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1.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(4): 332-337, 2021 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-33840403

RESUMO

OBJECTIVE: To compare the effect of delayed cord clamping (DCC) versus umbilical cord milking (UCM) on cerebral blood flow in preterm infants. METHODS: This was a single-center, prospective, double-blind, randomized controlled trial. A total of 46 preterm infants, with a gestational age of 30-33+6 weeks, who were born in Suining Central Hospital from November 2, 2018 to November 15, 2019 were enrolled and randomly divided into DCC group and UCM group, with 23 infants in each group. The primary outcome indexes included cerebral hemodynamic parameters[peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI)] measured by ultrasound within 0.5-1 hour, (24±1) hours, (48±1) hours, and (72±1) hours after birth. Secondary outcome indexes included hematocrit, hemoglobin, red blood cell count, and serum total bilirubin levels on the first day after birth and the incidence rate of intraventricular hemorrhage during hospitalization. RESULTS: A total of 21 preterm infants in the DCC group and 23 in the UCM group were included in the statistical analysis. There was no significant difference in PSV, EDV, and RI between the two groups at all time points after birth (P > 0.05). There was also no significant difference between the two groups in the hematocrit, hemoglobin, red blood cell count and total bilirubin levels on the first day after birth, and the incidence rate of intraventricular hemorrhage during hospitalization (P > 0.05). CONCLUSIONS: DCC and UCM have a similar effect on cerebral hemodynamics in preterm infants with a gestational age of 30-33+6 weeks.


Assuntos
Recém-Nascido Prematuro , Cordão Umbilical , Constrição , Hemodinâmica , Humanos , Lactente , Recém-Nascido , Estudos Prospectivos
2.
Life Sci ; 276: 119441, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794257

RESUMO

AIM: Ligature tightness of chronic constriction injury (CCI) model remains inconsistent and controversial, presenting barriers for researchers. METHODS: We summarized the different ligation criteria in literature and attempted to clarify their effects. To assess constriction under different criteria, we calculated the radial strain (εR) of ligated nerves from digital photographs. The mechanical withdrawal thresholds (MWT), thermal withdrawal latency (TWL) and sciatic functional index (SFI) were observed in rats of different groups to assess the state of model. Changes of myelin sheath were detected by pathological staining and immunohistochemistry. RESULTS: The median εR values in the Loose, Medium and Tight groups were 13.6%, 15.2% and 21.7%, respectively. Ligated groups had lower MWT than Sham group and the TWL of rats in the Loose approached to rats with sham operation, while that of the Tight group was higher than Medium group 14 days after surgery. Medium and Tight groups showed more abnormal in SFI, compared with the other two groups 14 days. Pathological staining revealed demyelination in three CCI groups, especially in the sciatic nerves. Myelin protein zero levels decreased in the sciatic nerves as the degree of constriction increased, but myelin basic protein of the Medium group was lowest abundant in the spinal cords of all rats. CONCLUSIONS: Our study demonstrated that the surrounding muscles briefly twitched when the diameter of the sciatic nerves was constricted by approximately 14-15%, which may provide a reference for other researchers for establishing CCI models.


Assuntos
Lesões por Esmagamento/complicações , Neuralgia/patologia , Nervo Isquiático/lesões , Traumatismos da Medula Espinal/complicações , Animais , Constrição , Lesões por Esmagamento/cirurgia , Ligadura , Masculino , Neuralgia/etiologia , Ratos , Ratos Sprague-Dawley , Nervo Isquiático/cirurgia , Traumatismos da Medula Espinal/cirurgia
3.
Int J Mol Sci ; 22(4)2021 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-33673008

RESUMO

Recently, Toll-like receptors (TLRs), a family of pattern recognition receptors, are reported as potential modulators for neuropathic pain; however, the desired mechanism is still unexplained. Here, we operated on the sciatic nerve to establish a pre-clinical rodent model of chronic constriction injury (CCI) in Sprague-Dawley rats, which were assigned into CCI and Decompression groups randomly. In Decompression group, the rats were performed with nerve decompression at post-operative week 4. Mechanical hyperalgesia and mechanical allodynia were obviously attenuated after a month. Toll-like receptor 5 (TLR5)-immunoreactive (ir) expression increased in dorsal horn, particularly in the inner part of lamina II. Additionally, substance P (SP) and isolectin B4 (IB4)-ir expressions, rather than calcitonin-gene-related peptide (CGRP)-ir expression, increased in their distinct laminae. Double immunofluorescence proved that increased TLR5-ir expression was co-expressed mainly with IB4-ir expression. Through an intrathecal administration with FLA-ST Ultrapure (a TLR5 agonist, purified flagellin from Salmonella Typhimurium, only the CCI-induced mechanical hyperalgesia was attenuated dose-dependently. Moreover, we confirmed that mu-opioid receptor (MOR) and phospho-protein kinase Cα (pPKCα)-ir expressions but not phospho-protein kinase A RII (pPKA RII)-ir expression, increased in lamina II, where they mostly co-expressed with IB4-ir expression. Go 6976, a potent protein kinase C inhibitor, effectively reversed the FLA-ST Ultrapure- or DAMGO-mediated attenuated trend towards mechanical hyperalgesia by an intrathecal administration in CCI rats. In summary, our current findings suggest that nerve decompression improves CCI-induced mechanical hyperalgesia that might be through the cross-talk of TLR5 and MOR in a PKCα-dependent manner, which opens a novel opportunity for the development of analgesic therapeutics in neuropathic pain.


Assuntos
Hiperalgesia/metabolismo , Proteína Quinase C-alfa/metabolismo , Receptores Opioides mu/metabolismo , Receptor 5 Toll-Like/metabolismo , Animais , Constrição , Ativação Enzimática , Hiperalgesia/etiologia , Hiperalgesia/fisiopatologia , Masculino , Medição da Dor/métodos , Ratos Sprague-Dawley , Receptor Cross-Talk , Nervo Isquiático/fisiopatologia , Transdução de Sinais , Corno Dorsal da Medula Espinal/metabolismo
4.
Psychopharmacology (Berl) ; 238(3): 877-886, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33404738

RESUMO

BACKGROUND: Memory deficit is a common cognitive comorbid in patients with neuropathic pain that need better treatment. Recent research revealed that nanocurcumin has an antinociceptive action and a protective effect against memory disorders, suggesting its possible effectiveness for the treatment of neuropathic pain and its comorbidity. METHODS: Adult male albino Wistar rats (n = 32) were randomly divided into four experimental groups: CCI+ nanocurcumin, CCI + vehicle, sham + nanocurcumin, and sham + vehicle. Neuropathic pain induced by a chronic constriction injury of the sciatic nerve. Nanocurcumin or vehicle was injected intraperitoneally for 10 days. Behavioral assessment achieved to evaluate pain threshold in the von Frey test and radiant heat test, also spatial learning and memory examined by the Morris water maze (MWM) test. To explore the possible relation, IL-1ß, and TNF-α levels of the hippocampus measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Our data showed that CCI caused neuropathic pain-related behaviors and spatial learning and memory disorders in rats. Chronic treatment with nanocurcumin significantly increased pain threshold (P < 0.001; F = 27.63, F = 20.58), improved spatial memory (P < 0.01; F = 47.37), and decreased the hippocampal levels of IL-1ß (P < 0.001; F = 33.57) and TNF-α (P < 0.01; F = 7.25) in CCI rats. CONCLUSION: Chronic nanocurcumin can ameliorate pain-related behavior, improve spatial learning and memory deficits, and is associated with the reduction of IL-1ß and TNF-α levels in the hippocampus in CCI rats. Nanocurcumin may be potentially providing a therapeutic alternative for the treatment of neuropathic pain and its memory impairment comorbidity.


Assuntos
Analgésicos/uso terapêutico , Curcumina/uso terapêutico , Hipocampo/efeitos dos fármacos , Interleucina-1beta/metabolismo , Neuralgia/tratamento farmacológico , Memória Espacial/efeitos dos fármacos , Fator de Necrose Tumoral alfa/metabolismo , Analgésicos/administração & dosagem , Analgésicos/química , Animais , Comportamento Animal/efeitos dos fármacos , Constrição , Curcumina/administração & dosagem , Curcumina/química , Modelos Animais de Doenças , Hipocampo/metabolismo , Masculino , Transtornos da Memória/complicações , Transtornos da Memória/tratamento farmacológico , Transtornos da Memória/metabolismo , Nanopartículas/administração & dosagem , Nanopartículas/química , Neuralgia/complicações , Neuralgia/metabolismo , Limiar da Dor/efeitos dos fármacos , Ratos , Ratos Wistar , Nervo Isquiático/efeitos dos fármacos , Nervo Isquiático/lesões
5.
Arq Bras Cir Dig ; 33(4): e1555, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33503115

RESUMO

BACKGROUND: Tourniquet for right hepatectomy tightened and secured with forceps (arrow). Laparoscopic liver resection is performed worldwide. Hemorrhage is a major complication and bleeding control during hepatotomy is an important concern. Pringle maneuver remains the standard inflow occlusion technique. AIM: Describe an extracorporeal, efficient, fast, cheap and reproducible way to execute the Pringle maneuver in laparoscopic surgery, using a chest tube. METHODS: From January 2014 to March 2020, our team performed 398 hepatectomies, 63 by laparoscopy. We systematically encircle the hepatoduodenal ligament and prepare a tourniquet to perform Pringle maneuver. In laparoscopy, we use a 24 Fr chest tube, which is inserted in the abdominal cavity through a small incision. We thread the cotton tape through the tube, pulling it out through the external end, outside the abdomen. To perform the tourniquet, we just need to push the tube as we hold the tape, clamping both with one forceps. RESULTS: The 24 Fr chest tube is firm and works perfectly to occlude blood inflow as the cotton band is tightened. It has an internal diameter of 5,5 mm, sufficient for a laparoscopic grasper pass through it to catch the cotton band, and an external diameter of 8 mm, which allows to be inserted in the abdomen through a tiny incision. The cost of this tube and the cotton band is less than US$ 1. No complications related to the method were identified in our patients. CONCLUSIONS: The extracorporeal Pringle maneuver presented here is a safe, cheap and reproducible method, that can be used for bleeding control in laparoscopic liver surgery.


Assuntos
Cavidade Abdominal/diagnóstico por imagem , Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Constrição , Humanos
6.
Zhonghua Wai Ke Za Zhi ; 59(1): 18-23, 2021 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-33412629

RESUMO

Objective: To evalutate the safety and efficacy of infrahepatic inferior vena cava clamping robot-assisted laparoscopic liver resection. Methods: All data about 24 patients with robotic liver resection at Hepatic Surgery Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology between February 2015 and December 2017 were collected and analyzed. These patients were divided into two groups based on different methods to decrease central venous pressure. Eight patients(6 males and 2 females,aged 49 years(range:50 to 56 years)) were applied with infrahepatic inferior vena cava clamping,and the other 16 matched cases (15 males and 1 female,aged 53 years(range:38 to 69 years)) were categorized into lowering central venous pressure group. Intraoperative blood loss,blood transfusion,intraoperative hemodynamic parameters,postoperative complications,and renal function were compared by t-test,non-parametric test,χ2 test,or Fisher exact test. Results: There was significantly difference in the intraoperative blood loss between the infrahepatic vena cava clamping group and the lowering central venous group(200(220) ml (range:100 to 400 ml) vs. 750(800) ml (range:100 to 2 000 ml),Z=‒2.169,P=0.030). The clamping time of portal triad and infrahepatic inferior vena cava were 24 (18) minutes and 29 (20) minutes in the infrahepatic inferior vena cava clamping group, and portal triad clamping time was 23 (23) minutes in the low central venous group. There was no significant difference between the two groups (Z=‒0.323, P=0.747). There was no intraoperative blood transfusion in the infrahepatic inferior vena cava clamping group, and 5 cases in the low central venous group, with a transfusion volume of 1.5(1.5)U. The difference between the two groups was statistically significant (Z=‒3.353, P=0.001). However, the mean arterial pressure in the infrahepatic vena cava clamping group decreased from (88.6±4.9) mmHg to (67.4±3.8) mmHg(1 mmHg=0.133 kPa), which was lower than that of lowering central venous group (72.4±3.3) mmHg (t=2.315,P=0.003). And there were no significant differences related to postoperative complications rate or hepatic and renal function in both groups. Conclusion: The infrahepatic inferior vena cava technology is safe and feasible to decrease central venous pressure during robotic liver resections,which will not affect the recovery of hepatic and renal functions.


Assuntos
Hepatectomia/métodos , Laparoscopia , Hepatopatias/cirurgia , Procedimentos Cirúrgicos Robóticos , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Inferior/cirurgia , Adulto , Idoso , Pressão Venosa Central/fisiologia , Constrição , Feminino , Humanos , Hepatopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Veia Cava Inferior/fisiologia , Veia Cava Inferior/fisiopatologia
7.
Int Heart J ; 62(1): 162-170, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455985

RESUMO

High-mobility group box 1 (HMGB1) is increased in the myocardium under pressure overload (PO) and is involved in PO-induced cardiac remodeling. The mechanisms of the upregulation of cardiac HMGB1 expression have not been fully elucidated. In the present study, a mouse transverse aortic constriction (TAC) model was used, and an angiotensin II (Ang II) type 1 (AT1) receptor inhibitor (losartan) or Ang II type 2 (AT2) receptor inhibitor (PD123319) was administrated to mice for 14 days. Cardiac myocytes were cultured and treated with Ang II for 5 minutes to 48 hours conditionally with the blockage of the AT1 or AT2 receptor. TAC-induced cardiac hypertrophy was observed at 14 days after the operation, which was partially reversed by losartan, but not by PD123319. Similarly, the upregulated HMGB1 expression levels observed in both the serum and myocardium induced by TAC were reduced by losartan. Elevated cardiac HMGB1 protein levels, but not mRNA or serum levels, were significantly decreased by PD123319. Furthermore, HMGB1 expression levels in culture media and cardiac myocytes were increased following Ang II treatment in vitro, positively associated with the duration of treatment. Similarly, Ang II-induced upregulation of HMGB1 in vitro was inhibited by both losartan and PD123319. These results suggest that upregulation of HMGB1 in serum and myocardium under PO, which are partially derived from cardiac myocytes, may be induced by Ang II via the AT1 and AT2 receptors. Additionally, amelioration of PO-induced cardiac hypertrophy following losartan treatment may be associated with the reduction of HMGB1 expression through the AT1 receptor.


Assuntos
Angiotensina II/farmacologia , Proteína HMGB1/efeitos dos fármacos , Losartan/farmacologia , Miocárdio/metabolismo , Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem , Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Animais , Aorta/patologia , Cardiomegalia/tratamento farmacológico , Cardiomegalia/metabolismo , Estudos de Casos e Controles , Constrição , Proteína HMGB1/sangue , Proteína HMGB1/metabolismo , Imidazóis/administração & dosagem , Imidazóis/farmacologia , Losartan/administração & dosagem , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Miócitos Cardíacos/efeitos dos fármacos , Piridinas/administração & dosagem , Piridinas/farmacologia , Regulação para Cima , Vasoconstritores/farmacologia
8.
Am J Orthod Dentofacial Orthop ; 159(3): 321-332, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33487499

RESUMO

INTRODUCTION: This study aimed to investigate the relative efficacy of maxillary protraction combined with a modified alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol compared with conventional protocols in the early orthopedic treatment of skeletal Class III malocclusion. METHODS: A sample of 39 patients was divided into 3 groups on the basis of different interventions. Conventional facemask (FM) with splint-type intraoral devices was performed in the FM group (7 males and 5 females; mean age, 9.53 ± 1.37 years). Maxillary expansion with an activation rate of 0.5 mm/d (twice a day) followed by FM therapy was applied in the rapid maxillary expansion group (RME/FM) (6 males and 6 females; mean age, 9.31 ± 1.60 years). In the Alt-RAMEC/FM group (7 males and 8 females; mean age, 10.01 ± 1.31 years), Alt-RAMEC was started simultaneously and throughout the entire course of maxillary protraction, with repetitive alternations between activation and deactivation of expanders (0.5 mm/d for 7 days). The patients in all groups were instructed to wear FMs for a minimum of 12 h/d. Pretreatment and posttreatment lateral cephalograms were all traced and measured. RESULTS: The Alt-RAMEC group showed statistically more significant maxillary advancement than other groups (A-VRP, 3.87 mm vs 3.04 mm [RME/FM], vs 2.04 mm [FM]; P <0.05). Analysis of variance did not reveal significant intergroup differences in palatal plane angulation changes (P >0.05). No pronounced mandibular clockwise rotations were noted in the Alt-RAMEC/FM group with distinct intergroup differences (P <0.05). There were more skeletal effects (88.7%) during overjet correction in the Alt-RAMEC/FM protocol. CONCLUSIONS: A combination of the modified Alt-RAMEC protocol with FM revealed more favorable skeletal effects compared with FM and RME/FM protocols in treating prepubertal patients with maxillary deficiency.


Assuntos
Má Oclusão de Angle Classe III , Técnica de Expansão Palatina , Cefalometria , Criança , Constrição , Aparelhos de Tração Extrabucal , Feminino , Humanos , Masculino , Má Oclusão de Angle Classe III/terapia , Máscaras , Maxila
9.
Nat Protoc ; 16(2): 775-790, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33328612

RESUMO

Cardiac disease is the main cause of death worldwide. Insufficient regeneration of the adult mammalian heart is a major driver of cardiac morbidity and mortality. Cardiac regeneration occurs in early postnatal mice, thus understanding mechanisms of mammalian cardiac regeneration could facilitate the development of novel therapeutic strategies. Here, we provide a detailed description of a neonatal mouse model of pressure overload by transverse aortic constriction (nTAC) that can be applied at postnatal days 1 and 7. We have previously used this model to demonstrate that mice are able to fully adapt to pressure overload following nTAC on postnatal day 1. In contrast, when nTAC is applied in the non-regenerative phase (at postnatal day 7), it is associated with a maladaptive response similar to that seen when transverse aortic constriction (TAC) is applied to adult mice. Once a user is experienced in nTAC surgery, the procedure can be completed in less than 10 min per mouse. We anticipate that this model will facilitate the discovery of therapeutic targets to treat patients or prevent pressure overload-induced cardiac failure in the future.


Assuntos
Cardiopatias/cirurgia , Coração/fisiologia , Regeneração/fisiologia , Animais , Animais Recém-Nascidos/fisiologia , Animais Recém-Nascidos/cirurgia , Aorta/cirurgia , Pressão Sanguínea/fisiologia , Constrição , Modelos Animais de Doenças , Feminino , Cardiopatias/metabolismo , Cardiopatias/fisiopatologia , Insuficiência Cardíaca/etiologia , Masculino , Camundongos , Camundongos Endogâmicos ICR , Miócitos Cardíacos/fisiologia
10.
Magy Seb ; 73(4): 160-166, 2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33310917

RESUMO

Összefoglaló. A thoracoabdominalis aortakirekesztés okozta gerincvelo ischemia súlyos neurológiai következményeit számos klinikai és kísérleti tanulmány bizonyítja. E nehezen kiszámítható, súlyos szövodmény megelozésének érdekében régi törekvés megfelelo intra- és posztoperatív monitorizálás kifejlesztése, ami elore jelzi a gerincvelo-funkció romlását, illetve a kialakuló celluláris károsodást. A legelterjedtebb, a klinikai gyakorlatban széles körben alkalmazott megoldás a gerincveloi kiváltott motoros potenciál (MEP) folyamatos ellenorzése. Ritkábban alkalmazott - bár ígéretes - eljárás a biokémiai változások nyomon követése, ami a sejtszintu károsodás markereit használja fel az ischemia okozta változások felismerésére. Korábbi dolgozatunkban kutyákon végzett kísérleteink azon eredményeit ismertettük, amelyekben a 60 perces thoracoabdominalis aortakirekesztés okozta neurológiai változások és a perfúzió adatainak összefüggéseit tárgyaltuk. Jelen tanulmányunkban a gerincveloi motoros (MEP) és szenzoros (SEP) kiváltott potenciálok változásait vizsgáljuk a neurológiai végállapot vonatkozásában. Megállapítottuk, hogy SEP változásai a neurológiai károsodás mértékével értékelheto összefüggést nem mutatnak. A MEP-amplitúdó és -latencia értékei biztonsággal jelzik a fenyegeto gerincvelo ischemiát. A neurológiai deficit mélységét (Tarlov 2,1,0) a MEP-értékek változásai numerikusan nem értékelhetoen követik. Summary. Severe neurological complications of the thoracoabdominal aortic clamping were published in numerous clinical and experimental studies. These hardly predictable, devastating consequences demanded to develop a monitoring system which might detect impending level of spinal cord ischemia in time - in order to introduce or enhance protective procedures and prevent permanent neurological deficit. The most widely used monitoring in clinical practice is the continuous surveillance of the motor evoked potentials (MEP) during and after thoracoabdominal aortic clamping. Much less used, but promising opportunity is to control the metabolic changes and cellular integrity utilizing specific markers like liquor lactate and neuron specific enolase (NSE) etc. In our earlier study we published data of our canine experiment related to coherencies between neurological outcome and specific perfusion of the spinal cord during and after one hour thoracoabdominal aortic clamping. In the present paper we investigate the behavior of motor evoked (MEP) and sensory evoked (SEP) potentials related to neurological changes. We conclude the behavior of SEP values hardly correlate with the neurologic outcome, meanwhile decrease of MEP amplitude provides reliable signal for developing spinal cord ischemia. We could not confirm a numeric correlation of these data and the level of the final neurologic outcome.


Assuntos
Aorta/cirurgia , Potencial Evocado Motor , Medula Espinal/irrigação sanguínea , Animais , Constrição , Cães , Pentalogia de Cantrell , Fosfopiruvato Hidratase
11.
Magy Seb ; 73(4): 153-159, 2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33310918

RESUMO

Összefoglaló. A thoracoabdominalis aorta kirekesztése a gerincvelo keringésének csökkenését okozza. Az ischemia klinikailag paraparesis, paraplegia formájában jelenik meg. Ez elsosorban nyitott mutétek során jelent aligha kiszámítható szövodményt, de a modern endovascularis technikák sem oldották meg teljes mértékben ennek biztonságos kivédését - bár arányát jelentosen mérsékelték. A javuló eredmények számos tényezore vezethetok vissza, mint a keringés kirekesztési idejének csökkentése, a gerincvelo-funkció és metabolismus ellenorzése. Mesterséges keringésjavító direkt és indirekt eljárások, liquor drainage, hutés mellett a collateralis keringés javítását szolgáló prekondicionáló módszerek kerültek bevezetésre. Kísérletes munkánkban 25-30 kg testsúlyú kutyákon vizsgáltuk - más paraméterek mellett - a distalis perfusio növelésének, a liquornyomás csökkentésének, illetve ezek kombinációjának protektív hatását egyórás thoracoabdominalis aortakirekesztés során. Dolgozatunkban a kísérleti állataink neurológiai végállapotát a keringési paraméterek és szöveti perfusio és a reperfusio változásainak összefüggésein keresztül tárgyaljuk. Megállapítottuk, hogy distalis gerincvelo reperfusiós hyperaemiája szorosan összefügg a neurológiai károsodás mértékével. Summary. Clamping of the thoracoabdominal aorta reduces perfusion of the spinal cord significantly, which clinically may present as paraparesis or paraplegia - devastating and unpredictable complications of open thoracoabdominal aortic surgery. Introduction of monitoring of evoked potentials and/or biochemical markers, methods increasing distal arterial pressure, indirect procedures enhancing residual flow (like liquor drainage), drugs, and use of hypothermia contributed to achieve better outcome. Preconditioning of spinal cord circulation is also a promising method. New endovascular techniques for thoracoabdominal aortic aneurysms and dissections reduced surgical trauma significantly. Despite all these progressions spinal cord ischemic damage is still a significant risk. To address this problem we carried out an experimental work using a canine model focusing on the protective effect of distal arterial perfusion, spinal fluid drainage, and their combination in a one hour setting of thoracoabdominal aortic clamping. In this paper we publish our data of circulatory and specific perfusion parameters of the spinal cord during and after declamping in correlation of final neurologic outcome.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/métodos , Isquemia/cirurgia , Paraplegia/complicações , Medula Espinal/cirurgia , Animais , Constrição , Cães , Perfusão , Medula Espinal/irrigação sanguínea
12.
J Card Surg ; 35(10): 2649-2656, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33043659

RESUMO

BACKGROUND: The aim of the study was to compare results off-pump coronary artery bypass (OPCAB) combined mitral valve reconstruction (MVR) with standard on-pump approach. METHODS: From January 2014 to December 2017, a total of 53 patients received a combined myocardial revascularization and MVR for multivessel coronary artery disease (CAD) complicated by severe ischemic mitral regurgitation (IMR). All the subjects were divided into two groups: group I: 27 patients, received OPCAB + MVR, and group II (control group): 26 patients with on-pump myocardial revascularization (ONCAB) + MVR. RESULTS: The aortic cross-clamp (ACC) and cardio-pulmonary bypass (CPB) times were longer in group II, 47.0 (44.0; 55.0) vs 94.5 (89.75; 105.5) minutes, P < .05 and 70.0 (63.0; 77.0) vs 138.5 (127.0; 157.5) minutes, P < .05, respectively. Evaluation of major clinical events showed that the implementation of the off-pump stage of myocardial revascularization in patients with severe IMR did not lead to significant changes in the mortality and postoperative complications. Furthermore, its use did not affect the volume of blood loss and need for blood transfusion, the duration of mechanical ventilation, the need for inotropic therapy, as well as the duration of the patient's resuscitation and the total duration of hospitalization, with the one exception: the troponin-T level increase in the OPCAB + MVR group was less than in the ONCAB + MVR group. CONCLUSION: OPCAB combined MVR in patients with CAD and severe IMR can be performed with shorter CPB and ACC times, and lower troponin-T level after surgery, without reducing the risk of surgical complications.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Ponte Cardiopulmonar , Constrição , Doença da Artéria Coronariana/complicações , Feminino , Seguimentos , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Duração da Cirurgia , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Troponina T
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4704-4707, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019042

RESUMO

Disposable forceps are frequently used in different surgical procedures to prevent infections caused by poorly sterilized reusable metal forceps. Compared to traditional rigid-joint mechanisms, compliant mechanisms are much easier to sterilize due to their monolithic structure, hence they are widely used for designing disposable surgical forceps. However, the clamping performance of plastic compliant forceps is generally less robust than metal forceps, which has greatly limited their use in medical applications. To cope with this problem, a novel 3D-printed plastic compliant forceps with optimized clamping performance was developed in this paper for open surgery and physical nursing applications. Bio-inspired topology optimization techniques were employed to synthesize the forceps. The clamping capability of the proposed forceps was evaluated by finite element analysis and loading tests. Results showed that the proposed forceps can generate greater and more stable clamping forces than the previous model of disposable compliant forceps. The proposed bionic optimization method also has potential for synthesizing compliant devices for robotic surgery.


Assuntos
Equipamentos Descartáveis , Reutilização de Equipamento , Biônica , Biópsia , Constrição , Instrumentos Cirúrgicos
15.
J Vis Exp ; (163)2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32986029

RESUMO

Based on twice transverse aortic constrictions (TACs) in mice, it is proved that myocardial hypertrophic preconditioning (MHP) could attenuate cardiomyocyte hypertrophy and slow down progression to heart failure. For novices, however, the MHP model is usually quite difficult to establish because of the technical obstacles in ventilator operation, opening the chest repeatedly, and bleeding caused by debanding. To facilitate this model, to increase the surgical success rate and to reduce the incidence of bleeding, we switched to absorbable sutures for the first TAC combing with a ventilator-free technique. Using a 2-week absorbable suture, we demonstrated that this procedure could cause significant myocardial hypertrophy in 2 weeks; and 4 weeks after surgery, myocardial hypertrophy was almost completely regressed to the baseline. Using this protocol, the operators could master the MHP model easily with a lower operation mortality.


Assuntos
Aorta/patologia , Aorta/cirurgia , Cardiomegalia/etiologia , Miocárdio/patologia , Suturas , Anestesia , Animais , Aorta/diagnóstico por imagem , Cardiomegalia/diagnóstico por imagem , Cardiomegalia/fisiopatologia , Constrição , Modelos Animais de Doenças , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Ligadura , Masculino , Camundongos Endogâmicos C57BL , Pressão , Sístole
16.
Int Heart J ; 61(5): 951-960, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32879260

RESUMO

The aim of this meta-analysis was to compare the clinical outcomes in patients who underwent rapid deployment aortic valve replacement (RDAVR) and conventional bio prosthetic aortic valve replacement (CAVR).We performed a literature search by August 2018. The primary outcomes were hospital and 1-year mortality, and the secondary endpoints included the aortic cross-clamp (ACC), cardiopulmonary bypass (CPB) time, and postoperative and valve-related complications.Two randomized controlled trials and 13 propensity score-matched studies were included. There was no difference between RDAVR and CAVR in hospital mortality (2.5% versus 2.1%; risk ratio (RR) 1.16 [95% confidence interval (CI) 0.80-1.68]) or 1-year mortality (2.9% versus 4.1%; RR 0.69 [95% CI 0.34-1.34]). RDAVR significantly reduced the ACC time ( (mean difference (MD) -24.33 [95% CI -28.35 to -20.32]) and CPB time (MD -21.51 [95% CI -22.83 to -20.20]). The pooled analysis showed that RDAVR doubled the occurrence of permanent pacemaker implantation (8.6% versus 4.3%; RR 2.05 [95% CI 1.62-2.60]). Meanwhile, the blood transfusion amount (MD -1.54 [95% CI -2.22 to -0.86]) and postoperative atrial fibrillation (POAF) occurrence (RR 0.83 [95% CI 0.69-0.99]) was reduced. The difference of paravalvular leakage frequency between RDAVR and CAVR was marginal (RR 1.77 [95% CI 1.00-3.17]; P = 0.05). Furthermore, RDAVR was related to larger valves (MD 0.70 cm [95% CI 0.33-1.07]) and lower mean pressure gradients (MD -1.93 mmHg [95% CI -3.58 to -0.28]).The hospital and 1-year survival rates between RDAVR and CAVR are comparable. RDAVR reduces POAF occurrence and blood transfusion but is associated with a higher occurrence of pacemaker implantation.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Mortalidade Hospitalar , Desenho de Prótese , Aorta , Ponte Cardiopulmonar , Constrição , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Fatores de Tempo
17.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(8): 1207-1212, 2020 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895191

RESUMO

OBJECTIVE: To compare the effects of different materials for partial sciatic nerve ligation on glial cell activation in the spinal cord in a rat model of chronic constriction injury (CCI). METHODS: SD rats were randomly divided into the sham group (n=15), silk suture CCI group (n=15) and chromic catgut CCI group (n=14). The mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) of the rats were detected at 3, 7, 11 and 15 days after the operation. The changes in the sciatic nerve, the activation of spinal cord glial cells and the expression of inflammatory factors were observed using Western blotting and RT-PCR. RESULTS: At 3 to 15 days after the surgery, MWT and TWL of the rats were significantly lower in silk suture group and chromic catgut group than in the control group (P < 0.05), and was significantly lower in chromic catgut group than in the silk suture group (P < 0.05) at 3 days after the surgery. The results of sciatic nerve myelin staining showed that the sciatic nerve was damaged and demyelinated in both the ligation groups. The expressions of CD11b, GFAP, IL-1ß and TNF-α in the two ligation groups were similar and all significantly higher than those in the control group (P < 0.05). IL-6 mRNA level was significantly higher in chromic catgut group than in the silk suture group (P < 0.05). CONCLUSIONS: The CCI models established by partial sciatic nerve ligation with silk suture and chromic catgut all show glial activation, and the inflammatory response is stronger in chromic catgut group.


Assuntos
Nervo Isquiático , Animais , Constrição , Neuroglia , Ratos , Ratos Sprague-Dawley , Medula Espinal
18.
Nat Methods ; 17(9): 874, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32873979
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