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1.
Heart Lung Circ ; 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33812787

RESUMO

BACKGROUND: The success rate of coronary angiography (CA) after transcatheter aortic valve implantation (TAVI) is variable. Our aim was to investigate CA difficulty, outcomes, and predictors of difficult CA after TAVI. METHOD: This was an international multicentric retrospective cohort study that included patients with TAVI and subsequent CA between January 2010 and December 2019. Difficulty with CA was graded as 1 (normal), 2 (partial engagement, complete vessel opacification), 3 (partial engagement, incomplete vessel opacification), and 4 (unsuccessful angiography). Patients were grouped as (a) "easy" (grade 1 for left and right) or (b) "difficult" (grade >1 for either). We compared baseline characteristics and outcomes, and performed multivariate logistic regression for predictors of difficult CA. RESULTS: Of 96 patients included (mean age 77.4±8.7 years, 48 [50%] male), 88 (92%) had successful CA. Right CA was successful in 80 (83%) patients and left CA in 91 (95%) (p<0.0001). The "difficult" group (n=41 [43%]) had higher Society of Thoracic Surgery (STS) scores (7.6±4.9 vs 5.4±4.0; p=0.022), smaller annulus perimeters (72.4±5.4 mm vs 76.2±9.4 mm; p=0.049), greater use of self-expanding valves (83% vs 18%; p<0.0001), increased valve size (26.8±2.1 mm vs 25.6±3.0 mm; p=0.032), and increased oversizing for area (44.3%±17.4% vs 23.6%±22.0%; p=0.0002) and perimeter (17.5%±8.2% vs 7.1%±10.8%; p<0.0001). There was no difference in outcomes except for increased major bleeding (7.3% vs 0.0%; p=0.042). The strongest predictor for "difficult" CA was self-expanding valves when compared to balloon-expandable valves (adjusted odds ratio [aOR], 15.23; 95% confidence interval [CI], 2.27-102.40). Society of Thoracic Surgery score was borderline predictive (aOR, 1.26; 95% CI, 1.04-1.52). CONCLUSIONS: Our results show that after TAVI, CA success rate is high, right CA is more difficult than left, self-expanding valves predispose to difficult CA, and STS score weakly predicts difficult CA. This study is hypothesis-generating and more research is required to confirm these findings.

2.
J Formos Med Assoc ; 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33766449

RESUMO

BACKGROUND/PURPOSE: Hypertension is a risk factor of incident diabetes. In 2017, the ACC/AHA updated the definition of hypertension to above 130/80 mmHg, while the 2018 ESC/ESH guideline and the JNC7 criteria remained the cutoff of 140/90 mmHg. This study was aimed to investigate how different cutoffs of hypertension affect the association of hypertension to incident diabetes and the progression of insulin resistance. METHODS: A total of 1177 subjects without diabetes at baseline were followed for 4.5 years. Diabetes was diagnosed by the results of oral glucose tolerance tests and hemoglobin A1c, or if anti-diabetic agents were used. RESULTS: Hypertension by both criteria was associated with incident diabetes. Change of HOMA2-IR every 5 years (ΔHOMA2-IR/5 yr) was higher in subjects with hypertension than those without (adjusted p = 0.044). Subjects with treated hypertension had the highest risk of diabetes (HR 2.98, p < 0.001) and ΔHOMA2-IR/5 yr, compared with subjects with normal blood pressure. However, the associations of hypertension, HR of incident diabetes and ΔHOMA2-IR/5 yr were attenuated by the 2017 ACC/AHA criteria, as compared with that by the JNC7 and 2018 ESC/ESH criteria. CONCLUSION: Hypertension by both criteria is associated with incident diabetes and accelerated progression of insulin resistance, and the associations are attenuated by the 2017 ACC/AHA criteria.

