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1.
Eur Heart J ; 44(34): 3278-3291, 2023 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-37592821

RESUMEN

BACKGROUND AND AIMS: For patients with congenitally corrected transposition of the great arteries (ccTGA), factors associated with progression to end-stage congestive heart failure (CHF) remain largely unclear. METHODS: This multicentre, retrospective cohort study included adults with ccTGA seen at a congenital heart disease centre. Clinical data from initial and most recent visits were obtained. The composite primary outcome was mechanical circulatory support, heart transplantation, or death. RESULTS: From 558 patients (48% female, age at first visit 36 ± 14.2 years, median follow-up 8.7 years), the event rate of the primary outcome was 15.4 per 1000 person-years (11 mechanical circulatory support implantations, 12 transplantations, and 52 deaths). Patients experiencing the primary outcome were older and more likely to have a history of atrial arrhythmia. The primary outcome was highest in those with both moderate/severe right ventricular (RV) dysfunction and tricuspid regurgitation (n = 110, 31 events) and uncommon in those with mild/less RV dysfunction and tricuspid regurgitation (n = 181, 13 events, P < .001). Outcomes were not different based on anatomic complexity and history of tricuspid valve surgery or of subpulmonic obstruction. New CHF admission or ventricular arrhythmia was associated with the primary outcome. Individuals who underwent childhood surgery had more adverse outcomes than age- and sex-matched controls. Multivariable Cox regression analysis identified older age, prior CHF admission, and severe RV dysfunction as independent predictors for the primary outcome. CONCLUSIONS: Patients with ccTGA have variable deterioration to end-stage heart failure or death over time, commonly between their fifth and sixth decades. Predictors include arrhythmic and CHF events and severe RV dysfunction but not anatomy or need for tricuspid valve surgery.


Asunto(s)
Insuficiencia Cardíaca , Transposición de los Grandes Vasos , Insuficiencia de la Válvula Tricúspide , Disfunción Ventricular Derecha , Adulto , Humanos , Femenino , Niño , Adulto Joven , Persona de Mediana Edad , Masculino , Transposición Congénitamente Corregida de las Grandes Arterias , Estudios Retrospectivos , Transposición de los Grandes Vasos/complicaciones , Transposición de los Grandes Vasos/cirugía , Insuficiencia de la Válvula Tricúspide/complicaciones , Disfunción Ventricular Derecha/complicaciones , Insuficiencia Cardíaca/complicaciones
2.
Cardiol Young ; : 1-5, 2024 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-38439634

RESUMEN

BACKGROUND: Obstructive sleep apnoea is a common sleep disorder, and adult congenital heart disease (CHD) is also a significant burden on the population. Early diagnosis and treatment are important for improving quality of life and reducing the risk of health complications. The limited research on obstructive sleep apnoea and adult CHD highlights the need for further investigation into the relationship between these two conditions and the mechanisms underlying this relationship. METHOD: We used NIS 2019 database to identify adult CHD admissions aged 18-44 years and assess the impact of obstructive sleep apnoea on all-cause mortality, dysrhythmia, and stroke. A propensity-matched cohort of individuals with and without obstructive sleep apnoea was obtained, and the outcomes were assessed using multivariable analysis and compared in terms of resource utilisation. RESULTS: Of the 41,950 young adult CHD admissions, 6.3% (n = 2630) had obstructive sleep apnoea. The obstructive sleep apnoea+ (n = 2590) and obstructive sleep apnoea- (n = 2590) cohorts were comparable in terms of median age (35 years) and were predominantly male (63.1% versus 62.5%). The obstructive sleep apnoea+ cohort had a higher frequency of risk factors like chronic obstructive pulmonary disease, hypothyroidism, and prior venous thromboembolism than the obstructive sleep apnoea cohort. We found significant association of obstructive sleep apnoea with dysrhythmia (adjusted odds ratio 2.99, 95% confidence interval 2.13-4.19, p < 0.001), but no significant impact on the risk of all-cause mortality or stroke. The obstructive sleep apnoea+ cohort also had higher transfers to short-term facilities, prolonged stays, and higher charges (p < 0.001). CONCLUSION: Our study provides important insights into relationship between obstructive sleep apnoea and adult CHD and highlights the need for further investigation into the impact of obstructive sleep apnoea on individuals with adult CHD.

