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1.
J Oral Maxillofac Surg ; 80(11): 1731-1739, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35952723

RESUMO

Dental occlusion ties (Minne Ties®) are a new example of the concept of an oral zip tie used to establish maxillomandibular fixation (MMF). Each tie uses a blunt introducer that is easily passed between embrasures and fed through a self-locking, unidirectional clasp. Five to six ties are used to establish MMF. They are fast, easy to use, and relatively safe because there are no sharps or wires associated with their use. The authors report their experience using this MMF method for temporomandibular joint replacement surgery, where over the last 2 years, over 65 collective cases have been completed using this method.


Assuntos
Fios Ortopédicos , Oclusão Dentária , Técnicas de Fixação da Arcada Osseodentária , Fraturas Mandibulares , Articulação Temporomandibular , Humanos , Fraturas Mandibulares/cirurgia , Articulação Temporomandibular/cirurgia
2.
BMJ Open ; 12(7): e058782, 2022 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-35790333

RESUMO

INTRODUCTION: Opioid analgesics are often used to treat moderate-to-severe acute non-cancer pain; however, there is little high-quality evidence to guide clinician prescribing. An essential element to developing evidence-based guidelines is a better understanding of pain management and pain control among individuals experiencing acute pain for various common diagnoses. METHODS AND ANALYSIS: This multicentre prospective observational study will recruit 1550 opioid-naïve participants with acute pain seen in diverse clinical settings including primary/urgent care, emergency departments and dental clinics. Participants will be followed for 6 months with the aid of a patient-centred health data aggregating platform that consolidates data from study questionnaires, electronic health record data on healthcare services received, prescription fill data from pharmacies, and activity and sleep data from a Fitbit activity tracker. Participants will be enrolled to represent diverse races and ethnicities and pain conditions, as well as geographical diversity. Data analysis will focus on assessing patients' patterns of pain and opioid analgesic use, along with other pain treatments; associations between patient and condition characteristics and patient-centred outcomes including resolution of pain, satisfaction with care and long-term use of opioid analgesics; and descriptive analyses of patient management of leftover opioids. ETHICS AND DISSEMINATION: This study has received approval from IRBs at each site. Results will be made available to participants, funders, the research community and the public. TRIAL REGISTRATION NUMBER: NCT04509115.


Assuntos
Dor Aguda , Analgésicos Opioides , Manejo da Dor , Assistência Centrada no Paciente , Dor Aguda/tratamento farmacológico , Dor Aguda/etiologia , Analgésicos Opioides/uso terapêutico , Serviço Hospitalar de Emergência , Humanos , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Transtornos Relacionados ao Uso de Opioides , Manejo da Dor/métodos , Assistência Centrada no Paciente/métodos , Estudos Prospectivos
3.
JAMA Ophthalmol ; 139(4): 406-413, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33599705

RESUMO

IMPORTANCE: Frozen section temporal artery biopsy (TAB) may prevent a contralateral biopsy from being performed. OBJECTIVE: To evaluate the sensitivity and specificity of TAB frozen vs permanent section pathology results for giant cell arteritis (GCA) and determine the discordance rate of bilateral TABs. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, medical records were reviewed from 795 patients 40 years or older who underwent TAB from January 1, 2010, to December 1, 2018, treated at a single tertiary care center with the ability to perform both frozen and permanent histologic sections. Data were analyzed from January 2019 to December 2020. MAIN OUTCOMES AND MEASURES: Sensitivity and specificity of frozen section TAB for detecting GCA, and discordance rates of bilateral permanent section TAB. RESULTS: Of the 795 included participants, 329 (41.4%) were male, and the mean (SD) age was 72 (10) years. From the 795 patients with 1162 TABs, 119 patients (15.0%) and 138 TABs had positive findings on permanent section. Of these 119 patients, 103 (86.6%) also had positive results on the frozen section, with 4 false-positives (0.6%) and 20 false-negatives (16.8%). Frozen section had a specificity of 99.4% (95% CI, 98.5-99.8), sensitivity of 83.2% (95% CI, 75.2-89.4), positive predictive value of 96.1% (95% CI, 90.4-98.9), negative predictive value of 96.6% (95% CI, 94.9-97.8), positive likelihood ratio of 140.6 (95% CI, 72.7-374.8), and a negative likelihood ratio of 0.17 (95% CI, 0.11-0.25). Simultaneous bilateral TABs were performed in 60 patients (7.5%) with a 5% discordance rate on permanent section. In comparison, bilateral frozen section-guided sequential TABs were performed in 307 patients (38.6%) with 5.5% discordance based on permanent section. In multivariate models, there was a greater odds of positive findings with age (odds ratio [OR], 1.04; 95% CI, 1.01-1.07; P = .008), vision loss (OR, 2.72; 95% CI, 1.25-5.75; P = .01), diplopia (OR, 3.33; 95% CI, 1.00-10.29; P = .04), headache (OR, 2.32; 95% CI, 1.25-4.53; P = .01), weight loss (OR, 2.37; 95% CI, 1.26-4.43; P = .007), and anorexia (OR, 5.65; 95% CI, 2.70-11.89; P < .001). CONCLUSIONS AND RELEVANCE: These results support the hypothesis that negative findings from frozen sections should not be solely relied on to refute the diagnosis of GCA, whereas positive findings from frozen sections can be reliably used to defer a contralateral biopsy pending the permanent section results.


Assuntos
Secções Congeladas , Arterite de Células Gigantes , Idoso , Biópsia/métodos , Feminino , Arterite de Células Gigantes/diagnóstico , Humanos , Masculino , Estudos Retrospectivos , Artérias Temporais/patologia
4.
J Clin Invest ; 117(7): 1995-2003, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17571165

RESUMO

Insulin resistance is a major factor in the pathogenesis of type 2 diabetes and is strongly associated with obesity. Increased concentrations of intracellular fatty acid metabolites have been postulated to interfere with insulin signaling by activation of a serine kinase cascade involving PKCtheta in skeletal muscle. Uncoupling protein 3 (UCP3) has been postulated to dissipate the mitochondrial proton gradient and cause metabolic inefficiency. We therefore hypothesized that overexpression of UCP3 in skeletal muscle might protect against fat-induced insulin resistance in muscle by conversion of intramyocellular fat into thermal energy. Wild-type mice fed a high-fat diet were markedly insulin resistant, a result of defects in insulin-stimulated glucose uptake in skeletal muscle and hepatic insulin resistance. Insulin resistance in these tissues was associated with reduced insulin-stimulated insulin receptor substrate 1- (IRS-1-) and IRS-2-associated PI3K activity in muscle and liver, respectively. In contrast, UCP3-overexpressing mice were completely protected against fat-induced defects in insulin signaling and action in these tissues. Furthermore, these changes were associated with a lower membrane-to-cytosolic ratio of diacylglycerol and reduced PKCtheta activity in whole-body fat-matched UCP3 transgenic mice. These results suggest that increasing mitochondrial uncoupling in skeletal muscle may be an excellent therapeutic target for type 2 diabetes mellitus.


Assuntos
Regulação da Expressão Gênica , Resistência à Insulina , Canais Iônicos/metabolismo , Metabolismo dos Lipídeos , Proteínas Mitocondriais/metabolismo , Músculo Esquelético/metabolismo , Proteínas Quinases Ativadas por AMP , Envelhecimento/fisiologia , Animais , Ativação Enzimática , Hormônios/sangue , Humanos , Insulina/sangue , Canais Iônicos/genética , Isoenzimas/metabolismo , Masculino , Camundongos , Camundongos Transgênicos , Proteínas Mitocondriais/genética , Complexos Multienzimáticos/metabolismo , Proteína Quinase C/metabolismo , Proteína Quinase C-theta , Proteínas Serina-Treonina Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Proteína Desacopladora 3 , Aumento de Peso
5.
J Clin Invest ; 114(6): 823-7, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15372106

RESUMO

Insulin resistance plays a primary role in the development of type 2 diabetes and may be related to alterations in fat metabolism. Recent studies have suggested that local accumulation of fat metabolites inside skeletal muscle may activate a serine kinase cascade involving protein kinase C-theta (PKC-theta), leading to defects in insulin signaling and glucose transport in skeletal muscle. To test this hypothesis, we examined whether mice with inactivation of PKC-theta are protected from fat-induced insulin resistance in skeletal muscle. Skeletal muscle and hepatic insulin action as assessed during hyperinsulinemic-euglycemic clamps did not differ between WT and PKC-theta KO mice following saline infusion. A 5-hour lipid infusion decreased insulin-stimulated skeletal muscle glucose uptake in the WT mice that was associated with 40-50% decreases in insulin-stimulated tyrosine phosphorylation of insulin receptor substrate-1 (IRS-1) and IRS-1-associated PI3K activity. In contrast, PKC-theta inactivation prevented fat-induced defects in insulin signaling and glucose transport in skeletal muscle. In conclusion, our findings demonstrate that PKC-theta is a crucial component mediating fat-induced insulin resistance in skeletal muscle and suggest that PKC-theta is a potential therapeutic target for the treatment of type 2 diabetes.


Assuntos
Tecido Adiposo/fisiologia , Resistência à Insulina/genética , Isoenzimas/deficiência , Isoenzimas/genética , Proteína Quinase C/deficiência , Proteína Quinase C/genética , Animais , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/terapia , Ácidos Graxos não Esterificados/sangue , Infusões Intravenosas , Insulina/sangue , Insulina/fisiologia , Proteínas Substratos do Receptor de Insulina , Isoenzimas/uso terapêutico , Lipídeos/administração & dosagem , Lipídeos/farmacologia , Camundongos , Camundongos Knockout , Músculo Esquelético/fisiologia , Fosfoproteínas/metabolismo , Fosforilação , Proteína Quinase C/uso terapêutico , Proteína Quinase C-theta , Transdução de Sinais/genética , Transdução de Sinais/fisiologia
6.
J Clin Invest ; 113(5): 756-63, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-14991074

RESUMO

Insulin resistance in skeletal muscle plays a major role in the development of type 2 diabetes and may be causally associated with increases in intramuscular fatty acid metabolites. Fatty acid transport protein 1 (FATP1) is an acyl-CoA synthetase highly expressed in skeletal muscle and modulates fatty acid uptake and metabolism by converting fatty acids into fatty acyl-CoA. To investigate the role of FATP1 in glucose homeostasis and in the pathogenesis of insulin resistance, we examined the effect of acute lipid infusion or chronic high-fat feeding on insulin action in FATP1 KO mice. Whole-body adiposity, adipose tissue expression of adiponectin, intramuscular fatty acid metabolites, and insulin sensitivity were not altered in FATP1 KO mice fed a regular chow diet. In contrast, FATP1 deletion protected the KO mice from fat-induced insulin resistance and intramuscular accumulation of fatty acyl-CoA without alteration in whole-body adiposity. These findings demonstrate an important role of intramuscular fatty acid metabolites in causing insulin resistance and suggest that FATP1 may be a novel therapeutic target for the treatment of insulin resistance and type 2 diabetes.


Assuntos
Tecido Adiposo/metabolismo , Proteínas de Transporte/fisiologia , Peptídeos e Proteínas de Sinalização Intercelular , Proteínas de Membrana Transportadoras , Músculo Esquelético/patologia , Adiponectina , Animais , Glicemia/metabolismo , Proteínas de Transporte/metabolismo , Diabetes Mellitus Tipo 2 , Proteínas de Transporte de Ácido Graxo , Ácidos Graxos/metabolismo , Feminino , Deleção de Genes , Regulação da Expressão Gênica , Glucose/metabolismo , Insulina/metabolismo , Resistência à Insulina , Masculino , Camundongos , Camundongos Knockout , Modelos Genéticos , Músculo Esquelético/metabolismo , Técnicas de Patch-Clamp , Fenótipo , Proteínas/metabolismo , Transdução de Sinais
7.
Diabetes ; 52(6): 1311-8, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12765938

RESUMO

To determine the role of adipocytes and the tissue-specific nature in the insulin sensitizing action of rosiglitazone, we examined the effects of 3 weeks of rosiglitazone treatment on insulin signaling and action during hyperinsulinemic-euglycemic clamps in awake A-ZIP/F-1 (fatless), fat-transplanted fatless, and wild-type littermate mice. We found that 53 and 66% decreases in insulin-stimulated glucose uptake and insulin receptor substrate (IRS)-1-associated phosphatidylinositol (PI) 3-kinase activity in skeletal muscle of fatless mice were normalized after rosiglitazone treatment. These effects of rosiglitazone treatment were associated with 50% decreases in triglyceride and fatty acyl-CoA contents in the skeletal muscle of rosiglitazone-treated fatless mice. In contrast, rosiglitazone treatment exacerbated hepatic insulin resistance in the fatless mice and did not affect already reduced IRS-2-associated PI 3-kinase activity in liver. The worsening of insulin action in liver was associated with 30% increases in triglyceride and fatty acyl-CoA contents in the liver of rosiglitazone-treated fatless mice. In conclusion, these data support the hypothesis that rosiglitazone treatment enhanced insulin action in skeletal muscle mostly by its ability to repartition fat away from skeletal muscle.


Assuntos
Resistência à Insulina/fisiologia , Fígado/metabolismo , Músculo Esquelético/metabolismo , Tiazóis/farmacologia , Tiazolidinedionas , Adipócitos/efeitos dos fármacos , Adipócitos/metabolismo , Tecido Adiposo/efeitos dos fármacos , Tecido Adiposo/metabolismo , Tecido Adiposo/transplante , Animais , Glicemia/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Feminino , Técnica Clamp de Glucose , Hipoglicemiantes/farmacologia , Insulina/sangue , Fígado/efeitos dos fármacos , Masculino , Camundongos , Camundongos Mutantes , Músculo Esquelético/efeitos dos fármacos , Rosiglitazona
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