Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 71
Filtrar
Más filtros

Medicinas Complementárias
Bases de datos
Tipo del documento
Intervalo de año de publicación
1.
Sci Rep ; 11(1): 19634, 2021 10 04.
Artículo en Inglés | MEDLINE | ID: mdl-34608194

RESUMEN

The persistent increase of multidrug-resistant (MDR) Mycobacterium tuberculosis (Mtb) infections negatively impacts Tuberculosis treatment outcomes. Host-directed therapies (HDT) pose an complementing strategy, particularly since Mtb is highly successful in evading host-defense by manipulating host-signaling pathways. Here, we screened a library containing autophagy-modulating compounds for their ability to inhibit intracellular Mtb-bacteria. Several active compounds were identified, including two drugs of the diphenylbutylpiperidine-class, Fluspirilene and Pimozide, commonly used as antipsychotics. Both molecules inhibited intracellular Mtb in pro- as well as anti-inflammatory primary human macrophages in a host-directed manner and synergized with conventional anti-bacterials. Importantly, these inhibitory effects extended to MDR-Mtb strains and the unrelated intracellular pathogen, Salmonella enterica serovar Typhimurium (Stm). Mechanistically Fluspirilene and Pimozide were shown to regulate autophagy and alter the lysosomal response, partly correlating with increased bacterial localization to autophago(lyso)somes. Pimozide's and Fluspirilene's efficacy was inhibited by antioxidants, suggesting involvement of the oxidative-stress response in Mtb growth control. Furthermore, Fluspirilene and especially Pimozide counteracted Mtb-induced STAT5 phosphorylation, thereby reducing Mtb phagosome-localized CISH that promotes phagosomal acidification. In conclusion, two approved antipsychotic drugs, Pimozide and Fluspirilene, constitute highly promising and rapidly translatable candidates for HDT against Mtb and Stm and act by modulating the autophagic/lysosomal response by multiple mechanisms.


Asunto(s)
Antibacterianos/farmacología , Antipsicóticos/farmacología , Antituberculosos/farmacología , Reposicionamiento de Medicamentos , Mycobacterium tuberculosis/efectos de los fármacos , Salmonella enterica/efectos de los fármacos , Autofagia/efectos de los fármacos , Línea Celular , Relación Dosis-Respuesta a Droga , Evaluación Preclínica de Medicamentos , Ensayos Analíticos de Alto Rendimiento , Humanos , Lisosomas/metabolismo , Pruebas de Sensibilidad Microbiana , Modelos Biológicos , Fagosomas/metabolismo , Pimozida/farmacología , Infecciones por Salmonella/tratamiento farmacológico , Infecciones por Salmonella/microbiología , Bibliotecas de Moléculas Pequeñas , Tuberculosis/tratamiento farmacológico , Tuberculosis/microbiología
2.
Nature ; 594(7861): 71-76, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34012114

RESUMEN

Micronutrient deficiencies (MNDs) remain widespread among people in sub-Saharan Africa1-5, where access to sufficient food from plant and animal sources that is rich in micronutrients (vitamins and minerals) is limited due to socioeconomic and geographical reasons4-6. Here we report the micronutrient composition (calcium, iron, selenium and zinc) of staple cereal grains for most of the cereal production areas in Ethiopia and Malawi. We show that there is geospatial variation in the composition of micronutrients that is nutritionally important at subnational scales. Soil and environmental covariates of grain micronutrient concentrations included soil pH, soil organic matter, temperature, rainfall and topography, which were specific to micronutrient and crop type. For rural households consuming locally sourced food-including many smallholder farming communities-the location of residence can be the largest influencing factor in determining the dietary intake of micronutrients from cereals. Positive relationships between the concentration of selenium in grain and biomarkers of selenium dietary status occur in both countries. Surveillance of MNDs on the basis of biomarkers of status and dietary intakes from national- and regional-scale food-composition data1-7 could be improved using subnational data on the composition of grain micronutrients. Beyond dietary diversification, interventions to alleviate MNDs, such as food fortification8,9 and biofortification to increase the micronutrient concentrations in crops10,11, should account for geographical effects that can be larger in magnitude than intervention outcomes.


