RESUMO
Epidermal growth factor receptor inhibitors (EGFRIs) frequently cause cutaneous adverse effects such as papulopustular eruptions. However, the mechanism of the reactions remains unclear. To assess the pathological mechanism of cutaneous adverse reactions caused by EGFRIs, we investigated whether EGFRIs have an influence on the innate immune response of the skin. Levels of human ß-defensins (hBDs), which serve as the first line of defence against infection by pathogenic microorganisms, in the stratum corneum samples of patients treated with EGFR. monoclonal antibodies were measured before and after starting therapy. There were no obvious trends in hBD production in patients without eruptions, whereas a significant decrease in hBD1 and hBD3 production and a nonsignficant decrease in hBD2 production were observed in patients who developed papulopustular eruptions. Our results suggest that a reduction in hBD contributes to the increased incidence of papulopustular eruptions.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Receptores ErbB/antagonistas & inibidores , beta-Defensinas/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos/análise , Anti-Infecciosos/metabolismo , Anticorpos Monoclonais/imunologia , Anticorpos Monoclonais/uso terapêutico , Toxidermias/etiologia , Toxidermias/imunologia , Toxidermias/microbiologia , Epiderme/efeitos dos fármacos , Epiderme/metabolismo , Epiderme/patologia , Receptores ErbB/imunologia , Feminino , Humanos , Imunidade Inata/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Infecções Cutâneas Estafilocócicas/induzido quimicamente , Infecções Cutâneas Estafilocócicas/epidemiologia , beta-Defensinas/análiseRESUMO
BACKGROUND: Ceramide is a crucial lipid in the stratum corneum (SC) which maintains the barrier function and hydration of the skin. In atopic dermatitis (AD) patients who have defective skin barrier function, ceramide levels are altered. We previously reported that although the amount of total ceramide was lower in involved skin compared with uninvolved skin of AD patients and with healthy control skin, the amounts of smaller ceramide species of Cer[NS] (<40 total carbons, which are total carbons of both sphingoid base and amide-linked fatty acid), especially Cer[NS] with 34 total carbons (C34-Cer[NS]), were higher. However, the enzyme(s) that produces the higher levels of smaller ceramide species in involved skin of AD patients was unclear. OBJECTIVE: To identify the enzyme(s) that produces higher levels of smaller ceramide species of Cer[NS] in the involved skin of AD patients. METHODS: Eight female Caucasian subjects who were diagnosed with AD on their arms (age range: 21-45 years) were enroled in this study. We compared ceramide levels in the SC and the expression levels of enzymes involved in ceramide metabolism using real-time PCR and immunohistochemistry between involved and uninvolved skin of AD patients. RESULTS: Level of mRNA encoding ceramide synthase 4 (CERS4), which is one of the enzymes that synthesize ceramide from a sphingoid base and an amide-linked fatty acid, was significantly higher in involved skin than in uninvolved skin (P < 0.01). Additionally, the protein expression level of CERS4 in the epidermis was also higher in involved skin compared with uninvolved skin. The expression level of CERS4 correlated with the amount of C34-Cer[NS] (P < 0.01) and the skin hydration value (P < 0.05). CONCLUSIONS: The elevated expression level of CERS4 contributes to the increase of C34-Cer[NS] and the impaired SC barrier function in involved skin of AD patients.
Assuntos
Dermatite Atópica/enzimologia , Pele/enzimologia , Esfingosina N-Aciltransferase/metabolismo , Adulto , Criança , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
WHAT IS KNOWN AND OBJECTIVE: Endoscopic submucosal dissection of early colorectal neoplasms (ESD-ECN) is known to be an operation with risk of contamination, possibly requiring pre-operative antimicrobial prophylaxis for the prevention of post-operative infection. However, an evaluation of the need for pre-operative antimicrobial prophylaxis for ESD-ECN has yet to be reported. The objective of this study was to determine whether pre-operative antimicrobial prophylaxis is associated with a reduced incidence of post-operative infection following ESD-ECN. METHODS: The present retrospective case-controlled study utilized a database built from the medical records of 14 university hospitals throughout Japan. Patients who were admitted and discharged from the hospital from April 2012 to October 2013 and who had undergone ESD-ECN were included in the study. Patients who had been undergone any other operation during their course of hospitalization, and patients who were prescribed antimicrobial agents for reasons other than post-operative infection or for prophylaxis were excluded. Characteristics of the study population, pre-operative antimicrobial prophylaxis and antimicrobial therapy for post-operative infection were investigated. In addition, we compared the characteristics of patients with post-operative infection (PI) and those with no post-operative infection (NPI). Univariate analyses were used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS AND DISCUSSION: We obtained the records of 522 patients who had undergone ESD-ECN from the database. After application of exclusion criteria, 421 patients were enrolled. The post-operative infection rate was 1·2%. Peritonitis was found most to be the most common post-operative infection (44%). Pre-operative antimicrobial prophylaxis was used for 314 patients (75%), with a median duration of 3·0 (range 1-11) days. Cefotiam was most frequently prescribed for pre-operative antimicrobial prophylaxis (56%). Antimicrobial therapies were started 1-10 days after ESD-ECN for a duration of 1-14 days. Pre-operative antimicrobial prophylaxis was not associated with post-operative infection rate, with an OR (95% CI) of 0·73 (0·08-6·61). However, digestive tract perforation was shown to be associated with post-operative infection and had an OR (95% CI) of 17·1 (1·66-176·45). WHAT IS NEW AND CONCLUSION: Post-operative infection is an exceedingly rare event following ESD-ECN. Pre-operative antimicrobial prophylaxis had no significant effect on post-operative infection following ESD-ECN and thus may be unnecessary. Instead, prevention of digestive tract perforation may be more critical for the decrease in post-operative infections.
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BACKGROUND: Viral infections and their occult reactivation occasionally cause not only organ damage, but also exacerbation of acute graft-versus-host disease (aGVHD), which may increase transplantation-related mortality synergistically. To determine correlations between viral reactivation and transplantation-related complications, we performed various viral screening tests on the 30th day after allogeneic hematopoietic stem cell transplantation (HSCT), and assessed the clinical implications. PATIENTS AND METHODS: Between August 2007 and January 2013, 49 patients (37 men, 12 women) underwent HSCT in our hospital. The stem cell sources were bone marrow (n = 21), peripheral blood (n = 13), and cord blood (n = 15). The presence of cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpesvirus (HHV) 6, and HHV7 in plasma samples prospectively collected from HSCT recipients on day 30 after HSCT was assayed by quantitative polymerase chain reaction, and the correlations with transplantation-related complications were evaluated. RESULTS: The positivities of CMV, EBV, HHV6, and HHV7 were 44.9%, 22.4%, 53.1%, and 18.3%, respectively. We analyzed transplantation-related complications, and a significant correlation was found only between HHV6 and grade 2-4 aGVHD from day 30 to day 100 (P < 0.001). Using a receiver operating characteristic curve, the area under the curve was calculated as 0.86 (95% confidence interval [CI], 0.74-0.98) between the viral load (VL) of HHV6 and grade 2-4 aGVHD. The sensitivity and specificity were 79% and 93%, respectively, when a cutoff value of 87 copies/mL was used. In multivariate analysis using the Fine and Gray proportional hazards model, the clinically determined high-risk patients (P = 0.004; hazard ratio [HR], 3.69; 95% CI, 1.52-9.00) and the positivity of HHV6 (P < 0.001; HR, 9.957; 95% CI, 2.68-37.06) were extracted as independent risk factors for the cumulative incidence of grade 2-4 aGVHD on or after post-HSCT day 30. The only risk factor extracted for the elevation of HHV6 VL >87 copies/mL was cord blood transplantation (P = 0.0032; odds ratio, 7.10; 95% CI, 1.98-30.00). CONCLUSION: All of the risk factors previously reported to predict severe aGVHD were obtained only during, but not after, HSCT. Our study suggests that the reactivation of HHV6 (≥ 87 copies/mL) at 30 days after HSCT is a possible predictive marker for grade 2-4 aGVHD on or after post-HSCT day 30.
Assuntos
Doença Enxerto-Hospedeiro/patologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Herpesvirus Humano 6/fisiologia , Infecções por Roseolovirus/virologia , Ativação Viral/fisiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Transplante Homólogo , Latência Viral , Adulto JovemRESUMO
BACKGROUND/AIMS: Despite our understanding that the care of back and buttock skin is important for elderly nursing patients, the stratum corneum (SC) functions of the skin on the trunk of elderly patients have not been well investigated. METHODS: Overall, 41 elderly subjects (average age: 75.9 years, 20 male and 21 female) and 20 middle-aged subjects (average age: 41.3 years, 10 male and 10 female) residing in Tokyo were recruited. Hydration of the SC, transepidermal water loss (TEWL), skin surface pH, total bacteria and inflammatory cytokines in the SC of skin on the buttocks, back, lower leg and inner forearm were measured. RESULTS AND CONCLUSION: The hydration of the SC decreased only on the lower leg with age. TEWL showed no change with age at any site. The pH was significantly higher in elderly skin than in middle-aged skin at all sites. The number of total bacteria on the forearm and back increased with age. The ratio of interleukin-1α (IL-1α) and IL-1α receptor antagonist was only higher on the middle-aged forearm compared to the elderly. No remarkable gender difference was found in these parameters without pH values. We clarified that most of the SC functional parameters change with age on both the trunk and the limbs in a similar manner, suggesting that the limbs are acceptable sites to estimate the SC functions of the trunk of elderly patients. Our study may be useful as basic data for future work to maintain the SC function of elderly patients.
Assuntos
Epiderme/fisiologia , Adulto , Fatores Etários , Idoso , Epiderme/microbiologia , Extremidades , Feminino , Humanos , Concentração de Íons de Hidrogênio , Proteína Antagonista do Receptor de Interleucina 1/análise , Interleucina-1alfa/análise , Masculino , Pessoa de Meia-Idade , Tronco , Perda Insensível de ÁguaRESUMO
PURPOSE: In Japan, a national surveillance study of antimicrobial consumption has never been undertaken. This study aimed to describe antimicrobial consumption and resistance to Pseudomonas aeruginosa in 203 Japanese hospitals, to identify targets for quality improvement. METHODS: We conducted an ecological study using retrospective data (2010). Antimicrobial consumption was collected in the World Health Organization (WHO) anatomical therapeutic chemical/defined daily dose (ATC/DDD) format. Rates of imipenem (IPM), meropenem (MEPM), ciprofloxacin (CPFX), or amikacin (AMK) resistance were expressed as the incidence of non-susceptible isolates. Additionally, hospitals were asked to provide data concerning hospital characteristics and infection control policies. Hospitals were classified according to functional categories of the Medical Services Act in Japan. RESULTS: Data were collected from 203 Japanese hospitals (a total of 91,147 beds). The total antimicrobial consumption was 15.49 DDDs/100 bed-days (median), with consumptions for penicillins, carbapenems, quinolones, and glycopeptides being 4.27, 1.60, 0.41, and 0.49, respectively. The median incidences of IPM, MEPM, CPFX, and AMK resistance were 0.15, 0.10, 0.13, and 0.03 isolates per 1,000 patient-days, respectively. Antimicrobial notification and/or approval systems were present in 183 hospitals (90.1 %). In the multivariate analysis, the piperacillin/tazobactam, quinolones, and/or total consumptions and the advanced treatment hospitals showed a significant association with the incidence of P. aeruginosa resistant to IPM, MEPM, CPFX, and AMK [adjusted R (2) (aR (2)) values of 0.23, 0.30, 0.22, and 0.35, respectively). CONCLUSION: This is the first national surveillance study of antimicrobial consumption in Japan. A continuous surveillance program in Japan is necessary in order to evaluate the association among resistance, antimicrobial restriction, and consumption.
Assuntos
Farmacorresistência Bacteriana Múltipla , Uso de Medicamentos/estatística & dados numéricos , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/efeitos dos fármacos , Amicacina/uso terapêutico , Antibacterianos/uso terapêutico , Ciprofloxacina/uso terapêutico , Revisão de Uso de Medicamentos/métodos , Hospitais/normas , Humanos , Imipenem/uso terapêutico , Incidência , Japão/epidemiologia , Meropeném , Testes de Sensibilidade Microbiana , Programas Nacionais de Saúde , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/isolamento & purificação , Estudos Retrospectivos , Inquéritos e Questionários , Tienamicinas/uso terapêuticoRESUMO
The objectives of this study were to identify a plant extract that would improve stratum corneum functions and to elucidate the mechanism(s) involved. Based on the information that stratum corneum functions depend on the level of ceramide in the stratum corneum, we identified a Eucalyptus extract that was able to increase the level of ceramide in human keratinocytes in culture and in human stratum corneum and that improves the stratum corneum water holding and barrier functions. Addition of the Eucalyptus extract to human keratinocytes in culture increased the level of ceramide in a dose-dependent manner and also increased the biosynthesis of ceramide, glucosylceramide and sphingomyelin. Topical application of the Eucalyptus extract on the dry skin of human subjects induced by acetone and diethylether treatment resulted in a significant increase in ceramide level in the stratum corneum, a significant improvement in its water-holding function and an improvement in its barrier function. The addition of macrocarpal A, one of the main components of the Eucalyptus extract, to human keratinocytes in culture increased the level of ceramide and the mRNA expression of serine palmitoyltransferase, acid sphingomyelinase, neutral sphingomyelinase, glucosylceramide synthase and glucocerebrosidase in a dose-dependent manner. Our results indicate that the increased content of ceramides in the stratum corneum may underlie the therapeutic effect of the Eucalyptus extract. Our results also indicate the possibility that macrocarpal A is the key component that stimulates the synthesis of ceramide in the stratum corneum.
Assuntos
Ceramidas/biossíntese , Eucalyptus/química , Queratinócitos/efeitos dos fármacos , Floroglucinol/análogos & derivados , Extratos Vegetais/administração & dosagem , Sesquiterpenos/administração & dosagem , Pele/efeitos dos fármacos , Administração Tópica , Adulto , Ceramidas/genética , Método Duplo-Cego , Feminino , Humanos , Queratinócitos/metabolismo , Masculino , Floroglucinol/administração & dosagem , Extratos Vegetais/isolamento & purificação , RNA Mensageiro/biossíntese , RNA Mensageiro/genética , Reação em Cadeia da Polimerase em Tempo Real , Pele/metabolismo , Perda Insensível de Água/efeitos dos fármacos , Adulto JovemRESUMO
Conspicuous facial pores are one type of serious aesthetic defects for many women. However, the mechanism(s) that underlie the conspicuousness of facial pores remains unclear. We previously characterized the epidermal architecture around facial pores that correlates with the appearance of those pores in various ethnic groups including Japanese. The goal of this study was to evaluate the possible relationships between facial pore size, the severity of impairment of epidermal architecture around facial pores and sebum output levels to investigate the possible role of IGF-1 in the pathogenesis of conspicuous facial pores. The subjects consisted of 38 healthy Japanese women (aged 22-41 years). IGF-1 was measured using immunoradiometric assay. Surface replicas were collected to compare pore sizes of cheek skin and horizontal cross-section images of cheek skin were obtained non-invasively from the same subjects using in vivo confocal laser scanning microscopy and the severity of impairment of epidermal architecture around facial pores was determined. The skin surface lipids of each subject were collected from their cheeks and lipid classes were determined using gas chromatography/flame ionization detection. The serum level of IGF-1 correlated significantly with total pore area (R = 0.36, P < 0.05), with the severity of impairment of epidermal architecture around facial pores (R = 0.43, P < 0.05) and with sebum output levels (R = 0.41, P < 0.01). The sebum output levels correlated with total pore area (R = 0.32, P < 0.05). Our study found that serum levels of IGF-1 are correlated with facial skin characteristics including facial pore size and with the severity of impairment of epidermal architecture around facial pores.
Assuntos
Face/anatomia & histologia , Fator de Crescimento Insulin-Like I/metabolismo , Sebo/metabolismo , Pele/anatomia & histologia , Adulto , Epiderme/anatomia & histologia , Epiderme/química , Epiderme/metabolismo , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Microscopia Confocal , Sebo/química , Pele/metabolismo , Estatísticas não Paramétricas , Gravação em Vídeo , Adulto JovemRESUMO
Scientific evaluation of fabric softener use on the friction of fabrics and on dry skin in real life is very limited. The coefficient of friction of fabrics was measured with a surface tester using model skin and cotton fabrics. The effects and safety of fabric softener-treated T-shirts on subjects with dry skin were evaluated in real-life conditions in the cold and arid environment. Twenty male volunteers with dry skin used T-shirts without softener for 1 week before day 0 and then wore softener-treated T-shirts for 14 days. Effects were evaluated by clinical grading, subjective symptoms, stratum corneum water content (SCWC) and transepidermal water loss (TEWL). A significant decrease in the coefficient of friction of fabrics was detected. A significant improvement in SCWC was observed on the torso, waist and shoulder, but no improvement was found on the inner forearm. There was a slight change in TEWL. The visual grading of dryness improved significantly at all sites, but no significant change was found in subjective symptoms. Our results suggest that fabric softener provides benefits to individuals with dry skin because of the decreased friction of the garments against the skin. It is possible that the softener treatment of fabrics contributes to the state of moisturization of the skin and may work in collaboration with the application of moisturizers.
Assuntos
Vestuário , Dermatite/terapia , Adulto , Fricção , Humanos , Masculino , Compostos Orgânicos , Perda Insensível de Água/efeitos dos fármacos , Adulto JovemRESUMO
OBJECTIVE: Vertigo and dizziness are frequent symptoms in patients at out-patient services. An accurate diagnosis for vertigo or dizziness is essential for symptom relief; however, it is often challenging. This study aimed to identify differences in diagnoses between primary-care physicians and specialised neurotologists. METHOD: In total, 217 patients were enrolled. To compare diagnoses, data was collected from the reference letters of primary-care physicians, medical questionnaires completed by patients and medical records. RESULTS: In total, 62.2 per cent and 29.5 per cent of the patients were referred by otorhinolaryngologists and internists, respectively. The cause of vertigo or dizziness and diagnosis was missing in 47.0 per cent of the reference letters. In addition, 67.3 per cent of the diagnoses by previous physicians differed from those reported by specialised neurotologists. CONCLUSION: To ensure patient satisfaction and high quality of life, an accurate diagnosis for vertigo or dizziness is required; therefore, methods or materials to improve the diagnostic accuracy are needed.
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Effects of eutrophication on arsenic speciation were studied in eutrophic Lake Kiba and mesotrophic Lake Biwa, Japan. By combining hydride generation atomic absorption spectrometry with ultraviolet irradiation, inorganic, methyl and ultraviolet-labile fractions of arsenic were determined. In both Lakes, inorganic species (As(V+III)) dominated over other forms of arsenic all the year round. Most of methylarsenic fraction was dimethylarsinic acid (DMAA), and the concentration of monomethylarsonic acid (MMAA) was below the detection limit. Measurements of size-fractioned arsenic concentrations in water column indicate that most of the DMAA was distributed in truly dissolved fraction (<10 kDa), while ultraviolet-labile fractions were distributed in particulate (>0.45 microm) and colloidal (10 kDa-0.45 microm) fractions. Arsenic speciation in eutrophic Lake Kiba fluctuated greatly with season. The ultraviolet-labile fractions were observed with the increase of DMAA from May to October, and they disappeared with the decrease of DMAA in January. In mesotrophic Lake Biwa, the ultraviolet-labile fractions of arsenic were not influenced as much as those in eutrophic Lake Kiba. On the other hand DMAA concentration was higher in Lake Biwa compared to that in Lake Kiba. The results suggest that the biosynthesis of complex organoarsenicals was enhanced by eutrophication, and the arsenic speciation would be influenced by the balance of biological processes in natural waters.
Assuntos
Arsenicais/análise , Eutrofização , Poluentes Químicos da Água/análise , Água Doce , Estações do Ano , Espectrofotometria AtômicaRESUMO
Stereotactic body radiation therapy (SBRT) is usually verified with a dynamic phantom or solid phantom, but there is a demand for phantoms that can accurately simulate tumor dynamics within an individual that would allow customized validation in every patient. We developed a new 4D dynamic target phantom (multi-cell 4D phantom) that allows simulation of tumor movement in patients. The basic quality and dynamic reproducibility of this new phantom was verified in this investigation. The newly developed multi-cell 4D phantom comprises four main components: soft tissue, bones, lungs, and tumor (target). The phantom structure was based on computed tomography (CT) data of a male. In this study, we investigated the basic performance of a multi-cell 4D phantom. All the CT numbers of the phantom were very close to those of human data. The geometric maximum amplitudes were 4.57 mm in the lateral direction, 4.59 mm in the ventrodorsal direction, and 3.68 mm in the cranio-caudal direction. Geometric errors were 0.84, 0.58, and 0.40 mm, respectively. Movements of the abdominal surface were stable for 60 s. Repeated measurements show no actual differences in target movements between multiple measurements and indicated high reproducibility (r > 0.97). End-to-end tests using Gafchromic film revealed a gamma pass rate of 98% or above (2 mm/3%). Although our phantom performed limited reproducibility in the movement of the patient tumor at present, a satisfactory level of precision was confirmed in general. This is a very promising device for use in the verification of radiation therapy for moving targets.
Assuntos
Tomografia Computadorizada Quadridimensional/instrumentação , Processamento de Imagem Assistida por Computador/métodos , Imagens de Fantasmas , Radiografia Abdominal/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Técnicas de Imagem de Sincronização Respiratória/métodos , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada Quadridimensional/métodos , Humanos , Pulmão/diagnóstico por imagem , Masculino , Movimento , Radiocirurgia/métodosRESUMO
BACKGROUND: Although fast acquisition of multidetector-row computed tomography (MDCT) can make it possible to acquire sufficient early vascular enhancement using small volumes and high concentrations of contrast material (CM), there are still some problems with nephrotoxicity and costs related to CM. PURPOSE: To compare the qualitative and quantitative performance in cervicocranial CT angiography (CTA) using two different iodine volumes and concentrations of CM. MATERIAL AND METHODS: CTA ranging from the aortic arch (AA) to distal to the circle of Willis (cW) was performed on a 32-MDCT system. Fifty-eight patients were randomly divided into two groups: group A (29 patients) received 60 ml of 300 mg I/ml CM, and group B (the other 29 patients) received 40 ml of 370 mg I/ml CM. Time to peak arterial enhancement at cW (T(c)) was calculated. As scan speed was 96.9 mm/s and injection rate was 4.0 ml/s, scanning delay was individually decided according to T(c) and scan duration between AA and cW. Arterial attenuation along the z-axis at eight points in the carotid-cerebral artery and venous attenuation of the internal jugular vein (IJV) at carotid bifurcation were measured. Mean attenuation values were then quantitatively analyzed. Postprocessing images were qualitatively assessed. RESULTS: Arterial attenuation profiles revealed maximum attenuation at the distal common carotid artery in both groups. Although there were no significant differences in mean arterial attenuation in group A versus group B (402+/-70 HU vs. 407+/-67 HU; P=0.78), venous attenuation of the IJV was lower in group B than in group A (114+/-57 HU vs. 224+/-81 HU; P<0.001). Although arterial images demonstrated no difference qualitatively between the two groups, the venous contamination of IVC was less prominent in group B. CONCLUSION: Although a different amount of CM was administered in both groups, quantitative and qualitative arterial images did not show significant differences between the two groups.
Assuntos
Angiografia/métodos , Artérias Carótidas/diagnóstico por imagem , Meios de Contraste , Iodo , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To present the international consensus for recommendations for Ménière's disease (MD) treatment. METHODS: Based on a literature review and report of 4 experts from 4 continents, the recommendations have been presented during the 21st IFOS congress in Paris, in June 2017 and are presented in this work. RESULTS: The recommendation is to change the lifestyle, to use the vestibular rehabilitation in the intercritic period and to propose psychotherapy. As a conservative medical treatment of first line, the authors recommend to use diuretics and Betahistine or local pressure therapy. When medical treatment fails, the recommendation is to use a second line treatment, which consists in the intratympanic injection of steroids. Then as a third line treatment, depending on the hearing function, could be either the endolymphatic sac surgery (when hearing is worth being preserved) or the intratympanic injection of gentamicin (with higher risks of hearing loss). The very last option is the destructive surgical treatment labyrinthectomy, associated or not to cochlear implantation or vestibular nerve section (when hearing is worth being preserved), which is the most frequent option.
Assuntos
Doença de Meniere/terapia , Algoritmos , Humanos , Internacionalidade , Guias de Prática Clínica como AssuntoRESUMO
The global and systematic demonstration for the practical usage of a direct three-dimensional in vivo measurement system (PRIMOS) to evaluate wrinkles was investigated. Ten repetitive measurements of the corner of the eye of a subject showed that the coefficient of variation (CV)% value was 7.0% in a typical line-length roughness parameter R(a) (the arithmetic mean of roughness), and that the CV% value in a typical surface area roughness parameter S(a) was 2.4%. The relationships between the roughness values obtained from the corners of the eye and the age or wrinkle scores of Japanese women aged 10-70 years was examined. The values of several roughness parameters within the evaluation line length or surface area increased with age and showed a good correlation coefficient (r > 0.743). Similar relationships between the wrinkle scores and the values of roughness parameters were observed (r > 0.699). The roughness values were widely distributed even in the same wrinkle score because the measurement areas were limited and the values of skin roughness, including the microreliefs and/or small warts, were included in the calculation. However, changes in roughness values are considerable following treatment with potent active ingredients such as retinoic acid, so that this in vivo evaluation method is sufficient to objectively evaluate wrinkles. We conclude that the direct three-dimensional analysis of wrinkles in vivo should become a popular method to objectively evaluate wrinkles in clinical tests of wrinkle-smoothing ingredients or following cosmetic surgery to provide evidence of quantitative results.
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Induction of leukemia in nude mice (BALB/c nu/nu) was attempted by inoculation with a human acute lymphocytic leukemia cell line (Ichikawa strain, maintained in an ascitic form in our institute). Inoculation of the cells i.v. in normal nude mice failed to produce leukemia. However, conditioning with whole-body irradiation (500 rads) resulted in induction of leukemia after i.v. inoculation, especially when such inocluation was performed 3 days after irradiation. The correlation of survival to inoculum size (10(5) to 10(5)) was inversely exponential. Leukemic infiltration was noted in the spleen, lymph nodes, bone marrow, meninges, liver, kidneys, etc., as seen in human leukemia. These cells retained their original cytological characteristics, ultrastructural features, and surface markers and revealed high terminal deoxynucleotidyltransferase activity as T-derived cells. Chromosome analysis revealed aneuploidy in a hypotetraploid range with a mode of 88 chromosomes.
Assuntos
Leucemia Experimental/patologia , Leucemia Linfoide/patologia , Animais , Contagem de Células , Linhagem Celular , Aberrações Cromossômicas , Humanos , Imunidade/efeitos da radiação , Leucemia Experimental/etiologia , Linfonodos/patologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Transplante de Neoplasias , Células Neoplásicas Circulantes , Formação de Roseta , Baço/patologia , Transplante HeterólogoRESUMO
Three alkaline RNases were purified from human pancreatic juice to near homogeneity as judged by sodium dodecyl sulfate and native polyacrylamide gel electrophoreses. The molecular weights of these RNases determined by sodium dodecyl sulfate electrophoresis were 27,000, 19,000, and 13,000. The activities of these three RNases were increased by addition of Mg2+, Ca2+, Co2+, K+, Na+, spermine, and spermidine and decreased by the addition of heparin, Cu2+, and Zn2+. These RNases showed higher hydrolytic activity toward polycytidylic acid than toward polyguanylic acid, polyuridylic acid, or polyadenylic acid. The three human pancreatic RNases were immunologically identical but differed from human liver RNase, as shown by Ouchterlony double-diffusion test. Radioimmunoassay of human pancreatic RNase showed that immunologically similar RNases are present in human saliva, and serum.
Assuntos
Suco Pancreático/enzimologia , Ribonucleases/isolamento & purificação , Animais , Bovinos , Cromatografia em Gel , Cromatografia por Troca Iônica , Reações Cruzadas , Humanos , Imunodifusão , Cinética , Peso Molecular , Radioimunoensaio , Ribonucleases/metabolismoRESUMO
A method for radioimmunoassay of human pancreatic RNase was developed. The method is sensitive, reproducible, and specific. Almost no cross-reactivity exists between human pancreatic and liver RNases. A good correlation was observed between the serum concentration of pancreatic RNase as measured by radioimmunoassay and its enzymatic activity using polycytidylic acid as substrate. The concentration of serum pancreatic RNase correlates well with age, blood urea nitrogen, and albumin contents but does not correlate with serum amylase activity. Using the data of 52 patients with malignant tumors except pancreatic cancer, serum RNase level could be expressed by a multiple regression equation: Immunoreactive RNase content in pancreatic cancer was elevated in patients with complications from renal failure. Serum pancreatic RNase contents in patients with pancreatic cancer measured by radioimmunoassay agreed well with the values calculated using the equation derived from the data of patients with other malignant tumors.
Assuntos
Neoplasias/enzimologia , Pâncreas/enzimologia , Ribonucleases/sangue , Humanos , Radioisótopos do Iodo , Cinética , Radioimunoensaio/métodos , Análise de Regressão , Albumina Sérica/análiseRESUMO
Mitochondrial uncoupling proteins are a proton transporter family involved in regulation mitochondrial superoxide and ATP production. Uncoupling proteins are expressed by rat spiral ganglion and vestibular ganglion cells [Hear Res 196 (2004) 39]. This study tests the hypothesis that uncoupling protein expression is up-regulated in response to the reactive oxygen species challenge imposed by kanamycin and antioxidant (2,3-dihydroxybenzoate) treatment in mice. In control C57BL/6, CBA/J and BALB/c mice, mRNA for uncoupling protein 1, uncoupling protein 2, uncoupling protein 3, Slc25a27 (uncoupling protein 4) and Slc25a14 (uncoupling protein 5/BMCP1) was expressed in the spiral and vestibular ganglia. After kanamycin-treatment (700 mg/kg twice daily for 14 days s.c.), uncoupling protein 2 and uncoupling protein 3 mRNA expression increased significantly in spiral and vestibular ganglia and kidney, but was unaffected in cerebral cortex. Significant Slc25a27 (uncoupling protein 4) mRNA up-regulation was also observed in spiral and vestibular ganglia, but not in kidney or cerebral cortex. These effects were blocked by simultaneous administration of kanamycin and 2,3-dihydroxybenzoate (300 mg/kg twice daily for 14 days s.c.). Western immunoblotting and immunohistochemistry confirmed the uncoupling protein 2 and uncoupling protein 3 up-regulation in inner ear. Finally, 2,3-dihydroxybenzoate treatment alone produced an upregulation of uncoupling protein 1 mRNA in the spiral ganglion, vestibular ganglion and cerebral cortex, but not the kidney. Uncoupling protein 2 and uncoupling protein 3 upregulation in the kidney and inner ear ganglia likely reflects their general role as a feedback pathway to reduce mitochondrial superoxide generation. Slc25a27 (uncoupling protein 4) upregulation in the inner ear ganglia, by contrast, is likely to be a secondary response to kanamycin-induced hair cell death. We propose that increased uncoupling protein 2, uncoupling protein 3 and Slc25a27 expression has several neuroprotective effects via reduction in mitochondrial superoxide generation and local thermogenesis, including: (1) reducing mean ROS load to prevent apoptosis, (2) increasing signal-to-noise characteristics of intracellular ROS signaling pathways (e.g. lipoxygenases, growth factor and transcription factors), (3) heat-related alteration of enzyme kinetics and (4) promotion of cell depolarization (activation of heat-gated ion channels).