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1.
Eur Urol Oncol ; 2024 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-38262800

RESUMO

BACKGROUND AND OBJECTIVE: Growing evidence supports the use of neoadjuvant chemotherapy (NAC) for upper tract urothelial carcinoma (UTUC). However, the implications of residual UTUC at radical nephroureterectomy (RNU) after NAC are not well characterized. Our objective was to compare oncologic outcomes for pathologic risk-matched patients who underwent RNU for UTUC who either received NAC or were chemotherapy-naïve. METHODS: We retrospectively identified 1993 patients (including 112 NAC recipients) who underwent RNU for nonmetastatic, high-grade UTUC between 1985 and 2022 in a large, international, multicenter cohort. We divided the cohort into low-risk and high-risk groups defined according to pathologic findings of muscle invasion and lymph node involvement at RNU. Recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS) estimates were calculated using the Kaplan-Meier method. Multivariable analyses were performed to determine clinical and demographic factors associated with these outcomes. KEY FINDINGS AND LIMITATIONS: Among patients with low-risk pathology at RNU, RFS, OS, and CSS were similar between the NAC and chemotherapy-naïve groups. Among patients with high-risk pathology at RNU, the NAC group had poorer RFS (hazard ratio [HR] 3.07, 95% confidence interval [CI] 2.10-4.48), OS (HR 2.06, 95% CI 1.33-3.20), and CSS (subdistribution HR 2.54, 95% CI 1.37-4.69) in comparison to the pathologic risk-matched, chemotherapy-naïve group. Limitations include the lack of centralized pathologic review. CONCLUSIONS AND CLINICAL IMPLICATIONS: Patients with residual invasive disease at RNU after NAC represent a uniquely high-risk population with respect to oncologic outcomes. There is a critical need to determine an optimal adjuvant approach for these patients. PATIENT SUMMARY: We studied a large, international group of patients with cancer of the upper urinary tract who underwent surgery either with or without receiving chemotherapy beforehand. We identified a high-risk subgroup of patients with residual aggressive cancer after chemotherapy and surgery who should be prioritized for clinical trials and drug development.

3.
ACG Case Rep J ; 10(5): e01064, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37235002

RESUMO

Schistosomiasis is a parasitic infection endemic to sub-Saharan Africa. The severe form of disease, caused by deposition of Schistosoma eggs in the portal vein, is known as hepatosplenic schistosomiasis. We present a case of a 26-year-old woman with esophageal varices in the setting of hepatosplenic schistosomiasis. This patient underwent partial splenic artery embolization to treat thrombocytopenia secondary to splenic sequestration. After embolization and improvement of cell counts, the patient was successfully able to undergo variceal band ligation.

4.
BJU Int ; 131(2): 165-172, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-35835519

RESUMO

OBJECTIVE: To provide a narrative review of the major advances regarding ischaemia and functional recovery after partial nephrectomy (PN), along with the ongoing controversies. METHODS: Key articles reflecting major advances regarding ischaemia and functional recovery after PN were identified. Special emphasis was placed on contributions that changed perspectives about surgical management. Priority was also placed on randomized trials of off-clamp vs on-clamp cohorts. RESULTS: A decade ago, 'Every minute counts' was published, showing strong correlations between duration of ischaemia and development of acute kidney injury (AKI) and chronic kidney disease after clamped PN. This reinforced perspectives that ischaemia was the main modifiable factor that could be addressed to improve functional outcomes and helped spur efforts towards reduced or zero ischaemia PN. These approaches were associated with strong functional recovery and some peri-operative risk, although they were generally safe in experienced hands. Further research demonstrated that, when parenchymal volume changes were incorporated into the analyses, ischaemia lost statistical significance, and percent parenchymal volume saved proved to be the main determinant. Cold ischaemia was confirmed to be highly protective, and limited warm ischaemia also proved to be safe. The reconstructive phase of PN, with avoidance of parenchymal devascularization, appears to be most important for functional outcomes. Randomized trials of on-clamp vs off-clamp PN have shown minimal impact of ischaemia on functional recovery. CONCLUSIONS: The past decade has witnessed great progress regarding functional recovery after PN, with many lessons learned. However, there are still unanswered questions, including: What is the threshold of warm ischaemia at which irreversible ischaemic injury begins to develop? Are some cohorts at increased risk for AKI or irreversible ischaemic injury? and Which patients should be prioritized for zero-ischaemia PN?


