Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 224
Filtrar
2.
Spine J ; 2024 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-39147142

RESUMO

BACKGROUND CONTEXT: Orthotic treatment is a common option for the conservative treatment of osteoporotic vertebral fractures (OVF). However, there is insufficient evidence of its clinical benefit. PURPOSE: To investigate the effectiveness of orthotic treatment for OVF. STUDY DESIGN/SETTING: Retrospective cohort study with data from two prospective studies. PATIENT SAMPLE: This study included 160 patients with fresh OVF enrolled in 2012 and 2020 prospective cohort studies. OUTCOME MEASURES: The visual analog scale (VAS) score for low back pain was used for clinical outcomes, and radiographic parameters included the percent height of the vertebra and angular change of the vertebral body. Moreover, the occurrence of secondary vertebral fractures was followed-up over time. METHODS: The patients were divided into brace and no-brace groups and were matched according to propensity score for age, sex, anterior percent height at the initial examination, and presence of old OVFs. Hazard ratio for the cumulative incidence of secondary vertebral fractures with and without bracing were calculated and analyzed using the generalized Wilcoxon test. In addition, the brace group was divided into soft and rigid brace groups and compared with the no-brace group. RESULTS: Each group had 61 cases after propensity score matching. There were no significant differences in the VAS improvement for low back pain and the change in percent height of the anterior and posterior walls from initial examination to 6 months after injury (p = 0.87, p = 0.39 and p = 0.14, respectively, mixed-effect models). Meanwhile, the mean angular change of fractured vertebrae was 4.3° / 3.2° initially and 1.2° / 2.5° at 6 months (the brace group / no-brace group, respectively; p = 0.007, mixed-effect models). A significant difference was also observed between the rigid brace group and the no-brace group (p = 0.008, mixed effect models). The incidence of secondary vertebral fractures was 1.6% / 11.4% at 1 month, indicating a significant difference (the brace group / no-brace group, respectively; p = 0.028). The hazard ratio for the cumulative incidence of secondary fractures due to orthotic treatment was 0.47 (95% confidence interval 0.20-1.09, p = 0.054). CONCLUSIONS: Although orthotic treatment for fresh OVF did not relieve pain, it might contribute to the stabilization of the fractured vertebra, especially using a rigid brace. Moreover, it might influence a reduction of the imminent vertebral fracture risk immediately after the onset of OVF. CLASSIFICATIONS: Clinical study.

3.
J Dermatol ; 2024 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-39046277

RESUMO

Amenamevir is an oral once-daily antiherpesvirus drug that can be administered without dose adjustment in patients with impaired renal function. There are currently no clinical data on immunocompromised patients with herpes zoster treated with amenamevir. Therefore, an exploratory study of the efficacy and safety of amenamevir against herpes zoster in patients with immunosuppression was conducted. Inclusion criteria included patients with acute herpes zoster receiving immunosuppressive drugs or those with malignant tumors or autoimmune diseases. Twenty-four patients were included and received amenamevir (400 mg once daily after meals) for up to 14 days. The primary end point of overall improvement in skin symptoms 7 days after treatment initiation (day 7) was 58.3% for "markedly improved" and 20.8% for "improved." The combined improvement rate was 79.2% (95% confidence interval, 57.8-92.9), and 20.8% of patients experienced "worsened" symptoms. The secondary end points of overall improvement in skin symptoms on day 14 and day 28 were 95.7% and 100%, respectively. The skin symptoms progressed during treatment, peaking on day 7, and then began to heal. By Kaplan-Meier estimation, the median periods to complete crusting and healing were both day 14. There were five adverse events with a possible causal relationship to amenamevir (bacterial skin infection, anemia, hyponatremia, headache, and abnormal liver function) in one of the 24 patients. Although the bacterial skin infection was severe, all events in this patient were reported to be either recovered or recovering. These findings indicate that amenamevir can be effective and safe in immunocompromised patients with herpes zoster. However, as worsening can happen around day 7, it is necessary to carefully monitor such patients and switch to other therapies such as intravenous acyclovir if necessary. Clinical trial identifier: Japan Registry of Clinical Trials jRCTs031190208.

4.
Sci Rep ; 14(1): 17634, 2024 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-39085360

RESUMO

Self-amplifying RNAs (saRNAs) are versatile vaccine platforms that take advantage of a viral RNA-dependent RNA polymerase (RdRp) to amplify the messenger RNA (mRNA) of an antigen of interest encoded within the backbone of the viral genome once inside the target cell. In recent years, more saRNA vaccines have been clinically tested with the hope of reducing the vaccination dose compared to the conventional mRNA approach. The use of N1-methyl-pseudouridine (1mΨ), which enhances RNA stability and reduces the innate immune response triggered by RNAs, is among the improvements included in the current mRNA vaccines. In the present study, we evaluated the effects of this modified nucleoside on various saRNA platforms based on different viruses. The results showed that different stages of the replication process were affected depending on the backbone virus. For TNCL, an insect virus of the Alphanodavirus genus, replication was impaired by poor recognition of viral RNA by RdRp. In contrast, the translation step was severely abrogated in coxsackievirus B3 (CVB3), a member of the Picornaviridae family. Finally, the effects of 1mΨ on Semliki forest virus (SFV), were not detrimental in in vitro studies, but no advantages were observed when immunogenicity was tested in vivo.


Assuntos
RNA Viral , Replicação Viral , RNA Viral/genética , Animais , Replicon/genética , Pseudouridina/metabolismo , Vírus de RNA de Cadeia Positiva/genética , Humanos , Vírus da Floresta de Semliki/genética , RNA Polimerase Dependente de RNA/genética , RNA Polimerase Dependente de RNA/metabolismo , Estabilidade de RNA , Enterovirus Humano B/genética , Enterovirus Humano B/fisiologia
5.
J ISAKOS ; 9(4): 609-614, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38825183

RESUMO

OBJECTIVES: Cement penetration (CP) plays a key role in implant stability for cemented total knee arthroplasty (TKA), and the radiolucent line (RLL) >2 â€‹mm is a preliminary sign for loosening of components. However, the direct relationship between CP and the frequency of RLL >2 â€‹mm is unclear, and the best cut-off value for CP to prevent RLL >2 â€‹mm also remains unclear. This study aimed to investigate this relationship between CP and RLL and to determine the clinical cut-off value for tibial CP in patients 2 years after TKA. METHODS: This retrospective study investigated 157 knees from 123 patients with osteoarthritis who underwent cemented TKA. The CP and RLL immediately after TKA and the RLL 2 years after TKA were measured for the medial, lateral, anterior, and posterior tibial baseplate zones. Receiver operating characteristic (ROC) curves were constructed to determine the best cut-off values for CP. RESULTS: RLL >2 â€‹mm was not observed just after TKA. An RLL >2 â€‹mm was observed in any tibial baseplate zone in 22 knees from 20 patients (RLL+ group) and was not observed in the remaining (RLL- group) 2 years after TKA. The mean CP for all zones was significantly higher in the RLL- group (2.5 â€‹± â€‹1.1 â€‹mm) than in the RLL+ group (1.7 â€‹± â€‹0.6 â€‹mm; P â€‹< â€‹0.001). An RLL >2 â€‹mm was seen in 21 knees in the medial zone, 9 knees in the lateral zone, 8 knees in the anterior zone, and 3 knees in the posterior zone. CP values with RLL >2 â€‹mm were significantly lower than those without the RLL at the medial, anterior, and posterior tibial baseplate zones. The best cut-off values from the ROC curve of CP in each zone were between 1.1 â€‹mm and 2.1 â€‹mm. CONCLUSIONS: The depth of the CP directly affects the incidence of an RLL >2 â€‹mm. The best cut-off value for tibial CP to prevent an RLL >2 â€‹mm is 2.1 â€‹mm.