3.
Aging Cell ; : e13340, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33783931

RESUMO

Amyloid-beta (Aß) oligomer is known to contribute to the pathophysiology of age-related macular degeneration. Herein, we aimed to elucidate the in vivo and in vitro effects of Aß1-42 application on retinal morphology in rats. Our in vivo studies revealed that intracerebroventricular administration of Aß1-42 oligomer caused dysmorphological changes in both retinal ganglion cells and retinal pigment epithelium. In addition, in vitro studies revealed that ARPE-19 cells following Aß1-42 oligomer application had decreased viability along with apoptosis and decreased expression of the tight junction proteins, increased expression of both phosphor-AKT and phosphor-GSK3ß and decreased expression of both SIRT1 and ß-catenin. Application of conditioned medium (CM) obtained from mesenchymal stem cells (MSC) protected against Aß1-42 oligomer-induced retinal pathology in both rats and ARPE-19 cells. In order to explore the potential role of peptides secreted from the MSCs, we applied mass spectrometry to compare the peptidomics profiles of the MSC-CM. Gene ontology enrichment analysis and String analysis were performed to explore the differentially expressed peptides by predicting the functions of their precursor proteins. Bioinformatics analysis showed that 3-8 out of 155-163 proteins in the MSC-CM maybe associated with SIRT1/pAKT/pGSK3ß/ß-catenin, tight junction proteins, and apoptosis pathway. In particular, the secretomes information on the MSC-CM may be helpful for the prevention and treatment of retinal pathology in age-related macular degeneration.

4.
J Am Heart Assoc ; 10(7): e019274, 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33749310

RESUMO

Background Mitral regurgitation (MR) is a major contributor for heart failure (HF) and atrial fibrillation. Despite the advancement of MR surgeries, an effective medical therapy to mitigate MR progression is lacking. Sodium glucose cotransporter 2 inhibitors, a new class of antidiabetic drugs, has shown measurable benefits in reduction of HF hospitalization and cardiovascular mortality but the mechanism is unclear. We hypothesized that dapagliflozin (DAPA), a sodium glucose cotransporter 2 inhibitor, can improve cardiac hemodynamics in MR-induced HF. Methods and Results Using a novel, mini-invasive technique, we established a MR model in rats, in which MR induced left heart dilatation and functional decline. Half of the rats were randomized to be administered with DAPA at 10 mg/kg per day for 6 weeks. After evaluation of electrocardiography and echocardiography, hemodynamic studies were performed, followed by postmortem tissue analyses. Results showed that DAPA partially rescued MR-induced impairment including partial restoration of left ventricular ejection fraction and end-systolic pressure volume relationship. Despite no significant changes in electrocardiography at rest, rats treated with DAPA exhibited lower inducibility and decreased duration of pacing-induced atrial fibrillation. DAPA also significantly attenuated cardiac fibrosis, cardiac expression of apoptosis, and endoplasmic reticulum stress-associated proteins. Conclusions DAPA was able to suppress cardiac fibrosis and endoplasmic reticulum stress and improve hemodynamics in an MR-induced HF rat model. The demonstrated DAPA effect on the heart and its association with key molecular contributors in eliciting its cardio-protective function, provides a plausible point of DAPA as a potential strategy for MR-induced HF.

5.
Mar Pollut Bull ; 165: 112091, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33549999

RESUMO

Microeukaryotes have been recognized as highly abundant and diverse both in form and function, however, data on their diversity and distribution along marine currents remain scarce. Herein, the distribution of microeukaryotes in surface seawaters was analyzed along a 9000 km stretch of the North Equatorial Current (NEC) and its bifurcation using high throughput DNA sequencing. Significant distance-decay patterns were detected, and the microeukaryote communities were further divided into Central Pacific Ocean (CPO), Western Pacific Ocean (WPO), and South China Sea (SCS) groups. Statistical analyses suggested that the microeukaryotic assembly in the WPO is maintained by the CPO community transported via the NEC. Environmental selection contributed more to community variations than spatial processes did. Temperature and salinity were the two most important environmental factors to shape the examined communities. Altogether, characterizing the microeukaryotic diversity and distribution along the NEC provided an insight into the drivers of their distribution in open oceans.


