RESUMO
A pedigree analysis was performed on eight French dairy cattle breeds to assess their change in genetic variability since a first analysis completed in 1996. The Holstein, Normande and Montbéliarde breeds are selected internationally with over hundreds of thousands cows registered in the performance recording system. Three breeds are internationally selected but with limited numbers of cows in France (Brown Swiss, French Simmental and French Red Pied). The last two remaining breeds (Abondance and Tarentaise) are raised at regional level. The effective numbers of ancestors of cows born between 2004 and 2007 varied between 15 (Abondance and Tarentaise) and 51 (French Red Pied). The effective population sizes (classical approach) varied between 53 (Abondance) and 197 (French Red Pied). This article also compares the genetic variability of the ex situ (collections of the French National Cryobank) and in situ populations. The results were commented in regard to the recent history of gene flows in the different breeds as well as the existence of more or less stringent bottlenecks. Our results showed that whatever the size of the breeds, their genetic diversity impoverished quite rapidly since 1996 and they all could be considered as quite poor from a genetic diversity point of view. It shows the need for setting up cryobanks as gene reservoirs as well as sustainable breeding programmes that include loss of genetic diversity as an integrated control parameter.
Assuntos
Bovinos/genética , Indústria de Laticínios , Evolução Molecular , Variação Genética/genética , Linhagem , Animais , Bovinos/anatomia & histologia , Feminino , Loci Gênicos/genética , Endogamia , Masculino , Densidade Demográfica , ProbabilidadeRESUMO
Wild and farmed animals are key elements of natural and managed ecosystems that deliver functions such as pollination, pest control and nutrient cycling within the broader roles they play in contributing to biodiversity and to every category of ecosystem services. They are subjected to global changes with a profound impact on the natural range and viability of animal species, the emergence and spatial distribution of pathogens, land use, ecosystem services and farming sustainability. We urgently need to improve our understanding of how animal populations can respond adaptively and therefore sustainably to these new selective pressures. In this context, we explored the common points between animal production science and animal ecology to identify promising avenues of synergy between communities through the transfer of concepts and/or methodologies, focusing on seven concepts that link both disciplines. Animal adaptability, animal diversity (both within and between species), selection, animal management, animal monitoring, agroecology and viability risks were identified as key concepts that should serve the cross-fertilization of both fields to improve ecosystem resilience and farming sustainability. The need for breaking down interdisciplinary barriers is illustrated by two representative examples: i) the circulation and reassortment of pathogens between wild and domestic animals and ii) the role of animals in nutrient cycles, i.e. recycling nitrogen, phosphorus and carbon through, for example, contribution to soil fertility and carbon sequestration. Our synthesis identifies the need for knowledge integration techniques supported by programmes and policy tools that reverse the fragmentation of animal research toward a unification into a single Animal Research Kinship, OneARK, which sets new objectives for future science policy. At the interface of animal ecology and animal production science, our article promotes an effective application of the agroecology concept to animals and the use of functional diversity to increase resilience in both wild and farmed systems. It also promotes the use of novel monitoring technologies to quantify animal welfare and factors affecting fitness. These measures are needed to evaluate viability risk, predict and potentially increase animal adaptability and improve the management of wild and farmed systems, thereby responding to an increasing demand of society for the development of a sustainable management of systems.
