Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 30
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J Biopharm Stat ; 29(5): 749-759, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31590626

RESUMO

A question that routinely arises in medical device clinical studies is the homogeneity across demographic subgroups, geographical regions, or investigational sites of the enrolled patients in terms of treatment effects or outcome variables. The main objective of this paper is to discuss statistical concepts and methods for the assessment of such homogeneity and to provide the practitioner a statistical framework and points to consider in conducting homogeneity assessment. Demographic subgroups, geographical regions, and investigational sites are discussed separately as each has its unique issues. Specific considerations are also given to randomized controlled trials, non-randomized comparative studies, and single-arm studies. We point out that judicious use of statistical methods, in conjunction with sound clinical judgment, is essential in handling the issue of homogeneity of treatment effect in medical device clinical studies.

2.
Phytomedicine ; 48: 94-103, 2018 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-30195885

RESUMO

BACKGROUND: Ginkgo biloba extract (EGb-761) has been in use to treat variety of ailments including memory loss and emotional disorders usually experienced after ischemic stroke. However, data regarding its protective role in stroke associated motor dysfunction is scarce. PURPOSE: The present work was designed to investigate the long-term effects of EGb-761 on the motor dysfunctions associated with permanent middle cerebral artery occlusion (pMCAO) in rats. STUDY DESIGN/METHODS: Focal ischemic stroke was induced in male Sprague-Dawley rats by pMCAO. These rats were orally administered with EGb-761 (25, 50, 100 mg/kg) and positive control butylphthalide (50 mg/kg) for up to 28 consecutive days. The motor function was evaluated by assessing neurological scores, rotarod performance and gait analysis after 7, 14, 21 and 28 days. After 28 days, the histological examination of in frontal cortex and hippocampus was also carried out. RESULTS: EGb-761 treatment significantly improved motor function with better outcome in coordination and gait impairment rats. EGb-761 (25, 50, 100 mg/kg) treatment for 28 days significantly decreased the neurological scores. After 28 days of treatment EGb-761 (50 and 100 mg/kg) significantly increased the latency in rotarod test, walk speed, and the body rotation, whereas, decreased the stride time and the left posterior swing length in gait were observed. EGb-761 (50, 100 mg/kg). EGb-761 (50, 100 mg/kg) significantly improved the pathological changes related to pMCAO. CONCLUSIONS: EGb 761 could improve motor function especially gait impairments among pMCAO rat model related to the decreased neuronal damage. Therefore, it might be the potential to be explored further as an effective therapeutic drug to treat post stroke motor dysfunctions.


Assuntos
Infarto da Artéria Cerebral Média/fisiopatologia , Locomoção/efeitos dos fármacos , Extratos Vegetais/farmacologia , Acidente Vascular Cerebral/tratamento farmacológico , Animais , Lobo Frontal/efeitos dos fármacos , Lobo Frontal/patologia , Ginkgo biloba , Hipocampo/efeitos dos fármacos , Hipocampo/patologia , Infarto da Artéria Cerebral Média/induzido quimicamente , Masculino , Neurônios/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley
3.
Pharmacol Res ; 136: 172-180, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30196102

RESUMO

Artemisinin (Qinghaosu) and its semi-synthetic derivatives have been demonstrated to alleviate neuroinflammatory response in the central nerve system (CNS). In this review, we summarized that artemisinins are capable to treat neuroinflammtion-related CNS diseases in both direct (via regulating inflammatory process in the CNS, exerting anti-oxidative stress and neuroprotective effect, and preventing Aß accumulation) and indirect (via maintaining BBB integrity, suppressing systemic inflammation and alleviating intestinal inflammtion) manner. However, the precise mechanism of their anti-neuroinflammatory effects and potential neurotoxicity, which hindered further progress in these aspects, remains unclear. We suggest that further understanding of the PK/PD properties and structure-action relationship of atemisinin and its derivatives will facilitate the development of new therapeutics with better curative effects and safety.


Assuntos
Anti-Inflamatórios/uso terapêutico , Antimaláricos/uso terapêutico , Artemisininas/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Doença de Alzheimer/tratamento farmacológico , Animais , Anti-Inflamatórios/farmacologia , Antimaláricos/farmacologia , Artemisininas/farmacologia , Sistema Nervoso Central/efeitos dos fármacos , Humanos , Intestinos/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia
4.
J Womens Health (Larchmt) ; 27(6): 808-814, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29741978

