RESUMO
Central nervous system leukemia (CNSL) relapse is relatively common among Philadelphia chromosome-positive (Ph+) leukemia patients who undergo allogeneic hematopoietic stem cell transplantation (allo-HSCT). The prognosis of patients is dismal for those with a BCR-ABL T315I mutation, which is resistant to TKIs including second-generation drugs. We assessed ponatinib for nine patients with recurrent Ph+ CNSL and a T315I mutation after allo-HSCT, including five patients with Ph+ acute lymphoblastic leukemia and four with chronic myelogenous leukemia. Five patients experienced isolated CNSL relapse, and four experienced CNSL with hematologic relapse. All patients received ponatinib combined with intrathecal chemotherapy, and four patients with hematologic relapse received systemic chemotherapy and/or donor lymphocyte infusion. All patients achieved a deep molecular response and central nervous system remission (CNSR) at a median time of 1.5 (range: 0.7-3) months after ponatinib treatment. Two patients experienced a second CNSL relapse due to ponatinib reduction, but they achieved CNSR again after an increase to the standard dosage. Six patients developed graft versus host disease. By April 1, 2019, eight patients were alive, and one died of pneumonia. The median time of survival after the first CNSL relapse posttransplantation was 18 (range: 11.2-48.5) months. Our data from a small number of samples suggests that ponatinib is effective for recurrent Ph+ CNSL patients with a BCR-ABL T315I mutation after allo-HSCT and warrants broader clinical evaluation.
Assuntos
Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Proteínas de Fusão bcr-abl/genética , Transplante de Células-Tronco Hematopoéticas/métodos , Imidazóis/uso terapêutico , Mutação , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Piridazinas/uso terapêutico , Adulto , Neoplasias do Sistema Nervoso Central/genética , Neoplasias do Sistema Nervoso Central/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Prognóstico , Inibidores de Proteínas Quinases/uso terapêutico , Recidiva , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: To report a case of neurogenic dry eye (NDE) that developed after intravitreal ranibizumab injection (IVR). CASE REPORT: A 71-year-old woman had a history of cataract phacoemulsification and intraocular lens (IOL) implantation, Nd:YAG laser posterior capsulotomy and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). Aneurysmal dilatation of the inferior temporal retina was found in the left fundus, which was diagnosed as retinal aneurysm, and intravitreal ranibizumab injection was administered. Dry eye was found in the left eye after the first injection. After the second injection, the patient developed severe dry eye with left eye dryness, photophobia, irritation, and blurred vision. The tear film breakup time (TBUT) value was 3â s, the Schirmer test value was 2â mm/5â min, corneal fluorescein staining (CFS) showed diffuse patellar staining of the corneal epithelium with a staining area of >50% and irregular staining at the edge of the corneal flap, and the corneal touch threshold value in the filament length was 1.5â cm in the left eye. CONCLUSIONS: Patients with a history of intraocular lens implantation, Nd:YAG laser posterior capsulotomy, and femtosecond laser-assisted laser in situ keratomileusis surgery may have increased drug permeability due to an increased concentration of anti-VEGF drugs in the aqueous layer and thinning of the stromal layer of the cornea. The corneal subepithelial nerve repair mechanism was destroyed, causing neurogenic dry eye.
Assuntos
Síndromes do Olho Seco , Ceratomileuse Assistida por Excimer Laser In Situ , Feminino , Humanos , Idoso , Injeções Intravítreas , Ranibizumab , Córnea , Síndromes do Olho Seco/induzido quimicamente , Síndromes do Olho Seco/diagnósticoRESUMO
This study determines the major weather factors affecting hiking activity and builds a prediction model to estimate participation. An empirical assessment of hiking participation using weather factors was demonstrated for trails on Kuanyin Mountain, Taiwan. By adapting the concepts of the range of tolerance and the eclectic model, a nonlinear function was used to explain hiking participation with weather factors. Stepwise multiple-regression analysis was carried out to determine the major weather factors affecting hiking participation. The results indicate that not only did participation vary with the season but hiking behavior was affected by different weather factors in each season. The explanation rates for the seasons exceeded 90% except that for spring.
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Modelos Teóricos , Caminhada , Humanos , Análise de Regressão , Estações do Ano , Taiwan , Tempo (Meteorologia)RESUMO
PURPOSE: To explore the offset distribution of pupillary centres, the offset between the pupil centre and the coaxially sighted corneal light reflex (P-Dist) and their correlation in femtosecond laser combined with excimer laser in situ keratomileusis. METHODS: Randomly selected 194 patients (398 eyes) who underwent femtosecond-assisted laser in situ keratomileusis with preoperative use of WaveLight Allegro Topolyzer Corneal Topography (WaveLight Laser Technologies AG, Erlangen, Germany) to measure the pupil size and centre position. The P-Dist of the patients was recorded by the X and Y axis eyeball tracking adjustment program of the WaveLight Eagle Vision EX500 excimer laser system. RESULTS: The P-Dist was 0.214â±â0.092âmm in the right eyes and 0.228â±â0.105âmm in the left eyes (Pâ=â.041). Under scotopic conditions, the pupil centre of left eye X-axis was -0.046â±â0.091âmm, the right eye was -0.152â±â0.084âmm, with significant differences (Pâ=â.015), and the Y-axis direction showed no significant changes (Pâ=â.062). The white to white was positively correlated with changes of pupil diameter (scotopic pupil diameter-photopic pupil diameter) (râ=â0.270, Pâ<â.001). The equivalent spherical mirror and measured centroid shift were negatively correlated (râ=â-0.214, Pâ=â.002). CONCLUSION: The angle kappa of the right eye is smaller than that of the left eye and from scotopic to photopic condition, the pupil centroid shift of both eyes to the nasal inferior side. If the cornea is too large, the low illumination environment should be maintained during the operation to improve the efficiency of pupil matching.
Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Córnea/cirurgia , Topografia da Córnea , Humanos , Lasers de Excimer , Miopia/cirurgia , Refração OcularRESUMO
OBJECTIVE: To investigate the effects of recombinant human interleukin 11 (rhIL-11) on hematological malignancy after allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: A total of 48 patients with hematological malignancy from January 2006 to June 2010 were alternately enrolled into a prospective randomized study. And they were assigned into the control and rhIL-11 injection groups. Later the investigators compared two groups with regards to hematopoietic reconstitution, graft versus host disease (GVHD) classification, clinical recurrence rate and disease-free survival. RESULTS: With the therapy of rhIL-11, the absolute neutrophil counts recovering to 0.5 × 10(9)/L and platelet recovering to 20 × 10(9)/L were (15.1 ± 1.6) and (18.2 ± 3.3) days respectively. And they were significantly lower than those in control group [(16.1 ± 1.6) vs (22.4 ± 5.5) days, P = 0.032, 0.003]. The incidence of acute GVHD was surprisingly low in the study group (26.1% vs 50.0%, P = 0.048). There was no significant difference in chronic GVHD (36.8% vs 38.9%, P = 0.899) or relapse rate (5.1% vs 7.7%, P = 0.662) between two groups during a median follow-up period of 11.7 months. A trend of improved 3-year-disease-free survival was observed in the study group (65.4% vs 50.9%, P = 0.637). CONCLUSION: The application of rhIL-11 after allo-HSCT may accelerate both neutrophil and platelet engraftment and lower the occurrence of acute GVHD.
Assuntos
Doença Enxerto-Hospedeiro/prevenção & controle , Neoplasias Hematológicas/tratamento farmacológico , Interleucina-11/uso terapêutico , Feminino , Neoplasias Hematológicas/mortalidade , Neoplasias Hematológicas/cirurgia , Transplante de Células-Tronco Hematopoéticas , Humanos , Masculino , Estudos Prospectivos , Proteínas Recombinantes/uso terapêutico , Taxa de Sobrevida , Transplante HomólogoRESUMO
RATIONALE: Breast carcinoma is the most common primary source of choroidal metastasis (CM). In the present case, esophageal cancer was the primary tumour, brain metastasis occurred, and CM occurred later in the left eye with 2 retinal detachments, which is very rare. PATIENT CONCERNS: A 62-year-old man complained of a sudden decrease in visual acuity consisting of a small shadow in front of his left eye with a sensation of covered vision after 1 cycle of systemic chemotherapy and radiotherapy for resected esophageal cancer with brain metastasis. Fundus examination revealed exudative retinal detachment without retinal tears. CM with exudative retinal detachment was also considered. The patient refused further treatment. After the second cycle of chemotherapy, there were no significant changes in the retina and visual acuity improved. However, after craniocerebral surgery for brain metastasis, the visual acuity decreased again and showed 3 choroidal masses with macular involvement and retinal detachment but without retinal tears. DIAGNOSIS: The final diagnosis was CM with retinal detachment. INTERVENTIONS: The patient was advised to undergo enucleation of the left eye during the second retinal detachment, but he refused. OUTCOMES: Two months after the second retinal detachment, the patient died of systemic metastases. LESSONS: It is important to consider CM when the first retinal detachment and known cancer are diagnosed. At present, it is necessary to develop a standardised treatment plan as well as a multidisciplinary approach to early diagnosis, combined treatment, and timely intervention for such cases.
Assuntos
Neoplasias Encefálicas/secundário , Neoplasias da Coroide/secundário , Neoplasias Esofágicas/patologia , Descolamento Retiniano/etiologia , Perfurações Retinianas/etiologia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/terapia , Neoplasias da Coroide/patologia , Terapia Combinada , Neoplasias Esofágicas/terapia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Penicillium digitatum is a widespread pathogen among Rutaceae species that causes severe fruit decay symptoms on infected citrus fruit (known as citrus green mold). The employment of fungicides can effectively control the citrus green mold, significantly reducing agricultural economic loss. In this study, we found that the X33 antifungal extract produced by Streptomyces lavendulae strain X33 inhibited the hyphae polarization of P. digitatum. Additionally, physiological and proteomic analysis strategies were applied to explore the inhibitory mechanism of the X33 antifungal extract of the S. lavendulae strain X33 on the mycelial growth of P. digitatum. A total of 277 differentially expressed proteins, consisting of 207 upregulated and 70 downregulated, were identified from the comparative proteomics analysis. The results indicated that the X33 antifungal extract induced mitochondrial membrane dysfunction and cellular integrity impairment, which can affect energy metabolism, oxidative stress, and transmembrane transport. The improved alkaline phosphatase activity and extracellular conductivity, increased H2O2 and malondialdehyde contents, and inhibition of energy, amino acid, and sugar metabolism indicated that the oxidative stress of P. digitatum is induced by the X33 antifungal extract. These findings provided insight into the antifungal mechanism of the X33 antifungal extract against P. digitatum by suggesting that it may be an effective fungicide for controlling citrus postharvest green mold.
RESUMO
PURPOSE: To analyze the distribution of the offset between the pupil center and the coaxially sighted corneal light reflex (P-Dist), the effects of 50% and 100% angle kappa adjustments on refractive and visual quality in patients with moderate myopia were investigated. METHODS: A randomly selected 254 patients (254 eyes) with moderate myopia who underwent femtosecond laser-combined LASIK were examined. During the operation, the P-Dist of the patients was recorded by the x- and y-axis eyeball-tracking adjustment program of the WaveLight Eagle Vision EX500 excimer laser system. Preoperatively and 3 months postoperatively, the WaveLight® ALLEGRO Topolyzer was used to measure the pupil size and center position, and the wavefront sensor was used to measure the wavefront aberrations. The visual function tester (OPTEC 6500) measured contrast sensitivity. RESULTS: The average P-Dist was 0.220 ± 0.102 mm. When the P-Dist >0.220 mm, the postoperative residual cylinder was 0.29 ± 0.34 D in the group with the 50% adjustment and 0.40 ± 0.32 D in the 100% group, which was significantly higher than the 50% group (P=0.036). The coma was 0.21 ± 0.17 µm in the 50% adjusted group and 0.34 ± 0.25 µm in the 100% group, which was significantly higher than that in the 50% group (P=0.021). At the 1.5 c/d spatial frequency, contrast sensitivity in the adjusted 100% group was significantly lower than that in the 50% group under visual glare conditions (P=0.039). CONCLUSION: The postoperative visual acuity and spherical equivalent were not affected in the two groups. However, when P-Dist >0.220 mm, the residual astigmatism and coma were lower in the 50% group. Individualized operations for those with moderate myopia and large-angle kappa in which 100% adjustment is chosen may not result in a better visual quality effect than 50%.
RESUMO
OBJECTIVE: To determine the required sample size for, and feasibility of, a RCT examining the effectiveness of early acupuncture for acute ischaemic stroke. METHODS: Thirty-eight patients aged 40-85â years with a first episode of acute ischaemic stroke presenting within 72â h of stroke onset were randomly assigned to receive manual acupuncture (MA group; n=20) plus standard care or standard care only (control group, n=18). The acupuncture treatment was provided daily for 2â weeks. The primary outcome was the change in the National Institutes of Health Stroke Scale (NIHSS) score between baseline and 4â weeks. Secondary outcomes included changes in the Fugl-Meyer assessment (FMA) and the functional independence measure scores between baseline and 4â weeks, and changes in NIHSS, Barthel Index and modified Rankin Scale scores at 12â weeks. RESULTS: Thirty-one patients completed the study (dropout rate=18%) and adverse effects were minimal. No significant differences were seen between groups in the improvements in NIHSS scores, although there tended to be a greater reduction in NIHSS score after 1â week in the MA group relative to the control group (p=0.066). The post-stroke motor activity at 4â weeks was associated with a significantly increased FMA score in the acupuncture group compared with the control group (p<0.05), but not supported by intergroup analysis. CONCLUSIONS: This pilot study indicates that acupuncture appears to be safe for patients in the acute stage of ischaemic stroke. A subsequent trial with a larger sample size (estimated at n=122) is required to confirm whether early acupuncture intervention contributes to earlier functional improvement and to assess the longer-term clinical efficacy of acupuncture. TRIAL REGISTRATION NUMBER: NCT02210988; Results.
Assuntos
Terapia por Acupuntura/métodos , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Índice de Gravidade de Doença , Método Simples-Cego , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the contributing factors for fever after tubeless percutaneous nephrolithotomy (PCNL). METHODS: Between May 2009 and December 2013, 395 tubeless PCNLs were performed at our hospital. After stone extraction, the bleeding points were cauterized for hemostasis to enable tubeless modification. In patients with troublesome bleeding after cauterization, oxidized regenerated cellulose (Surgicel) strips were used to tamponade the access tract to facilitate bleeding control. The contributory factors for fever were evaluated by a retrospective chart review. RESULTS: Forty-four patients (11.7%) developed fever after tubeless PCNL. There was no difference in gender, age, and body mass index in the development of fever. Episodes of febrile or septic urinary tract infection before PCNL were found to have occurred in 35 patients, but the incidence of postoperative fever was not significantly higher in these patients. There is no significant difference in the mean stone size in fever and nonfever patients. Complete staghorn stones were noted in 40 patients, and their fever rate was not significantly higher than patients with nonstaghorn stone. The operation time is not significantly higher in the group with urinary tract infection. Patients with postoperative fever had a high incidence of residual stones than the remaining patients (38.9% vs 20.4%). There was no significant difference in incidence of postoperative fever in patients with struvite stones than patients with nonstruvite stones. In patients who received Surgicel packing, the incidence of fever was not significantly higher. CONCLUSION: Incomplete stone extraction is a major contributing factor for the development of fever after tubeless PCNL.
Assuntos
Febre/etiologia , Nefrostomia Percutânea , Complicações Pós-Operatórias/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/métodos , Estudos Retrospectivos , Fatores de RiscoRESUMO
Many different microRNAs existed in nephrotic syndrome patients, and they may be involved in nephrotic syndrome occurrence. In order to further clarify miRNAs expression changes in nephrotic syndrome patients and their correlation with clinical features, this study investigated differential microRNA expression in the peripheral serum of patients with nephrotic syndrome and analyzed the correlation between miRNA with largest overexpression level and clinical features. miRNAs microarray was applied to screen different expressed miRNAs in nephrotic syndrome patients. Real-time PCR was performed to verify miRNA expression level. SPSS software was used to analyze correlation between miRNA expression and clinical features. Compared with healthy subjects, 35 miRNAs overexpressed and 24 miRNAs down-regulated in patients. After real-time PCR verification, 6 miRNAs up-regulated in nephrotic syndrome patients, including hsa-miR-181a, hsa-miR-210, hsa-miR-30a, hsa-miR-942, hsa-miR-192 and hsa-miR-586. miRNA-30a significantly overexpressed in nephrotic syndrome patients and with no difference between genders. miRNA-30a expression level in drug resistant nephrotic syndrome patients was obviously higher than the drug sensitive patients. miRNA-30a up-regulated most significantly in mesangial proliferative glomerulonephritis among different pathology types, while it decreased most obviously in glomerular lesions. miRNA differently expressed in the serum of nephrotic syndrome patients. miRNA-30a could be treated as the molecular marker in predict drug resistance and pathological type of nephrotic syndrome.
