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Zeitschriftendaten
Format
Zeitschrift
eISSN
1875-855X
Erstveröffentlichung
01 Jun 2007
Erscheinungsweise
6 Hefte pro Jahr
Sprachen
Englisch

Suche

Volumen 10 (2016): Heft 5 (October 2016)

Zeitschriftendaten
Format
Zeitschrift
eISSN
1875-855X
Erstveröffentlichung
01 Jun 2007
Erscheinungsweise
6 Hefte pro Jahr
Sprachen
Englisch

Suche

11 Artikel

Editorial

Uneingeschränkter Zugang

Rodent models of chronic kidney disease for studies of early renal tubulointerstitial fibrosis

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 421 - 422

Zusammenfassung

Original article

Uneingeschränkter Zugang

Effects of mirtazapine on quality of life of Thai patients with fibromyalgia syndrome: a double-blind, randomized, placebo-controlled trial

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 435 - 445

Zusammenfassung

Abstract

Fibromyalgia syndrome (FMS) is a physical and mood disorder that affects quality of life (QoL). Mirtazapine, which improves monoaminergic neurotransmission, may benefit patients with FMS.

To compare the QoL between Thai patients with FMS and healthy Thais, and investigate the effects of mirtazapine in a pilot study.

We compared the QoL between 76 Thai patients with FMS and 80 healthy Thai volunteers (HVs). A double-blind, randomized, placebo-controlled trial using 40 patients with FMS was conducted using a block design with parallel assignment. QoL data were obtained at week 0 (baseline), and repeatedly for 13 weeks after receiving placebo or mirtazapine 15 or 30 mg/day.

The mean baseline of SF-36 QoL was significantly lower in all domains in patients with FMS than in HVs (bodily pain 33 vs 87, general health 36 vs 84, mental health 63 vs 82, physical functioning 59 vs 96, role limitation because of emotional problems 41 vs 92, role limitation because of physical problems 30 vs 96, social functioning 53 vs 93, and vitality 48 vs 75 (scale 0-100, P < 0.01 all domains). Mirtazapine (15 and 30 mg/day) significantly reduced pain scores and improved all domains except social functioning, while placebo produced no change from baseline. Eight patients withdrew because of adverse events including somnolence and weight gain; no benefit, or lack of compliance.

The QoL of patients with FMS is lower than for healthy Thais. Mirtazapine is effective for reducing pain and improving QoL in patients with FMS.

ClinicalTrials.gov; Identifier: NCT00919295.

Office of the Higher Education Commission, Thailand.

Schlüsselwörter

  • Fibromyalgia
  • mirtazapine
  • noradrenergic and specific serotonergic antidepressant
  • pain
  • quality of life
Uneingeschränkter Zugang

Comparison of methods for deriving neural progenitor cells from nonhuman primate embryonic stem cells

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 423 - 433

Zusammenfassung

Abstract

Feeder-free monolayer culture and the suspension culture of embryoid bodies (EB) followed by adherent culture, rosette selection, and expansion are 2 methods for deriving neural progenitor cells (NPCs). Direct comparison of these 2 methods has not yet been reported.

To compare the influence of NPC derivation methods on the properties of NPCs derived from rhesus monkey (Macaca mulatta) embryonic stem cells (rhESCs).

rhESCs were used to derive NPC lines using 2 different methods. EB were produced from a suspension culture of rhESC clumps and rhESCs were cultured in feeder-free monolayers on poly-L-ornithine/laminin coated plates. NPCs were derived by exposure to induction factors. Cell morphology, neural and nonneural lineage markers were evaluated. We measured the expression of nuclear receptor tailless (TLX), which acts as repressor of glial fibrillary acidic protein (GFAP) expression.

NPCs were successful derived using either method, with homogenous populations based on the expression of nestin (>97%) and Pax6 (>99%) as shown by flow cytometry. No significant difference in NPC specific markers or ability to differentiate into neurons in vitro was found between the methods. However, the expression of GFAP was >400-fold higher in cells produced by the feeder-free method. This distinction was consistent with the lower expression of TLX.

NPCs derived by feeder-free and EB methods share similar morphology and properties. The elevated expression of GFAP and reduced expression of TLX in NPCs derived using the feeder-free method may explain their greater heterogeneity and tendency to differentiate toward cells of an astrocyte lineage.

Schlüsselwörter

  • Embryonic stem cells
  • neural progenitor cells
  • neural progenitor cell derivation
  • nonhuman primate
  • TLX

Brief communication (Original)

Uneingeschränkter Zugang

Association of CYP3A5 and POR polymorphisms with the maintenance tacrolimus dosage requirement in Thai recipients of kidney transplants

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 483 - 490

Zusammenfassung

Abstract

Cytochrome P450 (CYP) 3A5 is a major isoform metabolizing tacrolimus. Individual variation in the metabolism may result from CYP3A5 single nucleotide polymorphisms (SNPs). CYP3A5*3 polymorphism is strongly associated with tacrolimus pharmacokinetic variations in 65%–85% of Asian populations. A minor polymorphism related to requirement for tacrolimus is the POR*28 mutation, which increases in vivo CYP3A activity for tacrolimus. These two SNPs might affect individual maintenance dosages of tacrolimus.

To determine the association of CYP3A5*3 and POR*28 SNPs with maintenance dosage requirements for tacrolimus in Thai recipients of kidney transplants.

We enrolled 150 Thai recipients of kidney transplants. Clinical laboratory data were recorded 3 months after first administration of tacrolimus. Two SNPs; rs776746 A > G (CYP3A5*3 allele) and rs1057868 C > T (POR*28 allele) were assessed. All 300 genotypes were analyzed by real-time polymerase chain reactions.

Recipients were classified into 9 groups according to possible matching genotypes. The mean dosage required for the maintenance phase was significantly higher in the CYP3A5*1 allele or CYP3A5 expressers (groups 1-6, 0.163, 0.167, 0.141, 0.128, 0.131, and 0.174 mg/kg/day, respectively) than those not expressing CYP3A5*3/*3 or CYP3A5 (groups 7-9, 0.081, 0.073, and 0.069 mg/kg/day, respectively, P < 0.05). When the mean dosage was compared under POR*28 one or two alleles in CYP3A5 expressers, P was significantly smaller than in CYP3A5 expressers with POR*1/*1.

CYP3A5 polymorphism is key to determining tacrolimus dosage requirements during the maintenance phase in kidney transplant recipients and POR*28 may contribute to the interindividual variability

Schlüsselwörter

  • CYP3A5
  • kidney transplantation
  • maintenance dose
  • POR
  • single nucleotide polymorphisms
  • tacrolimus
Uneingeschränkter Zugang

Outcomes of hepatic resection for hepatocellular carcinoma with major portal or hepatic vein tumor thrombosis: retrospective cohort study

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 477 - 482

Zusammenfassung

Abstract

Major vascular invasion by hepatocellular carcinoma (HCC) is a poor prognostic factor. The outcome of hepatic resection for this advanced stage tumor remains unclear.

To clarify the outcome of hepatic resection for HCC with vascular invasion.

Between January 2005 and May 2013, 13 of 272 patients who underwent hepatic resection of HCC had a confirmed major portal or hepatic vein tumor thrombosis. The perioperative and long-term outcomes of this cohort of patients were retrospectively reviewed.

Ten of the 13 patients underwent preoperative transarterial chemoembolization (TACE). None showed tumor progression or liver function deterioration. All underwent hepatic resection with complete removal of tumor thrombus. The vascular resection margin was microscopically negative in all patients. Postoperative complications occurred in 62%. Most complications were pleural effusion, which necessitates percutaneous drainage. No perioperative mortality occurred. The median follow up time was 38.5 months (range 10–112). The median overall survival was 38.5 months. The 1-, 3-, and 5-year recurrence free survival was 93%, 36%, and 36%, respectively. The 1-, 3-, and 5 year-overall survival was 93%, 76%, and 48%, respectively. Nine patients had intrahepatic tumor recurrence, extrahepatic recurrence, or both. Five with recurrence underwent TACE, radiofrequency ablation, or surgical resection. On univariate analysis, the only factor that tended to relate to worse overall survival was underlying liver cirrhosis (P = 0.056).

Hepatic resection for HCC with invasive thrombosis, combined with careful patient selection, close postoperative follow up, and early treatment of recurrence offers a chance of long-term survival.

Schlüsselwörter

  • Hepatocellular carcinoma
  • preoperative TACE
  • surgical resection
  • survival outcomes
  • tumor thrombus
Uneingeschränkter Zugang

Successful weaning of adult patients with respiratory failure from mechanical ventilators using an L-piece

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 469 - 476

Zusammenfassung

Abstract

There are many methods for weaning patients from mechanical ventilation. Using either a T-piece or CPAP are effective for weaning. Weaning using an L-piece is a strategy similar to using a T-piece, but uses less oxygen flow with air and has less dead space than a T-piece.

To determine whether adult patients with respiratory failure can be successfully weaned from a ventilator using an L-piece, including a study of factors that may affect the success or failure of weaning.

Retrospective review of the medical records of a cohort of patients who had respiratory failure and were admitted to Wetchakarunrasm Hospital between January 1st, 2012 and September 30th, 2015.

We found 143 cases matched the inclusion criteria. There was a 95.1% success in weaning adult patients with respiratory failure from a ventilator by using an L-piece. No vital signs before weaning and during L-piece weaning were significantly different, except for respiratory rate, which was 1.4 times/min (7.7%, P < 0.001) higher using the L-piece than before weaning. The success of weaning a group using oxygen flow at 1-3 L/min was 92.2% and a group using oxygen flow at 4-6 L/min was 96.7%. There was no significant difference in the success rate between these groups (P = 0.25).

Weaning patients from mechanical ventilators using an L-piece is safe and has a success of 95.1%. This method of weaning can save oxygen use by reducing the flow of oxygen, which may be beneficial in patients with chronic obstructive pulmonary disease.

Schlüsselwörter

  • Extubation
  • failed weaning
  • L-piece
  • respiratory failure
  • successful weaning
  • ventilator
Uneingeschränkter Zugang

Retrospective review of oscillopsia: etiologies and clinical characteristics

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 461 - 468

Zusammenfassung

Abstract

Oscillopsia can result from dysfunction involving the vestibuloocular reflex (VOR). Few studies have detailed the full spectrum of clinical characteristics and laboratory findings of this disabling condition.

To review causes and clinical characteristics of oscillopsia.

Retrospective review of clinical records of a series of patients with oscillopsia from the University Health Network Multidisciplinary Neurotology Clinic.

Review of 109 patients with oscillopsia showed near equal sex distribution and a mean age of 54.9 years (standard deviation 15.7). The most common peripheral vestibular causes were ototoxicity (19.3%) and Meniere’s disease (10.1%). The most common central cause involved cerebellar degeneration (7.3%). Only 43.1% complained of vertigo at any time. Head impulse testing demonstrated bilateral refixation saccades in 70% of patients, while over 95% had a loss of dynamic visual acuity ≥5 lines on LogMAR chart testing. Some 38.8% of patients demonstrated normal caloric responses, whereas only 26.5% exhibited evidence of a bilateral caloric loss. Over 50% of patients maintained otolithic function as demonstrated by cervical vestibular evoked myogenic potential testing. Most patients demonstrated low VOR gains bilaterally on magnetic scleral search coil testing.

A wide spectrum of clinical characteristics was identified in patients with oscillopsia. It is important for the physician to perform a thorough history, physical examination (including head impulse and dynamic visual acuity), and laboratory investigations.

Schlüsselwörter

  • Bilateral vestibular loss
  • magnetic scleral search coil
  • oscillopsia
  • vestibuloocular reflex
Uneingeschränkter Zugang

Urinary exosomes from a mouse model of chronic tubulointerstitial kidney disease induced by chronic renal ischemia–reperfusion injury and nephrectomy

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 447 - 454

Zusammenfassung

Abstract

Biomarkers for the early diagnosis of chronic kidney disease (CKD) will lead to its better management. Rodent models will be helpful for biomarker discovery. Urinary exosomes, membrane bound vesicles, may contain interesting biomarkers.

To produce a mouse model of CKD with sufficient urine volume for exosome studies.

We characterized a mouse models of CKD induced by 55 min ischemia–reperfusion injury and contralateral nephrectomy at 1 wk after the chronic ischemia–reperfusion injury (Chr IR) in 7 mice and other 7 sham-operated control mice. We collected 24 h urine for urine exosome extraction.

Blood urea nitrogen, serum creatinine, and proteinuria increased as early as 2 wk, and reciprocally lower hematocrit. The renal injury, proteinuria, and anemia persisted 12 wk after nephrectomy as consistent with uremic symptoms. The mouse model of CKD showed renal histopathology of interstitial fibrosis with mild glomerular injury, and failure to grow. At 12 wk, the volume of urine collected in 24 h was sufficient for exosome extraction. Urinary exosomes were demonstrated by western blots showing tumor susceptibility gene 101 protein.

Mice with renal injury induced by Chr IR showed renal injury and proteinuria as early as 2 wk with uremic symptoms and tubulointerstitial fibrosis. Most importantly, the 24 h volume of urine at 12 wk was sufficient for exosome extraction.

Schlüsselwörter

  • Chronic ischemic reperfusion injury
  • chronic kidney disease
  • mouse model
  • urinary exosome

Brief communication (Original article)

Uneingeschränkter Zugang

A semiautomatic segmentation approach to biometric measurement of the talus bone of sedentary women and ballerinas using CT images

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 455 - 459

Zusammenfassung

Abstract

Ballet produces much stress on bones in the feet of ballerinas. Monitoring and detecting talus bone deformation is important for their quality of health and profession.

To determine differences in the talus bone between ballerinas and sedentary women.

We evaluated biometric differences in the talus bone of 5 ballerinas referenced to 5 similar sedentary women recruited into the present study. We acquired 20 multidetector computed tomographic images including right and left feet. Semiautomatic region-based image processing using 3D-Doctor (Able Software Corp) was used to create three-dimensional (3D) virtual models of the talus bones. Biometric measurements were made on the 3D models and statistical analysis conducted.

The mean talus bone length of ballerinas was 3.37 cm (SD 0.12; range 3.11 to 3.52). The talus bone length of sedentary women was 3.29 cm (SD 0.16; range 3.04 to 3.65), and tended to be shorter than that of the ballerinas (P = 0.08, t test). However, the test was insufficiently powered. The mean volume of the talus bones from the ballerinas was 24.8 cm3 (SD 0.83) and smaller than that from the sedentary women, 26.9 cm3 (SD 1.25) at P < 0.001 (t = 4.38, 18 degrees of freedom. Difference 2.1. Two-tailed 95% confidence interval for difference of means: 1.08 to 3.08). We found less variation in the feet of ballerinas than sedentary women.

Volumetric measurements show that feet of ballerinas are smaller and retain similar shape and size than the irregular feet of sedentary women.

Schlüsselwörter

  • Image processing
  • MDCT
  • segmentation
  • talus
  • 3D Model

Technical report (Original)

Uneingeschränkter Zugang

A folic acid-induced rat model of renal injury to identify biomarkers of tubulointerstitial fibrosis from urinary exosomes

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 491 - 502

Zusammenfassung

Abstract

Chronic tubulointerstitial (TI) fibrosis is difficult to diagnose. Urinary exosomes contain many potential biomarkers, and may be useful to identify biomarkers of TI fibrosis. However, a suitable animal model to investigate urinary exosome biomarkers for TI fibrosis has not yet been specifically identified.

To test the suitability of a folic-acid induced rat model of renal injury for identifying potential biomarkers of fibrosis from urinary exosomes.

We employed a rat model of renal injury using a single intraperitoneal injection of folic acid. Urinary exosomes were isolated and analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS)

We demonstrated severe acute kidney injury after folic acid injection by a 6-fold decrease in creatinine clearance at day 2, severe inflammatory cell infiltration in the TI area at day 7, and renal fibrosis at day 14. We collected 24 h urine samples from folic acid-injected rats and vehicle-injected control rats at days 7 and 14, then isolated urinary exosomes using a differential centrifugation method. We found that levels of exosomal marker proteins ALG-2-interacting protein 1 (ALIX; PDCD6IP) and tumor susceptibility gene 101 (TSG101) were higher in folic acid-injected rats than in control rats. LC-MS/MS analysis of urinary exosomal proteins from the folic acid-injected and control rats identified 372 proteins, including various potential TI fibrosis biomarkers

We demonstrated the feasibility of using a folic acid-induced rat model of TI fibrosis for urinary proteomic analysis. These rats excreted sufficient urinary exosomes permitting the large-scale analysis and discovery of potential biomarkers of renal fibrosis.

Schlüsselwörter

  • Biomarkers, chronic kidney disease, folic acid, interstitial fibrosis, proteomics, urine exosomes

Clinical report

Uneingeschränkter Zugang

Primary hyperparathyroidism in Thai children: case series and literature review

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 503 - 507

Zusammenfassung

Abstract

Primary hyperparathyroidism is a common disease in adults, but extremely rare in the pediatric age group. To our knowledge, pediatric primary hyperparathyroidism has never been reported in Thailand.

To describe 3 cases of primary hyperparathyroidism presenting in Thai children with different clinical manifestations.

Cases of primary hyperparathyroidism in 3 Thai pediatric patients are reported herein, with a brief literature review.

Three patients are described. The first patient, a 14-year-old Thai girl, presented with progressively worsening bowlegs and lordosis of the spine for 1.5 years. The second patient, a 15-year-old Thai boy, presented with a history of hip pain and constipation for 3 years. The third patient, an obese 11-year-old Thai boy, presented with acute abdominal pain, which was initially incorrectly diagnosed as acute pancreatitis.

The clinical symptoms of hyperparathyroidism in Thai children are nonspecific at an early stage of the disease. The diagnoses are usually delayed and the patients therefore suffer complications of long-term hypercalcemia such as bone deformities or renal nephrocalcinosis. We recommend initial laboratory screening in pediatric patients with nonspecific symptoms and complaints of persistent bone pain. Appropriate investigations to confirm or eliminate primary hyperparathyroidism should be made, as an early diagnosis can facilitate early treatment and prevent the organ damage that can result from delayed diagnosis.

Schlüsselwörter

  • Hypercalcemia
  • hyperparathyroidism
  • parathyroid adenoma
  • parathyroid hyperplasia
11 Artikel

Editorial

Uneingeschränkter Zugang

Rodent models of chronic kidney disease for studies of early renal tubulointerstitial fibrosis

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 421 - 422

Zusammenfassung

Original article

Uneingeschränkter Zugang

Effects of mirtazapine on quality of life of Thai patients with fibromyalgia syndrome: a double-blind, randomized, placebo-controlled trial

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 435 - 445

Zusammenfassung

Abstract

Fibromyalgia syndrome (FMS) is a physical and mood disorder that affects quality of life (QoL). Mirtazapine, which improves monoaminergic neurotransmission, may benefit patients with FMS.

To compare the QoL between Thai patients with FMS and healthy Thais, and investigate the effects of mirtazapine in a pilot study.

We compared the QoL between 76 Thai patients with FMS and 80 healthy Thai volunteers (HVs). A double-blind, randomized, placebo-controlled trial using 40 patients with FMS was conducted using a block design with parallel assignment. QoL data were obtained at week 0 (baseline), and repeatedly for 13 weeks after receiving placebo or mirtazapine 15 or 30 mg/day.

The mean baseline of SF-36 QoL was significantly lower in all domains in patients with FMS than in HVs (bodily pain 33 vs 87, general health 36 vs 84, mental health 63 vs 82, physical functioning 59 vs 96, role limitation because of emotional problems 41 vs 92, role limitation because of physical problems 30 vs 96, social functioning 53 vs 93, and vitality 48 vs 75 (scale 0-100, P < 0.01 all domains). Mirtazapine (15 and 30 mg/day) significantly reduced pain scores and improved all domains except social functioning, while placebo produced no change from baseline. Eight patients withdrew because of adverse events including somnolence and weight gain; no benefit, or lack of compliance.

The QoL of patients with FMS is lower than for healthy Thais. Mirtazapine is effective for reducing pain and improving QoL in patients with FMS.

ClinicalTrials.gov; Identifier: NCT00919295.

Office of the Higher Education Commission, Thailand.

Schlüsselwörter

  • Fibromyalgia
  • mirtazapine
  • noradrenergic and specific serotonergic antidepressant
  • pain
  • quality of life
Uneingeschränkter Zugang

Comparison of methods for deriving neural progenitor cells from nonhuman primate embryonic stem cells

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 423 - 433

Zusammenfassung

Abstract

Feeder-free monolayer culture and the suspension culture of embryoid bodies (EB) followed by adherent culture, rosette selection, and expansion are 2 methods for deriving neural progenitor cells (NPCs). Direct comparison of these 2 methods has not yet been reported.

To compare the influence of NPC derivation methods on the properties of NPCs derived from rhesus monkey (Macaca mulatta) embryonic stem cells (rhESCs).

rhESCs were used to derive NPC lines using 2 different methods. EB were produced from a suspension culture of rhESC clumps and rhESCs were cultured in feeder-free monolayers on poly-L-ornithine/laminin coated plates. NPCs were derived by exposure to induction factors. Cell morphology, neural and nonneural lineage markers were evaluated. We measured the expression of nuclear receptor tailless (TLX), which acts as repressor of glial fibrillary acidic protein (GFAP) expression.

NPCs were successful derived using either method, with homogenous populations based on the expression of nestin (>97%) and Pax6 (>99%) as shown by flow cytometry. No significant difference in NPC specific markers or ability to differentiate into neurons in vitro was found between the methods. However, the expression of GFAP was >400-fold higher in cells produced by the feeder-free method. This distinction was consistent with the lower expression of TLX.

NPCs derived by feeder-free and EB methods share similar morphology and properties. The elevated expression of GFAP and reduced expression of TLX in NPCs derived using the feeder-free method may explain their greater heterogeneity and tendency to differentiate toward cells of an astrocyte lineage.

Schlüsselwörter

  • Embryonic stem cells
  • neural progenitor cells
  • neural progenitor cell derivation
  • nonhuman primate
  • TLX

Brief communication (Original)

Uneingeschränkter Zugang

Association of CYP3A5 and POR polymorphisms with the maintenance tacrolimus dosage requirement in Thai recipients of kidney transplants

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 483 - 490

Zusammenfassung

Abstract

Cytochrome P450 (CYP) 3A5 is a major isoform metabolizing tacrolimus. Individual variation in the metabolism may result from CYP3A5 single nucleotide polymorphisms (SNPs). CYP3A5*3 polymorphism is strongly associated with tacrolimus pharmacokinetic variations in 65%–85% of Asian populations. A minor polymorphism related to requirement for tacrolimus is the POR*28 mutation, which increases in vivo CYP3A activity for tacrolimus. These two SNPs might affect individual maintenance dosages of tacrolimus.

To determine the association of CYP3A5*3 and POR*28 SNPs with maintenance dosage requirements for tacrolimus in Thai recipients of kidney transplants.

We enrolled 150 Thai recipients of kidney transplants. Clinical laboratory data were recorded 3 months after first administration of tacrolimus. Two SNPs; rs776746 A > G (CYP3A5*3 allele) and rs1057868 C > T (POR*28 allele) were assessed. All 300 genotypes were analyzed by real-time polymerase chain reactions.

Recipients were classified into 9 groups according to possible matching genotypes. The mean dosage required for the maintenance phase was significantly higher in the CYP3A5*1 allele or CYP3A5 expressers (groups 1-6, 0.163, 0.167, 0.141, 0.128, 0.131, and 0.174 mg/kg/day, respectively) than those not expressing CYP3A5*3/*3 or CYP3A5 (groups 7-9, 0.081, 0.073, and 0.069 mg/kg/day, respectively, P < 0.05). When the mean dosage was compared under POR*28 one or two alleles in CYP3A5 expressers, P was significantly smaller than in CYP3A5 expressers with POR*1/*1.

CYP3A5 polymorphism is key to determining tacrolimus dosage requirements during the maintenance phase in kidney transplant recipients and POR*28 may contribute to the interindividual variability

Schlüsselwörter

  • CYP3A5
  • kidney transplantation
  • maintenance dose
  • POR
  • single nucleotide polymorphisms
  • tacrolimus
Uneingeschränkter Zugang

Outcomes of hepatic resection for hepatocellular carcinoma with major portal or hepatic vein tumor thrombosis: retrospective cohort study

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 477 - 482

Zusammenfassung

Abstract

Major vascular invasion by hepatocellular carcinoma (HCC) is a poor prognostic factor. The outcome of hepatic resection for this advanced stage tumor remains unclear.

To clarify the outcome of hepatic resection for HCC with vascular invasion.

Between January 2005 and May 2013, 13 of 272 patients who underwent hepatic resection of HCC had a confirmed major portal or hepatic vein tumor thrombosis. The perioperative and long-term outcomes of this cohort of patients were retrospectively reviewed.

Ten of the 13 patients underwent preoperative transarterial chemoembolization (TACE). None showed tumor progression or liver function deterioration. All underwent hepatic resection with complete removal of tumor thrombus. The vascular resection margin was microscopically negative in all patients. Postoperative complications occurred in 62%. Most complications were pleural effusion, which necessitates percutaneous drainage. No perioperative mortality occurred. The median follow up time was 38.5 months (range 10–112). The median overall survival was 38.5 months. The 1-, 3-, and 5-year recurrence free survival was 93%, 36%, and 36%, respectively. The 1-, 3-, and 5 year-overall survival was 93%, 76%, and 48%, respectively. Nine patients had intrahepatic tumor recurrence, extrahepatic recurrence, or both. Five with recurrence underwent TACE, radiofrequency ablation, or surgical resection. On univariate analysis, the only factor that tended to relate to worse overall survival was underlying liver cirrhosis (P = 0.056).

Hepatic resection for HCC with invasive thrombosis, combined with careful patient selection, close postoperative follow up, and early treatment of recurrence offers a chance of long-term survival.

Schlüsselwörter

  • Hepatocellular carcinoma
  • preoperative TACE
  • surgical resection
  • survival outcomes
  • tumor thrombus
Uneingeschränkter Zugang

Successful weaning of adult patients with respiratory failure from mechanical ventilators using an L-piece

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 469 - 476

Zusammenfassung

Abstract

There are many methods for weaning patients from mechanical ventilation. Using either a T-piece or CPAP are effective for weaning. Weaning using an L-piece is a strategy similar to using a T-piece, but uses less oxygen flow with air and has less dead space than a T-piece.

To determine whether adult patients with respiratory failure can be successfully weaned from a ventilator using an L-piece, including a study of factors that may affect the success or failure of weaning.

Retrospective review of the medical records of a cohort of patients who had respiratory failure and were admitted to Wetchakarunrasm Hospital between January 1st, 2012 and September 30th, 2015.

We found 143 cases matched the inclusion criteria. There was a 95.1% success in weaning adult patients with respiratory failure from a ventilator by using an L-piece. No vital signs before weaning and during L-piece weaning were significantly different, except for respiratory rate, which was 1.4 times/min (7.7%, P < 0.001) higher using the L-piece than before weaning. The success of weaning a group using oxygen flow at 1-3 L/min was 92.2% and a group using oxygen flow at 4-6 L/min was 96.7%. There was no significant difference in the success rate between these groups (P = 0.25).

Weaning patients from mechanical ventilators using an L-piece is safe and has a success of 95.1%. This method of weaning can save oxygen use by reducing the flow of oxygen, which may be beneficial in patients with chronic obstructive pulmonary disease.

Schlüsselwörter

  • Extubation
  • failed weaning
  • L-piece
  • respiratory failure
  • successful weaning
  • ventilator
Uneingeschränkter Zugang

Retrospective review of oscillopsia: etiologies and clinical characteristics

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 461 - 468

Zusammenfassung

Abstract

Oscillopsia can result from dysfunction involving the vestibuloocular reflex (VOR). Few studies have detailed the full spectrum of clinical characteristics and laboratory findings of this disabling condition.

To review causes and clinical characteristics of oscillopsia.

Retrospective review of clinical records of a series of patients with oscillopsia from the University Health Network Multidisciplinary Neurotology Clinic.

Review of 109 patients with oscillopsia showed near equal sex distribution and a mean age of 54.9 years (standard deviation 15.7). The most common peripheral vestibular causes were ototoxicity (19.3%) and Meniere’s disease (10.1%). The most common central cause involved cerebellar degeneration (7.3%). Only 43.1% complained of vertigo at any time. Head impulse testing demonstrated bilateral refixation saccades in 70% of patients, while over 95% had a loss of dynamic visual acuity ≥5 lines on LogMAR chart testing. Some 38.8% of patients demonstrated normal caloric responses, whereas only 26.5% exhibited evidence of a bilateral caloric loss. Over 50% of patients maintained otolithic function as demonstrated by cervical vestibular evoked myogenic potential testing. Most patients demonstrated low VOR gains bilaterally on magnetic scleral search coil testing.

A wide spectrum of clinical characteristics was identified in patients with oscillopsia. It is important for the physician to perform a thorough history, physical examination (including head impulse and dynamic visual acuity), and laboratory investigations.

Schlüsselwörter

  • Bilateral vestibular loss
  • magnetic scleral search coil
  • oscillopsia
  • vestibuloocular reflex
Uneingeschränkter Zugang

Urinary exosomes from a mouse model of chronic tubulointerstitial kidney disease induced by chronic renal ischemia–reperfusion injury and nephrectomy

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 447 - 454

Zusammenfassung

Abstract

Biomarkers for the early diagnosis of chronic kidney disease (CKD) will lead to its better management. Rodent models will be helpful for biomarker discovery. Urinary exosomes, membrane bound vesicles, may contain interesting biomarkers.

To produce a mouse model of CKD with sufficient urine volume for exosome studies.

We characterized a mouse models of CKD induced by 55 min ischemia–reperfusion injury and contralateral nephrectomy at 1 wk after the chronic ischemia–reperfusion injury (Chr IR) in 7 mice and other 7 sham-operated control mice. We collected 24 h urine for urine exosome extraction.

Blood urea nitrogen, serum creatinine, and proteinuria increased as early as 2 wk, and reciprocally lower hematocrit. The renal injury, proteinuria, and anemia persisted 12 wk after nephrectomy as consistent with uremic symptoms. The mouse model of CKD showed renal histopathology of interstitial fibrosis with mild glomerular injury, and failure to grow. At 12 wk, the volume of urine collected in 24 h was sufficient for exosome extraction. Urinary exosomes were demonstrated by western blots showing tumor susceptibility gene 101 protein.

Mice with renal injury induced by Chr IR showed renal injury and proteinuria as early as 2 wk with uremic symptoms and tubulointerstitial fibrosis. Most importantly, the 24 h volume of urine at 12 wk was sufficient for exosome extraction.

Schlüsselwörter

  • Chronic ischemic reperfusion injury
  • chronic kidney disease
  • mouse model
  • urinary exosome

Brief communication (Original article)

Uneingeschränkter Zugang

A semiautomatic segmentation approach to biometric measurement of the talus bone of sedentary women and ballerinas using CT images

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 455 - 459

Zusammenfassung

Abstract

Ballet produces much stress on bones in the feet of ballerinas. Monitoring and detecting talus bone deformation is important for their quality of health and profession.

To determine differences in the talus bone between ballerinas and sedentary women.

We evaluated biometric differences in the talus bone of 5 ballerinas referenced to 5 similar sedentary women recruited into the present study. We acquired 20 multidetector computed tomographic images including right and left feet. Semiautomatic region-based image processing using 3D-Doctor (Able Software Corp) was used to create three-dimensional (3D) virtual models of the talus bones. Biometric measurements were made on the 3D models and statistical analysis conducted.

The mean talus bone length of ballerinas was 3.37 cm (SD 0.12; range 3.11 to 3.52). The talus bone length of sedentary women was 3.29 cm (SD 0.16; range 3.04 to 3.65), and tended to be shorter than that of the ballerinas (P = 0.08, t test). However, the test was insufficiently powered. The mean volume of the talus bones from the ballerinas was 24.8 cm3 (SD 0.83) and smaller than that from the sedentary women, 26.9 cm3 (SD 1.25) at P < 0.001 (t = 4.38, 18 degrees of freedom. Difference 2.1. Two-tailed 95% confidence interval for difference of means: 1.08 to 3.08). We found less variation in the feet of ballerinas than sedentary women.

Volumetric measurements show that feet of ballerinas are smaller and retain similar shape and size than the irregular feet of sedentary women.

Schlüsselwörter

  • Image processing
  • MDCT
  • segmentation
  • talus
  • 3D Model

Technical report (Original)

Uneingeschränkter Zugang

A folic acid-induced rat model of renal injury to identify biomarkers of tubulointerstitial fibrosis from urinary exosomes

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 491 - 502

Zusammenfassung

Abstract

Chronic tubulointerstitial (TI) fibrosis is difficult to diagnose. Urinary exosomes contain many potential biomarkers, and may be useful to identify biomarkers of TI fibrosis. However, a suitable animal model to investigate urinary exosome biomarkers for TI fibrosis has not yet been specifically identified.

To test the suitability of a folic-acid induced rat model of renal injury for identifying potential biomarkers of fibrosis from urinary exosomes.

We employed a rat model of renal injury using a single intraperitoneal injection of folic acid. Urinary exosomes were isolated and analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS)

We demonstrated severe acute kidney injury after folic acid injection by a 6-fold decrease in creatinine clearance at day 2, severe inflammatory cell infiltration in the TI area at day 7, and renal fibrosis at day 14. We collected 24 h urine samples from folic acid-injected rats and vehicle-injected control rats at days 7 and 14, then isolated urinary exosomes using a differential centrifugation method. We found that levels of exosomal marker proteins ALG-2-interacting protein 1 (ALIX; PDCD6IP) and tumor susceptibility gene 101 (TSG101) were higher in folic acid-injected rats than in control rats. LC-MS/MS analysis of urinary exosomal proteins from the folic acid-injected and control rats identified 372 proteins, including various potential TI fibrosis biomarkers

We demonstrated the feasibility of using a folic acid-induced rat model of TI fibrosis for urinary proteomic analysis. These rats excreted sufficient urinary exosomes permitting the large-scale analysis and discovery of potential biomarkers of renal fibrosis.

Schlüsselwörter

  • Biomarkers, chronic kidney disease, folic acid, interstitial fibrosis, proteomics, urine exosomes

Clinical report

Uneingeschränkter Zugang

Primary hyperparathyroidism in Thai children: case series and literature review

Online veröffentlicht: 31 Mar 2017
Seitenbereich: 503 - 507

Zusammenfassung

Abstract

Primary hyperparathyroidism is a common disease in adults, but extremely rare in the pediatric age group. To our knowledge, pediatric primary hyperparathyroidism has never been reported in Thailand.

To describe 3 cases of primary hyperparathyroidism presenting in Thai children with different clinical manifestations.

Cases of primary hyperparathyroidism in 3 Thai pediatric patients are reported herein, with a brief literature review.

Three patients are described. The first patient, a 14-year-old Thai girl, presented with progressively worsening bowlegs and lordosis of the spine for 1.5 years. The second patient, a 15-year-old Thai boy, presented with a history of hip pain and constipation for 3 years. The third patient, an obese 11-year-old Thai boy, presented with acute abdominal pain, which was initially incorrectly diagnosed as acute pancreatitis.

The clinical symptoms of hyperparathyroidism in Thai children are nonspecific at an early stage of the disease. The diagnoses are usually delayed and the patients therefore suffer complications of long-term hypercalcemia such as bone deformities or renal nephrocalcinosis. We recommend initial laboratory screening in pediatric patients with nonspecific symptoms and complaints of persistent bone pain. Appropriate investigations to confirm or eliminate primary hyperparathyroidism should be made, as an early diagnosis can facilitate early treatment and prevent the organ damage that can result from delayed diagnosis.

Schlüsselwörter

  • Hypercalcemia
  • hyperparathyroidism
  • parathyroid adenoma
  • parathyroid hyperplasia

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