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1.
Tech Coloproctol ; 26(6): 461-470, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35182278

RESUMO

BACKGROUND: Da Vinci® Single Port (dvSP) was recently developed. Its application in colorectal surgery is under investigation. The aim of this study was to explore the safety and feasibility of dvSP for intersphincteric (dvSP-ISR), right colectomy (dvSP-RC), and transverse colectomy (dvSP-TC). Surgical indication and short-term results were analyzed. METHODS: All consecutive patients from a prospective database of patients who underwent dvSP-ISR, dvSP-RC, and dvSP-TC at Korea University Anam Hospital from November 2020 to December 2021, were analyzed. Perioperative, pathological, and oncological short-term outcomes were analyzed. RESULTS: A total of 7 dvSP-ISR, 5 dvSP-RC, and 1 dvSP-TC were performed. Median age was 56.0 (55.0-61.0) years for the dvSP-ISR and 54.0 (44.7-63.5) years for the dvSP-RC/TC. Median body mass index was 22.8 (17.1-24.8) kg/m2 for the dvSP-ISR and 23.6 (20.8-26.9) kg/m2 for the dvSP-RC/TC. All dvSP-ISR patients received neoadjuvant long-course chemoradiotherapy, including one patient with squamocellular carcinoma who was treated with 5-fluorouracil (5-FU)/mitomycin. All other patients, excluding one dvSP-RC patient with Crohn's disease, had an adenocarcinoma. Median operation time was 280 (240-370) minutes for the dvSP-ISR and 220 (201-270) minutes for the dvSP-RC/TC. Estimated blood loss was insignificant. No intraoperative complications or conversions to multiport/open surgery was reported. Median post-operative stay was 7.0 (6.0-10.0) days for the dvSP-ISR and 5.0 (4.0-6.7) days for the dvSP-RC/TC. Quality of mesorectum was complete for six patients, and nearly complete for one. Median number of retrieved lymph nodes were 21 (17-25) for the dvSP-ISR and 28 (24-49) for the dvSP-RC/TC. Proximal and distal resection margins were tumor free. Four patients experienced post-operative complications not related to the platform which were: ileus, voiding dysfunction, infected pelvic hematoma, and wound infection. Median follow-up was 9 (6-11) months and 11 (7-17) months for the dvSP-ISR and dvSP-RC/TC, respectively. Two patients had systemic recurrence; all others were tumor free. CONCLUSIONS: The dvSP platform is safe and feasible for intersphincteric resection with right lower quadrant access, and right/transverse colectomy with suprapubic access. Further studies are needed to evaluate benefit differences compared to multiport robotic platform.


Assuntos
Adenocarcinoma , Cirurgia Colorretal , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Adenocarcinoma/cirurgia , Colectomia/métodos , Humanos , Laparoscopia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
2.
Eur J Surg Oncol ; 47(8): 2069-2077, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33781627

RESUMO

INTRODUCTION: Intersphincteric resection (ISR) is the ultimate anal-sparing technique as an alternative to abdominoperineal resection in selected patients. Oncological safety is still debated. This study analyses long-term oncological results and evaluates risk factors for local recurrence (LR) and overall survival (OS) after minimally-invasive ISR. MATERIALS AND METHODS: Retrospective single-center data were collected from a prospectively maintained colorectal database. A total of 161 patients underwent ISR between 2008 and 2018. OS and local recurrence-free survival (LRFS) were assessed using Kaplan-Meier analysis (log-rank test). Risk factors for OS and LRFS were assessed with Cox-regression analysis. RESULTS: Median follow-up was 55 months. LR occurred in 18 patients. OS and LRFS rates at 1, 3, and 5 years were 96%, 91%, and 80% and 96%, 89%, and 87%, respectively. Tumor size (p = 0.035) and clinical T-stage (p = 0.029) were risk factors for LRFS on univariate analysis. On multivariate analysis, tumor size (HR 2.546 (95% CI: 0.976-6.637); p = 0.056) and clinical T-stage (HR 3.296 (95% CI: 0.941-11.549); p = 0.062) were not significant. Preoperative CEA (p < 0.001), pathological T-stage (p = 0.033), pathological N-stage (p = 0.016) and adjuvant treatment (p = 0.008) were prognostic factors for OS on univariate analysis. Preoperative CEA (HR 4.453 (95% CI: 2.015-9.838); p < 0.001) was a prognostic factor on multivariate analysis. CONCLUSIONS: This study confirms the oncological safety of minimally-invasive ISR for locally advanced low-lying rectal tumors when performed in experienced centers. Despite not a risk factor for LR, tumor size and, locally advanced T-stage with anterior involvement should be carefully evaluated for optimal surgical strategy. Preoperative CEA is a prognostic factor for OS.


Assuntos
Adenocarcinoma/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Protectomia/métodos , Neoplasias Retais/cirurgia , Adenocarcinoma/sangue , Adenocarcinoma/patologia , Idoso , Canal Anal , Antígeno Carcinoembrionário/sangue , Quimiorradioterapia Adjuvante , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Análise Multivariada , Terapia Neoadjuvante , Tratamentos com Preservação do Órgão/métodos , Neoplasias Retais/sangue , Neoplasias Retais/patologia , Fatores de Risco , Taxa de Sobrevida , Carga Tumoral
3.
Colorectal Dis ; 22(10): 1415-1421, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32356391

RESUMO

AIM: Intussusception in adults is rare and requires surgery in most cases. While abdominal laparoscopic surgery (LS) is becoming more popular, there are few reports on the outcomes of adult intussusception treated with LS. This study compared the feasibility of LS vs open surgery (OS) for adult intussusception. METHOD: We reviewed retrospectively the medical records of adult patients with intussusception from three tertiary hospitals between 2000 and 2016. The patients were divided into LS and OS groups, and their surgical outcomes were compared. RESULTS: Surgery was indicated in 71 patients with intussusception (41 LS and 30 OS). The median age of the patients was 49.0 and 51.5 years in the LS and OS groups, respectively (P = 0.930). Overall, nine (12.7%) patients had a negative laparotomy or laparoscopy with spontaneous reduction of the intussusception. Conversion to OS from LS was necessary in one patient (2.4%). The operative time and intra-operative and postoperative complication rates were not significantly different. However, there were more serious complications such as bowel perforation and major vessel injury in the LS group. The patients in the LS group had a shorter time to first food intake and hospital stay vs patients in the OS group (4.0 vs 6.0 days, P < 0.001, and 7.0 vs 10.5 days, P < 0.001, respectively). CONCLUSION: LS may be feasible for adult intussusception; there may be more severe intra-operative complications than in OS.


Assuntos
Intussuscepção , Laparoscopia , Adulto , Humanos , Recém-Nascido , Intussuscepção/cirurgia , Tempo de Internação , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Esplenectomia , Resultado do Tratamento
4.
Tech Coloproctol ; 20(6): 369-374, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27118465

RESUMO

PURPOSE: A laparoscopic approach to proctocolectomy and ileal pouch-anal anastomosis (IPAA) in patients with chronic ulcerative colitis and familial adenomatous polyposis has grown in popularity secondary to reports of small series demonstrating short-term patient benefits. Limited data exist in large numbers of patients undergoing laparoscopic ileal pouch-anal anastomosis (L-IPAA). We aimed to analyze surgical outcomes in a large cohort of patients undergoing L-IPAA. METHODS: From a prospectively maintained surgical database, 30-day surgical outcome data were reviewed for all L-IPAA performed for chronic ulcerative colitis and familial adenomatous polyposis from 1999 to 2012. Demographics, operative approach, and operative and postoperative complications were analyzed. RESULTS: A total of 588 L-IPAA ileal pouch-anal anastomoses were performed predominantly for chronic ulcerative colitis (93.9 %). The mean age was 36.2 years, and 54.3 % were male, with a mean BMI of 24.1 kg/m(2). Three-stage operations were performed in 17.7 %. The mean operating time of the patients excluding 3-stage operation was 269.4 min. Minimally invasive techniques included hand-assist in 55 % and straight laparoscopy in 45 %. Conversion to open occurred in 8.8 %. Median length of stay was 5 days. There was no mortality. Complications occurred in 36.9 % of patients: Clavien grade I (17.5 %), grade II (72.8 %), and grade III (9.7 %). Analysis of the grouped data over time demonstrated a statistically significant reduction in operative time (p < 0.001) and an increase in the ratio of hand-assisted over straight laparoscopy (p = 0.001). CONCLUSIONS: Minimally invasive IPAA performed using either a laparoscopic or hand-assisted technique is safe, can be performed with low conversion rates, and confers beneficial perioperative outcomes.


Assuntos
Canal Anal/cirurgia , Bolsas Cólicas , Íleo/cirurgia , Laparoscopia/métodos , Proctocolectomia Restauradora/métodos , Polipose Adenomatosa do Colo/cirurgia , Adolescente , Adulto , Idoso , Anastomose Cirúrgica/métodos , Colite Ulcerativa/cirurgia , Conversão para Cirurgia Aberta/estatística & dados numéricos , Bases de Dados Factuais , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
5.
Oncogene ; 35(3): 377-88, 2016 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-25893289

RESUMO

Protein dynamics, modifications and trafficking are all processes that can modulate protein activity. Accumulating evidence strongly suggests that many proteins have distinctive roles dependent on cellular location. Nonsteroidal anti-inflammatory drug-activated gene-1 (NAG-1) is a transforming growth factor-ß (TGF-ß) superfamily protein that has a role in cancer, obesity and inflammation. NAG-1 is synthesized and cleaved into a mature peptide, which is ultimately secreted into the extracellular matrix (ECM). In this study, we have found that full-length NAG-1 is expressed in not only the cytoplasm and ECM, but also in the nucleus. NAG-1 is dynamically moved to the nucleus, exported into cytoplasm and further transported into the ECM. We have also found that nuclear NAG-1 contributes to inhibition of the Smad pathway by interrupting the Smad complex. Overall, our study indicates that NAG-1 is localized in the nucleus and provides new evidence that NAG-1 controls transcriptional regulation in the Smad pathway.


