976 resultados para PREMATURE ARREST


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

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The anesthesia-related cardiac arrest (CA) rate is a quality indicator to improve patient safety in the perioperative period. A systematic review with meta-analysis of the worldwide literature related to anesthesia-related CA rate has not yet been performed.This study aimed to analyze global data on anesthesia-related and perioperative CA rates according to country's Human Development Index (HDI) and by time. In addition, we compared the anesthesia-related and perioperative CA rates in low- and high-income countries in 2 time periods.A systematic review was performed using electronic databases to identify studies in which patients underwent anesthesia with anesthesia-related and/or perioperative CA rates. Meta-regression and proportional meta-analysis were performed with 95% confidence intervals (CIs) to evaluate global data on anesthesia-related and perioperative CA rates according to country's HDI and by time, and to compare the anesthesia-related and perioperative CA rates by country's HDI status (low HDI vs high HDI) and by time period (pre-1990s vs 1990s-2010s), respectively.Fifty-three studies from 21 countries assessing 11.9 million anesthetic administrations were included. Meta-regression showed that anesthesia-related (slope: -3.5729; 95% CI: -6.6306 to -0.5152; P = 0.024) and perioperative (slope: -2.4071; 95% CI: -4.0482 to -0.7659; P = 0.005) CA rates decreased with increasing HDI, but not with time. Meta-analysis showed per 10,000 anesthetics that anesthesia-related and perioperative CA rates declined in high HDI (2.3 [95% CI: 1.2-3.7] before the 1990s to 0.7 [95% CI: 0.5-1.0] in the 1990s-2010s, P < 0.001; and 8.1 [95% CI: 5.1-11.9] before the 1990s to 6.2 [95% CI: 5.1-7.4] in the 1990s-2010s, P < 0.001, respectively). In low-HDI countries, anesthesia-related CA rates did not alter significantly (9.2 [95% CI: 2.0-21.7] before the 1990s to 4.5 [95% CI: 2.4-7.2] in the 1990s-2010s, P = 0.14), whereas perioperative CA rates increased significantly (16.4 [95% CI: 1.5-47.1] before the 1990s to 19.9 [95% CI: 10.9-31.7] in the 1990s-2010s, P = 0.03).Both anesthesia-related and perioperative CA rates decrease with increasing HDI but not with time. There is a clear and consistent reduction in anesthesia-related and perioperative CA rates in high-HDI countries, but an increase in perioperative CA rates without significant alteration in the anesthesia-related CA rates in low-HDI countries comparing the 2 time periods.

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Many adverse pregnancy outcomes (APOs), including spontaneous preterm birth (PTB), are associated with placental dysfunction. Recent clinical and experimental evidences suggest that premature aging of the placenta may be involved in these events. Although placental aging is a well-known concept, the mechanisms of aging during normal pregnancy and premature aging in APOs are still unclear. This review was conducted to assess the knowledge on placental aging related biochemical changes leading to placental dysfunction in PTB and/or preterm premature rupture of membranes (pPROM). We performed a systematic review of studies published over the last 50 years in two electronic databases (Pubmed and Embase) on placental aging and PTB or pPROM. The search yielded 554 citations, 30 relevant studies were selected for full-text review and three were included in the review. Only one study reported oxidative stress-related aging and degenerative changes in human placental membranes and telomere length reduction in fetal cells as part of PTB and/or pPROM mechanisms. Similarly, two animal studies reported findings of decidual senescence and referred to PTB mechanisms. Placental and fetal membrane oxidative damage and telomere reduction are linked to premature aging in PTB and pPROM but the risk factors and biomolecular pathways causing this phenomenon are not established in the literature. However, no biomarkers or clinical indicators of premature aging as a pathology of PTB and pPROM have been reported. We document major knowledge gaps and propose several areas for future research to improve our understanding of premature aging linked to placental dysfunction.

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

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Melanoma is one of the most treatment-resistant malignancies and regardless of new therapeutic tactics the outcome remains dismal. Polo-like kinase 1 (PLK1) has been shown to be over-expressed in a variety of tumors, becoming an attractive target for cancer management. In the present study we tested the in vitro antitumor activities of BI 2536, a selective inhibitor of PLK1, against two melanoma cell lines. Our results showed that nanomolar concentrations (10-150 nmol/L) of the drug significantly decreased cell proliferation and clonogenicity, promoting cell cycle arrest in G2/M. Targeting the cell cycle offers an attractive potential cancer-treatment option. Herein we show that PLK1 inhibition may be a feasible approach for the impairment of tumor progression and dissemination. This in vitro profile of melanoma cell growth inhibition by PLK1 modulation may be an interesting model to be tested in association with first-line antineoplasic agents in melanomas.

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Phosphoethanolamine (Pho-s) is a compound involved in phospholipid turnover, acting as a substrate for many phospholipids of the cell membranes, especially phosphatidylcholine. We recently reported that synthetic Pho-s has potent effects on a wide variety of tumor cells. To determine if Pho-s has a potential antitumor activity, in this study we evaluated the activity of Pho-s against the B16-F10 melanoma both in vitro and in mice bearing a dorsal tumor. The treatment of B16F10 cells with Pho-s resulted in a dose-dependent inhibition of cell proliferation. At low concentrations, this activity appears to be involved in the arrest of the cell cycle at G2/M, while at high concentrations Pho-s induces apoptosis. In accordance with these results, the loss of mitochondrial potential and increased caspase-3 activity suggest that Phos has dual antitumor effects; i.e. it induces apoptosis at high concentrations and modulates the cell cycle at lower concentrations. In vivo, we evaluated the effect of Pho-s in mice bearing B16-F10 melanoma. The results show that Pho-s reduces the tumoral volume increasing survival rate. Furthermore, the tumor doubling time and tumor delays were substantially reduced when compared with untreated mice. Histological analyses reveal that Pho-s induces changes in cell morphology, typical characteristics of apoptosis, in addition the large areas of necrosis correlating with a reduction of tumor size. The results presented here support the hypothesis that Pho-s has antitumor effects by the induction of apoptosis as well as the inhibition of cell proliferation by arrest at G2/M. Thus, Pho-s can be regarded as a promising agent for the treatment of melanoma. Published by Elsevier Masson SAS.

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Background: Premature ventricular and supraventricular complexes (PVC and PsVC) are frequent and often symptomatic. The magnesium (Mg) ion plays a role in the physiology of cell membranes and cardiac rhythm. Objective: We evaluated whether the administration of Mg Pidolate (MgP) in patients with PVC and PsVC is superior to placebo (P) in improving symptoms and arrhythmia frequency. Methods: Randomized double-blind study with 60 consecutive symptomatic patients with more than 240 PVC or PsVC/h on 24-hour Holter monitoring who were selected to receive placebo or MgP. To evaluate symptom improvement, a categorical and a specific questionnaire for symptoms related to PVC and PsVC was made. Improvement in premature complex density (PCD) per hour was considered significant if percentage reduction was >= 70% after treatment. The dose of MgP was 3.0 g/day for 30 days, equivalent to 260mg of Mg element. None of the patients had structural heart disease or renal failure. Results: Of the 60 patients, 33 were female (55%). Ages ranged from 16 to 70 years old. In the MgP group, 76.6% of patients had a PCD reduction >70%, 10% of them >50% and only 13.4% <50%. In the P group, 40% showed slight improvement, <30%, in the premature complexes frequency (p < 0.001). Symptom improvement was achieved in 93.3% of patients in the MgP group, compared with only 16.7% in the P group (p < 0.001). Conclusion: Oral Mg supplementation decreases PCD, resulting in symptom improvement. (Arq Bras Cardiol 2012;98(6):480-487)

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Cockayne syndrome (CS) is a human premature aging disorder associated with neurological and developmental abnormalities, caused by mutations mainly in the CS group B gene (ERCC6). At the molecular level, CS is characterized by a deficiency in the transcription-couple DNA repair pathway. To understand the role of this molecular pathway in a pluripotent cell and the impact of CSB mutation during human cellular development, we generated induced pluripotent stem cells (iPSCs) from CSB skin fibroblasts (CSB-iPSC). Here, we showed that the lack of functional CSB does not represent a barrier to genetic reprogramming. However, iPSCs derived from CSB patients fibroblasts exhibited elevated cell death rate and higher reactive oxygen species (ROS) production. Moreover, these cellular phenotypes were accompanied by an up-regulation of TXNIP and TP53 transcriptional expression. Our findings suggest that CSB modulates cell viability in pluripotent stem cells, regulating the expression of TP53 and TXNIP and ROS production.

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Objective: To investigate prevalence of invasive candidiasis in a Neonatal Intensive Care Unit and to evaluate oral diseases and Candida spp. colonization in low birth weight preterm newborns. Methods: A descriptive epidemiological study performed in two stages. First, prevalence of candidiasis was analyzed in a database of 295 preterm patients admitted to hospital for over 10 days and birth weight less than 2,000g. In the second stage, oral changes and Candida spp. colonization were assessed in 65 patients weighing less than 2,000g, up to 4 week-old, hospitalized for over 10 days and presenting oral abnormalities compatible with fungal lesions. Swab samples were collected in the mouth to identify fungi. Results: Prevalence of candidiasis was 5.4% in the database analyzed. It correlated with prolonged hospital length of stay (p<0.001), in average, 31 days, and 85% risk of developing infection in the first 25 days. It correlated with low birth weight (p<0.001), with mean of 1,140g. The most frequent alterations were white soft plaques, detachable, in oral mucosa and tongue. Intense oral colonization by Candida spp was observed (80%). Conclusions: The frequency of invasive candidiasis was low and correlated with low birth weight and prolonged hospital stay. The most common oral changes were white plaques compatible with pseudomembranous candidiasis and colonization by Candida spp. was above average.

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Background Human homeobox genes encode nuclear proteins that act as transcription factors involved in the control of differentiation and proliferation. Currently, the role of these genes in development and tumor progression has been extensively studied. Recently, increased expression of HOXB7 homeobox gene (HOXB7) in pancreatic ductal adenocarcinomas (PDAC) was shown to correlate with an invasive phenotype, lymph node metastasis and worse survival outcomes, but no influence on cell proliferation or viability was detected. In the present study, the effects arising from the knockdown of HOXB7 in PDAC cell lines was investigated. Methods Real time quantitative PCR (qRT-PCR) (Taqman) was employed to assess HOXB7 mRNA expression in 29 PDAC, 6 metastatic tissues, 24 peritumoral tissues and two PDAC cell lines. siRNA was used to knockdown HOXB7 mRNA in the cell lines and its consequences on apoptosis rate and cell proliferation were measured by flow cytometry and MTT assay respectively. Results Overexpression of HOXB7 mRNA was observed in the tumoral tissues and in the cell lines MIA PaCa-2 and Capan-1. HOXB7 knockdown elicited (1) an increase in the expression of the pro-apoptotic proteins BAX and BAD in both cell lines; (2) a decrease in the expression of the anti-apoptotic protein BCL-2 and in cyclin D1 and an increase in the number of apoptotic cells in the MIA PaCa-2 cell line; (3) accumulation of cell in sub-G1 phase in both cell lines; (4) the modulation of several biological processes, especially in MIA PaCa-2, such as proteasomal ubiquitin-dependent catabolic process and cell cycle. Conclusion The present study confirms the overexpression of HOXB7 mRNA expression in PDAC and demonstrates that decreasing its protein level by siRNA could significantly increase apoptosis and modulate several biological processes. HOXB7 might be a promising target for future therapies.

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Konditionale Modellsysteme zur Untersuchung der ERBB2-induzierten Tumorgenese Die Rezeptor-Tyrosinkinase ERBB2 ist in einer Vielzahl epithelialer Tumore, wie Mamma- und Ovarialkarzinomen, überexprimiert. Diese erhöhte Expression korreliert mit aggressivem Tumorwachstum, verstärkter Metastasierung und schlechter Prognose für den Patienten. Zur genaueren Untersuchung molekularer Mechanismen, die zur Tumorentstehung infolge der ERBB2-Überexpression führen, wurden im Rahmen dieser Arbeit mit Hilfe des Tet-Systems induzierbare MCF-7 Zelllinien generiert. Diese exprimieren bei Gabe von Doxyzyklin ERBB2 bzw. die zum humanen ERBB2 homologe und durch Punktmutation onkogen aktivierte Rattenvariante NeuT. Nachdem die stringente Regulierbarkeit durch Doxyzyklin für die untersuchten Zellklone gezeigt werden konnte, stellte sich bei der Charakterisierung der Zelllinien heraus, dass die Induktion von ERBB2 erstaunlicherweise nicht zur Proliferation der Zellen, sondern zum Wachstumsarrest führt. Bei der Untersuchung verschiedener Zellzyklusregulatoren konnte dieser Zellzyklusarrest dem CDK-Inhibitor P21 zugeordnet werden, dessen Expression durch ERBB2 induziert wird. In P21-Antisense-Experimenten konnte nachgewiesen werden, dass P21 eine Schlüsselrolle beim ERBB2-induzierten Zellzyklusarrest spielt. Neben der Induktion von P21 und der daraus resultierenden Wachstumsinhibition zeigten die Zellen starke morphologische Veränderungen und waren positiv beim Nachweis der Seneszenz-assoziierten -Galaktosidase. Erstmals konnte gezeigt werden, dass die Induktion des Onkogens ERBB2 nicht zur Proliferation, sondern zur Aktivierung eines verfrühten Seneszenz-Programms führt, welches der Zelle Schutz gegen die Onkogeneinwirkung bietet. Bei der Untersuchung verschiedener Signaltransduktionskaskaden mit Inhibitormolekülen konnte die Aktivierung dieses Seneszenz-Programms der Stress-aktivierten Proteinkinase P38 zugeordnet werden. Zur Identifizierung von Genen, die für die ERBB2-induzierte Tumorgenese relevant sind, wurde die differenzielle Genexpression eines NeuT-Klons nach 8- bzw. 48-stündiger Induktion mit Doxyzyklin in einem cDNA-Array untersucht. Dabei zeigte sich eine besonders starke Induktion von Integrin 5 und Integrin 1, die zusammen den Fibronektinrezeptor bilden. Der funktionale Nachweis des Rezeptors in einem Adhäsionsassay demonstrierte ein stark erhöhtes Adhäsionsverhalten ERBB2-überexprimierender Zellen an Fibronektin. Bei der Untersuchung von Mamma-, Ovarial- und Endometriumkarzinomen konnte die Expression von ERBB2 mit der von Integrin 5 korreliert werden. Diese Ergebnisse machen Integrin 5 zu einem potenziellen neuen Tumormarker und Therapieziel in ERBB2-überexprimierenden Tumoren. Ein weiteres interessantes Gen, das sich im Array durch ERBB2 überexprimiert zeigte, war die Matrix-Metalloproteinase MMP-9. In einem Zymografieassay konnte die erhöhte Gelatinaseaktivität von MMP-9 in Dox-induzierten Zellen nachgewiesen werden. Der Einsatz verschiedener Signaltransduktionsinhibitoren ergab, dass auch die ERBB2-induzierte Expression von MMP-9 über die Aktivierung von P38 läuft. Bei der Suche nach weiteren MMPs, die für die ERBB2-induzierte Tumorgenese relevant sein könnten, wurde MMP-13 untersucht. Erstmals konnte gezeigt werden, dass diese Matrix-Metalloproteinase von ERBB2 induziert wird. Dieser interessante Befund wurde auch in einem anderen Zellmodell in NIH3T3 Mausfibroblasten verifiziert. Durch ihre Matrix-degradierenden Eigenschaften sind MMPs potente „Werkzeuge“ für Tumorzellen und stellen ein wichtiges Ziel zur Unterbindung der Invasion und Metastasierung dieser Zellen dar. Neben den Zellkulturarbeiten wurden im Rahmen dieser Dissertation transgene Responder-Mäuse generiert, die NeuT unter Kontrolle eines Tet-responsiven Promotors exprimieren. Von vier transgenen Gründerlinien zeigten zwei eine unerwünschte, basale NeuT-Expression, für die beiden anderen Linien konnte sowohl in MEF-Assays, als auch nach Kreuzung mit rtTA- bzw. tTA-Effektor-Mäusen eine Dox-abhängige Regulation des Transgens gezeigt werden. Die Tiere dieser Linien sollen in Zukunft mit Effektor-Mäusen gepaart werden, die den rtTA bzw. tTA spezifisch in für die ERBB2-Tumorgenese relevanten Geweben, wie Ovarial- oder Lungenepithelzellen, exprimieren. So können individuelle Tumormodelle für die verschiedenen epithelialen Tumore, bei denen die Überexpression von ERBB2 von Bedeutung ist, entwickelt und untersucht werden.

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Currently, few data exist on the association between post-cardiac arrest hemodynamic function and outcome. In this explorative, retrospective analysis, the association between hemodynamic variables during the first 24 h after intensive care unit admission and functional outcome at day 28 was evaluated in 153 normothermic comatose patients following a cardiac arrest.

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Background There is an ongoing debate as to whether combined antiretroviral treatment (cART) during pregnancy is an independent risk factor for prematurity in HIV-1-infected women. Objective The aim of the study was to examine (1) crude effects of different ART regimens on prematurity, (2) the association between duration of cART and duration of pregnancy, and (3) the role of possibly confounding risk factors for prematurity. Method We analysed data from 1180 pregnancies prospectively collected by the Swiss Mother and Child HIV Cohort Study (MoCHiV) and the Swiss HIV Cohort Study (SHCS). Results Odds ratios for prematurity in women receiving mono/dual therapy and cART were 1.8 [95% confidence interval (CI) 0.85–3.6] and 2.5 (95% CI 1.4–4.3) compared with women not receiving ART during pregnancy (P=0.004). In a subgroup of 365 pregnancies with comprehensive information on maternal clinical, demographic and lifestyle characteristics, there was no indication that maternal viral load, age, ethnicity or history of injecting drug use affected prematurity rates associated with the use of cART. Duration of cART before delivery was also not associated with duration of pregnancy. Conclusion Our study indicates that confounding by maternal risk factors or duration of cART exposure is not a likely explanation for the effects of ART on prematurity in HIV-1-infected women.