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1.
Sci Rep ; 10(1): 2671, 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32060386

RESUMO

Non-alcoholic steatohepatitis (NASH) is a complex disease consisting of various components including steatosis, lobular inflammation, and ballooning degeneration, with or without fibrosis. Therefore, it is difficult to diagnose NASH with only one imaging modality. This study was aimed to evaluate the feasibility of magnetic resonance imaging (MRI) for predicting NASH and to develop a non-invasive multiparametric MR index for the detection of NASH in non-alcoholic fatty liver disease (NAFLD) patients. This prospective study included 47 NAFLD patients who were scheduled to undergo or underwent ultrasound-guided liver biopsy within 2 months. Biopsy specimens were graded as NASH or non-NASH. All patients underwent non-enhanced MRI including MR spectroscopy (MRS), MR elastography (MRE), and T1 mapping. Diagnostic performances of MRS, MRE, and T1 mapping for grading steatosis, activity, and fibrosis were evaluated. A multiparametric MR index combining fat fraction (FF), liver stiffness (LS) value, and T1 relaxation time was developed using linear regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the newly devised MR index. Twenty NASH patients and 27 non-NASH patients were included. Using MRS, MRE, and T1 mapping, the mean areas under the curve (AUCs) for grading steatosis, fibrosis, and activity were 0.870, 0.951, and 0.664, respectively. The multiparametric MR index was determined as 0.037 × FF (%) + 1.4 × LS value (kPa) + 0.004 × T1 relaxation time (msec) -3.819. ROC curve analysis of the MR index revealed an AUC of 0.883. The cut-off value of 6 had a sensitivity of 80.0% and specificity of 85.2%. The multiparametric MR index combining FF, LS value, and T1 relaxation time showed high diagnostic performance for detecting NASH in NAFLD patients.

2.
J Clin Microbiol ; 58(2)2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31748320

RESUMO

There are several convenient and accurate molecular assays to detect respiratory bacterial infection. The NeoPlex RB-8 detection kit (NeoPlex RB-8) is a new multiplex real-time PCR assay that simultaneously detects Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila, Haemophilus influenzae, Bordetella pertussis, Bordetella parapertussis, and Moraxella catarrhalis in a single test. This study compared the clinical concordance of NeoPlex RB-8 with another method, Seeplex PneumoBacter ACE detection assay (Seeplex PB ACE), which simultaneously detects S. pneumoniae, M. pneumoniae, C. pneumoniae, L. pneumophila, H. influenzae, and B. pertussis We tested 2,137 nasopharyngeal swab and sputum specimens using both assays. For discordant Bordetella parapertussis and M. catarrhalis specimens, we also performed bidirectional sequencing. For S. pneumoniae, M. pneumoniae, C. pneumoniae, L. pneumophila, H. influenzae, and B. pertussis, which are detected by both NeoPlex RB-8 and Seeplex PB ACE, the positive and negative agreement between the two assays ranged from 91.7 to 100% (κ = 0.918 to 1). S. pneumoniae and H. influenzae were the most discordant targets and measured with higher sensitivity and specificity by NeoPlex RB-8 than Seeplex PB ACE. For Bordetella parapertussis and M. catarrhalis, which are not detected by Seeplex PB ACE, NeoPlex RB-8 sensitivity and specificity were >99%. Overall, NeoPlex RB-8 was highly comparable to Seeplex PB ACE, but NeoPlex RB-8 was more clinically accurate, with higher throughput and more convenience.

3.
Arthroscopy ; 36(2): 431-440, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31866278

RESUMO

PURPOSE: To evaluate the results of all-arthroscopic treatment of the terrible triad of the elbow, a combination of elbow dislocation, radial head dislocation, and coronoid process fracture, and its complications. METHODS: We performed a retrospective review of consecutive patients with terrible triad who underwent all-arthroscopic treatment between January 2011 and December 2016. All-arthroscopic treatment was performed in the unstable elbows after manual reduction. Clinical evaluation was performed at least 2 years postoperatively. Patients with another fracture in the upper extremity and previous fracture of the affected elbow were excluded. A radial head fracture that was stable enough to reduce or involved less than 25% of the articular surface for partial excision and Regan-Morrey classification type I and type II coronoid process fractures were treated arthroscopically. Range of motion, radiologic outcomes, surgical complications, and the Mayo Elbow Performance Score were evaluated at the final follow-up. The Mann-Whitney test was used for statistical analysis. RESULTS: A total of 24 patients met the inclusion criteria, and the average age was 47.6 years. Coronoid process fractures were fixed in all patients, by use of Kirschner wires in 15 (62.5%) and pullout sutures in 9 (37.5%). Radial head fractures were treated using screw or K-wire fixation in 4 patients (16.7%); only the fragment of the fracture was resected in 11 patients (45.8%). In all 24 cases (100%), the lateral collateral ligaments were repaired. At the final follow-up, the mean flexion contracture angle was 4.8° ± 1.1° and the mean flexion angle was 132.5° ± 6.3°. Clinical scores were satisfactory, with a mean Mayo Elbow Performance Score of 93 points. However, nonunion of coronoid fractures was observed in 4 patients (16.7%). There was 1 case of pin-site irritation. CONCLUSIONS: All-arthroscopic treatment for the terrible triad can provide an excellent safety profile without the need for a large incision if the indications are met. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

