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1.
Ann Ital Chir ; 90: 364-370, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31657358

RESUMO

OBJECTIVE: To evaluate in-hospital mortality and limb salvage of a series of patients presenting with arterial injury of the lower limbs complicating an osteoarticular trauma, and to determine any preoperative predictive factors of limb salvage. METHODS: Data of consecutive patients treated between 01/2007 and 12/2017 were retrospectively analyzed. Primary outcomes were in-hospital mortality and limb salvage. Multivariate analysis was performed to assess any variable that could affect limb salvage. P values <0.05 were considered statistically significant. RESULTS: The postoperative course, death occurred in 2 patients Lower limb amputation was performed in 13 cases (15.6%). The main factors predicting limb amputation were the timing of staged surgery, in particular when bone stabilization was performed first (P<0.001), and a delay Data concerning 74 patients with 83 traumatized lower limbs were analyzed. Most vascular lesions were located at the popliteal artery (47, 63.5%). Surgical bone stabilization was performed as a first step in 45 patients (60.8% of cases), followed by a delayed arterial repair. The median time to revascularization was 14.3 hours (range from 2 hours to 6 days). In 29 patients (39.2%) vascular repair and bone stabilization were performed simultaneously. During to limb revascularization longer than 6 hours (P<0.001). The location of injury at the popliteal artery (P=0.005), the presence of infection (P<0.001), and the severe ischemic signs at presentation (P=0.001) also were factors associated with amputation. CONCLUSIONS: The timing of staged surgical repair and the revascularization delay were the main predictor factors of limb salvage. KEY WORDS: Osteoarticular trauma, Vascular injury, Limb salvage, Orthopedic trauma.


Assuntos
Vasos Sanguíneos/lesões , Osso e Ossos/lesões , Osso e Ossos/cirurgia , Articulações/lesões , Articulações/cirurgia , Traumatismos da Perna/complicações , Traumatismos da Perna/cirurgia , Perna (Membro)/irrigação sanguínea , Perna (Membro)/cirurgia , Salvamento de Membro/estatística & dados numéricos , Traumatismo Múltiplo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Mortalidade Hospitalar , Humanos , Traumatismos da Perna/mortalidade , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/mortalidade , Estudos Retrospectivos , Procedimentos Cirúrgicos Vasculares , Adulto Jovem
3.
Zhongguo Ying Yong Sheng Li Xue Za Zhi ; 35(3): 193-198, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31257797

RESUMO

OBJECTIVE: To investigate the vascular damage effects and possible mechanism of acute exposure to ozone (O3) in male Wistar rats. METHODS: One hundred and twenty male Wistar rats were randomly divided into six groups, 20 in each group. The experimental animals were placed in a gas poisoning cabinet, the control group was exposed to filtered air, and the treatment group was exposed to ozone at concentrations of 0.12 ppm, 0.5 ppm, 1.0 ppm, 2.0 ppm, and 4.0 ppm, respectively, for 4 hours. Arterial blood pressure data were obtained by PC-lab medical physiological signal acquisition system. Blood rheology indicators and blood biochemical indicators were detected by Tianjin Dean Diagnostic Laboratory. Serum endothelin-1 (ET-1), homocysteine (HCY), von Willebrand factor (vWF), 8-hydroxydeoxyguanosine (8-OhdG), interleukin (IL-6) and tumor necrosis factor alpha (TNF-α) were detected by enzyme-linked immunosorbent assay (ELISA) microplate assay. Oxidative stress indicators superoxide dismutase (SOD) activity and malondialdehyde (MDA) were determined by xanthine oxidase method, thiobarbituric acid (TBA) method, reduced glutathione (GSH) and nitric oxide (NO) were tested by using microplate colorimetry. Paraffin sections were prepared from thoracic aorta tissue, and vascular structure was observed by HE staining. RESULTS: Acute exposure to 0.12 ppm ozone could cause a significant increase in arterial systolic blood pressure (SBP). Exposure to different concentrations of ozone could cause a significant increase in plasma viscosity, and the K value of the ESR equation was significantly increased in the 1.0 ppm ozone exposure group. Both the relative and reduced viscosities were significantly reduced at ozone concentrations of 0.5 ppm and 4.0 ppm, while the red blood cell deformation index was increased significantly at ozone concentrations of 0.12 ppm, 0.5 ppm, 1.0 ppm, and 2.0 ppm. Acute ozone exposure resulted in the decrease of total cholesterol content. The content of high-density lipoprotein cholesterol (HDL-C) was significantly reduced in the 0.12 ppm ozone exposure group. When the ozone concentration was higher than 1.0 ppm, the body may also had an inflammatory reaction (increased TNF-α) and oxidative stress (increased MDA, decreased GSH). Acute exposure to ozone could lead to elevated levels of ET-1 in the blood, with significant differences in the 4.0 ppm concentration group, while HCY levels were decreased firstly and then increased, reaching the highest in the 1.0 ppm concentration group. No obvious pathological changes were observed in the thoracic aorta. CONCLUSION: Acute ozone exposure can affect arterial blood pressure, blood rheology and cholesterol metabolism in rats. The possible mechanism is that ozone exposure leads to inflammatory reaction and oxidative stress reaction, causing vascular endothelial function damage, and vascular endothelial cells increase with ozone exposure concentration.


Assuntos
Vasos Sanguíneos/lesões , Estresse Oxidativo , Ozônio/toxicidade , 8-Hidroxi-2'-Desoxiguanosina , Animais , Desoxiguanosina/análogos & derivados , Desoxiguanosina/sangue , Endotelina-1/sangue , Homocisteína/sangue , Interleucina-6/sangue , Masculino , Malondialdeído/análise , Ratos , Ratos Wistar , Superóxido Dismutase/análise , Fator de Necrose Tumoral alfa/sangue , Fator de von Willebrand/análise
4.
Anticancer Res ; 39(6): 2721-2727, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177107

RESUMO

BACKGROUND/AIM: The aim of this study was to investigate radiation-induced tumour vascular damage and its impact thereof on the outcome of stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS: Vessel densities in animal tumours before and after a single dose of 20 Gy were quantified and used as input for simulations of three-dimensional tumours with heterogeneous oxygenation. SBRT treatments of the modelled tumours in 1-8 fractions were simulated. The impact of vessel collapse on the outcome of SBRT was investigated by calculating tumour control probability (TCP) and the dose required to obtain a TCP of 50% (D50). RESULTS: A radiation-induced increase of acute hypoxia in tumours during SBRT treatment could be simulated based on the experimental data. The D50 values for these tumours were higher than for the simulated tumours without vessel collapse. CONCLUSION: The vascular changes after high doses of radiation could compromise the outcome of SBRT by increasing tumour hypoxia.


Assuntos
Vasos Sanguíneos/lesões , Vasos Sanguíneos/efeitos da radiação , Neoplasias da Mama/radioterapia , Radiocirurgia/efeitos adversos , Animais , Vasos Sanguíneos/diagnóstico por imagem , Neoplasias da Mama/irrigação sanguínea , Neoplasias da Mama/diagnóstico por imagem , Hipóxia Celular , Linhagem Celular Tumoral , Fracionamento da Dose de Radiação , Feminino , Humanos , Camundongos , Microscopia de Fluorescência por Excitação Multifotônica , Modelos Biológicos , Transplante de Neoplasias , Resultado do Tratamento
5.
Anticancer Res ; 39(5): 2337-2340, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092425

RESUMO

BACKGROUND/AIM: This study investigated the impact of temporary vascular collapse on tumour control probability (TCP) in stereotactic body radiotherapy (SBRT), taking into account different radiosensitivities of chronically and acutely hypoxic cells. MATERIALS AND METHODS: Three-dimensional tumours with heterogeneous oxygenation were simulated assuming different fractions of collapsed vessels at every treatment fraction. The modelled tumours contained a chronically hypoxic subvolume of 30-60% of the tumour diameter, and a hypoxic fraction ≤5 mm Hg of 30-50%. The rest of the tumours were well-oxygenated at the start of the simulated treatment. RESULTS: For all simulated cases, the largest reduction in TCP from 97% to 2% was found in a tumour with a small chronically hypoxic core treated with 60 Gy in eight fractions and assuming a treatment-induced vascular collapse of 35% in the well-oxygenated region. CONCLUSION: The timing of SBRT fractions should be considered together with the tumour oxygenation to avoid loss of TCP in SBRT.


Assuntos
Vasos Sanguíneos/efeitos da radiação , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Hipóxia/fisiopatologia , Radiocirurgia/efeitos adversos , Vasos Sanguíneos/lesões , Vasos Sanguíneos/fisiopatologia , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/patologia , Sobrevivência Celular , Simulação por Computador , Fracionamento da Dose de Radiação , Humanos , Hipóxia/complicações , Hipóxia/etiologia , Modelos Biológicos , Oxigênio/metabolismo , Tolerância a Radiação , Resultado do Tratamento
6.
Nat Microbiol ; 4(6): 972-984, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30911127

RESUMO

Bacterial virulence factors are attractive targets for the development of therapeutics. Type IV pili, which are associated with a remarkable array of properties including motility, the interaction between bacteria and attachment to biotic and abiotic surfaces, represent particularly appealing virulence factor targets. Type IV pili are present in numerous bacterial species and are critical for their pathogenesis. In this study, we report that trifluoperazine and related phenothiazines block functions associated with Type IV pili in different bacterial pathogens, by affecting piliation within minutes. Using Neisseria meningitidis as a paradigm of Gram-negative bacterial pathogens that require Type IV pili for pathogenesis, we show that piliation is sensitive to altered activity of the Na+ pumping NADH-ubiquinone oxidoreductase (Na+-NQR) complex and that these compounds probably altered the establishment of the sodium gradient. In vivo, these compounds exert a strong protective effect. They reduce meningococcal colonization of the human vessels and prevent subsequent vascular dysfunctions, intravascular coagulation and overwhelming inflammation, the hallmarks of invasive meningococcal infections. Finally, they reduce lethality. This work provides a proof of concept that compounds with activity against bacterial Type IV pili could beneficially participate in the treatment of infections caused by Type IV pilus-expressing bacteria.


