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1.
J Nippon Med Sch ; 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34526471

RESUMO

Apalutamide, an oral androgen receptor signaling inhibitor, is approved for the treatment of non-metastatic castration-resistant prostate cancer and metastatic prostate cancer. In the international randomized placebo-controlled clinical trials, apalutamide was associated with a higher rate of rash than placebo. However, given that reports from a dermatological perspective are limited, the skin manifestations and histopathology of the skin lesions caused by apalutamide are largely unknown. Here, we report a case of apalutamide-induced drug eruption. A 66-year-old man developed itchy maculopapular erythema on the trunk and extremities 10 weeks after starting apalutamide for progressive prostate cancer. A biopsy specimen showed interface dermatitis with perivascular lymphocytic infiltration in the upper dermis. The lymphocyte transformation test was positive for apalutamide. The skin manifestations improved after discontinuation of apalutamide and treatment with topical corticosteroids and systemic prednisolone. A review of the dermatology literature on apalutamide-induced drug eruption yielded only six cases, including our case. Dermatologically, there were four cases of maculopapular rash and two of toxic epidermal necrolysis and histopathologically, there were three cases of interface dermatitis, two of epidermal necrosis, and one of spongiotic dermatitis. Four patients had peripheral eosinophilia. A lymphocyte transformation test was performed in three cases and was positive for apalutamide in all cases. Except for the two cases of toxic epidermal necrolysis, which were fatal, the skin eruptions appeared 10 weeks after starting apalutamide. Considering the increasing number of patients with prostate cancer being treated with apalutamide, cases of apalutamide-induced drug eruption need to be accumulated and analyzed.

2.
Int J Surg Case Rep ; 87: 106388, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34536768

RESUMO

INTRODUCTION AND IMPORTANCE: A duodenal diverticulum is a pseudodiverticulum that lacks a proper muscular layer. Cases of traumatic penetration or perforation of a duodenal diverticulum are relatively rare. CASE PRESENTATION: A 67-year-old woman was injured when her roommate kicked her in the upper abdomen, and was transferred to our hospital 6 h after the injury with upper abdominal pain and lethargy. Computed tomography revealed a duodenal diverticulum and retroperitoneal emphysematous changes and exudates. Peritonitis due to duodenal penetration was suspected and emergency laparotomy was performed. Intraoperative findings revealed two traumatic penetrations of the duodenal diverticulum. We resected the diverticulum with an automatic suture device and covered the resection site with omentum. Twenty-one days postoperatively, she was transferred to her original hospital with no complications following an uneventful postoperative course. CLINICAL DISCUSSION: Most causes of penetration or perforation of the duodenal diverticulum are diverticulitis, and few reports have described penetration or perforation of duodenal diverticulum due to trauma. Our case was extremely rare that caused by a kick to the upper abdomen and resulted in two penetrations of a duodenal diverticulum although factors contributing to the multiple penetrations were considered. CONCLUSION: Penetration or perforation of a duodenal diverticulum occasionally results in a rapid deterioration to a severe state. Comprehensive judgement of the general condition and laboratory findings and selection of an appropriate treatment policy is important.

3.
Chem Pharm Bull (Tokyo) ; 69(7): 674-680, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34193716

RESUMO

Quality by design (QbD) is an essential concept for modern manufacturing processes of pharmaceutical products. Understanding the science behind manufacturing processes is crucial; however, the complexity of the manufacturing processes makes implementing QbD challenging. In this study, structural equation modeling (SEM) was applied to understand the causal relationships between variables such as process parameters, material attributes, and quality attributes. Based on SEM analysis, we identified a model composed of the above-mentioned variables and their latent factors without including observational data. Difficulties in fitting the observed data to the proposed model are often encountered in SEM analysis. To address this issue, we adopted Bayesian estimation with Markov chain Monte Carlo simulation. The tableting process involving the wet-granulation process for acetaminophen was employed as a model case for the manufacturing process. The results indicate that SEM analysis could be useful for implementing QbD for the manufacturing processes of pharmaceutical products.


Assuntos
Análise de Classes Latentes , Comprimidos/química , Acetaminofen/química , Teorema de Bayes , Composição de Medicamentos/métodos , Cadeias de Markov , Método de Monte Carlo , Análise de Componente Principal
4.
Surg Endosc ; 2021 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-34142238

RESUMO

BACKGROUND: The efficacy of laparoscopic multivisceral resection (Lap-MVR) has been reported by several experienced high-volume centers. The Endoscopic Surgical Skill Qualification System (ESSQS) was established in Japan to improve the skill of laparoscopic surgeons and further develop surgical teams. We examined the safety and feasibility of Lap-MVR in general hospitals, and evaluated the effects of the Japanese ESSQS for this approach. METHODS: We retrospectively reviewed 131 patients who underwent MVR between April 2016 and December 2019. Patients were divided into the laparoscopic surgery group (LAC group, n = 98) and the open surgery group (OPEN group, n = 33). The clinicopathological and surgical features were compared between the groups. RESULTS: Compared with the OPEN group, BMI was significantly higher (21.9 vs 19.3 kg/m2, p = 0.012) and blood loss was lower (55 vs 380 ml, p < 0.001) in the LAC group. Operation time, postoperative complications, and postoperative hospital stay were similar between the groups. ESSQS-qualified surgeons tended to select the laparoscopic approach for MVR (p < 0.001). In the LAC group, ESSQS-qualified surgeons had superior results to those without ESSQS qualifications in terms of blood loss (63 vs 137 ml, p = 0.042) and higher R0 resection rate (0% vs 2.0%, p = 0.040), despite having more cases of locally advanced tumor. In addition, there were no conversions to open surgery among ESSQS-qualified surgeons, and three conversions among surgeons without ESSQS qualifications (0% vs 15.0%, p = 0.007). Multivariate analysis revealed blood loss (odds ratio 1.821; 95% CI 1.324-7.654; p = 0.010) as an independent predictor of postoperative complications. Laparoscopic approach was not a predictive factor. CONCLUSIONS: The present multicenter study confirmed the feasibility and safety of Lap-MVR even in general hospitals, and revealed superior results for ESSQS-qualified surgeons.

5.
Magn Reson Med Sci ; 20(2): 216-221, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32641589

RESUMO

We evaluated the effectiveness of distortion correction using a nonrigid image registration method in diffusion-weighted imaging, comparing it with readout-segmented echo planar imaging (RS-EPI). Unlike the RS-EPI, the effectiveness of the distortion correction of the nonrigid registration method depended on the slice level, being most accurate at the level of the basal ganglia, lateral ventricle, and centrum semiovale.


Assuntos
Encéfalo/anatomia & histologia , Encéfalo/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Imagem Ecoplanar/métodos , Aumento da Imagem/métodos , Humanos
6.
Phys Med ; 76: 194-201, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32707483

RESUMO

PURPOSE: Diagnostic positron emission tomography and computed tomography (PET/CT) images can be fused to the planning CT images by a deformable image registration (DIR). The aim of this study was to evaluate the standardized uptake value (SUV) and target delineation on deformed PET images. METHODS: We used a cylindrical phantom and removable inserts of four spheres (16-38 mm in diameter) and three ellipsoids with a volume equal to the 38-mm-diameter sphere (S38) in each. S38 was filled with 18F-fluorodeoxyglucose activity, and then PET/CT images were acquired. The contours of S38 were generated using original PET images by PET auto-segmentation (PET-AS) methods of (1) SUV2.5, (2) 40% of maximum SUV (SUV40%max), and (3) gradient-based (GB), and were deformed to the other inserts by DIR. We compared the volumes and the SUVmax with the generated contours using the deformed PET images. RESULTS: The SUVmax was slightly decreased by DIR; the mean absolute difference was -0.10 ± 0.04. For SUV2.5 and SUV40%max, the differences in S38 volumes between the original and deformed PET images were less than 5%, regardless of deformation type. For the GB, the contoured volumes obtained from deformed PET images were larger than those of the original PET images for the deformation type of ellipsoids. When the S38 was deformed to the 16-mm-diameter sphere, the maximum volume difference was -22.8%. CONCLUSIONS: Although SUV fluctuations by DIR were negligible, the target delineation on deformed PET images by the GB should be carefully considered owing to the distortion of intensity profiles.


Assuntos
Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Fluordesoxiglucose F18 , Imagens de Fantasmas
7.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 72(11): 1152-1160, 2016.
Artigo em Japonês | MEDLINE | ID: mdl-27867176

RESUMO

PURPOSE: The aim of this study was to investigate the impact of pelvic rotational setup error on lymph nodal dose in the whole pelvic intensity-modulated radiation therapy using the fiducial marker. METHODS: The dose differences of clinical target volume for pelvic lymph node (CTVLN) due to isocenter (IC) shift and pelvic rotation were evaluated using the radiation treatment planning system. The rotated computed tomography (CT) images were created for the simulation of the pelvic rotation. The original CT images were rotated around the IC of the original plan in the pitch and roll directions up to±3.0 deg. at 1.0 deg. intervals. As simulated plans, IC positions were shifted in the anterior-posterior and superior-inferior directions up to±10 mm at 2 mm intervals in the original and rotated CT images, and the dose distributions were calculated. The dose calculation was performed for each CT image while keeping the movement of multi leaf collimator and the monitor unit of the original plan. The differences between D98% of CTVLN in the original plan and simulated plans were calculated. RESULTS: In the posterior direction shifts of 4, 6, 8, and 10 mm, the dose reduction of 0.7, 2.1, 6.1, and 11.9% from the original plan were found for D98% of CTVLN, respectively. The dose reductions due to the rotation of pitch direction were greater than the rotation of roll direction. In the posterior direction shifts of 4, 6, 8, and 10 mm with 3.0 deg. rotation of pitch direction, the dose reduction of 2.2, 6.8, 12.8, and 19.0% from the original plan were found, respectively. CONCLUSION: The dose reduction of CTVLN might be occurred due to the rotational setup error of pitch direction.


Assuntos
Marcadores Fiduciais , Linfonodos/efeitos da radiação , Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada , Humanos , Masculino , Radioterapia de Intensidade Modulada/métodos
8.
Protein J ; 30(7): 457-63, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21853336

RESUMO

Oleosins contain a unique hydrophobic domain which is inserted into the oil matrix and are involved in the formation and stability of plant oil bodies. These proteins have also been reported to possess some allergenic properties. Therefore, knowledge of its three-dimensional structure is vital for further structural and immunological characterization. However, due to the difficulty of soluble recombinant expression in Escherichia coli, no studies have been done in line with this goal. Here, we have developed a novel expression and purification system for three peanut oleosin isoforms (14 k, 16 k, and 18 kDa oleosins). Oleosin cDNAs were cloned and subsequently expressed in soluble form in insect cell-baculovirus system. Recombinant proteins can be purified to homogeneity using only Ni Sepharose affinity chromatography. Thermal denaturation midpoint temperatures of recombinant oleosins were also assayed and found to be very similar to that of native oleosins, indicating proper structural conformation of the recombinant proteins.


Assuntos
Arachis/genética , Expressão Gênica , Proteínas de Plantas/genética , Proteínas de Plantas/isolamento & purificação , Sequência de Aminoácidos , Animais , Arachis/química , Arachis/metabolismo , Linhagem Celular , Cromatografia de Afinidade , Clonagem Molecular , Dados de Sequência Molecular , Proteínas de Plantas/química , Proteínas de Plantas/metabolismo , Estabilidade Proteica , Proteínas Recombinantes/química , Proteínas Recombinantes/genética , Proteínas Recombinantes/isolamento & purificação , Proteínas Recombinantes/metabolismo , Sementes/química , Sementes/genética , Sementes/metabolismo , Alinhamento de Sequência , Spodoptera
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