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1.
J Endocrinol Invest ; 47(2): 325-334, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37668886

RESUMO

OBJECTIVES: To explore the role of conventional X-ray imaging in detecting vertebral fractures (VFs) in patients with acromegaly, both at diagnosis of disease and at the last clinical visit. The risk factors for VFs were also evaluated. DESIGN AND METHODS: A retrospective cohort study was conducted on 60 consecutive patients with acromegaly, in a tertiary referral centre. Thoracolumbar spine radiography (X-spine) was performed at the last clinical visit during the follow-up in order to detect VFs. Routine chest radiograph, performed as a part of the general evaluation at diagnosis of acromegaly, were retrospectively analysed to screen for baseline VFs. RESULTS: At diagnosis of acromegaly, chest X-ray revealed that 10 (17%) patients had VFs. Of the 50 patients without VFs at diagnosis of acromegaly, 33 (66%) remained unfractured at the last clinical visit (median [IQR] time, 144 [96-192] months after the diagnosis of acromegaly), whereas 17 (34%) had VFs. Overall, 22 patients (37%) had novel VFs detected on X-spine including five patients with previous VFs. Risk factor for incident VFs was the presence of hypogonadism at diagnosis of acromegaly (p = 0.016). CONCLUSIONS: In acromegaly patients, conventional X-rays can detect vertebral fractures early at diagnosis of acromegaly. They can also reveal incident VFs, which may occur several years later even in patients without VFs at diagnosis, above all in relation to hypogonadism.


Assuntos
Acromegalia , Hipogonadismo , Fraturas da Coluna Vertebral , Humanos , Acromegalia/complicações , Acromegalia/diagnóstico por imagem , Estudos Retrospectivos , Raios X , Seguimentos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Radiografia , Densidade Óssea , Hipogonadismo/complicações
2.
Clin Exp Immunol ; 200(3): 272-286, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32149392

RESUMO

22q11.2 deletion syndrome (22q11.2DS) is characterized by a heterogeneous phenotype, including alterations in phospho-calcium metabolism and immunodeficiency. We analyzed vitamin D status and the immune assessment, focusing on T cell subpopulations and dendritic cells (DCs) in a cohort of 17 pediatric 22q11.2DS patients and 17 age-matched healthy subjects. As antigen-presenting cells, DCs are the main target of vitamin D, promoting a tolerogenic T cell response. Patients were subdivided into three groups according to the parameters of phospho-calcium metabolism and serum levels of 25OHD: normal values, vitamin D deficiency and hypoparathyroidism. Different degrees of T cell deficiency, ranging from normal to partial T cell numbers, were observed in the cohort of patients. The group with vitamin D deficiency showed a significant reduction of naive T cells and a significant increase of central memory T cells compared to controls. In this group the number of circulating DCs was significantly reduced. DC decrease affected both myeloid and plasmacytoid DC subsets (mDCs and pDCs), with the most relevant reduction involving pDCs. A direct correlation between 25OHD levels and recent thymic emigrant (RTE) and DC number was identified. Despite the limited cohort analyzed, our results show that deficiency of the pDC subset in patients with 22q11.2DS may be included among the causative factors of the progressive increase of risk of autoimmune diseases in these patients. As most patients suffer from increased susceptibility to infections and heightened prevalence of autoimmune disorders, we suggest a potential role of vitamin D supplementation in preventing autoimmune or proinflammatory diseases in 22q11.2DS.


Assuntos
Células Dendríticas/imunologia , Síndrome de DiGeorge/imunologia , Memória de Curto Prazo , Linfócitos T/imunologia , Deficiência de Vitamina D/imunologia , Vitamina D/imunologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino
3.
Colorectal Dis ; 22(11): 1724-1733, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32645247

