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1.
Enferm. foco (Brasília) ; 10(7): 90-95, dez. 2019. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1051334

RESUMO

Objetivo: Construir e validar um questionário para avaliação do Conhecimento, Atitude e Prática sobre o processo de Doação de órgãos e Tecidos. Método: Estudo metodológico para construção e validação do questionário a ser aplicado para os profissionais que atuam nas Comissões Intra-Hospitalares de Órgãos e Tecidos para Transplantes. Na primeira etapa, foi realizado um levantamento bibliográfico e formulação do conteúdo das questões. Na segunda, ocorreu a seleção dos juízes e validação de face e conteúdo do questionário através do cálculo de Índice de Validade de Conteúdo (IVC), com valor de corte superior a 0,79. Na terceira etapa, foi realizada a síntese das revisões dos juízes e estruturação do instrumento. Resultados: Foi elaborado um instrumento de 25 questões divididos em conhecimento, atitude e prática. Como juízes participaram nove profissionais. Todos os IVCs foram superiores a 0,889. Conclusão: O questionário foi construído e apresenta evidências de validade. (AU)


Objective: To construct and validate a questionnaire for the evaluation of Knowledge, Attitude and Practice on the process of Organ and Tissue Donation. Methodology: Methodological study for the construction and validation of the questionnaire to be applied to professionals working in the Intra-Hospital Organ and Transplant Tissue Commissions. In the first stage, a bibliographical survey and formulation of the content of the questions was carried out. In the second, the selection of the judges and validation of the face and content of the questionnaire were performed by calculating the Content Validity Index (IVC), with a cutoff value above 0.79. In the third stage, the synthesis of the judges' reviews and the structuring of the instrument were carried out. Results: An instrument of 25 questions divided into knowledge, attitude and practice was elaborated. As judges nine professionals participated. All IVCs were greater than 0.889. Conclusion: The constructed questionnaire presents evidence of validity. (AU)


Objetivo: Construir y validar un cuestionario para la evaluación del Conocimiento, Actitud y Práctica sobre el proceso de donación de órganos y tejidos. Metodologia: Estudio metodológico para la construcción y validación del cuestionario a ser aplicado para los profesionales que actúan en las Comisiones Intra-Hospitalarias de Órganos y Tejidos para trasplantes. En la primera etapa, se realizó un levantamiento bibliográfico y formulación del contenido de las cuestiones. En la segunda, ocurrió la selección de los jueces y validación de cara y contenido del cuestionario a través del cálculo del Índice de Validez de Contenido (IVC), con valor de corte superior a 0,79. En la tercera etapa, se realizó la síntesis de las revisiones de los jueces y la estructuración del instrumento. Resultados: Se elaboró un instrumento de 25 preguntas divididas en conocimiento, actitud y práctica. Como jueces participaron nueve profesionales. Todos los IVC fueron superiores a 0,889. Conclusión: El cuestionario construido y presenta evidencias de validez. (AU)


Assuntos
Obtenção de Tecidos e Órgãos , Transplante , Inquéritos e Questionários , Enfermagem , Gestão em Saúde
2.
Rev. bras. cir. plást ; 34(4): 477-484, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047906

RESUMO

Introdução: Sabe-se que o câncer de mama é hoje a segunda neoplasia mais frequente entre as mulheres, as quais são submetidas desde a tratamentos clínicos até cirúrgicos mutilantes da mama. Ter mamas bonitas e harmoniosas é um direito legítimo, sendo assim o conceito de reconstrução mamária e do complexo areolo papilar se torna importante na reinserção social feminina. Este estudo visa apresentar uma técnica eficaz de reconstrução areolar, utilizando enxerto cutâneo livre palpebral bilateral, demonstrando sua eficácia através de resultados fotográficos, comparação com outras técnicas já descritas e questionários de satisfação dos pacientes. Resultados: Foram avaliados, retrospectivamente, 50 pacientes operados de reconstrução areolar com enxerto de pele palpebral e outras técnicas já descritas, operados por um único cirurgião sênior. O grupo de pacientes operados com pele palpebral não obtiveram diferenças significativas dentro da análise de resultados, comparados com outras técnicas de reconstrução. Houve boa satisfação por parte dos pacientes, quanto ao resultado das cirurgias das aréolas. Conclusão: O estudo obteve baixos índices de complicações, apresentando-se como boa opção terapêutica, dentro do arsenal cirúrgico de reconstrução areolar.