Assuntos
Núcleo Celular/genética , Fator 15 de Diferenciação de Crescimento/biossíntese , Proteínas Smad/metabolismo , Transcrição Gênica , Apoptose/genética , Linhagem Celular Tumoral , Citoplasma/genética , Matriz Extracelular/genética , Fator 15 de Diferenciação de Crescimento/genética , Humanos , Regiões Promotoras Genéticas , Transdução de Sinais , Proteínas Smad/genética
6.
Minerva Chir ; 70(6): 459-65, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26479854

RESUMO

Surgical treatment of patients with rectal cancer is challenging. The concept of robotic surgery is attractive and has earned considerable interest after its successful implementation in the fields of urology and gynecology. Recently, robotic surgery for rectal cancer with total mesorectal excision (TME) has also obtained an increasing amount of attention in the colorectal field. In this review, we introduce the commonly performed methods of robotic rectal surgery and discuss results to date and future perspectives.


Assuntos
Colectomia , Laparoscopia , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos , Colectomia/métodos , Medicina Baseada em Evidências , Humanos , Laparoscopia/métodos , Metanálise como Assunto , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
7.
J Endocrinol Invest ; 37(3): 247-60, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24615361

RESUMO

BACKGROUND: Recently, aging has been shown to be associated with sarcopenic obesity (SO), of which decreased muscle mass and increased fat mass are features. Sarcopenia and obesity alone are known to be associated with abnormal lipid metabolism. However, it remains unclear whether SO has greater adverse effects on dyslipidemia than on sarcopenia or obesity alone. AIM: We aimed to investigate the association between SO and dyslipidemia in elderly Koreans. SUBJECTS AND METHODS: This study was based on data collected during the 2008-2010 Korea National Health and Nutrition Examination Survey. We included 1,466 men and 2,017 women aged 65 years and over. Sarcopenia was indicated in participants with height- or weight-adjusted appendicular skeletal muscle that was 1 standard deviation below the sex-specific mean for the young reference group, and obesity was defined as a body mass index ≥ 25 kg/m(2). Dyslipidemia was defined according to the National Cholesterol Education Program-Adult Treatment Panel III. RESULTS: After adjusting for confounding factors, the SO group had a higher risk for dyslipidemia [odds ratio (OR) 2.82 (95 % confidence interval 1.76-4.51)] than the obese group [2.12 (1.11-4.07)] and sarcopenic group [1.46 (1.01-2.11)] (p < 0.001) only in men. Furthermore, the SO group in men had the highest OR for hypercholesterolemia, hypertriglyceridemia, hypo-high-density lipoprotein cholesterolemia, hyper-low-density lipoprotein cholesterolemia, and a high ratio of triglyceride to high-density lipoprotein cholesterol even after further adjustments. CONCLUSIONS: In Korean elderly men, SO was associated with an increased risk for dyslipidemia compared with sarcopenia or obesity alone.


Assuntos
Dislipidemias/fisiopatologia , Obesidade/etiologia , Sarcopenia/complicações , Adulto , Idoso , Dislipidemias/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/epidemiologia , Prevalência , Prognóstico , República da Coreia/epidemiologia , Fatores de Risco , Sarcopenia/classificação , Sarcopenia/epidemiologia , Fatores de Tempo
8.
Eye (Lond) ; 28(6): 672-9, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24603415

RESUMO

OBJECTIVE: Elevated intraocular pressure (IOP) contributes to the progression of visual defects such as glaucoma. This study determined whether metabolic syndrome (MetS) and cardiovascular risk factors are associated with IOP in South Korean men. METHODS: We analyzed data on 4875 men who participated in the Korean National Health and Nutrition Examination Survey 2008-2010. We recorded the values for age, weight, height, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), insulin, homeostasis model assessment of estimated insulin resistance (HOMA-IR), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), non-HDL-C (NHDL-C), and TG/HDL-C, as well as sociodemographic factors. IOP was measured using Goldmann applanation tonometry. RESULTS: Weight, BMI, WC, SBP, DBP, FBG, insulin, HOMA-IR, TC, LDL-C, TG, NHDL-C, TG/HDL-C, and the prevalence of MetS differed significantly among the three groups with IOP (P<0.05). Mean IOP was higher in subjects who were obese and had hypertension, diabetes mellitus, MetS, abdominal obesity, high TG, high FBG, or high BP compared with normal subjects (P<0.005). Analysis using Pearson's correlation coefficient showed that all cardiometabolic risk factors were significantly associated with IOP (P<0.005), with the exception of WC and HDL-C. A multivariate linear regression analysis showed that IOP was positively correlated with BMI, SBP, DBP, FBG, HOMA-IR, TC, LDL-C, TG, NHDL-C, and TG/HDL-C after adjusting for all covariates (all P<0.05). CONCLUSIONS: Cardiometabolic risk factors, including the components of MetS, are associated with increased IOP.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Pressão Intraocular/fisiologia , Síndrome Metabólica/fisiopatologia , Hipertensão Ocular/fisiopatologia , Adulto , Povo Asiático , Glicemia/análise , Pressão Sanguínea/fisiologia , Constituição Corporal , Colesterol/sangue , Estudos Transversais , Diabetes Mellitus/fisiopatologia , Humanos , Hipertensão/fisiopatologia , Masculino , Inquéritos Nutricionais , Obesidade Abdominal/fisiopatologia , República da Coreia , Fatores de Risco , Tonometria Ocular
9.
Tech Coloproctol ; 18(9): 795-803, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24633427

RESUMO

BACKGROUND: There is emerging evidence that complete mesocolic excision (CME) for colon cancer produces favorable oncologic outcomes. The applicability of CME technique in laparoscopic colectomy has not been fully explored. The aim of our retrospective study was to evaluate the feasibility of the CME technique with D3 lymphadenectomy in laparoscopic colectomy and its short- and long-term outcomes. METHODS: Between September 2006 and December 2009, 168 laparoscopic colectomies were performed for stages II and III colon cancer. Prospectively, collected data on demographics, tumor characteristics, complications, and outcomes were analyzed retrospectively. RESULTS: Eighty-seven patients (51.8 %) had stage II colon cancer, and 81 patients had stage III cancer. The mean operative time was 196.0 ± 61.2 min. The overall morbidity rate was 17.8 %, which included anastomotic leak in 10 patients (5.9 %). There was no operative mortality. The number of lymph nodes harvested was 27.8 ± 13.6. With a median follow-up of 57.3 months, locoregional recurrence and systemic metastasis developed in 6 (3.6 %) and 14 patients (8.3 %), respectively. Seven patients died of causes related to cancer, and all had stage III cancer. Disease-free survival at 5-years was 95.2 % for patients with stage II and 80.9 % for patients with stage III. CONCLUSIONS: Standardization of laparoscopic CME and D3 lymphadenectomy is expedient. The technique is associated with acceptable morbidity and provides excellent oncologic outcomes for stage II and stage III colon cancer. A longer follow-up is needed to validate the enhancement of oncological outcome related to this surgical concept.


Assuntos
Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Colectomia/métodos , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Excisão de Linfonodo , Mesocolo/cirurgia , Adenocarcinoma/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Fístula Anastomótica/etiologia , Quimioterapia Adjuvante , Colectomia/efeitos adversos , Neoplasias do Colo/tratamento farmacológico , Intervalo Livre de Doença , Estudos de Viabilidade , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Excisão de Linfonodo/efeitos adversos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Duração da Cirurgia , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Int J Obes (Lond) ; 38(12): 1555-64, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24531647

RESUMO

OBJECTIVE: Obesity is a major health problem associated with high morbidity and mortality. NSAID-activated gene (NAG-1) is a TGF-ß superfamily member reported to alter adipose tissue levels in mice. We investigated whether hNAG-1 acts as a regulator of adiposity and energy metabolism. DESIGN/SUBJECTS: hNAG-1 mice, ubiquitously expressing hNAG-1, were placed on a control or high-fat diet for 12 weeks. hNAG-1-expressing B16/F10 melanoma cells were used in a xenograft model to deliver hNAG-1 to obese C57BL/6 mice. RESULTS: As compared with wild-type littermates, transgenic hNAG-1 mice have less white fat and brown fat despite equivalent food intake, improved glucose tolerance, lower insulin levels and are resistant to dietary- and genetic-induced obesity. hNAG-1 mice are more metabolically active with higher energy expenditure. Obese C57BL/6 mice treated with hNAG-1-expressing xenografts show decreases in adipose tissue and serum insulin levels. hNAG-1 mice and obese mice treated with hNAG-1-expressing xenografts show increased thermogenic gene expression (UCP1, PGC1α, ECH1, Cox8b, Dio2, Cyc1, PGC1ß, PPARα, Elvol3) in brown adipose tissue (BAT) and increased expression of lipolytic genes (Adrb3, ATGL, HSL) in both white adipose tissue (WAT) and BAT, consistent with higher energy metabolism. CONCLUSION: hNAG-1 modulates metabolic activity by increasing the expression of key thermogenic and lipolytic genes in BAT and WAT. hNAG-1 appears to be a novel therapeutic target in preventing and treating obesity and insulin resistance.


Assuntos
Tecido Adiposo/metabolismo , Fator 15 de Diferenciação de Crescimento/metabolismo , Lipólise , Obesidade/prevenção & controle , Termogênese , Tecido Adiposo/patologia , Animais , Western Blotting , Dieta Hiperlipídica , Ingestão de Alimentos , Metabolismo Energético , Ensaio de Imunoadsorção Enzimática , Humanos , Resistência à Insulina , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Obesos , Estresse Oxidativo/efeitos dos fármacos , Reação em Cadeia da Polimerase em Tempo Real
11.
Mediators Inflamm ; 2013: 641851, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23737651

RESUMO

NAG-1/GDF15 is a TGF- ß superfamily member with poorly characterized biological activity proposed to inhibit inflammatory cytokine production. Transgenic mice expressing human NAG-1/GDF15 (NAG-1 (Tg/Lox) ) are leaner with lower body weight and are resistant to chemically or genetically induced intestinal tumors. Because of the link between obesity, inflammation, and cancer, we examined whether these mice exhibit a reduced response to inflammatory stimuli. The NAG-1 (Tg/Lox) mice had a reduced inflammatory response to LPS based on the serum levels of cytokines KC, IL-6, MCP-1, and TNF α . In contrast to literature reports and our in vivo results, NAG-1 did not inhibit LPS-induced cytokine expression in vitro in RAW264.7 cells, mouse peritoneal macrophages, or mouse liver Kupffer cells, suggesting that NAG-1/GDF15 does not directly inhibit LPS-induced inflammatory cytokine production. However, NAG-1 (Tg/Lox) mice have less white adipose tissue, the major source of inflammatory adipokines including leptin. Basal and LPS-treated serum leptin and mRNA levels in the adipose tissue of NAG-1 (Tg/Lox) mice were lower than those in WT mice. We propose that the reduced white adipose tissue and reduced leptin expression may be responsible, in part, for the reduced inflammatory response to LPS and the decrease in intestinal tumors observed in NAG-1 (Tg/Lox) mice.


Assuntos
Tecido Adiposo Branco/metabolismo , Fator 15 de Diferenciação de Crescimento/metabolismo , Inflamação/metabolismo , Animais , Citocinas/metabolismo , Feminino , Fator 15 de Diferenciação de Crescimento/genética , Humanos , Inflamação/induzido quimicamente , Inflamação/genética , Leptina/metabolismo , Lipopolissacarídeos/farmacologia , Macrófagos Peritoneais/efeitos dos fármacos , Macrófagos Peritoneais/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos
12.
Anaesthesia ; 68(6): 585-90, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23590463

RESUMO

The GlideScope videolaryngoscope is widely used in the management of the difficult airway. However, passing the tracheal tube through the vocal cords can be awkward, and the use of a stylet to guide insertion is recommended. This randomised controlled trial evaluated a forceps-guided tube exchanger as an alternative to the stylet to aid intubation with the GlideScope in patients undergoing anaesthesia, with a simulated difficult airway created by the application of a semi-rigid cervical collar. Data were analysed from 178 patients randomly assigned to undergo intubation using either the stylet (n = 88) or a forceps-guided tube exchanger (n = 90). All intubations were completed successfully, with first attempt rates of 93.2% using the stylet and 94.4% using the exchanger (p = 0.597). The mean (SD) intubation time was 67.8 (28.7) s in the stylet group and 66.1 (15.5) s in the forceps-guided tube exchanger group (p = 0.11). The frequency of sore throat 1 h after extubation was 34.1% in the stylet group and 2.2% in the tube exchanger group (p < 0.001); 24 h after extubation the corresponding figures were 40.0% and 11.1% (p < 0.001). Using a forceps-guided tube exchanger may offer an advantage over a stylet in guiding tracheal intubation when the GlideScope is used.


Assuntos
Intubação Intratraqueal/instrumentação , Laringoscópios , Laringoscopia/instrumentação , Instrumentos Cirúrgicos , Adolescente , Adulto , Idoso , Desenho de Equipamento , Feminino , Humanos , Intubação Intratraqueal/métodos , Masculino , Pessoa de Meia-Idade , Gravação em Vídeo , Adulto Jovem
13.
Oncogene ; 29(37): 5182-92, 2010 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-20581861

RESUMO

Tolfenamic acid (TA) is a non-steroidal anti-inflammatory drug associated with anti-tumorigenic and pro-apoptotic properties in animal and in vitro models of cancer. However, the underlying cellular mechanisms by which TA exerts its effects are only partially understood. Activating transcription factor 3 (ATF3) is a member of the ATF/CREB subfamily of the basic region-leucine zipper family and has been known as a tumor suppressor in human colorectal cancer cells. The present study was performed to observe whether ATF3 mediates TA-induced apoptosis and to elucidate the molecular mechanism of ATF3 transcription induced by TA. TA treatment and ectopic expression of ATF3 increased apoptosis, whereas knockdown of ATF3 resulted in significant repression of TA-activated apoptosis. The TA treatment also induced ATF3 promoter activity. Internal deletion and point mutation of the predicted ATF/C/EBP binding site in ATF3 promoter abolished luciferase activation by TA. Overexpression of ATF2 resulted in significant increase in ATF3 promoter activity, and electrophoretic mobility shift assay identified this region as a core sequence to which ATF2 binds. TA treatment resulted in an increase in ATF2 phosphorylation, which was followed by a subsequent increase in ATF3 transcription. Knock down of ATF2 abolished TA-induced ATF3 expression. We further provide evidence that TA leads to increases in phospho-p38 MAPK, JNK and ERK levels. Inhibition of these pathways using selective inhibitors and dominant negative constructs ameliorated TA-induced ATF3 expression and promoter activities. The current study shows that TA stimulates ATF3 expression and subsequently induces apoptosis. These pathways are mediated through phosphorylation of ATF2, which is mediated by p38 MAPK-, JNK- and ERK-dependent pathways.


Assuntos
Fator 2 Ativador da Transcrição/fisiologia , Fator 3 Ativador da Transcrição/genética , Regulação da Expressão Gênica/efeitos dos fármacos , Sistema de Sinalização das MAP Quinases , ortoaminobenzoatos/farmacologia , Fator 2 Ativador da Transcrição/genética , Sequência de Bases , Linhagem Celular Tumoral , Neoplasias Colorretais/metabolismo , Neoplasias Colorretais/patologia , DNA , Humanos , Fosforilação , Regiões Promotoras Genéticas
14.
Int J Oral Maxillofac Surg ; 39(7): 678-83, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20413270

RESUMO

Human papilloma virus (HPV) infection is controversial as a causative factor in oral tongue cancer. This study aimed to clarify whether HPV directly affects the carcinogenesis and biological behaviour of oral tongue cancer by analyzing HPV prevalence, the physical status of the virus and clinicopathological parameters. Archival tissue was obtained from 36 patients diagnosed with T1 and T2 oral tongue cancer and 25 normal controls. HPV genotyping chip and real-time polymerase chain reaction were used to determine the prevalence, phenotype and physical status of HPV to clarify whether HPV directly affects oncogenesis. The results were also compared with clinicopathological parameters. HPV was detected in 36% (13/36) of oral tongue cancer patients, compared with 4% (1/25) of the control. In the HPV-positive group of oral tongue cancers, HPV-16 was the most common type and its prevalence rate was 85% (11/13). Of the HPV-16 infected oral tongue cancers, the integration rate of HPV-16 was 55% (6/11). The HPV-16 positive group showed shallower stromal invasion than the HPV-16 negative group (p=0.045). HPV-16 may be one of the causative factors in early squamous cell oral tongue carcinoma and be associated with its depth of invasion.


Assuntos
Carcinoma de Células Escamosas/virologia , Papillomavirus Humano 16/fisiologia , Infecções por Papillomavirus/virologia , Neoplasias da Língua/virologia , Carcinoma de Células Escamosas/patologia , DNA Viral/análise , Seguimentos , Genótipo , Papillomavirus Humano 16/classificação , Humanos , Leucoplasia Oral/virologia , Invasividade Neoplásica , Recidiva Local de Neoplasia/virologia , Estadiamento de Neoplasias , Fenótipo , Reação em Cadeia da Polimerase , Taxa de Sobrevida , Língua/virologia , Neoplasias da Língua/patologia , Carga Viral
15.
Vet Pathol ; 46(4): 576-88, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19276067

RESUMO

Canine cancer has become more prevalent in recent years because of increased life expectancy and greater attention to the health of pets. The range of cancers seen in dogs is as diverse as that in human patients, and despite more intensive therapeutic interventions, fatality rates remain unacceptably high in both species. Chemoprevention is therefore an important means of confronting this disease. Because domestic pets share our environment, greater cross-application and study of the protumorigenic and antitumorigenic factors in our shared environment will benefit all species, leading to the development of new families of less toxic antitumorigenic compounds based on novel and established molecular targets. Currently, the most interesting cancer preventive agents are nonsteroidal anti-inflammatory drugs, peroxisome proliferator-activated receptor-gamma ligands, and dietary compounds. This article provides an overview of what is known about how these agents affect molecular signaling in neoplastic disease, with reference to reported application and/or study in dogs where available.