RESUMO

AIM: Social media are used daily by both healthcare workers and patients. Online platforms have the potential to provide patients with useful information, increase their engagement and potentially revolutionize the patient-physician relationship. This survey aimed to evaluate the impact of the Internet and social media (I&SM) on patients affected by colorectal and proctological diseases to define a pathway to develop an evidence-based communications strategy. METHOD: A 31-item anonymous electronic questionnaire was designed. It consisted of different sections concerning demographics and education, reason for the visit, knowledge of the diseases, frequency of I&SM use and patients' opinions about physicians' websites. RESULTS: Over a 5-month period, 37 centres and 105 surgeons took part in the survey, and a total of 5800 patients enrolled. Approximately half of them reported using the Internet daily, and 74.6% of the study population used it at least once per week. There was a correlation (P < 0.001) between those who used the Internet for work and those who had knowledge of both symptoms and the likely diagnosis before consultation. Patients who used the Internet daily were more likely to request a consultation within 6 months of symptom onset (P < 0.0001). Patients with anorectal diseases were more likely to know about their disease and symptoms before the visit (P < 0.001). CONCLUSION: Colorectal patients use I&SM to look for health-related information mainly after their medical visit. Surgeons and hospital networks should plan a tailored strategy to increase patient engagement, delivering appropriate information on social media.


Assuntos
Neoplasias Colorretais , Mídias Sociais , Cirurgiões , Humanos , Internet , Relações Médico-Paciente , Inquéritos e Questionários
4.
Nature ; 511(7510): 440-3, 2014 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-25043049

RESUMO

Massive outflows driven by active galactic nuclei are widely recognized to have a key role in the evolution of galaxies, by heating the ambient gas, expelling it from the nuclear regions, and thereby affecting the star-formation histories of the galaxy bulges. It has been proposed that the powerful jets of relativistic particles (such as electrons) launched by some active nuclei can both accelerate and heat the molecular gas, which often dominates the mass budgets of the outflows. Clear evidence for this mechanism, in the form of detailed associations between the molecular gas kinematics and features in the radio-emitting jets, has however been lacking. Here we report that the warm molecular hydrogen gas in the western radio lobe of the Seyfert galaxy IC 5063 is moving at high velocities-up to about 600 kilometres per second-relative to the galaxy disk. This suggests that the molecules have been accelerated by fast shocks driven into the interstellar medium by the expanding radio jets. These results demonstrate the general feasibility of accelerating molecular outflows in fast shocks driven by active nuclei.

5.
World J Surg ; 42(8): 2444-2453, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29383423

RESUMO

PROBLEM STATEMENT: The aim of our study was to identify predictive factors for lymph node metastases (LNM) in children and adolescents with papillary thyroid carcinoma (PTC) and their impact on survival. METHODS: The authors conducted an Italian multicentric retrospective analysis on 132 pediatric patients (0-18 years old) affected by PTC between 2000 and 2014. The investigated variables were demographic characteristics of the patients, clinicopathological features of PTCs, and persistence/recurrence of disease. The female/male ratio was 3.1:1. The median age was 14.3 ± 3.5 years (range 4-18 years). Total thyroidectomy was performed in all the patients, followed by lymph node dissection in 87 patients (65.9%). Metastatic lymph node involvement was confirmed in 73 patients (55.3%): lateral compartment (LC) in 25 patients (34.2%), central compartment (CC) in 17 patients (23.3%), and both compartments in 31 patients (42.5%). RESULTS: Multifocality (P < .00), vascular invasion (P = .04), infiltration of the thyroid capsule (P < .00), minimal extrathyroidal extension (P < .00), diffuse sclerosing variant of PTC (P = .02), and presence of LNM in the LC (P < .00) were significantly associated with LNM in CC. Infiltration of the thyroid capsule (P < .00), massive extrathyroidal extension (P = .03), distant metastases (P = .02), PTC, not otherwise specified (P < .00), and presence of LNM in the CC (P < .00) were significantly associated with LNM in LC. Age, sex and size of PTC were not correlated with the presence of cervical LNM. Moreover, presence of LNM in CC increases the risk of persistence (P < .01) and recurrence (P < .02) of PTC in children and adolescents. CONCLUSIONS: Most predictors, unfortunately, are only identified post-operatively by histopathologic examination: Just a small part of them can be pre-operatively detected with a low-sensitivity neck ultrasonography. In PTC patients with pre-operative predictors, we suggest an accurate pre- and intra-operative evaluation of CC and/or LC to find suspicious lymph nodes. The presence of LNM in CC has an impact on disease/progression/relapse-free survival. We suggest performing RAI therapy and an accurate follow-up for pediatric patients with only post-operative predictors.


Assuntos
Carcinoma Papilar/secundário , Metástase Linfática , Pescoço/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Ultrassonografia , Adolescente , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/cirurgia , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/diagnóstico por imagem , Masculino , Recidiva Local de Neoplasia/patologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
6.
Diabet Med ; 34(6): 834-838, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-27990686

RESUMO

AIM: To validate the Composite Autonomic Symptom Score (COMPASS) 31, in its Italian version, for the diagnosis of diabetic cardiovascular autonomic neuropathy in a clinic-based, single-centre study. METHODS: A total of 73 participants with diabetes (age 55 ± 14 years) completed the COMPASS 31 questionnaire before undergoing cardiovascular autonomic neuropathy and diabetic polyneuropathy assessment according to cardiovascular reflex tests, neuropathic symptoms and signs, and vibration and thermal thresholds. RESULTS: The COMPASS 31 total weighted score differed between participants with and without cardiovascular autonomic neuropathy (29.9 ± 19.5 vs 16.1 ± 14.7; P = 0.003) and with and without diabetic polyneuropathy (28.9 ± 19.1 vs 12.7 ± 11.3; P < 0.0001). It was related to cardiovascular reflex tests score (rho = 0.38, P = 0.0013) as well as diabetic polyneuropathy symptoms (rho=0.61, P < 0.0001) and signs scores (rho = 0.49, P < 0.0001). Receiver-operating curve analysis showed a fair diagnostic accuracy of total score for cardiovascular autonomic neuropathy (area under the curve 0.748 ± 0.068, 95% CI 0.599-0.861) and diabetic polyneuropathy (area under the curve 0.742 ± 0.061, 95% CI 0.611-0.845). The best score thresholds were 16 for early cardiovascular autonomic neuropathy (sensitivity 75.0%, specificity 64.9%, positive predictive value 37.5% and negative predictive value 90.2%), and 17 for both confirmed cardiovascular autonomic neuropathy and diabetic polyneuropathy (sensitivity 70.0% and 65.5%, respectively; specificity 66.7% and 79.5%, respectively; positive predictive value 25.0% and 67.9%, respectively; and negative predictive value 93.0% and 77.8%, respectively). COMPASS 31 had a good internal consistency according to Cronbach's α coefficient of 0.73. CONCLUSIONS: COMPASS 31 can represent a valid, easy-to-use, quantitative assessment tool for autonomic symptoms in diabetic neuropathy, with a fair diagnostic accuracy for both cardiovascular autonomic neuropathy and diabetic polyneuropathy.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Angiopatias Diabéticas/líquido cefalorraquidiano , Neuropatias Diabéticas/diagnóstico , Técnicas de Diagnóstico Endócrino , Técnicas de Diagnóstico Neurológico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Projetos de Pesquisa , Sensibilidade e Especificidade , Índice de Gravidade de Doença
8.
J Neuroimmunol ; 386: 578272, 2024 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-38160122

RESUMO

We analyzed peripheral blood mononuclear cells (PBMCs) and serum inflammatory biomarkers in patients with mesial temporal lobe epilepsy (drug-resistant - DR, vs. drug-sensitive - DS). Patients with epilepsy showed higher levels of serum CCL2, CCL3, IL-8 and AOPP, and lower levels of FRAP and thiols compared to healthy controls (HC). Although none of the serum biomarkers distinguished DR from DS patients, when analysing intracellular cytokines after in vitro stimulation, DR patients presented higher percentages of IL-1ß and IL-6 positive monocytes compared to DS patients and HC. Circulating innate immune cells might be implicated in DR epilepsy and constitute potential new targets for treatments.


Assuntos
Epilepsia do Lobo Temporal , Epilepsia , Humanos , Citocinas , Monócitos , Leucócitos Mononucleares , Biomarcadores , Resistência a Medicamentos , Hipocampo
9.
Clin Neuropsychol ; 37(6): 1207-1220, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-35997036

RESUMO

Objective: In early stages of disease, the differential diagnosis between Parkinson's Disease (PD) and atypical parkinsonism, such as Progressive Supranuclear Palsy (PSP), could be challenging. Growing attention has recently been dedicated to investigating neuropsychological markers of degenerative parkinsonism. The Rey-Osterrieth Complex Figure Test (ROCFT) copy score was hypothesized able to differentiate PSP from PD. However, ROCFT is a drawing test requiring multiple cognitive abilities and it is still unknown which of them assumes an important role in PSP performance. Using a qualitative scoring system, we investigated which cognitive abilities underpin the PSP performance at the ROCFT copy trial. Moreover, we evaluated usefulness of the BQSS scores in discriminating PSP from PD. Methods: Thirty PSP-Richardson's Syndrome (PSP-RS) patients, 30 PD patients, and 30 healthy control (HC) comparable for age, education, and gender were enrolled. All subjects underwent a neuropsychological evaluation; ROCFT copy were evaluated with the 36-Point Score and with the Boston Qualitative Scoring System (BQSS). Results: PSP-RS patients performed worse in ROCFT 36-Point Score and in several BQSS scores compared to other groups. Most suitable scores discriminating PSP-RS from PD were "Perseveration" and "Vertical Expansion" of BQSS. A logistic regression model considering "Perseveration" and "Vertical Expansion" showed a diagnostic accuracy of 83,3% for PSP-RS condition. Conclusion: our findings showed that "Perseveration" and "Vertical Expansion" BQSS scores were useful in discriminating PSP-RS from PD. "Perseveration" and "Vertical Expansion" BQSS scores might be included in the cognitive evaluation along with quantitative scores when PSP diagnosis is considered.


Assuntos
Doença de Parkinson , Transtornos Parkinsonianos , Paralisia Supranuclear Progressiva , Humanos , Paralisia Supranuclear Progressiva/diagnóstico , Paralisia Supranuclear Progressiva/psicologia , Testes Neuropsicológicos , Transtornos Parkinsonianos/psicologia , Cognição
10.
Breast Cancer ; 30(5): 802-809, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37358721

RESUMO

INTRODUCTION: The oncoplastic conservative surgery was developed as a natural evolution of traditional surgery, attempting to improve the therapeutic and aesthetic outcomes where tumor resection could be followed by not-adequate results. Our primary aim is to evaluate how patient satisfaction and quality-of-life after conservative oncoplastic surgery, using BREAST-Q (BCT Module), change pre- and post-operatively. The secondary aim is to compare patient-reported outcome after oncoplastic or traditional conservative surgery. PATIENTS AND METHODS: We enrolled 647 patients who underwent traditional conservative surgery or oncoplastic surgery from January 2020 to December 2022. Only 232 women (35.9%) completed the BREAST-Q questionnaire on a web-based platform, at the preoperative phase and 3 months after treatment. RESULTS: The average score of "Psychosocial well-being" and "Satisfaction with Breasts" 3 months after surgery showed a statistically significant improvement, while the average score for "Physical well-being: Chest" at 3 months showed a worsening compared to the baseline. "Sexual well-being" did not show statistically significant change. A significant difference between the post-operative outcome of oncoplastic surgery and traditional surgery was observed only for Physical well-being (better for traditional surgery). CONCLUSIONS: The study showed significant improvement in patient-reported outcomes 3 months after the surgery, except for physical discomfort that increases especially after oncoplastic surgery. Furthermore, our data, as well as many others, point to the appropriateness of using OCS where there is an effective indication, while the perspective of patients cannot find significant superiority over TCS in any of the areas analyzed.


Assuntos
Neoplasias da Mama , Mamoplastia , Humanos , Feminino , Mastectomia Segmentar/efeitos adversos , Mastectomia Segmentar/métodos , Satisfação do Paciente , Estudos Prospectivos , Qualidade de Vida , Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Satisfação Pessoal , Resultado do Tratamento
11.
Diabet Med ; 29(5): 578-85, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22023377

RESUMO

AIMS: DN4 (Douleur Neuropathique en 4 Questions) is a screening tool for neuropathic pain consisting of interview questions (DN4-interview) and physical tests. It has not formally been validated in diabetes. We evaluated the validity and diagnostic accuracy of DN4 and DN4-interview in identifying neuropathic pain of painful diabetic polyneuropathy. METHODS: In 158 patients with diabetes, the presence of diabetic polyneuropathy and neuropathic pain was assessed using scoring system for symptoms and signs, quantitative sensory testing, nerve conduction studies, pain history, numerical rating scale, and Short-Form McGill Pain Questionnaire. Painful diabetic polyneuropathy was defined as the presence of diabetic polyneuropathy plus chronic neuropathic pain in the same area as neuropathic deficits. A blinded investigator performed DN4. RESULTS: The DN4 score was significantly related to all the neurological and electrophysiological measurements and to Short-Form McGill Pain Questionnaire (ρ = 0.58, P < 0.0001). DN4 and DN4-interview scores showed a high diagnostic accuracy for painful diabetic polyneuropathy with areas under the receiver operating characteristic curve of 0.94 and 0.93, respectively. At the cut-off of 4, DN4 displayed sensitivity of 80%, specificity of 92%, positive predictive value (PPV) of 82%, negative predictive value (NPV) of 91%, and likelihood ratio for a positive result (LR(+) ) of 9.6. At the cut-off of 3, DN4-interview showed sensitivity and specificity of 84%, PPV of 71%, NPV of 92%, and LR(+) of 5.3. CONCLUSIONS: This is the first validation study of DN4 for painful diabetic polyneuropathy, which supports its usefulness as both a screening tool for neuropathic pain in diabetes and a reliable component of the diagnostic work up for painful diabetic polyneuropathy.


Assuntos
Neuropatias Diabéticas/diagnóstico , Neuralgia/diagnóstico , Medição da Dor/métodos , Estudos Transversais , Neuropatias Diabéticas/epidemiologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Neuralgia/epidemiologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Inquéritos e Questionários , Vibração
12.
Nutr Metab Cardiovasc Dis ; 21(1): 69-78, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21247746

RESUMO

Despite its prevalence, clinical and prognostic impact, diabetic autonomic neuropathy, is widely under-diagnosed. The need for training and expertise to perform the cardiovascular tests (usually the task of diabetologists) is one possible reason. The availability of computer-assisted systems has allowed a wider diffusion of testing, but has also highlighted the need for an adequate knowledge of physiopathological backgrounds for their correct application and interpretation. The recommendations presented here were developed by the Neuropathy Study Group of the Italian Society of Diabetology and then endorsed by the Italian Association for the Study of Neurovegetative System, to promote the widespread adoption of good clinical practice in diabetic cardiovascular autonomic testing by outlining main evidence-based aspects, i.e. which tests, how to perform them, adequate interpretation of the results and their diagnostic use, confounding conditions that can impact on tests reliability. Therefore, these recommendations include the essential aspects of the physiopathological substrate of the tests, the controversial points in their analysis, their diagnostic characteristics, as well as safety. Detailed information is given on the physiological (age, weight, body position, resting heart rate and blood pressure, respiratory pattern, exercise, meals, acute blood glucose changes) and pathophysiological confounding factors, with emphasis on the effects of drugs. Instructions on how to perform the tests and interpret their results are also considered together with indications of candidate patients and periodicity of testing. A patient instruction sheet on why and how to perform the tests is included. Finally, the specific requirements for computerized systems to perform and evaluate cardiovascular tests are provided.


Assuntos
Fenômenos Fisiológicos Cardiovasculares , Neuropatias Diabéticas/diagnóstico , Biomarcadores , Cardiomiopatias Diabéticas/diagnóstico , Progressão da Doença , Guias como Assunto , Humanos , Cooperação do Paciente , Seleção de Pacientes , Padrões de Referência , Medição de Risco
14.
Clin Neurol Neurosurg ; 208: 106900, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34454205

RESUMO

BACKGROUND & PURPOSE: The safety and efficacy of the Woven EndoBridge (WEB) device has been proven in recent multicenter trials. This study investigated whether operator experience influences WEB treatment-related outcomes. MATERIAL AND METHODS: This was a retrospective analysis of a prospectively collected multicenter database. The data of all patients who underwent WEB treatment for an intracranial aneurysm from March 2014 to June 2020 in two high-volume centers were pooled. Operator experience was indexed by the number of WEB treatments performed previously. The primary endpoint was the overall complication rate. Secondary endpoints were long-term adequate (Raymond-Roy classification of 1-2.) angiographic occlusion, WEB-related complications, number of WEB not deployed, procedure duration, and radiation exposure (air kerma). RESULTS: Among 237 patients (mean age 59.4 +/- 11.5 years) treated with WEB (median aneurysm diameter, 5.8 mm; interquartile range 4.5-7 mm), WEB-related complications occurred in 28 patients (11.8%) and adequate long-term occlusion was achieved for 154 aneurysms (86%). The median number of WEB treatment performed previously per operator was 20 (IQR, 9-41). The overall complication rate, WEB-related complication rate and aneurysm occlusion rate were not significantly correlated with WEB operator experience. There were also no significant correlations between the WEB operator experience and the number of WEB not deployed, procedure duration or radiation exposure. CONCLUSION: There was no significant association between the number of WEB treatments previously performed per operator and any technical or clinical results after intracranial aneurysm treatment with WEB. These results imply a relatively short learning curve for this device in high-volume neurovascular centers.


Assuntos
Competência Clínica , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano/terapia , Idoso , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
15.
Diabet Med ; 26(7): 686-92, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19573117

RESUMO

AIMS: The aim of the present study was to determine the diagnostic accuracy of the Neuropad sudomotor test for diabetic cardiovascular autonomic neuropathy (CAN) and diabetic polyneuropathy (DPN), the latter assessed using a multi-level diagnostic approach. METHODS: In 51 diabetic patients, CAN, symptoms and signs of DPN, vibration perception threshold (VPT), cold (CTT) and warm thermal perception thresholds (WTT) were measured. Neuropad response was determined as normal (complete colour change) or abnormal (absent or incomplete colour change). The time until the complete colour change (CCC time) was recorded. RESULTS: CCC time showed significant correlations with all the neurological parameters, the strongest of which were with Valsalva ratio (rho = -0.64, P < 0.0001), symptoms of DPN (rho = 0.66, P < 0.0001), postural hypotension (rho = 0.54, P = 0.0001) and CTT (rho = -0.54, P = 0.0001). CCC time showed moderate diagnostic accuracy for both CAN and DPN: the areas under the receiver operating characteristic (ROC) curves were 0.71 and 0.76, respectively. The diagnostic characteristics of three cut-off values of CCC time, identified by ROC analysis (i.e. 10, 15 and 18 min), were analysed. Compared with 10 min, the 15-min cut-off value provided better specificity (from 27% to 52% and from 31% to 62% for CAN and DPN, respectively) and a better likelihood ratio for negative result (from 0.67 to 0.34 and from 0.58 to 0.33) without lowering sensitivity (from 82% to 82% and from 85% to 80%). CONCLUSIONS: Neuropad is a reliable diagnostic tool for both CAN and DPN, albeit of only moderate accuracy. Extending the observation period to 15 min provides greater diagnostic usefulness.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Neuropatias Diabéticas/diagnóstico , Adolescente , Adulto , Idoso , Temperatura Baixa , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polineuropatias/diagnóstico , Estatística como Assunto , Sensação Térmica , Fatores de Tempo , Vibração , Adulto Jovem
16.
AJNR Am J Neuroradiol ; 40(4): 687-693, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30872418

RESUMO

BACKGROUND: The safety and efficacy of flow diversion among distal anterior circulation aneurysms must be proved. PURPOSE: Our aim was to analyze the outcomes after flow diversion among MCA, anterior communicating artery, and distal anterior cerebral artery aneurysms. DATA SOURCES: A systematic search of 3 databases was performed for studies published from 2005 to 2018. STUDY SELECTION: According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting flow diversion of distal anterior circulation aneurysms. DATA ANALYSIS: Random-effects meta-analysis was used to pool aneurysm occlusion and complication rates. From the individual patient data, univariate and multivariate analyses were used to test predictors of occlusion and complications. DATA SYNTHESIS: We included 27 studies (484 aneurysms). The long-term adequate occlusion rate (O'Kelly-Marotta scale, C-D) was 82.7% (295/364; 95% CI, 77.4%-87.9%; I2 = 52%). Treatment-related complications were 12.5% (63/410; 95% CI, 9%-16%%; I2 = 18.8%), with 5.4% (29/418; 95% CI, 3.2%-7.5%; I2 = 0%) morbidity. MCA location was an independent factor associated with lower occlusion (OR = 0.5, P = .03) and higher complication rates (OR = 1.8, P = .02), compared with anterior communicating artery and distal anterior cerebral artery aneurysms. The Pipeline Embolization Device (versus other stents) gave better occlusion rates (OR = 2.6, P = .002), whereas large/giant aneurysms were associated with higher odds of complications (OR = 2.2, P = .03). The rates of occlusion and narrowing of arteries covered by flow-diverter stents were 6.3% (29/283; 95% CI, 3.5%-9.1%; I2 = 4.2%) and 23.8% (69/283; 95% CI, 15.7%-32%; I2 = 80%), respectively. Symptoms related to occlusion and narrowing of the jailed arteries were 3.5% (6/269; 95% CI, 1.1%-5%; I2 = 0%) and 3% (6/245; 95% CI, 1%-4%; I2 = 0%), respectively. LIMITATIONS: We reviewed small and retrospective series. CONCLUSIONS: Flow diversion among distal anterior circulation aneurysms is effective, leading to adequate aneurysm occlusion in 83% of cases. However, this strategy has some limitations among MCA and larger lesions, especially related to the higher rate of complications. Compared with the other devices, the Pipeline Embolization Device seems to be associated with a higher occlusion rate.


Assuntos
Prótese Vascular , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/cirurgia , Stents , Adulto , Idoso , Embolização Terapêutica/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
17.
Br J Pharmacol ; 154(4): 787-96, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18536732

RESUMO

BACKGROUND AND PURPOSE: Phosphodiesterase type-5 (PDE5) inhibitors constitute a novel and important therapeutic option for the treatment of pulmonary hypertension. The effects of the PDE5 inhibitors sildenafil, tadalafil and vardenafil on rabbit isolated pulmonary artery ring preparations and on intracellular Ca2+ concentration of thrombin-stimulated human platelets were investigated. EXPERIMENTAL APPROACH: Rabbit pulmonary artery rings were mounted in 10 mL organ bath containing Krebs solution. Tissues were connected to force-displacement transducers, and changes in isometric force were recorded. Ca2+ flux in human washed platelets was measured. KEY RESULTS: Sildenafil, tadalafil and vardenafil (0.0001-10 microM) concentration-dependently relaxed endothelium-intact and endothelium-denuded pulmonary artery rings. Endothelium denudation caused rightward shifts in the concentration-response curves to sildenafil, tadalafil and vardenafil (9-, 12- and 123-fold, respectively). Incubation with N(omega)-nitro-L-arginine methyl ester (100 microM) or ODQ (1H-[1,2,4] oxadiazolo [4,3,-a]quinoxalin-1-one) (10 microM) caused similar reductions of PDE5-induced vasorelaxations in intact rings. Sildenafil and tadalafil did not affect the phenylephrine-induced contractions, whereas vardenafil reduced the maximal responses, and shifted the phenylephrine-induced contraction curves to the right in endothelium-denuded rings (5- and 19-fold for 1 and 10 microM, respectively). Vardenafil (but neither sildenafil nor tadalafil) caused a marked rightward shift and a decrease of maximal contractile response to CaCl2. Vardenafil, but neither sildenafil nor tadalafil, significantly reduced the Ca2+ mobilization and Ca2+ influx in thrombin-stimulated washed platelets. CONCLUSIONS AND IMPLICATIONS: Our results indicate that vardenafil, in contrast to sildenafil or tadalafil, also blocked Ca2+ fluxes, thus enhancing its vasorelaxation of the pulmonary artery.


Assuntos
Bloqueadores dos Canais de Cálcio/farmacologia , Canais de Cálcio/efeitos dos fármacos , Cálcio/metabolismo , Inibidores de Fosfodiesterase/farmacologia , Animais , Plaquetas/efeitos dos fármacos , Plaquetas/metabolismo , Bloqueadores dos Canais de Cálcio/administração & dosagem , Canais de Cálcio/metabolismo , Carbolinas/administração & dosagem , Carbolinas/farmacologia , Relação Dose-Resposta a Droga , Endotélio Vascular/metabolismo , Humanos , Imidazóis/administração & dosagem , Imidazóis/farmacologia , Técnicas In Vitro , Masculino , Inibidores de Fosfodiesterase/administração & dosagem , Piperazinas/administração & dosagem , Piperazinas/farmacologia , Artéria Pulmonar/efeitos dos fármacos , Artéria Pulmonar/metabolismo , Purinas/administração & dosagem , Purinas/farmacologia , Coelhos , Citrato de Sildenafila , Sulfonas/administração & dosagem , Sulfonas/farmacologia , Tadalafila , Triazinas/administração & dosagem , Triazinas/farmacologia , Dicloridrato de Vardenafila , Vasodilatação/efeitos dos fármacos
18.
AJNR Am J Neuroradiol ; 39(11): 2057-2063, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30287459

RESUMO

BACKGROUND AND PURPOSE: Flow diversion with intermediate-porosity stents (braided stents) has been recently reported for distally located small aneurysms. The aim of this study was to evaluate the flow-diversion effect of LEO stents on covered vessels and for aneurysms treated with sole stent-placement therapy. MATERIALS AND METHODS: We retrospectively evaluated the following outcomes: 1) remodeling of covered side branches and perforators (extra-aneurysmal flow remodeling), and 2) the occlusion rate of aneurysms treated with sole stent-placement therapy (intra-aneurysmal flow remodeling). RESULTS: Seventy-six patients with 98 covered vessels were studied. Overall, 89 covered arteries (91%) were normal, 7 showed narrowing (7%), and 2 (2%) were occluded (1 posterior communicating artery and 1 MCA) without related complications (mean DSA follow-up, 14 months). Univariate and multivariate analyses highlighted smoking (P = .03) and the length of follow-up (P = .002) as factors associated with arterial remodeling. Of the 17 Sylvian (lenticulostriate arteries) and 7 basilar perforators, 1 (4%) group of Sylvian perforators covered with double stents had asymptomatic remodeling. Ten aneurysms (mean size, 3.5 mm) were treated with LEO stents as stent monotherapy (5 recanalized after coiling and 5 directly treated with the LEO). Complete occlusion (Raymond-Roy I) was achieved in 70% of aneurysms (mean follow-up, 14 months). The Raymond-Roy I occlusion rate among recanalized aneurysms and those directly treated with LEO stents was 80% and 60%, respectively (P = .9). CONCLUSIONS: The rate of flow remodeling on the covered arteries and perforators was 9% and 4%, respectively, and was clinically irrelevant in all cases. Complete occlusion of aneurysms treated with sole stent-placement therapy was 70%. These data stress the flow-diversion properties of LEO stents.


Assuntos
Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/cirurgia , Stents , Remodelação Vascular , Adulto , Idoso , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
19.
AJNR Am J Neuroradiol ; 39(11): 2064-2069, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30262643

RESUMO

BACKGROUND: The safety and efficacy of treatment with self-expandable braided stents (LEO and LVIS) required further investigation. PURPOSE: Our aim was to analyze the outcomes after treatment with braided stents. DATA SOURCES: A systematic search of 3 databases was performed for studies published from 2006 to 2017. STUDY SELECTION: According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting patients treated with LEO or LVIS stents. DATA ANALYSIS: Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and neurologic outcomes. DATA SYNTHESIS: Thirty-five studies evaluating 1426 patients treated with braided stents were included in this meta-analysis. Successful stent delivery and complete aneurysm occlusion were 97% (1041/1095; 95% CI, 95%-98%) (I2 = 44%) and 88.3% (1097/1256; 95% CI, 85%-91%) (I2 = 72%), respectively. Overall, treatment-related complications were 7.4% (107/1317; 95% CI, 5%-9%) (I2 = 44%). Ischemic/thromboembolic events (48/1324 = 2.4%; 95% CI, 1.5%-3.4%) (I2 = 27%) and in-stent thrombosis (35/1324 = 1.5%; 95% CI, 0.6%-1.7%) (I2 = 0%) were the most common complications. Treatment-related morbidity was 1.5% (30/1324; 95% CI, 0.9%-2%) and was comparable between the LEO and LVIS groups. Complication rates between the anterior (29/322 = 8.8%; 95% CI, 3.4%-12%) (I2 = 41%) versus posterior circulation (10/84 = 10.5%; 95% CI, 4%-16%) (I2 = 0%) and distal (30/303 = 8%; 95% CI, 4.5%-12%) (I2 = 48%) versus proximal aneurysms (14/153 = 9%; 95% CI, 3%-13%) (I2 = 46%) were comparable (P > .05). LIMITATIONS: Limitations were selection and publication biases. CONCLUSIONS: In this analysis, treatment with the LEO and LVIS stents was relatively safe and effective. The most common complications were periprocedural thromboembolisms and in-stent thrombosis. The rate of complications was comparable among anterior and posterior circulation aneurysms, as well as for proximal and distally located lesions.


Assuntos
Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/cirurgia , Complicações Pós-Operatórias/epidemiologia , Stents , Adulto , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Stents/efeitos adversos , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Resultado do Tratamento
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