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Houston, TX, United States

Shamshirsaz A.A.,Baylor College of Medicine | Fox K.A.,Baylor College of Medicine | Salmanian B.,Baylor College of Medicine | Diaz-Arrastia C.R.,Baylor College of Medicine | And 19 more authors.
American Journal of Obstetrics and Gynecology

Objective The purpose of this study was to test the hypothesis that a standardized multidisciplinary treatment approach in patients with morbidly adherent placenta, which includes accreta, increta, and percreta, is associated with less maternal morbidity than when such an approach is not used (nonmultidisciplinary approach). Study Design A retrospective cohort study was conducted with patients from 3 tertiary care hospitals from July 2000 to September 2013. Patients with histologically confirmed placenta accreta, increta, and percreta were included in this study. A formal program that used a standardized multidisciplinary management approach was introduced in 2011. Before 2011, patients were treated on a case-by-case basis by individual physicians without a specific protocol (nonmultidisciplinary group). Estimated blood loss, transfusion of packed red blood cells, intraoperative complications (eg, vascular, bladder, ureteral, and bowel injury), neonatal outcome, and maternal postoperative length of hospital stay were compared between the 2 groups. Results Of 90 patients with placenta accreta, 57 women (63%) were in the multidisciplinary group, and 33 women (37%) were in the nonmultidisciplinary group. The multidisciplinary group had more cases with percreta (P =.008) but experienced less estimated blood loss (P =.025), with a trend to fewer blood transfusions (P =.06), and were less likely to be delivered emergently (P =.001) compared with the nonmultidisciplinary group. Despite an approach of indicated preterm delivery at 34-35 weeks of gestation, neonatal outcomes were similar between the 2 groups. Conclusion The institution of a standardized approach for patients with morbidly adherent placentation by a specific multidisciplinary team was associated with improved maternal outcomes, particularly in cases with more aggressive placental invasion (increta or percreta), compared with a historic nonmultidisciplinary approach. Our standardized approach was associated with fewer emergency deliveries. © 2015 Elsevier Inc. All rights reserved. Source

Heidari-Tabaee-Zavare S.M.,Isfahan University of Medical Sciences | Qanavi M.,Isfahan University of Medical Sciences | Raeesi L.,Operating Room
Journal of Isfahan Medical School

Background: Pain is one of the most common postoperative complications that can be reduced via different methods like combination of two or more drugs to make synergistic effect. This research aimed to comparing the preventive effect of using combination of ketamine and fentanyl or ketamine and metoclopramide on the postoperative pain after laparoscopic cholecystectomy. Methods: In a double-blinded clinical trial study, 90 patients in class I and II of ASA (American Society of Anesthesiologists) classification who were candidates for laparoscopic cholecystectomy were divided into two groups. Half an hour before completion of the operation, patients in the first group received intravenous metoclopramide (0.1 mg/kg) and ketamine (0.5 mg/kg) slowly; while the patients in the second group received intravenous ketamine (0.5 mg/kg) and fentanyl (0.5 μg/kg) slowly. After completion of operation, the pain severity was evaluated based on the visual analogue score (VAS) and the data were compared between the two groups. Findings: The main pain score in ketamine and metoclopramide group at the end of recovery, also at the 2nd, 6th, 12th, 24th postoperative hours, was significantly lower than ketamine and fentanyl group (P < 0.001). Conclusion: Preventive administration of ketamine and metoclopramide causes more reduction in postoperative pain than ketamine and fentanyl and is not associated with any severe postoperative complication. © 2015, Isfahan University of Medical Sciences(IUMS). All Rights Reserved. Source

Wang X.,Record Room | Guo Y.,Weihai Municipal Hospital | Wang C.,Operating Room | Yu H.,Weihai Municipal Hospital | Yu X.,Weihai Municipal Hospital

Osteoarthritis (OA) is a degenerative joint disease characterized by articular cartilage degradation and joint inflammation in which microRNAs are significantly involved. Previous studies have reported that miR-142-3p is a novel mediator of inflammatory signaling pathways, but whether miR-142-3p regulates OA remains unknown. In this study, we aimed to investigate the potential role of miR-142-3p in OA and the underlying molecular mechanism. We showed that miR-142-3p was significantly reduced in the articular cartilage tissues from experimental OA mice. The expression of miR-142-3p was also decreased in chondrocytes treated with lipopolysaccharide (LPS) in vitro. Moreover, the overexpression of miR-142-3p significantly inhibited cell apoptosis, nuclear factor (NF)-kB, and the production of proinflammatory cytokines, including interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF)-α induced by LPS. Interestingly, bioinformatics analysis demonstrated that high mobility group box 1 (HMGB1), an important inflammatory mediator of OA, was predicted as a target of miR-142-3p, which was validated by dual-luciferase reporter assay. The high expression of HMGB1 in chondrocytes induced by LPS was significantly inhibited by miR-142-3p overexpression. Furthermore, the restoration of HMGB1 markedly abrogated the effect of miR-142-3p. In OA mice, the overexpression of miR-142-3p by lentivirus-mediated gene transfer significantly inhibited HMGB1 expression, NF-kB signaling, and proinflammatory cytokines. Moreover, the overexpression of miR-142-3p significantly alleviated OA progression in OA mice in vivo. Taken together, our study suggests that miR-142-3p inhibits chondrocyte apoptosis and inflammation in OA by inhibiting the HMGB1-mediated NF-kB signaling pathway. The overexpression of miR-142-3p impedes the OA progression in mice in vivo indicating that miR-142-3p is a potential molecular target for OA treatment. © 2016 Springer Science+Business Media New York Source

Wang L.,Operating Room | Wang H.,Xinxiang Medical University
Asian Pacific Journal of Cancer Prevention

Based on our previous report on gastric cancer which documented ATP4A and ATP4B mRNA down-regulation in gastric tumors relative to normal gastric tissues, we hypothesized that epigenetic mechanisms could be responsible. ATP4A and ATP4B mRNA expression in gastric cancer cell lines AGS, SNU638 and NUGC-3 was examined using reverse transcriptase PCR (RT-PCR). AGS cells were treated with TSA or 5'-AzaDC and methylation specific PCR (MSP) and bisulfite sequencing PCR (BSP) analysis were performed. MSP analysis was on DNA from paraffin embedded tissues sections and plasma. Expression analysis revealed downregulation of ATP4A and ATP4B genes in gastric cancer cell lines relative to normal gastric tissue, while treatment with 5'-AzaDC re-activated expression of both. Search for CpG islands in their putative promoter regions did not indicate CpG islands (CGI) but only further downstream in the bodies of the genes. Methylation specific PCR (MSP) in the exon1 of the ATP4B gene and exon7 in ATP4A indicated methylation in all the gastric cancer cell lines tested. MSP analysis in tumor tissue samples revealed methylation in the majority of tumor samples, 15/19, for ATP4B and 8/8 for ATP4A. There was concordance between ATP4B and ATP4A down-regulation and methylation status in the tumour samples tested. ATP4B methylation was detectable in cell free DNA from gastric cancer patient's plasma samples. Thus ATP4A and ATP4B down-regulation involves DNA methylation and methylated ATP4B DNA in plasma is a potential biomarker for gastric cancer. Source

Kang H.,Yantai Yuhuangding Hospital | Zhao F.,Yantai Yuhuangding Hospital | You L.,Operating Room | Giorgetta C.,University of Trento | And 3 more authors.
Annals of Indian Academy of Neurology

Ever since Kiloh (1961) [2] coined the term pseudo-dementia, it has been used a little loosely for describing the cognitive deficits in depression, especially, which is found in old age. However, several diagnostic dilemmas persist regarding the nosological status of this condition. Teasing out these individual diagnostic problems is important not only for administering appropriate therapy, but also for preventing them from the unnecessary diagnostic assessments towards the other diagnoses. Thus, it is important to have a detailed knowledge of the cognitive or neuropsychological deficits in this condition. In this review, we start by addressing the important issue of diagnostic confusion between dementia and pseudo-dementia. Subsequently, we proceed by reviewing the present scientific literature on the cognitive deficits found in this clinical condition. For the sake of convenience, we will divide the cognitive deficits into: Memory deficitsExecutive function deficits and Deficits in speech and language domains. Finally, we will look at the progression of this condition to see the components of this condition, which can be actually called "Pseudo". Source

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