993 resultados para AAA


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Objectives: To evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) programs in elective open surgical repair (OSR) of abdominal aortic aneurysm (AAA).Background: Open surgical repair of AAA is associated with high morbidity and mortality, prolonged hospital stay and high costs. ERAS programs contribute to the optimization of treatment by reducing hospital stay and improving clinical outcomes.Methods: A review of PubMed, EMBASE and LILACS databases was conducted. As only one randomized controlled trial was found, a pooled analysis of proportions from case series was conducted, considering it a complementary overview of the topic. Inclusion criteria were case series with more than five cases reported, adult patients who underwent an elective OSR of AAA and use of an ERAS program. ERAS was compared to conventional perioperative care. The pooled proportion and the confidence interval (CI) are shown for each outcome. The overlap of the CI suggests similar effect of the interventions studied.Results: Thirteen case series studies with ERAS involving 1,250 patients were compared to six case series with conventional care with a total of 1,429 patients. The pooled, respective proportions for ERAS and conventional care were: mortality, 1.51% [95% CI: 0.0091, 0.0226] and 3.0% [95% CI 0.0183, 0.0445]; and incidence of complications, 3.82% [95% CI 0.0259, 0.0528] and 4.0% [95% CI 0.03, 0.05].Conclusion: This review shows that ERAS and conventional care therapies have similar mortality and complication rates in OSR of AAA.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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With the emergence of areas degraded by human activities, the chemical soil properties and silvicultural characters became important in understanding the succession process of tree species and planning of landscape restoration. This study aimed to evaluate the distribution of tree species in areas with different levels of human disturbance, relating silvicultural aspects to the soil chemical properties and characterizing the type of vegetation, for integration of genetic conservation program in situ. The study was conducted in the area of Research and Extension Experimental Farm (FEPE) from UNESP, Ilha Solteira, in Selviria - MS. Through transect, 64 plots were marked 50 m equidistant with dimensions of 10 x 10 m, where: 29 plots were in an highly disturbed area (HDA), five in moderately disturbed area (MDA), 15 in lowly disturbed area (LDA), six in riparian stream of Vestia river (Riparian Forest) and nine in the legal reserve. Soil samples were collected at two depths (0.0 to 0.20 and 0.20 to 0.40 m) for the chemical analysis and the assessment of silvicultural characters, such as height, diameter at breast height (DBH) and shape. The study of the natural distribution of tree species and edaphic condition in the different evaluated areas showed that: the soil chemical properties associated with the level of human disturbance and conservation of the areas are influencing the natural occurrence, species diversity and development of the trees. Height, DBH and shape are good indicators to assess the growth of the tree community and relate them to soil chemical properties; LDA and legal reserve presented higher natural occurrence, number of individuals and number of species. In the riparian forest, basal area values, height, shape and chemical soil properties were higher. From the 97 species found, six have the potential to be used in a program of genetic conservation in situ. They are: Astronium fraxinifolium, Terminalia argentea, Curatella americana, Cupania vernalis, Qualea jundiahy and Andira cuyabensis.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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This paper presents the development and the main results for an interleaved boost rectifier operating as a special input power stage for a trolleybus type vehicle, allowing its feeding by alternate current (AC) or direct current (DC) distribution power systems. When feeding with two wires (single phase) alternate current distribution system, the converter accomplish active power factor correction, providing a relatively sinusoidal current with low total harmonic distortion (THD) and fully complying with IEC 61000-3-4 standards. In addition, a management control system promotes the required automatic operation changes for the proposed rectifier when the vehicle is changing from the DC distribution power system to the AC distribution power system and vice-versa, keeping its original electrical DC system characteristics for the adjustable speed driver sub-system. The main experimental results for a prototype rated at 150kW are presented, considering its application for a trolleybus with DC adjustable speed driver, demonstrating the proposed converter benefits and the possibility of AC feeding system for trolleybus type vehicle.

