RESUMEN
OBJECT: In recent years, the classical vertebroplasty has tended to be replaced by vertebral augmentation procedures. This article discusses the reliability of vertebral augmentation procedures using balloon kyphoplasty or a spine jack system, with intraoperative CT scan control coupled with the neuronavigation system as a treatment option for cervical and upper thoracic spine lesions. METHODS: In our neurosurgical department, in the past two years, 11 patients underwent either a kyphoplasty or a vertebral augmentation by a Spine Jack via a transpedicular route, under perioperative 3D imaging, for a total of 15 cervical/upper thoracic lesions. For these patients, we evaluated the clinical symptoms before and after surgery, the intraoperative and postoperative complications as well as the radiation exposure and the duration of their hospitalisation. RESULTS: We noted for all of the patients an improvement of the mean Karnofsky index, which improved from 50 to 80, and of the VAS that decreased from a mean of 75 to 15, as they were clearly alleviated after the operation. The radiation was lower for patients that were treated for 2 or more vertebrae, and much lower for the medical staff. The intraoperative complications rate (4 cement leakages for 15 vertebrae, 26%), was low and completely asymptomatic in all cases. The radiological follow-up examinations were satisfactory for all the patients. CONCLUSIONS: Our results suggest that percutaneous transpedicular vertebral augmentation techniques using intraoperative CT scan are a viable treatment for secondary lesions or traumatic compression fractures of the cervical and upper thoracic spine.
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Vértebras Cervicales/cirugía , Neuronavegación/métodos , Procedimientos Neuroquirúrgicos/métodos , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/complicaciones , Columna Vertebral/cirugía , Vértebras Torácicas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas por Compresión/cirugía , Humanos , Estado de Ejecución de Karnofsky , Masculino , Persona de Mediana Edad , Dosis de Radiación , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/efectos adversos , Tomografía Computarizada por Rayos X/métodos , VertebroplastiaRESUMEN
AIM: We evaluated the clinical and diabetes parameters of latent autoimmune diabetes in adults (LADA) patients according to the presence of thyroid autoimmunity (TA). MATERIALS AND METHODS: Patients with LADA (diabetes onset after 30 years of age, no need for insulin treatment for at least 6 months after diabetes onset, positive for glutamic acid decarboxylase antibodies (GADA)) were evaluated for the presence of thyroid peroxidase antibodies (TPOAb) and were subjected to clinical and laboratory evaluations of the glycated hemoglobin and basal C peptide levels. The patients were stratified into either group A (with TA) or group B (without TA). RESULTS: We evaluated 104 (57 female and 47 male) patients with LADA. The mean age at diabetes onset was 44±10 years. The prevalence of TA among the LADA patients was 28.8% (30 patients; 23 female and 7 male). In groups A and B, the mean age at diabetes onset was 41.47±10.15 and 45.07±10 years (p=0.03), the basal C peptide level was 0.69±0.16 and 1.9±1.3 ng/ml (p<0.0001), the glycated hemoglobin level was 9.8±2.2 and 9.1±2.2 (p=0.04), and the time to insulin treatment was 3.2±2.1 years and 4.98±2.2 years (p=0.038), respectively. The use of a basal bolus insulin regimen was more frequent in group A than in group B (56.7% and 35.1%, respectively; p=0.03). CONCLUSION: TA identifies a particular phenotype of LADA displaying a higher GADA titer, lower basal C peptide levels and poorer glycemic control.
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Autoanticuerpos/sangre , Complicaciones de la Diabetes/sangre , Diabetes Mellitus Tipo 1/sangre , Tiroiditis Autoinmune/sangre , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tiroiditis Autoinmune/etiologíaRESUMEN
BACKGROUND: Obese males frequently present with low androgen levels that may improve after weight loss achieved by bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) has been used often in the last decade as treatment for morbid obesity. The aim of this study was to evaluate modifications in the male reproductive hormone profile after LSG. PATIENTS AND METHODS: The prospective study included 28 males with body mass index (BMI) 35 kg m2 who underwent LSG.Total Testosterone (TT), Sex Hormone Binding Globulin(SHBG) and Luteinizing hormone (LH), together with biochemical and anthropometric data, were evaluated at baseline and after LSG. RESULTS: Baseline patients had a mean BMI of 50.10 (+-11.19)kg m2, SHBG 23.37 (+-17.47) nmol L, LH 3.83 (+-1.76)mUI ml and TT 8.31 (+-3.24) nmol L. After LSG, patients showed a mean BMI of 35.87 (+-7.02) kg m2 (p 0.001),SHBG 37.81 (+-18.95) nmol L (p 0.05), LH 4.76 (+-2.49)mUI ml (p 0.05), whereas mean TT was 12.7 (Â+-3.8) nmol L(p 0.001). The percentage of excess body weight loss (%EBL)was 43.07 (+-9.56) and metabolic syndrome prevalence decreased significantly from 75% to 25% (p 0.001). CONCLUSIONS: Beyond BMI loss, LSG significantly improved reproductive hormone levels in morbidly obese males.
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Gastrectomía , Laparoscopía , Síndrome Metabólico/sangre , Síndrome Metabólico/cirugía , Obesidad Mórbida/sangre , Obesidad Mórbida/cirugía , Testosterona/sangre , Adulto , Andrógenos/sangre , Biomarcadores/sangre , Índice de Masa Corporal , Estudios de Cohortes , Gastrectomía/métodos , Humanos , Masculino , Síndrome Metabólico/complicaciones , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Prevalencia , Resultado del Tratamiento , Pérdida de PesoRESUMEN
Inflammation likely has a role in the early genesis of certain malignancies. Interleukin (IL)-15, a proinflammatory cytokine and growth factor, is required for lymphocyte homeostasis. Intriguingly, the expression of IL-15 protein is tightly controlled by multiple posttranscriptional mechanisms. Here, we engineered a transgenic mouse to overexpress IL-15 by eliminating these posttranscriptional checkpoints. IL-15 transgenic mice have early expansions in natural killer (NK) and CD8+ T lymphocytes. Later, these mice develop fatal lymphocytic leukemia with a T-NK phenotype. These data provide novel evidence that leukemia, like certain other cancers, can arise as the result of chronic stimulation by a proinflammatory cytokine.
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Linfocitos T CD8-positivos/inmunología , Interleucina-15/genética , Células Asesinas Naturales/inmunología , Leucemia Experimental/genética , Leucemia Experimental/inmunología , Animales , Secuencia de Bases , Cartilla de ADN/genética , Ingeniería Genética , Memoria Inmunológica , Mediadores de Inflamación/inmunología , Leucemia Experimental/etiología , Linfocitosis/genética , Linfocitosis/inmunología , Linfocitosis/patología , Ratones , Ratones Transgénicos , Fenotipo , Factores de TiempoRESUMEN
Nifedipine (NIF), a calcium channel blocker (CCB) from the first generation of dihydropyridines, induces detrimental effects on patients with cardiovascular diseases. We designed experiments to study, at cellular and molecular level, the mechanisms involved in the induction of deleterious effects by this drug. To this purpose, cultured human smooth muscle cells (HSMC) were used. The effect of NIF and two other CCB (FEL, AML) and inhibitors of intracellular signaling pathways (RR, TG, CAF and GEN) on intracellular calcium [Ca(2+)]I was determined by spectrofluorimetry using Fura 2 AM assay. The results showed that: (i) 10 microM NIF induced the increase of [Ca(2+)]I above the basal values (202.77 +/- 23.98 nM vs. 48.68 +/- 6.45 nM), an effect that was prevented by RR (50.45 +/- 13.9 nM) and was not induced by the two other CCB; (ii) NIF had a thapsigargin-like effect, because it induced the same release of intracellular calcium as TG (212.1 +/- 25.62 nM); (iii) The response to NIF was reduced by 40% after the inhibition of IP3 receptor (121.21 +/- 26.01 nM) and by 50% after the inhibition of tyrosine kinase (101.91 +/- 7.76 nM). Together, these data demonstrate that NIF produces a deregulation of intracellular calcium homeostasis. The abnormal increase of [Ca(2+)]I is due to the activation of store operated channels from the plasma membrane responsible for capacitative calcium entry, a process modulated by the activity of tyrosine kinase and the Ca(2+)-ATPase pump from the sarcoplasmic reticulum.
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Bloqueadores de los Canales de Calcio/efectos adversos , Señalización del Calcio/efectos de los fármacos , Calcio/metabolismo , Músculo Liso Vascular/efectos de los fármacos , Músculo Liso Vascular/metabolismo , Nifedipino/efectos adversos , Amlodipino/farmacología , Aorta/embriología , Aorta/metabolismo , Cafeína/farmacología , ATPasas Transportadoras de Calcio/antagonistas & inhibidores , Células Cultivadas , Retículo Endoplásmico/metabolismo , Inhibidores Enzimáticos/farmacología , Felodipino/farmacología , Genisteína/farmacología , Humanos , Músculo Liso Vascular/citología , Proteínas Tirosina Quinasas/antagonistas & inhibidores , Tapsigargina/farmacologíaRESUMEN
Clotrimazole (CLT) is a drug known to interfere with cellular calcium homeostasis, which in turn is reported to intervene in cell proliferation and in the reactivity of small blood vessels. Experiments were designed to test the influence of CLT on the proliferative and vasorelaxant effect of bradykinin (BK) and on calcium homeostasis in smooth muscle cells (SMC). To this purpose two model systems were employed: (i) cultured human smooth muscle cells (HSMC), and (ii) isolated resistance arteries maintained in an organ bath. The effect of various concentrations of CLT (2-15 microM) on BK-induced proliferation of HSMC was quantitated by spectrometry following [3H]-thymidine incorporation, and intracellular calcium [Ca+]i was determined by spectrofluorimetry using Fura 2-AM assay. In other experiments the roles of BK receptor (AB2) and of thapsigargin were assessed. The reactivity of the resistance arteries was measured by the myograph technique, and the effects of BK, CLT, and NO synthase blocker, L-NAME were evaluated. The results showed that 10 microM CLT: (i) inhibits the BK-induced proliferation of HSMC by 45-50%: (ii) prevents the rise of [Ca2+]i induced by BK (120.8 +/- 12.4 nM vs. 235.8 +/- 34.1 nM), an cffect similar to that of "classic" L-type calcium channels blockers: (iii) reduces the release of Ca2+ entry induced by thapsigargin suggesting a possible inhibition of the capacitative Ca2+ entry. Organ bath assays showed that CLT enhanced the BK-induced relaxation of the resistance arteries by an endothelium NO-independent pathway. Together, these data suggest that the mechanism of action of CLT on SMC implies mainly a modification of intracellular calcium homeostasis, with a minor contribution of BK B2 receptors. These new distinctive features of CLT effects suggest the potential use of this drug in the therapy of cardiovascular diseases associated with SMC increased proliferation and impeded relaxation in small arteries, such as atherosclerosis and restenosis.
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Clotrimazol/farmacología , Inhibidores de Crecimiento/farmacología , Músculo Liso Vascular/efectos de los fármacos , Resistencia Vascular/efectos de los fármacos , Vasodilatadores/farmacología , Arteriosclerosis/tratamiento farmacológico , Bradiquinina/farmacología , Calcio/metabolismo , División Celular/efectos de los fármacos , Células Cultivadas , Clotrimazol/uso terapéutico , Interacciones Farmacológicas , Inhibidores Enzimáticos/farmacología , Inhibidores de Crecimiento/uso terapéutico , Humanos , Músculo Liso Vascular/citología , Músculo Liso Vascular/fisiología , Tapsigargina/farmacología , Vasodilatación/efectos de los fármacos , Vasodilatadores/uso terapéuticoRESUMEN
Restless legs syndrome (RLS), also known as Ekbom's syndrome, is a fairly common complaint which is not widely recognised by medical professionals, although it seems to affect 1-10% of the population. Despite recent attempts to better characterize RLS, this neurologic disorder remains poorly understood. Idiopathic RLS frequently follows an autosomal dominant inheritance with a variable clinical expressivity of symptoms. Secondary RLS is usually associated with neuropathy of chronic disorders (uremia, cryoglobulinemia, diabetes mellitus, infections, etc). RLS gives the sufferer an unpleasant sensation in the legs at rest, causing an irresistible desire to move which alleviates the discomfort. Other features that characterize RLS include sleep disturbance, involuntary movements in sleep or wakefulness, a normal neurologic examination, a chronic clinical course (waxing and waning over the time), and, in some cases, a positive family history. Periodic limb movements during sleep, which also may occur as an isolated finding, may or may not cause frequent arousals or awakenings. Clinical diagnosis of idiopathic or symptomatic forms of RLS can be supported with polysomnography. Full understanding of the features of RLS will provide the clinician with the strongest tool for recognizing the disorder. Many different treatments have been tried for RLS. Since the cause is unclear, therapy of RLS and PLMS remains symptomatic except for some secondary forms. Treatment of first choice consists of dopaminergic drugs or dopamine agonist, opioids and benzodiazepines.
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Dopaminérgicos/uso terapéutico , Síndrome de las Piernas Inquietas , Anciano , Humanos , Persona de Mediana Edad , Psicotrópicos/efectos adversos , Síndrome de las Piernas Inquietas/diagnóstico , Síndrome de las Piernas Inquietas/etiología , Síndrome de las Piernas Inquietas/fisiopatología , Trastornos del Sueño-Vigilia/etiologíaRESUMEN
PIP: The relationships among population trends, the labor force, and socioeconomic development in Romania are explored. The focus is on the period 1950-1985. The author describes the growing urbanization of the population, the declining proportion of the work force engaged in agriculture, and changes in the occupational structure.^ieng