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1.
J Matern Fetal Neonatal Med ; 37(1): 2358385, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38887786

RESUMO

OBJECTIVE: The purpose of this study was to determine the factors that influence physician preference for type of hysterotomy incisions in gravidas with a singleton or twin pregnancy undergoing cesarean section under 28 weeks, and to assess factors that result in delivery complications, defined as either intraoperative dystocia or hysterotomy extension. We hypothesized that compared to those with non-cephalic presentations, gravidas with a presenting fetus in cephalic presentation would have higher rates of low-transverse cesarean section, and reduced rates of delivery complications with low-transverse hysterotomy. METHODS: This was a retrospective cohort chart analysis of 128 gravidas between 23 0/7 and 27 6/7 weeks undergoing cesarean section at a single academic institution between August 2010 and December 2022. Data was abstracted for factors that might influence the decision for hysterotomy incision type, as well as for documentation of difficulty with delivery of the fetus or need for hysterotomy extension to affect delivery. RESULTS: There was a total of 128 subjects, 113 with a singleton gestation and 15 with twins. The presenting fetus was in cephalic presentation in 43 (33.6%), breech presentation in 71 (55.5%), transverse/oblique lie in 13 (10.2%), and not documented in 1 (0.8%). Sixty-eight (53.1%) had a low-transverse cesarean section (LTCS), 53 (41.4%) had a Classical, 5 (3.9%) had a low-vertical hysterotomy and 2 (1.6%) had a mid-transverse incision. There was a significantly higher rate of LTCS among gravidas with the presenting fetus in cephalic presentation (30/43, 69.8%) compared to those with breech (31/71, 43.7%) or transverse/oblique presentations (7/13, 53.8%), p = .03. No other significant associations were related to hysterotomy incision, including nulliparity, racially or ethnically minoritized status, plurality, indication for cesarean delivery, or pre-cesarean labor. Twenty (15.6%) subjects experienced either an intraoperative dystocia or hysterotomy extension. For the entire cohort, there was a greater median cervical dilatation in those with delivery complications (4.0 cm, IQR .5 - 10 cm) compared to those without complications (1.5, IQR 0 - 4.0), p = .03, but no significant association between delivery complications and fetal presentation, hysterotomy type, plurality, or other demographic/obstetrical factors. However, among gravidas undergoing low-transverse cesarean section, only 2/30 (6.7%) with cephalic presentations had a delivery complication, compared to 9/31 (29.0%) with breech presentations and 3/7 (42.9%) with a transverse/oblique lie, p = .03. CONCLUSION: In pregnancies under 28 weeks, the performance of a low-transverse cesarean section was significantly associated only with presentation of the presenting fetus. Among those with cephalic presentations, the rate of intrapartum dystocia or hysterotomy extension was low after a low-transverse hysterotomy, suggesting that in this subgroup, a low-transverse cesarean section should be considered.


Assuntos
Cesárea , Histerotomia , Humanos , Feminino , Gravidez , Cesárea/estatística & dados numéricos , Cesárea/métodos , Estudos Retrospectivos , Histerotomia/métodos , Histerotomia/efeitos adversos , Adulto , Gravidez de Gêmeos , Idade Gestacional , Apresentação Pélvica/cirurgia , Apresentação no Trabalho de Parto
3.
Conserv Biol ; 38(3): e14235, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38155500

