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1.
Acute Med ; 19(1): 42, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32226956

RESUMO

A 71-year old retired missionary presented with a 2- week history of increasing dyspnoea, orthopnoea, and peripheral oedema. The patient had no previous significant past medical history. On clinical examination, his heart sounds were dual and his jugular venous pressure was elevated to 7cm. On chest auscultation there were bilateral crepitations at his lung bases.

2.
Acute Med ; 19(1): 52-55, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32226959

RESUMO

Constrictive pericarditis though an uncommon diagnosis is a potentially reversible form of heart failure (with surgical pericardiectomy) and hence is imperative to diagnose. Diagnosis is dependent on a high index of clinical suspicion and further testing with appropriate cardiac investigations including cardiac imaging with invasive cardiac catheterisation as the gold standard.

3.
Tech Coloproctol ; 2020 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-32206962

RESUMO

BACKGROUND: The aim of the present study was to perform a systematic review and meta-analysis of cancer-specific outcomes after curative rectal cancer surgery comparing anastomotic leak (AL) with no leak. METHODS: PubMed, Medline and Embase databases were searched to identify studies comparing cancer-specific outcomes after rectal cancer surgery in patients with AL and without. A meta-analysis with a random-effects model was used to calculate pooled odds ratios (OR) and confidence intervals (CI) for each outcome measure. RESULTS: A total of 18 studies were included for meta-analysis, comprising a total of 18,039 patients after curative rectal resection (1764 AL, 16,275 without AL). The overall rate of AL was 9.8%. After AL and excluding 30-day mortality there was an increased risk of local recurrence (OR 1.50; CI 1.23, 1.82), worse overall survival (OR 0.69; CI 0.60-0.81), decreased disease free survival (OR 0.51; CI 0.36-0.73) and cancer specific survival (OR 0.71; CI 0.54-0.94). Distant recurrence (OR 1.10; CI 0.89-1.37) and overall recurrence (OR 1.33; CI 0.64-2.76) were not significantly different between the two groups. CONCLUSIONS: AL may negatively impact cancer-specific outcomes after curative rectal cancer surgery and could be considered an independent negative prognostic factor.

5.
Aging Clin Exp Res ; 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31808067

RESUMO

BACKGROUND: The NHS dementia strategy identifies patient and carer information and support (PCIS) as a core component of gold-standard dementia care. This is the first systematic review of PCIS, performed to analyse the literature and evidence for these interventions. AIMS: To systematically review literature evaluating the effectiveness of the provision of PCIS for people with dementia and their informal carers, in inpatient and outpatient settings. METHODS: Searches of four online biomedical databases, accessed in September 2018. Studies were selected if they were: relating to people with dementia or their informal carers, based in inpatient or outpatient settings, published in English-language peer-reviewed journals no earlier than the year 2000 and assessed dementia-related information or social support interventions, by measuring qualitative or quantitative carer or patient-reported outcomes. Standardised data extraction and quality appraisal forms were used. RESULTS: 7 of 43 full-text papers analysed were eligible for analysis. 3 papers were different arms of one original study. Trends were present in the quantitative results towards reduced patient and carer depression and anxiety and the themes in the qualitative analysis were in favour of the intervention. CONCLUSIONS: The studies analysed were too heterogeneous in design, population and outcomes measured to make a conclusive opinion about the efficacy of these interventions. It is surprising that for such a common condition, a gold-standard evidence-based intervention and standardised delivery for provision of PCIS for people living with dementia in the UK does not exist. Further research is therefore vital.

6.
J Mycol Med ; 29(4): 372-374, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31570305

RESUMO

Secondary amyloidosis results from the deposition of abnormally folded proteins in body organs due to chronic inflammatory disorders. Kidneys are the most commonly affected organ and manifest as nephrotic syndrome with or without renal failure. Chronic pulmonary aspergillosis (CPA) is a chronic infection of lung parenchyma affecting those with an underlying structural lung disease. Herein, we present a case of CPA where the initial manifestation was that of nephrotic syndrome due to renal amyloidosis. We also perform a systematic review for studies describing secondary amyloidosis due to CPA.

7.
Respir Med ; 157: 49-51, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31518707

RESUMO

OBJECTIVE: Inadequate lung nodule surveillance leads to diagnostic delays. We implemented a retrospective intervention program, Nodule Net, to improve surveillance in our hospital. METHODS: 9,224 Chest computed tomography (CT) scans between January 1, 2015 and December 31, 2016 were manually reviewed for lung nodules. For patients without follow-up, charts were reviewed to assess follow-up. If follow-up appeared indicated, the clinician or patient was contacted, and follow-up was tracked. RESULTS: Lung nodules were identified on 5,101 (55%) of 9,224 scans. Follow-up was potentially indicated and not completed in 1,385 (27%). 183 (13%) were excluded after imaging review. 1,202 received outreach. Of the 801 (66%) with a provider in our system, 225 (27%) returned for follow-up. Nodules were stable in 199 (88%), new or growing in 23 (11%), resolved in 3 (1%), and stage 1 lung cancer in 2 (1%). 90 (11%) had follow-up outside our system and 431 (51%) had no follow-up due to a clinical contraindication. 55 (7%) have imaging pending and 14 (2%) are awaiting pulmonary evaluation. Of the 302 (25%) patients with providers outside our system, 121 (40%) had followed-up elsewhere. 146 (48%) had no follow-up due to a clinical reason. 35 (12%) providers did not respond to outreach. CONCLUSIONS: We identified 1,202 patients with lung nodules who needed follow-up over a two-year period. Compliance was more successful with providers within our hospital system. We recommend robust surveillance for patients to ensure follow-up is completed and clinical contraindications are well documented.

8.
J Dairy Sci ; 102(12): 10799-10813, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521346

RESUMO

Spore formers are common spoilage-causing microorganisms in dairy products; however, their modes of spoilage (proteolysis, lipolysis, etc.) have not been described in detail for cultured dairy products such as sour cream and yogurt. The objective of the present study was to test the ability of spore-forming strains isolated from dairy environments for their spoilage-causing activities at typical sour cream (24°C) and yogurt (42°C) fermentation temperatures. A total of 25 spore-forming strains were isolated from different sources, including raw milk, pasteurizer balance tank, biofilms formed on heat exchangers, and milk powder. These strains were tested for proteolytic and lipolytic activities and for their ability to degrade phospholipids, common stabilizers (starch, gelatin, xanthan gum, pectin), and exopolysaccharides (EPS) at sour cream and yogurt fermentation temperatures. A higher percentage of positive strains was observed for selected activities at yogurt fermentation temperature compared with sour cream fermentation temperature. Identified proteolytic spore-forming strains, based on a skim milk agar method, were subsequently quantified for their level of proteolysis using non-casein nitrogen (NCN) content and sodium dodecyl sulfate-PAGE (SDS-PAGE). The proteolytic strains that showed the highest levels of proteolysis (highest percentages of NCN content) at 24°C were Bacillus mojavensis BC, Bacillus cereus DBC, Bacillus subtilis DBC, B. mojavensis DBC1, and Paenibacillus polymyxa DBC1. At 42°C the strains with the highest levels of proteolysis (highest percentages of NCN content) were B. subtilis DBC, B. mojavensis BC, B. mojavensis DBC1, B. cereus DBC, and Bacillus licheniformis DBC6. Results of SDS-PAGE demonstrated that proteolytic strains had primarily hydrolyzed ß- and κ-CN. A viscometric method was used to evaluate the susceptibility of exopolysaccharides (EPS) to degradation by selected spore formers. This method helped to determine that EPS produced by commercial yogurt and sour cream cultures is susceptible to degradation by spore formers present in dairy environments.


Assuntos
Bacillus/metabolismo , Proteínas do Leite/metabolismo , Leite/microbiologia , Fosfolipídeos/metabolismo , Animais , Fermentação , Microbiologia de Alimentos , Leite/metabolismo , Paenibacillus/metabolismo , Pasteurização , Esporos , Temperatura Ambiente , Iogurte/microbiologia
10.
Indian J Nephrol ; 29(1): 1-7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30814786

RESUMO

Chronic fluid overload as well as excessive fluid removal are associated with increased morbidity and mortality in hemodialysis (HD) patients. The clinical method to probe the dry weight is often inaccurate and the bioimpedance spectroscopy (BIS) is shown to improve the accuracy. We compared the impact of BIS and clinical methods to guide ultrafiltration (UF) in a randomized controlled study on the intradialytic complications and blood pressure control in prevalent HD patients. Fifty patients on maintenance HD were randomized to BIS method (BIS-group) and clinical method (CL-group) to guide UF. The body composition monitor (BCM) was done post-HD in all patients at baseline and 2-weeks interval during the study period of 6 months to determine the hydration status, but the result was revealed only to the nephrologist managing the patients in BIS-group to probe the dry weight. The endpoints of the study were blood pressure control, intradialytic complications and anti-hypertensive drug burden. The mean age was 56.0 ± 12.0 years and 70% were male. There was significant increase in patients with normal hydration in BIS-group (20% vs. 88%, p = 0.0001), but remained similar to baseline in CL-group (40% vs. 48%, p = 0.3) at 6 months. The incidence of intradialytic hypotension was significantly reduced in BIS-group (4.84 ± 3.0 vs. 2.8 ± 3.13 events/patient/6 months, p = 0.003). There was 35% reduction in hypertensive pill burden in BIS-group with similar blood pressure, compared to CL-group. Post-dialysis underhydration was more common than over or normal hydration at baseline in our population, indicating that clinical method to probe dry weight often resulted in hypovolemia. BIS method to determine dry weight resulted in normalization in volume status and consequently resulted in significant reduction in intradialytic hypotension and anti-hypertensive pill burden over 6-month period.

11.
Artigo em Inglês | MEDLINE | ID: mdl-30788074

RESUMO

Angiotensin converting-enzyme (ACE) inhibitors are commonly prescribed drugs with multiple indications including congestive heart failure, hypertension, and diabetic nephropathy. ACE inhibitor induced angioedema is commonly seen across emergency departments and clinics, with transient swelling of lips, tongue, and other facial structures being the common presentation. Isolated airway obstruction as a result of pharyngeal and laryngeal swelling without facial swelling is a rare presentation. We present a case of a patient on lisinopril therapy for one year who experienced severe airway compromise without the classic symptoms of ACE inhibitor induced angioedema. He required emergent cricothyroidotomy to secure his airway, as fiberoptic laryngoscopy showed 90% obstruction and inability to visualize true vocal cords. His ACE inhibitor therapy was discontinued, and he was discharged home within a few days with no residual symptoms.

12.
J Pharmacol Exp Ther ; 369(1): 37-46, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30635471

RESUMO

Sustained ligand-activated preconditioning (SLP), induced with chronic opioid receptor (OR) agonism, enhances tolerance to ischemia/reperfusion injury in young and aged hearts. Underlying mechanisms remain ill-defined, although early data implicate phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) during the induction phase, and ß 2-adrenoceptor (ß 2-AR), Gs alpha subunit (Gα s), and protein kinase A (PKA) involvement in subsequent cardioprotection. Here, we tested for induction of a protective ß 2-AR/Gα s/PKA signaling axis with SLP to ascertain whether signaling changes were PI3K-dependent (by sustained cotreatment with wortmannin), and whether the downstream PKA target Rho kinase (ROCK) participates in subsequent cardioprotection (by acute treatment with fasudil). A protected phenotype was evident after 5 days of OR agonism (using morphine) in association with increased membrane versus reduced cytosolic levels of total and phosphorylated ß 2-ARs; increased membrane and cytosolic expression of 52 and 46 kDa Gα s isoforms, respectively; and increased phosphorylation of PKA and Akt. Nonetheless, functional sensitivities of ß 2-ARs and adenylyl cyclase were unchanged based on concentration-response analyses for formoterol, fenoterol, and 6-[3-(dimethylamino)propionyl]-forskolin. Protection with SLP was not modified by ROCK inhibition, and changes in ß 2-AR, Gα s, and PKA expression appeared insensitive to PI3K inhibition, although 5 days of wortmannin alone exerted unexpected effects on signaling (also increasing membrane ß 2-AR and PKA expression/phosphorylation and Gα s levels). In summary, sustained OR agonism upregulates cardiac membrane ß 2-AR expression and phosphorylation in association with increased Gα s subtype levels and PKA phosphorylation. While Akt phosphorylation was evident, PI3K activity appears nonessential to OR upregulation of the ß 2-AR signal axis. This opioidergic remodeling of ß 2-AR signaling may explain ß 2-AR, Gα s, and PKA dependence of SLP protection.


Assuntos
Precondicionamento Isquêmico/métodos , Receptores Adrenérgicos beta 2/metabolismo , Transdução de Sinais , 1-(5-Isoquinolinasulfonil)-2-Metilpiperazina/análogos & derivados , 1-(5-Isoquinolinasulfonil)-2-Metilpiperazina/farmacologia , Adenilil Ciclases/metabolismo , Agonistas de Receptores Adrenérgicos beta 2/farmacologia , Animais , Proteínas Quinases Dependentes de AMP Cíclico/metabolismo , Relação Dose-Resposta a Droga , Subunidades alfa Gs de Proteínas de Ligação ao GTP/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Espaço Intracelular/efeitos dos fármacos , Espaço Intracelular/metabolismo , Ligantes , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Fosfatidilinositol 3-Quinases/metabolismo , Traumatismo por Reperfusão/prevenção & controle , Transdução de Sinais/efeitos dos fármacos , Quinases Associadas a rho/metabolismo
13.
Acta Neurochir (Wien) ; 161(2): 385-392, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30637487

RESUMO

BACKGROUND: Delayed cerebral ischemia (DCI) is an independent predictor of an unfavorable outcome after aneurysmal subarachnoid hemorrhage (aSAH). Many centers, but not all, use transcranial Doppler (TCD) to screen for vasospasm to help predict DCI. We used the United Kingdom and Ireland Subarachnoid Haemorrhage (UKISAH) Registry to see if outcomes were better in centers that used TCD to identify vasospasm compared to those that did not. METHODS: TCD screening practices were ascertained by national survey in 13 participating centers of the UKISAH. The routine use of TCD was reported by 5 "screening" centers, leaving 7 "non-screening" centers. Using a cross-sectional cohort study design, prospectively collected data from the UKISAH Registry was used to compare DCI diagnosis and favorable outcome (Glasgow Outcome Score 4 or 5) at discharge based on reported screening practice. RESULTS: A cohort of 2028 aSAH patients treated ≤ 3 days of hemorrhage was analyzed. DCI was diagnosed in 239/1065 (22.4%) and 220/963 (22.8%) of patients in non-screening and screening centers respectively while 847/1065 (79.5%) and 648/963 (67.2%) achieved a favorable outcome. Odds ratios adjusted for age, injury severity, comorbidities, need for cerebrospinal fluid diversion, and re-bleed returned neutral odds of diagnosing DCI of 0.90 (95% CI 0.72-1.12; p value = 0.347) in screening units compared to those of non-screening units but significantly decreased odds of achieving a favorable outcome 0.56 (95% CI 0.42-0.82; p value < 0.001). CONCLUSIONS: Centers that screened for vasospasm using TCD had poorer in-hospital outcomes and similar rates of DCI diagnosis compared to centers that did not.


Assuntos
Infarto Cerebral/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Hemorragia Subaracnóidea/epidemiologia , Ultrassonografia Doppler Transcraniana/estatística & dados numéricos , Vasoespasmo Intracraniano/diagnóstico por imagem , Idoso , Infarto Cerebral/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vasoespasmo Intracraniano/epidemiologia
14.
Aging Clin Exp Res ; 31(5): 595-610, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30259497

RESUMO

BACKGROUND: Specialist inpatient dementia units (SIDU) have been developed to address adverse outcomes often experienced by people living with dementia admitted to acute hospitals. However, the evidence base of their effectiveness remains limited. AIM: To review the current literature to establish the comparative effectiveness of acute hospital SIDU vs. standard ward care (SWC). METHODS: We did an online search of 12 biomedical databases from inception to 31st October 2017. Studies of inpatients with any form of dementia in acute hospitals, published in English language peer-reviewed journals, using experimental, observational or qualitative study designs, comparing SIDU with SWC and which measured any qualitative or quantitative outcome of the patient or carer experience were included in the search criteria. We used a standardised data extraction and appraisal form. RESULTS: Three of 46 full-text studies evaluated were suitable for analysis. Due to study heterogeneity, pooled odds ratios were only possible for mortality [OR 1.06 (CI 1.0-1.4)]. Otherwise, a narrative synthesis was performed. Although quantitative measures of length of stay, mortality and behavioural and psychiatric symptoms of dementia are not significantly lower, SIDU are associated with greater patient and carer satisfaction, reduced readmission rates, more accurate and comprehensive assessment processes, documentation of resuscitation decisions, and increased rates of discharge to the patient's own home. CONCLUSIONS: Although SIDU may be associated with improved care outcomes, the current evidence of their effectiveness is markedly limited. Further research and service evaluation of SIDU as a method for providing high-quality dementia care in acute NHS Trusts is needed. PROSPERO: CRD42017078364.


Assuntos
Demência/terapia , Hospitalização/estatística & dados numéricos , Cuidadores/psicologia , Unidades Hospitalares , Humanos , Estudos Observacionais como Assunto , Pesquisa Qualitativa , Qualidade da Assistência à Saúde
15.
Eur J Cancer ; 107: 124-132, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30562710

RESUMO

BACKGROUND: Atezolizumab (anti-programmed death-ligand 1 [PD-L1]) received approval from the US Food and Drug Administration and European Medicines Agency for previously treated advanced non-small-cell lung cancer based on OAK-a randomised, phase III trial that showed significantly improved survival with atezolizumab versus docetaxel regardless of PD-L1 expression. With longer follow-up, we summarised the characteristics of long-term survivors (LTSs). METHODS: In OAK (NCT02008227), patients were randomised 1:1 to receive atezolizumab or docetaxel until loss of clinical benefit or disease progression, respectively. Overall survival was evaluated after a 26-month minimum follow-up, including in patient subgroups defined by best overall response (BOR). LTSs were defined as patients who lived ≥24 months since randomisation. Non-LTSs died within 24 months, and patients censored before 24 months were excluded from the analysis. The baseline characteristics, including biomarkers, BOR, subsequent non-protocol therapy (NPT) and safety, are reported. RESULTS: Survival benefit with atezolizumab was observed across all patient subgroups defined by BOR. More atezolizumab-treated patients were LTSs versus those treated with docetaxel (28% versus 18%). Most atezolizumab responders were LTSs (77%) versus only 48% of docetaxel responders. However, 21% of atezolizumab-arm LTSs had progressive disease (PD) as BOR, and more atezolizumab-arm LTSs than non-LTSs continued treatment post-PD. Fifty-two percent of docetaxel-arm LTSs received immunotherapy as subsequent NPT. Despite extended treatment duration in atezolizumab-arm LTSs (median, 18 months), atezolizumab was well tolerated. CONCLUSIONS: After >2 years of follow-up, atezolizumab continued to provide durable survival benefit versus docetaxel, with tolerable safety. Atezolizumab-arm LTSs were enriched for patients with high PD-L1 expression and included PD-L1-negative patients. Long-term survival was not limited to responders.

16.
Clin Radiol ; 73(9): 836.e1-836.e7, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29970243

RESUMO

AIM: To present the initial 12 months of data of a straight-to-test (STT) computed tomography colonography (CTC) protocol as the first-line investigation for change in bowel habit (CIBH) and iron deficiency anaemia (IDA) in patients over 60 referred directly from primary care. MATERIALS AND METHODS: In 12 months, 1,792 STT CTC for IDA and CIBH were performed. No colonoscopies were performed as the primary investigation in this cohort. Data from this cohort were gathered prospectively. RESULTS: The colorectal cancer (CRC) detection rate was 4.9% and polyp detection rate was 13.5%. The CRC rate increased related to age (p=0.001), the CRC detection rate was 2.6% in patients aged 60-69 years, compared to 4.9%, 7.4%, and 11.4% in the 70-79, 80-89, and >90 years age groups. The CRC rate was higher in patients with IDA compared to CIBH (6.8% versus 3.9%, p=0.017). There were significantly more left-sided cancers (p=0.0165). Non-colonic cancers were found in 4.3% of patients and 6.8% had incidental findings that required further investigation and 11.9% had a new, potentially significant, incidental finding. CONCLUSION: These results are comparable to colonoscopy in terms of diagnostic accuracy and similar to those of CTC in published multicentre trials. This exciting model of care within radiology enables earlier testing, reduces waiting times, with fewer outpatient appointments, and results in good clinician and patient satisfaction.


Assuntos
Neoplasias do Colo/diagnóstico por imagem , Colonografia Tomográfica Computadorizada/métodos , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Diagnóstico Diferencial , Detecção Precoce de Câncer/métodos , Inglaterra , Fezes , Feminino , Humanos , Iopamidol , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medicina Estatal , Listas de Espera
17.
Anesth Essays Res ; 12(2): 381-385, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29962602

RESUMO

Background and Aims: Hypotension occurs in most of the cases following subarachnoid block in for cesarean sections. Studies comparing different bolus doses of phenylephrine for preventing hypotension induced by subarachnoid block in cesarean sections are sparse. Settings and Design: This study was conducted to compare the efficacy of two different bolus doses of phenylephrine for preventing subarachnoid block-induced hypotension in cesarean sections. Materials and Methods: Sixty parturients undergoing cesarean section were allocated into two groups. Group A (n = 30) received 150 mcg phenylephrine intravenously (IV) and Group B (n = 30) received 200 mcg phenylephrine IV prophylactically immediately after subarachnoid block. Then, for every 2 min, systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), and heart rate (HR) were measured for 20 min, and APGAR scores were measured. Statistical Analysis: The observations are expressed as mean ± standard deviation and were compared using unpaired t-test. The statistical significance of difference between groups was based on P value. P < 0.05 was considered statistically significant. Results: There was no difference in preventing hypotension in both the groups, the incidence in Group A being 16.6% and Group B also 16.6%. However, the rise in systolic pressure in Group B was higher than Group A in the first 2-6 min. The incidence of bradycardia was higher in Group B (43.3%) than Group A (20%). Conclusions: Both the doses of phenylephrine were equally efficient in prevention of hypotension after subarachnoid block. Lower prophylactic bolus phenylephrine 150 mcg IV is better in the prevention of hypotension after subarachnoid block in cesarean sections as the incidence of bradycardia is higher with phenylephrine 200 mcg.

18.
Clin Exp Reprod Med ; 45(2): 75-81, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29984207

RESUMO

Objective: Recapitulation of the spermatogenesis process in vitro is a tool for studying the biology of germ cells, and may lead to promising therapeutic strategies in the future. In this study, we attempted to transdifferentiate Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) into male germ cells using all-trans retinoic acid and Sertoli cell-conditioned medium. Methods: Human WJ-MSCs were propagated by the explant culture method, and cells at the second passage were induced with differentiation medium containing all-trans retinoic acid for 2 weeks. Putative germ cells were cultured with Sertoli cell-conditioned medium at 36℃ for 3 more weeks. Results: The gene expression profile was consistent with the stage-specific development of germ cells. The expression of Oct4 and Plzf (early germ cell markers) was diminished, while Stra8 (a premeiotic marker), Scp3 (a meiotic marker), and Acr and Prm1 (postmeiotic markers) were upregulated during the induction period. In morphological studies, approximately 5% of the cells were secondary spermatocytes that had completed two stages of acrosome formation (the Golgi phase and the cap phase). A few spermatid-like cells that had undergone the initial stage of tail formation were also noted. Conclusion: Human WJ-MSCs can be transdifferentiated into more advanced stages of germ cells by a simple two-step induction protocol using retinoic acid and Sertoli cell-conditioned medium.

19.
Ann R Coll Surg Engl ; 100(7): 520-528, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29909669

RESUMO

Introduction This study presents an extensive retrospective database of patients with polytrauma following train-related injuries and highlights the key lessons learnt in this rare clinical presentation. Materials and methods We retrospectively collected data from 127 patients who presented to Royal London Hospital after sustaining train related trauma. We analysed demographics, accident report data, aetiologies and clinical management interventions. All data were screened and injuries were mapped to various anatomical regions. The revised trauma score, injury severity score and new injury severity scores were used to quantify injury extent. Results Mean patient age was 41 years (range 16-81 years) with a 73% to 27% male to female ratio. Deliberate injuries occurred in 71% of patients, with accidental injury accounting for 29%. The mean new injury severity score was 26.48 (range 1-75), with the most common injuries sustained to the chest and the extremities. Pneumothorax, haemothorax or tension pneumothorax occurred in 44% of patients, with 11% suffering a flail chest injury. Traumatic amputations occurred in 33% of patients and 56% of patients required admission to intensive care. Total mortality rates were 19%, with 12% of patients dying at day 0 and 18% at day 7, respectively. Conclusions This study demonstrated the significant impact of train-related polytrauma and provided a comprehensive injury patterns. It was observed that deliberate polytrauma is related to psychiatric deliberate harm but there is no significant difference in the patterns of injuries between accidental and deliberately caused injuries. Overall injuries to the thorax and extremities were the most severe, demonstrating the highest mean injury scores.


Assuntos
Acidentes/estatística & dados numéricos , Traumatismo Múltiplo/epidemiologia , Ferrovias/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Escala de Gravidade do Ferimento , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Centros de Traumatologia/estatística & dados numéricos , Adulto Jovem
20.
Mol Psychiatry ; 23(5): 1226-1232, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29731509

RESUMO

We used a case-control genome-wide association (GWA) design with cases consisting of 1238 individuals from the top 0.0003 (~170 mean IQ) of the population distribution of intelligence and 8172 unselected population-based controls. The single-nucleotide polymorphism heritability for the extreme IQ trait was 0.33 (0.02), which is the highest so far for a cognitive phenotype, and significant genome-wide genetic correlations of 0.78 were observed with educational attainment and 0.86 with population IQ. Three variants in locus ADAM12 achieved genome-wide significance, although they did not replicate with published GWA analyses of normal-range IQ or educational attainment. A genome-wide polygenic score constructed from the GWA results accounted for 1.6% of the variance of intelligence in the normal range in an unselected sample of 3414 individuals, which is comparable to the variance explained by GWA studies of intelligence with substantially larger sample sizes. The gene family plexins, members of which are mutated in several monogenic neurodevelopmental disorders, was significantly enriched for associations with high IQ. This study shows the utility of extreme trait selection for genetic study of intelligence and suggests that extremely high intelligence is continuous genetically with normal-range intelligence in the population.


Assuntos
Proteína ADAM12/genética , Inteligência/genética , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Estudo de Associação Genômica Ampla/métodos , Humanos , Estudos Longitudinais , Masculino , Herança Multifatorial , Fenótipo , Polimorfismo de Nucleotídeo Único , Característica Quantitativa Herdável
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