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1.
Artículo en Inglés | MEDLINE | ID: mdl-33114587

RESUMEN

Aim: In this article, we aim to present a tool for the early assessment of medical technologies. This evaluation system was designed and implemented by the National Centre for HTA and the National Centre for Innovative Technologies of the Istituto Superiore di Sanita, Italy, in order to respond to an institutional commitment within the "Health Technologies Assessment Team" that was established to face the huge demand for the evaluation of Health Technologies during the pandemic event caused by COVID-19, with a smart and easy-to-use framework. Methods: Horizon scanning was conducted through a brief assessment carried out according to the multicriteria decision analysis methodology. Each HTA domain was attributed a score according to a pros/cons and opportunities/threats system, derived from evidence in the literature. Scores were weighted according to different perspectives. Scores were presented in a Cartesian graph showing the positioning according to the potential value and the perceived risk associated with the technology. Results: Two case studies regarding the early assessment were reported, concerning two specific technologies: an individual protection device and a contact tracking system.


Asunto(s)
Infecciones por Coronavirus , Técnicas de Apoyo para la Decisión , Pandemias , Neumonía Viral , Evaluación de la Tecnología Biomédica , Betacoronavirus , Humanos , Italia , Riesgo
2.
J Cardiovasc Med (Hagerstown) ; 21(7): 517-528, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32332378

RESUMEN

AIM: A validated algorithm for automatic aortic arch measurements in aortic coarctation (CoA) patients could standardize procedures for clinical planning. METHODS: The model-based assessment of the aortic arch anatomy consisted of three steps: first, machine-learning-based algorithms were trained on 212 three-dimensional magnetic resonance (MR) data to automatically allocate the aortic arch position in patients and segment the aortic arch; second, for each CoA patient (N = 33), the min/max aortic arch diameters were measured using the proposed software, manually and automatically, from noncontrast-enhanced three-dimensional steady-state free precession MRI sequence at five selected sites and compared ('internal comparison' referring to the same environment); third, moreover, the same min/max aortic arch diameters were compared, obtaining them independently, manually from common MR management software (MR Viewforum) and automatically from the model (external comparison). The measured sites were: aortic sinus, sino-tubular junction, mid-ascending aorta, transverse arch and thoracoabdominal aorta at the level of the diaphragm. RESULTS: Manual and software-assisted measurements showed a good agreement: the difference between diameter measurements was not statistically significant (at α = 0.05), with only one exception, for both internal and external comparison. A high coefficient of correlation was attained for both maximum and minimum diameters in each site (for internal comparison, R > 0.73 for every site, with P < 2 × 10). Notably, in tricuspid aortic valve patients external comparison showed no statistically significant difference at any measurement sites. CONCLUSION: The automatically derived aortic arch model, starting from three-dimensional MR images, could be a support to take the measurements in CoA patients and to quickly provide a patient-specific model of aortic arch anomalies.

3.
Methods Mol Biol ; 1702: 337-359, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29119514

RESUMEN

Processing and interpretation of biological images may provide invaluable insights on complex, living systems because images capture the overall dynamics as a "whole." Therefore, "extraction" of key, quantitative morphological parameters could be, at least in principle, helpful in building a reliable systems biology approach in understanding living objects. Molecular imaging tools for system biology models have attained widespread usage in modern experimental laboratories. Here, we provide an overview on advances in the computational technology and different instrumentations focused on molecular image processing and analysis. Quantitative data analysis through various open source software and algorithmic protocols will provide a novel approach for modeling the experimental research program. Besides this, we also highlight the predictable future trends regarding methods for automatically analyzing biological data. Such tools will be very useful to understand the detailed biological and mathematical expressions under in-silico system biology processes with modeling properties.