Assuntos
Injúria Renal Aguda , Neoplasias Renais , Humanos , Rim/cirurgia , Neoplasias Renais/complicações , Nefrectomia/efeitos adversos , Isquemia Quente/efeitos adversos , Isquemia/cirurgia , Injúria Renal Aguda/etiologia , Taxa de Filtração Glomerular , Estudos Retrospectivos
5.
J Colloid Interface Sci ; 635: 12-22, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36577351

RESUMO

HYPOTHESIS: Recently, the anomalous shrinkage of surface-supported hyaluronate/poly-l-lysine (HA/PLL) microgels (µ-gels), which exceeds that reported for any other multilayer-based systems, has been reported [1]. The current study investigates the capability of these unique µ-gels for the encapsulation and retention of macromolecules, and proposes the shrinkage-driven assembly of biopolymer-based µ-gels as a novel tool for one-step surface biofunctionalization. EXPERIMENTS: A set of dextrans (DEX) and their charged derivatives - carboxymethyl (CM)-DEX and diethylaminoethyl (DEAE)-DEX - has been utilized to evaluate the effects of macromolecular mass and net charge on µ-gel shrinkage and macromolecule entrapment. µ-gels formation on the surface of silicone catheters exemplifies their potential to tailor biointerfaces. FINDINGS: Shrinkage-driven µ-gel formation strongly depends on the net charge and mass content of encapsulated macromolecules. Inclusion of neutral DEX decreases the degree of shrinkage several times, whilst charged DEXs adopt to the backbone of oppositely charged polyelectrolytes, resulting in shrinkage comparable to that of non-loaded µ-gels. Retention of CM-DEX in µ-gels is significantly higher compared to DEAE-DEX. These insights into the mechanisms of macromolecular entrapment into biopolymer-based µ-gels promotes fundamental understanding of molecular dynamics within the multilayer assemblies. Organization of biodegradable µ-gels at biomaterial surfaces opens avenues for their further exploitation in a diverse array of bioapplications.


Assuntos
Microgéis , Géis
6.
Urol Clin North Am ; 50(1): 31-38, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36424081

RESUMO

Increased understanding of molecular pathophysiology has led to the detection of clinically applicable biomarkers across medicine, which allow for minimally invasive detection, management, and monitoring of disease processes. Although biomarkers have traditionally played a more significant role in malignancy, these goals also pertain to benign disease. Herein, the authors review ongoing research into biomarker investigation and application in urethral stricture disease, benign prostatic hyperplasia, bladder outlet obstruction, and overactive bladder. No biomarkers for these entities are currently in clinical use; however, numerous physiologic pathways provide targets for current and future study.


Assuntos
Estreitamento Uretral , Bexiga Urinária Hiperativa , Humanos , Estreitamento Uretral/diagnóstico , Constrição Patológica , Biomarcadores
7.
Pharmaceutics ; 14(11)2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36432674

RESUMO

The coating of particles or decomposable cores with polyelectrolytes via Layer-by-Layer (LbL) assembly creates free-standing LbL-coated functional particles. Due to the numerous functions that their polymers can bestow, the particles are preferentially selected for a plethora of applications, including, but not limited to coatings, cargo-carriers, drug delivery vehicles and fabric enhancements. The number of publications discussing the fabrication and usage of LbL-assembled particles has consistently increased over the last vicennial. However, past literature fails to either mention or expand upon how these LbL-assembled particles immobilize on to a solid surface. This review evaluates examples of LbL-assembled particles that have been immobilized on to solid surfaces. To aid in the formulation of a mechanism for immobilization, this review examines which forces and factors influence immobilization, and how the latter can be confirmed. The predominant forces in the immobilization of the particles studied here are the Coulombic, capillary, and adhesive forces; hydrogen bonding as well as van der Waal's and hydrophobic interactions are also considered. These are heavily dependent on the factors that influenced immobilization, such as the particle morphology and surface charge. The shape of the LbL particle is related to the particle core, whereas the charge was dependant on the outermost polyelectrolyte in the multilayer coating. The polyelectrolytes also determine the type of bonding that a particle can form with a solid surface. These can be via either physical (non-covalent) or chemical (covalent) bonds; the latter enforcing a stronger immobilization. This review proposes a fundamental theory for immobilization pathways and can be used to support future research in the field of surface patterning and for the general modification of solid surfaces with polymer-based nano- and micro-sized polymer structures.

8.
Curr Urol Rep ; 23(11): 303-308, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36308672

RESUMO

PURPOSE OF REVIEW: To provide an overview of female urethral stricture disease and updates on surgical outcomes. RECENT FINDINGS: In a large retrospective case series, women reported significant improvements in urinary symptoms and quality of life following treatment of their urethral stricture. Both vaginal flap and buccal mucosal graft urethroplasty have higher short- and long-term success rates than urethral dilation. Female urethral stricture disease is rare and surgical reconstruction has the highest likelihood of long-term success. Due to the complexity of reconstruction, referral to a reconstructive trained urologist should be considered.


Assuntos
Estreitamento Uretral , Feminino , Humanos , Estreitamento Uretral/cirurgia , Qualidade de Vida , Estudos Retrospectivos
9.
Urol Clin North Am ; 49(3): 553-565, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35931443

RESUMO

Rectourethral fistula (RUF) and puboprostatic fistula (PPF) are potentially devastating complications that can develop after various pelvic insults, most notable treatment of prostate cancer. Both entities represent surgical challenges given the complex anatomy, risk of injury to adjacent structures, and poor tissue quality and wound healing. While extirpative surgery may be necessary for some patients, meticulous surgical dissection and interposition of healthy muscle allow for fistula repair in a high proportion of appropriately selected patients, especially in RUF. Herein the authors describe the nature, management, and outcomes of RUF and PPF with a full review of the literature.


Assuntos
Neoplasias da Próstata , Fístula Retal , Doenças Uretrais , Fístula Urinária , Humanos , Masculino , Neoplasias da Próstata/cirurgia , Fístula Retal/etiologia , Fístula Retal/cirurgia , Estudos Retrospectivos , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia
10.
Top Spinal Cord Inj Rehabil ; 28(3): 9-14, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36017125

RESUMO

Background: Despite the therapeutic advancements of the last several decades, neurogenic bladder remains a significant source of morbidity for patients with a spinal pathology. Oxybutynin is a mainstay of treatment in pediatric populations despite significant side effects and highly variable bioavailability. Objectives: To characterize the use of oxybutynin in a cohort of pediatric patients with neurogenic bladder. Methods: Retrospective data were collected of dosing, drug interactions, and urodynamics parameters in the 100 consecutive patients in a spinal differences clinic who had an appointment between October 7, 2015, and December 30, 2015. In addition to descriptive statistics, a linear regression model of oxybutynin dose versus age and sex was developed to examine the impact of age on dosing variability. Results: One hundred patients (52% female) with a median age of 6.8 years were included. The median daily dose of oxybutynin was 0.36 mg/kg (interquartile range, 0.28-0.54 mg/kg). Of the 48 patients with a recent urodynamics study, 13 had a detrusor leak point pressure (DLPP) greater than the typical cutoff of 40 cm H2O, indicating a need for management escalation. However, of these 13 patients, 38% were already on or exceeding oxybutynin's maximum recommended dose. Conclusion: The wide dosing variability and high DLPPs despite maximal dosing indicate a need for further investigation of oxybutynin's bioavailability in this population compared to its side effects and clinical outcomes. If variability in response to the medication is due to differences in bioavailability, then a precision-dosing model based on patient genomics could be developed for oxybutynin.


