RESUMO
BACKGROUND: Chronic hepatitis C is considered a systemic disease because of extra-hepatic manifestations. Neuroimaging has been employed in hepatitis C virus-infected patients to find in vivo evidence of central nervous system alterations. AIMS: Systematic review and meta-analysis of neuroimaging research in chronic hepatitis C treatment naive patients, or patients previously treated without sustained viral response, to study structural and functional brain impact of hepatitis C. METHODS: Using PRISMA guidelines a database search was conducted from inception up until 1 May 2017 for peer-reviewed studies on structural or functional neuroimaging assessment of chronic hepatitis C patients without cirrhosis or encephalopathy, with control group. Meta-analyses were performed when possible. RESULTS: The final sample comprised 25 studies (magnetic resonance spectroscopy [N = 12], perfusion weighted imaging [N = 1], positron emission tomography [N = 3], single-photon emission computed tomography [N = 4], functional connectivity in resting state [N = 1], diffusion tensor imaging [N = 2] and structural magnetic resonance imaging [N = 2]). The whole sample was of 509 chronic hepatitis C patients, with an average age of 41.5 years old and mild liver disease. A meta-analysis of magnetic resonance spectroscopy studies showed increased levels of choline/creatine ratio (mean difference [MD] 0.12, 95% confidence interval [CI] 0.06-0.18), creatine (MD 0.85, 95% CI 0.42-1.27) and glutamate plus glutamine (MD 1.67, 95% CI 0.39-2.96) in basal ganglia and increased levels of choline/creatine ratio in centrum semiovale white matter (MD 0.13, 95% CI 0.07-0.19) in chronic hepatitis C patients compared with healthy controls. Photon emission tomography studies meta-analyses did not find significant differences in PK11195 binding potential in cortical and subcortical regions of chronic hepatitis C patients compared with controls. Correlations were observed between various neuroimaging alterations and neurocognitive impairment, fatigue and depressive symptoms in some studies. CONCLUSIONS: Patients with chronic hepatitis C exhibit cerebral metabolite alterations and structural or functional neuroimaging abnormalities, which sustain the hypothesis of hepatitis C virus involvement in brain disturbances.
Assuntos
Viroses do Sistema Nervoso Central/diagnóstico , Hepatite C Crônica/diagnóstico , Neuroimagem , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Encéfalo/virologia , Viroses do Sistema Nervoso Central/etiologia , Imagem de Tensor de Difusão , Feminino , Hepatite C Crônica/complicações , Hepatite C Crônica/patologia , Humanos , Cirrose Hepática/diagnóstico , Cirrose Hepática/patologia , Cirrose Hepática/virologia , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Masculino , Neuroimagem/métodosRESUMO
We report the determination of an effective protein-protein central potential for a lysozyme solution, obtained from the direct inversion of the total structure factor of the system, as extracted from small angle neutron scattering. The inversion scheme rests on a hypernetted-chain relationship between the effective potential and the structural functions, and is preliminarily tested for the case of a Lennard-Jones interaction. The characteristics of our potential are discussed in comparison with current models of effective interactions in complex fluids. The phase behavior predictions are also investigated.
Assuntos
Muramidase/química , Ligação Proteica , Conformação Proteica , SoluçõesRESUMO
Kinetic studies demonstrate that it is possible to achieve large rate enhancements (2 x 10(4)) for the hydrolysis of a urethane group by using metal-bound water or hydroxide as the nucleophile. [reaction: see text]
Assuntos
Metais/química , Uretana/química , Hidrólise , CinéticaAssuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Adulto , Feminino , HumanosRESUMO
A concise synthesis of calothrixins A (1) and B (2) that confirms their assigned structures and affords straightforward synthetic access to them is reported.
Assuntos
Antimaláricos/síntese química , Indóis/síntese química , Cristalografia por Raios X , Alcaloides IndólicosRESUMO
The D-isomer of the naturally-occurring tripeptide glutathione (gamma-L-Glu-L-Cys-Gly, L-GSH) has been synthesised using the Fmoc solid phase peptide synthesis strategy. The D-GSH obtained has been nitrosated to give the D-isomer of the bioactive thionitrite, S-nitroso-L-glutathione. The biological activity of both enantiomers of S-nitrosoglutathione has been studied and compared to the activity of the D- and L-isomers of N-acetyl-S-nitrosopenicillamine (SNAP) and S-nitrosocysteine (CysNO).
Assuntos
Glutationa/análogos & derivados , Glutationa/síntese química , Sondas Moleculares , Compostos Nitrosos/síntese química , Animais , Aorta , Glutationa/isolamento & purificação , Glutationa/farmacologia , Fármacos Neuroprotetores/síntese química , Fármacos Neuroprotetores/química , Fármacos Neuroprotetores/farmacologia , Nitrosação , Compostos Nitrosos/isolamento & purificação , Compostos Nitrosos/farmacologia , Penicilamina/análogos & derivados , Penicilamina/química , Penicilamina/farmacologia , Ratos , S-NitrosoglutationaRESUMO
Transesophageal echocardiography is a semi-invasive diagnostic technique with a very low incidence of significant complications. Only two deaths related to the procedure have been reported in the literature. We present the case of a 46-year-old man with a right atrial mass, presumably a cardiac myxoma. During attempts at esophageal intubation for a transesophageal echocardiography procedure, the mass fragmented and dislodged, causing massive pulmonary embolism and death. We believe that to avoid this potential complication, great care must be taken in the evaluation of patients with a right intracardiac mass by means of transesophageal echocardiography.
Assuntos
Ecocardiografia Transesofagiana/efeitos adversos , Embolia Pulmonar/etiologia , Evolução Fatal , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/complicações , Mixoma/diagnóstico por imagemAssuntos
Embolia Pulmonar/terapia , Terapia Trombolítica , Idoso , Contraindicações , Feminino , Humanos , Tromboflebite/complicaçõesRESUMO
A 65-year-old cardiac transplant recipient suffered rupture of the mitral valve apparatus during endomyocardial biopsy of the left ventricle. Severe mitral regurgitation resulted, and because of heart failure with progressive clinical deterioration the patient was finally subjected to mitral valve replacement. He had a favorable postoperative course and is now asymptomatic.
Assuntos
Transplante de Coração , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/etiologia , Valva Mitral/lesões , Miocárdio/patologia , Idoso , Biópsia/efeitos adversos , Humanos , Doença Iatrogênica , Masculino , Insuficiência da Valva Mitral/cirurgia , Cuidados Pós-Operatórios , RupturaRESUMO
BACKGROUND: The need for prophylactic cytolytic treatment in heart transplantation is a controversial issue. Its use, however, might prevent the onset of cellular rejection in the immediate postoperative period, facilitating patient management. It has recently been suggested that the administration of these products at low doses might have the same immunologic impact and would reduce secondary effects and the cost of treatment. METHODS: In a nonrandomized retrospective study, we assessed 45 consecutive patients who underwent orthotopic heart transplantation in 1992 and 1993. Six patients who died before receiving the complete OKT3 dose were excluded. Twenty-three patients were treated with 5mg/day doses of OKT3 for 7 consecutive days. Another 16 patients received 2.5 mg of OKT3 for 7 consecutive days. RESULTS: There were no significant differences between the two groups with respect to CD3 counts on days 2 (0.1% +/- 0.3% versus 0.04% +/- 0.25%; p > 0.05) and 6 (0.2% +/- 0.45% versus 0.1% +/- 0.3%; p > 0.05), number of rejection episodes (1.45% +/- 0.8% per year of follow-up versus 1.7% +/- 1.2%, p = 0.66), number of infectious complications (8 versus 3, p > 0.05), total methylprednisolone dose used to treat rejection crises (3900 +/- 2765 versus 3600 +/- 1963 mg; p = 0.71), adverse effects attributed to OKT3 (two versus none), or length of the postoperative hospital stay (36.8 +/- 19 versus 30.2 +/- 20.9 days). CONCLUSIONS: As cytolytic induction therapy in heart transplantation, a daily regimen of 2.5 mg of OKT3 for 7 days achieves the same clinical and immunologic effect as the conventional 5 mg/day dose. In addition, it results in a considerable reduction in the cost of treatment.
Assuntos
Rejeição de Enxerto/prevenção & controle , Transplante de Coração/imunologia , Muromonab-CD3/administração & dosagem , Azatioprina/uso terapêutico , Custos e Análise de Custo , Ciclosporina/uso terapêutico , Feminino , Rejeição de Enxerto/epidemiologia , Humanos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Muromonab-CD3/uso terapêutico , Prednisona/uso terapêutico , Estudos Retrospectivos , Fatores de TempoRESUMO
Arrhythmogenic right ventricular dysplasia is a rare disease that usually presents with ventricular arrhythmias and sometimes with heart failure. Rarely symptoms become severe and refractory to conventional therapy. We present the case of a 36-year-old man with this disease who had sustained ventricular arrhythmias and severe right heart failure. Because these symptoms were poorly controlled with medical therapy, cardiac transplantation was finally chosen as definitive treatment. The patient had a favorable course and now leads near-normal life.
Assuntos
Arritmias Cardíacas/cirurgia , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Ventrículos do Coração/anormalidades , Ventrículos do Coração/cirurgia , Adulto , Arritmias Cardíacas/complicações , Insuficiência Cardíaca/complicações , Humanos , MasculinoRESUMO
We present the case of a young man who developed severe cardiomyopathy eight years after receiving high-dose doxorubicin therapy as treatment for diffuse lymphoblastic lymphoma. He underwent cardiac transplantation and eighteen months later the tumor has not recurred and the patient has no cardiac symptoms.
Assuntos
Cardiomiopatia Dilatada/induzido quimicamente , Cardiomiopatia Dilatada/cirurgia , Doxorrubicina/efeitos adversos , Transplante de Coração , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cardiomiopatia Dilatada/patologia , Ciclofosfamida/administração & dosagem , Daunorrubicina/administração & dosagem , Doxorrubicina/administração & dosagem , Humanos , Masculino , Metotrexato/administração & dosagem , Miocárdio/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Prednisona/administração & dosagem , Fatores de Tempo , Vincristina/administração & dosagemRESUMO
With the aim of assessing the effectiveness and safety of lovastatin in patients with hypercholesterolemia after heart transplantation, as well as the potential differences in the lipid-lowering effect of lovastatin between patients with or without pretransplant coronary artery disease (CAD), we studied 63 heart transplant patients who had serum total cholesterol > 250 mg/dl in spite of dietary therapy. Mean age of subjects was 47 +/- 2 years. Triple-drug immunosuppressive therapy consisted of cyclosporine, azathioprine, and steroids. Thirty-nine patients (62%) had pretransplant CAD and 24 (38%) did not. Pretreatment serum lipid levels were: total cholesterol, 302 +/- 32 mg/dl; low-density lipoprotein (LDL) cholesterol, 201 +/- 35 mg/dl; high-density lipoprotein (HDL) cholesterol, 60 +/- 19 mg/dl; triglycerides, 205 +/- 86 mg/dl; and total/HDL cholesterol ratio, 5.4 +/- 1.6. Patients received 10 to 40 mg/day of lovastatin (mean dose 17 +/- 6) for 13 +/- 4 months. There were no serious adverse events. At 3 months, lovastatin decreased total cholesterol by 15% (p < 0.001), LDL cholesterol by 21% (p < 0.001), triglycerides by 17% (p < 0.05), and total/HDL cholesterol ratio by 17% (p < 0.001), and increased HDL cholesterol by 3% (NS). Although lovastatin was effective in both patients with pretransplant CAD and non-CAD, analysis of its effect in each subgroup (CAD and non-CAD) revealed that its lipid-lowering effect was higher for non-CAD patients (-20% vs -12% for total cholesterol, and -27% vs -17% for LDL cholesterol, both p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Doença da Artéria Coronariana/complicações , Transplante de Coração , Hipercolesterolemia/tratamento farmacológico , Lovastatina/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Colesterol/sangue , Feminino , Transplante de Coração/fisiologia , Humanos , Hipercolesterolemia/etiologia , Lovastatina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Triglicerídeos/sangueRESUMO
This is the introduction to the study of calculi which have large oxalate crystals. Calculi which are divided into three groups according to their other, non-oxalic compounds, which will be studied separately in three consecutive articles. Most of those large crystals are spectral and in spite of the fact that the calculi belonging to any group have the same components, the same formation mechanism and the same fundamental structures, they are not exact replicas of a prototype but, on the contrary, they all show a small difference from the previous and following ones which may lie in the duration of their development, in the amounts of their components or in the distribution of these components within them.