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1.
Ann Palliat Med ; 2021 Dec 07.
Artículo en Inglés | MEDLINE | ID: mdl-34894709

RESUMEN

BACKGROUND: Despite being one of the few chronic secondary heart diseases that can be prevented, current epidemiological data on rheumatic heart disease (RHD) in China are unavailable. This study examined mitral valve (MV) surgery trends in a large Chinese cardiovascular center over the last 10 years and provided insight into the distribution of RHDs and their changes. METHODS: Medical records of patients who underwent cardiac surgery, MV surgery, and MV surgery for rheumatic MV (rMV) disease at Beijing Anzhen Hospital between January 2010 and December 2019 were retrospectively reviewed. Patients' demographic and clinical characteristics were statistically analyzed among age groups. RESULTS: Overall, 7,736 patients underwent rMV surgery and 87.5% were aged 40-70 years. The proportion of patients aged >60 years increased annually (P<0.05), and the proportion of patients in all other age groups decreased. The proportion of patients with rMV diseases among those with cardiac or mitral valve diseases decreased each year, but the absolute number of patients with rMV disease remained stable. Approximately 90% of patients who underwent rMV surgery were from northern China. The incidence of rMV disease among patients with mitral valve disease moderately correlated with the per capita gross regional product (Per-GRP), an indicator of living standards (r=-0.517, P<0.05). CONCLUSIONS: RHD still exists in northern China and requires adequate resources for its management. The number of older patients with rMV disease presents a challenge for mitral valve surgery.

2.
Lancet HIV ; 8(2): e87-e95, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33539762

RESUMEN

BACKGROUND: Two phase 3 clinical trials showed that use of a monthly vaginal ring containing 25 mg dapivirine was well tolerated and reduced HIV-1 incidence in women by approximately 30% compared with placebo. We aimed to evaluate use and safety of the dapivirine vaginal ring (DVR) in open-label settings with high background rates of HIV-1 infection, an important step for future implementation. METHODS: We did a phase 3B open-label extension trial of the DVR (MTN-025/HIV Open-label Prevention Extension [HOPE]). Women who were HIV-1-negative and had participated in the MTN-020/ASPIRE phase 3 trial were offered 12 months of access to the DVR at 14 clinical research centres in Malawi, South Africa, Uganda, and Zimbabwe. At each visit (monthly for 3 months, then once every 3 months), women chose whether or not to accept the offer of the ring. Used, returned rings were tested for residual amounts of dapivirine as a surrogate marker for adherence. HIV-1 serological testing was done at each visit. Dapivirine amounts in returned rings and HIV-1 incidence were compared with data from the ASPIRE trial, and safety was assessed. This study is registered with ClinicalTrials.gov, NCT02858037. FINDINGS: Between July 16, 2016, and Oct 10, 2018, of 1756 women assessed for eligibility, 1456 were enrolled and participated in the study. Median age was 31 years (IQR 27-37). At baseline, 1342 (92·2%) women chose to take the DVR; ring acceptance was more than 79% at each visit up until 12 months and 936 (73·2%) of 1279 chose to take the ring at all visits. 12 530 (89·3%) of 14 034 returned rings had residual dapivirine amounts consistent with some use during the previous month (>0·9 mg released) and the mean dapivirine amount released was greater than in the ASPIRE trial (by 0·21 mg; p<0·0001). HIV-1 incidence was 2·7 per 100 person-years (95% CI 1·9-3·8, 35 infections), compared with an expected incidence of 4·4 per 100 person-years (3·2-5·8) among a population matched on age, site, and presence of a sexually transmitted infection from the placebo group of ASPIRE. No serious adverse events or grade 3 or higher adverse events observed were assessed as related to the DVR. INTERPRETATION: High uptake and persistent use in this open-label extension study support the DVR as an HIV-1 prevention option for women. With an increasing number of HIV-1 prophylaxis choices on the horizon, these results suggest that the DVR will be an acceptable and practical option for women in Africa. FUNDING: The Microbicide Trials Network and the National Institute of Allergy and Infectious Diseases, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute of Mental Health, all components of the US National Institutes of Health.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Dispositivos Anticonceptivos Femeninos , Infecciones por VIH/prevención & control , Pirimidinas/uso terapéutico , Tenofovir/uso terapéutico , Administración Intravaginal , Adulto , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/inmunología , Infecciones por VIH/virología , VIH-1/inmunología , Humanos , Malaui , Cooperación del Paciente/estadística & datos numéricos , Seguridad del Paciente , Seroconversión , Sudáfrica , Resultado del Tratamiento , Uganda , Zimbabwe
3.
BMC Cardiovasc Disord ; 21(1): 50, 2021 01 26.
Artículo en Inglés | MEDLINE | ID: mdl-33499803

