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1.
Eur J Vasc Endovasc Surg ; 35(6): 715-22, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18296081

RESUMO

OBJECTIVES: To compare the safety and efficacy of a bioresorbable paclitaxel-eluting wrap implanted with a synthetic vascular graft (treatment) versus the graft implanted alone (control). DESIGN: Prospective, randomized, controlled, multicentre, 2-year clinical study conducted in adults scheduled to undergo femoropopliteal peripheral bypass surgery with a polytetrafluoroethylene (PTFE) graft. MATERIALS AND METHODS: Hundred and nine subjects were randomized 2:1 to treatment or control. All subjects were implanted with a 6mm expanded PTFE vascular graft; in addition, treated subjects had a 2.5 cm x 4 cm paclitaxel-eluting wrap (1.6 microg/mm(2)) placed around the distal graft anastomosis. RESULTS: The overall incidence of adverse events was similar in both groups. Treated subjects required fewer limb amputations than controls (15.5% vs 18.4%) and time to amputation for those that required amputation was twice as long (153 days vs 76 days). Among diabetics, this effect was pronounced with 13.8% of treated subjects requiring limb amputations compared with 23.5% of controls. Over the course of study, the diameter at the distal graft anastomosis was greater in treated subjects than in controls (difference of 2.1mm at 2 yr, p=0.03). CONCLUSIONS: The paclitaxel-eluting wrap maintained graft patency at the distal anastomosis and was safe to use in patients who had received a peripheral bypass PTFE graft.


Assuntos
Bandagens , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Fármacos Cardiovasculares/administração & dosagem , Artéria Femoral/cirurgia , Paclitaxel/administração & dosagem , Doenças Vasculares Periféricas/cirurgia , Artéria Poplítea/cirurgia , Amputação Cirúrgica , Anastomose Cirúrgica , Implante de Prótese Vascular/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Europa (Continente) , Feminino , Artéria Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Antilhas Holandesas , Paclitaxel/efeitos adversos , Doenças Vasculares Periféricas/fisiopatologia , Politetrafluoretileno , Artéria Poplítea/fisiopatologia , Estudos Prospectivos , Desenho de Prótese , Reoperação , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
2.
Mol Biochem Parasitol ; 149(2): 128-34, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16766053

RESUMO

Selenoproteins result from the incorporation of selenocysteine (Sec-U) at an UGA-stop codon positioned within a gene's open reading frame and directed by selenocysteine insertion sequence (SECIS) elements. Although the selenocysteine incorporation pathway has been identified in a wide range of organisms it has not yet been reported in the Kinetoplastida Leishmania and Trypanosoma. Here we present evidence consistent with the presence of a selenocysteine biosynthetic pathway in Kinetoplastida. These include the existence of SECIS-containing coding sequences in Leishmania major and Leishmania infantum, the incorporation of (75)Se into Leishmania proteins, the occurrence of selenocysteine-tRNA (tRNA (sec) (uca)) in both Leishmania and Trypanosoma and in addition the finding of all genes necessary for selenocysteine synthesis such as SELB, SELD, PSTK and SECp43. As in other eukaryotes, the Kinetoplastids have no identifiable SELA homologue. To our knowledge this is the first report on the identification of selenocysteine insertion machinery in Kinetoplastida, more specifically in Leishmania, at the sequence level.


Assuntos
Leishmania/metabolismo , Proteínas de Protozoários/metabolismo , Selenoproteínas/metabolismo , Sequência de Aminoácidos , Animais , Sequência de Bases , DNA de Protozoário/genética , Leishmania/genética , Dados de Sequência Molecular , Conformação de Ácido Nucleico , RNA Mensageiro/genética , RNA de Protozoário/química , RNA de Protozoário/genética , RNA de Transferência Aminoácido-Específico/química , RNA de Transferência Aminoácido-Específico/genética , Homologia de Sequência de Aminoácidos , Homologia de Sequência do Ácido Nucleico
3.
Arch Intern Med ; 156(11): 1205-13, 1996 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-8639015

RESUMO

BACKGROUND: A randomized study was conducted to test the feasibility of cholesterol lowering in physician office practices using the National Cholesterol Education Program Adult Treatment Panel 1 guidelines. METHODS: Twenty-two physician practices in phase 1 and 23 in phase 2 were recruited from communities in Western Pennsylvania and West Virginia. These physicians treated a total of 450 adults in phase 1 (190 men and 260 women) and 480 adults in phase 2 (184 men and 296 women) with hypercholesterolemia. Three models (Usual Care [phase 1], Office Assisted [phase 2], and Nutrition Center [phase 2]) for implementing the National Cholesterol Education Program Adult Treatment Panel 1 guidelines were tested over an 18-month period. The baseline serum cholesterol levels were as follows: 6.51 mmol/L (252 mg/dL) in the Usual Care Model; 6.80 mmol/L (262 mg/dL) in the Office Assisted Model; and 6.96 mmol/L (269 mg/dL) in the Nutrition Center Model. RESULTS: In the patients who were not taking lipid-lowering medication, the mean cholesterol response was significantly different between the 3 models (P < .01). Serum cholesterol levels declined by 0.14 mmol/L (5.4 mg/dL) in the Usual Care Model; by 0.31 mmol/L (12 mg/dL) in the Office Assisted Model; and by 0.54 mmol/L (20.9 mg/dL) in the Nutrition Center Model. Two factors-length of time to follow-up measurement and change in weight-were independently related to cholesterol response across all models. African Americans demonstrated a significantly smaller response than whites in the Usual Care Model, while men demonstrated greater declines in serum cholesterol levels than women in the Office Assisted Model. Patient satisfaction was very favorable in both enhanced conditions; however, those treated in the the Nutrition Center Model were more satisfied (P < .05) with program components. CONCLUSIONS: The impact of nutrition intervention delivered through physician practices on serum cholesterol levels is less than clinically desirable, and new approaches with more aggressive therapy should be tested and implemented.


Assuntos
Colesterol/sangue , Hipercolesterolemia/dietoterapia , Visita a Consultório Médico , Educação de Pacientes como Assunto , Anticolesterolemiantes/uso terapêutico , Estudos de Viabilidade , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/tratamento farmacológico , Masculino , Satisfação do Paciente , Resultado do Tratamento
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