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BACKGROUND: While seasonality of hospital-acquired infections, including incisional SSI after orthopaedic surgery, is recognized, the seasonality of incisional SSI after general and gastroenterological surgeries remains unclear. AIM: To analyse the seasonality and risk factors of incisional SSI after general and gastroenterological surgeries. METHODS: This was a retrospective, single-institute, observational study using univariate and multivariate analyses. The evaluated variables included age, sex, surgical approach, surgical urgency, operation time, wound classification, and the American Society of Anesthesiologists physical status (ASA-PS). FINDINGS: A total of 8436 patients were enrolled. General surgeries (N = 2241) showed a pronounced SSI incidence in summer (3.9%; odds ratio (OR): 1.87; 95% confidence interval (CI): 1.05-3.27; P = 0.025) compared to other seasons (2.1%). Conversely, gastroenterological surgeries (N = 6195) showed a higher incidence in winter (8.3%; OR: 1.38; 95% CI: 1.10-1.73; P = 0.005) than in other seasons (6.1%). Summer for general surgery (OR: 1.90; 95% CI: 1.12-3.24; P = 0.018) and winter for gastroenterological surgery (1.46; 1.17-1.82; P = 0.001) emerged as independent risk factors for incisional SSI. Open surgery (OR: 2.72; 95% CI: 1.73-4.29; P < 0.001) and an ASA-PS score ≥3 (1.64; 1.08-2.50; P = 0.021) were independent risk factors for incisional SSI in patients undergoing gastroenterological surgery during winter. CONCLUSION: Seasonality exists in the incisional SSI incidence following general and gastroenterological surgeries. Recognizing these trends may help enhance preventive strategies, highlighting the elevated risk in summer for general surgery and in winter for gastroenterological surgery.
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This study aimed to evaluate the effects of triglycerides containing medium-chain fatty acids (MCT) and tributyrin (TB) supplementation in a milk replacer (MR) on growth performance, plasma metabolites, and hormone concentrations in dairy calves. Sixty-three Holstein heifer calves (body weight at 8 d of age, 41.1 ± 2.91 kg; mean ± SD) were randomly assigned to 1 of 4 experimental MR (28% crude protein and 18% fat): (1) containing 3.2% C8:0 and 2.8% C10:0 (in fat basis) without TB supplementation (CONT; n = 15), (2) containing 6.7% C8:0 and 6.4% C10:0 without TB supplementation (MCT; n = 16), (3) containing 3.2% C8:0 and 2.8% C10:0 with 0.6% (dry matter basis) TB supplementation (CONT+TB; n = 16), (4) containing 6.7% C8:0 and 6.4% C10:0 with 0.6% TB supplementation (MCT+TB; n = 16). The MR were offered at 600 g/d (powder basis) from 8 to 14 d, up to 1,300 g/d from 15 to 21 d, 1,400 g/d from 22 to 49 d, down to 700 g/d from 50 to 56 d, 600 g/d from 57 to 63 d, and weaned at 64 d of age. All calves were fed calf starter, chopped hay, and water ad libitum. The data were analyzed using a 2-way ANOVA via the fit model procedure of JMP Pro 16 (SAS Institute Inc.). Medium-chain fatty acid supplementation did not affect the total dry matter intake. However, calves that were fed MCT had greater feed efficiency (gain/feed) before weaning (0.74 ± 0.098 vs. 0.71 ± 0.010 kg/kg) compared with non-MCT calves. The MCT calves also had a lower incidence of diarrhea compared with non-MCT calves during 23 to 49 d of age and the weaning period (50 to 63 d of age; 9.2% vs. 18.5% and 10.5% vs. 17.2%, respectively). Calves fed with TB had a greater total dry matter intake during postweaning (3,465 vs. 3,232 g/d). Calves fed TB also had greater body weight during the weaning (90.7 ± 0.97 vs. 87.9 ± 1.01 kg) and postweaning period (116.5 ± 1.47 vs. 112.1 ± 1.50 kg) compared with that of non-TB calves. The plasma metabolites and hormone concentrations were not affected by MCT or TB. These results suggest that MCT and TB supplementation in the MR may improve the growth performance and gut health of dairy calves.
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Dieta , Ácidos Graxos , Animais , Bovinos , Feminino , Dieta/veterinária , Leite , Desmame , Peso Corporal , Triglicerídeos , Suplementos Nutricionais , Hormônios , Ração Animal/análiseRESUMO
OBJECTIVE: Joint injury rapidly induces expression of primary response genes (PRGs), which activate a cascade of secondary genes that destroy joint tissues and initiate post-traumatic osteoarthritis (PTOA). Bromodomain-containing-protein-4 (Brd4) and cyclin-dependent-kinase-9 (CDK9) cooperatively control the rate-limiting step of PRG transactivation, including pro-inflammatory genes. This study investigated whether Brd4 and CDK9 inhibitors suppress inflammation and prevent PTOA development in vitro and in a mouse PTOA model. METHODS: The effects of Brd4 and CDK9 inhibitors (JQ1 and Flavopiridol) on PRG and associated secondary damage were rigorously tested in different settings. Short-term effects of inflammatory stimuli (IL-1ß, IL-6, TNF) on human chondrocyte PRG expression were assessed by RT-PCR and microarray after 5-h. We quantified glycosaminoglycan release from IL-1ß-treated bovine cartilage explants after 3-6 days, and osteoarthritic changes in mice after ACL-rupture using RT-PCR (2-24hrs), in vivo imaging of MMP activity (24hrs), AFM-nanoindentation (3-7days), and histology (3days-4wks). RESULTS: Flavopiridol and JQ1 inhibitors act synergistically, and a combination of both almost completely prevented the activation of most IL-1ß-induced PRGs in vitro by microarray analysis, and prevented IL-1ß-induced glycosaminoglycan release from cartilage explants. Mice given the drug combination showed reduced IL-1ß and IL-6 expression, less in vivo MMP activity, and lower synovitis (1.5 vs 4.9) and OARSI scores (2.8 vs 6.0) than untreated mice with ACL-rupture. CONCLUSIONS: JQ1 and Flavopiridol work synergistically to reduce injury response after joint trauma, suggesting that targeting Brd4 and/or CDK9 could be a viable strategy for PTOA prevention and treatment of early OA.
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Azepinas/farmacologia , Cartilagem Articular/efeitos dos fármacos , Condrócitos/efeitos dos fármacos , Flavonoides/farmacologia , Osteoartrite do Joelho/metabolismo , Piperidinas/farmacologia , Inibidores de Proteínas Quinases/farmacologia , Triazóis/farmacologia , Animais , Lesões do Ligamento Cruzado Anterior/complicações , Artrite Experimental/etiologia , Artrite Experimental/metabolismo , Cartilagem Articular/metabolismo , Bovinos , Condrócitos/metabolismo , Quinase 9 Dependente de Ciclina/antagonistas & inibidores , Quinase 9 Dependente de Ciclina/metabolismo , Glicosaminoglicanos/metabolismo , Humanos , Técnicas In Vitro , Interleucina-1beta/efeitos dos fármacos , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Camundongos , Proteínas Nucleares/antagonistas & inibidores , Osteoartrite do Joelho/etiologia , Índice de Gravidade de Doença , Fatores de Transcrição/antagonistas & inibidores , Fator de Necrose Tumoral alfa/efeitos dos fármacos , Fator de Necrose Tumoral alfa/metabolismoAssuntos
Ceratodermia Palmar e Plantar/complicações , Melanoma/etiologia , Neoplasias Cutâneas/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante/métodos , Procedimentos Cirúrgicos Dermatológicos , Evolução Fatal , Feminino , Humanos , Japão , Ceratodermia Palmar e Plantar/genética , Ceratodermia Palmar e Plantar/patologia , Masculino , Melanoma/patologia , Melanoma/terapia , Pessoa de Meia-Idade , Mutação , Estadiamento de Neoplasias , Serpinas/genética , Pele/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapiaRESUMO
OBJECTIVES: Diabetes mellitus (DM) is known to impair fracture healing. Increasing evidence suggests that some microRNA (miRNA) is involved in the pathophysiology of diabetes and its complications. We hypothesized that the functions of miRNA and changes to their patterns of expression may be implicated in the pathogenesis of impaired fracture healing in DM. METHODS: Closed transverse fractures were created in the femurs of 116 rats, with half assigned to the DM group and half assigned to the control group. Rats with DM were induced by a single intraperitoneal injection of streptozotocin. At post-fracture days five, seven, 11, 14, 21, and 28, miRNA was extracted from the newly generated tissue at the fracture site. Microarray analysis was performed with miRNA samples from each group on post-fracture days five and 11. For further analysis, real-time polymerase chain reaction (PCR) analysis