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1.
J Physiol ; 602(9): 1893-1910, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38615232

RESUMEN

Dysferlin is a 237 kDa membrane-associated protein characterised by multiple C2 domains with a diverse role in skeletal and cardiac muscle physiology. Mutations in DYSF are known to cause various types of human muscular dystrophies, known collectively as dysferlinopathies, with some patients developing cardiomyopathy. A myriad of in vitro membrane repair studies suggest that dysferlin plays an integral role in the membrane repair complex in skeletal muscle. In comparison, less is known about dysferlin in the heart, but mounting evidence suggests that dysferlin's role is similar in both muscle types. Recent findings have shown that dysferlin regulates Ca2+ handling in striated muscle via multiple mechanisms and that this becomes more important in conditions of stress. Maintenance of the transverse (t)-tubule network and the tight coordination of excitation-contraction coupling are essential for muscle contractility. Dysferlin regulates the maintenance and repair of t-tubules, and it is suspected that dysferlin regulates t-tubules and sarcolemmal repair through a similar mechanism. This review focuses on the emerging complexity of dysferlin's activity in striated muscle. Such insights will progress our understanding of the proteins and pathways that regulate basic heart and skeletal muscle function and help guide research into striated muscle pathology, especially that which arises due to dysferlin dysfunction.


Asunto(s)
Calcio , Disferlina , Humanos , Calcio/metabolismo , Disferlina/metabolismo , Proteínas de la Membrana/metabolismo , Proteínas de la Membrana/genética , Proteínas de la Membrana/fisiología , Proteínas Musculares/metabolismo , Proteínas Musculares/genética , Proteínas Musculares/fisiología , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiología , Músculo Estriado/metabolismo , Músculo Estriado/fisiología
2.
Int J Mol Sci ; 24(15)2023 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-37569465

RESUMEN

Long QT syndrome (LQTS) can lead to ventricular arrhythmia and sudden cardiac death. The most common congenital cause of LQTS is mutations in the channel subunits generating the cardiac potassium current IKs. Zebrafish (Danio rerio) have been proposed as a powerful system to model human cardiac diseases due to the similar electrical properties of the zebrafish heart and the human heart. We used high-resolution all-optical electrophysiology on ex vivo zebrafish hearts to assess the effects of IKs analogues on the cardiac action potential. We found that chromanol 293B (an IKs inhibitor) prolonged the action potential duration (APD) in the presence of E4031 (an IKr inhibitor applied to drug-induced LQT2), and to a lesser extent, in the absence of E4031. Moreover, we showed that PUFA analogues slightly shortened the APD of the zebrafish heart. However, PUFA analogues failed to reverse the APD prolongation in drug-induced LQT2. However, a more potent IKs activator, ML-277, partially reversed the APD prolongation in drug-induced LQT2 zebrafish hearts. Our results suggest that IKs plays a limited role in ventricular repolarizations in the zebrafish heart under resting conditions, although it plays a more important role when the IKr is compromised, as if the IKs in zebrafish serves as a repolarization reserve as in human hearts. This study shows that potent IKs activators can restore the action potential duration in drug-induced LQT2 in the zebrafish heart.


Asunto(s)
Síndrome de QT Prolongado , Canales de Potasio con Entrada de Voltaje , Animales , Humanos , Antiarrítmicos/farmacología , Pez Cebra , Corazón , Arritmias Cardíacas/tratamiento farmacológico , Arritmias Cardíacas/genética , Síndrome de QT Prolongado/tratamiento farmacológico , Síndrome de QT Prolongado/genética , Potenciales de Acción , Canales de Potasio con Entrada de Voltaje/farmacología
3.
Curr HIV/AIDS Rep ; 19(2): 154-165, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-35147855

RESUMEN

PURPOSE OF REVIEW: Effective ways to diagnose the remaining people living with HIV who do not know their status are a global priority. We reviewed the use of risk-based tools, a set of criteria to identify individuals who would not otherwise be tested (screen in) or excluded people from testing (screen out). RECENT FINDINGS: Recent studies suggest that there may be value in risk-based tools to improve testing efficiency (i.e. identifying those who need to be tested). However, there has not been any systematic reviews to synthesize these studies. We identified 18,238 citations, and 71 were included. The risk-based tools identified were most commonly from high-income (51%) and low HIV (<5%) prevalence countries (73%). The majority were for "screening in" (70%), with the highest performance tools related to identifying MSM with acute HIV. Screening in tools may be helpful in settings where it is not feasible or recommended to offer testing routinely. Caution is needed for screening out tools, where there is a trade-off between reducing costs of testing with missing cases of people living with HIV.


Asunto(s)
Infecciones por VIH , Atención a la Salud , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Prueba de VIH , Humanos , Tamizaje Masivo , Prevalencia
4.
Am J Dermatopathol ; 44(11): e124-e126, 2022 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-36066124

RESUMEN

ABSTRACT: Posttransplant lymphoproliferative disorders are a serious complication of hematopoietic and solid organ transplants secondary to iatrogenic immunosuppression. Most cases present as B-cell proliferations which are often Epstein-Barr virus positive; however, ∼10% of cases are T/NK cell and are less commonly associated with Epstein-Barr virus. Of these, cutaneous T/NK-cell lymphomas are exceedingly rare. We report a case of a 69-year-old male, liver transplant recipient who presented with a tender, bright red papule on the left arm during his annual skin cancer screening. Histopathologic evaluation revealed pleomorphic cells with enlarged nuclei, vesicular chromatin, and frequent mitotic figures, intercalating through the dermis. The tumor formed single strands and small cords without epidermal involvement. A patchy mild mixed inflammatory infiltrate was associated with the tumor. Tumor cells were CD2(+), CD4(+), CD30(+), CD3(-), CD20(-), ALK-1(-), and EBER(-). Molecular studies revealed a monoclonal T-cell receptor gamma gene rearrangement by polymerase chain reaction (PCR); ALK gene rearrangement was negative by fluorescence in situ hybridization (FISH). Taken together, the findings were consistent with an ALK-negative anaplastic large cell lymphoma involving skin, which, given the history of liver transplant, qualified as a monomorphic T-cell posttransplant lymphoproliferative disorder. Follow-up imaging studies showed no evidence of systemic disease, supporting an interpretation of primary cutaneous anaplastic large cell lymphoma.


Asunto(s)
Infecciones por Virus de Epstein-Barr , Linfoma Anaplásico de Células Grandes , Linfoma Anaplásico Cutáneo Primario de Células Grandes , Trastornos Linfoproliferativos , Neoplasias Primarias Secundarias , Neoplasias Cutáneas , Cromatina , Infecciones por Virus de Epstein-Barr/complicaciones , Herpesvirus Humano 4/genética , Humanos , Hibridación Fluorescente in Situ , Linfoma Anaplásico de Células Grandes/etiología , Linfoma Anaplásico de Células Grandes/genética , Linfoma Anaplásico Cutáneo Primario de Células Grandes/patología , Trastornos Linfoproliferativos/diagnóstico , Trastornos Linfoproliferativos/etiología , Masculino , Proteínas Tirosina Quinasas Receptoras/genética , Neoplasias Cutáneas/genética , Linfocitos T/patología
5.
Breast Cancer Res Treat ; 188(3): 789-798, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33835293

