A revascularização cardíaca utilizando a ponte de safena é um procedimento bastante utilizado para restabelecer o fluxo coronariano. Apesar do sucesso deste procedimento, a patência deste enxerto pode chegar a menos de 50% em 10 anos. Atribui-se parte deste insucesso a variações no processo adaptativo à nova condição hemodinâmica, onde o shear stress e o estiramento aumentados podem estar interferindo na função endotelial e vascular. Este processo envolve a participação de diversas proteínas e o estudo de como elas participam conjuntamente é uma importante abordagem para entender as alterações fisiológicas e patológicas que ocorrem no enxerto vascular. Neste trabalho, tecnologias proteômicas, gel 2-D e ICAT, foram utilizadas para identificar as proteínas que são modificadas nas fases precoces da arterialização do enxerto venoso. Foi utilizado um sistema ex vivo de perfusão controlada, desenvolvido em nosso laboratório, onde a veia safena humana foi cultivada tanto em regime hemodinâmico venoso (5 mL/min) e arterial (50 mL/min, 80 mmHg) por 24 horas. Dentre as proteínas identificadas, a maioria apresenta funções estruturais como, por exemplo, -actina de músculo liso, CRP1, colágeno VI, tropomiosina, miosina, desmina e vimentina. Para avaliação funcional foram selecionadas a -SMA e a CRP. A -SMA mostrou-se diminuída nas fases mais precoces da arterialização venosa, com quase desaparecimento após 3 dias da cirurgia, seguido de um aumento nos períodos subseqüentes. A CRP3 mostrou-se com expressão predominantemente arterial tanto em amostra humana como de rato. A arterialização de segmentos venosos induziu a expressão da CRP3, sendo dependente do aumento do estiramento (stretch) nas células musculares lisas e não do aumento do shear stress na superfície endotelial. Coletivamente, neste trabalho caracterizamos duas proteínas que foram modificadas durante o processo de arterialização e/ou adaptação da veia à condição hemodinâmica arterial. As proteínas identificadas contribuirão para o melhor entendimento do processo de arterialização venosa e poderão ser testadas como novos alvos terapêuticos para melhorar a patência destes enxertos / Coronary artery bypass surgery by saphenous vein graft is still widely used to revascularization of ischemic heart. Despite the success of this procedure, about 50% occlude after 5-10 years. The vein graft is subjected to increased tensile stress and the adaptive vein response to the arterial hemodynamic condition may predispose to bypass occlusion. Several proteins are modulated during arterialization, the understanding of the molecular changes of this process may be useful to new therapeutics approaches development attempting to increase vein graft patency. In this work, proteomics plataform, gel 2-D and ICAT, were used to identify the proteins that are modified in the early stages of vein graft rterialization. Human saphenous vein were cultured in an ex vivo flow through system in both venous (5 ml / min) and arterial (50 ml / min, 80 mm Hg) hemodymanic conditions for 24 hours. The identified proteins were related to cell structural function, such as -SMA, CRP1, collagen VI, tropomyosin, myosin, desmin and vimentin. To functional characterization, -SMA and CRP were selected. In rat vein arterialization model, - SMA showed to be decreased during the early stages of arterialization and almost disappeared after 3 days of surgery. Later on, -SMA-positive cells increase reaching similar expression levels of normal jugular vein. The expressiom of CRP3 showed to be predominantly to arterial beds both in human and rat. When vein segment were submitted to arterial hemodynamic condition, it was observed a significant induction of CRP3 expression. Interestingly, the increase of CRP3 is dependent of stretch stimulus in smooth muscle cells while shear stress did not modify its expression in endothelial cells. Collectively, we successfully identified proteins differentially expressed during the vein arterialization by using proteomic technique. -SMA and CRP3 were modified in vein segments exposed to arterial hemodynamic condition and efficiently discriminate smooth muscle cell phenotype. The identified proteins will contribute to the better understanding of the venous arterialization process and may be tested as new therapeutic targets for improving the patency these grafts

Introdução: O tratamento da Insuficiência Venosa Crônica (IVC) é baseado na correção dos refluxos e obstruções ao fluxo sanguíneo venoso. A detecção, a gravidade e o tratamento dessas obstruções venosas, responsáveis pelos sinais e sintomas da IVC, têm sido recentemente estudados e melhor compreendidos. Estes estudos não definem qual o grau de obstrução significativa nem os critérios ultrassonográficos para sua detecção. O objetivo deste estudo foi determinar critérios ultrassonográficos para o diagnóstico das obstruções venosas ilíacas, avaliando a concordância deste método com o ultrassom intravascular (UI) em pacientes portadores de IVC avançada. Métodos: Foram avaliados 15 pacientes (30 membros; 49,4 ± 10,7 anos; 1 homem) com IVC inicial (Classificação Clínica-Etiológica-Anatômica-Physiopatológica - CEAP C1-2) no grupo I (GI) e 51 pacientes (102 membros; 50,53 ± 14,5 anos; 6 homens) com IVC avançada (CEAP C3-6) no grupo II (GII) pareados por sexo, idade e etnia. Todos pacientes foram submetidos à entrevista clínica e à ultrassonografia vascular com Doppler (UV-D), sendo obtidas as medidas de fasicidade de fluxo, os índices de fluxo e velocidades venosas femorais, e as relações de velocidade e de diâmetro da obstrução ilíaca. Foi analisado o escore de refluxo multisegmentar. Os indivíduos do GI foram avaliados por 3 examinadores independentes. Os pacientes do GII foram submetidos ao UI, sendo obtidos a área dos segmentos venosos comprometidos e comparados com os resultados obtidos pelo UV-D, agrupados em 3 categorias: obstruções < 50%; obstruções entre 50-79% e obstruções >= 80%. Resultados: A classe de severidade clinica CEAP predominante no GI foi C1 em 24/30 (80%) membros, e C3 em 54/102 (52,9%) membros no GII. O refluxo foi severo (escore de refluxo multisegmentar >= 3) em 3/30 (10%) membros no grupo I, e em 45/102 (44,1%) membros no grupo II (p<0,001). Houve uma concordância moderadamente elevada entre o UV-D e o UI, quando agrupadas em 3 categorias (K=0,598; p<0,001), e uma concordância elevada quando agrupadas em 2 categorias (obstruções <50% e >= 50%) (K= 0,784; p<0,001). Os melhores pontos de corte e sua correlação com o UI foram: índice de velocidade (0,9; r=-0,634; p<0,001); índice de fluxo (0,7; r=-0,623; p<0,001); relação de obstrução (0,5; r=0,750; p<0,001); relação de velocidade (2,5; r= 0,790; p<0,001); A ausência de fasicidade de fluxo esteve presente em 88,2% dos pacientes com obstrução >=80% ao UV-D. Foi construído um algoritmo ultrassonográfico vascular, utilizando as medidas e os pontos de corte descritos obtendo-se uma acurácia de 79,6% para 3 categorias (K=0,655; p<0,001) e de 86,7% para 2 categorias (k=0,730; p<0,001). Conclusões: O UV-D apresentou uma concordância elevada com o UI na detecção de obstruções >= 50%. A relação de velocidade na obstrução >= 2,5 é o melhor critério para detecção de obstruções venosas significativas em veias ilíacas. / Introduction: The treatment of Chronic Venous Insufficiency (CVI) is based on correction of reflux and obstruction of venous blood flow. The detection, severity and treatment of venous obstructions, responsible for signs and symptoms of CVI have been recently studied and better understood. These studies did not define the degree of significant obstruction or the sonographic criteria for its detection. The purpose of this study was to determine the sonographic criteria for diagnosis of iliac venous outflow obstruction by assessing the correlation of this method with intravascular ultrasound (IVUS) in patients with advanced chronic venous insufficiency (CVI). Methods: The evaluation included 15 patients (30 limbs, age 49.4 ± 10.7 years; 1 man) with initial CVI symptoms (Clinical-Etiology-Anatomy-Pathophysiology classification - CEAP C1-2) in group I (GI) and 51 patients (102 limbs, 50.53 ± 14.5 years, 6 men) with advanced CVI symptoms (CEAP C3-6) in group II (GII). Patients from both groups were matched by gender, age and ethnicity. All patients underwent a clinic interviews and Duplex Ultrasound (DU), measuring the flow phasicity, the femoral volume flows and velocities, and the velocities and obstructions ratios in the iliac vein. The Reflux Multisegment Score were analyzed. Three independent observers evaluated individuals in GI. GII patients were submitted to IVUS, in which the area of the impaired venous segments was obtained and compared to the DU results, and then grouped into 3 categories: obstructions < 50%; obstructions between 50 and 79% and obstructions >= 80%. Results: The predominant clinical severity CEAP class was C1 in 24/30 (80%) limbs in GI and C3 in 54/102 (52.9%) limbs in GII. Reflux was severe (reflux multisegment score >= 3) in 3/30 (10%) limbs in GI and 45/102 (44.1%) limbs in GII (p<0.001). There was a moderately high agreement between DU and IVUS findings when grouped into 3 categories (k= 0.598; p<0.001), and high agreement when grouped into 2 categories (obstructions <50% and >= 50%) (k=0.784; p<0.001). The best cut-off points and their correlation with IVUS were 0.9 for the velocity index (r =-0.634; p< 0.001); 0.7 for the flow index (r=-0.623; p<0.001); 0.5 for the obstruction ratio (r=0.750; p<0.001), and 2.5 for the velocity ratio (r=0.790; p<0.001). Absence of flow phasicity was observed in 62.5% of patients with obstructions >= 80%. An ultrasound algorithm was created using the measures and the described cut-off points with accuracy of 86.7% for detecting significant obstructions (>= 50%) with high agreement (k=0.73; p< 0.001). Conclusions: DU presented high agreement with IVUS for detection of obstructions >= 50%. The velocity ratio in obstructions >= 2.5 is the best criteria for detection of significant venous outflow obstructions in iliac veins.

The Federal Bureau of Investigation reported that cyber actors will likely increase cyber intrusions against healthcare systems and their concomitant medical devices because of the mandatory transition from paper to electronic health records, lax cyber security standards, and a higher financial payout for medical records in the deep web. The problem addressed in this quantitative correlational study was uncertainty surrounding the benefits of palm vein authentication adoption relative to the growing crime of medical identity theft. The purpose of this quantitative correlational study was to understand healthcare managers' and doctors' perceptions of the effectiveness of palm vein authentication technology. The research questions were designed to investigate the relationship between intention to adopt palm vein authentication technology and perceived usefulness, complexity, security, peer influence, and relative advantage. The unified theory of acceptance and use of technology was the theoretical basis for this quantitative study. Data were gathered through an anonymous online survey of 109 healthcare managers and doctors, and analyzed using principal axis factoring, Pearson's product moment correlation, multiple linear regression, and 1-way analysis of variance. The results of the study showed a statistically significant positive correlation between perceived usefulness, security, peer influence, relative advantage, and intention to adopt palm vein authentication. No statistically significant correlation existed between complexity and intention to adopt palm vein authentication. These findings indicate that by effectively using palm vein authentication, organizations can mitigate the risk of medical fraud and its associated costs, and positive social change can be realized.

No description available.

<p>The primary aim was to register the incidence of surgical wound infections (SWI) in sternotomy and leg incisions and potential risk factors for SWI following coronary artery by-pass graft (CAGB) procedures. Patients’ perspectives of SWI and the subsequent treatment were also considered. </p><p>Risk factors were registered for 374 patients. Patients were contacted by telephone 30 and 60 days after surgery and interviewed according to a questionnaire about symptoms and signs of wound infections. SWI was defined according to The Centers for Disease Control. Patients with mediastinitis were also interviewed within four months about how they experienced care, how they coped and how they thought the mediastinitis would influence their future life. </p><p>SWIs were diagnosed in 30 % of the patients. Seventy-three percent of the SWIs of the leg were diagnosed within 30 days of surgery and 27% were diagnosed within 31 to 60 days. Female gender and use of a monofilament suture for skin closure were the most important risk factors for SWI of the leg. Low preoperative haemoglobin concentration was the most important risk factor for sternal SWI. Patients with mediastinitis had higher BMI and had more often received erythrocyte transfusions on postoperative day 2 or later than those without infections. Patients without a diagnosis of diabetes who had increased blood glucose concentrations during the intermediate postoperative period had an increased risk of mediastinitis. It was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia as such. Patients’ experiences were influenced by the staffs’ medical knowledge, how care was given and how well information was provided. Perceived danger and stress influenced how they coped with the situation. The patients believed that the mediastinitis would not affect the final outcome of the CABG procedure, even though their confidence in this was influenced by uncertainties about the rehabilitation process.</p>

The primary aim was to register the incidence of surgical wound infections (SWI) in sternotomy and leg incisions and potential risk factors for SWI following coronary artery by-pass graft (CAGB) procedures. Patients’ perspectives of SWI and the subsequent treatment were also considered. Risk factors were registered for 374 patients. Patients were contacted by telephone 30 and 60 days after surgery and interviewed according to a questionnaire about symptoms and signs of wound infections. SWI was defined according to The Centers for Disease Control. Patients with mediastinitis were also interviewed within four months about how they experienced care, how they coped and how they thought the mediastinitis would influence their future life. SWIs were diagnosed in 30 % of the patients. Seventy-three percent of the SWIs of the leg were diagnosed within 30 days of surgery and 27% were diagnosed within 31 to 60 days. Female gender and use of a monofilament suture for skin closure were the most important risk factors for SWI of the leg. Low preoperative haemoglobin concentration was the most important risk factor for sternal SWI. Patients with mediastinitis had higher BMI and had more often received erythrocyte transfusions on postoperative day 2 or later than those without infections. Patients without a diagnosis of diabetes who had increased blood glucose concentrations during the intermediate postoperative period had an increased risk of mediastinitis. It was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia as such. Patients’ experiences were influenced by the staffs’ medical knowledge, how care was given and how well information was provided. Perceived danger and stress influenced how they coped with the situation. The patients believed that the mediastinitis would not affect the final outcome of the CABG procedure, even though their confidence in this was influenced by uncertainties about the rehabilitation process.

No description available.

Upper gastrointestinal bleeding episodes from variceal structures are severe complications in patients with portal hypertension. Endoscopic sclerotherapy and variceal ligation are the treatment options preferred for upper variceal bleeding owing to extrahepatic portal hypertension due to portal vein thrombosis (PVT). Recurrent duodenal variceal bleeding in non-cirrhotic patients with diffuse porto-splenic vein thrombosis and subsequent portal. cavernous transformation represent a clinical challenge if classic shunt surgery is not possible or suitable. In this study, we represent a case of recurrent bleeding of duodenal varices in a non-cirrhotic patient with cavernous transformation of the portal vein that was successfully treated with a collateral caval shunt operation.

Results from petrographic analyses, chemical analyses and mineral phase diagram calculations show that staurolite minerals grew in selvages adjacent to quartz veins. Previous studies show the same relationships between quartz veins and garnet, as well as kyanite growth. The selvages are formed as metamorphic fluids flow through cracks, altering the bulk composition by mass transfer and triggers the nucleation and growth of new minerals. A pseudosection for a staurolite absent sample has been calculated using THERMOCALC. No stability field correlates to visually observed mineralogy. This indicates that a reaction forming staurolite never was triggered since no fluids was present during metamorphism.

Characterization of the most frequently isolated virus found during a survey of eastern Ontario red clover fields, which was designated as the Ottawa isolate, was undertaken. Determination of the biological and physico-chemical properties of the virus showed that the virus studied differed in some respects from other WCMV isolates. An ultrastructural examination of virus localization of cytopathological changes in infected red clover and pea plants revealed various types of viral inclusions, including a membrane-bound mass of tubules, not usually associated with infection by potexviruses, in red clover leaves, and severe organelle disorganization within pea leaf tissues. WCMV infection significantly reduced several processes relevant to symbiotic nitrogen fixation, including plant growth, nodulation, nitrogenase activity, leghemoglobin content, and Rhizobium population, but nitrate reductase and acid phosphatase specific activities were increased. The correlation between leghemoglobin content and nitrogenase activity shown at ten-leaf and pre-blooming stages was absent during the flowering and senescence stages. Infectivity assays, immunosorbent electron microscopy, and an ultrastructural examination showed the presence of the virus in nodular tissues; the cytopathological changes seen in bacteroids suggested that virus infection accelerated nodule senescence. Application of a cytochemical technique using diaminobenzidine showed that the leghemoglobin was located in the peribacteroidal space.