle black spot in abterior first dorsal fin. Pectoral fin with two rows red orange spots in male. The phylogenetic comparisons have revealed that the great mitogenetic differences of R. yangminshanensis with all other congeneric species and sister species would be R. rubromaculatus in Taiwan. A diagnostic key to all valid species of Rhinogobius from Taiwan is also provided.
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Branquias , Perciformes , Masculino , Animales , Filogenia , Taiwán , Peces , Agua DulceRESUMEN
A new species of freshwater gobiid fish of genus Rhinogobius Gill, 1859, were collected from the upper tributary of Dongshi river basin of Janchou City in southern region of Fujian Province, China. Rhinogobius lingtongyanensis n. sp. can be well distinguished from other congeners by the following features: (1) fins: second dorsal fin rays I/8; anal fin rays I/7; pectoral fin rays modally 16; (2) squamation: longitudinal scale series 25-27 (modally 26); predorsal scales 3-6 (modally 5-6); (3) vertebral count 26; and (4) specific colouration in male: lateral body with 6-7 major patches of irregularly grayish to brownish black marks; cheek blackish brown with four oblique grayish black stripes; branchiostegal membrane grayish blue without any light spots; first dorsal fin broad grayish brown band in middle, outer margin pinkish orange; pectoral fin base with longitudinal deep brown bar in upper region; and caudal fin gray with four vertical rows of brown spots, its base with a short brownish black bar. It belongs to the non-diadromous, fluvial hill-stream species. A diagnostic key to all valid species from Fujian Province, China is also provided in this paper.
Asunto(s)
Perciformes , Ríos , Masculino , Animales , Peces , Agua Dulce , ChinaRESUMEN
Long-term data of fish assemblages collected in the rocky intertidal zone provides a valuable resource for elucidating the temporal variations in species diversity and intertidal ecosystems. In this study, we describe a long-term time-series dataset of fish collected by counting the number of anesthetized fish at sampling stations in the rocky tidepools on the southern coast of Taiwan. The species assemblages were monitored seasonally at the two stations for 16 y (2000-2008 and 2012-2018). In total, 86 samples containing 5137 individuals belonging to 82 species were recorded. Our data can be used for elucidating the temporal variations in fish assemblages and intertidal ecosystems and as background information for the resilience of the fish community conservation in coastal areas. The current study presents valuable data for researchers to understand the temporal and spatial variations in species abundance, richness, diversity, and composition in relation to climate change, environmental factors, and human activities.
Asunto(s)
Ecosistema , Peces , Animales , Humanos , Biodiversidad , Cambio Climático , Taiwán , Factores de TiempoRESUMEN
BACKGROUND: Trimethylamine N-oxide (TMAO) is a microbiota-derived metabolite, which is linked to vascular inflammation and atherosclerosis in cardiovascular (CV) diseases. But its effect in infectious diseases remains unclear. We conducted a single-center prospective study to investigate association of TMAO with in-hospital mortality in septic patients admitted to an intensive care unit (ICU). METHODS: Totally 95 septic, mechanically ventilated patients were enrolled. Blood samples were obtained within 24 h after ICU admission, and plasma TMAO concentrations were determined. Septic patients were grouped into tertiles according to TMAO concentration. The primary outcome was in-hospital death, which further classified as CV and non-CV death. Besides, we also compared the TMAO concentrations of septic patients with 129 non-septic patients who were admitted for elective coronary angiography (CAG). RESULTS: Septic patients had significantly lower plasma TMAO levels than did subjects admitted for CAG (1.0 vs. 3.0 µmol/L, p < 0.001). Septic patients in the lowest TMAO tertile (< 0.4 µmol/L) had poorer nutrition status and were given longer antibiotic courses before ICU admission. Circulating TMAO levels correlated positively with daily energy intake, the albumin and prealbumin concentration. Compared with those in the highest TMAO tertile, septic patients in the lowest TMAO tertile were at greater risk of non-CV death (hazard ratio 2.51, 95% confidence interval 1.21-5.24, p = 0.014). However, TMAO concentration was no longer an independent predictor for non-CV death after adjustment for disease severity and nutritional status. CONCLUSION: Plasma TMAO concentration was inversely associated with non-CV death among extremely ill septic patients, which could be characterized as TMAO paradox. For septic patients, the impact of malnutrition reflected by circulating TMAO levels was greater than its pro-inflammatory nature.
RESUMEN
The assemblage of fish species in the rocky intertidal zone is highly affected by the destructive impact of human activities and has an extended impact on land-sea interactions. There are a few long-term research projects that have focused on rocky intertidal ecosystems, especially on the resident fish community. Here, we describe a long-term time series dataset of fish collected by counting the number of anesthetized fishes at sampling stations in rocky tidepools in the intertidal zones on the northern coast of Taiwan. The species assemblages were monitored seasonally at three stations from 1999 to 2018. In total, 144 samples containing 1,577 individuals belonging to 106 species were recorded in the surveys. The resulting data can be used as background information for conservation and resilience studies of the fish community in coastal areas and to establish reasonable conservation strategies. This study presents valuable data to ecologists and fisheries biologists interested in understanding the temporal patterns of species abundance, richness, and composition in relation to environmental factors, climate change, and anthropogenic pressures.