Assuntos
Ecologia , Ecossistema , Agricultura , Animais , Biodiversidade , FazendasRESUMO
BACKGROUND: Chickens represent an important animal genetic resource and the conservation of local breeds is an issue for the preservation of this resource. The genetic diversity of a breed is mainly evaluated through its nuclear diversity. However, nuclear genetic diversity does not provide the same information as mitochondrial genetic diversity. For the species Gallus gallus, at least 8 maternal lineages have been identified. While breeds distributed westward from the Indian subcontinent usually share haplotypes from 1 to 2 haplogroups, Southeast Asian breeds exhibit all the haplogroups. The Vietnamese Ha Giang (HG) chicken has been shown to exhibit a very high nuclear diversity but also important rates of admixture with wild relatives. Its geographical position, within one of the chicken domestication centres ranging from Thailand to the Chinese Yunnan province, increases the probability of observing a very high genetic diversity for maternal lineages, and in a way, improving our understanding of the chicken domestication process. RESULTS: A total of 106 sequences from Vietnamese HG chickens were first compared to the sequences of published Chinese breeds. The 25 haplotypes observed in the Vietnamese HG population belonged to six previously published haplogroups which are: A, B, C, D, F and G. On average, breeds from the Chinese Yunnan province carried haplotypes from 4.3 haplogroups. For the HG population, haplogroup diversity is found at both the province and the village level (0.69).The AMOVA results show that genetic diversity occurred within the breeds rather than between breeds or provinces. Regarding the global structure of the mtDNA diversity per population, a characteristic of the HG population was the occurrence of similar pattern distribution as compared to G. gallus spadiceus. However, there was no geographical evidence of gene flow between wild and domestic populations as observed when microsatellites were used. CONCLUSIONS: In contrast to other chicken populations, the HG chicken population showed very high genetic diversity at both the nuclear and mitochondrial levels. Due to its past and recent history, this population accumulates a specific and rich gene pool highlighting its interest and the need for conservation.
Assuntos
Galinhas/genética , Variação Genética , Animais , Sequência de Bases , China , DNA Mitocondrial , Genética Populacional , Índia , VietnãRESUMO
BACKGROUND: During the last decades, there has been an acceleration of the loss of domestic animal biodiversity. For conservation purposes, the genetic diversity of the H'Mong cattle, an indigenous local breed was studied. Single-nucleotide polymorphisms (SNP) of the SRY gene and mtDNA D-Loop sequence were analysed to clarify the origin of the breed. The genetic diversity was assessed through genetic data with twenty-five FAO microsatellites, and morphometric data with five body measurements from 408 animals sampled from eight districts of the Ha Giang province. RESULTS: The SRY genes were all of the zebu type. Among the 27 mtDNA haplotypes, 12 haplotypes were of the taurine type and the remaining 15 of the zebu type. This indicates female taurine introgression in the zebu H'Mong. The observed and expected heterozygosity ranged from 0.616 to 0.673 and from 0.681 to 0.729 respectively according to district, with low genetic differentiation (F ST = 0.0076). Multivariate analysis on morphometric and genetic data shows a separation of districts into two groups following a south-west/north-east cline and admixture analysis confirmed the two clusters, but no differentiation of taurine introgression between clusters was observed. A possible admixture with the Yellow cattle breed from a neighbouring province was suggested through genetic data and householder interviews. CONCLUSIONS: In this study we demonstrate the interest of fine-scale sampling for the study of genetic structure of local breeds. Such a study allows avoiding erroneous conservation policies and on the contrary, proposes measures for conserving and limiting crossbreeding between the H'Mong and the Yellow cattle breeds.
Assuntos
Bovinos/genética , Genes sry , Variação Genética , Genética Populacional , Animais , Feminino , Fluxo Gênico , Haplótipos , Repetições de Microssatélites , Filogenia , Polimorfismo de Nucleotídeo Único , RNA Mensageiro , VietnãRESUMO
The water buffalo plays a key role in the socio-economy of South-East Asia as it is the main draught power for paddy rice cultivation. While in the Indian subcontinent the water buffalo is the riverine type, in South-East Asia the majority of buffaloes are of the swamp type. In the poor remote northern province of Ha Giang in Vietnam, improvement of the swamp buffalo breed may be one of the best ways to increase sustainability of farming systems. Therefore, analysis of the genetic structure of the province buffalo population is a prerequisite to any conservation or improvement project. A total of 1122 animals were described for 11 body and horn measurements for morphometric characterization. From this sample set, 744 animals were genotyped for 17 microsatellite markers. Also 17 animals from southern provinces of Vietnam were genotyped as a comparative sample. The results showed that genetic diversity as well as inbreeding value in the Ha Giang was high. The F(ST) values within the province and across Vietnam were low indicating that most of the population variation is explained by individual variability. Bayesian clustering analysis did not highlight the presence of subdivided populations. These results are useful for the implementation of a conservation and improvement strategy of the swamp buffalo in order to guarantee the householders' needs for sustainability of the farming system in the Ha Giang province.
