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1.
Surg Endosc ; 37(3): 2050-2061, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36289083

RESUMO

BACKGROUND: The aim of this study was to assess the transferability of surgical skills for the laparoscopic hernia module between the serious game Touch Surgery™ (TS) and the virtual reality (VR) trainer Lap Mentor™. Furthermore, this study aimed to collect validity evidence and to discuss "sources of validity evidence" for the findings using the laparoscopic inguinal hernia module on TS. METHODS: In a randomized crossover study, medical students (n = 40) in their clinical years performed laparoscopic inguinal hernia modules on TS and the VR trainer. TS group started with "Laparoscopic Inguinal Hernia Module" on TS (phase 1: Preparation, phase 2: Port Placement and Hernia Repair), performed the module first in training, then in test mode until proficiency was reached. VR group started with "Inguinal Hernia Module" on the VR trainer (task 1: Anatomy Identification, task 2: Incision and Dissection) and also performed the module until proficiency. Once proficiency reached in the first modality, the groups performed the other training modality until reaching proficiency. Primary endpoint was the number of attempts needed to achieve proficiency for each group for each task/phase. RESULTS: Students starting with TS needed significantly less attempts to reach proficiency for task 1 on the VR trainer than students who started with the VR trainer (TS = 2.7 ± 0.6 vs. VR = 3.2 ± 0.7; p = 0.028). No significant differences for task 2 were observed between groups (TS = 2.3 ± 1.1 vs. VR = 2.1 ± 0.8; p = 0.524). For both phases on TS, no significant skill transfer from the VR trainer to TS was observed. Aspects of validity evidence for the module on TS were collected. CONCLUSION: The results show that TS brought additional benefit to improve performances on the VR trainer for task 1 but not for task 2. Skill transfer from the VR trainer to TS could not be shown. VR and TS should thus be used in combination with TS first in multimodal training to ensure optimal training conditions.


Assuntos
Hérnia Inguinal , Cirurgiões , Realidade Virtual , Competência Clínica , Simulação por Computador , Estudos Cross-Over , Hérnia Inguinal/cirurgia , Laparoscopia , Estudantes de Medicina , Cirurgiões/educação , Jogos de Vídeo , Humanos , Masculino , Feminino , Adulto Jovem
2.
Surg Endosc ; 37(3): 1629-1648, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36781468

RESUMO

BACKGROUND: In recent years, the use of Indocyanine Green (ICG) fluorescence-guided surgery during open and laparoscopic procedures has exponentially expanded across various clinical settings. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on this topic with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS: An expert panel of surgeons has been selected and invited to participate to this project. Systematic reviews of the PubMed, Embase and Cochrane libraries were performed to identify evidence on potential benefits of ICG fluorescence-guided surgery on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by the panel; they were then submitted to all EAES members through a two-rounds online survey and results presented at the EAES annual congress, Barcelona, November 2021. RESULTS: A total of 18,273 abstracts were screened with 117 articles included. 22 statements and 16 recommendations were generated and approved. In some areas, such as the use of ICG fluorescence-guided surgery during laparoscopic cholecystectomy, the perfusion assessment in colorectal surgery and the search for the sentinel lymph nodes in gynaecological malignancies, the large number of evidences in literature has allowed us to strongly recommend the use of ICG for a better anatomical definition and a reduction in post-operative complications. CONCLUSIONS: Overall, from the systematic literature review performed by the experts panel and the survey extended to all EAES members, ICG fluorescence-guided surgery could be considered a safe and effective technology. Future robust clinical research is required to specifically validate multiple organ-specific applications and the potential benefits of this technique on clinical outcomes.


Assuntos
Colecistectomia Laparoscópica , Laparoscopia , Humanos , Verde de Indocianina , Consenso , Fluorescência , Laparoscopia/métodos
3.
Surg Endosc ; 36(2): 1064-1079, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33638104

RESUMO

BACKGROUND: Robotic-assisted surgery (RAS) potentially reduces workload and shortens the surgical learning curve compared to conventional laparoscopy (CL). The present study aimed to compare robotic-assisted cholecystectomy (RAC) to laparoscopic cholecystectomy (LC) in the initial learning phase for novices. METHODS: In a randomized crossover study, medical students (n = 40) in their clinical years performed both LC and RAC on a cadaveric porcine model. After standardized instructions and basic skill training, group 1 started with RAC and then performed LC, while group 2 started with LC and then performed RAC. The primary endpoint was surgical performance measured with Objective Structured Assessment of Technical Skills (OSATS) score, secondary endpoints included operating time, complications (liver damage, gallbladder perforations, vessel damage), force applied to tissue, and subjective workload assessment. RESULTS: Surgical performance was better for RAC than for LC for total OSATS (RAC = 77.4 ± 7.9 vs. LC = 73.8 ± 9.4; p = 0.025, global OSATS (RAC = 27.2 ± 1.0 vs. LC = 26.5 ± 1.6; p = 0.012, and task specific OSATS score (RAC = 50.5 ± 7.5 vs. LC = 47.1 ± 8.5; p = 0.037). There were less complications with RAC than with LC (10 (25.6%) vs. 26 (65.0%), p = 0.006) but no difference in operating times (RAC = 77.0 ± 15.3 vs. LC = 75.5 ± 15.3 min; p = 0.517). Force applied to tissue was similar. Students found RAC less physical demanding and less frustrating than LC. CONCLUSIONS: Novices performed their first cholecystectomies with better performance and less complications with RAS than with CL, while operating time showed no differences. Students perceived less subjective workload for RAS than for CL. Unlike our expectations, the lack of haptic feedback on the robotic system did not lead to higher force application during RAC than LC and did not increase tissue damage. These results show potential advantages for RAS over CL for surgical novices while performing their first RAC and LC using an ex vivo cadaveric porcine model. REGISTRATION NUMBER: researchregistry6029.


Assuntos
Colecistectomia Laparoscópica , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Animais , Colecistectomia/métodos , Colecistectomia Laparoscópica/métodos , Competência Clínica , Estudos Cross-Over , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Suínos
4.
Surg Endosc ; 35(1): 81-95, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32025924

RESUMO

Surgical resection is crucial for curative treatment of rectal cancer. Through multidisciplinary treatment, including radiochemotherapy and total mesorectal excision, survival has improved substantially. Consequently, more patients have to deal with side effects of treatment. The most recently introduced surgical technique is robotic-assisted surgery (RAS) which seems equally effective in terms of oncological control compared to laparoscopy. However, RAS enables further advantages which maximize the precision of surgery, thus providing better functional outcomes such as sexual function or contience without compromising oncological results. This review was done according to the PRISMA and AMSTAR-II guidelines and registered with PROSPERO (CRD42018104519). The search was planned with PICO criteria and conducted on Medline, Web of Science and CENTRAL. All screening steps were performed by two independent reviewers. Inclusion criteria were original, comparative studies for laparoscopy vs. RAS for rectal cancer and reporting of functional outcomes. Quality was assessed with the Newcastle-Ottawa scale. The search retrieved 9703 hits, of which 51 studies with 24,319 patients were included. There was a lower rate of urinary retention (non-RCTs: Odds ratio (OR) [95% Confidence Interval (CI)] 0.65 [0.46, 0.92]; RCTs: OR[CI] 1.29[0.08, 21.47]), ileus (non-RCTs: OR[CI] 0.86[0.75, 0.98]; RCTs: OR[CI] 0.80[0.33, 1.93]), less urinary symptoms (non-RCTs mean difference (MD) [CI] - 0.60 [- 1.17, - 0.03]; RCTs: - 1.37 [- 4.18, 1.44]), and higher quality of life for RAS (only non-RCTs: MD[CI]: 2.99 [2.02, 3.95]). No significant differences were found for sexual function (non-RCTs: standardized MD[CI]: 0.46[- 0.13, 1.04]; RCTs: SMD[CI]: 0.09[- 0.14, 0.31]). The current meta-analysis suggests potential benefits for RAS over laparoscopy in terms of functional outcomes after rectal cancer resection. The current evidence is limited due to non-randomized controlled trials and reporting of functional outcomes as secondary endpoints.


Assuntos
Laparoscopia/métodos , Protectomia/métodos , Neoplasias Retais/cirurgia , Reto/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias , Protectomia/efeitos adversos , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento
5.
Surg Endosc ; 34(6): 2429-2444, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32112252

RESUMO

OBJECTIVE: To compare outcomes of endoscopic and surgical treatment for infected necrotizing pancreatitis (INP) based on results of randomized controlled trials (RCT). BACKGROUND: Treatment of INP has changed in the last two decades with adoption of interventional, endoscopic and minimally invasive surgical procedures for drainage and necrosectomy. However, this relies mostly on observational studies. METHODS: We performed a systematic review following Cochrane and PRISMA guidelines and AMSTAR-2 criteria and searched CENTRAL, Medline and Web of Science. Randomized controlled trails that compared an endoscopic treatment to a surgical treatment for patients with infected walled-off necrosis and included one of the main outcomes were eligible for inclusion. The main outcomes were mortality and new onset multiple organ failure. Prospero registration ID: CRD42019126033 RESULTS: Three RCTs with 190 patients were included. Intention to treat analysis showed no difference in mortality. However, patients in the endoscopic group had statistically significant lower odds of experiencing new onset multiple organ failure (odds ratio (OR) confidence interval [CI] 0.31 [0.10, 0.98]) and were statistically less likely to suffer from perforations of visceral organs or enterocutaneous fistulae (OR [CI] 0.31 [0.10, 0.93]), and pancreatic fistulae (OR [CI] 0.09 [0.03, 0.28]). Patients with endoscopic treatment had a statistically significant lower mean hospital stay (Mean difference [CI] - 7.86 days [- 14.49, - 1.22]). No differences in bleeding requiring intervention, incisional hernia, exocrine or endocrine insufficiency or ICU stay were apparent. Overall certainty of evidence was moderate. CONCLUSION: There seem to be possible benefits of endoscopic treatment procedure. Given the heterogenous procedures in the surgical group as well as the low amount of randomized evidence, further studies are needed to evaluate the combination of different approaches and appropriate timepoints for interventions.


Assuntos
Pancreatite Necrosante Aguda/cirurgia , Drenagem/métodos , Endoscopia/efeitos adversos , Endoscopia/métodos , Humanos , Fístula Intestinal/etiologia , Fístula Pancreática/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Actas Urol Esp (Engl Ed) ; 47(9): 611-617, 2023 11.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-37574013

RESUMO

OBJECTIVE: To evaluate the transfer of the practical skills of robot-assisted surgery acquired in the dry-lab into a real live experimental setting for performing upper and lower urinary tract surgeries. MATERIAL AND METHODS: An in vivo experimental study design was utilized. Six urology trainees and fellows; two 2nd year trainees with no previous exposure to laparoscopic surgery (Group 1), two 4th year residents with medium exposure to laparoscopic surgery (Group 2) and two fellows trained to perform laparoscopic surgeries (Group 3) performed ureteral reimplantation into the bladder, pyeloplasty, and radical nephrectomy on three female pigs under general anesthesia. Prior to performing the requested procedures, each participant completed 10-14 h dry-lab robotic training acquiring skills in basic surgical tasks, such as suturing, cutting and needle passage. The recorded variables were the successful completion of the procedures, the console time, and the time to perform different steps and major complications. RESULTS: All procedures were completed successfully by all groups except the pyeloplasty by group 1 which was complicated by bleeding from the renal vein, and the procedure was abandoned. Group 3 achieved shorter console time for all successfully completed procedures and for separate surgical steps compared to all groups, followed by Group 2. The slowest group for all procedures and steps analyzed was Group 3. CONCLUSIONS: Although further clinical evidence is needed, the robotic-assisted urological procedures and the most challenging steps could be performed safely and effectively after proper training in the dry lab under mentor supervision according to our study.


Assuntos
Procedimentos Cirúrgicos Robóticos , Urologia , Humanos , Feminino , Animais , Suínos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Urologia/educação , Nefrectomia , Rim
7.
J Cell Biol ; 146(5): 1173-84, 1999 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-10477768

RESUMO

This study investigated the function of the adhesion molecule L1 in unmyelinated fibers of the peripheral nervous system (PNS) by analysis of L1- deficient mice. We demonstrate that L1 is present on axons and Schwann cells of sensory unmyelinated fibers, but only on Schwann cells of sympathetic unmyelinated fibers. In L1-deficient sensory nerves, Schwann cells formed but failed to retain normal axonal ensheathment. L1-deficient mice had reduced sensory function and loss of unmyelinated axons, while sympathetic unmyelinated axons appeared normal. In nerve transplant studies, loss of axonal-L1, but not Schwann cell-L1, reproduced the L1-deficient phenotype. These data establish that heterophilic axonal-L1 interactions mediate adhesion between unmyelinated sensory axons and Schwann cells, stabilize the polarization of Schwann cell surface membranes, and mediate a trophic effect that assures axonal survival.


Assuntos
Axônios/metabolismo , Glicoproteínas de Membrana/metabolismo , Bainha de Mielina/metabolismo , Moléculas de Adesão de Célula Nervosa/metabolismo , Neurônios Aferentes/citologia , Células de Schwann/citologia , Animais , Axônios/ultraestrutura , Adesão Celular , Polaridade Celular , Sobrevivência Celular , Feminino , Gânglios Espinais/citologia , Gânglios Espinais/metabolismo , Deleção de Genes , Complexo Antígeno L1 Leucocitário , Masculino , Glicoproteínas de Membrana/genética , Camundongos , Camundongos Knockout , Bainha de Mielina/ultraestrutura , Glicoproteína Associada a Mielina/genética , Glicoproteína Associada a Mielina/metabolismo , Degeneração Neural , Fibras Nervosas/metabolismo , Fibras Nervosas/ultraestrutura , Moléculas de Adesão de Célula Nervosa/genética , Neurônios Aferentes/metabolismo , Neurônios Aferentes/ultraestrutura , Sistema Nervoso Periférico/citologia , Pressão , Células de Schwann/metabolismo , Células de Schwann/ultraestrutura , Nervo Isquiático/transplante , Nervo Isquiático/ultraestrutura
8.
Plant Dis ; 90(1): 24-32, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30786470

RESUMO

Late blight, caused by the pathogen Phytophthora infestans, is a devastating disease of potato and tomato, but can also damage other solanaceous hosts. To gain a better understanding of the interaction between P. infestans and these other hosts, the susceptibility of species in three solanaceous genera was investigated. Of the 10 Calibrachoa × hybridus cultivars tested, four were susceptible and six were resistant to the pathogen; susceptible cultivars supported only very limited growth of P. infestans. The majority of the Petunia × hybrida (petunia) cultivars were susceptible, although less so than susceptible potatoes or tomatoes. Two petunia cultivars displayed differential resistance, suggesting the presence of R genes against P. infestans. The hypersensitive response was present in susceptible, partially resistant, and resistant petunia-P. infestans interactions, but was predominant in the resistant interaction. Young petunias (3 weeks) were more susceptible than older petunias (7 weeks). Nicotiana benthamiana was susceptible to all four P. infestans isolates tested in the lab and became infected during a field epidemic. Several of these isolates were tested for the presence of the inf1 gene, and were found to have and express the gene in vitro. In addition, culture filtrate from these isolates contained 10-kDa proteins and also elicited the hypersensitive response in Nicotiana tabacum and N. benthamiana.

9.
J Perinatol ; 35(11): 941-8, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26313054

RESUMO

OBJECTIVE: To implement feeding guidelines to reduce advancement time and the incidence of parenteral nutrition-associated liver disease (PNALD) among intestinal surgical infants requiring parenteral nutrition (PN). STUDY DESIGN: Feeding guidelines with higher initial enteral nutrition (EN) volume and specific advancement criteria were implemented for surgical infants aged <6 months. Preimplementation and postimplementation outcomes were compared. RESULTS: There were 57 preimplementation and 33 postimplementation infants. The initial EN volume improved from 10 to 20 ml kg(-1) day(-1) (P<0.001). Time to reach 50% of goal calories from EN decreased by a median of 6 days (P=0.012) without a change in necrotizing enterocolitis incidence after resuming feeding. PNALD incidence decreased from 70% to 48% (P=0.046), and median peak direct bilirubin (DB) decreased from 5.6 to 2.3 mg dl(-1) (P=0.011). CONCLUSION: Feeding guideline implementation with higher initial feeding volume was well tolerated and resulted in faster achievement of 50% goal EN calories. PNALD incidence and peak DB were reduced.


Assuntos
Anormalidades do Sistema Digestório/diagnóstico , Anormalidades do Sistema Digestório/cirurgia , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Hepatopatias/prevenção & controle , Guias de Prática Clínica como Assunto , Centros Médicos Acadêmicos , Feminino , Seguimentos , Humanos , Lactente , Cuidado do Lactente/métodos , Cuidado do Lactente/normas , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Hepatopatias/etiologia , Masculino , Terapia Nutricional/métodos , Terapia Nutricional/normas , Necessidades Nutricionais , Cuidados Pós-Operatórios/métodos , Resultado do Tratamento , Aumento de Peso/fisiologia
10.
Adv Drug Deliv Rev ; 40(3): 153-69, 2000 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-10837787

RESUMO

The efficacy of blood substitutes, as a whole, has been readily demonstrated, in animals as well as clinical studies. It is well known that stroma free hemoglobin (SF-Hb) is very toxic, due to effects on renal and coagulation functions and vascular tone. Several modifications have been made to the hemoglobin tetramer in an attempt to eliminate its toxicity. Conjugation, cross-linking, polymerization, and recombinant technology have all been used to reduce toxicity, while aiming to optimize the therapeutic value of hemoglobin based blood substitutes. The remaining issue seems to be the hypertensive response seen in many hemoglobin solutions. The cause of the hypertensive response, and hence what chemical modifications are suitable to alleviate it are still under debate.


Assuntos
Substitutos Sanguíneos/química , Hemoglobinas/química , Oxigênio/sangue , Animais , Hemoglobinas/isolamento & purificação , Humanos
11.
J Neuropathol Exp Neurol ; 55(3): 290-9, 1996 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-8786387

RESUMO

Peripheral Myelin Protein-22 (PMP22) is a membrane glycoprotein which represents up to 5% of total protein in myelin of peripheral nerves. Mutations affecting the PMP22 gene have been linked to the inherited peripheral neuropathies Charcot-Marie-Tooth disease type 1A (CMT1A; duplications and point mutations), Dejerine-Sottas syndrome (DSS; point mutations), and hereditary neuropathy with liability to pressure palsies (HNPP; deletions). In this study, we determined the ultrastructural distribution of PMP22 and other myelin proteins in normal human peripheral nervous system (PNS) nerves and in CMT1 patients with or without the CMT1A duplication on chromosome 17. Our results demonstrate that PMP22, P0 protein, and myelin basic protein are present in compact myelin of all patients examined. PMP22 was also present in the plasma membrane of Schwann cells of unmyelinated fibers and onion bulbs. Although the precise biological role of PMP22 remains to be discovered, our results support the hypothesis that this protein serves multiple functions in Schwann cells.


Assuntos
Doença de Charcot-Marie-Tooth/patologia , Proteínas da Mielina/ultraestrutura , Nervos Periféricos/patologia , Humanos , Imuno-Histoquímica , Microscopia Confocal , Pessoa de Meia-Idade , Proteínas da Mielina/análise
12.
Obstet Gynecol ; 38(4): 583-8, 1971 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-5098489

RESUMO

PIP: Field interviews were conducted to gather data on pregnancy wastage and illegitimacy among 990 urban black women in a North Carolina Standard Metropolitan Statistical Area. The sample range in age from 15-39, was at least gravida 1, and was at the poverty level (based on relationship of family size to income). 90% of births were illegitimate with little influence from economic status or income, but higher educational levels were associated with a greater percentage of conceptions resulting in illegitimate live births. The older the women, the lower was the proportion of illegitimate conceptions resulting in illegitimate births. In groups aged 15-24, and 30-39, there was a positive relationship between education and percentage of illegitimate live births, possibly due to general good health, awareness of health facilities for the more educated, and a reluctance to view abortion as acceptable. In this group aged 25-29, higher education was negatively related to illegitimate births, possibly explained by the relatively better health of this group, regardless of knowledge or availability of health care, and their tendency to view abortion as acceptable. Only 4% saw having children as a handicap to getting married. Only 9.7% of all conceptions which were terminated could have been via abortion, which is indicative of the corresponding attitudinal survey where 77% of the sample were opposed to abortion under any circumstances.^ieng


Assuntos
Negro ou Afro-Americano , Ilegitimidade , Aborto Espontâneo/epidemiologia , Adolescente , Adulto , Fatores Etários , Escolaridade , Características da Família , Feminino , Morte Fetal/epidemiologia , Humanos , Casamento , North Carolina , Pobreza , Gravidez , Complicações na Gravidez/epidemiologia , Fatores Socioeconômicos , População Urbana
13.
Ann Thorac Surg ; 69(2): 326-9, 2000 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10735656

RESUMO

BACKGROUND: Discussion of ethical issues occurs much less often in the surgical than in the medical literature. The reasons for this "ethics gap" are unknown. METHODS: Our clinical faculty ranked the ethical and legal acceptability of four treatment options in two cases of surrogate decision making. Only one option in each case was ethically and legally unacceptable (treating despite objection by the surrogate decision maker). RESULTS: Surprisingly often, faculty mistakenly believed the ethically unacceptable option to be acceptable, and the legally unacceptable option to be acceptable. Surgeons were not ethically different from other physicians. Surgeons (19 of 31, 62%), however, were significantly (p < 0.05) more likely than internists (18 of 51, 35%) or pediatricians (4 of 18, 22%) to believe, mistakenly, that operating on the baby without parental consent was legally acceptable. CONCLUSIONS: This pilot study did not identify why the surgical literature contains a relative dearth of ethics discussion. Broader investigations are needed, because it is important that we understand the reasons for the gap. Surgeons' strong ethic of personal responsibility for patients' welfare should be transmitted to young trainees, a goal best achieved by discussing and writing about ethics. Moreover, our legal data suggest that a gap may also exist between surgeons and other physicians in understanding health law.


Assuntos
Tomada de Decisões , Ética Médica , Cirurgia Geral , Adulto , Feminino , Humanos , Consentimento Livre e Esclarecido , Masculino , Projetos Piloto , Estados Unidos
14.
Am Psychol ; 53(7): 709-27, 1998 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9699456

RESUMO

In this article, the authors reflect on the lessons of their Stanford Prison Experiment, some 25 years after conducting it. They review the quarter century of change in criminal justice and correctional policies that has transpired since the Stanford Prison Experiment and then develop a series of reform-oriented proposals drawn from this and related studies on the power of social situations and institutional settings that can be applied to the current crisis in American corrections.


Assuntos
Direito Penal/tendências , Prisioneiros/psicologia , Prisões/tendências , Política Pública , Meio Social , Crime/classificação , Crime/legislação & jurisprudência , Crime/estatística & dados numéricos , Direito Penal/legislação & jurisprudência , Humanos , Grupos Minoritários/estatística & dados numéricos , Prisioneiros/legislação & jurisprudência , Prisioneiros/estatística & dados numéricos , Prisões/legislação & jurisprudência , Prisões/métodos , Prisões/normas , Medidas de Segurança/tendências , Justiça Social/legislação & jurisprudência , Justiça Social/normas , Estados Unidos
15.
Int J Food Microbiol ; 92(3): 289-95, 2004 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-15145587

RESUMO

The goal of this project was to quantify the concentration of heterotrophic plate count (HPC) bacteria within water reaching consumer's taps, and from the sources used by a major utility serving the City of Tucson, AZ. With this information, the amounts and sources of HPC bacteria consumed at the tap could be determined. Samples of water were collected on a monthly basis from two well fields, the CAVSARP recovery well field and Southern Avra Valley well field which serves as one of the groundwater sources for Tucson, AZ, and the distribution system which serves the same homes from which tap water was also tested. The average concentration of HPC in source waters within Southern Avra Valley Wells was 56 CFU/ml (range 1-1995/ml). From the CAVSARP recovery well field, corresponding values were 38 CFU/ml (1 to 502 CFU/ml). Unblended groundwater in the chlorinated distribution system averaged 22 CFU/ml (range 1-794). Blended water at the chlorinated distribution site averaged 47 CFU/ml (range 10-158). There was a major shift in the percentage of gram negative to gram-positive bacteria from the wells to the distribution system, to the tap. In the surface CAP source water, 76% of the bacteria were gram-negative compared to 27% gram-negative in the CAVSARP recovery wells. In contrast, Avra Valley wells contained 17% gram-negative bacteria. In both the Tucson groundwater distribution sites and blended distribution sites, the corresponding number of gram negative bacteria was 12%. Finally at the tap, only 0.2% of the bacteria were gram-negative. The average number of bacteria in household taps averaged 3072 HPC/ml and was equal or greater than 500 ml 68% of the time. This study shows that the number of HPC bacteria increases dramatically from the distribution system to the consumers tap. Thus, the major source of bacteria ingested by the average consumer in Tucson originates from bacteria within the household distribution system or the household tap, rather than from source waters or the distribution system. It is also clear that consumers' regularly consume more than 500 HPC/ml from drinking water taken from the household tap.


Assuntos
Bactérias/isolamento & purificação , Microbiologia da Água , Abastecimento de Água , Arizona , Bactérias/efeitos dos fármacos , Bactérias/crescimento & desenvolvimento , Cloro/farmacologia , Contagem de Colônia Microbiana , Qualidade de Produtos para o Consumidor , Bactérias Gram-Negativas/crescimento & desenvolvimento , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/crescimento & desenvolvimento , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Controle de Qualidade , Purificação da Água , Abastecimento de Água/análise , Abastecimento de Água/normas
16.
Lipids ; 33(1): 59-69, 1998 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9470174

RESUMO

We have examined the biosynthetic pathway of triacylglycerols containing ricinoleate to determine the steps in the pathway that lead to the high levels of ricinoleate incorporation in castor oil. The biosynthetic pathway was studied by analysis of products resulting from castor microsomal incubation of 1-palmitoyl-2-[14C]oleoyl-sn-glycero-3-phosphocholine, the substrate of oleoyl-12-hydroxylase, using high-performance liquid chromatography, gas chromatography, mass spectrometry, and/or thin-layer chromatography. In addition to formation of the immediate and major metabolite, 1-palmitoyl-2-[14C]ricinoleoyl-sn-glycero-3-phosphocholine, 14C-labeled 2-linoleoyl-phosphatidylcholine (PC), and 14C-labeled phosphatidylethanolamine were also identified as the metabolites. In addition, the four triacylglycerols that constitute castor oil, triricinolein, 1,2-diricinoleoyl-3-oleoyl-sn-glycerol, 1,2-diricinoleoyl-3-linoleoyl-sn-glycerol, 1,2-diricinoleoyl-3-linolenoyl-sn-glycerol, were also identified as labeled metabolites in the incubation along with labeled fatty acids: ricinoleate, oleate, and linoleate. The conversion of PC to free fatty acids by phospholipase A2 strongly favored ricinoleate among the fatty acids on the sn-2 position of PC. A major metabolite, 1-palmitoyl-2-oleoyl-sn-glycerol, was identified as the phospholipase C hydrolyte of the substrate; however, its conversion to triacylglycerols was blocked. In the separate incubations of 2-[14C]ricinoleoyl-PC and [14C]ricinoleate plus CoA, the metabolites were free ricinoleate and the same triacylglycerols that result from incubation with 2-oleoyl-PC. Our results demonstrate the proposed pathway: 2-oleoyl-PC-->2-ricinoleoyl-PC-->ricinoleate-->triacylglycerols. The first two steps as well as the step of diacylglycerol acyltransferase show preference for producing ricinoleate and incorporating it in triacylglycerols over oleate and linoleate. Thus, the productions of these triacylglycerols in this relatively short incubation (30 min), as well as the availability of 2-oleoyl-PC in vivo, reflect the in vivo drive to produce triricinolein in castor bean.


Assuntos
Microssomos/enzimologia , Oxigenases de Função Mista/metabolismo , Fosfatidilcolinas/metabolismo , Plantas Tóxicas , Ricinus communis/ultraestrutura , Triglicerídeos/biossíntese , Cromatografia Líquida de Alta Pressão , Ácidos Graxos não Esterificados/metabolismo , Espectrometria de Massas , Fosfatidiletanolaminas/metabolismo , Fosfolipases A/metabolismo , Fosfolipases A2 , Proteínas de Plantas , Ácidos Ricinoleicos/metabolismo , Especificidade por Substrato , Fosfolipases Tipo C/metabolismo
17.
Ethn Dis ; 9(3): 451-62, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10600068

RESUMO

Psychological stress may directly contribute to the disproportionately high rates of coronary heart disease morbidity and mortality and its etiologic risk factors in African Americans. Specifically, acute and chronic stress have been shown to raise serum lipids and are associated with clinical coronary events. The mechanisms by which stress contributes to alterations in lipid levels are not fully known, but various pathways (ie, hormonal, dietary, etc) have been implicated. Traditional methods for reducing blood serum lipids include diet, drugs or both. These methods have been criticized because of issues of compliance, side effects, and cost. Because of these limitations, nondrug behavioral methods are recommended by the National Cholesterol Education Program as the first line of prevention and treatment for hypercholesterolemia and other risk factors. Research shows that CHD morbidity and mortality and major risk factors may be modifiable by behavioral intervention. Specifically, the Transcendental Meditation technique, an effective antidote to stress, reduces levels of major CHD risk factors including hypercholesterolemia, as well as blood pressure and smoking. Using an effective stress reduction approach for prevention and treatment of CHD and its risk factors in African Americans may prove to be a valuable asset for this underserved population.


Assuntos
Negro ou Afro-Americano , Hipercolesterolemia/terapia , Estresse Psicológico/prevenção & controle , Comorbidade , Doença das Coronárias/psicologia , Exercício Físico , Humanos , Hipercolesterolemia/tratamento farmacológico , Hipercolesterolemia/epidemiologia , Meditação , Fatores de Risco , Estresse Psicológico/epidemiologia
18.
J Obstet Gynecol Neonatal Nurs ; 21(3): 187-95, 1992.
Artigo em Inglês | MEDLINE | ID: mdl-1640275

RESUMO

Respiratory distress remains a major source of morbidity and mortality among infants, despite advances in conventional mechanical ventilation over the past 20 years. High-frequency jet ventilation provides an alternative treatment modality for neonates suffering from pulmonary air leak syndromes, such as pulmonary interstitial emphysema and pneumothorax. This new technology presents special challenges to the nurse caring for these critically ill neonates and their families.


Assuntos
Ventilação em Jatos de Alta Frequência/enfermagem , Enfermagem Materno-Infantil/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/enfermagem , Ventilação em Jatos de Alta Frequência/instrumentação , Ventilação em Jatos de Alta Frequência/métodos , Humanos , Recém-Nascido , Avaliação em Enfermagem , Relações Pais-Filho , Pais/educação , Pais/psicologia , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia
19.
Behav Med ; 27(2): 83-95, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11763829

RESUMO

African Americans experience higher morbidity and mortality than Whites do as a result of hypertension and associated cardiovascular disease. Chronic psychosocial stress has been considered an important contributing factor to these high rates. The authors describe the rationale and design for a planned randomized controlled trial comparing Transcendental Meditation, a stress-reduction technique, with lifestyle education in the treatment of hypertension and hypertensive heart disease in urban African Americans. They pretested 170 men and women aged 20 to 70 years over a 3-session baseline period, with posttests at 6 months. Outcomes included clinic and ambulatory blood pressure, quality of life, left ventricular mass measured by M-mode echocardiography, left ventricular diastolic function measured by Doppler, and carotid atherosclerosis measured by beta-mode ultrasound. This trial was designed to evaluate the hypothesis that a selected stress reduction technique is effective in reducing hypertension and hypertensive heart disease in African Americans.


Assuntos
Terapia Comportamental/métodos , Negro ou Afro-Americano , Hipertensão/terapia , Adulto , Idoso , Arteriosclerose/epidemiologia , Arteriosclerose/fisiopatologia , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/fisiopatologia , Feminino , Humanos , Hipertensão/epidemiologia , Hipertrofia Ventricular Esquerda/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos
20.
Rev Neurol (Paris) ; 152(5): 314-9, 1996 May.
Artigo em Inglês | MEDLINE | ID: mdl-8881422

RESUMO

Peripheral neuropathies can result from a failure to form or maintain the myelin internode or from autoimmune-mediated demyelination. Several gene defects responsible for the most common inherited human peripheral neuropathies referred to as Charcot-Marie-Tooth disease have been reported. These studies identified PMP-22 and connexin-32 as proteins that are essentiel for normal myelination. Point mutations in Po protein, PMP-22, and connexin-32 have been identified as causes of inherited peripheral neuropathies. In addition, studies indicated for the first time that alterations in PMP-22 gene dosage (trisomy and monosomy) can induce inherited peripheral neuropathies. Little is known, however, about how these gene defects cause myelin pathology. This report describes the distributions of proteins within the peripheral myelin internode and discusses how these molecules contribute to the pathogenesis of inherited and autoimmune peripheral neuropathy. A better understanding of the molecular composition of the myelin internode is essential for diagnosis and treatment of human peripheral neuropathies.


Assuntos
Doenças Autoimunes/etiologia , Doenças Desmielinizantes/etiologia , Proteínas da Mielina/química , Doenças do Sistema Nervoso Periférico/etiologia , Doenças Autoimunes/genética , Doenças Autoimunes/imunologia , Doenças Desmielinizantes/genética , Doenças Desmielinizantes/imunologia , Humanos , Mutação , Proteínas da Mielina/genética , Doenças do Sistema Nervoso Periférico/genética
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