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1.
Eur Ann Otorhinolaryngol Head Neck Dis ; 139(2): 73-76, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34140266

RESUMO

OBJECTIVES: To study voice prosthesis survival, complications, efficacy and impact on quality of life. METHODS: A single-center observational study was performed in patients treated for squamous cell carcinoma of the larynx or hypopharynx by total (pharyngo)-laryngectomy between 2010 and 2015. Study data comprised: maximum phonation time (sec), number of and reasons for prosthesis exchanges (leakage through or around the prosthesis, expulsion or inclusion of the prosthesis), plus 2 quality of life questionnaires (QLQ-C30, QLQ-H&N35) and the Voice Handicap Inventory (VHI 30). RESULTS: Forty-nine patients were included. The most common causes of prosthesis exchange were leakage through (73.2%) or around the prosthesis (18.5%). The median time between exchanges was 4 months. Global quality of life status on the QLQ-C30 was 63.5. Mean maximum phonation time was 7.4sec. Mean VHI was 46/120; 10 patients had a mild voice handicap, 12 moderate and 10 severe. No relation emerged between the number of prosthesis exchanges per year and quality of life. Voice handicap significantly decreased quality of life, with QLQ-C30 72.3 for the 22 patients with mild to moderate voice handicap and 44.2 for the 10 patients with severe voice handicap (P=0.001). CONCLUSION: Voice restoration by tracheoesophageal prosthesis after total (pharyngo)-laryngectomy is a reliable technique that decreases voice handicap and, despite potentially serious complications, has little negative impact on quality of life.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Carcinoma de Células Escamosas de Cabeça e Pescoço , Voz , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Laringectomia/métodos , Qualidade de Vida , Fala , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia
2.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S11-S18, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32863156

RESUMO

OBJECTIVE: Multi-centre study of the National French Registry (EPIIC) of patients with cochlear implants, focusing on infants who were operated-on under the age of 24 months between 2012 and 2016. PATIENTS AND METHODS: A total of 615 profoundly deaf infants, who received cochlear implants (CIs) before their second birthday, were included in the registry by different CI centers. Epidemiological, surgical, speech therapy and school, follow-up data were included in the registry, 12, 24, 36 and 48 months thereafter. The following parameters were studied: type of implantation (uni- or bilateral), complications, cause of deafness, category of auditory perception (CAP), Open-set word recognition score (OSW), speech intelligibility rating, lexical comprehension with EVIP (Peabody), communication mode and type of schooling. Bilateral simultaneous CI (BiCI) and unilateral CI (UniCI) groups were compared. RESULTS: There were 744 implantations. The explantation-reimplantation rate, within the four-year follow-up, was just 3.6%. Mean implantation age was 16.0 months, and similar in the two groups (BiCI/UniCI). A total of 51% of children had their first implant between 12 and 18 months, and 15% before 12 months. Implantation was unilateral in 52% of cases. Fifty-six percent of the bilateral procedures were sequential, with a mean delay of 16.8 months for the second implantation. The cause of deafness was unknown in 52% of cases. Of the 48% (297/615) of attributed cases, 32% had clear genetic causes. The remaining deafness was due to cytomegalovirus (CMV, 8%), inner-ear malformation (5%) and meningitis (3%). The main complications were from infections (47%) and internal device failure (25%). Four years post-operation, 84% of the UniCI and 75% of BiCl groups had a CAP≥5, and 83% of UniCl and 100% BiCI had OSW≥80%. Furthermore 74% of UniCI and 77% of BiCI communicated orally and 85% of UniCI and 90% of BiCI integrated into mainstream schooling. CONCLUSION: The French Registry of cochlear implants (EPIIC) is the only such national registry in the world. Our analysis illustrates the immediate benefits of, either single or double, cochlear implantation for language, perception skills and schooling.


Assuntos
Percepção Auditiva , Linguagem Infantil , Implante Coclear/estatística & dados numéricos , Implantes Cocleares/estatística & dados numéricos , Surdez/reabilitação , Sistema de Registros/estatística & dados numéricos , Fatores Etários , Implante Coclear/efeitos adversos , Implante Coclear/métodos , Implantes Cocleares/efeitos adversos , Comunicação , Correção de Deficiência Auditiva/instrumentação , Correção de Deficiência Auditiva/estatística & dados numéricos , Surdez/etiologia , Remoção de Dispositivo/estatística & dados numéricos , Educação de Pessoas com Deficiência Auditiva/métodos , Educação de Pessoas com Deficiência Auditiva/estatística & dados numéricos , Seguimentos , França , Humanos , Lactente , Recém-Nascido , Inclusão Escolar/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Instituições Acadêmicas , Inteligibilidade da Fala , Fonoterapia/estatística & dados numéricos , Fatores de Tempo
3.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S5-S9, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32891589

RESUMO

Cochlear and brainstem implants have been included on the list of reimbursable products (LPPR) in France since March of 2009. The implants were initially inscribed for 5 years, after which an application for renewal with the French National Commission for the Evaluation of Medical Devices and Health Technologies (Commission Nationale d'évaluation des dispositifs médicaux et des technologies de santé - CNEDiMTS) was required [Haute Autorité de santé, 2009]. Upon registration to the list of reimbursable products, the companies and the reference centers for cochlear and brainstem implants were asked to set up a post-registration registry called EPIIC. This article reports the evolution in the EPIIC registry of the general indicators for 5051 patients over the five years from 2012-2016.


Assuntos
Implantes Auditivos de Tronco Encefálico/estatística & dados numéricos , Implantes Cocleares/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Comitês Consultivos/organização & administração , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Implantes Auditivos de Tronco Encefálico/economia , Implante Coclear/estatística & dados numéricos , Implantes Cocleares/economia , Segurança Computacional , Bases de Dados como Assunto , Aprovação de Equipamentos/legislação & jurisprudência , Remoção de Dispositivo/estatística & dados numéricos , França , Guias como Assunto/normas , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/legislação & jurisprudência , Humanos , Lactente , Recém-Nascido , Reembolso de Seguro de Saúde , Controle de Qualidade , Padrões de Referência , Fatores de Tempo
4.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S45-S49, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32826202

RESUMO

This study aims to determine the frequency and causes of cochlear explants with re-implantation (ERI) after 5 years' follow up of the patients included in the French national EPIIC (étude post-inscription des implants cochléaires) registry tracking patients with cochlear implantation. This multicenter, descriptive prospective study was conducted on 5051 patients enrolled in the EPIIC database between January 2012 and December 2016. Ninety-five patients (1.9%) received a primary implant and an ERI during the study. Of these, four benefitted from two ERIs. The number of ERIs was significantly higher in the pediatric population than among adults. The explantation and reimplantation were performed simultaneously in 86% of cases. The reasons for explantation were: in 46.4% of cases linked to a malfunction of the implant, and in 39.3% of cases for medical or surgical reasons. The number of electrodes inserted was significantly higher after the ERI than after the first implantation. There was just one post-ERI infection for these 95 explanted and re-implanted patients. As well as explantation with reimplantation rarely being necessary, it generally presents no major surgical difficulty and in most cases it allows a better integration than in the first implantation.


Assuntos
Implante Coclear/estatística & dados numéricos , Implantes Cocleares/estatística & dados numéricos , Remoção de Dispositivo/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Implantes Cocleares/efeitos adversos , França , Humanos , Lactente , Pessoa de Meia-Idade , Estudos Prospectivos , Falha de Prótese , Reimplante/estatística & dados numéricos , Fatores de Tempo , Adulto Jovem
5.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S57-S63, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32792302

RESUMO

This study concerns the results of cochlear implantation in children and adults from French cochlear implantation centers, monitored at one, two and three years by the Cochlear Implant French Registry EPIIC. This multicenter study enrolled 2603 subjects (1667 adults and 936 children) implanted in one ear. The following parameters were studied: hearing overall performances, monosyllabic or dissyllabic word perception, speech intelligibility, self-assessment questionnaire of Cochlear Implant (CI) benefits (Abbreviated profile of Hearing aid Benefit); professional activity and schooling. This study confirms the ceiling effect in adults' performances after the 1st year and the progressive growth in children's performances. It also shows that the contralateral hearing aid enhances performances compared to the CI alone condition, in all follow-up sessions. The French register of CIs is the only worldwide register of systematic follow-up on a period of three years and more of all adults and children implanted in a country.


Assuntos
Implante Coclear/estatística & dados numéricos , Implantes Cocleares/estatística & dados numéricos , Surdez/reabilitação , Qualidade de Vida , Sistema de Registros/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Percepção Auditiva , Criança , Pré-Escolar , Educação , Emprego , Seguimentos , França , Humanos , Lactente , Recém-Nascido , Autoavaliação (Psicologia) , Inteligibilidade da Fala , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
6.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S19-S25, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773333

RESUMO

OBJECTIVES: To analyze the performance of cochlear implants in French patients aged 65 and over, implanted between 2012 and 2016, using data from the French national registry for cochlear implants (EPIIC). MATERIALS AND METHODS: The French national registry incorporates patient data from before implantation and for three years after implantation, stratified in different age groups (18-39, 40-64years, 65-74years and>75years). Here, we assessed the latter two categories. Hearing was assessed using mono- and disyllabic words in a silent background. The Category of Auditory Performance (CAP) scale was also implemented and subjects took the Abbreviated Profile of Hearing Aid Benefit (Aphab) questionnaire. RESULTS: The population aged over 65 accounted for 38% (n=1193) of the 3178 adult implanted patients. The performance for mono- and disyllabic words in silence, the CAP scores and the APHAB questionnaire answers for ease of communication, background noise and reverberation were dramatically improved at one year post-implantation (P<0.0001 for each score) and remained stable between one and three years thereafter. The percentage improvement was similar across all age groups. The scores for loud-noise intolerance did not change after cochlear implantation in any age group. CONCLUSION: Cochlear implants improve hearing and communication in subjects aged 65 and over, with comparable efficiency to that achieved in younger subjects. Cochlear implantation should thus be proposed whenever hearing aids provide only limited benefit. However, between 2012 and 2016, cochlear implantation was given to less than 1% of the French population aged 65 and over with profound deafness.


Assuntos
Implante Coclear/estatística & dados numéricos , Implantes Cocleares/estatística & dados numéricos , Perda Auditiva/reabilitação , Sistema de Registros/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Percepção Auditiva , Implante Coclear/métodos , Comunicação , Feminino , França , Inquéritos Epidemiológicos , Perda Auditiva/etiologia , Testes Auditivos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Ruído/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
7.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S27-S35, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32763084

RESUMO

OBJECTIVE: Evaluate in France the outcomes of cochlear implantation outside the selection criteria, off-label. MATERIAL AND METHODS: This is a prospective cohort study including adults and children having received a cochlear implant (CI) in an off-label indication, that is outside the criteria established by the "Haute Autorité de santé (HAS)" in 2012. The data was collected from the "EPIIC" registry on recipients who received CIs in France between 2011 and 2014. Speech audiometry was performed at 60dB preimplantation and after one year of CI use, as well as an evaluation of the scores of the quality of life with the APHAB questionnaire, the scores for CAP and the professional/academic status in pre- and post-implantation conditions. Major and minor complications at surgery have been recorded. RESULTS: In total, 590 patients (447 adults and 143 children) with an off-label indication for CIs were included in this study from the EPIIC registry (11.7% of the whole cohort of EPIIC). For adults, the median percentage of comprehension using monosyllabic word lists was 41% in preimplantation condition versus 53% after one year of CI use (P<0.001) and 60% versus 71% in dissyllabic word lists (P<0.001). The CAP scores were 5 versus 6 in pre- and post-implantation conditions respectively (P<0.001) and the APHAB scores were statistically lower after implantation (P<0.001). In the children cohort, the median percentage of comprehension using monosyllabic word lists was 51% in preimplantation condition and 65% after CI (P<0.001), and 48% versus 82% (P<0.001) for dissyllabic word lists. The CAP scores were 5 versus 7 respectively in pre- and post-CI conditions (P<0.001). Thirty-two minor complications (5.4%) and 17 major complications (2.8%) were reported in our panel of off-label indication patients. CONCLUSION: These results suggest that a revision of the cochlear implantation candidacy criteria is necessary to allow more patients with severe or asymmetric hearing loss to benefit from a CI when there is an impact on quality of life despite the use of an optimal hearing aid.


Assuntos
Implante Auditivo de Tronco Encefálico/estatística & dados numéricos , Implante Coclear/estatística & dados numéricos , Implantes Cocleares/estatística & dados numéricos , Perda Auditiva/reabilitação , Seleção de Pacientes , Sistema de Registros/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Audiometria da Fala/métodos , Criança , Pré-Escolar , Implante Coclear/efeitos adversos , Implantes Cocleares/efeitos adversos , Feminino , França/epidemiologia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Uso Off-Label/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Cuidados Pré-Operatórios , Estudos Prospectivos , Qualidade de Vida , Adulto Jovem
8.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S51-S56, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32739279

RESUMO

OBJECTIVES: Assessment of the incidence and results of bilateral cochlear implantation in adults and children in France. MATERIALS AND METHODS: Multicenter retrospective study of data in the French national registry of cochlear implantations from January 1st 2012 to December 31st 2016. Functional results from CAP (Category of Auditory Performance) questionnaires and speech audiometry tests, with mono- and di-syllabic word-lists, were compared before and after implantation. Speech audiometry tests were carried out against a noisy background, except before simultaneous implantations. RESULTS: Nine hundred and forty two bilateral cochlear implantations were performed during this period, that is, 16.4% of all cochlear implantations. Five hundred and eighty eight bilateral implantations were performed sequentially. 59% of the bilateral implantations were performed in children. Bilateral implants significantly improved CAP scores in all cases (P<0.001). Auditory performance, with the two types of word-list, were significantly improved after simultaneous implantation (P<0.01). After sequential implantation, the speech discrimination score, already very good with the first implant, reached 63±26% [0-100] with monosyllabic word lists, and 72±28% [0-100] with dissyllabic words. There were more complications due to surgery in bilateral cases than in the entire population of cochlear recipients (9.1% vs 6.4%, P<0.02). CONCLUSION: Hearing is significantly improved by simultaneous cochlear implantation. For sequential implantation, at one year, when auditory results were already excellent from the first implant, in the bimodal condition CAP scores were significantly improved, although there was no further change in speech audiometry in noise.


Assuntos
Implante Coclear/métodos , Implantes Cocleares/estatística & dados numéricos , Surdez/reabilitação , Sistema de Registros/estatística & dados numéricos , Adulto , Audiometria da Fala/métodos , Percepção Auditiva , Criança , Implante Coclear/efeitos adversos , Implante Coclear/estatística & dados numéricos , Surdez/etiologia , Feminino , França , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Testes de Discriminação da Fala/estatística & dados numéricos
9.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S37-S43, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32861600

RESUMO

OBJECTIVES: The aim of this study was to evaluate peri- and post-operative complications related to cochlear implantations. We searched for risk factors predicting these complications and analyzed the complications in the youngest and most elderly. STUDY DESIGN: Retrospective analysis of cochlear implant patients. MATERIALS AND METHODS: All patients who underwent cochlear implantation in France between January 2012 and December 2016 were anonymized and registered in the EPIIC database. This population included 3483 adults and 2245 children. Their demographic and surgical data and their incidence of peri- or post-operative complications, including their severity, whether major or minor, were all indicated. RESULTS: The global complication rate was 6.84%. The risk of complication was higher in initial implantation versus reimplantation (P<0.0001). The risk was also higher for bilateral implantation versus unilateral (P<0.0001). Complications were more frequent for patients with cochlear malformation (P=0.002). There was no difference in complication rates across age groups; babies under 1 year old, and the elderly over 80 and even over 90, did not have more complications than the rest of the population. Patients treated in the daily care unit had no more complications than those who were hospitalized for one night or more (P=0.64). CONCLUSION: Cochlear implantation is a safe technique with a low incidence of complications. The absence of increased risk in patients at the extremes of the age spectrum justifies offering this solution to all, without age limitation.


Assuntos
Implante Coclear/efeitos adversos , Perda Auditiva/reabilitação , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Cóclea/anormalidades , Implante Coclear/métodos , Hospital Dia/estatística & dados numéricos , França/epidemiologia , Perda Auditiva/etiologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Lactente , Pessoa de Meia-Idade , Reoperação/efeitos adversos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
10.
Rhinology ; 46(2): 125-30, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18575014

RESUMO

BACKGROUND: Nasal Polyposis (NP) is defined as a chronic inflammatory disease of sinonasal mucosa leading to diffuse formation of benign polyps. Although family histories are frequently suggested in medical literature, no specific study focused on this point has been reported. The purpose of this study is to determine whether a hereditary factor could be implied for NP in a family where several members were affected. We included 99 members of this family. METHODS: All patients were assessed for conditions known to be associated with the development or presence of NP. Concerning NP, patients were screened with a validated questionnaire and selected patients had a medical examination by an Ear, Nose and Throat practitioner. RESULTS: Thirteen patients had a personal history of NP without asthma, aspirin intolerance, Churg Strauss syndrome, cystic fibrosis, Young's syndrome, bare lymphocyte syndrome, or primary ciliary dyskinesia. Within this family, 19.7% of those older than 17 years were affected by NP, as compared with the national French prevalence of 2.1%. CONCLUSIONS: Regarding the pedigree, we discuss different modes of inheritance. The presence of consanguineous unions in this family suggests the possibility of a common ancestor and thus a recessive autosomal mode of inheritance.


Assuntos
Consanguinidade , Padrões de Herança/genética , Pólipos Nasais/genética , Doenças dos Seios Paranasais/genética , Adolescente , Adulto , Criança , Feminino , França , Ligação Genética/genética , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/mortalidade , Pólipos Nasais/patologia , Doenças dos Seios Paranasais/mortalidade , Doenças dos Seios Paranasais/patologia , Linhagem
11.
Nature ; 450(7170): 654-6, 2007 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-18046399

RESUMO

Venus has no significant internal magnetic field, which allows the solar wind to interact directly with its atmosphere. A field is induced in this interaction, which partially shields the atmosphere, but we have no knowledge of how effective that shield is at solar minimum. (Our current knowledge of the solar wind interaction with Venus is derived from measurements at solar maximum.) The bow shock is close to the planet, meaning that it is possible that some solar wind could be absorbed by the atmosphere and contribute to the evolution of the atmosphere. Here we report magnetic field measurements from the Venus Express spacecraft in the plasma environment surrounding Venus. The bow shock under low solar activity conditions seems to be in the position that would be expected from a complete deflection by a magnetized ionosphere. Therefore little solar wind enters the Venus ionosphere even at solar minimum.

12.
Ann Otolaryngol Chir Cervicofac ; 124(1): 33-40, 2007 Mar.
Artigo em Francês | MEDLINE | ID: mdl-17336916

RESUMO

The conventional hearing aid has benefited from the progress made in electronic miniaturization and digital signal processing. The prescriber should be familiar with these improvements, the anatomic and acoustic limitations related to hearing aids, the possibilities of surgical rehabilitation, as well as the indications for other auditive rehabilitation techniques (bone conduction hearing, middle ear implant, and cochlear implant). A hearing aid should be prescribed within a precise context taking into account patient history, clinical examination, audiometric testing, and choice of the device. Optimal management of a hearing device for a child should be conducted within an adapted network including a specialized ENT physician, audiophonology, a qualified hearing prosthetist, a speech therapist, etc.).


Assuntos
Auxiliares de Audição , Adaptação Fisiológica , Audiometria , Condução Óssea , Transtornos da Audição/terapia , Humanos , Miniaturização , Processamento de Sinais Assistido por Computador , Localização de Som
13.
Am J Respir Crit Care Med ; 164(10 Pt 1): 1933-8, 2001 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-11734449

RESUMO

Oxidant-mediated reperfusion injury of the gut is a major contributor of the systemic inflammatory response in hemorrhagic shock. Recent studies have suggested that heme-oxygenase-1 (HO-1) represents an endogenous protective mechanism against oxidant stress. We assessed whether HO-1 induction modulates the synthesis of tumor necrosis factor-alpha (TNF-alpha) in hemorrhagic shock. In rats submitted to hemorrhagic shock, pretreatment with hemoglobin (Hb) increased HO-1 mRNA expression in macrophages. This increased expression was associated with a decreased expression of TNF-alpha mRNA, as well as decreased plasma concentrations of TNF-alpha. These effects of Hb were reduced by the HO-1 inhibitor tin-protoporphyrin (Sn-PP 20 micromol/kg), while Sn-PP had no effect in the absence of Hb. In parallel, Hb pretreatment reduced pulmonary edema, vascular injury, and increased mesenteric blood flow, and these effects were reduced by Sn-PP. Thus, induction of HO-1 is protective in hemorrhagic shock, possibly through its antioxidant properties. Interventions that induce HO-1 may be beneficial in the treatment of shock states, leading to a reduced systemic inflammatory response.


Assuntos
Modelos Animais de Doenças , Heme Oxigenase (Desciclizante)/fisiologia , Heme Oxigenase (Desciclizante)/uso terapêutico , Intestinos/irrigação sanguínea , Traumatismo por Reperfusão/complicações , Choque Hemorrágico/enzimologia , Choque Hemorrágico/imunologia , Síndrome de Resposta Inflamatória Sistêmica/enzimologia , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Fator de Necrose Tumoral alfa/fisiologia , Animais , Avaliação Pré-Clínica de Medicamentos , Hidratação/métodos , Regulação da Expressão Gênica/fisiologia , Hemodinâmica , Inflamação , Macrófagos Peritoneais/enzimologia , Masculino , RNA Mensageiro/análise , RNA Mensageiro/genética , Ratos , Ratos Wistar , Ressuscitação/métodos , Choque Hemorrágico/etiologia , Choque Hemorrágico/fisiopatologia , Choque Hemorrágico/terapia , Circulação Esplâncnica/fisiologia , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Fator de Necrose Tumoral alfa/análise
14.
Am J Gastroenterol ; 96(7): 2129-36, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11467644

RESUMO

OBJECTIVES: The pathophysiology of pouchitis occurring after ileal pouch-anal anastomosis remains controversial. Prostaglandins and nitric oxide synthesized in excess by cyclooxygenase-2 and nitric oxide synthase-2 are thought to be involved in the inflammatory process. Because heme oxygenase-1, by its antioxidant properties, could modulate inflammatory reaction, we analyzed mRNAs of the three enzymes (cyclooxygenase-2, nitric oxide synthase-2, and heme oxygenase-1) in patients with ileal pouch-anal anastomosis. METHODS: Endoscopic biopsies were obtained in eight patients with normal ileal pouch-anal anastomosis, in eight patients with pouchitis, and in normal ileum of six healthy subjects. A relative quantitative RT-PCR was performed to determine the levels of cyclooxygenase-2, nitric oxide synthase-2, and heme oxygenase-1 mRNAs. RESULTS: Cyclooxygenase-2 and nitric oxide synthase-2 mRNAs were increased both in normal ileal pouch-anal anastomosis and in pouchitis, compared with healthy subjects. Pouchitis disease activity index was correlated with mRNA levels of cyclooxygenase-2 (r = 0.71; p < 0.01) and nitric oxide synthase-2 (r = 0.51; p < 0.05). Heme oxygenase-1 mRNA levels were not significantly different in patients versus healthy subjects. CONCLUSIONS: The increase in cyclooxygenase-2 and nitric oxide synthase-2 mRNA levels both in pouchitis and normal ileal pouch-anal anastomosis demonstrates that a latent inflammatory process occurs in the ileal pouch mucosa. This inflammatory process was not found to be associated with an induction of heme oxygenase mRNA, a possible regulator of the inflammatory response.


Assuntos
Heme Oxigenase (Desciclizante)/biossíntese , Isoenzimas/biossíntese , Óxido Nítrico Sintase/biossíntese , Pouchite/enzimologia , Prostaglandina-Endoperóxido Sintases/biossíntese , Adulto , Ciclo-Oxigenase 1 , Ciclo-Oxigenase 2 , Feminino , Heme Oxigenase (Desciclizante)/genética , Heme Oxigenase-1 , Humanos , Isoenzimas/genética , Masculino , Proteínas de Membrana , Pessoa de Meia-Idade , Óxido Nítrico Sintase/genética , Óxido Nítrico Sintase Tipo II , Pouchite/genética , Prostaglandina-Endoperóxido Sintases/genética , RNA Mensageiro/biossíntese
15.
Crit Care Med ; 28(7): 2522-7, 2000 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10921588

RESUMO

OBJECTIVES: Intestinal ischemia/reperfusion during hemorrhage and resuscitation may be a major trigger for cytokine expression. To assess whether free radicals produced on tissue reperfusion may play a role in the inflammatory response after hemorrhage, we tested the effect of a free radical scavenger on the production of inflammatory cytokines in a rat model of hemorrhagic shock. DESIGN: A prospective, controlled animal study. SETTING: A university research laboratory. SUBJECTS: Male Wistar rats. INTERVENTIONS: Hemorrhage was induced in anesthetized rats. by bleeding the animal to achieve a mean arterial blood pressure of 40 mm Hg for 60 mins. Resuscitation was then induced by reinjecting shed blood followed by NaCl 0.9% to maintain arterial blood pressure within control values. Treated rats received the free radical scavenger N-2-mercaptopropionyl glycine (MPG; 20mg/kg iv bolus 30 mins before resuscitation followed by 20 mg/kg/hr). MEASUREMENTS AND MAIN RESULTS: MPG reduced the volume of saline necessary to restore blood pressure during resuscitation (untreated 85+/-6; MPG 35+/-5 mL/kg; p < .05). As compared with untreated rats, MPG markedly reduced the systemic and mesenteric plasma concentrations of tumor necrosis factor (TNF)-alpha (as measured by ELISA) and interleukin (IL)-6 (as measured by bioassay), assessed at the end of resuscitation. MPG also reduced TNF-alpha and IL-6 mRNA expression (as measured by reverse transcriptase-polymerase chain reaction) assessed in peritoneal macrophages isolated from shock rats. Finally, in vitro experiments showed that MPG also markedly reduced the mRNA expression and release of TNF-alpha and IL-6 in peritoneal macrophages isolated from normal rats and subjected to hypoxia and reoxygenation. CONCLUSION: Reactive oxygen species contribute to the production of proinflammatory cytokines during posthemorrhage resuscitation. Free radicals scavengers may be a useful treatment in the prevention of the systemic inflammatory response that occurs in shock states.


Assuntos
Antioxidantes/farmacologia , Glicina/análogos & derivados , Interleucina-6/biossíntese , Macrófagos Peritoneais/efeitos dos fármacos , Macrófagos Peritoneais/metabolismo , Choque Hemorrágico/metabolismo , Compostos de Sulfidrila/farmacologia , Fator de Necrose Tumoral alfa/biossíntese , Animais , Transfusão de Sangue Autóloga , Ensaio de Imunoadsorção Enzimática , Sequestradores de Radicais Livres/farmacologia , Glicina/farmacologia , Masculino , RNA Complementar/isolamento & purificação , Ratos , Ratos Wistar , Ressuscitação/métodos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Choque Hemorrágico/terapia
16.
Transfus Clin Biol ; 7(1): 70-5, 2000 Feb.
Artigo em Francês | MEDLINE | ID: mdl-10730348

RESUMO

Performances of filter systems for leucocyte removal (Pall BPF4 and Sepacell RZ 200 B) have been studied following the preparation of red blood cell concentrates (RBCCs) obtained either by a soft-spin centrifugation at 2967xg (n = 438) or by a hard-spin centrifugation at 5275xg (n = 187). After deleucocytation, 43, i.e., 9.8% of RBCCs obtained following a soft-spin centrifugation contained a number of residual leucocytes higher than 1 x 10(6) leucocytes/RBCC which represents the legal upper limit in France, whereas RBCCs obtained following a hard-spin centrifugation always contained a number of residual leucocytes lower than this limit. Our results strongly suggest that the quality of deleucocytation depends on an adequate ratio of platelets to leucocytes, which favours the capture of leucocytes by filters. In fact, this ratio was higher in RBCCs obtained following a hard-spin centrifugation. Our results demonstrate that the use of these filters does not allow the removal of leucocytes complying with the legal limit of leucodepletion for all preparations of RBCCs.


Assuntos
Separação Celular/instrumentação , Centrifugação/métodos , Transfusão de Eritrócitos/instrumentação , Filtração/instrumentação , Contagem de Leucócitos , Leucócitos , Contagem de Plaquetas , Falha de Equipamento , Transfusão de Eritrócitos/normas , Estudos de Avaliação como Assunto , Humanos
17.
Circulation ; 100(5): 541-6, 1999 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-10430769

RESUMO

BACKGROUND: Preconditioning with brief periods of ischemia protects the coronary endothelium against acute and chronic reperfusion injury, but the mechanisms of this endothelial protection remain unknown. We hypothesized that preconditioning protects endothelial cells through a decreased production of endothelial adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1), leading to a lesser adhesion of neutrophils to the endothelium. METHODS AND RESULTS: Cultured rat aortic endothelial cells were subjected to 6-hour anoxia followed by various durations of reoxygenation. Preconditioning was induced by 1-hour anoxia and 1-hour reoxygenation. ICAM-1 gene expression was measured by polymerase chain reaction, and the percentage of cells expressing ICAM-1 was assessed by confocal laser fluorescence microscopy. Anoxia/reoxygenation increased expression of ICAM-1, with a peak occurring after 6 hours of reoxygenation for mRNA and 9 hours for protein. Preconditioning prevented the increase in ICAM-1. Similar reductions were observed with the free radical scavenger N-2 mercaptopropionyl glycine (MPG). The inhibitory effect of preconditioning on ICAM-1 expression was abolished by an inhibitor of protein kinase C, an inhibitor of nitric oxide synthesis, and by MPG but was not affected by an adenosine receptor antagonist. Finally, both preconditioning and MPG partially prevented the increased adhesion of human neutrophils to reoxygenated endothelial cells. CONCLUSIONS: Preconditioning prevented reoxygenation-induced, free radical-mediated expression of ICAM-1 by a mechanism involving activation of protein kinase C and production of nitric oxide and free radicals, and this is associated with a lesser adhesion of neutrophils to endothelial cells. Such prevention of neutrophil adhesion may contribute to the protective effect of preconditioning against reperfusion-induced endothelial injury.


Assuntos
Endotélio Vascular/fisiopatologia , Hipóxia/fisiopatologia , Molécula 1 de Adesão Intercelular/biossíntese , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Neutrófilos/fisiologia , Animais , Aorta/citologia , Adesão Celular , Células Cultivadas , Primers do DNA , Endotélio Vascular/metabolismo , Ativação Enzimática , Radicais Livres/metabolismo , Regulação da Expressão Gênica , Hipóxia/metabolismo , Masculino , Traumatismo por Reperfusão Miocárdica/metabolismo , Óxido Nítrico/biossíntese , Reação em Cadeia da Polimerase , Proteína Quinase C/metabolismo , Ratos , Ratos Wistar
18.
Liver ; 19(4): 312-7, 1999 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10459630

RESUMO

AIMS/BACKGROUND: Liver regeneration is a physiological mechanism which leads to restoration of the hepatic parenchyma following hepatectomy or toxic injury. This process is mediated by a wide variety of cytokines and growth factors. The aim of the present study was to evaluate the influence of hepatectomy extent on the levels of intrahepatic mRNAs for cell-cycle markers and growth factors in rats submitted to a 30%, two-third or 80% hepatectomy. METHODS: Cyclins, thymidine kinase and growth factors mRNA levels were quantitatively assessed by RT-PCR at different time points post-hepatectomy (2h, 6h, 12h, days 1, 2, 6). RESULTS: As compared with a two-third hepatectomy, cyclins and thymidine kinase mRNA levels were increased but with a delayed peak at day 2 in the 80% hepatectomy group and showed a progressive increase until day 6 in the 30% hepatectomy group; mRNA levels for HGF or TGFalpha were increased with a delayed peak at 12 h or day 2 in the 80% hepatectomy group, respectively and this delay was more pronounced in the 30% hepatectomy group with a peak at day 1 or day 6. CONCLUSION: A regenerative response occurs whatever the extent of hepatectomy but the course of regeneration and expression of growth factors differs according to the volume of resected liver. A better knowledge of these events could improve the clinical results of hepatic resection for primary or metastatic liver disease.


Assuntos
Hepatectomia , Fator de Crescimento de Hepatócito/metabolismo , Regeneração Hepática/fisiologia , Fígado/metabolismo , Fator de Crescimento Transformador alfa/metabolismo , Animais , Biomarcadores , Ciclo Celular/genética , Ciclinas/metabolismo , Primers do DNA/química , Seguimentos , Fator de Crescimento de Hepatócito/genética , Fígado/citologia , Fígado/cirurgia , Masculino , RNA Mensageiro/genética , Ratos , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Timidina Quinase/genética , Timidina Quinase/metabolismo , Fator de Crescimento Transformador alfa/genética , Microglobulina beta-2/genética , Microglobulina beta-2/metabolismo
19.
Cytokine ; 11(5): 326-33, 1999 May.
Artigo em Inglês | MEDLINE | ID: mdl-10328872

RESUMO

Macrophage activation and the resulting inflammatory response may be a major component of tissue injury upon hypoxia and re-oxygenation. Activation of the haem oxygenase (HO)/carbon monoxide (CO) pathway may be an important regulator of the inflammatory response, through production of cyclic 3', 5'-monophosphate (cGMP). We have assessed whether HO contributes to the increased production of the pro-inflammatory cytokines TNF-alpha and IL-6 in re-oxygenated rat peritoneal macrophages.Hypoxia/re-oxygenation markedly increased levels of HO-1 mRNA and cGMP. The increase in cGMP was reduced by the HO-1 inhibitor tin-protoporphyrin (SnPP-9) given during re-oxygenation. Hypoxia and re-oxygenation also increased IL-6 and TNF-alpha mRNA expression, as well as IL-6 and TNF-alpha concentrations in the cell supernatant. These increases were nullified by SnPP-9 and by Methylene Blue, an inhibitor of guanylate cyclase, but were not affected by L-NNA, an inhibitor of NO synthesis. The inhibitory effect of SnPP on the synthesis of cytokines was reversed by co-administration of the stable analogue of cGMP, 8-Br-cGMP. Our results indicate that activation of haem oxygenase and of the CO/cGMP pathway is a major stimulus for the synthesis and release of pro-inflammatory cytokines in re-oxygenated macrophages. This pathway may play a central role in pathological situations in which local tissue hypoxia/re-oxygenation triggers a systemic inflammatory response, for example in patients with shock.


Assuntos
GMP Cíclico/fisiologia , Heme Oxigenase (Desciclizante)/biossíntese , Interleucina-6/biossíntese , Macrófagos Peritoneais/metabolismo , Oxigênio/metabolismo , Fator de Necrose Tumoral alfa/biossíntese , Animais , Hipóxia Celular/fisiologia , GMP Cíclico/análogos & derivados , GMP Cíclico/metabolismo , GMP Cíclico/farmacologia , Indução Enzimática , Inibidores Enzimáticos/farmacologia , Óxido Nítrico Sintase/antagonistas & inibidores , Óxido Nítrico Sintase/biossíntese , Nitroarginina/farmacologia , RNA Mensageiro/biossíntese , Ratos
20.
Eur J Biochem ; 261(1): 190-6, 1999 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10103050

RESUMO

Acute-phase protein synthesis in the liver during inflammation is regulated via cytokines and glucocorticoids. Using quantitative reverse transcription (RT)-PCR analysis and immunoassay, we explored, in the rat, the response of the acute-phase protein, alpha-2 macroglobulin (A2M), after systemic inflammation induced by lipopolysaccharide (LPS) or localized inflammation induced by turpentine oil (TO). The results indicate that synthesis of A2M is higher following TO-induced inflammation than LPS-induced inflammation and is not correlated with interleukin (IL)-6 or glucocorticoid levels. We studied the putative role of heme in this differential A2M expression following localized vs. systemic inflammation; addition of heme during LPS-induced inflammation can boost the expression of A2M, whereas blocking heme synthesis (by succinyl acetone) or enhancing its consumption in parallel biosynthetic pathways (cytochrome P450 induction by phenobarbital) decreases A2M expression. This decrease was abolished by exogenous heme supplementation. Finally, we demonstrate that heme supplementation is also able to increase the A2M response in female rats to a level similar to that in male rats providing a new insight into the puzzling sexual dimorphism observed previously during localized inflammation. We propose that heme should be considered a new regulatory element in controlling liver A2M expression during inflammation.


Assuntos
Proteínas de Fase Aguda/biossíntese , Heme/metabolismo , Inflamação/etiologia , Inflamação/metabolismo , Fígado/metabolismo , Proteínas de Fase Aguda/genética , Animais , Sequência de Bases , Sistema Enzimático do Citocromo P-450/biossíntese , Primers do DNA/genética , Feminino , Expressão Gênica , Heme Oxigenase (Desciclizante)/genética , Heme Oxigenase-1 , Inflamação/genética , Masculino , Fenobarbital/farmacologia , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos , Ratos Sprague-Dawley , alfa-Macroglobulinas/biossíntese , alfa-Macroglobulinas/genética
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