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1.
J Med Microbiol ; 70(8)2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34397349

RESUMO

Introduction. Lactococcus petauri LZys1 (L. petauri LZys1) is a type of lactic acid bacteria (LAB), which was initially isolated from healthy human gut.Hypothesis/Gap Statement. It was previously anticipated that L. petauri LZys1 has potential characteristics of probiotic properties. The genetic structure and the regulation functions of L. petauri LZys1 need to be better revealed.Aim. The aim of this study was to detect the probiotic properties L. petauri LZys1 and to reveal the genome information related to its genetic adaptation and probiotic profiles.Methodology. Multiple in vitro experiments were carried out to evaluate its lactic acid-producing ability, resistance to pathogenic bacterial strains, auto-aggregation and co-aggregation ability, and so on. Additionally, complete genome sequencing, gene annotation, and probiotic associated gene analysis were performed.Results. The complete genome of L. petauri LZys1 comprised of 1 985 765 bp, with a DNA G+C content of 38.07 %, containing 50 tRNA, seven rRNA, and four sRNA. A total of 1931 genes were classified into six functional categories by Kyoto Encyclopaedia of Genes and Genomes (KEGG) database. The neighbour-joining phylogeny tree based on the whole genome of L. petauri LZys1 and other probiotics demonstrated that L. petauri LZys1 has a significant similarity to Lactococcus garvieae. The functional genes were detected to expound the molecular mechanism and biochemical processes of its potential probiotic properties, such as atpB gene.Conclusion. All the results described in this study, together with relevant information previously reported, made L. prtauri LZys1 a very interesting potential strain to be considered as a prominent candidate for probiotic use.


Assuntos
Trato Gastrointestinal/microbiologia , Genoma Bacteriano , Lactococcus , Probióticos , Animais , Bactérias/crescimento & desenvolvimento , Bactérias/patogenicidade , Sequência de Bases , Fezes/microbiologia , Genes Bacterianos , Humanos , Lactococcus/citologia , Lactococcus/genética , Lactococcus/isolamento & purificação , Lactococcus/fisiologia , Masculino , Anotação de Sequência Molecular , Mariposas/microbiologia , Filogenia , Polissacarídeos Bacterianos/biossíntese , Polissacarídeos Bacterianos/genética , Sequenciamento Completo do Genoma , Adulto Jovem
2.
Endocr Relat Cancer ; 27(10): 583-589, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32856615

RESUMO

Studies have shown that pheochromocytoma (PHEO) is associated with glucose intolerance and decreased insulin sensitivity. In adipocytes, pyruvate dehydrogenase kinase 4 (PDK4) is involved in glucose uptake. However, very little is known about the role of PDK4 in the insulin signaling pathway in the adipose tissue of PHEO patients. We analyzed the expression of adipokines, oxidative stress-related genes, PDK4, phosphorylated AMPK (pAMPK) and phosphorylated IRS1 (pIRS1) in the periadrenal adipose tissue (peri-A) of patients with PHEO and non-functioning adrenal adenoma (NFA). We also investigated the effects of epinephrine on PDK4, pAMPK and pIRS1 in human stromal vascular fraction (SVF) cells, mouse 3T3-L1 preadipocytes and brown preadipocytes. PHEO patients had higher mRNA levels of PGC1α, C/EBPα, C/EBPß, COXII and AP2 and lower mRNA levels of PPARγ in their peri-A than NFA patients. Decreased pAMPK and increased PDK4 and pIRS1 were observed in the peri-A of PHEO patients. PHEO patients also had significantly higher NOX4 protein expression and lower Nrf2 and HO-1 protein expression in their peri-A than NFA patients. In vitro, epinephrine treatment upregulated PDK4 expression, inhibited AMPK phosphorylation and enhanced IRS1 phosphorylation. The knockdown of PDK4 by siRNA upregulated pAMPK and downregulated pIRS1. In conclusion, PDK4 may play an essential role in hypercatecholamine-induced insulin resistance in the periadrenal adipose tissues of PHEO patients.

3.
Adipocyte ; 8(1): 347-356, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718404

RESUMO

Although much is known about that corticosteroids affect the functions of adipose tissues, little genetic information is available for perirenal adipose tissue (peri-N) from patients with cortisol-producing adenoma (CPA). We conducted microarray analysis of peri-N from patients with CPA by using an Affymetrix human U133 plus 2.0 array. We also analysed the inflammation, fibrosis and oxidative stress in vitro. Compared with normotension (NT) group, CPA group has significantly higher protein levels of TNFα, IL-6, fibronectin (FN) and collagen I (COLI). The protein level of NADPH oxidase 4 (Nox4) significantly increased, while nuclear factor erythroid 2-related factor 2 (Nrf2) and hemeoxygenase-1 (HO-1) levels were significantly reduced in the CPA group. Dexamethasone markedly induced fibrosis and adipogenesis-related gene expression in predifferentiated stromal vascular fraction (SVF) cells, 3T3-L1 preadipocytes and brown preadipocytes. Chronic exposure to endogenous glucocorticoids due to CPA increases peri-N oxidative stress, inflammation and fibrosis, which may contribute to the metabolic disturbances associated with hypercortisolism in these patients.


Assuntos
Adenoma Hipofisário Secretor de ACT/genética , Adenoma/genética , Colágeno Tipo I/genética , Fibronectinas/genética , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Fator de Necrose Tumoral alfa/genética , Células 3T3-L1 , Adenoma Hipofisário Secretor de ACT/metabolismo , Adenoma Hipofisário Secretor de ACT/patologia , Adenoma/metabolismo , Adenoma/patologia , Tecido Adiposo/metabolismo , Adulto , Animais , Colágeno Tipo I/metabolismo , Feminino , Fibronectinas/metabolismo , Fibrose , Regulação da Expressão Gênica , Heme Oxigenase-1/metabolismo , Humanos , Masculino , Camundongos , Pessoa de Meia-Idade , NADPH Oxidase 4/metabolismo , Fator 2 Relacionado a NF-E2/metabolismo , Estresse Oxidativo , Fator de Necrose Tumoral alfa/metabolismo , Adulto Jovem
4.
Clin Neurol Neurosurg ; 182: 148-151, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31125898

RESUMO

OBJECTIVE: Surgical treatment should be considered for patients with medically refractory epilepsy, and neuronavigation may benefit and reduce the technical difficulties during surgery. In this study, we aimed to report our single-hospital experience of incorporating neuronavigation for treating patients with medically refractory epilepsy using 4 types of surgery. PATIENTS AND METHODS: Patients who were diagnosed as medically refractory epilepsy and received neuronavigation-assisted surgery were included in this retrospective analysis. The type of surgery was decided by the surgery committee after careful evaluation and discussion, including temporo-parietal-occipital (TPO) disconnection, anterior subtotal callosal section, functional hemispherectomy and resection of the epileptogenic zone(s). Postoperative seizure outcome at the last visit was evaluated using Engel classification. RESULTS: A total of 173 patients with medically refractory epilepsy who were treated surgically under the assistance of neuronavigation were included. The majority type of surgery was resection of epileptic zone, n = 104 (60.12%). An excellent seizure outcome, Engel Class I was found in 50.86% of the patients, followed by 23.12% patients with a good outcome of Engel Class II. CONCLUSION: Overall more than half of the patients could have excellent seizure outcome of Engel Class I, the postoperative complications were manageable. These results indicated that the applicability of neuronavigation, and the use of neuronavigation provides good efficacy and safety for all kinds of surgical procedures for patients with medically refractory epilepsy.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Epilepsia/cirurgia , Neuronavegação , Convulsões/cirurgia , Adolescente , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neuronavegação/métodos , Estudos Retrospectivos
5.
Endocrinology ; 159(1): 227-237, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29059354

RESUMO

The prevalence of primary aldosteronism is much higher than previously thought. Recent studies have shown that primary aldosteronism is related to a higher risk of cardiovascular events. However, the underlying mechanism is not yet clear. Here we investigate the characteristics, including inflammation, fibrosis, and adipokine expression, of adipose tissues from different deposits in patients with aldosterone-producing adenoma (APA). Inflammation and fibrosis changes were evaluated in perirenal and subcutaneous adipose tissues obtained from patients with APA (n = 16), normotension (NT; n = 10), and essential hypertension (EH; n = 5) undergoing laparoscopic surgery. We also evaluated the effect of aldosterone in isolated human perirenal adipose tissue stromal vascular fraction (SVF) cells and investigated the effect of aldosterone in mouse 3T3-L1 and brown preadipocytes. Compared with the EH group, significantly higher levels of interleukin-6 (IL-6) and tumor necrosis factor-α messenger RNA (mRNA) and protein were observed in perirenal adipose tissue of patients with APA. Expression of genes related to fibrosis and adipogenesis in perirenal adipose tissue was notably higher in patients with APA than in patients with NT and EH. Aldosterone significantly induced IL-6 and fibrosis gene mRNA expression in differentiated SVF cells. Aldosterone treatment enhanced mRNA expression of genes associated with inflammation and fibrosis and stimulated differentiation of 3T3-L1 and brown preadipocytes. In conclusion, these data indicate that high aldosterone in patients with APA may induce perirenal adipose tissue dysfunction and lead to inflammation and fibrosis, which may be involved in the high risk of cardiovascular events observed in patients with primary aldosteronism.


Assuntos
Adenoma/fisiopatologia , Aldosterona/metabolismo , Hipertensão Essencial/complicações , Hiperaldosteronismo/etiologia , Gordura Intra-Abdominal/patologia , Paniculite/etiologia , Células 3T3-L1 , Adenoma/complicações , Adenoma/metabolismo , Adenoma/cirurgia , Adipócitos Marrons/imunologia , Adipócitos Marrons/metabolismo , Adipócitos Marrons/patologia , Adipogenia , Adipocinas/metabolismo , Adrenalectomia , Animais , Células Cultivadas , Endotélio Vascular/imunologia , Endotélio Vascular/metabolismo , Endotélio Vascular/patologia , Feminino , Fibrose , Humanos , Gordura Intra-Abdominal/imunologia , Gordura Intra-Abdominal/metabolismo , Masculino , Camundongos , Pessoa de Meia-Idade , Paniculite/imunologia , Paniculite/metabolismo , Paniculite/patologia , Células Estromais/imunologia , Células Estromais/metabolismo , Células Estromais/patologia , Gordura Subcutânea Abdominal/imunologia , Gordura Subcutânea Abdominal/metabolismo , Gordura Subcutânea Abdominal/patologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-29230385

RESUMO

Objectives: Emerging evidence indicates that alterations to the urinary microbiome are related to lower urinary tract symptoms. Overactive bladder (OAB) is a common disorder with complex etiologies and usually accompanied by psychological diseases. More information concerning the urinary microbiome and psychological factors in OAB is required. The aim of this study was to characterize the female urinary microbiome associated with OAB and investigate the relationships between urinary microbiome and psychological factors. Methods: Thirty women with OAB and 25 asymptomatic controls were recruited and asked to finish the Overactive Bladder Symptom Score, Self-Rating Anxiety Scale and Self-Rating Depression Scale. Urine specimens were collected by transurethral catheterization and processed for 16S rRNA gene sequencing using Illumina MiSeq. Sequencing reads were processed using QIIME. LEfSe revealed significant differences in bacterial genera between controls and OAB patients. The relationships between the diversity of the urinary microbiome and psychological scores were identified by Pearson's correlation coefficient. Results: We found that bacterial diversity (Simpson index) and richness (Chao1) were lower in OAB samples compared to controls (P both = 0.038). OAB and control bacterial communities were significantly different (based on weighted UniFrac distance metric, R = 0.064, P = 0.037). LEfSe demonstrated that 7 genera were increased (e.g., Proteus and Aerococcus) and 13 were reduced (e.g., Lactobacillus and Prevotella) in OAB group compared to controls. There were negative correlations between scores on Self-Rating Depression Scale and both richness (Chao1, r = -0.458, P = 0.011) and diversity (Shannon index, r = -0.516, P = 0.003) of urinary microbiome in OAB group. Some bacterial genera of OAB women with anxiety or depression were significantly different from those without. Conclusions: The aberrant urinary microbiome with decreased diversity and richness may have strong implications in pathogenesis and treatment of OAB. Psychological conditions were correlated with characteristics of urinary microbiome in women with OAB. Further research is needed to understand the connection between central nervous system and urinary microbiome.


Assuntos
Microbiota , Psicologia , Bexiga Urinária Hiperativa/microbiologia , Bexiga Urinária Hiperativa/psicologia , Sistema Urinário/microbiologia , Adulto , Bactérias/classificação , Bactérias/genética , Biodiversidade , China , DNA Bacteriano/isolamento & purificação , Depressão , Feminino , Humanos , Consórcios Microbianos , Microbiota/genética , Microbiota/fisiologia , Pessoa de Meia-Idade , Filogenia , RNA Ribossômico 16S/genética , Índice de Gravidade de Doença , Adulto Jovem
7.
Nan Fang Yi Ke Da Xue Xue Bao ; 37(9): 1143-1148, 2017 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-28951353

RESUMO

OBJECTIVE: To assess the impact of delayed decompression on long-term neurological and bladder function recovery in patients with cauda equina syndrome (CES) secondary to lumbar disc herniation (LDH). METHODS: The clinical data of 35 patients receiving delayed decompression surgery for CES secondary to LDH were reviewed. The bladder empty function, bowel control, sexual ability and neurological functions of the lower limbs were evaluated after the operation, and the urodynamic changes were assessed in 6 patients with urodynamic data before and after the operation. RESULTS: Surgical decompression was performed at 4.1∓3.9 weeks in 12 patients with complete CES and at 5.5∓7.6 weeks in 23 patients with incomplete CES after the onset of symptoms. The patients were followed up for a mean of 43.0∓28.9 months (3-110 months). In the 23 patients with incomplete CES, 19 obtained full recovery, 4 had slight sensory alterations in the saddle area or the lower limbs. In the 12 patients with complete CES, 2 had full recovery, 4 reported slight sensory alterations in the saddle area or the lower limbs (including 2 with occasional constipation); 6 still had sense deficit in the saddle area and difficulties in bladder or bowl emptying, but they all reported significant improvements compared to the condition before operation. Urodynamic analysis in the 6 patients with pre- and postoperative urodynamic data showed increased abdominal pressure when voiding with significantly reduced residual urine in all the 6 patients; 4 patients with abnormal first desire volume before operation reported recovery after the operation. CONCLUSION: Patients with LDH-induced CES who missed the chance of early decompression can still expect favorable functional recovery in the long term. The improvement of bladder function following decompression is probably a result of recovery of bladder sensation and the compensation by increased intra-abdominal pressure. The key strategy to promote bladder function recovery in these patients is to promote the detrusor recovery.

8.
World J Surg ; 40(8): 1969-76, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27172803

RESUMO

BACKGROUND: It is a difficult and frustrating task for young surgeons and medical students to understand the anatomy of hepatic segments. We tried to develop an optimal 3D printing model of hepatic segments as a teaching aid to improve the teaching of hepatic segments. METHODS: A fresh human cadaveric liver without hepatic disease was CT scanned. After 3D reconstruction, three types of 3D computer models of hepatic structures were designed and 3D printed as models of hepatic segments without parenchyma (type 1) and with transparent parenchyma (type 2), and hepatic ducts with segmental partitions (type 3). These models were evaluated by six experts using a five-point Likert scale. Ninety two medical freshmen were randomized into four groups to learn hepatic segments with the aid of the three types of models and traditional anatomic atlas (TAA). Their results of two quizzes were compared to evaluate the teaching effects of the four methods. RESULTS: Three types of models were successful produced which displayed the structures of hepatic segments. By experts' evaluation, type 3 model was better than type 1 and 2 models in anatomical condition, type 2 and 3 models were better than type 1 model in tactility, and type 3 model was better than type 1 model in overall satisfaction (P < 0.05). The first quiz revealed that type 1 model was better than type 2 model and TAA, while type 3 model was better than type 2 and TAA in teaching effects (P < 0.05). The second quiz found that type 1 model was better than TAA, while type 3 model was better than type 2 model and TAA regarding teaching effects (P < 0.05). Only TAA group had significant declines between two quizzes (P < 0.05). CONCLUSIONS: The model with segmental partitions proves to be optimal, because it can best improve anatomical teaching about hepatic segments.


Assuntos
Educação de Graduação em Medicina , Fígado/anatomia & histologia , Modelos Anatômicos , Impressão Tridimensional , Humanos , Estudantes de Medicina
9.
Biochem Biophys Res Commun ; 474(4): 722-729, 2016 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-27155154

RESUMO

Androgen deprivation therapy is the gold standard regimen for advanced Prostate cancer (PCa) patients, nevertheless, patients eventually develop into castration-resistant prostate cancer (CRPC). Currently only a few chemotherapeutics are available for CRPC. Therefore, it is critical for identifying a new drug. In this study, we will explore a new agent, Saikosaponin-d (SSd), for CRPC therapy based on its mechanism of action. DU145 and CWR22Rv1 cells representing CRPC were employed in this study. A series of cell, biochemical, and molecular biologic assays such as Immunofluorescence, Zymography, Sphere formation, Colony formation, and MTT were used. Finally, we find SSd can significantly inhibit the growth of PCa cells in both dose- and time-dependent and suppress the colony formation during a long-term drug administration, it also can inhibit their migration and invasion abilities, which was accompanied by reverse the epithelial-mesenchymal transition (EMT) and suppress MMP2/9 expression as well as activities. Furthermore, SSd can suppress cancer stem cell (CSC) phenotypes such as self-renewal ability. Mechanistically, SSd blocks Wnt/ß-catenin signaling pathway by decreasing GSK3ß phosphorylation to affect EMT and CSC. These findings demonstrate the mechanism of anti-cancer activity of SSd in targeting EMT and CSC, suggesting SSd can be a potent agent for CRPC therapy.


Assuntos
Carcinoma/prevenção & controle , Carcinoma/secundário , Células-Tronco Neoplásicas/efeitos dos fármacos , Ácido Oleanólico/análogos & derivados , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Neoplasias de Próstata Resistentes à Castração/patologia , Saponinas/administração & dosagem , Antineoplásicos Fitogênicos/administração & dosagem , Apoptose/efeitos dos fármacos , Carcinoma/patologia , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Relação Dose-Resposta a Droga , Estudos de Viabilidade , Humanos , Masculino , Invasividade Neoplásica , Células-Tronco Neoplásicas/patologia , Ácido Oleanólico/administração & dosagem
10.
J Surg Educ ; 73(2): 264-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26868314

RESUMO

INTRODUCTION: Hepatic segment anatomy is difficult for medical students to learn. Three-dimensional visualization (3DV) is a useful tool in anatomy teaching, but current models do not capture haptic qualities. However, three-dimensional printing (3DP) can produce highly accurate complex physical models. Therefore, in this study we aimed to develop a novel 3DP hepatic segment model and compare the teaching effectiveness of a 3DV model, a 3DP model, and a traditional anatomical atlas. MATERIALS AND METHODS: A healthy candidate (female, 50-years old) was recruited and scanned with computed tomography. After three-dimensional (3D) reconstruction, the computed 3D images of the hepatic structures were obtained. The parenchyma model was divided into 8 hepatic segments to produce the 3DV hepatic segment model. The computed 3DP model was designed by removing the surrounding parenchyma and leaving the segmental partitions. Then, 6 experts evaluated the 3DV and 3DP models using a 5-point Likert scale. A randomized controlled trial was conducted to evaluate the educational effectiveness of these models compared with that of the traditional anatomical atlas. RESULTS: The 3DP model successfully displayed the hepatic segment structures with partitions. All experts agreed or strongly agreed that the 3D models provided good realism for anatomical instruction, with no significant differences between the 3DV and 3DP models in each index (p > 0.05). Additionally, the teaching effects show that the 3DV and 3DP models were significantly better than traditional anatomical atlas in the first and second examinations (p < 0.05). Between the first and second examinations, only the traditional method group had significant declines (p < 0.05). CONCLUSION: A novel 3DP hepatic segment model was successfully developed. Both the 3DV and 3DP models could improve anatomy teaching significantly.


Assuntos
Cirurgia Geral/educação , Imageamento Tridimensional , Fígado/anatomia & histologia , Fígado/cirurgia , Modelos Anatômicos , Impressão Tridimensional , Tomografia Computadorizada por Raios X , Simulação por Computador , Meios de Contraste , Educação de Graduação em Medicina , Avaliação Educacional , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários
11.
Nan Fang Yi Ke Da Xue Xue Bao ; 37(4): 563-566, 2016 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-28446415

RESUMO

OBJECTIVE: To investigate the expressions of inflammation- and fibrosis-related genes in perinephric and subcutaneous adipose tissues in patients with adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome. METHODS: The perinephric and subcutaneous adipose tissues adipose tissues were obtained from 8 patients with ACTH-independent Cushing's syndrome undergoing laparoscopic retroperitoneal adrenalectomy. Real-time PCR was used to detect the mRNA expression levels of interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), matrix metallopeptidase 2 (MMP-2), TIMP metallopeptidase inhibitor 1 (TIMP-1), early growth response 1 (EGR1), CCAAT/enhancer binding protein ß(CEBPß), uncoupling protein 1(UCP-1), PPARγ coactivator 1 alpha (PGC1α) and cell death-inducing DFFA-like effector a (CIDEA). RESULTS: The mRNA level of CIDEA was significantly higher in the perinephric adipose tissue (peri-N) than in the subcutaneous adipose tissue (subQ) (P<0.05). The expressions of CEBPß, UCP-1, and PGC1α mRNA in the peri-N were similar with those in the subQ. The expressions of IL-6, TIMP1 and EGR1 mRNA in the subQ were significantly higher than those in the peri-N (P<0.05). No significant difference in TNF-α and MMP-2 mRNA levels was found between peri-N and subQ. CONCLUSION: The expression levels of the inflammation- and fibrosis-related genes are higher in the subQ than in the peri-N of patients with ACTH-independent Cushing's syndrome, suggesting that chronic exposure to endogenous hypercortisolism may cause adipose tissue dysfunction.


Assuntos
Hormônio Adrenocorticotrópico , Síndrome de Cushing/metabolismo , Gordura Subcutânea/metabolismo , Adrenalectomia , Proteína beta Intensificadora de Ligação a CCAAT/metabolismo , Síndrome de Cushing/cirurgia , Proteína 1 de Resposta de Crescimento Precoce/metabolismo , Humanos , Metaloproteinase 2 da Matriz/metabolismo , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/metabolismo , Reação em Cadeia da Polimerase em Tempo Real , Inibidor Tecidual de Metaloproteinase-1/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Proteína Desacopladora 1/metabolismo
12.
J Neurosurg ; 125(1): 67-74, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26654176

RESUMO

OBJECT The objectives of this study were to describe a novel minimal-access subtemporal approach for selective resection of the amygdala and hippocampus in patients with medically refractory mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis, and to analyze the related outcomes. METHODS The authors analyzed data from all cases involving patients with unilateral MTLE due to hippocampal sclerosis who were treated with selective amygdalohippocampectomy via the posterior subtemporal approach through a relatively small craniotomy, without a neuronavigation system, at their institution during the period from September 2010 to September 2012. Data were obtained on baseline characteristics, preoperative evaluations of unilateral mesial temporal sclerosis, surgical complications, and Engel class seizure outcomes. All patients underwent memory testing, IQ testing, and language testing. RESULTS The mean duration of follow-up was 33.6 months (range 24-48 months). There were no deaths and no cases of significant postoperative morbidity. One patient had a mild complication. At 2-year follow-up, 19 patients were seizure free (Engel Class I outcome). Verbal memory scores obtained at 3 months and at 2 years after surgery were significantly lower than preoperative scores for patients who underwent surgery on the left side of the brain (p < 0.05). Pictorial memory scores were higher following surgery compared with before surgery regardless of whether patients underwent left- or right-sided brain surgery. There was also improvement in performance IQ and total IQ following surgery in both groups. For patients who underwent right-sided brain surgery, verbal comprehension and semantic fluency testing scores were significantly higher at both 3 months and 2 years after surgery than before surgery. For patients who underwent left-sided brain surgery, scores on all language tests were significantly lower at 3 months after surgery than before surgery. Verbal comprehension testing scores returned to the preoperative level at 2 years after surgery. CONCLUSIONS The posterior subtemporal approach through a relatively small craniotomy allows adequate exposure and safe resection of mesial temporal structures and effectively reduces medically intractable MTLE. It preserves IQ but may have a detrimental effect on verbal memory and language ability.


Assuntos
Tonsila do Cerebelo/cirurgia , Lobectomia Temporal Anterior/métodos , Craniotomia/métodos , Epilepsia do Lobo Temporal/cirurgia , Hipocampo/cirurgia , Adolescente , Adulto , Epilepsia do Lobo Temporal/psicologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
Neurosurg Rev ; 39(1): 99-108; discussion 108, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26277790

RESUMO

Surgical approaches for medically refractory mesial temporal lobe epilepsy (MTLE) that previously have been reported include anterior temporal lobectomy (ATL), transcortical selective amygdalohippocampectomy, transsylvian amygdalohippocampectomy, and subtemporal amygdalohippocampectomy. Each approach has its advantages and potential pitfalls. The purpose of this report is to describe our technique of keyhole corticoamygdalohippocampectomy for patients with MTLE due to hippocampal sclerosis. Operations were performed through a 6-cm vertical linear incision and a low 2.5-cm keyhole craniotomy at the anterior squamous temporal bone. Resection of the anterior-most portions of the middle and inferior temporal gyri provided a cylinder-like corridor to the mesial temporal lobe. Identification of the temporal horn through a basal approach was followed by resection of the amygdala, uncus, and hippocampus-parahippocampal gyrus. This 9-year series included 683 patients with a minimum follow-up duration of 2 years. Surgery times were short (range, 1 h 35 min to 2 h 30 min). Only a small percentage of patients had complications (1.76%), and the rate of Engel Class I seizure-free outcome was 87%. No overt speech problems or visual field deficits were identified. Compared with the most popular conventional trans-middle temporal gyrus approach, this technique can make the operation easier, safer, and less traumatic to functional lateral neocortex.


Assuntos
Tonsila do Cerebelo/cirurgia , Córtex Cerebral/cirurgia , Epilepsia do Lobo Temporal/cirurgia , Hipocampo/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Neurocirúrgicos/métodos , Ventrículos Cerebrais/cirurgia , Craniotomia , Seguimentos , Hipocampo/patologia , Humanos , Testes de Inteligência , Imageamento por Ressonância Magnética , Esclerose , Osso Temporal/cirurgia , Resultado do Tratamento , Campos Visuais
14.
Acta Neurochir (Wien) ; 157(1): 63-75, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25278241

RESUMO

PURPOSE: We reported our experience in the surgical treatment of a relatively large cohort of patients with occipital lobe epilepsy (OLE). We also carried out a systematic review of the literature on OLE. METHODS: Thirty-five consecutive patients who underwent occipital resection for epilepsy were included. Diagnoses were made following presurgical evaluations, including magnetic resonance imaging (MRI), fluorodeoxyglucose-positron emission tomography (FDG-PET), scalp video-electroencephalogram (EEG) monitoring, and intracranial EEG monitoring. At last follow-up, seizure outcome was classified using the Engel classification scheme. RESULTS: Twenty-five of 35 patients experienced/had experienced ≥1 type of aura before the seizure. Invasive recordings were used to define the epileptogenic area in 30 of 35 patients (85.7 %). All patients underwent occipital lesionectomies or topectomies. Histopathology revealed: cortical dysplasias, gliosis, dysembryoplastic neuroepithelial tumor, ganglioglioma, and tuberous sclerosis. After a mean follow-up of 44 months, 25 patients (71.4 %) were seizure free (Engel class I), 3 (8.6 %) rarely had seizures (Engel class II), 5 (14.3 %) improved more than 75 % (Engel class III), and 2 (5.7 %) had no significant improvement (Engel class IV). Preoperatively, 12 of 33 patients (36.4 %) had visual field deficits. Postoperatively, 25 patients (75.8 %) had new or aggravated visual field deficits. CONCLUSIONS: The management of OLE has been aided greatly by the availability of high-resolution diagnosis. Postoperative visual field deficits occur in a significant proportion of patients. Comprehensive intracranial EEG coverage of all occipital surfaces helps to define the epileptogenic area and preserve visual function, especially in cases of focal cortical dysplasia undetectable by MRI.


Assuntos
Epilepsias Parciais/cirurgia , Psicocirurgia , Adolescente , Adulto , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Criança , Pré-Escolar , Eletroencefalografia , Epilepsias Parciais/diagnóstico , Epilepsias Parciais/etiologia , Feminino , Seguimentos , Ganglioglioma/complicações , Ganglioglioma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Malformações do Desenvolvimento Cortical/complicações , Malformações do Desenvolvimento Cortical/cirurgia , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Resultado do Tratamento
15.
Epilepsy Behav ; 41: 91-7, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25461196

RESUMO

This study compared the long-term efficacy of anterior temporal lobectomy (ATL) for the treatment of medically refractory temporal lobe epilepsy (TLE) in patients who presented with ipsilateral temporal PET hypometabolism and nonlesional magnetic resonance imaging (PET+/MRI-) with that in patients who had mesial temporal sclerosis (MTS) on MRI. We described the electroclinical, MRI, PET, and pathological characteristics and seizure outcome of 28 PET+/MRI--patients without discordant ictal and interictal electroencephalography (EEG) who underwent ATL (2004-2007) for medically refractory partial epilepsy while avoiding intracranial monitoring. The primary outcome was the percentages of Engel Class I outcomes at 2 and 5 years of PET+/MRI--patients compared with those of patients with MTS on MRI; neuropsychological testing was used as the secondary outcome. At 2-year follow-up, 21 (75%) patients in the PET+/MRI--group were in Engel Class I compared with 66 (75.9%) patients with MTS, and at 5-year follow-up, 20 (71.4%) patients in the PET+/MRI--group were in Engel Class I compared with 64 (73.6%) patients in the group with MTS. There were no significant differences between the groups at either time period. We concluded that normal MRI results should not preclude presurgical evaluations in patients with medically refractory TLE, as favorable long-term postoperative seizure outcomes are possible, especially in patients with unilateral anterior interictal epileptiform discharges and ipsilateral temporal PET hypometabolism.


Assuntos
Lobectomia Temporal Anterior , Epilepsia do Lobo Temporal , Imageamento por Ressonância Magnética , Avaliação de Resultados em Cuidados de Saúde , Tomografia por Emissão de Pósitrons , Convulsões/cirurgia , Adulto , Eletroencefalografia , Epilepsia do Lobo Temporal/metabolismo , Epilepsia do Lobo Temporal/patologia , Epilepsia do Lobo Temporal/fisiopatologia , Epilepsia do Lobo Temporal/cirurgia , Feminino , Humanos , Masculino , Recidiva , Convulsões/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
16.
Epileptic Disord ; 16(3): 296-304, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25179817

RESUMO

AIM: To assess the surgical outcomes of temporo-parieto-occipital (TPO) and parieto-occipital (PO) disconnection surgery for children with intractable posterior quadrantic epilepsy and a unilateral posterior quadrant lesion based on MRI and functional imaging abnormality in the TPO region on one side. METHODS: A retrospective review of data of 12 children who underwent TPO or PO disconnective surgery was carried out from September 2009 to September 2012. Three-dimensional surface reconstructions of MRI scans and intraoperative electrophysiological monitoring were used during surgery. Drugs were not discontinued after surgery in any patient. RESULTS: The affected hemisphere was the left in seven patients and the right in five patients. The mean ages at seizure onset and at surgery were four years and 12.3 years, respectively. At the time of surgery, 3 children had atonic seizures, 4 had symptomatic epilepsy with focal seizures and alteration of conscioussness, 4 had secondarily generalised seizures, and 1 child had spasms and tonic seizures. All patients had developmental delay. A pure TPO disconnection was performed in 11 patients and a PO disconnection was performed in the remaining patient. On pathological examination, 3 patients were shown to have focal cortical dysplasia (FCD) Ib, 2 with FCD IIa, 5 with FCD IIb, 1 with gliosis, and 1 with gliosis plus FCD IIa. Following surgery, 2 patients had oedema; 1 required another operation to resect the occipital lobe. At a mean follow-up of 34.5 months, 9 patients (75%) were classified as Engel class I, 2 as Engel Class II, and 1 as Engel class III. All 12 children had contralateral hemianopia postoperatively and improvement in median IQ (p=0.04) was reported three months postoperatively. CONCLUSIONS: With respect to the limits of a retrospective and relatively small sample size series TPO and PO disconnection are safe and effective motor-sparing epilepsy surgical procedures in selected patients with the epileptiform zone located in the posterior quadrant on one side.


Assuntos
Encéfalo/cirurgia , Epilepsia/cirurgia , Gliose/cirurgia , Malformações do Desenvolvimento Cortical/cirurgia , Psicocirurgia/métodos , Adolescente , Encéfalo/patologia , Criança , Pré-Escolar , Epilepsia/complicações , Epilepsia/patologia , Feminino , Gliose/complicações , Gliose/patologia , Humanos , Masculino , Malformações do Desenvolvimento Cortical/complicações , Malformações do Desenvolvimento Cortical/patologia , Estudos Retrospectivos , Resultado do Tratamento
17.
Epilepsy Res ; 108(9): 1662-70, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25241139

RESUMO

Intracranial electroencephalographic monitoring with subdural and/or depth electrodes is widely used for the surgical localization of epileptic foci in patients with intractable partial epilepsy; however, data on safety and surgical outcome with this technique are still inadequate. The aims of this study were to assess the morbidity of intracranial recordings and the surgical outcomes in epileptic children. We retrospectively reviewed the clinical data for 137 children with epilepsy (mean age at implantation: 12.6 ± 3.8 years) who underwent intracranial monitoring with the implantation of strip or grid subdural electrodes and/or intracerebral depth electrodes from September 2004 to September 2011 at a tertiary epilepsy center in China. Complications were classified using five grades of severity (including mortality) and were further classified as either minor or severe. Outcome was classified according to Engel's classification. Regression analysis was performed to identify risk factors for complications. The mean duration of implantation was 5.3 ± 1.3 days. Among the 133 patients who underwent resection, 65 (48.9%) were seizure free (Engel Class I) at last known follow-up, which was >2 years after surgery for all patients. Also, 31 (23.3%) patients had a significant reduction in seizures (Engel Class II). Complications of any type were documented in 29 (21.7%) patients; 15 of these patients had intracranial hematoma. The results of multivariate analysis showed that the only independent risk factor for intracranial hematoma was number of electrode contacts. The most common pathologic diagnosis was focal cortical dysplasia (n=58). Our results showed that intracranial electroencephalographic monitoring in children provides good surgical outcomes and the level of risk is acceptable. When using this technique strategies such as using as few electrode contacts as possible should be adopted to minimize the risk of intracranial hematoma.


Assuntos
Encéfalo/fisiopatologia , Eletrodos Implantados , Epilepsia/diagnóstico , Epilepsia/patologia , Espaço Subdural/fisiopatologia , Adolescente , Criança , Eletrodos Implantados/efeitos adversos , Eletroencefalografia , Epilepsia/cirurgia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
18.
Epilepsy Behav ; 36: 47-52, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24857808

RESUMO

We report on the efficacy and safety of extended, one-stage anterior callosal section that spares the splenium, which is performed in a large series of pediatric patients with drop attacks. Twenty-nine pediatric patients with drop attacks were studied (19 males and 10 females; mean age: 9.9 years). As presurgical factors, the age at surgery, age at seizure onset, age at drop attack onset, sex, hemiparesis, severe mental retardation, electroencephalograph abnormalities, magnetic resonance imaging abnormalities, and (18)fluorodeoxyglucose positron emission tomography abnormalities were analyzed. All patients had multiple seizure types, including drop attacks, atypical absence seizures, complex partial seizures, tonic seizures, and generalized tonic-clonic seizures. All patients were developmentally impaired and had electroencephalograph results showing marked secondary bilateral synchrony. All patients received an extended, one-stage callosal section, leaving only the splenium intact. The mean follow-up time was 5.2 years. Seizure outcome (cessation of seizures or ≥ 90% seizure reduction) was achieved in 79.3% of patients with drop attacks. The families assessed the overall daily function as improved in 62.1% of the patients, unchanged in 24.1%, and worse in 13.8%. Family satisfaction with callosotomy was achieved in 82.8% of the patients. The majority of the patients had some degree of a transient acute postoperative disconnection syndrome that disappeared within 3 weeks. Postoperatively, patients showed a consistent increase in attention levels. We conclude that extended callosal sectioning that leaves the splenium intact should be considered a good palliative surgical option for pediatric patients with drop attacks and that diminishment of epileptic discharge synchrony is a good prognostic sign following callosotomy. We also found that the postoperative increase in attention levels was as useful as seizure control in improving the quality of life of these patients.


Assuntos
Corpo Caloso/cirurgia , Procedimentos Neurocirúrgicos , Síncope/cirurgia , Resultado do Tratamento , Adolescente , Criança , Pré-Escolar , Cognição/fisiologia , Eletroencefalografia , Feminino , Fluordesoxiglucose F18 , Humanos , Estudos Longitudinais , Masculino , Pediatria , Tomografia por Emissão de Pósitrons , Estudos Retrospectivos , Síncope/diagnóstico por imagem , Tomógrafos Computadorizados
19.
Nan Fang Yi Ke Da Xue Xue Bao ; 32(6): 894-6, 2012 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-22699079

RESUMO

OBJECTIVE: To evaluate the factors affecting the efficacy of extracorporeal shock wave lithotripsy (ESWL) and establish a model for predicting the success rate of a single ESWL session in the treatment of single renal calculus. METHODS: Between January 2008 and February 2010, 325 patients underwent ESWL monotherapy and were followed up for at most 3 months. The correlations between the outcome of a single ESWL session and the patients' age, gender, body mass index (BMI), disease duration, pretreatment renal colic, hematuria, urinary irritation symptoms, stone location, stone laterality, stone length and stone width were analyzed. The statistically significant factors identifies were further analyzed by multivariate logistic regression, and the predictive model was established. RESULTS: The stone-free rate of ESWL was 76.9%. Univariate analysis found that the patients' age, stone laterality, stone location, disease duration, pretreatment hematuria, stone length and width all significantly affected the outcome of the treatment. Logistic regression analysis indicated the factors including disease duration, pretreatment hematuria, stone length and stone width determined the success rate of the treatment. Hosmer and Lemeshow Test showed a good fitting of the predictive model (Χ(2)=18.144, df=8, P=0.168) with an overall accuracy of 87.4%. CONCLUSION: Disease duration, pretreatment hematuria, stone length and width are independent factors affecting the outcome of a single ESWL session for single renal calculus.


Assuntos
Cálculos Renais/terapia , Litotripsia , Modelos Logísticos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
20.
Zhong Xi Yi Jie He Xue Bao ; 9(1): 84-90, 2011 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-21227038

RESUMO

OBJECTIVE: To study the protective mechanism of Dusuqing Granule, a compound Chinese herbal medicine, on the senile multiple organ injury caused by bacterial pneumonia by observing the expression changes of molecules related to toll-like receptor 4 (TLR4) signaling. METHODS: A total of 55 male Sprague-Dawley aged rats were divided into control group, untreated group, Dusuqing group and lomefloxacin group. There were 25 rats in the untreated group and 10 rats in each of the other three groups. Multiple organ injury in a rat model of pneumonia was induced by injection of Klebsiella pneumoniae through tracheal intubation. By means of immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR), examinations were made on mRNA expressions of lipopolysaccharide-binding protein (LBP), CD14, TLR4 and interleukin-1 receptor-associated kinase-1 (IRAK-1) in the tissues of the lung, heart and small intestine, and also on the protein expressions of TLR4, tumor necrosis factor receptor-associated factor 6 (TRAF6) and nuclear factor-κB (NF-κB). RESULTS: Expressions of LBP, CD14, TLR4 and IRAK-1 mRNAs in the tissues of the lung, heart and small intestine in the untreated group were stronger than those in the control group (P<0.01 or Plt;0.05). The protein expressions of TLR4, TRAF6 and NF-κB were increased dramatically in the untreated group as compared with the control group (Plt;0.01 or Plt;0.05). Compared with the untreated group, the expressions of LBP, CD14, TLR4 and IRAK-1 mRNAs in the tissues of the lung, heart and small intestine in the Dusuqing group were weakened significantly (Plt;0.01 or Plt;0.05). Meanwhile, the protein expressions of TLR4, TRAF6 and NF-κB were decreased markedly in the Dusuqing group (Plt;0.01 or Plt;0.05). CONCLUSION: Dusuqing Granule is effective in suppressing toll-like receptor signal transduction activation and reducing the secretion of cytokines and inflammatory mediators, which can further reduce the organ tissue injury. Dusuqing Granule can decrease the levels of TLR signal transduction activation including the targets LBP, CD-14, TLR4, IRAK-1, TRAF6 and NF-κB, which is different from the special inhibitor that acts only on some segments.


Assuntos
Medicamentos de Ervas Chinesas/farmacologia , Insuficiência de Múltiplos Órgãos/complicações , Pneumonia Bacteriana/metabolismo , Receptor 4 Toll-Like/metabolismo , Animais , Masculino , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/patologia , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos
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