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1.
Adv Healthc Mater ; 9(1): e1901342, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31794161

RESUMO

Implanted pacemakers are usually bulky and rigid electronics that are constraint by limited battery lifetimes, and need to be installed and repaired via surgeries that risk secondary infection and injury. In this work, a flexible self-powered photoelectric cardiac stimulator is demonstrated based on hydrogenated amorphous Si (a-Si:H) radial p-i-n junctions (RJs), constructed upon standing Si nanowires grown directly on aluminum thin foils. The flexible RJ stimulators, with an open-circuit voltage of 0.67 V and short-circuit current density of 12.7 mA cm-2 under standard AM1.5G illumination, can be conformally attached to the uneven tissue surface to pace heart-beating under modulated 650 nm laser illumination. In vivo pacing evaluations on porcine hearts show that the heart rate can be effectively controlled by the external photoelectric stimulations, to increase from the normal rate of 101-128 beating min-1 . Importantly, the a-Si:H RJ units are highly biofriendly and biodegradable, with tunable lifetimes in phosphate-buffered saline environment controlled by surface coating and passivation, catering to the needs of short term or lasting cardiac pacing applications. This implantable a-Si:H RJ photoelectric stimulation strategy has the potential to establish eventually a self-powered, biocompatible, and conformable cardiac pacing technology for clinical therapy.

2.
J Thorac Dis ; 11(6): 2297-2304, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31372266

RESUMO

Background: Conventional percutaneous closure of patent foramen ovale (PFO) is usually performed under the guidance of fluoroscopy. Whether closure of PFO under transthoracic echocardiography (TTE) guidance only is safe and effective is unknown. The present study therefore aimed to assess the safety and efficacy of percutaneous closure of PFO under TTE guidance only. Methods: This study retrospectively enrolled a total of 52 consecutive patients (55.8% male, mean age 34.0±13.0 years, range, 10-59 years) with PFO treated at our institution from June 2015 to September 2017 by percutaneous closure under echocardiographic guidance only. The patients mean body weight was 58.7±10.8 kg. Patients underwent follow-up by TTE immediately post procedure by electrocardiogram and TTE at 1, 3, 6 and 12 months after discharge and annually thereafter, and by clinical evaluation at all time points. Results: Of the 52 patients, 47 (90.4%) were successfully treated by percutaneous closure under TTE guidance. The mean procedure duration (from puncture to sheath removal) was 21.0±6.2 (range, 11-33) minutes. A trivial residual shunt which disappeared 24 hours later was observed in only 1 (1.9%) patient immediately post procedure. Median hospital stay was 3.0 days without severe complications such as peripheral vascular injury or cardiac perforation at discharge. At median 15.5 (11.3, 18.0) months follow-up, there were no complications such as death, stroke, transient ischemic attack (TIA) and residual shunt. Conclusions: In this single center study of mostly lean patients, percutaneous closure of PFO under TTE guidance as the only imaging tool appeared effective at midterm follow-up, while avoiding radiation exposure, endotracheal intubation and contrast agent use.

3.
J Thorac Dis ; 10(9): 5222-5231, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30416769

RESUMO

Background: Transcatheter device closure has become an alternative therapy for ventricular septal defect (VSD). This study aimed to investigate the feasibility and safety of transcatheter perimembranous VSD (pm-VSD) closure under transthoracic echocardiography (TTE) guidance alone. Methods: Between October 2012 and July 2016, 118 patients with pm-VSD underwent an attempt of transcatheter device closure for pm-VSD through the femoral artery under TTE guidance alone. Patients were followed-up at 1, 3, 6, and 12 months after the procedure and yearly after discharge. Results: The mean age was 11.7±12.5 years (range, 1.0-53.0 years) and the mean body weight was 32.2±21.6 kg (range, 11.5-102.0 kg). The mean diameter of the VSD was 4.0±1.1 mm (range, 3.0-8.0 mm). Transcatheter device closure under TTE guidance alone was successful in 111 patients. The average procedural time was 44.9±7.3 minutes (range, 29.0-65.0 minutes). All 111 patients were followed-up for 3.4±2.3 years. At the last follow-up, two patients had a residual shunt smaller than 2 mm, seven patients had right bundle branch block (RBBB) including one patient with complete RBBB, six patients had mild or less tricuspid regurgitation, and two patients still had trivial aortic regurgitation including one patient that had it before the procedure. Occluder malposition, complete atrioventricular block, or other complications were not observed. Conclusions: Transcatheter pm-VSD closure can be successfully performed under TTE guidance alone with outcomes similar to those achieved with fluoroscopic guidance in selected patients with weight more than 10 kg and VSD smaller than 8 mm. However, long-term follow-up in a large number of patients would be necessary.

4.
Chin Med J (Engl) ; 130(17): 2063-2068, 2017 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-28836549

RESUMO

BACKGROUND: The pretreatment neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prognostic factor in various types of carcinomas. The aim of this study was to investigate the prognostic value of pretreatment NLR in a large cohort of Chinese patients with upper tract urothelial carcinoma (UTUC). METHODS: We retrospectively analyzed the medical data of 656 UTUC patients who underwent radical nephroureterectomy (RNU) from 2001 to 2011 at Peking University First Hospital. Receiver operating characteristic (ROC) curve analysis was performed to calculate the optimal cutoff point of pretreatment NLR. Uni- and multi-variate analyses were used to identify the prognostic factors for cancer-specific survival (CSS) and intravesical recurrence-free survival (IVRFS). RESULTS: The optimal cutoff point of pretreatment NLR was 2.40 by ROC curves, by which patients with high NLR (NLR ≥2.40) and low NLR (NLR <2.40) accounted for 314 (47.9%) and 342 (52.1%) patients, respectively. Patients with a high pretreatment NLR tended to have high tumor grades (χ2 = 15.725, P< 0.001), high tumor stages (χ2 = 25.416, P< 0.001), tumor sizes >5 cm (χ2 = 8.213, P= 0.005), ipsilateral hydronephrosis (χ2 = 4.624, P= 0.033), and concomitant carcinoma in situ(CIS) (χ2 = 9.517, P= 0.003). A high pretreatment NLR (hazard ratio [HR] = 1.820, P= 0.001), main tumor diameter >5 cm (HR = 1.789, P= 0.009), lymph node metastasis (HR = 1.863, P= 0.024), and high tumor stage (HR = 1.745, P< 0.001) independently predicted poor CSS after surgery, while only concomitant carcinoma in situ(CIS) (HR = 2.164, P= 0.034), ureteroscopy before surgery (HR = 1.701, P= 0.015), and high tumor grade (HR = 1.645, P= 0.018) were independent predictors of IVRFS after RNU. CONCLUSIONS: The pretreatment NLR was related to some adverse clinicopathological features and was an independent predictor of CSS, although not IVRFS, in Chinese UTUC patients.


Assuntos
Linfócitos/metabolismo , Neutrófilos/metabolismo , Neoplasias Urológicas/imunologia , Neoplasias Urológicas/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos
5.
Int Urol Nephrol ; 48(10): 1601-8, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27376898

RESUMO

OBJECTIVE: To explore the treatment strategies for patients with upper tract urothelial carcinoma (UTUC) of a solitary kidney. METHODS: A retrospective analysis of 61 cases who underwent operation for UTUC of a solitary kidney from 2000 to 2012 was performed. Radical nephroureterectomy (RNU) or conservative management was performed. Patients were divided into three groups according to preoperative renal function: group A (eGFR ≥ 60 mL/min), group B (15 mL/min ≤ eGFR < 60 mL/min) and group C (eGFR < 15 mL/min). We analyzed treatment outcomes of patients with different renal function and surgical approaches. RESULTS: No significant complications were observed, and short-time recovery after operation was satisfactory in all patients. The 5-year cancer-specific survival (CSS) rates for the groups A, B and C were 92.9, 75.3 and 63.7 %, respectively (p = 0.683). The 5-year overall survival (OS) and recurrence-free survival rates were 92.9 and 53 % for group A, respectively, 75.3 and 64.8 % for group B, respectively, and 63.7 and 29.5 % for group C, respectively (all p > 0.1). The conservative management arm was associated with older age (p = 0.002), smaller tumor size (p = 0.013), lack of renal replacement history (p = 0.007) and better preoperative renal function (p = 0.002). There were no significant differences in 5-year CSS, OS or recurrence-free survival between the RNU and conservative management groups. Long-term hemodialysis was required in only three patients in the conservative management arm. CONCLUSION: Long-term oncological outcomes after conservative management are comparable to RNU in selected cases, and conservative management should be considered an alternative treatment measure. Preoperative renal function and clinicopathological characteristics are important in surgery selection for patients with UTUC of a solitary kidney.


Assuntos
Carcinoma de Células de Transição , Tratamento Conservador , Neoplasias Renais , Nefrectomia , Neoplasias Ureterais , Idoso , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , China/epidemiologia , Tratamento Conservador/métodos , Tratamento Conservador/estatística & dados numéricos , Feminino , Humanos , Testes de Função Renal/métodos , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Nefrectomia/estatística & dados numéricos , Estudos Retrospectivos , Análise de Sobrevida , Neoplasias Ureterais/mortalidade , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Urotélio/patologia
6.
Sci Rep ; 5: 18014, 2015 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-26657777

RESUMO

The incidence of pan-urothelial cell carcinoma (panUCC), which refers to the presence of both bilateral (UTUC) and bladder tumor (BT), is relatively low. However, the profile of a panUCC cohort of patients remains to be elucidated. We reviewed the data of consecutive UTUC patients who received treatment at our center from 1999 to 2012. Overall, 45 patients were included in this study, with a median age of 64.5 years. Fourteen patients initially presented with unilateral UTUC, 11 initially with BT, and the remainder with multiple tumors. Patients with UTUC were more likely to manifest higher rates of muscle invasion and larger-sized tumors. Five patients were treated with complete urinary tract exenteration (CUTE), and most patients (73.3%) received combined management with conservative and radical surgery. After a median follow-up of 77 months, 18 patients (40%) died including 15 (33.3%) due to cancer. Higher tumor stage was the only risk factor predictive of worse survival. Nineteen patients experienced local recurrence after conservative surgery. This study indicated that PanUCC involves either synchronous or metachronous presentation of tumors with a high risk of tumor recurrence, progression, and dissemination after conservative surgery.


Assuntos
Carcinoma/diagnóstico , Carcinoma/terapia , Neoplasias Uretrais/diagnóstico , Neoplasias Uretrais/terapia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/terapia , Idoso , Terapia Combinada , Comorbidade , Progressão da Doença , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Resultado do Tratamento
7.
Ann Surg Oncol ; 22(8): 2789-98, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25564161

RESUMO

PURPOSE: To explore the characteristics, predictive risk factors, and prognostic effect of concomitant non-muscle-invasive bladder cancer (NMIBC) in patients with upper tract urothelial carcinoma (UTUC). METHODS: We evaluated 727 consecutive UTUC patients treated with radical resection between 2000 and 2012 in a high-volume center of China. Preoperative cystoscopy was performed in all patients. Patients with previous or concomitant total cystectomy were excluded. RESULTS: Overall, 73 patients (10.0 %) had NMIBC. Concomitant NMIBC was associated with previous bladder cancer (p = 0.003), tumor located in ureter (p = 0.008), multifocality (p < 0.001), and preoperative renal insufficiency (p = 0.023). The presence of concomitant NMIBC was predictive for lower tumor stage (p = 0.019), papillary architecture (p = 0.023), and organ-confined disease (pT < 3 and N-, p = 0.006). The median follow-up duration was 57 months. The presence of concomitant NMIBC was a risk factor for bladder recurrence (p < 0.001), and particularly in patients with non-muscle-invasive UTUCs, it affects cancer-specific survival (odds ratio 1.614, p = 0.030) and contralateral recurrence (odds ratio, 1.907, p = 0.016). Most concomitant NMIBC were found at the lateral wall or bladder neck, while most intravesical recurrences occurred near the site of surgery or posterior wall. CONCLUSIONS: The most common site for concomitant NMIBC was lateral wall and bladder neck, and previous bladder cancer, tumor located in ureter, tumor multifocality, and preoperative renal insufficiency were risk factors for concomitant NMIBC. The presence of concomitant NMIBC is predictive for relative better pathologic outcomes but higher rate of bladder recurrence, while the effect on postoperative survival was limited with patients early-stage UTUCs. The potential mechanisms need further investigation.


Assuntos
Carcinoma de Células de Transição/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias Primárias Múltiplas/epidemiologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Ureterais/patologia , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/patologia , Idoso , Carcinoma de Células de Transição/cirurgia , China/epidemiologia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Primárias Múltiplas/cirurgia , Valor Preditivo dos Testes , Insuficiência Renal/complicações , Fatores de Risco , Taxa de Sobrevida , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/cirurgia
8.
Urol Oncol ; 33(2): 66.e1-11, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25240760

RESUMO

OBJECTIVES: To investigate the incidence and treatment strategies for bilateral upper tract urothelial carcinoma (UTUC) and to compare the characteristic and oncologic outcomes of bilateral UTUC with those of unilateral tumors. METHODS AND MATERIALS: The study included 892 consecutive patients with UTUC. Bilateral UTUC was defined as synchronous bilateral carcinoma on preoperative imaging before confirmation by pathology or positive urine cytology result plus direct visualization. Radical nephroureterectomy (RNU) or nephron-sparing surgery (NSS) or both were carried out. RESULTS: A total of 39 patients (4.37%) suffered from bilateral disease. Discordant histological grade of bilateral tumor was found in 39.3% cases. Bilateral tumors were associated with female sex (P<0.001), preoperative renal insufficiency (P<0.001), previous or concomitant bladder tumors (P = 0.013), lower tumor stages (P = 0.020), papillary architecture (P = 0.001), and smaller-sized tumors (P = 0.020). Patients with worse renal function (P<0.001) or large-sized tumors (P = 0.039) tended to be treated with bilateral RNU. Most patients (67.6%) were treated with unilateral RNU plus unilateral NSS, with NSS being performed on tumors that only extended to the ureter (P = 0.003) and had a smaller size (P = 0.005). The median follow-up duration was 56 months. The 5-year cancer-specific survival and bladder recurrence-free survival rates were 81.2% and 64.5%, respectively, similar to those of unilateral tumors. Male sex (hazard ratio = 11.535) and higher tumor stage (hazard ratio = 3.386) were independent worse prognostic factors. CONCLUSIONS: The prevalence of bilateral UTUC is rare. Female patients, patients with renal insufficiency, and those with bladder tumor tended to suffer from bilateral disease and were less likely to present with worse pathological outcomes in the Chinese population. The tumor characteristics and renal function were informative in treatment selection. The oncologic outcomes were similar to those in unilateral UTUC, and male sex and a higher tumor stage were poor prognostic factors for these patients.


Assuntos
Neoplasias Urológicas/terapia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Intervalo Livre de Doença , Feminino , Humanos , Incidência , Neoplasias Renais/epidemiologia , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Resultado do Tratamento , Neoplasias Ureterais/epidemiologia , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Neoplasias Ureterais/terapia , Neoplasias Urológicas/epidemiologia , Neoplasias Urológicas/patologia , Neoplasias Urológicas/cirurgia
9.
Anal Chem ; 77(23): 7534-8, 2005 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-16316159

RESUMO

A generalized 2D correlation NMR (GEN2D-NMR) scheme capable of substantially reducing the experimental time for two-dimensional correlation NMR experiments is described. The experimental time used in GEN2D-NMR is shortened to less than one-tenth of that required in traditional double Fourier transform 2D-NMR (FT2D-NMR) for a 13C-13C spin diffusion experiment for Nephila edulis spider threads. Experimentally, one needs to acquire many fewer points in GEN2D-NMR than that in FT2D-NMR in the evolution time domain. By keeping other acquisition pulse sequence and parameters the same in both methods, the GEN2D-NMR technique can produce a 2D-NMR spectrum using fewer points along the evolution time domain equivalent to that produced by the FT2D-NMR technique using more points. GEN2D-NMR would provide a significant advantage for those molecules that are difficult to highly isotropically label, such as proteins, polypeptides, and polymers, or those which become unstable in a prolonged measurement time.


Assuntos
Ressonância Magnética Nuclear Biomolecular/métodos , Animais , Estrutura Molecular , Sensibilidade e Especificidade , Aranhas/química
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