RESUMEN

PURPOSE: Results from TAILOR-X suggest that up to 70% of hormone receptor-positive (HR+) node-negative (N0) ESBC patients (pts) may avoid chemotherapy (CT) with RS ≤ 25. We assess clinical and economic impacts of RS testing on treatment using real-world data. METHODS: From October 2011 to February 2019, a retrospective, cross-sectional observational study was conducted of HR+ N0 ESBC pts who had RS testing in Ireland. Pts were classified low risk (RS ≤ 25) and high risk (RS > 25). Clinical risk was calculated. Data were collected via electronic patient records. Cost data were supplied by the National Healthcare Pricing Regulatory Authority. RESULTS: 963 pts. Mean age is 56 years. Mean tumour size is 1.7 cm. 114 (11.8%), 635 (66%), 211 (22%), 3 (0.2%) pts had G1, G2, G3 and unknown G, respectively. 796 pts (82.8%) low RS, 159 (16.5%) high RS and 8 pts (0.7%) unknown RS. 263 pts (26%) were aged ≤ 50 at diagnosis; 117 (45%) had RS 0-15, 63 (24.5%) 16-20, 39 (15.3%) 21-25 and 40 (15.2%) RS 26-100. 4 pts (1.5%) had unknown RS. Post-RS testing, 602 pts (62.5%) had a change in CT decision; 593 changed to hormone therapy (HT) alone. In total, 262 pts received CT. Of pts receiving CT; 138 (53%) had RS > 25, 124 (47%) had RS ≤ 25. Of pts aged ≤ 50, 153 (58%) had high clinical risk, of whom 28 had RS 16-20. Assay use achieved a 62.5% change in treatment with 73% of pts avoiding CT. This resulted in savings of €4 million in treatment costs. Deducting assay costs, savings of €1.9 million were achieved. CONCLUSION: Over the 8 years of the study, a 62.5% reduction in CT use was achieved with savings of over €1,900,000.


Asunto(s)
Neoplasias de la Mama , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/epidemiología , Quimioterapia Adyuvante , Estudios Transversales , Femenino , Perfilación de la Expresión Génica , Humanos , Irlanda/epidemiología , Persona de Mediana Edad , Recurrencia Local de Neoplasia/genética , Receptores de Estrógenos/genética , Estudios Retrospectivos
6.
Heart Fail Rev ; 26(5): 1063-1080, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-32338334

RESUMEN

Heart failure (HF) patients represent one of the most prevalent as well as one of the most fragile population encountered in the cardiology and internal medicine departments nowadays. Estimated to account for around 26 million people worldwide, diagnosed patients present a poor prognosis and quality of life with a clinical history accompanied by repeated hospital admissions caused by an exacerbation of their chronic condition. The frequent hospitalizations and the extended hospital stays mean an extremely high economic burden for healthcare institutions. Meanwhile, the number of chronically diseased and elderly patients is continuously rising, and a lack of specialized physicians is evident. To cope with this health emergency, more efficient strategies for patient management, more accurate diagnostic tools, and more efficient preventive plans are needed. In recent years, telemonitoring has been introduced as the potential answer to solve such needs. Different methodologies and devices have been progressively investigated for effective home monitoring of cardiologic patients. Invasive hemodynamic devices, such as CardioMEMS™, have been demonstrated to be reducing hospitalizations and mortality, but their use is however restricted to limited cases. The role of external non-invasive devices for remote patient monitoring, instead, is yet to be clarified. In this review, we summarized the most relevant studies and devices that, by utilizing non-invasive telemonitoring, demonstrated whether beneficial effects in the management of HF patients were effective.


Asunto(s)
Insuficiencia Cardíaca , Telemedicina , Anciano , Enfermedad Crónica , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Hospitalización , Humanos , Monitoreo Fisiológico , Calidad de Vida
7.
Allergy ; 72(9): 1327-1337, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28213886

RESUMEN

BACKGROUND: Asthma is a complex lung disease resulting from the interplay of genetic and environmental factors. To understand the molecular changes that occur during the development of allergic asthma without genetic and environmental confounders, an experimental model of allergic asthma in mice was used. Our goals were to (1) identify changes at the small molecule level due to allergen exposure, (2) determine perturbed pathways due to disease, and (3) determine whether small molecule changes correlate with lung function. METHODS: In this experimental model of allergic asthma, matched bronchoalveolar lavage (BAL) fluid and plasma were collected from three groups of C57BL6 mice (control vs sensitized and/or challenged with ovalbumin, n=3-5/group) 6 hour, 24 hour, and 48 hour after the last challenge. Samples were analyzed using liquid chromatography-mass spectrometry-based metabolomics. Airway hyper-responsiveness (AHR) measurements and differential cell counts were performed. RESULTS: In total, 398 and 368 dysregulated metabolites in the BAL fluid and plasma of sensitized and challenged mice were identified, respectively. These belonged to four, interconnected pathways relevant to asthma pathogenesis: sphingolipid metabolism (P=6.6×10-5 ), arginine and proline metabolism (P=1.12×10-7 ), glycerophospholipid metabolism (P=1.3×10-10 ), and the neurotrophin signaling pathway (P=7.0×10-6 ). Furthermore, within the arginine and proline metabolism pathway, a positive correlation between urea-1-carboxylate and AHR was observed in plasma metabolites, while ornithine revealed a reciprocal effect. In addition, agmatine positively correlated with lung eosinophilia. CONCLUSION: These findings point to potential targets and pathways that may be central to asthma pathogenesis and can serve as novel therapeutic targets.


