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1.
Anticancer Res ; 41(11): 5855-5861, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732462

RESUMO

BACKGROUND: Large numbers of synchronous colorectal liver metastases are associated with poor prognosis. CASE REPORT: A 47-year-old male patient with rectal cancer and unresectable colorectal liver metastases (over 15 cm in diameter and over 30 metastases) was treated with a multidisciplinary treatment including systemic chemotherapy with mFOLFOX6/panitumumab and surgical therapies (colostomy, modified associating liver partition and portal vein ligation for staged hepatectomy together with radiofrequency ablation). For solitary recurrent colorectal liver metastases, percutaneous radiofrequency ablation with chemoembolization and open radiofrequency ablation in combination with the same systemic chemotherapy was performed. Since the diagnosis 3 years ago, he has been leading a good quality of life, free of any tumor or treatment. CONCLUSION: For patients with far-advanced but liver-only colorectal liver metastases, surgical therapy, systemic chemotherapy, and interventional treatment can be important for achieving good prognosis.


Assuntos
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/patologia , Hepatectomia , Neoplasias Hepáticas/terapia , Terapia Neoadjuvante , Veia Porta/cirurgia , Ablação por Radiofrequência , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/secundário , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimioterapia Adjuvante , Colostomia , Humanos , Ligadura , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Resultado do Tratamento
2.
Clin Ter ; 172(6): 520-522, 2021 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-34821343

RESUMO

Abstract: Haemorrhoids are considered among the most frequent proctologi-cal condition at a general practitioner (GP) practice. Acute prolapse of internal haemorrhoids is presented with oedema, inflammation and acute pain. The application of granulated sugar on swollen hae-morrhoids leads to an immediate reduction of their edema and to the patient's relief. After the topical application of sugar, haemorrhoids begin to shrink immediately and edema is drastically reduced, while haemorrhoidal tissue can easily retracted back into the anal canal. The method is a cheap, quick and painless way to control the worsening symptoms such as swelling, bleeding and irritation. In addition, this method can easily be applied in the GP practice without the necessity of any form of anaesthesia.


Assuntos
Hemorroidas , Canal Anal , Hemorroidas/complicações , Humanos , Ligadura , Dor , Açúcares
3.
Pol J Vet Sci ; 24(3): 365-373, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34730299

RESUMO

Periodontitis is a highly prevalent, chronic immune-inflammatory disease of the periodontium that results in the periodontium and alveolar bone loss's progressive destruction. In this study, the induction of periodontal disease via retentive ligature, lipopolysaccharide, and their combination at three different times were compared in a rat model. Seventy-two Sprague Dawley rats were distributed into four treatment groups: 1) control group with no treatment; 2) application of 4/0 nylon ligature around second maxillary molars; 3) combination of ligature and LPS injection (ligature-LPS); 4) intragingival injection of Porphyromonas gingivalis lipopolysaccharide (Pg-LPS) to the palatal mucosa of the second maxillary molars. Six rats were sacrificed from each group after 7, 14, and 30 days of periodontal disease induction. Alveolar bone loss, attachment loss, number of inflammatory cells, and blood vessels were evaluated histologically. A micro-CT scan was used as a parameter to know the rate of alveolar bone loss. Parametric data were analyzed using two-way ANOVA followed by Bonferroni correction with a significance set at 5%. Non-parametric data were analyzed using Kruskal-Wallis, followed by multiple comparisons with Bonferroni correction. The histological results revealed significant destructive changes in the periodontal tissues and alveolar bone following the ligature and ligature-LPS induction techniques. These changes were evident as early as seven days, maintained until 14 days post-treatment, and declined with time. The ligature technique was effective in inducing acute periodontal disease. The LPS injection technique did not induce alveolar bone loss, and its combination to ligature added insignificant effects.


Assuntos
Modelos Animais de Doenças , Lipopolissacarídeos/toxicidade , Doenças Periodontais/etiologia , Perda do Osso Alveolar/patologia , Animais , Ligadura , Masculino , Doenças Periodontais/patologia , Periodontite/patologia , Ratos , Ratos Sprague-Dawley
4.
Ann Ital Chir ; 92: 549-553, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795106

RESUMO

AIM: The ideal level of ligation of the inferior mesenteric artery (IMA) during resection for colorectal cancer is still controversial. The aim of this study was to demonstrate the real advantages and, above all, the adequacy of oncological staging after a low ligation of the IMA with additional LN retrieval in patients undergoing surgery for colorectal cancer. MATERIALS AND METHODS: Between January 2013 and December 2020, 157 patients who underwent curative resection of a primary colorectal tumor were retrospectively included: 64 patients underwent high ligation of the IMA and 93 patients underwent low ligation of the IMA with additional LN retrieval. Results - Mean number of lymphnodes harvested (the median number of harvested nodes was 16.2 in "high ligation" group vs 15.4 in "low ligation" group), operation time (272 minutes vs 293 minutes), intraoperative blood loss (40 cc vs 53 cc) and recovery time (median postoperative hospitalization was 6.4 days in both groups) were not significantly different between the groups. DISCUSSION: High ligation of the IMA preserves an adequate length of the colon to perform a successful anastomosis and facilitates apical LN dissection. However, it may be associated with an increased risk of anastomotic leakage. Low ligation of the IMA is less invasive and it is associated with a better preservation of genitourinary function and, futhermore, with an accurate oncological clearance. CONCLUSION: Low ligation of the IMA with additional LN retrieval might be an oncologically safe and less invasive procedure in the surgical management of patients with colorectal cancer. KEY WORDS: Colorectal cancer, Inferior mesenteric artery, Ligation.


Assuntos
Laparoscopia , Neoplasias Retais , Humanos , Ligadura , Excisão de Linfonodo , Linfonodos , Artéria Mesentérica Inferior/cirurgia , Neoplasias Retais/cirurgia , Estudos Retrospectivos
5.
BMC Gastroenterol ; 21(1): 413, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34715801

RESUMO

BACKGROUND: This study aims to assess the association between age and outcomes in patients undergoing hemorrhoidectomy. METHODS: This is a population-based cohort study. A retrospectively collected database with consecutive patients whose symptomatic prolapsed hemorrhoids managed by the LigaSure hemorrhoidectomy between Jan. 2015 and May 2017 was reviewed. Among 1238 patients, 1075 were under 65 years old (group 1), and 163 were 65 years old or older (group 2). Both groups were compared regarding baseline characteristics and surgical outcomes. RESULTS: All patients tolerated the whole course of the operation in the prone jackknife position without anesthetic-associated complications. There was no significant difference between these two groups regarding sex, hemorrhoids grade, operation time, duration of hospital stays, postoperative pain score, analgesic consumption, total postoperative complications, re-admission rate, reoperation rate and follow-up times. The multivariate logistic regression analysis that may contribute to postoperative complications revealed no significant difference for all complications between both groups. CONCLUSION: The LigaSure hemorrhoidectomy for elderly patients is safe and effective without significant difference in short-term operative outcomes and all complication rates, compared with younger patients.


Assuntos
Hemorroidectomia , Hemorroidas , Idoso , Estudos de Coortes , Hemorroidectomia/efeitos adversos , Hemorroidas/cirurgia , Humanos , Ligadura , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Resultado do Tratamento
6.
Int J Mol Sci ; 22(19)2021 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-34638670

RESUMO

Platelets, cellular mediators of thrombosis, are activated during sepsis and are increasingly recognized as mediators of the immune response. Platelet activation is significantly increased in sepsis patients compared to ICU control patients. Despite this correlation, the role of activated platelets in contributing to sepsis pathophysiology remains unclear. We previously demonstrated NOD-like receptor protein 3 inflammasome (NLRP3) inflammasome activation in sepsis-induced platelets from cecal-ligation puncture (CLP) rats. Activated platelets were associated with increased pulmonary edema and glomerular injury in CLP vs. SHAM controls. In this study, we investigated whether inhibition of platelet activation would attenuate NLRP3 activation and renal and pulmonary injury in response to CLP. CLP was performed in male and female Sprague Dawley (SD) rats (n = 10/group) to induce abdominal sepsis and SHAM rats served as controls. A subset of CLP animals was treated with Clopidogrel (10 mg/kg/day, CLP + CLOP) to inhibit platelet activation. At 72 h post-CLP, platelet activation and NLRP3 inflammasome assembly were evaluated, IL-1ß and IL-18 were measured in plasma, and tissues, renal and pulmonary pathology, and renal function were assessed. Activated platelets were 7.8 ± 3.6% in Sham, 22 ± 6% in CLP and significantly decreased to 14.5 ± 0.6% in CLP + CLOP (n = 8-10/group, p < 0.05). NLRP3 inflammasome assembly was inhibited in platelets of CLP + CLOP animals vs. CLP. Significant increases in plasma and kidney IL-1ß and IL-18 in response to CLP were decreased with Clopidogrel treatment. Renal injury, but not lung histology or renal function was improved in CLP + CLOP vs. CLP. These data provide evidence that activated platelets may contribute to sepsis-induced renal injury, possibly via NLRP3 activation in platelets. Platelets may be a therapeutic target to decrease renal injury in septic patients.


Assuntos
Plaquetas/efeitos dos fármacos , Plaquetas/metabolismo , Inflamassomos/efeitos dos fármacos , Inflamassomos/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Inibidores da Agregação Plaquetária/farmacologia , Sepse/metabolismo , Animais , Feminino , Interleucina-18/metabolismo , Interleucina-1beta/metabolismo , Rim/efeitos dos fármacos , Rim/metabolismo , Ligadura , Pulmão/efeitos dos fármacos , Pulmão/metabolismo , Masculino , Proteínas NLR/metabolismo , Ativação Plaquetária/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley
7.
Georgian Med News ; (318): 24-28, 2021 Sep.
Artigo em Russo | MEDLINE | ID: mdl-34628373

RESUMO

Objective - to evaluate the effectiveness of surgical treatment of varicothrombophlebitis complicated by transfascial thrombosis. The results of examination and treatment of 45 patients with varicothrombophlebitis of the great saphenous vein complicated by transfascial thrombosis. The indications for surgical prophylaxis of pulmonary embolism in transfascial thrombosis in the basin of the great saphenous vein have been substantiated. In the postoperative period, all patients with transfascial thrombosis, regardless of the radical nature of the surgical intervention, were offered to prescribe treatment as in deep vein thrombosis. The introduction of active surgical tactics in transfascial thrombosis allows for effective prevention of pulmonary embolism. In varicothrombophlebitis complicated by transfascial thrombosis, thrombectomy with further prevention of recurrence of the disease and pulmonary embolism should be considered the main standard of treatment. For perforating vein thrombosis, subfascial thrombectomy followed by perforating ligation should be performed. All patients with transfascial thrombosis, regardless of the volume of surgery, should be treated as for deep vein thrombosis.


Assuntos
Embolia Pulmonar , Trombose Venosa , Humanos , Ligadura , Embolia Pulmonar/cirurgia , Veia Safena/cirurgia , Trombectomia , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
8.
Int J Mol Sci ; 22(19)2021 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-34638585

RESUMO

Mammalian sperm must undergo two post-testicular processes to become fertilization-competent: maturation in the male epididymis and capacitation in the female reproductive tract. While caput epididymal sperm are unable to move and have not yet acquired fertilization potential, sperm in the cauda epididymis have completed their maturation, can move actively, and have gained the ability to undergo capacitation in the female tract or in vitro. Due to the impossibility of mimicking sperm maturation in vitro, the molecular pathways underlying this process remain largely unknown. We aimed to investigate the use of caput epididymal ligation as a tool for the study of sperm maturation in mice. Our results indicate that after seven days of ligation, caput sperm gained motility and underwent molecular changes comparable with those observed for cauda mature sperm. Moreover, ligated caput sperm were able to activate pathways related to sperm capacitation. Despite these changes, ligated caput sperm were unable to fertilize in vitro. Our results suggest that transit through the epididymis is not required for the acquisition of motility and some capacitation-associated signaling but is essential for full epididymal maturation. Caput epididymal ligation is a useful tool for the study of the molecular pathways involved in the acquisition of sperm motility during maturation.


Assuntos
AMP Cíclico/metabolismo , Fosforilação/fisiologia , Maturação do Esperma/fisiologia , Motilidade Espermática/fisiologia , Espermatozoides/fisiologia , Animais , Epididimo/metabolismo , Epididimo/fisiologia , Feminino , Fertilização/fisiologia , Ligadura/métodos , Masculino , Camundongos , Transdução de Sinais/fisiologia , Capacitação Espermática/fisiologia , Espermatozoides/metabolismo
9.
Ther Umsch ; 78(9): 495-498, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-34704475

RESUMO

Internal hemorrhoidal disease and non-surgical therapy Abstract. Haemorrhoids are a physiological part of the sphincter muscle which, under non-physiological conditions such as abdominal pressure, becomes enlarged and develops symptoms such as bleeding. The therapy consists of reducing the enlarged plexus. In addition to lifestyle adaptations, semi-invasive methods such as coagulation, rubber band ligations and, in more severe stages, surgical procedures such as the classic established methods (Milligan-Morgan, Ferguson, in selected cases Longo) can be considered.


Assuntos
Hemorroidas , Hemorroidas/diagnóstico , Hemorroidas/terapia , Humanos , Ligadura , Músculo Liso , Resultado do Tratamento
10.
Injury ; 52(11): 3217-3226, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34544588

RESUMO

The tourniquet or femoral artery ligation is widely used to stop extremity hemorrhage or create a bloodless operating field in the combat scenario and civilian setting. However, these procedures with subsequent reperfusion also induce ischemia-reperfusion (IR) injuries. To fully evaluate animal models of limb IR injuries, we compared tourniquet- and femoral artery ligation-induced IR injuries in the hindlimb of mice. In C57/BL6 mice, 3 h of unilateral hindlimb ischemia was induced by placement of a rubber band at the hip joint or a surgical ligation of the femoral artery. The tourniquet or femoral artery ligation was then released, allowing for 24 h of reperfusion. Compared to the femoral artery ligation/IR, the tourniquet/IR induced more severe skeletal muscle damage, including muscle necrosis and interruption of muscle fibers. There was no gastrocnemius muscle contraction in tourniquet/IR, while femoral artery ligation/IR markedly weakened gastrocnemius muscle contraction. Motor nerve terminals disappeared, and endplate potentials (EPPs) were undetectable in tourniquet/IR, whereas femoral artery ligation/IR only induced mild impairment of motor nerve terminals and decreased the amplitude of EPPs. Additionally, western blot data showed that proinflammatory cytokine levels (IL-1ß and TNF-α) were higher in the tourniquet/IR than that in femoral artery ligation/IR. Moreover, tourniquet/IR caused significant tissue edema and dilation of lymphatic vessels in the hindlimb, compared to femoral artery ligation/IR. The above data demonstrated that tourniquet/IR-induced acute hindlimb injuries are more severe than those induced by femoral artery ligation/IR. This suggests that future investigators should determine which hindlimb IR model (tourniquet/IR or femoral artery ligation/IR) is optimal depending on the purpose of their study.


Assuntos
Traumatismo por Reperfusão , Torniquetes , Animais , Modelos Animais de Doenças , Artéria Femoral/cirurgia , Membro Posterior , Isquemia , Ligadura , Camundongos , Camundongos Endogâmicos C57BL , Músculo Esquelético , Reperfusão
11.
Yonsei Med J ; 62(10): 918-927, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34558871

RESUMO

PURPOSE: We compared the clinical outcomes of modified procedures for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) based on a risk-reduced strategy with those of classic ALPPS procedures in treating large liver carcinoma. MATERIALS AND METHODS: Short-term outcomes, increases in future liver remnant (FLR) and functional FLR (FFLR), and overall survival (OS) were compared between 45 consecutive patients treated with modified ALPPS procedures and 34 patients treated with classic ALPPS procedures. RESULTS: Clinical outcomes after the 1st-stage operation markedly improved with the modified procedures. Although the proportions of liver cirrhosis and hepatocellular carcinoma were higher in the modified group, the mortality and incidence of severe complications did not increase. FLR and FFLR hypertrophy at 1 week after the 1st-stage operation were similar in both groups; however, kinetic growth rates in the modified group were lower. OS rates were similar. CONCLUSION: Modified ALPPS procedures could be safely applied to provide long-term survival for patients with liver cirrhosis without sufficient FLR.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/cirurgia , Hepatectomia , Humanos , Ligadura , Fígado/cirurgia , Neoplasias Hepáticas/cirurgia , Veia Porta/cirurgia
12.
Artigo em Inglês | MEDLINE | ID: mdl-34547068

RESUMO

This study evaluated the influence of different implant types on (1) radiographic marginal bone levels after healing and (2) radiographic and histomorphometric tissue levels and characteristics following ligature-induced peri-implantitis. Four implant types (Standard Plus, Straumann [S]; NobelReplace Tapered, Nobel Biocare [N]; In-Kone Universal, Global D [I]; and twinKon, Global D [T]) were randomly placed in the edentulous healed mandibular ridge of six dogs (T0), for a total of 57 implants placed. After 10 weeks, a peri-implantitis was ligature-induced (T1). After 12 weeks, biopsy samples were processed for histomorphometric analysis (T2). Standardized radiographs were taken at T0, T1, and T2 for imaging analysis. Statistical analysis was performed using mixed-effects linear modeling. After healing (T1), the radiographic marginal bone level was more coronal for implants I, T, and S compared to N. Following peri-implantitis (T2), the histologic marginal bone level was more coronal for implants I, T, and S compared to N, and for implants I and T compared to S. Also at T2, the radiographic marginal bone level was more coronal at implants I, T, and S compared to N. Implant type may influence bone remodeling during healing and bone loss during the early stages of experimental peri-implantitis.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Peri-Implantite , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/etiologia , Animais , Implantes Dentários/efeitos adversos , Cães , Ligadura , Mandíbula , Peri-Implantite/diagnóstico por imagem
13.
Kyobu Geka ; 74(10): 862-866, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34548460

RESUMO

Chylothorax is not a rare complication of lung surgery. Diagnosis is easy in most cases, but treatment is sometimes difficult. Dietary restriction is effective in reducing the chyle but does not always cease the lymph and chyle. Two surgical procedures for postoperative chylothorax are well known:direct closure of the ruptured lymph vessel and ligation of the thoracic duct. Direct closure often fails. It is difficult to detect lymphatic leakage pre- and peri-reoperation. Early reoperation decisions are important for successful direct closure. Thoracic duct ligation is ordinarily performed using the right thoracoscopic approach because the thoracic duct runs in front of the vertebrae along the azygos vein near the diaphragm in the right pleural cavity. The effect of the ligation should be shown immediately. Unfortunately, even if the thoracic duct is confirmed to have been ligated, it sometimes fails to cease the chyle pleural effusion. This may be due to the existence or formation of lymphatic bypass routes.


Assuntos
Quilotórax , Procedimentos Cirúrgicos Pulmonares , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Quilotórax/cirurgia , Humanos , Ligadura , Pulmão , Reoperação , Ducto Torácico/cirurgia
14.
Ann Ital Chir ; 92: 441-451, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34524119

RESUMO

OBJECTIVE: Pancreaticoduodenectomy has been established as the treatment of choice for the management of benign and malignant lesions of the pancreatic head, and pancreaticojejunal or pancreaticogastric anastomosis seems to be the safer choice for the management of the pancreatic duct. However, in certain seldom, but still existing circumstances, pancreatic duct ligation or occlusion with a chemical substance is a valuable and viable alternative. The aim of the current study is to compare these two methods of occlusion of the pancreatic duct regarding the endocrine and exocrine function of the pancreas and its histopathology. MATERIALS AND METHODS: 18 health mixed breed dog of both sexes were randomized in two groups: group A, in which the pancreatic duct was ligated and group B, in which the pancreatic duct was occluded with prolamine. RESULTS: None of the animals presented postoperatively steatorrhea and significant body weight changes. Peripancreatic inflammation at sacrifice, inflammatory cell infiltration and edema of the pancreas on the 15th postoperative day and 30th postoperative day were milder after occlusion with prolamine than after ligation. Ligation of pancreatic duct lead to significantly greater hyperamylasemia than prolamine occlusion every day until the 15th. Mild hyperglycemia presented from the first to the fourth day in both groups, which was associated with a significant drop in insulin. Glucagon remained within the normal values at all times during the experiment. None of glucose, insulin and glucagon differed between groups. CONCLUSION: Prolamine occlusion of the pancreatic duct causes milder hyperamylasemia and less extensive inflammation both macroscopically and microscopically than ligation. KEY WORDS: Pancreas, Pancreaticoduodenectomy, Hyperamylasemia.


Assuntos
Glucagon , Insulina , Amilases , Animais , Cães , Feminino , Glucose , Ligadura , Masculino , Pâncreas/cirurgia , Ductos Pancreáticos/cirurgia , Fenilpropanolamina
15.
Biomaterials ; 277: 121106, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34492581

RESUMO

Sepsis, a syndrome of acute organ dysfunction induced by various infections, could lead to a very high mortality in hospitals despite the development of advanced medical technologies. Herein, a type of two-phase releasing immune-stimulating composite is developed by mixing alginate (ALG) with muramyl dipeptide (MDP) and the nanoparticle formulation of monophosphoryl lipid A (MPLA), the latter two are immunomodulatory agents with different release rates from the formed ALG hydrogel. The obtained two phase-releasing composite could provide instantaneous sepsis protection by the rapid release of MDP to enhance the phagocytic and bactericidal function of macrophages. Later on, such composite could further offer long-term sepsis protection by the sustained release of MPLA to continuously activate the immune system, via up-regulating the production of various pro-inflammatory cytokines, promoting the polarization of macrophages, and increasing the percent of natural killer (NK) cells in the lesion after sepsis challenge. Mice survived from sepsis challenge after such treatment could resist a second infection. Notably, treatment with our composite could increase the mouse survival rate in a cecal ligation and puncture (CLP) induced polymicrobial sepsis model. This work provides an easy-translatable immune-stimulating formulation for effective protection against sepsis under various triggering causes. Our strategy may be promising for long-term broad prevention against various infections, and could potentially be used to protect medical workers under a new pandemic before a reliable vaccine is available.


Assuntos
Ceco , Sepse , Animais , Citocinas , Modelos Animais de Doenças , Ligadura , Macrófagos , Camundongos , Camundongos Endogâmicos C57BL , Sepse/prevenção & controle
16.
Int J Mol Sci ; 22(17)2021 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-34502521

RESUMO

BACKGROUND: Sepsis is a serious, heterogeneous clinical entity produced by a severe and systemic host inflammatory response to infection. Methotrexate (MTX) is a folate-antagonist that induces the generation of adenosine and also inhibits JAK/STAT pathway; MTX it is widely used as an anti-inflammatory drug to control the immune system. OBJECTIVE: The aim of this study was to assess the beneficial effects of a single and low dose of MTX in the systemic response and acute lung injury (ALI) induced by sepsis. As in the clinics, we treated our animals with antibiotics and fluids and performed the source control to mimic the current clinic treatment. METHODS AND MAIN RESULTS: Sepsis was induced in rats by a cecal ligation puncture (CLP) procedure. Six hours after induction of sepsis, we proceeded to the source control; fluids and antibiotics were administered at 6 h and 24 h after CLP. MTX (2.5 mg/Kg) was administered 6 h after the first surgery in one CLP experimental group and to one Sham group. A protective effect of MTX was observed through a significant reduction of pro-inflammatory cytokines and a decrease infiltration of inflammatory cells in the lung. In addition, we found a regulation in adenosine receptor A2aR and the metalloproteinases by MTX. CONCLUSION: A single, low dose of MTX attenuates sepsis lung-associated damage by decreasing pro-inflammatory response, infiltration of pro-inflammatory cells and avoiding defective tissue lung remodeling.


Assuntos
Lesão Pulmonar Aguda/tratamento farmacológico , Metotrexato/farmacologia , Sepse/tratamento farmacológico , Animais , Anti-Inflamatórios/uso terapêutico , Ceco/patologia , Modelos Animais de Doenças , Inflamação/tratamento farmacológico , Inflamação/fisiopatologia , Ligadura , Pulmão/efeitos dos fármacos , Masculino , Metotrexato/metabolismo , Punções , Ratos , Ratos Sprague-Dawley , Sepse/fisiopatologia
17.
Am J Physiol Regul Integr Comp Physiol ; 321(5): R768-R780, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34494467

RESUMO

The mechanoreflex is exaggerated in patients with peripheral artery disease (PAD) and in a rat model of simulated PAD in which a femoral artery is chronically (∼72 h) ligated. We found recently that, in rats with a ligated femoral artery, blockade of thromboxane A2 (TxA2) receptors on the sensory endings of thin fiber muscle afferents reduced the pressor response to 1 Hz repetitive/dynamic hindlimb skeletal muscle stretch (a model of mechanoreflex activation isolated from contraction-induced metabolite production). Conversely, we found no effect of TxA2 receptor blockade in rats with freely perfused femoral arteries. Here, we extended the isolated mechanoreflex findings in "ligated" rats to experiments evoking dynamic hindlimb skeletal muscle contractions. We also investigated the role played by inositol 1,4,5-trisphosphate (IP3) receptors, receptors associated with intracellular signaling linked to TxA2 receptors, in the exaggerated response to dynamic mechanoreflex and exercise pressor reflex activation in ligated rats. Injection of the TxA2 receptor antagonist daltroban into the arterial supply of the hindlimb reduced the pressor response to 1 Hz dynamic contraction in ligated but not "freely perfused" rats. Moreover, injection of the IP3 receptor antagonist xestospongin C into the arterial supply of the hindlimb reduced the pressor response to 1 Hz dynamic stretch and contraction in ligated but not freely perfused rats. These findings demonstrate that, in rats with a ligated femoral artery, sensory neuron TxA2 receptor and IP3 receptor-mediated signaling contributes to a chronic sensitization of the mechanically activated channels associated with the mechanoreflex and the exercise pressor reflex.


Assuntos
Receptores de Inositol 1,4,5-Trifosfato/metabolismo , Mecanorreceptores/metabolismo , Mecanotransdução Celular , Contração Muscular , Músculo Esquelético/inervação , Doença Arterial Periférica/metabolismo , Receptores de Tromboxano A2 e Prostaglandina H2/metabolismo , Reflexo , Animais , Modelos Animais de Doenças , Artéria Femoral/fisiopatologia , Artéria Femoral/cirurgia , Ligadura , Masculino , Doença Arterial Periférica/fisiopatologia , Ratos Sprague-Dawley
18.
Zhonghua Gan Zang Bing Za Zhi ; 29(8): 759-765, 2021 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-34517457

RESUMO

Objective: To study the predictive value for esophageal variceal bleeding (EVB) after esophageal variceal ligation (EVL) based on clinical data and endoscopic ultrasound examination among patients with liver cirrhosis. Methods: Routine endoscopy and endoscopic ultrasound were performed on 400 preventive EVL cases who met the enrollment criteria, and their clinical indicators, microscopic manifestations, diameter and number of peripheral collateral veins, para-esophageal veins, perforating veins, and so on were monitored. Multivariate Cox proportional hazard regression analysis was performed to determine the relevant factors. Nomogram predictive model was established based on the independent prognostic factors. Nomogram internal validation was carried out with C-index to check the prediction accuracy, calibration curve evaluation consistency, and clinical benefit evaluation for decision-making. Results: Age, gender, etiology, peri-ECV number, para-ECV diameter, portal vein diameter, and azygous vein diameter were the risk factors for disease progression (P < 0.05), and they were all included in the establishment of nomogram. The C-index obtained by internal validation was 0.864, and the area under the receiver operating characteristic curve (AUC) of the predicting bleeding progression model was 0.994 (P < 0.001), suggesting that the disease had high predictive value and the calibration curve validity had consistency. Conclusion: Nomogram predictive model established based on the clinical data and endoscopic ultrasound examination is a preventive and therapeutic intervention for liver cirrhotic patients with esophageal varices, which can effectively improve the therapeutic effects of this population, reduce the EVs occurrence, and improve their quality of life. In addition, it also has an outstanding favorable performance. Therefore, it has certain guiding significance for the judgment of clinical treatment.


Assuntos
Varizes Esofágicas e Gástricas , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Ligadura , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Nomogramas , Qualidade de Vida
19.
J Cardiothorac Surg ; 16(1): 272, 2021 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-34565438

RESUMO

BACKGROUND: The optimal sequence of pulmonary vessel interruption during lung cancer resection remains controversial. This review aimed to elucidate the association of vein-first versus artery-first ligation and survival of the patients. METHODS: We searched PubMed, Web of Science, Scopus, Embase, Cochrane Library and Google Scholar from their inception to September 2021 for published articles that compared vein-first (the pulmonary vein was interrupted first) and artery-first procedure (the pulmonary artery was ligated first) during lung cancer surgery. RESULTS: Finally, a total of 13 full articles were obtained. First, 7 studies with survival information were included for meta-analyses. As compared with the artery-first ligation, vein-first approach did not decrease the risk of local recurrence (risk ratio [RR] 0.92 in favour of vein-first; 95% confidence interval [CI] 0.61-1.39, p = 0.68) or distant metastasis (RR 0.92; 95% CI 0.30-2.85, p = 0.89); but it was associated with better disease-free survival (RR 0.52; 95% CI 0.37-0.73, p < 0.01) as well as 5-year overall survival (RR 0.60; 95% CI 0.41-0.86, p < 0.01). In addition, the operative time, intraoperative blood loss, total complications, and length of postoperative stay were mainly comparable between the two groups. Second, 7 studies provided the data of tumor cells indicated by different biomarkers and detection methods; and 3 of these reports showed that vein-first ligation decreased the extent of intraoperative tumor dissemination. However, a quantitative meta-analysis was not possible due to the significant heterogeneity. CONCLUSION: Vein-first ligation in lung cancer surgery may be associated with improved survival of the patients, which might be ascribed to potentially lower risk of tumor cell dissemination. Well-designed, large-scale trials are warranted to clarify these occasional findings.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Ligadura , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia , Pneumonectomia , Artéria Pulmonar/cirurgia
20.
Chirurgia (Bucur) ; 116(4): 387-398, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34498560

RESUMO

Hepatectomy is the only potentially curative treatment of hepatic tumors, but remains challenging in case of multiple, bilobar lesions and those located in the vicinity of the hepatic hilum and hepatic veins. Regenerative liver surgery utilizes the unique ability of the liver to re-grow after tissue loss and vascular deprivation. All concepts subsumed under this term aim to increase the resectability of hepatic tumors by stimulating growth of future liver remnant. Many of these techniques have evolved over the last decades. ALPPS (associated liver partition and portal vein ligation for staged hepatectomy) is an advanced technique combining portal vein ligation and parenchymal transection which gave rise to many variants, all with the common goal of extending resectability. This article reviews techniques currently available for regenerative liver surgery focusing on ALPPS, its mechanisms of liver regeneration, indications, advantages, drawbacks, results and future perspectives.


Assuntos
Neoplasias Hepáticas , Regeneração Hepática , Hepatectomia , Humanos , Ligadura , Fígado/cirurgia , Neoplasias Hepáticas/cirurgia , Veia Porta/cirurgia , Resultado do Tratamento
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