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1.
Neurol Sci ; 44(7): 2239-2245, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-37160544

RESUMEN

OBJECTIVE: There is concern that the coronavirus disease (COVID-19) vaccine may trigger or worsen autoimmune diseases. The objective of this study was to determine the impacts of COVID-19 vaccination on symptom severity in patients with myasthenia gravis (MG). METHODS: A total of 106 enrolled patients with MG who were vaccinated against COVID-19 were followed up, and a questionnaire was used to document in detail the exacerbation of muscle weakness after vaccination and all other uncomfortable reactions after vaccination. Demographic, clinical characteristics, medication, and vaccination data were collected by follow-up interview. The main observation outcome was whether the MG symptoms of patients were exacerbated. The definition of exacerbation is according to the subjective feeling of the patient or a 2-point increase in daily life myasthenia gravis activity score relative to before vaccination, within 30 days after vaccination. RESULTS: Of 106 enrolled patients [median age (SD) 41.0 years, 38 (35.8%) men, 53 (50.0%) with generalized MG, 74 (69.8%) positive for acetylcholine receptor antibody, and 21 (19.8%) with accompanying thymoma], muscle weakness symptoms were stable in 102 (96.2%) patients before vaccine inoculation. Muscle weakness worsened in 10 (9.4%) people after vaccination, of which 8 patients reported slight symptom worsening that resolved quickly (within a few days). Two (1.9%) of patients showed serious symptom aggravation that required hospitalization. CONCLUSION: Our results suggest that inactivated virus vaccines against COVID-19 may be safe for patients with MG whose condition is stable. Patients with generalized MG may be more likely to develop increased muscle weakness after vaccination.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Miastenia Gravis , Neoplasias del Timo , Adulto , Femenino , Humanos , Masculino , COVID-19/prevención & control , COVID-19/complicaciones , Vacunas contra la COVID-19/efectos adversos , Debilidad Muscular , Miastenia Gravis/complicaciones , Neoplasias del Timo/complicaciones , Vacunación/efectos adversos
2.
J Healthc Qual Res ; 38(4): 197-205, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36581557

RESUMEN

BACKGROUND: Total hip arthroplasty (THA) and hemiarthroplasty are common treatments for severe hip joint disease. To predict the probability of re-admission after discharge when patients are hospitalized will support providing appropriate health education and guidance. METHODS: The research aims to use logistic regression (LR), decision trees (DT), random forests (RF), and artificial neural networks (ANN) to establish predictive models and compare their performances on re-admissions within 30 days after THA or hemiarthroplasty. The data of this study includes patient demographics, physiological measurements, disease history, and clinical laboratory test results. RESULTS: There were 508 and 309 patients in the THA and hemiarthroplasty studies respectively from September 2016 to December 2018. The accuracies of the four models LR, DT, RF, and ANN in the THA experiment are 94.3%, 93.2%, 97.3%, and 93.9%, respectively. In the hemiarthroplasty experiment, the accuracies of the four models are 92.4%, 86.1%, 94.2%, and 94.8%, respectively. Among these, we found that the RF model has the best sensitivity and ANN model has the best area under the receiver operating characteristic (AUROC) score in both experiments. CONCLUSIONS: The THA experiment confirmed that the performance of the RF model is better than the other models. The key factors affecting the prognosis after THA surgery are creatinine, sodium, anesthesia duration, and dialysis. In the hemiarthroplasty experiment, the ANN model showed more accurate results. Poor kidney function increases the risk of hospital re-admission. This research highlights that RF and ANN model perform well on the hip replacement surgery outcome prediction.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Hemiartroplastia , Humanos , Artroplastia de Reemplazo de Cadera/métodos , Hemiartroplastia/métodos , Readmisión del Paciente , Hospitales , Aprendizaje Automático
3.
Zhonghua Yi Xue Za Zhi ; 102(19): 1445-1449, 2022 May 24.
Artículo en Chino | MEDLINE | ID: mdl-35599409

RESUMEN

Objective: To analyze the clinical characteristics and related genetic variation of juvenile myasthenia gravis (MG) patients. Methods: We collected the clinical data of adolescent MG patients who were treated in the Department of Neurology of the First Affiliated Hospital of Sun Yat-sen University from June 2019 to May 2020. After obtaining the patient's informed consent, the blood samples were collected. The Whole Exome Sequencing (WES) was performed on peripheral blood samples. And use biological information software and SPSS 22.0 for data processing and result analysis. Results: According to the inclusion and exclusion criteria, 54 patients with juvenile MG were included, 28 males and 26 females. And the average age of onset was (3.79±0.89) years. Among the enrolled patients, there were 52 (96.3%) patients with ocular MG, the MG-ADL scores of 54 patients were (3.44±0.44) points, and the titer of AChR antibody was (5.88±2.45) nmol/L. Two patients had thymic hyperplasia, and 5 patients had a family history of MG.A total of 169 variant genes were found in 54 patients, of which TTN gene variants had the largest number, with a total of 17 variants (31.5%). In the TTN gene variant group, 7(41.2%) patients had eye fixation symptoms, and 4 (10.8%) patients in the non-mutation group had eye fixation symptoms. And The difference between the two groups was statistically significant (P=0.016). In addition, the synaptic nucleus envelope protein-1 (SYNE1) and the ryanodine receptor-1 (RYR1) gene variations were also found in 7 cases (13.2%), and no clear relationship between these gene variations and clinical manifestations of MG was found. Conclusions: The incidence of juvenile MG was preschoolers with no gender difference, and ocular MG was more common. The proportion of TTN gene variation in adolescent MG was higher, suggesting that this gene may be a potential therapeutic target for juvenile MG patients.