RESUMO

The European Union Biodiversity Strategy 2030 (EUBDS) aims to regain biodiversity through enhanced forest conservation and protection, which may lead to increased timber harvest in non-EU countries. We aimed to identify the potential leakage of biodiversity risks as induced by the EUBDS. We created an indicator framework that allows one to quantify vulnerability of forest biodiversity. The framework is based on 26 biodiversity indicators for which indicator values were publicly available. We weighted single indicator values with countrywise modeled data on changed timber production under EUBDS implementation. Nearly 80% of the indicators pointed to higher vulnerability in the affected non-EU countries. Roundwood production was transferred to countries with, on average, lower governance quality (p = 0.0001), political awareness (p = 0.548), forest coverage (p = 0.034), and biomass (p = 0.272) and with less sustainable forest management (p = 0.044 and p = 0.028). These countries had more natural habitats (p = 0.039) and intact forest landscapes (p = 0.0001) but higher risk of species extinction (p = 0.006) and less protected area (p = 0.0001) than the EU countries. Only a few indicators pointed to lower vulnerability and biodiversity risks outside the EU. Safeguards are needed to ensure that implementation of EUBDS does not cause harm to ecosystems elsewhere. The EU regulation on deforestation-free supply chains might have limited effects because the sustainable management of existing and even expanding forests is not well considered. Sustained roundwood production in the EU is needed to avoid placing more pressure on more vulnerable ecosystems elsewhere. Decreasing species and habitat indicator values nevertheless call for global conservation and protection schemes. The EUBDS helped pave the way to the Kunming-Montreal Biodiversity Framework. Yet, lower values for the indicators mean governance and biodiversity engagement in non-EU countries suggest that this global framework might not sufficiently prevent leakage of risks to biodiversity. Effective land-use planning is necessary to balance conservation schemes with roundwood production.


Evaluación de la fuga de riesgos para la biodiversidad bajo la Estrategia de la Unión Europea sobre Biodiversidad 2030 Resumen La Estrategia de la Unión Europea sobre Biodiversidad 2030 (EEUSBD) busca recuperar la biodiversidad por medio de mejoras en la conservación y protección forestal, lo que podría derivar en un incremento en la producción maderera en los países que no pertenecen a la UE. Buscamos identificar la posible fuga de riesgos para la biodiversidad inducida por la EEUSBD. Creamos un marco indicador que permita cuantificar la vulnerabilidad de la biodiversidad forestal. El marco se basa en 26 indicadores de biodiversidad cuyos valores están disponibles al público. Ponderamos los valores de los indicadores individuales con datos modelados por países sobre los cambios en la producción maderera tras la aplicación de la EEUSBD. Casi el 80% de los indicadores señalaron un aumento de la vulnerabilidad en los países afectados que no pertenecen a la UE. La extracción forestal se transfirió a países que en promedio tienen menor calidad de gobierno (p = 0.0001), conciencia política (p = 0.548), cobertura forestal (p = 0.034) y biomasa (p = 0.272) y con un manejo forestal menos sustentable (p = 0.044 y p = 0.028). Estos países tienen más hábitats naturales (p = 0.039) y paisajes forestales intactos (p = 0.0001) pero un riesgo más elevado de extinción de especies (p = 0.006) y un área menos protegida (p = 0.0001) que los países de la UE. Sólo unos cuantos indicadores señalaron una reducción en la vulnerabilidad y los riesgos para la biodiversidad fuera de la UE. Se requieren salvaguardas para asegurar que la implementación de la EEUSBD no dañe los ecosistemas en otras partes. La regulación de la UE sobre las cadenas de producción libres de deforestación podría tener efectos limitados pues no se considera correctamente el manejo sustentable del bosque existente o en expansión. También se requiere una extracción forestal sostenida en la UE para evitar una mayor presión sobre otros ecosistemas vulnerables en otras localidades. Sin embargo, la reducción en los valores de los indicadores de especies y hábitat exige esquemas mundiales de conservación y protección. La EEUSBD ayudó a trazar el camino para el Marco Mundial de Biodiversidad de Kunming­Montreal, sin embargo, los valores más bajos de los indicadores de gobernanza y compromiso con la biodiversidad en países no pertenecientes a la UE sugieren que este marco global podría no prevenir efectivamente las fugas de riesgos para la biodiversidad. Es necesario planear eficientemente el uso de suelo para balancear los esquemas de conservación con la extracción forestal.


