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1.
Nat Immunol ; 21(10): 1172-1180, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32839611

RESUMO

Fibroblasts are one of the most common but also neglected types of stromal cells, the heterogeneity of which underlies the specific function of tissue microenvironments in development and regeneration. In the thymus, autoreactive T cells are thought to be negatively selected by reference to the self-antigens expressed in medullary epithelial cells, but the contribution of other stromal cells to tolerance induction has been poorly examined. In the present study, we report a PDGFR+ gp38+ DPP4- thymic fibroblast subset that is required for T cell tolerance induction. The deletion of the lymphotoxin ß-receptor in thymic fibroblasts caused an autoimmune phenotype with decreased expression of tissue-restricted and fibroblast-specific antigens, offering insight into the long-sought target of lymphotoxin signaling in the context of the regulation of autoimmunity. Thus, thymic medullary fibroblasts play an essential role in the establishment of central tolerance by producing a diverse array of self-antigens.


Assuntos
Fibroblastos/imunologia , Linfócitos T/imunologia , Timo/metabolismo , Animais , Autoantígenos/imunologia , Autoimunidade , Células Cultivadas , Microambiente Celular , Seleção Clonal Mediada por Antígeno , Dipeptidil Peptidase 4/metabolismo , Tolerância Imunológica , Receptor beta de Linfotoxina/genética , Glicoproteínas de Membrana/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Receptores do Fator de Crescimento Derivado de Plaquetas/metabolismo , Transdução de Sinais , Timo/citologia
2.
Nat Immunol ; 18(6): 675-682, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28436956

RESUMO

Immunoglobulin A (IgA) maintains a symbiotic equilibrium with intestinal microbes. IgA induction in the gut-associated lymphoid tissues (GALTs) is dependent on microbial sampling and cellular interaction in the subepithelial dome (SED). However it is unclear how IgA induction is predominantly initiated in the SED. Here we show that previously unrecognized mesenchymal cells in the SED of GALTs regulate bacteria-specific IgA production and diversify the gut microbiota. Mesenchymal cells expressing the cytokine RANKL directly interact with the gut epithelium to control CCL20 expression and microfold (M) cell differentiation. The deletion of mesenchymal RANKL impairs M cell-dependent antigen sampling and B cell-dendritic cell interaction in the SED, which results in a reduction in IgA production and a decrease in microbial diversity. Thus, the subepithelial mesenchymal cells that serve as M cell inducers have a fundamental role in the maintenance of intestinal immune homeostasis.


Assuntos
Microbioma Gastrointestinal/imunologia , Imunoglobulina A/imunologia , Tecido Linfoide/imunologia , Células-Tronco Mesenquimais/imunologia , Ligante RANK/imunologia , Animais , Linfócitos B/imunologia , Biodiversidade , Diferenciação Celular/imunologia , Quimiocina CCL20/imunologia , Células Dendríticas/imunologia , Citometria de Fluxo , Microbioma Gastrointestinal/genética , Centro Germinativo , Tecido Linfoide/citologia , Células-Tronco Mesenquimais/ultraestrutura , Camundongos , Microscopia Eletrônica , Ligante RANK/genética , RNA Ribossômico 16S/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa
3.
No Shinkei Geka ; 47(11): 1179-1184, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31761780

RESUMO

We report a case of rapidly progressing primary high-grade B-cell lymphoma of the central nervous system with c-Myc translocation and Bcl-2 protein expression that resulted in the patient's death 45 days after the onset of convulsions. Further, we provide a literature review. CASE:A 74-year-old man was admitted to our hospital for convulsions. Magnetic resonance imaging on admission showed tumorous lesions at the left temporoparietal junction. An open biopsy was performed promptly. The patient was diagnosed with primary high-grade B-cell lymphoma of the central nervous system with c-Myc translocation and Bcl-2 protein expression(<50%). The tumor showed rapid progression postoperatively. The patient did not respond to steroids and died 45 days after the onset of convulsions. CONCLUSION:The c-Myc translocation, showing a strong c-Myc protein positivity, and co-expression of the Bcl-2 protein were poor prognostic factors for the tumor.


Assuntos
Linfoma Difuso de Grandes Células B , Translocação Genética , Idoso , Biópsia , Humanos , Masculino , Proteínas Proto-Oncogênicas c-myc
4.
No Shinkei Geka ; 46(11): 983-988, 2018 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-30458435

RESUMO

A 93-year-old woman incurred a head bruise 5 days prior to presentation, and head CT revealed right subacute subdural hematoma. As she was on direct oral anti-coagulant(DOAC)treatment for non-valvular atrial fibrillation(NVAF), the DOAC administration was stopped temporarily to prevent an increase in the size of the hematoma. Dabigatran treatment was initiated after the confirmation of no change in hematoma size and the follow-up CT revealed a reduction in the hematoma. However, left upper limb paresis occurred on day 12 of dabigatran treatment and head CT revealed the onset of right chronic subdural hematoma. Emergency burr hole surgery was performed after intravenous administration of idarucizumab to neutralize the dabigatran. Her neurologic symptoms improved after the operation and no recurrence of subdural hematoma was observed even after dabigatran treatment was resumed. Dabigatran could be administered relatively safely, even for subacute intracranial hemorrhage complicated with NVAF, suggesting the possibility of the prevention of ischemic stroke. Moreover, even when intracranial hemorrhage recurred, the prompt neutralizing effect of idarucizumab, a dabigatran-specific neutralizing agent, was useful in the surgical intervention and perioperative management.


Assuntos
Anticorpos Monoclonais Humanizados , Antitrombinas , Fibrilação Atrial , Dabigatrana , Embolia , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/uso terapêutico , Antitrombinas/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Hemorragia Cerebral/complicações , Dabigatrana/uso terapêutico , Embolia/tratamento farmacológico , Embolia/etiologia , Feminino , Hematoma Subdural/complicações , Humanos
5.
No Shinkei Geka ; 46(2): 133-138, 2018 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-29449518

RESUMO

A 73-year-old man was admitted at another hospital after a traffic accident. The diagnosis was cervical vertebral fracture. Despite conservative treatment, 5 days later he manifested dysarthria due to cerebellar infarction and was transferred to our hospital. Imaging studies revealed right vertebral arterial dissection at the level of the axial fracture. We performed percutaneous transluminal angioplasty with stenting to address his subacute vertebral artery dissection prior to treating the cervical vertebral fracture using external fixation. His clinical course was good;ischemia did not recur after stenting and his dysarthria disappeared upon rehabilitation. Cerebral angiograms obtained 6 months later revealed no significant in-stent restenosis. While medical management tends to be the first-line treatment of traumatic vertebral artery dissection, percutaneous transluminal angioplasty with stenting is necessary before treating other traumatic lesions to prevent neurologic events.


Assuntos
Angioplastia , Infarto Encefálico/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Stents , Dissecação da Artéria Vertebral , Insuficiência Vertebrobasilar/cirurgia , Idoso , Infarto Encefálico/etiologia , Infarto Encefálico/cirurgia , Humanos , Masculino , Fraturas da Coluna Vertebral/complicações , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/etiologia
6.
J Stroke Cerebrovasc Dis ; 26(6): 1341-1348, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28314627

RESUMO

BACKGROUND AND PURPOSE: Because magnetic resonance imaging (MRI) focuses on the morphological characteristics of carotid artery plaques, its diagnostic value with respect to plaque vulnerability is limited. We examined the correlation between Nε-(carboxymethyl)lysine (CML), a main chemical structure of advanced glycation end-products, and the vulnerability of plaques visualized on MRI scans. MATERIALS AND METHODS: We enrolled 43 patients who had undergone carotid artery stenting (CAS) for carotid artery stenosis; all underwent MRI studies, including black-blood MRI and diffusion-weighted imaging (DWI). The signal intensity ratio (SIR) of plaques to adjacent sternocleidomastoid muscle (P/M) on T1- and T2-weighted images (T1WI, T2WI) was calculated. Protein samples were extracted from debris trapped by a filter device. The concentrations of CML and myeloperoxidase (MPO) were measured by solid-phase enzyme-linked immunosorbent assay. RESULTS: The patients were classified into 2 groups based on their SIR-P/M on T1WI and T2WI scans. We observed a higher incidence of post-CAS DWI lesions in patients with a higher than a lower SIR-P/M on T1WI; the CML and MPO concentrations in their CAS debris were also higher. No such differences were seen in patients with a higher or lower SIR-P/M on T2WI scans. The concentration of CML in CAS debris correlated independently with the SIR-P/M on T1WI of the carotid plaques, and was related to the concentration of MPO in CAS debris. CONCLUSIONS: Our findings suggest CML as a candidate molecular imaging probe for the identification of vulnerable plaques.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/terapia , Imagem de Difusão por Ressonância Magnética , Dispositivos de Proteção Embólica , Procedimentos Endovasculares/instrumentação , Lisina/análogos & derivados , Angiografia por Ressonância Magnética/métodos , Placa Aterosclerótica , Stents , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Artérias Carótidas/química , Estenose das Carótidas/sangue , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Distribuição de Qui-Quadrado , Cromatografia Líquida , Procedimentos Endovasculares/efeitos adversos , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Modelos Lineares , Lisina/sangue , Masculino , Imagem Molecular , Análise Multivariada , Peroxidase/sangue , Valor Preditivo dos Testes , Sistema de Registros , Medição de Risco , Fatores de Risco , Espectrometria de Massas em Tandem , Resultado do Tratamento
7.
J Stroke Cerebrovasc Dis ; 25(3): 533-9, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26657113

RESUMO

BACKGROUND: Stent-assisted coil embolization (SACE) is used to address wide-necked or complex aneurysms. However, as they may recanalize after SACE, predictors of recanalization are needed. We investigated the relationship between follow-up angiographic results and the morphology of sidewall (SW) aneurysms in patients treated by SACE. METHODS: Between September 2010 and September 2014, we performed 80 SACE procedures for SW intracranial aneurysms. Angiographic findings, obtained immediately after the procedure, 3-6 months thereafter, and when aneurysmal recanalization was suspected on MR angiogram scan, were recorded. Morphologically, the SW aneurysms were classified as "outside" (OS) and "partially inside" (PI) based on the curve of the axes of the proximal or distal parent artery with respect to the aneurysmal neck. Follow-up angiographic studies on OS- and PI SW aneurysms were compared. RESULTS: On the initial angiograms, we classified 42 aneurysms as OS and 38 as PI. Immediately after SACE, there was no significant difference in the angiographic findings on OS and PI aneurysms. However, on follow-up angiograms, there was a significant difference in the rate of spontaneous improvement (4 of 42 [OS] versus 21 of 38 [PI], P = .001). We performed additional coil embolization to treat 3 recanalized OS aneurysms. CONCLUSIONS: SW aneurysms classified morphologically as PI tended to occlude progressively even after incomplete occlusion by SACE. In contrast, aneurysms classified as OS must be observed carefully after SACE.


Assuntos
Embolização Terapêutica/efeitos adversos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/etiologia , Angiografia por Ressonância Magnética/métodos , Stents/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Imageamento Tridimensional , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
J Stroke Cerebrovasc Dis ; 25(11): 2580-2584, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27567294

