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1.
Eur J Neurol ; 27(2): 343-351, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31535427

RESUMO

BACKGROUND AND PURPOSE: The rate at which the chance of a good outcome of endovascular stroke therapy (EVT) decays with time when eligible patients are selected by baseline diffusion-weighted magnetic resonance imaging (DWI-MRI) and whether ischaemic core size affects this rate remain to be investigated. METHODS: This study analyses a prospective multicentre registry of stroke patients treated with EVT based on pretreatment DWI-MRI that was categorized into three groups: small [Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS)] (8-10), moderate (5-7) and large (<5) cores. The main outcome was a good outcome at 90 days (modified Rankin Scale 0-2). The interaction between onset-to-groin puncture time (OTP) and DWI-ASPECTS categories regarding functional outcomes was investigated. RESULTS: Ultimately, 985 patients (age 69 ± 11 years; male 55%) were analysed. Potential interaction effects between the DWI-ASPECTS categories and OTP on a good outcome at 90 days were observed (Pinteraction  = 0.06). Every 60-min delay in OTP was associated with a 16% reduced likelihood of a good outcome at 90 days amongst patients with large cores, although no associations were observed amongst patients with small to moderate cores. Interestingly, the adjusted rates of a good outcome at 90 days steeply declined between 65 and 213 min of OTP and then remained smooth throughout 24 h of OTP (Pnonlinearity  = 0.15). CONCLUSIONS: Our study showed that the probability of a good outcome after EVT nonlinearly decreased, with a steeper decline at earlier OTP than at later OTP. Discrepant effects of OTP on functional outcomes by baseline DWI-ASPECTS categories were observed. Thus, different strategies for EVT based on time and ischaemic core size are warranted.

2.
Clin Toxicol (Phila) ; 58(2): 117-123, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31092050

RESUMO

Background: Prepacked naloxone kits (PNKs) are frequently used to reverse opioid intoxication. It is unknown if the presence of illicitly manufactured fentanyl and its analogs (IMFs) in heroin supply is affecting the PNK doses given by laypersons. We investigated the trend of PNK dose administered to reverse opioid toxicity in suspected/undifferentiated opioid intoxication.Methods: We retrospectively reviewed PNK administrations reported to the Maryland Poison Center between 1 January 2015 and 15 October 2017. Primary outcome was the mean PNK dose administered to reverse opioid-induced central nervous system and ventilatory depression. Secondary outcomes included the reversal rate of opioid toxicity, patient disposition, and survival rate.Results: Our analysis involved 1139 PNK administrations. The mean age of subjects was 34.3 years; 68.8% (n = 781) were male. Ventilatory depression was present in 98.2% (n = 958) of cases, and 97% (n = 1097) were unresponsive. Law enforcement administered the majority of PNK (91.0%; n = 1035); the primary route was intranasal (97.9%; n = 1051). Toxicity was reversed in 79.2% (n = 886) of overdose victims after a mean PNK dose of 3.12 mg. EMS personnel gave 291 subjects additional naloxone (mean: 2.2 mg), reversing opioid toxicity in 94.2% (n = 254). Between 2015 and 2017, the mean PNK dose increased from 2.12 to 3.63 mg (p < .0001) while the reversal rate decreased from 82.1% to 76.4% (p = .04). One hundred and eighty-two patients (15.9%) refused transport; of those transported to a hospital, 73.4% (n = 569) were treated and released and 12.4% (n = 96) required hospitalization. Ninety-six percent (n = 1092) of the subjects survived. Forty subjects were pronounced dead at the scene. Fentanyl or its analog was detected in 36 of 55 opioid-related deaths (65.5%).Conclusions: PNK administration reversed toxicity in the majority of patients with undifferentiated opioid intoxication. Between 2015 and 2017, increasing doses of PNK were administered but the reversal rate decreased. These trends are likely multifactorial, including increasing availability of IMFs.

3.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(12): 963-968, 2019 Dec 24.
Artigo em Chinês | MEDLINE | ID: mdl-31877591

RESUMO

Objective: To evaluate the efficacy and safety of nifekalan (NIF) on cardioversion in atrial fibrillation (AF) patients post radiofrequency ablation, and investigate the relevant factors related to the cardioversion efficacy of NIF. Methods: We screened patients with sustained AF rhythm after radiofrequency ablation between November 2016 and July 2018. Participants were treated with intravenous NIF 0.4 mg/kg within 5-10 minutes after ablation. We observed the adverse reaction, and monitored the rhythm, heart rate, QT interval and QTc interval before the medication and at 5, 10, 20, 120 min after the medication. According to the drug outcome of NIF, patients were divided into conversion group and non-conversion group, related factors affecting conversion efficacy were evaluated using logistic regression analysis. Results: (1)A total of 116 patients were enrolled in the study (63 males and 53 females, mean age was (64±18) years). Among them, 72 patients were converted to sinus rhythm, and the overall successful rate was 62.1%. There were 84 patients with persistent AF, of which 50 cases (59.2%) were restored to sinus rhythm. There were 32 patients with paroxysmal AF, 22 cases (68.8%) of them were restored to sinus rhythm. The conversion time was 1.5 to 12 (6.8±3.4)min. (2) In 116 patients, the QT interval and QTc interval were significantly longer after medication than before the drug administration (P<0.01), and peaked at about 10th min, and restored to the level before drug administration at about 120th min. (3) There were 8 cases of bradycardia (6.9%), 3 cases of frequent and short ventricular tachycardia (2.6%). (4) The duration of atrial fibrillation was shorter and left atrial diameter was smaller in the cardioversion group than in the non-cardioversion group (both P<0.05). There were no significant differences in gender, disease history, atrial fibrillation type and structural heart disease between the two groups (P>0.05). (5) Multifactorial logistic regression analysis showed that the duration of atrial fibrillation (OR=0.980, 95%CI 0.966-0.994, P=0.004) and the left atrial diameter (OR=0.888, 95%CI 0.814-0.967, P=0.007) were the factors that influence the cardioversion efficacy of NIF on atrial fibrillation post ablation. Conclusions: The total effective rate of NIF was 62.1% in patients witrh sustained AF post radiofrequency ablation, was 68.8% in patients with paroxysmal AF. Besides, NIF has the advantage of short conversion time and few adverse reactions. Left atrium diameter and AF duration were relevant factors that influence the efficacy of NIF of cardioversion in patients with sustained AF after radiofrequency ablation.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/cirurgia , Cardioversão Elétrica , Feminino , Átrios do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
4.
J Child Orthop ; 13(5): 438-444, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31695810

RESUMO

Purpose: The purpose of this study was to explore whether increasing the hip abduction angle would increase the incidence of avascular necrosis (AVN) in patients with late- detected developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization. Methods: A total of 55 patients (59 hips) with late-detected DDH underwent MRI after CR. Hip abduction angle and hip joint distance were measured on postoperative MRI transverse sections. The acetabular index and centre-edge angle were measured on plain radiographs at the last follow-up. The presence of AVN according to Kalamchi and McEwen's classification was assessed. We retrospectively analyzed the associations among abduction angles, hip joint distances, radiographic parameters, AVN and final outcomes, exploring the relationship between hip joint abduction angle and AVN rate. Results: The mean age at the time of CR was 14.4 months SD 5.5 (6 to 28), and the mean follow-up was 26.2 months SD 8.1 (12.4 to 41.7). The mean hip abduction angle was 70.2° SD 7.2° (53° to 85°) on the dislocated side and 63.7° SD 8.8° (40° to 82°) on the normal side; the mean hip joint distance was 5.1 mm SD 1.9 (1.3 to 9.1) on the dislocated side and 2.2 mm SD 0.6 on the normal side (1.3 to 3.3). Eight of 59 hips (13.6%) developed AVN. Neither the amount of abduction nor hip joint distance increased the AVN rate (p = 0.97 and p = 0.65, respectively) or the dislocation rate (p = 0.38 and p = 0.14, respectively). Conclusion: Abduction angle up to 70.2° following CR did not increase the AVN rate in children aged six to 28 months with late-detected DDH treated by CR. Level of evidence: III.

5.
Clin Toxicol (Phila) ; : 1-6, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31617764

RESUMO

Background: Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilized to treat severe or refractory drug-induced cardiovascular shock. There is limited evidence regarding VA-ECMO's clinical utility in poisoning. Therefore, we investigated the clinical benefit of VA-ECMO use in drug-induced cardiovascular shock using the Extracorporeal Life Support Organization (ELSO)'s ECMO case registry. Methods: The ELSO registry was systematically searched retrospectively, using ICD-9/10 codes for poisoning-related cases from January 1, 2003 to July 30, 2018. All adult cases (age ≥ 18 years) that received VA-ECMO for cardiac support were included. Cardiogenic shock was defined as systolic blood pressure (SBP) <90 mmHg, mean arterial pressure (MAP) <65 mmHg, or requiring infusion of ≥2 vasopressor agents. Study outcomes included survival to discharge (i.e., from the ECMO center), changes in metabolic (acid/base), hemodynamic and ventilatory status, and complications related to ECMO support. Demographic and clinical characteristics of pre-ECMO and 24-h after VA-ECMO cannulation were compared between survivors vs. non-survivors. Results: A total of 113 cases were identified from the ELSO registry; 9 cases were excluded because cardiogenic shock was not related to poisoning, leaving 104 cases for analysis. The median age was 34 years and 53.5% (n = 54) were male. Cardiovascular agents were involved in 47.1% (n = 49) of the cases followed by opioids (n = 9, 6.7%); 34 cases experienced pre-ECMO cardiac arrest. About 92.4% of the cases (n = 85) received vasopressor infusion for hemodynamic support, most frequently norepinephrine (83.7%). Median duration of VA-ECMO was 68 h (interquartile range [IQR]: 48, 113 h); 52.9% (n = 55) of the cases survived to discharge. VA-ECMO significantly improved hemodynamics (MAP, SBP, and DBP), acidemia/acidosis (pH, HCO3 level) and ventilatory parameters (pO2, SpO2, and SvO2). Non-survivors showed persistent acidemia/acidosis at 24-h after VA-ECMO cannulation compared to survivors. Renal replacement therapy (50.9%) and arrhythmia (26.3%) were the most frequently reported complications. Conclusions: VA-ECMO improved hemodynamic and metabolic parameters in patients with drug-induced cardiogenic shock (DCS).

6.
PLoS One ; 14(10): e0223416, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31584977

RESUMO

Spleen stromal lines which support in vitro hematopoiesis are investigated for their lineage origin and hematopoietic support function in vivo. Marker expression and gene profiling identify a lineage relationship with mesenchymal stem cells and perivascular reticular cells described recently in bone marrow. Stromal lines commonly express Cxcl12, Pdgfra and Pdgfr typical of bone marrow derived perivascular reticular cells but reflect a unique cell type in terms of other gene and marker expression. Their classification as osteoprogenitors is confirmed through ability to undergo osteogenic, but not adipogenic or chondrogenic differentiation. Some stromal lines were shown to form ectopic niches for HSCs following engraftment under the kidney capsule of NOD/SCID mice. The presence of myeloid cells and a higher representation of a specific dendritic-like cell type over other myeloid cells within grafts was consistent with previous in vitro evidence of hematopoietic support capacity. These studies reinforce the role of perivascular/perisinusoidal reticular cells in hematopoiesis and implicate such cells as niches for hematopoiesis in spleen.

7.
J Pediatr Endocrinol Metab ; 32(10): 1155-1162, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31490774

RESUMO

Background Both psychosocial and socioeconomic risk factors contribute to poor glycemic control (GC). Previous research has identified that diabetes care behaviors are generally 'set' by late childhood, further highlighting the importance of psychosocial screening and intervention in the early course of disease management. The purpose of the current study was to determine whether this brief risk assessment tool is associated with GC and acute health care (HC) utilization, and to evaluate the discriminatory utility of the tool for predicting poor outcomes. Methods This was a retrospective cohort design in which we compared risk assessment scores with health outcomes at 6, 12, and 18 months after new-onset type 1 diabetes diagnosis for 158 patients between 2015 and 2017. The two primary outcome variables were GC and acute HC utilization. Results Our data demonstrate that the greatest utility of the tool is for predicting increased acute HC utilization. It was most useful in differentiating between patients with vs. without any acute HC utilization, with excellent discriminatory ability (area under the receiver operator characteristic curve [AUC] = 0.93), sensitivity (90%), and specificity (97%). Conclusions Knowledge of the risk category in addition to identification of individual risk factors within each domain allows for not only clear treatment pathways but also individualized interventions. The risk assessment tool was less effective at differentiating patients with poor GC; however, the tool did have high specificity (83%) for predicting poor GC at 18 months which suggests that the tool may also be useful for predicting patients at risk for poor GC.

8.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(4): 615-622, 2019 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-31420610

RESUMO

OBJECTIVE: To construct the prognostic model and identify the prognostic biomarkers based on long non-coding RNA (lncRNA) in bladder cancer. METHODS: The lncRNA expression data and corresponding clinical data of bladder cancer were collected from The Cancer Genome Atlas (TCGA) database. The software Perl and R, and R packages were used for data integration, extraction, analysis and visualization. Detailly, R package "edgeR" was utilized to screen differentially expressed lncRNA in bladder cancer tissues compared with the normal bladder samples. The univariate Cox regression and the least absolute shrinkage and selection operator (Lasso) regression were performed to identify key lncRNA that were utilized to construct the prognostic model by the multivariate Cox regression. According to the median value of the risk score, all patients were divided into the high-risk group and low-risk group to perform the Kaplan-Meier (K-M) survival curves, receiver operating characteristic (ROC) curve and C-index, estimating the prognostic power of the prognostic model. In addition, the hazard ratio (HR) and 95% confidence interval (CI) of each key lncRNA were also calculated by the multivariate Cox regression. Moreover, we performed the K-M survival analysis for each significant key lncRNA from the result of the multivariate Cox regression. RESULTS: A total of 691 lncRNA were identified as differentially expressed lncRNA, and 35 lncRNA signatures were initially considered associated with the prognosis of bladder cancer, where in 23 lncRNA were identified as key lncRNA associated with the prognosis. The overall survival time in years of the low-risk group was obviously longer than that of the high-risk group [(2.85±2.72) years vs. (1.58±1.51) years, P<0.001]. The area under the ROC curve (AUC) was 0.813 (3-year survival) and 0.778 (5-year survival) respectively, and the C-index was 0.73. In addition, HR and 95%CI of each key lncRNA were calculated by the multivariate Cox regression and 11 lncRNA were significant. Furthermore, K-M survival analysis revealed the independent prognostic value of 3 lncRNA, including AL589765.1 (P=0.004), AC023824.1 (P=0.022)and PKN2-AS1 (P=0.016). CONCLUSION: The present study successfully constructed the prognostic model based on the expression level of 23 lncRNA and finally identified one protective prognostic biomarker AL589765.1, and two adverse prognostic biomarkers including AC023824.1 and PKN2-AS1 in bladder cancer.


Assuntos
Neoplasias da Bexiga Urinária , Biomarcadores Tumorais , Biologia Computacional , Regulação Neoplásica da Expressão Gênica , Humanos , Prognóstico , RNA Longo não Codificante , Neoplasias da Bexiga Urinária/genética
9.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(4): 632-635, 2019 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-31420613

RESUMO

OBJECTIVE: To summarizes the intratesticular condition of azoospermia patients, to understand azoospermia more intuitively, and improve the ability of clinical doctors to predict the success rate of microsperm extraction in azoospermia patients. METHODS: Azoospermia patients (excluding Klinefelter's syndrome) who underwent a micro-TESE during January 2014 and January 2018 in a single center were enrolled. The types of seminiferous tubules were summarized, and the clinical characteristics of different types of seminiferous tubules compared with the success rates of sperm extraction. In this study, 472 cases of non-obstructive azoospermia (excluding Klinefelter's syndrome) were analyzed by SPSS 21.0 software package. Relevant data were expressed by median(minimum,maximum).t-test was used to compare the difference of success rate of sperm extraction between each group and the group with the lowest rate (a type). RESULTS: The 472 patients with non-obstructive azoospermia underwent micro-TESE. The mean age of the patients was 31 (23, 46) years, the mean testicular size was 10 (1, 20) mL, the mean FSH was 15.4 (1.21, 68.4) IU/L, the mean T was 8.34 (0.69, 30.2) nmol/L, and totally 202 patients achieved success in micro-TESE (42.7%, 202/472). According to the seminiferous tubules seen during the operation, they were divided into the following six types: Class a, seminiferous tubules developed well and uniformly; Class b, seminiferous tubules developed well, occasionally slightly thick; Class c, seminiferous tubules were generally thin; Class d, seminiferous tubules basically atrophied, occasionally well-developed seminiferous tubules; Class e, all seminiferous tubules atrophied; Class f, seminiferous tubules were infiltrated by yellow substances. The success rate of micro-TESE varied greatly among different types of the patients. A total of 78 patients with type a were 29 (24, 40) years old, FSH 11.1 (1.21, 15.8) IU/L, T 10.2 (3.29, 26.5) nmol/L), and testicular size 12 (12, 20) mL. The successful rate of sperm extraction was 6.41%; 82 patients with type b were 31 (23, 42) years old, FSH 13.8 (3.23, 19.6) IU/L, T 9.44 (3.58, 30.2) nmol/L), and testicular size 12(8,15) mL. The successful rate of sperm extraction was 74.39%; There were 162 patients in group c, aged 31 (25, 40), FSH 19.6 (9.28, 26.6) IU/L, T 8.75 (5.66, 18.6) nmol/L, and testicular size 8 (5, 12) mL. The successful rate of sperm extraction was 45.06%. There were 36 patients in group d, aged 25 (23,38) years and FSH 28.5 (19.3, 45.6) IU/L, T 6.52 (2.12, 9.83) nmol/L, and testicular size 5 (3, 8) mL, and the success rate of sperm extraction was 94.44%. 26 patients with type e were 28(23, 46) years old, FSH 31.3 (18.5, 68.4) IU/L, T 6.72 (0.69, 18.2) nmol/L, and testicular size 5 (1, 8) mL. The success rate of sperm extraction was 45.38%. 88 patients with type f were 29 (24, 38) years old, FSH 18.5 (5.23, 31.6) IU / L, T 8.32 (3.58, 16.5) nmol/L, and testicular size 12 (6, 20) mL. The success rate of sperm extraction was 28.41%. CONCLUSION: The success rate of micro-TESE in different types of seminiferous tubules in testis can be helpful to the judgement of the surgeon during the operation.


Assuntos
Azoospermia , Testículo , Adulto , Dissecação , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação Espermática , Espermatozoides , Adulto Jovem
10.
J Biophotonics ; 12(11): e201900098, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31240872

RESUMO

Corneal transplantation by full-thickness penetrating keratoplasty with human donor tissue is a widely accepted treatment for damaged or diseased corneas. Although corneal transplantation has a high success rate, a shortage of high-quality donor tissue is a considerable limitation. Therefore, bioengineered corneas could be an effective solution for this limitation, and a decellularized extracellular matrix comprises a promising scaffold for their fabrication. In this study, three-dimensional bioprinted decellularized collagen sheets were implanted into the stromal layer of the cornea of five rabbits. We performed in vivo noninvasive monitoring of the rabbit corneas using swept-source optical coherence tomography (OCT) after implanting the collagen sheets. Anterior segment OCT images and averaged amplitude-scans were acquired biweekly to monitor corneal thickness after implantation for 1 month. The averaged cornea thickness in the control images was 430.3 ± 5.9 µm, while the averaged thickness after corneal implantation was 598.5 ± 11.8 µm and 564.5 ± 12.5 µm at 2 and 4 weeks, respectively. The corneal thickness reduction of 34 µm confirmed the biocompatibility through the image analysis of the depth-intensity profile base. Moreover, hematoxylin and eosin staining supported the biocompatibility evaluation of the bioprinted decellularized collagen sheet implantation. Hence, the developed bioprinted decellularized collagen sheets could become an alternative solution to human corneal donor tissue, and the proposed image analysis procedure could be beneficial to confirm the success of the surgery.

11.
J Vasc Interv Radiol ; 30(9): 1407-1417, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31036460

RESUMO

The presence of branching vessels, a wide aneurysm neck, and/or fusiform morphology represents a challenge to conventional endovascular treatment of visceral artery aneurysms. A variety of techniques and devices have emerged for the treatment of intracranial aneurysms, in which more aggressive treatment algorithms aimed at smaller and morphologically diverse aneurysms have driven innovation. Here, modified neurointerventional techniques including the use of compliant balloons, scaffold- or stent-assisted coil embolization, and flow diversion are described in the treatment of visceral aneurysms. Neurointerventional devices and their mechanisms of action are described in the context of their application in the peripheral arterial system.

12.
J Appl Microbiol ; 127(2): 565-575, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31102489

RESUMO

AIMS: To observe the therapeutic effects of vaginal infusion of probiotic Clostridium butyricum WZ001 on bacterial vaginosis (BV) in mice. METHODS AND RESULTS: Female ICR mice were used to establish the model of BV by infecting oestrogen-treated mice with Escherichia coli, and then treated with high- and low dose of C. butyricum. Clinical indexes of mice in the C. butyricum-treated groups were significantly improved and comparable to those in the antibiotic group. Pap staining showed that neutrophil count was significantly increased after modelling and largely decreased after C. butyricum treatment (P < 0·01). Dynamic observation of E. coli and Lactobacillus showed that the number of E. coli significantly decreased in the C. butyricum-treated groups or in the antibiotic group with prolonged treatment (P < 0·01). Besides, the number of E. coli in the low-dose C. butyricum group was higher than that in either its high-dose counterpart or the antibiotic group respectively (P < 0·01). The number of Lactobacillus decreased evidently in the antibiotic group (P < 0·01), while that in the C. butyricum groups remained consistent. Moreover, C. butyricum inhibited the proliferation of E. coli by the experiment in vitro. The phosphorylation of nuclear factor-kappa B (NF-κB) p65 in vaginal tissue and the serum levels of inflammatory cytokines, IL-1ß, TNF-α and IL-6, increased after modelling and significantly decreased after treated with C. butyricum (P < 0·01), with no difference found when compared with the antibiotic group. CONCLUSION: Clostridium butyricum inhibits the growth of pathogenic bacteria as well as the inflammatory response induced by E. coli and promotes the growth of Lactobacillus to maintain the vaginal micro-ecological balance. SIGNIFICANCE AND IMPACT OF THE STUDY: Our results suggest that probiobitc C. butyricum WZ001 has a great potential in the clinical treatment of BV.


Assuntos
Clostridium butyricum , Infecções por Escherichia coli/terapia , Probióticos/uso terapêutico , Vaginose Bacteriana/terapia , Animais , Citocinas/sangue , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/imunologia , Infecções por Escherichia coli/metabolismo , Infecções por Escherichia coli/microbiologia , Feminino , Lactobacillus/isolamento & purificação , Camundongos , Camundongos Endogâmicos ICR , Fator de Transcrição RelA/metabolismo , Vagina/metabolismo , Vagina/microbiologia , Vaginose Bacteriana/imunologia , Vaginose Bacteriana/metabolismo , Vaginose Bacteriana/microbiologia
13.
Tech Coloproctol ; 23(4): 315-324, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31011846

RESUMO

BACKGROUND: Perhaps partly because intussusception in adults is rare, optimal treatment remains controversial. The aim of this study was to determine the appropriate surgical procedure for adult intussusception. METHODS: A systematic search was undertaken using PubMed, Embase, and Web of Science from 1/1980 to 12/2016. Adults (> 15 years) with intussusception treated by surgical or conservative measures were included. RESULTS: One thousand two hundred twenty-nine patients were identified from 40 retrospective case series. Pooled rates of malignant and benign tumors and idiopathic etiologies were 32.9% (95% CI 28.6-37.4), 37.4% (95% CI 32.7-42.3), and 15.1% (95% CI 11.7-19.3), respectively. Pooled rates of enteric, ileocolic, and colonic location types were 49.5% (95% CI 41.8-57.2), 29.1% (95% CI 23.0-36.1), and 19.9% (95% CI 16.3-24.1), respectively. Pooled rates of malignant tumors in enteric, ileocolic, and colonic intussusception were 22.5% (95% CI 18.3-27.3), 36.9% (95% CI 27.3-47.6), and 46.5% (31.1-62.6), respectively. Metastatic carcinoma was the main cause of malignant tumor in enteric intussusception. Conversely, primary adenocarcinoma was the main cause of malignant tumor in ileocolic and colonic intussusception. Considering the high rate of malignancy of colonic intussusception the majority of the studies surveyed recommend en bloc resection without reduction to avoid potential intraluminal seeding or venous tumor dissemination. Pooled rates of postoperative complications and mortality were 22.1% (95% CI 17.5-27.5) and 5.2% (95% CI 3.7-7.4), respectively. CONCLUSION: Whereas enteric intussusception can be managed by reduction followed by resection, colonic intussusception should be resected en bloc. Due to the intermediate forms between enteric and colonic intussusception, a selective approach is recommended. Surgery remains the mainstay in adult intussusception.


Assuntos
Doenças do Colo/cirurgia , Endoscopia Gastrointestinal/métodos , Intussuscepção/cirurgia , Adulto , Colo/patologia , Colo/cirurgia , Doenças do Colo/patologia , Colonoscopia/métodos , Feminino , Humanos , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Intussuscepção/patologia , Masculino
14.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(2): 365-368, 2019 Apr 18.
Artigo em Chinês | MEDLINE | ID: mdl-30996385

RESUMO

OBJECTIVE: The incidence of testicular tumors is relatively low which are mainly malignant, so the main way to treat testicular tumors is radical testicular resection. Testicular adenomatoid tumor is a rare testicular benign tumor, but is easily misdiagnosed as malignant tumors with removal of organs. This article aims to explore the clinical features of testicular adenomatoid tumor and its treatment. METHODS: There were 133 cases of testicular tumor in the Peking University Third Hospital from May 1994 to November 2016. We conducted a retrospective analysis of three patients who underwent the treatment of partial orchiectomy with preservation of the organ and were pathologically diagnosed with testicular adenomatoid tumor after surgery. The follow-up was done by outpatient clinics and telephone inquiry after surgery. The related literature was also reviewed for further discussion. RESULTS: Of all the 133 patients, 116 had radical resection of the testis and 17 had partial testicular resection due to specific reasons (5 cases of epidermoid cyst, 4 cases of teratoma, 3 cases of seminoma, 3 cases of adenomatoid tumor, and 2 cases of Sertoli cell tumor). The mean age of the 3 patients was (42.67±10.97) years (30-49 years), the mean hospital stay was (9.00±5.20) d (6-15 d), the mean body mass index was (26.20±1.42) kg/m2 (25.00-27.76 kg/m2), the mean serum human choionic gonadotophin (HCG) was (1.15±0.11) IU/L (1.07-1.23 IU/L) (all normal) and the mean serum alpha-fetoprotein (AFP) was (2.12±0.66) µg/L (1.65-2.58 µg/L) (both were normal). Ultrasound features revealed a clear or unclear border, solid, moderate echo nodule tumor in the testis. The mean maximal diameter of the tumor was (1.00±0.44) cm (0.50-1.30 cm), and the mean duration of intraoperative warm ischemia time was (19.67±17.10) min (0-31 min) (only the last two cases). No recurrence or malignant transformation was observed during the follow-up. CONCLUSION: Testicular adenomatoid tumor is mainly based on the characteristics of ultrasound to determine preoperatively, but easy to be misdiagnosed with testicular radical resection. The recommended surgery for adenomatoid tumor is partial resection of the testis via the inguinal approach according to the frozen section pathology to determine whether to retain the organ.


Assuntos
Tumor Adenomatoide , Neoplasias Testiculares , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos
15.
Expert Opin Drug Saf ; 18(6): 465-475, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31033357

RESUMO

INTRODUCTION: There has been an exponential increase in overdose fatalities as illicitly manufactured fentanyl and its analogs (IMF) are becoming more prevalent in the illicit drug supply. In response, overdose education and naloxone distribution (OEND) programs have been implemented throughout the United States as a harm reduction strategy. However, there are increasing reports that higher naloxone doses or repeat administration might be required for overdose victims involving IMF. AREAS COVERED: In this article, we provide a comprehensive review of the epidemiology, public health impact, and pharmacologic properties of IMF. The pharmacokinetic properties of currently available take-home naloxone (THN) kits, the role of THN as a harm reduction strategy and available data on its clinical use are discussed. Implications of occupational IMF exposure for first responders are also described. EXPERT OPINION: THN administration by a bystander is an effective harm reduction intervention. However, there is growing evidence that higher dose or multiple administrations of naloxone are required to fully reverse IMF related toxicity. Recently, the US Food and Drug Administration approved THN kits with a concentrated naloxone dose that produce high bioavailability. However, limited presence of OEND programs and cost of these new devices impede their accessibility to the general public.


Assuntos
Overdose de Drogas/tratamento farmacológico , Fentanila/envenenamento , Naloxona/administração & dosagem , Analgésicos Opioides/envenenamento , Animais , Overdose de Drogas/epidemiologia , Fentanila/análogos & derivados , Redução do Dano , Humanos , Naloxona/farmacocinética , Antagonistas de Entorpecentes/administração & dosagem , Antagonistas de Entorpecentes/farmacocinética , Transtornos Relacionados ao Uso de Opioides/complicações , Estados Unidos
16.
Bioessays ; 41(5): e1800234, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30970171

RESUMO

Bone marrow is the main site for hematopoiesis in adults. It acts as a niche for hematopoietic stem cells (HSCs) and contains non-hematopoietic cells that contribute to stem cell dormancy, quiescence, self-renewal, and differentiation. HSC also exist in resting spleen of several species, although their contribution to hematopoiesis under steady-state conditions is unknown. The spleen can however undergo extramedullary hematopoiesis (EMH) triggered by physiological stress or disease. With the loss of bone marrow niches in aging and disease, the spleen as an alternative tissue site for hematopoiesis is an important consideration for future therapy, particularly during HSC transplantation. In terms of harnessing the spleen as a site for hematopoiesis, here the remarkable regenerative capacity of the spleen is considered with a view to forming additional or ectopic spleen tissue through cell engraftment. Studies in mice indicate the potential for such grafts to support the influx of hematopoietic cells leading to the development of normal spleen architecture. An important goal will be the formation of functional ectopic spleen tissue as an aid to hematopoietic recovery following clinical treatments that impact bone marrow. For example, expansion or replacement of niches could be considered where myeloablation ahead of HSC transplantation compromises treatment outcomes.

17.
World Neurosurg ; 126: 513-527, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30898740

RESUMO

BACKGROUND: Despite decades of research, cerebral vasospasm (CV) continues to account for high morbidity and mortality in patients who survive their initial aneurysmal subarachnoid hemorrhage. OBJECTIVE: To define the scope of the problem and review key treatment strategies that have shaped the way CV is managed in the contemporary era. METHODS: A literature search was performed of CV management after aneurysmal subarachnoid hemorrhage. RESULTS: Recent advances in neuroimaging have led to improved detection of vasospasm, but established treatment guidelines including hemodynamic augmentation and interventional procedures remain highly variable among neurosurgical centers. Experimental research in subarachnoid hemorrhage continues to identify novel targets for therapy. CONCLUSIONS: Proactive and preventive strategies such as oral nimodipine and endovascular rescue therapies can reduce the morbidity and mortality associated with CV.


Assuntos
Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/terapia , Vasoespasmo Intracraniano/diagnóstico , Vasoespasmo Intracraniano/terapia , Animais , Isquemia Encefálica/complicações , Procedimentos Endovasculares/métodos , Humanos , Fármacos Neuroprotetores/uso terapêutico , Hemorragia Subaracnóidea/complicações , Vasoespasmo Intracraniano/complicações
18.
Intern Med J ; 49(3): 345-351, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30091271

RESUMO

BACKGROUND: Endovascular thrombectomy (EVT) for management of large vessel occlusion (LVO) acute ischaemic stroke is now current best practice. AIM: To determine if bridging intravenous (i.v.) alteplase therapy confers any clinical benefit. METHODS: A retrospective study of patients treated with EVT for LVO was performed. Outcomes were compared between patients receiving thrombolysis and EVT with EVT alone. Primary end-points were reperfusion rate, 90-day functional outcome and mortality using the modified Rankin Scale (mRS) and symptomatic intracranial haemorrhage (sICH). RESULTS: A total of 355 patients who underwent EVT was included: 210 with thrombolysis (59%) and 145 without (41%). The reperfusion rate was higher in the group receiving i.v. tissue plasminogen activator (tPA) (unadjusted odds ratio (OR) 2.2, 95% confidence interval (CI): 1.29-3.73, P = 0.004), although this effect was attenuated when all variables were considered (adjusted OR (AOR) 1.22, 95% CI: 0.60-2.5, P = 0.580). The percentage achieving functional independence (mRS 0-2) at 90 days was higher in patients who received bridging i.v. tPA (AOR 2.17, 95% CI: 1.06-4.44, P = 0.033). There was no significant difference in major complications, including sICH (AOR 1.4, 95% CI: 0.51-3.83, P = 0.512). There was lower 90-day mortality in the bridging i.v. tPA group (AOR 0.79, 95% CI: 0.36-1.74, P = 0.551). Fewer thrombectomy passes (2 versus 3, P = 0.012) were required to achieve successful reperfusion in the i.v. tPA group. Successful reperfusion (modified thrombolysis in cerebral infarction ≥2b) was the strongest predictor for 90-day functional independence (AOR 10.4, 95% CI:3.6-29.7, P < 0.001). CONCLUSION: Our study supports the current practice of administering i.v. alteplase before endovascular therapy.


Assuntos
Isquemia Encefálica/terapia , Acidente Vascular Cerebral/terapia , Trombectomia/métodos , Terapia Trombolítica/métodos , Doença Aguda , Administração Intravenosa , Idoso , Austrália/epidemiologia , Isquemia Encefálica/mortalidade , Terapia Combinada , Procedimentos Endovasculares/efeitos adversos , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Hemorragias Intracranianas/induzido quimicamente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/mortalidade , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento
19.
Transplant Proc ; 50(8): 2579-2580, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30316402

RESUMO

Focal segmental glomerulosclerosis (FSGS) is the most common form of post-transplant glomerulonephritis. We describe a case where a biopsy proved that early recurrence of FSGS on postoperative day 1 was the cause of delayed graft function. A 39-year-old man, on hemodialysis for 15 years due to polycystic kidney disease, received a cadaveric renal transplantation. On postoperative day 1, his hourly urine output decreased from 700-800 mL to 50 mL. The graft biopsy showed a mild acute kidney injury confusing nephrotic syndrome. On postoperative day 45, his creatinine level increased to 3.02 mg/dL with severe proteinuria. A kidney biopsy showed focal segmental glomerulosclerosis. On postoperative day 120, his creatinine level elevated again, concomitant with proteinuria. A kidney biopsy showed FSGS with antibody-mediated rejection. After plasmapheresis, his creatinine level decreased to 1.3 mg/dL with mild proteinuria. Once active in the allograft, de novo FSGS is a potentially aggressive process. In this case, it could be managed because of an accurate diagnosis and appropriate treatment.


Assuntos
Função Retardada do Enxerto/etiologia , Glomerulosclerose Segmentar e Focal/complicações , Glomerulosclerose Segmentar e Focal/diagnóstico , Rejeição de Enxerto/etiologia , Transplante de Rim/efeitos adversos , Adulto , Humanos , Masculino
20.
Proc Natl Acad Sci U S A ; 115(47): E11111-E11119, 2018 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-30297395

RESUMO

Staphylococcus aureus is the leading cause of skin and skin structure infection (SSSI), a primary portal of entry for invasive infection. Our prior studies discovered a role for protective innate memory against recurrent methicillin-resistant S. aureus (MRSA) SSSI. In the present study, the dynamics and mechanisms of this response were explored in recurrent SSSI in WT mice. Priming by prior infection reduced skin lesion severity and MRSA burden, and protected against dissemination at day 7 but not day 2. Cytokine and cellular signatures in SSSI differed at day 2 versus 7, and were distinct in skin versus blood or spleen. Cytokines associated with protection in skin included increased IL-17, IL-6, monokine inducible by IFN-γ (MIG), and RANTES, while increased IP-10 correlated with protection from dissemination. Cellular signatures of protection included increased Th17, M1 macrophage, and dendritic cell populations in abscesses, and total macrophages in lymph nodes. Priming potentiated S. aureus-specific phagocytic killing by bone marrow-derived macrophages in vitro, and their adoptive transfer into naïve skin afforded protective efficacy in vivo. Present findings indicate that protective immunity in recurrent S. aureus infection is locally targeted, and involves specific memory conferred by macrophages. These insights provide targets for vaccine and immunotherapeutic development against MRSA.


Assuntos
Imunidade Inata/imunologia , Memória Imunológica/imunologia , Macrófagos/imunologia , Macrófagos/transplante , Staphylococcus aureus Resistente à Meticilina/imunologia , Infecções Cutâneas Estafilocócicas/imunologia , Transferência Adotiva , Animais , Quimiocina CCL5/sangue , Quimiocina CXCL10/sangue , Células Dendríticas/imunologia , Modelos Animais de Doenças , Proteínas de Homeodomínio/genética , Interferon gama/sangue , Interleucina-17/sangue , Interleucina-6/sangue , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Infecções Cutâneas Estafilocócicas/microbiologia , Células Th17/imunologia
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