Asunto(s)
Biología Computacional/métodos , Modelos Biológicos , Imagen Molecular/métodos , Biología de Sistemas/métodos , Algoritmos , Animales , Simulación por Computador , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Programas Informáticos
4.
Ann Ist Super Sanita ; 52(3): 434-442, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27698303

RESUMEN

AIMS: To evaluate the quality of systematic reviews on telemedicine applications in palliative care. METHODS: A structured literature review was conducted to identify systematic reviews dealing with telemedicine in palliative care; the AMSTAR (Assessment of Multiple Systematic Reviews) checklist was used to appraise the evidence related to the systematic reviews. RESULTS: 405 records were initially identified; of these 14 were eligible for full-text analysis. In summary, the research strategy allowed the identification of 6 reviews to be included which showed a medium quality (AMSTAR score in between 4 and 7). All the included systematic reviews considered telemedicine applications as a feasible means to be used in palliative care; however, the positive findings are counterbalanced by several critical issues mainly related to the evidence from the primary studies included in each single review. CONCLUSIONS: Results of this first attempt to appraise the evidence in the field of telemedicine applications in palliative care highlighted that there is still limited evidence related to this approach. Strengths and weaknesses that impact on the general quality of the reviews were identified and relevant points to be taken into account for future research were suggested.


Asunto(s)
Cuidados Paliativos/métodos , Telemedicina , Humanos , Metaanálisis como Asunto , Comodidad del Paciente , Revisiones Sistemáticas como Asunto
5.
Artif Organs ; 40(1): 43-9, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26777148

RESUMEN

A relevant number of patients undergoing total cavopulmonary connection (TCPC) experience heart failure (HF). Heart transplant is then the final option when all other treatments fail. The axial flow blood pumps are now the state of the art; however, there is little experience in low-pressure circuits, such as support of the right ventricle or even a TCPC circulation. A new T-shaped model of mechanically assisted TCPC using the "Jarvik Child 2000" axial pump, (flow rates between 1 and 3 L/m in a range of 5000-9000 rpm) was designed, simulated numerically, and then tested in animals. Eight sheep (42-45 kg) were studied: two pilot studies, four pump-supported (PS) TCPC for 3 h, and two not pump-supported (NPS) TCPC. In the PS, the axial pump was set to maintain the baseline cardiac output (CO). Pressures, CO, systemic and pulmonary vascular resistance, lactate levels, and blood gases were recorded for 3 h. Computational fluid dynamics (CFD) study allows us to set the feasible operating condition and the safety margins to minimize the venous collapse risk. In the NPS animals, a circulatory deterioration, with increasing lactate level, occurred rapidly. In the PS animals, there was a stable cardiac index of 2.7 ± 1.4 L/min/m(2), central venous pressure of 12.3 ± 1 mm Hg, and a mean pulmonary artery pressure (PAP) of 18.1 ± 6 after 3 h of support up to 9000 rpm. systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), blood gasses, and arterial lactate levels remained stable to baseline values. No caval collapse occurred. A new pediatric axial flow pump provides normal CO and physiologic stability in a new T-shaped model of TCPC in sheep, in vivo. CFD and in vivo data showed that this experimental arrangement will allow us to evaluate the potential for mechanical support in patients with Fontan failure avoiding major adverse events.


Asunto(s)
Simulación por Computador , Procedimiento de Fontan/efectos adversos , Insuficiencia Cardíaca/terapia , Corazón Auxiliar , Hemodinámica , Modelos Cardiovasculares , Animales , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Modelos Animales , Análisis Numérico Asistido por Computador , Diseño de Prótesis , Ovinos , Factores de Tiempo
6.
Ann Ist Super Sanita ; 51(1): 11-8, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25857379

RESUMEN

AIMS: To evaluate the quality of systematic reviews on telerehabilitation. METHODS: The AMSTAR--Assessment of Multiple Systematic Reviews--checklist was used to appraise the evidence related to the systematic reviews. RESULTS: Among the 477 records initially identified, 10 systematic reviews matched the inclusion criteria. Fifty percent were of high quality; anyway the majority of them did not report the following aspects: i) analysis of the grey literature; ii) a list of the excluded studies and their characteristics; iii) the identification of possible source of bias and the assessment of its likehood; iv) an appropriate method to combine the findings of the included studies addressing the heterogeneity as well. From the main findings of the high-scored systematic reviews telerehabilitation resulted at least as effective as usual care: 1) in the short term treatment of mental health related to people affected by spinal cord injury; 2) in rural communities for treating patients affected by chronic conditions; 3) in treating common pathologies (mainly asthma) affecting children and adolescents. As for stroke, evidence is currently insufficient to reach conclusions about its effectiveness. As for costs, there is insufficient evidence to confirm that telerehabilitation is a cost-saving or cost-effective solution. CONCLUSIONS: In the authors' knowledge this is the first attempt to evaluate the quality of systematic reviews on telerehabilitation. This work also identified the main findings related to the high-scored systematic reviews; the analysis confirms that there is a mounting evidence concerning the effectiveness of telerehabilitation, at least for some pathologies.


