Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 257
Filtrar
1.
J Stroke Cerebrovasc Dis ; 28(10): 104301, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31375403

RESUMO

OBJECTIVE: The important factor for successful first-pass complete reperfusion (FPR) after combined techniques for mechanical thrombectomy (MT) is unclear. We consider that for successful FPR, the aspiration catheter (AC) should reach to and hold the thrombus before the device is pulled out. Therefore, we defined an ART (AC reached thrombus) sign characterized by the cessation of reverse blood flow in aspiration pump and deformation of stent retriever (SR) at the tip of AC. The purpose of this study was to identify the impact of the ART sign on the outcomes of the combined techniques. METHODS: A retrospective analysis was conducted between January 2015 and September 2018 on the data of consecutive patients who underwent MT for anterior circulation stroke using both SR and AC at the first-pass procedure. We divided the patients into 2 groups based on whether the first-pass procedure achieved the ART sign (ARTs group) or not (Non-ARTs group). The primary endpoint was FPR defined as modified thrombolysis in cerebral infarction (mTICI) score of 3. RESULTS: Sixty-six patients were included in our study (n = 38, ARTs group; n = 28, Non-ARTs group). There were no differences at mTICI 2b/3 (97.3% versus 89.2%, P = .30), but the FPR and mTICI3 were more common in the ARTs group (81.5% versus 14.2%, P < .001; and 89.4% versus 32.1%, P < .001, respectively). CONCLUSIONS: ART sign in combined technique was found to be an important factor for successful FPR.


Assuntos
Infarto Encefálico/terapia , Trombose Intracraniana/terapia , Reperfusão/instrumentação , Trombectomia/instrumentação , Dispositivos de Acesso Vascular , Idoso , Idoso de 80 Anos ou mais , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/fisiopatologia , Circulação Cerebrovascular , Feminino , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/fisiopatologia , Masculino , Reperfusão/efeitos adversos , Estudos Retrospectivos , Stents , Trombectomia/efeitos adversos , Resultado do Tratamento
2.
Int Urol Nephrol ; 51(10): 1873-1881, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31332701

RESUMO

BACKGROUND: Administration of ulinastatin was proved to protect many organs from ischemia/reperfusion (I/R) induced injury, yet its protective effects on renal I/R injury under cold condition and mechanism still remain unclear. AIMS: In the present study, the protective effects of ulinastatin on renal cold I/R injury as well as its mechanism were investigated. METHODS AND RESULTS: Renal cold I/R model was constructed via cross-clamping of left renal artery and vein at 4 °C. The ulinastatin was administrated and multi-methods were performed to evaluate the protective effects. The results showed that ulinastatin could mitigate the renal cold I/R injury. In addition, the attenuated kidney cold I/R injury by ulinastatin was also accompanied with its regulating capability of the microenvironment, such as decreased acute inflammatory response, oxidative stress damage and apoptosis, as well as attenuation of vasculature levels decrease, as evidence by reduced TNF-α, IL-6 mRNA expression, MDA levels and apoptosis, higher levels of SOD activity and CD31/α-SMA expression. CONCLUSION: The present study suggested that ulinastatin might be clinically useful in reducing preservation injury induced by cold I/R during renal transplantation surgery.


Assuntos
Lesão Renal Aguda/etiologia , Lesão Renal Aguda/prevenção & controle , Isquemia Fria/efeitos adversos , Glicoproteínas/administração & dosagem , Traumatismo por Reperfusão/prevenção & controle , Reperfusão/efeitos adversos , Animais , Infusões Intravenosas , Masculino , Ratos Sprague-Dawley
3.
Transplant Proc ; 51(6): 1926-1933, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31301856

RESUMO

BACKGROUND: Surgical factors and direct cytotoxicity of bile salts on cholangiocytes may play a role in the development of ischemic cholangiopathy (IC) after liver transplantation (LTx). There is no validated consensus on how to protect the bile ducts during procurement, static preservation, and LTx. Meanwhile, IC remains the most troublesome complication after LTx. AIM: To characterize bile duct management techniques during the LTx process among European transplant centers in cases of donation after brain death (DBD) and circulatory death (DCD). METHOD: An European Liver and Intestine Transplant Association-European Liver Transplant Registry web survey designed to conceal respondents' personal information was sent to surgeons procuring and/or transplanting livers in Europe. RESULTS: Sixty-five percent of responses came from large transplant centers (>50 procurements/y). In 8% of DBDs and 14% of DCDs the bile duct is not rinsed. In 46% of DBDs and 52% of DCDs surgeons prefer to remove the gallbladder after graft reperfusion. Protocols concerning preservation solutions (nature, pressure, volume) are extremely heterogeneous. In 54% of DBDs and 61% of DCDs an arterial back table pressure perfusion is performed. Steroids (20%-10%), heparin (72%-60%), prostacyclin (3%-7%), and fibrinolytics (4%-11%) are used as donor-protective interventions in DBD and DCD cases, respectively. In 2% of DBD and 6% of DCD cases a hepatic artery reperfusion is performed first. In 4% of DBD and 6% of DCD cases, fibrinolytics are administered through the hepatic artery during the bench and/or implantation. CONCLUSION: This European web survey shows for the first time the heterogeneity in the management of bile ducts during procurement, preservation, and transplantation in Europe. In the context of sharing more marginal liver grafts, an expert meeting must be organized to formulate guidelines to be applied to protect liver grafts against IC.


