RESUMEN
OBJECTIVES: To investigate the antihypertensive effect of crude extract of Chenopodium album (Ca.Cr), based on its medicinal use in hypertension. METHODS: Ca.Cr and its fractions were tested in-vivo in normotensive anesthetized rats for blood pressure-lowering effect. In-vitro experiments were performed on isolated rat aortae to explore the vascular mechanism(s). RESULTS: In normotensive anesthetized rats, Ca.Cr produced a dose-dependent (1-300mg/kg) fall (30%mmHg) in mean arterial pressure (MAP). Among the fractions, nHexane was the most potent (46% fall). In rat aortic rings precontracted with phenylephrine (PE), Ca.Cr and its fractions (except Ca.Aq) produced endothelium-dependent vasorelaxation, which was partially reversed with endothelium removal and by pretreating intact aortic rings with L-NAME (10µM) and atropine (1µM). This relaxation to Ca.Cr and fractions (nHexane, ethylacetate and chloroform) was also eliminated with indomethacin pretreatment, however, it unmasked a vasoconstriction effect with Ca.Cr only. Surprisingly, the aqueous fraction produced a calcium sensitive strong vasoconstriction instead of vasorelaxation. The crude extract and its fractions (except Ca.Aq) also antagonized vasoconstriction induced with high K+ (80mM), suggesting calcium antagonistic effect. The aqueous fraction produced mild vasorelaxation against high K+. This effect was further confirmed when pretreatment of the aortic rings with different concentrations of crude extract and fractions suppressed CaCl2 concentration response curves, similar to verapamil. In acute toxicity test, Ca.Cr extract was found safe up to 5g/kg body weight in mice. CONCLUSION: These findings suggest that crude extract and fractions of C. album produced vasorelaxant effect through muscarinic receptors linked-NO pathway, prostaglandin (endothelium-dependent) and calcium antagonism (endothelium-independent), which explains the blood pressure lowering effect of C. album in rats.
Asunto(s)
Chenopodium album , Vasodilatación , Ratas , Animales , Ratones , Presión Sanguínea , Chenopodium album/metabolismo , Calcio/metabolismo , Calcio/farmacología , Extractos Vegetales/farmacología , Ratas Sprague-Dawley , Vasodilatadores/farmacología , Bloqueadores de los Canales de Calcio , Endotelio/metabolismo , Endotelio Vascular/metabolismoRESUMEN
Urinary tract infection (UTI) is a common condition defined as the presence of bacteria within the urine above a certain threshold (usually >100,000 m/L). The lifetime risk in women is estimated to be 50%, of whom 25% will develop recurrence within 6 months. Unfortunately, the use of antibiotics to treat and manage recurrent UTI (rUTI) is a growing problem, due to the burden of growing antibiotic resistance on public health. As such, new approaches to manage rUTI are being investigated and developed. Competitive inoculation via instillation of Escherichia coli 83972 or HU2117 in the bladder is a new prophylactic non-antimicrobial therapy for rUTIs. It utilizes the principle of the protective nature of asymptomatic bacteriuria to prevent recurrence of symptomatic UTIs. However, the effectiveness and safety of this technique remains unclear. This systematic review examined the current outcomes data on competitive inoculation as an effective and safe treatment for rUTI prophylaxis. Based on a limited number of studies, current evidence suggests that competitive inoculation is an effective and safe prophylactic measure against UTIs in a select group of patients with incomplete bladder emptying. However, administration of the technology is both resource and time intensive, and there is strong data demonstrating low successful colonisation rates. Competitive inoculation is an alternative to antibiotics only to rUTI patients with incomplete bladder emptying. There is no evidence to suggest that the technology would be suitable for other subsets of rUTI patients. Further randomized controlled trials should be conducted to improve the evidence base before drawing conclusions for clinical practice, and ideas to improve colonisation rates and simplify the administration process should be explored.
RESUMEN
It is considered that COVID-19's pandemic expansion is responsible for the particular increase in deaths, especially among the population with comorbidities. The health system is often overwhelmed by the large number of cases of patients addressing it, by the regional limitation of funds, and by the gravity of cases at subjects suffering from this pathology. Several associated conditions including diabetes, cardiovascular illnesses, obesity, persistent lung condition, neurodegenerative diseases, etc., increase the mortality risk and hospitalization of subjects suffering from COVID-19. The rapid identification of patients with increased risk of death from the SARS-CoV-2 virus, the stratification in accordance with the risk and the allocation of human, financial, and logistical resources in proportion must be a priority for health systems worldwide.
Asunto(s)
COVID-19 , Humanos , COVID-19/epidemiología , SARS-CoV-2 , Comorbilidad , Pandemias , Medición de RiesgoRESUMEN
Certain types of cardiac arrhythmias are best treated with radiofrequency (RF) ablation, in which an electrode is inserted into the targeted area of the myocardium and then RF electrical current is applied to heat and destroy surrounding tissue. The resulting ablation lesion usually consists of a coagulative necrotic core surrounded by a rim region of mixed viable and non-viable cells. The characterization of the RF ablated lesion is of potential clinical importance. Here we aim to elaborate optical coherence tomography (OCT) imaging for the characterization of RF-ablated myocardial tissue. In particular, the underlying principles of OCT and its polarization-sensitive counterpart (PS-OCT) are presented, followed by the knowledge needed to interpret their optical images. Studies focused on real-time monitoring of RF lesion formation in the myocardium using OCT systems are summarized. The design and development of various hybrid probes incorporating both OCT guidance and RF ablation catheters are also discussed. Finally, the challenges related to the transmission of OCT imaging systems to cardiac clinics for real-time monitoring of RF lesions are outlined.
Asunto(s)
Ablación por Catéter , Fotoquimioterapia , Tomografía de Coherencia Óptica/métodos , Fotoquimioterapia/métodos , Miocardio/patología , Ablación por Catéter/métodosRESUMEN
PURPOSE: Urinary incontinence remains common in men after prostatectomy. Current guidance suggests early corrective surgery to those that are still incontinent after trying Pelvic Floor Muscle Therapy, however, other treatments are now available. This review aims to evaluate all currently available treatment options for men with post-prostatectomy incontinence (PPI). METHODS: A search of MEDLINE and CENTRAL databases on 2/2/2021 produced 879 articles. Any study evaluating incontinence before and after a treatment protocol was eligible for inclusion. After screening, 17 randomized control trials were included, and pre-defined data points were collected. Due to heterogeneity, pooled analysis was not possible, and a descriptive synthesis was produced in accordance with PRISMA guidelines. Cochrane Risk of Bias (RoB) tool was used to evaluate all studies. The search protocol and methods for this study was registered on the PROSPERO database before the search began, ID:(CRD42021229749). RESULTS: 3/17(18%) of studies focussed on pharmacotherapy, 2/17(12%) on vibration therapies, 8/17(47%) on pelvic floor muscle therapy (PFMT), 3/17(18%) on electrical stimulation (ES), and 1/17 (6%) on extracorporeal magnetic innervation (ExMI) as their main intervention. The use of Duloxetine, Solifenacin, PFMT, ES, and ExMI all show effective reduction in incontinence in men suffering from PPI. No study in this review evaluated surgical managements for PPI. CONCLUSION: A large number of treatments are available for PPI using an array of different methods. For this reason, a variety of treatments could be considered before early invasive procedures, to prevent unnecessary surgery and its associated negative complications.
Asunto(s)
Terapia por Estimulación Eléctrica , Incontinencia Urinaria , Masculino , Humanos , Diafragma Pélvico , Terapia por Estimulación Eléctrica/métodos , Terapia por Ejercicio/métodos , Incontinencia Urinaria/etiología , Incontinencia Urinaria/terapia , Prostatectomía/efectos adversosRESUMEN
The International Society for Extracellular Vesicles (ISEV) defines the extracellular vesicle (EV) as "the particles naturally released from the cell that are delimited by a lipid bilayer and cannot replicate, i.e. do not contain a functional nucleus". The size (diameter) of EVs ranges in ~30-1000 nm, with peak population at ~ 100 nm. Flow cytometry (FCM) is the most commonly used technique for analysis of EVs. However, accurate characterization, procedure standardization, instrument calibration and results interpretation/validation of EVs is confounded by their complex and variable composition, small size and substantial differences in physiological concentrations. Here, the challenges to and promises of FCM for characterization of EVs are discussed. Specifically, we systematically reviewed the pitfalls of FCM in the detection of (small) EVs and the corresponding strategies for enhancing the sensitivity and resolution of the instrument. The shortcomings and improvement in the overall FCM system are described in terms of reference material for calibration, the collection optics for fluorescence (FL), side scatter (SSC) and forward scatter (FSC) signals and fluidics. This study may provide a comprehensive reference for a brief overview pertaining to the challenges and promises of a modern FCM system for analysis of EVs.
Asunto(s)
Vesículas Extracelulares , Membrana Dobles de Lípidos , Citometría de Flujo/métodos , CalibraciónRESUMEN
The purpose of this review was to summarize and compare the efficacy among surgical interventions in terms of symptomatic relief in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). The review protocol was published on PROSPERO. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist was followed. Following database search, a narrative synthesis was performed. Data pertaining symptom scores, pain levels, and voiding frequency following surgery were summarized by calculating percentage change in these parameters. Multiple surgical treatments were identified. These included injections of hyaluronic acid (HA), botulinum toxin A (Botox A), triamcinolone, resiniferatoxin (RTX), platelet-rich plasma, and 50% dimethyl sulfoxide (DMSO) solution, neuromodulation, hydrodistension (HD), resection/fulguration of Hunner lesions, resection of ilioinguinal and iliohypogastric nerves, reconstructive surgery, and cystectomy. This review found no evidence suggesting that HD and RTX injections can ameliorate IC/BPS symptoms. Current evidence suggests that sacral neuromodulation, cystectomy, and transurethral resection/fulguration of Hunner lesions could lead to symptomatic relief in IC/BPS. Further research into the efficacy of Botox A, triamcinolone, 50% DMSO solution, and HA instillations is required. However, the best treatment options cannot be reliably stated due to the low level of evidence of the studies identified. Further research should report outcomes for Hunner-type IC and BPS separately given their differing histopathological characteristics. Performing high-quality randomized controlled trials could be hindered by the low prevalence of the condition and a small proportion of patients progressing to surgery.
Asunto(s)
Toxinas Botulínicas Tipo A , Cistitis Intersticial , Toxinas Botulínicas Tipo A/uso terapéutico , Cistitis Intersticial/tratamiento farmacológico , Cistitis Intersticial/cirugía , Dimetilsulfóxido/uso terapéutico , Humanos , Ácido Hialurónico/uso terapéutico , Triamcinolona/uso terapéuticoRESUMEN
The 'crazy-paving' pattern on high resolution computed tomography (HRCT) is a distinct imaging appearance that is still considered to be a radiological hallmark of pulmonary alveolar proteinosis. However, since its first description about three decades ago, more than 40 different clinical entities presenting as 'crazy-paving' patterns have been documented. This rather remarkable but uncommon imaging appearance is now considered to be a non-specific manifestation. A 62-year-old male referred for evaluation of productive cough, breathlessness and fever presented with 'crazy-paving' pattern on HRCT. Endobronchial biopsy done on presentation was consistent with the diagnosis of squamous cell carcinoma. This report highlights this atypical presentation of squamous cell carcinoma of the lung and adds to the increasing list of clinical entities presenting as a 'crazy-paving' pattern. To our knowledge, squamous cell carcinoma presenting as a 'crazy-paving' pattern on HRCT is yet to be documented.
RESUMEN
BACKGROUND: The clinical impact of the distressed communities index (DCI), a composite measure of economic well-being based on the U.S. zip code, is becoming increasingly recognized. Ranging from 0 (prosperous) to 100 (distressed), DCI's association with cardiovascular outcomes remains unknown. We aimed to study the association of the DCI with presentation and outcomes in adults with severe symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve intervention (TAVR) in an affluent county in New York. METHODS: The study population included 286 patients with severe symptomatic AS or degeneration of a bioprosthetic valve who underwent TAVR with a newer generation transcatheter heart valve (THV) from December 2015 to June 2018 at an academic tertiary medical center. DCI for each patient was derived from their primary residence zip code. Patients were classified into DCI deciles and then categorized into 4 groups. The primary and secondary outcomes of interest were 30-day, 1-year, and 3-year mortality, respectively. RESULTS: Among 286 patients studied, 26%, 28%, 28%, and 18% were categorized into DCI groups 1-4, respectively (DCI <10: n = 73; DCI 10-20: n = 81; DCI 20-30: n = 80; DCI >30: n = 52). Patients in group 4 were younger with worse kidney function compared to patients in groups 1 and 2. They also had smaller aortic annuli and were more likely to receive a smaller THV. No significant difference in hospital length of stay or distribution of in-hospital, 30-day, 1-year, and 3-year mortality was demonstrated. CONCLUSIONS: While the DCI was associated with differences in the clinical and anatomic profile, it was not associated with differences in clinical outcomes in this prospective observational study of adults undergoing TAVR suggesting that access to care is the likely discriminator.
Asunto(s)
Estenosis de la Válvula Aórtica , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/epidemiología , Estenosis de la Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Humanos , New York , Factores de Riesgo , Índice de Severidad de la Enfermedad , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Resultado del TratamientoRESUMEN
The prevailing formalisms for isolating individual polarization effects from the experimental Mueller matrix M can be broadly divided into two categories; decomposition of M to derive the individual optical effects and directly associating the individual optical effects to specific elements of M (i.e., non-decomposition techniques). Mueller matrix transformation (MMT) and direct interpretation of Mueller matrix (DIMM) are two popular techniques of the latter category. In this study, these two non-decomposition techniques (i.e., MMT and DIMM) are compared in a detailed quantitative analysis comprising of tissues (n = 53) and phantom (n = 45) samples. In particular, two commonly investigated polarimetric variables (i.e., depolarization and retardance) were calculated from the experimentally measured M using both the non-decomposition (i.e., MMT and DIMM) techniques. The comparison carried out with scatter plots (integrated with the correlation coefficients), violin plots and Bland and Altman plots revealed better agreement of depolarization-related variables (as compared to the retardance) between the two non-decomposition techniques. The comparative analyses presented here would be beneficial for the interpretation of polarimetric variables and optical characterization of turbid media.
RESUMEN
Bladder cancer (BC) is the 10th most common malignancy worldwide and the patient experience is found to be worse than that for patients diagnosed with other cancer types. We aimed to develop a wellbeing intervention to help improve the bladder cancer patient experience by ameliorating their health-related Quality of Life (HRQoL). We followed the 3 phases of the modified Medical Research Council (MRC) Framework for development of complex interventions. Following a systematic review of the literature on mental, sexual, and physical wellbeing, we conducted discussion groups with patients and healthcare professionals on these 3 themes. A consultation phase was then conducted with all relevant stakeholders to co-design a wellbeing intervention as part of a feasibility study. A pragmatic wellbeing feasibility trial was designed based on the hypothesis that a wellbeing program will increase patient awareness and attendance to services available to them and will better support their needs to improve HRQoL. The primary feasibility endpoints are patient attendance to the services offered and changes in HRQoL. The principle of patient centered care has strengthened the commitment to provide a holistic approach to support BC patients. In this study, we developed a wellbeing intervention in collaboration with patients and healthcare professionals to meet an unmet need in terms of the BC patient experience.
Asunto(s)
Calidad de Vida , Neoplasias de la Vejiga Urinaria , Estudios de Factibilidad , Personal de Salud , Humanos , Evaluación del Resultado de la Atención al Paciente , Neoplasias de la Vejiga Urinaria/terapiaRESUMEN
Refractive index (RI) is a characteristic optical variable that controls the propagation of light in the medium (e.g., biological tissues). Basic research with the aim to investigate the RI of biological tissues is of paramount importance for biomedical optics and associated applications. Herein, we reviewed and summarized the RI data of biological tissues and the associated insights. Different techniques for the measurement of RI of biological tissues are also discussed. Moreover, several examples of the RI applications from basic research, clinics and optics industry are outlined. This study may provide a comprehensive reference for RI data of biological tissues for the biomedical research and beyond.
Asunto(s)
Fotoquimioterapia , Refractometría , Fotoquimioterapia/métodos , Fármacos FotosensibilizantesRESUMEN
Cell refractive index (RI) is an intrinsic optical parameter that governs the propagation of light (i.e., scattering and absorption) in the cell matrix. The RI of cell is sensitively correlated with its mass distribution and thereby has the capability to provide important insights for diverse biological models. Herein, we review the cell refractive index and the fundamental models for measurement of cell RI, summarize the published RI data of cell and cell organelles and discuss the associated insights. Illustrative applications of cell RI in cell biology are also outlined. Finally, future research trends and applications of cell RI, including novel imaging techniques, reshaping flow cytometry and microfluidic platforms for single cell manipulation are discussed. The rapid technological advances in optical imaging integrated with microfluidic regime seems to enable deeper understanding of subcellular dynamics with high spatio-temporal resolution in real time.
Asunto(s)
Fotoquimioterapia , Refractometría , Modelos Biológicos , Imagen Óptica , Fotoquimioterapia/métodos , Fármacos FotosensibilizantesRESUMEN
Clostridioides difficile (CD) is responsible for nosocomial diarrhea syndrome with possible severe progression. Recurrence of the disease induces higher health system costs, as well as exposes patients to additional health risks. Patients with recurrence of this disease are difficult to identify, so the purpose of this study is to quantify various demographic, clinical, and treatment factors that could prevent further progression to recurrence of the disease. In the period 2018-2019, about 195 patients were diagnosed with more than one episode of CDI in the three months following the first episode. The recurrence rate for CDI was 53.84% (60.95% for one episode and 39.05% for multiple episodes). Most commonly afflicted were 60-69-year-old patients, or those with higher Charlson Comorbidity Index (CCI). Multiple analyses associated cardiovascular (odds ratios (OR) = 3.02, 95% confidence intervals (CI) = 1.23-7.39, p = 0.015), digestive (OR = 3.58, 95% CI = 1.01-12.63, p = 0.047), dementia (OR = 3.26, 95% CI = 1.26-8.41, p = 0.014), immunosuppressive (OR = 3.88, 95% CI = 1.34-11.21, p = 0.012) comorbidities with recurrences. Risk factor identification in the first episode of CDI could lead to the implementation of treatment strategies to improve the patients' quality of life affected by this disease.
RESUMEN
Mueller matrix polarimetry (MMP) has emerged as a simple, fast and non-invasive optical tool in basic and preclinical research whereby polarized light measurements are used to characterize biological samples. The skin tissue being exposed can be easily sampled, and the highly anisotropic nature of its ultra-structural components (e.g., the dense collagen/ elastin matrix, fibers) enable it a particularly suitable site for MMP investigations. In this study, we aim to survey, summarize, analyze and speculate on the trends in the literature which deals with the MMP of skin tissues. Specifically, we start with a brief description of the experimental implementation of MMP technique, with a focus on both the hardware and methodology, followed by a comprehensive online literature survey to summarize the MMP data pertaining to skin tissues and associated pathologies. Finally, the polarimetric data of skin tissues have been analyzed, quantitatively compared (using box and whisker plot and student t test) and the observed trends interpreted with the help of tissue morphology. We expect that this work will provide a useful reference to a comprehensive MMP analysis of the skin tissues.
Asunto(s)
Fotoquimioterapia , Elastina , Humanos , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes , Piel , Análisis EspectralRESUMEN
In an accomplishment of development of silver nanoparticles (AgNPs) based nanosensor for cysteine in its anionic and neutral forms, we have preferred N-(1-naphthyl)ethylenediamine cation (NEDA+) stabilized AgNPs (NEDA-AgNPs), because NEDA+ is a fluorescent active ion and it imparts excellent stability to AgNPs. Surface Plasmon resonance (SPR) of AgNPs and fluorescence property of NEDA+ are thus useful for presenting NEDA-AgNPs as a dual-tool nanosensor for cysteine molecules. The surface adsorbed NEDA+ cations interact selectively with cysteine as a consequence, the particles get aggregated, which was monitored using spectrophotometric method. The fluorescence property of NEDA+ is heavily quenched in NEDA-AgNPs, which could be reversed in presence of cysteine. The spectrofluorimetric method was thus used for quantification of cysteine as well. The detection limits (LOD to LOL) of anionic cysteine are 0.1784-1.598 µM and 0.0842-2.0 µM, respectively in spectrophotometric and spectrofluorimetric methods. From a real sample matrix, the recovery results are excellent, >95%. For neutral cysteine, the sensitivity is a bit low; 0.308-2.8 µM for spectrophotometric and 0.131-2.8 µM for spectrofluorimetric methods. It is found that the anionic cysteine (Kasso = 2.24 × 105 M-1/4.02 × 105 M-1) binds surface adsorbed NEDA+ cations strongly than that of neutral cysteine (Kasso = 3.69 × 104 M-1/1.24 × 105 M-1). Thus, NEDA-AgNPs show its potentials for being a dual-tool nanosensor as well as dual-form nanosensor for quantification of cysteine in a sample which may be the attractive system to an analyst.
Asunto(s)
Técnicas Biosensibles/instrumentación , Cisteína/análisis , Etilenodiaminas/química , Nanopartículas del Metal/química , Plata/química , Calibración , Cationes , Reactivos de Enlaces Cruzados/química , Dispersión Dinámica de Luz , Fluorescencia , Concentración de Iones de Hidrógeno , Cinética , Nanopartículas del Metal/ultraestructura , Tamaño de la Partícula , Espectrofotometría UltravioletaRESUMEN
BACKGROUND: The association between chronic kidney disease (CKD) and outcomes following transcatheter aortic valve replacement (TAVR) in the setting of newer-generation transcatheter heart valves (THVs) is not well known. Accordingly, we sought to assess the impact of CKD severity on outcomes in adults undergoing TAVR with newer-generation THVs. METHODS: The study population included 298 consecutive patients who underwent TAVR with a newer-generation THV (Sapien 3 [Edwards Lifesciences] or CoreValve Evolut R or Evolut Pro [Medtronic]) from December 2015 to June 2018 at an academic tertiary medical center. Patients were classified into three groups: group I, defined as creatinine clearance (CrCl) ≥60 mL/ min (n = 133); group II, defined as CrCl ≥30 mL/min and <60 mL/min (n = 128); and group III, defined as CrCl <30 mL/min (n = 37). RESULTS: Median length of stay was longer in groups II and III (2.0 days in group I vs 3.0 days in group II vs 4.0 days in group III; P<.01). While rates of 30-day readmission were significantly higher in groups II and III compared with group I (14.5% in group I vs 26.6% in group II vs 37.1% in group III; P<.01), rates of in-hospital and 30-day mortality and disabling stroke were similar. In multivariable analysis, CKD was independently associated with higher 30-day readmission rates (group II: odds ratio, 2.10; 95% confidence interval 1.02-4.32; group III: odds ratio, 3.52; 95% confidence interval, 1.40-8.87; group I: referent). CONCLUSIONS: In this prospective study of adults undergoing TAVR with newer-generation THVs, moderate and severe CKD was associated with a nearly 2-fold and 3-fold higher risk of 30-day readmission, respectively.
Asunto(s)
Estenosis de la Válvula Aórtica , Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Complicaciones Posoperatorias , Insuficiencia Renal Crónica , Reemplazo de la Válvula Aórtica Transcatéter , Anciano , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/cirugía , Diseño de Equipo/métodos , Femenino , Humanos , Pruebas de Función Renal/métodos , Pruebas de Función Renal/estadística & datos numéricos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/terapia , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/fisiopatología , Medición de Riesgo , Índice de Severidad de la Enfermedad , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Reemplazo de la Válvula Aórtica Transcatéter/métodosRESUMEN
In this study we demonstrate the analysis of biochemical changes in the human blood sera infected with Hepatitis B virus (HBV) using Raman spectroscopy. In total, 120 diseased blood samples and 170 healthy blood samples, collected from Pakistan Atomic Energy Commission (PAEC) general hospital, were analyzed. Spectra from each sample of both groups were collected in the spectral range 400-1700â¯cm-1. Careful spectral analyses demonstrated significant spectral variations (pâ¯<â¯0.0001) in the HBV infected individuals as compared to the normal ones. The spectral variations presumably occur because of the variations in the concentration of important biomolecules. Variations in spectral signatures were further exploited by using a neural network classifier towards machine-assisted classification of the two groups. Evaluation metrics of the classifier showed the diagnostic accuracy of (0.993), sensitivity (â¯=â¯0.992), specificity (â¯=â¯0.994), positive predictive value (â¯=â¯0.992) and negative predictive value (â¯=â¯0.994). The observed variations in the molecular concentration may be important markers of the hepatic performance and can be used in the diagnosis and machine-assisted classification of HBV infection.
Asunto(s)
Hepatitis B/diagnóstico , Redes Neurales de la Computación , Espectrometría Raman/métodos , Bilirrubina/análisis , Humanos , Pakistán , Fenilalanina/análisis , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Albúmina Sérica/análisis , Triptófano/análisisRESUMEN
The impact of gender on management and early outcomes after transcatheter aortic valve implantation (TAVI) in the setting of newer generation transcatheter heart valves (THVs) is not well known. We evaluated gender-specific differences on clinical management and in-hospital outcomes in adults who underwent TAVI with newer generation THVs. The study population included 298 consecutive patients who underwent TAVI and received a newer generation THV (Sapien 3 [Edwards Lifesciences, Irvine, California] or Corevalve Evolut R or Evolut Pro [Medtronic, Minneapolis, Minnesota]) from December 2015 to June 2018 at an academic tertiary medical center. Of the 298 patients, 154 (52%) were men and 144 (48%) were women. Compared with men, women were older, had lower serum creatinine, higher left ventricular ejection fraction, and lower rates of multiple co-morbidities, including previous coronary artery bypass graft surgery, previous myocardial infarction, and atrial fibrillation. Women were noted to have smaller aortic annular area and perimeter and underwent implantation of smaller THVs than men. At the time of discharge, women were more frequently prescribed a P2Y12 inhibitor (primarily clopidogrel) and less frequently prescribed oral anticoagulation (namely warfarin). Hospital length of stay and in-hospital rates of mortality, disabling stroke, and pacemaker were similar in men and women. In conclusion, in this observational prospective study of adults who underwent TAVI with newer generation THVs, while gender-related disparities in clinical presentation and procedural management were observed, no significant difference in clinical outcomes were noted in men and women. Further studies examining gender-related differences in procedural and postprocedural care after TAVI in the contemporary era are warranted to better understand and optimize clinical outcomes in both men and women.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Manejo de la Enfermedad , Prótesis Valvulares Cardíacas , Complicaciones Posoperatorias/epidemiología , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Complicaciones Posoperatorias/terapia , Pronóstico , Estudios Prospectivos , Diseño de Prótesis , Factores de Riesgo , Distribución por Sexo , Factores Sexuales , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: With the increased use of simulation for surgical training, there is a need for objective forms of assessment to evaluate trainees. The Global Evaluative Assessment of Robotic Skills (GEARS) is widely used for assessing skills in robotic surgery, but there are no recognised checklist scoring systems. This study aimed to develop a checklist for suturing in robotic surgery. METHODS: A suturing checklist for needle driving and knot tying was constructed following evaluation of participants performing urethrovesical anastomoses. Key procedural steps were identified from expert videos, while assessing novice videos allowed identification of common technical errors. 22 novice and 13 expert videos were marked on needle driving, while 18 novices and 10 experts were assessed on knot tying. Validation of the finalised checklist was performed with the assessment of 39 separate novices by an expert surgeon and compared to GEARS scoring. RESULTS: The internal consistency of the preliminary checklist was high (Cronbach's alpha = 0.870 for needle driving items; 0.736 for knot tying items), and after removal of poorly correlating items, the final checklist contained 23 steps. Both the needle driving and knot tying categories discriminated between novices and experts, p < 0.005. While the GEARS score demonstrated construct validity for needle driving, it could not significantly differentiate between novices and experts for knot tying, p = 0.286. The needle driving category significantly correlated with the corresponding GEARS scores (rs = 0.613, p < 0.005), but the correlation for knot tying was insignificant (rs = 0.296, p = 0.127). The pilot data indicates the checklist significantly correlated with the GEARS score (p < 0.005). CONCLUSION: This study reports the development of a valid assessment tool for suturing in robotic surgery. Given that checklists are simple to use, there is significant scope for this checklist to be used in surgical training.