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Understanding uncertainties in land cover projections is critical to investigating land-based climate mitigation policies, assessing the potential of climate adaptation strategies and quantifying the impacts of land cover change on the climate system. Here, we identify and quantify uncertainties in global and European land cover projections over a diverse range of model types and scenarios, extending the analysis beyond the agro-economic models included in previous comparisons. The results from 75 simulations over 18 models are analysed and show a large range in land cover area projections, with the highest variability occurring in future cropland areas. We demonstrate systematic differences in land cover areas associated with the characteristics of the modelling approach, which is at least as great as the differences attributed to the scenario variations. The results lead us to conclude that a higher degree of uncertainty exists in land use projections than currently included in climate or earth system projections. To account for land use uncertainty, it is recommended to use a diverse set of models and approaches when assessing the potential impacts of land cover change on future climate. Additionally, further work is needed to better understand the assumptions driving land use model results and reveal the causes of uncertainty in more depth, to help reduce model uncertainty and improve the projections of land cover.
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Mudança Climática , Incerteza , Clima , Planeta Terra , Previsões , PlantasRESUMO
Cry toxins, produced by the bacterium Bacillus thuringiensis, are of significant agronomic value worldwide due to their potent and highly specific activity against various insect orders. However, some of these pore-forming toxins display specific activity against a range of human cancer cells whilst possessing no known insecticidal activity; Cry41Aa is one such toxin. Cry41Aa has similarities to its insecticidal counterparts in both its 3-domain toxic core structure and pore-forming abilities, but how it has evolved to target human cells is a mystery. This work shows that some insecticidal Cry toxins can enhance the toxicity of Cry41Aa against hepatocellular carcinoma cells, despite possessing no intrinsic toxicity themselves. This interesting crossover is not limited to human cancer cells, as Cry41Aa was found to inhibit some Aedes-active Cry toxins in mosquito larval assays. Here, we present findings that suggest that Cry41Aa shares a receptor with several insecticidal toxins, indicating a stronger evolutionary relationship than their divergent activities might suggest.
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Toxinas de Bacillus thuringiensis , Bacillus thuringiensis , Proteínas de Bactérias , Endotoxinas , Proteínas Hemolisinas , Humanos , Endotoxinas/química , Endotoxinas/genética , Endotoxinas/metabolismo , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Proteínas de Bactérias/química , Bacillus thuringiensis/genética , Bacillus thuringiensis/metabolismo , Toxinas de Bacillus thuringiensis/metabolismo , Proteínas Hemolisinas/química , Proteínas Hemolisinas/genética , Proteínas Hemolisinas/metabolismo , Proteínas Hemolisinas/farmacologia , Animais , Inseticidas/química , Inseticidas/farmacologia , Antineoplásicos/farmacologia , Antineoplásicos/química , Aedes/efeitos dos fármacos , Aedes/genética , Linhagem Celular TumoralRESUMO
PURPOSE: The purpose of this study was to compare 3D MR imaging and open cadaveric measurements of the ACL's footprints to see whether 3D MR imaging measurements are accurate enough to be used for preoperative templating in anatomic ACL reconstruction. METHODS: Eight formalin-injected cadaveric knees were scanned by rapid acquisition isotropic 3D MR imaging. The femoral and tibial footprints were measured on MR imaging and compared with cadaveric dissection. Bland-Altman plots were used to assess the level of agreement. RESULTS: The AM and PL bundles were clearly appreciated in each specimen by 3D MR imaging and cadaveric dissection. The average paired difference in the femoral and tibial footprint measurements was 2, 1, 2, and 2 mm for the femoral footprint length, femoral footprint width, tibial footprint length, and tibial footprint width, respectively. The individual paired measurements were all within the mean difference ± two standard deviations of the difference in the Bland-Altman plot showing strong agreement. CONCLUSION: Measuring the ACL's footprint by 3D MR imaging or open cadaveric dissection has strong agreement and can be used interchangeably. 3D MR imaging has the potential to allow surgeons to: (1) tailor ACL reconstruction technique or graft choice based on ACL footprint size, (2) plan for selective bundle ACL reconstruction for partial tears, and (3) preoperatively template tunnel position according to the patient's individual anatomy.
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Ligamento Cruzado Anterior/anatomia & histologia , Imageamento Tridimensional , Articulação do Joelho/anatomia & histologia , Imageamento por Ressonância Magnética/métodos , Idoso , Idoso de 80 Anos ou mais , Reconstrução do Ligamento Cruzado Anterior , Cadáver , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pré-OperatórioRESUMO
Nature-based solutions to climate change are growing policy priorities yet remain hard to quantify. Here we use remote sensing to quantify direct and indirect benefits from community-led agroforestry by The International Small group and Tree planting program (TIST) in Kenya. Since 2005, TIST-Kenya has incentivised smallholder farmers to plant trees for agricultural benefit and to sequester CO2. We use Landsat-7 satellite imagery to examine the effect on the historically deforested landscape around Mount Kenya. We identify positive greening trends in TIST groves during 2000-2019 relative to the wider landscape. These groves cover 27,198 ha, and a further 27,750 ha of neighbouring agricultural land is also positively influenced by TIST. This positive 'spill-over' impact of TIST activity occurs at up to 360 m distance. TIST also benefits local forests, e.g. through reducing fuelwood and fodder extraction. Our results show that community-led initiatives can lead to successful landscape-scale regreening on decadal timescales.
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BACKGROUND: Nonanatomic placement of anterior cruciate ligament (ACL) grafts is a leading cause of ACL graft failure. Three-dimensional (3D) magnetic resonance imaging (MRI) femoral footprint localization could enhance planning for an ACL graft's position. PURPOSE: To determine the intra- and interobserver reliability of measurements of the ACL femoral footprint position and size obtained from 3D MRI scans. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 41 patients with complete ACL tears were recruited between November 2014 and May 2016. Preoperatively, a coronal-oblique proton-density fast spin echo 3D acquisition of the contralateral uninjured knee was obtained along the plane of the ACL using a 1.5T MRI scanner. ACL footprint parameters were obtained independently by 2 musculoskeletal radiologists (observers A and B). The distal and anterior positions of the center of the footprint were measured relative to the apex of the deep cartilage at the posteromedial aspect of the lateral femoral condyle, and the surface area of the ACL femoral footprint was approximated from multiplanar reformatted images. After 1 month, the measurements were repeated. Intraclass correlation coefficients (ICCs) were calculated to assess for intra- and interobserver reliability. Bland-Altman plots were produced to screen for potential systematic bias in measurement and to calculate limits of agreement. RESULTS: The ICCs for intraobserver reliability of the ACL femoral distal and anterior footprint coordinates were 0.75 and 0.78, respectively, for observer A. For observer B, they were 0.75 and 0.74, respectively. The ICCs for interobserver reliability were 0.75 and 0.85 for the distal and anterior coordinates, respectively. Bland-Altman plots demonstrated no significant systematic bias. For surface area measurements, the intraobserver ICCs were 0.37 and 0.62 for observers A and B, respectively. The interobserver reliability was 0.60. Observer B consistently measured the footprints as slightly larger versus observer A (1.19 ± 0.27 vs 1 ± 0.22 cm2, respectively; P < .001). CONCLUSION: Locating the center of the anatomic footprint of the ACL with 3D MRI showed substantial intra- and interobserver agreement. Interobserver agreement for the femoral footprint surface area was fair to moderate.
