RESUMO
BACKGROUND AND AIM: Longer diagnostic delay (DD) in Crohn's disease (CD) is associated with complications and related surgeries. However, the impact of DD on medical cost after CD diagnosis remains uncertain. METHODS: This was a claims-based cohort study. Our analysis used data from 2005 to 2018 from the Japanese Claims Database. We enrolled a total of 528 newly diagnosed CD patients (76.9% male) aged 31.5 ± 13.6 years. High medical cost was defined as the highest quartile of the average monthly medical cost. DD was defined as the interval between the first visit to a gastroenterologist and diagnosis with CD. In the multivariable logistic regression analysis, patients were stratified by the use of anti-tumor necrosis factor alpha (anti-TNFα) agents to exclude their influence on the observed effects. This study was approved by the ethics review board of the Juntendo University Faculty of Medicine (No. 2019178). RESULTS: The multivariable-adjusted odds ratios and 95% confidence intervals of high medical cost were 1.41 (0.81-2.43) and 0.91 (0.57-1.46), respectively, for a DD of >12 months and 1 to ≤12 months compared to <1 month. In patients receiving anti-TNFα agents, the multivariable-adjusted odds ratios for high medical cost were 2.63 (1.34-5.16) and 1.35 (0.79-2.28) for a DD of >12 months and 1 to ≤12 months, respectively, compared to <1 month. In patients without anti-TNFα, multivariable logistic regression analyses were not presented because of a small number of patients categorized into the high medical cost group. CONCLUSION: A delayed diagnosis of CD may incur high medical cost in patients who develop aggressive disease that requires treatment with anti-TNFα agents.
RESUMO
Several studies have indicated that one of the causes of alveolar bone destruction with periodontitis is lipopolysaccharide (LPS) from the cell wall of Gram-negative bacteria in plaque and that tobacco smoking may be an important risk factor for the development and severity of periodontitis. The present study was undertaken to determine the effect of nicotine and LPS on the expression of macrophage colony-stimulating factor (M-CSF), osteoprotegerin (OPG), and prostaglandin E2 (PGE2) in osteoblasts, and the indirect effect of nicotine and LPS on the formation of osteoclast-like cells. Saos-2 cells were cultured with 10(-3) M nicotine, or 1 or 10 microg/ml LPS and 10(-3) M nicotine, for up to 14 days. The gene and protein expression of M-CSF and OPG were determined using real-time PCR and ELISA, respectively. PGE2 expression was determined using ELISA. The formation of osteoclast-like cells was estimated using tartrate-resistant acid phosphatase (TRAP) staining of osteoclast precursors in culture with conditioned medium from nicotine and LPS-treated Saos-2 cells and the soluble receptor activator of NF-kappaB ligand (RANKL). M-CSF and PGE2 expression increased markedly in cells cultured with nicotine and LPS compared with those cultured with nicotine alone. OPG expression increased in the initial stages of culture with nicotine and LPS but decreased in the later stages of culture. The conditioned medium containing M-CSF and PGE2 produced by nicotine and LPS-treated Saos-2 cells with soluble RANKL increased the TRAP staining of osteoclast precursors compared with that produced by nicotine treatment alone. These results suggest that nicotine and LPS stimulate the formation of osteoclast-like cells via an increase in M-CSF and PGE2 production and that the stimulation is greater than with nicotine treatment alone.
Assuntos
Dinoprostona/metabolismo , Lipopolissacarídeos/toxicidade , Fator Estimulador de Colônias de Macrófagos/metabolismo , Nicotina/toxicidade , Osteoblastos/efeitos dos fármacos , Osteoclastos/efeitos dos fármacos , Fosfatase Alcalina/metabolismo , Animais , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Ensaio de Imunoadsorção Enzimática , Escherichia coli/química , Expressão Gênica/efeitos dos fármacos , Glicoproteínas/genética , Glicoproteínas/metabolismo , Humanos , Lipopolissacarídeos/isolamento & purificação , Fator Estimulador de Colônias de Macrófagos/genética , Camundongos , Osteoblastos/citologia , Osteoblastos/metabolismo , Osteoclastos/citologia , Osteoclastos/metabolismo , Osteoprotegerina , Receptores Citoplasmáticos e Nucleares/genética , Receptores Citoplasmáticos e Nucleares/metabolismo , Receptores do Fator de Necrose Tumoral/genética , Receptores do Fator de Necrose Tumoral/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Dentro do Projeto Medicina Popular, lançado pela Fundaçäo Projeto Rondon em 1985, desenvolveu-se juntamente com a Universidade do Sagrado Coraçäo um trabalho visando extrair o máximo de informaçöes sobre as propriedades farmacológicas e nutricionais das espécies nativas existentes nos cerrados do município de Bauru - SP. Esta primeira comunicaçäo, além da apresentaçäo do programa, inclui também os primeiros resultados do programa, inclui também os primeiros resultados da pesquisa bibliográfica feita com o pequi (Caryocar brasiliense Camb.)