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1.
Nat Commun ; 12(1): 4997, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404774

RESUMO

Epicardial formation is necessary for normal myocardial morphogenesis. Here, we show that differentiating hiPSC-derived lateral plate mesoderm with BMP4, RA and VEGF (BVR) can generate a premature form of epicardial cells (termed pre-epicardial cells, PECs) expressing WT1, TBX18, SEMA3D, and SCX within 7 days. BVR stimulation after Wnt inhibition of LPM demonstrates co-differentiation and spatial organization of PECs and cardiomyocytes (CMs) in a single 2D culture. Co-culture consolidates CMs into dense aggregates, which then form a connected beating syncytium with enhanced contractility and calcium handling; while PECs become more mature with significant upregulation of UPK1B, ITGA4, and ALDH1A2 expressions. Our study also demonstrates that PECs secrete IGF2 and stimulate CM proliferation in co-culture. Three-dimensional PEC-CM spheroid co-cultures form outer smooth muscle cell layers on cardiac micro-tissues with organized internal luminal structures. These characteristics suggest PECs could play a key role in enhancing tissue organization within engineered cardiac constructs in vitro.


Assuntos
Agregação Celular/fisiologia , Técnicas de Cocultura , Miócitos Cardíacos/fisiologia , Família Aldeído Desidrogenase 1/metabolismo , Fatores de Transcrição Hélice-Alça-Hélice Básicos , Proteína Morfogenética Óssea 4 , Cálcio/metabolismo , Diferenciação Celular , Genes do Tumor de Wilms , Humanos , Células-Tronco Pluripotentes Induzidas , Fator de Crescimento Insulin-Like II/metabolismo , Mesoderma , Miócitos de Músculo Liso , Retinal Desidrogenase/metabolismo , Semaforinas , Células-Tronco , Proteínas com Domínio T/metabolismo
2.
Methods Mol Biol ; 2320: 35-51, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34302646

RESUMO

The most common method for isolating cells of interest is an antibody method that recognizes cell surface antigens. However, specific surface antigens for many cell types have not been identified. We have developed the microRNA (miRNA)-responsive synthetic mRNA systems (miRNA switches), which isolate target cells based on endogenous miRNA activity. In this chapter, we describe protocols for isolating human pluripotent stem cell (hPSC)-derived cardiomyocytes using miRNA switches with or without cell sorting.


Assuntos
MicroRNAs/genética , Miócitos Cardíacos/citologia , Células-Tronco Pluripotentes/citologia , Técnicas de Cultura de Células/métodos , Diferenciação Celular/fisiologia , Linhagem Celular , Separação Celular/métodos , Citometria de Fluxo/métodos , Humanos , RNA Mensageiro/genética
3.
Methods Mol Biol ; 2320: 135-149, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34302655

RESUMO

Human iPSC-derived cardiomyocytes (hiPSC-CMs) are expected to be used in regenerative therapies and drug discovery for heart failure. hiPSC-CMs are a mixture of mainly ventricular CMs (VCMs) and also of atrial CMs (ACMs) and pacemaker cells. Here we describe a method to enrich VCM and ACM differentiation and to characterize these subtypes by gene expression analysis using qRT-PCR and by electrophysiological properties using the patch-clamp method. The differentiated VCMs and ACMs highly express VCM and ACM marker genes, respectively. Furthermore, both subtypes show specific properties of action potentials.


Assuntos
Ventrículos do Coração/citologia , Células-Tronco Pluripotentes Induzidas/citologia , Miócitos Cardíacos/citologia , Potenciais de Ação/fisiologia , Diferenciação Celular/fisiologia , Células Cultivadas , Fenômenos Eletrofisiológicos/fisiologia , Átrios do Coração/citologia , Humanos , Técnicas de Patch-Clamp/métodos
4.
Methods Mol Biol ; 2320: 171-180, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34302658

RESUMO

Engineered cardiac tissue (ECT) derived from human induced pluripotent stem cells (iPSCs) can replicate human heart in vitro and be applied to drug discovery and heart disease models. The contraction force of ECT is an important indicator of its function and of the disease phenotype. Here we describe a construction method of ECT using the Flexcell® Tissue Train® culture system and a contraction force measurement method based on the Frank-Starling law.


Assuntos
Células-Tronco Pluripotentes Induzidas/citologia , Contração Miocárdica/fisiologia , Miócitos Cardíacos/citologia , Engenharia Tecidual/métodos , Células Cultivadas , Humanos
5.
Br J Neurosurg ; : 1-2, 2021 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-34137311

RESUMO

PURPOSE: The abdominal procedure of ventriculoperitoneal or lumboperitoneal shunt is difficult because of a deep and narrow operative view, especially for obese patients. We have developed the 'Hoisting method,' which enables us to make abdominal procedures easy and safe. MATERIAL AND METHODS: We report our experience with five cases between April 2020 and March 2021. RESULTS: The placement of the shunt was easy and safe in all patients without any complications. CONCLUSION: The shunt method is very effective and easy without requiring additional devices.

6.
Nat Commun ; 12(1): 3596, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34155205

RESUMO

One of the earliest maturation steps in cardiomyocytes (CMs) is the sarcomere protein isoform switch between TNNI1 and TNNI3 (fetal and neonatal/adult troponin I). Here, we generate human induced pluripotent stem cells (hiPSCs) carrying a TNNI1EmGFP and TNNI3mCherry double reporter to monitor and isolate mature sub-populations during cardiac differentiation. Extensive drug screening identifies two compounds, an estrogen-related receptor gamma (ERRγ) agonist and an S-phase kinase-associated protein 2 inhibitor, that enhances cardiac maturation and a significant change to TNNI3 expression. Expression, morphological, functional, and molecular analyses indicate that hiPSC-CMs treated with the ERRγ agonist show a larger cell size, longer sarcomere length, the presence of transverse tubules, and enhanced metabolic function and contractile and electrical properties. Here, we show that ERRγ-treated hiPSC-CMs have a mature cellular property consistent with neonatal CMs and are useful for disease modeling and regenerative medicine.


Assuntos
Células-Tronco Pluripotentes Induzidas/citologia , Miócitos Cardíacos/citologia , Receptores de Estrogênio/fisiologia , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/genética , Regulação da Expressão Gênica/efeitos dos fármacos , Genes Reporter , Humanos , Células-Tronco Pluripotentes Induzidas/metabolismo , Modelos Biológicos , Miócitos Cardíacos/metabolismo , Receptores de Estrogênio/química , Proteínas Quinases Associadas a Fase S/antagonistas & inibidores , Sarcolema/efeitos dos fármacos , Sarcolema/metabolismo , Sarcômeros/efeitos dos fármacos , Sarcômeros/metabolismo , Transcriptoma/efeitos dos fármacos , Troponina I/genética , Troponina I/metabolismo
7.
IEEE J Transl Eng Health Med ; 9: 1700211, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33796417

RESUMO

Gastric endoscopy is a golden standard in the clinical process that enables medical practitioners to diagnose various lesions inside a patient's stomach. If a lesion is found, a success in identifying the location of the found lesion relative to the global view of the stomach will lead to better decision making for the next clinical treatment. Our previous research showed that the lesion localization could be achieved by reconstructing the whole stomach shape from chromoendoscopic indigo carmine (IC) dye-sprayed images using a structure-from-motion (SfM) pipeline. However, spraying the IC dye to the whole stomach requires additional time, which is not desirable for both patients and practitioners. Our objective is to propose an alternative way to achieve whole stomach 3D reconstruction without the need of the IC dye. We generate virtual IC-sprayed (VIC) images based on image-to-image style translation trained on unpaired real no-IC and IC-sprayed images, where we have investigated the effect of input and output color channel selection for generating the VIC images. We validate our reconstruction results by comparing them with the results using real IC-sprayed images and confirm that the obtained stomach 3D structures are comparable to each other. We also propose a local reconstruction technique to obtain a more detailed surface and texture around an interesting region. The proposed method achieves the whole stomach reconstruction without the need of real IC dye using SfM. We have found that translating no-IC green-channel images to IC-sprayed red-channel images gives the best SfM reconstruction result. Clinical impact We offer a method of the frame localization and local 3D reconstruction of a found gastric lesion using standard endoscopy images, leading to better clinical decision.

8.
Eur J Pain ; 25(7): 1525-1539, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33728717

RESUMO

BACKGROUND: To evaluate if early improvements in pain and function with subcutaneous tanezumab are meaningful and sustained over 24 weeks. METHODS: Patients with moderate-to-severe osteoarthritis (hip or knee) in Europe and Japan were randomized to placebo, tanezumab 2.5 mg or tanezumab 5 mg (baseline, Week 8 and Week 16). Outcomes included: average daily index joint pain score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales, rescue medication use, WOMAC responders (within-patient ≥30% reduction in WOMAC Pain or Physical Function), Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responders (within-patient) and Patient-reported Treatment Impact Assessment-Modified questionnaire. RESULTS: Patients received placebo (n = 282), tanezumab 2.5 mg (n = 283) or tanezumab 5 mg (n = 284). Changes from baseline in average daily index joint pain (within the first week) and WOMAC subscales (Week 2 through Week 24) were greater for each tanezumab group versus placebo (least squares [LS] mean, unadjusted p ≤ .05). Rescue medication use (days/week) was lower for each tanezumab group versus placebo from Week 2 through Week 12 (LS mean, unadjusted p ≤ .05) but not at Week 16 or 24. A higher proportion of each tanezumab group than placebo achieved ≥30% reduction from baseline in WOMAC Pain or Physical Function, or OMERACT-OARSI response (Week 2 through Week 24, unadjusted p ≤ .05), or were satisfied with treatment at Week 24 (unadjusted p ≤ .05). CONCLUSIONS: Subcutaneous tanezumab, compared with placebo, reduced pain within the first week, and pain and function were improved throughout 24 weeks. The proportions of responders and patients satisfied were higher with tanezumab than placebo. ClinicalTrials.gov:NCT02709486. SIGNIFICANCE: This exploratory analysis of data from a placebo-controlled, Phase 3 study of patients with moderate-to-severe osteoarthritis of the hip or knee for whom standard analgesics were not effective or could not be taken, found that onset of efficacy of subcutaneous tanezumab was within the first week, and efficacy was maintained through the 24-week treatment period. Tanezumab was effective in those patients with the most radiologically severe osteoarthritis.


Assuntos
Osteoartrite do Quadril , Osteoartrite do Joelho , Anticorpos Monoclonais Humanizados , Método Duplo-Cego , Humanos , Osteoartrite do Joelho/tratamento farmacológico , Dor , Medição da Dor , Resultado do Tratamento
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1848-1852, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018360

RESUMO

Gastric endoscopy is a standard clinical process that enables medical practitioners to diagnose various lesions inside a patient's stomach. If any lesion is found, it is very important to perceive the location of the lesion relative to the global view of the stomach. Our previous research showed that this could be addressed by reconstructing the whole stomach shape from chromoendoscopic images using a structure-from-motion (SfM) pipeline, in which indigo carmine (IC) blue dye-sprayed images were used to increase feature matches for SfM by enhancing stomach surface's textures. However, spraying the IC dye to the whole stomach requires additional time, labor, and cost, which is not desirable for patients and practitioners. In this paper, we propose an alternative way to achieve whole stomach 3D reconstruction without the need of the IC dye by generating virtual IC-sprayed (VIC) images based on image-to-image style translation trained on unpaired real no-IC and IC-sprayed images. We have specifically investigated the effect of input and output color channel selection for generating the VIC images and found that translating no-IC green-channel images to IC-sprayed red-channel images gives the best SfM reconstruction result.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Imageamento Tridimensional , Carmim , Humanos , Índigo Carmim , Estômago/diagnóstico por imagem
12.
Ann Rheum Dis ; 79(6): 800-810, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32234715

RESUMO

OBJECTIVE: Tanezumab, a nerve growth factor inhibitor, was investigated for osteoarthritis (OA) of the hip or knee in a study with 24-week treatment and 24-week safety follow-up. METHODS: This double-blind, randomised, phase III study enrolled adults in Europe and Japan with moderate-to-severe OA who had not responded to or could not tolerate standard-of-care analgesics. Patients were randomised to tanezumab 2.5 mg or 5 mg subcutaneously or matching placebo every 8 weeks (three doses). Co-primary end points were change from baseline to week 24 in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Physical Function, and Patient's Global Assessment of OA (PGA-OA). Joint safety and neurological assessments continued throughout the 48-week study. RESULTS: From March 2016 to December 2017, 849 patients were randomised and evaluated (placebo n=282, tanezumab 2.5 mg n=283, tanezumab 5 mg n=284). At week 24, there was a statistically significant improvement from baseline for tanezumab 5 mg compared with placebo for WOMAC Pain (least squares mean difference±SE -0.62±0.18, p=0.0006), WOMAC Physical Function (-0.71±0.17, p<0.0001) and PGA-OA (-0.19±0.07, p=0.0051). For tanezumab 2.5 mg, there was a statistically significant improvement in WOMAC Pain and Physical Function, but not PGA-OA. Rapidly progressive osteoarthritis (RPOA) was observed in 1.4% (4/283) and 2.8% (8/284) of patients in the tanezumab 2.5 mg and tanezumab 5 mg groups, respectively and none receiving placebo. Total joint replacements (TJRs) were similarly distributed across all three treatment groups (6.7%-7.8%). Tanezumab-treated patients experienced more paraesthesia (5 mg) and hypoaesthesia (both doses) than placebo. CONCLUSION: Tanezumab 5 mg statistically significantly improved pain, physical function and PGA-OA, but tanezumab 2.5 mg only achieved two co-primary end points. RPOA occurred more frequently with tanezumab 5 mg than tanezumab 2.5 mg. TJRs were similarly distributed across all three groups. TRIAL REGISTRATION NUMBER: NCT02709486.


Assuntos
Analgésicos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Dor Musculoesquelética/tratamento farmacológico , Osteoartrite do Quadril/tratamento farmacológico , Osteoartrite do Joelho/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Artroplastia de Quadril , Artroplastia do Joelho , Progressão da Doença , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Hipestesia/induzido quimicamente , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/cirurgia , Medição da Dor , Parestesia/induzido quimicamente , Desempenho Físico Funcional
13.
PLoS One ; 15(4): e0231077, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32282836

RESUMO

INTRODUCTION: This study aimed to investigate the differences in the Injustice Experience Questionnaire (IEQ) scores during the early period after the diagnosis of Whiplash-associated disorder (WAD) between Japanese and Canadian samples, and the associations between the IEQ scores and treatment terms in Japanese patients with acute WAD. METHODS: We used secondary data for the IEQ scores of Canadian patients with acute WAD. In Japan, we collected data from 85 consecutively enrolled patients with acute WAD, and their treatment terms were collected; these referred to the number of days between the date of injury and the closure date of the insurance claim and the number of treatment visits. Before treatment, the Numeric Rating Scale, Neck Disability Index, Hospital Anxiety and Depression Scale, IEQ, and Euro Quality of Life five-dimensional questionnaire were administered. The variables were subjected to multivariate analysis with each treatment term. RESULTS: The IEQ scores were higher in Japan than in Canada. Through multiple regression analysis, IEQ scores were independently correlated with treatment terms. The optimal cutoff point of the IEQ scores for a prolonged treatment term was 21 and 22 points, respectively. CONCLUSIONS: The IEQ scores were associated with treatment terms in patients with acute WAD in Japan.


Assuntos
Depressão/epidemiologia , Mialgia/epidemiologia , Dor/epidemiologia , Traumatismos em Chicotada/epidemiologia , Canadá/epidemiologia , Depressão/fisiopatologia , Depressão/psicologia , Depressão/terapia , Feminino , Humanos , Seguro , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Mialgia/fisiopatologia , Mialgia/psicologia , Mialgia/terapia , Dor/fisiopatologia , Dor/psicologia , Manejo da Dor , Análise de Regressão , Inquéritos e Questionários , Traumatismos em Chicotada/fisiopatologia , Traumatismos em Chicotada/psicologia , Traumatismos em Chicotada/terapia
14.
World Neurosurg ; 138: 1-6, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32105870

RESUMO

BACKGROUND: For several variants of quasi-moyamoya disease, cerebral revascularization treatment is as effective as it is for the more typical cases of moyamoya disease. Here, we examined a case of moyamoya disease with concurrent congenital rubella syndrome (CRS). On the basis of concurrent underlying disease, the patient was considered to have quasi-moyamoya disease and was treated with cerebral revascularization. CASE DESCRIPTION: A 36-year-old female presented with a large cerebral infarction. She was diagnosed with quasi-moyamoya disease on the basis of clinical and imaging features. The ischemic symptoms and cognitive dysfunction improved after combined direct and indirect revascularization. CONCLUSIONS: To our knowledge, this is the first known report of moyamoya disease with concurrent CRS. We treated this patient with revascularization as typical for other quasi-moyamoya conditions including Down syndrome. This case emphasizes the effectiveness of revascularization treatment for moyamoya disease with concurrent CRS for the prevention of ischemic stroke and improvement of cognitive function, despite existing cerebral infarction.