Asunto(s)
Asma/metabolismo , Redes y Vías Metabólicas/inmunología , Animales , Arginina/metabolismo , Líquido del Lavado Bronquioalveolar , Glicerofosfolípidos/metabolismo , Hipersensibilidad/metabolismo , Ratones , Ratones Endogámicos C57BL , Factores de Crecimiento Nervioso/metabolismo , Prolina/metabolismo , Esfingolípidos/metabolismo
8.
Br J Dermatol ; 176(2): 423-430, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28004387

RESUMEN

BACKGROUND: Previous studies have shown that skin disease in dermatomyositis (DM) is best assessed using the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI). Although the CDASI has been validated for use by dermatologists, it has not been validated for use by other physicians such as rheumatologists and neurologists, who also manage patients with DM and assess skin activity in clinical trials. OBJECTIVES: To assess the reliability of the CDASI among dermatologists, rheumatologists and neurologists. METHODS: Fifteen patients with cutaneous DM were assessed using the CDASI and the Physician Global Assessment (PGA) by five dermatologists, five rheumatologists and five neurologists. RESULTS: The mean CDASI activity scores for dermatologists, rheumatologists and neurologists were 21·0, 21·8 and 20·8, respectively. These mean scores were not different among the specialists. The CDASI damage score means for dermatologists, rheumatologists and neurologists were 5·3, 7·0 and 4·8, respectively. The mean scores between dermatologists and rheumatologists were significantly different, but the means between dermatologists and neurologists were not. The intraclass correlation coefficients (ICCs) for interrater reliability for CDASI activity and damage were good to excellent for dermatologists and rheumatologists, and moderate to excellent for neurologists. The ICCs for intrarater reliability for CDASI activity and damage were excellent for dermatologists and rheumatologists and moderate to excellent for neurologists. The PGA displayed lower interrater and intrarater reliability relative to the CDASI. CONCLUSIONS: Our results confirm the reliability of the CDASI when used by dermatologists and rheumatologists. The data for its use by neurologists were not as robust.


Asunto(s)
Dermatólogos , Dermatomiositis/diagnóstico , Neurólogos , Reumatólogos , Índice de Severidad de la Enfermedad , Análisis de Varianza , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados
9.
J Vasc Interv Radiol ; 28(11): 1544-1547, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28935473

RESUMEN

PURPOSE: To examine effects of lower extremity sequential compression devices (SCDs) on lymphatic transit during intranodal lymphangiography (IL) and thoracic duct interventions. MATERIALS AND METHODS: A retrospective review of 19 SCD-assisted IL (IL-SCD) procedures was performed. The control group comprised 18 consecutive IL-guided procedures performed in the immediately preceding time period. For IL-SCD procedures, SCDs were placed onto patients' calves before sterile preparation. Total procedure time and lymphatic transit time were measured. Mean age was 52 years in the IL-SCD group and 64 years in the control group. In the control group, 100% (18/18) of patients had a chylous leak, whereas only 74% (14/19) of patients in the IL-SCD group had a leak. RESULTS: In the IL-SCD group, mean total procedure time was 75 minutes (range, 34-126 min), and mean lymphatic transit time was 29 minutes (range, 8-63 min). In the control group, mean total procedure time was 105 minutes (range, 51-203 min), and mean lymphatic transit time was 56 minutes (range, 28-117 min). Lymphatic transit time and procedure time were significantly reduced in the IL-SCD group (P < .01 and P < .05, respectively). CONCLUSIONS: Use of lower extremity SCDs reduces lymphatic transit time and IL-dependent procedure time.


Asunto(s)
Quilotórax/diagnóstico por imagen , Quilotórax/terapia , Medios de Contraste/administración & dosificación , Medios de Contraste/farmacocinética , Embolización Terapéutica/métodos , Aparatos de Compresión Neumática Intermitente , Linfografía/métodos , Conducto Torácico/diagnóstico por imagen , Quilotórax/etiología , Femenino , Humanos , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
10.
Indoor Air ; 27(2): 409-416, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-27354176

RESUMEN

Assessing personal exposure to air pollution has long proven challenging due to technological limitations posed by the samplers themselves. Historically, wearable aerosol monitors have proven to be expensive, noisy, and burdensome. The objective of this work was to develop a new type of wearable monitor, an ultrasonic personal aerosol sampler (UPAS), to overcome many of the technological limitations in personal exposure assessment. The UPAS is a time-integrated monitor that features a novel micropump that is virtually silent during operation. A suite of onboard environmental sensors integrated with this pump measure and record mass airflow (0.5-3.0 L/min, accurate within 5%), temperature, pressure, relative humidity, light intensity, and acceleration. Rapid development of the UPAS was made possible through recent advances in low-cost electronics, open-source programming platforms, and additive manufacturing for rapid prototyping. Interchangeable cyclone inlets provided a close match to the EPA PM2.5 mass criterion (within 5%) for device flows at either 1.0 or 2.0 L/min. Battery life varied from 23 to 45 hours depending on sample flow rate and selected filter media. Laboratory tests of the UPAS prototype demonstrate excellent agreement with equivalent federal reference method samplers for gravimetric analysis of PM2.5 across a broad range of concentrations.


Asunto(s)
Aerosoles/análisis , Contaminantes Atmosféricos/análisis , Monitoreo del Ambiente/instrumentación , Ultrasonido/instrumentación , Dispositivos Electrónicos Vestibles , Diseño de Equipo , Humanos
12.
Br J Surg ; 103(7): 839-44, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27004443

RESUMEN

BACKGROUND: The majority of women with breast cancer present with localized disease. The optimal strategy for identifying patients with metastatic disease at diagnosis remains unclear. The aim of this study was to evaluate the additional diagnostic yield from isotope bone scanning when added to CT staging of the thorax, abdomen and pelvis (CT-TAP) in patients with newly diagnosed breast cancer. METHODS: All patients diagnosed with breast cancer who underwent staging CT-TAP and bone scan between 2011 and 2013 were identified from a prospective database of a tertiary referral breast cancer centre that provides a symptomatic and population-based screening breast service. Criteria for staging included: biopsy-proven axillary nodal metastases; planned neoadjuvant chemotherapy or mastectomy; locally advanced or inflammatory breast cancer and symptoms suggestive of metastases. RESULTS: A total of 631 patients underwent staging by CT-TAP and bone scan. Of these, 69 patients (10·9 per cent) had distant metastasis at presentation, with disease confined to a single organ in 49 patients (71 per cent) and 20 (29 per cent) having metastatic deposits in multiple organs. Bone metastasis was the most common site; 39 of 49 patients had bone metastasis alone and 12 had a single isolated metastatic deposit. All but two of these were to the axial skeleton. No preoperative histological factors identified a cohort of patients at risk of metastatic disease. Omission of the bone scan in systemic staging would have resulted in a false-negative rate of 0·8 per cent. CONCLUSION: For patients diagnosed with breast cancer, CT-TAP is a satisfactory stand-alone investigation for systemic staging.


Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Neoplasias de la Mama/patología , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/diagnóstico por imagen , Carcinoma Lobular/patología , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Neoplasias Primarias Múltiples/diagnóstico por imagen
13.
AJR Am J Roentgenol ; 207(4): 745-754, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27440524

RESUMEN

OBJECTIVE: The purposes of this article are to review available data regarding the range of protection devices and garments with a focus on eye protection and to summarize techniques for reducing scatter radiation exposure. CONCLUSION: Fluoroscopy operators and staff can greatly reduce their radiation exposure by wearing properly fitted protective garments, positioning protective devices to block scatter radiation, and adhering to good radiation practices. By understanding the essentials of radiation physics, protective equipment, and the features of each imaging system, operators and staff can capitalize on opportunities for radiation protection while minimizing ergonomic strain. Practicing and promoting a culture of radiation safety can help fluoroscopy operators and staff enjoy long, productive careers helping patients.


Asunto(s)
Fluoroscopía/instrumentación , Exposición Profesional/prevención & control , Ropa de Protección , Exposición a la Radiación/prevención & control , Protección Radiológica/instrumentación , Administración de la Seguridad , Humanos , Dosis de Radiación , Medición de Riesgo , Estados Unidos
14.
AJR Am J Roentgenol ; 207(4): 737-744, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28829623

RESUMEN

OBJECTIVE: Recent articles discussing cases of brain cancer in interventionalists have raised concerns regarding the hazards of occupational exposure to ionizing radiation. We review the basics of radiation dose and the potential radiation effects, particularly as they pertain to the operator. Then we present the data regarding the risk of each type of radiation effect to the fluoroscopy operator and staff, with special attention on cancer induction, radiation-induced cataracts, and the pregnant operator. CONCLUSION: Although the evidence overwhelmingly shows that exposure to higher doses of radiation carries a risk of cancer and tissue reactions, the risks of chronic exposure to low-level radiation are less clear. Many studies examining occupational exposure to radiation fail to show an increased risk of stochastic effects of radiation, but the positive results raise concern that the studies are underpowered to consistently detect the small risk. The lack of information in these studies about radiation doses and adherence to radiation protection further confound their interpretation. Large prospective studies of populations with occupational exposure to low-level radiation might clarify this issue. More clearly established are the risks of radiation to the fetus and the risk of cataracts in interventional cardiologists and interventional radiologists. Interventionalists can mitigate these risks by following established radiation safety practices.


Asunto(s)
Fluoroscopía/instrumentación , Exposición Profesional/prevención & control , Ropa de Protección , Exposición a la Radiación/prevención & control , Protección Radiológica/instrumentación , Administración de la Seguridad , Humanos , Dosis de Radiación , Medición de Riesgo , Estados Unidos
15.
World J Surg ; 40(9): 2157-62, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27206399

RESUMEN

INTRODUCTION: Axillary status remains an important prognostic indicator in breast cancer. Certain patients with a positive sentinel node (SLNB) may not benefit from axillary clearance (AC). Uncertainty remains if this approach could be applied to patients diagnosed with axillary metastases on ultrasound-guided fine needle aspiration cytology (USFNAC). The aim of this study was to compare nodal burden in patients with positive USFNAC and a positive SLNB. METHODS: A retrospective study was performed involving all BC patients between 2007 and 2014 who had either pre-operative USFNAC or a SLNB. Patient/tumour characteristics and nodal burden were examined in all patients proceeding to AC. RESULTS: 974 patients were eligible for analysis. 439 patients (45 %) had positive USFNAC and 535 (55 %) had a positive SLNB. USFNAC-positive patients were more likely to undergo mastectomy (Chi-square test; p < 0.001), have extra-nodal extension (p < 0.001), be oestrogen receptor negative (p < 0.001) and be HER2 positive (p < 0.001). The median total number of lymph nodes (LNs) excised during AC was higher in the USFNAC group (Mann-Whitney test; 23 vs. 21; p < 0.001). The median total number of involved LNs was 3 (range 1-47) in FNAC-positive patients versus 1 (range 1-37) in SLNB-positive patients (p < 0.001). The median number of involved LNs in level 1 was 3 in FNAC-positive patients versus 1 in SLNB-positive patients (p < 0.001). Within the SLN-positive group, 49 % of the patients had only one involved LN, 28 % had two nodes involved and 23 % had ≥3. In comparison, within the FNAC-positive group only 13 % of the patients had one involved LN, 12 % had two nodes involved and 74 % had ≥3. CONCLUSION: Patients with positive USFNAC have more aggressive clinico-pathological characteristics and higher nodal burden compared to SLNB-positive patients. Currently, the authors advocate that patients not receiving neoadjuvant chemotherapy, with a positive USFNAC, should proceed directly to an axillary ALND.


Asunto(s)
Biopsia con Aguja Fina , Neoplasias de la Mama/patología , Biopsia Guiada por Imagen , Ganglios Linfáticos/patología , Biopsia del Ganglio Linfático Centinela , Ultrasonografía Intervencional , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática/patología , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
16.
Emerg Radiol ; 23(2): 105-9, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26585759

RESUMEN

The pregnant abdominal trauma patient presents a unique diagnostic challenge. This study aimed to evaluate the accuracy of abdominal sonography for the detection of clinically important injuries in pregnant abdominal trauma patients. A retrospective review was performed of a trauma center database from 2001 to 2011. Medical records were reviewed to determine initial abdominal imaging test results and clinical course. Sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for detection of traumatic injury were calculated. Of 19,128 patients with suspected abdominal trauma, 385 (2 %) were pregnant. Of these, 372 (97 %) received ultrasound as the initial abdominal imaging test. All 13 pregnant patients who did not receive ultrasound received abdominal CT. Seven pregnant patients underwent both ultrasound and CT. Seven ultrasound examinations were positive, leading to one therapeutic Cesarean section and one laparotomy. One ultrasound was considered false positive (no injury was seen on subsequent CT). There were 365 negative ultrasound examinations. Of these, 364 were true negative (no abdominal injury subsequently found). One ultrasound was considered false negative (a large fetal subchorionic hemorrhage seen on subsequent dedicated obstetrical ultrasound). Sensitivity and positive predictive value were 85.7 %. Specificity and negative predictive value were 99.7 %. Abdominal sonography is an effective and sufficient imaging examination in pregnant abdominal trauma patients. When performed as part of the initial assessment using an abbreviated trauma protocol with brief modifications for pregnancy, ultrasound minimizes diagnostic delay, obviates radiation risk, and provides high sensitivity for injury in the pregnant population.


Asunto(s)
Traumatismos Abdominales/diagnóstico por imagen , Complicaciones del Embarazo/diagnóstico por imagen , Ultrasonografía , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto Joven
17.
East Mediterr Health J ; 22(3): 163-74, 2016 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-27334073

RESUMEN

A better understanding of risk factors for neonatal intensive care unit (NICU) admission can inform interventions to improve neonatal survival. This study aimed to describe a population of newborns admitted to a NICU in Amman, Jordan, and compare them with newborns discharged to home. Newborns born within 96 hours at Al-Bashir Hospital were enrolled from February 2010 to June 2011. Demographic and clinical data were collected for mothers and newborns. Of 5466 enrolled neonates, 373 (6.8%) were admitted to the NICU. The median gestational age of NICU infants was 36 weeks, median birth weight was 2.2 kg and 49.5% were delivered by non-elective caesarean section. Lower gestational age, lower birth weight, delivery by caesarean section and birth in the month of May were statistically significant risk factors for NICU admission. Risk factors for NICU admission were consistent with other populations worldwide; however, median gestational age and birth weight were higher than in developed countries.


Asunto(s)
Unidades de Cuidado Intensivo Neonatal , Admisión del Paciente , Adulto , Bases de Datos Factuales , Femenino , Humanos , Recién Nacido , Jordania , Estudios Retrospectivos , Factores de Riesgo , Encuestas y Cuestionarios
18.
Aust Crit Care ; 29(2): 104-9, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26320090

RESUMEN

Effective team decision making has the potential to improve the quality of health care outcomes. Medical Emergency Teams (METs), a specific type of team led by either critical care nurses or physicians, must respond to and improve the outcomes of deteriorating patients. METs routinely make decisions under conditions of uncertainty and suboptimal care outcomes still occur. In response, the development and use of Shared Mental Models (SMMs), which have been shown to promote higher team performance under stress, may enhance patient outcomes. This discussion paper specifically focuses on the development and use of SMMs in the context of METs. Within this process, the psychological mechanisms promoting enhanced team performance are examined and the utility of this model is discussed through the narrative of six habits applied to MET interactions. A two stage, reciprocal model of both nonanalytic decision making within the acute care environment and analytic decision making during reflective action learning was developed. These habits are explored within the context of a MET, illustrating how applying SMMs and action learning processes may enhance team-based problem solving under stress. Based on this model, we make recommendations to enhance MET decision making under stress. It is suggested that the corresponding habits embedded within this model could be imparted to MET members and tested by health care researchers to assess the efficacy of this integrated decision making approach in respect to enhanced team performance and patient outcomes.


Asunto(s)
Cuidados Críticos , Toma de Decisiones , Equipo Hospitalario de Respuesta Rápida/organización & administración , Cuerpo Médico de Hospitales/psicología , Mejoramiento de la Calidad , Competencia Clínica , Humanos , Comunicación Interdisciplinaria , Seguridad del Paciente
19.
Int Psychogeriatr ; 27(9): 1439-65, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25990373

RESUMEN

BACKGROUND: Provision of non-pharmacological interventions is a common policy objective for people with dementia, and support groups are an increasingly common intervention. However, there have been few attempts to synthesize evidence on the effectiveness of support groups for people with dementia. This review investigated the outcomes of support groups for people with dementia, explored participant characteristics and reviewed group formats. METHODS: A systematic review was undertaken and a narrative synthesis of data from 29 papers (reporting on 26 groups and a survey of a range of groups) was conducted. RESULTS: Support groups seem acceptable to people with dementia. Qualitative studies report subjective benefits for participants but there is limited evidence of positive outcomes based on quantitative data. Samples have tended to be homogenous and this may limit the generalizability of findings. CONCLUSIONS: Although qualitative studies will remain important in this area, further mixed-methods randomized controlled trials (RCTs)or comparison group studies with longer follow-up periods are needed to strengthen the evidence base.


Asunto(s)
Demencia/terapia , Psicología/educación , Grupos de Autoayuda/organización & administración , Humanos , Evaluación de Resultado en la Atención de Salud , Investigación Cualitativa , Apoyo Social
20.
Int J Sports Med ; 35(2): 95-100, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23900901

RESUMEN

Dual-energy X-ray absorptiometry (DXA) and adipose tissue percentage estimates (AT%) derived from regression based skinfold equations were compared. 35 Gaelic games players [20.9 ± 1.7 years; 78.1 ± 8.6 kg; 179.5 ± 5.7 cm] underwent whole body fan beam DXA scans following a standardised protocol and assessment of skinfold thickness at 8 sites. Adipose tissue% from the sum of skinfolds and/or via body density were calculated for general and athlete specific equations (SKf-AT %). The relationship, i. e., proportional bias, fixed bias and random error (SEE) between DXA-AT % and AT % derived from the 6 skinfold equations were determined using least squares regression analysis. Skinfold AT% estimates were underestimated relative to DXA-AT % across all skinfold equations except that of Durnin and Wormersley [9] (D&W-∑(4AT %)) (16.7 ± 3.4 vs. 16.6 ± 4.0 %). All equations demonstrated 95 % prediction intervals ranges exceeding ~10 %. Each equation failed to predict AT% relative to DXA within an accepted ± 3.5 % anthropometric error rate. It is recommended that the conversion of absolute skinfold thickness to an AT % is avoided and that the skinfold equations assessed herein are not utilised in Gaelic games players. Alternate 'sum of skinfold' approaches should be considered.


Asunto(s)
Absorciometría de Fotón , Adiposidad , Conceptos Matemáticos , Deportes , Adolescente , Adulto , Estatura , Peso Corporal , Humanos , Irlanda , Grosor de los Pliegues Cutáneos , Adulto Joven
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