1,721,068 research outputs found
Lung transplantation: is it still an experimental procedure?
No full textThe number of lung transplants performed worldwide is low and early and late results are worse in comparison with other solid organ transplants. The present review will focus on these two aspects analyzing the causes and describing the possible strategies to overcome these limitations.
RECENT FINDINGS:
The use of grafts from marginal and from nonheart-beating donors may increase the number of lung transplantation (LTx) with good results. Implementation of donor protocol and optimization of donor management have been reported to be effective in increasing the pool of suitable grafts. Ex-vivo reconditioning technique may be also helpful to better evaluate and recondition usually rejected lungs. This may allow a significant increase in the number of lung transplants performed worldwide. Early and late results of LTx are mainly affected by primary graft dysfunction and the onset of obliterative bronchiolitis. Different strategies have been adopted to reduce the incidence of these two complications with controversial results.
SUMMARY:
LTx maintains some features of experimental procedure especially in terms of number of performed procedures and early and late results. The various strategies to overcome the limited number of available grafts appear effective but not universally applied and accepted. The different treatments of PDG and obliterative bronchiolitis are still disappointing. To date, the onset of PDG and obliterative bronchiolitis after LTx still significantly impacts on outcomes. A better understanding of the underlying mechanisms in the pathogenesis of primary graft dysfunction and obliterative bronchiolitis may provide improved therapeutic strategies
Right Mini-thoracotomy Mitral Valve Surgery: The Art and Science of the Tailoring Approach
No full textPrimary Graft Failure after Heart Transplantation: Risk Factors Analysis and Long Term Results
No full textPurpose: Primary graft failure(PGF)is the most feared complication
in the immediate postoperative period of heart transplantation .It
manifests as a severe systolic dysfunction of the graft- left, right or
biventricular- requiring high inotropic doses with or without
mechanical circulatory support. This is a retrospective single-center
study aimed to define the impact of PGF in our population and to
identify any possible predictive factors in order to enable its
anticipation and early treatment.
Methods andMaterials: PGF was defined by four criteria reflecting
significant myocardial dysfunction, severe hemodynamic impairment,
early onset after heart transplantation, and absence of secondary
causes of graft dysfunction. More than 50 recipients, donors, and peri-
procedural variables were entered in a database. We performed an
univariate analysis of factors associated with the occurrence of PGF.
Variables associated with PGF were included in a multivariate analysis
in order to identify independent predictors of PGF.
Results: The study population consists of a series of 174 consecutive
heart transplantations performed in our institution between January
2005 andDecember2011.34patients(19%) had a PGF after
transplantation, with a 30-day mortality of 47.06%. The analysis of
donor and recipient characteristics has identified seven negative
predictors: recipient age greater than 60years, inotropes, IABP,
MCS or mechanical ventilation before surgery, urgent transplantation
and traumatic donor death(p o 0,01). Patients with three or more of
these risk factors have a chance of developing PGD three times higher
than other patients(c-statistic 1⁄4 0,71) and a 30-days mortality
increased by3times(c-statistic 1⁄4 0,74).
Conclusions: PGF confirmed to be a serious complication of the
immediate postoperative period of cardiac transplantation with a
mortality rate in our population of about 47%.The validation of
predictive factors with a larger, prospective study would allow
easier prevention of PGF and a nearly treatment oft his serious
complication
New life for macrolides.
No full textThis article is an attempt to analyze and discuss the role and the purported mechanisms of azithromycin (AZM) in non-eosinophilic severe asthma, including antineutrophil activity, an effect on gastroesophageal reflux or antibacterial activity against an underlying chronic infection, such as Chlamydia pneumoniae.
Macrolides have an expanding role in the therapy of chronic inflammatory diseases based on their additional anti-inflammatory and immunosuppressive properties.
Many studies have been performed in lung transplantation field and maintenance treatment has been proved to be effective in cystic fibrosis, bronchiectasis, diffuse panbronchiolitis, and in bronchiolitis obliterans syndrome and in the prevention of exacerbations in patients with chronic obstructive pulmonary
disease. Pathobiological studies of people with severe, refractory asthma focused on its heterogeneity encouraging more targeted and personalized approaches to asthma therapy. In neutrophilic asthma corticosteroids are not very effective, while the immunomodulatory action of macrolides is particularly relevant on neutrophils. Recently, The AZIthromycin in Severe ASThma (AZISAST) study, published on the April number of Thorax, provided evidences on the efficacy and safety of long-term add-on treatment with AZM in severe non-eosinophilic asthma.
Despite concerns about an increased proportion of macrolide-resistant organism and about the effects of macrolides on cardiovascular events, there was no evidence of an increased risk of pneumonia or other adverse events. Because the
AZISAST study was not able to demonstrate significant improvement in lung function and use of rescue medication, there is still a need for new data confirming the efficacy of AZM in severe non-eosinophilic asthma
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Protective ventilation for lung transplantation
Full text linkPurpose of review
Lung transplantation has been one of the great medical advances as the last option for the treatment of end-stage pulmonary disease. Optimal pulmonary care of potential donors and recipients can definitely increase the number of successful lung retrievals and reduce the incidence of complications.
Recent findings
The use of a lung-protective ventilatory strategy, associated with recruitment maneuvers, has a profound clinical impact, doubling the number of lungs available for transplant. Postoperatively, it is important to use a lung-protective ventilation strategy, whereas for patients with life-threatening reperfusion injury, extracorporeal membrane oxygenation can ensure a survival rate between 50 and 80%. Pumpless extracorporeal carbon dioxide removal system allows the maintenance of normal gas exchange and can be maintained in the perioperative period.
Summary
Perioperative ventilatory care of the transplanted patient still represents a challenge for the ICU clinician. The lung-protective strategy and the early application of carbon dioxide removal systems can increase the number of lung donor eligibility. Further studies are needed to increase the viability of other organs and to develop new strategies that reduce the risk of ischemia-reperfusion injury, which still represents the most common complication in the postoperative period
Bridging to lung transplantation by extracorporeal support
No full textIdeally, bridging patients with end stage severe respiratory failure to lung transplantation should significantly extend the pretransplant life expectancy to increase the chances to receive a suitable organ, as well as efficiently preserve the post-transplant long-term life expectancy by maintaining physiological homeostasis and avoiding multi-organ dysfunction. Various advanced strategies of extracorporeal circulation can replace at least in part the respiratory function of the lung and can potentially provide the appropriate mode and level of cardiopulmonary support for each patient's physiologic requirements. Therefore, patients on the lung transplant waiting list developing severe hypoxemic and/or hypercapnic respiratory failure can be supported for a prolonged period of time before the transplant, preserving a satisfactory post-transplant life expectancy. However, a more systematic clinical study on this issue is warranted in order to define the actual efficacy of these treatments in reducing the mortality rate on the waiting transplant list, and eventually improve the outcome of patients with end stage respiratory failure
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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