Assuntos
Revascularização Cerebral/métodos , Doença de Moyamoya/complicações , Doença de Moyamoya/cirurgia , Síndrome da Rubéola Congênita/complicações , Síndrome da Rubéola Congênita/cirurgia , Adulto , Feminino , Humanos , Masculino
15.
Pain Med ; 21(2): 326-332, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31165895

RESUMO

OBJECTIVES: Existing treatments for fibromyalgia have limited efficacy, and only a minority of individuals clinically respond to any single intervention. This study was a prospective, multicenter, randomized, double-blind, controlled clinical trial to evaluate the feasibility of alternating magnetic field therapy in fibromyalgia patients by comparing the Angel Touch device (AT-02) with a sham control (S-01). METHODS: Two sites enrolled 44 subjects with diagnosed fibromyalgia. After informed consent, subjects taking prohibited concomitant drugs underwent a washout period of two or more weeks. All subjects then began a one-week run-in period. Numerical rating scale (NRS) pain scores were collected without device intervention for one day, followed by S-01 application to four or more painful sites for 10 minutes at each site, twice daily for six days. Subjects were then randomized to AT-02 or S-01, applied to four or more painful sites for 10 minutes at each site, twice daily for eight weeks. NRS scores were obtained twice daily during the entire treatment period. RESULTS: The primary end point (change in NRS ± SD at week 8 vs baseline) was -0.94 ± 1.33 in the AT-02 group and -0.22 ± 1.38 in the S-01 group. A trend toward a between-group difference in eight-week NRS scores favored the AT-02 group (-0.73, 95% confidence interval = -1.56 to 0.11, P = 0.086). An adjusted repeated measure analysis detected a significant difference in NRS scores (P = 0.039). CONCLUSIONS: The reduction in NRS scores for AT-02 relative to sham was comparable to reductions observed in meta-analyses of fibromyalgia drug therapy. The unadjusted results and the persistence of the pain score reductions remain encouraging.


Assuntos
Fibromialgia/terapia , Terapia de Campo Magnético/instrumentação , Terapia de Campo Magnético/métodos , Manejo da Dor/instrumentação , Manejo da Dor/métodos , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Pain Pract ; 20(3): 269-276, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31638741

RESUMO

OBJECTIVES: This study aimed to determine the optimal cutoff score of the 9-item short version of the CSI, the CSI-9, by comparing patients with central sensitivity syndrome (CSS) not only to healthy volunteers as with the original version, but also to patients with musculoskeletal (MSK) disorders. METHODS: All participants filled out the CSI, EuroQol 5-dimension, Brief Pain Inventory, and Pain Catastrophizing Scale questionnaires. To identify a clinically relevant cutoff score, receiver operating characteristic analyses were conducted. The area under the curve was used to examine the ability of the CSI-9 to distinguish patients with fibromyalgia (FM) from patients with MSK disorders and healthy individuals. RESULTS: Twenty-six participants with FM, 30 patients with MSK disorders, and 28 healthy individuals were included. We determined 2 cutoff scores: 20 for distinguishing patients with FM from patients with MSK disorders and 17 for distinguishing patients with FM from healthy individuals. These cutoff scores had good sensitivity (patients with MSK disorders, 92.3%; healthy individuals, 96.2%) and specificity (patients with MSK disorders, 93.3%; healthy individuals, 100%). In addition, the patients who scored above the cutoff of 20 points exhibited worse clinical symptoms (higher pain intensity, higher pain interference, higher Pain Catastrophizing Scale scores, and lower EuroQol 5-dimension scores) than those who scored below it. Furthermore, a significantly higher number of subjects who scored more than 20 on the CSI-9 had a history of 2 or more diagnoses of CSS. CONCLUSION: The optimal CSI-9 cutoff score of 20 is beneficial to clinicians in the evaluation of central sensitization-related symptoms. The cutoff score helps to identify patients who need additional treatments, such as pain neuroscience education and cognitive behavioral therapy.


Assuntos
Sensibilização do Sistema Nervoso Central , Fibromialgia/diagnóstico , Doenças Musculoesqueléticas/diagnóstico , Inquéritos e Questionários , Adulto , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Feminino , Fibromialgia/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/complicações , Curva ROC , Valores de Referência , Sensibilidade e Especificidade
17.
J Stroke Cerebrovasc Dis ; 29(3): 104585, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31883791

RESUMO

BACKGROUND: Many known risk factors, including hypertension and hyperlipidemia cause intracerebral hemorrhage (ICH). Recently, microbleeds have been identified as one of the factors leading to ICH. While some patients have been found to have recurrent ICH, risk factors for recurrent ICH are scarcely reported. We conducted an observational study on the risk-factors of recurrent ICH, comparing stroke patients with a single hemorrhagic episode and those with recurrent ICH. METHODS: A retrospective analysis of a single-center database was performed to analyze the clinical presentation and characteristics of patients with a single and recurrent ICH. From January 2016 to December 2017, a total of 317 patients were analyzed based on suspected factors including patients' sex, age, medical history, antiplatelet therapy use, and presence of microbleeds on images. RESULTS: Of the 317 patients, 36 patients (11.4%) developed a second episode of cerebral hemorrhage. Brain magnetic resonance imaging (MRI) of the patients without microbleeds, predicted reduced risk of recurrence. This is the first report strongly associating the presence of microbleeds with the possibility of a recurrent ICH. Other factors under study did not show an apparent association with recurrent ICH probably because of the high statistical significance obtained with the presence of microbleeds. CONCLUSION: Our findings revealed that the absence of microbleeds on images is a factor that strongly predicts a reduced risk for recurrent ICH and that the detection of microbleeds on MRI performed in patients with a single hemorrhagic episode, is useful in defining further therapeutic management. These findings may benefit physicians treating stroke patients.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Imageamento por Ressonância Magnética , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/terapia , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
18.
NMC Case Rep J ; 6(4): 101-103, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31592396

RESUMO

Trigeminal neuralgia is caused by compression of the trigeminal nerve by arteries or veins in the posterior fossa. A persistent primitive trigeminal artery variant (PPTAv) is an anomalous artery that may cause trigeminal neuralgia. A 65-year-old man presented with left facial pain. Brain magnetic resonance imaging revealed a PPTAv. Constructive interference in steady state showed that both the PPTAv and the superior cerebellar artery (SCA) compressed the trigeminal nerve. Thus, we performed microvascular decompression and the patient's symptoms improved. PPTAv is a rare anomaly in the posterior fossa that can cause trigeminal neuralgia. Dual compression of the trigeminal nerve by the SCA and PPTAv demonstrates that trigeminal neuralgia may originate from multiple sources. It is therefore important to check preoperative images to adequately treat trigeminal neuralgia.

19.
Clin Lab ; 65(10)2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31625361

RESUMO

BACKGROUND: Acquired factor V deficiency (AFVD) caused by Factor V (FV) inhibition is a rare event, characterized by prolonged prothrombin time and activated partial thromboplastin time. To date, various factors were reported as triggers for developing FV inhibitor. Clinical symptoms range from asymptomatic to life-threatening bleeding. Case Report and Conclusions: Here, we report an 84-year-old Japanese male on hemodialysis due to renal failure who developed subcutaneous hemorrhage after administration of cefepime (CFPM) to treat bacteremia. Deficient FV activity (< 1.0%) was identified and AFVD with FV inhibitor titer of 9 BU/mL was diagnosed. Although the patient had multiple risks for developing FV inhibitor, CFPM was thought to be the major culprit in this case. After the diagnosis, oral prednisolone (30 mg/day) was initiated, but the patient died of respiratory/cardiac failure, unrelated to AFVD.


Assuntos
Cefepima/efeitos adversos , Deficiência do Fator V/diagnóstico , Fator V/antagonistas & inibidores , Hemorragia/diagnóstico , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Bacteriemia/tratamento farmacológico , Testes de Coagulação Sanguínea , Deficiência do Fator V/sangue , Deficiência do Fator V/induzido quimicamente , Evolução Fatal , Hemorragia/sangue , Hemorragia/induzido quimicamente , Humanos , Masculino , Diálise Renal
20.
Surg Neurol Int ; 10: 74, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31528412

RESUMO

Background: Brain metastasis from undifferentiated pleomorphic sarcoma (UPS) is a rare occurrence, and its clinical course is little known. In this report, we investigate a case of a rapidly growing brain metastasis from gastric UPS. Case Description: An 82-year-old man with a known gastric tumor, pathologically compatible with UPS, underwent partial gastrectomy at an outside facility. 3 months later, a 4-cm brain tumor was detected, which was completely resected. The patient was diagnosed with metastatic tumor from previously treated gastric UPS. Within 2 months of the initial resection, a large recurrent mass was detected in the same location, which was again removed. Although the patient underwent radiotherapy and chemotherapy for other metastatic tumors, he died 5 months after the second craniotomy. Conclusions: Brain metastasis from gastric UPS is rare and difficult to treat. Although aggressive treatment, such as surgical intervention, may improve patient survival in some cases, the timing of treatment is challenging because cerebral metastasis rapidly grows and and patients frequently suffer from synchronous systematic metastasis. Therefore, early detection and close follow-up of rapidly progressing brain metastasis are important to improve treatment outcomes.

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