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Li JY, Li XM, Cui XD, Hu XQ, Yu PC, Sun GB. [Preventing and treating anterior commissure adhesion with mucosal flap: a study in canines and clinical cases]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 57:161-167. [PMID: 35196759 DOI: 10.3760/cma.j.cn115330-20210415-00204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To evaluate the effectiveness of mucosal flap combined with silicone keel for preventing and treating anterior commissure adhesion in canines and clinical cases. Methods: A prospective experiment was performed from November 2019 to June 2021. Twenty five canines were randomly divided into 5 groups(A, B, C, D, E). Group A, B, C, D received anterior commissure injury by CO2 laser, then separately treated with free mucosal flap-keel complex,intralaryngeal mucosal flap-keel complex, silicone keels and without treatment, group E didn't injure the vocal cord after intubation. The keel was removed after 2 weeks, the larynx was harvested after 4 weeks. The effectiveness of anterior commissure adhesion prevention was evaluated by manifestation under laryngoscope, standard vocal cord length and standard glottic area. A retrospective analysis was performed on sixteen patients with anterior commissure lesion, who underwent mucosal flap-keel technique in Huashan Hospital of Fudan University from January 2019 to January 2021 (10 cases with free mucosal flap-keel complex and 6 cases with intralaryngeal mucosal flap-keel complex). All the patients underwent evaluation of laryngeal function included manifestation under laryngoscope each month and voice analysis before and 3 month after surgery. SPSS 20.0 software was used for statistical analysis. Results: No surgery accident or complication happened in canines and patients. The standard vocal cord length and standard glottic area after 4 weeks in group B were significantly higher than those in group A, C, D (Hstandard vocal cord length=31.688, Hstandard glottic area=16.444, P<0.05). The standard vocal cord length and standard glottic area after 4 weeks in group A were also significantly higher than those in group C, D(Hstandard vocal cord length=20.936, Hstandard glottic area=11.786, P<0.05). The standard vocal cord length and standard glottic area after 4 weeks in group A, B, E were not significantly different to that before surgery(tA left standard vocal cord length=2.636, tA right standard vocal cord length=2.582, tB left standard vocal cord length=2.707, tB right standard vocal cord length=2.673, tE left standard vocal cord length=0.370, tE right standard vocal cord length=0.821, tA standard glottic area=2.731, tB standard glottic area=2.753, tE standard glottic area=-0.529, P>0.05). The standard vocal cord length and standard glottic area after 4 weeks in group C, D were significantly lower than those before surgery(tC left standard vocal cord length=16.137, tC right standard vocal cord length=13.984, tD left standard vocal cord length=11.903, tD right standard vocal cord length=14.587, tC standard glottic area=10.280, tD standard glottic area=22.974, P<0.05). During 6-18 months of follow-up in clinical patients, no one developed a glottic web. Three months after surgery, Jitter, Shimmer, noise to harmonic ratio(NHR), the maximum phonation time(MPT)in all patients were significantly different from preoperative(tintralaryngeal mucosal flap jitter=24.885, tintralaryngeal mucosal flap shimmer=22.643, tintralaryngeal mucosal flap NHR=6.202, tintralaryngeal mucosal flap MPT=-9.661, tfree mucosal flap jitter=25.459, tfree mucosal flap shimmer=18.683, tfree mucosal flap NHR=5.705, tfree mucosal flap MPT=-20.840, P<0.05). Conclusion: Mucosal flap combined with silicone keel is an effective technique for preventing and treating anterior commissure adhesion. The effect of pedicled intralaryngea lmucosal flap is better.
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Affiliation(s)
- J Y Li
- Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai 200040, China
| | - X M Li
- Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai 200040, China
| | - X D Cui
- Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai 200040, China
| | - X Q Hu
- Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai 200040, China
| | - P C Yu
- Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai 200040, China
| | - G B Sun
- Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai 200040, China
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Gualandro DM, Puelacher C, Lurati Buse G, Glarner N, Cardozo FA, Vogt R, Hidvegi R, Strunz C, Bolliger D, Gueckel J, Yu PC, Liffert M, Arslani K, Prepoudis A, Calderaro D, Hammerer-Lercher A, Lampart A, Steiner LA, Schären S, Kindler C, Guerke L, Osswald S, Devereaux PJ, Caramelli B, Mueller C. Incidence and outcomes of perioperative myocardial infarction/injury diagnosed by high-sensitivity cardiac troponin I. Clin Res Cardiol 2021; 110:1450-1463. [PMID: 33768367 PMCID: PMC8405484 DOI: 10.1007/s00392-021-01827-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/21/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Perioperative myocardial infarction/injury (PMI) diagnosed by high-sensitivity troponin (hs-cTn) T is frequent and a prognostically important complication of non-cardiac surgery. We aimed to evaluate the incidence and outcome of PMI diagnosed using hs-cTnI, and compare it to PMI diagnosed using hs-cTnT. METHODS We prospectively included 2455 patients at high cardiovascular risk undergoing 3111 non-cardiac surgeries, for whom hs-cTnI and hs-cTnT concentrations were measured before surgery and on postoperative days 1 and 2. PMI was defined as a composite of perioperative myocardial infarction (PMIInfarct) and perioperative myocardial injury (PMIInjury), according to the Fourth Universal Definition of Myocardial Infarction. All-cause mortality was the primary endpoint. RESULTS Using hs-cTnI, the incidence of overall PMI was 9% (95% confidence interval [CI] 8-10%), including PMIInfarct 2.6% (95% CI 2.0-3.2) and PMIInjury 6.1% (95% CI 5.3-6.9%), which was lower versus using hs-cTnT: overall PMI 15% (95% CI 14-16%), PMIInfarct 3.7% (95% CI 3.0-4.4) and PMIInjury 11.3% (95% CI 10.2-12.4%). All-cause mortality occurred in 52 (2%) patients within 30 days and 217 (9%) within 1 year. Using hs-cTnI, both PMIInfarct and PMIInjury were independent predictors of 30-day all-cause mortality (adjusted hazard ratio [aHR] 2.5 [95% CI 1.1-6.0], and aHR 2.8 [95% CI 1.4-5.5], respectively) and, 1-year all-cause mortality (aHR 2.0 [95% CI 1.2-3.3], and aHR 1.8 [95% CI 1.2-2.7], respectively). Overall, the prognostic impact of PMI diagnosed by hs-cTnI was comparable to the prognostic impact of PMI using hs-cTnT. CONCLUSIONS Using hs-cTnI, PMI is less common versus using hs-cTnT. Using hs-cTnI, both PMIInfarct and PMIInjury remain independent predictors of 30-day and 1-year mortality.
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Affiliation(s)
- Danielle M Gualandro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland.
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
| | - Christian Puelacher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - Giovanna Lurati Buse
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Noemi Glarner
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - Francisco A Cardozo
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Ronja Vogt
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - Reka Hidvegi
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Celia Strunz
- Laboratory Medicine, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Daniel Bolliger
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Johanna Gueckel
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - Pai C Yu
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Marcel Liffert
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ketina Arslani
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - Alexandra Prepoudis
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - Daniela Calderaro
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | | | - Andreas Lampart
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Luzius A Steiner
- Department of Laboratory Medicine, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stefan Schären
- Department of Spinal Surgery, University Hospital Basel, Basel, Switzerland
| | - Christoph Kindler
- Department of Anesthesiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lorenz Guerke
- Department of Vascular Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - P J Devereaux
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Anesthesiology, Perioperative Medicine, and Surgical Research Unit C/o Hamilton General Hospital, McMaster University, Hamilton, Canada
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
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Azevedo FR, Santoro S, Correa-Giannella ML, Toyoshima MT, Giannella-Neto D, Calderaro D, Gualandro DM, Yu PC, Caramelli B. A Prospective Randomized Controlled Trial of the Metabolic Effects of Sleeve Gastrectomy with Transit Bipartition. Obes Surg 2019; 28:3012-3019. [PMID: 29704228 DOI: 10.1007/s11695-018-3239-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the effects of the sleeve gastrectomy with transit bipartition (SG + TB) procedure with standard medical therapy (SMT) in mildly obese patients with type II diabetes (T2D). METHODS This is a prospective, randomized, controlled trial. Twenty male adults, ≤ 65 years old, with T2D, body mass index (BMI) > 28 kg/m2 and < 35 kg/m2, and HbA1c level > 8% were randomized to SG + TB or to SMT. Outcomes were the remission in the metabolic and cardiovascular risk variables up to 24 months. RESULTS At 24 months, SG + TB group showed a significant decrease in HbaA1c values (9.3 ± 2.1 versus 5.5 ± 1.1%, P = < 0.05) whereas SMT group maintained similar levels from baseline (8.0 ± 1.5 versus 8.3 ± 1.1%, P = NS). BMI values were lower in the SG + TB group (25.3 ± 2.8 kg/m2 versus 30.9 ± 2.5 kg/m2; P = < 0.001). At 24 months, none patient in SG + TB group needed medications for hyperlipidemia/hypertension. HDL-cholesterol levels increased in the SG + TB group (33 ± 8 to 45 ± 15 mg/dL, P < 0.001). After 24 months, the area under the curve (AUC) of GLP1 increased and in the SG + TB group and the AUC of the GIP concentrations was lower in the SG + TB group than in the SMT. At 3 months, SG + TB group showed a marked increase in FGF19 levels (74.1 ± 45.8 to 237.3 ± 234 pg/mL; P = 0.001). CONCLUSIONS SG + TB is superior to SMT and was associated with a better metabolic and cardiovascular profile.
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Affiliation(s)
- Fernanda R Azevedo
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | | | - Maria L Correa-Giannella
- Laboratorio de Carboidratos e Radioimunoinsaio, LIM 18, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Marcos T Toyoshima
- Serviço de Onco-Endocrinologia, ICESP, HCFMUSP Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Giannella-Neto
- Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Daniela Calderaro
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | - Danielle M Gualandro
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | - Pai C Yu
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil.
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Gualandro DM, Puelacher C, Hidvegi R, Cardozo FA, Marbot S, Yu PC, Vogt R, Calderaro D, Gueckel J, Strunz C, Bolliger D, Rentsch K, Caramelli B, Mueller C. P2532Incidence and outcome of perioperative myocardial infarction/injury after non-cardiac surgeries diagnosed by high-sensitivity cardiac troponin I. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In order to differentiate perioperative myocardial infarction/injury (PMI) after non-cardiac surgery from preexisting cardiomyocyte injury from chronic disorders, recent studies have shown the importance of using an acute absolute increase as a criterion for PMI. For high-sensitivity troponin T (hs-cTnT), PMI defined as an absolute increase of 14ng/L (the 99th percentile) has been shown to be strongly associated with 30-day mortality. Until now, no data on hs-cTnI are available. This is a major unmet clinical need, as relevant differences between hs-cTnT and hs-cTnI have recently been identified and, as worldwide hs-cTnI is more commonly used as compared to hs-cTnT. We hypothesized that applying the same criterion to hs-cTnI, would reveal a similar association with outcomes.
Purpose
To evaluate the incidence and outcome of PMI diagnosed by hs-cTnI after non-cardiac surgery.
Methods
We included prospectively consecutive high cardiovascular risk patients undergoing non-cardiac surgery. Hs-cTnI concentrations were measured before surgery and, daily after surgery, for three days. PMI was defined as an absolute rise of ≥26ng/L (the 99th percentile of the assay studied) from baseline values. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, acute heart failure and arrhythmias, and the secondary outcome was all-cause mortality, within 30 days and one year.
Results
We included 2,018 patients submitted to 2,551 surgeries. Patients had median age of 73 years (IQR 68–79) and 56% were male. After surgery, 231 patients (9%, 95% CI 8–10%) fulfilled PMI diagnostic criterion. Patients with PMI had higher rates of MACE than patients without PMI, at 30 days (13% vs. 2%; P<0.001) and, at one-year follow-up (25% vs. 8%; P<0.001). All-cause mortality was also higher in PMI patients within 30 days and one year (9% vs. 1.5% and, 22% vs. 8%, respectively; P<0.001). In multivariate cox regression analysis, PMI showed a hazard ratio (HR) of 4.7 (95% CI, 2.9–7.6; P<0.001) within 30 days, and a HR of 2.7 (95% CI, 2.0–3.7; P<0.001) within one year for the occurrence of MACE. For total mortality, PMI showed a HR of 3.8 (95% CI, 2.1–6.8; P<0.001) within 30 days and a HR of 2.0 (95% CI, 1.4–2.7; P<0.001) after one year.
Conclusion
PMI is frequent and associated with high rates of MACE and mortality in short- and long-term follow-up after non-cardiac surgery, regardless of the high-sensitivity troponin assay used for diagnosis.
