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1.
Breast ; 52: 95-101, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32485607

RESUMO

BACKGROUND: Serum tumour markers, cancer antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA) are not routinely recommended for detecting breast cancer recurrence and monitoring treatment. In this study, we aim to evaluate the diagnostic accuracy of absolute CA 15-3 and CEA levels and report on the clinical utility of tumour marker velocity in breast cancer surveillance. METHODS: 67 consecutive patients over a 15-year period (1998-2012) with available serial serum CA 15-3 and CEA measurements at recurrence were matched to a control group of patients. Tumour marker velocity was derived from the average change in consecutive tumour marker values over time, expressed in unit/year. Logistic regression analysis was performed to investigate the association between tumour characteristics, tumour marker velocity and disease recurrence. RESULTS: Using the Youden index values, the optimal cut-off values for absolute CA 15-3 and CEA corresponded to the normal assay reference range while tumour marker velocity values were derived to be 2.5U/mL/year and 1.2ng/mL/year respectively. CA 15-3 velocity > 2.5U/mL/year had the highest AUROC value of 0.85 than CEA velocity alone. When either tumour marker velocity exceeded threshold values, the sensitivity, specificity, negative predictive value and positive predictive value were 94.0%, 73.1%, 92.5%, and 77.8% respectively. In the multivariate logistic regression analysis, having both CA 15-3 and CEA velocity exceeding the cut-off values was shown to be a significant predictor for disease recurrence (p = 0.01). CONCLUSION: These findings highlighted the clinical utility of serial tumour markers measurements and its velocity in breast cancer surveillance.


Assuntos
Neoplasias da Mama/química , Antígeno Carcinoembrionário/sangue , Mucina-1/sangue , Recidiva Local de Neoplasia/química , Adulto , Idoso , Biomarcadores Tumorais/sangue , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade
2.
East Asian Arch Psychiatry ; 29(3): 95-96, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31566186

RESUMO

We report a case of anti-voltage-gated potassium channel (VGKC) limbic encephalitis in a 47-year-old man presenting with a 2-year history of psychiatric features. The patient had cognitive impairment, slurred speech, and a mildly unsteady gait but no other neurological deficits or seizures. Results of blood, urine, and cerebrospinal fluid tests and magnetic resonance imaging of the brain were normal. However, electroencephalography showed an epileptogenic focus in the bilateral temporal regions with mild to moderate diffuse encephalopathy. Autoimmune panel results confirmed the diagnosis of anti-VGKC limbic encephalitis, with a serum VGKC concentration of 6730 pmol/L. The patient was treated with Keppra and pulsed intravenous methylprednisolone for 3 days, and his behaviour improved.


Assuntos
Encefalite Límbica/psicologia , Autoanticorpos/sangue , Encéfalo/patologia , Encefalopatias/complicações , Disfunção Cognitiva/complicações , Eletroencefalografia , Humanos , Encefalite Límbica/complicações , Encefalite Límbica/imunologia , Encefalite Límbica/patologia , Masculino , Pessoa de Meia-Idade , Canais de Potássio de Abertura Dependente da Tensão da Membrana/sangue , Canais de Potássio de Abertura Dependente da Tensão da Membrana/imunologia
3.
BJS Open ; 3(4): 445-452, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31388636

RESUMO

Background: The aim of this network meta-analysis was to compare the performance of blue dye alone or in combination with radioisotope (technetium-99m, Tc) with three novel techniques for sentinel lymph node detection in breast cancer: indocyanine green fluorescence (ICG), superparamagnetic iron oxide (SPIO) nanoparticles and contrast-enhanced ultrasound imaging (CEUS). Methods: PubMed, Embase, the Cochrane Library, China Knowledge Research Integrated Database, ClinicalTrials.gov and OpenGrey databases were searched up to 31 November 2017, without language restriction. Studies that compared the detection performance of at least one of the novel methods (ICG, SPIO and CEUS) with that of traditional methods (blue dye and/or radioisotope) were included in network meta-analysis. Results: Thirty-five studies were included. Pooled risk ratios (RRs) for Tc (1·09, 95 per cent c.i. 1·04 to 1·15), ICG (1·12, 1·07 to 1·16) and SPIO (1·09, 1·01 to 1·18) showed statistically better performance in detecting sentinel lymph nodes than blue dye alone. ICG had the lowest false-negative rate, with a RR of 0·29 (0·16 to 0·54), followed by Tc (RR 0·44, 0·20 to 0·96) and SPIO (RR 0·45, 0·14 to 1·45), with blue dye alone as the reference group. Conclusion: SPIO or ICG alone are superior to blue dye alone and comparable to the standard dual-modality technique of blue dye with Tc.


Assuntos
Neoplasias da Mama , Mama , Biópsia de Linfonodo Sentinela , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Corantes/uso terapêutico , Feminino , Humanos , Verde de Indocianina/uso terapêutico , Nanopartículas de Magnetita/uso terapêutico , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Biópsia de Linfonodo Sentinela/métodos , Biópsia de Linfonodo Sentinela/estatística & dados numéricos
4.
Oncogene ; 35(2): 158-72, 2016 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-25798844

RESUMO

The miR-200 family promotes the epithelial state by suppressing the Zeb1/Zeb2 epithelial gene transcriptional repressors. To identify other miR-200-regulated genes, we isolated mRNAs bound to transfected biotinylated miR-200c in mouse breast cancer cells. In all, 520 mRNAs were significantly enriched in miR-200c binding at least twofold. Putative miR-200-regulated genes included Zeb2, enriched 3.5-fold in the pull down. However, Zeb2 knockdown does not fully recapitulate miR-200c overexpression, suggesting that regulating other miR-200 targets contributes to miR-200's enhancement of epithelial gene expression. Candidate genes were highly enriched for miR-200c seed pairing in their 3'UTR and coding sequence and for genes that were downregulated by miR-200c overexpression. Epidermal growth factor receptor and downstream MAPK signaling pathways were the most enriched pathways. Genes whose products mediate transforming growth factor (TGF)-ß signaling were also significantly overrepresented, and miR-200 counteracted the suppressive effects of TGF-ß and bone morphogenic protein 2 (BMP-2) on epithelial gene expression. miR-200c regulated the 3'UTRs of 12 of 14 putative miR-200c-binding mRNAs tested. The extent of mRNA binding to miR-200c strongly correlated with gene suppression. Twelve targets of miR-200c (Crtap, Fhod1, Smad2, Map3k1, Tob1, Ywhag/14-3-3γ, Ywhab/14-3-3ß, Smad5, Zfp36, Xbp1, Mapk12, Snail1) were experimentally validated by identifying their 3'UTR miR-200 recognition elements. Smad2 and Smad5 form a complex with Zeb2 and Ywhab/14-3-3ß and Ywhag/14-3-3γ form a complex with Snail1. These complexes that repress transcription assemble on epithelial gene promoters. miR-200 overexpression induced RNA polymerase II localization and reduced Zeb2 and Snail1 binding to epithelial gene promoters. Expression of miR-200-resistant Smad5 modestly, but significantly, reduced epithelial gene induction by miR-200. miR-200 expression and Zeb2 knockdown are known to inhibit cell invasion in in vitro assays. Knockdown of each of three novel miR-200 target genes identified here, Smad5, Ywhag and Crtap, also profoundly suppressed cell invasion. Thus, miR-200 suppresses TGF-ß/BMP signaling, promotes epithelial gene expression and suppresses cell invasion by regulating a network of genes.


