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1.
Int J Surg Case Rep ; 119: 109683, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38688153

RESUMO

INTRODUCTION AND IMPORTANCE: Due to therapeutic advances and improvements in follow-up care, the diagnosis and treatment of extrahepatic metastases of hepatocellular carcinoma [HCC] have gained clinical significance. However, adrenal gland metastases of HCC remain a rare clinical encounter. Several systemic and local treatment options are discussed in current literature. Adrenalectomy in cases of isolated adrenal metastases with well-controlled intrahepatic lesions has been shown to benefit patients in case series. PRESENTATION OF THE CASE: This 65-year-old patient presented with suspected metachronous left sided adrenal metastasis seven years after bisegmentectomy for HCC and after undergoing trans-arterial chemoembolization [TACE] for multifocal intrahepatic recurrences while being listed for liver transplantation "beyond Milan criteria". Adrenalectomy was suggested for histopathological confirmation of the suspected metastasis and re-consideration for liver transplant. The resection was performed laparoscopically and metastasis of HCC was confirmed in histopathological analysis. Postoperatively, the patient recovered quickly. However, the patient decided against re-listing for liver transplantation. CLINICAL DISCUSSION: Current literature suggests, that minimally-invasive adrenalectomy should be considered in patients with no more than two extrahepatic lesions, a Child-Pugh-Score of less than A5, low alpha-fetoprotein [AFP] levels <100 ng/ml and size <3 cm. The oncological goal should be to achieve a tumor free extrahepatic situation with a potential oncological benefit. CONCLUSION: Our patient presented as an ideal candidate for resection of the adrenal gland metastasis and could have been re-assessed postoperatively for liver transplantation. Still, more research is needed to improve patient-selection for metastasectomy in HCC.

2.
Chirurgie (Heidelb) ; 95(1): 34-41, 2024 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-38085298

RESUMO

BACKGROUND: Abdominal wall reconstruction in large incisional hernia/laparostoma poses a particular challenge. A loss of domain is the extreme form of intestinal volume displacement. The challenge lies in overcoming retraction of the lateral abdominal muscles. OBJECTIVE: Experienced surgeons have access to a variety of techniques aimed at gaining lateral length along the abdominal wall or reducing suture tension at the midline. These techniques are intended to facilitate reconstruction even in complex cases and are outlined in this article from a practical perspective. MATERIAL AND METHODS: The application of botulinum toxin A (BTA) and progressive pneumoperitoneum (PPP) are described as preoperative methods to gain abdominal wall length. Peritoneal flaps, intraoperative fascial traction (IFT) and component separation including transversus abdominis muscle release (TAR) are available for the surgical reconstruction of the abdominal wall. Bridging and the intraperitoneal onlay mesh approach are fallback techniques. All these techniques were integrated into a practical algorithm for complex abdominal wall reconstruction including preoperative and postoperative care and assessed by the authors with respect to effort, effectiveness and complexity. RESULTS AND CONCLUSION: In the opinion of the authors, the status of complex abdominal wall reconstruction is currently best described by a combination of the most effective and proven techniques in terms of a "categorical algorithm". The combination of BTA, IFT and TAR presently appears to be the most effective method; however, experience and expertise are a prerequisite.


Assuntos
Parede Abdominal , Toxinas Botulínicas Tipo A , Hérnia Ventral , Humanos , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Parede Abdominal/cirurgia , Músculos Abdominais/cirurgia , Suturas
3.
J Chem Phys ; 158(11): 114309, 2023 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-36948802

RESUMO

The nucleation and growth of calcium-silicate-hydrate (C-S-H) is of fundamental importance for the strength development and durability of the concrete. However, the nucleation process of C-S-H is still not fully understood. The present work investigates how C-S-H nucleates by analyzing the aqueous phase of hydrating tricalcium silicate (C3S) by applying inductively coupled plasma-optical emission spectroscopy as well as analytical ultracentrifugation. The results show that the C-S-H formation follows non-classical nucleation pathways associated with the formation of prenucleation clusters (PNCs) of two types. Those PNCs are detected with high accuracy and reproducibility and are two species of the 10 in total, from which the ions (with associated water molecules) are the majority of the species. The evaluation of the density and molar mass of the species shows that the PNCs are much larger than ions, but the nucleation of C-S-H starts with the formation of liquid precursor C-S-H (droplets) with low density and high water content. The growth of these C-S-H droplets is associated with a release of water molecules and a reduction in size. The study gives experimental data on the size, density, molecular mass, and shape and outlines possible aggregation processes of the detected species.

4.
J Clin Psychol Med Settings ; 29(3): 498-508, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35524890

RESUMO

This study evaluates the impact of an intervention targeting high-risk behaviors among diverse, alcohol-using adults living with HIV (N = 267) from 2009 to 2013 in Miami, FL. The intervention took place in a group setting for eight sessions over 4 weeks and was compared to a didactic health promotion group. Assessments were conducted pre-intervention, post-intervention, and at 3, 6, and 12 months follow-up. Intervention participants (48% of sample) evidenced greater knowledge about HIV, more condom self-efficacy, and greater intentions to use condoms after participation. This was particularly noteworthy because associations among knowledge about HIV, more condom self-efficacy, and greater intentions to use condoms were negatively associated with intervention status at baseline. Participants also reported fewer heavy drinking days after participating in the intervention than those in the control group. Greater HIV knowledge, more condom self-efficacy and intentions to use condoms predicted more condom assertiveness; greater intentions to use condoms predicted fewer unprotected sexual behaviors. These findings underscore the importance of taking a comprehensive, multi-systemic approach to address risky behaviors in high-risk, diverse populations.


Assuntos
Infecções por HIV , Saúde Holística , Adulto , Cognição , Preservativos , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Assunção de Riscos , Comportamento Sexual/psicologia
5.
Langmuir ; 37(9): 2985-2992, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33621100

RESUMO

Cysteine is the simplest thiolated, chiral amino acid and is often used as the anchor for studies of self-assembled monolayers (SAMs) of complex biomolecules such as peptides. Understanding the interaction of SAMs of cysteine with low-energy secondary electrons (SEs) produced by X-rays can further our understanding of radiation damage in biomolecules. In particular, if the electrons are polarized, chiral-selective chemistry could have bearing on the origin of homochirality in nature. In the present paper, we use synchrotron radiation-based X-ray photoelectron spectroscopy to determine the changes that occur in the bonding of self-assembled layers of cysteine on gold as a result of soft X-ray irradiation. To investigate the possibility of chiral selectivity resulting from the interaction of low-energy, spin-polarized SEs (SPSEs), measurements were conducted on cysteine adsorbed on a 3 nm-thick gold layer deposited on a CoPt thin-film multilayer with perpendicular magnetic anisotropy. Time-dependent measurements of the C 1s, N 1s, O 1s, S 2p, and Au 4f core levels are used to follow the changes in surface chemistry and determine reaction cross-sections as a function of SE exposure. Analysis of the data results in cross-sections in the range of 5-7 Mb and suggests possible reaction pathways. Changing the magnetization direction of the CoPt multilayer produces SPSEs with opposite polarity. Some evidence of spin-dependent reactions is indicated but is inconclusive. Possible reasons for the discrepancy are posited.

6.
J Phys Chem Lett ; 11(23): 10182-10187, 2020 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-33200930

RESUMO

The damage of approximately monolayer films of l-histidine by low-energy spin-polarized electrons (SPE) ejected from a magnetized cobalt substrate has been probed using X-ray photoelectron spectroscopy (XPS). Average damage cross sections for N-containing motifs of l-histidine are 25-30 and 2-5 Mb for zwitterions and neutral molecules, respectively. The magnetization direction of the substrate, which controls the ejected SPE helicity, was reversed in situ, and statistically significant differences in the damage cross sections of 10-30% were measured between positive and negative electron helicities. This is the first measurement of spin dichroism (SD) in an amino acid. The differential cross sections suggest that inelastic scattering of SPE with chiral molecules could contribute to the persistence of one enantiomer vs the other under certain irradiation conditions, particularly for the zwitterionic species.


Assuntos
Aminoácidos/química , Elétrons , Histidina/química , Sequência de Aminoácidos , Espectroscopia Fotoeletrônica
7.
Acta Psychiatr Scand ; 140(3): 205-216, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31265120

RESUMO

OBJECTIVE: Several studies have found an increase in hippocampal volume following electroconvulsive therapy (ECT), but the effect on cortical thickness has been less investigated. We aimed to examine the effects of ECT on cortical thickness and their associations with clinical outcome. METHOD: Using 3 Tesla MRI scanner, we obtained T1-weighted brain images of 18 severely depressed patients at three time points: before, right after and 6 months after a series of ECT. The thickness of 68 cortical regions was extracted using Free Surfer, and Linear Mixed Model was used to analyze the longitudinal changes. RESULTS: We found significant increases in cortical thickness of 26 regions right after a series of ECT, mainly within the frontal, temporal and insular cortex. The thickness returned to the baseline values at 6-month follow-up. We detected no significant decreases in cortical thickness. The increase in the thickness of the right lateral orbitofrontal cortex was associated with a greater antidepressant effect, r = 0.75, P = 0.0005. None of the cortical regions showed any associations with cognitive side effects. CONCLUSION: The increases in cortical thickness induced by ECT are transient. Further multimodal MRI studies should examine the neural correlates of these increases and their relationship with the antidepressant effect.


Assuntos
Córtex Cerebral/patologia , Transtorno Depressivo/patologia , Transtorno Depressivo/terapia , Eletroconvulsoterapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Córtex Cerebral/diagnóstico por imagem , Transtorno Depressivo/diagnóstico por imagem , Feminino , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
J Chem Phys ; 150(20): 204709, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31153208

RESUMO

Radiation damage and stimulated desorption of nucleotides 2'-deoxyadenosine 5'-monophosphate (dAMP), adenosine 5'-monophosphate (rAMP), 2'-deoxycytidine 5'-monophosphate (dCMP), and cytidine 5'-monophosphate (rCMP) deposited on Au have been measured using x-rays as both the probe and source of low energy secondary electrons. The fluence dependent behavior of the O-1s, C-1s, and N-1s photoelectron transitions was analyzed to obtain phosphate, sugar, and nucleobase damage cross sections. Although x-ray induced reactions in nucleotides involve both direct ionization and excitation, the observed bonding changes were likely dominated by the inelastic energy-loss channels associated with secondary electron capture and transient negative ion decay. Growth of the integrated peak area for the O-1s component at 531.3 eV, corresponding to cleavage of the C-O-P phosphodiester bond, yielded effective damage cross sections of about 23 Mb and 32 Mb (1 Mb = 10-18 cm2) for AMP and CMP molecules, respectively. The cross sections for sugar damage, as determined from the decay of the C-1s component at 286.4 eV and the glycosidic carbon at 289.0 eV, were slightly lower (about 20 Mb) and statistically similar for the r- and d- forms of the nucleotides. The C-1s component at 287.6 eV, corresponding to carbons in the nucleobase ring, showed a small initial increase and then decayed slowly, yielding a low damage cross section (∼5 Mb). Although there is no statistical difference between the sugar forms, changing the nucleobase from adenine to cytidine has a slight effect on the damage cross section, possibly due to differing electron capture and transfer probabilities.


Assuntos
Dano ao DNA , Elétrons , Nucleotídeos/química , Termodinâmica
9.
J Fr Ophtalmol ; 40(10): 865-875, 2017 Dec.
Artigo em Francês | MEDLINE | ID: mdl-29174296

