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Kurtz T, Woitrain T, Godio-Raboutet Y, Ribeiro FLB, Arnoux PJ, Tailhan JL. Method for Evaluating Cortical Bone Young's Modulus: Numerical Twin Reconstruction, Finite Element Calculation, and Microstructure Analysis. J Biomech Eng 2023; 145:111013. [PMID: 37542711 DOI: 10.1115/1.4063100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/17/2023] [Indexed: 08/07/2023]
Abstract
The determination of bone mechanical properties remains crucial, especially to feed up numerical models. An original methodology of inverse analysis has been developed to determine the longitudinal elastic modulus of femoral cortical bone. The method is based on a numerical twin of a specific three-point bending test. It has been designed to be reproducible on each test result. In addition, the biofidelity of the geometric acquisition method has been quantified. As the assessment is performed at the scale of a bone shaft segment, the Young's modulus values obtained (between 9518.29 MPa and 14181.15 MPa) are considered average values for the whole tissue, highlighting some intersubject variability. The material microstructure has also been studied through histological analysis, and bone-to-bone comparisons highlighted discrepancies in quadrants microstructures. Furthermore, significant intrasubject variability exists since differences between the bone's medial-lateral and anterior-posterior quadrants have been observed. Thus, the study of microstructures can largely explain the differences between the elastic modulus values obtained. However, a more in-depth study of bone mineral density would also be necessary and would provide some additional information. This study is currently being setup, alongside an investigation of the local variations of the elastic modulus.
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Affiliation(s)
- T Kurtz
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille 13015, France
| | - T Woitrain
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille 13015, France
| | - Y Godio-Raboutet
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille 13015, France
| | - F L B Ribeiro
- Department of Civil Engineering, COPPE, Federal University of Rio de Janeiro, Centro de Tecnologia - Ilha do Fundao, Rio de Janeiro 21941, Brazil
| | - P-J Arnoux
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille 13015, France
| | - J-L Tailhan
- Univ Gustave Eiffel, MAST-EMGCU, Marne la Vallée 77454, France
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2
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de Paiva BBM, Pereira PD, de Andrade CMV, Gomes VMR, Souza-Silva MVR, Martins KPMP, Sales TLS, de Carvalho RLR, Pires MC, Ramos LEF, Silva RT, de Freitas Martins Vieira A, Nunes AGS, de Oliveira Jorge A, de Oliveira Maurílio A, Scotton ALBA, da Silva CTCA, Cimini CCR, Ponce D, Pereira EC, Manenti ERF, Rodrigues FD, Anschau F, Botoni FA, Bartolazzi F, Grizende GMS, Noal HC, Duani H, Gomes IM, Costa JHSM, di Sabatino Santos Guimarães J, Tupinambás JT, Rugolo JM, Batista JDL, de Alvarenga JC, Chatkin JM, Ruschel KB, Zandoná LB, Pinheiro LS, Menezes LSM, de Oliveira LMC, Kopittke L, Assis LA, Marques LM, Raposo MC, Floriani MA, Bicalho MAC, Nogueira MCA, de Oliveira NR, Ziegelmann PK, Paraiso PG, de Lima Martelli PJ, Senger R, Menezes RM, Francisco SC, Araújo SF, Kurtz T, Fereguetti TO, de Oliveira TC, Ribeiro YCNMB, Ramires YC, Lima MCPB, Carneiro M, Bezerra AFB, Schwarzbold AV, de Moura Costa AS, Farace BL, Silveira DV, de Almeida Cenci EP, Lucas FB, Aranha FG, Bastos GAN, Vietta GG, Nascimento GF, Vianna HR, Guimarães HC, de Morais JDP, Moreira LB, de Oliveira LS, de Deus Sousa L, de Souza Viana L, de Souza Cabral MA, Ferreira MAP, de Godoy MF, de Figueiredo MP, Guimarães-Junior MH, de Paula de Sordi MA, da Cunha Severino Sampaio N, Assaf PL, Lutkmeier R, Valacio RA, Finger RG, de Freitas R, Guimarães SMM, Oliveira TF, Diniz THO, Gonçalves MA, Marcolino MS. Potential and limitations of machine meta-learning (ensemble) methods for predicting COVID-19 mortality in a large inhospital Brazilian dataset. Sci Rep 2023; 13:3463. [PMID: 36859446 PMCID: PMC9975879 DOI: 10.1038/s41598-023-28579-z] [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: 12/12/2021] [Accepted: 01/20/2023] [Indexed: 03/03/2023] Open
Abstract
The majority of early prediction scores and methods to predict COVID-19 mortality are bound by methodological flaws and technological limitations (e.g., the use of a single prediction model). Our aim is to provide a thorough comparative study that tackles those methodological issues, considering multiple techniques to build mortality prediction models, including modern machine learning (neural) algorithms and traditional statistical techniques, as well as meta-learning (ensemble) approaches. This study used a dataset from a multicenter cohort of 10,897 adult Brazilian COVID-19 patients, admitted from March/2020 to November/2021, including patients [median age 60 (interquartile range 48-71), 46% women]. We also proposed new original population-based meta-features that have not been devised in the literature. Stacking has shown to achieve the best results reported in the literature for the death prediction task, improving over previous state-of-the-art by more than 46% in Recall for predicting death, with AUROC 0.826 and MacroF1 of 65.4%. The newly proposed meta-features were highly discriminative of death, but fell short in producing large improvements in final prediction performance, demonstrating that we are possibly on the limits of the prediction capabilities that can be achieved with the current set of ML techniques and (meta-)features. Finally, we investigated how the trained models perform on different hospitals, showing that there are indeed large differences in classifier performance between different hospitals, further making the case that errors are produced by factors that cannot be modeled with the current predictors.
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Affiliation(s)
- Bruno Barbosa Miranda de Paiva
- grid.8430.f0000 0001 2181 4888Computer Science Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Polianna Delfino Pereira
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil ,Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, 2359, building 21, room 507, Porto Alegre, Brazil
| | - Claudio Moisés Valiense de Andrade
- grid.8430.f0000 0001 2181 4888Computer Science Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Virginia Mara Reis Gomes
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Maira Viana Rego Souza-Silva
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Karina Paula Medeiros Prado Martins
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Thaís Lorenna Souza Sales
- grid.428481.30000 0001 1516 3599Universidade Federal de São João del-Rei, R. Sebastião Gonçalves Coelho, 400, Divinópolis, Brazil
| | | | - Magda Carvalho Pires
- grid.8430.f0000 0001 2181 4888Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, ICEx, room 4071, Belo Horizonte, Brazil
| | - Lucas Emanuel Ferreira Ramos
- grid.8430.f0000 0001 2181 4888Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, ICEx, room 4071, Belo Horizonte, Brazil
| | - Rafael Tavares Silva
- grid.8430.f0000 0001 2181 4888Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, ICEx, room 4071, Belo Horizonte, Brazil
| | | | | | | | | | | | | | | | - Daniela Ponce
- grid.410543.70000 0001 2188 478XFaculdade de Medicina de Botucatu-Universidade Estadual Paulista “Júlio de Mesquita Filho”, Av. Prof. Mário Rubens Guimarães Montenegro, s/n-UNESP-Campus de Botucatu, Botucatu, Brazil
| | | | | | - Fernanda d’Athayde Rodrigues
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre, R. Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Fernando Anschau
- grid.414914.dHospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | - Frederico Bartolazzi
- Hospital Santo Antônio, Pç. Dr. Márcio Carvalho Lopes Filho, 501, Curvelo, Brazil
| | - Genna Maira Santos Grizende
- grid.477816.b0000 0004 4692 337XHospital Santa Casa de Misericórdia de Belo Horizonte, Av. Francisco Sales, 1111, Belo Horizonte, Brazil
| | - Helena Carolina Noal
- grid.411239.c0000 0001 2284 6531Universidade Federal de Santa Maria/Hospital Universitário/EBSERH, Av. Roraima, 1000, building 22, Santa Maria, Brazil
| | - Helena Duani
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Isabela Moraes Gomes
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | | | | | | | - Juliana Machado Rugolo
- grid.410543.70000 0001 2188 478XFaculdade de Medicina de Botucatu-Universidade Estadual Paulista “Júlio de Mesquita Filho”, Av. Prof. Mário Rubens Guimarães Montenegro, s/n-UNESP-Campus de Botucatu, Botucatu, Brazil
| | - Joanna d’Arc Lyra Batista
- grid.440565.60000 0004 0491 0431Universidade Federal da Fronteira Sul, Av. Fernando Machado, 108E, Chapecó, Brazil
| | | | - José Miguel Chatkin
- grid.411379.90000 0001 2198 7041Hospital São Lucas PUCRS, Av. Ipiranga, 6690, Porto Alegre, Brazil
| | - Karen Brasil Ruschel
- grid.414871.f0000 0004 0491 7596Hospital Mãe de Deus, R. José de Alencar, 286, Porto Alegre, Brazil
| | | | | | - Luanna Silva Monteiro Menezes
- Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil ,Hospital Luxemburgo, R. Gentios, 1350, Belo Horizonte, Brazil
| | | | - Luciane Kopittke
- grid.414914.dHospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | - Luisa Argolo Assis
- grid.412520.00000 0001 2155 6671Pontifícia Universidade Católica de Minas Gerais, Av. Dom José Gaspar, 500, Belo Horizonte, Brazil
| | - Luiza Margoto Marques
- grid.419130.e0000 0004 0413 0953Faculdade de Ciências Médicas de Minas Gerais, Al. Ezequiel Dias, 275, Belo Horizonte, Brazil
| | - Magda Cesar Raposo
- grid.428481.30000 0001 1516 3599Universidade Federal de São João del-Rei, R. Sebastião Gonçalves Coelho, 400, Divinópolis, Brazil
| | - Maiara Anschau Floriani
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, R. Ramiro Barcelos, 910, Porto Alegre, Brazil ,Moinhos Research Institute, 910 Ramiro Barcelos Street, 5 floor, Porto Alegre, Brazil
| | - Maria Aparecida Camargos Bicalho
- grid.452464.50000 0000 9270 1314Fundação Hospitalar do Estado de Minas Gerais–FHEMIG, Cidade Administrativa de Minas Gerais, Edifício Gerais, 13rd floor, Rod. Papa João Paulo II, 3777, Belo Horizonte, Brazil
| | | | - Neimy Ramos de Oliveira
- grid.452464.50000 0000 9270 1314Hospital Eduardo de Menezes, R. Dr. Cristiano Rezende, 2213, Belo Horizonte, Brazil
| | | | | | | | - Roberta Senger
- grid.411239.c0000 0001 2284 6531Universidade Federal de Santa Maria/Hospital Universitário/EBSERH, Av. Roraima, 1000, building 22, Santa Maria, Brazil
| | | | | | | | - Tatiana Kurtz
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz do Sul, Brazil
| | - Tatiani Oliveira Fereguetti
- grid.452464.50000 0000 9270 1314Hospital Eduardo de Menezes, R. Dr. Cristiano Rezende, 2213, Belo Horizonte, Brazil
| | | | | | | | | | - Marcelo Carneiro
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz do Sul, Brazil
| | | | - Alexandre Vargas Schwarzbold
- grid.411239.c0000 0001 2284 6531Universidade Federal de Santa Maria/Hospital Universitário/EBSERH, Av. Roraima, 1000, building 22, Santa Maria, Brazil
| | | | - Barbara Lopes Farace
- grid.490178.3Hospital Risoleta Tolentino Neves, R. das Gabirobas, 01, Belo Horizonte, Brazil
| | | | | | | | | | - Gisele Alsina Nader Bastos
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, R. Ramiro Barcelos, 910, Porto Alegre, Brazil
| | | | | | | | | | | | - Leila Beltrami Moreira
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre, R. Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | | | | | | | - Máderson Alvares de Souza Cabral
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil
| | - Maria Angélica Pires Ferreira
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre, R. Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Mariana Frizzo de Godoy
- grid.411379.90000 0001 2198 7041Hospital São Lucas PUCRS, Av. Ipiranga, 6690, Porto Alegre, Brazil
| | | | | | - Mônica Aparecida de Paula de Sordi
- grid.410543.70000 0001 2188 478XFaculdade de Medicina de Botucatu-Universidade Estadual Paulista “Júlio de Mesquita Filho”, Av. Prof. Mário Rubens Guimarães Montenegro, s/n-UNESP-Campus de Botucatu, Botucatu, Brazil
| | | | - Pedro Ledic Assaf
- Hospital Metropolitano Doutor Célio de Castro, R. Dona Luiza, 311, Belo Horizonte, Brazil
| | - Raquel Lutkmeier
- grid.414914.dHospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | | | - Rufino de Freitas
- Hospital São João de Deus, R. do Cobre, 800, São João de Deus, Brazil
| | | | | | | | - Marcos André Gonçalves
- grid.8430.f0000 0001 2181 4888Computer Science Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Milena Soriano Marcolino
- Institute for Health Technology Assessment (IATS/ CNPq), R. Ramiro Barcelos, 2359, building 21, room 507, Porto Alegre, Brazil. .,Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, room 246, Belo Horizonte, Brazil. .,Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110 room 107. Santa Efigênia, Belo Horizonte, MG, CEP 30130-100, Brazil.
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3
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Souza-Silva MVR, Ziegelmann PK, Nobre V, Gomes VMR, Etges APBDS, Schwarzbold AV, Nunes AGS, Maurílio ADO, Scotton ALBA, Costa ASDM, Glaeser AB, Farace BL, Ribeiro BN, Ramos CM, Cimini CCR, de Carvalho CA, Rempel C, Silveira DV, Carazai DDR, Ponce D, Pereira EC, Kroger EMS, Manenti ERF, Cenci EPDA, Lucas FB, dos Santos FC, Anschau F, Botoni FA, Aranha FG, de Aguiar FC, Bartolazzi F, Crestani GP, Vietta GG, Nascimento GF, Noal HC, Duani H, Vianna HR, Guimarães HC, de Alvarenga JC, Chatkin JM, de Morais JDP, Carvalho JDSN, Rugolo JM, Ruschel KB, Gomes LDBW, de Oliveira LS, Zandoná LB, Pinheiro LS, Pacheco LS, Menezes LDSM, Sousa LDD, de Moura LCS, Santos LEA, Nasi LA, Cabral MADS, Floriani MA, Souza MD, Carneiro M, de Godoy MF, Cardoso MMDA, Nogueira MCA, Lima MOSDS, de Figueiredo MP, Guimarães-Júnior MH, Sampaio NDCS, de Oliveira NR, Andrade PGS, Assaf PL, Martelli PJDL, Martins RC, Valacio RA, Pozza R, Menezes RM, Mourato RLS, de Abreu RM, Silva RDF, Francisco SC, Guimarães SMM, Araújo SF, Oliveira TF, Kurtz T, Fereguetti TO, de Oliveira TC, Ribeiro YCNMB, Ramires YC, Polanczyk CA, Marcolino MS. Hospital characteristics associated with COVID-19 mortality: data from the multicenter cohort Brazilian Registry. Intern Emerg Med 2022; 17:2299-2313. [PMID: 36153772 PMCID: PMC9510333 DOI: 10.1007/s11739-022-03092-9] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic caused unprecedented pressure over health care systems worldwide. Hospital-level data that may influence the prognosis in COVID-19 patients still needs to be better investigated. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with in-hospital mortality in COVID-19 patients admitted to Brazilian institutions. This multicenter retrospective cohort study is part of the Brazilian COVID-19 Registry. We enrolled patients ≥ 18 years old with laboratory-confirmed COVID-19 admitted to the participating hospitals from March to September 2020. Patients' data were obtained through hospital records. Hospitals' data were collected through forms filled in loco and through open national databases. Generalized linear mixed models with logit link function were used for pooling mortality and to assess the association between hospital characteristics and mortality estimates. We built two models, one tested general hospital characteristics while the other tested ICU characteristics. All analyses were adjusted for the proportion of high-risk patients at admission. Thirty-one hospitals were included. The mean number of beds was 320.4 ± 186.6. These hospitals had eligible 6556 COVID-19 admissions during the study period. Estimated in-hospital mortality ranged from 9.0 to 48.0%. The first model included all 31 hospitals and showed that a private source of funding (β = - 0.37; 95% CI - 0.71 to - 0.04; p = 0.029) and location in areas with a high gross domestic product (GDP) per capita (β = - 0.40; 95% CI - 0.72 to - 0.08; p = 0.014) were independently associated with a lower mortality. The second model included 23 hospitals and showed that hospitals with an ICU work shift composed of more than 50% of intensivists (β = - 0.59; 95% CI - 0.98 to - 0.20; p = 0.003) had lower mortality while hospitals with a higher proportion of less experienced medical professionals had higher mortality (β = 0.40; 95% CI 0.11-0.68; p = 0.006). The impact of those association increased according to the proportion of high-risk patients at admission. In-hospital mortality varied significantly among Brazilian hospitals. Private-funded hospitals and those located in municipalities with a high GDP had a lower mortality. When analyzing ICU-specific characteristics, hospitals with more experienced ICU teams had a reduced mortality.
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Affiliation(s)
- Maira Viana Rego Souza-Silva
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais Brazil
| | - Patricia Klarmann Ziegelmann
- grid.8532.c0000 0001 2200 7498Departament of Statistics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul Brazil
| | - Vandack Nobre
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais Brazil
| | - Virginia Mara Reis Gomes
- grid.411452.70000 0000 9898 6728Centro Universitário de Belo Horizonte (UniBH), Belo Horizonte, Minas Gerais Brazil
| | | | | | | | | | | | | | - Andressa Barreto Glaeser
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul Brazil
| | - Bárbara Lopes Farace
- grid.490178.3Hospital Risoleta Tolentino Neves, Belo Horizonte, Minas Gerais Brazil
| | | | | | | | | | - Claudete Rempel
- grid.441846.b0000 0000 9020 9633Universidade Do Vale Do Taquari, Lajeado, Rio Grande do Sul Brazil
| | | | | | - Daniela Ponce
- grid.410543.70000 0001 2188 478XMedical School, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, São Paulo Brazil
| | | | | | | | | | | | | | - Fernando Anschau
- grid.414914.dHospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul Brazil
| | | | | | - Filipe Carrilho de Aguiar
- grid.411227.30000 0001 0670 7996University Hospital, Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
| | | | - Gabriela Petry Crestani
- grid.414871.f0000 0004 0491 7596Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul Brazil
| | | | | | - Helena Carolina Noal
- grid.488599.10000 0004 0481 6891Hospital Universitário de Santa Maria, Santa Maria, Rio Grande do Sul Brazil
| | - Helena Duani
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais Brazil
| | - Heloisa Reniers Vianna
- grid.419130.e0000 0004 0413 0953Faculdade de Ciências Médicas de Minas Gerais, University Hospital, Belo Horizonte, Minas Gerais Brazil
| | | | | | - José Miguel Chatkin
- grid.411379.90000 0001 2198 7041Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul Brazil
| | - Júlia Drumond Parreiras de Morais
- grid.419130.e0000 0004 0413 0953Faculdade de Ciências Médicas de Minas Gerais, University Hospital, Belo Horizonte, Minas Gerais Brazil
| | | | - Juliana Machado Rugolo
- grid.410543.70000 0001 2188 478XHospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, São Paulo Brazil
| | - Karen Brasil Ruschel
- grid.414871.f0000 0004 0491 7596Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul Brazil
| | | | | | - Liege Barella Zandoná
- grid.441846.b0000 0000 9020 9633Universidade Do Vale Do Taquari, Lajeado, Rio Grande do Sul Brazil
| | - Lílian Santos Pinheiro
- grid.411287.90000 0004 0643 9823Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Teófilo Otoni, Minas Gerais Brazil
| | - Liliane Souto Pacheco
- grid.488599.10000 0004 0481 6891Hospital Universitário de Santa Maria, Santa Maria, Rio Grande do Sul Brazil
| | - Luanna da Silva Monteiro Menezes
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais Brazil
| | | | | | - Luisa Elem Almeida Santos
- grid.441942.e0000 0004 0490 8155Centro Universitário de Patos de Minas, Patos de Minas, Minas Gerais Brazil
| | - Luiz Antonio Nasi
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul Brazil
| | - Máderson Alvares de Souza Cabral
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais Brazil
| | - Maiara Anschau Floriani
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul Brazil
| | - Maíra Dias Souza
- Hospital Metropolitano Odilon Behrens, Belo Horizonte, Minas Gerais Brazil
| | - Marcelo Carneiro
- Hospital Santa Cruz, Santa Cruz do Sul, Rio Grande do Sul Brazil
| | - Mariana Frizzo de Godoy
- grid.411379.90000 0001 2198 7041Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul Brazil
| | | | | | | | | | | | | | - Neimy Ramos de Oliveira
- grid.452464.50000 0000 9270 1314Hospital Eduardo de Menezes, Belo Horizonte, Minas Gerais Brazil
| | | | - Pedro Ledic Assaf
- Hospital Metropolitano Doutor Célio de Castro, Belo Horizonte, Minas Gerais Brazil
| | | | | | | | - Roberta Pozza
- Hospital Tacchini, Bento Gonçalves, Rio Grande do Sul Brazil
| | | | | | | | | | | | | | | | | | - Tatiana Kurtz
- Hospital Santa Cruz, Santa Cruz do Sul, Rio Grande do Sul Brazil
| | | | | | | | | | - Carísi Anne Polanczyk
- Institute for Health Technology Assessment (IATS/ CNPq), Porto Alegre, Rio Grande do Sul Brazil
- grid.8532.c0000 0001 2200 7498Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul Brazil
| | - Milena Soriano Marcolino
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais Brazil
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da Silveira WC, Ramos LEF, Silva RT, de Paiva BBM, Pereira PD, Schwarzbold AV, Garbini AF, Barreira BSM, de Castro BM, Ramos CM, Gomes CD, Cimini CCR, Pereira EC, Roesch EW, Kroger EMS, Aranha FFMG, Anschau F, Botoni FA, Aranha FG, Crestani GP, Vietta GG, Bastos GAN, Costa JHSM, da Fonseca JRCS, Ruschel KB, de Oliveira LS, Pinheiro LS, Pacheco LS, Segala LB, Couto LSF, Kopittke L, Floriani MA, Silva MM, Carneiro M, Ferreira MAP, Martins MAP, de Faria MNZ, Nogueira MCA, Guimarães Júnior MH, Sampaio NDCS, de Oliveira NR, Pertile NDM, Andrade PGS, Assaf PL, Valacio RA, Menezes RM, Francisco SC, Guimarães SMM, Araújo SF, Rezende SM, Pereira SA, Kurtz T, Fereguetti TO, Polanczyk CA, Pires MC, Gonçalves MA, Marcolino MS. Predictors of venous thromboembolism in COVID-19 patients: results of the COVID-19 Brazilian Registry. Intern Emerg Med 2022; 17:1863-1878. [PMID: 35648280 PMCID: PMC9156830 DOI: 10.1007/s11739-022-03002-z] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/06/2022] [Indexed: 12/15/2022]
Abstract
Previous studies that assessed risk factors for venous thromboembolism (VTE) in COVID-19 patients have shown inconsistent results. Our aim was to investigate VTE predictors by both logistic regression (LR) and machine learning (ML) approaches, due to their potential complementarity. This cohort study of a large Brazilian COVID-19 Registry included 4120 COVID-19 adult patients from 16 hospitals. Symptomatic VTE was confirmed by objective imaging. LR analysis, tree-based boosting, and bagging were used to investigate the association of variables upon hospital presentation with VTE. Among 4,120 patients (55.5% men, 39.3% critical patients), VTE was confirmed in 6.7%. In multivariate LR analysis, obesity (OR 1.50, 95% CI 1.11-2.02); being an ex-smoker (OR 1.44, 95% CI 1.03-2.01); surgery ≤ 90 days (OR 2.20, 95% CI 1.14-4.23); axillary temperature (OR 1.41, 95% CI 1.22-1.63); D-dimer ≥ 4 times above the upper limit of reference value (OR 2.16, 95% CI 1.26-3.67), lactate (OR 1.10, 95% CI 1.02-1.19), C-reactive protein levels (CRP, OR 1.09, 95% CI 1.01-1.18); and neutrophil count (OR 1.04, 95% CI 1.005-1.075) were independent predictors of VTE. Atrial fibrillation, peripheral oxygen saturation/inspired oxygen fraction (SF) ratio and prophylactic use of anticoagulants were protective. Temperature at admission, SF ratio, neutrophil count, D-dimer, CRP and lactate levels were also identified as predictors by ML methods. By using ML and LR analyses, we showed that D-dimer, axillary temperature, neutrophil count, CRP and lactate levels are risk factors for VTE in COVID-19 patients.
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Affiliation(s)
- Warley Cezar da Silveira
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
- grid.8430.f0000 0001 2181 4888University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Santa Efigênia, Belo Horizonte, MG CEP 30130-100 Brazil
| | - Lucas Emanuel Ferreira Ramos
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Rafael Tavares Silva
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Bruno Barbosa Miranda de Paiva
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Polianna Delfino Pereira
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359, Prédio 21 | Sala 507, Porto Alegre, Brazil
| | - Alexandre Vargas Schwarzbold
- grid.488599.10000 0004 0481 6891Hospital Universitário de Santa Maria, Av. Roraima, 1000, prédio 22, Santa Maria, Brazil
| | - Andresa Fontoura Garbini
- grid.414914.dHospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | - Bruno Mateus de Castro
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | | | - Caroline Danubia Gomes
- grid.414871.f0000 0004 0491 7596Hospital Mãe de Deus, Rua José de Alencar, 286, Porto Alegre, Brazil
| | - Christiane Corrêa Rodrigues Cimini
- grid.411287.90000 0004 0643 9823Mucuri Medical School – FAMMUC, Universidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM, Rua Cruzeiro, 01, Teófilo Otoni, Brazil
- Hospital Santa Rosalia, Rua do Cruzeiro, 01, Teófilo Otoni, Brazil
| | | | - Eliane Würdig Roesch
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | | | | | - Fernando Anschau
- grid.414914.dHospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | | | - Gabriela Petry Crestani
- grid.414871.f0000 0004 0491 7596Hospital Mãe de Deus, Rua José de Alencar, 286, Porto Alegre, Brazil
| | | | - Gisele Alsina Nader Bastos
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910, Porto Alegre, Brazil
| | | | | | - Karen Brasil Ruschel
- Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359, Prédio 21 | Sala 507, Porto Alegre, Brazil
- grid.414871.f0000 0004 0491 7596Hospital Mãe de Deus, Rua José de Alencar, 286, Porto Alegre, Brazil
| | | | | | - Liliane Souto Pacheco
- grid.488599.10000 0004 0481 6891Hospital Universitário de Santa Maria, Av. Roraima, 1000, prédio 22, Santa Maria, Brazil
| | - Luciana Borges Segala
- grid.488599.10000 0004 0481 6891Hospital Universitário de Santa Maria, Av. Roraima, 1000, prédio 22, Santa Maria, Brazil
| | - Luciana Siuves Ferreira Couto
- grid.411213.40000 0004 0488 4317Universidade Federal de Ouro Preto, Rua Diogo de Vasconcelos, 122, Ouro Preto, Brazil
| | - Luciane Kopittke
- grid.414914.dHospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | - Maiara Anschau Floriani
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Majlla Magalhães Silva
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Marcelo Carneiro
- Hospital Santa Cruz, Rua Fernando Abott, 174, Santa Cruz do Sul, Brazil
| | - Maria Angélica Pires Ferreira
- grid.414449.80000 0001 0125 3761Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | | | | | - Matheus Carvalho Alves Nogueira
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
- Hospitais da Rede Mater Dei, Av. do Contorno, 9000, Belo Horizonte, Brazil
| | | | | | - Neimy Ramos de Oliveira
- grid.452464.50000 0000 9270 1314Hospital Eduardo de Menezes, Rua Dr. Cristiano Rezende, 2213, Belo Horizonte, Brazil
| | - Nicole de Moraes Pertile
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910, Porto Alegre, Brazil
| | | | - Pedro Ledic Assaf
- Hospital Metropolitano Doutor Célio de Castro, Rua Dona Luiza, 311, Belo Horizonte, Brazil
| | | | | | | | | | | | - Suely Meireles Rezende
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Susany Anastácia Pereira
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Tatiana Kurtz
- Hospital Santa Cruz, Rua Fernando Abott, 174, Santa Cruz do Sul, Brazil
| | - Tatiani Oliveira Fereguetti
- grid.452464.50000 0000 9270 1314Hospital Eduardo de Menezes, Rua Dr. Cristiano Rezende, 2213, Belo Horizonte, Brazil
| | - Carísi Anne Polanczyk
- Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359, Prédio 21 | Sala 507, Porto Alegre, Brazil
| | - Magda Carvalho Pires
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Marcos André Gonçalves
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359, Prédio 21 | Sala 507, Porto Alegre, Brazil
| | - Milena Soriano Marcolino
- grid.8430.f0000 0001 2181 4888Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS/ CNPq), Rua Ramiro Barcelos, 2359, Prédio 21 | Sala 507, Porto Alegre, Brazil
- grid.8430.f0000 0001 2181 4888Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Belo Horizonte, Brazil
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Tailhan JL, Kurtz T, Godio-Raboutet Y, Rossi P, Thollon L. Macrocrack propagation in a notched shaft segment of human long bone: Experimental results and mechanical aspects. J Mech Behav Biomed Mater 2022; 128:105132. [DOI: 10.1016/j.jmbbm.2022.105132] [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] [Received: 07/06/2021] [Revised: 12/14/2021] [Accepted: 02/11/2022] [Indexed: 10/19/2022]
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Kurtz T, Feil AC, Nascimento LS, de Oliveira Abreu P, Scotta MC, Pinto LA. Effect of neonatal bacille Calmette-Guérin on the tuberculin skin test reaction in the first 2 years of life. Int J Tuberc Lung Dis 2020; 23:344-348. [PMID: 30871666 DOI: 10.5588/ijtld.18.0201] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Latent tuberculous infection (LTBI) is an important reservoir of disease reactivation that is sufficient to generate new cases for decades. The tuberculin skin test (TST) is an important tool to diagnose LTBI; however, neonatal bacille Calmette-Guérin (BCG) vaccination may impact interpretation of TST data. OBJECTIVES To analyse the effect of the neonatal BCG vaccine on TST reaction in the first 2 years of life in children with no identified contact with tuberculosis (TB). DESIGN This was a cross-sectional study in children up to 2 years of age who received neonatal BCG vaccination. In the absence of baseline comorbidities or contact with the bacillus, the children were given the TST. RESULTS Seventy-nine children participated in the study. A decline in TST reactivity was observed in the first 12-24 months of age in patients who had been vaccinated with neonatal BCG but with no contact with TB. After the age of 10 months, no patient showed a TST reaction of >5 mm. CONCLUSION BCG had low impact on the TST in children with no TB contact. This finding suggests the need to reassess the cut-off point to 5 mm of induration to improve TST specificity in LTBI identification.
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Affiliation(s)
- T Kurtz
- Paediatric Intensive Care Unit
| | - A C Feil
- Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul
| | - L S Nascimento
- Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul
| | | | | | - L A Pinto
- Paediatric Pulmonology Unit, Pontifícia Universidade Católica do Rio Grande do Sul, Santa Cruz do Sul, Rio Grande do Sul, Brazil
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Feil AC, Kurtz T, Abreu PDO, Zanotto JC, Selbach LS, Bianchi MF, Nascimento LS, Callai T, Dos Santos JK. Sepse tardia em Unidade de Tratamento Intensivo Neonatal. Rev Epidemiol Control Infect 2018. [DOI: 10.17058/reci.v8i4.11581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Justificativa e Objetivos: É essencial conhecer os microrganismos presentes em hemoculturas de pacientes pediátricos internados para uma melhor escolha da terapêutica antibiótica. Dessa forma, este trabalho tem como objetivo verificar a associação entre parâmetros clínicos e epidemiológicos com o desenvolvimento de sepse neonatal tardia em pacientes internados em um serviço de pediatria de um hospital do sul do Brasil. Métodos: Estudo transversal, descritivo, retrospectivo e qualiquantitativo que utilizou dados secundários oriundos dos prontuários de pacientes que apresentaram critérios clínicos para sepse neonatal, internados na Unidade de Tratamento Intensivo Neonatal (UTIN) do Hospital Santa Cruz. Resultados: Dos 588 pacientes internados na UTIN do Hospital Santa Cruz no período de 01/01/2013 a 31/12/2015, 123 recém-nascidos (RNs) preencheram os critérios para sepse neonatal tardia. Destes, 59 (47,97%) apresentaram hemocultura positiva, o que foi mais frequente em RNs prematuros (39,84%) e de baixo peso (43,90%), embora não tenha havido associação estatisticamente significativa entre estes fatores e hemocultura positiva. Dentre os possíveis fatores de risco para o desenvolvimento de sepse neonatal, o uso de ventilação mecânica (p=0,005), realização de cirurgia (p=0,019) e permanência no hospital por mais de um mês (p=0,001) apresentaram associação estatística com hemocultura positiva. Os microrganismos presentes em maior frequência nas hemoculturas foram os estafilococos coagulase negativa (S. epidermidis, S. saprophyticus e S. haemolyticus), encontrados em 35,71% das hemoculturas analisadas. Conclusão: O estudo evidenciou maior prevalência de sepse neonatal tardia em RNs prematuros e de baixo peso, que necessitaram de maiores cuidados e foram submetidos a maior manipulação durante a permanência na UTIN. Procedimentos invasivos e longa permanência hospitalar se associaram significativamente com hemocultura positiva, corroborando com o descrito na literatura.
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Sari J, Kurtz T, Hoerbe A, Silveira C, Santin L, Voos C. Síndrome de Gianotti Crosti: Relato de caso. Resid Pediatr 2015. [DOI: 10.25060/residpediatr-2015.v5n1-07] [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] Open
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Tocci G, Paneni F, Palano F, Sciarretta S, Ferrucci A, Kurtz T, Mancia G, Volpe M. Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and diabetes: a meta-analysis of placebo-controlled clinical trials. Am J Hypertens 2011; 24:582-90. [PMID: 21331058 DOI: 10.1038/ajh.2011.8] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To determine whether the administration of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) on top of standard cardiovascular (CV) therapies may reduce the incidence of new onset diabetes (NOD) in placebo-controlled clinical trials. The effects of these drugs on CV and non-CV mortality were also tested. METHODS We performed a meta-analysis of all randomized clinical trials (11 trials, n = 84,363 patients, aged 64.2 ± 5.86 years), published until 14 March 2010, in which ACE inhibitors or ARBs were compared with placebo and NOD incidence, CV, and non-CV mortality were reported. RESULTS Over an average follow-up of 4.0 ± 1.0 years, there were 1,284/15,142 (8.5%) cases of NOD in active-treated and 1,411/15,130 (9.3%) cases in placebo-treated patients in the ACE inhibitor trials, and 2,330/18,756 (12.4%) cases in active-treated and 2,669/18,800 (14.2%) cases in placebo-treated patients in the ARB trials. Overall, active therapy reduced NOD compared to placebo (odds ratio (OR) 95%, confidence interval (CI): 0.8 (0.8-0.9); P < 0.01). Both ACE inhibitors (OR 95%, CI: 0.8 (0.7-1.0); P = 0.07) and ARBs (OR 95%, CI: 0.8 (0.8-0.9); P < 0.01) reduced NOD as compared to placebo. Active treatment reduced CV mortality (OR 95%, CI: 0.9 (0.8-1.0); P < 0.01) and had a favorable impact on non-CV mortality (OR 95%, CI: 0.7 (0.9-1.0); P = 0.2) as compared to placebo. CONCLUSIONS Our findings demonstrated that ACE inhibitors or ARBs should be preferred in patients with clinical conditions that may increase risk of NOD, since these drugs reduced NOD incidence. In addition, these drugs have favorable effects on CV and non-CV mortality in high CV risk patients.
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Pravenec M, Landa V, Zidek V, Mlejnek P, Kazdova L, Kren V, Kurtz T. W09.249 Identification of SREBP1 as a quantitative trait locus for disordered lipid metabolism in the spontaneously hypertensive rat. ATHEROSCLEROSIS SUPP 2004. [DOI: 10.1016/s1567-5688(04)90248-1] [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: 10/26/2022]
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Kurtz T. 3WS16-6 Identification of angiotensin receptor antagonists with PPARγ modulating activity: Implications for treatment of the metabolic syndrome. ATHEROSCLEROSIS SUPP 2003. [DOI: 10.1016/s1567-5688(03)90797-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hajri T, Ibrahimi A, Coburn CT, Knapp FF, Kurtz T, Pravenec M, Abumrad NA. Defective fatty acid uptake in the spontaneously hypertensive rat is a primary determinant of altered glucose metabolism, hyperinsulinemia, and myocardial hypertrophy. J Biol Chem 2001; 276:23661-6. [PMID: 11323420 DOI: 10.1074/jbc.m100942200] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Genetic linkage studies implicated deficiency of CD36, a membrane fatty acid (FA) transporter, in the hypertriglyceridemia and hyperinsulinemia of the spontaneously hypertensive rat (SHR). In this study we determined whether loss of CD36 function in FA uptake is a primary determinant of the SHR phenotype. In vivo, tissue distribution of iodinated, poorly oxidized beta-methyliodophenyl pentadecanoic acid (BMIPP) was examined 2 h after its intravenous injection. Fatty acid transport was also measured in vitro over 20 to 120 s in isolated adipocytes and cardiomyocytes obtained from SHR and from a congenic line (SHRchr4) that incorporates a piece of chromosome 4 containing wild-type CD36. SHR heart and adipose tissue exhibited defects in FA uptake and in conversion of diglycerides to triglycerides that are similar to those observed in the CD36 null mouse. However, a key difference in SHR tissues is that fatty acid oxidation is much more severely impaired than fatty acid esterification, which may underlie the 4-5-fold accumulation of free BMIPP measured in SHR muscle. Studies with isolated adipocytes and cardiomyocytes directly confirmed both the defect in FA transport and the fact that it is underestimated by BMIPP. Heart, oxidative muscle, and adipose tissue in the SHR exhibited a large increase in glucose uptake measured in vivo using [(18)F]fluorodeoxyglucose. Supplementation of the diet with short-chain fatty acids, which do not require CD36-facilitated transport, eliminated the increase in glucose uptake, the hyperinsulinemia, and the heart hypertrophy in the SHR. This indicated that lack of metabolic energy consequent to deficient FA uptake is the primary defect responsible for these abnormalities. Hypertension was not alleviated by the supplemented diet suggesting it is unrelated to fuel supply and any contribution of CD36 deficiency to this trait may be more complex to determine. It may be worth exploring whether short-chain FA supplementation can reverse some of the deleterious effects of CD36 deficiency in humans, which may include hypertrophic cardiomyopathy.
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Affiliation(s)
- T Hajri
- Department of Physiology and Biophysics, State University of New York at Stony Brook, Stony Brook, New York 11794-8661, USA
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Mazolewski P, Turner JF, Baker M, Kurtz T, Little AG. The impact of nutritional status on the outcome of lung volume reduction surgery: a prospective study. Chest 1999; 116:693-6. [PMID: 10492273 DOI: 10.1378/chest.116.3.693] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [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: 11/01/2022] Open
Abstract
OBJECTIVES To study the incidence and clinical significance of nutritional deficiencies in patients with emphysema undergoing lung volume reduction surgery (LVRS). DESIGN Prospective observational study. SETTING University-based teaching hospital. PATIENTS Fifty-one consecutive patients with end-stage emphysema undergoing video-assisted thoracoscopic surgery for LVRS. INTERVENTIONS All patients had their body mass index (BMI) and serum nutritional indexes (albumin, transferrin, total protein, cholesterol) measured preoperatively and postoperatively. Various clinical parameters were also compared between two groups. RESULTS The BMI was normal in 24 patients (47%), and 27 patients (53%) had a below normal BMI. A preoperative analysis of the serum nutritional indexes revealed no clinically significant differences between the two groups, but postoperative levels were significantly lower in the low BMI group. Anthropometric measurements supported the designation of nutritional status by BMI. Clinically, 26% of the patients in the low BMI group required prolonged ventilatory support (> 24 h), compared to only 4% of the patients with a normal BMI. The hospital length of stay (LOS) also differed, averaging 15.9 days in the low BMI group, compared to an average of 11.8 days in the normal BMI group. CONCLUSION Approximately 50% of patients undergoing LVRS for emphysema have a deficient nutritional status identifiable by BMI, but not by standard nutritional indexes. This impaired nutritional status is associated with increased morbidity following LVRS. We suggest that BMI is an accurate determinant of nutritional status in this patient population, and we speculate that preoperative repletion of nutritional deficiencies may decrease hospital morbidity, hospital LOS, and overall costs in the malnourished population undergoing LVRS.
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Affiliation(s)
- P Mazolewski
- Department of Surgery, University of Nevada School of Medicine, Las Vegas 89102, USA
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Kurtz T, Emko P, White T, Belknap E, Kurtz D. The rose less sweet. J Fam Pract 1995; 41:433. [PMID: 7595255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Jacob HJ, Brown DM, Bunker RK, Daly MJ, Dzau VJ, Goodman A, Koike G, Kren V, Kurtz T, Lernmark A. A genetic linkage map of the laboratory rat, Rattus norvegicus. Nat Genet 1995; 9:63-9. [PMID: 7704027 DOI: 10.1038/ng0195-63] [Citation(s) in RCA: 349] [Impact Index Per Article: 12.0] [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: 01/26/2023]
Abstract
We report the construction of the first complete genetic linkage map of the laboratory rat. By testing 1171 simple sequence length polymorphisms (SSLPs), we have identified 432 markers that show polymorphisms between the SHR and BN rat strains and mapped them in a single (SHR x BN) F2 intercross. The loci define 21 large linkage groups corresponding to the 21 rat chromosomes, together with a pair of nearby markers on chromosome 9 that are not linked to the rest of the map. Because 99.5% of the markers fall into one of the 21 large linkage groups, the maps appear to cover the vast majority of the rat genome. The availability of the map should facilitate whole genome scans for genes underlying qualitative and quantitative traits relevant to mammalian physiology and pathobiology.
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Affiliation(s)
- H J Jacob
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown
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Duru K, Farrow S, Wang JM, Lockette W, Kurtz T. Frequency of a deletion polymorphism in the gene for angiotensin converting enzyme is increased in African-Americans with hypertension. Am J Hypertens 1994; 7:759-62. [PMID: 7986468 DOI: 10.1093/ajh/7.8.759] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In white populations, a deletion polymorphism in the gene for angiotensin converting enzyme (ACE) appears to be associated with increased risk for myocardial infarction but not for hypertension. In a population-association study in African-Americans, we compared the frequency of the ACE deletion polymorphism in subjects with hypertension versus those with normal blood pressure. The frequency of the ACE deletion allele was greater in African-Americans with hypertension than in those with normal blood pressure (P < 0.05). These findings raise the possibility that in some patient subgroups, sequence variation in or near the ACE gene may contribute to the risk for hypertension.
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Affiliation(s)
- K Duru
- Department of Medicine, Wayne State University, Detroit, Michigan
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Pravenec M, Simonet L, Kren V, St Lezin E, Levan G, Szpirer J, Szpirer C, Kurtz T. Assignment of rat linkage group V to chromosome 19 by single-strand conformation polymorphism analysis of somatic cell hybrids. Genomics 1992; 12:350-6. [PMID: 1740344 DOI: 10.1016/0888-7543(92)90384-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The rat provides a number of important models of human genetic disease; however, the rat genetic map has not been extensively developed. Although most rat chromosomes carry several gene assignments, some major linkage groups (LG) remain to be mapped. To determine the chromosome location of the largest unmapped linkage group in the rat (LG V containing multiple carboxylesterase loci), we used single-strand conformation polymorphism analysis to identify the rat esterase-10 gene in a panel of rat x mouse somatic cell hybrids. We found that the carboxylesterase gene family and hence LG V are located on rat chromosome 19. We have also confirmed the assignment of the angiotensinogen gene to rat chromosome 19 and have used a large set of recombinant inbred strains to map two anonymous variable number of tandem repeat (VNTR) markers to this chromosome. The current findings bring the total number of genes assigned to rat chromosome 19 from 3 to 19 and provide further evidence of substantial homology between this chromosome and chromosome 8 in the mouse.
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Affiliation(s)
- M Pravenec
- Institute of Physiology, Czechoslovak Academy of Sciences, Prague
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Pravenec M, Kren V, Klír P, Simonet L, Kurtz T. Identification of genes determining spontaneous hypertension. Review article. Sb Lek 1991; 93:136-41. [PMID: 1798912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- M Pravenec
- Department of Laboratory Medicine, University of California, San Francisco
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Pravenec M, Simonet L, Kren V, Kunes J, Levan G, Szpirer J, Szpirer C, Kurtz T. The rat renin gene: assignment to chromosome 13 and linkage to the regulation of blood pressure. Genomics 1991; 9:466-72. [PMID: 1674497 DOI: 10.1016/0888-7543(91)90412-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
It has recently been suggested that in the rat, sequence variation in the renin gene or closely linked genes may have the capacity to affect blood pressure and contribute to the pathogenesis of hypertension. To map the chromosomal location of the rat renin gene and to investigate its relationship to the inheritance of increased blood pressure, we studied a panel of rat x mouse somatic cell hybrids and a large set of recombinant inbred (RI) strains derived from spontaneously hypertensive rats (SHR) and normotensive Brown-Norway (BN) rats. We have found that in the rat, the renin gene is located on chromosome 13 and that it belongs to a conserved synteny group located on chromosome 1 in man and mouse. We have also found the median blood pressure of the RI strains that inherited the renin allele of the SHR to be greater than that of the RI strains that inherited the renin allele of the normotensive BN rat. These findings, together with the results of previous studies, suggest that in the rat, sequence variation in the renin gene, or in genes linked to the renin locus on chromosome 13, may have the capacity to affect blood pressure.
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Affiliation(s)
- M Pravenec
- Institute of Physiology, Czechoslovak Academy of Sciences, Prague
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Beyer WF, Schiwy-Bochat H, Hirschfelder H, Kurtz T. [Roentgen morphologic study of arthrosis of the sternoclavicular joint]. Z Orthop Ihre Grenzgeb 1990; 128:34-40. [PMID: 2138385 DOI: 10.1055/s-2008-1039858] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
X-rays of 102 sternoclavicular joints from post-mortem examination were interpreted systematically. In 89 cases we found an osteoarthrosis. We investigated the correlation between stage of osteoarthrosis and size and form of articular surface, age, sex and right or left preference. We also made a review about anatomy, embryology and pathology of the sternoclavicular joint. The differential diagnosis of sternoclavicular pain is discussed.
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Affiliation(s)
- W F Beyer
- Orthopädische Klinik der Universität Erlangen-Nürnberg
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Karczmar GS, Kurtz T, Tavares NJ, Weiner MW. Regulation of hepatic inorganic phosphate and ATP in response to fructose loading: an in vivo 31P-NMR study. Biochim Biophys Acta 1989; 1012:121-7. [PMID: 2742879 DOI: 10.1016/0167-4889(89)90084-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Fructose loading results in hepatic accumulation of fructose 1-phosphate (Fru1 P). The goals of the present experiments were: first, to distinguish between ATP, intracellular inorganic phosphate (Pi), and extracellular Pi as sources of phosphate for the phosphorylation of fructose, and second, to examine the influence of ATP and Fru1 P on movement of phosphate into and out of these three pools. To achieve these goals, 31P-NMR was used to monitor the response of hepatic ATP, Pi and Fru1 P to two consecutive injections of fructose. The first was administered with ATP at the control level, and the second, 1 h after the first, with ATP at 65% of the control level. Changes in intra- and extracellular Pi were distinguished by correlating measurements of total NMR-detectable phosphorus and NMR-detectable Pi with measurements of plasma Pi. The initial fructose injection resulted in rapid accumulation of Fru1 P, small decreases in plasma and NMR-detectable Pi and a dramatic decrease in ATP. Total NMR-detectable phosphorus did not change, suggesting that phosphate did not enter or leave the liver. Therefore, accumulation of Fru1 P was initially balanced by an equivalent decrease in ATP, without large changes in Pi. Following the second injection, when ATP was at 65% of control. Fru1 P accumulated at approximately the same rate and to the same level as achieved following the first injection. There was little further change in ATP and a marked decrease in NMR-detectable Pi, while plasma Pi was higher than after the first injection. Therefore the greater decrease in NMR-detectable Pi following the second injection represented a significant decrease in intracellular Pi. Return of Fru1 P to control coincided with a dramatic increase in plasma Pi, and a decrease in total NMR-detectable phosphate. This suggests that phosphate released from Fru1 P entered the extracellular space. These data suggest the mechanisms by which intracellular Pi is regulated. When sufficient ATP is available, ATP hydrolysis supplies phosphate for the synthesis of Fru1 P, and prevents a significant decrease in intracellular Pi. When ATP is reduced, accumulation of Fru1 P depletes intracellular Pi. Therefore, decreased availability of ATP correlates with increased utilization of intracellular Pi. When Fru1 P returns to control, the increase in intracellular Pi is limited by release of Pi into the plasma.
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Affiliation(s)
- G S Karczmar
- Department of Medicine, Veterans Administration Medical Center, San Francisco, CA 94121
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Chamouard P, Duclos B, Thomas G, Baumann R, Kurtz T, Weill JP. [Acute pancreatitis: what is the evidence in favor of a biliary etiology? Value and limits of microscopic examination of the bile]. Ann Gastroenterol Hepatol (Paris) 1988; 24:249-52. [PMID: 3061360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- P Chamouard
- Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, CHU Hautepierre, Strasbourg
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Mertz GJ, Eron L, Kaufman R, Goldberg L, Raab B, Conant M, Mills J, Kurtz T, Davis LG. Prolonged continuous versus intermittent oral acyclovir treatment in normal adults with frequently recurring genital herpes simplex virus infection. Am J Med 1988; 85:14-9. [PMID: 3044076] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In Year 1 of this two-year trial, patients with six or more genital herpes recurrences in the past year received suppressive treatment with either acyclovir, 400 mg, or placebo, orally twice daily for one year, and physician-documented recurrences were treated with open-labeled acyclovir, 200 mg, orally five times per day for five days (acute treatment). In Year 2, patients received open-labeled acyclovir treatment either with daily suppressive therapy or intermittent acute therapy. Among 683 patients who completed two years of treatment, 348 received continuous suppressive treatment for two years, 276 received acute treatment in Year 1 and suppressive treatment in Year 2, 24 received suppressive treatment in Year 1 and acute treatment in Year 2, and 35 received acute treatment for two years. Patient groups receiving intermittent acute acyclovir treatment experienced means of 7.0 to 12.6 recurrences/year during treatment as compared with 1.4 to 1.9 recurrences/year among groups receiving continuous suppressive treatment. No patients who received acute treatment remained recurrence-free for two years as compared with 29 percent of patients receiving continuous acyclovir suppression for two years. There was no evidence of cumulative toxicity detected by clinical, hematologic, or blood chemistry evaluations performed monthly in Year 1 and quarterly in Year 2. Suppressive oral acyclovir therapy remained effective and well-tolerated in this two-year trial.
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Affiliation(s)
- G J Mertz
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque 87131
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Eisenmann B, Fischbein L, Thiranos JC, Rimoli LF, Lévy M, Kurtz T, Kieny R. [Long-term course of syphilitic aortic insufficiency with ostial stenosis following surgical treatment]. Arch Mal Coeur Vaiss 1986; 79:1176-80. [PMID: 3096242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Syphilitic aortic insufficiency and coronary ostial stenosis is a rare condition. It was diagnosed in 8 patients referred for surgery. The infection, acknowledged in 3 cases, was contracted over 15 years prior to admission! The operative indication was aortic valve replacement in 6 cases (Stage II to IV dyspnoea) and coronary insufficiency in 2 cases (Stage III angina pectoris). Two cases of ostial stenosis were not identified at coronary angiography, illustrating the potential diagnostic pitfall of a disease which is often unrecognised nowadays. Preoperative echocardiography of the left main coronary artery, especially its intra-aortic segment, may be of value but was not performed in these old cases. Surgery consisted in aortic valve replacement and coronary revascularisation by decortication of the ostia or coronary bypass (1 case). The evolution was excellent in the 6 survivors, especially with respect to the anginal syndrome which was completely cured without associated treatment. A protocol of echocardiographic surveillance of the left main coronary artery has been instituted in these patients to detect any late postoperative changes after ostial decortication.
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Kerr P, Kurtz T, Hoff G. Pacemaker-associated endocarditis: report of 2 cases and review of the literature. J Am Osteopath Assoc 1986; 86:360-2. [PMID: 3733483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Drui S, Muller JJ, Kurtz T, Chatard JP, Steinmetz G, Eisenmann B. [Emboligenic abscess of the aortic ring disclosing gonococcal endocarditis. Value of echocardiography]. Ann Cardiol Angeiol (Paris) 1985; 34:89-92. [PMID: 3985557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Echocardiography has become a valuable diagnostic modality in bacterial endocarditis and of even more importance in following the subsequent course of the infection while on medical therapy. It can play an extremely important role in certain clinical circumstances, even before blood culture results are available or hemodynamic or auscultatory abnormalities appear. Nevertheless, in spite of this usefulness, the limitations of echocardiography should be recognized. The examination lacks absolute specificity and sensitivity which could result in inaccurate or delayed information in diagnosing a lesion or in recognizing local or regional complications. These advantages and limitations are well illustrated in an unusual case due to Neisseria gonorrhoeae, a causative agent whose incidence may increase over the years to come.
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Drui S, Muller JJ, Kurtz T, Chatard JP, Steinmetz G, Eisenmann B. [Current aspects of gonococcal endocarditis]. Presse Med 1984; 13:1745. [PMID: 6235493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Monassier JP, Kurtz T, Heitz A, Lachmann P, Kretz JG, Jeanblanc B, Eisenmann B, Kieny R, Kieny MT. [Aortic and mitral monovalvular replacements. Comparison of the ball prosthesis of Starr-Edwards (1260-6120) and the tilting disc prosthesis of Bjork-Shiley. Series of 390 patients]. Arch Mal Coeur Vaiss 1980; 73:79-84. [PMID: 6770788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The evaluation of short and long term replacement by the Björk-Shiley tilting disc prosthesis (BS) and by the Starr-Edwards ball and cage prosthesis (SE) was carried out on a series of 390 consecutive patients. In mitral replacement, operative mortality rate (SE 5.9 P. 100 - BS 4.8 P. 100), 5 year actuarial survival (SE 79.8 P. 100 +/- 3.8 P. 100 - BS 86.3 P. 100 +/- 9 p. 100) incidence of thromboembolic complications and valvular thrombosis (SE 1.6 P. 100 - BS 1.3 P. 100) as well as the degree of post-operative improvement were virtually identical in both types of prosthesis. Likewise, in aortic valve replacement, operative mortality rate (SE 4 p. 100 - BS 3.2 p. 100), 5 year survival (SE 82 +/- 7.8 P. 100 - BS 86 +/- 3.3 p. 100) incidence of thromboembolic complications (SE 2.2 p. 100 - BS 1.8 p. 100) and the degree of post-operative improvement were not statistically different. However, the incidence of sudden death was statistically smaller with a BS prosthesis than with a SE prosthesis (respectively 1.6 p. 100 and 6.9 p. 100).
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Eisenmann B, Jeanblanc B, Baehrel B, Kurtz T, Kieny MT, Kieny R. [Massive pulmonary embolism Apropos of 26 embolectomies with definitive survival, 10 of them by Trendelenburg's operation]. Arch Mal Coeur Vaiss 1977; 70:573-9. [PMID: 407871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The authors report 26 pulmonary embolectomies carried out successfully, 10 of them having been Trendelenberg procedures and 16 having been carried out under extracorporeal circulation. The latter method gives better results, and appears to be the procedure of choice. The haemodynamics before operation were always abnormal, and there were 4 cardiac arrests, 11 cases of severe shock, and 6 cases with less severe hypotension. In the other cases, cyanosis, respiratory distress and signs of acute cor pulmonale were the clinical features of the massive embolus. It was possible to carry out arteriography in 14 cases, and this showed extensive pulmonary vascular obstruction in between 70 and 90%. In 4 cases this procedure was followed by an exacerbation, and extremely urgent treatment became neccessary. This examination is important for diagnosis and for assessment of the prognosis. It seems clear to the authors that surgery has a certain place, alongside medical fibrinolysis of a severe prognosis. It seems clear to the authors that surgery has a certain place, alongside medical fibrinolysis of a severe pulmonary embolus. The essential indications for surgery are moribund patients, those in whom fibrinolysis is contraindicated or unsuccessful, and those with massive obstruction of the pulmonary arterial tree.
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Kieny R, Wolff F, Gross A, Mantz JM, Kurtz T, Kieny MT. [Post-traumatic interventricular communication. Closure under extracorporeal circulation]. Arch Mal Coeur Vaiss 1975; 68:97-103. [PMID: 804882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Report of one case of acquired traumatic interventricular septal defect due to a stab injury of the right ventricle by a knife. The highly-placed penetrating injury involved the muscular septum and very probably resulted in a right bundle-branch block of the His system. Surgical operation performed in view of a starting clinical intolerance with moderately increased right cardiac pressures, was done under ECC with easy suture of the septal wound. The post-operative course was normal and a quick clinical cure was noted, which persisted for 8 months after surgery. The interest of this case, in addition to the very severe condition of the patient who had sustained 11 stab-knife wounds, lies in the high localization of the septal wound, which explains the involvement of the intracardiac conduction pathways.
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Nikitine S, Schwab C, Carabatos C, Metzger H, Kurtz T, Jossot G. [Cardiac spectroscopy by means of Fourier's transformation]. Arch Mal Coeur Vaiss 1972; 65:729-34. [PMID: 4632960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Kuntzmann F, Reville P, Kurtz T, Jahn H, Stahl J. [Inhibition of natriuretic effect of angiotensin by spirolactones and salidiuretics in cirrhosis and arterial hypertension]. Pathol Biol (Paris) 1969; 17:447-58. [PMID: 4308377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Kuntzmann F, Reville P, Kurtz T, Vassaux C, Jahn H, Stahl J. [Effects of angiotensin on the kidney in liver cirrhosis]. Pathol Biol 1967; 15:1133-44. [PMID: 4295707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Jahn H, Reville P, Kurtz T, Kuntzmann F, Stahl J. [Some aspects of the action of angiotensin on the kidney]. Pathol Biol 1967; 15:641-8. [PMID: 4292970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Stahl J, Jahn H, Réville P, Kurtz T, Kuntzmann F. [Suppression by spirolactones of the natriuretic effect of angiotensin peculiar to certain cirrhotics]. C R Acad Hebd Seances Acad Sci D 1965; 261:5247-9. [PMID: 4285131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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