Assuntos
Búfalos/anatomia & histologia , Búfalos/genética , Animais , Feminino , Masculino , Repetições de Microssatélites , Filogenia , Polimorfismo Genético , VietnãRESUMO
UNLABELLED: Previous studies suggested that multiple domestication events in South and South-East Asia (Yunnan and surrounding areas) and India have led to the genesis of modern domestic chickens. Ha Giang province is a northern Vietnamese region, where local chickens, such as the H'mong breed, and wild junglefowl coexist. The assumption was made that hybridisation between wild junglefowl and Ha Giang chickens may have occurred and led to the high genetic diversity previously observed. The objectives of this study were i) to clarify the genetic structure of the chicken population within the Ha Giang province and ii) to give evidence of admixture with G. gallus. A large survey of the molecular polymorphism for 18 microsatellite markers was conducted on 1082 chickens from 30 communes of the Ha Giang province (HG chickens). This dataset was combined with a previous dataset of Asian breeds, commercial lines and samples of Red junglefowl from Thailand and Vietnam (Ha Noï). Measurements of genetic diversity were estimated both within-population and between populations, and a step-by-step Bayesian approach was performed on the global data set. RESULTS: The highest value for expected heterozygosity (> 0.60) was found in HG chickens and in the wild junglefowl populations from Thailand. HG chickens exhibited the highest allelic richness (mean A = 2.9). No significant genetic subdivisions of the chicken population within the Ha Giang province were found. As compared to other breeds, HG chickens clustered with wild populations. Furthermore, the neighbornet tree and the Bayesian clustering analysis showed that chickens from 4 communes were closely related to the wild ones and showed an admixture pattern. CONCLUSION: In the absence of any population structuring within the province, the H'mong chicken, identified from its black phenotype, shared a common gene pool with other chickens from the Ha Giang population. The large number of alleles shared exclusively between Ha Giang chickens and junglefowl, as well as the results of a Bayesian clustering analysis, suggest that gene flow has been taking place from junglefowl to Ha Giang chickens.
Assuntos
Galinhas/genética , Evolução Molecular , Fluxo Gênico , Genética Populacional , Animais , Teorema de Bayes , Análise por Conglomerados , Frequência do Gene , Variação Genética , Repetições de Microssatélites , Fenótipo , Polimorfismo Genético , Tailândia , VietnãRESUMO
Genetic relationships between 61 dog breeds were investigated, using a sampling of 1514 animals and a panel of 21 microsatellite markers. Based on the results from distance-based and Bayesian methods, breed constituted the main genetic structure, while groups including genetically close breeds showed a very weak structure. Depending on the method used, between 85.7% and 98.3% of dogs could be assigned to their breed, with large variations according to the breed. However, breed heterozygosity influenced assignment results differently according to the method used. Within-breed and between-breed diversity variations when breeds were removed were highly negatively correlated (r = -0.963, P < 0.0001), because of the genetic structure of the breed set.
Assuntos
Cruzamento , Cães/genética , Animais , Teorema de Bayes , DNA/química , DNA/genética , Variação Genética , Genética Populacional , Repetições de Microssatélites/genéticaRESUMO
The genetic diversity of 61 dog breeds raised in France was investigated. Genealogical analyses were performed on the pedigree file of the French kennel club. A total of 1514 dogs were also genotyped using 21 microsatellite markers. For animals born from 2001 to 2005, the average coefficient of inbreeding ranged from 0.2% to 8.8% and the effective number of ancestors ranged from 9 to 209, according to the breed. The mean value of heterozygosity was 0.62 over all breeds (range 0.37-0.77). At the breed level, few correlations were found between genealogical and molecular parameters. Kinship coefficients and individual similarity estimators were, however, significantly correlated, with the best mean correlation being found for the Lynch & Ritland estimator (r = 0.43). According to both approaches, it was concluded that special efforts should be made to maintain diversity for three breeds, namely the Berger des Pyrénées, Braque Saint-Germain and Bull Terrier.
Assuntos
Cruzamento , Cães/genética , Alelos , Animais , DNA/química , DNA/genética , França , Variação Genética , Repetições de Microssatélites/genética , Linhagem , Polimorfismo de Nucleotídeo Único , Estatísticas não ParamétricasRESUMO
French and Asian subsets of chicken breeds were first analysed using 22 microsatellites and then compared to the AVIANDIV European set using 14 loci. Positive correlations were observed between F(IT) or F(ST) and typological values or variance of markers using the multivariate analysis mcoa. The first axis of the multivariate representation separated Asian from European breeds, revealing breeds with Asian ancestor. Using all or 14 loci, correct assignation rate was always higher than 93%. The Weitzman index and the aggregate diversity D were calculated using 22 loci within French and Asian breeds. The French breed Coucou de Rennes and the Hua-Tung breed seemed to contribute the most to the global diversity of each subset. This approach on French-only breeds and then on French with AVIANDIV domestic breeds (14 loci) showed that the Marans breed contributed the most. The AVIANDIV framework could be useful to evaluate the genetic diversity of local breeds and to help in connecting national and regional conservation policies.
Assuntos
Galinhas/genética , Marcadores Genéticos , Variação Genética , Animais , Ásia , Galinhas/classificação , França , Frequência do Gene , Triagem de Portadores Genéticos , Genótipo , Desequilíbrio de Ligação , Repetições de MicrossatélitesRESUMO
To improve the health and welfare of pedigree dogs, national kennel clubs (KCs) are key players in the governance and regulation of dog breeding. In a survey conducted to investigate differences between KCs in breeding policies and management of pedigree dogs, a questionnaire was completed by 15 KCs from 11 European countries (Austria, Belgium, Denmark, France, Germany, Ireland, Latvia, The Netherlands, Norway, Sweden and the United Kingdom) and four non-European countries (Australia, Mexico, Uruguay and the USA). The most important concerns reported by KCs were exaggerated morphological features and inherited disorders. A wide variety of information, tools and strategies was used to address these issues, with implementation differing across countries and breeds. KCs reported progress in the collection and provision of information related to canine health and welfare. Implementation of advanced breeding tools, such as genetic evaluation and online advisory mating tools, and balanced breeding strategies, endorsed by clubs and breeders, remain challenging and require further development.
Assuntos
Cruzamento/legislação & jurisprudência , Doenças do Cão/genética , Doenças do Cão/prevenção & controle , Linhagem , Bem-Estar do Animal , Animais , Cães , Feminino , MasculinoRESUMO
To evaluate the effect of volume loading in the low output state associated with right ventricular infarction, isolated right ventricular infarction was produced in seven dogs with the pericardium intact. Volume loading and pericardiotomy were then sequentially performed. After the production of right ventricular infarction, right ventricular systolic pressure decreased by 25%, aortic pressure by 36% and cardiac output by 32%. Right ventricular ejection fraction decreased by 57%, but left ventricular ejection fraction did not change significantly. Left ventricular transmural pressure and diastolic size decreased, and right ventricular diastolic size increased. Intrapericardial pressure increased and equalization of diastolic pressures was noted. Volume loading resulted in increased right ventricular systolic pressure and stroke work, increased aortic pressure and cardiac output and increased transmural pressure and diastolic size in both ventricles. Pericardiotomy resulted in further increases in right and left ventricular filling, stroke work and cardiac output, as well as resolution of equalized diastolic pressures. These results indicate that cardiac output in experimental right ventricular infarction increases with volume loading, which enhances left ventricular preload by augmenting right ventricular output. Elevated intrapericardial pressure affects filling of both ventricles and may play a role in the pathophysiology of low cardiac output in right ventricular infarction.
Assuntos
Baixo Débito Cardíaco/etiologia , Infarto do Miocárdio/complicações , Animais , Baixo Débito Cardíaco/fisiopatologia , Volume Cardíaco , Cães , Ecocardiografia , Coração/diagnóstico por imagem , Contração Miocárdica , Infarto do Miocárdio/fisiopatologia , Pressão , Cintilografia , Albumina Sérica , Cloreto de Sódio , Volume Sistólico , Tecnécio , Agregado de Albumina Marcado com Tecnécio Tc 99m , Resistência VascularRESUMO
Nonocclusive intestinal infarction developed in a 29-year-old man after phenobarbital overdose. He was found 72 hours after the overdose, at which time examination of the abdomen disclosed no abnormalities and he was not hypotensive. During the next ten hours, abdominal distention, ileus, and gas within the intestinal wall and portal venous system developed. Laparotomy disclosed ischemic intestinal infarction of the right colon and distal ileum with no evidence of thrombosis of the mesenteric vessels. The patient recovered fully after ileostomy with subsequent reanastomosis. To our knowledge, ischemic intestinal infarction after drug overdose has not been reported previously.
Assuntos
Colo/irrigação sanguínea , Íleo/irrigação sanguínea , Infarto/induzido quimicamente , Fenobarbital/intoxicação , Adulto , Colo/diagnóstico por imagem , Humanos , Íleo/diagnóstico por imagem , Infarto/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios XRESUMO
The effects of the pericardium on the amount and distribution of left ventricular myocardial blood flow were studied. In 10 normal dogs, transfusion of blood from a donor dog resulted in modest increases in coronary flow and ventricular diameter that were greater with an open than a closed pericardium. The ratio of subendocardial to subepicardial flow remained normal with or without the pericardium, at low and high diastolic ventricular pressure, and before and after pharmacological vasodilation with chromonar. In 18 dogs, cardiac failure was induced by constant infusion of the metabolic inhibitor, phenformin. Modest ventricular dilatation occurred if the pericardium was open. A progressive rise in myocardial blood flow developed in those with the pericardium open (1.06 rising to 3.02 ml . g-1 . min-1). A lesser increase (0.62 to 1.75 ml . g-1 . min-1) was seen in dogs with the pericardium closed; they selectively increased subendocardial flow, producing an average subendocardial to subepicardial flow ratio of 2.25. Pharmacological vasodilatation then resulted in uniform transmural flow. The pericardium can influence myocardial flow indirectly by influencing myocardial metabolic demand, when the heart is stressed. It may have a beneficial role in preventing the increased oxygen and coronary flow requirements produced by ventricular dilatation.
Assuntos
Circulação Coronária , Pericárdio/fisiologia , Animais , Circulação Coronária/efeitos dos fármacos , Doença das Coronárias/induzido quimicamente , Cães , Testes de Função Cardíaca , Ventrículos do Coração , Hemodinâmica/efeitos dos fármacos , Pericárdio/fisiopatologia , Fenformin/farmacologiaRESUMO
Early endothelial injury may play a role in the development of transplant arteriosclerosis. The present study documents early endothelial changes using a rat aortic graft model. Abdominal aortic allografts from PVG rats were orthotopically transplanted to DA rats. Controls were DA to DA transplants. Endothelial cell (EC) injury, regeneration, and leukocyte infiltration in the intima were evaluated using scanning electron microscopy and histological and immunocytochemical techniques. Nontransplanted aortic segments showed partial loss of ECs after 1 or 2 hr of preservation. Control isografts demonstrated extensive EC denudation and neutrophil adherence to residual ECs at 1 day post-transplantation. After 3 days, isografts showed continued regeneration of ECs in the central area and ingrowth of endothelium from both clamped sites in the recipient aorta. Reendothelialization was complete by day 14. Allografts showed similar findings to isografts up to day 3. In contrast to isografts, however, there was a secondary EC loss beginning at day 7. Monocytes/macrophages and T cells were noted to be adherent to residual ECs in 7- and 14-day allografts. At 20 days, ECs were absent from the luminal surface in the center of allografts. Endothelium did extend from clamped sites toward the midgraft region as in isografts. By 60 days allografts were completely reendothelialized. These results demonstrate that in both isografts and allografts there is initial EC loss due to mechanical trauma and ischemia/reperfusion injury, followed by partial reendothelialization. This latter process continues unabated in isografts, whereas in allografts the secondary EC loss occurs due to an allogenic response. This is followed by complete reendothelialization that occurs during the concurrent development of significant intimal hyperplasia.
Assuntos
Aorta/transplante , Arteriosclerose/etiologia , Animais , Aorta/patologia , Adesão Celular , Endotélio Vascular/patologia , Microscopia Eletrônica de Varredura , Monócitos/patologia , Neutrófilos/patologia , Ratos , Ratos Endogâmicos , Regeneração , Traumatismo por Reperfusão/patologia , Fatores de Tempo , Transplante HomólogoRESUMO
The purpose of this study was to determine whether individual patients show different patterns of fibrinolytic response to cardiopulmonary bypass (CPB) and whether preoperative or intraoperative parameters were predictive of these different patterns. Active t-PA, active PAI-1 and total t-PA antigen were measured in plasma samples obtained from 38 subjects, age 32 to 85 (median 69 years), before, during and after CPB. Four patterns of fibrinolytic response were noted: 1) 40% of patients showed the "typical" response, a rapid rise in active and total t-PA during CPB followed postoperatively by elevated PAI-1 and reduced t-PA, 2) 10% showed no change in t-PA or PAI-1 during or after CPB, 3) 24% showed no change in t-PA with an increase in PAI-1 postoperatively, and 4) 26% showed an increase in t-PA during CPB with no change in PAI-1 postoperatively. When present, the t-PA response was rapid, occurring within the first 30 min of CPB and was more common in patients undergoing valve surgery than in coronary artery bypass grafting (p < 0.005). Increased levels of PAI-1 postoperatively were associated with ischemic times greater than 70 min (p = 0.003) but not with the total length of CPB. Age, sex, CPB temperature, total CPB time and preoperative levels of t-PA and PAI-1 were not associated in the intra- or postoperative fibrinolytic response pattern. We conclude that the fibrinolytic response to CPB is heterogeneous. Further studies will be needed to determine whether different response patterns are clinically significant.
Assuntos
Ponte Cardiopulmonar , Fibrinólise , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Inibidor 1 de Ativador de Plasminogênio/análise , Complicações Pós-Operatórias/sangue , Ativador de Plasminogênio Tecidual/análiseRESUMO
Stentless tissue valves may provide more favorable hemodynamics than conventional stented valves. Hemodynamic findings from a large multicenter trial have not been previously reported. The present report describes the hemodynamic findings from a multinational, multicenter study after implantation of the Toronto SPV valve. A total of 577 patients underwent aortic valve replacement with the Toronto SPV valve at 12 sites in 3 countries. Echocardiograms were recorded in the early postoperative period, 3 to 6 months after surgery, 1 year after surgery, and yearly thereafter, with follow-up to 3 years. Gradients decreased and effective orifice area increased in the months after surgery. One year after surgery, mean gradient for valve sizes 20 to 22, 23, 25, 27, and 29 mm was 7.3 +/- 4.4, 7.4 +/- 4.5, 6.1 +/- 3.3, 4.9 +/- 2.4, and 4.0 +/- 2.1 mm Hg, respectively; effective orifice area was 1.3 +/- 0.7, 1.5 +/- 0.5, 1.7 +/- 0.4, 2.0 +/- 0.4, and 2.4 +/- 0.6 cm2, respectively. There was a very low prevalence of significant aortic regurgitation at all time periods. There was significant left ventricular (LV) mass regression between the early and 3- to 6-month periods and between the 3- to 6-month and 1-year postoperative periods. The Toronto SPV valve has an excellent hemodynamic profile supported by significant regression of LV hypertrophy in the year after implantation. Data through 3 years demonstrates maintenance of low gradients and freedom from significant aortic regurgitation.
Assuntos
Bioprótese , Próteses Valvulares Cardíacas , Hemodinâmica , Hipertrofia Ventricular Esquerda , Idoso , Valva Aórtica , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Estudos de Coortes , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/cirurgia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Complicações Pós-Operatórias/diagnóstico por imagem , Período Pós-Operatório , Prevalência , UltrassonografiaRESUMO
Leading a division or department of cardiothoracic surgery is both a tremendous honor and a significant responsibility. Key to such a position of leadership are committed, functional, and loyal teams focused on the end points of success, and the ability of the leader to develop a strategic vision and to implement a functional operating system.
