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Spinal cord injury (SCI) research is a very complex field lending to why reviews of SCI literatures can be beneficial to current and future researchers. This review focuses on recent articles regarding potential modalities for the treatment and management of SCI. The modalities were broken down into four categories: neuroprotection-pharmacologic, neuroprotection-non-pharmacologic, neuroregeneration-pharmacologic, neuroregeneration-non-pharmacologic. Peer-reviewed articles were found using PubMed with search terms: "spinal cord injury", "spinal cord injury neuroregeneration", "olfactory ensheathing cells spinal cord injury", "rho-rock inhibitors spinal cord injury", "neural stem cell", "scaffold", "neural stem cell transplantation", "exosomes and SCI", "epidural stimulation SCI", "brain-computer interfaces and SCI". Most recent articles spanning two years were chosen for their relevance to the categories of SCI management and treatment. There has been a plethora of pre-clinical studies completed with their results being difficult to replicate in clinical studies. Therefore, scientists should focus on understanding and applying the results of previous research to develop more efficacious preclinical studies and clinical trials.
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BACKGROUND: While household contact investigation is widely recommended as a means to reduce the burden of tuberculosis (TB) among children, only 27% of eligible pediatric household contacts globally received preventive treatment in 2018. We assessed the cost-effectiveness of household contact investigation for TB treatment and short-course preventive therapy provision for children under 15 years old across 12 high TB burden countries. METHODS: We used decision analysis to compare the costs and estimated effectiveness of three intervention scenarios: (a) status quo (existing levels of coverage with isoniazid preventive therapy), (b) contact investigation with treatment of active TB but no additional preventive therapy, and (c) contact investigation with TB treatment and provision of short-course preventive therapy. Using country-specific demographic, epidemiological and cost data from the literature, we estimated annual costs (in 2018 USD) and the number of TB cases and deaths averted across 12 countries. Incremental cost effectiveness ratios were assessed as cost per death and per disability-adjusted life year [DALY] averted. FINDINGS: Our model estimates that contact investigation with treatment of active TB and provision of preventive therapy could be highly cost-effective compared to the status quo (ranging from $100 per DALY averted in Malawi to $1,600 in Brazil; weighted average $383 per DALY averted [uncertainty range: $248 - $1,130]) and preferred to contact investigation without preventive therapy (weighted average $751 per DALY averted [uncertainty range: $250 - $1,306]). Key drivers of cost-effectiveness were TB prevalence, sensitivity of TB diagnosis, case fatality for untreated TB, and cost of household screening. INTERPRETATION: Based on this modeling analysis of available published data, household contact investigation with provision of short-course preventive therapy for TB has a value-for-money profile that compares favorably with other interventions. FUNDING: Unitaid (2017-20-IMPAACT4TB).
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Biatrial flutter is a rare form of macro-reentrant atrial tachycardia that involves both the right and left atria. Single-loop biatrial flutter is typically associated with scarring of the septum from prior ablation or surgery and is generally made up of two interatrial connections-that is, the coronary sinus and Bachmann's bundle. Entrainment and high-density mapping allow for rapid diagnosis and development of a treatment strategy. Ablation planning should also take into consideration the preservation of interatrial conduction. We herein discuss a case of single-loop biatrial flutter presenting as a typical atrial flutter and review the differential diagnosis and physiology of the arrhythmia.
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The computed vertical energy, E v,a/f, from the equilibrium geometry of the initial electronic state is frequently considered as representative of the experimental excitation/emission energy, E abs/fl = hc/λ max. Application of the quantum mechanical version of the Franck-Condon principle does not involve precise specification of nuclear positions before, after, or during an electronic transition. Moreover, the duration of an electronic transition is not experimentally accessible in spectra with resolved vibrational structure. It is shown that computed vibronic spectra based on TDDFT methods and application of quantum mechanical FC analysis predict E abs = hc/λ max with a 10-fold improvement in accuracy compared to E v,a for nine cyanine dyes. It is argued that part of the reason for accuracy when this FC analysis is compared to experiment as opposed to E v,a/f is the unspecified verticality of transitions in the context of the quantum version of the FC principle. Classical FC transitions that preserve nuclear kinetic energy before and after an electronic transition were previously found to occur at a weighted average of final and initial electronic state molecular geometries known as the r-centroid. Inspired by this approach a qualitative method using computed vertical and adiabatic energies and the harmonic approximation is developed and applied yielding a 5-fold improvement in accuracy compared to E v,a. This improvement results from the dominance of low frequency vibronic transitions in the cyanine dye major band. The model gives insight into the nature of the redshift when qPCR dye EvaGreen is complexed to λDNA and is applicable to the low frequency band of similar non cyanine dyes such as curcumin. It is found that the computed vibronic cyanine dye spectra from time-dependent FC analysis at 0 K and 298 K show decreased intensity at higher temperature suggestive of increased intensity with restricted motion shown when cyanine dyes are used in biomedical imaging. A 2-layer ONIOM model of the DNA minor groove indicates restricted motion of the TC-1 dye excited state in this setting indicative of enhanced fluorescence.
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OBJECTIVE: The short-term outcomes were evaluated in patients treated for tricuspid valve endocarditis using a novel extracellular matrix (ECM) cylinder reconstruction technique. METHODS: Patients with clinically significant tricuspid regurgitation whose valves were not repairable by conventional techniques underwent valve replacement with a cylindrical construct sewn out of CorMatrix ECM (CorMatrix Cardiovascular, Roswell, Ga). The cylinders were sized to the native valve dimensions and attached distally to the papillary muscles using polypropylene sutures and ECM pledgets, and proximally to the annulus using a running suture. Patient data were collected retrospectively. RESULTS: From November 2011 to October 2013, 12 surgeons performed 19 tricuspid valve cylinder reconstructions in 8 men and 10 women (age range, 19-53 years). Of the 19 patients, 11 had active and 5 had treated endocarditis. One case was robotic-assisted. No deaths occurred, and no new cases of heart block developed. The papillary attachments were disrupted intraoperatively in 1 patient and after 7 days in another; both were successfully revised. A third patient experienced recurrent disruption of the implant at 13 and 22 months and ultimately received a pericardial valve. Fungal infection occurred in 1 cylinder at 6 months; a second ECM cylinder was implanted. Follow-up data were available for 13 patients at 1 to 2 months, 8 at 6 months, and 3 at 12 and 18 months. Other than patients undergoing reoperation, all showed well-functioning tricuspid valves with no to mild regurgitation. CONCLUSIONS: Cylinder reconstruction with ECM could be a suitable technique for replacing the tricuspid valve while preserving annuloventricular continuity in patients with infective endocarditis not repairable by conventional techniques.
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Bioprótese , Endocardite Bacteriana/cirurgia , Matriz Extracelular/transplante , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Procedimentos de Cirurgia Plástica/instrumentação , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Adulto , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Técnicas de Sutura , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/microbiologia , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/microbiologia , Ultrassonografia , Adulto JovemAssuntos
Circulação Extracorpórea/métodos , Emulsões Gordurosas Intravenosas/administração & dosagem , Flecainida/intoxicação , Parada Cardíaca Extra-Hospitalar/induzido quimicamente , Ressuscitação/métodos , Antiarrítmicos/intoxicação , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Eletrocardiografia/efeitos dos fármacos , Feminino , Flecainida/uso terapêutico , Frequência Cardíaca/efeitos dos fármacos , Humanos , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/terapia , Taquicardia Paroxística/tratamento farmacológicoRESUMO
The intervalvular fibrosa, the structure that connects the mitral and the aortic valves, can be injured during aortic valve replacement. Although this complication is rare, it may require complex and extensive repair. Herein, we describe management of a damaged aortic-mitral curtain and fibrous body during tissue aortic valve replacement in a patient with mixed connective tissue disorder. A "U" suture repair combining an external and internal reinforcement repair technique via the aorta, without explanting the prosthetic valve technique, is described. The purpose of using the "externalized" buttressed U-stitch was to obliterate any residual cavity and to assure control of hemorrhage externally. Repair of damaged fibrous body during aortic valve replacement (AVR) is challenging. We managed this difficult situation in a satisfactory surgical approach without explanting the aortic prosthesis.
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Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valva Mitral/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/lesões , Tecido Conjuntivo/diagnóstico por imagem , Tecido Conjuntivo/lesões , Tecido Conjuntivo/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/lesões , Reoperação , Técnicas de Sutura , UltrassonografiaRESUMO
Ascending aortic pseudoaneurysm (AAP) is a rare but serious complication after cardiothoracic surgery. Patients typically present with chest pain, fever, or mass effects, but asymptomatic individuals with abnormal imaging results have been reported. Currently, there are no established guidelines regarding the management of AAP, but most authors recommend surgical treatment even in asymptomatic patients. Here, we describe a 39-year-old woman with Marfan syndrome who developed an AAP approximately 7 years after cardiac surgery. She was treated conservatively and remained asymptomatic until the past 2 years when she developed progressive chest pain and dyspnea upon exertion. Computed tomography angiography, coronary angiography, and ascending aortography were performed and revealed the presence of a pseudoaneurysm of the ascending aorta. Surgical intervention was successful and she was discharged home without significant issues.
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Falso Aneurisma/etiologia , Aneurisma Aórtico/etiologia , Ponte de Artéria Coronária/efeitos adversos , Síndrome de Marfan/complicações , Veia Safena/transplante , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Aortografia/métodos , Feminino , Humanos , Reoperação , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos VascularesRESUMO
A case with clinical and hemodynamic findings consistent with constrictive pericarditis is reported. At surgery, the pericardium was not thickened or adherent to the epicardial wall. As suggested by echocardiography, a diagnosis of severe tricuspid regurgitation was confirmed. This case illustrates that invasive hemodynamic findings consistent with a picture of pericardial constriction can be produced by processes other than constrictive pericarditis.
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Pericardite Constritiva/diagnóstico , Insuficiência da Valva Tricúspide/diagnóstico , Idoso , Ecocardiografia Transesofagiana , Feminino , Hemodinâmica , Humanos , Pericardite Constritiva/fisiopatologia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologiaRESUMO
BACKGROUND: Potassium-rich cardioplegia has advantages over other cardioplegic solutions in preserving the myocardium during cardiopulmonary bypass, but it is avoided in patients with renal failure because of hyperkalemia. METHODS: We first determined the ability of intraoperative hemodialysis (IHD) to remove potassium during cardiopulmonary bypass with potassium-rich cardioplegia in 9 patients by measuring potassium levels in all dialysate and urine. We then studied 24 patients with renal failure, grouped with the 9 previous patients, to assess safety, rebound hyperkalemia, and patient outcome with this technique. RESULTS: In the first phase, 9 patients were administered 128 +/- 11 mmol of potassium in potassium-rich cardioplegia, and IHD removed 157 +/- 23 mmol. Urinary potassium excretion was only 10 +/- 3 mmol. Potassium removal occurred at a rate of 1.25 mmol/min with 0-mEq/L (mmol/L) potassium dialysate and a rate of 0.75 mmol/min with 3.0-mEq/L (mmol/L) potassium dialysate. In all 33 patients, successful initiation of cardiac rhythm occurred after cardiopulmonary bypass, and 5 patients had cardiac arrhythmias possibly from hypokalemia. In the next 24 hours, 5 dialysis-dependent patients developed hyperkalemia (potassium > 5.2 mEq/L [mmol/L]) requiring hemodialysis. Postoperative hemodialysis was delayed 2 to 3 days in the other patients. The overall death rate was 24% at 30 days. CONCLUSION: IHD effectively and safely removes potassium administered during potassium-rich cardioplegia during cardiopulmonary bypass in patients with renal failure and prevents postoperative hyperkalemia in the majority of patients. Overall mortality in patients with acute and chronic renal failure undergoing cardiac surgery is high irrespective of control of potassium balance in these patients.
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Soluções Cardioplégicas/farmacologia , Ponte Cardiopulmonar , Parada Cardíaca Induzida/métodos , Cuidados Intraoperatórios , Potássio/farmacologia , Diálise Renal , Idoso , Ponte Cardiopulmonar/instrumentação , Soluções Cristaloides , Desenho de Equipamento , Feminino , Cardiopatias/complicações , Cardiopatias/cirurgia , Humanos , Hiperpotassemia/induzido quimicamente , Hiperpotassemia/prevenção & controle , Complicações Intraoperatórias/induzido quimicamente , Complicações Intraoperatórias/prevenção & controle , Soluções Isotônicas , Masculino , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Substitutos do Plasma/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Potássio/administração & dosagem , Potássio/urina , Diálise Renal/instrumentação , Insuficiência Renal/sangue , Insuficiência Renal/complicações , Insuficiência Renal/terapia , Resultado do TratamentoRESUMO
A membranous structure causing functional stenosis at the mouth of the left atrial appendage (LAA) has been reported. In this study we describe the presence of nonobstructive membranes traversing the cavity of the LAA found incidentally on transesophageal echocardiography (TEE).
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Apêndice Atrial/anatomia & histologia , Apêndice Atrial/diagnóstico por imagem , Idoso , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Membranas/anatomia & histologia , Membranas/diagnóstico por imagem , Pessoa de Meia-IdadeRESUMO
Infarct related intramyocardial dissection, an unusual mechanical complication associated with recent inferior/inferoposterior myocardial infarction, is characterized by a septal defect and a dissection tract that originates on the left side of the interventricular septum, extends beyond the septum into the right ventricular free wall, and subsequently re-enters the right ventricle. The utility of echocardiography for diagnosis has been described. Despite aggressive therapy, the prognosis of intramyocardial dissection is reported to be dismal. We describe the use of prompt echocardiography in two patients, which established the diagnosis of infarct related intramyocardial dissection allowing early definitive surgery and long-term survival.