Assuntos
Ductos Biliares/irrigação sanguínea , Colangite/etiologia , Isquemia/etiologia , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/etiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Ductos Biliares/transplante , Europa (Continente) , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Preservação de Órgãos/efeitos adversos , Preservação de Órgãos/métodos , Perfusão/efeitos adversos , Perfusão/métodos , Reperfusão/efeitos adversos , Reperfusão/métodos , Inquéritos e Questionários , Coleta de Tecidos e Órgãos/métodos
4.
Eur J Appl Physiol ; 119(8): 1819-1828, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31187281

RESUMO

PURPOSE: The aim was to compare changes in peripheral and cerebral oxygenation, as well as metabolic and performance responses during conditions of blood flow restriction (BFR, bilateral vascular occlusion at 0% vs. 45% of resting pulse elimination pressure) and systemic hypoxia (~ 400 m, FIO2 20.9% vs. ~ 3800 m normobaric hypoxia, FIO2 13.1 ± 0.1%) during repeated sprint tests to exhaustion (RST) between leg- and arm-cycling exercises. METHODS: Seven participants (26.6 ± 2.9 years old; 74.0 ± 13.1 kg; 1.76 ± 0.09 m) performed four sessions of RST (10-s maximal sprints with 20-s recovery until exhaustion) during both leg and arm cycling to measure power output and metabolic equivalents as well as oxygenation (near-infrared spectroscopy) of the muscle tissue and prefrontal cortex. RESULTS: Mean power output was lower in arms than legs (316 ± 118 vs. 543 ± 127 W; p < 0.001) and there were no differences between conditions for a given limb. Arms demonstrated greater changes in concentration of deoxyhemoglobin (∆[HHb], - 9.1 ± 6.1 vs. - 6.5 ± 5.6 µm) and total hemoglobin concentration (∆[tHb], 15.0 ± 10.8 vs. 11.9 ± 7.9 µm), as well as the absolute maximum tissue saturation index (TSI, 62.0 ± 8.3 vs. 59.3 ± 8.1%) than legs, respectively (p < 0.001), demonstrating a greater capacity for oxygen extraction. Further, there were greater changes in tissue blood volume [tHb] during BFR only compared to all other conditions (p < 0.01 for all). CONCLUSIONS: The combination of BFR and/or hypoxia led to increased changes in [HHb] and [tHb] likely due to greater vascular resistance, to which arms were more responsive than legs.


Assuntos
Treinamento Intervalado de Alta Intensidade/métodos , Hipóxia/fisiopatologia , Músculo Esquelético/irrigação sanguínea , Consumo de Oxigênio , Córtex Pré-Frontal/irrigação sanguínea , Reperfusão/efeitos adversos , Adulto , Feminino , Treinamento Intervalado de Alta Intensidade/efeitos adversos , Humanos , Masculino , Músculo Esquelético/fisiologia , Oxiemoglobinas/metabolismo
5.
Transplant Proc ; 51(5): 1545-1548, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31155189

RESUMO

The deep peribiliary glands (DPBG) are a niche of progenitor cells in the wall of the biliary duct (BD) and are the second line of multiplication when severe lesion of the epithelium occurs. Previous studies have identified DPBG injury as a cause of post-liver transplant (LT) biliary stenosis; this complication is a major cause of post-LT morbidity. The incidence of biliary stenosis in our center is high (38.1%). This study evaluates the lesion of DPBG in response to ischemia. Graft BD was collected in adult LT between August 2016-July 2017, from donation after brain death. Samples of 45 grafts were collected at 2 moments: BD1-during graft preparation and BD2-before biliary anastomosis. Histological analysis of the samples was performed and then classified according to degree of lesion (0, ≤50%, and >50%). A comparison was made between the degree of lesion and graft ischemia, graft histology, donor, and procurement variables. The DPBG lesion was more frequent in BD2 (20.9% vs 7%, P = .079). BD2 lesions with DPBG lesions had higher medians and means at all times of ischemia. The difference was greater in the warm ischemia time (0: 43.3 ± 12.53 minutes vs ≤50%: 52.4 ± 14.38 minutes, P = .068). The group of BD1 with DPBG lesion presented superior median cold ischemia time (CIT). In the analysis of the remaining variables there were also no statistically significant differences. We concluded that during the period of CIT there is already lesion of the DPBG, which increases after reperfusion of the graft, in greater association with longer warm ischemia time.


Assuntos
Ductos Biliares/patologia , Isquemia Fria/efeitos adversos , Transplante de Fígado , Isquemia Quente/efeitos adversos , Adulto , Feminino , Humanos , Isquemia/patologia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Masculino , Estudos Prospectivos , Reperfusão/efeitos adversos
6.
Cerebrovasc Dis ; 47(3-4): 127-134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30965319

RESUMO

BACKGROUND AND PURPOSE: Recent studies have demonstrated that endovascular reperfusion therapy improves clinical outcomes at 90 days after ischemic stroke. However, the effects on long-term outcomes are not well known. We hypothesized that successful reperfusion might be associated with long-term improvement beyond 90 days after endovascular therapy. To assess the long-term effects beyond 90 days, we analyzed the association of successful reperfusion with a temporal change in modified Rankin Scale (mRS) score from 90 days to 1 year after endovascular therapy. METHODS: We retrospectively analyzed a database of consecutive patients with acute ischemic stroke who received endovascular therapy between April 2006 and March 2016 at 4 centers. We compared the incidences of improvement and deterioration in patients with successful reperfusion (i.e., modified thrombolysis in cerebral infarction score of 2b or 3) with those in patients with unsuccessful reperfusion. We defined improvement and deterioration as decrease and increase on the mRS score by 1 point or more from 90 days to 1 year after endovascular therapy respectively. RESULTS: A total of 268 patients were included in the current study. The rate of patients with improvement tended to be higher in patients with successful reperfusion than in patients with unsuccessful reperfusion (20% [34/167 patients] vs. 12% [12/101], p = 0.07). The rate of patients with deterioration was lower in patients with successful reperfusion than in patients with unsuccessful reperfusion (25% [42/167] vs. 42% [42/101], p < 0.01). After adjustment for confounders, successful reperfusion was associated with improvement (adjusted OR 2.65; 95% CI 1.23-5.73; p < 0.05) and deterioration (adjusted OR 0.33; 95% CI 0.18-0.62; p < 0.01), independent of the 90-day mRS score. CONCLUSIONS: Successful reperfusion has further beneficial legacy effects on long-term outcomes beyond 90 days after stroke.


Assuntos
Isquemia Encefálica/terapia , Procedimentos Endovasculares , Reperfusão/métodos , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Bases de Dados Factuais , Avaliação da Deficiência , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Japão , Masculino , Recuperação de Função Fisiológica , Reperfusão/efeitos adversos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
7.
J Neurointerv Surg ; 11(10): 970-974, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30842304

RESUMO

INTRODUCTION: Endovascular treatment (EVT) for tandem occlusion (TO) of the anterior circulation is complex but effective. The effect of extracranial internal carotid artery (EICA) lesion severity on the outcomes of EVT is unknown. In this study we investigated the effect of EICA lesion severity on the outcomes of tandem occlusion EVT. METHODS: A multicenter retrospective TITAN (Thrombectomy In TANdem lesions) study that included 18 international endovascular capable centers was performed. Patients who received EVT for atherosclerotic TO with or without EICA lesion intervention were included. Patients were divided into two groups based on the EICA lesion severity (high-grade stenosis (≥90% North American Symptomatic Carotid Endarterectomy Trial) vs complete occlusion). Outcome measures included the 90-day clinical outcome (modified Rankin Scale score (mRS)), angiographic reperfusion (modified Thrombolysis In Cerebral Ischemia (mTICI) at the end of the procedure), procedural complications, and intracranial hemorrhage at 24 hours follow-up. RESULTS: A total of 305 patients were included in the study, of whom 135 had complete EICA occlusion and 170 had severe EICA stenosis. The EICA occlusion group had shorter mean onset-to-groin time (259±120 min vs 305±202 min; p=0.037), more patients with diabetes, and fewer with hyperlipidemia. With respect to the outcome, mTICI 2b-3 reperfusion was lower in the EICA occlusion group (70% vs 81%; p=0.03). The favorable outcome (90-day mRS 0-2), intracerebral hemorrhage and procedural complications were similar in both groups. CONCLUSION: Atherosclerotic occlusion of the EICA in acute tandem strokes was associated with a lower rate of mTICI 2b-3 reperfusion but similar functional and safety outcomes when compared with high-grade EICA stenosis.


Assuntos
Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/cirurgia , Procedimentos Endovasculares/métodos , Sistema de Registros , Índice de Gravidade de Doença , Trombectomia/métodos , Idoso , Hemorragia Cerebral/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
8.
Microvasc Res ; 121: 24-29, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30218671

RESUMO

BACKGROUND: Ischemia and reperfusion remain inseparable elements of numerous medical procedures such as by-pass surgery, organ transplantation or other cardiology and intervention radiology. The contraction of the smooth muscle of the vessel is considered to be one of the basic components leading to impaired perfusion, an increase in the oxygen deficit of the endothelium of the vessel, and subsequently also to tissues vascularized by the vessel. Main aim of this study was to evaluate the effect of ischemia and reperfusion on vascular smooth muscle cells stimulated pharmacologically with mastoparan-7 (direct G-protein activator) in comparison to stimulation of G-protein coupled receptor agonist - phenylephrine, and direct calcium channel activator - Bay K8644. MATERIAL AND METHODS: Experiments were performed on isolated and perfused tail artery of Wistar rats. Contraction force in our model was measured by increased level of perfusion pressure with a constant flow. RESULTS: Concentration-response curves obtained for phenylephrine, mastoparan-7 and Bay K8644 presented a sigmoidal relation. Ischemia induced hyporreactivity of vessels, whereas during reperfusion the significant time related hyperreactivity for phenylephrine and mastoparan-7 only but not for Bay K8644. These reactions were secondary to the modulation of calcium influx from intra- and extracellular calcium stores. CONCLUSIONS: Results of our experiments suggest that mastoparan-7 significantly induces contraction of vascular smooth muscle cells not only for controls but in the presence of ischemia and reperfusion too. Potential therapeutic applications of the observed reactions are important. They may include regenerative processes within the nervous system, studies on the improvement of blood flow within the microcirculation, or antimicrobial activity. Modulation of the G protein-phospholipase C response may also be an interesting point of action of future drugs modifying the response to stimulation during ischemia in particular, such activities could take place during the transport of organs for transplantation.


