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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.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie - 相似文献
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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
6.
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
7.
Alternative pathway complement activation induces proinflammatory activity in human proximal tubular epithelial cells 总被引:7,自引:1,他引:6
David S; Biancone L; Caserta C; Bussolati B; Cambi V; Camussi G 《Nephrology, dialysis, transplantation》1997,12(1):51-56
Background. Proximal tubular epithelial cells express
a surface C3-convertase activity which induces C fixation and insertion of
the C5b-9 membrane attack complex (MAC) into the cell plasma membrane. The
physiopathological consequences of this phenomenon are unknown.
Methods. The effect of C fixation on the production of
inflammatory mediators by human proximal tubular epithelial cells in
culture was explored. Results. Proximal tubular
epithelial cells incubated with a sublytic amount of normal human serum as
a source of C, but not with heat-inactivated human serum, showed a
time-dependent calcium influx and a concomitant release of
14C-arachidonic acid
(14C-AA). Eicosanoid synthesis following the
arachidonic acid mobilization was studied as prostaglandin E2 release.
Mg2+/EGTA, which did not prevent C activation by the
C3-convertase, and p-bromodiphenacyl bromide, a phospholipase A2-inhibitor,
inhibited mobilization of 14C-AA. These results
suggest the activation of an extracellular
Ca2+-dependent, phospholipase A2. Complement
fixation was associated with the synthesis of proinflammaotry cytokines
such as IL-6 and TNF-&agr;. Experiments with C6-deficient sera
indicated that the release of 14C-AA and the
production of cytokines were dependent on the insertion of the terminal
components of complement in the plasma membrane. Indeed, the reconstitution
of normal haemolytic activity of C6-deficient sera with purified C6
restored also the release of 14C-AA and the
production of cytokines. Conclusion. In
vitro complement activation on the proximal tubular cell surface
triggers the generation of proinflammatory mediators, which may potentially
contribute to the pathogenesis of tubulointerstitial injury. 相似文献
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9.
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
10.