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Gigola F, Mantovani A, Zulli A, Bortot G, Cini C, Olivera L, Landi L, Taverna M, Masieri L, Elia A. Modified PATIO technique for urethrocutaneous fistula after hypospadias repair: Experience from a tertiary referral hospital. J Pediatr Urol 2024:S1477-5131(24)00072-X. [PMID: 38369430 DOI: 10.1016/j.jpurol.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/15/2024] [Accepted: 01/31/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Urethrocutaneous fistula (UCF) is a common complication after hypospadias repair with an incidence of 5-10%. Several techniques are described for its repair: small UCFs are frequently corrected by isolation, excision, and closure with apposition of a protective second layer. In 2008 Malone described the PATIO technique: the fistula tract is turned inside out in the urethral lumen preventing contact with passing urine without direct urethral sutures. OBJECTIVE Aim of our study is to present our outcomes using a modified version of the PATIO technique, with a more reproducible isolation of the tract and without its fixation at the urethral meatus. STUDY DESIGN We retrospectively reviewed all cases of UCFs corrected with a modified PATIO technique at our center between 2016 and 2020. Data collected from electronical clinical notes were age at UCF closure, location of UCF, presence of meatal stenosis and clinical outcomes. Data are presented as median and IQR. RESULTS In the study period we performed 425 urethroplasties for distal and mid penile hypospadias. The incidence of UCFs was 7% (30/425) and 25 patients underwent UCF correction with modified PATIO. Median age at repair was 4.5 years (IQR: 2.5-6.2). At a median follow-up of 3 years (IQR: 2-4) recurrence was observed in 5 cases out of 24 with one patient who was lost at follow-up (20.8%). One case was corrected successfully with re-do modified PATIO technique, while 4 are awaiting repair. One cases was lost at follow-up. UFC-recurrence was homogeneously distributed along the study period. DISCUSSION Risk factors for UCF recurrence are mostly the type of hypospadias, neo-urethral length, and quality of the urethral plate. Among the many existing techniques, we propose a modified version of Malone's PATIO repair. We believe that the use of four stay-suture to isolate the fistula allows a well-defined dissection of the tract along its surface, compared to the use of a single stay-suture. In our experience, there is no need to keep and fix the traction on the fistula tract to the urethral meatus, probably reflecting the efficacy of the fistula closure during the introflection, which is then maintained without traction. Limitations to our study include the retrospective nature of the review, the small sample size of the cohort and the absence of control groups. CONCLUSIONS Our results appear consistent with literature regarding the efficacy of PATIO principles in treating UCF. Modified PATIO seem to be particularly reproducible, showing encouraging results.
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Affiliation(s)
- Francesca Gigola
- School of Paediatric Surgery, University of Florence, Florence, Italy; Department of Paediatric Urology, Meyer's Children Hospital IRCCS, Florence, Italy
| | - Alberto Mantovani
- Department of Paediatric Urology, Meyer's Children Hospital IRCCS, Florence, Italy.
| | - Andrea Zulli
- School of Paediatric Surgery, University of Florence, Florence, Italy; Department of Paediatric Urology, Meyer's Children Hospital IRCCS, Florence, Italy
| | - Giulia Bortot
- Department of Paediatric Urology, Meyer's Children Hospital IRCCS, Florence, Italy
| | - Chiara Cini
- Department of Paediatric Urology, Meyer's Children Hospital IRCCS, Florence, Italy
| | - Laura Olivera
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Luca Landi
- Department of Paediatric Urology, Meyer's Children Hospital IRCCS, Florence, Italy
| | - Maria Taverna
- Department of Paediatric Urology, Meyer's Children Hospital IRCCS, Florence, Italy
| | - Lorenzo Masieri
- Department of Paediatric Urology, Meyer's Children Hospital IRCCS, Florence, Italy; Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Elia
- Department of Paediatric Urology, Meyer's Children Hospital IRCCS, Florence, Italy
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Cantone N, Catania VD, Zulli A, Thomas E, Severi E, Tocchioni F, Centonze N, Ciardini E, Noccioli B, Libri M, Gargano T, Lima M. Correction to: Comparison between two minimally invasive techniques for Hirschsprung disease: transanal endorectal pull-through (TERPT) versus laparoscopic-TERPT. Pediatr Surg Int 2023; 39:224. [PMID: 37395830 DOI: 10.1007/s00383-023-05496-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
- Noemi Cantone
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Vincenzo Davide Catania
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy.
