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1.
Rev Med Interne ; 43(11): 640-644, 2022 Nov.
Artigo em Francês | MEDLINE | ID: mdl-36068122

RESUMO

INTRODUCTION: Colchicine is a narrow therapeutic margin drug that does not have the adverse effects of corticosteroids and immunosuppressants. Its use in non-severe ocular inflammatory disease excluding Behcet's disease has not been studied. METHODS: We included patients seen in the internal medicine department of Dijon University Hospital consecutively between September 2020 and September 2021 if they had received colchicine during their pathology. Patients with suspected Behçet's disease were excluded. Treatment efficacy was studied in patients with at least one year of disease progression who had received more than one year of colchicine. Successful treatment was defined as a 50 % reduction in the number of annual relapses on colchicine. RESULTS: Sixteen patients were included (9 women and 7 men). They had recurrent anterior uveitis (n=10), recurrent scleritis (n=5) and intermediate uveitis. Opthalmological involvement was neither severe nor complicated. All patients combined, the annual relapse ratio (ARR) decreased from 1.8 (0.8-3.5) to 0.3 (0-1.6), (P=0.06). Colchicine was considered effective in three of 10 analyzable patients. In only one patient, treatment was stopped for adverse effects after six weeks. CONCLUSION: In view of the interesting benefit-risk ratio of colchicine, it seems appropriate to focus on this molecule in non-granulomatous anterior uveitis and non-severe recurrent scleritis.


Assuntos
Síndrome de Behçet , Esclerite , Uveíte Anterior , Uveíte , Masculino , Humanos , Feminino , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamento farmacológico , Colchicina/efeitos adversos , Esclerite/diagnóstico , Esclerite/tratamento farmacológico , Esclerite/etiologia , Transtornos da Visão , Uveíte Anterior/complicações , Uveíte Anterior/tratamento farmacológico , Recidiva , Inflamação/complicações , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Uveíte/etiologia
2.
ESMO Open ; 7(3): 100470, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35461024

RESUMO

BACKGROUND: Resection of liver metastases from colorectal cancer (CRC) in the oligometastatic stage improves survival and is a potentially curative treatment. Thus, predictive scores that reliably identify those patients who especially benefit from surgery are essential. PATIENTS AND METHODS: In this multicenter analysis, 512 patients had undergone surgery for liver metastases from CRC. We investigated distinct cancer-specific risk factors that are routinely available in clinical practice and developed a predictive preoperative score using a training cohort (TC), which was thereafter tested in a validation cohort (VC). RESULTS: Inflammatory response to the tumor, a right-sided primary tumor, multiple liver metastases, and node-positive primary tumor were significant adverse variables for overall survival (OS). Patients were stratified in five groups according to the cumulative score given by the presence of these risk factors. Median OS for patients without risk factors was 133.8 months [95% confidence interval (CI) 81.2-not reached (nr)] in the TC and was not reached in the VC. OS decreased significantly for each subsequent group with increasing number of risk factors. Median OS was significantly shorter (P < 0.0001) for patients presenting all four risk factors: 14.3 months (95% CI 10.5 months-nr) in the TC and 16.6 months (95% CI 14.6 months-nr) in the VC. CONCLUSIONS: Including easily obtainable variables, this preoperative score identifies oligometastatic CRC patients with prolonged survival rates that may be cured, and harbors potential to be implemented in daily clinical practice.


Assuntos
Neoplasias Colorretais , Neoplasias Hepáticas , Neoplasias Colorretais/patologia , Humanos , Neoplasias Hepáticas/cirurgia , Prognóstico , Fatores de Risco
3.
IEEE Trans Biomed Eng ; 68(11): 3356-3365, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33822717

