TCR Group Research Articles

Prognostic factors for trigeminocardiac reflex during cerebrovascular intervention operation.

IntroductionTrigeminocardiac reflex (TCR) is a brainstem reflexive response of hemodynamic instability during surgery. Identification of risk factors relevant to TCR during cerebrovascular intervention procedures is helpful to efficiently prevent and treat its occurrence. The purpose of this study was to demonstrate the risk factors for Onyx embolization during cerebrovascular intervention operation so as to optimize perioperative management strategies on TCR.MethodsWe performed a retrospective study on the patients with Onyx embolization under general anaesthesia over 6-years period from 2013 to 2018. 354 patients were finally eligible for inclusion, and then divided into TCR group (group T) and control group (group N). Patient characteristics, clinical diagnosis, comorbidities, lesion sites, hemodynamics changes, and complications were compared between two groups. Several multivariable regression models were applied to analyze the risk factors associated with TCR.ResultsTCR occurred in 59 patients (16.7%) among 354 patients. There was no significant difference in patient characteristics between two groups (P > 0.05). During DMSO/Onyx injection, HR and MAP were much lower in group T than group N (P < 0.01). Notably, univariable analysis revealed that the patients with dural arteriovenous fistula (DAVF) and middle meningeal artery being affected were associated with a higher incidence of TCR (P < 0.01). Furthermore, multivariable analysis showed that there was a close link of TCR with DAVF [OR = 4.12; 95% CI (1.83–10.65)] and middle meningeal artery embolization [OR = 3.90; 95% CI (1.58–9.63)]. Further stratified analysis of patients with TCR found that patients with middle meningeal artery embolization were more likely to experience hypotension during TCR episode (P < 0.05). Finally, more incidence of postoperative adverse events was observed when TCR episode (P < 0.05).ConclusionWe found that DAVF and middle meningeal artery embolization were independent risk factors for TCR episodes during Onyx endovascular embolization, highly likely leading to intraoperative hemodynamics fluctuations and postoperative adverse events.

Value of tumor diameter to preoperative carcinoembryonic antigen ratio in evaluating prognosis of non-metastatic colorectal cancer patients

Objective To explore the value of tumor diameter to preoperative carcinoembryonic antigen (CEA) ratio (TCR) in predicting prognosis of patients with non-metastatic colorectal cancer. Methods The clinical data of 144 patients with colorectal cancer in Hainan Hospital of PLA General Hospital between July 2012 and December 2017 were retrospectively analyzed. Patients were divided into the low TCR group and the high TCR group according to the optimal value of TCR in predicting the disease-free survival (DFS) determined by the receiver operating characteristic curve (ROC). The clinicopathological features of both groups were analyzed, and the influencing factors of DFS were also analyzed by using Cox proportional hazard model. Results ROC analysis showed that TCR had a certain value in predicting DFS, and area under the curve (AUC) was 0.614 (95% CI 0.507-0.722); when the value of TCR was set at 0.690, the sensitivity and specificity of predicting the 3-year DFS rate was 46.3% and 70.9%, respectively. According to 0.690 of TCR, there were 50 cases in the low TCR ( 0.05). Univariate analysis showed that TCR, preoperative CEA level and TNM stage played a role in predicting DFS of patients (all P < 0.05), while Cox multivariate analysis indicated that TCR < 0.690 (HR = 2.369, 95% CI 1.279-4.388, P = 0.006) and Ⅲ stage in TNM stage (HR = 2.214, 95% CI 1.346-3.640, P = 0.002) were the independent risk factors of influencing DFS (all P < 0.01). The 3-year DFS rate of patients in the low TCR group was lower than that of those in the high TCR group (62.0% vs. 83.0%, P = 0.007). Conclusion TCR could have a certain value in judging the prognosis of non-metastatic colorectal cancer patients, and low TCR patients have a poorer prognosis. Key words: Colorectal neoplasms; Tumor diameter; Carcinoembryonic antigen; Disease-free survival; Prognosis

TREINAMENTO CONCORRENTE E CONSUMO DE REFRIGERANTE: EFEITO NA MUSCULATURA DE RATOS. CONCURRENT TRAINING AND SOFT DRINK CONSUMPTION: EFFECT ON THE MUSCULATURE OF RATS.

In recent decades, due to modernity, food patterns have undergone changes, increasing the consumption of sugary and industrialized drinks such as soft drinks that contribute to weight gain and the appearance of morbidities. In this context, physical training emerges as a way to fight excess weight and increase physical capacities. Thus, the objective of the study was to verify the effect of concurrent training on skeletal striated muscles of animals submitted to soda consumption. Twenty-two male Wistar rats were used as samples, distributed in four groups (n= 32): Control (C [n= 8]); Refrigerant Control (CR [n= 8]); Concurrent Training (T [n= 8]); Concurrent Training with Refrigerant (TR [n= 8). The aerobic training protocol was composed of 3 weekly sessions at 80% of the anaerobic threshold and the strength training was composed of 4 series of 10 aquatic jumps. After preparation and measurement of muscle tissue, the values ​​for the smallest diameter of the muscle fibers were obtained. When comparing the averages of the diameter of the sample groups, the CR and T groups showed significant results in relation to the C group (p<0.05). There was muscle hypertrophy in the TC group in relation to the TCR group (TC: 39.99 µm vs TCR: 39.22 µm), however, with no statistically significant difference (p> 0.05). Thus, the study concludes that CT was efficient for hypertrophy in muscle mass, being superior in the group where there was no soft drink intake. However, the change was not statistically significant, however, both the intake of soda and the practice of concurrent training resulted in a significant increase in the diameter of muscle fibers, compared to the control group.

Haploidentical HSCT for hemoglobinopathies: improved outcomes with TCRαβ+/CD19+-depleted grafts

AbstractWe examined outcomes of haploidentical hematopoietic cell transplantation (haplo-HCT) using T-cell receptor αβ+ (TCRαβ+)/CD19+-depleted grafts (TCR group, 14 patients) in children with hemoglobinopathies. Patients received a preparative regimen consisting of busulfan, thiotepa, cyclophosphamide, and antithymocyte globulin preceded by fludarabine, hydroxyurea, and azathioprine. The median follow-up among surviving patients was 3.9 years. The 5-year probabilities of overall survival (OS) and disease-free survival (DFS) were 84% and 69%, respectively. The incidence of graft failure was 14%. We compared outcomes to a historical group of 40 patients with hemoglobinopathies who received CD34+-selected grafts (CD34 group). The median follow-up of surviving patients for the CD34 group was 7.5 years. The 5-year probabilities of OS and DFS were 78% and 39%, respectively. The CD34 group had a significantly higher incidence of graft failure (45%) than the TCR group (14%) (P = .048). The incidences of grades 2 to 4 acute graft-versus-host disease (GVHD) in the TCR and CD34 groups were 28% and 29%, respectively, and 21% and 10% (P = .1), respectively, for extensive chronic GVHD. Viral reactivation was common in both groups. The overall incidence of posttransplant lymphoproliferative disorders for the entire group was 16%. Among all patients, 5 developed autoimmune hemolytic anemia or thrombocytopenia, with the overall cumulative incidence of 11%. The 2 groups showed suboptimal CD4+ recovery within the first 6 months of transplantation with no significant difference between groups. These data demonstrate that TCRαβ+/CD19+-depleted grafts are associated with a reduced incidence of graft failure, but delayed immune reconstitution and associated morbidity and mortality remain a significant challenge.

The effect of nonsurgical periodontal treatment on the severity of drug-induced gingival overgrowth in transplant patients.

Immunosuppressive drugs may induce an increase of the gingival connective tissue in the extracellular matrix. The aim of this study was to assess the effectiveness of nonsurgical periodontal treatment in reducing gingival overgrowth (GO) in transplant patients taking cyclosporin A (CsA) or tacrolimus (Tcr). An observational cohort study employing 68 transplant patients with diagnosis of GO, 51 taking CsA and 17 in therapy with Tcr, was performed at the Periodontal Unit of the School of Dental Sciences (University of Trieste, Italy). Percentages of plaque index (PI), bleeding on probing (BoP), sites with probing depth (PD) > 3 mm, and hypertrophy index (HI) were registered at baseline, 90 days, 180 days, and at 1 year after nonsurgical periodontal therapy. Furthermore, HI at baseline and after 1 year was investigated by multiple linear regression. Both groups have significantly improved their clinical parameters: CsA group: PIbaseline = 41.67%; PIyear = 33%; BoPbaseline = 13.88%; BoPyear = 6.94%; PD > 3 mmbaseline = 18.6%; PD > 3 mmyear = 12.96%; HIbaseline = 22%; HIyear = 10%; Tcr group: PIbaseline = 40.73%; PIyear = 38.54%; BoPbaseline = 20.78%; BoPyear = 12.5%; PD > 3 mmbaseline = 21.53%; PD > 3 mmyear = 13.19%; HIbaseline = 12%; HIyear = 6.5%. Age showed a statistical negative correlation with HI at baseline (P < .05), while PD > 3 mm was positively correlated to the baseline HI (P < .001). Only HI at baseline showed a statistically significant negative relation with HI at 1 year (P < .001). After nonsurgical periodontal therapy no patients needed additional periodontal surgery. Nonsurgical periodontal treatment itself represents an efficacious therapy in transplant patients treated with CsA and Tcr.

Trial shows partial caries removal is an effective technique in primary molars.

Randomised controlled trial in a university setting. Children aged three to eight years, with at least one molar with an acute, deep carious lesion into the dentine were recruited. Treatment took place under rubber dam with decayed dentine being removed completely from the lateral walls of cavities in both groups using round burs operated at low speed. TCR or PCR was then performed in the pulpal wall of each tooth. After caries removal teeth were restored with calcium hydroxide cement and composite resin. Teeth with pulpal exposure were pulpotomised using ferric sulphate. The presence of a fistula, swelling, spontaneous pain and mobility not compatible with root resorption were considered to be clinical signs of failure. Radiolucency at the furcation or in the periapical region and internal or external pathological resorption were considered to be radiographic signs of failure. One hundred and twenty-four teeth in 51 patients were randomised. In the TCR group there were 57 teeth and 38 patients, with 41 patients and 67 teeth in the PCR group. Three patients (four teeth; one PCR and three TCR) dropped out leaving 120 teeth (PCR: n = 66; TCR: n = 54) for analysis. In the TCR group 27.5% (15) teeth in 13 children had pulp exposure compared with one tooth in one child in the PCR group (2%). The mean operative time was significantly higher for TCR (28.1 min; 95% CI: 23.6-32.6 min) than for PCR (17.9 min; 95% CI: 16.3-19.5 min). There was no statistical difference in success rates at 24 months between the groups. The success rate in the TCR group was 96%; (95% CI: 85-99%) compared with 92%; (95% CI: 81-96%) in the PCR group. The clinical and radiographic success rates of PCR and TCR in primary teeth with deep carious lesions were high and did not differ significantly, indicating that PCR is a reliable minimally invasive approach in primary teeth and that the retention of carious dentine does not interfere with pulp vitality. Moreover, PCR provided other clinically relevant advantages over TCR, especially lower incidence of pulp exposure and lower operative time.

Creatine supplementation and oxidative stress in rat liver.

BackgroundThe objective of this study was to determine the effects of creatine supplementation on liver biomarkers of oxidative stress in exercise-trained rats.MethodsForty 90-day-old adult male Wistar rats were assigned to four groups for the eight-week experiment. Control group (C) rats received a balanced control diet; creatine control group (CCr) rats received a balanced diet supplemented with 2% creatine; trained group (T) rats received a balanced diet and intense exercise training equivalent to the maximal lactate steady state phase; and supplemented-trained (TCr) rats were given a balanced diet supplemented with 2% creatine and subjected to intense exercise training equivalent to the maximal lactate steady state phase. At the end of the experimental period, concentrations of creatine, hydrogen peroxide (H2O2) and thiobarbituric acid reactive substances (TBARS) were measured as well as the enzyme activity of superoxide dismutase (SOD), glutathione peroxidase (GSH-GPx) and catalase (CAT). Liver tissue levels of reduced glutathione (GSH), oxidized glutathione (GSSG) and the GSH/GSSG ratio were also determined.ResultsHepatic creatine levels were highest in the CCr and TCr groups with increased concentration of H2O2 observed in the T and TCr animal groups. SOD activity was decreased in the TCr group. GSH-GPx activity was increased in the T and TCr groups while CAT was elevated in the CCr and TCr groups. GSH, GGS and the GSH/GSSG ratio did not differ between all animal subsets.ConclusionsOur results demonstrate that creatine supplementation acts in an additive manner to physical training to raise antioxidant enzymes in rat liver. However, because markers of liver oxidative stress were unchanged, this finding may also indicate that training-induced oxidative stress cannot be ameliorated by creatine supplementation.

Gingival Overgrowth Among Patients Medicated With Cyclosporin A and Tacrolimus Undergoing Renal Transplantation: A Prospective Study

The aim of this study is to make a longitudinal evaluation of the incidence and severity of gingival overgrowth (GO) induced by immunosuppressive agents, such as tacrolimus (Tcr) and cyclosporin A (CsA), in the absence of calcium channel blockers in patients undergoing renal transplantation (RT). This longitudinal study is conducted in 49 patients with RT who were divided into a CsA group (n = 25) and Tcr group (n = 24). The individuals were assessed at four time intervals: before transplant and 30, 90, and 180 days after RTs. Demographic data and periodontal clinical parameters (plaque index, cemento-enamel junction to the gingival margin, probing depth, clinical attachment level, bleeding on probing [BOP], and GO) were collected at all time intervals. The mean GO index was significantly lower in the Tcr group compared to the CsA group after 30 (P = 0.03), 90 (P = 0.004), and 180 (P = 0.01) days of immunosuppressive therapy. One hundred eighty days after RTs, a clinically significant GO was observed in 20.0% of individuals in the CsA group and 8.3% of individuals in the Tcr group. However, this difference was not statistically significant (P = 0.41). There was a reduction in periodontal clinical parameters regarding the time of immunosuppressive therapy for PI and BOP (P <0.001) in both groups. Although there was no statistical difference in the incidences of clinically significant GO after 180 days of immunosuppressive therapy, it was observed that GO occurred later in the Tcr group, and the severity of GO in this group was lower than in patients who used CsA.

Gingival overgrowth in subjects under immunosuppressive regimens based on cyclosporine, tacrolimus, or sirolimus

To assess the prevalence and variables associated with gingival overgrowth (GO) in renal transplant recipients medicated with cyclosporine (CsA), tacrolimus (Tcr), or sirolimus (Sir). One hundred and thirty-five eligible subjects were divided in CsA, Tcr, and Sir groups comprising 45 subjects each. GO was visually assessed and subjects were assigned as GO+ or GO- in a post hoc definition. Saliva samples were collected and the presence of periodontal pathogens was assessed through polymerase chain reaction. Variables of interest were compared between GO+ and GO- subjects through univariate and multivariate analysis. Prevalence of GO was of 60.0% for CsA, 28.9% for Tcr, and 15.6% for Sir groups. Within the CsA group, GO was associated with papillary bleeding index (p=0.001); within the Tcr group, GO was associated with CsA previous use (p=0.013), and calcium channel blockers (CCB) use (p=0.003); within the Sir group, GO was associated with papillary bleeding index (p=0.018), and CCB use (p=0.020). A higher frequency of Tannerella forsythia was observed among GO+ subjects medicated with Tcr. Pharmacological and periodontal variables were associated with GO in different immunosuppressive regimens. Integration between the medical and the dental team may be an important approach in the post-transplant maintenance routine.

Impact of Baseline Antiretroviral Resistance Status on Efficacy Outcomes Among Patients Receiving Maraviroc Plus Optimized Background Therapy in the MOTIVATE 1 and 2 Trials

Purpose: The MOTIVATE studies assessed maraviroc with optimized background therapy (OBT) in treatment-experienced patients with R5 HIV-1. This post hoc analysis compared outcomes between patients with and without HIV-1 resistance to ε3 classes of antiretrovirals at screening (triple-class-resistant [TCR] versus not-TCR [nTCR]). Methods: Week 48 changes (N = 635) in HIV-1 RNA and CD4 + cells were compared between TCR and nTCR groups receiving twice-daily maraviroc+OBT or placebo+OBT. Results: HIV-1 RNA change from baseline on maraviroc was significantly greater in the nTCR group (–2.05 vs –1.74 log₁₀ copies/mL; 95% CI difference 0.05–0.58 log₁₀) though proportions <400 or <50 copies/mL were not. Week 48 CD4 increases were significantly greater in the nTCR group overall (mean +150 vs +110 cells/mm3; 95% CI difference 18–62 cells/mm3) and in those with <50 RNA copies/mL (nTCR +192 vs +126 cells/mm3; 95% CI difference, 19–93 cells/mm3) or receiving ε2 active OBT agents (weighted score; nTCR +184 vs +125 cells/mm3; 95% CI difference 8–110 cells/mm3). Conclusions: Virologic suppression on maraviroc was greater in the nTCR than the TCR group, though proportions <50 or 400 copies/mL were not significantly different. Optimal CD4 increases on maraviroc appeared to accrue from initiation before development of TCR virus.

Gingival overgrowth in cyclosporine, tacrolimus, or sirolimus-based immunosuppressive regimens and the single nucleotide IL-6 (−174 G/C) gene polymorphism

Objective Interleukin-6 (IL-6) may be involved in drug-induced gingival overgrowth (GO). The present study was conducted to assess the association between IL-6 (−174 G/C) gene polymorphism and GO in renal transplant recipients under cyclosporine (CsA), tacrolimus (Tcr), or sirolimus (Sir)-based regimens. Methods Within an eligible population, 45 unrelated subjects were selected for each CsA, Tcr, and Sir group, totaling a sample of 135 subjects. GO was visually assessed and subjects were assigned as controls (non-responders) or cases (responders) in a post hoc definition. IL-6 gene polymorphism was assessed using the polymerase chain reaction amplification and digestion. The distribution of genotypes and allele frequencies in responders and non-responders were compared using the Chi-squared test. Results The number of responders was 27 (60.0%), 13 (28.9%), and 7 (15.6%) in the CsA, Tcr, and Sir groups, respectively. No differences could be observed at frequencies of −174GG, −174CG, and −174CC genotypes when comparing responders to non-responders in the CsA, Tcr, and Sir groups. Similar to genotypes, allele frequencies showed no differences between responders and non-responders in all groups. Conclusions No association between IL-6 (−174 G/C) gene polymorphism and gingival overgrowth was observed in renal transplant recipients under CsA, Tcr, or Sir-based immunosuppressive maintenance regimens.

Incidence of tacrolimus‐induced gingival overgrowth in the absence of calcium channel blockers: a short‐term study

The aim of this study was to determine the incidence and severity of gingival overgrowth (GO) induced by tacrolimus (Tcr) compared with ciclosporin A (CiA) in the absence of calcium channel blockers (CCB) in renal transplant recipients. Forty patients (20 Tcr and 20 CiA) were evaluated before and 30 and 90 days after kidney transplantation. Demographic (age, gender) and periodontal parameters were recorded for all patients. Patients taking CCB at any time during the study were excluded from the investigation. The mean GO score was significantly lower (p=0.014) in the Tcr group (6.4%) compared with the CiA group (17.9%) after 90 days of immunosuppressive therapy. At 90 days post-transplant, clinically significant GO was observed in four patients of the CiA group and in two of the Tcr group. This difference was not statistically significant (0.66). No significant difference in the incidence of clinically significant GO was observed between the CiA and Tcr groups up to 90 days of immunosuppressive therapy.

Prevalence, Severity, and Risk Variables Associated With Gingival Overgrowth in Renal Transplant Subjects Treated Under Tacrolimus or Cyclosporin Regimens

Some reports suggest that the prevalence and severity of gingival overgrowth (GO) is lower in patients taking tacrolimus (Tcr) than in those taking cyclosporin A (CsA). The present study was conducted to determine the prevalence and severity of GO in a group of renal transplant recipients treated with Tcr in comparison to those treated with CsA and to evaluate the risk variables associated with the development of GO in these two drug regimens. A cross-sectional study was conducted in a public hospital in Belo Horizonte City, Brazil. Demographic, pharmacological, and periodontal data were recorded for each subject. Variables from 134 subjects taking Tcr were compared to 451 subjects taking CsA using independent sample t, chi(2) statistic, or Mann-Whitney tests. The effects of potential risk factors on GO severity were determined using forward and backward stepwise regression analysis. Subjects taking CsA showed a higher mean GO score (29.03% +/- 22.9%) compared to subjects taking Tcr (16.9% +/- 3.4%) (P = 0.0038). In the Tcr group, 17.9% of the subjects had clinically significant GO compared to 38.1% in the CsA group (P = 0.045). In the multivariate final model, papillary bleeding index, azathioprine dosage, and concomitant use of calcium channel blockers (CCB) were significant variables associated with severity of GO in Tcr and CsA groups. In addition, previous CsA use also remained significant for GO in subjects under a Tcr regimen. The prevalence and severity of GO is lower in transplant subjects taking Tcr compared to CsA. GO severity in both groups was strongly associated with the papillary bleeding index, highlighting the role of inflammation in this condition. Concomitant CCB use, azathioprine dosage, and previous CsA use in the Tcr group reinforces the possible synergistic effects of these pharmacological variables on GO severity.

Advancement of ovulation and oestrus after temporary calf removal and FSH supplementation in postpartum beef cows

To evaluate the effect of temporary calf removal and/or FSH supplementation on post-partum ovarian and oestrous activity, 40 anoestrous multiparous Aberdeen Angus cows under grazing conditions were used. The animals were allocated, on the basis of calving date and body condition, to four initially similar groups according to a 2 × 2 factorial design (ten animals per group) involving a 72 h calf removal (TCR) and exogenous follicle stimulating hormone supplementation (FSH). Anoestrus was determined by measuring plasma progesterone concentrations before treatments, which began at 29.6 ± 4.9 days postpartum. Total FSH supplementation (12 mg, porcine FSH) was performed by six intramuscular decreasing doses (3, 3, 2, 2, 1 and 1 mg, respectively) distributed at 12 h intervals, beginning 24 h before TCR. Oestrus detection (twice daily) and blood sample collection (every 2–3 days) were performed from 7 days before the start of treatments and for 45 days thereafter. The TCR plus FSH group had higher oestrous and ovulation rates at 40 days postpartum (control, 10% and 10%; TCR, 10% and 10%; FSH, 10% and 10%; TCR plus FSH, 60% and 60%) and 60 days postpartum (control, 30% and 30%; TCR, 50% and 50%; FSH, 40% and 50%; TCR plus FSH, 80% and 100%). These differences were significant ( P < 0.05) for oestrous rates at 40 days postpartum and for ovulation rates at 40 and 60 days postpartum. TCR plus FSH significantly shortened ( P < 0.05) the intervals (mean ± s.e.m., days) from calving to first ovulation (control, 61.2 ± 5.5; TCR, 62.8 ± 4.6; FSH, 61.6 ± 3.8 and TCR plus FSH, 43.4 ± 3.1) and a similar trend ( P > 0.05) was observed for the intervals from calving to first oestrus (control, 61.2 ± 5.5; TCR, 62.3 ± 5.4; FSH, 63.4 ± 3.9 and TCR + FSH, 47.7 ± 5.2). The rate of short first luteal phases (⩽ 10 days) was: control, 40%; TCR, 33%; FSH, 43%; TCR plus FSH, 89% ( P < 0.12). In summary, TCR plus FSH resulted in increased ovulation and oestrus rates, shorter postpartum intervals, but subnormal corpora lutea were formed following the first ovulation in early postpartum beef cows.