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1.
Ann Otol Rhinol Laryngol ; 132(12): 1617-1620, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37246364

RESUMO

INTRODUCTION: The anterior ethmoidal artery (AEA) flap has been demonstrated to be a reliable option for endoscopic repair of symptomatic nasal septal perforations. The purpose of this study is to study the outcome of this technique. METHODS: A retrospective case series of all consecutive patients who underwent repair of nasal septal perforation utilizing the AEA flap among 2 institutions from August 2020 to July of 2022 was conducted. Demographics and comorbidities were collected preoperatively and postoperatively. The main outcome of this study was to identify the risk factors for surgical failure. RESULTS: Forty-one patients were included. Mean perforation size was 2.2 cm (range 0.5-4.5 cm). Mean age was 42.5 years (range 14-65 years), 53.6% were female, 39% were active smokers, mean body-mass-index (BMI) was 31.9 (range 19.1-45.5), 20% with history of CRS and 31.7% had diabetes mellitus (DM). Etiologies of the perforation included idiopathic (n = 12), iatrogenic (n = 13), intranasal drug use (n = 7), trauma (n = 6), and secondary to tumor resection (n = 3). Overall success rate for complete closure was 73.2%. Active smoking, history of intranasal drug use, and DM were significantly associated with surgical failure (72.7%vs 26.7%, P = .007; 36.4%vs 10%, P = .047; and 63.6%vs 20%, P = .008 respectively). CONCLUSION: The endoscopic AEA flap is a reliable technique for closure of nasal septal perforation. It may not work when the etiology is intranasal drug use. Close attention to diabetes and smoking status is also needed.


Assuntos
Perfuração do Septo Nasal , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Masculino , Perfuração do Septo Nasal/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Retalhos Cirúrgicos , Septo Nasal/cirurgia , Septo Nasal/patologia
4.
J Neurol Surg B Skull Base ; 83(Suppl 2): e521-e529, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35832934

RESUMO

Objective Osteoradionecrosis (ORN) of the skull base can have catastrophic consequences if not detected early and managed appropriately. This is a systematic review of the different treatment modalities for skull base ORN and their outcomes. Study Design This study is a systematic review. Materials and Methods Two researchers extracted information including patient population, surgical technique, outcomes of interest, and study design. A computerized search of Medline, Embase, and the Cochrane library (January 1990-June 2020) looked for several papers on the subject of skull base ORN. Results A total of 29 studies had met inclusion criteria, including data from 333 patients. Nasopharyngeal carcinoma was the most common primary tumor (85%). Average age at diagnosis of ORN was 55.9 years (range = 15-80 years) and 72.3% of patients were males. The average time to diagnosis of ORN after radiation therapy was 77 months with an average radiation dose of 76.2 Gy (range = 46-202 Gy). Nighty-eight patients (29.4%) also had chemotherapy as part of their treatment regimen. Although all parts of the central skull base were reported to be involved, the clivus and sphenoid bone were the most commonly reported subsites. Trial of medical treatment had a success rate of 41.1%. About 66% of patients needed surgical treatment, either primarily or after failing medical treatment. Success rate was 77.3%. Overall, the surgical treatment was superior to medical treatment ( p < 0.0001). Conclusion ORN is a rare complication of the treatment of skull base tumors. Most cases require surgical treatment, including endoscopic debridement or free flap reconstruction, which has a high success rate. Level of Evidence Level 3 evidence as a systematic review of case studies, case reports, retrospective, and prospective trials with no blinding or controls.

5.
Am J Otolaryngol ; 43(1): 103227, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34563805

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) in the setting of Aspirin Exacerbated Respiratory Disease (AERD) have high rate of treatment failure and disease recurrence. OBJECTIVE: Evaluate the long-term effect of zileuton on sinonasal outcomes in patients with AERD. METHODS: AERD patients were reviewed and divided into two cohorts, depending if they were treated with zileuton during their clinical course. Demographic data, 22-item sinonasal outcome test (SNOT-22), Lund-Kennedy (LK) endoscopy score, duration of treatment, and number of sinus surgeries performed were collected. RESULTS: 40 AERD patients were included, with follow-up duration up to 10 years (avg of 5.2 years). All patients were treated with topical saline and budesonide irrigations, intranasal steroid spray, and montelukast. 19 patients had uncontrolled sinus disease requiring multiple steroid tapers and were switched from montelukast to zileuton (cohort 1, 47.5%) at some point in their treatment. 21 patients (cohort 2, 52.5%) never needed zileuton. The average duration of treatment with zileuton was 6 years. Patients who required zileuton had a worse SNOT-22 (32.1 vs 19, p = 0.117), worse LK score (8.1 vs 7.5, p = 0.504), and higher average number of surgeries (1.9 vs 1.6, p = 0.343). The outcomes in the zileuton cohort trended toward improvement, however these did not reach statistical significance with an improved SNOT-22 from 32.1 to 27.4 (p = 0.617) and LK score from 7.9 to 6.2 (p = 0.092); The addition of zileuton significantly lowered the number of surgeries needed to an average of 0.5 (p < 0.0001). CONCLUSION: Zileuton may help decrease the number of sinus surgeries needed in AERD.


Assuntos
Asma Induzida por Aspirina/tratamento farmacológico , Hidroxiureia/análogos & derivados , Antagonistas de Leucotrienos/uso terapêutico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Adulto , Idoso , Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Asma Induzida por Aspirina/complicações , Doença Crônica , Feminino , Humanos , Hidroxiureia/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rinite/induzido quimicamente , Índice de Gravidade de Doença , Sinusite/induzido quimicamente , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
Biomolecules ; 11(8)2021 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-34439835

RESUMO

Increasing evidence has demonstrated that oxidized low-density lipoproteins (oxLDL) and lipopolysaccharide (LPS) enhance accumulation of interleukin (IL)-1 beta-producing macrophages in atherosclerotic lesions. However, the potential synergistic effect of native LDL (nLDL) and LPS on the inflammatory ability and migration pattern of monocyte subpopulations remains elusive and is examined here. In vitro, whole blood cells from healthy donors (n = 20) were incubated with 100 µg/mL nLDL, 10 ng/mL LPS, or nLDL + LPS for 9 h. Flow cytometry assays revealed that nLDL significantly decreases the classical monocyte (CM) percentage and increases the non-classical monocyte (NCM) subset. While nLDL + LPS significantly increased the number of NCMs expressing IL-1 beta and the C-C chemokine receptor type 2 (CCR2), the amount of NCMs expressing the CX3C chemokine receptor 1 (CX3CR1) decreased. In vivo, patients (n = 85) with serum LDL-cholesterol (LDL-C) >100 mg/dL showed an increase in NCM, IL-1 beta, LPS-binding protein (LBP), and Castelli's atherogenic risk index as compared to controls (n = 65) with optimal LDL-C concentrations (≤100 mg/dL). This work demonstrates for the first time that nLDL acts in synergy with LPS to alter the balance of human monocyte subsets and their ability to produce inflammatory cytokines and chemokine receptors with prominent roles in atherogenesis.


Assuntos
Receptor 1 de Quimiocina CX3C/genética , LDL-Colesterol/farmacologia , Interleucina-1beta/genética , Lipopolissacarídeos/farmacologia , Monócitos/efeitos dos fármacos , Receptores CCR2/genética , Proteínas de Fase Aguda/genética , Proteínas de Fase Aguda/imunologia , Adolescente , Adulto , Proteína C-Reativa/genética , Proteína C-Reativa/imunologia , Receptor 1 de Quimiocina CX3C/imunologia , Proteínas de Transporte/genética , Proteínas de Transporte/imunologia , Linhagem da Célula/efeitos dos fármacos , Linhagem da Célula/imunologia , HDL-Colesterol/sangue , Sinergismo Farmacológico , Feminino , Citometria de Fluxo , Expressão Gênica , Voluntários Saudáveis , Humanos , Interleucina-1beta/imunologia , Masculino , Glicoproteínas de Membrana/genética , Glicoproteínas de Membrana/imunologia , Pessoa de Meia-Idade , Monócitos/citologia , Monócitos/imunologia , Cultura Primária de Células , Receptores CCR2/imunologia , Triglicerídeos/sangue
8.
Int Forum Allergy Rhinol ; 11(10): 1417-1423, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33864707

RESUMO

OBJECTIVE: To evaluate disease presence in the central compartment (CC) in patients with eosinophilic chronic rhinosinusitis (CRS). METHODS: Patients with eosinophilic CRS were divided into three endotypes: aspirin-exacerbated respiratory disease (AERD), allergic fungal rhinosinusitis (AFRS), and eosinophilic CRS with nasal polyps (eCRSwNP). CT scans were reviewed for CC involvement, defined as the area between the superior nasal septum (SNS) and middle turbinate (MT). CC involvement was measured based on the degree of opacification (0: no opacification, 1: up to 50% opacification, and 2: >50% opacification), and distance from SNS to MT (mm). Patients who had lateralized MTs from prior surgery as the cause of CC widening were excluded. Patients who underwent orbital decompression were included as a control group. RESULTS: Fifty patients in each group (AERD, AFRS, and eCRSwNP) and 50 control patients were included. Average number of surgeries was 2.5 in AERD (p = 0.05), 2 in AFRS (p = 0.4), and 1.7 in eCRSwNP. Preoperative CC distance was significantly higher in AERD versus control, AFRS, and eCRSwNP: 4.2 versus 2.8 mm (p < 0.0001), 4.2 versus 1.9 mm (p < 0.0001), and 4.2 versus 2.7 mm (p < 0.0001), respectively. Postoperatively, CC distance and degree of opacification were significantly higher in AERD versus control, AFRS, and eCRSwNP. Within the AERD group, CC distance was significantly higher postoperatively than preoperatively (6.5 vs. 4.2 mm, p = 0.002). CONCLUSION: CC involvement is more significant in AERD patients and if present, rhinologists should be suspicious of the diagnosis. This area could represent a source of inflammatory load in patients with AERD.


Assuntos
Asma Induzida por Aspirina , Pólipos Nasais , Rinite Alérgica , Rinite , Sinusite , Doença Crônica , Humanos
9.
J Neurol Surg B Skull Base ; 82(Suppl 1): S8-S9, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33717801

RESUMO

Objectives The video demonstrates the steps for an endoscopic transnasal approach for resection of the odontoid causing platybasia with basilar invasion. Design The video reviews the clinical presentation, preoperative workup and imaging, patient positioning, technical nuances of the procedure, reconstruction, and clinical outcomes including postoperative imaging. Setting The surgery was performed by a skull base team including otolaryngologists and neurological surgeons at a large regional tertiary care facility. Participants A 59-year-old female with the Chiari I malformation with history of multiple revision cervical spinal surgeries presents with neck pain. Preoperative imaging showed a hypoplastic clivus and platybasia with basilar invasion. Main Outcome Measures The main outcome measures consist of safely removing the odontoid with appropriate closure, reversal of the patient symptoms, and prevention of both operative complications and ventral compression of the brainstem. Results The patient's neck pain improved. There were no intraoperative or postoperative complications besides anterior rightward nasal septal deviation causing unilateral nasal obstruction. A septoplasty was performed to correct the septal deviation 6 months after the initial procedure. Conclusions The endoscopic transnasal approach to the resection of odontoid is a safe and effective treatment to address basilar invasion and ventral compression of the brainstem. The link to the video can be found at: https://youtu.be/m_c3-Vn-l80 .

10.
Am J Rhinol Allergy ; 35(5): 574-577, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33283537

RESUMO

BACKGROUND: The pathophysiology of allergic fungal rhinosinusitis (AFRS) is not well understood. OBJECTIVES: To study the incidence of sinonasal anatomic variants (AVs) in AFRS. METHODS: Retrospective cohort study. Patients with AFRS presenting to our clinic from 2008 to 2018 were reviewed for laterality of the disease. Patients with unilateral involvement were further studied for AV presence by reviewing their preoperative sinus CT scan at original presentation. Each patient's uninvolved side served as its own control. AVs studied include agger nasi (AN), Haller's cells (HC), concha bullosa (CB) and supraorbital ethmoid cells (SOEC). RESULTS: A total of 155 patients with AFRS were identified. 30 patients (19.3%) had unilateral disease involvement. Of these, 16 patients had left sided and 14 patients had right sided disease. AV were present in 26 of the 30 AFRS sides (86.7%) and in 21 of the 30 healthy sides (70%), (chi squared = 2.45, p = 0.117). CB were present in 12 of 30 AFRS sides (40%) and only in 1 of 30 healthy sides (3%), (chi squared = 11.88, p = 0.0006). The presence of HC was more common in the AFRS vs healthy sides (7 of 30, 23.3% vs 2 of 30, 6.7%, respectively, p = 0.071). AN and SOEC presence was similar in both AFRS and healthy sides (p = 0.598 and p = 0.718 respectively). CONCLUSION: AV are more common on the sides with AFRS compared to healthy sides, with the presence of CB reaching unquestionable statistical significance. Further study is needed to determine the possible association of AV, especially concha bullosa, with the pathophysiology of AFRS.


Assuntos
Micoses , Rinite Alérgica , Sinusite , Doença Crônica , Humanos , Micoses/epidemiologia , Estudos Retrospectivos , Rinite Alérgica/epidemiologia , Sinusite/epidemiologia
11.
Am J Rhinol Allergy ; 35(2): 187-194, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32689821

RESUMO

OBJECTIVE: The presence of tissue eosinophilia is a determinate of disease severity in patients with chronic rhinosinusitis (CRS). The impact of eosinophilic mucin (EM) as an independent variable has not yet been elucidated. STUDY DESIGN: Retrospective review. SETTING: Tertiary academic clinic.Subjects Methods: CRS patients who failed medical therapy were classified by tissue eosinophilia, presence of polyps and EM. Tissue eosinophilia count per high power field (HPF) as well as the presence of EM were determined by pathologic examination of sinus tissue removed during surgery. Sinonasal Outcomes Test (SNOT-22), Lund-Mackay (LM), and Lund-Kennedy (LK) scores were compared between all groups preoperatively and postoperatively up to two and a half years (30 months). RESULTS: 192 patients with CRS were included in the study. 87 were diagnosed with eosinophilic CRS with polyps, 58 with eosinophilic CRS without polyps, 14 with noneosinophilic CRS with polyps, and 33 with noneosinophilic CRS without polyps. Only patients with eosinophilia had EM on pathology. Of eosinophilic CRS, 50% of patients with polyps and 12% of cases without polyps demonstrated EM, respectively. EM presence portended more severe disease in patients with eosinophilia on subjective and objective scores preoperatively (P < 0.005). Postoperatively, EM patients experienced a greater improvement of symptoms, but continued to have worse endoscopy scores until 1.5 years. A tissue eosinophil count of 30 or greater per HPF was identified as a potential marker for the development of EM. CONCLUSIONS: The presence of eosinophilic mucin predicts overall worse disease severity in patients with eosinophilic CRS.


Assuntos
Pólipos Nasais , Rinite , Doença Crônica , Humanos , Mucinas , Pólipos Nasais/diagnóstico , Estudos Retrospectivos , Rinite/diagnóstico , Índice de Gravidade de Doença
12.
J Neurol Surg B Skull Base ; 81(4): 369-375, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33072478

RESUMO

This article reviews the most common locations and natural history of sinonasal carcinomas. It also reviews surgical indications and current evidence regarding adjuvant and neoadjuvant therapies. In the past, orbital clearance was generally done for ethmoid and maxillary cancers, even without a marked neoplastic infiltration; however, such indications have changed in the recent years due to advances in our understanding of the disease, as well as new chemotherapeutic and radiotherapy protocols. Surgical resection of tumors close to the orbit exhibits the challenging task of balancing treatment goals and patient's desires.

13.
Biomolecules ; 10(4)2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32283759

RESUMO

The relationship of uric acid with macrophages has not been fully elucidated. We investigated the effect of uric acid on the proinflammatory ability of human macrophages and then examined the possible molecular mechanism involved. Primary human monocytes were differentiated into macrophages for subsequent exposure to 0, 0.23, 0.45, or 0.9 mmol/L uric acid for 12 h, in the presence or absence of 1 mmol/L probenecid. Flow cytometry was used to measure proinflammatory marker production and phagocytic activity that was quantified as a percentage of GFP-labeled Escherichia coli positive macrophages. qPCR was used to measure the macrophage expression of the urate anion transporter 1 (URAT1). As compared to control cells, the production of tumor necrosis factor-alpha (TNF-alpha), toll-like receptor 4 (TLR4), and cluster of differentiation (CD) 11c was significantly increased by uric acid. In contrast, macrophages expressing CD206, CX3C-motif chemokine receptor 1 (CX3CR1), and C-C chemokine receptor type 2 (CCR2) were significantly reduced. Uric acid progressively increased macrophage phagocytic activity and downregulated URAT1 expression. Probenecid-a non-specific blocker of URAT1-dependent uric acid transport-inhibited both proinflammatory cytokine production and phagocytic activity in macrophages that were exposed to uric acid. These results suggest that uric acid has direct proinflammatory effects on macrophages possibly via URAT1.


Assuntos
Escherichia coli/metabolismo , Mediadores da Inflamação/metabolismo , Inflamação/patologia , Macrófagos/patologia , Transportadores de Ânions Orgânicos/metabolismo , Proteínas de Transporte de Cátions Orgânicos/metabolismo , Fagocitose/efeitos dos fármacos , Ácido Úrico/toxicidade , Adolescente , Adulto , Receptor 1 de Quimiocina CX3C/metabolismo , Células Cultivadas , Humanos , Interleucina-1beta/metabolismo , Lectinas Tipo C/metabolismo , Macrófagos/efeitos dos fármacos , Macrófagos/metabolismo , Masculino , Receptor de Manose , Lectinas de Ligação a Manose/metabolismo , Probenecid/farmacologia , Receptores CCR2/metabolismo , Receptores de Superfície Celular/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Adulto Jovem
14.
J Neurol Surg B Skull Base ; 80(6): 577-585, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31750043

RESUMO

Context The effect on recurrence rate between patients with juvenile nasopharyngeal angiofibroma (JNA), treated by an endoscopic versus open approach, has not been well established. Objective A meta-analysis of the available literature concerning recurrence rate in patients who underwent surgery for JNA. Methods A retrospective meta-analysis of studies analyzing recurrence rate after endoscopic or open surgery for patients with JNA was performed using the DerSimonian-Laird random-effects method. English and non-English articles were reviewed using Embase, Medline, and Cochrane databases. Results Among nine studies, including 362 patients from 1981 to 2015, with a mean follow-up of 49.4 months, a total of 89 patients (24.5%) had recurrence. Our analysis revealed a total effect size of -0.16 in favor of endoscopic approach (-0.25 to -0.06, CI [confidence interval] 95%). When analyzing tumor by stage (Radkowski's IA-IIIB n = 299), the endoscopic approach proved to be superior independent of tumor stage (2 vs. 17% for tumors stage IA-IIA, and 26 vs. 32% for tumor stage IIB-IIIB for endoscopic and open approaches respectively; p < 0.05). The endoscopic approach has a statistical significant lower recurrence rate in patients without intracranial compromise when compared with the open approach (13 vs. 28%; p < 0.02). No statistical difference was seen in patients with intracranial compromise ( p = 0.5) Conclusion The use of an endoscopic approach to treat JNA has a significantly lower recurrence rate when compared with open approaches. Independent of disease stage, an endoscopic approach should be the standard of care to surgically treat JNA. For cases with intracranial compromise, either approach can be used for surgical resection.

15.
J Immunol Res ; 2019: 6105059, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31183389

RESUMO

Sucralose is a noncaloric artificial sweetener that is widely consumed worldwide and has been associated with alteration in glucose and insulin homeostasis. Unbalance in monocyte subpopulations expressing CD11c and CD206 hallmarks metabolic dysfunction but has not yet been studied in response to sucralose. Our goal was to examine the effect of a single sucralose sip on serum insulin and blood glucose and the percentages of classical, intermediate, and nonclassical monocytes in healthy young adults subjected to an oral glucose tolerance test (OGTT). This study was a randomized, placebo-controlled clinical trial. Volunteers randomly received 60 mL water as placebo (n = 20) or 48 mg sucralose dissolved in 60 mL water (n = 25), fifteen minutes prior to an OGTT. Blood samples were individually drawn every 15 minutes for 180 minutes for quantifying glucose and insulin concentrations. Monocyte subsets expressing CD11c and CD206 were measured at -15 and 180 minutes by flow cytometry. As compared to controls, volunteers receiving sucralose exhibited significant increases in serum insulin at 30, 45, and 180 minutes, whereas blood glucose values showed no significant differences. Sucralose consumption caused a significant 7% increase in classical monocytes and 63% decrease in nonclassical monocytes with respect to placebo controls. Pearson's correlation models revealed a strong association of insulin with sucralose-induced monocyte subpopulation unbalance whereas glucose values did not show significant correlations. Sucralose ingestion decreased CD11c expression in all monocyte subsets and reduced CD206 expression in nonclassical monocytes suggesting that sucralose does not only unbalance monocyte subpopulations but also alter their expression pattern of cell surface molecules. This work demonstrates for the first time that a 48 mg sucralose sip increases serum insulin and unbalances monocyte subpopulations expressing CD11c and CD206 in noninsulin-resistant healthy young adults subjected to an OGTT. The apparently innocuous consumption of sucralose should be reexamined in light of these results.


Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Monócitos/fisiologia , Sacarose/análogos & derivados , Adulto , Glicemia , Antígeno CD11c/metabolismo , Ingestão de Alimentos , Feminino , Teste de Tolerância a Glucose , Voluntários Saudáveis , Humanos , Insulina/metabolismo , Lectinas Tipo C/metabolismo , Masculino , Receptor de Manose , Lectinas de Ligação a Manose/metabolismo , Receptores de Superfície Celular/metabolismo , Sacarose/administração & dosagem , Adulto Jovem
16.
Ear Nose Throat J ; 98(5): 283-286, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30961371

RESUMO

BACKGROUND: A lymph node yield (LNY) over 20 is considered a quality metric for lateral neck dissection to ensure an oncologic representative sample. Anecdotally, however, LNY in patients undergoing neck dissection after radiation therapy (RT) is lower due to atrophy and fibrosis. OBJECTIVE: To determine whether preoperative RT decreases LNY in patients with laryngeal cancers undergoing surgery. METHODS: Medical record database was queried for patients presenting between 2006 and 2015 with laryngeal cancer. Tabulation was made for location (glottic/supraglottic), stage, and side for the total number of lymph nodes between primary surgery and RT (salvage surgery) groups. Descriptive analysis and a paired Student t test were used for statistical analysis. RESULTS: Fifty-nine patients were included in the study for a total of 98 neck dissections. Twenty-six (44%) patients had primary surgery, and 33 (56%) patients had salvage surgery. The mean left and right total LNY in the salvage surgery group was 27.6 and 29.5, respectively, and 32.2 and 33.7 for the primary surgery group. A difference of 4.5 (left) and 4.3 (right) in LNY between the salvage surgery and primary surgery group was found. A Student t test showed no statistically significant difference in LNY between both groups when analyzed per site (glottic and supraglottic), side, and stage (III-IV). CONCLUSION: Although patients with prior RT had a lower mean of LNY, our results did not demonstrate a statistically significant difference. Further studies with a larger number of patients are recommended.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Laríngeas , Linfonodos/patologia , Esvaziamento Cervical/métodos , Cuidados Pré-Operatórios/métodos , Radioterapia , Idoso , Atrofia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Feminino , Fibrose , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Avaliação de Resultados em Cuidados de Saúde , Radioterapia/efeitos adversos , Radioterapia/métodos , Terapia de Salvação/métodos
17.
Sleep Sci ; 11(3): 146-151, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30455846

RESUMO

OBJECTIVES: To determine the sleep-disordered breathing in patients with decompensated HF (DHF) at an altitude of 2640m. METHODS: Polysomnogram during the first 48 hours of admission in patients hospitalized for DHF. Sleep apnea (SA) was defined as an apnea hypopnea index (AHI) > 5/hour and central sleep apnea (CSA) as central apnea index (CAI) ≥ 50% of the AHI. RESULTS: Sixteen participants, LVEF 24.2±9.9%. All patients had SA, severe in 12 (75%), CSA in 8 (50%) and 7 (43.8%) presented Cheyne-Stokes respiration (CSR). Out of the eight patients with obstructive SA, five had a central component (CAI ≥ 5/h). The SpO2 decreased during sleep to 80.6±5.5% and in patients with CSR to 77.6±6.9%. CONCLUSIONS: At an altitude of 2640m all patients with DHF presented sleep apnea, most were severe, with CSA and a significant percentage of CSR that was associated with higher oxygen desaturation.

18.
Scand J Immunol ; 88(5): e12716, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30260514

RESUMO

Insulin resistance is the inability to respond to insulin and is considered a key pathophysiological factor in the development of type 2 diabetes. Tumor necrosis factor-alpha (TNF-alpha) can directly contribute to insulin resistance by disrupting the insulin signalling pathway via protein-tyrosine phosphatase 1B (PTP1B) activation, especially in adipocytes. Infliximab (Remicade® ) is a TNF-alpha-neutralizing antibody that has not been fully studied in insulin resistance. We investigated the effect of infliximab on TNF-alpha-induced insulin resistance in 3T3L1 adipocytes in vitro, and examined the possible molecular mechanisms involved. Once differentiated, adipocytes were cultured with 5 mmol L-1 2-deoxy-D-glucose-3 H and stimulated twice with 2 µmol L-1 insulin, in the presence or absence of 5 ng/mL TNF-alpha and/or 10 ng/mL infliximab. Glucose uptake was measured every 20 minutes for 2 hour, and phosphorylated forms of insulin receptor (IR), insulin receptor substrate-2 (IRS-2), protein kinase B (AKT) and PTP1B were determined by Western blotting. TNF-alpha-treated adipocytes showed a significant 64% decrease in insulin-stimulated glucose uptake as compared with control cells, whereas infliximab reversed TNF-alpha actions by significantly improving glucose incorporation. Although IR phosphorylation remained unaltered, TNF-alpha was able to increase PTP1B activation and decrease phosphorylation of IRS-2 and AKT. Notably, infliximab restored phosphorylation of IRS-2 and AKT by attenuating PTP1B activation. This work demonstrates for the first time that infliximab ameliorates TNF-alpha-induced insulin resistance in 3T3L1 adipocytes in vitro by restoring the insulin signalling pathway via PTP1B inhibition. Further clinical research is needed to determine the potential benefit of using infliximab for treating insulin resistance in patients.


Assuntos
Adipócitos/imunologia , Adipócitos/metabolismo , Infliximab/farmacologia , Resistência à Insulina/imunologia , Proteína Tirosina Fosfatase não Receptora Tipo 1/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Células 3T3-L1 , Adipócitos/efeitos dos fármacos , Animais , Ativação Enzimática , Glucose/metabolismo , Insulina/farmacologia , Camundongos , Modelos Biológicos , Fosforilação , Transdução de Sinais , Fator de Necrose Tumoral alfa/farmacologia
19.
J Diabetes Res ; 2018: 7209872, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29675435

RESUMO

Experimental evidence in mice suggests a role for interleukin- (IL-) 13 in insulin resistance and low-grade systemic inflammation. However, IL-13 serum levels have not been assessed in subjects with insulin resistance, and associations of IL-13 with parameters of low-grade systemic inflammation are still unknown. Our main goal was to examine the systemic levels of IL-13 in patients with insulin resistance, while also studying the relationship of IL-13 with anthropometric, metabolic, and low-grade systemic inflammatory markers. Ninety-two participants were included in the study and divided into insulin-resistant patients and noninsulin-resistant controls. Blood levels of IL-13, glucose, insulin, triglycerides, cholesterol, tumor necrosis factor-alpha (TNF-α), IL-10, proinflammatory (Mon-CD11c+CD206-), and anti-inflammatory (Mon-CD11c-CD206+) monocytes, as well as anthropometric parameters, were measured in all volunteers. Insulin-resistant patients showed 2.5-fold higher serum levels of IL-13 than controls (P < 0.0001) and significantly increased values of TNF-α and Mon-CD11c+CD206-, with concomitant reductions in IL-10 and Mon-CD11c-CD206+. Increased IL-13 was extraordinarily well associated with hyperglycemia (r = 0.7362) and hypertriglyceridemia (r = 0.7632) but unexpectedly exhibited no significant correlations with TNF-α (r = 0.2907), IL-10 (r = -0.3882), Mon-CD11c+CD206- (r = 0.2745) or Mon-CD11c-CD206+ (r = -0.3237). This study demonstrates that IL-13 serum levels are elevated in patients with insulin resistance without showing correlation with parameters of low-grade systemic inflammation.


Assuntos
Glicemia , Inflamação/sangue , Resistência à Insulina/fisiologia , Insulina/sangue , Interleucina-13/sangue , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Triglicerídeos/sangue , Fator de Necrose Tumoral alfa/sangue , Adulto Jovem
20.
Foodborne Pathog Dis ; 15(1): 55-57, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29028444

RESUMO

Listeriosis is a foodborne disease caused by Listeria monocytogenes. The aims of this work were to develop and validate an in-house real-time polymerase chain reaction (RT-PCR) for the detection of L. monocytogenes, and to determine its prevalence in raw ground beef samples from 53 butcheries that also sell ready-to-eat foods. One set of primers and one hydrolysis probe were designed for hly gene detection and then challenged with pure strains. The detection was successful for all L. monocytogenes strains analyzed and negative for all non-L. monocytogenes strains (detection limit, 10 colony forming unit [CFU]/mL). Inclusivity, exclusivity, and analytical accuracy were 100%. L. monocytogenes was detected in 41.5% of raw ground beef samples from the 53 butcheries analyzed. This RT-PCR may be a valuable method for rapid detection of L. monocytogenes in meat.


Assuntos
Microbiologia de Alimentos , Listeria monocytogenes/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real , Carne Vermelha/microbiologia , Animais , Bovinos , Inspeção de Alimentos/métodos , Indústria de Embalagem de Carne , Sensibilidade e Especificidade
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