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1.
Artigo em Inglês | MEDLINE | ID: mdl-32003276

RESUMO

Background: Endoscopic submucosal tunnel dissection (ESTD) has recently been an effective procedure for resecting large early esophageal neoplasm. However, excessive dissection beyond the distal limit may occur because the prepared distal end often cannot be distinguished through the tunnel. This study aimed to assess the efficacy and safety of a novel crystal violet navigation (CVN) for identifying the distal end.Material and methods: In the observational case series study, all 22 patients who underwent esophageal ESTD using the CVN were included. When setting the distal end, the distal incision line was dyed purple using a crystal violet solution. The rates of purple color identified via the tunnel, successful tunnel penetration without extra dissection, en bloc and curative resection, procedure time for ESTD and CVN, and procedure-associated complications were evaluated.Results: The rates of purple color and successful tunnel penetration were both 100%. En bloc and curative resection were 100%, and 86%, respectively. The mean total procedure time was 103.9 ± 46.2 (mean ± SD) minutes, while the mean time for the CVN was 14.1 ± 3.44 s. No complications were observed.Conclusions: The simple CVN method can be a navigation tool for identifying the distal end during the ESTD procedure.

2.
Biol Cybern ; 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31960137

RESUMO

The 1/f-like gait cycle variability, characterized by temporal changes in stride-time intervals during steady-state human walking, is a well-documented gait characteristic. Such gait fractality is apparent in healthy young adults, but tends to disappear in the elderly and patients with neurological diseases. However, mechanisms that give rise to gait fractality have yet to be fully clarified. We aimed to provide novel insights into neuro-mechanical mechanisms of gait fractality, based on a numerical simulation model of biped walking. A previously developed heel-toe footed, seven-rigid-link biped model with human-like body parameters in the sagittal plane was implemented and expanded. It has been shown that the gait model, stabilized rigidly by means of impedance control with large values of proportional (P) and derivative (D) gains for a linear feedback controller, is destabilized only in a low-dimensional eigenspace, as P and D decrease below and even far below critical values. Such low-dimensional linear instability can be compensated by impulsive, phase-dependent actions of nonlinear controllers (phase resetting and intermittent controllers), leading to the flexible walking with joint impedance in the model being as small as that in humans. Here, we added white noise to the model to examine P-value-dependent stochastic dynamics of the model for small D-values. The simulation results demonstrated that introduction of the nonlinear controllers in the model determined the fractal features of gait for a wide range of the P-values, provided that the model operates near the edge of stability. In other words, neither the model stabilized only by pure impedance control even at the edge of linear stability, nor the model stabilized by specific nonlinear controllers, but with P-values far inside the stability region, could induce gait fractality. Although only limited types of controllers were examined, we suggest that the impulsive nonlinear controllers and criticality could be major mechanisms for the genesis of gait fractality.

4.
Adv Exp Med Biol ; 1232: 331-337, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893428

RESUMO

Obesity, a risk factor of coronary artery disease, is known to cause peripheral microcirculatory disturbances. This study evaluated the relationship between the degree of obesity and peripheral microcirculatory disturbances, using peripheral near infrared spectroscopy (NIRS) with a vascular occlusion test (VOT). We compared correlations between the NIRS parameter changes induced by VOT and body mass index (BMI) in patients with and without statin therapy. A NIRS probe was set on the right thenar eminence, brachial artery blood flow was blocked for 3 min, and then released. Although total hemoglobin (ΔcHb), deoxyhemoglobin (ΔHHb) and tissue oxygenation index (ΔTOI) were not correlated with BMI, a significant negative correlation was found between oxyhemoglobin (ΔO2Hb) and BMI in the overall study population (r = -0.255, p-value 0.02). In addition, a significant negative correlation was found between ΔO2Hb and BMI in patients without statin therapy (r = -0.353, p-value 0.02) but not in patients with statin therapy (r = -0.181, p-value 0.27). These findings suggest that ΔO2Hb may be a useful indicator to assess peripheral microcirculation.


Assuntos
Índice de Massa Corporal , Doença da Artéria Coronariana , Espectroscopia de Luz Próxima ao Infravermelho , Idoso , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Microcirculação/fisiologia , Oxigênio , Consumo de Oxigênio , Oxiemoglobinas/metabolismo , Fatores de Risco , Espectroscopia de Luz Próxima ao Infravermelho/normas
5.
Adv Exp Med Biol ; 1232: 355-360, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893431

RESUMO

Epicardial adipose tissue (EAT) is associated with visceral fat and various cardiac disorders, such as atrial fibrillation and adverse cardiovascular events. Therefore, it is important to develop a simple and non-invasive inspection method to assess EAT, to prevent unfavorable cardiac events. This study assessed correlations between near-infrared spectroscopy (NIRS) changes induced by a vascular occlusion test (VOT) and EAT volume measured by cardiac computed tomography (CCT) in patients with suspected coronary artery disease. We also assessed correlations between body mass index (BMI) and EAT volume in the same population. In addition, these correlations were compared in patients treated with statin therapy and in those without statin therapy. A NIRS probe was set on the right thenar eminence, and brachial artery blood flow was blocked for 3 min before being released. A negative correlation was found between oxyhemoglobin (ΔO2Hb) and EAT volume in the overall study population (r = -0.236, p = 0.03). Interestingly, although a strong correlation was observed in patients without statin therapy (r = -0.488, p < 0.001), this correlation was not observed in patients with statin therapy (r = 0.157, p = 0.34). These findings suggest that NIRS measurements with VOT may be a useful method to identify patients with high EAT volume and high cardiovascular risks.


Assuntos
Doença da Artéria Coronariana , Espectroscopia de Luz Próxima ao Infravermelho , Tecido Adiposo/metabolismo , Idoso , Índice de Massa Corporal , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/diagnóstico , Feminino , Humanos , Masculino , Oxiemoglobinas/metabolismo , Fatores de Risco
6.
Magn Reson Med Sci ; 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31956176

RESUMO

PURPOSE: Modified Look-Locker inversion recovery (MOLLI) using a 5s(3s)3s scheme is robust to tachycardia, but some errors are occasionally observed in myocardial T1 mapping. We sought to evaluate the relationship between measurement errors in T1 mapping and heart rate (HR) using a confidence map. METHODS: We enrolled 69 male patients with normal native T1 values of the septal myocardium measured by a 5s(3s)3s MOLLI. The degree of measurement errors in the septal myocardium was assessed by two independent observers on a confidence map using a 4-point scale: 0, no errors; 1, errors located on the myocardial contour; 2, errors extended into the myocardial contour; and 3, errors extended into the midwall. We compared the scores of measurement errors and the average, maximum, minimum or variability of the HR indicated during the MOLLI scan (iHR), image phases of MOLLI or left ventricular ejection fraction (LVEF). RESULTS: Patients with score >1 for the septal myocardium had significantly lower minimum iHR than those with a score ≤1 (P < 0.01; 49.8 ± 10.1 vs. 59.6 ± 9.7 beat per min). CONCLUSION: The confidence map shows more measurement errors in patients with lower minimum iHR. The myocardial T1 values should be measured carefully in patients with bradycardia during MOLLI scanning.

7.
Am J Physiol Gastrointest Liver Physiol ; 318(3): G401-G409, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31905024

RESUMO

Hepatitis B virus (HBV)-related hepatocarcinogenesis is not necessarily associated with the liver fibrotic stage and is occasionally seen at early fibrotic stages. MicroRNAs (miRNAs) are essentially 18- to 22-nucleotide-long endogenous noncoding RNAs. Aberrant miRNA expression is a common feature of various human cancers. The aberrant expression of specific miRNAs has been shown in hepatocellular carcinoma (HCC) tissue compared with nontumor tissue. Thus, we examined targetable miRNAs as a potential new biomarker related to the high risk of HBV-related hepatocarcinogenesis, toward the prevention of cancer-related deaths. HCC tissue samples from 29 patients who underwent hepatectomy at our hospital in 2002-2013 were obtained. We extracted the total RNA and analyzed it by microRNA array, real-time RT-PCR, and three comparisons: 1) HBV-related HCC and adjacent nontumor tissue, 2) HCV-related HCC and adjacent nontumor tissue, and 3) non-HBV-, non-HCV-related HCC and adjacent nontumor tissue. We also performed a functional analysis of miRNAs specific for HBV-related HCC by using HBV-positive HCC cell lines. MiR-210-3p expression was significantly increased only in the HBV-related HCC tissue samples. MiR-210-3p expression was upregulated, and the levels of its target genes were reduced in the HBV-positive HCC cells. The inhibition of miR-210-3p enhanced its target gene expression in the HBV-positive HCC cells. In addition, miR-210-3p regulated the HBx expression in HBV-infected Huh7/NTCP cells. The enhanced expression of miR-210-3p was detected specifically in HBV-related HCC and regulated various target genes, including HBx in the HBV-positive HCC cells. MiR-210-3p might, thus, be a new biomarker for the risk of HBV-related HCC.NEW & NOTEWORTHY Our present study demonstrated that miR-210-3p is the only microRNA with enhanced expression in HBV-related HCC, and the enhanced expression of miR-210-3p upregulates HBx expression. Therefore, miR-210-3p might be a pivotal biomarker of HBV-related hepatocarcinogenesis, and the inhibition of miR-210-3p could prevent inducing hepatocarcinogenesis related to HBV infection.

8.
Nutr Metab Cardiovasc Dis ; 30(2): 190-200, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-31757571

RESUMO

BACKGROUND AND AIM: Higher fish consumption has been reported to be associated with a lower incidence of coronary artery disease (CAD). We hypothesized that higher fish intake may be associated with lower serum level of non-high-density lipoprotein cholesterol (non-HDL-C) levels, representing the entire dyslipidemia spectrum, and a healthy lifestyle. METHODS AND RESULTS: This cross-sectional study was conducted in a population of 1270 apparently healthy males over the age of 50 years without lipid-modifying therapy at the Health Planning Center of Nihon University Hospital between April and August 2018. The average number of days of fish intake per week was 2.6 ± 1.4. We performed analysis of variance using fish consumption as a categorical variable (0-1 day, 2-3 days, 4-5 days, or 6-7 days per week). The serum non-HDL-C levels in the 6-7 days fish intake group were significantly lower than those in the 0-1 and 2-3days fish intake groups. Furthermore, with increasing frequency of fish intake per week, the proportion of subjects with cigarette smoking decreased (p = 0.026), that of subjects engaging in habitual aerobic exercises increased (p = 0.034), and the sleep duration of the subjects increased (p < 0.0001). CONCLUSIONS: These results suggest that a high frequency of fish intake, that is a fish intake of 6-7 days per week, was associated with healthier lifestyle behaviours as well as lower non-HDL-C levels, and thus may represent a component of a healthy lifestyle associated with a lower risk of CAD in Japanese males over the age of 50. CLINICAL TRIAL REGISTRATION: UMIN (http://www.umin.ac.jp/). STUDY ID: UMIN000035899.

9.
World J Surg ; 44(1): 45-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31602521

RESUMO

BACKGROUND: Intraoperative hypothermia is a common adverse event. For avoiding the complication due to hypothermia, many warming devices and methods have been used in perioperative period. It has been reported that more patients undergoing laparoscopic surgery tend to have hypothermia than with open surgery. To avoid intraoperative hypothermia, many kinds of warming tools have been used. But, it was also reported that some warming methods increased perceptions of distraction and physical demand. METHODS: To achieve both patients' normothermia and surgeons' comfort, new air conditioning (AC) system was designed with considering the characteristics of laparoscopic surgery. The temperature of the airflows to the patient and to the surgeons can be adjusted independently in this new system. The new system has two parts. One controls the temperature of the central area over the operation table. The air from this part falls on the patients. The other part is the lateral area beside the operating table; the air from this part falls on the surgeons. The subjects of this study were 160 gastric cancer patients and 316 colorectal cancer patients undergoing laparoscopic surgery. The temperature of the central flow was set 23.5 °C, and the temperature of the lateral flow was set 22 °C just after the anesthesia. The number of timepoints the patient spent in hypothermic state, defined as a temperature cooler by 0.5 °C or more than that at the starting point of surgery, was determined in each patient. RESULTS: In the results, the rate of hypothermic state in old operation rooms was 23.8% and that in new operation rooms was 2.7% in male gastric cancer patients (p < 0.01). And those were 37.1% in old operation rooms and 0.9% in new operation rooms in female gastric cancer patients (p < 0.01). The rate of hypothermic state in old operation rooms was 30.0% and that in new operation rooms was 9.5% in male colorectal cancer patients (p < 0.01). And those were 41.6% in old operation rooms and 8.9% in new operation rooms in female colorectal cancer patients (p < 0.01). The similar results were showed in the study, which subjects were limited the patients undergoing surgery in 2015 and 2016; which were the last year the old operation rooms were used and the first year the new operation rooms were used. CONCLUSIONS: Thus, the usefulness of the new air conditioning system for achieving both patients' normothermia and comfort of surgeons could be verified in this study.

10.
Eur Heart J Cardiovasc Imaging ; 21(2): 222-230, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31185091

RESUMO

AIMS: Anomalous origin of the coronary artery (AOCA) with an inter-arterial course (IAC) between the great vessels poses a risk for a life-threatening cardiovascular event. We assessed, in a registry-based study, the clinical features, treatment strategies, and prognoses of life-threatening cardiovascular events ensuant to AOCA. METHODS AND RESULTS: Included were 65 AOCA patients (48 men/17 women, aged 41 ± 23 years) from 40 clinical centres who had experienced sudden cardiac arrest (SCA) (n = 30), acute myocardial infarction (AMI) (n = 5), angina (n = 23), or syncope (n = 7). The anomalous vessel was the right coronary artery in 72% of patients and left coronary artery in 28%; the ostium was slit-like in 42%. Coronary luminal narrowing ≥75% was absent in patients with SCA or syncope (86% and 57%, respectively), but occlusion or narrowing was seen in those with AMI (100%) or angina (52%). Age ≤40 years, male sex, sporting activity, absence of prodromal symptoms, acutely angled (≤30°) take-off from the aorta, and absence of luminal narrowing of the IAC segment were associated with SCA in this patient group. Coronary vasospasm was inducible in 12 of 17 patients without coronary narrowing. Management included surgical revascularization (n = 26) percutaneous coronary intervention (n = 9), and medical treatment (n = 26). Four SCA patients died while hospitalized; no others died during the median 5.0 (range, 1.8-7.0)-year follow-up period. CONCLUSIONS: In patients with AOCA, age ≤40 years, male sex, sporting activity, and an acute take-off angle appear to be risk factors for SCA. Appropriate management can be beneficial. Confirmation in a large-scale study is warranted.

11.
J Gastrointestin Liver Dis ; 28(4): 397-404, 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31826062

RESUMO

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) has become a standard treatment for early gastric neoplasia. However, as the upper and middle body of the greater curvature has a rich vasculature and submucosal fibrosis, ESD of neoplasia in these locations requires a specific strategy. We aimed to investigate the efficacy and safety of the J-shaped superficial cutting and splashed submucosal dissection (JSCS) technique for neoplasia of the greater curvature by comparing ESD using JSCS with conventional ESD. METHODS: Twenty-two patients who underwent ESD for gastric neoplasia affecting the upper and middle body of the greater curvature were divided into two groups for retrospective analysis. Nine patients underwent conventional ESD (c-Group), while 13 underwent ESD with JSCS (j-Group). Primary outcome was the en bloc resection rate. Secondary outcomes included complete resection (R0) rate, procedure time, perforation rate, total bleeding time, and the total number of massive bleeding events and of hemostatic forceps times applied during ESD. RESULTS: There were no significant differences between both groups (c-Group vs j-Group) in en bloc resection rate, or R0 resection rate. Compared with the c-Group, the j-Group tended to have a decreased mean procedure time (mean 133 minutes vs 74 minutes, p=0.11) and perforation rate (11% vs 0%, p=0.41). Compared with the c-Group, the j-Group had significantly fewer bleeding incidents (13.4 times vs 6.6 times, p=0.0095), shorter total bleeding time (17.6 min vs 7.4 min, p=0.036), and fewer usages of hemostatic forceps (6.3 times vs 2.4 times, p=0.026) during ESD. CONCLUSION: Endoscopic submucosal dissection with JSCS is superior to conventional ESD, as it reduces intraprocedural bleeding. This technique has the potential to become the standard strategy for neoplasia affecting the upper and middle body of the greater curvature.

12.
Anticancer Drugs ; 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31815765

RESUMO

Gallbladder cancer is the most common biliary tract cancer with poor prognosis and wide variation in incidence rates worldwide, being very high in some countries in Latin America and Asia. Treatment of type 2 diabetes with metformin causes a reduction in the incidence of cancer. Till date, there are no reports on the anti-tumor effects of metformin in gall bladder cancer. Therefore, this study evaluated the effects of metformin on the proliferation of human gallbladder adenocarcinoma cells in vitro and in vivo, as well as explored the microRNAs associated with the anti-tumor effects of metformin. Metformin inhibited the proliferation in gallbladder adenocarcinoma cell lines NOZ, TGBC14TKB, and TGBC24TKB, and blocked the G0 to G1 transition in the cell cycle. This was accompanied by strong reduction in the expression of G1 cyclins, especially cyclin D1 and its catalytic subunits including cyclin-dependent kinase 4, and in retinoblastoma protein phosphorylation. In addition, metformin reduced the phosphorylation of receptor tyrosine kinases, especially Tie-2, ALK, PYK, EphA4, and EphA10, as well as angiogenesis-related proteins, including RANTES, TGF-ß, and TIMP-1. Moreover, metformin also markedly altered microRNA expression profile leading to an anti-tumor effect. Treatment of athymic nude mice bearing xenograft tumors with metformin inhibited tumor growth. These results suggest that metformin may be used clinically for the treatment of gallbladder adenocarcinoma.

13.
Pediatr Int ; 2019 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-31834972

RESUMO

BACKGROUND: While it is well known that the cognitive apprenticeship is an effective workplace-based teaching approach for clinical teachers, the effects of faculty development (FD) have not been analyzed from that perspective. The purpose of this study was to investigate the self-assessment by clinical teachers of their educational perceptions and behaviors after FD using the cognitive apprenticeship model. METHODS: Board-certified pediatricians participated in a 3-day FD program on practical clinical teaching were asked to fill out the questionnaires. Fifty participants completed two questionnaires prior to and three and six months after the FD program: the first on the participants' general perceptions and behaviors in relation to their own clinical education and the second as a self-assessment using the Maastricht Clinical Teaching Questionnaire (MCTQ), which was developed based on the cognitive apprenticeship theory. RESULTS: A general survey demonstrated that 78% of the participants felt positive changes in their educational perceptions six months after FD. Self-assessment using the MCTQ showed that the scores in the categories of "articulation", "exploration", and "safe learning environment" remained significantly improved six months after FD. CONCLUSION: The participants' self-perceived improvement in behaviors was sustainable for six months after the participation of the FD program. The results of the MCTQ show that through their experiences in the FD program, the participants seemingly transformed their clinical teaching to become contemporary facilitators encouraging self-directed learning. Our results also suggest that the MCTQ can be used for the self-assessment of clinical teachers and to enhance the effectiveness of the FD program.

14.
BMC Surg ; 19(1): 186, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31796066

RESUMO

BACKGROUND: The perioperative factors predicting or influencing early pancreatic ductal adenocarcinoma recurrence are unclear. This study attempted to identify the predictive factors for early pancreatic ductal adenocarcinoma recurrence post-pancreatectomy and the influence of pre- and post- operative adjuvant therapy. METHODS: One hundred and fifteen patients undergoing curative resection for pancreatic ductal adenocarcinoma between 2000 and 2016 at our institution were retrospectively analyzed. Patients were divided into two groups: those who did (n = 34) and did not (n = 81) experience a recurrence within 6 months postoperatively. RESULTS: Multivariate analyses demonstrated postoperative CA19-9 de-normalization, no postoperative adjuvant chemotherapy, and serosal invasion were independent risk factors for early recurrence (P < 0.001, P = 0.001, and P = 0.010, respectively). A subgroup analysis showed patients with (n = 51) and without (n = 64) preoperative chemoradiotherapy had different predictors. Although postoperative adjuvant chemotherapy was not a significant indicator in patients with preoperative chemoradiotherapy, CA19-9 de-normalization and no postoperative adjuvant chemotherapy were significant indicators in patients without preoperative chemotherapy. Preoperative chemotherapy strongly prevented early local recurrence while postoperative adjuvant chemotherapy prevented early distant recurrence. CONCLUSIONS: CA19-9 de-normalization was an important predictor of early recurrence of pancreatic ductal adenocarcinoma. Although postoperative adjuvant chemotherapy was an important preventive measure against early recurrence, particularly for distant recurrence, preoperative chemoradiotherapy could strongly prevent the early local recurrence of pancreatic ductal adenocarcinoma. These perioperative adjuvant therapies could have a complementary relationship.

15.
World J Gastroenterol ; 25(47): 6847-6856, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31885425

RESUMO

BACKGROUND: The influence of bile contamination on the infectious complications of patients undergoing pancreaticoduodenectomy (PD) has not been thoroughly evaluated. AIM: To evaluate the effect of preoperative biliary drainage and bile contamination on the outcomes of patients who undergo PD. METHODS: The database of 4101 patients who underwent PD was reviewed. Preoperative biliary drainage was performed in 1964 patients (47.9%), and bile contamination was confirmed in 606 patients (14.8%). RESULTS: The incidence of postoperative infectious complications was 37.9% in patients with preoperative biliary drainage and 42.4% in patients with biliary contamination, respectively. Patients with extrahepatic bile duct carcinoma, ampulla of Vater carcinoma, and pancreatic carcinoma had a high frequency of preoperative biliary drainage (82.9%, 54.6%, and 50.8%) and bile contamination (34.3%, 26.2%, and 20.2%). Bile contamination was associated with postoperative pancreatic fistula (POPF) Grade B/C, wound infection, and catheter infection. A multivariate logistic regression analysis revealed that biliary contamination (odds ratio 1.33, P = 0.027) was the independent risk factor for POPF Grade B/C. The three most commonly cultured microorganisms from bile (Enterococcus, Klebsiella, and Enterobacter) were identical to those isolated from organ spaces. CONCLUSION: In patients undergoing PD, bile contamination is related to postoperative infectious complication including POPF Grade B/C. The management of biliary contamination should be standardised for patients who require preoperative biliary drainage for PD, as the main microorganisms are identical in both organ spaces and bile.

16.
Pediatr Int ; 2019 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-31883414

RESUMO

BACKGROUND: The purpose of this study is to identify the attributes of good clinical teachers in pediatrics (CTPs) in Japan and to clarify pediatricians and pediatric trainees' perceptions of these attributes. METHODS: The attributes of good CTPs were identified qualitatively by conducting thematic analysis of questionnaires answered by board-certified pediatricians and pediatric trainees. The attributes obtained were rated quantitatively by a large number of participants in both groups. RESULTS: Forty-eight individual attributes of good CTPs, which were classified into three domains, namely, personal, pediatrician, and teacher domains, were identified. The three domains and most of the attributes were consistent with previous studies. However, a few additional attributes, including "is kind/thoughtful toward others" and "defends trainees", which may be unique for pediatricians in Japan, were identified. Significant differences in the pediatricians' and trainees' perceptions of these attributes were elucidated: The differences were most noticeable for teacher attributes and least for personal attributes. CONCLUSION: Although most of the identified attributes of good CTPs in our study appear to be universal, there were significant differences in the pediatricians' and trainees' perceptions of good CTPs, especially in relation to teacher attributes. Our study provides additional bases for good CTPs and future faculty development for enhanced pediatric clinical education.

17.
Ann Surg ; 2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31599805

RESUMO

OBJECTIVE: The goal of this retrospective study was to clarify the clinical implications of immunohistochemically detected protein expression for genes that are frequently mutated in pancreatic neuroendocrine tumors (PNETs). BACKGROUND: The clinical management of PNETs is hindered by their heterogenous biological behavior. Whole-exome sequencing recently showed that 5 genes (DAXX/ATRX, MEN1, TSC2, and PTEN) are frequently mutated in PNETs. However, the clinical implications of the associated alterations in protein expression remain unclear. METHODS: We collected Grade 1 and 2 (World Health Organization 2017 Classification) primary PNETs samples from 100 patients who underwent surgical resection. ATRX, DAXX, MEN1, TSC2, and PTEN expression were determined immunohistochemically to clarify their relationships with prognosis and clinicopathological findings. RESULTS: Kaplan-Meier analysis indicated that loss of TSC2 (n = 58) or PTEN (n = 37) was associated with significantly shorter overall survival, and that loss of TSC2 or ATRX (n = 41) was associated with significantly shorter recurrence-free survival. Additionally, loss of ATRX or TSC2 was significantly associated with nodal metastasis. In a multivariate analysis, combined loss of TSC2 and ATRX (n = 31) was an independent prognostic factor for shorter recurrence-free survival (hazard ratio 10.1, 95% confidence interval 2.1-66.9, P = 0.003) in G2 PNETs. CONCLUSIONS: Loss of ATRX, TSC2, and PTEN expression might be useful as a method of clarifying the behavior and clinical outcomes of Grade 1 and 2 PNETs in routine clinical practice. Combined loss of TSC2 and ATRX had an especially strong, independent association with shorter recurrence-free survival in patients with G2 PNETs. Loss of pairs in ATRX, TSC2, or PTEN would be useful for selecting the candidate for postoperative adjuvant therapy.

18.
Mol Clin Oncol ; 11(5): 447-454, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31602300

RESUMO

The prognosis of hepatocellular carcinoma (HCC) patients exhibiting macroscopic vascular invasion (MVI) is poor, and the most appropriate treatment approach remains unclear. The current study aimed to investigate the efficacy and safety of sorafenib treatment following chemoradiotherapy for advanced HCC exhibiting MVI. A newly reported regimen, including 5-fluorouracil and cisplatin therapy (NewFP), plus three-dimensional conformal radiotherapy (3D-CRT) for MVI was used as the initial treatment. Additionally, sorafenib, as a secondary treatment, was administered after NewFP plus 3D-CRT for MVI. The present retrospective study enrolled patients with unresectable advanced HCC that was treated with NewFP plus 3D-CRT for MVI between January 2009 and December 2017. In total, 32 HCC patients with MVI were registered. Of these 32 patients, 18 were treated with NewFP plus 3D-CRT for MVI (NewFP + 3D-CRT group) and 14 were treated with sorafenib following NewFP plus 3D-CRT for MVI (sorafenib after NewFP + 3D-CRT group). The study endpoints were overall survival, overall response rate and disease control rate. Clinical factors influencing overall survival were identified using univariate and multivariate analyses. The median survival time in the NewFP + 3D-CRT group and sorafenib following NewFP + 3D-CRT group was 6.7 and 49.2 months, respectively (P=0.0003). For patients with advanced HCC exhibiting MVI, the initial treatment with NewFP plus 3D-CRT for MVI was well tolerated. The administration of sorafenib as the secondary treatment following NewFP plus 3D-CRT for MVI was associated with a significantly higher overall response rate, disease control rate and increased overall survival as compared with the NewFP plus 3D-CRT treatment.

19.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31383682

RESUMO

Coronary artery aneurysm (CAA) is a rare cause of myocardial infarction. However, only a few studies have investigated this aspect. An 84-year-old woman with a history of hypertension presented with nausea. showed ST elevation in the inferior leads, and coronary angiography revealed two giant CAAs in the right coronary artery. Percutaneous coronary intervention was difficult because of risk of CAA rupture. Thus, these aneurysms were further evaluated using multimodality cardiac imaging to determine the treatment. MRI using late gadolinium enhancement revealed structural features of the aneurysms and the viability of the myocardium. Only antithrombotic medication was administered on the basis of the results of the multimodality cardiac imaging. Here, we report a rare case of a patient diagnosed with ST elevation myocardial infarction caused by thrombosis in giant CAAs using multimodality cardiac imaging, particularly MRI.


Assuntos
Aneurisma Coronário/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Imagem Multimodal/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Idoso de 80 Anos ou mais , Meios de Contraste , Aneurisma Coronário/complicações , Doença da Artéria Coronariana/complicações , Feminino , Gadolínio , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia
20.
J Hum Genet ; 64(11): 1153-1171, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31455839

RESUMO

Mucopolysaccharidoses (MPS) are a group of lysosomal storage disorders, which lack an enzyme corresponding to the specific type of MPS. Enzyme replacement therapy (ERT) has been the standard therapeutic option for some types of MPS because of the ability to start immediate treatment with feasibility and safety and to improve prognosis. There are several disadvantages for current ERT, such as limited impact to the brain and avascular cartilage, weekly or biweekly infusions lasting 4-5 h, the immune response against the infused enzyme, a short half-life, and the high cost. Clinical studies of ERT have shown limited efficacy in preventing or resolving progression in neurological, cardiovascular, and skeletal diseases. One focus is to penetrate the avascular cartilage area to at least stabilize, if not reverse, musculoskeletal diseases. Although early intervention in some types of MPS has shown improvements in the severity of skeletal dysplasia and stunted growth, this limits the desired effect of ameliorating musculoskeletal disease progression to young MPS patients. Novel ERT strategies are under development to reach the brain: (1) utilizing a fusion protein with monoclonal antibody to target a receptor on the BBB, (2) using a protein complex from plant lectin, glycan, or insulin-like growth factor 2, and (3) direct infusion across the BBB. As for MPS IVA and VI, bone-targeting ERT will be an alternative to improve therapeutic efficacy in bone and cartilage. This review summarizes the effect and limitations on current ERT for MPS and describes the new technology to overcome the obstacles of conventional ERT.

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