RESUMO
BACKGROUND: The aim of this retrospective study was to collect additional data on the long-term success (LTS) of external dacryocystorhinostomy (ext-DCR) and the impact of pre-, intra- and postoperative factors on the surgical outcome. This was intended to increase the precision of the indication for DCR. METHOD: A retrospective, non-comparative study was conducted on 637 ext-DCR due to dacryocystitis performed at the Department of Ophthalmology, University Hospital Halle. This included all surgical interventions on patients of at least 11 years of age. Using standardised questionnaires and patient records, 60.75â% (n = 387) of patients were surveyed. Follow-up was 1.0 to 12.0 years (mean, 4.0 years). RESULTS: Analysis of patient satisfaction showed satisfactory (20.2â%) and very satisfactory (74.2â%) results. LTS was 94.4â% (n = 365). Factors negatively influencing postoperative outcome were prior surgical interventions of nose and/or sinus, previous ext-DCR and transcanalicular lacrimal surgery. Surgical outcome was positively influenced by lacrimal sac size and lacrimal stenting. Large saccus lacrimales and use of monocanalicular intubates improved LTS. CONCLUSIONS: LTS of ext-DCR shows very good results, thus underlining its superiority to other surgical approaches. Special attention should be paid to diseases and previous surgical interventions on the nose and/or sinus that effect the lacrimal duct system. Therefore, a special committee of ENT physicians and ophthalmologists has been established at the Department of Ophthalmology, University Hospital Halle. From the surgical point of view, it is important to create an adequate mucosal anastomosis using lacrimal and nasal mucosa. Restoration is possible with lacrimal stent materials. The indication for ext-DCR was restricted by competition with transcanalicular endoscopic interventions to preserve physiological lacrimal drainage.
Assuntos
Dacriocistorinostomia/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Obstrução dos Ductos Lacrimais/epidemiologia , Obstrução dos Ductos Lacrimais/terapia , Satisfação do Paciente/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Humanos , Obstrução dos Ductos Lacrimais/diagnóstico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Resultado do TratamentoRESUMO
BACKGROUND: Congenital nasolacrimal duct obstruction (CNLDO) is one of the most frequent issues in pediatric ophthalmology. There are different therapeutic options, including conservative treatments as well as surgical interventions. These strategies can be classified using a staged therapeutic concept. OBJECTIVE: What are the therapeutic strategies for CNLDO from an ophthalmologist's point of view? METHODS: In this review, different kinds of CNLDO are described. Existing therapeutic interventions are dedicated to the different forms of CNLDO and summarized in a staged therapeutic concept. RESULTS: CNLDO is not a homogeneous disease. Different and also combined pathologies exist. According to symptoms and localization of stenosis, different therapeutic interventions are available. The most common CNLDO manifestation is a persistent Hasner's membrane. If conservative approaches have failed, pressurized probing and syringing of the nasolacrimal duct is the method of choice. This can usually be done under local anesthesia. Since some children show persisting symptoms, other therapies (probing and syringing under general anesthesia with nasolacrimal duct intubation, external dacryocystorhinostomy) have to be considered. Here, dacryoendoscopy offers additional diagnostic and therapeutic options. CONCLUSION: The precise classification of CNLDO and knowledge concerning possible therapeutic interventions are essential. Due to ongoing development of surgical approaches, an increasingly individualized therapy is possible. A gradual therapeutic regimen is available for CNLDO, which has to be adapted individually.
Assuntos
Dacriocistorinostomia/métodos , Endoscopia/métodos , Obstrução dos Ductos Lacrimais/diagnóstico , Obstrução dos Ductos Lacrimais/terapia , Ducto Nasolacrimal/cirurgia , Sucção/métodos , Criança , Pré-Escolar , Terapia Combinada/métodos , Dacriocistorinostomia/instrumentação , Medicina Baseada em Evidências , Feminino , Humanos , Lactente , Recém-Nascido , Obstrução dos Ductos Lacrimais/congênito , Masculino , Resultado do TratamentoRESUMO
BACKGROUND: Lacrimal probing and syringing for connatal dacryostenosis can be performed under local (LA) and general anesthesia (GA). In cases of invasive medical procedures, pain and anxiety can be distressing for children and their parents. MATERIALS AND METHODS: Using questionnaires (n = 65), parents were asked to evaluate their own stress and that of their child during lacrimal probing and syringing. Analyzing different subgroups, the impact of the kind of anesthesia (LA vs. GA), trust in medical treatment, therapeutic success, prior experiences with GA, parental educational level, age of parents and children, number of children, and time between the intervention and the interview on the stress was examined. Stress level was evaluated on a scale from 1 (no stress) to 10 (maximal stress). RESULTS: Mean children's age was 8.5 ± 7.42 months. Mean age of the parents was 30.8 ± 6.17 years. Treating children under LA, parents reported moderate to severe stress levels for themselves (mean, M = 7.15) and for their children (M = 7.82). Children's stress levels were significantly higher when the treatment was performed under LA (n = 47; M = 7.34) in comparison to GA (n = 18; M = 6.06; p < 0.05). Parents having two or more children reported significantly lower stress levels than those with only one child. Furthermore, prior experiences with GA led to significantly higher parental stress levels when their children were treated under GA. Other factors did not show any impact on parent's and children's stress levels. CONCLUSIONS: Parents might have been influenced by hearing the children's reaction (e. g., crying) during the intervention under LA. Nevertheless, parents had a higher acceptance of this type of intervention (LA) in comparison to GA. This effect was even stronger among parents with prior experience of GA.
Assuntos
Ansiedade/psicologia , Dor Ocular/psicologia , Obstrução dos Ductos Lacrimais/psicologia , Pais/psicologia , Sucção/efeitos adversos , Sucção/psicologia , Adulto , Ansiedade/etiologia , Criança , Dor Ocular/etiologia , Feminino , Humanos , Obstrução dos Ductos Lacrimais/complicações , Obstrução dos Ductos Lacrimais/terapia , Masculino , Sucção/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Pathologies of the lacrimal duct system show a frequent occurrence in paediatric ophthalmology. Mostly, the connection between the nasolacrimal duct and the nose fails to open but also combined diseases or congenital anomalies may be the reason. Because of complications, the chance for healing after a conservative therapeutic approach decreases and surgical intervention is necessary. PATIENTS AND METHODS: The opportunity for transcanalicular endoscopy of the lacrimal duct system in children is shown by the presentation of three different case reports. Typical clinical findings are given and the use of dacryoendoscopy for diagnostic and therapeutic benefit is pointed out. Therefore, we present an 8-week-old child, suffering recurrent purulent inflammation due to an amniotocele (1), a 5-year-old child having a congenital lacrimal fistula (2) and another 5-year-old child with a severe chronic dacryocystitis of both eyes after several lacrimal duct surgeries showing remaining intrasaccal silicone tubes (3). RESULTS: In all these cases transcanalicular endoscopy could be used successfully for reconstruction of the lacrimal duct systems. A bullous Hasner's membrane could be localized and opened (1). The lacrimal fistula was identified to communicate with the common canaliculus and combined stenosis of the canaliculus and saccus were treated (2). In the third case fragments of intrasaccal silicone tubes could be localised and the foreign bodies could be evacuated by transcanalicular surgery (3). The children with lacrimal fistula and the intrasaccal foreign bodies were treated with self-threading silicone tubing which was removed three months later. In the follow-up period (16 months in case 2, 22 months in case 3 and 38 months in case 1) recurrences of the lacrimal pathologies or clinical complaints were absent. CONCLUSION: Transcanalicular endoscopy of the lacrimal duct system should not be regarded as the means of choice but it does offer additional diagnostic and therapeutic options for special indications. A main advantage of this kind of surgery is its minimally invasive character. Under visual control, topographic anatomy can be preserved. Dacryoendoscopy in children should be done only by experienced surgeons.
Assuntos
Endoscopia/métodos , Doenças do Aparelho Lacrimal/patologia , Doenças do Aparelho Lacrimal/cirurgia , Aparelho Lacrimal/patologia , Aparelho Lacrimal/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Pré-Escolar , Dacriocistorinostomia/métodos , Humanos , Lactente , Masculino , Resultado do TratamentoRESUMO
PURPOSE: Concerning safety and efficiency in surgery of isolated orbital floor fractures, several treatment modalities are being discussed. It is a matter of recent interest that prefabricated titanium meshes provide significant advantages. The purpose of this study was to review the usability of the MatrixORBITAL® plate. MATERIAL AND METHODS: In a prospective study we evaluated 10 patients (June 2011 to November 2013) with an isolated orbital floor fracture. All patients in the study group had undergone reconstruction with the MatrixORBITAL® plate. For purposes of analysis were recorded: age, gender, fracture category according to Jaquiéry et al. (2007), duration of surgery, complications, globe motility (Harms wall), exophthalmometry, function of the infraorbital nerve, evaluation of facial symmetry and aesthetic as well as personal contentment of the patient. A reference group received a PDS® sheet, an antral balloon or other materials. RESULTS: In the study group (2 women and 8 men aged between 26 and 83 years) all cases presented a large disruption of the orbital floor (> 2 cm2 bony defect; category II-III). Volume changes were universally associated with diplopia, but only in two cases with an entrapment of the inferior rectus muscle. The mean duration of the operation was 110 minutes (minimum 50, maximum 135 minutes). Postoperatively diplopia was decreasing in all cases. None of the patients had a significant impairment of visus and no reoperation was necessary. The analysis of functional outcomes between the groups mesh, PDS sheet and antral balloon revealed no significant differences. CONCLUSIONS: Based on this experience and due to good intraoperative handling, the authors recommend the prefabricated titanium plate in the treatment of isolated orbital wall fractures or in combination with the medial wall despite the material costs.
Assuntos
Placas Ósseas , Procedimentos Cirúrgicos Oftalmológicos/instrumentação , Fraturas Orbitárias/cirurgia , Procedimentos de Cirurgia Plástica/instrumentação , Telas Cirúrgicas , Titânio , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Orbitárias/diagnóstico por imagem , Desenho de Prótese , Radiografia , Resultado do TratamentoAssuntos
Doenças do Desenvolvimento Ósseo/diagnóstico , Doenças do Desenvolvimento Ósseo/cirurgia , Deformidades da Mão/diagnóstico , Obstrução dos Ductos Lacrimais/diagnóstico por imagem , Osso Nasal/anormalidades , Doenças do Desenvolvimento Ósseo/complicações , Dacriocistorinostomia/métodos , Diagnóstico Diferencial , Deformidades da Mão/complicações , Humanos , Lactente , Obstrução dos Ductos Lacrimais/etiologia , Obstrução dos Ductos Lacrimais/terapia , Masculino , Osso Nasal/cirurgia , Sucção/métodos , Avaliação de Sintomas/métodos , Cirurgia Endoscópica Transanal/métodos , Resultado do TratamentoRESUMO
BACKGROUND: In recent years, a variety of innovative therapeutics for castration-resistant prostate cancer have been developed, including novel anti-androgenic drugs, such as abiraterone or VPC-13566. Therapeutic monitoring of these pharmaceuticals is performed either by measuring PSA levels in serum or by imaging. PET using PSMA ligands labeled with Fluor-18 or Gallium-68 is the most sensitive and specific imaging modality for detection of metastases in advanced prostate cancer. To date, it remains unclear how PSMA expression is modulated by anti-hormonal treatment and how it correlates with PSA secretion. METHODS: We analyzed modulation of PSMA-mRNA and protein expression, 68Ga-PSMA uptake and regulation of PSA secretion by abiraterone or VPC-13566 in LNCaP cells in vitro. RESULTS: We found that abiraterone and VPC-13566 upregulate PSMA protein and mRNA expression but block PSA secretion in LNCaP cells. Both anti-androgens also enhanced 68Ga-PSMA uptake normalized by the number of cells, whereas abiraterone and VPC-13566 reduced 68Ga-PSMA uptake in total LNCaP monolayers treated due to cell death. CONCLUSION: Our data indicate that PSA secretion and PSMA expression are differentially regulated upon anti-androgen treatment. This finding might be important for the interpretation of 68Ga-PSMA PET images in monitoring therapies with abiraterone and VPC-13566 in prostate cancer patients, but needs to be validated in vivo.
Assuntos
Adenocarcinoma/metabolismo , Antagonistas de Androgênios/farmacologia , Antígenos de Superfície/genética , Ácido Edético/análogos & derivados , Glutamato Carboxipeptidase II/genética , Oligopeptídeos/farmacocinética , Antígeno Prostático Específico/metabolismo , Neoplasias da Próstata/metabolismo , Adenocarcinoma/diagnóstico , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Antagonistas de Androgênios/uso terapêutico , Androstenos/farmacologia , Androstenos/uso terapêutico , Antígenos de Superfície/metabolismo , Linhagem Celular Tumoral , Ácido Edético/farmacocinética , Isótopos de Gálio , Radioisótopos de Gálio , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Glutamato Carboxipeptidase II/metabolismo , Humanos , Masculino , Células PC-3 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Antígeno Prostático Específico/efeitos dos fármacos , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , Via Secretória/efeitos dos fármacosRESUMO
INTRODUCTION: Human sclera grafts are widely used in ophthalmic surgery. Mainly they are used for coating orbital implants after enucleation. METHODS: For the preparation of sclera grafts, all other tissues must be removed from the donor bulb including the retina, choroid, cornea, corpus vitreum and lens. The sclera graft can be stored dry or in ethanol until transplantation. RESULTS AND CONCLUSION: The processing of sclera grafts in an eye bank is easy to handle compared to the complexity of cornea transplants. The common way is dry storing for at least 1 year. Thus, the demand for sclera grafts can be covered without a lot of trouble.
Assuntos
Bancos de Olhos/métodos , Procedimentos Cirúrgicos Oftalmológicos , Preservação de Órgãos , Esclera/transplante , Coleta de Tecidos e Órgãos , HumanosRESUMO
AIM: The extracellular matrix plays an important physiological role in the architecture of the vascular wall. In arterialized vein grafts severe early changes, such as thrombosis and neointimal hyperplasia occur. Paclitaxel is in clinical use as antiproliferative coating of coronary stents. We aimed to investigate the early connective tissue changes in arterialized vein grafts and the influence of perivascular paclitaxel treatment in an in vivo model. METHODS: C57 black mice underwent interposition of the vena cava into the carotid artery. Neointimal hyperplasia, thrombosis, acid mucopolysaccharides (Alcian), collagen fibers (trichrome Masson), elastic fibers, and apoptosis rate (TUNEL) were quantified in paclitaxel treated veins and controls. RESULTS: In both, controls and paclitaxel treated vein grafts acid mucopolysaccharides and elastic fibers were found predominantly in the neointima, whereas collagen fibers were found mainly in the media and adventitia. At 4 weeks postoperatively the neointimal thickness in controls was 52 (13-130) microm, whereas in 0.6 mg/mL l paclitaxel treated veins it was 103 (43-318) microm (P=0.094). At 8 weeks postoperatively paclitaxel treated veins showed a significantly increased neointimal thickness of 136 (87-199) microm compared with 79 (62-146) microm in controls (P=0.032). There was no difference in apoptosis rate between the two groups (P=NS). Even with the lowest concentration of 0.008 mg/mL paclitaxel veins showed a neointimal thickness of 67 (46-205) microm at 4 weeks postoperatively (P=NS vs controls). CONCLUSION: Early vein graft disease is characterised by an accumulation of acid mucopolysaccharides and elastic fibers in the thickened neointima. Paclitaxel treatment increases the neointimal hyperplasia in mouse vein grafts in vivo.
Assuntos
Tecido Conjuntivo/patologia , Veia Cava Inferior/transplante , Animais , Apoptose/efeitos dos fármacos , Artérias Carótidas/cirurgia , Colágeno/metabolismo , Tecido Conjuntivo/metabolismo , Glicosaminoglicanos/metabolismo , Oclusão de Enxerto Vascular/patologia , Oclusão de Enxerto Vascular/fisiopatologia , Hiperplasia , Marcação In Situ das Extremidades Cortadas , Camundongos , Camundongos Endogâmicos C57BL , Paclitaxel/farmacologia , Trombose/induzido quimicamente , Túnica Íntima/efeitos dos fármacos , Túnica Íntima/patologia , Veia Cava Inferior/efeitos dos fármacos , Veia Cava Inferior/patologiaRESUMO
The simultaneous detection of multiple somatic mutations in the context of molecular diagnostics of cancer is frequently performed by means of amplicon-based targeted next-generation sequencing (NGS). However, only few studies are available comparing multicenter testing of different NGS platforms and gene panels. Therefore, seven partner sites of the German Cancer Consortium (DKTK) performed a multicenter interlaboratory trial for targeted NGS using the same formalin-fixed, paraffin-embedded (FFPE) specimen of molecularly pre-characterized tumors (n = 15; each n = 5 cases of Breast, Lung, and Colon carcinoma) and a colorectal cancer cell line DNA dilution series. Detailed information regarding pre-characterized mutations was not disclosed to the partners. Commercially available and custom-designed cancer gene panels were used for library preparation and subsequent sequencing on several devices of two NGS different platforms. For every case, centrally extracted DNA and FFPE tissue sections for local processing were delivered to each partner site to be sequenced with the commercial gene panel and local bioinformatics. For cancer-specific panel-based sequencing, only centrally extracted DNA was analyzed at seven sequencing sites. Subsequently, local data were compiled and bioinformatics was performed centrally. We were able to demonstrate that all pre-characterized mutations were re-identified correctly, irrespective of NGS platform or gene panel used. However, locally processed FFPE tissue sections disclosed that the DNA extraction method can affect the detection of mutations with a trend in favor of magnetic bead-based DNA extraction methods. In conclusion, targeted NGS is a very robust method for simultaneous detection of various mutations in FFPE tissue specimens if certain pre-analytical conditions are carefully considered.
Assuntos
Biomarcadores Tumorais/genética , DNA de Neoplasias/análise , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Neoplasias/genética , Humanos , Patologia Molecular/métodos , Patologia Molecular/normas , Reprodutibilidade dos Testes , Pesquisa Translacional Biomédica/métodosRESUMO
BACKGROUND: Transcanalicular lacrimal duct surgery has become more important over the past two decades. OBJECTIVES: The aim of the study was to prove the prognostic value of postoperative lacrimal syringing and the testing of spontaneous drainage of lacrimal fluid immediately after tube removal. METHODS: A total of 110 cases with postoperative lacrimal syringing and 183 cases with verification of the postoperative lacrimal fluid drainage performed between January 2001 and August 2008 were retrospectively evaluated. The indication for postoperative diagnostics was set by the investigator. The prognostic value of these two procedures was determined by using prognostic parameters (positive predictive value, PPV; negative predictive value, NPV) and analyzing recurrence nonexistence via Cox regression and Kaplan-Meier estimator. The observation period was limited to 12 months. Predominantly, recurrence was defined on the patient's satisfaction and absence of symptoms, which was determined with the help of a questionnaire. RESULTS: Postoperative verification of the lacrimal syringing is a suitable instrument to estimate surgical success within the first year after lacrimal surgery with a PPV of 92.31%. Testing of the spontaneous drainage of lacrimal fluid after tube removal reached a PPV of 63.33%. CONCLUSION: The proven prognostic value shows that syringing of the lacrimal duct and verification of spontaneous drainage should be integrated into postoperative care in a standardized manner. Hereby, early information for the patient about the expected result of the surgical procedure is enabled.
Assuntos
Dacriocistorinostomia/estatística & dados numéricos , Intubação/instrumentação , Intubação/estatística & dados numéricos , Obstrução dos Ductos Lacrimais/diagnóstico , Obstrução dos Ductos Lacrimais/epidemiologia , Irrigação Terapêutica/estatística & dados numéricos , Adulto , Idoso , Remoção de Dispositivo , Feminino , Alemanha/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Silicones , Resultado do TratamentoRESUMO
Genetically engineered pigs are a promising source for islet cell transplantation in type 1 diabetes, but the strong human anti-pig immune response prevents its successful clinical application. Here we studied the efficacy of neonatal porcine islet-like cell clusters (NPICCs) overexpressing LEA29Y, a high-affinity variant of the T cell co-stimulation inhibitor CTLA-4Ig, to engraft and restore normoglycemia after transplantation into streptozotocin-diabetic NOD-SCID IL2rγ-/- (NSG) mice stably reconstituted with a human immune system. Transplantation of INSLEA29Y expressing NPICCs resulted in development of normal glucose tolerance (70.4%) and long-term maintenance of normoglycemia without administration of immunosuppressive drugs. All animals transplanted with wild-type NPICCs remained diabetic. Immunohistological examinations revealed a strong peri- and intragraft infiltration of wild-type NPICCs with human CD45+ immune cells consisting of predominantly CD4+ and CD8+ lymphocytes and some CD68+ macrophages and FoxP3+ regulatory T cells. Significantly less infiltrating lymphocytes and only few macrophages were observed in animals transplanted with INSLEA29Y transgenic NPICCs. This is the first study providing evidence that beta cell-specific LEA29Y expression is effective for NPICC engraftment in the presence of a humanized immune system and it has a long-lasting protective effect on inhibition of human anti-pig xenoimmunity. Our findings may have important implications for the development of a low-toxic protocol for porcine islet transplantation in patients with type 1 diabetes.
Assuntos
Abatacepte/genética , Expressão Gênica , Terapia de Imunossupressão , Ilhotas Pancreáticas/metabolismo , Animais , Biomarcadores , Sobrevivência Celular , Técnicas de Inativação de Genes , Xenoenxertos , Humanos , Imunidade/genética , Imuno-Histoquímica , Imunofenotipagem , Terapia de Imunossupressão/métodos , Camundongos , Camundongos Knockout , Camundongos Transgênicos , SuínosRESUMO
BACKGROUND: Case report of a 6-year-old boy with bilateral choroidal osteoma. CASE REPORT: The patient was followed up for the next 6 years and during this period bilateral tumor progression was observed. In one eye a staphyloma posticum developed in the area of the osteoma which led to secondary anisometric myopia. CONCLUSION: If undetected, this rare complication can lead to anisometric amblyopia; therefore, repeated cycloplegic refractometry is advisable in children with choroidal osteoma.
Assuntos
Neoplasias da Coroide/complicações , Doenças da Córnea/diagnóstico , Doenças da Córnea/etiologia , Miopia Degenerativa/diagnóstico , Miopia Degenerativa/etiologia , Osteoma/complicações , Criança , Neoplasias da Coroide/diagnóstico , Diagnóstico Diferencial , Progressão da Doença , Humanos , Masculino , Osteoma/diagnóstico , Conduta ExpectanteRESUMO
Signaling molecules of the Wnt gene family are involved in the regulation of dorso-ventral, segmental and tissue polarity in Xenopus and Drosophila embryos. Members of the frizzled gene family, such as Drosophila frizzled-2 and rat frizzled-1, have been shown encode Wnt binding activity and to engage intracellular signal transduction molecules known to be part of the Wnt signaling pathway. Here we describe the cloning and characterization of Fritz, a mouse (mfiz) and human (hfiz) gene which codes for a secreted protein that is structurally related to the extracellular portion of the frizzled genes from Drosophila and vertebrates. The Fritz protein antagonizes Wnt function when both proteins are ectopically expressed in Xenopus embryos. In early gastrulation, mouse fiz mRNA is expressed in all three germ layers. Later in embryogenesis fiz mRNA is found in the central and peripheral nervous systems, nephrogenic mesenchyme and several other tissues, all of which are sites where Wnt proteins have been implicated in tissue patterning. We propose a model in which Fritz can interfere with the activity of Wnt proteins via their cognate frizzled receptors and thereby modulate the biological responses to Wnt activity in a multitude of tissue sites.
Assuntos
Proteínas de Drosophila , Regulação da Expressão Gênica no Desenvolvimento , Glicoproteínas/biossíntese , Família Multigênica , Proteínas Proto-Oncogênicas/antagonistas & inibidores , Sequência de Aminoácidos , Animais , Sequência de Bases , Linhagem Celular , Cricetinae , Drosophila , Embrião de Mamíferos , Embrião não Mamífero/fisiologia , Receptores Frizzled , Gástrula , Glicoproteínas/química , Glicoproteínas/fisiologia , Humanos , Hormônios de Inseto/biossíntese , Peptídeos e Proteínas de Sinalização Intracelular , Proteínas de Membrana/biossíntese , Proteínas de Membrana/química , Camundongos , Dados de Sequência Molecular , Fases de Leitura Aberta , Ratos , Receptores Acoplados a Proteínas G , Proteínas Recombinantes/biossíntese , Proteínas Recombinantes/química , Alinhamento de Sequência , Homologia de Sequência de Aminoácidos , Homologia de Sequência do Ácido Nucleico , Transdução de Sinais , Vertebrados , Xenopus laevis/embriologiaRESUMO
BACKGROUND: Pressurized probing and irrigation is the method of choice for congenital lacrimal duct obstruction after conservative therapeutic strategies have failed. The aim of this study was to evaluate age dependence and success rates of different therapeutic options. MATERIAL AND METHODS: A prospective cohort study of children with congenital lacrimal duct obstruction was performed. All children treated during the period between May 2009 and June 2010 were included. Surgical success was defined as the absence of epiphora and mucous discharge for a postoperative follow-up of 3 months. Odds ratios (OR) and 95 % confidence intervals (CI) of different variables were estimated using logistic regression. RESULTS: A total of 111 children (137 eyes) underwent treatment for congenital lacrimal duct obstruction. The mean age of the children was 7.7 months (range 1-30 months). The success rate of probing under local anesthesia was 85.5 % (n = 100). Probing under general anesthesia without intubation of the lacrimal pathway was successful in 28.6 % (n = 2). Treatment under general anesthesia with intubation of the lacrimal pathway had a success rate of 94.2 %. If the primary treatment was complicated the OR was 1.9 (95 % CI: 0.7-5.1), for males the OR was 1.7 (95 % CI: 0.8-3.5) and in cases of a positive family history the OR was 1.5 (95 % CI: 0.7-3.3). With every increasing month of age the risk not to be treated successfully increased (OR: 1.3, 95 % CI: 1.2-1.5). CONCLUSION: Syringing under local anesthesia is an effective therapy. The highest success rates were found at the ages of 1-6 months. Therapy with additional silicone tube intubation was highly successful.
Assuntos
Obstrução dos Ductos Lacrimais/congênito , Obstrução dos Ductos Lacrimais/terapia , Anestesia Local , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Stents , Irrigação Terapêutica , Resultado do TratamentoRESUMO
smad genes encode transcription factors involved in the signal transduction of members of the TGFbeta superfamily. We report here the cloning, characterization and genomic mapping of smad2, smad3 and smad4 from the zebrafish, Danio rerio. In Xenopus, smad2 overexpression has been shown to interfere with gastrulation and dorsal cell fate specification. However, full-length zebrafish smad2, although functionally active in Xenopus explants, has no effect when overexpressed in zebrafish embryos. In contrast, an N-terminally truncated, constitutively active version of Smad2 protein causes severe dorsalization or partial secondary axis formation, pointing to a role of Smad2 during mesoderm and axis formation. The temporal and spatial expression patterns of zebrafish smad2, 3 and 4 were investigated by developmental RT-PCR and whole mount in-situ hybridization. All three genes show strong and ubiquitous maternal expression. Zygotic expression is weak and ubiquitous in the case of smad2, and strong and ubiquitious in the case of smad4, while smad3 shows a spatially restricted zygotic expression pattern. It is expressed in migrating neural crest cells of the trunk and a subset of cells in the diencephalon in close proximity to the expression domain of the Nodal-related protein Cyclops/Ndr2/Znr1, a potential signal upstream of Smad2/3 required for eye-field separation and floor plate specification. Overexpression of truncated smad2 in cyclops mutant embryos leads to a rescue of the eye and floorplate defects. These data suggest that Smad2 acts as a mediator of Nodal signals during zebrafish midline signaling, while Smad3 might be involved in later steps of eye field separation.
Assuntos
Proteínas de Ligação a DNA/genética , Transativadores/genética , Proteínas de Xenopus , Proteínas de Peixe-Zebra , Peixe-Zebra/genética , Sequência de Aminoácidos , Animais , Mapeamento Cromossômico , Clonagem Molecular , Embrião não Mamífero/metabolismo , Desenvolvimento Embrionário , Regulação da Expressão Gênica no Desenvolvimento , Peptídeos e Proteínas de Sinalização Intracelular , Dados de Sequência Molecular , Mutação , Fatores de Crescimento Neural , RNA Mensageiro/administração & dosagem , RNA Mensageiro/genética , Homologia de Sequência de Aminoácidos , Proteínas Smad , Proteína Smad2 , Proteína Smad3 , Proteína Smad4 , Fator de Crescimento Transformador beta/genética , Xenopus/genética , Peixe-Zebra/embriologiaRESUMO
The survey "integrative preschool education - an inquiry in Bavarian preschools/kindergartens" aimed to obtain a representative picture of the situation of handicapped children in regular preschool settings - as opposed to special institutions. In this paper we present information regarding distribution among different group-sizes as well as different defining/diagnosing systems. We also investigated the influence of certain ecological conditions such as size of place where the preschool is situated and distance between preschool and the nearest special institution. Furthermore we gained insight into the conditions which hinder and those which promote the admission of handicapped children.
Assuntos
Pessoas com Deficiência , Inclusão Escolar , Pré-Escolar , Estudos Transversais , Avaliação da Deficiência , Alemanha Ocidental , Humanos , Fatores de RiscoRESUMO
Soil C is the largest pool of carbon in the terrestrial biosphere, and yet the processes of C accumulation, transformation and loss are poorly accounted for. This, in part, is due to the fact that soil C is not uniformly distributed through the soil depth profile and most current landscape level predictions of C do not adequately account the vertical distribution of soil C. In this study, we apply a method based on simple soil specific depth functions to map the soil C stock in three-dimensions at landscape scale. We used soil C and bulk density data from the Soil Survey for England and Wales to map an area in the West Midlands region of approximately 13,948 km(2). We applied a method which describes the variation through the soil profile and interpolates this across the landscape using well established soil drivers such as relief, land cover and geology. The results indicate that this mapping method can effectively reproduce the observed variation in the soil profiles samples. The mapping results were validated using cross validation and an independent validation. The cross-validation resulted in an R(2) of 36% for soil C and 44% for BULKD. These results are generally in line with previous validated studies. In addition, an independent validation was undertaken, comparing the predictions against the National Soil Inventory (NSI) dataset. The majority of the residuals of this validation are between ± 5% of soil C. This indicates high level of accuracy in replicating topsoil values. In addition, the results were compared to a previous study estimating the carbon stock of the UK. We discuss the implications of our results within the context of soil C loss factors such as erosion and the impact on regional C process models.