RESUMO
Rotation-advancement repair (RAR) has been the most widely used technique for unilateral cleft lip repair. We recently used a straight-line repair with medial orbicularis muscle lengthening (SLR-ml) technique, based on the hypothesis that it could minimize the postoperative scar appearance without causing s short-lip deformity when muscle reorientation is performed correctly. A retrospective cohort study was conducted on unilateral complete cleft lip patients who underwent cheiloplasty between 2009 and 2017. Two cheiloplasty techniques were compared: RAR and SLR-ml. Outcomes were evaluated by assessing follow-up photographs using three methods: (1) glance impression on a five-point scale, (2) Manchester Scar Scale, and (3) indirect anthropometry. Seventy-one patients were analysed: 41 in the RAR group (28 male, 13 female) and 30 in the SLR-ml group (15 male, 15 female). The glance impression (P=0.506) and Manchester Scar Scale (P=0.347) scores did not differ between the groups. According to the symmetry ratio (cleft side value/non-cleft side value), vertical lip height (P=0.804), horizontal lip length (P=0.881), and Cupid's bow width (P=0.122) did not differ significantly between the groups. The preoperative lip height discrepancy was not correlated with the postoperative vertical lip height. The SLR-ml method can be regarded as a successful tool for symmetric repair of unilateral cleft lip.
Assuntos
Fenda Labial , Procedimentos de Cirurgia Plástica , Fenda Labial/cirurgia , Feminino , Humanos , Lábio/cirurgia , Masculino , Estudos Retrospectivos , RotaçãoRESUMO
AIM: This study investigated the clinical characteristics of diabetic ketoacidosis (DKA) and compared the DKA characteristics between patients treated with and without SGLT2 inhibitors. METHODS: Data were collected from patients aged ≥ 18 years admitted for DKA at nine centres in Korea between September 2014 and April 2017. The electronic medical records of these subjects were retrospectively reviewed. Based on their history of medications taken before admission, subjects were classified as either users or non-users of SGLT2 inhibitors and their clinical characteristics of DKA were compared. RESULTS: During the study, the main subtype of DKA episodes (n = 523) was identified as type 2 diabetes (51%). Average hospitalization duration was 11 days, and average intensive care unit (ICU) time was 2.5 days. The in-hospital mortality rate was 3%, but no users of SGLT2 inhibitors died during DKA treatment. In patients taking SGLT2 inhibitors (n = 15), DKA manifested at 124 days, on average, after starting the inhibitors (range: 7-380 days). Also, SGLT2 inhibitors users had significantly lower plasma glucose levels (413 mg/dL) compared with non-users (554 mg/dL), and longer ICU stays (4 vs. 2 days; P = 0.019). CONCLUSION: In this report of recent data on the clinical features of DKA in Korea, patients using SGLT2 inhibitors needed longer treatment in ICUs compared with non-users and had lower levels of blood glucose, whereas DKA associated with SGLT2 inhibitors was rare.
Assuntos
Glicemia , Diabetes Mellitus/tratamento farmacológico , Cetoacidose Diabética/diagnóstico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Adulto , Diabetes Mellitus/sangue , Diabetes Mellitus/mortalidade , Cetoacidose Diabética/sangue , Cetoacidose Diabética/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: While the utilization of transcatheter aortic valve replacement (TAVR) for patients with severe aortic stenosis has been increasing, in-hospital infective endocarditis (IE) following TAVR has not been well described. AIM: To identify in-hospital IE following TAVR. METHODS: All patients who underwent TAVR between 2012 and 2014 were identified using the National Inpatient Sample database. Multi-variate logistic regression was performed to identify the predictors of in-hospital IE after TAVR. FINDINGS: Of the 41,025 patients who received TAVR, 120 patients (0.3%) developed in-hospital IE. Viridans group streptococci (20.8%) was the most frequent causative organism for in-hospital IE, followed by Staphylococcus aureus (16.7%) and enterococci (8.3%). Patients who developed in-hospital IE after TAVR had significantly higher rates of death (20.8% vs 4.1%, P<0.001), septic shock (16.7% vs 0.8%, P<0.001), cardiogenic shock (12.5% vs 3.4%, P=0.02), acute kidney injury requiring haemodialysis (16.7% vs 1.6%, P<0.001), bleeding requiring transfusion (29.2% vs 11.3%, P=0.01), myocardial infarction (12.5% vs 2.1%, P<0.001) and permanent pacemaker removal (4.2% vs 0.05%, P<0.001) compared with patients without IE. Independent predictors of in-hospital IE after TAVR include younger age [odds ratio (OR) 0.92, 95% confidence interval (CI) 0.89-0.95], drug abuse (OR 48.9, 95% CI 6.9-347.3) and human immunodeficiency virus (HIV) infection (OR 7.8, 95% CI 1.4-44.4). CONCLUSION: IE occurred in 0.3% of patients after TAVR during the same hospitalization, resulting in higher rates of adverse outcomes including mortality. Patients with younger age, a history of drug abuse or HIV infection are at greater risk of in-hospital IE following TAVR, and would benefit from vigilant preventive measures perioperatively.
Assuntos
Endocardite/epidemiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/classificação , Bactérias/isolamento & purificação , Estudos Transversais , Endocardite/microbiologia , Endocardite/mortalidade , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Análise de Sobrevida , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Heat stress in hot seasons is a major problem in poultry production, particularly in humid areas. The aim of this study was to determine the pharmacodynamics of betaine on the blood and cecal short chain fatty acid profile in meat-type ducks exposed to heat stress. Three-hundred-sixty meat-type ducks (Anas platyrhynchos domesticus) were randomly allocated into 4 treatments: C (heat stress control without betaine), T1 (700 ppm betaine), T2 (1,000 ppm betaine), and T3 (1,300 ppm betaine). Each treatment had 6 replicated pens with 15 meat-type ducks per pen. The study was conducted for 42 days. Our findings revealed that the betaine group had higher body weight gain compared to the control group under heat stress (P < 0.05). Betaine supplementation resulted in more significant improvement in hematological indicators such as RBCs and platelet counts than the heat stress control group (P < 0.05). Under the heat-wave environment, supplementation of betaine manifested a significant decrease in blood pH (P < 0.05) but not in electrolytes (Na+, K+ and Cl-) and gas concentration. The concentration of short chain fatty acids (SCFA) in the cecum was higher than the control under heat stress conditions. The total SCFA, acetic acid, and propionic acid production was higher in the betaine supplemented groups compared to the heat stress control group (P < 0.05). Results showed that betaine supplementation has beneficial effects in meat-type ducks under heat stress on short chain fatty acid levels, blood biochemical parameters, and body weight.
Assuntos
Betaína/farmacologia , Suplementos Nutricionais , Patos/fisiologia , Temperatura Alta/efeitos adversos , Estresse Fisiológico/efeitos dos fármacos , Ração Animal/análise , Animais , Contagem de Células Sanguíneas/veterinária , Peso Corporal/efeitos dos fármacos , Dieta/veterinária , Ácidos Graxos Voláteis/análise , Ácidos Graxos Voláteis/sangue , Fezes/químicaRESUMO
BACKGROUND: Adult onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown aetiology, frequently accompanying multiple lymphadenopathy. It often mimics malignant lymphoma, and immunohistochemical and molecular studies are needed for definite diagnosis. AIMS: To aid in diagnosis and understand the pathogenesis of the disease by clarifying lymph node (LN) pathology in AOSD. METHODS: Thirteen biopsies (one follow up biopsy) and medical records of 12 patients were reviewed. Immunohistochemistry, polymerase chain reaction for T cell receptor gamma chain (TCRgamma) and immunoglobulin heavy chain gene rearrangement, and Epstein-Barr virus in situ hybridisation were performed. RESULTS: Histologically, LN lesions were classified into four patterns. The most common (six biopsies) showed paracortical hyperplasia, with prominent vascular proliferation, scattered large B/T immunoblasts, and infiltration by reactive lymphocytes and inflammatory cells. In the second pattern (two biopsies), paracortical hyperplasia was accompanied by massive sinus histiocytosis and S-100 positive histiocyte aggregates. The third pattern (three patients) showed an exuberant immunoblastic reaction, in the form of patchy/diffuse infiltration of large T immunoblasts with high mitotic activity, although clonal rearrangement of the TCRgamma gene was not detected. The fourth pattern showed distinct follicular hyperplasia (two cases). One patient with a follow up biopsy showed a pattern change from pronounced follicular hyperplasia to atypical paracortical hyperplasia. CONCLUSIONS: AOSD LN lesions show a dynamic histological spectrum, including atypical paracortical hyperplasia, burnt out histiocytic reaction, exuberant immunoblastic reaction, and follicular hyperplasia. During the course of disease, LN reactivity changes and mixed B and T cells are involved in the pathogenesis.