监测区域保护的治理和管理有效性早已被视为实现国家和全球生物多样性目标和实现适应性管理的重要基础。然而, 保护行动者(包括受治理和管理系统影响的人们)在实施保护活动和计划, 以及收集和利用治理和管理数据为跨时空尺度的决策提供信息的过程中, 仍面临重重阻碍。本文探讨了当前和过去为评估治理和管理有效性所做的努力、行动者在使用产出数据时面临的阻碍, 以及为保护决策提供信息的洞见。为了帮助克服这些阻碍, 我们开发了Elinor这一免费开源监测工具, 该工具以诺贝尔奖获得者Elinor Ostrom的研究成果为基础, 旨在促进不同治理和管理类型区域跨空间尺度的环境治理和管理数据的收集、存储、共享、分析和使用。本文介绍了与保护科学家和实践者共同设计和试用Elinor的过程, 以及其评估和在线数据系统的主要组成部分。我们还考虑了Elinor如何对现有方法进行补充, 包括:在单一评估中高水平地处理不同类型区域保护的治理和管理问题, 为数据收集提供灵活的选择, 以及整合数据系统与评估来支持不同空间尺度的数据使用和共享, 包括对《全球生物多样性框架》的全球监测。虽然挑战持续存在, 但Elinor的开发过程和工具本身为克服系统性收集和使用治理与管理数据中面临的阻碍提供了切实的解决方案。随着Elinor被更广泛地采用, 它将在实现更有效、更包容和更长期的基于区域的保护中发挥宝贵作用。【翻译:胡怡思;审校:聂永刚】.


Assuntos
Biodiversidade , Conservação dos Recursos Naturais , União Europeia , Conservação dos Recursos Naturais/métodos , Florestas , Agricultura Florestal
4.
J Assist Reprod Genet ; 40(8): 1925-1932, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37410222

RESUMO

PURPOSE: To evaluate and quantify the character and amount of lesbian, gay, bisexual, transgender, and queer (LGBTQ +) content on sperm, oocyte, and embryo provider websites in the USA. METHODS: Websites with LGBTQ + information were categorized into "minimal," "moderate," and "significant" content. The presence and type (category) of LGBTQ + content were assessed in its relationship to geographic regions, in vitro fertilization (IVF) cycles/year, and website types. Interobserver reliability was assessed for the categorization system created. RESULTS: Out of 373 unique websites, 191 (51.2%) had LGBTQ + content of any kind. Regarding the amount of content, websites were categorized as "none" (48.8%), "minimal" (8.0%), "moderate" (28.4%), and "significant" (14.8%). "Private fertility clinic" websites were more likely to have LGBTQ + content and a significantly increased amount of content compared to other website types ("academic hospital" and "sole sperm, oocyte, and embryo provider" websites) (p < 0.0001). Fertility clinics with more IVF cycles/year were more likely to have increased amount of LGBTQ + content compared to those with fewer IVF cycles/year (OR = 4.280; 95% CI, 1.952-9.388). Northeast, West, South, and Midwest regions showed no statistically significant difference in presence and type of content (p = 0.06 and p = 0.13, respectively). CONCLUSION: Approximately half of websites had LGBTQ + content. Private fertility clinics and fertility clinics with increased IVF cycles/year show a positive relationship to the presence and type of LGBTQ + content, while LGBTQ + website content was similar across four geographic regions.


Assuntos
Minorias Sexuais e de Gênero , Pessoas Transgênero , Masculino , Humanos , Reprodutibilidade dos Testes , Sêmen , Oócitos
5.
Sci Rep ; 13(1): 2180, 2023 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-36750712

RESUMO

Cross-scale studies combining information on policy instruments and on drivers of deforestation and forest degradation are key to design and implement effective forest protection measures. We investigated the scale and country dependency of stakeholder perceptions about future threats to tropical forests (e.g. agriculture, logging, woodfuel) and preferred policy instruments (e.g. reforestation, protected areas, combat illegal logging), by interviewing 224 representatives of forest-related institutions. We conducted analysis of variance and principal component analysis for eighteen variables across three countries (Zambia, Ecuador and the Philippines) and four spatial levels (from international to local). We found that the overall alertness about commercial drivers and the confidence in policy instruments are significantly lower at subnational levels and also in Zambia. Stakeholder expectations about the most important drivers and the most effective policies in the coming decade follow regional narratives, suggesting that there are no one-size-fits-all solutions in international forest policy. However, we found an unexpected consensus across scales, indicating potential for collaboration between institutions operating at different geographical levels. Overall, agriculture remains the driver with the highest expected influence (43%), while a strong favoritism for reforestation and forest restoration (38%) suggests a paradigm shift from protected areas to a stronger focus on integrative approaches.


Assuntos
Conservação dos Recursos Naturais , Florestas , Agricultura , Política Pública , Zâmbia
6.
J Matern Fetal Neonatal Med ; 35(25): 9277-9281, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35016588

RESUMO

OBJECTIVE: To determine an optimal timing strategy for rescue corticosteroids in gravidas with preterm prelabor rupture of membranes (PPROM) prior to 33 0/7 weeks. METHODS: This was a retrospective cohort analysis of 109 gravidas with a singleton gestation and PPROM between 23 0/7 and 32 6/7 weeks who delivered at a single inner city tertiary care center. The time of the actual first dose of corticosteroids was chosen as Time 0. The date and time of labor onset, chorioamnionitis, heavy bleeding, cord prolapse, or fetal heart rate decelerations warranting delivery were recorded, as well as the date and time of delivery. We then compared hypothetical timing strategies for administration of the rescue course of corticosteroids at either 1, 2, or 3 weeks after the first course if still undelivered, compared to a strategy of withholding the rescue course until the recognition of spontaneous labor or the need for delivery. For each strategy, we calculated the percentage of gravidas who would have delivered within the optimal window after rescue course corticosteroids, defined as delivery at 24 h to 7 days from the first rescue dose. RESULTS: The median time from PPROM to delivery among the 109 gravidas was 8.9 days (interquartile range 4.4-17.9 days). Forty-eight (44%) gravidas delivered within the first week after initial corticosteroid administration, leaving 61 (56%) eligible for a rescue dose. In our hypothetical models, the strategy of giving rescue corticosteroids at either 1, 2, or 3 weeks from the first course would have resulted in 34.4%, 23.0%, and 19.7% of infants being born at 24 h to 7 days after the first rescue dose, respectively. These differences among the three groups or between any two groups were not statistically significant. However, all fixed interval strategies were statistically superior to the strategy of waiting for spontaneous labor or the need for delivery, in which only 4.9% would have delivered within the optimal window. CONCLUSION: In gravidas with PPROM prior to 33 0/7 weeks, giving rescue corticosteroids at a fixed interval of either 1, 2, or 3 weeks after the first course would result in a greater percentage of infants being born within the optimal 24 h to 7 day window compared to administering the rescue course at the onset of labor, infection, bleeding, or abnormal fetal heart rate tracing.


Assuntos
Ruptura Prematura de Membranas Fetais , Nascimento Prematuro , Recém-Nascido , Gravidez , Lactente , Feminino , Humanos , Estudos Retrospectivos , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Corticosteroides/uso terapêutico
8.
Nanoscale ; 13(35): 15038-15047, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34533180

RESUMO

Nanoparticles (NPs) of Pd1--xGax (x = 0.67, 0.5, 0.33), stabilized in non-aqueous colloidal solution, were obtained via an organometallic approach under mild conditions using [Pd2(dvds)3] and GaCp* as all-hydrocarbon ligated metal-precursor compounds (dvds = 1,1,3,3-tetramethyl-1,3-divinyl-disiloxane; Cp* = η5-C5Me5; Me = CH3). The reaction of the two precursors involves the formation of a library of molecular clusters [PdnGamCp*y(dvds)z], as shown by liquid injection field desorption ionization mass spectrometry (LIFDI-MS). Full characterization of the catalytic system (HR-TEM, EDX, DLS, PXRD, XPS, NMR, IR, Raman) confirmed the formation of ultra-small, spherical NPs with narrow size distributions ranging from 1.2 ± 0.2 nm to 2.1 ± 0.4 nm (depending on the Pd : Ga ratio). The catalytic performance of the Pd1--xGax NPs in the semi-hydrogenation of terminal and internal alkynes and the influence of the gallium content on product selectivity were investigated. The highest activities (65%) and selectivities (81%) are achieved using colloids with a "stoichiometric" Pd/Ga ratio of 1 : 1 at 0 °C and 2.0 bar H2 pressure. While lower Ga ratios lead to an increase in activity, higher Ga contents increase the olefin selectivity but are detrimental to the activity.

9.
Ther Adv Med Oncol ; 13: 1758835920980558, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33613692

RESUMO

INTRODUCTION: We report on the results of the German early access program (EAP) with the third-generation ALK- and ROS1-inhibitor lorlatinib. PATIENTS AND METHODS: Patients with documented treatment failure of all approved ALK/ROS1-specific therapies or with resistance mutations not covered by approved inhibitors or leptomeningeal carcinomatosis were enrolled and analyzed. RESULTS: In total, 52 patients were included [median age 57 years (range 32-81), 54% female, 62% never smokers, 98% adenocarcinoma]; 71% and 29% were ALK- and ROS1-positive, respectively. G1202R and G2032R resistance mutations prior to treatment with lorlatinib were observed in 10 of 26 evaluable patients (39%), 11 of 39 patients showed TP53 mutations (28%). Thirty-six patients (69%) had active brain metastases (BM) and nine (17%) leptomeningeal carcinomatosis when entering the EAP. Median number of prior specific TKIs was 3 (range 1-4). Median duration of treatment, progression-free survival (PFS), response rate and time to treatment failure were 10.4 months, 8.0 months, 54% and 13.0 months. Calculated 12-, 18- and 24-months survival rates were 65, 54 and 47%, overall survival since primary diagnosis (OS2) reached 79.6 months. TP53 mutations were associated with a substantially reduced PFS (3.7 versus 10.8 month, HR 3.3, p = 0.003) and were also identified as a strong prognostic biomarker (HR for OS2 3.0 p = 0.02). Neither prior treatments with second-generation TKIs nor BM had a significant influence on PFS and OS. CONCLUSIONS: Our data from real-life practice demonstrate the efficacy of lorlatinib in mostly heavily pretreated patients, providing a clinically meaningful option for patients with resistance mutations not covered by other targeted therapies and those with BM or leptomeningeal carcinomatosis.

12.
Radiol Case Rep ; 14(9): 1069-1071, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31320963

RESUMO

A fetal growth scan was performed on a 34-year-old Caucasian woman, G4P3, with a history of gestational diabetes diagnosed at 32 weeks gestation. The examination revealed an absence of normal left globe with an echogenic mass in its expected location with a rim of surrounding hypoechoic fluid. The right orbit and globe were normal, and no other structural anomalies were identified. Prior to this examination, the patient had a normal anatomic survey and fetal echocardiogram at 20 weeks, however due to fetal positioning there was limited visualization of the orbits on initial scan. Fetal MRI was performed at 36 weeks gestation and confirmed near-complete absence of the left globe with asymmetrically smaller size of the left orbit. Normal right orbit and globe were present, and no additional fetal structural abnormalities were observed. Figure 1 congenital microphthalmia was diagnosed based on the imaging findings, preparing the family and alerting the medical team of appropriate care needed postnatally.

13.
J Matern Fetal Neonatal Med ; 31(7): 907-913, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28320237

RESUMO

OBJECTIVE: To compare the rates of successful induction of labor during three one-year periods over 20 years at a single institution. METHODS: All women at 37 weeks or beyond with a living, singleton, cephalic fetus admitted for induction of labor in 1992, 2002, and 2012 were included. The use of induction agents and rates of successful vaginal delivery were compared. RESULTS: A total of 627 women were evaluated, 219 in 1992, 220 in 2002, and 188 in 2012. Various induction agents were employed over the 20 year period. However, the rates of successful vaginal deliveries did not significantly vary over the three time periods, 79.5% in 1992, 72.3% in 2002, 76.1% in 2012, p = .21. In subgroup analysis, no significant differences were found among women with one or more prior vaginal delivery, no prior vaginal delivery, or after excluding those with a prior cesarean section. In multiple variable logistic regression analysis, no induction agent besides amniotomy improved successful vaginal delivery rates. CONCLUSIONS: Despite the multiple induction agents available at our tertiary care institution over the past 20 years, we were unable to demonstrate any significant improvement in successful vaginal delivery rates after induction of labor.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Trabalho de Parto Induzido/estatística & dados numéricos , Adulto , Parto Obstétrico/métodos , Feminino , Humanos , Trabalho de Parto Induzido/métodos , Ocitócicos , Gravidez , Resultado da Gravidez , Análise de Regressão , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
14.
Appl Opt ; 54(31): F201-9, 2015 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-26560609

RESUMO

In this article, we review and discuss the research programs at the Naval Research Laboratory (NRL) on high-power lasers for directed-energy (DE) applications in the atmosphere. Physical processes affecting propagation include absorption/scattering, turbulence, and thermal blooming. The power levels needed for DE applications require combining a number of lasers. In atmospheric turbulence, there is a maximum intensity that can be placed on a target that is independent of the initial beam spot size and laser beam quality. By combining a number of kW-class fiber lasers, scientists at the NRL have successfully demonstrated high-power laser propagation in a turbulent atmosphere and wireless recharging. In the NRL experiments, four incoherently combined fiber lasers having a total power of 5 kW were propagated to a target 3.2 km away. These successful high-power experiments in a realistic atmosphere formed the basis of the Navy's Laser Weapon System. We compare the propagation characteristics of coherently and incoherently combined beams without adaptive optics. There is little difference in the energy on target between coherently and incoherently combined laser beams for multi-km propagation ranges and moderate to high levels of turbulence. Unlike incoherent combining, coherent combining places severe constraints on the individual lasers. These include the requirement of narrow power spectral linewidths in order to have long coherence times as well as polarization alignment of all the lasers. These requirements are extremely difficult for high-power lasers.

15.
J Raptor Res ; 49(3): 259-268, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26392679

RESUMO

We analyzed counts from the annual Midwinter Bald Eagle Survey to examine state, regional, and national trends in counts of wintering Bald Eagles (Haliaeetusleucocephalus) within the conterminous 48 United States from 1986 to 2010. Using hierarchical mixed model methods, we report trends in counts from 11,729 surveys along 844 routes in 44 states. Nationwide Bald Eagle counts increased 0.6% per yr over the 25-yr period, compared to an estimate of 1.9% per yr from 1986 to 2000. Trend estimates for Bald Eagles were significant (P≤0.05) and positive in the northeastern and northwestern U.S. (3.9% and 1.1%, respectively), while trend estimates for Bald Eagles were negative (P≤0.05) in the southwestern U.S. (-2.2%). After accounting for potential biases resulting from temporal and regional differences in surveys, we believe trends reflect post-DDT recovery and subsequent early effects of density-dependent population regulation.

16.
J Orthop Trauma ; 29(1): 60-8, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25186842

RESUMO

OBJECTIVE: To report and compare the clinical and radiographic outcomes of patients treated with reverse shoulder arthroplasty (RSA) or hemiarthroplasty for acute complex proximal humeral fractures. DATA SOURCES: A systematic review of PubMed, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, and Cochrane Central Register of Controlled Trials was conducted. All published English language studies before January 2014 were reviewed for possible inclusion. Search terms included the following: proximal humerus, fracture, arthroplasty, hemiarthroplasty, RSA, and reverse total shoulder arthroplasty. STUDY SELECTION: Studies reporting outcomes in human subjects after either RSA or hemiarthroplasty for acute proximal humeral fractures were assessed for inclusion. Additional inclusion criteria included a minimum clinical follow-up of 1 year. Level V evidence, basic science/cadaveric studies, and those studies reporting outcomes after revision arthroplasty were excluded. DATA EXTRACTION: Patient demographics, clinical/radiographic outcomes, and complications were recorded. Posttreatment weighted means were calculated and reported. Homogenous outcome measures were analyzed, and a direct comparison of outcomes between treatment groups was performed. CONCLUSIONS: Patients treated with RSA possess improved forward flexion (RSA: 118 degrees, Hemi: 108 degrees) but decreased external rotation (RSA: 20 degrees, Hemi: 30 degrees) compared with patients undergoing hemiarthroplasty after acute proximal humeral fracture. No significant clinical difference in either American Shoulder and Elbow Surgeons Shoulder Score (RSA: 64.7, Hemi: 63.0) or Constant score (RSA: 54.6, Hemi: 58.0) was identified. RSA was associated with an increased rate of clinical complications (9.6%) and a lower revision rate (0.93%) at short-term to midterm follow-up compared with hemiarthroplasty. RSA offers an acceptable surgical option for patients after complex acute proximal humeral fractures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artroplastia de Substituição , Hemiartroplastia , Fraturas do Ombro/cirurgia , Articulação do Ombro/cirurgia , Humanos
17.
Leuk Lymphoma ; 56(3): 694-702, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24937122

RESUMO

Today's treatment options for indolent lymphoma and chronic lymphocytic leukemia (CLL) range from watch & wait, immunochemotherapy up to allogeneic transplantation. We describe changes in the diagnosis and treatment of indolent lymphoma and CLL in Germany between 2006 and 2009. Two nation-wide surveys in the fourth quarter of 2006 and 2009 included patients with indolent lymphoma and CLL. Data from 576 patients from 46 centers in Q4/2006 were compared with data from 521 patients from 57 centers in Q4/2009. The subpopulation of patients ≥ 70 years of age and the number of patients with comorbidities increased from 39% to 55% and 47% to 55%, respectively. Both in indolent lymphoma and CLL, Rituximab and R-based immunochemotherapy (50.6% vs. 64.4%) as well as bendamustine (4.8 % vs. 24%) were much more frequently applied. In contrast, high dose chemotherapy consolidation was almost abandoned in first line treatment. Supportive care is given more frequently, with exception of erythropoietin and immunoglobulins. Our national survey confirmed that scientific results were rapidly transferred into clinical care of indolent lymphoma.


Assuntos
Leucemia Linfocítica Crônica de Células B/diagnóstico , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Antineoplásicos Alquilantes/uso terapêutico , Cloridrato de Bendamustina/uso terapêutico , Feminino , Alemanha , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rituximab/uso terapêutico , Adulto Jovem
18.
J Matern Fetal Neonatal Med ; 28(16): 1901-6, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25293840

RESUMO

OBJECTIVE: To determine the optimal time for initiating group B streptococcus (GBS) antibiotic prophylaxis for women in spontaneous preterm labor. METHODS: In total, 227 women delivering singleton infants after presenting with spontaneous preterm labor and intact membranes at 24 0/7-36 6/7 weeks were evaluated, as well as 150 undelivered women with threatened preterm labor during the same time period. The date and time of each cervical examination throughout labor were recorded. We calculated the percentages who would have correctly received at least 4 h of GBS prophylaxis if antibiotics were routinely initiated for various cervical dilatation thresholds during labor, as well as the percentage of undelivered women who would have received unnecessary antibiotic exposure at each cervical dilatation cutoff. RESULTS: Delaying antibiotics until cervical dilatation reached 2 cm or greater would have resulted in 62.1% receiving four or more hours of antibiotics, compared to 66.5% if antibiotics were started on all women at admission (p = 0.33), while significantly reducing unnecessary antibiotic exposure in undelivered women from 100% to 62.0% (p < 0.001). The 2-cm threshold was applicable regardless of gestational age period or prior vaginal delivery ≥ 20 weeks. CONCLUSIONS: GBS antibiotic prophylaxis may reasonably be withheld for women with suspected preterm labor until the cervix reaches 2 cm or greater at any time during labor.


Assuntos
Antibioticoprofilaxia/métodos , Prescrição Inadequada/prevenção & controle , Primeira Fase do Trabalho de Parto , Trabalho de Parto Prematuro/tratamento farmacológico , Complicações Infecciosas na Gravidez/prevenção & controle , Infecções Estreptocócicas/prevenção & controle , Streptococcus agalactiae , Adulto , Antibacterianos/uso terapêutico , Esquema de Medicação , Feminino , Humanos , Prescrição Inadequada/estatística & dados numéricos , Trabalho de Parto Prematuro/diagnóstico , Gravidez , Estudos Retrospectivos
19.
Mol Ecol ; 23(22): 5628-44, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25277863

RESUMO

Ectomycorrhizal fungi are major ecological players in temperate forests, but they are rarely used in measures of forest condition because large-scale, high-resolution, standardized and replicated belowground data are scarce. We carried out an analysis of ectomycorrhizas at 22 intensively monitored long-term oak plots, across nine European countries, covering complex natural and anthropogenic environmental gradients. We found that at large scales, mycorrhizal richness and evenness declined with decreasing soil pH and root density, and with increasing atmospheric nitrogen deposition. Shifts in mycorrhizas with different functional traits were detected; mycorrhizas with structures specialized for long-distance transport related differently to most environmental variables than those without. The dominant oak-specialist Lactarius quietus, with limited soil exploration abilities, responds positively to increasing nitrogen inputs and decreasing pH. In contrast, Tricholoma, Cortinarius and Piloderma species, with medium-distance soil exploration abilities, show a consistently negative response. We also determined nitrogen critical loads for moderate (9.5-13.5 kg N/ha/year) and drastic (17 kg N/ha/year) changes in belowground mycorrhizal root communities in temperate oak forests. Overall, we generated the first baseline data for ectomycorrhizal fungi in the oak forests sampled, identified nitrogen pollution as one of their major drivers at large scales and revealed fungi that individually and/or in combination with others can be used as belowground indicators of environmental characteristics.


Assuntos
Florestas , Micorrizas/fisiologia , Quercus/microbiologia , Microbiologia do Solo , Europa (Continente) , Concentração de Íons de Hidrogênio , Dados de Sequência Molecular , Nitrogênio/química , Raízes de Plantas/crescimento & desenvolvimento , Raízes de Plantas/microbiologia , Solo/química , Árvores/microbiologia
20.
Environ Pollut ; 194: 171-180, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25118942

RESUMO

Defoliation is an indicator for forest health in response to several stressors including air pollutants, and one of the most important parameters monitored in the International Cooperative Programme on Assessment and Monitoring of Air Pollution Effects on Forests (ICP Forests). The study aims to estimate crown defoliation in 2030, under three climate and one nitrogen deposition scenarios, based on evaluation of the most important factors (meteorological, nitrogen deposition and chemical soil parameters) affecting defoliation of twelve European tree species. The combination of favourable climate and nitrogen fertilization in the more adaptive species induces a generalized decrease of defoliation. On the other hand, severe climate change and drought are main causes of increase in defoliation in Quercus ilex and Fagus sylvatica, especially in Mediterranean area. Our results provide information on regional distribution of future defoliation, an important knowledge for identifying policies to counteract negative impacts of climate change and air pollution.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/estatística & dados numéricos , Mudança Climática , Florestas , Nitrogênio/análise , Árvores/fisiologia , Poluentes Atmosféricos/toxicidade , Secas , Nitrogênio/toxicidade , Árvores/efeitos dos fármacos
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