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1.
Sci Total Environ ; : 151189, 2021 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-34757105

RESUMO

Marine heatwaves (MHWs) are weather-timescale extreme events in the oceans and can have devastating effects on marine bivalves and ecosystems they support, with considerable socio-economic consequences. Yet, the extent to which marine bivalves have the capacity to acclimate and adapt to MHWs remains unknown. Understanding molecular responses to MHWs is imperative to develop strategies for conservation of ecologically and economically important marine organisms. Here, using RNA-Seq, we investigate how various MHWs scenarios elicit molecular changes in threatened and vulnerable pearl oysters, Pinctada maxima (Jameson). Acute exposure of MHWs - mimicked by rapid increases of seawater temperature from 24 °C to 28 °C and 32 °C, respectively - significantly affected the expression levels of metabolic and immune-related genes, with thermal stress-responsive genes especially like HSP20, HSP70 and HSP90 being remarkably up-regulated. Following repeat exposure to MHWs, encouragingly, pearl oysters exhibited evident acclimation responses, as best exemplified by significantly lowered expression levels of key stress-responsive genes involved in metabolism and immunity in comparison to those observed during acute exposure. Findings of the present study provide a better understanding of molecular processes underpinning the acclimation and adaptation of marine bivalves to MHWs in the context of climate change.

2.
Neurol Sci ; 2021 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-34816317

RESUMO

BACKGROUND: Low-grade epilepsy-associated neuroepithelial tumor (LEAT) is highly responsive to surgery in general. The appropriate surgical strategy remains controversial in temporal LEAT. The aim of this study is to analyze the surgical seizure outcome of temporal LEAT, focusing on the aspects of surgical strategy. METHODS: Sixty-one patients from a single epilepsy center with temporal LEAT underwent surgery. The surgical strategy was according to the multidisciplinary presurgical evaluation. Electrocorticogram (ECoG)-assisted resection was utilized. Surgical extent including lesionectomy and extended resection was described in detail. Seizure outcome was classified as satisfactory (Engel class I) and unsatisfactory (Engel classes II-IV). RESULTS: After a median follow-up of 36.0 (30.0) months, 83.6% of patients achieved satisfactory outcome, including 72.1% with Engel class Ia. There was 39.3% (24/61) of patients with antiepileptic drug (AED) withdrawal. Use of ECoG (χ2 = 0.000, P > 0.1), preresection spike (χ2 = 0.000, P = 0.763), or spike residue (P = 0.545) was not correlated with the seizure outcome. For lateral temporal LEAT, outcome from lesionectomy was comparable to extended resection (χ2 = 0.499, P > 0.1). For mesial temporal LEAT, 94.7% (18/19) of patients who underwent additional hippocampectomy were satisfactory, whereas only 25% (1/4) of patients who underwent lesionectomy were satisfactory (P = 0.009). CONCLUSION: Surgical treatment was highly effective for temporal LEAT. ECoG may not influence the seizure outcome. For lateral temporal LEAT, lesionectomy with or without cortectomy was sufficient in most patients. For mesial temporal LEAT, extended resection was recommended.

3.
Chem Commun (Camb) ; 57(94): 12627-12630, 2021 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-34761762

RESUMO

Calixarenes are reportedly excellent activators that can remarkably improve the transport efficiencies of cell penetrating peptides. We employed eight calixarenes to systematically study the influence of structure on activation efficiency, which revealed that the scaffold, head group, and alkyl chain are all significant factors for activation efficiency by affecting affinities with the peptide and membrane.

4.
Aging Dis ; 12(7): 1741-1752, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34631218

RESUMO

Progranulin (GRN) mutations are a major cause of frontotemporal dementia (FTD); the spectrum of clinical phenotypes of FTD is much more extensive than previously reported. The frequency and locations of GRN mutations in Chinese patients with FTD remain uncertain. We performed cDNA sequencing in one sporadic male patient who initially presented FTD symptoms. Brain magnetic resonance imaging (MRI) and positron emission computed tomography/computed tomography (PET/CT) were applied to further confirm the diagnosis of FTD from this patient. Cellular apoptosis and survival test were performed to identify the function of GRN. We identified one novel missense GRN mutation (c.1498G>A, p.V500I) in this patient, who initially presented typical behavioral-variant frontotemporal dementia (bvFTD) features but then presented progressive supranuclear palsy (PSP) clinical characteristics 5 years after onset. Besides, WT GRN protein showed an adequate trophic stimulus to preserve the survival of SH-SY5Y cells in the medium free of serum, while GRN mutation (c.1498G>A, p.V500I) may impair the ability of supporting cell survival. This study owns significant implications for genetic counseling and clinical heterogeneity. We illustrate the fact that FTD presenting features of bvFTD and PSP in one patient could be considered as a specific phenotype in patients with GRN mutations. GRN p.V500I led to the neuronal degeneration in vitro; this finding provides a significant evidence that this mutation may be a new causative mutation in patients with FTD.

5.
Artigo em Inglês | MEDLINE | ID: mdl-34634101

RESUMO

AIMS: Current guidelines recommend a heart team in the decision making for patients with complex coronary artery disease (CAD). However, the decision-making stability of these teams has not been evaluated and the optimum protocol is unknown. We assessed inter-team agreement for revascularization decision-making and influencing factors to inform the development of a heart team protocol. METHODS AND RESULTS: This sequential, explanatory mixed methods study included (1) a cross-sectional quantitative study to assess inter-team agreement on treatment strategy for retrospectively enrolled complex CAD patients and (2) a qualitative study that used semi-structured interviews with heart team members to identify factors influencing decision-making discrepancy. We randomly selected 101 complex CAD patients. Sixteen specialists were randomly assigned to 4 heart teams to make decisions for these patients. The primary outcome kappa of inter-team decision-making agreement was moderate (kappa 0.58). Factors influencing decision-making were generated through inductive thematic analysis and were summarized by 3 themes (specialist quality, team composition, meeting process) and 10 subthemes. Recommendations of heart team implementation were generated based on qualitative and quantitative data at 5 levels: specialist selection, specialist training, team composition, team training, and meeting process. A detailed protocol on the integration of guidelines, previous experience and recommendations was generated to establish and deploy a qualified heart team. CONCLUSIONS: Agreement between heart teams for revascularization decision-making in complex CAD patients was moderate. Potential factors associated with decision discrepancies were summarized and recommendations were generated. A detailed heart team protocol was designed and should be validated in future.

7.
Ther Adv Neurol Disord ; 14: 17562864211050027, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34671424

RESUMO

Background: Malformation of cortical development (MCD) is one of the most common causes of pharmacoresistant epilepsy. Improving the knowledge of antiseizure medications (ASMs) treatment response in epileptic patients with MCD is crucial for optimal treatment options, either pharmacological therapy or non-pharmacological intervention. Aim: To investigate the patterns of medical treatment outcome and the predictors for seizure freedom (SF) with ASM regimens in epilepsy caused by MCD. Methods: The epileptic patients with MCD were consecutively enrolled from March 2013 to June 2019. SF was defined as no seizures for at least 12 months or three times the longest pretreatment inter-seizure interval, whichever was longer. Outcomes were classified into three patterns: pattern A: patients achieved SF at one point and remained so throughout follow-up; pattern B: patients' seizures fluctuated between periods of SF and relapse; pattern C: SF never attained. The terminal SF was defined if the patients remained SF at the last follow-up visit. Results: A total of 164 epileptic patients with MCD were included. Pattern A was observed in 22, pattern B in 42, and pattern C in 100 patients. SF was ever achieved in 64 (pattern A and B) patients. Twenty-nine patients had terminal SF after a median follow-up time of 4.3 years. With continuing ASM treatment, seizure relapse risk was very low after a 5-year seizure-free period. The pretreatment seizure frequency was the only independent predictor for pattern A and seizure relapse. Sodium channel blockers monotherapy (33.8%) was more effective than levetiracetam (4.5%) in rendering SF in the initial ASM regimen. Conclusion: Medical treatment can be successful in a minority of epileptic patients with MCD, and pretreatment seizure frequency helps to predict the treatment outcome. An unequal efficacy of ASMs in epilepsy caused by MCD suggests etiological evaluation is vital in the management of focal epilepsy.

8.
Front Surg ; 8: 607417, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34497825

RESUMO

Background: Conventional corticospinal fluid (CSF) diversion surgery for idiopathic normal pressure hydrocephalus (iNPH) includes ventriculoperitoneal shunt and ventriculoatrial shunt. Ventriculosternal (VS) shunt may be considered if both the abdominal cavity and atrium are not feasible. Methods: A 76-year-old woman was admitted to our hospital with gait disturbance and urinary incontinence for 2 years, and the condition aggravated in the last 1 month. Based on clinical assessment and imaging findings, the patient was diagnosed with iNPH, with surgical indications. She was on peritoneal dialysis for chronic renal failure, and a cardiac Doppler echocardiogram showed enlargement of the left atrium and decreased diastolic function of the left ventricle. Due to these conditions, we chose the sternum as the vessel for CSF absorption and performed VS shunt. Results: No swelling, exudation, and effusion were found in the suprasternal fossa. Gait disturbance and urinary incontinence improved significantly immediately and 1 week after surgery, respectively. No shunt-related complication was reported at 16 months follow-up. Conclusion: This case demonstrated VS shunting as a feasible and alternative for the management of hydrocephalus.

9.
Polymers (Basel) ; 13(17)2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34503020

RESUMO

Water repellent is an important functional finish for cotton fabric. However, cotton fabrics often have poor washing resistance and other performances after actual finishing. In this study, based on the structural characteristics of cotton fiber and durability of water repellent, a cross-linked amino long-chain alkyl polysiloxane (CAHPS) was first prepared, and then reacted with modified silica. Finally, a chemically bonded organic-inorganic nanohybrid cross-linked polysiloxane (rSiO2-CAHPS) was fabricated. Furthermore, the rSiO2-CAHPS was emulsified to obtain a durable fluorine-free water repellent. The water repellent finishing for cotton fabric was carried out by the pad-dry-cure process. After finishing, the cotton fabric had good resistance to conventional liquids and excellent washing resistance, and still maintained good water repellency after 30 rounds of soaping. Moreover, properties including air permeability, mechanical property and whiteness are hardly affected after finishing. SEM and XPS characterization show that a layer of dense silicon film is formed on the surface of cotton fabric by rSiO2-CAHPS water repellent. The existence of nanosilica can improve the surface roughness of cotton fibers. The synergistic effect of fiber matrix, nanoparticles and CAHPS endows the fabric with a micro/nano-multi-scale micro-rough structure, which improves the water repellency of cotton fabric after water repellent finishing.

10.
Mar Pollut Bull ; 173(Pt A): 112932, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34534933

RESUMO

Marine heatwaves (MHWs) have occurred with increasing duration, frequency and intensity in the past decade in the South China Sea, posing serious threats to marine ecosystems and fisheries. However, the impact of MHWs on marine bivalves - one of the most ecologically and economically important fauna in coastal ecosystems - remains largely unknown. Here, we investigated physiological responses of the pearl oyster, Pinctada maxima inhabiting a newly identified climate change hotspot (Beibu Gulf, South China Sea) to short-lasting and repeatedly-occurring MHWs scenarios. Following 3-day exposure to short-lasting MHWs scenarios with water temperature rapidly arising from 24 °C to 28 °C, 32 °C and 36 °C, respectively, mortality rates of pearl oysters increased, and especially they suffered 100% mortality at 36 °C. Activities of enzymes including acid phosphatase (ACP), alkaline phosphatase (AKP), glutathione (GSH) and level of malondialdehyde (MDA) increased significantly with increasing intensity and duration of MHWs, indicating thermal stress responses. When exposed to repeatedly-occurring MHWs scenarios, mortality rates of pearl oysters increased slightly, and thermal stress responses were alleviated, as exemplified by significant decreases in ACP, AKP, GSH and MDA activities compared with those during short-lasting MHWs scenarios, demonstrating the potential of P. maxima to acclimate rapidly to MHWs. These findings advance our understanding of how marine bivalves respond to MHWs scenarios varying in duration, frequency, and intensity.

11.
Antibiotics (Basel) ; 10(9)2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34572663

RESUMO

Background: Evaluating the options for antibiotic treatment for carbapenem-resistant Gram-negative bacteria (CR-GNB)-associated pneumonia remains crucial. We compared the therapeutic efficacy and nephrotoxicity of two combination therapies, namely, colistin + carbapenem (CC) versus colistin + tigecycline (CT), for treating CR-GNB-related nosocomial pneumonia in critically ill patients. Methods: In this multicenter, retrospective, and cohort study, we recruited patients admitted to intensive care units and diagnosed with CR-GNB-associated nosocomial pneumonia. We divided the enrolled patients into CC (n = 62) and CT (n = 59) groups. After propensity score matching (n = 39), we compared the therapeutic efficacy by mortality, favorable outcome, and microbiological eradication and compared nephrotoxicity by acute kidney injury between groups. Results: There was no significant difference between the CC and CT groups regarding demographic characteristics and disease severities as assessed using the Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, and other organ dysfunction variables. Therapeutic efficacy was non-significantly different between groups in all-cause mortality, favorable outcomes, and microbiological eradication at days 7, 14, and 28; as was the Kaplan-Meier analysis of 28-day survival. For nephrotoxicity, both groups had similar risks of developing acute kidney injury, evaluated using the Kidney Disease Improving Global Outcomes criteria (p = 1.000). Conclusions: Combination therapy with CC or CT had similar therapeutic efficacy and risk of developing acute kidney injury for treating CR-GNB-associated nosocomial pneumonia in critically ill patients.

12.
Photodiagnosis Photodyn Ther ; 36: 102536, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34536605

RESUMO

Seborrheic keratosis (SK) is a common benign lesion in which malignancies like cutaneous squamous cell carcinoma (cSCC) can arise rarely. We report a case of an 81-year-old man who presented a well-demarcated reddish-brown plaque with central raised coarse nodules on the top of his head. Dermoscopy and reflectance confocal microscopy (RCM) showed the possibility of malignant transformation. cSCC was confirmed by histopathology and immunohistochemistry. Considering the fact of local low-risk cSCC within a large SK lesion, carbon dioxide (CO2) laser was used to treat the SK lesion, and reduce the thickness of local cSCC simultaneously. Three sessions of 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) were performed after CO2 laser. Finally, no atypical cells were found by multi-point biopsy after treatment, and follow-up was continued for one year. Therefore, malignant changes of SK are relatively uncommon, but should be suspected when abnormal appearance or symptoms occurred. ALA-PDT combined with CO2 is a safe, effective, and minimally invasive treatment for cSCC arising from a huge SK.

13.
Artigo em Inglês | MEDLINE | ID: mdl-34380080

RESUMO

To compare the outcomes in patients undergoing isolated aortic valve replacement with bicuspid (BAV) vs tricuspid aortic valves (TAV). A total of 1204 consecutive patients (BAV, n = 454; TAV, n = 750) underwent isolated aortic valve replacement (AVR) between 2002 and 2009 at a single institution. Adverse aortic events were defined as the occurrence of aortic dissection or the ascending aorta diameter greater than 50 mm or sudden death during follow-up. Propensity score matching yielded 318 patient pairs. Follow-up was obtained on 1156 patients. The mean length of follow up was 10.4 ± 3.9 years. A total of 155 (13.4%) patients died, and adverse aortic events occurred in 44 (3.8%) patients. After propensity score matching, the 12-year survivals was 85.5% in the BAV group and 89.2% in the TAV group; hazard ratio (HR) 1.6; 95% confidence interval (CI) 1.0-2.5; P = 0.057. The 12-year cumulative incidence of late adverse aortic events was 14.6% in the BAV group and 10.8% in the TAV group; subdistribution hazard ratio (sHR) 1.1; 95% CI 0.6-2.0; P = 0.758. In the isolated aortic regurgitation subgroup, the rate of adverse aortic events was significantly higher in the BAV group than in the TAV group (sHR, 2.1; 95% CI, 1.1-4.0; P = 0.021). The long-term survival after isolated AVR was similar in both BAV and TAV patients. BAV does not increase the adverse aortic events after isolated AVR compared with the TAV.

14.
Artigo em Inglês | MEDLINE | ID: mdl-34343295

RESUMO

OBJECTIVES: Thoracoscopic epicardial ablation with a limited lesion set led to suboptimal results for advanced paroxysmal atrial fibrillation (AF) or persistent AF. Whether additional right atrial lesions improve the result is unclear. METHODS: We conducted a retrospective study involving 80 consecutive patients with paroxysmal or persistent AF, left atrial (LA) dilation (LA diameter >40 mm) and failed prior interventional ablation (40 patients, 50%) who underwent thoracoscopic epicardial ablation with box lesions (36 patients) or bi-atrial (BA) lesion (44 patients) in our institution. Freedom from atrial tachyarrhythmias after the procedures was compared between the box lesion group and BA lesion group. RESULTS: Baseline differences included more patients with persistent AF (86.4% vs 47.2%) and larger left atrium [48.00 (44.00-50.75) vs 42.00 (41.25-44.00) mm] in the BA lesion group. There was no difference in procedural complications between the 2 groups. After a mean follow-up of 32 months, the freedom from atrial tachyarrhythmias off antiarrhythmic drugs at 6, 12 and 24 months was 77.2%, 77.2% and 77.2% in the BA lesion group and 69.4%, 50.0% and 40.6% in the box lesion group, respectively (P = 0.006). After adjustment for sex, age, body mass index, LA diameter, AF type, history of AF, and previous interventional ablation, BA lesion was an independent predictor of lower atrial tachyarrhythmia recurrence (hazard ratio 0.447, 95% confidential interval 0.208-0.963; P = 0.040). CONCLUSIONS: Compared with the box lesion set, thoracoscopic epicardial ablation with BA lesion sets might provide better freedom from atrial tachyarrhythmias for paroxysmal or persistent AF with LA dilation. Randomized control trials are warranted to confirm the benefit of BA lesion sets in these patients.

15.
Environ Int ; 157: 106820, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34391985

RESUMO

Exposure to per- and polyfluoroalkyl substances (PFASs) has raised significant public health concerns due to their persistence and toxicity in the human body. Here, we aimed to investigate the characteristics of exposure to chlorinated polyfluoroalkyl ether sulfonic acids (Cl-PFESAs) and legacy PFASs and the relative contribution from different external pathways to human exposure. Three Cl-PFESAs and fourteen legacy PFASs were detected in human serum, fish, indoor dust and drinking water collected from Shijiazhuang, China. Results showed that 6:2 Cl-PFESA was the third most predominant compound, with an average concentration of 2.70 ng/mL in serum, which was lower than those of perfluorooctane sulfonate (PFOS) and perfluorooctane acid (PFOA) (14.79 and 4.91 ng/mL). The estimated daily intake of 6:2 Cl-PFESA via dust ingestion (mean: 0.008 ng/kg bw/day) was found to be highest among all detected PFASs, while the highest value via fish and drinking water was found for PFOS and PFOA (0.438-9.799 and 0.034-0.155 ng/kg bw/day), respectively. The similar composition of PFASs between serum and fish suggests that fish consumption is a major contributor to human exposure to PFASs. However, the increasing ratios of EDIindoor dust/EDIfish for PFOS, PFOA and 6:2 Cl-PFESA indicated that the contribution of dust ingestion for PFASs, especially 6:2 Cl-PFESA, could not be ignored. The modeled serum concentrations of 6:2 Cl-PFESA higher than its observed levels hint at its gradually increasing exposure levels in the general population. Combined with the lower modeled levels of PFOS than the observed levels, the substituent with 6:2 Cl-PFESA for PFOS is obvious in China. Therefore, further studies on contributions from more detailed external sources and risk assessments of Cl-PFESAs are recommended, especially for some vulnerable subpopulations, considering their widespread exposure and similar environmental behaviors compared with those of their predecessors.


Assuntos
Ácidos Alcanossulfônicos , Água Potável , Fluorcarbonetos , Animais , China , Poeira/análise , Éter , Éteres , Fluorcarbonetos/análise , Humanos , Ácidos Sulfônicos/análise
16.
J Med Internet Res ; 23(8): e29529, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397393

RESUMO

BACKGROUND: Mechanical heart valve replacement (MHVR) is an effective method for the treatment of severe heart valve disease; however, it subjects patient to lifelong warfarin therapy after MHVR with the attendant risk of bleeding and thrombosis. Whether internet-based warfarin management reduces complications and improves patient quality of life remains unknown. OBJECTIVE: This study aimed to compare the effects of internet-based warfarin management and the conventional approach in patients who received MHVR in order to provide evidence regarding alternative strategies for long-term anticoagulation. METHODS: This was a prospective, multicenter, randomized, open-label, controlled clinical trial with a 1-year follow-up. Patients who needed long-term warfarin anticoagulation after MHVR were enrolled and then randomly divided into conventional and internet-based management groups. The percentage of time in the therapeutic range (TTR) was used as the primary outcome, while bleeding, thrombosis, and other events were the secondary outcomes. RESULTS: A total of 721 patients were enrolled. The baseline characteristics did not reach statistical differences between the 2 groups, suggesting the random assignment was successful. As a result, the internet-based group showed a significantly higher TTR (mean 0.53, SD 0.24 vs mean 0.46, SD 0.21; P<.001) and fraction of time in the therapeutic range (mean 0.48, SD 0.22 vs mean 0.42, SD 0.19; P<.001) than did those in the conventional group. Furthermore, as expected, the anticoagulation complications, including the bleeding and embolic events had a lower frequency in the internet-based group than in the conventional group (6.94% vs 12.74%; P=.01). Logistic regression showed that internet-based management increased the TTR by 7% (odds ratio [OR] 1.07, 95% CI 1.05-1.09; P<.001) and reduced the bleeding and embolic risk by 6% (OR 0.94, 95% CI 0.92-0.96; P=.01). Moreover, low TTR was found to be a risk factor for bleeding and embolic events (OR 0.87, 95% CI 0.83-0.91; P=.005). CONCLUSIONS: The internet-based warfarin management is superior to the conventional method, as it can reduce the anticoagulation complications in patients who receive long-term warfarin anticoagulation after MHVR. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1800016204; http://www.chictr.org.cn/showproj.aspx?proj=27518. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2019-032949.


Assuntos
Qualidade de Vida , Varfarina , Anticoagulantes/uso terapêutico , Valvas Cardíacas , Humanos , Coeficiente Internacional Normatizado , Internet , Estudos Prospectivos , Resultado do Tratamento , Varfarina/efeitos adversos
17.
Brain Stimul ; 14(5): 1226-1233, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34400379

RESUMO

OBJECTIVE: Deep brain stimulation (DBS) has been used as a treatment of last resort for treatment-resistant depression (TRD) for more than a decade. Many DBS targets have been proposed and tested clinically, but the underlying circuit mechanisms remain unclear. Uncovering white matter tracts (WMT) activated by DBS targets may provide crucial information about the circuit substrates mediating DBS efficacy in ameliorating TRD. METHODS: We performed probabilistic tractography using diffusion magnetic resonance imaging datas from 100 healthy volunteers in Human Connectome Project datasets to analyze the structural connectivity patterns of stimulation targeting currently-used DBS target for TRD. We generated mean and binary fiber distribution maps and calculated the numbers of WMT streamlines in the dataset. RESULTS: Probabilistic tracking results revealed that activation of distinct DBS targets demonstrated modulation of overlapping but considerably distinct pathways. DBS targets were categorized into 4 groups: Cortical, Striatal, Thalamic, and Medial Forebrain Bundle according to their main modulated WMT and brain areas. Our data also revealed that Brodmann area 10 and amygdala are hub structures that are associated with all DBS targets. CONCLUSIONS: Our results together suggest that the distinct mechanism of DBS targets implies individualized target selection and formulation in the future of DBS treatment for TRD. The modulation of Brodmann area 10 and amygdala may be critical for the efficacy of DBS-mediated treatment of TRD.


Assuntos
Conectoma , Estimulação Encefálica Profunda , Transtorno Depressivo Resistente a Tratamento , Depressão , Transtorno Depressivo Resistente a Tratamento/diagnóstico por imagem , Transtorno Depressivo Resistente a Tratamento/terapia , Humanos , Feixe Prosencefálico Mediano
18.
PLoS One ; 16(8): e0255662, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34343224

RESUMO

BACKGROUND: The performance of traditional scores is significantly limited to predict mortality in high-risk cardiac surgery. The aim of this study was to compare the performance of STS, ESII and HiriSCORE models in predicting mortality in high-risk patients undergoing CABG. METHODS: Cross-sectional analysis in the international prospective database of high-risk patients: HiriSCORE project. We evaluated 248 patients with STS or ESII (5-10%) undergoing CABG in 8 hospitals in Brazil and China. The main outcome was mortality, defined as all deaths occurred during the hospitalization in which the operation was performed, even after 30 days. Five variables were selected as predictors of mortality in this cohort of patients. The model's performance was evaluated through the calibration-in-the-large and the receiver operating curve (ROC) tests. RESULTS: The mean age was 69.90±9.45, with 52.02% being female, 25% of the patients were on New York Heart Association (NYHA) class IV and 49.6% had Canadian Cardiovascular Society (CCS) class 4 angina, and 85.5% had urgency or emergency status. The mortality observed in the sample was 13.31%. The HiriSCORE model showed better calibration (15.0%) compared to ESII (6.6%) and the STS model (2.0%). In the ROC curve, the HiriSCORE model showed better accuracy (ROC = 0.74) than the traditional models STS (ROC = 0.67) and ESII (ROC = 0.50). CONCLUSION: Traditional models were inadequate to predict mortality of high-risk patients undergoing CABG. However, the HiriSCORE model was simple and accurate to predict mortality in high-risk patients.

19.
JTCVS Tech ; 5: 34-42, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34318103

RESUMO

Background: The efficacy of catheter-based or thoracoscopic ablation for treating long-standing persistent atrial fibrillation (AF) with a dilated atrium remains suboptimal. This study aimed to assess the feasibility and initial results of simultaneous hybrid ablation with a new biatrial lesion set in these patients. Methods: Twenty-seven consecutive patients with long-standing persistent AF and dilated atrium underwent simultaneous hybrid ablation with a new biatrial lesion set consistent with the principle of the Cox maze procedure at our institution. Patients were followed up at 3, 6, and 12 months after the procedure and annually thereafter. Results: After thoracoscopic epicardial ablation, endocardial mapping confirmed complete bilateral pulmonary vein isolation in 25 patients (96.2%). All patients were followed for a mean of 18.7 ± 8.9 months. Freedom from atrial tachyarrhythmia at 1 year after the single hybrid procedure was 64% with antiarrhythmic drugs and 60% without antiarrhythmic drugs. Freedom from atrial tachyarrhythmia at latest follow-up after the hybrid procedure and redo catheter ablation was 77.8% with antiarrhythmic drugs and 74.1% without antiarrhythmic drugs. In patients with sinus rhythm restoration, mean left atrial diameter decreased from 54.4 ± 4.3 mm to 45.2 ± 4.1 mm (P < .001), and mean right atrial diameter decreased from 59.4 ± 3.9 mm to 54.9 ± 4.4 mm (P < .001). Postoperative pleural effusion was observed in 3 patients (11.1%), and no adverse events occurred during follow-up. Conclusions: In patients with long-standing persistent AF and a dilated atrium, simultaneous hybrid ablation with the new biatrial lesion set, in combination with touch-up catheter ablation when necessary, can achieve promising results. More studies are needed to confirm these findings.

20.
J Am Heart Assoc ; 10(15): e019531, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34320820

RESUMO

Background Coronary computed tomography angiography (CCTA) is a noninvasive, less expensive, low-radiation alternative to invasive coronary angiography (ICA). ICA is recommended for coronary evaluation before heart valvular surgery, and the supporting evidence for CCTA is insufficient. Our study is a single-center, prospective cohort study designed to evaluate the feasibility of CCTA instead of ICA in detection of coronary artery disease before surgery. Methods and Results Heart valvular surgery candidates were consecutively enrolled between April 2017 and December 2018. Nine hundred fifty-eight patients in the CCTA group underwent CCTA primarily, and those with ≥50% coronary stenosis or uncertain diagnosis underwent subsequent ICA. One thousand five hundred twenty-five patients in the ICA group underwent ICA directly before surgery. Coronary artery bypass grafting decision was made by surgeons according to CCTA or ICA results. Most of the patients (78.8%) in the CCTA group avoided invasive angiography. Thirty-day mortality (0.7% versus 0.9%, P=0.821), myocardial infarction (6.4% versus 6.9%, P=0.680 ), and low cardiac output syndrome (4.2% versus 2.8%, P=0.085) were similar in the CCTA and ICA groups. Median duration of follow-up was 19.3 months (interquartile range, 14.2-30.0 months), cumulative rates of mortality (2.6% versus 2.6%, P=0.882) and major adverse cardiac events (9.6% versus 9.0%, P=0.607) showed no difference between the 2 groups. Coronary evaluation expense was lower in the CCTA group ($149.6 versus $636.0, P<0.001). Conclusions The strategy of using CCTA as a doorkeeper in coronary evaluation before heart valvular surgery showed noninferiority in identification of candidates for coronary artery bypass grafting and postoperative safety.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Cuidados Pré-Operatórios , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Tomada de Decisão Clínica , Estudos de Coortes , Ponte de Artéria Coronária , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Estudos de Viabilidade , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Resultado do Tratamento
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