Assuntos
Linfonodos/patologia , Doença de Still de Início Tardio/patologia , Adolescente , Adulto , Antígenos Virais/análise , Linfócitos B/imunologia , Feminino , Rearranjo Gênico de Cadeia Pesada de Linfócito B , Rearranjo Gênico da Cadeia gama dos Receptores de Antígenos dos Linfócitos T , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/imunologia , Humanos , Imuno-Histoquímica/métodos , Hibridização In Situ/métodos , Linfonodos/imunologia , Masculino , Reação em Cadeia da Polimerase/métodos , RNA Viral/análise , Doença de Still de Início Tardio/imunologia , Linfócitos T/imunologiaRESUMO
BACKGROUND AND PURPOSE: Different lesion locations in the atherosclerotic carotid bulb stenosis have not been clearly defined. We sought to evaluate 2 locations of carotid bulb stenosis in high-risk patients and to determine the relationship of each location to atherosclerotic risk factors and clinical features. MATERIALS AND METHODS: Atherosclerotic carotid plaques of apical versus body lesions, defined according to the area and extent of plaque involvement, were retrospectively analyzed in 200 consecutive high-risk patients who underwent carotid stent placement because of > or =50% symptomatic stenosis. We evaluated interobserver concordance and assessed each type of lesion relative to 13 atherosclerotic risk factors, mode of symptom presentation, infarct pattern, procedure-related factors, and clinical outcomes, by univariate and multivariable logistic regression analysis. RESULTS: Interobserver concordance showed good agreement for differentiating apical and body lesions (kappa = 0.745). Univariate analysis revealed that apical lesions (n = 108, 54%) were associated with pseudo-occlusion (P = .027), older age (P = .073), and alcohol intake (P = .080), whereas body lesions (n = 92, 46%) were associated with hyperlipidemia (P = .001), a wedge-shaped cortical infarct pattern (P = .057), and hyperperfusion syndrome (P = .083). Multivariable logistic regression analysis adjusted by age revealed that hyperlipidemia (P = .002; OR, 3.462; 95% CI, 1.595-7.515) and hyperperfusion (P = .026; OR, 6.727; 95% CI, 1.261-35.894) were independent predictors of body-type lesions. CONCLUSIONS: Atherosclerotic carotid bulb stenosis was found to have 2 distinct locations, body and apical. Hyperlipidemia and cortical wedge-shaped infarcts were more frequently associated with body than with apical stenosis at the time of presentation.
Assuntos
Doenças das Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/terapia , Estenose das Carótidas/cirurgia , Estenose das Carótidas/terapia , Endarterectomia das Carótidas , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/epidemiologia , Estenose das Carótidas/epidemiologia , Angiografia Cerebral , Infarto Cerebral/epidemiologia , Infarto Cerebral/patologia , Feminino , Humanos , Hiperlipidemias/epidemiologia , Modelos Logísticos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
Previous analyses of tso1 mutants revealed a loss of control of directional cellular expansion and coordination of growth of adjacent cells, and defects in karyokinesis and cytokinesis. We isolated TSO1 using a map-based approach, and show that it is a member of a family of at least three genes in Arabidopsis. Consistent with the mutant phenotype, TSO1 transcript was most abundant in flowers, where it accumulated to the highest levels in developing ovules and microspores. The putative TSO1 protein has two cysteine-rich regions that are similar to the CXC domains of a variety of proteins from plants and animals, including a class of kinesins involved in chromosome segregation, and enhancer of zeste-type proteins. Visualization of TSO1-fusion proteins indicated that TSO1 is a nuclear protein. The tso1 mutant phenotypes and the novelty of the TSO1 sequence suggest the existence of previously unknown participants in regulation of directional processes in eukaryotic cells.