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1.
L. Ruiz-Martínez M. De-Cos-Gómez R. Valero-San-Cecilio E. Rodrigo-Calabia M. Heras-Vicario M. Serrano-Soto L. Belmar-Vega R. Palomar-Fontanet E. Miñambres-García J.C. Ruiz-San-Millán 《Transplantation proceedings》2019,51(2):337-340
Introduction
Our study compares 2 immunosuppressive strategies to reduce tacrolimus nephrotoxicity and its risk of acute tubular necrosis: delayed introduction of tacrolimus plus thymoglobulin vs initial tacrolimus plus basiliximab on the results of kidney transplant (KT) using type-III donation after circulatory death (III-DCD).Material and methods
We analyzed all the transplants performed using type-III DCD in our hospital (42 cases). They were distributed in a first stage with delayed tacrolimus (3°-4° day) + thymoglobulin and a second one with initial tacrolimus + basiliximab, with a follow-up of 6 months. The rate of delayed graft function, the evolution of renal function, and the incidence of rejection were compared.Results
28 patients received thymoglobulin with delayed tacrolimus, and 13 patients received basiliximab and tacrolimus from day 0 (1 excluded). There were no significant differences in delayed graft function (27% group 1 and 23% group 2) or in rejection (10.7% and 15.4%), respectively. Serum creatinine at day 3, 7, 14, 30, and 180 showed no statistically significant differences. The levels of tacrolimus measured at 10, 30, 90, and 180 days after transplantation were similar, except for the first month: 10.10 ± 2.3 in group 1 and 12 ± 1.7 ng/mL in group 2 (P = .007).Conclusions
Delayed introduction of tacrolimus does not seem to suppose a benefit in KT using type-III DCD; therefore, the use of thymoglobulin, with its higher profile of adverse effects, seems unjustified in patients with normal immunological risk. 相似文献2.
C.L. Choong H.S. Wong F.Y. Lee C.K. Lee J.V. Kho Y.X. Lai T. Vikneswaran 《Transplantation proceedings》2018,50(8):2515-2520
Background
Inhibition of calcineurin inhibitor (CNI) metabolism with diltiazem reduces the dose of tacrolimus required to achieve its therapeutic blood concentration in kidney transplant recipients (KTRs). This cost-savings maneuver is practiced in several countries, including Malaysia, but the actual impacts of diltiazem on tacrolimus blood concentration, dose-response relationship, cost-savings, and safety aspects are unknown.Methods
This retrospective study was performed on all KTRs ≥18 years of age at our center from January 1, 2006 to December 31, 2015, who were prescribed diltiazem as tacrolimus-sparing agent. Blood tacrolimus trough level (TacC0) and other relevant clinical data for 70 eligible KTRs were reviewed.Results
The dose of 1 mg tacrolimus resulted in a median TacC0 of 0.83 ± 0.52 ng/mL. With the introduction of a 90-mg/d dose diltiazem, there was a significant TacC0 increase to 1.39 ± 1.31 ng/mL/mg tacrolimus (P < .01). A further 90-mg increase in diltiazem to 180 mg/d resulted in a further increase of TacC0 to 1.66 ± 2.58 ng/mL/mg tacrolimus (P = .01). After this, despite a progressive increment of every 90-mg/d dose diltiazem to 270 mg/d and 360 mg/d, there was no further increment in TacC0 (1.44 ± 1.15 ng/mL/mg tacrolimus and 1.24 ± 0.94 ng/mL/mg tacrolimus, respectively [P < .01]). Addition of 180 mg/d diltiazem reduced the required tacrolimus dose to 4 mg/d, resulting in a cost-savings of USD 2045.92 per year (per patient) at our center. Adverse effects reported within 3 months of diltiazem introduction were bradycardia (1.4%) and postural hypotension (1.4%), which resolved after diltiazem dose reduction.Conclusion
Coadministration of tacrolimus and diltiazem in KTRs appeared to be safe and resulted in a TacC0 increment until reaching a 180-mg/d total diltiazem dose, at which point it began to decrease. This approach will result in a marked savings in immunosuppression costs among KTRs in Malaysia. 相似文献3.
Background
Genetic polymorphism is an important factor that influences tacrolimus concentrations and has the potential to predict the optimal dosage of tacrolimus in personalized medicine. Tacrolimus, a drug of narrow therapeutic index, is used in renal transplant recipients as an immunosuppressant agent. It is a substrate of cytochrome P450 3A (CYP3A) and has highly variable pharmacokinetic parameters.Objective
The aim of this study was to identify the proportion of CYP3A5 gene polymorphism in Myanmar kidney transplant recipients and to determine the impact of CYP3A5 gene polymorphisms on tacrolimus level in CYP3A5 expressors and nonexpressors.Methods
This study included 41 adult Myanmar post–renal transplant patients. Tacrolimus trough blood levels were determined and CYP3A5 genotype analysis was conducted by using polymerase chain reaction amplification of target followed by detection by restriction fragment length polymorphism analysis.Results. The CYP3A5 nonexpressors and expressors were detected in 25 (60.97%) and 16 (39.02%) of the 41 renal transplant recipients, respectively. The tacrolimus concentration/dose ratio in the CYP3A5 expressor group was lower than in the CYP3A5 nonexpressor group (1.49 ± 0.69 vs 3.49 ± 3.08 [P = .003] at 1 month; and 1.54 ± 0.9 vs 7.88 ± 8.25 [P = .0001] at 3 months).Conclusions
The findings of the present study revealed that more than one half of the study population were carrying the mutant allele CYP3A5*3(A6986G). CYP3A5 genetic polymorphism is one of the important factors in determining daily requirements for tacrolimus and in adjusting tacrolimus trough concentrations. 相似文献4.
This study investigated the safety and effectiveness of conversion from cyclosporine- to prolonged-release tacrolimus (PR-T)-based immunosuppression in kidney transplant recipients (KTRs) in Japanese routine clinical practice.
Materials and methods
This was a prospective observational study of stable KTRs who were converted from cyclosporine to PR-T according to local clinical practice. Clinical data were collected up to 12 months postconversion. Study outcomes included conversion dosing ratios, PR-T dose and trough levels, change in estimated glomerular filtration rate between conversion and month 12, graft/patient survival, and rejection rate (Kaplan–Meier). Outcomes of ongoing preconversion hypertrichosis, gingival hypertrophy, and cyclosporine-related renal toxicity were detailed. Data for adverse drug reactions were collected.Results
Overall, 266 patients (mean ±?SD age 51.9?±?13.5 years) were included. The mean ±?SD conversion ratio (PR-T:cyclosporine, mg:mg) was 0.029?±?0.017. After an initial decrease between conversion and month 3, mean ±?SD PR-T daily dose remained stable up to month 12 (2.4?±?1.5 mg at months 3 and 12), as did tacrolimus trough blood levels (3.5?±?1.8 vs 3.6?±?1.7 ng/mL, respectively). Estimated glomerular filtration rate was stable over 12 months (mean ±?SD change from conversion to month 12 was 0.3?±?7.8 mL/min/1.73m2). Month 12 Kaplan–Meier patient and graft survival rates were 99.6% and 95.5%, respectively. Eight patients reported 9 rejection episodes. PR-T demonstrated potential to improve cyclosporine-related renal toxicity, hypertrichosis, and gingival hypertrophy. Postconversion, 46 adverse drug reactions were reported in 39 patients (14.7%); there was 1 death.Conclusions
Conversion from cyclosporine to PR-T in Japanese stable KTRs was effective and tolerable over 12 months, with low rates of rejection reported. 相似文献5.
T.M. Manzia R. Angelico L. Toti C. Grimaldi D. Sforza I. Vella L. Tariciotti I. Lenci G. Breshanaj L. Baiocchi G. Tisone 《Transplantation proceedings》2018,50(1):175-183
Aim
We designed a retrospective case-control study to determine the efficacy and feasibility of everolimus (EVR) combined with low-dose tacrolimus (Tac) ab initio versus standard-dose Tac after liver transplantation (LT).Methods
Seventy-one adult LT patients, receiving EVR and low-dose Tac without corticosteroids or induction therapy from postoperative day 1 (EVR group) were compared with a well-matched control group of 61 recipients treated with standard-dose Tac in association with antimetabolite.Results
Baseline characteristics for the two groups were comparable. The overall patient and graft survival rates were similar (P = .908). Liver function was stable during the follow-up. In the EVR group, biopsy-proven acute rejection occurred in two cases (2.8%), whereas chronic rejection occurred in one (1.4%). The EVR group experienced a better renal function already after 2 weeks (estimated glomerular filtration rate: 89.85 [36.46 to 115.3] mL/min/1.73 m2 vs. 68.77 [16.11 to 115.42] mL/min/1.73 m2; P = .013), which was also observed after a median time of 27 months (range, 0 to 82 months) from LT (estimated glomerular filtration rate: 80 [45 to 118.3] mL/min/1.73 m2 vs. 70.9 [45 to 88.4] mL/min/1.73 m2; P = .04). After a median time of 27 months, the EVR group showed lower incidence of arterial hypertension and insulin-dependent diabetes mellitus.Conclusion
Ab initio EVR-based immunosuppression could be a valid option immediately after surgery in recipients at high-risk for post-LT renal impairment. 相似文献6.
J. Zegarska E. Hryniewiecka D. Zochowska E. Samborowska R. Jazwiec K. Maciej S. Nazarewski M. Dadlez L. Paczek 《Transplantation proceedings》2018,50(7):2235-2239
Background
Tacrolimus (Tac), an essential component of immunosuppressive therapy after solid-organ transplantation, has a narrow therapeutic index and requires therapeutic drug monitoring. Monitoring of Tac predose blood concentrations seems to be not always sufficient to avoid adverse effects. The aim of the study was to evaluate the levels of main Tac metabolites, 13-O-demethyl tacrolimus (13-DMT), 31-O-demethyl tacrolimus (31-DMT), and 15-O-demethyl tacrolimus (15-DMT), in kidney transplant recipients and to link them to clinical and biochemical parameters.Methods
In 63 kidney transplant patients, concentrations of 13-DMT, 31-DMT, and 15-DMT were quantified using liquid chromatography combined with tandem mass spectrometry (LC/MS/MS).Results
None of the patients had detectable 31-DMT blood levels. There was a positive correlation between 13-DMT/Tac and alanine aminotransferase (ALAT) (r = 0.29, P = .046) and a negative correlation between 13-DMT/Tac and hemoglobin (r = ?0.33, P = .008). Tac level did not correlate with ALAT nor with hemoglobin. There was no relationship between 13-DMT/Tac or 15-DMT/Tac and other biochemical or hematologic parameters or data, such as age, body mass index, arterial pressure, or time posttransplant. We observed significantly higher Tac concentrations in patients with hypercholesterolemia or hypertriglyceridemia compared with those without these comorbidities (6.45 ± 2.32 vs 5.16 ± 2.12 ng/mL, P = .043; 6.60 ± 2.30 vs 5.34 ± 2.20 ng/mL, P = .033, respectively).Conclusion
Our data may reflect 13-DMT accumulation in liver dysfunction and higher Tac clearance in anemia. However, these results may suggest that 13-DMT/Tac ratio is a marker of myelotoxicity and hepatotoxicity. Further studies should be carried out to determine whether monitoring of 13-DMT could be beneficial in minimizing the adverse effects. 相似文献7.
V. Martinelli M. Gregorini P. Politi F. Erasmi A. Contardi M. Abelli E. Ticozzelli M. Canevari A. Pietrabissa M. Chiappedi T. Rampino 《Transplantation proceedings》2019,51(1):143-146
Background
In the context of kidney transplantation (KT), multidisciplinary interventions, including assessment and management of psychosocial aspects, are important to improve transplant's outcome. The aim of this study was to describe a multidisciplinary team approach to KT, with a specific focus on early detection and treatment of psychological distress and psychopathologic conditions in the early phase postsurgery.Methods
The multidisciplinary team in kidney transplantation was implemented in January 2016. In this team approach, all transplant recipients are invited to 3 scheduled appointments for a multidisciplinary evaluation at 1, 3, and 6 months posttransplant, including a psychiatric interview, with the aim to assess the patient's adjustment after transplantation and provide support when necessary.Results
This pilot study involved all 41 KT recipients consecutively referred for the first multidisciplinary appointment after transplantation. Five subjects (12% of the study sample) presented with a current psychiatric diagnosis. Psychopharmacologic treatment was confirmed or introduced for all these patients. Further psychological support was suggested to 4 other patients (10%).Conclusion
KT significantly improves patients' quality of life. However, the percentage of subjects receiving psychopharmacologic treatment and referred for further psychological and psychiatric support (22%) suggests the need for careful monitoring of psychosocial aspects over the long term. 相似文献8.