Asunto(s)
Metaanálisis como Asunto , Rehabilitación/normas , Telemedicina/normas , Análisis Costo-Beneficio , Medicina Basada en la Evidencia , Humanos , Rehabilitación/economía , Rehabilitación/tendencias , Telemedicina/economía , Telemedicina/tendencias
7.
Artículo en Inglés | MEDLINE | ID: mdl-26737004

RESUMEN

BACKGROUND: Prosthetic heart valves can be associated to mechanical loading of blood, potentially linked to complications (hemolysis and thrombogenicity) which can be clinically relevant. In order to test such devices in pulsatile mode, pulse duplicators (PDs) have been designed and built according to different concepts. This study was carried out to compare anemometric measurements made on the same prosthetic device, with two widely used PDs. METHODS: The valve (a 27-mm bileaflet valve) was mounted in the aortic section of the PD. The Sheffield University PD and the RWTH Aachen PD were selected as physical models of the circulation. These two PDs differ mainly in the vertical vs horizontal realization, and in the ventricular section, which in the RWTH PD allows for storage of potential energy in the elastic walls of the ventricle. A glassblown aorta, realized according to the geometric data of the same anatomical district in healthy individuals, was positioned downstream of the valve, obtaining 1:1 geometric similarity conditions. A NaI-glycerol-water solution of suitable kinematic viscosity and, at the same time, the proper refractive index, was selected. The flow field downstream of the valve was measured by means of the stereo-PIV (Particle Image Velocimetry) technique, capable of providing the complete 3D velocity field as well as the entire Reynolds stress tensor. The measurements were carried out at the plane intersecting the valve axis. RESULTS: A three-jet profile was clearly found in the plane crossing the leaflets, with both PDs. The extent of the typical recirculation zone in the Valsalva sinus was much larger in the RWTH PD, on account of the different duration of the swirling motion in the ventricular chamber, caused by the elasticity of the ventricle and its geometry. CONCLUSION: The comparison of the hemodynamical behaviour of the same bileaflet valve tested in two PDs demonstrated the role of the mock loop in affecting the valve performance.


Asunto(s)
Aorta/anatomía & histología , Válvula Aórtica/anatomía & histología , Prótesis Valvulares Cardíacas , Imagenología Tridimensional/métodos , Diseño de Prótesis , Aorta/fisiología , Válvula Aórtica/fisiología , Calibración , Simulación por Computador , Elasticidad , Diseño de Equipo , Glicerol/química , Válvulas Cardíacas/anatomía & histología , Válvulas Cardíacas/fisiología , Hemodinámica , Humanos , Reología , Estrés Mecánico , Agua/química
8.
PLoS One ; 9(4): e95183, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24788065

RESUMEN

The role of variable regions of HIV-1 gp120 in immune escape of HIV has been investigated. However, there is scant information on how conserved gp120 regions contribute to virus escaping. Here we have studied how molecular sequence characteristics of conserved C3, C4 and V3 regions of clade C HIV-1 gp120 that are involved in HIV entry and are target of the immune response, are modulated during the disease course. We found an increase of "shifting" putative N-glycosylation sites (PNGSs) in the α2 helix (in C3) and in C4 and an increase of sites under positive selection pressure in the α2 helix during the chronic stage of disease. These sites are close to CD4 and to co-receptor binding sites. We also found a negative correlation between electric charges of C3 and V4 during the late stage of disease counteracted by a positive correlation of electric charges of α2 helix and V5 during the same stage. These data allow us to hypothesize possible mechanisms of virus escape involving constant and variable regions of gp120. In particular, new mutations, including new PNGSs occurring near the CD4 and CCR5 binding sites could potentially affect receptor binding affinity and shield the virus from the immune response.