Assuntos
MicroRNAs/genética , Síndrome Nefrótica/genética , Biópsia , Estudos de Casos e Controles , Feminino , Perfilação da Expressão Gênica/métodos , Regulação da Expressão Gênica , Estudos de Associação Genética , Marcadores Genéticos , Humanos , Rim/patologia , Masculino , MicroRNAs/sangue , Síndrome Nefrótica/sangue , Síndrome Nefrótica/diagnóstico , Análise de Sequência com Séries de Oligonucleotídeos , Valor Preditivo dos Testes , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
This study was conducted in an attempt to investigate the effectiveness of an educational card game we developed for learning human immunology. Two semesters of evaluation were included to examine the impact of the game on students' understanding and perceptions of the game-based instruction. Ninety-nine senior high school students (11th graders) were recruited for the first evaluation, and the second-semester group consisted of 72 students (also 11th graders). The results obtained indicate that students did learn from the educational card game. Moreover, students who learned from playing the game significantly outperformed their counterparts in terms of their understanding of the processes and connections among different lines of immunological defense (first semester: t = 2.92, p < 0.01; second semester: t = 3.45, p < 0.01) according to the qualitative analysis of an open-ended question. They generally had positive perceptions toward the game-based instruction and its learning efficiency, and they felt the game-based instruction was much more interesting than traditional didactic lectures (first semester: t = 2.79, p < 0.01; second semester: t = 2.41, p < 0.05). This finding is evidence that the educational card game has potential to facilitate students' learning of how the immune system works. The implications and suggestions for future work are further discussed.
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Alergia e Imunologia , Avaliação Educacional/métodos , Aprendizagem , Formação de Conceito , Humanos , Sistema Imunitário/fisiologia , Percepção , EstudantesRESUMO
Global influenza surveillance is one of the most effective strategies for containing outbreaks and preparing for a possible pandemic influenza. Since the end of 2003, highly pathogenic avian influenza viruses (HPAI) H5N1 have caused many outbreaks in poultries and wild birds from East Asia and have spread to at least 48 countries. For such a fast and wide-spreading virulent pathogen, prediction based on changes of micro- and macro-environment has rarely been evaluated. In this study, we are developing a new climatic approach by investigating the conditions that occurred before the H5N1 avian influenza outbreaks for early predicting future HPAI outbreaks and preventing pandemic disasters. The results show a temperature drop shortly before these outbreaks in birds in each of the Eurasian regions stricken in 2005 and 2006. Dust storms, like those that struck near China's Lake Qinghai around May 4, 2005, exacerbated the spread of this HPAI H5N1 virus, causing the deaths of a record number of wild birds and triggering the subsequent spread of H5N1. Weather monitoring could play an important role in the early warning of outbreaks of this potentially dangerous virus.
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Surtos de Doenças/veterinária , Virus da Influenza A Subtipo H5N1 , Influenza Aviária/epidemiologia , Temperatura , Tempo (Meteorologia) , Animais , Ásia/epidemiologia , Aves/virologia , China/epidemiologia , Temperatura Baixa , Suscetibilidade a Doenças , Poeira , Europa (Continente)/epidemiologia , Aves Domésticas/virologia , Doenças das Aves Domésticas/epidemiologia , Estresse FisiológicoRESUMO
OBJECTIVE: To study the epidemiology and etiologic characteristics of a Dengue fever outbreak in Fuzhou from the beginning of September to the end of October in 2004 in order to understand the source of infection. METHODS: Data on descriptive epidemiology was collected to study the characteristics and related factors to the epidemic. Dengue virus was isolated through the use of C6/36 cell line while viral serotypes were identified by indirect immunofluorecent assay with type-specific monoclonal antibody. The sources of infection were traced by nucleotide sequencing. RESULTS: During the epidemic, 93 cases occured consistently with the region entomoplily growth and decay. The viruses of 6 strains isolated from 10 patients' blood specimens were identified as dengue virus type 1. Phylogenetic evidence suggested that the viral isolate had high genetic relation with the isolates from Kampuchea (DENV-1/KHM/2001; GenBank Accession No. L0904278). CONCLUSION: The epidemic was caused by introduction of patients migrating into Fuzhou.