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1.
J Dairy Sci ; 103(4): 3804-3815, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32037178

RESUMO

Dairy farms have been under pressure to reduce negative environmental impacts while remaining profitable during times with volatile milk and commodity prices. Double cropping has been promoted to reduce negative environmental impacts and increase total dry matter yield per hectare. Three dairy farms that double cropped winter annuals and corn were selected from northern and western Pennsylvania. Data were collected from recorded crop and dairy records and financial data for 2016 and 2017. Farms ranged in size from 336 to 511 ha with 233 to 663 cows. Data were used to set parameters for the Integrated Farm System Model, which was then used to simulate 8 scenarios for each farm: current operation; 0, 50, and 100% of corn hectares double cropped; 30% feed price increase with and without double cropping; and 30% feed price decrease with and without double cropping at the farm's current level of double cropping. A 20-yr time period, using weather data that was representative of the actual farms, was used in the Integrated Farm System Model simulation to produce both financial and environmental outputs. Double cropping winter annuals and corn silage increased dry matter yield per hectare by 19%, when comparing 0 to 100% of the corn area double cropped. With all corn land double cropped, net return to management per hundredweight (45.36 kg) of milk increased by 1.8%, N leached per hectare per year decreased by an average of 4.5%, and phosphorus loss was reduced by an average of 9.2% across farms. When feed prices increased by 30%, double cropping increased net return over feed cost and net return to management by 1.6 and 2.2%, respectively, across farms. When feed prices decreased by 30%, double cropping decreased net return over feed cost and net return to management by smaller amounts of 0.13% and 0.11%, respectively, across farms. Modeling indicated that double cropping winter annuals with corn silage can have both environmental and economic benefits when winter-annual silage yields are enough to cover expenses.


Assuntos
Agricultura/métodos , Ração Animal/economia , Bovinos/fisiologia , Meio Ambiente , Fazendas/economia , Zea mays/crescimento & desenvolvimento , Agricultura/economia , Animais , Indústria de Laticínios/economia , Feminino , Lactação/fisiologia , Leite/economia , Leite/metabolismo , Modelos Biológicos , Pennsylvania , Fósforo , Estações do Ano , Silagem/economia
2.
J Dairy Sci ; 97(5): 3073-80, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24612799

RESUMO

Feed is generally the greatest expense for milk production. With volatility in feed and milk markets, income over feed cost (IOFC) is a more advantageous measure of profit than simply feed cost per cow. The objective of this study was to evaluate the effects of ration cost and ingredient composition on IOFC and milk yield. The Pennsylvania State Extension Dairy Team IOFC tool (http://extension.psu.edu/animals/dairy/business-management/financial-tools/income-over-feed-cost/introduction-to-iofc) was used to collect data from 95 Pennsylvania lactating dairy cow herds from 2009 to 2012 and to determine the IOFC per cow per day. The data collected included average milk yield, milk income, purchased feed cost, ration ingredients, ingredient cost per ton, and amount of each ingredient fed. Feed costs for home-raised feeds for each ration were based on market values rather than on-farm cost. Actual costs were used for purchased feed for each ration. Mean lactating herd size was 170 ± 10.5 and daily milk yield per cow was 31.7 ± 0.19 kg. The mean IOFC was $7.71 ± $1.01 cost per cow, ranging from -$0.33 in March 2009 to $16.60 in September 2011. Data were analyzed using a one-way ANOVA in SPSS (IBM Corp., Armonk, NY). Values were grouped by quartiles and analyzed with all years combined as well as by individual year. Purchased feed cost per cow per day averaged $3.16 ± $1.07 for 2009 to 2012. For 2009 to 2012 combined, milk yield and IOFC did not differ with purchased feed cost. Intermediate levels (quartiles 2 and 3) of forage cost per cow per day between $1.45 and $1.97 per cow per day resulted in the greatest average IOFC of $8.19 and the greatest average milk yield of 32.3 kg. Total feed costs in the fourth quartile ($6.27 or more per cow per day) resulted in the highest IOFC. Thus, minimizing feed cost per cow per day did not maximize IOFC. In 2010, the IOFC was highest at $8.09 for dairies that fed 1 or more commodity by-products. Results of the study indicated that intermediate levels of forage cost and higher levels of total feed cost per cow per day resulted in both higher milk yield and higher IOFC. This suggests that optimal ration formulation rather than least cost strategies may be key to increasing milk yield and IOFC, and that profit margin may be affected more by quality of the feed rather than the cost.


Assuntos
Ração Animal/análise , Bovinos/fisiologia , Indústria de Laticínios/economia , Lactação/fisiologia , Leite/economia , Ração Animal/economia , Animais , Custos e Análise de Custo , Feminino , Renda , Modelos Biológicos
3.
Curr Oncol ; 21(6): e760-7, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25489264

RESUMO

PURPOSE: We evaluated the novel combination of aprepitant and granisetron for the prophylaxis of radiotherapy-induced nausea and vomiting (rinv) among patients receiving moderately-emetogenic radiotherapy for thoracolumbar bone metastases. METHODS: In this single-centre two-arm nonrandomized prospective pilot study, patients undergoing single-fraction radiotherapy (8 Gy) received aprepitant 125 mg and granisetron 2 mg on the day of radiotherapy and aprepitant 80 mg on each of the first 2 days after the day of radiotherapy. Patients undergoing multiple-fraction radiotherapy (20 Gy in 5 fractions) received aprepitant 125 mg on day 1 of radiotherapy, aprepitant 80 mg on days 3 and 5 of radiotherapy, and granisetron 2 mg on every day of radiotherapy. Symptoms and total medication intake were recorded daily during the acute phase (day 1 of radiotherapy until the first day after the last day of radiotherapy), and the delayed phase (days 2-10 after the last day of radiotherapy). Control of vomiting, retching, and nausea was defined as no symptoms and no use of rescue medication. RESULTS: Control rates for single-fraction patients (n = 13) were 100% for acute nausea, 62% for delayed nausea, 100% for acute vomiting and retching, and 85% for delayed vomiting and retching. Control rates for multiple-fraction patients (n = 6) were 67% for acute nausea, 83% for delayed nausea, 67% for acute vomiting and retching, and 83% for delayed vomiting and retching. No grade 3 or 4 toxicities attributable to the study intervention were observed. CONCLUSIONS: The combination of aprepitant and granisetron was safe and efficacious for the prophylaxis of rinv after both single- and multiple-fraction moderately emetogenic radiotherapy for thoracolumbar bone metastases. Our results require confirmation in a larger population.

4.
J Toxicol Environ Health A ; 76(9): 556-86, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23751001

RESUMO

Postapplication exposure assessment related to indoor residential application of pesticide products requires consideration of product use information, application methods, chemical-specific deposition, time-dependent availability and transferability of surface residues, reentry time, and temporal location and macro- and microactivity/behavior patterns ( Baker et al., 2000 ). Children's mouthing behavior results in potential postapplication exposure to available pesticides in treated microenvironments through the nondietary ingestion route, in addition to the dermal or inhalation routes. Children's activities and associated behaviors may result in multiple or repeat contact of dermal areas (clothed and unclothed body areas and hands) with treated surfaces, or surfaces that may have indirect sources of residues. Further, some surfaces contacted may have transferable pesticide residues and others may not. Transfer of residues from the indoor residential environment to the dermal surface (e.g., hands) of an individual has been assumed to be linear as a function of time and number of contacts. However, studies suggest that this transfer process to the hands and other body areas may be rapidly saturable. In the most recent U.S. Environmental Protection Agency (EPA), Office of Pesticide Programs (OPP) "Residential Exposure Assessment Standard Operating Procedures" (U.S. EPA, 2012), the input variable for the number of dermal contacts (with treated surfaces) is an exponent, making the relationship nonlinear. Further, removal processes such as hand washing and transfer to untreated surfaces are important to consider. Predictive algorithms for estimating children's hand-to-mouth-related incidental ingestion exposures post pesticide application have been developed by the EPA/OPP and incorporated into probabilistic models. A review of literature addressing variables used to estimate potential incidental ingestion exposure is presented. Data relevant to input variables for predictive algorithms are discussed, including the results of a multiyear, pesticide transferable residue measurement program conducted by the Non-Dietary Exposure Task Force (NDETF) and the associated distributional characterization for this key variable. Sources of conservative bias in current hand-to-mouth, incidental ingestion exposure estimation and the role of biomonitoring to evaluate predicted exposures are discussed.


Assuntos
Algoritmos , Comportamento Infantil , Exposição Ambiental/efeitos adversos , Monitoramento Ambiental/métodos , Poluentes Ambientais/metabolismo , Praguicidas/metabolismo , Absorção , Administração Oral , Adolescente , Criança , Pré-Escolar , Exposição Ambiental/análise , Poluentes Ambientais/análise , Feminino , Humanos , Lactente , Masculino , Praguicidas/análise , Medição de Risco/métodos
5.
Curr Oncol ; 20(5): e396-405, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24155637

RESUMO

OBJECTIVE: We examined whether patterns of practice in the prescription of palliative radiation therapy for bone metastases had changed over time in the Rapid Response Radiotherapy Program (rrrp). METHODS: After reviewing data from August 1, 2005, to April 30, 2012, we analyzed patient demographics, diseases, organizational factors, and possible reasons for the prescription of various radiotherapy fractionation schedules. The chi-square test was used to detect differences in proportions between unordered categorical variables. Univariate logistic regression analysis and the simple Fisher exact test were also used to determine the factors most significant to choice of dose-fractionation schedule. RESULTS: During the study period, 2549 courses of radiation therapy were prescribed. In 65% of cases, a single fraction of radiation therapy was prescribed, and in 35% of cases, multiple fractions were prescribed. A single fraction of radiation therapy was more frequently prescribed when patients were older, had a prior history of radiation, or had a prostate primary, and when the radiation oncologist had qualified before 1990. CONCLUSIONS: For patients with bone metastasis, a single fraction of radiation therapy was prescribed with significantly greater frequency.

6.
Curr Oncol ; 20(3): e206-11, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23737690

RESUMO

OBJECTIVE: We set out to review the Rapid Response Radiotherapy Program (rrrp). METHODS: We retrospectively reviewed a prospective database of patients referred to the rrrp between August 1, 2008, and June 30, 2012, extracting patient demographics, case dispositions, and wait times in days from referral to consultation and from consultation to treatment. RESULTS: Of 2742 patients referred to the rrrp, 1458 (53%) were men, and 1284 (47%) were women. Median age was 64 years. The most prevalent primary cancer sites were lung (33%), breast (21%), and prostate (17%). The most common reasons for referral were bone metastases (53%) and brain metastases (21%). Palliative radiation therapy was given to 1890 patients. The median wait time from referral to consultation was 3 days. Among treated patients, 60% were treated on the day of their consultation, and 33%, within 1-6 days. CONCLUSIONS: The rrrp continues to deliver timely palliative radiation therapy to patients, comparable to earlier reviews. The continued success of the rrrp will remain a model for future rapid-access palliative radiation therapy clinics.

7.
BMJ Mil Health ; 169(3): 271-276, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33547188

RESUMO

Coronavirus disease 2019 (COVID-19) causes significant mortality and morbidity, with an unknown impact in the medium to long term. Evidence from previous coronavirus epidemics indicates that there is likely to be a substantial burden of disease, potentially even in those with a mild acute illness. The clinical and occupational effects of COVID-19 are likely to impact on the operational effectiveness of the Armed Forces. Collaboration between Defence Primary Healthcare, Defence Secondary Healthcare, Defence Rehabilitation and Defence Occupational Medicine resulted in the Defence Medical Rehabilitation Centre COVID-19 Recovery Service (DCRS). This integrated clinical and occupational pathway uses cardiopulmonary assessment as a cornerstone to identify, diagnose and manage post-COVID-19 pathology.


Assuntos
COVID-19 , Epidemias , Medicina , Humanos , Atenção à Saúde , Centros de Reabilitação
8.
Hum Reprod ; 27(6): 1723-34, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22434853

RESUMO

BACKGROUND: The current understanding of hormonal regulation of matrix metalloproteinase-26 (MMP-26) in the primate endometrium is incomplete. The goal of this work was to clarify estrogen and progesterone regulation of MMP-26 in the endometrium of ovariectomized, hormone-treated rhesus macaques. METHODS: Ovariectomized rhesus macaques (n= 66) were treated with estradiol (E(2)), E(2) plus progesterone, E(2) followed by progesterone alone or no hormone. Endometrium was collected from the hormone-treated animals during the early, mid- and late proliferative and secretory phases of the artificial menstrual cycle. MMP-26 expression was quantified by real-time PCR, and MMP-26 transcript and protein were localized by in situ hybridization and immunohistochemistry and correlated with estrogen receptor 1 and progesterone receptor (PGR). RESULTS: MMP-26 was localized to glandular epithelium and was undetectable in the endometrial stroma and vasculature. MMP-26 transcript levels were minimal in the hormone-deprived macaques and treatment with E(2) alone did not affect MMP-26 levels. Treatment with progesterone both in the presence and absence of E(2) stimulated MMP-26 expression in the early and mid-secretory phases (P < 0.001). MMP-26 expression preceded decidualization of endometrial stroma. MMP-26 levels then declined to baseline in the late secretory phase (P < 0.01) despite continued E(2) plus progesterone treatment. Loss of detectable MMP-26 expression in the late secretory phase was correlated with late secretory phase loss of glandular epithelial PGR. CONCLUSIONS: Endometrial MMP-26 expression is dependent on the presence of progesterone in the early secretory phase and then gradually becomes refractory to progesterone stimulation in the late secretory phase. In the macaque, MMP-26 is a marker of the pre-decidual, secretory endometrium. During the second half of the late secretory phase, and during decidualization, MMP-26 loses its response to progesterone concurrent with the loss of epithelial PGR. The decline in MMP-26 levels between the mid- and late secretory phases may play a role in the receptive window for embryo implantation.


Assuntos
Endométrio/enzimologia , Estradiol/farmacologia , Regulação Enzimológica da Expressão Gênica/efeitos dos fármacos , Macaca mulatta , Metaloproteinases da Matriz Secretadas/análise , Metaloproteinases da Matriz Secretadas/genética , Progesterona/farmacologia , Animais , Epitélio/enzimologia , Feminino , Imuno-Histoquímica , Ciclo Menstrual/fisiologia , Ovariectomia , RNA Mensageiro/análise , Reação em Cadeia da Polimerase em Tempo Real , Receptores de Progesterona/análise
9.
Cureus ; 13(9): e18308, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34722080

RESUMO

Lumbar synovial cysts (LSC) can impinge neural structures, causing radicular back pain. Conservative treatment options; however, are often ineffective, and traditional surgical techniques can cause joint instability. We describe two cases in which interventional pain physicians used transforaminal endoscopic spine surgery to treat LSC. The patients reported complete resolution of their lower back and radicular pain and the procedures preserved their motor function and sensation in their bilateral lower extremities. This technique is a viable option for remediation of LSC and can be performed by well-trained pain physicians.

10.
Cureus ; 13(10): e19112, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34858754

RESUMO

INTRODUCTION:  Spinal stenosis is a chronic, debilitating condition that is expected to affect an increasing number of people as the population ages. Symptomatic spinal stenosis, like other spine pathologies, including disc herniation and degenerative disc disease, traditionally required an open decompressive surgical approach if more conservative approaches failed. An emerging alternative has been developed to address the needs of this population of patients in the form of endoscopic spine surgery (ESS). Advantages of ESS include minimal tissue trauma, decreased risk of damage to the neurovascular structures, minimal epidural fibrosis/scarring, reduced hospital stay, early functional recovery, and improved cosmetic outcomes. The purpose of this study was to review the outcomes of patients undergoing transforaminal endoscopic spinal decompression at an academic pain program. METHODS: We conducted a retrospective review of electronic medical records with approval from the University of Florida Institutional Review Board (IRB #202001529). Twenty patients underwent successful transforaminal endoscopic lumbar spinal decompression surgery at UF Health Pain Medicine from July 1, 2019, to June 1, 2020. The majority of cases were performed at L4-5 (n = 14), followed by an equal number (n = 3) of cases at L3-4 and L5-S1. Preoperative and postoperative visual analog scale (VAS) pain scores from patients' pain clinic appointments were obtained from the electronic health records system to assess the intervention as a pain relief strategy. RESULTS:  Patients had an average pain reduction of 82% (SD = 31%), resulting in an average postoperative pain score of 1.8 (SD = 2.8) on a 10-point VAS. CONCLUSION:  This study highlights the benefits of endoscopic spine surgery for patients, including pain reduction and reduced scarring.

11.
Clin Nephrol ; 74 Suppl 1: S105-12, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20979974

RESUMO

BACKGROUND: Glomerular hypertrophy occurs in a number of normal and pathological states. Glomerular volume in kidneys at autopsy is usually indirectly derived from estimates of total glomerular mass and nephron number, and provides only a single value per kidney, with no indication of the range of volumes of glomeruli within the kidney of any given subject. We review findings of the distribution of volumes of different glomeruli within subjects without kidney disease, and their correlations with age, nephron number, birth weight and body mass index (BMI). METHODS: The study describes findings from autopsy kidneys of selected adult white males from the Southeast USA who had unexpected deaths, and who did not have renal scarring or renal disease. Total glomerular (nephron) number and total glomerular volume were estimated using the disector/fractionator combination, and mean glomerular volume (Vglom) was derived. The volumes of 30 individual glomeruli (IGV) in each subject were determined using the disector/Cavalieri method. IGV values were compared by categories of age, nephron number, birth weight and BMI. RESULTS: There was substantial variation in IGV within subjects. Older age, lower nephron number, lower birth weight and gross obesity were associated with higher mean IGV and with greater IGV heterogeneity. High Vglom and high IGVs were associated with more glomerulosclerosis. However, amongst the generally modest numbers of sclerosed glomeruli, the pattern was uniformly of ischemic collapse of the glomerular tuft. There was no detectable focal segmental glomerular tuft injury. DISCUSSION: In this series of people without overt renal disease, greater age, nephron deficit, lower birth weight and obesity were marked by glomerular enlargement and greater glomerular volume heterogeneity within individuals.


Assuntos
Glomérulos Renais/anatomia & histologia , Adulto , Fatores Etários , Idoso , Autopsia , Peso ao Nascer , Índice de Massa Corporal , Humanos , Masculino , Pessoa de Meia-Idade , Néfrons/anatomia & histologia , Tamanho do Órgão
12.
A A Pract ; 14(8): e01264, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32643906

RESUMO

Approximately 30% of health care workers (HCWs) fail the respirator fit test. Evidence suggests that addressing face leaks in the 3M respirator enhances its fit and improves its efficacy. Between March 31 and April 9, 2020, HCWs who failed fit tests for 3M 1860 and 1860S respirators were invited to retest with an adhesive modification of the 3M respirator. Sixty-eight percent of HCWs who failed the fit test with their first-choice respirator passed with a modified adhesive respirator. To increase the efficacy and safety of 3M respirators, ineffective face seals need substantial improvement in design.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Desenho de Equipamento/métodos , Pessoal de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Dispositivos de Proteção Respiratória/estatística & dados numéricos , Adesivos , Adulto , COVID-19 , Feminino , Humanos , Masculino , Projetos Piloto , SARS-CoV-2
13.
J Investig Allergol Clin Immunol ; 19(4): 283-91, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19639724

RESUMO

BACKGROUND: Lupine is used increasingly in food products. The development of lupine allergy in peanut-allergic patients is believed to occur as a result of cross-reactivity between lupine and peanut proteins. OBJECTIVE: To investigate the degree of immunoglobulin (Ig) E cross-reactivity between allergens in lupine and peanut. METHODS: We investigated IgE cross-reactivity between lupine alpha-, beta-, gamma-, and delta-conglutins and the major peanut allergens Ara h 1, Ara h 2 and Ara h 3 using enzyme-linked immunosorbent assay with sera from patients with coexisting peanut and lupine allergy. RESULTS: Peanut proteins inhibited IgE binding towards alpha- conglutins, delta-conglutins, and, to a lesser degree, beta-conglutins, while no IgE cross-reaction with delta-conglutin was observed. Ara h 2 most potently inhibited IgE binding to lupine and delta-conglutins, while Ara h 1 most potently cross-reacted with beta-conglutin. Ara h 3 was apparently not involved in these mechanisms. CONCLUSIONS: The present study reveals IgE cross-reactivity between the 2S albumins Ara h 2 and delta-conglutin, and the 7S vicilin-like Ara h 1 and beta-conglutin, which are possibly based on homologies between phylogenetically related proteins. Ara h 2 was the most potent inhibitor of IgE binding to lupine conglutins.


Assuntos
Arachis/imunologia , Hipersensibilidade Alimentar/imunologia , Imunoglobulina E/imunologia , Lupinus/imunologia , Albuminas 2S de Plantas/imunologia , Adolescente , Alérgenos/imunologia , Antígenos de Plantas/imunologia , Ligação Competitiva , Criança , Reações Cruzadas , Ensaio de Imunoadsorção Enzimática , Epitopos , Feminino , Hipersensibilidade Alimentar/sangue , Glicoproteínas/imunologia , Humanos , Imunoglobulina E/sangue , Masculino , Proteínas de Membrana , Hipersensibilidade a Amendoim/sangue , Hipersensibilidade a Amendoim/imunologia , Proteínas de Plantas/imunologia , Proteínas de Armazenamento de Sementes/imunologia , Homologia de Sequência de Aminoácidos
14.
Int J Audiol ; 48(9): 645-54, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19513917

RESUMO

This study investigates the effect of the Nucleus CI24RE implant's neural response telemetry (NRT) system, which has less internal noise compared to its predecessor, the CI24M/R implant, on the NRT threshold (TNRT) profile across the array. CI24M/R measurements were simulated by ignoring CI24RE measurements with response amplitudes below 50 uV. Comparisons of the estimated TNRTs from the CI24RE measurements and the CI24M/R simulations suggest that, apart from a constant level difference, the TNRT profiles from the newer implant generally would not have differed very much from those of its predecessor. This view was also reflected by principal component analysis (PCA) results which revealed a 'shift' component similar to that reported by Smoorenburg et al (2002). On the whole, there is no indication that current practices of using the TNRT profiles for assisting with speech processor programming need to be revised for the CI24RE implant.


Assuntos
Percepção Auditiva/fisiologia , Implantes Cocleares , Surdez/fisiopatologia , Surdez/terapia , Potenciais Evocados Auditivos , Telemetria/instrumentação , Adulto , Idoso , Cóclea/fisiopatologia , Simulação por Computador , Humanos , Pessoa de Meia-Idade , Neurônios/fisiologia , Análise de Componente Principal , Fatores de Tempo
15.
Int J Gynecol Cancer ; 18(1): 43-50, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-17466047

RESUMO

Ovarian germ cell tumors are rare but very curable at all stages of disease. There is good evidence that surveillance for stage I dysgerminomas is a safe option although many centers worldwide still advocate adjuvant chemotherapy for stage IA nondysgerminomatous tumors, despite the significant risk of developing long-term treatment side effects. Here, we review the safety of our ongoing surveillance program of all stage IA female germ cell tumors. Thirty-seven patients (median age 26, range 14-48 years) with stage I disease were referred to Mount Vernon and Charing Cross Hospitals between 1981 and 2003. Patients underwent surgery and staging followed by intense surveillance, which included regular tumor markers and imaging. The median period of follow-up was 6 years. Relapse rates for stage IA nondysgerminomatous tumors and dysgerminomas were 8 of 22 (36%) and 2 of 9 (22%), respectively, plus one patient with mature teratoma and glial implants also relapsed; 10 of these 11 patients (91%) were successfully cured with platinum-based chemotherapy. Only one patient died from chemoresistant disease. All relapses occurred within 13 months of initial surgery. The overall disease-specific survival of malignant ovarian germ cell tumors was 94%. Over 50% of patients who underwent fertility-sparing surgery went on to have successful pregnancies. We have confirmed again that surveillance of all stage IA ovarian germ cell tumors is very safe and that the outcome is comparable with testicular tumors. We question the need for potentially toxic adjuvant chemotherapy in nondysgerminoma patients who have greater than 90% chance of being salvaged with chemotherapy if they relapse later.


Assuntos
Disgerminoma/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Ovarianas/diagnóstico , Teratoma/diagnóstico , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/metabolismo , Disgerminoma/metabolismo , Disgerminoma/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/metabolismo , Estadiamento de Neoplasias , Neoplasias Ovarianas/metabolismo , Neoplasias Ovarianas/terapia , Vigilância da População , Prognóstico , Gestão de Riscos , Teratoma/metabolismo , Teratoma/terapia , Resultado do Tratamento
16.
Clin Oncol (R Coll Radiol) ; 20(10): 729-37, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18838256

RESUMO

AIMS: Most men with low-risk localised prostate cancer prefer treatments with high control rates and minimal disruption to their lives. Hypofractionating external radiation treatments can theoretically maintain high bioequivalent tumour doses, decrease treatment visits and decrease acute and late toxicities. The aim of this study was to assess the toxicity and feasibility of a hypofractionated accelerated regimen for these patients. MATERIALS AND METHODS: The present study was a phase I/II study in which patients with T1-2b, Gleason < or = 6 and prostate-specific antigen (PSA) < or = 10 ng/ml prostate cancer received 35Gy in five fractions, once a week over 29 days. Treatment was delivered with intensity-modulated radiotherapy on standard linear accelerators, with daily image guidance using gold seed fiducials, and a 4mm clinical target volume to planning target volume margin. RESULTS: As of January 2008, the target accrual of 30 patients had been reached and all had completed treatment and at least 6 months of follow-up. Dose-volume histogram objectives were achievable in all patients. Treatment was very well tolerated with no grade 3 or 4 genitourinary toxicity, gastrointestinal toxicity nor fatigue observed (95% confidence interval 0-12%). As a group, compared with baseline, the following additional grade 2 toxicities were observed: 13% genitourinary, 7% gastrointestinal and 10% fatigue. At 6 months all scores had returned to or improved over baseline. The median PSA before treatment was 6.0 ng/ml. At 6 months, the median PSA was 1.8 ng/ml and 75% had a PSA < or = 3.0 ng/ml. CONCLUSIONS: This novel technique using standard linear accelerators seems feasible and is well tolerated. Further follow-up will be carried out to document late toxicity and efficacy.


Assuntos
Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada , Adulto , Idoso , Fracionamento da Dose de Radiação , Humanos , Masculino , Pessoa de Meia-Idade , Antígeno Prostático Específico/análise , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/patologia , Neoplasias da Próstata/fisiopatologia , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/efeitos adversos , Resultado do Tratamento , Sistema Urogenital/patologia , Sistema Urogenital/fisiopatologia , Sistema Urogenital/efeitos da radiação , Adulto Jovem
17.
J Occup Environ Med ; 60(10): 896-900, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29851744

RESUMO

OBJECTIVE: The aim of the study was to assess the relationship between leisure time exercise and whether workers ever had modified duty or lost time (MD/LT) due to low back pain (LBP) in an occupational cohort. METHODS: Workers (N = 827) completed a structured interview assessing characteristics of their LBP, whether or not the pain caused modified or lost work time, and their participation in leisure time exercise. Odds ratio of modified/lost time and minutes of exercise participation were assessed. RESULTS: Workers who participated in over 316 min/wk of leisure time exercise incurred significantly less modified/lost time, adjusted odds ratio = 0.46 (95% confidence interval, 0.23 to 0.98). There also lies a significant trend between increases in leisure time exercise and reductions in modified/lost time (P = 0.0016). CONCLUSION: These results suggest exercise reduces risk of MD/LT from LBP.


Assuntos
Exercício Físico , Dor Lombar , Doenças Profissionais , Licença Médica/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Atividades de Lazer , Dor Lombar/complicações , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/complicações , Fatores de Tempo
18.
Clin Oncol (R Coll Radiol) ; 19(1): 63-70, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17305256

RESUMO

AIMS: To determine the cerebrospinal fluid concentrations and the functional and pain outcomes after a single intravenous infusion of erythropoietin at the start of a standard radiotherapy and steroid protocol. MATERIALS AND METHODS: Ten paraparetic patients with malignant extradural spinal cord compression who were eligible for radiotherapy, lumbar puncture and intravenous epoetin alpha were enrolled. The patients received epoetin alpha 1500 IU/kg intravenously over 30 min followed by a standardised dexamethasone and radiotherapy protocol. A lumbar puncture and venipuncture were carried out 24-30 h after the epoetin alpha infusion. The patients were followed closely at defined intervals. RESULTS: Erythropoietin was detectable in the cerebrospinal fluid in all eight patients sampled (median 92.5 mIU/ml, range 17.8-214.0 mIU/ml). Before treatment, eight patients were non-ambulatory and two patients were ambulatory with assistance. After treatment, eight (80%, 95% confidence interval [CI] 44-97%) improved at least one functional class and recovered or maintained ambulation. Five of seven patients (71%; 95% CI 29-96%) with objective sensory deficits and one of seven (14%; 95% CI 0-58%) catheter-dependent patients recovered. Overall, 78% (95% CI 40-97%) had a pain response. CONCLUSIONS: After an intravenous infusion of epoetin alpha, radiotherapy and steroids, high concentrations of erythropoietin were detectable in the cerebrospinal fluid. Patients with malignant extradural spinal cord compression showed encouraging improvements in neurological function and pain.


Assuntos
Eritropoetina/administração & dosagem , Eritropoetina/líquido cefalorraquidiano , Compressão da Medula Espinal/tratamento farmacológico , Neoplasias da Coluna Vertebral/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Dexametasona/uso terapêutico , Epoetina alfa , Eritropoetina/farmacocinética , Feminino , Glucocorticoides/uso terapêutico , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Cuidados Paliativos , Paraparesia/etiologia , Proteínas Recombinantes , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/radioterapia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/radioterapia , Taxa de Sobrevida
19.
J Immunol Methods ; 314(1-2): 114-22, 2006 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-16870207

RESUMO

Allergy to hazelnut is one of the most prevalent causes of severe food-allergic reactions in Norway, as recorded by The Norwegian National Reporting System and Register of Severe Allergic Reactions to Food. In the majority of the reported cases, there is "hidden", unlabelled hazelnut protein in processed foods like chocolate, cookies and cereal mixtures the eliciting agent. For a food survey study performed to evaluate the labelling practices with regards to hazelnut on behalf of the Norwegian Food Safety Authority, a new sensitive time-resolved fluoroimmunoassay (TR-FIA) for the detection of hazelnut protein traces in food matrices was developed and validated. The unique fluorometric properties of the europium-chelates used improved the signal-to-noise ratio because of low matrix interference and led to an enhanced sensitivity. The limit of detection was 0.1 mg/kg and the limit of quantitation was 0.33 mg/kg hazelnut protein. The recovery ranged from 73% to 123% in cookies and cereals, and from 50 to 77% in chocolate. The intra-assay precision was 7% and the inter-assay precision was 19%. Of 100 randomly chosen retail food products in Norway labelled "may contain hazelnut", 36 contained <0.2 mg/kg and seven >10 mg/kg hazelnut protein, demonstrating how differently this precautionary label is used.


Assuntos
Corylus/química , Fluorimunoensaio/métodos , Análise de Alimentos/métodos , Contaminação de Alimentos/análise , Hipersensibilidade a Noz , Proteínas de Plantas/química , Corylus/efeitos adversos , Fluorimunoensaio/normas , Immunoblotting , Elementos da Série dos Lantanídeos/química , Proteínas de Plantas/isolamento & purificação , Sensibilidade e Especificidade
20.
J Dairy Sci ; 89(3): 1116-20, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16507709

RESUMO

The objectives were to identify relationships between human resource management (HRM) practices used by dairy farm businesses and the productivity and profitability of the dairies. Explanatory variables were the following practices: training, job descriptions, standard operating procedures, milk quality incentives, and the employment of Spanish-speaking employees. The dependent variables were return on assets, return on equity, rolling herd average, and somatic cell count. The effects of individual HRM practices were analyzed to test for means separation between groups that "used" and those that "did not use" HRM practices. The results did not support expectations that differences exist between the groups. However, a significant positive relationship was found between return on equity and the use of continued training (used = 10.61%; did not use = -62.38%), and a significant negative relationship was found between the use of standard operating procedures for feeding and somatic cell count (used = 263,000; did not use = 214,000). Profitability and productivity did not seem to be major factors in producers' decisions to use or not use HRM practices.


Assuntos
Indústria de Laticínios/organização & administração , Gestão de Recursos Humanos/métodos , Animais , Bovinos , Contagem de Células , Indústria de Laticínios/educação , Indústria de Laticínios/métodos , Planos para Motivação de Pessoal , Feminino , Descrição de Cargo , Idioma , México/etnologia , Leite/citologia , Leite/economia , Controle de Qualidade , Inquéritos e Questionários , Estados Unidos
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