RESUMO
Community-based real-world outcomes on effectiveness of antiviral therapies for chronic hepatitis B virus (CHB) in Asians are limited. Whether hepatitis B surface antigen (HBsAg) loss correlates with undetectable virus and alanine aminotransferase (ALT) normalization on treatment or what predicts risk of seroreversion or detectable virus after stopping therapy is unclear. We aim to evaluate rates and predictors of HBsAg loss, seroconversion, ALT normalization and undetectable HBV DNA, including HBsAg seroreversion or re-emergence of HBV DNA among Asian CHB patients. We retrospectively evaluated 1072 CHB adults on antiviral therapy at two community gastroenterology clinics from 1997 to 2015. Rates of HBsAg loss, ALT normalization, achieving undetectable HBV DNA and developing surface antibody (anti-HBs) were stratified by HBeAg status. Following HBsAg loss, HBsAg seroreversion or re-emergence of detectable HBV DNA was analysed. With median treatment of 76.7 months, the overall rate of HBsAg loss was 4.58%, with similar HBsAg loss rates between HBeAg-positive and HBeAg-negative patients (4.44% vs 4.71%, P=.85) in a predominantly Asian population (98.1%). Among HBsAg loss patients, 33.3% developed anti-HBs, 95.8% achieved undetectable virus and 66.0% normalized ALT. No significant baseline or on-treatment predictors of HBsAg loss were observed. While six patients who achieved HBsAg loss had seroreversion with re-emergence of HBsAg positivity, viral load remained undetectable, demonstrating the sustainability of viral suppression. Among a large community-based real-world cohort of Asian CHB patients treated with antiviral therapy, rate of HBsAg loss was 4.58%. Despite only 33.3% of HBsAg loss patients achieving anti-HBs, nearly all patients achieved sustained undetectable virus.
Assuntos
Antivirais/uso terapêutico , Antígenos de Superfície da Hepatite B/sangue , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/virologia , Resposta Viral Sustentada , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Ásia , DNA Viral/sangue , Feminino , Anticorpos Anti-Hepatite B , Hepatite B Crônica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Soroconversão , Resultado do Tratamento , Carga Viral , Adulto JovemRESUMO
Aortocardiac fistula is a broad term used to describe defects between the aorta and other cardiac chambers that can occur in humans and animals. A 1.5-year-old, 1.7 kg, male castrated Holland lop rabbit (Oryctolagus cuniculus) was presented for a two-week history of a heart murmur with corresponding cardiomegaly on radiographs. Physical examination confirmed a grade-V/VI continuous heart murmur on the right sternal border with a regular rhythm and a gallop sound. Echocardiography revealed an aortic-to-right-atrial fistula causing severe left-sided volume overload. Based on the echocardiographic findings, rupture of the right aortic sinus was suspected. Due to the poor prognosis, euthanasia was elected. On necropsy, a fistula was found connecting the right aortic sinus with the right atrium, without evidence of an inflammatory response nor evidence of an infectious etiology. The sudden onset of a heart murmur supported acquired fistulation from a ruptured aortic sinus (also known as the sinus of Valsalva), though a congenital malformation could not be completely excluded.
Assuntos
Ruptura Aórtica , Seio Aórtico , Animais , Coelhos , Masculino , Seio Aórtico/diagnóstico por imagem , Ruptura Aórtica/veterinária , Ruptura Aórtica/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Ruptura Espontânea/veterinária , Fístula/veterinária , Fístula/diagnóstico por imagem , Fístula Vascular/veterinária , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Ecocardiografia/veterinária , Cardiopatias/veterinária , Cardiopatias/diagnóstico por imagem , Sopros Cardíacos/veterinária , Sopros Cardíacos/etiologiaRESUMO
Natural processes and human activities both cause morphological changes in channels. Remote sensing products are often used to assess planform changes, but they tend to overlook vertical changes. However, considering both planform and vertical changes is crucial for a comprehensive evaluation of morphological changes. Using spatiotemporal aerial imagery and topographic data, remote sensing plays a vital role in evaluating channel morphological changes and flood-carrying capacity. This study aimed to investigate the morphological changes of a creek in an urban catchment using very high-resolution remote sensing products. In this study, we developed a new framework for investigating overall channel morphology change by employing very high-resolution aerial imagery and a LiDAR-derived digital elevation model (DEM). By digitizing channel boundaries using ArcGIS Pro 3.0, and analyzing various morphological parameters, erosion, and deposition patterns, we examined the impact of urban expansion and infrastructure development on channel adjustments. Channel adjustments have been performed in the case study catchment (Dry Creek, South Australia, Australia) due to urban expansion and development of infrastructure in the downstream reaches. Our findings revealed a significant southwest shift in the planform of the channel, with a maximum shift of 478 m and an average shift of 217 m since 1998. This alteration resulted in an increase in the sinuosity index reaching 1.2. Over the period from 2018 to 2022, the channel experienced a net deposition depth of 3.4 cm to 3.6 cm in downstream reaches. The annual deposition volume in the downstream reaches was 1963 m3, necessitating regular desilting to prevent channel capacity loss and flooding in the surrounding environment. This study also highlights the incremental growth of riparian vegetation within the channel, which affects surface roughness, channel slope, and carrying capacity. These findings provide a valuable baseline for future investigations into stream channel morphology changes and emphasize the importance of implementing appropriate measures such as desilting and vegetation management to mitigate deposition levels, reduce flood risks, and enhance the overall health and functionality of Dry Creek. The framework used in this study can be applied to other case studies employing reliable and high-resolution remote sensing data products.
RESUMO
BACKGROUND: Flumetasone is a potent corticosteroid reportedly used in horses to decrease inflammation associated with strenuous exercise. There are currently no reports describing the use of this drug in horses. OBJECTIVES: To describe the pharmacokinetics and effects on cortisol and eicosanoid concentrations, following administration of flumetasone to exercised horses. STUDY DESIGN: Parallel design. METHODS: Twelve exercised horses received a single i.v. administration of 5 mg of flumetasone. Blood and urine samples were collected before and for 72 h post-drug administration for determination of flumetasone and cortisol concentrations. Whole blood samples were collected at various time and challenged with lipopolysaccharide, calcium ionophore or methanol to induce ex vivo synthesis of eicosanoids. Concentrations of flumetasone, cortisol and eicosanoids were measured using LC-MS/MS and pharmacokinetic/pharmacodynamic analysis performed. RESULTS: Flumetasone was detected for 23.5 ± 1.73 h in blood. The volume of distribution at steady state, systemic clearance and elimination half-life was 5.90 ± 0.200 L/kg, 30.7 ± 0.166 mL/min/kg and 4.84 ± 0.83 h respectively. Cortisol concentrations were still suppressed at last time point collected (72 h). For cortisol, Kin , Kout and the t1/2out were 30.3 ± 1.56 ng/mL × h, 0.331 ± 0.02 1/h and 2.1 h respectively. Stimulation with lipopolysaccharide resulted in a decrease in TXB2 , PGF2 , LTB4 , 15-HETE and 5-HETE for up to 72 h and PGE2 for 24 h post-flumetasone administration. Stimulation of whole blood with calcium ionophore resulted in a decrease in LTB4 for up to 6 h and 15-HETE at 8 h. MAIN LIMITATIONS: Lack of sample collection for determination of biomarker concentrations beyond 72 h and the use of a single sample for determination of baseline cortisol concentrations. CONCLUSIONS: Flumetasone is rapidly cleared from blood following administration to horses. It is a potent anti-inflammatory with prolonged effects on production of cortisol and other inflammatory mediators.
Assuntos
Flumetasona/farmacocinética , Cavalos/fisiologia , Hidrocortisona/sangue , Inflamação/veterinária , Animais , Área Sob a Curva , Biomarcadores , Citocinas/genética , Citocinas/metabolismo , Flumetasona/sangue , Flumetasona/farmacologia , Regulação da Expressão Gênica/efeitos dos fármacos , Glucocorticoides/sangue , Glucocorticoides/farmacocinética , Meia-Vida , Cavalos/sangue , Inflamação/metabolismoRESUMO
Optic nerve glioma is a rare tumor usually occurring in small children. How these tumors should be treated, is a matter of controversy. Recommended treatment ranges from a wait-and-see policy to radical excision with or without subsequent radio- or chemotherapy. Comparative data on these lesion are limited, as there are no randomized investigations and long-term studies reported in the literature. In 11 patients interstitial radiotherapy was carried out, by the implantation of J-125 seeds following confirmation of the histological diagnosis. The results are compared with those of 10 patients who underwent only biopsy for histological confirmation. CT-stereotactic biopsy to verify the diagnosis with subsequent interstitial irradiation is presented as an alternative therapy for optic gliomas.
Assuntos
Astrocitoma/cirurgia , Neoplasias dos Nervos Cranianos/cirurgia , Quiasma Óptico/cirurgia , Adolescente , Adulto , Astrocitoma/patologia , Astrocitoma/radioterapia , Biópsia , Braquiterapia/métodos , Criança , Pré-Escolar , Terapia Combinada , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/radioterapia , Feminino , Seguimentos , Humanos , Lactente , Radioisótopos do Iodo/uso terapêutico , Masculino , Quiasma Óptico/patologia , Quiasma Óptico/efeitos da radiaçãoRESUMO
The case of a seriously disabled and retarded female patient with neurofibromatosis type 2 (NF2) is reported. She suffered from bilateral vestibular schwannomas, multiple intracranial meningiomas and neurinomas. The constitutional karyotype of the patient was 46, XX, r(22)/45,XX,-22. A constitutional G to A transition in the proximal 3' untranslated region of isoforms 1 and 2 was identified in the patient's NF2 gene and shown not to affect differential splicing or mRNA stability. The instability of the ring chromosome 22 with the associated loss of tumor suppressor genes on chromosome 22, in particular the loss of the NF2 gene, are assumed to have caused multiple tumorigenesis in this patient.