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1.
Otolaryngol Head Neck Surg ; 166(3): 572-579, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34154442

RESUMO

OBJECTIVE: Examine the rates and factors associated with under- and overreporting of subjective changes in smell or taste as compared with objective measures. STUDY DESIGN: Cross-sectional analysis. SETTING: National Health and Nutrition Examination Survey (2013-2014). METHODS: We examined participants ≥40 years old who completed subjective questionnaires (smell, n = 3510; taste, n = 3089), validated objective 8-odor pocket smell tests, and NaCl/quinine taste tests. Over- and underreporting was determined by the difference in subjective and objective results. Univariate and multivariate logistic regression analyses incorporated sampling weights. RESULTS: A majority of participants correctly classified impairment: smell (73.7%; 95% CI, 71.2%-76.1%) and taste (78.3%; 95% CI, 75.6%-80.7%). Age ≥65 years (odds ratio, 2.23; P = .001) was associated with underreporting impairment, and persistent cold symptoms (odds ratio, 2.15; P = .001) were associated with overreporting smell impairment. Smoke, onion, and natural gas scents were incorrectly identified more frequently by individuals aged ≥65 years after Bonferroni correction. No factors were associated with under- and overreporting taste impairment. CONCLUSION: Although the concordance rate between subjective and objective assessment of smell and taste impairment remains high, we found that older age was associated with incorrect report of impairment. This suggests that the subjective perception of smell varies across demographical and clinical factors, and it is important to not overlook such factors in clinical practice. Potentially using a simplified odor assessment regularly in the clinical setting may aid in early detection and intervention.


Assuntos
Transtornos do Olfato , Olfato , Adulto , Estudos Transversais , Humanos , Inquéritos Nutricionais , Transtornos do Olfato/diagnóstico , Paladar , Distúrbios do Paladar/diagnóstico
2.
Tissue Barriers ; 8(3): 1804249, 2020 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-32835592

RESUMO

Periodontitis is one of the most common oral diseases worldwide and is caused by a variety of interactions between oral bacteria and the host. Here, pathogens induce inflammatory host responses that cause the secretion of proinflammatory cytokines such as IL-1ß, IL-6, and IL-8 by oral epithelial cells. In various systems, it has been shown that inflammation compromises physical barriers, which enables bacteria to invade the tissue. In this study, we investigated the barrier properties of the oral mucosa under physiological and inflamed conditions. For this purpose, we assessed the influence of IL-1ß on the transepithelial electrical resistance and in particular on tight junctions in vitro in human stratified squamous epithelium models. Indirect immunofluorescence and western blot analyses were performed to investigate localization and expression of tight junction proteins in primary gingival cells, immortalized gingival cells and native gingiva. Furthermore, the TEER of gingival keratinocytes was assessed. The results showed that IL-1ß led to strengthening of the gingival keratinocyte barrier. This was demonstrated by an increase in TEER, the upregulation of TJ proteins, and an increase in the formation of TJ strands. The IL-1ß-mediated upregulation of occludin was prevented by the NF-κB inhibitor BAY 11-7085. These observations provide insights into host responses in the early stages of periodontal disease and offer information about TJ formation in human gingival epithelial cells under physiological and inflammatory conditions. Comprehensive knowledge of the physical barrier during inflammation may help in developing strategies to effectively target the inflammatory barrier to improve the bioavailability of drugs for the treatment of periodontitis.


Assuntos
Gengiva/metabolismo , Interleucina-1beta/farmacologia , Queratinócitos/efeitos dos fármacos , Junções Íntimas/metabolismo , Linhagem Celular , Gengiva/citologia , Humanos , Queratinócitos/metabolismo , NF-kappa B/metabolismo , Ocludina/metabolismo
3.
Biochem Biophys Res Commun ; 520(1): 225-230, 2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31587870

RESUMO

AIM: AF1q has a precise oncogenic function. The purpose of this study is to investigate whether CBD has an effect on the AF1q/ICAM-1 regulatory axis in Burkitt's lymphoma (BL), and thus has potential to enhance immunotherapy and reduce side effects. METHODS: We established BL cell lines with altered AF1q expression using lentivirus. After confirmation of gene expression by RT-PCR, cells were treated with CBD followed by co-culture of killing assay. RESULTS: AF1q increased oncogenic growth and colony formation, and induced resistance against cell-mediated cytotoxic chemotherapy through attenuation of ICAM-1 expression in BL. CBD was able to reverse the acquired resistance mediated by AF1q/ICAM-1 regulatory axis. CONCLUSION: CBD holds potential to enhance the efficacy of immunotherapy for BL with hyperactive AF1q/ICAM-1 regulatory axis, and warrants further study.