RESUMO

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a less invasive alternative approach to surgery. Individual randomized clinical trials evaluating the safety and efficacy of TAVR were mostly underpowered for conducting separate analyses for women and men. We pooled data from premarket TAVR clinical trials comparing short (30 days)- and long-term (∼2 years) outcomes by sex. METHODS: Patient-level data from the TAVR arms of six clinical trials were pooled (2515 patients). Random-effects models for time-to-event outcomes (odds ratios [ORs] for 30-day outcomes and hazard ratios [HRs] for complete follow-up for mortality, ischemic stroke, kidney injury, major bleeding, myocardial infarction, and device migration) and dichotomous outcomes (ORs for reintervention, rehospitalization, and pacemaker implantation) were then fit to directly compare outcomes between women and men. RESULTS: Overall, the pattern of individual comorbidities was more severe in men. There was no difference in mortality risk at 30 days (female-to-male OR = 1.00 [0.69-1.46]); however, at follow-up completion (∼2 years post-TAVR), women had a 24% lower mortality risk than men (HR = 0.76 [95% CI: 0.65-0.89]). Women also had a 30% lower risk of kidney injury at 30 days (OR = 0.70 [0.49-0.98]), which increased to 33% over the complete follow-up period (HR = 0.67 [0.51-0.87]). Major bleeding was more common in women compared to men at both 30 days (OR = 1.44 [1.19-1.76]) and long-term follow-up (HR = 1.22 [1.04-1.43]). For dichotomous outcomes, women had a 68% lower risk for reinterventions (OR = 0.32 [0.18-0.58]). We did not observe any difference in the risk of ischemic stroke, myocardial infarction, device migration, rehospitalizations, or pacemaker implantations between sexes. CONCLUSIONS: This patient-level data meta-analysis of six premarket clinical trials found that women who received TAVR had fewer comorbidities at baseline. Acute outcomes (30 day) with respect to mortality were similar. Women were observed to have a lower risk of kidney injury, but higher risk of major bleeding compared to men receiving TAVR at 30 days. At complete follow-up, statistically significant advantages for women emerged in improved survival and lower reintervention risk. No differences in ischemic stroke, pacemaker implantation, or rehospitalization were observed. That women are healthier at baseline and develop fewer postprocedural complications than men may explain their higher survival.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter/métodos , Lesão Renal Aguda/epidemiologia , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Ensaios Clínicos como Assunto , Comorbidade , Feminino , Humanos , Masculino , Hemorragia Pós-Operatória/epidemiologia , Fatores Sexuais , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
5.
Phytother Res ; 32(6): 1023-1029, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29468732

RESUMO

Depression is a common, dysthymic, and psychiatric disorder, resulting in enormous social and economic burden. Dammarane sapogenins (DS), an active fraction from oriental ginseng, has shown antidepressant-like effects in chronic restraint rats and sleep interruption-induced mice, and the present study aimed to further confirm the antidepressant effects of DS in a model of chronic unpredictable mild stress (CUMS) and to explore the underlying mechanism. Oral administration of DS (20, 40, and 80 mg/kg) markedly improved depressant-like behaviors, increasing the sucrose intake in the sucrose preference test and reducing the latency in the novelty-suppressed feeding test, and decreasing the immobility time in both the tail suspension and forced swimming tests, compared with the CUMS mice. Biochemical analysis of brain tissue and serum showed that DS treatment restored the decreased hippocampal neurotransmitter concentrations of serotonin, dopamine, norepinephrine (noradrenaline), and gamma-aminobutyric acid, and decreased the elevated of serum hormone levels (corticotrophin releasing factor, adrenocorticotrophic hormone, and corticosterone) induced by CUMS. Our findings confirm that DS exerts an antidepressant-like effect in the CUMS model of depression in mice, and suggest it may be mediated by regulation of neurotransmitters and hypothalamic-pituitary-adrenal axis.


Assuntos
Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Sapogeninas/uso terapêutico , Estresse Psicológico/tratamento farmacológico , Triterpenos/uso terapêutico , Animais , Antidepressivos/farmacologia , Modelos Animais de Doenças , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Sapogeninas/farmacologia , Triterpenos/farmacologia
6.
Exp Ther Med ; 12(5): 3213-3220, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27882140

RESUMO

In the present study, we investigated the effects of hydroxyethyl starch (HES) 130/0.4 on serum pro-inflammatory variables, immunologic variables, fluid balance (FB)-negative(-) rate and renal function in severe acute pancreatitis (SAP) patients. From October, 2007 to November, 2008, a total of 120 SAP patients were enrolled in this retrospective study. Fifty-nine patients in the HES group received 6% HES 130/0.4 combined with crystalloid solution for fluid resuscitation (HES group). In the control group, 61 patients received only crystalloid solution after admission. Interleukin (IL)-1, IL-6, IL-8 and tumor necrosis factor (TNF)-α levels in serum were measured on days 1, 2, 4 and 8. The peripheral blood CD4+CD8+ T lymphocyte rates, serum BUN and Cr values were also measured on days 1, 4 and 8. Patients with FB(-) rates were recorded from day 1 to 8. Interaction term analysis (hospital stay and fluid resuscitation methods) based on mixed-effects regression model revealed significantly lower levels of IL-1 and TNF-α in the HES group compared with the control group. The difference in curve's risk ratio was not significant for IL-6, CD4+CD8+ T lymphocyte rate, BUN and Cr values (P>0.05). In the HES group, we detected a significantly higher rate of patients with FB(-) from day 4 to 8 (P<0.05). Thus, HES 130/0.4 resuscitation could decrease the IL-1 and IL-8 levels, shorten the duration of positive FB, and preserve the patient's immune status as well as renal function during the early phase of SAP.

