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1.
Microorganisms ; 12(6)2024 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-38930512

RESUMEN

In medicine, parasitic cysts (e.g., brain cysticerci) are believed to be sterile, and are primarily treated with antiparasitic medications, not antibiotics, which could prevent abscess formation and localized inflammation. This study quantified the microbial composition of parasitic cysts in a wild rodent, using multi-kingdom metagenomics to comprehensively assess if parasitic cysts are sterile, and further understand gut microbial translocation and adaptation in wildlife confined environments, outside the gut. Analysis was conducted on DNA from two hepatic parasitic cysts from a feline tapeworm, Hydatigera (Taenia) taeniaeformis, affecting a wild vole mouse (Microtus pennsylvanicus), and from feces, liver and peritoneal fluid of this and two other concurrent individual wild voles trapped during pest control in one of our university research vegetable gardens. Bacterial metagenomics revealed the presence of gut commensal/opportunistic species, Parabacteroides distasonis, Bacteroides (Bacteroidota); Klebsiella variicola, E. coli (Enterobacteriaceae); Enterococcus faecium and Lactobacillus acidophilus (Bacillota) inhabiting the cysts, and peritoneal fluid. Remarkably, viral metagenomics revealed various murine viral species, and unexpectedly, a virus from the insect armyworm moth (Pseudaletia/Mythimna unipuncta), known as Mythimna unipuncta granulovirus A (MyunGV-A), in both cysts, and in one fecal and one peritoneal sample from the other non-cyst voles, indicating the survival and adaption potential of the insect virus in voles. Metagenomics also revealed a significantly lower probability of fungal detection in cysts compared to that in peritoneal fluid/feces (p < 0.05), with single taxon detection in each cyst (Malassezia and Pseudophaeomoniella oleicola). The peritoneal fluid had the highest probability for fungi. In conclusion, metagenomics revealed that bacteria/viruses/fungi coexist within parasitic cysts supporting the potential therapeutic benefits of antibiotics in cystic diseases, and in inflammatory microniches of chronic diseases, such as Crohn's disease gut wall cavitating micropathologies, from which we recently isolated similar synergistic pathogenic Bacteroidota and Enterobacteriaceae, and Bacillota.

2.
bioRxiv ; 2024 Mar 23.
Artículo en Inglés | MEDLINE | ID: mdl-38562820

RESUMEN

In medicine, parasitic cysts or cysticerci (fluid-filled cysts, larval stage of tapeworms) are believed to be sterile (no bacteria), and therein, the treatment of cysticerci infestations of deep extra-intestinal tissues (e.g., brain) relies almost exclusively on the use of antiparasitic medications, and rarely antibiotics. To date, however, it is unclear why common post-treatment complications include abscessation. This study quantified the microbial composition of parasitic cyst contents in a higher-order rodent host, using multi-kingdom shotgun metagenomics, to improve our understanding of gut microbial translocation and adaptation strategies in wild environments. Analysis was conducted on DNA from two hepatic parasitic cysts (Hydatigera (Taeenia) taeniaeformis) in an adult vole mouse (Microtus arvalis), and from feces, liver, and peritoneal fluid of three other vole family members living in a vegetable garden in Ohio, USA. Bacterial metagenomics revealed the presence of gut commensal/opportunistic species, including Parabacteroides distasonis, Klebsiella variicola, Enterococcus faecium, and Lactobacillus acidophilus, inhabiting the cysts. Parabacteroides distasonis and other species were also present outside the cyst in the peritoneal fluid. Remarkably, viral metagenomics revealed various murine viral species, but unexpectedly, it detected an insect-origin virus from the army moth (Pseudaletia/Mythimna unipuncta) known as Mythimna unipuncta granulovirus A (MyunGV-A) in both cysts, and in one fecal and one peritoneal sample from two different voles, indicating survival of the insect virus and adaption in voles. Metagenomics also revealed a significantly lower probability of fungal detection in the cysts compared to other samples (peritoneal fluid, p<0.05; and feces p<0.05), with single taxon detection in each cyst for Malassezia and Pseudophaeomoniella oleicola. The samples with a higher probability of fungi were the peritoneal fluid. In conclusion, commensal/pathobiont bacterial species can inhabit parasitic tapeworm cysts, which needs to be considered during therapeutic decisions of cysticerci or other chronic disease scenarios where immune privileged and spatially restricted ecosystems with limited nutrients and minimal presence of immune cells could facilitate microbial adaptation, such as within gut wall cavitating micropathologies in Crohn's disease.

3.
Nutrients ; 15(3)2023 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-36771430

RESUMEN

The intestinal microbial population is recognized for its impact on cancer treatment outcomes. Little research has reported microbiome changes during cancer progression or the interplay of disease progression, dietary sugar/fat intake, and the microbiome through surgery and chemotherapy. In this study, the murine gut microbiome was used as a model system, and changes in microbiome diversity, richness, and evenness over the progression of the cancer and treatment were analyzed. Mice were categorized into four diet cohorts, combinations of either high or low sucrose and high or low omega-3 fatty acids, and two treatment cohorts, saline vehicle or chemotherapy, for a total of eight groups. Fecal samples were collected at specific timepoints to assess changes due to diet implementation, onset of cancer, lumpectomy, and chemotherapy. Akkermansia muciniphila abundance was very high in some samples and negatively correlated with overall Amplicon Sequence Variant (ASV) richness (r(64) = -0.55, p = 3 × 10-8). Throughout the disease progression, ASV richness significantly decreased and was impacted by diet and treatment. Alpha-diversity and differential microbial abundance were significantly affected by disease progression, diet, treatment, and their interactions. These findings help establish a baseline for understanding how cancer progression, dietary macronutrients, and specific treatments impact the murine microbiome, which may influence outcomes.


Asunto(s)
Microbioma Gastrointestinal , Microbiota , Neoplasias , Animales , Ratones , Dieta , Verrucomicrobia , Progresión de la Enfermedad , Heces , Neoplasias/terapia
4.
Front Immunol ; 11: 604989, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33603741

RESUMEN

With the epidemic of human obesity, dietary fats have increasingly become a focal point of biomedical research. Epidemiological studies indicate that high-fat diets (HFDs), especially those rich in long-chain saturated fatty acids (e.g., Western Diet, National Health Examination survey; NHANES 'What We Eat in America' report) have multi-organ pro-inflammatory effects. Experimental studies have confirmed some of these disease associations, and have begun to elaborate mechanisms of disease induction. However, many of the observed effects from epidemiological studies appear to be an over-simplification of the mechanistic complexity that depends on dynamic interactions between the host, the particular fatty acid, and the rather personalized genetics and variability of the gut microbiota. Of interest, experimental studies have shown that certain saturated fats (e.g., lauric and myristic fatty acid-rich coconut oil) could exert the opposite effect; that is, desirable anti-inflammatory and protective mechanisms promoting gut health by unanticipated pathways. Owing to the experimental advantages of laboratory animals for the study of mechanisms under well-controlled dietary settings, we focus this review on the current understanding of how dietary fatty acids impact intestinal biology. We center this discussion on studies from mice and rats, with validation in cell culture systems or human studies. We provide a scoping overview of the most studied diseases mechanisms associated with the induction or prevention of Inflammatory Bowel Disease in rodent models relevant to Crohn's Disease and Ulcerative Colitis after feeding either high-fat diet (HFD) or feed containing specific fatty acid or other target dietary molecule. Finally, we provide a general outlook on areas that have been largely or scarcely studied, and assess the effects of HFDs on acute and chronic forms of intestinal inflammation.


Asunto(s)
Colitis Ulcerosa/etiología , Enfermedad de Crohn/etiología , Citocinas/metabolismo , Ácidos Grasos/efectos adversos , Mediadores de Inflamación/metabolismo , Mucosa Intestinal/metabolismo , Linfocitos T/metabolismo , Adipoquinas/metabolismo , Animales , Colitis Ulcerosa/inmunología , Colitis Ulcerosa/metabolismo , Colitis Ulcerosa/prevención & control , Enfermedad de Crohn/inmunología , Enfermedad de Crohn/metabolismo , Enfermedad de Crohn/prevención & control , Ácidos Grasos/administración & dosificación , Ácidos Grasos/metabolismo , Microbioma Gastrointestinal , Humanos , Absorción Intestinal , Mucosa Intestinal/inmunología , Mucosa Intestinal/microbiología , Estrés Oxidativo , Transducción de Señal , Linfocitos T/inmunología
5.
Nutrients ; 11(8)2019 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-31416193

RESUMEN

Cancer patients receiving treatment are at a higher risk for the acquisition of foodborne illness than the general population. Despite this, few studies have assessed the food safety behaviors, attitudes, risk perceptions, and food acquisition behaviors of this population. Further, no studies have, yet, quantified the food safety knowledge of these patients. This study aims to fill these gaps in the literature by administering a thorough questionnaire to cancer patients seeking treatment in three hospitals in a Midwest, metropolitan area. Demographic, treatment, food security, and food safety knowledge, behaviors, attitudes, risk perceptions, and acquisition information was assessed for 288 patients. Specific unsafe attitudes, behaviors, and acquisition practices were identified. Most notable is that 49.4% (n = 139) of participants were not aware that they were at increased risk of foodborne infection, due to their disease and treatment. Additionally, though patients exhibited a general understanding of food safety, the participant average for correctly answering the food safety questions was 74.77% ± 12.24%. The section concerning food storage showed lowest participant knowledge, with an average score of 69.53% ± 17.47%. Finally, patients reporting low food security also reported a higher incidence of unsafe food acquisition practices (P < 0.05). These findings will help healthcare providers to better educate patients in the food safety practices necessary to decrease risk of foodborne infection, and to provide targeted food safety education to low-food-security patients.


Asunto(s)
Dieta/efectos adversos , Contaminación de Alimentos , Abastecimiento de Alimentos , Enfermedades Transmitidas por los Alimentos/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Neoplasias/terapia , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Enfermedades Transmitidas por los Alimentos/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Medición de Riesgo , Factores de Riesgo , Determinantes Sociales de la Salud , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
6.
Nutrients ; 10(8)2018 Aug 04.
Artículo en Inglés | MEDLINE | ID: mdl-30081543

RESUMEN

A high diet quality is associated with a lower risk of cancer mortality. However, the predictive factors of diet quality among cancer patients are not well understood. This study determines the socio-demographic and disease-related factors that affect diet quality among cancer patients. Two hundred and forty-two cancer patients completed questionnaires assessing sociodemographic and disease-related characteristics. Diet quality was measured using the Healthy Eating Index 2010 (HEI). Independent sample t-tests and one-way ANOVA with post-hoc analysis using the Tukey HSD test were used to compare mean HEI scores across these characteristics. A regression model was used to determine factors that predicted diet quality. The overall HEI score among cancer patients was 61.59 (SD = 11.67). Patients with a high school degree or General Education Diploma (GED) or less had lower HEI scores (ß = -4.03, p = 0.04; ß = -7.77, p = 0.001, respectively) compared to those with college degrees. Additionally, homemakers had significantly higher HEI scores (ß = 7.95, p = 0.008) compared to those who worked at least 40 hours per week. Also, individuals with some types of cancers (e.g., endometrial or uterine) had significantly higher HEI scores (ß = 12.56, p = 0.002) than those with other cancers (e.g., head and neck). Our findings will help oncology healthcare providers identify and target cancer patients with specific demographic characteristics who are at increased risk for consuming poor-quality diets with much needed food resource interventions.


Asunto(s)
Dieta Saludable , Neoplasias/fisiopatología , Estado Nutricional , Valor Nutritivo , Adulto , Anciano , Anciano de 80 o más Años , Encuestas sobre Dietas , Femenino , Disparidades en Atención de Salud , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Neoplasias/mortalidad , Neoplasias/terapia , Ohio/epidemiología , Pronóstico , Factores Protectores , Ingesta Diaria Recomendada , Factores de Riesgo , Factores Socioeconómicos
7.
Inflamm Bowel Dis ; 24(5): 1005-1020, 2018 04 23.
Artículo en Inglés | MEDLINE | ID: mdl-29554272

RESUMEN

Background: Epidemiological studies indicate that the use of artificial sweeteners doubles the risk for Crohn's disease (CD). Herein, we experimentally quantified the impact of 6-week supplementation with a commercial sweetener (Splenda; ingredients sucralose maltodextrin, 1:99, w/w) on both the severity of CD-like ileitis and the intestinal microbiome alterations using SAMP1/YitFc (SAMP) mice. Methods: Metagenomic shotgun DNA sequencing was first used to characterize the microbiome of ileitis-prone SAMP mice. Then, 16S rRNA microbiome sequencing, quantitative polymerase chain reaction, fluorescent in situ hybridization (FISH), bacterial culture, stereomicroscopy, histology, and myeloperoxidase (MPO) activity analyses were then implemented to compare the microbiome and ileitis phenotype in SAMP with that of control ileitis-free AKR/J mice after Splenda supplementation. Results: Metagenomics indicated that SAMP mice have a gut microbial phenotype rich in Bacteroidetes, and experiments showed that Helicobacteraceae did not have an exacerbating effect on ileitis. Splenda did not increase the severity of (stereomicroscopic/histological) ileitis; however, biochemically, ileal MPO activity was increased in SAMP treated with Splenda compared with nonsupplemented mice (P < 0.022) and healthy AKR mice. Splenda promoted dysbiosis with expansion of Proteobacteria in all mice, and E. coli overgrowth with increased bacterial infiltration into the ileal lamina propria of SAMP mice. FISH showed increase malX gene-carrying bacterial clusters in the ilea of supplemented SAMP (but not AKR) mice. Conclusions: Splenda promoted gut Proteobacteria, dysbiosis, and biochemical MPO reactivity in a spontaneous model of (Bacteroidetes-rich) ileal CD. Our results indicate that although Splenda may promote parallel microbiome alterations in CD-prone and healthy hosts, this did not result in elevated MPO levels in healthy mice, only CD-prone mice. The consumption of sucralose/maltodextrin-containing foods might exacerbate MPO intestinal reactivity only in individuals with a pro-inflammatory predisposition, such as CD.


Asunto(s)
Enfermedad de Crohn/patología , Disbiosis/fisiopatología , Ileítis/patología , Mucosa Intestinal/patología , Sacarosa/análogos & derivados , Edulcorantes/efectos adversos , Animales , Bacteroidetes/efectos de los fármacos , Bacteroidetes/genética , Enfermedad de Crohn/metabolismo , Modelos Animales de Enfermedad , Femenino , Humanos , Ileítis/metabolismo , Hibridación Fluorescente in Situ , Mucosa Intestinal/metabolismo , Masculino , Ratones , Ratones Endogámicos AKR , Microbiota , Peroxidasa/metabolismo , Proteobacteria/efectos de los fármacos , Proteobacteria/genética , ARN Ribosómico 16S/genética , Sacarosa/efectos adversos
8.
J Pathog ; 2016: 5748745, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27630775

RESUMEN

We report and investigated a case of inadvertent contamination of 125 mice (housed in two germ-free positive-pressurized isolators) with emerging human and coral pathogen Aspergillus sydowii. The infected mice correspond to genetic line SAMP1/YitFc, which have 100% immune predisposition to develop Crohn's disease-like spontaneous pathologies, namely, inflammatory bowel disease (IBD). Pathogen update based on a scoping review of the literature and our clinical observations and experimentation are discussed. The unwanted infection of germ-free mice (immunologically prone to suffer chronic inflammation) with human pathogen A. sydowii resulted in no overt signs of clinical disease over 3-week exposure period, or during DSS-induced colitis experiments. Results and observations suggest that A. sydowii alone has limited clinical effect in immunocompromised germ-free mice or that other commensal microbial flora is required for Aspergillus-associated disease to occur.

9.
J Am Soc Echocardiogr ; 28(3): 317-27, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25560484

RESUMEN

BACKGROUND: The aim of this study was to determine right ventricular (RV) and right atrial (RA) deformation assessed by two-dimensional echocardiographic and three-dimensional echocardiographic (3DE) imaging in patients with prediabetes and type 2 diabetes mellitus. METHODS: This cross-sectional study included 47 untreated normotensive subjects with prediabetes, 57 recently diagnosed normotensive patients with diabetes, and 54 healthy controls of similar sex and age distributions. All subjects underwent laboratory analyses and complete two-dimensional echocardiographic and 3DE examinations. RESULTS: Three-dimensional echocardiographic RV end-diastolic volume index gradually decreased from controls across patients with diabetes to those with diabetes (69 ± 10 vs 63 ± 8 vs 58 ± 8 mL/m(2), P < .001), whereas 3DE RV end-systolic volume index was higher in controls compared with patients with diabetes and those with diabetes (25 ± 4 vs 23 ± 4 vs 22 ± 4 mL/m(2), P < .001). However, there was no difference in 3DE RV ejection fraction among the three groups (63 ± 4% vs 62 ± 4% vs 61 ± 5%, P = .063). RV and RA global strain and systolic and early diastolic strain rates were decreased in patients with prediabetes and in those with diabetes compared with controls, whereas RV and RA late diastolic strain rates were increased in these patients. Multivariate regression analysis showed that RV global strain was associated with glycated hemoglobin, independent of left ventricular parameters. CONCLUSIONS: RV and RA myocardial deformation and function obtained by 3DE and two-dimensional echocardiographic strain, even in normal ranges, were decreased in patients with prediabetes and in those with diabetes compared with controls. The long-term parameter of glucose control was correlated with the right heart mechanics.


Asunto(s)
Diabetes Mellitus Tipo 2/fisiopatología , Ecocardiografía Tridimensional/métodos , Diagnóstico por Imagen de Elasticidad/métodos , Estado Prediabético/fisiopatología , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/fisiopatología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Femenino , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Masculino , Persona de Mediana Edad , Estado Prediabético/complicaciones , Estado Prediabético/diagnóstico por imagen , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Volumen Sistólico , Disfunción Ventricular Derecha/etiología
10.
Echocardiography ; 32(6): 947-55, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25287318

RESUMEN

BACKGROUND: Our aim was to investigate left ventricular (LV) mechanics estimated by two- (2DE) and three-dimensional echocardiography (3DE) strains in subjects with type 2 diabetes mellitus (DM). METHODS: This cross-sectional study included 50 untreated normotensive DM subjects and 50 healthy controls similar by sex and age. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination. RESULTS: Left ventricular mechanics, assessed by 2DE, was impaired in all three directions. Global longitudinal 3DE strain was significantly decreased in the DM group in comparison with the controls (-17.8 ± 2.5 vs. -19.1 ± 2.7%, P = 0.014). Similar results were found for 3DE global circumferential strain (-18.9 ± 2.9 vs. -20.4 ± 3.2%, P = 0.01), 3DE global radial strain (40.3 ± 6.9 vs. 43.1 ± 7.3%, P = 0.035), and 3DE global area strain (-29.2 ± 3.7 vs. -31 ± 4%, P = 0.024). LV torsion was similar between the DM patients and the controls (2.1 ± 0.6 vs. 1.9 ± 0.5 °/cm, P = 0.073); whereas LV untwisting rate was significantly increased in the DM subjects (-114 ± 26 vs. -96 ±23 °/s, P < 0.001). A multivariate analysis showed that 3DE global longitudinal and area myocardial functions were associated with HbA1c independently of 3DE LV mass index. CONCLUSION: Left ventricular deformation obtained by 3DE is significantly impaired in the type 2 DM patients. HbA1c is independently associated with LV mechanics that implies that early anti-diabetic therapy and normalization of the fasting glucose level and HbA1c could impede further cardiac damage.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Ecocardiografía Tridimensional/métodos , Diagnóstico por Imagen de Elasticidad/métodos , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , Femenino , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Volumen Sistólico
11.
Eur J Endocrinol ; 170(1): 77-85, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24114432

RESUMEN

BACKGROUND: We sought to investigate right ventricular (RV) function and deformation assessed by three-dimensional echocardiography (3DE) and speckle tracking in patients with subclinical hypothyroidism (SHT), and to evaluate the influence of levothyroxine (L-T4) therapy on RV remodeling. METHODS: We included 50 untreated women with SHT and 45 healthy control women matched by age. The L-T4 therapy was prescribed to all SHT patients who were followed 1 year after euthyroid status was achieved. All study participants underwent laboratory analyses which included thyroid hormone levels, and complete two-dimensional echocardiography (2DE) and 3DE examinations. RESULTS: 3DE RV end-diastolic volume and ejection fraction were significantly reduced in the SHT patients before therapy in comparison with the healthy controls and treated SHT subjects. RV longitudinal strain, systolic, and early diastolic strain rates (SRs) were significantly decreased, whereas RV late diastolic SR was increased in the SHT patients before therapy when comparing with the controls. 2DE speckle tracking imaging revealed that L-T4 substitution therapy significantly improved RV systolic mechanics, whereas RV diastolic deformation was not completely recovered. Right atrial (RA) function and deformation were significantly impacted by SHT. Replacement L-T4 treatment improved but did not completely restore RA mechanics in the SHT patients. CONCLUSION: RV and RA function and mechanics are significantly affected by SHT. L-T4 therapy and 1-year maintenance of euthyroid status improved but did not completely recover RV and RA function and deformation in the SHT patients, which implies that right heart remodeling caused by SHT is not reversible in a 1-year period.


Asunto(s)
Remodelación Atrial/efectos de los fármacos , Cardiopatías/prevención & control , Terapia de Reemplazo de Hormonas , Hipotiroidismo/tratamiento farmacológico , Tiroxina/uso terapéutico , Disfunción Ventricular Derecha/prevención & control , Remodelación Ventricular/efectos de los fármacos , Adulto , Función del Atrio Derecho/efectos de los fármacos , Volumen Cardíaco/efectos de los fármacos , Ecocardiografía Doppler de Pulso/efectos de los fármacos , Ecocardiografía Tridimensional/efectos de los fármacos , Femenino , Estudios de Seguimiento , Corazón/efectos de los fármacos , Corazón/fisiopatología , Cardiopatías/diagnóstico por imagen , Cardiopatías/etiología , Humanos , Hipotiroidismo/sangre , Hipotiroidismo/etiología , Hipotiroidismo/fisiopatología , Volumen Sistólico/efectos de los fármacos , Hormonas Tiroideas/sangre , Tiroiditis Autoinmune/fisiopatología , Tiroxina/sangre , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/etiología , Función Ventricular Derecha/efectos de los fármacos
12.
Stroke ; 40(4): 1359-64, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19233936

RESUMEN

BACKGROUND AND PURPOSE: We hypothesized that transcranial laser therapy (TLT) can use near-infrared laser technology to treat acute ischemic stroke. The NeuroThera Effectiveness and Safety Trial-2 (NEST-2) tested the safety and efficacy of TLT in acute ischemic stroke. METHODS: This double-blind, randomized study compared TLT treatment to sham control. Patients receiving tissue plasminogen activator and patients with evidence of hemorrhagic infarct were excluded. The primary efficacy end point was a favorable 90-day score of 0 to 2 assessed by the modified Rankin Scale. Other 90-day end points included the overall shift in modified Rankin Scale and assessments of change in the National Institutes of Health Stroke Scale score. RESULTS: We randomized 660 patients: 331 received TLT and 327 received sham; 120 (36.3%) in the TLT group achieved favorable outcome versus 101 (30.9%), in the sham group (P=0.094), odds ratio 1.38 (95% CI, 0.95 to 2.00). Comparable results were seen for the other outcome measures. Although no prespecified test achieved significance, a post hoc analysis of patients with a baseline National Institutes of Health Stroke Scale score of <16 showed a favorable outcome at 90 days on the primary end point (P<0.044). Mortality rates and serious adverse events did not differ between groups with 17.5% and 17.4% mortality, 37.8% and 41.8% serious adverse events for TLT and sham, respectively. CONCLUSIONS: TLT within 24 hours from stroke onset demonstrated safety but did not meet formal statistical significance for efficacy. However, all predefined analyses showed a favorable trend, consistent with the previous clinical trial (NEST-1). Both studies indicate that mortality and adverse event rates were not adversely affected by TLT. A definitive trial with refined baseline National Institutes of Health Stroke Scale exclusion criteria is planned.


Asunto(s)
Isquemia Encefálica/radioterapia , Terapia por Luz de Baja Intensidad/efectos adversos , Terapia por Luz de Baja Intensidad/métodos , Accidente Cerebrovascular/radioterapia , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/mortalidad , Femenino , Humanos , Rayos Infrarrojos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/mortalidad , Resultado del Tratamiento
13.
Stroke ; 38(6): 1843-9, 2007 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-17463313

RESUMEN

BACKGROUND AND PURPOSE: The NeuroThera Effectiveness and Safety Trial-1 (NEST-1) study evaluated the safety and preliminary effectiveness of the NeuroThera Laser System in the ability to improve 90-day outcomes in ischemic stroke patients treated within 24 hours from stroke onset. The NeuroThera Laser System therapeutic approach involves use of infrared laser technology and has shown significant and sustained beneficial effects in animal models of ischemic stroke. METHODS: This was a prospective, intention-to-treat, multicenter, international, double-blind, trial involving 120 ischemic stroke patients treated, randomized 2:1 ratio, with 79 patients in the active treatment group and 41 in the sham (placebo) control group. Only patients with baseline stroke severity measured by National Institutes of Health Stroke Scale (NIHSS) scores of 7 to 22 were included. Patients who received tissue plasminogen activator were excluded. Outcome measures were the patients' scores on the NIHSS, modified Rankin Scale (mRS), Barthel Index, and Glasgow Outcome Scale at 90 days after treatment. The primary outcome measure, prospectively identified, was successful treatment, documented by NIHSS. This was defined as a complete recovery at day 90 (NIHSS 0 to 1), or a decrease in NIHSS score of at least 9 points (day 90 versus baseline), and was tested as a binary measure (bNIH). Secondary outcome measures included mRS, Barthel Index, and Glasgow Outcome Scale. Primary statistical analyses were performed with the Cochran-Mantel-Haenszel rank test, stratified by baseline NIHSS score or by time to treatment for the bNIH and mRS. Logistic regression analyses were conducted to confirm the results. RESULTS: Mean time to treatment was >16 hours (median time to treatment 18 hours for active and 17 hours for control). Time to treatment ranged from 2 to 24 hours. More patients (70%) in the active treatment group had successful outcomes than did controls (51%), as measured prospectively on the bNIH (P=0.035 stratified by severity and time to treatment; P=0.048 stratified only by severity). Similarly, more patients (59%) had successful outcomes than did controls (44%) as measured at 90 days as a binary mRS score of 0 to 2 (P=0.034 stratified by severity and time to treatment; P=0.043 stratified only by severity). Also, more patients in the active treatment group had successful outcomes than controls as measured by the change in mean NIHSS score from baseline to 90 days (P=0.021 stratified by time to treatment) and the full mRS ("shift in Rankin") score (P=0.020 stratified by severity and time to treatment; P=0.026 stratified only by severity). The prevalence odds ratio for bNIH was 1.40 (95% CI, 1.01 to 1.93) and for binary mRS was 1.38 (95% CI, 1.03 to 1.83), controlling for baseline severity. Similar results held for the Barthel Index and Glasgow Outcome Scale. Mortality rates and serious adverse events (SAEs) did not differ significantly (8.9% and 25.3% for active 9.8% and 36.6% for control, respectively, for mortality and SAEs). CONCLUSIONS: The NEST-1 study indicates that infrared laser therapy has shown initial safety and effectiveness for the treatment of ischemic stroke in humans when initiated within 24 hours of stroke onset. A larger confirmatory trial to demonstrate safety and effectiveness is warranted.


Asunto(s)
Isquemia Encefálica/radioterapia , Rayos Infrarrojos , Terapia por Luz de Baja Intensidad/efectos adversos , Accidente Cerebrovascular/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/epidemiología , Método Doble Ciego , Femenino , Humanos , Internacionalidad , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/epidemiología , Factores de Tiempo
14.
Photomed Laser Surg ; 24(4): 458-66, 2006 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16942425

RESUMEN

OBJECTIVE: The aim of the present study was to investigate the possible short- and long-term adverse neurological effects of low-level laser therapy (LLLT) given at different power densities, frequencies, and modalities on the intact rat brain. BACKGROUND DATA: LLLT has been shown to modulate biological processes depending on power density, wavelength, and frequency. To date, few well-controlled safety studies on LLLT are available. METHODS: One hundred and eighteen rats were used in the study. Diode laser (808 nm, wavelength) was used to deliver power densities of 7.5, 75, and 750 mW/cm2 transcranially to the brain cortex of mature rats, in either continuous wave (CW) or pulse (Pu) modes. Multiple doses of 7.5 mW/cm2 were also applied. Standard neurological examination of the rats was performed during the follow-up periods after laser irradiation. Histology was performed at light and electron microscopy levels. RESULTS: Both the scores from standard neurological tests and the histopathological examination indicated that there was no long-term difference between laser-treated and control groups up to 70 days post-treatment. The only rats showing an adverse neurological effect were those in the 750 mW/cm2 (about 100-fold optimal dose), CW mode group. In Pu mode, there was much less heating, and no tissue damage was noted. CONCLUSION: Long-term safety tests lasting 30 and 70 days at optimal 10x and 100x doses, as well as at multiple doses at the same power densities, indicate that the tested laser energy doses are safe under this treatment regime. Neurological deficits and histopathological damage to 750 mW/cm2 CW laser irradiation are attributed to thermal damage and not due to tissue-photon interactions.


Asunto(s)
Encéfalo/efectos de la radiación , Terapia por Luz de Baja Intensidad/métodos , Animales , Relación Dosis-Respuesta en la Radiación , Masculino , Ratas , Ratas Sprague-Dawley
15.
Lasers Surg Med ; 38(1): 70-3, 2006 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-16444697

RESUMEN

BACKGROUND AND OBJECTIVES: Low-level laser therapy (LLLT) has been shown to have beneficial effects on ischemic skeletal and heart muscles tissues. The aim of the present study was to approve the effectiveness of LLLT treatment at different locations on the brain in acute stroked rats. STUDY DESIGN/MATERIALS AND METHODS: Stroke was induced in 169 rats that were divided into four groups: control non-laser and three laser-treated groups where laser was employed ipsilateral, contralateral, and both to the side of the induced stroke. Rats were tested for neurological function. RESULTS: In all three laser-treated groups, a marked and significant improvement in neurological deficits was evident at 14, 21, and 28 days post stroke relative to the non-treated group. CONCLUSIONS: These observations suggest that LLLT applied at different locations in the skull and in a rather delayed-phase post stroke effectively improves neurological function after acute stroke in rats.


Asunto(s)
Terapia por Luz de Baja Intensidad/métodos , Accidente Cerebrovascular/radioterapia , Análisis de Varianza , Animales , Ratas , Ratas Sprague-Dawley , Estadísticas no Paramétricas
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