Assuntos
Anti-Inflamatórios não Esteroides/farmacologia , Quimioprevenção/veterinária , Doenças do Cão/prevenção & controle , Neoplasias/veterinária , Transdução de Sinais/efeitos dos fármacos , Animais , Quimioprevenção/métodos , Ciclo-Oxigenase 1/metabolismo , Ciclo-Oxigenase 2/metabolismo , Suplementos Nutricionais , Cães , Proteína 1 de Resposta de Crescimento Precoce/metabolismo , Ligantes , Estrutura Molecular , Neoplasias/prevenção & controle , PPAR gama/metabolismo , Transdução de Sinais/fisiologia
16.
Int J Oral Maxillofac Surg ; 37(12): 1099-105, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18722091

RESUMO

The treatment of oropharyngeal squamous cell carcinoma (OSCC) remains controversial. This study reviews the authors' experience of treating OSCC, evaluates the oncologic outcome and assesses the factors affecting local/regional recurrence. A retrospective analysis of 110 consecutive OSCC patients treated primarily by surgery and/or postoperative radiotherapy was carried out. 82% of patients had advanced disease (stage III or IV). The 5-year overall survival and disease specific survival rates (DSSR) were 58% and 65%, respectively. The DSSR of the soft palate or posterior pharyngeal wall, tonsillar area, and base of tongue were 80%, 62%, and 51%, respectively (P<0.05). The 5-year DSSR according to the American Joint Committee on Cancer stages was 94% for early stage and 56% for advanced stage (P<0.05). The overall recurrence rate was 38% (42 patients). The most frequent site of recurrence was the neck (46%). Only 14% of patients with recurrences were treated successfully. Positive resection margins and the presence of pathologic lymph nodes influenced the recurrence at the primary lesion and in the neck, respectively, in a statistically significant manner. Surgery and postoperative radiotherapy provided a superior outcome in patients with advanced OSCC. A randomized study is required to assess the oncologic and functional superiority of surgery or chemoradiation.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Terapia Neoadjuvante , Neoplasias Orofaríngeas/cirurgia , Adulto , Idoso , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/secundário , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Coreia (Geográfico) , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Pescoço/patologia , Esvaziamento Cervical , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/radioterapia , Palato Mole/efeitos da radiação , Palato Mole/cirurgia , Dosagem Radioterapêutica , Radioterapia Adjuvante , Estudos Retrospectivos , Terapia de Salvação , Taxa de Sobrevida , Neoplasias da Língua/radioterapia , Neoplasias da Língua/cirurgia , Neoplasias Tonsilares/radioterapia , Neoplasias Tonsilares/cirurgia , Resultado do Tratamento
17.
J Phys Chem A ; 112(39): 9277-82, 2008 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-18505247

RESUMO

By preparing methyl bromide (CH3Br) in selected rotational levels of the CH3Br(X(1)A1; v1 = 1) state with infrared (IR) laser excitation prior to vacuum-ultraviolet (VUV) laser pulsed field ionization-photoelectron (PFI-PE) measurements, we have observed rotationally resolved photoionization transitions to the CH3Br(+)(X(2)E(3/2); v1(+) = 1) state, where v1 and v1(+) are the symmetric C-H stretching vibrational mode for the neutral and cation, respectively. The VUV-PFI-PE origin band for CH3Br(+)(X(2)E(3/2)) has also been measured. The simulation of these IR-VUV-PFI-PE and VUV-PFI-PE spectra have allowed the determination of the v1(+) vibrational frequency (2901.8 +/- 0.5 cm(-1)) and the ionization energies of the origin band (85 028.3 +/- 0.5 cm(-1)) and the v1(+) = 1 <-- v1 = 1 band (84 957.9 +/- 0.5 cm(-1)).

18.
J Chem Phys ; 128(10): 104306, 2008 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-18345887

RESUMO

By using a high-resolution single mode infrared-optical parametric oscillator laser to prepare CH(3)I in single (J,K) rotational levels of the nu(1) (symmetric C-H stretching) =1 vibrational state, we have obtained rovibrationally resolved infrared-vacuum ultraviolet-pulsed field ionization-photoelectron (IR-VUV-PFI-PE) spectra of the CH(3)I(+)(X(2)E(32);nu(1)(+)=1;J(+),P(+)) band, where (J,K) and (J(+),P(+)) represent the respective rotational quantum numbers of CH(3)I and CH(3)I(+). The IR-VUV-PFI-PE spectra observed for K=0 and 1 are found to have nearly identical structures. The IR-VUV-PFI-PE spectra for (J,K)=(5,0) and (7, 0) are also consistent with the previous J-selected IR-VUV-PFI-PE measurements. The analysis of these spectra indicates that the photoionization cross section of CH(3)I depends strongly on DeltaJ(+)=J(+)-J: but not on J and K. This observation lends strong support for the major assumption adopted for the semiempirical simulation scheme, which has been used for the simulation of the origin bands observed in VUV-PFI-PE study of polyatomic molecules. Using the state-to-state photoionization cross sections determined in this IR-VUV study, we have obtained excellent simulation of the VUV-PFI-PE origin band of CH(3)I(+)(X (2)E(32)), yielding more precise IE(CH(3)I)=76 930.7+/-0.5 cm(-1) and nu(1) (+)=2937.8+/-0.2 cm(-1).

19.
Artigo em Inglês | MEDLINE | ID: mdl-12711249

RESUMO

The activation of peroxisome proliferator activated receptor gamma (PPARgamma) may play a role in the control of colorectal carcinogenesis. The expression of PPARgamma was examined by Western blotting in human colorectal tumors and matched normal adjacent tissues, as well as in various colorectal carcinoma cell lines. In the tissues, the expression of PPARgamma was elevated in tumors relative to the adjacent normal tissues. Each colorectal carcinoma cell line expressed PPARgamma. The ability of various eicosanoids to bind PPARgamma in colorectal carcinoma cells was investigated using luciferase reporter assays. The well-known PPARgamma ligands, troglitazone and 15-deoxy-Delta(12,14)-prostaglandin J(2) strongly induced PPARgamma binding activity. Products of lipoxygenases displayed moderate binding activity, while other prostaglandins and fatty acids displayed little or no reporter activation. The activation of PPARgamma by 13(S)-HODE, the major metabolite of 15-lipoxygenase-1 from linoleic acid, was concentration dependent reaching maximum at 10 micro M (35-fold activation). The endogenous production of 13(S)-HODE by expression of 15-LO-1 did not activate PPARgamma. The ability of various nonsteroidal anti-inflammatory drugs (NSAIDs) to induce PPARgamma activation was also evaluated. The conventional NSAIDs that inhibit both cyclooxygenases (COX-1 and COX-2) also induced PPARgamma binding activity. In general, however, neither COX-1- nor COX-2-specific inhibitors induced the activation of PPARgamma. Taken together, the metabolites of 15-lipoxygenase and the conventional NSAIDs were confirmed as exogenous ligands for PPARgamma in colorectal carcinoma cells.


Assuntos
Anti-Inflamatórios não Esteroides/farmacologia , Neoplasias Colorretais/tratamento farmacológico , Eicosanoides/farmacologia , Receptores Citoplasmáticos e Nucleares/metabolismo , Fatores de Transcrição/metabolismo , Anti-Inflamatórios não Esteroides/metabolismo , Western Blotting , Células CACO-2 , Linhagem Celular Tumoral , Cromatografia Líquida de Alta Pressão , Neoplasias Colorretais/metabolismo , Neoplasias Colorretais/patologia , Eicosanoides/metabolismo , Eletroforese em Gel de Poliacrilamida , Vetores Genéticos/genética , Humanos , Ligantes , Ácido Linoleico/metabolismo , Ácido Linoleico/farmacologia , Ácidos Linoleicos/metabolismo , Ácidos Linoleicos/farmacologia , Luciferases/genética , Luciferases/metabolismo , Ligação Proteica , Receptores Citoplasmáticos e Nucleares/genética , Fatores de Transcrição/genética
20.
J Pharmacol Exp Ther ; 299(2): 468-76, 2001 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11602656

RESUMO

Cyclooxygenases (COX)-1 and -2 are the key enzymes in the conversion of arachidonic acid to prostaglandins. COX-2 appears to play an emerging role in inflammation and carcinogenesis. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for the treatment of numerous diseases and reduce the risk of developing colorectal cancer. Polymorphisms in the COX-2 gene could alter enzyme expression, function, and/or the response to NSAIDs. Therefore, they could modify individual risks for developing cancer and other diseases or the occurrence of side effects or sensitivity toward selective or nonselective COX inhibitors. We sequenced the COX-2 gene of 72 individuals and identified rare polymorphisms in the promoter and the coding region. A COX-2 molecular model was used to locate the coding region polymorphisms relative to functional sites in the protein, and the COX-2 V511A polymorphism was very near to the active site. This variant protein was expressed, and function was evaluated, but no difference was detected in metabolism of the COX-2 substrates, arachidonic acid, linoleic acid, and 2-arachidonyl glycerol, compared with the wild type. The Km values for arachidonic acid showed no differences between the COX-2 wild type and V511A mutant. Inhibition with selective or nonselective COX inhibitors was essentially the same for the two enzymes. The absence of functionally important polymorphisms in the COX-2 gene may suggest that there has been selective pressure against those single nucleotide polymorphisms because of the critical role of this enzyme in maintenance of homeostasis.


Assuntos
Isoenzimas/genética , Prostaglandina-Endoperóxido Sintases/genética , Anti-Inflamatórios não Esteroides/farmacologia , Povo Asiático , População Negra , Western Blotting , Linhagem Celular , Células Cultivadas , Cromatografia Líquida de Alta Pressão , Clonagem Molecular , Ciclo-Oxigenase 2 , DNA/análise , DNA/genética , Humanos , Isomerismo , Proteínas de Membrana , Modelos Moleculares , Mutagênese Sítio-Dirigida , Polimorfismo Genético , Prostaglandinas/biossíntese , População Branca
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