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1.
Acta Radiol ; : 284185120920806, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32380909

RESUMO

BACKGROUND: Quantitative evaluation of degeneration of the substantia nigra (SN) is important for early, pre-symptomatic diagnosis of Parkinson's disease (PD). Accordingly, a clinically feasible imaging and quantification technique are needed. PURPOSE: To investigate the T1 value of the SN in healthy individuals from phase-sensitive inversion recovery (PSIR) images and to clarify its correlation with the SN characteristics on neuromelanin (NM) images to identify an imaging biomarker for early diagnosis of PD. MATERIAL AND METHODS: T1-weighted and NM images of the SN from 32 healthy volunteers were obtained using PSIR and turbo spin-echo sequences. The contrast between the SN and cerebral peduncle (CP) and area of the SN were measured; the T1 values of the SN from PSIR images and relationships between the T1 value and age/SN area were evaluated. RESULTS: There was a significant negative correlation between age and the SN area obtained using PSIR imaging. The SN area on PSIR images (104.9 ± 20.9 mm2) was significantly larger than that on NM images (72.1 ± 14.9 mm2). There was a significant negative correlation between the SN area and the T1 value of the SN obtained from PSIR images. CONCLUSION: In healthy adults, the area and T1 value of the SN measured on PSIR images were different from those obtained from NM images. This suggests that PSIR imaging may help in the assessment of SN degeneration.

2.
Jpn J Radiol ; 38(6): 572-578, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32172468

RESUMO

PURPOSE: Because appendiceal diverticulitis (AD) has a high risk of perforation, precise diagnosis is important for patients with suspected acute appendicitis (AA). In this study, we aimed to reveal the characteristics of computed tomography (CT) images of AD. METHODS: CT images were comparatively analyzed in patients who underwent appendectomy and had histopathologically proved AD (n = 23) or AA (n = 365) to reveal specific findings of CT image for AD and determine sensitivity and specificity of CT for AD. RESULTS: Univariate analysis showed that maximal diameter of the appendix in AD was significantly smaller than that in AA. Multivariate analysis showed that saccular structure of the appendix wall, cecum or ascending colon diverticulum and peri-appendiceal or -cecal fluid collection were significant independent indicators of AD. Based on that saccular structure of the appendix wall which was the most important specific finding, the sensitivity and specificity of CT for AD were 48% and 99%, respectively. CONCLUSION: The saccular structure of the appendix wall, cecum or ascending colon diverticulum and peri-appendiceal or -cecal fluid collection in CT suggest AD in patients with suspected AA. The sensitivity and specificity of CT for diagnosing AD were 48% and 99%, respectively.

3.
Mol Cancer Res ; 18(4): 632-643, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31974290

RESUMO

The signaling lymphocytic activation molecule family 3 (SLAMF3) is a member of the immunoglobulin superfamily expressed on T, B, and natural killer cells and modulates the activation and cytotoxicity of these cells. SLAMF3 is also expressed on plasma cells from patients with multiple myeloma (MM), although its role in MM pathogenesis remains unclear. This study found that SLAMF3 is highly and constitutively expressed on MM cells regardless of disease stage and that SLAMF3 knockdown/knockout suppresses proliferative potential and increases drug-induced apoptosis with decreased levels of phosphorylated ERK protein in MM cells. SLAMF3-overexpressing MM cells promote aggressive myeloma behavior in comparison with cytoplasmic domain-truncated SLAMF3 (ΔSLAMF3) cells. SLAMF3 interacts directly with adaptor proteins SH2 domain-containing phosphatase 2 (SHP2) and growth factor receptor bound 2 (GRB2), which also interact with each other. SLAMF3 knockdown, knockout, ΔSLAMF3, and SHP2 inhibitor-treated MM cells decreased phosphorylated ERK protein levels. Finally, serum soluble SLAMF3 (sSLAMF3) levels were markedly increased in advanced MM. Patients with high levels of sSLAMF3 progressed to the advanced stage significantly more often and had shorter progression-free survival times than those with low levels. This study revealed that SLAMF3 molecules consistently expressed on MM cells transmit MAPK/ERK signals mediated via the complex of SHP2 and GRB2 by self-ligand interaction between MM cells and induce a high malignant potential in MM. Furthermore, high levels of serum sSLAMF3 may reflect MM disease progression and be a useful prognostic factor. IMPLICATIONS: SLAMF3 may be a new therapeutic target for immunotherapy and novel agents such as small-molecule inhibitors.