Acknowledgement/Funding
Swiss Heart Foundation, University basel, Abbott, Astra zeneca, Forschungsfond Kantonsspital Aarau, Cardiovascular Research Foundation Basel, FAPESP
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Affiliation(s)
| | - C Puelacher
- University Hospital Basel, Basel, Switzerland
| | - R Hidvegi
- University Hospital Basel, Basel, Switzerland
| | - F A Cardozo
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - S Marbot
- University Hospital Basel, Basel, Switzerland
| | - P C Yu
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - R Vogt
- University Hospital Basel, Basel, Switzerland
| | - D Calderaro
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - J Gueckel
- University Hospital Basel, Basel, Switzerland
| | - C Strunz
- Heart Institute of the University of Sao Paulo (InCor), Laboratory medicine, Sao Paulo, Brazil
| | - D Bolliger
- University Hospital Basel, Basel, Switzerland
| | - K Rentsch
- University Hospital Basel, Basel, Switzerland
| | - B Caramelli
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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Gualandro DM, Puelacher C, LuratiBuse G, Lampart A, Strunz C, Cardozo FA, Yu PC, Jaffe AS, Barac S, Bock L, Badertscher P, du Fay de Lavallaz J, Marbot S, Sazgary L, Bolliger D, Rentsch K, Twerenbold R, Hammerer-Lercher A, Melo ES, Calderaro D, Duarte AJ, de Luccia N, Caramelli B, Mueller C. Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery. Am Heart J 2018; 203:67-73. [PMID: 30041065 DOI: 10.1016/j.ahj.2018.06.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/30/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery. METHODS We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery. RESULTS Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P < .001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P < .001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0-2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59-0.75) for hs-cTnI versus 0.59 (95% CI 0.51-0.67, P = .012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3-2.0, and aOR 3.0, 95% CI 2.0-4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71-0.83, and 0.79, 95% CI 0.73-0.85, P = ns). CONCLUSIONS Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.
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Affiliation(s)
- Danielle M Gualandro
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil; Department of Cardiology, University Hospital Basel, University of Basel, Switzerland.
| | - Christian Puelacher
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Giovanna LuratiBuse
- Department of Anaesthesiology, University Hospital Düsseldorf, Germany; Department of Anaesthesiology, University Hospital Basel, University of Basel, Switzerland
| | - Andreas Lampart
- Department of Anaesthesiology, University Hospital Basel, University of Basel, Switzerland
| | - Celia Strunz
- Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Francisco A Cardozo
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Pai C Yu
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Allan S Jaffe
- Department of Cardiology and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Sanela Barac
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Lukas Bock
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | | | - Stella Marbot
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Lorraine Sazgary
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Daniel Bolliger
- Department of Anaesthesiology, University Hospital Basel, University of Basel, Switzerland
| | - Katharina Rentsch
- Department of Laboratory Medicine, University Hospital Basel, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland; Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany
| | | | - Edielle S Melo
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Daniela Calderaro
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Alberto Js Duarte
- Laboratory of Immunogenetics and Experimental Transplantation, University of Sao Paulo Medical School, Brazil
| | - Nelson de Luccia
- Vascular and Endovascular Surgery Clinic of the Clinics Hospital, University of São Paulo Medical School, Brazil
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
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Gualandro DM, Shinjo SK, Santoro J, Calderaro D, Yu PC, Strunz C, Silva MG, Caramelli B. P3487The role of high-sensitivity troponin I for risk prediction in patients with systemic autoimmune myopathies. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D M Gualandro
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - S K Shinjo
- Clinics Hospital, University of São Paulo Medical School, Reumathology, São Paulo, Brazil
| | - J Santoro
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - D Calderaro
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - P C Yu
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - C Strunz
- Heart Institute (InCor), University of São Paulo Medica School, Laboratory, Sao Paulo, Brazil
| | - M G Silva
- Clinics Hospital, University of São Paulo Medical School, Reumathology, São Paulo, Brazil
| | - B Caramelli
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
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7
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Gualandro DM, Puelacher C, LuratiBuse G, Llobet GB, Yu PC, Cardozo FA, Glarner N, Zimmerli A, Espinola J, Corbière S, Calderaro D, Marques AC, Casella IB, de Luccia N, Oliveira MT, Lampart A, Bolliger D, Steiner L, Seeberger M, Kindler C, Osswald S, Gürke L, Caramelli B, Mueller C. Prediction of major cardiac events after vascular surgery. J Vasc Surg 2017; 66:1826-1835.e1. [DOI: 10.1016/j.jvs.2017.05.100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/06/2017] [Indexed: 12/20/2022]
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Zhou H, Li Y, Chen RF, Tao XY, Yu PC, Cao SC, Li L, Chen ZH, Zhu WY, Yin WW, Li YH, Wang CL, Yu HJ. [Technical guideline for human rabies prevention and control (2016)]. Zhonghua Liu Xing Bing Xue Za Zhi 2016; 37:139-63. [PMID: 26917506 DOI: 10.3760/cma.j.issn.0254-6450.2016.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In order to promote the prevention and control programs on rabies in our country, to regulate the prevention and disposition of rabies and to reduce the deaths caused by rabies, the Chinese Center for Disease Control and Prevention has organized a panel of experts, in the reference with Guidelines issued by WHO, American Advisory Committee on Immunization Practices, and the latest research progress from home and abroad, and compiled this document-"Technical Guidelines for Human Rabies Prevention and Control (2016)". The Guidelines conducted a systematic review on the etiology, clinical characteristics, laboratory diagnosis, epidemiology of rabies and provided evidence on varieties, mechanisms, effects, side-effects and security of rabies vaccine, as well as on other preparations on passive immunity of its kind, on methods related to prevention and disposition of exposure etc, finally to have come up with the recommendation on the above mentioned various techniques. The guidelines will be used by staff working on prevention and control of rabies from the Center for Disease Control and Prevention at all levels, from the departments of outpatient and divisions of infection and emergency control in all the medical institutions. The guideline will be updated and revised, following the research progress from home and abroad.
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Affiliation(s)
- H Zhou
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Y Li
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - R F Chen
- Navy General Hospital, Beijing 100048, China
| | - X Y Tao
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - P C Yu
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - S C Cao
- National Instisutes for Food and Drug Control, Beijing 100050, China
| | - L Li
- Chaoyang Center for Disease Control and Prevention, Beijing 100021, China
| | - Z H Chen
- Beijing Ditan Hospital Capital Medical University, Beijing 100015, China
| | - W Y Zhu
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - W W Yin
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Y H Li
- National Instisutes for Food and Drug Control, Beijing 100050, China
| | - C L Wang
- Peking University People's Hospital, Beijing 100044, China
| | - H J Yu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China
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Toledo AASFD, Yu PC, Guallandro DM, Calderaro D, Carmo GALD, Fernandes BFS, Neves MA, Feitosa R, Rodrigues AC, Ribeiro ALP, Nitrini R, Caramelli P, Caramelli B. Design and protocols of the GIRAF prevention trial: A randomized, prospective, parallel, two-center study to compare cognitive outcomes in subjects with atrial fibrillation using warfarin or dabigatran. ACTA ACUST UNITED AC 2015. [DOI: 10.18203/2349-3259.ijct20151240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<p class="abstract"><strong>Background:</strong> Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with cognitive impairment and dementia. Cognitive and functional impairments have been neglected in clinical trials with patients affected by AF. Dabigatran is a new drug, which can offer a more stable long-term anticoagulant therapy compared to warfarin. This advantage could be associated with a minor incidence of cognitive and functional decline. The objective of the study is to evaluate the effects of dabigatran compared with warfarin on cognitive and functional impairments, thrombin production, bleeding occurrence and cerebrovascular complications in elderly patients with AF.</p><p class="abstract"><strong>Methods:</strong> A randomized, prospective parallel, two-center, active-controlled trial will be performed in a sample of 200 patients with AF randomly designated to take dabigatran (150 mg twice daily) or warfarin (once daily, dose controlled by INR between 2 and 3). After one and two years, subjects will be assessed considering cognitive outcomes. Additionally, patients will be submitted to brain magnetic resonance imaging (MRI) at the beginning and ending of study to identify possible cerebrovascular events, as well as carotid ultrasonography to search for atherosclerotic disease.</p><strong>Conclusions:</strong> The GIRAF study expects to provide data about prevention of cognitive and functional impairments among patients on anticoagulant therapy for AF, and to explore new concepts on potential prevention of cognitive decline and benefits for AF patients and their relatives.
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Marques AC, Calderaro D, Yu PC, Gualandro DM, Carmo GAL, Azevedo FR, Pastana AF, Lima EMO, Monachini M, Caramelli B. Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations. Clinics (Sao Paulo) 2014; 69:666-71. [PMID: 25518017 PMCID: PMC4221308 DOI: 10.6061/clinics/2014(10)03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 06/23/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations. METHODS We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected. RESULTS Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99). CONCLUSIONS Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations.
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Affiliation(s)
- André C Marques
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Daniela Calderaro
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pai C Yu
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Danielle M Gualandro
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gabriel A L Carmo
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fernanda R Azevedo
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Adriana F Pastana
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eneas M O Lima
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Marques AC, Bellen BV, Caramelli B, Presti C, Pinho C, Calderaro D, Gualandro DM, Carvalho FC, Carmo GAL, Correa Filho H, Casella IB, Fornari LS, Vacanti LJ, Vieira MLC, Monachini MC, Luccia N, Yu PC, Farsky OS, Heinisch RH, Gualandro SFM, Mathias Junior W. Atualização e Enfoque em Operações Vasculares Arteriais da II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2013; 101:2-32. [DOI: 10.5935/abc.2013s011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lorga Filho AM, Azmus AD, Soeiro AM, Quadros AS, Avezum Junior A, Marques AC, Franci A, Manica ALL, Volschan A, De Paola AAV, Greco AIL, ACN F, Sousa ACS, Pesaro AEP, Simão AF, Lopes ASSA, Timerman A, Ramos AIO, Alves BR, Caramelli B, Mendes BA, Polanczyk CA, Montenegro CEL, Barbosa CJDG, Serrano Junior CV, Melo CCL, Pinho C, Moreira DAR, Calderaro D, Gualandro DM, Armaganijan D, Machado Neto EA, Bocchi EA, Paiva EF, Stefanini E, D’Amico E, Evaristo EF, Silva EER, Fernandes F, Brito Junior FS, Bacal F, Ganem F, Gomes FLT, Mattos FR, Moraes Neto FR, Tarasoutchi F, Darrieux FCC, Feitosa GS, Fenelon G, Morais GR, Correa Filho H, Castro I, Gonçalves Junior I, Atié J, Souza Neto JD, Ferreira JFM, Nicolau JC, Faria Neto JR, Annichino-Bizzacchi JM, Zimerman LI, Piegas LS, Pires LJT, Baracioli LM, Silva LB, Mattos LAP, Lisboa LAF, Magalhães LPM, Lopes MACQ, Montera MW, Figueiredo MJO, Malachias MVB, Gaz MVB, Andrade MD, Bacellar MSC, Barbosa MR, Clausell NO, Dutra OP, Coelho OR, Yu PC, Lavítola PL, Lemos Neto PA, Andrade PB, Farsky PS, Franco RA, Kalil RAK, Lopes RD, Esporcatte R, Heinisch RH, Kalil Filho R, Giraldez RRCV, Alves RC, Leite REGS, Gagliardi RJ, Ramos RF, Montenegro ST, Accorsi TAD, Jardim TSV, Scudeler TL, Moisés VA, Portal VL. Diretrizes Brasileiras de Antiagregantes Plaquetários e Anticoagulantes em Cardiologia. Arq Bras Cardiol 2013; 101:1-95. [DOI: 10.5935/abc.2013s009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Carmo GAL, Calderaro D, Yu PC, Gualandro DM, Marques AC, Bittar CS, Pastana AF, Caramelli B. Perioperative cardiovascular evaluation: heads or tails? Rev Assoc Med Bras (1992) 2012; 58:505-512. [PMID: 22930033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 04/09/2012] [Indexed: 06/01/2023]
Abstract
When dealing with surgical patients, a perioperative evaluation is essential to anticipate complications and institute measures to reduce the risks. Several algorithms and exams have been used to identify postoperative cardiovascular events, which account for more than 50% of perioperative mortality. However, they are far from ideal. Some of these algorithms and exams were proposed before important advances in cardiology, at a time when pharmacological risk reduction strategies for surgical patients were not available. New biomarkers and exams, such as C-reactive protein, brain natriuretic peptide, and multislice computed tomography have been used in cardiology and have provided important prognostic information. The ankle-brachial index is another significant marker of atherosclerosis. However, specific information regarding the perioperative context of all these methods is still needed. The objective of this article is to evaluate cardiovascular risk prediction models after noncardiac surgery.
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Affiliation(s)
- Gabriel A L Carmo
- Instituto do Coração Cardiology Unit, Instituto do Coração, Hospital das Clínicas, Medical School, Universidade de São Paulo, Brazil.
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Carmo GA, Calderaro D, Yu PC, Gualandro DM, Marques AC, Bittar CS, Pastana AF, Caramelli B. Perioperative cardiovascular evaluation: heads or tails? Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000400025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Carmo GA, Calderaro D, Yu PC, Gualandro DM, Marques AC, Bittar CS, Pastana AF, Caramelli B. Perioperative cardiovascular evaluation: heads or tails? Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70237-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Methods have been described for the extraction and purification of an agent inhibiting the hemagglutination of red cells by influenza (PR8) and mumps viruses. Human red cells have served as the chief source of the inhibitor but the latter has also been found in human lung. The active extracts have been purified to the extent that 0.1 gamma of material suffices to inhibit one hemagglutinating dose of virus. Incomplete chemical characterization of the most highly purified fractions available indicates the presence of 2.6 per cent nitrogen, at least 50 per cent of polysaccharide, and no phosphorus. In the ultracentrifuge the purified preparation behaves as a polydisperse macromolecular substance. The active material can be obtained from red cell stroma in an ether- and chloroform-soluble form which, on further treatment, can be converted into chloroform-insoluble material. It is possible that the former represents more closely the virus receptor as it exists in the red cell. The purified inhibitor is inactivated on incubation with the virus at 37 degrees C. The nature of this effect is being investigated.
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Affiliation(s)
- P M Deburgh
- Department of Bacteriology and Immunology, Harvard Medical School, Boston
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Lima EM, Gualandro DM, Yu PC, Giuliano IDC, Marques AC, Calderaro D, Caramelli B. Cardiovascular prevention in HIV patients: Results from a successful intervention program. Atherosclerosis 2009; 204:229-32. [DOI: 10.1016/j.atherosclerosis.2008.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 08/02/2008] [Accepted: 08/04/2008] [Indexed: 10/21/2022]
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Marques AC, Calderaro D, Yu PC, Gualandro DM, Gonçalves LFG, Mariani AW, Caramelli B. Acute pericarditis with transient constriction: surgical impetus must be contained. BMJ Case Rep 2009; 2009:bcr07.2008.0571. [PMID: 21686742 DOI: 10.1136/bcr.07.2008.0571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Constrictive pericarditis is typically a chronic and progressive condition characterised by debilitating chronic right heart failure and surgical pericardiectomy remains the treatment of choice. Although most cases of acute pericarditis are self-limiting, an uncommon but known complication is a transient form of constrictive pericarditis that shares the same clinical features with the chronic form but resolves without surgical intervention.We report a case of a 29-year-old man with acute idiopathic pericarditis complicated with overt signs of constriction with complete recovery after medical treatment. The knowledge of this transient pattern of cardiac constriction complicating acute pericarditis may avoid unnecessary morbidity and mortality related to surgical procedure in a pericardium with acute inflammatory reaction.
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Affiliation(s)
- Andre C Marques
- Heart Institute, Interdisciplinary Medicine in Cardiology Unit, Av Dr Eneas Carvalho de Aguiar, 44, São Paulo, 05406000, Brazil
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Huang TL, Chen TY, Cheng YF, Weng HH, Yu PC, Lee TY, Chen YS, Wang CC, Wang SH, Chiu KW, Chiang YC, Eng HL, Jawan B, de Villa VH, Chen CL. The significance of hepatic vein outflow volume in adult-to-adult living donor liver transplantation evaluated by Doppler ultrasound. Transplant Proc 2003; 35:68-9. [PMID: 12591311 DOI: 10.1016/s0041-1345(02)03810-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- T L Huang
- Department of Diagnostic Radiology, Chang Gung University and Memmorial Hospital, Kaohsiung, Taiwan
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Abstract
Traumatic injury of the aorta, inferior vena cava, and iliac vessels due to penetration of the anterior anulus fibrosus and anterior longitudinal ligament is a recognized complication of lumbar disc surgery. The authors report, to the best of their knowledge, the first case of discectomy-related superior rectal artery injury treated by endovascular intervention.
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Affiliation(s)
- Y D Tsai
- Department of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan
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Yu PC, Lin YC, Chen HM, Chen MF. Malignant phyllodes tumor of the breast metastasizing to the pancreas: case report. Chang Gung Med J 2000; 23:503-7. [PMID: 11039254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Phyllodes tumor of the breast, or cystosarcoma phyllodes, is an unusual breast tumor. It is usually considered a benign lesion but may have malignant potential. Only a small proportion of malignant phyllodes tumors will metastasize. A phyllodes tumor of the breast metastasizing to the pancreas is rare. This 39-year-old female patient initially presented to us with a 5 x 4 x 2 cm tumor of a right breast. After excision of the tumor, she received another wise excision for a local recurrence of the tumor. Three years had passed when she started having hematemesis and tarry stools intermittently over a period of about one month. Clinical evaluation disclosed a huge mass with an ulcerated and bloody base over the second portion of the duodenum. A pancreatoduodenectomy was then performed. During the postoperative recovery period, a rapidly enlarging tumor of the right breast was noted. She subsequently underwent a total mastectomy of the right breast. Both the duodenal tumor and the breast tumor were found to be malignant phyllodes tumors. The rarity of this kind of patient and presentation is discussed.
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Affiliation(s)
- P C Yu
- Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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Juan CC, Fang VS, Hsu YP, Huang YJ, Hsia DB, Yu PC, Kwok CF, Ho LT. Overexpression of vascular endothelin-1 and endothelin-A receptors in a fructose-induced hypertensive rat model. J Hypertens 1998; 16:1775-82. [PMID: 9869011 DOI: 10.1097/00004872-199816120-00010] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the temporal relationship between hyperinsulinemia and hypertension in the fructose-hypertensive rat model and to study the function of endothelin-1 (ET-1) in fructose-induced hypertension. DESIGN Since ET-1 induces insulin resistance in conscious rats, we tested the hypothesis that both hyperinsulinemia and hypertension developed in the fructose-hypertensive rat model might be the sequelae of an elevated tissue content of ET-1 and ET(A) receptors. MATERIALS AND METHODS Systolic hypertension was induced within 3 weeks in male Sprague-Dawley rats fed on a fructose-rich diet. After continual monitoring of blood pressure and plasma insulin concentrations, the animals were killed at the end of experiment to determine plasma levels of ET-1, the contractile response of aortic rings to ET-1, and ET-1 and ET(A) receptor gene expressions. In a separate experiment, BQ-610 was administered to lower the effect of ET-1 in rats with fructose-induced hypertension. RESULTS Compared with control rats given normal chow, the fructose-fed rats developed systolic hypertension after 3 weeks of the diet (127+/-3.7 versus 110+/-5.5 mmHg, P < 0.01) and hyperinsulinemia both before (1 07.1+/-32.5 versus 48.5+/-14.3 pmol/l, P < 0.005) and after (96.6+/-63.7 versus 50.4+/-5.6 pmol/l, P< 0.05) they became hypertensive. Although plasma ET-1 levels did not differ between the rat groups, aortic ring contraction-concentration curves, indicating vessel contractility in response to ET-1, were significantly greater in these rats than in controls (F1,72 = 12.34, P< 0.00077). Messenger RNA extracted from the tail arteries and blotted with both ET-1 and ET(A) probes showed that fructose-fed rats had greater ET-1 and ET(A)-receptor gene expression than control rats. Concomitant administration of BQ-610 to rats fed on a fructose diet significantly reduced the hypertension. Conclusions These findings suggest that elevated vascular expression of ET-1 and ET(A) receptor genes may mediate the development of hypertension and hyperinsulinemia in rats fed a fructose-rich diet
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Affiliation(s)
- C C Juan
- Department of Physiology, National Yang-Ming University, Veterans General Hospital-Taipei, Taiwan, Republic of China
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Chen TY, Cheng YF, Huang TL, Lee TY, Yu PC, Chen YS, Eng HL, Chen CL. Preoperative assessment of the portal vein in potential pediatric liver transplantation recipients: comparison of sonography and invasive portography. Transplant Proc 1998; 30:3195-6. [PMID: 9838411 DOI: 10.1016/s0041-1345(98)00990-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- T Y Chen
- Department of Diagnostic Radiology, Chang Gung University, Kaohsiung, Taiwan
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Lin HC, Yang MC, Huang YT, Yu PC, Hou MC, Hong CY, Lee SD. The hemodynamic effects of AT-112, an analog of ketanserin, in portal hypertensive rats. Pharmacology 1997; 54:16-23. [PMID: 9065957 DOI: 10.1159/000139465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A serotonin mechanism has been reported to contribute to the hyperdynamic circulation of portal hypertension. Different studies have demonstrated that serotonin antagonists decrease portal pressure in portal hypertensive patients and animals. The present study was undertaken to investigate the effect of AT-112, an analog of ketanserin, on portal hypertension induced by partial portal vein ligation in rats. Since ketanserin is known to possess alpha 1-adrenergic antagonistic activity, the effect of AT-112 was compared to that of prazosin. A single dose (prazosin 4.2 micrograms/kg, AT-112 1 mg/kg) was chosen to produce a similar hypotensive effect (-20 +/- 4% for prazosin and -24 +/- 4% for AT-112). At this dose, prazosin significantly decreased total peripheral resistance whereas AT-112 significantly decreased cardiac index and heart rate. Both agents significantly decreased the portal tributary blood flow and portal pressure. In rats receiving AT-112, a significant correlation was found between the magnitudes of decrease in cardiac index and the decrease in portal tributary blood flow. We also found that the magnitude of reduction in portal pressure was greater following AT-112 administration. This study suggested that AT-112 may have more beneficial hemodynamic effects than prazosin in portal hypertensive rats. Our results provide further support for the serotonergic mechanism in the pathogenesis of hyperdynamic circulation in portal hypertension.
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Affiliation(s)
- H C Lin
- Department of Medicine, Veterans General Hospital Taipei, Taiwan
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Abstract
The hemodynamic effects of long-term administration of octreotide in portal hypertension has not been established. In addition, whether long-term octreotide treatment prevents the development of portosystemic shunts has not yet been evaluated. Hence, the current study was undertaken to evaluate the effects of long-term administration of octreotide in rats with portal vein stenosis. Immediately after portal vein stenosis or sham operation, rats were given either a long-term octreotide administration of 100 micrograms/kg or a placebo every 12 hours by subcutaneous injection for 14 consecutive days. Systemic hemodynamics and regional blood flows, degree of mesenteric-systemic shunts, and plasma glucagon concentrations were measured after the final dose of octreotide or placebo. A fifth group of portal vein-stenosed rats received hemodynamic and plasma glucagon measurements after 1-day octreotide treatment given at 14 days after surgery. Long-term octreotide treatment modified the hyperdynamic circulation without affecting the degree of mesenteric-systemic shunts, and 1-day octreotide treatment decreased portal tributary blood flow without affecting the portal pressure, systemic hemodynamics, and degree of mesenteric-systemic shunts. Plasma glucagon levels were decreased in portal vein-stenosed rats receiving either long-term or 1-day octreodtide compared with rats receiving placebo. In contrast, chronic octreotide treatment did not affect any of the hemodynamic values or plasma glucagon levels in sham-operated rats. In conclusion, long-term administration of octreotide modified in part the development of portal hypertension and hyperdynamic circulation in portal vein-stenosed rats without affecting the degree of mesenteric-systemic shunts.
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Affiliation(s)
- H C Lin
- Department of Medicine, Veterans General Hospital, Taipei, Taiwan
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Abstract
BACKGROUND/AIMS Vascular hyporesponsiveness in portal hypertension is well documented in the arterial tissue. The present study aimed to investigate the possible changes in the portal vein from portal hypertensive rats. METHODS Portal hypertension was induced by partial portal vein ligation. Fourteen days after surgery, portal veins were removed for contractile study and measurement of cAMP, cGMP and [Ca2+]i. RESULTS In vitro tension preparation showed a decreased maximum response to norepinephrine in portal vein of portal vein ligated rats (38.3 +/- 4.1 vs. 23.4 +/- 1.5 mN/mm2). The pA2 values of WB4101 and yohimbine (alpha1- and alpha2-adrenoceptor antagonist, respectively) were not different between the two groups. Tissue cAMP (14.4 +/- 0.9 vs. 12.2 +/- 0.7 pmol/mg protein), but not cGMP, content was increased and intracellular calcium [Ca2+]i levels (247 +/- 9 vs. 281 +/- 13 nM) were decreased in portal vein ligated rats. CONCLUSIONS These results showed that in portal vein from portal vein ligated rats, vascular hyporesponsiveness and an increase in basal cAMP content and a decrease in basal [Ca2+]i were observed.
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Affiliation(s)
- Y T Huang
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taiwan
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28
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Huang YT, Yu PC, Lee MF, Lin HC, Hong CY, Yang MC. Decreased vascular contractile and inositol phosphate responses in portal hypertensive rats. Can J Physiol Pharmacol 1995; 73:378-82. [PMID: 7648517 DOI: 10.1139/y95-048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to investigate the vascular contractile and inositol phosphate responses in portal hypertensive rats. Portal hypertension was induced by partial portal vein ligation (PVL) in Sprague-Dawley rats. Sham-operated rats served as controls. Pressures, vasoconstrictor responses, and inositol phosphate responses were determined at 14 days after surgery. The portal venous pressure was significantly higher, while systemic arterial pressure and heart rate were lower, in PVL rats. Dose-dependent contractile responses were observed for both norepinephrine (1 x 10(-8) - 3 x 10(-6) M) and vasopressin (3 x 10(-10) - 3 x 10(-8) M) in the tail artery of both groups. The contractile response to norepinephrine was significantly decreased in PVL rats compared with controls at all doses. The contractile response to vasopressin was significantly decreased in PVL rats at higher doses. After myo-[3H]inositol incorporation in tail artery, the levels of 3H-labelled phosphatidylinositols (cpm/mg) were similar between the two groups. Norepinephrine (10(-7) - 10(-5) M) and vasopressin (10(-10) - 10(-8) M) dose dependently stimulated the 3H-labelled inositol phosphate production in the tail artery of both PVL and sham-operated rats. However, the response was significantly lower in PVL rats. The results suggested that the attenuation of vascular contractile responses in portal hypertension was reflected in the phosphoinositide messenger system.
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Affiliation(s)
- Y T Huang
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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29
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Abstract
A method for the simultaneous measurement of serotonin catecholamines, and their metabolites in rat plasma by ultrafiltration and microbore liquid chromatography with electrochemical detection (LC-ED) in small volumes is established. Prior to the LC assay, sixteen plasma ultrafiltrates are readily prepared within 30 min in the present study. The present method, applying a dual-electrode detection technique, provides an additional reliable assignment or measurement of peaks by identifying the peaks on the basis of their redox ratios. In addition, the important early-eluting peaks and interfering peaks are eliminated in the cathodic chromatogram resulting in a reliable measurement of norepinephrine, epinephrine, and 3,4-dihydroxyphenylacetic acid. Isocratic separation of serotonin, catecholamines, and their metabolites by a microbore column is achieved within 15 min. Hence, theoretically, over 90 analyses can be performed in a working day. The limit of detection (signal-to-noise ratio = 3) of this method is ca. 0.2-0.5 pg per injection for all analytes. The required volume of the plasma samples can be less than 100 microliters. Hence, the remainder of the plasma sample can be analysed for other substances. This rapid, simple, and sensitive method can thus be used as a research tool in the simultaneous measurement of rat plasma serotonin, catecholamines, and their metabolites.
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Affiliation(s)
- F C Cheng
- Department of Medical Research and Geriatric Medical Center, Taichung Veterans General Hospital, Taiwan
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30
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Abstract
1. Vascular hyporesponsiveness in portal hypertension has been demonstrated to various vasoconstrictors including noradrenaline (NA). The present study aimed to determine whether the attenuated vascular responsiveness to NA is due to a change in the affinity or the number of alpha 1-adrenoceptors. 2. Partial portal vein ligation (PVL) was performed in Sprague-Dawley rats to produce portal hypertension. Vascular responsiveness to NA was assayed in portal vein, mesenteric artery or tail artery. The affinity and number of alpha 1-adrenoceptors were determined by specific binding of [125I]-HEAT (2-beta-4-hydroxy-3-iodophenyethyl-aminomethyltetralone). 3. In the presence of yohimbine (10(-7) M, an alpha 2-adrenoceptor antagonist), propranolol (10(-6) M, a beta-adrenoceptor antagonist), and two catecholamine uptake inhibitors, desipramine (10(-7) M) and normetanephrine (10(-6) M), the maximum responses to NA were decreased in all three blood vessels of PVL rats: 45% decrease in portal vein, 25% in mesenteric artery and 18% in tail artery. 4. The EC50 values of NA and the pA2 values of prazosin, an alpha 1-adrenoceptor antagonist, in all three blood vessels were not significantly different between sham-operated and PVL rats. 5. The KD and Bmax values for specific binding of [125I]-HEAT or the Ki values for NA in the crude membrane preparations of either mesenteric artery or tail artery were also not significantly different between the two groups. 6. It is concluded that the vascular hyporesponsiveness to NA in the mesenteric artery or tail artery of PVL rats is not due to changes in the affinity or number of alpha 1-adrenoceptors.
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MESH Headings
- Adrenergic alpha-1 Receptor Antagonists
- Adrenergic alpha-2 Receptor Antagonists
- Adrenergic alpha-Antagonists/pharmacokinetics
- Adrenergic alpha-Antagonists/pharmacology
- Adrenergic beta-Antagonists/pharmacology
- Animals
- Blood Pressure/drug effects
- Blood Pressure/physiology
- Hypertension, Portal/drug therapy
- Hypertension, Portal/physiopathology
- Male
- Membranes/drug effects
- Membranes/metabolism
- Muscle Contraction/drug effects
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Neurotransmitter Uptake Inhibitors/pharmacology
- Norepinephrine/pharmacology
- Phenethylamines/pharmacokinetics
- Phenethylamines/pharmacology
- Portal Vein/physiology
- Prazosin/pharmacology
- Rats
- Rats, Sprague-Dawley
- Receptors, Adrenergic, alpha-1/drug effects
- Receptors, Adrenergic, alpha-1/physiology
- Tetralones
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Affiliation(s)
- J F Liao
- Department and Institute of Pharmacology, National Yang-Ming Medical College, Taipei, Taiwan
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31
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Abstract
The effects of reserpine were investigated in two models of portal hypertension in rats. Twenty-four hours after 1 mg/kg of reserpine was administered intraperitoneally to normal and portal vein stenosed rats, the cardiac index, mean arterial pressure, heart rate, and portal pressure were significantly decreased compared with normal and portal vein stenosed rats receiving placebo. In addition, the portal tributary blood flow was significantly decreased in portal vein stenosed rats receiving reserpine, but was unchanged in normal rats. In cirrhotic rats receiving a single dose of reserpine, 0.1 mg/kg intraperitoneally for 24 h, there were significant decreases in cardiac index, mean arterial pressure and heart rate compared with cirrhotic rats receiving placebo, while the portal pressure and portal tributary blood flow followed a decreasing trend after reserpine administration. The degree of hemodynamic change was similar in the groups of rats receiving reserpine, even though cirrhotic rats received lower doses than either normal or portal vein stenosed rats. This study suggests enhanced sympathetic nervous activity observed in cirrhotic rats.
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Affiliation(s)
- H C Lin
- Department of Medicine, Taipei Veterans General Hospital, Republic of China
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32
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Abstract
In addition to its hypotensive action, the parathyroid hormone also decreases portal pressure in portal hypertensive rats. The purpose of this study was to characterize the vascular effects of the parathyroid hormone on the portal vein of portal vein-stenosed rats. When intravenously infused at the rate of 1.62 x 10(-11) mol/kg per min, the parathyroid hormone lowered portal pressure (15.1 +/- 0.7 vs. 14.0 +/- 0.8 mmHg) without affecting systemic blood pressure. With the portal vein isolated, the parathyroid hormone shifted the dose-response curves of KCl and acetylcholine to the right. However, the vasodilator effect of the parathyroid hormone was significantly less in portal hypertensive rats (EC50 of KCl increased 129.2% and acetylcholine 199.3%), compared to sham-operated rats (EC50 of KCl increased 158.7% and acetylcholine 270.2%). Similar results were found for the vasodilator action of verapamil (10(-9)-10(-6) M). On the other hand, the vasodilator effect of forskolin was similar for both groups. These results suggest that decreased responsiveness to the parathyroid hormone may be associated with calcium utilization by vascular smooth muscles.
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Affiliation(s)
- T W Chao
- Department of Medical Research, Veterans General Hospital-Taipei, Taiwan, Republic of China
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33
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Abstract
1. Effects of endothelin-1 on systemic arterial blood pressure, heart rate and portal venous pressure were compared in normal Sprague-Dawley rats and rats with portal hypertension induced by CCl4 and partial portal vein ligation. 2. Endothelin-1 produced biphasic effects on systemic blood pressure and portal venous pressure in all three groups of rats. However, the magnitude of the changes in blood pressure was less in portal hypertensive rats. 3. The ability of endothelin-1 to increase the portal venous pressure was also significantly diminished in portal hypertensive rats. On the other hand, the initial decrease in portal pressure was augmented in rats with partial portal vein ligation, and disappeared at higher dosage in CCl4-treated rats. 4. In accordance with the pressure recording in vivo, the dose-response vasoconstrictive activity of endothelin-1 was significantly attenuated in the intrahepatic vasculature. 5. The plasma immunoreactive endothelin concentration was significantly higher (5.55 +/- 0.81 fmol/ml) in Sprague-Dawley rats than in CCl4-treated rats (2.83 +/- 0.56 fmol/ml) and rats with partial portal vein ligation (2.68 +/- 0.53 fmol/ml). 6. It was concluded that a lower plasma level of endothelin and a reduced vascular responsiveness may contribute, at least in part, to the hyperdynamics of portal hypertension.
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Affiliation(s)
- P C Yu
- Department of Medical Research, Veterans General Hospital-Taipei, Taiwan, Republic of China
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Lin SN, Yu PC, Huang JK, Yang MC, Chang LS, Chai CY, Kuo JS. Castration may not affect the penile erection ability in terms of peripheral neurocavernous mechanism in dogs. J Urol 1990; 143:172-4. [PMID: 2294249 DOI: 10.1016/s0022-5347(17)39904-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The penile erection ability (PEA) was assessed in 27 dogs with intact orchids (Group I), seven dogs with bilateral orchidectomy for one month (Group II) and four dogs with bilateral orchidectomy for three months (Group III). PEA was indicated by the increase of the intracorporeal pressure (ICP) upon electrical stimulation of the cavernous nerves. PEA was significantly decreased in both orchidectomized groups. However, when reduction in the blood pressure was considered, the difference in PEA between Group I and the orchidectomized group was no longer significant. Before the orchidectomy, plasma testosterone level of 22 adult male dogs varied widely from 105 to 6302 pg./ml. At one or three months after the orchidectomy in 11 dogs, it decreased to a level below 100 pg./ml. There was no significant change in the body weight in the post orchidectomy period. These findings indicate that the castration and/or the resulting low plasma testosterone level does not directly affect PEA through the peripheral neural and cavernosal mechanism.
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Affiliation(s)
- S N Lin
- Department of Urology, National Cheng-Kung University Hospital, Tainan, Taiwan, Republic of China
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35
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Abstract
Endothelin is a vasoconstrictor peptide which has recently been isolated and sequenced from the vascular endothelial cells. It was reported to increase blood pressure in vivo and produce a prolonged contraction with a slow onset in vitro. The purpose of this study was to investigate whether endothelin can lower the portal pressure as another endogenous vasoconstriction peptidevasopressin (AVP) can. Heart rate, systemic blood pressure, portal pressure, and portal vein blood flow were measured. Effects of endothelin on these parameters were compared with those of AVP. Endothelin 10(-10) mol/Kg significantly decreased all of the parameters mentioned. At the higher dose (5 x 10(-10) mol/Kg), however, the portal pressure and blood pressure were increased and portal vein blood flow was unchanged. On the other hand, AVP decreased the portal pressure and portal vein blood flow but elevated the systemic blood pressure. In vitro experiments revealed that endothelin contracted both tail artery and portal vein of rat and vasopressin contracted only tail artery. We concluded that although both are endogenous vasoconstricting peptides, endothelin and AVP affect differently on arterial and venous vascular beds as well as on portal pressure.
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Affiliation(s)
- M C Yang
- Department of Medical Research, Veterans General Hospital, Taipei, Taiwan, R.O.C
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36
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Abstract
The present study evaluates both penile xenon-133 washout (XWT) and papaverine tests (PT) in the diagnosis of vasculogenic impotence. XWT was accomplished by subcutaneous injection of xenon-133 (1-2 mCi in 0.1 mL saline solution) into the dorsal coronal prepuce. Abnormal XWT was suggested in patients whose clearance time (T1/2) was longer than 7.5 minutes and whose penile blood flow rate (Q) was less than 6 mL/100 g tissue/min. PT was done by intracavernous injection of papaverine (60 mg in 20 mL normal saline). Abnormal PT was indicated in patients whose onset of full erection was more than ten minutes after papaverine injection and whose duration of erection was less than one hour. Ten young and 11 older normal volunteers were examined with XWT only; all showed normal results. A total of 60 impotent patients were examined with both XWT and PT and were classified into four groups: in 2 patients (3.3%) both XWT and PT were normal (group I); in 8 (13.3%) XWT was abnormal and PT normal (group II); in 14 (23.3%) XWT was normal and PT abnormal (group III); and in 36 (60%) both XWT and PT were abnormal (group IV). On further examination with bilateral hypogastric arteriography in 10 XWT-abnormal patients and on surgical correction of abnormal curvature in 5 XWT-abnormal patients, all (100%) were proved to have penile arterial insufficiency. Erection cavernosography performed in 15 PT-abnormal patients confirmed penile venous insufficiency in 80 percent. We conclude both XWT and PT are simple and effective for evaluation of the penile arterial blood flow and venous competence, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S N Lin
- Department of Surgery, Veterans General Hospital, Taiwan, Republic of China
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37
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Abstract
Dogs, 8.5 to 10 kg. in weight, were anesthetized with sodium pentobarbital (35 mg./kg.), intraperitoneally. Penile erection as indicated by an increase in the intracorporal pressure (ICP-increase) was produced by electrical stimulation of the right cavernous nerves. Drugs were administered into the internal pudendal artery (IPA) and femoral vein. A low dose (0.2 to 0.4 microgram/kg.) of clonidine, an alpha 2 adrenoceptor agonist, which could not affect either ICP or systemic arterial pressure (SAP) through an intravenous route, did suppress the ICP-increase markedly via direct injection into the IPA which supplies the penile blood flow. By intra-IPA injection, yohimbine (2.5 micrograms/kg.), an alpha 2 adrenoceptor antagonist, remarkably restored the ICP to the erection state. By intravenous injection, clonidine at a dose of 1.6 to 3.2 micrograms/kg. also profoundly reduced the ICP-increase, but only negligibly lowered the SAP. The IPA blood flow (IPAF) decreased coincidentally when the ICP-increase was effectively reduced by either intravenous or intra-IPA injection of clonidine. These findings suggest clonidine could act locally in the penile structure to suppress penile erection, possibly resulting from a penile vasoconstriction involving alpha 2 adrenoceptor. Whether this vasoconstriction is caused by a direct alpha 2 stimulating effect on the vascular smooth muscle or by an alpha 2 presynaptic inhibition of the vasodilator nerve (cavernous nerve) endings has been discussed.
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Affiliation(s)
- S N Lin
- Department of Surgery, Veterans General Hospital, Taipei, Taiwan, Republic of China
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38
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Yu PC. [Nursing for a child with a huge umbilical hernia]. Zhonghua Hu Li Za Zhi 1984; 19:140-1. [PMID: 6568883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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39
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Yu PC, Chen HS. A clinical study of wintomylon in the treatment of shigellosis. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1965; 6:127-31. [PMID: 5861506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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