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1.
Radiology ; : 191606, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32602828

RESUMO

Background Little is known about factors that influence the efficacy of transarterial radioembolization (TARE). Purpose To determine the relationship between tumor radiation-absorbed dose and survival and tumor response in locally advanced inoperable hepatocellular carcinoma treated with TARE. Materials and Methods This was a secondary analysis of prospectively acquired data (between December 2011 and March 2015) from participants who received TARE in the Sorafenib versus Radioembolization in Advanced Hepatocellular Carcinoma (SARAH) trial (ClinicalTrials.gov identifier: NCT01482442). Tumor-absorbed dose was computed using technetium 99m (99mTc) macroaggregated human albumin (MAA) SPECT/CT. Visual agreement among CT, 99mTc-MAA SPECT/CT, and yttrium 90 (90Y) SPECT/CT or PET/CT was scored as optimal, suboptimal, or not optimal. Overall survival (OS) and tumor response at 6-month follow-up CT (Response Evaluation Criteria in Solid Tumors, version 1.1) were assessed. OS was evaluated using Kaplan-Meier tests. A propensity score comparing participants receiving a tumor dose greater than or equal to 100 Gy (best cut-off according to the receiver operating characteristic curve and median tumor radiation-absorbed dose values in the study groups) with those receiving sorafenib was calculated. Results One hundred twenty-one participants (median age, 67 years; interquartile range [IQR]: 61-73 years; 110 men) were evaluated in the dose-survival group, and 109 (median age, 66 years; IQR: 61-71 years; 100 men) were evaluated in the dose-tumor response group. In the dose-survival group, median OS was 9.3 months (95% confidence interval [CI]: 6.7 months, 10.7 months), and median tumor radiation-absorbed dose was 112 Gy (IQR: 68-220 Gy). Participants who received at least 100 Gy (n = 67) had longer survival than those who received less than 100 Gy (median, 14.1 months [95% CI: 9.6 months, 18.6 months] vs 6.1 months [95% CI: 4.9 months, 6.8 months], respectively; P < .001), and those with optimal agreement (n = 24) had the longest median OS (24.9 months; 95% CI: 9.6 months, 33.9 months). In the dose-tumor response group, tumor radiation-absorbed dose was higher in participants with disease control versus those with progressive disease (median, 121 Gy [IQR: 86-190 Gy] vs 85 Gy [IQR: 58-164 Gy]; P = .02). The highest disease control rate was observed in 31 of 40 participants (78%) with a tumor radiation-absorbed dose greater than or equal to 100 Gy and optimal agreement. Conclusion Higher tumor radiation-absorbed dose computed at technetium 99m macroaggregated human albumin SPECT/CT was associated with better overall survival and disease control in hepatocellular carcinoma treated with transarterial radioembolization with yttrium 90 in the Sorafenib versus Radioembolization in Advanced Hepatocellular Carcinoma trial. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Sofocleous and Kamarinos in this issue.

2.
Small ; : e2001975, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32603002

RESUMO

Grooved topography and inherent cell contact guidance has shown promising results regarding cell proliferation, morphology, and lineage-specific differentiation. Yet these approaches are limited to 2D applications. Sandwich-culture conditions are developed to bridge the gap between 2D and 3D culture, enabling both ventral and dorsal cell surface stimulation. The effect of grooved surface topography is accessed on cell orientation and elongation in a highly controlled manner, with simultaneous and independent stimuli on two cell sides. Nanogrooved and non-nanogrooved substrates are assembled into quasi-3D systems with variable relative orientations. A plethora of sandwich-culture conditions are created by seeding cells on lower, upper, or both substrates. Software image analysis demonstrates that F-actin of cells acquires the orientation of the substrate on which cells are initially seeded, independently from the orientation of the second top substrate. Contrasting cell morphologies are observed, with a higher elongation for nanogrooved 2D substrates than nanogrooved sandwich-culture conditions. Correlated with an increased pFAK activity and vinculin staining for sandwich-culture conditions, these results point to an enhanced cell surface stimulation versus control conditions. The pivotal role of initial cell-biomaterial contact on cellular alignment is highlighted, providing important insights for tissue engineering strategies aiming to guide cellular response through mechanotransduction approaches.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32629839

RESUMO

BACKGROUND: The use of rehabilitation protocols carried out in water has been progressively increasing due to the favorable physical properties of the water. Electromyography allows one to register muscle activity even under water. AIM: To compare muscle activity between two groups (healthy young adults (HYA) and healthy older adults (HOA)) in two different environments (dry land and aquatic) using surface electromyography during the execution of four different test/functional movements. METHODS: Analytical cross-sectional study. HYA and HOA carried out four functional tasks (Step Up and Down, Sit To Stand test, Gait Initiation and Turns During Gait) in two different environments (dry land and aquatic). Absolute and relative muscle activation was compared between each group and between each environment. In addition, the stability of the measured was calculated through a test-retest (ICC 2:1). RESULTS: Within the same environment there were significant differences between young and older adults in three of the four functional tasks. In contrast, in the gait initiation, hardly any significant differences were found between the two groups analysed, except for the soleus and the anterior tibial. Measurement stability ranged from good to excellent. CONCLUSIONS: Level of the musculature involvement presents an entirely different distribution when the test/functional task is performed on dry land or in water. There are differences both in the relative activation of the musculature and in the distribution of the partition of the muscles comparing older and young adults within the same environment.

5.
Mater Sci Eng C Mater Biol Appl ; 113: 110966, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32487385

RESUMO

The engineering of biomaterial surfaces and scaffolds for specific biomedical and clinical application is of growing interest. Certain functionalised surfaces can capture and deliver bioactive molecules, such as growth factors (GF), enhancing the clinical efficacy of such systems. With a custom-made plasma polymerisation reactor described here we have developed bioactive polymer coatings based on poly(ethyl acrylate) (PEA). This remarkable polymer unfolds fibronectin (FN) upon adsorption to allow the GF binding region of FN to sequester and present GFs with high efficiency. We systematically evaluate process conditions and their impact on plasma polymerised PEA coatings and characterise the effect of plasma power and deposition time on thickness, wettability and chemical composition of the coatings. We demonstrate that functional substrate roughness can be maintained after deposition of the polymer coatings. Importantly, we show that coatings deposited at different conditions all maintain a similar or better bioactivity than spin coated PEA references. We show that in PEA plasma polymerised coatings FN assembles into nanonetworks with high availability of integrin and GF binding regions that sequester bone morphogenetic protein-2 (BMP-2). We also report similar mesenchymal stem cell adhesion behaviour, as characterised by focal adhesions, and differentiation potential on BMP-2 coated surfaces, regardless of plasma deposition conditions. This is a potent and versatile technology that can help facilitate the use of GFs in clinical applications.

6.
Artigo em Inglês | MEDLINE | ID: mdl-32496753

RESUMO

Integration of the ON-OFF cooperative spin crossover (SCO) properties of FeII coordination polymers as components of electronic and/or spintronic devices is currently an area of great interest for potential applications. This requires the selection and growth of thin films of the appropriate material onto selected substrates. In this context, two new series of cooperative SCO two-dimensional FeII coordination polymers of the Hofmann-type formulated {FeII(Pym)2[MII(CN)4]·xH2O}n and {FeII(Isoq)2[MII(CN)4]}n (Pym = pyrimidine, Isoq = isoquinoline; MII = Ni, Pd, Pt) have been synthesized, characterized, and the corresponding Pt derivatives selected for fabrication of thin films by liquid-phase epitaxy (LPE). At ambient pressure, variable-temperature single-crystal X-ray diffraction, magnetic, and calorimetric studies of the Pt and Pd microcrystalline materials of both series display strong cooperative thermal induced SCO properties. In contrast, this property is only observed for higher pressures in the Ni derivatives. The SCO behavior of the {FeII(L)2[PtII(CN)4]}n thin films (L = Pym, Isoq) were monitored by magnetization measurements in a SQUID magnetometer and compared with the homologous samples of the previously reported isostructural {FeII(Py)2[PtII(CN)4]}n (Py = pyridine). Application of the theory of regular solutions to the SCO of the three derivatives allowed us to evaluate the effect on the characteristic SCO temperatures and the hysteresis, as well as the associated thermodynamic parameters when moving from microcrystalline bulk solids to nanometric thin films.

7.
Clin Rehabil ; 34(7): 948-959, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32517498

RESUMO

OBJECTIVE: To compare the effectiveness of supervised physical therapy program versus non-supervised on pain, functionality, fear of movement and quality of life in patients with non-specific chronic low back pain. DESIGN: A randomized double-blind clinical trial. SETTING: Clinical outpatient unit; home. SUBJECTS: A total of 64 participants with non-specific chronic low back pain were randomized into either supervised exercise group (n = 32) or non-supervised home exercise group (n = 32). INTERVENTIONS: The supervised group was treated with therapy exercises (strengthen lumbopelvic musculature), while the non-supervised received an informative session of the exercises, which were performed un-supervised at home. Both groups received three weekly sessions for eight weeks. MAIN MEASURES: Pain, disability, fear of movement, quality of life, trunk muscle endurance and trunk anteflexion motion were assessed at baseline, two, and six months of follow-up. RESULTS: Although analysis of variance (ANOVA) test showed statistically significant differences between groups for pain (P = 0.028; supervised: 2.5 ± 2.1; non-supervised: 3.5 ± 1.5) and disability for Roland-Morris Disability Questionnaire (P = 0.004; supervised: 3.1 ± 2.2; non-supervised: 5.1 ± 3.0) and for Oswestry Disability Index (P = 0.034; supervised: 14.5 ± 7.1; non-supervised: 19.2 ± 10.0) at 8 weeks immediately posttreatment, there were no differences between the groups in patient-rated pain, functionality, fear of movement and quality of life at six months of follow-up. CONCLUSION: Patients with chronic low back pain who received supervised exercise showed more improvement in both the short and long term in all patient-rated outcomes over the non-supervised group, but the differences were small and not clinically significant.

9.
Physiol Meas ; 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32585652

RESUMO

BACKGROUND: Grip strength is a powerful predictor of disability as well as a good indicator of physical activity. The aim of this study was to relate ultrasound and electromyography simultaneously to maximum hand-grip strength during an isometric contraction. METHODS: Cross-sectional study. Data acquisition was done by dynamometer, electromyography and ultrasonography. Outcomes variables: maximum strength during the hand-grip gesture, maximum muscle activity and muscle thickness. A nonlinear regression analysis was performed to analyse the relationship between all outcome variables. RESULTS: Thirty-eight subjects (18 men/20 women) participated in the study. The mean results of the sample were: maximum hand-grip strength was 25.50±6.55kg, muscle thickness change was 1.83±0.75mm and EMG activity was 499.29±224.20uV. Hand-grip strength had a high correlation with muscle thickness (R2=0.61) and EMG activity (R2=0.95). The correlation between maximum muscle activity and muscle thickness was R2=0.83. CONCLUSION: The results of the present study demonstrate that both electromyographic activity and muscular architecture are important in the development of the hand-grip test.

10.
Biomaterials ; 252: 120090, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32413593

RESUMO

Basement membranes (BMs) are specialised extracellular matrices that provide structural support to tissues as well as influence cell behaviour and signalling. Mutations in COL4A1/COL4A2, a major BM component, cause a familial form of eye, kidney and cerebrovascular disease, including stroke, while common variants in these genes are a risk factor for intracerebral haemorrhage in the general population. These phenotypes are associated with matrix defects, due to mutant protein incorporation in the BM and/or its absence by endoplasmic reticulum (ER) retention. However, the effects of these mutations on matrix stiffness, the contribution of the matrix to the disease mechanism(s) and its effects on the biology of cells harbouring a collagen IV mutation remain poorly understood. To shed light on this, we employed synthetic polymer biointerfaces, poly(ethyl acrylate) (PEA) and poly(methyl acrylate) (PMA) coated with ECM proteins laminin or fibronectin (FN), to generate controlled microenvironments and investigate their effects on the cellular phenotype of primary fibroblasts harbouring a COL4A2+/G702D mutation. FN nanonetworks assembled on PEA induced increased deposition and assembly of collagen IV in COL4A2+/G702D cells, which was associated with reduced ER size and enhanced levels of protein chaperones such as BIP, suggesting increased protein folding capacity of the cell. FN nanonetworks on PEA also partially rescued the reduced stiffness of the deposited matrix and cells, and enhanced cell adhesion through increased actin-myosin contractility, effectively rescuing some of the cellular phenotypes associated with COL4A1/4A2 mutations. The mechanism by which FN nanonetworks enhanced the cell phenotype involved integrin ß1-mediated signalling. Collectively, these results suggest that biomaterials and enhanced integrin signalling via assembled FN are able to shape the matrix and cellular phenotype of the COL4A2+/G702D mutation in patient-derived cells.

11.
Biomaterials ; 252: 120104, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32422492

RESUMO

Extracellular matrix (ECM)-derived matrices such as Matrigel are used to culture numerous cell types in vitro as they recapitulate ECM properties that support cell growth, organisation, migration and differentiation. These ECM-derived matrices contain various growth factors which make them highly bioactive. However, they suffer lot-to-lot variability, undefined composition and lack of controlled physical properties. There is a need to develop rationally designed biomaterials that can also recapitulate ECM roles. Here, we report the development of fibronectin (FN)-based 3D hydrogels of controlled stiffness and degradability that incorporate full-length FN to enable solid-phase presentation of growth factors in a physiological manner. We demonstrate, in vitro and in vivo, the effect of incorporating vascular endothelial growth factor (VEGF) and bone morphogenetic protein 2 (BMP2) in these hydrogels to enhance angiogenesis and bone regeneration, respectively. These hydrogels represent a step-change in the design of well-defined, reproducible, synthetic microenvironments for 3D cell culture that incorporate growth factors to achieve functional effects.

12.
Artigo em Inglês | MEDLINE | ID: mdl-32412087

RESUMO

INTRODUCTION: In the alpaca diencephalon, the distribution of immunoreactive cell bodies and fibers containing methionine-enkephalin (MET) or substance P (SP) has been studied. MATERIAL AND METHODS: The immunohistochemical study was performed in the diencephalon of alpacas that lived at sea level. RESULTS: Fibers containing MET or SP were widely distributed by the thalamus and hypothalamus. MET- and SP-immunoreactive fibers showed a similar distribution by the whole diencephalon. Immunoreactive cell bodies containing MET or SP were only observed in the hypothalamus. The distribution of MET-immunoreactive cell bodies was more widespread than that observed for cell bodies containing SP. CONCLUSIONS: A close neuroanatomical relationship between the tachykininergic (SP) and enkephalinergic (MET) systems was observed by the whole diencephalon suggesting multiple physiological interactions between both systems.

13.
Food Funct ; 11(6): 5266-5274, 2020 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-32458936

RESUMO

The aim of this work was to evaluate whether the immune-modulatory bacterium Lactobacillus fermentum CECT5716 (LC40) protects the kidneys in a female mouse model of lupus with hypertension. Twenty-week-old female NZBWF1 (lupus) and NZW/LacJ (control) mice were treated with vehicle or LC40 (5 × 108 colony-forming units day-1) for 13 weeks. LC40 treatment reduced the increased plasma anti-dsDNA, endotoxemia, and high blood pressure in NZBWF1 mice. In parallel, LC40 also prevented alterations in kidney function parameters, measured by reduced creatinine and urea in urine excretion, and kidney injury, evaluated by albumin excretion in lupus mice. The main histological features found in the kidneys of lupus mice, such as glomerular, tubulointerstitial or vascular lesions present in the renal parenchyma, accompanied by immune-complex deposition and inflammatory infiltrates were also reduced by LC40. In addition, LC40 inhibited the increased levels of pro-inflammatory cytokines, NADPH oxidase activity and infiltration of Th17 and Th1 cells in the kidneys of NZBWF1 mice. Interestingly, no significant changes were observed in control mice treated with LC40. In conclusion, these results indicate that the consumption of LC40 can prevent the impairment of kidney function and damage, in part due to its capacity to reduce anti-dsDNA production and circulating levels of lipopolysaccharides, with the subsequent reduction of immune complex deposition, inflammation and oxidative stress. These results open new possibilities for the prevention of renal complications associated with hypertensive systemic lupus erythematosus by the chronic administration of the probiotic LC40.

14.
Artigo em Inglês | MEDLINE | ID: mdl-32443738

RESUMO

The aim of the present study was to define and contrast a explicative model of the relationship between the variables of quality of life that make up the KIDSCREEN-52 questionnaire. METHODS: A total of 1641 Colombian university students aged between 17 and 18 years (17.69 + 0.490) participated in this research (61.2% males and 38.8% females) analyzing the dimensions of the KIDSCREEN-52 quality of life questionnaire. A model of structural equation was made and adjusted (χ2 = 118.021; DF = 6; p < 0.001; CFI = 0.953; NFI = 0.951; IFI = 0.954; RMSEA = 0.076). RESULTS: The analyzed dimensions of quality of life were related in a positive and direct way, except for the Parent Relationship and Family Life (Family L.) with Social Acceptance (Social A.), which were associated in a negative and indirect manner. CONCLUSIONS: The main conclusion of this investigation is that all dimensions of quality of life associate in a positive manner with the exception of Parent Relationship and Family Life (Family L.) which associated with Social Acceptance (Social A.). The qualities improve together, highlighting the idea that working on any of the areas that comprise quality of life will cause development of the remaining areas.

15.
Endocr Connect ; 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32375121

RESUMO

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a complex metabolic disorder associated with ovulatory dysfunction, hyperandrogenism, obesity, and insulin resistance, that leads to subfertility. Sam68 is an RNA-binding protein with signaling functions that is ubiquitously expressed, including gonads. Sam68 is recruited to leptin signaling, mediating different leptin actions. OBJECTIVE: We aimed to investigate the role of Sam68 in leptin signaling mediating the effect on aromatase expression in granulosa cells, and the posible implication of Sam68 in the leptin resistance in PCOS. MATERIALS AND METHODS: Granulosa cells were from healthy donor (n=25) and women with PCOS (n=25), within age range 20-40 years old, from Valencian Infertility Institute (IVI), Seville, Spain. Sam68 expression was inhibited by siRNA method and overexpressed by expression vector. Expression level was analysed by qPCR and immunoblot. Statistical significance was assessed by ANOVA followed by different post hoc tests. A P value <0.05 was considered statistically significant. RESULTS: We have found that leptin stimulation increases phosphorylation, and expression level of Sam68, and aromatase in granulosa cells. Downregulation of Sam68 expression resulted in a lower activation of MAPK and PI3K pathways in response to leptin, whereas overexpression of Sam68 increased leptin stimulation of signaling, enhancing aromatase expression. Granulosa cells from women with PCOS presented lower expression of Sam68 and were resistant to the leptin effect on aromatase expression. CONCLUSIONS: These results suggest the participation of Sam68 in leptin receptor signaling, mediating the leptin effect on aromatase expression in granulosa cells, and points to a new target in leptin resistance in PCOS.

16.
Cochrane Database Syst Rev ; 4: CD003769, 2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32315460

RESUMO

BACKGROUND: Inguinal or femoral hernia is a tissue protrusion in the groin region and has a cumulative incidence of 27% in adult men and of 3% in adult women. As most hernias become symptomatic over time, groin hernia repair is one of the most frequently performed surgical procedures worldwide. This type of surgery is considered 'clean' surgery with wound infection rates expected to be lower than 5%. For clean surgical procedures, antibiotic prophylaxis is not generally recommended. However after the introduction of mesh-based hernia repair and the publication of studies that have high wound infection rates the debate as to whether antibiotic prophylaxis is required to prevent postoperative wound infections started again. OBJECTIVES: To determine the effectiveness of antibiotic prophylaxis in reducing postoperative (superficial and deep) wound infections in elective open inguinal and femoral hernia repair. SEARCH METHODS: We searched several electronic databases: Cochrane Registry of Studies Online, MEDLINE Ovid, Embase Ovid, Scopus and Science Citation Index (search performed on 12 November 2019). We also searched two trial registers and the reference list of included studies. SELECTION CRITERIA: We included randomised controlled trials comparing any type of antibiotic prophylaxis versus placebo or no treatment for preventing postoperative wound infections in adults undergoing inguinal or femoral open hernia repair surgery (tissue repair and mesh repair). DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data and assessed risk of bias. We separately analysed results for two different surgical methods (herniorrhaphy and hernioplasty). Several studies revealed infection rates that were higher than the expected 5% for clean surgery and we therefore divided studies into two subgroups: high infection risk environments (≥ 5% infection rate); and low infection risk environments (< 5% infection rate). We performed meta-analyses with random-effects models. We analysed three outcomes: superficial surgical site infections (SSSI); deep surgical site infections (DSSI); and all postoperative wound infections (SSSI + DSSI). MAIN RESULTS: In this review update we identified and included 10 new studies. In total, we included 27 studies with 8308 participants in this review. It is uncertain whether antibiotic prophylaxis as compared to placebo (or no treatment) prevents all types of postoperative wound infections after herniorrhaphy surgery (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.56 to 1.33; 5 studies, 1865 participants; very low quality evidence). Subgroup analysis did not change these results. We could not perform meta-analyses for SSSI or DSSI as these outcomes were not reported separately. Twenty-two studies related to hernioplasty surgery (total of 6443 participants) and we analysed three outcomes: SSSI; DSSI; SSSI + DSSI. Within the low infection risk environment subgroup, antibiotic prophylaxis as compared to placebo probably makes little or no difference for the outcomes 'prevention of all wound infections' (RR 0.71, 95% CI 0.44 to 1.14; moderate-quality evidence) and 'prevention of SSSI' (RR 0.71, 95% CI 0.44 to 1.17, moderate-quality evidence). Within the high infection risk environment subgroup it is uncertain whether antibiotic prophylaxis reduces all types of wound infections (RR 0.58, 95% CI 0.43 to 0.77, very low quality evidence) or SSSI (RR 0.56, 95% CI 0.41 to 0.77, very low quality evidence). When combining participants from both subgroups, antibiotic prophylaxis as compared to placebo probably reduces the risk of all types of wound infections (RR 0.61, 95% CI 0.48 to 0.78) and SSSI (RR 0.60, 95% CI 0.46 to 0.78; moderate-quality evidence). Antibiotic prophylaxis as compared to placebo probably makes little or no difference in reducing the risk of postoperative DSSI (RR 0.65, 95% CI 0.26 to 1.65; moderate-quality evidence), both in a low infection risk environment (RR 0.67, 95% CI 0.11 to 4.13; moderate-quality evidence) and in the high infection risk environment (RR 0.64, 95% CI 0.22 to 1.89; low-quality evidence). AUTHORS' CONCLUSIONS: Evidence of very low quality shows that it is uncertain whether antibiotic prophylaxis reduces the risk of postoperative wound infections after herniorrhaphy surgery. Evidence of moderate quality shows that antibiotic prophylaxis probably makes little or no difference in preventing wound infections (i.e. all wound infections, SSSI or DSSI) after hernioplasty surgery in a low infection risk environment. Evidence of low quality shows that antibiotic prophylaxis in a high-risk environment may reduce the risk of all wound infections and SSSI, while evidence of very low quality shows that it is uncertain whether antibiotic prophylaxis reduces DSSI after hernioplasty surgery.

17.
Eur J Intern Med ; 2020 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-32303456

RESUMO

BACKGROUND: While many risk factors for Atrial Fibrillation (AF) have been identified, there are important differences in their relative impact between sexes. The aim of our study was to investigate the influence of sex as a long-term predictor of adverse events in "real world" AF patients treated with direct oral anticoagulants. METHODS: The FANTASIIA registry is a prospective, national and multicentric study including outpatients with anticoagulated AF patients. Baseline characteristics and adverse events at 3 years of follow-up were collected and classified by sex. Cox multivariate analysis was performed to investigate the role of sex in major events and composite outcomes. RESULTS: A total of 1956 patients were included in the study. 43.9% of them were women, with a mean age of 73.8 ± 9.4 years (women were older 76.5 ± 7.9 vs 71.7 ± 10.1, p<0.001). Women had higher rate of cardiovascular risk factors and higher mean of CHA2DS2-VASc (4.4 ± 1.4 vs 3.7 ± 1.6, p<0.001) and HAS-BLED (2.1 ± 1.0 vs 1.9 ± 1.1, p<0.001) than men. After 3 years of follow-up, rates of major events were similar in both groups with limit difference for all-cause mortality (4.4%/year in women vs 5.6%/year in men; p = 0.056). However, all the composite events were more frequent in women. We observed in the non-adjusted adverse events lower rate of all-cause mortality (HR 0.62, 95%CI 0.47-0.81; p<0.001), composite 1 outcomes (HR 0.80, 95%CI 0.65-0.98; p = 0.029) and composite 2 (HR 0.77, 95%CI 0.64-0.94; p = 0.010) in women compared with men. In multivariate Cox regression analysis observed that female sex was an independently protector factor for all-cause mortality and for the composite outcomes 1 and 2. CONCLUSIONS: In this "real world" study of anticoagulated AF patients, women could have a protective role against development of adverse events, mainly on all-cause mortality and combined events.

18.
Adv Ther ; 37(5): 1946-1959, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32291648

RESUMO

PURPOSE: This is a comprehensive review of the current literature on central neuropathic pain mechanisms that is secondary to spinal cord injury. It reviews recent and seminal findings on the pathophysiology, diagnosis, and treatment and compares treatment options and recommendations. RECENT FINDINGS: Neuropathic pain (NP) is a common complication of spinal cord injury (SCI). Chronicity of NP is attributed to increased abundance of inflammatory mediators and ion channel dysfunction leading to afferent nerve sensitization; nerve damage and nerve-glia cross talk have also been implicated. Conventional treatment is medical and has had limited success. Recent studies have made headway in identifying novel biomarkers, including microRNA and psychosocial attributes that can predict progress from SCI to chronic NP (CNP). Recent advances have provided evidence of efficacy for two promising drugs. Baclofen was able to provide good, long-lasting pain relief. Ziconotide, a voltage-gated calcium channel blocker, was studied in a small trial and was able to provide good analgesia in most participants. However, several participants had to be withdrawn because of worrisome creatine phosphokinase (CPK) elevations, and further studies are required to define its safety profile. Non-medical interventions include brain sensitization and biofeedback techniques. These methods have recently had encouraging results, albeit preliminary. Case reports of non-conventional techniques, such as hypnosis, were also reported. CNP is a common complication of SCI and is a prevalent disorder with significant morbidity and disability. Conventional medical treatment is limited in efficacy. Recent studies identified baclofen and ziconotide as possible new therapies, alongside non-medical interventions. Further research into the pathophysiology is required to identify further therapy candidates. A multidisciplinary approach, including psychosocial support, medical and non-medical interventions, is likely needed to achieve therapeutic effects in this difficult to treat syndrome.

19.
Adv Ther ; 37(5): 2003-2016, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32297285

RESUMO

PURPOSE OF REVIEW: This is a comprehensive review of the literature about the use of bupivacaine hydrochloride for the treatment of post-herpetic neuralgia (PHN). It briefly reviews the background, biology, diagnosis and conventional treatment for PHN, and then introduces and compares the recent evidence for the use of topical bupivacaine. RECENT FINDINGS: PHN is defined by pain lasting 90 days or more after the initial presentation of herpes zoster ("Shingles", HZ) rash and is the most common complication of this disease. A product of re-activation of the Varicella-Zoster virus (VZV), HZ is diagnosed more than 1 million times annually in the United States. Approximately 20% of patients with HZ will experience PHN and will continue to suffer intermittent neuropathic symptoms, including itching and pain, that is sharp, stabbing, throbbing or burning, with the pain localized to the site of their original rash. This long-lasting pain compares with the severity of long-standing rheumatics and osteo-arthritis and is accompanied by severe allodynia causing significant suffering, and a financial burden that is manifested in both healthcare costs and loss of quality-adjusted life years. Prevention of PHN may be achieved with the Zoster vaccine, although there is still a large segment of unvaccinated population. Moreover, the Zoster vaccine is not always effective for prevention. Current treatment includes medical (systemic tricyclic antidepressants, anticonvulsants and opioids, topical lidocaine and capsaicin) and interventional (subcutaneous Botox injections, nerve blocks and nerve stimulation) therapies. These therapies are not always effective, and each carries their own profile of side effects and risks. Moreover, up to 50% of patients with PHN are refractory to management. Recent evidence is emerging to support the use of topical local anesthetics for the treatment of PHN. Two small studies recently found topical lidocaine spray to be effective in treating paroxysmal pain attacks associated with PHN. Bupivacaine is a longer-lasting local anesthetic, and a film-forming formulation allows easy and durable application to the affected skin. Recent studies show that topical film-forming bupivacaine is safe and as effective as lidocaine for the treatment of PHN. PHN is an important though common complication of HZ and can cause long-lasting pain and disability. Current treatment for PNH is limited by efficacy and safety profiles of individual therapies. Recent evidence points to topical local anesthetics as an effective and safe alternative to conventional therapy. Film-forming bupivacaine may offer a durable and safe option for this otherwise difficult to treat syndrome.

20.
Cir. plást. ibero-latinoam ; 46(supl.1): S75-S84, abr. 2020. tab, ilus, graf
Artigo em Espanhol | IBECS-Express | ID: ibc-ET2-5880

RESUMO

INTRODUCCIÓN Y OBJETIVO: El desbridamiento enzimático ha demostrado ser eficaz y rápido en su aplicación sobre quemaduras, a la vez que conservador con el tejido sano. Su uso sobre quemaduras inferiores al 15% ha mostrado reducir la cantidad de injertos, el sangrado y las escarotomías quirúrgicas. El objetivo de este estudio es comparar 2 grupos de pacientes grandes quemados, uno tratado mediante desbridamiento enzimático frente a otro tratado mediante tratamiento estándar, y su impacto en la estancia hospitalaria, necesidades de escarotomías, tiempo hasta desbridamiento, uso de hemoderivados y cantidad de cirugías durante el ingreso. MATERIAL Y MÉTODO: Estudio de cohortes retrospectivas con 197 pacientes (SCQ 20-50%), mayores de 18 años, tratados entre 2012 y 2017, con 2 grupos: 32 pacientes tratados con Nexobrid® para el desbridamiento enzimático, y 165 pacientes en el grupo control con desbridamiento tangencial convencional. Ambos homogéneos para SCQ, edad, sexo, mecanismo de lesión y comorbilidades. RESULTADOS: La edad media fue de 48.4 ± 19.4 años, con una SCQ media de 29.5 ± 9.4%. Observamos disminución del tiempo hasta el inicio del desbridamiento de la quemadura (5.1 ± 4.9 días en el grupo control frente a 0.8±0.9 en el grupo de desbridamiento enzimático, p < 0.05). El grupo de Nexobrid® presentó una reducción de la cantidad de tiempos quirúrgicos durante su ingreso, siendo de 1.9±2.0 frente a 2.6±2.1 en el grupo control. El uso de hemoderivados se redujo en un 95% durante el desbridamiento. La necesidad de escarotomías se redujo un 60%. Finalmente, el grupo de Nexobrid® tuvo un 36% menos de estancia en la Unidad de Quemados Críticos, con diferencias estadísticamente significativas. CONCLUSIONES: La aplicación precoz del desbridamiento enzimático en grandes quemados (20-50% SCQ), permite la escarectomía completa del paciente reduciendo la necesidad de hemoderivados, el número de tiempos quirúrgicos, las escarotomías y la estancia en la unidad de cuidados intensivos


BACKGROUND AND OBJECTIVE: Use of enzymatic debridement has demonstrated be fast and efficient after its application over burn wounds, being more delicate over healthy tissue. Its use in burns under 15% TBSA has shown less grafting procedures, bleeding and surgical escharotomies. The aim of this study was compare 2 groups of major burns; one treated by enzymatic debridement and other treated by standard of care. Length of stay, escharotomies, time until debridement, use of blood packs and number of surgeries during hospitalization were evaluated. METHODS: A retrospective cohort study was designed with 197 patients (TBSA 20-50%), older than 18 years old, treated between 2012 and 2017, and divided in 2 groups: 32 patients were debrided using Nexobrid®, and 165 patients were included in the control group. Both groups were homogeneous for TBSA, age, gender, mechanism and comorbidities index. RESULTS: Mean age was 48.4±19.4 years, with a 29.5±9.4% of TBSA. A reduction of the number of days until the burns debridement were found, with 5.1±4.9 in the control group and 0.8±0.9 days in the enzymatic debridement group (p < 0.05). The number of surgeries during the hospitalization were less in the Nexobrid® group, with a reduction of 2.6±2.1 surgeries to 1.9±2.0. The number of blood packs was a 95% lower in the enzymatic debridement, and a 60% less escharotomies were observed. Finally, a shorter length of stay in the intensive care unit were found in the Nexobrid® group, with 36% less days, this difference were statistically significant. CONCLUSIONS: Early application of enzymatic debridement in major burns (20-50% TBSA) allows a complete removal of eschar reducing the blood packs use, number of surgeries, escharotomies and length of stay in the intensive care unit

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