Assuntos
Isquemia/fisiopatologia , Músculo Liso Vascular/fisiopatologia , Traumatismo por Reperfusão/fisiopatologia , Reperfusão/efeitos adversos , Cauda/irrigação sanguínea , Vasoconstrição , Éster Metílico do Ácido 3-Piridinacarboxílico, 1,4-Di-Hidro-2,6-Dimetil-5-Nitro-4-(2-(Trifluormetil)fenil)/farmacologia , Animais , Relação Dose-Resposta a Droga , Peptídeos e Proteínas de Sinalização Intercelular , Masculino , Músculo Liso Vascular/efeitos dos fármacos , Peptídeos/farmacologia , Fenilefrina/farmacologia , Ratos Wistar , Vasoconstrição/efeitos dos fármacos , Vasoconstritores/farmacologia
9.
Hepatobiliary Pancreat Dis Int ; 18(1): 4-11, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30579736

RESUMO

BACKGROUND: Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction. This study was to compare the prevalence of non-anastomotic biliary stricture and other surgical complications based on Clavien-Dindo scoring system, in initial portal reperfusion (sequential) versus simultaneous or initial artery reperfusion. DATA SOURCES: Meta-analysis of published studies comparing the outcomes of both techniques was carried out. Data search was conducted across the major databases and studies were selected under the guidance of the Cochrane guidelines for systematic reviews and meta-analysis. RESULTS: Seven studies were included to address the primary and the secondary outcomes. No statistical difference was found in the incidence of non-anastomotic biliary strictures (OR = 0.40; P = 0.14), regardless of reperfusion technique. The pooled estimate of the Clavien-Dindo grading of complications was not significantly different between the techniques, though Clavien-Dindo II complications were higher in the simultaneous or initial artery reperfusion group than the initial portal reperfusion group (OR = 2.73; P = 0.01). Similarly, there was no difference in the operative time, hospital stay and other outcomes addressed in this report. CONCLUSIONS: The available evidence suggests that there is no significant difference demonstrated in the rate of non-anastomotic biliary strictures or other complications, between the two techniques, except for Clavien-Dindo II complications.


Assuntos
Colestase/epidemiologia , Transplante de Fígado/efeitos adversos , Traumatismo por Reperfusão/etiologia , Reperfusão/efeitos adversos , Colestase/diagnóstico , Humanos , Incidência , Transplante de Fígado/métodos , Prevalência , Reperfusão/métodos , Traumatismo por Reperfusão/diagnóstico , Medição de Risco , Fatores de Risco , Resultado do Tratamento
10.
Sci Rep ; 8(1): 16306, 2018 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-30390037

RESUMO

Many liver transplant recipients experience intraoperative hyperglycemia after graft reperfusion. Accordingly, we introduced the Portland intensive insulin therapy (PoIIT) in our practice to better control blood glucose concentration (BGC). We evaluated the effects of PoIIT by comparing with our conventional insulin therapy (CoIT). Of 128 patients who underwent living donor liver transplantation (LDLT) during the phaseout period of CoIT, 89 were treated with the PoIIT and 39 were treated with CoIT. The primary outcome was hyperglycemia (BGC > 180 mg/dL) during the intraoperative postreperfusion phase. The secondary outcomes were postoperative complications such as infection. The incidence of hyperglycemia (22.5% vs. 53.8%, p = 0.001) and prolonged hyperglycemia for >2 hours (7.9% vs. 30.8%, p = 0.002) was significantly lower in PoIIT group than in CoIT group. A mixed linear model further demonstrated that repeatedly measured BGCs were lower in PoIIT group (p < 0.001). The use of PoIIT was significantly associated with decreases in major infections (OR = 0.23 [0.06-0.85], p = 0.028), prolonged mechanical ventilation (OR = 0.29 [0.09-0.89], p = 0.031), and biliary stricture (OR = 0.23 [0.07-0.78], p = 0.018) after adjustments for age, sex, and diabetes mellitus. In conclusion, the PoIIT is effective for maintaining BGC and preventing hyperglycemia during the intraoperative postreperfusion phase of living donor liver transplantation with potential clinical benefits.


Assuntos
Hiperglicemia/prevenção & controle , Insulina/administração & dosagem , Cuidados Intraoperatórios/métodos , Complicações Intraoperatórias/prevenção & controle , Transplante de Fígado/efeitos adversos , Reperfusão/efeitos adversos , Adulto , Glicemia/análise , Protocolos Clínicos , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/etiologia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
Nat Rev Nephrol ; 14(12): 767-781, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30367174

RESUMO

Increasing evidence indicates an integral role for the complement system in the deleterious inflammatory reactions that occur during critical phases of the transplantation process, such as brain or cardiac death of the donor, surgical trauma, organ preservation and ischaemia-reperfusion injury, as well as in humoral and cellular immune responses to the allograft. Ischaemia is the most common cause of complement activation in kidney transplantation and in combination with reperfusion is a major cause of inflammation and graft damage. Complement also has a prominent role in antibody-mediated rejection (ABMR) owing to ABO and HLA incompatibility, which leads to devastating damage to the transplanted kidney. Emerging drugs and treatment modalities that inhibit complement activation at various stages in the complement cascade are being developed to ameliorate the damage caused by complement activation in transplantation. These promising new therapies have various potential applications at different stages in the process of transplantation, including inhibiting the destructive effects of ischaemia and/or reperfusion injury, treating ABMR, inducing accommodation and modulating the adaptive immune response.


Assuntos
Ativação do Complemento , Proteínas do Sistema Complemento/metabolismo , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/imunologia , Isquemia/fisiopatologia , Transplante de Rim , Imunidade Adaptativa , Animais , Humanos , Imunomodulação , Inflamação/metabolismo , Reperfusão/efeitos adversos
12.
Medicine (Baltimore) ; 97(34): e11893, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30142789

RESUMO

RATIONALE: Postreperfusion syndrome is the most severe cardiovascular and metabolic alteration which typically occurs after the declamping of the portal vein of the grafted liver during liver transplantation, and it could affect the mortality and morbidity of the patient. PATIENT CONCERNS: We report the case of ischemic change in electrocardiogram with substantial increase of central venous pressure, from 6 to 16 mmHg, that developed immediately after reperfusion. DIAGNOSES: Based on his hemodynamic parameters, it was suspected that this event was caused by sudden volume overload in the right ventricle after reperfusion rather than hypovolemic status, thromboembolism, or any other possibilities. INTERVENTIONS: He was treated with active venesection of 300 mL and isosorbide dinitrates infusion at the rate of 30 µg/min. OUTCOMES: The parameter values were restored to normal within 15 to 20 minutes after treatment, and the patient was discharged postoperatively without any significant cardiac sequelae. LESSONS: Although ischemic ST change during reperfusion reported without any previous cardiac complication is limited, the patient could recover rapidly with careful identification of the cause of PRS and immediate treatment.


Assuntos
Dinitrato de Isossorbida/administração & dosagem , Transplante de Fígado/efeitos adversos , Flebotomia/métodos , Veia Porta/cirurgia , Reperfusão/efeitos adversos , Terapia Combinada , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
J Trauma Acute Care Surg ; 85(4): 717-724, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29985233

RESUMO

BACKGROUND: Uncontrolled hemorrhage is a leading cause of tactical trauma-related deaths. Hemorrhage from the pelvis and junctional regions are particularly difficult to control due to the inability of focal compression. The Abdominal Aortic and Junctional Tourniquet (AAJT) occludes aortic blood flow by compression of the abdomen. The survivability of tourniquet release beyond 120 minutes is unknown and fluid requirements to maintain sufficient blood pressure during prolonged application are undetermined. We therefore compared 60-minute and 240-minute applications and release of the AAJT for 30 minutes, with crystalloid fluid therapy, after a Class II hemorrhage. METHODS: Sixty-kilogram anesthetized pigs were subjected to 900-mL hemorrhage and AAJT application for 60 minutes (n = 5), 240 minutes (n = 5), and fluid therapy only for 240 minutes (n = 5) and reperfusion for 30 minutes. RESULTS: The AAJT application was hemodynamically and respiratory tolerable for 60 minutes and 240 minutes. Cumulative fluid requirements decreased by 64%, comparable to 3000 mL of crystalloids. Mechanical ventilation was impaired. AAJT increased the core temperature by 0.9°C compared with fluid therapy. Reperfusion consequences were reversible after 60 minutes but not after 240 minutes. A 240-minute application resulted in small intestine and liver ischemia, persisting hyperkalemia, metabolic acidosis, and myoglobinemia, suggesting rhabdomyolysis. CONCLUSION: The AAJT application for 240 minutes with reperfusion was survivable in an intensive care setting and associated with abdominal organ damage. Long time consequences and spinal cord effects was not assessed. We propose an application time limit within 60 minutes to 240 minutes, though further studies are needed to increase the temporal resolution. The AAJT application may be considered as a rescue option to maintain central blood pressure and core temperature in cases of hemorrhagic shock from extremity bleedings, if fluid therapy is unavailable or if the supply is limited. LEVEL OF EVIDENCE: Therapeutic study, level II.


Assuntos
Hemorragia/terapia , Intestino Delgado/irrigação sanguínea , Isquemia/etiologia , Fígado/irrigação sanguínea , Reperfusão/efeitos adversos , Torniquetes/efeitos adversos , Acidose/etiologia , Animais , Aorta Abdominal , Soluções Cristaloides/administração & dosagem , Hidratação , Hiperpotassemia/etiologia , Complacência Pulmonar , Masculino , Distribuição Aleatória , Respiração Artificial , Suínos , Volume de Ventilação Pulmonar , Fatores de Tempo , Veia Cava Inferior
14.
Sci Rep ; 8(1): 9832, 2018 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-29959399

RESUMO

We evaluated the effects of admission hyperglycemia with different cut-off levels on 3-month outcomes, infarct growth, and hemorrhagic transformation in acute stroke patients with large artery occlusion of anterior circulation who received endovascular treatment (EVT). Between January 2011 and May 2016, patients that underwent EVT with pre-procedural and post-procedural diffusion-weighted imaging were identified from a multicenter registry. Normoglycemia was defined as a glucose level ≤ 110 mg/dL, moderate hyperglycemia as >110 and ≤170 mg/dL, and overt hyperglycemia as >170 mg/dL. Its effects on poor outcomes (3-month modified Rankin Scale score 3-6), infarct growth, and parenchymal hematoma type 2 were analyzed. Of 720 patients encountered, 341 patients were eligible. There was a statistically significant difference in glycated hemoglobin levels between the normoglycemia/moderate hyperglycemia and overt hyperglycemia groups (p < 0.001). Moderate hyperglycemia (odds ratio 2.37 [95% confidence interval 1.26-4.45], p = 0.007) and overt hyperglycemia (2.84 [1.19-6.81], p = 0.019) were associated with poor outcomes. Post-procedural infarct volumes were significantly greater in hyperglycemic patients (padjusted = 0.003). Only overt hyperglycemia (9.28 [1.66-51.88], p = 0.011) was associated with parenchymal hematoma type 2. Overall hyperglycemia was associated with poor outcomes and infarct growth, whereas overt hyperglycemia was associated with parenchymal hematoma type 2.


Assuntos
Infarto Encefálico/patologia , Isquemia Encefálica/terapia , Hemorragia Cerebral/patologia , Procedimentos Endovasculares/efeitos adversos , Hiperglicemia/fisiopatologia , Reperfusão/efeitos adversos , Acidente Vascular Cerebral/terapia , Idoso , Glicemia/análise , Infarto Encefálico/etiologia , Isquemia Encefálica/fisiopatologia , Hemorragia Cerebral/etiologia , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Masculino , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
15.
IEEE Trans Biomed Eng ; 65(9): 2058-2065, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29989941

RESUMO

OBJECTIVE: Hemorrhagic transformation (HT) is the most severe complication of reperfusion therapy in acute ischemic stroke (AIS) patients. Management of AIS patients could benefit from accurate prediction of upcoming HT. While prediction of HT occurrence has recently provided encouraging results, the prediction of the severity and territory of the HT could bring valuable insights that are beyond current methods. METHODS: This study tackles these issues and aims to predict the spatial occurrence of HT in AIS from perfusion-weighted magnetic resonance imaging (PWI) combined with diffusion weighted imaging. In all, 165 patients were included in this study and analyzed retrospectively from a cohort of AIS patients treated with reperfusion therapy in a single stroke center. RESULTS: Machine learning models are compared within our framework; support vector machines, linear regression, decision trees, neural networks, and kernel spectral regression were applied to the dataset. Kernel spectral regression performed best with an accuracy of $\text{83.7} \pm \text{2.6}\%$. CONCLUSION: The key contribution of our framework formalize HT prediction as a machine learning problem. Specifically, the model learns to extract imaging markers of HT directly from source PWI images rather than from pre-established metrics. SIGNIFICANCE: Predictions visualized in terms of spatial likelihood of HT in various territories of the brain were evaluated against follow-up gradient recalled echo and provide novel insights for neurointerventionalists prior to endovascular therapy.


Assuntos
Hemorragia Cerebral , Interpretação de Imagem Assistida por Computador/métodos , Angiografia por Ressonância Magnética/métodos , Reperfusão/efeitos adversos , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/prevenção & controle , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia
16.
Arterioscler Thromb Vasc Biol ; 38(8): 1761-1771, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29903733

RESUMO

Objective- Hemorrhagic transformation is a serious complication of ischemic stroke after recanalization therapies. This study aims to identify mechanisms underlying hemorrhagic transformation after cerebral ischemia/reperfusion. Approach and Results- We used wild-type mice and Selplg-/- and Fut7-/- mice defective in P-selectin binding and lymphopenic Rag2-/- mice. We induced 30-minute or 45-minute ischemia by intraluminal occlusion of the middle cerebral artery and assessed hemorrhagic transformation at 48 hours with a hemorrhage grading score, histological means, brain hemoglobin content, or magnetic resonance imaging. We depleted platelets and adoptively transferred T cells of the different genotypes to lymphopenic mice. Interactions of T cells with platelets in blood were studied by flow cytometry and image stream technology. We show that platelet depletion increased the bleeding risk only after large infarcts. Lymphopenia predisposed to hemorrhagic transformation after severe stroke, and adoptive transfer of T cells prevented hemorrhagic transformation in lymphopenic mice. CD4+ memory T cells were the subset of T cells binding P-selectin and platelets through functional P-selectin glycoprotein ligand-1. Mice defective in P-selectin binding had a higher hemorrhagic score than wild-type mice. Adoptive transfer of T cells defective in P-selectin binding into lymphopenic mice did not prevent hemorrhagic transformation. Conclusions- The study identifies lymphopenia as a previously unrecognized risk factor for secondary hemorrhagic transformation in mice after severe ischemic stroke. T cells prevent hemorrhagic transformation by their capacity to bind platelets through P-selectin. The results highlight the role of T cells in bridging immunity and hemostasis in ischemic stroke.


