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1.
Am J Transplant ; 20(1): 231-240, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31265753

RESUMO

Combining simultaneously lung and liver procurement in controlled donation after circulatory death (cDCD) using normothermic abdominal perfusion (NRP) for abdominal grafts and cooling and rapid recovery technique (RR) for the lungs increases the complexity of the procurement procedure and might injure the grafts. A total of 19 cDCDs from two centers using this combined procedure were evaluated, and 16 liver and 21 lung transplantations were performed. As controls, 34 donors after brain death (DBDs) were included (29 liver and 41 lung transplantations were performed). Two cDCD liver recipients developed primary nonfunction (12.5%). No cases of ischemic cholangiopathy were observed among cDCD recipients. The 1-year and 2-year liver recipients survival was 87.5% and 87.5% for the cDCD group, and 96% and 84.5% for the DBD group, respectively (P = .496). The 1-year and 2-year lung recipients survival was 84% and 84% for the cDCD group and 90% and 90% for the DBD group, respectively (P = .577). This is the largest experience ever reported in cDCD with the use of NRP combined with RR of the lungs. This combined method offers an outstanding recovery rate and liver and lung recipients survival comparable with those transplanted with DBDs. Further studies are needed to confirm our findings.

5.
Am J Transplant ; 19(4): 1195-1201, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30582287

RESUMO

We aimed to propose a simple and effective preservation method in lungs procured for transplantation from uncontrolled donation after circulatory death (uDCD) associated with excellent long-term results. Outcome measures for lung recipients were survival and primary graft dysfunction (PGD) grade 3. Survival was estimated using the Kaplan-Meier method. A total of 9 lung uDCDs were evaluated and 8 lung transplants were performed. Mean no-flow time was 9.8 minutes (standard deviation [SD] 8.6). Mean time from cardiac arrest to topical cooling was 96.8 minutes (SD 16.8). Preservation time was 159 minutes (SD 31). Ex vivo lung perfusion was used to assess lung function prior to transplantation in 2 cases. Mean recipient age was 60.8 years (SD 3.1), and mean total ischemic time was 678 minutes (SD 132). PGD grade 3 was observed in 2 cases (25%). The 1-month, 1-year, and 5-year survival rates were 100%, 87.5%, and 87.5%, respectively. Mean follow-up was 52 months. The logistic complexity of procuring lungs from uDCDs for transplantation requires the development of new strategies designed to facilitate this type of donation. A program based on strict selection criteria, using a simple and effective preservation technique, may recover lung grafts with excellent long-term posttransplant outcomes.

7.
Arch. bronconeumol. (Ed. impr.) ; 53(8): 421-426, ago. 2017. tab
Artigo em Inglês | IBECS | ID: ibc-166014

RESUMO

Background: One-year survival in lung transplant is around 85%, but this figure has not increased in recent years, in spite of technical improvements. Methods: Retrospective, multicenter cohort study. Data from 272 eligible adults with lung transplant were recorded at 7 intensive care units (ICU) in Spain in 2013. The objective was to identify variables that might help to guide future clinical interventions in order to reduce the risk of death in the postoperative period. Results: One patient (0.3%) died in the operating room and 27 (10%) within 90 days. Twenty (7.4%) died within 28 days, after a median of 14 ICU days. Grade 3 pulmonary graft dysfunction was documente in 108 patients, of whom 21 died, compared with 6 out of 163 without pulmonary graft dysfunction (P < .001). At ICU admission, non-survivors had significantly lower (P = .03) median PaO2/FiO2 (200 mmHg vs 280 mmHg), and the difference increased after 24 hours (178 vs 297 mmHg, P < .001). Thirteen required extracorporeal membrane oxygenation, and 7(53.8%) died. A logistic regression model identified pulmonary graft dysfunction (OR: 6.77), donor age > 60yr (OR: 2.91) and SOFA > 8 (OR: 2.53) as independent predictors of 90-day mortality. At ICU admission, higher median procalcitonin (1.6 vs 0.6) and lower median PaO2/FiO2 (200 vs 280 mmHg) were significantly associated with mortality. Conclusion: Graft dysfunction remains a significant problem in lung transplant. Early ICU interventions in patients with severe hypoxemia or high procalcitonin are crucial in order to lower mortality (AU)


