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2.
Nucleic Acids Res ; 50(14): 8093-8106, 2022 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-35849338

RESUMO

DNA damage response pathways rely extensively on nuclease activity to process DNA intermediates. Exonuclease 1 (EXO1) is a pleiotropic evolutionary conserved DNA exonuclease involved in various DNA repair pathways, replication, antibody diversification, and meiosis. But, whether EXO1 facilitates these DNA metabolic processes through its enzymatic or scaffolding functions remains unclear. Here, we dissect the contribution of EXO1 enzymatic versus scaffolding activity by comparing Exo1DA/DA mice expressing a proven nuclease-dead mutant form of EXO1 to entirely EXO1-deficient Exo1-/- and EXO1 wild type Exo1+/+ mice. We show that Exo1DA/DA and Exo1-/- mice are compromised in canonical DNA repair processing, suggesting that the EXO1 enzymatic role is important for error-free DNA mismatch and double-strand break repair pathways. However, in non-canonical repair pathways, EXO1 appears to have a more nuanced function. Next-generation sequencing of heavy chain V region in B cells showed the mutation spectra of Exo1DA/DA mice to be intermediate between Exo1+/+ and Exo1-/- mice, suggesting that both catalytic and scaffolding roles of EXO1 are important for somatic hypermutation. Similarly, while overall class switch recombination in Exo1DA/DA and Exo1-/- mice was comparably defective, switch junction analysis suggests that EXO1 might fulfill an additional scaffolding function downstream of class switching. In contrast to Exo1-/- mice that are infertile, meiosis progressed normally in Exo1DA/DA and Exo1+/+ cohorts, indicating that a structural but not the nuclease function of EXO1 is critical for meiosis. However, both Exo1DA/DA and Exo1-/- mice displayed similar mortality and cancer predisposition profiles. Taken together, these data demonstrate that EXO1 has both scaffolding and enzymatic functions in distinct DNA repair processes and suggest a more composite and intricate role for EXO1 in DNA metabolic processes and disease.


Assuntos
Enzimas Reparadoras do DNA , Reparo do DNA , Exodesoxirribonucleases , Neoplasias , Animais , Linfócitos B , Enzimas Reparadoras do DNA/genética , Enzimas Reparadoras do DNA/metabolismo , Exodesoxirribonucleases/genética , Exodesoxirribonucleases/metabolismo , Imunidade , Meiose/genética , Camundongos , Neoplasias/genética , Neoplasias/imunologia , Hipermutação Somática de Imunoglobulina
4.
Sci Total Environ ; 827: 154310, 2022 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-35257781

RESUMO

This study investigated a gas fractionation enhanced soil washing method for poly-and perfluoroalkyl substances (PFAS) removal from contaminated soil. With the assistance of gas fractionation, PFAS removal was increased by a factor of 9, compared to the conventional soil washing method. Pre-extraction (pre-treatment) of the soil with water before gas fractionation enhanced PFAS removal from soil. The optimum extraction time varied based on the soil particle size, since it will change the swelling time of the soil. The influence of various operational conditions such as water to soil mass ratio (W:S ratio), gas type in fractionation, gas flowrate, fractionation time and soil pre-treatment condition have been studied to identify the critical influencing factors. Among various W:S ratios (2, 4, 5, 6, 8, and 10) studied, higher W:S ratio resulted in better PFAS removals, but PFAS removal began to plateau as the W:S ratio increased. PFAS removal could be improved by repeated treatment with low water consumption. Air, oxygen, and ozone generated by air and oxygen were used, in which ozone generated by oxygen achieved the highest PFAS removals of 55.9%. Among different fractionation times (10 min, 20 min and 30 min), a fractionation time of 20 min achieved better total PFAS removal for studied soil, because PFOS was the dominant species in the total PFAS. However, the removal of some PFAS species, such as PFHxS, would be increased with extended fractionation time. With constant fractionation time (10 min), PFAS removal performance improved with the increasing gas flowrate.


