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1.
Medicine (Baltimore) ; 99(45): e23122, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157990

RESUMO

INTRODUCTION: Hemorrhoidal disease is one of the most common and frequently occurring benign anorectal disorders, presented with bleeding and prolapsed, and surgery is the main and effective method for severe prolapsed hemorrhoids. Yet, the recurrence rate after procedure for prolapse and hemorrhoids (PPH) is significantly higher. To reduce the recurrence rate and protect the anus function, we try to carry out a randomized, controlled, prospective study to compare the efficacy and recurrence rate of tissue selecting technique (TST) with mega-window stapler (TST-MS) combined with anal canal epithelial preservation operation and PPH combined with external hemorrhoidectomy and inferior internal hemorrhoid ligation operation for the treatment of severe prolapsed hemorrhoids. METHODS: This study is a single-center, evaluator-blinded, randomized, controlled clinical trial. Participants meet the inclusion and exclusion criteria in this RCT will be randomly divided into treatment group (TST-MS combined with anal canal epithelial preservation operation group) and control group (PPH combined with external hemorrhoidectomy and inferior internal hemorrhoid ligation operation) in a 1:1 ratio according to a computer-generated randomization list. The outcomes of recurrence, anal function, intraoperative variables, and postoperative complications will be recorded at different follow-ups. CONCLUSION: The findings of the study will help to explore the efficacy and recurrence rate of TST-MS combined with anal canal epithelial preservation operation on the treatment of severe prolapsed hemorrhoids. TRIAL REGISTRATION: This study protocol was registered in open science framework (OSF). (Registration number: DOI 10.17605 / OSF.IO / 4JYNF).


Assuntos
Hemorroidectomia/métodos , Hemorroidas/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Prolapso Retal/cirurgia , Grampeamento Cirúrgico , Método Duplo-Cego , Hemorroidas/complicações , Humanos , Mucosa Intestinal , Ligadura/métodos , Tratamentos com Preservação do Órgão , Estudos Prospectivos , Prolapso Retal/etiologia , Índice de Gravidade de Doença , Grampeamento Cirúrgico/métodos
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5049-5052, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019121

RESUMO

Suture ligation of vascular tissues is slow and skill intensive. Ultrasonic (US) and radiofrequency (RF) devices enable more rapid vascular tissue ligation to maintain hemostasis, than sutures and mechanical clips, which leave foreign objects in the body and require exchange of instruments. However, US and RF devices are limited by excessive collateral thermal damage to adjacent tissues, and high jaw temperatures that require a long time to cool. A novel alternative method using infrared (IR) laser energy is being developed for more rapid and precise sealing of vessels. This study describes design, modeling, and initial testing of several optical beam shaping geometries for integration into the standard jaws of a laparoscopic device. The objective was to transform the circular laser beam into a linear beam, for uniform, cross-irradiation and sealing of blood vessels. Cylindrical mirrors organized in a staircase geometry provided the best spatial beam profile.Clinical Relevance-This study explored several optical designs for potential integration into the standard jaws of a laparoscopic vessel sealing device, transforming a circular laser beam into a linear beam for sealing of vascular structures.


Assuntos
Laparoscopia , Lasers , Ligadura , Instrumentos Cirúrgicos , Suturas
3.
Am J Vet Res ; 81(9): 755-759, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33112165

RESUMO

OBJECTIVE: To compare the bursting strength of the uterine horns (UHs) and cervical-vestibule junction (CVJs) of rabbits following sealing with a vessel-sealing device (VSD) or encircling ligatures. SAMPLE: UHs and CVJs collected from 30 rabbit (Oryctolagus cuniculus) cadavers. PROCEDURES: UHs and CVJs were randomly assigned to sealing with encircling Miller knot ligatures (LIG; n = 10 CVJs and 20 UHs) or a VSD (12 CVJs and 24 UHs). Lumens were infused with saline (0.9% NaCl) solution under pressure until seals burst or to a maximum pressure of 300 mm Hg. RESULTS: For CVJs, median (range) bursting pressure of the LIG and VSD groups was > 300 mm Hg (224 to > 300 mm Hg) and 35 mm Hg (0 to 60 mm Hg), respectively. Five of 12 CVJs in the VSD group failed at pressures < 33 mm Hg. For UHs, median (range) bursting pressure of the LIG and VSD groups was 255 mm Hg (120 to > 300 mm Hg) and 154 mm Hg (range, 44 to 202 mm Hg), respectively. CONCLUSIONS AND CLINICAL RELEVANCE: The evaluated VSD was effective in sealing UHs at bursting pressures well in excess of expected physiologic pressures, indicating that the VSD may be useful for ovariectomy procedures in rabbits. However, CVJ seals created with the VSD were ineffective and could potentially burst at low pressures, which could predispose to urine entering the abdomen. Given these results, we do not recommend sealing of the CVJ with a VSD for ovariohysterectomy in rabbits.


Assuntos
Histerectomia , Instrumentos Cirúrgicos , Animais , Feminino , Histerectomia/veterinária , Ligadura/veterinária , Ovariectomia/veterinária , Coelhos
4.
Medicine (Baltimore) ; 99(41): e22206, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031263

RESUMO

BACKGROUND: Surgery for lung cancer squeezes the tumor, further promoting the circulation of tumor cells, which may be one of the reasons for lung cancer metastasis and recurrence. In theory, the potential risk of tumor cell proliferation can be minimized if the outflow veins are ligated first (via veins first [V-first]) rather than arteries first (via arteries first [A-first]). However, due to the lack of sufficient evidence, this technical concept has not been widely accepted as a standard in surgical oncology in the current guidelines. This systematic review and meta-analysis will be used to determine which techniques will yield longer patient survival and benefit patients during segmentectomy. METHODS: We will search PubMed, Web of Science, Embase, Cancerlit, the Cochrane Central Register of Controlled Trials, and Google Scholar databases for relevant clinical trials published in any language before January 1, 2021. Randomized controlled trials (RCTs), quasi-RCTs, propensity score-matched comparative studies, and prospective cohort studies of interest, published or unpublished, that meet the inclusion criteria will be included. Subgroup analysis of the type of operation, tumor pathological stage, and ethnicity will be performed. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: As far as we know, this study will be the first meta-analysis to compare the efficacy of the vein-first and artery-first surgical technique of segmentectomy for patients diagnosed with resectable non-small cell lung cancer. Due to the nature of the disease and intervention methods, RCTs may be inadequate, and we will carefully consider inclusion in high-quality, non-RCTs, but this may result in high heterogeneity and affect the reliability of the results.INPLASY registration number: INPLASY202080062.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Células Neoplásicas Circulantes/patologia , Artéria Pulmonar/cirurgia , Veias Pulmonares/cirurgia , Projetos de Pesquisa , Humanos , Ligadura , Metanálise como Assunto , Pneumonectomia , Fatores de Risco , Revisões Sistemáticas como Assunto
5.
Zhonghua Wai Ke Za Zhi ; 58(11): 835-840, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120445

RESUMO

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can speed up the regeneration of future liver remnant (FLR) in short period of time, and offer a chance for surgical resection for patients without sufficient FLR. However, ALPPS still remains controversy due to its high perioperative morbidity and mortality, as well as the uncertain long-term oncological benefits. How to solve these problems is the key to ensure the safety of surgery.This article focus on the indication selection, liver function reserve evaluation and timing to perform the second stage surgery, surgical mode evolution and comparison with portal venous embolization/portal venous ligation+two-stage hepatectomy.


Assuntos
Hepatectomia , Neoplasias Hepáticas , Fígado/cirurgia , Veia Porta/cirurgia , Embolização Terapêutica , Hepatectomia/métodos , Humanos , Ligadura , Fígado/anatomia & histologia , Fígado/fisiologia , Neoplasias Hepáticas/cirurgia , Regeneração Hepática , Resultado do Tratamento
7.
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
8.
J Med Vasc ; 45(5): 241-247, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862980

RESUMO

OBJECTIVE: The persistent sciatic artery (PSA) is a rare congenital anomaly with a high rate of aneurysm formation, occlusion and stenosis. It may lead to severe complications including thrombosis, distal embolisation, or aneurysm rupture. We reported herein our experience in the management of PSA and its complications, and discuss the therapeutic options. METHODS: Eight patients with 10 PSA were managed in our institutions between 1985 and 2017. An analysis was done for the clinical data, surgical technique, and results. RESULTS: The series included six women and two men. The median age of the patients was 66,5 years (37-80 years). Physical examination found a pulsatile gluteal mass in five patients, sciatic neuropathy in two cases. Four patients had an acute ischemia of the lower limb. Cowie's sign was described in only two patients (diminished or absent femoral pulse but presence of popliteal pulse). Digital subtraction angiography was performed in all patients, and was completed with a computed tomography angiography (CTA) with a diagnosis of PSA, associated with a symptomatic aneurysmal lesion in seven cases and with an occlusion in one case. The treatment was surgical in all cases: bipolar exclusion of the aneurysm and bypass between the iliac artery and the PSA distal to the aneurysm was performed in four cases, only proximal and distal ligation was done in 2 other cases. A Chopart amputation was necessary in 2 cases. CONCLUSION: We consider that the treatment of PSA is usually surgical in symptomatic cases. Surgical techniques depend on symptoms and classification describing anatomy of the PSA. However, future studies should compare the open versus the endovascular approach to optimize patient selection criteria and identify the most safe and effective strategy. In an asymptomatic patient, PSA does not require any intervention; continued follow-up is required because of the high incidence of aneurysmal formation and the risk of thromboembolic events.


Assuntos
Artérias/anormalidades , Isquemia/etiologia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/etiologia , Malformações Vasculares/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação , Artérias/diagnóstico por imagem , Artérias/cirurgia , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Ligadura , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/cirurgia , Fatores de Tempo , Resultado do Tratamento , Enxerto Vascular , Malformações Vasculares/diagnóstico por imagem
9.
J Med Vasc ; 45(5): 248-253, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862981

RESUMO

Splenic artery aneurysms are rare. Giant aneurysms more than 2,5cm are extremely rare. The splenic artery is the third site after the aorta and iliac arteries, and the first location for aneurysmal lesion of the visceral arteries. The etiology of splenic artery aneurysms is not yet well established, however, fibromuscular dysplasia, non-cirrhotic portal hypertension and pregnancy seem to contribute to the emergence and evolution of arterial lesions. The majority of splenic artery aneurysms are asymptomatic. However, epigastric or left hypochondrial pain may occur. Doppler ultrasound, computed tomography angiography or magnetic resonance imaging are usually performed in the diagnostic workup. Treatment procedure, surgical or endovascular, depends on the aneurysmal site (proximal or distal) and the type of elective or urgent intervention. The present study reports six cases of splenic artery aneurysm, with a diameter greater than 50mm, treated successfully with surgery.


Assuntos
Aneurisma , Artéria Esplênica , Adulto , Idoso , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esplenectomia , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
10.
Medicine (Baltimore) ; 99(35): e21975, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871947

RESUMO

To investigate the efficiency of high ligation, great saphenous vein stripping and subfascial perforator vein surgery for treating great saphenous vein varicosis under the assistance of sterilized electric pneumatic tourniquet and Esmarchs bandage.In total, 274 patients confirmed with primary varicosis between January 2014 and November 2017 were included in this study. Patients were divided intoAfter surgery, the affected limbs in both groups were wrapped up using the elastic bandage for 2 weeks, followed by wearing elastic stocking for 6 months. Then we analyzed the intraoperative bleeding, surgery time, subcutaneous hemorrhage after surgery and postoperative pains.The surgical time in the treatment group was significantly lower than that of control group (58.62 ±â€Š7.47 minutes vs 76.35 ±â€Š9.24 minutes, P < .01). The intraoperative bleeding in the treatment group was significantly lower than that of the control group (17.56 ±â€Š3.52 ml vs 49.87 ±â€Š8.78 ml, P < .01).High ligation, great saphenous vein stripping, and subfascial perforator vein surgery under the assistance of sterilized electric pneumatic tourniquet and Esmarch's bandage was effective for the treatment of varicosis in lower limbs featured by reduced surgery time and less bleeding.


Assuntos
Veia Safena/cirurgia , Torniquetes , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares/instrumentação , Adulto , Idoso , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade
11.
Khirurgiia (Mosk) ; (8): 107-109, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869623

RESUMO

Aneurysmal transformation of arteriovenous fistula (AVF) is a common complication and associated with increased risk of arrosive bleeding. Ligation of fistulous vein is conventional surgery for bleeding. This is followed by AVF malfunction and need for implantation of central venous catheter. We report reconstructive surgery and maintaining the function of AVF in a patient with aneurysmal transformation of AVF after arrosive bleeding. Reconstructive vascular surgery can significantly extend the period of patent AVF for hemodialysis. This is extremely important in patients with reduced resources of native vessels suitable for AVF formation. The same is true if conversion of the type of renal replacement therapy is associated with significant difficulties.


Assuntos
Aneurisma/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Hemorragia/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma/etiologia , Hemorragia/etiologia , Humanos , Ligadura , Diálise Renal , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/cirurgia
12.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(4): 468-476, 2020 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895098

RESUMO

Objective To establish an improved animal model of sepsis induced by cecal ligation and puncture(CLP). Methods Ninety-six male Sprague-Dawley rats were randomly divided into sham operation group(n=24),intubation group(n=24),CLP group(n=24),and CLP+intubation group(n=24).The mortality rate,abdominal cavity condition,pathological changes and pathological scores of heart,lungs,liver,and kidneys of rats in each group were observed after modeling.Blood samples were obtained from the inferior vena cava for measuring the whole blood cells(WBC)and platelets(PLT)counts and analyzing serum interleukin(IL)-6,tumor necrosis factor(TNF)-α,serum troponin T(cTnT),creatine kinase-MB(CK-MB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),creatinine(CREA),and blood urea nitrogen(BUN)levels.Blood gas analysis of the aorta was also performed. Results The mortality rates 24 h after modeling were 0 in sham operation group and intubation group,20.8% in CLP group,and 54.2% in CLP+intubation group.Pathologically,swelling and inflammatory cell infiltration in the heart,lungs,liver,and kidneys were seen in the CLP+intubation group,inflammatory cell infiltration in a single organ was seen in most rats in the CLP group,and no obvious swelling and infiltration of inflammatory cells was observed in the sham-operation group and intubation group.The myocardial histopathology score,lung tissue injury pathology score,and kidney tissue injury pathology score in both the sham-operation group and the intubation group were significantly lower than those in the CLP group and the CLP+intubation group(all P=0.000).TNF-α,PaO2,CK-MB,cTnT,AST,TBIL,BUN,and CREA were significantly different between sham-operation group and intubation group/CLP group/CLP+intubation group and between intubation group and CLP group/CLP+intubation group(all P=0.000).The pH level was significantly different between sham operation group and intubation group/CLP group,between intubation group and CLP group/CLP+intubate group(all P=0.000). Conclusions Although both CLP and CLP+intubation can well mimic the pathophysiological mechanism of sepsis in rats,multiple organ dysfunction occurs in the latter.Thus,CLP+intubation can establish animal models of multiple organ dysfunction caused by sepsis induced by clinically effective abdominal infection.


Assuntos
Sepse , Animais , Aspartato Aminotransferases , Modelos Animais de Doenças , Ligadura , Masculino , Punções , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa
14.
Arq Bras Cir Dig ; 33(2): e1504, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32844877

RESUMO

BACKGROUND: Transanal haemorrhoidal dearterialization with mucopexy (THD-M) is a valuable option for treating patients with haemorrhoidal disease. However, there is still controversy with regard to its efficacy for more advanced grades. AIM: To evaluate the effectiveness of THD-M technique for treating hemorrhoidal disease and to compare the immediate and late results in different grades. METHOD: Seven hundred and five consecutive patients with Goligher's grade II, III or IV symptomatic haemorrhoids underwent surgical treatment using the THD-M method in five participating centres. Six well-trained and experienced surgeons operated on the patients. Average follow-up was 21 months (12-48). RESULTS: Intraoperative complications were observed in 1.1% of cases, including four cases of haematoma, two of laceration of the mucosa, and two of bleeding. All of these were controlled by means of haemostatic suturing. In relation to postoperative complications, the most common of these were as follows: transitory tenesmus (21.4%); pain (7.2%); mucosal or haemorrhoidal prolapse (6.4%); residual skin tag (5.6%); faecal impaction (3.2%); haemorrhoidal thrombosis (2.8%); bleeding (2.1%); anal fissure (0.7%); and anal abscess (0.3%). Most of the complications were treated conservatively, and only 7.5% (53/705) required some type of surgical approach. There was no mortality or any severe complications. The recurrence of prolapse and bleeding was greater in patients with grade IV haemorrhoidal disease than in those with grade III and II (26.54% and 7.96% vs. 2.31% and 0.92% vs. 2.5% and 1.25%), respectively. CONCLUSION: The THD-M method is safe and effective for haemorrhoidal disease grades II and III with low rates of surgical complications. However, for grade IV hemorrhoids, it is associated with higher recurrence of prolapse and bleeding. So, THD-M method should not be considered as an effective option for the treatment of grade IV hemorrhoids.


Assuntos
Canal Anal/irrigação sanguínea , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Hemorroidas/cirurgia , Reto/irrigação sanguínea , Canal Anal/cirurgia , Artérias , Brasil , Hemorroidectomia , Hemorroidas/classificação , Humanos , Ligadura/métodos , Reto/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(34): e21849, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846835

RESUMO

INTRODUCTION: Patent ductus venosus (PDV) is a rare and critical disease, and the majority of patients present with pulmonary arterial hypertension (PAH) or hepatopulmonary syndrome due to congenital portosystemic shunt. We reported that both PAH and hypersplenism were major complications of PDV in this case. This case report can assist the treatment and recovery of the patients with similar symptoms. PATIENT CONCERNS: A 4-year-old male patient presented to our institution with a history of recurrent respiratory infections accompanied by leukocytopenia, thrombocytopenia and presented with tachypnoea. upon mild exertion. DIAGNOSIS: A wide communication, 10 mm in diameter, between the portal vein and inferior vena cava was identified in the subcostal echocardiogram and computed tomography images. Echocardiography showed an estimated systolic pulmonary artery pressure of 106 mm Hg. Right-sided cardiac catheterization indicated a mean pulmonary arterial pressure of 30 mm Hg and a pulmonary vascular resistance of 3 Wood units. Chest X-ray revealed cardiomegaly with a prominent pulmonary segment. INTERVENTIONS: The patient was treated with combination pharmacotherapy of bosentan and tadalafil and PDV ligation. OUTCOMES: A year later, the boy showed normal exercise tolerance and weight gain. Liver and spleen parameters, liver function, blood cells and the general condition of the boy improved. CONCLUSION: Initial combination therapy of bosentan and tadalafil is safe and effective in children with PAH associated with PDV. When PDV banding test shows normal portal pressure, PDV ligation is considered acceptable in children with PAH and hypersplenism associated with PDV.


Assuntos
Hiperesplenismo/etiologia , Ligadura/métodos , Veia Porta/anormalidades , Hipertensão Arterial Pulmonar/etiologia , Malformações Vasculares/cirurgia , Assistência ao Convalescente , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Bosentana/administração & dosagem , Bosentana/uso terapêutico , Cardiomegalia/diagnóstico por imagem , Pré-Escolar , Terapia Combinada/métodos , Ecocardiografia/métodos , Humanos , Masculino , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Hipertensão Arterial Pulmonar/fisiopatologia , Radiografia Torácica/métodos , Tadalafila/administração & dosagem , Tadalafila/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/tratamento farmacológico , Resistência Vascular/fisiologia , Vasodilatadores/administração & dosagem , Vasodilatadores/uso terapêutico
16.
PLoS One ; 15(8): e0237613, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790786

RESUMO

BACKGROUND: Nordihydroguaiaretic acid (NDGA) is a plant extract that has been shown to act as a free radical scavenger and pluripotent inhibitor of pro-inflammatory cytokines, two major cellular processes involved in the pathophysiology of sepsis. We investigated whether NDGA would improve markers of organ injury as well as survival in a rodent model of sepsis. METHODS: Abdominal sepsis was induced by cecal ligation and double puncture (CLP) in male Sprague-Dawley rats. NDGA was administered either at the time of injury (pre-) or 6 hours later (post-treatment). A sham surgery group and a vehicle only group were also followed as controls. Blood and lung tissue were collected 24 h after CLP. Lung tissue was used for histopathologic analysis and to measure pulmonary edema. Arterial oxygenation was measured directly to generate PaO2/FiO2, and markers of renal injury (blood urea nitrogen), liver injury (alanine aminotransferase), and tissue hypoxia (lactate) were measured. In a separate set of animals consisting of the same treatment groups, animals were followed for up to 36 hours for survival. RESULTS: NDGA pre-treatment resulted in improved oxygenation, less lung edema, lower lactate, lower BUN, and reduced histologic lung injury. NDGA post-treatment resulted in less lung edema, lower lactate, lower BUN, and less histologic lung injury, but did not significantly change oxygenation. None of the NDGA treatment groups statistically affected ALT or creatinine. NDGA pre-treatment showed improved survival compared with control CLP animals at 36 hours, while post-treatment did not. CONCLUSIONS: NDGA represents a novel pleiotropic anti-inflammatory agent with potential clinical utility for modulation of organ injury secondary to sepsis.


Assuntos
Antioxidantes/farmacologia , Ceco/cirurgia , Ligadura/efeitos adversos , Pneumopatias/tratamento farmacológico , Masoprocol/farmacologia , Punções/efeitos adversos , Sepse/cirurgia , Animais , Pneumopatias/etiologia , Pneumopatias/patologia , Masculino , Ratos , Ratos Sprague-Dawley
17.
Eur J Vasc Endovasc Surg ; 60(4): 587-593, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32739105

RESUMO

OBJECTIVE: The aim was to validate the SYM VEIN consensus 3D scoring tool in chronic venous disease (CVD). METHODS: This was a prospective cohort study with a total of 35 consecutive patients with CVD. Patients with CVD undergoing saphenectomy were assessed with the revised Venous Clinical Severity Score (r-VCSS), the CIVIQ-20 quality of life score questionnaire, and the SYM VEIN consensus statement 3D system, pre-operatively and four weeks post-operatively. The total 3D score was tested for reliability, construct validity, and responsiveness. RESULTS: The total 3D score demonstrated good reliability and internal consistency (Cronbach's alpha 0.85). Principal component analysis identified three groups of symptoms (paraesthesia, burning pain, and pruritus, vs. heaviness, sensation of swelling and aching/pain, vs. restless leg and throbbing pain) demonstrating a high intragroup correlation and likely to share similar pathophysiology, indicative of adequate construct validity. The total 3D score showed a significant correlation with r-VCSS and CIVIQ-20 score (rho .46, p = .005 and rho .65, p < .001, respectively) indicative of adequate convergent validity. After saphenectomy, significant reductions (p < .001) of the total 3D, and 3D scores for all but two individual venous symptoms were observed, indicative of excellent responsiveness. Median total 3D score was reduced from 31 to 6 (83.8% decrease, p < .001), median r-VCSS was reduced from 6 to 0 (100% decrease, p < .001), and median CIVIQ-20 score was reduced from 24 to 14 (40% decrease, p < .001). The difference of median percentage change between r-VCSS and CIVIQ-20 score vs. total 3D score was significant (p = .005 and p < .001, respectively). CONCLUSION: The total SYM VEIN 3D score has good reliability, construct validity and excellent responsiveness, although less prone to change after saphenectomy compared with r-VCSS.


Assuntos
Avaliação de Sintomas , Varizes/diagnóstico , Insuficiência Venosa/diagnóstico , Adulto , Idoso , Doença Crônica , Feminino , Nível de Saúde , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Qualidade de Vida , Reprodutibilidade dos Testes , Veia Safena/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento , Varizes/complicações , Varizes/cirurgia , Insuficiência Venosa/complicações , Insuficiência Venosa/cirurgia
20.
Am J Physiol Heart Circ Physiol ; 319(3): H705-H721, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32762560

RESUMO

Myeloperoxidase (MPO)-derived hypochlorous (HOCl) reacts with membrane plasmalogens to yield α-chlorofatty aldehydes such as 2-chlorofatty aldehyde (2-ClFALD) and its metabolite 2-chlorofatty acid (2-ClFA). Recent studies showed that 2-ClFALD and 2-ClFA serve as mediators of the inflammatory responses to sepsis by as yet unknown mechanisms. Since no scavenger for chlorinated lipids is available and on the basis of the well-established role of the MPO/HOCl/chlorinated lipid axis in inflammatory responses, we hypothesized that treatment with MPO inhibitors (N-acetyl lysyltyrosylcysteine amide or 4-aminobenzoic acid hydrazide) would inhibit inflammation and proinflammatory mediator expression induced by cecal ligation and puncture (CLP). We used intravital microscopy to quantify in vivo inflammatory responses in Sham and CLP rats with or without MPO inhibition. Small intestines, mesenteries, and lungs were collected to assess changes in MPO-positive staining and lung injury, respectively, as well as free 2-ClFA and proinflammatory mediators levels. CLP caused neutrophil infiltration, 2-ClFA generation, acute lung injury, leukocyte-/platelet-endothelium interactions, mast cell activation (MCA), plasminogen activator inhibitor-1 (PAI-1) production, and the expression of several cytokines, chemokines, and vascular endothelial growth factor, changes that were reduced by MPO inhibition. Pretreatment with a PAI-1 inhibitor or MC stabilizer prevented CLP-induced leukocyte-endothelium interactions and MCA, and abrogated exogenous 2-ClFALD-induced inflammatory responses. Thus, we provide evidence that MPO instigates these inflammatory changes in CLP and that chlorinated lipids may serve as a mechanistic link between the enzymatic activity of MPO and PAI-1- and mast cell-dependent adhesive interactions, providing a rationale for new therapeutic interventions in sepsis.NEW & NOTEWORTHY Using two distinct myeloperoxidase (MPO) inhibitors, we show for the first time that MPO plays an important role in producing increases in free 2-chlorofatty aldehyde (2-ClFALD)-a powerful proinflammatory chlorinated lipid in plasma and intestine-a number of cytokines and other inflammatory mediators, leukocyte and platelet rolling and adhesion in postcapillary venules, and lung injury in a cecal ligation and puncture model of sepsis. In addition, the use of a plasminogen activator inhibitor-1 (PAI-1) inhibitor or a mast cell stabilizer prevented inflammatory responses in CLP-induced sepsis. PAI-1 inhibition also prevented the proinflammatory responses to exogenous 2-ClFALD superfusion. Thus, our study provides some of the first evidence that MPO-derived free 2-ClFA plays an important role in CLP-induced sepsis by a PAI-1- and mast cell-dependent mechanism.


Assuntos
Ceco/microbiologia , Ácidos Graxos/metabolismo , Ácido Hipocloroso/metabolismo , Mediadores da Inflamação/metabolismo , Inflamação/enzimologia , Peroxidase/metabolismo , Sepse/enzimologia , Aldeídos/metabolismo , Animais , Anti-Inflamatórios/farmacologia , Ceco/cirurgia , Citocinas/metabolismo , Modelos Animais de Doenças , Inibidores Enzimáticos/farmacologia , Inflamação/imunologia , Inflamação/microbiologia , Inflamação/prevenção & controle , Mediadores da Inflamação/antagonistas & inibidores , Intestino Delgado/enzimologia , Intestino Delgado/imunologia , Ligadura , Pulmão/enzimologia , Pulmão/imunologia , Mastócitos/enzimologia , Mastócitos/imunologia , Mesentério/enzimologia , Mesentério/imunologia , Peroxidase/antagonistas & inibidores , Inibidor 1 de Ativador de Plasminogênio/metabolismo , Punções , Ratos Sprague-Dawley , Sepse/imunologia , Sepse/microbiologia , Sepse/prevenção & controle , Transdução de Sinais
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