7.
J Ethnopharmacol ; 194: 819-826, 2016 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-27623554

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Depression induce distressed emotional state and cognitive deficits simultaneously, which both should be improved in the treatment. Hemerocallis citrina Baroni (HC) is a traditional herbal medicine in Eastern-Asia areas and the total phenols extract of HC (HCPE) contains the main active ingredients. It has been reported that HC has the emotional improvement effect. But the cognitive effect of HC was seldom researched. AIM OF THE STUDY: We designed to evaluate the antidepressant and cognitive improvement effect of HCPE using a chronic unpredictable mild stress (CUMS) model, and the potential mechanisms were explored by investigating the corticosterone (CORT), monoamine neurotansmitters, brain-derived neurotropic factor (BDNF) and oxidative stress. MATERIALS AND METHODS: The depression rats were induced by CUMS procedures and treated with HCPE (10, 20, 40mg/kg/day, by gastric gavage). The antidepressant effect was evaluated by sucrose preference test, open field test and body weight, while the cognitive improvement was investigated using morris water maze test. Besides, the levels of monoamine neurotransmitters in the hippocampus and frontal cortex were measured by ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). The serum CORT and BDNF in hippocampus were test using enzyme-linked immunosorbent assay (ELISA) kits. The oxidative stress indicators in frontal cortex were also analyzed. RESULTS: HCPE (40mg/kg) improved the emotion and cognition related behaviors in depression effectively. Moreover, HCPE increased the neurotransmitters concentration (5-HT, DA and NE) in the hippocampus and frontal cortex compared with CUMS rats. Meanwhile, the CUMS induced changes of serum corticosterone level and the hippocampus BDNF level were reversed. Besides, HCPE reduced malondialdehyde (MDA) in the frontal cortex of model rats. CONCLUSION: It suggested that HCPE could improve the depression-like emotional status and associated cognitive deficits in CUMS rats, which might be mediated by regulation of neurotransmitters and BDNF levels in brain, alleviation of corticosterone level as well as the alleviation of oxidative stress.


Assuntos
Antidepressivos/farmacologia , Cognição/efeitos dos fármacos , Depressão/tratamento farmacológico , Hemerocallis/química , Nootrópicos/farmacologia , Extratos Vegetais/farmacologia , Estresse Psicológico/tratamento farmacológico , Animais , Comportamento Animal/efeitos dos fármacos , Monoaminas Biogênicas/metabolismo , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Corticosterona/metabolismo , Depressão/metabolismo , Modelos Animais de Doenças , Lobo Frontal/efeitos dos fármacos , Lobo Frontal/metabolismo , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Masculino , Neurotransmissores/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Fenóis/química , Extratos Vegetais/química , Ratos , Ratos Sprague-Dawley , Estresse Psicológico/metabolismo
8.
J Huazhong Univ Sci Technolog Med Sci ; 36(2): 205-210, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27072963

RESUMO

Locally advanced pancreatic cancer is associated with a very poor prognosis. This study was performed to evaluate whether patients with locally advanced pancreatic cancer benefit from (125)I seed implantation. This retrospective study included 224 patients with locally advanced pancreatic cancer, with 137 patients (61.2%) in the implantation (IP) group and 87 (38.9%) in the non-implantation (NIP) group. The survival status, complications and objective curative effects were compared between the groups. The average operative time in the IP group was significantly longer than that in the NIP group (243±51 vs. 214±77 min). The tumor response rates were 9.5% and 0 at the 2nd month after surgery in the IP and NIP groups, respectively (P<0.05). The IP group exhibited a trend toward pain relief at the 6th month after surgery. The global health status scores of the IP group were higher than those of the NIP group at the 3rd and 6th month after surgery. The median survival time in the IP group was significantly longer than that in the NIP group. In conclusion, patients with locally advanced pancreatic cancer can benefit from (125)I seed implantation in terms of local tumor control, survival time, pain relief and quality of life.


