RESUMO
Prostatic artery embolisation (PAE) is used to treat patients with benign prostatic hyperplasia and with lower urinary obstructive tract symptoms. It is an interventional procedure which uses fluoroscopy equipment and can result in exposure to high doses of radiation in patients and staff. We aimed to demonstrate the reduction of radiation doses received by staff during PAE by implementing an optimised protocol called Radiation Exposure Curtailment for Embolisation (RECiFE). This protocol was implemented in cooperation with the medical team and technical team using Siemens Combined Applications to Reduce Exposure (CARE) protocol. The results showed approximately 83% reduction in the radiation doses received by the main physician during PAE. Thus, by adjusting the acquisition parameters of the angiographic equipment and implementing the RECiFE protocol, it is possible to optimise the PAE procedure and reduce the staff radiation dose.
Assuntos
Embolização Terapêutica/efeitos adversos , Exposição Ocupacional/efeitos adversos , Imagens de Fantasmas , Hiperplasia Prostática/terapia , Exposição à Radiação/efeitos adversos , Proteção Radiológica/métodos , Radiografia Intervencionista/efeitos adversos , Brasil , Humanos , MasculinoRESUMO
BACKGROUND AND AIMS: Macrophages derived from monocytes play an important role in atherosclerosis progression. Subpopulations of circulating classical, intermediate, and non-classical monocytes possess distinct functions and phenotypes, and participate in the pathogenesis of disease. The aim of this study was to compare the quantity and phenotypes of circulating monocyte subpopulations in patients with established atherosclerosis and healthy control individuals. Additionally, the study aimed to provide insight into the functional activity of monocytes against a heat shock protein (HSP60). METHODS: Chemokine and pattern recognition receptors in monocyte subsets obtained from peripheral blood of acute and chronic coronary artery disease patients and controls were quantified by flow cytometry. Furthermore, monocytes from healthy controls were stimulated in vitro with HSP60, and the cytokines produced by them were evaluated by flow cytometry. RESULTS: Eighteen controls (C), 34 individuals with risk factors for cardiovascular disease (RF), 32 patients with stable angina (SA), and 16 patients with unstable angina (UA) were enrolled in the study. The absolute count of intermediate monocytes was found to be increased in patients of the UA group; high frequencies of the chemokine receptors CCR2, CCR5, and CX3CR1 were also observed in this subpopulation. Moreover, the pattern recognition receptors TLR2 and TLR4 were more frequent in intermediate monocytes from the UA group. Furthermore, the intermediate monocytes from healthy individuals produced IL-12p70 after stimulation with HSP60. CONCLUSIONS: Our results show that intermediate monocytes of UA patients exhibited an enhanced expression of the receptors involved in the recognition of damage-associated molecular patterns (DAMPs) and enhancement of the migratory function. Hence, they might contribute to the propagation and progression of inflammation observed in atherosclerosis, especially in the acute setting.
Assuntos
Angina Instável/metabolismo , Quimiocinas/metabolismo , Monócitos/metabolismo , Receptores de Reconhecimento de Padrão/metabolismo , Receptor 1 de Quimiocina CX3C/metabolismo , Chaperonina 60/metabolismo , Feminino , Humanos , Interleucina-12/metabolismo , Masculino , Pessoa de Meia-Idade , Receptores CCR2/metabolismo , Receptores CCR5/metabolismo , Receptor 2 Toll-Like/metabolismo , Receptor 4 Toll-Like/metabolismoRESUMO
Respiratory syncytial virus (RSV)-specific CD8(+) T cell responses do not protect against reinfection. Activation of mammalian target of rapamycin (mTOR) impairs memory CD8(+) T cell differentiation. Our hypothesis was that RSV inhibits the formation of CD8(+) T cells memory responses through mTOR activation. To explore this, human and mouse T cells were used. RSV induced mTOR phosphorylation at Ser2448 in CD8 T cells. mTOR activation by RSV was completely inhibited using rapamycin. RSV-infected children presented higher mTOR gene expression on nasal washes comparing to children infected with metapneumovirus and rhinovirus. In addition, RSV-infected infants presented a higher frequency of CD8(+) pmTORser2448(+) T cells in nasal washes compared to RSV-negative infants. Rapamycin treatment increased the frequency of mouse CD8 RSV-M282-90 pentamer-positive T cells and the frequency of RSV-specific memory T cells precursors. These data demonstrate that RSV is activating mTOR directly in CD8 T cells, indicating a role for mTOR during the course of RSV infection.
Assuntos
Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/metabolismo , Líquido da Lavagem Nasal/imunologia , Infecções por Vírus Respiratório Sincicial/imunologia , Infecções por Vírus Respiratório Sincicial/metabolismo , Vírus Sinciciais Respiratórios/imunologia , Serina-Treonina Quinases TOR/metabolismo , Animais , Linfócitos T CD8-Positivos/efeitos dos fármacos , Criança , Humanos , Memória Imunológica/efeitos dos fármacos , Imunossupressores/farmacologia , Lactente , Ativação Linfocitária/efeitos dos fármacos , Camundongos , Líquido da Lavagem Nasal/virologia , Fosforilação , Infecções por Vírus Respiratório Sincicial/virologia , Sirolimo/farmacologia , Serina-Treonina Quinases TOR/genéticaRESUMO
BACKGROUND: Since July 2006, the Model for End-stage Liver Disease (MELD) score has served as the national basis for allocation of donor livers for transplantation in Brazil. Patients with higher MELD scores receive greater priority for allocation regardless of the time on the waiting list. PURPOSE: To investigate the impact of MELD score implementation on the survival of waiting list patients. METHODS: A retrospective study of patients registered at the national Organ Procurement Organization (OPO) for the liver transplantation waiting list between January 2004 and June 2006 (pre-MELD) and between July 2006 and December 2008 (post-MELD). RESULTS: We included listed patients awaiting liver transplantation in the pre-MELD era (n = 250, 48.4%) and in the post-MELD era (n = 266, 51.6%). The times awaiting transplant prior to and after the MELD system were 487.2 +/- 384.8 days and 183.9 +/- 157.2 days, respectively. Prior to the MELD score, waiting list survivals were greater when compared to rates in the current system. Early posttransplant patient survival rates were significantly reduced in the post-MELD era (83.4%) compared to the period before MELD implementation (93.2%). CONCLUSIONS: MELD score provides a transparent, objective system to drive allocation policy; however, it presents several important limitations. Constant need of changes and reevaluation are needed as an evolutionary process. Future changes in the present system may be addressed by adjusting the MELD system.
Assuntos
Falência Hepática/cirurgia , Transplante de Fígado/estatística & dados numéricos , Listas de Espera , Adolescente , Adulto , Idoso , Cadáver , Criança , Pré-Escolar , Feminino , Humanos , Falência Hepática/mortalidade , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Alocação de Recursos/métodos , Estudos Retrospectivos , Taxa de Sobrevida , Sobreviventes , Doadores de Tecidos/estatística & dados numéricosRESUMO
Although imaging and clinical criteria are already established for the diagnosis of mucoid degeneration of the anterior cruciate ligament (ACL), many radiologists remain unaware of their existence. Once regarded as a rare occurrence, it has been recently suggested that its incidence is in fact very much higher than previously thought, and that it is probably underdiagnosed or misdiagnosed as partial ruptures of the ACL or as cystic ganglia. In this review, the authors revisit the literature concerning this subject and present their personal experience with it, stressing the paramount importance of magnetic resonance imaging and correlation with clinical data for a correct diagnosis.
Assuntos
Ligamento Cruzado Anterior/patologia , Artropatias/diagnóstico , Articulação do Joelho/patologia , Imageamento por Ressonância Magnética/métodos , Envelhecimento , Diagnóstico Diferencial , Cistos Glanglionares/diagnóstico , Humanos , Muco , Amplitude de Movimento ArticularRESUMO
In this report seven cases of diffusely altered signal intensity of the posterior cruciate ligament (PCL) at magnetic resonance imaging (MRI) are described. The abnormalities resemble those of mucoid degeneration of the anterior cruciate ligament (ACL) and are associated with it in six cases. Although mucoid degeneration of the ACL is an increasingly reported entity, with well-established imaging criteria at MRI, to the authors' knowledge similar findings were never described before for the PCL. It is hypothesized that these abnormalities of the cruciate ligaments are similar in nature, probably related to degenerative changes of the connective tissue.
Assuntos
Ligamento Cruzado Anterior/patologia , Doenças do Tecido Conjuntivo/diagnóstico , Artropatias/diagnóstico , Articulação do Joelho/patologia , Imageamento por Ressonância Magnética/métodos , Ligamento Cruzado Posterior/patologia , Adulto , Idoso , Doenças do Tecido Conjuntivo/complicações , Feminino , Humanos , Artropatias/complicações , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Amplitude de Movimento ArticularRESUMO
Seventy-one hip joints in 69 infants and children with pyogenic arthritis were studied. Twenty joints (28%) with the radiographic characteristics of avascular necrosis were identified and the changes classified into 3 groups: Group 1 (infants up to the age of 6 months) had ischaemic changes characterized by the absence or delayed appearance of the epiphyseal ossification centre; Group 2 (children aged between 7 months and 5 years) showed disappearance of this centre whether followed by revascularization or not, with the shape of the cartilaginous femoral head preserved in either case; and in Group 3 (children 6-16 years of age) the femoral epiphysis was either totally or partially involved with increased bone density; collapse of the head may or may not have occurred. At follow-up for between 2 and 15 years, a trend towards more severe deformities was seen in the 11 hip joints of Group 3 when compared to the 9 hip joints in Groups 1 and 2. The opposite was observed in relation to less severe deformities. Early diagnosis and treatment of infection is mandatory in patients with pyogenic arthritis and increased intra-articular hydrostatic pressure, or those with septic thrombosis of the epiphyseal vessels, which could cause avascular necrosis (AVN).