Asunto(s)
Analgesia , Nocicepción , Humanos , Presión Sanguínea , Sistema Nervioso Autónomo , Barorreflejo , Frecuencia CardíacaRESUMEN
Various immediate early genes (IEGs) upregulated during the early process of liver regeneration are transcriptional targets of the serum response factor (SRF). We show here that the expression of SRF is rapidly induced in rodent liver after partial hepatectomy. Because the inactivation of the SRF gene in mice is embryonic lethal, the in vivo role of SRF in liver regeneration after partial hepatectomy was analyzed in mutant mice conditionally deleted for SRF in the liver. We demonstrate that SRF is not an essential factor for liver ontogenesis. However, adult mutant mice show impaired liver regeneration after partial hepatectomy, associated with a blunted upregulation of various SRF target IEGs. In conclusion, our work suggests that SRF is an early response transcription factor that may contribute to the initial phases of liver regeneration through its activation of IEGs.
Asunto(s)
Regeneración Hepática , Hígado/metabolismo , Factor de Respuesta Sérica/metabolismo , Animales , Ciclo Celular , Proteínas de Ciclo Celular/genética , Proteínas de Ciclo Celular/metabolismo , Proliferación Celular , ADN/biosíntesis , Hepatectomía , Proteínas Inmediatas-Precoces/genética , Proteínas Inmediatas-Precoces/metabolismo , Hígado/citología , Hígado/fisiología , Hígado/cirugía , Regeneración Hepática/genética , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Ratones Noqueados , ARN Mensajero/metabolismo , Factor de Respuesta Sérica/deficiencia , Factor de Respuesta Sérica/genética , Factores de Tiempo , Activación TranscripcionalRESUMEN
OBJECTIVE: Aortic surgery is associated with various hemodynamic and cardiac output modifications. These disorders may be partly caused by blood flow redistribution between supra-aortic and descending aorta regions during clamping and unclamping. A new echo-esophageal Doppler (Hemosonic 100; Arrow, Reading, PA) calculates cardiac output from a simultaneous measurement of blood flow velocity and diameter of the descending aorta. This calculation may be affected by blood redistribution during aortic clamping. The aim of this study was to compare cardiac output measured by echo-esophageal Doppler and by bolus thermodilution catheter during infrarenal aortic surgery. DESIGN: Prospective, observational study. SETTING: University hospital, single institution. PARTICIPANTS: Twenty-two adult patients. INTERVENTIONS: Infrarenal aortic surgery. MEASUREMENTS AND MAIN RESULTS: Cardiac outputs monitored by both devices were highly correlated during the whole surgical procedure (r2 ranging from 0.54 to 0.76). Bland and Altman analysis showed absence of significant bias before and after clamping (ranging from 0.1 +/- 0.73 L/min to 0.18 +/- 1 L/min, p > 0.05) and a significant bias of 0.5 +/- 1.05 L/min (p < 0.05) during aortic clamping. Limits of agreement did not differ significantly during the whole surgical procedure (ranging from -1.36/2.19 to -2.23/2.49). During clamping and unclamping, changes in cardiac output obtained by both methods were positively correlated (r2 = 0.7). CONCLUSIONS: Bias between both methods was clinically acceptable, and limits of agreement were not significantly modified by aortic clamping. However, larger studies including homogenous aortic pathologies are necessary to validate this method during infrarenal aortic surgery.