Introduction: Breast cancer is currently the second most common neoplasm among women who undergo clinical treatments and breast-mutilating surgeries. Having beautiful and harmonious breasts is a legitimate right, so the concept of reconstructing the breast and nipple-areolar complex becomes important in female social reinsertion. This study aimed to present an effective technique of areolar reconstruction using free bilateral eyelid skin grafts and demonstrate its effectiveness through photographic results, comparison with previously described techniques, and patient satisfaction questionnaires. Results: The authors retrospectively evaluated 50 patients who underwent areolar reconstruction with eyelid skin grafts and other techniques performed by a single senior surgeon. Patients who underwent eyelid skin graft surgery did not achieve significantly different results from those who underwent other reconstruction techniques. Patients who underwent areola surgeries reported good satisfaction. Conclusion: The study revealed low complication rates and demonstrated that the use of eyelid skin is a good therapeutic option for areolar reconstruction.


Assuntos
Humanos , Feminino , História do Século XXI , Pacientes , Pele , Transplante , Mama , Satisfação do Paciente , Procedimentos Cirúrgicos Reconstrutivos , Estética , Pálpebras , Mamilos , Transplante/métodos , Transplante/estatística & dados numéricos , Mama/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Pálpebras/cirurgia , Mamilos/cirurgia
3.
Horiz. méd. (Impresa) ; 19(3): 20-26, Set. 2019. ilus, graf, tab
Artigo em Espanhol | LILACS, LIPECS | ID: biblio-1022286

RESUMO

Objetivo: Realizar una evaluación de la cicatrización en la zona donante de injerto de piel parcial con uso de sustituto dérmico comparado con xenoinjerto, en pacientes con lesiones diversas que requirieron injerto de piel parcial. Materiales y métodos: Se presenta el reporte de 20 pacientes entre 19 y 65 años de la Unidad de Cirugía Plástica del Hospital María Auxiliadora de Lima Metropolitana-Perú, entre diciembre 2017 y junio 2018, donde se evaluó la cicatrización en zonas donantes de injerto de piel parcial. El estudio es de tipo intervención, analítico, prospectivo y longitudinal. Emplea el diseño doble ciego para controlar posibles sesgos. Para analizar la significancia estadística se usaron pruebas no paramétricas con un nivel de confianza 95 %. Resultados: Con el uso del sustituto dérmico se aprecia una mejor calidad de cicatrización de zonas donantes de epitelización en comparación con el xenoinjerto. Ambas técnicas se evaluaron con la escala de Vancouver que considera cinco aspectos (cicatrización, vascularidad, pigmentación, flexibilidad y altura), de los cuales, la cicatrización tuvo resultados significativos (p<0,05). Al estimar el riesgo de evolución de cicatrización según el modelo de riesgos proporcionales de Cox, se obtuvo un H=0,60 (IC95% 0,46-0,78), lo cual indica que el menor tiempo de cicatrización se encontró en el grupo en que se empleó el sustituto dérmico. Conclusiones: El sustituto dérmico es una alternativa importante que favorece buena calidad de la cicatrización en las zonas donantes. El sustituto dérmico es más eficiente que el xenoinjerto convencional al ser evaluado y comparado en la escala de cicatrización de Vancouver.


Objective: To evaluate healing in partial skin graft donor sites using a skin substitute compared to a xenograft in patients with different diseases requiring partial skin grafting. Materials and methods: This paper presents a report of 20 patients between 19 and 65 years from the Plastic Surgery Unit of the Hospital María Auxiliadora in Lima Metropolitan Area, Peru, between December 2017 and June 2018, where healing was evaluated in partial skin graft donor sites. An interventional, analytical, prospective and longitudinal study was conducted using a double-blind design to control possible biases. For the statistical significance analysis, nonparametric tests with a 95 % confidence interval were used. Results: Using a skin substitute, a better healing quality of donor sites of epithelialization was seen compared with xenografting. Both techniques were evaluated with the Vancouver scale, which considers five aspects (healing, vascularity, pigmentation, flexibility and height), out of which healing showed significant results (p<0.05). Estimation of the risk in the healing process according to the Cox proportional hazards model showed that H = 0.60 (95 % CI 0.46- 0.78), which indicates that the shortest healing time was found in the skin substitute group. Conclusions: Skin substitutes are an important alternative that favors the good quality of healing in donor sites. skin substitutes proved to be more effective than conventional xenografting when evaluated and compared using the Vancouver healing scale.


Assuntos
Humanos , Xenoenxertos , Transplante , Cicatrização , Tecido de Granulação
4.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3 Supl): 287-290, jul.-set. 2019.
Artigo em Português | LILACS | ID: biblio-1023063

RESUMO

Existem poucos sistemas de avaliação de mortalidade após transplante cardíaco (TC) que se baseiem em fatores relacionados com o doador e que sejam capazes de predizer o prognóstico. Identificar características dos doadores que têm impacto na sobrevida depois do TC pode contribuir para melhorar os resultados e a alocação de órgãos. Aplicamos um sistema de avaliação americano para predizer a mortalidade pós-TC em uma coorte brasileira. Objetivo: Avaliar um escore americano como preditor de mortalidade depois de TC em uma coorte brasileira. Métodos: Análise de uma base de dados de um centro de TC brasileiro de 2013 a 2015. Foram avaliadas quatro características dos doadores: tempo de isquemia, idade do doador, discordância racial doador/receptor e a função renal do doador. A sobrevida foi estimada pelo teste de log-rank em faixas de pontuação pré-determinadas. Resultados: Foram 110 doadores, 89% homens e 62% brancos. A principal causa de morte foi trauma (66,6%). Os doadores tinham em média 29,8 anos, 18,6 de relação Nitrogênio da ureia sanguínea / Creatinina, 175 minutos de tempo de isquemia e 42% de discordância racial com o receptor. Não houve diferença de sobrevida entre as faixas de pontuação. Conclusão: Apesar de preditor de mortalidade após transplante cardíaco em uma população americana, esse escore não foi útil para uma coorte de transplante brasileira. As diferenças, inclusive a alta taxa de miscigenação pode ser uma explicação para esses achados


here are few systems to assess mortality after heart transplantation (CT) that are based on donor-related factors and can predict prognosis. Identifying donor characteristics that impact post-CT survival can contribute to improved outcomes and organ allocation. We applied a US evaluation system to predict mortality after CT in a Brazilian cohort. Objective: To evaluate an American score as a predictor of mortality following CT in a Brazilian cohort. Method: Database analysis of a Brazilian CT center from 2013 to 2015. Four donor characteristics were evaluated: ischemia time, donor age, donor-recipient race mismatch, and donor renal function. Survival was estimated by the log-rank test in predetermined score ranges. Results: There were 110 donors, 89% male and 62% white. The main cause of death was trauma (66.6%). Donors had a mean age of 29.8 years, a mean blood urea nitrogen / creatinine ratio of 18.6, a mean ischemia time of 175 minutes, and race mismatch with the recipient of 42%. There was no difference in survival between the score ranges. Conclusion: Although it was a predictor of mortality after cardiac transplantation in an American population, this score was not useful for a Brazilian transplant cohort. Differences, including the high rate of miscegenation, may explain these findings


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doadores de Tecidos , Transplante/mortalidade , Transplante de Coração/mortalidade , Prognóstico , Doenças Cardiovasculares , Análise de Sobrevida , Prevalência , Valor Preditivo dos Testes , Estudos de Coortes , Resultado do Tratamento , Insuficiência Cardíaca/terapia
6.
Internist (Berl) ; 60(7): 678-683, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31089769

RESUMO

Infections in immunosuppressed patients represent a particular challenge in the diagnostics and treatment. They often present with atypical and particularly severe courses, for which rapid diagnostics and treatment are decisive for treatment success. Opportunistic infections with human herpes viruses occur not only more frequently in immunocompromised patients compared to healthy people but also represent a special challenge. In the treatment of immunosuppressed patients, e.g. with human immunodeficiency virus infections and patients with solid organ transplantations, infections with herpes simplex virus, varicella zoster virus, Epstein-Barr virus and cytomegalovirus are particularly important. The symtoms are very variable, ranging from asymptomatic detection of viremia to vital life-threatening organ manifestations. This review article describes the most important clinical presentations of these opportunistic infections. Furthermore, the diagnostic, therapeutic and prophylactic strategies for human herpes viruses are summarized.


Assuntos
Herpes Zoster/diagnóstico , Infecções por Herpesviridae/diagnóstico , Hospedeiro Imunocomprometido/imunologia , Infecções Oportunistas/diagnóstico , Transplante de Órgãos , Transplante/efeitos adversos , Antivirais/uso terapêutico , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Herpes Zoster/tratamento farmacológico , Infecções por Herpesviridae/tratamento farmacológico , Herpesvirus Humano 3 , Herpesvirus Humano 4 , Humanos , Imunossupressão , Infecções Oportunistas/tratamento farmacológico
7.
Wiad Lek ; 72(4): 707-710, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31055561

RESUMO

OBJECTIVE: Introduction: From January 1, 2019, the Law of Ukraine "On application of the transplantation of anatomical materials to a human being" dated May 17, 2018, № 2427-VIII (hereinafter referred to as Law № 2427), which defined a new system of legal relationship in the field of transplantation and related activities. Simultaneously the validity of the Law of Ukraine "On transplantation of organs and other anatomical materials to a human being" adopted in July 16, 1999. № 1007-XIV was canceled. The development of medical science overlooks the prospect of humanity's salvation from many incurable diseases. One of the directions of medical advancing is the development of transplantation, which is special method of treatment that involves the transplantation of anatomical human material from a donor to a recipient and a focuses on the restoration of human health. Admitting the fact that life or health can be saved for hundreds of thousands of people with its' usage today and the need for it is growing relentlessly. Therefore, research and improvement of legislation on the transplantation of human anatomical materials is well-grounded and timely. The aim: To establish and specify the problematic issues of legal regulation that arise in the transplantation of human anatomical materials sphere. PATIENTS AND METHODS: Materials and methods: During the study, international acts, national legislation and Conclusions of scientists were used. The article is based on dialectical, legal comparative, systemic, historical and complex methods of research. RESULTS: Review: In this paper the main problems of legal regulation of transplantation of human anatomical materials according to the Ukrainian legislation are analyzed and specific suggestions for their solution are proposed. CONCLUSION: Conclusions: The solution to this problem is to create a legislative framework and provide an effective and effective mechanism for regulating and implementing transplantation of human anatomical materials.


Assuntos
Transplante/legislação & jurisprudência , Humanos , Ucrânia
8.
Georgian Med News ; (287): 146-152, 2019 Feb.
Artigo em Russo | MEDLINE | ID: mdl-30958308

RESUMO

The objective of the article is to study the main organizational and legal problems of carrying out transplantation of organs and anatomical materials in Ukraine. To achieve this objective, the author has formulated the methodological complex, which included both general scientific methods and special methods of cognition. The application of the historical method made it possible to analyze the retrospective of legal provision of transplantation, to find out the errors (shortcomings) and to establish achievements both in theory and in the activities of medical institutions in the field of transplantation. Systemic and functional analysis allowed us to characterize transplantation as the comprehensive system and its components. By using the comparative and legal method, the author has analyzed international legal acts on the organization and conduction of transplantation in order to formulate propositions for the improvement of Ukrainian legislation. The author in the course of the research has highlighted legal problems that lie in the lack of legal regulation of mutual relations in the process of transplantation between donors, recipients and health care professionals. The author has stressed on the need to revise the principles of conducting transplantation in Ukraine, which is necessary to provide an orderly, acceptable structural basis for the procedures of the acquisition and transplantation of human cells, tissues and organs for therapeutic purposes in compliance with ethical principles. The current situation in the health care system directly indicates the fact that prohibitions and control do not save lives of people. It is necessary to stipulate by the law the possibility of realizing human rights under the condition of inadmissibility of the state's monopoly on transplantation surgeries.


Assuntos
Assistência à Saúde/legislação & jurisprudência , Direitos Humanos , Transplante/legislação & jurisprudência , Humanos , Legislação Médica , Direitos do Paciente , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Ucrânia
9.
Blood Cells Mol Dis ; 77: 17-22, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30913447

RESUMO

BACKGROUND: Ehrlichiosis is an acute febrile tick-borne disease which can rarely be a trigger for secondary hemophagocytic lymphohistiocytosis (HLH). METHODS: We reviewed our experience with Ehrlichia infections at a tertiary-care academic medical center. RESULTS: Over 10 years, 157 cases of ehrlichiosis were identified. Ten patients (6.4%) had infection with E. ewingii, 7(4.5%) of whom were transplant patients as compared to 3(1.9%) non-transplant patients (p = .035). Transplant patients were more likely to have leukopenia and elevated creatinine compared to immunocompetent patients; length of hospital stay and early mortality were not different between the two groups. Ten patients met the HLH-2004 diagnosis criteria, which could be an underestimation of HLH occurrence as most patients were not completely evaluated for these criteria. We calculated the H-Score to find the probability of HLH; 25 patients scored high making the occurrence rate of HLH at least 16%. Ehrlichia-induced HLH patients (N = 25) had more anemia, thrombocytopenia, elevated creatinine and AST. Moreover, they had a significantly longer hospital stay (median 9 days) compared to patients without HLH (median 4 days) (p = .006). CONCLUSIONS: Ehrlichia-induced HLH is a potential serious complication with relatively high occurrence rate; patients manifest severe disease with end-organ damage requiring longer hospital stay.


Assuntos
Centros Médicos Acadêmicos , Ehrlichiose/epidemiologia , Adolescente , Adulto , Idoso , Criança , Ehrlichiose/etiologia , Ehrlichiose/transmissão , Feminino , Humanos , Hospedeiro Imunocomprometido , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Vigilância em Saúde Pública , Estudos Retrospectivos , Transplante/efeitos adversos , Adulto Jovem
10.
Transpl Int ; 32(7): 673-685, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30920056

RESUMO

Since the beginning of transplant medicine in the 1950s, advances in surgical technique and immunosuppressive therapy have created the success story of modern organ transplantation. However, today more than ever, we are facing a huge discrepancy between organ supply and demand, limiting the potential for transplantation to save and improve the lives of millions. To address the current limitations and shortcomings, a variety of emerging new technologies focusing on either maximizing the availability of organs or on generating new organs and organ sources hold great potential to eventully overcoming these hurdles. These advances are mainly in the field of regenerative medicine and tissue engineering. This review gives an overview of this emerging field and its multiple sub-disciplines and highlights recent advances and existing limitations for widespread clinical application and potential impact on the future of transplantation.


Assuntos
Preservação de Órgãos/tendências , Medicina Regenerativa/tendências , Engenharia Tecidual/tendências , Transplante/tendências , Animais , Bioimpressão , Criopreservação , Humanos , Imunossupressão , Preservação de Órgãos/métodos , Perfusão , Impressão Tridimensional , Medicina Regenerativa/métodos , Engenharia Tecidual/métodos , Tecidos Suporte , Obtenção de Tecidos e Órgãos , Transplante/métodos , Transplante Heterólogo
11.
Lancet Haematol ; 6(3): e154-e166, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30738834

RESUMO

BACKGROUND: Tolerability of treatments for multiple myeloma can depend on the characteristics of the patient being treated. We aimed to develop and validate a risk profile, using routinely collected data, that could predict overall survival in patients with multiple myeloma who were ineligible for stem-cell transplantation. METHODS: We used patient data from two randomised controlled trials done in patients with newly diagnosed multiple myeloma who were ineligible for stem-cell transplantation (the NCRI Myeloma XI study [NCRI-XI, n=1852] and the MRC Myeloma IX study [MRC-IX, n=520]), to develop the UK Myeloma Research Alliance Risk Profile (MRP) for overall survival. We used multivariable Cox regression with a least absolute shrinkage and selection operator penalty term. Multiple imputation by chained equations was used to account for missing data in the development and internal validation of the model. The MRP was internally validated in NCRI-XI and externally validated in MRC-IX. The D-statistic was estimated in the developed model and used to internally and externally validate the model according to prespecified criteria. FINDINGS: The MRP included WHO performance status, International Staging System, age, and C-reactive protein concentration as prognostic variables. The MRP was prognostic of overall survival and was successfully internally validated in NCRI-XI and externally validated in MRC-IX (D-statistic NCRI-XI: 0·840 [95% CI 0·718-0·963] and MRC-IX: 0·654 [0·497-0·811]). The MRP groups defining low-risk, medium-risk, and high-risk patients were associated with progression-free survival and early mortality. A decrease in the percentage of protocol dose delivered and quality of life at baseline were associated with increased risk. The MRP groups remained prognostic in patients exposed to different therapeutic combinations and in patients with genetic high-risk disease defined according to both the UK and International Myeloma Working Group definitions. INTERPRETATION: We have developed and externally validated a risk profile for overall survival containing widely available clinical parameters. This risk profile could aid decision making in patients with multiple myeloma ineligible for stem-cell transplantation, but further external validation is required. FUNDING: Medical Research Council, Novartis, Schering Health Care, Chugai, Pharmion, Celgene, Ortho Biotech, Cancer Research UK, Celgene, Merck Sharp & Dohme, and Amgen.


Assuntos
Modelos Estatísticos , Mieloma Múltiplo/terapia , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Definição da Elegibilidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Qualidade de Vida , Transplante , Resultado do Tratamento
12.
Nurs Res ; 68(4): 317-323, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30720564

RESUMO

BACKGROUND: Pediatric blood and marrow transplant (PBMT) patients experience significant symptom distress, and the use of mobile health (mHealth) technologies may enhance symptom management by providing patient-generated health data to foster personalized health strategies. OBJECTIVES: The aim of this study was to present a study protocol to explore feasibility, acceptability, and usability of integrating mHealth technologies to collect and monitor symptom data for PBMT patients. METHODS: An exploratory mixed-methods design is employed for 20 PBMT patients to monitor symptoms using real-time data from two mHealth devices: (a) a self-developed mHealth application and (b) a wearable tracking device. Patient-Reported Outcomes Measurement Information System surveys for fatigue, pain, and sleep disturbance are obtained monthly. Interviews are conducted to obtain further feasibility and usability data. RESULTS: The study began in October 2017; data collection should be completed in 2018. Feasibility and usability results to monitor and record symptom-related data daily via mobile devices will be reported. Patient-Reported Outcomes Measurement Information System surveys and interviews will further explore patients' symptoms and experiences with the mobile devices. DISCUSSION: This study will be among the first to explore the feasibility, acceptability, and usability of integrating multiple mHealth technologies to obtain patient-generated symptom data for the PBMT population. Results will enhance our understanding of how these data present, interact, and cluster together throughout the posttransplant period for these children and lead to symptom management strategies. Results will focus on a high-risk population that potentially stands to benefit from the use of mobile technologies.


Assuntos
Telemedicina , Transplante/reabilitação , Adolescente , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Projetos de Pesquisa , Transplante/efeitos adversos
14.
FEMS Microbiol Lett ; 366(4)2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30715301

RESUMO

Bacterial vaginosis (BV), caused by the vaginal dysbacteriosis as well as the excessive growth of pathogenic bacteria, is a pathological condition of the vagina; its treatment using the antibiotics metronidazole or clindamycin often causes high recurrence rates. Considering the similar physiological environments of the intestinal tract and vaginal tract, as well as the pathological mechanism of intestinal infection and vaginal infection, we first propose the conception of vaginal microbiota transplantation (VMT) and discuss its potential use in BV. This review focuses on the pathology of BV and the side effects caused by its standardised treatment. The extremely dynamic and diverse gut microbiota forms the most intensive microbial system and also plays a significant role in human body, and Lactobacilli dominate in the vaginal tract of women, keeping them healthy. Accordingly, we also propose the concept of VMT based on the effects of faecal microbiota transplantation (FMT) in treating intestinal infections, and list the potential hurdles for the implementation of VMT.


Assuntos
Microbiota/fisiologia , Vagina/microbiologia , Vaginose Bacteriana/microbiologia , Vaginose Bacteriana/terapia , Feminino , Humanos , Transplante
15.
Clin Lab Med ; 39(1): 107-123, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30709500

RESUMO

There is growing evidence supporting the genetic variability outside of HLA system that is contributing to the variation in transplant outcomes. Determining novel predictors could help to identify patients at risk and tailor their immunosuppressive regimens. This article discusses the various single nucleotide polymorphisms in costimulatory molecules and cytokines that have been evaluated for their effect on transplantation. An overview of how gene polymorphism studies are conducted and factors to consider in the experimental design to ensure meaningful data can be concluded are discussed.


Assuntos
Antígenos B7/genética , Citocinas/genética , Rejeição de Enxerto/imunologia , Polimorfismo de Nucleotídeo Único , Transplante , Antígenos B7/metabolismo , Antígenos B7/fisiologia , Estudo de Associação Genômica Ampla , Humanos , Receptores do Fator de Necrose Tumoral/genética , Linfócitos T/imunologia , Linfócitos T/fisiologia , Resultado do Tratamento , Fator de Necrose Tumoral alfa/genética
16.
Clin Lab Med ; 39(1): 157-169, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30709504

RESUMO

It is increasingly recognized that calcineurin inhibitors (CNI) such as cyclosporine and tacrolimus are not ideal immunosuppressive agents. Side effects, including increased rates of infection, hypertension, and malignancy, can be severe. Thus, in the past decade, there has been much focus on the development of novel therapeutic agents and strategies designed to replace or minimize CNI exposure in transplant patients. This article reviews potential novel targets in T cells, alloantibody-producing B cells, plasma cells, and complement in transplantation.


Assuntos
Imunossupressão/métodos , Transplante , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Fatores Imunológicos/uso terapêutico , Modelos Imunológicos , Linfócitos T/fisiologia , Condicionamento Pré-Transplante/métodos
17.
Transplant Proc ; 51(1): 96-99, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30655156

RESUMO

The question of whether a medical procedure is to be considered experimental or routine practice has enormous practical implications. In transplant surgery, as compared with pharmacologic clinical trials, the transition from experimental procedure to normal care is far from clear cut. Clinical trials comprise 4 well-established phases of evaluation going from phase I, aimed at assessing safety and identifying side effects in a few healthy volunteers, to phase IV, which involves entire populations and is aimed at long-term postmarketing surveillance. In transplant surgery, technical progress and experimentation follow more atypical and individual routes. As compared with pharmacologic research, the decision about "routine practice readiness" of a surgical procedure does not rely on a standardized formal act but rather on experts' capacity to find a consensus based on best practices and on ad-hoc criteria as well. Independent assessment by a panel of experts and oversight by an institutional review board are key to facilitating meaningful protection of transplant recipients and allowing the research to go forward. The framework of the human subjects protection regulations should also consider the transplant of organs that have previously been part of a research project.


Assuntos
Comitês de Ética em Pesquisa/normas , Transplante/ética , Transplante/normas , Humanos , Projetos de Pesquisa
18.
Cold Spring Harb Protoc ; 2019(1)2019 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-29769398

RESUMO

Fate maps identify the precursors of an organ, and tracing the members of a blastomere lineage over time shows how its descendants come to populate that organ. The fates of the individual blastomeres of the two- to 32-cell Xenopus embryo have been fully mapped to reveal which cells are the major contributors to various cell types, tissues, and organs. However, because these fate maps were produced in the normal embryo, they do not reveal whether a precursor blastomere is competent to give rise to additional tissues or is already committed to its fate-mapped repertoire of descendants. To identify the mechanisms by which a cell's fate is committed, one needs to expose the cell to different experimental environments. If the cell's fate is determined, it will express its normal fate or gene expression profile in novel environments, whereas if it is not yet determined it will express different fates or gene expression profiles when exposed to novel external factors or neighboring cells. This protocol describes two techniques for testing cell fate commitment: single cell deletion and single cell transplantation. Deleting a blastomere allows one to test whether the deleted cell is required for the remaining cells to produce their normal, specific cell fates. Transplanting a blastomere to a novel location in a host embryo allows one to test whether the transplanted cell is committed to produce its normal fate-mapped repertoire, or whether it is still competent to respond to novel cell-cell interactions.


Assuntos
Blastômeros/citologia , Blástula/citologia , Blástula/crescimento & desenvolvimento , Diferenciação Celular , Técnicas de Cultura de Órgãos/métodos , Transplante/métodos , Xenopus/embriologia , Animais , Meios de Cultura/química
19.
Transpl Int ; 32(1): 6-15, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29907979

RESUMO

Citations are widely used for measuring scientific impact. The goal of the present study was to predict citation counts of manuscripts submitted to Transplant International (TI) in the two calendar years following publication. We considered a comprehensive set of 21 manuscript, author, and peer-review-related predictor variables available early in the peer-review process. We also evaluated how successfully the peer-review process at TI identified and accepted the most promising manuscripts for publication. A developed predictive model with nine selected variables showed acceptable test performance to identify often cited articles (AUROC = 0.685). Particularly important predictors were the number of pages, month of publication, publication type (review versus other), and study on humans (yes versus no). Accepted manuscripts at TI were cited more often than rejected but elsewhere published manuscripts (median 4 vs. 2 citations). The predictive model did not outperform the actual editorial decision. Both findings suggest that the peer-review process at TI, in its current form, was successful in selecting submitted manuscripts with a high scientific impact in the future. Predictive models might have the potential to support the review process when decisions are made under great uncertainty.


Assuntos
Publicações Periódicas como Assunto/tendências , Transplante , Calibragem , Tomada de Decisões , Políticas Editoriais , Humanos , Fator de Impacto de Revistas , Revisão por Pares , Curva ROC
20.
Transplant Proc ; 50(10): 2899-2904, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30577147

RESUMO

Burnout (emotional exhaustion, depersonalization, and low personal accomplishment) is the enervation an individual experiences from a chronically taxing work environment. Little research has examined the demands of the sandwich generation (both children and older adults in the home) on burnout and marital satisfaction. METHODS: This is a cross-sectional survey of American and European transplant surgeons on the effects of sandwich generation-related demands on burnout and marital satisfaction, covarying for transplant surgeon age. RESULTS: A total of 286 married or partnered transplant surgeons were included. Presence (vs absence) of children in the home did not impact burnout, but those with children who reported difficulties with flexible childcare reported greater emotional exhaustion (P = .03) and depersonalization (P = .02) than those without difficulties. A total of 38.5% of married transplant surgeons reported marital distress. European transplant surgeons reported lower marital satisfaction than those from the United States (P < .01). Having an older adult in the home may also negatively impact transplant surgeons' marital satisfaction (P = .048). DISCUSSION: As health care organizations move forward with programs aimed at creating a sustainable workforce, providing professional environments supportive of important family-related demands is imperative.


Assuntos
Esgotamento Profissional/psicologia , Relações Familiares/psicologia , Cirurgiões/psicologia , Transplante/psicologia , Idoso , Criança , Estudos Transversais , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos , Local de Trabalho/psicologia
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