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1.
Br J Surg ; 107(5): 586-594, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32162301

RESUMEN

BACKGROUND: Japan Clinical Oncology Group (JCOG) 0212 (ClinicalTrials.gov NCT00190541) was a non-inferiority phase III trial of patients with clinical stage II-III rectal cancer without lateral pelvic lymph node enlargement. The trial compared mesorectal excision (ME) with ME and lateral lymph node dissection (LLND), with a primary endpoint of recurrence-free survival (RFS). The planned primary analysis at 5 years failed to confirm the non-inferiority of ME alone compared with ME and LLND. The present study aimed to compare ME alone and ME with LLND using long-term follow-up data from JCOG0212. METHODS: Patients with clinical stage II-III rectal cancer below the peritoneal reflection and no lateral pelvic lymph node enlargement were included in this study. After surgeons confirmed R0 resection by ME, patients were randomized to receive ME alone or ME with LLND. The primary endpoint was RFS. RESULTS: A total of 701 patients from 33 institutions were assigned to ME with LLND (351) or ME alone (350) between June 2003 and August 2010. The 7-year RFS rate was 71.1 per cent for ME with LLND and 70·7 per cent for ME alone (hazard ratio (HR) 1·09, 95 per cent c.i. 0·84 to 1·42; non-inferiority P = 0·064). Subgroup analysis showed improved RFS among patients with clinical stage III disease who underwent ME with LLND compared with ME alone (HR 1·49, 1·02 to 2·17). CONCLUSION: Long-term follow-up data did not support the non-inferiority of ME alone compared with ME and LLND. ME with LLND is recommended for patients with clinical stage III disease, whereas LLND could be omitted in those with clinical stage II tumours.


ANTECEDENTES: El JCOG0212 (ClinicalTrials.gov: NCT00190541) fue un ensayo fase III de no inferioridad en pacientes con cáncer de recto en estadio clínico II/III sin ganglios linfáticos aumentados de tamaño en la pared pélvica lateral. El ensayo comparó la escisión del mesorrecto (mesorectal excision, ME) con la ME con disección de los ganglios linfáticos laterales (lateral lymph node dissection, LLND), siendo el criterio de valoración principal la supervivencia libre de recidiva (recurrence free survival, RFS). El análisis primario planificado a los 5 años de seguimiento no pudo confirmar la no inferioridad de la ME frente a la ME con LLND. Este estudio tuvo como objetivo comparar la ME como procedimiento único y la ME con LLND utilizando datos de seguimiento a largo plazo del ensayo JCOG0212. MÉTODOS: En este estudio se incluyeron pacientes con cáncer de recto en estadio clínico II/III por debajo de la reflexión peritoneal sin ganglios linfáticos aumentados de tamaño en la pared pélvica lateral. Después de que los cirujanos confirmaran la resección R0 mediante la ME, los pacientes fueron asignados al azar al brazo de ME sola o al brazo de ME con LLND. El criterio de valoración principal fue la supervivencia libre de recidiva (RFS). RESULTADOS: Un total de 701 pacientes de 33 instituciones fueron asignados al azar para ser tratados mediante una ME con LLND (n = 351) o EM sola (n = 350) entre junio de 2003 y agosto de 2010. Las tasas de RFS a 7 años fueron del 71,1% para ME con LLND y 70,7 % para ME sola (cociente de riesgos instantáneos, hazard ratio, HR: 1,09 (i.c. del 95% 0,84-1,42), no inferioridad P = 0,064)). El análisis de subgrupos mostró una mejor RFS entre los pacientes en estadio clínico III que se sometieron a ME con LLND en comparación con ME sola (HR: 1,49 (i.c. del 95%: 1,02-2,17)). CONCLUSIÓN: Los datos de seguimiento a largo plazo no justificaron la no inferioridad de la ME en comparación con la ME con LLND. Se recomienda la ME con LLND para pacientes en estadio clínico III, mientras que LLND podría omitirse para pacientes en estadio clínico II.


Asunto(s)
Escisión del Ganglio Linfático , Proctectomía/métodos , Neoplasias del Recto/cirugía , Supervivencia sin Enfermedad , Estudios de Equivalencia como Asunto , Estudios de Seguimiento , Humanos , Ganglios Linfáticos/patología , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Neoplasias del Recto/patología
2.
Osteoporos Int ; 30(1): 231-239, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30406309

RESUMEN

Root amputation, immunosuppressive therapy, mandibular tooth extraction, pre-existing inflammation, and longer duration of treatment with bone-modifying agents were significantly associated with an increased risk of medication-related osteonecrosis of the jaw. Hopeless teeth should be extracted without drug holiday before the development of inflammation in cancer patients receiving high-dose bone-modifying agents. INTRODUCTION: No studies have comprehensively analyzed the influence of pre-existing inflammation, surgical procedure-related factors such as primary wound closure, demographic factors, and drug holiday on the incidence of medication-related osteonecrosis of the jaw (MRONJ). The purpose of this study was to retrospectively investigate the relationships between these various factors and the development of MRONJ after tooth extraction in cancer patients receiving high-dose bone-modifying agents (BMAs) such as bisphosphonates or denosumab. METHODS: Risk factors for MRONJ after tooth extraction were evaluated with univariate and multivariate analyses. The following parameters were investigated in all patients: demographics, type and duration of BMA use, whether BMA use was discontinued before tooth extraction (drug holiday), the duration of such discontinuation, the presence of pre-existing inflammation, and whether additional surgical procedures (e.g., incision, removal of bone edges, root amputation) were performed. RESULTS: We found that root amputation (OR = 22.62), immunosuppressive therapy (OR = 16.61), extraction of mandibular teeth (OR = 12.14), extraction of teeth with pre-existing inflammation, and longer duration (≥ 8 months) of high-dose BMA (OR = 7.85) were all significantly associated with MRONJ. CONCLUSIONS: Tooth extraction should not necessarily be postponed in cancer patients receiving high-dose BMA. The effectiveness of a short-term drug holiday was not confirmed, as drug holidays had no significant impact on MRONJ incidence. Tooth extraction may be acceptable during high-dose BMA therapy until 8 months after initiation.


Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/etiología , Neoplasias/tratamiento farmacológico , Extracción Dental/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Conservadores de la Densidad Ósea/efectos adversos , Denosumab/efectos adversos , Difosfonatos/efectos adversos , Femenino , Humanos , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Raíz del Diente/cirugía
3.
Eur J Clin Microbiol Infect Dis ; 36(10): 1839-1845, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28477235

RESUMEN

Daptomycin (DAP) is widely used in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection. The emergence of DAP non-susceptible MRSA strains during therapy is a major concern in clinical settings. Recent studies revealed that MRSA spontaneously reverts to a subsequent methicillin-susceptible S. aureus (MSSA) strain. However, it is not clear whether DAP non-susceptible MRSA has the ability to revert to a susceptible strain. We obtained an MRSA strain pair, DAP non-susceptible strain and subsequent DAP susceptible strain, from a patient. To understand the underlying mechanism by which DAP non-susceptible MRSA reverts to a susceptible strain, we performed genetic and phenotypic analysis in the strain pair. Although whole-genome analysis revealed four missense mutations, including L826F in mprF, in both strains, the net cell-surface charge was similar between the DAP non-susceptible and susceptible strains. However, the thickness of the cell wall was higher in the DAP non-susceptible strain, which was decreased to the same level as the control after reversion to the DAP susceptible strain. Moreover, the non-susceptible strain showed higher mRNA expression of the two-component system (TCS), such as VraSR, yycG and GraS, with the up-regulated transcription levels of cell-wall biosynthesis-related genes. The expression levels of those genes were decreased after reversion to the susceptible strain. These results indicated that DAP non-susceptibility due to up-regulation of the TCS and cell-wall biosynthesis-related genes may be reversible by the discontinuation of DAP, leading to reversion to the DAP susceptible phenotype.


Asunto(s)
Antibacterianos/farmacología , Pared Celular/metabolismo , Daptomicina/farmacología , Regulación Bacteriana de la Expresión Génica , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Anciano , Análisis Mutacional de ADN , Femenino , Perfilación de la Expresión Génica , Genotipo , Humanos , Staphylococcus aureus Resistente a Meticilina/genética , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Mutación Missense , Fenotipo
4.
Int J Sports Med ; 37(8): 614-8, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27176889

RESUMEN

Ischemic preconditioning (IPC) enhances whole-body exercise endurance. However, it is poorly understood whether the beneficial effects originate from systemic (e. g., cardiovascular system) or peripheral (e. g., skeletal muscle) adaptations. The present study examined the effects of IPC on local muscle endurance during fatiguing isometric exercise. 12 male subjects performed sustained isometric unilateral knee-extension exercise at 20% of maximal voluntary contraction until failure. Prior to the exercise, subjects completed IPC or control (CON) treatments. During exercise trial, electromyography activity and near-infrared spectroscopy-derived deoxygenation in skeletal muscle were continuously recorded. Endurance time to task failure was significantly longer in IPC than in CON (mean±SE; 233±9 vs. 198±9 s, P<0.001). Quadriceps electromyography activity was not significantly different between IPC and CON. In contrast, deoxygenation dynamics in the quadriceps vastus lateralis muscle was significantly faster in IPC than in CON (27.1±3.4 vs. 35.0±3.6 s, P<0.01). The present study found that IPC can enhance muscular endurance during fatiguing isometric exercise. Moreover, IPC accelerated muscle deoxygenation dynamics during the exercise. Therefore, we suggest that the origin of beneficial effects of IPC on exercise performance may be the enhanced mitochondrial metabolism in skeletal muscle.


Asunto(s)
Ejercicio Físico/fisiología , Precondicionamiento Isquémico , Resistencia Física/fisiología , Músculo Cuádriceps/fisiología , Electromiografía , Humanos , Contracción Isométrica , Rodilla , Masculino , Fatiga Muscular/fisiología , Oxígeno/fisiología , Consumo de Oxígeno , Adulto Joven
5.
Clin Genet ; 88(2): 155-60, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25046119

RESUMEN

In current practice of clinical genetics, molecular diagnosis has become more widely used than ever before. DNA diagnosis is important for appropriate medical care of the patient, and proper genetic counseling to the family. However, genetic testing of orphan disease cannot always be performed easily. In multiple congenital anomalies (MCA) syndromes by monogenic cause, the broad mutational spectrum and large size of responsible genes often make molecular diagnosis expensive and cumbersome. We solve this problem with on-demand genetic testing by CHIPS (CEL nuclease mediated heteroduplex incision with polyacrylamide gel electrophoresis and silver staining) technology, which is the ultimately conventional and economical mutation screening system. In this article, we show eight patients with MCA syndromes who were recently treated at our hospital, and demonstrate that CHIPS successfully offers efficient and inexpensive genetic testing and facilitates clinical genetic service in our local region.


Asunto(s)
Anomalías Múltiples/diagnóstico , Pruebas Genéticas/métodos , Técnicas de Diagnóstico Molecular/métodos , Análisis de Secuencia por Matrices de Oligonucleótidos/métodos , Anomalías Múltiples/genética , Adulto , Niño , Femenino , Asesoramiento Genético , Humanos , Lactante , Recién Nacido , Masculino , Mutación/genética
8.
J Arthroplasty ; 29(12): 2439-46, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25047458

RESUMEN

Edoxaban, an oral direct factor Xa inhibitor, has proven antithrombotic efficacy. In a multicenter, phase II study, 264 total hip arthroplasty (THA) patients randomly received edoxaban 15 or 30 mg once daily or enoxaparin 2000IU (20-mg) twice daily for 11-14 days. Thromboembolic event incidences were 3.8% (3/78), 2.8% (2/72), and 4.1% (3/74) for edoxaban 15-mg, 30-mg, and enoxaparin, respectively (P=1.00). Edoxaban-induced prolongation of prothrombin time, international normalized ratio, and activated partial thromboplastin time were proportional to plasma edoxaban concentration. Major or clinically relevant non-major bleeding incidences were 2.2% (2/89), 1.2% (1/85), and 2.3% (2/87) for edoxaban 15-mg, 30-mg, and enoxaparin, respectively (P=1.00). Once-daily edoxaban showed similar efficacy and safety to enoxaparin for prevention of thromboembolic events in patients undergoing THA.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Inhibidores del Factor Xa/administración & dosificación , Piridinas/administración & dosificación , Tiazoles/administración & dosificación , Tromboembolia Venosa/prevención & control , Trombosis de la Vena/prevención & control , Anciano , Antitrombinas/administración & dosificación , Método Doble Ciego , Enoxaparina/administración & dosificación , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Taiwán , Resultado del Tratamiento , Tromboembolia Venosa/etiología , Trombosis de la Vena/etiología
9.
Oral Dis ; 19(7): 683-93, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23279451

RESUMEN

OBJECTIVE: The aim of this study was to investigate how atopic dermatitis (AD) contributes to root resorption during orthodontic tooth movement. MATERIALS AND METHODS: Atopic dermatitis model mice and wild-type mice were subjected to an excessive orthodontic force (OF) to induce movement of the upper first molars. The expression levels of the tartrate-resistant acid phosphatase (TRAP), IL-17, IL-6, and RANKL proteins were determined in the periodontal ligament (PDL) by an immunohistochemical analysis. Furthermore, the effects of the compression force on co-cultures of CD4(+) cells from AD patients or healthy individuals and human PDL cells were investigated with regard to the levels of secretion and mRNA expression of IL-17, IL-6, RANKL, and osteoprotegerin. RESULTS: The immunoreactivities for TRAP, IL-17, IL-6, and RANKL in the AD group were found to be significantly increased. The double immunofluorescence analysis for IL-17/CD4 detected immunoreaction. The secretion of IL-17, IL-6, and RANKL, and the mRNA levels of IL-6 and RANKL in the AD patients were increased compared with those in healthy individuals. CONCLUSION: Th17 cells may therefore be associated with the deterioration of root resorption of AD mice, and may explain why AD patients are more susceptible to root resorption than healthy individuals when an excessive OF is applied.


Asunto(s)
Dermatitis Atópica/inmunología , Resorción Radicular/inmunología , Células Th17/inmunología , Técnicas de Movimiento Dental , Fosfatasa Ácida/análisis , Adulto , Animales , Linfocitos T CD4-Positivos/inmunología , Técnicas de Cultivo de Célula , Técnicas de Cocultivo , Dermatitis Atópica/patología , Modelos Animales de Enfermedad , Femenino , Humanos , Inmunoglobulina E/sangre , Interleucina-17/análisis , Interleucina-17/sangre , Interleucina-6/análisis , Isoenzimas/análisis , Masculino , Ratones , Ratones Endogámicos BALB C , Osteoprotegerina/análisis , Ligamento Periodontal/inmunología , Ligamento Periodontal/patología , Ligando RANK/análisis , Resorción Radicular/patología , Estrés Mecánico , Fosfatasa Ácida Tartratorresistente , Técnicas de Movimiento Dental/efectos adversos , Adulto Joven
10.
Hernia ; 27(5): 1131-1138, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-36595086

RESUMEN

PURPOSE: This study aimed to compare perioperative outcomes of robotic and laparoscopic transabdominal peritoneal repair (TAPP) for unilateral inguinal hernia. METHODS: This single institutional retrospective cohort study used de-identified data of patients who underwent robotic TAPP (R-TAPP) or laparoscopic TAPP (L-TAPP) for unilateral inguinal hernia between January 1, 2016 and October 31, 2021. Two cohorts were propensity matched, and data were analyzed. The learning curve was evaluated in the R-TAPP group. RESULTS: Among 938 patients analyzed, 704 were included. After propensity-score matching, 80 patients were included in each group. The difference in operative time between R-TAPP and L-TAPP groups was 10 min (99.5 and 89.5 min, p = 0.087); however, console/laparoscopic time was similar (67 and 66 min, p = 0.71). The dissection time for medial-type hernia in the R-TAPP group was marginally shorter than that in the L-TAPP group (17 and 27 min, p = 0.056); however, there was no difference for lateral-type hernia (38.5 and 40 min p = 0.37). Perioperative variables, including estimated blood loss, postoperative hospital stay, and postoperative pain, had no significant difference, and chronic pain, which needed medication or intervention, was not observed in each group. The number of cases needed to achieve plateau performance was 7-10 in the R-TAPP group. CONCLUSION: This study suggests that R-TAPP was safely introduced, and its perioperative outcomes were not inferior to those of L-TAPP. A shorter dissection time for medial-type hernia might be due to the robot's advantages, and a fast-learning curve could help with the early standardization of the procedure.


Asunto(s)
Hernia Inguinal , Laparoscopía , Procedimientos Quirúrgicos Robotizados , Robótica , Humanos , Hernia Inguinal/cirugía , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/métodos , Estudios Retrospectivos , Herniorrafia/efectos adversos , Herniorrafia/métodos , Laparoscopía/métodos , Resultado del Tratamiento
11.
Anaesthesia ; 67(8): 881-4, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22506698

RESUMEN

We compared the Pentax Airway Scope(TM) with the Airtraq(TM) optical laryngoscope in an infant manikin. Twenty-three anaesthetists randomly performed tracheal intubation: at rest, (a) with the Airway Scope and (b) with the Airtraq; and during chest compressions, (c) with the Airway Scope and (d) with the Airtraq. The success rate, modified Cormack and Lehane classification for glottic view, time taken to view the glottis, and time to place the tracheal tube were recorded. There was no difference in intubation success rate or quality of glottic view between the two devices. The median (IQR [range]) time taken to obtain a view of the glottis was 4.5 (3.7-6.4 [1.8-14.0]) s using the Airway Scope compared with 7.1 (5.5-9.6 [3.3-12.0]) s using the Airtraq (p = 0.001), and to successful placement of the tracheal tube was 8.3 (6.8-9.4 [3.7-20.7]) s using the Airway Scope compared with 11.2 (10.4-13.8 [4.9-23.7]) s using the Airtraq (p = 0.001). During chest compressions, the median (IQR [range]) time taken to view the glottis was 5.1 (4.0-7.2 [2.0-12.4]) s using the Airway Scope compared with 7.5 (5.0-13.2 [4.2-26.4]) s using the Airtraq (p = 0.006), and to successful placement of the tracheal tube was 9.5 (6.6-13.7 [4.5-16.2]) s using the Airway Scope compared with 11.7 (9.1-18.1 [6.2-37.4]) s using the Airtraq (p = 0.022). We conclude that both devices provided good quality views of the glottis and successful tracheal intubation in an infant manikin both at rest and during external chest compressions. Use of the Airway Scope resulted in a shorter time to view the glottis and perform successful tracheal intubation compared with the Airtraq.


Asunto(s)
Intubación Intratraqueal/instrumentación , Laringoscopios , Maniquíes , Humanos , Lactante
12.
J Neuroinflammation ; 8: 70, 2011 Jun 22.
Artículo en Inglés | MEDLINE | ID: mdl-21696573

RESUMEN

BACKGROUND: How glial cells and cytokines are associated with the progression of delayed neuronal death induced by transient global ischemia is still unclear. To further clarify this point, we studied morphological changes in glial cells (microglial cells and astrocytes), and cytokine protein levels, during the progression of neuronal cell loss in CA1 (Cornu Ammonis 1) of the hippocampus after transient global ischemia. METHODS: Morphological changes in glial cells were studied immuno-histochemically. Nine cytokines (IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-10, GM-CSF, IFN-γ and TNF-α) were simultaneously measured by a multiplexed bead-based immunoassay from 6 h to day21 after transient four vessel occlusion (4VO) in rats. RESULTS: During the process of neuronal loss, we observed four distinct phases: (1) lag phase day0-2 (no NeuN+ cell loss observed), (2) exponential phase day2-7 (NeuN+ cells reduced in number exponentially), (3) deceleration phase day7-14 (reduction rate of NeuN+ cells became low), (4) stationary phase day14 onward (NeuN+ cell loss progressed no longer). In the lag phase, activated glial cells were observed in the entire hippocampus but later were gradually restricted to CA1. Cytokine protein levels in the lag and exponential phases were lower than in the deceleration and stationary phases. IL-1α, IL-1ß, IL-4, IL-6 and IFN-γ in 4VO were significantly higher in all four phases than in sham. Compared with sham level, GM-CSF was significantly high in the deceleration phase. TNF-α was significantly high in both the deceleration and stationary phases. CONCLUSION: Ischemic stress in 4VO activated glial cells in areas beyond CA1 in the lag phase. Pyramidal neurons were injured in CA1 from the end of the lag phase and then neuronal cells reduced in CA1 in the exponential phase. After neuronal death began, the influence of dead cells on glial cells and cytokine expression gradually became stronger than the influence by ischemic stress. Therefore, from the deceleration phase, changes in glial cells and cytokine production were likely caused by dead cells. Cytokine interaction in the microenvironment may determine the functions of IL-1α, IL-1ß, IL-4, IL-6 and IFN-γ in all four phases. The function of GM-CSF and TNF-α in the deceleration phase may be neurotrophic.


Asunto(s)
Citocinas/metabolismo , Ataque Isquémico Transitorio/fisiopatología , Degeneración Nerviosa/fisiopatología , Neuroglía/citología , Neuroglía/metabolismo , Animales , Región CA1 Hipocampal/citología , Región CA1 Hipocampal/metabolismo , Región CA1 Hipocampal/patología , Ataque Isquémico Transitorio/patología , Masculino , Degeneración Nerviosa/patología , Ratas , Ratas Wistar
13.
Eur J Vasc Endovasc Surg ; 41(5): 579-88, 2011 May.
Artículo en Inglés | MEDLINE | ID: mdl-21334227

RESUMEN

OBJECTIVE: To assess the usefulness of completion angiography in the prevention of stroke, carotid occlusion and residual stenosis after primary carotid endarterectomy (CEA) in the setting of a teaching hospital. MATERIAL AND METHODS: From January 1995 to August 2009, 1055 consecutive patients having 1179 CEAs were entered in a prospective study excluding patients with severe renal insufficiency, allergy to contrast media and patients with repeat CEA or carotid bypass. In this cohort, 552 patients (52.3%) were asymptomatic, 318 (30.2%) had a transient ischaemic attack (TIA) and 185 (17.5%) had a stroke. Routine completion angiography was obtained in all 1055 patients. The decision to perform a surgical revision was decided for any of the following defects: (1) a residual stenosis of more than 50% of the internal carotid artery (ICA) or common carotid artery (CCA) and of more than 70% of the external carotid artery (ECA), (2) any flap and (3) any intraluminal-filling defect. A postoperative duplex scan was obtained within a week after surgery and thereafter on a yearly basis. Median follow-up was 7 years. RESULTS: CEA was performed by a senior surgeon as first operator in 812 cases (69%) and by a trainee, with a scrubbed senior surgeon, in 367 cases (31%). Completion angiography revealed significant defects in 72 cases (6.1%) warranting revision for ECA flap (n = 30), thrombus in contact with the patch (n = 7), distal ICA flap or stenosis (n = 20) and CCA flap or residual plaque (n = 15). Logistic regression analysis showed that total length of the carotid plaque >6 cm (p = 0.02, Odds ratio: 2.31; 95% confidence interval (CI) (1.21-3.72)), eversion endarterectomy of the ECA (p = 0.01, Odds ratio 3.41; 95%CI (2.10-5.94)) and trainee as first operator (p = 0.02, Odds ratio 2.42; 95%CI (1.81-4.23)) were independent predictors of operative defects seen on completion angiography. No complication in relation to carotid catheterisation or injection of contrast media occurred in this series. The 30-day combined stroke and death rate was 1.5%, comparable between senior surgeons and trainees (p = 0.60). There was no significant difference in the combined stroke and death rate observed in patients with normal completion angiography (1.4%) compared with that of the patients with a defect corrected (2.8%) (p = 0.28, Odds ratio: 0.67; 95%CI (0.22-2.09)). But there was an increased incidence of postoperative TIA in the group with revision (p = 0.001, odds ratio: 5.8, 95%CI: 1.8-18.9). At 7 years, the freedom rate from >50% carotid restenosis or occlusion was 87.5 ± 6.7% in patients with normal completion angiography and 92 ± 5.4% in patients, who undergo a surgical revision. CONCLUSION: In a single centre, CEA with routine completion angiography resulted in good perioperative outcome. Plaque length, technique for external carotid artery (ECA) endarterectomy and trainee as first operator were independent predictors of operative defects seen on completion angiography.


Asunto(s)
Angiografía/métodos , Estenosis Carotídea/diagnóstico por imagen , Endarterectomía Carotidea , Hospitales de Enseñanza , Cuidados Preoperatorios/métodos , Accidente Cerebrovascular/prevención & control , Anciano , Angiografía/estadística & datos numéricos , Estenosis Carotídea/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Cuidados Preoperatorios/estadística & datos numéricos , Estudios Prospectivos , Factores de Tiempo
15.
Clin Nephrol ; 76(1): 64-7, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21722607

RESUMEN

We treated a patient with 6p partial deletion syndrome diagnosed after proteinuria was detected during developmental examination 3 years after birth. External anomalies included ocular hypertelorism, saddle nose, elongated philtrum, tent-like lips, and low-set auricles. Mental retardation was evident. The karyotype was 46,XX,del(6) (p.22.1-p22.3) with an interstitial deletion. The kidneys showed no abnormality on imaging such as hydronephrosis, atrophy, or malformation. Examination of a renal biopsy specimen disclosed focal segmental glomerulosclerosis. No cardiac anomaly or Rieger anomaly, which often are present in this syndrome, were noted.


Asunto(s)
Deleción Cromosómica , Cromosomas Humanos Par 6/genética , Glomeruloesclerosis Focal y Segmentaria/genética , Anomalías Múltiples/genética , Biopsia , Niño , Femenino , Glomeruloesclerosis Focal y Segmentaria/diagnóstico , Humanos , Riñón/diagnóstico por imagen , Riñón/patología , Radiografía
16.
Clin Nephrol ; 75(4): 369-73, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21426892

RESUMEN

We encountered a patient with marked hyperimmunoglobulinemia E who had a mutation of the signal transducer and activator of transcription 3 gene (STAT3) and developed minimal change nephrotic syndrome (MCNS). From early infancy, the patient showed repeated episodes of refractory chronic eczema accompanied by impetigo vulgaris with cicatrization, as well as otitis media. Serum IgE was markedly increased (from 4,000 to 25,000 IU/ml). The nephrotic syndrome (NS) frequently relapsed, and was alternately responsive and resistant to corticosteroids. The STAT3 mutation was heterozygous, located in exon 23 of the transactivation domain and causing A744V substitution. Presently treated with mycophenolate mofetil, the patient has less frequent MCNS recurrences. Increases in circulating Th2 cytokines and IgE combined with suppression of the Th1 cytokine interferon-γ caused by the STAT3 abnormality, presumably caused MCNS by altering the Th1/Th2 balance among T-lymphocytes. To our knowledge, this is the first report of type I hyper-IgE syndrome (HIES) showing a STAT3 gene mutation and MCNS.


Asunto(s)
Síndrome de Job/genética , Factor de Transcripción STAT3/genética , Adolescente , Humanos , Masculino , Mutación , Nefrosis Lipoidea/genética
17.
Oral Dis ; 17(5): 489-98, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21496183

RESUMEN

OBJECTIVE: The aim of this study was to investigate how interleukin (IL)-8 (cytokine-induced neutrophil chemoattractant; CINC-1) and monocyte chemotactic protein (MCP)-1/CCL2 contribute to root resorption during orthodontic tooth movement. MATERIALS AND METHODS: Forty 6-week-old male Wistar rats were subjected to orthodontic force of 10 or 50 g to induce a mesially tipping movement of the upper first molars for 7 days. We determined the expressions of CINC-1, CXCR2, and MCP-1 proteins in root resorption area using immunohistochemistry. Furthermore, we investigated the effects of compression forces (CF) on IL-8 and MCP-1 production by human periodontal ligament (hPDL) cells. We observed an effect of chemokine treatment on rat odonto/osteoclasts in dentin slices that recapitulated root resorption. RESULTS: The immunoreactivity for CINC-1/CXCR2 and MCP-1 was detected in odontoclasts and PDL fibroblasts by the orthodontic force of 50 g on day 7. CF increased the secretion and the expression of mRNA of IL-8 and MCP-1 from PDL cells in a magnitude-dependent manner. Moreover, CINC-1 and MCP-1 stimulated osteoclastogenesis from rat osteoclast precursor cells. CONCLUSION: IL-8 (CINC-1) and MCP-1 may therefore facilitate the process of root resorption because of excessive orthodontic force.


Asunto(s)
Quimiocina CCL2/análisis , Citocinas/análisis , Interleucina-8/análisis , Osteoclastos/fisiología , Ligamento Periodontal/citología , Técnicas de Movimiento Dental , Fosfatasa Ácida/análisis , Adolescente , Animales , Fenómenos Biomecánicos , Técnicas de Cultivo de Célula , Diferenciación Celular/fisiología , Quimiocina CXCL1/análisis , Dentina/patología , Femenino , Fibroblastos/fisiología , Humanos , Inmunohistoquímica , Isoenzimas/análisis , Masculino , Diente Molar/patología , Ratas , Ratas Wistar , Receptores de Interleucina-8B/análisis , Resorción Radicular/patología , Estrés Mecánico , Fosfatasa Ácida Tartratorresistente
18.
Int J Oral Maxillofac Surg ; 50(9): 1182-1186, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33583664

RESUMEN

Odontogenic gingival epithelial hamartoma (OGEH) is a rare odontogenic epitheliallesion. Distinguishing OGEH from peripheral ameloblastoma can pose a differential diagnostic challenge. We report a case of OGEH affecting the lower gingiva in a 78-year-old male patient. The lesion presented as a large, painless, pedunculated mass with a pleomorphic histological appearance. A diagnosis of OGEH was made after the exclusion of peripheral ameloblastoma and peripheral adenomatoid odontogenic tumour. Previous studies have reported differences in sex and age between patients with OGEH and peripheral ameloblastoma; this suggests that peripheral ameloblastoma is not derived from OGEH. Histological findings suggest that the lesions are independent entities.


Asunto(s)
Ameloblastoma , Neoplasias Gingivales , Hamartoma , Tumores Odontogénicos , Anciano , Ameloblastoma/diagnóstico por imagen , Encía , Hamartoma/diagnóstico por imagen , Humanos , Masculino , Tumores Odontogénicos/diagnóstico por imagen
19.
AJNR Am J Neuroradiol ; 42(3): 471-478, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33414234

RESUMEN

BACKGROUND AND PURPOSE: Synthetic MR imaging creates multiple contrast-weighted images based on a single time-efficient quantitative scan, which has been mostly performed for 2D acquisition. We assessed the utility of 3D synthetic MR imaging in patients with MS by comparing its diagnostic image quality and lesion volumetry with conventional MR imaging. MATERIALS AND METHODS: Twenty-four patients with MS prospectively underwent 3D quantitative synthetic MR imaging and conventional T1-weighted, T2-weighted, FLAIR, and double inversion recovery imaging, with acquisition times of 9 minutes 3 seconds and 18 minutes 27 seconds for the synthetic MR imaging and conventional MR imaging sequences, respectively. Synthetic phase-sensitive inversion recovery images and those corresponding to conventional MR imaging contrasts were created for synthetic MR imaging. Two neuroradiologists independently assessed the image quality on a 5-point Likert scale. The numbers of cortical lesions and lesion volumes were quantified using both synthetic and conventional image sets. RESULTS: The overall diagnostic image quality of synthetic T1WI and double inversion recovery images was noninferior to that of conventional images (P = .23 and .20, respectively), whereas that of synthetic T2WI and FLAIR was inferior to that of conventional images (both Ps < .001). There were no significant differences in the number of cortical lesions (P = .17 and .53 for each rater) or segmented lesion volumes (P = .61) between the synthetic and conventional image sets. CONCLUSIONS: Three-dimensional synthetic MR imaging could serve as an alternative to conventional MR imaging in evaluating MS with a reduced scan time.


Asunto(s)
Encéfalo/diagnóstico por imagen , Imagenología Tridimensional/métodos , Imagen por Resonancia Magnética/métodos , Esclerosis Múltiple/diagnóstico por imagen , Adulto , Encéfalo/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/patología
20.
J Exp Med ; 142(6): 1416-24, 1975 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-1081579

RESUMEN

A method is described which employs differential centrifugation and sucrose density gradient centrifugation to isolate a membrane fraction from human lymphocytes. Membrane preparations from long-term human cultured B- and T-lymphoid lines, peripheral blood lymphocytes, tonsillar lymphocytes, and thymocytes were analyzed on 0.5% sodium dodecyl sulfate-7.5% polyacrylamide gels stained for protein and carbohydrate. The most important finding was a major glycoprotein of approximately 30,000 daltons associated with the membrane preparations from B lymphocytes. T-lymphocyte preparations did not contain readily detectable amounts of this membrane-associated component. The T-cell lymphoid line MOLT-4 was unique in that it had a narrow protein band at approximately 30,000 daltons which did not contain carbohydrate.


Asunto(s)
Linfocitos B/análisis , Glicoproteínas/análisis , Linfocitos T/análisis , Antígenos/análisis , Linfocitos B/ultraestructura , Línea Celular , Membrana Celular/análisis , Membrana Celular/inmunología , Electroforesis en Gel de Poliacrilamida , Humanos , Inmunoglobulinas/análisis , Leucemia Linfoide/sangre , Tonsila Palatina/citología , Dodecil Sulfato de Sodio , Linfocitos T/ultraestructura , Timo/citología
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