Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 126
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Cancer Med ; 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32091667

RESUMO

BACKGROUND: Pre-resection pleural lavage cytology is useful to predict tumor recurrence and the prognosis of lung cancer patients. Recently, extracellular vesicles (EVs) isolated from effusion specimens have come under the spotlight, and several studies showed that microRNA in EVs is associated with prognosis. MicroRNA-21 (miR-21) is a representative onco-microRNA, and miR-21 in EVs (EV-miR-21) promotes cancer dissemination by inducing mesothelial to mesenchymal transition (MMT) in the peritoneal cavity. In this study, we isolated EVs from pleural lavage fluid and focused on EV-miR-21 as a diagnostic factor with a relationship to pleural dissemination. METHODS: The Cancer Genome Atlas dataset comprising of 448 cases of lung adenocarcinoma, tissue microarray of 144 cases of lung adenocarcinoma, and pleural lavage fluid of 41 cases was used to examine miR-21 expression levels. The function of EV-miR-21 was investigated in vitro. RESULTS: The miR-21 expression level in primary sites was associated with a poor prognosis and correlated with pleural invasion of adenocarcinoma. EV-miR-21 levels in pleural lavage fluid were associated with positive cytology and pleural invasion in the primary sites, even in cytology-negative cases. In vitro studies demonstrated that EV-miR-21 induces the MMT. Mesothelial cells in the MMT showed functions similar to cancer-associated fibroblasts, which are an important stromal component in primary sites and disseminated pleural lesions. CONCLUSIONS: EV-miR-21 in pleural lavage fluid is important as a diagnostic and prognostic factor. Moreover, EV-miR-21 induces the MMT, which can form premetastatic niches of dissemination in the pleural cavity.

2.
Gen Thorac Cardiovasc Surg ; 68(2): 112-121, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31300951

RESUMO

OBJECTIVES: This study aimed to demonstrate the efficacy and safety of a newly developed elastomeric sealant, which does not require any blood coagulation system to exert its effect, during thoracic aortic surgery. METHODS: This is a multicenter, randomized study conducted in six hospitals in Japan. A total of 81 patients undergoing replacement surgery of a thoracic aortic aneurysm using cardiopulmonary bypass were randomized with a ratio of 2-:1 for those patients designated to receive the sealant (Group S, 54 patients) or those without the usage of the sealant (Group C, 27 patients). The primary endpoints were bleeding from each anastomosis at two time points: (1) immediately before applying protamine and (2) 15 min after applying protamine. The patients were followed for 6 months. RESULTS: The number of anastomoses checked for bleeding was 196 in Group S and 117 in Group C. Before protamine sulfate administration, complete hemostasis was obtained in 155 anastomoses (79%) in Group S compared to 45 anastomoses (38%) in Group C (p < 0.001). Fifteen minutes after the administration of protamine sulfate infusion, bleeding stopped completely in 173 anastomoses (88%) in Group S and in 71 anastomoses (61%, p < 0.001) in Group C. Between the two groups, there were no marked differences in the patient background or in the incidence of major adverse events. CONCLUSIONS: The sealant is effective in achieving hemostasis, even under fully heparinized conditions. The novel sealant is safe and effective in thoracic aortic surgery, one of the most demanding surgical situations for hemostasis.

3.
Gen Thorac Cardiovasc Surg ; 68(2): 102-111, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31646476

RESUMO

BACKGROUND: The Japanese registry for mechanical assisted circulatory support (J-MACS) is a prospective registry to collect all data of implantable left ventricular assist device (LVAD) (and part of paracorporeal VAD) established in 2010. The first analytical report was published in 2017. The organization running J-MACS was used to be the pharmaceuticals and medical devices agency (PMDA), but has been changed to the council for clinical use of ventricular assist device related academic societies in 2017. METHODS: Since 2018, we changed the analytical methods as follows: first, we eliminated paracorporeal VAD from the analysis. Second, we included not only primary implantation but bridge to bridge (BTB) implantation of LVAD. Third, we added the analyses of adverse events that were not included in the previous analysis. RESULTS: As of Oct 2018, 711 primary LVAD implants and 168 BTB implants were enrolled. Survival rate of primary LVAD was 93% at 360 days and 91% at 720 days, and that of BTB was 86% at 360 days and 82% at 720 days. CONCLUSION: We first reported the results of BTB in the second official report of J-MACS. The prognosis after LVAD implantation has been kept good in Japanese circumstances.

