RESUMEN

Pancreatic cancer (PC) is the most lethal type of gastrointestinal cancer, and early detection and monitoring is an urgent problem. Circulating tumor cells (CTCs) are emerging as a non-invasive biomarker for tumor detection. However, the low sensitivity is a main problem in the traditional CellSearch System for detecting CTCs, especially in patients with PC. In this study, we used negative enrichment (NE), immunofluorescence and in situ hybridization (FISH) of chromosome 8 (NE-iFISH) to capture and identify CTCs in PC patients. We showed that the NE-iFISH system exhibited a dramatically high detection rate of CTCs in PC patients (90%). The diagnostic rate of PC reached 97.5% when combining CTCs ≥ 2 and carbohydrate antigen 19-9 (CA19-9) > 37 µmol/L. The 1-year survival in the group of CTCs < 3 was significantly higher than that of CTCs ≥ 3 (p = 0.043). In addition, we analyzed the role of chromosomal instability in CTCs detection. The group of triploid (three hybridization signals of chromosome 8) CTCs ≥ 3 showed a shorter 1-year survival (p = 0.0279) and overall survival (p = 0.0188) than the group with triploid CTCs < 3. Importantly, the triploid CTC number but not the overall CTC counts could be a predictor of chemo-sensitivity. Moreover, circulating tumor microembolus (CTMs) were found in stage IV patients, and were positively related to the poor response to chemotherapy. In conclusion, the NE-iFISH system significantly improved the positive detection rate of CTCs and triploid CTC could be used to predict prognosis or the response to the chemotherapy of PC patients. CTM is a potential indicator of the chemotherapeutic effect in advanced PC patients.

Asunto(s)

Detección Precoz del Cáncer/métodos , Hibridación Fluorescente in Situ/métodos , Técnicas de Diagnóstico Molecular/métodos , Células Neoplásicas Circulantes/patología , Neoplasias Pancreáticas/sangre , Adulto , Anciano , Estudios de Casos y Controles , Línea Celular Tumoral , Inestabilidad Cromosómica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/patología , Ploidias

RESUMEN

PURPOSE: The aim of this study is to determine the stability of carotid atherosclerotic plaque (CAP) using contrast-enhanced ultrasound (CEUS). METHODS: CEUS images of 93 patients were evaluated to observe new vessels within CAPs. Microembolic signals (MES) were detected using transcranial Doppler (TCD). Thirty-four patients with hyperechoic plaques were evaluated as the control group. RESULTS: Eighty percent (75/93) of plaques showed contrast enhancement on CEUS, including 50.7% (38/75) of hypoechoic plaques and 49.3% (37/75) of mixed echoic plaques. No plaques in the control group showed enhancement on CEUS. With TCD, 35.5% (33/93) of patients were positive for MES. Plaques with grade 2 or 3 enhancement on CEUS had a higher positive rate for MES. Forty-one patients with grade 2 or 3 enhancement on CEUS presented with fresh infarctions confirmed by computed tomography (CT) and magnetic resonance imaging (MRI). CONCLUSIONS: In conclusion, grade 2 or 3 contrast enhancement observed on CEUS indicated vulnerable plaques.

Asunto(s)

Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Placa Aterosclerótica/diagnóstico por imagen , Ultrasonografía Doppler Transcraneal/métodos , Anciano , Anciano de 80 o más Años , Enfermedades de las Arterias Carótidas/patología , Enfermedades de las Arterias Carótidas/fisiopatología , Medios de Contraste , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/patología , Placa Aterosclerótica/fisiopatología , Tomografía Computarizada por Rayos X

RESUMEN

BACKGROUND: The mechanisms behind the association of atrial fibrillation (AF) and dementia are unknown. One possibility is that exposure to chronic microembolism or microbleeds results in repetitive cerebral injury that is manifest by cognitive decline. OBJECTIVE: The purpose of this study was to test the hypothesis that AF patients with a low percentage of time in the therapeutic range (TTR) are at higher risk for dementia due to under- or overanticoagulation. METHODS: Patients anticoagulated with warfarin (target international normalized ratio [INR] 2-3), managed by the Intermountain Healthcare Clinical Pharmacist Anticoagulation Service with no history of dementia or stroke/transient ischemic attack, were included in the study. The primary outcome was dementia incidence defined by ICD-9 codes. Percent time in TTR was calculated using the method of linear interpolation and stratified as >75%, 51%-75%, 26%-50%, and ≤25%. Multivariable Cox hazard regression was used to determine dementia incidence by percentage categories of TTR. RESULTS: A total of 2605 patients (age 73.7 ± 10.8 years, 1408 [54.0%] male) were studied. The CHADS2 score distribution was 0: 216 (8.3%); 1: 579 (22.2%); 2: 859(33.0%); 3: 708 (27.2%); and ≥4: 243 (9.3%). The percent TTR averaged 63.1 ± 21.3, with percent INR <2.0: 25.6% ± 17.9% and percent INR >3.0: 16.2% ± 13.6%. Dementia was diagnosed in 109 patients (4.2%) (senile: 37 [1.4%]; vascular: 8 [0.3%]; Alzheimer: 64 (2.5%]). After adjustment, decreasing categories of percent TTR were associated with increased dementia risk (vs >75%): <25%: hazard ratio (HR) 5.34, P < .0001; 26%-50%: HR 4.10, P < .0001; and 51%-75%: HR = 2.57, P = .001. CONCLUSION: Quality of anticoagulation management represented as percent TTR among AF patients without dementia was associated with dementia incidence. These data support the possibility of chronic cerebral injury as a mechanism that underlies the association of AF and dementia.

Asunto(s)

Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/epidemiología , Demencia/epidemiología , Relación Normalizada Internacional , Warfarina/efectos adversos , Anciano , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Fibrilación Atrial/diagnóstico , Estudios de Cohortes , Comorbilidad , Demencia/etiología , Demencia/fisiopatología , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Warfarina/administración & dosificación

RESUMEN

Alzheimer's disease(AD),a most common type of dementia,often results in cognitive and behavioral dysfunction,A growing body of research suggested that there are specific correlations between AD and traditional vascular risk factors.There are significant associations between the incidence of AD and diabetes mellitus,hypercholesterolemia,hypertension,hyperhomocysteinemia,antioxidants,alcohol consumption,smoking,physical activity,and the presence of atrial fibrillation.These risk factors may he the potentially preventable etiologies of AD.

RESUMEN

0.05)Both the anticoagulants and the anti-platelet agents can reduce MES. During 1.5 year, s follow-up, the recurrent rate of ischemic event in the MES positive group was markedly higher than that in the MES negative group(P