Assuntos
Traumatismos da Medula Espinal , Bexiga Urinaria Neurogênica , Criança , Feminino , Humanos , Masculino , Ácidos Mandélicos/efeitos adversos , Ácidos Mandélicos/uso terapêutico , Estudos Retrospectivos , Bexiga Urinaria Neurogênica/tratamento farmacológico , Urodinâmica
11.
Urology ; 164: 16-17, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35710167
12.
World J Urol ; 40(6): 1523-1528, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35384486

RESUMO

PURPOSE: To describe a single stage, glans-sparing urethroplasty technique for fossa navicularis strictures using a transurethral dorsal inlay buccal mucosa graft. METHODS: We conducted a retrospective review of a prospectively maintained urethral stricture database to identify all fossa navicularis strictures reconstructed with a single stage, transurethral dorsal inlay buccal mucosa graft urethroplasty (5/2015-6/2020). Primary outcomes were anatomic success, defined as the ability to pass a 17 Fr flexible cystoscope, and functional success, defined as the lack of obstructive voiding symptoms and no need for further procedures. Secondary outcomes were postoperative complications and patient satisfaction. RESULTS: Sixteen patients were included. Mean age was 63.1 years (43.9-75.6) and mean stricture length was 1.7 cm (1.4-2.0). Stricture etiology included internal trauma (62.5%), idiopathic (25.0%), and lichen sclerosus (12.5%). Prior endoscopic procedures were done in 75% of patients. Over a median follow-up of 28.8 months (IQR 17.6-38.0), anatomic success was 15/16 (93.8%) and functional success was 16/16 (100%). The single anatomic recurrence was at 4.2 months postoperatively. No additional procedures were required. Urinary tract infection occurred in 25% (4/16). There were no instances of de novo erectile dysfunction, chordee, or wound infection. All patients would recommend urethroplasty to others and all patients were either very satisfied (83.3%) or satisfied (16.7%) with the procedure. Penile sensitivity was unchanged in 83.3%, increased in 8.3% and decreased in 8.3%. CONCLUSION: Transurethral dorsal inlay buccal mucosa graft urethroplasty is a viable option for reconstruction of fossa navicularis strictures that avoids splitting the glans and results in excellent cosmesis.


Assuntos
Mucosa Bucal , Estreitamento Uretral , Constrição Patológica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/transplante , Estudos Retrospectivos , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
13.
Micromachines (Basel) ; 13(3)2022 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-35334765

RESUMO

Former studies have demonstrated a strong interest toward the crystallization of CaCO3 polymorphs in solution. Nowadays, CaCO3 crystallization on solid surfaces is extensively being studied using biomolecules as substrates for the control of the growth aiming at various applications of CaCO3. Calcium carbonate exists in an amorphous state, as three anhydrous polymorphs (aragonite, calcite and vaterite), and as two hydrated polymorphs (monohydrocalcite and ikaite). The vaterite polymorph is considered as one of the most attractive forms due to its large surface area, biocompatibility, mesoporous nature, and other features. Based on physical or chemical immobilization approaches, vaterite can be grown directly on solid surfaces using various (bio)molecules, including synthetic polymers, biomacromolecules such as proteins and peptides, carbohydrates, fibers, extracellular matrix components, and even biological cells such as bacteria. Herein, the progress on the modification of solid surfaces by vaterite CaCO3 crystals is reviewed, focusing on main findings and the mechanism of vaterite growth initiated by various substances mentioned above, as well as the discussion of the applications of such modified surfaces.

14.
Eur Urol ; 81(5): 492-500, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35058086

RESUMO

BACKGROUND: Most partial nephrectomies (PNs) are performed with hilar occlusion to reduce blood loss and optimize visualization. However, the histologic status of the preserved renal parenchyma years after PN is unknown. OBJECTIVE: To compare the histologic chronic kidney disease (CKD) score of renal parenchyma before and years after PN, and to explore factors associated with CKD-score increase and glomerular filtration rate (GFR) decline. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of 147 renal cell carcinoma patients who underwent PN and subsequent radical nephrectomy (RN) due to tumor recurrence was performed in 19 Chinese centers and Cleveland Clinic. Macroscopic normal renal parenchyma was evaluated at least 5 mm away from the tumor in PN specimens and at remote sites in RN specimens. INTERVENTION: PN/RN and ischemia. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Histologic CKD score (0-12) represents a summary of glomerular/tubular/interstitial/vascular status. Predictive factors for a substantial increase of CKD score (≥3) were evaluated by logistic regression. RESULTS AND LIMITATIONS: Sixty-five patients with all necessary data were analyzed. The median interval between PN and RN was 2.4 yr. Median durations of warm ischemia (n = 42) and hypothermia (n = 23) were both 23 min. The histologic CKD score was increased after RN in 47 (72%) patients, with 29 (45%) experiencing more substantial increase (≥3). There was no significant difference in the change of CKD score related to the type and duration of ischemia (p = 0.7 and p = 0.4, respectively) or interval from PN to RN (p > 0.9). However, patients with comorbidities of hypertension, diabetes, and/or pre-existing CKD (hypertension [HTN]/diabetes mellitus [DM]/CKD) demonstrated increased rate and extent of CKD-score increase. On univariate analysis, HTN/DM/CKD was the only predictor of a substantial CKD-score increase (odds ratio: 3.53 [1.12-11.1]). Decline of GFR was modest and similar between patients with/without a substantial CKD-score increase. CONCLUSIONS: Within the context of conventional, limited durations of ischemia, histologic deterioration of preserved parenchyma after PN appears to be primarily due to pre-existing medical comorbidities rather than ischemia. A subsequent decline in renal function was mild and independent of histologic changes. PATIENT SUMMARY: After clamped PN, the preserved renal parenchyma demonstrated histologic deterioration in many cases, which correlated with the presence of comorbidities such as hypertension, diabetes mellitus, or chronic kidney disease. In contrast, the type and duration of ischemia did not correlate with histologic changes after PN, suggesting that ischemia insult had only limited impact on parenchyma deterioration.


Assuntos
Carcinoma de Células Renais , Diabetes Mellitus , Hipertensão , Neoplasias Renais , Insuficiência Renal Crônica , Carcinoma de Células Renais/patologia , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/complicações , Isquemia/complicações , Isquemia/patologia , Rim/patologia , Rim/fisiologia , Rim/cirurgia , Neoplasias Renais/patologia , Masculino , Recidiva Local de Neoplasia/patologia , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Insuficiência Renal Crônica/diagnóstico , Estudos Retrospectivos
15.
Br J Ophthalmol ; 106(5): 623-627, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-33414244

RESUMO

PURPOSE: To evaluate the refractive accuracy of current intraocular lens (IOL) formulas and propose a modification in calculation of corneal power in eyes undergoing combined cataract extraction and Descemet membrane endothelial keratoplasty (DMEK). DESIGN: Retrospective cohort study. METHODS: Patients with Fuchs endothelial corneal dystrophy undergoing uncomplicated combined cataract surgery and DMEK at a single institution were included. The Hoffer Q, SRK/T, Holladay I, Barrett Universal II and Haigis formulas were compared. A modified corneal power was calculated using a thick lens equation based on anterior and posterior corneal radii and corneal thickness from Pentacam imaging. Error calculations were adjusted based on the difference in optical biometry and the modified corneal power. Mean absolute error (MAE) for each formula was compared between the corneal power modification and optical biometry corneal power. RESULTS: In 86 eyes, the mean error ranged from 0.90 D for the Barrett Universal II formula to -0.10 D for the Haigis formula, with 4 of 5 formulas resulting in a mean hyperopic error. The corneal power modification resulted in a significantly lower MAE for the Hoffer Q (0.82 D), Holladay I (0.85 D), SRK/T (0.85 D) and Barrett Universal II (0.90 D) formulas compared with optical biometry corneal power for the Hoffer Q (1.02 D; p<0.005), Holladay I (0.97 D; p<0.005), SRK/T (0.93 D; p<0.01) and Barrett Universal II (1.16 D; p<0.005) formulas. CONCLUSIONS: All formulas except the Haigis formula resulted in a hyperopic error. The corneal power modification significantly reduced error in four out of five IOL formulas.


Assuntos
Extração de Catarata , Transplante de Córnea , Hiperopia , Lentes Intraoculares , Facoemulsificação , Biometria/métodos , Lâmina Limitante Posterior , Humanos , Implante de Lente Intraocular/métodos , Óptica e Fotônica , Facoemulsificação/métodos , Refração Ocular , Estudos Retrospectivos
16.
Cornea ; 41(7): 833-839, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34369391

RESUMO

PURPOSE: The purpose of this study was to report trends in the prevalence of early graft failure after endothelial keratoplasty in the United States. METHODS: Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) graft volumes were collected from records maintained by 6 major eye banks in the United States from January 1, 2013, to December 31, 2018. The prevalence and presumed cause of early graft failures (defined as a graft with persistent edema or regrafted within 8 weeks after keratoplasty) each year were sourced from surgeon-reported adverse events. Failed graft cases from the 3 eye banks were compared with nonfailures at the donor and recipient levels to perform subset analysis of factors associated with early graft failure. RESULTS: A total of 51,887 endothelial keratoplasty tissues were distributed during the study period; 72% were DSAEK grafts. The total number of early graft failures reported was 168 of 14,284 (1.18%) for DMEK and 322 of 37,603 (0.86%) for DSAEK. Early DMEK failures decreased from 2013 (7.69%) to 2018 (0.68%). In generalized linear mixed model analyses adjusting for donor tissue characteristics, recipient age, and diagnosis, an association of borderline significance was found between higher donor age and early failure [odds ratio (95% confidence interval): 1.03 (1.00-1.05); unit change of 1 yr] and DSAEK [odds ratio 1.02 (1.00-1.04); unit of change 1 yr] cases. CONCLUSIONS: The proportion of early graft failures in DMEK decreased over time and was comparable with failure rates in DSAEK at the end of the study period. The surgical learning curve might have played a role.


Assuntos
Doenças da Córnea , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Doenças da Córnea/epidemiologia , Doenças da Córnea/etiologia , Doenças da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Endotélio Corneano , Sobrevivência de Enxerto , Humanos , Curva de Aprendizado , Razão de Chances , Estudos Retrospectivos , Estados Unidos/epidemiologia , Acuidade Visual
17.
Urology ; 164: 63-67, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34780846

RESUMO

OBJECTIVE: To provide the first nationwide characterization of the clinical learning environment in American urological training programs. MATERIALS AND METHODS: A survey was sent to program directors (PD) at American Urological Association-accredited urological training programs after requesting their email address from each program coordinator. The 21-question survey was designed to ascertain key components of each training environment: demographics, training model, clinic structure, and resident perception. RESULTS: The program coordinator of 131 American Urological Association-accredited training programs received an email for participation, yielding the PD email for 113 programs. 60/113 (53%) PDs responded to the survey. Residents participated in clinic at the following types of hospitals: Children's 51 (85%), County/Indigent 23 (38%), Private 29 (48%), University 56 (93%), Veterans Administration 38 (63%). Prevalence of clinical training models is presented in table 1. On average, PDs estimated their residents spend 2.6 half days in clinic each week (1-6). Thirteen programs (22%) reported a "clinic only" rotation, varying from 1 to 6 months total. PDs reported time constraint and schedule to be the biggest barrier to teaching in clinic and 40% felt residents see clinic as a valuable part of their training while 30% felt residents see clinic as a necessary exercise but with limitations to learning opportunities. CONCLUSION: We present the first characterization of resident participation in the clinical learning environment. Structure is highly variable and directed effort is necessary to move toward improved assessment and monitoring of resident competency in clinic.


Assuntos
Internato e Residência , Criança , Competência Clínica , Humanos , Inquéritos e Questionários , Estados Unidos
18.
Nanomaterials (Basel) ; 11(10)2021 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-34684943

RESUMO

One of the undeniable trends in modern bioengineering and nanotechnology is the use of various biomolecules, primarily of a polymeric nature, for the design and formulation of novel functional materials for controlled and targeted drug delivery, bioimaging and theranostics, tissue engineering, and other bioapplications. Biocompatibility, biodegradability, the possibility of replicating natural cellular microenvironments, and the minimal toxicity typical of biogenic polymers are features that have secured a growing interest in them as the building blocks for biomaterials of the fourth generation. Many recent studies showed the promise of the hard-templating approach for the fabrication of nano- and microparticles utilizing biopolymers. This review covers these studies, bringing together up-to-date knowledge on biopolymer-based multilayer capsules and beads, critically assessing the progress made in this field of research, and outlining the current challenges and perspectives of these architectures. According to the classification of the templates, the review sequentially considers biopolymer structures templated on non-porous particles, porous particles, and crystal drugs. Opportunities for the functionalization of biopolymer-based capsules to tailor them toward specific bioapplications is highlighted in a separate section.

19.
Ophthalmic Surg Lasers Imaging Retina ; 52(4): 200-206, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-34039185

RESUMO

BACKGROUND AND OBJECTIVE: To evaluate a novel measure of compliance, follow-up appointment delay, and assess its relationship with clinical and sociodemographic factors in patients undergoing treatment for diabetic macular edema (DME). PATIENTS AND METHODS: This is a comparative case series of patients treated for DME. The novel measure of compliance - the time in days from the intended day of return and actual day of return, or follow-up appointment delay - was studied and compared to a traditional measure: the percentage of visits missed. These were correlated with clinical and sociodemographic characteristics: best-corrected visual acuity, hemoglobin A1C percent (HbA1c), median household income, smoking status, type of insurance held, marital status, gender, and age. Univariate and multivariable analyses were conducted. RESULTS: One hundred fifty-five patients (212 eyes) were included in the study. The median times between recommended and actual appointments was 5.0 days (range: 2.0-14.0 days). The mean percentage of visits missed was 31.7% (± 13.3%). The two measures of compliance were positively associated, but the correlation was moderate (r = 0.44). Non-white race, lack of bilateral injections, and higher baseline HBA1c were significant predictors of a median time greater than 7 days between the intended and actual follow-up dates. CONCLUSIONS: The current study identified a novel method of measuring compliance of DME patients seen by retina specialists and has identified non-white race, lack for bilateral treatment, and poorer glycemic control as risk factors for noncompliance. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:200-206.].


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/terapia , Seguimentos , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Edema Macular/terapia , Retina , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual
20.
ACS Appl Mater Interfaces ; 13(2): 3259-3269, 2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33410679

RESUMO

The polymer layer-by-layer assembly is accounted among the most attractive approaches for the design of advanced drug delivery platforms and biomimetic materials in 2D and 3D. The multilayer capsules can be made of synthetic or biologically relevant (e.g., natural) polymers. The biopolymers are advantageous for bioapplications; however, the design of such "biocapsules" is more challengeable due to intrinsic complexity and lability of biopolymers. Until now, there are no systematic studies that report the formation mechanism for multilayer biocapsules templated upon CaCO3 crystals. This work evaluates the structure-property relationship for 16 types of capsules made of different biopolymers and proposes the capsule formation mechanism. The capsules have been fabricated upon mesoporous cores of vaterite CaCO3, which served as a sacrificial template. Stable capsules of polycations poly-l-lysine or protamine and four different polyanions were successfully formed. However, capsules made using the polycation collagen and dextran amine underwent dissolution. Formation of the capsules has been correlated with the stability of the respective polyelectrolyte complexes at increased ionic strength. All formed capsules shrink upon core dissolution and the degree of shrinkage increased in the series of polyanions: heparin sulfate < dextran sulfate < chondroitin sulfate < hyaluronic acid. The same trend is observed for capsule adhesiveness to the glass surface, which correlates with the decrease in polymer charge density. The biopolymer length and charge density govern the capsule stability and internal structure; all formed biocapsules are of a matrix-type, other words are microgels. These findings can be translated to other biopolymers to predict biocapsule properties.


Assuntos
Carbonato de Cálcio/química , Polímeros/química , Cápsulas , Composição de Medicamentos , Sistemas de Liberação de Medicamentos , Polieletrólitos/química , Porosidade
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