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2.
Zhonghua Xue Ye Xue Za Zhi ; 40(8): 662-666, 2019 Aug 14.
Artigo em Chinês | MEDLINE | ID: mdl-31495133

RESUMO

Objective: To establish a new method for chimerism analysis after allogeneic hematopoietic stem cell transplantation by using multiple nucleotide polymorphism sequencing (MNPseq) , and to explore its feasibility and superiority. Methods: One hundred MNP fragments were screened and chimeric analysis was performed by high-throughput sequencing technology. The accuracy and sensitivity of the method were verified by simulating chimeric samples and post-transplant samples and comparing them with short tandem repeat (STR) analysis, fusion gene quantitative detection and flow cytometry for minimal residual disease. Results: The accuracy and sensitivity of MNPseq were better than those of STR, in which the sensitivity could reach 0.01%, about 100 times more sensitive than STR. MNPseq could further distinguish 42 STR fully chimeric samples, and after corrected by cutoff value, it was correlated with the quantitative detection of fusion gene. MNPseq could correct false positive of STR caused by the shadow peak, and could be used to detect chimeric samples lacking pre-transplant information from donors and recipients. Conclusion: MNPseq analysis based on high-throughput sequencing is a more accurate and sensitive chimerism detection method, and it solves the problem that chimerism cannot be detected due to the lack of pre-transplant information, which has extremely high clinical application value.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Humanos , Polimorfismo Genético , Doadores de Tecidos , Quimeras de Transplante
10.
Rev Col Bras Cir ; 46(3): e20192180, 2019 Aug 05.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31389525

RESUMO

OBJECTIVE: to characterize the profile of potential and effective organ donors, and to identify the factors related to non-donation. METHODS: the data was collected from the Organization of Organ Donation forms during the period of January 2013 to April 2018. The statistical analysis was done by the Biostatistic Service of the School of Medical Sciences of UNICAMP. RESULTS: the study analyzed 1,772 potential donors; the male gender was predominant (57.39%). Vascular injuries (n=996) were the main cause of brain death. The family refusal (42.8%) was the leading cause of non-donation of organs. There was statistical difference between donors and non-donors in regard to the mean age and mean systolic blood pressure. There was also a relationship between the donation of organs and the absence of diabetes and smoking. CONCLUSION: the majority of effective organ donors were young males. The main causes of brain death (BD) and family refusal of organ donation were cerebrovascular disorder and no desire to donate organs after death, respectively. Alcoholics and males were more frequently found in traumatic causes of BD. Therefore, initiatives for population awareness and discussion among the families regarding organ donation can lead to increase the number of effective organ donors.


Assuntos
Família , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Adulto , Idoso , Morte Encefálica , Causas de Morte , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade
11.
Stud Health Technol Inform ; 264: 10-14, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437875

RESUMO

Kidney transplantation is recommended for patients with End-Stage Renal Disease (ESRD). However, complications, such as graft rejection are hard to predict due to donor and recipient variability. This study discusses the role of machine learning (ML) in predicting graft rejection following kidney transplantation, by reviewing the available related literature. PubMed, DBLP, and Scopus databases were searched to identify studies that utilized ML methods, in predicting outcome following kidney transplants. Fourteen studies were included. This study reviewed the deployment of ML in 109,317 kidney transplant patients from 14 studies. We extracted five different ML algorithms from reviewed studies. Decision Tree (DT) algorithms revealed slightly higher performance with overall mean Area Under the Curve (AUC) for DT (79.5% ± 0.06) was higher than Artificial Neural Network (ANN) (78.2% ± 0.08). For predicting graft rejection, ANN and DT were at the top among ML models that had higher accuracy and AUC.


Assuntos
Rejeição de Enxerto , Transplante de Rim , Aprendizado de Máquina , Sobrevivência de Enxerto , Humanos , Doadores de Tecidos
13.
BJOG ; 126(11): 1310-1319, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31410987

RESUMO

Uterine transplantation restores reproductive anatomy in women with absolute uterine factor infertility and allows the opportunity to conceive, experience gestation, and acquire motherhood. The number of cases being performed is increasing exponentially, with detailed outcomes from 45 cases, including nine live births, now available. In light of the data presented herein, including detailed surgical, immunosuppressive and obstetric outcomes, the feasibility of uterine transplantation is now difficult to refute. However, it is associated with significant risk with more than one-quarter of grafts removed because of complications, and one in ten donors suffering complications requiring surgical repair. TWEETABLE ABSTRACT: Uterine transplantation is feasible in women with uterine factor infertility, but is associated with significant risk of complication.


Assuntos
Sobrevivência de Enxerto/fisiologia , Imunossupressão/métodos , Infertilidade Feminina/cirurgia , Transplante de Órgãos , Doadores de Tecidos , Útero/transplante , Adulto , Feminino , Rejeição de Enxerto , Humanos , Nascimento Vivo , Pessoa de Meia-Idade , Transplante de Órgãos/métodos , Gravidez , Resultado do Tratamento , Adulto Jovem
14.
Medicine (Baltimore) ; 98(29): e16498, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335716

RESUMO

RATIONALE: Relapse is the main cause of death after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Unfortunately, there are no efficient methods to prevent relapse after allo-HSCT. Chimeric antigen receptor T (CAR-T) cells have achieved favorable outcomes in the treatment of refractory/relapsed acute lymphoblastic leukemia (ALL) because of their strong anti-leukemia activity. However, it is unclear whether the CAR-T cells constructed using viral systems can be used as preventive infusions to prevent relapse after haploidentical HSCT. PATIENT CONCERNS: Two patients with ALL with high risk received haploidentical HSCT. DIAGNOSES: Two patients were diagnosed with ALL with high risk. INTERVENTIONS: Patients received preventive infusion of donor-derived CAR-T cells constructed using viral systems on day 60 after haploidentical HSCT. OUTCOMES: The CAR-T cells were continually detected, and no graft versus host disease developed. The two patients survived with disease-free for 1 year and 6 months, respectively. LESSONS: Preventive infusion of donor-derived CAR-T cells after haploidentical HSCT may be safe and that immunosuppressors may not affect the proliferation of CAR-T cells.


Assuntos
Doença Enxerto-Hospedeiro/prevenção & controle , Transplante de Células-Tronco Hematopoéticas/métodos , Imunoterapia Adotiva/métodos , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Receptores de Antígenos Quiméricos/uso terapêutico , Transplante Haploidêntico , Adulto , Pré-Escolar , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Imunossupressores/uso terapêutico , Masculino , Doadores de Tecidos
15.
Artigo em Inglês | MEDLINE | ID: mdl-31307313

RESUMO

A 38-year-old female with tricuspid atresia and normally related great arteries, initially palliated with Björk modified Fontan, and ultimately converted to extracardiac conduit Fontan, with a history of ventricular tachycardia and hepatitis C virus (HCV) treated with sofosbuvir/ledipasvir, was referred to our center for consideration of combined heart and liver transplantation. The patient's blood group was O with panel reactive antibodies of 52%. She consented to consideration of HCV-positive donors. Fifteen days later, an HCV-positive donor was identified, and she underwent heart transplantation with pulmonary artery reconstruction performed jointly by adult and pediatric transplant surgeons. To our knowledge, this the first time an HCV-positive donor heart has been to transplant an adult with congenital heart disease.


Assuntos
Cardiopatias Congênitas/cirurgia , Transplante de Coração/métodos , Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/imunologia , Hepatite C/virologia , Doadores de Tecidos , Adulto , Feminino , Anticorpos Anti-Hepatite C/sangue , Humanos , Transplantados , Carga Viral
17.
Einstein (Sao Paulo) ; 17(4): eAO4288, 2019 Jul 15.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31314859

RESUMO

OBJECTIVE: To assess the feasibility and impact of ex vivo lung perfusion with hyperoncotic solution (Steen Solution™) in the utilization of these organs in Brazil. METHODS: In this prospective study, we subjected five lungs considered to be high risk for transplantation to 4 hours of ex vivo lung perfusion, with evaluation of oxygenation capacity. High-risk donor lungs were defined by specific criteria, including inflammatory infiltrates, pulmonary edema and partial pressure of arterial oxygen less than 300mmHg (inspired oxygen fraction of 100%). RESULTS: During reperfusion, the mean partial pressure of arterial oxygen (inspired oxygen fraction of 100%) of the lungs did not change significantly (p=0.315). In the first hour, the mean partial pressure of arterial oxygen was 302.7mmHg (±127.66mmHg); in the second hour, 214.2mmHg (±94.12mmHg); in the third hour, 214.4mmHg (±99.70mmHg); and in the fourth hour, 217.7mmHg (±73.93mmHg). Plasma levels of lactate and glucose remained stable during perfusion, with no statistical difference between the moments studied (p=0.216). CONCLUSION: Ex vivo lung perfusion was reproduced in our center and ensured the preservation of lungs during the study period, which was 4 hours. The technique did not provide enough improvement for indicating organs for transplantation; therefore, it did not impact on use of these organs.


Assuntos
Transplante de Pulmão/métodos , Preservação de Órgãos/métodos , Perfusão/métodos , Doadores de Tecidos , Adulto , Brasil , Estudos Transversais , Seleção do Doador , Feminino , Humanos , Pulmão/irrigação sanguínea , Complacência Pulmonar , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
18.
Nat Commun ; 10(1): 2945, 2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31270332

RESUMO

Age- and sex-related alterations in gene transcription have been demonstrated, however the underlying mechanisms are unresolved. Neuroepigenetic pathways regulate gene transcription in the brain. Here, we measure in vivo expression of the epigenetic enzymes, histone deacetylases (HDACs), across healthy human aging and between sexes using [11C]Martinostat positron emission tomography (PET) neuroimaging (n = 41). Relative HDAC expression increases with age in cerebral white matter, and correlates with age-associated disruptions in white matter microstructure. A post mortem study confirmed that HDAC1 and HDAC2 paralogs are elevated in white matter tissue from elderly donors. There are also sex-specific in vivo HDAC expression differences in brain regions associated with emotion and memory, including the amygdala and hippocampus. Hippocampus and white matter HDAC expression negatively correlates with emotion regulation skills (n = 23). Age and sex are associated with HDAC expression in vivo, which could drive age- and sex-related transcriptional changes and impact human behavior.


Assuntos
Encéfalo/fisiologia , Epigênese Genética , Caracteres Sexuais , Adamantano/análogos & derivados , Adamantano/farmacocinética , Adolescente , Adulto , Fatores Etários , Idoso , Encéfalo/diagnóstico por imagem , Radioisótopos de Carbono/farmacocinética , Emoções , Feminino , Histona Desacetilase 1/metabolismo , Histona Desacetilase 2/metabolismo , Humanos , Ácidos Hidroxâmicos/farmacocinética , Masculino , Pessoa de Meia-Idade , Doadores de Tecidos , Substância Branca/anatomia & histologia , Substância Branca/diagnóstico por imagem , Adulto Jovem
20.
BJOG ; 126(11): 1320-1326, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31215750

RESUMO

Absolute uterine factor infertility is the final hurdle for assisted reproductive treatments. Uterus transplant trials are happening worldwide; to advance the debate around uterine transplantation (UTx), this article considers selection criteria for clinical trials from a UK perspective and makes recommendations for future selection criteria for UTx treatment. Recommendations advanced include the use of donor eggs, access for single women and women in same-sex relationships, prohibiting participation of women who are already mothers, and a preference for deceased donors and bioengineered uteri. With UTx treatment on the horizon, it is important to proactively consider future selection criteria. TWEETABLE ABSTRACT: Review of UK selection criteria for clinical trials for uterus transplantation; recommendations for the future.


Assuntos
Imunossupressores/uso terapêutico , Infertilidade Feminina , Transplante de Órgãos/métodos , Seleção de Pacientes , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Útero/transplante , Adulto , Ensaios Clínicos como Assunto , Feminino , Humanos , Infertilidade Feminina/cirurgia , Transplante de Órgãos/ética , Seleção de Pacientes/ética , Suécia , Reino Unido , Adulto Jovem
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