RESUMEN
A series of seleno-containing polyfunctionalized compounds was synthesized exploring cyanohydrin chemistry, including α-hydroxy esters, α-hydroxy acids, 1,2-diols, and 1,2-diacetates, with yields ranging from 26 up to 99 %. The cytotoxicity of all synthesized compounds was then evaluated using a non-tumor cell line (BALB/3T3 murine fibroblasts), and those deemed non-cytotoxic had their anti-melanoma activity evaluated using B16-F10 murine melanoma cells. These assays identified two compounds with selective cytotoxic activity against the tested melanoma cell line, showing a potential anti-melanoma application.
Asunto(s)
Antineoplásicos , Nitrilos , Compuestos de Organoselenio , Animales , Ratones , Anhídridos/química , Anhídridos/farmacología , Antineoplásicos/farmacología , Antineoplásicos/química , Antineoplásicos/síntesis química , Células 3T3 BALB , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Ensayos de Selección de Medicamentos Antitumorales , Melanoma/tratamiento farmacológico , Melanoma/patología , Melanoma Experimental/tratamiento farmacológico , Melanoma Experimental/patología , Estructura Molecular , Nitrilos/química , Nitrilos/farmacología , Nitrilos/síntesis química , Compuestos de Organoselenio/química , Compuestos de Organoselenio/farmacología , Compuestos de Organoselenio/síntesis química , Selenio/química , Selenio/farmacología , Relación Estructura-Actividad , Acetatos/síntesis química , Acetatos/química , Acetatos/farmacologíaRESUMEN
OBJECTIVE: To evaluate a novel mentor program for 27 US surgeons, charged with improving quality at their respective hospitals, having been paired 1:1 with 27 surgeon mentors through a state-wide quality improvement (QI) initiative. DESIGN: Mixed-methods utilizing quantitative surveys and in-depth semi-structured interviews. SETTING: The Illinois Surgical Quality Improvement Collaborative (ISQIC) utilized a novel Mentor Program to guide surgeons new to QI. PARTICIPANTS: All mentor-mentee pairs received the survey (n = 27). Purposive sampling identified a subset of mentors (n = 8) and mentees (n = 4) for in-depth semi-structured interviews. INTERVENTION: Surgeons with expertise in QI mentored surgeons new to QI. MAIN OUTCOME MEASURES: (i) Quantitative: self-reported satisfaction with the mentor program; (ii) Qualitative: key themes suggesting actions and strategies to facilitate mentorship in QI. RESULTS: Mentees expressed satisfaction with the mentor program (n = 24, 88.9%) and agreed that mentorship is vital to ISQIC (n = 24, 88.9%). Analysis of interview data revealed four key themes: (i) nuances of data management, (ii) culture of quality and safety, (iii) mentor-mentee relationship and (iv) logistics. Strategies from these key themes include: utilize raw data for in-depth QI understanding, facilitate presentations to build QI support, identify opportunities for in-person meetings and establish scheduled conference calls. The mentor's role required sharing experiences and acting as a resource. The mentee's role required actively bringing questions and identifying barriers. CONCLUSIONS: Mentorship plays a vital role in advancing surgeon knowledge and engagement with QI in ISQIC. Key themes in mentorship reflect strategies to best facilitate mentorship, which may serve as a guide to other collaboratives.
Asunto(s)
Mentores , Mejoramiento de la Calidad/organización & administración , Cirujanos/psicología , Servicio de Cirugía en Hospital/normas , Conducta Cooperativa , Femenino , Humanos , Relaciones Interprofesionales , Masculino , Satisfacción Personal , Evaluación de Programas y Proyectos de Salud , Encuestas y CuestionariosRESUMEN
INTRODUCTION: In 2014, 56 Illinois hospitals came together to form a unique learning collaborative, the Illinois Surgical Quality Improvement Collaborative (ISQIC). Our objectives are to provide an overview of the first three years of ISQIC focused on (1) how the collaborative was formed and funded, (2) the 21 strategies implemented to support quality improvement (QI), (3) collaborative sustainment, and (4) how the collaborative acts as a platform for innovative QI research. METHODS: ISQIC includes 21 components to facilitate QI that target the hospital, the surgical QI team, and the peri-operative microsystem. The components were developed from available evidence, a detailed needs assessment of the hospitals, reviewing experiences from prior surgical and non-surgical QI Collaboratives, and interviews with QI experts. The components comprise 5 domains: guided implementation (e.g., mentors, coaches, statewide QI projects), education (e.g., process improvement (PI) curriculum), hospital- and surgeon-level comparative performance reports (e.g., process, outcomes, costs), networking (e.g., forums to share QI experiences and best practices), and funding (e.g., for the overall program, pilot grants, and bonus payments for improvement). RESULTS: Through implementation of the 21 novel ISQIC components, hospitals were equipped to use their data to successfully implement QI initiatives and improve care. Formal (QI/PI) training, mentoring, and coaching were undertaken by the hospitals as they worked to implement solutions. Hospitals received funding for the program and were able to work together on statewide quality initiatives. Lessons learned at one hospital were shared with all participating hospitals through conferences, webinars, and toolkits to facilitate learning from each other with a common goal of making care better and safer for the surgical patient in Illinois. Over the first three years, surgical outcomes improved in Illinois. DISCUSSION: The first three years of ISQIC improved care for surgical patients across Illinois and allowed hospitals to see the value of participating in a surgical QI learning collaborative without having to make the initial financial investment themselves. Given the strong support and buy-in from the hospitals, ISQIC has continued beyond the initial three years and continues to support QI across Illinois hospitals.
RESUMEN
BACKGROUND/AIMS: To review cases of fetal/newborn goiter due to excess maternal iodine ingestion. METHODS: We reviewed the medical records of all patients that presented with congenital goiter in 2003. We used the PubMed search engine to conduct a review of publications addressing congenital goiter and excessive iodine intake. RESULTS: Maternal ingestion of large amounts of iodine due to an error in the manufacturing of a prenatal vitamin caused a goiter in her fetus. Seven other women who received the same prenatal vitamin had newborn children with goiters. Three of these children were hypothyroid at the time of initial examination. Three patients (2 hypothyroid and 1 euthyroid) had thyroid scans with radioactive iodine; iodine uptake was elevated (>80%) in all 3, and in 1 the perchlorate washout test was positive. CONCLUSION: The finding of congenital goiter and increased iodine uptake in a newborn is considered diagnostic of dyshormonogenesis, a permanent form of hypothyroidism. Our description is important because it demonstrates that iodine excess during pregnancy may mimic some forms of dyshormonogenesis. The differentiation between the two causes of newborn goiter may prevent the lifelong use of supplemental levothyroxine in patients with a transient abnormality.
Asunto(s)
Bocio/congénito , Yodo/efectos adversos , Hipotiroidismo Congénito/diagnóstico por imagen , Hipotiroidismo Congénito/etiología , Femenino , Bocio/diagnóstico por imagen , Bocio/etiología , Humanos , Recién Nacido , Yodo/administración & dosificación , Radioisótopos de Yodo , Masculino , Intercambio Materno-Fetal , Embarazo , Cintigrafía , Ultrasonografía PrenatalRESUMEN
INTRODUCTION: The association of 18-ring chromosome syndrome and growth hormone deficiency (GHD) is extremely rare, with only two reports in the literature. CASE REPORT: A one year-old, non-white female was referred due to hypoglycemic seizures. She had developmental delay and poor nutrition. Her physical examination was significant for a weight Z score of -6.95, height Z score of -5,05, cleft palate, epicanthic folds and generalized hypotony. Karyotype was 46XX r(18) (p11,2- q.23)--18 ring chromosome syndrome, the MRI showed an ectopic neurohypophysis. The diagnosis GHD was made due to low GH levels during spontaneous severe hypoglycemia at the age of 16 months. She was started on hGH 0.1 U/kg/day. Three months later, TSH deficiency was diagnosed and L-thyroxin therapy was started. During hGH replacement the hypoglycemic events stopped but after 3 years of hGH therapy, she did not improve growth velocity. DISCUSSION: We were unable to find any report of GHD and hypothyroidism associated with the 18-ring chromosome syndrome. Children with 18-ring chromosome should undergo investigation of GHD. In our child with 18-ring syndrome the hGH therapy did not improve growth velocity.
Asunto(s)
Cromosomas Humanos Par 18/genética , Hormona de Crecimiento Humana/deficiencia , Hipotiroidismo/diagnóstico , Cromosomas en Anillo , Tiroxina , Femenino , Humanos , Hipotiroidismo/tratamiento farmacológico , Lactante , Recién Nacido , Recien Nacido Prematuro , Tiroxina/uso terapéuticoRESUMEN
INTRODUÇÃO: A associação de síndrome do cromossomo 18 em anel com deficiência de hormônio de crescimento (DGH) é muito rara, com apenas dois relatos na literatura. RELATO DO CASO: Paciente feminina, negra, 1 ano de idade, encaminhada para investigação de crises de hipoglicemia desde os 6 meses, acompanhadas de crise convulsiva. Apresentava atraso do desenvolvimento neuropsicomotor e erro alimentar. Ao exame físico, criança desnutrida (escores z peso/idade de -6,95 e estatura/idade de -5,05), fenda palatina, prega epicântica e hipotonia generalizada. O diagnóstico de DGH foi feito em vigência de hipoglicemia e iniciado o tratamento com somatropina 0,1 U/kg aos 16 meses de idade. A RM do crânio evidenciou neuro-hipófise ectópica. O hipotireoidismo foi diagnosticado com 1 ano e 7 meses, sendo adicionada levotiroxina ao tratamento. O cariótipo 46XX r(18) (p11,2 q.23), estabeleceu o diagnóstico de síndrome do cromossomo 18 em anel. Está em uso de GH há 3 anos, os episódios de hipoglicemia com crise convulsiva desapareceram mas não houve melhora da velocidade de crescimento. DISCUSSÃO: Não foram encontrados na literatura relatos da associação de DGH, hipotireoidismo e cromossomo 18 em anel. Crianças com cromossomo 18 em anel merecem investigação para DGH. A reposição com GH não melhorou o crescimento da nossa paciente.
INTRODUCTION: The association of 18-ring chromosome syndrome and growth hormone deficiency (GHD) is extremely rare, with only two reports in the literature. CASE REPORT: A one year-old, non-white female was referred due to hypoglycemic seizures. She had developmental delay and poor nutrition. Her physical examination was significant for a weight Z score of -6.95, height Z score of -5,05, cleft palate, epicanthic folds and generalized hypotony. Karyotype was 46XX r(18) (p11,2 q.23) - 18 ring chromosome syndrome, the MRI showed an ectopic neurohypophysis. The diagnosis GHD was made due to low GH levels during spontaneous severe hypoglycemia at the age of 16 months. She was started on hGH 0.1 U/kg/day. Three months later, TSH deficiency was diagnosed and L-thyroxin therapy was started. During hGH replacement the hypoglycemic events stopped but after 3 years of hGH therapy, she did not improve growth velocity. DISCUSSION: We were unable to find any report of GHD and hypothyroidism associated with the 18-ring chromosome syndrome. Children with 18-ring chromosome should undergo investigation of GHD. In our child with 18-ring syndrome the hGH therapy did not improve growth velocity.