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F. Clavijo Sánchez T. Vázquez Sánchez M. Cabello Díaz V.E. Sola Moyano C. Jironada Gallego D. Hernández Marrero 《Transplantation proceedings》2018,50(2):581-582
Visceral leishmaniasis is a disease caused by the protozoan Leishmania and is transmitted by Lutzomyia longipalpis (sand fly). It is an endemic parasitic infection in numerous areas around the Mediterranean basin. Though immunocompetent patients may not develop the disease, in transplant recipients the use of corticoids and intensified immunosuppressants to prevent graft rejection may accelerate the disease, causing severe damage to the liver, spleen, and hematopoietic system. We report 2 cases of visceral leishmaniasis with an atypical presentation in transplant recipients. The first patient, who had a kidney transplant, was treated successfully with liposomal amphotericin B, and the second patient, a combined kidney-pancreas transplant recipient, suffered a relapse 3 years after treatment. Visceral leishmaniasis should be considered in the differential diagnosis of pancytopenia or unexplained fever occurring after organ transplantation in patients living in endemic areas or returning from endemic countries. 相似文献
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Sean M. O’Brien Liqi Feng Xia He Ying Xian Jeffrey P. Jacobs Vinay Badhwar Paul A. Kurlansky Anthony P. Furnary Joseph C. Cleveland Kevin W. Lobdell Christina Vassileva Moritz C. Wyler von Ballmoos Vinod H. Thourani J. Scott Rankin James R. Edgerton Richard S. D’Agostino Nimesh D. Desai Fred H. Edwards David M. Shahian 《The Annals of thoracic surgery》2018,105(5):1419-1428
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Chang Wook Jeong Cheol Yong Yoon Seong Jin Jeong Sung Kyu Hong Seok-Soo Byun Cheol Kwak Sang Eun Lee 《Urologic oncology》2013,31(8):1448-1456
ObjectivesThe aim of this study was to investigate the effects of induction and knocking down of hypoxia-inducible factor (HIF)-1α and/or -2α on tumor biology in androgen insensitive prostate cancer cell lines.Materials and methodsThe induction patterns of HIF-1α and -2α after treatment with ZnSO4 were evaluated in PC3 and DU145 cells. Both cell lines were transfected with siRNA targeted against HIF-1α and/or -2α, and the expression patterns of these 2 HIF isoforms were examined. We next performed cell counting Kit-8 (CCK-8) assays and matrigel invasion assays. Potential additive effects of HIF blockade to chemotherapy (docetaxel) or target agents (sunitinib and sorafenib) were examined. In addition, gene expression changes were determined in ZnSO4-treated DU145 cells using Western blotting.ResultsZnSO4 affected the expression of HIF in a dose-dependent manner. HIF expression was increased within the first 3 hours but then decreased. Cells in which HIF-1α and/or -2α had been knocked down using siRNA showed decreased cell viability. Invasion abilities were increased by ZnSO4 treatment in both cell lines overexpressing HIF. However, invasion potencies were decreased in response to treatment with HIF siRNAs. Blocking HIF prominently augmented the antitumor effects of target agents. The underlying mechanism could be associated with p21, cMET, IGF-1, and GLUT-1.ConclusionsOur results demonstrate that HIF-1α and -2α are important for cell proliferation and invasion ability in prostate cancer. Together, our results indicate that combinations of target agents with HIF knockdown may represent a promising strategy for the treatment of prostate cancer. 相似文献
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E. N. Pijnappel N. Bhoo-Pathy J. Suniza M. H. See G. H. Tan C. H. Yip M. Hartman N. A. Taib H. M. Verkooijen 《World journal of surgery》2014,38(12):3133-3137
Background