Assuntos
Fluorocarbonos , Ozônio , Poluentes Químicos da Água , Fluorocarbonos/análise , Solo , Tecnologia , Água , Poluentes Químicos da Água/análise
5.
Lancet Infect Dis ; 21(5): 677-687, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33482143

RESUMO

BACKGROUND: The incidence of invasive meningococcal disease in the UK decreased by approximately four times from 1999 to 2014, with reductions in serogroup C and serogroup B disease. Lower serogroup C invasive meningococcal disease incidence was attributable to implementation of the meningococcal serogroup C conjugate vaccine in 1999, through direct and indirect protection, but no vaccine was implemented against serogroup B disease. UK Meningococcal Carriage surveys 1-3 (UKMenCar1-3), conducted in 1999, 2000, and 2001, were essential for understanding the impact of vaccination. To investigate the decline in invasive meningococcal disease incidence, we did a large oropharyngeal carriage survey in 2014-15, immediately before the changes to meningococcal vaccines in the UK national immunisation schedule. METHODS: UKMenCar4 was a cross-sectional survey in adolescents aged 15-19 years who were enrolled from schools and colleges geographically local to one of 11 UK sampling centres between Sept 1, 2014, and March 30, 2015. Participants provided an oropharyngeal swab sample and completed a questionnaire on risk factors for carriage, including social behaviours. Samples were cultured for putative Neisseria spp, which were characterised with serogrouping and whole-genome sequencing. Data from this study were compared with the results from the UKMenCar1-3 surveys (1999-2001). FINDINGS: From the 19 641 participants (11 332 female, 8242 male, 67 not stated) in UKMenCar4 with culturable swabs and completed risk-factor questionnaires, 1420 meningococci were isolated, with a carriage prevalence of 7·23% (95% CI 6·88-7·60). Carriage prevalence was substantially lower in UKMenCar4 than in the previous surveys: carriage prevalence was 16·6% (95% CI 15·89-17·22; 2306/13 901) in UKMenCar1 (1999), 17·6% (17·05-18·22; 2873/16 295) in UKMenCar2 (2000), and 18·7% (18·12-19·27; 3283/17 569) in UKMenCar3 (2001). Carriage prevalence was lower for all serogroups in UKMenCar4 than in UKMenCar1-3, except for serogroup Y, which was unchanged. The prevalence of carriage-promoting social behaviours decreased from 1999 to 2014-15, with individuals reporting regular cigarette smoking decreasing from 2932 (21·5%) of 13 650 to 2202 (11·2%) of 19 641, kissing in the past week from 6127 (44·8%) of 13 679 to 7320 (37·3%) of 19 641, and attendance at pubs and nightclubs in the past week from 8436 (62·1%) of 13 594 to 7662 (39·0%) of 19 641 (all p<0·0001). INTERPRETATION: We show that meningococcal carriage prevalence in adolescents sampled nationally during a low incidence period (2014-15) was less than half of that in an equivalent population during a high incidence period (1999-2001). Disease and carriage caused by serogroup C was well controlled by ongoing vaccination. The prevalence of behaviours associated with carriage declined, suggesting that public health policies aimed at influencing behaviour might have further reduced disease. FUNDING: Wellcome Trust, UK Department of Health, and National Institute for Health Research.


Assuntos
Portador Sadio/prevenção & controle , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas/imunologia , Adolescente , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Neisseria meningitidis , Neisseria meningitidis Sorogrupo C , Prevalência , Fatores de Risco , Sorogrupo , Reino Unido/epidemiologia , Vacinação , Adulto Jovem
6.
Am J Surg ; 221(4): 675-676, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33454024
7.
ACS Appl Mater Interfaces ; 11(44): 41347-41355, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31652047

RESUMO

The efficiency of a thermophotovoltaic (TPV) system depends critically upon the spectral selectivity and stability of an emitter, which may operate most effectively at temperatures in excess of 1000 °C. We computationally design and experimentally demonstrate a novel selective emitter design based on multilayer nanostructures, robust to off-normal emission angles. A computational search of the material and temperature compatibility space of simple emitter designs motivates new material classes and identifies several promising multilayer nanostructure designs for both TPV absorber and emitter applications. One such structure, comprising a thin (<100 nm) tunable TixAl1-xN (TiAlN) absorber and refractory oxide Bragg reflector is grown on W metal foil. In agreement with simulations, the emitter achieves record spectral efficiency (43.4%) and power density (3.6 W/cm2) for an emitter with at least 1 h of high temperature (>800 °C) operation.

8.
PLoS Genet ; 15(6): e1008177, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170160

RESUMO

During meiotic prophase I, double-strand breaks (DSBs) initiate homologous recombination leading to non-crossovers (NCOs) and crossovers (COs). In mouse, 10% of DSBs are designated to become COs, primarily through a pathway dependent on the MLH1-MLH3 heterodimer (MutLγ). Mlh3 contains an endonuclease domain that is critical for resolving COs in yeast. We generated a mouse (Mlh3DN/DN) harboring a mutation within this conserved domain that is predicted to generate a protein that is catalytically inert. Mlh3DN/DN males, like fully null Mlh3-/- males, have no spermatozoa and are infertile, yet spermatocytes have grossly normal DSBs and synapsis events in early prophase I. Unlike Mlh3-/- males, mutation of the endonuclease domain within MLH3 permits normal loading and frequency of MutLγ in pachynema. However, key DSB repair factors (RAD51) and mediators of CO pathway choice (BLM helicase) persist into pachynema in Mlh3DN/DN males, indicating a temporal delay in repair events and revealing a mechanism by which alternative DSB repair pathways may be selected. While Mlh3DN/DN spermatocytes retain only 22% of wildtype chiasmata counts, this frequency is greater than observed in Mlh3-/- males (10%), suggesting that the allele may permit partial endonuclease activity, or that other pathways can generate COs from these MutLγ-defined repair intermediates in Mlh3DN/DN males. Double mutant mice homozygous for the Mlh3DN/DN and Mus81-/- mutations show losses in chiasmata close to those observed in Mlh3-/- males, indicating that the MUS81-EME1-regulated crossover pathway can only partially account for the increased residual chiasmata in Mlh3DN/DN spermatocytes. Our data demonstrate that mouse spermatocytes bearing the MLH1-MLH3DN/DN complex display the proper loading of factors essential for CO resolution (MutSγ, CDK2, HEI10, MutLγ). Despite these functions, mice bearing the Mlh3DN/DN allele show defects in the repair of meiotic recombination intermediates and a loss of most chiasmata.


Assuntos
Proteínas de Ligação a DNA/genética , Endonucleases/genética , Prófase Meiótica I/genética , Proteínas MutL/genética , Animais , Pareamento Cromossômico/genética , Troca Genética , Quebras de DNA de Cadeia Dupla , Reparo do DNA/genética , Recombinação Homóloga/genética , Masculino , Meiose/genética , Camundongos , Proteína 1 Homóloga a MutL/genética , Proteínas MutS/genética , Rad51 Recombinase/genética , Espermatócitos/crescimento & desenvolvimento , Espermatócitos/metabolismo
9.
Echocardiography ; 35(12): 2047-2055, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30387206

RESUMO

We reviewed the role of transesophageal echocardiography (TEE) in the management of renal cell carcinoma (RCC) with associated tumor thrombus. Many consider intraoperative TEE as imperative in cases of Level 4 thrombi with atrial involvement, as well as in cases that require the use of cardiopulmonary bypass (CPB). However, the role of TEE in the surgical management of RCC with associated inferior vena cava (IVC) thrombus may expand beyond this subset. When performed after induction, TEE provides updated information regarding tumor thrombus staging, which is essential for optimal surgical planning. Furthermore, TEE provides feedback regarding properties of the thrombus, such as fragility and adherence, which may alter surgical technique. TEE can also be used intraoperatively for central venous line placement, to monitor cardiovascular and fluid status, to guide vascular clamp placement, and to ensure complete removal of the tumor thrombus. In some cases, the use of TEE allows for less morbid procedures and safe avoidance of CPB. We therefore recommend the use of preoperative TEE in all cases with a known tumor thrombus with discretion as to what extent TEE is used throughout the remainder of the case. Further investigation is necessary to elucidate the effect of TEE on patient outcomes, including surgical complication rates, morbidity and mortality of procedures, and cancer control.


Assuntos
Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/diagnóstico , Trombectomia/métodos , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/diagnóstico , Carcinoma de Células Renais/complicações , Ecocardiografia Transesofagiana/métodos , Humanos , Neoplasias Renais/complicações , Células Neoplásicas Circulantes , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
10.
J Surg Res ; 232: 271-274, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30463729