Introducción: La supervivencia anual del trasplante de pulmón está alrededor del 85% y este porcentaje no se ha incrementado recientemente, a pesar de mejoras técnicas. Métodos: Estudio de cohortes, multicéntrico, retrospectivo. Se recogieron datos de 272 adultos con trasplante de pulmón en 7 unidades de cuidados intensivos españolas en 2013. El objetivo fue identificar variables que pudieran ser de utilidad para guiar futuras intervenciones clínicas para disminuir el riesgo de fallecer en el postoperatorio. Resultados: Un paciente (0,3%) falleció en quirófano y 27 (10%) a los 90 días. Veinte (7,4%) fallecieron en 28 días, después de una mediana de 14 días en unidad de cuidados intensivos. La disfunción primaria grado 3 se documentó en 108 pacientes, de los cuales 21 fallecieron, comparado con 6 de 163 sin disfunción primaria grado 3 (p < 0,001). Al ingreso en unidad de cuidados intensivos, los no supervivientes mostraban una significativa menor mediana (p = 0,03) de PaO2/FiO2 (200 vs. 280 mmHg); esta diferencia se incrementó a las 24 h (178 vs. 297 mmHg, p < 0,001). Trece requirieron oxigenación con membrana extracorpórea (53,8%) y 7 fallecieron. Un modelo de regresión logística múltiple identificó la disfunción primaria grado 3 (OR: 6,77), edad donante > 60 años (OR: 2,91) y SOFA > 8 (OR: 2,53) como predictores independientes (p < 0,05) de mortalidad a los 90 días. En el ingreso en unidad de cuidados intensivos, una mediana de procalcitonina plasmática superior (1,6 vs. 0.6 ng/mL) e inferior de PaO2/FiO2 (200 vs. 280 mmHg) se asociaron independientemente (p < 0,05) con la mortalidad. Conclusión: La disfunción primaria del injerto continúa siendo un problema significativo en el trasplante pulmonar. Las intervenciones precoces dirigidas a mejorar la hipoxemia o la identificación de elevación de procalcitonina representan oportunidades para disminuir la mortalidad (AU)


Assuntos
Humanos , Transplante de Pulmão/mortalidade , Rejeição de Enxerto/epidemiologia , Disfunção Primária do Enxerto/epidemiologia , Doença Pulmonar Obstrutiva Crônica/cirurgia , Unidades de Terapia Intensiva/estatística & dados numéricos , Fatores de Risco , Complicações Pós-Operatórias/epidemiologia , Intervalo Livre de Doença , Biomarcadores/análise , Estudos Retrospectivos
8.
Arch Bronconeumol ; 53(8): 421-426, 2017 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28256290

RESUMO

BACKGROUND: One-year survival in lung transplant is around 85%, but this figure has not increased in recent years, in spite of technical improvements. METHODS: Retrospective, multicenter cohort study. Data from 272 eligible adults with lung transplant were recorded at 7 intensive care units (ICU) in Spain in 2013. The objective was to identify variables that might help to guide future clinical interventions in order to reducethe risk of death in the postoperative period. RESULTS: One patient (0.3%) died in the operating room and 27 (10%) within 90 days. Twenty (7.4%) died within 28 days, after a median of 14 ICU days. Grade 3 pulmonary graft dysfunction was documented in 108 patients, of whom 21 died, compared with 6 out of 163 without pulmonary graft dysfunction (P<.001). At ICU admission, non-survivors had significantly lower (P=.03) median PaO2/FiO2 (200mmHg vs 280mmHg), and the difference increased after 24hours (178 vs 297mmHg, P<.001). Thirteen required extracorporeal membrane oxygenation, and 7(53.8%) died. A logistic regression model identified pulmonary graft dysfunction (OR: 6.77), donor age>60yr (OR: 2.91) and SOFA>8 (OR: 2.53) as independent predictors of 90-day mortality. At ICU admission, higher median procalcitonin (1.6 vs 0.6) and lower median PaO2/FiO2 (200 vs 280mmHg) were significantly associated with mortality. CONCLUSION: Graft dysfunction remains a significant problem in lung transplant. Early ICU interventions in patients with severe hypoxemia or high procalcitonin are crucial in order to lower mortality.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Transplante de Pulmão/mortalidade , APACHE , Idoso , Biomarcadores , Calcitonina/sangue , Estudos de Coortes , Bases de Dados Factuais , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Oxigênio/sangue , Pressão Parcial , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/mortalidade , Disfunção Primária do Enxerto/sangue , Disfunção Primária do Enxerto/mortalidade , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Análise de Sobrevida
9.
Eur J Cardiothorac Surg ; 49(6): 1719-24, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26792924

RESUMO

OBJECTIVES: Competing requirements for organ perfusion may call for antagonistic strategies such as fluid replacement or high positive end-expiratory pressure. We recently proposed an intensive lung donor treatment protocol that nearly tripled lung procurement rates and validated it in a multicentre study. The next step was to evaluate the impact of our proposal on the other organ grafts recovered from lung donors and on the recipients' outcome after transplantation of those grafts. METHODS: A quasi-experimental study was conducted in six Spanish hospitals during 2013 (2010-12 was historical control). Organ donor management was led by a trained and experienced intensive care staff. RESULTS: A total of 618 actual donors after brain death (DBDs) were included, 453 DBDs in the control period (annual average 151) and 165 in the protocol period. No baseline differences were found between the periods. Heart, liver, kidney and pancreas retrieval rates were similar in both periods, and heart, liver, kidney and pancreas recipients' survival at 3 months showed no differences between both periods. CONCLUSIONS: Our lung donor treatment protocol is safe for other grafts obtained from donors undergoing these procedures with the aim of increasing lungs available for transplantation. It has no negative impact on the recovery rates of other grafts or on early survival of heart, liver, pancreas or kidney recipients.


Assuntos
Protocolos Clínicos , Transplante de Pulmão/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/métodos , Adulto , Idoso , Morte Encefálica , Feminino , Sobrevivência de Enxerto , Humanos , Transplante de Pulmão/mortalidade , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/mortalidade , Transplante de Órgãos/estatística & dados numéricos , Espanha/epidemiologia , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/normas , Obtenção de Tecidos e Órgãos/estatística & dados numéricos
10.
J Heart Lung Transplant ; 33(2): 178-84, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24365763

RESUMO

BACKGROUND: An intensive lung donor-management protocol based on a strict protocol would increase the lung procurement rate. The aim of this study was to determine the effect of such a protocol on the rate of lung grafts available for transplant. METHODS: A lung-management protocol for donors after brain death (DBD) was implemented in 2009. Lung donors from 2009 to 2011 were the prospective cohort, and those from 2003 to 2008 formed the historical control. We analyzed the synergic effect of several measures, such as protective ventilation, ventilator recruitment maneuvers, high positive end-expiratory pressure, fluid restriction with reduced extravascular lung water values, and hormonal resuscitation therapy in multiorgan DBD. The number of lungs available for transplantation was the main outcome measure. For recipients, early survival and the rate of primary graft dysfunction (PGD) grade 3 were the main outcome measures. RESULTS: The DBD rate was more than 40 donors per 1 million population in both periods. The rate of lung donors increased from 20.1% to 50% (p < 0.001), quadrupling the number of lung donors (p < 0.001), grafts retrieved (p = 0.02), and patients who received a lung transplant (p < 0.01). No differences were observed in the survival of early recipients (p = 0.203) or in the rate of PGD grade 3 (p = 0.835). CONCLUSION: The management of multiorgan DBDs should be approached as a global treatment requiring attentive bedside management. Implementing an intensive lung donor-management protocol based on synergic measures increases lung procurement rates, negative effect on early survival of lung recipients or PGD grade 3.


Assuntos
Transplante de Pulmão/mortalidade , Obtenção de Tecidos e Órgãos/normas , Adulto , Idoso , Morte Encefálica , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida , Doadores de Tecidos
11.
PLoS One ; 8(11): e80601, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24236187

RESUMO

The effector and regulatory T cell subpopulations involved in the development of acute rejection episodes in lung transplantation remain to be elucidated. Twenty-seven lung transplant candidates were prospectively monitored before transplantation and within the first year post-transplantation. Regulatory, Th17, memory and naïve T cells were measured in peripheral blood of lung transplant recipients by flow cytometry. No association of acute rejection with number of peripheral regulatory T cells and Th17 cells was found. However, effector memory subsets in acute rejection patients were increased during the first two months post-transplant. Interestingly, patients waiting for lung transplant with levels of CD8(+) effector memory T cells over 185 cells/mm(3) had a significant increased risk of rejection [OR: 5.62 (95% CI: 1.08-29.37), p=0.04]. In multivariate analysis adjusted for age and gender the odds ratio for rejection was: OR: 5.89 (95% CI: 1.08-32.24), p=0.04. These data suggest a correlation between acute rejection and effector memory T cells in lung transplant recipients. The measurement of peripheral blood CD8(+) effector memory T cells prior to lung transplant may define patients at high risk of acute lung rejection.


Assuntos
Linfócitos T CD8-Positivos/imunologia , Rejeição de Enxerto/imunologia , Memória Imunológica , Transplante de Pulmão/efeitos adversos , Contagem de Linfócitos , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Risco , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo , Linfócitos T Reguladores/imunologia , Células Th17/imunologia , Células Th17/metabolismo , Doadores de Tecidos , Adulto Jovem
12.
Nephrol Dial Transplant ; 25(7): 2352-6, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20154365

RESUMO

BACKGROUND: Restrictive management of fluid status has been proposed to increase the rates of lung grafts available for transplant. However, no studies have supported the effect of this negative fluid balance in the kidney graft recipients. METHODS: We evaluated the effect of restrictive fluid balance in brain-dead donors and their impact in 404 kidney recipients using Kaplan-Meier curves and Cox regression for long-term effects, and logistic regression for short-term effects. Our primary interest was graft survival and the second was occurrence of delayed graft function (DGF). RESULTS: A negative or equalized fluid balance with a central venous pressure (CVP) <6 mm Hg affects neither graft survival in kidney recipients (P = 0.983) nor the development of DGF (P = 0.573). A positive fluid balance between brain death and organ retrieval does not reduce either the risk of graft survival or the risk of DGF. CONCLUSION: We concluded that restrictive management of fluid balance in a multiorgan donor supports adequate perfusion to vital organ systems even with a CVP <6 mm Hg. A strict fluid balance could avoid volume overload and lung neurogenic oedema, increasing the rate of lung grafts available for transplant without impacting either kidney graft survival or DGF development.


Assuntos
Sobrevivência de Enxerto/fisiologia , Transplante de Rim/métodos , Rim/fisiologia , Transplante de Pulmão/métodos , Obtenção de Tecidos e Órgãos/métodos , Equilíbrio Hidroeletrolítico , Adulto , Feminino , Seguimentos , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Preservação de Órgãos/métodos , Fatores de Tempo , Doadores de Tecidos
13.
Eur J Cardiothorac Surg ; 35(6): 1056-62, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19369087

RESUMO

We aim to perform a systematic review and meta-analysis of the cases of postintubation tracheal rupture (PiTR) published in the literature, with the aim of determining the risk factors that contribute to tracheal rupture during endotracheal intubation. A further objective has been to determine the ideal treatment for this condition (surgical repair or conservative management). A MEDLINE review of cases of tracheal rupture after intubation published in the English language and a review of the references in the articles found. The articles included were those that reported at least the demographic data (age and sex), the treatment performed, and the outcome. Those papers that did not detail the above variables were excluded. The search found 50 studies that satisfied the inclusion criteria. These studies included 182 cases of postintubation tracheal rupture. The overall mortality was 22% (40 patients). A statistical analysis was performed determining the relative risk (RR), 95% confidence intervals (95% CI) and/or statistical significance. The analysis was performed on the overall group and after dividing into 2 subgroups: patients in whom the lesion was detected intraoperatively, and other patients. Patient age (p=0.015) and emergency intubation (RR=3.11; 95% CI, 1.81-5.33; p=0.001) were variables associated with an increased mortality. In those patients in whom the PiTR was detected outside the operating theatre (delayed diagnosis), emergency intubation (RR=3.05; 95% CI, 1.69-5.51; p<0.0001), the absence of subcutaneous emphysema (RR=2.17; 95% CI, 1.25-4; p=0.001), and surgical treatment (RR=2.09; 95% CI, 1.08-4.07; p=0.02) were associated with an increased mortality. In addition, age (p=0.1) and male gender (RR=1.89; 95% CI, 0.98-3.63; p=0.13) showed a clear trend towards an increased mortality. PiTR is an uncommon condition but carries a high morbidity and mortality. Emergency intubation is the principal risk factor, increasing the risk of death threefold compared to elective intubation. Conservative treatment is associated with a better outcome. However, the group of patients who would benefit from surgical treatment has not been fully defined. Further studies are required to evaluate the best treatment options.


Assuntos
Intubação Intratraqueal/efeitos adversos , Traqueia/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Ruptura/etiologia , Adulto Jovem
14.
Hippocampus ; 19(1): 57-65, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18680140

RESUMO

Rats use time-of-day cues to modulate learned taste aversion memories. If adult rats are accustomed to drinking saline in the evening and they receive a lithium chloride injection after drinking saline in the morning, they form a stronger aversion to saline than rats that were conditioned after drinking saline at the familiar time. The difference indicated that the rats formed segregated representations of saline taste and the time of day the saline was consumed. This was inferred because the modulation of learning by time of day was observed when the aversions were tested at the familiar evening drinking time. If the rats had formed a compound representation of saline taste and the time of day it was consumed, the opposite pattern of differences would be expected. We used this modulation of learning by time of day to assay whether aged rats have an impaired ability to form segregated representations of experience. We find that aged rats had similar saline aversions if they were conditioned at either the familiar or the unfamiliar time of day. Furthermore, dorsal hippocampal lesions affecting also the overlying parietal cortex in the aged rats caused greater saline aversions if the rats were conditioned after drinking saline at the familiar time of day. This indicated that aged rats are aware of the time of day but after the lesion, they act as if they do not segregate saline taste from the time of day it was consumed. The results suggest that the ability to form segregated representations of a complex experience is impaired in aging and abolished by hippocampal lesions.


Assuntos
Envelhecimento/fisiologia , Hipocampo/fisiologia , Aprendizagem/fisiologia , Memória/fisiologia , Percepção do Tempo/fisiologia , Animais , Antimaníacos/farmacologia , Aprendizagem da Esquiva/fisiologia , Denervação , Cloreto de Lítio/farmacologia , Masculino , Transtornos da Memória/fisiopatologia , Lobo Parietal/anatomia & histologia , Lobo Parietal/fisiologia , Ratos , Ratos Wistar
15.
J Neurotrauma ; 25(6): 581-91, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18363508

RESUMO

One of the most important recent observations in traumatic brain injury (TBI) relates to the potential role of apoptosis in secondary brain injury. We aimed to analyze the presence of apoptosis and the expression of apoptosis-related proteins in brain samples from patients with TBI. We also tried to find any association between the in situ results and the in vitro observations in a neuronal model of induced-apoptosis. Brain tissue from the pericontusional zone (PCZ) of patients with traumatic contusions and from post-mortem samples was analyzed. Immunohistochemical analyses of apoptosis-related proteins and the terminal deoxynucleotide transferase-mediated nick end labeling (TUNEL) method to determine the presence of apoptotic cells were performed. Apoptotic rates on neuronal cells induced by jugular bulb vein sera was determined by flow cytometry. TUNEL-positive cells were detected in all PCZ of traumatic contusions and in most of PCZ in post-mortem specimens (none in control; p = 0.026). In vivo samples showed higher expression of antiapoptotic proteins Bcl-2 (p = 0.027) and Bcl-XL (p = 0.014) than post-mortem samples. In autopsies, the expression of Fas and Bim (p < 0.05) were higher in PCZ than in the zone distal from the contusion. In vitro studies showed that apoptotic rate was an independent factor associated with mortality at 6 months (p = 0.014). In the receiving operator curve (ROC) curve, a cut-off point of 66.5% showed a sensitivity of 89.5% and specificity of 66.7% in the prediction of patients' death. Cerebral apoptosis is a prominent form of cell death in the PCZ of human traumatic cerebral contusions, and high rates of in vitro apoptosis are associated with a poorer prognosis after TBI.


Assuntos
Apoptose , Lesões Encefálicas/patologia , Encéfalo/patologia , Degeneração Neural/patologia , Neurônios/patologia , Adulto , Idoso , Animais , Proteínas Reguladoras de Apoptose/análise , Proteínas Reguladoras de Apoptose/metabolismo , Proteína 11 Semelhante a Bcl-2 , Biomarcadores/análise , Biomarcadores/metabolismo , Encéfalo/metabolismo , Lesões Encefálicas/metabolismo , Progressão da Doença , Feminino , Citometria de Fluxo , Humanos , Imuno-Histoquímica , Marcação In Situ das Extremidades Cortadas , Masculino , Proteínas de Membrana/metabolismo , Pessoa de Meia-Idade , Degeneração Neural/metabolismo , Neurônios/metabolismo , Células PC12 , Mudanças Depois da Morte , Valor Preditivo dos Testes , Prognóstico , Proteínas Proto-Oncogênicas/metabolismo , Curva ROC , Ratos , Receptor fas/metabolismo
16.
Neurobiol Learn Mem ; 89(3): 352-9, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18054256

RESUMO

Reconsolidation has proven to be a common phenomenon relevant to memory processing. However, the functional significance of this process is still a matter of debate. Previous work has shown that reconsolidation is indeed a process by which updated information is integrated, through the synthesis of proteins, to a memory trace. To further analyze the role that updated information plays in retrieved spatial memory susceptibility to disruption, we injected anisomycin bilaterally in the dorsal hippocampus of Wistar rats. Implanted animals were trained for 5 days on the Morris water maze (MWM) task and injected with anisomycin before the third or fifth training session. When memory was assessed a week later, only animals injected on the third training session showed disruption of long-term memory. Furthermore, when animals were trained for either 3 (middle-trained) or 5 (well-trained) days and a week later anisomycin was infused before a reminder session, only middle-trained rats infused with anisomycin showed reduced performance when tested for long-term memory. Finally, animals trained for 5 days and injected with anisomycin 7 days later on an extinction session showed impaired long-term extinction when tested. These results suggest that for spatial memory tasks acquisition of updated information is a necessary feature to undergo this process. We propose that reconsolidation is not an accurate term because it implies that consolidation happens again. This conception does not fit with the evidence; hence, we suggest that updating consolidation is a more descriptive term to refer to this process.


Assuntos
Anisomicina/farmacologia , Hipocampo/efeitos dos fármacos , Memória/efeitos dos fármacos , Inibidores da Síntese de Proteínas/farmacologia , Amnésia/induzido quimicamente , Animais , Anisomicina/administração & dosagem , Extinção Psicológica/efeitos dos fármacos , Lateralidade Funcional , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Inibidores da Síntese de Proteínas/administração & dosagem , Ratos , Ratos Wistar , Percepção Espacial/efeitos dos fármacos
18.
Eur J Emerg Med ; 14(3): 177-9, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17473617

RESUMO

Iatrogenic tracheobronchial ruptures are rare but severe complications after intubation. Therefore, we evaluated the reasons, the therapy and the outcome of patients with postintubation tracheal rupture, who were admitted to our intensive care unit. We reviewed the literature of tracheal rupture after endotracheal intubation in respects of the risk factors, diagnosis, the possible mechanisms of the injury, and suggest strategies of management.


Assuntos
Doença Iatrogênica , Intubação Intratraqueal/efeitos adversos , Ruptura/etiologia , Adulto , Idoso , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Ruptura/cirurgia , Ruptura/terapia , Fatores de Tempo
19.
Cir Esp ; 81(2): 78-81, 2007 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-17306122

RESUMO

INTRODUCTION: Complex liver injuries carry high morbidity and mortality ranging between 40 and 80%. OBJECTIVES: To describe the characteristics of patients with liver trauma in the intensive care unit of our hospital, and the causes, severity scales, diagnoses, and treatments of these injuries, as well as length of hospital stay, morbidity and mortality. PATIENTS AND METHOD: We retrospectively reviewed the patients with liver trauma admitted to our intensive care unit (ICU) from January 2000 to December 2005. There were two groups of patients: those who underwent surgery and those who received conservative treatment. RESULTS: Univariate analysis revealed statistically significant differences between the two groups in the Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission to the ICU, the Injury Severity Score (ISS), and the percentage of severelesions according to the Liver Injury Scale (LIS), as well as in the coexistence of lesions in the large intestine. CONCLUSIONS: From the statistical point of view, the two main variables guiding the therapeutic approach were hemodynamic instability and the need for transfusion. The indication for surgery showed a clear, although non-significant, association with mortality. Lastly, there was an association between the surgical option of packing and mortality.


Assuntos
Fígado/lesões , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
20.
J Mol Biol ; 367(5): 1270-80, 2007 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-17320102

RESUMO

The Dlk1 gene appears to function as a regulator of adipogenesis. Adult Dlk1-deficient mice are obese, but adipose tissue still develops in transgenic mice overexpressing an Fc-dlk1 fusion protein, and neither type of genetically modified mice displays serious abnormalities. It was therefore possible that one yet unidentified gene might either compensate or antagonize for the absence or for overexpression, respectively, of Dlk1 in those animals. In database searches, we found a novel gene, EGFL9, encoding for a protein whose structural features are virtually identical to those of dlk1, suggesting it may function in a similar way. As dlk1 does, the protein encoded by EGFL9/Dlk2 affects adipogenesis of 3T3-L1 preadipocytes and mesenchymal C3H10T1/2 cells; however, it does so in an opposite way to that of dlk1. In addition, expression levels of both genes appear to be inversely correlated in both cell lines. Moreover, enforced changes in the expression of one gene affect the expression levels of the other. Our data suggest that adipogenesis may be modulated by the coordinated expression of Dlk1 and EGFL9/Dlk2.


Assuntos
Adipogenia/genética , Peptídeos e Proteínas de Sinalização Intercelular/genética , Peptídeos e Proteínas de Sinalização Intercelular/fisiologia , Células 3T3-L1 , Adipócitos/citologia , Adipócitos/metabolismo , Sequência de Aminoácidos , Animais , Proteínas de Ligação ao Cálcio , Células Cultivadas , Regulação da Expressão Gênica , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Camundongos , Camundongos Endogâmicos , Dados de Sequência Molecular , Filogenia , Homologia de Sequência de Aminoácidos , Distribuição Tecidual , Transfecção
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