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1.
Plant Dis ; 108(6): 1786-1792, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38254325

RESUMO

Maize dwarf mosaic (MDM) is one of the most important virus diseases of maize worldwide. Caused by the potyviruses maize dwarf mosaic virus (MDMV) or sugarcane mosaic virus (SCMV), MDM can cause up to 90% yield loss in susceptible hybrids. One of the most effective management strategies for MDM is growing potyvirus-resistant corn varieties. However, yield impacts associated with MDM and the corresponding efficacy of genetic resistance present in modern United States commercial hybrid lines is uncharacterized. In this study, we evaluated the disease response of 78 commercial hybrids to MDMV and SCMV and quantified yield losses associated with infection over multiple trials. We determined that while 97% of the hybrids tested were resistant to MDMV, 100% were susceptible to SCMV, with mean disease incidence per line averaging between 45 and 78% across six trial years. Despite only one hybrid displaying visible mosaic symptoms when inoculated with MDMV, MDMV reduced average yields by approximately 5% across all hybrids compared with the mock-inoculated treatment. The yield impact of SCMV was more severe, reducing average yields by 10% across replicated experiments. These results indicate that while most commercial hybrids are resistant to MDMV, possibly due to the presence of the major Scmv1 resistance locus on chromosome 6, additional potyvirus resistance genes are needed to manage SCMV-induced MDM. Pyramiding resistance loci, such as Scmv2 on chromosome 3 or Scmv3 on chromosome 10 in addition to Scmv1, could be an effective strategy to mitigate the yield impact of MDM disease.


Assuntos
Resistência à Doença , Doenças das Plantas , Potyvirus , Zea mays , Doenças das Plantas/virologia , Doenças das Plantas/prevenção & controle , Zea mays/virologia , Zea mays/genética , Potyvirus/fisiologia , Potyvirus/genética , Resistência à Doença/genética , Hibridização Genética
2.
Phytopathology ; 108(6): 748-758, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29287150

RESUMO

The recent rapid emergence of maize lethal necrosis (MLN), caused by coinfection of maize with Maize chlorotic mottle virus (MCMV) and a second virus usually from the family Potyviridae, is causing extensive losses for farmers in East Africa, Southeast Asia, and South America. Although the genetic basis of resistance to potyviruses is well understood in maize, little was known about resistance to MCMV. The responses of five maize inbred lines (KS23-5, KS23-6, N211, DR, and Oh1VI) to inoculation with MCMV, Sugarcane mosaic virus, and MLN were characterized. All five lines developed fewer symptoms than susceptible controls after inoculation with MCMV; however, the virus was detected in systemic leaf tissue from each of the lines similarly to susceptible controls, indicating that the lines were tolerant of MCMV rather than resistant to it. Except for KS23-5, the inbred lines also developed fewer symptoms after inoculation with MLN than susceptible controls. To identify genetic loci associated with MCMV tolerance, large F2 or recombinant inbred populations were evaluated for their phenotypic responses to MCMV, and the most resistant and susceptible plants were genotyped by sequencing. One to four quantitative trait loci (QTL) were identified in each tolerant population using recombination frequency and positional mapping strategies. In contrast to previous studies of virus resistance in maize, the chromosomal positions and genetic character of the QTL were unique to each population. The results suggest that different, genotype-specific mechanisms are associated with MCMV tolerance in maize. These results will allow for the development of markers for marker-assisted selection of MCMV- and MLN-tolerant maize hybrids for disease control.


Assuntos
Cromossomos de Plantas/genética , Gammaherpesvirinae , Doenças das Plantas/genética , Doenças das Plantas/virologia , Locos de Características Quantitativas/genética , Zea mays/genética , Mapeamento Cromossômico , Predisposição Genética para Doença , Genótipo
3.
Undersea Hyperb Med ; 44(5): 387-391, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29116692

RESUMO

A pilot study was conducted in mid-Michigan to evaluate knowledge of appropriate hyperbaric oxygen therapy referrals in "first contact" physicians who did not have additional hyperbaric training. The hypothesis for this study is that many first-contact physicians have little or no exposure to hyperbaric oxygen (HBO2) therapy and its indications. A survey was distributed regarding accepted indications combined with conditions not currently approved or contraindicated for HBO2. Answers were tallied for correct identification of approved indications, missed approved indications, and inappropriate identification of unapproved indications. Ninety (90) surveys were distributed and 62 physicians of various specialties responded. There were notably high percentages of missed indications, as high as 93%. Many emergent/urgent indications were missed as well. The highest percentage of wrong indications was 32%. Very concerning is the 13% who chose refractory pneumothorax as a condition responsive to HBO2 therapy. This study showed significant lack of familiarity of HBO2 treatment indications among physicians who did not have additional hyperbaric training. Inclusion of hyperbaric education during residencies may increase HBO2 referrals and improve outcomes for various disorders.