RESUMO

BACKGROUND: Black-blood magnetic resonance imaging (BB-MRI) is useful for the characterization and assessment of carotid artery plaques. The plaque-to-muscle signal intensity (SI) ratio (plaque/muscle ratio [PMR]) is used widely to evaluate plaques. However, the correlation between the PMR and the T1 relaxation time needs to be determined. We measured the T1 relaxation time of carotid plaques using T1 mapping and compared the results with the PMR on BB-MRI scans. METHODS: Between April 2014 and July 2015, 20 patients with carotid artery stenosis were treated by carotid artery stenting. All patients underwent preoperative magnetic resonance plaque imaging. The ratio of the plaque SI to the sternocleidomastoid muscle was calculated on T1-weighted BB-MRI scans. T1 mapping was performed in the region where the vessel was narrowest using the inversion recovery technique. The T1 relaxation time was recorded to determine whether there was a correlation with the PMR. RESULTS: The plaque T1 value was 577.3 ± 143.2 milliseconds; the PMR value obtained on BB-MRI scans was 1.23 ± .27. There was a statistically significant decrease in the T1 value as the PMR increased (P < .0001). CONCLUSIONS: As the T1 relaxation time was well correlated with the PMR on BB-MRI scans, the evaluation of vulnerable plaques using the PMR was reliable and convenient.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Músculos do Pescoço/diagnóstico por imagem , Placa Aterosclerótica , Idoso , Idoso de 80 Anos ou mais , Angioplastia/instrumentação , Estenose das Carótidas/terapia , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Stents
9.
J Stroke Cerebrovasc Dis ; 24(7): 1513-9, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25900412

RESUMO

BACKGROUND: Stent-assisted coil embolization is effective for intracranial aneurysms, especially for wide-necked aneurysms; however, the optimal antiplatelet regimens for postoperative ischemic events have not yet been established. We aimed at determining the efficacy and safety of a triple antiplatelet therapy regimen after intracranial stent-assisted coil embolization. METHODS: We retrospectively evaluated patients who underwent stent-assisted coil embolization for unruptured intracranial aneurysms or during the chronic phase of a ruptured intracranial aneurysm (≥ 4 weeks after subarachnoid hemorrhage onset). We recorded the incidence of ischemic and bleeding events 140 days postoperatively. RESULTS: We assessed 79 cases in patients who received either dual (n = 51) or triple (n = 28) antiplatelet therapy. The duration of triple antiplatelet therapy was 49 ± 29 days. Seven patients in the dual group experienced postoperative ischemic events. Compared to the dual group, the triple group had a similar incidence of postoperative bleeding events but a significantly lower incidence of postoperative ischemic events (P < .05). CONCLUSIONS: Triple antiplatelet therapy had a significantly lower incidence of postoperative ischemic events and a similar incidence of postoperative bleeding events 140 days postoperatively.


Assuntos
Aneurisma Roto/terapia , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Inibidores da Agregação Plaquetária/uso terapêutico , Stents , Hemorragia Subaracnóidea/terapia , Adulto , Idoso , Aneurisma Roto/diagnóstico , Aneurisma Roto/fisiopatologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/prevenção & controle , Quimioterapia Combinada , Embolização Terapêutica/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Humanos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/fisiopatologia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
10.
J Stroke Cerebrovasc Dis ; 24(1): 210-4, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25440341

RESUMO

BACKGROUND: We investigated the incidence of embolic protection device retrieval difficulties at carotid artery stenting (CAS) with a closed-cell stent and demonstrated the usefulness of a manual carotid compression assist technique. METHODS: Between July 2010 and October 2013, we performed 156 CAS procedures using self-expandable closed-cell stents. All procedures were performed with the aid of a filter design embolic protection device. We used FilterWire EZ in 118 procedures and SpiderFX in 38 procedures. The embolic protection device was usually retrieved by the accessory retrieval sheath after CAS. We applied a manual carotid compression technique when it was difficult to navigate the retrieval sheath through the deployed stent. We compared clinical outcomes in patients where simple retrieval was possible with patients where the manual carotid compression assisted technique was used for retrieval. RESULTS: Among the 156 CAS procedures, we encountered 12 (7.7%) where embolic protection device retrieval was hampered at the proximal stent terminus. Our manual carotid compression technique overcame this difficulty without eliciting neurologic events, artery dissection, or stent deformity. CONCLUSIONS: In patients undergoing closed-cell stent placement, embolic protection device retrieval difficulties may be encountered at the proximal stent terminus. Manual carotid compression assisted retrieval is an easy, readily available solution to overcome these difficulties.


Assuntos
Artérias Carótidas/cirurgia , Remoção de Dispositivo/métodos , Procedimentos Neurocirúrgicos/métodos , Stents , Idoso , Doenças das Artérias Carótidas/cirurgia , Estenose das Carótidas/cirurgia , Infarto Cerebral/complicações , Infarto Cerebral/cirurgia , Remoção de Dispositivo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Paresia/etiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
11.
J Stroke Cerebrovasc Dis ; 23(4): 771-7, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23954608

RESUMO

BACKGROUND: Stent-assisted coil embolization is effective for intracranial aneurysms, especially wide-necked aneurysms; however, the optimal antiplatelet regimens for ischemic events that develop after coil embolization have not yet been established. We aimed to determine the onset time of such postoperative ischemic events and the relationship between these events and antiplatelet therapy. METHODS: We performed coil embolization using a vascular reconstruction stent for 43 cases of intracranial aneurysms and evaluated the incidence of postoperative ischemic events in these cases. RESULTS: Nine patients showed postoperative ischemic events during the follow-up period (13 ± 7 months). Two patients developed cerebral infarction within 24 hours. Five patients developed transient ischemic attack within 40 days while they were receiving dual antiplatelet therapy. In addition, 1 patient showed cerebral infarction 143 days postoperatively during single antiplatelet therapy, and a case of transient visual disturbance was reported 191 days postoperatively (49 days after antiplatelet therapy had been discontinued). We increased the number of antiplatelet agents in 4 of these patients. The other 5 patients were under strict observation with dual antiplatelet therapy. All these patients were shifted to single antiplatelet therapy 3-13 months postoperatively. No recurrence of ischemic events was noted. CONCLUSIONS: Postoperative ischemic events are most likely to occur within 40 days postoperatively. For patients with postoperative ischemic events, additional ischemic events can be prevented by increasing the number of antiplatelet agents; subsequently, they can be shifted to single antiplatelet therapy after the risk of recurrence has decreased.


Assuntos
Isquemia Encefálica/etiologia , Embolização Terapêutica/efeitos adversos , Inibidores da Agregação Plaquetária/uso terapêutico , Stents/efeitos adversos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia
12.
J Stroke Cerebrovasc Dis ; 23(10): 2827-2833, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25307432

RESUMO

BACKGROUND: No predictor of postoperative ischemic events has been identified in patients undergoing carotid artery stenting (CAS). We aimed to determine whether N(ε)-(carboxymethyl)lysine (CML) in debris trapped by an embolic protection filter device is a predictor of postoperative ischemic events. METHODS: We enrolled 27 patients (73.4 ± 7.2 years; 22 male, 5 female) who underwent CAS for carotid artery stenosis. Diffusion-weighted magnetic resonance imaging was performed before and after the procedure. Protein samples were extracted from the debris. CML and myeloperoxidase were examined by solid phase enzyme-linked immunosorbent assay and Western blot analysis. RESULTS: Seventeen patients had 0 or 1 new lesion (nonmultiple lesions) postoperatively, whereas 10 patients had 2 or more new lesions postoperatively (multiple lesions). The CML concentration of the protein sample was significantly higher in patients with multiple lesions than in those with nonmultiple lesions (6.26 ± 2.77 ng/mg protein and 3.36 ± 1.57 ng/mg protein, respectively; P = .010). Statin therapy for dyslipidemia was associated with a lower incidence of multiple lesions and a lower concentration of CML in the protein sample (P = .004 and P = .02, respectively). Receiver operating characteristic analysis showed that the area under the curve for CML was significantly greater than .5 (.877; 95% confidence interval, .742-1.00). CONCLUSIONS: CML derived from debris may distinguish between patients with postoperative multiple ischemic lesions and those with postoperative nonmultiple lesions who undergo CAS.


Assuntos
Angioplastia/instrumentação , Isquemia Encefálica/etiologia , Estenose Coronária/terapia , Dispositivos de Proteção Embólica , Lisina/análogos & derivados , Stents , Idoso , Idoso de 80 Anos ou mais , Angioplastia/efeitos adversos , Área Sob a Curva , Biomarcadores/análise , Western Blotting , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/metabolismo , Estenose Coronária/complicações , Estenose Coronária/diagnóstico , Imagem de Difusão por Ressonância Magnética , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Lisina/análise , Masculino , Pessoa de Meia-Idade , Peroxidase/análise , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco , Resultado do Tratamento
14.
J Stroke Cerebrovasc Dis ; 22(5): 615-9, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22209646

RESUMO

Hyperperfusion syndrome (HPS) is a rare but severe complication after carotid artery stenting (CAS). Reliable methods for predicting HPS remain to be developed. We aimed to establish a predictive value of hemorrhagic HPS after CAS. Our retrospective study included 136 consecutive patients who had undergone CAS. We determined the cerebral circulation time (CCT) by measuring the interval between the point of maximal opacification of the terminal portion of the internal carotid artery and the cortical vein. We calculated intraprocedural CCT changes (ΔCCT) by subtracting postprocedural CCT values from preprocedural CCT values. The mean ΔCCT was 0.9 ± 0.9 seconds; 3 patients (2.2%) with prolonged ΔCCT (2.7, 5.4, and 5.8 seconds) developed HPS. The cutoff time of 2.7 seconds predicted hemorrhagic HPS retrospectively with 100% sensitivity and 99% specificity. Our findings suggest that post-CAS HPS can be predicted by using the ΔCCT value obtained by intraprocedural digital subtraction angiography. Patients with a ΔCCT >2.7 seconds require careful intensive hemodynamic and neurologic monitoring after CAS.


Assuntos
Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Doenças das Artérias Carótidas/terapia , Circulação Cerebrovascular , Transtornos Cerebrovasculares/etiologia , Hemorragias Intracranianas/etiologia , Stents , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Velocidade do Fluxo Sanguíneo , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/fisiopatologia , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Análise Multivariada , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Síndrome , Fatores de Tempo
15.
Neuroradiology ; 54(5): 481-6, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-21732085

RESUMO

INTRODUCTION: Selection of the appropriate diameter of stent is difficult in patients with the size mismatch between the internal carotid artery (ICA) and the common carotid artery (CCA). Although stent overexpansion (SOE) in the ICA after carotid artery stenting (CAS) is suspected of producing restenosis, SOE has not been well established. We discuss its incidence, predictors, and outcomes. METHODS: We retrospectively reviewed follow-up angiographs of 206 CAS-treated arteries in 201 patients who had undergone CAS. SOE was defined as angiographic evidence of an intimal gap between the non-stented normal and the dilated stented ICA at the distal stent edge. We also collected data on the patients' clinical status, comorbidities, and radiological and procedural data. Patients with SOE were further followed up closely by duplex ultrasound scans. RESULTS: SOE was detected in nine of 206 CAS-treated ICAs (4.4%). Univariate analysis revealed a significant association between SOE and open-cell stents, the stent diameter (p < 0.01), pre-procedural stenosis, the ICA diameter, ICA/CCA ratio, and the ICA/stent ratio (p < 0.05). Entering these variables into a logistic regression model, open-cell stents were the only variable that significantly increased the risk for SOE (OR 2.36; 95% CI 0.99-4.60; p < 0.05). During a mean clinical follow-up of 31.1 months (range 24-39 months), none of the patients with SOE developed new neurologic ischemic symptoms, stent-edge stenosis, or in-stent restenosis. CONCLUSION: SOE after CAS was not associated with clinical adverse effects. This study suggests that the diameter of stent should be determined by reference to the CCA diameter without respect to the ICA diameter.


Assuntos
Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Angiografia Cerebral , Oclusão de Enxerto Vascular/diagnóstico por imagem , Stents , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Ajuste de Prótese , Recidiva , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estatísticas não Paramétricas , Ultrassonografia Doppler Dupla
16.
Artigo em Inglês | MEDLINE | ID: mdl-36498046

RESUMO

Waste management workers experience high stress and physical strain in their work environment, but very little empirical evidence supports effective health management practices for waste management workers. Hence, this study investigated the effects of worker characteristics and biometric indices on workers' physical and psychological loads during waste-handling operations. A biometric measurement system was installed in an industrial waste management facility in Japan to understand the actual working conditions of 29 workers in the facility. It comprised sensing wear for data collection and biometric sensors to measure heart rate (HR) and physical activity (PA) based on electrocardiogram signals. Multiple regression analysis was performed to evaluate significant relationships between the parameters. Although stress level is indicated by the ratio of low frequency (LF) to high frequency (HF) or high LF power in HR, the results showed that compared with workers who did not handle waste, those who did had lower PA and body surface temperature, higher stress, and lower HR variability parameters associated with higher psychological load. There were no significant differences in HR, heart rate interval (RRI), and workload. The psychological load of workers dealing directly with waste was high, regardless of their PA, whereas others had a low psychological load even with high PA. These findings suggest the need to promote sustainable work relationships and a quantitative understanding of harsh working conditions to improve work quality and reduce health hazards.


Assuntos
Saúde Ocupacional , Gerenciamento de Resíduos , Humanos , Estudos Transversais , Carga de Trabalho , Frequência Cardíaca/fisiologia , Exercício Físico
17.
Neuroradiology ; 52(9): 831-6, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19953236

RESUMO

INTRODUCTION: We assessed the morphological change of calcified plaque after carotid artery stenting (CAS) in vessels with heavily calcified circumferential lesions and discuss the possible mechanisms of stent expansion in these lesions. METHODS: We performed 18 CAS procedures in 16 patients with severe carotid artery stenosis accompanied by plaque calcification involving more than 75% of the vessel circumference. All patients underwent multidetector-row computed tomography (MDCT) to evaluate lesion calcification before and within 3 months after intervention. The angiographic outcome immediately after CAS and follow-up angiographs obtained 6 months post-CAS were examined. RESULTS: The preoperative mean arc of the calcifications was 320.1 +/- 24.5 degrees (range 278-360 degrees ). In all lesions, CAS procedures were successfully carried out; excellent dilation with residual stenosis

Assuntos
Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Angiografia , Prótese Vascular , Feminino , Humanos , Masculino , Stents , Resultado do Tratamento
18.
Nat Metab ; 1(9): 868-875, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-32694743

RESUMO

Receptor activator of NF-κB ligand (RANKL) is a multifunctional cytokine known to affect immune and skeletal systems, as well as oncogenesis and metastasis1-4. RANKL is synthesized as a membrane-bound molecule, and cleaved into its soluble form by proteases5-7. As the soluble form of RANKL does not contribute greatly to bone remodelling or ovariectomy-induced bone loss8, whether soluble RANKL has a role in pathological settings remains unclear. Here we show that soluble RANKL promotes the formation of tumour metastases in bone. Mice that selectively lack soluble RANKL (Tnfsf11ΔS/ΔS)5-7,9 have normal bone homoeostasis and develop a normal immune system but display markedly reduced numbers of bone metastases after intracardiac injection of RANK-expressing melanoma and breast cancer cells. Deletion of soluble RANKL does not affect osteoclast numbers in metastatic lesions or tumour metastasis to non-skeletal tissues. Therefore, soluble RANKL is dispensable for physiological regulation of bone and immune systems, but has a distinct and pivotal role in the promotion of bone metastases.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias/patologia , Receptor Ativador de Fator Nuclear kappa-B/fisiologia , Animais , Remodelação Óssea/fisiologia , Diferenciação Celular/fisiologia , Feminino , Humanos , Masculino , Camundongos , Camundongos Knockout , Metástase Neoplásica , Osteoclastos/citologia , Receptor Ativador de Fator Nuclear kappa-B/genética
19.
Radiat Med ; 26(5): 318-23, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18661218

RESUMO

An 82-year-old man with an asymptomatic left high-grade carotid stenosis was treated with carotid artery stenting (CAS) under distal protection. The procedure consisted with predilation with a 5 x 40 mm percutaneous transluminal angioplasty (PTA) balloon, deployment of a 10 x 20 mm self-expandable stent, post-dilation with a 7 x 20 mm PTA balloon, and aspiration of debris with 60 ml of blood. The cervical carotid angiogram immediately after deflation of the distal blocking balloon demonstrated a small in-stent filling defect of the contrast medium that protruded from the anterior wall of the carotid artery. The following cranial carotid angiogram showed abrupt occlusion of the left middle cerebral artery (MCA). Because the in-stent lesion had vanished in the repeat study after recognition of this embolic event, it was suggested that an embolus had been liberated from the in-stent lesion, reaching the left MCA and obliterating it. In this case, the embolus was speculated to originate in the ruptured plaque, which protruded into the stent through the cells of the device and became liberated into the bloodstream. Attention should be paid so as not to overlook any plaque protrusion, which may be seen subsequently as a cerebral embolism on the angiogram obtained immediately after CAS.


Assuntos
Angioplastia com Balão/efeitos adversos , Estenose das Carótidas/terapia , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/etiologia , Stents/efeitos adversos , Idoso de 80 Anos ou mais , Angiografia Cerebral , Meios de Contraste , Humanos , Masculino , Tomografia Computadorizada por Raios X
20.
Neurol Med Chir (Tokyo) ; 58(2): 79-84, 2018 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-29269633

RESUMO

We investigated the safety and efficacy of consciousness sedation with dexmedetomidine (DEX) during the endovascular treatment of patients with acute cerebral infarction. Between April 2014 and November 2016, 38 stroke patients underwent endovascular thrombectomy (EVT) under local anesthesia and DEX consciousness sedation. The continuous intravenous administration of low-dose DEX (0.3-0.4 µg/kg/h) was started before entering the operating room. Patients not completely immobilized received an iv bolus of pentazocine (PTZ) and/or DEX (0.5-0.6 µg/kg/h). EVT was performed using a stent retriever and/or direct thrombo-aspiration. DEX sedation was stopped as soon as the operation was finished. A stent retriever was used in 8 (21.1%), direct thrombo-aspiration in 10 (26.3%), a stent retriever plus thrombo-aspiration in 14 (36.8%), and other devices in 6 patients (15.8%). Reperfusion exceeding 50% (thrombolysis in cerebral infarction >2b) was obtained in 30 patients (78.9%). DEX sedation alone immobilized 24 patients (63.2%), 14 (36.8%) required the additional injection of DEX or PTZ when EVT devices were navigated to the lesion. The administration of DEX and PTZ elicited no significant respiratory depression or cardiac dysfunction interfering with the procedures. Consciousness sedation by DEX was effective during the endovascular treatment of acute stroke patients. Under DEX sedation and the injection of PTZ, EVT was possible without significantly changing the patients' vital signs.


Assuntos
Infarto Cerebral/cirurgia , Sedação Consciente , Dexmedetomidina , Procedimentos Endovasculares , Pentazocina , Trombectomia , Adjuvantes Anestésicos , Idoso , Idoso de 80 Anos ou mais , Anestesia Local , Infarto Cerebral/complicações , Infarto Cerebral/diagnóstico , Estudos de Viabilidade , Feminino , Humanos , Hipnóticos e Sedativos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia
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