Asunto(s)
Adaptación Fisiológica/fisiología , Proteína gp120 de Envoltorio del VIH/fisiología , VIH-1/fisiología , Glicosilación , Proteína gp120 de Envoltorio del VIH/metabolismo , VIH-1/genética , VIH-1/metabolismo , Filogenia
9.
Artículo en Inglés | MEDLINE | ID: mdl-24110475

RESUMEN

DNA fingerprinting is a reliable tool for identifying, tracing and characterizing bacterial clonal population structure. A recent technique is given by the Multiple Loci VNTR Analysis (MLVA), where VNTR denotes Variable Number of Tandem Repeats, that meets the need for fast and reliable typing methods by combining the polymorphic nature of tandem repeats (TR) and the use of Polymerase Chain Reaction (PCR) methodology. The key point in the MLVA technique is the selection of a set of TRs which have a sufficient variability (polymorphism) across strains, in order to allow easy strain typing. In this work, we present a program which analyses a set of N genomes and outputs the list of shared TRs and associated information. The program compares the TRs for each possible genome pair, and finds the sets of TRs that are shared by at least M genomes. The subsequent determination of "virtual amplicons" enables the user to consider the actual polymorphism exhibited by the different strains with regards to each given TR, which is the critical parameter for the experimental strain typing.


Asunto(s)
Dermatoglifia del ADN/métodos , Repeticiones de Minisatélite/genética , Programas Informáticos , Tipificación Molecular/métodos , Reacción en Cadena de la Polimerasa , Análisis de Secuencia de ADN
10.
Artículo en Inglés | MEDLINE | ID: mdl-24110791

RESUMEN

Contact lens are a widespread medical device. In view of the importance of a proper oxygenation of the cornea, new materials are continuously being tested, with a high permeability to oxygen. Taking into account the limitations of the methods for testing soft contact lenses, as presented in the relevant international standards, this paper focuses on the polarographic method and on the approach of measuring oxygen permeability of stacked contact lenses. The effect of the interspersed saline solution layers on the measurable permeability of the stack is considered, using Fick's law of diffusive flux, and a proposal for accuracy improvement in oxygen permeability measurements is presented.


Asunto(s)
Lentes de Contacto Hidrofílicos , Oxígeno/metabolismo , Córnea/metabolismo , Modelos Teóricos , Consumo de Oxígeno/fisiología , Permeabilidad , Polarografía/instrumentación , Polarografía/métodos
11.
Telemed J E Health ; 19(3): 224-32, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23438362

RESUMEN

BACKGROUND: When designing a complete process of daily telerehabilitation, it should be borne in mind that patients should be furnished with properly designed methodologies for executing specific motion tasks and the assessment of the relevant parameters. In general, such a process should comprehend three basic elements in both the hospital and the home: (a) instrumented walkways, (b) walking aids or supports, and (c) equipment for the assessment of parameters. The objective, with gait being the focus, of this study was thus to design a simple, portable kit-as an alternative to the complex and expensive instruments currently used-to be easily interfaced or integrated with the instrumented walkways and aids/supports both for self-monitoring while patients are exercising with their own aids and for clinical reporting. MATERIALS AND METHODS: The proposed system is a portable kit that furnishes useful parameters with feedback to both the patient and the trainer/therapist. Capable of being integrated with the most common mechanical tools used in motion rehabilitation (handrail, scales, walkways, etc.), it constantly monitors and quantitatively assesses progress in rehabilitation care. It is composed of one step counter, photo-emitter detectors, one central unit for collecting and processing the telemetrically transmitted data, and a software interface. RESULTS AND DISCUSSION: The system has been successfully validated on 16 subjects at the second level of the Tinetti test in a clinical application for both home and the hospital. The portable kit can be used with different rehabilitation tools and on varying ground rugosity. Advantages include (a) very low cost, when compared with optoelectronic solutions or other portable devices, (b) very high accuracy, also for subjects with imbalance problems, compared with other commercial solutions, and (c) integration (compatibility) with any rehabilitative tool.


Asunto(s)
Monitoreo Ambulatorio/métodos , Modalidades de Fisioterapia/organización & administración , Telemedicina/organización & administración , Adulto , Anciano , Femenino , Marcha , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Ambulatorio/instrumentación , Equipo Ortopédico , Reproducibilidad de los Resultados , Telemedicina/instrumentación
12.
Int J Artif Organs ; 35(5): 376-84, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22669589

RESUMEN

Fetal cardiac surgery (FCS) represents a challenging issue for the in utero treatment of congenital heart defects. However, FCS has still not gained the sufficient reliability for clinical practice due to an incompletely elucidated fetal stress response. For example, blood sampling can contribute to its onset, leading to fetoplacental unit dysfunction, one of the main causes of failure of the surgical procedure. In order to address this issue, the role of the autonomic control system during an experimental procedure of cardiac bypass on ewe fetuses was investigated by means of recurrence quantification analysis (RQA), a well-recognized method for the analysis of nonlinear systems. RQA was applied to time series extracted from fetal arterial pressure recordings before and after the cardiac bypass established by means of an extracorporeal circuit, including an axial blood pump, and taking advantage of the capability of the placenta to work as a natural oxygenator. Statistically significant correlations were found among RQA-based metrics and fetal blood gas data, suggesting the possibility to infer the clinical status of the fetus starting from its hemodynamic signals.This study shows the relevance of RQA as a complementary tool for the monitoring of the fetal status during cardiac bypass.


Asunto(s)
Puente Cardiopulmonar/efectos adversos , Sufrimiento Fetal/diagnóstico , Corazón Fetal/cirugía , Monitoreo Fetal , Frecuencia Cardíaca Fetal , Monitoreo Intraoperatorio/métodos , Dinámicas no Lineales , Procesamiento de Señales Asistido por Computador , Animales , Sistema Nervioso Autónomo/fisiopatología , Presión Sanguínea , Determinación de la Presión Sanguínea , Femenino , Sufrimiento Fetal/etiología , Sufrimiento Fetal/fisiopatología , Corazón Fetal/inervación , Corazón Fetal/fisiopatología , Modelos Animales , Valor Predictivo de las Pruebas , Embarazo , Ovinos , Factores de Tiempo
13.
Comput Methods Programs Biomed ; 107(2): 294-307, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22119762

RESUMEN

Today the risk factors related to the use of Video Display Terminals (VDT) are assessed by investigating the actual activities at the VDT through subjective questionnaires and/or quantitative measurements. Questionnaire outcomes are quite imprecise and seldom objective. Quantitative measurements (EMG recordings, electrogoniometers, motion analysis systems) mostly prevent subjects from moving freely while working at the VDT. The paper presents an automatic tool for the monitoring of activity at VDTs, using a quantitative, objective approach. The suitability of the proposed tool was fully tested in the laboratory, both in terms of functionalities, accuracy of the tool, and acceptance by the subjects involved. The outcomes show that the tool allows for a detailed analysis of VDT activities and may be used to improve VDT-related risk analysis with high accuracy and good acceptance by workers.


Asunto(s)
Actigrafía/métodos , Periféricos de Computador , Terminales de Computador , Artropatías/epidemiología , Monitoreo Ambulatorio/métodos , Enfermedades Profesionales/epidemiología , Programas Informáticos , Diagnóstico por Computador/métodos , Humanos , Artropatías/diagnóstico , Masculino , Enfermedades Profesionales/diagnóstico , Diseño de Software , Adulto Joven
14.
NeuroRehabilitation ; 27(4): 287-304, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-21160118

RESUMEN

This paper aims at delivering a structured overview of telerehabilitation literature by analysing the entire set of articles under the search terms "telerehabilitation" or "tele-rehabilitation" to portray "state of the art" ten years after the publication of the first scientific article on the topic. A structured study has been conducted by considering all those articles containing the word "telerehabilitation" or "tele-rehabilitation". Medline, Embase, Cochrane, UK Centre for Reviews and Dissemination, Canadian Agency for Drugs and Technologies in Health databases have been interrogated for articles between 1998 and 2008. 146 scientific articles were found. 56 articles focus on patient treatment, 23 are reviews, 3 are to be considered as both patient treatment papers and reviews, 53 are either technical reports, system descriptions or analyses of new approaches; 8 are general discussion on telerehabilitation. The present paper draw the scenario of the first ten years of telerehabilitation, focussing on clinical applications and technologies. Basically, it confirms the lack of comprehensive studies providing evidence for supporting decision and policy-makers in adopting telerehabilitation technologies in the clinical practice. An overall lack of standardisation in the used terminology also results from the analysis of keywords, which is typical of quite recent fields of application.


Asunto(s)
Rehabilitación/tendencias , Telemedicina/tendencias , Tecnología Biomédica , Humanos
16.
Ann Ist Super Sanita ; 46(2): 115-22, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20567061

RESUMEN

The paper approaches a new technological scenario relevant for the introduction of the digital cytology (D-CYT) in the health service. A detailed analysis of the state of the art on the status of the introduction of D-CYT in the hospital and more in general in the dispersed territory has been conducted. The analysis was conducted in a form of review and was arranged into two parts: the first part focused on the technological tools needed to carry out a successful service (client server architectures, e-learning, quality assurance issues); the second part focused on issues oriented to help the introduction and evaluation of the technology (specific training in D-CYT, health technology assessment in-routine application, data format standards and picture archiving computerized systems (PACS) implementation, image quality assessment, strategies of navigation, 3D-virtual-reality potentialities). The work enlightens future scenarios of actions relevant for the introduction of the technology.


Asunto(s)
Microscopía , Procesamiento de Señales Asistido por Computador , Telepatología/métodos , Sistemas de Información en Hospital , Interfaz Usuario-Computador
17.
Ann Ist Super Sanita ; 46(2): 130-7, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20567063

RESUMEN

The paper describes a fundamental feature of digital cytology relevant to the implementation of the technology in the hospital net services: the electronic recording of the virtual slides (VS) in the hospital information system (HIS) through a picture archiving and communication system (PACS). Starting from the digital cytology (D-CYT) state of art and considering the most important products in the field, particular attention has been devoted in this review to the comparison with the digital radiology (D-RAD). Two main indications emerged from the study: 1. there is not a standard in the digital files relevant to the virtual slides in D-CYT, while in D-RAD the standard digital imaging and communications in medicine (DICOM), introduced by the National Electrical Manufacturers Association (NEMA), has been adopted from several years; 2. the PACS in D-CYT are not standardized from manufacturers. The study makes a proposal of a useful software architecture to improve the PACS integration for D-CYT applications, with potentialities in the HIS.


Asunto(s)
Sistemas de Información Radiológica , Procesamiento de Señales Asistido por Computador , Telepatología
18.
J Telemed Telecare ; 16(4): 204-6, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20511576

RESUMEN

We investigated the use of surface electromyography with biofeedback for telerehabilitation. The aim was to investigate the therapist's point of view, and the general acceptability of the system for the patient and for the therapist. The system allowed a therapist to modulate the rehabilitation protocol remotely, by changing the configuration variables, e.g. threshold and duration. The case study focused on a patient with arm impairment following a stroke. After two weeks of daily usage, there were some differences between the patient and the therapist about the ease of use of the equipment. However, there was general agreement about the usefulness of the system, ease of the performed tasks, appropriateness of the performed tasks and overall opinion. Wireless technology would reduce the complexity of the tasks required of the patient.


Asunto(s)
Actitud del Personal de Salud , Neurorretroalimentación/métodos , Terapia Ocupacional/métodos , Terapia Ocupacional/psicología , Rehabilitación/métodos , Telemedicina/métodos , Electromiografía , Hospitales , Humanos , Persona de Mediana Edad , Satisfacción del Paciente , Rehabilitación de Accidente Cerebrovascular , Telemetría/instrumentación , Telemetría/métodos , Interfaz Usuario-Computador
19.
J Mater Sci Mater Med ; 21(4): 1353-62, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19957022

RESUMEN

This work focuses on the evaluation of the potential use of electrospun poly(epsilon-caprolactone) (PCL) micrometric and/or sub-micrometric fibrous membranes for rat hippocampal astrocyte (HA) and rat cerebro-microvascular endothelial cell (CEC) cultures. Both mats supported cell adhesion, proliferation, cellular phenotype and spreading. Microfibrous mats allowed cellular infiltration, while both HAs and CECs were unable to migrate within the sub-micrometric fibrous mat, leaving an acellularized inner region. This finding was correlated to the presence of larger voids within electrospun PCL microfibrous mats, suggesting that the morphology should be accurately selected for the realization of a cell environment-mimicking mat. Based on our results, the proper fiber architecture can be regarded as a crucial issue to be considered in order to deal with suitable polymeric mats tailored for specific in vitro application.


Asunto(s)
Astrocitos/efectos de los fármacos , Cerebro/efectos de los fármacos , Células Endoteliales/efectos de los fármacos , Membranas Artificiales , Poliésteres/farmacología , Animales , Animales Recién Nacidos , Astrocitos/fisiología , Materiales Biocompatibles/química , Materiales Biocompatibles/farmacología , Células Cultivadas , Cerebro/citología , Cerebro/fisiología , Electroquímica/métodos , Células Endoteliales/fisiología , Ensayo de Materiales , Nanofibras/química , Nanotecnología/métodos , Poliésteres/química , Ratas , Ratas Sprague-Dawley , Ingeniería de Tejidos/métodos , Andamios del Tejido/química
20.
J Thorac Cardiovasc Surg ; 138(5): 1154-9, 2009 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19660416

RESUMEN

OBJECTIVES: Two innovative surgical approaches addressing systemic venous anomalies in single-ventricle patients are evaluated. METHODS: Between 2003 and 2007, 7 patients underwent a unifocal bilateral bidirectional cavopulmonary anastomosis, and 5 patients underwent a hepatoazygos venous connection associated with a previous (n = 4) or concomitant (n = 1) Kawashima operation. Computational fluid dynamics simulations allowed investigation of 2 sets of comparative models: (1) bifocal versus unifocal bilateral bidirectional cavopulmonary anastomosis and (2) classic hepatic vein-pulmonary artery channel versus hepatoazygos direct anastomosis for Fontan completion after or combined with the Kawashima operation. RESULTS: There was 1 hospital death in the unifocal bilateral bidirectional cavopulmonary anastomosis group. At a mean follow-up of 15.6 +/- 7.40 months after a unifocal bilateral bidirectional cavopulmonary anastomosis and of 38.7 +/- 13.2 months after direct hepatoazygos venous connection, respectively, all 11 survivors are in New York Heart Association class I with functional anastomoses. Computational assessment of bifocal bilateral bidirectional cavopulmonary anastomosis demonstrated weak perfusion between caval veins against symmetric and steady bilateral flow fields in the unifocal arrangement. In the classic post-Kawashima Fontan completion model, the hepatic venous flow to the pulmonary artery was held back by means of preponderant opposite flow, whereas in the direct hepatoazygos venous connection model, the hepatic venous flow merged smoothly into the azygos vein. Power-loss calculation showed no significant difference between bifocal and unifocal bilateral bidirectional cavopulmonary anastomosis topology, whereas the hepatoazygos connection clearly had better energy preservation than the classical connection. CONCLUSIONS: This limited clinical and computational fluid dynamics assessment suggests the efficacy of this new rationale to reduce the additional thrombotic risks produced by systemic venous anomalies in single-ventricle patients.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/anomalías , Vena Cava Superior/anomalías , Anastomosis Quirúrgica , Vena Ácigos , Velocidad del Flujo Sanguíneo , Procedimientos Quirúrgicos Cardíacos/mortalidad , Angiografía Coronaria , Femenino , Procedimiento de Fontan , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/mortalidad , Ventrículos Cardíacos/cirugía , Venas Hepáticas , Mortalidad Hospitalaria , Humanos , Lactante , Recién Nacido , Masculino , Arteria Pulmonar/anomalías , Venas Pulmonares/anomalías , Resultado del Tratamiento , Vena Cava Superior/diagnóstico por imagen
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