4.
Int J Mol Sci ; 20(24)2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31817350

RESUMO

Our laboratory and others previously showed that Annexin A2 knockout (A2KO) mice had impaired blood-brain barrier (BBB) development and elevated pro-inflammatory response in macrophages, implying that Annexin A2 (AnxA2) might be one of the key endogenous factors for maintaining homeostasis of the neurovascular unit in the brain. Traumatic brain injury (TBI) is an important cause of disability and mortality worldwide, and neurovascular inflammation plays an important role in the TBI pathophysiology. In the present study, we aimed to test the hypothesis that A2KO promotes pro-inflammatory response in the brain and worsens neurobehavioral outcomes after TBI. TBI was conducted by a controlled cortical impact (CCI) device in mice. Our experimental results showed AnxA2 expression was significantly up-regulated in response to TBI at day three post-TBI. We also found more production of pro-inflammatory cytokines in the A2KO mouse brain, while there was a significant increase of inflammatory adhesion molecules mRNA expression in isolated cerebral micro-vessels of A2KO mice compared with wild-type (WT) mice. Consistently, the A2KO mice brains had a significant increase in leukocyte brain infiltration at two days after TBI. Importantly, A2KO mice had significantly worse sensorimotor and cognitive function deficits up to 28 days after TBI and significantly larger brain tissue loss. Therefore, these results suggested that AnxA2 deficiency results in exacerbated early neurovascular pro-inflammation, which leads to a worse long-term neurologic outcome after TBI.

5.
Ann Occup Environ Med ; 31: e6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543967

RESUMO

Background: In Korea, around the abandoned metal mines, heavy metals are being accumulating in the cultivated areas. Among exposed heavy metals, mercury is known to harm for cardiovascular system known to affect blood pressure. So, we studied the relationship between blood mercury level and hypertension in residents around abandoned metal mines. Methods: From 2008 to 2011, we surveyed 7,055 residents in provinces affected by abandoned metal mines and collected data from 6 Hospitals. We conducted a personal questionnaire interview survey with residents on the basis of household questionnaires, sex, age, household income, smoking, and drinking items. Multiple logistic regression analysis was performed to investigate the association between blood mercury level and hypertension. Results: We compared residents with low and high groups based on blood mercury level 5.8 µg/L, and higher group was significantly higher risk of hypertension than lower group (odds ratio [OR]: 1.277; 95% confidence interval [CI]: 1.135-1.436), also in adjusted model, higher group was significantly higher risk of hypertension than lower group (OR: 1.276; 95% CI: 1.117-1.457). Conclusions: This study showed a significant correlation between mercury and hypertension in residents around abandoned metal mines. Therefore, we should continuously monitor people who are higher than the standard value and the hypertensive patients.

6.
Technol Health Care ; 27(3): 243-256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30932906

RESUMO

BACKGROUND: Although actigraphy is widely used to measure sleep quality, few studies directly compared actigraphy data with polysomnography data, especially electromyography data. OBJECTIVE: We developed an algorithm which transforms actigraphy and electromyography signals to verify the interchangeability between them and tested the utility of this algorithm in sleep healthcare. METHODS: Thirty-eight subjects underwent polysomnography and actigraphy. We transformed electromyography signals extracted from polysomnography as integrated electromyography (IEMG) and actigraphy signals as integrated acceleration (IACC) using their physical properties. We compared receiver operating characteristic (ROC) curves obtained from transformed datasets with those of raw datasets in distinguishing REM and non-REM sleep. RESULTS: There was no significant correlation between raw electromyography and raw actigraphy data (r= 0.001, p= 0.124). After applying our transformation algorithm, significant correlation between IEMG and IACC was shown (r= 0.392, p< 0.001). In order to overcome small adjusted R2 from simple regression model (adjusted R=2 0.153, p< 0.001), we used panel data regression model to correct individual variances (adjusted R=2 0.542, p< 0.001). In ROC curve for distinguishing REM and non-REM sleep, AUCs were 0.536, 0.735 and 0.729 in raw data, IEMG and IACC respectively. CONCLUSIONS: The transformation algorithm revealed the relationship between electromyography and actigraphy data, and also yielded improved sleep staging ability.


Assuntos
Actigrafia/métodos , Algoritmos , Eletromiografia/métodos , Polissonografia/métodos , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia , Adolescente , Adulto , Eletricidade , Feminino , Humanos , Cinética , Masculino , Fases do Sono , Adulto Jovem
7.
Eur Radiol ; 29(6): 2821-2829, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30552478

RESUMO

OBJECTIVES: Second shot arterial phase (SSAP) imaging is an additional arterial phase image obtained by re-injecting a small amount of contrast medium after routine dynamic imaging in gadoxetic acid-enhanced liver MRI. We aimed to evaluate the feasibility and additional value of a SSAP image in gadoxetic acid-enhanced liver MRI. METHODS: One hundred seventy-two patients who underwent SSAP imaging after re-injection of 4 mL of contrast material after routine dynamic imaging (original) in gadoxetic acid-enhanced liver MRIs were included. Motion artifacts on arterial phase (AP) images were rated using a 5-point scale and were compared between the original AP images and SSAP images. We evaluated visual detection rates of arterial hypervascularity on the original AP and SSAP images and their subtraction images in patients with hypervascular hepatocellular carcinoma (HCC). RESULTS: The motion artifact of the SSAP images was significantly lower than that of the original AP images (mean score, 1.76 vs 2.06; p < 0.001). In particular, motion artifacts reduced significantly in the SSAP images of patients with substantial motion artifacts in their original AP images (2.28 vs 3.28; p < 0.001). Among the 30 HCC lesions showing hypervascularity on original AP images, only four (4/30, 13.3%) appeared hyperintense on SSAP images. However, subtraction images of SSAP clearly demonstrated arterial hypervascularity in all HCCs. CONCLUSION: SSAP images showed significantly fewer motion artifacts than the original AP images. Subtraction images of SSAP maintained the detectability of arterial hypervascularity, although SSAP images showed poor visual detection of arterial hypervascularity of HCC. KEY POINTS: • Arterial phase images obtained after a second injection of a small amount of contrast medium (second shot arterial phase [SSAP]) improved motion artifacts compared to the original AP images. • The motion artifacts improved significantly in the SSAP images of patients with substantial motion artifacts in their original AP images. • Subtraction images of SSAP demonstrated the arterial hypervascularity characteristic of HCC at a level comparable to that of the original AP image.


Assuntos
Artefatos , Carcinoma Hepatocelular/diagnóstico por imagem , Gadolínio DTPA/farmacologia , Artéria Hepática/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/irrigação sanguínea , Meios de Contraste/farmacologia , Feminino , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
J Comput Assist Tomogr ; 43(1): 119-127, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30052618

RESUMO

OBJECTIVE: The aim of this study was to describe magnetic resonance imaging findings of newly categorized ovarian seromucinous tumors. METHODS: We retrospectively reviewed the images of 29 patients with seromucinous tumor for the following factors: size, configuration, signal intensity (SI), and accompanying ovarian endometriosis. RESULTS: Thirty-two tumors (17 benign, 7 borderline, 8 carcinoma) were found on computed tomography or magnetic resonance imaging. Their mean size was 11.4 cm. Benign tumors appeared as unilocular or multilocular cystic masses. Borderline tumors and carcinomas appeared as complex cystic-solid masses. T2-weighted SI of the solid portion was hyperintense in borderline tumors and intermediate in carcinomas. Endometriosis was present in 18 tumors, and hemorrhage (on images) in 20. CONCLUSIONS: The imaging features of seromucinous tumors varied by tumor type. More than half of tumors were accompanied by endometriosis. High T2-weighted SI of the solid portion could be a specific feature of borderline tumors. It is hard to differentiate seromucinous carcinomas from other endometriosis-related carcinomas.


Assuntos
Imagem por Ressonância Magnética/métodos , Neoplasias Císticas, Mucinosas e Serosas/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Ovário/diagnóstico por imagem , Estudos Retrospectivos
9.
Arthroscopy ; 34(9): 2530-2536, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30173793

RESUMO

PURPOSE: To identify the risk factors for recurrent instability after arthroscopic Bankart repair and evaluate the recurrence rate and functional outcomes. METHODS: A retrospective review was performed of patients with anterior-inferior shoulder instability who underwent arthroscopic Bankart repair between 2008 and 2014. Patients below 30 years of age who were available for follow-up at least for 2 years were sorted into 2 groups according to the presence of recurrent instability. Furthermore, statistical analysis by binary logistic regression analysis included the significance of various risk factors including gender, demographic factors, number of preoperative dislocations, time interval between the first dislocation and the surgery (shorter than 6 months or not), generalized hyperlaxity, concomitant injury, bony Bankart, and off-track lesion. The functional outcomes were assessed with the Rowe and Walch-Duplay scores. RESULTS: A total of 170 shoulders were included (without-recurrence group: 138, recurrent group: 32). The overall postoperative recurrent instability rate was 18.8%. SLAP repair, interval closure, and capsular plication were performed when necessary. However, these additional procedures were not influenced by recurrence (P = .37). The 2 groups showed significant differences in the number of preoperative dislocations (P = .048; adjusted odds ratio [OR] 2-5 times, 6.41; more than 5 times, 8.77), time interval between the first dislocation and surgery (P = .003, adjusted OR 5.62), and off-track Hill-Sachs lesion (P = .04, adjusted OR 4.31). There was significant improvement in the mean Rowe and Walch-Duplay scores at 2 years postoperatively (P < .001 in both cases), but the mean scores were lower in the group with recurrence than in the group without (P = .021 and .014, respectively). CONCLUSIONS: The overall results suggest that surgery within 6 months of the first dislocation should be considered, with meticulous attention in patients with a high number of preoperative dislocations or off-track Hill-Sachs lesions. LEVEL OF EVIDENCE: Level III, retrospective case-control study.


Assuntos
Artroscopia/métodos , Lesões de Bankart/cirurgia , Instabilidade Articular/cirurgia , Luxação do Ombro/cirurgia , Adolescente , Adulto , Artroplastia/efeitos adversos , Artroscopia/efeitos adversos , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Razão de Chances , Complicações Pós-Operatórias , Recidiva , Estudos Retrospectivos , Fatores de Risco , Tempo para o Tratamento , Adulto Jovem
10.
Int Orthop ; 42(4): 867-874, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29197943

RESUMO

PURPOSE: This study aimed to evaluate the clinical outcomes and persistent infection rate of two-stage revision of infected shoulder arthroplasty. METHODS: We enrolled 12 patients who developed an infection after undergoing shoulder arthroplasty between January 2009 and January 2014. They underwent a two-stage revision with PROSTALAC implantation and shoulder re-implantation in the first- and second-stage surgery, respectively. The mean follow-up period was 40.88 months (range, 36-52 months). After the second-stage re-implantation, clinical scores, erythrocyte sedimentation rate, as well as C-reactive protein level were evaluated, and the presence of re-infection and complications were analyzed. RESULTS: Infection was improved in all the cases after PROSTALAC insertion. The mean range of motion of forward elevation, external rotation, and internal rotation at the final follow-up after the second-stage re-implantation were 81.67°, 40.42°, and 16.67° (vertebral level), respectively. The mean visual analog scale score improved from 7.08 points before surgery to 2.33 points after surgery. The Modified American Shoulder and Elbow Surgeons score improved from 32.25 before surgery to 64.17 after surgery (P < 0.05). The Constant shoulder score also improved from 30.92 before surgery to 66.08 after surgery (P < 0.05). Infection had not recurred until the final follow-up. However, dislocation and separation of components were found in two patients who needed a structural allograft because of segmental bone defects. CONCLUSION: Using PROSTALAC in two-stage revision arthroplasty is effective for infection control and produced good clinical outcomes after second-stage shoulder re-implantation. However, cases involving segmental bone defects require additional precautions in maintaining the appropriate tension and height to prevent complications.


Assuntos
Antibacterianos/administração & dosagem , Artrite Infecciosa/cirurgia , Artroplastia do Ombro/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Reoperação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/métodos , Cimentos para Ossos/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese/efeitos adversos , Desenho de Prótese/métodos , Infecções Relacionadas à Prótese/microbiologia , Amplitude de Movimento Articular , Reoperação/efeitos adversos , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Prótese de Ombro/efeitos adversos , Prótese de Ombro/microbiologia , Resultado do Tratamento , Escala Visual Analógica
11.
Cell Death Dis ; 8(12): 3201, 2017 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-29233982

RESUMO

Peroxisome proliferator-activated receptor γ (PPARγ) is the master regulator of adipocyte differentiation and is closely linked to the development of obesity. Despite great progress in elucidating the transcriptional network of PPARγ, epigenetic regulation of this pathway by histone modification remains elusive. Here, we found that CDK2-associated cullin 1 (CACUL1), identified as a novel SIRT1 interacting protein, directly bound to PPARγ through the co-repressor nuclear receptor (CoRNR) box 2 and repressed the transcriptional activity and adipogenic potential of PPARγ. Upon CACUL1 depletion, less SIRT1 and more LSD1 were recruited to the PPARγ-responsive gene promoter, leading to increased histone H3K9 acetylation, decreased H3K9 methylation, and PPARγ activation during adipogenesis in 3T3-L1 cells. These findings were reversed upon fasting or resveratrol treatment. Further, gene expression profiling using RNA sequencing supported the repressive role of CACUL1 in PPARγ activation and fat accumulation. Finally, we confirmed CACUL1 function in human adipose-derived stem cells. Overall, our data suggest that CACUL1 tightly regulates PPARγ signaling through the mutual opposition between SIRT1 and LSD1, providing insight into its potential use for anti-obesity treatment.


Assuntos
Adipócitos/metabolismo , Adipogenia/genética , Proteínas de Transporte/genética , Epigênese Genética , Histona Desmetilases/genética , PPAR gama/genética , Sirtuína 1/genética , Células 3T3-L1 , Adipócitos/citologia , Adipócitos/efeitos dos fármacos , Adipogenia/efeitos dos fármacos , Animais , Proteínas de Transporte/metabolismo , Diferenciação Celular , Proteínas Correpressoras/genética , Proteínas Correpressoras/metabolismo , Proteínas Culina , Células HCT116 , Células HEK293 , Histona Desmetilases/metabolismo , Histonas/genética , Histonas/metabolismo , Humanos , Camundongos , PPAR gama/metabolismo , Resveratrol , Análise de Sequência de RNA , Transdução de Sinais , Sirtuína 1/metabolismo , Estilbenos/farmacologia
12.
Sensors (Basel) ; 17(10)2017 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-29065564

RESUMO

Hotspot analysis was implemented to find regions in the province of Alberta (Canada) with high frequency Cloud to Ground (CG) lightning strikes clustered together. Generally, hotspot regions are located in the central, central east, and south central regions of the study region. About 94% of annual lightning occurred during warm months (June to August) and the daily lightning frequency was influenced by the diurnal heating cycle. The association rule mining technique was used to investigate frequent CG lightning patterns, which were verified by similarity measurement to check the patterns' consistency. The similarity coefficient values indicated that there were high correlations throughout the entire study period. Most wildfires (about 93%) in Alberta occurred in forests, wetland forests, and wetland shrub areas. It was also found that lightning and wildfires occur in two distinct areas: frequent wildfire regions with a high frequency of lightning, and frequent wild-fire regions with a low frequency of lightning. Further, the preference index (PI) revealed locations where the wildfires occurred more frequently than in other class regions. The wildfire hazard area was estimated with the CG lightning hazard map and specific land use types.

13.
Int J Mol Sci ; 18(8)2017 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-28786931

RESUMO

This study was conducted to evaluate the effect of biphasic calcium phosphate (BCP) coated with reduced graphene oxide (rGO) as bone graft materials on bone regeneration. The rGO-coated BCP bone graft material was fabricatied by mixing rGO and BCP at various concentrations. The surface charge of rGO-coated BCP was measured to be -14.43 mV, which formed a static electrostatic interaction. Cell viabilities were significantly diminished at higher concentrations of ≥100 µg/mL. The calvarial defects of 48 rats were implanted rGO-coated BCPs at a weight ratio of 2:1000 (rGO2), 4:1000 (rGO4), and 10:1000 (rGO10), repectively. BCP was used as a control group. The micro-CT and histological analysis were performed to evaluate new bone formation at 2 and 8 weeks after surgery. The results showed that the new bone volume (mm³) was significantly higher in the experimental groups than in the control group. Histological analysis showed that new bone areas (%) were significantly higher in the rGO2 and rGO10 than in the control, and significantly higher in rGO4 than in the rGO2 and rGO10. Conclusively, the rGO-coated BCP was found to be effective on osteogenesis and the concentration of the composite was an important factor.


Assuntos
Regeneração Óssea , Substitutos Ósseos , Materiais Revestidos Biocompatíveis , Grafite/química , Hidroxiapatitas/química , Osteogênese , Óxidos , Animais , Substitutos Ósseos/química , Transplante Ósseo , Linhagem Celular , Sobrevivência Celular , Masculino , Osteoblastos/citologia , Osteoblastos/metabolismo , Óxidos/química , Ratos , Microtomografia por Raio-X
14.
Am J Sports Med ; 45(11): 2555-2562, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28787191

RESUMO

BACKGROUND: The subscapularis tendon is essential in maintaining normal glenohumeral biomechanics. However, few studies have addressed the outcomes of tears extending to the subscapularis tendon in massive rotator cuff tears. PURPOSE: To assess the clinical and structural outcomes of arthroscopic repair of massive rotator cuff tears involving the subscapularis. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between January 2010 and January 2014, 122 consecutive patients with massive rotator cuff tear underwent arthroscopic rotator cuff repair. Overall, 122 patients were enrolled (mean age, 66 years; mean follow-up period, 39.5 months). Patients were categorized into 3 groups based on subscapularis tendon status: intact subscapularis tendon (I group; n = 45), tear involving less than the superior one-third (P group; n = 35), and tear involving more than one-third of the subscapularis tendon (C group; n = 42). All rotator cuff tears were repaired; however, subscapularis tendon tears involving less than the superior one-third in P group were only debrided. Pain visual analog scale, Constant, and American Shoulder and Elbow Surgeons scores and passive range of motion were measured preoperatively and at the final follow-up. Rotator cuff integrity, global fatty degeneration index, and occupation ratio were determined via magnetic resonance imaging preoperatively and 6 months postoperatively. RESULTS: We identified 37 retears (31.1%) based on postoperative magnetic resonance imaging evaluation. Retear rate in patients in the C group (47.6%) was higher than that in the I group (22.9%) or P group (20.0%) ( P = .011). Retear subclassification based on the involved tendons showed that subsequent subscapularis tendon retears were noted in only the C group. The improvement in clinical scores after repair was statistically significant in all groups but not different among the groups. Between-group comparison showed significant differences in preoperative external rotation ( P = .021). However, no statistically significant difference was found in any shoulder range of motion measurements after surgery. CONCLUSION: Arthroscopic repair of massive tears results in substantial improvements in shoulder function, despite the presence of combined subscapularis tears. However, this study showed a high failure rate of massive posterosuperior rotator cuff tear repair extending more than one-third of the subscapularis tendon. When combined subscapularis tendon tear was less than the superior one-third of the subscapularis tendon, arthroscopic debridement was a reasonable treatment method where comparable clinical and anatomic outcomes could be expected.


Assuntos
Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/cirurgia , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/cirurgia , Idoso , Artroscopia/métodos , Desbridamento , Feminino , Seguimentos , Humanos , Lacerações/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor , Amplitude de Movimento Articular , Recidiva , Estudos Retrospectivos , Rotação , Lesões do Manguito Rotador/patologia , Ruptura/cirurgia , Traumatismos dos Tendões/patologia , Resultado do Tratamento
15.
J Orthop Surg Res ; 12(1): 93, 2017 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-28615040

RESUMO

BACKGROUND: Attempts have been made to validate the significance of remnant preservation with anterior cruciate ligament (ACL) reconstruction using immunohistochemical and immunocytochemical techniques. The purpose of this study was to examine the expression of mechanoreceptors in the remnant tissue of ACL reconstruction performed with the remnant-preserving technique. METHODS: Tissue samples were obtained from 10 patients who underwent ACL reconstruction with the remnant-preserving technique. The specimens were obtained from remnant ACL tissue and Achilles allografts superficially and at the tibial attachment. The control group consisted of three normal ACLs procured from young males who underwent partial meniscectomy. Tissues and cells from the ACL remnants and Achilles allografts were characterized using hematoxylin and eosin (H&E) staining and immunohistochemical, immunocytochemical, and immunoblotting assays. In particular, the sensitivity of neural cell validation was improved using nerve growth factor (NGF) to stimulate the expression of neural cells. RESULTS: The results are summarized as follows. (1) In H&E staining and immunohistochemical assays, no neural cells were detected in remnant or allograft tissue. (2) In the immunocytochemical study, neural cells were detected in remnant tissue. (3) The increased proliferation of remnant ACL cells with NGF treatment suggested their identity as neural cells. (4) NGF treatment also stimulated protein and RNA expression of Nestin (a specific marker for neural cells) in remnant ACL cells. CONCLUSIONS: The improved immunocytochemical methodology proved useful. Although mechanoreceptors were detected relatively less frequently than expected, the authors consider that this finding does not negate the necessity of remnant-preserving ACL reconstruction.


Assuntos
Tendão do Calcâneo/transplante , Reconstrução do Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/citologia , Mecanorreceptores , Adolescente , Adulto , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Invest Radiol ; 52(10): 605-611, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28441159

RESUMO

PURPOSE: The aim of this study was to compare intraindividual single and multiple arterial phase acquisitions and evaluate which acquisition method was more advantageous for obtaining high-quality hepatic arterial phase in gadoxetic acid-enhanced liver magnetic resonance imaging (MRI). MATERIALS AND METHODS: Sixty-seven patients who underwent gadoxetic acid-enhanced liver MRIs and had all 3 kinds of acquisitions (single, dual, and triple arterial phases) were retrospectively included. For hepatic arterial phase imaging, controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) with or without time-resolved imaging with interleaved stochastic trajectories (TWIST) was used. The adequacy of optimal hepatic arterial timing was assessed and respiratory motion artifacts were rated using a 5-point scale, with the highest score indicating the worst image quality. Optimal timing and respiratory motion artifacts among 3 different acquisitions were compared using Fisher exact test and repeated measures one-way analysis of variance with multiple comparisons. RESULTS: Optimal timing of hepatic arterial phase was observed in 89.6% (60/67) of single arterial phase acquisitions and 98.5% (66/67) of both dual and triple arterial phase acquisitions (P = 0.015). Respiratory motion artifact was significantly lower in single and dual arterial acquisitions than in triple arterial acquisition (mean score, 1.70 vs 1.90 vs 2.49; P < 0.001), although there was no significant difference between single and dual arterial acquisitions (P = 0.091). CONCLUSIONS: A 15-second breath-hold dual arterial phase acquisition during gadoxetic acid-enhanced MRI reliably offers well-timed hepatic arterial phase with less respiratory motion artifact. However, a 13-second breath-hold single arterial phase acquisition was most effective in reducing respiratory motion artifact.


Assuntos
Meios de Contraste , Gadolínio DTPA , Aumento da Imagem/métodos , Neoplasias Hepáticas/diagnóstico , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artefatos , Suspensão da Respiração , Feminino , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/patologia , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Movimento (Física) , Estudos Retrospectivos
17.
Arthroscopy ; 33(8): 1506-1511, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28454997

RESUMO

PURPOSE: To evaluate the clinical and functional outcomes of arthroscopic debridement arthroplasty with the release of the posterior band of the medial collateral ligament in patients with primary osteoarthritis. METHODS: We evaluated 43 patients treated with arthroscopic debridement arthroplasty for elbow osteoarthritis from February 2006 to February 2014. In group A (n = 19), the posterior band of the medial collateral ligament was released, and in group B (n = 24), it was not released. The mean follow-up period in groups A and B was 55.4 months (range, 24-100 months) and 62.2 months (range, 24-103 months), respectively. Clinical results were evaluated by measuring the preoperative and postoperative range of motion (ROM) of the elbow, visual analog scale score, and Mayo Elbow Performance Score. RESULTS: Both groups showed significant improvement in clinical outcome (visual analog scale and Mayo Elbow Performance Score) at the final follow-up compared with preoperative evaluation (group A, P = .009 and .013, respectively; group B, P = .015 and .008, respectively). Group A showed significant improvement in increased flexion at 6 months of follow-up (P = .043). However, there was no statistically significant difference in postoperative ROM and clinical results between the 2 groups at the final follow-up (P = .482). CONCLUSIONS: Arthroscopic debridement arthroplasty with the release of the posterior band of the medial collateral ligament was associated with improved flexion at the 6-month postoperative follow-up, but no significant difference between the groups was observed at the final follow-up. Therefore, the additional release of the posterior band of the medial collateral ligament may be unnecessary for improving postoperative ROM. LEVEL OF EVIDENCE: Level IV, therapeutic case series.


Assuntos
Ligamentos Colaterais/cirurgia , Articulação do Cotovelo/cirurgia , Osteoartrite/cirurgia , Adulto , Artroscopia/métodos , Desbridamento/métodos , Feminino , Humanos , Masculino , Medição da Dor , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
18.
Clin Imaging ; 43: 127-131, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28314197

RESUMO

OBJECTIVES: To determine the prognostic value of Gd-EOB-DTPA MRI findings of liver metastasis from breast cancer. METHODS: 29 metastatic lesions from 12 breast cancer patients who received chemotherapy were retrospectively reviewed. We evaluated hepatobiliary phase of the lesions and classified them as a "target" or "non-target" appearance. The relationship of appearance or SI ratio with tumor response was analyzed. RESULTS: A non-target appearance was more frequent in disease control group than in non-control group [14/18 (77.8%) vs. 4/18 (22.2%)], and it was associated with a better response [p=0.048]. CONCLUSION: HBP analysis may be useful to predict the response to chemotherapy and survival.


Assuntos
Sistema Biliar/diagnóstico por imagem , Neoplasias da Mama/patologia , Meios de Contraste , Gadolínio DTPA , Neoplasias Hepáticas/secundário , Fígado/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Antineoplásicos/uso terapêutico , Sistema Biliar/patologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Feminino , Gadolínio , Humanos , Fígado/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Pessoa de Meia-Idade , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
19.
Eur J Radiol ; 89: 169-176, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28267535

RESUMO

PURPOSE: To compare the response to transcatheter arterial chemoembolization (TACE) between hepatocellular carcinoma (HCC) with paradoxical uptake on the hepatobiliary phase (HBP) (HCCpara) and HCC with defect on the HBP (HCCdef), and to identify some imaging features that can differentiate between two groups. MATERIALS AND METHODS: Ninety-three HCCs from 54 patients who underwent gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) prior to TACE were included. HCCs were classified into two groups according to the signal intensity (SI) on the HBP: HCCpara and HCCdef. Using post-TACE computed tomography (CT) as a reference standard, initial compact lipiodol uptake was assessed and compared between groups. The arterial enhancement ratio (AER), SI ratios of the arterial phase and HBP, and presence of the capsule appearance were compared between groups. After initial response, local tumor recurrence within 6 and 18 months was evaluated based on follow-up CT or MRI. RESULTS: Fifteen HCCpara and 78 HCCdef were included. Compared to HCCdef, HCCpara showed more frequent initial compact lipiodol uptake (p=0.009), larger mean size (p=0.019), lower AER (p=0.005), higher SI ratio of the HBP (p<0.0001), and more frequent capsule appearance (p<0.0001). Local tumor recurrence rate within 6 months was also significantly lower in HCCpara than in HCCdef (p=0.008). CONCLUSION: Despite larger size and lower AER, HCCpara showed more frequent initial compact lipiodol uptake and lower early local recurrence rate after TACE than did HCCdef.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Meios de Contraste/farmacocinética , Óleo Etiodado/farmacocinética , Feminino , Gadolínio DTPA , Humanos , Neoplasias Hepáticas/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
20.
Int. j. morphol ; 35(1): 21-25, Mar. 2017. ilus
Artigo em Inglês | LILACS | ID: biblio-840926

RESUMO

The incidence of detection of accessory hepatic vein (AHV) using MRI or CT has been reported. However, previous studies had a small sample size or only reported on the incidence of hepatic vein variants. To the best of our knowledge, there has been no previous report evaluating the factors predictive of the presence of an AHV. To evaluate the incidence and morphology of the accessory hepatic vein (AHV) using multidetector row computed tomography (MDCT) and to investigate the factors which may be helpful in predicting the presence of an AHV. We enrolled 360 patients who underwent abdominal MDCT. We investigated whether the AHV was present and evaluated the frequency of AHVs greater than 5 mm in diameter. We classified the morphology of the AHV entering the inferior vena cava (IVC). We also examined the factors that predicted the presence of an AHV by comparing the diameter of the middle hepatic vein (MHV) and the right hepatic vein (RHV). We identified an AHV in 164 of the 360 patients (45.6 %). Among the 164 AHVs, 56.7 % were larger than 5 mm in diameter. The most common morphologies of the inferior RHV were a single main trunk (58.5 %), followed by two main trunks with a V-shape (19.5 %) and two trunks entering the IVC separately (17.0 %). The possibility that an AHV will be present was significantly higher when the diameter of the RHV was smaller than that of the MHV. MDCT can provide important information regarding AHV incidence and morphology. The possibility of an AHV being present was significantly higher when the diameter of the RHV was smaller than that of the MHV.


Se ha informado de la incidencia de la detección de la vena hepática accesoria (VHA) mediante RM o TC. Sin embargo, estudios previos tenían un tamaño muestral pequeño o solo informaban sobre la incidencia de variantes de las venas hepáticas. Hasta donde sabemos, no ha habido ningún informe previo que evalúe los factores predictivos de la presencia de una VHA. El objetivo del estudio fue evaluar la incidencia y morfología de la vena hepática accesoria (VHA) mediante tomografía computarizada multidetector (TCMD) e investigar los factores que pueden ser útiles para predecir la presencia de un VHA. Se evaluaron 360 pacientes que se sometieron a TCMD abdominal. Se investigó si la VHA estaba presente y se evaluó la frecuencia de VHA mayores de 5 mm de diámetro. Se clasificó la morfología del VHA que drenaba en la vena cava inferior (VCI). Además, se examinaron los factores que predijeron la presencia de una VHA mediante la comparación del diámetro de la vena hepática media (VHM) y la vena hepática derecha (VHD). Se identificó un VHA en 164 de los 360 pacientes (45,6%). Entre las 164 VHA, el 56,7% tenía más de 5 mm de diámetro. Las morfologías más frecuentes del VHD inferior fueron un tronco principal único (58,5%), seguido por dos troncos principales con forma de V (19,5%) y dos troncos que drenaban en la VCI por separado (17,0%). La posibilidad de que una VHA esté presente fue significativamente mayor cuando el diámetro de la VHD era menor que la de la VHM. La MDCT puede proporcionar información importante sobre la incidencia de la VHA y su morfología. La posibilidad de que un VHA estuviera presente era significativamente mayor cuando el diámetro del VHD era menor que la VHM.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Veias Hepáticas/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Veias Hepáticas/anormalidades , Fígado/irrigação sanguínea , Prognóstico
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