RESUMEN

BACKGROUND: To identify the association between tricuspid annular circumference and secondary tricuspid regurgitation and analyze the risk factors of recurrent tricuspid regurgitation after concomitant tricuspid annuloplasty during left heart surgery. METHODS: From October 2018 to June 2019, a total of 117 patients receiving concomitant tricuspid annuloplasty within left heart surgery were enrolled. Severity of tricuspid regurgitation was classified as 4 subtypes: normal, mild, moderate and severe. Perioperative data and mid-term outcome were collected. Tricuspid annular circumference (TAC) was measured under cardiac arrest during surgery procedure by cardioplegia. Optimal TAC and TAC index (TAC/body surface area, BSA) cutoffs of significant tricuspid annulus dilatation (moderate and severe) were obtained. Univariable and multivariable logistic regression analyses were performed to identify the risk factors of postoperative recurrent tricuspid regurgitation. The follow up period is 13-19 months (mean 15.5 ± 3.2 months). RESULTS: There was 1 patient was excluded who died after surgery. A total of 116 patients receiving tricuspid annuloplasty were included. Optimal cutoffs of significant tricuspid annulus dilatation were recommended (TAC 11.45 cm, Sensitivity 82.89%, Specificity 73.68%, AUC 0.915; TAC index 7.09 cm/m2, Sensitivity 73.68%, Specificity 85%, AUC 0.825, respectively). Based on findings of multivariable logistic regression, it has been showed that TAC index and postoperative atrial fibrillation were the independent risk factors of recurrent regurgitation after surgery. Optimal TAC index cutoff to predict recurrent tricuspid regurgitation was 7.86 cm/m2 CONCLUSIONS: The severity of secondary tricuspid regurgitation is associated with the tricuspid annular circumference. The cut-offs of significant tricuspid regurgitation (more than moderate) were TAC 11.45 cm and TAC index 7.09 cm/m2, respectively. Clinically, concomitant tricuspid annuloplasty is relative safe and effective. TAC index ≥ 7.86 cm/m2 and postoperative atrial fibrillation are the risk factors of recurrent significant tricuspid regurgitation after concomitant tricuspid annuloplasty during left heart surgery.


Asunto(s)
Anuloplastia de la Válvula Cardíaca/efectos adversos , Complicaciones Posoperatorias/etiología , Insuficiencia de la Válvula Tricúspide/cirugía , Válvula Tricúspide/cirugía , Anciano , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Recurrencia , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/fisiopatología , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/fisiopatología
4.
J Thorac Cardiovasc Surg ; 162(1): 72-82.e7, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-32169372

RESUMEN

OBJECTIVE: Whether mitral valve repair is superior to replacement in the population with rheumatic heart disease has been debated. This study aims to compare outcomes of repair with replacement by the propensity score method. METHODS: This observational, prospective study enrolled patients with rheumatic heart disease who underwent mitral valve repair and replacement from January 2011 to April 2019. The propensity score method was used to select 2 groups with similar baseline characteristics. Baseline, clinical, and follow-up data were collected. Clinical outcomes included death from any cause, reoperation, and valve-related complications. RESULTS: The overall population before matching (N = 1644) included 612 patients who underwent repair and 1032 patients who underwent replacement. The propensity score analysis generated matches for 1058 patients (529 pairs). The median follow-up time was 4.12 years. Early mortality and death from any cause during follow-up were significantly lower in the repair group compared with the replacement group (hazard ratio, 0.19; 95% confidence interval [CI], 0.05-0.64; P = .003; hazard ratio, 0.38; 95% CI, 0.19-0.74; P = .003, respectively). Patients in the repair group had a lower risk of valve-related complications compared with patients in the replacement group (subhazard ratio, 0.44; 95% CI, 0.21-0.90; P = .025). In terms of reoperation, no significant difference was observed between the repair and replacement groups (subhazard ratio, 2.54; 95% CI, 0.89-7.22; P = .081). CONCLUSIONS: The results suggest that rheumatic mitral valve repair in select patients is superior to mitral valve replacement with regard to lower mortality and fewer valve-related complications; meanwhile, it has a comparable risk of reoperation compared with replacement.