RESUMO

OBJECTIVES: Organ transplant volume is at an all-time high. Prospective applicants often utilize individual programs' websites for information when deciding if and where to apply for fellowship training. Accessibility and content from one program's website to the next is highly variable and may contribute to the selection of programs. The aim of this study was to evaluate the accessibility and content of abdominal transplant surgery fellowship websites. MATERIALS AND METHODS: The American Society of Transplant Surgeons (ASTS) website provides a complete list of abdominal transplant fellowship programs in the United States. A Google search was performed to determine the presence and accessibility of a program's website. Available websites were evaluated on the presence of 20 content criteria. RESULTS: Sixty-five programs in the United States were identified using the ASTS directory. Websites for fifty-one (78%) fellowship programs were identified. Three-fourths of websites contained 50% or less of the 20 evaluated data points, whereas 24% of websites contained 5 or less criteria. The most and least included data points were program description (100%) and on-call expectations (10%), respectively. CONCLUSIONS: The accessibility and content of a program's website is one major factor that can influence a potential applicant's decision on where to pursue transplant surgery fellowship training. This study revealed that a significant percentage of programs fail to provide a functional website. Of the fifty-one programs that did have websites, information deemed important to prospective applicants may be considered inadequate.


Assuntos
Abdome/cirurgia , Bolsas de Estudo , Internet , Transplante de Órgãos/educação , Cirurgiões/educação , Humanos , Estados Unidos
11.
Diabetes ; 67(12): 2657-2667, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30213823

RESUMO

Increasing evidence points to the fact that defects in the resolution of inflammatory pathways predisposes individuals to the development of chronic inflammatory diseases, including diabetic complications such as accelerated atherosclerosis. The resolution of inflammation is dynamically regulated by the production of endogenous modulators of inflammation, including lipoxin A4 (LXA4). Here, we explored the therapeutic potential of LXA4 and a synthetic LX analog (Benzo-LXA4) to modulate diabetic complications in the streptozotocin-induced diabetic ApoE-/- mouse and in human carotid plaque tissue ex vivo. The development of diabetes-induced aortic plaques and inflammatory responses of aortic tissue, including the expression of vcam-1, mcp-1, il-6, and il-1ß, was significantly attenuated by both LXA4 and Benzo-LXA4 in diabetic ApoE-/- mice. Importantly, in mice with established atherosclerosis, treatment with LXs for a 6-week period, initiated 10 weeks after diabetes onset, led to a significant reduction in aortic arch plaque development (19.22 ± 2.01% [diabetic]; 12.67 ± 1.68% [diabetic + LXA4]; 13.19 ± 1.97% [diabetic + Benzo-LXA4]). Secretome profiling of human carotid plaque explants treated with LXs indicated changes to proinflammatory cytokine release, including tumor necrosis factor-α and interleukin-1ß. LXs also inhibited platelet-derived growth factor-stimulated vascular smooth muscle cell proliferation and transmigration and endothelial cell inflammation. These data suggest that LXs may have therapeutic potential in the context of diabetes-associated vascular complications.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Aorta/efeitos dos fármacos , Aterosclerose/tratamento farmacológico , Diabetes Mellitus Experimental/tratamento farmacológico , Inflamação/tratamento farmacológico , Lipoxinas/uso terapêutico , Animais , Anti-Inflamatórios não Esteroides/farmacologia , Aterosclerose/etiologia , Quimiocina CCL2/metabolismo , Citocinas/metabolismo , Diabetes Mellitus Experimental/complicações , Humanos , Inflamação/etiologia , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Lipoxinas/farmacologia , Camundongos , Molécula 1 de Adesão de Célula Vascular/metabolismo
12.
J Am Soc Nephrol ; 29(5): 1437-1448, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29490938

RESUMO

Background The failure of spontaneous resolution underlies chronic inflammatory conditions, including microvascular complications of diabetes such as diabetic kidney disease. The identification of endogenously generated molecules that promote the physiologic resolution of inflammation suggests that these bioactions may have therapeutic potential in the context of chronic inflammation. Lipoxins (LXs) are lipid mediators that promote the resolution of inflammation.Methods We investigated the potential of LXA4 and a synthetic LX analog (Benzo-LXA4) as therapeutics in a murine model of diabetic kidney disease, ApoE-/- mice treated with streptozotocin.Results Intraperitoneal injection of LXs attenuated the development of diabetes-induced albuminuria, mesangial expansion, and collagen deposition. Notably, LXs administered 10 weeks after disease onset also attenuated established kidney disease, with evidence of preserved kidney function. Kidney transcriptome profiling defined a diabetic signature (725 genes; false discovery rate P≤0.05). Comparison of this murine gene signature with that of human diabetic kidney disease identified shared renal proinflammatory/profibrotic signals (TNF-α, IL-1ß, NF-κB). In diabetic mice, we identified 20 and 51 transcripts regulated by LXA4 and Benzo-LXA4, respectively, and pathway analysis identified established (TGF-ß1, PDGF, TNF-α, NF-κB) and novel (early growth response-1 [EGR-1]) networks activated in diabetes and regulated by LXs. In cultured human renal epithelial cells, treatment with LXs attenuated TNF-α-driven Egr-1 activation, and Egr-1 depletion prevented cellular responses to TGF-ß1 and TNF-αConclusions These data demonstrate that LXs can reverse established diabetic complications and support a therapeutic paradigm to promote the resolution of inflammation.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Nefropatias Diabéticas/tratamento farmacológico , Nefropatias Diabéticas/genética , Proteína 1 de Resposta de Crescimento Precoce/genética , Lipoxinas/uso terapêutico , Albuminúria/etiologia , Animais , Anti-Inflamatórios não Esteroides/farmacologia , Colágeno/metabolismo , Diabetes Mellitus Experimental , Nefropatias Diabéticas/complicações , Modelos Animais de Doenças , Regulação da Expressão Gênica/efeitos dos fármacos , Mesângio Glomerular/patologia , Humanos , Injeções Intraperitoneais , Lipoxinas/farmacologia , Masculino , Camundongos Knockout para ApoE , NF-kappa B/genética , Fator de Crescimento Derivado de Plaquetas/genética , Transcriptoma , Fator de Crescimento Transformador beta1/genética , Fator de Necrose Tumoral alfa/genética
13.
J Infect ; 76(2): 140-148, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29197599

RESUMO

OBJECTIVES: Carriers of Neisseria meningitidis are a key source of transmission. In the African meningitis belt, where risk of meningococcal disease is highest, a greater understanding of meningococcal carriage dynamics is needed. METHODS: We randomly selected an age-stratified sample of 400 residents from 116 households in Bamako, Mali, and collected pharyngeal swabs in May 2010. A month later, we enrolled all 202 residents of 20 of these households (6 with known carriers) and collected swabs monthly for 6 months prior to MenAfriVac vaccine introduction and returned 10 months later to collect swabs monthly for 3 months. We used standard bacteriological methods to identify N. meningitidis carriers and fit hidden Markov models to assess acquisition and clearance overall and by sex and age. RESULTS: During the cross-sectional study 5.0% of individuals (20/400) were carriers. During the longitudinal study, 73 carriage events were identified from 1422 swabs analyzed, and 16.3% of individuals (33/202) were identified as carriers at least once. The majority of isolates were non-groupable; no serogroup A carriers were identified. CONCLUSIONS: Our results suggest that the duration of carriage with any N. meningitidis averages 2.9 months and that males and children acquire and lose carriage more frequently in an urban setting in Mali. Our study informed the design of a larger study implemented in seven countries of the African meningitis belt.


Assuntos
Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Infecções Meningocócicas/epidemiologia , Neisseria meningitidis/isolamento & purificação , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Mali/epidemiologia , Programas de Rastreamento , Meningite Meningocócica/epidemiologia , Infecções Meningocócicas/transmissão , Neisseria meningitidis Sorogrupo A/isolamento & purificação , Faringe/microbiologia , Projetos Piloto , Adulto Jovem
14.
Diabetes ; 66(8): 2266-2277, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28487436

RESUMO

The let-7 miRNA family plays a key role in modulating inflammatory responses. Vascular smooth muscle cell (SMC) proliferation and endothelial cell (EC) dysfunction are critical in the pathogenesis of atherosclerosis, including in the setting of diabetes. Here we report that let-7 levels are decreased in diabetic human carotid plaques and in a model of diabetes-associated atherosclerosis, the diabetic ApoE-/- mouse. In vitro platelet-derived growth factor (PDGF)- and tumor necrosis factor-α (TNF-α)-induced vascular SMC and EC activation was associated with reduced let-7 miRNA expression via Lin28b, a negative regulator of let-7 biogenesis. Ectopic overexpression of let-7 in SMCs inhibited inflammatory responses including proliferation, migration, monocyte adhesion, and nuclear factor-κB activation. The therapeutic potential of restoring let-7 levels using a let-7 mimic was tested: in vitro in SMCs using an endogenous anti-inflammatory lipid (lipoxin A4), ex vivo in murine aortas, and in vivo via tail vein injection in a 24-h murine model. Furthermore, we delivered let-7 mimic to human carotid plaque ex vivo and observed significant changes to the secretome in response to let-7 therapy. Restoration of let-7 expression could provide a new target for an anti-inflammatory approach in diabetic vascular disease.


Assuntos
Aterosclerose/genética , Estenose das Carótidas/genética , Complicações do Diabetes/genética , MicroRNAs/metabolismo , Miócitos de Músculo Liso/metabolismo , Animais , Apolipoproteínas E/genética , Artérias Carótidas/citologia , Proliferação de Células/genética , Proteínas de Ligação a DNA/metabolismo , Células Endoteliais/metabolismo , Humanos , Inflamação/genética , Camundongos , Camundongos Endogâmicos NOD , MicroRNAs/administração & dosagem , Músculo Liso Vascular/citologia , Fator de Crescimento Derivado de Plaquetas/metabolismo , Proteínas de Ligação a RNA , Fator de Necrose Tumoral alfa/metabolismo
15.
Carbohydr Polym ; 164: 162-169, 2017 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-28325313

RESUMO

Ostensibly hydrophilic alginates are known to foul hydrophobic membranes, under various conditions. Here, controlled experiments have been conducted at high and low pH on the fouling of a polypropylene membrane by alginate and the results suggest that the observed fouling is due to an intrinsic property of the alginate. Thus quantum chemical calculations on the M and G monomers of alginate reveal that M adopts an equilibrium geometry that is hydrophilic on one face and hydrophobic on the other, i.e. is potentially amphiphilic. Molecular dynamics simulations on short alginate chains of different sequences interacting with a modelled polypropylene surface, show that this characteristic is carried over to the polymer and results in hydrophobic patches along the chain that facilitate attractive interactions with the polypropylene surface. This concept is buttressed by an analysis of the binding characteristics of a previously reported X-ray structure of the mannuronan C-5 epimerase AlgE4 enzyme.

16.
Hepatol Commun ; 1(4): 338-346, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-29404463

RESUMO

Transarterial chemoembolization (TACE) is the most common oncologic therapy used according to the American Association for the Study of Liver Diseases (AASLD) guidelines established in 2005, revised in 2011. The purpose of this study was to determine how AASLD criteria for the management of hepatocellular carcinoma (HCC) have impacted TACE practice in the community. Clinical, demographic, and cause of death information were collected for patients diagnosed with HCC in the 2012 linkage of the Surveillance, Epidemiology, and End Results Medicare database. Propensity score survival analysis was used to compare survival outcomes in patients whose HCC tumor characteristics were less than, met, or were beyond AASLD criteria. The proportion of patients with HCC receiving TACE who met the AASLD-recommended criteria increased after the 2005 guidelines were published. Up to 17% of patients treated with TACE had tumor characteristics less than the AASLD criteria and were not offered potentially curative therapies. Propensity score matching demonstrated the largest survival advantage in patients with HCC whose tumor characteristics met the AASLD criteria (hazard ratio, 0.42; 95% confidence interval, 0.38-0.47). A significant survival advantage was also observed in patients with HCC whose tumor characteristics exceeded the AASLD criteria. Conclusion: The AASLD criteria successfully identify a population of patients with HCC that maximally benefit from TACE therapy. However, patients with HCC with tumor characteristics beyond the AASLD criteria also appear to receive a significant survival advantage with TACE. Further studies are necessary to improve referral patterns and appropriate use of chemoembolization in the management of unresectable HCC. (Hepatology Communications 2017;1:338-346).

17.
J Vasc Interv Radiol ; 28(2): 231-237.e2, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27939085

RESUMO

PURPOSE: To measure transarterial chemoembolization utilization and survival benefit among patients with hepatocellular carcinoma (HCC) in the Surveillance, Epidemiology, and End Results (SEER) patient population. MATERIALS AND METHODS: A retrospective study identified 37,832 patients with HCC diagnosed between 1991 and 2011. Survival was estimated by Kaplan-Meier method and compared by log-rank test. Propensity-score matching was used to address an imbalance of covariates. RESULTS: More than 75% of patients with HCC did not receive any HCC-directed treatment. Transarterial chemoembolization was the most common initial therapy (15.9%). Factors associated with the use of chemoembolization included younger age, more HCC risk factors, more comorbidities, higher socioeconomic status, intrahepatic tumor, unifocal tumor, vascular invasion, and smaller tumor size (all P < .001). Median survival was improved in patients treated with chemoembolization compared with those not treated with chemoembolization (20.1 vs 4.3 mo; P < .0001). Similar findings were demonstrated in propensity-scoring analysis (14.5 vs 4.2 mo; P < .0001) and immortal time bias sensitivity analysis (9.5 vs 3.6 mo; P < .0001). There was a significantly improved survival hazard ratio (HR) in patients treated with chemoembolization (HR, 0.42; 95% confidence interval, 0.39-0.45). CONCLUSIONS: Patients with HCC treated with transarterial chemoembolization experienced a significant survival advantage compared with those not treated with transarterial chemoembolization. More than 75% of SEER/Medicare patients diagnosed with HCC received no identifiable oncologic treatment. There is a significant public health need to increase awareness of efficacious HCC treatments such as transarterial chemoembolization.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/tendências , Neoplasias Hepáticas/terapia , Padrões de Prática Médica/tendências , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/mortalidade , Quimioembolização Terapêutica/estatística & dados numéricos , Distribuição de Qui-Quadrado , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Modelos Logísticos , Masculino , Medicare , Seleção de Pacientes , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Programa de SEER , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
18.
Ann Thorac Surg ; 103(2): 541-545, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27623271

RESUMO

BACKGROUND: There is a paucity of information available regarding the impact of cardiac surgical procedures on patients who have undergone previous liver transplantation. The primary purpose of this study was to ascertain the survival rate and predictors of death in this specific patient population. METHODS: This retrospective cohort study consisted of a consecutive series of patients with a functioning liver allograft who subsequently underwent cardiac surgical procedures between January 1991 and December 2012. The optimal Model for End-Stage Liver Disease (MELD) score for predicting late death was identified using receiver operating characteristic curve analysis. Risk of postoperative death was determined by parametric hazard analysis. RESULTS: Between January 1991 and December 2012, 43 patients (median age, 60 years) underwent cardiac surgical procedures after liver transplantation. The median interval between liver transplant and cardiac operation was 63 months (range, 1.1 to 217 months). Three operative deaths and 24 late deaths occurred. Receiver operating characteristic curve analysis identified the optimal preoperative and postoperative MELD score cut points for predicting late death as greater than 13.8 (area under the curve = 0.674) and greater than 17 (area under the curve = 0.633), respectively. Patients with a preoperative MELD score of 13.8 or less had significantly greater survival rates than those with a MELD score greater than 13.8 (p = 0.028); patients with a postoperative MELD score of 17 of less had significantly greater survival rates than those with a MELD score greater than 17 (p < 0.001). Multivariate parametric hazard analysis identified postoperative peak creatinine level as a statistically significant predictor of death (relative risk, 1.8; p = 0.01). The 1-, 5-, and 10-year Kaplan-Meier survival rates were 90%, 51%, and 35%, respectively; postoperative mortality rates followed a constant phase model with a hazard of death of 10% per year. CONCLUSIONS: Cardiac surgical procedures can be performed with acceptable short-term and long-term outcomes in liver transplant recipients. Elevated preoperative and postoperative MELD scores and postoperative peak creatinine level may portend death in this cohort. There is a constant hazard of death of 10% per year.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/métodos , Causas de Morte , Transplante de Fígado/mortalidade , Transplante de Fígado/métodos , Adulto , Idoso , Aloenxertos , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
19.
Free Radic Biol Med ; 97: 556-567, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27445103

RESUMO

Smooth muscle cell (SMC) proliferation and fibrosis contribute to the development of advanced atherosclerotic lesions. Oxidative stress caused by increased production or unphysiological location of reactive oxygen species (ROS) is a known major pathomechanism. However, in atherosclerosis, in particular under hyperglycaemic/diabetic conditions, the hydrogen peroxide-producing NADPH oxidase type 4 (NOX4) is protective. Here we aim to elucidate the mechanisms underlying this paradoxical atheroprotection of vascular smooth muscle NOX4 under conditions of normo- and hyperglycaemia both in vivo and ex vivo. Following 20-weeks of streptozotocin-induced diabetes, Apoe(-/-) mice showed a reduction in SM-alpha-actin and calponin gene expression with concomitant increases in platelet-derived growth factor (PDGF), osteopontin (OPN) and the extracellular matrix (ECM) protein fibronectin when compared to non-diabetic controls. Genetic deletion of Nox4 (Nox4(-/)(-)Apoe(-/-)) exacerbated diabetes-induced expression of PDGF, OPN, collagen I, and proliferation marker Ki67. Aortic SMCs isolated from NOX4-deficient mice exhibited a dedifferentiated phenotype including loss of contractile gene expression, increased proliferation and ECM production as well as elevated levels of NOX1-associated ROS. Mechanistic studies revealed that elevated PDGF signalling in NOX4-deficient SMCs mediated the loss of calponin and increase in fibronectin, while the upregulation of NOX1 was associated with the increased expression of OPN and markers of proliferation. These findings demonstrate that NOX4 actively regulates SMC pathophysiological responses in diabetic Apoe(-/-) mice and in primary mouse SMCs through the activities of PDGF and NOX1.