Assuntos
Mobilidade Ocupacional , Educação de Pós-Graduação em Medicina/normas , Docentes de Medicina , Administradores Hospitalares , Cirurgia Torácica/educação , Cirurgia Torácica/normas , Departamentos Hospitalares/normas , Humanos , Liderança , Pesquisa , Estados UnidosRESUMO
Preparing to begin a career in academic cardiothoracic surgery requires forethought and desire. Success mandates honesty, discipline, opportunity, and support. This article will attempt to review some fundamental concepts important in starting such an academic career. The thoughts are somewhat personal and not meant to be inclusive. The article will briefly discuss the following issues: choosing the first job, transitions, effective time management, developing clinical confidence, the continued need for mentorship, developing educational value, developing a philosophy of academic growth, intellectual and emotional honesty, myths, mental and physical health, and keys to success.
Assuntos
Escolha da Profissão , Docentes de Medicina , Cirurgia Torácica , Mobilidade Ocupacional , Competência Clínica , Apoio à Pesquisa como Assunto , Cirurgia Torácica/educaçãoRESUMO
The charts of 61 patients treated from 1970 through 1981 were reviewed to determine the clinical outcome after treatment of air embolism from blunt (15 patients) and penetrating (21 gunshot and 25 stabbing) thoracic injuries. The diagnosis of air embolism was confirmed by the presence of air in the coronary arteries (57%), air aspirated from the heart (30%) or major artery (10%), or Doppler findings (3%). All patients were in shock or cardiac arrest, and in 36% of these patients there were early signs of hemoptysis or unexpected arrest after intubation and positive-pressure ventilation. Successful management included (1) early thoracotomy for diagnosis as well as for specific treatment, (2) hilar cross-clamping for control of bronchovenous communication, (3) maintenance of perfusion pressures with fluids, vasopressors, or aortic cross-clamping, and (4) prompt correction of the embolic source, usually a lung resection. The overall survival rate was 44%, which correlated with the mechanism of injury, with associated nonthoracic injuries, and with the occurrence of arrest in a controlled setting. We conclude that (1) air embolism can insidiously occur even in blunt trauma; (2) suspicion should be high with hemoptysis or unexpected arrest; and (3) successful treatment includes immediate thoracotomy for diagnosis, resuscitation, and prompt control of the bronchovenous communication.
Assuntos
Embolia Aérea/terapia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações , Adolescente , Adulto , Idoso , Aorta Torácica , Criança , Pré-Escolar , Constrição , Embolia Aérea/etiologia , Embolia Aérea/mortalidade , Humanos , Pulmão/cirurgia , Lesão Pulmonar , Pessoa de Meia-Idade , Prognóstico , Ressuscitação , Estudos RetrospectivosRESUMO
The 12 mm Dacron conduit containing a porcine valve is the smallest valved conduit manufactured and is used in the youngest infants with the most diminutive pulmonary arterial system. The outcome of patients with such a conduit is unknown. Between 1975 and 1985 there were 49 hospital survivors after placement of a 12 mm extracardiac valved conduit from the right ventricle to the pulmonary artery. Follow-up is available in 42 patients, aged 1 to 16 months (mean 3.5) and weighing 2.5 to 8.7 kg (mean 3.8). Twenty-eight patients (67%) have undergone subsequent conduit replacement, and 11 (26%) are alive and asymptomatic with a mean follow-up of 56 months. There were three late deaths. The interval between implantation and conduit change was 4.5 to 101 months (mean 44), allowing a weight gain of 2.7 to 23 kg (mean 10.4) before reoperation at age 12 to 117 months (mean 49). Despite elevated right ventricular pressures equaling systemic values, 37% of these patients were clinically asymptomatic. The gradient across the 12 mm valved conduit before explantation ranged from 30 to 173 torr (mean 83) with an almost equal predilection for stenosis at the proximal anastomosis, valve, conduit, distal anastomosis, and main pulmonary artery. The intervening pulmonary artery growth determined the size of the replacement conduit, 14 to 25 mm (mean 16), and was the main factor influencing the results of reoperation. This study demonstrates that the 12 mm porcine valve-containing conduit affords palliation in this difficult subset of patients with the smallest pulmonary arterial tree.