Assuntos
Transferência Adotiva , Plaquetas/metabolismo , Linfócitos T CD4-Positivos/transplante , Infarto da Artéria Cerebral Média/terapia , Hemorragias Intracranianas/prevenção & controle , Linfopenia/terapia , Selectina-P/metabolismo , Traumatismo por Reperfusão/prevenção & controle , Reperfusão/efeitos adversos , Animais , Plaquetas/imunologia , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD4-Positivos/metabolismo , Proteínas de Ligação a DNA/genética , Proteínas de Ligação a DNA/metabolismo , Modelos Animais de Doenças , Fucosiltransferases/genética , Fucosiltransferases/metabolismo , Genótipo , Memória Imunológica , Infarto da Artéria Cerebral Média/genética , Infarto da Artéria Cerebral Média/imunologia , Infarto da Artéria Cerebral Média/metabolismo , Hemorragias Intracranianas/genética , Hemorragias Intracranianas/imunologia , Hemorragias Intracranianas/metabolismo , Linfopenia/genética , Linfopenia/imunologia , Linfopenia/metabolismo , Masculino , Glicoproteínas de Membrana/genética , Glicoproteínas de Membrana/metabolismo , Camundongos Endogâmicos C57BL , Camundongos Knockout , Selectina-P/imunologia , Traumatismo por Reperfusão/genética , Traumatismo por Reperfusão/imunologia , Traumatismo por Reperfusão/metabolismo , Fatores de Risco , Fatores de Tempo
17.
Braz J Cardiovasc Surg ; 33(2): 143-150, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29898143

RESUMO

INTRODUCTION: Hypothermic circulatory arrest is widely used for correction of acute type A aortic dissection pathology. We present our experience of 45 consecutive patients operated in our unit with bilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest. METHODS: Between January 2011 and April 2015, 45 consecutive patients were admitted for acute type A aortic dissection and operated emergently under moderate hypothermic circulatory arrest and bilateral antegrade cerebral perfusion. RESULTS: Mean age was 58±11.4 years old. Median circulatory arrest time was 41.5 (30-54) minutes while the 30-day mortality and postoperative permanent neurological deficits rates were 6.7% and 13.3%, respectively. Unadjusted analysis revealed that the factors associated with 30-day mortality were: preoperative hemodynamic instability (OR: 14.8, 95% CI: 2.41, 90.6, P=0.004); and postoperative requirement for open sternum management (OR: 5.0, 95% CI: 1.041, 24.02, P=0.044) while preoperative hemodynamic instability (OR: 8.8, 95% CI: 1.41, 54.9, P=0.02) and postoperative sepsis or multiple organ dysfunction (OR: 13.6, 95% CI: 2.1, 89.9, P=0.007) were correlated with neurological dysfunction. By multivariable logistic regression analysis, postoperative sepsis and multiple organ dysfunction independently predicted (OR: 15.9, 95% CI: 1.05, 96.4, P=0.045) the incidence of severe postoperative neurological complication. During median follow-up of 6 (2-12) months, the survival rate was 86.7%. CONCLUSION: Bilateral antegrade cerebral perfusion and direct carotid perfusion for cardiopulmonary bypass, in the surgical treatment for correction of acute aortic dissection type A, is a valuable technique with low 30-day mortality rate. However, postoperative severe neurological dysfunctions remain an issue that warrants further research.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Encéfalo/irrigação sanguínea , Ponte Cardiopulmonar/métodos , Parada Circulatória Induzida por Hipotermia Profunda/métodos , Reperfusão/métodos , Doença Aguda , Idoso , Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/mortalidade , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/mortalidade , Parada Circulatória Induzida por Hipotermia Profunda/efeitos adversos , Parada Circulatória Induzida por Hipotermia Profunda/mortalidade , Feminino , Hemodinâmica , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Complicações Pós-Operatórias , Reperfusão/efeitos adversos , Reperfusão/mortalidade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
Ann Transplant ; 23: 334-344, 2018 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-29773782

RESUMO

BACKGROUND Postreperfusion syndrome (PRS) is a dreadful and well-documented complication in adult liver transplantation (LT). However, information regarding PRS in pediatric LT is still scarce. We aimed to identify the incidence, risk factors and associated outcomes of pediatric LT in a single-center study. MATERIAL AND METHODS The medical records of 75 consecutive pediatric patients who underwent deceased donor liver transplantation (DDLT) from July 2015 to October 2017 were retrospectively reviewed. PRS was determined according to the Peking criteria when significant arrhythmia or refractory hypotension occurred following revascularization of the liver graft. Patients were divided into PRS and non-PRS groups. Preoperative, intraoperative, and postoperative data were collected and compared between the 2 groups. Independent risk factors for PRS were analyzed using binary logistic regression analysis. RESULTS PRS occurred in 26 patients (34.7%). Univariate analysis showed that the graft-to-recipient weight ratio (P=0.023), donor warm ischemia time (P<0.001), and the use of an expanded criteria donor (ECD) liver graft (P<0.001) were significant predictors of PRS. Binary logistic regression showed that the use of an ECD liver graft (odds ratio [OR]: 18.668; 95% confidence interval [95% CI]: 4.866-71.622) and lower hematocrit (HCT) level before reperfusion (OR: 0.878; 95% CI: 0.782-0.985) were independent predictors of PRS. PRS was significantly associated with early allograft dysfunction (73.1% vs. 18.4%, P<0.001), primary nonfunction (11.5% vs. 0.0%, P=0.039), and a prolonged hospital stay (median: 30.5 vs. 21.0, P=0.007). CONCLUSIONS The use of an ECD liver graft and lower HCT level before reperfusion were independent risk factors for PRS in pediatric DDLT. Intraoperative PRS occurrence seems to be associated with poor liver allograft function and worsened patient postoperative outcomes.