RESUMO

PURPOSE: The Icare® Home tonometer is a new rebound tonometer, developed for intraocular pressure (IOP) self-monitoring. The main objective of our study was to evaluate the reliability and reproducibility of measurements taken with the Icare® Home tonometer in glaucoma patients compared to the Goldmann applanation tonometer. A secondary objective was to investigate factors that could influence the reproducibility of these measurements. MATERIALS AND METHODS: Fifty-two glaucoma patients were included in this prospective, non-randomized, monocentric study. IOP measurements were performed on the right eye and then on the left eye in the following order (3 measurements of IOP for each method): air tonometer (T-Air), Icare® Home tonometer by the patient (RT-P), Icare® Home tonometer by an ophthalmologist (RT-O), Goldmann applanation tonometer (GAT). RESULTS: Forty-four patients (85%) managed to take their IOP on both eyes with the Icare® Home tonometer. Mean IOPs were 14.35±3.93mmHg (T-Air), 13.43±4.65mmHg (RT-P), 14.13±4.29mmHg (RT-O), 14.74±3.84mmHg (GAT). The intraclass correlation indices (ICC) on the 3 repeated IOP measurements were 0.924, 0.872, 0.947 and 0.957, respectively. Bland-Altman analysis found a mean difference (bias) between GAT and RT-P, between GAT and RT-O, and between RT-O and RT-P, respectively, of 1.31, 0.61 and 0.70mmHg, with a 95% confidence interval of -3.34 to 5.96, -3.91 to 5.14 and -3.44 to 4.84mmHg, respectively. The reproducibility of the measurements taken with the Icare® Home tonometer did not vary according to corneal thickness or age of the patients. CONCLUSION: The Icare® Home tonometer provides reliable and reproducible IOP values in glaucoma patients, although it appears to slightly underestimate the IOP measurements compared to the Goldmann applanation tonometer.


Assuntos
Glaucoma/diagnóstico , Pressão Intraocular , Hipertensão Ocular/diagnóstico , Tonometria Ocular/instrumentação , Tonometria Ocular/métodos , Idoso , Autoavaliação Diagnóstica , Feminino , Glaucoma/fisiopatologia , Serviços de Assistência Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/fisiopatologia , Reprodutibilidade dos Testes , Autocuidado , Sensibilidade e Especificidade
10.
J Fr Ophtalmol ; 40(1): 22-28, 2017 Jan.
Artigo em Francês | MEDLINE | ID: mdl-28081918

RESUMO

PURPOSE: To evaluate the lowering of intraocular pressure (IOP) one year after SLT and to assess if differences are related to number of pre-SLT topical treatments in ocular hypertension (OHT) and primary open angle glaucoma (POAG) patients. METHODS: Retrospective review of 106 eyes of 13 OHT and 93 POAG patients treated by SLT for insufficient IOP control, allergy, discomfort or non-compliance to glaucoma medications, excluding patients with less than 1 year of follow-up after SLT. IOP was measured by applanation before and at 1, 6 and 12 months after SLT. RESULTS: Hundred and six eyes untreated (n=13), or treated with one (n=25), two (n=40) or three or more (n=28) glaucoma medications were included. Mean IOP decreased from 19.4±3.6mmHg preoperatively to 15.7±3.1mmHg at 12 months, which corresponds to an average decrease of 18.8%. At 1 year, 62.2% (n=66) were responders (IOP reduction≥3mmHg): 92.3% without medications (n=12), 68% with one (n=17), 57.5% with two (n=23) and 50% with three or more medications (n=14). Their average IOP decreased from 20.7±3.4 to 15.2±2.9mmHg (26.6%), respectively from 20.8±2.6 to 15.8±3.2 (25%) without medications, 20.6±3.2 to 14.9±3.7 (27.3%) with one, 20.8±4.1 to 15.5±3.3 (25.1%) with two and 20.7±3.2 to 14.4±2.4mmHg (29.7%) with three medications. CONCLUSIONS: The number of responders seems to be greater in OHT and POAG patients without or with few glaucoma medications, but the IOP reduction seems to be similar regardless of the number of glaucoma medications.


Assuntos
Anti-Hipertensivos/administração & dosagem , Glaucoma de Ângulo Aberto/tratamento farmacológico , Glaucoma de Ângulo Aberto/cirurgia , Pressão Intraocular/efeitos dos fármacos , Terapia a Laser/métodos , Hipertensão Ocular/tratamento farmacológico , Hipertensão Ocular/cirurgia , Trabeculectomia/métodos , Administração Tópica , Terapia Combinada , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Hipertensão Ocular/fisiopatologia , Cuidados Pré-Operatórios/métodos , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento
11.
Int J Obes (Lond) ; 40(8): 1310-9, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27005405

RESUMO

BACKGROUND: Obesity is strongly associated with prevalence of obstructive sleep apnea (OSA), and weight loss has been shown to reduce disease severity. OBJECTIVE: To investigate whether liraglutide 3.0 mg reduces OSA severity compared with placebo using the primary end point of change in apnea-hypopnea index (AHI) after 32 weeks. Liraglutide's weight loss efficacy was also examined. SUBJECTS/METHODS: In this randomized, double-blind trial, non-diabetic participants with obesity who had moderate (AHI 15-29.9 events h(-1)) or severe (AHI ⩾30 events h(-1)) OSA and were unwilling/unable to use continuous positive airway pressure therapy were randomized for 32 weeks to liraglutide 3.0 mg (n=180) or placebo (n=179), both as adjunct to diet (500 kcal day(-1) deficit) and exercise. Baseline characteristics were similar between groups (mean age 48.5 years, males 71.9%, AHI 49.2 events h(-1), severe OSA 67.1%, body weight 117.6 kg, body mass index 39.1 kg m(-2), prediabetes 63.2%, HbA1c 5.7%). RESULTS: After 32 weeks, the mean reduction in AHI was greater with liraglutide than with placebo (-12.2 vs -6.1 events h(-1), estimated treatment difference: -6.1 events h(-1) (95% confidence interval (CI), -11.0 to -1.2), P=0.0150). Liraglutide produced greater mean percentage weight loss compared with placebo (-5.7% vs -1.6%, estimated treatment difference: -4.2% (95% CI, -5.2 to -3.1%), P<0.0001). A statistically significant association between the degree of weight loss and improvement in OSA end points (P<0.01, all) was demonstrated post hoc. Greater reductions in glycated hemoglobin (HbA1c) and systolic blood pressure (SBP) were seen with liraglutide versus placebo (both P<0.001). The safety profile of liraglutide 3.0 mg was similar to that seen with doses ⩽1.8 mg. CONCLUSIONS: As an adjunct to diet and exercise, liraglutide 3.0 mg was generally well tolerated and produced significantly greater reductions than placebo in AHI, body weight, SBP and HbA1c in participants with obesity and moderate/severe OSA. The results confirm that weight loss improves OSA-related parameters.


Assuntos
Hipoglicemiantes/uso terapêutico , Liraglutida/uso terapêutico , Obesidade/complicações , Obesidade/tratamento farmacológico , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/tratamento farmacológico , Adolescente , Adulto , Fármacos Antiobesidade/farmacologia , Fármacos Antiobesidade/uso terapêutico , Método Duplo-Cego , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Hipoglicemiantes/farmacologia , Liraglutida/farmacologia , Masculino , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Polissonografia , Estudos Prospectivos , Apneia Obstrutiva do Sono/fisiopatologia , Resultado do Tratamento , Estados Unidos/epidemiologia , Redução de Peso/efeitos dos fármacos , Adulto Jovem
12.
J Fr Ophtalmol ; 38(9): 832-43, 2015 Nov.
Artigo em Francês | MEDLINE | ID: mdl-26494495

RESUMO

PURPOSE: To evaluate intra- and interobserver reproducibility of macular GCC thickness measurement by automated segmentation on the Canon HS-100 SD-OCT (Tokyo, Japan) in normal (N), hypertensive (OHT) and glaucomatous eyes. METHODS: A total of 179 eyes of 93 patients were included: 90 N, 28 OHT and 36 early glaucoma and 25 advanced glaucoma. All patients underwent a complete ophthalmologic exam, central corneal thickness and 24-2 standard automated perimetry (HFA SITA standard). Each of two observers performed three macular acquisitions with the Canon OCT HS-100. Acquisitions were analyzed with the Glaucoma 3D mode, which estimated the macular GCC thickness in global, superior and inferior hemisectors, and in eight separate macular areas. Reproducibility was assessed by intraclass correlation coefficient (ICC), coefficient of variation (CV) and test-retest variability (TRTV) calculated as 1.96 times the standard deviation. RESULTS: Mean GCC thickness was respectively 92.4 µm, 89.0 µm, 80.7 µm and 71.2 µm in N, OHT, early and advanced glaucomatous eyes. In all groups, intra- and interobserver reproducibility ranged respectively for ICC from 89.8 to 99.8% and from 90.2 to 99.4%, for CV from 0.43 to 1.95% and from 0.58 to 2.16% and for TRTV from 0.8 to 3.22 µm and from 1.04 to 3.53 µm. GCC thickness measurements using the new HS-100 SD-OCT were highly reproducible. However, in the advanced glaucoma group, while the reproducibility of GCC thickness measurement is good in the average, superior and inferior hemisectors of the macula, it was slightly less for the paracentral sectors, especially inferior. These sectors correspond generally to the areas most affected by glaucoma. CONCLUSION: The reproducibility of GCC thickness measurements using the new Canon HS-100 SD-OCT is high for normal, OHT, and glaucomatous eyes. It is thus a reliable and reproducible ancillary test available to the clinician for the examination of glaucomatous optic neuropathies.


Assuntos
Hipertensão Ocular/patologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica , Desenho de Equipamento , Glaucoma/patologia , Humanos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Células Ganglionares da Retina/citologia , Tomografia de Coerência Óptica/instrumentação
13.
Phys Rev Lett ; 114(21): 217001, 2015 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-26066451

RESUMO

X-ray magnetic circular dichroism (XMCD) measurements on single-crystal and powder samples of Ba_{0.6}K_{0.4}Mn_{2}As_{2} show that the ferromagnetism below T_{C}≈100 K arises in the As 4p conduction band. No XMCD signal is observed at the Mn x-ray absorption edges. Below T_{C}, however, a clear XMCD signal is found at the As K edge which increases with decreasing temperature. The XMCD signal is absent in data taken with the beam directed parallel to the crystallographic c axis indicating that the orbital magnetic moment lies in the basal plane of the tetragonal lattice. These results show that the previously reported itinerant ferromagnetism is associated with the As 4p conduction band and that distinct local-moment antiferromagnetism and itinerant ferromagnetism with perpendicular easy axes coexist in this compound at low temperature.

15.
J Fr Ophtalmol ; 38(1): 46-52, 2015 Jan.
Artigo em Francês | MEDLINE | ID: mdl-25575418

RESUMO

INTRODUCTION: Clinical determination of the outer limits of the optic disk (OD) doesn't always correspond to the true anatomic limits of the optic nerve head (ONH) defined by the Bruch's membrane opening (BMO). A new index analyzing the OD with optical coherence tomography (OCT), "minimal rim width" (BMO-MRW), evaluates the smallest thickness of the neuroretinal rim between the BMO and the internal limiting membrane. The purpose of this study was to evaluate new software for automatic measurement of the BMO-MRW. MATERIALS AND METHODS: This study investigated 95 eyes: 40 control eyes and 55 eyes followed and treated for primary open angle glaucoma (42 early glaucoma, 7 moderate glaucoma and 6 advanced glaucoma). After a precise localization of the OD center, 24 radial scans of the ONH are taken with the Spectralis OCT (Heidelberg Engineering, Germany). From the 48 measurements of BMO-MRW, the mean thickness as well as that in each of the 6 papillary sectors of this new index are calculated. ROC curves analysis (receiver operating characteristic) was used to assess the diagnostic capabilities of the various parameters. RESULTS: Thicknesses of all parameters were statistically lower in glaucoma than in controls. The mean value and inferotemporal sector (IT) had the best diagnostic capabilities without significant difference between them (BMO-MRW-average = 0.890 ± 0.062, BMO-MRW-IT = 0.881 ± 0.066, P = 0.59). The area under the curve was lowest in the temporal sector (0.820 ± 086 statistically lower than the average value, P = 0.04). CONCLUSIONS: This preliminary study of a new automated analysis of the neuroretinal rim highlights the diagnostic value of the BMO-MRW index. This evaluation appears to be best correlated with the anatomy of the ONH with good diagnostic sensitivity.


Assuntos
Antropometria/métodos , Lâmina Basilar da Corioide/ultraestrutura , Disco Óptico/ultraestrutura , Tomografia de Coerência Óptica/métodos , Idoso , Algoritmos , Antropometria/instrumentação , Área Sob a Curva , Feminino , Glaucoma de Ângulo Aberto/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Software , Tomografia de Coerência Óptica/instrumentação
16.
Phys Chem Chem Phys ; 16(29): 15319-25, 2014 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-24943511

RESUMO

We have performed a comparison of the radiation damage occurring in DNA adsorbed on gold in two different configurations, when the DNA is thiolated and bound covalently to the substrate and when it is unthiolated and interacts with the substrate through the bases. Both molecules were found to organize so as to protrude from the surface at ~45 degrees. Changes in the time-dependent C 1s and O 1s X-ray photoelectron (XP) spectra resulting from irradiation were interpreted to arise from cleavage of the phosphodiester bond and possibly COH desorption. By fitting the time-dependent XP spectra to a simple kinetic model, time constants were extracted, which were converted to cross sections and quantum yields for the damage reaction. The radiation induced damage is significantly higher for the thiolated DNA. N 1s X-ray absorption spectrum revealed the N-C=N LUMO is more populated in the unthiolated molecule, which is due to a higher degree of charge transfer from the substrate to this LUMO in the unthiolated case. Since the N-C=N LUMO of the thiolated molecule is comparatively less populated, it is more effective in capturing low energy electrons resulting in a higher degree of damage.


Assuntos
Dano ao DNA/efeitos da radiação , DNA/efeitos da radiação , Elétrons , Ouro/química , Compostos de Sulfidrila/química , DNA/química , Espectroscopia Fotoeletrônica , Espectroscopia de Infravermelho com Transformada de Fourier , Propriedades de Superfície , Espectroscopia por Absorção de Raios X , Raios X
17.
Aliment Pharmacol Ther ; 40(1): 72-82, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24815064

RESUMO

BACKGROUND: Use of anaesthesia services during endoscopy has increased, increasing cost of endoscopy. AIM: To identify risk factors for and develop a clinical prediction score to predict difficult conscious sedation. METHODS: We performed a retrospective cross-sectional study of all patients who underwent oesophagogastroduodenoscopy (OGD) and colonoscopy with endoscopist-administered conscious sedation. The endpoint of difficult sedation was a composite of receipt of high doses (top quintile) of benzodiazepines and opioids, or the documentation of agitation or discomfort. Univariate and multivariate analyses were performed to measure association of the outcome with: age, sex, body mass index (BMI), procedure indication, tobacco use, self-reported psychiatric history, chronic use of benzodiazepines, opioids or other psychoactive medications, admission status and participation of a trainee. A clinical prediction score was constructed using statistically significant variables. RESULTS: We identified 13,711 OGDs and 21,763 colonoscopies, 1704 (12.4%) and 2299 (10.6%) of which met the primary endpoint, respectively. On multivariate analysis, factors associated with difficulty during OGD were younger age, procedure indication, male sex, presence of a trainee, psychiatric history and benzodiazepine and opioid use. Factors associated with difficulty during colonoscopy were younger age, female sex, BMI <25, procedure indication, tobacco, benzodiazepine, opioid and other psychoactive medication use. A clinical prediction score was developed and validated that may be used to risk-stratify patients undergoing OGD and colonoscopy across five risk classes. CONCLUSIONS: Using the Stratifying Clinical Outcomes Prior to Endoscopy (SCOPE) score, patients may be risk stratified for difficult sedation/high sedation requirement during OGD and colonoscopy.


Assuntos
Anestesia/métodos , Colonoscopia/métodos , Sedação Consciente/métodos , Endoscopia do Sistema Digestório/métodos , Adolescente , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Benzodiazepinas/administração & dosagem , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
18.
Case Rep Dermatol ; 6(1): 49-53, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24707250

RESUMO

Even though the incidence of toxic epidermal necrolysis (TEN) is low, it is also associated with a high mortality rate. The condition predominantly affects the skin, but may also affect the gastrointestinal tract, dramatically increasing mortality. We present a case of perforated sigmoid diverticulitis in the presence of TEN. The patient was taking medication, known to be a risk factor, and presented an affected total body surface area and temporal development similar to previously reported cases of TEN. Characteristic abdominal symptoms, however, were missing. Gastrointestinal involvement in TEN appears to be a poor prognostic factor; medical staff must therefore be alert to patients with TEN who complain of abdominal discomfort. The exact pathogenesis, however, remains unclear.

19.
Br J Cancer ; 110(10): 2544-50, 2014 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-24722182

RESUMO

BACKGROUND: Current histopathological staging procedures in colon carcinomas depend on midline division of the lymph nodes with one section of haematoxylin & eosin (H&E) staining only. By this method, tumour deposits outside this transection line may be missed and could lead to understaging of a high-risk group of stage UICC II cases, which recurs in ∼20% of cases. A new diagnostic semiautomated system, one-step nucleic acid amplification (OSNA), detects cytokeratin (CK) 19 mRNA in lymph node metastases and enables the investigation of the whole lymph node. The objective of this study was to assess whether histopathological pN0 patients can be upstaged to stage UICC III by OSNA. METHODS: Lymph nodes from patients who were classified as lymph node negative after standard histopathology (single (H&E) slice) were subjected to OSNA. A result revealing a CK19 mRNA copy number >250, which makes sure to detect mainly macrometastases and not isolated tumour cells (ITC) or micrometastases only, was regarded as positive for lymph node metastases based on previous threshold investigations. RESULTS: In total, 1594 pN0 lymph nodes from 103 colon carcinomas (median number of lymph nodes per patient: 14, range: 1-46) were analysed with OSNA. Out of 103 pN0 patients, 26 had OSNA-positive lymph nodes, resulting in an upstaging rate of 25.2%. Among these were 6/37 (16.2%) stage UICC I and 20/66 (30.3%) stage UICC II patients. Overall, 38 lymph nodes were OSNA positive: 19 patients had one, 3 had two, 3 had three, and 1 patient had four OSNA-positive lymph nodes. CONCLUSIONS: OSNA resulted in an upstaging of over 25% of initially histopathologically lymph node-negative patients. OSNA is a standardised, observer-independent technique, allowing the analysis of the whole lymph node. Therefore, sampling bias due to missing investigation of certain lymph node tissue can be avoided, which may lead to a more accurate staging.


Assuntos
Adenocarcinoma/secundário , Neoplasias do Colo/patologia , Metástase Linfática/genética , Estadiamento de Neoplasias/métodos , Técnicas de Amplificação de Ácido Nucleico , RNA Mensageiro/análise , RNA Neoplásico/análise , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/genética , Adenocarcinoma/cirurgia , Adulto , Idoso , Quimioterapia Adjuvante , Colectomia , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/genética , Neoplasias do Colo/cirurgia , Europa (Continente) , Reações Falso-Negativas , Feminino , Humanos , Linfonodos/química , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Prospectivos , RNA Mensageiro/genética , RNA Neoplásico/genética , Coloração e Rotulagem , Adulto Jovem
20.
J Fr Ophtalmol ; 36(8): 693-703, 2013 Oct.
Artigo em Francês | MEDLINE | ID: mdl-23969009

RESUMO

Corneal neovascularization is defined as the invasion of vessels into the normally avascular clear corneal stroma, secondary to acute or chronic tissue injury. In addition to decreasing visual acuity, vascularity introduces circulating immune cells, reducing corneal immune privilege and the graft survival of subsequent keratoplasty. Thus, reducing neovascularization has become a recent therapeutic target in order to increase the success of corneal transplantation. Comparing the effects of antiangiogenic drugs assumes that we are able to quantify corneal neovascularization before and after treatment. In the first part of this literature review, we present the various methods to document neovessels (color photos, fluorescein and indocyanine green anterior segment angiography, in vivo confocal microscopy). Next, we report methods to classify and quantify corneal neovascularization.


Assuntos
Neovascularização da Córnea/diagnóstico , Neovascularização da Córnea/patologia , Diagnóstico por Imagem/métodos , Técnicas de Diagnóstico Oftalmológico , Progressão da Doença , Angiofluoresceinografia , Humanos , Verde de Indocianina , Microscopia Confocal , Fotografação
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