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1.
Nano Lett ; 24(22): 6813-6820, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38781191

RESUMO

Spintronic devices incorporating magnetic skyrmions have attracted significant interest recently. Such devices traditionally focus on controlling magnetic textures in 2D thin films. However, enhanced performance of spintronic properties through the exploitation of higher dimensionalities motivates the investigation of variable-thickness skyrmion devices. We report the demonstration of a skyrmion injection mechanism that utilizes charge currents to drive skyrmions across a thickness step and, consequently, a metastability barrier. Our measurements show that under certain temperature and field conditions skyrmions can be reversibly injected from a thin region of an FeGe lamella, where they exist as an equilibrium state, into a thicker region, where they can only persist as a metastable state. This injection is achieved with a current density of 3 × 108 A m-2, nearly 3 orders of magnitude lower than required to move magnetic domain walls. This highlights the possibility to use such an element as a skyrmion source/drain within future spintronic devices.

2.
Skeletal Radiol ; 51(3): 451-475, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34155550

RESUMO

Periarticular calcification and ossification is a frequent finding on imaging and may sometimes pose a diagnostic challenge. The differential diagnoses for this radiological finding are wide and can be classified into broad groups such as idiopathic, developmental, trauma, burns, infection, tumor, connective tissue disease, crystalline, metabolic, vascular, and foreign bodies. With careful consideration of the clinical and imaging findings as well as awareness of mimickers of periarticular mineralization, the list of differential diagnoses can be narrowed down. This article aims to review the clinical-radiologic findings of periarticular calcified or ossified lesions with relevant imaging illustrations.


Assuntos
Calcinose , Osteoartrite , Calcinose/diagnóstico por imagem , Diagnóstico Diferencial , Humanos
3.
Soc Work Health Care ; 60(1): 62-77, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33588694

RESUMO

The Mount Sinai Hospital in New York City was in the epicenter of the COVID-19 pandemic and had to transform from a tertiary to crisis care hospital and increase its bed capacity by 50 percent to care for COVID-19 patients. The size, scope, complexity and uncertainty of this crisis was unparalleled. This article describes the comprehensive response of the Department of Social Work Services, one of the largest hospital social work departments in the country. The response was informed by four Departmental principles, as well as crisis intervention strategies. This article describes organizational structures, practice models, policies, and protocols developed to respond quickly and effectively, given infection prevention mandates, to patient, population and workforce needs. Finally, it includes how social workers addressed COVID-19 related physical and psychosocial needs and applied and modified interprofessional communication and collaboration. Lessons learned and clinical and administrative changes that will assist in navigating "new normal" operations are discussed.


Assuntos
COVID-19/epidemiologia , Liderança , Serviço Hospitalar de Assistência Social/organização & administração , Serviço Social/organização & administração , Comunicação , Comportamento Cooperativo , Serviço Hospitalar de Emergência/organização & administração , Humanos , Unidades de Terapia Intensiva/organização & administração , Relações Interprofissionais , Cidade de Nova Iorque/epidemiologia , Saúde Ocupacional , Cuidados Paliativos/organização & administração , Pandemias , SARS-CoV-2 , Populações Vulneráveis
4.
Am J Gastroenterol ; 112(9): 1389-1396, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28440304

RESUMO

OBJECTIVES: Acute liver failure (ALF) is classically defined by coagulopathy and hepatic encephalopathy (HE); however, acute liver injury (ALI), i.e., severe acute hepatocyte necrosis without HE, has not been carefully defined nor studied. Our aim is to describe the clinical course of specifically defined ALI, including the risk and clinical predictors of poor outcomes, namely progression to ALF, the need for liver transplantation (LT) and death. METHODS: 386 subjects prospectively enrolled in the Acute Liver Failure Study Group registry between 1 September 2008 through 25 October 2013, met criteria for ALI: International Normalized Ratio (INR)≥2.0 and alanine aminotransferase (ALT)≥10 × elevated (irrespective of bilirubin level) for acetaminophen (N-acetyl-p-aminophenol, APAP) ALI, or INR≥2.0, ALT≥10x elevated, and bilirubin≥3.0 mg/dl for non-APAP ALI, both groups without any discernible HE. Subjects who progressed to poor outcomes (ALF, death, LT) were compared, by univariate analysis, with those who recovered. A model to predict poor outcome was developed using the random forest (RF) procedure. RESULTS: Progression to a poor outcome occurred in 90/386 (23%), primarily in non-APAP (71/179, 40%) vs. only 14/194 (7.2%) in APAP patients comprising 52% of all cases (13 cases did not have an etiology assigned; 5 of whom had a poor outcome). Of 82 variables entered into the RF procedure: etiology, bilirubin, INR, APAP level and duration of jaundice were the most predictive of progression to ALF, LT, or death. CONCLUSIONS: A majority of ALI cases are due to APAP, 93% of whom will improve rapidly and fully recover, while non-APAP patients have a far greater risk of poor outcome and should be targeted for early referral to a liver transplant center.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Sistema de Registros , Adulto , Alanina Transaminase/sangue , Doença Hepática Induzida por Substâncias e Drogas/sangue , Doença Hepática Induzida por Substâncias e Drogas/complicações , Interpretação Estatística de Dados , Feminino , Encefalopatia Hepática/complicações , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença , Estados Unidos/epidemiologia
5.
Inorg Chem ; 56(19): 11633-11639, 2017 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-28933829

RESUMO

In an effort to understand the structure-property relationship in magnetically frustrated systems, an orthorhombic analog of the S = 1/2 Re-based oxide Li4MgReO6 has been successfully synthesized and its physical properties were investigated. Li4MgReO6 had been previously synthesized in a monoclinic system in an ordered NaCl structure type. That system was shown to exhibit spin glass behavior below ∼12 K. The crystal structure of the latter phase was determined using powder X-ray diffraction data. A structural model was refined in the orthorhombic Fddd space group that resulted in cell dimensions of a = 5.84337 (7) Å, b = 8.33995 (9) Å, and c = 17.6237 (2) Å. The magnetic ions, Re6+ (S = 1/2), consist of various arrangements of interconnected triangles and trigonal prisms that offer potential for geometric magnetic frustration. Temperature dependent magnetic susceptibility reveals an AFM transition below ∼2 K along with a ZFC/FC divergence suggestive of spin freezing. The Curie-Weiss fitting parameters to the paramagnetic regime result in θ = -124 (1) K, which is indicative of predominant AFM interactions. A frustration index of ∼62 is in accordance with a highly frustrated magnetic ground state. Zero field (ZF) µSR data provides evidence for the onset of magnetic order below 4 K, along with the evidence for dynamical fluctuations up to 5 K. Moreover, longitudinal field (LF) µSR data reveals a complete decoupling in applied field at 2 K, which is indicative of static order in most or all of the volume fraction at ∼2 K, with partial ordered volumes coexisting with dynamical fluctuations up to 5 K. Estimates of the relative strengths of various magnetic exchange pathways at the level of spin-dimer analysis for this novel system are calculated and are compared to those of the previously reported values for the monoclinic analog.

6.
Scand J Med Sci Sports ; 27(9): 990-998, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27418064

RESUMO

A model that takes into account the current workload, and the workload the athlete has been prepared for, as an acute:chronic workload ratio has been previously used as a novel way to monitor training load and injury risk. Fifty-nine elite Australian football players from one club participated in this 2-year study. Global Positioning System technology was used to provide information on running workloads of players. An injury was defined as any non-contact "time-loss" injury. One-week (acute), along with 4-week (chronic) workloads were calculated for a range of variables. The size of the acute workload in relation to the chronic workload was calculated as an acute:chronic workload ratio. An acute:chronic workload ratio of >2.0 for total distance during the in-season was associated with a 5 to 8-fold greater injury risk in the current [relative risk (RR) = 8.65, P = 0.001] and subsequent week (RR = 5.49, P = 0.016). Players with a high-speed distance acute:chronic workload ratio of >2.0 were 5-11 times more likely to sustain an injury in the current (RR = 11.62, P = 0.006) and subsequent week (RR = 5.10, P = 0.014). These findings demonstrate that sharp increases in running workload increase the likelihood of injury in both the week the workload is performed, and the subsequent week.


Assuntos
Traumatismos em Atletas/epidemiologia , Corrida/lesões , Futebol/lesões , Adulto , Atletas , Austrália , Sistemas de Informação Geográfica , Humanos , Masculino , Adulto Jovem
7.
Ann Oncol ; 27(10): 1818-28, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27436850

RESUMO

BACKGROUND: Chemotherapy (CT) combined with radiotherapy is the standard treatment of 'limited-stage' small-cell lung cancer. However, controversy persists over the optimal timing of thoracic radiotherapy and CT. MATERIALS AND METHODS: We carried out a meta-analysis of individual patient data in randomized trials comparing earlier versus later radiotherapy, or shorter versus longer radiotherapy duration, as defined in each trial. We combined the results from trials using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival. RESULTS: Twelve trials with 2668 patients were eligible. Data from nine trials comprising 2305 patients were available for analysis. The median follow-up was 10 years. When all trials were analysed together, 'earlier or shorter' versus 'later or longer' thoracic radiotherapy did not affect overall survival. However, the HR for overall survival was significantly in favour of 'earlier or shorter' radiotherapy among trials with a similar proportion of patients who were compliant with CT (defined as having received 100% or more of the planned CT cycles) in both arms (HR 0.79, 95% CI 0.69-0.91), and in favour of 'later or longer' radiotherapy among trials with different rates of CT compliance (HR 1.19, 1.05-1.34, interaction test, P < 0.0001). The absolute gain between 'earlier or shorter' versus 'later or longer' thoracic radiotherapy in 5-year overall survival for similar and for different CT compliance trials was 7.7% (95% CI 2.6-12.8%) and -2.2% (-5.8% to 1.4%), respectively. However, 'earlier or shorter' thoracic radiotherapy was associated with a higher incidence of severe acute oesophagitis than 'later or longer' radiotherapy. CONCLUSION: 'Earlier or shorter' delivery of thoracic radiotherapy with planned CT significantly improves 5-year overall survival at the expense of more acute toxicity, especially oesophagitis.


Assuntos
Cisplatino/uso terapêutico , Tratamento Farmacológico , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Carcinoma de Pequenas Células do Pulmão/radioterapia , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Ensaios Clínicos Controlados Aleatórios como Assunto , Carcinoma de Pequenas Células do Pulmão/patologia
8.
Inorg Chem ; 55(20): 10701-10713, 2016 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-27700052

RESUMO

Double perovskites (DP) of the general formula Ba2MReO6, where M = Mg, Zn, and Y2/3, all based on Re6+ (5d1, t2g1), were synthesized and studied using magnetization, heat capacity, muon spin relaxation, and neutron-scattering techniques. All are cubic, Fm3̅m, at ambient temperature to within the resolution of the X-ray and neutron diffraction data, although the muon data suggest the possibility of a local distortion for M = Mg. The M = Mg DP is a ferromagnet, Tc = 18 K, with a saturation moment ∼0.3 bohr magnetons at 3 K. There are two anomalies in the heat capacity: a sharp feature at 18 K and a broad maximum centered near 33 K. The total entropy loss below 45 K is 9.68 e.u., which approaches R ln 4 (11.52 e.u.) supporting a j = 3/2 ground state. The unit cell constants of Ba2MgReO6 and the isostructural, isoelectronic analogue, Ba2LiOsO6, differ by only 0.1%, yet the latter is an anti-ferromagnet. The M = Zn DP also appears to be a ferromagnet, Tc = 11 K, µsat(Re) = 0.1 µB. In this case the heat capacity shows a somewhat broad peak near 10 K and a broader maximum at ∼33 K, behavior that can be traced to a smaller particle size, ∼30 nm, for this sample. For both M = Mg and Zn, the low-temperature magnetic heat capacity follows a T3/2 behavior, consistent with a ferromagnetic spin wave. An attempt to attribute the broad 33 K heat capacity anomalies to a splitting of the j = 3/2 state by a crystal distortion is not supported by inelastic neutron scattering, which shows no transition at the expected energy of ∼7 meV nor any transition up to 100 meV. However, the results for the two ferromagnets are compared to the theory of Chen, Pereira, and Balents, and the computed heat capacity predicts the two maxima observed experimentally. The M = Y2/3 DP, with a significantly larger cell constant (3%) than the ferromagnets, shows predominantly anti-ferromagnetic correlations, and the ground state is complex with a spin frozen component Tg = 16 K from both direct current and alternating current susceptibility and µSR data but with a persistent dynamic component. The low-temperature heat capacity shows a T1 power law. The unit cell constant of B = Y2/3 is less than 1% larger than that of the ferromagnetic Os7+ (5d1) DP, Ba2NaOsO6.

11.
Cancer ; 120(11): 1725-32, 2014 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-24590359

RESUMO

BACKGROUND: Since 2002, priority Model for End-stage Liver Disease (MELD) exception status has been given to patients with hepatocellular carcinoma (HCC) who meet the Milan criteria. Since then, the number of liver transplantations performed in patients with HCC has increased, but to the authors' knowledge, few studies to date have examined the effect of MELD exception recommendations on therapy use and survival rates in a nationwide sample. The current study examines therapy use and long-term survival rates among patients with HCC tumors meeting the Milan criteria in the post-MELD exception era. METHODS: The current study is a retrospective cohort study of 2179 patients with localized HCC meeting the Milan criteria who were registered between 2004 and 2007 in the Surveillance, Epidemiology, and End Results database. RESULTS: A total of 43% of patients did not receive any specific therapy. Overall, the 5-year relative survival rate for patients receiving only supportive care was dismal at 24% (95% confidence interval [95% CI], 21%-27%), whereas that for patients undergoing liver transplantation was 77% (95% CI, 71%-82%). Long-term survival was found to be dependent on age, race/ethnicity, and type of therapy received. A multivariate Cox proportional hazards model adjusted for age, race/ethnicity, and type of therapy received demonstrated that, compared with white patients, black patients had significantly poorer survival outcomes (hazards ratio, 1.23; 95% CI, 1.03-1.47 [P = .02]), whereas Asian/Pacific Islander patients had significantly better survival rates when compared with white patients (HR, 0.66; 95% CI, 0.57-0.77 [P < .001]). CONCLUSIONS: Despite having localized disease that met transplantation criteria, nearly 50% of the large nationwide cohort of patients with HCC in the current study received only supportive care and had dismal 5-year relative survival rates, especially among black patients.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/etnologia , Carcinoma Hepatocelular/mortalidade , Feminino , Humanos , Neoplasias Hepáticas/etnologia , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Índice de Gravidade de Doença , Caracteres Sexuais
12.
Antimicrob Agents Chemother ; 58(9): 5466-72, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24982093

RESUMO

A racemic mixture of R and S enantiomers of praziquantel (PZQ) is currently the treatment of choice for schistosomiasis. Though the S enantiomer and the metabolites are presumed to contribute only a little to the activity of the drug, in-depth side-by-side studies are lacking. The aim of this study was to investigate the in vitro activities of PZQ and its main metabolites, namely, R- and S-cis- and R- and S-trans-4'-hydroxypraziquantel, against adult worms and newly transformed schistosomula (NTS). Additionally, we explored the in vivo activity and hepatic shift (i.e., the migration of the worms to the liver) produced by each PZQ enantiomer in mice. Fifty percent inhibitory concentrations of R-PZQ, S-PZQ, and R-trans- and R-cis-4'-hydroxypraziquantel of 0.02, 5.85, 4.08, and 2.42 µg/ml, respectively, for adult S. mansoni were determined in vitro. S-trans- and S-cis-4'-hydroxypraziquantel were not active at 100 µg/ml. These results are consistent with microcalorimetry data and studies with NTS. In vivo, single 400-mg/kg oral doses of R-PZQ and S-PZQ achieved worm burden reductions of 100 and 19%, respectively. Moreover, worms treated in vivo with S-PZQ displayed an only transient hepatic shift and returned to the mesenteric veins within 24 h. Our data confirm that R-PZQ is the main effector molecule, while S-PZQ and the metabolites do not play a significant role in the antischistosomal properties of PZQ.


Assuntos
Praziquantel/farmacologia , Schistosoma mansoni/efeitos dos fármacos , Esquistossomose mansoni/tratamento farmacológico , Esquistossomicidas/farmacologia , Animais , Fígado/parasitologia , Camundongos
13.
Clin Exp Immunol ; 177(2): 428-38, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24654775

RESUMO

We reported the expression of the homeodomain-containing transcription factor Engrailed-2 (EN2) in prostate cancer and showed that the presence of EN2 protein in the urine was highly predictive of prostate cancer. This study aimed to determine whether patients with prostate cancer have EN2 autoantibodies, what the prevalence of these antibodies is and whether they are associated with disease stage. The spontaneous immunoglobulin (Ig)G immune response against EN2 and for comparison the tumour antigen New York Esophageal Squamous Cell Carcinoma 1 (NY-ESO-1), were tested by enzyme-linked immunosorbent assay (ELISA) in three different cohorts of prostate cancer patients as well as a group of men genetically predisposed to prostate cancer. Thirty-two of 353 (9·1%) of the SUN cohort representing all stages of prostate cancer demonstrated EN2 IgG responses, 12 of 107 patients (11·2%) in the advanced prostate cancer patients showed responses, while only four of 121 patients (3·3%) with castrate-resistant prostate cancer showed EN2 autoantibodies. No significant responses were found in the predisposed group. Anti-EN2 IgG responses were significantly higher in patients with prostate cancer compared to healthy control males and similarly prevalent to anti-NY-ESO-1 responses. While EN2 autoantibodies are not a useful diagnostic or monitoring tool, EN2 immunogenicity provides the rationale to pursue studies using EN2 as an immunotherapeutic target.


Assuntos
Autoanticorpos/imunologia , Proteínas de Homeodomínio/imunologia , Proteínas do Tecido Nervoso/imunologia , Neoplasias da Próstata/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoanticorpos/sangue , Biomarcadores Tumorais , Neoplasias da Mama/sangue , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Masculino , Pessoa de Meia-Idade , Neoplasias Ovarianas/sangue , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/terapia
14.
Phys Rev Lett ; 113(4): 045305, 2014 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-25105631

RESUMO

We report the direct observation of resistive flow through a weak link in a weakly interacting atomic Bose-Einstein condensate. Two weak links separate our ring-shaped superfluid atomtronic circuit into two distinct regions, a source and a drain. Motion of these weak links allows for creation of controlled flow between the source and the drain. At a critical value of the weak link velocity, we observe a transition from superfluid flow to superfluid plus resistive flow. Working in the hydrodynamic limit, we observe a conductivity that is 4 orders of magnitude larger than previously reported conductivities for a Bose-Einstein condensate with a tunnel junction. Good agreement with zero-temperature Gross-Pitaevskii simulations and a phenomenological model based on phase slips indicate that the creation of excitations plays an important role in the resulting conductivity. Our measurements of resistive flow elucidate the microscopic origin of the dissipation and pave the way for more complex atomtronic devices.

15.
Parasitology ; 141(1): 148-57, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23985301

RESUMO

Open science is a new concept for the practice of experimental laboratory-based research, such as drug discovery. The authors have recently gained experience in how to run such projects and here describe some straightforward steps others may wish to take towards more openness in their own research programmes. Existing and inexpensive online tools can solve many challenges, while some psychological barriers to the free sharing of all data and ideas are more substantial.


Assuntos
Revelação/ética , Descoberta de Drogas , Disseminação de Informação/métodos , Software , Anti-Helmínticos/síntese química , Anti-Helmínticos/farmacologia , Antimaláricos/síntese química , Antimaláricos/farmacologia , Humanos , Disseminação de Informação/ética , Internet , Malária/tratamento farmacológico , Malária/parasitologia , Esquistossomose/tratamento farmacológico , Esquistossomose/parasitologia
16.
Med Vet Entomol ; 28 Suppl 1: 14-25, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24912919

RESUMO

Insecticide-treated clothing has been used for many years by the military and in recreational activities as personal protection against bites from a variety of arthropods including ticks, chigger mites, sandflies and mosquitoes. Permethrin is the most commonly used active ingredient, but others, including bifenthrin, deltamethrin, cyfluthrin, DEET (N,N-diethyl-3-methylbenz-amide) and KBR3023, have also been trialled. Treatment is usually carried out by home or factory dipping. However, new microencapsulation technologies which may prolong the activity of insecticides on clothing are now available and may help to overcome the inevitable reduction in efficacy over time that occurs as a result of washing, ultraviolet light exposure, and the normal wear and tear of the fabric. The aim of this article is to review the evidence base for the use of insecticide-treated clothing for protection against bites from arthropods and its effect on arthropod-borne pathogen transmission. Although some studies do demonstrate protection against pathogen transmission, there are surprisingly few, and the level of protection provided varies according to the disease and the type of study conducted. For example, insecticide-treated clothing has been reported to give between 0% and 75% protection against malaria and between 0% and 79% protection against leishmaniasis. Studies vary in the type of treatment used, the age group of participants, the geographical location of the study, and the pathogen transmission potential. This makes it difficult to compare and assess intervention trials. Overall, there is substantial evidence that insecticide-treated clothing can provide protection against arthropod bites. Bite protection evidence suggests that insecticide-treated clothing may be useful in the prevention of pathogen transmission, but further investigations are required to accurately demonstrate transmission reduction.


Assuntos
Vetores Artrópodes/efeitos dos fármacos , Vestuário , Controle de Doenças Transmissíveis/métodos , Mordeduras e Picadas de Insetos/prevenção & controle , Inseticidas/farmacologia , Permetrina/farmacologia , Animais
17.
Eur Spine J ; 23(8): 1767-71, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24622957

RESUMO

PURPOSE: Incidental durotomy is a potential complication of spinal surgery which can cause a number of intra-operative and post-operative complications. The purpose of this study was to determine if the primary operator's credentials impacted on the incidence of durotomy intra-operatively. METHODS: Prospectively collected data of operator credentials in relation to the incidence of durotomy were acquired from the International Eurospine Tango database. The significance of variability and risk factors between operators was measured using the Chi-squared test. RESULTS: Data from a total of 3,764 patients were captured from the Tango registry. Of these 162 (4.3%) had a durotomy. Of the total number of patients, the primary operator was neurosurgical in 1,369 (36.4%) cases; orthopaedic in 180 (4.8%) cases; other (pre-certification) in 236 (6.3%) cases; specialised spine surgeon in 1,741 (46.3%) cases; 6 cases had missing operator data. cerebrospinal fluid (CSF) leak occurred in 57 (4.16%) of neurosurgeon-operated cases; 5 (2.78%) orthopaedic-operated cases; 19 (4.06%) of other surgeon-operated cases; and 81 (4.65%) in specialised spine surgeon-operated cases. Using Chi-squared test, the significance of the variation in incidence of CSF leak between primary operator groups was not statistically significant (P = 0.1405). CONCLUSION: From the data captured and analysed, the rate of durotomy ranged from 2.78 to 4.65% between operator groups with a mean rate of 4.3%. The primary operator credentials do not appear to significantly impact the rate of durotomy in spine surgery.


Assuntos
Credenciamento/normas , Dura-Máter/cirurgia , Complicações Intraoperatórias/epidemiologia , Procedimentos Ortopédicos/efeitos adversos , Coluna Vertebral/cirurgia , Cirurgiões/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Competência Clínica/normas , Bases de Dados Factuais/normas , Dura-Máter/lesões , Feminino , Humanos , Incidência , Lactente , Complicações Intraoperatórias/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros/normas , Fatores de Risco , Adulto Jovem
18.
Colorectal Dis ; 15(4): 487-91, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23323626

RESUMO

AIM: Rubber band ligation is a common office procedure for the treatment of symptomatic haemorrhoids. It can be associated with pain and vasovagal symptoms. The effect of local anaesthetic use during banding was studied. METHOD: A single-blinded randomized controlled trial was carried out in the colorectal outpatient clinic. Patients presenting with symptomatic haemorrhoids suitable for banding were prospectively recruited and randomized to undergo the procedure with local anaesthetic or without (control). Submucosal bupivacaine was injected immediately after banding just proximal to the site. Vasovagal symptoms were assessed at the time of banding and pain scores (visual analogue scale) were recorded at the conclusion of the procedure, after 15 min, and on leaving the clinic. RESULTS: Seventy-two patients (40 local anaesthetic injection, group 1; 32 no injection, group 2) were recruited. The mean ages were 50 and 54 years respectively, the median duration of symptoms was 12 months in each group and the median number of haemorrhoids banded was three in each group. The mean pain score on leaving the clinic was 2.6 (95% CI 2.1, 3.1) in group 1 and 4.1 (95% CI 3.3, 5.0) (P = 0.04) in group 2. There were no complications related to local anaesthetic use. No significant difference in vasovagal symptoms was found (P = 0.832). CONCLUSION: Local anaesthetic injection at the time of banding is simple and safe. It may reduce patient discomfort following banding of haemorrhoids.


Assuntos
Anestesia Local , Hemorroidas/cirurgia , Dor Pós-Operatória/prevenção & controle , Anestésicos Locais , Bupivacaína , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Medição da Dor , Método Simples-Cego
19.
ScientificWorldJournal ; 2013: 281291, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23766685

RESUMO

INTRODUCTION: HER-2 has been associated with castrate resistant prostate cancer and matrix metalloproteinase-2 (MMP-2) in the dissemination and invasion of tumor cells as well as activating angiogenesis. We present an immunocytochemical study of the effect of androgen blockade on the expression of HER-2 and MMP-2 in bone marrow micrometastasis and the surrounding stromal cells in men with prostate cancer. METHODS AND PATIENTS: A cross-sectional study of men with prostate cancer. Touch preps were obtained from bone marrow biopsies of men with prostate cancer, before and after radical prostatectomy and during androgen blockade. Micrometastasis detected with anti-PSA immunocytochemistry underwent processing with anti-HER-2 and anti-MMP-2 immunocytochemistry. Patients were defined as HER-2 positive or negative, MMP-2 negative or an MMP-2 pattern described as border or central and stromal MMP-2 defined as positive or negative. The expression of the biomarkers was compared before and after primary treatment and during androgen blockade in relation to the serum PSA at the time of sampling and duration of androgen blockade. RESULTS: 191 men participated, 35 men before surgery and 43 after surgery; there were no significant differences in HER-2 expression between groups, there was no MMP-2 expression centrally or stromal expression of MMP-2. In men with androgen blockade, HER-2 expression was significantly higher; there was a trend for increasing HER-2 expression up to 5 years; central MMP-2 expression significantly increased after 3 years, while stromal MMP-2 significantly increased after 6 years. MMP-2 expression both in micrometastasis and stroma was significantly associated with HER-2 expression. Expression of MMP-2 at the border of the micrometastasis was not associated with HER-2 expression and occurred in the absence of androgen blockade. CONCLUSIONS: Androgen blockade decreases serum PSA by eliminating HER-2 negative prostate cancer cells. However, there is early selection of HER-2 positive cancer cells which leads to androgen independence and to increased expression of MMP-2 activity in the micrometastasis. The increased MMP-2 activity in the micrometastasis increases the expression of MMP-2 in the surrounding stromal cells and thus could promote angiogenesis and tumor growth resulting in macrometastatic androgen independent disease.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Neoplasias da Medula Óssea/metabolismo , Neoplasias da Medula Óssea/secundário , Metaloproteinase 2 da Matriz/metabolismo , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/metabolismo , Receptor ErbB-3/metabolismo , Idoso , Medula Óssea/efeitos dos fármacos , Medula Óssea/metabolismo , Neoplasias da Medula Óssea/prevenção & controle , Humanos , Masculino , Células Estromais/efeitos dos fármacos , Células Estromais/metabolismo , Resultado do Tratamento
20.
J Orthop Sci ; 18(4): 578-85, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23686084

RESUMO

BACKGROUND: Reported revision of internal fixation for undisplaced intracapsular hip fractures is between 12 and 17% at 1 year. This risk is greater for elderly patients, for whom mortality after such a fracture is also higher. Our purpose was to identify predictors of fixation failure and mortality for elderly patients sustaining undisplaced intracapsular hip fractures, and to assess whether their socioeconomic status affected their outcome. METHODS: During a 3-year period we prospectively compiled a consecutive series of 162 elderly (≥65 years old) patients who underwent internal fixation for an undisplaced (Garden stage I or II) intracapsular hip fracture. Patient demographics, American Society of Anesthesiologists (ASA) grade, and posterior tilt (measured on the lateral radiograph) were recorded pre-operatively. All patients were followed up for a minimum of 1 year. Each patient's socioeconomic status was assigned by use of the Scottish Index of Multiple Deprivation. Patient mortality was established by use of the General Register Office for Scotland. RESULTS: There were 28 failures of fixation during the study period. In Cox regression analysis, ASA grade and the presence of posterior tilt (p < 0.0001) were significant independent predictors of fixation failure. Overall unadjusted mortality at 1 year was 19% (n = 30/162). Cox regression analysis also affirmed ASA grade to be the only significant independent predictor of 1-year mortality (p = 0.003). The standardised mortality rate for the cohort was 2.3 (p < 0.001), and was significantly greater for patients less than 80 years of age (p = 0.004). Socioeconomic status did not affect outcome, but the most deprived patients sustain their fracture at a significantly younger age (p = 0.001). CONCLUSION: We have demonstrated that ASA grade and posterior tilt of the femoral neck are independent predictors of fixation failure of undisplaced intracapsular hip fractures in elderly patients, and ASA grade was also an independent predictor of mortality.


Assuntos
Fixação Interna de Fraturas , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Fatores Socioeconômicos , Taxa de Sobrevida
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