Assuntos
Aterosclerose/enzimologia , Diabetes Mellitus Experimental/enzimologia , Miócitos de Músculo Liso/fisiologia , NADPH Oxidase 4/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Animais , Aorta/metabolismo , Aorta/patologia , Aterosclerose/etiologia , Aterosclerose/patologia , Becaplermina , Proliferação de Células , Células Cultivadas , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/patologia , Fibrose , Masculino , Camundongos da Linhagem 129 , Camundongos Endogâmicos C57BL , Camundongos Knockout , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patologia , NADPH Oxidase 1/metabolismo , NADPH Oxidase 4/genética , Osteopontina/genética , Osteopontina/metabolismo , Proteínas Proto-Oncogênicas c-sis/genética , Proteínas Proto-Oncogênicas c-sis/metabolismo , Superóxidos/metabolismo
20.
Clin Sci (Lond) ; 130(15): 1363-74, 2016 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-27190136

RESUMO

Oxidative stress and inflammation are central mediators of atherosclerosis particularly in the context of diabetes. The potential interactions between the major producers of vascular reactive oxygen species (ROS), NADPH oxidase (NOX) enzymes and immune-inflammatory processes remain to be fully elucidated. In the present study we investigated the roles of the NADPH oxidase subunit isoforms, NOX4 and NOX1, in immune cell activation and recruitment to the aortic sinus atherosclerotic plaque in diabetic ApoE(-/-) mice. Plaque area analysis showed that NOX4- and NOX1-derived ROS contribute to atherosclerosis in the aortic sinus following 10 weeks of diabetes. Immunohistochemical staining of the plaques revealed that NOX4-derived ROS regulate T-cell recruitment. In addition, NOX4-deficient mice showed a reduction in activated CD4(+) T-cells in the draining lymph nodes of the aortic sinus coupled with reduced pro-inflammatory gene expression in the aortic sinus. Conversely, NOX1-derived ROS appeared to play a more important role in macrophage accumulation. These findings demonstrate distinct roles for NOX4 and NOX1 in immune-inflammatory responses that drive atherosclerosis in the aortic sinus of diabetic mice.


Assuntos
Aortite/enzimologia , Apolipoproteínas E/deficiência , Aterosclerose/enzimologia , Diabetes Mellitus Experimental/enzimologia , Imunidade Celular , NADH NADPH Oxirredutases/metabolismo , NADPH Oxidases/metabolismo , Seio Aórtico/enzimologia , Animais , Aortite/genética , Aortite/imunologia , Aortite/patologia , Apolipoproteínas E/genética , Aterosclerose/genética , Aterosclerose/imunologia , Aterosclerose/patologia , Linfócitos T CD4-Positivos/enzimologia , Linfócitos T CD4-Positivos/imunologia , Quimiotaxia de Leucócito , Citocinas/imunologia , Citocinas/metabolismo , Diabetes Mellitus Experimental/genética , Diabetes Mellitus Experimental/imunologia , Diabetes Mellitus Experimental/patologia , Predisposição Genética para Doença , Mediadores da Inflamação/imunologia , Mediadores da Inflamação/metabolismo , Macrófagos/enzimologia , Macrófagos/imunologia , Camundongos Knockout , NADH NADPH Oxirredutases/deficiência , NADH NADPH Oxirredutases/genética , NADPH Oxidase 1 , NADPH Oxidase 4 , NADPH Oxidases/deficiência , NADPH Oxidases/genética , Estresse Oxidativo , Fenótipo , Placa Aterosclerótica , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais , Seio Aórtico/imunologia , Seio Aórtico/patologia
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