RESUMO

The integration of robotics into retinal microsurgery leads to a reduction in surgeon perception of tool-to-tissue interaction forces. This blunting of human tactile sensory input, which is due to the inflexible mass and large inertia of the robotic arm as compared to the milli-Newton scale of the interaction forces and fragile tissues during ophthalmic surgery, identifies a potential iatrogenic risk during robotic eye surgery. In this paper, we aim to evaluate two variants of an adaptive force control scheme implemented on the Steady-Hand Eye Robot (SHER) that are intended to mitigate the risk of unsafe scleral forces. The present study enrolled ten retina fellows and ophthalmology residents into a simulated procedure, which simply asked the trainees to follow retinal vessels in a model retina surgery environment. For this purpose, we have developed a force-sensing (equipped with Fiber Bragg Grating (FBG)) instrument to attach to the robot. A piezo-actuated linear stage for creating random lateral motions to the eyeball phantom has been provided to simulate disturbances during surgery. The SHER and all of its dependencies were set up in an operating room in the Wilmer Eye Institute at the Johns Hopkins Hospital. The clinicians conducted robot-assisted experiments with the adaptive controls incorporated as well as freehand manipulations. The results indicate that the Adaptive Norm Control (ANC) method, is able to maintain scleral forces at predetermined safe levels better than even freehand manipulations. Novice clinicians in robot training however, subjectively preferred freehand maneuvers over robotic manipulations. Clinician preferences once highly skilled with the robot is not assessed in this study.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Microcirurgia , Retina , Esclera/cirurgia
4.
Int J Nephrol ; 2021: 8864183, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33777453

RESUMO

INTRODUCTION: Acute kidney injury (AKI) significantly worsens the prognosis of hospitalized patients. In recent years, cell-based strategies have been established as a reliable option for improving AKI outcomes in experimental AKI. Our previous studies focused on the so-called proangiogenic cells (PACs). Mechanisms that contribute to PAC-mediated AKI protection include production/secretion of extracellular vesicles (MV, microvesicles). In addition, the cells most likely act by paracrinic processes (secretome). The current study evaluated whether AKI may be preventable by the administration of either PAC-derived MV and/or the secretome alone. METHODS: AKI was induced in male C57/Bl6N mice (8-12 weeks) by bilateral renal ischemia (IRI-40 minutes). Syngeneic murine PACs were stimulated with either melatonin, angiopoietin-1 or -2, or with bone morphogenetic protein-5 (BMP-5) for one hour, respectively. PAC-derived MV and the vesicle-depleted supernatant were subsequently collected and i.v.-injected after ischemia. Mice were analyzed 48 hours later. RESULTS: IRI induced significant kidney excretory dysfunction as reflected by higher serum cystatin C levels. The only measure that improved AKI was the injection of MV, collected from native PACs. The following conditions worsened after ischemic renal function even further: MV + Ang-1, MV + BMP-5, MV + melatonin, and MV + secretome + Ang-1. CONCLUSION: Together, our data show that PAC-mediated AKI protection substantially depends on the availability of cell-derived MV. However, since previous data showed improved AKI-protection by PACs after cell preconditioning with certain mediators (Ang-1 and -2, melatonin, BMP-5), mechanisms other than exclusively vesicle-dependent mechanisms must be involved in PAC-mediated AKI protection.

5.
Transl Vis Sci Technol ; 9(10): 2, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32953242

RESUMO

Purpose: This study aims to map force interaction between instrument and sclera of in vivo rabbits during retinal procedures, and verify if a robotic active force control could prevent unwanted increase of forces on the sclera. Methods: Experiments consisted in the performance of intraocular movements of a force sensing instrument, adjacent to the retinal surface, in radial directions, from the center to the periphery and back, and compared manual manipulations with robotic assistance and also robotic assistance with an active force control. This protocol was approved by the Animal Use and Ethical Committee and experiments were according to ARVO Statement of Animal Use. Results: Mean forces using manual manipulations were 115 ± 51 mN. Using robotic assistance, mean forces were 118 ± 49 mN. Using an active force control method, overall mean forces reduced to 69 ± 15, with a statistical difference compared with other methods (P < 0.001). Comparing intraocular directions, superior sector required higher forces and the force control method reduced differences in forces between users and retained the same force pattern between them. Conclusions: Results validate that the introduction of robotic assistance might increase the dynamic interactions between instrument and sclera, and the addition of an active force control method reduces the forces at levels lower than manual manipulations. Translational Relevance: All marketing benefits from extreme accuracy and stability from robots, however, redundancy of safety mechanisms during intraocular manipulations, especially on force control and surgical awareness, would allow all utility of robotic assistance in ophthalmology.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Animais , Microcirurgia , Coelhos , Retina/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Esclera/cirurgia
6.
Biochemistry (Mosc) ; 84(8): 954-962, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31522677

RESUMO

Recent pharmacological findings regarding rimonabant, an anorectic and cannabinoid type 1 receptor (CB1R) antagonist, strongly suggest that some of its effects on the metabolic parameters and energy balance in rats are not related to the centrally mediated reduction in caloric intake. Instead, they may be associated with acute induction of glycogenolysis in the liver, in combination with transient increase in glucose oxidation and persistent increase in fat oxidation. It is possible that rimonabant produced direct short- or long-term stimulatory effect on these processes in primary and cultured rat cells. Rimonabant slightly stimulated ß-oxidation of long-chain fatty acids in cultured rat myocytes overexpressing glucose transporter isoform 4, as well as activated phosphorylation of adenosine monophosphate-dependent protein kinase (AMPK) in primary rat hepatocytes upon long-term incubation. However, short-term action of rimonabant failed to stimulate ß-oxidation in myocytes, myotubes, and hepatocytes, as well as to upregulate AMPK phosphorylation, glycogenolysis, and cAMP levels in hepatocytes. As a consequence, the acute effects of rimonabant on hepatic glycogen content (reduction) and total energy expenditure (increase) in rats fed with a standard diet cannot be explained by direct stimulation of glycogenolysis and fatty acid oxidation in muscles and liver. Rather, these effects seem to be centrally mediated.


Assuntos
Ácidos Graxos/metabolismo , Glicogenólise/efeitos dos fármacos , Fígado/metabolismo , Fibras Musculares Esqueléticas/metabolismo , Oxirredução/efeitos dos fármacos , Receptor CB1 de Canabinoide/antagonistas & inibidores , Rimonabanto/farmacologia , Adenilato Quinase/metabolismo , Animais , Linhagem Celular , AMP Cíclico/metabolismo , Glucose/metabolismo , Glicogênio/metabolismo , Hepatócitos/metabolismo , Metabolismo dos Lipídeos/efeitos dos fármacos , Masculino , Fosforilação/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos
7.
Br J Oral Maxillofac Surg ; 57(1): 82-84, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30598320

RESUMO

Metastatic basal cell carcinoma (BCC) is rare. We treated a 44-year-old woman with an extended facial metatypical BCC in whom staging showed no local or distant metastases, but one year after resection, we diagnosed a local recurrence. Re-staging, using a fludeoxyglucose positron emission tomography-computed tomogram, (FDG PET-CT) showed suspected accumulations of FDG in the whole axial skeleton. Bone punch biopsy examination confirmed extensive bony metastases, and after resection of the relapse, we began her on a systemic treatment with a Hedgehog-pathway inhibitor (vismodegib), which resulted in partial remission.


Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Adulto , Feminino , Fluordesoxiglucose F18 , Humanos , Recidiva Local de Neoplasia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos Radiofarmacêuticos , Neoplasias Cutâneas/diagnóstico por imagem
8.
Artigo em Inglês | MEDLINE | ID: mdl-31890281

RESUMO

Eye surgery, specifically retinal micro-surgery involves sensory and motor skill that approaches human boundaries and physiological limits for steadiness, accuracy, and the ability to detect the small forces involved. Despite assumptions as to the benefit of robots in surgery and also despite great development effort, numerous challenges to the full development and adoption of robotic assistance in surgical ophthalmology, remain. Historically, the first in-human-robot-assisted retinal surgery occurred nearly 30 years after the first experimental papers on the subject. Similarly, artificial intelligence emerged decades ago and it is only now being more fully realized in ophthalmology. The delay between conception and application has in part been due to the necessary technological advances required to implement new processing strategies. Chief among these has been the better matched processing power of specialty graphics processing units for machine learning. Transcending the classic concept of robots performing repetitive tasks, artificial intelligence and machine learning are related concepts that has proven their abilities to design concepts and solve problems. The implication of such abilities being that future machines may further intrude on the domain of heretofore "human-reserved" tasks. Although the potential of artificial intelligence/machine learning is profound, present marketing promises and hype exceeds its stage of development, analogous to the seventieth century mathematical "boom" with algebra. Nevertheless robotic systems augmented by machine learning may eventually improve robot-assisted retinal surgery and could potentially transform the discipline. This commentary analyzes advances in retinal robotic surgery, its current drawbacks and limitations, and the potential role of artificial intelligence in robotic retinal surgery.

9.
Z Rheumatol ; 78(9): 881-888, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30276727

RESUMO

OBJECTIVE: To assess safety, effectiveness and onset of effect of rituximab (RTX) in routine clinical treatment of severe, active rheumatoid arthritis (RA). METHODS: Prospective, multi-centre, non-interventional study in rheumatological outpatient clinics or private practices in Germany. RTX-naïve adult patients were to receive RTX according to marketing authorisation and at their physician's discretion. Also according to their physician's discretion, patients could receive a second cycle of RTX (re-treatment = treatment continuation). Major outcome was the change in Disease Activity Score based on 28-joints count and erythrocyte sedimentation rate (DAS28-ESR) over 24 weeks and during 6 months of re-treatment. RESULTS: Overall, 1653 patients received at least one cycle RTX; 99.2% of these had received disease-modifying antirheumatic drugs (DMARD) pre-treatment and 75.5% anti-tumor necrosis factor(TNF)­α pre-treatment. After a mean interval of 8.0 months, 820 patients received RTX re-treatment. Mean DAS28-ESR decreased from 5.3 at baseline to 3.8 after 24 weeks (-1.5 [95% confidence interval, CI: -1.6; -1.4]), and from 4.1 at start of cycle 2 to 3.5 at study end (change from baseline: -1.8 [95% CI: -2.0; -1.7]). Improvements in DAS28-ESR and Health Assessment Questionnaire (HAQ) score occurred mainly during the first 12 weeks of RTX treatment, with further DAS28-ESR improvement until week 24 or month 6 of re-treatment. Improvements in DAS28-ESR and EULAR responses were more pronounced in seropositive patients. RF was a predictor of DAS28-ESR change to study end. Safety analysis showed the established profile of RTX. CONCLUSION: RTX was safe and effective in a real-life setting with rapid and sustained improvement in RA signs and symptoms.


Assuntos
Antirreumáticos , Artrite Reumatoide , Rituximab/uso terapêutico , Adulto , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Alemanha , Humanos , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
10.
Braz. j. med. biol. res ; 52(2): e7637, 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-984028

RESUMO

Non-diabetic individuals use hormones like insulin to improve muscle strength and performance. However, as insulin also leads the liver and the adipose tissue to an anabolic state, the purpose of this study was to investigate the effects of insulin on liver metabolism in trained non-diabetic Swiss mice. The mice were divided into four groups: sedentary treated with saline (SS) or insulin (SI) and trained treated with saline (TS) or insulin (TI). Training was made in a vertical stair, at 90% of the maximum load, three times per week. Insulin (0.3 U/kg body weight) or saline were given intraperitoneally five times per week. After eight weeks, tissue and blood were collected and in situ liver perfusion with glycerol+lactate or alanine+glutamine (4 mM each) was carried out. The trained animals increased their muscle strength (+100%) and decreased body weight gain (-11%), subcutaneous fat (-42%), mesenteric fat (-45%), and peritoneal adipocyte size (-33%) compared with the sedentary groups. Insulin prevented the adipose effects of training (TI). The gastrocnemius muscle had greater density of muscle fibers (+60%) and less connective tissue in the trained groups. Liver glycogen was increased by insulin (SI +40% and TI +117%), as well as liver basal glucose release (TI +40%). Lactate and pyruvate release were reduced to a half by training. The greater gluconeogenesis from alanine+glutamine induced by training (TS +50%) was reversed by insulin (TI). Insulin administration had no additional effect on muscle strength and reversed some of the lipolytic and gluconeogenic effects of the resistance training. Therefore, insulin administration does not complement training in improving liver glucose metabolism.


