RESUMO
Objective This study investigated whether the incidence of opportunistic infection differed in systemic lupus erythematosus patients who received different doses of corticosteroids. Methods We included patients with diagnosed systemic lupus erythematosus from 1997 to 2010 using Taiwan national health insurance data. The index day for systemic lupus erythematosus patients was 3 months after the systemic lupus erythematosus diagnosis. A non-steroid cohort was matched 4:1 with the steroid cohort according to age, sex and index day. The end of the follow-up period was the day of opportunistic infection diagnosis, 1 year after the index day, or death. Results The overall cumulative incidence of opportunistic infection was 136-fold higher in the steroid cohort than in the non-steroid cohort. The adjusted hazard ratio for developing mycobacterium infection in the steroid cohort was 11, and the adjusted hazard ratio for developing herpes zoster was 43.6 compared to the non-steroid cohort after adjusting for immunosuppressive agents and comorbidities. The adjusted hazard ratio value for opportunistic infection was 1.40 (95% confidence interval (CI) 0.78-2.51) for a daily prednisone-equivalent dose of 7.5-15 mg, 1.72 (95% CI 1.02-2.91) for 15-30 mg, 1.96 (95% CI 1.17-3.28) for 30-60 mg and 2.24 (95% CI 1.26-4.00) for over 60 mg compared with low-dose steroids (<7.5 mg). Conclusion This study confirmed that the risk of opportunistic infection is higher in systemic lupus erythematosus patients treated with steroids in the first 3 months after diagnosis versus those not treated with steroids. Medium and high doses were associated with a higher risk of opportunistic infection compared with low doses. However, there was no controlling for disease activity, making it hard to know if increases in infection were due to disease itself or corticosteroids.
Assuntos
Corticosteroides/administração & dosagem , Imunossupressores/administração & dosagem , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Infecções Oportunistas/epidemiologia , Adolescente , Corticosteroides/efeitos adversos , Adulto , Idoso , Estudos de Coortes , Comorbidade , Relação Dose-Resposta a Droga , Feminino , Herpes Zoster/epidemiologia , Humanos , Imunossupressores/efeitos adversos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Taiwan/epidemiologia , Adulto JovemRESUMO
BACKGROUND: The aim of this retrospective observational study is to evaluate the effectiveness and impact on glycemia of the administration of 10 gram glucose and 10 units insulin in treating hyperkalemia during living donor liver transplantation (LDLT). METHODS: In LDLT, patients whose serum potassium exceeded 5.4 mEq/L and were treated with 10 gram glucose and 10 U regular insulin were included in this study. The descriptive statistics summarize the demographic data, baseline laboratory values, and intra-operative parameters of the treated patients. The changes of the serum potassium and serum glucose levels after treatment were analyzed by the paired Student's t-test. All the data were given as means ± SD. A P value < 0.05 was regarded as statistically significant. RESULTS: After administration of 10 gram glucose and 10 units regular insulin bolus intravenously, a drastic and significant decreased of serum potassium from 5.73 ± 0.44 to 4.48 ± 0.06 mEq/L was noted. The serum glucose level was slightly higher after the treatment (166.6 ± 32.1 and 196.8 ± 44.3 mg/dl respectively, p = 0.05). CONCLUSIONS: An intravenous bolus of 10 units regular insulin with 10 gram glucose was able to decrease the serum -potassium level effectively and additionally increase serum glucose in LDLT patients.
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Glucose/administração & dosagem , Hiperpotassemia/tratamento farmacológico , Insulina/administração & dosagem , Cuidados Intraoperatórios/métodos , Complicações Intraoperatórias/tratamento farmacológico , Transplante de Fígado , Doadores Vivos , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/etiologia , Hipoglicemiantes/administração & dosagem , Complicações Intraoperatórias/sangue , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Estudos RetrospectivosRESUMO
Developing low-cost and high-performance biosorbent for water purification continues drawing more and more attention. In this study, cellulose-chitosan composite hydrogels were fabricated via a co-dissolution and regeneration process using a molten salt hydrate (a 60 wt% aqueous solution of LiBr) as a solvent. The addition of chitosan not only introduced functionality for metal adsorption but also increased the specific surface area and improved the mechanical strength of the composite hydrogel, compared to pure cellulose hydrogel. Batch adsorption experiments indicated that the composite hydrogel with 37% cellulose and 63% chitosan exhibited an adsorption capacity of 94.3 mg/g (1.49 mmol/g) toward Cu2+ at 23 °C, pH 5, and initial metal concentration of 1500 mg/L, which was 10 times greater than the adsorption capacity of pure cellulose hydrogel. Competitive adsorption from a mixed metals solution revealed that the cellulose-chitosan composite hydrogel exhibited selective adsorption of the metals in the order of Cu2+ > Zn2+ > Co2+. This study successfully demonstrated an innovative method to fabricate biosorbents from abundant and renewable natural polymers (cellulose and chitosan) for removing metal ions from water.
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Quitosana , Metais Pesados , Poluentes Químicos da Água , Purificação da Água , Adsorção , Celulose , Hidrogéis , Concentração de Íons de Hidrogênio , Cinética , Solubilidade , Poluentes Químicos da Água/análiseRESUMO
OBJECTIVES: Physiological and behavioral circadian rhythmicities are exhibited by all mammals and are generated by intracellular levels of circadian oscillators, which are composed of transcriptional/translational feedback loops involving a set of circadian-clock genes, such as Clock, Per1-3, Cry1-2, Bmal1, Dbp, E4BP4 and CK1varepsilon. These circadian-clock genes play important roles in regulating circadian rhythms and also energy homeostasis and metabolism. Determining whether obesity induced by high-fat diet affected the expressions of circadian-clock genes and their related genes in peripheral tissues, was the main focus of this study. To address this issue, we fed male C57BL/6 mice a high-fat diet for 11 months to induce obesity, hyperglycemic, hypercholesterolemic and hyperinsulinemic symptoms, and used quantitative real-time reverse transcription-PCR to measure gene expression levels. RESULTS: We found that the expressions of circadian-clock genes and circadian clock-controlled genes, including Per1-3, Cry1-2, Bmal1, Dbp, E4BP4, CK1varepsilon, PEPCK, PDK4 and NHE3, were altered in the livers and/or kidneys. CONCLUSIONS: These results indicate that obesity induced by high-fat diet alters the circadian-clock system, and obesity and metabolic syndrome are highly correlated with the expressions of circadian-clock genes and their downstream, circadian clock-controlled genes.
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Peso Corporal/genética , Peptídeos e Proteínas de Sinalização do Ritmo Circadiano/genética , Ritmo Circadiano/genética , Síndrome Metabólica/genética , Obesidade/genética , Animais , Proteínas CLOCK/genética , Proteínas CLOCK/metabolismo , Peptídeos e Proteínas de Sinalização do Ritmo Circadiano/metabolismo , Gorduras na Dieta/administração & dosagem , Regulação da Expressão Gênica , Rim/metabolismo , Fígado/metabolismo , Masculino , Síndrome Metabólica/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Obesidade/metabolismo , Transativadores/genéticaRESUMO
Cytokines, costimulatory and counter-regulatory molecules play important roles in the regulation of inflammatory response, and are good candidates involved in the development of ankylosing spondylitis (AS). This study investigated the genotypic distribution of proinflammatory cytokines and T-cell negative regulator cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) in healthy subjects and AS patients. Genomic DNA was extracted from 143 AS patients and 166 ethnic-matched healthy subjects. Nine polymorphisms within the genes of interleukin-4 (IL-4) (-34T>C, -81A>G, -285C>T and -589T>C), interleukin-6 (IL-6) (-174G>C), interleukin-10 (IL-10) (-592A>C and -819T>C) and CTLA-4 (-318C>T and +49A>G) were examined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Significantly less AS patients carried the CTLA-4 high-expressing -318 T allele (P = 0.040). The CTLA-4 +49A>G genotypes were associated with circulatory levels of the inflammatory marker C-reactive protein (CRP) (P = 0.022). Our study documented the most complete genetic information of Taiwanese AS patients. The observations that CTLA-4 +49A>G genotypes are associated with circulatory CRP levels and significantly less AS subjects carrying CTLA-4 higher-secretor -318 T allele suggest the level and regulation of inflammation in AS subjects may be pre-determined by and associated with CTLA-4 genotypes.
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Povo Asiático/genética , Interleucina-10/genética , Interleucina-4/genética , Interleucina-6/genética , Polimorfismo Genético , Abatacepte , Antígenos CD , Biomarcadores , Proteína C-Reativa/imunologia , Antígeno CTLA-4 , Genes , Genótipo , Humanos , Imunoconjugados , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Espondilite Anquilosante/genética , TaiwanRESUMO
This study analyzed the prevalence of antibiotics resistance and the distribution of genes responsible for carbapenems resistance in Acinetobacter baumannii isolates. Clinical A. baumannii isolates were cultured, identified, and collected during the period from May 2007 to February 2009. Antibiotics resistance rates of the clinical isolates were analyzed by antimicrobial susceptibility testing. The distribution of carbapenemase alleles were investigated in the multidrug-resistant (MDR) A. baumannii isolates by multiplex polymerase chain reaction (PCR) techniques. A total of 1,265 independent A. baumannii isolates were identified. Approximately 70% of the clinical isolates were resistant to ampicillin/sulbactam, followed by imipenem, meropenem, cefepime, piperacillin/tazobactam, ceftazidime, and cefoperazone. Overall, 15.18% (192/1,265) of the isolates were characterized as MDR strains. All of the MDR A. baumannii isolates carried the bla (OXA51-like) allele. The detection rate of the bla (OXA23-like) and bla (OXA24-like) alleles was 96.35% (185/192) and 0.52% (1/192), respectively. Most of the isolates (185/192, 96.35%) carried genes which encode more than one carbapenemase. This report demonstrated that approximately 15% of A. baumannii clinical isolates in central Taiwan are MDR strains, with most of them harboring multiple carbapenemases. This study provides updated data regarding the prevalence of beta-lactam resistance and genotyping information of carbapenems resistance of A. baumannii in central Taiwan.
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Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/genética , Proteínas de Bactérias/genética , beta-Lactamases/genética , Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/enzimologia , Acinetobacter baumannii/isolamento & purificação , Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Farmacorresistência Bacteriana Múltipla/genética , Humanos , Prevalência , Taiwan/epidemiologia , Resistência beta-Lactâmica/genéticaRESUMO
This study aimed to estimate the natural history and transmission parameters based on experimental viral shedding and symptom dynamics in order to understand the key epidemiological factors that characterize influenza (sub)type epidemics. A simple statistical algorithm was developed by combining a well-defined mathematical scheme of epidemiological determinants and experimental human influenza infection. Here we showed that (i) the observed viral shedding dynamics mapped successfully the estimated time-profile of infectiousness and (ii) the profile of asymptomatic probability was obtained based on observed temporal variation of symptom scores. Our derived estimates permitted evaluation of relationships between various model-derived and data-based estimations, allowing evaluation of trends proposed previously but not tested fully. As well as providing insights into the dynamics of viral shedding and symptom scores, a more profound understanding of influenza epidemiological parameters and determinants could enhance the viral kinetic studies of influenza during infection in the respiratory tracts of experimentally infected individuals.
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Influenza Humana/epidemiologia , Transmissão de Doença Infecciosa , Humanos , Vírus da Influenza A Subtipo H1N1/crescimento & desenvolvimento , Vírus da Influenza A Subtipo H1N1/patogenicidade , Vírus da Influenza A Subtipo H3N2/crescimento & desenvolvimento , Vírus da Influenza A Subtipo H3N2/patogenicidade , Vírus da Influenza B/crescimento & desenvolvimento , Vírus da Influenza B/patogenicidade , Influenza Humana/transmissão , Modelos Biológicos , Eliminação de Partículas ViraisRESUMO
OBJECTIVE: Long non-coding RNA SUMO1P3 has been reported to act as an oncogene in the tumorigenesis of several types of human malignancy. However, to the best of our knowledge, the exact biological functions and potential mechanism of lncRNA SUMO1P3 in glioma remains unknown. Therefore, the aim of this study was to investigate the potential role of SUMO1P3 in glioma and to explore the underlying mechanism. PATIENTS AND METHODS: The present study examined SUMO1P3 expression in glioma tissues and cell lines using reverse transcription-quantitative polymerase chain reaction. Cell Counting Kit-8 (CCK-8) and transwell assays were used to examine the effects of SUMO1P3 on the proliferation and invasion of glioma cells, respectively. Furthermore, Western blot was used to detect the expression levels of proteins in the epithelial-mesenchymal transition (EMT) process. RESULTS: The expression level of SUMO1P3 was higher in glioma tissues compared with corresponding adjacent normal tissues. In addition, a high expression level of SUMO1P3 was significantly associated with clinical progression and poor survival for patients with glioma. Furthermore, the knockdown of SUMO1P3 inhibited the proliferation, migration and invasion of U87 and U251 cells. In addition, the knockdown of SUMO1P3 inhibits glioma growth in vivo. Finally, the knockdown of SUMO1P3 inhibited the epithelial-mesenchymal transition and reduced the expression levels of active ß-catenin, C-myc, and cyclin D1 in U87 and U251 cells. By contrast, the overexpression of SUMO1P3 promoted glioma cell proliferation, migration, and invasion. CONCLUSIONS: SUMO1P3 promotes glioma cell proliferation, migration, and invasion, and may be involved in Wnt/ß-catenin signaling.
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Neoplasias do Sistema Nervoso Central/metabolismo , Glioma/metabolismo , RNA Longo não Codificante/metabolismo , beta Catenina/metabolismo , Adulto , Animais , Movimento Celular , Proliferação de Células , Células Cultivadas , Neoplasias do Sistema Nervoso Central/patologia , Feminino , Glioma/patologia , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Neoplasias Experimentais/metabolismo , Neoplasias Experimentais/patologia , RNA Longo não Codificante/genética , Via de Sinalização WntRESUMO
OBJECTIVE: To explore the effect of dexmedetomidine (DEX) on sepsis-induced liver injury in rats and the mechanism of action, providing certain references for the prevention and treatment of sepsis-induced liver injury in clinical practice. MATERIALS AND METHODS: A total of 60 male Sprague Dawley (SD) rats were randomly divided into 3 groups, namely sham operation group (Sham group, n=20), sepsis-induced liver injury group [lipopolysaccharides (LPS) group, n=20], and sepsis-induced liver injury + DEX group (LPS + DEX group, n=20) using a random number table. Rat models of sepsis-induced liver injury were established by intraperitoneal injection of LPS (10 mg/kg), and at the same time, DEX was intragastrically injected at a dose of 50 µg/kg. After 24 h, the survival analysis curves of each group of rats were plotted. Meanwhile, the levels of liver function indexes and oxidative stress markers were measured at 12 h in each group of rats. Hematoxylin-eosin (H&E) staining assay was carried out to detect the morphological changes of rat liver cells in each group. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling (TUNEL) staining assay was performed to detect the apoptosis level in rat liver tissues in each group. In addition, the expression level of Caspase 3 in three groups of rats was measured through immunohistochemical staining assay. Lastly, the effect of DEX on the protein expression of extracellular signal-regulated kinases 1/2 (ERK1/2) in liver tissues was detected via Western blotting. RESULTS: DEX significantly improved liver dysfunction induced by LPS and raised the 24 h-survival rates of rats (p<0.05). Besides, H&E staining results showed that DEX clearly relieved the pathological damage of rat liver cells caused by LPS. In comparison with LPS group, LPS + DEX group displayed more neatly arranged liver cells, less degradation and necrosis, and evidently attenuated cellular edema. Immunohistochemistry results revealed that DEX significantly reversed the increase in Caspase 3 expression resulting from LPS. The results of the TUNEL staining assay showed that DEX clearly inhibited the apoptosis of rat liver cells induced by LPS. The results of Western blotting revealed that DEX notably reversed the decrease of phosphorylated ERK1/2 (p-ERK1/2) in rat liver tissues compared with LPS group. CONCLUSIONS: DEX is able to markedly relieve LPS-induced liver injury in rats and the underlying mechanism may be related to the activation of the ERK1/2 signaling pathway.
Assuntos
Dexmedetomidina/administração & dosagem , Lipopolissacarídeos/efeitos adversos , Hepatopatias/tratamento farmacológico , Sepse/complicações , Animais , Dexmedetomidina/farmacologia , Modelos Animais de Doenças , Hepatopatias/etiologia , Hepatopatias/metabolismo , Masculino , Proteína Quinase 1 Ativada por Mitógeno/metabolismo , Proteína Quinase 3 Ativada por Mitógeno/metabolismo , Fosforilação/efeitos dos fármacos , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Sepse/induzido quimicamente , Sepse/metabolismo , Análise de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVE: Areca (betel) chewing is associated with an increase in the incidence of periodontal diseases. Aberrations in matrix metalloproteinase (MMP) expression have been reported to be associated with periodontal disease. This study investigated the effects of areca nut extract on MMP activity and the phenotype of human gingival epithelial cells. MATERIAL AND METHODS: Reverse transcription-polymerase chain reaction, western blotting and gelatin zymography were used to assay MMPs. Cell viability, mobility and detachment assays were performed to characterize the phenotypic impact. Confocal microscopy was employed to evaluate cell aggregation and the distribution of E-cadherin and F-actin. RESULTS: Treatment of gingival epithelial cells with 10 microg/mL of areca nut extract reduced its cell viability. Treatment with 5 and 10 microg/mL of areca nut extract for 24 h activated MMP-9 but not MMP-2 in gingival epithelial cells. This activation could be nuclear factor-kappaB dependent and was abrogated by 10 microM curcumin. Areca nut extract also reduced the migration and detachment of gingival epithelial cells. The differentiated cell-cell contact of gingival epithelial cells was markedly impaired by areca nut extract. This was accompanied by a disruption of distribution of E-cadherin and F-actin. CONCLUSION: The areca nut extract-mediated activation of MMP-9 in gingival epithelial cells could signify a potential periodontal pathogenesis in areca chewers. The areca nut extract-mediated inhibition of cell viability and migration, together with the changed aggregation in gingival epithelial cells, suggests that impairment of the re-epithelization underlies the process and this, in turn, might exacerbate gingival inflammation.
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Areca/efeitos adversos , Células Epiteliais/efeitos dos fármacos , Gengiva/efeitos dos fármacos , Metaloproteinase 9 da Matriz/biossíntese , Extratos Vegetais/toxicidade , Western Blotting , Adesão Celular/efeitos dos fármacos , Diferenciação Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Curcumina/farmacologia , Indução Enzimática/efeitos dos fármacos , Células Epiteliais/enzimologia , Gengiva/citologia , Gengiva/enzimologia , Humanos , NF-kappa B/antagonistas & inibidores , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
BACKGROUND: To evaluate the effect of dextrose contained in banked blood products on the changes of blood glucose levels in adult living donor liver transplantation patients retrospectively. METHODS: Four hundred seventy-seven patients were divided into a non-blood transfusion (BT) group (G1) and a BT group (G2). The changes in blood glucose levels during the operation were compared using a Mann-Whitney U test, and a P value less than .05 was regarded as significant. RESULTS: No significant changes were detected in blood glucose levels after anesthesia, during dissection phase, in the anhepatic phase, or after reperfusion between the groups. Estimated blood loss for G1 (n = 89) and G2 (n = 388) were 718 ± 514 and 5804 ± 877 mL respectively, G1 had no blood transfusion but G2 had received 4350 ± 6230 mL leukocyte-poor red blood cell transfusion, the pre- and end operation hemoglobin for G1 and G2 were 13.2 ± 2.0, 10.2 ± 1.9 and 10.1 ± 1.6, 10.2 ± 1.9 mg/dL respectively, indicating that they were not under or over transfused. CONCLUSION: When banked blood products are used to replace ongoing blood loss, the dextrose contained in citrate-phosphate-dextrose-adenine seems to have no effect on the changes in the blood glucose levels of the recipients.
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Glicemia/análise , Transfusão de Sangue/estatística & dados numéricos , Hemostasia Cirúrgica/métodos , Transplante de Fígado/métodos , Adulto , Bancos de Sangue , Citratos/sangue , Feminino , Glucose , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estatísticas não ParamétricasRESUMO
OBJECTIVES: The aims of this study were to compare the core temperature changes between pediatric patients lying on regular operating room linen drapes and a water-repellent sheepskin rug during living donor liver transplantation (LDLT) and to evaluate the effectiveness of using a water-repellent sheepskin rug in preventing profound hypothermia due to fluid overflow from the abdominal cavity during LDLT. PATIENTS AND METHODS: The operative records of pediatric patients who underwent LDLT from June 1994-September 2003 were reviewed retrospectively. The nasopharyngeal temperature (NT) changes during the LDLT procedure between patients lying on regular operating room drapes (GI) and water-repellent sheepskin rug (GII) were compared and analyzed using the Mann-Whitney U test. A P value <.05 was regarded as significant. RESULTS: Thirty-two patients were included in GI and 56 in GII. Profound hypothermia was not observed in any recipients lying on a water-repellent sheepskin rug (GII). The NT after induction and the following 4 hours into the LT procedure were significantly higher in GII than GI. CONCLUSION: Pediatric patients lying on water-repellent sheepskin preserved their core temperature better in comparison to patients lying on linen drapes. The use of a water-repellent sheepskin rug seems to be effective in preventing profound hypothermia related to physical contact with abdominal fluid overflow during the LDLT.
Assuntos
Roupas de Cama, Mesa e Banho , Temperatura Corporal , Transplante de Fígado/métodos , Absorção Fisico-Química , Animais , Pré-Escolar , Desenho de Equipamento , Feminino , Humanos , Interações Hidrofóbicas e Hidrofílicas , Doadores Vivos , Masculino , Salas Cirúrgicas , Estudos Retrospectivos , Ovinos , ÁguaRESUMO
BACKGROUND: Opsite (Smith & Nephew, Hull, UK) is widely used in wound care but its use in eye protection against corneal abrasion during major surgery is rarely reported. The purpose of the current study is to compare the effectiveness of using Opsite in eye protection with either wet gauze alone or with wet gauze following application of eye ointment in patients undergoing living donor liver transplantation (LDLT). METHODS: This is a prospective, double-blinded, randomized controlled trial. Forty-one patients undergoing liver transplantation were enrolled. One eye of each patient was protected with sterile gauze soaked with normal saline solution and covered with Opsite. Duratears (ALCON, Fort Worth, Tex, United States) ointment was applied to the other eye before covering it with sterile wet gauze and Opsite (ointment group). The corneal examination was carried out after fluorescein staining before and at the end of surgery by the same doctor. A Student t-test and a χ2 test were used for the statistical analyses. RESULTS: Forty-one patients with 82 eyes were observed in this study. No corneal epithelial defects were found in either the normal saline group or the ointment group. CONCLUSION: Opsite combined with wet gauze with or without additional eye ointment provided 100% protection against corneal abrasion in patients undergoing LDLT.
Assuntos
Anestesia Geral/efeitos adversos , Lesões da Córnea/prevenção & controle , Transplante de Fígado/métodos , Curativos Oclusivos , Poliuretanos/administração & dosagem , Bandagens , Lesões da Córnea/etiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Blood loss during liver surgery is found to be correlated with central venous pressure (CVP). The aim of the current retrospective study is to find out the cutoff value of CVP and stroke volume variation (SVV), which may increase the risk of having intraoperative blood loss of more than 100 mL during living liver donor hepatectomies. METHOD AND PATIENTS: Twenty-seven adult living liver donors were divided into 2 groups according to whether they had intraoperative blood loss of less (G1) or more than 100 mL (G2). The mean values of the patients' CVP and SVV at the beginning of the transaction of the liver parenchyma was used as the cutoff point. Its correlation to intraoperative blood loss was evaluated using the χ2 test; P < .001 was regarded as significant. RESULTS: The cutoff points of CVP and SVV were 8 mm Hg and 13% respectively. The odds ratio of having blood loss exceeding 100 mL was 91.25 (P < .001) and 0.36 (P < .001) for CVP and SVV, respectively. CONCLUSION: CVP less than 5 mm Hg, as suggested by most authors, is not always clinical achievable. Our results show that a value of less than 8 mm Hg or SVV 13% is able to achieve a minimal blood loss of 100 mL during parenchyma transaction during a living donor hepatectomy. Measurements used to lower the CVP or increased SVV in our serial were intravenous fluids restriction and the use of a diuretic.
Assuntos
Perda Sanguínea Cirúrgica/fisiopatologia , Pressão Venosa Central/fisiologia , Hepatectomia/métodos , Volume Sistólico/fisiologia , Coleta de Tecidos e Órgãos/métodos , Adulto , Feminino , Humanos , Fígado/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Masculino , Valores de Referência , Estudos RetrospectivosRESUMO
The epidermal growth factor receptor (EGFR) is the major driver of non-small cell lung carcinoma (NSCLC). Mitochondrial accumulation of EGFR has been shown to promote metastasis in NSCLC, yet little is known about how the mitochondrial localization of EGFR is regulated. In this work, we show that Tid1 (also known as mitochondrial HSP40) is involved in the mitochondrial localization of EGFR, and that the DnaJ domain of Tid1-S is essential for the Tid1-S-mediated transportation of EGFR into mitochondria. Overexpression of Tid1-S increased the migration and invasion of NSCLC cells cultured in vitro. High levels of EGFR and Tid1-S were detected in the mitochondria of cancerous lesions from stage IV NSCLC patients, and high levels of mitochondrial Tid1-S/EGFR were correlated with lymph node metastasis and poor overall survival of NSCLC patients. We thus conclude that Tid1-S critically governs the mitochondrial localization of EGFR through the mtHSP70 transportation pathway, and that the mitochondrial accumulation of EGFR appears to promote metastasis in NSCLC.
RESUMO
BACKGROUND: Hyperkalemia, defined as a serum potassium level higher than 5 mEq/L, is common in the liver transplantation setting. Severe hyperkalemia may induce fatal cardiac arrhythmias; therefore, it should be monitored and treated accordingly. The aim of the current retrospective study is to evaluate and indentify the predictive risk factors of hyperkalemia during living-donor liver transplantation (LDLT). METHODS AND PATIENTS: Four hundred eighty-seven adult LDLT patients were included in the study. Intraoperative serum potassium levels were monitored at least five times during LDLT; patients with a potassium level higher than 5 mEq/L were included in group 1, and the others with normokalemia in group 2. Patients' categorical characteristics and intraoperative numeric variables with a P value <.1 were selected into a multiple binary logistic regression model. In multivariate analysis, a P value of <.05 is regarded as a risk factor in the development of hyperkalemia. RESULTS: Fifty-one of 487 (10.4%) patients had hyperkalemia with a serum potassium level higher than 5.0 mEq/L during LDLT. Predictive factors with P < .1 in univariate analysis (Table 1), such as anesthesia time, preoperative albumin level, Model for End-stage Liver Disease score, preoperative bilirubin level, amount of blood loss, red blood cell (RBC) and fresh frozen plasma transfused, 5% albumin administered, hemoglobin at the end of surgery, and the amount of furosemide used, were further analyzed by multivariate binary regression. Results show that the anesthesia time, preoperative serum albumin level, and RBC count are determinant risk factors in the development of the hyperkalemia in our LDLT serials. CONCLUSION: Prolonged anesthesia time, preoperative serum albumin level, and intraoperative RBC transfusion are three determinant factors in the development of intraoperative hyperkalemia, and close monitoring of serum potassium levels in patients with abovementioned risk factors are recommended.
Assuntos
Hiperpotassemia/etiologia , Complicações Intraoperatórias/etiologia , Transplante de Fígado/efeitos adversos , Doadores Vivos , Adulto , Doença Hepática Terminal/fisiopatologia , Doença Hepática Terminal/cirurgia , Transfusão de Eritrócitos/métodos , Feminino , Humanos , Hiperpotassemia/sangue , Testes de Função Hepática , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Plasma , Potássio/sangue , Estudos Retrospectivos , Fatores de Risco , TransplantadosRESUMO
BACKGROUND: The aim of this study is to determine whether preoperative portal vein flow velocity or size has any correlative effect on hemodynamic changes during clamping of the inferior vena cava in liver transplantation. PATIENTS AND METHODS: A total of 42 anesthesia charts of adult patients who underwent living donor liver transplantation (LDLT) were analyzed and compared retrospectively. Preoperative portal vein (PV) flow velocity and sizes were obtained using Doppler ultrasound. All changes in the hemodynamic data before and after clamping of the portal vein (PV) and inferior vena cava (IVC) were recorded and analyzed by linear regression. A P value of <.05 was considered significant. RESULTS: Heart rate (HR), mean arterial blood pressure (MAP), central venous pressure (CVP), cardiac output (CO), cardiac index (CI), and stroke volume (SV) before and after clamping of the PV and IVC were significantly different for as long as the PV and IVC were clamped. Linear regression analysis indicated that R2 of HR, MAP, CVP, CO, and CI in correlation with the PV velocity were 0.002, 0.035, 0.024, and 0.001; R2 of the PV diameter for HR, MAP, CVP, CO, and CI were 0.028, 0.01, 0.034, and 0.004. The changes in the percentages of cardiac output at 1- and 5-minute intervals after IVC clamping were not correlated significantly with either the preoperative flow velocity or the size of the PV. CONCLUSION: Preoperative PV flow velocity and size are not correlated or associated with hemodynamic changes during IVC clamping in liver transplantation.
Assuntos
Hemodinâmica/fisiologia , Transplante de Fígado/métodos , Veia Porta/fisiopatologia , Período Pré-Operatório , Veia Cava Inferior/cirurgia , Adulto , Idoso , Débito Cardíaco , Pressão Venosa Central , Constrição , Feminino , Frequência Cardíaca , Humanos , Modelos Lineares , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Veia Porta/cirurgia , Estudos Retrospectivos , Volume Sistólico , Veia Cava Inferior/fisiopatologiaRESUMO
BACKGROUND: In this study, as our center transitions from using patient-controlled analgesia (PCA) morphine with intravenous (IV) ketorolac to PCA morphine with IV parecoxib, the two regimens are compared in terms of quality of pain control. METHODS: Post-operative pain management sheets were collected retrospectively among the living donors of liver transplantation during this transitional period. Group parecoxib was given plain PCA morphine. A single dose of IV parecoxib 40 mg was given 30 minutes before the end of surgery. Group ketorolac was given PCA morphine pre-mixed ketorolac with a concentration of 1.87 mg/mL. Daily and total morphine consumption, Visual Analog Score (VAS), and number of rescue attempts made up to 3 post-operative days, together with satisfaction score and incidence of side effects of PCA usage, were analyzed and compared by means of the Mann-Whitney U test; a value of P < .05 was regarded as significant, and data are given as mean ± SD. RESULTS: Fifty patients were analyzed; group 1 comprised 21 patients and group 2 comprised 29 patients. There was no difference between group 1 and group 2 in terms of daily VAS. PCA morphine requirements were significantly lower at day 2 and day 3 in group 1. However, the total overall morphine usage and satisfactory score was not statistically different (P = .863, P = .052). CONCLUSIONS: A single dose of IV parecoxib 40 mg can provide satisfactory pain control when paired with PCA morphine for donors undergoing living donor liver transplantation. The use of parecoxib in the multimodal analgesia regimen has similar efficacy, with possibly less morphine consumption, when compared with ketorolac.
Assuntos
Analgesia Controlada pelo Paciente/métodos , Transplante de Fígado , Doadores Vivos , Dor Pós-Operatória/tratamento farmacológico , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Analgésicos Opioides/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Isoxazóis/administração & dosagem , Cetorolaco/administração & dosagem , Masculino , Morfina/administração & dosagem , Manejo da Dor/métodos , Medição da Dor , Dor Pós-Operatória/etiologia , Estudos RetrospectivosRESUMO
The present studies aimed to determine whether cocaine- and amphetamine-regulated transcript (CART) peptide in the nucleus of accumbens shell (AcbSh) is implicated in the regulation of food intake. Bilateral intranuclear injections of CART peptide (55-102, 1 microg/microl/side) into the AcbSh decreased food intake with no change in locomotion activity and attenuated the orexigenic effect of the GABA(A) agonist muscimol (100 ng/microl/side) in male Sprague-Dawley rats. Decreased food intake after bilateral intranuclear injections of CART was more sustained in freely fed rats than in food-deprived rats, suggesting fuel availability is an important factor in modulating the function of CART in the regulation of feeding. Our anatomical findings indicate that in addition to the perifornical region and the arcuate nucleus, some neurons within the AcbSh also project within the AcbSh. Moreover, many of these efferent cells contain CART immunoreactivity, including those which reside within the AcbSh, suggesting that accumbal CART circuitry is involved in the central function of the nucleus accumbens. Furthermore, fasting suppressed CART mRNA levels in the AcbSh, paraventricular nucleus of the hypothalamus, arcuate nucleus, and the perifornical region, indicating that the Acb is sensitive to fuel availability to an extent similar to those regions in the hypothalamus. Our findings are the first to demonstrate that CART mRNA in the AcbSh is sensitive to metabolic challenges and that injection of CART peptide into the AcbSh has an inhibitory effect on food intake.
Assuntos
Comportamento Alimentar/efeitos dos fármacos , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/farmacologia , Núcleo Accumbens/efeitos dos fármacos , Núcleo Accumbens/fisiologia , Animais , Jejum/fisiologia , Comportamento Alimentar/fisiologia , Agonistas GABAérgicos/farmacologia , Agonistas de Receptores de GABA-A , Expressão Gênica/fisiologia , Masculino , Microinjeções , Atividade Motora/efeitos dos fármacos , Muscimol/farmacologia , RNA Mensageiro/análise , Ratos , Ratos Sprague-DawleyRESUMO
We evaluated the impact of lumbar instrumented circumferential fusion on the development of adjacent level vertebral compression fractures (VCFs). Instrumented posterior lumbar interbody fusion (PLIF) has become a popular procedure for degenerative lumbar spine disease. The immediate rigidity produced by PLIF may cause more stress and lead to greater risk of adjacent VCFs. However, few studies have investigated the relationship between PLIF and the development of subsequent adjacent level VCFs. Between January 2005 and December 2009, a total of 1936 patients were enrolled. Of these 224 patients had a new VCF and the incidence was statistically analysed with other covariants. In total 150 (11.1%) of 1348 patients developed new VCFs with PLIF, with 108 (72%) cases at adjacent segment. Of 588 patients, 74 (12.5%) developed new subsequent VCFs with conventional posterolateral fusion (PLF), with 37 (50%) patients at an adjacent level. Short-segment fusion, female and age older than 65 years also increased the development of new adjacent VCFs in patients undergoing PLIF. In the osteoporotic patient, more rigid fusion and a higher stress gradient after PLIF will cause a higher adjacent VCF rate.