9 research outputs found
Simulated Surface-Induced Thrombin Generation in a Flow Field
No full textA computational model of blood coagulation is presented with particular emphasis on the regulatory effects of blood flow, spatial distribution of tissue factor (TF), and the importance of the thrombomodulin-activated protein C inhibitory pathway. We define an effective prothrombotic zone that extends well beyond the dimensions of injury. The size of this zone is dependent on the concentrations of all reactive species, the dimensions of TF expression, the densities of surface molecules, and the characteristics of the flow field. In the case of tandem sites of TF, the relationship between the magnitude of the effective prothrombotic zone and the interval distance between TF sites dictate the net response of the system. Multiple TF sites, which individually failed to activate the coagulation pathway, are shown to interact in an additive manner to yield a prothrombotic system. Furthermore, activation of the thrombomodulin-activated protein C pathway in the regions between sites of TF downregulate the thrombin response at subsequent TF sites. The implications of prothrombotic effects, which extend downstream beyond the discrete site of injury to interact with subsequent lesions are critical given the systemic nature of atherosclerotic disease.National Institutes of Health (U.S.) (Grant DK069275)National Institutes of Health (U.S.) (Grant HL106018)National Institutes of Health (U.S.) (Grant HL083867)National Institutes of Health (U.S.) (Grant HL56819
Self-Assembling Peptide Monolayers: Endothelial Cell Behavior on Functionalized Metal Substrates
No full textAbstractDespite the high initial success rate with metallic stents for the treatment of a variety of vascular lesions, problems have included occlusion due to thrombus formation or intimal proliferation. Improving the biological behavior of these and other other implantable metallic devices may require the use of biomimetic peptide coatings which promote specific cellular responses at the biological-materials interface.Thiol-terminated peptides, without the addition of a cysteine residue, were synthesized by a modification of standard solid phase methodology. Gold/mica or gold/glass surfaces were exposed for 6 hours at 23 °C to one of three peptide solutions: GRGD(βA)3YNH(CH2)2SH (RGD); (βA)6NH (CH2)2SH (bAla); or a 1:1 mix of both peptides. Peptide films were examined by external reflectance infrared (IR) spectroscopy and atomic force microscopy (AFM) which confirmed the presence of unique close-packed structures for bAla and the 1:1 mix. Endothelial cell proliferative, migratory, and adhesive behavior were evaluated using 3H-thymidine and 51Cr labeling techniques, respectively. Cell proliferation, migration, and adhesion were significantly higher on RGD containing peptide films.Well-ordered protein assemblies on metallic substrates can be produced with the proper choice of peptide chain structure and terminal residues. Biological activity is a function of film composition and oligopeptide pendant structure.</jats:p
Flow-simulated thrombin generation profiles as a predictor of thrombotic risk among pre-menopausal women
No full textClinical epidemiolog
A bibliometric analysis of abdominal aortic aneurysm (2014–2024)
No full textBackgroundAbdominal aortic aneurysm (AAA) is a localized bulge of the abdominal aorta, which mainly manifests as a pulsatile mass in the abdomen. Once an abdominal aortic aneurysm ruptures, the patient's life is seriously endangered. Surgery is the preferred treatment for abdominal aortic aneurysm. At present, there has been no comprehensive review of the current status of abdominal aortic aneurysm research. Therefore, this study aimed to identify global trends in abdominal aortic aneurysm research over the last 10 years through bibliometric analysis and to inform clinical practice, research funding allocation, and decision-making.MethodsWe downloaded research articles and reviews on abdominal aortic aneurysm from 1 January 2014, to 1 March 2024, from the Web of Science core collection. CiteSpace (version 6.2.1), RStudio and VOSviewer (version 1.6.18) were used for visual analysis of regional distribution, institutions, authors, keywords and other information.ResultsThe number of documents on abdominal aortic aneurysm research increased continuously and has stabilized in recent years. A total of 9,905 publications from 67 countries were published from 1 January 2014, to 1 March 2024. A total of 2,142 (29.52%) studies were from the United States, 1,293 (13.05%) were from China, and 919 (9.28%) were from the United Kingdom. A total of 205 studies were conducted at Stanford University, 172 were conducted at Harvard Medical School, and 165 were conducted at the Mayo Clinic. The top three coauthorship authors were Schermerhorn, Marc L (114); Golledge, Jonathan (102); and De Vries, Jean Paul P.M. (74). The most cocited reference was Chaikof EL, 2018, J Vasc Surg, v67, p. 2; the most cocited journal was the Journal of Vascular Surgery; and the most cocited author was Lederle, FA. “Abdominal aortic aneurysm” was the most frequently used author keyword (2,492). Twenty-five references with strong citation bursts were identified by “CiteSpace”. “Artificial intelligence”, “clinical outcomes” and “bridging stent” were the primary keywords of emerging research hotspots.ConclusionThis is the first bibliometric study to comprehensively summarize the research trends in abdominal aortic aneurysm research. This information can help us to identify the current research hotspots and directions. This study will provide extensive help for future research
Acompanhamento do reparo endovascular de aneurisma de aorta abdominal através da pressão intra-saco:resultados de uso de sensor de pressão em cursto e médio prazo.
No full textTrabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Dapartamento de Clínica Cirúrgica
Late Survival Of Patients Submitted To Elective Abdominal Aortic Aneurysm Open Repair
No full textBackground: The authors performed a review of patients who underwent surgery at a community hospital to determine the cause of late mortality, evolution of other aortic segments and graft-related complications. Objectives: To report the late follow-up of a series of 76 patients submitted to elective abdominal aortic aneurysm open repair from March 1995 to January 2007. Methods: Recruitment of patients for a follow-up visit; those who could not attend personally were contacted by telephone. Results: Thirty-day operative mortality was 5.3%. Late survival obtained by life table was 95% in 1 year, 88% in 3 years and 72% in 8 years. Cardiovascular diseases were the main cause of late mortality, followed by malignant neoplasia. Dilatation of proximal aortic segment during follow-up occurred in 9.7% of the patients, and graft-related complications occurred in four cases (5.3%): one graft infection, one proximal pseudoaneurysm, one pseudoaneurysm of the iliac artery and one branch occlusion. Conclusion: Open surgery for abdominal aortic aneurysm repair has good long-term outcome, similar to that in the national and international literature, and is a good option for patients who have a low surgical risk.63Conway, K.P., Byrne, J., Townsend, M., Lane, I.F., Prognosis of patients turned down for conventional abdominal aortic aneurysm repair in the endovascular and sonographic era: Szilagyi revisited? (2001) J Vasc Surg, 33, pp. 752-757Brewster, D.C., Cronenwett, J.L., Hallett, J.W., Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery (2003) J Vasc Surg, 37, pp. 1106-1117Biancari, F., Ylönen, K., Anttila, V., Durability of open repair of infrarenal abdominal aortic aneurysm: A 15-year follow-up study (2002) J Vasc Surg, 35, pp. 87-93Cherr, G.S., Edwards, M.S., Craven, T.E., Survival of young patients after abdominal aortic aneurysm repair (2002) J Vasc Surg, 35, pp. 94-99Taylor, J.C., Shaw, E., Whyman, M.R., Poskitt, K.R., Heather, B.P., Earnshaw, J.J., Late survival after elective repair of aortic aneurysms detected by screening (2004) Eur J Vasc Endovasc Surg, 28, pp. 270-273Back, M.R., Leo, F., Cuthbertson, D., Johnson, B.L., Shames, M.L., Bandyk, D.F., Long-term survival after vascular surgery: Specific influence of cardiac factors and implications for preoperative evaluation (2004) J Vasc Surg, 40, pp. 752-760Cao, P., Verzini, F., Parlani, G., Clinical effect of abdominal aortic aneurysm endografting: 7-year concurrent comparison with open repair (2004) J Vasc Surg, 40, pp. 841-848Lifeline registry of endovascular aneurysm repair: Long-term primary outcome measures (2005) J Vasc Surg, 42, pp. 1-10. , Lifeline Registry of EVAR Publications CommitteeAdam, D.J., Fitridge, R.A., Raptis, S., Late reintervention for aortic graft-related events and new aortoiliac disease after open abdominal aortic aneurysm repair in an Australian population (2006) J Vasc Surg, 43, pp. 701-705Becker, M., Bonamigo, T.P., Faccini, F.P., Avaliação da mortalidade cirúrgica em aneurismas infra-renais da aorta abdominal (2002) J Vasc Bras, 1, pp. 15-21Carvalho, F.C., Brito, V.P.M.R., Tribulatto, E.C., Bellen, B.V., Estudo prospectivo da morbi-mortalidade precoce e tardia da cirurgia do aneurisma da aorta abdominal (2005) Arq Bras Cardiol, 84, pp. 292-296Mendonça, C.T., Moreira, R.C.R., Timi, J.R.R., Comparação entre os tratamentos aberto e endovascular dos aneurismas da aorta abdominal em pacientes de alto risco cirúrgico (2005) J Vasc Bras, 4, pp. 232-242Suggested standards for reports dealing with lower extremity ischemia. Prepared by the Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery (1986) J Vasc Surg, 4, pp. 80-94Illig, K.A., Green, R.M., Ouriel, K., Riggs, P., Bartos, S., DeWeese, J.A., Fate of the proximal aortic cuff: Implications for endovascular aneurysm repair (1997) J Vasc Surg, 26, pp. 492-499. , discussion 499-501Kalman, P.G., Rappaport, D.C., Merchant, N., Clarke, K., Johnston, K.W., The value of late computed tomographic scanning identification of vascular abnormalities after abdominal aortic aneurysm repair (1999) J Vasc Surg, 29, pp. 442-450May, J., White, G.H., Waugh, R., Improved survival after endoluminal repair with second-generation prostheses compared with open repair in the treatment of abdominal aortic aneurysms: A 5-year concurrent comparison using life table method (2001) J Vasc Surg, 33 (2 SUPPL.), pp. S21-S26Luccas, G.C., Lobato, A.C., Menezes, F.H., Superior mesenteric artery syndrome: An uncommon complication of abdominal aortic aneurysm repair (2004) Ann Vasc Surg, 18, pp. 250-253Ballard, J.L., Abou-Zamzam, A.M., Teruya, T.H., Bianchi, C., Petersen, F.F., Quality of life before and after endovascular and retroperitoneal abdominal aortic aneurysm repair (2004) J Vasc Surg, 39, pp. 797-803Soulez, G., Thérasse, E., Monfared, A.A., Endovascular versus open repair of abdominal aortic aneurysms in patients at low risk (2005) J Vasc Interv Radiol, 16, pp. 1093-1100Aljabri, B., Al Wahaibi, K., Abner, D., Patient-reported quality of life after abdominal aortic aneurysm surgery: A prospective comparison of endovascular and open repair (2006) J Vasc Surg, 44, pp. 1182-1187Menard, M.T., Nguyen, L.L., Chan, R.K., Thoracovisceral segment aneurysm repair after previous infrarenal abdominal aortic aneurysm surgery (2004) J Vasc Surg, 39, pp. 1163-1170Matsumura, J.S., Chaikof, E.L., Continued expansion of aortic necks after endovascular repair of abdominal aortic aneurysms. EVT Investigators. EndoVascular Technologies, Inc (1998) J Vasc Surg, 28, pp. 422-430. , discussion 30-1Makaroun, M.S., Deaton, D.H., Is proximal aortic neck dilatation after endovascular aneurysm exclusion a cause for concern? (2001) J Vasc Surg, 33 (2 SUPPL.), pp. S39-S45Prinssen, M., Wever, J.J., Mali, W.P., Eikelboom, B.C., Blankensteijn, J.D., Concerns for the durability of the proximal abdominal aortic aneurysm endograft fixation from a 2-year and 3-year longitudinal computed tomography angiography study (2001) J Vasc Surg, 33 (2 SUPPL.), pp. S64-S69Waasdorp, E.J., de Vries, J.P., Hobo, R., Aneurysm diameter and proximal aortic neck diameter influence clinical outcome of endovascular abdominal aortic repair: A 4-year EUROSTAR experience (2005) Ann Vasc Surg, 19, pp. 755-761Litwinski, R.A., Donayre, C.E., Chow, S.L., The role of aortic neck dilation and elongation in the etiology of stent graft migration after endovascular abdominal aortic aneurysm repair with a passive fixation device (2006) J Vasc Surg, 44, pp. 1176-1181Liapis, C., Kakisis, J., Kaperonis, E., Changes of the infrarenal aortic segment after conventional abdominal aortic aneurysm repair (2000) Eur J Vasc Endovasc Surg, 19, pp. 643-647Baker, D.M., Hinchliffe, R.J., Yusuf, S.W., Whitaker, S.C., Hopkinson, B.R., True Juxta-anastomotic aneurysms in the residual infra-renal abdominal aorta (2003) Eur J Vasc Endovasc Surg, 25, pp. 412-415Hassen-Khodja, R., Feugier, P., Favre, J.P., Nevelsteen, A., Ferreira, J., University Association for Research in Vascular Surgery. Outcome of common iliac arteries after straight aortic tube-graft placement during elective repair of infrarenal abdominal aortic aneurysms (2006) J Vasc Surg, 44, pp. 943-948Carpenter, J.P., Baum, R.A., Barker, C.F., Durability of benefits of endovascular versus conventional abdominal aortic aneurysm repair (2002) J Vasc Surg, 35, pp. 222-228Gioia, L.C., Filion, K.B., Haider, S., Pilote, L., Eisenberg, M.J., Hospital readmissions following abdominal aortic aneurysm repair (2005) Ann Vasc Surg, 19, pp. 35-41Dion, Y.M., Gracia, C.R., Ben El Kadi, H.H., Totally laparoscopic abdominal aortic aneurysm repair (2001) J Vasc Surg, 33, pp. 181-185Dion, Y.M., Griselli, F., Douville, Y., Langis, P., Early and mid-term results of totally laparoscopic surgery for aortoiliac disease. Lessons learned (2004) Surg Laparosc Endosc Percutan Tech, 14, pp. 328-334Kolvenbach, R., Schwierz, E., Wasilljew, S., Miloud, A., Puerschel, A., Pinter, L., Total laparoscopically and robotically assisted aortic aneurysm surgery: A critical evaluation (2004) J Vasc Surg, 39, pp. 771-776Kolvenbach, R., Pinter, L., Raghunandan, M., Cheshire, N., Ramadan, H., Dion, Y.M., Laparoscopic remodeling of abdominal aortic aneurysms after endovascular exclusion: A technical description (2002) J Vasc Surg, 36, pp. 1267-1270Kolvenbach, R., Lin, J., Combining laparoscopic and endovascular techniques to improve the outcome of aortic endografts. Hybrid techniques (2005) J Cardiovasc Surg (Torino), 46, pp. 415-42
Выбор тактики хирургического лечения аневризмы брюшного отдела аорты у октогерианцев
No full textCurrently, the treatment of abdominal aortic aneurysm does not pose significant difficulties, with modern cardiovascular surgery offering the possibility of both open and endovascular repair (EVAR) techniques. However, the personalized selection of the most optimal surgical intervention for each patient remains a relevant question. In some cases, one of the important factors influencing the choice of surgical method is the patient’s age and accompanying diseases. Abdominal aortic aneurysm is an age-related condition with a high risk of fatal outcomes. In our practice, we encountered a rare case of abdominal aortic aneurysm in an octogenarian woman with severe somatic status, poorly controlled arterial hypertension, and complex anatomical enlargement of the aneurysm. The question arose regarding the choice of optimal tactics and surgical treatment method. According to the MSCT, the diameter of the expansion was 67 mm, posing a 20% risk of rupture in the first year. In this clinical case, EVAR technique was unsuitable due to the anatomical features of the aneurysm, as the length of the neck in the infrarenal segment of the aorta was 2.5–3 cm, and the angle of inclination to the right exceeded 85°. Additionally, considering gender-specific factors, particularly female gender, indications for EVAR need to be carefully determined, as women have a higher likelihood of complications following the operation, as shown in several studies. After a detailed analysis of the re-evaluation results and assessment of surgical risk factors, we determined an individual surgical strategy and minimized risks, ultimately achieving a good outcome.В настоящее время лечение аневризм брюшного отдела аорты не вызывает особых сложностей, в распоряжении современной сердечно-сосудистой хирургии есть возможность использования как открытой, так и закрытой (EVAR) методики реконструкции. При этом остается актуальным вопрос персонифицированного выбора наиболее оптимального вида оперативного вмешательства для каждого пациента. В ряде случаев одним из важных факторов, оказывающих влияние на выбор метода хирургии, выступает возраст пациента и его сопутствующие заболевания. Аневризма брюшного отдела аорты является возрастным заболеванием с высоким риском летального исхода. В нашей практике мы столкнулись с редким случаем аневризмы брюшного отдела аорты у женщины-октогерианца, имеющей тяжелый соматический статус, медикаментозно трудно контролируемую артериальную гипертензию и сложную анатомию аневризматического расширения. Перед нами встал вопрос о выборе оптимальной тактики и метода хирургического лечения. По данным МСКТ диаметр расширения составил 67 мм, риск разрыва в таком случае составляет 20% в первый год. В данном клиническом случае методика EVAR была неприменима из-за анатомических особенностей аневризмы: в инфраренальном отделе аорты длина шейки составляла 2,5–3 см, а угол наклона вправо превышал 85°. Также учитывая женский пол пациента, необходимо тщательно определять показания для EVAR, так как женщины согласно ряду исследований имеют бо́льшую вероятность возникновения осложнений после операции. После детального анализа результатов дообследования и оценки хирургических факторов риска мы определили индивидуальную тактику и стратегию хирургического лечения, минимизировали риски и достигли хорошего результата
ПРОФИЛАКТИКА ОСЛОЖНЕНИЙ, ОБУСЛОВЛЕННЫХ ИШЕМИЕЙ-РЕПЕРФУЗИЕЙ МИОКАРДА, ПРИ ЭКСТРАКАРДИАЛЬНЫХ ОПЕРАТИВНЫХ ВМЕШАТЕЛЬСТВАХ
No full textIn the next 20 years, the aging population will be a major factor affecting the characteristics of perioperative anesthesia tactics. Domestic researchers have reported that the incidence of cardiac complications after general surgical procedures in patients with middle and old age is 9.1%, and mortality in these complications reached 45.5%. Analyzed current data on myocardial ischemia-reperfusion, the etiopathogenesis of perioperative cardiac complications, recurrence of their development and the possible consequences. It is concluded that prevention and timely treatment of complications resulting from ischemia-reperfusion of the myocardium, with noncardiac surgical interventions is an important tactical (prevention of perioperative myocardial infarction, arrhythmias, cardiac death) and policy (prevention of cardiac remodeling and post-hospital disability of patients) anaesthesiological tasks. Research carried out in the Nrgovsky Research Institute of General Reanimatology showed that in the real practice Detsky index, Lee index and echocardiographic left ventricular ejection fraction did not provide high accuracy prediction of cardiac events. More informative proved preoperative determination of blood N-terminal part of the pro-brain natriuretic peptide (NT-proBNP). In assessing the predictive ability of NT-proBNP area under the ROC-curve achieved 0.86. NT-proBNP value 358 pg/ml and above provided 77% sensitivity and 85% specificity. The comparative assessment and recommendations on the use to reduce the risk of cardiac complications of β-blockers, statins, calcium channel blockers, nitrates, clonidine, dexmedetomidine, levosimendan and phosphocreatine. Phosphocreatine, introduced in practice domestic cardiac surgery and transplantology more than 20 years ago, continues to be studied and used at the moment. Recently demonstrated that perioperative phosphocreatine usage appointment in older oncological patients with a high risk of cardiac complications reduces the incidence of acute ischemia and delirium, shortens the length of stay the intensive care unit and hospital stay. It was concluded that the reduction in the incidence of cardiac events has undoubted relevance with noncardiac operations. В ближайшие 20 лет старение населения станет основным фактором, влияющим на особенности периоперационной анестезиологической тактики. Отечественные исследователи сообщают, что частота кардиальных осложнений после общехирургических операций у больных пожилого и старческого возраста составляет 9,1%, а летальность при таких осложнениях достигает 45,5%. Проанализированы современные данные об ишемии-реперфузии миокарда, этиопатогенезе периоперационных кардиальных осложнений, цикличности их развития и возможных последствиях. Сделано заключение, что профилактика и своевременное лечение осложнений, обусловленных ишемией-реперфузией миокарда, при экстракардиальных оперативных вмешательствах является важной тактической (профилактика периоперационного инфаркта миокарда, аритмий, кардиальной смерти) и стратегической (профилактика ремоделирования сердца и постгоспитальной инвалидизации больных) задачей анестезиолога-реаниматолога. Исследование, выполненное в НИИ общей реаниматологии им. В.А. Неговского, показало, что в реальных условиях индекс Detsky, индекс Lee и эхокардиографическая фракция изгнания левого желудочка не обеспечивают высокой точности прогнозирования кардиальных осложнений. Более информативным оказалось предоперационное определение содержания в крови N-терминального отрезка неактивного предшественника BNP (NT-proBNP). При оценке прогностической способности NT-proBNP площадь под ROC-кривой достигла 0,86. Значение NT-proBNP 358 пг/мл и выше обеспечило чувствительность 77% и специфичность 85%. Приводится сравнительная оценка и рекомендации по использованию для снижения риска кардиальных осложнений β-адреноблокаторов, статинов, блокаторов кальциевых каналов, нитратов, клофелина, дексмедетомидина, левосимендана и фосфокреатина. Фосфокреатин, введенный в практику отчественной кардиохирургии и трансплантологии более 20 лет назад, продолжает изучаться и использоваться в настоящее время. Недавно показано, что периоперационное назначение фосфокреатина онкологическим пожилым больным с высоким риском кардиальных осложнений снижает частоту острой ишемии и делирия, укорачивает длительность пребывания больных в отделении реанимации и интенсивной терапии и общую длительность госпитализации. Сделано заключение, что снижение частоты кардиальных осложнений при экстракардиальных операциях имеет несомненную актуальность.
Периоперационные повреждение миокарда и сердечная недостаточность в некардиальной хирургии (обзор). Часть 1. Этиопатогенез и прогнозирование периоперационных кардиальных осложнений
No full textThe purpose of this paper is to provide scientific and practical information on assessment of the risk of myocardical damage development after noncardiac operations (NOMD): ischemia or myocardial infarction (MI), and/or heart failure (HF) and their prevention in adult patients. This overview of literature consists of two parts. The first part analyzes epidemiology, etiopathogeneis, and POCC risk prediction methods; the second part describes the possibilities of adjuvant pharmacological cardioprotection and approaches to optimizing anesthesiological support of operative interventions in high cardiac risk patients.The problem of perioperative cardiac complications in noncardiac surgey is one of relevant complex issues of contemporary medicine. In line with contemporary views, NOMD is now regarded as a separate variant of a pathological process in the heart muscle. According to extensive studies, about 40% of mortality of adult patients during non-cardial operative inverventions are caused by various NOMD and/or HF. The problem under discussion is particularly relevant when medical assistance is rendered to elderly patients.Цель публикации – предоставить научно-практическую информацию по оценке риска развития миокардиальных повреждений после некардиохирургических операций (МПНО): ишемии или инфаркта миокарда (ИМ), и/или сердечной недостаточности (СН) и их предупреждению у взрослых пациентов. Настоящий обзор литературы состоит из двух частей. В 1-й части пронализированы эпидемиология, этипатогенез и методы прогнозирования риска ПОКО, во 2-й — возможности адъювантной фармакологической кардиопротекции, а также подходы к оптимизации анестезиологического обеспечения оперативных вмешательств у больных высокого кардиального риска.Проблема периоперационных кардиальных осложнений в некардиальной хирургии является одной из актуальных комплексных проблем современной медицины. В соответствии с современными представлениями МПНО стали рассматривают в качестве отдельного варианта патологического процесса в сердечной мышце. По данным обширных исследований у взрослых больных около 40% летальности при некардиальных оперативных вмешательствах обусловлено различными вариантами МПНО и/или СН. Особую актуальность рассматриваемая проблема имеет при оказании медицинской помощи пожилым