Assuntos
Linfoma de Burkitt/terapia , Canabidiol/farmacologia , Imunoterapia , Neoplasias da Mama/terapia , Linhagem Celular Tumoral , Proliferação de Células , Sobrevivência Celular , Técnicas de Cocultura , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Molécula 1 de Adesão Intercelular/metabolismo , Lentivirus , Leucócitos Mononucleares/citologia , Linfócitos/metabolismo , Metástase Neoplásica , Proteínas de Neoplasias/metabolismo , Proteínas Proto-Oncogênicas/metabolismo
4.
Lasers Med Sci ; 34(4): 703-709, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30280300

RESUMO

Non-invasive skin-tightening devices can induce thermal denaturation and skin shrinkage via externally applied radiofrequency emissions or high-frequency ultrasound. Therefore, the purpose of this study is to develop and test a method for measurement of skin reduction associated with application of such energy devices. Twenty-five healthy participants with mild to moderate skin laxity of the arms were enrolled. Pinpoint microtattoos were placed at each of the treatment sites to delineate two 6 × 12 cm rectangles per subject. A non-stretchable filament, tape and marking pen apparatus was used to measure the size of each rectangle before treatment and at follow-up visit by two blinded investigators. After randomization, one side received a single pass with a radiofrequency device (6.78 MHz), while the contralateral side received multiple passes. Participants underwent two treatment sessions to each side 2 weeks apart, and returned for follow-up 4 weeks after the second treatment. Length and area measurement were analyzed to assess precision and accuracy of measurements and to compare efficacy of treatment between pre- and post-treatment. Concordance correlation coefficients (CCC) demonstrated substantial inter-investigator reliability and precision in length measurements (CCC, 0.94 to 0.98 in pre-treatment; 0.95 to 0.98 in post-treatment). Measurements at the 6-week post-treatment follow-up demonstrated a statistically significant skin reduction in all six of the measured parameters. A simple skin measurement method requiring minimal instrumentation can quantitatively evaluate skin shrinkage associated with non-invasive skin-tightening devices.


Assuntos
Envelhecimento da Pele/patologia , Pele/patologia , Tatuagem , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Ondas de Rádio , Reprodutibilidade dos Testes , Resultado do Tratamento
5.
Sci Transl Med ; 10(465)2018 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-30381410

RESUMO

Hydrocephalus is a common and costly neurological condition caused by the overproduction and/or impaired resorption of cerebrospinal fluid (CSF). The current standard of care, ventricular catheters (shunts), is prone to failure, which can result in nonspecific symptoms such as headaches, dizziness, and nausea. Current diagnostic tools for shunt failure such as computed tomography (CT), magnetic resonance imaging (MRI), radionuclide shunt patency studies (RSPSs), and ice pack-mediated thermodilution have disadvantages including high cost, poor accuracy, inconvenience, and safety concerns. Here, we developed and tested a noninvasive, skin-mounted, wearable measurement platform that incorporates arrays of thermal sensors and actuators for precise, continuous, or intermittent measurements of flow through subdermal shunts, without the drawbacks of other methods. Systematic theoretical and experimental benchtop studies demonstrate high performance across a range of practical operating conditions. Advanced electronics designs serve as the basis of a wireless embodiment for continuous monitoring based on rechargeable batteries and data transmission using Bluetooth protocols. Clinical studies involving five patients validate the sensor's ability to detect the presence of CSF flow (P = 0.012) and further distinguish between baseline flow, diminished flow, and distal shunt failure. Last, we demonstrate processing algorithms to translate measured data into quantitative flow rate. The sensor designs, fabrication schemes, wireless architectures, and patient trials reported here represent an advance in hydrocephalus diagnostics with ability to visualize flow in a simple, user-friendly mode, accessible to the physician and patient alike.


Assuntos
Derivações do Líquido Cefalorraquidiano , Epiderme/fisiologia , Hidrocefalia/fisiopatologia , Dispositivos Eletrônicos Vestíveis , Tecnologia sem Fio , Humanos , Reologia , Incerteza
6.
Exp Cell Res ; 373(1-2): 99-111, 2018 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-30342992

RESUMO

Neuroinflammation is often associated with pathological changes in the function of the blood-brain barrier (BBB) caused by disassembly of tight and adherens junctions that under physiological conditions are important for the maintenance of the BBB integrity. Consequently, in inflammation the BBB becomes dysfunctional, facilitating leukocyte traversal of the barrier and accumulation of immune cells within the brain. The extracellular matrix (ECM) also contributes to BBB integrity but the significance of the main ECM receptors, the ß1 integrins also expressed on endothelial cells, is less well understood. To evaluate whether ß1 integrin function is affected during inflammation and impacts barrier function, we used a transformed human brain microvascular endothelial cell (THBMEC)-based Interleukin 1ß (IL-1ß)-induced inflammatory in vitro BBB model. We demonstrate that IL-1ß increases cell-matrix adhesion and induces a redistribution of active ß1 integrins to the basal surface. In particular, binding of α5ß1 integrin to its ligand fibronectin is enhanced and α5ß1 integrin-dependent signalling is upregulated. Additionally, localisation of the tight junction protein claudin-5 is altered. Blockade of the α5ß1 integrin reduces the IL-1ß-induced transendothelial migration of peripheral blood mononuclear cells (PBMCs). These data imply that IL-1ß-induced inflammation not only destabilizes tight junctions but also increases α5ß1 integrin-dependent cell-matrix adhesion to fibronectin.


Assuntos
Encéfalo/irrigação sanguínea , Células Endoteliais/metabolismo , Endotélio Vascular/metabolismo , Integrina alfa5beta1/metabolismo , Interleucina-1beta/farmacologia , Leucócitos Mononucleares/fisiologia , Migração Transendotelial e Transepitelial , Barreira Hematoencefálica , Adesão Celular/efeitos dos fármacos , Células Cultivadas , Células Endoteliais/efeitos dos fármacos , Células Endoteliais/enzimologia , Endotélio Vascular/enzimologia , Fibronectinas/metabolismo , Proteína-Tirosina Quinases de Adesão Focal/metabolismo , Humanos , Integrina alfa5/metabolismo , Integrina alfa5beta1/antagonistas & inibidores , Integrina beta1/metabolismo , Proteínas Proto-Oncogênicas pp60(c-src)/metabolismo , Transdução de Sinais/efeitos dos fármacos , Regulação para Cima
7.
Semin Thromb Hemost ; 43(6): 553-561, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28359134

RESUMO

Thrombosis leads to ischemic organ damage in cardiovascular and thromboembolic diseases. Neutrophils promote thrombosis in vitro and in vivo by releasing neutrophil extracellular traps (NETs). NETs are composed of DNA filaments coated with histones and neutrophil enzymes such as myeloperoxidase (MPO). Circulating extracellular DNA (ceDNA) is widely used as a surrogate marker to monitor NET formation in thrombosis. This narrative review summarizes the association of ceDNA with human thrombosis. Levels of ceDNA indicate the extent and outcome of several cardiovascular and thromboembolic diseases, including myocardial infarction, stroke, and venous thromboembolism. ceDNA correlates with markers of coagulation and platelet consumption, thus supporting the hypothesis that ceDNA may be a surrogate marker of thrombus formation. In addition, ceDNA levels correlate with markers of cell injury and size of ischemic lesions, suggesting that ceDNA does not derive from NETs but is probably released from damaged organs. Few studies identified NET-specific biomarkers such as DNA-MPO complexes in the blood of patients with thrombosis. In conclusion, it remains to be established whether ceDNA in patients derives from NETs and is a cause or consequence of thrombosis.


Assuntos
DNA/sangue , Armadilhas Extracelulares/metabolismo , Infarto do Miocárdio/sangue , Trombose/sangue , Biomarcadores/sangue , Humanos
8.
Res Theory Nurs Pract ; 31(1): 8-27, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-28196574

RESUMO

BACKGROUND: Long-term care (LTC) employees are at high risk for cardiovascular disease. Despite the documented benefits of worksite health promotion (WHP) programs for employees and employers and the potential benefits to residents in LTC facilities, LTC employees are rarely offered WHP programs. PURPOSE: The purpose of the intervention described in this article is to reduce cardiovascular disease risk factors among LTC workers using a physical activity, nutrition, and stress management WHP implemented during paid work time with 98 LTC staff members. METHODS: This article describes a 9-month physical activity, nutrition, and stress management WHP intervention delivered during paid work time to reduce the cardiovascular disease risk of employees working in LTC. The intervention is rooted in the social ecological model and social cognitive theory. The intervention is based on formative research and evidence-based practice recommendations and is specifically designed to reduce barriers to intervention participation (e.g., inconsistent break times and unpredictable resident care needs) and enhance motivators to program participation (e.g., enhanced social support). RESULTS: The intervention is ongoing, but measures are described. CONCLUSION: As more employers offer WHP programs, it is important that programs are tailored to meet specific employee groups and work environments. This article operationalizes a WHP research protocol with LTC employees that can be applied to reduce cardiovascular disease risk in LTC employees or similar employee groups in similar work environments.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Assistência de Longa Duração , Autoeficácia , Local de Trabalho , Adulto , Feminino , Promoção da Saúde , Humanos , Masculino , Pesquisa em Enfermagem , Serviços de Saúde do Trabalhador , Projetos de Pesquisa , Recursos Humanos
9.
Genes Dev ; 30(9): 1058-69, 2016 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-27151977

RESUMO

Motor axons approach muscles that are prepatterned in the prospective synaptic region. In mice, prepatterning of acetylcholine receptors requires Lrp4, a LDLR family member, and MuSK, a receptor tyrosine kinase. Lrp4 can bind and stimulate MuSK, strongly suggesting that association between Lrp4 and MuSK, independent of additional ligands, initiates prepatterning in mice. In zebrafish, Wnts, which bind the Frizzled (Fz)-like domain in MuSK, are required for prepatterning, suggesting that Wnts may contribute to prepatterning and neuromuscular development in mammals. We show that prepatterning in mice requires Lrp4 but not the MuSK Fz-like domain. In contrast, prepatterning in zebrafish requires the MuSK Fz-like domain but not Lrp4. Despite these differences, neuromuscular synapse formation in zebrafish and mice share similar mechanisms, requiring Lrp4, MuSK, and neuronal Agrin but not the MuSK Fz-like domain or Wnt production from muscle. Our findings demonstrate that evolutionary divergent mechanisms establish muscle prepatterning in zebrafish and mice.


Assuntos
Evolução Biológica , Proteínas da Matriz Extracelular/metabolismo , Proteínas do Tecido Nervoso/metabolismo , Junção Neuromuscular/embriologia , Junção Neuromuscular/genética , Receptores Proteína Tirosina Quinases/metabolismo , Transdução de Sinais , Proteínas de Peixe-Zebra/metabolismo , Peixe-Zebra/embriologia , Animais , Padronização Corporal/genética , Proteínas da Matriz Extracelular/genética , Proteínas de Homeodomínio , Camundongos , Proteínas do Tecido Nervoso/genética , Receptores Proteína Tirosina Quinases/genética , Peixe-Zebra/genética , Proteínas de Peixe-Zebra/genética
10.
J Am Acad Dermatol ; 75(3): 585-589, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27125531

RESUMO

BACKGROUND: Guided imagery and music can reportedly reduce pain and anxiety during surgery, but no comparative study has been performed for cutaneous surgery to our knowledge. OBJECTIVES: We sought to determine whether short-contact recorded guided imagery or relaxing music could reduce patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures. METHODS: Subjects were adults undergoing excisional surgery for basal and squamous cell carcinoma. Randomization was to guided imagery (n = 50), relaxing music (n = 54), or control group (n = 51). Primary outcomes were pain and anxiety measured using visual analog scale and 6-item short-form of the State-Trait Anxiety Inventory, respectively. Secondary outcomes were anxiety of surgeons measured by the 6-item short-form of the State-Trait Anxiety Inventory and physical stress of patients conveyed by vital signs, respectively. RESULTS: There were no significant differences in subjects' pain, anxiety, blood pressure, and pulse rate across groups. In the recorded guided imagery and the relaxing music group, surgeon anxiety was significantly lower than in the control group. LIMITATIONS: Patients could not be blinded. CONCLUSION: Short-contact recorded guided imagery and relaxing music appear not to reduce patient pain and anxiety during excisional procedures under local anesthetic. However, surgeon anxiety may be reduced when patients are listening to such recordings.


Assuntos
Ansiedade/prevenção & controle , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Imagens, Psicoterapia/métodos , Música/psicologia , Dor/prevenção & controle , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Ansiedade/etiologia , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Satisfação do Paciente/estatística & dados numéricos , Terapia de Relaxamento , Medição de Risco , Método Simples-Cego , Neoplasias Cutâneas/patologia , Cirurgiões/psicologia , Resultado do Tratamento
12.
JAMA Dermatol ; 150(8): 844-9, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24919799

RESUMO

IMPORTANCE: Neocollagenesis can be achieved using a dermal rolling needle device, thereby reducing the appearance of acne scars. OBJECTIVE: To determine the efficacy of a needling device for treatment of acne scars. DESIGN, SETTING, AND PARTICIPANTS: We performed a single-center, rater-blinded, balanced (1:1), split-face, placebo-controlled, parallel-group randomized clinical trial at an urban academic institution. The study took place from November 30, 2009, through July 27, 2010. Twenty healthy adults (age range, 20-65 years) with acne scars on both sides of the face were enrolled. Fifteen individuals completed the study, and no enrolled participants were withdrawn for adverse effects. INTERVENTIONS: For each participant, one side of the face was randomized for needling. Three needling treatments were performed at 2-week intervals. MAIN OUTCOMES AND MEASURES: Two blinded dermatologists separately rated participants' acne scars based on standard digital photographs obtained at baseline and at the 3-month and 6-month follow-up visits on the quantitative global scarring grading system. RESULTS: Mean scar scores were significantly lower in the treatment group compared with baseline at 6 months (mean difference, 3.4; 95% CI, 0.2-6.5; P = .03) and nominally but not significantly lower compared with baseline at 3 months (mean difference, 2.4; 95% CI, -0.01 to 4.8; P = .052). In the control group, mean scar scores did not vary significantly from baseline at 3 months (mean difference, 1.0; 95% CI, -1.4 to 3.4; P = .96) and at 6 months (mean difference, 0.4; 95% CI, -2.3 to 3.5; P > .99). The needling procedure was not particularly painful, with a mean pain rating of 1.08 of 10. Participants perceived a 41% mean improvement in overall scar appearance on the treated side. No adverse events were reported. CONCLUSIONS AND RELEVANCE: After 3 needling treatments, there was improvement in the appearance of acne scars over time compared with the control group, with minimal pain reported. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00974870.


Assuntos
Acne Vulgar/complicações , Cicatriz/terapia , Técnicas Cosméticas/instrumentação , Dermatoses Faciais/terapia , Agulhas , Adulto , Idoso , Cicatriz/etiologia , Cicatriz/patologia , Técnicas Cosméticas/efeitos adversos , Face , Dermatoses Faciais/etiologia , Dermatoses Faciais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Método Simples-Cego , Resultado do Tratamento
13.
JAMA Dermatol ; 150(5): 550-8, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24599088

RESUMO

IMPORTANCE: Excisional skin cancer surgery is a common procedure, with no formal consensus for mitigating the risk of wrong-site cutaneous surgery. OBJECTIVE: To systematically consider the usefulness and feasibility of proposed methods for correct biopsy site identification in dermatology. EVIDENCE REVIEW: Survey study with a formal consensus process. Item development was via a literature review and expert interviews, followed by 2 stages of a Delphi process to develop consensus recommendations. FINDINGS: In total, 2323 articles were reviewed in the literature search, with data extraction from 14. Twenty-five experts underwent 30-minute structured interviews, which were transcribed and coded. The resulting survey was composed of 42 proposed interventions by multiple stakeholders (biopsying physicians, operating physicians, nurses, ancillary staff, patients, caregivers, and family members) at 3 time points (day of biopsy, delay and consultation period, and day of definitive surgery). Two rounds of a Delphi process with 59 experts (25 academic and 34 private practice) scored the survey. Strong consensus was obtained on 14 behaviors, and moderate consensus was obtained on 21 other behaviors. In addition, a 2-state simultaneous algorithm was developed to model surgeon behavior on the day of definitive surgery based on surgeon and patient perceptions. CONCLUSIONS AND RELEVANCE: When definitive surgery is performed after the initial biopsy and by a different surgeon, procedures can be implemented at several time points to increase the likelihood of correct site identification. The specific circumstances of a case suggest which methods may be most appropriate and feasible, and some may be implemented. The risk of wrong-site cutaneous surgery can be reduced but not eliminated.


Assuntos
Biópsia por Agulha/métodos , Consenso , Técnica Delfos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Estudos Transversais , Procedimentos Cirúrgicos Dermatológicos/normas , Procedimentos Cirúrgicos Dermatológicos/tendências , Dermatologia/normas , Dermatologia/tendências , Estudos de Viabilidade , Feminino , Humanos , Masculino , Corpo Clínico Hospitalar , Participação do Paciente , Papel do Médico , Padrões de Prática Médica , Sensibilidade e Especificidade , Resultado do Tratamento
14.
JAMA Dermatol ; 149(12): 1378-85, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24080866

RESUMO

IMPORTANCE: Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events. OBJECTIVES: To quantify adverse events associated with MMS and detect differences relevant to safety. DESIGN, SETTING, AND PARTICIPANTS: Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. EXPOSURE: Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events. RESULTS: Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. CONCLUSIONS AND RELEVANCE: Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Cirurgia de Mohs/efeitos adversos , Neoplasias Cutâneas/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Anti-Infecciosos Locais/administração & dosagem , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Estudos de Coortes , Feminino , Luvas Cirúrgicas , Humanos , Masculino , Cirurgia de Mohs/métodos , Estudos Prospectivos , Infecção da Ferida Cirúrgica/prevenção & controle , Estados Unidos , Cicatrização/fisiologia
15.
Nature ; 489(7416): 438-42, 2012 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-22854782

RESUMO

Motor axons receive retrograde signals from skeletal muscle that are essential for the differentiation and stabilization of motor nerve terminals. Identification of these retrograde signals has proved elusive, but their production by muscle depends on the receptor tyrosine kinase, MuSK (muscle, skeletal receptor tyrosine-protein kinase), and Lrp4 (low-density lipoprotein receptor (LDLR)-related protein 4), an LDLR family member that forms a complex with MuSK, binds neural agrin and stimulates MuSK kinase activity. Here we show that Lrp4 also functions as a direct muscle-derived retrograde signal for early steps in presynaptic differentiation. We demonstrate that Lrp4 is necessary, independent of MuSK activation, for presynaptic differentiation in vivo, and we show that Lrp4 binds to motor axons and induces clustering of synaptic-vesicle and active-zone proteins. Thus, Lrp4 acts bidirectionally and coordinates synapse formation by binding agrin, activating MuSK and stimulating postsynaptic differentiation, and functioning in turn as a muscle-derived retrograde signal that is necessary and sufficient for presynaptic differentiation.


Assuntos
Diferenciação Celular , Músculo Esquelético/inervação , Junção Neuromuscular/citologia , Junção Neuromuscular/metabolismo , Terminações Pré-Sinápticas/metabolismo , Receptores de LDL/metabolismo , Transdução de Sinais , Esclerose Amiotrófica Lateral , Animais , Células Cultivadas , Técnicas de Cocultura , Diafragma , Proteínas Relacionadas a Receptor de LDL , Camundongos , Neurônios Motores/metabolismo , Músculo Esquelético/citologia , Músculo Esquelético/metabolismo , Tubo Neural/citologia , Tubo Neural/metabolismo , Ligação Proteica , Receptores Proteína Tirosina Quinases/metabolismo , Sarcopenia , Sinapsinas/metabolismo , Técnicas de Cultura de Tecidos
16.
Reprod Health ; 9: 9, 2012 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-22866753

RESUMO

BACKGROUND: Mobile health (mHealth) is emerging as a useful tool to improve healthcare access especially in the developing world, where limited access to health services is linked to poor antenatal care, and maternal and perinatal mortality.The objective of this study is to 1) understand pregnant women's access and usage of cell phones and 2) survey the health information needs and interests in a population attending public hospitals and health centers of two cities in Argentina. This information is not available and it is the basis to develop a strategy for improving maternal care via cell phones. METHODS: Questionnaires were verbally administered to pregnant women who were attending an antenatal care visit in community health centers and public hospitals in Rosario, Santa Fe and Mercedes, Corrientes. Participants were 18 years of age or older and had previously given birth. The data obtained was qualitative and analyzed using SPSS version 18. RESULTS: A total of 147 pregnant women meeting inclusion criteria (Rosario: 63; Mercedes: 84) were approached and verbally consented to participate. The average age was 29.5 years, most lived in urban areas (89%) with a mean travel time of 43.4 minutes required to get to the health center and 57.3 minutes to get the hospital.Ninety-six percent of women (n = 140) responded that they would like to receive text messages and cell phone calls with information regarding prenatal care, although the topics and period of time to receive information varied greatly. CONCLUSIONS: Considering the vast majority of the interviewed women had access to and were interested in receiving text messages and calls with educational information regarding pregnancy and infant health, pregnant women in Argentina could benefit from such an mHealth program. The low access to Internet suggests it is not an option for this population; however, this cannot be assumed as representative of the country's situation.To retain active participation, other forms of health communication, such as a 2-way text message systems or toll-free numbers, could be considered in the future. Cost of use and implementing these options should be studied.


Assuntos
Comunicação em Saúde/métodos , Assistência Perinatal , Gestantes/psicologia , Envio de Mensagens de Texto/estatística & dados numéricos , Adolescente , Adulto , Argentina/epidemiologia , Atitude , Feminino , Humanos , Serviços de Saúde Materna/métodos , Motivação/fisiologia , Assistência Perinatal/métodos , Assistência Perinatal/normas , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/normas , Gravidez , Melhoria de Qualidade , Inquéritos e Questionários , Adulto Jovem
17.
J Am Acad Dermatol ; 66(1): 86-91, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21798624

RESUMO

BACKGROUND: There is little information regarding commonalities, differences, and trends in the regulation of minimally invasive cosmetic procedures (MICP) across different state medical boards in the United States. OBJECTIVE: We sought to assess current state medical board regulations regarding MICP, so as to better understand current and emerging trends in rules regarding delegation, and management of patient complaints. METHODS: We conducted structured interviews with officials at US allopathic medical boards, supplemented with information from board World Wide Web sites. RESULTS: A total of 31 (62%) boards participated. Most (20 boards; 63% of total respondents) reported that all MICP can be delegated at the physician's discretion and responsibility to at least one category of nonphysician; 7 states were expecting changes in delegation rules; and 4 states had very specific delegation requirements. Approximately equal numbers of boards required some general supervision of nonphysicians (14, 45%), or required some type of on-site supervision (13, 42%); a small number explicitly permitted off-site supervision (4, 13%). There was variation in the number of physician assistants one physician could supervise. Most boards (15 states) required some type of mandatory reporting, but not necessarily of incidents involving MICP. Very few (4) required reporting of both office- and nonoffice-based MICP incidents. Western states had liberal delegation and supervision requirements; these requirements were more stringent in Southern states. LIMITATIONS: Not all boards participated in this study. CONCLUSION: There is substantial variation in board regulation of MICP. Many boards are promulgating new rules. Medical boards also have limited ability to regulate nonphysicians.


Assuntos
Técnicas Cosméticas/normas , Conselhos de Especialidade Profissional , Pessoal Técnico de Saúde , Humanos , Notificação de Abuso , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Estados Unidos
18.
Blood ; 118(10): 2733-42, 2011 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-21653324

RESUMO

Hematopoiesis is the process leading to the sustained production of blood cells by hematopoietic stem cells (HSCs). Growth, survival, and differentiation of HSCs occur in specialized microenvironments called "hematopoietic niches," through molecular cues that are only partially understood. Here we show that agrin, a proteoglycan involved in the neuromuscular junction, is a critical niche-derived signal that controls survival and proliferation of HSCs. Agrin is expressed by multipotent nonhematopoietic mesenchymal stem cells (MSCs) and by differentiated osteoblasts lining the endosteal bone surface, whereas Lin(-)Sca1(+)c-Kit(+) (LSK) cells express the α-dystroglycan receptor for agrin. In vitro, agrin-deficient MSCs were less efficient in supporting proliferation of mouse Lin(-)c-Kit(+) cells, suggesting that agrin plays a role in the hematopoietic cell development. These results were indeed confirmed in vivo through the analysis of agrin knockout mice (Musk-L;Agrn(-/-)). Agrin-deficient mice displayed in vivo apoptosis of CD34(+)CD135(-) LSK cells and impaired hematopoiesis, both of which were reverted by an agrin-sufficient stroma. These data unveil a crucial role of agrin in the hematopoietic niches and in the cross-talk between stromal and hematopoietic stem cells.


Assuntos
Agrina/fisiologia , Proliferação de Células , Hematopoese , Células-Tronco Hematopoéticas/citologia , Células-Tronco Hematopoéticas/fisiologia , Nicho de Células-Tronco , Animais , Western Blotting , Células da Medula Óssea/metabolismo , Diferenciação Celular , Células Cultivadas , Feminino , Citometria de Fluxo , Imunofluorescência , Regulação da Expressão Gênica , Técnicas Imunoenzimáticas , Masculino , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/fisiologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Osteoblastos/citologia , Osteoblastos/metabolismo , RNA Mensageiro/genética , Receptores de Fatores de Crescimento , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transdução de Sinais
19.
J Am Acad Dermatol ; 65(2): 377-388, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21496952

RESUMO

Nonmelanoma skin cancers can be treated by various modalities, including electrodessication and curettage, excisional techniques, and radiation. In selected cases, radiation may be preferable to surgery. When radiation is an option, brachytherapy, a form of radiation therapy that places the radiation source close to the area to be treated, may have advantages relative to conventional external beam radiation in particular patients. After brachytherapy, recurrence rates for nonmelanoma skin cancers are low, especially for small, superficial lesions, with good to excellent functional and cosmetic results. This article reviews the indications, efficacy, and adverse effects of brachytherapy in the treatment of nonmelanoma skin cancers.


Assuntos
Braquiterapia/métodos , Carcinoma Basocelular/radioterapia , Carcinoma de Células Escamosas/radioterapia , Neoplasias Cutâneas/radioterapia , Braquiterapia/efeitos adversos , Carcinoma Basocelular/mortalidade , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Intervalo Livre de Doença , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Humanos , Masculino , Seleção de Pacientes , Lesões por Radiação/prevenção & controle , Dosagem Radioterapêutica , Medição de Risco , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Análise de Sobrevida , Resultado do Tratamento
20.
Arch Dermatol ; 146(1): 33-7, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20083690

RESUMO

OBJECTIVE: To assess the comparative efficacy of energy treatments in resolving cherry angiomata. DESIGN: Rater-blinded randomized controlled trial. SETTING: Outpatient dermatology clinic in an urban referral academic medical center. PARTICIPANTS: Fifteen healthy adults aged 21 to 65 years were enrolled. Two eligible individuals who were approached declined to participate, and no one enrolled was withdrawn for adverse effects. INTERVENTIONS: For each participant, 3 areas on the torso were demarcated such that each area contained 4 cherry angiomata. Each area was then randomly assigned to receive 1 of the 3 treatments: pulsed-dye laser (PDL) (595 nm), potassium titanyl phosphate (KTP) laser (532 nm), or electrodesiccation. Two treatments spaced 2 weeks apart were delivered to each area. MAIN OUTCOME MEASURES: Standardized photographs from before treatment and 3 months after the last treatment were evaluated for color and texture on visual analog scales. RESULTS: Mean change in color was a significant improvement of 7.77 (P<.001), but there was no significant difference across treatment arms (P=.19). Mean change in texture was a significant improvement of 6.23 (P<.001), and the degree of textural change also differed across treatments (P<.001). In pairwise comparisons, cherry angiomata treated with electrodesiccation were significantly less improved than were those receiving KTP laser (P=.003) and those treated with PDL (P=.001). The effects of KTP laser and PDL on texture were not different (P=.50). CONCLUSIONS: Cherry angiomata can be effectively treated with electrodesiccation and with laser. Laser, especially PDL, may minimize the likelihood of treatment-associated textural change. Trial Registration clinicaltrials.gov Identifier: NCT00509977.


Assuntos
Angiomatose/terapia , Dessecação/métodos , Eletrocirurgia/métodos , Terapia a Laser/instrumentação , Lasers de Corante/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Dermatopatias/terapia , Adulto , Idoso , Angiomatose/patologia , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dermatopatias/patologia , Resultado do Tratamento , Adulto Jovem
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