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61.
Leoncini G Ratto E Viazzi F Conti N Falqui V Parodi A Tomolillo C Deferrari G Pontremoli R 《Journal of hypertension》2008,26(3):427-432
OBJECTIVE: Microalbuminuria and a reduction in creatinine clearance are well known, independent predictors of unfavourable cardiovascular prognosis. Our aim was to evaluate the impact of renal damage on global risk stratification in 459 non-diabetic, untreated hypertensive patients (64% men, mean age 47.3 years). METHODS: Renal damage was defined as creatinine clearance < 60 ml/min per 1.73 m2 (Cockcroft-Gault formula) or the presence of microalbuminuria (albumin to creatinine ratio). Cardiac and vascular organ damage was assessed by ultrasound scan. We evaluated the impact of renal damage, left ventricular hypertrophy and carotid atherosclerosis on risk stratification as recommended by the 2007 European Society of Hypertension-European Society of Cardiology Guidelines. RESULTS: The prevalence of renal damage, microalbuminuria and creatinine clearance < 60 ml/min per 1.73 m2 was 24, 12 and 13%, respectively. There was no correlation between albuminuria and estimated creatinine clearance, and only 0.9% of patients showed microalbuminuria and reduced creatinine clearance simultaneously. The presence of renal damage entailed a 3.3 times higher risk of having cardiovascular abnormalities. Based on routine work-up, 58% of our study patients were classified as high-very high risk. The simultaneous evaluation of albuminuria and creatinine clearance resulted in a significant change in risk stratification, since 68% of patients were classified in the high-very high risk class. The search for left ventricular hypertrophy or carotid atherosclerosis by ultrasonography did not improve risk stratification significantly as compared to the assessment of renal damage. CONCLUSIONS: Our findings support the assessment of renal abnormalities as the first step when evaluating target organ damage for cardiovascular risk assessment in hypertensive patients. 相似文献
62.
Lauren S. Tufts Emma D. Jarnagin Jessica R. Flynn Mithat Gonen Jose G. Guillem Philip B. Paty Garrett M. Nash Joshua J. Smith Iris H. Wei Emmanouil Pappou Michael I. DAngelica Peter J. Allen T. Peter Kingham Vinod P. Balachandran Jeffrey A. Drebin Julio Garcia-Aguilar William R. Jarnagin Martin R. Weiser 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):181-186
Background
Surgical site infections (SSIs) are a major cause of morbidity, mortality, and healthcare costs, and patients undergoing simultaneous colorectal/liver resections are at an especially high SSI risk.Methods
Data were collected on all patients undergoing synchronous colorectal/liver resection from 2011 to 2016 (n = 424). The intervention, implemented in 2013, included 13 multidisciplinary perioperative components. The primary endpoints were superficial/deep and organ space SSIs. Secondary endpoints were hospital length of stay (LOS) and 30-day readmission rate. To control for changes in SSI rates independent of the intervention, interrupted time series analysis was conducted.Results
Overall, superficial/deep, and organ space SSIs decreased by 60.5% (p < 0.001), 80.6% (p < 0.001), and 47.6% (p = 0.008), respectively. In the pre-intervention cohort (n = 231), there were 79 (34.2%), 31 (13.4%), and 48 (20.8%) total, superficial/deep, and organs space SSIs, respectively. In the post-intervention cohort (n = 193), there were 26 (13.5%), 5 (2.6%), and 21 (10.9%) total, superficial/deep, and organs space SSIs, respectively. Median LOS decreased from 9 to 8 days (p < 0.001). Readmission rates did not change (p = 0.6). Interrupted time series analysis found no significant trends in SSI rate within the pre-intervention (p = 0.35) and post-intervention (p = 0.55) periods.Conclusion
In combined colorectal/liver resection patients, implementation of a multidisciplinary care bundle was associated with a 61% reduction in SSIs, with the greatest impact on superficial/deep SSI, and modest reduction in LOS. The absence of trends within each time period indicated that the intervention was likely responsible for SSI reduction. Future efforts should target further reduction in organ space SSI. 相似文献63.
Thays Martins Vital Angelica Miki Stein Flávia Gomes de Melo Coelho Franciel José Arantes Elizabeth Teodorov Ruth Ferreira Santos-Galduróz 《Archives of gerontology and geriatrics》2014
The aim of this study was to conduct a systematic review of studies that verified the effects of physical exercise on vascular endothelial growth factor (VEGF) in elderly. 相似文献
64.
Paola Quarello Emanuela Garelli Adriana Carando Rebecca Cillario Alfredo Brusco Elisa Giorgio Daniela Ferrante Paola Corti Marco Zecca Matteo Luciani Filomena Pierri Maria C. Putti Maria E. Cantarini Piero Farruggia Angelica Barone Simone Cesaro Giovanna Russo Franca Fagioli Irma Dianzani Ugo Ramenghi the AIEOP working group on Diamond Blackfan Anaemia 《British journal of haematology》2020,190(1):93-104
Diamond–Blackfan anaemia (DBA) is a rare and heterogeneous disease characterised by hypoplastic anaemia, congenital anomalies and a predisposition for malignancies. The aim of this paper is to report the findings from the Italian DBA Registry, and to discuss the Registry’s future challenges in tackling this disease. Our 20-year long work allowed the connection of 50 Italian Association of Paediatric Haematology and Oncology (AIEOP) centres and the recruitment of 283 cases. Almost all patients have been characterised at a molecular level (96%, 271/283), finding a causative mutation in 68% (184/271). We confirm the importance of determination of erythrocyte adenosine deaminase activity (eADA) and of ribosomal RNA assay in the diagnostic pipeline and characterisation of a remission state. Patients with mutations in large ribosomal subunit protein (RPL) genes had a significant correlation with the incidence of malformations, higher eADA levels and more severe outcomes, compared to patients with mutations in small ribosomal subunit protein (RPS) genes. Furthermore, as a consequence of our findings, particularly the incidence of malignancies and the high percentage of patients aged >18 years, we stress the importance of collaboration with adult clinicians to guarantee regular multi-specialist follow-up. In conclusion, this study highlights the importance of national registries to increase our understanding and improve management of this complex disease. 相似文献
65.
Marcia M. Mellado Lagarde Guoqiang Wan LingLi Zhang Angelica R. Gigliello John J. McInnis Yingxin Zhang Dwight Bergles Jian Zuo Gabriel Corfas 《Proceedings of the National Academy of Sciences of the United States of America》2014,111(47):16919-16924
Supporting cells in the cochlea play critical roles in the development, maintenance, and function of sensory hair cells and auditory neurons. Although the loss of hair cells or auditory neurons results in sensorineural hearing loss, the consequence of supporting cell loss on auditory function is largely unknown. In this study, we specifically ablated inner border cells (IBCs) and inner phalangeal cells (IPhCs), the two types of supporting cells surrounding inner hair cells (IHCs) in mice in vivo. We demonstrate that the organ of Corti has the intrinsic capacity to replenish IBCs/IPhCs effectively during early postnatal development. Repopulation depends on the presence of hair cells and cells within the greater epithelial ridge and is independent of cell proliferation. This plastic response in the neonatal cochlea preserves neuronal survival, afferent innervation, and hearing sensitivity in adult mice. In contrast, the capacity for IBC/IPhC regeneration is lost in the mature organ of Corti, and consequently IHC survival and hearing sensitivity are impaired significantly, demonstrating that there is a critical period for the regeneration of cochlear supporting cells. Our findings indicate that the quiescent neonatal organ of Corti can replenish specific supporting cells completely after loss in vivo to guarantee mature hearing function.Inner hair cells (IHCs), the sensory cells of the mammalian auditory sensory epithelium, are surrounded by specialized supporting cells (SCs) called “inner border cells” (IBCs) and “inner phalangeal cells” (IPhCs) (Fig. S1A). IBCs and IPhCs, together with other SCs, are known to play critical roles during the development and maturation of the organ of Corti, in processes such as patterning of the epithelium, synaptogenesis, and initiation of electrical activity in auditory nerves before the onset of hearing and formation of extracellular matrices (1–7). SCs also are essential for the function of the mature organ of Corti, where they contribute to the maintenance of the reticular lamina at the apical surface of the epithelium (8), control the extracellular concentration of ions (e.g., K+) (9, 10) and neurotransmitters (e.g., glutamate) (11), and support hair cell (HC) and auditory sensory neuron survival (5, 12–15). SCs also have been proposed to regulate the effects of insults on HCs by releasing molecules that either promote (e.g., ERK1 and 2) (16) or reduce (e.g., heat shock protein 70) (17) HC death. Additionally, SCs impact the extent of damage in the auditory epithelium through scar formation and clearance of HC debris (18). Furthermore, SCs are considered a potential source of cells for HC replacement in mammals, because SCs are a documented source of new HCs in cultured neonatal cochlea (19) and in adult utricles (20). Additionally, nonmammalian vertebrates regenerate HCs and SCs after damage and recover hearing, with the SCs being the source of the regenerative response (21–23). Indeed, if SCs are damaged by insults, the regenerative response is severely compromised (1, 24). Thus, it is assumed that the presence of these cells in the postnatal cochlea is essential for hearing, but specific roles of IBCs and IPhCs in HC maintenance and cochlear function have not been established.To determine the consequences of neonatal IBC and IPhC loss on the mature organ of Corti, we ablated these cells in vivo using an inducible diphtheria toxin fragment A (DTA) transgenic approach (25). Unexpectedly, we found that when these IHC supporting cells are eliminated immediately after birth, they are replaced efficiently within days. Moreover, this regeneration preserves the structure and function of the organ of Corti, so that mice with transient IBC/IPhC loss retain normal hearing as adults. In contrast, IBCs and IPhCs do not regenerate if ablation occurs after the onset of hearing, resulting in IHC loss and severe hearing impairment. Our studies also indicate that IBC and IPhC replacement in the neonatal cochlea results from transdifferentiation of less-specified SCs within the neighboring greater epithelial ridge (GER or Kölliker’s organ), which does not require cell proliferation. The unexpected regenerative capacity of SCs in the early postnatal organ of Corti in vivo may provide new strategies to regenerate its nonsensory and sensory cells after damage. 相似文献
66.
Angelica Conversano Simona Macina Rocco Indellicato Domenico Lacavalla Dario D’Abbicco 《International journal of surgery case reports》2014,5(10):774-778
INTRODUCTIONMelanoma shows a particular predilection in involving small intestine both in a single site and in multiple localization and acute or chronic gastrointestinal bleedings are often the first sign of tumour.PRESENTATION OF CASEWe report two cases of GI metastases of malignant melanoma, one presented with only a big mass that cause intestinal obstruction and the other with a tumour spread throughout the small intestine that produce enterorrhagia.DISCUSSIONDiagnosis and follow-up are very difficult: CT scan, PET-CT scan and capsule endoscopy should be complementary for the assessment of patients with GI symptoms and melanoma history.CONCLUSIONWhat is the role of surgery? Several studies suggest metastasectomy to achieve both R0 results and palliative resolutions of acute symptoms, such as obstruction, pain, and bleeding. 相似文献
67.
Rodrigo Muñoz Angelica Dominguez Fernando Muñoz Cesar Muñoz Milenko Slako Dannae Turiel Fernando Pimentel Alan Sharp Alex Escalona 《Surgical endoscopy》2014,28(4):1056-1062
Introduction
Endoscopic treatment with the duodenal-jejunal bypass liner (DJBL) leads to significant weight loss in obese patients. We sought to identify clinical factors associated with weight loss in obese patients treated with the DJBL for 1 year.Methods
Subjects with morbid obesity were enrolled in a single-arm, open-label, prospective trial and implanted with the DJBL. Patient demographics along with baseline comorbidities, anthropometrics, and biochemical variables were selected for univariate and multivariate analysis.Results
The DJBL was implanted in 79 subjects and 61 completed 12 months of follow-up. There were 18 early removals. Baseline mean age and body mass index (BMI) were 35.4 ± 9.7 years and 43 ± 5.6 kg/m2, respectively. Forty-four (72 %) were women. This population included 22 subjects with type 2 diabetes (T2DM). Twelve months after treatment, patients had a mean excess body weight loss (%EBWL) of 46 ± 18 %. Univariate analysis identified that fasting glycemia (r 2 = ?0.303, p < 0.013), insulin-resistance determined by HOMA-IR (r 2 = ?0.457, p < 0.019), and glycated hemoglobin (HbA1c) (r 2 = ?0.471, p < 0.013) were associated inversely with %EBWL at 1 year. In this cohort of patients, the multivariate analysis indicated that only baseline HbA1c levels were associated inversely with %EBWL after 1 year of treatment (β adjusted coefficient ?0.758, p < 0.016). Importantly, no differences at 1 year in %EBWL were observed between patients with or without T2DM (%EBWL T2D 46.7 ± 20 % vs. non-T2DM 46.8 ± 18.6 %, p = 0.988).Conclusions
This analysis indicates that higher baseline HbA1c levels are associated independently with diminished body weight loss in obese patients treated with the DJBL independent of their diabetic status. These results show that DJBL induces clinically significant weight loss in both T2DM and non-T2DM patients. 相似文献68.
David Veale Iona Naismith Ertiniss Eshkevari Nell Ellison Ana Costa Dudley Robinson Lanka Abeywickrama Angelica Kavouni Linda Cardozo 《International urogynecology journal》2014,25(6):831-839
Introduction and hypothesis
Our goal was to determine psychosexual outcome after labiaplasty in the long-term with specific measures of genital body image and sexual dysfunction.Method
We conducted a prospective study with a matched-comparison group of women not wanting labiaplasty. Forty-nine women were compared against a group of 39 women matched for age, sexual orientation, ethnicity, and marital status. The labiaplasty group was assessed before, 3 months after and between 11 and 42 months after surgery. The comparison group was assessed at two time points 3 months apart to control for the passage of time. The primary outcome measure was the Genital Appearance Satisfaction (GAS) scale.Results
Of the 49 women receiving labiaplasty, 19 (38.8 %) were lost to follow-up but were reassessed clinically. Twenty-four of 25 (96 %) women in the labiaplasty group showed a reliable and clinically significant improvement on the GAS scale 3 months after the procedure; 21/23 (91.3 %) showed an improvement at the long-term follow-up. A large effect size was found for improvements on the GAS scale in the labiaplasty group. Small-effect sizes were found for improvements in sexual functioning. Nine women obtaining labiaplasty met diagnostic criteria for body dysmorphic disorder before the operation; eight lost that diagnosis at the 3-month follow-up; 26 % reported minor side effects.Conclusions
Labiaplasty is effective in improving genital appearance and sexual satisfaction, but larger studies are required to determine the prevalence of potential side effects. 相似文献69.
Calixto‐Hope G. Lucas Javier E. Villanueva‐Meyer Nicholas Whipple Nancy Ann Oberheim Bush Tabitha Cooney Susan Chang Michael McDermott Mitchel Berger Elaine Cham Peter P. Sun Angelica Putnam Hong Zhou Robert Bollo Samuel Cheshier Matthew M. Poppe Kar‐Ming Fung Sarah Sung Chad Glenn Xuemo Fan Serguei Bannykh Jethro Hu Moise Danielpour Rong Li Elizabeth Alva James Johnston Jessica Van Ziffle Courtney Onodera Patrick Devine James P. Grenert Julieann C. Lee Melike Pekmezci Tarik Tihan Andrew W. Bollen Arie Perry David A. Solomon 《Brain pathology (Zurich, Switzerland)》2020,30(3):479-494
“Myxoid glioneuronal tumor, PDGFRA p.K385‐mutant” is a recently described tumor entity of the central nervous system with a predilection for origin in the septum pellucidum and a defining dinucleotide mutation at codon 385 of the PDGFRA oncogene replacing lysine with either leucine or isoleucine (p.K385L/I). Clinical outcomes and optimal treatment for this new tumor entity have yet to be defined. Here, we report a comprehensive clinical, radiologic, and histopathologic assessment of eight cases. In addition to its stereotypic location in the septum pellucidum, we identify that this tumor can also occur in the corpus callosum and periventricular white matter of the lateral ventricle. Tumors centered in the septum pellucidum uniformly were associated with obstructive hydrocephalus, whereas tumors centered in the corpus callosum and periventricular white matter did not demonstrate hydrocephalus. While multiple patients were found to have ventricular dissemination or local recurrence/progression, all patients in this series remain alive at last clinical follow‐up despite only biopsy or subtotal resection without adjuvant therapy in most cases. Our study further supports “myxoid glioneuronal tumor, PDGFRA p.K385‐mutant” as a distinct CNS tumor entity and expands the spectrum of clinicopathologic and radiologic features of this neoplasm. 相似文献
70.
Sandra Jeremias dos Santos Catarino Angelica Beate Winter Boldt Marcia Holsbach Beltrame Renato Mitsunori Nisihara Marcelo Derbli Schafranski Iara Jose de Messias-Reason 《Human immunology》2014
MASP-2 is a key protein of the lectin pathway of complement system. Several MASP2 polymorphisms were associated with MASP-2 serum levels or functional activity. Here we investigated a possible association between MASP2 polymorphisms and MASP-2 serum levels with the susceptibility to rheumatic fever (RF) and rheumatic heart disease (RHD). We haplotyped 11 MASP2 polymorphisms with multiplex sequence-specific PCR in 145 patients with history of RF from south Brazil (103 with RHD and 42 without cardiac lesion [RFo]) and 342 healthy controls. MASP-2 levels were determined by ELISA. The low MASP-2 producing p.377A and p.439H variants were negatively associated with RF (P = 0.02, OR = 0.36) and RHD (P = 0.01, OR = 0.25). In contrast, haplotypes that share the intron 9 – exon 12 g.1961795C, p.371D, p.377V and p.439R polymorphisms increased the susceptibility to RHD (P = 0.02, OR = 4.9). MASP-2 levels were associated with MASP2 haplotypes and were lower in patients (P < 0.0001), which may reflect protein consumption due to complement activation. MASP2 gene polymorphisms and protein levels seem to play an important role in the development of RF and establishment of RHD. 相似文献