Asunto(s)
Implantación de Prótesis de Válvulas Cardíacas , Válvula Mitral/cirugía , Cardiopatía Reumática/cirugía , Adulto , Anciano , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/cirugía , Complicaciones Posoperatorias , Puntaje de Propensión , Estudios Prospectivos , Reoperación/estadística & datos numéricos , Resultado del Tratamiento
5.
J Thorac Dis ; 12(11): 6542-6551, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33282356

RESUMEN

Background: The elevation of troponin after coronary artery bypass grafting (CABG) is common This study aimed to investigate the association between very early cardiac troponin I (cTnI) concentration and its longitudinal change within 24 hours after CABG and 30-day adverse events. Methods: This study prospectively enrolled 633 patients who underwent isolated off-pump CABG from January 2019 to May 2019. Serum cTnI levels were measured in all patients at two examinations within 24 hours postoperatively (1 hour and 12-18 hours), and a proportional hazards model was used to determine the association between cTnI levels and their change with adverse events, which were defined as a composite of 30-day mortality, stroke, heart failure, myocardial infarction (MI), and ventricular fibrillation. Results: cTnI levels of the two examinations and absolute change of cTnI levels were significantly higher in the event group than in the non-event group (P<0.01, both). Earlier and later cTnI concentrations were associated with 30-day complications [adjusted hazard ration (HR) 1.598, 95% confidence interval (CI), 1.158-2.204 and HR 1.499, 95% CI, 1.228-1.831, respectively]. With regard to longitudinal change in cTnI levels, participants with persistently high levels of cTnI and those with progression from a low level to high level concentration experienced a significantly increased risk of adverse events than did participants who had a trend of persistently low cTnI levels (HR 3.105, 95% CI, 1.748-5.517 versus HR 2.944, 95% CI, 1.488-5.824). Conclusions: Longitudinal change in cTnI levels within 24 hours and early cTnI concentrations, even less than 1 hour after CABG, are associated with adverse events. These data will be useful in identifying patients at an increased risk of complications.

6.
J Thorac Dis ; 12(11): 6752-6760, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33282376

RESUMEN

Background: Many comparative studies of percutaneous balloon mitral valvuloplasty (PBMV) and surgical mitral commissurotomy (SMC) in rheumatic mitral stenosis (MS) were done in the last few decades. With the development of valve repair techniques, various surgical rheumatic valve repair techniques have been applied in clinic, but there is a lack of comparison with PBMV. Our study was designed to compare the perioperative and mid-term outcomes of PBMV and mitral valve repair with "four-step" procedure in the treatment of rheumatic MS. Methods: Patients with MS were treated with PBMV or rheumatic mitral valve repair (rMVP) at Beijing Anzhen Hospital between January 1, 2013 and September 30, 2018 were selected. By using propensity score matching (PSM) method, we compared the changes in post-operation clinical outcomes between the two matched groups. Kaplan-Meier analyses was used for survival analysis and drawing the curve, and log-rank test were used to compare intergroup differences. Results: A total of 252 cases were enrolled after selection, 74 cases in PBMV and 178 cases in rMVP. Seventy-four pairs were matched successfully after PSM. There were 53 females in PBMV and 54 in rMVP. The mean age of two groups was 46.95±12.50 and 47.55±11.91 years respectively. There was no significantly differences in mitral valve orifice area (MVOA) (1.05±0.32 vs. 0.97±0.24 cm2, P=0.12) and left ventricular ejection fraction (EF) (62.36%±5.17% vs. 62.52%±4.94%, P=0.76) between two groups preoperatively. Baseline characteristics were basically balanced after PSM. In each group, there was one case transferred to surgical mitral valve replacement due to the failure of valvuloplasty before discharge. All patients survived the interventions and no severe complications were found. MVOA were significantly increased in rMVP compared with PBMV postoperatively, as well as grading of MS and tricuspid regurgitation (TR) were significantly improved in rMVP. Three cases in PBMV were lost during the follow-up. Mitral replacement was performed in 11 patients and one of them died in PBMV, while none of patients underwent re-intervention in rMVP, but one patient died of pneumonia. Conclusions: For selected patients with rheumatic MS in China, our study shows that there are comparable clinical outcomes in terms of operative, mid-term mortality and complications between PBMV and surgical rMVP with "four-step" procedure. Surgical rMVP shows more advantageous in the correction of valve stenosis and the management of concomitant tricuspid valve lesions and atrial fibrillation (AF).