was performed at each timepoint. RESULTS: Microarray analysis showed that there were 14 miRNAs at day five and 17 miRNAs at day 11, with a greater than twofold change in the DM group compared with the control group. Among these types of miRNA, five were selected based on a comparative and extended literature review. Real-time PCR analysis revealed that five types of miRNA (miR-140-3p, miR-140-5p, miR-181a-1-3p, miR-210-3p, and miR-222-3p) were differentially expressed with changing patterns of expression during fracture healing in diabetic rats compared with controls. CONCLUSIONS: Our findings provide information to further understand the pathology of impaired fracture healing in a diabetic rat model. These results may allow the potential development of molecular therapy using miRNA for the treatment of impaired fracture healing in patients with DM.Cite this article: S. Takahara, S. Y. Lee, T. Iwakura, K. Oe, T. Fukui, E. Okumachi, T. Waki, M. Arakura, Y. Sakai, K. Nishida, R. Kuroda, T. Niikura. Altered expression of microRNA during fracture healing in diabetic rats. Bone Joint Res 2018;7:139-147. DOI: 10.1302/2046-3758.72.BJR-2017-0082.R1.
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UNLABELLED: Abnormalities of swallowing in patients with mandibular prognathism have not been evaluated quantitatively. The aim of this study was to compare tongue pressure production for bolus transfer between volunteers with normal occlusion and patients with mandibular prognathism. The control group had 10 female volunteers with normal occlusion, and the patient group had 10 women with mandibular prognathism. Tongue pressure was measured by a palatal sensor sheet at five sites on swallowing 4 mL of a tasteless and odourless jelly. RESULTS: The tongue pressure waveform differed between the control and patient groups. The incidence of a double-peak tongue pressure waveform was more frequent in the patient group. In both groups, the exertion of tongue pressure began at the anterior point of the sensor sheet, followed by the peripheral parts. Although the order of expression of tongue pressure was the same for the two groups, maximum tongue pressure at all parts of the sensor sheet was lower in the patient group than in the control group. Furthermore, swallowing time was longer in the patient group than in the control group at the peripheral parts of the palate. These results clearly show the difference in tongue pressure production during swallowing between patients with mandibular prognathism and volunteers with normal occlusion. The current findings suggest that maxillofacial morphology may affect tongue movement during swallowing.
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Deglutição , Prognatismo/fisiopatologia , Língua/fisiopatologia , Adolescente , Feminino , Alimentos , Humanos , Palato/anatomia & histologia , Pressão , Processamento de Sinais Assistido por Computador , Transdutores de Pressão , Adulto JovemRESUMO
BACKGROUND/ PURPOSE: A skin movement artifact is a major problem in three-dimensional motion analysis. Furthermore, skin tension lines are important in plastic surgery. Skin tension depends upon the body area and the direction of resistance. From the perspective of skin continuity and clinical observation, we hypothesized that the contralateral side of the skin of the extremities moves in the opposite direction. This study aimed to examine kinematics of thigh skin including movement direction during pelvic sway. METHODS: Fifteen healthy men participated in this study. Kinematic data were obtained using a three-dimensional motion analysis system. To detect opposite skin movement, 42 markers were attached to the front, back, lateral, and medial sides of the thigh and pelvis. Front and back markers in the sagittal plane and lateral and medial markers in the frontal plane were arranged in a line connecting the hip and ankle joint centers, respectively. Subjects performed maximal pelvic movements in the anterior-posterior and rightward-leftward directions. RESULTS: The results showed that the front skin of the thigh was transferred upward and that the back skin was transferred downward during pelvic anterior sway. Opposite skin movements were observed during posterior pelvic sway. We also found that the lateral skin was transferred upward and that the medial skin was transferred downward during hip adduction and vice-versa during hip abduction. CONCLUSION: These findings suggest that the skin moves according to certain physiological rules.
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Pontos de Referência Anatômicos/anatomia & histologia , Pontos de Referência Anatômicos/fisiologia , Articulações/anatomia & histologia , Articulações/fisiologia , Movimento/fisiologia , Amplitude de Movimento Articular/fisiologia , Adulto , Artefatos , Marcadores Fiduciais , Humanos , Imageamento Tridimensional/métodos , Perna (Membro)/fisiologia , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Coxa da Perna/anatomia & histologia , Coxa da Perna/fisiologiaRESUMO
UNLABELLED: The stem cell compartment in the esophageal epithelium is possibly located in the basal layer. We have identified significant expression of Smad2/3, phosphorylated at specific linker threonine residues (pSmad2/3L-Thr), in the epithelial cells of murine stomach and intestine, and have suggested that these cells are epithelial stem cells. In this study, we explore whether pSmad2/3L-Thr could serve as a biomarker for esophageal stem cells. We examined esophageal tissues from normal C57BL/6 mice and those with esophagitis. Double immunofluorescent staining of pSmad2/3L-Thr with Ki67, CDK4, p63, or CK14 was performed. After immunofluorescent staining, we stained the same sections with hematoxylin-eosin and observed these cells under a light microscope. We used the 5-bromo-2-deoxyuridine (BrdU) labeling assay to examine label retention of pSmad2/3L-Thr immunostaining-positive cells. We collected specimens 5, 10, 15 and 20 days after repeated BrdU administrations and observed double immunofluorescent staining of pSmad2/3L-Thr with BrdU. In the esophagus, pSmad2/3L-Thr immunostaining-positive cells were detected in the basal layer. These cells were detected between Ki67 immunostaining-positive cells, but they were not co-localized with Ki67. pSmad2/3L-Thr immunostaining-positive cells showed co-localization with CDK4, p63, and CK14. Under a light microscope, pSmad2/3L-Thr immunostaining-positive cells indicated undifferentiated morphological features. Until 20 days follow-up period, pSmad2/3L-Thr immunostaining-positive cells were co-localized with BrdU. pSmad2/3L-Thr immunostaining-positive cells significantly increased in the regeneration phase of esophagitis mucosae, as compared with control mice (esophagitis vs. CONTROL: 6.889 ± 0.676/cm vs. 4.293 ± 0.659/cm; P < 0.001). We have identified significant expression of pSmad2/3L-Thr in the specific epithelial cells of murine esophagi. We suggest that these cells are slow-cycling epithelial stem-like cells before re-entry to the cell cycle.
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Proteínas de Ciclo Celular/análise , Ciclo Celular , Esôfago/citologia , Proteína Smad2/análise , Proteína Smad3/análise , Células-Tronco/química , Treonina , Animais , Pontos de Checagem do Ciclo Celular , Quinase 4 Dependente de Ciclina/análise , Células Epiteliais/química , Mucosa Esofágica/citologia , Mucosa Esofágica/patologia , Esofagite/metabolismo , Esofagite/patologia , Esôfago/patologia , Antígeno Ki-67/análise , Camundongos , Camundongos Endogâmicos C57BL , Fosfoproteínas/análise , Fosforilação , Coloração e Rotulagem , Células-Tronco/citologia , Transativadores/análiseRESUMO
OBJECTIVE: The aim of this study was to compare the biocompatibility of a new Senko E-Ternal coating (SEC) for cardiopulmonary bypass (CPB) circuits with the well-established poly-2-methoxyethyl acrylate (PMEA) coating. METHODS: Forty patients undergoing aortic valve replacement were randomly assigned to either an SEC-coated group (n = 20) or a PMEA-coated group (n = 20). Clinical data and the following markers were analyzed: platelet count, platelet factor (PF) 4, fibrinogen, fibrinogen degradation products (FDPs), antithrombin III (AT III), thrombin-antithrombin complex (TAT), plasminogen, complement hemolytic activity (CH50), complement 3 (C3) and interleukin-6 (IL-6). Blood samples were obtained at five time points in both groups. RESULTS: CPB time, aortic cross-clamp time and blood loss and transfusion were similar in both groups. There were no significant differences between the groups in terms of platelet count, PF4 and all coagulation and fibrinolytic parameters (FDP, AT III, TAT, and plasminogen) at any time points. Inflammatory markers (CH50, C3 and IL-6) were also similar in both groups at all time points. CONCLUSIONS: The SEC-coated circuit demonstrated equivalent biocompatibility to the PMEA-coated circuit. SEC-coated circuits are, therefore, favorably comparable to PMEA-coated circuits for clinical use in CPB.
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Ponte Cardiopulmonar/instrumentação , Materiais Revestidos Biocompatíveis , Teste de Materiais/métodos , Acrilatos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Proteínas Sanguíneas/metabolismo , Feminino , Humanos , Masculino , PolímerosRESUMO
BACKGROUND: Chronic low back pain (CLBP) is common and results in significant costs to individuals, families and society. Although some research supports the efficacy of hypnosis for CLBP, we know little about the minimum dose needed to produce meaningful benefits, the roles of home practice and hypnotizability on outcome, or the maintenance of treatment benefits beyond 3 months. METHODS: One hundred veterans with CLBP participated in a randomized, four-group design study. The groups were (1) an eight-session self-hypnosis training intervention without audio recordings for home practice; (2) an eight-session self-hypnosis training intervention with recordings; (3) a two-session self-hypnosis training intervention with recordings and brief weekly reminder telephone calls; and (4) an eight-session active (biofeedback) control intervention. RESULTS: Participants in all four groups reported significant pre- to post-treatment improvements in pain intensity, pain interference and sleep quality. The hypnosis groups combined reported significantly more pain intensity reduction than the control group. There was no significant difference among the three hypnosis conditions. Over half of the participants who received hypnosis reported clinically meaningful (≥ 30%) reductions in pain intensity, and they maintained these benefits for at least 6 months after treatment. Neither hypnotizability nor amount of home practice was associated significantly with treatment outcome. CONCLUSIONS: The findings indicate that two sessions of self-hypnosis training with audio recordings for home practice may be as effective as eight sessions of hypnosis treatment. If replicated in other patient samples, the findings have important implications for the application of hypnosis treatment for chronic pain management.
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Biorretroalimentação Psicológica , Dor Crônica/terapia , Hipnose , Dor Lombar/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipnose/métodos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Risco , Resultado do TratamentoRESUMO
BACKGROUND: A quantitative understanding of the histological alteration of the skin is important for assessing the severity of photoaging. METHODS: We performed Elastica-van Gieson staining and immunohistochemistry for decorin on 34 facial skin sections. We evaluated the alteration of collagen fibers and decorin (a modulator for collagen fibrillogenesis), according to the 5 grades of morphological change in elastic fibers that was established by Kligman (1969). The objectivity of a stage (Stages I-VI), which was established in this study, was evaluated using weighted kappa statistical analysis based on the degree of agreement in stage determination by 11 observers using a blind procedure. Correlation between the crow's-feet-area wrinkles grades of another 26 women and stages was also analyzed. RESULTS: The initial alteration of elastic fibers was observed in the deep dermis. Decorin was not detected in very severely altered skin. Based on the combination of changes in the elastic fibers, collagenic fibers, and decorin, skin tissues were categorized into 6 stages according to severity. The statistical analysis showed almost perfect agreement between observers. Significant positive correlation between stages and wrinkle scores was found. CONCLUSIONS: We propose a new objective histological scale that is useful for assessing the severity of photoaging.
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Decorina/metabolismo , Colágenos Fibrilares/metabolismo , Envelhecimento da Pele/fisiologia , Pele/citologia , Pele/metabolismo , Escala Visual Analógica , Idoso , Biomarcadores/metabolismo , Dermoscopia/métodos , Tecido Elástico/citologia , Tecido Elástico/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Pele/efeitos da radiação , Envelhecimento da Pele/efeitos da radiaçãoRESUMO
BACKGROUND: 'Public domain application' is a flexible drug approval system in Japan, similar to the fast track designation in the United States. METHODS: From 1999 to 2009, four drugs and three regimens received approval from `Public domain application'. The data from the review reports were extracted, and the reviewing process was critically re-evaluated. RESULTS: The study drugs were categorized into three groups according to the sizes of the studies and evidence levels in the original articles that were submitted. Carboplatin was categorized into the first group with a large number of study patients and a high evidence level; the review report had studies with more than 15 000 total patients and 8 phase III studies. The ifosfamide and vinblastine regimen was categorized into the second group, with a low number of study patients and a low evidence level; the review report had studies with less than 1000 total patients and 1 phase III study. Dacarbazine; cytarabine; methotrexate, vinblastine, doxorubicin, and cisplatin; bleomycin, etoposide, and cisplatin; and fludarabine were categorized into the remaining third group, with a moderate number of study patients and evidence level. CONCLUSIONS: Drugs with various backgrounds, including evidence levels and physicians' experiences, were approved via `Public domain application'. The approvals of most drugs were evaluated to be appropriate.
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Antineoplásicos , Aprovação de Drogas , Tomada de Decisões , Humanos , JapãoRESUMO
OBJECTIVE: To determine the function of platelet-derived growth factor (PDGF) in the final differentiation phase of tongue striated muscle cells. MATERIALS AND METHODS: We analyzed the expressions of PDGF-A, -B, platelet-derived growth factor receptor (PDGFR)-α, and PDGFR-ß in mouse tongues between embryonic days (E) 11 and 15. Furthermore, we examined the effects of human recombinant PDGF-AB and the peptide antagonist for PDGFRs using an organ culture system of mouse embryonic tongue. Mouse tongues at E12 were cultured in BGJb medium containing human recombinant PDGF-AB for 4 days or the peptide antagonist for PDGF receptors for 8 days. RESULTS: PDGF-A, -B, PDGFR-α, and -ß were expressed in the differentiating muscle cells between E11 and 15. The human recombinant PDGF-AB induced increases in the mRNA expressions of myogenin and muscle creatine kinase (MCK) and the number of fast myosin heavy chain (fMHC)-positive cells, markers for the differentiation of muscle cells. On the other hand, the peptide antagonist for PDGFRs induced suppressions in the mRNA expressions of myogenin and MCK, and the number of fMHC-positive cells. Both the PDGF-AB and the antagonist failed to affect the expressions of cell proliferation markers. CONCLUSION: These results suggest that PDGF functions as a positive regulator in the final differentiation phase of tongue muscle cells in mouse embryos.
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Células Musculares/citologia , Músculo Esquelético/embriologia , Fator de Crescimento Derivado de Plaquetas/fisiologia , Língua/embriologia , Animais , Diferenciação Celular/fisiologia , Proliferação de Células , Creatina Quinase Forma MM/análise , Idade Gestacional , Humanos , Camundongos , Desenvolvimento Muscular/fisiologia , Miogenina/análise , Cadeias Pesadas de Miosina/análise , Técnicas de Cultura de Órgãos , Fator de Crescimento Derivado de Plaquetas/análise , Proteínas Proto-Oncogênicas c-sis/análise , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/análise , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/antagonistas & inibidores , Receptor beta de Fator de Crescimento Derivado de Plaquetas/análise , Receptor beta de Fator de Crescimento Derivado de Plaquetas/antagonistas & inibidores , Proteínas RecombinantesRESUMO
Blood pressure (BP) screening is important to identify those at risk of cardiovascular disease, but there has been little data on the appropriate interval of screening. We aimed to evaluate the optimal interval and the best measure for BP re-screening by estimating the long-term, true change variance ('signal') and short-term, within-person variance ('noise'). Study design was a cohort study from 2005 to 2008. Target population was Japanese healthy adults not taking antihypertensive medication at baseline, in a teaching hospital. We measured annually the systolic BP (SBP) and the diastolic BP (DBP), and calculated the pulse pressure (PP) and the mean arterial pressure (MAP). A total of 15,055 individuals (51% male) with a mean age of 49 years had annual check-ups. Short-term coefficient of variation was lowest for MAP at 5.2%, followed by SBP (5.7%) and DBP (5.8%), and highest for PP (12%). After 3 years, the 'signal' of true BP changes of only SBP and MAP equaled the 'noise' of BP measurement; however, it was larger for those with higher initial BPs. SBP or MAP appears to be a better screening measure. The optimal interval should be 3 years or more, with SBP<130 mm Hg and 2 years for those with SBP ≥ 130 mm Hg.
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Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto JovemRESUMO
BACKGROUND: To identify the optimal interval for repeat prostate-specific antigen (PSA) testing to screen for prostate cancer in healthy adults. PATIENTS AND METHODS: A retrospective cohort study was conducted on 7332 healthy males without prostate cancer at baseline from 2005 to 2008. Participants underwent annual health checkups including PSA testing at the Center for Preventive Medicine in Japan. Participants with high PSA (≥ 4.0 ng/ml) underwent further examination for prostate cancer. A subgroup analysis was conducted age group (<50 years, ≥ 50 years). RESULTS: Mean age was 50 years. Mean PSA at baseline was 1.2 ng/ml. In over 50-year group, for those with initial PSA of <1.0, 1.0-1.9, 2.0-2.9, and 3.0-3.9 ng/ml at baseline, the 3-year cumulative incidence of prostate cancer was 0%, 0.1%, 0.3%, and 5.7%, respectively. No prostate cancer was identified in those <50 years, regardless of PSA level. CONCLUSIONS: If PSA screening is recommended, males >50 years with PSA of 3.0-3.9 ng/ml at baseline should undergo rescreening at 2 years. For men with PSA <3.0 ng/ml, PSA rescreening at intervals of ≥ 3 years is appropriate. PSA screening may not be indicated in males of <50 years of age.
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Carcinoma/diagnóstico , Técnicas de Diagnóstico Endócrino/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Antígeno Prostático Específico/análise , Neoplasias da Próstata/diagnóstico , Adulto , Carcinoma/sangue , Estudos de Coortes , Técnicas de Diagnóstico Endócrino/normas , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/prevenção & controle , Estudos Retrospectivos , Fatores de TempoRESUMO
BACKGROUND/AIMS: The aim of this study was to investigate onset patterns and initial symptoms in patients with dementia with Lewy bodies (DLB) and their association with SPECT findings. METHODS: We studied 29 probable and 12 possible DLB patients. Onset was defined as 'acute' when symptoms (in various combinations) present within a few weeks or 'chronic' when a few symptoms present and progress during a longer period of time. Initial symptoms were dichotomized into 'cognitive' and 'non-cognitive'. We conducted voxel-to-voxel statistical analyses of SPECT, and uptake deviations from age-matched controls were depicted with Z-scores. RESULTS: In acute patients, decreases were more apparent in the bilateral frontal and temporal lobes, whereas chronic patients showed decreases in the bilateral occipital, posterior cingulate and precuneal regions. Differences in the left frontal and left posterior cingulate were significant and those in the left temporal region showed a tendency toward significance. Patients with cognitive symptoms demonstrated more marked decreases in the bilateral temporal, parietal, occipital, cingulate and precuneal regions. Differences in the left parietal area reached significance and the total decreases were larger in patients with cognitive than non-cognitive symptoms, with a trend toward significance. CONCLUSIONS: The multiplicity of onset patterns and initial symptoms may possibly be based on pathophysiological diversities in DLB.
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AIMS: To investigate the incidence and severity of the 'head-turning sign' (HTS), i.e. turning the head back to the caregiver(s) for help, in patients with various dementias and discuss its clinical specificity in Alzheimer's disease (AD). METHODS: WE INVESTIGATED THE INCIDENCE AND SEVERITY OF HTS WHILE ADMINISTERING A SHORT COGNITIVE TEST (THE REVISED HASEGAWA DEMENTIA RATING SCALE: HDSR) in outpatients with AD [125 patients, including 4 with AD + vascular dementia (VaD)], 8 with amnestic mild cognitive impairment (aMCI), 34 with dementia with Lewy bodies (DLB), 8 with progressive supranuclear palsy (PSP) and 6 with VaD. RESULTS: Significant differences were found among the 5 disease groups in the incidence and severity of HTS, and HDSR scores. Given the significant differences between AD and DLB in post hoc analyses, patients were dichotomized into AD-related (AD and aMCI) and AD-nonrelated (PSP, DLB and VaD) groups. Both incidence (41 vs. 17%, p = 0.002) and severity of HTS (0.80 ± 1.13 vs. 0.21 ± 0.60, p = 0.001) were significantly higher in the AD-related group, while average age and HDSR scores were comparable between both groups. AD-related disease, female gender and low HDSR score contributed significantly to the occurrence and severity of HTS. CONCLUSIONS: HTS can be a clinical marker of AD and aMCI, and may represent a type of excuse behavior as well as a sign of dependency on and trust in the caregivers.
Assuntos
Pessoal de Saúde , Testes Imunológicos/economia , Interferon gama/biossíntese , Radiografia Pulmonar de Massa/economia , Programas de Rastreamento/economia , Tuberculose Pulmonar/diagnóstico , Adulto , Análise Custo-Benefício , Humanos , Incidência , Tuberculose Latente/diagnóstico , Tuberculose Latente/diagnóstico por imagem , Tuberculose Latente/epidemiologia , Tuberculose Latente/imunologia , Cadeias de Markov , Pessoa de Meia-Idade , Mycobacterium tuberculosis/imunologia , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/imunologiaRESUMO
AIMS: To describe obsessive-compulsive symptoms (OCS) as under-recognized behavioral and psychological symptoms of dementia of progressive supranuclear palsy (PSP) and to discuss possible mechanisms based on MRI and SPECT findings. METHODS: We studied 74 PSP patients. OCS are defined as persistent and unreasonable, but non-delusional/hallucinatory, ideas and behaviors. Demography, cognition, the widths of middle cerebellar peduncles (MCP) and the inter-caudate distances (ICD), both corrected by the intracranial size (MCP and ICD ratios), and changes on voxel-based SPECT were compared between the subgroups with and without OCS. Finally, the predicative power of various factors to OCS was investigated. RESULTS: We observed OCS in 18 patients (24%). They were obsessed with daily trifles and physical symptoms among other things. OCS was not associated with demography or cognitive levels. OCS-positive patients had significantly smaller MCP and ICD ratios and showed marked uptake decreases in the orbitofrontal cortex, caudate and thalamus. Relative uptake increases in the cerebellum, specifically the tonsils, were milder in OCS-positive than -negative patients. A smaller right MCP, a smaller ICD ratio and lower uptake increases in the right cerebellar were the significant predictors of OCS. CONCLUSIONS: OCS are frequent but under-recognized behavioral and psychological symptoms of dementia in PSP. Dysfunction of the fronto-caudate-thalamus-cerebellum circuit may be involved.
Assuntos
Cerebelo , Comportamento Compulsivo , Comportamento Obsessivo , Paralisia Supranuclear Progressiva/complicações , Tálamo , Idoso , Idoso de 80 Anos ou mais , Cerebelo/diagnóstico por imagem , Cerebelo/patologia , Comportamento Compulsivo/diagnóstico , Comportamento Compulsivo/etiologia , Comportamento Compulsivo/fisiopatologia , Comportamento Compulsivo/psicologia , Demência/diagnóstico , Demência/etiologia , Demência/patologia , Demência/psicologia , Escolaridade , Feminino , Humanos , Testes de Inteligência , Imageamento por Ressonância Magnética , Masculino , Comportamento Obsessivo/diagnóstico , Comportamento Obsessivo/etiologia , Comportamento Obsessivo/fisiopatologia , Comportamento Obsessivo/psicologia , Valor Preditivo dos Testes , Fatores Sexuais , Paralisia Supranuclear Progressiva/diagnóstico , Paralisia Supranuclear Progressiva/patologia , Paralisia Supranuclear Progressiva/psicologia , Tálamo/diagnóstico por imagem , Tálamo/patologia , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
BACKGROUND AND OBJECTIVE: Enamel sheath protein (ESP) is involved in the construction of the enamel sheath during tooth development. The 17 kDa ESP is a one-step cleavage product processed by proteolysis from the N-terminal side of sheathlin (ameloblastin/amelin), one of the porcine enamel matrix proteins. Enamel sheath protein exhibits periodontal ligament and cementum regeneration activity in a buccal dehiscence model in dogs, and promotes the cytodifferentiation of cultured human periodontal ligament (HPDL) cells. The aim of this study was to determine the peptide segment on the C-terminal side sequence of the human ESP that possesses a cytodifferentiation activity on cultured HPDL cells. MATERIAL AND METHODS: The peptides synthesized on the basis of human ESP C-terminal side sequence were tested for their ability to increase the alkaline phosphatase (ALP) and mineralization activity of cultured HPDL cells. The expressions of osteocalcin, osteopontin and bone sialoprotein were measured by semi-quantitative PCR and therefore were determined to be specific indicators of mineralized tissue differentiation. RESULTS: Multiple synthetic peptides from the human ESP increased the ALP activity and stimulated matrix mineralization in long-term cultures of HPDL cells. Semi-quantitative PCR demonstrated the osteocalcin, osteopontin and bone sialoprotein expressions to increase relative to the control values. The peptide SDKPPKPELPGVDF had the strongest cytodifferentiation activity among all the synthetic peptides tested. CONCLUSION: A specific peptide sequence derived from the C-terminal side of the human ESP promotes the cytodifferentiation and mineralization activity of HPDL cells in a cell culture system.