In settings with limited resources, sentinel lymph node biopsy (SNB) is only offered to breast cancer patients with small tumors and a low a priori risk of axillary metastases.Objective
We investigated whether CancerMath, a free online prediction tool for axillary lymph node involvement, is able to identify women at low risk of axillary lymph node metastases in Malaysian women with 3–5 cm tumors, with the aim to offer SNB in a targeted, cost-effective way.Methods
Women with non-metastatic breast cancers, measuring 3–5 cm were identified within the University Malaya Medical Centre (UMMC) breast cancer registry. We compared CancerMath-predicted probabilities of lymph node involvement between women with versus without lymph node metastases. The discriminative performance of CancerMath was tested using receiver operating characteristic (ROC) analysis.Results
Out of 1,017 patients, 520 (51 %) had axillary involvement. Tumors of women with axillary involvement were more often estrogen-receptor positive, progesterone-receptor positive, and human epidermal growth factor receptor (HER)-2 positive. The mean CancerMath score was higher in women with axillary involvement than in those without (53.5 vs. 51.3, p = 0.001). In terms of discrimination, CancerMath performed poorly, with an area under the ROC curve of 0.553 (95 % confidence interval CI 0.518–0.588). Attempts to optimize the CancerMath model by adding ethnicity and HER2 to the model did not improve discriminatory performance.Conclusion
For Malaysian women with tumors measuring 3–5 cm, CancerMath is unable to accurately predict lymph node involvement and is therefore not helpful in the identification of women at low risk of node-positive disease who could benefit from SNB. 相似文献7.
Mario Musella Jan Apers Karl Rheinwalt Rui Ribeiro Emilio Manno Francesco Greco Michal Čierny Marco Milone Carla Di Stefano Sahin Guler Isa Mareike Van Lessen Anabela Guerra Mauro Natale Maglio Riccardo Bonfanti Radoslava Novotna Guido Coretti Luigi Piazza 《Obesity surgery》2016,26(5):933-940
Background
A retrospective study was undertaken to define the efficacy of both mini gastric bypass or one anastomosis gastric bypass (MGB/OAGB) and sleeve gastrectomy (SG) in type 2 diabetes mellitus (T2DM) remission in morbidly obese patients (pts).Methods
Eight European centers were involved in this survey. T2DM was preoperatively diagnosed in 313/3252 pts (9.62 %). In 175/313 patients, 55.9 % underwent MGB/OAGB, while in 138/313 patients, 44.1 % received SG between January 2006 and December 2014.Results
Two hundred six out of 313 (63.7 %) pts reached 1 year of follow-up. The mean body mass index (BMI) for MGB/OAGB pts was 33.1?±?6.6, and the mean BMI for SG pts was 35.9?±?5.9 (p?<?0.001). Eighty-two out of 96 (85.4 %) MGB/OAGB pts vs. 67/110 (60.9 %) SG pts are in remission (p?<?0.001). No correlation was found in the % change vs. baseline values for hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) in relation to BMI reduction, for both MGB/OAGB or SG (ΔFPG 0.7 and ΔHbA1c 0.4 for MGB/OAGB; ΔFPG 0.7 and ΔHbA1c 0.1 for SG). At multivariate analysis, high baseline HbA1c [odds ratio (OR)?=?0.623, 95 % confidence interval (CI) 0.419–0.925, p?=?0.01], preoperative consumption of insulin or oral antidiabetic agents (OR?=?0.256, 95 % CI 0.137–0.478, p?=?<0.001), and T2DM duration >10 years (OR?=?0.752, 95 % CI 0.512–0.976, p?=?0.01) were negative predictors whereas MGB/OAGB resulted as a positive predictor (OR?=?3.888, 95 % CI 1.654–9.143, p?=?0.002) of diabetes remission.Conclusions
A significant BMI decrease and T2DM remission unrelated from weight loss were recorded for both procedures if compared to baseline values. At univariate and multivariate analyses, MGB/OAGB seems to outperform significantly SG. Four independent variables able to influence T2DM remission at 12 months have been identified.8.
Jean-Jacques Dubost Bruno Pereira Anne Tournadre Zuzana Tatar Marion Couderc Martin Soubrier 《Joint, bone, spine : revue du rhumatisme》2017,84(1):47-50
Objectives
To see whether the frequency and features of septic arthritis (SA) complicating rheumatoid arthritis (RA) have changed over the last 35 years.Methods
This retrospective single-center study included all patients hospitalized at the rheumatology department for SA bacteriologically documented by synovial fluid and/or blood culture samples. The periods 1979–2002 (before biotherapies) and 2003–2013 (the era of biotherapies) were compared.Results
Between 1979 and 2013, 64/514 (12.5%) SA presented with a RA – 21/157 (13.4%) in the 2003–2013 period and 43/357 (12.0%) in the 1979–2002 period. Over the past decade, median age of RA SA patients increased (61 vs. 68 years; P < 0.02) and predominant gender became males (52% vs. 40%). The features of the RA remained unchanged: history (18 vs. 16 years), rheumatoid factor (95% vs. 87%), and corticosteroids (91% vs. 81%). Over the last decade 24% (vs. 0; P < 0.003) of the patients received a biologic DMARD: etanercept (n = 2), adalimumab (n = 1), rituximab (n = 1), tocilizumab (n = 1). Proportion of polyarticular infection had decreased strongly (9.5% vs. 37%; P < 0.02). Proportion of Staphyloccus aureus infections remained stable, but there was a higher incidence of MRSA infections (31 vs. 6%; P < 0.05). Blood cultures less often tested positive (29% vs. 47%; NS). Case fatality rate had fallen slightly in RA SA (5% vs. 9%; NS), but not in non-RA SA cases (7% vs. 6%; NS).Conclusion
This study brings reassuring findings – in the era of biotherapies, the rate of septic arthritis amongst patients with RA has not increased, and the most severe septic polyarticular forms are on the decline. 相似文献9.
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Francesco Benazzo Matteo Marullo Giacomo Zanon Cristian Indino Francesco Pelillo 《Journal of orthopaedics and traumatology》2013,14(2):83-89
Background
Proximal hamstring tendinopathy typically afflicts athletes. The poor knowledge of this pathology can lead to late diagnosis and late treatment, which in chronic cases could be challenging. Surgical treatment could resolve the symptoms and could permit the return to full sport activity also in chronic cases.Materials and methods
We retrospectively evaluated 17 high-level athletes surgically treated for proximal hamstring tendinopathy. Symptoms lasted for an average of 23 months and were resistive to conservative treatment.Results
The follow-up period averaged 71 months. Return to run without pain occurred at a mean of 2.4 months (range 1–4) after surgery. All patients returned to sports at their pre-symptom level at a mean of 4.4 months after surgery. Results were excellent in 15 patients (88 %) and good in two patients (12 %). No results were fair or poor.Conclusions
Surgical treatment to manage chronic proximal hamstring tendinopathy in high-level athletes showed excellent results in terms of relief from symptoms and return to previous sport level. 相似文献11.
Elizabeth Timbrook Brown Ryan M. Krlin J. Christian Winters 《Current urology reports》2013,14(5):403-408
Urodynamics testing is a diagnostic assessment of the lower urinary tract system composed of multiple tests to obtain physiologic data regarding lower urinary tract function (detrusor and outlet) during storage and emptying. The necessity of urodynamics has been both supported and challenged in various urologic conditions such as urinary incontinence, neurogenic bladder, lower urinary tract symptoms, and bladder outlet obstruction. This review discusses the most recent studies with regards to the utility of urodynamics in current practice, highlighting the recent American Urologic Association Adult Urodynamics and Overactive Bladder Guidelines and the Value of Urodynamic Evaluation study. 相似文献
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Yoshimura N Muraki S Oka H Kawaguchi H Nakamura K Akune T 《Journal of bone and mineral metabolism》2011,29(6):699-708
We aimed to clarify changes in biochemical markers of bone turnover (BTMs) over 10 years, associations with changes in bone
mineral density (BMD), and birth-cohort effects in a Japanese community. We randomly selected 400 individuals (age, 40–79 years;
50 of each gender and age stratum) from a list of registered residents in 1993. We measured BMD of the spine and hip, and
serum concentrations of total osteocalcin (OC), beta-C-terminal cross-linking telopeptide of type I collagen (beta-CTX), and
N-terminal cross-linking telopeptide of type I collagen (NTX), in 1993 and 2003. Of the 400 subjects, 322 (153 men, 169 women)
completed the 10-year follow-up. Mean change rates (standard deviation) for serum total OC, beta-CTX, and NTX over 10 years
were –1.00 (3.74)%/year, 5.10 (22.48)%/year, and 0.40 (3.41)%/year, respectively, in men, and 0.02 (5.32)%/year, 5.53 (14.54)%/year,
and 0.62 (3.26)%/year, respectively, in women. Change rates of BTMs were higher for women in their forties than for women
in their fifties to seventies (P < 0.05), and higher in the menstrual transition group than in pre- and postmenopausal groups (P < 0.001). Changes in levels of BTMs over 10 years in women were significantly associated with change rates of BMDs at L2–L4
and total hip after adjusting for potential confounders. A significant birth-cohort effect was observed among women in their
fifties. We concluded that change rates of BTMs during the 10 years were influenced by menstrual transition, age, and sex
and associated with bone loss at L2–L4 and total hip. 相似文献
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Yasutaka Hirata Norimichi Hirahara Arata Murakami Noboru Motomura Hiroaki Miyata Shinichi Takamoto 《General thoracic and cardiovascular surgery》2018,66(1):4-7
Objectives
We analyzed the mortality and morbidity of congenital heart surgery in Japan using the Japan Cardiovascular Surgery Database (JCVSD).Methods
Data regarding congenital heart surgery performed between January 2013 and December 2014 were obtained from JCVSD. The 20 most frequent procedures were selected and the mortality rates and major morbidities were analyzed.Results
The mortality rates of atrial septal defect repair and ventricular septal defect repair were less than 1%, and the mortality rates of tetralogy of Fallot repair, complete atrioventricular septal defect repair, bidirectional Glenn, and total cavopulmonary connection were less than 2%. The mortality rates of the Norwood procedure and total anomalous pulmonary venous connection repair were more than 10%. The rates of unplanned reoperation, pacemaker implantation, chylothorax, deep sternal infection, phrenic nerve injury, and neurological deficit were shown for each procedure.Conclusion
Using JCVSD, the national data for congenital heart surgery, including postoperative complications, were analyzed. Further improvements of the database and feedback for clinical practice are required.15.
Purpose
Prospective data was evaluated to see whether bariatric procedure type made any difference to diabetes remission.Methods
One hundred eighty-six consecutive patients of Indian ethnicity (M:F 89:97) with type 2 diabetes mellitus (T2DM) and HbA1c >?6.5 were assessed before and at 1 year following surgery. Age, BMI, C-peptide and duration of diabetes (ABCD - described by WJ Lee), insulin use, baseline HbA1c, and % weight loss were tested as modifiers. We present remission rates (HbA1c ≤?6.0%) and between group remission odds ratio (OR) and adjusted OR after controlling for key modifiers.Results
Patients selecting RYGB (n?=?113) vs SG (n?=?73) were older (50.7 vs 44.2 years), had a lower BMI (44.1 vs 46.7), lower C-peptide (3.5 vs 4.7 ng/ml), greater duration of diabetes (8 vs 3 years), and higher HbA1c (8.90 and 7.9%) respectively p?<?0.05 for all (combined R2?=?0.38). Weight loss at 1 year was 27 and 30% for RYGB and SG respectively (p?=?0.01). Remission at 1 year was achieved by 37% of patient selecting RYGB and 74% for the SG (OR?=?0.21, 95% CI 0.11–0.41, p?<?0.001). After adjusting for ABCD, the adjusted OR (AOR) still favored the SG (AOR?=?0.32, 0.14–0.74, p?=?0.01), and adjustment for HbA1c and weight loss (AOR 0.4, 0.17–0.95, p?=?0.038) attenuated the effect.Conclusion
The analysis suggests SG may be superior to RYGB in this Indian population. Ethnicity may play a role in predicting the response to bariatric surgery and hence the choice of procedure. A randomized controlled trial is needed to clarify the relative benefit.16.
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Background
The aim of this study was to assess the effects of smoking on albuminuria risk in adults with type 2 diabetes mellitus (T2DM).Methods
A literature search was conducted using MEDLINE, EMBASE, and China National Knowledge Infrastructure from the established date to October 2017. Summary relative risks (SRR) and 95% confidence intervals (CI) were computed utilizing a random effect inverse variance method.Results
This meta-analysis included a total of 19 relevant observational studies (four prospective cohort, seven case–control, and eight cross-sectional studies), reporting 105,031 participants and 23,366 albuminuria events. Compared with never-smokers with T2DM, the SRRs of albuminuria were 1.43 (95% CIs 1.27–1.61) for ever-smokers, 2.61 (95% CIs 1.86–3.64) for current smokers, and 1.86 (95% CIs 1.37–2.52) for former smokers. Considerable heterogeneity was observed among these studies, and study design was a significant modifier for this association. There were significantly elevated risk associations for microalbuminuria (SRRs = 1.24, 95% CIs 1.05–1.46) and for macroalbuminuria (SRRs = 1.65, 95% CIs 1.03–2.66), respectively.Conclusions
Our systematic review and meta-analysis indicates that cigarette smoking might be a potential factor for the development of albuminuria in adults with T2DM. Future studies are required to investigate the association between smoking cessation and intensity and incident albuminuria in adults with T2DM.18.
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Philippe Valenti Pablo Valle Philippe Sauzieres Omar Boughebri Tina Moraiti Ali Maqdes Christian K. Spies Frank Unglaub Franck Marie Leclère 《Archives of orthopaedic and trauma surgery》2014,134(6):785-791
Introduction
Glenoid component loosening comprises 25 % of all complications related to total shoulder arthroplasties (TSA). This prospective study was undertaken to assess the accuracy of an uncemented metal-back glenoid component in cases of revision of aseptic glenoid loosening.Materials and methods
Between September 2007 and January 2010, a total of ten patients with symptomatic glenoid loosening after TSA (7 cemented and 3 non-cemented) underwent revision surgery with an uncemented metal-back glenoid component (MB). The rotator cuff was functional in all cases. The reconstruction of the glenoid was obtained using an iliac crest graft (8 patients) or synthetic bone substitute (2 patients). The non-cemented glenoid component was fixed into the glenoid native bone, thus stabilizing the graft reconstruction. A clinical and radiological checkup was performed at the long-term follow-up and compared with the preoperative values. The patients were also asked to quantify their pain and satisfaction.Results
There were no intraoperative complications. In all cases, the radiological evaluation showed a good integration of the bone graft with no radiolucency or new glenoid loosening. In one patient, the revision surgery was indicated for the dissociation between MB and polyethylene. After more than 2 years of follow-up, all patients were satisfied or highly satisfied with the outcomes. The pain VAS score (0–10) decreased from 5.1 to 0.6 (p < 0.001). The simple shoulder test increased from 3.4 to 7.9 points (gain 4.5; p < 0.001). The Constant and Murley score increased from 39.4 to 71 points (gain 31.6; p < 0.001). The gain in anterior elevation was 31°, from 118° to 149° (p < 0.001). External rotation elbow to the body (ER1) increased from an average of 34° preoperatively to 47° after surgery (p < 0.001) and external rotation at 90° of abduction from 43° to 66° (p < 0.001).Conclusion
This study suggests that revision with a non-cemented glenoid component associated with a bone graft can solve the difficult challenge of glenoid loosening, provided that the rotator cuff is functional and the glenoid is reconstructable.Level of evidence and study type
Cohort studies (prospective) without controls, Level IV. 相似文献20.
Guohua Zeng Wei Zhu Jiasheng Li Zhijian Zhao Tao Zeng Chenli Liu Yang Liu Jian Yuan Shaw P. Wan 《World journal of urology》2015,33(8):1159-1164