RESUMO
There have been many important milestones on humanity's long journey towards achieving environmental sanitation. In particular, the development of the activated sludge system can be claimed to be one of the most groundbreaking advances in the protection of both public health and the wider ecosystem. The first wastewater treatment plants (WWTPs) were developed over a century ago and were soon configured for use with activated sludge. However, despite their long history and service, conventional activated sludge (CAS) plants have become an unsustainable method of wastewater treatment. In addition, conventional WWTPs are intensive energy-consumers and at best allow only very limited material recovery. A paradigm shift to convert existing WWTPs into more sustainable facilities must therefore be considered necessary and to this end the wastewater biorefinery (WWBR) concept may be considered a solution that maximizes both energy and material recovery, in line with the circular economy approach.
Assuntos
Esgotos , Purificação da Água , Eliminação de Resíduos Líquidos , Ecossistema , Águas ResiduáriasRESUMO
Multi-contrast images are commonly acquired together to maximize complementary diagnostic information, albeit at the expense of longer scan times. A time-efficient strategy to acquire high-quality multi-contrast images is to accelerate individual sequences and then reconstruct undersampled data with joint regularization terms that leverage common information across contrasts. However, these terms can cause features that are unique to a subset of contrasts to leak into the other contrasts. Such leakage-of-features may appear as artificial tissues, thereby misleading diagnosis. The goal of this study is to develop a compressive sensing method for multi-channel multi-contrast magnetic resonance imaging (MRI) that optimally utilizes shared information while preventing feature leakage. Joint regularization terms group sparsity and colour total variation are used to exploit common features across images while individual sparsity and total variation are also used to prevent leakage of distinct features across contrasts. The multi-channel multi-contrast reconstruction problem is solved via a fast algorithm based on Alternating Direction Method of Multipliers. The proposed method is compared against using only individual and only joint regularization terms in reconstruction. Comparisons were performed on single-channel simulated and multi-channel in-vivo datasets in terms of reconstruction quality and neuroradiologist reader scores. The proposed method demonstrates rapid convergence and improved image quality for both simulated and in-vivo datasets. Furthermore, while reconstructions that solely use joint regularization terms are prone to leakage-of-features, the proposed method reliably avoids leakage via simultaneous use of joint and individual terms, thereby holding great promise for clinical use.
Assuntos
Imageamento por Ressonância Magnética , Mapeamento Encefálico , Simulação por Computador , Humanos , Imagens de Fantasmas , Razão Sinal-RuídoRESUMO
This study was performed to clarify the role of extracellular and intracellular Ca2+ on rho-kinase enzyme inhibition-induced relaxation in rabbit renal arteries. The response to rho-kinase inhibitor (Y-27632) was studied in isolated renal artery segments precontracted with phenylephrine in the presence of voltage-gated calcium channel blocker nifedipine and in the absence of intracellular or extracellular Ca2+. Cumulative addition of rho-kinase inhibitor Y-27632 (10-8-10-5 M) produced a concentration-dependent relaxation in renal artery rings precontracted with phenylephrine. Preincubation with nifedipine (1µM) resulted in a significant increase in relaxation response to rho-kinase inhibitor Y-27632 compared with preincubation with DMSO; the solvent of nifedipine. The maximal relaxation to Y-27632 in renal arteries precontracted with phenylephrine was significantly increased in the Ca-free Krebs containing 100 µmol/l ethylene glycol tetraacetic acid (EGTA) but after depletion of intracellular stores with 20 mmol/l caffeine and 1mmol/l EGTA in Ca2+ free Krebs there was no significant difference between the relaxation to Y-27632 from control response in 2.5 mmol/l Ca2+ Krebs in the renal artery. These results suggest the involvement of extracellular Ca and L-type voltage-operated Ca2+ channels in phenylephrine-induced rho-kinase activation (Fig. 3, Ref. 20).
Assuntos
Amidas/farmacologia , Cálcio/fisiologia , Inibidores Enzimáticos/farmacologia , Piridinas/farmacologia , Artéria Renal/efeitos dos fármacos , Artéria Renal/fisiologia , Quinases Associadas a rho/antagonistas & inibidores , Animais , Masculino , Relaxamento Muscular/efeitos dos fármacos , Músculo Liso Vascular/efeitos dos fármacos , CoelhosRESUMO
BACKGROUND: Diabetic foot is a complex syndrome that is associated with other diabetic complications, such as peripheral arte-rial disease and peripheral neuropathy. Optimization of plasma glucose and glycated hemoglobin (HbA1c) is one of the main principles of standard care and treatment approaches in individuals with diabetes mellitus (DM). In this study, the relationship of HbA1c level at the time of diagnosis was evaluated with diabetic foot disease severity score and surgical extension in patients with Type 2 DM. METHODS: This study included 301 consecutive patients who were diagnosed with diabetic foot in the general surgery diabetic foot clinic and were hospitalized for surgery. The relationships between the HbA1c levels of the patients with the Wagner and PEDIS (Perfusion, Extent, Dept, Infection, Sensation) classification system grades, and the surgical procedures performed were analyzed and the treatment outcomes were evaluated. RESULTS: It was determined that there was a 90% statistically significant relationship between HbA1c values of ≥10.1% and the de-velopment of Wagner Grade 4 diabetic foot ulcer (DFU) (P=0.037). A strong statistically significant relationship at the rate of 85% was determined between HbA1c values of ≥10.1% and the development of PEDIS Grade 3 ulcers. As the HbA1c values increased, so there was determined to be a statistically significant relationship with the development of PEDIS Grade 3 ulcer (P=0.003). In the comparison of the HbA1c values according to the type of surgery performed, a weak relationship was determined at the rate of 26%, and it was determined that as the HbA1c values increased, so there could be an increase in the amputation level. CONCLUSION: The results of this study showed that as HbA1c values at diagnosis increased in patients with diabetic foot; Wagner/PEDIS grades, disease severity, surgical extension, amputation level, and tissue loss increased. To reduce the severity of diabetic foot disease and prevent amputation, compliance with diabetic treatment and glycemic control should be increased.
Assuntos
Diabetes Mellitus , Pé Diabético , Humanos , Pé Diabético/complicações , Pé Diabético/cirurgia , Hemoglobinas Glicadas , Gravidade do Paciente , Amputação Cirúrgica , Cooperação do PacienteRESUMO
PURPOSE: Magnetic particle imaging (MPI) is a relatively new method to image the spatial distribution of magnetic nanoparticle (MNP) tracers administered to the body with high spatial and temporal resolution using an inhomogeneous magnetic field. The spatial information of the MNP's is encoded using a field free point (FFP), or a field free line (FFL), in which the magnetic field vanishes at a point, or on a line, respectively. FFL scanning has the advantage of improved sensitivity compared to FFP scanning as a result of higher signal-to-noise ratio. The trajectory traversed by the FFL or FFP is an important parameter of the MPI system and should be selected to achieve the best imaging quality in minimum scan time, while considering hardware constraints and patient safety. In this study, we analyzed the image quality of different FFL trajectories for a large field of view (FOV) using simulations, to provide a baseline information for FFL scanning MPI system design. METHODS: We simulated a human-sized FFL scanning MPI configuration to image a circular FOV with 160 mm diameter, and compared Radial, Spiral, Uniform Spiral, Flower, and Lissajous trajectories with different trajectory densities scanned by the FFL for constant scan time. We analyzed the system matrices of the trajectories in terms of mutual coherence and homogeneity of the spatial sensitivity. We calculated the maximum electric fields induced on a homogeneous conductive body by the selection field (SF) and the focus field (FF) to compare the trajectories based on the nerve stimulation threshold. The images were obtained using the system matrix reconstruction approach with two different image reconstruction methods. In the first one, we used the conventional image reconstruction method, algebraic reconstruction technique (ART), which gives a regularized least-squares solution. In the second one, we used the state-of-the-art alternating direction method of multipliers (ADMM), which minimizes a weighted sum of the l1 -norm and the total variation (TV) of the images. RESULTS: The Radial and Spiral trajectories resulted in a poor imaging performance at low trajectory densities due to relatively high coherency and poor sensitivity of the measurements, respectively. For ART reconstruction, the highest image quality with the lowest trajectory density was achieved with the Uniform Spiral trajectory. Uniform Spiral, Flower, and Lissajous trajectories yielded comparable performance with ADMM reconstruction. The rotating SF induced higher electric field amplitude compared to the FF. Consequently, maximum allowable gradient at the same trajectory density was greater for the Radial trajectory compared to the other trajectories. CONCLUSIONS: For a large FOV coverage, the Uniform Spiral trajectory offers a good compromise between image quality and imaging time, taking safety and hardware limitations into account. The Radial trajectory, especially using l1 -norm and TV priors in the reconstruction, may be favorable in case the SF induced electric field is higher than that of the FF at the same frequency (e.g., relatively small FOV coverage). In general, ADMM reconstruction resulted in higher contrast and resolution compared to ART, leading to lighter requirements on the density of the trajectory.
Assuntos
Campos Magnéticos , Imageamento por Ressonância Magnética/métodos , Nanopartículas de Magnetita/química , Imagens de Fantasmas , Razão Sinal-Ruído , Algoritmos , Humanos , Processamento de Imagem Assistida por Computador/métodosRESUMO
Magnetic particle imaging (MPI) is a relatively new medical imaging modality, which detects the nonlinear response of magnetic nanoparticles (MNPs) that are exposed to external magnetic fields. The system matrix (SM) method for MPI image reconstruction requires a time consuming system calibration scan prior to image acquisition, where a single MNP sample is measured at each voxel position in the field-of-view (FOV). The scanned sample has the maximum size of a voxel so that the calibration measurements have relatively poor signal-to-noise ratio (SNR). In this paper, we present the coded calibration scene (CCS) framework, where we place multiple MNP samples inside the FOV in a random or pseudo-random fashion. Taking advantage of the sparsity of the SM, we reconstruct the SM by solving a convex optimization problem with alternating direction method of multipliers using CCS measurements. We analyze the effects of filling rate, number of measurements, and SNR on the SM reconstruction using simulations and demonstrate different implementations of CCS for practical realization. We also compare the imaging performance of the proposed framework with that of a standard compressed sensing SM reconstruction that utilizes a subset of calibration measurements from a single MNP sample. The results show that CCS significantly reduces calibration time while increasing both the SM reconstruction and image reconstruction performances.
Assuntos
Imageamento por Ressonância Magnética/métodos , Nanopartículas de Magnetita/química , Processamento de Sinais Assistido por Computador , Algoritmos , Calibragem , Simulação por Computador , Imagens de Fantasmas , Razão Sinal-RuídoRESUMO
A central limitation of multiple-acquisition magnetic resonance imaging (MRI) is the degradation in scan efficiency as the number of distinct datasets grows. Sparse recovery techniques can alleviate this limitation via randomly undersampled acquisitions. A frequent sampling strategy is to prescribe for each acquisition a different random pattern drawn from a common sampling density. However, naive random patterns often contain gaps or clusters across the acquisition dimension that, in turn, can degrade reconstruction quality or reduce scan efficiency. To address this problem, a statistically segregated sampling method is proposed for multiple-acquisition MRI. This method generates multiple patterns sequentially while adaptively modifying the sampling density to minimize k-space overlap across patterns. As a result, it improves incoherence across acquisitions while still maintaining similar sampling density across the radial dimension of k-space. Comprehensive simulations and in vivo results are presented for phase-cycled balanced steady-state free precession and multi-echo [Formula: see text]-weighted imaging. Segregated sampling achieves significantly improved quality in both Fourier and compressed-sensing reconstructions of multiple-acquisition datasets.
Assuntos
Algoritmos , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Encéfalo/diagnóstico por imagem , Humanos , Imagens de FantasmasRESUMO
OBJECTIVE: B-type natriuretic peptide (BNP) is a neurohormone secreted from cardiac ventricles in response to ventricular strain. The aim of present study was to evaluate the role of BNP in the diagnosis of the right ventricular (RV) dysfunction in acute pulmonary embolism (PE). METHODS: BNP levels were measured in patients with acute PE as diagnosed by high probability lung scan or positive spiral computed tomography. All patients underwent standard echocardiography and blood tests during the second hour of the diagnosis. RESULTS: Forty patients diagnosed as acute PE (mean age, 60.4 +/- 13.2 years; 62.5% women) were enrolled in this study. Patients with RV dysfunction had significantly higher BNP levels than patients without RV dysfunction (426 +/- 299.42 pg/ml vs. 39.09 +/- 25.22 pg/ml, p < 0.001). BNP-discriminated patients with or without RV dysfunction (area under the receiver operating characteristic curve, 0.943; 95% CI, 0.863-1.022). BNP > 90 pg/ml was associated with a risk ratio of 165 (95% CI, 13.7-1987.2) for the diagnosis of RV dysfunction. There was a significant correlation between RV end-diastolic diameter and BNP (r = 0.89, p < 0.001). Sixteen patients (40%) were diagnosed as having low-risk PE, 19 patients (47.5%) with submassive PE and five patients (12.5%) with massive PE. The mean BNP was 39.09 +/- 25.2, 378.4 +/- 288.4 and 609.2 +/- 279.2 pg/ml in each group respectively. CONCLUSION: Measurement of BNP levels may be a useful approach in diagnosis of RV dysfunction in patients with acute PE. The possibility of RV dysfunction in patients with plasma BNP levels > 90 pg/ml should be strongly considered.
Assuntos
Peptídeo Natriurético Encefálico/sangue , Embolia Pulmonar/complicações , Disfunção Ventricular Direita/diagnóstico , Doença Aguda , Idoso , Biomarcadores/sangue , Ecocardiografia Doppler em Cores , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/sangue , Tomografia Computadorizada Espiral , Disfunção Ventricular Direita/complicaçõesRESUMO
BACKGROUND: This study aims to describe patients' perception of early breast cancer, factors influencing the choice of operation, patients' sources of information about the disease and the seriousness with which this information is considered, and to address what surgeons can do to enlighten their patients prior to decision-making. METHODS: Patients were asked to complete a questionnaire consisting of 3 sections: The first section addressed influential factors during the decision-making process; the second pertained to the role of surgeons or health facilities in the process; and the third asked patients to revisit their initial choice of surgery. RESULTS: 237 patients were included in the study. Statistical analyzes regarding demographic features showed that nulliparous, younger than 50 years, never or <5 years married, highly educated, business-owning, employed, and stage I breast cancer patients preferred breast-conserving surgery (BCS) to mastectomy. CONCLUSION: Although the rate of BCS is a technical quality indicator for breast cancer centers, providing sufficient patient counseling, involving the patient in the decision-making process, and offering every possible surgical option are key to improving quality of life. Systematic counseling should be provided to breast cancer patients who have primary tumors that are eligible for BCS.
Assuntos
Neoplasias da Mama/cirurgia , Aconselhamento , Tomada de Decisões , Mastectomia Segmentar/psicologia , Neoplasias da Mama/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Preferência do Paciente , Percepção , Relações Médico-Paciente , Qualidade de Vida , Cirurgiões/psicologia , TurquiaRESUMO
In this study, vasodilator effect of iloprost on KCl-induced contraction in human internal mammary artery (IMA) was studied and compared with other vasodilators papaverin and diltiazem. Ring segments of IMA were studied in organ baths for measurement of isometric tension. After the tissues has reached their baseline tension, precontraction was induced by 100 mm KCl and cumulative concentration-relaxation was measured by the application of iloprost (10(-9)-10(-6) m), papaverine (10(-5)-10(-4) m), diltiazem (10(-9)-10(-4) m) or ethanol; a solvent for iloprost; alone. The maximal relaxation of IMA segments to iloprost was 13.5 +/- 2.2%. Iloprost caused significantly limited relaxation when compared with papaverin (106.0 +/- 2.9%) and diltiazem (93.6 +/- 2.5%) (P < 0.001). Papaverin produced the greatest maximal relaxation to KCl-induced contraction of IMA. The potency of iloprost (-log EC(50) = 6.59 +/- 0.19) was significantly higher than those of papaverine (-log EC(50) = 4.21 +/- 0.11) and diltiazem (-log EC(50) = 5.63 +/- 0.06) (P < 0.001). In addition, -log EC(50) of diltiazem was significantly greater than papaverin (P < 0.001). Iloprost appears to be more potent than those of papaverine and diltiazem but it was inefficient in maximal inhibition on KCl-induced contraction. Iloprost may have little benefit in KCl-related vasoconstriction on human IMA segments.
Assuntos
Iloprosta/farmacologia , Artéria Torácica Interna/efeitos dos fármacos , Vasodilatadores/farmacologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bloqueadores dos Canais de Cálcio/farmacologia , Diltiazem/farmacologia , Feminino , Humanos , Técnicas In Vitro , Masculino , Artéria Torácica Interna/fisiologia , Pessoa de Meia-Idade , Papaverina/farmacologia , Inibidores de Fosfodiesterase/farmacologia , Cloreto de Potássio/farmacologia , Vasoconstrição/efeitos dos fármacos , Vasoconstritores/farmacologia , Vasodilatação/efeitos dos fármacosRESUMO
The possibility of using natural killer (NK) cells in treatment of human hematological malignancies has increased in recent years. One factor contributing to this is the introduction of new methods for ex vivo generation of enriched populations of clinical grade NK cells. The objective of the present study was to evaluate the safety and efficacy of human ex vivo expanded clinical grade NK cells against K562 leukemia cells in severe combined immunodeficiency disease (SCID)-beige mice. Irradiated SCID-beige mice were injected intravenously (i.v.) with K562 leukemia cells. Following leukemia cell injection, mice were injected with ex vivo expanded human NK cells. NK cells were followed in vivo and mice monitored for survival from leukemia. Administration of these ex vivo expanded clinical grade NK cells was safe and prevented leukemia development. In conclusion, these results imply possibilities for the use of this NK cell preparation in treatment trials of human hematological malignancies and possibly other forms of cancer.
Assuntos
Imunoterapia Adotiva/métodos , Células Matadoras Naturais/imunologia , Células Matadoras Naturais/transplante , Leucemia Experimental/imunologia , Leucemia Experimental/terapia , Transfusão de Linfócitos/métodos , Animais , Transplante de Células , Citotoxicidade Imunológica , Modelos Animais de Doenças , Citometria de Fluxo , Doença Enxerto-Hospedeiro/prevenção & controle , Humanos , Técnicas In Vitro , Injeções Intraperitoneais , Células K562 , Células Matadoras Naturais/citologia , Leucemia Experimental/genética , Camundongos , Camundongos SCID , Transplante de Neoplasias , Fenótipo , Transplante Heterólogo , Células Tumorais CultivadasRESUMO
Massive hemorrhage causes instant and early deaths because of hypovolemia. However, even if the victim makes it to the hospital, hypothermia, metabolic acidosis, and coagulation impairments caused by bleeding pose a great risk for survival. Many topical hemostatic agents are developed for neck, armpit, or groin injuries that are not amenable to tourniquet application and for extremity wounds to be used in conjunction with tourniquets. This paper focuses on those hemostatics that differ based on the action mechanism and are suitable for pre-hospital setting and summarizes the latest recommendations regarding their usage.
Assuntos
Hemorragia/terapia , Hemostáticos , Administração Tópica , Hemostáticos/administração & dosagem , Hemostáticos/uso terapêutico , Humanos , Hipovolemia/prevenção & controleRESUMO
BACKGROUND: It is essential to interpret fine needle aspiration biopsy (FNAB) material correctly to create a common language among pathologists and surgeons, leading to a uniform approach to thyroid nodule management. We aimed to compare FNAB reports of patients at our institution who were treated with total thyroidectomy, before and after the Bethesda classification system. PATIENTS AND METHODS: Patients who underwent total thyroidectomy for thyroid nodules are reviewed. 226 patients who underwent total thyroidectomy before the Bethesda era (2006-2009) were classified as Group-I, and 316 patients in whom total thyroidectomy was performed after the Bethesda classification system was introduced (2010-2014) were classified as Group-II. RESULTS: Before Bethesda, 'nondiagnostic' or 'benign' lesions were reported in 16.4 and 45% of patients, respectively, which then significantly decreased to 4.7 and 32.9% as the Bethesda classification criteria came into use. In Group-II, the actual malignancy rates were 13.3, 2.8, 7.3, 15.5, 85.4, and 96.5% for Bethesda I, II, III, IV, V, and VI, respectively. CONCLUSION: Our experience confirms that the Bethesda classification system leads to a significant reduction in lesions that used to be reported as 'benign' without compromising the actual rates of malignancy. It ensures better classification of so-called suspicious lesions, and allows for more accurate predictions of suspicious or malignant lesions.
Assuntos
Biópsia por Agulha Fina/estatística & dados numéricos , Biópsia por Agulha Fina/normas , Estadiamento de Neoplasias/normas , Nódulo da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/patologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Prevalência , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/estatística & dados numéricos , Turquia/epidemiologiaRESUMO
OBJECTIVE: To report the clinical and pathological features and surgical treatment outcomes of patients with granulomatous mastitis. DESIGN: Case series. PLACE AND DURATION OF STUDY: Ankara Oncology Training and Research Hospital, between 1999-2003. PATIENTS AND METHODS: Data of 16 patients with granulomatous mastitis treated surgically by total excision with disease-free margins were reviewed. Patients given additional medical therapy or treated with mastectomy because of the size and extent of the disease were excluded. RESULTS: The mean age of patients at the time of diagnosis was 31.8 (range: 22-45 years). All patients were diagnosed from the pathological tissue specimens obtained by surgery. Clinical and radiological examinations suggested breast carcinoma in 82.1% patients. Except one patient who developed a fistula from the incision which was treated again with surgery, no other complications were noted, including recurrence of disease during a median follow-up period of 12.8 months (range: 4-30 months). CONCLUSION: Although granulomatous mastitis is a rare benign breast disease, it usually mimics breast carcinoma both clinically and radiologically, making the diagnosis difficult and challenging. As long as good cosmetic results can be achieved, surgical excision is quick, safe and effective treatment method for idiopathic granulomatous mastitis.
Assuntos
Mastite/cirurgia , Adulto , Feminino , Granuloma/patologia , Granuloma/cirurgia , Humanos , Mastite/patologia , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
B-cell chronic lymphocytic leukemia (B-CLL) is the most common leukemia in the Western world. It is currently an incurable disease, making new treatment options such as immunotherapy desirable. Monoclonal antibodies (Mabs) to surface antigens of the tumor cell is one option. Administration of cytotoxic cells such as natural killer (NK) and natural killer-like T (NKT) cells expanded in vitro might be a useful treatment modality alone or in combination with MAbs. A limiting step in the development of successful cellular immunotherapy has been the availability of appropriate cytotoxic cells. Here, we report the feasibility of expanding populations of the human killer cells, CD3-CD56+ NK and CD3+CD56+ NKT cells, from peripheral blood mononuclear cells (PBMCs) of B-CLL patients. The influence of tumor B cells on the in vitro expansion of killer cells was assessed by depleting B cells from PBMCs by microbead separation before culture. The 21-day cultures from both B-cell- and non-B-cell-depleted PBMC showed a marked expansion of NK cells, and also of T cells, among which almost half had the NKT phenotype. Depletion of B cells before culture did not change the expansion rates of NK and NKT cells significantly. In patients with progressive B-CLL, NK cell expansion capacity was improved after fludarabine treatment when compared to samples obtained before treatment. Repeated samples of PBMCs from individual untreated patients with both indolent and progressive disease cultured under identical conditions gave similar NK cell expansion rates. Expanded killer cell populations had cytotoxic function against the NK-sensitive target K562 cell line and expressed high levels of Granzyme B. From our studies, we conclude that NK cells as well as NKT cells from the peripheral blood of B-CLL patients can be expanded, and that these cells have cytotoxic capacity.
Assuntos
Células Matadoras Naturais/imunologia , Leucemia de Células B/imunologia , Linfócitos T/imunologia , Idoso , Antígenos CD/sangue , Citotoxicidade Imunológica , Feminino , Citometria de Fluxo , Humanos , Imunoterapia/métodos , Leucemia de Células B/terapia , Contagem de Linfócitos , Depleção Linfocítica , Masculino , Pessoa de Meia-Idade , Subpopulações de Linfócitos T/imunologia , Linfócitos T/classificaçãoRESUMO
The response of the abdominal viscera and the contraction of the intercostal muscles during the respiratory phase of sneezing increases intrathoracic pressure, which may lead to several complications. However, there are no reports in the literature concerning aortic dissection after sneezing. We report a patient in whom the development of dissection was secondary to sneezing, although hypertension was present as a risk factor, and we discuss the relationship between sneezing and aortic dissection. To our knowledge, this is the first report of aortic dissection provoked by sneezing in the literature.
Assuntos
Aneurisma da Aorta Torácica/etiologia , Dissecção Aórtica/etiologia , Espirro , Doença Aguda , Dissecção Aórtica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
A case report of dramatic increases in serum digoxin levels after alprazolam administration prompted our investigation. Twelve inpatients receiving long-term digoxin (0.25 mg daily) randomly received oral administration of either 1.0 or 0.5 mg alprazolam per day for 7 days. In each dosage group, three patients were older than and three were younger than 65 years of age. The area under the concentration-time curve for serum digoxin increased significantly in patients receiving 1 mg alprazolam daily, and this increase was more pronounced in patients older than 65 years of age. Clinical digoxin toxicity developed in one elderly patient who was receiving 1 mg/day alprazolam.
Assuntos
Envelhecimento/metabolismo , Alprazolam/farmacologia , Digoxina/farmacocinética , Idoso , Digoxina/sangue , Relação Dose-Resposta a Droga , Interações Medicamentosas , Humanos , Pessoa de Meia-IdadeRESUMO
Adoptive transfer of immunocompetent cells may induce anti-tumor effects in vivo. However, a significant obstacle to the development of successful cellular immunotherapy has been the availability of appropriate cytotoxic cells. Among the immunologic effector cells that are considered mediators of anti-tumor effects, those with the highest per-cell cytotoxic capacity express a natural killer (NK) cell phenotype, i.e., CD56(+)CD3(-). However, such cells are normally present only in low numbers in peripheral blood mononuclear cells (PBMCs), lymphokine activated killer (LAK), and cytokine induced killer (CIK) cell preparations. To optimize the expansion of human NK cells, PBMCs were cultured in different serum free medium supplemented with monoclonal anti-CD3 antibodies and interleukin (IL)-2 at varying concentrations. By using Cellgro stem cell growth medium supplemented with 5% human serum and IL-2 (500 U/ml) cells expanded 193-fold (median, range 21-277) after 21 days, and contained 55% (median, range 7-92) CD3(-)CD56(+) cells. The remaining cells were CD3(+) T cells, 22% (median, range 2-68) of which co-expressed CD56. The expanded cell population lysed 26 to 45% of K562 targets in a 1:1 effector to target ratio, signifying substantial cytotoxic efficacy. The described method is a simple and efficient way of expanding and enriching human NK cells. We have termed these high-yield CD3(-)CD56(+) cells cytokine-induced natural killer (CINK) cells.
Assuntos
Complexo CD3/biossíntese , Antígeno CD56/biossíntese , Técnicas de Cultura de Células/métodos , Citotoxicidade Imunológica , Células Matadoras Naturais/citologia , Células Matadoras Naturais/imunologia , Ativação Linfocitária , Divisão Celular/imunologia , Separação Celular , Células Cultivadas , Centrifugação com Gradiente de Concentração , Meios de Cultura Livres de Soro , Testes Imunológicos de Citotoxicidade , Humanos , Imunofenotipagem , Imunoterapia Adotiva , Interleucina-2/farmacologia , Células Matadoras Naturais/metabolismo , Leucócitos Mononucleares/citologia , Leucócitos Mononucleares/imunologia , Leucócitos Mononucleares/metabolismoRESUMO
OBJECTIVE: To investigate the excretion of gentamicin into human breast milk and resulting serum gentamicin levels in nursing newborn infants. METHODS: Women delivered by cesarean received gentamicin, 240 mg/day (80 mg intramuscularly three times a day) for 5 days postpartum. On day 4, maternal serum samples were collected 1 and 7 hours after gentamicin administration. Milk samples were collected 1, 3, 5, and 7 hours following administration. The infants were fed 1 hour after gentamicin administration, and serum samples were collected from the newborns 1 hour later. The concentrations of gentamicin were measured by a fluorescence polarization immunoassay. RESULTS: The mean (+/- standard deviation) maternal serum gentamicin levels at 1 and 7 hours were 3.94 +/- 1.12 and 1.02 +/- 0.78 microgram/mL, respectively. Milk gentamicin levels were: 0.42 +/- 0.26, 0.48 +/- 0.17, 0.49 +/- 0.17, and 0.41 +/- 0.25 microgram/mL at 1, 3, 5, and 7 hours, respectively. The mean milk:plasma gentamicin ratios were 0.11 and 0.44 at 1 and 7 hours, respectively. The correlation between maternal peak serum levels and milk levels was not statistically significant (P > .05). Detectable (above 0.27 microgram/mL) gentamicin levels were found in five of the ten newborn serum samples, with a mean level of 0.41 +/- 0.05 microgram/mL. CONCLUSION: Gentamicin is transferred into breast milk, and half of nursing newborn infants have detectable serum gentamicin levels.
Assuntos
Aleitamento Materno , Gentamicinas/metabolismo , Recém-Nascido/sangue , Leite Humano/metabolismo , Adulto , Feminino , Gentamicinas/administração & dosagem , Gentamicinas/farmacocinética , Humanos , Período Pós-PartoRESUMO
In order to assess the lung clearance of aerosolized 99mTc Erythromycin Lactobionate (EL), 99mTc EL was administered to 9 New Zealand rabbits by inhalation. 5 rabbits inhaled cigarette smoke before 99mTc EL. Clearance half times were 3.0 +/- 0.9 hours in normals, 5.5 +/- 1.0 hours after smoke exposure. Clearance was not affected after destroying the surfactant layer. Slower clearance after smoke exposure may be due to the inhibition of mucociliary clearance. 99mTc EL can be considered as an alternative radioaerosol for ventilation imaging.