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1.
J Neuroinflammation ; 21(1): 146, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38824594

RESUMO

T cells play an important role in the acquired immune response, with regulatory T cells (Tregs) serving as key players in immune tolerance. Tregs are found in nonlymphoid and damaged tissues and are referred to as "tissue Tregs". They have tissue-specific characteristics and contribute to immunomodulation, homeostasis, and tissue repair through interactions with tissue cells. However, important determinants of Treg tissue specificity, such as antigen specificity, tissue environment, and pathology, remain unclear. In this study, we analyzed Tregs in the central nervous system of mice with ischemic stroke and experimental autoimmune encephalomyelitis (EAE), a mouse model of multiple sclerosis. The gene expression pattern of brain Tregs in the EAE model was more similar to that of ischemic stroke Tregs in the brain than to that of spinal cord Tregs. In addition, most T-cell receptors (TCRs) with high clonality were present in both the brain and spinal cord. Furthermore, Gata3+ and Rorc+ Tregs expressed TCRs recognizing MOG in the spinal cord, suggesting a tissue environment conducive to Rorc expression. Tissue-specific chemokine/chemokine receptor interactions in the spinal cord and brain influenced Treg localization. Finally, spinal cord- or brain-derived Tregs had greater anti-inflammatory capacities in EAE mice, respectively. Taken together, these findings suggest that the tissue environment, rather than pathogenesis or antigen specificity, is the primary determinant of the tissue-specific properties of Tregs. These findings may contribute to the development of novel therapies to suppress inflammation through tissue-specific Treg regulation.


Assuntos
Encéfalo , Encefalomielite Autoimune Experimental , Camundongos Endogâmicos C57BL , Medula Espinal , Linfócitos T Reguladores , Animais , Linfócitos T Reguladores/imunologia , Camundongos , Encefalomielite Autoimune Experimental/imunologia , Encefalomielite Autoimune Experimental/patologia , Medula Espinal/imunologia , Medula Espinal/patologia , Medula Espinal/metabolismo , Encéfalo/imunologia , Encéfalo/metabolismo , Encéfalo/patologia , Feminino , Modelos Animais de Doenças
2.
Dig Endosc ; 36(3): 314-322, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37343173

RESUMO

OBJECTIVES: Clinical outcomes of endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma (ESCC) with esophageal varices (EVs) are obscure. We aimed to elucidate the clinical outcomes of ESD for ESCC with EVs in a multicenter, retrospective study. METHODS: We established a retrospective cohort of 30 patients with ESCC complicating EVs, who underwent ESD at 11 Japanese institutions. Rates of en bloc resection and R0 resection, procedure time, and adverse events were evaluated as indicators of the feasibility and safety of ESD. Additional treatment, recurrence, and metastasis of the lesions were evaluated as indicators of the long-term efficacy of ESD. RESULTS: Portal hypertension was caused by cirrhosis, of which alcohol was the most common cause. En bloc resection was achieved in 93.3% and R0 resection in 80.0% of the patients. The median procedure time was 92 min. Adverse events included a case of uncontrolled intraoperative bleeding leading to discontinuation of ESD and a case of esophageal stricture due to extensive resection. During the follow-up period of a median for 42 months, a patient with local recurrence and another patient with liver metastasis were observed. One patient died of liver failure after receiving chemoradiotherapy as an additional treatment after ESD. No patient died of ESCC. CONCLUSION: This multicenter, retrospective cohort study demonstrated the safety and efficacy of ESD for ESCC with EVs. Further studies are needed to establish appropriate treatment methods for EVs before ESD and additional treatments for patients with insufficient ESD.


Assuntos
Carcinoma de Células Escamosas , Ressecção Endoscópica de Mucosa , Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Varizes Esofágicas e Gástricas , Humanos , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/métodos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/complicações , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagoscopia/métodos , Estudos Retrospectivos , Resultado do Tratamento
3.
Surg Today ; 53(4): 409-419, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35987967

RESUMO

PURPOSE: Inflammation is one of the hallmarks of cancer, and inflammation-based markers that are calculated easily from laboratory results have shown predictive abilities. We investigated the prognostic values of the preoperative platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and pan-immune-inflammation value (PIV) in patients with non-metastatic obstructive colorectal cancer (OCRC) and a self-expandable metallic stent inserted as a bridge to curative surgery. METHODS: The subjects of this retrospective study were 86 patients with pathological stage I to III OCRC. We examined the associations of these biomarkers with short- and long-term outcomes. RESULTS: Multivariate analyses revealed that a preoperative PLR < 149, SII < 597, and PIV < 209 were independently associated with poorer relapse-free survival (RFS) (P = 0.007, P < 0.001, and P = 0.002, respectively) and that a PIV < 209 was independently associated with poorer cancer-specific survival (P = 0.030). A platelet count < 240 was significantly associated with worse RFS, whereas the lymphocyte count was not. Pre-stenting PLR < 221 was an independent poor prognostic factor for RFS (P = 0.045). CONCLUSION: This study showed that decreased preoperative PLR, SII, PIV, and pre-stenting PLR were associated with poorer RFS, contrary to the findings of most previous studies. Our results suggest that platelets and obstruction contributed primarily to the opposite relationships, which might provide new insight into the possible pathophysiology of platelet-tumor interactions generated in the OCRC environment.


Assuntos
Neoplasias Colorretais , Recidiva Local de Neoplasia , Stents , Humanos , Neoplasias Colorretais/cirurgia , Inflamação , Linfócitos , Recidiva Local de Neoplasia/cirurgia , Neutrófilos , Prognóstico , Estudos Retrospectivos
4.
Surg Today ; 2023 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-38091062

RESUMO

PURPOSE: Sarcopenia influences the short- and long-term outcomes of various medical conditions including malignancy. Ishii's screening test estimates the probability of sarcopenia based on a score calculated by three simple variables: age, grip strength, and calf circumference. We investigated the clinical significance of Ishii's score for patients with non-metastatic obstructive colorectal cancer (OCRC) who underwent curative surgery after intraluminal decompression. METHODS: Ishii's score was calculated in 79 patients with OCRC. Muscle volume loss and decreased muscle quality were evaluated by computed tomography (CT) images as skeletal muscle index (SMI) and intramuscular adipose tissue content (IMAC), respectively. RESULTS: There were 46 men and 33 women, with a median age of 70 years old. The cutoff value for Ishii's score was 155.1 and 15 patients were in the high-score group. The high-score group was significantly associated with worse time to recurrence (TTR) and overall survival (OS), and a high Ishii's score was an independent negative prognostic factor for TTR (hazard ratio = 2.93, P = 0.015). A high Ishii's score was significantly associated with a low SMI value but not with the IMAC value. CONCLUSION: A high Ishii's score was independently associated with poorer TTR in patients with non-metastatic OCRC.

5.
Surg Today ; 52(12): 1699-1710, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35441270

RESUMO

PURPOSE: The prognostic significance of the mean corpuscular volume (MCV) and red cell distribution width (RDW) in patients with malignancy have not been intensely investigated and are largely overlooked. We, therefore, investigated the clinical significance of MCV and RDW in non-metastatic obstructive colorectal cancer (OCRC) patients with a self-expandable metallic stent inserted as a bridge to curative surgery. METHODS: Eighty-five pathological stage II and III OCRC patients were retrospectively evaluated. The associations of the preoperative MCV and RDW values with short- and long-term outcomes were examined. RESULTS: There were 50 males and 35 females, and the median age was 71 years old. The median interval between stenting and surgery was 17 days, and the median postoperative hospital stay was 16 days. Fifty-six patients were in the MCV ≥ 87 group, and 47 were in the RDW ≥ 13.8 group. Multivariate analyses revealed the MCV ≥ 87 status to be independently associated with a poor relapse-free survival (hazard ratio [HR] = 4.70, 95% confidence interval [CI] 1.52-14.58, P = 0.007). The RDW ≥ 13.8% was an independent predictor of postoperative infectious complications (HR = 7.28, 95% CI 1.24-42.70, P = 0.028). CONCLUSION: The MCV and RDW are simple but strong predictors of postoperative outcomes in OCRC patients.


Assuntos
Neoplasias Colorretais , Índices de Eritrócitos , Masculino , Feminino , Humanos , Idoso , Prognóstico , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Stents , Neoplasias Colorretais/cirurgia
6.
Surg Today ; 52(4): 681-689, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34648067

RESUMO

PURPOSE: Intestinal decompression using self-expandable metallic colonic stents (SEMSs) as a bridge to surgery is now considered an attractive alternative to emergency surgery. However, data regarding the optimal timing of surgery after stenting are limited. METHODS: We investigated the impact of the interval between stenting and surgery on short- and long-term outcomes in 92 obstructive colorectal cancer (OCRC) patients who had a SEMS inserted and subsequently received curative surgery. RESULTS: The median age of the patients was 70.5 years, and the median interval between SEMS insertion and the surgery was 17 (range 5-47) days. There were 35 postoperative complications, including seven major postoperative complications. An interval of more than 16 days was an independent predictor of a poor relapse-free survival (hazard ratio [HR] = 3.12, 95% confidence interval [CI] 1.24-7.81, p = 0.015). An interval of more than 35 days was independently associated with major postoperative complications (HR = 16.6, 95% CI 2.21-125, p = 0.006). CONCLUSION: A longer interval between stenting and surgery significantly compromised the short- and long-term outcomes. Surgery within 16 days after stenting might help maximize the benefit of SEMS without interfering with short- and long-term outcomes.


Assuntos
Neoplasias Colorretais , Obstrução Intestinal , Idoso , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Recidiva Local de Neoplasia , Estudos Retrospectivos , Stents/efeitos adversos , Resultado do Tratamento
7.
Nihon Shokakibyo Gakkai Zasshi ; 119(3): 227-235, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-35264486

RESUMO

A 79-year-old male with a positive fecal occult blood test result underwent total colonoscopy, which revealed a 15-mm-semipedunculated polyp in the rectum. The polyp appeared to be an adenoma using narrow-band imaging observation in magnifying endoscopy, although a 3mm reddish segment with a different surface structure was identified adjacent to the base of the polyp. En-bloc endoscopic mucosal resection (EMR) was performed. From the pathological evaluation using the specimen, the polyp was mainly a tubular adenoma with an adenocarcinoma component within the lesion. Additionally, a tiny plasmablastic lymphoma (PBL) component, which was positive for CD45, CD79a, CD30, CD38, MUM1, and lambda light chain;negative for CD3, CD5, CD20, CD56, CD138, cyclin D1, PAX5, IgG, IgA, IgM, IgE, HHV8, and kappa light chain, coexisted near the stalk. The proliferation index using Ki-67 immunohistochemistry was approximately 80%. Furthermore, Epstein-Barr virus-encoded RNAs were identified in in-situ hybridization, although the human immunodeficiency virus was not detected. The patient received contrast-enhanced computed tomography (CT) and positron emission tomography-CT (PET-CT) follow-ups after treatment without recurrence for two years. This is the first report of gastrointestinal PBL that could be treated using EMR.


Assuntos
Ressecção Endoscópica de Mucosa , Infecções por Vírus Epstein-Barr , Linfoma Plasmablástico , Neoplasias Retais , Idoso , Biomarcadores Tumorais/análise , Infecções por Vírus Epstein-Barr/complicações , Herpesvirus Humano 4 , Humanos , Masculino , Linfoma Plasmablástico/complicações , Linfoma Plasmablástico/patologia , Linfoma Plasmablástico/cirurgia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgia
8.
Digestion ; 102(4): 630-639, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32932255

RESUMO

BACKGROUND/AIMS: For early gastric cancer (EGC) treated using endoscopic submucosal dissection (ESD) with poor curability defined by the Japanese Guidelines (non-curative EGC, N-EGC), additional gastrectomy has been recommended. However, N-EGC patients without additional gastrectomy often die of other diseases within a relatively short interval after ESD. It has been unclear whether additional gastrectomy is beneficial or not for such patients. The aim of this study was to clarify predictors for short-term survival of N-EGC patients without additional gastrectomy after ESD. METHODS: One hundred six N-EGC patients without additional gastrectomy were included in this study. Factors related to short-term survival, defined as death within 3 years after ESD, were evaluated using uni- and multivariate analyses by comparing patients with and without short-term survival (Groups S and C, respectively). RESULTS: During the mean follow-up period of 89 months, 39 patients died (14 patients died within 3 years, being Group S). The cause of death was gastric cancer for only 1 patient in the Group C. The 3- and 5-year overall survival rates were 86.8 and 81.8%, respectively, and the 3- and 5-years disease-specific survival rates were 100 and 98.9%, respectively. Univariate analyses showed that short-term survival was statistically associated with elevated morphology, high-risk status for lymph node metastases as defined by the eCura system, severe comorbidity (Charlson Comorbidity Index [CCI] ≥3), low level of activity in daily living (being unable to go out by oneself), habitation (a nursing home), and several poor nutritional prognostic indices (neutrophil to lymphocyte ratio ≥2.5, geriatric nutritional risk index <92, C-reactive protein ≥1.0). In the multivariate analysis, a high CCI (≥3) was the independent predictor for short-term survival after ESD (odds ratio, 8.1; 95% confidence interval, 1.53-43.0; p = 0.014). CONCLUSIONS: Severe comorbidity indicated by a high CCI score (≥3) was the independent predictor for short-term survival for EGC patients without additional gastrectomy after non-curative ESD. Since the cause of death for most patients was not gastric cancer, observational follow-ups without additional gastrectomy might be a reasonable option for patients with a poor general status indicated by a CCI ≥3.


Assuntos
Ressecção Endoscópica de Mucosa , Neoplasias Gástricas , Idoso , Ressecção Endoscópica de Mucosa/efeitos adversos , Gastrectomia/efeitos adversos , Mucosa Gástrica/cirurgia , Humanos , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Resultado do Tratamento
9.
Surg Today ; 51(1): 144-152, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32623583

RESUMO

PURPOSE: The Controlling Nutritional Status (CONUT) Score, originally developed as a nutritional screening tool, is a cumulative score calculated from the serum albumin level, total cholesterol level, and total lymphocyte count. Previous studies have demonstrated that the score has significant prognostic value in various malignancies. We investigated the relationship between the CONUT score and long-term survival in obstructive colorectal cancer (OCRC) patients who underwent self-expandable metallic colonic stent placement and subsequently received curative surgery. METHODS: We retrospectively analyzed 57 pathological stage II and III OCRC patients between 2013 and 2019. The associations between the preoperative CONUT score and clinicopathological factors and patient survival were evaluated. RESULTS: A receiver operating characteristic curve analysis revealed that the optimal cut-off value for the CONUT score was 7. A CONUT score of ≥ 7 was significantly associated with elevated CA19-9 level (p = 0.03). Multivariate analyses revealed that a CONUT score of ≥ 7 was independently associated with cancer-specific survival (hazard ratio [HR] = 10.2, 95% confidence interval [CI] 1.2-85.9, p = 0.03) and disease-free survival (HR = 7.1, 95% CI 2.3-21.7, p = 0.0006). CONCLUSION: The results demonstrated that the CONUT score was a potent prognostic indicator. Evaluating the CONUT score might result in more precise patient assessment and tailored treatment.


Assuntos
Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Estado Nutricional , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Colesterol/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Prognóstico , Estudos Retrospectivos , Albumina Sérica , Taxa de Sobrevida
10.
Surg Today ; 50(10): 1272-1281, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32346761

RESUMO

PURPOSE: Inflammation-based markers predict long-term outcomes of various malignancies. We investigated the relationship between these markers and the long-term survival in obstructive colorectal cancer (OCRC) patients with self-expandable metallic colonic stents (SEMSs) who subsequently received curative surgery. METHODS: We retrospectively analyzed 72 consecutive pathological stage II and III OCRC patients between 2013 and 2019. The prognostic significance of the prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and platelet-lymphocyte ratio (PLR) was evaluated. RESULTS: The overall survival (OS), cancer-specific survival, and disease-free survival (DFS) were significantly shorter in the PNI < 35 group than in the PNI ≥ 35 group (p = 0.006, p < 0.001, and p = 0.003, respectively), and multivariate analyses revealed the PNI to be the only inflammation-based marker independently associated with the survival. A PNI < 35 was significantly associated with an elevated CA 19-9 level (p = 0.04) and longer postoperative hospital stay (p = 0.03). Adjuvant chemotherapy was also significantly associated with the OS (p = 0.040) and DFS (p = 0.011) in multivariate analyses. CONCLUSION: The results showed that the PNI was a potent prognostic indicator. For OCRC patients, both systemic inflammation and the nutrition status seem to be important for predicting the prognosis, and administering adjuvant chemotherapy was very important.


Assuntos
Neoplasias Colorretais/cirurgia , Avaliação Nutricional , Estado Nutricional , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígeno CA-19-9 , Quimioterapia Adjuvante , Neoplasias Colorretais/complicações , Neoplasias Colorretais/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Inflamação , Obstrução Intestinal/etiologia , Obstrução Intestinal/mortalidade , Obstrução Intestinal/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Stents Metálicos Autoexpansíveis
11.
Surg Today ; 50(3): 232-239, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31407166

RESUMO

PURPOSE: Inflammation-based markers predict the long-term outcomes of various malignancies. We investigated the relationship between the modified Glasgow prognostic score (mGPS) and the long-term outcomes of obstructive colorectal cancer in patients who underwent self-expandable metallic colonic stent placement and subsequently received curative surgery. METHODS: We retrospectively analyzed 63 consecutive patients with pathological stage II and III obstructive colorectal cancer from 2013 to 2018. The mGPS was calculated before stenting and surgery, and the difference of the scores was defined as the d-mGPS. RESULTS: All d-mGPS = 2 patients were > 70 years of age (p = 0.01). Postoperative complications were more common in the preoperative mGPS = 2 group (p = 0.02). The postoperative hospital stay was significantly longer in the mGPS = 2 group (p = 0.007). Multivariate analyses revealed that d-mGPS was an independent prognostic factor for overall survival (OS) (hazard ratio [HR] = 9.18, p = 0.004) and cancer-specific survival (HR = 9.98, p = 0.01). Preoperative mGPS = 2 was significantly associated with poor OS (HR = 5.53, p = 0.04). CONCLUSION: The results indicated that mGPS might serve as a valuable indicator of the immunonutritional status of preoperative patients, and a preoperative change of the status might affect the long-term outcomes of patients with obstructive colorectal cancer.


Assuntos
Neoplasias Colorretais/cirurgia , Escala de Resultado de Glasgow , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Stents , Idoso , Neoplasias Colorretais/complicações , Neoplasias Colorretais/imunologia , Neoplasias Colorretais/patologia , Humanos , Estadiamento de Neoplasias , Estado Nutricional , Valor Preditivo dos Testes , Período Pré-Operatório , Fatores de Tempo
12.
Nihon Shokakibyo Gakkai Zasshi ; 117(5): 413-420, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32389913

RESUMO

A 15-mm whitish, depressed lesion was observed in the stomach of a 39-year-old using screening esophagogastroduodenoscopy. The lesion had grown to a size of 40mm and had a cobblestone-like appearance at an 11-year endoscopic follow-up. Using endoscopic submucosal dissection (ESD) as a diagnostic therapy, gastric mucosa-associated lymphoid tissue (MALT) lymphoma with MALT translocation gene 1 without Helicobacter pylori infection was detected. Although the patient did not undergo additional treatments, he remained alive without for recurrence 5 years after ESD.


Assuntos
Ressecção Endoscópica de Mucosa , Infecções por Helicobacter , Helicobacter pylori , Linfoma de Zona Marginal Tipo Células B , Neoplasias Gástricas , Adulto , Mucosa Gástrica , Humanos , Tecido Linfoide , Masculino , Recidiva Local de Neoplasia
13.
Biochem Biophys Res Commun ; 512(1): 1-6, 2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-30853179

RESUMO

The recently discovered circular RNAs (circRNAs) are mostly formed by back-splicing where the downstream 5' splice site splices to the upstream 3' splice site by conventional pre-mRNA splicing. These circRNAs regulate gene expression by acting as sponges for micro-RNAs or RNA-binding proteins. Here we show that the NR5A1 (previously called Ad4BP or SF-1) gene which is exclusively expressed in the adrenal cortex and steroidogenic tissue can form atypical circRNAs by unconventional splicing. Two stem loops with inositol-requiring protein-1α (IRE1α) cleavage sites are connected by an IRE1α cleavage site to form a circRNA (circIRE RNA). From total RNA of normal human adrenal cortex, we detected a circIRE RNA with connected ends by IRE1α cleavage sites in exon 6 and exon 1 (circIRE NR5A1 ex6-1 RNA). circIRE NR5A1 ex6-1 RNA was not detected in the adrenocortical cancer cell line, H295R. When IRE1α was expressed in H295R cells a different circIRE NR5A1 RNA connecting IRE1-cleavage sites in exon 7 and exon 1 was detected (circIRE NR5A1 ex7-1 RNA). The expression of this circIRE RNA was inhibited by the IRE1 inhibitor 1, STF-083010, implicating that it was formed via the ER stress pathway, where IRE1α is a major factor. This is the first report of this type of circular RNA connected by IRE1-cleavage sites found to be expressed in mammalian cells in a tissue-specific manner. To our surprise, the concomitant expression of NR5A1 was increased by IRE1α implicating that NR5A1 was not subjected to IRE1-dependent decay of mRNA (RIDD) but rather activating a transcriptional regulatory network to cope with ER stress in steroidogenic tissue reminiscent to XBP1 in other tissue. We believe this is the first report of such tissue-specific transcriptional cascade responding to ER stress as well as the novel finding of circular RNAs connected by IRE1α cleavage sites expressed in mammalian tissue.


Assuntos
Córtex Suprarrenal/metabolismo , Endorribonucleases/genética , Proteínas Serina-Treonina Quinases/genética , RNA Circular/biossíntese , RNA Circular/genética , Fator Esteroidogênico 1/genética , Córtex Suprarrenal/citologia , Neoplasias do Córtex Suprarrenal/genética , Neoplasias do Córtex Suprarrenal/metabolismo , Neoplasias do Córtex Suprarrenal/patologia , Sequência de Bases , Sítios de Ligação/genética , Linhagem Celular Tumoral , Estresse do Retículo Endoplasmático , Endorribonucleases/antagonistas & inibidores , Endorribonucleases/metabolismo , Éxons , Expressão Gênica , Humanos , Modelos Biológicos , Proteínas Serina-Treonina Quinases/antagonistas & inibidores , Proteínas Serina-Treonina Quinases/metabolismo , Splicing de RNA , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Sulfonamidas/farmacologia , Tiofenos/farmacologia
16.
Dig Endosc ; 27(3): 303-9, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25357187

RESUMO

BACKGROUND AND AIM: To assess the usefulness of the thread-traction method (TT method) in esophageal endoscopic submucosal dissection (ESD). METHODS: A total of 40 lesions that were scheduled to be treated by esophageal ESD were included in the study. The TT method was used for 20 lesions (group TT) and conventional ESD was used for 20 lesions (group C) after randomization. The hook-knife method was used in all cases. In group TT, after circumferential mucosal incision, a clip with thread was attached to the oral edge of the lesion. RESULTS: ESD was carried out in all cases. Effective countertraction was created by the TT method, and it was possible to carry out an efficient dissection operation. Significant shortening of dissection time was achieved in group TT compared with group C (19.8 min vs 31.8 min, P = 0.044). Mean number of local injections during dissection was significantly less in group TT compared with that in group C (0.6 times vs 2.2 times, P < 0.001). As for the amount of local injection, group TT required significantly less compared with group C (2.6 mL vs 7.5 mL, P < 0.01). No complications were encountered. CONCLUSION: The TT method in esophageal ESD was safe and contributed to shortening of dissection time. The TT method is expected to become widespread as a safe and useful procedure.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Dissecação/instrumentação , Neoplasias Esofágicas/cirurgia , Esofagoscopia/métodos , Mucosa/cirurgia , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Dissecação/métodos , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Mucosa/patologia , Duração da Cirurgia , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/terapia , Segurança do Paciente , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/fisiopatologia , Hemorragia Pós-Operatória/terapia , Medição de Risco , Instrumentos Cirúrgicos , Taxa de Sobrevida , Resultado do Tratamento
17.
J Clin Microbiol ; 51(1): 70-6, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23100338

RESUMO

The capsular antigen detection (CAD) kit is widely used in clinics to detect Streptococcus pneumoniae infection from urine, because it is rapid, convenient, and effective. However, there are several disadvantages, including false-positive results in children colonized with S. pneumoniae and prolonged positive readings even after the bacteria have been cleared. RP-L7/L12 is a component of the 50S ribosome that is abundant in all bacteria and is specific for each bacterial species. We investigated whether RP-L7/L12 could be used to accurately diagnose pneumococcal pneumonia infection in mouse models of pneumonia and colonization generated by infecting CBA/JN or CBA/N mice, respectively, with S. pneumoniae strain 741. RP-L7/L12 detection by enzyme-linked immunosorbent assay accurately assessed active lung infection, as RP-L7/L12 levels decreased simultaneously with the bacterial lung burden after imipenem administration in the pneumonia mouse model. Based on the data, antibodies detecting RP-L7/L12 were applied to rapid immunochromatographic strips (ICS) for urine sample testing. When we compared the ICS test with the CAD kit in the pneumonia model, the results correlated well. Interestingly, however, when the lung bacterial burden became undetectable after antibiotic treatment, the ICS test was correspondingly negative, even though the same samples tested by the CAD kit remained positive. Similarly, while the ICS test exhibited negative results in the nasal colonization model, the CAD kit demonstrated positive results. Bacterial RP-L7/L12 may be a promising target for the development of new methods to diagnose infectious disease. Further studies are warranted to determine whether such a test could be useful in children.


Assuntos
Técnicas Bacteriológicas/métodos , Pneumonia Pneumocócica/diagnóstico , Proteínas Ribossômicas/análise , Streptococcus pneumoniae/química , Streptococcus pneumoniae/isolamento & purificação , Urina/química , Animais , Carga Bacteriana , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática/métodos , Humanos , Pulmão/microbiologia , Camundongos , Camundongos Endogâmicos CBA
18.
Dig Dis Sci ; 58(7): 1985-90, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23504354

RESUMO

BACKGROUND AND AIMS: To prospectively evaluate the role of contrast-enhanced computed tomography (CE-CT) in the detection of colonic diverticular bleeding (CDB). PATIENTS AND METHODS: Consecutive patients who presented with hematochezia and were clinically suspected of CDB were prospectively enrolled. Those who could undergo both CE-CT and total colonoscopy, and who were finally diagnosed as CDB, were included in the analysis. RESULTS: Fifty-two cases were finally included in the analysis. The detection rate of CDB by CT was 15.4 % (8/52). Univariate analysis showed that the interval from the latest episode of hematochezia to the performance of CT and the presence of a past history of CDB were contributing factors for detection. The interval was 1.6 ± 4.6 h (mean ± SD) in patients detected by CT, and 3.4 ± 3.2 h in those without detection. The detection rate of CDB by total colonoscopy was 38.5 % (20/52). The overall detection rate was 46.2 % (24/52), which was superior to what CT or colonoscopy alone achieved. CONCLUSIONS: CE-CT may play a complementary role to colonoscopy in patients with suspected CDB, but is not recommended for all cases due to its low detection rate. Patients who can be examined within 2 h of last hematochezia would be candidates for urgent CT.


Assuntos
Doenças do Colo/diagnóstico por imagem , Colonografia Tomográfica Computadorizada/métodos , Divertículo do Colo/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Tomografia Computadorizada Multidetectores/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Colo/complicações , Colonoscopia , Meios de Contraste , Divertículo do Colo/complicações , Feminino , Humanos , Iopamidol , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos
19.
Nihon Yakurigaku Zasshi ; 158(4): 304-307, 2023.
Artigo em Japonês | MEDLINE | ID: mdl-37394549

RESUMO

As the brain is a prime immune privileged organ, immune responses in it were not studied as intensively as other peripheral organs in the past. However, the brain is studded with immune cells called microglia, which play important roles particularly in diseased conditions. In addition, from recent descriptive works, we have learned a lot about immune cells in neighboring tissues. Recent progress has rather made it clearer that the immune responses in and around the brain are complicated reactions with both positive and negative effects. And we still have not identified the way(s) we should pursue for clinical applications. Here we introduce microglia and macrophages in the steady state. We also discuss their roles in stroke, a major cause of death and disability in Japan, and Alzheimer's disease, which account for 60 to 70% of dementia.


Assuntos
Doença de Alzheimer , Acidente Vascular Cerebral , Humanos , Microglia , Macrófagos/fisiologia , Encéfalo , Doença de Alzheimer/etiologia
20.
J Anus Rectum Colon ; 7(2): 63-73, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37113588

RESUMO

Objectives: The geriatric nutritional risk index (GNRI) is a nutrition-related risk index calculated easily from serum albumin and the ratio of body weight to ideal body weight. We investigated the prognostic values of the GNRI in elderly patients with obstructive colorectal cancer (OCRC) who had a self-expandable metallic stent inserted as a bridge to curative surgery. Methods: We retrospectively evaluated 61 patients aged ≥65 years with pathological stage I to III OCRC. Associations of preoperative GNRI and pre-stenting GNRI (ps-GNRI) with short- and long-term outcomes were examined. Results: Multivariate analyses revealed GNRI of <85.3 and ps-GNRI of <92.9 were independently associated with worse cancer-specific survival (CSS; P = 0.016, and P = 0.041, respectively), and overall survival (OS; P = 0.020, and P = 0.024, respectively). A ps-GNRI of <92.9 was correlated with poorer relapse-free survival (RFS) only in the univariate analysis (P = 0.034). For the OCRC cohort without age restriction (n = 86), GNRI of <85.3 and ps-GNRI of <92.9 were independently associated with worse CSS (P = 0.021), and OS (P = 0.023), respectively. In univariate analysis, ps-GNRI of <92.9 was significantly correlated with poorer RFS (P = 0.006). Moreover, ps-GNRI of <92.9 was significantly associated with Clavien-Dindo grade of ≥III postoperative complications (P = 0.037), anastomotic leak (P = 0.032), infectious complications (P = 0.002), and longer postoperative hospital stay (17 days vs. 15 days; P = 0.048). Conclusions: In OCRC patients, decreased preoperative and pre-stenting GNRI were significantly correlated with poorer survival, and decreased pre-stenting GNRI was significantly associated with worse short- and long-term outcomes.

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