Assuntos
Neoplasias da Mama/genética , Transição Epitelial-Mesenquimal/genética , Proteínas de Homeodomínio/genética , MicroRNAs/genética , Proteínas Repressoras/genética , Fatores de Transcrição/genética , Regiões 3' não Traduzidas , Animais , Proteína Morfogenética Óssea 2/metabolismo , Proteína Morfogenética Óssea 2/farmacologia , Neoplasias da Mama/patologia , Caderinas/genética , Caderinas/metabolismo , Linhagem Celular Tumoral , Transição Epitelial-Mesenquimal/efeitos dos fármacos , Feminino , Regulação Neoplásica da Expressão Gênica , Redes Reguladoras de Genes , Proteínas de Homeodomínio/metabolismo , Camundongos , Células NIH 3T3 , Proteínas Repressoras/metabolismo , Fatores de Transcrição da Família Snail , Fatores de Transcrição/metabolismo , Fator de Crescimento Transformador beta/metabolismo , Fator de Crescimento Transformador beta/farmacologia , Homeobox 2 de Ligação a E-box com Dedos de Zinco
5.
Nat Commun ; 4: 1673, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23575677

RESUMO

The use of nanomaterials has raised safety concerns, as their small size facilitates accumulation in and interaction with biological tissues. Here we show that exposure of endothelial cells to TiO2 nanomaterials causes endothelial cell leakiness. This effect is caused by the physical interaction between TiO2 nanomaterials and endothelial cells' adherens junction protein VE-cadherin. As a result, VE-cadherin is phosphorylated at intracellular residues (Y658 and Y731), and the interaction between VE-cadherin and p120 as well as ß-catenin is lost. The resulting signalling cascade promotes actin remodelling, as well as internalization and degradation of VE-cadherin. We show that injections of TiO2 nanomaterials cause leakiness of subcutaneous blood vessels in mice and, in a melanoma-lung metastasis mouse model, increase the number of pulmonary metastases. Our findings uncover a novel non-receptor-mediated mechanism by which nanomaterials trigger intracellular signalling cascades via specific interaction with VE-cadherin, resulting in nanomaterial-induced endothelial cell leakiness.


Assuntos
Antígenos CD/metabolismo , Caderinas/metabolismo , Permeabilidade Capilar/efeitos dos fármacos , Endotélio Vascular/efeitos dos fármacos , Nanoestruturas , Titânio/farmacologia , Animais , Apoptose , Endotélio Vascular/citologia , Endotélio Vascular/metabolismo , Camundongos , Camundongos Endogâmicos BALB C , Estresse Oxidativo
6.
Singapore Med J ; 50(2): 132-8, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19296027

RESUMO

INTRODUCTION: The incidence of breast cancer in Asia is rapidly rising. Knowledge and perception often influence attendance at screening programmes. However, there has not been any survey to assess the level of knowledge of breast cancer in an Asian population. Singapore has a multiracial population and is the only Asian country with a national screening programme. We conducted a survey on 1,000 women to assess their level of knowledge and screening practices. METHODS: A self-administered questionnaire was used, where one point was given for a correct answer and zero for an incorrect / "not sure" response. The maximum knowledge score was 19. The women were also surveyed for their screening practices. Points were not assigned to questions on practice. RESULTS: The response rate was 100 percent. The mean score was 11.4 and the median was 12 (range 0-19). The scores were high for general knowledge and disease progression, but poor for risk factors, screening, symptoms and treatment. Several myths and misconceptions were prevalent. Only 53 percent did regular breast self-examination (BSE), while 57 percent of women aged 40 years and above had gone for a screening mammogram. Increasing age, Malay race, lower educational level, lower socioeconomic class and not knowing anyone with breast cancer were significant independent predictors of poor knowledge. Higher educational level and knowledge scores were significant independent predictors of BSE practice and screening mammogram attendance. CONCLUSION: Knowledge affects practice. Public education is required to correct misconceptions and focus on women with poor knowledge. This would help to improve screening attendance rates.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Autoexame de Mama , Adulto , Idoso , Povo Asiático , Detecção Precoce de Câncer , Feminino , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Educação de Pacientes como Assunto , Singapura , Inquéritos e Questionários
7.
Bone Marrow Transplant ; 43(5): 399-410, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19139738