7.
Nat Commun ; 11(1): 4679, 2020 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-32917895

RESUMEN

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

8.
J Cardiovasc Surg (Torino) ; 61(4): 496-504, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32715718

RESUMEN

BACKGROUND: Rheumatic mitral valve repair and replacement techniques are frequently used with excellent outcomes in experienced centers. This study aims to evaluate the impact of procedural types on left ventricular function in quinquagenarians. METHODS: Between January 2018 and September 2019, patients with severe rheumatic mitral stenosis were prospectively recruited. Propensity score matching was performed to reduce the selection bias. We compared the strain, twist and synchrony parameters of left ventricle in 70 quinquagenarian patients who underwent rheumatic mitral valve repair and replacement 12 hours before surgery, at 7 days and 6 months postoperatively. RESULTS: The overall group displayed significant improvement of left ventricular deformation after rheumatic mitral valve surgery. Compared with patients undergoing posterior chordal-sparing mitral valve replacement, patients undergoing rheumatic mitral valve repair showed more significant amelioration in global longitudinal strain (-18.6% versus -16.2%, P<0.001), twist (18.2° versus 15.9°, P<0.001), torsion (1.8°/cm versus 1.3°/cm, P<0.001), apical rotation (10.5° versus 8.8°, P<0.001), basal rotation (-7.7° versus -7.1°, P=0.049), systolic dyssynchrony index (4.7% versus 5.1%, P=0.021), standard deviation of time to peak longitudinal (46.9 ms versus 49.3 ms, P=0.024) and radial strain (15.8 ms versus 17.1 ms, P=0.037) at 6-month follow-up. CONCLUSIONS: Rheumatic mitral valve repair might provide patients with better postoperative left ventricular performance than posterior chordal-sparing mitral valve replacement. Longer follow-up is required to compare long-term outcomes.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Insuficiencia de la Válvula Mitral/cirugía , Cardiopatía Reumática/cirugía , Función Ventricular Izquierda , Ecocardiografía Tridimensional , Femenino , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Puntaje de Propensión , Estudios Prospectivos , Reproducibilidad de los Resultados , Cardiopatía Reumática/diagnóstico por imagen
9.
Nat Commun ; 11(1): 2407, 2020 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-32415066

RESUMEN

Optical read-out of motion is widely used in sensing applications. Recent developments in micro- and nano-optomechanical systems have given rise to on-chip mechanical sensing platforms, potentially leading to compact and integrated optical motion sensors. However, these systems typically exploit narrow spectral resonances and therefore require tuneable lasers with narrow linewidth and low spectral noise, which makes the integration of the read-out extremely challenging. Here, we report a step towards the practical application of nanomechanical sensors, by presenting a sensor with ultrawide (∼80 nm) optical bandwidth. It is based on a nanomechanical, three-dimensional directional coupler with integrated dual-channel waveguide photodiodes, and displays small displacement imprecision of only 45 fm/Hz1/2 as well as large dynamic range (>30 nm). The broad optical bandwidth releases the need for a tuneable laser and the on-chip photocurrent read-out replaces the external detector, opening the way to fully-integrated nanomechanical sensors.

10.
J Thorac Dis ; 11(9): 3951-3961, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31656669

RESUMEN

Background: We compared and analyzed differences between repair vs. replacement of mitral valves on severe rheumatic mitral stenosis by looking at mid-term clinical outcomes. Methods: Patients with severe rheumatic mitral stenosis (mitral valve area ≤1.5 cm2, with or without mitral valve regurgitation) from January 2011 to September 2017 were divided into two groups: a mitral valve repair group (MVP) and a mitral valve replacement group (MVR). After propensity score matching between the two groups, we compared changes in post-operation clinical outcomes. We also monitored changes in left ventricular longitudinal and circumferential strain in successfully matched patients (20 pairs) by echocardiography speckle tracing. Results: A total of 921 patients were recruited (221 in MVP and 700 in MVR). After a propensity score matching, 216 cases were selected with 108 patients in each group. With a follow-up period of 3 months to 7.1 years, the incidence of heart failure was observed to be significantly higher in the MVR group than in the MVP group (P<0.05). Echocardiographic speckle tracking imaging analysis showed that left ventricular longitudinal strain decreased in the MVR group, suggesting that a change of cardiac structure may affect the cardiac function. Conclusions: Selecting suitable patients for mitral valve repair is feasible even for patients with severe rheumatic mitral stenosis. In our study, compared with prosthetic valve replacement in these patients, valve repair still significantly reduced the valve-related complications rates and improved the quality of life during the follow-up.

11.
Surg Infect (Larchmt) ; 20(8): 637-642, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31120386

RESUMEN

Objective: To evaluate the diagnostic criteria, surgical indications, and prognostic factors in the surgical treatment of infective endocarditis (IE). Methods: A total of 161 cases of post-operative IE treated at our hospital from January 2007 to December 2016 were included. The IE was diagnosed by the modified Duke criteria. Echocardiography and standard blood cultures were performed. These cases were divided into severe and non-severe adverse event groups. The association between prognostic factors and severe versus non-severe outcomes was examined using logistic regression. Results: Thirty patients (20.1%) with post-operative IE had positive pre-operative blood cultures, and 130 patients (80.7%) had valve vegetations. Four patients (2.5%) died within 30 days post-operatively. Twenty-two patients experienced severe adverse events. There were significant differences between the two groups regarding their serum albumin and creatinine concentrations, ejection fraction, and hospitalization, cardiopulmonary bypass, aortic cross-clamp, intensive care unit (ICU), and ventilation times (all p < 0.05). The bypass time, aortic cross-clamp time, and ICU time were identified as prognostic factors for severe adverse events. Conclusion: Echocardiography is an important diagnostic method for IE, and repeated tests might improve the sensitivity of diagnosis. Cardiac surgery seems to be an effective treatment for IE. Patient screening and reducing the operative time may improve the prognosis for patients who undergo surgical treatment for IE.


Asunto(s)
Reglas de Decisión Clínica , Pruebas Diagnósticas de Rutina/métodos , Endocarditis/cirugía , Complicaciones Posoperatorias/epidemiología , Cuidados Preoperatorios/métodos , Adolescente , Adulto , Anciano , Niño , Ecocardiografía/métodos , Endocarditis/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/patología , Pronóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto Joven
12.
JMIR Med Inform ; 7(2): e13123, 2019 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-30932865

RESUMEN

BACKGROUND: Medical care for the Chinese population has been focused on first-line treatment, but with little follow-up on treated patients. As an important part of clinical work, follow-up evaluations are of great significance for the long-term survival of patients and for clinical and scientific research. However, the overall follow-up rate of discharged patients after surgery has been low for many years because of the limitations of certain follow-up methods and the presence of objective, practical problems. OBJECTIVE: This study aimed to construct a new two-way interactive telemedicine follow-up platform to improve the collection of clinical data after cardiac surgery and provide reliable and high-quality follow-up services. METHODS: Computer and network technologies were employed in the context of "Internet +" to develop follow-up databases and software compatible with a mobile network. Postoperative follow-up quality data including the follow-up rate and important postoperative indices were used as standards to evaluate the new follow-up management model after cardiac surgery. RESULTS: This system has been officially operated for more than 5 years. A total of 5347 patients undergoing cardiac surgery have been enrolled, and the total follow-up rate was 90.22%. In addition, 6349 echocardiographic images, 4717 electrocardiographic images, and 3504 chest radiographic images have been uploaded during follow-up assessments. The international standardized ratio was 20,696 person-times. CONCLUSIONS: This new management follow-up platform can be used to effectively collect clinical data, provide technical support for academic research, extend medical services, and provide more help to patients. It is of great significance for managing patients after cardiac surgery.

13.
J Acquir Immune Defic Syndr ; 79(5): 566-572, 2018 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-30383589

RESUMEN

BACKGROUND: Monthly use of the dapivirine vaginal ring has been shown to be safe and effective for HIV-1 prevention in nonpregnant reproductive-aged women. The impact of dapivirine on pregnancy outcomes and infant is not known. We compared pregnancy incidence and outcomes by study arm among HIV-1-uninfected women who became pregnant while participating in MTN-020/ASPIRE. METHODS: ASPIRE was a randomized, double-blind, placebo-controlled phase III safety and effectiveness study of the dapivirine ring for HIV-1 prevention. Sexually active women aged 18-45 years from Malawi, South Africa, Uganda, and Zimbabwe were enrolled. Urine pregnancy tests were performed monthly, and, if positive, study product was withheld during pregnancy and breastfeeding. Pregnancy-related outcomes included the following: pregnancy incidence, pregnancy outcomes (live birth, preterm birth, pregnancy loss, and congenital anomalies), and infant growth. RESULTS: Of 2629 women enrolled in ASPIRE, 169 became pregnant during follow-up, resulting in 179 incident pregnancies and 181 pregnancy outcomes. No difference in pregnancy incidence by study arm was observed (hazard ratio = 0.93; 95% confidence interval: 0.68 to 1.26). The distribution of pregnancy outcomes was similar by study arm, and no difference was noted in the frequency or pattern of congenital anomalies or infant growth parameters by study arm. CONCLUSIONS: Dapivirine use in the periconception period does not seem to be associated with adverse effects on pregnancy or infant outcomes. Our findings provide support for additional safety studies of the dapivirine ring throughout pregnancy.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Dispositivos Anticonceptivos Femeninos , Infecciones por VIH/prevención & control , Resultado del Embarazo , Pirimidinas/administración & dosificación , Adolescente , Adulto , África del Sur del Sahara , Desarrollo Infantil , Método Doble Ciego , Femenino , Humanos , Recién Nacido , Persona de Mediana Edad , Placebos/administración & dosificación , Embarazo , Adulto Joven
14.
Exp Ther Med ; 16(5): 4265-4270, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30402164

RESUMEN

The present study was performed to determine an optimal time-point for monitoring the concentration of the immunosuppressive drug cyclosporin A (CsA) in heart transplant patients and its efficacy in the prevention of transplant rejection. A total of 32 transplant recipients were randomly assigned for three treatment approaches. Recipients in groups A (n=11), B (n=13) and C (n=8) received oral administration of CsA at doses of 3.2, 3.5 and 4.4 mg/kg, respectively. The plasma CsA concentrations were examined at 2 h intervals over 12 h. Furthermore, their correlation with the 4 h pharmacokinetic profiles as the area under the plasma CsA concentration vs. time curve (AUC0-4 h) were calculated The efficacy of CsA in inhibiting cardiac allograft rejection was assessed at 2 h after oral CsA intake (C2) and adverse events of the drug were examined in the C2-monitored recipients. The plasma CsA concentration rapidly increased in most recipients with a peak level detected at ~2 h after dosing. Regression analysis revealed that among all time-points assessed, the CsA had the highest correlation with the AUC0-4 h at C2. At C2, increasing CsA doses exhibited a positive association with the measure of AUC0-4 h. The efficacy of increasing CsA target levels at C2 in preventing heart transplant rejection was comparable, as the survival rate was 100% in all of the treatment groups. However, the proportion of recipients with side effects in group A was obviously lower than that in the other two groups. In conclusion, C2 is an ideal time-point for monitoring plasma CsA levels with a utility for individualising the next scheduled dose for each patient to ensure that target levels are maintained and achieve a high efficacy and safety of CsA therapy in heart transplant recipients (clinical trial no. 12002610).

15.
J Thorac Dis ; 10(5): 2908-2915, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29997956

RESUMEN

Background: Mobility and flexibility of anterior mitral leaflet (AML) are considered to be the important factor for mitral valve (MV) repair in rheumatic population, we try to use the bending angle of AML to quantify its' mobility and flexibility and investigate whether it can predict the success of rheumatic MV repair or not. Methods: Total 54 patients underwent rheumatic MV surgeries with mild lesions of subvalvular apparatus from August, 2017 to November, 2017 at the author institution, we divided the patients into MV repair and MV replacement groups which included directly MV replacement and repair attempt but failed repairing transfer to replacement intraoperatively. Patients' MV structure was carefully evaluated on transthoracic echocardiography (TTE) and scored by the Wilkins score (WS) preoperatively. The bending angle of AML was measured during systole and diastole at different level before surgery. Results: The differences of patients' demographic characteristics between repair group and replacement group were not statistically significant (P value >0.05) and the differences among B-angle, T-angle, Bs-angle, C-angle of AML between repair group and replacement groups were not statistically significant (P value >0.05). Only BT-angle in repair group was significantly larger than that of replacement group (21.56°±3.84°, 10.29°±6.02°, respectively, P<0.001), therefore the BT-angle was tested as a predictor of reparability by observing the receiver operating characteristic (ROC) curve (ROC area: 0.944, standard error: 0.06, 95% CI: 0.826-1), BT-angle of AML on preoperative transthoracic echo of 15.5° or more predicts feasibility of rheumatic MV repair with 100% sensitivity and 85.7% specificity in patients with mild lesions of subvalvular apparatus. Logistic regression for a single area of calcification (diameter <0.8 cm) at commissure were shown that: ß: 0.08, Exp (ß): 1.083, P: 0.777>0.05, the minor single calcified area at commissure had no effect on reparability of rheumatic MV disease. The differences of total WS and each component score between repair group and replacement group were not statistically significant (P value >0.05). By observing the ROC curve for total WS (ROC area: 0.508), the WS cannot be a predictor for the rheumatic MV repair. Conclusions: The bending angle of AML which was considered as quantification of mobility and flexibility of AML can be a predictor for MV repair in patients with rheumatic heart disease (RHD). The small single area of commissural calcification had no effect on reparability of rheumatic MV disease. WS cannot appropriately predict the outcome of rheumatic MV repair.

16.
J Thorac Dis ; 10(3): 1460-1467, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29707295

RESUMEN

Background: This study aimed to summarize percutaneous occluder device closure of atrial septal defects (ASD) through the femoral vein, using guidance by transthoracic echocardiography under local anesthesia without radiation or fluoroscopic guidance. Methods: This was a case series of fourteen patients, 3 males and 11 females, diagnosed with central ASD, the diameter of the defect ranged from 9 to 32 mm, and the patients had no other heart malformations or organ dysfunction. The patients underwent a novel surgical technique of occluder device closure for ASD. The occluder closure procedures were completed through puncture of the femoral vein, and fluoroscopy-free catheter guidance by transthoracic echography without radiation. Results: All of the cases had successful closure of the ASD, without residual shunt or complications. The median operation time was 18.7±22.5 min (range, 12-56 min), with no ICU-stay time and a short hospital stay of 2.3±0.5 days (range, 1-3 days). All patients were followed up for 2 years and there were no cases of residual shunt. All occluders remained in place. Conclusions: Percutaneous occluder device closure of ASDs through the femoral vein with fluoroscopy-free guidance by transthoracic echography without radiation under local anesthesia could be an easy choice for some simple ASD patients, and may also be favored by cardiac surgeons.

17.
J Am Heart Assoc ; 5(12)2016 12 05.
Artículo en Inglés | MEDLINE | ID: mdl-27919928

RESUMEN

BACKGROUND: This study assessed the role of surgical ablation for atrial fibrillation (AF) in decreasing tricuspid regurgitation (TR) and right-sided heart remodeling in patients after mitral valve procedure. METHODS AND RESULTS: Between 1994 and 2014, 1568 consecutive patients with AF undergoing mitral valve procedure were identified. In 26.0% (n=408), surgical ablation of AF was used. Propensity-score matching (PSM) was performed on the basis of 41 known perioperative risk variables. Survival, reoperation, stroke, and moderate-to-severe TR, as well as echocardiography indices in long-term follow-up, were compared in 406 matched patient pairs (ablated and nonablated groups). The nonablated group showed significantly higher risks of death (hazard ratio [HR], 1.644; 95% CI, 1.081-2.501; P=0.020), reoperation (HR, 2.644; 95% CI, 1.299-5.466; P=0.008), and moderate-to-severe TR (HR, 1.436; 95% CI, 1.059-1.948; P=0.020), associated with a significantly deteriorated cardiac function, progression of TR, and right-sided heart remodeling after 5-year follow-up. In a subgroup comparison of ablated patients with sinus rhythm versus AF recurrence, a PSM analysis was performed at the 5-year follow-up. The recurrent group showed significantly higher risks of moderate-to-severe TR (HR, 2.427; 95% CI, 1.261-4.671; P=0.008). AF recurrence was associated with progressive TR and significant deterioration in right-sided heart remodeling. CONCLUSIONS: In a retrospective PSM analysis, mitral valve disease with AF was associated with TR progression as well as right-sided heart remodeling, which are alleviated by surgical ablation.


Asunto(s)
Fibrilación Atrial/cirugía , Remodelación Atrial , Ablación por Catéter , Implantación de Prótesis de Válvulas Cardíacas , Anuloplastia de la Válvula Mitral , Insuficiencia de la Válvula Mitral/cirugía , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Remodelación Ventricular , Adulto , Fibrilación Atrial/complicaciones , Progresión de la Enfermedad , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/complicaciones , Puntaje de Propensión , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Insuficiencia de la Válvula Tricúspide/complicaciones , Insuficiencia de la Válvula Tricúspide/fisiopatología
18.
Nanotechnology ; 27(40): 405302, 2016 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-27581085

RESUMEN

Area-selective atomic layer deposition (AS-ALD) of platinum (Pt) was studied using photosensitive polyimide as a masking layer. The polyimide films were prepared by spin-coating and patterned using photolithography. AS-ALD of Pt using poly(methyl-methacrylate) (PMMA) masking layers was used as a reference. The results show that polyimide has excellent selectivity towards the Pt deposition, after 1000 ALD cycles less than a monolayer of Pt is deposited on the polyimide surface. The polyimide film could easily be removed after ALD using a hydrogen plasma, due to a combination of weakening of the polyimide resist during Pt ALD and the catalytic activity of Pt traces on the polyimide surface. Compared to PMMA for AS-ALD of Pt, polyimide has better temperature stability. This resulted in an improved uniformity of the Pt deposits and superior definition of the Pt patterns. In addition, due to the absence of reflow contamination using polyimide the nucleation phase during Pt ALD is drastically shortened. Pt patterns down to 3.5 µm were created with polyimide, a factor of ten smaller than what is possible using PMMA, at the typical Pt ALD processing temperature of 300 °C. Initial experiments indicate that after further optimization of the polyimide process Pt features down to 100 nm should be possible, which makes AS-ALD of Pt using photosensitive polyimide a promising candidate for patterning at the nanoscale.

19.
Opt Lett ; 40(12): 2755-7, 2015 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-26076254

RESUMEN

Grating couplers are widely used to couple light between photonic integrated circuits and optical fibers. Here, we fabricate and characterize a device based on a buried metal grating. In contrast to dielectric gratings, simulations predict strongly reduced parasitic leakage of light to the substrate and are performance independent of the optical buffer thickness, while using standard fabrication processes with high yield. The gratings show a 3 dB bandwidth of 61 nm and chip-to-fiber coupling efficiency of 54%, which makes them attractive building blocks for on-wafer testing and dense optical interconnects.

20.
Interact Cardiovasc Thorac Surg ; 19(6): 946-54, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25217622

RESUMEN

OBJECTIVES: This study aimed to evaluate risk factors that affect mitral valve (MV) repair outcomes. METHODS: From 2002 to 2012, 580 consecutive patients with mitral regurgitation (MR) underwent MV repair. Of the total number of patients, 48.9% were found to be in New York Heart Association (NYHA) Class III or IV. Anterior, posterior and bileaflet prolapse was present in 34.8, 47.6 and 17.6% of patients, respectively. Atrial fibrillation (AF) was found in 29.7% of patients. The mean follow-up was 5.3 ± 2.6 years. RESULTS: There were eight early and 14 late deaths. NYHA Class III/IV, left ventricular ejection fraction ≤50%, systolic pulmonary artery pressure ≥50 mmHg, AF and low cardiac output syndrome with extracorporeal membrane oxygen were independent predictors of early mortality. AF, NYHA Class III/IV, left ventricular end-systolic diameter ≥40 mm and systolic pulmonary artery pressure ≥50 mmHg remained predictors of late mortality. At 5 years, the rate of survival, freedom from reoperation and recurrent moderate to severe MR was 99.0 ± 0.6 97.2 ± 0.8 and 93.3 ± 1.2%, respectively. Anterior leaflet involvement was predictive of reoperation and recurrent moderate to severe MR. In patients with a moderate tricuspid regurgitation (TR) and annulus <40 mm, the degree of TR during follow-up was worse with right ventricular dilatation. CONCLUSIONS: MV repair should be performed before the deterioration of ventricular function, development of pulmonary hypertension and AF occurrence. The pathophysiology of MR affects MV repair durability, while concomitant tricuspid annuloplasty should be considered in patients with moderate TR despite annular dilatation.


Asunto(s)
Anuloplastia de la Válvula Mitral , Insuficiencia de la Válvula Mitral/cirugía , Prolapso de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Adolescente , Adulto , Anciano , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Femenino , Hemodinámica , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Válvula Mitral/fisiopatología , Anuloplastia de la Válvula Mitral/efectos adversos , Anuloplastia de la Válvula Mitral/mortalidad , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/mortalidad , Insuficiencia de la Válvula Mitral/fisiopatología , Prolapso de la Válvula Mitral/diagnóstico , Prolapso de la Válvula Mitral/mortalidad , Prolapso de la Válvula Mitral/fisiopatología , Modelos de Riesgos Proporcionales , Recurrencia , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Válvula Tricúspide/fisiopatología , Válvula Tricúspide/cirugía , Insuficiencia de la Válvula Tricúspide/diagnóstico , Insuficiencia de la Válvula Tricúspide/fisiopatología , Insuficiencia de la Válvula Tricúspide/cirugía , Adulto Joven
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