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1.
Chem Commun (Camb) ; 55(61): 9015-9018, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31290867
2.
Medicine (Baltimore) ; 98(25): e16075, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232946

RESUMO

RATIONALE: Gastric cancer is still one of the most common cancer in East Asia. More than 70% gastric cancer patients are diagnosed at an advanced stage in China. Moreover, about 10% cases are unresectable which usually suffer a poor prognosis with a median survival time of 5 to 12 months. In recent years, some clinical studies found that many unresectable gastric cancer cases could get opportunity for surgery after treatment that improve prognosis significantly PATIENT CONCERNS:: 64-year-old male patient was admitted with upper abdominal pain. Upper gastrointestinal endoscopy showed a large ulcerated tumor located from the cardia to the anterior wall of the upper gastric body. Histopathological examination showed it was moderately differentiated adenocarcinoma. Computed tomography (CT) scan image showed a large bulging mass with internal ulcer at the lesser curvature wall, left gastric artery and coeliac trunk were surrounded by fused lymph nodes. DIAGNOSES: Based on the histopathological examination and imaging findings, patient was diagnosed advanced gastric cancer and hardly to resect radically. INTERVENTION: Oral chemotherapy combined with trans-arterial chemotherapy and embolization (TACE) was initiated. Eight weeks after initial therapy, radical laparoscopy-assisted total gastrectomy with D2 lymph node dissection and Roux-en-Y anastomosis were performed successfully. OUTCOMES: Patient was discharged on postoperative day 11 without complications. Histological analysis of the specimen and resected 31 lymph nodes revealed no malignancy. The patient experienced a pathological complete response (pCR). LESSONS: In this case, oral chemotherapy combined with TACE which was rarely reported in the treatment of unresectable gastric cancer achieves a great therapeutic benefit. Although further clinical studies will be needed to establish, it may be a potent strategy for degrading stage and supplying a new chance for surgery.


Assuntos
Quimioembolização Terapêutica/métodos , Tratamento Farmacológico/métodos , Neoplasias Gástricas/tratamento farmacológico , Administração Oral , China , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada por Raios X/métodos
3.
Expert Opin Pharmacother ; 20(9): 1153-1160, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30958725

RESUMO

INTRODUCTION: Standard treatment for diabetic foot ulcers (DFUs) includes off-loading, debridement, moisture balance, management of infection and peripheral arterial disease (PAD) as well as adequate glycemic control. The outcomes so far are unsatisfactory. AREAS COVERED: Herein, the authors provide an outline of newer pharmacological agents for the management of DFUs and give their expert perspectives on future treatment strategies. EXPERT OPINION: Evidence-based healthcare calls for high quality evidence from large RCTs before the implementation of new guidelines for the management of DFUs. Empagliflozin and liraglutide can be recommended for glucose control in patients with DFUs and PAD, while intensive lipid lowering therapy with evolocumab when primary cholesterol goals are not met could be offered to patients with DFUs. Further clinical studies are warranted to develop a structured algorithm for the treatment of DFUs that fail to heal after four weeks of current standard of care. Sucrose octasulfate dressings, becaplermin gel, and platelet-rich plasma (PRP) could also be considered as advanced treatment options for the management of hard to heal DFUs.


Assuntos
Pé Diabético/tratamento farmacológico , Tratamento Farmacológico/métodos , Cicatrização/efeitos dos fármacos , Pé Diabético/patologia , Humanos
4.
Expert Opin Pharmacother ; 20(9): 1109-1121, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30983431

RESUMO

INTRODUCTION: Prosthetic joint infections are an increasingly important problem among patients undergoing arthroplasty procedures, and are associated with significant morbidity, reduced quality of life, substantial healthcare costs, and even mortality. Arthroplasties are performed with increasing frequency in elderly patients, who present specific problems. AREAS COVERED: Surgical therapy is clearly influenced by the clinical status of the patient, which in some case can contraindicate surgery. Antibiotic selection is also affected by comorbidities and underlying diseases, which in some cases reduce therapeutic options. The authors review this together with the changes in pharmacokinetics and pharmacodynamics in the elderly population and the prospects for future research on prevention and treatment. EXPERT OPINION: The management of PJI in the elderly makes multidisciplinary teams even more mandatory than in other patients, because the complexity of these patients. A frequent scenario is that in which surgery is contraindicated with long-term suppressive treatment as the only available option. Treating physicians must consider the presence of multiple comorbidities, interactions with other treatments and secondary effects when choosing antibiotic treatment. An in-depth knowledge of the alterations in pharmacokinetics and pharmacodynamics in elderly patients is key for a proper treatment selection.


Assuntos
Desenvolvimento de Medicamentos/métodos , Tratamento Farmacológico/métodos , Infecções Relacionadas à Prótese/tratamento farmacológico , Qualidade de Vida/psicologia , Idoso , Comorbidade , Humanos , Infecções Relacionadas à Prótese/patologia
5.
Rev Bras Enferm ; 72(2): 391-399, 2019 Mar-Apr.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31017201

RESUMO

OBJECTIVE: Construct and validate instrument content for nursing consultation in an adult chemotherapy outpatient clinic. METHOD: Methodological study composed of two stages: elaboration of the instrument and validation of content. A literary review of the dimensions of customer care was carried out in the light of Theory of Basic Human Needs Theory, culminating in two instruments: one for admission consultation and other for follow-up. The content was validated by the evaluation of listed experts based on the adapted Fehring's Validation Model. RESULTS: In the first round, two items of the admission instrument and three items of follow-up required reformulation. In the second round, there was an increase in agreement rate: 11% in the instrument of admission and 10% in follow-up. FINAL CONSIDERATION: The instrument represents a guideline for the Nursing Process and future research, but it cannot be seen as a substitute for nurses' knowledge and clinical reasoning.


Assuntos
Assistência Ambulatorial/métodos , Tratamento Farmacológico/métodos , Encaminhamento e Consulta , Assistência Ambulatorial/tendências , Tratamento Farmacológico/tendências , Humanos , Inquéritos e Questionários
6.
Int J Antimicrob Agents ; 53(6): 726-745, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30831234

RESUMO

Acinetobacter baumannii remains a difficult-to-treat pathogen that poses a significant challenge to clinicians and costs to the healthcare system. There is a lack of clinical efficacy data to aid in the selection of optimal treatment for multidrug-resistant (MDR) A. baumannii infections. This paper aimed to review recent literature on the treatment of MDR A. baumannii infections and novel agents in the pipeline and to discuss the clinical data supporting their use. Colistin has been widely studied as monotherapy or as part of combination therapy, but its use is limited due to nephrotoxicity. The clinical benefit of combination therapy, whether empirical or targeted, has yet to be demonstrated owing to a lack of definitive evidence from randomised controlled trials (RCTs). Most available clinical studies are retrospective and lack control groups, which offers low-grade evidence. Novel agents such as cefiderocol, plazomicin, eravacycline and sulbactam/ETX2514 combination are promising options for the treatment of different infectious pathologies caused by MDR A. baumannii, but these have yet to be evaluated in RCTs. A better understanding of the pharmacokinetics/pharmacodynamics of the 'old' antibiotics is required to optimise their dosing regimens in order to maximise bacterial killing, minimise toxicities and improve clinical outcomes.


Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/administração & dosagem , Antibacterianos/farmacocinética , Farmacorresistência Bacteriana Múltipla , Tratamento Farmacológico/métodos , Humanos , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(13): e14135, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921175

RESUMO

BACKGROUND: Combination therapy based on epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is an emerging trend in cancer treatment, but the clinical value of EGFR-TKIs combination therapy remains controversial. Thus, we conducted a comprehensive analysis of randomized controlled trials (RCTs) comparing EGFR-TKIs combination therapies with monotherapies, aiming to evaluate the safety and efficacy of EGFR-TKIs based combination therapy and to find a more beneficial combination strategy. METHODS: We searched for clinical studies that evaluated EGFR-TKIs combination therapy in cancer. We extracted data from these studies to evaluate the relative risk (RR) of overall response rate (ORR) and grade 3/4 treatment-related adverse events (AEs), the hazard ratios (HRs) of overall survival (OS), and progression-free survival (PFS). RESULTS: Fourteen RCTs were identified (n = 3774). Treatments included combinations of EGFR-TKIs and chemotherapy, combinations of EGFR-TKIs and radiotherapy, and combinations of EGFR-TKIs and bevacizumab. EGFR-TKIs combination therapies showed higher ORR [RR: 1.62; 95% confidence interval (95% CI):1.16-2.26; P = .005], PFS (HR: 0.76; 95% CI: 0.64-0.89; P = .001), and OS (HR: 0.88; 95% CI: 0.79-0.97; P = .013) values than monotherapies. However, higher grade 3/4 treatment-related AEs (RR: 1.79; 95% CI: 1.02-3.15; P = .000) were observed in combination therapy than in monotherapy. CONCLUSION: Our pooled analysis and subgroup analysis results showed that the addition of chemotherapy to EGFR-TKIs better benefits PFS and safety. Adding bevacizumab was associated with better ORR and OS. The efficacy and safety of a bevacizumab-EGFR-TKIs-chemotherapy combination should be investigated further.


Assuntos
Bevacizumab/farmacologia , Receptores ErbB/antagonistas & inibidores , Neoplasias Pulmonares/tratamento farmacológico , Inibidores de Proteínas Quinases/farmacologia , Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Bevacizumab/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Neoplasias Colorretais/radioterapia , Intervalo Livre de Doença , Tratamento Farmacológico/métodos , Cloridrato de Erlotinib/administração & dosagem , Cloridrato de Erlotinib/farmacologia , Gefitinibe/administração & dosagem , Gefitinibe/farmacologia , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/radioterapia , Inibidores de Proteínas Quinases/administração & dosagem , Inibidores de Proteínas Quinases/efeitos adversos , Radioterapia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Rev Bras Enferm ; 72(1): 125-133, 2019 Jan-Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30916277

RESUMO

OBJECTIVE: To analyze the social representations of chemotherapy and the experiences built by people with cancer. METHOD: Descriptive study with a qualitative approach. Data collection occurred between August and December 2016, through interviews with 29 cancer patients undergoing chemotherapy at an institution in the northern part of Paraná State, and the Thematic-Categorical Content Analysis. RESULTS: Four categories have emerged denoting attitudes, feelings and experiences associated with chemotherapy and the need for reconstruction of daily life, permeated by the distancing of social life and work. At the same time, we note the close ties with friends and family, as well as adaptive strategies, new meanings of experiences lived and life priority setting. FINAL CONSIDERATIONS: Cancer represents an interruption of plans and dreams, modifying everyday tasks and generating new experiences. This process facilitates giving a new meaning to the past and the reconstruction of subjectivity.


Assuntos
Tratamento Farmacológico/normas , Neoplasias/complicações , Adaptação Psicológica , Adulto , Brasil , Tratamento Farmacológico/métodos , Tratamento Farmacológico/psicologia , Feminino , Humanos , Relações Interpessoais , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Pesquisa Qualitativa , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Resultado do Tratamento
9.
BMJ Case Rep ; 12(3)2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30872337

RESUMO

Paraneoplastic autoimmune encephalopathic syndromes have been described most often in association with small cell lung cancer or breast cancer, tumours of the ovaries, testes, lymphoma and thymoma. Antibodies associated with paraneoplastic encephalopathies are, among others, anti-Hu, anti-Ma2 and, in part, anti-N-methyl-D-aspartate(NMDA)-receptor antibodies. Here, we present the case of a 72-year-old patient hospitalised due to progressive cognitive decline and disorientation. Diagnostic workup revealed paraneoplastic anti-amphiphysin associated limbic encephalitis on the basis of an aortic angiosarcoma with metastases to kidney, muscle and bones. Highly aggressive chemotherapy as well as immunosuppressive therapy and cytoreductive laparoscopic nephrectomy were initiated. However, follow-up revealed further tumour progress and a worsening of neurological symptoms.


Assuntos
Doenças da Aorta/complicações , Encefalite Límbica/diagnóstico , Proteínas do Tecido Nervoso/antagonistas & inibidores , Idoso , Doenças da Aorta/patologia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Tratamento Farmacológico/métodos , Evolução Fatal , Hemangiossarcoma , Humanos , Imunossupressores/uso terapêutico , Neoplasias Renais/complicações , Neoplasias Renais/patologia , Neoplasias Renais/secundário , Neoplasias Renais/cirurgia , Encefalite Límbica/complicações , Encefalite Límbica/tratamento farmacológico , Encefalite Límbica/imunologia , Masculino , Neoplasias Musculares/complicações , Neoplasias Musculares/patologia , Neoplasias Musculares/secundário , Metástase Neoplásica/patologia , Nefrectomia/métodos , Proteínas do Tecido Nervoso/metabolismo
10.
BMJ Case Rep ; 12(3)2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30872340

RESUMO

A 17-year-old man with no significant past medical history presented with a 2-week history of worsening jaundice, lethargy, anorexia and progressive right upper quadrant abdominal pain. There were no stigmata of chronic liver disease. Initial investigations were suggestive of cholangitis with large intrahepatic and extrahepatic bile duct strictures but otherwise normal hepatic and splenic appearances. A percutaneous transhepatic cholangiogram with the positioning of drains was performed to alleviate the obstructive jaundice. Within 2 weeks of the first presentation, full blood count revealed a significantly raised white blood count and a subsequent peripheral blood smear and bone marrow were consistent with a diagnosis of acute myeloid leukaemia. Chemotherapy was started after partial improvement of his obstructive jaundice. Complete morphological and cytogenetic remission was obtained 4 weeks after the first cycle of chemotherapy (half dose of daunorubicin and full dose of cytarabine, treated off trial) on control bone marrow. The patient remains in remission.


Assuntos
Ductos Biliares Extra-Hepáticos/patologia , Colangite/etiologia , Leucemia Mieloide Aguda/complicações , Adolescente , Antibióticos Antineoplásicos/uso terapêutico , Antimetabólitos Antineoplásicos/uso terapêutico , Ductos Biliares Extra-Hepáticos/diagnóstico por imagem , Colangiografia/métodos , Colangite/diagnóstico , Colestase/etiologia , Constrição Patológica , Citarabina/administração & dosagem , Citarabina/uso terapêutico , Daunorrubicina/administração & dosagem , Daunorrubicina/uso terapêutico , Tratamento Farmacológico/métodos , Humanos , Icterícia Obstrutiva/etiologia , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/patologia , Masculino , Resultado do Tratamento
11.
BMJ Case Rep ; 12(3)2019 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-30852518

RESUMO

Chondrosarcoma (CS) is a malignant tumour of long and flat bone characterised by the formation of cartilage. Mesenchymal chondrosarcoma (MCS) is a rare subtype of CS that is more aggressive and may lead to erroneous diagnosis in a limited biopsy. The diagnosis is mainly based on the histopathological appearance of biphasic pattern of undifferentiated small round cells separated by islands of well-differentiated hyaline cartilage. We report a case of 13-year-old boy who initially presented with gum swelling and the biopsy result suggested a benign fibrous lesion. Following an extensive lesion shown in radiologic findings, the tumour excision was done and finally was diagnosed as an MCS of the maxilla. The patient was given postoperative chemotherapy (EURO-EWING 99 regimen), and now on regular follow-up for monitoring of local recurrence or tumour metastasis.


Assuntos
Condrossarcoma Mesenquimal/diagnóstico por imagem , Condrossarcoma Mesenquimal/patologia , Maxila/patologia , Neoplasia Residual/cirurgia , Adolescente , Assistência ao Convalescente , Biópsia , Condrossarcoma Mesenquimal/tratamento farmacológico , Condrossarcoma Mesenquimal/cirurgia , Diagnóstico Diferencial , Tratamento Farmacológico/métodos , Humanos , Masculino , Maxila/diagnóstico por imagem , Neoplasia Residual/diagnóstico por imagem , Doenças Raras , Reoperação , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
12.
Worldviews Evid Based Nurs ; 16(2): 92-101, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30854763

RESUMO

BACKGROUND: Exercise may effectively reduce side effects caused by chemotherapy. However, no meta-analyses of exercise during or postchemotherapy for cancer patients have been definitely performed to guide clinical practice. AIMS: To evaluate and summarize available scientific evidence to provide recommendations of an exercise intervention for cancer patients undergo chemotherapy. METHODS: A systematic review and meta-analysis were performed with databases searching of MEDLINE, Cochrane Library, and Embase from their inception to October 15, 2017. Literature was selected to identify randomized controlled trials of exercise during or postchemotherapy for cancer patients. Risk-of-bias assessment was performed by two reviewers independently. Data were analyzed using the Cochrane Collaboration's RevMan 5.3 (Review Man, Copenhagen, Denmark). RESULTS: A total of 10 trials with 838 participants were included in our study. Exercise could have a beneficial effect in cancer patients undergo chemotherapy in the outcome of physical fitness (MD: 0.16, 95% CI: 0.08-0.25, p < .01 and MD: 2.46, 95% CI: 1.44-3.47, p < .01) and depression (MD: -1.36, 95% CI: -2.68 to -0.04, p = .04), but not in FACT-G, FACT-B, anxiety, weight, and BMI (all p > .05). Exercise sequence (during or postchemotherapy) did not influence the effect of exercise for cancer patients undergo chemotherapy. In total, six studies were assessed as an overall low risk of bias. Subgroup analyses and sensitivity analyses reached results similar to those of the meta-analyses, which reflected our results were reliable and robust. LINKING EVIDENCE TO ACTION: Exercise seems to have a beneficial effect on physical fitness and depression, but not on quality of life, anxiety, weight, and BMI. More specific and detailed description of the implementation of exercise programs should be proposed in the future.


Assuntos
Tratamento Farmacológico/enfermagem , Terapia por Exercício/normas , Neoplasias/terapia , Tratamento Farmacológico/métodos , Terapia por Exercício/métodos , Humanos , Neoplasias/tratamento farmacológico
13.
Nanotechnology ; 30(28): 285706, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-30849773

RESUMO

Circulating tumor cells (CTCs) are a type of rare cell that are firstly shed from solid tumors and then exist in the bloodstream. The effective capture and separation of CTCs has significant meaning in cancer diagnosis and prognosis. In this study, novel Fe3O4-FePt magnetic nanocomposites (Fe3O4-FePt MNCs) were constructed by integrating face centered cubic (fcc) FePt nanoparticles (NPs) onto the surface of the Fe3O4@SiO2 core. After further modification with NH2-PEG-COOH and the tumor-targeting molecule tLyP-1, the acquired Fe3O4-FePt MNCs possesses excellent biocompatibility and stability and could efficiently target and capture tLyP-1 receptor-positive CTCs. Based on the acidic microenvironment within cancer cells, the FePt layer could rapidly release active Fe2+ ions, which could catalyze H2O2 into reactive oxygen species (ROS) and further induce in situ apoptosis in cancer cells while having no distinct cytotoxicity to normal cells. Moreover, the Fe3O4@SiO2 core with its intrinsic magnetism has huge potential for the bioseparation of CTCs. The in vitro ROS fluorescence imaging experiments and cell capture and separation experiments indicated that the Fe3O4-FePt MNCs could specifically capture and separate cancer cells in the CTCs model and further induce in situ apoptosis. Therefore, the Fe3O4-FePt MNCs could serve as a promising multifunctional nanoseparator for efficiently capturing CTCs and simultaneously inducing in situ chemotherapy.


Assuntos
Separação Celular/métodos , Tratamento Farmacológico/métodos , Nanopartículas de Magnetita/química , Células Neoplásicas Circulantes/química , Sobrevivência Celular , Compostos Férricos/química , Humanos , Ferro , Células MCF-7 , Nanopartículas de Magnetita/ultraestrutura , Microesferas , Platina/química , Espécies Reativas de Oxigênio
14.
Medicine (Baltimore) ; 98(11): e14883, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30882698

RESUMO

RATIONALE: Signet-ring cell is a rare morphological finding in bone marrow, which usually indicates metastatic carcinoma from either the gastrointestinal tract or a primary hematolymphoid neoplasm. Here, we present a very unusual case of lobular breast carcinoma with metastasis to the bone marrow. PATIENT CONCERNS: A 67-year-old female with estrogen receptor (ER)-positive lobular breast carcinoma was staged as T3N3M0, and treated with modified radical mastectomy followed by chemotherapy and radiotherapy. One year after treatment, she was noted to have moderate thrombocytopenia on complete blood count with the remainder of the parameters within normal limits. Radiographic examination revealed no evidence of recurrent disease. DIAGNOSIS: Bone marrow biopsy was performed to exclude therapy-related myelodysplastic syndrome (MDS), which demonstrated hypercellularity with "hyperplastic" hematopoiesis. Upon closer inspection, a few signet-ring cells were identified which morphologically resembled histiocytes. These formed an interstitial infiltrate among the predominantly hematopoietic elements, and could have been easily overlooked. Immunohistochemistry demonstrated that these signet-ring cells were positive for pancytokeratin as well as ER which confirmed metastatic lobular breast carcinoma. On retrospective review of the aspirate smear, rare signet-ring cells were identified. INTERVENTIONS: The patient was treated with additional chemotherapy. OUTCOMES: The patient eventually succumbed to overt dissemination after 14 months. LESSONS: Due to the relative discohesiveness of lobular breast carcinoma, the cells frequently assume single-cell infiltration in bone marrow. This attribute, along with small cell size, bland cytologic features and paucity of tissue response, contributes to its escaping from identification on hematoxylin-eosin (H&E) sections. In this case, the signet-ring cells were hidden in apparently hyperplastic hematopoiesis. Careful inspection raised the possibility of occult metastasis which was readily detected and confirmed with immunohistochemistry.


Assuntos
Neoplasias da Mama/complicações , Carcinoma de Células em Anel de Sinete/etiologia , Idoso , Biópsia/métodos , Medula Óssea/anormalidades , Medula Óssea/patologia , Medula Óssea/fisiopatologia , Neoplasias da Mama/patologia , Tratamento Farmacológico/métodos , Feminino , Humanos , Mastectomia/métodos , Radioterapia/métodos
15.
Brain Dev ; 41(6): 501-506, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30795919

RESUMO

OBJECTIVE: We aimed to clarify the current status of pharmacotherapy for tic disorders and comorbidities in Japan. We used a systematic survey to collate the consensus of Japanese experts and compare it with the recent international evidence. METHODS: We devised a questionnaire on pharmacotherapy for tics and comorbidities and sent it to Japanese experts on tic disorders. Based on the response to the first survey, we revised the questionnaire and conducted a second survey to determine the consensus among the experts on a 4-point Likert scale by the Delphi method. RESULTS: The first survey revealed variability in preferred medications and dosages among the experts in Japan. However, we were able to build a general consensus on pharmacotherapy for tic disorders and comorbidities based on the second survey. Aripiprazole and risperidone were the first- and second-line medication for tic disorders, respectively. Agonists of α-2 adrenergic receptors were seldom prescribed. Fluvoxamine was the first-line medication for comorbid obsessive-compulsive disorder, and atomoxetine for comorbid attention deficit/hyperactivity disorder. CONCLUSIONS: This study will help Japanese physicians choose medications for tic disorders more judiciously and will improve the quality of tic pharmacotherapy in Japan.


Assuntos
Transtornos de Tique/tratamento farmacológico , Transtornos de Tique/epidemiologia , Adulto , Idoso , Aripiprazol/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Comorbidade , Consenso , Tratamento Farmacológico/métodos , Prova Pericial , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Médicos , Risperidona/uso terapêutico , Inquéritos e Questionários , Tiques/tratamento farmacológico , Tiques/etiologia , Síndrome de Tourette/tratamento farmacológico , Síndrome de Tourette/epidemiologia
16.
Biol Pharm Bull ; 42(2): 149-157, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30713247

RESUMO

To date, limited drug information is available for the individual optimization of pharmacotherapy. The author attempted multiple evaluations of patient data on factors related to the pharmacokinetics, drug efficacy, and adverse reactions observed in clinical settings. Through the clinical studies, drug information on the individual optimization of pharmacotherapy needed by health professionals including physicians and pharmacists was identified. Major findings were: 1) Cachectic cancer patients had high plasma concentrations of oxycodone via the reduction of CYP3A activity. The metabolic reduction in cachectic cancer patients was potentially related to the elevated serum level of interleukin-6. 2) Dopamine receptor D2 (DRD2) genetic mutations and being female led to poor antiemetic efficacy of the treatment of opioid-induced nausea in prochlorperazine-treated patients. The opioid receptor µ1 (OPRM1) wild genotype in addition to being female and having high plasma concentrations of prochlorperazine increased prolactin secretion during oxycodone treatment. 3) Rheumatoid arthritis patients with a genetic mutation of ATP-binding cassette subfamily B member 1 (ABCB1) had high plasma concentrations of tacrolimus and its 13-O-demethylate. The ABCB1 genetic mutation and associated high plasma concentration of tacrolimus decreased kidney function. 4) Chronic inflammation increased the plasma voriconazole concentration via its poor metabolism, whereas it did not alter the plasma itraconazole concentration. Although co-administration of prednisolone did not affect the plasma concentration of triazole antifungals, it weakly increased voriconazole metabolism. 5) In breastfeeding women, the median milk/plasma concentration ratio of amlodipine was 0.85. However, the observed relative infant dose of amlodipine in most patients was less than 10%.


Assuntos
Tratamento Farmacológico/métodos , Medicina de Precisão/métodos , Feminino , Humanos , Masculino , Fatores Sexuais
17.
Theor Biol Med Model ; 16(1): 4, 2019 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-30803437

RESUMO

BACKGROUND: The application of effective vaccines against pig cysticercosis and mass chemotherapy against pig cysticercosis and human taeniasis have shown the feasibility of interrupting the parasite's life cycle in endemic areas. METHODS: A mathematical model that divides the population into susceptible, infected, and vaccinated individuals is formulated. The model is based upon the life cycle of the parasite. Computer numerical simulation experiments to evaluate the impact of pig vaccination under different vaccination schedules, and combined intervention strategies including pig vaccination and anthelmintic treatment against human taeniasis are carried out. RESULTS: Vaccination against either pig cysticercosis or against human taeniasis will influence the transmission dynamics not only among vaccinees but also the dynamics of the other hosts as well. When the protective efficacy and/or the coverage rate is less than 100%, different mass interventions like vaccinating the pig population twice in combination with chemotherapeutic treatment against human taeniasis, the elimination of the infection in both pigs and humans can also be achieved. CONCLUSIONS: Our mathematical model has the potential for planning, and designing effective intervention strategies including both mass vaccination and/or chemotherapeutic treatment to eliminate pig cysticercosis, human taeniasis and human neurocysticercosis. The model can be adapted to any given community with mild, moderate endemicity, or even in hyperendemic regions.


Assuntos
Cisticercose/prevenção & controle , Modelos Teóricos , Teníase/prevenção & controle , Vacinação/métodos , Vacinas/administração & dosagem , Animais , Cisticercose/transmissão , Tratamento Farmacológico/métodos , Humanos , Suínos , Teníase/transmissão
18.
Curr Protein Pept Sci ; 20(6): 492-494, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30674253

RESUMO

In the medical field, drug-target interactions are very important for the diagnosis and treatment of diseases, they also can help researchers predict the link between biomolecules in the biological field, such as drug-protein and protein-target correlations. Therefore, the drug-target research is a very popular study in both the biological and medical fields. However, due to the limitations of manual experiments in the laboratory, computational prediction methods for drug-target relationships are increasingly favored by researchers. In this review, we summarize several computational prediction models of the drug-target connections during the past two years, and briefly introduce their advantages and shortcomings. Finally, several further interesting research directions of drug-target interactions are listed.


Assuntos
Biologia Computacional/métodos , Simulação por Computador , Sistemas de Liberação de Medicamentos/métodos , Algoritmos , Bases de Dados de Produtos Farmacêuticos , Descoberta de Drogas/métodos , Tratamento Farmacológico/métodos , Humanos
19.
Surg Infect (Larchmt) ; 20(3): 184-191, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30676237

RESUMO

BACKGROUND: After publication of the Study to Optimize Peritoneal Infection Therapy (STOP IT) trial, we sought to determine if we were implementing study findings into practice appropriately. We had three objectives: evaluate antibiotic usage; evaluate patient outcomes; and delineate differences in antibiotic usage between general surgeons (GS) and trauma/acute care surgery trained surgeons (TACS). PATIENTS AND METHODS: This was an analysis of patients with complicated intra-abdominal infection admitted via the emergency department from February 2014 through May 2017. Complicated intra-abdominal infection (cIAI) was defined as perforated viscus, complicated appendicitis, or ischemic bowel. Patients were excluded if they had an ICD-9/10 code for diverticular/anorectal disease, did not undergo source control, or if the post-operative antibiotic course was not given or was incomplete because of withdrawal of care, change in code status, or death. Outcomes and antibiotic usage were compared before and after the STOP IT publication date. Short-course antibiotic regimens were defined as four days or less of antibiotics after source control. RESULTS: A total of 133 patients met inclusion criteria, with 47 admitted before STOP IT and 86 admitted after. Demographics and other characteristics were similar between these groups. Total antibiotic days and antibiotic days after source control decreased after STOP IT publication (p = 0.031 and p = 0.047, respectively). There were no differences in hospital length of stay (LOS), intensive care unit (ICU) LOS, surgical site infections, intra-abdominal abscesses, or death between the two groups. Short-course antibiotic compliance increased after publication from 30% to 52% (p = 0.012). Compared with GS, patients managed by TACS had decreased total antibiotic days (p = 0.030) and antibiotic days after source control (p = 0.025). CONCLUSION: We demonstrated decreased antibiotic days and increased use of short-course antibiotic regimens for patients with cIAI after the publication of STOP IT. However, there still appears to be opportunity for improved adherence to short-course regimens, as well as opportunities to educate our colleagues.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Infecções Intra-Abdominais/tratamento farmacológico , Infecções Intra-Abdominais/cirurgia , Adulto , Tratamento Farmacológico/métodos , Serviço Hospitalar de Emergência , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
20.
BMJ Case Rep ; 12(1)2019 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-30642851

RESUMO

A 19-year-old woman presented to the outpatient department with occasional ocular pain and redness and a perilimbal mass, which she noticed 5 months ago in her left eye. She had no systemic complaints. Ultrasound biomicroscopy of the mass showed a hypoechoic lesion with uniform reflectivity. The patient underwent an excision biopsy and a histopathological analysis revealed features suggestive of a granulocytic sarcoma/myeloid sarcoma. Further haematopathological evaluation confirmed concurrent acute myeloid (myelomonocytic) leukaemia French American British classification M4. There was complete remission of the ocular surface lesion and leukaemia with systemic chemotherapy. At the last follow-up of 18 months post-treatment the patient is free of disease.


Assuntos
Dor Ocular/diagnóstico , Sarcoma Mieloide/patologia , Sarcoma Mieloide/cirurgia , Assistência ao Convalescente , Biópsia , Tratamento Farmacológico/métodos , Dor Ocular/etiologia , Dor Ocular/patologia , Feminino , Humanos , Leucemia Mielomonocítica Aguda/patologia , Microscopia Acústica/métodos , Indução de Remissão , Sarcoma Mieloide/diagnóstico por imagem , Sarcoma Mieloide/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
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