Assuntos
Oxigenoterapia Hiperbárica , Humanos , Michigan , Médicos de Atenção Primária , Projetos Piloto , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta , Sociedades Médicas , Inquéritos e Questionários
4.
Phytopathology ; 105(7): 956-65, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25822185

RESUMO

In sub-Saharan Africa, maize is a staple food and key determinant of food security for smallholder farming communities. Pest and disease outbreaks are key constraints to maize productivity. In September 2011, a serious disease outbreak, later diagnosed as maize lethal necrosis (MLN), was reported on maize in Kenya. The disease has since been confirmed in Rwanda and the Democratic Republic of Congo, and similar symptoms have been reported in Tanzania, Uganda, South Sudan, and Ethiopia. In 2012, yield losses of up to 90% resulted in an estimated grain loss of 126,000 metric tons valued at $52 million in Kenya alone. In eastern Africa, MLN was found to result from coinfection of maize with Maize chlorotic mottle virus (MCMV) and Sugarcane mosaic virus (SCMV), although MCMV alone appears to cause significant crop losses. We summarize here the results of collaborative research undertaken to understand the biology and epidemiology of MLN in East Africa and to develop disease management strategies, including identification of MLN-tolerant maize germplasm. We discuss recent progress, identify major issues requiring further research, and discuss the possible next steps for effective management of MLN.


Assuntos
Potyviridae/fisiologia , Tombusviridae/fisiologia , Zea mays/virologia , África Subsaariana , Abastecimento de Alimentos , Interações Hospedeiro-Patógeno , Controle de Pragas , Doenças das Plantas/virologia
5.
Theor Appl Genet ; 127(4): 867-80, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24500307

RESUMO

KEY MESSAGE: Novel and previously known resistance loci for six phylogenetically diverse viruses were tightly clustered on chromosomes 2, 3, 6 and 10 in the multiply virus-resistant maize inbred line, Oh1VI. Virus diseases in maize can cause severe yield reductions that threaten crop production and food supplies in some regions of the world. Genetic resistance to different viruses has been characterized in maize populations in diverse environments using different screening techniques, and resistance loci have been mapped to all maize chromosomes. The maize inbred line, Oh1VI, is resistant to at least ten viruses, including viruses in five different families. To determine the genes and inheritance mechanisms responsible for the multiple virus resistance in this line, F1 hybrids, F2 progeny and a recombinant inbred line (RIL) population derived from a cross of Oh1VI and the virus-susceptible inbred line Oh28 were evaluated. Progeny were screened for their responses to Maize dwarf mosaic virus, Sugarcane mosaic virus, Wheat streak mosaic virus, Maize chlorotic dwarf virus, Maize fine streak virus, and Maize mosaic virus. Depending on the virus, dominant, recessive, or additive gene effects were responsible for the resistance observed in F1 plants. One to three gene models explained the observed segregation of resistance in the F2 generation for all six viruses. Composite interval mapping in the RIL population identified 17 resistance QTLs associated with the six viruses. Of these, 15 were clustered in specific regions of chr. 2, 3, 6, and 10. It is unknown whether these QTL clusters contain single or multiple virus resistance genes, but the coupling phase linkage of genes conferring resistance to multiple virus diseases in this population could facilitate breeding efforts to develop multi-virus resistant crops.


Assuntos
Resistência à Doença/genética , Endogamia , Doenças das Plantas/genética , Doenças das Plantas/virologia , Vírus de Plantas/fisiologia , Zea mays/genética , Zea mays/virologia , Mapeamento Cromossômico , Cruzamentos Genéticos , Progressão da Doença , Padrões de Herança/genética , Fenótipo , Doenças das Plantas/imunologia , Locos de Características Quantitativas/genética , Recombinação Genética/genética
6.
JSLS ; 27(1)2023.
Artigo em Inglês | MEDLINE | ID: mdl-37009063

RESUMO

Described is a simple modification of the O'Reilly esophageal retractor to aid in performing laparoscopic posterior gastric wraps during antireflux procedures. A 3-mm hole was drilled into the distal end of the reticulating arm. Once the arm is positioned posteriorly to the gastroesophageal (GE) junction, the freed gastric fundus can be secured to the retractor with a suture. The fundus can then be pulled posteriorly to the GE junction and held into position for placement of the fundoplication sutures.


Assuntos
Refluxo Gastroesofágico , Laparoscopia , Humanos , Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Junção Esofagogástrica , Laparoscopia/métodos
7.
Artigo em Inglês | MEDLINE | ID: mdl-38117617

RESUMO

Point cloud completion is the task of producing a complete 3D shape given an input of a partial point cloud. It has become a vital process in 3D computer graphics, vision and applications such as autonomous driving, robotics, and augmented reality. These applications often rely on the presence of a complete 3D representation of the environment. Over the past few years, many completion algorithms have been proposed and a substantial amount of research has been carried out. However, there are not many in-depth surveys that summarise the research progress in such a way that allows users to make an informed choice of what algorithms to employ given the type of data they have, the end result they want, the challenges they may face and the possible strategies they could use. In this study, we present a comprehensive survey and classification of papers on point cloud completion untill August 2023 based on the strategies, techniques, inputs, outputs, and network architectures. We will also cover datasets, evaluation methods, and application areas in point cloud completion. Finally, we discuss challenges faced by the research community and future research directions.

8.
Vet Rec ; 190(6): e1384, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35303326

RESUMO

BACKGROUND: Since 2013, badger culling has been part of the UK Government's strategy for controlling bovine tuberculosis (bTB) within a high-risk area (HRA) in England. Government surveillance data now enables an examination of bTB herd incidence and prevalence, its headline indicators, within and outside cull areas over the period 2009-2020. METHODS: Analysis compared herd incidence and prevalence data from within and outside badger culling areas. A range of models (GLMs, GLMMs, GAMs and GAMMs) were used to analyse incidence and prevalence in culled and unculled areas using frequentist and Bayesian approaches. Change in incidence across ten county areas within the HRA for the period 2010-2020 was also compared. RESULTS: Analyses based on Defra published data using a variety of statistical methodologies did not suggest that badger culling affected herd bTB incidence or prevalence over the study period. In 9 of 10 counties, bTB incidence peaked and began to fall before badger culling commenced. LIMITATIONS: There are limitations around the data available on culling location, temporal information and other confounding factors. As such, further analysis of any future datasets that may be released on bTB levels in areas where badger culling has been implemented is warranted. CONCLUSION: This examination of government data obtained over a wide area and a long time period failed to identify a meaningful effect of badger culling on bTB in English cattle herds. These findings may have implications for the use of badger culling in current and future bTB control policy.


Assuntos
Doenças dos Bovinos , Mustelidae , Tuberculose Bovina , Animais , Teorema de Bayes , Bovinos , Inglaterra/epidemiologia , Incidência , Tuberculose Bovina/epidemiologia , Tuberculose Bovina/prevenção & controle
9.
Theor Appl Genet ; 123(5): 729-40, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21667271

RESUMO

Genes on chromosomes six (Wsm1), three (Wsm2) and ten (Wsm3) in the maize (Zea mays L.) inbred line Pa405 control resistance to Wheat streak mosaic virus (WSMV), and the same or closely linked genes control resistance to Maize dwarf mosaic virus (MDMV) and Sugarcane mosaic virus (SCMV). Near isogenic lines (NIL) carrying one or two of the genes were developed by introgressing regions of the respective chromosomes into the susceptible line Oh28 and tested for their responses to WSMV, MDMV, and SCMV in the field and greenhouse. F(1) progeny from NIL × Oh28 were also tested. Wsm1, or closely linked genes, provided resistance to all three viruses, as determined by symptom incidence and severity. Wsm2 and Wsm3 provided resistance to WSMV. Wsm2 and/or Wsm3 provided no resistance to MDMV, but significantly increased resistance in plants with one Wsm1 allele. NIL carrying Wsm1, Wsm2, or Wsm3 had similar SCMV resistance in the field, but NIL with Wsm2 and Wsm3 were not resistant in the greenhouse. Addition of Wsm2 to Wsm1 increased SCMV resistance in the field. For all viruses, symptom incidence was higher in the greenhouse than in the field, and relative disease severity was higher in the greenhouse for WSMV and MDMV. An Italian MDMV isolate and the Ohio SCMV infected the Wsm1 NIL, while the Ohio MDMV and Seehausen SCMV isolates did not. Our results indicate that the three genes, or closely linked loci, provide virus resistance. Resistance conferred by the three genes is influenced by interactions among the genes, the virus species, the virus isolate, and the environment.


Assuntos
Doenças das Plantas/genética , Potyviridae/fisiologia , Zea mays/genética , Cromossomos de Plantas , Resistência à Doença/genética , Genes de Plantas/fisiologia , Genótipo , Doenças das Plantas/virologia , Zea mays/virologia
10.
ACS Med Chem Lett ; 12(2): 217-227, 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33603968

RESUMO

Novel therapies are required to treat chronic bacterial infections in cystic fibrosis (CF) sufferers. The most common pathogen responsible for these infections is Pseudomonas aeruginosa, which persists within the lungs of CF sufferers despite intensive antibiotic treatment. P. aeruginosa elastase (also known as LasB or pseudolysin) is a key virulence determinant that contributes to the pathogenesis and persistence of P. aeruginosa infections in CF patients. The crucial role of LasB in pseudomonal virulence makes it a good target for the development of an adjuvant drug for CF treatment. Herein we discuss the discovery of a new series of LasB inhibitors by virtual screening and computer assisted drug design (CADD) and their optimization leading to compounds 29 and 39 (K i = 0.16 µM and 0.12 µM, respectively).

11.
JSLS ; 24(4)2020.
Artigo em Inglês | MEDLINE | ID: mdl-33100816

RESUMO

PURPOSE: Beginning with the graduating class of 2018, the American Board of Surgery (ABS) requires that residents complete the ABS Flexible Endoscopy Curriculum, Fundamentals of Endoscopic Surgery (FES). This curriculum includes both didactic and simulator training. In the ideal setting residents gain proficiency using simulation prior to performing endoscopies in the clinical setting. This new requirement creates an increased demand for endoscopic simulators in all General Surgery residency programs. Due to the cost prohibitive nature of virtual reality simulators an economic alternative is needed. METHODS: A mechanical simulator was created from inexpensive items easily acquired at a hardware store and in the hospital. Total cost of the simulator was approximately $120 USD. To validate the simulator, experienced endoscopists completed a training session with the device. A seven-question Likert scale survey (1 - strongly disagree to 5 - strongly agree) was completed after the session evaluated the simulated experience versus live upper endoscopies and the device's ability to meet the goals of the FES curriculum. RESULTS: Eight proficient endoscopists completed the training session and survey and agreed that the device closely replicated live colonoscopies and would meet all training requirements in the FES curriculum. Mean responses to all seven survey questions ranged from 3.8-4.4. CONCLUSION: This device is a cost-effective method for simulating live upper endoscopies and is appropriate for use in FES training.


Assuntos
Competência Clínica/estatística & dados numéricos , Simulação por Computador , Educação de Pós-Graduação em Medicina/métodos , Endoscopia Gastrointestinal/educação , Cirurgia Geral/educação , Internato e Residência/métodos , Realidade Virtual , Análise Custo-Benefício , Currículo , Educação de Pós-Graduação em Medicina/economia , Endoscopia Gastrointestinal/economia , Cirurgia Geral/economia , Humanos , Internato e Residência/economia , Treinamento por Simulação/métodos
12.
IEEE Trans Vis Comput Graph ; 15(1): 49-61, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19008555

RESUMO

Photon mapping is an efficient method for producing high-quality, photorealistic images with full global illumination. In this paper we present a more accurate and efficient approach to final gathering using the photon map based upon hierarchical evaluation of the photons over each surface. We use the footprint of each gather ray to calculate the irradiance estimate area rather than deriving it from the local photon density. We then describe an efficient method for computing the irradiance from the photon map given an arbitrary estimate area. Finally, we demonstrate how the technique may be used to reduce variance and increase efficiency when sampling diffuse and glossy-specular BRDFs.


Assuntos
Algoritmos , Interpretação de Imagem Assistida por Computador/métodos , Iluminação/métodos , Modelos Estatísticos , Fotometria/métodos , Simulação por Computador , Luz , Fótons , Espalhamento de Radiação
13.
IEEE Trans Vis Comput Graph ; 15(6): 969-76, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19834161

RESUMO

In this paper, we present a new visual way of exploring state sequences in large observational time-series. A key advantage of our method is that it can directly visualize higher-order state transitions. A standard first order state transition is a sequence of two states that are linked by a transition. A higher-order state transition is a sequence of three or more states where the sequence of participating states are linked together by consecutive first order state transitions. Our method extends the current state-graph exploration methods by employing a two dimensional graph, in which higher-order state transitions are visualized as curved lines. All transitions are bundled into thick splines, so that the thickness of an edge represents the frequency of instances. The bundling between two states takes into account the state transitions before and after the transition. This is done in such a way that it forms a continuous representation in which any subsequence of the time series is represented by a continuous smooth line. The edge bundles in these graphs can be explored interactively through our incremental selection algorithm.We demonstrate our method with an application in exploring labeled time-series data from a biological survey, where a clustering has assigned a single label to the data at each time-point. In these sequences, a large number of cyclic patterns occur, which in turn are linked to specific activities. We demonstrate how our method helps to find these cycles, and how the interactive selection process helps to find and investigate activities.


Assuntos
Biologia Computacional/métodos , Gráficos por Computador , Animais , Comportamento Animal , Análise por Conglomerados , Bases de Dados Factuais , Spheniscidae , Fatores de Tempo
14.
IEEE Trans Image Process ; 28(11): 5322-5335, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31107647

RESUMO

A fully-parallelized work-time optimal algorithm is presented for computing the exact Euclidean Distance Transform (EDT) of a 2D binary image with the size of n×n . Unlike existing PRAM (Parallel Random Access Machine) and other algorithms, this algorithm is suitable for implementation on modern SIMD (Single Instruction Multiple Data) architectures such as GPUs. As a fundamental operation of 2D EDT, 1D EDT is efficiently parallelized first. Specifically, the GPU algorithm for the 1D EDT, which uses CUDA (Compute Unified Device Architecture) binary functions, such as ballot(), ffs(), clz(), and shfl(), runs in O(log32n) time and performs O(n) work. Using the 1D EDT as a fundamental operation, the fully-parallelized work-time optimal 2D EDT algorithm is designed. This algorithm consists of three steps. Step 1 of the algorithm runs in O(log32n) time and performs O(N) ( N = n2 ) of total work on GPU. Step 2 performs O(N) of total work and has an expected time complexity of O(logn) on GPU. Step 3 runs in O(log32n) time and performs O(N) of total work on GPU. As far as we know, this algorithm is the first fully-parallelized and realized work-time optimal algorithm for GPUs. The experimental results show that this algorithm outperforms the prior state-of-the-art GPU algorithms.

15.
Wounds ; 31(3): E18-E20, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30924794

RESUMO

INTRODUCTION: Hyperbaric oxygen therapy is known to improve wound healing in the setting of chronic, nonhealing wounds of irradiated skin; however, failure of wound healing may still occur. Dehydrated human amnion/chorion membrane (dHACM) grafting is a technology that has been proven to promote wound healing of wounds related to venous stasis. Little has been published to date regarding use of dHACM in the setting of nonhealing wounds of irradiated skin. CASE REPORT: A 75-year-old man with a history of squamous cell carcinoma of the nose presented to the wound clinic with a chronic, nonhealing nasal wound following tumor resection, radiation therapy, and full-thickness skin graft and auricular cartilage allograft failure. The patient was found to have a nasal cutaneous fistula associated with rhinorrhea, adjacent skin irritation, and discomfort related to the passage of air through the fistulous tract. Following 30 days of standard wound care in the wound clinic (including weekly debridement), the patient continued to have an open, nonhealing wound. As he preferred not to proceed with a surgical flap reconstruction, the patient elected to continue with more conservative management. Hyperbaric oxygen therapy was initiated with some success but with continued presence of a nonhealing fistula tract. A dHACM graft then was applied with successful resolution of the patient's symptoms and decrease in defect size of 45% after 4 applications. CONCLUSIONS: This treatment approach ultimately resulted in complete reepithelization of the wound, and a decrease in defect area. The patient's symptoms of nasal drainage and physical discomfort due to air passage through the fistula also had resolved completely. Although the fistula was still present at the conclusion of treatment, the tract was well-epithelialized and overall size of the defect diminished greatly.


Assuntos
Aloenxertos , Âmnio/transplante , Carcinoma de Células Escamosas/patologia , Córion/transplante , Oxigenoterapia Hiperbárica , Neoplasias Nasais/patologia , Cicatrização/fisiologia , Idoso , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Desbridamento , Humanos , Masculino , Neoplasias Nasais/radioterapia , Neoplasias Nasais/cirurgia , Resultado do Tratamento
16.
ACS Infect Dis ; 5(1): 131-140, 2019 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-30427656

RESUMO

The clinical effectiveness of carbapenem antibiotics such as meropenem is becoming increasingly compromised by the spread of both metallo-ß-lactamase (MBL) and serine-ß-lactamase (SBL) enzymes on mobile genetic elements, stimulating research to find new ß-lactamase inhibitors to be used in conjunction with carbapenems and other ß-lactam antibiotics. Herein, we describe our initial exploration of a novel chemical series of metallo-ß-lactamase inhibitors, from concept to efficacy, in a survival model using an advanced tool compound (ANT431) in conjunction with meropenem.


Assuntos
Antibacterianos/farmacologia , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla , Infecções por Enterobacteriaceae/tratamento farmacológico , Inibidores de beta-Lactamases/química , Carbapenêmicos/farmacologia , Cristalografia por Raios X , Concentração Inibidora 50 , Meropeném/farmacologia , Testes de Sensibilidade Microbiana , Ácidos Picolínicos/química , Ácidos Picolínicos/farmacologia , Ligação Proteica , Relação Estrutura-Atividade , Inibidores de beta-Lactamases/farmacologia , beta-Lactamases
17.
Bioorg Med Chem Lett ; 18(14): 4146-9, 2008 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-18539454

RESUMO

We describe a novel series of imidazopyridine substituted phenylalanines which are potent VLA-4 antagonists. A wide variety of substituents are tolerated as replacements for the pendant 3-pyridyl ring. A clear structure-activity relationship was identified around the substitution of the 3-amino-cyclobut-2-enone portion of the molecule.


Assuntos
Química Farmacêutica/métodos , Integrina alfa4beta1/antagonistas & inibidores , Fenilalanina/química , Piridinas/química , Animais , Desenho de Fármacos , Humanos , Concentração Inibidora 50 , Integrina alfa4beta1/sangue , Camundongos , Modelos Químicos , Conformação Molecular , Ligação Proteica , Ratos , Relação Estrutura-Atividade
18.
Am J Surg ; 215(1): 116-119, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28669533

RESUMO

This is the largest single center retrospective study to date looking at response to laparoscopic cholecystectomy in patients with acalculous biliary disease. A chart review was completed on 1116 patients from 2009 to 2014 who had admitting diagnoses related to acalculous cholecystitis and biliary colic. Four hundred and seventy four patients were available for long term follow up (6 months or longer). Multiple factors were studied as related to cholescintigraphy scans with cholecystokinin administration (HIDA with CCK). Hyperkinetic, normokinetic and hypokinetic ejection fractions (EF), as well as reproduction of symptoms with administration of CCK were catagorized. ROME III criteria (Table 1) were used to describe cholecystitis/biliary colic symptoms. (1). It was found that rates of resolution of symptoms after laparoscopic cholecystectomy in normokinetic and hypokinetic were similar. It was also found that reproduction of symptoms after administration of CCK was a better predictor of favorable response to surgery than calculated ejection fraction.


Assuntos
Colecistite Acalculosa/cirurgia , Discinesia Biliar/cirurgia , Colecistectomia Laparoscópica , Colecistite Acalculosa/diagnóstico , Colecistite Acalculosa/etiologia , Colecistite Acalculosa/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Discinesia Biliar/complicações , Discinesia Biliar/diagnóstico , Discinesia Biliar/metabolismo , Feminino , Seguimentos , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
J Am Coll Surg ; 227(1): 64-76, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29551697

RESUMO

BACKGROUND: It is increasingly important for faculty to teach deliberately and provide timely, detailed, and formative feedback on surgical trainee performance. We initiated a multicenter study to improve resident evaluative processes and enhance teaching and learning behaviors while engaging residents in their education. STUDY DESIGN: Faculty from 7 US postgraduate training programs rated resident operative performances using the perioperative briefing, intraoperative teaching, debriefing model, and rated patient visits/academic performances using the entrustable professional activities model via a web-based platform. Data were centrally analyzed and iterative changes made based on participant feedback, individual preferences, and database refinements, with trends addressed using the Plan, Do, Check, Act improvement methodology. RESULTS: Participants (92 surgeons, 150 residents) submitted 3,880 assessments during July 2014 through September 2017. Evidence of preoperative briefings improved from 33.9% ± 2.5% to 95.5% ± 1.5% between April and September 2014 compared with April and September 2017 (p < 0.001). Postoperative debriefings improved from 10.6% ± 2.7% to 90.2% ± 2.5% (p < 0.001) for the same period. Meaningful self-reflection by residents improved from 28.6% to 67.4% (p < 0.001). The number of assessments received per resident during a 6-month period increased from 6.4 ± 6.2 to 13.4 ± 10.1 (p < 0.003). Surgeon-entered assessments increased from 364 initially to 685 in the final period, and the number of resident assessments increased from 308 to 445. We showed a 4-fold increase in resident observed activities being rated. CONCLUSIONS: By adopting recognized educational models with repeated Plan, Do, Check, Act cycles, we increased the quality of preoperative learning objectives, showed more frequent, detailed, and timely assessments of resident performance, and demonstrated more effective self-reflection by residents. We monitored trends, identified opportunities for improvement and successfully sustained those improvements over time, applying a team-based approach.


Assuntos
Educação de Pós-Graduação em Medicina/organização & administração , Cirurgia Geral/educação , Internet , Internato e Residência , Melhoria de Qualidade , Avaliação Educacional , Feedback Formativo , Humanos , Michigan , Modelos Educacionais , Desenvolvimento de Programas , Estados Unidos
20.
JSLS ; 11(1): 72-5, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17651560

RESUMO

BACKGROUND: Over the last decade, many advances have been made in laparoscopic techniques in various surgical specialties. The technique of laparoscopic-assisted colectomy (LAC) has been reported since 1992 and has been slowly gaining popularity in the surgical community. Several studies have compared laparoscopic versus open colectomy, assessing its applicability to patients with colon cancer, Crohn's disease, and diverticular disease. Studies to date have assessed length of stay, operative time, and clinical outcome. This study focuses on return of bowel function and length of hospital stay in patients undergoing LAC compared with those undergoing open colectomy. METHODS: We performed a retrospective review of patients undergoing either open colon resection or LAC between January 2000 and December 2005. All disease processes and both emergent and elective cases were included. Return of bowel function was determined by passage of flatus or first passage of stool and compared between the 2 groups. The data were statistically analyzed using the Student t test for interval data, and nominal data were analyzed using the chi-square analysis (95% confidence interval; CI). RESULTS: The study included 247 patients; 179 (72.5%) underwent open colectomy and 68 (27.5%) underwent LAC. Passage of flatus took 3.6 days (95% CI .18 or 3.4 to 3.8) for open colectomy, and 2.9 days (95% CI .19 or 2.7 to 3.1) for LAC. First bowel movement took 4.4 days (95% CI .19 or 4.2 to 4.6) for open colectomy and 3.7 days (95% CI .22 or 3.5 to 3.9) for LAC. When compared between the groups, mean length of hospital stay was 8.01 days (95% CI .93 or 7.1 to 8.9) for open colectomy and 4.38 days (95% CI .38 or 4.0 to 4.8) for LAC. CONCLUSION: Both return of bowel function and length of stay were statistically significantly shorter in LAC compared with those in open colectomy, which may indicate faster recovery after bowel surgery in patients undergoing the laparoscopic approach.


Assuntos
Colectomia/métodos , Defecação , Flatulência , Laparoscopia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade
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