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2.
Rev. cuba. pediatr ; 90(2): 227-237, abr.-jun. 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-901483

RESUMO

Introducción: el maltrato es un tipo de violencia que sigue en aumento, pero esto no se ha descrito en poblaciones de Los Andes peruanos. Objetivo: determinar los factores socio-educativos asociados a la percepción de maltrato físico y psicológico, en 31 colegios de nivel secundario de una ciudad de la serranía peruana. Métodos: estudio de tipo transversal analítico. La población de estudio estuvo conformada por 10 382 escolares, de 31 instituciones educativas públicas y privadas, de nivel secundario, de la ciudad de Huancayo-Perú. Las variables principales fueron: haber sufrido maltrato físico y psicológico, que se obtuvo de una encuesta -previamente validada- en nuestro medio. Se obtuvieron asociaciones estadísticas. Resultados: los maltratos psicológicos y físicos más frecuentes fueron: el haber recibido gritos y carga académica excesiva, respectivamente. Estuvieron asociados al maltrato psicológico el sexo femenino (razón de prevalencia ajustada [RPa]: 0,86; intervalo de confianza [IC] 95 por ciento: 0,81-0,90; valor p< 0,001), el estudiar en colegio nacional (RPa: 0,83; IC 95 por ciento: 0,79-0,88; valor p< 0,001), la edad (RPa: 1,05; IC 95 por ciento: 1,02-1,10; valor p= 0,003), el año de estudios (RPa: 1,04; IC 95 por ciento: 1,01-1,10; valor p= 0,020), la condición de repitente (RPa: 1,20; IC 95 por ciento: 1,09-1,31; valor p< 0,001), así como el color de la piel (RPa: 1,22; IC 95 por ciento: 1,00-1,49; valor p= 0,046). Por su parte, se asoció al maltrato físico el sexo femenino (RPa: 0,77; IC 95 por ciento: 0,74-0,80; valor p< 0,001), el ser de colegio nacional (RPa: 0,91; IC 95 por ciento: 0,88-0,95; valor p< 0,001), la edad (RPa: 1,03; IC 95 por ciento: 1,01-1,05; valor p= 0,014) y la condición de repitente (RPa: 1,08; IC 95 por ciento: 1,01-1,15; valor p= 0,015). Conclusiones: el maltrato se asocia con muchas características particulares, por lo que deben generarse programas de detección y apoyo a las víctimas(AU)


Introduction: abuse is a type of violence that continues to increase, but this has not been described in populations of the Peruvian Andes. Objective: to determine the socio-educational factors associated with the perception of physical and psychological abuse in 31 secondary schools in a city in the Peruvian highlands. Methods: analytical, cross-sectional study. The studied population consisted of 10 382 schoolchildren from 31 public and private educational institutions of secondary level, from the city of Huancayo, Peru. The main variables were having suffered physical and psychological abuse, and this data was obtained from a survey -previously validated- in our environment. Statistical associations were obtained. Results: the most frequent psychological and physical abuses were: having received shouts and excessive academic load, respectively. Associated with psychological abuse was the female sex (adjusted prevalence ratio [RPa]: 0.86; confidence interval [CI] 95 percent: 0.81-0.90; p value < 0.001), to study in a national college ( RPa: 0.83, 95 percent CI: 0.79-0.88; p value < 0.001); age (RPa: 1.05, 95 percent CI: 1.02-1.10; p value= 0.003); the year of studies (RPa: 1.04, 95 percent CI: 1.01-1.10; p value= 0.020), the condition of being an student repeating the year (RPa: 1.20; 95 percent CI: 1.09-1,31, p value< 0.001); as well as skin color (RPa: 1.22; 95 percent CI: 1.00-1.49; percentp value= 0.046). On the other hand were associated to physical abuse: the female sex (RPa: 0.77, 95 percent CI: 0.74-0.80, p value< 0.001), being in a national school (RPa: 0.91; 95 percent: 0.88-0.95; p value< 0.001), age (RPa: 1.03; 95 percent CI: 1.01-1.05; p value= 0.014) and the condition of being an student repeating the year (RPa: 1.08; 95 percent CI: 1.01-1.15; p value= 0.015). Conclusions: abuse is associated with many particular characteristics, which is why screening and support programs for victims must be generated(AU)


Assuntos
Adolescente , Bullying/prevenção & controle , Maus-Tratos Infantis/psicologia , Estudos Transversais , Peru
3.
J Tissue Eng Regen Med ; 12(3): e1623-e1635, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29024475

RESUMO

The development of an alternative source for donor lungs would change the paradigm of lung transplantation. Recent studies have demonstrated the potential feasibility of using decellularized lungs as scaffolds for lung tissue regeneration and subsequent implantation. However, finding a reliable cell source and the ability to scale up for recellularization of the lung scaffold still remain significant challenges. To explore the possibility of regeneration of human lung tissue from stem cells in vitro, populations of lung progenitor cells were generated from human iPSCs. To explore the feasibility of producing engineered lungs from stem cells, we repopulated decellularized human lung and rat lungs with iPSC-derived epithelial progenitor cells. The iPSCs-derived epithelial progenitor cells lined the decellularized human lung and expressed most of the epithelial markers when were cultured in a lung bioreactor system. In decellularized rat lungs, these human-derived cells attach and proliferate in a manner similar to what was observed in the decellularized human lung. Our results suggest that repopulation of lung matrix with iPSC-derived lung epithelial cells may be a viable strategy for human lung regeneration and represents an important early step toward translation of this technology.

6.
Biores Open Access ; 5(1): 118-26, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27186445

RESUMO

The demand for donated organs greatly exceeds the availability. Alternatives to organ donation, such as laboratory-engineered organs, are therefore being developed. One approach is to decellularize the organ and reseed it with selected cells, ideally from the organ recipient. Organ decellularization has typically been attempted by the administration of detergents into vessels such as the portal vein in the liver. However, in the case of the lung, the airway provides another potential administration route, because it has a wide contact area between cells and detergents in the tracheal tree and alveoli. In the present study, we introduce a novel ventilation-based decellularization system for the lung and compare its efficacy to ordinary decellularization systems administering detergent through the pulmonary artery. Rat lungs were decellularized using 500 mL of 3-[(3-cholamidopropyl) dimethylammonio]-1-Propanesulfonate (CHAPS) decellularization solution administrated through the pulmonary artery (vessel group) or through the trachea (airway group). The vessel group was infused CHAPS solution using a gravitational pressure head of 20 cmH2O. The airway group was infused with the detergent using negative pressure and positive end-expiratory pressure, for a volume 10cc with each inspiration in a bioreactor. Pathological and immunohistochemical findings indicated that components of the extracellular matrix (ECM), including proteoglycans, elastic fibers, fibronectin, and laminin, were more decreased in the airway group than in the vessel group. Western blot analysis showed that MHC class I antigen and ß-actin were not detected in both decellularized groups. A collagen assay showed that collagen was 70% preserved in both groups compared to native lung. Glycosaminoglycan (GAG) and DNA assays showed that GAG and DNA contents were strongly diminished in both decellularized groups, but those contents were smaller in the airway group than in the vessel group. Accordingly, the alveolar wall was thinner on electron microscopy, and DNA remnants were not observed in the airway group. Infusion of red blood cells indicated that capillary walls were preserved without blood leakage in both groups. In conclusion, we describe a novel approach for decellularization through the airway that represents a more stringent method for both DNA and ECM removal, with capillary wall preservation.

8.
Arch. bronconeumol. (Ed. impr.) ; 51(11): 564-570, nov. 2015. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-144371

RESUMO

Introducción: El objetivo de este estudio es el análisis del impacto de los trastornos asociados al consumo de alcohol (TCA) en las neumonías neumocócicas adquiridas en la comunidad (NNAC), en términos de exceso de mortalidad intrahospitalaria, prolongación de estancias y sobrecostes. Material y métodos: Estudio observacional retrospectivo de una muestra de pacientes que presentaron NNAC recogidos en los conjuntos mínimos básicos de datos de 87 hospitales españoles durante el periodo 2008-2010. Se calculó la mortalidad, la prolongación de estancias y los sobrecostes atribuibles a los TCA controlando mediante análisis multivariado de la covarianza variables como la edad y el sexo, el tipo de hospital, los trastornos adictivos y las comorbilidades. Resultados: Se estudiaron 16.202 ingresos urgentes por NNAC de 18 a 74años de edad, entre los cuales hubo 2.685 pacientes con TCA. Los ingresos con NNAC y TCA fueron predominantemente varones, con mayor prevalencia de trastornos por tabaco y drogas y con índices de comorbilidad de Charlson más elevados. Los pacientes con NNAC y TCA presentaron importantes excesos de mortalidad (50,8%; IC95%: 44,3-54,3%), prolongación indebida de estancias (2,3días; IC95%: 2,0-2,7días) y sobrecostes (1.869,2€; IC95%: 1.498,6-2.239,8€). Conclusiones: De acuerdo con los resultados de este estudio, los TCA en pacientes con NNAC aumentan significativamente la mortalidad, la duración de la estancia hospitalaria y sus costes (AU)


Introduction: The aim of this study was to investigate the impact of alcohol use disorders (AUD) on community-acquired pneumococcal pneumonia (CAPP) admissions, in terms of in-hospital mortality, prolonged stay and increased hospital spending. Methods: Retrospective observational study of a sample of CAPP patients from the minimum basic datasets of 87 Spanish hospitals during 2008-2010. Mortality, length of hospital stay and additional spending attributable to AUD were calculated after multivariate covariance analysis for variables such as age and sex, type of hospital, addictions and comorbidities. Results: Among 16,202 non-elective admissions for CAPP in patients aged 18-74years, 2,685 had AUD. Patients admitted with CAPP and AUD were predominantly men with a higher prevalence of tobacco or drug use disorders and higher Charlson comorbidity index. Patients with CAPP and AUD had notably higher in-hospital mortality (50.8%; CI95%: 44.3-54.3%), prolonged length of stay (2.3days; CI95%: 2.0-2.7days) and increased costs (1,869.2€; CI95%: 1,498.6-2,239.8€). Conclusions: According to the results of this study, AUD in CAPP patients was associated with increased in-hospital mortality, length of hospital stay and hospital spending (AU)


Assuntos
Humanos , Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos Induzidos por Álcool/epidemiologia , Pneumonia Pneumocócica/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Mortalidade , Efeitos Psicossociais da Doença , Tempo de Internação/estatística & dados numéricos , Estudos Retrospectivos
9.
Tissue Eng Part A ; 21(21-22): 2673-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26414101

RESUMO

Kidney transplantation is often the most effective therapy for end-stage renal disease, but there are not enough donor organs to meet the rising demand. Tissue engineering of kidneys is a potential solution to this organ shortage. Achieving microvascular perfusion has been a major barrier to engineering tissues beyond thin muscularized sheets such as the bladder wall. Our laboratory has previously reported that human umbilical vein endothelial cells (ECs) transduced with the antiapoptotic protein Bcl-2 will spontaneously organize into perfused microvessels within type I collagen gels when implanted in immunodeficient mice. To test if this system can be used to perfuse more complex structures, we combined Bcl-2-transduced ECs (Bcl-2-ECs) with renal glomeruli, the specialized vascular filtration units of the kidney. Microdissected green fluorescent protein-expressing rat glomeruli suspended in type I collagen gels were implanted within immunodeficient mice with or without the inclusion of Bcl-2-ECs. Survival of rat glomeruli was enhanced by coimplantation with Bcl-2-ECs. Intravital rhodamine dextran injections demonstrated that surviving glomeruli were perfused through Bcl-2-EC-derived microvessels. Perfused glomeruli maintained podocin staining, but transmission electron microscopy revealed endothelial swelling and podocyte foot process effacement. Anastomosis of microvessels derived from Bcl-2-ECs with glomerular capillaries provides proof of concept that self-assembled microvessels can perfuse specialized organ structures such as glomeruli, but that perfusion alone may be insufficient to maintain normal structure.


Assuntos
Células Endoteliais/citologia , Células Endoteliais/transplante , Glomérulos Renais/irrigação sanguínea , Microvasos/crescimento & desenvolvimento , Reperfusão/métodos , Engenharia Tecidual/métodos , Animais , Células Cultivadas , Células Endoteliais/fisiologia , Feminino , Humanos , Técnicas In Vitro , Glomérulos Renais/fisiologia , Glomérulos Renais/cirurgia , Camundongos Endogâmicos C57BL , Microvasos/citologia , Ratos , Ratos Transgênicos , Veias Umbilicais/citologia
10.
CCH, Correo cient. Holguín ; 19(3): 556-564, jul.-set. 2015. ilus
Artigo em Espanhol | LILACS-Express | ID: lil-760131

RESUMO

Se realizó una revisión relativa a la gangrena de Fournier, motivada por la presentación de un caso atendido en el Servicio de Coloproctología del Hospital Provincial General “Vladimir I. Lenin,” de Holguín, en año 2014. Se trató de un adulto masculino de 59 años con diagnóstico de esta enfermedad en la región perianal, que de forma fugaz invadió los genitales externos. Se realizó intervención quirúrgica de urgencia, se trató con antibióticos por vía endovenosa y se practicó desbridamiento quirúrgico con orquiectomía izquierda. Luego de controlada la infección perianal, se trasladó al Servicio de Urología del Hospital Clínico Quirúrgico Lucía Iñiguez Landin de Holguín con una estadía de 43 días, al controlar la infección de los genitales, se realizó una reconstrucción de la región escrotal y se dio alta para seguimiento ambulatorio. La aparición de esta enfermedad no es frecuente, pero sí es potencialmente letal por lo que una vez diagnosticada, los especialistas deben, tratar la enfermedad de la manera más rápida posible.


A review on Fournier's gangrene, motivated by the presentation of a case treated at the Coloproctology Service of "Vladimir I. Lenin General Provincial Hospital," Holguin, in 2014 was done. A male patient of 59 years of age diagnosed with this disease in the perianal region fleetingly was spread the external genitals. Emergency surgery was performed, treated with intravenous antibiotics and surgical debridement was performed with left orchiectomy. After the perianal infection was controlled, the patient was reffered to the Urology Department of Lucia Iñiguez Landin Surgical Hospital of Holguin with a stay of 43 days, to control the infection of the genitals; a reconstruction of the crotch region was performed. The patient was discharged for follow-up outpatient consultation. The emergence of this disease is rare, but potentially lethal so once diagnosed the specialists must treat the disease as soon as possible.

11.
Cir. Esp. (Ed. impr.) ; 93(7): 444-449, ago.-sept. 2015. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-143036

RESUMO

Introducción: Los objetivos de este estudio fueron el análisis de los factores asociados a la incidencia de dehiscencia postoperatoria de la laparotomía y el impacto de esta última en la mortalidad, las estancias y los costes hospitalarios. Métodos: Estudio observacional retrospectivo de una muestra de pacientes intervenidos mediante laparotomía recogidos en los conjuntos mínimos básicos de datos de 87 hospitales españoles durante el periodo 2008-2010. Resultados: Se estudiaron 323.894 ingresos por cirugía abdominal, entre los cuales hubo 2.294 pacientes con DPL. Los pacientes de mayor edad, varones, con ingreso urgente, con trastornos por alcohol, tabaco y drogas, y con más comorbilidades presentaron mayor incidencia. Además, aquellos con DPL presentaron un incremento de mortalidad (107,5%), una estancia mas prolongada (15,6 días) y un exceso de costes (14.327 euros). Conclusiones: Hay una asociación entre ciertas variables demográficas, conductuales y comorbilidades, y la incidencia de DPL, y esta complicación aumenta la mortalidad, la duración de la estancia y su coste. Medidas preventivas podrían disminuir su incidencia y su impacto sanitario y económico (AU)


Introduction: The objectives of this study were to investigate the relationship between several factors and the incidence of postoperative abdominal wall dehiscence (POAD), and to estimate the influence of POAD on in-hospital mortality, excess length of stay and costs. Methods: Retrospective observational study of a sample of abdominal surgery patients from a minimal basic data set of 87 Spanish hospitals during 2008-2010. Results: Among 323,894 admissions for abdominal surgery reviewed there were 2,294 patients with POAD. Elderly patients, male, with non-elective admission, with alcohol, tobacco or drugs abuse, and with more comorbidities had higher incidence. POAD patients had an increase in in-hospital death (mortality excess of 107.5%), excess length of stay (15.6 days) and higher cost (14,327 euros). Conclusions: Certain demographic and behavioral variables, and several comorbidities are associated with the incidence of POAD, and this complication shows an increase in in-hospital mortality, the length of hospital stay and costs. Preventive measures might decrease the incidence of POAD and its impact on health and extra-costs (AU)


Assuntos
Humanos , Laparotomia/efeitos adversos , Deiscência da Ferida Operatória/complicações , Tempo de Internação/estatística & dados numéricos , Fatores de Risco , Efeitos Psicossociais da Doença , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
12.
Crit Ultrasound J ; 7(1): 29, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26123610

