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1.
Transpl Int ; 36: 11729, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37841645

RESUMO

Primary sclerosing cholangitis (PSC) is the classical hepatobiliary manifestation of inflammatory bowel disease (IBD) and a lead indication for liver transplantation (LT) in the western world. In this article, we present a Consensus Statement on LT practice, developed by a dedicated Guidelines' Taskforce of the European Society of Organ Transplantation (ESOT). The overarching goal is to provide practical guidance on commonly debated topics, including indications and timing of LT, management of bile duct stenosis in patients on the transplant waiting list, technical aspects of transplantation, immunosuppressive strategies post-transplant, timing and extension of intestinal resection and futility criteria for re-transplantation.


Assuntos
Colangite Esclerosante , Doenças Inflamatórias Intestinais , Transplante de Fígado , Humanos , Colangite Esclerosante/complicações , Colangite Esclerosante/cirurgia , Fatores de Risco , Imunossupressores/uso terapêutico , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/cirurgia
2.
Eur J Appl Physiol ; 111(10): 2409-26, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21805156

RESUMO

Neuromuscular electrical stimulation (NMES) generates contractions by depolarising axons beneath the stimulating electrodes. The depolarisation of motor axons produces contractions by signals travelling from the stimulation location to the muscle (peripheral pathway), with no involvement of the central nervous system (CNS). The concomitant depolarisation of sensory axons sends a large volley into the CNS and this can contribute to contractions by signals travelling through the spinal cord (central pathway) which may have advantages when NMES is used to restore movement or reduce muscle atrophy. In addition, the electrically evoked sensory volley increases activity in CNS circuits that control movement and this can also enhance neuromuscular function after CNS damage. The first part of this review provides an overview of how peripheral and central pathways contribute to contractions evoked by NMES and describes how differences in NMES parameters affect the balance between transmission along these two pathways. The second part of this review describes how NMES location (i.e. over the nerve trunk or muscle belly) affects transmission along peripheral and central pathways and describes some implications for motor unit recruitment during NMES. The third part of this review summarises some of the effects that the electrically evoked sensory volley has on CNS circuits, and highlights the need to identify optimal stimulation parameters for eliciting plasticity in the CNS. A goal of this work is to identify the best way to utilize the electrically evoked sensory volley generated during NMES to exploit mechanisms inherent to the neuromuscular system and enhance neuromuscular function for rehabilitation.


Assuntos
Potencial Evocado Motor/fisiologia , Músculo Esquelético/inervação , Músculo Esquelético/fisiologia , Junção Neuromuscular/fisiologia , Estimulação Elétrica/métodos , Eletromiografia , Humanos , Modelos Biológicos , Neurônios Motores/fisiologia , Rede Nervosa/fisiologia , Nervos Periféricos/fisiologia
3.
Eur J Med Genet ; 64(6): 104231, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33905896

RESUMO

Primary sclerosing cholangitis (PSC) is a rare, inflammatory cholestatic liver disease that causes biliary strictures which can lead to secondary complications. About 30-50% of PSC patients develop dominant strictures (DS) in the biliary tree, which are both the cause of jaundice and bacterial cholangitis as well as predilection spots for development of neoplastic development. Cancer is the most common cause of death in PSC. A central concern is to distinguish malignant from benign strictures, which eventually is done by invasive methods to obtain a brush cytology or biopsy sample, in most cases via endoscopic retrograde cholangiography-pancreatography (ERCP). Since medical therapies, like ursodesoxycholic acid or immunosuppressive drugs have no proven effect, therapeutic ERCP has become the primary management strategy to improve symptoms and in some patients may slow down disease progression. This article aims at outlining the current and emerging methods in ERCP in PSC patients.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangite Esclerosante/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/normas , Humanos
4.
Genes Immun ; 10(6): 601-5, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19387457

RESUMO

We reported earlier that two mitochondrial gene polymorphisms, UCP2 -866 G/A (rs659366) and mtDNA nt13708 G/A (rs28359178), are associated with multiple sclerosis (MS). Here we aim to investigate whether these functional polymorphisms contribute to other eight chronic inflammatory diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Wegener' granulomatosis (WG), Churg-Strauss syndrome (CSS), Crohn's disease (CD), ulcerative colitis (UC), primary sclerosing cholangitis (PSC) and psoriasis. Compared with individual control panels, the UCP2 -866 G/A polymorphism was associated with RA and SLE, and the mtDNA nt13708 G/A polymorphism with RA. Compared with combined controls, the UCP2 -866 G/A polymorphism was associated with SLE, WG, CD and UC. When all eight disease panels and the original MS panel were combined in a meta-analysis, the UCP2 was associated with chronic inflammatory diseases in terms of either alleles (odds ratio (OR)=0.91, 95% confidence interval (95% CI): 0.86-0.96), P=0.0003) or genotypes (OR=0.88, (95% CI: 0.82-0.95), P=0.0008), with the -866A allele associated with a decreased risk to diseases. As the -866A allele increases gene expression, our findings suggest a protective role of the UCP2 protein in chronic inflammatory diseases.


Assuntos
Artrite Reumatoide/genética , DNA Mitocondrial/genética , Canais Iônicos/genética , Lúpus Eritematoso Sistêmico/genética , Proteínas Mitocondriais/genética , Polimorfismo de Nucleotídeo Único/genética , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/imunologia , Estudos de Casos e Controles , Colangite Esclerosante/epidemiologia , Colangite Esclerosante/genética , Colangite Esclerosante/imunologia , Doença Crônica , Síndrome de Churg-Strauss/epidemiologia , Síndrome de Churg-Strauss/genética , Síndrome de Churg-Strauss/imunologia , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/genética , Colite Ulcerativa/imunologia , Doença de Crohn/epidemiologia , Doença de Crohn/genética , Doença de Crohn/imunologia , Genótipo , Alemanha/epidemiologia , Humanos , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/imunologia , Metanálise como Assunto , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/genética , Esclerose Múltipla/imunologia , Psoríase/epidemiologia , Psoríase/genética , Psoríase/imunologia , Fatores de Risco , Países Escandinavos e Nórdicos/epidemiologia , Proteína Desacopladora 2
5.
J Cell Biol ; 53(1): 66-72, 1972 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-4259051

RESUMO

Separation of Neurospora mitochondrial outer membranes from the inner membrane/matrix fraction was effected by digitonin treatment and discontinuous density gradient centrifugation. The solubilization of four isoleucine-valine biosynthetic enzymes was studied as a function of digitonin concentration and time of incubation in the detergent. The kinetics of the appearance of valine biosynthetic function in fractions outside of the inner membrane/matrix fraction, coupled with enzyme solubilization patterns similar to that for the matrix marker, mitochondrial malate dehydrogenase, indicate that the four isoleucine-valine pathway enzymes are localized in the mitochondrial matrix.


Assuntos
Isoleucina/biossíntese , Mitocôndrias/enzimologia , Neurospora/enzimologia , Valina/biossíntese , Oxirredutases do Álcool/metabolismo , Centrifugação com Gradiente de Concentração , Citocromos , Glicosídeos Digitálicos , Hidroliases/metabolismo , Cinurenina , Liases/metabolismo , Malato Desidrogenase/metabolismo , Membranas , Mitocôndrias/efeitos dos fármacos , Oxigenases de Função Mista/metabolismo , Neurospora crassa/citologia , Neurospora crassa/enzimologia , Oxirredutases/metabolismo , Saponinas , Espirostanos , Succinatos , Transaminases/metabolismo
6.
Ann Rheum Dis ; 67(9): 1287-91, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18065500

RESUMO

BACKGROUND AND OBJECTIVES: The Fc receptor-like 3 (FCRL3) gene -169T>C single nucleotide polymorphism (SNP) has been reported to be associated with several autoimmune diseases (AIDs) in Japanese populations. However, association results in other populations have been conflicting. Therefore, we investigated this SNP in a Scandinavian panel of AIDs. METHODS: We genotyped patients with rheumatoid arthritis (RA; n = 708), juvenile idiopathic arthritis (JIA; n = 524), systemic lupus erythaematosus (SLE; n = 166), ulcerative colitis (UC; n = 335), primary sclerosing cholangitis (PSC; n = 365), Crohn disease (CD; n = 149), a healthy control group (n = 1030) and 425 trio families with type 1 diabetes (T1D). Statistical analysis consisted of case-control and family-based association tests. RESULTS: RA was associated with the C allele (odds ratio (OR) = 1.16, 95% CI 1.01 to 1.33) and the CC genotype (OR = 1.30, 95% CI 1.01 to 1.67) of the FCRL3 -169T>C SNP in our material. Suggestive evidence for association was also found for JIA (CC genotype: OR = 1.30, 95% CI 0.99 to 1.70), and clinical subgroup analysis indicated that this was connected to the polyarticular subgroup. No significant association was found with SLE, UC, CD, PSC or T1D. In patients with RA, we found no significant interaction between the FCRL3 -169T>C and PTPN22 1858C>T SNPs, nor between the FCRL3 -169CC genotype and IgM-rheumatoid factor or anti-cyclic citrullinated peptide titre levels. CONCLUSION: We found an association between the FCRL3 -169T>C SNP and RA, and suggestive evidence for involvement with JIA, in a Norwegian population. These findings lend support for a role for this SNP in RA across ethnically diverse populations, and warrant follow-up studies in JIA.


Assuntos
Artrite Juvenil/genética , Artrite Reumatoide/genética , Polimorfismo de Nucleotídeo Único , Receptores Imunológicos/genética , Doenças Autoimunes/genética , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Humanos , Noruega
7.
Acta Radiol ; 49(8): 855-62, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18608012

RESUMO

BACKGROUND: Early detection of cholangiocarcinoma (CC) is very difficult, especially in patients with primary sclerosing cholangitis (PSC) who are at increased risk of developing CC. PURPOSE: To evaluate 1H magnetic resonance spectroscopy ((1)H-MRS) of bile as a diagnostic marker for CC in patients with and without PSC. MATERIAL AND METHODS: The institutional review board approved the study, and all patients gave informed consent. Bile from 49 patients was sampled and investigated using 1H-MRS. MR spectra of bile samples from 45 patients (18 female; age range 22-87 years, mean age 57 years) were analyzed both conventionally and using computerized multivariate analysis. Sixteen of the patients had CC, 18 had PSC, and 11 had other benign findings. RESULTS: The spectra of bile from CC patients differed from the benign group in the levels of phosphatidylcholine, bile acids, lipid, and cholesterol. It was possible to distinguish CC from benign conditions in all patients with malignancy. Two benign non-PSC patients were misclassified as malignant. The sensitivity, specificity, and accuracy were 88.9%, 87.1%, and 87.8%, respectively. CONCLUSION: With 1H-MRS of bile, cholangiocarcinoma could be discriminated from benign biliary conditions with or without PSC.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos , Bile/química , Colangiocarcinoma/diagnóstico , Colangite Esclerosante/complicações , Espectroscopia de Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ácidos e Sais Biliares/análise , Ductos Biliares Intra-Hepáticos/patologia , Biomarcadores Tumorais/análise , Colesterol/análise , Diagnóstico Diferencial , Feminino , Humanos , Lipídeos/análise , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fosfatidilcolinas/análise , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
8.
Aliment Pharmacol Ther ; 47(2): 238-245, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29064110

RESUMO

BACKGROUND: Despite the close relationship between primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD), the association between colectomy and the prognosis of PSC remains controversial. AIM: To explore whether colectomy prior to PSC-diagnosis is associated with transplant-free survival. METHODS: A nationwide cohort study in Sweden including all patients aged 18 to 69 years in whom both PSC and IBD was diagnosed between 1987 and 2014 was undertaken. Each patient was followed from date of both PSC and IBD diagnoses until liver transplantation or death, or 31 December 2014. Patients with colon in situ, and colectomy prior to PSC-diagnosis were compared. Survival analyses were performed using the Kaplan-Meier method and multivariable Cox regression models. RESULTS: Of the 2594 PSC-IBD patients, 205 patients were treated with colectomy before PSC-diagnosis. During follow-up, liver transplantations were performed in 327 patients and 509 died. The risk of liver transplantation or death was lower in patients treated with colectomy prior to PSC-diagnosis (HR 0.71, 95% CI 0.53-0.95) than in patients with colon in situ. Male gender, longer time between IBD and PSC-diagnosis and older age were all associated with an increased risk of liver transplantation or death. Colectomy after PSC-diagnosis was however not associated with an increased risk of liver transplantation or death during long-term follow-up. CONCLUSIONS: In PSC-IBD patients, colectomy prior to PSC-diagnosis is associated with a decreased risk of liver transplantation or death.


Assuntos
Colangite Esclerosante/complicações , Colangite Esclerosante/diagnóstico , Colectomia/estatística & dados numéricos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/cirurgia , Adolescente , Adulto , Idoso , Colangite Esclerosante/mortalidade , Colangite Esclerosante/cirurgia , Estudos de Coortes , Feminino , Sobrevivência de Enxerto , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/mortalidade , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Prognóstico , Análise de Sobrevida , Suécia/epidemiologia , Resultado do Tratamento , Adulto Jovem
9.
Clin Liver Dis ; 2(2): 283-301, viii, 1998 May.
Artigo em Inglês | MEDLINE | ID: mdl-15560033

RESUMO

This article describes clinical features in primary sclerosing cholangitis, including clinical presentation and complications. The natural history of the disease is discussed, as well as the strong association to inflammatory bowel disease.


Assuntos
Colangite Esclerosante/complicações , Colangite Esclerosante/diagnóstico , Colangite Esclerosante/epidemiologia , Humanos , Doenças Inflamatórias Intestinais/complicações
10.
Best Pract Res Clin Gastroenterol ; 15(4): 643-56, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11492973

RESUMO

The increased risk for cholangiocarcinoma in primary sclerosing cholangitis (PSC) is well established, but the factors responsible for the malignant development in the bile ducts in this disease are not known. The pathogenesis of cholangiocarcinoma in PSC including the role of chronic inflammation and oncogenic mutations will be discussed. Cholangiocarcinoma is a leading cause of death in PSC and the prognosis even after liver transplantation is poor, with a median survival after cancer diagnosis of 5 months. Therefore, it is of great importance to identify PSC patients who are at risk of developing cholangiocarcinoma in order to transplant them before cancer has developed.


Assuntos
Neoplasias dos Ductos Biliares/etiologia , Ductos Biliares Intra-Hepáticos , Colangiocarcinoma/etiologia , Colangite Esclerosante/complicações , Neoplasias dos Ductos Biliares/diagnóstico , Colangiocarcinoma/diagnóstico , Humanos
11.
Equine Vet J ; 14(2): 129-33, 1982 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-6211350

RESUMO

Back pain was induced in Standardbred horses by multiple intramuscular injections of a concentrated lactic acid solution into the left longissimus dorsi muscle. The investigation was divided into 2 parts. In Stage 1, 2 trotters were exercised on a treadmill and filmed by high speed cinematography before and after the induction of back pain. No signs of hindlimb lameness were evident and no quantitative changes in the components of the gait resulted, but a noticeable reduction was seen in performance capacity. Stage 2 involved a more intensive clinical and cinematic analysis of 3 horses. In these animals some changes were detected in the stride pattern, but no obvious gait disturbance was produced. The principal effect was stiffness in the thoracolumbar spine and an inability to perform at fast paces.


Assuntos
Dor nas Costas/veterinária , Marcha , Doenças dos Cavalos/fisiopatologia , Cavalos/fisiologia , Esforço Físico , Animais , Dor nas Costas/induzido quimicamente , Dor nas Costas/fisiopatologia , Feminino , Doenças dos Cavalos/induzido quimicamente , Lactatos , Ácido Láctico , Masculino , Miosite/induzido quimicamente , Miosite/fisiopatologia , Miosite/veterinária
12.
Health Serv J ; 108(5605): 30-1, 1998 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-10180173

RESUMO

In one area in Merseyside, primary care teams were only identifying elderly people with dementia in times of crisis, resulting in earlier than necessary residential or nursing home placements. Employing a social worker to work with primary care teams as a specialist care manager for this group has resulted in earlier and more appropriate care in the view of both carers and care workers. Following the appointment, interviews with 10 carers revealed that eight out of 10 patients were now receiving health and social care when nine out of 10 had previously received none.


Assuntos
Demência/enfermagem , Avaliação Geriátrica , Equipe de Assistência ao Paciente , Atenção Primária à Saúde/organização & administração , Serviço Social/organização & administração , Idoso , Comportamento Cooperativo , Demência/terapia , Medicina de Família e Comunidade/organização & administração , Pesquisas sobre Atenção à Saúde , Humanos , Encaminhamento e Consulta , Reino Unido
14.
J Appl Physiol (1985) ; 113(1): 78-89, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22556395

RESUMO

Neuromuscular electrical stimulation (NMES) can be delivered over a nerve trunk or muscle belly and both can generate contractions through peripheral and central pathways. Generating contractions through peripheral pathways is associated with a nonphysiological motor unit recruitment order, which may limit the efficacy of NMES rehabilitation. Presently, we compared recruitment through peripheral and central pathways for contractions of the knee extensors evoked by NMES applied over the femoral nerve vs. the quadriceps muscle. NMES was delivered to evoke 10 and 20% of maximum voluntary isometric contraction torque 2-3 s into the NMES (time(1)) in two patterns: 1) constant frequency (15 Hz for 8 s); and 2) step frequency (15-100-15 Hz and 25-100-25 Hz for 3-2-3 s, respectively). Torque and electromyographic activity recorded from vastus lateralis and medialis were quantified at the beginning (time(1)) and end (time(2); 6-7 s into the NMES) of each pattern. M-waves (peripheral pathway), H-reflexes, and asynchronous activity (central pathways) during NMES were quantified. Torque did not differ regardless of NMES location, pattern, or time. For both muscles, M-waves were ∼7-10 times smaller and H-reflexes ∼8-9 times larger during NMES over the nerve compared with over the muscle. However, unlike muscles studied previously, neither torque nor activity through central pathways were augmented following 100 Hz NMES, nor was any asynchronous activity evoked during NMES at either location. The coefficient of variation was also quantified at time(2) to determine the consistency of each dependent measure between three consecutive contractions. Torque, M-waves, and H-reflexes were most variable during NMES over the nerve. In summary, NMES over the nerve produced contractions with the greatest recruitment through central pathways; however, considering some of the limitations of NMES over the femoral nerve, it may be considered a good complement to, as opposed to a replacement for, NMES over the quadriceps muscle for maintaining muscle quality and reducing contraction fatigue during NMES rehabilitation.


Assuntos
Nervo Femoral/fisiologia , Músculo Quadríceps/inervação , Recrutamento Neurofisiológico/fisiologia , Adulto , Estimulação Elétrica , Eletromiografia , Feminino , Reflexo H/fisiologia , Humanos , Contração Isométrica/fisiologia , Joelho/inervação , Joelho/fisiologia , Masculino , Pessoa de Meia-Idade , Músculo Quadríceps/fisiologia , Torque , Adulto Jovem
15.
Neurosci Lett ; 529(1): 80-5, 2012 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-22985510

RESUMO

Neuromuscular electrical stimulation (NMES) increases the excitability of corticospinal (CS) pathways by altering circuits in motor cortex (M1). How NMES affects circuits interposed between the ascending afferent volley and descending CS pathways is not known. Presently, we hypothesized that short-latency afferent inhibition (SAI) would be reduced and afferent facilitation (AF) enhanced when NMES increased CS excitability. NMES was delivered for 40 min over the ulnar nerve. To assess CS excitability, motor evoked potentials (MEPs) were evoked using transcranial magnetic stimulation (TMS) delivered at 120% resting threshold for first dorsal interosseus muscle. These MEPs increased by ∼1.7-fold following NMES, demonstrating enhanced CS excitability. SAI and AF were tested by delivering a "conditioning" electrical stimulus to the ulnar nerve 18-25 ms and 28-35 ms before a "test" TMS pulse, respectively. Conditioned MEPs were compared to unconditioned MEPs evoked in the same trials. TMS was adjusted so unconditioned MEPs were not different before and after NMES. At the SAI interval, conditioned MEPs were 25% smaller than unconditioned MEPs before NMES but conditioned and unconditioned MEPs were not different following NMES. At the AF interval, conditioned MEPs were not different from unconditioned MEPs before NMES, but were facilitated by 33% following NMES. Thus, when NMES increases CS excitability there are concurrent changes in the effect of afferent input on M1 excitability, resulting in a net increase in the excitatory effect of the ascending afferent volley on CS circuits. Maximising this excitatory effect on M1 circuits may help strengthen CS pathways and improve functional outcomes of NMES-based rehabilitation programs.


Assuntos
Vias Aferentes/fisiologia , Estimulação Elétrica , Inibição Neural/fisiologia , Junção Neuromuscular/fisiologia , Tratos Piramidais/fisiologia , Tempo de Reação/fisiologia , Transmissão Sináptica/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
J Appl Physiol (1985) ; 110(3): 627-37, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21183628

RESUMO

Neuromuscular electrical stimulation (NMES) can be delivered over a nerve trunk or muscle belly and can generate contractions by activating motor (peripheral pathway) and sensory (central pathway) axons. In the present experiments, we compared the peripheral and central contributions to plantar flexion contractions evoked by stimulation over the tibial nerve vs. the triceps surae muscles. Generating contractions through central pathways follows Henneman's size principle, whereby low-threshold motor units are activated first, and this may have advantages for rehabilitation. Statistical analyses were performed on data from trials in which NMES was delivered to evoke 10-30% maximum voluntary torque 2-3 s into the stimulation (Time(1)). Two patterns of stimulation were delivered: 1) 20 Hz for 8 s; and 2) 20-100-20 Hz for 3-2-3 s. Torque and soleus electromyography were quantified at the beginning (Time(1)) and end (Time(2); 6-7 s into the stimulation) of each stimulation train. H reflexes (central pathway) and M waves (peripheral pathway) were quantified. Motor unit activity that was not time-locked to each stimulation pulse as an M wave or H reflex ("asynchronous" activity) was also quantified as a second measure of central recruitment. Torque was not different for stimulation over the nerve or the muscle. In contrast, M waves were approximately five to six times smaller, and H reflexes were approximately two to three times larger during NMES over the nerve vs. the muscle. Asynchronous activity increased by 50% over time, regardless of the stimulation location or pattern, and was largest during NMES over the muscle belly. Compared with NMES over the triceps surae muscles, NMES over the tibial nerve produced contractions with a relatively greater central contribution, and this may help reduce muscle atrophy and fatigue when NMES is used for rehabilitation.


Assuntos
Estimulação Elétrica/métodos , Contração Muscular/fisiologia , Músculo Esquelético/inervação , Músculo Esquelético/fisiologia , Nervos Periféricos/fisiologia , Recrutamento Neurofisiológico/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
Aliment Pharmacol Ther ; 32(9): 1154-62, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21039677

RESUMO

BACKGROUND: Reliable epidemiological data for portal vein thrombosis are lacking. AIMS: To investigate the incidence, prevalence and survival rates for patients with portal vein thrombosis. METHODS: Retrospective multicentre study of all patients registered with the diagnosis of portal vein thrombosis between 1995 and 2004. RESULTS: A total of 173 patients (median age 57 years, 93 men) with portal vein thrombosis were identified and followed up for a median of 2.5 years (range 0-9.7). The mean age-standardized incidence and prevalence rates were 0.7 per 100,000 per year and 3.7 per 100,000 inhabitants, respectively. Liver disease was present in 70 patients (40%), malignancy in 27%, thrombophilic factors in 22% and myeloproliferative disorders in 11%. Two or more risk factors were identified in 80 patients (46%). At diagnosis, 65% were put on anticoagulant therapy. Thrombolysis, TIPS, surgical shunting and liver transplantation were performed in 6, 3, 2 and 8 patients, respectively. The overall survival at 1 year and 5 years was 69% and 54%. In the absence of malignancy and cirrhosis, the survival was 92% and 76%, respectively. CONCLUSIONS: The incidence and prevalence rates of portal vein thrombosis were 0.7 per 100,000 inhabitants per year and 3.7 per 100,000 inhabitants, respectively. Concurrent prothrombotic risk factors are common. The prognosis is variable and highly dependent on underlying disease.


Assuntos
Veia Porta , Trombose Venosa/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Estudos Retrospectivos , Suécia/epidemiologia , Trombose Venosa/fisiopatologia , Trombose Venosa/terapia , Adulto Jovem
19.
Genes Immun ; 8(3): 275-8, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17301827

RESUMO

Approximately 80% of patients with primary sclerosing cholangitis (PSC) of Northern European origin have inflammatory bowel disease (IBD), the majority ulcerative colitis (UC). An inherent problem in interpreting positive findings in genetic association studies of PSC is thus to distinguish between factors associated with hepatobiliary versus intestinal pathology. We aimed to clarify to what extent human leukocyte antigen (HLA) class II associations in UC patients with and without PSC differ. High-resolution DRB1 and DQB1 typing was performed in 365 Scandinavian PSC patients, an independent cohort of 330 Norwegian UC patients and 368 healthy controls. HLA associations found in PSC were mostly distinct from those seen in UC, and no significant differences were noted between PSC patients with concurrent UC and PSC patients without IBD. This suggests different HLA associated genetic susceptibility to PSC and UC, and supports notions that UC in PSC may represent a distinct UC phenotype.


Assuntos
Colangite Esclerosante/complicações , Colangite Esclerosante/imunologia , Colite Ulcerativa/complicações , Colite Ulcerativa/imunologia , Antígenos HLA-DQ , Antígenos HLA-DR , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alelos , Estudos de Casos e Controles , Criança , Pré-Escolar , Colangite Esclerosante/genética , Colite Ulcerativa/genética , Feminino , Frequência do Gene , Predisposição Genética para Doença , Antígenos HLA-DQ/genética , Cadeias beta de HLA-DQ , Antígenos HLA-DR/genética , Cadeias HLA-DRB1 , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Suécia
20.
J Intern Med ; 262(3): 393-401, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17697161

RESUMO

OBJECTIVE: To determine the causes and outcome of all patients with acute liver failure (ALF) in Sweden 1994-2003 and study the diagnostic accuracy of King's College Hospital (KCH) criteria and the model for end-stage liver disease (MELD) score with transplant-free deaths as a positive outcome. RESEARCH DESIGN AND METHODS: Adult patients in Sweden with international normalized ratio (INR) of >or=1.5 due to severe liver injury with and without encephalopathy at admission between 1994-2003 were included. RESULTS: A total of 279 patients were identified. The most common cause of ALF were acetaminophen toxicity in 42% and other drugs in 15%. In 31 cases (11%) no definite etiology could be established. The KCH criteria had a positive-predictive value (PPV) of 67%, negative-predictive value (NPV) of 84% in the acetaminophen group. Positive-predictive value and negative-predictive value of KCH criteria in the nonacetaminophen group were 54% and 63% respectively. MELD score>30 had a positive-predictive value of 21%, negative-predictive value of 94% in the acetaminophen group. The corresponding figures for the nonacetaminophen group were 64% and 76% respectively. CONCLUSIONS: Acetaminophen toxicity was the most common cause in unselected patients with ALF in Sweden. KCH criteria had a high NPV in the acetaminophen group, and in combination with MELD score<30 predicts a good prognosis in acetaminophen patients without transplantation.


Assuntos
Falência Hepática Aguda/etiologia , Transplante de Fígado , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Falência Hepática Aguda/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Suécia/epidemiologia
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