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This paper shows the modeling and control of a single-phase full-bridge inverter with high-frequency transformer that may be used as part of a two-stage converter with transformerless DC-DC side or as a single-stage converter (simple DC-AC converter) for grid-connected PV applications. The inverter is modeled in order to obtain a small-signal transfer function used to design the P+Resonant current controller. A highfrequency step-up transformer results in reduced voltage switches and better efficiency compared with converters in which the transformer is used on the DC-DC side. Simulations and experimental results with a 200 W prototype are shown. 1

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Endovascular aortic aneurysm repair (EVAR) involving renal and visceral arteries remains a great challenge. Several techniques have been developed over the time to treat juxtarenal, pararenal and thoracoabdominal aneurysms, highlighting the fenestrated and branched endografts, parallel prostheses as Chimney, Periscope and Sandwich Techniques and the use of flow modulation by multilayer stent. We report a case of saccular juxtarenal aortic aneurysm with high surgical risk for complex airway access due to a history of radical laryngectomy for laryngeal neoplasm. Due to chronic aorto-iliac obstructive disease, ostial stenosis of renal artery and limited diameter of the suprarenal aorta, we discarded options involving fenestrated/branched endografts and involving parallel prostheses techniques. We present this case as a therapeutic challenge and a successful treatment option in the short-term evaluation.

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Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.

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Objectives: To evaluate the colour stability of paints used for ocular prosthesis iris painting submitted for accelerated artificial ageing (AAA). Materials and methods: Forty specimens of acrylic resin for sclera (16 x 2 mm) were made and separated into eight groups (n = 10) according to the type of paint (gouache, GP; oil, OP; acrylic AP; and composite resin for characterisation, CR) and the colours used (blue/brown). After drying (72 h), a new layer of colourless acrylic resin was applied and the initial colour readout was performed (Spectrophotometer PCB 6807). New colour readouts were performed after AAA, and Delta E was calculated. Results: Statistical analysis (two-way ANOVA-Bonferroni, p < 0.05) demonstrated that the brown colour showed lower Delta E means in comparison with the blue colour, with statistically significant difference for AP only. Blue colour showed no statistically significant difference with regard to the type of paint used. Brown AP showed lower Delta E than the other groups, with significant difference for OP and GP. GP showed greater alteration in Delta E for the brown colour, being statistically similar only to OP. Conclusions: Only the AP group for brown pigment shows clinically acceptable values for colour stability after AAA.

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The aim of this study was to evaluate the color stability of composites subjected to different periods of accelerated artificial aging (AAA). A polytetrafluorethylene matrix (10 x 2 mm) was used to fabricate 24 test specimens of three different composites (n=8): Tetric Ceram (Ivoclar/Vivadent); Filtek P90 and Z250 (3M ESPE), shade A3. After light activation for 20 s (FlashLite 1401), polishing and initial color readout (Spectrophotometer PCB 687; BYK Gardner), the test specimens were subjected to AAA (C-UV; Comexim), in 8-h cycles: 4 h exposure to UV-B rays at 50°C and 4 h condensation at 50°C. At the end of each cycle, color readouts were taken and the test ended when the mean value of ΔE attained a level ≥3.30. Tetric Ceram presented alteration in ΔE equal to 3.33 in the first aging cycle. For Filtek P90 and Z250, two (ΔE=3.60) and four (ΔE=3.42) AAA cycles were necessary. After each cycle, there was a reduction of luminosity in all the samples (ΔL). It was concluded that a short period of AAA was sufficient to promote clinically unacceptable color alteration in composites, and that this alteration was material-dependent.