Assuntos
Salinidade , Água do Mar , China , Oceanos e Mares , Oceano Pacífico
6.
Hum Vaccin Immunother ; : 1-7, 2021 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-33616474

RESUMO

Vitiligo is an autoimmune disease in which pigment is lost in patches of the skin. CD4+ T cells are implicated in vitiligo while regulatory T cells (Tregs) could ameliorate vitiligo. Rapamycin together with autoantigen have been shown to induce immunological tolerance and promote Tregs in multiple autoimmune diseases. In the current study, we synthesized nanoparticles containing rapamycin and autoantigen HEL46-61 (NPHEL46-61/Rapa) and investigated their effects on vitiligo. We treated bone marrow-derived dendritic cells (BMDCs) from TrpHEL mice with NPHEL46-61/Rapa and monitored the phenotype of BMDCs. We investigated the effects of NPHEL46-61/Rapa-treated BMDCs on CD4+ T cell proliferation and differentiation. We administrated NPHEL46-61/Rapa to TCR-TrpHEL mice and investigated the effects on vitiligo. We found that BMDCs can uptake the NPHEL46-61/Rapa, which resulted in decreased expression of costimulation molecules CD80 and CD86 in BMDCs. BMDCs treated with NPHEL46-61/Rapa suppressed antigen-specific CD4+ T cell proliferation while promoted the differentiation of these CD4+ T cell to Tregs in vitro. Administration of NPHEL46-61/Rapa to TCR-TrpHEL mice ameliorated vitiligo, promoted Treg production, and suppressed IFN-γ and IL-6 production, while induced IL-10 production. Therefore, our study provides experimental evidence that nanoparticles containing rapamycin and autoantigen could induce antigen-specific immunological tolerance and prevent vitiligo.

7.
BMJ Open ; 11(1): e042587, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33402409

RESUMO

INTRODUCTION: Optimal antithrombotic strategy following transcatheter aortic valve replacement (TAVR) is still unknown. We hypothesised that the direct factor Xa inhibitor edoxaban can potentially prevent subclinical leaflet thrombosis and cerebral embolisation compared with conventional dual antiplatelet therapy (DAPT) in patients undergoing TAVR. METHODS AND ANALYSIS: The ADAPT-TAVR trial is an international, multicentre, randomised, open-label, superiority trial comparing edoxaban-based strategy and DAPT strategy in patients without an indication for oral anticoagulation who underwent successful TAVR. A total of 220 patients are randomised (1:1 ratio), 1-7 days after successful TAVR, to receive either edoxaban (60 mg daily or 30 mg daily if patients had dose-reduction criteria) or DAPT using aspirin (100 mg daily) plus clopidogrel (75 mg daily) for 6 months. The primary endpoint was an incidence of leaflet thrombosis on four-dimensional, volume-rendered cardiac CT imaging at 6 months post-TAVR. The key secondary endpoints were the number of new lesions and new lesion volume on brain diffusion-weighted MRI and the changes in neurological and neurocognitive function assessment between immediate post-TAVR and 6 months of study drug administration. Detailed clinical information on thromboembolic and bleeding events were also assessed. ETHICS AND DISSEMINATION: Ethic approval has been obtained from the Ethics Committee/Institutional Review Board of Asan Medical Center (approval number: 2017-1317) and this trial is also approved by National Institute of Food and Drug Safety Evaluation of Republic of Korea (approval number: 31511). Results of this study will be disseminated in scientific publication in reputed journals. TRIAL REGISTRATION NUMBER: NCT03284827.

8.
Ying Yong Sheng Tai Xue Bao ; 32(1): 39-45, 2021 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33477211

RESUMO

The aggravation of global nitrogen deposition may change plant water utilization and affect plant growth. Understanding the changes of vegetation water consumption under nitrogen deposition is of great significance for simulating and predicting the evolution of each component of forest hydrological cycle. We used the hydrogen and oxygen isotope tracer method to analyze water consumption source, quantity and law of Quercus mongolica (Qm), Fraxinus manshurica (Fm) and Tilia amurensis (Ta), the dominant species in broadleaved Korean pine forest of Changbai Mountain, under different add amounts of nitrogen [low nitrogen addition group (11.8 kg·hm-2·a-1), LN; high nitrogen addition group (23.6 kg·hm-2· a-1), HN] and different amounts of simulated precipitation (water addition amount were 0, 400, 800 and 1600 mL, equivalent to single rainfall amount were 0, 16, 32 and 64 mm, respectively). The results showed that under the condition of relative drought, soil water utilization ratio of Qm, Fm and Ta in the LN group were 26%, 12% and 20%, higher than that in HN group. When the amount of simulated precipitation was 16 mm, soil water utilization ratio of Qm, Fm and Ta in LN group reached the highest, being 73%, 70% and 43%, respectively. This ratio also reached a high value in HN group, but being less than the values in LN group. When the amount of simulated precipitation was 32 mm, soil water content approximated the average value in broadleaved Korean pine forest in the growing season in Changbai Mountain. The average soil water utilization ratio of test tree species in HN group was 39%, higher than that in LN group (16%). When the amount of simulated precipitation reached 64 mm, the soil water was saturation. Soil water utilization ratio of Qm, Fm and Ta in LN group was 14%, 5% and 1%, which was lower than that in HN group, the corresponding ratio were 64%, 13% and 10%, respectively. In conclusion, under the condition of less precipitation and relatively dry soil, the soil water utilization ratio of those three tree species were lower, and the increases of nitrogen availability further reduced the ratio. When the amount of precipitation was high and soil moisture was higher than the average value of the growing season, soil water utilization ratio of those tree species was higher. With the increases of soil nitrogen availability, this ratio was further increased.


Assuntos
Pinus , Água , China , Florestas , Nitrogênio/análise , República da Coreia , Solo , Árvores
9.
Open Heart ; 8(1)2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33419935

RESUMO

OBJECTIVES: Transcatheter aortic valve replacement (TAVR) is increasingly performed. Physically small Asians have smaller aortic root and peripheral vessel anatomy. The influence of gender of Asian patients undergoing TAVR is unknown and may affect outcomes. The aim of this study was to assess sex differences in Asian patients undergoing TAVR. METHODS: Patients undergoing TAVR from eight countries were enrolled. In this retrospective analysis, we examined differences in characteristics, 30-day clinical outcomes and 1-year survival between female and male Asian patients. RESULTS: Eight hundred and seventy-three patients (54.4% women) were included. Women were older, smaller and had less coronary artery and lung disease but tended to have higher logistic EuroSCOREs. Smaller prostheses were used more often in women. Major vascular complications occurred more frequently in women (5.5% vs 1.8%, p<0.01); however, 30-day stroke and mortality (women vs men: 1.5% vs 1.6%, p=0.95% and 4.3% vs 3.4%, p=0.48) were similar. Functional status improvement was significant and comparable between the sexes. Conduction disturbance and permanent pacemaker requirements (11.2% vs 9.0%, p=0.52) were also similar as was 1-year survival (women vs men: 85.6% vs 88.2%, p=0.25). The only predictors of 30-day mortality were major vascular injury in women and age in men. CONCLUSIONS: Asian women had significantly smaller stature and anatomy with some differences in clinical profiles. Despite more frequent major vascular complications, women had similar 30-day stroke or mortality rates. Functional status improvement was significant and comparable between the sexes. Conduction disturbance and permanent pacemaker requirements were similar as was 1-year survival.

10.
Sheng Li Xue Bao ; 72(6): 730-736, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33349830

RESUMO

Informatization is an effective way to promote the reform and innovation of higher education and improve its quality. Virtual simulation teaching is indispensable in the educational informatization. Here, we describe the development and current situation of virtual simulation teaching, and introduce electronic standardized patient (ESP) based-virtual human body system powered by the real-time human physiological parameters. We also discuss how to build an ESP-based community in the teaching of human physiology, preclinical integrated case learning and other teaching projects. These ESP-based virtual simulation projects display the advantages of interdisciplinary fusion and the combination of basic and clinical knowledge, and open up the third type of functional experiments. Therefore, ESP-based virtual simulation teaching platform presumably becomes a considerable option for the first-class course construction in physiology.


Assuntos
Aprendizagem , Interface Usuário-Computador , Simulação por Computador , Eletrônica , Humanos
11.
BMC Cancer ; 20(1): 1112, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33198676

RESUMO

BACKGROUND: This study aimed to quantify the dosimetric differences between the planned and delivered dose to tumor and normal organs in locally advanced non-small cell lung cancer (LANSCLC) treated with hypofractionated radiotherapy (HRT), and to explore the necessity and identify optimal candidates for adaptive radiotherapy (ART). METHODS: Twenty-seven patients with stage III NSCLC were enrolled. Planned radiation dose was 51Gy in 17 fractions with cone-beam CT (CBCT) acquired at each fraction. Virtual CT was generated by deformable image registration (DIR) of the planning CT to CBCT for dose calculation and accumulation. Dosimetric parameters were compared between original and accumulated plans using Wilcoxon signed rank test. Correlations between dosimetric differences and clinical variables were analyzed using Mann-Whitney U test or Chi-square test. RESULTS: Patients had varied gross tumor volume (GTV) reduction by HRT (median reduction rate 11.1%, range - 2.9-44.0%). The V51 of planning target volume for GTV (PTV-GTV) was similar between original and accumulated plans (mean, 88.2% vs. 87.6%, p = 0.452). Only 11.1% of patients had above 5% relative decrease in V51 of PTV-GTV in accumulated plans. Compared to the original plan, limited increase (median relative increase < 5%) was observed in doses of total lung (mean dose, V20 and V30), esophagus (mean dose, maximum dose) and heart (mean dose, V30 and V40) in accumulated plans. Less than 30% of patients had above 5% relative increase of lung or heart doses. Patients with quick tumor regression or baseline obstructive pneumonitis showed more notable increase in doses to normal structures. Patients with baseline obstructive atelectasis showed notable decrease (10.3%) in dose coverage of PTV-GTV. CONCLUSIONS: LANSCLC patients treated with HRT had sufficient tumor dose coverage and acceptable normal tissue dose deviation. ART should be applied in patients with quick tumor regression and baseline obstructive pneumonitis/atelectasis to spare more normal structures.

12.
J Clin Aesthet Dermatol ; 13(8): 28-35, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33178379

RESUMO

Platelet-rich plasma (PRP) has been receiving considerable attention in the field of dermatology since the elucidation of its mechanism and reports of its clinical efficacy. PRP alone or in combination with other therapies has demonstrated benefits for some cosmetic problems and skin diseases. Only a few transient or short-term side effects have been reported with the use of PRP. In this review, we highlight the potential efficacy and benefits of PRP with a focus on its applications in skin rejuvenation, androgenic alopecia, alopecia areata, chronic vitiligo, melasma, inflammatory nail disorders, and psoriasis. We suggest that detailed studies be conducted to standardize PRP preparation and optimize treatment methods in order to further improve its usefulness.

13.
Sci Rep ; 10(1): 17420, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33060829

RESUMO

Elevated central pulse pressure (CPP) had a negative influence on long-term outcome in patients with hypertension (HT). However, little is known about the impact of central pulse pressure on long-term outcomes in hypertensive patients undergoing PCI. A total number of 1184 hypertensive patients who received PCI procedure were prospectively collected. They were divided into two groups according to the median of central pulse pressure. Baseline characteristics, risk factors, hemodynamic data including central systolic pressure (CSP), central diastolic pressure (CDP) and CPP were measured. Invasive strategies were also analyzed to compare the long term outcome between patients with reference CPP and patients with high CPP. We further analyzed the predictors for myocardial infarction (MI), mortality, repeated PCI procedure in hypertensive patients undergoing PCI. We found patients in the reference CPP group had a lower CSP and higher CDP compared with high CPP group (Both P < 0.001) and male preponderance (P < 0.001). Patients with diabetes and chronic kidney disease (CKD) tend to have a high CPP (both P < 0.001). Drugs including Angiotensin Converting Enzyme inhibitors (ACEI) and statin were used more frequently in patients with reference CPP group (P = 0.035 and P = 0.001, respectively). Freedom from all-cause mortality and cardiovascular(CV) mortality was lower in the patients with high CPP group (P = 0.001, P = 0.01, respectively).Logistic regression revealed that CPP is a major predictor for all-cause mortality and repeated PCI procedure [hazard ratio (HR): 2.46 and 1.41, respectively]. In hypertensive patients receiving PCI, elevated CPP had a negative impact on long-term mortality; CPP also strongly predicts all-cause mortality and repeated PCI procedures in hypertensive patients undergoing PCI.

