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1.
N Engl J Med ; 390(8): 701-711, 2024 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-38329148

RESUMO

BACKGROUND: Thrombolytic agents, including tenecteplase, are generally used within 4.5 hours after the onset of stroke symptoms. Information on whether tenecteplase confers benefit beyond 4.5 hours is limited. METHODS: We conducted a multicenter, double-blind, randomized, placebo-controlled trial involving patients with ischemic stroke to compare tenecteplase (0.25 mg per kilogram of body weight, up to 25 mg) with placebo administered 4.5 to 24 hours after the time that the patient was last known to be well. Patients had to have evidence of occlusion of the middle cerebral artery or internal carotid artery and salvageable tissue as determined on perfusion imaging. The primary outcome was the ordinal score on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability and a score of 6 indicating death) at day 90. Safety outcomes included death and symptomatic intracranial hemorrhage. RESULTS: The trial enrolled 458 patients, 77.3% of whom subsequently underwent thrombectomy; 228 patients were assigned to receive tenecteplase, and 230 to receive placebo. The median time between the time the patient was last known to be well and randomization was approximately 12 hours in the tenecteplase group and approximately 13 hours in the placebo group. The median score on the modified Rankin scale at 90 days was 3 in each group. The adjusted common odds ratio for the distribution of scores on the modified Rankin scale at 90 days for tenecteplase as compared with placebo was 1.13 (95% confidence interval, 0.82 to 1.57; P = 0.45). In the safety population, mortality at 90 days was 19.7% in the tenecteplase group and 18.2% in the placebo group, and the incidence of symptomatic intracranial hemorrhage was 3.2% and 2.3%, respectively. CONCLUSIONS: Tenecteplase therapy that was initiated 4.5 to 24 hours after stroke onset in patients with occlusions of the middle cerebral artery or internal carotid artery, most of whom had undergone endovascular thrombectomy, did not result in better clinical outcomes than those with placebo. The incidence of symptomatic intracerebral hemorrhage was similar in the two groups. (Funded by Genentech; TIMELESS ClinicalTrials.gov number, NCT03785678.).


Assuntos
Isquemia Encefálica , AVC Isquêmico , Imagem de Perfusão , Tenecteplase , Trombectomia , Ativador de Plasminogênio Tecidual , Humanos , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/mortalidade , Isquemia Encefálica/cirurgia , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Fibrinolíticos/uso terapêutico , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/diagnóstico por imagem , Perfusão , Imagem de Perfusão/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/cirurgia , Tenecteplase/administração & dosagem , Tenecteplase/efeitos adversos , Tenecteplase/uso terapêutico , Trombectomia/efeitos adversos , Trombectomia/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem , Ativador de Plasminogênio Tecidual/efeitos adversos , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento , Método Duplo-Cego , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/tratamento farmacológico , AVC Isquêmico/mortalidade , AVC Isquêmico/cirurgia , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/tratamento farmacológico , Infarto da Artéria Cerebral Média/cirurgia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/tratamento farmacológico , Doenças das Artérias Carótidas/cirurgia , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Tempo para o Tratamento
2.
Epilepsia ; 65(6): e87-e96, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38625055

RESUMO

Febrile infection-related epilepsy syndrome (FIRES) is a subset of new onset refractory status epilepticus (NORSE) that involves a febrile infection prior to the onset of the refractory status epilepticus. It is unclear whether FIRES and non-FIRES NORSE are distinct conditions. Here, we compare 34 patients with FIRES to 30 patients with non-FIRES NORSE for demographics, clinical features, neuroimaging, and outcomes. Because patients with FIRES were younger than patients with non-FIRES NORSE (median = 28 vs. 48 years old, p = .048) and more likely cryptogenic (odds ratio = 6.89), we next ran a regression analysis using age or etiology as a covariate. Respiratory and gastrointestinal prodromes occurred more frequently in FIRES patients, but no difference was found for non-infection-related prodromes. Status epilepticus subtype, cerebrospinal fluid (CSF) and magnetic resonance imaging findings, and outcomes were similar. However, FIRES cases were more frequently cryptogenic; had higher CSF interleukin 6, CSF macrophage inflammatory protein-1 alpha (MIP-1a), and serum chemokine ligand 2 (CCL2) levels; and received more antiseizure medications and immunotherapy. After controlling for age or etiology, no differences were observed in presenting symptoms and signs or inflammatory biomarkers, suggesting that FIRES and non-FIRES NORSE are very similar conditions.


Assuntos
Febre , Estado Epiléptico , Humanos , Estado Epiléptico/etiologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Febre/etiologia , Febre/complicações , Adulto Jovem , Adolescente , Epilepsia Resistente a Medicamentos/etiologia , Criança , Convulsões Febris/etiologia , Eletroencefalografia , Idoso , Imageamento por Ressonância Magnética , Síndromes Epilépticas , Pré-Escolar
3.
Epilepsia ; 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38837761

RESUMO

In response to the evolving treatment landscape for new-onset refractory status epilepticus (NORSE) and the publication of consensus recommendations in 2022, we conducted a comparative analysis of NORSE management over time. Seventy-seven patients were enrolled by 32 centers, from July 2016 to August 2023, in the NORSE/FIRES biorepository at Yale. Immunotherapy was administered to 88% of patients after a median of 3 days, with 52% receiving second-line immunotherapy after a median of 12 days (anakinra 29%, rituximab 25%, and tocilizumab 19%). There was an increase in the use of second-line immunotherapies (odds ratio [OR] = 1.4, 95% CI = 1.1-1.8) and ketogenic diet (OR = 1.8, 95% CI = 1.3-2.6) over time. Specifically, patients from 2022 to 2023 more frequently received second-line immunotherapy (69% vs 40%; OR = 3.3; 95% CI = 1.3-8.9)-particularly anakinra (50% vs 13%; OR = 6.5; 95% CI = 2.3-21.0), and the ketogenic diet (OR = 6.8; 95% CI = 2.5-20.1)-than those before 2022. Among the 27 patients who received anakinra and/or tocilizumab, earlier administration after status epilepticus onset correlated with a shorter duration of status epilepticus (ρ = .519, p = .005). Our findings indicate an evolution in NORSE management, emphasizing the increasing use of second-line immunotherapies and the ketogenic diet. Future research will clarify the impact of these treatments and their timing on patient outcomes.

4.
Dig Dis ; : 1-10, 2024 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-38648736

RESUMO

INTRODUCTION: Endoscopic submucosal dissection (ESD) has been popular worldwide to treat laterally spreading tumors and large polyps. Post-ESD coagulation syndrome (PECS) is more common than the two major ESD-related complications, perforation, and bleeding. The aim of this study was to assess the prevalence of PECS, identify the risk factors for PECS, and create a risk prediction model for PECS. METHODS: Retrospective cross-sectional study analyzed a total of 986 patients who underwent colorectal ESD. Logistic regression models were used to assess risk factors with PECS. Each risk factor was scored, and the 3-step risk stratification index of prediction model was assessed. RESULTS: The prevalence of PECS was 21.4% (95% confidence interval [CI] = 18.9-24.1%). The risk factors of PECS in the multivariate logistic regression were tumor size (+1 cm: odds ratio [OR], 1.29; 95% CI, 1.16-7.09), cecal lesion (OR, 1.96; 95% CI, 1.09-1.53), procedure time (+30 min: OR, 1.19; 95% CI, 1.02-1.39), and ESD with snaring (OR, 0.64; 95% CI, 0.43-0.95). Applying a simplified weighted scoring system based on adjusted OR increments of 1, the risk of PECS was 12.3% (95% CI, 0.3-16.0%) for the low-risk group (score ≤4) and was 36.0% (95% CI = 29.4-43.2%) for the high-risk group (score ≥8). Overall discrimination (C-statistic = 0.629; 95% CI = 0.585-0.672) and calibration (p = 0.993) of the model were moderate to good. CONCLUSION: PECS occurs frequently, and the prediction model can be helpful for effective treatment and prevention of PECS.

5.
BMC Biol ; 21(1): 30, 2023 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-36782243

RESUMO

BACKGROUND: Aging is known to exert an effect on liver regeneration, with the ability of liver to regenerate displaying a significant decline over time. Liver physiological parameters such as liver volume, blood flow, and metabolism, as well as the ability to regenerate after injury have all been shown to decrease at old age in humans and model systems, with a number of molecular mechanisms proposed to be involved, including DNA methylation-dependent genome remodeling. To address how changes in DNA methylation mediate the adverse aging effect on liver regeneration, we searched for differentially methylated genomic regions (DMRs) in mouse livers co-regulated by aging and regeneration and determined their associated genes and enriched pathways. RESULTS: DMRs were identified using whole-genome bisulfite sequencing (WGBS). Pathway analysis of aging DMR-mapped genes revealed two distinct phases of aging, 2-to-8 and 8-to-16 months old (m/o). Regenerative DMR-mapped differentially expressed genes (DEGs) were enriched in pathways controlling cell proliferation and differentiation. Most DMRs shared by both aging and regeneration changed in the same methylation direction between 2 and 8 m/o but in the opposite direction between 8 and 16 m/o. Regenerative DMRs inversely affected by aging during 8-to-16 m/o were found in the promoter/gene regions of 12 genes. Four regenerative DEGs were synchronously regulated by early aging and inversely regulated by mid-to-late aging DMRs. Lead DMR-mapped genes were validated by their expression profiles in liver aging and regeneration. CONCLUSIONS: Our study has uncovered new DMRs and gene targets inversely affected by liver aging and regeneration to explain the adverse aging effect on liver regeneration. These findings will be of fundamental importance to understand the epigenomic changes underlying the biology of aging on liver regeneration.


Assuntos
Epigênese Genética , Epigenoma , Humanos , Animais , Camundongos , Lactente , Regeneração Hepática/genética , Metilação de DNA , Envelhecimento/genética
6.
Sensors (Basel) ; 24(2)2024 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-38257409

RESUMO

Apples are widely cultivated in the Republic of Korea and are preferred by consumers for their sweetness. Soluble solid content (SSC) is measured non-destructively using near-infrared (NIR) spectroscopy; however, the SSC measurement error increases with the change in apple size since the distance between the light source and the near-infrared sensor is fixed. In this study, spectral characteristics caused by the differences in apple size were investigated. An optimal SSC prediction model applying partial least squares regression (PLSR) to three measurement conditions based on apple size was developed. The three optimal measurement conditions under which the Vis/NIR spectrum is less affected by six apple size levels (Levels I-VI) were selected. The distance from the apple center to the light source and that to the sensor were 125 and 75 mm (Distance 1), 123 and 75 mm (Distance 2), and 135 and 80 mm (Distance 3). The PLSR model applying multiplicative scatter correction pretreatment under Distance 3 measurement conditions showed the best performance for Level IV-sized apples (Rpre2 = 0.91, RMSEP = 0.508 °Brix). This study shows the possibility of improving the SSC prediction performance of apples by adjusting the distance between the light source and the NIR sensor according to fruit size.

7.
Sensors (Basel) ; 24(5)2024 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-38475048

RESUMO

Citrus fruits were sorted based on external qualities, such as size, weight, and color, and internal qualities, such as soluble solid content (SSC), acidity, and firmness. Visible and near-infrared (VNIR) hyperspectral imaging techniques were used as rapid and nondestructive techniques for determining the internal quality of fruits. The applicability of the VNIR hyperspectral imaging technique for predicting the SSC in citrus fruits was evaluated in this study. A VNIR hyperspectral imaging system with a wavelength range of 400-1000 nm and 100 W light source was used to acquire hyperspectral images from citrus fruits in two orientations (i.e., stem and calyx ends). The SSC prediction model was developed using partial least-squares regression (PLSR). Spectrum preprocessing, effective wavelength selection through competitive adaptive reweighted sampling (CARS), and outlier detection were used to improve the model performance. The performance of each model was evaluated using the coefficient of determination (R2) and root mean square error (RMSE). In the present study, the PLSR model was developed using only a citrus cultivar. The SSC prediction CARS-PLSR model with outliers removed exhibited R2 and RMSE values of approximatively 0.75 and 0.56 °Brix, respectively. The results of this study are expected to be useful in similar fields such as agricultural and food post-harvest management, as well as in the development of an online system for determining the SSC of citrus fruits.


Assuntos
Citrus , Espectroscopia de Luz Próxima ao Infravermelho , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Imageamento Hiperespectral , Frutas , Algoritmos , Análise dos Mínimos Quadrados
8.
J Clin Monit Comput ; 2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38896344

RESUMO

Hand hygiene among anesthesia personnel is important to prevent hospital-acquired infections in operating rooms; however, an efficient monitoring system remains elusive. In this study, we leverage a deep learning approach based on operating room videos to detect alcohol-based hand hygiene actions of anesthesia providers. Videos were collected over a period of four months from November, 2018 to February, 2019, at a single operating room. Additional data was simulated and added to it. The proposed algorithm utilized a two-dimensional (2D) and three-dimensional (3D) convolutional neural networks (CNNs), sequentially. First, multi-person of the anesthesia personnel appearing in the target OR video were detected per image frame using the pre-trained 2D CNNs. Following this, each image frame detection of multi-person was linked and transmitted to a 3D CNNs to classify hand hygiene action. Optical flow was calculated and utilized as an additional input modality. Accuracy, sensitivity and specificity were evaluated hand hygiene detection. Evaluations of the binary classification of hand-hygiene actions revealed an accuracy of 0.88, a sensitivity of 0.78, a specificity of 0.93, and an area under the operating curve (AUC) of 0.91. A 3D CNN-based algorithm was developed for the detection of hand hygiene action. The deep learning approach has the potential to be applied in practical clinical scenarios providing continuous surveillance in a cost-effective way.