Asunto(s)
Miastenia Gravis , Hiperplasia del Timo , Adolescente , Anticuerpos , Preescolar , Femenino , Variación Genética , Humanos , Masculino , Miastenia Gravis/diagnóstico , Miastenia Gravis/genética , Receptores Colinérgicos/genética , Estudios Retrospectivos
4.
Zhonghua Yi Xue Za Zhi ; 102(13): 942-947, 2022 Apr 05.
Artículo en Chino | MEDLINE | ID: mdl-35385966

RESUMEN

Objective: To investigate the clinical manifestations, treatment characteristics and outcomes of myasthenia gravis (MG) dually positive for anti-acetylcholine receptor antibody (AChR-Ab) and anti-muscle-specific tyrosine kinase antibody (MuSK-Ab). Method: MG patients hospitalized in the First Affiliated Hospital of Sun Yat-sen University from August 2017 to November 2020 were retrospectively collected. Thirty-four MuSK-Ab positive MG (MuSK-MG) patients, 11 double-antibodies positive MG (DP-MG) patients, and 80 AChR-Ab positive MG (AChR-MG) patients were included and allocated to three different groups. The clinical data of patients in the three groups were collected, and the differences of demographic characteristics, clinical manifestations and treatment outcomes between DP-MG patients and AChR-MG and MuSK-MG patients were analyzed. Result: The proportion of female and male patients in DP-MG group was 7/11 and 4/11 respectively, and the onset age of DP-MG was (41±27) years.The difference in gender distribution between DP-MG and AChR-MG groups was statistically significant (P<0.05). The proportion of extraocular muscle involvement in the DP-MG and MuSK-MG groups (8/11 and 52.9%) was lower than that in the AChR-MG group (83.8%), and the difference was statistically significant (P<0.05). The incidence of myasthenia crisis in DP-MG and MuSK-MG groups (54.5% and 61.8%) were higher than that in AChR-MG group (20.0%), with astatistically significant difference(P<0.05). The positive rate of neostigmine test in DP-MG and MuSK-MG groups(8/11 and 74.2%) were lower than that of AChR-MG group (96.8%), and the positive rate of low frequency repetitive nerve stimulation (RNS) in DP-MG group (5/10) was lower than that in AChR-MG group (85.1%), with statistically significant differences (all P<0.05). MuSK-Ab titer was positively correlated with the course of disease (r=0.466, P<0.05), and antibody titer decreased after symptom improvement (P<0.05). The response of patients in DP-MG and MuSK-MG groups to cholinesterase inhibitors (2/11 and 9.1%) was worse than that in the AChR-MG group (66.3%), and the incidence of side effects in the two groups (5/11 and 39.4%) was higher than that in the AChR-MG group (15.0%), with statistically significant differences (all P<0.05). There were 4 DP-MG patients underwent thymectomy, and the pathological results detected two cases of thymoma and two cases of thymic hyperplasia. Subsequent follow-up showed that 5 (5/11) DP-MG patients achieved minimal manifestation status or better status. Conclusion: The gender distribution, age of onset, pharmacological characteristics and electrophysiological examination of DP-MG patients were similar to those of MuSK-MG patients, but the severity of DP-MG patients was between that of AChR-MG and MuSK-MG patients.


Asunto(s)
Miastenia Gravis , Neoplasias del Timo , Adolescente , Adulto , Anciano , Autoanticuerpos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculos/patología , Miastenia Gravis/diagnóstico , Proteínas Tirosina Quinasas Receptoras , Receptores Colinérgicos , Estudios Retrospectivos , Tirosina , Adulto Joven
5.
Zhonghua Yi Xue Za Zhi ; 99(32): 2522-2526, 2019 Aug 27.
Artículo en Chino | MEDLINE | ID: mdl-31484280

RESUMEN

Objective: To retrospectively analyze the characteristics of the electromyography (EMG) study in generalized myasthenia gravis (gMG) patients. Methods: A total of 111 gMG patients were enrolled. Patients were divided into two groups: 36 severe patients discontinuing pyridostigmine bromide (PB) for 8 hours were included in 8 h group, and 75 g MG patients discontinuing PB for at least 18 hours were included in>18 h group. The clinical information and EMG study data were collected and analyzed. Results: There were statistically significant differences in the initial location of the myasthenia muscle (P=0.027), the affected muscle detected by the EMG (P=0.015) and quantitative myasthenia gravis (QMG) score (P<0.01) between the two groups. Comparisons in each group revealed that the highest positive rate of low-frequency repetitive nerve stimulation (RNS) of facial in 8 h group and>18 h group was 94.4% and 60.0%, respectively. Comparisons between the two groups showed that the positive rate of low-frequency RNS in 8 h group was significantly higher than that in>18 h group (94.4% vs 70.7%, χ(2)=8.115, P=0.004). In particular, the positive rate of RNS in facial nerves and the extent of the amplitude decrease under different electrical stimulations (1 Hz, 3 Hz, and 5 Hz) were dramatically higher in the 8 h group (P<0.01). Conclusions: For gMG patients, the facial and accessory nerve detection can improve the positive rate of RNS. Different muscles had various sensitivity to PB, and orbicularis oculi muscle seemed the least sensitive muscle to PB. For suspect MG patients in severe condition, only discontinuing PB medication for 8 h before low-frequency RNS testing can avoid the deterioration and also obtain similar positive rate.