3.
Curr Opin Cardiol ; 38(3): 241-249, 2023 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-37016995

RESUMEN

PURPOSE OF REVIEW: Patients with single-ventricle Fontan palliation surgery often wish to pursue pregnancy. Pregnancies should be planned with well tolerated and effective contraception, and preconception risk stratification by adult congenital heart disease and maternal foetal medicine specialists. RECENT FINDINGS: Although infertility and foetal complications, including pregnancy loss, preterm birth and foetal growth restriction, are common, most patients with Fontan palliations can successfully complete pregnancy with a team-based approach. Important risk predictors are resting oxygen saturations, baseline functional status and the presence of systemic complications of the Fontan repair, including advanced Fontan associated liver disease, plastic bronchitis and ventricular dysfunction. Common maternal cardiovascular complications include arrhythmia, heart failure and thromboembolism. Delivery planning with input from an obstetric anaesthesiologist who has knowledge of complex congenital heart defects can facilitate appropriate, individualized monitoring and pain control. A vaginal delivery with consideration of an assisted second stage is appropriate for most single ventricle patients, in the absence of obstetric or foetal indications for caesarean delivery. Close postpartum monitoring and follow up is recommended, as the early postpartum period is the highest risk time for cardiovascular complications in patients with congenital heart disease. SUMMARY: A multidisciplinary approach to managing pregnancy and delivery in patients with Fontan circulation facilitates optimal maternal and infant outcomes.


Asunto(s)
Procedimiento de Fontan , Cardiopatías Congénitas , Nacimiento Prematuro , Embarazo , Femenino , Humanos , Recién Nacido , Adulto , Cardiopatías Congénitas/cirugía , Nacimiento Prematuro/etiología , Cesárea , Arritmias Cardíacas/etiología
4.
PLoS Genet ; 16(4): e1008652, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32267837

RESUMEN

Forward genetic screens remain at the forefront of biology as an unbiased approach for discovering and elucidating gene function at the organismal and molecular level. Past mutagenesis screens targeting maternal-effect genes identified a broad spectrum of phenotypes ranging from defects in oocyte development to embryonic patterning. However, earlier vertebrate screens did not reach saturation, anticipated classes of phenotypes were not uncovered, and technological limitations made it difficult to pinpoint the causal gene. In this study, we performed a chemically-induced maternal-effect mutagenesis screen in zebrafish and identified eight distinct mutants specifically affecting the cleavage stage of development and one cleavage stage mutant that is also male sterile. The cleavage-stage phenotypes fell into three separate classes: developmental arrest proximal to the mid blastula transition (MBT), irregular cleavage, and cytokinesis mutants. We mapped each mutation to narrow genetic intervals and determined the molecular basis for two of the developmental arrest mutants, and a mutation causing male sterility and a maternal-effect mutant phenotype. One developmental arrest mutant gene encodes a maternal specific Stem Loop Binding Protein, which is required to maintain maternal histone levels. The other developmental arrest mutant encodes a maternal-specific subunit of the Minichromosome Maintenance Protein Complex, which is essential for maintaining normal chromosome integrity in the early blastomeres. Finally, we identify a hypomorphic allele of Polo-like kinase-1 (Plk-1), which results in a male sterile and maternal-effect phenotype. Collectively, these mutants expand our molecular-genetic understanding of the maternal regulation of early embryonic development in vertebrates.


Asunto(s)
División Celular/genética , Desarrollo Embrionario/genética , Herencia Materna/genética , Mutación , Pez Cebra/embriología , Pez Cebra/genética , Alelos , Animales , Blástula/citología , Blástula/embriología , Blástula/metabolismo , Tipificación del Cuerpo/genética , Núcleo Celular , Citocinesis/genética , Femenino , Infertilidad Masculina/genética , Masculino , Mutagénesis , Fenotipo , Proteínas de Pez Cebra/genética
5.
Appl Environ Microbiol ; 88(22): e0121722, 2022 11 22.
Artículo en Inglés | MEDLINE | ID: mdl-36286507

RESUMEN

Periprosthetic joint infection (PJI) after joint replacement is a major clinical issue requiring multiple surgeries and antibiotic interventions. Recent in vitro research has shown that PJI staphylococcal strains rapidly form antibiotic-resistant free-floating aggregates in the presence of bovine synovial fluid (BSF). Staphylococcal aggregates are also present in human PJI joint fluid. However, the influence of surface roughness and fluid shear on the attachment and retention of such aggregates on surfaces is not known. Our aim was to assess how surface roughness and fluid shear stress influenced the attachment and retention of Staphylococcus aureus BSF-mediated aggregates on smooth- and rough-patterned titanium in flow cells compared to nonaggregated cells. The attachment of S. aureus aggregates was significantly greater than that of single cells but was independent of surface roughness; however, on the patterned surfaces, aggregates preferentially accumulated in the grooves. Fibrous components in the BSF were also colocalized with the grooves. After a 24-h attachment-and-incubation period, different shear stresses were applied. There was significant detachment from flat surfaces at a flow rate of 1 mL/min (τw = 0.0012 Pa) but minimal detachment from the patterned surfaces, even at flow rates as high as 13.9 mL/min (τw = 0.0169 Pa). The retention of bacterial aggregates and biofilms on rough surfaces exposed to shear might be an important consideration for the location of colonization on orthopedic implants, which can have wide ranges of roughness and surface features and can influence the efficacy of shear-based debridement methods such as pulse lavage. IMPORTANCE Periprosthetic joint infections occurring after joint replacement are a major clinical problem requiring repeated surgeries and antibiotic interventions. Staphylococcus aureus is the most prominent bacterium causing most implant-related infections. S. aureus can form a biofilm, which is defined as a group of attached bacteria with the formation of an envelope that is resistant to antibiotics. The attachment and retention of these bacteria on implant surfaces are not clearly understood. Recent in vitro research investigations have shown that staphylococcal strains rapidly form aggregates in the presence of bovine synovial fluid (BSF) in the joints, which allows bacteria time to attach to the implant surface, leading to biofilm formation. Thus, in this study, we examined the attachment of aggregates on titanium surfaces with varying roughnesses and found robust bacterial attachment and retention along the ridges and grooves, which colocalized with the deposition of fibrous components present in the BSF.


Asunto(s)
Infecciones Estafilocócicas , Staphylococcus aureus , Bovinos , Animales , Humanos , Líquido Sinovial/microbiología , Titanio , Infecciones Estafilocócicas/microbiología , Antibacterianos/farmacología , Staphylococcus , Bacterias
6.
Curr Opin Cardiol ; 37(5): 424-430, 2022 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-35880447

RESUMEN

PURPOSE OF REVIEW: Hypertension (HTN) remains the most common and strongest contributing factor to the development of heart failure with preserved ejection fraction (HFpEF). In this review, we aim to summarize the pathophysiological processes linking HTN to HFpEF and highlight novel concepts in medical and device-based management of HFpEF and HTN. RECENT FINDINGS: Despite the global increase in the prevalence of HFpEF, there has been limited benefit in current medication and device-based therapy for this complex syndrome. The hallmark of HFpEF is an elevated left intra-atrial and ventricular pressure and exertional dyspnea. Traditional medications used for treating HTN in patients with reduced left ventricular ejection fraction have unclear benefits in patients with HFpEF. Careful analysis of emerging medications such as angiotensin receptor-neprilysin inhibitor and sodium-glucose co-transporter-2 inhibitors showed benefit in reducing not only blood pressure but also hospitalizations in patients with HFpEF. Current data on device-based therapy aims to reduce left intra-atrial pressure, ventricular pressure and stimulate baroreceptors to lower blood pressure; however, needs further investigation. SUMMARY: The nexus of HTN and HFpEF remains strong and complex. Although traditional medications for treating HFrEF did not affect long-term outcomes, novel therapies with angiotensin receptor neprilysin-inhibitor and sodium-glucose co-transporter-2 inhibitor offer promising results. Many device-based interventions in the HFpEF population are being developed with the aim to reduce left intra-atrial and ventricular pressure; however, their role in HFpEF hypertensive patients needs to be further investigated.


Asunto(s)
Insuficiencia Cardíaca , Hipertensión , Simportadores , Glucosa/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Hipertensión/tratamiento farmacológico , Neprilisina , Receptores de Angiotensina/uso terapéutico , Sodio/uso terapéutico , Volumen Sistólico/fisiología , Simportadores/uso terapéutico , Función Ventricular Izquierda/fisiología
7.
Scand J Med Sci Sports ; 32(1): 18-44, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34695249

RESUMEN

Physical activity (PA) is a complex human behavior, which implies that multiple dimensions need to be taken into account in order to reveal a complete picture of the PA behavior profile of an individual. This scoping review aimed to map advanced analytical methods and their summary variables, hereinafter referred to as wearable-specific indicators of PA behavior (WIPAB), used to assess PA behavior. The strengths and limitations of those indicators as well as potential associations with certain health-related factors were also investigated. Three databases (MEDLINE, Embase, and Web of Science) were screened for articles published in English between January 2010 and April 2020. Articles, which assessed the PA behavior, gathered objective measures of PA using tri-axial accelerometers, and investigated WIPAB, were selected. All studies reporting WIPAB in the context of PA monitoring were synthesized and presented in four summary tables: study characteristics, details of the WIPAB, strengths, and limitations, and measures of association between those indicators and health-related factors. In total, 7247 records were identified, of which 24 articles were included after assessing titles, abstracts, and full texts. Thirteen WIPAB were identified, which can be classified into three different categories specifically focusing on (1) the activity intensity distribution, (2) activity accumulation, and (3) the temporal correlation and regularity of the acceleration signal. Only five of the thirteen WIPAB identified in this review have been used in the literature so far to investigate the relationship between PA behavior and health, while they may provide useful additional information to the conventional PA variables.


Asunto(s)
Actividad Motora , Envío de Mensajes de Texto , Acelerometría , Ejercicio Físico , Humanos , Factores de Tiempo
8.
Echocardiography ; 38(4): 574-581, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33704836

RESUMEN

INTRODUCTION: The shift toward value-based health care drives physicians to examine opportunities to optimize use of healthcare resources. There is discordance between providers' use of cardiovascular imaging (CVI) in assessing patients for infective endocarditis (IE) with Staphylococcus aureus bacteremia (SAB). An evidence-based algorithm was created to minimize variation of CVI use. The primary objective was to ensure sensitivity of the algorithm to recommend CVI in patients suspected of IE. METHODS: A retrospective review evaluated patients at Ochsner Medical Center who developed SAB between 1/1/13 and 12/31/14. Predefined patient demographics, use of CVI, outcomes, and 12-week follow-up for readmission after first positive blood culture were collected from chart review. The created algorithm was applied retrospectively to determine its sensitivity and specificity in recommending the right CVI test. RESULTS: 181 patients admitted were admitted with SAB, of which 114 (63%) were male. There were 115 TTEs and 55 TEEs performed. Out of 15 patients diagnosed with IE, 3 were found on TTE and 12 were found on TEE. The algorithm would have recommended a TEE in all 15 patients who had high-risk features for IE and a true diagnosis of IE, suggesting a sensitivity of 100% and specificity of 74.7% for the algorithm to have recommended a highly sensitive CVI modality. CONCLUSION: This algorithm optimizes CVI for diagnosing IE in patients with SAB. As healthcare adapts to a value-based system, use of best-practice algorithms will promote consistency in practice among providers and help optimize patient outcomes and use of resources.


Asunto(s)
Bacteriemia , Endocarditis Bacteriana , Endocarditis , Infecciones Estafilocócicas , Bacteriemia/diagnóstico , Ecocardiografía Transesofágica , Endocarditis/diagnóstico por imagen , Endocarditis Bacteriana/diagnóstico por imagen , Femenino , Humanos , Masculino , Estudios Retrospectivos , Infecciones Estafilocócicas/diagnóstico , Staphylococcus aureus
9.
Adv Exp Med Biol ; 1323: 81-90, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32797406

RESUMEN

Septic arthritis and prosthetic joint infection (PJI) are conditions commonly associated with Gram-positive cocci, however, a drastic increase in cases derived from enterobacterial species has been observed. Recently it has been reported by multiple groups that staphylococci rapidly form free-floating aggregates in the presence of synovial fluid. These aggregates are comparatively more resistant to antimicrobial challenge than their planktonic counterparts, and thus may play a role in the pathogenesis of joint infection. While staphylococcal aggregates have been the primary focus of interest in the field, it is unclear just how widespread synovial fluid mediated aggregation (SFMA) is in Gram negative enterobacteria (GNE). Through this work we have evaluated SFMA in clinical GNE isolated from PJIs. Two PJI clinical strains each of Enterobacter cloacae, Escherichia coli, Klebsiella pneumonia and Proteus mirabilis strains representing a range of antibiotic susceptibilities were exposed to 10% bovine synovial fluid supernatant (BSF) using a relatively simple, quick semi-quantitative method using an imaging plate reader. BSF stimulated aggregation within 0.5 h both strains of E. cloacae and P. mirabilis and one strain of E.coli. In one strain of P. mirabilis and E.coli, the size of the aggregates significantly increased from 0.5 to 2 h exposure. In contrast, neither K. pneumoniae strain aggregated in BSF. These preliminary findings show that aggregation can occur quickly in GNE, but the extent appears strain and species specific. Further work is required to assess the impact of SFMA on antibiotic tolerance, host innate immunity and the establishment of biofilms.


Asunto(s)
Enterobacteriaceae , Líquido Sinovial , Animales , Antibacterianos/farmacología , Biopelículas , Bovinos , Klebsiella pneumoniae , Proteus mirabilis
10.
Appl Environ Microbiol ; 86(19)2020 09 17.
Artículo en Inglés | MEDLINE | ID: mdl-32709721

RESUMEN

Periprosthetic joint infection (PJI) occurring after artificial joint replacement is a major clinical issue requiring multiple surgeries and antibiotic interventions. Staphylococcus aureus is the bacterium most commonly responsible for PJI. Recent in vitro research has shown that staphylococcal strains rapidly form aggregates in the presence of synovial fluid (SF). We hypothesize that these aggregates provide early protection to bacteria entering the wound site, allowing them time to attach to the implant surface, leading to biofilm formation. Thus, understanding the attachment kinetics of these aggregates is critical in understanding their adhesion to various biomaterial surfaces. In this study, the number, size, and surface area coverage of aggregates as well as of single cells of S. aureus were quantified under various conditions on different orthopedic materials relevant to orthopedic surgery: stainless steel (316L), titanium (Ti), hydroxyapatite (HA), and polyethylene (PE). It was observed that, regardless of the material type, SF-induced aggregation resulted in reduced aggregate surface attachment and greater aggregate size than the single-cell populations under various shear stresses. Additionally, the surface area coverage of bacterial aggregates on PE was relatively high compared to that on other materials, which could potentially be due to the rougher surface of PE. Furthermore, increasing shear stress to 78 mPa decreased aggregate attachment to Ti and HA while increasing the aggregates' average size. Therefore, this study demonstrates that SF induced inhibition of aggregate attachment to all materials, suggesting that biofilm formation is initiated by lodging of aggregates on the surface features of implants and host tissues.IMPORTANCE Periprosthetic joint infection occurring after artificial joint replacement is a major clinical issue that require repeated surgeries and antibiotic interventions. Unfortunately, 26% of patients die within 5 years of developing these infections. Staphylococcus aureus is the bacterium most commonly responsible for this problem and can form biofilms to provide protection from antibiotics as well as the immune system. Although biofilms are evident on the infected implants, it is unclear how these are attached to the surface in the first place. Recent in vitro investigations have shown that staphylococcal strains rapidly form aggregates in the presence of synovial fluid and provide protection to bacteria, thus allowing them time to attach to the implant surface, leading to biofilm formation. In this study, we investigated the attachment kinetics of Staphylococcus aureus aggregates on different orthopedic materials. The information presented in this article will be useful in surgical management and implant design.


Asunto(s)
Equipo Ortopédico/microbiología , Resistencia al Corte , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/fisiología , Estrés Mecánico , Líquido Sinovial/microbiología
11.
Curr Opin Cardiol ; 34(4): 359-366, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31045585

RESUMEN

PURPOSE OF REVIEW: Hypertension (HTN) is one of the strongest risk factors for heart failure and is prevalent in up to 91% of patients with newly diagnosed heart failure. This article offers a practical approach to HTN in patients with heart failure. RECENT FINDINGS: To date, no randomized trials comparing specific antihypertensive regimens have been conducted in the heart failure population. Management of heart failure with reduced ejection fraction patients with elevated blood pressure (BP) should include guideline-directed medical therapy [angiotensin-converting-enzyme inhibitors (ACEis), aldosterone receptor blockers, AT1 neprilysin-inhibitors, beta blockers and aldosterone blockers] titrated to maximal tolerated doses regardless of BP. Despite the lack of survival benefit current available data suggest the use of ACEis, aldosterone receptor blockers as first-line therapy for HTN in patients with heart failure with preserved ejection fraction. SUMMARY: Management of HTN in heart failure patients should be based on left ventricular function. Recent findings suggest that AT1 neprilysin-inhibitors offer better BP control when compared with ACEi, or aldosterone receptor blockers and therefore should be used as first-line therapy in hypertensive patients with heart failure with reduced ejection fraction. Their role as antihypertensive agents in heart failure with preserved ejection fraction seems promising but remains under investigation.


Asunto(s)
Insuficiencia Cardíaca , Hipertensión , Antagonistas de Receptores de Angiotensina , Inhibidores de la Enzima Convertidora de Angiotensina , Antihipertensivos , Humanos
12.
Methods ; 150: 49-62, 2018 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-29936090

RESUMEN

Large-scale genomic studies have recently identified genetic variants causative for major neurodevelopmental disorders, such as intellectual disability and autism. However, determining how underlying developmental processes are affected by these mutations remains a significant challenge in the field. Zebrafish is an established model system in developmental neurogenetics that may be useful in uncovering the mechanisms of these mutations. Here we describe the use of voxel-intensity, deformation field, and volume-based morphometric techniques for the systematic and unbiased analysis of gene knock-down and environmental exposure-induced phenotypes in zebrafish. We first present a computational method for brain segmentation based on transgene expression patterns to create a comprehensive neuroanatomical map. This map allowed us to disclose statistically significant changes in brain microstructure and composition in neurodevelopmental models. We demonstrate the effectiveness of morphometric techniques in measuring changes in the relative size of neuroanatomical subdivisions in atoh7 morphant larvae and in identifying phenotypes in larvae treated with valproic acid, a chemical demonstrated to increase the risk of autism in humans. These tools enable rigorous evaluation of the effects of gene mutations and environmental exposures on neural development, providing an entry point for cellular and molecular analysis of basic developmental processes as well as neurodevelopmental and neurodegenerative disorders.


Asunto(s)
Mapeo Encefálico/métodos , Encéfalo/diagnóstico por imagen , Microscopía Intravital/métodos , Pez Cebra/fisiología , Animales , Animales Modificados Genéticamente , Trastorno Autístico/inducido químicamente , Trastorno Autístico/genética , Conducta Animal/efectos de los fármacos , Conducta Animal/fisiología , Encéfalo/anatomía & histología , Encéfalo/efectos de los fármacos , Encéfalo/fisiología , Mapeo Encefálico/instrumentación , Simulación por Computador , Proteínas de Unión al ADN/genética , Modelos Animales de Enfermedad , Embrión no Mamífero , Técnicas de Silenciamiento del Gen , Humanos , Microscopía Intravital/instrumentación , Microscopía Confocal/instrumentación , Microscopía Confocal/métodos , Morfolinos/genética , Neurogénesis/efectos de los fármacos , Neurogénesis/fisiología , Ácido Valproico/toxicidad , Pez Cebra/anatomía & histología , Proteínas de Pez Cebra/genética
13.
Echocardiography ; 36(1): 15-21, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30450684

RESUMEN

INTRODUCTION: The aim of this study was to evaluate appropriateness of transesophageal echocardiography (TEE) studies based on 2011 Appropriate Use Criteria (AUC) for Echocardiography and its impact on patient management. METHODS AND RESULTS: In a retrospective analysis of 100 inpatient TEEs, 85% of the TEEs ordered were determined to be appropriate, 9% were inappropriate, and 6% were uncertain. Inter-observer differences in the determination of AUC were seen in 24% of the studies, requiring a senior-level cardiologist to make the final determination of AUC score. The variance in interpretation by experts is concerning for how that might translate into differences in clinical practice. Of all TEEs, only 63% led to an active change in care, including changes in medications or procedures, while 37% did not. We found a statistically significant difference between cardiologists' and non-cardiologists' orders for TEE having an impact on patient's clinical care (41% vs 22%, respectively, P < 0.05) (Table ). While not statistically significant, a trend toward clinical change was observed in the appropriate vs inappropriate TEEs (70% vs 44%, respectively, P = 0.06). CONCLUSION: Ideally, the role of a diagnostic cardiovascular imaging test, such as a TEE, is to influence clinical care, if it is ordered appropriately on the right patient. While the AUC guides clinicians on the appropriate use of cardiovascular imaging, it is broadly written and offers room for interpretation to encompass variety of clinical scenarios. Clinical care paths that utilize AUC and standardize use of multidisciplinary institutional resources offer opportunity for optimal clinical impact and patient care.


Asunto(s)
Ecocardiografía Transesofágica/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
14.
Nucleic Acids Res ; 44(D1): D733-45, 2016 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-26553804

RESUMEN

The RefSeq project at the National Center for Biotechnology Information (NCBI) maintains and curates a publicly available database of annotated genomic, transcript, and protein sequence records (http://www.ncbi.nlm.nih.gov/refseq/). The RefSeq project leverages the data submitted to the International Nucleotide Sequence Database Collaboration (INSDC) against a combination of computation, manual curation, and collaboration to produce a standard set of stable, non-redundant reference sequences. The RefSeq project augments these reference sequences with current knowledge including publications, functional features and informative nomenclature. The database currently represents sequences from more than 55,000 organisms (>4800 viruses, >40,000 prokaryotes and >10,000 eukaryotes; RefSeq release 71), ranging from a single record to complete genomes. This paper summarizes the current status of the viral, prokaryotic, and eukaryotic branches of the RefSeq project, reports on improvements to data access and details efforts to further expand the taxonomic representation of the collection. We also highlight diverse functional curation initiatives that support multiple uses of RefSeq data including taxonomic validation, genome annotation, comparative genomics, and clinical testing. We summarize our approach to utilizing available RNA-Seq and other data types in our manual curation process for vertebrate, plant, and other species, and describe a new direction for prokaryotic genomes and protein name management.


Asunto(s)
Bases de Datos Genéticas , Genómica , Animales , Bovinos , Perfilación de la Expresión Génica , Genoma Fúngico , Genoma Humano , Genoma Microbiano , Genoma de Planta , Genoma Viral , Genómica/normas , Humanos , Invertebrados/genética , Ratones , Anotación de Secuencia Molecular , Nematodos/genética , Filogenia , ARN Largo no Codificante/genética , Ratas , Estándares de Referencia , Análisis de Secuencia de Proteína , Análisis de Secuencia de ARN , Vertebrados/genética
15.
J Cell Sci ; 128(5): 900-12, 2015 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-25593128

RESUMEN

Cell migration is an essential and highly regulated process. During development, glia cells and neurons migrate over long distances - in most cases collectively - to reach their final destination and build the sophisticated architecture of the nervous system, the most complex tissue of the body. Collective migration is highly stereotyped and efficient, defects in the process leading to severe human diseases that include mental retardation. This dynamic process entails extensive cell communication and coordination, hence, the real challenge is to analyze it in the entire organism and at cellular resolution. We here investigate the impact of the N-cadherin adhesion molecule on collective glial migration, by using the Drosophila developing wing and cell-type specific manipulation of gene expression. We show that N-cadherin timely accumulates in glial cells and that its levels affect migration efficiency. N-cadherin works as a molecular brake in a dosage-dependent manner, by negatively controlling actin nucleation and cytoskeleton remodeling through α/ß catenins. This is the first in vivo evidence for N-cadherin negatively and cell autonomously controlling collective migration.


Asunto(s)
Cadherinas/metabolismo , Movimiento Celular/fisiología , Citoesqueleto/metabolismo , Proteínas de Drosophila/metabolismo , Neuroglía/metabolismo , Animales , Cadherinas/genética , Células Cultivadas , Citoesqueleto/genética , Proteínas de Drosophila/genética , Drosophila melanogaster , Humanos , Neuroglía/citología , alfa Catenina/genética , alfa Catenina/metabolismo , beta Catenina/genética , beta Catenina/metabolismo
16.
PLoS Genet ; 10(6): e1004422, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24967891

RESUMEN

Maternal homozygosity for three independent mutant hecate alleles results in embryos with reduced expression of dorsal organizer genes and defects in the formation of dorsoanterior structures. A positional cloning approach identified all hecate mutations as stop codons affecting the same gene, revealing that hecate encodes the Glutamate receptor interacting protein 2a (Grip2a), a protein containing multiple PDZ domains known to interact with membrane-associated factors including components of the Wnt signaling pathway. We find that grip2a mRNA is localized to the vegetal pole of the oocyte and early embryo, and that during egg activation this mRNA shifts to an off-center vegetal position corresponding to the previously proposed teleost cortical rotation. hecate mutants show defects in the alignment and bundling of microtubules at the vegetal cortex, which result in defects in the asymmetric movement of wnt8a mRNA as well as anchoring of the kinesin-associated cargo adaptor Syntabulin. We also find that, although short-range shifts in vegetal signals are affected in hecate mutant embryos, these mutants exhibit normal long-range, animally directed translocation of cortically injected dorsal beads that occurs in lateral regions of the yolk cortex. Furthermore, we show that such animally-directed movement along the lateral cortex is not restricted to a single arc corresponding to the prospective dorsal region, but occur in multiple meridional arcs even in opposite regions of the embryo. Together, our results reveal a role for Grip2a function in the reorganization and bundling of microtubules at the vegetal cortex to mediate a symmetry-breaking short-range shift corresponding to the teleost cortical rotation. The slight asymmetry achieved by this directed process is subsequently amplified by a general cortical animally-directed transport mechanism that is neither dependent on hecate function nor restricted to the prospective dorsal axis.


Asunto(s)
Tipificación del Cuerpo/genética , Proteínas Portadoras/genética , Desarrollo Embrionario/genética , Proteínas de Xenopus/genética , Pez Cebra/genética , Alelos , Animales , Proteínas Portadoras/biosíntesis , Proteínas del Citoesqueleto/genética , Citoesqueleto/genética , Embrión no Mamífero , Regulación del Desarrollo de la Expresión Génica , Péptidos y Proteínas de Señalización Intracelular , Proteínas Asociadas a Microtúbulos/genética , Microtúbulos/genética , Oocitos/crecimiento & desarrollo , Oocitos/metabolismo , Dominios PDZ/genética , Fenotipo , ARN Mensajero/biosíntesis , Proteínas Wnt/genética , Xenopus , Proteínas de Xenopus/biosíntesis , Pez Cebra/embriología , Proteínas de Pez Cebra/genética
18.
Mamm Genome ; 26(9-10): 379-90, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26215545

