ABSTRACT
Abstract Biliary drainage for Perihilar Cholangiocarcinoma (PCCA) can be performed either by endoscopic retrograde cholangiopancreatography or Percutaneous Transhepatic Biliary Drainage (PTBD). To date there is no consensus about which method is preferred. Taking that into account, the aim of this study is to compare Endoscopic Biliary Drainage (EBD) versus percutaneous transhepatic biliary drainage in patients with perihilar cholangiocarcinoma through a systematic review and metanalysis. A comprehensive search of multiple electronic databases was performed. Evaluated outcomes included technical success, clinical success, post drainage complications (cholangitis, pancreatitis, bleeding, and major complications), crossover, hospital length stay, and seeding metastases. Data extracted from the studies were used to calculate Mean Differences (MD). Seventeen studies were included, with a total of 2284 patients (EBD = 1239, PTBD = 1045). Considering resectable PCCA, the PTBD group demonstrated lower rates of crossover (RD = 0.29; 95% CI 0.07-0.51; p = 0.009 I2 = 90%), post-drainage complications (RD = 0.20; 95% CI 0.06-0.33; p < 0.0001; I2 = 78%), and post-drainage pancreatitis (RD = 0.10; 95% CI 0.05-0.16; p < 0.0001; I2 = 64%). The EBD group presented reduced length of hospital stay (RD = -2.89; 95% CI -3.35 - -2,43; p < 0.00001; I2 = 42%). Considering palliative PCCA, the PTBD group demonstrated a higher clinical success (RD = -0.19; 95% CI -0.27 - -0.11; p < 0.00001; I2 = 0%) and less post-drainage cholangitis (RD = 0.08; 95% CI 0.01-0.15; p = 0.02; I2 = 48%) when compared to the EBD group. There was no statistical difference between the groups regarding: technical success, post-drainage bleeding, major post-drainage complications, and seeding metastases.
ABSTRACT
Background: The overall aim of this work was to study the impact of combined aerobic and anaerobic training in relation to hemodynamic response (heart rate, systolic blood pressure, and double product), serum oxidative stress markers (lipoperoxides, nitrites-nitrates) and platelet ATP synthase activities in patients with coronary heart disease. Materials and Methods: Ten subjects, 9 male and 1 female, (mean age 57.7±7.2 years) with coronary heart disease participated in this study. Patients performed combined aerobic and anaerobic exercise for 24 sessions (three times a week). Results: The results suggest myocardium adaptations, manifested in the reduction of heart rate with increased workloads and increased double product [(heart rate) x (systolic blood pressure)] according to the intensity, frequency and duration of training. The ATP synthesis rate was significantly increased at session 3 (post-exercise) compared to session 1 (pre exercise). Furthermore, rate of ATP hydrolysis was significantly decreased at session 24 (post-exercise 3) compared to session 1 (post-exercise 1). Serum lipid peroxidation products and nitric oxide catabolites were significantly diminished at session 24 (pre-exercise). Conclusion: In some patients hemodynamic responses showed improvements in response to exercise. The exercise sessions induced lower levels of lipid peroxidation products, nitric oxide catabolites and ATPase activity. Conversely, ATP synthase activity showed higher values at the end of the experiment. These results confirm the beneficial effect of combined aerobic and anaerobic exercise.
ABSTRACT
Spinal Muscular Atrophy (SMA) is a group of inherited disorders that involve mainly bulbar and spinal motor neurons; causing muscle weakness and atrophy of proximal and symmetrical predominantly in lower extremities, without affecting the facial muscles and the intellectual ability. It is also unclear if SMA is a developmental or a neurodegenerative disease and occurs predominantly in childhood. The continuous clinical spectrum of SMA has been divided into 3 types based on the age at onset and highest motor milestones achieved. SMA type I was described by Hoffman in 1894 and in 1900 was reported as a disease characterized by hypotonia during the first 3 months of life, as well, is considered as the leading cause of death in children under two years of age among genetic diseases worldwide. SMA type II patients can achieve sitting but not walking. While SMA type III patients achieve full milestones with a progressive loss of walking ability. Deterioration in muscle strength and motor function eventually occurs in SMA type II and III. SMA occurs due to depletion of SMN, a ubiquitously expressed protein, which in all cells regulates RNA biogenesis and splicing through its role in the assembly of small nuclear ribonucleoprotein (snRNP) complexes.