RESUMEN
Basal cell carcinoma (BCC) is the most common malignancy in the face. Surgical removal and reconstruction is the first choice of treatment options for BCC, but it tends to be invasive and sometimes is accompanied by a drastic change in appearance. We report here a case of BCC in the eyelid of a patient who was successfully treated by gamma knife radiosurgery (GKRS). He was 88 years old at this time. The ulcer disappeared within 3 weeks after GKRS and was covered with normal epithelium. This is the first report to describe an eyelid BCC that was treated by GKRS.
Asunto(s)
Carcinoma Basocelular/cirugía , Neoplasias del Ojo/cirugía , Párpados/cirugía , Radiocirugia/métodos , Anciano de 80 o más Años , Carcinoma Basocelular/radioterapia , Neoplasias del Ojo/radioterapia , Humanos , MasculinoRESUMEN
BACKGROUND: A long period is generally required for ischemic ulcer to heal after revascularization. The strategy of postoperative wound care can affect wound healing. This study was conducted to investigate the degree to which aggressive wound care (AWC) by a team of multidisciplinary specialists actually shortens the time to wound healing and increases the rate of wound healing in limbs undergoing surgical bypass for ischemic tissue loss in a real clinical setting. METHODS: A total of consecutive 126 patients undergoing infrainguinal bypass for tissue loss from April 2011 to March 2015 were reviewed. Prior to March 2013, standard wound care (SWC) including typical daily dressing change with disinfection and irrigation, occasional surgical debridement, and negative pressure wound therapy (when necessary) was performed by vascular surgeons. Thereafter, in addition to SWC, AWC including intense daily bedside surgical debridement under a sciatic nerve block by an anesthesiologist and active skin grafting by a dermatologist, if necessary, was performed. Wound healing and major amputation were defined as the end points. The 1-year outcomes of the 2 groups were calculated using the Kaplan-Meier method and compared, and the significant predictors of each outcome were determined by a Cox proportional hazards analysis. RESULTS: The wound healing of the AWC group was superior to that of the SWC group (AWC versus SWC, 1-year wound healing rate: 92% vs. 80%; mean wound healing time: 48 days vs. 82 days; P = 0.011), and no significant difference between the 2 regimens in the freedom from major amputation was observed. AWC, Rutherford 5, no wound infection, normal serum albumin, direct angiosome, and cilostazol use were significant predictors of wound healing, and female gender and no cilostazol use were significant predictors of major amputation by a multivariate analysis. CONCLUSIONS: Aggressive wound care by the team consisting of multidisciplinary specialists remarkably shortened the time to wound healing and increased the rate of wound healing within 1 year.
Asunto(s)
Isquemia/cirugía , Úlcera de la Pierna/cirugía , Extremidad Inferior/irrigación sanguínea , Grupo de Atención al Paciente , Procedimientos Quirúrgicos Vasculares , Cicatrización de Heridas , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica , Terapia Combinada , Enfermedad Crítica , Desbridamiento/métodos , Supervivencia sin Enfermedad , Desinfección/métodos , Femenino , Humanos , Isquemia/diagnóstico , Isquemia/fisiopatología , Estimación de Kaplan-Meier , Úlcera de la Pierna/diagnóstico , Úlcera de la Pierna/fisiopatología , Recuperación del Miembro , Masculino , Análisis Multivariante , Bloqueo Nervioso/métodos , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Trasplante de Piel , Irrigación Terapéutica , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversosRESUMEN
Psoriasis vulgaris is occasionally accompanied by autoimmune bullous diseases, but the opposite is very rare. We document here the first reported case of generalized pustular psoriasis that appeared during steroid therapy for bullous pemphigoid. The serum cytokine levels and the results of an immunohistochemical study over the disease course suggest that the immunological state was consistent with a shift from Th2-dominance to Th1-dominance. IL-17-producing cells appeared in the skin lesions when each disease was most exacerbated and disappeared after remission. Thus, the present case demonstrated a dynamic immunological state in which the appearances of Th1 and Th2 as well as Th17 varied during the course of the disease.
Asunto(s)
Penfigoide Ampolloso/inmunología , Psoriasis/inmunología , Linfocitos T Colaboradores-Inductores/inmunología , Linfocitos T Reguladores/inmunología , Adulto , Betametasona/uso terapéutico , Glucocorticoides/uso terapéutico , Humanos , Inmunohistoquímica , Interferón gamma/sangre , Masculino , Penfigoide Ampolloso/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/sangreRESUMEN
We developed a vision sensor system that performs a scale-invariant feature transform (SIFT) in real time. To apply the SIFT algorithm efficiently, we focus on a two-fold process performed by the visual system: whole-image parallel filtering and frequency-band parallel processing. The vision sensor system comprises an active pixel sensor, a metal-oxide semiconductor (MOS)-based resistive network, a field-programmable gate array (FPGA), and a digital computer. We employed the MOS-based resistive network for instantaneous spatial filtering and a configurable filter size. The FPGA is used to pipeline process the frequency-band signals. The proposed system was evaluated by tracking the feature points detected on an object in a video.
Asunto(s)
Sistemas de Computación , Computadores , Reconocimiento de Normas Patrones Automatizadas/métodos , Algoritmos , Sistemas de Computación/tendencias , Computadores/tendencias , Humanos , Reconocimiento de Normas Patrones Automatizadas/tendencias , Estimulación Luminosa/métodos , SemiconductoresRESUMEN
CARMA1-mediated NF-κB activation controls lymphocyte activation through antigen receptors and survival of some malignant lymphomas. CARMA1 clusters are formed on physiological receptor-mediated activation or by its oncogenic mutation in activated B-cell-diffuse large B-cell lymphomas (ABC-DLBCLs) with constitutive NF-κB activation. However, regulatory mechanisms and relevance of CARMA1 clusters in the NF-κB pathway are unclear. Here we show that SH3 and GUK domain interactions of CARMA1 link CARMA1 clustering to signal activation. SH3 and GUK domains of CARMA1 interact by either intra- or intermolecular mechanisms, which are required for activation-induced assembly of CARMA1. Disruption of these interactions abolishes the formation of CARMA1 microclusters at the immunological synapse, CARMA-regulated signal activation following antigen receptor stimulation as well as spontaneous CARMA1 clustering and NF-κB activation by the oncogenic CARMA1 mutation in ABC-DLBCLs. Thus, the SH3-GUK interactions that regulate CARMA1 cluster formations are promising therapeutic targets for ABC-DLBCLs.
Asunto(s)
Proteínas Adaptadoras de Señalización CARD/biosíntesis , Guanilato Ciclasa/biosíntesis , Subunidad p50 de NF-kappa B/metabolismo , Transducción de Señal , Animales , Proteínas Adaptadoras de Señalización CARD/química , Análisis por Conglomerados , Cristalografía por Rayos X , Homólogo 4 de la Proteína Discs Large , Femenino , Guanilato Ciclasa/química , Guanilato-Quinasas/biosíntesis , Guanilato-Quinasas/química , Humanos , Sistema Inmunológico/fisiología , Péptidos y Proteínas de Señalización Intracelular/biosíntesis , Péptidos y Proteínas de Señalización Intracelular/química , Células Jurkat , Linfocitos/citología , Masculino , Proteínas de la Membrana/biosíntesis , Proteínas de la Membrana/química , Ratones , Ratones Endogámicos C57BL , Ratones Transgénicos , Microscopía Fluorescente , Mutación , Unión Proteica , Conformación Proteica , Estructura Terciaria de Proteína , Ratas , Fracciones Subcelulares/metabolismo , Dominios Homologos srcRESUMEN
A variety of reactive organic compounds, called haptens, can cause allergic contact dermatitis. However, the innate immune mechanisms by which haptens stimulate dendritic cells (DCs) to sensitize T cells remain unclear. Here we show that the coupling of ITAM-Syk-CARD9 signalling to interleukin-1 (IL-1) secretion in DCs is crucial for allergic sensitization to haptens. Both MyD88 and Caspase recruitment domain-containing protein 9 (CARD9) signalling are required for contact hypersensitivity (CHS). Naïve T cells require signals received through IL-1R1-MyD88 for effector differentiation, whereas DCs require CARD9 and spleen tyrosine kinase (Syk) signalling for hapten-induced IL-1α/ß secretion and their ability to prime T cells. DC-specific deletion of CARD9, DAP12, Syk or NLRP3, but not MyD88, is sufficient to abolish CHS. All tested haptens, but not irritants, can induce Syk activation, leading to both the CARD9/BCL10-dependent pro-IL-1 synthesis (signal1) and reactive oxygen species-mediated NLRP3 inflammasome activation (signal2), required for IL-1 secretion. These data unveil an innate immune mechanism crucial for allergic contact sensitization to chemical compounds.