Trombendarterectomia aorto-femoral

PURPOSE: To study whether endarterectomy is feasible in all patients with aortofemoral atherosclerotic obstruction, considering early and late results. METHODS: A clinical, prospective, and descriptive study carried out in a university hospital. Inclusion criteria were atherosclerotic aortofemoral obstructive disease, clinical status compatible with major surgery, and absence of prior restorative procedure. Exclusion criteria were aneurysm, inflammatory arterial disease, and prior restorative procedure found during surgery. Eighty patients entered the protocol, but 9 were excluded (11.2%). Seventy-one patients, mean age of 57.3 years, underwent endarterectomy. Operative indications were intermittent claudication and critical ischemia. A ring-stripper endarterectomy technique was employed in all patients. Results were related to age, gender, symptoms, presence of diabetes mellitus, extension of endarterectomy, and extent of obstructive disease. Chi square or Fisher exact tests were used when appropriate, and the Wilkoxon (Gehan) test was used to compare survival curves. RESULTS: Sixty-eight (100%) endarterectomies were patent at discharge. The mortality rate was 4.2%. The amputation rate (4.3%) was higher in diabetic patients and when there was associated femoropopliteal obstruction. The 5-year survival rate was 83.3%, and late deaths were mostly cardiovascular. Diabetes mellitus, age above 65 years, and associated femoropopliteal obstruction lowered the survival rate. The 5-year patency rate was 87.0%. Critical ischemia and less extensive endarterectomies were associated with a lower patency rate. There were no anastomotic aneurysms or deep infections. CONCLUSIONS: Aortofemoral thromboendarterectomy is feasible in 90% of patients, early mortality rate is low, diabetic patients and those with associated femoropopliteal obstructive disease have a higher mortality rate, amputation rate is low, late deaths are mostly cardiovascular, and late patency rate is high, and even higher in the intermittent claudication group.OBJETIVO: Estudar a exeqüibilidade da trombendarterectomia em todos os portadores de obstrução aortilíaco-femoral aterosclerótica, seus resultados imediatos e tardios. MÉTODO: Trabalho clínico, prospectivo e descritivo feito em hospital universitário. Os critérios de inclusão foram: obstrução aortilíaco-femoral aterosclerótica associada ou não a obstruções fêmoro-poplíteas, condições clínicas para suportar cirurgia de grande porte e ausência de restaurações arteriais nos territórios aortofemoral e fêmoro-poplíteo. Os critérios de exclusão foram: aneurismas, doença arterial inflamatória e restauração arterial prévia reconhecidos apenas no ato cirúrgico. Foram incluídos 80 doentes. Nove (11,2%) foram excluídos. Participaram do estudo 71 doentes, 54 homens (76,1%) e 17 mulheres (23,9%), com média de idades igual a 57,3+9,9 anos. As indicações cirúrgicas foram claudicação intermitente e isquemia crítica. A técnica da trombendarterectomia com anéis foi empregada em todos doentes. Os resultados foram relacionados: a idade, sexo, queixa, diabetes mellitus, extensão da trombendarterectomia, extensão da doença obstrutiva arterial. Para a análise estatística foram empregados os testes de Qui quadrado ou exato de Fisher quando necessários e Wilkoxon (Gehan) para comparação de curvas de sobrevivência. RESULTADOS: Sessenta e oito (100%) restaurações estavam pérvias. A obstrução imediata ocorreu em 13 (18,3%) doentes e 12 foram reoperados com sucesso. Não houve diferenças significativas na distribuição das reoperações em relação às variáveis estudadas. Houve três amputações (4,2%) no grupo de isquemia crítica. A mortalidade foi 4,2% e aumentou significativamente nos pacientes diabéticos e nos que apresentaram obstruções fêmoro-poplíteas associadas. Após cinco anos 87,0±5,6% das restaurações estavam pérvias; isquemia crítica e endarterectomias aorto-ilíacas ou ilíaco-femorais estavam associadas à durabilidade menor. Após cinco anos 85,3±5,8% dos doentes estavam vivos; diabetes, idade acima de 65 anos e obstruções fêmoro-poplíteas associadas estavam relacionadas à diminuição da sobrevida dos pacientes. CONCLUSÕES: A trombendarterectomia pode ser aplicada em aproximadamente 90% dos casos de obstruções ateroscleróticas aortilíaco-femorais, a mortalidade imediata é aceitável, a taxa de amputações maiores imediatas é baixa, a taxa de reoperações imediatas é mais alta, os óbitos tardios são de causa cárdio-vascular na sua maioria, a restauração é durável principalmente quando indicada para tratamento da claudicação intermitente

Fueling the gender gap? Oil and women's labor and marriage market outcomes

This paper analyzes the effect of resource-based economic specialization on women's labor market outcomes. Using information on the location and discovery of major oil fields in the Southern United States coupled with a county-level panel derived from US Census data for 1900-1940, we specifically test the hypothesis that the presence of mineral resources can induce changes in the sectoral composition of the local economy that are detrimental to women's labor market outcomes. We find evidence that the discovery of oil at the county level may constitute a substantial male biased demand shock to local labor markets, as it is associated with a higher gender pay gap. However, we find no evidence that oil wealth lowers female labor force participation or has any impact on local marriage and fertility patterns. While our results are consistent with oil shocks limiting female labor market opportunities in some sectors (mainly manufacturing), this effect tends to be compensated by the higher availability of service sector jobs for women who are therefore not driven out of the labor market

Whole-body MRI in pediatric patients with cancer

Cancer is the leading cause of natural death in the pediatric populations of developed countries, yet cure rates are greater than 70% when a cancer is diagnosed in its early stages. Recent advances in magnetic resonance imaging methods have markedly improved diagnostic and therapeutic approaches, while avoiding the risks of ionizing radiation that are associated with most conventional radiological methods, such as computed tomography and positron emission tomography/computed tomography. The advent of whole-body magnetic resonance imaging in association with the development of metabolic- and function-based techniques has led to the use of whole-body magnetic resonance imaging for the screening, diagnosis, staging, response assessment, and post-therapeutic follow-up of children with solid sporadic tumours or those with related genetic syndromes. Here, the advantages, techniques, indications, and limitations of whole-body magnetic resonance imaging in the management of pediatric oncology patients are presented.AC Camargo Canc Ctr, Dept Imaging, Rua Prof Antonio Prudente 211, BR-01509010 Sao Paulo, SP, BrazilUniv Fed Vale Sao Francisco UNIVASF, Av Jose Sa Manicoba, BR-56304917 Petrolina, PE, BrazilAC Camargo Canc Ctr, Dept Imaging, Rua Prof Antonio Prudente 211, BR-01509010 Sao Paulo, SP, BrazilUniv Sao Paulo, Ribeirao Preto Med Sch, Div Radiol, Dept Internal Med, Av Bandeirantes 3900, BR-14049090 Ribeirao Preto, SP, BrazilUniv Fed Sao Paulo, Dept Diagnost Imagem, Disciplina Diagnost Imagem Pediat, Rua Napoleao de Barros 800, BR-04024002 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Ctr Diagnost Imagem, Inst Oncol Pediat & Med Radiol, Inst Oncol Pediat, Rua Napoleao Barros 800, BR-04024002 Sao Paulo, SP, BrazilUniv Texas MD Anderson Canc Ctr, Dept Diagnost Radiol, 1515 Holcombe Blvd, Houston, TX 77030 USAUniv Fed Ciencias Saude Porto Alegre, Dept Radiol, Ctr Hist, Rua Prof Anes Dias 285, BR-90020090 Porto Alegre, RS, BrazilUniv Fed Rio de Janeiro, Dept Radiol, Rua Thomaz Cameron 438, BR-25685129 Petropolis, RJ, BrazilUniv Fed Sao Paulo, Dept Diagnost Imagem, Disciplina Diagnost Imagem Pediat, Rua Napoleao de Barros 800, BR-04024002 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Ctr Diagnost Imagem, Inst Oncol Pediat & Med Radiol, Inst Oncol Pediat, Rua Napoleao Barros 800, BR-04024002 Sao Paulo, SP, BrazilWeb of Scienc

Enhanced Collateral Growth by Double Transplantation of Gene-Nucleofected Fibroblasts in Ischemic Hindlimb of Rats

BACKGROUND: Induction of neovascularization by releasing therapeutic growth factors is a promising application of cell-based gene therapy to treat ischemia-related problems. In the present study, we have developed a new strategy based on nucleofection with alternative solution and cuvette to promote collateral growth and re-establishment of circulation in ischemic limbs using double transplantation of gene nucleofected primary cultures of fibroblasts, which were isolated from rat receiving such therapy. METHODS AND RESULTS: Rat dermal fibroblasts were nucleofected ex vivo to release bFGF or VEGF165 in a hindlimb ischemia model in vivo. After femoral artery ligation, gene-modified cells were injected intramuscularly. One week post injection, local confined plasmid expression and transient distributions of the plasmids in other organs were detected by quantitative PCR. Quantitative micro-CT analyses showed improvements of vascularization in the ischemic zone (No. of collateral vessels via micro CT: 6.8±2.3 vs. 10.1±2.6; p<0.05). Moreover, improved collateral proliferation (BrdU incorporation: 0.48±0.05 vs. 0.57±0.05; p<0.05) and increase in blood perfusion (microspheres ratio: gastrocnemius: 0.41±0.10 vs. 0.50±0.11; p<0.05; soleus ratio: soleus: 0.42±0.08 vs. 0.60±0.08; p<0.01) in the lower hindlimb were also observed. CONCLUSIONS: These results demonstrate the feasibility and effectiveness of double transplantation of gene nucleofected primary fibroblasts in producing growth factors and promoting the formation of collateral circulation in ischemic hindlimb, suggesting that isolation and preparation of gene nucleofected cells from individual accepting gene therapy may be an alternative strategy for treating limb ischemia related diseases

Phylogenetic ctDNA analysis depicts early-stage lung cancer evolution.

The early detection of relapse following primary surgery for non-small-cell lung cancer and the characterization of emerging subclones, which seed metastatic sites, might offer new therapeutic approaches for limiting tumour recurrence. The ability to track the evolutionary dynamics of early-stage lung cancer non-invasively in circulating tumour DNA (ctDNA) has not yet been demonstrated. Here we use a tumour-specific phylogenetic approach to profile the ctDNA of the first 100 TRACERx (Tracking Non-Small-Cell Lung Cancer Evolution Through Therapy (Rx)) study participants, including one patient who was also recruited to the PEACE (Posthumous Evaluation of Advanced Cancer Environment) post-mortem study. We identify independent predictors of ctDNA release and analyse the tumour-volume detection limit. Through blinded profiling of postoperative plasma, we observe evidence of adjuvant chemotherapy resistance and identify patients who are very likely to experience recurrence of their lung cancer. Finally, we show that phylogenetic ctDNA profiling tracks the subclonal nature of lung cancer relapse and metastasis, providing a new approach for ctDNA-driven therapeutic studies