Assuntos
Fímbrias Bacterianas/efeitos dos fármacos , Fímbrias Bacterianas/fisiologia , Infecções Meningocócicas/prevenção & controle , Neisseria meningitidis/efeitos dos fármacos , Fatores de Virulência , Animais , Antibacterianos/farmacologia , Vasos Sanguíneos/lesões , Vasos Sanguíneos/microbiologia , Vasos Sanguíneos/patologia , Combinação de Medicamentos , Complexo I de Transporte de Elétrons , Feminino , Fímbrias Bacterianas/genética , Perfilação da Expressão Gênica , Regulação Bacteriana da Expressão Gênica/efeitos dos fármacos , Bactérias Gram-Negativas , Humanos , Camundongos , Neisseria meningitidis/genética , Neisseria meningitidis/crescimento & desenvolvimento , Fenotiazinas/farmacologia , Pele/patologia , Transplante de Pele , ATPase Trocadora de Sódio-Potássio , Trifluoperazina/farmacologia
7.
Cochrane Database Syst Rev ; 1: CD006583, 2019 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-30657163

RESUMO

BACKGROUND: Laparoscopy is a common procedure in many surgical specialties. Complications arising from laparoscopy are often related to initial entry into the abdomen. Life-threatening complications include injury to viscera (e.g. bowel, bladder) or to vasculature (e.g. major abdominal and anterior abdominal wall vessels). No clear consensus has been reached as to the optimal method of laparoscopic entry into the peritoneal cavity. OBJECTIVES: To evaluate the benefits and risks of different laparoscopic entry techniques in gynaecological and non-gynaecological surgery. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, and trials registers in January 2018. We also checked the references of articles retrieved. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared one laparoscopic entry technique versus another. Primary outcomes were major complications including mortality, vascular injury of major vessels and abdominal wall vessels, visceral injury of bladder or bowel, gas embolism, solid organ injury, and failed entry (inability to access the peritoneal cavity). Secondary outcomes were extraperitoneal insufflation, trocar site bleeding, trocar site infection, incisional hernia, omentum injury, and uterine bleeding. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risk of bias, and extracted data. We expressed findings as Peto odds ratios (Peto ORs) with 95% confidence intervals (CIs). We assessed statistical heterogeneity using the I² statistic. We assessed the overall quality of evidence for the main comparisons using GRADE methods. MAIN RESULTS: The review included 57 RCTs including four multi-arm trials, with a total of 9865 participants, and evaluated 25 different laparoscopic entry techniques. Most studies selected low-risk patients, and many studies excluded patients with high body mass index (BMI) and previous abdominal surgery. Researchers did not find evidence of differences in major vascular or visceral complications, as would be anticipated given that event rates were very low and sample sizes were far too small to identify plausible differences in rare but serious adverse events.Open-entry versus closed-entryTen RCTs investigating Veress needle entry reported vascular injury as an outcome. There was a total of 1086 participants and 10 events of vascular injury were reported. Four RCTs looking at open entry technique reported vascular injury as an outcome. There was a total of 376 participants and 0 events of vascular injury were reported. This was not a direct comparison. In the direct comparison of Veress needle and Open-entry technique, there was insufficient evidence to determine whether there was a difference in rates of vascular injury (Peto OR 0.14, 95% CI 0.00 to 6.82; 4 RCTs; n = 915; I² = N/A, very low-quality evidence). Evidence was insufficient to show whether there were differences between groups for visceral injury (Peto OR 0.61, 95% CI 0.06 to 6.08; 4 RCTs; n = 915: I² = 0%; very low-quality evidence), or failed entry (Peto OR 0.45, 95% CI 0.14 to 1.42; 3 RCTs; n = 865; I² = 63%; very low-quality evidence). Two studies reported mortality with no events in either group. No studies reported gas embolism or solid organ injury.Direct trocar versus Veress needle entryTrial results show a reduction in failed entry into the abdomen with the use of a direct trocar in comparison with Veress needle entry (OR 0.24, 95% CI 0.17 to 0.34; 8 RCTs; N = 3185; I² = 45%; moderate-quality evidence). Evidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.59, 95% CI 0.18 to 1.96; 6 RCTs; n = 1603; I² = 75%; very low-quality evidence), visceral injury (Peto OR 2.02, 95% CI 0.21 to 19.42; 5 RCTs; n = 1519; I² = 25%; very low-quality evidence), or solid organ injury (Peto OR 0.58, 95% Cl 0.06 to 5.65; 3 RCTs; n = 1079; I² = 61%; very low-quality evidence). Four studies reported mortality with no events in either group. Two studies reported gas embolism, with no events in either group.Direct vision entry versus Veress needle entryEvidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.39, 95% CI 0.05 to 2.85; 1 RCT; n = 186; very low-quality evidence) or visceral injury (Peto OR 0.15, 95% CI 0.01 to 2.34; 2 RCTs; n = 380; I² = N/A; very low-quality evidence). Trials did not report our other primary outcomes.Direct vision entry versus open entryEvidence was insufficient to show whether there were differences between groups in rates of visceral injury (Peto OR 0.13, 95% CI 0.00 to 6.50; 2 RCTs; n = 392; I² = N/A; very low-quality evidence), solid organ injury (Peto OR 6.16, 95% CI 0.12 to 316.67; 1 RCT; n = 60; very low-quality evidence), or failed entry (Peto OR 0.40, 95% CI 0.04 to 4.09; 1 RCT; n = 60; very low-quality evidence). Two studies reported vascular injury with no events in either arm. Trials did not report our other primary outcomes.Radially expanding (STEP) trocars versus non-expanding trocarsEvidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.24, 95% Cl 0.05 to 1.21; 2 RCTs; n = 331; I² = 0%; very low-quality evidence), visceral injury (Peto OR 0.13, 95% CI 0.00 to 6.37; 2 RCTs; n = 331; very low-quality evidence), or solid organ injury (Peto OR 1.05, 95% CI 0.07 to 16.91; 1 RCT; n = 244; very low-quality evidence). Trials did not report our other primary outcomes.Other studies compared a wide variety of other laparoscopic entry techniques, but all evidence was of very low quality and evidence was insufficient to support the use of one technique over another. AUTHORS' CONCLUSIONS: Overall, evidence was insufficient to support the use of one laparoscopic entry technique over another. Researchers noted an advantage of direct trocar entry over Veress needle entry for failed entry. Most evidence was of very low quality; the main limitations were imprecision (due to small sample sizes and very low event rates) and risk of bias associated with poor reporting of study methods.


Assuntos
Parede Abdominal , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Complicações Intraoperatórias , Laparoscopia/efeitos adversos , Vasos Sanguíneos/lesões , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Intestinos/lesões , Complicações Intraoperatórias/prevenção & controle , Laparoscopia/métodos , Masculino , Cavidade Peritoneal , Ensaios Clínicos Controlados Aleatórios como Assunto , Bexiga Urinária/lesões
8.
Cells ; 8(2)2019 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-30678104

RESUMO

Vascular smooth muscle cell (VSMC) dedifferentiation is a common feature of vascular disorders leading to pro-migratory and proliferative phenotypes, a process induced through growth factor and cytokine signaling cascades. Recently, many studies have demonstrated that small non-coding RNAs (miRNAs) can induce phenotypic effects on VSMCs in response to vessel injury. However, most studies have focused on the contribution of individual miRNAs. Our study aimed to conduct a detailed and unbiased analysis of both guide and passenger miRNA expression in vascular cells in vitro and disease models in vivo. We analyzed 100 miRNA stem loops by TaqMan Low Density Array (TLDA) from primary VSMCs in vitro. Intriguingly, we found that a larger proportion of the passenger strands was significantly dysregulated compared to the guide strands after exposure to pathological stimuli, such as platelet-derived growth factor (PDGF) and IL-1α. Similar findings were observed in response to injury in porcine vein grafts and stent models in vivo. In these studies, we reveal that the miRNA passenger strands are predominantly dysregulated in response to vascular injury.


Assuntos
Vasos Sanguíneos/lesões , Regulação da Expressão Gênica , MicroRNAs/metabolismo , Animais , Vasos Sanguíneos/efeitos dos fármacos , Vasos Sanguíneos/patologia , Citocinas/farmacologia , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/farmacologia , Masculino , MicroRNAs/genética , Músculo Liso Vascular/patologia , Miócitos de Músculo Liso/efeitos dos fármacos , Miócitos de Músculo Liso/metabolismo , Suínos
9.
Urology ; 124: 38-45, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30445123

RESUMO

OBJECTIVE: To explore the clinical significance of the fused renal pyramid (FRP) in establishing percutaneous renal access, and the anatomic basis for avoiding vascular injury caused by puncturing through this renal pyramid with the aim of achieving accurate puncture in percutaneous nephrolithotomy. MATERIALS AND METHODS: Sixty-two cadaveric kidneys and 105 porcine kidneys were selected for the assessment of regional anatomy, to explore the anatomic structure of the FRP and determine its frequency. Then, we compared the effects of 4 different puncture paths on the occurrence of renal vascular injury when respectively punctured through the normal renal pyramid (group A), the centerline of one side pyramid of the FRP (group B), the center of the entire FRP (group C) and the renal column (group D). RESULTS: The incidence of FRP in human kidneys is not low. The artery in the kidney can be divided into 6 grades. The grade IV branch-interlobar artery courses through the FRP. There was significant difference in the degree of arterial injury between the group A and C (P = .003), while no significant difference between the group A and B (P = .151). There was significant difference in the proportion of interlolar artery injury between group A and C (P <.001), while no significant difference between group A and B (P = .239). CONCLUSION: It is necessary to carefully identify and bypass the FRP when establishing a percutaneous renal access. If unavoidable, the puncture path should be on the centerline of one side pyramid of the FRP.


Assuntos
Medula Renal/anatomia & histologia , Nefrolitotomia Percutânea/métodos , Animais , Vasos Sanguíneos/lesões , Humanos , Complicações Intraoperatórias/prevenção & controle , Rim/lesões , Medula Renal/irrigação sanguínea , Punções/efeitos adversos , Punções/métodos , Suínos
10.
J Laparoendosc Adv Surg Tech A ; 29(2): 206-212, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30256167

RESUMO

PURPOSE: Bile duct injuries (BDIs) are more frequent during laparoscopic cholecystectomy (LC). Several BDI classifications are reported, but none encompasses anatomy of damage and vascular injury (A), timing of detection (To), and mechanism of damage (M). Aim was to apply the ATOM classification to a series of patients referred for BDI management after LC. METHODS: From 2008 to 2016, 26 patients (16 males and 10 females, median age 63 years, range 34-82 years) with BDIs were observed. Fifteen patients were managed by percutaneous transhepatic cholangiography (PTC)+endoscopic retrograde cholangiopancreatography (ERCP); five and six underwent PTC and ERCP alone, respectively. Median overall follow-up duration was 34 months. Three patients died from sepsis. RESULTS: Out of 26 patients, 20 presented with main bile duct and six with nonmain bile duct injuries. Using the ATOM classification, every aspect of the BDI in every case was included, unlike with other classifications (Neuhaus, Lau, Strasberg, Bergman, and Hanover). CONCLUSIONS: The all-inclusive European Association for Endoscopic Surgery (EAES) classification contains objective data and emphasizes the underlying mechanisms of damage, which is relevant for prevention. It also integrates vascular injury, necessary for ultimate management, and timing of discovery, which has diagnostic implications. The management complexity of these patients requires specialized referral centers.


Assuntos
Traumatismos Abdominais/classificação , Traumatismos Abdominais/etiologia , Vasos Sanguíneos/lesões , Colecistectomia Laparoscópica/efeitos adversos , Ducto Colédoco/lesões , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
11.
Asian J Surg ; 42(1): 409-413, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30097397

RESUMO

BACKGROUND: Though microvascular clamps are widely used for anastomosis training, there still have several shortcomings, including the bulging, expensiveness and unavailability due to sterilization. The aim of this study is to introduce a simple and novel microvascular training model without use of microvascular clamps. METHODS: Femoral vessels of Sprague Dawley rats training model were used to evaluate the usefulness of 4-0 silk as a slipknot for performing arterio-arterial and veno-venous microvascular anastomoses. A total of 12 Sprague Dawley rats were randomly assigned to either slipknot group or vascular clamp group. We also assess other endpoints, including ischemic time, patency rate, and clinical features. An additional histological study was performed to compare their immediate traumatic effects on vessel wall. RESULTS: There was no ischemic change or congestive sign in the lower limb after microvascular anastomosis. The total warm ischemic time for the vascular anastomosis was not significantly different. We performed the patency test immediately after microvascular anastomosis and one week after surgery. No intraoperative vascular bleeding was found during these procedures and no thrombosis occurred postoperatively. The histologic damages to occluded area were not significantly different in both groups. CONCLUSION: We demonstrate a microsurgical suture technique performed without any vascular clamp on a rat model. This rat model was designed for training in the technique of microvascular anastomosis. Compared with microvascular clamps, silk slipknot is a cheap, easily available, less space-occupying technique while performing microvascular anastomoses training. This preliminary study provides a simple and effective alternative method for microvascular anastomosis training.


Assuntos
Anastomose Cirúrgica/educação , Educação Médica/métodos , Microcirurgia/educação , Microcirurgia/métodos , Seda , Técnicas de Sutura/educação , Suturas , Procedimentos Cirúrgicos Vasculares/educação , Animais , Perda Sanguínea Cirúrgica , Vasos Sanguíneos/lesões , Vasos Sanguíneos/patologia , Educação Médica/economia , Extremidade Inferior/irrigação sanguínea , Modelos Animais , Ratos Sprague-Dawley , Instrumentos Cirúrgicos , Técnicas de Sutura/economia , Suturas/economia , Grau de Desobstrução Vascular
12.
Blood Coagul Fibrinolysis ; 29(7): 573-584, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30063477

RESUMO

: Hemostasis is the most important protective mechanism for human survival following harmful vascular damage caused by internal disease or external injury. Physiological mechanism of hemostasis is partially understood. Hemostasis can be initiated by either intravascular injury or external bodily injury involving two different levels of damage [i.e., limited to the endothelium or combined with extravascular tissue (EVT)]. In intravascular injury, traumatic damage limited to local endothelium typically is of no consequence, but disease-induced endothelial damage associated with systemic endothelial injury seen in sepsis and other critical illnesses could cause generalized 'endotheliopathy'. It triggers no bleeding but promotes serious endothelial molecular response. If intravascular local trauma extends beyond the endothelium and into EVT, it causes intravascular 'bleeding' and initiate 'clotting' via normal hemostasis. In external bodily injury, local traumatic damage always extends to the endothelium and EVT, and triggers 'bleeding' and 'clotting'. Systemic endotheliopathy activates only unusually large von Willebrand factor multimers (ULVWF) path and mediates 'microthrombogenesis', producing 'microthrombi' strings. This partial activation of hemostasis with ULVWF path leads to vascular microthrombotic disease. But localized traumatic injury extending to the endothelium and EVT activates both ULVWF and tissue factor paths. Combined activation of ULVWF and tissue factor paths provides normal hemostasis in external bodily injury, but causes 'macrothrombus' formation in intravascular injury. This 'two-path unifying theory' concept succinctly elucidates simplified nature of hemostasis in intravascular and external bodily injuries. It also clarifies different pathogenesis of every hemorrhagic disease and thrombotic disorder related to internal vascular disease and external vascular injury.


Assuntos
Hemostasia/fisiologia , Transtornos Hemostáticos/classificação , Vasos Sanguíneos/lesões , Endotélio Vascular/lesões , Humanos , Tromboplastina/metabolismo , Fator de von Willebrand/metabolismo
13.
Expert Opin Biol Ther ; 18(sup1): 131-139, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30063849

RESUMO

INTRODUCTION: Formation of the vasculature is a complex process, defects in which can lead to embryonic lethality or disease in later life. Understanding mechanisms of vasculogenesis may facilitate the treatment of developmental defects and may be extrapolated to promote wound healing and tissue repair. Thymosin ß4 (Tß4) is an actin monomer binding protein with recognized roles in vascular development, neovascularization and protection against disease. AREAS COVERED: Vascular network assembly is complex, regulated by multiple signals and cell types; Tß4 functions in many of the underlying processes, including vasculogenesis, angiogenesis, arteriogenesis, endothelial-mesenchymal transition and extracellular matrix remodeling. Loss of Tß4 perturbs vessel growth and stability, whereas exogenous application enhances capillary formation and pericyte recruitment, during development and in injury models. EXPERT OPINION: Although vascular functions for Tß4 have been well documented, the underlying molecular mechanisms remain obscure. While Tß4-induced cytoskeletal remodeling likely mediates the directional migration of endothelial cells, paracrine roles have also been implicated in migration and differentiation of smooth muscle cells. Moreover, nuclear functions of Tß4 have been described but remain to be explored in the vasculature. Delineati+ng the molecular pathways impacted by Tß4 to promote vascular growth and remodeling may reveal novel targets for prevention and treatment of vascular disease.


Assuntos
Vasos Sanguíneos , Doenças Cardiovasculares/prevenção & controle , Citoproteção , Timosina/fisiologia , Cicatrização , Animais , Vasos Sanguíneos/efeitos dos fármacos , Vasos Sanguíneos/embriologia , Vasos Sanguíneos/crescimento & desenvolvimento , Vasos Sanguíneos/lesões , Diferenciação Celular/efeitos dos fármacos , Citoproteção/efeitos dos fármacos , Citoproteção/genética , Células Endoteliais/efeitos dos fármacos , Células Endoteliais/metabolismo , Matriz Extracelular/efeitos dos fármacos , Matriz Extracelular/metabolismo , Humanos , Miócitos de Músculo Liso/efeitos dos fármacos , Miócitos de Músculo Liso/fisiologia , Neovascularização Fisiológica/efeitos dos fármacos , Timosina/uso terapêutico , Cicatrização/efeitos dos fármacos , Cicatrização/genética
14.
Foot Ankle Int ; 39(12): 1502-1508, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30132696

RESUMO

BACKGROUND:: Talonavicular (TN) fusion using screws dorsomedially and dorsolaterally can cause neurovascular injury. The purpose of our cadaveric study was to evaluate the safety of percutaneous screw insertion in relation to dorsal neurovascular structures. METHODS:: Ten fresh-frozen cadaver legs were used for this study. Percutaneous cannulated screws were inserted to perform isolated TN arthrodesis. The screws were inserted at 3 consistent sites: a "medial screw" at the dorsomedial navicular where it intersected at the medial plane of the first cuneiform, a "central screw" at the edge of the dorsal navicular between the medial and intermediate cuneiforms, and a "lateral screw" at the edge of the dorsal navicular between the intermediate and lateral cuneiforms. Superficial and deep dissections were carried out to identify any injured nerves, arteries, and/or tendons. RESULTS:: The medial screw injured the anterior tibialis tendon in 2 cases (20%), the central screw injured the extensor hallucis longus tendon in 3 cases (30%), and the lateral screw injured the anterior branch of the superior peroneal nerve (SPN), the lateral branch of the SPN, and the medial branch of the distal peroneal nerve (DPN) once each in a total of 3 cases (30%). Despite no direct injury, the central screw indicated a potential risk of neurovascular injury: closest distance to the anterior SPN was 2 mm and to the medial DPN 2 mm. CONCLUSION:: Although neurovascular injury risk exists for all of these screw placements, TN fusion with a central screw introduced a potentially decreased risk of neurovascular injury at the expense of increased risk of tendon injury compared to the lateral screw. CLINICAL RELEVANCE:: Based on these results, we recommend a careful dissection be performed prior to percutaneous screw insertion.


Assuntos
Artrodese/efeitos adversos , Vasos Sanguíneos/lesões , Parafusos Ósseos , Nervo Fibular/lesões , Ossos do Tarso/cirurgia , Traumatismos dos Tendões/etiologia , Idoso , Idoso de 80 Anos ou mais , Artrodese/instrumentação , Artrodese/métodos , Cadáver , Feminino , Humanos , Masculino , Ossos do Tarso/irrigação sanguínea , Ossos do Tarso/inervação
15.
Rev. chil. cir ; 70(4): 362-366, ago. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-959397

RESUMO

Objetivo: Presentar un caso clínico y discutir el manejo del trauma de arteria axilar y revisar la literatura actual. Caso Clínico: se presenta el caso de un paciente con lesión de arteria axilar, que es traído en shock hipovolémico al Servicio de Emergencias de nuestro hospital. En pabellón, se aprecia sección incompleta de la segunda porción de la arteria axilar. Se controla y repara con anastomosis primaria término-terminal. En su posoperatorio evoluciona de forma satisfactoria. Discusión: El manejo del trauma vascular debe ser metódico y multidisciplinario. Los signos duros de trauma vascular son indicación de exploración quirúrgica inmediata. Los pacientes con signos blandos pueden complementarse con imágenes. En una sección incompleta de arteria axilar, la anastomosis término-terminal ha mostrado buenos resultados. Conclusiones: las lesiones de arteria axilar en el contexto de traumas son infrecuentes. Su manejo necesita de un alto índice de sospecha, un enfoque multidisciplinario y un acceso quirúrgico adecuado al contexto.


Objective: To present a clinical case and discuss the management of axillary artery trauma and to review current literature. Clinical case: Male patient with axillary artery injury, who is brought in hypovolemic shock to the Emergency Department. Surgical findings demonstrated an incomplete section of the second portion of the axillary artery which was repaired with primary end-to-end anastomosis. Postoperatively, the patient evolves without pain and is discharged. Discussion: The management of vascular trauma should be methodical and multidisciplinary. Hard signs of vascular trauma mandate immediate surgical exploration. Patients with soft signs may need further evaluation with images. In an incomplete section of the axillary artery the end-to-end anastomosis has shown good results. Conclusions: Axillary artery lesions in the context of trauma are infrequent. Its management requires a high index of suspicion, a multidisciplinary approach and adequate surgical access.


Assuntos
Humanos , Masculino , Adulto , Artéria Axilar/cirurgia , Artéria Axilar/lesões , Procedimentos Cirúrgicos Vasculares/métodos , Ferimentos Perfurantes/cirurgia , Vasos Sanguíneos/lesões , Anastomose Cirúrgica/métodos
16.
Br J Radiol ; 91(1088): 20170562, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29848014

RESUMO

OBJECTIVE: The purpose of this preliminary retrospective study was to analyse if cone beam CT (CBCT) is able to identify more bleeding sites and corresponding feeding arteries in patients with haemorrhage of uncertain origin. METHODS: In 18 vascular territories (16 patients), pre-interventional CT angiography (CTA) and selective angiograms resulted in discordant information regarding the suspected bleeding site and hence received CBCT. Image data of CTA and selective angiograms in comparison to CBCT were independently reviewed by two interventional radiologists. Image quality, diagnostic confidence, number of bleeding sites and involved vascular territories were investigated. Additionally, the correlation between number of bleeding sites and involved vascular territories with a  clinical gold-standard (super-selective angiographic findings and definitive clinical outcomes) was analysed. RESULTS: Overall, subjective image quality did not significantly differ between investigated imaging modalities. However, CBCT significantly improved diagnostic confidence in both readers in detecting bleeding vessel (s) (p = 0.0024/0.0005; Reader 1/Reader2). High correlation coefficients regarding the number of bleeding sites (r = 0.9163/0.7692) in contrast to the number of involved vascular territories (r = 0.2888/0.0105) were observed for CTA in comparison to clinical gold-standard. In this context, CBCT demonstrated a very strong correlation for both parameters, the number of bleeding vessels (r = 0.9720/0.9721) and the number involved vascular territories (r = 0.9441/0.9441). CONCLUSION: In complex cases of suspected haemorrhage, CBCT images can aid the interventionalist in detecting bleeding sites as well as narrowing down the number of involved vascular territories and thereby identifying feeding arteries of the bleeding source. Advances in knowledge: (1) CBCT showed no improvement in image quality. However, in complex bleeding cases CBCT information might aid in treatment planning. (2) CBCT improves visualization of bleeding vessels and involved feeding arteries. (3) Particularly, less experienced interventionalists might benefit from the three-dimensional information gathered by CBCT.


Assuntos
Vasos Sanguíneos/diagnóstico por imagem , Vasos Sanguíneos/lesões , Tomografia Computadorizada de Feixe Cônico , Hemorragia/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Idoso , Feminino , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
J Craniofac Surg ; 29(2): e155-e158, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29303851

RESUMO

PURPOSE: The aim of this study was to investigate the protection of the inferior alveolar neurovascular bundle in alveolar bone operation in conditions such as chronic osteomyelitis and cementoma. PATIENTS AND METHODS: The study enrolled 7 cases, 4 with chronic osteomyelitis and 3 with cementoma with pain. Computed tomography scan and 3-dimensional reconstruction were performed for the diseases. Data were processed by ProPlan CMF 1.3 software. The edge of lesion was defined and the inferior alveolar nerve was marked. Template was designed to guide the osteotomy line. Piezosurgery was used for osteotomy, with the avoidance of nerve canal. Current perception threshold (CPT) was performed to evaluate the nerve function after operation. RESULTS: The CPT difference of the affected side before and after operation showed no statistically significant differences compared with that of the unaffected side (P = 0.0556). CONCLUSIONS: Digital template protects the inferior alveolar neurovascular bundle with the aid of piezosurgery during alveolar bone resection, which obtained satisfying clinical results. As powerful assistive tools of functional surgery, digital template and piezosurgery achieve both the purposes of treatment and function.


Assuntos
Processo Alveolar/cirurgia , Cementoma/cirurgia , Neoplasias Mandibulares/cirurgia , Osteomielite/cirurgia , Osteotomia/métodos , Traumatismos do Nervo Trigêmeo/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Processo Alveolar/irrigação sanguínea , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/inervação , Vasos Sanguíneos/lesões , Cementoma/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional , Masculino , Mandíbula/cirurgia , Neoplasias Mandibulares/diagnóstico por imagem , Nervo Mandibular , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Osteomielite/diagnóstico por imagem , Osteotomia/efeitos adversos , Piezocirurgia , Tomografia Computadorizada por Raios X , Lesões do Sistema Vascular/prevenção & controle
19.
Cell ; 171(6): 1368-1382.e23, 2017 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-29195076

RESUMO

Blood platelets are critical for hemostasis and thrombosis and play diverse roles during immune responses. Despite these versatile tasks in mammalian biology, their skills on a cellular level are deemed limited, mainly consisting in rolling, adhesion, and aggregate formation. Here, we identify an unappreciated asset of platelets and show that adherent platelets use adhesion receptors to mechanically probe the adhesive substrate in their local microenvironment. When actomyosin-dependent traction forces overcome substrate resistance, platelets migrate and pile up the adhesive substrate together with any bound particulate material. They use this ability to act as cellular scavengers, scanning the vascular surface for potential invaders and collecting deposited bacteria. Microbe collection by migrating platelets boosts the activity of professional phagocytes, exacerbating inflammatory tissue injury in sepsis. This assigns platelets a central role in innate immune responses and identifies them as potential targets to dampen inflammatory tissue damage in clinical scenarios of severe systemic infection.


Assuntos
Infecções Bacterianas/imunologia , Plaquetas/imunologia , Animais , Bactérias/classificação , Plaquetas/citologia , Vasos Sanguíneos/lesões , Vasos Sanguíneos/patologia , Cálcio/metabolismo , Movimento Celular , Polaridade Celular , Humanos , Inflamação/imunologia , Integrinas/metabolismo , Camundongos , Miosinas/metabolismo , Neutrófilos/citologia
20.
Thorac Surg Clin ; 27(4): 339-346, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28962706

RESUMO

The learning curve of the uniportal video-assisted thoracoscopic surgery (VATS) approach is linked to a larger rate of intraoperative complications, which can lead to an emergency conversion to thoracotomy. Despite technical advancements and the large number of surgical videos posted on specialized websites, live surgery events and experimental courses have significantly contributed to accelerate the learning and evolution of minimally invasive thoracic surgery. Bleeding and other complications are the most dreaded event for many VATS surgeons. This article analyzes possible major intraoperative complications during uniportal VATS and explains how to manage them effectively and safely.


Assuntos
Vasos Sanguíneos/lesões , Hemorragia/terapia , Complicações Intraoperatórias/terapia , Pneumonectomia/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Toracotomia
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