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This study evaluated the effect of artificially accelerated aging (AAA) on the surface hardness of eight composite resins: Filtek Z250, Filtek Supreme, 4 Seasons, Herculite, P60, Tetric Ceram, Charisma, and Filtek Z100. Sixteen specimens were made from the test piece of each material, using an 8.0 × 2.0 mm teflon matrix. After 24 hours, eight specimens from each material were submitted to three surface hardness readings using a Shimadzu Microhardness Tester for 5 seconds at a load of 50 gf. The other eight specimens remained in the artificially accelerated aging machine for 382 hours and were submitted to the same surface hardness analysis. The means of each test specimen were submitted to the Kolmogorov-Smirnov test (p > 0.05), ANOVA and Tukey test (p < 0.05). With regard to hardness (F = 86.74, p < 0.0001) the analysis showed significant differences among the resin composite brands. But aging did not influence the hardness of any of the resin composites (F = 0.39, p = 0.53). In this study, there was interaction between the resin composite brand and the aging factors (F = 4.51, p < 0.0002). It was concluded that notwithstanding the type of resin, AAA did not influence surface hardness. However, with regard to hardness there was a significant difference among the resin brands.

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Reactivity and titers of autoantibodies vary during the course of autoimmune hepatitis (AIH), and some autoantibodies have been associated with disease activity and adverse outcomes after treatment. The aim of this study was to assess the autoantibody behavior in AIH and its significance as predictors of biochemical and histological remission. A total of 117 patients with AIH (mean age 18.6 [4-69] years) were evaluated and tested for auto- antibodies at disease onset and successively (mean 3.2 [2-6] times) after a mean follow-up evaluation of 70 [20-185] months. Antismooth muscle (ASMA), antiliver kidney micro- some type 1 (anti-LKM1), antiliver cytosol type 1 (anti-LC1), antimitochondrial, antinu- clear (ANA), and antiactin antibodies (AAA) were determined at disease onset and 379 other times during the follow-up evaluation through indirect immunofluorescence in rodent tissues, HEp-2 cells, and human fibroblasts. Anti-SLA/LP were assessed 45 times in the follow-up evaluation of 19 patients using enzyme-linked immunosorbent assay (ELISA). Upon admission, AIH types 1 and 2 were observed in 95 and 17 patients, respectively. Five subjects had AIH with anti-SLA/LP as the sole markers. Patients initially negative for AAA did not develop these antibodies thereafter. ANA were detected de novo in six and three subjects with AIH types 1 and 2, respectively. After treatment, only ASMA ( > 1:80) and AAA ( > 1:40) were significantly associated with biochemical (76.9% and 79.8%) and histological features (100% and 100%) of disease activity ( P < 0.001). Conclusion: With the exception of ANA, the autoantibody profile does not markedly vary in the course of AIH. The persistence of high titers of ASMA and/or AAA in patients with AIH is associated with disease activity.

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Background: Kasashima et al hanno individuato nella popolazione giapponese un sottogruppo di aneurismi aortici addominali (AAA) infiammatori con le caratteristiche clinico patologiche della Malattia autoimmune Sistemica IgG4 Correlata. La distinzione tra i diversi gruppi di AAA è clinicamente importante sia per il follow up che per il trattamento di questa patologia. Obiettivo dello studio era la valutazione della componente flogistica, vascolare e stromale della parete aortica aneurismatica, la ricerca di aneurismi infiammatori ed in particolare di AAA- IgG4 correlati anche nella popolazione caucasica. Materiali e metodi: Sono stati esaminati i dati relativi a 21 pazienti trattati chirurgicamente per AAA presso l’Unità Operativa di Chirurgia Vascolare di Ferrara. Sono state eseguite analisi immunoistochimiche di prelievi intraoperatori di parete aortica aneurismatica. Risultati: I dati emersi hanno identificato 3 sottopopolazioni di pazienti con AAA: aneurismi di tipo aterosclerotico con negatività ai markers infiammatori (AAAa), aneurismi infiammatori con positività ai markers infiammatori e negatività per le IgG4 (AAAI) ed infine aneurismi infiammatori con positività alle IgG4 (AAAI-IgG4). Conclusioni: Questo studio ha confermato l’ipotesi che la malattia aneurismatica IgG4 correlata è presente anche nella popolazione caucasica. Con il proseguimento del nostro studio sarà interessante verificare la conferma di questi dati anche in altri pazienti al fine di ricercare la miglior strategia terapeutica e minimizzare il rischio di complicanze.