RESUMO
We report two the cases of patients with imported Plasmodium falciparum malaria during the COVID-19 pandemic. One was coinfected with COVID-19 and the other was misdiagnosed with COVID-19; either way, the diagnosis of malaria was delayed. These cases suggest that physicians should beware of cognitive biases during pandemics and carefully evaluate febrile patients. Malaria should be considered in any febrile patient returning from a malaria-endemic area.
Assuntos
COVID-19 , Malária Falciparum , Malária , Humanos , Pandemias , COVID-19/diagnóstico , Malária Falciparum/diagnóstico , Malária Falciparum/tratamento farmacológico , Malária/diagnóstico , Malária/tratamento farmacológico , Malária/epidemiologia , Febre , Erros de Diagnóstico , Cognição , Plasmodium falciparum , ViagemRESUMO
SLC25A39/40, involved in mitochondrial GSH (mGSH) import from the cytoplasm, is essential for protection against oxidative stress and mitochondrial dysfunction. We examined the effects of cholestasis, through bile duct ligation (BDL) and lipopolysaccharide (LPS)-induced inflammation in mice, on Slc25a39/40 expression. Additionally, we used human clear cell renal carcinoma (KMRC-1) cells to elucidate the mechanism of regulation of SLC25A39/40 expression in the kidneys after LPS treatment. BDL resulted in a decrease in Slc25a39 mRNA in the liver and a decrease in Slc25a39/40 mRNA and protein in the kidneys. Consequently, there was a significant decrease in mGSH levels in the kidneys of BDL mice compared with those in sham mice. LPS treatment resulted in increased Slc25a40 expression in the kidneys. In KMRC-1 cells, the combination treatment of LPS-RS or FPS-ZM1 with LPS suppressed the LPS-induced increase in SLC25A40, suggesting that SLC25A40 expression could be regulated by the signaling pathway via toll-like receptor 4 and the receptor for advanced glycation end products, respectively. Our findings contribute to understanding the role of mGSH in the maintenance of the mitochondrial redox state. To the best of our knowledge, this is the first study that demonstrates the changes in Slc25a39/40 expression in mice with cholestasis-associated renal injury and LPS-induced inflammation.
Assuntos
Colestase , Lipopolissacarídeos , Proteínas de Transporte da Membrana Mitocondrial/metabolismo , Animais , Ductos Biliares/metabolismo , Colestase/metabolismo , Glutationa/metabolismo , Humanos , Inflamação/patologia , Ligadura , Lipopolissacarídeos/farmacologia , Fígado/metabolismo , Camundongos , RNA Mensageiro/metabolismoRESUMO
Cryptococcosis is an invasive fungal infection that mainly affects the lungs and central nervous system. While patients with cell-mediated immunodeficiency are at high risk of developing cryptococcosis, there have been increasing reports of cryptococcosis in immunocompetent individuals with no underlying conditions. Herein, we report a case of cryptococcal meningitis in a 55-year-old apparently immunocompetent man with a history of heavy alcohol consumption. Although the patient was initially treated for tuberculous meningitis and varicella-zoster virus induced vasculopathy due to a history of exposure to tuberculosis and a presence of stroke, a multiplex polymerase chain reaction (PCR) assay of cerebrospinal fluid (CSF) identified Cryptococcus species unexpectedly, enabling swift treatment and a favorable clinical outcome. The multiplex PCR assay, which can identify multiple pathogens simultaneously and instantly, may lead to early diagnosis and treatment by detecting unanticipated pathogens. Furthermore, the strain was identified through multilocus sequence typing (MLST) analysis as Cryptococcus neoformans var. grubii, Sequence Type 5, molecular type: VNI. Although simplified microbial identification techniques such as mass spectrometry have recently been developed, molecular biological assays are still essential for the accurate identification of infectious strains.
Assuntos
Criptococose , Cryptococcus neoformans , Meningite Criptocócica , Meningite , Bioensaio , Cryptococcus neoformans/genética , Diagnóstico Precoce , Genótipo , Humanos , Masculino , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/tratamento farmacológico , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Reação em Cadeia da Polimerase Multiplex , Técnicas de Tipagem MicológicaRESUMO
BACKGROUND: Several clinical studies have indicated the efficacy of cilostazol, a selective inhibitor of phosphodiesterase 3, in preventing cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). They were not double-blinded trial resulting in disunited results on assessment of end points among the studies. The randomized, double-blind, placebo-controlled study was performed to assess the effectiveness of cilostazol on cerebral vasospasm. METHODS: Patients with aneurysmal SAH admitted within 24 h after the ictus who met the following criteria were enrolled in this study: SAH on CT scan was diffuse thick, diffuse thin, or local thick, Hunt and Hess score was less than 4, administration of cilostazol or placebo could be started within 48 h of SAH. Patients were randomly allocated to placebo or cilostazol after repair of a ruptured saccular aneurysm by aneurysmal neck clipping or endovascular coiling, and the administration of cilostazol or placebo was continued up to 14 days after initiation of treatment. The primary end point was the occurrence of symptomatic vasospasm (sVS), and secondary end points were angiographic vasospasm (aVS) evaluated on digital subtraction angiography, vasospasm-related new cerebral infarction evaluated on CT scan or MRI, and clinical outcome at 3 months of SAH as assessed by Glasgow Outcome Scale, in which poor outcome was defined as severe disability, vegetative state, and death. All end points were evaluated with blinded assessment. RESULTS: One hundred forty eight patients were randomly allocated to the cilostazol group (n = 74) or the control group (n = 74). The occurrence of sVS was significantly lower in the cilostazol group than in the control group (10.8 vs. 24.3%, p = 0.031), and multiple logistic analysis showed that cilostazol use was an independent factor reducing sVS (OR 0.293, 95% CI 0.099-0.568, p = 0.027). The incidence of aVS and vasospasm-related cerebral infarction were not significantly different between the groups. Poor outcome was significantly lower in the cilostazol group than in the control group (5.4 vs. 17.6%, p = 0.011), and multiple logistic analyses demonstrated that cilostazol use was an independent factor that reduced the incidence of poor outcome (OR 0.221, 95% CI 0.054-0.903, p = 0.035). Severe adverse events due to cilostazol administration did not occur during the study period. CONCLUSIONS: Cilostazol administration is effective in preventing sVS and improving outcomes without severe adverse events. A larger-scale study including more cases was necessary to confirm this efficacy of cilostazol.
Assuntos
Artérias Cerebrais/efeitos dos fármacos , Hemorragia Subaracnóidea/tratamento farmacológico , Tetrazóis/uso terapêutico , Vasoconstrição/efeitos dos fármacos , Vasodilatadores/uso terapêutico , Vasoespasmo Intracraniano/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Angiografia Cerebral/métodos , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/fisiopatologia , Cilostazol , Angiografia por Tomografia Computadorizada , Método Duplo-Cego , Procedimentos Endovasculares , Feminino , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Estudos Prospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/fisiopatologia , Tetrazóis/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Vasodilatadores/efeitos adversos , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/fisiopatologia , Adulto JovemRESUMO
Towards early detection of Alzheimer dementia (AD), this paper focuses on time-series instability of heart rate of AD patient, and proposes the AD detection method based on heart rate acquired by an unconstrained mattress sensor for daily life use. Through the human subject experiments on 124 days of heart rate of one AD patient and 39 days of heart rate of 21 healthy subjects, the following implication have been revealed: (1) an accuracy of the proposed AD detection method based on the time-series features of heart rate is approximately 98%; and (2) the time-series instability of heart rate is found in the rapid oscillation of heart rate (i.e., an increase/decrease of heart rate over 2 seconds).
Assuntos
Doença de Alzheimer , Humanos , Doença de Alzheimer/diagnóstico , Frequência CardíacaRESUMO
Early brain injury (EBI) is considered an important cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). As a factor in EBI, microcirculatory dysfunction has become a focus of interest, but whether microcirculatory dysfunction is more important than angiographic vasospasm (aVS) remains unclear. Using data from 128 cases, we measured the time to peak (TTP) in several regions of interest on digital subtraction angiography. The intracerebral circulation time (iCCT) was obtained between the TTP in the ultra-early phase (the baseline iCCT) and in the subacute phase and/or at delayed cerebral ischemia (DCI) onset (the follow-up iCCT). In addition, the difference in the iCCT was calculated by subtracting the baseline iCCT from the follow-up iCCT. Univariate analysis showed that DCI was significantly increased in those patients with a prolonged baseline iCCT, prolonged follow-up iCCT, increased differences in the iCCT, and with severe aVS. Poor outcome was significantly increased in patients with prolonged follow-up iCCT and increased differences in the iCCT. Multivariate analysis revealed that increased differences in the iCCT were a significant risk factor that increased DCI and poor outcome. The results suggest that the increasing microcirculatory dysfunction over time, not aVS, causes DCI and poor outcome after aneurysmal aSAH.
Assuntos
Angiografia Digital , Lesões Encefálicas , Isquemia Encefálica , Circulação Cerebrovascular , Microcirculação , Hemorragia Subaracnóidea , Idoso , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/mortalidade , Lesões Encefálicas/fisiopatologia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/mortalidade , Isquemia Encefálica/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/mortalidade , Hemorragia Subaracnóidea/fisiopatologiaRESUMO
This paper focuses on the REM sleep estimation with bio-vibration data acquired from mattress sensor, and proposes its "correction" method based on Time-Series Confidence (TSC) of the REM sleep prediction calculated by Random Forest (RF) as one of the Machine Learnings (MLs). Unlike the conventional MLs that classify whether the REM sleep or not as its binary prediction, the proposed method determines whether the estimated REM sleep should be corrected or not from its continuous prediction. Concretely, the proposed method computes the REM sleep prediction as the percentage of trees that classify the REM sleep for each epoch (30 seconds), calculates TSC of the REM sleep prediction by windowing the REM sleep prediction of a certain number of epochs to smooth them, and the REM sleep estimated by other MLs is corrected when TSC is lower than a certain threshold. Through the human subject experiments, the following implications have been revealed: (1) the proposed method shows a small TSC in the sudden wrong REM sleep estimation, which contributes to correct it; and (2) because of this feature of the proposed method, the number of False-Positive of the REM sleep estimation is successfully reduced, which improves Precision from 51.4% (w/o TSC) to 59.4% (w/ TSC).
Assuntos
Aprendizado de Máquina , Sono REM , Humanos , Processos Mentais , Fatores de TempoRESUMO
It is important to detect daily Alzheimer dementia (AD) possibility using unconstrained mattress sensors because dementia takes time before subjective symptoms appear and the main treatment is to slow the rate of progression. Forcusing on circadian rhythm disorder which tend to occur with AD, this paper analyzes the features of unstable circadian rhythms of heart rate associated with its weakening and misalignment in AD. It is found that the external feature of heart rate of AD that of up and down changes seen frequently compared to that of healthy subjects makes the multiple types of effects on the estimation process of the AD detection method based on the circadian instability represented by the trigonometric regression equation estimated from the heart rate. So, we designed two feature values from the effects and analyzed them in an analysis experiment. An analysis experiment was conducted on the heart rate of total 72 days data of one AD patient and total 30 days data of 21 healthy people, and the result confirmed significant differences between the AD and the healthy people at from 0.01% to 0.1 % level for the first feature and at from 0.1% to 5% level for the second feature. And the result shows the possibility that differences in the heart rate features is found between AD and healthy people.
Assuntos
Doença de Alzheimer , Ritmo Circadiano , Doença de Alzheimer/diagnóstico , Leitos , Voluntários Saudáveis , Frequência Cardíaca , HumanosRESUMO
The role of high mobility group box 1 (HMGB1) in the regulation of efflux transporters in the liver and kidney remains unclear, although it has been reported that HMGB1 can increase Pglycoprotein (Pgp) expression in the brain. The present study aimed to clarify the involvement of HMGB1 in the regulation of Pgp expression in the liver and kidney of mice with lipopolysaccharide (LPS)induced inflammation. Mice were treated with LPS or LPS + glycyrrhizin (GL); GL is as an HMGB1 inhibitor. Subsequently, the expression levels of transporters, such as Pgp, and HMGB1 receptors, such as tolllike receptor (TLR)4 and receptor for advanced glycation endproducts (RAGE), were determined by quantitative PCR and LCMS/MSbased targeted proteomics. For the in vitro study, HepG2 and KMRC1 cells were used, as was a coculture of KMRC1 and differentiated THP1 cells. The mRNA and protein expression levels of Mdr1a and Tlr4 in the kidneys of LPS + GLtreated mice were significantly decreased compared with those in LPS mice. The results indicated that HMGB1 had little effect on the expression of Mdr1a and Tlr4 in the liver, since there was little change in of Mdr1a and Mdr1b expression between the LPS and LPS + GLtreated mice. Notably, regarding MDR1 mRNA expression, KMRC1 cells were more responsive to LPS than HepG2 cells, and KMRC1 cells treated with LPS exhibited increased levels compared with control KMRC1 cells. In differentiated THP1 cells, LPS treatment decreased the mRNA expression levels of TLR4, whereas they were restored to control levels by HMGB1. In conclusion, HMGB1 in the plasma and TLR4 in macrophages may be involved in the regulation of Pgp expression in the kidneys of inflamed mice.
Assuntos
Proteína HMGB1 , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/genética , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/metabolismo , Animais , Cromatografia Líquida , Ácido Glicirrízico/farmacologia , Proteína HMGB1/metabolismo , Inflamação/induzido quimicamente , Inflamação/genética , Rim/metabolismo , Lipopolissacarídeos/efeitos adversos , Fígado/metabolismo , Camundongos , RNA Mensageiro/genética , Receptor para Produtos Finais de Glicação Avançada/genética , Receptor para Produtos Finais de Glicação Avançada/metabolismo , Transdução de Sinais , Espectrometria de Massas em Tandem , Receptor 4 Toll-Like/genética , Receptor 4 Toll-Like/metabolismoRESUMO
This paper proposes the novel Alzheimer dementia (AD) detection method based on unstable circadian rhythm of heartrate acquired from mattress sensor. Concretely, the pro-posed method, UCRADD (Unstable Circadian Rhythm based Alzheimer Dementia Detection), estimates the circadian rhythm of heartrate by calculating the regression of the trigonometric functions with the maximum likelihood estimation, and judges instability of the circadian rhythm by the coefficients of the equation estimated trigonometric functions. Through the human subject experiment with one elderly AD subject in two months (i.e., August and December), three elderly (age from 60-70) non-AD subjects, the ten middle-aged non-AD subjects and eight young non-AD subjects, the following implications have been revealed: (1) UCRADD succeeds to detect the AD patients in the high rate and keeps it in two months (78.9% in August and 82.4% in December), while our previous method cannot keep the rate at the same level in two months (57.9% in August and 82.4% in December). (2) the instability of circadian rhythm of heartrate has the potential of being new symptom of AD.
Assuntos
Doença de Alzheimer , Idoso , Doença de Alzheimer/diagnóstico , Pré-Escolar , Ritmo Circadiano , Frequência Cardíaca , Humanos , Pessoa de Meia-IdadeRESUMO
Uptake transporters in brain microvascular endothelial cells (BMECs) are involved in the penetration of basic (cationic) drugs such as diphenhydramine (DPHM) into the brain. Lipopolysaccharide (LPS)-induced inflammation alters the expression levels and activities of uptake transporters, which change the penetration of DPHM into the brain. A brain microdialysis study showed that the unbound brain-to-plasma partition coefficient (K p,uu,brain) for DPHM in LPS rats was approximately two times higher than that in control rats. The transcellular transport of DPHM to BMECs was increased when BMECs were cultured with serum from LPS rats. Compared with control rats or BMECs, the brain uptake of DPHM in LPS rats was increased and the intracellular accumulation of DPHM was increased under a high intracellular pH in BMECs from LPS rats, respectively. Treatment of BMECs with transporter inhibitors or inflammatory cytokines had little impact on the intracellular accumulation of DPHM in BMECs. This study suggests that LPS-induced inflammation promotes unidentified proton-coupled organic cation (H+/OC) antiporters that improve the penetration of DPHM into rat brain via the blood-brain barrier.
RESUMO
BACKGROUND: The most uncontrollable complication during coil embolization of a ruptured cerebral aneurysm is thromboembolic ischemia. We analyzed whether thromboembolic complications could be reduced by using preoperative antiplatelet medications for acute subarachnoid hemorrhage in multicenter fashion. METHODS: We selected antiplatelet medicines according to an official protocol: a combination of 200 mg aspirin, 150 or 300 mg clopidogrel, and 200 mg cilostazol. Systemic heparinization was done after sheath insertion in all cases. One hundred and ten consecutive, ruptured cerebral saccular aneurysms that underwent coiling at our institute were analyzed. Procedure-related thrombus formation on digital subtraction angiography and clinical evidence of ischemia and procedure-related stroke on computed tomography scan were reviewed. RESULTS: Eighty cases (73%) were medicated with multiple antiplatelet medications, 22 cases (20%) were treated with a single medication, and 8 cases (7%) were treated without antiplatelet medication. Thromboembolic complications were reduced in an inverse relationship with the number of antiplatelet medications. Hemorrhagic complications because of antiplatelet medications did not occur. Postoperative symptomatic vasospasm tended to decrease, and outcome also tended to improve in the multiple medications groups. Reduction of thromboembolic complications significantly improved clinical outcome in logistic regression analysis. CONCLUSIONS: Preoperative multiple antiplatelet medication reduced thromboembolic events in coiling during acute stage subarachnoid hemorrhage and improved clinical outcomes.
Assuntos
Aneurisma Roto/terapia , Embolização Terapêutica/métodos , Aneurisma Intracraniano/terapia , Inibidores da Agregação Plaquetária/uso terapêutico , Tromboembolia/prevenção & controle , Adulto , Idoso , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Tromboembolia/etiologiaRESUMO
BACKGROUND AND PURPOSE: Carotid plaque contains biologically active substances released into the blood during carotid artery stenting (CAS). The main purpose of this prospective study was to analyse sequential changes in oxidative stress during CAS and their relationship to clinical factors. METHODS: Twenty-two consecutive CAS procedures were performed between May 2014 and April 2016. Arterial blood was collected four times: (1) after the sheath insertion without edaravone; (2) pre-angioplasty with edaravone from the carotid artery; (3) after post-stenting angioplasty from an occluded carotid artery; and (4) before sheath removal. Derivatives of reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP) were measured photometrically. The relationship between d-ROMs or BAP and preoperatively investigated biochemical parameters, cognitive function, and number of diffusion-weighted image (DWI) high spot lesions was analysed using one-way ANOVA and the Tukey-Kramer HSD test. RESULTS: The d-ROM values for CAS were 355±58.8 Carratelli Units at sheath insertion, 315±57.2 after edaravone infusion, 328±56.8 after post-stenting angioplasty, and 315±53.0 just before sheath removal. The d-ROM values were reduced significantly after edaravone infusion (P<0.05). The BAP at sheath insertion was reduced significantly according to age (P<0.05). The d-ROMs at sheath insertion correlated negatively with the dementia scale and positively with the post-CAS DWI high spots (1.00±1.07; P<0.05). Other biochemical parameters did not correlate with the d-ROM values or BAP. CONCLUSION: Oxidative stress is correlated negatively with cognitive function and positively with postoperative ischemic lesions. Antioxidant potential decreases with ageing.
Assuntos
Estenose das Carótidas/metabolismo , Estenose das Carótidas/cirurgia , Transtornos Cognitivos/metabolismo , Estresse Oxidativo/fisiologia , Complicações Pós-Operatórias/metabolismo , Stents/efeitos adversos , Adulto , Idoso , Angioplastia/efeitos adversos , Antioxidantes/farmacologia , Antioxidantes/uso terapêutico , Transtornos Cognitivos/tratamento farmacológico , Transtornos Cognitivos/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo/efeitos dos fármacos , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Estudos ProspectivosRESUMO
Statins have pleiotropic effects that are considered beneficial in preventing cerebral vasospasm and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage (aSAH). Many studies using statins have been performed but failed to show remarkable effects. We hypothesized that a long-acting statin would be more effective, due to a longer half-life and stronger pleiotropic effects. Patients with aSAH were randomly assigned to a pitavastatin group (4 mg daily; n = 54) and a placebo group ( n = 54) after repair of a ruptured aneurysm. The primary efficacy end point was vasospasm-related delayed ischemic neurological deficits (DIND), and the secondary end points were cerebral vasospasm evaluated by digital subtraction angiography (DSA), vasospasm-related new cerebral infarctions, and outcome at three months. Severe cerebral vasospasms on DSA were statistically fewer in the pitavastatin group than in the placebo group (14.8% vs. 33.3%; odds ratio, 0.32; 95% confidence interval, 0.11-0.87, p = 0.042); however, the occurrence of DIND and new infarctions and outcome showed no statistically significant differences between the groups. The present study is the first to prove the definite, statin-induced amelioration of cerebral vasospasm on DSA. However, administration of any type of statin at the acute phase of aSAH is not recommended.
Assuntos
Aneurisma Roto/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Aneurisma Intracraniano/tratamento farmacológico , Quinolinas/administração & dosagem , Hemorragia Subaracnóidea/tratamento farmacológico , Vasoespasmo Intracraniano/tratamento farmacológico , Adulto , Idoso , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/patologia , Aneurisma Roto/fisiopatologia , Preparações de Ação Retardada/administração & dosagem , Preparações de Ação Retardada/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Masculino , Pessoa de Meia-Idade , Quinolinas/efeitos adversos , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/patologia , Hemorragia Subaracnóidea/fisiopatologia , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/fisiopatologiaRESUMO
The relatively high rate of post-operative recurrence in the treatment of chronic subdural hematoma (CSDH) is a significant problem. Goreisan is an herbal medicine that exhibits a hydragogue effect by inhibiting the expression of aquaporins, and its efficacy in preventing post-operative CSDH recurrence has been suggested by several case trials. This multi-center prospective randomized controlled trial was performed to investigate the preventative effect of goreisan on post-operative CSDH recurrence. Patients with symptomatic CSDH over 60 years old undergoing burr hole surgery were enrolled in this study. The patients were randomly allocated to the control group or the goreisan group, in which oral administration of goreisan (7.5 g daily) was continued for 12 weeks. The primary end-point was the post-operative recurrence rate at 12 weeks and the secondary end-point was hematoma volume reduction rates on computed tomography scan at 12 weeks. The analyses were performed not only on patients of all ages older than 60 years, but also on patients divided into those over or under 75 years old. One hundred and eighty patients were followed and analyzed (the control group, n = 88; the goreisan group, n = 92). The recurrence rates considering patients of all ages and patients under 75 years old were relatively low in the goreisan group but without a significant difference. The hematoma volume reduction rates showed no significant difference. Based on the results of the present study, a larger-scale study including more cases is necessary in future to confirm the efficacy of goreisan.
Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Hematoma Subdural Crônico/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma Subdural Crônico/cirurgia , Humanos , Masculino , Medicina Kampo , Pessoa de Meia-Idade , RecidivaRESUMO
Stroke remains a major cause of disability throughout the world: paralysis, cognitive impairment, aphasia, and so on. Surgical or medical intervention is curative in only a small number of cases. Nearly all stroke cases require rehabilitation. Neurorehabilitation generally improves patient outcome, but it sometimes has no effect or even a mal-influence. The aim of this review is the clarification of the mechanisms of neurorehabilitation. We systematically reviewed recently published articles on neural network remodeling, especially from 2014 to 2016. Finally, we summarize progress in neurorehabilitation and discuss future prospects.
Assuntos
Plasticidade Neuronal/fisiologia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Animais , HumanosRESUMO
BACKGROUND AND AIMS: Apple polyphenol contains abundant procyanidins, which have been associated with an anti-atherosclerosis and cholesterol-lowering effect. The aim of this study was to investigate whether apple procyanidins (APCs) feature therapeutic efficacy in terms of regressing atherosclerosis and whether this efficacy is due to mechanisms other than a cholesterol-lowering effect. METHODS: After eight weeks on an atherogenic diet, rabbits were given a normal diet for another eight weeks to normalize the increased serum lipids level. The rabbits in the baseline group were sacrificed at this stage. The control group was subsequently fed a normal diet for eight weeks, while the APCs group was administrated 50 mg/kg/day of APCs in addition to the normal diet. Serum lipids and aortic intimal-medial thickness (IMT) were serially examined, and the resected aorta was examined histologically and through molecular biology. RESULTS: Aortic IMT on ultrasonography and the lipid accumulation area examined using Sudan IV staining were significantly reduced in the APCs group as compared to the control group. Serum lipid profiles were not different between the groups. Immunohistochemistry showed significantly decreased staining of an oxidative stress marker and significantly increased staining of ATP-binding cassette subfamily A member 1 (ABCA1) in the APCs group. Western blotting and RT-PCR also showed increased expression of ABCA1 mRNA and its protein in the APCs group. CONCLUSIONS: This study revealed that APCs administration causes a regression of atherosclerosis. APCs might hold promise as an anti-atherosclerotic agent.
Assuntos
Transportador 1 de Cassete de Ligação de ATP/agonistas , Aorta/efeitos dos fármacos , Doenças da Aorta/prevenção & controle , Aterosclerose/prevenção & controle , Biflavonoides/farmacologia , Fármacos Cardiovasculares/farmacologia , Catequina/farmacologia , Frutas/química , Malus/química , Proantocianidinas/farmacologia , Transportador 1 de Cassete de Ligação de ATP/genética , Transportador 1 de Cassete de Ligação de ATP/metabolismo , Animais , Aorta/metabolismo , Aorta/patologia , Doenças da Aorta/metabolismo , Doenças da Aorta/patologia , Aterosclerose/metabolismo , Aterosclerose/patologia , Biflavonoides/isolamento & purificação , Fármacos Cardiovasculares/isolamento & purificação , Catequina/isolamento & purificação , Colesterol/sangue , Modelos Animais de Doenças , Lipoproteínas LDL/sangue , Masculino , Estresse Oxidativo/efeitos dos fármacos , Fitoterapia , Plantas Medicinais , Placa Aterosclerótica , Proantocianidinas/isolamento & purificação , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Espécies Reativas de Oxigênio/sangue , Receptores Depuradores Classe E/metabolismo , Fatores de Tempo , Regulação para CimaRESUMO
In order to investigate the effects of collagen peptide ingestion on fibroblasts and the extracellular matrix in the dermis, collagen peptide was administered orally to pigs at 0.2 g/kg body weight/d for 62 d, and its effects were compared with those of lactalbumin and water controls. Fibroblast density, and diameter and density of collagen fibrils were significantly larger in the collagen peptide group than in the lactalbumin and water control groups. The two major components of dermal glycosaminoglycans, hyaluronic acid and dermatan sulfate, which are present in the inter-fibrillar space, did not differ significantly among the three groups. However, the ratio of dermatan sulfate, which is derived from fibril-bound decorin, was largest in the collagen peptide group. These results suggest that ingestion of collagen peptide induces increased fibroblast density and enhances formation of collagen fibrils in the dermis in a protein-specific manner.
Assuntos
Colágeno/farmacologia , Derme/metabolismo , Fibroblastos/metabolismo , Glicosaminoglicanos/metabolismo , Administração Oral , Análise de Variância , Animais , Colágeno/administração & dosagem , Dermatan Sulfato/metabolismo , Derme/efeitos dos fármacos , Derme/ultraestrutura , Fibroblastos/efeitos dos fármacos , Fibroblastos/ultraestrutura , Ácido Hialurônico/metabolismo , Lactalbumina/administração & dosagem , Microscopia Eletrônica de Transmissão/métodos , Suínos , Água/administração & dosagemRESUMO
BACKGROUND: The number of elderly subarachnoid hemorrhage (SAH) patients has been increasing. The aim of this study was to analyze long-term outcome for elderly (≥75 years) SAH patients and to establish a treatment strategy. METHODS: From January 2005 to December 2013, 86 consecutive cases were treated. We used a modified Rankin Scale (mRS) at the outpatient clinic or a telephone interview of patients and/or families. Kaplan-Meier plots were done for mortality and independent (mRS 0 â¼ 2) state. Multivariate analysis was done to distinguish factors that influence on outcome. RESULTS: Median age was 79, Hunt-Kosnik grade 1 â¼ 3 was 79%, and the radical intervention (clipping or coiling) rate was 78%. Mean follow-up period was 28.7 ± 3.4 standard error months. Half of deaths occurred during the first two months. The number of cases of independent living gradually decreased to 50% at 28 months after SAH. Half of patients lived independently for 36 months at HK grades 1 to 3, and 3 months at HK grades 4 to 5 (p < 0.05). Half of patients lived independently for 40 months in the radical intervention group, and 14 months in the conservative treatment group (p < 0.05). Multivariate analysis for independent living revealed that gender, pre-morbid condition, HK grade, and postoperative complication were significant (p < 0.05). CONCLUSIONS: Good-grade elderly SAH cases that were independent pre-stroke should have radical intervention performed for aneurysm. Avoiding perioperative complications have a positive influence on long-term independent living.
Assuntos
Atividades Cotidianas/psicologia , Procedimentos Neurocirúrgicos/mortalidade , Procedimentos Neurocirúrgicos/psicologia , Qualidade de Vida/psicologia , Hemorragia Subaracnóidea/psicologia , Hemorragia Subaracnóidea/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Vida Independente/estatística & dados numéricos , Japão/epidemiologia , Estudos Longitudinais , Masculino , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Prevalência , Fatores de Risco , Hemorragia Subaracnóidea/mortalidade , Taxa de Sobrevida , Resultado do TratamentoRESUMO
The aim of this study was to investigate alterations of cultured tendon tissues to determine whether tissue culture is a useful method for biological analyses of the tendon. Tendon tissues for tissue culture were isolated from Achilles tendons of rabbits. The tendon segments were placed one segment per well and incubated in growth medium consisting of Dullbecco's modified Eagle's medium supplemented with 5% fetal bovine serum at 37 degrees C in a humidified atmosphere with 5% CO(2) for various periods. The alignment of collagen fibrils was preserved for 48 h, but tendon structure has disintegrated at 96 h. Alcian blue staining and gelatine zymography revealed that proteoglycan markedly diminished and that matrix metalloproteinase (MMPs) activity was upregulated sharply at 72 and 96 h. The ratio of collagen fibrils with large diameter had increased and the mean diameter and mass average diameter value had reached maximum at 48 h. The values then decreased and mean diameters at 72 and 96 h were significantly different from that at 48 h. At 96 h, the ratio of collagen fibrils with small diameters had increased and collagen fibrils with large diameters had disappeared. These findings indicate that structural alteration is possible to be induced by disintegration of collagen fibrils and disappearance of glycosaminoglycans from extracellular matrix (ECM), subsequent of upregulation of MMPs activity. Although the study period is limited, the tissue culture method is available for investigating cell-ECM interaction in tendons.