Assuntos
Artroplastia do Joelho , Cimentos Ósseos , Osteoartrite do Joelho , Tíbia , Humanos , Artroplastia do Joelho/métodos , Estudos Retrospectivos , Masculino , Feminino , Tíbia/cirurgia , Idoso , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Incidência , Falha de Prótese , Curva ROC , Radiografia/métodos , Prótese do Joelho , Idoso de 80 Anos ou mais , Articulação do Joelho/cirurgia
6.
Plast Reconstr Surg Glob Open ; 12(5): e5810, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38808145

RESUMO

Background: Various classifications of hemifacial microsomia (HFM) have been described previously. Although some of these classifications are used widely, others use external outlines of reference organs, even in three-dimensional (3D) images. The purpose of this study was to investigate the 3D characteristics of the mandibular condyle in HFM and to update the Pruzansky and Kaban classification as a 3D classification. Methods: Fifty-three patients with HFM were classified according to the Pruzansky and Kaban classification (type I, IIA, IIB, and III) using computed tomographic scan images. 3D images of the mandible were isolated, and the 3D characteristics were observed; furthermore, the angle of inclination of the mandibular condyle was measured in 3D. Results: Subtypes of retroflexed mandibular condyle in 3D were observed in the Pruzansky and Kaban classification type IIA and IIB, termed as type IIAß (33.3% in type IIA) and type IIBß (100% in type IIB). Although some differences were observed in the inclination of the mandibular condyle between the control and the affected sides in type I and IIAα, multiple differences were observed in type IIAß and IIBß. Conclusions: To the best of our knowledge, this is the first report that identified the retroflexed mandibular condyle as subtypes type IIAß and IIBß. Notably, this could not be identified in the two-dimensional images (lateral cephalogram) yet. We proposed to update the Pruzansky and Kaban classification as a 3D classification with a new 3D subtype. The angle of the retroflexed mandibular condyle may predict mandibular growth in HFM.

7.
Knee ; 48: 14-21, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38479077

RESUMO

BACKGROUND: The tibial tubercle-to-trochlear groove (TT-TG) distance and Insall-Salvati (I/S) ratio are widely used to determine the need for distal realignment in conjunction with medial patellofemoral ligament (MPFL) reconstruction in patients with recurrent patellar dislocation. A TT-TG distance >20 mm and an I/S ratio >1.3 are significant anatomical risk factors for patellar instability. However, these parameters have traditionally been measured using non-weight-bearing (NWB) imaging modalities. As patellar dislocation occurs during weight-bearing actions, these two parameters should be measured under weight-bearing conditions. Thus, this study aimed to measure the TT-TG distance and I/S ratio using upright full-weight-bearing (FWB) computed tomography (CT) scans and compare the data with NWB CT scans. METHODS: This study included 49 knee joints of 26 healthy volunteers. CT images were obtained under both FWB and NWB standing conditions using a 320-detector row upright CT scanner. TT-TGs in the axial plane and I/S ratios in the sagittal plane were measured and compared. RESULTS: The average FWB TT-TG distance was 20.3 ± 3.9 mm, whereas the average NWB TT-TG distance was 12.3 ± 4.7 mm. The TT-TG level was significantly higher in the FWB condition than that in the NWB condition (P < 0.001). The I/S ratios were comparable between the FWB and NWB conditions (P = 0.29). CONCLUSIONS: The TT-TG distance in the standing weight-bearing condition was larger than the conventional TT-TG distance and surpassed the historical cutoff value of TT-TG, which may affect the indication of additional distal realignment in MPFL reconstruction for patellar instability.


Assuntos
Tíbia , Tomografia Computadorizada por Raios X , Suporte de Carga , Humanos , Suporte de Carga/fisiologia , Tíbia/diagnóstico por imagem , Masculino , Feminino , Adulto , Adulto Jovem , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Posição Ortostática , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/fisiopatologia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Voluntários Saudáveis , Fêmur/diagnóstico por imagem
8.
Front Immunol ; 15: 1305587, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38487530

RESUMO

Maternal immunoglobulin transfer plays a key role in conferring passive immunity to neonates. Maternal blood immunoglobulin Y (IgY) in avian species is transported to newly-hatched chicks in two steps: 1) IgY is transported from the maternal circulation to the yolk of maturing oocytes, 2) the IgY deposited in yolk is transported to the circulation of the embryo via the yolk sac membrane. An IgY-Fc receptor, FcRY, is involved in the second step, but the mechanism of the first step is still unclear. We determined whether FcRY was also the basis for maternal blood IgY transfer to the yolk in the first step during egg development. Immunohistochemistry revealed that FcRY was expressed in the capillary endothelial cells in the internal theca layer of the ovarian follicle. Substitution of the amino acid residue in Fc region of IgY substantially changed the transport efficiency of IgY into egg yolks when intravenously-injected into laying quail; the G365A mutant had a high transport efficiency, but the Y363A mutant lacked transport ability. Binding analyses of IgY mutants to FcRY indicated that the mutant with a high transport efficiency (G365A) had a strong binding activity to FcRY; the mutants with a low transport efficiency (G365D, N408A) had a weak binding activity to FcRY. One exception, the Y363A mutant had a remarkably strong binding affinity to FcRY, with a small dissociation rate. The injection of neutralizing FcRY antibodies in laying quail markedly reduced IgY uptake into egg yolks. The neutralization also showed that FcRY was engaged in prolongation of half-life of IgY in the blood; FcRY is therefore a multifunctional receptor that controls avian immunity. The pattern of the transport of the IgY mutants from the maternal blood to the egg yolk was found to be identical to that from the fertilized egg yolk to the newly-hatched chick blood circulation, via the yolk sac membrane. FcRY is therefore a critical IgY receptor that regulates the IgY uptake from the maternal blood circulation into the yolk of avian species, further indicating that the two steps of maternal-newly-hatched IgY transfer are controlled by a single receptor.


Assuntos
Galinhas , Células Endoteliais , Imunoglobulinas , Animais , Feminino , Humanos , Recém-Nascido , Células Endoteliais/metabolismo , Receptores Fc , Anticorpos/metabolismo
9.
J Atheroscler Thromb ; 31(8): 1179-1193, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38355124

RESUMO

AIM: Several studies have shown the efficacy and safety of low-molecular-weight heparin use in coronavirus disease 2019 (COVID-19), but that of unfractionated heparin (UFH) has not been investigated. We investigated the prevalence of bleeding complications during UFH administration, its impact on mortality, and the risk factors of bleeding outcomes associated with UFH. METHODS: This retrospective cohort study was conducted at a single-center tertiary care hospital, including hospitalized patients with COVID-19. The primary outcomes were measured as the prevalence of bleeding complications during hospitalization, and the secondary outcomes were thromboembolic events and 60-day mortality rates. Logistic regression analysis and propensity score matching were used to assess risk factors for bleeding complications and their impact on mortality. RESULTS: Among 1035 included patients, 516 patients were treated with UFH. Twelve (2.3%) patients in the UFH group experienced major bleeding. The prevalence of major bleeding in patients treated with therapeutic-dose UFH was 9.2%. Logistic regression analysis showed that age ≥ 60 years (adjusted odds ratio [aOR], 3.89; 95% confidence interval [CI], 1.01-15.0; P<.05) and COVID-19 severity (aOR, 35.9; 95% CI, 4.57-282; P<.05) were associated with major bleeding complications. After propensity score matching, 11 major and 11 non-major bleeding cases (including minor bleeding) were matched. The 60-day cumulative mortality rate between the two groups did not differ significantly (P=.13, log-rank test). CONCLUSIONS: The incidence of major bleeding in COVID-19 patients using therapeutic-dose UFH was relatively high. Critical COVID-19 and older age were risk factors for bleeding complications.


Assuntos
Anticoagulantes , COVID-19 , Hemorragia , Heparina , Humanos , Masculino , Feminino , Japão/epidemiologia , Estudos Retrospectivos , Hemorragia/epidemiologia , Hemorragia/induzido quimicamente , COVID-19/epidemiologia , COVID-19/complicações , COVID-19/mortalidade , Heparina/efeitos adversos , Idoso , Pessoa de Meia-Idade , Incidência , Anticoagulantes/efeitos adversos , Fatores de Risco , SARS-CoV-2 , Tratamento Farmacológico da COVID-19 , Idoso de 80 Anos ou mais , Tromboembolia/epidemiologia , Tromboembolia/etiologia
10.
Metabolites ; 14(2)2024 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-38392987

RESUMO

Efficient cold-chain delivery is essential for maintaining a sustainable global food supply. This study used metabolomic analysis to examine meat quality changes during the "wet aging" of crossbred Wagyu beef during cold storage. The longissimus thoracic (Loin) and adductor muscles (Round) of hybrid Wagyu beef, a cross between the Japanese Black and Holstein-Friesian breeds, were packaged in vacuum film and refrigerated for up to 40 days. Sensory evaluation indicated an increase in the umami and kokumi taste owing to wet aging. Comprehensive analysis using gas chromatography-mass spectrometry identified metabolite changes during wet aging. In the Loin, 94 metabolites increased, and 24 decreased; in the Round, 91 increased and 18 decreased. Metabolites contributing to the umami taste of the meat showed different profiles during wet aging. Glutamic acid increased in a cold storage-dependent manner, whereas creatinine and inosinic acid degraded rapidly even during cold storage. In terms of lipids, wet aging led to an increase in free fatty acids. In particular, linoleic acid, a polyunsaturated fatty acid, increased significantly among the free fatty acids. These results provide new insight into the effects of wet aging on Wagyu-type beef, emphasizing the role of free amino acids, organic acids, and free fatty acids generated during cold storage.

11.
Brain Imaging Behav ; 2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-38376715

RESUMO

In panic disorder (PD), functional disturbance of the hypothalamus-pituitary-adrenal (HPA) axis has been considered. However, in neuroimaging studies of PD, the hypothalamus and pituitary gland are poorly studied.We investigated the volume of PD patients' hypothalamus and pituitary gland, enrolling 38 PD patients and 38 healthy controls. Severity of PD was mild to moderate according to the Panic Disorder Severity Scale, and the illness duration was relatively short (median = 2.8 years). The hypothalamus' gray matter was automatically extracted and segmented, whereas the pituitary gland was manually traced. Regarding the hypothalamus, the paraventricular nucleus (PVH), which produces the corticotropin-releasing hormone, was of interest.The volumes of the pituitary and the bilateral anterior-superior hypothalamic subunits, where the PVH would be located, were compared by the multiple regression analyses controlling for age and intracranial content volume. To compensate for limitation in the abovementioned segmentation and analyses, the voxel-based morphometry with small volume correction (VBM-SVC) targeting the whole hypothalamus was also performed.The multiple regression analyses did not find significant effect of PD diagnosis on the volumes. However, in the VBM-SVC analysis, volume reduction of the PVH was suggested in PD even when patients who experienced PD for ≥ 3 years were excluded [peak coordinate (x, y, z = -2, 3, -8), FWE-corrected P = .022 (cluster-level) and 0.003 (peak-level), voxel size = 63]. Our results suggested structural alteration of the PVH in PD patients for the first time, indicating importance of the HPA-axis in PD pathology.

12.
Neurobiol Pain ; 15: 100148, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38174056

RESUMO

Objective: This study aimed to investigate the effects of low-intensity pulsed ultrasound (LIPUS) phonophoresis with diclofenac on inflammation and pain in the acute phase of carrageenan-induced arthritis in rats. Design: 60 male Wistar rats were randomly divided into the arthritis, diclofenac, LIPUS, phonophoresis, and sham-arthritis control groups. LIPUS and transdermal diclofenac gel were applied to the lateral side of the inflamed knee for 7 days, initiated postinjection day 1. In the phonophoresis group, diclofenac gel was rubbed onto the skin, followed by LIPUS application over the medication. Knee joint transverse diameters, pressure pain thresholds (PPTs), and paw withdrawal thresholds (PWT) were evaluated. The number of CD68-, CD11c-, and CD206-positive cells, and IL-1ß and COX-2 mRNA expression were analyzed 8 days after injection. Results: In the phonophoresis group, the transverse diameter, PPT, PWT significantly recovered at the day 8 compared to those in the LIPUS and diclofenac groups. The number of CD68- and CD11c-positive cells in the phonophoresis group was significantly lower than that in the LIPUS and diclofenac groups, but no significant differences were observed among three groups in CD206-positive cells. IL-1ß and COX-2 mRNA levels were lower in the phonophoresis group than in the arthritis group, although there were no differences among the LIPUS, diclofenac, and phonophoresis groups. Conclusion: LIPUS phonophoresis with diclofenac is more effective to ameliorate inflammation and pain compared to diclofenac or LIPUS alone, and the mechanism involves the decrease of M1 macrophages.

13.
Oncology ; 2024 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-38286117

RESUMO

BACKGROUND: Lenvatinib and sorafenib are key therapeutic agents for hepatocellular carcinoma. However, there are no useful biomarkers for selecting molecular-targeted agents (MTAs). Skeletal muscle volume is associated with the clinical outcomes in these patients. We investigated the effects of lenvatinib and sorafenib on the skeletal muscles of patients with HCC. METHODS: We evaluated the impact of skeletal muscle changes over a 3-month period for each MTA (n = 117; lenvatinib/sorafenib, 45/72). The skeletal muscle mass index (SMI) was measured at the third lumbar vertebra. Furthermore, we evaluated the direct effect of each MTA on primary human skeletal muscle cells by estimating muscle protein synthesis using western blot analysis. RESULTS: The median change in SMI was -0.7% (p = 0.959) and -5.9% (p <0.001) for the lenvatinib and sorafenib groups, respectively. Sorafenib had a greater effect on skeletal muscle loss than lenvatinib (p < 0.001). Additionally, SMI significantly decreased in the sorafenib group regardless of initial skeletal muscle volume (p < 0.001), whereas no significant differences were observed in the lenvatinib group. Sorafenib therapy (odds ratio [OR], 2.98; p = 0.023) and non-muscle depletion (OR, 3.31; p = 0.009) were associated with a decreased SMI. In vitro analysis showed that sorafenib negatively affected muscle synthesis compared to lenvatinib. CONCLUSIONS: Sorafenib may have a more negative effect on skeletal muscle than lenvatinib.

14.
Science ; 383(6678): 55-61, 2024 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-38175903

RESUMO

Decision-making is always coupled with some level of risk, with more pathological forms of risk-taking decisions manifesting as gambling disorders. In macaque monkeys trained in a high risk-high return (HH) versus low risk-low return (LL) choice task, we found that the reversible pharmacological inactivation of ventral Brodmann area 6 (area 6V) impaired the risk dependency of decision-making. Selective optogenetic activation of the mesofrontal pathway from the ventral tegmental area (VTA) to the ventral aspect of 6V resulted in stronger preference for HH, whereas activation of the pathway from the VTA to the dorsal aspect of 6V led to LL preference. Finally, computational decoding captured the modulations of behavioral preference. Our results suggest that VTA inputs to area 6V determine the decision balance between HH and LL.


Assuntos
Assunção de Riscos , Área Tegmentar Ventral , Animais , Área Tegmentar Ventral/citologia , Área Tegmentar Ventral/fisiologia , Macaca fuscata
15.
Injury ; 55(5): 111267, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38129233

RESUMO

BACKGROUND: Severe trauma patients often require emergent interventions, such as massive transfusion, resuscitative procedures, and surgical procedures, and consume considerable human and medical resources. However, few practical indices can be easily used for emergent interventions. In recent years, it has become clear that rSIG (Reverse Shock Index multiplied by Glasgow Coma Scale [GCS] score), which can be easily calculated from vital signs, is a promising predictor of mortality. However, it is unclear whether rSIG is useful for emergent interventions. METHODS: Data collected by the Japan Trauma Data Bank for adult patients admitted directly from the scene of trauma between April 2019 and December 2020 were analysed. The outcomes were massive transfusion, resuscitative procedures, surgical procedures and emergent interventions. Emergent interventions were defined as the composite outcome of massive transfusion, resuscitative procedures, and surgical procedures. The ability of rSIG to predict massive transfusion was compared with that of the ABC score and FASILA score by receiver-operating characteristic curve analysis. The ability of rSIG to predict resuscitative and surgical procedures was compared with that of the Shock Index (SI), GCS, Triage Revised Trauma score (T-RTS), and Previous Simple Prediction (PSP) score. The ability of rSIG to predict emergent interventions was compared with that of T-RTS, PSP, ABC, and FASILA. In addition to rSIG, rSIM (Reverse Shock Index multiplied by best motor response score) was also analysed as a supplement. RESULTS: The study included 32,201 patients, 6,371 of whom required emergent interventions. The area under the receiver-operating characteristic curve (AUROC) for massive transfusion was highest for rSIG (0.846 [95 % confidence interval 0.832-0.859]) and significantly higher for rSIG than for rSIM, ABC and FASILA (all p < 0.0001). AUROCs for resuscitative and surgical procedures were highest for rSIG (0.777 [0.769-0.785] and 0.731 [0.720-0.741], respectively) and significantly higher than those for rSIM, SI, GCS, T-RTS, and PSP (all p < 0.0001). The AUROC for emergent interventions was highest for rSIG (0.760 [0.753-0.768]) and significantly higher for rSIG than for rSIM, T-RTS, PSP, ABC, or FASILA (all p < 0.0001). CONCLUSIONS: rSIG is a simple and effective point-of-care predictor of emergent interventions during initial management of trauma.


Assuntos
Sistemas Automatizados de Assistência Junto ao Leito , Ferimentos e Lesões , Adulto , Humanos , Escala de Coma de Glasgow , Estudos de Coortes , Estudos Retrospectivos , Curva ROC , Escala de Gravidade do Ferimento , Índices de Gravidade do Trauma
16.
Artigo em Inglês | MEDLINE | ID: mdl-38083429

RESUMO

We have developed a novel composite filler with Poly(3,4-ethylenedioxythiophene) : poly(styrenesulfonic acid) (PEDOT:PSS), a biocompatible organic conductive polymer, adsorbed on carbon particles for biological electrodes. This composite filler enables to fabricate high-performance biological electrodes simply by adding it to resin in the same way as conventional conductive fillers. The fabricated electrodes achieve ion exchange properties similar to those of PEDOT:PSS polymers and therefore low skin and electrode contact impedance. Electroencephalogram (EEG) measurements show that these electrodes capture various brain activities and exhibit high correlation (≥ 0.9) to commercially available wet and AgCl electrodes. Additionally, each electrode can be molded into various shapes and structures while retaining its electrode characteristics. Therefore, the proposed electrode is promising for EEG measurement, which requires high comfort and signal quality.


Assuntos
Compostos Bicíclicos Heterocíclicos com Pontes , Polímeros , Compostos Bicíclicos Heterocíclicos com Pontes/química , Eletrodos , Polímeros/química , Condutividade Elétrica , Eletroencefalografia
17.
Cell Transplant ; 32: 9636897231214370, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38014622

RESUMO

Amyotrophic lateral sclerosis (ALS) is characterized by progressive loss of motor neurons. Multilineage-differentiating stress-enduring (Muse) cells are unique endogenous stem cells that show therapeutic effects on motor function in ALS mouse models. We conducted a single-center open phase II clinical trial to evaluate the safety and clinical effects of repeated intravenous injections of an allogenic Muse cell-based product, CL2020, in patients with ALS. Five patients with ALS received CL2020 intravenously once a month for a total of six doses. The primary endpoints were safety and tolerability, and the secondary endpoint was the rate of change in the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) score. In addition, serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), sphingosine-1-phosphate (S1P), cerebrospinal fluid chitotriosidase-1 (CHIT-1), and neurofilament light chain (NfL) levels were evaluated. The CL2020 treatment was highly tolerated without serious side effects. The ALSFRS-R score change trended upward at 12 months post-CL2020 treatment compared with that at 3 months pre-administration, but the difference was not statistically significant. Among five patients diagnosed with ALS, three exhibited a decrease in the rate of ALSFRS-R score change, one demonstrated an increase, and another showed no change. In addition, the patients' serum IL-6 and TNF-α levels and cerebrospinal fluid CHIT-1 and NfL levels increased for up to 6 months post-treatment; however, their serum S1P levels continuously decreased over 12 months. These findings indicate a favorable safety profile of CL2020 therapy. In the near future, a double-blind study of a larger number of ALS patients should be conducted to confirm the efficacy of ALS treatment with CL2020.


Assuntos
Esclerose Lateral Amiotrófica , Animais , Camundongos , Humanos , Esclerose Lateral Amiotrófica/tratamento farmacológico , Alprostadil/uso terapêutico , Interleucina-6 , Fator de Necrose Tumoral alfa , Neurônios Motores
18.
Int J Surg Case Rep ; 112: 108933, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37856973

RESUMO

INTRODUCTION: Bipartite patella (BP) is usually recognized as an incidental radiographic finding. Therefore, no reports have observed the process of accessory fragment migration. We present the case of a professional baseball pitcher with significant migration of the fragment during follow-up. PRESENTATION OF CASE: A 26-year-old man was diagnosed with symptomatic BP and underwent conservative therapy. Eleven months later, he was unable to play baseball because of gradually worsening knee pain without obvious trauma. On radiographs, the accessory fragment which had located at the superolateral pole 11 months earlier migrated posterolaterally. The diagnosis of Saupe's type III BP was established, and open excision of the accessory fragment was performed. Postoperatively, full-weight-bearing walking and range-of-motion exercises were started the day after surgery. Three months after surgery, he could pitch with all his power without pain. DISCUSSION: Since our patient was a professional baseball right-handed pitcher who needed to step strongly on his left knee during pitching, strong traction force from the vastus lateralis was likely to have been repeatedly applied to the accessory fragment. It might lead to migration of the accessory fragment. The open excision of the accessory fragment was performed because the accessory fragment had migrated away from the patella body. CONCLUSION: We report a case of professional baseball player with symptomatic BP, in which case the chronological migration of the accessory fragment was observed without obvious trauma. When the accessory fragment is identified without obvious trauma, one of the differential diseases could be a BP.

19.
Sci Rep ; 13(1): 17798, 2023 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-37853067

RESUMO

Whether a tourniquet should be used for anterior cruciate ligament reconstruction (ACLR) when the operative field is secured remains controversial. Little is known about the influence of not using a tourniquet on total perioperative blood loss and soft tissue damage. The aim of this study was to compare total perioperative blood loss and soft tissue damage with and without tourniquet use during ACLR. Seventy-seven consecutive ACLRs in 76 patients were performed without tourniquet use at our hospital and enrolled in this study (T- group) between November 2018 and September 2021. The control group (T + group) comprised 55 historical ACLRs in 55 patients performed with tourniquet use at our hospital between April 2017 and September 2018. Total perioperative blood loss, calculated from the change in hemoglobin between that preoperatively and on postoperative day (POD) 1, and indicators of soft tissue damage including serum white blood cell (WBC) counts, creatine phosphokinase (CPK), and C-reactive protein (CRP) values measured on POD 1 and POD 7 were compared between groups. Total blood loss was significantly higher in the T- group (339 ± 216 mL) than in the T + group (258 ± 199 mL; P = 0.030). On POD 1, WBC counts were significantly higher in the T- group (9.7 ± 2.4 × 103 cells/µL) than in the T + group (9.1 ± 2.5 × 103 cells/µL; P = 0.043), CPK levels were significantly higher in the T- group (294 ± 417 U/L) than in the T + group (255 ± 88 U/L; P = 0.046), and CRP levels were also significantly higher in the T- group (1.40 ± 1.12 mg/dL) than in the T + group (0.91 ± 0.76 mg/dL; P = 0.016). No significant differences in WBC counts or CPK or CRP levels were seen between groups on POD 7. Total blood loss and soft tissue damage were significantly increased without tourniquet use during ACLR. No advantage was found for not using a tourniquet in terms of blood loss or soft tissue damage.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Humanos , Estudos Retrospectivos , Perda Sanguínea Cirúrgica , Torniquetes/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Exsanguinação , Lesões do Ligamento Cruzado Anterior/cirurgia
20.
CMAJ ; 195(40): E1390-E1391, 2023 10 16.
Artigo em Francês | MEDLINE | ID: mdl-37844927
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA