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1.
J Inherit Metab Dis ; 38(5): 863-72, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25633902

RESUMEN

In the folate cycle MTHFD1, encoded by MTHFD1, is a trifunctional enzyme containing 5,10-methylenetetrahydrofolate dehydrogenase, 5,10-methenyltetrahydrofolate cyclohydrolase and 10-formyltetrahydrofolate synthetase activity. To date, only one patient with MTHFD1 deficiency, presenting with hyperhomocysteinemia, megaloblastic anaemia, hemolytic uremic syndrome (HUS) and severe combined immunodeficiency, has been identified (Watkins et al J Med Genet 48:590-2, 2011). We now describe four additional patients from two different families. The second patient presented with hyperhomocysteinemia, megaloblastic anaemia, HUS, microangiopathy and retinopathy; all except the retinopathy resolved after treatment with hydroxocobalamin, betaine and folinic acid. The third patient developed megaloblastic anaemia, infection, autoimmune disease and moderate liver fibrosis but not hyperhomocysteinemia, and was successfully treated with a regime that included and was eventually reduced to folic acid. The other two, elder siblings of the third patient, died at 9 weeks of age with megaloblastic anaemia, infection and severe acidosis and had MTFHD1 deficiency diagnosed retrospectively. We identified a missense mutation (c.806C > T, p.Thr296Ile) and a splice site mutation (c.1674G > A) leading to exon skipping in the second patient, while the other three harboured a missense mutation (c.146C > T, p.Ser49Phe) and a premature stop mutation (c.673G > T, p.Glu225*), all of which were novel. Patient fibroblast studies revealed severely reduced methionine formation from [(14)C]-formate, which did not increase in cobalamin supplemented culture medium but was responsive to folic and folinic acid. These additional cases increase the clinical spectrum of this intriguing defect, provide in vitro evidence of disturbed methionine synthesis and substantiate the effectiveness of folic or folinic acid treatment.


Asunto(s)
Ácido Fólico/uso terapéutico , Leucovorina/uso terapéutico , Metilenotetrahidrofolato Deshidrogenasa (NADP)/deficiencia , Metilenotetrahidrofolato Deshidrogenasa (NADP)/genética , Anemia Megaloblástica/tratamiento farmacológico , Anemia Megaloblástica/genética , Anemia Megaloblástica/patología , Células Cultivadas , Resultado Fatal , Femenino , Deficiencia de Ácido Fólico/tratamiento farmacológico , Deficiencia de Ácido Fólico/genética , Deficiencia de Ácido Fólico/patología , Humanos , Hiperhomocisteinemia/tratamiento farmacológico , Hiperhomocisteinemia/genética , Hiperhomocisteinemia/patología , Lactante , Recién Nacido , Masculino , Antígenos de Histocompatibilidad Menor , Inmunodeficiencia Combinada Grave/tratamiento farmacológico , Inmunodeficiencia Combinada Grave/genética , Inmunodeficiencia Combinada Grave/patología , Adulto Joven
2.
Bone Marrow Transplant ; 48(1): 26-31, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22732703

RESUMEN

We investigated the administration of i.v. BU combined with melphalan (Mel) in patients with ALL undergoing allogeneic hematopoietic SCT. Forty-seven patients with a median age of 33 years (range 20-61) received a matched sibling (n=27) or matched unrelated donor transplant (n=20) for ALL in first CR (n=26), second CR (n=13), or with more advanced disease (n=8). BU was infused daily for 4 days, either at a fixed dose of 130 mg/m² (5 patients) or using pharmacokinetic (PK) dose adjustment (42 patients), to target an average daily area-under-the-curve (AUC) of 5000 µmol/min, determined by a test dose of i.v. BU at 32 mg/m². This was followed by a rest day, then two daily doses of Mel at 70 mg/m². Stem cells were infused on the following day. The 2-year OS, PFS and non-relapse mortality (NRM) rates were 35% (95% confidence interval (CI), 23-51%), 31% (95% CI, 21-48%) and 37% (95% CI, 23-50%), respectively. Acute NRM at 100 days was favorable at 12% (95% CI, 5-24%); however, the 2-year NRM was significantly higher for patients older than 40 years, 58% vs 20%, mainly due to GVHD.


Asunto(s)
Antineoplásicos Alquilantes/uso terapéutico , Busulfano/uso terapéutico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Melfalán/uso terapéutico , Agonistas Mieloablativos/uso terapéutico , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Acondicionamiento Pretrasplante , Adulto , Factores de Edad , Antineoplásicos Alquilantes/administración & dosificación , Antineoplásicos Alquilantes/efectos adversos , Busulfano/administración & dosificación , Busulfano/efectos adversos , Quimioterapia Combinada/efectos adversos , Femenino , Estudios de Seguimiento , Enfermedad Injerto contra Huésped/epidemiología , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/prevención & control , Humanos , Incidencia , Infusiones Intravenosas , Masculino , Melfalán/efectos adversos , Persona de Mediana Edad , Agonistas Mieloablativos/administración & dosificación , Agonistas Mieloablativos/efectos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/prevención & control , Prevención Secundaria , Análisis de Supervivencia , Texas , Acondicionamiento Pretrasplante/efectos adversos , Trasplante Homólogo , Adulto Joven
3.
Phytopathology ; 102(3): 323-30, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22085300

RESUMEN

Late blight caused by Phytophthora infestans (Mont.) de Bary is a constraint to both potato and tomato crops in Nicaragua. The hypothesis that the Nicaraguan population of P. infestans is genotypically and phenotypically diverse and potentially subdivided based on host association was tested. A collection of isolates was analyzed using genotypic markers (microsatellites and mitochondrial DNA haplotype) and phenotypic markers (mating type, virulence, and fungicide sensitivity). The genotypic analysis revealed no polymorphism in 121 of 132 isolates of P. infestans tested. Only the Ia haplotype and the A2 mating type were detected. Most of the tested isolates were resistant to metalaxyl. The virulence testing showed variation among isolates of P. infestans. No evidence was found of population differentiation among potato and tomato isolates of P. infestans based on the genotypic and phenotypic analysis. We conclude that the Nicaraguan population of P. infestans consists of a single clonal lineage (NI-1) which belongs to the A2 mating type and the Ia mitochondrial DNA haplotype. Moreover, based on the markers used, this population of P. infestans does not resemble the population in countries from which potato seed is imported to Nicaragua or the population in neighboring countries. The data presented here indicate that the NI-1 clonal lineage is the primary pathogen on both potato and tomato, and its success on both host species is unique in a South American context.


Asunto(s)
Variación Genética/genética , Phytophthora infestans/genética , Enfermedades de las Plantas/microbiología , Solanum lycopersicum/microbiología , Solanum tuberosum/microbiología , Alanina/análogos & derivados , Alanina/farmacología , Carbamatos/farmacología , ADN/genética , ADN/aislamiento & purificación , ADN Mitocondrial/genética , Genotipo , Haplotipos , Repeticiones de Microsatélite/genética , Nicaragua , Fenotipo , Phytophthora infestans/clasificación , Phytophthora infestans/efectos de los fármacos , Phytophthora infestans/aislamiento & purificación , Semillas/microbiología
4.
Phytopathology ; 102(4): 429-33, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22185335

RESUMEN

Potato late blight, caused by Phytophthora infestans, is a major disease in potato production throughout the world. In southern Sweden, hairy nightshade (Solanum physalifolium), an alternative non-crop host to the pathogen, is an increasing weed problem. Single-lesion leaves infected by P. infestans were collected from potato and hairy nightshade to determine phenotypic and genotypic population differentiation of P. infestans between the two hosts. Genotypic variation was estimated using microsatellites as markers. The results showed no genotypic differentiation in the samples between the two hosts. Aggressiveness tests were performed using the sampled isolates to cross-inoculate potato and hairy nightshade. The proportion of infected leaves, latency period, lesion growth rate, and sporulation capacity were measured. For isolates from hairy nightshade, the odds of infection were higher on both hosts combined. When tested on potato leaves, isolates from hairy nightshade showed a significantly shorter latency period and higher sporulation capacity compared with isolates from potato. This indicates that an alternative host can filter populations of P. infestans toward a higher aggressiveness, which could lead to increasing problems in controlling potato late blight.


Asunto(s)
Interacciones Huésped-Parásitos/fisiología , Phytophthora infestans/patogenicidad , Enfermedades de las Plantas/microbiología , Solanum tuberosum/parasitología , Solanum/parasitología , Marcadores Genéticos , Genética de Población , Genotipo , Modelos Logísticos , Repeticiones de Microsatélite/genética , Fenotipo , Phytophthora infestans/fisiología , Hojas de la Planta/parasitología , Esporangios
5.
Acta Anaesthesiol Scand ; 55(7): 812-8, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21658010

RESUMEN

BACKGROUND: Low plasma glutamine concentration is an independent prognostic factor for an unfavourable outcome in the intensive care unit (ICU). Intravenous (i.v.) supplementation with glutamine is reported to improve outcome. In a multi-centric, double-blinded, controlled, randomised, pragmatic clinical trial of i.v. glutamine supplementation for ICU patients, we investigated outcomes regarding sequential organ failure assessment (SOFA) scores and mortality. The hypothesis was that the change in the SOFA score would be improved by glutamine supplementation. METHODS: Patients (n=413) given nutrition by an enteral and/or a parenteral route with the aim of providing full nutrition were included within 72 h after ICU admission. Glutamine was supplemented as i.v. l-alanyl-l-glutamine, 0.283 g glutamine/kg body weight/24 h for the entire ICU stay. Placebo was saline in identical bottles. All included patients were considered as intention-to-treat patients. Patients given supplementation for >3 days were considered as predetermined per protocol (PP) patients. RESULTS: There was a lower ICU mortality in the treatment arm as compared with the controls in the PP group, but not at 6 months. For change in the SOFA scores, no differences were seen, 1 (0,3) vs. 2 (0.4), P=0.792, for the glutamine group and the controls, respectively. CONCLUSION: In summary, a reduced ICU mortality was observed during i.v. glutamine supplementation in the PP group. The pragmatic design of the study makes the results representative for a broad range of ICU patients.


Asunto(s)
Cuidados Críticos/métodos , Glutamina/uso terapéutico , APACHE , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Dinamarca , Método Doble Ciego , Determinación de Punto Final , Femenino , Finlandia , Glutamina/administración & dosificación , Mortalidad Hospitalaria , Humanos , Islandia , Inyecciones Intravenosas , Unidades de Cuidados Intensivos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/prevención & control , Noruega , Suecia , Resultado del Tratamiento , Adulto Joven
6.
Dig Surg ; 25(3): 165-74, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18515968

RESUMEN

Nutritional concern is one of the most important issues to be addressed in the perioperative care given to gastrointestinal patients. Not at least, malnutrition may be detrimental and relate to postoperative morbidity. Perioperative nutritional management, integrated with other modern perioperative care policies, allows the establishment of multimodal strategies with an attempt to optimize the patients' course of disease. The present review evaluates available data regarding pre- and postoperative nutrition, nutritional supplements, including immunonutrition, and their clinical role. It is to be concluded that pre- and postoperative prolonged fasting has no routine role in management. Instead, for example, early postoperative feeding administered perorally or enterally may reduce postoperative complications and length of hospital stay. There are also indications that perioperative immunonutrition may reduce postoperative infectious complications and length of hospital stay, though further studies in this field are needed.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Procedimientos Quirúrgicos Electivos , Apoyo Nutricional/métodos , Atención Perioperativa/métodos , Arginina/administración & dosificación , Carbohidratos de la Dieta/administración & dosificación , Suplementos Dietéticos , Nutrición Enteral/normas , Ácidos Grasos Omega-3/administración & dosificación , Glutamina/administración & dosificación , Humanos , Inmunoterapia/métodos , Apoyo Nutricional/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
7.
Genes Immun ; 7(6): 514-21, 2006 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-16826235

RESUMEN

We performed a network-based analysis of DNA microarray data from allergen-challenged CD4(+) T cells from patients with seasonal allergic rhinitis. Differentially expressed genes were organized into a functionally annotated network using the Ingenuity Knowledge Database, which is based on manual review of more than 200,000 publications. The main function of this network is the regulation of lymphocyte apoptosis, a role associated with several genes of the tuber necrosis factor superfamily. The expression of TNFRSF4, one of the genes in this family, was found to be 48 times higher in allergen-challenged cells than in diluent-challenged cells. TNFRSF4 is known to inhibit apoptosis and to enhance Th2 proliferation. Examination of a different material of allergen-stimulated peripheral blood mononuclear cells showed a higher number of interleukin-4(+) type 2 CD4(+) T (Th2) cells in patients than in controls (P<0.01), as well as a higher number of non-apoptotic Th2 cells in patients (P<0.01). The number of Th2 cells expressing TNFRSF4, TNFSF7 and TNFRSF1B was also significantly higher in patients. Treatment with anti-TNFSF4 resulted in a significantly decreased number of Th2 cells (P<0.05). A logical inference from all this is that the proliferation of allergen-challenged Th2 cells is associated with a decreased apoptosis of Th2 cells and an increase in TNFRSF4 signalling.


Asunto(s)
Alérgenos/inmunología , Linfocitos T CD4-Positivos/inmunología , Rinitis Alérgica Estacional/inmunología , Adolescente , Adulto , Algoritmos , Betula/inmunología , Linfocitos T CD4-Positivos/metabolismo , Proliferación Celular , Bases de Datos Genéticas , Femenino , Citometría de Flujo , Humanos , Leucocitos Mononucleares/inmunología , Masculino , Persona de Mediana Edad , Análisis de Secuencia por Matrices de Oligonucleótidos , Polen/inmunología , Receptores OX40/metabolismo , Rinitis Alérgica Estacional/genética , Células Th2/citología
8.
Water Sci Technol ; 50(7): 157-62, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15553471

RESUMEN

At many large wastewater treatment plants (WWTPs) the increased hydraulic load, caused by combined sewer systems during storm events, results in primary effluent overflow when the capacity of further treatment is exceeded. Due to stringent effluent standards, regulating the total discharge from the WWTPs, the Rya WWTP in Göteborg and the Sjölunda WWTP in Malmö will have to reduce the impact of primary effluent overflow. Separate, high rate, precipitation processes operated only during high flow conditions have been investigated in pilot units at the two WWTPs. Precipitation in existing primary settlers operated at a surface loading of 3.75 m/h removed phosphorus to 0.35 mg/l. The Actiflo process was also shown to remove suspended solids and phosphorus well. BOD was reduced by 50-60%. With such processes the overall effluent concentrations from the plants can be reduced significantly. Key upgrading features are small footprints, short start up time and high efficiency.


Asunto(s)
Aguas del Alcantarillado , Eliminación de Residuos Líquidos/instrumentación , Eliminación de Residuos Líquidos/métodos , Purificación del Agua/instrumentación , Purificación del Agua/métodos , Reactores Biológicos , Nitrógeno , Fósforo , Factores de Tiempo , Eliminación de Residuos Líquidos/normas , Movimientos del Agua , Contaminación del Agua
9.
Indoor Air ; 13(3): 277-82, 2003 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-12950591

RESUMEN

The effect of substrate on the emission of aldehydes from linseed oil paint was investigated. Plates of glass, fiberboard, gypsum board, lime mortar and wood lath were painted, and then placed into emission chambers. Samples were collected every eighth hour over 10 days with 2,4-dinitrophenylhydrazin samplers. Analysis was performed with liquid chromatography/UV-detection and mass spectrometry. Paint applied on gypsum board gave the highest total amount of emitted carbonyls, and that on wood lath gave the least. Painted glass had the highest contribution of unsaturated species, and lime mortar, the lowest. Lime mortar also had the highest momentary levels of a single species, 443 nmol/h/m2 of propanal, while fiberboard peaked at only 123 nmol/h/m2 of propanal. In turn, the emission from the painted fiberboard had the slowest decline, and thus at the end of the experiment the highest levels. All substrates gave an emission that peaked within 16 h.


Asunto(s)
Aldehídos/análisis , Materiales de Construcción , Aceite de Linaza/química , Contaminación del Aire Interior/análisis , Cromatografía Liquida , Pintura , Volatilización
10.
Br J Community Nurs ; 8(8): 353-63, 2003 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-12937374

RESUMEN

Collaboration between Kronoberg County Council and Växjö University, Sweden, and Hull and East Riding Community NHS Trust and the University of Hull, UK, enabled an international comparison of care of patients with chronic leg ulcers in the two countries. An aim of the survey study was to compare what "holistic care" meant to nurses working in primary health care (PHC) and nursing home settings in Kronoberg County (KC) and the East Riding of Yorkshire and Hull (ER). A questionnaire, which obtained quantitative and qualitative data, was returned by 311 (222 completed) nurses in KC and 124 in ER (response rates of 54 and 50% respectively). Assessment and planning of wound management focused on the wound. Swedish nurses paid more attention to patients' experience of the wound, lifestyle factors and environment than UK nurses, but in both countries holistic care appeared to be lacking. Issues for nurse education concerning holistic care were identified. Revision of guidelines and consensus documents to facilitate holistic care is also suggested.


Asunto(s)
Enfermería en Salud Comunitaria/estadística & datos numéricos , Comparación Transcultural , Enfermería Holística/estadística & datos numéricos , Úlcera de la Pierna/enfermería , Actitud del Personal de Salud , Vendajes/estadística & datos numéricos , Enfermería en Salud Comunitaria/métodos , Documentación/métodos , Documentación/estadística & datos numéricos , Enfermería Holística/métodos , Humanos , Educación del Paciente como Asunto/métodos , Educación del Paciente como Asunto/estadística & datos numéricos , Relaciones Profesional-Familia , Suecia , Reino Unido
11.
J Prosthet Dent ; 85(3): 231-2, 2001 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11264928

RESUMEN

The use of Procera AllCeram laminates for patients with discolored teeth has been described. In our experience, these laminates are simple to use and provide possibilities for excellent esthetics.


Asunto(s)
Óxido de Aluminio , Porcelana Dental , Coronas con Frente Estético , Diseño de Prótesis Dental , Estética Dental , Humanos , Incisivo , Decoloración de Dientes/terapia , Preparación Protodóncica del Diente
12.
Int J Prosthodont ; 14(5): 432-8, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-12066638

RESUMEN

PURPOSE: The aim of the study was to compare results after 1 and 3 years when single crowns supported by CerAdapt (test) ceramic abutments or CeraOne (control) titanium abutments were loaded. MATERIALS AND METHODS: The material was divided into two groups: in group A, 69 (34 test, 35 control) abutments/crowns from all involved clinics were followed for 1 year; and in group B, 20 (10 test, 10 control) abutments/crowns from one of the clinics were followed for 3 years. RESULTS: No implant failed, giving a cumulative success rate of 100% for the implants. Two CerAdapt abutments in group A fractured, giving a cumulative success rate of 93% for the CerAdapt and 100% for the CeraOne abutments after 1 year. No abutment failed in group B, giving a cumulative success rate of 100% both for the CerAdapt and the CeraOne abutments between 1 and 3 years. The CerAdapt fractures might have been due to the fact that the abutments were impaired through too-extensive preparation and/or had been exposed to a too-high bending moment. Almost no marginal bone loss was recorded, indicating a stable bone situation both at CerAdapt and CeraOne abutments on single-tooth implants. Healthy conditions, with a relatively stable level of the periimplant mucosa in relation to the abutment/crown, were recorded for soft tissues both at CerAdapt and CeraOne abutments. Both clinicians and patients rated the esthetic result as excellent for practically all cases. CONCLUSION: The results demonstrate the esthetic possibilities and the safety of single-tooth replacement when accepted treatment concepts are followed and documented components are used. The tested abutments worked well, although the fractured CerAdapt abutments indicate that ceramic abutments are more sensitive to handling procedures than the titanium abutments.


Asunto(s)
Óxido de Aluminio , Cerámica , Coronas , Pilares Dentales , Implantes Dentales de Diente Único , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Óxido de Aluminio/química , Pérdida de Hueso Alveolar/clasificación , Cerámica/química , Distribución de Chi-Cuadrado , Placa Dental/clasificación , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Estética Dental , Femenino , Estudios de Seguimiento , Hemorragia Gingival/clasificación , Humanos , Tablas de Vida , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estadística como Asunto , Estadísticas no Paramétricas , Estrés Mecánico , Titanio/química , Preparación Protodóncica del Diente , Resultado del Tratamiento
13.
Int J Prosthodont ; 14(6): 504-9, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-12066695

RESUMEN

PURPOSE: This is a report on Procera AllCeram crowns in a prospective multicenter study. The aim of the study was to evaluate AllCeram crowns in dental practice over a 5- to 10.5-year period. Some of the AllCeram crowns were among the very first that were placed. MATERIALS AND METHODS: The crowns were placed between 1989 and 1995. Twelve clinicians at nine clinics placed 87 crowns in 50 patients. The California Dental Association quality evaluation system was used for assessment of marginal integrity and esthetics. RESULTS: After 5 and 10 years a cumulative survival rate of 97.7% and 93.5%, respectively, and a cumulative success rate of 97.7% and 92.2%, respectively, was recorded. Six crowns (7%) were recorded as failures; five of these crowns (6%) had to be remade. The marginal integrity was considered excellent or acceptable for 92% of the crowns. Bleeding was somewhat more often recorded at teeth with AllCeram crowns (39%) than at contralateral teeth (27%). Endodontic treatment was performed for a low number (2%) of the AllCeram crowns. The patients found the esthetics to be excellent. CONCLUSION: The results of this study demonstrate about the same clinical outcome as has been reported by similar studies on all-ceramic crowns built on a core of alumina. The outcome is also in agreement with that reported for metal-ceramic crowns. The results indicate a good prognosis for Procera AllCeram crowns also for posterior teeth.


Asunto(s)
Óxido de Aluminio , Coronas , Porcelana Dental , Adulto , Anciano , Diente Premolar , Diente Canino , Diseño de Prótesis Dental , Fracaso de la Restauración Dental , Estética Dental , Femenino , Estudios de Seguimiento , Hemorragia Gingival/clasificación , Humanos , Incisivo , Tablas de Vida , Masculino , Aleaciones de Cerámica y Metal , Persona de Mediana Edad , Diente Molar , Pronóstico , Estudios Prospectivos , Tratamiento del Conducto Radicular , Propiedades de Superficie , Análisis de Supervivencia , Resultado del Tratamiento
14.
J Natl Cancer Inst ; 92(3): 225-33, 2000 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-10655439

RESUMEN

BACKGROUND: Uncontrolled studies have reported encouraging outcomes for patients with high-risk primary breast cancer treated with high-dose chemotherapy and autologous hematopoietic stem cell support. We conducted a prospective randomized trial to compare standard-dose chemotherapy with the same therapy followed by high-dose chemotherapy. PATIENTS AND METHODS: Patients with 10 or more positive axillary lymph nodes after primary breast surgery or patients with four or more positive lymph nodes after four cycles of primary (neoadjuvant) chemotherapy were eligible. All patients were to receive eight cycles of 5-fluorouracil, doxorubicin (Adriamycin), and cyclophosphamide (FAC). Patients were stratified by stage and randomly assigned to receive two cycles of high-dose cyclophosphamide, etoposide, and cisplatin with autologous hematopoietic stem cell support or no additional chemotherapy. Tamoxifen was planned for postmenopausal patients with estrogen receptor-positive tumors and chest wall radiotherapy was planned for all. All P values are from two-sided tests. RESULTS: Seventy-eight patients (48 after primary surgery and 30 after primary chemotherapy) were registered. Thirty-nine patients were randomly assigned to FAC and 39 to FAC followed by high-dose chemotherapy. After a median follow-up of 6.5 years, there have been 41 relapses. In intention-to-treat analyses, estimated 3-year relapse-free survival rates were 62% and 48% for FAC and FAC/high-dose chemotherapy, respectively (P =.35), and 3-year survival rates were 77% and 58%, respectively (P =.23). Overall, there was greater and more frequent morbidity associated with high-dose chemotherapy than with FAC; there was one septic death associated with high-dose chemotherapy. CONCLUSIONS: No relapse-free or overall survival advantage was associated with the use of high-dose chemotherapy, and morbidity was increased with its use. Thus, high-dose chemotherapy is not indicated outside a clinical trial.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Trasplante de Células Madre Hematopoyéticas , Adulto , Anciano , Neoplasias de la Mama/patología , Quimioterapia Adyuvante , Ciclofosfamida/administración & dosificación , Supervivencia sin Enfermedad , Doxorrubicina/administración & dosificación , Esquema de Medicación , Femenino , Fluorouracilo/administración & dosificación , Estudios de Seguimiento , Humanos , Metástasis Linfática , Persona de Mediana Edad , Terapia Neoadyuvante , Estudios Prospectivos , Radioterapia Adyuvante , Análisis de Supervivencia , Trasplante Autólogo , Resultado del Tratamiento
15.
Cardiology ; 89(3): 170-7, 1998 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-9570430

RESUMEN

Earlier studies have shown that spinal cord stimulation (SCS) has antianginal and anti-ischemic effects in severe coronary artery disease. In the present study, 14 patients were subjected to right-sided atrial catheterization and atrial pacing. The patients were paced to angina during a control session and during spinal cord stimulation. Myocardial extraction of beta-endorphin (BE) during control pacing (8 +/- 22%) changed to release at the maximum pacing rate during treatment (-21 +/- 47%, a negative value representing release). Furthermore, the results indicate local myocardial turnover of leuenkephalin, BE and calcitonin-gene-related peptide. In addition, it is implied that SCS may induce myocardial release of BE which could explain the beneficial effects in myocardial ischemia.


Asunto(s)
Angina de Pecho/metabolismo , Péptido Relacionado con Gen de Calcitonina/metabolismo , Estimulación Cardíaca Artificial/efectos adversos , Encefalina Leucina/metabolismo , Miocardio/metabolismo , Médula Espinal/fisiología , betaendorfina/metabolismo , Anciano , Angina de Pecho/etiología , Angina de Pecho/rehabilitación , Cateterismo Cardíaco , Terapia por Estimulación Eléctrica , Electrodos Implantados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/etiología , Isquemia Miocárdica/metabolismo , Radioinmunoensayo
16.
Int J Oral Maxillofac Implants ; 12(4): 486-94, 1997.
Artículo en Inglés | MEDLINE | ID: mdl-9274077

RESUMEN

Screw-shaped implants were prepared with three different surface topographies: One was left as machined, ie, a turned surface, and two were blasted surfaces with differing degrees of surface roughness. The surface topography was measured with a confocal laser scanning profilometer and the surface roughness was characterized using height and spatial descriptive parameters. The turned surface had an average surface roughness of 0.96 micron and an average peak spacing of 8.6 microns. The two blasted surfaces had surface roughness values of 1.16 microns and 1.94 microns, respectively; the corresponding values for the peak spacing parameter were 10.00 microns and 13.22 microns, respectively. After 1 year in rabbit bone, the bone response to the turned implants was compared with the response to the two blasted implant surfaces. Firmer bone fixation was found for the two blasted surfaces, with statistically significant increases in removal torque and percentage of bone-to-metal contact. Furthermore, about 2 mm from the implant surface, the titanium release was similar for the turned and the 25-micron aluminum oxide-blasted implants.


Asunto(s)
Huesos/cirugía , Oseointegración , Prótesis e Implantes , Titanio , Óxido de Aluminio/química , Animales , Tornillos Óseos , Huesos/ultraestructura , Colorantes , Femenino , Fémur , Estudios de Seguimiento , Microscopía Confocal , Conejos , Espectrometría por Rayos X , Propiedades de Superficie , Tibia , Titanio/análisis , Titanio/química , Cloruro de Tolonio , Torque
17.
Br J Haematol ; 97(2): 466-73, 1997 May.
Artículo en Inglés | MEDLINE | ID: mdl-9163617

RESUMEN

The outcome of allogeneic haemopoietic transplants including the rate of immune complications for patients with chronic lymphocytic leukaemia (CLL) refractory to or relapsing after chemotherapy with fludarabine was analysed. Fifteen patients with advanced CLL who received allogeneic transplantation were prospectively analysed. All patients had previously received chemotherapy with fludarabine for 3-15 courses; 12 were refractory. The median number of circulating CD4+ and CD8+ lymphocytes at the time of transplant was 0.49 x 10(9)/l and 0.23 x 10(9)/l, respectively. One patient was transplanted from a one HLA-antigen mismatched unrelated donor. Three others received a one or two antigen mismatched graft and 11 had HLA-identical sibling donors. Patients received cyclosporine or tacrolimus in addition to methotrexate or methylprednisolone for prophylaxis of acute graft-versus-host disease (aGVHD). Fourteen patients engrafted; one patient had graft failure, but recovered after therapy with intravenous immunoglobulin. 13 (87%) achieved complete remission (CR). Nine (53%) remain alive and in CR with a median follow-up of 36 (range 3-60) months. None developed visceral graft-versus-host disease. These data compared favourably to published reports in other leukaemia patients and for patients with CLL who received a comparable immunosuppressive therapy but without prior fludarabine exposure. This data indicates that allogeneic haemopoietic transplantation can induce durable remission in patients with CLL refractory to fludarabine and that it is reasonable to delay transplantation until failure of fludarabine therapy. It also suggests that prior exposure to fludarabine may decrease the incidence of severe aGVHD, possibly through its immunosuppressive effects. Further studies are warranted to evaluate this observation.


Asunto(s)
Antineoplásicos/uso terapéutico , Transfusión de Sangre Autóloga/métodos , Trasplante de Médula Ósea/métodos , Enfermedad Injerto contra Huésped/etiología , Leucemia Linfocítica Crónica de Células B/terapia , Vidarabina/análogos & derivados , Adulto , Antineoplásicos/efectos adversos , Transfusión de Sangre Autóloga/efectos adversos , Trasplante de Médula Ósea/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Supervivencia , Trasplante Homólogo , Resultado del Tratamiento , Vidarabina/efectos adversos , Vidarabina/uso terapéutico
18.
Cytogenet Cell Genet ; 78(1): 21-4, 1997.
Artículo en Inglés | MEDLINE | ID: mdl-9345899

RESUMEN

Using human and bovine short cDNA sequences as probes we screened human cosmid and P1 libraries for components of the complex I multi-subunit enzyme of oxidative phosphorylation. We isolated genomic recombinants encoding cI-B8 (gene NDUFA2), cI-B14 (gene NDUFA6), cI-B14.5a (gene NDUFA7), cI-ASHI (gene NDUFB8) and cI-23kD (gene NDUFS8). Genomic versions of these genes have not been previously cloned in the human although they are represented as anonymous entries in public cDNA databases. By using the derived genomic clones for in situ hybridisation studies we determined the following chromosome locations: NDUFA2, 5q31; NDUFA6, 21q22; NDUFA7, 20p13; NDUFB8, 12q21; NDUFS8, 3q28.


Asunto(s)
Mapeo Cromosómico , Transporte de Electrón/genética , NAD(P)H Deshidrogenasa (Quinona)/genética , Animales , Bovinos , Cósmidos , ADN Complementario , Ligamiento Genético , Genoma Humano , Humanos , Hibridación Fluorescente in Situ , Mutación , Reacción en Cadena de la Polimerasa
19.
Eur Heart J ; 18(12): 1890-6, 1997 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-9447316

RESUMEN

AIMS: Spinal cord stimulation has been used in the treatment of intractable angina pectoris since the beginning of the 1980s. This study was designed to investigate whether the documented anti-ischaemic effects of spinal cord stimulation are mediated through a decrease in sympathetic activity. METHODS AND RESULTS: Ten patients with a spinal cord stimulator implanted as anti-anginal treatment were included in the study. Atrial pacing until the patient experienced moderate angina was performed and after 50 min rest the procedure was repeated during spinal cord stimulation. Total body and cardiac norepinephrine spillover was calculated and the former was found to have increased during pacing (47%, P = 0.02). When spinal cord stimulation was applied, total body norepinephrine spillover decreased at a comparable pacing rate (18%, P = 0.02). Cardiac norepinephrine spillover was not affected during the procedure. CONCLUSION: The results of this study indicate that the anti-ischaemic effect of spinal cord stimulation is not due to reduced cardiac sympathetic activity. However, spinal cord stimulation decreases overall sympathetic activity which may benefit the heart, possibly by reducing oxygen demand.


Asunto(s)
Angina de Pecho/terapia , Terapia por Estimulación Eléctrica/métodos , Médula Espinal , Anciano , Angina de Pecho/sangre , Angina de Pecho/fisiopatología , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Norepinefrina/sangre , Sistema Nervioso Simpático/fisiopatología
20.
Acta Radiol ; 37(3 Pt 1): 332-6, 1996 May.
Artículo en Inglés | MEDLINE | ID: mdl-8845264

RESUMEN

PURPOSE: Chest radiographs from 3 digital systems--2 based on luminescent phosphors and one on selenium--and a conventional film-screen system were evaluated and compared. MATERIAL AND METHODS: Computed radiography (CR) has for the past years been dominated by a single manufacturer, but now several systems have been marketed. Using a chest phantom and, as test objects, 2 simulated tumours for the lung and mediastinum, respectively, and one object simulating pulmonary lines, a total of 400 exposures were made, 100 on each system. The test objects were placed randomly with a ratio of presence/absence of each object of about 50. Six radiologists participated, 2 residents and 4 staff members. A receiver operating characteristics (ROC) analysis was performed with construction of curves, and the difference between the curves was estimated with a 2-tailed paired t-test. RESULTS AND CONCLUSION: The selenium-based system performed significantly better for pulmonary line detection than all the other systems, and better than one storage phosphor system for the lung "tumour" (p < 0.05), while one storage phosphor system was slightly better than the other in diagnosing all 3 test objects. The score for the film-screen system was only average.


Asunto(s)
Fantasmas de Imagen , Intensificación de Imagen Radiográfica/instrumentación , Radiografía Torácica/instrumentación , Selenio , Pantallas Intensificadoras de Rayos X , Humanos , Mediciones Luminiscentes , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias del Mediastino/diagnóstico por imagen , Curva ROC
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