4.
World Neurosurg ; 134: 10-13, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31629133

RESUMO

BACKGROUND: Most plasmacytomas arise in the bone marrow (intramedullary), as part of multiple myeloma (MM). In contrast, extramedullary plasmacytoma without MM is rare, and plasmacytoma primarily occurring in the brain parenchyma is extremely rare. Clinical behaviors of primary plasmacytoma in the brain have remained unclear. We report a case of primary plasmacytoma in the cerebellum and review the literature. CASE DESCRIPTION: The patient was a 33-year-old woman, displaying vertigo and peripheral facial nerve palsy. A tumor was identified in the subcortical white matter of the middle-upper cerebellum. Magnetic resonance imaging showed no specific findings for this lesion. Tumor was surgically resected because of aggressive tumor growth. Pathologic diagnosis of the tumor was plasmacytoma. The patient was treated with irradiation to the tumor bed after surgery. Although histology of the bone marrow showed a few atypical plasma cells (1%-2%), below the threshold of the diagnostic criterion for MM, we started chemotherapy to prevent occurrence of MM. Neither tumor recurrence nor development of MM was found for 16 months after surgery. CONCLUSIONS: Histology is essential for diagnosis of primary plasmacytoma in the brain because of the lack of specific findings on neuroimaging. A finding of a few atypical plasma cells in the bone marrow might support the assumption that extramedullary plasmacytoma represents a harbinger of subsequent development of MM. In addition to appropriate therapies combining maximum tumor removal and radiotherapy to the brain, rigorous hematological management might have contributed to favorable outcomes.


Assuntos
Neoplasias Cerebelares/patologia , Plasmocitoma/patologia , Adulto , Antineoplásicos/uso terapêutico , Bortezomib/uso terapêutico , Neoplasias Cerebelares/complicações , Neoplasias Cerebelares/diagnóstico por imagem , Neoplasias Cerebelares/cirurgia , Quimioterapia Adjuvante , Doenças do Nervo Facial/etiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Quimioterapia de Manutenção , Procedimentos Neurocirúrgicos , Plasmocitoma/complicações , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/cirurgia , Radioterapia , Vertigem/etiologia
5.
Int J Hematol ; 111(1): 65-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31701481

RESUMO

Novel therapies are needed for patients with newly diagnosed multiple myeloma (NDMM). Elotuzumab plus lenalidomide and dexamethasone (ELd) is approved for the treatment of relapsed/refractory multiple myeloma (RRMM). This phase 2 study in Japan evaluated ELd vs lenalidomide and dexamethasone (Ld) in patients with NDMM who were ineligible for stem cell transplantation. Elotuzumab infusion was accelerated to 5 mL/min by dose 3, cycle 1, allowing most subsequent infusions to be completed within 1 h. The primary endpoint was overall response rate (ORR) in the ELd arm. Secondary endpoints were the difference in ORR between treatments, and progression-free survival (PFS). Patients were randomized to ELd (n = 40) or Ld (n = 42); median number of treatment cycles was 13 (ELd) and 12 (Ld). In the ELd arm, ORR was 88% [70% confidence interval (CI) 80-93]. The estimated difference in ORR between treatments was 13% (95% CI - 4, 30) in favor of ELd. Progression-free survival data were immature. Safety was consistent with previous findings of ELd in Japanese patients with RRMM. No infusion reactions occurred at the maximum rate of 5 mL/min, which was used in 89% of elotuzumab infusions. ELd may be an effective, well-tolerated frontline treatment for patients with NDMM ineligible for stem cell transplantation.

6.
Nagoya J Med Sci ; 81(4): 647-654, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31849382

RESUMO

Minimally invasive cardiac surgery requires fewer blood transfusions and mediastinitis is less frequently observed compared to conventional median sternotomy surgical intervention, and it leads to earlier recovery and discharge. However, once reexpansion pulmonary edema occurs, the patient requires long-term management in the intensive care unit. This retrospective study was performed to investigate the incidence of reexpansion pulmonary edema in minimally invasive cardiac surgery. Patients who underwent minimally invasive cardiac valve surgery using cardiopulmonary bypass and port-access by a minimal right lateral thoracic incision between January 2010 and January 2018 were enrolled in this single-center retrospective study, which was approved by the institutional review board of Japanese Red Cross Nagoya Daiichi Hospital (Nagoya, Japan), and the requirement for written informed consent was waived. All data were collected from electronic charts. The primary outcome was the incidence rate of reexpansion pulmonary edema in patients undergoing minimally invasive cardiac surgery. A total of 662 patients underwent minimally invasive cardiac surgery, and we analyzed 651 of these cases. No case of reexpansion pulmonary edema was observed in this study. The statistically-calculated incidence rate of reexpansion pulmonary edema was less than 0.6% (95% confidence interval: 0.0-0.6). The incidence of cerebral infarction was 0.92% (n = 6). Intensive care unit stay days, hospital stay days after surgery, and the death rate after 30 days were 1.5 ± 2.0 days, 9.6 ± 3.9 days, and 0.15%, respectively. Although there was no incidence of clinical reexpansion pulmonary edema in this study, the predicted incidence of reexpansion pulmonary edema by statistical analysis was less than 0.6%.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Edema Pulmonar/etiologia , Idoso , Infarto Cerebral/etiologia , Intervalos de Confiança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cirurgia Torácica
7.
Ann Hematol ; 98(5): 1209-1216, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30824955

RESUMO

Febrile neutropenia is often observed in patients with hematologic malignancies, especially in those with acute leukemia. Meropenem has potent and broad antibacterial activity against gram-positive and gram-negative bacteria, and is recommended as first-line empiric therapy for febrile neutropenia. In contrast, the safety and efficacy of doripenem in patients with febrile neutropenia and hematologic malignancies is limited. In this randomized, prospective, cooperative, open-label trial, we compared doripenem (1.0 g every 8 h) to meropenem (1.0 g every 8 h) as first-line empiric antibacterial treatment of febrile neutropenia. To evaluate efficacy and safety, 133 hospitalized patients with acute leukemia or high-risk myelodysplastic syndrome, who developed febrile neutropenia during or after chemotherapy, were randomized to each drug. Resolution of fever within 3 to 5 days without treatment modification (i.e., the primary endpoint) did not significantly differ between the doripenem and meropenem groups (60.0% vs. 45.6%, respectively; P = 0.136). However, resolution of fever within 7 days of treatment was significantly higher in the doripenem group than in the meropenem group (78.4% vs. 60.2%, respectively; P = 0.037). Similar rates of adverse events (grades 1-2) were observed in both groups. Thus, we conclude that both drugs are safe and well-tolerated for the treatment of febrile neutropenia in patients with acute leukemia or high-risk myelodysplastic syndrome, and that the clinical efficacy of doripenem is noninferior to that of meropenem. UMIN Clinical Trial Registry number: 000006124.


Assuntos
Neutropenia Febril Induzida por Quimioterapia/tratamento farmacológico , Doripenem/administração & dosagem , Leucemia/tratamento farmacológico , Meropeném/administração & dosagem , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doripenem/efeitos adversos , Feminino , Febre/tratamento farmacológico , Humanos , Masculino , Meropeném/efeitos adversos , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/tratamento farmacológico , Estudos Prospectivos
8.
J Anesth ; 33(1): 26-32, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30413879

RESUMO

PURPOSE: Previous work showed that 20 mL of local anesthetic (LA) did not spread into the paravertebral space (PVS) via the intramuscular quadratus lumborum block (QLBi). If spread of LA into the PVS can be achieved by increasing the total LA volume, QLBi can be more effective. We hypothesized that a larger volume of LA for the QLBi would spread into the PVS. METHODS: This crossover volunteer study included five healthy men. For comparison, both the ultrasound-guided QLB type 2 (QLB2) and QLBi were employed on opposite sides of each volunteer, and the spread of LA solution (0.7 mL/kg) mixed with contrast media in the PVS was assessed 1 h after the first injection using magnetic resonance imaging. Sensory loss was evaluated by pinprick 90 min post-injection. Each volunteer underwent both QLB types, and the same procedures were administered on opposite sides 7 days after the first experiment. RESULTS: In total, 20 QLB blocks (10 QLB2 and 10 QLBi) were performed. LA did not spread into the PVS after the QLBi. The sensory block area included the lower abdomen after the QLB2, but not after the QLBi. The sensory block area did not extend to the upper abdominal region or the midline of the lower abdomen with either block method. CONCLUSION: LA administered by the QLB2 spreads into the PVS of T10-T12, resulting in lower and lateral abdominal sensory loss. In contrast, LA administered by the QLBi does not spread into the PVS and results in only lateral abdominal sensory loss.


Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/métodos , Adulto , Estudos Cross-Over , Humanos , Injeções , Imagem por Ressonância Magnética , Masculino , Ultrassonografia de Intervenção , Adulto Jovem
9.
Oncotarget ; 9(78): 34784-34793, 2018 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-30410677

RESUMO

The signaling lymphocytic activation molecule family (SLAMF7; also known as CS1 or CD319) is highly expressed on plasma cells from multiple myeloma (MM) as well as natural killer (NK) cells and is a well-known therapeutic target of elotuzumab. The objective of this study was to evaluate the clinical significance of serum soluble SLAMF7 (sSLAMF7) levels in patients with MM (n=103) and furthermore the impact of sSLMF7 on the antitumor activity of anti-SLAMF7 antibody. Thirty-one percent of MM patients, but not patients with monoclonal gammopathy of undetermined significance and healthy controls, had detectable levels of serum sSLAMF7, which were significantly increased in advanced MM patients. Further, MM in sSLAMF7-postive patients exhibited aggressive clinical characteristics with shorter progression-free survival times in comparison with sSLAMF7-negative patients. In responders to MM therapy, the levels of sSLAMF7 were undetectable or decreased compared with those before treatment. In addition, the anti-SLAMF7 antibody-mediated antibody-dependent cellular cytotoxicity of NK cells against MM cell lines was inhibited by recombinant SLAMF7 protein. Thus, our findings suggest that high concentrations of sSLAMF7, which could transiently suppress the therapeutic effects of elotuzumab, may be a useful indicator of disease progression in MM patients.

10.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 74(11): 1302-1312, 2018.
Artigo em Japonês | MEDLINE | ID: mdl-30464098

RESUMO

We performed a basic evaluation for measuring the input function using a fan-beam collimator. Furthermore, we examined the validity of the brain blood flow quantitative measurement from the input function. Using the fanbeam collimator, we imaged syringes of various diameters containing 99 mTc as well as a virtual aorta inside a thoracic phantom. We changed the collimator distance and angle in relation to the sources, and the syringe was placed in vertical and horizontal positions as well. For evaluation, we used region of interest (ROI) of various sizes and positions. Furthermore, we conducted clinical evaluation for 19 subjects and calculated whole-brain mean cerebral blood flow using improved brain uptake ratio method by examination of 99 mTc-ECD cerebral blood flow. For ROIs smaller in size than diameter of the syringes and virtual ascending aorta, amount of change in the ROI counts by fan-beam collimator became smaller as distance to the source became closer, with less than 5% at 175 mm. Also, change with respect to angle of the collimator was less than 5% at 20°. In a clinical study, aortas could be imaged without truncation and input-functions could be measured in all 19 patients. By using ROIs smaller than the aorta diameter and placing the collimator close to the source, it was suggested that fan-beam collimator can be used to determine the input function.


Assuntos
Encéfalo , Circulação Cerebrovascular , Tomografia Computadorizada de Emissão de Fóton Único , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Câmaras gama , Humanos , Imagens de Fantasmas
11.
Int J Hematol ; 108(5): 510-515, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30043334

RESUMO

High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is widely used as a salvage therapy for relapsed or high-risk diffuse large B-cell lymphoma (DLBCL). To investigate the safety and efficacy of regimens including high-dose MCNU followed by ASCT for DLBCL, we analyzed the data from prospective multicenter trials. Twenty-nine patients were analyzed, and the median follow-up time for survival patients was 70 months. Fifteen patients received MCVC conditioning regimen, and fourteen patients received MEAM regimen. Major toxicities associated with these conditioning regimens included nausea (69%), anorexia (66%), febrile neutropenia (62%), diarrhea (59%), and mucositis (34%). One patient who developed severe sinusoidal obstructive syndrome and acute lung injury died without disease progression, and overall therapy-related mortality at 5 years was 3%. No patient developed therapy-related hematological malignancy. At 5 years, overall survival and progression-free survival in all patients were 82.8 and 58.2%, respectively. The 5-year OS in patients treated by the MCVC and MEAM regimens were 73.3 and 92.9%, respectively. These results suggest that regimens including high-dose MCNU followed by ASCT are feasible and effective for the treatment of relapsed or high-risk DLBCL. Further investigation is needed to evaluate of these regimens.


Assuntos
Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/terapia , Compostos de Nitrosoureia/administração & dosagem , Transplante de Células-Tronco , Adulto , Autoenxertos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Compostos de Nitrosoureia/efeitos adversos , Estudos Prospectivos , Taxa de Sobrevida
12.
Asia Ocean J Nucl Med Biol ; 6(2): 129-138, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29998146

RESUMO

Objectives: We recently developed a new uptake index method for 123I-metaiodobenzylguanidine (123I-MIBG) heart uptake measurements by using planar images (radioisotope angiography and planar image) for the diagnosis of Lewy body disease (LBD), including Parkinson's disease (PD) and dementia with Lewy bodies (DLB). However, the diagnostic accuracy of the uptake index was approximately equal to that of the heart-to-mediastinum ratio (H/M) for the discrimination of the LBD and non-LBD patients. A simple and pain-free uptake index method using 123I-MIBG SPECT images by modifying the uptake index method may show better diagnostic accuracy than the planar uptake index method. We hypothesized that the development of a new uptake index method for the determination of 123I-MIBG using single-photon emission computed tomography (SPECT) imaging would provide a reliable and reproducible diagnostic tool for clinical application. Regarding this, the purpose of this study was to develop a new uptake index method with a simple protocol to determine 123I-MIBG uptake on SPECT. Methods: The 123I-MIBG input function was determined from the input counts of the pulmonary artery, assessed by analyzing the pulmonary artery time-activity curves. The 123I-MIBG output function was obtained from 123I-MIBG SPECT counts on the polar map. The uptake index was calculated through dividing the output function by the input function (SPECT uptake method). For the purpose of the study, 77 patients underwent 123I-MIBG SPECT, with an average of 31.5 min after clinical assessment and injection of the tracer. The H/M values, as well as planar and SPECT uptake indices were calculated, and then correlated with clinical features. Results: According to the results, values obtained for LBD were significantly lower than those for non-LBD in all analyses (P<0.01). The overlap of the H/M values between the LBD and non-LBD cases ranged from 2.06 to 2.50. Furthermore, the overlap in uptake index values between LBD and non-LBD cases in planar image analysis was 1.05-1.29. The SPECT uptake index method showed the least overlap of 1.23-1.25, with the highest value for LBD patients clearly distinguished from the lowest value for the non-LBD patients. Conclusion: The new 123I-MIBG SPECT quantification method, developed by the input counts of the pulmonary artery, clearly distinguished LBD from non-LBD. Therefore, this method may be appropriate for routine clinical study.

13.
Health Phys ; 115(2): 221-226, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29957686

RESUMO

The effect of temperature and shielding on the lower detection limit of a thyroid I monitoring system was investigated in an anthropomorphic thyroid-neck phantom fitted with an imaging plate. The phantom was loaded with an I aqueous solution and monitored with the imaging plate for 10 min. After exposure, the plates were incubated with or without the shield at 0, 10, 20, 25, 30, or 40°C. The latent image was read out at 0 min to 7 d after exposure. The thyroid equivalent doses corresponding to the detection limit were calculated in six age categories, using the inhalation equivalent dose coefficients recommended by the International Commission on Radiological Protection. The detection limit was distributed between 0.13 and 4.2 kBq, and depended on the age of subjects, elapsed time, temperature, and shielding provision. The maximum detection limit of 4.2 kBq was below the emergency screening level of 30 kBq in Japan. The thyroid equivalent dose corresponding to the detection limit ranged from 0.17 to 46 mSv. From the maximum equivalent dose of 46 mSv, the effective dose was estimated as 1.8 mSv, lower than the annual effective dose limit of 20 mSv for radiation workers. At 2 d after exposure, the measured dose was below the annual effective dose limit of 1 mSv for the public, regardless of age, temperature, and shielding provision. The imaging plate system effectively monitors the I thyroid levels in emergency situations.


Assuntos
Radioisótopos do Iodo/efeitos adversos , Imagens de Fantasmas , Monitoramento de Radiação/instrumentação , Cintilografia/métodos , Glândula Tireoide/diagnóstico por imagem , Humanos , Doses de Radiação , Glândula Tireoide/efeitos da radiação
15.
Int J Hematol ; 108(1): 39-46, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29594921

RESUMO

In the era of novel therapeutic agents for multiple myeloma (MM), both the significance of achieving the plateau phase and the efficacy of subsequent maintenance therapy remain unclear. In the present study, we evaluated the efficacy and safety of bortezomib maintenance therapy (biweekly for 1 year) in transplant-ineligible MM patients who plateaued after bortezomib-based induction therapy. Of 36 evaluable patients, the overall response rate during induction therapy was 61%, with a stringent complete response in 6%, a complete response in 6%, a very good partial response in 17%, and a partial response in 33%. Twenty patients achieved the plateau phase and subsequently received bortezomib maintenance therapy. Median progression-free survival from the induction and maintenance therapies was 13.8 months (95% confidence interval, 11.4-23.7 months) and 10.7 months (95% confidence interval, 3.7-10.7 months), respectively. During maintenance therapy, there were no cases with grade ≥ 2 peripheral neuropathy, nor was there any improvement in the quality of the response. In conclusion, although maintenance therapy with biweekly bortezomib for up to 1 year was feasible, plateau-oriented bortezomib induction therapy followed by bortezomib maintenance therapy was not adequate in newly diagnosed transplant-ineligible MM patients.


Assuntos
Antineoplásicos/administração & dosagem , Bortezomib/administração & dosagem , Quimioterapia de Indução , Quimioterapia de Manutenção , Mieloma Múltiplo/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/mortalidade , Resultado do Tratamento
16.
Reg Anesth Pain Med ; 43(4): 372-377, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29389680

RESUMO

BACKGROUND AND OBJECTIVES: Several types of quadratus lumborum block (QLB) are used for postoperative analgesia and are believed to be effective against both somatic and visceral pain via a local anesthetic (LA) effect in the paravertebral space (PVS). However, it remains unclear whether all QLB techniques result in LA spread into the PVS. We hypothesized that LA administered via intramuscular QLB would spread into the paravertebral space and investigated the spread and sensory block area of LA in intramuscular QLB. METHODS: This volunteer study included 5 healthy men and 1 woman, with no previous medical history. Intramuscular QLB and lateral transversus abdominis plane block were performed under real-time ultrasound guidance for comparison of sensory deprivation range. Two days later, the same procedure was performed on the contralateral side of the body. The spread of LA via intramuscular QLB spread to the PVS was assessed 1 hour after the first injections using magnetic resonance imaging. Sensory perception was also evaluated by the pinprick test at 90 minutes after injection. RESULTS: In total, we performed 11 intramuscular QLBs and 11 lateral transversus abdominis plane blocks. Magnetic resonance imaging showed that LA did not spread into the PVS after ultrasound-guided intramuscular QLB. The analgesic area corresponded to the side of the body that was ipsilateral to the block. CONCLUSIONS: Ultrasound-guided intramuscular QLBs are not clinically useful for procedures requiring LA spread into the PVS but do result in an ipsilateral analgesic effect in healthy volunteers. CLINICAL TRIAL REGISTRATION: This study was registered at University Hospital Medical Information Network Clinical Trials Registry, UMIN 000019149.


Assuntos
Músculos Abdominais/diagnóstico por imagem , Anestésicos Locais/administração & dosagem , Músculos do Dorso/diagnóstico por imagem , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Músculos Abdominais/efeitos dos fármacos , Adulto , Músculos do Dorso/efeitos dos fármacos , Feminino , Voluntários Saudáveis , Humanos , Injeções Intramusculares , Masculino
17.
Asia Ocean J Nucl Med Biol ; 6(1): 50-56, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29333467

RESUMO

Objectives: We developed a simple non-invasive I-123-N-isopropyl-p-iodoamphetamine (123I-IMP) quantification method by analyzing chest RI-angiography and single photon emission computed tomography (SPECT) images based on the microsphere model (SIMS method). Theoretically, the SIMS method could be changed to the simple non-invasive ARG (SIARG) method by modifying the integrated washout ratio (WR) to one-point WR. If the regional cerebral blood flow (rCBF) values derived from the SIARG and ARG methods correlate well, the facilities employing the ARG method can easily switch to the SIARG method. The purpose of this study was to develop the SIARG method by modifying the SIMS method, and to confirm the feasibility of this method. Methods: The correlation between the input counts of the SIARG method and the blood counts was determined by linear regression analysis. The rCBF values determined by the SIARG method were compared with the values obtained with the ARG and SIMS methods. Results: There was a good linear correlation between the SIARG counts and the arterial blood counts obtained by the ARG method (r=0.85, P<0.001, n=29). The rCBF values obtained by the ARG and SIARG methods (n=29, 696 ROIs) correlated well (y=1.01x - 3.6, r=0.85, P<0.001). Similarly, the rCBF values obtained by the SIARG and SIMS methods (n=29, 696 ROIs) correlated well (y=0.98x - 15.2, r=0.90, P<0.001). rCBF values obtained by the SIARG method were almost the same as the values obtained by the ARG method, and values of the SIMS method were 15 ml/100g/min higher that of those obtained by the SIARG method. Conclusion: The rCBF values obtained by the ARG, SIARG, and SIMS methods correlated very well. Therefore, the SIARG method is potentially useful for examinations in routine clinical practice.

19.
Eur J Haematol ; 100(1): 27-35, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28895203

RESUMO

OBJECTIVES: We conducted a phase-II study to evaluate the efficacy and safety of dasatinib in patients newly diagnosed with chronic-phase chronic myeloid leukaemia (CML-CP) in Japan (IMIDAS PART 2 study). METHODS: Seventy-nine patients were administered 100 mg dasatinib once daily. We examined pretreatment and post-treatment influences of various factors. The BCR-ABL1 international scale (IS), halving time (HT) and reduction rate of BCR-ABL1 transcript within the initial 1 or 3 months of therapy (RR-BCR-ABL11m,3m ) were the post-treatment factors investigated to predict the molecular response. RESULTS: The estimated major molecular response (MMR), molecular response 4.0 (MR4.0) and molecular response 4.5 (MR4.5) rates were 77.2%, 49.4% and 35.4%, respectively, at 12 months. Grade 3/4 non-haematologic adverse events were infrequent. Multivariate analysis showed that age >65 years was significantly correlated with MR4.0 and MR4.5 (deep molecular response: DMR) at 12 months. All post-treatment factors at 3 months predicted DMR by univariate analysis. However, RR-BCR-ABL13m was the only significant landmark for predicting DMR by multivariate analysis. CONCLUSIONS: Primary treatment of CML-CP with dasatinib enabled early achievement of MMR and DMR, particularly in elderly patients, with high safety. Furthermore, RR-BCR-ABL13m was found to be a more useful predictor of DMR than HT-BCR-ABL1 and BCR-ABL1 IS.


Assuntos
Antineoplásicos/uso terapêutico , Dasatinibe/uso terapêutico , Proteínas de Fusão bcr-abl/genética , Expressão Gênica , Leucemia Mieloide de Fase Crônica/tratamento farmacológico , Leucemia Mieloide de Fase Crônica/genética , Inibidores de Proteínas Quinases/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Dasatinibe/administração & dosagem , Dasatinibe/efeitos adversos , Feminino , Humanos , Leucemia Mieloide de Fase Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Inibidores de Proteínas Quinases/administração & dosagem , Inibidores de Proteínas Quinases/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
20.
Asia Ocean J Nucl Med Biol ; 5(1): 37-43, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28840137

RESUMO

OBJECTIVES: Iodine-123 metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy has been used to evaluate cardiac sympathetic denervation in Lewy body disease (LBD), including Parkinson's disease (PD) and dementia with Lewy bodies (DLB). The heart-to-mediastinum ratio (H/M) in PD and DLB is significantly lower than that in Parkinson's plus syndromes and Alzheimer's disease. Although this ratio is useful for distinguishing LBD from non-LBD, it fluctuates depending on the system performance of the gamma cameras. Therefore, a new, simple quantification method using 123I-MIBG uptake analysis is required for clinical study. The purpose of this study was to develop a new uptake index with a simple protocol to determine 123I-MIBG uptake on planar images. METHODS: The 123I-MIBG input function was obtained from the input counts of the pulmonary artery (PA), which were assessed by analyzing the PA time-activity curves. The heart region of interest used for determining the H/M was used for calculating the uptake index, which was obtained by dividing the heart count by the input count. RESULTS: Forty-eight patients underwent 123I-MIBG chest angiography and planar imaging, after clinical feature assessment and tracer injection. The H/M and 123I-MIBG uptake index were calculated and correlated with clinical features. Values for LBD were significantly lower than those for non-LBD in all analyses (P<0.001). The overlapping ranges between non-LBD and LBD were 2.15 to 2.49 in the H/M method, and 1.04 to 1.22% in the uptake index method. The diagnostic accuracy of the uptake index (area under the curve (AUC), 0.98; sensitivity, 96%; specificity, 91%; positive predictive value (PPV), 90%; negative predictive value (NPV), 93%; and accuracy, 92%) was approximately equal to that of the H/M (AUC, 0.95; sensitivity, 93%; specificity, 91%; PPV, 90%; NPV, 93%; and accuracy, 92%) for discriminating patients with LBD and non-LBD. CONCLUSION: A simple uptake index method was developed using 123I-MIBG planar imaging and the input counts determined by analyzing chest radioisotope angiography images of the PA. The diagnostic accuracy of the uptake index was approximately equal to that of the H/M for discriminating patients with LBD and non-LBD.

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