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1.
Proc Natl Acad Sci U S A ; 120(52): e2314808120, 2023 Dec 26.
Artículo en Inglés | MEDLINE | ID: mdl-38134196

RESUMEN

Infectious virus shedding from individuals infected with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) is used to estimate human-to-human transmission risk. Control of SARS-CoV-2 transmission requires identifying the immune correlates that protect infectious virus shedding. Mucosal immunity prevents infection by SARS-CoV-2, which replicates in the respiratory epithelium and spreads rapidly to other hosts. However, whether mucosal immunity prevents the shedding of the infectious virus in SARS-CoV-2-infected individuals is unknown. We examined the relationship between viral RNA shedding dynamics, duration of infectious virus shedding, and mucosal antibody responses during SARS-CoV-2 infection. Anti-spike secretory IgA antibodies (S-IgA) reduced viral RNA load and infectivity more than anti-spike IgG/IgA antibodies in infected nasopharyngeal samples. Compared with the IgG/IgA response, the anti-spike S-IgA post-infection responses affected the viral RNA shedding dynamics and predicted the duration of infectious virus shedding regardless of the immune history. These findings highlight the importance of anti-spike S-IgA responses in individuals infected with SARS-CoV-2 for preventing infectious virus shedding and SARS-CoV-2 transmission. Developing medical countermeasures to shorten S-IgA response time may help control human-to-human transmission of SARS-CoV-2 infection and prevent future respiratory virus pandemics.


Asunto(s)
COVID-19 , Humanos , SARS-CoV-2 , Esparcimiento de Virus , Formación de Anticuerpos , Tiempo de Reacción , Anticuerpos Antivirales , ARN Viral , Inmunoglobulina G , Inmunoglobulina A , Inmunoglobulina A Secretora
2.
J Gastroenterol Hepatol ; 38(1): 61-69, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36180941

RESUMEN

BACKGROUND AND AIM: Small intestinal bacterial overgrowth (SIBO) is diagnosed by using quantitative culture of duodenal aspirates and/or a hydrogen breath test. However, few studies have analyzed bacterial microbiota in Japanese patients with SIBO. METHODS: Twenty-four patients with any abdominal symptoms and suspected SIBO were enrolled. Quantitative culture of duodenal aspirates and a glucose hydrogen breath test were performed on the same day. SIBO was diagnosed based on a bacterial count ≥ 103  CFU/mL or a rise in the hydrogen breath level of ≥ 20 ppm. The composition of the duodenal microbiota was analyzed by 16S rRNA gene sequencing. RESULTS: Small intestinal bacterial overgrowth was diagnosed in 17 of the 24 patients (71%). The positive rates for the hydrogen breath test and quantitative culture of duodenal aspirates were 50% and 62%, respectively. Patients with SIBO showed significantly reduced α-diversity compared with non-SIBO patients, and analysis of ß-diversity revealed significantly different distributions between SIBO and non-SIBO patients. In addition, the intestinal microbiome in SIBO patients was characterized by increased relative abundance of Streptococcus and decreased relative abundance of Bacteroides compared with non-SIBO patients. CONCLUSIONS: Duodenal dysbiosis was identified in patients with SIBO and may play a role in the pathophysiology of SIBO.


Asunto(s)
Microbioma Gastrointestinal , Intestino Delgado , Humanos , Intestino Delgado/microbiología , Microbioma Gastrointestinal/fisiología , ARN Ribosómico 16S/genética , Duodeno/microbiología , Pruebas Respiratorias , Hidrógeno
3.
Br J Anaesth ; 131(1): 170-177, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-36967279

RESUMEN

BACKGROUND: Diagnosis of perioperative anaphylaxis is difficult because of its non-specific and variable signs and symptoms. Therapeutic agents used to treat anaphylaxis and anaesthesiologist responses also vary depending on the case, which might affect outcomes; however, only a few studies have focused on these factors. METHODS: This prospective study of perioperative anaphylaxis, a part of the Japanese Epidemiologic Study for Perioperative Anaphylaxis, investigated the clinical signs, its severity, therapeutic drugs, epinephrine administration, and anaesthesiologist responses in cases of perioperative anaphylaxis to assess trends and variability. Shock index was used to assess severity of cardiovascular collapse. RESULTS: In 43 patients analysed in this study, cardiovascular signs (88.4%) were the most frequent, followed by skin (81.4%) and respiratory signs (60.5%). The presence of signs increased during the clinical course. The median time from the first signs to diagnosis of anaphylaxis was 10 (5.0-17.8) min. The rates of epinephrine use were 30.2% (unused), 48.8% (i.v.), and 20.9% (i.m.). The median time from diagnosis of anaphylaxis to epinephrine administration was 7 (inter-quartile range: 1.5-8.0) min. Antihistamines and corticosteroids were each used in 69.8% of cases. The worst shock index was higher in patients who received i.v. epinephrine (2.77 [0.90] mean [standard deviation]) than in both no epinephrine use cases (1.35 [0.41]) and i.m. epinephrine cases (1.89 [0.77] (P<0.001]). CONCLUSIONS: The clinical signs and treatments of perioperative anaphylaxis are variable, and the choice regarding epinephrine administration is based on symptom severity. CLINICAL TRIAL REGISTRATION: UMIN000035350.


Asunto(s)
Anafilaxia , Anestesia , Humanos , Corticoesteroides/uso terapéutico , Anafilaxia/diagnóstico , Anafilaxia/tratamiento farmacológico , Anafilaxia/epidemiología , Pueblos del Este de Asia , Epinefrina/uso terapéutico , Estudios Prospectivos , Anestesia/efectos adversos
4.
Emerg Infect Dis ; 28(5): 998-1001, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35290176

RESUMEN

To determine virus shedding duration, we examined clinical samples collected from the upper respiratory tracts of persons infected with severe acute respiratory syndrome coronavirus 2 Omicron variant in Japan during November 29-December 18, 2021. Vaccinees with mild or asymptomatic infection shed infectious virus 6-9 days after onset or diagnosis, even after symptom resolution.


Asunto(s)
COVID-19 , Enfermedades Transmisibles , Infecciones Asintomáticas , Humanos , SARS-CoV-2 , Esparcimiento de Virus
5.
J Med Virol ; 94(2): 582-586, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-31021428

RESUMEN

OBJECTIVE: Approximately 1 million adenovirus immunochromatography (IC) kits are annually used in Japan. However, no practical strategies have been developed regarding their use for detecting adenovirus. The present study aims to verify the usefulness of clinical manifestations in making decisions regarding the use of adenovirus IC kits for children with upper respiratory infections (URI). METHODS: The medical records of 825 pediatric cases tested by IC kits for adenovirus were extracted from clinical laboratory department database over a 3-year period at our hospital. Among them, 585 patients were suspected adenovirus URI, and their clinical manifestations were reviewed. After data cleaning, 10 types of clinical manifestations were statistically analyzed between adenovirus IC kit-positive and -negative groups. Multivariate analysis was performed to select significant clinical manifestations using adenovirus IC kit positivity as the objective variable. RESULTS: Among 585 pediatric patients, the cases of 420 patients, with suitable data for whom no other pathogen was detected, were reviewed. Adenovirus was detected in 86 cases. Multivariate analysis identified a significant difference for three clinical manifestations: (1) fever ≥ 39.0°C, (2) rhinorrhea, and (3) tonsillar exudate. The negativity rate for the IC kit was 90% when none of the three manifestations was observed. CONCLUSIONS: The results suggested that IC kits for adenovirus tend to give negative results in cases that lack all the three above mentioned clinical manifestations.


Asunto(s)
Infecciones por Adenovirus Humanos/diagnóstico , Adenovirus Humanos/aislamiento & purificación , Cromatografía de Afinidad/normas , Juego de Reactivos para Diagnóstico/normas , Infecciones del Sistema Respiratorio/virología , Infecciones por Adenovirus Humanos/virología , Niño , Preescolar , Cromatografía de Afinidad/métodos , Bases de Datos Factuales , Femenino , Fiebre/etiología , Humanos , Límite de Detección , Modelos Logísticos , Masculino , Análisis Multivariante , Infecciones del Sistema Respiratorio/complicaciones , Estudios Retrospectivos , Rinorrea/etiología
6.
BMC Gastroenterol ; 22(1): 195, 2022 Apr 21.
Artículo en Inglés | MEDLINE | ID: mdl-35448957

RESUMEN

BACKGROUNDS: Optimal concentration of ustekinumab (UST) predicting endoscopic remission has not been fully investigated in Crohn's disease (CD). We aimed to identify the optimal UST trough levels predicting clinical, laboratory and endoscopic remission in CD patients. METHODS: Twenty-eight patients with CD were enrolled and investigated (27 patients by enteroscopy and 1 by colonoscopy). The endoscopic activity was assessed using the scoring system that applied the Rutgeerts score to observed intestine. Serum UST trough levels and anti-UST antibodies (AUAs) levels were determined by in-house immunoassays. RESULTS: Endoscopic activity was negatively correlated with serum UST trough levels (Spearman's rank correlation coefficient (ρ) = - 0.66, P = 0.0001) and serum albumin levels (ρ = - 0.60, P = 0.0007). The endoscopic activity was positively and significantly correlated with CRP (ρ = 0.59, P = 0.0009) and ESR (ρ = 0.44, P = 0.033). There was no significant association between the endoscopic score and AUA levels and/or Crohn's disease activity index (CDAI). Serum UST trough levels and albumin levels were significantly higher in the endoscopic remission group (scores of 0 and 1) than in the non-endoscopic remission group (UST trough, mean 3.3 vs. 1.8 µg/mL). No significant difference was observed in AUAs between the endoscopic remission and non-remission groups. Receiver operation curve (ROC) analysis revealed that the optimal cutoff value of UST trough levels predicting normal CRP and serum albumin levels was 1.7 µg/mL for each, and the optimal cutoff value predicting endoscopic remission was 2.0 µg/mL (AUC: 0.80, 95% CI 0.64-0.96). CONCLUSION: Achievement of endoscopic remission requires higher UST trough levels than required for normalization of CRP and serum albumin levels.


Asunto(s)
Enfermedad de Crohn , Ustekinumab , Colonoscopía , Enfermedad de Crohn/tratamiento farmacológico , Endoscopía Gastrointestinal , Humanos , Inducción de Remisión , Albúmina Sérica , Ustekinumab/uso terapéutico
7.
Endocr J ; 69(4): 399-406, 2022 Apr 28.
Artículo en Inglés | MEDLINE | ID: mdl-34853196

RESUMEN

This study aimed to reveal the relationship between quality of life (QOL) and sleep quality in patients with type 1 diabetes mellitus (T1DM). Overall, 202 patients with T1DM were registered in our study, and 192 were eligible for analysis. Baseline characteristics and laboratory values were determined. Patients completed the Japanese versions of the Pittsburgh Sleep Quality Index (PSQI) and Diabetes Therapy-Related QOL (DTR-QOL) questionnaires. We investigated the relationship between the global PSQI and DTR-QOL total scores by using linear regression analysis. In univariate regression analysis, DTR-QOL total scores were associated with body mass index, alcohol consumption, hypertension, hemoglobin A1c (HbA1c), and global PSQI score (all p-value <0.05) but not with sleep duration. When the association between PSQI subscales and DTR-QOL total scores was examined, DTR-QOL total scores were significantly related to subjective sleep quality and daytime dysfunction. In a multivariate regression analysis, the global PSQI score was negatively related to DTR-QOL total scores. Patients with an HbA1c concentration ≥8.0% had significantly lower DTR-QOL total scores. We revealed a relationship between QOL and sleep quality in T1DM patients and showed that the relationship between QOL and PSQI subscales in T1DM patients may be different from that in patients with type 2 diabetes mellitus. Assessing and managing sleep quality may be necessary for patients with diabetes to improve QOL.


Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Trastornos del Sueño-Vigilia , Estudios Transversales , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Hemoglobina Glucada , Humanos , Japón , Calidad de Vida , Sueño , Calidad del Sueño , Trastornos del Sueño-Vigilia/complicaciones , Trastornos del Sueño-Vigilia/etiología , Encuestas y Cuestionarios
8.
J Card Surg ; 37(4): 1028-1030, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35040518

RESUMEN

BACKGROUND: Four-dimensional flow magnetic resonance imaging (4D flow MRI) can directly estimate turbulent kinetic energy (TKE) which is associated with pressure loss that are not assessable by other imaging modalities. METHODS AND RESULTS: A 55-year-old woman developed hemolytic anemia after emergency ascending aortic replacement for acute type A aortic dissection. Although computed tomographic angiography or doppler echocardiography could not identify the culprit stenotic legion, 4D flow MRI revealed jet flow and highly elevated TKE at the highly stenosed proximal anastomosis of a replaced ascending aorta. CONCLUSION: Our findings suggest that 4D flow MRI evaluation and TKE estimation enable more accurate and detailed assessment of abnormal flow dynamics than conventional imaging modalities.


Asunto(s)
Anemia Hemolítica , Disección Aórtica , Anemia Hemolítica/etiología , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Aorta/diagnóstico por imagen , Aorta/cirugía , Velocidad del Flujo Sanguíneo , Femenino , Humanos , Imagenología Tridimensional/métodos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad
9.
J Gastroenterol Hepatol ; 35(7): 1163-1170, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31860733

RESUMEN

BACKGROUND AND AIM: Ustekinumab is a human monoclonal antibody to the p40 subunit of human IL-12/IL-23. The purpose of this report is to verify the newly developed immunoassays for serum ustekinumab and anti-ustekinumab antibody (AUA) concentrations and assess their clinical utility. METHODS: Serum ustekinumab trough levels and AUA levels were measured using new immunoassays in 38 patients with Crohn's disease under ustekinumab maintenance injection. RESULTS: Mean ustekinumab trough levels were 2.54 ± 2.1 µg/mL, and 3 of 38 patients (7.9%) were positive for AUAs. There was no association between ustekinumab trough levels and AUA levels. The optimal trough level of ustekinumab to maintain negative C-reactive protein levels (≤ 0.3 mg/dL) was 1.67 µg/mL determined by receiver operating characteristic curve analysis. Ustekinumab trough level negatively but significantly correlated with C-reactive protein, erythrocyte sedimentation rate, and Crohn's disease activity index and positively and significantly correlated with serum albumin levels. Ustekinumab trough levels were significantly higher in biologics-naïve patients than in biologics-experienced patients, although there was no difference in AUA levels. CONCLUSIONS: We developed new assays for serum ustekinumab trough and AUA levels. These assays might provide new insights into therapeutic drug monitoring-based management of Crohn's disease patients under ustekinumab therapy.


Asunto(s)
Anticuerpos/sangre , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/tratamiento farmacológico , Monitoreo de Drogas/métodos , Inmunoensayo/métodos , Ustekinumab/uso terapéutico , Adulto , Biomarcadores/sangre , Proteína C-Reactiva , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROC , Albúmina Sérica , Ustekinumab/sangre , Ustekinumab/inmunología
10.
Digestion ; 100(4): 238-246, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30602158

RESUMEN

BACKGROUND/AIMS: Thiopurines are key drugs in maintenance therapy for treating inflammatory bowel disease (IBD). Time-dependent 5-aminosalicylates (5-ASA) releasing preparations (time-dependent 5-ASA) increase 6-thioguanine nucleotide (6-TGN), an active metabolite of thiopurines. However, the effects of pH-dependent 5-ASA releasing preparations (pH-dependent 5-ASA) on thiopurine metabolism were not reported. METHODS: We conducted a retrospective study of 134 IBD patients who received thiopurine treatment. The 6-methylmercaptopurine (6-MMP)/6-TGN values after taking the same dose of thiopurine preparations for at least 28 days were included. RESULTS: There was a significant decrease in the 6-MMP/6-TGN ratio in time-dependent 5-ASA compared with group without 5-ASA preparations and the pH-dependent 5-ASA group (p = 0.008 and < 0.001 respectively). Spearman's rank correlation coefficient indicated a negative relationship between the daily oral dose of time-dependent 5-ASA and the 6-MMP/6-TGN ratio (r = -0.362, p = 0.003). Multivariate logistic regression analysis was performed in the groups with 6-MMP/6-TGN ratios of 1 or more and less than 1. The use of time-dependent 5-ASA and concomitant allopurinol negatively affected the independent 6-MMP/6-TGN ratio (p = 0.006 and 0.007 respectively). CONCLUSION: Our study revealed that time-dependent but not pH-dependent 5-ASA decreases the 6-MMP/6-TGN ratio. We also confirmed that concomitant allopurinol results in a low 6-MMP/6TGN ratio.


Asunto(s)
Antiinflamatorios no Esteroideos/farmacocinética , Inmunosupresores/farmacocinética , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Mercaptopurina/análogos & derivados , Mesalamina/farmacocinética , Administración Oral , Adolescente , Adulto , Anciano , Alopurinol/administración & dosificación , Alopurinol/farmacocinética , Antiinflamatorios no Esteroideos/administración & dosificación , Interacciones Farmacológicas , Liberación de Fármacos , Femenino , Nucleótidos de Guanina/administración & dosificación , Nucleótidos de Guanina/farmacocinética , Humanos , Concentración de Iones de Hidrógeno , Inmunosupresores/administración & dosificación , Enfermedades Inflamatorias del Intestino/sangre , Enfermedades Inflamatorias del Intestino/metabolismo , Masculino , Mercaptopurina/administración & dosificación , Mercaptopurina/farmacocinética , Mesalamina/administración & dosificación , Persona de Mediana Edad , Estudios Retrospectivos , Tionucleótidos/administración & dosificación , Tionucleótidos/farmacocinética , Factores de Tiempo , Adulto Joven
11.
Endocr J ; 66(11): 971-982, 2019 Nov 28.
Artículo en Inglés | MEDLINE | ID: mdl-31270291

RESUMEN

The short-term efficacy and safety of insulin degludec U100 (IDeg) in patients with type 2 diabetes have not been reported widely. We compared insulin IDeg and insulin glargine U100 (IGla) for glycemic control and glucose variability in hospitalized patients with type 2 diabetes. In an open-label, multicenter, randomized controlled trial, 74 patients were randomly assigned to either the IDeg (36 patients) or IGla (38 patients) group and were administered with basal-bolus therapy during hospitalization. Following the start of the treatment, on day 11, glucose variability was assessed by continuous glucose monitoring. A fasting blood glucose level of 110 mg/dL and 2-hour postprandial blood glucose level of 180 mg/dL throughout at least one day during the observation period were achieved in 31.3% (10/32) and 30.6% (11/36) of the patients in the IDeg and IGla groups, respectively. The 6-point self-monitoring of blood glucose profiles showed a significant difference between the two groups. On day 7, the intra-day variation was larger in the IDeg group than in the IGla group. The incidence of hypoglycemia or glucose variability was comparable in the two groups. This study suggests that short-term efficacy and safety of IDeg and IGla in patients with type 2 diabetes during the initial phase of basal-bolus therapy were comparable, and these results can help in deciding which treatment to opt for.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina Glargina/uso terapéutico , Insulina de Acción Prolongada/uso terapéutico , Anciano , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Ayuno/metabolismo , Femenino , Hospitalización , Humanos , Hipoglucemia/inducido químicamente , Insulina/administración & dosificación , Masculino , Comidas , Persona de Mediana Edad , Periodo Posprandial , Resultado del Tratamiento
13.
BMC Gastroenterol ; 18(1): 166, 2018 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-30400828

RESUMEN

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) often requires deep sedation. Dexmedetomidine, a highly selective α2-adrenoceptor agonist with sedative activity and minimal effects on respiration, has recently been widely used among patients in the intensive care unit. However, its use in endoscopic procedures in very elderly patients is unclear. In this study, we retrospectively investigated the safety and efficacy of dexmedetomidine sedation during ERCP. METHODS: The study included 62 very elderly patients (aged over 80 years) who underwent ERCP from January 2014, with sedation involving dexmedetomidine (i.v. infusion at 3.0 µg/kg/h over 10 min followed by continuous infusion at 0.4 µg/kg/h) along with midazolam. For comparison, the study included 78 patients who underwent ERCP before January 2014, with midazolam alone. We considered additional administration of midazolam as needed to maintain a sedation level of 3-4, according to the Ramsay sedation scale. The outcome measures were amount of midazolam, adverse events associated with sedation, and hemodynamics. RESULTS: The incidence of decreased SpO2 and median dose of additional midazolam were significantly lower in the dexmedetomidine group than in the conventional group. The minimum systolic blood pressure and minimum heart rate during and after examination was significantly lower in the dexmedetomidine group than in the conventional group. However, serious acute heart failure or arrhythmia was not noted. CONCLUSIONS: Dexmedetomidine can decrease the incidence of respiratory complications and the total dose of other sedative agents. It can be used as an alternative to conventional methods with midazolam for adequate sedation during ERCP in very elderly patients.


Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica/métodos , Dexmedetomidina/administración & dosificación , Dexmedetomidina/efectos adversos , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/efectos adversos , Midazolam/administración & dosificación , Anciano de 80 o más Años , Presión Sanguínea/efectos de los fármacos , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Infusiones Intravenosas , Masculino , Insuficiencia Respiratoria/inducido químicamente , Estudios Retrospectivos , Factores de Tiempo
14.
Anesth Analg ; 126(5): 1509-1516, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29517573

RESUMEN

BACKGROUND: Sugammadex is used to reverse the effects of neuromuscular blocking agents in many cases of general anesthesia. However, there are several reports of anaphylaxis after its use. Skin testing is the gold standard for detecting the causative agent of anaphylaxis. However, due to the lack of validated protocols for skin testing with sugammadex, the diagnostic accuracy might be inadequate. Recently, the basophil activation test (BAT) has been established as a tool to detect the causative agent of anaphylaxis with high sensitivity and specificity. However, few studies have investigated the utility of the BAT for sugammadex-induced anaphylaxis. METHODS: Eight patients who presented with immediate hypersensitivity to sugammadex during general anesthesia were included in this study. We conducted skin tests to confirm the diagnosis of sugammadex-induced anaphylaxis. Twenty-one sugammadex-naive individuals who had a negative skin test for allergy to this drug were enrolled as controls. Basophils were selected on a CD3/CRTH2 gate and labeled with CD63 and CD203c. RESULTS: The ratios of activated basophils in the patients were much higher than those in controls: the median values of areas under the curves in the patients and controls for CD203c were 1,265,985 (95% confidence interval [CI], 77,580-5,040,270) and 116,325 (95% CI, -268,605 to 232,690), respectively (Mann-Whitney U test, P < .01), and the areas under the curves in the patients and controls for CD63 were 788,647 (95% CI, 120,285-3,523,410) and 220,005 (95% CI, -50,346 to 404,680), respectively (Mann-Whitney U test, P < .01). The patients, but not controls, demonstrated clear dose-dependent CD203c upregulation. This was also true for CD63. In the case of CD203c, the sensitivity of the BAT for sugammadex was 88% (95% CI, 47%-100%), and specificity was 100% (95% CI, 84%-100%), while sensitivity and specificity for CD63 were 75% (95% CI, 35%-97%) and 100% (95% CI, 84%-100%), respectively. CONCLUSIONS: The BAT seems to have comparable accuracy to skin tests for the diagnosis of sugammadex-induced anaphylaxis. For this purpose, both CD203c and CD63 can be used to detect activated basophils.


Asunto(s)
Anafilaxia/sangre , Anafilaxia/diagnóstico , Basófilos/efectos de los fármacos , Basófilos/metabolismo , Sugammadex/efectos adversos , Adolescente , Adulto , Anciano , Anafilaxia/inducido químicamente , Hipersensibilidad a las Drogas/sangre , Hipersensibilidad a las Drogas/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bloqueantes Neuromusculares/efectos adversos , Estudios Prospectivos , Pruebas Cutáneas/métodos
16.
Genes Chromosomes Cancer ; 55(12): 975-986, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27461516

RESUMEN

Primary tumor (PT) heterogeneity can significantly affect the genetic profile of clones at metastatic sites. To understand the mechanisms underlying metastasis, we compared the genetic profile of paired PT and metastatic lymph node (MLN) samples obtained from patients with oral tongue squamous cell carcinoma (OTSCC). Large-scale genetic profiling was performed on paired PT-MLN samples obtained from 10 OTSCC patients using high-density single-nucleotide polymorphism microarrays. We compared the genetic profile of PT and MLN OTSCC samples to identify common and specific copy number alterations and copy-neutral loss-of-heterozygosity (CN-LOH). Unsupervised hierarchical clustering analysis indicated that 8 of the 10 PT-MLN sample pairs formed clusters, indicating that the primary and metastatic tumors were composed of predominantly genetically similar tumor cells. In 6 of the 10 pairs, 8q11.21, 8q12.2-3, and 8q21.3 gains, and 22q11.23 loss were detected in both the PT and MLN. In addition, 16p11.2 CN-LOH was identified in 9 of the 10 pairs. Conversely, 20q11.2 gain was only observed in the MLNs of 5 of the 10 sample pairs, indicating that genes in this chromosomal region may play a significant role in OTSCC lymph node metastasis. To confirm this, we investigated the expression of two candidate 20q11.2 genes in a separate patient cohort. The expression of one of these genes, E2F1, was significantly increased during the process of metastasis. This study indicates that additional genetic changes, such as 20q11.2 gain, which encodes the E2F1 gene, can be acquired through clonal evolution, and may be required for the metastatic process. © 2016 Wiley Periodicals, Inc.


Asunto(s)
Desequilibrio Alélico/genética , Biomarcadores de Tumor/genética , Carcinoma de Células Escamosas/genética , Aberraciones Cromosómicas , Variaciones en el Número de Copia de ADN/genética , Neoplasias de la Boca/genética , Neoplasias de la Lengua/genética , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/secundario , Estudios de Casos y Controles , ADN de Neoplasias/genética , Femenino , Estudios de Seguimiento , Humanos , Pérdida de Heterocigocidad , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/patología , Pronóstico , Neoplasias de la Lengua/patología
17.
Masui ; 66(4): 424-430, 2017 Apr.
Artículo en Japonés | MEDLINE | ID: mdl-30382647

RESUMEN

We experienced rocuronium-induced anaphylaxis in a 62-year-old man who was scheduled for laparoscopic ileocecal excision for cecal cancer under general anes- thesia. The patient did not have a preoperative history and examinations suggestive of heart disease, or pre- disposing factors for myocardial infarction. Just after induction of anesthesia, we noticed abnormally low blood pressure and ST segment elevation on his elec- trocardiogram. The surgery was postponed and percu- taneous coronary intervention was performed to treat coronary artery stenosis. Re-operation was planned 73-days after the first operation. The patient suffered cardiac arrest just after induction of general anesthesia At the same time, we noticed systemic erythema all over his body, which led to the diagnosis of anaphy- laxis. Cardiopulmonary resuscitation was performed and the surgery was postponed once again. Cardiovas- cular agents, including adrenaline, noradrenaline, atro- pine and amiodarone, improved his hemodynamics. In addition, steroids and anti-histamines were also admin- istered to treat anaphylaxis. We advised him to undergo skin tests to determine the causative agent of anaphylaxis, but he declined. Instead, a basophil activa- tion test was performed, which showed a positive reac- tion to rocuronium. Therefore, we planned general anesthesia without using muscle relaxants such as rocuronium for the third attempt at surgery. The sur- gery was performed safely with this protocol. It is likely that his symptoms in the first general anesthesia were caused by Kounis syndrome. We conclude that the basophil activation test seems to be valuable in determining the causative agent of anaphylaxis, partic- ularly when a patient does not agree to undergo skin tests.


Asunto(s)
Anafilaxia/inducido químicamente , Basófilos/efectos de los fármacos , Síndrome de Kounis , Rocuronio/efectos adversos , Anestesia General , Neoplasias del Apéndice/cirugía , Humanos , Masculino , Persona de Mediana Edad
18.
Scand J Gastroenterol ; 51(8): 934-41, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26888161

RESUMEN

Objective In patients with ulcerative colitis (UC), the relationship between the initial endoscopic findings and the response to anti-tumor necrosis factor (TNF)-α antibodies remains unclear. We herein evaluated the potential of endoscopic assessment using the ulcerative colitis endoscopic index of severity (UCEIS) to predict the response to anti-TNF-α antibodies. Methods We enrolled 64 patients with UC undergoing anti-TNF-α maintenance therapy with infliximab (IFX) or adalimumab (ADA) between April 2010 and March 2015. Anti-TNF-α trough levels were determined by ELISA. Endoscopic disease activity was assessed using the UCEIS. Results The clinical response rate at 8 weeks was 77.4% for IFX and 66.7% for ADA. Serum albumin levels were significantly higher and the UCEIS bleeding descriptor before treatment was significantly lower in the responders than in the non-responders (p < 0.05 each). The CRP levels at 2 weeks were significantly lower in the responders (p < 0.001). The serum albumin levels before treatment were significantly higher and the UCEIS erosions and ulcers descriptor was significantly lower in the mucosal healing group than in the non-mucosal healing group (p < 0.05 each). A significant and negative correlation between the trough levels of anti-TNF-α antibodies and the UCEIS descriptors was observed. The trough levels of anti-TNF-α antibodies to achieve mucosal healing were 2.7 µg/mL for IFX and 10.3 µg/mL for ADA. Conclusions The UCEIS score, as well as some clinical markers (serum albumin and CRP levels), is useful for the prediction of the treatment outcome of UC patients in response to anti-TNF-α antibodies.


Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Colitis Ulcerosa/patología , Colitis Ulcerosa/terapia , Factor de Necrosis Tumoral alfa/inmunología , Adalimumab/uso terapéutico , Anticuerpos Monoclonales/análisis , Endoscopía , Predicción , Humanos , Infliximab/uso terapéutico
19.
Digestion ; 93(1): 59-65, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26789999

RESUMEN

BACKGROUND: The global alteration of the gut microbial community (dysbiosis) plays an important role in the pathogenesis of inflammatory bowel diseases (IBDs). However, bacterial species that characterize dysbiosis in IBD remain unclear. In this study, we assessed the alteration of the fecal microbiota profile in patients with Crohn's disease (CD) using 16S rRNA sequencing. SUMMARY: Fecal samples from 10 inactive CD patients and 10 healthy individuals were subjected to 16S rRNA sequencing. The V3-V4 hypervariable regions of 16S rRNA were sequenced by the Illumina MiSeq™II system. The average of 62,201 reads per CD sample was significantly lower than the average of 73,716 reads per control sample. The genera Bacteroides, Eubacterium, Faecalibacterium and Ruminococcus significantly decreased in CD patients as compared to healthy controls. In contrast, the genera Actinomyces and Bifidobacterium significantly increased in CD patients. At the species level, butyrate-producing bacterial species, such as Blautia faecis, Roseburia inulinivorans, Ruminococcus torques, Clostridium lavalense, Bacteroides uniformis and Faecalibacterium prausnitzii were significantly reduced in CD patients as compared to healthy individuals (p < 0.05). These results of 16S rRNA sequencing were confirmed in additional CD patients (n = 68) and in healthy controls (n = 46) using quantitative PCR. The abundance of Roseburia inulinivorans and Ruminococcus torques was significantly lower in C-reactive protein (CRP)-positive CD patients as compared to CRP-negative CD patients (p < 0.05). KEY MESSAGE: The dysbiosis of CD patients is characterized by reduced abundance of multiple butyrate-producing bacteria species.


Asunto(s)
Enfermedad de Crohn/microbiología , Disbiosis/microbiología , Microbioma Gastrointestinal/genética , Actinomyces/genética , Actinomyces/metabolismo , Adulto , Bacteroides/genética , Bacteroides/metabolismo , Bifidobacterium/genética , Bifidobacterium/metabolismo , Butiratos/metabolismo , Estudios de Casos y Controles , Clostridium/genética , Clostridium/metabolismo , Enfermedad de Crohn/metabolismo , ADN Bacteriano/genética , ADN Ribosómico/genética , Disbiosis/metabolismo , Eubacterium/genética , Eubacterium/metabolismo , Heces/microbiología , Femenino , Microbioma Gastrointestinal/fisiología , Humanos , Masculino , ARN Ribosómico 16S/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Ruminococcus/genética , Ruminococcus/metabolismo , Análisis de Secuencia de ADN , Análisis de Secuencia de ARN
20.
J Clin Biochem Nutr ; 59(1): 65-70, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27499582

RESUMEN

Altered gut microbial ecology contributes to the development of metabolic diseases including obesity. In this study, we performed 16S rRNA sequence analysis of the gut microbiota profiles of obese and lean Japanese populations. The V3-V4 hypervariable regions of 16S rRNA of fecal samples from 10 obese and 10 lean volunteers were sequenced using the Illumina MiSeq(TM)II system. The average body mass index of the obese and lean group were 38.1 and 16.6 kg/m(2), respectively (p<0.01). The Shannon diversity index was significantly higher in the lean group than in the obese group (p<0.01). The phyla Firmicutes and Fusobacteria were significantly more abundant in obese people than in lean people. The abundance of the phylum Bacteroidetes and the Bacteroidetes/Firmicutes ratio were not different between the obese and lean groups. The genera Alistipes, Anaerococcus, Corpococcus, Fusobacterium and Parvimonas increased significantly in obese people, and the genera Bacteroides, Desulfovibrio, Faecalibacterium, Lachnoanaerobaculum and Olsenella increased significantly in lean people. Bacteria species possessing anti-inflammatory properties, such as Faecalibacterium prausnitzii, increased significantly in lean people, but bacteria species possessing pro-inflammatory properties increased in obese people. Obesity-associated gut microbiota in the Japanese population was different from that in Western people.

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