RESUMO
1. The objective of this study was to characterise the regulation of the pathways that synthesise long-chain polyunsaturated fatty acids (PUFA) on developing adipose deposits in broiler embryos and chicks. Subcutaneous adipose depots were harvested from embryos and embryonic d E13, E15 and E17. Subcutaneous, abdominal and crop (neck) adipose, as well as liver, were collected at 7 and 14 d post-hatch. 2. Targeted RNA sequencing was used to quantify expression of 6 elongation of very long-chain fatty acid (ELOVL) genes, two isoforms of stearoyl-CoA desaturase (SCD and SCD5), and three fatty acid desaturases (FADS1, FADS2, and FADS6) in each depot and in the liver. Expression levels of marker genes for fatty acid oxidation and adipogenesis (peroxisome proliferator-activated receptor gamma (PPARG)) were quantified. Fatty acid composition of subcutaneous adipose was analysed using gas chromatograph-mass spectrometry (GC/MS). 3. Genes in the PUFA synthetic pathway were differentially expressed across developmental ages and between depots. These include elongase and desaturase genes, that have not previously been characterised in chicken. Correlation analyses identified subsets of co-regulated genes and fatty acids and highlighted relationships that may influence adipose metabolism and development. 4. It was concluded that PUFA synthesis is an active and dynamically regulated pathway in developing adipose deposits in the broiler chick. These data highlighted potential novel roles for specific elongase and desaturase genes in adipose deposition and metabolism.
Assuntos
Adipogenia , Galinhas , Animais , Galinhas/genética , Ácidos Graxos Dessaturases/genética , Ácidos Graxos , Ácidos Graxos InsaturadosRESUMO
Objectives: In this study we assess the antibiotic resistance genes in three metronidazole-resistant Prevotella bivia clinical isolates. Methods: Strains were whole-genome sequenced. De novo assembly was performed and genes were annotated in RAST. Manual adjustments were made, when required, to the annotation and length of the genes. Results: In all three strains a novel nim gene, nimK, was encountered located on a mobile genetic element (MGE). The nimK gene was associated with an IS1380 family transposase. On the same MGE, genes encoding an efflux small MDR (SMR) transporter were present and were associated with a crp/fnr regulator. Conclusions: This is the first description of the presence of a novel nim gene in metronidazole-resistant P. bivia clinical isolates. This gene is co-located with an efflux SMR transporter on an MGE, which has been named Tn6456 (MG827401). The identification of these resistance genes on an MGE is worrisome, since this indicates the horizontal gene transfer of antibiotic and/or biocide resistance from one strain to the other.
Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana/genética , Sequências Repetitivas Dispersas , Proteínas de Membrana Transportadoras/genética , Metronidazol/farmacologia , Prevotella/efeitos dos fármacos , Prevotella/genética , Infecções por Bacteroidaceae/microbiologia , DNA Bacteriano/genética , Genes Bacterianos , Genoma Bacteriano , Humanos , Masculino , Testes de Sensibilidade Microbiana , Sequenciamento Completo do GenomaRESUMO
Herein, we report an aerobic synthesis method to produce bismuth nanoparticles (Bi NPs) with average diameters in the range 40-80 nm using commercially available bismuth triiodide (BiI3) as the starting material; the method uses only readily available chemicals and conventional laboratory equipment. Furthermore, size data from replicates of the synthesis under standard reaction conditions indicate that this method is highly reproducible in achieving Bi NP populations with low standard deviations in the mean diameters. We also investigated the mechanism of the reaction, which we determined results from the reduction of a soluble alkylammonium iodobismuthate precursor species formed in situ. Under appropriate concentration conditions of iodobismuthate anion, we demonstrate that burst nucleation of Bi NPs results from reduction of Bi3+ by the coordinated, redox non-innocent iodide ligands when a threshold temperature is exceeded. Finally, we demonstrate phase transfer and silica coating of the Bi NPs, which results in stable aqueous colloids with retention of size, morphology, and colloidal stability. The resultant, high atomic number, hydrophilic Bi NPs prepared using this synthesis method have potential for application in emerging x-ray contrast and x-ray therapeutic applications.
RESUMO
This study aims at characterizing the diversity and temporal changes of species richness and composition of fungi in an ecotone of a forest border and a meadow in the Taunus mountain range in Germany. All macroscopically visible, epigeous fungi and vascular plants were sampled monthly over three years, together with climatic variables like humidity and temperature that influence fungal diversity and composition as shown by previous studies. In this mosaic landscape, a total of 855 fungal species were collected and identified based on morphological features, the majority of which belonged to Ascomycota (51 %) and Basidiomycota (45 %). Records of fungal species and plant species (218) for this area yielded a fungus to plant species ratio of 4:1, with a plant species accumulation curve that reached saturation. The three years of monitoring, however, were not sufficient to reveal the total fungal species richness and estimation factors showed that a fungus to plant species ratio of 6:1 may be reached by further sampling efforts. The effect of climatic conditions on fungal species richness differed depending on the taxonomic and ecological group, with temporal patterns of occurrence of Basidiomycota and mycorrhizal fungi being strongly associated with temperature and humidity, whereas the other fungal groups were only weakly related to abiotic conditions. In conclusion, long-term, monthly surveys over several years yield a higher diversity of macroscopically visible fungi than standard samplings of fungi in autumn. The association of environmental variables with the occurrence of specific fungal guilds may help to improve estimators of fungal richness in temperate regions.
RESUMO
Posaconazole is an extended-spectrum triazole antifungal used in the treatment and prophylaxis of Aspergillus infections. It is available as oral suspension (POS-Liq) and delayed-release tablets (POS-Tab). The aim of this longitudinal, retrospective study was to compare the clinical effectiveness, toxicity and pharmacokinetics of POS-Liq vs POS-Tab in lung transplant recipients (LTx-recipients), who were treated with both formulations subsequently. Twenty-four consecutive LTx-recipients with 191 documented posaconazole trough levels (PTLs) for POS-Liq or POS-Tab were included. The administered daily doses were 300 mg for POS-Tab and 600 mg (prophylaxis) or 800 mg (therapy) for POS-Liq. Target PTLs were ≥700 ng/mL (prophylaxis) and ≥1250 ng/mL (therapy). The overall prophylactic and therapeutic response rates were 78% and 67%, respectively. No cases of hepatotoxicity or QT-prolongation were observed with either formulation. The achieved target PTLs were tripled under POS-Tab compared to POS-Liq with fewer risk factors for sub-therapeutic PTLs. Concomitant administration of POS-Tab significantly reduced the tacrolimus concentration-to-dose ratio (P = .001). We suggest the use of POS-Tab is appropriate for prophylaxis and therapy of Aspergillus infections in LTx-recipients, since POS-Tab displayed more reliable PTLs with no added adverse events. However, we recommend regular drug monitoring for POS-Liq and for therapy with POS-Tab and that immunosuppressant levels are monitored closely when the posaconazole formulation is switched.
Assuntos
Antifúngicos/administração & dosagem , Antifúngicos/farmacocinética , Transplante de Pulmão , Transplantados , Triazóis/administração & dosagem , Triazóis/farmacocinética , Administração Oral , Adulto , Idoso , Antifúngicos/uso terapêutico , Aspergilose/sangue , Aspergilose/tratamento farmacológico , Preparações de Ação Retardada/administração & dosagem , Preparações de Ação Retardada/uso terapêutico , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Infecções Fúngicas Invasivas/tratamento farmacológico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Suspensões , Comprimidos , Triazóis/uso terapêutico , Adulto JovemRESUMO
Polyelectrolyte complexation has long been known to result in both liquid and solid complexes. However, the exact nature of the liquid-to-solid transition remains an open question. We have used rheology to explain this phenomenon for the model system of poly(4-styrenesulfonic acid, sodium salt) (PSS) and poly(diallyldimethyl ammonium chloride) (PDADMAC) in the presence of potassium bromide (KBr). The use of a time-salt superposition allows for a detailed analysis of changes in the linear viscoelastic response for both liquid complex coacervates and solid polyelectrolyte complexes as a function of salt concentration, and facilitates unambiguous determination of the mechanism for this phase transition. Decreasing salt concentration, and the commensurate decrease in the water content of PSS/PDADMAC/KBr complexes is shown to lead to the formation of a physical gel due to the development of a network with trapped electrostatic crosslinks that percolates the sample at a critical salt concentration.
RESUMO
Hydrogen gas is produced photocatalytically using 470 nm light, PVP-coated carbon quantum dots (CQDs) as the photosensitizer, and nickel nanoparticles (NiNPs) as the catalyst. The effect of the amount of polyvinylpyrrolidone (PVP) on the ability of the CQD/NiNP composites to catalyze proton reduction was studied. A maximum of 330 mmols H2/g CQD is produced using 68 µg ml-1 of CQDs and 6 µg ml-1 of NiNPs, with activity persisting for 4 h when 20 wt%-PVP-coated CQDs were used. The H2 production quantum yield under these conditions is 6%. It was found that composites having higher weight percent PVP had decreased rates of H2 production, but increased duration. Increasing the weight percent of PVP coating also increases the fluorescence quantum yield of CQDs. Fluorescence quenching titrations reveal that H2 production could occur by either a reductive or oxidative quenching mechanism. The nanomaterials, prepared using simple methods, are used as the photosensitizer and catalyst in the proton reduction system that operates using visible light.
RESUMO
The primary aim of this long-term angler-led tagging programme was to gain information about seasonal changes in distribution of the starry smooth-hound shark Mustelus asterias, along the Dutch coast for management and conservation purposes. Between 2011 and 2014, M. asterias comprised 92·6% (n = 2418) of the total elasmobranch catch (n = 2612) by the licenced group of taggers within the Dutch Delta of which 2244 M. asterias were fin-tagged with plastic rototags. Sex and total length (LT ) composition inside the eastern tidal basin (Oosterschelde) were significantly different, i.e. more females and larger individuals, than outside indicating a pupping ground, which was confirmed by the capture of 30 newborn pups (≤32 cm). The distribution pattern of reported recaptured M. asterias (return-rate 3·6%, n = 80) showed a circannual migration between summering in the southern North Sea and wintering in the English Channel and the Bay of Biscay, and suggests that M. asterias is philopatric. The Dutch angling season for M. asterias runs from approximately mid-May to mid-October when the water temperature is above 13° C. Recaptures of eight mature females, but no males in the Bay of Biscay, indicate partial spatial segregation by sex, where mature females migrate over larger distances than immature females and males. These observations, with the absence of recaptures in other known summering areas (i.e. the Irish Sea and Bristol Channel), suggest that the southern North Sea is used by a separate population. Implications for management and recommendations to improve and expand the study approach are discussed.
Assuntos
Sistemas de Identificação Animal , Migração Animal/fisiologia , Estações do Ano , Tubarões/fisiologia , Distribuição Animal , Animais , Feminino , Pesqueiros , Masculino , Mar do Norte , TemperaturaRESUMO
Chronic lung allograft dysfunction (CLAD) is a limiting factor for long-term survival in lung transplant recipients. Donor-specific human leukocyte antigen (HLA)-antibodies (DSA) have been suggested as potential risk factors for CLAD. However, their impact on clinical outcome following lung transplantation remains controversial. We performed a single-center study of 120 lung transplant recipients transplanted between 2006 and 2011. Patient sera were investigated before and after transplantation. The sera were screened by means of Luminex(®) technology (Luminex Inc., Austin, TX, USA) for IgG-HLA-class I and class II antibodies (ab). Using single antigen beads, DSA were identified and correlated retrospectively with clinical parameters. After transplantation 39 out of 120 patients (32.5%) were positive for HLA-ab. The incidence of de novo DSA formation was 27 of 120 patients (22.5%). Eleven of 27 (41%) of de novo DSA-positive patients developed BOS compared to 13 of 93 (14%) DSA-negative patients (p = 0.002). Furthermore, the generation of de novo DSA was independently associated with the development of BOS in multivariable analysis [hazard ration (HR) 2.5, 95% confidence interval (CI) 1.0-6.08; p = 0.046). Our results indicate that de novo DSA are associated with the development of BOS after lung transplantation. Monitoring of HLA-ab after transplantation is useful for identifying high-risk patients and offers an opportunity for early therapeutic intervention.
Assuntos
Anticorpos/imunologia , Bronquiolite Obliterante/imunologia , Antígenos HLA/imunologia , Adulto , Feminino , Humanos , Transplante de Pulmão , Masculino , Pessoa de Meia-Idade , Doadores de TecidosRESUMO
High molecular weight PBTTT-C12 is blended with the pure trimer, BTTT-3, to enhance intergrain connectivity and charge transport. Analysis of the morphology and crystallinity of the blends shows that the polymer and oligomer are well-integrated, leading to high hole mobilities, greater than 0.1 cm(2) V(-1) s(-1), in films that contain as much as 83% oligomer.
RESUMO
BACKGROUND: The purpose of the present study was to determine differences in prognostic factors for survival of patients with pulmonary metastases resected in curative intent from colon or rectum cancer. METHODS: Between 1980 and 2006, prognostic factors after resection of pulmonary metastases in 171 patients with primary rectum or colon tumor were evaluated. Survival of patients after surgical metastasectomy was compared with that of patients receiving standard chemotherapy by matched-pair analysis. RESULTS: Median survival after pulmonary resection was 35.2 months (confidence interval 27.3-43.2). One-, 3-, and 5-year survival for patients following R0 resection was 88.8, 52.1, and 32.9 % respectively. Complete metastasectomy (R0), UICC stage of the primary tumor, pleural infiltration, and hilar or mediastinal lymph node metastases are independent prognostic factors for survival. Matched-pair analysis confirmed that pulmonary metastasectomy significantly improved survival. Although no difference in survival for patients with pulmonary metastases from lower rectal compared to upper rectal or colon cancer was observed, factors to predict survival are different for patients with lower and middle rectal cancer (R0, mediastinal and/or hilar lymph nodes, gender, UICC stage) compared with patients with upper rectal or colon cancer (R0, number of metastases). CONCLUSIONS: Our results indicate that distinct prognostic factors exist for patients with pulmonary metastases from lower rectal compared with upper rectal or colon cancer. This supports the notion that colorectal cancer should not be considered as a single-tumor entity. Metastasectomy, especially after complete resection resulted in a dramatic improvement of survival compared with patients treated with chemotherapy alone.
Assuntos
Neoplasias do Colo/mortalidade , Neoplasias Pulmonares/mortalidade , Excisão de Linfonodo/mortalidade , Metastasectomia/mortalidade , Neoplasias Retais/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Metástase Linfática , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Taxa de SobrevidaRESUMO
Globally, biogenic temperate reefs are among the most threatened habitats. In the North Sea in particular, large shellfish reefs were lost owing to fishing activities in the 1900s. The impact of offshore wind farms (OWFs) on marine wildlife is extensive, and it offers the possibility to reintroduce new hard substrate habitats that are protected from fisheries at a large scale. In addition to the submerged structures of OWFs, marine hard substrate habitat can be further enhanced by providing extra artificial reefs. In an operational OWF along the Dutch coast, four artificial reefs (two with a scour bed and two without) were deployed in the vicinity of a wind turbine. Acoustic telemetry was used to monitor the fine-scale movement of 64 Atlantic cod (Gadus morhua). The monitoring ran from July 2021 to January 2023. Detailed information on behaviour, area utilization and attraction to the structures was determined. Results showed strong attraction (high site fidelity and residency) to the artificial reef, with no significant difference between the two tested types of reefs, and only a few individuals staying over winter. Cod spent a large proportion of their time hiding in the artificial reefs, suggesting that adding pipes for shelter has a beneficiary effect.
RESUMO
Genomics is a crucial part of managing surgical disease. This review focuses on some of the genomic advances that are available now and looks to the future of their application in surgical practice. Whole-genome sequencing enables unbiased coverage across the entire human genome of approximately three billion base pairs. Newer technologies, such as those that permit long-read sequence analysis, provide additional information in longer phased fragment and base pair epigenomic (methylomic) data. Whole-genome sequencing is currently available in England for cancers in children, teenagers and young adults, central nervous system tumours, sarcoma and haematological malignancies. Circulating tumour DNA (ctDNA), immunotherapy and pharmacogenomics have emerged as groundbreaking approaches in the field of cancer treatment. These are now revolutionising the way oncologists and surgeons approach curative cancer surgery. Cancer vaccines offer an innovative approach to reducing recurrence after surgery by priming the immune system to trigger an immune response. The Cancer Vaccine Launch Pad project facilitates cancer vaccine studies in England. The BNT122-01 trial is recruiting patients with ctDNA-positive high-risk colorectal cancer after surgery to assess the impact of cancer vaccines. The evolving landscape of cancer treatment demands a dynamic and integrated approach from the surgical multidisciplinary team. Immunotherapy, ctDNA, pharmacogenomics, vaccines, mainstreaming and whole-genome sequencing are just some of the innovations that have the potential to redefine the standards of care. The continued exploration of these innovative diagnostics and therapies, the genomic pathway evolution and their application in diverse cancer types highlights the transformative impact of precision medicine in surgery.
Assuntos
Vacinas Anticâncer , DNA Tumoral Circulante , Neoplasias , Cirurgiões , Criança , Humanos , Adolescente , DNA Tumoral Circulante/genética , GenômicaRESUMO
Diadromous fish such as the European eel (Anguilla anguilla L.) are hampered by a high density of barriers in estuaries and freshwater systems. Modified and fragmented waterbodies lack tidal flows, and habitat may be less accessible and underutilized compared to free-flowing rivers and estuaries. With rising sea levels and increased occurrence of droughts, the number of barriers may further increase, implying that the need to study migration in such areas may even become more urgent worldwide. To study glass eel migration and behaviour in such highly modified water systems, a mark-recapture study was carried out in the North Sea Canal (NSC) basin, which drains into the North Sea via a large sluice complex. In total, eight uniquely tagged groups (3,797 glass eels) were released near the sluice complex, and 11 groups (2,663 glass eels) were released at inland barriers upstream over a 28 km long stretch in the NSC in spring 2018. The sluice complex attracted 10.3 million glass eel and did not block or delay their immigration. The large and diurnally intensively used coastal ship locks and allowings some saltwater intrusion, efficiently facilitated glass eel migration. Once in the NSC, water outlets from adjacent polders attracted glass eels relative proportional to the discharge of pumping stations. In the NSC, average migration speeds of 0.7 km/day (max. 1.8 km/day) were measured, and this increased with higher temperatures. Redistribution of glass eel from accumulations at inland barriers to other outlet locations was observed in both upstream and downstream directions in the NSC. Passage success and residence time ('delays' of 4.1-13.7 days) varied between the different inland barriers. Most of the glass eel, however, appears to settle in the easily accessible habitats within the brackish NSC catchment. This study combined an integral assessment of successive bottlenecks in a modified inland water system.
RESUMO
INTRODUCTION AND OBJECTIVES: Adjuvant platinum-based chemotherapy for completely resected non-small cell lung cancer is associated with modest improvement in survival; nevertheless, no validated biomarker exists for predicting the benefit or harm of adjuvant platinum-based chemotherapy. MATERIALS AND METHODS: We simultaneously measured 27 cytokines in operative tumor specimens from a discovery cohort (n = 97) by multiplex immunoassay; half of the patients received adjuvant platinum-based chemotherapy, and the other half were observed. We tested possible prognostic and predictive factors in multivariate Cox models for overall survival (OS) and relapse-free survival (RFS), and a tree-based method was applied to detect predictive factors with respect to RFS. The results were validated in an independent validation cohort (n = 93). RESULTS: Fifty-two of 97 (54 %) patients in the discovery cohort and 50 of 93 (54 %) in the validation cohort received adjuvant chemotherapy; forty-four (85 %) patients in the discovery cohort and 37 (74 %) in the validation cohort received four cycles as planned. In patients with low IL-1ß-expressing tumors, RFS and OS were worse after adjuvant chemotherapy than after observation. The limited effect of adjuvant chemotherapy for patients with low IL-1ß-expressing tumors was confirmed in the validation cohort. Additionally, RFS and OS were prolonged by adjuvant chemotherapy only in patients with high IL-1ß-expressing tumors in the validation cohort. CONCLUSIONS: This study identified and validated low tumor IL-1ß expression as a potential biomarker of a limited response to adjuvant platinum-based chemotherapy after complete resection of pulmonary adenocarcinoma. This finding has the potential to inform adjuvant treatment decisions.
RESUMO
Monodispersed conjugated oligothiophenes are receiving attention in fundamental and applied science due to their interesting optical, optoelectronic, and charge transport properties. These "low molecular weight" polymers serve as model structures for the corresponding polymer analogues, which are inherently polydispersed. Here we report the synthesis, electronic structure, molecular packing/morphology, and charge transport properties of monodispersed oligothiophenes with up to six didodecylquaterthiophene (DDQT) building block repeat units (i.e., 24 thiophene units). At the point where the effective conjugation length is reached, the electronic structure showed convergence behavior to the corresponding polymer, poly(3,3"-didodecyl-quaterthiophene) (PQT-12). X-ray crystal structure analysis of the dimer (DDQT-2) showed that terminal thiophenes exhibit syn-conformations, similar to the terminal syn-conformations observed in the trimer (DDQT-3). The dimer also exhibits a rare bending of the terminal alkyl side chains in order to prevent steric hindrance with neighboring hydrogens attached to core thiophenes. Grazing incidence X-ray scattering measurements revealed a morphology evolution from small molecule-like packing to polymer-like packing in thin films, with a morphology transition occurring near the effective conjugation length. Charge transport measurements showed a mobility increase with decreasing chain length. We correlated the molecular packing and morphology to charge transport and determined that carrier mobilities are most sensitive to crystallinity and crystal grain misorientation. This indicates that molecular weight is not a decisive factor for improved carrier mobility in the low molecular weight region, but rather the degree in crystallinity and in-plane crystal orientation. These results represent a fundamental advancement in understanding the relationship between conjugation length and carrier mobilities in oligothiophene semiconductors.
RESUMO
We demonstrate that quantum scattering of fast atoms and molecules under grazing angles of incidence can be exploited to study the structure of organic molecules on metal surfaces. Making use of keV H and He atoms as well as H2 molecules, the surface structures of the chiral amino acid alanine adsorbed on a Cu(110) surface is studied. We present a detailed investigation on the (3×2) phase of a monolayer of enantiopure and racemic alanine on Cu(110), revealing the formation of an elongated surface unit cell of c(n×2) symmetry with n=3.16±0.04 for the sticking out methyl groups of the alanine molecules.
RESUMO
Pathogenic mutations in a large number of human epithelial keratins have been well characterized. However, analogous mutations in the hard alpha-keratins of hair and nail have not yet been described. Monilethrix is a rare autosomal dominant hair defect with variable expression. Hairs from affected individuals show a beaded structure of alternating elliptical nodes and constrictions (internodes). These internodes exhibit a high prospensity to weathering and fracture. Strong evidence that trichocyte keratin defects might underlie this hair disorder was provided by genetic linkage analyses that mapped this disease to the type-II keratin gene cluster on 12q13. All affected individuals from a four-generation British family with monilethrix, previously linked to the type-II keratin gene cluster, as well as three unrelated single monilethrix patients, exhibited a heterozygous point mutation in the gene for type-II hair cortex keratin hHb6, leading to lysine substitution of a highly conserved glutamic acid residue in the helix termination motif (Glu 410 Lys). In a three-generation French family with monilethrix of a milder and variable phenotype, we detected another heterozygous point mutation in the same glutamic acid codon of hHb6, which resulted in a conservative aspartic acid substitution (Glu 410 Asp). These mutations provide the first direct evidence for involvement of hair keratins in hair disease.
Assuntos
Doenças do Cabelo/genética , Queratinas/genética , Mutação , Adolescente , Criança , Feminino , Ácido Glutâmico , Doenças do Cabelo/patologia , Heterozigoto , Humanos , Lisina , Masculino , Pessoa de Meia-Idade , LinhagemRESUMO
A 49-year-old woman presented with unspecific symptoms including polydipsia, increasing fatigue for several weeks, and vague abdominal pain. Serum calcium (5.30 mmol/l; normal range 2.00-2.60) and parathyroid hormone levels (> 2500.0 ng/l; normal range 15.0-68.0) were extremely elevated. Imaging studies showed a huge mediastinal tumor. Based on these findings a hypercalcemic crisis caused by primary hyperparathyroidism was diagnosed. After intensive care treatment and further diagnostic procedures, the patient's parathyroid adenoma was removed by parathyroidectomy. The postoperative course was uneventful.
Assuntos
Dor Abdominal/etiologia , Adenoma/complicações , Adenoma/diagnóstico , Fadiga/etiologia , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico , Polidipsia/etiologia , Dor Abdominal/diagnóstico , Dor Abdominal/prevenção & controle , Adenoma/cirurgia , Diagnóstico Diferencial , Fadiga/diagnóstico , Fadiga/prevenção & controle , Feminino , Humanos , Neoplasias do Mediastino , Pessoa de Meia-Idade , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia , Polidipsia/diagnóstico , Polidipsia/prevenção & controle , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVE: Pharmacokinetics (PK) are severely altered in pregnant women due to changes in volume of distribution (Vd) and/or drug clearance (CL), affecting target attainment of antibiotics in pregnant women. This review is part of a series that reviews literature on the description of PK and target attainment of antibiotics in pregnant women with specific focus on penicillins. METHODS: A systematic literature search was carried out in PubMed. Articles were labelled as relevant when information on PK of penicillins in pregnant women was available. RESULTS: Thirty-two relevant articles were included, 8 of which discussed amoxicillin (with and without clavulanic acid), 15 ampicillin, 4 benzylpenicillin, 1 phenoxymethylpenicillin, and 4 piperacillin (with and without tazobactam). No studies were found on pheneticillin and flucloxacillin in pregnant women. Ten out of 32 articles included information on both Vd and CL. During the second and third trimester of pregnancy, a higher CL and larger Vd was reported than in non-pregnant women and in pregnant women during first trimester. Reduced target attainment was described in second and third trimester pregnant women. Only 7 studies reported dosing advice, 4 of which were for amoxicillin. CONCLUSION: The larger Vd and higher CL in second and third trimester pregnant women might warrant a higher dosage or shortening of the dosing interval of penicillins to increase target attainment. Studies frequently fail to provide dosing advice for pregnant women, even if the necessary PK information was available.