916 resultados para peripheral venous catheters


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Exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. The objectives of this research were to assess the impact of an exercise intervention in addition to routine evidence-based care on the healing rates, functional ability and health-related quality of life for adults with venous leg ulcers (VLUs). This study included 63 patients with VLUs. Patients were randomised to receive either a 12-week exercise intervention with a telephone coaching component or usual care plus telephone calls at the same timepoints. The primary outcome evaluated the effectiveness of the intervention in relation to wound healing. The secondary outcomes evaluated physical activity, functional ability and health-related quality of life measures between groups at the end of the 12 weeks. A per protocol analysis complemented the effectiveness (intention-to-treat) analysis to highlight the importance of adherence to an exercise intervention. Intention-to-treat analyses for the primary outcome showed 77% of those in the intervention group healed by 12 weeks compared to 53% of those in the usual care group. Although this difference was not statistically significant due to a smaller than expected sample size, a 24% difference in healing rates could be considered clinically significant. The per protocol analysis for wound healing, however, showed that those in the intervention group who adhered to the exercise protocol 75% or more of the time were significantly more likely to heal and showed higher rates for wound healing than the control group (P = 0·01), that is, 95% of those who adhered in the intervention group healed in 12 weeks. The secondary outcomes of physical activity, functional ability and health-related quality of life were not significantly altered by the intervention. Among the secondary outcomes (physical activity, functional ability and health-related quality of life), intention-to-treat analyses did not support the effectiveness of the intervention. However, per protocol analyses revealed encouraging results with those participants who adhered more than 75% of the time (n = 19) showing significantly improved Range of Ankle Motion from the self-management exercise programme (P = 0·045). This study has shown that those participants who adhere to the exercise programme as an adjunctive treatment to standard care are more likely to heal and have better functional outcomes than those who do not adhere to the exercises in conjunction with usual care.

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A conceptually unifying and flexible approach to the ABC and FGH segments of the nortriterpenoid rubrifloradilactone C, each embodying a furo[3,2-b]furanone moiety, from the appropriate Morita-Baylis-Hillman adducts is delineated. (C) 2010 Elsevier Ltd. All rights reserved.

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Radical catalyzed thiol-ene reaction has become a useful alternative to the Huisgen-type click reaction as it helps to expand the variability in reaction conditions as well as the range of clickable entities. Thus, direct generation of hyper-branched polymers bearing peripheral allyl groups that could be clicked using a variety of functional thiols would be of immense value. A specifically designed AB(2) type monomer, that carries two allyl benzyl ethers groups and one alcohol functionality, was shown to undergo self-condensation under acid-catalyzed melt-transetherification to yield a hyperbranched polyether that carries numerous allyl end-groups. Importantly, it was shown that the kinetics of polymerization is not dramatically affected by the change of the ether unit from previously studied methyl benzyl ether to an allyl benzyl ether. The peripheral allyl groups were readily clicked quantitatively, using a variety of thiols, to generate an hydrocarbon-soluble octadecyl-derivative, amphiphilic systems using 2-mercaptoethanol and chiral amino acid (N-benzoyl cystine) derivatized hyperbranched structures; thus demonstrating the versatility of this novel class of clickable hyperscaffolds. (C) 2011 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 49:1735-1744, 2011

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The GasBench II peripheral along with MAT 253 combination provides a more sensitive platform for the determination of water isotope ratios. Here, we examined the role of adsorbed moisture within the gas chromatography (GC) column of the GasBench II on measurement uncertainties. The uncertainty in O-18/O-16 ratio measurements is determined by several factors, including the presence of water in the GC. The contamination of GC with water originating from samples as water vapour over a longer timeframe is a critical factor in determining the reproducibility of O-18/O-16 ratios in water samples. The shift in isotope ratios observed in the experiment under dry and wet conditions correlates strongly with the retention time of analyte CO2, indicating the effect of accumulated moisture. Two possible methods to circumvent or minimise the effect of adsorbed water on isotope ratios are presented here. The proposed methodology includes either the regular baking of the GC column at a higher temperature (120 degrees C) after analysis of a batch of 32 sample entries or conducting the experiment at a low GC column temperature (22.5 degrees C). The effects of water contamination on long-term reproducibility of reference water, with and without baking protocol, have been described.

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Peripherally heterofunctionalized hyperbranched polymers (HBPs) undergo immiscibility-driven self-segregation of the outer segments to form Janus molecular entities (Macromolecules 2012, 45, 2348). In HBPs prepared via AB2 type self-condensation, single-step peripheral heterofunctionalization would lead to random distribution of the two types of terminal units, namely, homofunctionalized (homo-T) and heterofunctionalized (hetero-T) termini. Here, we examine the role of such hetero-T units on the self-segregation of heterofunctionalized pseudodendritic hyperbranched polydithioacetals. Three different heterofunctionalized HB dithioacetals bearing roughly 50 mol % each of docsyl (C-22) and MPEG-350 chains at the periphery were prepared: one of them carried a statistical distribution of homo-T and hetero-T units, and the other carried only two types of homo-T (-TR1R1 and -TR2R2) termini, whereas the third carried largely hetero-T (-TR1R2) termini. Careful examination of DSC and SAXS data reveals that the self-segregation is most effective in HBPs devoid of hetero-T units; interestingly, however, it also showed that randomly heterofunctionalized HBPs self-segregated nearly as effectively.

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INTRODUCTION: MicroRNAs (miRNAs) are being increasingly studied in relation to energy metabolism and body composition homeostasis. Indeed, the quantitative analysis of miRNAs expression in different adiposity conditions may contribute to understand the intimate mechanisms participating in body weight control and to find new biomarkers with diagnostic or prognostic value in obesity management. OBJECTIVE: The aim of this study was the search for miRNAs in blood cells whose expression could be used as prognostic biomarkers of weight loss. METHODS: Ten Caucasian obese women were selected among the participants in a weight-loss trial that consisted in following an energy-restricted treatment. Weight loss was considered unsuccessful when <5% of initial body weight (non-responders) and successful when >5% (responders). At baseline, total miRNA isolated from peripheral blood mononuclear cells (PBMC) was sequenced with SOLiD v4. The miRNA sequencing data were validated by RT-PCR. RESULTS: Differential baseline expression of several miRNAs was found between responders and non-responders. Two miRNAs were up-regulated in the non-responder group (mir-935 and mir-4772) and three others were down-regulated (mir-223, mir-224 and mir-376b). Both mir-935 and mir-4772 showed relevant associations with the magnitude of weight loss, although the expression of other transcripts (mir-874, mir-199b, mir-766, mir-589 and mir-148b) also correlated with weight loss. CONCLUSIONS: This research addresses the use of high-throughput sequencing technologies in the search for miRNA expression biomarkers in obesity, by determining the miRNA transcriptome of PBMC. Basal expression of different miRNAs, particularly mir-935 and mir-4772, could be prognostic biomarkers and may forecast the response to a hypocaloric diet.

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Background: Vitamin K has been related to glucose metabolism, insulin sensitivity and diabetes. Because inflammation underlies all these metabolic conditions, it is plausible that the potential role of vitamin K in glucose metabolism occurs through the modulation of cytokines and related molecules. The purpose of the study was to assess the associations between dietary intake of vitamin K and peripheral adipokines and other metabolic risk markers related to insulin resistance and type 2 diabetes mellitus. Methods: Cross-sectional and longitudinal assessments of these associations in 510 elderly participants recruited in the PREDIMED centers of Reus and Barcelona (Spain). We determined 1-year changes in dietary phylloquinone intake estimated by food frequency questionnaires, serum inflammatory cytokines and other metabolic risk markers. Results: In the cross-sectional analysis at baseline no significant associations were found between dietary phylloquinone intake and the rest of metabolic risk markers evaluated, with exception of a negative association with plasminogen activator inhibitor-1. After 1-year of follow-up, subjects in the upper tertile of changes in dietary phylloquinone intake showed a greater reduction in ghrelin (-15.0%), glucose-dependent insulinotropic peptide (-12.9%), glucagon-like peptide-1 (-17.6%), IL-6 (-27.9%), leptin (-10.3%), TNF (-26.9%) and visfatin (-24.9%) plasma concentrations than those in the lowest tertile (all p<0.05). Conclusion: These results show that dietary phylloquinone intake is associated with an improvement of cytokines and other markers related to insulin resistance and diabetes, thus extending the potential protection by dietary phylloquinone on chronic inflammatory diseases.

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Os resultados permitiram a redação de quatro artigos. Aspectos microbiológicos e clínicos de corinebacterioses em pacientes com câncer observados durante cinco anos foram descritos no Artigo 1. No Artigo 2 foram apresentados casos de bacteremia causados por corinebactérias invasivas não toxigênicas em dois períodos com intervalo de sete anos. As infecções em pacientes com câncer por C. diphtheriae, causando casos clínicos atípicos foram descritas no Artigo 3, além do estudo dos principais fatores de virulência de uma cepa de C. diphtheriae isolada de infecção associada ao cateter de nefrostomia foi descrita no Artigo 4. Resumidamente no Artigo 1, além dos aspectos clínico-epidemiológicos foram avaliados os perfis de resistência aos antimicrobianos e o potencial de virulência dos micro-organismos. Em cinco anos, 932 amostras de corinebactérias, com perfis de resistência aos antimicrobianos testados, foram isoladas de pacientes com câncer. As espécies predominantes foram Corynebacterium amycolatum (44,7%), Corynebacterium minutissimum (18,3%) e Corynebacterium pseudodiphtheriticum (8,5%). O uso de catéteres de longa permanência e a neutropenia, foram às condições importantes para infecção por corinebactérias. As doenças de base mais comuns foram os tumores sólidos. Pacientes hospitalizados apresentaram risco seis vezes maior de morrer, quando relacionadas às taxas de mortalidade com 30 dias (RC= 5,5; IC 95%= 1,15-26,30; p= 0,033). As bacteremias (Artigo 2) causadas por corinebactérias foram observadas em dois períodos: 2003-2004 (n=38) e de 2012-2013 (n=24). As espécies multirresistentes C. amycolatum e Corynebacterium jeikeium foram os principais responsáveis pelos quadros de bacteremia. Havia 34 pacientes com tumores sólidos e 28 pacientes com doenças linfoproliferativas, sendo que 21 deles apresentavam neutropenia e 54 utilizavam cateter venoso central. Em 41 pacientes havia infecção relacionada ou associada aos dispositivos intravasculares. Os pacientes com bacteremia responderam ao tratamento com vancomicina após a remoção do cateter. O comportamento agressivo da neoplasia, o tempo de internação hospitalar e o uso de CVC aumentaram o risco de bacteremias por Corynebacterium spp. No Artigo 3, 17 casos de infecções atípicas causadas por Corynebacterium diphtheriae foram diagnosticadas de 1996 a 2013. A incidência de C. diphtheriae correspondeu a 15,8 casos/100.000 admissões, 465 vezes maior que a incidência de difteria na população brasileira. Sintomas toxêmicos foram observados em nove pacientes, embora quadros de difteria clássica e endocardite não fossem observados. O perfil eletroforético em campo pulsado (PFGE) demonstrou um perfil de distribuição endêmica, apesar de haver dois casos de pacientes com o mesmo perfil eletroforético sugerindo transmissão relacionada aos cuidados à saúde. A adesão em superfícies bióticas e abióticas e produção de biofilme em cateter de poliuretano (Artigo 4) foi demonstrada em C. diphtheriae não toxigênico no sítio de inserção do cateter de nefrostomia. Os dados desses artigos permitiram concluir que (i) diferentes espécies de corinebactérias multirresistentes foram capazes de causar infecções em pacientes com câncer, incluindo bacteremias; (ii) C. diphtheriae foi capaz de causar infecções graves em indivíduos imunocomprometidos, incluindo infecções relacionadas ao uso de dispositivos invasivos em populações de risco, tais como pacientes com câncer.

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Esta pesquisa teve como objeto de estudo a segurança do recém-nascido no processo de utilização do Cateter Central de Inserção Periférica (PICC) e, como objetivos: conhecer o significado de segurança para o enfermeiro no processo de utilização do PICC em recém-nascidos; descrever os cuidados prestados pelo enfermeiro no uso do PICC em recém-nascidos e analisar os nexos entre segurança e os princípios bioéticos no uso do PICC em recém-nascidos na prática assistencial dos enfermeiros. Trata-se de um estudo descritivo de abordagem qualitativa. O cenário foi a unidade de terapia intensiva neonatal de um Hospital Universitário localizado no município do Rio de Janeiro e os sujeitos, 11 enfermeiros plantonistas capacitados e que realizam a implantação do PICC em recém-nascidos. Para a coleta de dados realizou-se a entrevista semiestruturada, gravada em fita cassete, entre os meses de março e junho de 2012. Posteriormente estas foram transcritas e analisadas por meio da análise de conteúdo de Bardin, na modalidade temática e interpretada à luz dos princípios bioéticos e da segurança do paciente. Como resultados emergiram 04 categorias: Técnicas e Procedimentos, Cuidados com o recém-nascido, Aspectos relacionados à equipe e Aspectos relacionados à família. Para os enfermeiros, segurança no processo de utilização do PICC no recém-nascido, significa saber indicar o uso deste dispositivo de acordo com as peculiaridades de cada criança. Exercer cuidados antes, durante e após o uso do cateter, valorizar os cuidados técnicos relacionados ao procedimento, possuir conhecimento teórico-prático e ter disponibilidade de recursos materiais e humanos para desenvolver um cuidado seguro. Além de atentar para os registros e protocolos da unidade acerca desta prática assistencial. Para preservar a segurança do neonato, compreendem ser necessária a tomada de decisão em conjunto com o médico acerca do momento ideal para se implantar este dispositivo, bem como a escolha do tipo ideal de sedação para o mesmo, dentre outros aspectos. No processo de utilização do PICC, os enfermeiros entendem a manutenção da temperatura corporal, a realização de medidas de conforto perante a dor, a prevenção de infecções e o posicionamento adequado do recém-nascido durante o procedimento, como atitudes essenciais para a promoção de sua segurança. Buscam, também, esclarecer os pais quanto ao procedimento que será realizado com seu filho. Conclui-se que o enfermeiro, no que diz respeito à prática do PICC, atua de acordo com os princípios bioéticos de beneficência e não-maleficência, já que realiza sua assistência visando o bem-estar do neonato, procurando minimizar os desconfortos associados a esse procedimento. Apesar de esclarecerem os pais quanto ao procedimento que será realizado com seu filho, alguns enfermeiros, não os consultam previamente acerca da autorização para implantação deste dispositivo infringindo, assim, o princípio bioético da autonomia.

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Different types of haematocytes found in the peripheral blood of walking catfish Clarias batrachus, have been characterized and identified using morphological, morphometric and cytochemical techniques. These cells are: erythrocytes, reticulocytes, large and small lymphocytes, thrombocytes, monocytes and polymorphonuclear leucocytes (neutrophils).

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The mitochondrial DNA (mtDNA) control region is believed to play an important biological role in mtDNA replication. Large deletions in this region are rarely found, but when they do occur they might be expected to interfere with the replication of the molecule, thus leading to a reduction of mtDNA copy number. During a survey for mtDNA sequence variations in 5,559 individuals from the general Chinese population and 2,538 individuals with medical disorders, we identified a 50-bp deletion (m.298_347del50) in the mtDNA control region in a member of a healthy Han Chinese family belonging to haplogroup B4c1b2, as suggested by complete mtDNA genome sequencing. This deletion removes the conserved sequence block II (CSBII; region 299-315) and the replication primer location (region 317-321). However, quantification of the mtDNA copy number in this subject showed a value within a range that was observed in 20 healthy subjects without the deletion. The deletion was detected in the hair samples of the maternal relatives of the subject and exhibited variable heteroplasmy. Our current observation, together with a recent report for a benign 154-bp deletion in the mtDNA control region, suggests that the control of mtDNA replication may be more complex than we had thought. Hum Mutat 31:538-543, 2010. (C) 2010 Wiley-Liss, Inc.

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Non-human primates such as Chinese rhesus macaques are the favorable models for preclinical study of potential therapeutic drugs, vaccines and mechanisms of human diseases. Little is known about the normal levels of leukocyte subpopulations of Chinese rhe

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Neuregulin-1 (Nrg-1)(1) gene has been considered as a schizophrenia susceptibility gene. In order to observe the association of Nrg-1 gene with schizophrenia, the study was designed to investigate the effect of anti-psychotic treatment on the Nrg-1 mRNA e