Asunto(s)
Grano Comestible/química , Nutrientes/análisis , Valor Nutritivo , Agricultura , Calcio/análisis , Dieta/estadística & datos numéricos , Etiopía , Humanos , Hierro/análisis , Malaui , Micronutrientes/análisis , Selenio/análisis , Encuestas y Cuestionarios , Triticum/química , Zinc/análisis
3.
Sci Total Environ ; 733: 139231, 2020 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-32446063

RESUMEN

Grain and soil were sampled across a large part of Amhara, Ethiopia in a study motivated by prior evidence of selenium (Se) deficiency in the Region's population. The grain samples (teff, Eragrostis tef, and wheat, Triticum aestivum) were analysed for concentration of Se and the soils were analysed for various properties, including Se concentration measured in different extractants. Predictive models for concentration of Se in the respective grains were developed, and the predicted values, along with observed concentrations in the two grains were represented by a multivariate linear mixed model in which selected covariates, derived from remote sensor observations and a digital elevation model, were included as fixed effects. In all modelling steps the selection of predictors was done using false discovery rate control, to avoid over-fitting, and using an α-investment procedure to maximize the statistical power to detect significant relationships by ordering the tests in a sequence based on scientific understanding of the underlying processes likely to control Se concentration in grain. Cross-validation indicated that uncertainties in the empirical best linear unbiased predictions of the Se concentration in both grains were well-characterized by the prediction error variances obtained from the model. The predictions were displayed as maps, and their uncertainty was characterized by computing the probability that the true concentration of Se in grain would be such that a standard serving would not provide the recommended daily allowance of Se. The spatial variation of grain Se was substantial, concentrations in wheat and teff differed but showed the same broad spatial pattern. Such information could be used to target effective interventions to address Se deficiency, and the general procedure used for mapping could be applied to other micronutrients and crops in similar settings.


Asunto(s)
Selenio , Grano Comestible , Etiopía , Suelo , Triticum
4.
J Surg Oncol ; 121(5): 823-832, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31950511

RESUMEN

BACKGROUND: Hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with improved survival when compared with surgery alone for non-metastatic gastric cancer patients in randomized trials and meta-analyses. However, little evidence is available regarding the use of HIPEC in nonmetastatic patients who are treated with perioperative chemotherapy and radical surgery. The aim of this study was to investigate the putative survival benefit of HIPEC in the subgroup of gastric cancer patients treated with perioperative chemotherapy and surgery. PATIENTS AND METHODS: This was a retrospective cohort study that included gastroesophageal junction and gastric cancer patients who were treated with perioperative chemotherapy and curative resection in a single cancer center in the period between 2006 and 2017. In this time period, younger patients with diffuse-type tumors and serosa invasion or positive lymph node disease were often offered an adjuvant HIPEC protocol. This study compared the survival outcomes of these patients to the ones of those who received only perioperative chemotherapy and resection. A 2:1 propensity-score matched analysis for the two groups was also performed, and variables used were postchemotherapy T (ypT) and N (ypN) stages, histology and tumor site. RESULTS: The study population comprised 269 subjects, 241 treated with chemotherapy and surgery and 28 who also received HIPEC. The mean age was 59 years old (standard deviation: 12.2) and 60% of all individuals were male. A total gastrectomy was performed in 137 patients and a distal resection in 132, with a D2-lymphadenectomy in 97.4% of the sample. Overall 60-day morbidity and mortality rates were 35.3% and 3.3%, respectively. In the HIPEC group, patients were younger, and more frequently had American Society of Anesthesiologists (ASA) 1 to 2 classification, tumors located in the gastric body, had diffuse histology, and ypN+ disease. Overall survival (OS; 5 years) results in the HIPEC and no HIPEC group were 59.5% vs 68.7% (P = .453), and disease-free survival (DFS) ones were 49.5% and 65.8% (P = .060), respectively. In the multivariable Cox regression model, ypT and ypN were independent overall and DFS predictors; also, ASA 3 to 4 classification and diffuse histology were associated with worse OS. In the matched analysis, HIPEC did not improve either overall (53.5% vs 59.5%; P = .517) or DFS (50.0% vs 49.5%; P = .993). CONCLUSION: Treatment with HIPEC in patients who received perioperative chemotherapy and a D2-resection did not improve survival outcomes. Both ypT and ypN stages remained as the most important survival predictors in this cohort.


