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1.
Medicine (Baltimore) ; 100(31): e26819, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397842

RESUMO

ABSTRACT: Recently, activities of daily living (ADL) were identified as a prognostic factor among elderly patients with heart disease; however, a specific association between ADL and prognosis after cardiac and aortic surgery is not well established. We aimed to clarify the impact of ADL capacity at discharge on prognosis in elderly patients after cardiac and aortic surgery.This retrospective cohort study included 171 elderly patients who underwent open operation for cardiovascular disease in a single center (median age: 74 years; men: 70%). We used the Barthel Index (BI) as an indicator for ADL. Patients were classified into 2 groups according to the BI at discharge, indicating a high (BI ≥ 85) or low (BI < 85) ADL status. All-cause mortality and unplanned readmission events were observed after discharge.Thirteen all-cause mortality and 44 all-cause unplanned readmission events occurred during the median follow-up of 365 days. Using Kaplan-Meier analysis, a low ADL status was determined to be significantly associated with all-cause mortality and unplanned readmission. In the multivariable Cox proportional hazard models, a low ADL status was an independent predictor of all-cause mortality and unplanned readmission after adjusting for age, sex, length of hospital stay, and other variables (including preoperative status, surgical parameter, and postoperative course).A low ADL status at discharge predicted all-cause mortality and unplanned readmission in elderly patients after cardiac and aortic surgery. A comprehensive approach from the time of admission to postdischarge to improve ADL capacity in elderly patients undergoing cardiac and aortic surgery may improve patient outcomes.


Assuntos
Atividades Cotidianas , Procedimentos Cirúrgicos Cardiovasculares , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Assistência ao Convalescente/métodos , Assistência ao Convalescente/organização & administração , Idoso , Doenças Cardiovasculares/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Procedimentos Cirúrgicos Cardiovasculares/métodos , Procedimentos Cirúrgicos Cardiovasculares/mortalidade , Feminino , Humanos , Japão/epidemiologia , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Masculino , Desempenho Físico Funcional , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco
2.
Methods Mol Biol ; 2320: 295-302, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34302666

RESUMO

Recent evidence has provided exciting proof of concepts for the use of pluripotent stem cell-derived cardiomyocytes (PSC-CMs) for cardiac repair; however, large animal studies, which better reflect human disease, are required for clinical application. Here, we describe how to create myocardial infarction in cynomolgus monkey followed by transplantation of PSC-CMs. This method ensures the establishment of a myocardial infarction model and enables reliable PSC-CM transplantation.


Assuntos
Modelos Animais de Doenças , Células-Tronco Pluripotentes Induzidas/citologia , Macaca fascicularis , Infarto do Miocárdio/terapia , Miócitos Cardíacos/transplante , Anestesia por Inalação/métodos , Anestesia por Inalação/veterinária , Animais , Atropina/uso terapêutico , Bradicardia/tratamento farmacológico , Bradicardia/prevenção & controle , Células Cultivadas , Complicações Intraoperatórias/tratamento farmacológico , Complicações Intraoperatórias/prevenção & controle , Ligadura
3.
Eur J Cardiothorac Surg ; 59(3): 666-673, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33253365

RESUMO

OBJECTIVES: We aimed to identify predictors of postoperative permanent neurological deficits (PNDs) and evaluate the early management of cerebral perfusion in patients undergoing surgical repair of acute type A aortic dissection with cerebral malperfusion. METHODS: Between October 2009 and September 2018, a total of 197 patients with acute type A aortic dissection underwent aortic replacement. Of these, 42 (21.3%) patients had an imaging cerebral malperfusion (ICM). ICM was assessed preoperatively, which also revealed whether dissected supra-aortic branch vessels were occluded or narrowed by a thrombosed false lumen. After September 2017, early reperfusion and extra-anatomic revascularization were performed in cases with ICM. RESULTS: Hospital mortality rates for cases with ICM were 4.8% (2/42). Before September 2017, PND were observed in 6 patients (54.5%) with preoperative neurological symptoms (n = 11), and 7 patients (33.3%) without neurological symptoms (n = 21) in patients with ICM. Occlusion or severe stenosis of supra-aortic branch vessels (odds ratio, 7.66; P < 0.001), regardless of preoperative clinical neurological symptoms, was a risk factor for PND. After September 2017, 7 of 10 patients with ICM underwent early reperfusion and extra-anatomic revascularization. PND did not occur in any of these 7 patients. CONCLUSIONS: Occlusion or severe stenosis of supra-aortic branch vessels is a predictor of PND risk in patients undergoing surgery for acute type A aortic dissection. Early reperfusion and extra-anatomic revascularization may reduce the risk of neurological complications in patients with ICM, with or without neurological symptoms.

4.
Sci Rep ; 10(1): 11883, 2020 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-32681032

RESUMO

Accumulating evidence suggests that human pluripotent stem cell-derived cardiomyocytes can affect "heart regeneration", replacing injured cardiac scar tissue with concomitant electrical integration. However, electrically coupled graft cardiomyocytes were found to innately induce transient post-transplant ventricular tachycardia in recent large animal model transplantation studies. We hypothesised that these phenomena were derived from alterations in the grafted cardiomyocyte characteristics. In vitro experiments showed that human embryonic stem cell-derived cardiomyocytes (hESC-CMs) contain nodal-like cardiomyocytes that spontaneously contract faster than working-type cardiomyocytes. When transplanted into athymic rat hearts, proliferative capacity was lower for nodal-like than working-type cardiomyocytes with grafted cardiomyocytes eventually comprising only relatively matured ventricular cardiomyocytes. RNA-sequencing of engrafted hESC-CMs confirmed the increased expression of matured ventricular cardiomyocyte-related genes, and simultaneous decreased expression of nodal cardiomyocyte-related genes. Temporal engraftment of electrical excitable nodal-like cardiomyocytes may thus explain the transient incidence of post-transplant ventricular tachycardia, although further large animal model studies will be required to control post-transplant arrhythmia.


Assuntos
Diferenciação Celular , Células-Tronco Embrionárias/citologia , Células-Tronco Embrionárias/metabolismo , Ventrículos do Coração/citologia , Ventrículos do Coração/metabolismo , Miócitos Cardíacos/citologia , Miócitos Cardíacos/metabolismo , Regeneração , Potenciais de Ação , Biomarcadores , Imunofluorescência , Expressão Gênica , Perfilação da Expressão Gênica , Imuno-Histoquímica , Filogenia
5.
Interact Cardiovasc Thorac Surg ; 30(5): 739-745, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32163575

RESUMO

OBJECTIVES: Although skeletal muscle quantity is linked to surgical outcomes, quality remains unexamined. In this study, we evaluated whether skeletal muscle quality and quantity could predict surgical outcomes in acute type A aortic dissection (ATAAD). METHODS: Skeletal muscle quality and quantity were evaluated using computed tomography (CT) values and the psoas muscle mass index, respectively. From May 2004 to December 2017, 324 ATAAD patients underwent aortic replacement after CT scans and psoas muscle mass index measurements. Patients were grouped into intramuscular fat (IMF; n = 55) and non-IMF (n = 269) deposition groups. RESULTS: The mean ages of the patients were 72.3 ± 9.7 and 66.8 ± 12.1 years (P = 0.002), and hospital mortality rates were 3.6% (2/55) and 7.4% (20/269; P = 0.393) for IMF and non-IMF deposition groups, respectively. IMF deposition was a risk factor for a deterioration in activities of daily living at discharge by multivariable analysis [odds ratio 0.33, 95% confidence interval (CI) 0.16-0.69; P = 0.003]. The mean follow-up was 43.9 ± 36.8 months. The 5-year survival was significantly worse for the IMF deposition group (IMF 73.8% vs non-IMF 88.2%; P = 0.010). The multivariable Cox proportional hazard analysis showed that IMF deposition significantly predicted poor survival (hazard ratio 3.26, 95% CI 1.47-7.24; P = 0.004), unlike psoas muscle mass index and age. CONCLUSIONS: Skeletal muscle quality, defined by IMF deposition, was an independent predictor of overall survival and postoperative activities of daily living dependence risk in patients undergoing surgery for ATAAD. Thus, IMF deposition may be an additional risk factor for estimating late outcomes of ATAAD surgery.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Músculo Esquelético/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Atividades Cotidianas , Idoso , Aneurisma Dissecante/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
6.
Ann Thorac Surg ; 106(5): 1349-1355, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30086279

RESUMO

BACKGROUND: Although frailty is used to predict morbidity and mortality, its effect on the outcomes of acute type A aortic dissection has not been examined. Therefore, the objective of this study was to evaluate the role of frailty in predicting postoperative morbidity and mortality of patients with acute type A aortic dissection. METHODS: A retrospective analysis of a prospectively maintained database was undertaken for all patients (n = 310) undergoing aortic surgery between May 2004 and March 2017. Frailty was evaluated using an index consisting of age more than 70 years, body mass index less than 18.5 kg/m2, serum creatinine greater than 1.2 mg/dL, anemia, history of stroke, hypoalbuminemia, and the psoas muscle area index. One point was given for each criterion met, for a frailty score between 0 and 7. Frailty was defined as a score of 3 or more. RESULTS: Of all patients, 106 (34.2%) were defined as frail. Inhospital mortality rates of frail versus nonfrail patients were not significantly different (10.4% versus 8.3%, respectively; p = 0.54). Incidences of postoperative major morbidities without reexploration for bleeding were also not statistically different. Five-year survival rates were significantly worse for frail patients than for nonfrail patients (57.7% versus 85.1%, respectively; p = 0.0001). A frailty score of 3 or greater was associated with late mortality, and long-term outcomes were clearly stratified by frailty score. CONCLUSIONS: Frailty, as defined using a seven-component frailty index, can serve as an independent predictor of the risk of late mortality for patients undergoing surgery for acute type A aortic dissection. Such frailty markers, all of which are easily assessed preoperatively, may provide valuable information for patient counseling and risk stratification before aortic surgery.


Assuntos
Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Fragilidade/mortalidade , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Implante de Prótese Vascular/mortalidade , Bases de Dados Factuais , Feminino , Fragilidade/fisiopatologia , Avaliação Geriátrica , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
7.
Sci Rep ; 7(1): 8630, 2017 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-28819182

RESUMO

Pluripotent stem cell-derived cardiomyocytes show great promise in regenerating the heart after myocardial infarction; however, several uncertainties exist that must be addressed before clinical trials. One practical issue is graft survival following transplantation. Although a pro-survival cocktail with Matrigel has been shown to enhance graft survival, the use of Matrigel may not be clinically feasible. The purpose of this study was to test whether a hyaluronan-based hydrogel, HyStem, could be a substitute for Matrigel. Human induced pluripotent stem cell-derived cardiomyocytes diluted with HyStem alone, HyStem plus pro-survival factors, or a pro-survival cocktail with Matrigel (PSC/MG), were transplanted into a rat model of acute myocardial infarction. Histological analysis at 4 weeks post transplantation revealed that, among the three groups, recipients of PSC/MG showed the largest graft size. Additionally, the grafted cardiomyocytes in the recipients of PSC/MG had a more matured phenotype compared to those in the other two groups. These findings suggest that further studies will be required to enhance not only graft size, but also the maturation of grafted cardiomyocytes.


Assuntos
Matriz Extracelular/metabolismo , Infarto do Miocárdio/terapia , Miócitos Cardíacos/transplante , Células-Tronco Pluripotentes/citologia , Animais , Diferenciação Celular , Linhagem Celular , Transplante de Células/métodos , Modelos Animais de Doenças , Humanos , Hidrogéis/metabolismo , Células-Tronco Pluripotentes Induzidas/citologia , Masculino , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Miócitos Cardíacos/citologia , Ratos Endogâmicos F344 , Ratos Nus
8.
Circ J ; 81(7): 929-935, 2017 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-28603177

RESUMO

Pluripotent stem cells (PSCs) have gained interest for cell-based regenerative therapies because of their capacity to differentiate into most somatic cell types, including cardiomyocytes. Remarkable progress in the generation of PSC-derived cardiomyocytes has been made in this decade, and recent preclinical transplantation studies using various animal models have provided proof-of-principle for their use in heart regeneration. However, several obstacles preclude their effective and safe clinical application for cardiac repair, including the need for approaches that prevent tumorigenesis, arrhythmogenesis, and immune rejection. In this review, we focus on recent progress in the field of PSC-based cardiac regenerative therapy, including the remaining hurdles and potential approaches to circumventing them.


Assuntos
Diferenciação Celular , Cardiopatias , Coração/fisiologia , Miócitos Cardíacos , Células-Tronco Pluripotentes , Regeneração , Medicina Regenerativa/métodos , Animais , Cardiopatias/metabolismo , Cardiopatias/patologia , Cardiopatias/terapia , Humanos , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/patologia , Células-Tronco Pluripotentes/metabolismo , Células-Tronco Pluripotentes/patologia , Células-Tronco Pluripotentes/transplante , Medicina Regenerativa/tendências
9.
Nature ; 538(7625): 388-391, 2016 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-27723741

RESUMO

Induced pluripotent stem cells (iPSCs) constitute a potential source of autologous patient-specific cardiomyocytes for cardiac repair, providing a major benefit over other sources of cells in terms of immune rejection. However, autologous transplantation has substantial challenges related to manufacturing and regulation. Although major histocompatibility complex (MHC)-matched allogeneic transplantation is a promising alternative strategy, few immunological studies have been carried out with iPSCs. Here we describe an allogeneic transplantation model established using the cynomolgus monkey (Macaca fascicularis), the MHC structure of which is identical to that of humans. Fibroblast-derived iPSCs were generated from a MHC haplotype (HT4) homozygous animal and subsequently differentiated into cardiomyocytes (iPSC-CMs). Five HT4 heterozygous monkeys were subjected to myocardial infarction followed by direct intra-myocardial injection of iPSC-CMs. The grafted cardiomyocytes survived for 12 weeks with no evidence of immune rejection in monkeys treated with clinically relevant doses of methylprednisolone and tacrolimus, and showed electrical coupling with host cardiomyocytes as assessed by use of the fluorescent calcium indicator G-CaMP7.09. Additionally, transplantation of the iPSC-CMs improved cardiac contractile function at 4 and 12 weeks after transplantation; however, the incidence of ventricular tachycardia was transiently, but significantly, increased when compared to vehicle-treated controls. Collectively, our data demonstrate that allogeneic iPSC-CM transplantation is sufficient to regenerate the infarcted non-human primate heart; however, further research to control post-transplant arrhythmias is necessary.


Assuntos
Coração/fisiologia , Células-Tronco Pluripotentes Induzidas/citologia , Infarto do Miocárdio/terapia , Miócitos Cardíacos/citologia , Miócitos Cardíacos/transplante , Regeneração/fisiologia , Animais , Diferenciação Celular , Sobrevivência Celular , Feminino , Fibroblastos/citologia , Sobrevivência de Enxerto , Haplótipos , Imunossupressores , Macaca fascicularis , Complexo Principal de Histocompatibilidade/genética , Masculino , Contração Miocárdica/fisiologia , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Miócitos Cardíacos/imunologia , Miócitos Cardíacos/metabolismo , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Transplante Homólogo
10.
Int Heart J ; 55(5): 463-5, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25070122

RESUMO

Cardiac tumors and tumor-like lesions are uncommon; most are true neoplasms. We here report a case of a pericoronary tumor-like lesion surrounding the right coronary artery in a 39-year-old man who presented with fever and chest pain. Although clarithromycin was administered for 1 week, his fever persisted. Helicobacter cinaedi (H. cinaedi) was isolated from blood cultures and found to be sensitive to ceftriaxone. A computed tomography scan showed a tumor-like lesion with no (18)F-fl uorodeoxyglucose uptake surrounding the right coronary artery. After administration of ceftriaxone, the tumor-like lesion diminished in size according to meticulous computed tomography examinations. We therefore concluded that it was caused by H. cinaedi infection. The patient has been followed up closely for 1 year and remains asymptomatic.


Assuntos
Granuloma de Células Plasmáticas/microbiologia , Cardiopatias/microbiologia , Infecções por Helicobacter/microbiologia , Helicobacter/isolamento & purificação , Adulto , Antibacterianos/administração & dosagem , Ceftriaxona/administração & dosagem , Vasos Coronários , Diagnóstico Diferencial , Granuloma de Células Plasmáticas/diagnóstico , Granuloma de Células Plasmáticas/tratamento farmacológico , Cardiopatias/diagnóstico , Cardiopatias/tratamento farmacológico , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Humanos , Injeções Intravenosas , Imagem Cinética por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X
11.
Int J Clin Oncol ; 8(5): 322-5, 2003 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-14586759

RESUMO

BACKGROUND: Photodynamic therapy (PDT) has been proven to be a promising therapeutic modality for selected dysplasias and malignancies in a variety of organs. We assessed the effectiveness of PDT for treating cervical intraepithelial neoplasia (CIN) by cytological and histological examinations and investigated its impact on human papillomavirus (HPV) infection. METHODS: A series of 31 patients with CIN (2 with CIN2, 29 with CIN3) were given polyhematoporphyrin ether/ester (PHE) 2 mg/kg IV. After 60 h their cervices were exposed to a 630-nm YAG-OPO laser. HPV-DNA extracted from cervical smears was amplified by the polymerase chain reaction and typed for HPV using restriction fragment length polymorphism. RESULTS: At 3 months after PDT, cytology and directed biopsy of the cervix revealed regression of the disease in 28 [complete remission (CR) rate 90%] of 31 patients, and HPV-DNA could be no longer detected in the cervical smears of 22 (76%) of 29 HPV-positive patients. After 12 months, all 31 patients had achieved a CR on biopsy, although HPV-DNA was still present in the cervical smears of 6 patients. The types of HPV-DNA detected 12 months after PDT were different from those seen before PDT in each of the 6 patients, suggesting that they might be reinfected with other HPV types after PDT. CONCLUSION: PDT is effective not only in improving the cytological and histological measures when treating CIN but also for eradicating cervical HPV.


Assuntos
Neoplasia Intraepitelial Cervical/tratamento farmacológico , Neoplasia Intraepitelial Cervical/virologia , Papillomaviridae/isolamento & purificação , Fotoquimioterapia , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/virologia , Adulto , Antineoplásicos/uso terapêutico , Antivirais/uso terapêutico , Colo do Útero/virologia , DNA Viral/análise , Éter de Diematoporfirina/uso terapêutico , Feminino , Humanos , Infecções por Papillomavirus/tratamento farmacológico , Recidiva
12.
J Reprod Med ; 47(8): 608-10, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12216424

RESUMO

OBJECTIVE: To evaluate the role of transarterial embolization followed by hysteroscopic removal of a placental polyp with preservation of reproductive capacity. STUDY DESIGN: Three patients with placental polyps with abundant blood flow, suspected on ultrasonography with color Doppler imaging and on magnetic resonance imaging, were studied. They underwent transarterial embolization followed by hysteroscopic removal of the polyp. Transarterial embolization of the bilateral uterine arteries was carried out using an absorbable gelatin sponge. Selective removal via hysteroscopy was performed on the following day using a cutting loop without electrical stimulation. The polyp was gradually resected to the level of the surrounding endometrium. RESULTS: Complete removal of the placental polyp was achieved in all patients. The presence of a placental polyp was confirmed by pathologic examination. The operative time was ranged from 26 to 53 minutes. In all cases, no complications were noted, and bleeding was minimal during and immediately after the procedure. Postoperative ultrasonography demonstrated a uterine cavity free of residual mass in each case. CONCLUSION: Transarterial embolization of the uterine arteries followed by selective hysteroscopic removal is a safe and effective method of minimizing bleeding and preserves fertility in the treatment of placental polyps with an abundant blood flow.


Assuntos
Embolização Terapêutica , Fertilidade , Histeroscopia , Doenças Placentárias/terapia , Pólipos/terapia , Útero/irrigação sanguínea , Útero/cirurgia , Artérias/diagnóstico por imagem , Artérias/patologia , Artérias/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Avaliação de Resultados em Cuidados de Saúde , Doenças Placentárias/diagnóstico por imagem , Doenças Placentárias/patologia , Pólipos/diagnóstico por imagem , Pólipos/patologia , Gravidez , Estudos Retrospectivos , Ultrassonografia Doppler em Cores , Útero/patologia
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