Assuntos
Stents Farmacológicos/efeitos adversos , Radioisótopos do Iodo/administração & dosagem , Neoplasias Pancreáticas/radioterapia , Compostos Radiofarmacêuticos/administração & dosagem , Adulto , Idoso , Feminino , Humanos , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/patologia , Qualidade de Vida , Compostos Radiofarmacêuticos/uso terapêutico , Análise de Sobrevida
9.
J Huazhong Univ Sci Technolog Med Sci ; 36(1): 99-105, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26838748

RESUMO

This study aimed to examine the clinical efficacy of minimally invasive percutaneous catheter drainage (PCD) versus open laparotomy with temporary closure in the treatment of abdominal compartment syndrome (ACS) in patients with early-stage severe acute pancreatitis (SAP). Clinical data of 212 patients who underwent PCD and 61 patients who were given open laparotomy with temporary closure in our hospital over the last 10-year period were retrospectively analyzed, and outcomes were compared, including total and post-decompression intensive care unit (ICU) and hospital stays, physiological data, organ dysfunction, complications, and mortality. The results showed that the organ dysfunction scores were similar between the PCD and open laparotomy groups 72 h after decompression. In the PCD group, 134 of 212 (63.2%) patients required postoperative ICU support versus 60 of 61 (98.4%) in the open laparotomy group (P<0.001). Additionally, 87 (41.0%) PCD patients experienced complications as compared to 49 of 61 (80.3%) in the open laparotomy group (P<0.001). There were 40 (18.9%) and 32 (52.5%) deaths, respectively, in the PCD and open laparotomy groups (P<0.001). In conclusion, minimally invasive PCD is superior to open laparotomy with temporary closure, with fewer complications and deaths occurring in PCD group.


Assuntos
Cateterismo/efeitos adversos , Descompressão Cirúrgica/efeitos adversos , Drenagem/efeitos adversos , Hipertensão Intra-Abdominal/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Pancreatite/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/métodos , Descompressão Cirúrgica/métodos , Drenagem/métodos , Feminino , Humanos , Hipertensão Intra-Abdominal/complicações , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pancreatite/complicações , Complicações Pós-Operatórias
10.
Zhonghua Nan Ke Xue ; 19(6): 506-10, 2013 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-23862227

RESUMO

OBJECTIVE: To investigate the inhibitory effect of cocoomyxa gloeobotrydifomis (CGD) on benign prostate hyperplasia (BPH) in aged rats and its underlying mechanism. METHODS: Thirty SD male rats aged 21 months were equally randomized to three groups, aged control, low-dose CGD and high-dose CGD, the latter two groups fed on a diet with CGD at 50 and 100 mg per kg per d for 3 months, while the aged controls on normal laboratory chow. Another 10 3-month-old male rats were included in a young control group and fed on the same diet as the aged control rats. At the end of 3 months of CGD treatment, the prostates of all the rats were harvested and weighed. The histomorphological and interstitial changes of the prostatic tissue were observed by HE staining and Masson staining, respectively. The expressions of phosphorylated phosphoinositide-dependent kinase 1 (PDK1), phosphorylated Akt (Ser 473) and phosphorylated PTEN in the rat prostate were determined by Western blotting. RESULTS: The wet weight and index of the prostate were significantly higher in the aged controls than in the young controls ([1 220 +/- 140] vs [550 +/- 60] mg, P < 0.01; 2.08 +/- 0.17 vs 1.94 +/- 0.10, P < 0.05). High-dose CGD significantly inhibited the increase in the prostatic wet weight and index of the aged rats ([1 080 +/- 97] mg and 1.85 +/- 0.16) as compared with the aged controls (P < 0.01 and P < 0.05). The epithelium and interstitium, particularly the latter, were evidently thicker in the aged control than in the CGD-treated rats. The protein levels of phosphorylated PDK1 and Akt were significantly enhanced, while that of phosphorylated PTEN remarkably down-regulated in the aged rats as compared with the young ones. The expressions of phosphorylated PDK1 and Akt were significantly decreased, whereas that of phosphorylated PTEN markedly increased in both the low-dose and high-dose CGD groups. CONCLUSION: CGD can significantly inhibit BPH in aged rats through down-regulating the PI3K/Akt pathway.


Assuntos
Clorófitas/química , Polissacarídeos/farmacologia , Próstata/metabolismo , Hiperplasia Prostática/tratamento farmacológico , Animais , Regulação para Baixo , Masculino , Fosfatidilinositol 3-Quinases/metabolismo , Hiperplasia Prostática/metabolismo , Hiperplasia Prostática/patologia , Proteínas Proto-Oncogênicas c-akt/metabolismo , Ratos , Ratos Sprague-Dawley
11.
Ultrasonics ; 53(6): 1079-83, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23522685

RESUMO

Within the linear elasticity approximation the speed of a small-amplitude sound in conventional linear elasticity is determined only by the second order elastic (SOE) constants and the density of the medium. Subjecting the conveying solid to a static strain of a sufficient magnitude introduces the third-order elastic (TOE) constants in the equation of the sound speed. In this work we applied a homogeneous isotropic deformation caused by a thermal expansion of an aluminum alloy sample. Velocities of three acoustic modes: longitudinal, shear and Rayleigh waves were measured as functions of temperature within a range of 25-100 °C. Two TOE constants C111 and C112 were evaluated in an assumption that the third independent module C144 is far smaller than the former two.

12.
Ying Yong Sheng Tai Xue Bao ; 22(9): 2447-56, 2011 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-22126061

RESUMO

By using GC-ECD, the concentrations of organochlorine pesticides hexachlorocyclohexane (HCH) and dichlorodiphenyltrichloroethane (DDT) in the shellfish culture environment (sea water, sediments, and culture-shellfishes) in Xiamen sea area were analyzed, and the accumulation and degradation patterns of the HCH and DDT were preliminarily approached. In the sea area, there existed remarkable differences in the accumulation and degradation of HCH and DDT among different shellfish culture environments, being mostly associated with the habitation environment and physiological life habits of shellfish. The accumulated HCH isomers (Rx > 1) were mainly beta-HCH, delta-HCH, and gamma-HCH, whereas the degraded HCH isomers (Rx < 1) were mainly alpha-HCH. The ratio of alpha-HCH to gamma-HCH was less than or equal to 1.0, suggesting that the HCH was come from industrial HCH and lindane, most of the HCH had remained in the culture environment for a longer time, and a small amount of lindane was imported. The DDT in the sea water was aerobically degraded, its main degradation product was DDE, and the ratios of (DDD+DDE) to DDTs (p,p-DDE+p,p-DDD+o,p-DDT+p,p-DDT) was less than 0.5, whereas the DDT in sediments and shellfishes was anaerobically degraded, its main degradation product was DDD, and the ratios of (DDD+DDE) to DDTs was greater than 0.5, suggesting that there was a small amount of DDT newly imported in the sea water, and most DDT in sediments and shellfishes were already degraded and transformed into DDD and DDE. There were definite differences in the degradation rates of HCH isomers in the culture environment, suggesting the conformational change of HCH in its transformation processes in the shellfish culture ecosystem.


Assuntos
Aquicultura , Hidrocarbonetos Clorados/análise , Resíduos de Praguicidas/análise , Frutos do Mar , Poluentes Químicos da Água/análise , Animais , China , Crustáceos/crescimento & desenvolvimento , DDT/análise , DDT/química , DDT/metabolismo , Hexaclorocicloexano/análise , Hexaclorocicloexano/química , Hexaclorocicloexano/metabolismo , Hidrocarbonetos Clorados/química , Hidrocarbonetos Clorados/metabolismo , Resíduos de Praguicidas/química , Resíduos de Praguicidas/metabolismo , Água do Mar , Poluentes Químicos da Água/química , Poluentes Químicos da Água/metabolismo
13.
Cancer Invest ; 28(10): 1054-62, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20873989

RESUMO

Epidermal growth factor receptor (EGFR) is a target in head and neck cancer. High EGFR expression and phosphorylated EGFR predicts poor survival in head and neck cancer patients, but does not correlate with advanced stage disease. The aim of this study is to determine if clinical biological correlates are more accurate when different aspects of EGFR are evaluated in combination. We analyzed the EGFR phosphorylation, expression, and mutations in 60 primary head and neck tumors. We not only found that head and neck tumors with either truncated or activated EGFR tend to have higher tumor and nodal stage but also discovered two novel EGFR truncations.


Assuntos
Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patologia , Receptores ErbB/genética , Receptores ErbB/metabolismo , Neoplasias de Cabeça e Pescoço/genética , Neoplasias de Cabeça e Pescoço/patologia , Idoso , Carcinoma de Células Escamosas/metabolismo , Análise Mutacional de DNA , Feminino , Neoplasias de Cabeça e Pescoço/metabolismo , Humanos , Imuno-Histoquímica , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Mutação , Estadiamento de Neoplasias , Fosforilação , Reação em Cadeia da Polimerase Via Transcriptase Reversa
14.
Arch Ophthalmol ; 127(11): 1412-9, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19901205

RESUMO

OBJECTIVE: To document age-related macular degeneration (AMD) progression after cataract surgery. METHODS: Surgeons prospectively enrolled patients with nonneovascular AMD who were awaiting cataract surgery. Fluorescein angiography was performed preoperatively and at the postoperative week 1, month 3, and month 12 visits. Incidence of neovascular AMD development within 12 months after operation was the primary outcome measure. RESULTS: A total of 108 subjects were enrolled. Of 86 eyes with preoperatively photographically confirmed nonneovascular AMD, 71 had gradable images by month 12. Neovascular AMD was observed in 9 of 71 eyes (12.7%; 95% confidence interval, 6.0%-22.7%). The progression rate between week 1 and month 12 decreased to 3 of 65 eyes (4.6%; 95% confidence interval, 1.0%-12.9%) after excluding 5 neovascular events identified on the postoperative week 1 visit and 1 case with missing photographs at this visit. CONCLUSION: The low incidence rate of neovascular AMD development between 1 week and 1 year after cataract surgery did not support the hypothesis that cataract surgery increases the risk of AMD progression. Several eyes appeared to have disease progression on postsurgery week 1 fluorescein angiograms, suggesting that many cases of presumed progression to neovascular AMD following cataract surgery may have been present prior to cataract surgery, but not recognized owing to lens opacity.


Assuntos
Catarata/complicações , Implante de Lente Intraocular , Degeneração Macular/epidemiologia , Degeneração Macular/fisiopatologia , Facoemulsificação , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , Corantes , Progressão da Doença , Feminino , Angiofluoresceinografia , Seguimentos , Humanos , Incidência , Verde de Indocianina , Degeneração Macular/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
15.
Retina ; 29(6): 819-24, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19516120

RESUMO

OBJECTIVE: To identify risk factors associated with the development of rhegmatogenous retinal detachment (RRD) in patients enrolled in the Submacular Surgery Trials. METHODS: One thousand fifteen patients with eligible subfoveal neovascular lesions in the study eye were assigned randomly to observation or to surgery. Eyes were examined at 3 months, 6 months, 12 months, and 24 months after enrollment to assess study outcomes and adverse events, including RRDs. Adverse events also were reported at other times as clinical personnel became aware of them. Potential risk factors for the development of RRD in study eyes were evaluated using recursive partitioning and logistic regression analysis. RESULTS: Among 506 eyes assigned to surgery, RRD developed in 44 (8.7%) compared with 4 (0.8%) of 509 eyes assigned to observation. Of the 44 eyes in which RRD developed, 27 had age-related macular degeneration (AMD) and large (>3.5 MPS disk areas) hemorrhagic subfoveal neovascular lesions at baseline and represented 16.1% of all eyes with such lesions assigned to surgery. Eyes with AMD and larger hemorrhagic lesions (>16 MPS disk areas) together with relatively poor visual acuity (best-corrected visual acuity < or =20/1280) had a higher risk of RRD (odds ratio = 6.2, 95% confidence interval: 2.2-16.7) compared with those with smaller lesions and better visual acuity at baseline. CONCLUSION: Poor visual acuity and very large, predominantly hemorrhagic subfoveal neovascular AMD lesion type were the greatest risk factors for RRD after submacular surgery. Submacular surgery should be undertaken in such eyes with full awareness of the risk of RRD during subsequent follow-up.


Assuntos
Neovascularização de Coroide/cirurgia , Complicações Pós-Operatórias , Descolamento Retiniano/etiologia , Idoso , Neovascularização de Coroide/etiologia , Infecções Oculares Fúngicas/complicações , Infecções Oculares Fúngicas/cirurgia , Histoplasmose/complicações , Histoplasmose/cirurgia , Humanos , Degeneração Macular/complicações , Degeneração Macular/cirurgia , Observação , Procedimentos Cirúrgicos Oftalmológicos , Fatores de Risco , Acuidade Visual/fisiologia
16.
Optom Vis Sci ; 86(6): 741-747, 2009 06.
Artigo em Inglês | MEDLINE | ID: mdl-19430326

RESUMO

PURPOSE: To investigate myopia progression in Correction of Myopia Evaluation Trial (COMET) participants who switched to soft contact lenses (CLs) vs. remained in spectacles after the clinical trial ended. METHODS: Four hundred sixty-nine ethnically diverse, 6- to 11-year-old myopic children were randomly assigned to wear single vision lenses (SVLs) or progressive addition spectacle lenses (PALs) for 5 years as part of COMET. Afterwards they could choose another lens type, including CLs. Data in this article are from 286 participants who wore their original spectacle lenses for 6 years (n = 199) or wore CLs most or all the time between the 5- and 6-year visits (n = 87). Refractive error and axial length (AL) were measured after cycloplegia with 1% Tropicamide. The primary outcome was myopia progression between the 5- and 6-year visits. Two-year myopia progression was evaluated in a subset of 183 participants who wore the same lens type for an additional year. Myopia progression and AL were compared between the two lens groups using multiple linear regression. RESULTS: Participants in the two groups were similar with respect to age, ethnicity, myopia at 5-years, accommodation and phoria, but more girls switched to CLs than remained in spectacles (p < 0.0001). Mean (+/-SD) myopia progression was higher (p = 0.003) after 1 year in the CL group[-0.28+/- 0.33 diopter (D)] than the spectacle group (-0.14+/- 0.36 D), and remained higher after 2 years in the 2-year subset (-0.52+/- 0.46 D vs.-0.25+/- 0.39 D, p < 0.0001). Results were similar after adjustment for related factors. No significant differences in AL were found between groups after adjustment. Corneal curvature remained unchanged in both groups. CONCLUSIONS: COMET children switching from glasses to CLs experienced a small, statistically significant but clinically inconsequential increase in myopia progression.

17.
Ophthalmic Epidemiol ; 14(4): 230-7, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17896302

RESUMO

PURPOSE: To evaluate factors associated with the development of high myopia (worse than -6.00 D) over 7 years of follow-up in the COMET cohort. METHODS: COMET enrolled 469 ethnically diverse children (6-11 years) with myopia between -1.25 and -4.50 D. They were randomized to either progressive addition lenses (PALs) or single vision lenses (SVLs), and followed for 5 years in their original lens assignment and 2 additional years wearing either spectacles (PALs or SVLs) or contact lenses. Refractive error was measured annually by cycloplegic autorefraction and axial length by A-Scan ultrasonography. Myopia for each child was defined as the mean spherical equivalent refractive error (SER) of the 2 eyes. Analyses were based on 7 years of follow-up. Time to high myopia was analyzed by Cox proportional hazard models and linear regression. Parental refraction data were available from 240 COMET subjects. RESULTS: Younger (6-7 years) versus older (11 years) age at baseline was a significant risk factor (adjusted hazard ratio (HR) = 6.6, 95% CI = 3.4, 12.7) for having high myopia within 7 years. More (SER from -2.26 to -4.50 D) vs. less (SER from -1.25 to -2.25 D) baseline myopia was also a significant risk factor for high myopia at 7 years (adjusted HR = 7.4, 95% CI = 4.4, 12.4). Gender, ethnicity, and treatment assignment were not associated with the risk of high myopia within 7 years. Increased number of myopic parents was associated with a significant risk of high myopia in the children (p = 0.008). CONCLUSIONS: Children who developed high myopia during 7 years of follow-up were younger and had more myopia at baseline. They also were more likely to have two myopic parents. These children may be at greater risk for sight-threatening conditions later in life.


Assuntos
Óculos , Miopia Degenerativa/etiologia , Miopia Degenerativa/terapia , Criança , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
18.
Ophthalmology ; 114(11): 1965-72, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17628686

RESUMO

PURPOSE: To determine progression factors at the end of the Early Manifest Glaucoma Trial (EMGT) based on all EMGT patients and evaluate separately patients with higher and lower baseline intraocular pressure (IOP; median split). DESIGN: Cohort of clinical trial participants. PARTICIPANTS: Patients with early open-angle glaucoma randomized to argon laser trabeculoplasty plus betaxolol (n = 129) or no immediate treatment (n = 126), examined every 3 months for up to 11 years. METHODS: Cox proportional hazard analyses, expressed by hazard ratios (HRs) and 95% confidence intervals (CIs). MAIN OUTCOME MEASURE: Time to progression, defined by perimetric and photographic disc criteria. RESULTS: Overall progression was 67% when follow-up ended (median, 8 years). Treatment approximately halved progression risk (HR, 0.53; 95% CI, 0.39-0.72); results were similar for patients with higher and lower baseline IOP (HRs, 0.41 and 0.55). Baseline progression factors (HRs, 1.51-2.12; P<0.01) were higher IOP, exfoliation, bilateral disease, and older age, as previously reported. New baseline predictors were lower ocular systolic perfusion pressure in all patients (< or =160 mmHg; HR, 1.42; 95% CI, 1.04-1.94), cardiovascular disease history (HR, 2.75; 95% CI, 1.44-5.26) in patients with higher baseline IOP, and lower systolic blood pressure (BP) (< or =125 mmHg; HR, 0.46; 95% CI, 0.21-1.02) in patients with lower baseline IOP. Postbaseline progression factors were IOP levels at follow-up, with 12% to 13% average increase per millimeter of mercury in all patients (HRs, 1.12-1.13 per mmHg higher) and similar results in patients with higher and lower baseline IOP (HRs, 1.15 and 1.13 per mmHg higher). Disc hemorrhages (HR, 1.02; 95% CI, 1.01-1.03 per percent higher frequency) also predicted progression. Thinner central corneal thickness (CCT) (HR, 1.25; 95% CI, 1.01-1.55 per 40 microm lower) was a new significant factor, a result observed in patients with higher baseline IOP (HR, 1.42; 95% CI, 1.05-1.92 per 40 microm lower) but not lower baseline IOP, with significant IOP-CCT interaction. CONCLUSIONS: Treatment and follow-up IOP continued to have a marked influence on progression, regardless of baseline IOP. Other significant factors were age, bilaterality, exfoliation, and disc hemorrhages, as previously determined. Lower systolic perfusion pressure, lower systolic BP, and cardiovascular disease history emerged as new predictors, suggesting a vascular role in glaucoma progression. Another new factor was thinner CCT, with results possibly indicating a preferential CCT effect with higher IOP.


Assuntos
Anti-Hipertensivos/uso terapêutico , Betaxolol/uso terapêutico , Glaucoma de Ângulo Aberto/fisiopatologia , Glaucoma de Ângulo Aberto/terapia , Trabeculectomia , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Doenças Cardiovasculares/fisiopatologia , Terapia Combinada , Progressão da Doença , Hemorragia Ocular/fisiopatologia , Feminino , Seguimentos , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Óptico/fisiopatologia , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores de Tempo
19.
Invest Ophthalmol Vis Sci ; 48(2): 562-70, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17251451

RESUMO

PURPOSE: The present study investigated the relationship between parental refractive error and myopia progression in their offspring and the interaction between parental ametropia and the effects of wearing progressive-addition (PALs) or single-vision (SVLs) lenses on the progression of myopia in children enrolled in the Correction of Myopia Evaluation Trial (COMET). METHODS: The progression of myopia in a subset of COMET children (N= 232; 49% of initial group) was defined as the difference in mean spherical equivalent refraction of both eyes obtained by cycloplegic autorefraction between the baseline and 5-year visit. Parental refractions were obtained by noncycloplegic autorefraction (81%) or from recent eye examination records (19%). RESULTS: The number of myopic parents (mean spherical equivalent refraction

Assuntos
Filho de Pais Incapacitados , Óculos , Miopia/fisiopatologia , Miopia/terapia , Pais , Acomodação Ocular/fisiologia , Adulto , Criança , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prescrições , Refração Ocular/fisiologia , Acuidade Visual/fisiologia
20.
Arch Ophthalmol ; 124(2): 226-38, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16476893

RESUMO

OBJECTIVE: To describe health- and vision-targeted quality of life following treatment with iodine 125 brachytherapy vs enucleation for choroidal melanoma in a subgroup of patients who were treated and observed prospectively as part of a large randomized clinical trial. MAIN OUTCOME MEASURES: Difficulty with driving, near vision activities, and activities using stereopsis or binocularity; anxiety; and depression. PARTICIPANTS: Two hundred nine patients who enrolled in the Collaborative Ocular Melanoma Study trial for medium-sized tumors between March 1995 and July 1998 and gave informed consent prior to randomization to participation in an ancillary study of quality of life. METHODS: Patients were interviewed by telephone by a trained interviewer from the Collaborative Ocular Melanoma Study Coordinating Center at baseline (prior to randomization), at 6 months, and on annual anniversaries of enrollment. The questionnaire battery included the Medical Outcomes Study Short Form 36, the Activities of Daily Vision Scale, the National Eye Institute Visual Function Questionnaire, and the Hospital Anxiety and Depression Scale. Additional questions concerning satisfaction with posttreatment appearance and concerns about cancer recurrence also were included in posttreatment interviews. RESULTS: There was a significant increase in both treatment groups in levels of reported difficulty for most vision-oriented activities, and in bodily and ocular pain, 6 months following treatment. Differences in visual function between treatment groups reported during follow-up were relatively small, but significant differences favoring brachytherapy-treated patients were observed for driving during the first year of follow-up and for peripheral vision during the first 2 years of follow-up. Anxiety levels in both groups decreased significantly following treatment, but patients treated with brachytherapy with symptoms of anxiety were less likely to report later resolution of symptoms than patients with symptoms of anxiety who were treated with enucleation. This study was unable to assess impact of treatment on satisfaction with appearance and concern about cancer recurrence during the first year after treatment, but no treatment-related differences were found on these measures at 2 years and later follow-up times. CONCLUSIONS: Patients treated with brachytherapy reported significantly better visual function than patients treated with enucleation with respect to driving and peripheral vision for up to 2 years following treatment. Differences between treatments in visual function diminished by 3 to 5 years posttreatment, paralleling decline in visual acuity in brachytherapy-treated eyes. Patients treated with brachytherapy were more likely to have symptoms of anxiety during follow-up than patients treated with enucleation. APPLICATION TO CLINICAL PRACTICE: Given that no significant differences in survival between enucleation and brachytherapy have been found, the differences demonstrated here for driving and anxiety will allow the individual patient and physician to make informed choices regarding treatment based on personal preferences.


Assuntos
Braquiterapia/métodos , Neoplasias da Coroide/terapia , Enucleação Ocular , Radioisótopos do Iodo/uso terapêutico , Melanoma/terapia , Qualidade de Vida , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/fisiopatologia , Condução de Veículo , Neoplasias da Coroide/radioterapia , Neoplasias da Coroide/cirurgia , Depressão/fisiopatologia , Percepção de Profundidade/fisiologia , Feminino , Nível de Saúde , Humanos , Masculino , Melanoma/radioterapia , Melanoma/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Perfil de Impacto da Doença , Visão Binocular/fisiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA