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1.
Cureus ; 16(7): e65813, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-39219938

RESUMO

Diverticulosis of the appendix (DA) is a rare condition, often asymptomatic and incidentally discovered, with a significant association with neoplasia. The prevalence of neoplasia in specimens without DA versus those with DA was 1.28% and 26.94%, respectively. Here, we discuss a case of a 54-year-old male presented with left flank pain and dysuria. Examination showed left renal angle tenderness and leukocytosis. CT scan revealed a left ureteric stone and an enlarged appendix. The urology team placed a double-J catheter, and surgical consultation led to an appendectomy. Histopathology confirmed DA with acute inflammation, serositis, and fibroblast proliferation without malignancy. This case underscores the need to consider DA in differential diagnoses and the importance of thorough histopathological examination and timely surgical intervention.

2.
J Pediatr Nurs ; 79: 83-90, 2024 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-39241272

RESUMO

PURPOSE: The study aimed to identify the prevalence of Attention-Deficit / Hyperactivity Disorder (ADHD) signs exhibited in Palestinian school-age students while comparing their sociodemographic characteristics. DESIGN AND METHODS: A cross-sectional descriptive correlation study was conducted. The study included children aged 6-12 in West Bank schools, without a previous ADHD diagnoses or other neurodevelopmental disorders. This study used a parent questionnaire with three sections: child's sociodemographic data, parents' data, and Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS), which has a Cronbach's alpha values of 0.94 for total ADHD. All collected data were analyzed using SPSS version 25, with confidence interval of 95 %. RESULTS: A total 487 school-aged children participated in the study (46.4 % females and 53.6 % males). The results showed that 8.7 % of the children exhibited ADHD signs, with ADHD-I being the most prevalent subtype (3.3 %). Significant associations were found between ADHD signs and the following factors: males (P = 0.003); children with lower academic averages (less than 79.9 %) (P = 0.000); children speaking only one language (P = 0.002); children of mothers exposed to tobacco during pregnancy (P = 0.004); children whose mothers faced complications during pregnancy (P = 0.000); children whose mothers were 19 years old or younger at childbirth scores (P = 0.05); and children with relatives having ADHD (P = 0.000). No significant associations were found with variables such as child's age, birth weight, gestational age, number of countries lived in, school class, place of residency, parents' marital status, educational level, employment status, average income, number of children, or child's birth order. A moderate negative correlation was found between ADHD signs and poor academic performance (r = -0.169, P = 0.000). CONCLUSION: The study found a significant prevalence of ADHD signs in Palestinian school-age children (8.7 %), with ADHD-I having the highest prevalence. Risk factors included gender, languages, maternal exposure to tobacco, maternal complications, mother's age, and relatives with ADHD. Early detection is crucial to mitigate its impact on academic performance. PRACTICE IMPLICATIONS: Nurses play a crucial role in managing ADHD in school-aged children. They conduct educational programs, early screening programs, and work with a multidisciplinary team to evaluate and monitor suspected ADHD cases. They also advocate for research and policy development to improve ADHD care and outcomes. This ensures children receive necessary treatment and support services.

3.
Artigo em Inglês | MEDLINE | ID: mdl-39175429

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To examine how community-level economic disadvantage impacts short-term outcomes following posterior cervical decompression and fusion (PCDF) for cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: The effects of socioeconomic factors, measured by the Distress Community Index (DCI), on postoperative outcomes after PCDF are underexplored. By understanding the impact of socioeconomic status (SES) on PCDF outcomes, disparities in care can be addressed. MATERIALS AND METHODS: Retrospective review of 554 patients who underwent PCDF for cervical spondylotic myelopathy between 2017 and 2022. SES was assessed using DCI obtained from patient zip codes. Patients were stratified into quintiles from Prosperous to Distressed based on DCI. Bivariate analyses and multivariate regressions were performed to evaluate the associations between social determinants of health and surgical outcomes including length of stay, home discharge, complications, and readmissions. RESULTS: Patients living in At-Risk/Distressed communities were more likely to be Black (53.3%). Patients living in At-Risk/Distressed communities had the longest hospitalization (6.24 d vs. Prosperous: 3.92, P=0.006). Significantly less At-Risk/Distressed patients were discharged home without additional services (37.3% vs. Mid-Tier: 52.5% vs. Comfortable: 53.4% vs. Prosperous: 56.4%, P<0.001). On multivariate analysis, residing in an At-Risk/Distressed community was independently associated with non-home discharge (odds ratio (OR): 2.28, P=0.007) and longer length of stay (E:1.54, P=0.017). CONCLUSION: Patients from socioeconomically disadvantaged communities experience longer hospitalizations and are more likely to be discharged to a rehabilitation or skilled nursing facility following PCDF. Social and economic barriers should be addressed as part of presurgical counseling and planning in elective spine surgery to mitigate these disparities and improve the quality and value of health care delivery, regardless of socioeconomic status.

4.
Isotopes Environ Health Stud ; 60(4): 417-427, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39192383

RESUMO

An important method for measuring radionuclide activity is alpha spectrometry. Ten soil samples were collected from the studied area. The activity concentrations of 238U and 234U in the collected soil samples ranged between 135 and 218 Bq kg-1 and between 117 and 183 Bq kg-1, respectively. 232Th, 230Th and 228Th activity concentrations ranged between 101 and 339, between 122 and 234 and between 106 and 385 Bq kg-1, respectively. When calculating the amount of radionuclide transport across the food chain, assessment models usually employ a transfer factor. Through root uptake, U and Th are transferred from the soil to food plants. To monitor the movement of radionuclides from the uranium series in diverse environments, it may be possible to use the ratios of uranium and thorium isotopes. Uranium mobility in soil depends on different physicochemical, organic and enzymatic factors and mechanisms. The high mobility of uranium is the main reason for the accumulation of uranium in the soil at root level and the possibility of its transfer to plants. A group of plants were selected that are grown in this area and the population relies on them mainly to meet their food needs. The concentration and transfer factor values of uranium isotopes were the highest in roots as compared with leaves and stems. Uranium in plants accumulates in roots and is then transferred to leaves. The mobility of uranium in plant tissues is constrained because it frequently adsorbs cell wall components. As a result, concentrations are frequently higher in tissues located in lower parts of the plant, with root surfaces having the highest concentrations.


Assuntos
Radiação de Fundo , Monitoramento de Radiação , Poluentes Radioativos do Solo , Tório , Urânio , Urânio/análise , Tório/análise , Poluentes Radioativos do Solo/análise , Monitoramento de Radiação/métodos , Adsorção , Plantas/química , Plantas/metabolismo , Solo/química , Raízes de Plantas/química , Raízes de Plantas/metabolismo
5.
Eur Spine J ; 33(9): 3516-3522, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38913182

RESUMO

INTRODUCTION: Revision lumbar fusion is most commonly due to nonunion, adjacent segment disease (ASD), or recurrent stenosis, but it is unclear if diagnosis affects patient outcomes. The primary aim of this study was to assess whether patients achieved the patient acceptable symptom state (PASS) or minimal clinically important difference (MCID) after revision lumbar fusion and assess whether this was influenced by the indication for revision. METHODS: We retrospectively identified all 1-3 level revision lumbar fusions at a single institution. Oswestry Disability Index (ODI) was collected at preoperative, three-month postoperative, and one-year postoperative time points. The MCID was calculated using a distribution-based method at each postoperative time point. PASS was set at the threshold of ≤ 22. RESULTS: We identified 197 patients: 56% with ASD, 28% with recurrent stenosis, and 15% with pseudarthrosis. The MCID for ODI was 10.05 and 10.23 at three months and one year, respectively. In total, 61% of patients with ASD, 52% of patients with nonunion, and 65% of patients with recurrent stenosis achieved our cohort-specific MCID at one year postoperatively with ASD (p = 0.78). At one year postoperatively, 33.8% of ASD patients, 47.8% of nonunion patients, and 37% of patients with recurrent stenosis achieved PASS without any difference between indication (p = 0.47). CONCLUSIONS: The majority of patients undergoing revision spine fusion experience significant postoperative improvements regardless of the indication for revision. However, a large proportion of these patients do not achieve the patient acceptable symptom state. While revision spine surgery may offer substantial benefits, these results underscore the need to manage patient expectations.


Assuntos
Vértebras Lombares , Reoperação , Fusão Vertebral , Humanos , Fusão Vertebral/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Idoso , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Adulto , Resultado do Tratamento , Diferença Mínima Clinicamente Importante
6.
J Neurooncol ; 169(1): 175-185, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38789843

RESUMO

PURPOSE: High-grade glioma (HGG) is the most common and deadly malignant glioma of the central nervous system. The current standard of care includes surgical resection of the tumor, which can lead to functional and cognitive deficits. The aim of this study is to develop models capable of predicting functional outcomes in HGG patients before surgery, facilitating improved disease management and informed patient care. METHODS: Adult HGG patients (N = 102) from the neurosurgery brain tumor service at Washington University Medical Center were retrospectively recruited. All patients completed structural neuroimaging and resting state functional MRI prior to surgery. Demographics, measures of resting state network connectivity (FC), tumor location, and tumor volume were used to train a random forest classifier to predict functional outcomes based on Karnofsky Performance Status (KPS < 70, KPS ≥ 70). RESULTS: The models achieved a nested cross-validation accuracy of 94.1% and an AUC of 0.97 in classifying KPS. The strongest predictors identified by the model included FC between somatomotor, visual, auditory, and reward networks. Based on location, the relation of the tumor to dorsal attention, cingulo-opercular, and basal ganglia networks were strong predictors of KPS. Age was also a strong predictor. However, tumor volume was only a moderate predictor. CONCLUSION: The current work demonstrates the ability of machine learning to classify postoperative functional outcomes in HGG patients prior to surgery accurately. Our results suggest that both FC and the tumor's location in relation to specific networks can serve as reliable predictors of functional outcomes, leading to personalized therapeutic approaches tailored to individual patients.


Assuntos
Neoplasias Encefálicas , Glioma , Aprendizado de Máquina , Imageamento por Ressonância Magnética , Humanos , Masculino , Glioma/cirurgia , Glioma/diagnóstico por imagem , Glioma/patologia , Feminino , Imageamento por Ressonância Magnética/métodos , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Idoso , Descanso , Prognóstico , Gradação de Tumores , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Encéfalo/patologia , Encéfalo/fisiopatologia
8.
Am Surg ; 90(9): 2323-2324, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38631338

RESUMO

Gastropleural fistulas are rare complications with significant mortality and morbidity. There are limited reports on the successful management of gastropleural fistulas with advanced endoscopic procedures. The following case of a 75-year-old woman with a history of recurrent pseudomyxoma peritonei secondary to ruptured low-grade appendiceal mucinous neoplasm status post cytoreductive surgery highlights the successful treatment of a gastropleural fistula with endoscopic suturing.


Assuntos
Fístula Gástrica , Doenças Pleurais , Humanos , Feminino , Idoso , Fístula Gástrica/cirurgia , Fístula Gástrica/etiologia , Doenças Pleurais/cirurgia , Doenças Pleurais/diagnóstico por imagem , Pseudomixoma Peritoneal/cirurgia
9.
Clin Nephrol ; 102: 25-31, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38660889

RESUMO

Incorporating genetic testing in routine outpatient nephrology clinic can improve on chronic kidney disease (CKD) diagnosis and utilization of precision medicine. We sent a genetic test on patients with atypical presentation of common kidney diseases, electrolytes derangements, and cystic kidney diseases. We were able to identify a gene variant contributing to patients' kidney disease in more than half of our cohort. We then showed that patients with ApoL1 risk allele have likely worse kidney disease, and we were able to confirm genetic focal segmental glomerulosclerosis (FSGS) in 2 patients and avoid unnecessary immunosuppression. Genetic testing has also improved our operation to establish a polycystic kidney disease excellence center by confirming our diagnosis, especially in patients without a well-defined family history. In conclusion, utilizing genetic testing in a routine outpatient renal clinic did not cause any burden to either patients or nephrologists, with minimal administrative effort and no financial cost to our patients. We expect that genetic testing in the right setting should become routine in nephrology to achieve a patient-centered precision medicine with less invasive means of kidney disease diagnosis.


Assuntos
Testes Genéticos , Humanos , Testes Genéticos/métodos , Masculino , Feminino , Apolipoproteína L1/genética , Adulto , Pessoa de Meia-Idade , Predisposição Genética para Doença , Glomerulosclerose Segmentar e Focal/genética , Glomerulosclerose Segmentar e Focal/diagnóstico , Nefrologia , Insuficiência Renal Crônica/genética , Insuficiência Renal Crônica/diagnóstico , Instituições de Assistência Ambulatorial , Doenças Renais Policísticas/genética , Doenças Renais Policísticas/diagnóstico
10.
Cureus ; 16(3): e56205, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38618308

RESUMO

We report the case of a woman presenting with small bowel obstruction secondary to an enterolith that formed within a jejunal diverticulum. Prior to this acute presentation, the patient had experienced regular abdominal pain albeit not as severe as the current episode. The CT scan on admission required review by two consultant radiologists before the cause of the small bowel obstruction was diagnosed. Successful surgical management was performed involving a laparotomy, small bowel enterotomy, and removal of the enterolith. Although complications secondary to jejunal diverticula are documented, there is minimal literature on the complexities of making the diagnosis and the best management approach that should be adopted.

11.
RSC Adv ; 14(20): 13915-13925, 2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38686298

RESUMO

The efficacy of aluminium phosphide (Al12P12) nanocage toward sensing methanol (MeOH) and ethanol (EtOH) volatile organic compounds (VOCs) was herein thoroughly elucidated utilizing various density functional theory (DFT) computations. In this perspective, MeOH⋯ and EtOH⋯Al12P12 complexes were investigated within all plausible configurations. According to the energetic features, the EtOH⋯Al12P12 complexes exhibited larger negative values of adsorption and interaction energies with values up to -27.23 and -32.84 kcal mol-1, respectively, in comparison to the MeOH⋯Al12P12 complexes. Based on the symmetry-adapted perturbation theory (SAPT) results, the electrostatic forces were pinpointed as the predominant component beyond the adsorption process within the preferable MeOH⋯ and EtOH⋯Al12P12 complexes. The findings of the noncovalent interaction (NCI) index and quantum theory of atoms in molecules (QTAIM) outlined the closed-shell nature of the interactions within the studied complexes. Substantial variations were found in the molecular orbitals distribution patterns of MeOH/EtOH molecules and Al12P12 nanocage, outlining the occurrence of the adsorption process within the complexes under investigation. Thermodynamic parameters were denoted with negative values, demonstrating the spontaneous exothermic nature of the most favorable complexes. New energy states were observed within the extracted density of states plots, confirming the impact of adsorbing MeOH and EtOH molecules on the electronic properties of the Al12P12 nanocage. The appearance of additional peaks in Infrared Radiation (IR) and Raman spectra revealed the apparent effect of the adsorption process on the features of the utilized sensor. The emerging results declared the potential uses of Al12P12 nanocage as a promising candidate for sensing VOCs, particularly MeOH and EtOH.

12.
Langenbecks Arch Surg ; 409(1): 140, 2024 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-38676721

RESUMO

INTRODUCTION: Textbook oncologic outcome (TOO) is attained when all desired short-term quality metrics are met following an oncologic operation. The objective of this study was to determine the impact of race on TOO attainment following colectomy for colon cancer. METHODS: The 2004-2017 National Cancer Database was queried for patients with non-metastatic colon cancer who underwent colectomy. TOO was defined as: negative margins (R0), adequate lymphadenectomy (LAD) (n ≥ 12), no prolonged length of stay (LOS), no 30-day readmission or mortality, and initiation of systemic therapy in ≤ 12 weeks. Racial groups were defined as White, Black, or Hispanic. RESULTS: 508,312 patients were identified of which 34% achieved TOO. Blacks attained the least TOO (31.4%) as well as the TOO criteria of adequate LAD (81.1%), no prolonged LOS (52.3%), and no 30-day readmission (89.7%). Hispanics were least likely to have met the criteria of R0 resection (94.3%), no 30-day mortality (87.3%), and initiation of systemic therapy in ≤ 12 weeks (81.8%). Patients who attained TOO had a higher median overall survival (OS) than those without TOO (148.2 vs. 84.2 months; P < 0.001). Hispanic TOO patients had the highest median OS (181.2 months), while White non-TOO patients experienced the lowest (80.2 months, P < 0.001). Multivariate logistic regression models suggest that Black and Hispanic patients are less likely to achieve TOO than their White counterparts. CONCLUSIONS: Racial disparities exist in the achievement of TOO, with Blacks and Hispanics being less likely to attain TOO compared to their White counterparts.


Assuntos
Colectomia , Neoplasias do Colo , Bases de Dados Factuais , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos de Coortes , Neoplasias do Colo/cirurgia , Neoplasias do Colo/mortalidade , Neoplasias do Colo/etnologia , Neoplasias do Colo/patologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Hispânico ou Latino/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , População Branca/estatística & dados numéricos , Brancos , Negro ou Afro-Americano
13.
J Surg Case Rep ; 2024(3): rjae135, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38469205

RESUMO

Adenocarcinoma and lymphoma, potential complications of Crohn's disease (CD), may result in small intestinal perforations, particularly in those on immunosuppressive therapy. The ileum is typically the site of small intestinal perforations in CD, and the link between CD and lymphoma remains uncertain. This case report explores a long-term CD patient on immunosuppressive therapy who presented with acute abdominal pain. Imaging revealed signs of intestinal perforation, successfully managed with surgery. The final pathology report confirms the diagnosis of diffuse large B-cell lymphoma. This report sheds light on the complicated nature of gastrointestinal lymphoma in CD patients.

14.
Clin Spine Surg ; 2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38490967

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: (1) To compare cervical magnetic resonance imaging (MRI) radiology reports to a validated grading system for cervical foraminal stenosis (FS) and (2) to evaluate whether the severity of cervical neural FS on MRI correlates to motor weakness or patient-reported outcomes. BACKGROUND: Radiology reports of cervical spine MRI are often reviewed to assess the degree of neural FS. However, research looking at the association between these reports and objective MRI findings, as well as clinical symptoms, is lacking. PATIENTS AND METHODS: We retrospectively identified all adult patients undergoing primary 1 or 2-level anterior cervical discectomy and fusion at a single academic center for an indication of cervical radiculopathy. Preoperative MRI was assessed for neural FS severity using the grading system described by Kim and colleagues for each level of fusion, as well as adjacent levels. Neural FS severity was recorded from diagnostic radiologist MRI reports. Motor weakness was defined as an examination grade <4/5 on the final preoperative encounter. Regression analysis was conducted to evaluate whether the degree of FS by either classification was related to patient-reported outcome measure severity. RESULTS: A total of 283 patients were included in the study, and 998 total levels were assessed. There were significant differences between the MRI grading system and the assessment by radio-logists (P< 0.001). In levels with moderate stenosis, 28.9% were classified as having no stenosis by radiology. In levels with severe stenosis, 29.7% were classified as having mild-moderate stenosis or less. Motor weakness was found similarly often in levels of moderate or severe stenosis (6.9% and 9.2%, respectively). On regression analysis, no associations were found between baseline patient-reported outcome measures and stenosis severity assessed by radiologists or MRI grading systems. CONCLUSION: Radiology reports on the severity of cervical neural FS are not consistent with a validated MRI grading system. These radiology reports underestimated the severity of neural foraminal compression and may be inappropriate when used for clinical decision-making. LEVEL OF EVIDENCE: Level III.

15.
Am Surg ; 90(4): 819-828, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37931215

RESUMO

BACKGROUND: Textbook oncologic outcome (TOO) is a composite outcome measure realized when all desired short-term quality metrics are met following an oncologic operation. This study examined whether minimally invasive gastrectomy (MIG) is associated with increased likelihood of TOO attainment. METHODS: The 2010-2016 National Cancer Database was queried for patients with gastric cancer who underwent gastrectomy. Surgical approach was described as open (OG), laparoscopic (LG), or robotic (RG). TOO was defined as having met five metrics: R0 resection, AJCC compliant lymph node evaluation (n ≥ 15), no prolonged length of stay (< 75th percentile by year), no 30-day readmission, and receipt of guideline-accordant systemic therapy. RESULTS: Of 21,015 patients identified, 5708 (27.2%) underwent MIG (LG = 21.9%, RG = 5.3%). Patients who underwent RG were more likely to have met all TOO criteria, and consequently TOO. Logistic regression models revealed that patients undergoing MIG were significantly more likely to attain TOO. MIG was associated with a higher likelihood of adequate LAD, no prolonged LOS, and concordant chemotherapy. Patients who underwent LG and achieved TOO had the highest median OS (86.7 months), while the OG non-TOO cohort experienced the lowest (34.6 months). The median OS for the RG TOO group was not estimable; however, the mortality rate (.7%) was the lowest of the six cohorts. CONCLUSION: RG resulted in a significantly increased likelihood of TOO attainment. Although TOO is associated with increased OS across all surgical approaches, attainment of TOO following MIG is associated with a statistically significantly higher median OS.


