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BACKGROUND: Pulmonary artery (PA) dilatation is often seen in pulmonary hypertension (PH) and is considered a long-term consequence of elevated pressure. The PA dilates over time and therefore may reflect disease severity and duration. Survival is related to the stage of the disease at the time of diagnosis and therefore PA diameter might be used to predict prognosis. This study evaluates the outcome of patients with pulmonary arterial hypertension (PAH) and chronic thrombo-embolic pulmonary hypertension (CTEPH) and investigates whether PA diameter at the time of diagnosis is associated with mortality. METHODS: Patients visiting an outpatient clinic of a tertiary centre between 2004 and 2018 with a cardiac catheterisation confirmed diagnosis of PAH or CTEPH and a CT scan available for PA diameter measurement were included. PA diameter and established predictors of survival were collected (New York Heart Association (NYHA) class, Nterminal pro-brain natriuretic peptide (NT-proBNP) level and 6min walking distance (6MWD)). RESULTS: In total 217 patients were included (69% female, 71% NYHA class ≥III). During a median follow-up of 50 (22-92) months, 54% of the patients died. Overall survival was 87% at 1 year, 70% at 3 years and 58% at 5 years. The mean PA diameter was 34.2⯱ 6.2â¯mm and was not significantly different among all the diagnosis groups. We found a weak correlation between PA diameter and mean PA pressure ( râ¯= 0.23, pâ¯< 0.001). Male sex, higher age, shorter 6MWD and higher NT-proBNP level were independently associated with mortality, but PA diameter was not. CONCLUSION: The prognosis of PAH and CTEPH is still poor. Known predictors of survival were confirmed, but PA diameter at diagnosis was not associated with survival in PAH or CTEPH patients.
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Systemic sclerosis (SSc) is a rare complex disease, characterized by microvascular damage, auto-immunity, and fibrosis. Nailfold capillary microscopy (NCM), a safe and noninvasive imaging technique, can be used to visualize specific microvascular alterations in SSc. In this review, we discuss an interesting case of a patient with changes in microvascular pattern on NCM after pulmonary transplantation. We provide an overview of microvascular alterations in systemic sclerosis and the evidence in the literature about the effect of vasoactive and immunomodulation therapy on these vascular changes. We also outline the influence of pulmonal pathology, such as interstitial lung disease and pulmonary arterial hypertension, on the capillaroscopic pattern, and finally, we discuss how NCM could possibly serve as a biomarker of treatment.
Assuntos
Doenças Pulmonares Intersticiais , Escleroderma Sistêmico , Capilares , Humanos , Angioscopia Microscópica , UnhasRESUMO
In this study, we studied the "passive" diffusion through myoglobin solutions by determining the oxygen diffusion coefficient (DO(2)) and the oxygen permeability (permeability O(2)) of metmyoglobin (metMb) solutions (3-33 g. 100 mL(-1)) at 25 degrees C. These oxygen diffusion parameters were determined in a diffusion chamber using a non-steady-state method and were also determined of albumin solutions (4-32 g. 100 mL(-1)) and distilled water for comparison. From these parameters, the oxygen solubility (alphaO(2)) could be calculated, because alphaO(2) = permeabilityO(2)/DO(2). Both DO(2) and permeabilityO(2) decreased with increasing metMb and albumin concentration. The values of DO(2), permeabilityO(2) and alphaO(2) of both metMb solutions and albumin solutions were comparable with literature values of methemoglobin (metHb) and serum protein solutions. The values of the metMb solutions can be used in following studies of facilitated oxygen diffusion through myoglobin solutions.
Assuntos
Metamioglobina/química , Oxigênio/química , Albuminas/química , Difusão , Modelos QuímicosRESUMO
nma, a novel gene, was isolated by using a subtractive hybridization technique in which the gene expression was compared in a panel of human melanoma cell lines with different metastatic potential. nma mRNA expression (1.5 kb) is high in poorly metastatic human melanoma cell lines and xenografts and completely absent in highly metastatic human melanoma cell lines. Fluorescence in situ hybridization combined with the analysis of a panel of human-rodent somatic cell hybrids indicated that the nma gene is located on human chromosome 10, in the region p11.2-p12.3. Sequence analysis of nma showed no homologies with other known genes or proteins, except for several partially sequenced cDNAs. The predicted amino acid sequence suggests that the protein encoded by nma contains a transmembrane domain. Expression of nma is high in human kidney medulla, placenta and spleen, low in kidney cortex, liver, prostate and gut and absent in lung and muscle. Whereas nma is not expressed in normal skin tissue, expression is high in melanocytes and in 3 out of 11 melanoma metastases tested.