9.
Curr Issues Mol Biol ; 45(8): 6415-6431, 2023 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-37623224

RESUMO

Type 2 diabetes (T2D) is a serious health issue with increasing incidences worldwide. However, current medications have limitations due to side effects such as decreased appetite, stomach pain, diarrhea, and extreme tiredness. Here, we report the effect of fermented ice plant (FMC) in the T2M mouse model of db/db mice. FMC showed a greater inhibition of lipid accumulation compared to unfermented ice plant extract. Two-week oral administration with FMC inhibited body weight gain, lowered fasting blood glucose, and improved glucose tolerance. Serum parameters related to T2D including insulin, glycosylated hemoglobin, adiponectin, and cholesterols were improved as well. Histological analysis confirmed the protective effect of FMC on pancreas and liver destruction. FMC treatment significantly increased the expression and phosphorylation of IRS-1, PI3K, and AKT. Additionally, AMP-activated protein kinase phosphorylation and nuclear factor erythroid 2-related factor 2 were also increased in the liver tissues of db/db mice treated with FMC. Overall, our results indicate the anti-diabetic effect of FMC; therefore, we suggest that FMC may be useful as a therapeutic agent for T2D.

10.
Am J Gastroenterol ; 118(12): 2166-2172, 2023 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-37610029

RESUMO

INTRODUCTION: Gastric adenoma is a precursor lesion of gastric cancer. We investigated whether the removal of gastric adenoma prevented gastric cancer incidence and its mortality. METHODS: Using the linkage of nationwide databases, we assessed gastric cancer incidence and mortality among patients who had gastric adenomas removed between 2011 and 2013 in Korea. These outcomes were compared primarily with those of the Korean general population by estimating the standardized incidence and mortality ratio and secondarily with internal control subjects who did not have gastric neoplasm after esophagogastroduodenoscopy and were matched for age, sex, and calendar year by calculating hazard ratios (HR) with the Cox proportional hazards model. RESULTS: We identified 44,405 adenoma removal patients. During a median follow-up of 8.4 years, 1,038 (2.34%) of them were given a diagnosis of gastric cancer and a total of 524 gastric cancers were expected for a standard incidence ratio of 1.98 (95% confidence interval [CI], 1.84-2.13). A total of 199 deaths from gastric cancer were expected and 99 were observed for a standard mortality ratio of 0.50 (95% CI, 0.40-0.60). Compared with the nonadenoma cohort (n = 39,826), the adenoma removal patients had a higher risk of gastric cancer (HR, 2.84; 95% CI, 2.51-3.21) and associated mortality (HR, 1.66; 95% CI, 1.19-2.31). DISCUSSION: Removal of gastric adenoma resulted in lower-than-expected mortality but higher-than-expected incidence due to gastric cancer than that in the general population. Our analyses indicated the importance of follow-up strategy after removal of gastric adenoma.


Assuntos
Adenoma , Neoplasias Colorretais , Neoplasias Gástricas , Humanos , Estudos de Coortes , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Incidência , Neoplasias Colorretais/patologia , Adenoma/epidemiologia , Adenoma/cirurgia , Fatores de Risco , Estudos Retrospectivos
11.
Sensors (Basel) ; 23(4)2023 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-36850558

RESUMO

A Tungsten-Halogen (TH) lamp is the most popular light source in NIR spectroscopy and hyperspectral imaging, which requires a warm-up to reach very high temperatures of up to 250 °C and take a long time for radiation stabilization. Consequently, it has a large enough volume to enable heat dissipation to prevent the thermal runaway of the electric circuit and turn out its power efficiency very low. These are major barriers for miniaturizing spectral systems and hyperspectral imaging devices. However, TH lamps can be replaced by pc-NIR LEDs in order to avoid high temperature and large volume. We compared the spectral emission of the available commercial pc-NIR LEDs under the same condition. As a replacement for the TH lamp, the VIS + NIR LED module was developed to combine a warm-white LED and pc-NIR LEDs. In order to feature out the availability of the VIS + NIR LED module against the TH lamp, they were used as the light source for evaluating the Soluble Solid Content (SSC) of an apple through VIS-NIR spectroscopy. The results show a remarkable feasibility in the performance of the partial least square (PLS) model using the VIS + NIR LED module; during PLS calibration, the correlation coefficient (R) values are 0.664 and 0.701, and the Mean Square Error (MSE) values are 0.681 and 0.602 for the TH lamp and VIS + NIR LED module, respectively. In VIS-NIR spectroscopy, this study indicates that the TH lamp could be replaceable with a warm-white LED and pc-NIR LEDs.

12.
Sensors (Basel) ; 23(4)2023 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-36850574

RESUMO

Due to climate change, soil moisture may increase, and outflows could become more frequent, which will have a considerable impact on crop growth. Crops are affected by soil moisture; thus, soil moisture prediction is necessary for irrigating at an appropriate time according to weather changes. Therefore, the aim of this study is to develop a future soil moisture (SM) prediction model to determine whether to conduct irrigation according to changes in soil moisture due to weather conditions. Sensors were used to measure soil moisture and soil temperature at a depth of 10 cm, 20 cm, and 30 cm from the topsoil. The combination of optimal variables was investigated using soil moisture and soil temperature at depths between 10 cm and 30 cm and weather data as input variables. The recurrent neural network long short-term memory (RNN-LSTM) models for predicting SM was developed using time series data. The loss and the coefficient of determination (R2) values were used as indicators for evaluating the model performance and two verification datasets were used to test various conditions. The best model performance for 10 cm depth was an R2 of 0.999, a loss of 0.022, and a validation loss of 0.105, and the best results for 20 cm and 30 cm depths were an R2 of 0.999, a loss of 0.016, and a validation loss of 0.098 and an R2 of 0.956, a loss of 0.057, and a validation loss of 2.883, respectively. The RNN-LSTM model was used to confirm the SM predictability in soybean arable land and could be applied to supply the appropriate moisture needed for crop growth. The results of this study show that a soil moisture prediction model based on time-series weather data can help determine the appropriate amount of irrigation required for crop cultivation.


Assuntos
Glycine max , Memória de Curto Prazo , Mudança Climática , Redes Neurais de Computação , Solo
13.
J Pharmacol Exp Ther ; 380(1): 34-46, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34663676

RESUMO

Novel combinations of specific opioid agonists like loperamide and oxymorphindole targeting the µ- and δ-opioid receptors, respectively, have shown increased potency with minimized opioid-associated risks. However, whether their interaction is pharmacokinetic or pharmacodynamic in nature has not been determined. This study quantitatively determined whether these drugs have a pharmacokinetic interaction that alters systemic disposition or central nervous system (CNS) distribution. We performed intravenous and oral in vivo pharmacokinetic assessments of both drugs after discrete dosing and administration in combination to determine whether the combination had any effect on systemic pharmacokinetic parameters or CNS exposure. Drugs were administered at 5 or 10 mg/kg i.v. or 30 mg/kg orally to institute for cancer research (ICR) mice and 5 mg/kg i.v. to Friend leukemia virus strain B mice of the following genotypes: wild-type, breast cancer resistance protein (Bcrp-/- ) (Bcrp knockout), Mdr1a/b-/- [P-glycoprotein (P-gp) knockout], and Bcrp-/- Mdr1a/b-/- (triple knockout). In the combination, clearance of oxymorphindole (OMI) was reduced by approximately half, and the plasma area under the concentration-time curve (AUC) increased. Consequently, brain and spinal cord AUCs for OMI in the combination also increased proportionately. Both loperamide and OMI are P-gp substrates, but administration of the two drugs in combination does not alter efflux transport at the CNS barriers. Because OMI alone shows appreciable brain penetration but little therapeutic efficacy on its own, and because loperamide's CNS distribution is unchanged in the combination, the mechanism of action for the increased potency of the combination is most likely pharmacodynamic and most likely occurs at receptors in the peripheral nervous system. This combination has favorable characteristics for future development. SIGNIFICANCE STATEMENT: Opioids have yet to be replaced as the most effective treatments for moderate-to-severe pain and chronic pain, but their side effects are dangerous. Combinations of opioids with peripheral activity, such as loperamide and oxymorphindole, would be valuable in that they are effective at much lower doses and have reduced risks for dangerous side effects because the µ-opioid receptor agonist is largely excluded from the CNS.


Assuntos
Sistema Nervoso Central/metabolismo , Loperamida/farmacocinética , Morfolinas/farmacocinética , Receptores Opioides/agonistas , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/genética , Membro 2 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Animais , Combinação de Medicamentos , Sinergismo Farmacológico , Feminino , Genótipo , Loperamida/administração & dosagem , Masculino , Camundongos , Camundongos Endogâmicos ICR , Morfolinas/administração & dosagem , Distribuição Tecidual
14.
Liver Transpl ; 28(2): 304-313, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34608746

RESUMO

Liver transplantation (LT), the only cure for end-stage liver disease, is a lifesaving, costly, and limited resource. LT recipients (LTRs) are aging with an increasing burden of medical comorbidities. Patient and graft survival rates exceed 70% at 5 years; however, patient-centered health outcomes beyond survival have received relatively little attention. LTRs must have strong self-management skills to navigate health systems, adhere to clinical monitoring, and take complex, multidrug regimens. All of these tasks require formidable cognitive abilities for active learning and problem solving. Yet, LTRs are at higher risk for impaired cognition as a result of the high prevalence of pretransplant hepatic encephalopathy, multiple chronic conditions, alcohol use, physical frailty, sarcopenia, and older age. Cognitive impairment after transplant may persist and has been causally linked to poor self-management skills, worse physical function, and inferior health outcomes in other health care settings, yet its impact after LT is largely unknown. There is a need to study potentially modifiable, posttransplant targets including caregiver support, physical activity, sleep, and treatment adherence to inform future health system responses to promote the long-term health and well-being of LTRs. Prospective, longitudinal data collection that encompasses key sociodemographic, cognitive-behavioral, psychosocial, and medical factors is needed to improve risk prediction and better inform patient and caregiver expectations. Interventions with proactive monitoring, reducing medical complexity, and improved care coordination can be tailored to optimize posttransplant care. We propose a research agenda focused on understudied, potentially modifiable risk factors to improve the long-term health of LTRs. Our conceptual model accounts for cognitive function, caregiver and patient self-management skills, health behaviors, and patient-centered outcomes beyond mortality. We propose actionable health-system, patient, and caregiver-directed interventions to fill knowledge gaps and improve outcomes.


Assuntos
Encefalopatia Hepática , Transplante de Fígado , Humanos , Transplante de Fígado/efeitos adversos , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida
15.
Drug Metab Dispos ; 50(3): 277-286, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34887255

RESUMO

Bioluminescent imaging (BLI) is a powerful tool in biomedical research to measure gene expression and tumor growth. The current study examined factors that influence the BLI signal, specifically focusing on the tissue distribution of two luciferase substrates, D-luciferin and CycLuc1. D-luciferin, a natural substrate of firefly luciferase, has been reported to have limited brain distribution, possibly due to the efflux transporter, breast cancer resistance protein (Bcrp), at the blood-brain barrier. CycLuc1, a synthetic analog of D-luciferin, has a greater BLI signal at lower doses than D-luciferin, especially in the brain. Our results indicate that limited brain distribution of D-luciferin and CycLuc1 is predominantly dictated by their low intrinsic permeability across the cell membrane, where the efflux transporter, Bcrp, plays a relatively minor role. Both genetic ablation and pharmacological inhibition of Bcrp decreased the systemic clearance of both luciferase substrates, significantly increasing exposure in the blood and, hence, in organs and tissues. These data also indicate that the biodistribution of luciferase substrates can be differentially influenced in luciferase-bearing tissues, leading to a "tissue-dependent" BLI signal. The results of this study point to the need to consider multiple mechanisms that influence the distribution of luciferase substrates. SIGNIFICANCE STATEMENT: Bioluminescence is used to monitor many biological processes, including tumor growth. This study examined the pharmacokinetics, brain distribution, and the role of active efflux transporters on the luciferase substrates D-luciferin and CycLuc1. CycLuc1 has a more sustained systemic circulation time (longer half-life) that can provide an advantage for the superior imaging outcome of CycLuc1 over D-luciferin. The disparity in imaging intensities between brain and peripheral sites is due to low intrinsic permeability of these luciferase substrates across the blood-brain barrier.


Assuntos
Neoplasias Encefálicas , Medições Luminescentes , Membro 2 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Membro 2 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/metabolismo , Neoplasias Encefálicas/diagnóstico por imagem , Humanos , Luciferases/metabolismo , Luciferases de Vaga-Lume/genética , Luciferases de Vaga-Lume/metabolismo , Medições Luminescentes/métodos , Proteínas de Neoplasias/metabolismo , Distribuição Tecidual
16.
Sensors (Basel) ; 22(14)2022 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-35890809

RESUMO

In the current scenario of anthropogenic climate change, carbon credit security is becoming increasingly important worldwide. Topsoil is the terrestrial ecosystem component with the largest carbon sequestration capacity. Since soil organic matter (SOM), which is mostly composed of organic carbon, and can be affected by rainfall, cultivation, and pollutant inflow, predicting SOM content through regular monitoring is necessary to secure a stable carbon sink. In addition, topsoil in the Republic of Korea is vulnerable to erosion due to climate, topography, and natural and anthropogenic causes, which is also a serious issue worldwide. To mitigate topsoil erosion, establish an efficient topsoil management system, and maximize topsoil utilization, it is necessary to construct a database or gather data for the construction of a database of topsoil environmental factors and topsoil composition. Spectroscopic techniques have been used in recent studies to rapidly measure topsoil composition. In this study, we investigated the spectral characteristics of the topsoil from four major rivers in the Republic of Korea and developed a machine learning-based SOM content prediction model using spectroscopic techniques. A total of 138 topsoil samples were collected from the waterfront area and drinking water protection zone of each river. The reflection spectrum was measured under the condition of an exposure time of 136 ms using a spectroradiometer (Fieldspec4, ASD Inc., Alpharetta, GA, USA). The reflection spectrum was measured three times in wavelengths ranging from 350 to 2500 nm. To predict the SOM content, partial least squares regression and support vector regression were used. The performance of each model was evaluated through the coefficient of determination (R2) and root mean square error. The result of the SOM content prediction model for the total topsoil was R2 = 0.706. Our findings identified the important wavelength of SOM in topsoil using spectroscopic technology and confirmed the predictability of the SOM content. These results could be used for the construction of a national topsoil database.


Assuntos
Ecossistema , Solo , Carbono , Mudança Climática , Solo/química , Aprendizado de Máquina Supervisionado
17.
Molecules ; 27(23)2022 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-36500343

RESUMO

Sargassum horneri (SH) is a seaweed that has several features that benefit health. In this study, we investigated the immune-enhancing effect of SH, focusing on the role of spleen-mediated immune functions. Chromatographic analysis of SH identified six types of monosaccharide contents, including mannose, rhamnose glucose, galactose xylose and fucose. SH increased cell proliferation of primary cultured naïve splenocytes treated with or without cyclophosphamide (CPA), an immunosuppression agent. SH also reversed the CPA-induced decrease in Th1 cytokines. In vivo investigation revealed that SH administration can increase the tissue weight of major immune organs, such as the spleen and thymus. A similar effect was observed in CPA-injected immunosuppressed BALB/c mice. SH treatment increased the weight of the spleen and thymus, blood immune cell count and Th1 cytokine expression. Additionally, the YAC-1-targeting activities of natural killer cells, which are important in innate immunity, were upregulated upon SH treatment. Overall, our study demonstrates the immune-enhancing effect of SH, suggesting its potential as a medicinal or therapeutic agent for pathologic conditions involving immunosuppression.


Assuntos
Sargassum , Camundongos , Animais , Sargassum/química , Camundongos Endogâmicos BALB C , Ciclofosfamida/farmacologia , Terapia de Imunossupressão , Citocinas/metabolismo
18.
J Pharmacol Exp Ther ; 379(3): 343-357, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34556535

RESUMO

The effective treatment of brain tumors is a considerable challenge in part because of the presence of the blood-brain barrier (BBB) that limits drug delivery. Glioblastoma multiforme (GBM) is an aggressive and infiltrative primary brain tumor with an extremely poor prognosis after standard-of-care therapy with surgery, radiotherapy (RT), and chemotherapy. DNA damage response (DDR) pathways play a critical role in DNA repair in cancer cells, and inhibition of these pathways can potentially augment RT and chemotherapy tumor cell toxicity. The ataxia telangiectasia and Rad3-related protein (ATR) kinase is a key regulator of the DDR network and is potently and selectively inhibited by the ATR inhibitor berzosertib. Although in vitro studies demonstrate a synergistic effect of berzosertib in combination with temozolomide, in vivo efficacy studies have yet to recapitulate this observation using intracranial tumor models. In the current study, we demonstrate that delivery of berzosertib to the brain is restricted by efflux at the BBB. Berzosertib has a high binding affinity to brain tissue compared with plasma, thereby leading to low free drug concentrations in the brain. Berzosertib distribution is heterogenous within the tumor, wherein concentrations are substantially lower in normal brain and invasive tumor rim (wherein the BBB is intact) when compared with those in the tumor core (wherein the BBB is leaky). These results demonstrate that high tissue binding and limited and heterogenous brain distribution of berzosertib may be important factors that influence the efficacy of berzosertib therapy in GBM. SIGNIFICANCE STATEMENT: This study examined the brain delivery and efficacy of berzosertib in patient-derived xenograft models of glioblastoma multiforme (GBM). Berzosertib is actively effluxed at the blood-brain barrier and is highly bound to brain tissue, leading to low free drug concentrations in the brain. Berzosertib is heterogeneously distributed into different regions of the brain and tumor and, in this study, was not efficacious in vivo when combined with temozolomide. These factors inform the future clinical utility of berzosertib for GBM.


Assuntos
Encéfalo/metabolismo , Glioblastoma/metabolismo , Isoxazóis/administração & dosagem , Isoxazóis/metabolismo , Pirazinas/administração & dosagem , Pirazinas/metabolismo , Animais , Proteínas Mutadas de Ataxia Telangiectasia/antagonistas & inibidores , Proteínas Mutadas de Ataxia Telangiectasia/metabolismo , Encéfalo/efeitos dos fármacos , Linhagem Celular Tumoral , Feminino , Glioblastoma/tratamento farmacológico , Células HEK293 , Humanos , Bombas de Infusão , Masculino , Camundongos , Camundongos Knockout , Camundongos Nus , Ensaios Antitumorais Modelo de Xenoenxerto/métodos
19.
Virol J ; 18(1): 17, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33436020

RESUMO

BACKGROUND: Integrase (IN) is an essential protein for HIV replication that catalyzes insertion of the reverse-transcribed viral genome into the host chromosome during the early steps of viral infection. Highly active anti-retroviral therapy is a HIV/AIDS treatment method that combines three or more antiviral drugs often formulated from compounds that inhibit the activities of viral reverse transcriptase and protease enzymes. Early IN inhibitors (INIs) mainly serve as integrase strand transfer inhibitors (INSTI) that disrupt strand transfer by binding the catalytic core domain of IN. However, mutations of IN can confer resistance to INSTI. Therefore, non-catalytic integrase inhibitors (NCINI) have been developed as next-generation INIs. METHODS: In this study, we evaluated and compared the activity of INSTI and NCINI according to the analysis method. Antiviral activity was compared using p24 ELISA with MT2 cell and TZM-bl luciferase system with TZM-bl cell. Each drug was serially diluted and treated to MT2 and TZM-b1 cells, infected with HIV-1 AD8 strain and incubated for 5 and 2 days, respectively. Additionally, to analyze properties of INSTI and NCINI, transfer inhibition assay and 3'-processing inhibition assay were performed. RESULTS: During screening of INIs using the p24 ELISA and TZM-bl luciferase systems, we found an inconsistent result with INSTI and NCINI drugs. Following infection of MT2 and TZM-bl cells with T-tropic HIV-1 strain, both INSTI and NCINI treatments induced significant p24 reduction in MT2 cells. However, NCINI showed no antiviral activity in the TZM-bl luciferase system, indicating that this widely used and convenient antiretroviral assay is not suitable for screening of NCINI compounds that target the second round of HIV-1 replication. CONCLUSION: Accordingly, we recommend application of other assay procedures, such as p24 ELISA or reverse transcription activity, in lieu of the TZM-bl luciferase system for preliminary NCINI drug screening. Utilization of appropriate analytical methods based on underlying mechanisms is necessary for accurate assessment of drug efficacy.


Assuntos
Fármacos Anti-HIV/farmacologia , Inibidores de Integrase de HIV/análise , Inibidores de Integrase de HIV/farmacologia , Integrase de HIV/metabolismo , HIV-1/efeitos dos fármacos , Linhagem Celular , Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/classificação , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Replicação Viral/efeitos dos fármacos
20.
Fish Shellfish Immunol ; 108: 109-115, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33301932

RESUMO

Outbreaks of infectious disease in shrimp pose a serious threat to shrimp agriculture worldwide. Shrimp lack adaptive immunity and depend only on innate immunity as a defense system against infectious disease. Toll-like receptors (TLR) are reported to play a critical role in the innate immune system. In this study, we identified a Toll-like receptor gene of a species of freshwater shrimp, Macrobrachium nipponense, designated MnToll, for the first time. The sequence of MnToll encoded 935 residues arranged as 10 leucine-rich repeat (LRR) domains, a leucine-rich repeat C-terminal (LRR CT) domain and a Toll/interleukin-1 receptor (TIR) domain and displayed 90% amino acid similarity to previously identified TLRs (Toll 1 and 2) of Macrobrachium rosenbergii. We additionally evaluated mRNA expression of MnToll in various tissues, including heart, gills, stomach, digestive gland, ventral nerve cord, antennal gland and muscle. Following infection with a viral pathogen, white spot syndrome virus (WSSV), MnToll expression was significantly upregulated between 12 and 72 h. Our data collectively suggest that the newly identified MnToll gene belongs to the TLR family in shrimp and is potentially involved in innate host defense, especially against WSSV.


Assuntos
Regulação da Expressão Gênica/imunologia , Imunidade Inata/genética , Penaeidae/genética , Penaeidae/imunologia , Receptores Toll-Like/genética , Receptores Toll-Like/imunologia , Vírus da Síndrome da Mancha Branca 1/fisiologia , Sequência de Aminoácidos , Animais , Proteínas de Artrópodes/química , Proteínas de Artrópodes/genética , Proteínas de Artrópodes/imunologia , Sequência de Bases , Perfilação da Expressão Gênica , Filogenia , Alinhamento de Sequência , Receptores Toll-Like/química
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