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This paper used an evidence and gap map (EGM) to advance the scientific understanding of sibling relationship quality among children aged 2 to 18 years by synthesizing literature on 277 empirical studies from 1985 to 2022 to delineate patterns of study design, sampling, and measurement. Most existing research has utilized majority of White, middle-to-upper class, and/or two-caregiver family samples. Nearly 85% (n = 235) of studies used quantitative methods to measure sibling relationship quality across eight domains: conflict, warmth/affection, quality, cohesion, hostility, power/control, positive engagement, and conflict management. A total of 122 studies used a measure of sibling relationship quality as a predictor of sibling behavior, social, psychological, cognitive, health, or physiological outcomes. Future directions for research are discussed.
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Relações entre Irmãos , Humanos , Criança , Adolescente , Pré-EscolarRESUMO
PURPOSE: To demonstrate delivery of Au nanocages to cells using the galectin-1 binding peptide anginex (Ax) and to demonstrate the value of this targeting for selective in vitro photothermal cell killing. MATERIALS AND METHODS: Au nanocages were synthesised, coated with polydopamine (PDA), and conjugated with Ax. Tumour and endothelial cell viability was measured with and without laser irradiation. Photoacoustic (PA) mapping and PA flow cytometry were used to confirm cell targeting in vitro and in tissue slices ex vivo. RESULTS: Cell viability was maintained at ≥50% at 100 pM suggesting low toxicity of the nanocage alone. Combining the targeted construct (25 pM) with low power 808 nm laser irradiation for 10-20 min (a duration previously shown to induce rapid and sustained heating of Au nanocages [AuNC] in solution), resulted in over 50% killing of endothelial and tumour cells. In contrast, the untargeted construct combined with laser irradiation resulted in negligible cell killing. We estimate approximately 6 × 104 peptides were conjugated to each nanocage, which also resulted in inhibition of cell migration. Binding of the targeted nanocage reached a plateau after three hours, and cell association was 20-fold higher than non-targeted nanocages both in vitro and ex vivo on tumour tissue slices. A threefold increase in tumour accumulation was observed in preliminary in vivo studies. CONCLUSIONS: These studies demonstrate Ax's potential as an effective targeting agent for Au-based theranostics to tumour and endothelial cells, enabling photothermal killing. This platform further suggests potential for multimodal in vivo therapy via next-generation drug-loaded nanocages.
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Galectina 1/metabolismo , Ouro/metabolismo , Nanoestruturas/química , Fototerapia/métodos , Animais , Camundongos , Camundongos Endogâmicos BALB CRESUMO
PURPOSE: To assess the ability of the recently developed adult spinal deformity frailty index (ASD-FI) to predict odds of perioperative complications, odds of reoperation, and length of hospital stay after adult spinal deformity (ASD) surgery using a database other than the one used to create the index. METHODS: We used the ASD-FI to calculate frailty scores for 266 ASD patients who had minimum postoperative follow-up of 2 years in the European Spine Study Group (ESSG) database. Patients were enrolled from 2012 through 2013. Using ASD-FI scores, we categorized patients as not frail (NF) (< 0.3 points), frail (0.3-0.5 points), or severely frail (SF) (> 0.5 points). Multivariable logistic regression, adjusted for preoperative and surgical factors such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and odds of major complications, odds of reoperation, and length of hospital stay. RESULTS: We categorized 135 patients (51%) as NF, 90 patients (34%) as frail, and 41 patients (15%) as SF. Overall mean ASD-FI score was 0.29 (range 0-0.8). The adjusted odds of experiencing a major intraoperative or postoperative complication (OR 4.5, 95% CI 2.0-10) or having a reoperation (OR 3.9, 95% CI 1.7-8.9) were higher for SF patients compared with NF patients. Mean hospital stay was 2.1 times longer (95% CI 1.8-2.4) for SF patients compared with NF patients. CONCLUSIONS: Greater patient frailty, as measured by the ASD-FI, is associated with longer hospital stays and greater odds of major complications and reoperation. These slides can be retrieved under Electronic Supplementary Material.