Assuntos
Neoplasias Gástricas , Oncologia Cirúrgica , Humanos , Neoplasias Gástricas/cirurgia , Oncologia , Benchmarking , Gastrectomia
16.
Semin Neurol ; 44(1): 47-52, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38158211

RESUMO

The lack of treatments with durable response in neuro-oncology highlights the critical need for clinical trials to advance patient care. The intersection of relatively low incidence, evolving classification schema, and entrenched community, healthcare provider, and organizational factors have been historic challenges against successful trial enrollment and implementation. The additional need for multidisciplinary, often tertiary-level care, further magnifies latent national and international health inequities with rural and under-served populations. The COVID-19 pandemic both unveiled fundamental weaknesses in historical approaches and prompted the necessity of new approaches and systems for conducting clinical trials. Here, we provide an overview of traditional barriers to clinical trial enrollment in neuro-oncology, the effect of COVID-19 on these barriers, and the discovery of additional systemic weaknesses. Finally, we discuss future directions by reflecting on lessons learned with strategies to broaden access of care and streamline clinical trial integration into clinical practice.


Assuntos
COVID-19 , Neoplasias , Humanos , COVID-19/epidemiologia , Oncologia , Neoplasias/epidemiologia , Neoplasias/terapia , Pandemias , Ensaios Clínicos como Assunto
17.
J Orthop Trauma ; 38(1): 49-55, 2024 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-37559208

RESUMO

OBJECTIVE: To identify technical factors associated with nonunion after operative treatment with lateral locked plating. DESIGN: Retrospective cohort study. SETTING: Ten Level I trauma centers. PATIENT SELECTION CRITERIA: Adult patients with supracondylar distal femur fractures (OTA/AO type 33A or C) treated with lateral locked plating from 2010 through 2019. OUTCOME MEASURES AND COMPARISONS: Surgery for nonunion stratified by risk for nonunion. RESULTS: The cohort included 615 patients with supracondylar distal femur fractures. The median patient age was 61 years old (interquartile range: 46 -72years) and 375 (61%) were female. Observed were nonunion rates of 2% in a low risk of nonunion group (n = 129), 4% in a medium-risk group (n = 333), and 14% in a high-risk group (n = 153). Varus malreduction with an anatomic lateral distal femoral angle greater than 84 degrees, was associated with double the odds of nonunion compared to those without such varus [odds ratio, 2.1; 95% confidence interval (CI), 1.1-4.2; P = 0.03]. Malreduction by medial translation of the articular block increased the odds of nonunion, with 30% increased odds per 4 mm of medial translation (95% CI, 1.0-1.6; P = 0.03). Working length increased the odds of nonunion in the medium risk group, with an 18% increase in nonunion per 10-mm increase in working length (95% CI, 1.0-1.4; P = 0.01). Increased proximal screw density was protective against nonunion (odds ratio, 0.71; 95% CI, 0.53-0.92; P = 0.02) but yielded lower mRUST scores with each 0.1 increase in screw density associated with a 0.4-point lower mRUST (95% CI, -0.55 to -0.15; P < 0.001). Lateral plate length and type of plate material were not associated with nonunion. ( P > 0.05). CONCLUSIONS: Malreduction is a surgeon-controlled variable associated with nonunion after lateral locked plating of supracondylar distal femur fractures. Longer working lengths were associated with nonunion, suggesting that bridge plating may be less likely to succeed for longer fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fraturas Femorais Distais , Fraturas do Fêmur , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Fraturas do Fêmur/cirurgia , Fraturas do Fêmur/etiologia , Fatores de Risco , Fixação Interna de Fraturas/efeitos adversos , Placas Ósseas/efeitos adversos , Fêmur
18.
Am J Surg ; 227: 111-116, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37798148

RESUMO

INTRODUCTION: The objective of this study was to determine the incidence of textbook oncologic outcome (TOO) and its impact on overall survival (OS) among patients with invasive ductal carcinoma (IDC) following modified radical mastectomy (MRM) versus MRM with contralateral prophylactic mastectomy (MRM â€‹+ â€‹CPM). METHODS: The 2004-2017 National Cancer Database was queried for patients with IDC who underwent MRM and MRM â€‹+ â€‹CPM. TOO was defined as: resection with negative margins, adequate lymphadenectomy, length of stay ≤50th percentile, and no 30-day readmission or mortality. RESULTS: 87,573 patients were identified, of which 14.3% underwent MRM â€‹+ â€‹CPM. Logistic regression models revealed that MRM â€‹+ â€‹CPM is independently associated with a reduced likelihood of achieving TOO (AOR â€‹= â€‹0.71; P â€‹< â€‹0.001). MRM patients who achieved TOO had a higher median OS compared to those who did not (164.6 vs.142.2 months, P â€‹< â€‹0.001). CONCLUSIONS: MRM â€‹+ â€‹CPM is associated with a lower incidence of TOO attainment compared to MRM.


Assuntos
Neoplasias da Mama , Carcinoma Ductal de Mama , Carcinoma Lobular , Mastectomia Profilática , Humanos , Feminino , Mastectomia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/patologia , Carcinoma Lobular/patologia
19.
Chemosphere ; 349: 140961, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38104733

RESUMO

Polyaromatic hydrocarbons (PAHs) are life-threatening organic pollutants that severely threaten ecosystems worldwide due to their poisonous qualities, cancer-causing properties, and mutation-causing qualities. Water and soil together form a critical component of the ecosystem that supports all life. Due to the pollutants that are being disposed of in them, their characteristics have changed, and their toxicity has increased. The goal of this study was to investigate the ability of hausmannite nanoparticles to degrade fluorene from soil and water. Using the chemical method, hausmannite nanoparticles were synthesized and further characterization was performed using UV-Vis, FTIR, DLS, XRD, and SEM-EDAX. Hausmannite significantly degraded fluorene using the batch adsorption method. The degradation was also confirmed by performing reactive kinetics using Freundlich's isotherm model and Langmuir's pseudo-second-order model of soil and water. In addition to the degradation efficacy, hausmannite was also proved to inhibit biofilm formation by Pseudomonas aeruginosa. The findings of the experiments confirmed the presence of hausmannite nanoparticles, as well as their physical properties, chemical properties, degradation properties, and parameters of the kinetic study. As a result, synthesized nanoparticles have been extensively utilized as a low-cost option for removing pollutants and microbial biofilm.


Assuntos
Poluentes Ambientais , Nanopartículas Metálicas , Hidrocarbonetos Policíclicos Aromáticos , Ecossistema , Fluorenos , Água , Nanopartículas Metálicas/toxicidade , Nanopartículas Metálicas/química , Biofilmes , Solo , Hidrocarbonetos Policíclicos Aromáticos/química
20.
Biomedicines ; 11(11)2023 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-38001897

RESUMO

Over the past decade, there have been significant developments in treatment for ovarian cancer, yet the lack of targeted therapy with few side effects still represents a major issue. The cytochrome P450 (CYP) enzyme family plays a vital role in the tumorigenesis process and metabolism of drugs and has a negative impact on therapy outcomes. Gaining more insight into CYP expression is crucial to understanding the pathophysiology of ovarian cancer since many isoforms are essential to the metabolism of xenobiotics and steroid hormones, which drive the disease's development. To the best of our knowledge, no review articles have documented the intratumoral expression of CYPs and their implications in ovarian cancer. Therefore, the purpose of this review is to provide a clear understanding of differential CYP expression in ovarian cancer and its implications for the prognosis of ovarian cancer patients, together with the effects of CYP polymorphisms on chemotherapy metabolism. Finally, we discuss opportunities to exploit metabolic CYP expression for the development of novel therapeutic methods to treat ovarian cancer.

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