14.
Signal Transduct Target Ther ; 5(1): 215, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33093457

RESUMO

Immunotherapy has limited efficacy against locally advanced pancreatic cancer (LAPC) due to the presence of an immunosuppressive microenvironment (ISM). Irreversible electroporation (IRE) can not only induce immunogenic cell death, but also alleviate immunosuppression. This study aimed to investigate the antitumor efficacy of IRE plus allogeneic γδ T cells in LAPC patients. A total of 62 patients who met the eligibility criteria were enrolled in this trial, then randomized into two groups (A: n = 30 and B: n = 32). All patients received IRE therapy and after receiving IRE, the group A patients received at least two cycles of γδ T-cell infusion as one course continuously. Group A patients had better survival than group B patients (median OS: 14.5 months vs. 11 months; median PFS: 11 months vs. 8.5 months). Moreover, the group A patients treated with multiple courses of γδ T-cell infusion had longer OS (17 months) than those who received a single course (13.5 months). IRE combined with allogeneic γδ T-cell infusion is a promising strategy to enhance the antitumor efficacy in LAPC patients, yielding extended survival benefits.ClinicalTrials.gov ID: NCT03180437.

15.
Orphanet J Rare Dis ; 15(1): 288, 2020 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054853

RESUMO

BACKGROUND: Isolated macrodactyly is a severe congenital hand anomaly with functional and physiological impact. Known causative genes include PIK3CA, AKT1 and PTEN. The aim of this study is to gain insights into the genetics basis of isolated macrodactyly. RESULTS: We enrolled 24 patients with isolated macrodactyly. Four of them were diagnosed with Proteus syndrome based on skin presentations characteristic to this disease. Targeted next-generation sequencing was performed using patients' blood and affected tissues. Overall, 20 patients carry mosaic PIK3CA pathogenic variants, i.e. p.His1047Arg (N = 7), p.Glu542Lys (N = 6), p.Glu545Lys (N = 2), p.His1047Leu (N = 2), p.Glu453Lys (N = 1), p.Gln546Lys (N = 1) and p.His1047Tyr (N = 1). Four patients who met the diagnostic criteria of Proteus syndrome carry mosaic AKT1 p.Glu17Lys variant. Variant allele frequencies of these mosaic variants obtained through next-generation sequencing range from 10 to 33%. In genotype-phenotype correlation analysis of patients with PIK3CA variant, we found that patients with the macrodactyly of the lower limbs tend to carry PIK3CA variants located in the helical domain (P = 0.005). CONCLUSIONS: Mosaic PIK3CA and AKT1 variants can be found in all of our samples with isolated macrodactyly. Insights into phenotypic and genetic spectrum of isolated macrodactyly may be helpful in perusing a more precise and effective management of isolated macrodactyly.

