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1.
Mult Scler ; 22(14): 1850-1858, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-26920380

RESUMO

OBJECTIVE: To compare the frequency and pattern of cognitive impairment (CI) between patients with neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). METHODS: A total of 82 NMOSD patients, 58 MS patients, and 45 healthy controls (HCs) underwent a neuropsychological assessment. RESULTS: CI was observed in 29% of NMOSD and 50% of MS patients (p < 0.001); CI was considered present if a patient scored lower than the fifth percentile compared with HCs in at least three domains. A lower frequency of CI was consistently found when CI was indicated by at least two failed tests (p < 0.001). MS patients performed worse than did NMOSD patients on verbal learning and verbal and visual memory tests. Levels of education and depression and the interval from disease onset to treatment were associated with a negative influence on cognition in patients with NMOSD. CONCLUSION: CI in patients with NMOSD may be not as common as in patients with MS. MS patients exhibited severe impairment, particularly on learning and memory tests, compared with NMOSD patients. Differential prevalence and patterns of CI between NMOSD and MS patients suggest that the two diseases have different mechanisms of brain injury.


Assuntos
Disfunção Cognitiva/fisiopatologia , Esclerose Múltipla/fisiopatologia , Neuromielite Óptica/fisiopatologia , Adulto , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/epidemiologia , Neuromielite Óptica/complicações , Neuromielite Óptica/diagnóstico por imagem , Neuromielite Óptica/epidemiologia
2.
J Korean Med Sci ; 30(11): 1604-10, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26539004

RESUMO

Breast cancer is the most common type of female cancer. Tamoxifen, a selective estrogen receptor modulator, is widely used to decrease breast cancer recurrence and mortality among patients. However, it also increases the risk of endometrial cancer. This study aimed to assess knowledge and decisional conflict regarding tamoxifen use. Between June and October 2014, breast cancer patients using tamoxifen were consecutively screened and requested to complete a survey including the EQ-5D, Satisfaction with Decision Scale (SWD), Decisional Conflict Scale (DCS), and a self-developed, 15-item questionnaire measuring tamoxifen-related knowledge. The study sample comprised 299 patients. The mean total knowledge score was 63.4 of a possible 100.0 (range, 13.3-93.3). While 73.9% of the participants knew that tamoxifen reduces the risk of breast cancer recurrence, only 57.9% knew that the drug increases endometrial cancer risk. A higher education level (≥ college) was associated with a higher, total knowledge score (ß = 4.291; P = 0.017). A higher knowledge score was associated with a decreased DCS score (ß = -0.366; P < 0.001). A higher SWD score was also associated with decreased decisional conflict (ß = -0.178; P < 0.001). In conclusion, the breast cancer patients with higher levels of tamoxifen-related knowledge showed lower levels of decisional conflict regarding tamoxifen use. Clinicians should provide the exact information about tamoxifen treatment to patients, based on knowledge assessment results, so as to aid patients' decision-making with minimal conflict.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Termos de Consentimento/estatística & dados numéricos , Neoplasias do Endométrio/induzido quimicamente , Educação de Pacientes como Assunto/estatística & dados numéricos , Tamoxifeno/efeitos adversos , Tamoxifeno/uso terapêutico , Adulto , Idoso , Antineoplásicos Hormonais/efeitos adversos , Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/epidemiologia , Tomada de Decisões , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/prevenção & controle , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricos , Prevalência , República da Coreia , Medição de Risco
3.
J Korean Med Sci ; 30(8): 1150-6, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26240494

RESUMO

We investigated trends in perioperative chemotherapy use, and determined factors associated with neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) use in Korean patients with muscle-invasive bladder cancer (MIBC). We recruited 1,324 patients who had MIBC without nodal invasion or metastases and had undergone radical cystectomies (RC) between 2003 and 2013. The study's cut-off time for AC was three months after surgery, and the study's timespan was divided into three periods based on NAC use, namely, 2003-2005, 2006-2009, and 2010-2013. Complete remission was defined as histologically confirmed T0N0M0 after RC. NAC and AC were administered to 7.3% and 18.1% of the patients, respectively. The median time interval between completing NAC and undergoing RC was 32 days and the mean number of cycles was 3.2. The median time interval between RC and AC was 43 days and the mean number of cycles was 4.1. Gemcitabine and cisplatin were most frequently used in combination for NAC (49.0%) and AC (74.9%). NAC use increased significantly from 4.6% between 2003 and 2005 to 8.4% between 2010 and 2013 (P < 0.05), but AC use did not increase. Only 1.9% of patients received NAC and AC. Complete remission after NAC was achieved in 12 patients (12.5%). Multivariable modeling revealed that an advanced age, the earliest time period analyzed, and clinical tumor stage ≤ cT2 bladder cancer were negatively associated with NAC use (P < 0.05). While NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice.


Assuntos
Antineoplásicos/uso terapêutico , Cistectomia/estatística & dados numéricos , Músculo Liso/patologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante/estatística & dados numéricos , Quimioterapia Adjuvante/tendências , Cistectomia/tendências , Vias de Administração de Medicamentos , Esquema de Medicação , Feminino , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Mau Uso de Serviços de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/estatística & dados numéricos , Terapia Neoadjuvante/tendências , Invasividade Neoplásica , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Prevalência , República da Coreia/epidemiologia , Fatores de Risco , Resultado do Tratamento , Neoplasias da Bexiga Urinária/epidemiologia
4.
JAMA Neurol ; 72(9): 989-95, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26167726

RESUMO

IMPORTANCE: Despite the increased use of rituximab therapy in neuromyelitis optica spectrum disorder (NMOSD), the overall efficacy and safety of long-term rituximab treatment in a large group of patients is uncertain. Furthermore, the identification of a predictor of rituximab response is an important issue for assessing the individual risk-benefit of therapy and making treatment decisions. OBJECTIVE: To assess the long-term clinical efficacy and safety of rituximab treatment in patients with NMOSD and the influence of fragment c gamma receptor 3A (FCGR3A) polymorphisms on rituximab response. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of 100 patients with relapsing NMOSD treated with rituximab for at least 6 months, from February 1, 2006, to January 31, 2015, at the institutional referral center. After induction therapy, a single infusion of rituximab (375 mg/m2) as maintenance therapy was administered whenever a reemergence of CD27+ memory B cells among peripheral blood mononuclear cells occurred. Using an allele-specific polymerase chain reaction-based method, the gene polymorphisms FCGR3A-V158F were assessed. MAIN OUTCOMES AND MEASURES: The primary end point was annualized relapse rate; disability (Expanded Disability Status Scale score), safety of rituximab treatment, event of insufficient memory B-cell depletion following rituximab, and time to retreatment of rituximab were secondary end points. RESULTS: By January 31, 2015, a total of 100 patients received repeated rituximab treatment during a median of 67 months. Of these patients, 41 had more than 5 years' follow-up and 24 had more than 7 years' follow-up. The annualized relapse rate was reduced significantly by 96% (mean [SD] annualized relapse rate of prerituximab vs postrituximab, 2.4 [2.0] vs 0.1 [0.6]) and disability improved or stabilized in 96% of patients. Rates of adverse events were generally stable. The FCGR3A-F allele was associated with a risk of relapse while receiving rituximab treatment (additive model, P < .05; recessive model, P = .04; maximum, P = .03) and insufficient memory B-cell depletion (additive model, P = .03; recessive model, P = .03; maximum, P = .03). CONCLUSIONS AND RELEVANCE: Repeated rituximab treatment for NMOSD was observed in an increasing number of patients and increasing duration of exposure and maintained good efficacy and a safety profile consistent with previous reports. The finding of a relationship between FCGR3A genetic polymorphisms and rituximab response suggests the importance of individualized rituximab treatment strategies in NMOSD.


Assuntos
Fatores Imunológicos/uso terapêutico , Neuromielite Óptica/tratamento farmacológico , Neuromielite Óptica/genética , Polimorfismo de Nucleotídeo Único/genética , Receptores de IgG/genética , Rituximab/uso terapêutico , Adulto , Anticorpos/sangue , Aquaporina 4/imunologia , Avaliação da Deficiência , Feminino , Citometria de Fluxo , Genótipo , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neuromielite Óptica/sangue , Farmacogenética , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
5.
Biosci Biotechnol Biochem ; 66(9): 1859-64, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12400684

RESUMO

An anticoagulant was purified from a Chinese herb, Taraxacum platycarpum. Its activity was heat-labile, and was decreased by incubation with subtilisin Carlburg or proteinase K, indicating that the active component was a protein. The protein had a molecular mass of 31 kDa by gel filtration and 33 kDa by sodium dodecyl sulfate polyacrylamide gel electrophoresis, so it probably was a monomer. When present at the concentration of 70, 255, and 873 nM, respectively, the protein doubled the thrombin time, prothrombin time, and activated partial thromboplastin time. It inhibited thrombin and kallikrein, but did not hydrolyze fibrinogen. The protein bound the anion-binding exosite of thrombin, competing with the fibrinogen binding site. In addition, the protein caused the murine macrophage cell line Raw 264.7 to produce cyclooxygenase-2, nitric oxide synthase, nitric oxide, and tumor necrosis factor-alpha.


Assuntos
Anticoagulantes/isolamento & purificação , Anticoagulantes/farmacologia , Coagulação Sanguínea/efeitos dos fármacos , Taraxacum/química , Animais , Anticoagulantes/química , Linhagem Celular , Ciclo-Oxigenase 2 , Estabilidade de Medicamentos , Medicamentos de Ervas Chinesas , Temperatura Alta , Isoenzimas/metabolismo , Calicreínas/antagonistas & inibidores , Calicreínas/metabolismo , Ativação de Macrófagos/efeitos dos fármacos , Macrófagos/efeitos dos fármacos , Macrófagos/enzimologia , Macrófagos/metabolismo , Camundongos , Peso Molecular , Óxido Nítrico Sintase/metabolismo , Tempo de Tromboplastina Parcial , Prostaglandina-Endoperóxido Sintases/metabolismo , Tempo de Protrombina , Trombina/antagonistas & inibidores , Trombina/metabolismo , Tempo de Trombina , Fator de Necrose Tumoral alfa/metabolismo
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