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[PMID]:28455803
[Au] Autor:Blanchet MC; Gignoux B; Matussière Y; Vulliez A; Lanz T; Monier F; Frering V
[Ad] Endereço:Clinique de la Sauvegarde, Lyon, France. blanchet@chirurgien-digestif.com.
[Ti] Título:Experience with an Enhanced Recovery After Surgery (ERAS) Program for Bariatric Surgery: Comparison of MGB and LSG in 374 Patients.
[So] Source:Obes Surg;27(7):1896-1900, 2017 Jul.
[Is] ISSN:1708-0428
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Strategic multidisciplinary protocols for "enhanced recovery after surgery" (ERAS) have demonstrated reductions in length of hospital stay (LOS), morbidity, and costs in conjunction with bariatric procedures. METHODS: We prospectively investigated the effectiveness and safety of an ERAS protocol with laparoscopic omega loop gastric bypass ("mini" gastric bypass, MGB) and LSG in morbidly obese patients. RESULTS: Average LOS was 1.24 days (range 1-14); 86.1% discharged on day 1; 96.9% by day 2, a value comparable or better than that of other ERAS studies vs standard care according to meta-analysis. Complications 2.9%; readmission 2.1%; reintervention 1.3%. CONCLUSION: The program was equally safe with both procedures. Postoperative antithrombotic heparin does not appear necessary in low-risk patients. Bariatric surgical ERAS programs are evolving and not yet standardized.
[Mh] Termos MeSH primário: Protocolos Clínicos
Gastrectomia
Derivação Gástrica
Obesidade Mórbida/cirurgia
Assistência Perioperatória/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Assistência ao Convalescente/métodos
Assistência ao Convalescente/normas
Idoso
Convalescença
Custos e Análise de Custo
Feminino
Gastrectomia/economia
Gastrectomia/métodos
Derivação Gástrica/economia
Derivação Gástrica/métodos
Seres Humanos
Laparoscopia
Tempo de Internação/economia
Masculino
Meia-Idade
Morbidade
Assistência Perioperatória/normas
Período Pós-Operatório
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180115
[Lr] Data última revisão:
180115
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1007/s11695-017-2694-6


  2 / 3005 MEDLINE  
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[PMID]:28534323
[Au] Autor:Zhou Y
[Ad] Endereço:Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao 266003, China. zhouyanbing999@aliyun.com.
[Ti] Título:[Era of enhanced recovery after surgery and robotic gastric cancer surgery].
[So] Source:Zhonghua Wei Chang Wai Ke Za Zhi;20(5):495-499, 2017 May 25.
[Is] ISSN:1671-0274
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:Enhanced recovery after surgery (ERAS) has been rapidly developing by combining several techniques with evidence-based adjustments, including preoperative education, preoperative carbohydrate loading, epidural or regional anesthesia, early initiation of enteral nutrition, ambulation and multi-modal pain management. The core part of ERAS is to reduce and reverse surgical stress and therefore greatly improve clinical outcome. Under the guidance of ERAS, perioperative management of robotic gastric cancer operation should follow the basic principles of ERAS and clinical pathway to maximize the advantages of the robotic surgery. ERAS protocol is safe and feasible for patients undergoing robotic radical gastrectomy and it can reduce surgical stress, shorten hospital stay, improve quality of life and does not increase complications, whose mechanism may be associated with the reduction of inflammation and insulin resistance, the decrease of resting energy exposure, and the protection of mitochondria function. It is worth emphasizing that it is very important to fully understand the changes of pathophysiology during perioperative period, to strictly implement the ERAS pathway based on optimized evidence-based medicine, to cooperate closely with the multidisciplinary team, to observe and manage the postoperative complications dynamically by systemic classification. The improvement of ERAS program on the outcome of patients should be summarized regularly and the new interventional strategies should be evaluated further according to the international standard.
[Mh] Termos MeSH primário: Cuidados Pós-Operatórios/métodos
Cuidados Pós-Operatórios/normas
Complicações Pós-Operatórias/prevenção & controle
Procedimentos Cirúrgicos Robóticos/reabilitação
Neoplasias Gástricas/cirurgia
[Mh] Termos MeSH secundário: Anestesia Epidural
Anestesia Local
Convalescença
Procedimentos Clínicos
Nutrição Enteral
Gastrectomia/instrumentação
Gastrectomia/métodos
Gastrectomia/reabilitação
Seres Humanos
Tempo de Internação
Manejo da Dor
Educação de Pacientes como Assunto
Cuidados Pré-Operatórios
Qualidade de Vida
Recuperação de Função Fisiológica
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170524
[St] Status:MEDLINE


  3 / 3005 MEDLINE  
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[PMID]:28476252
[Au] Autor:Defromont L; Groulez C; François G; Dekerf B
[Ad] Endereço:Établissement public de santé mentale (EPSM) Lille-Métropole, BP 10, 59487 Armentières cedex, France; Espace Alan Turing, 5, place de Coubertin, 59790 Ronchin, France. Electronic address: ldefromont@epsm-lille-metropole.fr.
[Ti] Título:['Zero isolation', a care practice oriented towards recovery].
[Ti] Título:"Zéro isolement", une pratique de soins orientée vers le rétablissement..
[So] Source:Soins Psychiatr;38(310):23-25, 2017 May - Jun.
[Is] ISSN:0241-6972
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:Some institutions do not have an isolation room. Agitation is managed otherwise, with the idea that restraint or isolation can only be a terrible experience. The care pathway is therefore designed to favour autonomy and to limit restrictions of freedom. In this context, professionals are in constant contact with the user. Example of a unit which advocates this concept of rehabilitation.
[Mh] Termos MeSH primário: Convalescença/psicologia
Transtornos Mentais/enfermagem
Transtornos Mentais/reabilitação
Defesa do Paciente/legislação & jurisprudência
Defesa do Paciente/psicologia
Isolamento de Pacientes/legislação & jurisprudência
Isolamento de Pacientes/psicologia
Autonomia Pessoal
Restrição Física/legislação & jurisprudência
Restrição Física/psicologia
[Mh] Termos MeSH secundário: França
Acesso aos Serviços de Saúde
Hospitais Psiquiátricos
Seres Humanos
Transtornos Mentais/psicologia
Cura Mental
Relações Enfermeiro-Paciente
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170507
[St] Status:MEDLINE


  4 / 3005 MEDLINE  
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[PMID]:28226356
[Au] Autor:Hu J; Yang K; Chen X; Zhang W; Liu K; Chen X; Zhao L; Zhou Z
[Ad] Endereço:Department of Gastrointestinal Surgery, Institute of Gastric Cancer, West China Hospital, Sichuan University, Chengdu 610041, China. hujkwch@126.com.
[Ti] Título:[Application of clockwise modularized lymphadenectomy in laparoscopic gastrectomy for gastric cancer].
[So] Source:Zhonghua Wei Chang Wai Ke Za Zhi;20(2):200-206, 2017 Feb 25.
[Is] ISSN:1671-0274
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:OBJECTIVE: To investigate the feasibility and efficacy of clockwise modularized lymphadenectomy in laparoscopic gastrectomy for gastric cancer. METHODS: Clinical data of 19 cases who underwent the laparoscopic clockwise modularized lymphadenectomy for gastric cancer (clockwise group) from July 2016 to September 2016 were analyzed retrospectively. The clockwise modularized lymphadenectomy included the fixed operative order, detailed procedure and requirement of lymphadenectomy, which mainly reflected in assisting the exposure of operative field and dissection of lymph nodes through suspending the liver and banding the greater omentum, as well as proposing the requirements and attentions for the dissections of each station of lymph nodes to facilitate the quality control of lymphadenectomy. The operative time, intraoperative complications, intraoperative estimate blood loss, number of total harvested lymph nodes, morbidity and postoperative recovery, were compared with the data of another 19 cases who received traditional lymphadenectomy from January 2016 to June 2016 (control group). RESULTS: The baseline data were comparable between two groups. All the patients were performed successfully by laparoscopy without conversion and intraoperative complications. The operative time, intraoperative estimated blood loss and number of total harvested lymph node were (278.4±29.9) min, (91.1±41.6) ml and 38.2±15.1 in clockwise group, and were (296.7±30.3) min, (102.2±32.2) ml and 37.0±12.3 in control group without significant differences (all P>0.05). However, the mean number of retrieved No.11p lymph nodes was 2.2±1.8 in clockwise group, which was significantly higher than that in control group (0.8±1.0) (P=0.013). Four patients in each group suffered from pulmonary infections, who were cured by conservative therapies. There was no anastomotic leakage, intraperitoneal hemorrhage, intraperitoneal infection or intestinal obstruction in each group. CONCLUSION: The clockwise modularized lymphadenectomy can contribute to the facilitation of the retraction and exposure, decrease of the surgical duration and intraoperative blood loss, and radicalization of lymph node dissection, especially for the lymph nodes dissection around the celiac trunk.
[Mh] Termos MeSH primário: Gastrectomia/métodos
Laparoscopia/métodos
Excisão de Linfonodo/métodos
Duração da Cirurgia
Neoplasias Gástricas/cirurgia
Resultado do Tratamento
[Mh] Termos MeSH secundário: Perda Sanguínea Cirúrgica/prevenção & controle
Perda Sanguínea Cirúrgica/estatística & dados numéricos
Convalescença
Seres Humanos
Complicações Intraoperatórias/epidemiologia
Excisão de Linfonodo/estatística & dados numéricos
Linfonodos/cirurgia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170223
[St] Status:MEDLINE


  5 / 3005 MEDLINE  
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[PMID]:28193740
[Au] Autor:Tsuchido Y; Nakamura-Uchiyama F; Toyoda K; Iwagami M; Tochitani K; Shinohara K; Hishiya N; Ogawa T; Uno K; Kasahara K; Ouji Y; Kano S; Mikasa K; Shimizu T; Yoshikawa M; Maruyama H
[Ad] Endereço:Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan.
[Ti] Título:Development of Delayed Hemolytic Anemia After Treatment with Oral Artemether-Lumefantrine in Two Patients with Severe Falciparum Malaria.
[So] Source:Am J Trop Med Hyg;96(5):1185-1189, 2017 May.
[Is] ISSN:1476-1645
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:AbstractRecently, reports of delayed hemolytic anemia after treatment with artemisinin and its derivatives have emerged. Here we report two cases of delayed hemolytic anemia in a patient with severe falciparum malaria after treatment with oral artemether-lumefantrine (AL). The first patient, a 20-year-old Japanese male student, was diagnosed with falciparum malaria and was administered AL. As having a high parasitemia rate (20.6%) was the only severe malaria criterion met in this case and his general condition was stable, we continued with AL treatment. Despite disappearance of malarial parasites after 4 days of AL administration, a persistent fever remained. On days 13 and 16, a diagnosis of hemolytic anemia was made (lactate dehydrogenase [LDH]: 1,466 U/L, hemoglobin [Hb]: 7.2 g/dL). A blood smear at that time revealed no parasites. He recovered naturally from delayed hemolysis. The second patient, a 27-year-old Japanese female student, was diagnosed with falciparum malaria (parasitemia: 4.5%) and treated initially with oral quinine hydrochloride and doxycycline. The following day, parasitemia increased to 7.9% and oral AL was initiated. She was discharged on day 4 after achieving parasite clearance and afebrility. However, on day 5, fever (body temperature > 38°C) recurred, and on day 11, a diagnosis of hemolytic anemia was made (LDH: 712 U/L, Hb: 8.8 g/dL). A follow-up confirmed that her condition improved gradually. AL treatment of severe malaria can cause delayed hemolytic anemia. Patients should be followed up for up to 4 weeks to detect signs of hemolysis and provide appropriate symptomatic treatment.
[Mh] Termos MeSH primário: Anemia Hemolítica/induzido quimicamente
Antimaláricos/efeitos adversos
Artemisininas/efeitos adversos
Etanolaminas/efeitos adversos
Fluorenos/efeitos adversos
Malária Falciparum/tratamento farmacológico
Parasitemia/tratamento farmacológico
Plasmodium falciparum/efeitos dos fármacos
[Mh] Termos MeSH secundário: Adulto
Anemia Hemolítica/sangue
Anemia Hemolítica/diagnóstico
Antimaláricos/administração & dosagem
Artemisininas/administração & dosagem
Contagem de Células Sanguíneas
Convalescença
Combinação de Medicamentos
Etanolaminas/administração & dosagem
Feminino
Fluorenos/administração & dosagem
Hemoglobinas/metabolismo
Seres Humanos
L-Lactato Desidrogenase/sangue
Malária Falciparum/parasitologia
Malária Falciparum/patologia
Masculino
Parasitemia/parasitologia
Parasitemia/patologia
Plasmodium falciparum/crescimento & desenvolvimento
Plasmodium falciparum/patogenicidade
Fatores de Tempo
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antimalarials); 0 (Artemisinins); 0 (Drug Combinations); 0 (Ethanolamines); 0 (Fluorenes); 0 (Hemoglobins); 0 (artemether-lumefantrine combination); EC 1.1.1.27 (L-Lactate Dehydrogenase)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170215
[St] Status:MEDLINE
[do] DOI:10.4269/ajtmh.16-0460


  6 / 3005 MEDLINE  
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[PMID]:28142190
[Au] Autor:Ademolue TW; Amodu OK; Awandare GA
[Ad] Endereço:West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana.
[Ti] Título:Sickle cell trait is associated with controlled levels of haem and mild proinflammatory response during acute malaria infection.
[So] Source:Clin Exp Immunol;188(2):283-292, 2017 May.
[Is] ISSN:1365-2249
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The controlled induction of haemoxygenase-1 (HO-1), an enzyme that catabolizes haem, has been shown to reduce haem, preventing pathologies associated with haem toxicity. The hemoglobin genotype HbAS confers reduced susceptibility to severe complications of malaria by a mechanism that is not well understood. Using a longitudinal approach, we investigated the effect of baseline concentrations of HO-1 on the accumulation of haem during acute Plasmodium falciparum malaria in HbAS and HbAA genotypes. Plasma concentrations of haem, HO-1 and cytokines were quantified in venous blood obtained from children (9 months-5 years of age) during malaria infection, and at convalescence (baseline levels). Parasitaemia was determined during malaria infection. In patients with the HbAA genotype, there was a significant elevation in the plasma concentration of haem (P = 0.002), and a consequent increased induction of HO-1 (P < 0.001) during falciparum malaria compared with levels at convalescence. Contrary to HbAA, plasma concentration of haem did not change in the HbAS genotypical group (P = 0·110), and the induction of HO-1 was reduced during malaria compared with levels at convalescence (P = 0·006). Higher plasma levels of haem were observed in HbAS compared with HbAA at convalescence (P = 0·010), but this difference did not affect the levels of HO-1 within each genotype (P = 0·450). Relatively milder proinflammatory responses were observed in HbAS children during malaria infection compared to HbAA children. Our findings suggest that a mechanism of reduced susceptibility to severe malaria pathologies by the HbAS genotype may involve the control of haem, leading to controlled levels of HO-1 and milder proinflammatory responses during acute malaria.
[Mh] Termos MeSH primário: Heme Oxigenase-1/sangue
Heme/análise
Malária Falciparum/sangue
Malária Falciparum/complicações
Traço Falciforme/complicações
[Mh] Termos MeSH secundário: Pré-Escolar
Convalescença
Citocinas/sangue
Feminino
Genótipo
Hemoglobinas/genética
Seres Humanos
Lactente
Inflamação
Malária/sangue
Malária/imunologia
Malária/parasitologia
Malária Falciparum/imunologia
Malária Falciparum/parasitologia
Masculino
Plasmodium falciparum/imunologia
Plasmodium falciparum/isolamento & purificação
Traço Falciforme/imunologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cytokines); 0 (Hemoglobins); 42VZT0U6YR (Heme); EC 1.14.14.18 (HMOX1 protein, human); EC 1.14.14.18 (Heme Oxygenase-1)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170505
[Lr] Data última revisão:
170505
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170201
[St] Status:MEDLINE
[do] DOI:10.1111/cei.12936


  7 / 3005 MEDLINE  
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[PMID]:28005631
[Au] Autor:Ran F; Shi Y; Qiao T; Shang T; Liu Z; Liu CJ
[Ad] Endereço:Departments of *Vascular Surgery, and †Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
[Ti] Título:Comparison of Foam Sclerotherapy Alone or Combined With Stripping of the Great Saphenous Vein for Treating Varicose Veins.
[So] Source:Dermatol Surg;43(4):541-547, 2017 Apr.
[Is] ISSN:1524-4725
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Varicose veins (VVs) have a substantial impact on patients' quality of life. OBJECTIVE: The study aimed to retrospectively compare the short-term clinical outcomes of 2 treatment methods for VVs, namely high ligation and stripping (HL/S) of the great saphenous vein combined with foam sclerotherapy (FS), and FS alone. MATERIALS AND METHODS: Totally, 180 patients with VVs were included and treated with FS alone or HL/S+FS. Assessments included the first injection efficacy, postoperative status, complications, operative time, and recovery time. A follow-up duration was performed. Patient satisfaction was also recorded. RESULTS: No significant differences in the complete occlusion rate of the varicose tributaries, as well as in postoperative complications, were found between the treatment groups (p > 0.05). The complete occlusion rates of the varicose tributaries in the FS and HL/S+FS groups were 90% and 90%, respectively. Although mild phlebitis and local pigmentation were found in both groups, they disappeared during the follow-up period. Operative and recovery times were higher in the HL/S+FS group than in the FS group. CONCLUSION: The HL/S+FS and FS alone showed equivalent efficacy for treating patients with VVs. Considering the increased operative and recovery times, FS alone is recommended to treat VVs in clinical practice.
[Mh] Termos MeSH primário: Convalescença
Veia Safena/cirurgia
Escleroterapia
Varizes/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Terapia Combinada/efeitos adversos
Feminino
Seres Humanos
Hiperpigmentação/etiologia
Ligadura/efeitos adversos
Masculino
Meia-Idade
Duração da Cirurgia
Flebite/etiologia
Complicações Pós-Operatórias/etiologia
Estudos Retrospectivos
Escleroterapia/efeitos adversos
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170502
[Lr] Data última revisão:
170502
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161223
[St] Status:MEDLINE
[do] DOI:10.1097/DSS.0000000000001022


  8 / 3005 MEDLINE  
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[PMID]:27867062
[Au] Autor:Sahr F; Ansumana R; Massaquoi TA; Idriss BR; Sesay FR; Lamin JM; Baker S; Nicol S; Conton B; Johnson W; Abiri OT; Kargbo O; Kamara P; Goba A; Russell JB; Gevao SM
[Ad] Endereço:34 Military Hospital, Wilberforce, Freetown, Sierra Leone; College of Medicine and Allied Health Sciences, Freetown, Sierra Leone.
[Ti] Título:Evaluation of convalescent whole blood for treating Ebola Virus Disease in Freetown, Sierra Leone.
[So] Source:J Infect;74(3):302-309, 2017 Mar.
[Is] ISSN:1532-2742
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Convalescent blood therapy has been a promising form of treatment for Ebola Virus Disease (EVD), but less attention has been focused on it for treatment. METHOD: We assessed the effectiveness of convalescent whole blood (CWB) in the treatment of consented EVD patients. We recruited 69 subjects in December 2014 up to April 2015, at the 34 Military Hospital in Wilberforce and the PTS 1 Ebola Treatment Unit in Hastings, Freetown. Forty-four were given CWB, and 25 who consented but preferred to be exempted from the CWB treatment were used to compare clinical outcomes. All were given routine treatment used at the Ebola Treatment Unit. RESULTS: One of 44 subjects treated with CWB dropped out of the study and 31 recovered while 12 succumbed to the disease with a case fatality rate of 27.9%. For the group that was given routine treatment without CWB, 11 died with a case fatality rate of 44%. There was a significant difference between admission viral load and viral load after the first 24 h of treatment with convalescent whole blood (P < 0.01). The odds ratio for survival with CWB was 2.3 (95% CI, 0.8-6.5). CONCLUSION: CWB is promising for treating EVD in resource-poor settings, especially in the early phases of outbreaks when resource-mobilization is done. Even though our sample size was small and the evaluation was not randomised, our results contribute to existing evidence that convalescent whole blood could be considered as a useful candidate for treating EVD. Further studies that are randomised will be required to further assess the efficacy of CWB as treatment option during any EVD outbreak.
[Mh] Termos MeSH primário: Transfusão de Sangue
Doença pelo Vírus Ebola/terapia
Soros Imunes/administração & dosagem
Imunização Passiva
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Convalescença
Surtos de Doenças
Feminino
Doença pelo Vírus Ebola/epidemiologia
Doença pelo Vírus Ebola/mortalidade
Hospitalização
Seres Humanos
Masculino
Meia-Idade
Razão de Chances
Serra Leoa/epidemiologia
Carga Viral/efeitos dos fármacos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Immune Sera)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161122
[St] Status:MEDLINE


  9 / 3005 MEDLINE  
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[PMID]:27733645
[Au] Autor:Weiss ER; Alter G; Ogembo JG; Henderson JL; Tabak B; Bakis Y; Somasundaran M; Garber M; Selin L; Luzuriaga K
[Ad] Endereço:Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
[Ti] Título:High Epstein-Barr Virus Load and Genomic Diversity Are Associated with Generation of gp350-Specific Neutralizing Antibodies following Acute Infectious Mononucleosis.
[So] Source:J Virol;91(1), 2017 Jan 01.
[Is] ISSN:1098-5514
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The Epstein-Barr virus (EBV) gp350 glycoprotein interacts with the cellular receptor to mediate viral entry and is thought to be the major target for neutralizing antibodies. To better understand the role of EBV-specific antibodies in the control of viral replication and the evolution of sequence diversity, we measured EBV gp350-specific antibody responses and sequenced the gp350 gene in samples obtained from individuals experiencing primary EBV infection (acute infectious mononucleosis [AIM]) and again 6 months later (during convalescence [CONV]). EBV gp350-specific IgG was detected in the sera of 17 (71%) of 24 individuals at the time of AIM and all 24 (100%) individuals during CONV; binding antibody titers increased from AIM through CONV, reaching levels equivalent to those in age-matched, chronically infected individuals. Antibody-dependent cell-mediated phagocytosis (ADCP) was rarely detected during AIM (4 of 24 individuals; 17%) but was commonly detected during CONV (19 of 24 individuals; 79%). The majority (83%) of samples taken during AIM neutralized infection of primary B cells; all samples obtained at 6 months postdiagnosis neutralized EBV infection of cultured and primary target cells. Deep sequencing revealed interpatient gp350 sequence variation but conservation of the CR2-binding site. The levels of gp350-specific neutralizing activity directly correlated with higher peripheral blood EBV DNA levels during AIM and a greater evolution of diversity in gp350 nucleotide sequences from AIM to CONV. In summary, we conclude that the viral load and EBV gp350 diversity during early infection are associated with the development of neutralizing antibody responses following AIM. IMPORTANCE: Antibodies against viral surface proteins can blunt the spread of viral infection by coating viral particles, mediating uptake by immune cells, or blocking interaction with host cell receptors, making them a desirable component of a sterilizing vaccine. The EBV surface protein gp350 is a major target for antibodies. We report the detection of EBV gp350-specific antibodies capable of neutralizing EBV infection in vitro The majority of gp350-directed vaccines focus on glycoproteins from lab-adapted strains, which may poorly reflect primary viral envelope diversity. We report some of the first primary gp350 sequences, noting that the gp350 host receptor binding site is remarkably stable across patients and time. However, changes in overall gene diversity were detectable during infection. Patients with higher peripheral blood viral loads in primary infection and greater changes in viral diversity generated more efficient antibodies. Our findings provide insight into the generation of functional antibodies, necessary for vaccine development.
[Mh] Termos MeSH primário: Anticorpos Neutralizantes/sangue
Anticorpos Antivirais/sangue
DNA Viral/genética
Herpesvirus Humano 4/genética
Imunoglobulina G/sangue
Mononucleose Infecciosa/imunologia
Glicoproteínas de Membrana/genética
Proteínas da Matriz Viral/genética
[Mh] Termos MeSH secundário: Doença Aguda
Adulto
Sequência de Aminoácidos
Linfócitos B/imunologia
Linfócitos B/virologia
Sequência de Bases
Estudos de Casos e Controles
Linhagem Celular Tumoral
Doença Crônica
Convalescença
DNA Viral/imunologia
Variação Genética
Herpesvirus Humano 4/crescimento & desenvolvimento
Herpesvirus Humano 4/imunologia
Interações Hospedeiro-Patógeno
Seres Humanos
Imunoglobulina G/classificação
Mononucleose Infecciosa/sangue
Mononucleose Infecciosa/virologia
Glicoproteínas de Membrana/imunologia
Monócitos/imunologia
Monócitos/virologia
Fagocitose
Cultura Primária de Células
Alinhamento de Sequência
Análise de Sequência de DNA
Carga Viral/genética
Carga Viral/imunologia
Proteínas da Matriz Viral/imunologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Neutralizing); 0 (Antibodies, Viral); 0 (DNA, Viral); 0 (GP 300-350, Epstein-Barr virus); 0 (Immunoglobulin G); 0 (Membrane Glycoproteins); 0 (Viral Matrix Proteins)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170616
[Lr] Data última revisão:
170616
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161014
[St] Status:MEDLINE


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[PMID]:27664890
[Au] Autor:Kleif J; Vilandt J; Gögenur I
[Ad] Endereço:Department of Surgery, Nordsjællands Hospital, Copenhagen University Hospital, Hillerød, Denmark. Electronic address: jakob.kleif@regionh.dk.
[Ti] Título:Recovery and convalescence after laparoscopic surgery for appendicitis: A longitudinal cohort study.
[So] Source:J Surg Res;205(2):407-418, 2016 Oct.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Information about predictors for the duration of convalescence and the overall general wellbeing after laparoscopic surgery for suspected appendicitis is missing in the scientific literature. We aimed to describe and identify predictors for the duration of convalescence and the quality of recovery for patients undergoing laparoscopic surgery for suspected appendicitis. METHODS: A prospective cohort of adult patients undergoing laparoscopic surgery for suspected appendicitis was performed between July 2014 and December 2014. Patients completed a QoR-15 questionnaire six times during the 30-d postoperative period. Time until resumption of recreational and occupational activities was recorded. Potential predictors for the duration of convalescence and the quality of recovery measured by the QoR-15 score were identified. RESULTS: A total of 108 patients were included, and 95 patients were eligible for analysis. The median duration of convalescence was 13 d. Disease, depressive mood, level of recreational activities, age, and pain at rest on the first postoperative day were significant predictors of the duration of convalescence. Gender, postoperative complications, disease, and anxiety were significant predictors of the quality of recovery during the 30-d postoperative period. A 10% increase in the QoR-15 score increased the hazard ratio of 1.24 (95% confidence interval, 1.08-1.43, P = 0.002) for ending the period of convalescence. CONCLUSIONS: Duration of convalescence after laparoscopic surgery for appendicitis seems long. Psychological factors, demographical factors, and perioperative outcomes were important predictors for the quality of recovery and the duration of convalescence. Increased quality of recovery is associated with a shorter period of convalescence.
[Mh] Termos MeSH primário: Apendicectomia/métodos
Apendicite/cirurgia
Convalescença
Laparoscopia
Recuperação de Função Fisiológica
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Apendicectomia/reabilitação
Feminino
Seres Humanos
Laparoscopia/reabilitação
Estudos Longitudinais
Masculino
Meia-Idade
Modelos de Riscos Proporcionais
Estudos Prospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170806
[Lr] Data última revisão:
170806
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160925
[St] Status:MEDLINE



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