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1.
Handchir Mikrochir Plast Chir ; 53(3): 312-319, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-34134163

RESUMO

Necrotizing fasciitis (NF) is a soft tissue infection spreading along the fasciae to the surrounding subcutaneous fat, overlying skin and finally musculature, that may rapidly lead to septic shock and death. In order to avoid a massive systemic spread of the infective process, an immediate and extensive radical debridement of necrotic tissues is mandatory complemented by a broad spectrum intravenous antibiotic therapy. Nevertheless, mortality is persistently high at 20-40 %. Because of the lack of specific clinical features in the initial stage of the disease, it is often underestimated or confused with cellulitis or abscess. Hence, early diagnosis is missed or delayed in 85 %-100 % of cases with the passage of valuable time.The aim of this review is to give an overview of the clinical and laboratory elements to be considered for diagnosis as well as the essential therapeutic patterns.


Assuntos
Fasciite Necrosante , Abscesso , Antibacterianos/uso terapêutico , Desbridamento , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/cirurgia , Humanos , Necrose/tratamento farmacológico
2.
J Med Life ; 14(2): 284-286, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104254

RESUMO

We are reporting a case of spontaneous acute esophageal necrosis "black esophagus" of unclear etiology in a kidney transplant recipient. A patient with end-stage renal disease due to IgA nephropathy received a deceased-donor kidney transplant. The surgical procedure was uneventful, without hemodynamic instability. He was started on alemtuzumab for immunosuppression induction followed by maintenance immunosuppression with intravenous methylprednisolone for 3 days, then oral prednisone, mycophenolate mofetil and tacrolimus (a target level between 8 and 10ng/ml) daily. On postoperative day (POD) 3, the patient started to develop significant gastro-intestinal symptoms: epigastric pain, dysphagia, odynophagia, eructation, pyrosis, nausea, and regurgitation of food contents. He was diagnosed with esophageal necrosis by upper endoscopy on postoperative day 4. We describe a successful treatment with supportive therapy and complete recovery despite receiving immunosuppressive therapy. To our knowledge, this case is one of the few reported cases of esophageal necrosis in kidney transplant recipients and the first case that was not associated with clinical risk factors.


Assuntos
Esôfago/patologia , Transplante de Rim/efeitos adversos , Doença Aguda , Humanos , Imunossupressores/efeitos adversos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Necrose , Tacrolimo/uso terapêutico
3.
Toxins (Basel) ; 13(5)2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-34067062

RESUMO

Local tissue swelling, inflammation, and wound necrosis are observed in Taiwan cobra bites. Knowledge of the factors influencing local tissue necrosis after cobra bites might improve the cobra bite treatment strategy. Therefore, we aimed to explore the factors influencing local tissue necrosis after cobra bites. This was a retrospective observational cohort study. All patients clinical presentations including serum venom levels for determining the influential factors in this study were obtained from Hung et al.'s previous study. Clinical features, such as bite information, initial swelling, patient presentation time, serum venom levels, and antivenom, use were extracted. The measurement outcome was the development of wound necrosis. The factors influencing wound necrosis were investigated using univariate and logistic regression analyses. The influential factors of local tissue necrosis and their areas under the curve were: initial limb swelling, 0.88; presentation time × serum level, 0.80; initial necrosis, 0.75; patient presentation time, 0.70. Serum venom level alone cannot be used as a predictive factor. The development of tissue necrosis might be associated with the venom factor, time factor, and their interaction. These influential factors can be used in future studies to evaluate antivenom efficacy.


Assuntos
Antivenenos/administração & dosagem , Venenos Elapídicos/toxicidade , Mordeduras de Serpentes/complicações , Adulto , Animais , Estudos de Coortes , Elapidae , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Estudos Retrospectivos , Mordeduras de Serpentes/patologia , Mordeduras de Serpentes/terapia , Taiwan
4.
Nat Commun ; 12(1): 3364, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099649

RESUMO

Necroptosis is a lytic, inflammatory form of cell death that not only contributes to pathogen clearance but can also lead to disease pathogenesis. Necroptosis is triggered by RIPK3-mediated phosphorylation of MLKL, which is thought to initiate MLKL oligomerisation, membrane translocation and membrane rupture, although the precise mechanism is incompletely understood. Here, we show that K63-linked ubiquitin chains are attached to MLKL during necroptosis and that ubiquitylation of MLKL at K219 significantly contributes to the cytotoxic potential of phosphorylated MLKL. The K219R MLKL mutation protects animals from necroptosis-induced skin damage and renders cells resistant to pathogen-induced necroptosis. Mechanistically, we show that ubiquitylation of MLKL at K219 is required for higher-order assembly of MLKL at membranes, facilitating its rupture and necroptosis. We demonstrate that K219 ubiquitylation licenses MLKL activity to induce lytic cell death, suggesting that necroptotic clearance of pathogens as well as MLKL-dependent pathologies are influenced by the ubiquitin-signalling system.


Assuntos
Infecções por Herpesviridae/metabolismo , Lisina/metabolismo , Proteínas Quinases/metabolismo , Pele/metabolismo , Animais , Linhagem Celular , Células Cultivadas , Células HEK293 , Células HT29 , Infecções por Herpesviridae/genética , Infecções por Herpesviridae/virologia , Humanos , Lisina/genética , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Muromegalovirus/fisiologia , Células NIH 3T3 , Necroptose/genética , Necrose , Proteínas Quinases/genética , Pele/patologia , Ubiquitinação
5.
BMJ Case Rep ; 14(6)2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: covidwho-1255540

RESUMO

At the outset of the pandemic, SARS-CoV-2 was thought to present simply as persistent cough and fever. However, with time, the medical community noted a myriad of associated symptoms well-described in the literature. Medical complications were particularly common in elderly populations and many early publications described pneumonia, organ failure, acute respiratory distress syndrome, hypercoagulability/microthrombosis and superimposed bacterial/viral infections. There is, however, a lack of literature describing surgical complications of COVID-19 and as such little knowledge regarding safe surgical interventions. This case describes the presentation/management of a patient who developed COVID-19-associated necrotising pneumonia. Video-assisted thoracoscopy lobectomy was performed following CT demonstration of necrotising pneumonia. Pathological evaluation of the surgical resection specimen demonstrated the microarchitecture of a severely diseased COVID-19 lung-fibrosis. This case demonstrates the safe management of a necrotic lung using a minimal access approach in the context of COVID-19 infection.


Assuntos
COVID-19 , Pneumonia , Idoso , Humanos , Necrose , Pandemias , SARS-CoV-2
6.
Ecotoxicol Environ Saf ; 221: 112423, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34146985

RESUMO

Tetrabromodiphenyl ether (BDE-47) is widely used as commercial flame retardants that can be released into the environment and finally enter human body through the food chain. It has been identified to generate neurotoxicity, but little is known about auditory damage and the underlying mechanism following BDE-47 exposure. This study aimed to assess the cell viability with BDE-47 concentration ranging from 0 to 150 µM in mouse organ of Corti-derived cell lines (HEI-OC1). Aryl hydrocarbon receptor (AhR) as an environmental sensor, reactive oxygen species (ROS), NLRP3 inflammasome and p38 MAPK pathways were detected. Results: (1) BDE-47 inhibited the viability in a time- and dose-dependent way in HEI-OC1 cells. Cell cycle was arrested in G1 phase by BDE-47; (2) Elevated intracellular ROS, LDH levels and necrosis were found, which was alleviated by pretreatment with ROS scavenger N-acetylcysteine (NAC); (3) AhR plays an essential role in ligand-regulated transcription factor activation by exogenous environmental compounds. We found increased expression of AhR and decreased downstream targets of CYP 1A1 and CYP 1B1 in BDE-47-treated HEI-OC1 cells, which was reversed by the AhR antagonist CH-223191 for 2 h before BDE-47 exposure. No significant change was detected in CYP 2B; (4) Enhanced expressions of NLRP3 and caspase-1 were induced by BDE-47, with up-regulations of both pro-inflammatory factors for IL-1ß, IL-6 and TNF-α, and anti-inflammatory factors for IL-4, IL-10 and IL-13, but down-regulation for IL-1α; (5) Additionally, the p38 MAPK signaling pathway was activated with increased phosphorylation levels of MKK/3/6, p38 MAPK and NF-kB. Overall, our findings illustrate a role of AhR in ROS-induced necrosis of cochlear hair cells by BDE-47 exposure, in which NLRP3 inflammasome and p38 MAPK signaling pathways are activated. The current study first elucidates the sense of hearing damage induced by BDE-47, and cell-specific or mixture exposures in vivo or human studies are needed to confirm this association.


Assuntos
Retardadores de Chama/toxicidade , Células Ciliadas Auditivas/efeitos dos fármacos , Éteres Difenil Halogenados/toxicidade , Animais , Fatores de Transcrição Hélice-Alça-Hélice Básicos/metabolismo , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Citocinas/metabolismo , Células Ciliadas Auditivas/metabolismo , Células Ciliadas Auditivas/patologia , Inflamassomos/metabolismo , Camundongos , Proteína 3 que Contém Domínio de Pirina da Família NLR , Necrose/induzido quimicamente , Necrose/metabolismo , Necrose/patologia , Espécies Reativas de Oxigênio/metabolismo , Receptores de Hidrocarboneto Arílico/metabolismo , Transdução de Sinais/efeitos dos fármacos , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
7.
J Trauma Acute Care Surg ; 91(1): 241-246, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1276289

RESUMO

BACKGROUND: During the coronavirus disease 2019 pandemic, New York instituted a statewide stay-at-home mandate to lower viral transmission. While public health guidelines advised continued provision of timely care for patients, disruption of safety-net health care and public fear have been proposed to be related to indirect deaths because of delays in presentation. We hypothesized that admissions for emergency general surgery (EGS) diagnoses would decrease during the pandemic and that mortality for these patients would increase. METHODS: A multicenter observational study comparing EGS admissions from January to May 2020 to 2018 and 2019 across 11 NYC hospitals in the largest public health care system in the United States was performed. Emergency general surgery diagnoses were defined using International Classification Diseases, Tenth Revision, codes and grouped into seven common diagnosis categories: appendicitis, cholecystitis, small/large bowel, peptic ulcer disease, groin hernia, ventral hernia, and necrotizing soft tissue infection. Baseline demographics were compared including age, race/ethnicity, and payor status. Outcomes included coronavirus disease (COVID) status and mortality. RESULTS: A total of 1,376 patients were admitted for EGS diagnoses from January to May 2020, a decrease compared with both 2018 (1,789) and 2019 (1,668) (p < 0.0001). This drop was most notable after the stay-at-home mandate (March 22, 2020; week 12). From March to May 2020, 3.3%, 19.2%, and 6.0% of EGS admissions were incidentally COVID positive, respectively. Mortality increased in March to May 2020 compared with 2019 (2.2% vs. 0.7%); this difference was statistically significant between April 2020 and April 2019 (4.1% vs. 0.9%, p = 0.045). CONCLUSION: Supporting our hypothesis, the coronavirus disease 2019 pandemic and subsequent stay-at-home mandate resulted in decreased EGS admissions between March and May 2020 compared with prior years. During this time, there was also a statistically significant increase in mortality, which peaked at the height of COVID infection rates in our population. LEVEL OF EVIDENCE: Epidemiological, level IV.


Assuntos
COVID-19/prevenção & controle , Emergências/epidemiologia , Mortalidade Hospitalar/tendências , Admissão do Paciente/estatística & dados numéricos , Doença Aguda/mortalidade , Doença Aguda/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicite/diagnóstico , Apendicite/mortalidade , Apendicite/cirurgia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/transmissão , Colecistite/diagnóstico , Colecistite/mortalidade , Colecistite/cirurgia , Serviço Hospitalar de Emergência , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/mortalidade , Hérnia Inguinal/cirurgia , Hérnia Ventral/diagnóstico , Hérnia Ventral/mortalidade , Hérnia Ventral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/mortalidade , Necrose/cirurgia , New York/epidemiologia , Pandemias/prevenção & controle , Admissão do Paciente/tendências , Úlcera Péptica/diagnóstico , Úlcera Péptica/mortalidade , Úlcera Péptica/cirurgia , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/mortalidade , Infecções dos Tecidos Moles/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Tempo para o Tratamento/tendências , Adulto Jovem
8.
Am J Case Rep ; 22: e928394, 2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34181635

RESUMO

BACKGROUND Esophageal necrosis is a rare entity characterized by the presence of extensive circumferential necrosis of the esophagus. It generally affects older adults who have associated chronic pathologies and has a reported mortality rate of approximately 32%. Most patients with esophageal necrosis have a complex clinical course. CASE REPORT We present the case of a 37-year-old man with idiopathic chronic renal failure who presented to the Emergency Department with sudden esophageal necrosis and mediastinitis, associated with invasive candidiasis. Diagnosis was challenging owing to the rarity of the condition. The patient required intensive care management and multiple surgical procedures. CONCLUSIONS Esophageal necrosis is an uncommon pathology that can be fatal because of associated complications. Its pathophysiology is unclear, and its treatment is based on the control of local injury and signs and symptoms. Acute esophageal necrosis associated with invasive Candida sp. infection is even more infrequent, with only a few cases reported in the literature.


Assuntos
Candidíase Invasiva , Mediastinite , Adulto , Idoso , Candidíase Invasiva/complicações , Candidíase Invasiva/diagnóstico , Esôfago , Humanos , Masculino , Mediastinite/diagnóstico , Necrose
9.
J Int Med Res ; 49(6): 3000605211020697, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34187211

RESUMO

Persistent bleeding from the remaining cervix after laparoscopic supracervical hysterectomy (LSH) is normally related to the presence of residual functioning endometrial tissue. However, postoperative significant vaginal hemorrhage caused by cervical necrosis following LSH is relatively rare. A 39-year-old nulligravida was admitted to the emergency department with hypovolemic shock after LSH performed in another hospital for treatment of uterine fibroids 18 days previously. Following hemodynamic stabilization and mechanical tamponade of the bleeding uterine cervix, laparoscopic simple trachelectomy was carried out and antibiotics were administered. The patient developed no surgical or clinical complications and was discharged 4 days after surgery. Histologic examination revealed extensive areas of tissue necrosis and no signs of malignancy. Stump necrosis and accompanying bleeding are rare but serious complications of LSH. Infection is an important component of this entity and should be treated. Endoscopic management of this condition appears to be feasible and safe.


Assuntos
Histerectomia , Laparoscopia , Adulto , Feminino , Humanos , Histerectomia/efeitos adversos , Necrose , Resultado do Tratamento , Hemorragia Uterina/cirurgia
10.
Molecules ; 26(9)2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-34062818

RESUMO

Salivary gland stem cells (SGSCs) are potential cell sources for the treatment of salivary gland diseases. The control of cell survival is an essential factor for applying stem cells to regenerative medicine or stem cell-based research. The purpose of this study was to investigate the effects of the ROCK inhibitor Y-27632 on the survival of SGSCs and its underlying mechanisms. SGSCs were isolated from mouse submandibular glands and cultured in suspension. Treatment with Y-27632 restored the viability of SGSCs that was significantly decreased during isolation and the subsequent culture. Y-27632 upregulated the expression of anti-apoptotic protein BCL-2 in SGSCs and, in the apoptosis assay, significantly reduced apoptotic and necrotic cell populations. Matrigel was used to mimic the extracellular environment of an intact salivary gland. The expression of genes regulating apoptosis and the ROCK signaling pathway was significantly reduced when SGSCs were embedded in Matrigel. SGSCs cultured in Matrigel and treated with Y-27632 showed no difference in the total numbers of spheroids and expression levels of apoptosis-regulating genes. Matrigel-embedded SGSCs treated with Y-27632 increased the number of spheroids with budding structures and the expression of acinar cell-specific marker AQP5. We demonstrate the protective effects of Y-27632 against dissociation-induced apoptosis of SGSCs during their culture in vitro.


Assuntos
Amidas/farmacologia , Piridinas/farmacologia , Glândulas Salivares/efeitos dos fármacos , Quinases Associadas a rho/antagonistas & inibidores , Animais , Apoptose , Morte Celular , Sobrevivência Celular , Células Cultivadas , Colágeno/química , Combinação de Medicamentos , Matriz Extracelular/metabolismo , Feminino , Laminina/química , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos DBA , Necrose , Proteoglicanas/química , Esferoides Celulares , Células-Tronco/citologia , Glândula Submandibular/efeitos dos fármacos
11.
J Zoo Wildl Med ; 52(2): 853-857, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34130436

RESUMO

Cardiac disease is of importance in captive chimpanzee (Pan troglodytes) health. Here we report an eosinophilic and necrotizing myocarditis in a 17-y-old chimpanzee with no previous history of cardiac disease that progressed to death within 48 h. Toxic and infectious causes were ruled out. The chimpanzee had eosinophilia at different occasions in previous years. The animal had a severe, diffuse, and acute monophasic necrotizing myocarditis, with a moderate lymphoplasmacytic infiltrate that was rich in eosinophils. Ante- and postmortem investigations are compatible with an unusual eosinophilic myocarditis with clinical evolution and morphology comparable with human eosinophilic myocarditis secondary to hypereosinophilic syndrome.


Assuntos
Doenças dos Símios Antropoides/patologia , Eosinofilia/veterinária , Miocardite/veterinária , Miocárdio/patologia , Pan troglodytes , Animais , Eosinofilia/patologia , Evolução Fatal , Masculino , Miocardite/patologia , Necrose/patologia , Necrose/veterinária
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(6): 750-755, 2021 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-34142503

RESUMO

Objective: To investigate whether the technical modifications regarding the risk factors related to the partial necrosis of the distally pedicled sural flap could reduce the partial necrosis rate of the flap. Methods: A clinical data of 254 patients (256 sites) (modified group), who used modified technique to design and cut distally pedicled sural flaps to repair the distal soft tissue defects of the lower limbs between April 2010 and December 2019, was retrospectively analyzed. Between April 2001 and March 2010, 175 patients (179 sites) (control group) who used the traditional method to design and cut the skin flap to repair the distal soft tissue defects of the lower limbs were compared. Various technical modifications were used to lower the top-edge of the flap, reduce the length-width ratio (LWR) of the flap and width of the skin island. There was no significant difference in gender, age, etiology, duration from injury to operation, site and area of the soft tissue defect between groups ( P>0.05). The length and width of the skin island and adipofascial pedicle, the total length of the flap and LWR, and the pivot point position were measured and recorded. The top-edge of the flap was determined according to the division of 9 zones in the posterior aspect of the lower limb. The occurrence of partial necrosis of the flap and the success rate of defect reconstruction were observed postoperatively. Results: There was no significant difference in the length and width of the skin island, the length of the adipofascial pedicle, total length and LWR of the flap, and pivot point position of the flap between groups ( P>0.05). The width of the adipofasical pedicle in modified group was significant higher than that in control group ( t=-2.019, P=0.044). The top-edge of 32 flaps (17.88%) in control group and 31 flaps (12.11%) in modified group were located at the 9th zone; the constituent ratio of the LWR more than 5∶1 in modified group (42.58%, 109/256) was higher than that in control group (42.46%, 76/179); and the constituent ratio of width of skin island more than 8 cm in control group (59.78%, 107/179) was higher than that in modified group (57.42%, 147/256). There was no significant difference in the above indicators between groups ( P>0.05). In control group, 155 flaps (86.59%) survived completely, 24 flaps (13.41%) exhibited partial necrosis. Among them, 21 wounds healed after symptomatic treatments, 3 cases were amputated. The success rate of defects reconstruction was 98.32% (176/179). In modified group, 241 flaps (94.14%) survived completely, 15 flaps (5.86%) exhibited partial necrosis. Among them, 14 wounds healed after symptomatic treatments, 1 case was amputated. The success rate of defect reconstruction was 99.61% (255/256). The partial necrosis rate in modified group was significantly lower than that in control group ( χ 2=7.354, P=0.007). There was no significant difference in the success rate between the two groups ( P=0.310). All patients in both groups were followed up 1 to 131 months (median, 9.5 months). All wounds in the donor and recipient sites healed well. Conclusion: The partial necrosis rate of the distally based sural flap can be decreased effectively by applying personalized modified technical for specific patients.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Humanos , Necrose , Estudos Retrospectivos , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento
13.
J Wound Care ; 30(6): 465-468, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34121440

RESUMO

This case report describes the progressive wound infection in the left thigh of a 34-year-old man due to an old landmine explosion. The infection developed into rapidly spreading skin and soft tissue necrotising Saksenaea infection, despite antifungal therapy and surgical debridement. The report provides evidence that Saksenaea spp. should be added to the list of mucoralean fungi that can cause severe necrotising infection. It also highlights the need for improved early diagnostic procedures and enhanced understanding of Saksenaea virulence factors that contribute to necrotising infection.


Assuntos
Mucorales/isolamento & purificação , Mucormicose/diagnóstico , Necrose , Infecção dos Ferimentos , Adulto , Antifúngicos/uso terapêutico , Dermatomicoses/diagnóstico , Dermatomicoses/tratamento farmacológico , Evolução Fatal , Humanos , Masculino , Infecção dos Ferimentos/tratamento farmacológico
14.
BMJ Case Rep ; 14(6)2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34083188

RESUMO

At the outset of the pandemic, SARS-CoV-2 was thought to present simply as persistent cough and fever. However, with time, the medical community noted a myriad of associated symptoms well-described in the literature. Medical complications were particularly common in elderly populations and many early publications described pneumonia, organ failure, acute respiratory distress syndrome, hypercoagulability/microthrombosis and superimposed bacterial/viral infections. There is, however, a lack of literature describing surgical complications of COVID-19 and as such little knowledge regarding safe surgical interventions. This case describes the presentation/management of a patient who developed COVID-19-associated necrotising pneumonia. Video-assisted thoracoscopy lobectomy was performed following CT demonstration of necrotising pneumonia. Pathological evaluation of the surgical resection specimen demonstrated the microarchitecture of a severely diseased COVID-19 lung-fibrosis. This case demonstrates the safe management of a necrotic lung using a minimal access approach in the context of COVID-19 infection.


Assuntos
COVID-19 , Pneumonia , Idoso , Humanos , Necrose , Pandemias , SARS-CoV-2
15.
Radiologe ; 61(6): 532-540, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-34061214

RESUMO

CLINICAL PROBLEM: Imaging plays a major role to differentiate interstitial edematous from necrotic pancreatitis and to describe relevant local complications for proper patient management and decision-making in acute pancreatitis. STANDARD RADIOLOGICAL PROCEDURES: The revised Atlanta classification 2012 of acute pancreatitis divides patients into mild, moderately severe and severe groups. Computed tomography (CT) and magnetic resonance imaging (MRI) are well established for diagnosis and follow-up of acute pancreatitis and its complications METHODOLOGICAL INNOVATIONS AND ASSESSMENT: Based on the revised Atlanta classification, CT and MRI allow for adequate categorization of interstitial edematous and necrotic pancreatitis. Imaging and standardized reporting nomenclature enable confident differentiation of early and late complications in acute pancreatitis. RECOMMENDATIONS: The aim of this review article is to present an image-rich overview of different morphologic characteristics of acute pancreatitis and associated local complications by CT or MRI using case examples.


Assuntos
Pancreatite , Doença Aguda , Humanos , Imageamento por Ressonância Magnética , Necrose , Pancreatite/diagnóstico por imagem , Tomografia Computadorizada por Raios X
16.
Int J Mol Sci ; 22(10)2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-34068110

RESUMO

The aim of the study was to investigate the anticancer potential of LY294002 (PI3K inhibitor) and temozolomide using glioblastoma multiforme (T98G) and anaplastic astrocytoma (MOGGCCM) cells. Apoptosis, autophagy, necrosis, and granules in the cytoplasm were identified microscopically (fluorescence and electron microscopes). The mitochondrial membrane potential was studied by flow cytometry. The activity of caspases 3, 8, and 9 and Akt was evaluated fluorometrically, while the expression of Beclin 1, PI3K, Akt, mTOR, caspase 12, and Hsp27 was determined by immunoblotting. SiRNA was used to block Hsp27 and PI3K expression. Cell migration and localization of Hsp27 were tested with the wound healing assay and immunocytochemistry, respectively. LY294002 effectively diminished the migratory potential and increased programmed death of T98G and MOGGCCM. Autophagy was dominant in MOGGCCM, while apoptosis was dominant in T98G. LY294002 with temozolomide did not potentiate cell death but redirected autophagy toward apoptosis, which was correlated with ER stress. A similar effect was observed after blocking PI3K expression with siRNA. Transfection with Hsp27 siRNA significantly increased apoptosis related to ER stress. Our results indicate that inhibition of the PI3K/Akt/mTOR pathway sensitizes glioma cells to apoptosis upon temozolomide treatment, which was correlated with ER stress. Hsp27 increases the resistance of glioma cells to cell death upon temozolomide treatment.


Assuntos
Biomarcadores Tumorais/metabolismo , Cromonas/farmacologia , Resistencia a Medicamentos Antineoplásicos/genética , Regulação Neoplásica da Expressão Gênica , Glioblastoma/tratamento farmacológico , Morfolinas/farmacologia , Fosfatidilinositol 3-Quinases/metabolismo , Temozolomida/farmacologia , Antineoplásicos Alquilantes/farmacologia , Apoptose , Biomarcadores Tumorais/genética , Proliferação de Células , Inibidores Enzimáticos/farmacologia , Glioblastoma/genética , Glioblastoma/metabolismo , Glioblastoma/patologia , Humanos , Potencial da Membrana Mitocondrial , Necrose , Fosfatidilinositol 3-Quinases/química , Fosfatidilinositol 3-Quinases/genética , Células Tumorais Cultivadas
17.
BMC Ophthalmol ; 21(1): 257, 2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112120

RESUMO

BACKGROUND: We report a case of chronic retinal necrosis (CRN) combined with cytomegalovirus (CMV) corneal endotheliitis. CASE PRESENTATION: An 80-year old man was diagnosed with CRN that developed after tube shunt surgery with vitrectomy for secondary glaucoma associated with CMV corneal endotheliitis. After the use of oral valganciclovir and panretinal photocoagulation, the retinal lesion resolved rapidly and he has maintained visual acuity better than before the onset of CRN. CONCLUSIONS: Use of oral valganciclovir, prophylactic panretinal photocoagulation for the non- perfusion area and vitrectomy were effective in maintaining the visual acuity for the patient with CRN.


Assuntos
Infecções por Citomegalovirus , Infecções Oculares Virais , Glaucoma , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Humor Aquoso , Citomegalovirus/genética , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/tratamento farmacológico , DNA Viral , Epitélio Posterior , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/tratamento farmacológico , Ganciclovir/uso terapêutico , Glaucoma/tratamento farmacológico , Glaucoma/cirurgia , Humanos , Masculino , Necrose/tratamento farmacológico
18.
Molecules ; 26(10)2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-34068314

RESUMO

The Myrteacae family is known as a rich source of phloroglucinols, a group of secondary metabolites with notable biological activities. Leaves of Psidium cattleianum were extracted with chloroform: methanol 8:2 to target the isolation of phloroglucinol derivatives. Isolated compounds were characterized using different spectroscopic methods: nuclear magnetic resonance (NMR), ultra-violet (UV) and mass spectrometry (MS). Two new phloroglucinols were evaluated for cytotoxicity against a panel of six human cancer cell lines, namely colorectal adenocarcinoma cells (HT-29 and HCT-116); hepatocellular carcinoma cells (HepG-2); laryngeal carcinoma (Hep-2); breast adenocarcinoma cells (MCF7 and MDA-MB231), in addition to normal human melanocytes HFB-4. Additionally, cell cycle analysis and annexin-V/FITC-staining were used to gain insights into the mechanism of action of the isolated compounds. The new phloroglucinol meroterpenoids, designated cattleianal and cattleianone, showed selective antiproliferative action against HT-29 cells with IC50's of 35.2 and 32.1 µM, respectively. Results obtained using cell cycle analysis and annexin-V/FITC-staining implicated both necrosis and apoptosis pathways in the selective cytotoxicity of cattleianal and cattleianone. Our findings suggest that both compounds are selective antiproliferative agents and support further mechanistic studies for phloroglucinol meroterpenoids as scaffolds for developing new selective chemotherapeutic agents.


Assuntos
Carcinoma/patologia , Folhas de Planta/química , Psidium/química , Terpenos/farmacologia , Apoptose/efeitos dos fármacos , Ciclo Celular/efeitos dos fármacos , Morte Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Humanos , Concentração Inibidora 50 , Necrose , Terpenos/isolamento & purificação
19.
Zhonghua Wai Ke Za Zhi ; 59(6): 470-476, 2021 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-34102730

RESUMO

Object To examine the preliminary clinical efficacy of custom-made three-dimensional(3D) printed talus prosthesis in the treatment of collapse talus necrosis. Methods: The clinical data of 8 patients who received 3D printed custom-made talus prostheses replacement for severe collapsed necrosis of the talus at the Orthopaedic Sports Medical Center, the First Affiliated Hospital to Army Medical University were analyzed retrospectively.All patients were male,with an average age of 38.0 years (range:22 to 65 years).There were 5 cases of left talus collapse and 3 cases of right talus collapse,with the course of disease of 29.7 weeks (range:6 to 96 weeks).The CT data of contralateral healthy talus were used for mirror image design references for the prosthesis,and the electron-beam 3D printing technology was used to prepare the prosthesis.Titanium alloy (Ti6Al4V) was taken as the material for the preparation of the talus body prosthesis,and Co-Cr-Mo material was used as the material for the preparation of the tibialis talus lateral joint surface prosthesis,and the subtalar joint surface of the prosthesis was made from a microporous casting technique.The prosthesis was analyzed preoperatively by digital three-dimensional finite element analysis and solid comparison techniques to measure anatomic match of the prosthesis.A longitudinal incision on medial ankle was made.The necrotic talus was completely removed and the prosthesis was then implanted.The patient was reexamined in the outpatient department 3, 6, and 12 months after surgery.Primary outcome measures were the American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hind foot score,visual analogue scale(VAS) and ankle range of motion.Changes in imaging data and plantar pressure were also assessed.Repeated measures analysis of variance and paired-t test were used to compare the data. Results: The talus prosthesis measure preoperatively was completely consistent with that contralateral healthy talus and there was no operation-related complication. All the wounds healed primarily. The patients were followed up effectively for 23.17 months (range:12 to 48 months).The preoperative dorsiflexion of patients was (7.6±5.7)°,it increased to(14.2±6.6)° at 12 month after surgery (t=-2.67,P=0.03).The plantar flexion increased from (22.0±9.9)°preoperatively to (29.2±8.7)° at 12 month after surgery (t=-8.95,P<0.01).Preoperative AOFAS ankle-hind foot score was 26.3±6.6,and it increased to 70.1±2.2,76.0±3.4 and 79.3±4.2 at 3 month,6 month and 12 month after surgery(F=56.81,P<0.01);Pre-operative VAS was[M(QR)]3.0(0.8),and it increased to 2.5(1.0),1.5(1.0),1.0(1.0)at 3 month,6 month and 12 month after surgery(F=20.00,P<0.01).At the last follow-up,imaging reexamination showed that the prosthesis of all patients were in stable position with no sign of subsidence.No secondary ankle fusion or revision was required.The talus height increased from (27.6±6.0)mm preoperatively to (34.6±3.5)mm (t=-2.94,P<0.01).The plantar pressure showed that the maximum pressure on the healthy ankle was(629.9±26.1)N,and that on the affected side was(521.4±14.4)N.The pressure on the healthy ankle was(350.6±29.6)N,and that on the necrotic side was (212.3±9.7)N.The load on the contralateral forefoot was(38.1±2.8)% and that on the necrotic side was(11.5±2.0)%.The load on the contralateral hindfoot was (24.6±2.5)% and that on the necrotic side was (21.1±1.8)%. Conclusions: The custom-made 3D printed talus prosthesis could restore the talus anatomy,recover the ankle joint function,relieve the pain of patients and improve the life quality of patients.The effect on plantar pressure is mainly achieved by adjusting the center of gravity of plantar pressure backwards and the increase of weight bearing of the healthy foot.


Assuntos
Tálus , Articulação do Tornozelo , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Necrose , Impressão Tridimensional , Próteses e Implantes , Estudos Retrospectivos , Tálus/cirurgia , Resultado do Tratamento
20.
Molecules ; 26(9)2021 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-34066903

RESUMO

The effect of effective microorganisms (EM) on internal organ morphology, intestinal morphometry, and serum biochemical activity in Japanese quails under Clostridium perfringens challenge was determined. After 30 days of EM addition, one group of quails was orally inoculated with Clostridium perfringens. The second group did not receive EM and was inoculated with C. perfringens. In the gut, EM supplementation reduced the number of lesions, enhanced gut health, and protected the mucosa from pathogenic bacteria. EM showed an anti-inflammatory effect and fewer necrotic lesions in villi. In the internal organs, EM showed a protective effect against a typical lesion of C. perfringens infection. Necrosis and degeneration of the hepatocytes, necrosis of bile ducts, and bile duct proliferation were more severe in the infected group without EM. Morphometric evaluation showed significantly higher villi in the jejunum after EM addition. A greater crypt depth was observed in the C. perfringens group. Biochemical analysis of the blood indicated lower cholesterol on the 12th day of the experiment and between-group differences in total protein, lactate dehydrogenase (LDH), and albumin levels in the EM group. Further studies are needed to improve EM activity against pathologic bacteria as a potential alternative to antibiotics and to develop future natural production systems.


Assuntos
Anti-Inflamatórios/uso terapêutico , Doenças das Aves/sangue , Doenças das Aves/dietoterapia , Infecções por Clostridium/sangue , Infecções por Clostridium/dietoterapia , Clostridium perfringens , Enterite/sangue , Enterite/dietoterapia , Mucosa Intestinal/microbiologia , Probióticos/uso terapêutico , Substâncias Protetoras/uso terapêutico , Codorniz/sangue , Codorniz/microbiologia , Ração Animal/microbiologia , Animais , Ductos Biliares/patologia , Doenças das Aves/microbiologia , Colesterol/sangue , Infecções por Clostridium/microbiologia , Enterite/microbiologia , Feminino , Hepatócitos/patologia , Mucosa Intestinal/patologia , Jejuno/microbiologia , Jejuno/patologia , L-Lactato Desidrogenase/sangue , Necrose , Albumina Sérica/análise , Resultado do Tratamento
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