Asunto(s)
Gastrectomía , Hipertermia Inducida , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/terapia , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/terapia , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Humanos , Escisión del Ganglio Linfático , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Puntaje de Propensión , Estudios Retrospectivos , Neoplasias Gástricas/patología
5.
Med Sci Sports Exerc ; 51(9): 1828-1837, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-30933004

RESUMEN

Cancer cachexia, an unintentional body weight loss due to cancer, affects patients' survival, quality of life, and response to chemotherapy. Although exercise training is a promising intervention to prevent and treat cancer cachexia, our mechanistic understanding of cachexia's effect on contraction-induced muscle adaptation has been limited to the examination of male mice. Because sex can affect muscle regeneration and response to contraction in humans and mice, the effect of cachexia on the female response to eccentric contraction warrants further investigation. PURPOSE: The purpose of this study was to determine whether high-frequency electric stimulation (HFES) could attenuate muscle mass loss during the progression of cancer cachexia in female tumor-bearing mice. METHODS: Female wild-type (WT) and Apc (Min) mice (16-18 wk old) performed either repeated bouts or a single bout of HFES (10 sets of 6 repetitions, ~22 min), which eccentrically contracts the tibialis anterior (TA) muscle. TA myofiber size, oxidative capacity, anabolic signaling, and catabolic signaling were examined. RESULTS: Min had reduced TA muscle mass and type IIa and type IIb fiber sizes compared with WT. HFES increased the muscle weight and the mean cross-sectional area of type IIa and type IIb fibers in WT and Min mice. HFES increased mTOR signaling and myofibrillar protein synthesis and attenuated cachexia-induced AMPK activity. HFES attenuated the cachexia-associated decrease in skeletal muscle oxidative capacity. CONCLUSION: HFES in female mice can activate muscle protein synthesis through mTOR signaling and repeated bouts of contraction can attenuate cancer-induced muscle mass loss.


Asunto(s)
Caquexia/fisiopatología , Caquexia/terapia , Terapia por Estimulación Eléctrica/métodos , Músculo Esquelético/fisiopatología , Animales , Peso Corporal , Caquexia/etiología , Creatina Quinasa/sangre , Modelos Animales de Enfermedad , Femenino , Humanos , Ratones , Contracción Muscular/fisiología , Proteínas Musculares/biosíntesis , Músculo Esquelético/patología , Miofibrillas/metabolismo , Miofibrillas/patología , Neoplasias/complicaciones , Tamaño de los Órganos , Transducción de Señal/fisiología , Serina-Treonina Quinasas TOR/fisiología
6.
Nutr Diabetes ; 7(3): e256, 2017 03 20.
Artículo en Inglés | MEDLINE | ID: mdl-28319109

RESUMEN

BACKGROUND/OBJECTIVE: There is little randomised evidence using a whole food plant-based (WFPB) diet as intervention for elevated body mass index (BMI) or dyslipidaemia. We investigated the effectiveness of a community-based dietary programme. Primary end points: BMI and cholesterol at 6 months (subsequently extended). SUBJECTS: Ages 35-70, from one general practice in Gisborne, New Zealand. Diagnosed with obesity or overweight and at least one of type 2 diabetes, ischaemic heart disease, hypertension or hypercholesterolaemia. Of 65 subjects randomised (control n=32, intervention n=33), 49 (75.4%) completed the study to 6 months. Twenty-three (70%) intervention participants were followed up at 12 months. METHODS: All participants received normal care. Intervention participants attended facilitated meetings twice-weekly for 12 weeks, and followed a non-energy-restricted WFPB diet with vitamin B12 supplementation. RESULTS: At 6 months, mean BMI reduction was greater with the WFPB diet compared with normal care (4.4 vs 0.4, difference: 3.9 kg m-2 (95% confidence interval (CI)±1), P<0.0001). Mean cholesterol reduction was greater with the WFPB diet, but the difference was not significant compared with normal care (0.71 vs 0.26, difference: 0.45 mmol l-1 (95% CI±0.54), P=0.1), unless dropouts were excluded (difference: 0.56 mmol l-1 (95% CI±0.54), P=0.05). Twelve-month mean reductions for the WFPB diet group were 4.2 (±0.8) kg m-2 BMI points and 0.55 (±0.54, P=0.05) mmol l-1 total cholesterol. No serious harms were reported. CONCLUSIONS: This programme led to significant improvements in BMI, cholesterol and other risk factors. To the best of our knowledge, this research has achieved greater weight loss at 6 and 12 months than any other trial that does not limit energy intake or mandate regular exercise.


Asunto(s)
Diabetes Mellitus Tipo 2/dietoterapia , Dieta Vegetariana , Isquemia Miocárdica/dietoterapia , Obesidad/dietoterapia , Sobrepeso/dietoterapia , Adulto , Anciano , Índice de Masa Corporal , Colesterol/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Humanos , Hipercolesterolemia/sangre , Hipercolesterolemia/complicaciones , Hipercolesterolemia/dietoterapia , Hipertensión/sangre , Hipertensión/complicaciones , Hipertensión/dietoterapia , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/sangre , Isquemia Miocárdica/complicaciones , Obesidad/sangre , Obesidad/complicaciones , Sobrepeso/sangre , Sobrepeso/complicaciones , Factores de Riesgo , Resultado del Tratamiento
7.
Curr Diabetes Rev ; 13(2): 141-147, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-27280721

RESUMEN

Diabetes mellitus (DM) is an emerging global healthcare problem and its prevalence is increasing at an alarming rate. Despite improvements in both medical and pharmacological therapies, a complex medical condition may demand a diversified approach, such as: drug therapy, healthy diet and exercises, diabetes education programs, adherence to medical treatment and active participation of the patients in their lifestyle changes, such as stress management. The concept of mindfulness is here defined as the awareness that unfolds from the intention to attentively observe the current experience in a non-judgmental and non-evaluative way. This state of awareness can be enhanced through the use of mindfulness-based interventions (MBIs), which have been associated to many physical and psychological health indicators. The aim of this overview is to offer the rationale and potential benefits of mindfulness in the control of DM and its complications. METHODS: a narrative review of the current and updated literature available on online database and which came up using the terms "mindfulness" and "diabetes mellitus". Mindfulness-based Interventions (MBIs) can be seen as preventive and complementary interventions in DM, particularly for the relief of symptoms related to depression and anxiety in diabetic patients and also in the management of other factors, including mindful eating, physical exercises and treatment adherence. Although many studies only present research protocols, mindfulness seems to have beneficial effects on all aspects of diabetes, including incidence, control and complications. Furthermore, longer term and more carefully controlled trials are necessary in order to draw consistent conclusions on the beneficial role of MBIs on DM.


Asunto(s)
Diabetes Mellitus/terapia , Atención Plena , Diabetes Mellitus/psicología , Humanos
8.
Eur J Clin Nutr ; 67(8): 802-7, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23801093

RESUMEN

BACKGROUND/OBJECTIVES: Invasive procedures such as surgery cause immunosuppression, leading to increased risk of complications, infections and extended hospital stay. Emerging research around immune-enhancing nutrition supplements and their ability to reduce postoperative complications and reduce treatment costs is promising. This randomised controlled trial aims to examine the effect of preoperative immunonutrition supplementation on length of hospital stay (LOS), complications and treatment costs in both well-nourished and malnourished gastrointestinal surgery patients. SUBJECTS/METHODS: Ninety-five patients undergoing elective upper and lower gastrointestinal surgery were recruited. The treatment group (n=46) received a commercial immuno-enhancing supplement 5 days preoperatively. The control group (n=49) received no supplements. The primary outcome measure was LOS, and secondary outcome measures included complications and cost. RESULTS: A nonsignificant trend towards a shorter LOS within the treatment group was observed (7.1 ± 4.1 compared with 8.8 ± 6.5 days; P=0.11). For malnourished patients, this trend was greater with hospital stay reduced by 4 days (8.3 ± 3.5 vs 12.3 ± 9.5 days; P=0.21). Complications and unplanned intensive care admission rates were very low in both the groups. The average admission cost was reduced by AUD1576 in the treatment group compared with the control group (P=0.37). CONCLUSIONS: Preoperative immunonutrition therapy in gastrointestinal surgery has the potential to reduce the LOS and cost, with greater treatment benefit seen in malnourished patients; however, there is a need for additional research with greater patient numbers.


Asunto(s)
Suplementos Dietéticos , Alimentos Formulados , Tracto Gastrointestinal/cirugía , Tiempo de Internación , Desnutrición/inmunología , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/métodos , Anciano , Cuidados Críticos/economía , Procedimientos Quirúrgicos del Sistema Digestivo/economía , Procedimientos Quirúrgicos Electivos/economía , Femenino , Costos de la Atención en Salud , Humanos , Tiempo de Internación/economía , Masculino , Desnutrición/complicaciones , Desnutrición/dietoterapia , Persona de Mediana Edad , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/inmunología , Prevalencia , Valores de Referencia
9.
World J Surg Oncol ; 10: 195, 2012 Sep 19.
Artículo en Inglés | MEDLINE | ID: mdl-22992263

RESUMEN

BACKGROUND: Gastric cancer relapse occurs in about 30% of the patients treated with gastrectomy and D2-lymphadenectomy, mainly as distant or peritoneal metastases. Hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with an improvement in survival and lower peritoneal recurrence, albeit with increased morbidity. The aim of this study is to report the preliminary results of the association of perioperative chemotherapy, radical surgery and HIPEC in high-risk gastric patients in a single institution. METHODS: Treatment protocol was started in 2007 and included patients younger than 65 years old, with good performance status and gastric adenocarcinoma with serosa involvement and lymph node metastases, located in the body or antrum. Patients should receive three preoperative cycles of DCF (Docetaxel 75 mg/m2, Cisplatin 75 mg/m2 and continuous intravenous infusion of 5-Fluorouracil 750 mg/m2 for 5 days), followed by gastric resection with D2-lymphadenectomy, hyperthermic intraperitoneal chemotherapy with Mytomicin C 34 mg/m2 and three more postoperative cycles of DCF. RESULTS: Ten patients were included between 2007 and 2011. Their median age was 47 years old and six were male. Nine were staged with cT4 cN + tumors and one as cT3 cN+. Nine patients completed all three preoperative chemotherapy cycles. Eight individuals were treated with a total gastrectomy and the other two had a distal gastrectomy, all having HIPEC. Postoperative morbidity was 50%, with no deaths. Regarding postoperative chemotherapy, only 5 patients completed three cycles. With a median follow-up of 25 months, three relapses were identified and 7 patients remain disease-free, two with more than 4 years of follow-up. CONCLUSION: The association of perioperative systemic and intraperitoneal chemotherapy plus radical surgery is a feasible multimodality treatment, with acceptable morbidity. With a longer follow-up and a larger group of patients, we hope to be able to determine if it also influences survival outcomes and patterns of recurrence. MINI-ABSTRACT: The association of perioperative chemotherapy, gastric resection and D2-lymphadenectomy and hyperthermic intraperitoneal chemotherapy proved to be associated with acceptable morbidity. For survival analysis, a longer follow-up is needed.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Quimioterapia del Cáncer por Perfusión Regional , Hipertermia Inducida , Neoplasias Gástricas/terapia , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Adenocarcinoma/terapia , Adulto , Femenino , Gastrectomía , Humanos , Masculino , Persona de Mediana Edad , Cavidad Peritoneal , Neoplasias Peritoneales/secundario , Neoplasias Peritoneales/terapia , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía
10.
J Food Sci ; 73(3): S152-7, 2008 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-18387128

RESUMEN

This study was conducted to develop a new soy-based food product that could utilize okara (a byproduct from soymilk production) and maximize the health benefits of okara for the consumer. A Japanese commercial okara snack product was used as a standard reference. Two types of dried okara powder, a commercially dried okara powder with 7.7% moisture content made from regular (lipoxygenase-present) soybeans and a partially dried okara with 44.3% moisture content made from lipoxygenase-free (LOX-null) soybeans, were used in this study. Commercial low saturated soybean oil and commercial low linolenic acid soybean oil were also used in the same formulation to compare and find the best formulation for a baked or deep-fat-fried soy-based food product. Two descriptive analysis studies were performed with a minimum of 15 trained panelists. Instrumental analyses with a Hunter Lab system and a TA.XT2i texture analyzer and chemical analysis were performed to compare with the sensory results. All the results were statistically analyzed. The baked product made from commercial low saturated soybean oil and the partially dried LOX-null okara powder gave the closest flavor, texture, and appearance to the reference standard. The final product contained 11.4% protein and 7.4% dietary fiber, which were, respectively, 1.5 and 2.0 times higher than the reference. The calcium content was also 4.3 times higher than the reference. The objectives of this study were achieved by developing a new soy-based snack food, which has more health benefits with an enjoyable flavor and texture than the existing commercial product.


Asunto(s)
Manipulación de Alimentos/métodos , Alimentos Orgánicos , Alimentos de Soja/análisis , Leche de Soja/química , Proteínas de Soja/análisis , Fibras de la Dieta/análisis , Proteínas en la Dieta/análisis , Humanos , Lipooxigenasa/química , Valor Nutritivo , Proteínas de Plantas , Polisacáridos , Reología , Aceite de Soja/química , Proteínas de Soja/química , Gusto , Viscosidad
11.
Environ Pollut ; 149(1): 114-24, 2007 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-17618022

RESUMEN

From 1998 to 2001 we examined spatial and temporal variation in uptake of contaminants by surf scoters (Melanitta perspicillata) in the Georgia Basin region of the Pacific coast of Canada. Samples were collected during late fall and early spring at industrialized and reference locations, carcasses examined, and tissues collected for histology, biomarkers, and contaminant analyses. Scoters from both Vancouver and Victoria harbours had significantly higher hepatic concentrations of summation operatorbutyltins than birds from a reference site. In adult male surf scoters, hepatic summation operatorbutyltins increased over the winter at two sites (p=0.02, n=26), while mercury increased (p=0.03, n=15) and selenium decreased at one site (p=0.001, n=15). Body condition decreased over the winter at both the treatment site, Howe Sound (p<0.0001, n=12), and the reference site, Baynes Sound (p=0.02, n=15). Multiple regression analysis using Akaike's Information Criteria (AIC(C)) showed an association between hepatic butyltin concentrations and overall body condition (p=0.06, r=-0.237).


Asunto(s)
Aves/fisiología , Contaminantes Ambientales/análisis , Residuos de Plaguicidas/análisis , Oligoelementos/análisis , Compuestos de Trialquiltina/análisis , Animales , Carga Corporal (Radioterapia) , Constitución Corporal , Colombia Británica , Cobre/análisis , Ecología/métodos , Hígado/química , Mercurio/análisis , Estaciones del Año , Selenio/análisis
12.
Clin Radiol ; 61(1): 40-52, 2006 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-16356815

RESUMEN

The skeletal changes of untreated thalassaemia result from ineffective erythropoiesis and expansion of the bone marrow and affect every part of the skeleton. These changes include osteoporosis, growth retardation, platyspondyly and kyphosis. Erythropoiesis occurs at extra-medullary sites, most commonly resulting in a paraspinal mass but occasionally affecting organs containing pluripotential stem cells. Repeated transfusion unaccompanied by iron chelation causes haemosiderosis; iron is deposited at various sites causing functional impairment. Iron-chelation therapy with desferrioxamine (DFX) prevents haemosiderosis but causes a skeletal dysplasia predominantly affecting the rapidly growing long bones, in particular the distal ulna, and causing irregularity and sclerosis of the physeal-metaphyseal junction and splaying of the metaphysis. DFX also exacerbates the observed growth retardation. DFX-induced skeletal dysplasia may herald toxicity, which is associated with visual and auditory impairment. Therefore, careful balancing of the transfusion regimen and iron-chelation therapy is required. Magnetic resonance imaging (MRI) is the most sensitive technique for the detection of DFX-induced dysplasia.


Asunto(s)
Huesos/diagnóstico por imagen , Talasemia beta/diagnóstico por imagen , Adulto , Enfermedades del Desarrollo Óseo/diagnóstico por imagen , Niño , Diagnóstico Diferencial , Femenino , Trastornos del Crecimiento/inducido químicamente , Humanos , Lactante , Quelantes del Hierro/efectos adversos , Imagen por Resonancia Magnética/métodos , Masculino , Osteoporosis/diagnóstico por imagen , Radiografía , Reacción a la Transfusión
13.
J Clin Oncol ; 22(15): 3061-9, 2004 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-15284256

RESUMEN

PURPOSE: The poor functional outcome in patients with advanced head and neck squamous cell carcinoma (HNSCC) with surgery and radiation has led to alternative approaches to advanced disease. We conducted a phase II study of induction chemotherapy followed by concurrent chemoradiotherapy for organ preservation in patients with advanced resectable and unresectable (nasopharyngeal) tumors. PATIENTS AND METHODS: Forty-two patients with stage III to IV resectable HNSCC and nasopharyngeal tumors received induction chemotherapy with two courses of cisplatin (20 mg/m2/d continuous infusion [CI]), fluorouracil (800 mg/m2/d CI), and leucovorin (500 mg/m2/d CI; PFL) for 4 days followed by concurrent therapy with cisplatin (100 mg/m2/d on days 1 and 22) and approximately 70 Gy of external-beam radiotherapy. RESULTS: Response to induction chemotherapy included partial response rate of 52% and complete response rate of 24%. The most common grade 3 or 4 toxicity was neutropenia (59%). After cisplatin chemoradiotherapy the complete response rate was 67%. Toxicities of cisplatin chemoradiotherapy consisted of grade 3 or 4 mucositis (79%) and neutropenia (51%). At a median follow-up of 71.5 months, 43% of the patients are still alive and disease-free. The 5-year progression-free survival (PFS) rate was 60%, and the 2- and 5-year overall survival (OS) rates were 67% and 52%, respectively. Three patients died of second primaries. Late complications of treatment included xerostomia and hoarseness. One patient had persistent dysphagia and required laser epiglotectomy 108 months after treatment. CONCLUSION: Induction chemotherapy with PFL followed by concurrent cisplatin chemoradiotherapy is well tolerated and results in a good likelihood of organ preservation and excellent PFS and OS.


Asunto(s)
Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/terapia , Cisplatino/administración & dosificación , Cisplatino/uso terapéutico , Fluorouracilo/uso terapéutico , Neoplasias de Cabeza y Cuello/terapia , Leucovorina/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Braquiterapia , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/radioterapia , Cisplatino/efectos adversos , Terapia Combinada , Esquema de Medicación , Femenino , Fluorouracilo/efectos adversos , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Leucovorina/efectos adversos , Masculino , Persona de Mediana Edad , Calidad de Vida , Inducción de Remisión , Tasa de Supervivencia , Resultado del Tratamiento
14.
J Spinal Disord Tech ; 16(3): 280-4, 2003 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-12792343

RESUMEN

To describe a new method of catheter insertion in intradiscal electrothermal therapy, which eliminates the need for reinsertion of the cannula and catheter from the contralateral side in those patients in whom optimal positioning is not achieved with the standard technique. This new technique has not been described before. In those patients in whom adequate catheter position cannot be achieved with the standard technique, instead of withdrawing the cannula after the initial treatment, we recommend rotating the cannula 180 degrees through its long axis. This will allow the catheter to hit the anterior anulus and deflect backwards toward the cannula. It can then be negotiated across the midline to adequately thermally treat the whole posterior anulus. We have performed our technique in 42 consecutive patients in whom initial navigation was difficult. This new method proved to be simple and did not cause patients additional discomfort. The "pig tail" technique is safe and effective in intradiscal electrothermal therapy of those patients with difficult navigation. It avoids the need for second needle insertion, therefore avoiding the use of more local anesthesia, further discomfort for the patient, and additional radiographic exposure.


Asunto(s)
Cateterismo/métodos , Hipertermia Inducida/métodos , Desplazamiento del Disco Intervertebral/cirugía , Disco Intervertebral/cirugía , Dolor de la Región Lumbar/cirugía , Algoritmos , Cateterismo/instrumentación , Protocolos Clínicos , Calor/uso terapéutico , Humanos , Hipertermia Inducida/instrumentación , Desplazamiento del Disco Intervertebral/complicaciones , Dolor de la Región Lumbar/etiología , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Enfermedades Neurodegenerativas/complicaciones , Enfermedades Neurodegenerativas/terapia
15.
J Spinal Disord Tech ; 16(2): 130-6, 2003 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-12679666

RESUMEN

Magnetic resonance imaging changes to the symptomatic intervertebral disc following intradiscal electrothermal therapy were determined in this prospective study. Magnetic resonance images before the intradiscal electrothermal therapy procedure were compared with those taken at 6 months postprocedure in 10 patients. The presence and absence of high-intensity zone, the disc height and hydration, and Modic changes were determined from the images. In six of the 10 patients, a high-intensity zone was present on the magnetic resonance images of the disc before the intradiscal electrothermal therapy procedure. In all six patients, a high-intensity zone was still present after the procedure. In all 10 patients, there were no changes to other disc parameters assessed. Our findings question the clinical relevance of the high-intensity zone. They also suggest that the main mechanism of action of intradiscal electrothermal therapy may be other than that of sealing the anular tear.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Calor/uso terapéutico , Disco Intervertebral/patología , Dolor de la Región Lumbar/terapia , Imagen por Resonancia Magnética/métodos , Adulto , Terapia por Estimulación Eléctrica/instrumentación , Terapia por Estimulación Eléctrica/estadística & datos numéricos , Femenino , Humanos , Dolor de la Región Lumbar/patología , Vértebras Lumbares , Imagen por Resonancia Magnética/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sacro
16.
Br J Nutr ; 86 Suppl 1: S37-53, 2001 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-11520423

RESUMEN

One of the problems which may beset epidemiological studies is the difficulty of accurately measuring the dietary intakes of participants. Biomarkers of diet promise to provide a more accurate measure of dietary intake and a more objective one in that they are not reliant on the subject's memory. This review considers some issues of importance in epidemiology when information is obtained from biomarkers. The approach taken is to use examples both of normal dietary constituents and of contaminants in relation to a range of diet and health questions to illustrate these points. A brief overview of the role of sample collection, processing and storage is given including some generic recommendations for maximising the reliability of subsequent analytical data. Using the examples of phytoestrogens and iodine the question of whether biomarkers can accurately reflect the intake of the dietary constituents of interest at the population level or at the individual level is considered. The relationship of the biomarker to the natural history of the disease is exemplified using the role of folate in neural tube defects. Finally, intakes of vitamin D and heterocyclic amines are used to illustrate the integration of biomarkers into epidemiological studies of prostate and colorectal cancer, respectively. It is concluded that biomarkers may provide a more accurate and objective measure of diet than estimates of current or usual intake but that this approach also has limitations. A combination of methods will probably prove to be most valuable and this approach is being taken in current large prospective studies.


Asunto(s)
Biomarcadores/análisis , Dieta/efectos adversos , Factores Epidemiológicos , Encuestas Epidemiológicas , Neoplasias Colorrectales/etiología , Culinaria , Estrógenos no Esteroides/administración & dosificación , Femenino , Ácido Fólico/sangre , Predisposición Genética a la Enfermedad , Genisteína/análisis , Compuestos Heterocíclicos/efectos adversos , Humanos , Yodo/administración & dosificación , Yodo/orina , Isoflavonas/análisis , Masculino , Carne , Persona de Mediana Edad , Defectos del Tubo Neural/etiología , Estado Nutricional , Fitoestrógenos , Preparaciones de Plantas , Valor Predictivo de las Pruebas , Embarazo , Neoplasias de la Próstata/etiología , Factores de Riesgo , Manejo de Especímenes , Vitamina D/análisis
20.
Am J Chin Med ; 28(1): 35-40, 2000.
Artículo en Inglés | MEDLINE | ID: mdl-10794115

RESUMEN

Preterm labor (PTL) is one of the main causes of fetal mortality and morbidity in obstetrical medicine. Current methods of treatment are not very effective and often have significant side effects. For this reason new methods of preventing PTL are currently being sought. In Western medicine the newest development is oxytocin antagonists. In Oriental medicine acupuncture and moxibustion are being utilized for the purpose of stopping PTL. The goals of this study were to determine if acupuncture in pregnant rats can suppress oxytocin induced uterine contractions and to compare these results with those inhibited by an oxytocin antagonist. Uterine contractions were induced by continuous infusion of exogenous oxytocin. The first fetus in one uterine horn near the ovarian end was removed and distilled water-filled catheter was inserted into that vacated amniotic sac to measure uterine contractions as intrauterine pressure changes. Two acupoints of Ho-Ku (LI-4) and San-Yin-Chiao (Sp-6) were selected for acupuncture and Kuan-Yüan (Co-4) was used for moxibustion. The oxytocin-induced uterine contractions were significantly suppressed by acupuncture on the LI-4 (p < 0.05), but not by Sp-6. Stimulation of Co-4 by moxibustion had no significant (p > 0.05) tocolytic effect. The administration of oxytocin antagonist eliminated all the uterine contractions induced by oxytocin. The application of acupuncture to re-stimulate the activity that was suppressed by the oxytocin antagonist did not produce any positive results. However, prostaglandins did cause the uterus to contract. In conclusion, acupuncture on LI-4 was found to suppress uterine contractions induced by oxytocin in the pregnant rat. If acupuncture is similarly effective in counteracting the effects of oxytocin in women, then this may an alternative medical treatment for women in preterm labor.


Asunto(s)
Terapia por Acupuntura/estadística & datos numéricos , Miometrio/fisiología , Preñez , Contracción Uterina , Animales , Femenino , Miometrio/efectos de los fármacos , Oxitocina/administración & dosificación , Oxitocina/antagonistas & inhibidores , Embarazo , Ratas , Ratas Sprague-Dawley , Contracción Uterina/efectos de los fármacos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA