RESUMEN

BACKGROUND/AIM: Endoscopic stenting is an accepted treatment option for children with symptomatic or progressive primary obstructive megaureter (PROM). Here, long-term outcomes with endoscopic stenting are reviewed. METHODS: Patients with PROM treated surgically over a 12-year period were identified using a prospectively maintained departmental database. Data were analysed using Microsoft Excel 2013 and unpaired t-tests through GraphPad Software QuickCalcs. RESULTS: Fifty-seven patients with PROM were surgically managed in the study centre from 2005 to 2017. Twenty-nine of fifty-seven patients had the stent as the primary procedure, whereas the remainder had ureterostomy, re-implantation or nephrectomy. Six patients had bilateral PROM, giving a total of 35 renal units that were fully analysed. There was 7:1 male predominance, and 20 of 29 patients (69%) were diagnosed antenatally. The median age at stent insertion was 8 months (40 days-10 years); the median prestent ureteric diameter was 19 mm and the median pre-operative function on MAG3 was 44%. Cystoscopic stent insertion was feasible in all patients. The stent was left for a median of 183 days. In 9 of 35 (26%) renal units, the JJ stent was a successful sole long-term treatment, with median follow-up of 5 years and 8 months. The success rate was not different in children aged <1 year (8/22; 36%) in comparison to children aged >1 year (1/13; 8%), P = 0.1. The remaining 26 renal units required further surgical intervention: ureteric re-implantation in 25 and nephrectomy in one. Indications for further surgery were stent complications in 11 renal units and stent failure in 15 (Table 1). Complications related to the stent were noted in 14 renal units (41%), half being stent migration. Other complications included UTIs, stent encrustation and recurrent haematuria. There was no identifiable prestent parameter, whether clinical or radiological, that could predict which patients were likely to be successfully managed solely by stent insertion. Stent insertion was never successful as a definitive procedure when the distal ureteric diameter was >12 mm on the ultrasound after stent removal. DISCUSSION: Success rates with primary stenting as a sole treatment for PROM was 26%, which is less than that seen in other reports (50-66%). This may be attributed to the long-term follow-up in this study, together with the strict criteria for success. CONCLUSION: In the authors' experience, cystoscopically inserted JJ stents are of limited success as the sole treatment for PROM. In infants aged <1 year, stent insertion remains a reasonable temporising measure until the infant is old enough for a definitive procedure.

Asunto(s)

Stents , Uréter/cirugía , Obstrucción Ureteral/cirugía , Ureteroscopía , Niño , Preescolar , Dilatación Patológica , Femenino , Humanos , Lactante , Masculino , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento , Uréter/patología , Procedimientos Quirúrgicos Urológicos/instrumentación , Procedimientos Quirúrgicos Urológicos/métodos

RESUMEN

Embolic events including thromboembolism, air embolism, and amniotic fluid embolism can cause cardiovascular collapse during cesarean delivery. Differentiation between the three conditions is challenging because they share many of the initial clinical and echocardiographic findings, but an accurate, definitive diagnosis allows the administration of specific therapy that may help in saving the life of the mother and/or the fetus. We report a case of cardiovascular collapse during cesarean delivery under general anesthesia; massive pulmonary thromboembolism was suspected and unfractionated heparin was administered. Cardiac arrest followed and was managed with standard cardiopulmonary resuscitation, resulting in return of spontaneous circulation. Postoperatively, the patient remained hemodynamically unstable in spite of heparin, norepinephrine infusions and intravenous fluids. A transthoracic echocardiogram revealed right-sided pressure overload. Thrombolysis was initiated. Streptokinase (1,500,000IU over 2hours) was administered with no clinical response, followed by infusion (100,000IU/h) for 12hours. The patient's hemodynamics improved gradually and she was successfully weaned from norepinephrine and mechanical ventilation. Significant bleeding ensued, necessitating discontinuation of anticoagulation and transfusion of red blood cells. Eventually, the patient was discharged home, in good condition, and on oral warfarin therapy.

Asunto(s)

Cesárea/efectos adversos , Choque/diagnóstico , Choque/etiología , Adulto , Anestesia General , Reanimación Cardiopulmonar , Electrocardiografía , Embolia de Líquido Amniótico , Femenino , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/terapia , Embarazo , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Respiración Artificial , Choque/terapia , Terapia Trombolítica

Asunto(s)

Angioplastia Coronaria con Balón , Bloqueo de Rama/terapia , Dispositivos de Terapia de Resincronización Cardíaca , Terapia de Resincronización Cardíaca , Estenosis Coronaria/terapia , Insuficiencia Cardíaca/terapia , Anciano , Bloqueo de Rama/complicaciones , Bloqueo de Rama/diagnóstico , Bloqueo de Rama/fisiopatología , Angiografía Coronaria , Estenosis Coronaria/complicaciones , Estenosis Coronaria/diagnóstico por imagen , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Resultado del Tratamiento

RESUMEN

MicroRNAs have been implicated as important mediators of cancer cell homeostasis, and accumulating data suggest compelling roles for them in the apoptosis pathway. X-linked inhibitor of apoptosis protein (XIAP) is a potent caspase inhibitor and an important barrier to apoptotic cell death, but the mechanisms that determine the diverse range of XIAP expression seen in cancer remains unclear. In this study, we present evidence that miR-24 directly targets the 3'UTR of the XIAP messenger RNA (mRNA) to exert translational repression. Using a heuristic algorithm of bioinformatics analysis and in vitro screening, we identified miR-24 as a candidate regulator of XIAP expression. Array comparative genomic hybridization and spectral karyotype analysis reveal that genomic copy number loss at the miR-24 locus is concordant with the loss of endogenous miR-24 in cancer cells. Using a luciferase construct of the XIAP 3'UTR, we showed that miR-24 specifically coordinates to the XIAP mRNA. Interference with miR-24's binding of the critical seed region, resulting from site-directed mutagenesis of the 3'UTR, significantly abrogated miR-24's effects on XIAP expression. Moreover, miR-24 overexpression can overcome apoptosis resistance in cancer cells via downregulation of XIAP expression, and the resulting cancer cell death induced by tumor necrosis factor-related apoptosis-inducing ligand is executed by the canonical caspase-mediated apoptosis pathway. In summary, our data suggest a novel mechanism by which miR-24 directly modulates XIAP expression level and consequently the apoptosis threshold in cancer cells.

Asunto(s)

Apoptosis/fisiología , MicroARNs/genética , Neoplasias/genética , Neoplasias/patología , Proteína Inhibidora de la Apoptosis Ligada a X/metabolismo , Regiones no Traducidas 3' , Apoptosis/genética , Procesos de Crecimiento Celular/genética , Procesos de Crecimiento Celular/fisiología , Línea Celular Tumoral , Regulación hacia Abajo , Células HeLa , Humanos , MicroARNs/metabolismo , Neoplasias/metabolismo , Transfección , Proteína Inhibidora de la Apoptosis Ligada a X/genética

RESUMEN

The relationship of AIDS knowledge and self-efficacy to high-risk sexual practices among Lebanese males in NewYork was examined. Self-administered questionnaires were completed by a convenience sample. Relationships between AIDS-knowledge and self-efficacy and high-risk sexual practices for the 25 homosexual men were rarely significant, probably because of the small sample. The 261 heterosexual participants had statistically significant relationships between AIDS-knowledge and 9 high-risk sexual practices and between self-efficacy and 18 high-risk sexual practices. For heterosexuals, and to a lesser degree for homosexuals, high-risk sexual practices increased as drug-related behaviours and sex with prostitutes increased.

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Actitud Frente a la Salud/etnología , Conocimientos, Actitudes y Práctica en Salud , Asunción de Riesgos , Autoeficacia , Conducta Sexual/etnología , Síndrome de Inmunodeficiencia Adquirida/etnología , Síndrome de Inmunodeficiencia Adquirida/etiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adolescente , Adulto , Análisis de Varianza , Escolaridad , Emigración e Inmigración , Humanos , Líbano/etnología , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Ciudad de Nueva York/epidemiología , Análisis de Regresión , Educación Sexual/normas , Conducta Sexual/estadística & datos numéricos , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/etnología , Encuestas y Cuestionarios , Población Urbana/estadística & datos numéricos

RESUMEN

The relationship of AIDS knowledge and self-efficacy to high-risk sexual practices among Lebanese males in NewYork was examined. Self-administered questionnaires were completed by a convenience sample. Relationships between AIDS-knowledge and self-efficacy and high-risk sexual practices for the 25 homosexual men were rarely significant, probably because of the small sample. The 261 heterosexual participants had statistically significant relationships between AIDS-knowledge and 9 high-risk sexual practices and between self-efficacy and 18 high-risk sexual practices. For heterosexuals, and to a lesser degree for homosexuals, high-risk sexual practices increased as drug-related behaviours and sex with prostitutes increased

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Análisis de Varianza , Actitud Frente a la Salud , Emigración e Inmigración , Evaluación de Necesidades , Encuestas y Cuestionarios , Asunción de Riesgos , Autoeficacia , Educación Sexual , Conducta Sexual , Conocimientos, Actitudes y Práctica en Salud

RESUMEN

OBJECTIVE: To evaluate the feasibility of using the perfluorochemical, perfluorodecalin, for partial liquid ventilation (PLV) with respect to gas exchange and lung mechanics in normal and saline-injured lungs of juvenile rabbits. DESIGN: Experimental, prospective, randomized, controlled study. SETTING: Physiology laboratory at a university medical school. SUBJECTS: Seventeen juvenile rabbits assigned to three groups. INTERVENTIONS: The conventional mechanical ventilation (CMV)-injury group (n = 5) was treated with CMV after establishing a lung injury; the PLV-injury group (n = 6) was treated with PLV after lung injury; and the PLV-healthy group (n = 6) was supported with PLV without lung injury. Lung injury was created by repeated saline lung lavages. PLV-treated animals received a single dose of intratracheal perfluorodecalin at a volume equal to the measured preinjury gas functional residual capacity (functional residual capacity = 18.6+/-1.5 [SEM] mL/kg). MEASUREMENTS AND MAIN RESULTS: Sequential measurements of total respiratory compliance and arterial blood chemistries were performed in all groups. Oxygenation index (OI) and ventilation efficiency index were calculated. After lung injury, there was a significant (p < .05) decrease in PaO2, total respiratory compliance, and ventilation efficiency index and an increase in OI and PaCO2. In the PLV-injury group, PLV significantly (p < .05) improved PaO2 (+60%) and OI (-33%) over time. Compliance was significantly (p < .05) higher (90%) than in the CMV-injury group over time. CONCLUSIONS: These results demonstrate that PLV with perfluorodecalin improved oxygenation and increased respiratory compliance in the saline-injured rabbit lung. In addition, similar to the effects of several other perfluorochemical liquids on normal lungs, pulmonary administration of perfluorodecalin was associated with a small impairment in gas exchange and a significant decrease in lung compliance in the juvenile rabbit model.

Asunto(s)

Fluorocarburos , Sustitutos del Plasma , Intercambio Gaseoso Pulmonar/fisiología , Respiración Artificial , Síndrome de Dificultad Respiratoria del Recién Nacido/fisiopatología , Mecánica Respiratoria/fisiología , Animales , Humanos , Recién Nacido , Pulmón/fisiopatología , Conejos

RESUMEN

Hypertension in pregnancy includes a group of distinct disorders that require special consideration in both prevention and pharmacologic treatment. In recent years, there have been few advances regarding the pathophysiology and prevention of preeclampsia, or in recommendations for first-line drug therapy of the hypertensive complications of preeclampsia. Similarly, the recommendations for pharmacologic treatment of women with chronic hypertension antedating pregnancy have changed little, primarily because first-line medications have the advantage of having been the subjects of extensive research experience. Recent clinical trials have demonstrated the efficacy and safety of various second-line drugs for treating hypertensive disorders of pregnancy; whether these therapies can eventually replace the standard recommended medications will require more extensive long-term investigation.

Asunto(s)

Hipertensión/tratamiento farmacológico , Complicaciones Cardiovasculares del Embarazo/tratamiento farmacológico , Enfermedad Crónica , Femenino , Humanos , Hipertensión/clasificación , Preeclampsia/complicaciones , Preeclampsia/diagnóstico , Preeclampsia/etiología , Preeclampsia/terapia , Embarazo , Complicaciones Cardiovasculares del Embarazo/clasificación

RESUMEN

BACKGROUND: Sickle cell disease (SCD) is a common disease in Saudi Arabia, with a high prevalence in the Eastern and Southern regions. This study reports on 53 cases of SCD encountered in the Madina area. PATIENTS AND METHODS: In a retrospective study of 6000 pediatric patients, 53 children (0.88%) with sickle cell disease were admitted in the Maternity and Childrenâs Hospital at Madina, between November 1990 and October 1991. Of these, 39 patients (73.58%) were Saudis and 14 (26.41%) were non-Saudis. RESULTS: Thirty-six patients were homozygous SS and 17 were sickle thalassemic. The main causes of admission were vaso-occlusive crisis (77.35%), infection (67.92%), acute chest syndrome (22.64%), anemia (12.6%), and cerebrovascular accident (9.43%). The lowest and highest age groups recorded in this study were six months and 12 years, respectively. About 70% of the patients are still being followed up, and none of the patients has died. CONCLUSION: . This disease is one of the major causes of morbidity in this region of Saudi Arabia. Measures required include neonatal screening programs for the early detection of the disease, as well as research into new drugs to counter the disease.

Asunto(s)

Helmintiasis/epidemiología , Parasitosis Intestinales/epidemiología , Esquistosomiasis mansoni/epidemiología , Adolescente , Niño , Cristianismo , Helmintiasis/complicaciones , Humanos , Islamismo , Prevalencia , Esquistosomiasis mansoni/complicaciones , Sudán/epidemiología

RESUMEN

In vitro culture of day-15.5 murine fetal liver (FL) cells in the presence of recombinant interleukin-2 (IL-2) results in the expansion of Fc gamma RII/III+ CD3-Ti-NK1.1+ cells displaying both natural killer (NK) and antibody-dependent cell cytotoxicity (ADCC) cytolytic activities. These FL-derived NK cells express Fc gamma RIII (CD16) in association with an Fc epsilon RI gamma homodimer on their surface. In contrast, in vitro expansion of FL cells in the absence of IL-2 generates noncytotoxic cells belonging to the myelomonocytic lineage (Mac1+Gr1+NK1.1-). Hence, IL-2 appears to be critical for the proliferation and differentiation of NK cells from FL progenitors. Experiments in which FL cells were fractionated by density gradient centrifugation before in vitro expansion showed that NK progenitors are contained within a cell population with a density of 1.04 < d < 1.08 g/mL. Cells with d > 1.08 g/mL (representing > or = 40% of FL cells) have no such NK progenitor activity. In addition, after intrathymic injection into Ly5 congenic host animals, day-15.5 CD4-CD8- FL cells mature into CD4+CD8+ thymocytes within 12 days. Interestingly, this T-cell progenitor activity is restricted to subpopulations of FL cells that also contain NK progenitors, but is absent in high-density (d > 1.08 g/mL) FL cells. Finally, fractionation of FL cells according to surface expression of Fc gamma RII/III complexes shows that NK (and T-lymphocyte) progenitors are found in both Fc gamma RII/III+ and Fc gamma RII/III-FL subpopulations.

Asunto(s)

Feto/citología , Células Asesinas Naturales/citología , Hígado/embriología , Receptores de IgG/análisis , Células Madre/citología , Animales , Femenino , Células Asesinas Naturales/ultraestructura , Ratones , Embarazo , Células Madre/ultraestructura

RESUMEN

We have recently identified a dominant wave of CD4-CD8- (double-negative [DN]) thymocytes in early murine fetal development that express low affinity Fc gamma receptors (Fc gamma RII/III) and contain precursors for Ti alpha/beta lineage T cells. Here we show that Fc gamma RII/III is expressed in very immature CD4low single-positive (SP) thymocytes and that Fc gamma RII/III expression is downregulated within the DN subpopulation and before the CD3-CD8low SP stage in T cell receptor (TCR)-alpha/beta lineage-committed thymocytes. DN Fc gamma RII/III+ thymocytes also contain a small fraction of TCR-gamma/delta lineage cells in addition to TCR-alpha/beta progenitors. Fetal day 15.5 DN TCR-alpha/beta lineage progenitors can be subdivided into three major subpopulations as characterized by cell surface expression of Fc gamma RII/III vs. CD2 (Fc gamma RII/III+CD2-, Fc gamma RII/III+CD2+, Fc gamma RII/III-CD2+). Phenotypic analysis during fetal development as well as adoptive transfer of isolated fetal thymocyte subpopulations derived from C57B1/6 (Ly5.1) mice into normal, nonirradiated Ly5.2 congenic recipient mice identifies one early differentiation sequence (Fc gamma RII/III+CD2(-)-->Fc gamma RII/III+CD2(+)-->Fc gamma RII/III-CD2+) that precedes the entry of DN thymocytes into the CD4+CD8+ double-positive (DP) TCRlow/- stage. Unseparated day 15.5 fetal thymocytes develop into DP thymocytes within 2.5 d and remain at the DP stage for > 48 h before being selected into either CD4+ or CD8+ SP thymocytes. In contrast, Fc gamma RII/III+CD2- DN thymocytes follow this same developmental pathway but are delayed by approximately 24 h before entering the DP compartment, while Fc gamma RII/III-CD2+ display accelerated development by approximately 24 h compared with total day 15.5 thymocytes. Fc gamma RII/III-CD2+ are also more developmentally advanced than Fc gamma RII/III+CD2- fetal thymocytes with respect to their TCR beta chain V(D)J rearrangement. At day 15.5 in gestation, beta chain V(D)J rearrangement is mostly, if not entirely, restricted to the Fc gamma RII/III-CD2+ subset of DN fetal thymocytes. Consistent with this analysis in fetal thymocytes, > 90% of adult thymocytes derived from mice carrying a disrupting mutation at the recombination-activating gene 2 locus (RAG-2-/-) on both alleles are developmentally arrested at the DN CD2- stage. In addition, there is a fivefold increase in the relative percentage of thymocytes expressing Fc gamma RII/III in TCR and immunoglobulin gene rearrangement-incompetent homozygous RAG-2-/- mice (15% Fc gamma RII/III+) versus rearrangement-competent heterozygous RAG-2+/- mice (< 3% Fc gamma RII/III+). Thus, Fc gamma RII/III expression defines an early DN stage preceding V beta(D beta)I beta rearrangement, which in turn is followed by surface expression of CD2. Loss of Fc gamma RII/III and acquisition of CD2 expression characterize a late DN stage immediately before the conversion into DP thymocytes.

Asunto(s)

Antígenos de Diferenciación de Linfocitos T/biosíntesis , Reordenamiento Génico de la Cadena beta de los Receptores de Antígenos de los Linfocitos T , Receptores de Antígenos de Linfocitos T alfa-beta/genética , Receptores de IgG/biosíntesis , Receptores Inmunológicos/biosíntesis , Subgrupos de Linfocitos T/metabolismo , Timo/citología , Envejecimiento/inmunología , Animales , Secuencia de Bases , Antígenos CD2 , Antígenos CD4/metabolismo , Antígenos CD8/metabolismo , Ciclo Celular , Separación Celular , ADN , Ratones , Ratones Endogámicos C57BL , Datos de Secuencia Molecular , Fenotipo , Subgrupos de Linfocitos T/citología , Subgrupos de Linfocitos T/inmunología , Timo/embriología , Timo/crecimiento & desarrollo

RESUMEN

Aside from CD4+CD8+ double-positive (DP) thymocytes, the subpopulations of T lineage cells affected by negative selection are unknown. To address whether this process occurs in more mature cell types, we have compared the responses of purified single-positive (SP) murine thymocytes and peripheral T cells to the superantigen staphylococcal enterotoxin B (SEB) utilizing as antigen-presenting cells (APC) a fibroblast cell line expressing transfected I-Ek class II molecules. Whereas approximately 70% of SEB-reactive SP thymocytes, either CD4+ or CD8+, undergo programmed cell death (apoptosis) and, therefore, negative selection, CD4+ and CD8+ antigen-specific peripheral T cells are predominantly activated and proliferate to APC+SEB. Thus, mature thymocytes and peripheral T cells, with identical patterns and levels of expression of CD4, CD8 and T cell receptor (TCR), are programmed to elicit different responses following TCR stimulation. Unexpectedly, however activation of peripheral T cells was preceded by deletion of a large fraction of V beta 8+ T lymphocytes (SEB specific). This surprising phenomenon was also observed in in vivo studies: in fact, administration of SEB to adult mice resulted in depletion of the majority of antigen-specific T cells from the peripheral lymphoid tissues analyzed (lymph nodes and spleen). This depletion is the consequence of deletion as indicated by program cell death of V beta 8+ T cells and is followed by proliferation of the remaining SEB-reactive T cells. Clonal elimination of peripheral T cells may represent a mechanism by which tolerance to self antigens never expressed in and/or exported to the thymus is achieved.

Asunto(s)

Apoptosis , Tolerancia Inmunológica , Receptores de Antígenos de Linfocitos T alfa-beta/metabolismo , Linfocitos T/inmunología , Animales , Secuencia de Bases , Linfocitos T CD4-Positivos/citología , Antígenos CD8/análisis , Diferenciación Celular , Células Clonales , Enterotoxinas/inmunología , Reordenamiento Génico de la Cadena beta de los Receptores de Antígenos de los Linfocitos T , Activación de Linfocitos , Ratones , Ratones Endogámicos , Datos de Secuencia Molecular , Oligodesoxirribonucleótidos/química , Linfocitos T/citología , Timo/citología

RESUMEN

Self-tolerance is mainly established through clonal deletion of autoreactive T cells during thymic differentiation. The mechanisms by which deletion is achieved are poorly understood. Here we use a specific polymerase chain reaction-based system to characterize DNA fragmentation and show that after in vivo treatment of neonatal mice with staphylococcus enterotoxin B, selective apoptosis of V beta 8+ thymocytes occurs. This process precedes detectable deletion of V beta 8+ cells as determined by phenotypic analysis. Moreover, in vivo administration of cycloheximide and, to a lesser extent, actinomycin D, inhibits apoptosis of staphylococcus enterotoxin B specific thymocytes. Thus, macromolecular synthesis is a requirement for negative selection.

Asunto(s)

Antígenos Bacterianos/inmunología , Enterotoxinas/inmunología , Tolerancia Inmunológica , Receptores de Antígenos de Linfocitos T alfa-beta/genética , Animales , Apoptosis/efectos de los fármacos , Secuencia de Bases , Cicloheximida/farmacología , Daño del ADN , Dactinomicina/farmacología , Reordenamiento Génico de la Cadena beta de los Receptores de Antígenos de los Linfocitos T , Ratones , Ratones Endogámicos , Datos de Secuencia Molecular , Oligodesoxirribonucleótidos/química , Reacción en Cadena de la Polimerasa , Staphylococcus aureus/inmunología

RESUMEN

The extraction of tungsten by chloroform solutions of 8-hydroxyquinoline(I), 2-methyl-8-hydroxyquinoline(II), 5,7-dibromo-8-hydroxyquinoline(III) and 8-mercaptoquinoline(IV), as a function of the concentration of tungsten and reagent and the acidity of the aqueous phase, has been studied. Evidence was obtained for the quantitative extraction of tungsten over a wide range of acidity. The degree of extraction of tungsten at 10(-5)M concentration with I,III and IV gives two maxima when plotted against acidity. The extraction maximum for the more acidic solutions lies in the region where the reagents exist in the protonated form and its position depends on the reagent used. It is suggested that different tungsten complexes are extracted, depending on the acidity of the aqueous phase.