RESUMO
This review focuses on the recent progress in the management of primary central nervous system lymphoma (PCNSL). Multiomic analyses allowed to better understand the tumorigenesis of PCNSL and to establish a molecular classification with prognostic value that will optimize patient management and guide future targeted approaches. Cooperative clinical trials have demonstrated the feasibility and efficacy, in selected fit patients, of high-dose chemotherapy with autologous stem cell transplantation as post-induction consolidation, that will progressively replace whole brain radiotherapy associated with a much higher risk of delayed neurotoxicity. Several novel treatments have shown efficacy and overall good tolerance in PCNSL patients, such as Bruton's tyrosine kinase (BTK) inhibitors, imids, immune checkpoint inhibitors and chimeric antigen receptor T-cells (CAR-T). This opens promising therapeutic perspectives to improve the current standard treatment, especially for elderly and unfit patients who represent a growing population.
Assuntos
Neoplasias do Sistema Nervoso Central , Transplante de Células-Tronco Hematopoéticas , Linfoma , Humanos , Idoso , Neoplasias do Sistema Nervoso Central/terapia , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Transplante Autólogo , Terapia Combinada , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma/terapia , Linfoma/tratamento farmacológicoRESUMO
Alzheimer's disease (AD) is the most common neurodegenerative dementia. It manifests as early-onset or late-onset AD. Early-onset AD represents about 5.5% of the total cases and occurs in patients under age 65. The EOAD progresses more aggressively and has a shorter life expectancy due to a greater pathogenic load. We present two asymptomatic siblings, a 30-year-old male and a 34- year-old female, who are heterozygous carriers of a pathogenic variant c.428T>C (Ile143Thr) in the presenilin 1 (PSEN1) gene. During genetic counseling, assisted reproduction techniques (ART) coupled with embryo biopsy and a preimplantation genetic test for monogenic disorders (PGT-M) were recommended to provide reproductive care for the patients and their partners. ART and preimplantation genetic testing (PGT) have made it possible to have chromosomally normal and genetically unaffected offspring, allowing patients with genetic diseases to become parents.
Assuntos
Doença de Alzheimer , Presenilina-1 , Adulto , Feminino , Humanos , Masculino , Doença de Alzheimer/genética , Doença de Alzheimer/patologia , Precursor de Proteína beta-Amiloide , Mutação , Presenilina-1/genéticaRESUMO
La evolución del tratamiento de oxigenación por membrana extracorpórea (ECMO) y en particular del transporte de los pacientes sometidos a él, ha cambiado de forma significativa en la última década y lo ha hecho de manera desigual en diferentes regiones. Se ha demostrado que la creación de centros de referencia especializados mejora los resultados. Por todo ello ha sido necesario crear redes de equipos especializados y el número de transportes secundarios de pacientes con este tratamiento está en aumento. Con el fin de mejorar la calidad del tratamiento y ofrecer una guía para los servicios que intervienen en estos transportes, los grupos de trabajo de transporte crítico de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) y la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) han realizado un trabajo conjunto de elaboración de estas recomendaciones, enfocadas a los siguientes aspectos: indicaciones, sistemas de centros de referencia, medios de transporte, características y equipamiento, equipos humanos, formación y seguridad clínica (AU)
The evolution of extracorporeal membrane oxygenation treatment and the transport of patients receiving this treatment has changed dramatically in the last decade unevenly in different regions. The creation of specialized referral centers has been shown to improve outcomes. For all these reasons, it has been necessary to create networks of specialized teams and the number of secondary transports of patients with this treatment is increasing. In order to improve the quality of treatment and offer a guide to the services involved in these transports, the critical transport working groups of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) and the Spanish Society of Pediatric Intensive Care (SECIP) have carried out a joint effort to prepare these recommendations, focused on the following aspects: indications, reference center systems, means of transport, characteristics and equipment, human teams, training and clinical safety (AU)
Assuntos
Humanos , Oxigenação por Membrana Extracorpórea , Cuidados Críticos , Transporte de Pacientes/métodos , Sociedades Médicas , Consenso , EspanhaRESUMO
The evolution of extracorporeal membrane oxygenation treatment and the transport of patients receiving this treatment has changed dramatically in the last decade unevenly in different regions. The creation of specialized referral centers has been shown to improve outcomes. For all these reasons, it has been necessary to create networks of specialized teams and the number of secondary transports of patients with this treatment is increasing. In order to improve the quality of treatment and offer a guide to the services involved in these transports, the critical transport working groups of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) and the Spanish Society of Pediatric Intensive Care (SECIP) have carried out a joint effort to prepare these recommendations, focused on the following aspects: indications, reference center systems, means of transport, characteristics and equipment, human teams, training and clinical safety.
Assuntos
Oxigenação por Membrana Extracorpórea , Criança , Consenso , Cuidados Críticos , Oxigenação por Membrana Extracorpórea/efeitos adversos , HumanosRESUMO
Under pathological conditions, nitric oxide can become a mediator of oxidative cellular damage, generating an unbalance between oxidant and antioxidant systems. The participation of neuronal nitric oxide synthase (nNOS) in the neurodegeneration mechanism has been reported; the activation of N-methyl-D-aspartate (NMDA) receptors by agonist quinolinic acid (QUIN) triggers an increase in nNOS function and promotes oxidative stress. The aim of the present work was to elucidate the participation of nNOS in QUIN-induced oxidative stress in knock-out mice (nNOS-/-). To do so, we microinjected saline solution or QUIN in the striatum of wild-type (nNOS +/+), heterozygote (nNOS+/-), and knock-out (nNOS-/-) mice, and measured circling behavior, GABA content levels, oxidative stress, and NOS expression and activity. We found that the absence of nNOS provides a protection against striatal oxidative damage induced by QUIN, resulting in decreased circling behavior, oxidative stress, and a partial protection reflected in GABA depletion. We have shown that nNOS-derived NO is involved in neurological damage induced by oxidative stress in a QUIN-excitotoxic model.
Assuntos
Corpo Estriado/efeitos dos fármacos , Óxido Nítrico Sintase Tipo I/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Ácido Quinolínico/farmacologia , Animais , Antioxidantes/farmacologia , Corpo Estriado/metabolismo , Peroxidação de Lipídeos/efeitos dos fármacos , Masculino , Camundongos Knockout , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase/efeitos dos fármacos , Óxido Nítrico Sintase/metabolismo , Óxido Nítrico Sintase Tipo I/metabolismo , Ácido Quinolínico/metabolismo , Receptores de N-Metil-D-Aspartato/efeitos dos fármacos , Receptores de N-Metil-D-Aspartato/metabolismoRESUMO
No disponible
Assuntos
Humanos , Feminino , Lactente , Síndrome de Cushing/tratamento farmacológico , Etomidato/farmacocinética , Hipertensão/complicações , Hipopotassemia/complicações , Resultado do Tratamento , Hormônio Adrenocorticotrópico/análiseRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/toxicidade , Dor Abdominal/etiologia , Dipirona/administração & dosagem , Acetaminofen/administração & dosagem , Insuficiência Renal/complicações , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Anti-Inflamatórios não Esteroides , Dipirona/toxicidade , Hipovolemia/induzido quimicamente , Hiponatremia/induzido quimicamente , Hipoalbuminemia/induzido quimicamenteAssuntos
Síndrome de Cushing/tratamento farmacológico , Etomidato/uso terapêutico , Hipertensão/etiologia , Hipopotassemia/etiologia , Córtex Suprarrenal/efeitos dos fármacos , Córtex Suprarrenal/metabolismo , Córtex Suprarrenal/patologia , Síndrome de Cushing/sangue , Síndrome de Cushing/complicações , Síndrome de Cushing/fisiopatologia , Suscetibilidade a Doenças , Infecções por Escherichia coli/complicações , Etomidato/farmacologia , Evolução Fatal , Feminino , Humanos , Hidrocortisona/sangue , Hidrocortisona/metabolismo , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Hospedeiro Imunocomprometido , Lactente , Labetalol/uso terapêutico , Choque Séptico/complicaçõesRESUMO
No disponible
Assuntos
Humanos , Apneia/diagnóstico , Morte Encefálica/diagnóstico , Pressão Positiva Contínua nas Vias Aéreas , Consumo de Oxigênio/fisiologiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Criança , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/prevenção & controle , Cateteres Venosos Centrais/efeitos adversosRESUMO
OBJECTIVE: To determine if a relationship exists between pregnancy rates obtained in patients undergoing in vitro fertilization (lVF) with donor eggs and levels of thyroid stimulating hormone greater than 2.5 mlU/L but still within a range considered normal. STUDY DESIGN: Retrospective comparative cohort study. With prior approval of the Ethics Committee, 233 patients undergoing IVF with donor eggs, in a two-year period, were included. Patients were grouped depending on the thyroid stimulating hormone (TSH) level. Pregnancy rates were compared. Statistical analysis was made with the Chi-square test. RESULTS: Pregnancy rates, depending on the TSH level, were 56.6% in patients with TSH levels below 2.49 mU/L vs. 21.6%, in patients with levels above 2.5 mU/L. This difference was statistically significant (p < 0.001). CONCLUSIONS: Mild abnormalities of thyroid function may adversely affect the pregnancy rates in patients un- dergoing in vitro fertilization with donor eggs. A possible alteration in endometrial function may be associated.