16.
Orphanet J Rare Dis ; 15(1): 250, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933559

RESUMO

BACKGROUND: We previously reported a novel clinically distinguishable subtype of congenital scoliosis (CS), namely, TBX6-associated congenital scoliosis (TACS). We further developed the TBX6-associated CS risk score (TACScore), a multivariate phenotype-based model to predict TACS according to the patient's clinical manifestations. In this study, we aimed to evaluate whether using the TACScore as a screening method prior to performing whole-exome sequencing (WES) is more cost-effective than using WES as the first-line genetic test for CS. METHODS: We retrospectively collected the molecular data of 416 CS patients in the Deciphering disorders Involving Scoliosis and COmorbidities (DISCO) study. A decision tree was constructed to estimate the cost and the diagnostic time required for the two alternative strategies (TACScore versus WES). Bootstrapping simulations and sensitivity analyses were performed to examine the distributions and robustness of the estimates. The economic evaluation considered both the health care payer and the personal budget perspectives. RESULTS: From the health care payer perspective, the strategy of using the TACScore as the primary screening method resulted in an average cost of $1074.2 (95%CI: $1044.8 to $1103.5) and an average diagnostic duration of 38.7d (95%CI: 37.8d to 39.6d) to obtain a molecular diagnosis for each patient. In contrast, the corresponding values were $1169.6 (95%CI: $1166.9 to $1172.2) and 41.4d (95%CI: 41.1d to 41.7d) taking WES as the first-line test (P < 0.001). From the personal budget perspective, patients who were predicted to be positive by the TACScore received a result with an average cost of $715.1 (95%CI: $594.5 to $835.7) and an average diagnostic duration of 30.4d (95%CI: 26.3d to 34.6d). Comparatively, the strategy of WES as the first-line test was estimated to have significantly longer diagnostic time with an average of 44.0d (95%CI: 43.2d to 44.9d), and more expensive with an average of $1193.4 (95%CI: $1185.5 to $1201.3) (P < 0.001). In 100% of the bootstrapping simulations, the TACScore strategy was significantly less costly and more time-saving than WES. The sensitivity analyses revealed that the TACScore strategy remained cost-effective even when the cost per WES decreased to $8.8. CONCLUSIONS: This retrospective study provides clinicians with economic evidence to integrate the TACScore into clinical practice. The TACScore can be considered a cost-effective tool when it serves as a screening test prior to performing WES.

17.
Sci Rep ; 10(1): 14409, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873851

RESUMO

To date, there is no good evidence that intestine epithelial cells (IEC) affected by ischemia/reperfusion (I/R) injury are able to cause cortical neuron injury directly. Additionally, it remains unclear whether the neuronal damage caused by I/R injured IEC can be affected by therapeutic hypothermia (TH, 32 °C). To address these questions, we performed an oxygen-glucose deprivation (OGD) affected IEC-6-primary cortical neuron coculture system under normothermia (37 °C) or TH (32 °C) conditions. It was found that OGD caused hyperpermeability in IEC-6 cell monolayers. OGD-preconditioned IEC-6 cells caused cortical neuronal death (e.g., decreased cell viability), synaptotoxicity, and neuronal apoptosis (evidenced by increased caspase-3 expression and the number of TUNEL-positive cells), necroptosis (evidenced by increased receptor-interacting serine/threonine-protein kinase-1 [RIPK1], RIPK3 and mixed lineage kinase domain-like pseudokinase [MLKL] expression), and pyroptosis (evidenced by an increase in caspase-1, gasdermin D [GSDMD], IL-1ß, IL-18, the apoptosis-associated speck-like protein containing a caspase recruitment domain [ASC], and nucleotide oligomerization domain [NOD]-like receptor [NLRP]-1 expression). TH did not affect the intestinal epithelial hyperpermeability but did attenuate OGD-induced neuronal death and synaptotoxicity. We also performed quantitative real-time PCR to quantify the genes encoding 84 exosomal microRNAs in the medium of the control-IEC-6, the control-neuron, the OGD-IEC-6 at 37 °C, the OGD-IEC-6 at 32 °C, the neuron cocultured with OGD-IEC-6 at 37 °C, and the neurons cocultured with OGD-IEC-6 at 32 °C. We found that the control IEC-6 cell s or cortical neurons are able to secrete a basal level of exosomal miRNAs in their medium. OGD significantly up-regulated the basal level of each parameter for IEC-6 cells. As compared to those of the OGD-IEC-6 cells or the control neurons, the OGD-IEC-6 cocultured neurons had significantly higher levels of 19 exosomal miRNAs related to apoptosis, necroptosis, and/or pyroptosis events. Our results identify that I/R injured intestinal epithelium cells can induce cortical neuron death via releasing paracrine mediators such as exosomal miRNAs associated with apoptosis, necroptosis, and/or pyroptosis, which can be counteracted by TH.