Assuntos
Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Transplante de Fígado/efeitos adversos , Traumatismo por Reperfusão/diagnóstico , Traumatismo por Reperfusão/etiologia , Reperfusão/efeitos adversos , Criança , Pré-Escolar , Feminino , Hematócrito , Humanos , Incidência , Lactente , Complicações Intraoperatórias/terapia , Modelos Logísticos , Masculino , Traumatismo por Reperfusão/terapia , Estudos Retrospectivos , Fatores de Risco , Síndrome , Doadores de Tecidos , Obtenção de Tecidos e Órgãos
19.
Brain Behav ; 8(5): e00959, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29761012

RESUMO

Introduction: Ischemia/reperfusion (I/R) injury, such as myocardial infarction, stroke, and peripheral vascular disease, has been recognized as the most frequent causes of devastating disorders and death currently. Protective effect of various preconditioning stimuli, including hyperbaric oxygen (HBO), has been proposed in the management of I/R. Methods: In this study, we searched and reviewed up-to-date published papers to explore the pathophysiology of I/R injury and to understand the mechanisms underlying the protective effect of HBO as conditioning strategy. Results: Animal study and clinic observation support the notion that HBO therapy and conditioning provide beneficial effect against the deleterious effects of postischemic reperfusion. Several explanations have been proposed. The first likely mechanism may be that HBO counteracts hypoxia and reduces I/R injury by improving oxygen delivery to an area with diminished blood flow. Secondly, by reducing hypoxia-ischemia, HBO reduces all the pathological events as a consequence of hypoxia, including tissue edema, increased affective area permeability, postischemia derangement of tissue metabolism, and inflammation. Thirdly, HBO may directly affect cell apoptosis, signal transduction, and gene expression in those that are sensitive to oxygen or hypoxia. HBO provides a reservoir of oxygen at cellular level not only carried by blood, but also by diffusion from the interstitial tissue where it reaches high concentration that may last for several hours, improves endothelial function and rheology, and decreases local inflammation and edema. Conclusion: Evidence suggests the benefits of HBO when used as a preconditioning stimulus in the setting of I/R injury. Translating the beneficial effects of HBO into current practice requires, as for the "conditioning strategies", a thorough consideration of risk factors, comorbidities, and comedications that could interfere with HBO-related protection.


Assuntos
Oxigenação Hiperbárica/métodos , Precondicionamento Isquêmico/métodos , Traumatismo por Reperfusão/prevenção & controle , Animais , Apoptose/fisiologia , Modelos Animais de Doenças , Feminino , Humanos , Masculino , Oxigênio/administração & dosagem , Ratos Sprague-Dawley , Reperfusão/efeitos adversos
20.
J Trauma Acute Care Surg ; 85(3): 512-518, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29847535

RESUMO

BACKGROUND: New strategies to mitigate ischemia during REBOA and to prolong its maximal duration are needed. We hypothesized that simple external cooling of the hind limbs would decrease ischemia-reperfusion injury following prolonged Zone 3 REBOA. METHODS: Twelve swine were anesthetized, instrumented, splenectomized, and then underwent 15% total blood volume hemorrhage. Animals were randomized to hypothermia or control followed by 4 hours of Zone 3 REBOA, resuscitation with shed blood, and 3 hours of critical care. Physiologic parameters were continuously recorded, and laboratory specimens were obtained at regular intervals. Baseline and end-of-study muscle biopsies were obtained for histologic analysis. RESULTS: There were no significant differences between groups at baseline or after hemorrhage. Maximum creatine kinase was significantly lower in the hypothermia group compared with the normothermia group (median [interquartile range] = 3,445 U/mL [3,380-4,402 U/mL] vs. 22,544 U/mL [17,030-24,981 U/mL]; p < 0.01). Maximum serum myoglobin was also significantly lower in the hypothermia group (1,792 ng/mL [1,250-3,668 ng/mL] vs. 21,186 ng/mL [14,181-24,779 ng/mL]; p < 0.01). Fascial compartment pressures were significantly lower during critical care in the hypothermia group (p = 0.03). No histologic differences were observed in hind limb skeletal muscle. CONCLUSIONS: External cooling during prolonged Zone 3 REBOA decreased ischemic muscle injury and resulted in lower compartment pressures following reperfusion. Hypothermia may be a viable option to extend the tolerable duration of Zone 3 occlusion, beyond what is currently achievable. Future survival studies are required to assess functional outcomes.


Assuntos
Temperatura Baixa/efeitos adversos , Procedimentos Endovasculares/instrumentação , Extremidade Inferior/irrigação sanguínea , Traumatismo por Reperfusão/prevenção & controle , Animais , Oclusão com Balão/métodos , Creatina Quinase/metabolismo , Modelos Animais de Doenças , Feminino , Hemorragia/prevenção & controle , Membro Posterior/irrigação sanguínea , Membro Posterior/fisiopatologia , Hipotermia/complicações , Isquemia , Extremidade Inferior/fisiopatologia , Masculino , Músculos/irrigação sanguínea , Músculos/metabolismo , Músculos/patologia , Mioglobina/sangue , Reperfusão/efeitos adversos , Ressuscitação/instrumentação , Choque Hemorrágico , Suínos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA