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The cytoplasmic domain of receptor tyrosine kinases (RTKs) plays roles as a kinase and a protein scaffold; however, the allocation of these two functions is not fully understood. Here, we analyzed the assembly of the transmembrane (TM)-juxtamembrane (JM) region of EGFR, one of the best studied members of RTKs, by combining single-pair fluorescence resonance energy transfer (FRET) imaging and a nanodisc technique. The JM domain of EGFR contains a threonine residue (T654) that is phosphorylated after ligand association. We observed that the TM-JM peptides of EGFR form anionic lipid-induced dimers and cholesterol-induced oligomers. The two forms involve distinct molecular interactions, with a bias toward oligomer formation upon threonine phosphorylation. We further analyzed the functions and oligomerization of whole EGFR molecules, with or without a substitution of T654 to alanine, in living cells. The results suggested an autoregulatory mechanism in which T654 phosphorylation causes a switch of the major function of EGFR from kinase-activating dimers to scaffolding oligomers.
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Lipídeos de Membrana , Treonina , Receptores ErbB/genética , Receptores ErbB/metabolismo , Lipídeos de Membrana/metabolismo , Fosforilação , Transdução de Sinais , Treonina/metabolismoRESUMO
Biallelic pathogenic variants in RMRP, the gene encoding the RNA component of RNase mitochondrial RNA processing enzyme complex, have been reported in individuals with cartilage hair hypoplasia (CHH). CHH is prevalent in Finnish and Amish populations due to a founder pathogenic variant, n.71A > G. Based on the manifestations in the Finnish and Amish individuals, the hallmarks of CHH are prenatal-onset growth failure, metaphyseal dysplasia, hair hypoplasia, immunodeficiency, and other extraskeletal manifestations. Herein, we report six Japanese individuals with CHH from four families. All probands presented with moderate short stature with mild metaphyseal dysplasia or brachydactyly. One of them had hair hypoplasia and the other immunodeficiency. By contrast, the affected siblings of two families showed only mild short stature. We also reviewed all previously reported 13 Japanese individuals. No n.71A > G allele was detected. The proportions of Japanese versus Finnish individuals were 0% versus 70% for birth length < -2.0 SD, 84% versus 100% for metaphyseal dysplasia and 26% versus 88% for hair hypoplasia. Milder manifestations in the Japanese individuals may be related to the difference of genotypes. The mildest form of CHH phenotypes is mild short stature without overt skeletal alteration or extraskeletal manifestation and can be termed "RMRP-related short stature".
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Cabelo , Osteocondrodisplasias , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Alelos , Nanismo/genética , Nanismo/patologia , População do Leste Asiático , Genótipo , Cabelo/anormalidades , Cabelo/patologia , Doença de Hirschsprung/genética , Doença de Hirschsprung/patologia , Doença de Hirschsprung/diagnóstico , Japão/epidemiologia , Mutação/genética , Osteocondrodisplasias/genética , Osteocondrodisplasias/patologia , Osteocondrodisplasias/congênito , Linhagem , Fenótipo , Doenças da Imunodeficiência Primária/genética , Doenças da Imunodeficiência Primária/patologia , RNA Longo não Codificante/genéticaRESUMO
We present a computational approach that implements the time-dependent complete-active-space self-consistent-field method, as introduced in [Phys. Rev. A 88, 023402 (2013)]. Our implementation addresses the challenge of diatomic molecules subjected to an intense laser pulse by considering the full dimensionality of the problem using prolate spheroidal coordinates. The method incorporates the gauge-invariant frozen-core approximation, boosts the evaluation of the electron-electron interaction term using finite-element discrete-variable representation with Neumann expansion, and utilizes an exponential time differencing scheme tailored for the stable propagation of the stiff nonlinear orbital functions. We have successfully applied this methodology to study high-harmonic generation in diatomic molecules such as H2, LiH, and N2, shedding light on the impact of electron correlations in these systems.
RESUMO
Five time-dependent orbital optimized coupled-cluster methods, of which four can converge to the time-dependent complete active space self-consistent-field method, are presented for fermion-mixtures with arbitrary fermion kinds and numbers. Truncation schemes maintaining the intragroup orbital rotation invariance, as well as equations of motion of coupled-cluster (CC) amplitudes and orbitals, are derived. Present methods are compact CC-parameterization alternatives to the time-dependent multiconfiguration self-consistent-field method for systems consisting of arbitrarily different kinds and numbers of interacting fermions. Theoretical analysis of applications of present methods to various chemical systems is reported.
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There have been no reports comparing neonatal external genitalia of 5α-reductase deficiency (5αRD) with those of other 46,XY differences of sex differentiation (DSD). This study enrolled 31 Japanese cases of 46,XY DSD whose external genitalia was examined during the neonatal period; four were diagnosed as 5αRD and 15 were defined as non-5αRD by genetic analysis of SRD5A2 or urinary steroid metabolites. We compared the following characteristics between 5αRD and non-5αRD groups, adjusting the severity of undermasculinization of the external genitalia: stretched penile length (SPL), glans width, location of the external urethral opening, and proportion of undescended testis. The external genitalia of all the 5αRD cases were Quigley classification grade 2 or 3. We compared the phenotypes between the four 5αRD cases and 11 non-5αRD cases with grade 2 or 3. The median (range) of SPL in the 5αRD group (14 mm [11-16]) was significantly lower than that in the non-5αRD group (22 mm [15-29]) (p = 0.003). An SPL cut-off value of <15 mm yielded a sensitivity of 50% (95% confidence interval [CI]; 7-93%) and specificity of 100% (95% CI, 72-100%) for discriminating between the groups. The median glans width, location of the external urethral opening, and proportion of undescended testis were not significantly different between the groups. The SPL of 5αRD in Quigley classification grade 2 or 3 was significantly shorter than that of other 46,XY DSDs with the equivalent grade.
Assuntos
3-Oxo-5-alfa-Esteroide 4-Desidrogenase , Transtorno 46,XY do Desenvolvimento Sexual , Genitália Masculina , Humanos , Masculino , Recém-Nascido , 3-Oxo-5-alfa-Esteroide 4-Desidrogenase/deficiência , 3-Oxo-5-alfa-Esteroide 4-Desidrogenase/genética , Genitália Masculina/anormalidades , Transtorno 46,XY do Desenvolvimento Sexual/genética , Pênis/anormalidades , Fenótipo , Japão , Proteínas de MembranaRESUMO
From the biota beneath the sea ice in Lake Saroma, which is adjacent to Sea of Okhotsk, a diatom culture of Saroma 16 was isolated. Strutted processes and a labiate process in Saroma 16 were characteristic of those in Thalassiosira nordenskioeldii. Similarity search analysis showed that the 826-bp rbcL-3P region sequence of this strain was 100% identical to multiple sequences registered as T. nordenskioeldii in a public database. The 4305-bp PCR-amplified mitochondrial cytochrome c oxidase subunit I (COI) gene (COI)-5P region of Saroma 16 included a 1060-bp open reading frame (ORF), which was interrupted by 934-bp and 2311-bp introns that included frame-shifted ORFs encoding reverse-transcriptase (RTase)-like proteins. Previous reports showed that a strain of the same species, CNS00052, originating from the East China Sea included no introns in the COI, whereas North Atlantic Ocean strains of the same species, such as CCMP992, CCMP993, and CCMP997, included a 2.3-kb intron in the same position as Saroma 16.
Assuntos
Diatomáceas , Complexo IV da Cadeia de Transporte de Elétrons , Complexo IV da Cadeia de Transporte de Elétrons/genética , Sequência de Bases , Sequência de Aminoácidos , Diatomáceas/genética , Íntrons/genética , DNA Mitocondrial/genéticaRESUMO
Mast cells (MCs) mature locally, thus possessing tissue-dependent phenotypes for their critical roles in both protective immunity against pathogens and the development of allergy or inflammation. We previously reported that MCs highly express P2X7, a receptor for extracellular ATP, in the colon but not in the skin. The ATP-P2X7 pathway induces MC activation and consequently exacerbates the inflammation. Here, we identified the mechanisms by which P2X7 expression on MCs is reduced by fibroblasts in the skin, but not in the other tissues. The retinoic-acid-degrading enzyme Cyp26b1 is highly expressed in skin fibroblasts, and its inhibition resulted in the upregulation of P2X7 on MCs. We also noted the increased expression of P2X7 on skin MCs and consequent P2X7- and MC-dependent dermatitis (so-called retinoid dermatitis) in the presence of excessive amounts of retinoic acid. These results demonstrate a unique skin-barrier homeostatic network operating through Cyp26b1-mediated inhibition of ATP-dependent MC activation by fibroblasts.
Assuntos
Sistema Enzimático do Citocromo P-450/metabolismo , Dermatite/imunologia , Fibroblastos/imunologia , Mastócitos/imunologia , Receptores Purinérgicos P2X7/metabolismo , Pele/metabolismo , Trifosfato de Adenosina/imunologia , Animais , Degranulação Celular/efeitos dos fármacos , Degranulação Celular/genética , Sistema Enzimático do Citocromo P-450/genética , Imidazóis/administração & dosagem , Imunidade Inata/efeitos dos fármacos , Imunidade Inata/genética , Mastócitos/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Camundongos Knockout , Microbiota/imunologia , Receptores Purinérgicos P2X7/genética , Ácido Retinoico 4 Hidroxilase , Pele/imunologia , Pele/microbiologia , Receptor 2 Toll-Like/genética , Receptor 2 Toll-Like/metabolismo , Tretinoína/imunologiaRESUMO
We propose the use of the erfgau potential as a smooth alternative to the pure Coulomb potential between nuclei and electrons in simulating the dynamics of electrons within atoms and molecules driven by high-intensity laser pulses. Even without the sophistication of pseudopotentials, by utilizing a well-designed simple approximate potential, it is possible to make the simulations computationally less demanding while keeping accuracy. By employing the erfgau potential designed for the stationary state of hydrogen-like atoms, we demonstrate that it is possible to simulate not only the high harmonic generation from a hydrogen atom but also that of multielectron systems, including molecules.
RESUMO
Lactosylceramide (Lac-Cer) constitutes the backbone structure of various gangliosides whose abnormal expression is associated with malignancy of neuroblastoma. The understanding of the regulatory mechanism of Lac-Cer contributes to the development of neuroblastoma therapy. In this study, the transcriptional mechanism of mouse ß4-galactosyltransferase (ß4GalT) 6, which is one of Lac-Cer synthase, was analyzed using mouse neuroblastoma cell line Neuro-2a. The -226 to -13 region relative to the most downstream transcriptional start site was determined to be the promoter region by luciferase assay using the 5'-deletion constructs. The mutation into the activating protein (AP) 4-binding site -110/-101 drastically decreased the promoter activity, indicating that this site is mainly implicated in the transcription. Furthermore, the mutation into the GATA-binding site -210/-201 or another AP4-binding site -202/-193 partially decreased the promoter activity. The study suggests that the mouse ß4GalT6 gene is transcriptionally regulated by AP4 in cooperation with GATA family transcription factor in neuroblastoma.
Assuntos
Galactosiltransferases , Neuroblastoma , Camundongos , Animais , Galactosiltransferases/metabolismo , Regiões Promotoras Genéticas , Linhagem Celular Tumoral , Sítios de Ligação , Neuroblastoma/genética , Transcrição GênicaRESUMO
BACKGROUND: Neonatal abstinence syndrome (NAS) induced by opiate use is common worldwide. Psychiatric drugs are a more common cause of NAS in Japan but infants of mothers taking psychiatric medications do not always develop NAS. The purpose of this study was to develop a practical model for predicting the onset of nonopiate-induced NAS, using variables available at birth. METHODS: In this diagnostic study, prediction models were developed using multivariable logistic regression with retrospective data collected at our hospital between 2010 and 2019. The NAS diagnosis was based on the Isobe score, and maternal medications were converted to dose equivalents. RESULTS: A total of 164 maternal and infant dyads met the inclusion criteria; 91 were included in the analysis, of whom 29 infants (32%) were diagnosed with NAS. Final models were created with and without the drug indices. The model without the drug indices consisted of neonatal head circumference in z-scores and Apgar scores at 5 min < 9, and the model with the drug indices included these, as well as antipsychotics and hypnotics indices. The C-statistics were 0.747 (95% CI: 0.638-0.856), and 0.795 (95% CI: 0.683-0.907), respectively, indicating that the models possessed good predictive accuracy for NAS onset. CONCLUSIONS: This study developed models that predicted nonopiate-induced NAS accurately. They may be further improved through the use of drug indices.
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Antipsicóticos , Síndrome de Abstinência Neonatal , Recém-Nascido , Lactente , Feminino , Humanos , Síndrome de Abstinência Neonatal/diagnóstico , Síndrome de Abstinência Neonatal/etiologia , Síndrome de Abstinência Neonatal/tratamento farmacológico , Estudos Retrospectivos , Mães/psicologia , Hipnóticos e Sedativos/efeitos adversos , Antipsicóticos/uso terapêuticoRESUMO
The association between swallowing function and cough strength in patients with unilateral vocal fold paralysis (UVFP) is unknown. We evaluated the relationship between voluntary cough strength and dysphagia among patients with UVFP (UVFP group) by comparing their data with that of corresponding healthy participants (healthy control [HC] group) in a prospective observational study. From February 1st, 2018 to March 30th, 2019, we recruited patients with a voice disorder due to UVFP, who were referred to our university hospital. Patients with a history of laryngeal surgery, vagal nerve paralysis, or cardiac and respiratory failure were excluded. Descriptive and clinical data regarding swallowing, voice, and cough peak flow (CPF) were collected as a measure of cough strength. The UVFP group comprised six women and seven men (median age, 68.0 years), and the HC group comprised six women and eight men (median age 65.5 years). The groups differed significantly in the Eating Assessment Tool (EAT)-10 scores and CPF rates (P < 0.001). Among patients with UVFP, 84.6% had an abnormal EAT-10 score of ≥ 3. Additionally, 16.7% of the patients exhibited liquid aspiration with contrast medium on a videofluorographic swallowing study (VFSS). There was no correlation between the CPF values, EAT-10 scores, or the VFSS results. Therefore, patients with severe UVFP, whose condition had been fixed, had difficulties when swallowing (85% of cases), and some even presented with aspiration on VFSS (20% of cases), while receiving a regular diet.
Assuntos
Transtornos de Deglutição , Paralisia das Pregas Vocais , Voz , Masculino , Humanos , Feminino , Idoso , Prega Vocal , Transtornos de Deglutição/etiologia , Tosse/etiologia , Paralisia das Pregas Vocais/complicaçõesRESUMO
PURPOSE: Laryngeal framework surgery, including medialization laryngoplasty and arytenoid adduction (AA), is expected to have a lasting or permanent effect in patients with unilateral vocal fold paralysis (UVFP); however, there are few reports about the long-term outcomes of AA. This study aimed to evaluate the long-term postoperative effects of AA surgery and examine its stability and reliability. METHODS: This study collected the voice handicap index (VHI) questionnaire from patients with UVFP who underwent AA more than 2 years previously. The VHI values preoperatively and 3 months postoperatively (early postoperative evaluation) were retrospectively calculated, and VHI values more than 2 years after surgery (late postoperative evaluation) were collected by mailing a sheet to the patients and asking to fill and return it. Possible influenced subscales such as age, sex, causes of UVFP, affected side, and surgeons were also analyzed. RESULTS: A total of 77 patients with UVFP who underwent AA had significantly lower early and late postoperative evaluations than preoperative evaluations. In 38 patients with no missing values, there were no significant differences between early and late postoperative evaluations, measured at a median of approximately 5 years. There were also no significant differences between early and late postoperative evaluations in any of the subscale groups. CONCLUSION: Patients with UVFP who underwent AA surgery achieved stable voice improvement in the long term after surgery.
Assuntos
Laringoplastia , Paralisia das Pregas Vocais , Humanos , Prega Vocal , Qualidade da Voz , Estudos Retrospectivos , Reprodutibilidade dos Testes , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/cirurgia , Resultado do TratamentoRESUMO
We examined a phase separation process of a dynamically asymmetric blend of unentangled polyisoprene (PI) and poly(4-ethylstyrene) (PC2St) exhibiting the upper critical solution temperature. PI having the type-A dipole was the dielectrically active fast component, whereas PC2St was the dielectrically inert slow component whose dynamics can be detected by rheological measurements. To precisely model the phase separation process, it is important to estimate the composition dependence of the mobility, which is needed to describe the phase separation dynamics. For that purpose, we conducted dielectric and rheological measurements to determine the friction coefficient of each component in a homogeneous state sufficiently above the phase separation temperature. The temperature dependence of the friction coefficient of each component was reasonably expressed by the Williams-Landel-Ferry equation. Extrapolating this dependence obtained for blends of various compositions to the test temperature T* below the phase separation temperature, we were able to estimate the friction coefficient of the chain at T* as a function of the composition. This friction coefficient was then used to determine the mobility Λ defined for the material fluxes at T*. The time-dependent Ginzburg-Landau (TDGL) equation incorporating this Λ well described the experimentally observed phase separation dynamics. In particular, the 2D TDGL simulation with this Λ qualitatively captured the phase-separated structure observed with the optical microscope as well as broad dielectric mode distribution of the blend at T*.
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Congenital hypogonadotropic hypogonadism (CHH) is a rare disorder that causes gonadotropin-releasing hormone (GnRH) deficiency and sexual immaturity. CHH may accompany an abnormal sense of smell (Kallmann syndrome, KS) or no such manifestation (normosmic-CHH). This unusual combination of manifestations is explained by the fact that GnRH neurons originate in the olfactory placode and migrate to the forebrain during embryogenesis. We describe the case of a 31-year-old man with normosmic-CHH, who also had obesity, type 2 diabetes and intellectual disability. He was noticed to have sexual immaturity (small testes with no pubic hair) at age 20 years, when diabetic ketoacidosis developed. Basal and GnRH-stimulated levels of LH (1.0â12.0 IU/L) and FSH (1.9â6.1 IU/L) were detectable but low. The results of the T&T olfactometer and the Alinamin test were definitely normal, with an anatomically normal olfactory system on MRI. Sequencing of 22 CHH-related genes was performed, and compound heterozygous PROKR2 variants were identified: one was a previously known loss-of-function variant (p.Trp178Ser) and the other was a nonsense variant (p.Trp212*). Through a literature review, we found 22 patients (including our patient) with CHH due to biallelic PROKR2 variants, which led us to recognize that most of the patients (86%) were diagnosed with KS. Clinical observations in this study indicate that, even though they have CHH, biallelic PROKR2 variant carriers may have a normal olfactory system as well as presumably normal migration of GnRH neurons. This suggests that the PROK2-PROKR2 pathway affects the function of GnRH neurons after their migration.
Assuntos
Diabetes Mellitus Tipo 2 , Hipogonadismo , Síndrome de Kallmann , Receptores Acoplados a Proteínas G , Receptores de Peptídeos , Adulto , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/genética , Hormônio Liberador de Gonadotropina/genética , Heterozigoto , Humanos , Hipogonadismo/genética , Síndrome de Kallmann/diagnóstico , Síndrome de Kallmann/genética , Masculino , Mutação , Receptores Acoplados a Proteínas G/genética , Receptores de Peptídeos/genética , Adulto JovemRESUMO
Iatrogenic Cushing syndrome (ICS) may be caused by exposure to corticosteroid therapy. We report a case of ICS caused by topical corticosteroids applied to the skin after skin graft surgery. We presume that the development of ICS, in this case, was attributed to a combination of skin barrier disruption, usage of high-potency corticosteroids, broad application area/ large quantity of the corticosteroid, and the extended treatment period. Patients may be at risk for ICS after extensive skin graft surgery if large amounts of very potent topical corticosteroids are applied for an extended period to prevent scar formation or relieve itching.
Assuntos
Síndrome de Cushing , Nevo Pigmentado , Administração Tópica , Corticosteroides/efeitos adversos , Síndrome de Cushing/induzido quimicamente , Síndrome de Cushing/cirurgia , Humanos , Doença Iatrogênica , Transplante de PeleRESUMO
OBJECTIVES: To compare the loudness functions (loudness ratings as a function of sound level) obtained from patients diagnosed as having functional hearing loss (FHL) with those for patients with sensorineural hearing loss (SNHL) and healthy volunteers. DESIGN: Loudness functions for a 1000 Hz tone for patients with FHL and SNHL were assessed based on the categorical loudness scaling method. The data were compared with control data obtained in our facilities. STUDY SAMPLE: 18 patients (33 ears) with FHL and 10 patients (19 ears) with SNHL. RESULTS: For patients with SNHL and healthy volunteers, loudness increased progressively with increasing sound level above the audiometric threshold, with no exceptions. However, for about 70% of the patients with FHL, a different type of loudness function was obtained; the thresholds determined from the loudness function, which were defined as the minimum sound levels at which loudness could be judged, were 10 dB or more lower than the audiometric threshold (>10 dB), and/or the loudness ratings were elevated for a sound at the audiometric threshold. CONCLUSIONS: The results support the hypothesis that patients with FHL often make threshold judgments based on a certain loudness.
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Perda Auditiva Funcional , Perda Auditiva Neurossensorial , Audiometria , Limiar Auditivo , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Percepção SonoraRESUMO
The green sulfur bacterium, Chlorobaculum tepidum, is an anaerobic photoautotroph that performs anoxygenic photosynthesis. Although genes encoding rubredoxin (Rd) and a putative flavodiiron protein (FDP) were reported in the genome, a gene encoding putative NADH-Rd oxidoreductase is not identified. In this work, we expressed and purified the recombinant Rd and FDP and confirmed dioxygen reductase activity in the presence of ferredoxin-NAD(P)+ oxidoreductase (FNR). FNR from C. tepidum and Bacillus subtilis catalyzed the reduction of Rd at rates comparable to those reported for NADH-Rd oxidoreductases. Also, we observed substrate inhibition at high concentrations of NADPH similar to that observed with ferredoxins. In the presence of NADPH, B. subtilis FNR and Rd, FDP promoted dioxygen reduction at rates comparable to those reported for other bacterial FDPs. Taken together, our results suggest that Rd and FDP participate in the reduction of dioxygen in C. tepidum and that FNR can promote the reduction of Rd in this bacterium.
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Chlorobi/química , Chlorobi/enzimologia , Ferredoxina-NADP Redutase/metabolismo , Rubredoxinas/metabolismo , Bacillus subtilis/enzimologia , Proteínas de Bactérias/metabolismo , NAD/metabolismo , NADP/metabolismo , Oxirredução , Enxofre/metabolismoRESUMO
RESEARCH QUESTION: Can artificial intelligence (AI) improve the prediction of live births based on embryo images? DESIGN: The AI system was created by using the Attention Branch Network associated with deep learning to predict the probability of live birth from 141,444 images recorded by time-lapse imaging of 470 transferred embryos, of which 91 resulted in live birth and 379 resulted in non-live birth that included implantation failure, biochemical pregnancy and clinical miscarriage. The possibility that the calculated confidence scores of each embryo and the focused areas visualized in each embryo image can help predict subsequent live birth was examined. RESULTS: The AI system for the first time successfully visualized embryo features in focused areas that had potential to distinguish between live and non-live births. No visual feature of embryos were visualized that were associated with live or non-live births, although there were many images in which high-focused areas existed around the zona pellucida. When a cut-off level for the confidence score was set at 0.341, the live birth rate was significantly greater for embryos with a score higher than the cut-off level than for those with a score lower than the cut-off level (P < 0.001). In addition, the live birth rate of embryos with good morphological quality and confidence scores higher than 0.341 was 41.1%. CONCLUSIONS: The authors have created an AI system with a confidence score that is useful for non-invasive selection of embryos that could result in live birth. Further study is necessary to improve selection accuracy.
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Inteligência Artificial , Embrião de Mamíferos/diagnóstico por imagem , Fertilização in vitro , Nascido Vivo , Imagem com Lapso de Tempo , Adulto , Estudos de Coortes , Transferência Embrionária , Embrião de Mamíferos/fisiologia , Feminino , Humanos , Gravidez , Estudos RetrospectivosRESUMO
OBJECTIVE. The purpose of this study was to clarify the natural history of unruptured visceral artery aneurysms due to segmental arterial mediolysis and the efficacy of transcatheter arterial embolization. MATERIALS AND METHODS. Patients with a pathologic or clinical diagnosis of visceral artery aneurysms due to segmental arterial mediolysis between 2005 and 2015 were enrolled. For patients with clinical diagnoses, images were collected and assessed by central radiologic review. To clarify the natural history of unruptured aneurysms, the morphologic changes were assessed. The efficacy and safety of transcatheter arterial embolization for aneurysms due to segmental arterial mediolysis were evaluated. RESULTS. Forty-five patients with 123 aneurysms due to segmental arterial mediolysis were enrolled. Among the 123 aneurysms, 70 unruptured aneurysms were evaluated for natural history. Forty-five of the 70 (64%) aneurysms had no change in morphology. Among the other 25 aneurysms, nine (13% of the 70) were reduced in size, 13 (19%) disappeared, and three (4%) were newly found at follow-up. Aneurysms of the middle colic artery were ruptured in 10 of 11 (91%) cases. Transcatheter arterial embolization was performed on 45 aneurysms and was successful in all cases but caused slight arterial injury in three cases (6.7%). CONCLUSION. At initial diagnosis, unruptured aneurysms due to segmental arterial mediolysis are likely to be stable or to resolve, but the risk of rupture of aneurysms of the middle colic artery appears high. Transcatheter arterial embolization is a useful treatment, but careful manipulation is necessary.
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Aneurisma/terapia , Artérias , Embolização Terapêutica/métodos , Vísceras/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma/etiologia , Aneurisma/patologia , Aneurisma/cirurgia , Aneurisma Roto/etiologia , Artéria Celíaca , Embolização Terapêutica/efeitos adversos , Feminino , Artéria Gástrica , Artéria Gastroepiploica , Artéria Hepática , Humanos , Japão , Masculino , Artéria Mesentérica Inferior , Artéria Mesentérica Superior , Pessoa de Meia-Idade , Estudos Retrospectivos , Artéria Esplênica , Túnica MédiaRESUMO
PURPOSE: To clarify the correlations among symptoms, swallowing functions, and ingestion status and to validate a method of swallowing evaluation during chemoradiotherapy (CRT) for head and neck cancer. METHODS: Oropharyngeal and hypopharyngeal cancer patients who were to receive definitive CRT as initial treatment were included in this prospective, single-center, observational study. The Functional Oral Intake Scale (FOIS) for ingestion status and grades of symptoms (dryness, dysgeusia, mucositis, and the analgesic ladder); the Yale Pharyngeal Residue Severity Rating Scale on fiberoptic endoscopic evaluation of swallowing (FEES) and the Penetration-Aspiration Scale (PAS) on videofluoroscopic (VF) evaluation for swallowing functions; and the 10-item Eating Assessment Tool (EAT-10) questionnaire were assessed at 5 time points unless the participant refused. The FEES and VF evaluation findings at each point were also compared. RESULTS: There were 38 participants. Dysgeusia, mucositis, and pain grade, as well as the FOIS score, were the worst at 70 Gy and then improved after treatment. The improvements of pharyngeal residue and the PAS after treatment were limited. The EAT-10 and the pain ladder were highly correlated with the FOIS changes at many time points. The VF evaluation rate dropped after 40 Gy, whereas the FEES rate remained high. There were good correlations between pharyngeal residue and the PAS at 0 Gy, 70 Gy, and 3 months. CONCLUSION: The EAT-10 and pain reflected the FOIS score changes well, while two swallowing evaluations did not. To avoid aspiration, VF evaluation may not be necessary during CRT because of high correlations with pharyngeal residue on FEES.