RESUMO
BACKGROUND: There are few studies on the time to return to activities of daily living (ADL) after craniotomy in patients with brain tumors. This study aimed to investigate the duration before returning to ADLs after craniotomy for brain tumors and present data that can provide information and guidelines on the appropriate time needed. METHODS: Patients (n = 183 of 234) who underwent craniotomy for brain tumors between April 2021 and July 2021 capable of self-care upon discharge were enrolled, and data of 158 were collected. The start time of 85 ADL items was prospectively investigated for 4 months postoperatively, using the self-recording sheet. RESULTS: Over 89% and 87% of the patients performed basic ADL items within a month and instrumental ADL items within 2 months (medians: within 18 days), except for a few. Regarding work, 50% of the patients returned within 4 months. Washing hair with a wound was performed at 18 days of median value, after 4 months of dyeing/perming hair, 6 days of drinking coffee/tea, after 4 months of air travel, and 40 days of complementary and alternative medicine. In patients with infratentorial tumors or surgical problems, return times were much later for various items. CONCLUSIONS: It is possible to provide practical information and guidelines on the duration to return to ADL after craniotomy in brain tumor patients. These study findings also reduce uncertainty about recovery and daily life and help patients return to their daily life at the appropriate time, thereby maintaining function and daily well-being after surgery.
Assuntos
Atividades Cotidianas , Neoplasias Encefálicas , Humanos , Estudos Prospectivos , Fatores de Tempo , Neoplasias Encefálicas/cirurgia , CraniotomiaRESUMO
Hepatic steatosis (HS) beyond a certain degree can jeopardize living donor (LD) safety, particularly in right lobe (RL) donors, making it a major obstacle for donor pool expansion in adult-to-adult living donor liver transplantation (ALDLT). From July 2004 to June 2016, 58 LDs donated their RLs despite having moderate HS (30%-50% steatosis) determined by intraoperative biopsy at a single center. We performed greedy matching to compare the outcomes of the donors and recipients of this group with those of LDs with no HS. The mean left lobe (LL) HS value in the 58 cases was 20.9 ± 12.4%, which was significantly lower than the mean RL HS value (38.8 ± 6.7%, P < 0.001). The mean ratio of the remnant LL to the total liver volume was 37.8 ± 2.2. No differences were observed in the postoperative liver function and donor and recipient morbidity and mortality rates. The liver regeneration rates in recipients and donors at 1 month, 6 months, and 1 year postoperatively did not differ significantly. The patient and graft survival rates of the recipients showed no differences. The use of well-selected RL grafts with moderate steatosis does not impair graft function, recipient outcomes, or donor safety.
Assuntos
Fígado Gorduroso , Transplante de Fígado , Adulto , Hepatectomia/efeitos adversos , Humanos , Fígado , Doadores Vivos , Estudos RetrospectivosRESUMO
BACKGROUND & AIMS: Living-donor liver transplantation (LDLT) can simultaneously cure hepatocellular carcinoma (HCC) and underlying liver cirrhosis, improving long-term results in patients with HCC. ABO-incompatible LDLT could expand the living-donor pool, reduce waiting times for deceased-donor liver transplantation, and improve long-term survival for some patients with HCC. METHODS: We retrospectively reviewed the medical records of patients undergoing LDLT for HCC from November 2008 to December 2015 at a single institution in Korea. In total, 165 patients underwent ABO-incompatible and 753 patients underwent ABO-compatible LDLT for HCC. ABO-incompatible recipients underwent desensitization to overcome the ABO blood group barrier, including pretransplant plasma exchange and rituximab administration (300-375â¯mg/m2 /body surface area). RESULTS: We performed 1:1 propensity score matching and included 165 patients in each group. 82.4% of ABO-incompatible and 83.0% of -compatible LDLT groups had HCC within conventional Milan criteria, respectively, and 92.1% and 92.7% of patients in each group had a Child-Pugh score of A or B. ABO-incompatible and -compatible LDLT groups were followed up for 48.0 and 48.7â¯months, respectively, with both groups showing comparable recurrence-free survival rates (hazard ratio [HR] 1.14; 95% CI 0.68-1.90; pâ¯=â¯0.630) and overall patient-survival outcomes (HR 1.10; 95% CI 0.60-2.00; pâ¯=â¯0.763). CONCLUSIONS: These findings suggested that ABO-incompatible liver transplantation is a feasible option for patients with HCC, especially for those with compensated cirrhosis with HCC within conventional Milan criteria. LAY SUMMARY: Despite hypothetical immunological concerns that the desensitization protocol for breaking through the ABO blood group barrier might have a negative impact on the recurrence of hepatocellular carcinoma, our experience demonstrated no significant differences in the long-term overall survival and recurrence-free survival rates between patients receiving ABO-compatible or ABO-incompatible liver transplantation. In conclusion, results from our institution indicated that ABO-incompatible living-donor liver transplantation constitutes a potentially feasible option for patients with hepatocellular carcinoma, especially those with compensated cirrhosis with hepatocellular carcinoma within conventional Milan criteria.
Assuntos
Incompatibilidade de Grupos Sanguíneos/imunologia , Carcinoma Hepatocelular/imunologia , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/imunologia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Doadores Vivos , Sistema ABO de Grupos Sanguíneos/imunologia , Adulto , Intervalo Livre de Doença , Seleção do Doador , Feminino , Humanos , Estimativa de Kaplan-Meier , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Pontuação de Propensão , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Imunologia de TransplantesRESUMO
Randomized, open-label, comparative, single-center, Phase 4, 24-week study comparing pharmacokinetics (PK), safety, and efficacy of once-daily, prolonged-release tacrolimus (PR-T) with twice-daily, immediate-release tacrolimus (IR-T) in adult de novo living-donor liver transplant (LDLT) recipients in Korea. All patients received intravenous tacrolimus from Day 0 (transplantation) for 4 days and were randomized (1:1) to receive oral PR-T or IR-T from Day 5. PK profiles were taken on Days 6 and 21. Primary endpoint: area under the concentration-time curve over 24 hour (AUC0-24 ). Predefined similarity interval for confidence intervals of ratios: 80%-125%. Secondary endpoints included: tacrolimus concentration at 24 hour (C24 ), patient/graft survival, biopsy-confirmed acute rejection (BCAR), treatment-emergent adverse events (TEAEs). One-hundred patients were included (PR-T, n = 50; IR-T, n = 50). Compared with IR-T, 40% and 66% higher mean PR-T daily doses resulted in similar AUC0-24 between formulations on Day 6 (PR-T:IR-T ratio of means 96.8%), and numerically higher AUC0-24 with PR-T on Day 21 (128.8%), respectively. Linear relationship was similar between AUC0-24 and C24 , and formulations. No graft loss/deaths, incidence of BCAR and TEAEs similar between formulations. Higher PR-T vs IR-T doses were required to achieve comparable systemic exposure in Korean de novo LDLT recipients. PR-T was efficacious; no new safety signals were detected.
Assuntos
Rejeição de Enxerto/tratamento farmacológico , Sobrevivência de Enxerto/efeitos dos fármacos , Transplante de Fígado/efeitos adversos , Doadores Vivos/provisão & distribuição , Complicações Pós-Operatórias/tratamento farmacológico , Tacrolimo/administração & dosagem , Tacrolimo/farmacologia , Adulto , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/etiologia , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/farmacocinética , Imunossupressores/farmacologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Prognóstico , Tacrolimo/farmacocinética , Distribuição TecidualRESUMO
Postoperative management after transsphenoidal surgery (TSS) is important; however, the guidelines for resuming daily activities after TSS are insufficient. This study aimed to examine the time to return to activities of daily living (ADL) after TSS for pituitary tumors. A 4-month prospective data collection was completed for 114 of 117 patients who underwent TSS for pituitary tumors from April to July 2021. The time when the patient returned to ADL after surgery was measured using the self-recording sheet. More than 97% and 92% of the patients returned within 1 month (median: within 7 days) for the elements of basic ADL and within 2 months (median: within 15 days) for the elements of instrumental ADL, excluding a few. Notably, 73.3% of patients returned to work within 4 months. The median time for the activities included 64 days for washing hair head down, 44 days for blowing nose, 59 days for lifting heavy objects, and 102 days for sexual activity. For patients who received extended-TSS or had postoperative problems, the time to return was delayed. Based on these results, it will be possible to provide practical information and guidelines on the time to return to ADL after TSS in pituitary tumor patients.
Assuntos
Atividades Cotidianas , Neoplasias Hipofisárias , Humanos , Neoplasias Hipofisárias/cirurgia , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/cirurgia , Estudos RetrospectivosRESUMO
Drosophila ecdysone-induced protein 78 (E78) belongs to the nuclear receptor (NR) superfamily, it plays a role directly related to ecdysone signaling. We isolated a cDNA of Drosophila E78 orthologue from the Platyhelminth Schistosoma mansoni (SmE78). It is the first E78 orthologue known outside of the molting animals--the Ecdysozoa. The SmE78 cDNA is 3471 base pairs long and contains an entire open reading frame (ORF) encoding a 1087 amino acid protein. Phylogenetic analysis of the ligand-binding domain (LBD) demonstrates that the LBD of SmE78 is phylogenetically related to the Drosophila E78. Gene structure of SmE78 was determined showing it to consist of six exons spanning more than 32 kbp. Quantitative real-time reverse-transcriptase polymerase chain reaction (RT-PCR) demonstrated that SmE78 was expressed throughout schistosome development but with the highest levels of expression in miracidia and egg stage. The result is consistent with the previous studies that Ecdysterone was effective in stimulating host location activities in miracidia. The data suggest that SmE78 may be involved in transduction of an ecdysone signal in S. mansoni.
Assuntos
Proteínas de Helminto/genética , Receptores Citoplasmáticos e Nucleares/genética , Schistosoma mansoni/genética , Sequência de Aminoácidos , Animais , Teorema de Bayes , Biomphalaria , Cricetinae , DNA Complementar/química , DNA Complementar/isolamento & purificação , Proteínas de Drosophila/genética , Éxons , Feminino , Regulação da Expressão Gênica , Proteínas de Helminto/química , Ligantes , Funções Verossimilhança , Masculino , Mesocricetus , Dados de Sequência Molecular , Filogenia , Receptores Citoplasmáticos e Nucleares/química , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Schistosoma mansoni/química , Alinhamento de SequênciaRESUMO
BACKGROUND: Hepatitis C virus (HCV) universally recurs after liver transplantation (LT). Although the introduction of direct-acting antiviral agents (DAAs) has revolutionized the treatment of HCV infection, no optimal treatment for HCV recurrence after LT has been developed. METHODS: This study retrospectively evaluated the efficacy of DAAs as a pre-emptive treatment for recurrent HCV infection after living donor liver transplantation (LDLT). From January 2010 to December 2016, 70 patients received pegylated interferon (PegIFN) and 35 patients were treated with DAA-based regimens to treat recurrent HCV after LDLT. All antiviral treatments were pre-emptive. RESULTS: Genotype 1b was the most common HCV type (61.9%). Twenty-two recipients in the DAA group were treated with ledipasvir/sofosbuvir, nine received daclatasvir plus asunaprevir, three received sofosbuvir, and one received sofosbuvir plus daclatasvir. All 35 patients (100%) in the DAA group achieved a sustained virologic response (SVR), a percentage significantly higher than that (71.4%) in the PegIFN group (p < 0.001). In the PegIFN group, the 1-, 3-, and 5-year graft survival rates were 85.7, 73.9, and 70.7%, respectively, whereas those in the DAA group were 100, 100, and 100%, respectively (p = 0.008). CONCLUSION: DAA-based regimens are an effective treatment for HCV recurrence after LDLT, resulting in an improved SVR and better graft survival than PegIFN.
Assuntos
Antivirais/uso terapêutico , Sobrevivência de Enxerto , Hepatite C Crônica/prevenção & controle , Transplante de Fígado , Prevenção Secundária/métodos , Resposta Viral Sustentada , Adulto , Idoso , Benzimidazóis/uso terapêutico , Carbamatos , Quimioterapia Combinada , Feminino , Fluorenos/uso terapêutico , Genótipo , Hepacivirus/genética , Humanos , Imidazóis/uso terapêutico , Interferon alfa-2/uso terapêutico , Interferon-alfa/uso terapêutico , Isoquinolinas/uso terapêutico , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/uso terapêutico , Pirrolidinas , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos , Sofosbuvir/uso terapêutico , Sulfonamidas/uso terapêutico , Uridina Monofosfato/análogos & derivados , Uridina Monofosfato/uso terapêutico , Valina/análogos & derivadosRESUMO
OBJECTIVES: Sustained-release once-daily tacrolimus pharmacokinetics have not yet been characterized in de novo living-donor liver transplant recipients. Here, a 12-week, phase IV, single center, open-label, prospective pilot study was conducted to investigate the pharmacokinetics of this formulation in these patients. MATERIALS AND METHODS: Patients received continuous intravenous infusion of tacrolimus on days 0 to 5 after transplant, which was followed by oral once-daily sustained-release tacrolimus. Two 24-hour pharmacokinetics profiles were generated for 10 patients on days 6 and 14. Secondary endpoints were minimum (trough level) and maximum whole blood concentrations, time to maximum concentration, and incidences of acute rejection, patient and graft survival, and adverse events. RESULTS: Mean doses (± standard deviation) of sustained-release tacrolimus on days 6 and 14 were 0.14 ± 0.03 and 0.17 ± 0.04 mg/kg. Levels were within the recommended range throughout the study. When the actual dose was examined, area under the curve from 0 to 24 hours on day 14 was 1.8-fold higher than that on day 6 (423.9 vs 235.7 ng × h/mL). When tacrolimus was normalized to 0.1 mg/kg, area under the curve from 0 to 24 hours on day 14 was 1.5-fold higher than on day 6 (279.3 vs 183.4 ng × h/mL). When we used the actual dose, we found the correlation coefficient between area under the curve from 0 to 24 hours and trough level to be higher on day 6 (r = 0.87) than on day 14 (r = 0.691). No acute rejections, graft losses, patient deaths, or drug-related adverse events were reported. CONCLUSIONS: Initial intravenous followed by sustained-release tacrolimus was safe and efficacious in living-donor liver transplant recipients. The mean area under the curve from 0 to 24 hours on day 14 was higher than previously reported; this difference may reflect cautious dosing regimens.
Assuntos
Inibidores de Calcineurina/farmacocinética , Imunossupressores/farmacocinética , Transplante de Fígado/métodos , Doadores Vivos , Tacrolimo/farmacocinética , Administração Oral , Área Sob a Curva , Inibidores de Calcineurina/administração & dosagem , Inibidores de Calcineurina/efeitos adversos , Inibidores de Calcineurina/sangue , Preparações de Ação Retardada , Esquema de Medicação , Composição de Medicamentos , Cálculos da Dosagem de Medicamento , Monitoramento de Medicamentos , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Imunossupressores/sangue , Infusões Intravenosas , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Projetos Piloto , Estudos Prospectivos , República da Coreia , Tacrolimo/administração & dosagem , Tacrolimo/efeitos adversos , Tacrolimo/sangue , Resultado do TratamentoRESUMO
We report the case of a 32-year-old woman who was diagnosed as having small cell variant type anaplastic large cell lymphoma with peripheral involvement. A cytogenetic study showed a complex translocation, t(2;5;13)(p23;q35;q14). Fluorescence in situ hybridization with ALK break-apart probes confirmed that the three-break rearrangement involves the ALK gene.
Assuntos
Cromossomos Humanos Par 2 , Cromossomos Humanos Par 5 , Linfoma Difuso de Grandes Células B/genética , Adulto , Quinase do Linfoma Anaplásico , Feminino , Humanos , Hibridização in Situ Fluorescente , Cariotipagem , Linfoma Difuso de Grandes Células B/patologia , Proteínas Tirosina Quinases/genética , Receptores Proteína Tirosina Quinases , Translocação GenéticaRESUMO
Gene amplification is a relatively rare event in hematologic malignancies. The ABL gene on chromosome band 9q34 is a proto-oncogene and is the well-known translocation partner of the BCR gene on 22q11 giving rise to t(9;22)(q34;q11), which is the hallmark of chronic myeloid leukemia and is the most common chromosomal abnormality in adult acute lymphoblastic leukemia (ALL). Amplification of ABL is an exceedingly rare event, with only less than 5 cases reported in the literature. The p16(INK4a) (or CDKN2A) gene on 9p21 is a tumor suppressor gene, and deletion thereof is recently recognized as one of the most common genetic abnormalities in ALL. The authors herein describe an 8-year-old male patient with precursor T-cell ALL harboring both ABL gene amplification and p16(INK4a) gene deletion. Fluorescence in situ hybridization (FISH) analysis using BCR/ABL probes revealed five or more ABL signals, indicating amplification in 51.5% of interphase nuclei. FISH using p16(INK4a) gene probes showed heterozygous p16(INK4a) deletion in 71.0%. On conventional cytogenetic analysis, however, only 10 metaphases were available, which showed the normal karyotype, 46,XY[10], serving no evidence for the findings on FISH. This is the first report of an ALL case with ABL amplification, and the authors speculate that both ABL proto-oncogene amplification and the p16(INK4a) tumor suppressor gene deletion have been implicated in leukemogenesis in the present case, although whether the ABL amplification truly contributes to the leukemogenesis or merely an epiphenomenon representing underlying genomic instability remains to be determined.