RESUMEN

Complete and accurate annotation of the mouse genome is critical to the advancement of research conducted on this important model organism. The National Center for Biotechnology Information (NCBI) develops and maintains many useful resources to assist the mouse research community. In particular, the reference sequence (RefSeq) database provides high-quality annotation of multiple mouse genome assemblies using a combinatorial approach that leverages computation, manual curation, and collaboration. Implementation of this conservative and rigorous approach, which focuses on representation of only full-length and non-redundant data, produces high-quality annotation products. RefSeq records explicitly link sequences to current knowledge in a timely manner, updating public records regularly and rapidly in response to nomenclature updates, addition of new relevant publications, collaborator discussion, and user feedback. Whole genome re-annotation is also conducted at least every 12-18 months, and often more frequently in response to assembly updates or availability of informative data. This article highlights key features and advantages of RefSeq genome annotation products and presents an overview of NCBI processes to generate these data. Further discussion of NCBI's resources highlights useful features and the best methods for accessing our data.


Asunto(s)
Secuencia de Aminoácidos/genética , Bases de Datos Genéticas , Bases de Datos de Ácidos Nucleicos , Genoma , Animales , Internet , Ratones
19.
Dev Biol ; 373(2): 322-37, 2013 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-23149077

RESUMEN

The complete neuronal repertoire of the central brain of Drosophila originates from only approximately 100 pairs of neural stem cells, or neuroblasts. Each neuroblast produces a highly stereotyped lineage of neurons which innervate specific compartments of the brain. Neuroblasts undergo two rounds of mitotic activity: embryonic divisions produce lineages of primary neurons that build the larval nervous system; after a brief quiescence, the neuroblasts go through a second round of divisions in larval stage to produce secondary neurons which are integrated into the adult nervous system. Here we investigate the lineages that are associated with the larval antennal lobe, one of the most widely studied neuronal systems in fly. We find that the same five neuroblasts responsible for the adult antennal lobe also produce the antennal lobe of the larval brain. However, there are notable differences in the composition of larval (primary) lineages and their adult (secondary) counterparts. Significantly, in the adult, two lineages (lNB/BAlc and adNB/BAmv3) produce uniglomerular projection neurons connecting the antennal lobe with the mushroom body and lateral horn; another lineage, vNB/BAla1, generates multiglomerular neurons reaching the lateral horn directly. lNB/BAlc, as well as a fourth lineage, vlNB/BAla2, generate a diversity of local interneurons. We describe a fifth, previously unknown lineage, BAlp4, which connects the posterior part of the antennal lobe and the neighboring tritocerebrum (gustatory center) with a higher brain center located adjacent to the mushroom body. In the larva, only one of these lineages, adNB/BAmv3, generates all uniglomerular projection neurons. Also as in the adult, lNB/BAlc and vlNB/BAla2 produce local interneurons which, in terms of diversity in architecture and transmitter expression, resemble their adult counterparts. In addition, lineages lNB/BAlc and vNB/BAla1, as well as the newly described BAlp4, form numerous types of projection neurons which along the same major axon pathways (antennal tracts) used by the antennal projection neurons, but which form connections that include regions outside the "classical" olfactory circuit triad antennal lobe-mushroom body-lateral horn. Our work will benefit functional studies of the larval olfactory circuit, and shed light on the relationship between larval and adult neurons.


Asunto(s)
Linaje de la Célula , Drosophila melanogaster/citología , Drosophila melanogaster/crecimiento & desarrollo , Neuronas/citología , Vías Olfatorias/citología , Animales , Antenas de Artrópodos/citología , Encéfalo/citología , Interneuronas/citología , Interneuronas/metabolismo , Larva/citología , Larva/crecimiento & desarrollo , Vías Olfatorias/crecimiento & desarrollo , Pupa/citología
20.
J Neurogenet ; 28(3-4): 190-8, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24749508

RESUMEN

Cell migration is a key mechanism during neural development, as it allows cells to reach their final destination from their birthplace. In some cases, cells migrate in isolation, whereas in others they migrate in collectives, as chains, streams, clusters, or sheets. The coordinated and timely process of collective migration eventually ensures the proper organization of the nervous system and its misregulation leads to severe diseases, including neurological disorders. This review impinges upon the cellular and molecular interactions underlying collective cell migration in animal models, and highlights the recent advances made through in vivo analyses of the Drosophila wing glia.


Asunto(s)
Movimiento Celular/fisiología , Drosophila/fisiología , Neuroglía/citología , Neuronas/citología , Alas de Animales/citología , Animales , Roedores , Alas de Animales/fisiología , Pez Cebra
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