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1.
Biochem Med (Zagreb) ; 30(1): 010502, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31839720

RESUMO

Extravascular body fluids (EBF) analysis can provide useful information in the differential diagnosis of conditions that caused their accumulation. Their unique nature and particular requirements accompanying EBF analysis need to be recognized in order to minimize possible negative implications on patient safety. This recommendation was prepared by the members of the Working group for extravascular body fluid samples (WG EBFS). It is designed to address the total testing process and clinical significance of tests used in EBF analysis. The recommendation begins with a chapter addressing validation of methods used in EBF analysis, and continues with specific recommendations for serous fluids analysis. It is organized in sections referring to the preanalytical, analytical and postanalytical phase with specific recommendations presented in boxes. Its main goal is to assist in the attainment of national harmonization of serous fluid analysis and ultimately improve patient safety and healthcare outcomes. This recommendation is intended to all laboratory professionals performing EBF analysis and healthcare professionals involved in EBF collection and processing. Cytological and microbiological evaluations of EBF are beyond the scope of this document.


Assuntos
Líquidos Corporais/química , Técnicas de Laboratório Clínico/normas , Líquidos Corporais/metabolismo , Exsudatos e Transudatos/química , Exsudatos e Transudatos/metabolismo , Guias como Assunto , Humanos , Segurança do Paciente , Derrame Pleural/diagnóstico , Garantia da Qualidade dos Cuidados de Saúde , Sociedades Médicas , Manejo de Espécimes/normas
2.
Medicine (Baltimore) ; 98(45): e17843, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702640

RESUMO

BACKGROUND: Acupuncture therapy is frequently used to treat Knee Osteoarthritis (KOA) in clinic, and usually used local acupoints near the diseased knees as therapeutic targets. Some local acupoints appeared sensitization phenomenon which was called sensitized acupoints, which were regarded as important therapeutic targets to get better therapeutic effect on clinic. Therefore, it is necessary to explore the biological basis of acupoint sensitization. Meanwhile, there is a lack of an analysis of the metabolism for sensitized acupoints in KOA patients. Considering that acupuncture effect could be multi-targeted, omics (such as metabolomics) may be a useful method to reveal the relationship between sensitized acupoints and clinical efficacy of acupuncture. METHODS AND ANALYSIS: This study is a parallel design trial. Thirty KOA patients and 30 healthy volunteers will be recruited in this study. Mechanical pain threshold will be measured by Electron Von frey in order to confirm the highest sensitized acupoints. Then collect tissue fluid from the highest sensitized acupoints by micro dialysis technical, then apply electro-acupuncture method on the highest sensitized acupoints to treat KOA patients, after 20 sessions treatments, measure and collect again. Liquid chromatography-tandem mass spectrometry method will be used to analyze the metabonomics of dialysate. RESULTS: This study will provide a high-quality evidence to reveal the local molecular mechanism of acupuncture sensitized acupoints for patient with KOA. CONCLUSION: This study will provide up-date evidence of whether acupuncture sensitized acupoints have local molecular mechanism for KOA. TRIAL REGISTRATION NUMBER: NCT03599180 (24 Jul. 2018).


Assuntos
Terapia por Acupuntura/métodos , Exsudatos e Transudatos/química , Metabolômica/métodos , Osteoartrite do Joelho/terapia , Pontos de Acupuntura , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Microdiálise , Pessoa de Meia-Idade , Osteoartrite do Joelho/metabolismo , Projetos Piloto
3.
Ecotoxicology ; 28(4): 429-434, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30904977

RESUMO

Root exudate autotoxicity (i.e. root exudates from a given plant have toxic effects on itself) has been recognized to be widespread. Here we examined how plant species identity and soil phosphorus (P) availability influenced this autotoxicity and the possible stoichiometric mechanisms. We conducted an experiment with three species (Luctuca sativa, Sesbania cannabina, and Solidago canadensis), which were subject to four treatments consisting of activated carbon (AC) and soil P. AC addition increased the whole-plant biomass of each species under high P conditions and this AC effect varied strongly with species identity. For Solidago, the relative increase in whole-plant biomass due to AC addition was larger in the low P than in the high P. Root exudate autotoxicity differed between roots and shoots. AC addition decreased root N:P ratios but failed to influence shoot N:P ratios in three species. These findings suggest that soil P enrichment might mediate root exudate autotoxicity and that this P-mediated autotoxicity might be related to root N and P stoichiometry. These patterns and their implications need to be addressed in the context of plant communities.


Assuntos
Exsudatos e Transudatos , Alface/efeitos dos fármacos , Fósforo/metabolismo , Raízes de Plantas/química , Sesbania/efeitos dos fármacos , Poluentes do Solo/metabolismo , Solidago/efeitos dos fármacos , Disponibilidade Biológica , Biomassa , Monitoramento Ambiental , Exsudatos e Transudatos/química , Alface/metabolismo , Raízes de Plantas/metabolismo , Sesbania/metabolismo , Solidago/metabolismo
4.
Pest Manag Sci ; 75(9): 2474-2481, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30828973

RESUMO

BACKGROUND: One of the roles of plant trichomes is thought to be reducing feeding damage from herbivores. Among trichomes, glandular trichomes play a role in chemical defense systems in plants by means of stored biologically active phytochemicals. These phytochemicals act as pest repellents. They show antimicrobial and insecticidal activities, and they have also been isolated and identified from wild plants. RESULTS: The Asteraceae species Heterotheca subaxillaris has many glandular trichomes on the leaf surface, and these contain sesquiterpene carboxylates, which show insect antifeedant activity. Because these sesquiterpene carboxylates are major constituents of glandular trichomes, they may act as a chemical defense in H. subaxillaris. The Orobanchaceae species Parentucellia viscosa also has many glandular trichomes on the leaf surface and produces an insect antifeedant clerodane-type diterpene, kolavenic acid, in these trichomes. Additionally, two other Orobanchaceae species, Bellardia trixago and Parentucellia latifolia, also have many glandular trichomes, but the constituents of these glandular trichomes did not show biological activities against test insects. However, the seco-labdane diterpene alcohol trixagol and its hemi-malonate were major constituents in B. trixago, and these terpenes may act as physical defenses against herbivores by interfering with feeding due to their viscosity. CONCLUSION: The secondary metabolites from glandular trichomes of H. subaxillaris and P. viscosa showed insect antifeedant activity, and these secondary metabolites were presumed to act as chemical defenses for these plant species. On the other hand, non-biologically active secondary metabolites produced by two other Orobanchaceae, B. trixago and P. latifolia, were presumed to act as physical defenses due to their viscosity. Defense systems such as these may be applicable to new crop breeding to enhance protection against insect pests. © 2019 Society of Chemical Industry.


Assuntos
Asteraceae/química , Agentes de Controle Biológico/farmacologia , Inseticidas/farmacologia , Orobanchaceae/química , Spodoptera/efeitos dos fármacos , Animais , Agentes de Controle Biológico/química , Exsudatos e Transudatos/química , Inseticidas/química , Larva/efeitos dos fármacos , Larva/crescimento & desenvolvimento , Folhas de Planta/química , Spodoptera/crescimento & desenvolvimento , Tricomas/química
5.
Stroke ; 50(2): 328-335, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30661497

RESUMO

Background and Purpose- Cerebral amyloid angiopathy (CAA) is a common small vessel disease that independently effects cognition in older individuals. The pathophysiology of CAA and CAA-related bleeding remains poorly understood. In this postmortem study, we explored whether blood-brain barrier leakage is associated with CAA and microvascular lesions. Methods- Eleven CAA cases (median [IQR] age=69 years [65-79 years], 8 males) and 7 cases without neurological disease or brain lesions (median [IQR] age=77 years [68-92 years], 4 males) were analyzed. Cortical sections were sampled from each lobe, and IgG and fibrin extravasation (markers of blood-brain barrier leakage) were assessed with immunohistochemistry. We hypothesized that IgG and fibrin extravasation would be increased in CAA cases compared with controls, that this would be more pronounced in parietooccipital brain regions compared with frontotemporal brain regions in parallel with the posterior predilection of CAA, and would be associated with CAA severity and number of cerebral microbleeds and cerebral microinfarcts counted on ex vivo magnetic resonance imaging of the intact brain hemisphere. Results- Our results demonstrated increased IgG positivity in the frontotemporal ( P=0.044) and parietooccipital ( P=0.001) cortex in CAA cases compared with controls. Within CAA cases, both fibrin and IgG positivity were increased in parietooccipital brain regions compared with frontotemporal brain regions ( P=0.005 and P=0.006, respectively). The percentage of positive vessels for fibrin and IgG was associated with the percentage of amyloid-ß-positive vessels (Spearman ρ=0.71, P=0.015 and Spearman ρ=0.73, P=0.011, respectively). Moreover, the percentage of fibrin and IgG-positive vessels, but not amyloid-ß-positive vessels, was associated with the number of cerebral microbleeds on magnetic resonance imaging (Spearman ρ=0.77, P=0.005 and Spearman ρ=0.70, P=0.017, respectively). Finally, we observed fibrin deposition in walls of vessels involved in cerebral microbleeds. Conclusions- Our results raise the possibility that blood-brain barrier leakage may be a contributory mechanism for CAA-related brain injury.


Assuntos
Barreira Hematoencefálica , Angiopatia Amiloide Cerebral/patologia , Idoso , Idoso de 80 Anos ou mais , Peptídeos beta-Amiloides/análise , Autopsia , Proteínas Sanguíneas/análise , Permeabilidade Capilar , Angiopatia Amiloide Cerebral/fisiopatologia , Córtex Cerebral/química , Exsudatos e Transudatos/química , Feminino , Fibrina/análise , Humanos , Imunoglobulina G/análise , Imagem por Ressonância Magnética , Masculino , Microvasos/patologia , Neuroimagem
6.
Int Wound J ; 16(2): 503-510, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30604928

RESUMO

In this study, we evaluated a new aspect of negative pressure wound therapy (NPWT) as an analytical tool for pharmacokinetic studies. Twenty-one patients with soft tissue defects scheduled to receive NPWT were included in this study. Concomitant to NPWT, all patients received intravenous moxifloxacin (MX). At different time intervals, blood plasma levels of MX were sampled and compared with synchronous concentrations of MX in the exudate obtained from the NPWT drainage system. Serial measurements were performed upon initiation of the therapy as well as in the steady state (after 5 days). At steady state, wound tissue was obtained intraoperatively. High-performance liquid-chromatography (HPLC) was used for analysis. At 1 hour post-administration, the exudate/plasma levels (mg/L) were 1.92/3.07; at 12 hours, 0.80/1.14; at 24 hours, 0.26/0.43; and at 120 hours (steady state), 0.42/0.47. There was a correlation between exudate and plasma levels reaching approximately 0.75. Until now, methods for pharmacokinetic studies concerning interstitial fluid are difficult to apply in the clinical context. The presented method showed limitations, but we believe that, after methodological improvements, measurements of substances in the interstitial fluid by means of NPWT are feasible.


Assuntos
Antibacterianos/análise , Antibacterianos/farmacocinética , Exsudatos e Transudatos/química , Moxifloxacina/análise , Moxifloxacina/farmacocinética , Tratamento de Ferimentos com Pressão Negativa/métodos , Ferimentos e Lesões/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Moxifloxacina/uso terapêutico , Cicatrização/fisiologia
8.
New Phytol ; 221(1): 503-514, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30040116

RESUMO

Phloem sap quality can differ between and within plants, and affect the performance of aphids. In turn, aphid infestation may change the chemical composition and nutritional value of phloem sap. However, the effects of different aphid species on the overall phloem sap composition of distinct parts within plant individuals in relation to aphid performance remain unclear. To test the specificity of plant responses to aphids, we used two chemotypes of Tanacetum vulgare plants and placed the monophagous aphids Macrosiphoniella tanacetaria and Uroleucon tanaceti on different plant parts (stems close to the inflorescence, young and old leaves). Aphid population growth was determined and sugars, organic acids, amino acids and metabolic fingerprints of phloem exudates were analysed. Macrosiphoniella tanacetaria performed best on stems, whereas U. tanaceti performed best on old leaves, indicating differences in niche conformance. Aphid infestation led to distinct changes in the phloem exudate composition of distinct metabolite classes, differing particularly between plant parts but less between chemotypes. In summary, plant responses to aphids are highly specific for the chemotype, plant part, metabolite class and aphid species. These changes may indicate that aphids construct their own niche, optimizing the food quality on the plant parts they prefer.


Assuntos
Afídeos/fisiologia , Herbivoria/fisiologia , Floema/química , Tanacetum/química , Tanacetum/fisiologia , Aminoácidos/análise , Animais , Exsudatos e Transudatos/química , Metaboloma , Floema/fisiologia , Folhas de Planta , Caules de Planta , Crescimento Demográfico , Especificidade da Espécie , Açúcares/análise
9.
J Wound Care ; 27(11): 724-734, 2018 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-30398935

RESUMO

OBJECTIVE: To compare matrix metalloproteinase (MMP)-9 and the antiproteinase tissue inhibitor of metalloproteinases (TIMP)-1 in wound fluids and sera from patients with chronic non-healing or acute healing wounds. In addition, the functional consequences on MMP-9 activity and general gelatinase activity were assessed. METHOD: In this observational study, samples were collected from patients with venous leg ulcers (VLUs), patients with type 2 diabetes with neuropathic foot ulcers (DFUs), and from another cohort of VLU patients with sterile split-thickness skin graft donor sites after autologous skin grafting, serving as healing control wounds. MMP-9 and TIMP-1 concentrations were determined by enzyme-linked immunosorbent assays. MMP-9 and gelatinase activities were determined in wound fluids in subsets of the patients. RESULTS: A total of 24 patients took part in the study. No significant differences in MMP-9 wound fluid levels were found among the three groups. TIMP-1 levels were markedly and significantly lower in the two chronic wound groups resulting in a severely unbalanced MMP-9/TIMP-1 ratio, especially notable in the VLU group and possibly in the elevated endogenous MMP-9 activity (p<0.01) compared with the acute wound fluids. At least 20% of the chronic wound fluids displayed atypical patterns on gelatin zymography and showed high general gelatinase activity that was not inhibited by either TIMP-1 or by a gelatinase inhibitor (AG3340). MMP-9 levels were higher in the sera of the patients with type 2 diabetes. CONCLUSION: We hypothesise that non-MMP proteinases contribute to matrix destruction in a significant number of chronic wounds. Blocking the excessive MMP-9 activity may be insufficient to normalise wound healing. The reasons and effects of the very low TIMP-1 levels in chronic wounds need further clarification.


Assuntos
Pé Diabético/metabolismo , Exsudatos e Transudatos/química , Gelatina/metabolismo , Metaloproteinase 9 da Matriz/sangue , Inibidor Tecidual de Metaloproteinase-1/sangue , Úlcera Varicosa/metabolismo , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Varicosa/fisiopatologia
10.
BMC Pulm Med ; 18(1): 176, 2018 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-30470216

RESUMO

BACKGROUND: We aimed to determine the presepsin concentration in pleural fluid from patients with pleural effusions of different aetiologies and to compare its diagnostic value with that of pleural fluid C-reactive protein (CRP) and procalcitonin (PCT). METHODS: We enrolled 132 patients with pleural effusion who underwent diagnostic evaluation, and we classified them into six categories: empyema, parapneumonic effusion, tuberculous effusion, malignant effusion, paramalignant effusion, and transudate effusion. Additionally, all pleural effusions were categorised as infectious or non-infectious effusions. RESULTS: Receiver operating characteristic analysis was used to evaluate diagnostic performance. When diagnosing empyema, the marker with the highest sensitivity was pleural fluid presepsin (cut-off: 754 pg/mL; sensitivity: 90.9%, specificity: 74.4%) and that with the highest specificity was pleural fluid CRP (cut-off: 4.91 mg/dL; sensitivity: 63.6%, specificity: 89.3%). Pleural fluid PCT tended to be lower in patients with empyema than in those with parapneumonic effusion, but this was not useful for the diagnosis of empyema. When diagnosing infectious pleural effusion, a combination of pleural fluid CRP (cut-off: 2.59 mg/dL) and presepsin (cut-off: 680 pg/mL) produced the highest diagnostic accuracy (83.3%). CONCLUSIONS: Pleural fluid presepsin was found at high levels in patients with empyema and parapneumonic effusion. This pattern closely resembles the previously reported pattern of pleural fluid CRP. Some combinations of pleural fluid inflammatory markers may be more clinically useful than these markers in isolation.


Assuntos
Proteína C-Reativa/análise , Exsudatos e Transudatos/química , Receptores de Lipopolissacarídeos/análise , Fragmentos de Peptídeos/análise , Derrame Pleural/etiologia , Pró-Calcitonina/análise , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Curva ROC
11.
Expert Rev Proteomics ; 15(12): 967-982, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30348024

RESUMO

INTRODUCTION: Metalloproteinases play key roles in health and disease, by generating novel proteoforms with variable structure and function. Areas covered: This review focuses on the role of endogenous [a Disintegrin and Metalloproteinase (ADAMs), ADAMs with thrombospondin motifs (ADAMTS), and matrix metalloproteinases (MMPs)] and exogenous metalloproteinases in various disease conditions, and describes the application of mass spectrometry-based proteomics to detect qualitative and quantitative changes in protein profiles in tissues and body fluids in disease. Emphasis is placed on the proteomic analysis of exudates collected from affected tissues, including methods that enrich newly generated protein fragments derived from proteolysis in cells, stroma, or extracellular matrix. The use of proteomic analysis of exudates in the study of the local tissue damage induced by metalloproteinases derived from viperid snake venoms is discussed, particularly in relation to extracellular matrix degradation and to the overall pathology of these envenomings. Expert commentary: The information provided by these proteomics approaches is paving the way for the identification of biomarkers based on particular proteolytic signatures associated with different pathologies. Together with other methodological approaches, a comprehensive view of the mechanisms and dynamics of diseases can be achieved. Such basis of knowledge allows for the design of novel diagnostic and therapeutic approaches within the frame of 'precision' or 'personalized' medicine.


Assuntos
Metaloproteases/análise , Técnicas de Diagnóstico Molecular/métodos , Proteômica/métodos , Mordeduras de Serpentes/metabolismo , Biomarcadores/análise , Biomarcadores/metabolismo , Exsudatos e Transudatos/química , Exsudatos e Transudatos/metabolismo , Humanos , Metaloproteases/metabolismo , Mordeduras de Serpentes/patologia
12.
Int J Mycobacteriol ; 7(3): 261-264, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30198507

RESUMO

Background: Pleural tuberculosis (TB) diagnosis is sometimes controversial because the microbiologic confirmation ratio is very low in pleural fluid. There are few pediatric pleural TB case series in the literature. Methods: We retrospectively evaluated our TB cases below 18 years of age and extracted pleural TB cases. Results: Seven cases with pleural TB were identified. About 42.9% of the patients had isolated pleural TB whereas 57.1% of the patients had accompanying pulmonary TB. Lymphocytic pleural effusion and increased adenosine deaminase (ADA) (>40 U/L) level are found in 85.7% of the patients. Six patients had uncomplicated effusion (transudate) according to Light's criteria and one had complicated effusion (exudate). Lung decortication was needed in three patients. All patients were given 6 months anti-TB medication and recovered completely. Conclusion: In the lymphocyte-predominant pleural effusion, an increased ADA level highly supported TB disease. The complicated effusion (exudate) in pleural TB is not rule; uncomplicated effusion (transudate) could be seen.


Assuntos
Adenosina Desaminase/análise , Derrame Pleural/microbiologia , Tuberculose Pleural/diagnóstico , Adolescente , Antituberculosos/uso terapêutico , Criança , Exsudatos e Transudatos/química , Exsudatos e Transudatos/citologia , Feminino , Humanos , Masculino , Derrame Pleural/imunologia , Radiografia , Estudos Retrospectivos , Tórax/diagnóstico por imagem , Resultado do Tratamento , Tuberculose Pleural/tratamento farmacológico
13.
BMJ Case Rep ; 20182018 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-29735508

RESUMO

We report the case of a 41-year-old woman who presented with a unilateral exudative effusion with prominent eosinophils on pleural cytology. Carbimazole had been started 4 weeks prior to presentation. No immediate cause was identified on imaging or laboratory testing. The effusion persisted at 2-month follow-up. Further investigation at this time, including autoimmune serology was negative. At 2-month follow-up, the effusion was loculated on ultrasound imaging and had a low fluid pH on diagnostic aspiration, in keeping with an empyema. The patient received treatment for pleural empyema, including antibiotics, intercostal drain insertion and video-assisted thoracoscopic pleural biopsy. Carbimazole was stopped, and following treatment for the empyema, the effusion did not reaccumulate.This case illustrates the diagnostic difficulties that pleural effusions may present. It demonstrates that drug reactions should be considered in the differential diagnosis following thorough investigation for other potential causes and also describes the complications that may occur.


Assuntos
Carbimazol/efeitos adversos , Empiema Pleural/patologia , Exsudatos e Transudatos/química , Pleura/patologia , Derrame Pleural/induzido quimicamente , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Antitireóideos/efeitos adversos , Diagnóstico Diferencial , Empiema Pleural/diagnóstico por imagem , Empiema Pleural/tratamento farmacológico , Empiema Pleural/cirurgia , Eosinófilos/citologia , Eosinófilos/patologia , Exsudatos e Transudatos/citologia , Exsudatos e Transudatos/microbiologia , Feminino , Humanos , Pleura/citologia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/microbiologia , Streptococcus oralis/isolamento & purificação , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos
14.
Khirurgiia (Mosk) ; (3. Vyp. 2): 39-42, 2018.
Artigo em Russo | MEDLINE | ID: mdl-29652321

RESUMO

AIM: To evaluate the effect of various methods of thoracoplasty on local production of cytokines in patients with pulmonary tuberculosis. MATERIAL AND METHODS: The main group consisted of patients after traditional thoracoplasty. Thoracoplasty was compared with endoprosthesis of polypropylene mesh 'Surgipro - SPMM-149'. TNF-α and IL-10 cytokines in exudate from surgical area were measured by using of solid-phase enzyme immunoassay (OOO 'Vector-Best', Russia). RESULTS: It was revealed that local production of pro- and anti-inflammatory cytokines is more pronounced after thoracoplasty with polypropylene mesh 'Surgipro - SPMM-149'. Local cytokine balance changes towards inflammation were more pronounced after thoracoplasty with mesh implant and did not depend on the degree of drug sensitivity.


Assuntos
Exsudatos e Transudatos/química , Interleucina-10/análise , Telas Cirúrgicas/efeitos adversos , Toracoplastia/efeitos adversos , Tuberculose Pulmonar/cirurgia , Fator de Necrose Tumoral alfa/análise , Materiais Biocompatíveis , Citocinas/análise , Humanos , Inflamação/imunologia , Polipropilenos , Toracoplastia/métodos
15.
CEN Case Rep ; 7(2): 189-194, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29572611

RESUMO

Refractory pleural effusion can be a life-threatening complication in patients receiving maintenance hemodialysis. We report successful treatment of refractory pleural effusion using a Denver® pleuroperitoneal shunt in one such patient. A 54-year-old Japanese man, who had previously undergone left nephrectomy, was admitted urgently to our department because of a high C-reactive protein (CRP) level, right pleural effusion, and right renal abscess. Because antibiotics proved ineffective and his general state was deteriorating, he underwent emergency insertion of a thoracic drainage tube and nephrectomy, and hemodialysis was started. Although his general state improved slowly thereafter, the pleural effusion, which was unilateral and transudative, remained refractory and therefore he needed to be on oxygenation. To control the massive pleural effusion, a pleuroperitoneal shunt was inserted. Thereafter, his respiratory condition became stable without oxygenation and he was discharged. His general condition has since been well. Although pleural effusion is a common complication of maintenance hemodialysis, few reports have documented the use of pleuroperitoneal shunt to control refractory pleural effusion. Pleuroperitoneal shunt has been advocated as an effective and low-morbidity treatment for refractory pleural effusion, and its use for some patients with recurrent pleural effusion has also been reported, without any severe complications. In the present case, pleuroperitoneal shunt improved the patient's quality of life sufficiently to allow him to be discharged home without oxygenation. Pleuroperitoneal shunt should be considered a useful treatment option for hemodialysis patients with refractory pleural effusion.


Assuntos
Drenagem/instrumentação , Rim/microbiologia , Cavidade Peritoneal/cirurgia , Derrame Pleural/cirurgia , Diálise Renal/efeitos adversos , Proteína C-Reativa/análise , Tubos Torácicos/normas , Exsudatos e Transudatos/química , Humanos , Rim/patologia , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Oxigenoterapia/métodos , Alta do Paciente , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/terapia , Resultado do Tratamento
16.
J Tissue Eng Regen Med ; 12(3): e1549-e1558, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28972309

RESUMO

Tissue engineering chamber (TEC) is a technique that could incubate up to 16 folds volume increase of a fat flap. But the mechanism in the silicone chamber was still unknown. The function of exudate in the chamber was noticed recently. We developed a special model called fluid drainage model (FDM) that consisted of a traditional TEC on the back and paired fat flaps without a chamber in the groins. Then we used a silicon tube to dynamically transfer the exudate from dorsal TEC to one of the paired inguinal fat flap and the other inguinal fat flap with a sham tube was set as control. At Week 4, the volume of drainage group reached 8.7 ± 2.3 ml, 576 ± 152% to its original volume whereas the growth ratio of control group was only 130 ± 39%. Similar volume change and histological change were observed within fat flap from TEC model and drainage group. The exudate in the TEC is a heterogeneous cocktail contains cytokines as well as cells. Intriguingly, transferred exudate in the TEC model sustain the ability to incubate large amount of adipose tissue remotely.


Assuntos
Tecido Adiposo/fisiologia , Exsudatos e Transudatos/química , Engenharia Tecidual/métodos , Animais , Citocinas/metabolismo , Drenagem , Feminino , Imagem Tridimensional , Antígeno Ki-67/metabolismo , Neovascularização Fisiológica , Coelhos , Retalhos Cirúrgicos , Microtomografia por Raio-X
18.
Eur J Intern Med ; 50: 60-64, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29157885

RESUMO

BACKGROUND: Light's criteria misclassify about 30% of cardiac effusions as exudates, possibly leading to unnecessary testing. Our purpose was to derive and validate a scoring model to effectively identify these falsely categorized cardiac effusions, in the setting of natriuretic peptide lacking data. METHODS: We retrospectively analyzed data from 3182 patients with exudative pleural effusions based on Light's criteria, of whom 276 had heart failure (derivation set). A scoring model was generated with those variables identified as independent predictors of cardiac effusions in a logistic regression analysis, and further evaluated in an independent population of 1165 patients. RESULTS: The score consisted of age ≥75years (3 points), albumin gradient >1.2g/dL (3 points), pleural fluid lactate dehydrogenase <250U/L (2 points), bilateral effusions on chest radiograph (2 points), and protein gradient >2.5g/dL (1 point). At the best cutoff of ≥7 points, the score yielded 92% diagnostic accuracy, a likelihood ratio positive of 12.7 and a likelihood ratio negative of 0.39 for labeling cardiac effusions in the derivation sample. The respective figures in the validation sample were 87%, 6.5 and 0.33. Notably, the score had higher discriminatory properties than protein and albumin gradients in both the derivation (respective area under the curve - AUC - of 0.925, 0.825, and 0.801) and validation (respective AUC of 0.908 0.862 and 0.802; all p≤0.01) cohorts. CONCLUSIONS: A simple scoring system can assist clinicians in accurately identifying false cardiac exudates when natriuretic peptides are not available.


Assuntos
Exsudatos e Transudatos/química , Insuficiência Cardíaca/complicações , Derrame Pleural/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , L-Lactato Desidrogenase/análise , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/etiologia , Valor Preditivo dos Testes , Proteínas/análise , Curva ROC , Estudos Retrospectivos
19.
Clin Respir J ; 12(2): 467-473, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27502152

RESUMO

INTRODUCTION: Growing evidence suggests a role of vitamin D in various cancers but the significance of vitamin D in malignant pleural disease remains unexplored. We sought to investigate the concentration and diagnostic role of 25-hydroxyvitamin D (25(OH)D) in malignant pleural effusions. MATERIALS AND METHODS: Prospective study of consecutive treatment-naïve patients with a new diagnosis of pleural effusion. RESULTS: Seventy-eight patients were studied, 45 of whom had malignant pleural effusions. Concentration of 25(OH)D in pleural fluid was significantly higher than serum in both malignant (15.2 ng/mL (9.7, 25.6) versus 10.2 ng/mL (6.4, 17.7), P < .001) and benign (11.4 ng/mL (8.4, 23.6) versus 7.9 (5.9, 16.1), P < .001) pleural disease. Pleural fluid 25(OH)D was almost significantly higher in exudates compared to transudates (P = .050) but it did not differ significantly between malignant and benign effusions (P = .217) and it was not diagnostic for malignant pleural disease (area under the ROC curve .58, 95% CI .45-.71). CONCLUSIONS: In subjects with unselected pleural effusions, 25(OH)D in pleural fluid was not diagnostic for malignant pleural disease. The novel finding of convincingly and consistently higher 25(OH)D in pleural fluid than serum suggests a role for vitamin D in pleural disease and merits further research.


Assuntos
Pleura/patologia , Doenças Pleurais/patologia , Derrame Pleural Maligno/patologia , Vitamina D/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Biomarcadores/química , Exsudatos e Transudatos/química , Exsudatos e Transudatos/metabolismo , Feminino , Grécia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pleura/química , Pleura/cirurgia , Doenças Pleurais/sangue , Doenças Pleurais/cirurgia , Derrame Pleural Maligno/sangue , Derrame Pleural Maligno/cirurgia , Estudos Prospectivos , Toracentese/métodos , Vitamina D/sangue
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