| | - Andrea Zulli
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Eduje Thomas
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy
| | - Elisa Severi
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Francesca Tocchioni
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Nicola Centonze
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Enrico Ciardini
- Department of Pediatric Surgery, Hospital "Santa Chiara" APSS of Trento, Trento, Italy
| | - Bruno Noccioli
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Michele Libri
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy
| | - Tommaso Gargano
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy
| | - Mario Lima
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy
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Cantone N, Catania VD, Zulli A, Thomas E, Severi E, Francesca T, Nicola C, Enrico C, Bruno N, Michele L, Tommaso G, Mario L. Comparison between two minimally invasive techniques for Hirschsprung disease: transanal endorectal pull-through (TERPT) versus laparoscopic-TERPT. Pediatr Surg Int 2023; 39:198. [PMID: 37178268 DOI: 10.1007/s00383-023-05473-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Surgical treatment for Hirschsprung disease (HD) has recently evolved into different minimally invasive techniques. The aim of the present study is to compare results from two different minimal invasive approaches, transanal endorectal pull-through (TERPT) and laparoscopic-assisted endorectal pull-through (LA-TERPT). METHODS Patients have been divided into two groups according to surgical technique. Data of HD patients treated by TERPT and those treated by LA-TERPT, respectively, performed at two different centers from January 2007 to December 2017, were retrospectively collected. Patients with aganglionosis confined to the recto-sigmoid colon with a minimum follow-up period of 4 years have been included. Demographic, clinical, surgical and functional outcome data were reviewed for each group using Chi-square and Fisher tests (statistical differences were considered for p < 0.05). RESULTS Among patients treated for HD in the two centers during the study period, 65 met the inclusion criteria (37 TERPT group and 28 LA-TERPT group). No differences regarding demographic and clinical data were observed between the two groups. Operative time was longer in the LA-TERPT group (p < 0.001). Time to start oral feeding was faster in the TERPT group while hospital stay was similar between the two groups. Three patients of the TERPT group required an additional abdominal approach. The rate of early complications was higher in the TERPT group. Long-term bowel function was assessed in 31 patients for the TERPT group and 24 patients for the LA-TERPT group. Outcomes showed that the bowel functional outcome was good (BFS ≥ 17) in 55% (n = 17) of TERPT group and 54% of LA-TERPT group (p = 0.97), moderate (BFS 12 to 16) in 16% (n = 5) and 33% (n = 8), respectively (p = 0.24), and poor in 29% (n = 9) and 13% (n = 3), respectively (p = 0.23). CONCLUSIONS Both TERPT and LA-TERPT techniques should be considered safe and feasible for the treatment of HD patients. TERPT patients present faster time to return to normal bowel function while LA-TERPT patients have slightly lower incidence of postoperative complications. Long-term functional outcomes are similar between the two groups. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Noemi Cantone
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Vincenzo Davide Catania
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy.
| | - Andrea Zulli
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Eduje Thomas
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy
| | - Elisa Severi
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Tocchioni Francesca
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Centonze Nicola
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Ciardini Enrico
- Department of Pediatric Surgery, Hospital "Santa Chiara" APSS of Trento, Trento, Italy
| | - Noccioli Bruno
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Libri Michele
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy
| | - Gargano Tommaso
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy
| | - Lima Mario
- Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy
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Zulli A, Tocchioni F, Oreglio C, Biagiotti R, Di Maurizio M, Morini F. Prenatal diagnosis of isolated bowel malrotation and its impact on post-natal management. A case report and review of the literature. Journal of Pediatric Surgery Case Reports 2023. [DOI: 10.1016/j.epsc.2023.102627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Pezzoli F, Parigi S, Moroni M, Sacchini M, Mancano G, Zulli A, Morini F, Sandini E, Berti E, Gabbrielli G, Serafini L, Agostini E, Azzarà A, Padrini L, Cioni ML, Ingargiola A, Petrucci L, Paternoster F, Catarzi S. Diaphragmatic hernia in a term newborn with congenital myotonic dystrophy: case report. Acta Biomed 2023; 94:e2023097. [PMID: 36883684 DOI: 10.23750/abm.v94is1.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/12/2023] [Indexed: 03/09/2023]
Abstract
Background and aim Myotonic dystrophy (DM) is a genetic disorder determined by an amplified trinucleotide CTG repeat in the untranslated region of the DMPK gene on chromosome 19q13.3. The incidence of the congenital form is 1 in 47619 live births and the mortality in the neonatal period is up to 40%. Methods: We report a case of congenital DM (CDM, also designated Myotonic Dystrophy Type 1), presented with congenital right diaphragmatic hernia and cerebral bilateral ventricular dilatation, genetically diagnosed. Conclusions: Since no case of congenital diaphragmatic hernia associated with CDM is reported, the present case report could be considered of particular interest.
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Affiliation(s)
- Francesco Pezzoli
- Department of Paediatrics, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy.
| | - Sara Parigi
- Department of Paediatrics, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy.
| | - Marco Moroni
- Neonatal Intensive Care Unit, Interdisciplinary Specialistic Department, Intensive Activity and Emergency Area, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Michele Sacchini
- Metabolic and Muscular Unit, Meyer Children's Hospital IRCCS, Italy.
| | - Giorgia Mancano
- Medical Genetics Unit, Meyer Children's Hospital IRCCS, Florence, Italy..
| | - Andrea Zulli
- Department of Paediatrics, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy.
| | - Francesco Morini
- Neonatal Surgery Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Elena Sandini
- Neonatal Intensive Care Unit, Interdisciplinary Specialistic Department, Intensive Activity and Emergency Area, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Elettra Berti
- Neonatal Intensive Care Unit, Interdisciplinary Specialistic Department, Intensive Activity and Emergency Area, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Gabriella Gabbrielli
- Neonatal Intensive Care Unit, Interdisciplinary Specialistic Department, Intensive Activity and Emergency Area, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Lisa Serafini
- Neonatal Intensive Care Unit, Interdisciplinary Specialistic Department, Intensive Activity and Emergency Area, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Elisabetta Agostini
- Neonatal Intensive Care Unit, Interdisciplinary Specialistic Department, Intensive Activity and Emergency Area, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Angelo Azzarà
- Neonatal Intensive Care Unit, Interdisciplinary Specialistic Department, Intensive Activity and Emergency Area, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Letizia Padrini
- Neonatal Intensive Care Unit, Interdisciplinary Specialistic Department, Intensive Activity and Emergency Area, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Maria Luce Cioni
- Neonatal Intensive Care Unit, Interdisciplinary Specialistic Department, Intensive Activity and Emergency Area, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Anna Ingargiola
- Neonatal Intensive Care Unit, Interdisciplinary Specialistic Department, Intensive Activity and Emergency Area, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Letizia Petrucci
- Neonatal Intensive Care Unit, Interdisciplinary Specialistic Department, Intensive Activity and Emergency Area, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Filomena Paternoster
- Neonatal Intensive Care Unit, Interdisciplinary Specialistic Department, Intensive Activity and Emergency Area, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Serena Catarzi
- Neonatal Intensive Care Unit, Interdisciplinary Specialistic Department, Intensive Activity and Emergency Area, Meyer Children's Hospital IRCCS, Florence, Italy.
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Zulli A, Coletta R, Aldeiri B, Morabito A. Intestinal Bowel Lengthening within the First 6 Months of Life: Institutional Experience and Review of the Literature. J Indian Assoc Pediatr Surg 2023; 28:103-110. [PMID: 37197243 PMCID: PMC10185026 DOI: 10.4103/jiaps.jiaps_204_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/12/2022] [Accepted: 03/26/2022] [Indexed: 05/19/2023] Open
Abstract
Background Management of short bowel syndrome in children has been surrounded by much debate with timing of the lengthening procedure still controversial. Early bowel lengthening procedure (EBLP) has been defined as any bowel lengthening procedure performed before 6 months of age. The purpose of this paper is to report the institutional experience in EBLP and to review the literature on this subject to identify common indications. Methods An institutional retrospective analysis of all the intestinal lengthening procedures was performed. Furthermore, an Ovid/Embase search regarding children who underwent bowel lengthening in the past 38 years was conducted. Primary diagnosis, age at procedure, type of procedure, indication, and outcome were analyzed. Results Ten EBLP were performed in Manchester from 2006 to 2017. Median age at surgery was 121 days (102-140), preoperative small bowel (SB) length was 30 cm (20-49) while postoperative SB length was 54 cm (40-70), with a median increased bowel length of 80%. Ninety-seven papers were reviewed, with more than 399 lengthening procedures performed. Twenty-nine papers matched criteria with more than 60 EBLP were observed of which 10 were performed in a single center from 2006 to 2017. EBLP was performed due to SB atresia, to excessive bowel dilatation or failure to enteral feeds, at a median age of 60 days (1-90). Serial transverse enteroplasty was the most frequent procedure used lengthening the bowel from 40 cm (29-62.5) to 63 cm (49-85), with a median increased bowel length of 57%. Conclusions This study confirms that no clear consensus on indication or timing to perform early SB lengthening is reported. According to the gathered data, EBLP should be considered, only in cases of actual necessity after review of qualified intestinal failure center.
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Affiliation(s)
- Andrea Zulli
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Riccardo Coletta
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Bashar Aldeiri
- Department of Pediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
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Zulli A, Martin A, Facchini F, Coletta R, Tamburini A, Oranges T, Filippeschi C, Bassi A, Buccoliero AM, Morabito A. A Unique Case of Primary Cutaneous Adenoid Cystic Carcinoma Associated with Aplasia Cutis Congenita in a Four-Year-Old Female: A Case Report. Children 2022; 9:children9020292. [PMID: 35205012 PMCID: PMC8870953 DOI: 10.3390/children9020292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/16/2022]
Abstract
Introduction: Primary cutaneous adenoid-cystic carcinoma (PCACC) is a rare malignant tumour reported in only about 450 cases in the literature, with only two adolescent cases reported. PCACC seems to occur between the fifth and seventh decade of life, and the most frequent regions involved are head and neck (46%). Aplasia cutis congenita (ACC) has an incidence of 1:10,000, and it seems to be rarely associated with neoplastic lesions. Interestingly, the association between PCACC and ACC has, so far, never been described. Methods: We report a case of PCACC in the scalp associated with ACC in a four-year-old patient. Discussion: The patient was under follow-up at the dermatology unit, but suddenly a red lesion appeared within the ACC. This red, ulcerated area increased rapidly over six months, so it was surgically removed, and the pathological examination results were suggestive for cribriform PCACC. According to the guidelines for skin tumours, the patient underwent widening resection, and an advancement-sliding skin flap was performed to recreate the scalp. After one year of follow-up, the patient has no local or widespread recurrence of the PCACC, and the surgical scar appears to have healed well. Conclusions: This clinical case is the first known patient with PCACC associated with ACC. A skin excision biopsy should be performed with wide margins to avoid a second widening resection of skin in a similar scenario. Genetic studies may help to identify the origin of this rare association.
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Affiliation(s)
- Andrea Zulli
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (A.M.); (F.F.); (R.C.); (A.M.)
- Correspondence:
| | - Alessandra Martin
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (A.M.); (F.F.); (R.C.); (A.M.)
| | - Flavio Facchini
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (A.M.); (F.F.); (R.C.); (A.M.)
| | - Riccardo Coletta
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (A.M.); (F.F.); (R.C.); (A.M.)
| | - Angela Tamburini
- Department of Hematology-Oncology, Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Teresa Oranges
- Dermatology Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (T.O.); (C.F.); (A.B.)
| | - Cesare Filippeschi
- Dermatology Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (T.O.); (C.F.); (A.B.)
| | - Andrea Bassi
- Dermatology Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (T.O.); (C.F.); (A.B.)
| | | | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (A.M.); (F.F.); (R.C.); (A.M.)
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Coletta R, Zulli A, O’Shea K, Mussi E, Bianchi A, Morabito A. Minimizing Enterostomy Complication in Neonates, Lessons Learnt from Three European Tertiary Centres. Children (Basel) 2022; 9:children9020162. [PMID: 35204883 PMCID: PMC8870697 DOI: 10.3390/children9020162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Stoma formation in neonates is often a life-saving procedure across a variety of conditions but is still associated with significant morbidity. Tube stoma technique was originally described for short bowel patients, but in selected cases of neonates this approach could prevent the incidence of stoma-related complications. The aim of the study was to evaluate the safety and utility of tube stomas as an alternative to conventional enterostomy in the neonatal population. MATERIAL AND METHODS A retrospective multicentre analysis of neonates undergoing emergency laparotomy and tube stoma formation between 2005 and 2017 was performed. Tube stoma complications were analysed. The investigation focused on stricture, skin lesion, enteric fistula and prolapse. RESULTS Thirty-seven neonates underwent tube stoma fashioning during the study period. Tube-stoma complications were limited to three patients (8.1%), with two children (5.4%) requiring additional stoma surgery during the first 30 days because of an enterocutaneous fistula, and one child (2.7%) for bowel stenosis. CONCLUSIONS In select neonates, such as those with proximal enteric stomas, the tube stoma avoids some of the commonly encountered complications (prolapse, skin excoriation). Further prospective studies are needed to validate these findings in order for us to recommend this technique as superior.
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Affiliation(s)
- Riccardo Coletta
- Department of Paediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (A.Z.); (A.M.)
- School of Environment and Life Science, University of Salford, Salford M5 4NT, UK
- Correspondence:
| | - Andrea Zulli
- Department of Paediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (A.Z.); (A.M.)
- Department of Neurofarba, University of Florence, Viale Pieraccini 6, 50121 Florence, Italy
| | - Kathryn O’Shea
- Department of Paediatric Surgery, Royal Manchester Children’s Hospital, Manchester M13 9WL, UK;
| | - Elisa Mussi
- Department of Industrial Engineering, University of Florence, 50139 Florence, Italy;
| | - Adrian Bianchi
- Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK;
| | - Antonino Morabito
- Department of Paediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (A.Z.); (A.M.)
- Department of Neurofarba, University of Florence, Viale Pieraccini 6, 50121 Florence, Italy
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Levinger I, Brennan-Speranza TC, Zulli A, Parker L, Lin X, Lewis JR, Yeap BB. Multifaceted interaction of bone, muscle, lifestyle interventions and metabolic and cardiovascular disease: role of osteocalcin. Osteoporos Int 2017; 28:2265-2273. [PMID: 28289780 DOI: 10.1007/s00198-017-3994-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/28/2017] [Indexed: 12/22/2022]
Abstract
Undercarboxylated osteocalcin (ucOC) may play a role in glucose homeostasis and cardiometabolic health. This review examines the epidemiological and interventional evidence associating osteocalcin (OC) and ucOC with metabolic risk and cardiovascular disease. The complexity in assessing such correlations, due to the observational nature of human studies, is discussed. Several studies have reported that higher levels of ucOC and OC are correlated with lower fat mass and HbA1c. In addition, improved measures of glycaemic control via pharmacological and non-pharmacological (e.g. exercise or diet) interventions are often associated with increased circulating levels of OC and/or ucOC. There is also a relationship between lower circulating OC and ucOC and increased measures of vascular calcification and cardiovascular disease. However, not all studies have reported such relationship, some with contradictory findings. Equivocal findings may arise because of the observational nature of the studies and the inability to directly assess the relationship between OC and ucOC on glycaemic control and cardiovascular health in humans. Studying OC and ucOC in humans is further complicated due to numerous confounding factors such as sex differences, menopausal status, vitamin K status, physical activity level, body mass index, insulin sensitivity (normal/insulin resistance/T2DM), tissue-specific effects and renal function among others. Current observational and indirect interventional evidence appears to support a relationship between ucOC with metabolic and cardiovascular disease. There is also emerging evidence to suggest a direct role of ucOC in human metabolism. Further mechanistic studies are required to (a) clarify causality, (b) explore mechanisms involved and
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Affiliation(s)
- I Levinger
- Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
| | - T C Brennan-Speranza
- Department of Physiology and Bosch Institute for Medical Research, University of Sydney, Sydney, Australia
| | - A Zulli
- Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - L Parker
- Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - X Lin
- Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - J R Lewis
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - B B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia
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Affiliation(s)
- A. Zulli
- College of Health and Biomedicine, Victoria University, St Albans, Australia
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - D.L. Hare
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
- Department of Cardiology, Austin Health, Heidelberg, Australia
| | - B.F. Buxton
- Department of Cardiac Surgery, Austin Health, Heidelberg, Australia
| | - R.E. Widdop
- Department of Pharmacology, Monash University, Australia
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Wookey P, Szeto P, Zulli A, Hare D. The Recruitment of Blood-Borne Qdot-Labeled Cells into Atherosclerotic Plaque. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wookey P, Zulli A, Hare D. Calcitonin receptor-immunoreactivity associated with specific cells in diseased arteries. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Abstract
A growing body of evidence suggests that the angiotensin II fragments, Ang(1-7) and Ang(3-8), have a vasoactive role, however ACE2, the enzyme that produces Ang(1-7), or AT4R, the receptor that binds Ang (3-8), have yet been simultaneously localised in both normal and diseased human conduit blood vessels. We sought to determine the immunohistochemical distribution of ACE2 and the AT4R in human internal mammary and radial arteries from patients undergoing coronary artery bypass surgery. We found that ACE2 positive cells were abundant in both normal and diseased vessels, being present in neo-intima and in media. ACE2 positive immunoreactivity was not present in the endothelial layer of the conduit vessels, but was clearly evident in small newly formed angiogenic vessels as well as the vaso vasorum. Endothelial AT4R immunoreactivity were rarely observed in either normal and diseased arteries, but AT4R positive cells were observed adjacent to the internal elastic lamine in the internal mammary artery, in the neo-intima of radial arteries, as well as in the media of both internal mammary artery and radial artery. AT4R was abundant in vaso vasorum and within small angiogenic vessels. Both AT4R and ACE2 co-localised with smooth muscle cell alpha actin. This study identifies smooth muscle cell alpha actin positive ACE2 and AT4R in human blood vessels as well as in angiogenic vessels, indicating a possible role for these enzymes in pathological disease.
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Affiliation(s)
- A Zulli
- Department of Cardiology, Austin Health, Heidelberg 3084, Australia.
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Wookey PJ, Zulli A, Buxton BF, Hare DL. Calcitonin receptor immunoreactivity associated with specific cell types in diseased radial and internal mammary arteries. Histopathology 2008; 52:605-12. [PMID: 18370957 DOI: 10.1111/j.1365-2559.2008.02979.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To determine and quantify calcitonin receptor (CTR) immunoreactivity associated with specific cell types within, and associated with, the endothelial layers, neo-intima, media and vasa vasorum of diseased radial and internal mammary arteries. METHODS AND RESULTS Immunohistochemistry and anti-CTR antibodies were used to identify positive cells within remnants of diseased human radial (n = 3) and internal mammary arteries (n = 4) that remained after bypass surgery. Three cell types expressed CTR, including endothelial cells, fibroblast-like cells within the neo-intima, and cellular structures aligned with the smooth muscle cells of the media. Other smaller cells within the surrounding parenchyma of the vasa vasorum of diseased vessels and blood-borne cells were also immunoreactive. Immunoquantification of CTR expression (Intensity x Proportional Area) in the endothelium (P < 0.05), neo-intima (P < 0.02) and media (P < 0.03) established a significant statistical correlation (Students' two-tailed t-test) with the ratio of intimal/media thickness. CONCLUSIONS Increased immunoreactivity developed using anti-CTR antibodies was associated with specific cell types in the endothelial layers, neo-intima, media and vasa vasorum of diseased regions of radial and internal mammary arteries, in which there was an increased intimal/media ratio. Furthermore, CTR+, blood-borne cells present in the vessels of diseased regions suggest recruitment into these surrounding tissues.
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Affiliation(s)
- P J Wookey
- Departments of Cardiology, Medicine (University of Melbourne), and Cardiac Surgery, Austin Health, Heidelberg, Victoria, Australia.
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Zulli A, Widdop R, Buxton B, Burrell L, Hare D. Tu-P7: 146 Evidence for a functional role for angiotensin (1–7), angiotensin IV and the angiotensin II type 2 receptor in human blood vessels. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80852-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chu V, Brown K, Colussi D, Gao J, Bostwick J, Kasiewski C, Bentley R, Morgan S, Guertin K, Pauls HW, Gong Y, Zulli A, Perrone MH, Dunwiddie CT, Leadley RJ. Pharmacological characterization of a novel factor Xa inhibitor, FXV673. Thromb Res 2001; 103:309-24. [PMID: 11562341 DOI: 10.1016/s0049-3848(01)00328-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
FXV673 is a novel, potent, and selective factor Xa (FXa) inhibitor. FXV673 inhibited human, dog, and rabbit FXa with a K(i) of 0.52, 1.41, and 0.27 nM, respectively. FXV673 also displayed excellent specificity toward FXa relative to other serine proteases. It showed selectivity of more than 1000-fold over thrombin, activated protein C (aPC), plasmin, and tissue-plasminogen activator (t-PA). FXV673 prolonged plasma activated partial thromboplastin time (APTT) and prothrombin time (PT) in a dose-dependent fashion. In the APTT assays, the concentrations (microM) required for doubling coagulation time were 0.41 (human), 0.65 (monkey), 1.12 (dog), 0.25 (rabbit), and 0.80 (rat). The concentrations (microM) required in the PT assays were 1.1 (human), 1.32 (monkey), 2.31 (dog), 0.92 (rabbit), and 1.69 (rat). A coupled-enzyme assay was performed to measure thrombin activity following prothrombinase conversion of prothrombin to thrombin. FXV673 showed IC(50)s of 1.38 and 2.55 nM, respectively, when artificial phosphatidylserine/phosphatidylcholine (PS/PC) liposomes or fresh platelets were used as the phospholipid source for prothrombinase complex formation. It was demonstrated that FXV673 could inhibit further thrombin generation in the prothrombinase complex using PS/PC liposomes. FXV673 dose-dependently prolonged the time to vessel occlusion and inhibited thrombus formation in well-characterized canine models of thrombosis. Interspecies extrapolation (approximately 2.5-fold higher sensitivity for FXa inhibition in human than in dog) suggested that 100 ng/ml of FXV673 would be an effective plasma concentration for clinical studies. Currently FXV673 is undergoing clinical studies to be developed as an antithrombotic agent.
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Affiliation(s)
- V Chu
- Aventis Pharmaceuticals, Mail Stop: EM-A1B, Route 202 and 206, P.O. Box 6800, Bridgewater, NJ 08807, USA.
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Shen J, Zulli A, Buxton B, Liu J. Altered regulatory proteins of cell cycle progression and apoptosis in genetic hypertension. Heart Lung Circ 2000. [DOI: 10.1046/j.1443-9506.2000.08631.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE The present studies were undertaken to identify apoptosis in cardiomyocytes of genetic hypertension and to study the relationship among apoptosis, aging and blood pressure, and the effect of angiotensin-converting enzyme (ACE) inhibitors on apoptosis. METHODS Apoptosis in the hearts of spontaneously hypertensive rats (SHR) was identified by electron microscopy (EM) and DNA laddering, and quantified from age 3 weeks to 64 weeks in comparison with normotensive rats (WKY). Fibroblasts and protein products of Bcl-2 and Bax were measured by quantitative immunohistochemistry. SHR were treated with ramipril, an ACE inhibitor. RESULTS The results showed that: (1) ultrastructural characteristics of apoptosis were observed in cardiomyocytes of SHR, with shrinkage of the cell and condensation of the cytoplasm and chromatin. A DNA ladder was shown; (2) a significant increase in apoptosis in SHR began as early as age 4 weeks and reached a plateau at 16 weeks and maintained at high levels up to 64 weeks. Blood pressure (BP) in SHR started to increase significantly at age 5 weeks; (3) fibroblasts were significantly increased in the heart of SHR; (4) the ratio of Bcl-2/Bax was significantly reduced in SHR; and (6) ramipril effectively reduced apoptosis and fibroblasts, and increased the ratio of Bcl-2/Bax. CONCLUSION Apoptosis occurs in the cardiomyocytes of genetic hypertension although fibroblasts are increased, and a significant, age-dependent increase in apoptosis is observed. The increase in apoptosis occurs before the difference in blood pressure is detectable. The ACE inhibitor ramipril may be useful for prevention of apoptosis in the heart.
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Affiliation(s)
- J J Liu
- Cardiovascular Biology Unit, Austin Hospital, University of Melbourne, Heidelberg, Victoria, Australia.
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Peng L, Bradley CJ, Zulli A, Liu JJ. The relationship between apoptosis and spontaneous hypertension. Chin Med J (Engl) 1999; 112:562-8. [PMID: 11601340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
OBJECTIVE To explore the relationship between apoptosis and spontaneous hypertension, and the effect of angiotensin converting enzyme (ACE) inhibitor on apoptosis. METHODS Male spontaneously hypertensive rats (SHR) and normotensive control rats (WKY) at different ages were used, meanwhile, the treatment of SHR with ramipril, an inhibitor of ACE was administered orally (1 mg.kg-1.d-1) to SHR from 3 to 10 or from 5 to 10 weeks of age. Apoptosis in cardiomyocytes of SHR was quantified by a maximal labeling (Lmax) method and the characteristic features of apoptosis were identified by electron microscopy (EM), in situ labeling of DNA strand breaks with terminal deoxynucleotidyl transferase mediated dUTP end labeling (TUNEL) and autoradiographic analysis of DNA fragments. RESULTS The results of a quantitative method showed an age-dependent increase in apoptosis in the cardiac tissues of SHR. A significant increase in DNA breaks occurred as early as 4 weeks and continued to increase up to a plateau at 16 weeks in the cardiac tissue of SHR whereas there was no significant change in apoptosis in WKY up to 64 weeks. Moreover, after the treatment of SHR with ramipril, an inhibitor of angiotensin converting enzyme (ACE), from 3 to 10 or from 5 to 10 weeks of age, the DNA fragmentation as well as blood pressure (BP) was reduced significantly compared with that of untreated SHR (P < 0.01), and similar to that of the control WKY. CONCLUSION There is a significant increase in the apoptosis of SHR cardiac tissues with increasing age, and ramipril can significantly prevent the increase of apoptosis and in blood pressure, which demonstrates that apoptosis may be involved in the pathogenesis of genetic hypertension. The inhibition of apoptosis as well as hypertension by ACE inhibitors may open a new avenue for developing therapeutic approach for hypertension.
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Affiliation(s)
- L Peng
- Department of Laboratory Medicine, First University Hospital, West China University of Medical Sciences, Chengdu 610041, China.
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Zulli A, Buxton BF, Doolan L, Liu JJ. Augmented effects of methionine and cholesterol in decreasing the elastic lamina while thickening the aortic wall in the rat aorta. Clin Sci (Lond) 1998; 95:589-93. [PMID: 9791045 DOI: 10.1042/cs0950589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
1. Patients with an elevated plasma level of either homocysteine or cholesterol are at increased risk of cardiovascular disease. Both methionine, the precursor of homocysteine, and cholesterol are found primarily in the same foods; therefore we investigated the effect of methionine feeding alone, cholesterol feeding alone, and both, on the thickness of the aortic wall and the aortic elastic lamina of normotensive animals.2. Twenty normotensive rats were divided into four groups of five animals. The following diet was administered for 15 weeks: normal chow; normal chow supplemented with 2% methionine; normal chow supplemented with 2% cholesterol; normal chow supplemented with 2% methionine+2% cholesterol.3. The results showed a 3-fold decrease (P<0.003) in the aortic elastic lamina in the 2% methionine group and a 2.5-fold decrease in the 2% cholesterol group compared with the normal chow group. There was a 9-fold (P<0.0003) decrease in the 2% methionine+2% cholesterol group compared with the normal chow group. Furthermore, feeding with methionine plus cholesterol significantly increased aortic wall thickness compared with the methionine group, cholesterol group or control.4. These results demonstrate an augmented effect of cholesterol plus methionine in the deterioration of the aortic elastic lamina, and furthermore, the combination of these two agents increases the thickness of the aortic wall. The results indicate a more important role for these two agents in combination than for either agent alone.
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Affiliation(s)
- A Zulli
- Vascular Biology Unit, Department of Cardiac Surgery, University of Melbourne Austin Hospital, Heidelberg, Victoria 3084, Australia
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Abstract
A high plasma homocysteine level is a newly regarded risk factor for coronary artery disease. We report a synergistic effect of homocysteine plus cholesterol feeding on further raising total plasma homocysteine, cholesterol and triglycerides levels than each agent alone, which further enhances the risk of coronary artery disease.
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Affiliation(s)
- A Zulli
- Department of Cardiac Surgery, University of Melbourne, Austin Hospital, Heidelberg, VIC, Australia.
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Zulli A, Liu JJ. A novel immunohistochemical semiquantitative technique for endothelial constitutive nitric oxide synthase immunoreactivity in rat coronary artery. J Histochem Cytochem 1998; 46:257-62. [PMID: 9446833 DOI: 10.1177/002215549804600215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
It has been difficult to quantify protein production in small pathological specimens by conventional techniques. We describe a new method for semiquantification of immunohistochemical staining, which involves application of the enzyme-labeled avidin (LAB) technique, coupled with an ultra-sensitive and fast chemiluminescent substrate for alkaline phosphatase. The entire procedure can be completed in less than 3 hr. The final step involves X-ray film exposure for 30 min, and the optical density of the subsequent images is examined with a microcomputer imaging device. The optical densities are translated into relative protein concentrations by a reference standard curve, obtained via an immunoblot. To establish a model for semiquantification of endothelial constitutive nitric oxide synthase (eNOS) protein, we compared the coronary arteries of WKY rats fed a normal chow diet to the coronary arteries of WKY rats fed a cholesterol diet. Using this technique, we have found a relative 130-fold decrease in eNOS in the cholesterol-fed group compared to the normal chow-fed group.
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Affiliation(s)
- A Zulli
- Vascular Biology Unit, Department of Cardiac Surgery, University of Melbourne Austin Hospital, Heidelberg, Australia
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