Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 21
Filtrar
1.
J Rheumatol ; 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33262295

RESUMO

OBJECTIVE: Macrophage activation syndrome (MAS), a life-threatening inflammatory complication, is increasingly recognized in childhood-onset SLE (cSLE). It can be a challenge to differentiate active cSLE from MAS. We generated decision rules for discriminating MAS from active cSLE in newly diagnosed patients. METHODS: We conducted a retrospective cohort study of consecutive, newly diagnosed, active cSLE patients with fever, requiring hospital admission to SickKids from January 2003 - December 2007 (cohort 1), and January 2008 - December 2013 (Cohort 2). All patients met ≥4 ACR or SLICC criteria, were steroid naïve and infection free. MAS was diagnosed based on expert opinion. Recursive partitioning was applied to each cohort to derive a decision rule based on clinical and laboratory features, distinguishing MAS from non-MAS cSLE. Each decision rule was applied to the alternate, independent cohort. Sensitivity and specificity of these decision rules were compared to existing criteria. RESULTS: Cohort 1 (n=34) and cohort 2 (n=41) each had 10 MAS patients. Recursive partitioning in cohort 1 identified ferritin ≥699 µg/L, as the sole best discriminator between MAS and non- MAS patients (R2=0.48) and in cohort 2 ferritin ≥1107 µg/L, followed by lymphocytes < 0.72 x103/mm3 were the best discriminators for MAS (R2=0.52). Cross-validation of our decision rules maintained 90-100% sensitivity and 65-85% specificity. CONCLUSION: Our decision rule demonstrated improved performance compared to preliminary guidelines for MAS in cSLE from the Lupus Working Group of the Paediatric Rheumatology European Society, and familial Hemophagocytic Lymphohistiocytosis diagnostic criteria. Validation in independent cohorts is required.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33306423

RESUMO

INTRODUCTION: To date, the transmission of Coronavirus Disease-2019 (COVID-19) is still overwhelming with the fact that numbers of confirmed cases and deaths keep increasing. As of 1 October, 2020, 33,842,281 confirmed cases and 1,010,634 confirmed deaths have been reported to the World Health Organization from 216 countries. Despite the urgent need of effective treatment strategies, there is no specific antiviral treatment for COVID-19 currently and the treatment guidelines for COVID-19 vary among countries. AREA COVERED: In this article, we summarized the current knowledge about the causative pathogen and the pandemic worldwide. The epidemiology, pathogenesis, prevention and various treatment options of COVID-19 will be discussed for better acknowledgment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). EXPERT OPINION: The situation of the COVID-19 pandemic is still unpredictable. There is no effective vaccine or specific anti-viral drug to treat serve COVID-19 patients. Combination therapies such as a triple combination of interferon beta-1b, lopinavir-ritonavir and ribavirin or hydroxychloroquine plus azithromycin have shown promising clinical improvement. Repurposing FDA-approved drugs might be one of possible treatment options. Without specific treatment and vaccines for COVID-19, the most effective way to prevent from being infected is to generate an ecosystem with effective protection, precautions and preventive measures.

3.
J Perinat Med ; 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32889795

RESUMO

Objectives Pregnancy-associated venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is associated with increased risk of maternal mortality and morbidity. This study aimed to assess potential risk factors for pregnancy-associated VTE. Methods In this case-control study, women with pregnancy-associated VTE were identified via International Classification of Diseases codes and included if they had been objectively diagnosed with VTE during pregnancy or within six weeks postpartum, from 2004 to 2016, at KK Women's and Children's Hospital or Singapore General Hospital in Singapore. Controls, i.e. pregnant women without VTE, were selected from a prospective longitudinal study. The odds ratio (OR) for VTE was computed for a range of maternal and obstetric factors. Results and conclusions From 2004 to 2016, 89 cases of pregnancy-associated VTE and 926 controls were identifed and analysed using logistic regression. The most significant risk factors for pregnancy-associated VTE were smoking (OR 5.44, p=0.0002) and preterm delivery (OR 5.06, p=0.023). Malay race, multiparity, non-O blood group and caesarean section, were also identified to be of higher risk. These risk factors should be useful in the development of thromboprophylaxis strategies for pregnancy and the postpartum period, especially in Singapore.

4.
Artigo em Inglês | MEDLINE | ID: mdl-32976694

RESUMO

OBJECTIVE: The aim of this study was to examine the impact of timing of childhood-onset systemic lupus erythematosus (cSLE) diagnosis relative to menarchal status, on final height, accounting for and disease associated factors. METHODS: A cohort study of female cSLE patients <18 years of age at diagnosis, followed at a tertiary care, pediatric center from July 1982 to March 2016, restricted to patients with documented age of menarche and final height. We compared final height between patients diagnosed pre- and post-menarche. We tested the association of timing of cSLE diagnosis with final height, adjusted for ethnicity, in linear regression models. We performed subgroup analyses of patients with growth during follow-up, additionally adjusting for average daily corticosteroid dose and disease activity. RESULTS: Of 401 female cSLE patients in the study, 115 patients (29%) were diagnosed pre-menarche and 286 (71%) post-menarche. Patients diagnosed pre-menarche were older at menarche compared with patients diagnosed post-menarche (13.5 ± 1.4 vs. 12.5 ± 1.3 years; p < 0.001). The mean final height for females diagnosed post-menarche (161.4 cm [SD 6.9 cm]) was greater than those diagnosed pre-menarche (158.8 cm [SD 7.3 cm], P=0.001). In regression analysis, those diagnosed post-menarche were significantly taller than those diagnosed pre-menarche, adjusted for ethnicity, and disease severity (Beta=2.6cm, [SD 0.7cm], P=0.0006). CONCLUSION: In this large cohort study of females with cSLE, patients diagnosed post-menarche achieved a taller final height than those diagnosed pre-menarche even after accounting for ethnicity and disease severity.

5.
Sci Rep ; 10(1): 14186, 2020 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-32843693

RESUMO

Infections cause varying degrees of haemostatic dysfunction which can be detected by clot waveform analysis (CWA), a global haemostatic marker. CWA has been shown to predict poor outcomes in severe infections with disseminated intravascular coagulopathy. The effect of less severe bacterial and viral infections on CWA has not been established. We hypothesized that different infections influence CWA distinctively. Patients admitted with bacterial infections, dengue and upper respiratory tract viral infections were recruited if they had an activated partial thromboplastin time (aPTT) measured on admission. APTT-based CWA was performed on Sysmex CS2100i automated analyser using Dade Actin FSL reagent. CWA parameters [(maximum velocity (min1), maximum acceleration (min2) and maximum deceleration (max2)] were compared against control patients. Infected patients (n = 101) had longer aPTT than controls (n = 112) (34.37 ± 7.72 s vs 27.80 ± 1.59 s, p < 0.001), with the mean (± SD) aPTT longest in dengue infection (n = 36) (37.99 ± 7.93 s), followed by bacterial infection (n = 52) (33.96 ± 7.33 s) and respiratory viral infection (n = 13) (29.98 ± 3.92 s). Compared to controls (min1; min2; max2) (5.53 ± 1.16%/s; 0.89 ± 0.19%/s2; 0.74 ± 0.16%/s2), bacterial infection has higher CWA results (6.92 ± 1.60%/s; 1.04 ± 0.28%/s2; 0.82 ± 0.24%/s2, all p < 0.05); dengue infection has significantly lower CWA values (3.93 ± 1.32%/s; 0.57 ± 0.17%/s2; 0.43 ± 0.14%/s2, all p < 0.001) whilst respiratory virus infection has similar results (6.19 ± 1.32%/s; 0.95 ± 0.21%/s2; 0.73 ± 0.18%/s2, all p > 0.05). CWA parameters demonstrated positive correlation with C-reactive protein levels (min1: r = 0.54, min2: r = 0.44, max2: r = 0.34; all p < 0.01). Different infections affect CWA distinctively. CWA could provide information on the haemostatic milieu triggered by infection and further studies are needed to better define its application in this area.

6.
J Rheumatol ; 47(11): 1687-1695, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31941805

RESUMO

OBJECTIVE: Mental health problems are prevalent in youth with rheumatologic disease. Gaps in knowledge exist regarding their effect, as well as strategies for detection and effective treatment. To address these gaps, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mental Health Workgroup developed and prioritized an agenda of research topics. METHODS: We systematically reviewed the literature and identified 5 major research domains in further need of study: (A) mental health burden and relationship to pediatric rheumatologic disease, (B) effect of mental health disorders on outcomes, (C) mental health awareness and education, (D) mental health screening, and (E) mental health treatment. Research topics within these areas were developed by workgroup leaders and refined by the workgroup. Members were surveyed to prioritize the topics by importance, feasibility of study, and actionability. RESULTS: Fifty-nine members (57%) completed the survey. Among the proposed research topics, 31/33 were rated as highly important and 4/33 were rated highly for importance, feasibility, and actionability. Topics rated most important related to (A) mental health burden and relationship to rheumatologic disease, and (B) the effect of mental health on outcomes. Topics rated most feasible and actionable were related to (D) mental health screening. CONCLUSION: Addressing gaps in knowledge regarding mental health in youth with rheumatologic disease is essential for improving care. We have identified high priority research topics regarding mental health of pediatric rheumatology patients in need of further investigation that are feasible to study and believed to lead to actionable results in patient care.

7.
Rheumatology (Oxford) ; 59(1): 90-98, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31236574

RESUMO

OBJECTIVE: LN is one of the most common and severe manifestations of SLE. Our aim was to test the association of SLE risk loci with LN risk in childhood-onset SLE (cSLE) and adult-onset SLE (aSLE). METHODS: Two Toronto-based tertiary care SLE cohorts included cSLE (diagnosed <18 years) and aSLE patients (diagnosed ⩾18 years). Patients met ACR and/or SLICC SLE criteria and were genotyped on the Illumina Multi-Ethnic Global Array or Omni1-Quad arrays. We identified those with and without biopsy-confirmed LN. HLA and non-HLA additive SLE risk-weighted genetic risk scores (GRSs) were tested for association with LN risk in logistic models, stratified by cSLE/aSLE and ancestry. Stratified effect estimates were meta-analysed. RESULTS: Of 1237 participants, 572 had cSLE (41% with LN) and 665 had aSLE (30% with LN). Increasing non-HLA GRS was significantly associated with increased LN risk [odds ratio (OR) = 1.26; 95% CI 1.09, 1.46; P = 0.0006], as was increasing HLA GRS in Europeans (OR = 1.55; 95% CI 1.07, 2.25; P = 0.03). There was a trend for stronger associations between both GRSs and LN risk in Europeans with cSLE compared with aSLE. When restricting cases to proliferative LN, the magnitude of these associations increased for both the non-HLA (OR = 1.30; 95% CI 1.10, 1.52; P = 0.002) and HLA GRS (OR = 1.99; 95% CI 1.29, 3.08; P = 0.002). CONCLUSION: We observed an association between known SLE risk loci and LN risk in children and adults with SLE, with the strongest effect observed among Europeans with cSLE. Future studies will include SLE-risk single nucleotide polymorphisms specific to non-European ancestral groups and validate findings in an independent cohort.


Assuntos
Idade de Início , Loci Gênicos/genética , Predisposição Genética para Doença/genética , Lúpus Eritematoso Sistêmico/genética , Nefrite Lúpica/genética , Adolescente , Adulto , Criança , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Predisposição Genética para Doença/etnologia , Genótipo , Humanos , Modelos Logísticos , Lúpus Eritematoso Sistêmico/etnologia , Nefrite Lúpica/etnologia , Masculino , Razão de Chances , Polimorfismo de Nucleotídeo Único/genética , Fatores de Risco , Adulto Jovem
8.
Expert Rev Mol Diagn ; 19(9): 785-793, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31414918

RESUMO

Introduction: Metabolomics, the study of metabolites, is a promising research field for cancers. The metabolic pathway in a tumor cell is different from a normal tissue cell. There are two approaches to study the metabolism, targeted and untargeted. The general approach is that metabolomic data are interpreted by bioinformatics tools correlating with metabolomic databases to obtain significant findings. With the use of specific analysis tools, such as nuclear magnetic resonance (NMR) and mass spectrometer (MS) combined with chromatography, metabolic profile or metabolic fingerprint of various biological specimens could be obtained. The applications of metabolomics are used to discover potential cancer biomarkers and monitor the metastatic state, therapeutic and drug response for better patient management. Areas covered: In this review, the author introduce metabolomics and discuss the use of metabolomics approaches in different cancers, including the study of colorectal cancer, prostate cancer, liver cancer, pancreatic cancer and breast cancer using NMR and MS. Expert opinion: Knowledge on the molecular basis of cancer metabolism and its potential clinical applications has been improving recently. However, there are still many challenges for the technological development and integration of metabolomics with other omics spaces such as genomics. In the near future, it is expected that metabolomics will play an important role in cancer molecular diagnostics.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias Colorretais/diagnóstico , Neoplasias Hepáticas/diagnóstico , Metabolômica/métodos , Neoplasias Pancreáticas/diagnóstico , Neoplasias da Próstata/diagnóstico , Neoplasias da Mama/genética , Neoplasias Colorretais/genética , Feminino , Humanos , Neoplasias Hepáticas/genética , Imagem por Ressonância Magnética/métodos , Masculino , Espectrometria de Massas/métodos , Técnicas de Diagnóstico Molecular/métodos , Neoplasias Pancreáticas/genética , Patologia Molecular/métodos , Neoplasias da Próstata/genética
9.
J Infect Dis ; 218(11): 1739-1745, 2018 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-29931158

RESUMO

Background: Human papillomavirus (HPV) is a known causative factor in the etiology of cervical cancer. Methods: HPV DNA genotyping was performed in menstrual blood (MB) collected in napkins from patients with cervical intraepithelial neoplasia (CIN), HPV infection and sexually active apparently normal subjects. In the same patient cohort, MB TAP1 I333V and TAP1 D637G gene polymorphisms were examined. Results: The sensitivity, specificity, and positive and negative predictive values of HPV DNA in the detection of CIN or HPV infection were 83% (223 of 268), 98% (131 of 134), 99% (223 of 226), and 74% (131 of 176), respectively. Moreover, HPV DNA was found in 24% (28/118) patients who had loop electrosurgical excision procedure treatment and 0% (0/76) HPV infected or CIN1 patient with proven recovery. On the other hand, the risk of developing high-grade CIN was significantly reduced for AG and GG genotypes compared with AA genotype and for carriers with a G allele compared with those with an A allele for both polymorphisms. Conclusions: MB HPV DNA is a potential noninvasive marker for screening and monitoring of squamous intraepithelial lesion. Together with TAP1 I333V and TAP1 D637G gene polymorphisms, the combined test may be useful for stratifying high-risk patients for better follow-up strategies.


Assuntos
Membro 2 da Subfamília B de Transportadores de Cassetes de Ligação de ATP/genética , Neoplasia Intraepitelial Cervical/diagnóstico , Menstruação/sangue , Papillomaviridae/genética , Infecções por Papillomavirus/diagnóstico , Adulto , Neoplasia Intraepitelial Cervical/virologia , DNA Viral/sangue , DNA Viral/genética , Feminino , Marcadores Genéticos/genética , Humanos , Infecções por Papillomavirus/virologia , Polimorfismo de Nucleotídeo Único/genética
10.
Oncotarget ; 9(29): 20426-20438, 2018 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-29755662

RESUMO

Colorectal cancer (CRC) is the third most common cancer and the fourth leading cause of cancer deaths worldwide. Recent studies have shown that cancer stem cells (CSCs) are an important cause of tumor recurrence and metastasis. We hypothesized that CSCs marker CD166-positive CRC and colorectal adenoma (CAD) cells consist of more hotspot mutations than CD166-negative CRC and colorectal adenoma cells. To verify this, formalin fixed paraffin embedded tissue specimens from 42 patients each with CRC and CAD were recruited and CD166 immunohistochemical (IHC) staining followed by macrodissection was performed. DNA extracted was used for quantitative polymerase chain reaction detection on a somatic mutation array. Results showed that the immunoreactivity of CD166 protein had significant difference among CRC, CAD, and normal colorectal epithelial tissues (NCET) (P < 0.0001, Kruskal-Wallis test). Moreover, nucleotide changes were found in APC, KRAS, P53, PIK3CA, FBXW7 and SRC genes. Among those genes, KRAS exon 2 mutations were validated in another cohort of 70 CRC and 72 CAD specimens. Results showed that the difference in percentage of KRAS exon 2 mutations between CD166 positive and CD166 negative CRC specimens was significant (P < 0.05, chi-square test). Long term follow-up of the CRC patients showed that CD166-positive KRAS exon 2 mutations was useful in discriminating CRC patients with worse outcome. This study has provided evidence that KRAS exon 2 mutations are concentrated in CD166-positive cancer cells, with prognostic significance in CRC, and those mutations are also detected in CAD.

11.
Expert Rev Mol Diagn ; 18(5): 433-441, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29641941

RESUMO

INTRODUCTION: Acquired immunodeficiency syndrome (AIDS) is a kind of acquired disease that breaks down the immune system. Human immunodeficiency virus (HIV) is the causative agent of AIDS. By the end of 2016, there were 36.7 million people living with HIV worldwide. Early diagnosis can alert infected individuals to risk behaviors in order to control HIV transmission. Infected individuals are also benefited from proper treatment and management upon early diagnosis. Thanks to the public awareness of the disease, the annual increase of new HIV infections has been slowly declining over the past decades. The advent of molecular diagnostics has allowed early detection and better management of HIV infected patients. Areas covered: In this review, the authors summarized and discussed the current and future technologies in molecular diagnosis as well as the biomarkers developed for HIV infection. Expert Commentary: A simple and rapid detection of viral load is important for patients and doctors to monitor HIV progression and antiretroviral treatment efficiency. In the near future, it is expected that new technologies such as digital PCR and CRISPR-based technology will play more important role in HIV detection and patient management.


Assuntos
Infecções por HIV/diagnóstico , HIV/genética , Técnicas de Diagnóstico Molecular , Síndrome de Imunodeficiência Adquirida/diagnóstico , Síndrome de Imunodeficiência Adquirida/virologia , Anticorpos Antivirais/imunologia , Antígenos Virais/genética , Antígenos Virais/imunologia , Biomarcadores , Técnicas Biossensoriais , Repetições Palindrômicas Curtas Agrupadas e Regularmente Espaçadas , Gerenciamento Clínico , Ensaio de Imunoadsorção Enzimática , HIV/imunologia , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Hibridização in Situ Fluorescente , Técnicas de Amplificação de Ácido Nucleico , Carga Viral , Latência Viral/genética
12.
Expert Rev Mol Diagn ; 17(1): 95-103, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27917695

RESUMO

INTRODUCTION: Formalin-fixed, paraffin-embedded (FFPE) tissue sample is a gold mine of resources for molecular diagnosis and retrospective clinical studies. Although molecular technologies have expanded the range of mutations identified in FFPE samples, the applications of existing technologies are limited by the low nucleic acids yield and poor extraction quality. As a result, the routine clinical applications of molecular diagnosis using FFPE samples has been associated with many practical challenges. NanoString technologies utilize a novel digital color-coded barcode technology based on direct multiplexed measurement of gene expression and offer high levels of precision and sensitivity. Each color-coded barcode is attached to a single target-specific probe corresponding to a single gene which can be individually counted without amplification. Therefore, NanoString is especially useful for measuring gene expression in degraded clinical specimens. Areas covered: This article describes the applications of NanoString technologies in molecular diagnostics and challenges associated with its applications and the future development. Expert commentary: Although NanoString technology is still in the early stages of clinical use, it is expected that NanoString-based cancer expression panels would play more important roles in the future in classifying cancer patients and in predicting the response to therapy for better personal therapeutic care.


Assuntos
Perfilação da Expressão Gênica/métodos , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Amplificação de Ácido Nucleico/métodos , Inclusão em Parafina , Manejo de Espécimes/métodos , Humanos
13.
J Clin Imaging Sci ; 6: 34, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27833776

RESUMO

Percutaneous microwave coagulation therapy has been one of the major new developments in tumor ablation. Microwave ablation has also been used intraoperatively to achieve hemostasis at surgical margins in laparotomy. However, the use of microwave ablation for coagulation and hemostasis through percutaneous approach has not been described in the literature. Here, we report a case of hepatic amyloidosis with massive post biopsy liver hemorrhage, which could not be by transarterial embolization, and subsequently controlled by ultrasound-guided percutaneous microwave ablation. To the best of our knowledge, this is the first reported case of this technology application in human.

14.
Urology ; 97: e13-e14, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27542861

RESUMO

Ureterosciatic hernia is an extremely rare condition. Here we report a case of ureterosciatic hernia presented with sudden loin pain, with contrast computed tomography and antegrade pyelogram demonstrating ureterosciatic hernia causing ureteric obstruction and renal pelvic rupture. Subsequently, laparotomy with hernia reduction and mesh repair was performed.


Assuntos
Hérnia/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Pelve Renal/diagnóstico por imagem , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia , Idoso , Meios de Contraste , Feminino , Hérnia/complicações , Humanos , Nefropatias/etiologia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/etiologia , Tomografia Computadorizada por Raios X , Urografia
15.
Arthritis Rheumatol ; 68(1): 237-46, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26361097

RESUMO

OBJECTIVE: To determine whether longer disease duration negatively impacts carotid intima-media thickness (CIMT), flow-mediated dilation (FMD), and pulse wave velocity (PWV) in a cohort of patients with childhood-onset systemic lupus erythematosus (SLE), and to compare CIMT, FMD, and PWV in patients with childhood-onset SLE with those in healthy children and explore determinants of vascular test results in childhood-onset SLE. METHODS: Cross-sectional analysis was performed in a prospective longitudinal cohort of patients with childhood-onset SLE at the latest followup visit. Clinical and laboratory data were collected for patients with childhood-onset SLE. CIMT, FMD, and PWV were measured using standardized protocols in patients with childhood-onset SLE and healthy children. Correlations between disease duration and results of the 3 vascular tests were performed. Vascular data in patients with childhood-onset SLE were compared with those in healthy children. Multivariable linear regression was used to identify determinants of CIMT, FMD, and PWV in childhood-onset SLE. RESULTS: Patients with childhood-onset SLE (n = 149) and healthy controls (n = 178) were enrolled. The median age of the patients was 17.2 years (interquartile range [IQR] 15.7-17.9 years), and their median disease duration was 3.2 years (IQR 1.8-4.9 years). The median age of the healthy children was 14.7 years (IQR 13.1-15.9 years). Longer disease duration correlated with worse FMD (r = -0.2, P = 0.031) in patients with childhood-onset SLE. Patients with childhood-onset SLE had smaller (better) CIMT, higher (better) FMD, and similar PWV compared with healthy controls. Linear regression analysis explained <24% of the variation in vascular test results in patients with childhood-onset SLE, suggesting that other variables should be explored as important determinants of CIMT, FMD, and PWV. CONCLUSION: In this cohort of 149 patients with childhood-onset SLE, patients did not have worse CIMT, FMD, or PWV than did healthy controls. Longer disease duration was associated with worse FMD, suggesting progressive endothelial dysfunction over time.


Assuntos
Aterosclerose/fisiopatologia , Doenças das Artérias Carótidas/fisiopatologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Vasodilatação/fisiologia , Adolescente , Idade de Início , Aterosclerose/diagnóstico por imagem , Aterosclerose/etiologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/etiologia , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Estudos Prospectivos , Análise de Onda de Pulso , Fatores de Tempo
16.
Arthritis Rheumatol ; 67(8): 2257-62, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25891295

RESUMO

OBJECTIVE: Systemic lupus erythematosus (SLE) is characterized by increased cardiovascular risk in adult-onset and childhood-onset SLE. Type I interferons (IFNs) appear to play a prominent role in premature vascular damage in adult-onset SLE, at least in part, by inducing impairments in the phenotype and function of endothelial progenitor cells (EPCs), thereby hampering vascular repair. It is not clear whether EPC dysfunction is present in childhood-onset SLE in association with a type I IFN signature. METHODS: The phenotype and numbers of EPCs were quantified in patients with childhood-onset SLE, patients with juvenile idiopathic arthritis (JIA), and matched healthy control subjects. In a separate cohort of patients with childhood-onset SLE, markers of subclinical atherosclerosis and endothelial dysfunction were quantified using standardized protocols and analyzed for associations with serum type I IFN activity. RESULTS: EPC numbers and function were significantly decreased in patients with childhood-onset SLE compared with patients with JIA and healthy control subjects. Serum from patients with childhood-onset SLE impaired differentiation of EPCs into mature endothelial cells in healthy controls, and this effect was blocked by inhibition of the type I IFN pathway. Type I IFN activity in serum was not significantly associated with subclinical atherosclerosis and endothelial function in patients with childhood-onset SLE. CONCLUSION: As in adult-onset SLE, childhood-onset SLE is characterized by phenotypic and functional EPC abnormalities, which are likely triggered by type I IFNs. Although cross-sectional analysis revealed no global association between type I IFN signatures and vascular measures of subclinical atherosclerosis, longitudinal assessments are needed to evaluate whether progression of vascular damage in patients with childhood-onset SLE is associated with type I IFNs, as observed in patients with adult-onset SLE.


Assuntos
Aterosclerose/fisiopatologia , Células Progenitoras Endoteliais/citologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Vasodilatação/fisiologia , Adolescente , Artrite Juvenil/epidemiologia , Artrite Juvenil/imunologia , Artrite Juvenil/fisiopatologia , Doenças Assintomáticas , Aterosclerose/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Diferenciação Celular/fisiologia , Criança , Estudos Transversais , Feminino , Humanos , Interferon Tipo I/antagonistas & inibidores , Interferon Tipo I/imunologia , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Fenótipo , Análise de Onda de Pulso , Fatores de Risco
17.
Asian J Endosc Surg ; 6(2): 78-81, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23601995

RESUMO

INTRODUCTION: We previously conducted a randomized trial comparing the endo-laparoscopic approach (i.e. placing self-expanding metallic stents followed by laparoscopic resection) and conventional open surgery in the treatment of obstructing left-sided colon cancer. This study is a follow-up of the previous randomized trial and aims to report the long-term outcomes of the two groups. METHODS: Forty-eight patients from the randomized trial were followed up in an outpatient clinic with regular monitoring. Patients were compared for clinicopathological variables, disease recurrence and survival rates. RESULTS: Clinicopathological details were comparable between the two groups. During the median follow-up periods of 32 months for the open group and 65 months endo-laparoscopic group, no statistically significant difference was observed between the groups in disease recurrence rate, 5-year overall survival (27% vs 48%, P = 0.076) and 5-year disease-free survival rates (48% vs 52%, P = 0.63). CONCLUSION: Besides being a safe bridge to subsequent elective laparoscopic surgery, preoperative self-expanding metallic stents insertion does not adversely affect oncological outcomes and patient survival. Based on our data, the endo-laparoscopic approach is the treatment of choice for patients presenting with malignant left-sided colonic obstruction.


Assuntos
Colectomia , Neoplasias do Colo/cirurgia , Obstrução Intestinal/cirurgia , Laparoscopia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/complicações , Neoplasias do Colo/mortalidade , Feminino , Seguimentos , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/mortalidade , Laparoscopia/instrumentação , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Resultado do Tratamento
18.
Int J Pediatr Otorhinolaryngol ; 74(8): 907-12, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20846502

RESUMO

OBJECTIVE: The purpose of the study was to investigate the effects of age and gender on adolescents' vocal tract dimensional development with acoustic reflection technology (ART). METHODS: A total of ninety-five male and female adolescents aged between 10 and 18 divided into three age groups were tested with acoustic reflection technology (ART) and acoustic program to secure their vocal tract dimensional parameters and the vowel formant frequencies. RESULTS: Significant age and gender effects were found not only in vocal tract length, but also segmental volumetric measurements, as well as the vowel formant frequencies. CONCLUSIONS: The findings of this study have provided insights on the developmental trend of adolescents' vocal tracts. The study has also offered a preliminary anatomical database of adolescents' vocal tract dimensional growth for otolaryngologists, clinical anatomists, speech therapists and other health professionals of swallowing, respiration and communicative disorders.


Assuntos
Fonação/fisiologia , Acústica da Fala , Prega Vocal/anatomia & histologia , Adolescente , Fatores Etários , Análise de Variância , Criança , Desenvolvimento Infantil/fisiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Fatores Sexuais , Prega Vocal/crescimento & desenvolvimento , Qualidade da Voz
19.
Drug Deliv ; 16(7): 371-7, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19583460

RESUMO

Three formulations including methylene blue solution (MB-S), MB water-in-oil microemulsion (MB-ME), and MB multiple microemulsion (MB-MME) were prepared with the aim to evaluate whether the three formulations can carry MB target to regional lymph nodes and show lymphatic tropism after subcutaneous administration. The pseudo-ternary phase diagrams were also studied. The morphology of MB-ME and MB-MME was examined by transmission electron microscopy to characterize the microstructure. The particle size and viscosity were also measured. MB concentrations in plasma, lymph nodes, and limb soles were quantitatively analyzed using HPLC. Results show that MME can target MB to regional lymph nodes, and can be employed as a potential lymph tracer in sentinel lymph node biopsy.


Assuntos
Sistemas de Liberação de Medicamentos/métodos , Linfonodos/metabolismo , Azul de Metileno/administração & dosagem , Azul de Metileno/metabolismo , Animais , Emulsões , Feminino , Linfonodos/efeitos dos fármacos , Camundongos
20.
Rheumatology (Oxford) ; 48(5): 497-501, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19269958

RESUMO

OBJECTIVES: Patients with SLE are at risk for premature atherosclerosis and metabolic syndrome. Cytokines produced by adipocytes, adipokines, are important in glucose/lipid metabolism and the development of atherosclerosis. The objectives of this study were to evaluate leptin, adiponectin and ghrelin concentrations in paediatric SLE (pSLE) and to correlate these concentrations with measures of disease activity, serum lipid concentrations, measures of insulin resistance and serum homocysteine concentrations. METHODS: Two hundred and eight samples from 105 patients with pSLE and 77 samples from 77 healthy paediatric controls were evaluated by ELISA to measure leptin, adiopnectin and ghrelin. Students' t-test was used for analysis. Concentrations of adipokines were correlated with disease activity, serum lipids, insulin resistance and homocysteine. RESULTS: Overall 35 SLE patients (34%) had an abnormally elevated leptin level. The only significant correlation of leptin concentrations was with homocysteine concentrations but not disease activity, prednisone dose, lipids or insulin resistance. There was no difference in the mean adiponectin concentrations between the control and patient groups and none of the patient samples were below the normal lower limit while seven were elevated. There was a significant correlation of adiponectin concentrations with prednisone dose, lipid concentrations and insulin resistance but not with disease activity or homocysteine. Elevated ghrelin concentrations were found in 20% of the pSLE patients. The only correlation of ghrelin concentrations was with homocysteine. CONCLUSIONS: Adipokines are novel biomarkers in pSLE. They may represent cardiovascular risk and are not just surrogate markers for disease activity, therapy or serum lipids. Their correlation with atherosclerosis needs to be explored.


Assuntos
Adipocinas/sangue , Lúpus Eritematoso Sistêmico/sangue , Adiponectina , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Estudos de Coortes , Relação Dose-Resposta a Droga , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Grelina/sangue , Glucocorticoides/administração & dosagem , Homocisteína/sangue , Humanos , Resistência à Insulina , Leptina/sangue , Lipídeos/sangue , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Masculino , Prednisona/administração & dosagem , Índice de Gravidade de Doença
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA