RESUMO
The efficiency of deep-ocean CO2 sequestration is regulated by the relative balance between inorganic and organic carbon export respectively acting through the biological carbon pump (BCP) and the carbonate counter pump (CCP). The composition and abundance of calcifying species in the prevailing oceanic plankton community plays a major role in driving the CCP. Here we assess the role of these calcifying organisms in regulating the strength of the CCP in a Southern Ocean region (northern Scotia Sea) known to be a major hotspot for the drawdown of atmospheric CO2. We show that, when shelled pteropods dominate the calcifying community, the total annual reduction of CO2 transferred to the deep ocean doubles (17%) compared to when other plankton calcifiers dominate (3-9%). Furthermore, predation enhances their contribution through the removal of organic soft tissue. Pteropods are threatened in polar regions by ocean warming and acidification. We determine that their potential decline would have major implications to the comparative strengths of the BCP and CCP.
Assuntos
Carbonatos/análise , Espécies em Perigo de Extinção , Oceanos e Mares , Carbono/análise , Compostos Orgânicos/análise , Material Particulado/análise , Plâncton/metabolismo , Estações do AnoRESUMO
We compared the clinical efficacy of orally administered valdecoxib and piroxicam for the prevention of pain, trismus and swelling after removal of horizontally and totally intrabony impacted lower third molars. Twenty-five patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Valdecoxib (40 mg) or piroxicam (20 mg) was administered in a double-blind, randomized and crossed manner for 4 days after the surgical procedures. Objective and subjective parameters were recorded for comparison of postoperative courses. Both agents were effective for postoperative pain relief (N = 19). There was a similar mouth opening at suture removal compared with the preoperative values (86.14 +/- 4.36 and 93.12 +/- 3.70% of the initial measure for valdecoxib and piroxicam, respectively; ANOVA). There was no significant difference regarding the total amount of rescue medication taken by the patients treated with valdecoxib or piroxicam (173.08 +/- 91.21 and 461.54 +/- 199.85 mg, respectively; Wilcoxon test). There were no significant differences concerning the swelling observed on the second postoperative day compared to baseline measures (6.15 +/- 1.84 and 8.46 +/- 2.04 mm for valdecoxib and piroxicam, respectively; ANOVA) or on the seventh postoperative day (1.69 +/- 1.61 and 2.23 +/- 2.09 mm for valdecoxib and piroxicam, respectively; ANOVA). The cyclooxygenase-2 selective inhibitor valdecoxib is as effective as the non-selective cyclooxygenase inhibitor piroxicam for pain, trismus and swelling control after removal of horizontally and totally intrabony impacted lower third molars.
Assuntos
Inibidores de Ciclo-Oxigenase/uso terapêutico , Edema/tratamento farmacológico , Isoxazóis/uso terapêutico , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Piroxicam/uso terapêutico , Sulfonamidas/uso terapêutico , Trismo/tratamento farmacológico , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Extração Dentária , Resultado do TratamentoRESUMO
Fifty patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Meloxicam 7.5 or 15 mg was once daily administered in a double-blind, randomized and crossover manner after the surgery for 4 days. Objective and subjective parameters were recorded for comparison of postoperative courses. Patients treated with 7.5mg meloxicam who underwent osteotomy reported higher pain scores at 1.5, 3, 4, 10, 12 and 16 h (P<0.05) and ingested a greater amount of rescue analgesic medication (P<0.05) than those who did not require osteotomy. A higher percentage of patients who underwent osteotomy medicated with 7.5mg meloxicam needed rescue medication as compared to those who did not require osteotomy (P<0.05). There was a similar mouth opening at suture removal compared with preoperative values for both doses (P>0.05). There were no significant differences concerning swelling observed on the 2nd or 7th postoperative days in comparison with baseline (P>0.05) between the two doses. Pain, trismus and swelling after lower third molar removal not requiring osteotomy can be successfully controlled by a dose regimen of 7.5mg meloxicam once daily. For more aggressive extractions 15 mg meloxicam is advisable.
Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Dente Serotino/cirurgia , Dor Pós-Operatória/prevenção & controle , Tiazinas/administração & dosagem , Tiazóis/administração & dosagem , Extração Dentária , Administração Oral , Adulto , Análise de Variância , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Edema/prevenção & controle , Feminino , Humanos , Masculino , Meloxicam , Osteotomia , Amplitude de Movimento Articular , Estatísticas não Paramétricas , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Trismo/prevenção & controleRESUMO
Carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) infections are an emerging cause of death after hematopoietic stem cell transplantation (HSCT). In allogeneic transplants, mortality rate may rise up to 60%. We retrospectively evaluated 540 patients receiving a transplant from an auto- or an allogeneic source between January 2011 and October 2015. After an Institutional increase in the prevalence of KPC-Kp bloodstream infections (BSI) in June 2012, from July 2012, 366 consecutive patients received the following preventive measures: (i) weekly rectal swabs for surveillance; (ii) contact precautions in carriers (iii) early-targeted therapy in neutropenic febrile carriers. Molecular typing identified KPC-Kp clone ST512 as the main clone responsible for colonization, BSI and outbreaks. After the introduction of these preventive measures, the cumulative incidence of KPC-Kp BSI (P=0.01) and septic shocks (P=0.01) at 1 year after HSCT was significantly reduced. KPC-Kp infection-mortality dropped from 62.5% (pre-intervention) to 16.6% (post-intervention). Day 100 transplant-related mortality and KPC-Kp infection-related mortality after allogeneic HSCT were reduced from 22% to 10% (P=0.001) and from 4% to 1% (P=0.04), respectively. None of the pre-HSCT carriers was excluded from transplant. These results suggest that active surveillance, contact precautions and early-targeted therapies, may efficiently control KPC-Kp spread and related mortality even after allogeneic HSCT.
Assuntos
Proteínas de Bactérias/biossíntese , Neoplasias Hematológicas , Transplante de Células-Tronco Hematopoéticas , Infecções por Klebsiella , Klebsiella pneumoniae , Choque Séptico , beta-Lactamases/biossíntese , Adolescente , Adulto , Idoso , Aloenxertos , Autoenxertos , Feminino , Seguimentos , Neoplasias Hematológicas/mortalidade , Neoplasias Hematológicas/terapia , Humanos , Infecções por Klebsiella/genética , Infecções por Klebsiella/mortalidade , Infecções por Klebsiella/terapia , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/metabolismo , Klebsiella pneumoniae/patogenicidade , Masculino , Pessoa de Meia-Idade , Choque Séptico/genética , Choque Séptico/mortalidade , Choque Séptico/terapiaRESUMO
The clinical outcome of primary refractory (PRF) AML patients is poor and only a minor proportion of patients is rescued by allogenic hematopoietic stem cell transplantation (HSCT). The identification of pre-HSCT variables may help to determine PRF AML patients who can most likely benefit from HSCT. We analyzed PRF AML patients transplanted between 1999 and 2012 from a sibling, unrelated donor or a cord blood unit. Overall, 227 patients from 26 Gruppo Italiano Trapianto di Midollo Osseo e Terapia cellulare centers were included in the analysis. At 3 years, the overall survival was 14%. By multivariate analysis, the number of chemotherapy cycles, (hazard ratio (HR): 1.87; 95% confidence interval (CI): 1.24-2.85; P=0.0028), the percentage of bone marrow or peripheral blood blasts (HR: 1.75; 95% CI: 1.16-2.64; P=0.0078), the adverse cytogenetic (HR: 1.44; 95% CI: 1.00-2.07; P=0.0508) and the age of patients (HR: 1.77; 95% CI: 1.08-2.88; P=0.0223) remained significantly associated with survival. Thus, we set up a new score predicting at 3 years after transplantation, an overall survival probability of 32% for patients with score 0 (no or 1 prognostic factor), 10% for patients with score 1 (2 prognostic factors) and 3% for patients with score 2 (3 or 4 prognostic factors).
Assuntos
Transplante de Células-Tronco de Sangue do Cordão Umbilical , Transplante de Células-Tronco Hematopoéticas , Leucemia Mieloide Aguda , Irmãos , Doadores não Relacionados , Adolescente , Adulto , Idoso , Aloenxertos , Intervalo Livre de Doença , Feminino , Humanos , Leucemia Mieloide Aguda/mortalidade , Leucemia Mieloide Aguda/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Hematopoietic stem cell transplantation (HSCT) from human leukocyte antigen (HLA) haploidentical family donors is a promising therapeutic option for high-risk hematologic malignancies. Here we explored in 121 patients, mostly with advanced stage diseases, a sirolimus-based, calcineurin-inhibitor-free prophylaxis of graft-versus-host disease (GvHD) to allow the infusion of unmanipulated peripheral blood stem cell (PBSC) grafts from partially HLA-matched family donors (TrRaMM study, Eudract 2007-5477-54). Conditioning regimen was based on treosulfan and fludarabine, and GvHD prophylaxis on antithymocyte globulin Fresenius (ATG-F), rituximab and oral administration of sirolimus and mycophenolate. Neutrophil and platelet engraftment occurred in median at 17 and 19 days after HSCT, respectively, and full donor chimerism was documented in patients' bone marrow since the first post-transplant evaluation. T-cell immune reconstitution was rapid, and high frequencies of circulating functional T-regulatory cells (Treg) were documented during sirolimus prophylaxis. Incidence of acute GvHD grade II-IV was 35%, and occurrence and severity correlated negatively with Treg frequency. Chronic GvHD incidence was 47%. At 3 years after HSCT, transpant-related mortality was 31%, relapse incidence 48% and overall survival 25%. In conclusion, GvHD prophylaxis with sirolimus-mycophenolate-ATG-F-rituximab promotes a rapid immune reconstitution skewed toward Tregs, allowing the infusion of unmanipulated haploidentical PBSC grafts.
Assuntos
Doença Enxerto-Hospedeiro/imunologia , Doença Enxerto-Hospedeiro/prevenção & controle , Antígenos HLA/imunologia , Transplante de Células-Tronco de Sangue Periférico , Sirolimo/uso terapêutico , Linfócitos T Reguladores/imunologia , Administração Oral , Adolescente , Adulto , Idoso , Anticorpos Monoclonais Murinos/uso terapêutico , Soro Antilinfocitário/uso terapêutico , Plaquetas/citologia , Bussulfano/análogos & derivados , Bussulfano/uso terapêutico , Criança , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Neutrófilos/citologia , Estudos Prospectivos , Rituximab , Linfócitos T/imunologia , Doadores de Tecidos , Condicionamento Pré-Transplante , Resultado do Tratamento , Vidarabina/análogos & derivados , Vidarabina/uso terapêutico , Adulto JovemRESUMO
This is a retrospective study about the treatment of spontaneous muscle haematomas (SMH) that are an uncommon disease that occurs especially in elderly patients with acquired coagulopathy. We report the management of 10 cases admitted to our Emergency Surgical Unit (ESU) between March 2011 and October 2012. For this analysis we have considered some parameters such as age, drug history, current symptoms, location of the haematoma, cause, and imaging examination. Our attention focused on: clinical presentation, differential diagnosis, diagnostic imaging techniques and treatments.
RESUMO
Diagnosis of invasive fungal infection remains challenging. Here we report a case of early diagnosis of invasive aspergillosis in a neutropenic patient affected by acute myeloid leukaemia, achieved through the detection of Aspergillus fumigatus species-specific ribonucleic acid sequences by a sensitive multiplex real-time polymerase chain reaction-based molecular assay. Thanks to the early diagnosis, targeted therapy was promptly established and the severe fungal infection controlled, allowing the patient to subsequently receive allogeneic hematopoietic stem cell transplantation from a haploidentical donor, her only curative option. Also in this instance, targeted secondary antifungal prophylaxis with voriconazole avoided any other fungal infection afterwards. This report suggests how the implementation of molecular assays in combination with routine diagnostic procedures, can improve microbiological diagnosis in sepsis, particularly in case of fungal infection, difficult to detect with standard microbiological culture methods.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Sirolimo/administração & dosagem , Condicionamento Pré-Transplante , Triazóis/administração & dosagem , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Doença de Hodgkin/terapia , Humanos , Leucemia Mieloide Aguda/terapia , Linfoma não Hodgkin/terapia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/terapia , Indução de Remissão , Risco , Transplante Homólogo , Resultado do Tratamento , Adulto JovemRESUMO
In this study, 53 patients received piroxicam, administered orally or sublingually, after undergoing removal of symmetrically positioned lower third molars, during two separate appointments. This study used a randomized, blind, cross-over protocol. Objective and subjective parameters were recorded for comparison of postoperative results for 7 days after surgery. Patients treated with oral or sublingual piroxicam reported low postoperative pain scores. The patients who received piroxicam orally took a similar average amount of analgesic rescue medication compared with patients who received piroxicam sublingually (p>0.05). Patients exhibited similar values for mouth opening measured just before surgery and immediately following suture removal 7 days later (p>0.05), and showed no significant differences between routes of piroxicam administration for swelling control during the second or seventh postoperative days (p>0.05). In summary, pain, trismus and swelling after lower third molar extraction, independent of surgical difficulty, could be controlled by piroxicam 20mg administered orally or sublingually and no significant differences were observed between the route of delivery used in this study.
Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Piroxicam/administração & dosagem , Extração Dentária , Acetaminofen/uso terapêutico , Administração Oral , Administração Sublingual , Analgésicos não Narcóticos/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Estudos Cross-Over , Edema/tratamento farmacológico , Feminino , Seguimentos , Humanos , Masculino , Mandíbula/cirurgia , Osteotomia , Complicações Pós-Operatórias/tratamento farmacológico , Amplitude de Movimento Articular/fisiologia , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Trismo/tratamento farmacológico , Adulto JovemRESUMO
In a clinical research which involves disabled children, family plays a fundamental role for the stipulation of consent - according to international ethical guidelines - as well as it has to be considered one of the main caregivers in this context. Therefore this fundamental role has to be recognized when considering the development of pediatric research programs, in which the family should be involved. In fact, therapeutic alliance between families and researchers should be considered, not only as a fundamental basis for children health and well-being, but also as an important resource for better outcomes in terms of research, health care and efficacy.
Assuntos
Pesquisa Biomédica , Criança , Família , Humanos , Papel (figurativo) , Terminologia como AssuntoAssuntos
Infecções por Citomegalovirus , Citomegalovirus , Transplante de Células-Tronco Hematopoéticas , Recuperação de Função Fisiológica/imunologia , Adolescente , Adulto , Idoso , Aloenxertos , Biomarcadores/sangue , Citomegalovirus/imunologia , Citomegalovirus/metabolismo , Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/imunologia , Feminino , Antígenos HLA , Neoplasias Hematológicas/sangue , Neoplasias Hematológicas/imunologia , Neoplasias Hematológicas/terapia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: Panoramic radiographs are routinely employed for surgical planning of unerupted third molars. The objective of this study was to evaluate distortions in the position of mandibular third molars on panoramic radiographs. MATERIALS AND METHODS: Panoramic radiographs of 14 patients with indication for extraction of the mandibular third molars were used. Transurgical impressions of the crowns of the teeth to be extracted and adjacent second molars (n=19) were achieved with addition silicone and poured with type IV plaster for comparison of the inclinations of the third molars on the radiographs and study casts. RESULTS: There was a mean difference of -5.37 degrees between the position of the third molar on the panoramic radiograph and on the study cast (standard deviation 1.46, P<0.05, Student's t-test). CONCLUSION: There is distortion in the position of teeth on the panoramic radiograph, which may influence the surgical planning; however, this does not invalidate it as the main tool for diagnosis and surgical planning of mandibular third molars.
Assuntos
Artefatos , Dente Serotino/diagnóstico por imagem , Odontometria/métodos , Radiografia Panorâmica , Dente Impactado/diagnóstico por imagem , Classificação , Humanos , Modelos Dentários , Dente Serotino/patologia , Dente Serotino/cirurgia , Odontometria/instrumentação , Planejamento de Assistência ao Paciente , Dente Impactado/classificação , Dente Impactado/cirurgiaRESUMO
The social inferiority of an elderly person stems from his physical inferiority--actual or alleged but always possible. And yet this "inferior" body is paradoxically hypertrophic: at first it masks the person, then takes up its space until it negates it. Hence, an elderly person is not only a body but a lonely body. In his relations with other people, his body becomes a receiver, a receptacle and a source of communication. Social violence underlies relations with elderly people: such violence may be deceptive, widespread and continuous or, on the other hand, manifest, episodic and conspicuous. In the first case it may be a way of assigning subalternate roles to them in relation to the efficiency expected of them or a way of mythologizing their condition as one of pseudo-happiness. In the second case is generally relates to assaults, thefts, bag-snatching, etc. In any case, however, communication with them entails violence: their body perceives this and reacts to it. This is why their body's language is violent: their body cries out, it is stunned and it is acted upon (even--and unavoidably--in relations with a therapist).
Assuntos
Idoso/psicologia , Abuso de Idosos , Comunicação não Verbal , Feminino , Humanos , Cinésica , Masculino , Isolamento Social , Percepção Social , ViolênciaRESUMO
We compared the clinical efficacy of orally administered valdecoxib and piroxicam for the prevention of pain, trismus and swelling after removal of horizontally and totally intrabony impacted lower third molars. Twenty-five patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Valdecoxib (40 mg) or piroxicam (20 mg) was administered in a double-blind, randomized and crossed manner for 4 days after the surgical procedures. Objective and subjective parameters were recorded for comparison of postoperative courses. Both agents were effective for postoperative pain relief (N = 19). There was a similar mouth opening at suture removal compared with the preoperative values (86.14 ± 4.36 and 93.12 ± 3.70 percent of the initial measure for valdecoxib and piroxicam, respectively; ANOVA). There was no significant difference regarding the total amount of rescue medication taken by the patients treated with valdecoxib or piroxicam (173.08 ± 91.21 and 461.54 ± 199.85 mg, respectively; Wilcoxon test). There were no significant differences concerning the swelling observed on the second postoperative day compared to baseline measures (6.15 ± 1.84 and 8.46 ± 2.04 mm for valdecoxib and piroxicam, respectively; ANOVA) or on the seventh postoperative day (1.69 ± 1.61 and 2.23 ± 2.09 mm for valdecoxib and piroxicam, respectively; ANOVA). The cyclooxygenase-2 selective inhibitor valdecoxib is as effective as the non-selective cyclooxygenase inhibitor piroxicam for pain, trismus and swelling control after removal of horizontally and totally intrabony impacted lower third molars.