Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 5 de 5
Filtrar
Más filtros










Base de datos
Intervalo de año de publicación
1.
Cancers (Basel) ; 16(1)2023 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-38201565

RESUMEN

Cerebral hypoxia significantly impacts the progression of brain tumors and their resistance to radiotherapy. This study employed streamlined quantitative blood-oxygen-level-dependent (sqBOLD) MRI to assess the oxygen extraction fraction (OEF)-a measure of how much oxygen is being extracted from vessels, with higher OEF values indicating hypoxia. Simultaneously, we utilized vessel size imaging (VSI) to evaluate microvascular dimensions and blood volume. A cohort of ten patients, divided between those with glioma and those with brain metastases, underwent a 3 Tesla MRI scan. We generated OEF, cerebral blood volume (CBV), and vessel size maps, which guided 3-4 targeted biopsies per patient. Subsequent histological analyses of these biopsies used hypoxia-inducible factor 1-alpha (HIF-1α) for hypoxia and CD31 for microvasculature assessment, followed by a correlation analysis between MRI and histological data. The results showed that while the sqBOLD model was generally applicable to brain tumors, it demonstrated discrepancies in some metastatic tumors, highlighting the need for model adjustments in these cases. The OEF, CBV, and vessel size maps provided insights into the tumor's hypoxic condition, showing intertumoral and intratumoral heterogeneity. A significant relationship between MRI-derived measurements and histological data was only evident in the vessel size measurements (r = 0.68, p < 0.001).

2.
Health Promot Perspect ; 10(3): 250-256, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32802762

RESUMEN

Background: The Personal Wellbeing Index-Adults (PWI-A) is the most widely used instrumentfor measuring subjective-quality of life (QoL). The current study seeks to investigate the constructvalidity and reliability of the Arabic version of the PWI-A on adults with bilateral hearingimpairment by comparing the single-factor solution with the two-factor solution. Methods: A cross-sectional study was conducted at the Audio-Vestibular Medicine Unit of Alexandria University from July-2017 to January-2018. A total of 205 adults were interviewed tomeasure the subjective-QoL using the PWI-A instrument. Internal consistency was determinedusing both Cronbach's alpha and composite reliability (CR). Validity was assessed by constructvalidity, including ordinal regression, ordinal exploratory factor analysis (OEFA), and ordinalconfirmatory factor analysis (OCFA). Results: The first four items of the PWI-A which are: satisfaction with living standard, health,achievements, and relationships were the most important indicators of subjective-wellbeing(Part r2 0.0547, 0.0324, 0.0361, and 0.0225, respectively). OEFA suggested that the two-factormodel contributes better than the single-factor model. OCFA validated this suggested solution;(two-factor: RMSEA=0.084 (90% CI=0.01-0.14); CFI=0.964; AIC=52.64; single-factor: RMSEA=0.119 (90% CI=0.07-0.17); CFI=0.922; AIC=62.77). Good internal consistency wasalso presented (two-factor: Cronbach's alpha=0.719, 0.693; single-factor: Cronbach's alpha =0.750). Conclusion: The Arabic version of the PWI-A is a multidimensional scale that consists of twodimensions: the first is related to subjective-QoL, and the second is related to satisfaction withthe community. Thus, it is recommended to use the short version of the PWI-A with only fouritems to measure subjective-QoL, as it achieved sufficient reliability and construct validity.

3.
West J Emerg Med ; 19(3): 542-547, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29760853

RESUMEN

Operation Enduring Freedom (OEF-A) in Afghanistan and Operation Iraqi Freedom (OIF) represent the first major, sustained wars in which emergency physicians (EPs) fully participated as an integrated part of the military's health system. EPs proved invaluable in the deployments, and they frequently used the full spectrum of trauma and medical care skills. The roles EPs served expanded over the years of the conflicts and demonstrated the unique skill set of emergency medicine (EM) training. EPs supported elite special operations units, served in medical command positions, and developed and staffed flying intensive care units. EPs have brought their combat experience home to civilian practice. This narrative review summarizes the history, contributions, and lessons learned by EPs during OEF-A/OIF and describes changes to daily clinical practice of EM derived from the combat environment.


Asunto(s)
Medicina de Emergencia/educación , Medicina de Emergencia/métodos , Personal Militar/estadística & datos numéricos , Médicos/estadística & datos numéricos , Guerra , Campaña Afgana 2001- , Humanos , Guerra de Irak 2003-2011 , Traumatismo Múltiple , Asignación de Recursos
4.
Pediatr Res ; 71(2): 199-204, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22258132

RESUMEN

INTRODUCTION: Traumatic brain injury (TBI) is a leading cause of death and disability in children. Metabolic failure is an integral component of the pathological aftermath of TBI. The oxygen extraction fraction (OEF) is a valuable parameter for characterization and description of metabolic abnormalities; however, OEF measurement has required either invasive procedures or the use of ionizing radiation, which significantly limits its use in pediatric research. RESULTS: Patients with TBI had depressed OEF levels that correlated with the severity of injury. In addition, the OEF measured within 2 weeks of injury was predictive of patient outcome at 3 mo after injury. In pediatric TBI patients, low OEF-a marker of metabolic dysfunction-correlates with the severity of injury and outcome. DISCUSSION: Our findings support previous literature on the role of metabolic dysfunction after TBI. METHODS: Using a recently developed magnetic resonance (MR) technique for the measurement of oxygen saturation, we determined the whole-brain OEF in both pediatric TBI patients and in healthy controls. Injury and outcome were classified using pediatric versions of the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale-Extended (GOS-E), respectively.


Asunto(s)
Lesiones Encefálicas/metabolismo , Encéfalo/metabolismo , Consumo de Oxígeno , Oxígeno/metabolismo , Adolescente , Factores de Edad , Análisis de Varianza , Encéfalo/patología , Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/patología , Estudios de Casos y Controles , Niño , Preescolar , Imagen de Difusión por Resonancia Magnética , Regulación hacia Abajo , Escala de Coma de Glasgow , Humanos , Missouri , Oximetría , Valor Predictivo de las Pruebas , Pronóstico , Índice de Severidad de la Enfermedad , Factores de Tiempo
5.
Neurosurg Focus ; 28(5): E3, 2010 May.
Artículo en Inglés | MEDLINE | ID: mdl-20568943

RESUMEN

OBJECT: In support of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom-Afghanistan (OEF-A), military neurosurgeons in the combat theater are faced with the daunting task of stabilizing patients in such a way as to prevent irreversible neurological injury from cerebral edema while simultaneously allowing for prolonged transport stateside (5000-7000 miles). It is in this setting that decompressive craniectomy has become a mainstay of far-forward neurosurgical management of traumatic brain injury (TBI). As such, institutional experience with cranioplasty at the Walter Reed Army Medical Center (WRAMC) and the National Naval Medical Center (NNMC) has expanded concomitantly. Battlefield blast explosions create cavitary injury zones that often extend beyond the border of the exposed surface wound, and this situation has created unique reconstruction challenges not often seen in civilian TBI. The loss of both soft-tissue and skull base support along with the need for cranial vault reconstruction requires a multidisciplinary approach involving neurosurgery, plastics, oral-maxillofacial surgery, and ophthalmology. With this situation in mind, the authors of this paper endeavored to review the cranial reconstruction complications encountered in these combat-related injuries. METHODS: A retrospective database review was conducted for all soldiers injured in OIF and OEF-A who had undergone decompressive craniectomy with subsequent cranioplasty between April 2002 and October 2008 at the WRAMC and NNMC. During this time, both facilities received a total of 408 OIF/OEF-A patients with severe head injuries; 188 of these patients underwent decompressive craniectomies in the theater before transfer to the US. Criteria for inclusion in this study consisted of either a closed or a penetrating head injury sustained in combat operations, resulting in the performance of a decompressive craniectomy and subsequent cranioplasty at either the WRAMC or NNMC. Excluded from the study were patients for whom primary demographic data could not be verified. Demographic data, indications for craniectomy, as well as preoperative, intraoperative, and postoperative parameters following cranioplasty, were recorded. Perioperative and postoperative complications were also recorded. RESULTS: One hundred eight patients (male/female ratio 107:1) met the inclusion criteria for this study, 93 with a penetrating head injury and 15 with a closed head injury. Explosive blast injury was the predominant mechanism of injury, occurring in 72 patients (67%). The average time that elapsed between injury and cranioplasty was 190 days (range 7-546 days). An overall complication rate of 24% was identified. The prevalence of perioperative infection (12%), seizure (7.4%), and extraaxial hematoma formation (7.4%) was noted. Twelve patients (11%) required prosthetic removal because of either extraaxial hematoma formation or infection. Eight of the 13 cases of infection involved cranioplasties performed between 90 and 270 days from the date of injury (p = 0.06). CONCLUSIONS: This study represents the largest to date in which cranioplasty and its complications have been evaluated in a trauma population that underwent decompressive craniectomy. The overall complication rate of 24% is consistent with rates reported in the literature (16-34%); however, the perioperative infection rate of 12% is higher than the rates reported in other studies. This difference is likely related to aspects of the initial injury pattern-such as skull base injury, orbitofacial fractures, sinus injuries, persistent fluid collection, and CSF leakage-which can predispose these patients to infection.


Asunto(s)
Campaña Afgana 2001- , Lesiones Encefálicas/cirugía , Craniectomía Descompresiva/métodos , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/cirugía , Adulto , Traumatismos por Explosión/cirugía , Craneotomía/métodos , Craniectomía Descompresiva/efectos adversos , Femenino , Cirugía General/métodos , Traumatismos Cerrados de la Cabeza/cirugía , Traumatismos Penetrantes de la Cabeza/cirugía , Hospitales Militares/estadística & datos numéricos , Humanos , Masculino , Medicina Militar/métodos , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...