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Fragilidade , Doenças da Coluna Vertebral , Adulto , Fragilidade/classificação , Fragilidade/diagnóstico , Humanos , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias , Reoperação , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Doenças da Coluna Vertebral/classificação , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/cirurgiaRESUMO
OBJECTIVE The goal of this study was to analyze the value of an adult spinal deformity frailty index (ASD-FI) in preoperative risk stratification. Preoperative risk assessment is imperative before procedures known to have high complication rates, such as ASD surgery. Frailty has been associated with risk of complications in trauma surgery, and preoperative frailty assessments could improve the accuracy of risk stratification by providing a comprehensive analysis of patient factors that contribute to an increased risk of complications. METHODS Using 40 variables, the authors calculated frailty scores with a validated method for 417 patients (enrolled between 2010 and 2014) with a minimum 2-year follow-up in an ASD database. On the basis of these scores, the authors categorized patients as not frail (NF) (< 0.3 points), frail (0.3-0.5 points), or severely frail (SF) (> 0.5 points). The correlation between frailty category and incidence of complications was analyzed. RESULTS The overall mean ASD-FI score was 0.33 (range 0.0-0.8). Compared with NF patients (n = 183), frail patients (n = 158) and SF patients (n = 109) had longer mean hospital stays (1.2 and 1.6 times longer, respectively; p < 0.001). The adjusted odds of experiencing a major intraoperative or postoperative complication were higher for frail patients (OR 2.8) and SF patients ( 4.1) compared with NF patients (p < 0.01). For frail and SF patients, respectively, the adjusted odds of developing proximal junctional kyphosis (OR 2.8 and 3.1) were higher than those for NF patients. The SF patients had higher odds of developing pseudarthrosis (OR 13.0), deep wound infection (OR 8.0), and wound dehiscence (OR 13.4) than NF patients (p < 0.05), and they had 2.1 times greater odds of reoperation (p < 0.05). CONCLUSIONS Greater patient frailty, as measured by the ASD-FI, was associated with worse outcome in many common quality and value metrics, including greater risk of major complications, proximal junctional kyphosis, pseudarthrosis, deep wound infection, wound dehiscence, reoperation, and longer hospital stay.
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Fragilidade/cirurgia , Cifose/cirurgia , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/efeitos adversos , Adulto , Idoso , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/métodosRESUMO
Exposure to adversity and traumatic events affects well-being across important domains of functioning, including mental, physical, social, emotional, spiritual, and neurobiological. Situated as a focal point throughout neighborhoods, recreation centers are a prime opportunity to cultivate spaces of safety and healing. However, current models of trauma-informed care largely do not map neatly onto the recreation organizational structure and functioning. This paper describes the efforts over the past five years to transform the City of Cleveland, Ohio's 22 recreation centers into trauma-informed Neighborhood Resource and Recreation Centers (NRRCs)--places where children, youth, and adults can readily acquire the support and services they need in an environment in which trauma-informed care principles are fully embedded in the fabric of the organization's culture. Phase 1 included transitioning the recreation centers to NRRCs, hiring of trained social workers and counselors to work within the recreation centers, and training all recreation staff about trauma. Phase 2 included development of NRRC trauma-informed standards, development of the Trauma-Informed Progress Tool to track change over time, development of Trauma-Informed Leadership Competencies for Center Managers, and ongoing training for the social workers and counselors. We discuss ideas for future work and lessons learned from each phase.
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Brown adipose tissue (BAT) plays a key role in energy expenditure through its thermogenic function, making its activation a popular target to reduce obesity. We recently reported that male mice housed at thermoneutrality with uncoupling protein 1 (UCP1) deficiency had increased weight gain and glucose intolerance, but eicosapentaenoic acid (EPA) ameliorated these effects. Whether female mice respond similarly to lack of UCP1 and to EPA remains unknown. We hypothesize that the effects of EPA on BAT activation are independent of UCP1 expression. We used female wild type (WT) and UCP1 knockout (KO) mice housed at thermoneutrality (30°C) as an obesogenic environment and fed them high fat (HF) diets with or without EPA for up to 14 weeks. Body weight (BW), body composition, and insulin and glucose tolerance tests were performed during the feeding trial. At termination, serum and BAT were harvested for further analyses. Mice in the KO-EPA group had significantly lower BW than KO-HF mice. In addition, KO-HF mice displayed significantly impaired glucose tolerance compared to their WT-HF littermates. However, EPA significantly enhanced glucose clearance in the KO mice compared to KO-HF mice. Protein levels of the mitochondrial cytochrome C oxidase subunits I, II, and IV were significantly lower in KO mice compared to WT. Our findings support that ablation of UCP1 is detrimental to energy metabolism of female mice in thermoneutral conditions. However, unexpectedly, EPA's protective effects against diet-induced obesity and glucose intolerance in these mice were independent of UCP1.
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Tecido Adiposo Marrom/metabolismo , Ácido Eicosapentaenoico/farmacologia , Obesidade/tratamento farmacológico , Proteína Desacopladora 1/metabolismo , Animais , Peso Corporal/efeitos dos fármacos , Dieta Hiperlipídica/efeitos adversos , Metabolismo Energético/efeitos dos fármacos , Feminino , Intolerância à Glucose/metabolismo , Teste de Tolerância a Glucose/métodos , Camundongos , Camundongos Knockout , Camundongos Obesos , Obesidade/metabolismo , Temperatura , Termogênese/efeitos dos fármacosRESUMO
Healthcare workers have been on the front lines throughout the COVID-19 pandemic, treating affected patients and navigating overwhelmed healthcare systems. Emotional connection has been associated with resilient outcomes following collective trauma. This qualitative study examined how healthcare workers define emotional connectedness during the COVID-19 pandemic and their adaptive emotional connection strategies. Data were gathered through the first wave of the online COVID-19 Pandemic and Emotional Well-Being study, a prospective panel study of the psychological impact of COVID-19 on frontline workers and the general public. This study focused on three extended-response questions about definitions of and strategies for emotional connectedness. Data were analyzed using reflexive thematic analysis. Participants conceptualize emotional connectedness as having empathy and value, help and support, presence, and vulnerability. They also describe emotionally connected relationships as being characterized by mutuality and frequent contact. Participants identify current behavioral strategies for cultivating emotional connectedness, such as using technology, providing instrumental help or sending gifts via mail, and building quality time within their households. They also report challenges in maintaining these connections. Future research must contribute knowledge about effective interventions for essential healthcare workers in the aftermath of COVID-19. Specific recommendations for social work practitioners are also discussed.
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Obesity is a widespread epidemic that increases the risk for several metabolic diseases. Despite several beneficial health effects of eicosapentaenoic acid (C20:5n-3, EPA), previous studies have used very high doses of EPA. In this study, dose-dependent effects of EPA on metabolic outcomes were determined in diet-induced obese mice. We used B6 male mice, fed high-fat diet (HF, 45% kcal fat) or HF diet supplemented with 9, 18, and 36 g/kg of EPA-enriched fish oil for 14 weeks. We conducted metabolic phenotyping during the feeding period, and harvested tissues and blood at termination. Only mice fed 36 g/kg of EPA significantly (p < 0.05) lowered body weight, fat content and epididymal fat pad weight, compared to HF. Both 18 and 36 g/kg doses of EPA significantly increased glucose clearance and insulin sensitivity, compared to HF or 9 g/kg of EPA. Locomotor activity was significantly increased with both 18 and 36 g/kg doses of EPA. Interestingly, all doses of EPA compared to HF, significantly increased energy expenditure and oxygen consumption and significantly reduced serum insulin, leptin, and triglycerides levels. These results demonstrate weight- and adiposity-independent metabolic benefits of EPA, at doses comparable to those currently used to treat hypertriglyceridemia.
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Dieta Hiperlipídica/efeitos adversos , Suplementos Nutricionais , Ácido Eicosapentaenoico/administração & dosagem , Ácido Eicosapentaenoico/farmacologia , Obesidade/etiologia , Obesidade/metabolismo , Tecido Adiposo/metabolismo , Adiposidade/efeitos dos fármacos , Animais , Peso Corporal , Metabolismo Energético/efeitos dos fármacos , Glucose/metabolismo , Insulina/sangue , Resistência à Insulina , Leptina/sangue , Masculino , Camundongos Endogâmicos , Atividade Motora/efeitos dos fármacos , Consumo de Oxigênio/efeitos dos fármacos , Triglicerídeos/sangueRESUMO
The health benefits of regular recreational physical activity are well known in reducing secondary health consequences of a sedentary lifestyle in the general population. However, individuals with physical disabilities participate less frequently in recreational activity compared with those without disabilities. Although evidence on the impact of recreational physical activity on quality of life in this population is in its infancy, regular recreational and sports activity participation has shown to have a positive association with improvements in quality of life, life satisfaction, community reintegration, mood, and employment in those with disabilities. Facilitators of participating in adaptive sports include a desire to improve social support, physical fitness, health, and fun. Unfortunately, those with disabilities face numerous barriers to participate in adaptive sports including accessibility, transportation, awareness, finances, and physical and cognitive impairments. Further studies are needed to investigate facilitators and barriers to participating in adaptive sports to capitalize on the physical and psychosocial benefits of regular recreational activity. The aim of this article is to review the available literature on the effects of adaptive sports participation on quality of life.
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Pessoas com Deficiência/psicologia , Qualidade de Vida , Participação Social , Esportes para Pessoas com Deficiência , Emprego , Humanos , Transtornos do Humor/prevenção & controle , Satisfação Pessoal , AutoeficáciaRESUMO
SCOPE: Brown adipose tissue (BAT) dissipates energy through uncoupling protein 1 (UCP1) and has been proposed as an anti-obesity target. It was reported previously that a high-fat (HF) diet enriched in eicosapentaenoic acid (EPA) significantly increased UCP1 and other thermogenic markers in BAT. It is hypothesized that these effects are mediated through UCP1-dependent regulation. METHODS AND RESULTS: Wild-type (WT) and UCP1 knockout (KO) B6 male mice were housed at thermoneutrality and fed a HF diet, without or with eicosapentaenoic acid (EPA)-enriched fish oil. HF-fed KO mice were heavier and had higher BAT lipid content than other groups. Protective effects of EPA in WT, previously observed at 22 °C (reduced adiposity, improved glucose tolerance, and increased UCP1), disappeared at thermoneutrality. Mitochondrial proteins, cytochrome c oxidase subunit 1 (COX I), COX I, II, and IV were reduced in the KO mice compared to WT. Unexpectedly, EPA attenuated weight and fat mass gain and improved glucose tolerance in the KO mice. Finally, EPA increased BAT peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PGC1α) protein and gene expression, and whole-body oxygen consumption in KO mice, consistent with increased mitochondria DNA (mtDNA)/nuclear DNA (nucDNA) ratio. CONCLUSIONS: EPA rescued the weight gain and glucose intolerance in UCP1 KO mice at thermoneutrality, independent of UCP1; these effects may be mediated in part via increased oxygen consumption and BAT PGC1α.
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Tecido Adiposo/efeitos dos fármacos , Ácido Eicosapentaenoico/farmacologia , Intolerância à Glucose/tratamento farmacológico , Oxigênio/metabolismo , Proteína Desacopladora 1/genética , Tecido Adiposo/metabolismo , Animais , Dieta Hiperlipídica/efeitos adversos , Ingestão de Alimentos/efeitos dos fármacos , Metabolismo Energético/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos dos fármacos , Masculino , Camundongos Knockout , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Obesidade/metabolismo , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/genética , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/metabolismo , Temperatura , Proteína Desacopladora 1/metabolismo , Aumento de Peso/efeitos dos fármacosRESUMO
OBJECTIVE Given the recent shift in health care toward quality reporting requirements and a greater emphasis on a cost-quality approach, patient stratification with respect to long-term outcomes and the use of health care resources is of increasing value. Stratification tools may be effective if they are simple and evidence based. The authors hypothesize that preoperative patient-reported activity levels might independently predict postoperative outcomes in patients with adult spinal deformity. METHODS This is a retrospective cohort. A total of 575 patients in a prospective adult spinal deformity surgical database were identified with complete data regarding the preoperative level of activity. Answers to question 5 of the Scoliosis Research Society-22r Patient Questionnaire (SRS-22r) were used to stratify patients into active and inactive groups. Outcomes were length of hospital stay (LOS), level of activity, and reaching the minimum clinically important difference (MCID) for SRS-22r domains and the Physical Component Summary (PCS) of the SF-36 at 2 years postoperatively. The 2 groups were compared with respect to several potential confounders. Covariates with p < 0.1 were controlled for. The impact of activity on LOS was assessed using multivariate negative binomial regression analysis. Multivariate logistic regression models additionally controlling for the respective baseline health-related quality of life (HRQOL) scores were used to assess the association between preoperative activity levels and reaching the MCID at 2 years postoperatively. RESULTS A total of 420 (73%) of the 575 patients who met the inclusion criteria had complete data at 2 years postoperatively. The inactive group was more likely to be significantly older, have a higher Charlson Comorbidity Index, worse baseline radiographic deformity, and greater correction of most radiographic parameters. After controlling for possible confounders, the active group had a significantly shorter LOS (incidence risk ratio 0.91, p = 0.043). After adding respective baseline HRQOL scores to the models, active patients were significantly more likely to reach the MCID for the SRS-22r pain domain (OR 1.72, p = 0.026) and PCS (OR 1.94, p = 0.013). Active patients were also significantly more likely to be active at 2 years postoperatively on multivariate analysis (OR 8.94, p < 0.001). CONCLUSIONS The authors' results show that patients who belong to the inactive group are likely to have a longer LOS and lower odds of reaching the MCID in HRQOL or being active at 2 years postoperatively. Inquiring about patients' preoperative activity levels might be a reliable and simple stratification tool in terms of long- and short-term outcomes in ASD patients.
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Exercício Físico , Curvaturas da Coluna Vertebral/diagnóstico , Curvaturas da Coluna Vertebral/cirurgia , Comorbidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Comportamento Sedentário , Autorrelato , Índice de Gravidade de Doença , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/fisiopatologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To determine the value of a novel adult cervical deformity frailty index (CD-FI) in preoperative risk stratification. METHODS: We reviewed a prospective, multicenter database of adults with cervical spine deformity. We selected 40 variables to construct the CD-FI using a validated method. Patients were categorized as not frail (NF) (<0.2), frail (0.2-0.4), or severely frail (SF) (>0.4) according to CD-FI score. We performed multivariate logistic regression to determine the relationships between CD-FI score and incidence of complications, length of hospital stay, and discharge disposition. RESULTS: Of 61 patients enrolled from 2009 to 2015 with at least 1 year of follow-up, the mean CD-FI score was 0.26 (range 0.25-0.59). Seventeen patients were categorized as NF, 34 as frail, and 10 as SF. The incidence of major complications increased with greater frailty, with a gamma correlation coefficient of 0.25 (asymptotic standard error, 0.22). The odds of having a major complication were greater for frail patients (odds ratio 4.4; 95% confidence interval 0.6-32) and SF patients (odds ratio 43; 95% confidence interval 2.7-684) compared with NF patients. Greater frailty was associated with a greater incidence of medical complications and had a gamma correlation coefficient of 0.30 (asymptotic standard error, 0.26). Surgical complications, discharge disposition, and length of hospital stay did not correlate significantly with frailty. CONCLUSIONS: Greater frailty was associated with greater risk of major complications for patients undergoing cervical spine deformity surgery. The CD-FI may be used to improve the accuracy of preoperative risk stratification and allow for adequate patient counseling.
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Vértebras Cervicais/anormalidades , Vértebras Cervicais/cirurgia , Fragilidade/diagnóstico , Fragilidade/cirurgia , Cuidados Pré-Operatórios/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
STUDY DESIGN: Analysis of a prospective multicenter database. OBJECTIVE: To assess the ability of the recently created Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) to predict odds of major complications and length of hospital stay for patients who had more severe preoperative deformity and underwent more invasive ASD surgery compared with patients in the database used to create the index. SUMMARY OF BACKGROUND DATA: Accurate preoperative estimates of risk are necessary given the high complication rates currently associated with ASD surgery. METHODS: Patients were enrolled by participating institutions in Europe, Asia, and North America from 2009 to 2011. ASD-FI scores were used to classify 267 patients as not frail (NF) (<0.3), frail (0.3-0. 5), or severely frail (SF) (>0.5). Multivariable logistic regression, adjusted for preoperative and surgical covariates such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and incidence of major complications, overall incidence of complications, and length of hospital stay. RESULTS: The mean ASD-FI score was 0.3 (range, 0-0.7). We categorized 105 patients as NF, 103 as frail, and 59 as SF. The adjusted odds of developing a major complication were higher for SF patients (odds ratioâ=â4.4; 95% CI 2.0, 9.9) compared with NF patients. After adjusting for covariates, length of hospital stay for SF patients increased by 19% (95% CI 1.4%, 39%) compared with NF patients. The odds of developing a major complication or having increased length of stay were similar between frail and NF patients. CONCLUSION: Greater patient frailty, as measured by the ASD-FI, is associated with a longer hospital stay and greater risk of major complications among patients who have severe preoperative deformity and undergo invasive surgical procedures. LEVEL OF EVIDENCE: 2.
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Bases de Dados Factuais/estatística & dados numéricos , Fragilidade , Tempo de Internação/estatística & dados numéricos , Procedimentos Neurocirúrgicos , Doenças da Coluna Vertebral , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias , Estudos ProspectivosRESUMO
CASE: A 29-year-old woman presented with spontaneous, isolated, total palmar scaphoid subluxation in the left hand approximately 6 weeks postpartum. She had a positive Watson scaphoid shift test, with an easily subluxable and reducible scaphoid unilaterally. She was diagnosed with scapholunate ligamentous laxity with dynamic instability. Approximately 4 months after stopping lactation, she had complete resolution of the scapholunate subluxation; there was no recurrence of symptoms over the next 5 years of follow-up. CONCLUSION: Women can have manifestations of pregnancy and lactation-related ligamentous laxity, including scapholunate instability, which may spontaneously resolve upon cessation of lactation.
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Ossos do Carpo/diagnóstico por imagem , Luxações Articulares/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Ligamentos Articulares/diagnóstico por imagem , Osso Escafoide/diagnóstico por imagem , Adulto , Ossos do Carpo/patologia , Feminino , Humanos , Lactação/fisiologia , Ligamentos Articulares/patologia , Doenças Musculares/complicações , Período Pós-Parto , Gravidez , Radiografia , Osso Escafoide/patologia , Resultado do TratamentoRESUMO
Adult spinal deformity (ASD) may cause severe disability and difficulty with daily activities. The purpose of this study was to investigate the impact of preoperative functional status on 30-day major complication occurrence in ASD surgery. A review of the prospectively-collected American College of Surgeons National Surgical Quality Improvement database was performed for the years 2007-2013. Inclusion criteria were adult patients (over 21years of age) who underwent spinal fusion for ASD. Functional status was defined as "independent" or "dependent" (requiring assistance from another person) for activities of daily living such as bathing, dressing, feeding, toileting, or mobility. The association between functional status and complications (overall and major) was investigated via multivariate analysis. Results are presented as odds ratios (OR) with 95% confidence intervals (CI). A total of 1247 patients met inclusion criteria (94.4% independent and 5.6% dependent patients). The overall 30-day complication rate was 16.0% (15.6% for independent patients and 22.9% for dependent patients, p=0.10); major complications occurred in 9.2% of independent patients and 17.1% for dependent patients (p=0.02). After controlling for patient age, smoking status, preoperative hematocrit, revision status, use of osteotomy, number of levels fused, and operative time, being dependent on another person for activities of daily living was found to be a significant predictor of major complication development (OR 2.09; 95% CI, 1.04-4.20; p=0.03). Depending on others for activities of daily living before undergoing ASD surgery may predict the development of major perioperative complications, increasing the risk by 2-fold compared to independent patients.
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Atividades Cotidianas , Procedimentos Ortopédicos/efeitos adversos , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Curvaturas da Coluna Vertebral/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The systemic flux of glycerol and palmitate [a representative nonesterified free fatty acid (NEFA)] was assessed in three different phases of the menstrual cycle at rest and during moderate-intensity exercise. It was hypothesized that circulating glycerol and NEFA turnover would be greatest in the midfollicular (MF) phase of the menstrual cycle, when estrogen is elevated but progesterone low, followed by the midluteal phase (ML; high estrogen and progesterone), and lowest in the early follicular (EF) phase of the menstrual cycle (low estrogen and progesterone). Subjects included moderately active, eumenorrheic, healthy women. Testing occurred after 3 days of diet control and after an overnight fast (12-13 h). Resting and exercise (50% maximal oxygen uptake, 90 min) measurements of tracer-determined glycerol and palmitate kinetics were made. There was a significant increase in both glycerol and palmitate turnover from rest to exercise in all phases of the menstrual cycle (P<0.0001). No significant differences, however, were observed between cycle phases in the systemic flux of glycerol or palmitate, at rest or during exercise. Maximal peripheral lipolysis during exercise, as represented by glycerol rate of appearance at 90 min, equaled 8.45+/-0.96, 8.35+/-1.12, and 7.71+/-0.96 micromol.kg-1.min-1 in the EF, MF, and ML phases, respectively. Circulating free fatty acid utilization also peaked at 90 min of exercise, as indicated by the palmitate rate of disappearance (3.31+/-0.35, 3.17+/-0.39, and 3.47+/-0.26 micromol.kg-1.min-1) in the EF, MF, and ML phases, respectively. In conclusion, systemic rates of glycerol and NEFA turnover (as represented by palmitate flux) were not significantly affected by the cyclic fluctuations in estrogen and progesterone that occur throughout the normal menstrual cycle, either at rest or during 90 min of moderate exercise.
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Exercício Físico/fisiologia , Glicerol/sangue , Ciclo Menstrual/fisiologia , Palmitatos/sangue , Adulto , Estrogênios/sangue , Estrogênios/fisiologia , Ácidos Graxos não Esterificados/sangue , Feminino , Fase Folicular/sangue , Fase Folicular/fisiologia , Humanos , Fase Luteal/sangue , Fase Luteal/fisiologia , Ciclo Menstrual/sangue , Oxirredução , Progesterona/sangue , Progesterona/fisiologia , Fatores de Tempo , Triglicerídeos/sangueRESUMO
Image-guided percutaneous needle biopsy has become the preferred diagnostic modality for bone and soft tissue tumors. However, to the authors' knowledge, the levels of patient anxiety, pain, and satisfaction before and after the procedure have not been studied. Sixty-five patients undergoing image-guided needle biopsy of a possible bone or soft tissue tumor were prospectively surveyed to quantify preprocedure and postprocedure levels of anxiety and pain and to determine demographic and clinical correlates of anxiety, pain, and satisfaction. Anxiety was measured with the Spielberger State-Trait Anxiety Inventory, pain was measured with a visual analog scale, and satisfaction was measured by patient willingness to repeat the procedure if necessary. Statistical analysis was performed with Student's t test, Fisher's exact test, and linear regression analysis. Compared with preprocedure values, trait anxiety (defined as the underlying level of anxiety, P<.0011), state anxiety (defined as the current level of situational anxiety, P<.001), and pain (P<.05) decreased significantly postprocedure. The relationship between changes in pain and state anxiety was significant (r=0.31, P=.014), whereas no relationship was seen between changes in pain and trait anxiety (r=0.13, P=.28). Patients who were somewhat satisfied with the procedure reported higher levels of postprocedure pain than those who were completely satisfied (5.24±2.19 cm vs 1.70±2.08 cm, respectively; P<.001). In other words, lower levels of experienced pain correlated with patient satisfaction. Older age was inversely correlated with postprocedure pain (r=0.41, P=.001), and there was a trend toward increasing dissatisfaction among younger patients.
Assuntos
Ansiedade/etiologia , Neoplasias Ósseas/patologia , Biópsia Guiada por Imagem , Dor/etiologia , Satisfação do Paciente , Neoplasias de Tecidos Moles/patologia , Adulto , Fatores Etários , Idoso , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/psicologia , Neoplasias Ósseas/psicologia , Osso e Ossos/patologia , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/psicologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Período Pós-Operatório , Período Pré-Operatório , Escalas de Graduação Psiquiátrica , Neoplasias de Tecidos Moles/psicologiaRESUMO
OBJECTIVE The aim of this study was to investigate the incidence of and factors associated with complications following idiopathic scoliosis surgery in adolescents. METHODS The Nationwide Inpatient Sample database was used to identify patients 10-18 years of age who had undergone spinal fusion for adolescent idiopathic scoliosis (AIS) from 2002 to 2011. Twenty-three unique in-hospital postoperative complications, including death, were examined. A series of logistic regressions was used to determine if any demographic, comorbid, or surgical parameter was associated with complication development. Results of multiple logistic regression analyses were reported as odds ratios with 95% confidence intervals. All analyses were performed after the application of discharge weights to produce national estimates. RESULTS A total of 36,335 patients met the study inclusion criteria, 7.6% of whom (95% CI 6.3%-8.9%) developed at least one in-hospital complication. The 3 most common complications were respiratory failure (3.47%), reintubation (1.27%), and implant related (1.14%). Major complications such as death, pancreatitis, disseminated intravascular coagulation, visual loss, spinal cord injury, cardiac arrest, sepsis, nerve root injury, deep vein thrombosis, pulmonary embolism, shock, malignant hyperthermia, myocardial infarction, and iatrogenic stroke each had an incidence ≤ 0.2%. On multiple logistic regression analysis, an increasing age (OR 0.80) was associated with significantly lower odds of complication development; patients who were male (OR 1.80) or who had anemia (OR 2.10), hypertension (OR 2.51), or hypothyroidism (OR 2.27) or underwent revision procedures (OR 5.55) were at a significantly increased risk for complication development. The rates of postoperative complications for posterior, anterior, and combined approaches were 6.7%, 10.0%, and 19.8%, respectively (p < 0.001). Length of fusion (< 8 vs ≥ 8 levels) was not associated with complication development (p = 0.311). CONCLUSIONS Analysis of 36,335 patients who had undergone surgery for AIS revealed that younger patients, male patients, patients with a history of anemia, hypertension, or hypothyroidism, as well as those undergoing revision or anterior or combined approaches may have higher rates of postoperative complications. However, the overall complication rate was low (7.6%), and major complications had a rate ≤ 0.2% for each event. These findings suggest that surgery for AIS remains relatively safe, and future prospective investigations may further help to decrease the postoperative morbidity rate.
Assuntos
Hospitalização/tendências , Complicações Pós-Operatórias/epidemiologia , Escoliose/epidemiologia , Escoliose/cirurgia , Adolescente , Criança , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Escoliose/diagnóstico , Estados Unidos/epidemiologiaRESUMO
Resistance to conventional antibiotics is a growing public health concern that is quickly outpacing the development of new antibiotics. This has led the Infectious Diseases Society of America (IDSA) to designate Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species as "ESKAPE pathogens" on the basis of the rapidly decreasing availability of useful antibiotics. This emphasizes the urgent need for alternative therapeutic strategies to combat infections caused by these and other bacterial pathogens. In this study, we used Staphylococcus aureus (S. aureus) as a proof-of-principle ESKAPE pathogen to demonstrate that an appropriate antibiotic (daptomycin) can be incorporated into polydopamine-coated gold nanocages (AuNC@PDA) and that daptomycin-loaded AuNC@PDA can be conjugated to antibodies targeting a species-specific surface protein (staphylococcal protein A; Spa) as a means of achieving selective delivery of the nanoconstructs directly to the bacterial cell surface. Targeting specificity was confirmed by demonstrating a lack of binding to mammalian cells, reduced photothermal and antibiotic killing of the Spa-negative species Staphylococcus epidermidis, and reduced killing of S. aureus in the presence of unconjugated anti-Spa antibodies. We demonstrate that laser irradiation at levels within the current safety standard for use in humans can be used to achieve both a lethal photothermal effect and controlled release of the antibiotic, thus resulting in a degree of therapeutic synergy capable of eradicating viable S. aureus cells. The system was validated using planktonic bacterial cultures of both methicillin-sensitive and methicillin-resistant S. aureus strains and subsequently shown to be effective in the context of an established biofilm, thus indicating that this approach could be used to facilitate the effective treatment of intrinsically resistant biofilm infections.
RESUMO
Prolonged length of stay (PLOS) has been associated with increased hospital resource utilization and worsened patient outcomes in multiple studies. In this study, we defined and identified factors associated with PLOS after posterior surgery for cervical spondylotic myelopathy in patients over the age of 65. PLOS was defined as length of stay beyond the "prolongation point" (that is, the day after which discharge rates begin to decline). Using the United States Nationwide Inpatient Sample database, 2742 patients met inclusion criteria, out of whom 16.5% experienced PLOS (stay beyond 6days). After multivariate analysis, increasing age was independently associated with PLOS (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.06). Multiple comorbid conditions were associated with PLOS, including alcohol abuse (OR 3.85, 95% CI 1.87-7.94), congestive heart failure (OR 1.72, 95% CI 1.11-2.64), obesity (OR 1.70, 95% CI 1.14-2.55), and deficiency anemia (OR 1.44, 95% CI 1.01-2.05); the strongest associated operative parameter was blood transfusion (OR 2.39, 95% CI 1.75-3.28). Major complications independently associated with PLOS were deep vein thrombosis (OR 18.32, 95% CI 6.50-51.61), myocardial infarction (OR 8.98, 95% CI 2.92-27.56), pneumonia (OR 6.67, 95% CI 3.17-14.05), acute respiratory failure (OR 6.27, 95% CI 3.43-11.45), hemorrhage/hematoma (OR 5.04, 95% CI 2.69-9.44), and implant-related complications (OR 2.49, 95% CI 1.24-4.98). Average total hospital charges for patients who experienced PLOS were $122,965 US dollars, compared to $76,870 for the control group (p<0.001). Mortality for patients who experienced PLOS was 2.7% versus 0.5% for patients who did not epxerience PLOS (p<0.001). In conclusion, patients over the age of 65 who underwent posterior surgery for cervical myelopathy and stayed over 6days in hospital were defined as having PLOS. Hospital charges and mortality rates were significantly higher for patients who experienced PLOS. Potentially modifiable and/or preventable risk factors were also identified.