Intracardiac correction of tetralogy of Fallot in the first year of life: short-term and midium-term results

OBJECTIVE: To evaluate short-term and medium-term results of intracardiac correction of Tetralogy of Fallot in the first year of life. METHODS: From January 1996 to October 2004, 67 consecutive infants ranging in age from 1 to 11 months (mean: 7.2 months) and weighing from 4 to 10 kilograms (mean: 7.1 kilograms) underwent elective total correction of Tetralogy of Fallot. The surgery was accomplished with conventional cardiopulmonary bypass and moderate hypothermia. Right ventriculotomy was performed in 60 (89.5%) cases and an atriopulmonary approach was used in the other seven (10.5%) cases. RESULTS: Cardiopulmonary bypass time ranged from 35 to 147 minutes (mean: 78.8 ± 21 minutes), and aortic clamping time ranged from 25 to 86 minutes (mean: 51.8 ± 15.6 minutes). Transannular enlargement of the right ventricular outflow tract was needed in 50 (64.1%) patients. Gradient between the right ventricle and pulmonary artery after correction varied from 0 to 54 mmHg (mean: 15.5 ± 10.8 mmHg). There were two (2.98%) early deaths. Follow-up of the 65 survivors ranged from 7 to 115 months (mean:44.0 ± 35 months). There was one late noncardiac death. All other patients are asymptomatic. The actuarial survival curve at 12 years, including operative mortality, was 97%. Ten patients were evaluated by magnetic nuclear angioresonance. CONCLUSIONS: Intracardiac correction of Tetralogy of Fallot in the first year of life may be performed with low morbidity and mortality and good late results.OBJETIVO: Avaliar os resultados a curto e médio prazos da correção intracardíaca da tetralogia de Fallot no primeiro ano de vida. MÉTODOS: De janeiro de 1996 a outubro de 2004, 67 crianças com idade variando de 1 a 11 meses (média: 7,2 meses) e pesando entre 4 a 10 quilos (média: 7,1 kg) foram eletivamente submetidas a correção intracardíaca da tetralogia de Fallot. A cirurgia foi realizada com circulação extracorpórea convencional e hipotermia moderada. Ventriculotomia direita foi realizada em 60 (89,5%) casos e em sete (10,5%) utilizou-se a abordagem do defeito pela via atriopulmonar. RESULTADOS: O tempo de circulação extracorpórea variou de 35 a 147 minutos (média:78,8 ± 21 minutos), e o tempo de pinçamento da aorta variou de 25 a 86 minutos (média: 51,8 ± 15,6 minutos). Ampliação transanular da via de saída do ventrículo direito foi necessária em 50 (64,1%) casos. O gradiente entre o ventrículo direito e a artéria pulmonar, após a correção, variou de 0 a 54 mmHg (média: 15,5 ± 10,8 mmHg). Ocorreram dois (2,98%) óbitos no pós-operatório imediato. O seguimento tardio variou de 7 a 115 meses (média: 44,0 ± 35 meses). Houve uma morte tardia não-cardíaca. Todos os outros pacientes estão assintomáticos. A curva de sobrevida actuarial, incluindo a mortalidade operatória, revelou que a probabilidade de sobrevida, 12 anos após a operação, é de 97%. Dez pacientes foram avaliados por angiorresonânia magnética nuclear. CONCLUSÕES: A correção intracardíaca da tetralogia de Fallot no primeiro ano de vida pode ser feita com baixas morbidade e mortalidade e bons resultados tardios.Escola Paulista de MedicinaInstituto do Coração de PernambucoUniversidade Federal de Pernambuco Departamento de Cirurgia do Centro de Ciências da SaúdeUNIFESP, EPMSciEL

