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1.
Clin Radiol ; 76(3): 224-232, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33402260

RESUMO

AIM: To evaluate whether shear-wave velocity (SWV) can be used for predicting the prognoses of patients with colorectal cancer liver metastases (CRLMs) after chemotherapy. MATERIALS AND METHODS: Our institutional review board approved this prospective study, and written informed consent was obtained. SWV of CRLMs were obtained using point shear-wave elastography using acoustic radiation force impulse from 25 patients prior to and 2, 7, and 14 days after chemotherapy. Progression-free survival (PFS) after chemotherapy was estimated using the Kaplan-Meier method. The Cox proportional hazard regression model was used to determine significant predictive factors for PFS. For measurement reproducibility, an additional 37 patients with CRLMs were enrolled and assessed using intraclass correlation coefficients (ICCs). RESULTS: After chemotherapy, 10 and 15 patients were classified into responder and non-responder groups, respectively. The estimated 1- and 3-year PFS values in the whole cohort were 36% and 8%, respectively. A decrease in the SWV value on day 2 relative to the initial value was a significant predictive factor for better PFS outcome (hazard ratio = 0.20, 95% confidence interval = 0.07-0.57, p=0.003). The estimated 1 and 3-year PFS rates were 66.7% and 22.2%, respectively, in nine patients with decreased SWV values on day 2 and significantly higher than 18.8% and 0% of 16 patients with increased SWV values on day 2. The ICC value of SWV of CRLMs in the additional 37 patients was 0.823 (95% CI = 0.685-0.905), indicating good agreement. CONCLUSION: SWV values of CRLMs could provide prognostic information in patients with CRLMs treated with chemotherapy, as decreased SWV values on day 2 after chemotherapy was a significant predictive factor for better PFS.


Assuntos
Neoplasias Colorretais/patologia , Técnicas de Imagem por Elasticidade/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do Tratamento
2.
Eur Radiol ; 29(8): 4303-4314, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30350166

RESUMO

OBJECTIVE: To investigate the incidence of thoracic recurrence and the diagnostic value of chest CT for postoperative surveillance in curatively-resected colorectal cancer (CRC) patients. METHODS: This retrospective study consisted of 648 CRC patients (M:F, 393:255; mean age, 66.2 years) treated with curative surgery between January 2010 and December 2012. The presence of CRC recurrence over follow-ups was analysed and recurrence-free survival and risk factors of recurrence were assessed using Kaplan-Meier analysis with log-rank test and Cox-regression analysis, respectively. RESULTS: Over a median follow-up of 57 months, thoracic recurrence occurred in 8.0% (52/648) of patients with a median recurrence-free survival rate of 19.5 months. Among the 52 patients with thoracic recurrence, 18 (2.7%) had isolated thoracic recurrence, and only five (0.8%) were diagnosed through chest CT. Risk factors of overall thoracic recurrence included age, positive resection margin, presence of venous invasion, positive pathologic N-class, and presence of abdominal recurrence (odds ratio [OR] = 1.78, 19.691, 2.993, 2.502, and 31.137; p = 0.045, 0.004, 0.001, 0.005, and p < 0.001, respectively). As for isolated thoracic recurrence, serum carcinoembryonic antigen level ≥ 5 ng/mL during postoperative follow-up (OR = 9.112; p < 0.001) was demonstrated to be the only predictive factor. There were no thoracic recurrences in patients with CRC stages 0 and I. CONCLUSION: In patients with curatively-resected CRCs, routine surveillance using chest CT may be of limited value, particularly in those with CRC stages 0 or I, as recurrence only detectable through chest CT was shown to be rare. KEY POINTS: • Postoperative thoracic recurrence only detectable through chest CT was shown to be rare. • There were no thoracic recurrences in colorectal cancers stage 0 and I. • Postoperative surveillance chest CT is of limited value in patients with curatively resected colorectal cancers.


Assuntos
Colectomia , Neoplasias Colorretais/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Torácicas/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Idoso , Biomarcadores Tumorais/sangue , Antígeno Carcinoembrionário/sangue , Neoplasias Colorretais/secundário , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Incidência , Masculino , Período Pós-Operatório , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Torácicas/diagnóstico
3.
Mol Cancer Ther ; 16(11): 2528-2542, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29021293

RESUMO

Metastatic breast cancer is still incurable so far; new specifically targeted and more effective therapies for triple-negative breast cancer (TNBC) are required in the clinic. In this study, our clinical data have established that basal and claudin-low subtypes of breast cancer (TNBC types) express significantly higher levels of Annexin A1 (ANXA1) with poor survival outcomes. Using human cancer cell lines that model the TNBC subtype, we observed a strong positive correlation between expression of ANXA1 and PPARγ. A similar correlation between these two markers was also established in our clinical breast cancer patients' specimens. To establish a link between these two markers in TNBC, we show de novo expression of ANXA1 is induced by activation of PPARγ both in vitro and in vivo and it has a predictive value in determining chemosensitivity to PPARγ ligands. Mechanistically, we show for the first time PPARγ-induced ANXA1 protein directly interacts with receptor interacting protein-1 (RIP1), promoting its deubiquitination and thereby activating the caspase-8-dependent death pathway. We further identified this underlying mechanism also involved a PPARγ-induced ANXA1-dependent autoubiquitination of cIAP1, the direct E3 ligase of RIP1, shifting cIAP1 toward proteosomal degradation. Collectively, our study provides first insight for the suitability of using drug-induced expression of ANXA1 as a new player in RIP1-induced death machinery in TNBCs, presenting itself both as an inclusion criterion for patient selection and surrogate marker for drug response in future PPARγ chemotherapy trials. Mol Cancer Ther; 16(11); 2528-42. ©2017 AACR.


Assuntos
Anexina A1/genética , Proteínas Inibidoras de Apoptose/genética , Complexo de Proteínas Formadoras de Poros Nucleares/genética , PPAR gama/genética , Proteínas de Ligação a RNA/genética , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Animais , Caspase 8/genética , Proliferação de Células/genética , Domínio de Morte/genética , Enzimas Desubiquitinantes , Resistencia a Medicamentos Antineoplásicos/genética , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Ligantes , Células MCF-7 , Camundongos , Metástase Neoplásica , Neoplasias de Mama Triplo Negativas/genética , Neoplasias de Mama Triplo Negativas/patologia , Ensaios Antitumorais Modelo de Xenoenxerto
4.
Epidemiol Infect ; 143(3): 515-21, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24866366

RESUMO

In February 2012, an outbreak of gastroenteritis was reported in school A; a successive outbreak was reported at school B. A retrospective cohort study conducted in school A showed that seasoned green seaweed with radishes (relative risk 7·9, 95% confidence interval 1·1-56·2) was significantly associated with illness. Similarly, a case-control study of students at school B showed that cases were 5·1 (95% confidence interval 1·1-24·8) times more likely to have eaten seasoned green seaweed with pears. Multiple norovirus genotypes were detected in samples from students in schools A and B. Norovirus GII.6 isolated from schools A and B were phylogenetically indistinguishable. Green seaweed was supplied by company X, and norovirus GII.4 was isolated from samples of green seaweed. Green seaweed was assumed to be linked to these outbreaks. To our knowledge, this is the first reported norovirus outbreak associated with green seaweed.


Assuntos
Infecções por Caliciviridae/epidemiologia , Surtos de Doenças , Microbiologia de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Gastroenterite/epidemiologia , Norovirus/isolamento & purificação , Ulva , Adolescente , Infecções por Caliciviridae/virologia , Estudos de Casos e Controles , Criança , Estudos de Coortes , Feminino , Doenças Transmitidas por Alimentos/virologia , Gastroenterite/virologia , Genótipo , Humanos , Masculino , Norovirus/classificação , Norovirus/genética , República da Coreia/epidemiologia , Estudos Retrospectivos , Instituições Acadêmicas
5.
Br J Radiol ; 85(1017): e609-15, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22422385

RESUMO

OBJECTIVES: The objective of this study was to determine the in vivo efficacy of radiofrequency ablation (RFA) in porcine liver using Octopus® electrodes for creating a large coagulation compared with RFA using clustered electrodes. METHODS: A total of 39 coagulations were created using a 200-W generator and clustered electrodes or Octopus electrodes during laparotomy in 19 pigs. Radiofrequency was applied to the livers using four protocols: (1) Group A-1, monopolar mode using a clustered electrode (n=11); (2) Group A-2, monopolar mode using an Octopus electrode (n=11); (3) Group B-1, consecutive monopolar mode using three, clustered electrodes (n=8); and (4) Group B-2, switching monopolar mode using two Octopus electrodes (n=9). The energy efficiency, shape, diameters (D) and volume (V) of the coagulation volume were compared in each of the two groups. RESULTS: The mean maximum D and V of the coagulations in Group A-2 (4.7 cm and 33.1 cm(3), respectively) were significantly larger than those in Group A-1 (4.1 cm and 20.3 cm(3), respectively) (p<0.05). Furthermore, the mean minimum D, maximum D and V of the coagulations in Group B-2 were significantly larger than those in Group B-1, i.e. 5.3 vs 4.0 cm, 6.6 vs 4.9 cm and 66.9 vs 30.2 cm(3), respectively (p<0.05). The energy efficiencies were also significantly higher in Groups A-2 and B-2 than in Groups A-1 and B-1 (p<0.05). CONCLUSION: The Octopus electrodes were more efficient for creating a large ablation zone than clustered electrodes, and the efficacy of RFA with Octopus electrodes can be amplified in the switching monopolar mode.


Assuntos
Ablação por Cateter/instrumentação , Eletrodos , Hepatectomia/instrumentação , Fígado/patologia , Fígado/cirurgia , Animais , Desenho de Equipamento , Análise de Falha de Equipamento , Masculino , Suínos
6.
AJNR Am J Neuroradiol ; 33(1): 175-9, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21998105

RESUMO

BACKGROUND AND PURPOSE: Patients with acute CTO generally have a poor prognosis, despite IV or IA thrombolytic treatment. The goal of this study was to analyze the results of patients with CTO who had IA urokinase treatment with or without initial IV rtPA based on a bridging protocol. MATERIALS AND METHODS: Sixteen consecutive patients with acute ischemic stroke due to CTO who had combined IV and IA or a single IA thrombolytic treatment were enrolled. The baseline characteristics and prognosis were described. The patients who did and did not develop a PH shortly after treatment were compared. RESULTS: The mean age was 66.4 years, and the median initial NIHSS score was 17. The median dose of IA urokinase was 320,000 U, and recanalization (TICI grade II-III) was achieved in 12 patients (75%). However, 5 patients died and 10 patients had poor prognosis with mRS 5-6 at discharge. Six patients (37.5%) with a PH had a higher NIHSS score 1 day after treatment (26.7 versus 13.6, P = .002), and they had more frequent mortality (66.7% versus 10.0%, P = .018) and worse prognosis (mRS 5-6; 100% versus 40%, P = .016) at discharge than patients without PH. CONCLUSIONS: Patients with CTO who received IA urokinase treatment based on a bridging protocol had a poor prognosis. The development of PH might affect this outcome.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Ativador de Plasminogênio Tecidual/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Combinada , Feminino , Humanos , Injeções Intra-Arteriais , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Radiografia , Proteínas Recombinantes/administração & dosagem , Resultado do Tratamento
7.
Eur J Neurol ; 18(9): 1151-8, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21299736

RESUMO

BACKGROUND AND PURPOSE: Extensive evidence has shown that oxidative stress mediates neuronal death in animal models of hypoxic-ischaemia. Brain biomarkers of oxidative stress need to be identified in order to better understand and treat brain damage in human stroke patients. The present study was conducted to identify potential target proteins of oxidative stress in the cerebrospinal fluid (CSF) of stroke patients with acute ischaemic brain injury. METHODS: We performed two-dimensional polyacrylamide gel electrophoresis to separate protein samples obtained from the CSF of control and stroke patients. To determine protein oxidation levels, oxyblot was then used to detect protein carbonyls that were determined by formation of a stable 2,4-dinitrophenylhydrazine (DNP) product using an anti-DNP antibody. RESULTS: We found that oxidation of serum albumin was increased in the CSF from stroke patients as well as rats who underwent permanent middle cerebral artery occlusion (6.5%, 23%, respectively). In stroke patients, oxidized albumin levels correlated to neurologic indications. CONCLUSIONS: The present study suggests that oxidized albumin in CSF can be utilized as an oxidative stress marker in human stroke patients.


Assuntos
Biomarcadores/líquido cefalorraquidiano , Estresse Oxidativo/fisiologia , Albumina Sérica/líquido cefalorraquidiano , Acidente Vascular Cerebral/líquido cefalorraquidiano , Animais , Western Blotting , Eletroforese em Gel Bidimensional , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ratos , Ratos Sprague-Dawley
8.
J Neurol Neurosurg Psychiatry ; 80(12): 1390-3, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19917819

RESUMO

BACKGROUND: Acute brainstem infarction with basilar artery (BA) occlusive disease is the most fatal type of all ischaemic strokes. This report investigates the prognostic impact of the posterior communicating artery (PcoA) and whether its anatomy is a safeguard or not. METHODS: Consecutive patients who had acute brainstem infarction with at least 50% stenosis of BA upon CT angiography (CTA) were studied. The configuration of PcoA was divided into two groups upon CTA: "textbook" group (invisible PcoA with good P1 and P2 segment) and "fetal-variant of PcoA" group (only visible PcoA with absent P1 segment). Baseline demographics, radiological findings and stroke mechanisms were analysed. A multiple regression analysis was performed to predict clinical outcome at 30 days (modified Rankin disability Scale (mRS

Assuntos
Infartos do Tronco Encefálico/patologia , Círculo Arterial do Cérebro/patologia , Insuficiência Vertebrobasilar/patologia , Idoso , Infartos do Tronco Encefálico/fisiopatologia , Círculo Arterial do Cérebro/fisiopatologia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Insuficiência Vertebrobasilar/fisiopatologia
9.
Gene Ther ; 16(10): 1234-44, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19626053

RESUMO

Amyotrophic lateral sclerosis (ALS) is the most common adult onset motoneuron disease. The etiology and precise pathogenic mechanisms of the disease remain unknown, and there is no effective treatment. Vascular endothelial growth factor (VEGF) has recently been shown to exert direct neurotrophic and neuroprotective effects in animal models of ALS. Here we show that intrathecal transplantation of immortalized human neural stem cells (NSCs) overexpressing human VEGF gene (HB1.F3.VEGF) significantly delayed disease onset and prolonged the survival of the SOD1G93A mouse model of ALS. At 4 weeks, post-transplantation grafted cells were found within the gray matter of the spinal cord. Furthermore, transplanted F3.VEGF cells that express neuronal phenotype (MAP2+) were found in the anterior horn of the spinal cord gray matter indicating that the transplanted human NSCs migrated into the gray matter, took the correct structural position, integrated into the spinal cord anterior horn and differentiated into motoneurons. Intrathecal transplantation of F3.VEGF cells provides a neuroprotective effect in the diseased spinal cord by concomitant downregulation of proapoptotic proteins and upregulation of antiapoptotic proteins. Our results suggest that this treatment modality of intrathecal transplantation of human NSCs genetically modified to overexpress neurotrophic factor(s) might be of value in the treatment of ALS patients without significant adverse effects.


Assuntos
Esclerose Lateral Amiotrófica/terapia , Neurônios/transplante , Transplante de Células-Tronco/métodos , Fator A de Crescimento do Endotélio Vascular/biossíntese , Esclerose Lateral Amiotrófica/fisiopatologia , Animais , Modelos Animais de Doenças , Sobrevivência de Enxerto , Humanos , Injeções Espinhais , Camundongos , Camundongos Transgênicos , Microscopia de Fluorescência , Atividade Motora/fisiologia , Neurônios Motores/metabolismo , Neurônios/metabolismo , Medula Espinal/metabolismo , Células-Tronco/metabolismo , Análise de Sobrevida , Fator A de Crescimento do Endotélio Vascular/genética
10.
J Neurol Neurosurg Psychiatry ; 80(10): 1087-92, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19414436

RESUMO

OBJECTIVES: The diameters of the vertebral arteries (VAs) are very often unequal. Therefore, this study investigated if unequal VA flow contributes to the development of basilar artery (BA) curvature and if it is a link to the laterality of pontine or cerebellar infarcts occurring around the vertebrobasilar junction. METHODS: Radiological factors were analysed (infarct laterality, VA dominance, BA curvature and their directional relationships) in 91 patients with acute unilateral pontine or posterior inferior cerebellar artery (PICA) territory infarcts. The "dominant" VA side was defined as either that the VA was larger in diameter or the VA was connected with the BA in more of a straight line, if both VAs looked similar in diameter on CT angiography. Multiple regression analysis was performed to predict moderate to severe BA curvature. RESULTS: The dominant VA was more frequent on the left side (p<0.01). Most patients had an opposite directional relationship between the dominant VA and BA curvature (p<0.01). Pontine infarcts were opposite to the side of BA curvature (p<0.01) and PICA infarcts were on the same side as the non-dominant VA side (p<0.01). The difference in VA diameters was the single independent predictor for moderate to severe BA curvature (OR per 1 mm, 2.70; 95% CI 1.22 to 5.98). CONCLUSIONS: Unequal VA flow is an important haemodynamic contributor of BA curvature and development of peri-vertebrobasilar junctional infarcts.


Assuntos
Artéria Basilar/patologia , Artéria Basilar/fisiopatologia , Infartos do Tronco Encefálico/etiologia , Artéria Vertebral/patologia , Artéria Vertebral/fisiopatologia , Insuficiência Vertebrobasilar/etiologia , Idoso , Infartos do Tronco Encefálico/patologia , Infartos do Tronco Encefálico/fisiopatologia , Estudos de Casos e Controles , Cerebelo/irrigação sanguínea , Cerebelo/patologia , Estudos de Coortes , Dilatação Patológica/complicações , Dilatação Patológica/patologia , Dilatação Patológica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Insuficiência Vertebrobasilar/patologia , Insuficiência Vertebrobasilar/fisiopatologia
11.
Clin Pharmacol Ther ; 83(5): 723-30, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-17898702

RESUMO

We evaluated the feasibility and safety of therapy with mesenchymal stem cells (MSCs) through consecutively intra-arterial and three repeated intravenous injections and compared the long-term prognosis between MSC-treated (n=11) and control multiple system atrophy (MSA) patients (n=18). The MSC-treated patients showed significantly greater improvement on the unified MSA rating scale (UMSARS) than the control patients at all visits throughout the 12-month study period. Orthostasis in UMSARS I items and cerebellar dysfunction-related items of UMSARS II items were significantly different in favor of MSC treatment compared to controls. Serial positron emission tomography scan in the MSC-treated group showed that increased fluorodeoxyglucose uptake from baseline was noted in cerebellum and frontal white matters. No serious adverse effects related to MSC therapy occurred. This study demonstrated that MSC therapy in patients with MSA was safe and delayed the progression of neurological deficits with achievement of functional improvement in the follow-up period.


Assuntos
Transplante de Células-Tronco Mesenquimais , Atrofia de Múltiplos Sistemas/cirurgia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Progressão da Doença , Estudos de Viabilidade , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Pessoa de Meia-Idade , Atrofia de Múltiplos Sistemas/diagnóstico por imagem , Atrofia de Múltiplos Sistemas/patologia , Tomografia por Emissão de Pósitrons , Estudos Prospectivos
12.
J Neural Transm (Vienna) ; 113(10): 1435-9, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16465458

RESUMO

alpha-Synuclein, a synaptic protein of unknown function, is a major component of Lewy bodies and may play a role in the pathophysiological process of Parkinson's disease (PD). In this study, we measured the plasma alpha-synuclein levels in 105 patients with PD, 38 patients with multiple system atrophy (MSA), and 51 age-matched controls. The alpha-synuclein level was significantly elevated in patients with PD (79.9 +/- 4.0 pg/ml, p < 0.001) and in those with MSA (78.1 +/- 3.5 pg/ml, p = 0.019) compared with the level in controls (76.1 +/- 3.9 pg/ml). The alpha-synuclein level was higher in patients with PD than in those with MSA (79.9 +/- 4.0 vs 78.1 +/- 3.5, p = 0.016). Our study demonstrated that the alpha-synuclein level in plasma is elevated in patients with PD and MSA.


Assuntos
Atrofia de Múltiplos Sistemas/sangue , Doença de Parkinson/sangue , alfa-Sinucleína/sangue , Adulto , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
J Neurol Neurosurg Psychiatry ; 76(12): 1659-63, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16291890

RESUMO

BACKGROUND AND PURPOSE: The pathogenesis of deep white matter medullary (WMM) artery infarcts remains controversial. To address this question, we analysed the stroke patterns of WMM infarcts using diffusion weighted magnetic resonance imaging (DWI) to detect embolic signals and investigate stroke subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classifications. METHODS: We identified WMM infarcts on DWI using templates to determine the subcortical vascular territories. We classified WMM infarcts into those with small artery disease (SAD), large artery disease (LAD), cardioembolism (CE), two or more aetiologies, or undetermined aetiology. Clinical course, risk factors, and cortical spotty lesions were compared. RESULTS: Of the 1420 consecutive patients, 103 (7.3%) met the criteria for WMM infarcts. The stroke subtypes were as follows: 65 (63.1%) patients with LAD, 18 (17.5%) with SAD, 12 (11.7%) with CE, four (3.9%) with two or more aetiologies, three (2.1%) with undetermined aetiology, and one (1.0%) with other determined aetiology. LAD (87.7%) or CE (83.3%) was significantly accompanied by cortical embolic signals as compared to SAD (0%, p<0.001). The LAD infarcts were larger and tended to be chain-like in shape. Ischaemic stroke recurrence was more common in strokes with cortical embolic signals than in those without embolic signals (18.9% v 0%, p = 0.009). CONCLUSIONS: In present study, the most common pathogenesis of WMM infarcts was LAD. Our study indicates that WMM infarcts accompanying cortical embolic signals warrant evaluation of the underlying embolic sources in the large artery or the heart.


Assuntos
Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/fisiopatologia , Bulbo/irrigação sanguínea , Bulbo/patologia , Idoso , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Embolia Intracraniana , Masculino , Pessoa de Meia-Idade , Radiografia , Fatores de Risco
14.
Neurology ; 65(2): 296-8, 2005 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-16043803

RESUMO

To investigate the impact of metabolic syndrome (MetSD) on the development of intracranial atherosclerotic stroke, the authors evaluated the components of the MetSD in 512 patients with stroke. The MetSD was observed most frequently in patients with intracranial atherosclerosis (p = 0.007). In multiple regression analysis, the MetSD, but not conventional risk factors, was independently associated with intracranial atherosclerosis (p = 0.005). The results suggest that treatment of metabolic abnormalities may be an important prevention strategy for intracranial atherosclerosis.


Assuntos
Arteriosclerose Intracraniana/epidemiologia , Síndrome Metabólica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Angiografia Digital , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Encéfalo/fisiopatologia , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Artérias Carótidas/metabolismo , Artérias Carótidas/patologia , Artérias Carótidas/fisiopatologia , Artérias Cerebrais/metabolismo , Artérias Cerebrais/patologia , Artérias Cerebrais/fisiopatologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Arteriosclerose Intracraniana/fisiopatologia , Angiografia por Ressonância Magnética , Masculino , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Acidente Vascular Cerebral/fisiopatologia
15.
J Neurol Neurosurg Psychiatry ; 76(8): 1128-34, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16024892

RESUMO

BACKGROUND: The apparent differences in risk factors for intra- and extracranial atherosclerosis are unclear and the mechanisms that underlie strokes in patients with intracranial atherosclerosis are not well known. We investigated the conventional vascular risk factors as well as other factors in stroke patients with large artery atherosclerosis. METHODS: Using diffusion weighted imaging (DWI) and vascular and cardiologic studies, we selected patients with acute non-cardioembolic cerebral infarcts within the middle cerebral artery (MCA) territory. Patients were divided into two groups: those with atherosclerotic lesions on the carotid sinus (n = 112) and those with isolated lesions on the proximal MCA (n = 160). Clinical features, risk factors, and DWI patterns were compared between groups. RESULTS: There were no differences in conventional risk factors, but markers for inflammation were significantly higher in patients with carotid atherosclerosis than in those with isolated MCA atherosclerosis (p < 0.01 for both). After adjustments for age/sex and the severity of stroke, an inverse correlation was observed between C-reactive protein levels and MCA atherosclerosis (odds ratio 0.57 per 1 mg/dl increase; 95% confidence interval 0.35 to 0.92; p = 0.02). Internal borderzone infarcts suggestive of haemodynamic causes were the most frequent DWI pattern in patients with MCA occlusion, whereas territorial infarcts suggesting plaque ruptures were most common in those with carotid occlusion. CONCLUSIONS: Our results indicate that inflammatory markers, rather than conventional risk factors, reveal clinical and radiological differences between patients with carotid and MCA atherosclerosis. Plaques associated with MCA atherosclerosis may be more stable than those associated with carotid atherosclerosis.


Assuntos
Proteína C-Reativa/metabolismo , Doenças das Artérias Carótidas/metabolismo , Doenças das Artérias Carótidas/patologia , Fibrinogênio/metabolismo , Infarto da Artéria Cerebral Média/metabolismo , Arteriosclerose Intracraniana/metabolismo , Arteriosclerose Intracraniana/patologia , Artéria Cerebral Média/patologia , Doença Aguda , Adulto , Idoso , Doenças das Artérias Carótidas/epidemiologia , Intervalos de Confiança , Feminino , Hemodinâmica/fisiologia , Hospitalização , Humanos , Infarto da Artéria Cerebral Média/epidemiologia , Infarto da Artéria Cerebral Média/patologia , Arteriosclerose Intracraniana/epidemiologia , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
16.
Neurology ; 62(8): 1291-6, 2004 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-15111664

RESUMO

OBJECTIVE: To compare clinical and radiologic characteristics of atherosclerotic middle cerebral artery (MCA) vs internal carotid artery (ICA) disease. METHODS: The authors defined atherosclerotic MCA and ICA disease as >50% symptomatic stenosis or occlusion without significant ICA and MCA stenosis on MR angiography. Patients with potential cardiac sources of embolism were excluded. The authors analyzed clinical, laboratory, and neuroradiologic data of the two groups. RESULTS: Among the 920 consecutive patients with acute ischemic strokes, 112 met the criteria for atherosclerotic MCA and 71 met the criteria for ICA disease. Clinically, the MCA group more frequently presented with lacunar syndrome (p = 0.001), whereas the ICA group more often presented with total anterior circulation infarct and had higher initial NIH Stroke Scale scores than the MCA group (all p < 0.001). Whereas deep perforator and internal border-zone infarcts were associated with MCA disease (p < 0.001 and 0.012), territorial infarcts and superficial perforator infarcts were associated with ICA disease (p < 0.001 and p = 0.009). The topographic patterns with respect to the degree of stenosis were also significantly different between the two groups. CONCLUSIONS: The clinical and radiologic stroke patterns were distinctively different between atherosclerotic MCA and ICA disease, suggesting different underlying pathogeneses.


Assuntos
Isquemia Encefálica/diagnóstico , Doenças das Artérias Carótidas , Doenças das Artérias Carótidas/diagnóstico , Infarto da Artéria Cerebral Média/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Doença Aguda , Isquemia Encefálica/etiologia , Doenças das Artérias Carótidas/complicações , Artéria Carótida Interna/patologia , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Infarto da Artéria Cerebral Média/complicações , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/patologia , Variações Dependentes do Observador , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/etiologia , Grau de Desobstrução Vascular
17.
J Neurol Neurosurg Psychiatry ; 75(5): 727-32, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15090568

RESUMO

BACKGROUND: Isolated atherosclerotic middle cerebral artery (MCA) disease is often difficult to differentiate from cardioembolic disease if intracranial atherosclerosis coexists with cardiac disease. OBJECTIVES: To evaluate whether clinical and neuroradiological features of isolated MCA disease differ according to the underlying aetiology. METHODS: Isolated MCA disease was defined as a unilateral angiographically occlusive lesion of the MCA on the symptomatic side without lesions of other intracranial or extracranial vessels. Patients with isolated MCA disease were divided into atherosclerotic and potentially cardioembolic, and the clinical, laboratory, and neuroradiological data analysed. RESULTS: Among the 850 consecutive patients with acute ischaemic stroke or transient ischaemic attack, 107 (12.6%) met the criteria for isolated MCA disease (76 with atherosclerotic disease and 31 with a potential source of cardiac embolism). Total anterior circulation infarcts were more common and baseline NIHSS score was higher in potentially embolic occlusions than in atherosclerotic disease (each p<0.001). While cortical infarcts and territorial infarcts were more common in the potential embolism group (p = 0.028 and p<0.001, respectively), subcortical border zone infarcts were more common in the atherosclerotic group (p<0.001). Multiple regression analysis showed that border zone infarcts and mild stroke were independently associated with atherosclerotic MCA disease, while territorial and cortical infarcts were associated with potential cardiac embolic disease. CONCLUSIONS: Clinical and neuroradiological characteristics can differentiate isolated atherosclerotic MCA disease from MCA disease associated with potential sources of cardiac embolism, and may reflect the differences in underlying pathogenesis.


Assuntos
Encéfalo/irrigação sanguínea , Infarto da Artéria Cerebral Média/diagnóstico , Arteriosclerose Intracraniana/diagnóstico , Doença Aguda , Encéfalo/patologia , Feminino , Humanos , Infarto da Artéria Cerebral Média/patologia , Arteriosclerose Intracraniana/patologia , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/patologia , Angiografia por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Patient Educ Couns ; 49(1): 13-8, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12527148

RESUMO

The objective of this study was to evaluate the impact of a pharmaceutical care program on children with asthma. A comprehensive asthma education and monitoring program that includes basic asthma knowledge, symptoms and exacerbation evaluation, pharmacotherapy assessment including inhaler technique, and quality of life measurements was developed and applied in an outpatient paediatric clinic of the Catholic University of Chile. All patients with moderate asthma scheduled for outpatient visits with their internist over a 1-year period were referred for pharmacist intervention. Patients (aged 7-17) with moderate asthma attending the clinic were allocated to the intervention (group A) or control group (group B). Intervention patients were educated on their disease, pharmacotherapy, self-management, and inhalation techniques. The group B were children with their regular treatment for asthma but without pharmaceutical intervention. A paediatric asthma quality of life questionnaire (PAQLQ) was applied to both groups at 0, 2, and 9 weeks to assess the quality of life. Spirometry was done at the beginning and at the completion of the 9-week study. Beta-agonists used by each patient were also recorded. Eleven children (10.0+/-0.7 years) were included in the pharmaceutical care program, and ten children (9.9+/-0.6 years) in group B. For the individual domains of activities (A), emotions (E), and symptoms (S) there was a significant improvement in the children who received pharmaceutical care in comparison with those who did not receive it. The scores of group B did not change during the 9 weeks of follow-up. There were no significant changes in spirometric values in either group.


Assuntos
Asma/prevenção & controle , Educação de Pacientes como Assunto/organização & administração , Farmacêuticos/organização & administração , Qualidade de Vida , Análise de Variância , Asma/psicologia , Criança , Chile , Monitoramento de Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Cooperação do Paciente/psicologia , Farmacêuticos/psicologia , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida/psicologia , Autocuidado , Inquéritos e Questionários
19.
J Neurosci Res ; 66(1): 117-21, 2001 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-11599008

RESUMO

We have recently shown that cholinergic effects on synaptic transmission and plasticity in the superficial (II/III) layers of the rat medial entorhinal cortex (EC) are similar, but not identical, to those in the hippocampus (Yun et al. [2000] Neuroscience 97:671-676). Because the superficial and deep layers of the EC preferentially convey afferent and efferent hippocampal projections, respectively, it is of interest to compare cholinergic effects between the two regions. We therefore investigated the physiological effects of cholinergic agents in the layer V of medial EC slices under experimental conditions identical to those in the previous study. Bath application of carbachol (0.5 microM) induced transient depression of field potential responses in all cases tested (30 of 30; 18.5% +/- 2.3%) and rarely induced long-lasting potentiation (only 3 of 30; 20.4% +/- 3.2% in successful cases). At 5 microM, carbachol induced transient depression only (20 of 20, 48.9% +/- 2.8%), which was blocked by atropine (10 microM). Paired-pulse facilitation was enhanced during carbachol-induced depression, suggesting presynaptic action of carbachol. Long-term potentiation (LTP) could be induced in the presence of 10 microM atropine by theta burst stimulation, but its magnitude was significantly lower (9.1% +/- 4.7%, n = 15) compared to LTP in control slices (22.4% +/- 3.9%, n = 20). These results, combined with our previous findings, demonstrate remarkably similar cholinergic modulation of synaptic transmission and plasticity across the superficial and deep layers of EC.


Assuntos
Acetilcolina/fisiologia , Córtex Entorrinal/fisiologia , Potenciação de Longa Duração/fisiologia , Sinapses/fisiologia , Animais , Atropina/farmacologia , Carbacol/farmacologia , Agonistas Colinérgicos/farmacologia , Potenciação de Longa Duração/efeitos dos fármacos , Masculino , Antagonistas Muscarínicos/farmacologia , Técnicas de Cultura de Órgãos , Ratos , Ratos Sprague-Dawley , Receptores Muscarínicos/fisiologia , Transmissão Sináptica/efeitos dos fármacos , Transmissão Sináptica/fisiologia
20.
J Neurosci Res ; 63(6): 509-15, 2001 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-11241586

RESUMO

We investigated the cognition enhancing effects of ginsenoside Rb1 and Rg1. Mice were trained in a Morris water maze following injection (i.p.) of Rb1 (1 mg/kg) or Rg1 (1 mg/kg) for 4 days. Both Rb1- and Rg1-injected mice showed enhanced spatial learning compared to control animals. The hippocampus, but not the frontal cortex, of treated mice contained higher density of a synaptic marker protein, synaptophysin, compared to control mice. Electrophysiological recordings in hippocampal slices revealed that Rb1 or Rg1 injection did not change the magnitude of paired-pulse facilitation or long-term potentiation. Our results suggest that Rb1 and Rg1 enhance spatial learning ability by increasing hippocampal synaptic density without changing plasticity of individual synapses.


Assuntos
Fármacos do Sistema Nervoso Central/farmacologia , Hipocampo/metabolismo , Aprendizagem em Labirinto/efeitos dos fármacos , Saponinas/farmacologia , Sinaptofisina/metabolismo , Animais , Cognição/efeitos dos fármacos , Eletrofisiologia , Ginsenosídeos , Hipocampo/efeitos dos fármacos , Potenciação de Longa Duração/efeitos dos fármacos , Memória/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos C57BL , Percepção Espacial/efeitos dos fármacos , Sinapses/efeitos dos fármacos , Sinapses/fisiologia
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