18.
Medicine (Baltimore) ; 99(32): e21564, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769899

RESUMO

In the study's early stage, the research group had established an evaluation index system for the rational drug use of primary nephrotic syndrome in children. To assess the feasibility of the established index system, we conducted this empirical study.The cross-sectional study was conducted by using the Hospital Information System to extract some general clinical data of hospitalized children with primary nephrotic syndrome, which included registration number, age, sex, diagnosis and medication, etc. Utilize the SPSS23.0 software and Excel 2016 to descriptively analyze information.224 hospitalized children with primary nephrotic syndrome who met the inclusion criteria were included, ranging from 18 years old and 10 months to 11 months and 23 days, with an average age of 8.40, plus or minus 4.30 years. 148 males (66.07%) and 76 females (33.93%). The duration of hospitalization was 1-57 days, with an average hospitalization time of 10.59 days. The most common is respiratory infections, such as the bronchopneumonia, the mycoplasma pneumonia, etc. This study had successfully completed the measurement of the evaluation index system for the rational drug use of primary nephrotic syndrome in children.All indicators are feasible, but the operability and applicability need further research and improvement.


Assuntos
Indicadores Básicos de Saúde , Hormônios/uso terapêutico , Fatores Imunológicos/uso terapêutico , Síndrome Nefrótica/tratamento farmacológico , Indicadores de Qualidade em Assistência à Saúde , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Estudos de Viabilidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino
19.
J Card Surg ; 35(9): 2142-2146, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32720374

RESUMO

OBJECTIVES: The impact of the COVID-19 pandemic on the treatment of patient with aortic valve stenosis is unknown and there is uncertainty on the optimal strategies in managing these patients. METHODS: This study is supported and endorsed by the Asia Pacific Society of Interventional Cardiology. Due to the inability to have face to face discussions during the pandemic, an online survey was performed by inviting key opinion leaders (cardiac surgeon/interventional cardiologist/echocardiologist) in the field of transcatheter aortic valve implantation (TAVI) in Asia to participate. The answers to a series of questions pertaining to the impact of COVID-19 on TAVI were collected and analyzed. These led subsequently to an expert consensus recommendation on the conduct of TAVI during the pandemic. RESULTS: The COVID-19 pandemic had resulted in a 25% (10-80) reduction of case volume and 53% of operators required triaging to manage their patients with severe aortic stenosis. The two most important parameters used to triage were symptoms and valve area. Periprocedural changes included the introduction of teleconsultation, preprocedure COVID-19 testing, optimization of protests, and catheterization laboratory set up. In addition, length of stay was reduced from a mean of 4.4 to 4 days. CONCLUSION: The COVID-19 pandemic has impacted on the delivery of TAVI services to patients in Asia. This expert recommendation on best practices may be a useful guide to help TAVI teams during this period until a COVID-19 vaccine becomes widely available.

20.
Int J Clin Exp Pathol ; 13(4): 818-826, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32355532

RESUMO

BACKGROUND: To investigate the clinicopathologic features, differential diagnosis, and factors associated with recurrence in patients with smooth muscle tumors of uncertain malignant potential (STUMP). METHODS: The clinical and pathologic data of STUMP patients diagnosed in Mindong Hospital of Ningde City from 2017 to 2018 were collected and slides reviewed, the high-frequency color Doppler ultrasound and pathological characteristics were observed, and the literature was reviewed. RESULTS: All the STUMP diagnoses were confirmed by slide review. The age of onset was 23-61 years (mean 42.96 years). The main clinical symptoms were leiomyoma of uterus, prolonged menstruation, and increased menstruation. Color Doppler ultrasonography showed hypoechoic uterine wall nodules. The mean follow-up time was 62.9 months (range: 13-96 months). CONCLUSIONS: Smooth muscle tumors of undetermined malignant potential (STUMP) in the uterus are one of the rare gynecologic neoplasms. Although not malignant, they should be considered as low malignant potential tumors because they occasionally recur. Six of 13 recurrent tumors recurred in the years following hysterectomy with preservation. These six recurrent tumors are the only ones that had a strong immune response to p16 and p53. In support of early observation, these markers may help predict STUMP behavior. Patients diagnosed with STUMP should be monitored over time.

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