The RNA-binding protein, ZFP36L2, influences ovulation and oocyte maturation

ZFP36L2 protein destabilizes AU-rich element-containing transcripts and has been implicated in female fertility. In the C57BL/6NTac mouse, a mutation in Zfp36l2 that results in the decreased expression of a form of ZFP36L2 in which the 29 N-terminal amino acid residues have been deleted, ΔN-ZFP36L2, leads to fertilized eggs that arrest at the two-cell stage. Interestingly, homozygous ΔN-Zfp36l2 females in the C57BL/6NTac strain release 40% fewer eggs than the WT littermates (Ramos et al., 2004), suggesting an additional defect in ovulation and/or oocyte maturation. Curiously, the same ΔN-Zfp36l2 mutation into the SV129 strain resulted in anovulation, prompting us to investigate a potential problem in ovulation and oocyte maturation. Remarkably, only 20% of ΔN-Zfp36l2 oocytes in the 129S6/SvEvTac strain matured ex vivo, suggesting a defect on the oocyte meiotic maturation process. Treatment of ΔN-Zfp36l2 oocytes with a PKA inhibitor partially rescued the meiotic arrested oocytes. Furthermore, cAMP levels were increased in ΔN-Zfp36l2 oocytes, linking the cAMP/PKA pathway and ΔN-Zfp36l2 with meiotic arrest. Since ovulation and oocyte maturation are both triggered by LHR signaling, the downstream pathway was investigated. Adenylyl cyclase activity was increased in ΔN-Zfp36l2 ovaries only upon LH stimulation. Moreover, we discovered that ZFP36L2 interacts with the 3′UTR of LHR mRNA and that decreased expression levels of Zfp36l2 correlates with higher levels of LHR mRNA in synchronized ovaries. Furthermore, overexpression of ZFP36L2 decreases the endogenous expression of LHR mRNA in a cell line. Therefore, we propose that lack of the physiological down regulation of LHR mRNA levels by ZFP36L2 in the ovaries is associated with anovulation and oocyte meiotic arrest.Fil: Ball, Christopher B.. University of North Carolina; Estados UnidosFil: Rodriguez, Karina F.. National Institutes of Health; Estados UnidosFil: Stumpo, Deborah J.. National Institutes of Health; Estados UnidosFil: Ribeiro Neto, Fernando. National Institutes of Health; Estados UnidosFil: Korach, Kenneth S.. National Institutes of Health; Estados UnidosFil: Blackshear, Perry J.. University of Duke; Estados Unidos. National Institutes of Health; Estados UnidosFil: Birnbaumer, Lutz. National Institutes of Health; Estados Unidos. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ramos, Silvia B. V.. University of North Carolina; Estados Unido

Should the diabetics have the internal thoracic artery skeletonized? Assessment of sternal perfusion by scintillography

OBJECTIVE: To assess, by scintillography, the effect of using bilateral internal thoracic arteries (BITAs) - prepared by two different techniques - on the sternal perfusion. METHODS: 35 patients undergone coronary artery bypass grafting (CABG) were divided into two groups: Group A (18) had both ITA's dissected using skeletonization technique and group B (17) as pedicle preparation. There was no difference in the two groups relating gender, age and demographic characteristics. On the 7th postoperative day the patients underwent bone scintillography. The statistical analysis was performed using the Student's t test with 95% significance. RESULTS: Group A (skeletonized ITA) showed higher perfusion (11.5%) of the sternum as a mean, than Group B (pedicled ITA) patients; however this was not statistically significant (P = 0.127). On the other hand, comparing the diabetic population, seven in each group, there was a marked 47.4% higher perfusion of the sternum in Group A patients (skeletonized ITA) comparing to Group B (pedicled ITA) and this difference reached statistical significance (P = 0.004). CONCLUSION: 1- Sternal perfusion is not affected significantly apart from the dissection technique used for both internal thoracic arteries in the general population when assessed by bone scintillography. 2 - In the diabetic subgroup, a significant preservation of the sternal perfusion was observed in patients undergone skeletonized dissection of the internal thoracic arteries. Although these findings should be confirmed in a greater number of cases, diabetic patients should have the internal thoracic arteries dissected using skeletonization techinque.OBJETIVO: Avaliar o impacto na vascularização do esterno, por cintilografia óssea, da utilização de ambas as artérias torácicas internas (ATIs), preparadas por duas técnicas diferentes. MÉTODOS: Trinta e cinco pacientes coronarianos foram divididos em dois grupos: Grupo A - 18 pacientes tiveram as duas ATIs dissecadas de forma esqueletizada; Grupo B - 17 pacientes tiveram as duas ATIs dissecadas pela técnica pediculada. Não houve diferença nos dois grupos com relação a gênero, idade e características demográficas. Realizou-se cintilografia óssea 7 dias após a cirurgia. A análise estatística foi realizada utilizando-se o teste de t de Student. com significância estabelecida em 95%. RESULTADOS: No grupo A (ATI esqueletizada), o nível de captação do esterno foi de 11,5% mais alto em comparação com a média dos 17 pacientes do grupo B (ATI pediculada), mas essa diferença não foi estatisticamente significante (P = 0,127). Entretanto, a média dos níveis de captação do esterno nos sete pacientes diabéticos do Grupo A (ATI esqueletizada) foi 47,4% mais alta em comparação à média dos sete pacientes diabéticos do grupo B (ATI pediculada), e esta diferença foi estatisticamente significante (P = 0,004). CONCLUSÃO: 1- A forma de dissecção das ATIs não altera de maneira estatisticamente significativa a perfusão esternal, avaliada por cintilografia óssea, no conjunto geral da população estudada. 2- No subgrupo de pacientes diabéticos, observou-se melhor perfusão do esterno nos pacientes submetidos à dissecção esqueletizada. Embora a confirmação desse achado num maior número de casos seja necessária, pacientes diabéticos devem ter as artérias torácicas internas dissecadas de forma esqueletizada.Instituto do Coração de PernambucoUniversidade Federal de Pernambuco Centro de Ciências da Saúde Departamento de CirurgiaEscola Paulista de MedicinaPronto Socorro de Cardiologia de PernambucoInstituto de Medicina Nuclear e Endocrinologia do RecifeReal Hospital Português de Beneficência em PernambucoUniversidade Federal de PernambucoUNIFESP, EPMSciEL

On human-in-the-loop CPS in healthcare: a cloud-enabled mobility assistance service

Despite recent advancements on cloud-enabled and human-in-the-loop cyber-physical systems, there is still a lack of understanding of how infrastructure-related quality of service (QoS) issues affect user-perceived quality of experience (QoE). This work presents a pilot experiment over a cloud-enabled mobility assistive device providing a guidance service and investigates the relationship between QoS and QoE in such a system. In our pilot experiment, we employed the CloudWalker, a system linking smart walkers and cloud platforms, to physically interact with users. Different QoS conditions were emulated to represent an architecture in which control algorithms are performed remotely. Results point out that users report satisfactory interaction with the system even under unfavorable QoS conditions. We also found statistically significant data linking QoE degradation to poor QoS conditions. We finalize discussing the interplay between QoS requirements, the human-in-the-loop effect, and the perceived QoE in healthcare applications

PERFIL DE RESISTÊNCIA ANTIMICROBIANA EM AMOSTRAS DE SECREÇÃO DE OROFARINGE NA REGIÃO DO CARIRI CEARENSE NO PERÍODO DE 2018 A 2019

ABSTRACT: Introduction: The upper airways are important sites for the emergence and proliferation of many pathogens, mainly due to direct contact with the external environment, presence of oxygen, moisture, nutrients and adequate temperature, promoting an infectious, inflammatory and irritative process in the affected site, characterized as one of the most frequent problems found in public health services. Objective: To evaluate the antimicrobial sensitivity profile in cultures of oropharyngeal secretion and positive sputum in the region of Cariri, Ceará. Methodology: This is an epidemiological, documentary, cross-sectional study, with retrospective collection of materials, from 07/01/18 to 06/30/19, from the database of the Clinical Analysis Laboratory of Cariri Vicente Lemos, who collects material from residents of the Cariri region. Results: 132,124 positive samples of oropharyngeal and sputum secretion were evaluated with antimicrobial tests, which revealed 85,691 (64.85%) sensitive, 43,338 (33.05%) resistant and 3,099 (2.35%) of character intermediate in relation to its efficacy to the antibiotics used. Furthermore, the most prevalent profile of microorganisms in the samples was revealed, such as: Streptococcus pyogenes, Staphylococcus coagulase-negative, Escherichia coli, Enterococcus sp., Pseudomonas aeruginosa and Acinetobacter baumannii/calcoaceticus complex, which are directly related to several systemic infections. Conclusion: In this context, several microorganisms have been showing a higher degree of resistance to some antimicrobials in the region of Cariri Ceará, impairing clinical practice in relation to the diagnosis and treatment of certain diseases.Introducción: Las vías respiratorias superiores son sitios importantes para la aparición y proliferación de muchos patógenos, principalmente debido al contacto directo con el ambiente externo, presencia de oxígeno, humedad, nutrientes y temperatura adecuada, promoviendo un proceso infeccioso, inflamatorio e irritativo en el sitio afectado, caracterizándolo como uno de los problemas más frecuentes que se encuentran en los servicios de salud pública. Objetivo: Evaluar el perfil de sensibilidad antimicrobiana en cultivos de secreción de orofaringe y cicatrices positivas en la región de Cariri de Ceará. Metodología: Se trata de un estudio epidemiológico, documental transversal, con colección retrospectiva de materiales, del 01/07/18 al 30/06/19, de la base de datos del Laboratorio de Análisis Clínicos de Cariri Vicente Lemos, que recoge el material de residentes de la región de Cariri. Resultados: Se evaluaron un total de 1324 muestras positivas de orofaringe y secreción cicatricial con pruebas antimicrobianas, en las que revelaron 85.691 (64,85%) sensibles, 43.338 (33,05%) resistentes y 3.099 (2,35%) intermedias en relación a su eficacia con los antibióticos utilizados. Además, se reveló el perfil de mayor prevalencia de microorganismos en las muestras: Streptococcus pyogenes, Staphylococcus coagulasa negativo, Escherichia coli, Enterococcus sp., Pseudomonas aeruginosa y Complejo Acinetobacter baumannii/calcoaceticus, que están directamente relacionados con varias infecciones sistémicas. Conclusión: En este contexto, varios microorganismos han presentado un mayor grado de resistencia a algunos antimicrobianos en la región de cariri ceará, perjudicando en la práctica clínica en relación con el diagnóstico y tratamiento de ciertas enfermedades.Introdução: As vias aéreas superiores são importantes sítios para o surgimento e proliferação de muitos patógenos, devido, principalmente, ao contato direto com o meio externo, presença de oxigênio, umidade, nutrientes e temperatura adequada, promovendo um processo infeccioso, inflamatório e irritativo no local acometido, caracterizando-se como um dos problemas mais frequentes encontrados em serviços de saúde pública. Objetivo: Avaliar o perfil de sensibilidade aos antimicrobianos em culturas de secreção orofaringe e de escarros positivas na região do Cariri cearense. Metodologia: Trata-se de um estudo epidemiológico, documental, em corte transversal, com coleta retrospectiva dos materiais, no período de 01/07/18 a 30/06/19, a partir da base de dados do Laboratório de Análises Clínicas do Cariri Vicente Lemos, que coleta o material de moradores da região do Cariri. Resultados:        Foram avaliadas 132.124 amostras positivas de secreção de orofaringe e de escarro com os testes de antimicrobianos, nos quais revelaram 85.691 (64,85%) sensíveis, 43.338 (33,05%) resistentes e 3.099 (2,35%) de caráter intermediário em relação à sua eficácia aos antibióticos utilizados. Além disso, foi revelado o perfil de maior prevalência dos microrganismos nas amostras como: de Streptococcus pyogenes, Staphylococcus coagulase-negativa, Escherichia coli, Enterococcus sp., Pseudomonas aeruginosa e Acinetobacter baumannii/ calcoaceticus complexo, que estão diretamente relacionados com diversas infecções sistêmicas. Conclusão: Nesse contexto, diversos microrganismos vêm apresentando um grau maior de resistência a alguns antimicrobianos na região do cariri cearense, prejudicando na prática clínica em relação ao diagnóstico e ao tratamento de certas doenças

Comparative efficacy of the conventional and automated methods for determining neutral and acid detergent fiber

Different methods are available to determine fiber content in feeds. However, information about the accuracy of this methods for neutral detergent fiber (NDF) and acid detergent fiber ADF contents estimation (obtained with the use of TNT-100 nylon filtering bags) is very limited related to the large number of ruminant feed analysis. The purpose of this study was to compare the efficacy of the automated and conventional Van Soest methods to determine NDF and ADF contents for bovine cattle and feed supplements. Four classes of samples (tropical forage, maize silage hybrid, concentrated supplements and bovine cattlecattle) were evaluated for NDF and ADF contents using conventional and automated methods. Analysis involved a hierarchical factorial scheme with an entirely randomized design executed with repetitions. It was concluded that the automated method procedure generated similar results when compared to the conventional method for the determination of NDF contents in tropical forage, bovine cattle and maize silage samples, although is not recommended for samples with a high starch content. This system was not efficient for ADF determination in the evaluated samples.Different methods are available to determine fiber content in feeds. However, information about the accuracy of this methods for neutral detergent fiber (NDF) and acid detergent fiber ADF contents estimation (obtained with the use of TNT-100 nylon filtering bags) is very limited related to the large number of ruminant feed analysis. The purpose of this study was to compare the efficacy of the automated and conventional Van Soest methods to determine NDF and ADF contents for bovine cattle and feed supplements. Four classes of samples (tropical forage, maize silage hybrid, concentrated supplements and bovine cattlecattle) were evaluated for NDF and ADF contents using conventional and automated methods. Analysis involved a hierarchical factorial scheme with an entirely randomized design executed with repetitions. It was concluded that the automated method procedure generated similar results when compared to the conventional method for the determination of NDF contents in tropical forage, bovine cattle and maize silage samples, although is not recommended for samples with a high starch content. This system was not efficient for ADF determination in the evaluated samples

Effects of rosiglitazone on contralateral iliac artery after vascular injury in hypercholesterolemic rabbits

<p>Abstract</p> <p>Background</p> <p>The objective was to evaluate the effects of rosiglitazone on iliac arteries of hypercholesterolemic rabbits undergoing balloon catheter injury in the contralateral iliac arteries.</p> <p>Methods</p> <p>White male rabbits were fed a hypercholesterolemic diet for 6 weeks and divided into two groups as follows: rosiglitazone group, 14 rabbits treated with rosiglitazone (3 mg/Kg body weight/day) during 6 weeks; and control group, 18 rabbits without rosiglitazone treatment. All animals underwent balloon catheter injury of the right iliac artery on the fourteenth day of the experiment.</p> <p>Results</p> <p>There was no significant difference in intima/media layer area ratio between the control group and the rosiglitazone group. Rosiglitazone did not reduce the probability of lesions types I, II, or III (72.73% vs. 92.31%; <it>p </it>= 0.30) and types IV or V (27.27% vs. 7.69%; <it>p </it>= 0.30). There were no differences in the extent of collagen type I and III deposition or in the percentage of animals with macrophages in the intima layer. The percentage of rabbits with smooth muscle cells in the intima layer was higher in rosiglitazone group (<it>p </it>= 0.011).</p> <p>Conclusion</p> <p>These findings demonstrate that rosiglitazone given for 6 weeks did not prevent atherogenesis at a vessel distant from the injury site.</p