RESUMO

BACKGROUND: The evaluation of fluid responsiveness in patients with hemodynamic instability remains to be challenging. This investigation aimed to determine whether respiratory variation in carotid Doppler peak velocity (ΔCDPV) predicts fluid responsiveness in patients with septic shock and lung protective mechanical ventilation with a tidal volume of 6 ml/kg. METHODS: We performed a prospective cohort study at an intensive care unit, studying the effect of 59 fluid challenges on 19 mechanically ventilated patients with septic shock. Pre-fluid challenge ΔCDPV and other static or dynamic measurements were obtained. Fluid challenge responders were defined as patients whose stroke volume index increased more than 15 % on transpulmonary thermodilution. The area under the receiver operating characteristic curve (AUROC) was compared for each predictive parameter. RESULTS: Fluid responsiveness rate was 51 %. The ΔCDPV had an AUROC of 0.88 (95 % confidence interval (CI) 0.77-0.95); followed by stroke volume variation (0.72, 95 % CI 0.63-0.88), passive leg raising (0.69, 95 % CI 0.56-0.80), and pulse pressure variation (0.63, 95 % CI 0.49-0.75). The ΔCDPV was a statistically significant superior predictor when compared with the other parameters. Sensitivity, specificity, and positive and negative predictive values were also the highest for ΔCDPV, with an optimal cutoff at 14 %. There was good correlation between ΔCDPV and SVI increment after the fluid challenge (r = 0.84; p < 0.001). CONCLUSIONS: ΔCDPV can be more accurate than other methods for assessing fluid responsiveness in patients with septic shock receiving lung protective mechanical ventilation. ΔCDPV also has a high correlation with SVI increase after fluid challenge.

13.
CCM ; 19(3): 56-564, jul 2015. ilus
Artigo em Espanhol | CUMED | ID: cum-65669

RESUMO

Se realizó una revisión relativa a la gangrena de Fournier, motivada por la presentación de un caso atendido en el Servicio de Coloproctología del Hospital Provincial General “Vladimir I. Lenin,” de Holguín, en año 2014. Se trató de un adulto masculino de 59 años con diagnóstico de esta enfermedad en la región perianal, que de forma fugaz invadió los genitales externos. Se realizó intervención quirúrgica de urgencia, se trató con antibióticos por vía endovenosa y se practicó desbridamiento quirúrgico con orquiectomía izquierda. Luego de controlada la infección perianal, se trasladó al Servicio de Urología del Hospital Clínico Quirúrgico Lucía Iñiguez Landin de Holguín con una estadía de 43 días, al controlar la infección de los genitales, se realizó una reconstrucción de la región escrotal y se dio alta para seguimiento ambulatorio. La aparición de esta enfermedad no es frecuente, pero sí es potencialmente letal por lo que una vez diagnosticada, los especialistas deben, tratar la enfermedad de la manera más rápida posible.(AU)


A review on Fournier's gangrene, motivated by the presentation of a case treated at the Coloproctology Service of "Vladimir I. Lenin General Provincial Hospital," Holguin, in 2014 was done. A male patient of 59 years of age diagnosed with this disease in the perianal region fleetingly was spread the external genitals. Emergency surgery was performed, treated with intravenous antibiotics and surgical debridement was performed with left orchiectomy. After the perianal infection was controlled, the patient was reffered to the Urology Department of Lucia Iñiguez Landin Surgical Hospital of Holguin with a stay of 43 days, to control the infection of the genitals; a reconstruction of the crotch region was performed. The patient was discharged for follow-up outpatient consultation. The emergence of this disease is rare, but potentially lethal so once diagnosed the specialists must treat the disease as soon as possible.(AU)


Assuntos
Humanos , Masculino , Adulto , Gangrena de Fournier/complicações , Gangrena de Fournier/diagnóstico , Gangrena de Fournier/cirurgia , Infecções Bacterianas/tratamento farmacológico , Infecções por Escherichia coli/tratamento farmacológico
14.
Cir Esp ; 93(7): 444-9, 2015 Aug-Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-25956459

RESUMO

INTRODUCTION: The objectives of this study were to investigate the relationship between several factors and the incidence of postoperative abdominal wall dehiscence (POAD), and to estimate the influence of POAD on in-hospital mortality, excess length of stay and costs. METHODS: Retrospective observational study of a sample of abdominal surgery patients from a minimal basic data set of 87 Spanish hospitals during 2008-2010. RESULTS: Among 323,894 admissions for abdominal surgery reviewed there were 2,294 patients with POAD. Elderly patients, male, with non-elective admission, with alcohol, tobacco or drugs abuse, and with more comorbidities had higher incidence. POAD patients had an increase in in-hospital death (mortality excess of 107.5%), excess length of stay (15.6 days) and higher cost (14,327 euros). CONCLUSIONS: Certain demographic and behavioral variables, and several comorbidities are associated with the incidence of POAD, and this complication shows an increase in in-hospital mortality, the length of hospital stay and costs. Preventive measures might decrease the incidence of POAD and its impact on health and extra-costs.


Assuntos
Parede Abdominal/cirurgia , Custos de Cuidados de Saúde , Mortalidade Hospitalar , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Deiscência da Ferida Operatória/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
15.
Biomaterials ; 53: 621-33, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25890758

RESUMO

Endothelial cells (ECs) exist in different microenvironments in vivo, including under different levels of shear stress in arteries versus veins. Standard stem cell differentiation protocols to derive ECs and EC-subtypes from human induced pluripotent stem cells (hiPSCs) generally use growth factors or other soluble factors in an effort to specify cell fate. In this study, a biomimetic flow bioreactor was used to subject hiPSC-derived ECs (hiPSC-ECs) to shear stress to determine the impacts on phenotype and upregulation of markers associated with an anti-thrombotic, anti-inflammatory, arterial-like phenotype. The in vitro bioreactor system was able to efficiently mature hiPSC-ECs into arterial-like cells in 24 h, as demonstrated by qRT-PCR for arterial markers EphrinB2, CXCR4, Conexin40 and Notch1, as well protein-level expression of Notch1 intracellular domain (NICD). Furthermore, the exogenous addition of soluble factors was not able to fully recapitulate this phenotype that was imparted by shear stress exposure. The induction of these phenotypic changes was biomechanically mediated in the shear stress bioreactor. This biomimetic flow bioreactor is an effective means for the differentiation of hiPSC-ECs toward an arterial-like phenotype, and is amenable to scale-up for culturing large quantities of cells for tissue engineering applications.


Assuntos
Biomimética , Reatores Biológicos , Endotélio Vascular/citologia , Células-Tronco Pluripotentes Induzidas/citologia , Biomarcadores/metabolismo , Diferenciação Celular , Células Cultivadas , Endotélio Vascular/metabolismo , Humanos
16.
Arch Bronconeumol ; 51(11): 564-70, 2015 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25766125

RESUMO

INTRODUCTION: The aim of this study was to investigate the impact of alcohol use disorders (AUD) on community-acquired pneumococcal pneumonia (CAPP) admissions, in terms of in-hospital mortality, prolonged stay and increased hospital spending. METHODS: Retrospective observational study of a sample of CAPP patients from the minimum basic datasets of 87 Spanish hospitals during 2008-2010. Mortality, length of hospital stay and additional spending attributable to AUD were calculated after multivariate covariance analysis for variables such as age and sex, type of hospital, addictions and comorbidities. RESULTS: Among 16,202 non-elective admissions for CAPP in patients aged 18-74years, 2,685 had AUD. Patients admitted with CAPP and AUD were predominantly men with a higher prevalence of tobacco or drug use disorders and higher Charlson comorbidity index. Patients with CAPP and AUD had notably higher in-hospital mortality (50.8%; CI95%: 44.3-54.3%), prolonged length of stay (2.3days; CI95%: 2.0-2.7days) and increased costs (1,869.2€; CI95%: 1,498.6-2,239.8€). CONCLUSIONS: According to the results of this study, AUD in CAPP patients was associated with increased in-hospital mortality, length of hospital stay and hospital spending.


Assuntos
Transtornos Relacionados ao Uso de Álcool/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Custos Hospitalares/estatística & dados numéricos , Pneumonia Pneumocócica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Relacionados ao Uso de Álcool/economia , Infecções Comunitárias Adquiridas/economia , Comorbidade , Feminino , Mortalidade Hospitalar , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Papel do Médico , Vacinas Pneumocócicas , Pneumonia Pneumocócica/economia , Prevalência , Estudos Retrospectivos , Espanha/epidemiologia , Uso de Tabaco/epidemiologia
17.
Tissue Eng Part A ; 21(11-12): 1916-28, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25789725

RESUMO

Type II cells are the defenders of the alveolus. They produce surfactant to prevent alveolar collapse, they actively transport water to prevent filling of the air sacs that would otherwise prevent gas exchange, and they differentiate to type I epithelial cells. They are an indispensable component of functional lung tissue. To understand the functionality of type II cells in isolation, we sought to track their fate in decellularized matrices and to assess their ability to contribute to barrier function by differentiation to type I alveolar epithelial cells. Rat type II cells were isolated from neonatal rat lungs by labeling with the RTII-70 surface marker and separation using a magnetic column. This produced a population of ∼50% RTII-70-positive cells accompanied by few type I epithelial cells or α-actin-positive mesenchymal cells. This population was seeded into decellularized rat lung matrices and cultured for 1 or 7 days. Culture in Dulbecco's modified Eagle's medium +10% fetal bovine serum (FBS) resulted in reduced expression of epithelial markers and increased expression of mesenchymal markers. By 7 days, no epithelial markers were visible by immunostaining; nearly all cells were α-actin positive. Gene expression for the mesenchymal markers, α-actin, vimentin, and TGF-ßR, was significantly upregulated on day 1 (p=0.0005, 0.0005, and 2.342E-5, respectively). Transcript levels of α-actin and TGF-ßR remained high at 7 days (p=1.364E-10 and 0.0002). Interestingly, human type II cells cultured under the same conditions showed a similar trend in the loss of epithelial markers, but did not display high expression of mesenchymal markers. Rat cells additionally showed the ability to produce and degrade the basement membrane and extracellular matrix components, such as fibronectin, collagen IV, and collagen I. Quantitative real-time reverse transcription polymerase chain reaction (RT-PCR) showed significant increases in expression of the fibronectin and matrix metalloprotease-2 (MMP-2) genes after 1 day in culture (p=0.0135 and 0.0128, respectively) and elevated collagen I expression at 7 days (p=0.0016). These data suggest that the original type II-enriched population underwent a transition to increased expression of mesenchymal markers, perhaps as part of a survival or wound-healing program. These results suggest that additional medium components and/or the application of physiologically appropriate stimuli such as ventilation may be required to promote lung-specific epithelial phenotypes.


Assuntos
Células Epiteliais Alveolares/citologia , Transição Epitelial-Mesenquimal/fisiologia , Matriz Extracelular , Pulmão/citologia , Tecidos Suporte , Actinas/biossíntese , Animais , Animais Recém-Nascidos , Técnicas de Cultura de Células , Células Cultivadas , Colágeno Tipo I/biossíntese , Fibronectinas/biossíntese , Humanos , Metaloproteinase 2 da Matriz/biossíntese , Ratos , Ratos Endogâmicos F344 , Ratos Sprague-Dawley , Receptores de Fatores de Crescimento Transformadores beta/biossíntese , Vimentina/biossíntese , Cicatrização
18.
Tissue Eng Part A ; 21(9-10): 1621-32, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25668104

RESUMO

Adipose-derived mesenchymal cells (ACs) and bone marrow-derived mesenchymal cells (BMCs) have been widely used for bone regeneration and can be seeded on a variety of rigid scaffolds. However, to date, a direct comparison of mesenchymal cells (MC) harvested from different tissues from the same donor and cultured in identical osteogenic conditions has not been investigated. Indeed, it is unclear whether marrow-derived or fat-derived MC possess intrinsic differences in bone-forming capabilities, since within-patient comparisons have not been previously done. This study aims at comparing ACs and BMCs from three donors ranging in age from neonatal to adult. Matched cells from each donor were studied in three distinct bioreactor settings, to determine the best method to create a viable osseous engineered construct. Human ACs and BMCs were isolated from each donor, cultured, and seeded on decellularized porcine bone (DCB) constructs. The constructs were then subjected to either static or dynamic (stirring or perfusion) bioreactor culture conditions for 7-21 days. Afterward, the constructs were analyzed for cell adhesion and distribution and osteogenic differentiation. ACs demonstrated higher seeding efficiency than BMCs. However, static and dynamic culture significantly increased BMCs proliferation more than ACs. In all conditions, BMCs demonstrated stronger osteogenic activity as compared with ACs, through higher alkaline phosphatase activity and gene expression for various bony markers. Conversely, ACs expressed more collagen I, which is a nonspecific matrix molecule in most connective tissues. Overall, dynamic bioreactor culture conditions enhanced osteogenic gene expression in both ACs and BMCs. Scaffolds seeded with BMCs in dynamic stirring culture conditions exhibit the greatest osteogenic proliferation and function in vitro, proving that marrow-derived MC have superior bone-forming potential as compared with adipose-derived cells.


Assuntos
Tecido Adiposo/citologia , Células da Medula Óssea/citologia , Técnicas de Cultura de Células/métodos , Células-Tronco Mesenquimais/citologia , Osteogênese , Doadores de Tecidos , Adulto , Fosfatase Alcalina/metabolismo , Animais , Reatores Biológicos , Células da Medula Óssea/metabolismo , Osso e Ossos/citologia , Cálcio/metabolismo , Adesão Celular , Células Cultivadas , Criança , DNA/metabolismo , Feminino , Imunofluorescência , Regulação da Expressão Gênica , Humanos , Lactente , Masculino , Células-Tronco Mesenquimais/metabolismo , Osteocalcina/metabolismo , Osteogênese/genética , Sus scrofa
19.
Biomaterials ; 40: 61-71, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25433608

RESUMO

Non-healing, chronic wounds are a growing public health problem and may stem from insufficient angiogenesis in affected sites. Here, we have developed a fibrin formulation that allows adipose-derived mesenchymal stromal cells (ADSCs) to form tubular structures in vitro. The tubular structures express markers of endothelium, including CD31 and VE-Cadherin, as well as the pericyte marker NG2. The ability for the MSCs to form tubular structures within the fibrin gels was directly dependent on the stoichiometric ratios of thrombin and fibrinogen and the resulting gel concentration, as well as on the presence of bFGF. Fibrin gel formulations that varied in stiffness were tested. ADSCs that are embedded in a stiff fibrin formulation express VE-cadherin and CD31 as shown by PCR, FACS and immunostaining. Confocal imaging analysis demonstrated that tubular structures formed, containing visible lumens, in the stiff fibrin gels in vitro. There was also a difference in the amounts of bFGF secreted by ADSCs grown in the stiffer gels as compared to softer gels. Additionally, hAT-MSCs gave rise to perfusable vessels that were VE-cadherin positive after subcutaneous injection into mice, whereas the softer fibrin formulation containing ADSCs did not. The application of ADSCs delivered in the stiff fibrin gels allowed for the wounds to heal more quickly, as assessed by wound size, amount of granulation tissue and collagen content. Interestingly, following 5 days of healing, the ADSCs remained within the fibrin gel and did not integrate into the granulation tissue of healing wounds in vivo. These data show that ADSCs are able to form tubular structures within fibrin gels, and may also contribute to faster wound healing, as compared with no treatment or to wounds treated with fibrin gels devoid of ADSCs.


Assuntos
Adesivo Tecidual de Fibrina/farmacologia , Células-Tronco Mesenquimais/citologia , Neovascularização Fisiológica/efeitos dos fármacos , Cicatrização/efeitos dos fármacos , Adulto , Animais , Biomarcadores/metabolismo , Colágeno/metabolismo , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática , Feminino , Fator 2 de Crescimento de Fibroblastos/metabolismo , Citometria de Fluxo , Humanos , Imuno-Histoquímica , Masculino , Células-Tronco Mesenquimais/efeitos dos fármacos , Células-Tronco Mesenquimais/metabolismo , Células-Tronco Mesenquimais/ultraestrutura , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Reologia/efeitos dos fármacos , Tela Subcutânea/efeitos dos fármacos
20.
Tissue Eng Part C Methods ; 20(12): 1028-36, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24735501

RESUMO

The creation of decellularized organs for use in regenerative medicine requires the preservation of the organ extracellular matrix (ECM) as a means to provide critical cues for differentiation and migration of cells that are seeded onto the organ scaffold. The purpose of this study was to assess the influence of varying pH levels on the preservation of key ECM components during the decellularization of rat lungs. Herein, we show that the pH of the 3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonate (CHAPS)-based decellularization solution influences ECM retention, cell removal, and also the potential for host response upon implantation of acellular lung tissue. The preservation of ECM components, including elastin, fibronectin, and laminin, were better retained in the lower pH conditions that were tested (pH ranges tested: 8, 10, 12); glycosaminoglycans were preserved to a higher extent in the lower pH groups as well. The DNA content following decellularization of the rat lung was inversely correlated with the pH of the decellularization solution. Despite detectible levels of cyotoskeletal proteins and significant residual DNA, tissues decellularized at pH 8 demonstrated the greatest tissue architecture maintenance and the least induction of host response of all acellular conditions. These results highlight the effect of pH on the results obtained by organ decellularization and suggest that altering the pH of the solutions used for decellularization may influence the ability of cells to properly differentiate and home to appropriate locations within the scaffold, based on the preservation of key ECM components and implantation results.


Assuntos
Ácidos Cólicos/farmacologia , Matriz Extracelular/metabolismo , Pulmão/citologia , Engenharia Tecidual/métodos , Animais , Colágeno/metabolismo , Elastina/metabolismo , Matriz Extracelular/efeitos dos fármacos , Fibronectinas/metabolismo , Glicosaminoglicanos/metabolismo , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Implantes Experimentais , Laminina/metabolismo , Pulmão/efeitos dos fármacos , Pulmão/ultraestrutura , Masculino , Ratos Sprague-Dawley , Tela Subcutânea/fisiologia
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