Asunto(s)
Miastenia Gravis , Estimulación Eléctrica , Electromiografía , Músculos Faciales , Humanos , Estudios Retrospectivos
6.
Zhonghua Yi Xue Za Zhi ; 97(37): 2884-2889, 2017 Oct 10.
Artículo en Chino | MEDLINE | ID: mdl-29050155

RESUMEN

Objective: To investigate the clinical features of the Pre-Crisis State and analyze the correlated risk factors of Pre-Crisis State of myasthenia crisis. Methods: We included 93 patients with myasthenia gravis (MG) who experienced 127 times Pre-Crisis State between October 2007 and July 2016. Those patients were hospitalized in the MG specialize center, Department of Neurological Science, first Affiliated Hospital of Sun Yat-sen University. The information of the general situation, the clinical manifestations and the blood gas analysis in those patients were collected using our innovated clinical research form. Statistic methods were applied including descriptive analysis, univariate logistic analysis, multivariate correlation logistic analysis, etc. Results: (1)The typical features of MG Pre-Crisis State included: dyspnea (127 times, 100% not requiring intubation or non-invasive ventilation), bulbar-muscle weakness (121 times, 95.28%), the increased blood partial pressure of carbon dioxide (PCO(2)) (94 times, 85.45%), expectoration weakness (99 times, 77.95%), sleep disorders (107 times, 84.25%) and the infection (99 times, 77.95%). The occurrence of dyspnea in combination with bulbar-muscle weakness (P=0.002) or the increased blood PCO(2) (P=0.042) often indicated the tendency of crisis. (2) The MG symptoms which were proportion to the occurrence of crisis includes: bulbar-muscle weakness (P=0.028), fever (P=0.028), malnutrition (P=0.066), complications (P=0.071), excess oropharyngeal secretions (P=0.005) and the increased blood PCO(2) (P=0.007). The perioperative period of thymectomy would not increase the risk of crisis. Conclusions: Dyspnea indicates the occurrence of the Pre-Crisis State of MG. In order to significantly reduce the morbidity of myasthenia crisis, the bulbar-muscle weakness, the increased blood PCO(2), expectoration weakness, sleep disorders, infection & fever and excess oropharyngeal secretions should be treated timely.


Asunto(s)
Miastenia Gravis , Humanos , Análisis Multivariante , Complicaciones Posoperatorias , Factores de Riesgo , Timectomía
7.
Zhonghua Yi Xue Za Zhi ; 97(19): 1463-1468, 2017 May 23.
Artículo en Chino | MEDLINE | ID: mdl-28535636

RESUMEN

Objective: To investigate the characteristics of the distribution and amount of different subtypes of dendritic cell (DC) in myasthenia gravis(MG). Methods: We collected the thymic specimens from 32 patients who received thymoctomy because of cardiac surgery from January 2016 to December 2016 and selected 14 of them as normal control. Meantime, 61 MG patients who combined with thymic hyperplasia and received extended thymectomy were collected and selected 8 of them as experiment group.Immunohistochemical methods were used to label the two subtype DCs: plasmacytoid dendritic cell (pDC) and classical/conventional dendritic cell (cDC), to observe the distribution of these two DC subtypes in thymus and also quantify them in different thymus structures by image analysis software.Comparing with normal thymus of the same age, we intended to demonstrate the characteristics of distribution and density of DC subtypes in patients who had MG and hyperplastic thymus. Results: (1) We labeled pDC and cDC by staining with CD123 and CD11c.The two DC subtypes distributed in both cortex and medulla, and the majority gathered in medulla, the density of pDC in thymus cortex was (34±6)/mm(2)(n=14), the density of pDC in thymus medulla was (247±35)/mm(2)(n=14), the density of cDC in thymus cortex was (21±4)/mm(2)(n=14), the density of cDC in thymus medulla was (123±16)/mm(2) (n=14). (2) The density of pDC in thymus cortex and medulla of patients with MG was lower when compared with the normal group (the density of pDC in thymus cortex, [(39±10)/mm(2) vs (29±5)/mm(2)], the density of pDC in thymus medulla, [(279±48)/mm(2) vs (236±49)/mm(2)], but with no significant difference.There was no significant difference between the density of cDC in thymus cortex of patients with MG patients and normal people, however, the amount of cDC increases in medulla and the difference was statistically significant (P<0.05). (3) The density of cDC in thymus medulla (except for germinal center) was higher than normal people (110±18) /mm(2) vs (187±29/mm(2)), though the difference was not statistically significant (P=0.059 9). The density of cDC in the ectopic germinal center (GC) of MG patients increased obviously compared with that in thymus medulla [(203±44) /mm(2) vs (439±69)/mm(2)] and the difference was statistically significant (P<0.05). Conclusions: The density of cDC increases significantly in thymus medulla of MG patients, especially gathering around or in the ectopic GC. It indicates that cDC may play an important role in the formation of ectopic GC in the hyperplasia thymus, thus involves in the disease process.


Asunto(s)
Células Dendríticas , Miastenia Gravis/patología , Hiperplasia del Timo/cirugía , Humanos , Miastenia Gravis/terapia , Timectomía , Timo
8.
Oncogene ; 35(26): 3410-8, 2016 06 30.
Artículo en Inglés | MEDLINE | ID: mdl-26477307

RESUMEN

Aberrant activation of Wnt/ß-catenin pathway contributes to colorectal cancer (CRC) progression. However, little is known about regulatory mechanisms of the ß-catenin activity in cancer progression. Here we investigated the role of DBC1, which was recently reported as a negative regulator of SIRT1 and a transcriptional coactivator, in the regulation of Wnt/ß-catenin signaling. We identified the genome-wide targets of DBC1 and found that loss of DBC1 inhibits the expression of ß-catenin target genes including PROX1, a transcription factor linked to CRC progression. Mechanistically, DBC1 stabilizes LEF1-ß-catenin interaction by inhibiting SIRT1-mediated ß-catenin deacetylation, thereby enhancing LEF1-ß-catenin complex formation and long-range chromatin looping at the PROX1 locus. Furthermore, DBC1 is also required for the transcriptional activity of PROX1, suggesting that DBC1 has a dual function in regulating ß-catenin-PROX1 signaling axis: as a coactivator for both ß-catenin and PROX1. Importantly, loss of DBC1 inhibited growth and tumorigenic potential of colon cancer cells, and DBC1 expression correlated with shorter relapse-free survival in patients with advanced CRC. Our results firmly establish DBC1 as a critical positive regulator of ß-catenin-PROX1 signaling axis and a key factor in ß-catenin-PROX1-mediated CRC progression.


Asunto(s)
Proteínas Adaptadoras Transductoras de Señales/genética , Neoplasias Colorrectales/genética , Proteínas de Homeodominio/genética , Transducción de Señal/genética , beta Catenina/genética , Proteínas Adaptadoras Transductoras de Señales/metabolismo , Animales , Línea Celular , Línea Celular Tumoral , Neoplasias Colorrectales/metabolismo , Neoplasias Colorrectales/patología , Progresión de la Enfermedad , Femenino , Regulación Neoplásica de la Expresión Génica , Células HEK293 , Células HT29 , Proteínas de Homeodominio/metabolismo , Humanos , Inmunohistoquímica , Ratones Endogámicos BALB C , Ratones Desnudos , Interferencia de ARN , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Trasplante Heterólogo , Proteínas Supresoras de Tumor , beta Catenina/metabolismo
9.
Allergy ; 70(11): 1477-84, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26214611

RESUMEN

BACKGROUND: Atopic dermatitis affects 15-30% of children worldwide. Onset of disease usually occurs within the first year of life, over half of which regress by 6 years of age. The aim of this study was to investigate the risk factors related to the persistence of infantile atopic dermatitis. METHODS: In this birth cohort study, patients were enrolled prenatally and followed until 6 years of age; 246 patients had infantile atopic dermatitis at 6 months of age. Family history, maternal and paternal total and specific Immunoglobulin E (IgE) levels, and cord blood IgE were recorded. Clinical examination, questionnaire survey, and blood samples for total and specific IgE of the children were collected at each follow-up visit. RESULTS: Of the 246 patients with infantile atopic dermatitis at 6 months of age, 48 patients had persisted atopic dermatitis at 6 years of age (19.5%). Risk factors associated with persistent infantile atopic dermatitis included egg white sensitization (odds ratio: 3.801, P = 0.020), and atopic dermatitis involving two or more areas at 6 months old (odds ratio: 2.921, P = 0.018) after multivariate analysis with logistic regression. Patients with persistent infantile atopic dermatitis had a higher risk of asthma before 6 years old (39.6% vs 24.2%, P = 0.032). CONCLUSION: Egg white sensitization and the initial involvement of two or more areas at 6 months of age were associated with the persistent infantile atopic dermatitis. Patients with persistent infantile atopic dermatitis are more likely to develop asthma by 6 years of age.


Asunto(s)
Dermatitis Atópica/epidemiología , Dermatitis Atópica/etiología , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Inmunoglobulina E/sangre , Inmunoglobulina E/inmunología , Lactante , Recién Nacido , Masculino , Exposición Materna , Embarazo , Estudios Prospectivos , Factores de Riesgo , Taiwán/epidemiología
10.
Oral Dis ; 21(2): 207-15, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24724948

RESUMEN

OBJECTIVE: Previous studies examining the association between genetic variations in prostaglandin pathway and risk of head and neck cancer (HNC) have only included polymorphisms in the PTGS2 (COX2) gene. This study investigated the association between genetic polymorphisms of six prostaglandin pathway genes (PGDS, PTGDS, PTGES, PTGIS, PTGS1 and PTGS2), and risk of HNC. METHODS: Interviews regarding the consumption of alcohol, betel quid, and cigarette were conducted with 222 HNC cases and 214 controls. Genotyping was performed for 48 tag and functional single-nucleotide polymorphisms (SNPs). RESULTS: Two tag SNPs of PTGIS showed a significant association with HNC risk [rs522962: log-additive odds ratio (OR) = 1.42, 95% confidence interval (CI): 1.01-1.99 and dominant OR = 1.58, 95% CI: 1.02-2.47; rs6125671: log-additive OR = 1.49, 95% CI: 1.08-2.05 and dominant OR = 1.96, 95% CI: 1.16-3.32]. In addition, a region in PTGIS tagged by rs927068 and rs6019902 was significantly associated with risk of HNC (global P = 0.007). Finally, several SNPs interacted with betel quid and cigarette to influence the risk of HNC. CONCLUSIONS: Genetic variations in prostaglandin pathway genes are associated with risk of HNC and may modify the relationship between use of betel quid or cigarette and development of HNC.


Asunto(s)
Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/metabolismo , Neoplasias de Cabeza y Cuello/genética , Neoplasias de Cabeza y Cuello/metabolismo , Prostaglandinas/biosíntesis , Prostaglandinas/genética , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple , Carcinoma de Células Escamosas de Cabeza y Cuello , Adulto Joven
11.
Clin Exp Allergy ; 42(9): 1386-96, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22925325

RESUMEN

BACKGROUND: The prevalence of atopic diseases has increased rapidly in recent decades globally. The administration of probiotics to reduce gastrointestinal inflammation has been popular, but its role in the prevention or treatment of allergic disease remains controversial. This study evaluated the effectiveness of prenatal and postnatal probiotics in the prevention of early childhood and maternal allergic diseases. METHODS: In a prospective, double-blind, placebo-controlled clinical trial, pregnant women with atopic diseases determined by history, total immunoglobulin (Ig)E > 100 kU/L, and/or positive specific IgE were assigned to receive either probiotics (Lactobacillus GG; ATCC 53103; 1 × 10(10) colony-forming units daily) or placebo from the second trimester of pregnancy. Both of clinical evaluation performed by questionnaires concerning any allergic symptoms and plasma total IgE, and allergen-specific IgE were obtained in high-risk parents and children at 0, 6, 18, and 36 months of age. The primary and secondary outcomes were the point and cumulative prevalence of sensitization and developing of allergic diseases, and improvement of maternal allergic symptom score and plasma immune parameters before and after intervention, respectively. RESULTS: In total, 191 pregnant women (LGG group, n = 95; control group, n = 96) were enrolled. No significant effects of prenatal and postnatal probiotics supplementation on sensitization, development of allergic diseases, and maternal IgE levels between placebo and LGG groups. Symptoms of maternal allergic scores improved significantly in the LGG group (P = 0.002). Maternal allergic diseases improvement was more prominent in pregnant women with IgE > 100 kU/L (P = 0.01) and significantly associated with higher interleukin-12p70 levels (P = 0.013). CONCLUSIONS: LGG administration beginning at the second trimester of pregnancy reduced the severity of maternal allergic disease through increment of Th1 response, but not the incidence of childhood allergic sensitization or allergic diseases (ClinicalTrials.govnumber, IDNCT00325273).


Asunto(s)
Hipersensibilidad Inmediata/prevención & control , Lactobacillus , Atención Posnatal , Atención Prenatal , Probióticos/administración & dosificación , Adulto , Preescolar , Método Doble Ciego , Femenino , Edad Gestacional , Humanos , Hipersensibilidad Inmediata/epidemiología , Inmunoglobulina E/sangre , Lactante , Edad Materna , Embarazo , Probióticos/uso terapéutico , Estudios Prospectivos , Resultado del Tratamiento , Adulto Joven
12.
Minerva Anestesiol ; 78(9): 996-1004, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22531563

RESUMEN

BACKGROUND: Although a sensitive flow triggering (FT) level is supposed to be associated with reduced breathing effort, the incidence of autotriggering (AT) is likely to be increased. The actual effects of various FT levels on the work of breathing and occurrence of AT in mechanically ventilated patients are unknown. We investigated the effects of different FT levels (1-8 L/min) on breathing effort and incidence of AT in mechanically ventilated patients under pressure support ventilation using a Puritan-Bennett 840 ventilator. METHODS: Eight FT levels were randomly studied in mechanically ventilated patients under pressure support ventilation. The triggering effort (pressure-time product of triggering, PTPtr) was assessed by quantitating a segment of the pressure-time product of the esophagus (PTPes). The total PTPes, inspiratory work of breathing (Wi) and P0.1 were determined. RESULTS: Nine patients with appropriately recorded signals were included. The incidence of AT significantly decreased with increasing FT level (FT1, 1 L/min: 30.7%, FT8: 0.2%). PTPtr significantly increased with increasing FT level (0.020 ± 0.004 cmH2O • S in FT1 to 0.190 ± 0.017 cmH2O • S in FT8), but P0.1 remained similar. PTPtr accounted for only1-3% of total PTPes. Wi and PTPes were significantly lower only at FT1, but there was no significant difference in Wi and PTPes at different FT levels when AT breaths were excluded. CONCLUSION: A higher FT level was associated with lower incidence of AT, but without a significant increase in breathing effort. A higher FT level may be more reasonable in mechanically ventilated patients with this particular ventilator.


Asunto(s)
Cuidados Críticos/métodos , Respiración con Presión Positiva , Reología , Trabajo Respiratorio , Anciano , Anciano de 80 o más Años , Elasticidad , Esófago , Femenino , Humanos , Inhalación , Masculino , Manometría , Persona de Mediana Edad , Respiración con Presión Positiva/métodos , Estudios Prospectivos , Estómago , Pared Torácica/fisiopatología , Volumen de Ventilación Pulmonar
13.
Clin Exp Allergy ; 40(10): 1482-90, 2010 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-20701609

RESUMEN

BACKGROUND: The prevalence of allergic diseases has increased in the past decades. It is unknown whether expression of certain microRNAs (miRNAs) in neonatal leucocytes is correlated to IgE production and/or allergic diseases. OBJECTIVE: This study investigated the association of miRNA expression in neonatal leucocytes with cord blood IgE (CBIgE) elevation and development of allergic disease. METHODS: We screened for the expression of a panel of 157 miRNAs in mononuclear leucocytes from human umbilical cord blood (CB) samples with elevated CBIgE and tracked the association of down-regulated miRNA expression to the miRNA-targeted gene expression and to children with allergic rhinitis (AR). RESULTS: Among the initial screen of 10 CB samples with elevated CBIgE, expression of eight of the 157 miRNAs was low. Of these eight down-expressed miRNAs, three remained down-regulation in a validation with other 20 CB samples, and two of the three miRNAs, miR-21 and miR-126, were significantly lower in monocytes from AR children. Further analysis of mRNA expression of the miR-21-targeted genes identified that TGFBR2 expression on monocytes was significantly up-regulated in CB with elevated CBIgE, and in AR patients. Transfection of miR-21 precursor into monocytes from patients with AR increased miR-21 expression and decreased TGFBR2 expression. CONCLUSION: This study demonstrated the first in the literature that lower miR-21 expression in CB and increased TGFBR2 expression is associated with antenatal IgE production and development of AR.


Asunto(s)
Hipersensibilidad/genética , Inmunoglobulina E/sangre , MicroARNs/sangre , Rinitis/genética , Western Blotting , Regulación hacia Abajo , Sangre Fetal/inmunología , Técnica del Anticuerpo Fluorescente , Expresión Génica , Perfilación de la Expresión Génica , Humanos , Hipersensibilidad/sangre , Hipersensibilidad/inmunología , Técnicas para Inmunoenzimas , Inmunoglobulina E/genética , Inmunoglobulina E/inmunología , Recién Nacido , Leucocitos/inmunología , MicroARNs/inmunología , Monocitos/inmunología , Monocitos/metabolismo , Proteínas Serina-Treonina Quinasas/biosíntesis , Proteínas Serina-Treonina Quinasas/inmunología , Receptor Tipo II de Factor de Crecimiento Transformador beta , Receptores de Factores de Crecimiento Transformadores beta/biosíntesis , Receptores de Factores de Crecimiento Transformadores beta/inmunología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Rinitis/sangre , Rinitis/inmunología
15.
Allergy ; 65(6): 731-9, 2010 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-19968631

RESUMEN

BACKGROUND: Prevalence of allergic diseases in children has increased worldwide over the past decades. Allergy sensitization may occur in fetal life. This study investigated whether gene-gene and gene-environment interactions affected cord blood IgE (CBIgE) levels. METHODS: A total of 575 cord blood DNA samples were subjected to a multiplex microarray for 384 single nucleotide polymorphisms (SNPs) in 159 allergy candidate genes. Genetic association was initially assessed by univariate and multivariate analyses. Multifactor dimensionality reduction (MDR) was used to identify gene-gene and gene-environment interactions. Environmental factors for analysis included maternal atopy, paternal atopy, parental smoking, gender, and prematurity. RESULTS: Twenty-one SNPs in 14 genes were associated with CBIgE elevation (>or =0.5 KU/l) in univariate analysis. Multivariate analysis identified eleven genes (IL13, IL17A, IL2RA, CCL17, CXCL1, PDGFRA, FGF1, HAVCR1, GNAQ, C11orf72, and ADAM33) which were significantly associated with CBIgE elevation. MDR analyses of gene-gene interactions identified IL13 interacted with IL17A and/or redox genes on CBIgE elevation with the prediction accuracy of 62.52%. Analyses of gene-environment interactions identified that maternal atopy combined with IL13, rs1800925 and CCL22, rs170359 SNPs had the highest prediction accuracy of 67.15%. All the high and low risk classifications on gene-gene and gene-environment interactions by MDR analyses could be validated by Chi-square test. CONCLUSIONS: Gene-gene (e.g. immune and redox genes) and gene-environment (e.g. maternal atopy and FGF1or redox genes) interactions on IgE production begin in prenatal stage, suggesting that prevention of IgE-mediated diseases may be made possible by control of maternal atopy and redox responses in prenatal stage.


Asunto(s)
Sangre Fetal/inmunología , Feto/inmunología , Estudios de Asociación Genética , Hipersensibilidad/genética , Inmunoglobulina E/biosíntesis , Quimiocina CCL22/genética , Femenino , Predisposición Genética a la Enfermedad , Humanos , Hipersensibilidad/etiología , Interleucina-13/genética , Masculino , Análisis de Secuencia por Matrices de Oligonucleótidos , Oxidación-Reducción , Padres , Polimorfismo de Nucleótido Simple , Factores Sexuales , Fumar
16.
J Virol Methods ; 155(2): 109-17, 2009 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-18952125

RESUMEN

Molecular methods for HIV-1 infection using dried blood-spot (DBS) for HIV-1 CRF01_AE subtypes have not been fully optimized. In this study assays for HIV-1 diagnosis or quantitation were evaluated using infant DBS from Thailand. Paired DBS and whole blood samples from 56 HIV-1 CRF01_AE or B'-infected infants were tested for infant diagnosis using modified Amplicor DNA PCR and NucliSens RNA NASBA and an in-house real-time PCR assay. The Amplicor Monitor viral load (VL) assay, with modifications for DBS, was also evaluated. DBS VL were hematocrit corrected. Stability studies were done on DBS stored at -70 degrees C to 37 degrees C for up to 1 year. The DBS diagnostic assays were 96-100% sensitive and 100% specific for HIV-1 diagnosis. DBS HIV-1 VL were highly correlated with plasma VL when corrected using the actual or an assumed hematocrit factor (r(c)=0.88 or 0.93, respectively). HIV-1 DNA in DBS appeared to be more stable than RNA and could be detected after up to 9 months at most temperatures. DBS VL could be consistently determined when stored frozen. These results show that DBS can be used accurately instead of whole blood for the diagnosis of HIV-1 infection and VL quantitation, particularly if samples are appropriately stored.


Asunto(s)
Recolección de Muestras de Sangre/métodos , ADN Viral/sangre , Infecciones por VIH/diagnóstico , VIH-1/aislamiento & purificación , ARN Viral/sangre , Carga Viral , Adulto , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/virología , VIH-1/clasificación , VIH-1/genética , VIH-1/fisiología , Humanos , Lactante , Reacción en Cadena de la Polimerasa/métodos , Juego de Reactivos para Diagnóstico , Replicación de Secuencia Autosostenida , Sensibilidad y Especificidad , Manejo de Especímenes , Tailandia
17.
Open AIDS J ; 2: 17-25, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18923696

RESUMEN

A two day meeting hosted by the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) was held in May 2006 in Entebbe, Uganda to review the laboratory performance of virologic molecular methods, particularly the Roche Amplicor DNA PCR version 1.5 assay, in the diagnosis of HIV-1 infection in infants. The meeting was attended by approximately 60 participants from 17 countries. Data on the performance and limitations of the HIV-1 DNA PCR assay from 9 African countries with high-burdens of HIV/AIDS were shared with respect to different settings and HIV- subtypes. A consensus statement on the use of the assay for early infant diagnosis was developed and areas of needed operational research were identified. In addition, consensus was reached on the usefulness of dried blood spot (DBS) specimens in childhood as a means for ensuring greater accessibility to serologic and virologic HIV testing for the paediatric population.

18.
J Clin Microbiol ; 46(5): 1588-95, 2008 May.
Artículo en Inglés | MEDLINE | ID: mdl-18322061

RESUMEN

Serodiagnosis of human immunodeficiency virus (HIV) infection in the United States has traditionally relied on a sequential two-test algorithm: an initial screen with an enzyme immunoassay (EIA) and reflex testing of EIA-reactive specimens with a more specific supplemental test such as Western blotting or immunofluorescence. The supplemental tests are tedious, subjective, and expensive. In addition, there have been major improvements in the performance and accuracy of the EIA tests as well as the introduction of rapid serologic tests (RT) and HIV nucleic acid amplification tests (NAAT). Related to these improvements is the possibility that alternative algorithms using combinations of currently approved HIV tests may function as well as if not better than the current algorithm, with more flexibility, improved accuracy, and lower cost. To this end, we evaluated the performance of 12 currently licensed tests and 1 in-house HIV test (6 EIA, 4 RT, and 3 NAAT) on panels of plasma samples from HIV-infected (n = 621 HIV type 1 [HIV-1] and 34 HIV-2) and uninfected (n = 513) people and of sequential specimens from people early in seroconversion (183 specimens from 15 patients). Test combinations were analyzed in two dual-test (sensitivity-optimized and specificity-optimized) algorithms and in a three-test (tie-breaking) algorithm, and performance was compared to the conventional algorithm. The results indicate that alternative algorithm strategies with currently licensed tests compare favorably with the conventional algorithm in detecting and confirming established HIV infection. Furthermore, there was a lower frequency of discordant or indeterminate results that require follow-up testing, and there was improved detection of early infection.


Asunto(s)
Algoritmos , Infecciones por VIH/diagnóstico , VIH/genética , VIH/inmunología , Inmunoensayo/métodos , Técnicas de Amplificación de Ácido Nucleico/métodos , Anticuerpos Antivirales/sangre , Humanos , Plasma/inmunología , Plasma/virología , ARN Viral/sangre , Sensibilidad y Especificidad , Estados Unidos
19.
Clin Exp Allergy ; 37(5): 680-7, 2007 May.
Artículo en Inglés | MEDLINE | ID: mdl-17456215

RESUMEN

BACKGROUND: Genetic heritability and maternal atopy have been correlated to antenatal IgE production, but very few studies have studied gene-maternal atopy interaction on antenatal IgE production. This study investigated the interaction of CTLA-4 polymorphism with prenatal factors on the elevation of cord blood IgE (CBIgE). METHODS: Pregnant women were antenatally recruited for collection of prenatal environmental factors by a questionnaire. Umbilical cord blood samples were collected for CBIgE detection by fluorescence-linked enzyme assay and CTLA-4 polymorphism measurement by restriction fragment length polymorphism. RESULTS: A total of 1104 pregnant women initially participated in this cohort study, and 898 of them completed cord blood collection. 21.4% of the newborns had elevation of CBIgE (>or=0.5 kU/L). The CTLA-4+49A allele (P=0.021), maternal atopy (P<0.001) and gender (P=0.034), but not the CTLA-4+49G allele, -318C allele, -318T allele, parental smoking or paternal atopy, were significantly correlated with the CBIgE elevation in multivariate analysis. A dichotomous analysis of gene-maternal atopy interactions identified maternal atopy and CTLA-4+49A allele had an additive effect on the CBIgE elevation, especially prominent in male newborns; and in the absence of maternal atopy, CTLA-4+49GG genotype had a protective effect on CBIgE elevation in female newborns. CONCLUSIONS: Maternal but not paternal atopy has significant impacts on CBIgE elevation depending on gender and CTLA-4+49A/G polymorphism of newborns. Control of maternal atopy and modulation of CTLA-4 expression in the prenatal stage may be a target for the early prevention of perinatal allergy sensitization.


Asunto(s)
Antígenos CD/genética , Antígenos de Diferenciación/genética , Hipersensibilidad Inmediata/genética , Inmunoglobulina E/biosíntesis , Polimorfismo Genético , Complicaciones del Embarazo/genética , Antígeno CTLA-4 , Padre , Femenino , Sangre Fetal/inmunología , Predisposición Genética a la Enfermedad , Humanos , Hipersensibilidad Inmediata/inmunología , Recién Nacido , Masculino , Madres , Polimorfismo de Longitud del Fragmento de Restricción , Embarazo , Complicaciones del Embarazo/inmunología , Efectos Tardíos de la Exposición Prenatal , Factores Sexuales
20.
Clin Exp Allergy ; 34(1): 32-7, 2004 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-14720259

RESUMEN

BACKGROUND: A variety of genes are related to allergic disorders in different ethnic populations. The genetic basis for the gender discrepancy of allergic diseases remains to be determined. OBJECTIVE: This study was conducted to investigate whether IL-4 promoter (-590 C/T) and cytotoxic T lymphocyte antigen 4 (CTLA-4) (+49 A/G) polymorphisms were correlated with a gender discrepancy of total IgE levels and allergic diseases in a Chinese population. METHODS: A total of 1333 participants aged 19-49 years were enrolled in this study. Allergic diseases were recognized by the presence of asthma, rhinitis or atopic dermatitis in conjunction with detectable specific IgE in the blood. Polymorphisms of IL-4 promoter (-590) and CTLA-4 (+49) were determined by restriction fragment length polymorphism. RESULTS: Males or females with allergic diseases had higher total IgE levels than those without (P=0.000). Females with the A/A genotype in the CTLA-4 (+49) position had significantly higher total IgE levels than those with A/G, and those with the G/G genotype had the lowest IgE levels (154.9 vs. 107.1 vs. 79.8 KU/L; mean log values: 1.79 vs. 1.65 vs. 1.54, P< 0.001). However, males with different genotypes in the CTLA-4 (+49) position exhibited no difference in the total IgE levels. Females with allergic rhinitis had a significantly higher frequency of the A/A genotype in the CTLA-4 (+49) polymorphism than those without atopic diseases (P=0.016). In contrast, males with and without allergic disorders exhibited no significant difference in the CTLA-4 (+49) polymorphisms (P>0.05). The IL-4 promoter (-590) polymorphisms, however, had no correlation with the total IgE levels or allergic diseases in either females or males. CONCLUSION: In females only, the CTLA-4 (+49), but not the IL-4 promoter (-590), polymorphism was significantly associated with elevation of total IgE levels and allergic rhinitis. Here, we have, for the first time, demonstrated a gender-linked genetic relationship with allergic disease.


Asunto(s)
Antígenos de Diferenciación/genética , Identidad de Género , Hipersensibilidad Inmediata/genética , Inmunoglobulina E/sangre , Polimorfismo Genético , Adulto , Antígenos CD , Antígenos de Diferenciación/sangre , Antígeno CTLA-4 , Distribución de Chi-Cuadrado , Estudios Transversales , Femenino , Humanos , Hipersensibilidad Inmediata/inmunología , Interleucina-4/sangre , Interleucina-4/genética , Masculino , Prevalencia
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