ABSTRACT
Introduction Thrombosis of tunneled central venous catheters (CVC) in hemodialysis (HD) patients is common and it can lead to the elimination of vascular sites. To compare the efficacy of alteplase vs. urokinase in reestablishing adequate blood flow through completely occluded vascular catheters. Methods In this randomized study, patients with completely occluded tunneled HD catheters received 40 minutes intracatheter dwell with alteplase (1 mg/mL) or urokinase (5000 IU/mL). Primary endpoint was the proportion of patients with occluded catheters achieving post-thrombolytic blood flow of ≥250 mL/min. Safety endpoints included the incidence of hemorrhagic and infectious complications. Findings Eligible adult patients (n = 100) were treated with alteplase (n = 44) or urokinase (n = 56). The two groups were similar in gender (male: 51.8% vs. 56.8%, P = 0.35), age (60 ± 12 vs. 59 ± 13 years, P = 0.71), time on dialysis (678 ± 203 vs. 548 ± 189 days, P = 0.77), diabetes and cardiovascular disease (55.6% vs. 70.4%, P = 0.08 and 17.8% vs. 22.7%, P = 0.38, respectively), jugular vein as main vascular access (54.8% vs. 62.5%, P = 0.57), and time of CVC (278 ± 63 vs. 218 ± 59 days, P = 0.67). Primary success with alteplase and urokinase occurred in 42/44 (95%) vs. 46/56 (82%), P = 0.06. Success was not achieved after the second dose of alteplase and urokinase in 1 and 7 cases, respectively (2% vs. 12%, P = 0.075). Serious adverse effects were not observed in both groups. There was no difference between the two groups in infectious complications (P = 0.94). Discussion Alteplase and urokinase are effective thrombolytic agents for restoring HD catheter patency. Our study has revealed a likely slight superiority of alteplase over urokinase for unblocking central lines, but which has enrolled too few patients to be able to detect a difference of this size.
Subject(s)
Catheterization, Central Venous/adverse effects , Renal Dialysis/adverse effects , Thrombosis/drug therapy , Tissue Plasminogen Activator/therapeutic use , Urokinase-Type Plasminogen Activator/therapeutic use , Adult , Aged , Female , Humans , Male , Middle Aged , Renal Dialysis/instrumentation , Thrombosis/etiology , Tissue Plasminogen Activator/adverse effects , Urokinase-Type Plasminogen Activator/adverse effectsABSTRACT
Nas últimas décadas, a incidência de indivíduos com sobrepeso ou obesos vem aumentando exponencialmente. Hoje, a obesidade é considerada pela Organização Mundial da Saúde como uma epidemia mundial, com graves consequências que podem levar à morte. A obesidade é uma desordem multifatorial que envolve fatores hereditários, ambiente e estilo de vida, e suas consequências não são apenas sociais ou psicológicas, mas estão principalmente relacionadas à presença de co-morbidades como a hipertensão arterial, diabetes tipo II, doenças cardiovasculares e vários tipos de câncer. Portanto, o controle da obesidade é um desafio para a manutenção da saúde humana, atraindo o interesse de inúmeros pesquisadores que buscam o entendimento dos mecanismos associados ao seu desenvolvimento, bem como novos métodos terapêuticos e de prevenção. Com base nessas premissas, o presente estudo objetivou avaliar a associação entre alterações genéticas e a obesidade, com especial foco para a presença de danos no DNA e para o perfil de expressão e polimorfismos gênicos. A casuística do estudo incluiu 300 mulheres cadastradas na lista de espera para a realização de cirurgia bariátrica e 300 mulheres saudáveis, eutróficas, pareadas por idade. O teste do cometa foi utilizado para avaliação de danos primários no DNA de células sanguíneas; os polimorfismos dos genes da grelina (GHRL)e leptina (LEP)e dos seus receptores (GHSR e LEPR), da interleucina 6(IL-6) e da serotonina (5-HT2C) foram analisados pela técnica de RT-PCR; o perfil de expressão gênica em linfócitos foi avaliado pela metodologia do DNA microarray e a expressão dos genes adiponectina (ADIPOQ) e leptina (LEP) em adipócitos foi avaliada pela técnica de qRT-PCR...
In the last decades, the incidence of overweight and obesity has increased worldwide. Nowadays, obesity is considered by the World Health Organization as a global epidemic with severe consequences that can lead to death. Obesity is a multifactorial disorder which involves different factors such as genetic, environment and life style, and its consequences are not only social or psychological, but are also related to the presence of comorbidities such as hyperthension, type 2 diabetes, heart diseases and many types of cancer. Therefore, obesity control has become a challenge for the human health maintenance, catching the attention of researchers that are trying to understand the mechanisms associated to its development, as well as therapeutical and preventive methods. Based on the information above, the present study aimed to evaluate the association between genetic alterations and obesity, with special focus on the presence of DNA damage, gene expression profiling and genetic polymorphisms. Our study included 300 morbid obese women registered for the bariatric surgery and 300 healthy eutrophic women, matched by age. The comet assay was used to assess primary DNA damage in blood cells; the genetic polymorphisms of ghrelin (GHRL), leptin (LEP) and their receptors (GHSR and LEPR), interleukin-6 (IL-6) and serotonin receptor (5-HT2C) were evaluated by the RT-PCR; gene expression profiling in lymphocytes was assessed by DNA microarrays; and adiponectin (ADIPOQ) and leptin (LEP) gene expression in adipocytes were evaluated by qRT-PCR...