Assuntos
Animais , Masculino , Coelhos , Condicionamento Físico Animal/fisiologia , Força Muscular , Glucose/administração & dosagem , Glucose/efeitos adversos , Fígado/efeitos dos fármacos , Teste de Esforço , Treinamento Resistido , Glucose/metabolismo , Fígado/metabolismo
11.
Eur J Med Res ; 23(1): 56, 2018 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-30413175

RESUMO

BACKGROUND: Both psoriasis (Ps) and psoriasis arthritis (PsA) have been associated with increased cardiovascular risk. Also, both are characterized by increased neovascularization. Endothelial progenitor cells (EPCs) have been implicated in promoting vascular repair in ischemic diseases. The aim of the study was to correlate the EPC system with CV risk factors and with parameters of vascular stiffness in Ps and PsA. METHODS: Twenty-six healthy subjects, 30 patients with Ps, and 31 patients PsA were included in the study. eEPC regeneration was evaluated by a colony-forming assay, circulating eEPCs were measured by cytometric analysis. For vascular analysis, all subjects underwent quantification of pulse wave velocity (PWV) and augmentation index (AIX). RESULTS: Patients were categorized upon the duration of disease, severity of skin involvement (PASI-Ps), individual pain as reflected by the VAS (PsA), CRP values, and history of treatment with one or more biologicals. Regarding the eEPC system, no significant differences were observed between the respective categories. Correlation analyses between parameters of vascular stiffness (PWV and AIX) and patterns of colony formation/circulating eEPCs did not show any correlation at all. CONCLUSION: Parameters of vascular stiffness are not significantly deteriorated in Ps/PsA. Thus, pulse wave analysis may not be suitable for CVR assessment in certain autoimmune-mediated diseases. Regenerative activity of the eEPC system/circulating eEPC numbers are not altered in Ps/PsA. One may conclude that malfunctions of the eEPC are not substantially involved in perpetuating the micro-/macrovascular alterations in Ps/PsA.


Assuntos
Artrite Psoriásica/fisiopatologia , Células Progenitoras Endoteliais/fisiologia , Psoríase/fisiopatologia , Rigidez Vascular/fisiologia , Doenças Cardiovasculares/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Medição de Risco , Fatores de Risco
12.
Occup Med (Lond) ; 68(4): 246-254, 2018 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-29590486

RESUMO

Background: The ageing of the US labour force highlights the need to examine older adults' physical and psychological ability to work, under varying levels of occupational burnout. Aims: To examine how age and burnout interact in predicting physical and psychological work ability. Methods: Using a cohort of actively working nurses, we assessed factors on the Work Ability Index at 12-month follow-up and determined how these were related to age and exhaustion-related burnout at baseline. Results: The study group consisted of 402 nurses aged 25-67 (mean = 41.7). Results indicated age by burnout interactions in which decrements in physical work ability with greater age were observed at all but the lowest level of burnout (1.5 SD below mean: ß = -0.14, 95% CI -0.36, 0.07; 1 SD below: ß = -0.23, 95% CI -0.39, -0.06; mean: ß = -0.39, 95% CI -0.50, -0.29; 1 SD above: ß = -0.56, 95% CI -0.70, -0.42; 1.5 SD above: ß = -0.64, 95% CI -0.83, -0.46). In contrast, we observed decrements in psychological work ability with age at higher levels of burnout only (1 SD above: ß = -0.20, 95% CI -0.35, -0.05; 1.5 SD above: ß = -0.30, 95% CI -0.49, -0.11); at lower levels of burnout, older age was associated with improvements in this (1 SD below: ß = 0.19, 95% CI 0.03, 0.35; 1.5 SD below: ß = 0.29, 95% CI 0.08, 0.50). Conclusions: Findings indicated physical and psychological dimensions of work ability that differed by age and occupational burnout. This emphasizes the need for interventions to reduce burnout and to address age-related strengths and vulnerabilities relating to physical and psychological work ability.


Assuntos
Fatores Etários , Esgotamento Profissional/etiologia , Programas de Rastreamento/estatística & dados numéricos , Enfermeiras e Enfermeiros/psicologia , Estresse Ocupacional/complicações , Avaliação da Capacidade de Trabalho , Adulto , Idoso , Esgotamento Profissional/psicologia , Estudos de Coortes , Escolaridade , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Estresse Ocupacional/psicologia , Sudeste dos Estados Unidos , Local de Trabalho/psicologia , Local de Trabalho/normas , Local de Trabalho/estatística & dados numéricos
13.
Rev Med Interne ; 39(5): 332-338, 2018 May.
Artigo em Francês | MEDLINE | ID: mdl-29397233

RESUMO

Hyper-IgE may be found under many pathological conditions. The role of IgE is essentially associated with the occurrence of allergic manifestations, which may be accompanied by an increase of their serum levels. Elevation of total IgE has also been reported in association with certain rare genetic immune deficiencies called hyper-IgE syndromes. Other circumstances such as infectious diseases, tumors or autoimmune diseases may also be accompanied by an excessive synthesis of IgE. Considering the diversity of these situations, discussion of the prognostic value of total IgE is useful to the internist.


Assuntos
Imunoglobulina E/sangue , Síndrome de Job/diagnóstico , Citocinas/sangue , Humanos , Medicina Interna , Síndrome de Job/terapia
14.
Rev Med Interne ; 39(2): 107-116, 2018 Feb.
Artigo em Francês | MEDLINE | ID: mdl-28457682

RESUMO

Systemic lupus erythematosus (SLE) is a chronic disease that considerably hampers patient's daily living. Qualitative studies with patients' interviews have been conducted to describe the experiences and perspectives of adults living with SLE. Among existing generic and disease-specific quality of life (QOL) questionnaires, none succeeded to exhaustively measure patient's preoccupations. However, these tools are useful to quantify the burden of the disease. Social precariousness, socioeconomic status and education level are intimately correlated to QOL measures, either generic or disease-specific. Musculoskeletal disease activity is also associated with a lower QOL. Using disease-specific tools may be useful because of a better aptitude to record an improvement in health status. Moreover, using generic and disease-specific questionnaires together may help to identify factors associated with a lower quality of life but not related to SLE from the patient's perspective (such as smoking or obesity). Developing new ways of recording QOL data in the future may help to evaluate the real benefit of using QOL scales in daily practice.


Assuntos
Lúpus Eritematoso Sistêmico/psicologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adulto , Humanos , Fatores de Risco , Inquéritos e Questionários
15.
Trials ; 18(1): 202, 2017 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-28454590

RESUMO

BACKGROUND: Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. METHODS/DESIGN: The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH2O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH2O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint. DISCUSSION: To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016.


Assuntos
Anestesia Geral , Cuidados Intraoperatórios/métodos , Pneumopatias/prevenção & controle , Pulmão/fisiopatologia , Obesidade/complicações , Respiração com Pressão Positiva/métodos , Procedimentos Cirúrgicos Operatórios , Anestesia Geral/efeitos adversos , Índice de Massa Corporal , Protocolos Clínicos , Feminino , Humanos , Cuidados Intraoperatórios/efeitos adversos , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Pneumopatias/fisiopatologia , Masculino , Obesidade/diagnóstico , Obesidade/fisiopatologia , Respiração com Pressão Positiva/efeitos adversos , Fatores de Proteção , Projetos de Pesquisa , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
16.
Braz. j. biol ; 77(1): 60-67, Jan-Mar. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-839160

RESUMO

Abstract Crepuscular period is one of the factors that may influence the biting activity of mosquitoes. Many of these insects have a peak activity in this period. The purpose of this study was to investigate the afternoon crepuscular activity of Culicidae in a remaining area of Atlantic Forest in western Santa Catarina, southern Brazil. Moreover, the possible influence of abiotic factors, the abundance and species richness were verified. In order to better analyze the influence of crepuscular period in specific composition and abundance of mosquitoes, the dusk was divided into three periods: pre-sunset, sunset and post-sunset. At the end of the study, nine hundred and eight four specimens distributed in 12 genera and 23 species were collected. Trichoprosopon pallidiventer (Lutz, 1905) (59.76%), Aedes crinifer (Theobald, 1903) (8.13%), Ae. scapularis (Rondani, 1848) (5.89%) were the most abundant species. Spring time presented the greatest abundance and species richness. During the study, among the three periods evaluated, pre-sunset had the greatest abundance and post-sunset the lowest. Pre-sunset and sunset had the greatest similarity between species. Regarding to the abiotic factors evaluated seven and 15 days before sampling, they did not present significant correlation for the three most abundant species. However, temperature had a positive correlation to these species. Moreover, the correlation between collected species and its possible role as vectors of etiological agents of diseases was discussed.


Resumo O período crepuscular é um dos fatores que pode influenciar na atividade hematofágica dos mosquitos. Muitos desses insetos iniciam ou terminam suas atividades nesse período. O objetivo deste trabalho foi estudar os Culicidae que ocorrem no crepúsculo vespertino em uma área de Floresta Atlântica no oeste de Santa Catarina, sul do Brasil. Além disso, foi analisada a possível influência de fatores abióticos, bem como abundância e riqueza de espécies. Para melhor avaliar a influência do período crepuscular na composição das espécies e na abundância destas, o crepúsculo foi dividido em três períodos: pré-crepúsculo, crepúsculo e pós-crepúsculo. Ao final do estudo foram coletados 984 exemplares distribuídos em 12 gêneros e 23 espécies. Trichoprosopon pallidiventer (Lutz, 1905) (59,76%), Aedes crinifer (Theobald, 1903) (8,13%) e Ae. scapularis (Rondani, 1848) (5,89%) foram as espécies mais abundantes. A maior abundância e riqueza de espécies se deram na primavera. Dentre os três períodos estudados, o pré-crepúsculo apresentou a maior abundância de mosquitos, em contrapartida, o pós-crepúsculo apresentou a menor abundância. Os períodos pré-crepuscular e crepuscular apresentaram maior similaridade entre si com relação à composição das espécies. Relacionando os fatores abióticos e as três espécies mais abundantes, não foi observada correlação significativa nos dados avaliados nos sete e 15 dias anteriores às coletas. Entretanto, a temperatura apresentou uma correlação positiva para estas três espécies. A relação entre as espécies coletadas e a potencial transmissão de agentes etiológicos causadores de doenças foi comentada.


Assuntos
Animais , Culicidae/fisiologia , Estações do Ano , Fatores de Tempo , Clima Tropical , Brasil , Florestas , Comportamento Alimentar/fisiologia , Insetos Vetores/classificação , Insetos Vetores/fisiologia , Culicidae/classificação
17.
Rehabilitation (Stuttg) ; 55(5): 276-283, 2016 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-27728933

RESUMO

Objective: Effects of a combined orthopedic and psychosomatic rehabilitation (VOP) concept are evaluated in contrast to psychosomatic and orthopedic rehabilitation. Therefore both mental and physical health of rehabilitants are compared. Methods: A prospective case-control study was performed in order to gather psychic strain and bodily constitution. Covariance analysis was conducted to expose significant differences between groups. Results: An equal clinically relevant reduction of psychological distress could be achieved with psychosomatic rehabilitation (N=322) and VOP (N=511). Moreover, bodily constitution could be increased by the same amount through VOP and orthopedic rehabilitation (N=135). In conclusion the therapy concept is successful in patients with both somatic and psychic problems.


Assuntos
Procedimentos Ortopédicos/psicologia , Procedimentos Ortopédicos/reabilitação , Psicoterapia/estatística & dados numéricos , Estresse Psicológico/prevenção & controle , Estresse Psicológico/psicologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Terapia Combinada/psicologia , Terapia Combinada/estatística & dados numéricos , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estresse Psicológico/epidemiologia , Resultado do Tratamento , Adulto Jovem
18.
J Investig Allergol Clin Immunol ; 26(4): 249-55, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27373883

RESUMO

BACKGROUND AND OBJECTIVE: Vitamin A has been linked to the development of allergic diseases although its role is not fully understood, Retinoic acid (RA), a metabolite of Vitamin A, has been previously associated with the prostaglandin pathway, and PTGDR, a receptor of PGD2, has been proposed as a candidate gene in allergy and asthma. Considering the role of PTGDR in allergy, the goal of this study was to analyze the effect of RA on the activation of the promoter region of the PTGDR gene. METHODS: A549 lung epithelial cells were transfected with 4 combinations of genetic variants of the PTGDR promoter and stimulated with all-trans RA (ATRA); luciferase assays were performed using the Dual Luciferase Reporter System, and real-time quantitative polymerase chain reaction was used to measure the expression of PTGDR, CYP26A1, RARA, RARB, RARG, and RXRA in basal A549 cell cultures and after ATRA treatment. We also performed an in silico analysis. RESULTS: After ATRA treatment increased expression of CYP26A1 (12-fold) and RARB (4-fold) was detected. ATRA activated PTGDR promoter activity in transfected cells (P<.001) and RA response element sequences were identified in silico in this promoter region. CONCLUSIONS: RA modulated PTGDR promoter activity. Differential response to RA and to new treatments based on PTGDR modulation could depend on genetic background in allergic asthmatic patients.


Assuntos
Regiões Promotoras Genéticas , Receptores Imunológicos/genética , Receptores de Prostaglandina/genética , Tretinoína/farmacologia , Região 5'-Flanqueadora , Sítios de Ligação , Linhagem Celular Tumoral , Humanos , Regiões Promotoras Genéticas/efeitos dos fármacos
19.
Am J Physiol Renal Physiol ; 311(2): F382-94, 2016 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-27194716

RESUMO

Acute kidney injury (AKI) dramatically increases mortality of hospitalized patients. Incidences have been increased in recent years. The most frequent cause is transient renal hypoperfusion or ischemia which induces significant tubular cell dysfunction/damage. In addition, two further events take place: interstitial inflammation and microvasculopathy (MV). The latter evolves within minutes to hours postischemia and may result in permanent deterioration of the peritubular capillary network, ultimately increasing the risk for chronic kidney disease (CKD) in the long term. In recent years, our understanding of the molecular/cellular processes responsible for acute and sustained microvasculopathy has increasingly been expanded. The methodical approaches for visualizing impaired peritubular blood flow and increased vascular permeability have been optimized, even allowing the depiction of tissue abnormalities in a three-dimensional manner. In addition, endothelial dysfunction, a hallmark of MV, has increasingly been recognized as an inductor of both vascular malfunction and interstitial inflammation. In this regard, so-called regulated necrosis of the endothelium could potentially play a role in postischemic inflammation. Endothelial progenitor cells (EPCs), represented by at least two major subpopulations, have been shown to promote vascular repair in experimental AKI, not only in the short but also in the long term. The discussion about the true biology of the cells continues. It has been proposed that early EPCs are most likely myelomonocytic in nature, and thus they may simply be termed proangiogenic cells (PACs). Nevertheless, they reliably protect certain types of tissues/organs from ischemia-induced damage, mostly by modulating the perivascular microenvironment in an indirect manner. The aim of the present review is to summarize the current knowledge on postischemic MV and EPC-mediated renal repair.


Assuntos
Injúria Renal Aguda/terapia , Células Progenitoras Endoteliais , Transplante de Células-Tronco Hematopoéticas/métodos , Isquemia/patologia , Microvasos/patologia , Circulação Renal , Injúria Renal Aguda/patologia , Injúria Renal Aguda/fisiopatologia , Animais , Humanos
20.
Braz. j. biol ; 75(4): 1027-1029, Nov. 2015. tab
Artigo em Inglês | LILACS | ID: lil-768186

RESUMO

Abstract During the period 2010-2012, eighty individuals of Calidris fuscicollis (Vieillot, 1819) were collected on the southern coast of Rio Grande do Sul, Brazil, with the objective of determining the presence of feather mites. Of the 80 birds examined, 32.5% were infested by mites, identified as Avenzoaria calidridis (Oudemans, 1904) (Avenzoariidae) (31.25%), Montchadskiana securicata (Megnin & Trouessart 1884) (Pterolichidae) (22.5%) and Alloptes limosae (Dubinin, 1951) (Alloptidae) (6.25%). This is the first report of feather mites on Calidris fuscicollis in Brazil.


Resumo Durante o período de 2010-2012, oitenta espécimes de Calidris fuscicollis (Vieillot, 1819) foram coletados na costa sul do Estado do Rio Grande do Sul, com o objetivo de determinar a presença de ácaros de pena. Das 80 aves examinadas, 32,5% estavam infestadas por ácaros, os quais foram identificados como Avenzoaria calidridis (Oudemans, 1904) (Avenzoariidae) (31,25%), Montchadskiana securicata (Megnin & Trouessart 1884) (Pterolichidae) (22,5%) e Alloptes limosae (Dubinin, 1951) (Alloptidae) (6,25%). Este é o primeiro relato de ácaros de pena em Calidris fuscicollis no Brasil.


Assuntos
Animais , Doenças das Aves/epidemiologia , Charadriiformes , Infestações por Ácaros/veterinária , Ácaros/fisiologia , Migração Animal , Doenças das Aves/parasitologia , Brasil/epidemiologia , Plumas/parasitologia , Infestações por Ácaros/epidemiologia , Infestações por Ácaros/parasitologia , Ácaros/classificação , Estações do Ano
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