4.
Pathol Int ; 69(12): 688-696, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31625265

RESUMO

Anaplastic lymphoma kinase-rearranged (ALK+ ) lung cancers show characteristic histological features, such as solid signet ring cell patterns and mucinous cribriform patterns; however, these features are not always observed in ALK+ lung cancers. We noticed that club cell (Clara cell)-like cells (CLCs) were frequently present in the papillary portion of ALK+ lung adenocarcinomas. In this study, we investigated the importance of CLCs in papillary patterns of ALK+ lung cancers. We compared the histological features of 18 ALK+ cases with 62 control cases (22 epidermal growth factor receptor-positive (EGFR+ ) and 40 ALK- and EGFR-negative (ALK- /EGFR- ) cases). The present study analyzed presence of papillary pattern, proportion of papillary pattern area, presence of micropapillary pattern, frequency of CLCs and lengths of snout. The frequency of CLCs in ALK+ cases was significantly higher than that in EGFR+ cases and ALK- /EGFR- cases. Micropapillary pattern was more frequently observed in ALK+ cases than that in ALK- /EGFR- cases (P < 0.001). The present study indicated that the high frequency of CLCs in papillary patterns was significantly associated with ALK+ cases. When solid signet ring cell patterns and mucinous cribriform patterns are absent, the high frequency of CLCs in papillary adenocarcinoma could be a useful histological marker for ALK+ lung cancers.

6.
PLoS One ; 14(7): e0213114, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31295264

RESUMO

BACKGROUND: 2-Cl-C.OXT-A (COA-Cl) is a novel synthesized adenosine analog that activates Sphingosine-1-phosphate 1 receptor (S1P1R) and combines with the adenosine A1 receptor (A1R) in G proteins and was shown to enhance angiogenesis and improve the brain function in rat stroke models. However, the role of COA-Cl in hearts remains unclear. COA-Cl, which has a similar structure to xanthine derivatives, has the potential to suppress phosphodiesterase (PDE), which is an important factor involved in the beating of heart muscle. METHODS AND RESULTS: Cardiac organoids with fibroblasts, human induced pluripotent stem cell-derived cardiac myocytes (hiPSC-CMs), and hiPSC-derived endothelial cells (hiPSC-ECs) were cultured until they started beating. The beating and contraction of organoids were observed before and after the application of COA-Cl. COA-Cl significantly increased the beating rate and fractional area change in organoids. To elucidate the mechanism underlying these effects of COA-Cl on cardiac myocytes, pure hiPSC-CM spheroids were evaluated in the presence/absence of Suramin (antagonist of A1R). The effects of COA-Cl, SEW2871 (direct stimulator of S1P1R), two positive inotropes (Isoproterenol [ISO] and Forskolin [FSK]), and negative inotrope (Propranolol [PRP]) on spheroids were assessed based on the beating rates and cAMP levels. COA-Cl stimulated the beating rates about 1.5-fold compared with ISO and FSK, while PRP suppressed the beating rate. However, no marked changes were observed with SEW2871. COA-Cl, ISO, and FSK increased the cAMP level. In contrast, the level of cAMP did not change with PRP or SEW2871 treatment. The results were the same in the presence of Suramin as absence. Furthermore, an enzyme analysis showed that COA-Cl suppressed the PDE activity by half. CONCLUSIONS: COA-Cl, which has neovascularization effects, suppressed PDE and increased the contraction of cardiac organoids, independent of S1P1R and A1R. These findings suggest that COA-Cl may be useful as an inotropic agent for promoting angiogenesis in the future.


Assuntos
Adenosina/farmacologia , Células-Tronco Pluripotentes Induzidas/citologia , Contração Miocárdica/efeitos dos fármacos , Miócitos Cardíacos/efeitos dos fármacos , Inibidores de Fosfodiesterase/farmacologia , Adenosina/análogos & derivados , Linhagem Celular , Humanos , Miócitos Cardíacos/citologia , Miócitos Cardíacos/metabolismo , Organoides/citologia , Organoides/efeitos dos fármacos , Organoides/metabolismo , Inibidores de Fosfodiesterase/química , Diester Fosfórico Hidrolases/metabolismo
7.
J Cardiothorac Surg ; 14(1): 141, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337418

RESUMO

BACKGROUND: Severe carotid and intracranial artery stenosis disease (CIAD) is major risk for perioperative stroke in coronary artery bypass grafting. Then, preoperative risk assessment is quite important. CASE PRESENTATION: A 58-years old Japanese woman with bilateral carotid stenosis and bilateral middle cerebral artery occlusion was suffered from worsening effort angina due to severe three coronary vessel disease. Magnetic resonance imaging angiography demonstrated severe carotid and intracranial vessel stenosis. Selective carotid/cerebral angiography also showed severe stenosis and delayed filling of the right internal carotid artery and moderate stenosis of the left internal carotid artery, with occlusion of the bilateral middle cerebral arteries. However, quantitative evaluation with brain perfusion, single-photon emission computed tomography (SPECT) with acetazolamide showed depleted cerebral perfusion volume and vascular responses, particularly in the left middle cerebral artery area. However, both sides of MCA reserve cerebral blood flow was maintained at > 34 ml/100 g/min. So, we finally considered that her cerebral perfusion reserve was maintained a certain level and could tolerate open heart surgery. Then, she underwent off-pump coronary artery grafting. Before sternotomy, prophylactic intra-aortic balloon pump support was used to minimize possible perioperative stroke. As a result, hemodynamic status and brain regional oxygen saturation were stable throughout the operation, and recovered uneventfully. CONCLUSIONS: Preoperative quantitative evaluation using brain perfusion SPECT with acetazolamide is useful in assessing hemodynamic cerebrovascular risk in patients with severe obstructive CIAD. Off pump coronary artery bypass grafting with intra aortic balloon pump assist is a good option for prevention of cerebrovascular morbidity in ischemic heart disease with severe CIAD.


Assuntos
Estenose das Carótidas/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Acetazolamida/administração & dosagem , Estenose das Carótidas/fisiopatologia , Estenose das Carótidas/cirurgia , Artérias Cerebrais/fisiopatologia , Artérias Cerebrais/cirurgia , Circulação Cerebrovascular , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/fisiopatologia , Constrição Patológica/cirurgia , Ponte de Artéria Coronária , Feminino , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Medição de Risco , Acidente Vascular Cerebral/prevenção & controle , Tomografia Computadorizada de Emissão de Fóton Único
8.
Nat Commun ; 10(1): 2244, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31113942

RESUMO

Before they are used in the clinical setting, the effectiveness of artificially produced human-derived tissue-engineered medical products should be verified in an immunodeficient animal model, such as severe combined immunodeficient mice. However, small animal models are not sufficient to evaluate large-sized products for human use. Thus, an immunodeficient large animal model is necessary in order to properly evaluate the clinical efficacy of human-derived tissue-engineered products, such as artificial grafts. Here we report the development of an immunodeficient pig model, the operational immunodeficient pig (OIDP), by surgically removing the thymus and spleen, and creating a controlled immunosuppressive protocol using a combination of drugs commonly used in the clinical setting. We find that this model allows the long-term accommodation of artificial human vascular grafts. The development of the OIDP is an essential step towards a comprehensive and clinically relevant evaluation of human cell regeneration strategies at the preclinical stage.


Assuntos
Órgãos Bioartificiais , Prótese Vascular , Hospedeiro Imunocomprometido , Modelos Animais , Engenharia Tecidual , Animais , Implante de Prótese Vascular/métodos , Linhagem Celular , Fibroblastos , Humanos , Masculino , Impressão Tridimensional , Baço/imunologia , Baço/cirurgia , Suínos , Porco Miniatura/imunologia , Porco Miniatura/cirurgia , Timo/imunologia , Timo/cirurgia , Fatores de Tempo
9.
Interact Cardiovasc Thorac Surg ; 29(3): 442-448, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31106332

RESUMO

OBJECTIVES: Spread through air space (STAS) is recognized as a pattern of invasion in lung adenocarcinoma and has been reported to be a predictor of recurrence and survival in patients with early-stage lung adenocarcinoma. However, this parameter has not been studied well in stage III (N2) lung adenocarcinoma. In this study, we evaluated the association between STAS invasion patterns and recurrence and survival in stage III (N2) lung adenocarcinoma. METHODS: We retrospectively reviewed data from 76 patients at University of Tokyo with stage III (N2) lung adenocarcinoma who underwent surgery from August 1998 to December 2013. Statistical analysis was performed to determine the impact of STAS invasion clinicopathological features and clarify the relationship between this pattern of invasion and survival. RESULTS: Tumour STAS was observed in 46 of 76 patients (60.5%) and was significantly associated with the presence of lymphatic invasion (P < 0.001), papillary components (P < 0.001) and micropapillary components (P < 0.001). STAS was also significantly associated with recurrence (5-year recurrence-free probability: 19.0% vs 46.1%, P < 0.05). Univariate analyses showed that STAS was a significant risk factor for recurrence (hazard ratio 1.94, 95% confidence interval 1.07-3.51; P = 0.029). CONCLUSIONS: The presence of STAS invasion pattern is a significant risk factor for recurrence in stage III (N2) lung adenocarcinoma.


Assuntos
Adenocarcinoma de Pulmão/patologia , Neoplasias Pulmonares/patologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Adenocarcinoma de Pulmão/mortalidade , Adenocarcinoma de Pulmão/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão/epidemiologia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/mortalidade , Pneumonectomia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
10.
Gen Thorac Cardiovasc Surg ; 67(11): 999-1000, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30968259

RESUMO

We herein report a new procedure to prevent type 3 endoleakage (EL3) after open stent graft (OSG) surgery with thoracic endovascular aortic repair (TEVAR) extension. The OSG Dacron graft portion is reversed and folded inside the OSG stent graft portion intraoperatively, filling the crack between the OSG and TEVAR device. We applied this procedure in two patients with no postoperative complications. Our folding procedure may prevent EL3 after OSG surgery if TEVAR extension is needed in the future.


Assuntos
Fístula Anastomótica/prevenção & controle , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Complicações Pós-Operatórias/prevenção & controle , Fístula Anastomótica/etiologia , Aorta Torácica/cirurgia , Prótese Vascular/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Stents/efeitos adversos , Resultado do Tratamento
11.
Semin Thorac Cardiovasc Surg ; 31(3): 414-421, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30654025

RESUMO

To investigate postoperative pectoral atrophy in 141 patients undergoing aortic arch surgery involving bilateral axillary artery cannulations with side grafts. The depth from the skin to the axillary artery surrounding the thoracoacromial artery (zone 1), and the thicknesses of pectoralis major (zone 2) and pectoralis minor (zone 3) were measured by computed tomography before surgery, at 1 and 6 months after surgery, and at the most recent follow-up assessment (PostT2) (mean = 41 months, range 11-75 months). Based on the median value (47.4 mm) of zone 1, the preoperative pectoral thickness was categorized into 2 groups: pectoral thickness >47.4 mm (thick group) and ≤47.4 mm (thin group). Mean changes in the pectoral thickness from baseline were evaluated using the longitudinal mixed-effects model. Forty-three of 110 patients underwent total arch replacements and extra-anatomical bypasses for left subclavian artery anastomoses. In 3 patients, axillary artery grafts became infected. There was no obvious harm associated with muscle wasting. Mean changes from baseline in zones 1, 2, and 3 showed significant declines at PostT2 (-13.40 ± 9.73 mm [P < 0.0001], -7.00 ± 5.23 mm [P < 0.0001], and -7.23 ± 6.42 mm [P < 0.0001], respectively). In the thick group, the progression of pectoral atrophy in zones 1 and 3 was significantly more than that of the thin group (P < 0.0001 for both zones). Postoperative pectoral atrophy progressed rapidly. The preoperative pectoral size might be of no use in the prevention of pectoral atrophy. Further investigation to prevent the pectoral atrophy is needed.


Assuntos
Aorta Torácica/cirurgia , Artéria Axilar , Implante de Prótese Vascular , Cateterismo Periférico/efeitos adversos , Atrofia Muscular/etiologia , Músculos Peitorais/patologia , Idoso , Idoso de 80 Anos ou mais , Implante de Prótese Vascular/efeitos adversos , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia Muscular/diagnóstico por imagem , Atrofia Muscular/patologia , Músculos Peitorais/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
PLoS One ; 13(12): e0209162, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30557409

RESUMO

A major challenge in cardiac tissue engineering is the host's immune response to artificial materials. To overcome this problem, we established a scaffold-free system for assembling cell constructs using an automated Bio-3D printer. This printer has previously been used to fabricate other three-dimensional (3D) constructs, including liver, blood vessels, and cartilage. In the present study, we tested the function in vivo of scaffold-free cardiac tubular construct fabricated using this system. Cardiomyocytes derived from induced pluripotent stem cells (iCells), endothelial cells, and fibroblasts were combined to make the spheroids. Subsequently, tubular cardiac constructs were fabricated by Bio-3D printer placing the spheroids on a needle array. Notably, the spheroid fusion and beat rate in the constructs were observed while still on the needle array. After removal from the needle array, electrical stimulation was used to test responsiveness of the constructs. An increased beat rate was observed during stimulation. Importantly, the constructs returned to their initial beat rate after stimulation was stopped. In addition, histological analysis shows cellular reorganization occurring in the cardiac constructs, which may mimic that observed during organ transplantation. Taken together, our results indicate that these engineered cardiac tubular constructs, which address both the limited supply of donor tissues as well as the immune-induced transplant rejection, has potential to be used for both clinical and drug testing applications. To our knowledge, this is the first time that cardiac tubular constructs have been produced using optimized Bio-3D printing technique and subsequently tested for their use as cardiac pumps.


Assuntos
Bioimpressão/métodos , Miócitos Cardíacos/citologia , Impressão Tridimensional , Tecidos Suporte , Estimulação Elétrica , Células Endoteliais/citologia , Fibroblastos/citologia , Humanos , Esferoides Celulares/citologia
13.
J Clin Biochem Nutr ; 63(1): 66-69, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30087546

RESUMO

This study aimed i) to investigate about items with high relevance for aspiration pneumonia during hospitalization among cases evaluated using Diagnosis Procedure Combination data, and ii) to determine whether the concern factors for aspiration pneumonia during hospitalization were exacerbated with the trend of the time. The Diagnosis Procedure Combination data were gathered from 2010 through to 2015 with 63,390 cases at Saga University Hospital. The occurrence of concern factors of aspiration pneumonia during hospitalization were compared in the two time periods set (2010-2012 and 2013-2015). The concern factors included: male, age, dysphagia at admission and during hospitalization, use and days in the emergency care unit or high care unit, use of the intensive care unit, and use of an ambulance. Age, dysphagia, and use of the intensive care unit were time-dependently exacerbated. The incidence of aspiration pneumonia during hospitalization in hospitalized cases did not differ between years 2010-2012 and 2013-2015. Aspiration pneumonia during hospitalization complicated with surgery and number days in the emergency care unit or high care unit diminished in years 2013-2015. Despite an increased concern of aspiration pneumonia during hospitalization, the complication rate of aspiration pneumonia during hospitalization did not increase.

14.
Tissue Cell ; 53: 61-67, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30060828

RESUMO

BACKGROUND: We havebeen attempting to use cardiac spheroids to construct three-dimensional contractilestructures for failed hearts. Recent studies have reported that neuralprogenitors (NPs) play significant roles in heart regeneration. However, theeffect of NPs on the cardiac spheroid has not yet been elucidated. OBJECTIVE: This studyaims to demonstrate the influence of NPs on the function of cardiac spheroids. METHODS: Thespheroids were constructed on a low-attachment-well plate by mixing humaninduced pluripotent stem (hiPS) cell-derived cardiomyocytes and hiPScell-derived NPs (hiPS-NPs). The ratio of hiPS-NPs was set at 0%, 10%, 20%,30%, and 40% of the total cell number of spheroids, which was 2500. The motionwas recorded, and the fractional shortening and the contraction velocity weremeasured. RESULTS: Spheroidswere formed within 48 h after mixing the cells, except for the spheroidscontaining 0% hiPS-NPs. Observation at day 7 revealed significant differencesin the fractional shortening (analysis of variance; p = 0.01). The bestfractional shortening was observed with the spheroids containing 30% hiPS-NPs.Neuronal cells were detected morphologically within the spheroids under aconfocal microscope. CONCLUSION: Theaddition of hiPS-NPs influenced the contractile function of the cardiacspheroids. Further studies are warranted to elucidate the underlying mechanism.


Assuntos
Células-Tronco Pluripotentes Induzidas/metabolismo , Contração Miocárdica , Miócitos Cardíacos/metabolismo , Células-Tronco Neurais/metabolismo , Esferoides Celulares/metabolismo , Humanos , Células-Tronco Pluripotentes Induzidas/citologia , Miócitos Cardíacos/citologia , Células-Tronco Neurais/citologia , Esferoides Celulares/citologia
15.
Sci Rep ; 8(1): 8838, 2018 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-29892003

RESUMO

Cancer-associated fibroblasts (CAFs) interact closely with cancer cells, supporting their growth and invasion. To investigate the role of microRNA-21 (miR-21) in lung adenocarcinoma, and especially in its CAF component, in situ hybridisation was applied to samples from 89 invasive lung adenocarcinoma cases. MiR-21 expression was observed in both cancer cells and CAFs. When the patients were stratified by expression, miR-21 levels in CAFs (n = 9), but not in cancer cells (n = 21), were inversely correlated with patient survival; patients with miR-21high CAFs exhibited lower survival than those with miR-21low CAFs. The underlying mechanism was investigated in vitro. Conditioned medium (CM) from A549 lung cancer cells increased miR-21 expression in MRC-5 and IMR-90 lung fibroblasts through the transforming growth factor-ß pathway, and induced CAF-like morphology and migratory capacity. MiR-21 up-regulation in lung fibroblasts induced a novel CAF-secreted protein, calumenin, as well as known CAF markers (periostin, α-smooth muscle actin, and podoplanin). Moreover, CM from the lung fibroblasts increased A549 cell proliferation in a calumenin-dependent manner. Thus, miR-21 expression in lung fibroblasts may trigger fibroblast trans-differentiation into CAFs, supporting cancer progression. Therefore, CAF miR-21 represents a pivotal prognostic marker for this scar-forming cancer of the lungs.


Assuntos
Adenocarcinoma de Pulmão/patologia , Fibroblastos Associados a Câncer/metabolismo , Neoplasias Pulmonares/patologia , MicroRNAs/metabolismo , Células A549 , Proliferação de Células , Progressão da Doença , Células Epiteliais/fisiologia , Humanos , Estadiamento de Neoplasias , Análise de Sobrevida , Tóquio
16.
Ann Thorac Surg ; 105(3): e141-e143, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29455830

RESUMO

There is controversy about handling functional mitral regurgitation in patients undergoing aortic valve or proximal aortic operations. We describe a transaortic Alfieri edge-to-edge repair for functional mitral regurgitation that reduces operative excessive invasion and prolonged cardiopulmonary bypass time. Between May 2013 and December 2016, 10 patients underwent transaortic Alfieri edge-to-edge mitral repair. There were no operative deaths. The severity of mitral regurgitation immediately after the operation by transesophageal echocardiography was none or trivial in all patients. A transaortic Alfieri edge-to-edge repair for functional mitral regurgitation is a simple and safe approach.


Assuntos
Aorta/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Am J Respir Cell Mol Biol ; 59(1): 45-55, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29365277

RESUMO

IFN-ß is reported to improve survival in patients with acute respiratory distress syndrome (ARDS), possibly by preventing sepsis-induced immunosuppression, but its therapeutic nature in ARDS pathogenesis is poorly understood. We investigated the therapeutic effects of IFN-ß for postseptic ARDS to better understand its pathogenesis in mice. Postseptic ARDS was reproduced in mice by cecal ligation and puncture to induce sepsis, followed 4 days later by intratracheal instillation of Pseudomonas aeruginosa to cause pneumonia with or without subcutaneous administration of IFN-ß 1 day earlier. Sepsis induced prolonged increases in alveolar TNF-α and IL-10 concentrations and innate immune reprogramming; specifically, it reduced alveolar macrophage (AM) phagocytosis and KC (CXCL1) secretion. Ex vivo AM exposure to TNF-α or IL-10 duplicated cytokine release impairment. Compared with sepsis or pneumonia alone, pneumonia after sepsis was associated with blunted alveolar KC responses and reduced neutrophil recruitment into alveoli despite increased neutrophil burden in lungs (i.e., "incomplete alveolar neutrophil recruitment"), reduced bacterial clearance, increased lung injury, and markedly increased mortality. Importantly, IFN-ß reversed the TNF-α/IL-10-mediated impairment of AM cytokine secretion in vitro, restored alveolar innate immune responsiveness in vivo, improved alveolar neutrophil recruitment and bacterial clearance, and consequently reduced the odds ratio for 7-day mortality by 85% (odds ratio, 0.15; 95% confidence interval, 0.03-0.82; P = 0.045). This mouse model of sequential sepsis → pneumonia infection revealed incomplete alveolar neutrophil recruitment as a novel pathogenic mechanism for postseptic ARDS, and systemic IFN-ß improved survival by restoring the impaired function of AMs, mainly by recruiting neutrophils to alveoli.


Assuntos
Interferon beta/uso terapêutico , Macrófagos Alveolares/patologia , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Sepse/tratamento farmacológico , Sepse/fisiopatologia , Animais , Citocinas/metabolismo , Modelos Animais de Doenças , Humanos , Imunidade Inata/efeitos dos fármacos , Interferon beta/farmacologia , Lesão Pulmonar/sangue , Lesão Pulmonar/tratamento farmacológico , Lesão Pulmonar/etiologia , Lesão Pulmonar/fisiopatologia , Macrófagos Alveolares/efeitos dos fármacos , Masculino , Camundongos Endogâmicos C57BL , Modelos Biológicos , Pneumonia/sangue , Pneumonia/complicações , Síndrome do Desconforto Respiratório do Adulto/sangue , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Sepse/sangue , Transdução de Sinais/efeitos dos fármacos , Análise de Sobrevida , Resultado do Tratamento
18.
Interact Cardiovasc Thorac Surg ; 26(2): 216-223, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29049799

RESUMO

OBJECTIVES: To evaluate the efficacy of intensive craniocervical screening before elective cardiovascular surgery. METHODS: A retrospective analysis of 1134 consecutive patients who underwent routine screening before cardiovascular surgery between November 2004 and December 2014 was conducted. The study was divided into 2 distinct cohorts of patients undergoing surgery: before (n = 500) and after (n = 634) the introduction of intensive screening in January 2009. In 2009, preoperative screening underwent a transition from the evaluation of carotid atherosclerosis alone to that of craniocervical atherosclerosis. Additionally, patients with moderate or greater stenosis on intensive screening underwent single-photon emission computed tomography with acetazolamide. Craniocervical atherosclerosis was classified as no or mild [0-49%: n = 836 (before/after: 370/466)], moderate [50-69%: n = 118 (56/62)] or severe [70-100%: n = 141 (36/105)]. One of 166 (0.6%) patients with moderate or greater stenosis undergoing single-photon emission computed tomography with acetazolamide after the introduction of intensive screening was diagnosed as having impaired cerebral autoregulation. RESULTS: The occurrences of perioperative stroke were 2.8% before the introduction of intensive screening and 0.9% after that (P = 0.033). Notably, intraoperative stroke significantly decreased from 1.4% to 0.2% (P = 0.034). Specifically, the occurrence of perioperative stroke in patients with no or mild stenosis decreased significantly after the introduction of intensive screening, from 2.7% to 0.4% (P = 0.007). CONCLUSIONS: The incidence of perioperative stroke decreased following the introduction of intensive screening. Intensive screening may be able to detect patients with a greater risk of perioperative stroke.


Assuntos
Estenose das Carótidas/cirurgia , Procedimentos Cirúrgicos Eletivos/métodos , Acidente Vascular Cerebral/prevenção & controle , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Estenose das Carótidas/diagnóstico , Feminino , Humanos , Incidência , Japão/epidemiologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler
20.
J Thorac Dis ; 9(8): 2419-2426, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28932547

RESUMO

BACKGROUND: Cancer relapse is caused by residual isolated tumor cells (ITCs) remaining in the body after surgery. It is speculated that surgical manipulation may cause circulating tumor cells (CTCs) which are the origin of ITCs in the body. The occurrence of CTCs in surgical patients with non-small cell lung cancer (NSCLC) has been shown in retrospective observation, but not prospectively, thus we conducted a multicenter prospective study regarding the occurrence of CTCs by surgical manipulation. METHODS: Patients with T1b-2N0M0 lung cancer were studied. Blood samples were collected from the peripheral artery in the operating room at both pre- and post-lobectomy to extract CTCs by a size selection method. The CTCs detection rate, pathological findings, and background of each patient were studied. RESULTS: The histological diagnosis of 29 patients were adenocarcinoma in 24 patients, squamous cell carcinoma in 3 patients, and other types in 2 patients. The number of pre-CTCs positive patients was 13 and the number of post CTCs positive patients was 17. Among the 16 patients who were pre-CTCs negative, 4 patients showed post CTCs positive, while all pre-CTCs positive patients remained post-CTCs positive. CONCLUSIONS: The likelihood of CTC dislodgement by surgical manipulation is indicated based on the result that CTCs were detected after lung cancer surgery, where there were no cases of pre-CTCs positive and post CTCs negative.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA