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1.
Can Assoc Radiol J ; : 8465371241254966, 2024 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-38813997

RESUMO

Imaging of pregnant patients who sustained trauma often causes fear and confusion among patients, their families, and health care professionals regarding the potential for detrimental effects from radiation exposure to the fetus. Unnecessary delays or potentially harmful avoidance of the justified imaging studies may result from this understandable anxiety. This guideline was developed by the Canadian Emergency, Trauma and Acute Care Radiology Society (CETARS) and the Canadian Association of Radiologists (CAR) Working Group on Imaging the Pregnant Trauma Patient, informed by a literature review as well as multidisciplinary expert panel opinions and discussions. The working group included academic subspecialty radiologists, a trauma team leader, an emergency physician, and an obstetriciangynaecologist/maternal fetal medicine specialist, who were brought together to provide updated, evidence-based recommendations for the imaging of pregnant trauma patients, including patient safety aspects (eg, radiation and contrast concerns) and counselling, initial imaging in maternal trauma, specific considerations for the use of fluoroscopy, angiography, and magnetic resonance imaging. The guideline strives to achieve clarity and prevent added anxiety in an already stressful situation of injury to a pregnant patient, who should not be imaged differently.

2.
Ann Emerg Med ; 72(4): 478-489, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29866583

RESUMO

STUDY OBJECTIVE: Point-of-care ultrasonography protocols are commonly used in the initial management of patients with undifferentiated hypotension in the emergency department (ED). There is little published evidence for any mortality benefit. We compare the effect of a point-of-care ultrasonography protocol versus standard care without point-of-care ultrasonography for survival and clinical outcomes. METHODS: This international, multicenter, randomized controlled trial recruited from 6 centers in North America and South Africa and included selected hypotensive patients (systolic blood pressure <100 mm Hg or shock index >1) randomized to early point-of-care ultrasonography plus standard care versus standard care without point-of-care ultrasonography. Diagnoses were recorded at 0 and 60 minutes. The primary outcome measure was survival to 30 days or hospital discharge. Secondary outcome measures included initial treatment and investigations, admissions, and length of stay. RESULTS: Follow-up was completed for 270 of 273 patients. The most common diagnosis in more than half the patients was occult sepsis. We found no important differences between groups for the primary outcome of survival (point-of-care ultrasonography group 104 of 136 patients versus standard care 102 of 134 patients; difference 0.35%; 95% binomial confidence interval [CI] -10.2% to 11.0%), survival in North America (point-of-care ultrasonography group 76 of 89 patients versus standard care 72 of 88 patients; difference 3.6%; CI -8.1% to 15.3%), and survival in South Africa (point-of-care ultrasonography group 28 of 47 patients versus standard care 30 of 46 patients; difference 5.6%; CI -15.2% to 26.0%). There were no important differences in rates of computed tomography (CT) scanning, inotrope or intravenous fluid use, and ICU or total length of stay. CONCLUSION: To our knowledge, this is the first randomized controlled trial to compare point-of-care ultrasonography to standard care without point-of-care ultrasonography in undifferentiated hypotensive ED patients. We did not find any benefits for survival, length of stay, rates of CT scanning, inotrope use, or fluid administration. The addition of a point-of-care ultrasonography protocol to standard care may not translate into a survival benefit in this group.


Assuntos
Protocolos Clínicos , Hipotensão/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Serviço Hospitalar de Emergência , Feminino , Humanos , Hipotensão/diagnóstico por imagem , Hipotensão/mortalidade , Masculino , Pessoa de Meia-Idade , América do Norte , Melhoria de Qualidade , África do Sul
3.
J Clin Child Adolesc Psychol ; 47(sup1): S21-S34, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-27043323

RESUMO

Parents raising youth in high-risk communities at times rely on active, involved monitoring strategies in order to increase both knowledge about youth activities and the likelihood that adolescents will abstain from problem behavior. Key monitoring literature suggests that some of these active monitoring strategies predict increases in adolescent problem behavior rather than protect against it. However, this literature has studied racially homogenous, low-risk samples, raising questions about generalizability. With a diverse sample of youth (N = 753; 58% male; 46% Black) and families living in high-risk neighborhoods, bidirectional longitudinal relations were examined among three aspects of monitoring (parental discussions of daily activities, parental curfew rules, and adolescent communication with parents), parental knowledge, and youth delinquency. Parental discussion of daily activities was the strongest predictor of parental knowledge, which negatively predicted delinquency. However, these aspects of monitoring did not predict later delinquency. Findings were consistent across gender and race/urbanicity. Results highlight the importance of active and involved parental monitoring strategies in contexts where they are most needed.


Assuntos
Comportamento do Adolescente/psicologia , Delinquência Juvenil/psicologia , Relações Pais-Filho , Poder Familiar/psicologia , Pais/psicologia , Grupos Raciais/psicologia , Adolescente , Comportamento do Adolescente/etnologia , Criança , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Delinquência Juvenil/etnologia , Estudos Longitudinais , Masculino , Relações Pais-Filho/etnologia , Poder Familiar/etnologia , Pais/educação , Comportamento Problema/psicologia , Grupos Raciais/etnologia , Distribuição Aleatória , Fatores de Risco , Instituições Acadêmicas/tendências , Inquéritos e Questionários
4.
J Arthroplasty ; 29(2): 325-8, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23856063

RESUMO

Limited research assessing risks of continued clopidogrel perioperatively in patients undergoing elective orthopedic procedures exists. Patients that underwent elective primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) from 2007 to 2012 while taking clopidogrel at the time of surgical evaluation were retrospectively identified. Patient demographics, last dose of clopidogrel, intraoperative blood loss, blood transfusion, and presence of 30-day adverse cardiac events (ACE) were collected. Of 142 patients meeting criteria, 24 (16.9%) patients remained on clopidogrel perioperatively. Patients that continued clopidogrel were more likely to receive a blood transfusion within 24 hours of surgery (31.8% vs. 7.7%; P=0.004) and during hospitalization (37.5% vs. 15.3%; P=0.02), but the incidence of 30-day ACE was not significantly different. Continuation of clopidogrel perioperatively for elective THA or TKA should be carefully considered.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Transfusão de Sangue , Inibidores da Agregação Plaquetária/efeitos adversos , Ticlopidina/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Clopidogrel , Procedimentos Cirúrgicos Eletivos , Feminino , Cardiopatias/etiologia , Cardiopatias/terapia , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco , Ticlopidina/efeitos adversos , Resultado do Tratamento
5.
Arch Phys Med Rehabil ; 93(3): 496-502, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22244248

RESUMO

OBJECTIVE: To examine whether there was a dose response for valgus unloader brace wear on knee pain, function, and muscle strength in participants with medial compartment knee osteoarthritis. DESIGN: In this single-group study, participants with medial compartment knee osteoarthritis were followed for approximately 6 months. SETTING: Recruitment was conducted in the general community, and testing was performed at a university laboratory. PARTICIPANTS: A convenience sample of patients (N=32) who were prescribed a valgus unloader brace agreed to participate, met the inclusion criteria, and completed the baseline data collection. Twenty-four participants (20 men, 4 women) completed baseline and follow-up collections. INTERVENTION: Participants wore their valgus unloader brace as needed. MAIN OUTCOME MEASURES: Knee extensor, flexor, and plantar flexor strength was tested at baseline and follow-up. Participants filled out Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Medical Outcomes Study 36-Item Short-Form Health Survey questionnaires to assess pain and function. Self-selected walking velocity and stride length were objective measures of function. Brace usage (dose) and activity (step count) were recorded at least 4 days/week for the study duration. RESULTS: Positive relationships existed between brace wear usage and percent change in step count (r=.59, P=.006) and percent change in hamstrings strength (r=.37, P=.072). At follow-up, there was significant improvement in hamstrings strength (P=.013), and trends toward improvements in WOMAC pain (P=.059) and WOMAC function (P=.089). CONCLUSIONS: Our results indicate that greater brace use may positively affect physical activity level, but there was minimal effect of brace wear dosage on lower-limb muscle strength. Only knee flexion showed a positive relationship. Our finding of no decreased muscle strength indicates that increased brace use over a 6-month period does not result in muscle impairment.


Assuntos
Braquetes , Força Muscular/fisiologia , Osteoartrite do Joelho/reabilitação , Dor/reabilitação , Idoso , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Dor/etiologia , Fatores de Tempo
6.
CJEM ; 23(6): 797-801, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34537915

RESUMO

OBJECTIVE: To determine how many Level 1 and Level 2 trauma centres in Canada have implemented a resuscitative endovascular balloon occlusion of the aorta (REBOA) program, and to identify facilitators and barriers to successful implementation of REBOA programs. METHODS: An electronic survey was developed and administered in November 2019 (updated in July 2021) via email to directors at all 32 Level 1 and Level 2 trauma centres across Canada, and to the medical director in PEI (no Level 1 or Level 2 capacity). Survey responses were supplemented by an online search in PubMed and the grey literature. Responses were analyzed using simple descriptive statistics including frequencies and proportions. RESULTS: We received responses from directors at 22 sites (17 Level 1 trauma centres, 4 Level 2 trauma centres, PEI) for a response rate of 66.7%. There are 6 Level 1 trauma centres with REBOA programs; all were implemented between 2017 and 2019. One additional Level 1 trauma centre that did not respond was found to have a REBOA program; thus, 21.9% (7/32) of Canadian Level 1 and Level 2 trauma centres have an existing REBOA program. These programs are located in three provinces (British Columbia, Ontario, Quebec). Five other centres are planning on implementing a REBOA program in the next 2 years. The number of REBOA cases performed ranged from 0 to 30 (median 2). Factors contributing most to successful program implementation were having physician champions and patient populations with sufficient REBOA candidates, while cost and lack of expertise were the greatest barriers identified. CONCLUSION: As of July 2021, 21.9% (7/32) of Canadian Level 1 and Level 2 trauma centres have a REBOA program. Physician champions and a patient population with sufficient numbers of REBOA candidates were the most important factors contributing to successful implementation of these programs.


RéSUMé: OBJECTIFS: Déterminer combien de centres de traumatologie de niveau 1 et de niveau 2 au Canada ont mis en œuvre un programme d'occlusion endovasculaire par ballonnet de l'aorte en réanimation (REBOA), et identifier les facilitateurs et les obstacles à la mise en œuvre réussie des programmes REBOA. MéTHODES: Un sondage électronique a été élaboré et administré en novembre 2019 (mis à jour en juillet 2021) par courriel aux directeurs des 32 centres de traumatologie de niveau 1 et 2 au Canada, ainsi qu'au directeur médical de l'Î.-P.-É. (aucune capacité de niveau 1 ou 2). Les réponses à l'enquête ont été complétées par une recherche en ligne dans PubMed et la littérature grise. Les réponses ont été analysées à l'aide de statistiques descriptives simples, y compris les fréquences et les proportions. RéSULTATS: Nous avons reçu des réponses des directeurs de 22 sites (17 centres de traumatologie de niveau 1, 4 centres de traumatologie de niveau 2, Î.-P.-É.), soit un taux de réponse de 66,7 %. Il existe 6 centres de traumatologie de niveau 1 avec des programmes REBOA ; tous ont été mis en œuvre entre 2017 et 2019. Un autre centre de traumatologie de niveau 1 qui n'a pas répondu s'est avéré avoir un programme de REBOA ; ainsi, 21,9 % (7/32) des centres de traumatologie canadiens de niveau 1 et de niveau 2 ont déjà un programme de REBOA. Ces programmes sont situés dans 3 provinces (Colombie-Britannique, Ontario, Québec). Cinq autres centres prévoient de mettre en place un programme REBOA dans les 2 prochaines années. Le nombre de cas de REBOA effectués allait de 0 à 30 (médiane 2). Les facteurs contribuant le plus à une mise en œuvre réussie du programme étaient le fait d'avoir des médecins champions et des populations de patients avec suffisamment de candidats au REBOA, tandis que le coût et le manque d'expertise étaient les plus grands obstacles identifiés. CONCLUSIONS: En juillet 2021, 21,9 % (7/32) des centres canadiens de traumatologie de niveau 1 et 2 disposent d'un programme de REBOA. Les médecins champions et une population de patients avec un nombre suffisant de candidats au REBOA ont été les facteurs les plus importants contribuant à la réussite de la mise en œuvre de ces programmes.


Assuntos
Oclusão com Balão , Procedimentos Endovasculares , Aorta , Colúmbia Britânica , Humanos , Ressuscitação , Estudos Retrospectivos , Centros de Traumatologia
7.
CJEM ; 23(4): 528-536, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33751492

RESUMO

OBJECTIVES: To perform a province-wide evaluation of adult major traumas and determine the proportion of patients who met clinical and/or anatomical criteria for resuscitative endovascular balloon occlusion of the aorta (REBOA). METHODS: This is a retrospective analysis of all major trauma patients (age > 16) presenting to the sole adult level 1 trauma centre in Nova Scotia over a 5-year period (2012-2017). Data were collected from the Nova Scotia Trauma Registry and medical charts. We identified potential REBOA candidates using either: (1) clinical criteria (primary survey, Focused Assessment with Sonography for Trauma, pelvic/chest X-ray); or (2) anatomical criteria (ICD-10-CA codes). Potential candidates with persistent hypotension were considered true REBOA candidates. RESULTS: Overall 2885 patients were included in the analysis, of whom 248 (8.6%) patients were in shock (including 106 transfer patients) and had their charts reviewed. A total of 137 patients met clinical criteria for REBOA; 44 (1.5%) had persistent hypotension 10-20 min into resuscitation and were considered true REBOA candidates. There were 59 patients who met anatomical criteria for REBOA, of whom 15 (0.5%) patients had persistent hypotension and were true REBOA candidates. The 15 REBOA candidates based on anatomical criteria also met clinical criteria for REBOA. CONCLUSIONS: In this registry-based retrospective analysis, 1.5% of adult major trauma patients Nova Scotia were REBOA candidates based on resuscitative clinical presentation, while 0.5% were candidates based on post hoc anatomical injury patterns. Our findings suggest that using clinical findings and bedside imaging modalities as criteria may overestimate the number of candidates for REBOA.


RéSUMé: OBJECTIFS: Effectuer une évaluation à l'échelle de la province des traumatismes majeurs chez l'adulte et déterminer la proportion de patients qui répondaient aux critères cliniques et/ou anatomiques de l'occlusion endovasculaire par ballonnet de réanimation de l'aorte (REBOA). LES MéTHODES: Analyse rétrospective de tous les patients ayant subi un traumatisme majeur (âge > 16 ans) qui se sont présentés au seul centre de traumatologie de niveau 1 pour adultes en Nouvelle-Écosse sur une période de 5 ans (2012-2017). Les données ont été recueillies à partir du registre des traumatismes de la Nouvelle-Écosse et des dossiers médicaux. Nous avons identifié des candidats potentiels à la REBOA en utilisant l'un ou l'autre : 1) des critères cliniques (enquête primaire, évaluation ciblée avec échographie pour les traumatismes, radiographie pelvienne/du thorax) ; ou 2) des critères anatomiques (codes CIM-10-CA). Les candidats potentiels présentant une hypotension persistante étaient considérés comme de véritables candidats au REBOA. RéSULTATS: Au total, 2 885 patients ont été inclus dans l'analyse, dont 248 (8,6 %) étaient en état de choc (dont 106 patients transférés) et ont vu leur dossier révisé. Au total, 137 patients répondaient aux critères cliniques pour la REBOA ; 44 (1,5 %) présentaient une hypotension persistante de 10 à 20 minutes en réanimation et étaient considérés comme de véritables candidats à la REBOA. Il y avait 59 patients qui répondaient aux critères anatomiques pour le REBOA, dont 15 (0,5 %) avaient une hypotension persistante et étaient de véritables candidats au REBOA. Les 15 candidats REBOA basés sur des critères anatomiques répondaient également aux critères cliniques de REBOA. CONCLUSIONS: Dans cette analyse rétrospective basée sur un registre, 1,5 % des patients adultes ayant subi un traumatisme majeur en Nouvelle-Écosse étaient des candidats au REBOA sur la base d'une présentation clinique de réanimation, tandis que 0,5 % étaient des candidats sur la base de modèles de blessures anatomiques post-hoc. Nos conclusions suggèrent que l'utilisation des résultats cliniques et des modalités d'imagerie au chevet du patient comme critères peut surestimer le nombre de candidats à la REBOA.


Assuntos
Oclusão com Balão , Procedimentos Endovasculares , Adulto , Aorta , Humanos , Nova Escócia/epidemiologia , Ressuscitação , Estudos Retrospectivos
8.
Cureus ; 12(8): e9899, 2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32968565

RESUMO

Introduction Point of Care Ultrasound (PoCUS) protocols are commonly used to guide resuscitation for patients with undifferentiated hypotension, yet there is a paucity of evidence for any outcome benefit. We undertook an international multicenter randomized controlled trial (RCT) to assess the impact of a PoCUS protocol on key clinical outcomes. Here we report on resuscitation markers.  Methods Adult patients presenting to six emergency departments (ED) in Canada and South Africa with undifferentiated hypotension (systolic blood pressure (SBP) <100mmHg or a Shock Index >1.0) were randomized to receive a PoCUS protocol or standard care (control). Reported physiological markers include shock index (SI), and modified early warning score (MEWS), with biochemical markers including venous bicarbonate and lactate, at baseline and four hours.  Results A total of 273 patients were enrolled, with data collected for 270. Baseline characteristics were similar for each group. Improvements in mean values for each marker during initial treatment were similar between groups: Shock Index; mean reduction in Control 0.39, 95% CI 0.34 to 0.44 vs. PoCUS 0.33, 0.29 to 0.38; MEWS, mean reduction in Control 2.56, 2.22 to 2.89 vs. PoCUS 2.91, 2.49 to 3.32; Bicarbonate, mean reduction in Control 2.71 mmol/L, 2.12 to 3.30 mmol/L vs. PoCUS 2.30 mmol/L, 1.75 to 2.84 mmol/L, and venous lactate, mean reduction in Control 1.39 mmol/L, 0.93 to 1.85 mmol/L vs. PoCUS 1.31 mmol/L, 0.88 to 1.74 mmol/L. Conclusion We found no meaningful difference in physiological and biochemical resuscitation markers with or without the use of a PoCUS protocol in the resuscitation of undifferentiated hypotensive ED patients. We are unable to exclude improvements in individual patients or in specific shock types.

9.
Pediatrics ; 143(2)2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30642952

RESUMO

BACKGROUND: Gay men have become fathers in the context of a heterosexual relationship, by adoption, by donating sperm to 1 or 2 lesbian women and subsequently sharing parenting responsibilities, and/or by engaging the services of a surrogate pregnancy carrier. Despite legal, medical, and social advances, gay fathers and their children continue to experience stigma and avoid situations because of fear of stigma. Increasing evidence reveals that stigma is associated with reduced well-being of children and adults, including psychiatric symptoms and suicidality. METHODS: Men throughout the United States who identified as gay and fathers completed an online survey. Dissemination of the survey was enhanced via a "snowball" method, yielding 732 complete responses from 47 states. The survey asked how the respondent had become a father, whether he had encountered barriers, and whether he and his child(ren) had experienced stigma in various social contexts. RESULTS: Gay men are increasingly becoming fathers via adoption and with assistance of an unrelated pregnancy carrier. Their pathways to fatherhood vary with socioeconomic class and the extent of legal protections in their state. Respondents reported barriers to becoming a father and stigma associated with fatherhood in multiple social contexts, most often in religious institutions. Fewer barriers and less stigma were experienced by fathers living in states with more legal protections. CONCLUSIONS: Despite growing acceptance of parenting by same-gender adults, barriers and stigma persist. States' legal and social protections for lesbian and gay individuals and families appear to be effective in reducing experiences of stigma for gay fathers.


Assuntos
Relações Pai-Filho , Pai/psicologia , Minorias Sexuais e de Gênero/psicologia , Estigma Social , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
10.
11.
J Neuroimmunol ; 172(1-2): 9-17, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16325924

RESUMO

A devastating consequence of HSV-1 infection is development of HSV-1-induced encephalitis (HSVE). While only a minority of individuals infected with HSV-1 experiences HSVE, clearly defined variables that consistently predict development of the disease remain to be elucidated. The current study examined the effects of a single dose of morphine prior to infection with HSV-1 on the development of HSVE in BALB/cByJ mice. Acute morphine exposure was observed to potentiate the development of HSVE in HSV-1 infected mice. The present data implicate a potential role for the blood-brain barrier in the development of HSVE in morphine-treated mice.


Assuntos
Encefalite/etiologia , Encefalite/virologia , Herpesvirus Humano 1/fisiologia , Morfina/farmacologia , Entorpecentes/farmacologia , Animais , Ataxia/etiologia , Ataxia/virologia , Barreira Hematoencefálica/efeitos dos fármacos , Barreira Hematoencefálica/fisiopatologia , Barreira Hematoencefálica/virologia , Encéfalo/efeitos dos fármacos , Encéfalo/patologia , Encéfalo/virologia , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Herpesvirus Humano 1/patogenicidade , Imunoglobulina G/metabolismo , Imuno-Histoquímica/métodos , Masculino , Manitol/farmacologia , Camundongos , Camundongos Endogâmicos BALB C , Paralisia/etiologia , Paralisia/virologia , RNA Mensageiro/biossíntese , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Índice de Gravidade de Doença , Fatores de Tempo
12.
Brain Res ; 1103(1): 164-72, 2006 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-16806120

RESUMO

The number of adults in the US affected by bipolar disorder, depression, or schizophrenia is approaching 15 million. Despite decades of research, etiologies of these illnesses remain elusive. Theories of aberrant brain morphology, neurotransmission, and signal conduction have provided the heuristic framework for a large body of literature, with attention focused upon hypotheses of monoamine signaling underlying psychiatric disease. More recently, attention has turned to potential contributions of other signaling pathways, including the arachidonic acid cascade and generation of prostaglandins (PG). To determine the potential involvement of the pathways leading to PGE2 synthesis in psychiatric disease, immunohistochemistry and immunoblotting were performed to measure regional expression of the cyclooxygenases (COX) and one of the terminal PGE2 synthases (PGES) in postmortem tissue provided by The Stanley Medical Research Institute. For normal, bipolar, depressed, and schizophrenic subjects, COX-1 and COX-2 protein levels did not differ across region and patient populations. In contrast, there was a significant effect of diagnosis on cytosolic PGES (cPGES) protein levels in the frontal cortex, with remarkable decreases observed in all psychiatric groups relative to normal tissue (P < 0.05). Significant reduction of cPGES expression was also found in the temporal cortex of bipolar subjects. Evaluation of medicated vs. non-medicated subjects revealed a significant effect of medication on cPGES expression in the frontal cortex of bipolar, but not depressed or schizophrenic subjects. These novel findings further support hypotheses of abnormalities in fatty acid and phospholipid metabolism in regions associated with psychiatric disease.


Assuntos
Córtex Cerebral/enzimologia , Citosol/enzimologia , Oxirredutases Intramoleculares/biossíntese , Transtornos Mentais/enzimologia , Adulto , Idoso , Ácido Araquidônico/metabolismo , Transtorno Bipolar/enzimologia , Western Blotting , Estudos de Coortes , Ciclo-Oxigenase 1/biossíntese , Ciclo-Oxigenase 2/biossíntese , Interpretação Estatística de Dados , Transtorno Depressivo/enzimologia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Prostaglandina-E Sintases , Prostaglandinas/biossíntese , Esquizofrenia/enzimologia
13.
Disabil Rehabil Assist Technol ; 11(2): 158-165, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24848442

RESUMO

PURPOSE: To evaluate lower extremity mechanics and muscle activation associated with the sit-to-stand transfer using a portable lifting-seat device and to compare these data to an unassisted transfer in healthy young and older adults. METHODS: Bilateral lower extremity and low back musculature electromyography, three-dimensional leg and trunk motion, and ground reaction forces were recorded from 10 young (mean age = 25) and 10 older (mean age = 69) adults during five trials of (i) no assist and (ii) assisted transfers. Data were time normalized to represent the period of seat-off to standing. Peak sagittal plane joint angles, moments, and muscle activity profiles were calculated. Analysis of variance models was used to test for main effects and interactions (α = 0.05). RESULTS: Trunk, hip, and knee angles were significantly reduced and dorsiflexion increased with assisted transfer (p < 0.05). Peak hip and ankle joint moments were reduced (p < 0.05) and no change found in knee moments (p > 0.05). Peak muscle activity was lower during the assisted transfer (p < 0.05). Seat device effects were similar between age groups. Older adults used higher relative muscle activation. CONCLUSION: Variables indicative of sit-to-stand functional demand were reduced with lifting-seat device use. Data provide a framework for future recommendations on product prescription, use, and research pertaining to the advancement of adaptive seating. Implications for Rehabilitation Hip and trunk mechanical demands, and muscle activation were reduced with portable lifting seat device use. Greater ankle dorsiflexion was found with portable lifting seat device use, suggesting this range of motion should be considered when prescribing this device. Healthy older and younger adults used similar knee and trunk joint mechanics yet older adults completed the sit-to-stand trials with greater lower extremity and low back muscle activation.

14.
Clin Pediatr (Phila) ; 55(14): 1305-1317, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26965032

RESUMO

An online survey was distributed via snowball sampling and resulted in responses from 61 gay fathers raising children in 2 states. Fathers reported on the barriers they experienced and the pathways they took to becoming parents. They reported also on experiences of stigma directed at them and their children, especially from family members, friends, and people in religious institutions. Despite these difficulties they reported that they engaged actively in parenting activities and that their child(ren)'s well-being was consistent with national samples.


Assuntos
Relações Pai-Filho , Pai/psicologia , Homossexualidade Masculina/psicologia , Poder Familiar/psicologia , Adolescente , Adulto , California , Criança , Pré-Escolar , Feminino , Felicidade , Humanos , Lactente , Masculino , Saúde Mental , Estigma Social , Tennessee , Adulto Jovem
15.
Radiat Res ; 186(6): 614-623, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27905869

RESUMO

Understanding the dose-toxicity profile of radiation is critical when evaluating potential health risks associated with natural and man-made sources in our environment. The purpose of this study was to evaluate the effects of low-dose whole-body high-energy charged (HZE) iron (Fe) ions and low-energy gamma exposure on proliferation and differentiation of adult-born neurons within the dentate gyrus of the hippocampus, cells deemed to play a critical role in memory regulation. To determine the dose-response characteristics of the brain to whole-body Fe-ion vs. gamma-radiation exposure, C57BL/6J mice were irradiated with 1 GeV/n Fe ions or a static 137Cs source (0.662 MeV) at doses ranging from 0 to 300 cGy. The neurogenesis was analyzed at 48 h and one month postirradiation. These experiments revealed that whole-body exposure to either Fe ions or gamma radiation leads to: 1. An acute decrease in cell division within the dentate gyrus of the hippocampus, detected at doses as low as 30 and 100 cGy for Fe ions and gamma radiation, respectively; and 2. A reduction in newly differentiated neurons (DCX immunoreactivity) at one month postirradiation, with significant decreases detected at doses as low as 100 cGy for both Fe ions and gamma rays. The data presented here contribute to our understanding of brain responses to whole-body Fe ions and gamma rays and may help inform health-risk evaluations related to systemic exposure during a medical or radiologic/nuclear event or as a result of prolonged space travel.


Assuntos
Raios gama/efeitos adversos , Ferro/efeitos adversos , Neurogênese/efeitos da radiação , Irradiação Corporal Total/efeitos adversos , Animais , Relação Dose-Resposta à Radiação , Proteína Duplacortina , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Fatores de Tempo
16.
J Neurosci ; 24(20): 4875-83, 2004 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-15152048

RESUMO

Human herpesvirus 6 (HHV-6), a common resident virus of the human CNS, has been implicated in both acute and chronic inflammatory--demyelinating diseases. Although HHV-6 persists within the human CNS and has been described to infect mature oligodendrocytes, nothing is known about the susceptibility of glial precursors, the ancestors of myelin-producing oligodendrocytes, to viral infection. We show that HHV-6 infects human glial precursor cells in vitro. Active infection was demonstrated by both electron microscopy and expression of viral gene transcripts and proteins, with subsequent formation of cell syncytia. Infection leads to alterations in cell morphology and impairment of cell replication but not increased cell death. Infected cells showed decreased proliferation as measured by bromodeoxyuridine uptake, which was confirmed by blunting of the cell growth rate of infected cells compared with uninfected controls over time. The detailed analysis using novel, fluorescent-labeled HHV-6A or HHV-6B reagents demonstrated strong G1/S phase inhibition in infected precursor cells. Cell cycle arrest in HHV-6-infected cells was associated with a profound decrease in the expression of the glial progenitor cell marker A2B5 and a corresponding increase in the oligodendrocyte differentiation marker GalC. These data demonstrate for the first time that infection of primary human glial precursor cells with a neurologically relevant human herpesvirus causes profound alterations of critical precursor cell properties. In light of recent observations that repair of CNS demyelination is dependent on the generation of mature oligodendrocytes from the glial precursor cell pool, these findings may have broad implications for both the ineffective repair seen in demyelinating diseases and the disruption of normal glial maturation.


Assuntos
Diferenciação Celular/fisiologia , Herpesvirus Humano 6/crescimento & desenvolvimento , Herpesvirus Humano 6/fisiologia , Neuroglia/virologia , Células-Tronco/virologia , Antígenos de Diferenciação/metabolismo , Bromodesoxiuridina/farmacocinética , Morte Celular/fisiologia , Divisão Celular/fisiologia , Células Cultivadas , Efeito Citopatogênico Viral/fisiologia , Fase G1/fisiologia , Humanos , L-Lactato Desidrogenase/metabolismo , Neuroglia/fisiologia , Neuroglia/ultraestrutura , Fase S/fisiologia , Células-Tronco/fisiologia , Células-Tronco/ultraestrutura
17.
Neurobiol Aging ; 24(3): 511-8, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12600726

RESUMO

With increasing age, there is a trend towards greater morbidity and injury extent with brain injury. Because several reports have suggested that microglia and astrocytes have an exacerbated response to brain injury in the aged, we set out to explore glial responses to facial nerve axotomy. This model was chosen because the glial responses are well-characterized in young rats and there is no perturbation of the blood-brain barrier (BBB). Immunohistochemistry was performed for glial fibrillary acidic protein (GFAP), leukocyte common antigen, type 3 complement receptor, and major histocompatability complex classes I and II. Quantitative analysis showed that age does not affect the glial response to axotomy in the lesioned facial nucleus; however, an aging-related contralateral effect with enhanced GFAP-labeling was observed. Interestingly, despite a lack of infiltrating neutrophils, a T cell influx was observed in both young and aged rats. Overall, these results suggest that neutrophil extravasion and BBB breakdown are underappreciated with regards to aging and injury exacerbation.


Assuntos
Astrócitos/patologia , Traumatismos do Nervo Facial/patologia , Nervo Facial/patologia , Microglia/patologia , Ponte/patologia , Envelhecimento/patologia , Animais , Axotomia/efeitos adversos , Barreira Hematoencefálica/fisiologia , Modelos Animais de Doenças , Nervo Facial/cirurgia , Traumatismos do Nervo Facial/fisiopatologia , Proteína Glial Fibrilar Ácida/análise , Masculino , Ratos , Ratos Endogâmicos F344
19.
J Neurotrauma ; 19(1): 1-15, 2002 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11852973

RESUMO

Cyclooxygenase (COX) is the obligate, rate-limiting enzyme for the conversion of arachidonic acid into prostaglandins. Two COX enzymes have been identified: a constitutively expressed COX-1 and an inducible, highly regulated COX-2. Widely used to treat chronic inflammatory disorders, COX inhibitors have shown promise in attenuating inflammation associated with brain injury. However, the use of COX inhibition in the treatment of brain injury has met with mixed success. This review summarizes our current understanding of COX expression in the central nervous system and the effects of COX inhibitors on brain injury. Three major targets for COX inhibition in the treatment brain injury have been identified. These are the cerebrovasculature, COX-2 expression by vulnerable neurons, and the neuroinflammatory response. Evidence suggests that given the right treatment paradigm, COX inhibition can influence each of these three targets. Drug interactions and general considerations for administrative paradigms are also discussed. Although therapies targeted to specific prostaglandin species, such as PGE2, might prove more ameliorative for brain injury, at the present time non-specific COX inhibitors and COX-2 specific inhibitors are readily available to researchers and clinicians. We believe that COX inhibition will be a useful, ameliorative adjunct in the treatment of most forms of brain injury.


Assuntos
Lesões Encefálicas/tratamento farmacológico , Lesões Encefálicas/metabolismo , Inibidores de Ciclo-Oxigenase/uso terapêutico , Animais , Humanos
20.
Postgrad Med ; 116(6): 15-6, 21-4, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15620124

RESUMO

For many years, hepatorenal syndrome was considered a uniformly and rapidly fatal complication of end-stage liver disease. Although the syndrome still carries a poor long-term prognosis, increased understanding of its hemodynamic derangements has led to new pharmacologic treatments that significantly improve short-term outcomes. In this article, Drs Tong, Hurley, and Hayashi discuss a case of remarkable reversal of hepatorenal syndrome with use of oral midodrine hydrochloride, subcutaneous octreotide acetate, and intravenous albumin. The authors highlight the great progress that has been made in this field and review new therapeutic options that are on the market or under study. It is important for physicians who are caring for patients with hepatorenal syndrome to know about and consider the available treatments before an approach of "supportive care only" is taken.


Assuntos
Albuminas/administração & dosagem , Fármacos Gastrointestinais/administração & dosagem , Síndrome Hepatorrenal/tratamento farmacológico , Midodrina/administração & dosagem , Octreotida/administração & dosagem , Vasoconstritores/administração & dosagem , Administração Oral , Adulto , Creatinina/sangue , Quimioterapia Combinada , Evolução Fatal , Hepatite Alcoólica/complicações , Síndrome Hepatorrenal/sangue , Síndrome Hepatorrenal/etiologia , Humanos , Infusões Intravenosas , Injeções Subcutâneas , Masculino
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