Y. Takahashi S. Shishido Y. Hyodo T. Yonekura H. Nihei Y. Itabashi M. Muramatsu Y. Hamasaki T. Kawamura A. Aikawa 《Transplantation proceedings》2017,49(1):37-40
Background
The aim of this study was to assess the differences in pharmacokinetic (PK) profiles after the 1:1 ratio-based conversion from a twice-daily to a once-daily tacrolimus formulation (TD-TAC and OD-TAC, respectively) in pediatric recipients of kidney transplants.Methods
TD-TAC was initially administered to 29 pediatric patients who underwent kidney transplantations between April 2010 and September 2015 and were then subsequently switched to OD-TAC. The switch dose ratio was 1:1, and the 24-hour complete PK parameter assessment was performed before and after the regimen was changed from TD-TAC to OD-TAC.Results
The mean total daily dose at baseline was 5.5 ± 2.9 mg (0.18 ± 0.10 mg/kg body weight). Consecutive PK studies revealed no significant difference in the mean time to achieve maximum concentrations and the area under the concentration–time curve from 0 to 24 hours (AUC0–24) of both drug formulations. However, the mean trough concentration (Cmin) and the maximum concentration of OD-TAC were 22% and 6% lower and higher, respectively, than those of TD-TAC. Therefore, a better correlation was observed between the AUC0–24 and Cmin of OD-TAC than between those of TD-TAC.Conclusions
After the change from TD-TAC to OD-TAC, the AUC0–24 values were equivalent despite a 22% reduction in Cmin. Cmin may therefore be an excellent predictor in the therapeutic drug monitoring of OD-TAC because of its superior correlation with AUC0–24. 相似文献9.
Adam Tucker Seamus O’Brien Emer Doran Nicola Gallagher David E. Beverland 《The Journal of arthroplasty》2019,34(1):40-46.e1
Background
Valgus knee deformity accounts for only 10% of total knee arthroplasties (TKAs), but is frequently considered the most challenging to manage. This study provides a 10-year follow-up on a previously reported series of severe valgus knees performed using an unconstrained mobile-bearing TKA with a modified technique to validate this technique.Methods
A consecutive series of 275 predominantly cementless TKAs in 262 patients were performed for severe valgus (≥10°) deformity and prospectively followed to 10 years. Patient-reported outcome measures included the Oxford Knee Score, American Knee Society Score, Bartlett Patellar Score, and the Short Form 12 questionnaire.Results
Average valgus deformity was reduced from 15.6° to 3.8° (P < .001). At a mean follow-up of 10.4 years (range, 9.5-14.1), 90 (34.4%) patients had died. Of the reviewed survivors, the mean Oxford Knee Score was 27.8 ± 9.8, with an American Knee Society clinical score of 85.6 ± 17.0 and a functional score of 65.1 ± 20.4, with 78% of patients reporting good to excellent results. To date, there has been 1 (0.36%) revision and 13 (4.73%) reoperations. Kaplan-Meier implant survival was 99.6% at 10 years.Conclusion
Despite its challenging nature, the valgus knee is associated with excellent survivorship and satisfactory long-term results using this modified technique.Level of Evidence
Level IV. 相似文献10.
Ahmet Issın Ali Öner Hakan Sofu Hakan Yurten 《Acta orthopaedica et traumatologica turcica》2019,53(1):45-49
Purpose
The aim of this retrospective study was to evaluate the clinical outcomes of the patients who underwent primary anterior cruciate ligament (ACL) reconstruction surgery with either hamstring autograft or freeze-dried tibialis anterior allograft, which performed by the same surgeon using the same fixation technique.Methods
In this retrospective study, patients who had primary ACL reconstruction using either four-strand hamstring autograft (FSH) or freeze-dried irradiated tibialis anterior allograft (FDT) between 2012 and 2015 were evaluated. Patients who were skeletally mature with a minimum follow-up of 24 months and who had no previous surgery from the affected knee were included; patients who had multiple ligament injuries or chondral lesions over Outerbridge grade 2 were excluded from the study. Patients were grouped according to the graft type used in ACL reconstruction. Tegner activity scale and Lysholm knee scoring scale were used to assess patients' activity levels and functional status preoperatively and at the final follow-up. KT-2000 arthrometer measurements were done at the final follow-up to evaluate anterior laxity.Results
There were 27 patients (mean age 27 ± 8.9 years) in the FSH group and 36 patients (mean age 27.1 ± 6.7 years) in the FDT group. The mean follow-up time was 38.2 ± 3.5 months for the FSH group and 41 ± 6.1 months for the FDT group. There were no statistically significant differences between the groups when preoperative and postoperative Tegner-Lysholm scores were compared (Tegner P = 0.583, 0.742; Lysholm P = 0.592, 0.249). The mean anteroposterior laxity and side-to-side differences measured by KT-2000 were 4.1 mm and 2.1 mm for the FSH group, respectively; 4.2 mm and 2.2 mm for the FDT group, respectively. There was not a statistically significant difference (P = 0.745, 0.562 respectively).Conclusions
Primary ACL reconstruction with a single loop freeze-dried irradiated tibialis anterior allograft revealed comparable results with four-strand hamstring autograft in non-athlete patients.Level of evidence
Level III, Therapeutic study. 相似文献11.
Chahine C. Assi Hanane B. Barakat Jacques H. Caton Elie N. Najjar Camille T. Samaha Kaissar F. Yammine 《The Journal of arthroplasty》2019,34(2):333-337
Background
The dual mobility cups (DMCs) were shown to reduce dislocation rate following total hip arthroplasty for any etiology, including femoral neck fractures. No reported studies evaluating DMC results for femoral neck fracture in a Middle Eastern population were found in the literature.Methods
This study aims to look for mortality rate, clinical, and functional outcomes in a population having specific rituals involving extreme hip positions as part of their daily activities.Results
Of an initial sample of 174 patients (177 operated hips), 18 (10.3%) patients (20 hips) died after a mean of 39.6 ± 13.8 months (ranging from 2 to 49 months) with only 3 (1.7%) during the first post-operative year. Twelve patients (13 hips) were lost to follow-up and 19 patients (19 hips) had their radiological data incomplete. In the final sample of 125 patients (125 hips), no dislocation, aseptic loosening, or infection was encountered. The mean modified Hip Harris Score was of 94.8 ± 8.4. The mean modified Hip Harris Score of 40 patients who used to practice regularly oriental sitting position or prayers was 94.1 ± 3.1. After surgery, 36 of these 40 patients (90%) described their hip as “a forgotten hip.” Multivariate analyses found correlation only between mortality and cardiovascular co-morbidities.Conclusion
DMC implants showed excellent clinical and functional results. The majority of patients having rituals and customs involving extreme hip positions were able to resume their daily activities. The observed low mortality rate should incite future research to investigate its correlation with the use of DMCs. 相似文献12.
O. Konno T. Yokoyama Y. Kihara Y. Nakamura T. Ueno H. Takeuchi H. Iwamoto 《Transplantation proceedings》2018,50(8):2457-2460
Background
Extended-release tacrolimus (TacER), administered once daily, offers improved adherence with reduced side effects while still maintaining an immunosuppressive potency equivalent to that of conventional tacrolimus preparations.Methods
The study included 83 patients who received consecutive living-donor kidney transplants at our facility from June 2013 to December 2016. Comparisons were made between 48 cases of induction with TacER and 35 cases of induction with cyclosporine (CyA). The observation period was 3 months after transplantation. Transplanted kidney function, rejection, infectious disease, lipid abnormalities, and glucose tolerance were compared.Results
The 2 groups showed no significant difference in donor background or transplanted kidney function. Within the 3-month observation period, an acute rejection response was observed in 2 cases in the TacER group and in 8 cases in the CyA group. After transplantation, hyperlipidemia requiring medication was observed more frequently in the CyA group. The 2 groups did not show a marked difference in systemic infection or renal calcineurin inhibitor toxicity in histopathologic examination of the transplanted kidneys 3 months after surgery.Discussion
Proactive use of TacER leads to improved adherence while yielding immunosuppressive potency equivalent to that of conventional tacrolimus preparations; however, tacrolimus has a potent blood sugar-elevating effect; thus, direct comparison with the CyA group is important for assessing the side effects.Conclusion
TacER has the potential to also reduce side effects in the early stages after surgery, suggesting its potential as a drug of first choice. 相似文献13.
Micah W. Smith Agnes Ith Eugene J. Carragee Ivan Cheng Todd F. Alamin S. Raymond Golish Kyle Mitsunaga Gaetano J. Scuderi Matthew Smuck 《The spine journal》2019,19(2):e28-e33
Background context
Protein biomarkers associated with lumbar disc disease have been studied as diagnostic indicators and therapeutic targets. Recently, a cartilage degradation product, the fibronectin-aggrecan complex (FAC) identified in the epidural space, has been shown to predict response to lumbar epidural steroid injection in patients with radiculopathy from herniated nucleus pulposus (HNP).Purpose
Determine the ability of FAC to predict response to microdiscectomy for patients with radiculopathy due to lumbar disc herniationStudy design/setting
Single-center prospective consecutive cohort study.Patient sample
Patients with radiculopathy from HNP with concordant symptoms to MRI who underwent microdiscectomy.Outcomes measures
Oswestry disability index (ODI) and visual analog scores (VAS) were noted at baseline and at 3-month follow-up. Primary outcome of clinical improvement was defined as patients with both a decrease in VAS of at least 3 points and ODI >20 points.Methods
Intraoperative sampling was done via lavage of the excised fragment by ELISA for presence of FAC. Funding for the ELISA was provided by Cytonics, Inc.Results
Seventy-five patients had full complement of data and were included in this analysis. At 3-month follow-up, 57 (76%) patents were “better.” There was a statistically significant association of the presence of FAC and clinical improvement (p=.017) with an 85% positive predictive value. Receiver-operating-characteristic (ROC) curve plotting association of FAC and clinical improvement demonstrates an area under the curve (AUC) of 0.66±0.08 (p=.037). Subset analysis of those with weakness on physical examination (n=48) plotting the association of FAC and improvement shows AUC on ROC of 0.81±0.067 (p=.002).Conclusions
Patients who are “FAC+” are more likely to demonstrate clinical improvement following microdiscectomy. The data suggest that the inflammatory milieu plays a significant role regarding improvement in patients undergoing discectomy for radiculopathy in lumbar HNP, even in those with preoperative weakness. The FAC represents a potential target for treatment in HNP. 相似文献14.
H. Kato M. Usui Y. Muraki M. Okuda K. Nakatani A. Hayasaki T. Ito Y. Iizawa Y. Murata A. Tanemura N. Kuriyama Y. Azumi M. Kishiwada S. Mizuno H. Sakurai S. Isaji 《Transplantation proceedings》2018,50(9):2684-2689
Background
We compared achievement rate of sufficient tacrolimus blood concentration in the early postoperative period and incidence of acute cellular rejection within 1 month after living donor liver transplantation (LDLT) between tacrolimus intravenous (IV) and oral administration groups.Methods
From October 2005 to November 2016, 61 LDLT patients administered tacrolimus, who could be genotyped for CYP3A5*3 and *1, were chosen from the electronic record database. The patients were then divided into the 2 groups (an IV group [n = 38] and an oral group [n = 23]). We defined patients with 1*1 or *1*3 as expressors and those with *3*3 as nonexpressors. Sufficient trough level tacrolimus blood concentration on postoperative day (POD) 3 was defined as 10–20 ng/mL.Results
Comparable concentrations were seen between the 2 groups, with mean blood concentration 13.7 ± 8.5 ng/mL in the oral group and 15.2 ± 4.3 ng/mL in the IV group. Achievement rate of sufficient tacrolimus concentration on POD 3 was significantly higher in the IV group than in oral group: 97% (37 of 38) vs 65% (15 of 23), respectively (P = .001). When we focused on achievement rate in the oral group according to CYP3A5 polymorphism, the frequency of expressors (17%) was significantly lower than that of nonexpressors (82%) (P = .016). However, in the IV group this negative influence was totally eliminated, resulting in high achievement rates regardless of CYP3A5 polymorphism. In terms of incidence of acute cellular rejection, there was no significant difference between the 2 groups (IV 32% vs oral 17%, P = .250).Conclusion
IV administration of tacrolimus allowed us to obtain more stable control of blood concentration regardless of CYP3A5 genotype. 相似文献15.
Michihiro Osumi Masahiko Sumitani Hiroaki Abe Yuko Otake Shin-ichiro Kumagaya Shu Morioka 《Journal of hand therapy》2019,32(1):41-47
Introduction
Chemotherapy-induced peripheral neuropathy (CIPN) usually affects both sensory and motor function of hands and feet, resulting in impaired skilled hand function (e.g., typing a keyboard). However, quantitative and objective evaluations for this condition have not been established.Purpose of the Study
We evaluated skilled hand function using a kinematic analysis and investigated relationships among hand kinematic function and the clinical sensory and motor features of CIPN.Study Designs
Clinical measurement.Methods
Twelve CIPN patients and 12 age-matched control participants were enrolled. We recorded their reach and grasp movements using a three-dimensional measurement system, and calculated the normalized jerk of these movements as quantitative indexes of skilled hand function. Additionally, we used the number of sequential hand grip–release cycles in 10 seconds as an evaluation of clinical motor function.Results
Our kinematic analyses revealed significant difference in normalized jerk of grasp movement (CIPN: 3.7 ± 0.2, control: 3.4 ± 0.1; P = .005), but this was not the case for reach movement (CIPN: 2.5 ± 0.1, control: 2.5 ± 0.2; P = .43), indicating that the distal part of the forearm is particularly affected in CIPN. Such disturbed grasp movement was directly correlated with poor scores on the hand grip–release test and the sensory tests.Discussion
We revealed deficit impaired hand function objectively and quantitatively in CIPN patients using a kinematic analysis. Further, the hand grip test could represent such kinematic abnormality and could be useful for evaluating skilled hand function of CIPN patients.Conclusions
Our kinematic and clinical measurements objectively and quantitatively evaluate skilled hand function in individuals with CIPN in clinical settings.Level of Evidence
Cross-sectional observational study. 相似文献16.
Y. Matsuda S. Eba F. Hoshi H. Oishi T. Sado M. Noda A. Sakurada T. Watanabe H. Niikawa M. Akiba Y. Okada 《Transplantation proceedings》2018,50(9):2768-2770
Background
Calcineurin inhibitors are a commonly used immunosuppressive drug and over 80% of lung transplant (LTx) recipients use tacrolimus. Sustained-release tacrolimus (SRT) was developed as a once-daily formulation, resulting in slower release and reduction in peak concentration compared with twice-daily immediate-release tacrolimus (IRT). Previous reports indicate that SRT may carry fewer side effects than IRT; however, the impact of SRT in bronchiolitis obliterans syndrome (BOS) after LTx is unclear.Objective
Our study objective was to evaluate the effect of SRT in BOS after LTx.Materials and methods
We investigated the effect of SRT for BOS among 75 LTx recipients who were alive in 2017 in our LTx program. All analyses were carried out using student t test or F test.Results
Thirty-five recipients took IRT, 32 recipients used SRT, 7 recipients used cyclosporine, and 1 patient who received bone marrow and a lung graft from the same donor did not use a calcineurin inhibitor. The most frequent reason for conversion of IRT to SRT was kidney dysfunction, followed by other IRT complications. Five recipients underwent conversion of IRT to SRT because of decline of forced expiratory volume in 1 second (FEV1) with fluctuation of the tacrolimus trough level. After induction of SRT, the fluctuation of the tacrolimus trough level was significantly reduced in 4 of 5 patients (P < .05). Before drug form conversion, the FEV1 in these 5 patients was significantly decreased; however, this exacerbation of FEV1 was attenuated after SRT induction (P < .05).Conclusion
SRT appeared to stabilize decline of FEV1 in patients with BOS possibly due to reducing the fluctuation of tacrolimus trough blood concentration. 相似文献17.
Abdelkader Hawasli Moutamn Sadoun Ahmed Meguid Mosab Dean Mohamad Sahly Bianca Hawasli 《American journal of surgery》2019,217(3):496-499
Background
Management of severe reflux after sleeve gastrectomy (SG) is often done by conversion to Roux-en-Y gastric bypass (RYGB). The LINX® system could be an alternative treatment.Method
Between 2015 and 2017, 13 patients had LINX® system placed to manage their reflux after SG. Pre-operative evaluation included a barium swallow, endoscopy with pH monitor and esophageal motility.Results
Ten females and three males with mean age of 49?±?13 years were evaluated. Their mean weight before placing the LINX® system was 193?±?45 lbs. and mean BMI of 33?±?6?kg/m2. The mean time between SG and placing the LINX® system was 43?±?19 months. The mean Bravo score was 46?±?26 (normal 14.7). One patient developed severe dysphagia post-operatively requiring removal of the LINX® after 18 days and one patient was lost to follow up. The mean follow-up in the remaining 11 patients was 26?±?12 months. The mean GERD-HRQL score dropped significantly from 47/75?±?17/75 to 12/75?±?14/75 (p?=?.0003).Conclusion
The LINX® system may be used as an alternative to RYGB conversion in managing refractory post-SG reflux. 相似文献18.
S. Brakemeier S.I. Taxeidi B. Zukunft D. Schmidt J. Gaedeke M. Dürr S. Hansen K. Budde 《Transplantation proceedings》2017,49(8):1757-1765
Background
Prevalence of extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-E) has risen in kidney transplant (KT) patients, with no long-term data so far on graft function or survival.Methods
KT patients with ESBL-E–positive urine culture were retrospectively analyzed regarding initial adequate antimicrobial therapy, recurrent infection, transplant function, and survival compared with an ESBL-E–negative KT control cohort.Results
ESBL-E–positive KT patients (n = 93) were older (55.5 ± 16.1 vs 49.5 ± 16.8 y; P = .001), presented with higher trough levels of cyclosporine and tacrolimus (121 ± 71 vs 102 ± 32 ng/mL [P = .04]; and 7.9 ± 3.3 vs 7.0 ± 2.3 ng/mL [P = .04], respectively), higher dosages of mycophenolate (1,533 ± 670 vs 1,493 ± 436; P = .001), and more acute rejection episodes within 3 months before diagnosis (12.9% vs 0.8%; P < .0001) compared with control subjects (n = 591). Five-year patient survival was superior in control subjects compared with ESBL-E–positive patients (91.2% vs 83.5%; P = .034) but long-term graft function was similar. Hospitalization rates were higher in patients presenting with ESBL-E–related urinary tract infection (UTI) compared with control subjects with ESBL-E–negative UTI (60.3% vs 31.3%; P = .002) but 5-year graft survival was superior in patients presenting with ESBL-E–related UTI (88.6% vs 69.8%; P = .035) compared with control subjects with ESBL-E–negative UTI. Recurrence rates were similar in patients with or without ESBL-E–related UTI. Initial antibiotic treatment was adequate in 41.2% of patients presenting with ESBL-E–related urosepsis, resulting in a reevaluation of antibiotic stewardship in our clinic.Conclusions
ESBL-E detection in general was associated with higher mortality, but graft survival in patients with ESBL-E–related UTI was significantly better compared with ESBL-E–negative UTI. 相似文献19.
Background
Tacrolimus is widely used in renal transplantation to help prevent acute and chronic rejection, but the nephrotoxicity of tacrolimus may compromise renal function. This study investigates the safety and efficacy in delayed initiation of tacrolimus after antilymphocyte induction therapy in kidney transplant recipients.Methods
This retrospective cohort analysis involved data from 68 kidney transplant recipients receiving standard induction therapy (basiliximab [Simulect] or thymoglobulin) combined with tacrolimus. The patients were divided into 2 groups according to whether the start time of tacrolimus therapy was before or after 24 hours posttransplantation. Acute rejection, common complications of immunosuppression, and graft survival were compared.Results
The mean (SD) timing of tacrolimus administered in the Delayed group was 4 (1.9) days after transplantation. The Delayed group patients had a higher percentage of slow graft function and delayed graft function than the No-delay group. Compared with the No-delay group, delayed initiation of tacrolimus did not increase risk of biopsy-proven acute rejection, infection, posttransplant diabetes mellitus, graft survival, and patient survival.Conclusions
Our study confirmed delayed initiation of tacrolimus after antilymphocyte induction therapy is safe and effective in renal transplant recipients with slow or delayed graft function. 相似文献20.
S. Zmonarski K. Madziarska M. Banasik O. Mazanowska M. Magott-Procelewska K. Hap M. Krajewska 《Transplantation proceedings》2018,50(6):1744-1749
Both Toll-like receptor 4 (TLR4) and monocytes focus stimuli, causing them to contribute differently to chronic injury of a transplanted kidney.