RESUMO

The GVL effect following allo-SCT is one of the most prominent examples showing the ability of the immune system to eliminate malignant hematological diseases. Tumor-associated Ags (TAA), for instance WT1 and proteinase-3, have been proposed as targets for T cells to establish a GVL effect. Here, we examined an additional TAA (MUC1) as a possible T-cell target of GVL-related immune responses. We have defined new peptide epitopes from the MUC1 Ag to broaden patients' screening and to expand the repertoire of immunologic monitoring as well as for therapeutic approaches in the future. Twenty-eight patients after allo-SCT have been screened for T-cell responses toward TAA (proteinase-3, WT1, MUC1). We could detect a significant relationship between relapse and the absence of a TAA-specific T-cell response, whereby only 2/13 (15%) patients with TAA-specific CTL relapsed, in contrast to 9/15 (60%) patients without TAA-specific CTL responses (P<0.05). In conclusion, CD8(+) T-cell responses directed to TAA might contribute to the GVL effect. These observations highlight both the importance and the potential of immunotherapeutic approaches after allo-SCT.


Assuntos
Antígenos de Neoplasias/imunologia , Linfócitos T CD8-Positivos/imunologia , Transplante de Células-Tronco Hematopoéticas , Citomegalovirus/imunologia , Epitopos , Efeito Enxerto vs Leucemia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Antígenos de Histocompatibilidade Classe I/imunologia , Humanos , Leucemia Mieloide Aguda/mortalidade , Leucemia Mieloide Aguda/terapia , Mucina-1/imunologia , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/terapia , Recidiva , Transplante Homólogo
8.
Singapore Med J ; 49(3): e82-5, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18362994

RESUMO

Pseudoangiomatous stromal hyperplasia of the breast is a benign entity characterised by dense, collagenous proliferation of mammary stroma, forming interanastomosing capillary-like spaces lined by slender spindle cells. These spaces are not true vascular spaces, hence the term "pseudoangiomatous". We report two 14-year-old girls, who presented to us with pseudoangiomatous stromal hyperplasia of the breast. We believe that our patients represent two of the youngest ethnic Chinese females to be reported with this rare condition. The development of such a rapidly enlarging lesion often leads to anxiety and concern about malignancy, and emphasises the importance in appropriate diagnosis and management. We discuss the aetiology, clinical presentation, radiological and pathological features, as well as management of this unusual condition.


Assuntos
Angiomatose/diagnóstico , Doenças Mamárias/diagnóstico , Células Estromais/patologia , Adolescente , Angiomatose/diagnóstico por imagem , Angiomatose/patologia , Angiomatose/cirurgia , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Doenças Mamárias/cirurgia , Neoplasias da Mama/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Hiperplasia/diagnóstico , Mamoplastia , Radiografia
9.
Breast ; 17(3): 252-7, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18054231

RESUMO

Ultrasound elastography using the extended combined auto-correlation method of tissue elasticity allows for real-time strain image visualisation using a free-hand probe with concurrent conventional B mode imaging. Four hundred and fifteen consecutive women with 550 breast lesions confirmed on B mode ultrasound were assessed with elastography using the elasticity score. There were 119 malignant and 431 benign lesions. The elastography sensitivity was 78.0%, specificity was 98.5% and overall accuracy was 93.8%. The median score for malignancy was 5 and that for benign lesions was 2. There was good correlation with B mode BIRADS category. 98.6% of lesions with an elasticity score of 2 or below (95%CI=96.8-99.4) were benign. BIRADS 3 lesions with an elasticity score of 2 or below may be re-classified as BIRADS 2 lesions. We found that 15.3% of BIRADS 2 and 3 lesions with an elasticity score of 3 were malignant. Real-time ultrasound elastography is user-friendly with a high accuracy rate, thereby improving B mode ultrasound assessment.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Ultrassonografia Mamária/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Lobular/diagnóstico por imagem , Sistemas Computacionais , Feminino , Humanos , Pessoa de Meia-Idade , Palpação , Sarcoma/diagnóstico por imagem , Sensibilidade e Especificidade
10.
Cytotherapy ; 9(8): 699-711, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17917875

RESUMO

Human cytomegalovirus (HCMV) infection or reactivation is a frequent cause of morbidity and mortality in immunocompromised individuals such as transplant recipients. Primary HCMV infection or reactivation of HCMV from latency is mostly asymptomatic in immunocompetent individuals and is controlled by the host's cell-mediated immune response. Healthy HCMV seropositive individuals develop high frequencies of HCMV-specific cytotoxic T lymphocytes (CTL) in the peripheral blood. Furthermore, a direct correlation between the recovery of HCMV-specific CTL responses and an improved outcome of HCMV disease could be demonstrated in immunocompromised patients. Deriving from these observations, the strategy of an adoptive transfer of HCMV-specific T cells has been developed. Protective immunity can be transferred successfully by the infusion of donor-derived HCMV-specific CD8+ cytotoxic T-cell clones or cell lines. In addition, several studies have supported the importance of antiviral effector functions of Th cells in maintaining CTL responses after adoptive transfer and their capacity to produce antiviral cytokines. Until today, a broad variety of clinical protocols for HCMV-specific immunotherapy has been published. These protocols vary regarding the isolation procedure, composition of cellular product, number of transferred cells and thus treatment efficacy. In this review, we aim to provide a comprehensive synopsis of the current standard of knowledge concerning cellular HCMV-specific immunotherapeutic approaches.


Assuntos
Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/terapia , Citomegalovirus , Hospedeiro Imunocomprometido , Imunoterapia Adotiva , Subpopulações de Linfócitos T/imunologia , Linfócitos T Citotóxicos/imunologia , Apresentação de Antígeno , Antígenos Virais/imunologia , Doença Enxerto-Hospedeiro/imunologia , Doença Enxerto-Hospedeiro/prevenção & controle , Humanos , Imunoterapia Adotiva/efeitos adversos , Imunoterapia Adotiva/métodos , Imunoterapia Adotiva/tendências , Ativação Linfocitária , Complexo Principal de Histocompatibilidade/imunologia , Transplante de Células-Tronco
12.
Singapore Med J ; 48(2): 158-62, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17304397

RESUMO

INTRODUCTION: Health professionals are a direct source of medical information to the public. Hence, it is crucial that their knowledge is accurate and aids in building awareness. Our aim was to ascertain the level of breast cancer knowledge and screening practices among nurses in a general hospital. METHODS: Between January and April 2004, all registered nurses in a general hospital were surveyed by a self-administered questionnaire for their knowledge of breast cancer and screening practices. One point was given for a correct knowledge answer and zero for wrong/"not sure" answer. The maximum knowledge score was 19. RESULTS: There were 716 (79.4 percent) respondents. The median score was 16 (range 2-19). The scores were high for general knowledge and natural disease progression, fair for knowledge of symptoms and treatment, but dropped when it came to knowledge of risk factors and screening. Nurses also held several common misconceptions held by the public. Those who had managed breast cancer patients had higher total scores (15.7). Only 63 percent did regular breast self-examination (BSE) and only 35 percent had gone for a screening mammogram. Chinese nurses who had managed breast cancer patients were more likely to do regular BSE. CONCLUSION: Nurses working in a general hospital had good knowledge of breast cancer progression, average understanding of symptoms and treatment, but lacked knowledge in risk factors and screening. They had low BSE and mammographic screening rates. Experience in managing breast cancer patients improved their knowledge and practices.


Assuntos
Neoplasias da Mama/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Recursos Humanos de Enfermagem Hospitalar , Adulto , Autoexame de Mama/estatística & dados numéricos , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
Breast ; 16(2): 113-9, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17081753

RESUMO

Nationwide breast cancer screening with mammography is well-established in many western countries. Many studies have shown its benefit in mortality reduction. However, breast cancer screening in Asia has been slow to implement, as it was perceived that the breast cancer incidence was low and the parenchyma of Asian women was difficult to assess mammographically. With changing disease patterns, breast cancer is now one of the most common cancers amongst women in Asia. Breast cancer screening has become an important and relevant health problem. However, apart from biological differences between western and Asian women, cultural and economic considerations need to be addressed. This paper looks at the various issues pertaining to the feasibility and relevance of population-based screening in the Asia/Pacific region.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/prevenção & controle , Mamografia/estatística & dados numéricos , Programas de Rastreamento , Área Carente de Assistência Médica , Ásia/epidemiologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/etiologia , Feminino , Humanos , Ilhas do Pacífico/epidemiologia
14.
Ann Rheum Dis ; 64(5): 743-9, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15458959

RESUMO

BACKGROUND: In K/BxN mice, anti-glucose-6-phosphate isomerase (GPI) antibodies (Abs) are arthritogenic, and their transfer into naive mice induces arthritis. Anti-GPI Abs develop in many human patients with RA and are associated with more severe forms of the disease. OBJECTIVE: To elucidate the serum and synovial fluid (SF) anti-GPI IgG profiles among different patient groups with a variety of arthritides. METHODS: Blood and SF obtained concomitantly from 91 patients with clinically well defined arthritis were tested for concentrations of total anti-GPI IgG, anti-GPI IgG subclasses, B lymphocyte stimulator (BLyS), and APRIL by ELISA. RESULTS: Anti-GPI IgG was detected in sera and SF of patients with many arthritic diseases, but was preferentially associated with inflammatory arthritis, in general, and RA, in particular. The anti-GPI IgG subclass usage was skewed and varied among the different arthritic disease groups. Inverse correlations between serum levels of BLyS and anti-GPI IgG and positive correlations between serum levels of APRIL and anti-GPI IgG were seen among immune based arthritic patients and patients with RA but not among non-immune based patients. No correlations were found in SF from any group of arthritic patients. CONCLUSION: Raised circulating anti-GPI Abs are not unique to patients with RA but are present in many patients with inflammatory arthritis. The difference in anti-GPI IgG subclass usage among disease groups may influence effector function and disease outcome. The inverse correlation between serum BLyS and anti-GPI IgG levels suggests that anti-GPI B cells may be regulated differently from other autoantibody producing B cells. Anti-GPI Abs may serve a pathogenic function in humans by promoting the maintenance of existing disease.


Assuntos
Artrite/imunologia , Autoanticorpos/análise , Glucose-6-Fosfato Isomerase/imunologia , Imunoglobulina G/análise , Líquido Sinovial/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite/metabolismo , Artrite Reumatoide/imunologia , Artrite Reumatoide/metabolismo , Autoanticorpos/sangue , Fator Ativador de Células B , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Glucose-6-Fosfato Isomerase/metabolismo , Humanos , Imunoglobulina G/sangue , Masculino , Proteínas de Membrana/análise , Proteínas de Membrana/sangue , Pessoa de Meia-Idade , Proteínas Nucleares/análise , Proteínas Nucleares/sangue , Líquido Sinovial/metabolismo , Fator de Necrose Tumoral alfa/análise
15.
Ann Rheum Dis ; 63(9): 1096-103, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15308519

RESUMO

OBJECTIVE: To assess longitudinal expression of a proliferation-inducing ligand (APRIL) in patients with systemic lupus erythematosus (SLE) and its correlation with B lymphocyte stimulator (BLyS) expression, serum anti-dsDNA titres, and clinical disease activity. METHODS: Sixty eight patients with SLE were longitudinally followed up for a median of 369 days. At each visit the physician assessed disease activity by SLEDAI, and blood was collected for determination of serum APRIL and BLyS levels and of blood APRIL and BLyS mRNA levels. Fifteen normal control subjects underwent similar laboratory evaluation. RESULTS: Dysregulation of APRIL was not as great as that of BLyS. Changes in serum levels of APRIL and BLyS over time were usually discordant, whereas blood levels of APRIL and BLyS mRNA strongly paralleled each other. Serum APRIL levels modestly, but significantly, inversely correlated with serum anti-dsDNA titres in anti-dsDNA positive patients analysed in aggregate. Moreover, serum APRIL levels modestly, but significantly, inversely correlated with clinical disease activity in all patients analysed in aggregate. CONCLUSION: Serum levels of APRIL and BLyS are differentially regulated. APRIL may serve as a down modulator of serological and/or clinical autoimmunity in patients with SLE. This may have important ramifications for BLyS targeted treatment, and it remains to be determined whether agents which neutralise only BLyS will be preferable to agents which neutralise both BLyS and APRIL.


Assuntos
Lúpus Eritematoso Sistêmico/sangue , Neuropeptídeos/sangue , Proteínas Nucleares/sangue , Anticorpos Antinucleares/sangue , Fator Ativador de Células B , DNA/imunologia , Seguimentos , Humanos , Proteínas de Membrana/sangue , Proteínas de Membrana/genética , Neuropeptídeos/genética , Proteínas Nucleares/genética , RNA Mensageiro/sangue , Fator de Necrose Tumoral alfa/genética
16.
Anaesth Intensive Care ; 30(6): 771-4, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12500516

RESUMO

The aim of this crossover study was to determine the optimal size of laryngeal mask airway in children weighing 10 to 20 kg. In each of 67 apnoeic anaesthetized children, the size 2 and size 2 1/2 laryngeal mask airways were inserted consecutively by a skilled user and the cuff inflated to 60 cmH2O. Each LMA was assessed for the ease of insertion (by the number of attempts), oropharyngeal leak pressure, anatomical position (assessed fibreoptically) and the volume of air required to achieve intracuff pressure of 60 cmH2O. During the measurement of oropharyngeal leak pressure, the airway pressure was not allowed to exceed 30 cmH2O. There was no failed attempt at insertion with any size. The oropharyngeal leak pressure was significantly less for the size 2 LMA compared to the size 2 1/2 LMA (P < 0.001). The oesophagus was visible on three occasions, all with the size 2 LMA. Gastric insufflation occurred in three patients, all with the size 2 LMA. The incidence of low oropharyngeal leak pressure (< 10 cmH2O) was low (9.0%) and all occurred with the size 2 LMA. The fibreoptic bronchoscope scores were not significantly different between the two sizes of LMAs. The volume of air to achieve intracuff pressure of 60 cmH2O was much lower than the maximum recommended volume (5.1 ml for size 2 and 6.2 ml for size 2 1/2). We conclude that the size 2 1/2 LMA provides a better fit than size 2 in children 10 to 20 kg.


Assuntos
Anestesia , Máscaras Laríngeas , Peso Corporal , Broncoscopia , Criança , Pré-Escolar , Estudos Cross-Over , Desenho de Equipamento , Feminino , Humanos , Lactente , Masculino
17.
Anaesth Intensive Care ; 30(5): 668-70, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12413271

RESUMO

Phaeochromocytoma of the urinary bladder is rare. We report a case of a patient with undiagnosed bladder phaeochromocytoma who developed haemodynamic disturbances during routine diagnostic cystoscopy. The diagnosis was only confirmed postoperatively.


Assuntos
Cistectomia/métodos , Feocromocitoma/diagnóstico , Feocromocitoma/cirurgia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Biópsia por Agulha , Cistoscopia , Feminino , Seguimentos , Humanos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
18.
Anesth Analg ; 95(5): 1318-23, table of contents, 2002 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-12401619

RESUMO

UNLABELLED: Previous studies show that the human 40-Hz auditory steady-state response (ASSR) disappears on induction of general anesthesia, suggesting that it may be a good candidate for a monitor of anesthesia. In this study, we aimed to learn whether all normal alert adults display ASSRs with adequate signal-to-noise ratio. Clicks were presented at a series of frequencies between 35 and 70 Hz and electroencephalographic records taken at the vertex were Fourier transformed. ASSRs were observable as sharp peaks in the electroencephalograph spectrum at the frequency of the clicks. Initial results showed that a discernible ASSR could not be obtained from about half the subjects studied at any click frequency used. Further investigation revealed that in subjects whose ASSR was undetectable in the alert state, induction of a drowsy mental state resulted in appearance of an observable ASSR. This was attributable to an increase in signal in the drowsy state, not to a decrease in noise. We conclude that, because a significant proportion of subjects do not display easily recordable ASSRs when alert, it is not practical to use disappearance of the ASSR as a routine test for adequacy of anesthesia. IMPLICATIONS: Auditory steady-state responses (ASSRs) are brain waves evoked by auditory stimuli. Because they reportedly disappear under general anesthesia, they have been suggested as potential indicators of anesthetic depth. However, in this study, we show that about half our normal adult subjects did not produce measurable ASSRs when awake. This suggests that ASSRs are not good candidates for use in monitoring anesthetic depth during surgery.


Assuntos
Anestesia , Potenciais Evocados Auditivos/efeitos dos fármacos , Monitorização Intraoperatória/métodos , Estimulação Acústica , Adulto , Idoso , Nível de Alerta , Eletroencefalografia/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Eur J Surg Oncol ; 28(3): 203-8, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11944950

RESUMO

AIMS: Early invasive lobular breast carcinoma (ILC) is associated with few symptoms and signs. The individual sensitivity of clinical examination, mammography, ultrasonography, cytology and core biopsy have each been reported to be of limited value. The aim of this study was to evaluate the accuracy of triple assessment in the pre-operative detection of patients identified to have ILC from their surgical pathology. METHODS: Pure ILC was defined as tumours containing at least 90% lobular features. The triple assessment of 273 patients diagnosed primarily at our institution were reviewed. RESULTS: 87.5% of women were symptomatic and 12.5% were screen detected. The mean patient age was 59 (range 30-81) years and the median tumour size was 26 (range 5-110) mm. The main mammographic abnormalities were a spiculated lesion (33.3%), an ill-defined mass (33.3%) or architectural distortion (23.5%). The sensitivities for detecting ILC of each modality were: clinical examination (76.6%), mammography (79.8%), ultrasound examination (93.9%), fine-needle aspiration cytology (FNAC) (60.5%) and core biopsy (90.8%). Combining the three modalities of clinical examination, imaging and cyto/pathology increased the pre-operative detection rate of ILC. CONCLUSION: Triple assessment is useful in the diagnosis of ILC. As the features of ILC may be subtle, a high index of suspicion is required to facilitate early diagnosis.


Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma Lobular/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Lobular/diagnóstico por imagem , Carcinoma Lobular/patologia , Carcinoma Lobular/cirurgia , Feminino , Humanos , Mamografia , Pessoa de Meia-Idade , Palpação , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade
20.
Eur J Cancer ; 37(18): 2331-8, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11720825

RESUMO

We report the medium-term (median follow-up=52 months) results of a prospective randomised trial of multimodal therapy (neoadjuvant chemotherapy, Patey mastectomy, postoperative radiotherapy and adjuvant hormone therapy) (n=56) versus initial hormone therapy (n=52) for locally advanced primary breast cancer. Compared with multimodal therapy, initial hormone therapy was associated with reduced number of therapies for disease control (mean=3.6 versus 4.9) and mastectomy rate (31%). Multimodal therapy conferred better initial locoregional control and a longer disease-free interval. Nevertheless, there was no statistically significant differences in the rates of survival, metastasis and uncontrolled locoregional disease, as well as in the time to metastasis between the two therapy groups. Regardless of the therapy groups, oestrogen receptor positivity conferred a lower metastasis rate, better survival and locoregional control. Thus, initial hormone therapy may be a reasonable option for managing locally advanced primary breast cancer, especially for oestrogen receptor-positive tumours.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante/métodos , Terapia Combinada/métodos , Feminino , Seguimentos , Humanos , Mastectomia/métodos , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Mitoxantrona/administração & dosagem , Metástase Neoplásica/prevenção & controle , Recidiva Local de Neoplasia/prevenção & controle , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Receptores de Estrogênio/análise , Análise de Sobrevida , Resultado do Tratamento
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