RESUMO
A retrospective study of a systematic sample of 150 patients who underwent abdominal surgery revealed that 53 (35.3%) had all intraoperative temperatures in the hypothermic range (<36.0°C). Fifty-two (98.1%) of the 53 patients met 1 or both surgical care improvement project criteria for normothermia. Improved metrics are needed to assure normothermia.
Assuntos
Temperatura Corporal , Documentação/normas , Hipotermia/diagnóstico , Cuidados Intraoperatórios/normas , Melhoria de Qualidade , Abdome/cirurgia , Anestesia Geral , Humanos , Hipotermia/fisiopatologia , Hipotermia/terapia , Guias de Prática Clínica como Assunto , Estudos RetrospectivosAssuntos
Centros Médicos Acadêmicos , Transfusão de Sangue/legislação & jurisprudência , Regulamentação Governamental , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Centros Médicos Acadêmicos/legislação & jurisprudência , Centros Médicos Acadêmicos/métodos , Centros Médicos Acadêmicos/normas , Centros Médicos Acadêmicos/tendências , Algoritmos , Bancos de Sangue/legislação & jurisprudência , Bancos de Sangue/organização & administração , Segurança do Sangue/métodos , Segurança do Sangue/normas , Transfusão de Sangue/métodos , Transfusão de Sangue/tendências , Implementação de Plano de Saúde/legislação & jurisprudência , Implementação de Plano de Saúde/organização & administração , Humanos , Guias de Prática Clínica como Assunto/normas , Meio Social , Integração de Sistemas , Obtenção de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/organização & administração , Obtenção de Tecidos e Órgãos/normas , Obtenção de Tecidos e Órgãos/tendências , Estados Unidos , Estudos de Validação como AssuntoRESUMO
The proteins, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor 1 (PAI-1), act in concert to balance thrombus formation and degradation, thereby modulating the development of arterial thrombosis and excessive bleeding. PAI-1 is upregulated by the renin-angiotensin system (RAS), specifically by angiotensin II, the product of angiotensin converting enzyme (ACE) cleavage of angiotensin I, which is produced by the cleavage of angiotensinogen (AGT) by renin (REN). ACE indirectly stimulates the release of t-PA which, in turn, activates the corresponding fibrinolytic system. Single polymorphisms in these pathways have been shown to significantly impact plasma levels of t-PA and PAI-1 differently in Ghanaian males and females. Here we explore the involvement of epistatic interactions between the same polymorphisms in central genes of the RAS and fibrinolytic systems on plasma t-PA and PAI-1 levels within the same population (n = 992). Statistical modeling of pairwise interactions was done using two-way ANOVA between polymorphisms in the ETNK2, RENIN, ACE, PAI-1, t-PA, and AGT genes. The most significant interactions that associated with t-PA levels were between the ETNK2 A6135G and the REN T9435C polymorphisms in females (p = 0.006) and the REN T9435C and the TPA I/D polymorphisms (p = 0.005) in males. The most significant interactions for PAI-1 levels were with REN T9435C and the TPA I/D polymorphisms (p = 0.001) in females, and the association of REN G6567T with the TPA I/D polymorphisms (p = 0.032) in males. Our results provide evidence for multiple genetic effects that may not be detected using single SNP analysis. Because t-PA and PAI-1 have been implicated in cardiovascular disease these results support the idea that the genetic architecture of cardiovascular disease is complex. Therefore, it is necessary to consider the relationship between interacting polymorphisms of pathway specific genes that predict t-PA and PAI-1 levels.
Assuntos
Epistasia Genética , Inibidor 1 de Ativador de Plasminogênio/genética , Polimorfismo Genético , Ativador de Plasminogênio Tecidual/genética , Análise de Variância , Feminino , Regulação da Expressão Gênica , Gana/epidemiologia , Humanos , Masculino , Inibidor 1 de Ativador de Plasminogênio/sangue , Fatores Sexuais , Ativador de Plasminogênio Tecidual/sangueRESUMO
Several previous studies have demonstrated that administration of autologous bone marrow-derived mononuclear cells (BMMNCs) improves cardiac function in patients after acute myocardial infarction (AMI). However, optimum timing of administration has not been investigated in a clinical trial. The Cardiovascular Cell Therapy Research Network was developed and funded by the National Heart, Lung, and Blood Institute to address important questions such as timing of cell delivery and to accelerate research in the use of cell-based therapies. The TIME trial is a randomized, phase II, double-blind, placebo-controlled clinical trial. The 5 member clinical sites of the Cardiovascular Cell Therapy Research Network will enroll 120 eligible patients with moderate-to-large anterior AMIs who have undergone successful percutaneous coronary intervention of the left anterior descending coronary artery and have a left ventricular (LV) ejection fraction =45% by echocardiography. Participants will have bone marrow aspirations and intracoronary infusions of 150 x 10(6) BMMNCs or placebo on day 3 or day 7 post-AMI. Objectives of this study are (1) to evaluate effects of BMMNCs on regional and global LV function compared to placebo therapy in patients with acute AMI as assessed by cardiac magnetic resonance imaging at 6 months and (2) to assess whether effects of BMMNC infusion on global and regional LV function and safety are influenced by the time of administration. This study will provide further insight into the clinical feasibility and appropriate timing of autologous BMMNC therapy in high-risk patients after AMI and percutaneous coronary intervention.