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1.
Haya Mohammed BSc MChB M. Yousuf Salmasi MRCS Massimo Caputo PhD Gianni D. Angelini PhD Hunaid A. Vohra PhD 《Journal of cardiac surgery》2020,35(6):1209-1219
Background
Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to median sternotomy (MS) for multiple valvular disease (MVD). This systematic review and meta-analysis aims to compare operative and peri-operative outcomes of MIS vs MS in MVD.Methods
PubMed, Ovid, and Embase were searched from inception until August 2019 for randomized and observational studies comparing MIS and MS in patients with MVD. Clinical outcomes of intra- and postoperative times, reoperation for bleeding and surgical site infection were evaluated.Results
Five observational studies comparing 340 MIS vs 414 MS patients were eligible for qualitative and quantitative review. The quality of evidence assessed using the Newcastle-Ottawa scale was good for all included studies. Meta-analysis demonstrated increased cardiopulmonary bypass time for MIS patients (weighted mean difference [WMD], 0.487; 95% confidence interval [CI], 0.365-0.608; P < .0001). Similarly, aortic cross-clamp time was longer in patients undergoing MIS (WMD, 0.632; 95% CI, 0.509-0.755; P < .0001). No differences were found in operative mortality, reoperation for bleeding, surgical site infection, or hospital stay.Conclusions
MIS for MVD have similar short-term outcomes compared to MS. This adds value to the use of minimally invasive methods for multivalvular surgery, despite conferring longer operative times. However, the paucity in literature and learning curve associated with MIS warrants further evidence, ideally randomized control trials, to support these findings.2.
Luca Busetto Claudia Pisent Gianni Segato Francesco De Marchi Franco Favretti Mario Lise Giuliano Enzi 《Obesity surgery》1997,7(6):505-512
Objective: To evaluate the effects of a new timing strategy of band adjustment on the short-term outcome of obese women operated
with adjustable silicone gastric banding. Subjects: The outcome of 30 women without binge-eating disorder operated with laparoscopic
adjustable silicone gastric banding with a wider intraoperatory band calibration (LAP-BAND) was compared to that of 30 body
mass index-matched women without binge-eating disorder previously operated with adjustable silicone gastric banding (ASGB)
applied by laparotomy with the usual intraoperatory band calibration. The patients were evaluated 3, 6 and 12 months after
surgery. Measurements: (1) weight loss; (2) total daily energy intake; (3) percent as liquid, soft or solid food; (4) vomiting
frequency; (5) rate of postoperative percutaneous band adjustments; (6) rate of band-related complications. Results: Both
the weight loss and the daily energy intake did not differ between patients with LAP-BAND and patients with ASGB. After surgery,
the patients with LAP-BAND ate more solid food and less liquid food than the patients with ASGB. Vomiting frequency was higher
in patients with ASGB than in patients with LAP-BAND. The total number of percutaneous band adjustments was higher in women
with LAP-BAND than in women with ASGB. Band inflation because of weight stabilization was performed in six (20.0%) women with
ASGB and in 19 (63.3%) women with LAP-BAND. Neostoma stenosis occurred in one women with ASGB, but in none of the women with
LAP-BAND. One patient with LAP-BAND presented band slippage. Conclusions: The wider intraoperatory band calibration performed
in patients with LAP-BAND did not reduce the short-term efficacy of adjustable silicone gastric banding. This new timing strategy
of band adjustment required more postoperative percutaneous band inflations, but it improved the eating pattern of the patients
(low vomiting frequency and high intake of solid food). 相似文献
3.
We present a case of a female patient suffering from type I complex regional pain syndrome (CRPS) who developed “mirror imaging” of her CRPS and was successfully treated with dual spinal cord stimulation (SCS) in the paraforaminal epidural space. This patient initially had unilateral pain that was unsuccessfully treated with midline SCS and single‐lead lateral epidural lead placement “paraforaminally.” One year later, because we believed that paraforaminal stimulation would preferentially stimulate primary sensitized afferents innervating the painful area, we reperformed SCS with two leads positioned laterally and paraforaminally close to the roots within the epidural space. After repositioning and after 1 year of paraforaminal stimulation, there was significant improvement in the patient's symptoms, resolving all unilateral and “mirrored” symptoms. We conclude that paraforaminal stimulation may be a valid therapeutic option for the treatment of CRPS. 相似文献
4.
5.
Claudia Giaroli Gianfranco Riccò Gianni Vecchi Stefano Belli Caterina Bruno Mario Grignoli Silvia Candela Salvatore Minisci Roberto Poletti Guiseppina Venturi Antonio Ziccardi Pietro Comba 《International archives of occupational and environmental health》1994,66(1):7-11
The present study describes cause-specific mortality of asbestos cement workers in the Emilia Romagna region of Italy. The cohort included workers in ten factories, most of which started operating between 1955 and 1965. Asbestos, mainly chrysotile, constituted 10%–20% of the dry component of the mixture. Crocidolite range between 5% and 50% of total asbestos. Asbestos concentrations up to 44 ff/cc were reported prior to 1975, while in recent years they have usually been below 0–1 ff/cc. The cohort included 3341 workers who had at some time been employed in the ten factories under study. Their mortality experience was compared with that of the population resident in Emilia Romagna. Vital status was ascertained at 1989. Seventy-three subjects were lost to followup (2.2%). Mortality from all causes and from all types of cancer was increased in the cohort. Malignant neoplasms of the respiratory tract showed a significant increase (SMR: 134; 90% confidence interval: 101–175; 40 observed) due to lung cancer (SMR: 124; 90% confidence interval: 91–166; 33 observed) and neoplasms of the pleura, mediastinum, and other parts of the respiratory tract (SMR: 602; 90% confidence interval 237–1267; 5 observed). The discrepancy between observed and expected mortality mainly concerned subjects with at least 20 years of employment in the factories. Five more cases of histologically confirmed mesothelioma occurred after the end of follow-up. 相似文献
6.
Annalisa Volpi Francesco Bacci Angelo Paradiso Luca Saragoni Emanuela Scarpi Monica Ricci Mirella Aldi Simonetta Bianchi Pietro Muretto Fiorella Nuzzo Gianni Simone Anita Mangia Francesco Schittulli Dino Amadori 《Modern pathology》2004,17(9):1038-1044
Available results highlight the lack of good level of evidence studies on the pure prognostic value of histological grade. In the present study, the prognostic relevance of histological grade and of its three components, tubule formation, nuclear pleomorphism and mitotic count, was analyzed in a series of 372 patients with node-negative breast cancer treated with locoregional therapy alone until early relapse. Histological grade was determined blindly by two observers and discordance between evaluations was resolved after joint review using a multihead microscope. No relation was observed between histological grade and any of its three components and disease-free survival. Conversely, a significant relation was observed between histological grade and distant metastasis-free survival (at 6 years, 94, 86 and 76% for grades 1, 2 and 3, respectively, P=0.013) as well as overall survival (98, 90 and 86%, P=0.001). A breakdown analysis as a function of the three components showed that neither tubule formation nor nuclear pleomorphism was associated with prognosis, and only mitotic count strongly influenced both distant metastasis-free survival (91, 82 and 74%, P=0.014) and overall survival (97, 87 and 85%, P=0.011). Histological grade suffers from a much higher subjectivity than any other microscopic evaluation of biomarkers as it is the sum of three different morphological features. Within the Italian Network for Quality Assessment of Tumor Biomarkers program we observed that histological grade is an independent prognostic variable, but also that this role is ascribable only to the number of mitotic figures. In conclusion, due to the ever smaller size of diagnosed breast cancers, resulting in less cancer tissue for biofunctional and molecular analysis, mitotic count evaluated under strict quality control conditions seems to be an accurate and feasible prognostic variable. 相似文献
7.
8.
Sofia Avnet Annavera Lamolinara Nicoletta Zini Liliana Solimando Gianni Quacquaruccio Donatella Granchi Nadir Mario Maraldi Armando Giunti Nicola Baldini 《Journal of orthopaedic research》2006,24(8):1699-1708
Cathepsin K is a cystein protease that displays a proteolytic activity against Type I collagen and is abundantly and selectively expressed in osteoclasts where it plays a critical role in bone degradation. Its direct role in bone tissue has been defined by knock-out mice studies and inhibiting strategies in animals models. However, direct proof of cathepsin K function in human osteoclast model in vitro is lacking. The aim of this study is to analyze cathepsin K expression and localization in human osteoclasts obtained from peripheral blood and to examine cathepsin K function in these cells by antisense oligodeoxynucleotide (AS-ODN) strategy. AS-ODN was added to the culture of osteoclast precursors induced to differentiate by RANKL and M-CSF. AS-ODN treatment produced a significant down-regulation of cathepsin K mRNA (>80%) and protein expression, as verified respectively by Real-time PCR and by immunocytochemistry or Western blot. The cathepsin K inhibition caused an impairment of resorption activity as evaluated by a pit formation assay ( p = 0.045) and by electron microscopy, while the acidification process was unaffected. We demonstrated that antisense strategies against cathepsin K are selectively effective to inhibit resorption activity in human osteoclasts, like in animal models. 相似文献
9.
Gianni Biolo Beniamino Ciocchi Manuela Stulle Arianna Piccoli Stefania Lorenzon Viviana Dal Mas Rocco Barazzoni Michela Zanetti Gianfranco Guarnieri 《Journal of renal nutrition》2005,15(1):49-53
Physical inactivity is associated with alteration of normal physiologic processes leading to muscle atrophy, reduced exercise capacity, insulin resistance, and altered energy balance. Bed rest studies in human beings using stable isotopes of amino acids indicate that muscle unloading decreases the turnover rates of muscle and whole-body proteins, with a prevailing inhibition of protein synthesis. In the fasting state, muscle and whole-body nitrogen loss was not accelerated during bed rest. In experimental postprandial states, the amino acid-mediated stimulation of protein synthesis was impaired, whereas the ability of combined insulin and glucose infusion to decrease whole-body proteolysis was not affected by muscle inactivity. Thus, an impaired ability of protein/amino acid feeding to stimulate body protein synthesis is the major catabolic mechanism for the effect of bed rest on protein metabolism. This suggests that a protein intake level greater than normal could be required to achieve the same postprandial anabolic effect during muscle inactivity. Metabolic adaptation to muscle inactivity also involves development of resistance to the glucoregulatory action of insulin, decreased energy requirements, and increased insulin and leptin secretion. These alterations may lead to the development of the metabolic syndrome that is defined as the association of hyperinsulinemia, dyslipidemia, hypertension, hyperglycemia, and abdominal obesity. This cluster of metabolic abnormalities is a risk factor for coronary artery disease and stroke. Evidence indicates that exercise training programs may counteract all of these abnormalities both in healthy sedentary subjects and in patients affected by a variety of chronic disease states. 相似文献
10.
Onelio Geatti Brahm Shapiro Pier Giuseppe Orsolon Gianni Proto Ugo Paolo Guerra Francesco Antonucci Daniele Gasparini 《European journal of nuclear medicine and molecular imaging》1994,21(1):17-22
Technetium-99m methoxyisobutylisonitrile (MIBI), like thallium-201, has recently been introduced as a myocardial perfusion agent and is now also showing very promising results in parathyroid scintigrapy. The results of 201Tl/99mTc-pertechnetate and 99mTc-MIBI/99mTc-pertechnetate subtraction scintigraphy, ultrasonography and computed tomography are presented in a series of 43 patients operated on for hyperparathyroidism. All four imaging modalities were confirmed to be reliable, scintigraphy being the most accurate. Sensitivities ranged from 81% to 95%, that of 99mTc-MIBI being the highest. Moreover this tracer, which has more favourable physical and also biochemical properties, yielded images of superior quality. This allowed localization of the lesion by visual inspection only in as many as 86% of the patients with positive 99mTc-MIBI/99mTc-pertechnetate subtraction scintigraphy. We believe that the higher sensitivity, superior image quality and lower cost of 99mTc-MIBI imaging will make 99mTc-MIBI the new radiopharmaceutical of choice for parathyroid scintigraphy (when one takes into account the stability of labelling with large activities it is possible to perform three or four cardiac studies together with one parathyroid scintigraphic examination using one lyophililzed vial). 相似文献