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PURPOSE: To dynamically assess for Hill-Sachs engagement with animated 3-dimensional (3D) shoulder models. METHODS: We created 3D shoulder models from reconstructed computed tomography (CT) images from a consecutive series of patients with recurrent anterior dislocation. They were divided into 2 groups based on the perceived Hill-Sachs severity. For our cohort of 14 patients with recurrent anterior dislocation, 4 patients had undergone osteoarticular allografting of Hill-Sachs lesions and 10 control patients had undergone CT scanning to quantify bone loss but no treatment for bony pathology. A biomechanical analysis was performed to rotate each 3D model using local coordinate systems to the classical vulnerable position of the shoulder (abduction = 90°, external rotation = 0-135°) and through a functional range. A Hill-Sachs lesion was considered "dynamically" engaging if the angle between the lesion's long axis and anterior glenoid was parallel. Results: In the vulnerable position of the shoulder, none of the Hill-Sachs lesions aligned with the anterior glenoid in any of our patients. However, in our simulated physiological shoulder range, all allograft patients and 70% of controls had positions producing alignment. CONCLUSIONS: The technique offers a visual representation of an engaging Hill-Sachs using 3D-animated reconstructions with open-source software and CT images. In our series of patients, we found multiple shoulder positions that align the Hill-Sachs and glenoid axes that do not necessarily meet the traditional definition of engagement. Identifying all shoulder positions at risk of "engaging," in a broader physiological range, may have critical implications toward selecting the appropriate surgical management of bony defects. LEVEL OF EVIDENCE: level III, case-control study.
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OBJECTIVE: Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor usually affecting the extremities of children and young adults and has a favorable prognosis. The purpose of this study was to report the magnetic resonance imaging appearance in 2 cases of AFH. CONCLUSIONS: Although the overall features of AFH can be confused with other subtypes of malignant fibrous histiocytoma, the young age at presentation, the location of the mass, the presence of intralesional blood-filled cystic spaces with fluid-fluid levels, associated features of hemosiderin deposition, and an enhancing fibrous pseudocapsule are all potential hints favoring this entity.
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Histiocitoma Fibroso Benigno/diagnóstico , Imageamento por Ressonância Magnética/métodos , Neoplasias de Tecidos Moles/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Braço , Feminino , Histiocitoma Fibroso Benigno/cirurgia , Humanos , Estudos Retrospectivos , Ombro , Neoplasias de Tecidos Moles/cirurgiaRESUMO
Aneurysmal bone cysts (ABC) are rare, benign primary bone tumors. Although benign, they can be locally aggressive resulting in erosion of bone and surrounding tissues over time. In later stages, depending on the clinical urgency, immunotherapy or surgical resection remain treatment options. This report illustrates a case of a 32-year-old female who presented with chronic worsening low back pain without neurological deficits. Radiological imaging revealed a large destructive mass arising from the thoracic spine invading into the central canal, causing critical central stenosis and cord compression. Histopathology revealed ABC. This case highlights the importance of including ABCs and other 'benign'/locally aggressive lesions in the differential of patients with insidious musculoskeletal complaints. This case also demonstrates that one can be neurologically asymptomatic despite having critical central canal stenosis and cord compression if the causative lesion is slow growing. Understanding this allows us to arrange for most appropriate management.
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PURPOSE: To prospectively assess the safety and effectiveness of computed tomography (CT)-guided placement of fiber-coated microcoils used to guide video-assisted thoracoscopic surgical (VATS) excision of small peripheral lung nodules, with successful excision as the primary outcome and successful CT-guided microcoil placement and procedural complications as secondary outcomes. MATERIALS AND METHODS: The institutional review board approved the study protocol. Informed consent was obtained from all 69 enrolled patients (30 men, 39 women; mean age, 60.7 years +/- 10.1 [standard deviation]) with 75 nodules. At CT, one end of an 80-mm long, 0.018-inch-diameter fiber-coated microcoil was placed deep to the small peripheral lung nodule, and the other end was coiled in the pleural space. VATS excision of lung tissue, nodules, and the microcoil was performed with fluoroscopic guidance. RESULTS: Seventy-three (97%) 4-24-mm nodules were successfully removed at fluoroscopically guided VATS excision; two nodules could not be removed. CT-guided microcoil placement was successful in all cases; however, two (3%) of 75 coils were displaced at VATS excision. Pneumothorax requiring chest tube placement occurred in two (3%) patients, and asymptomatic hemothorax occurred in one (1%) patient. The microcoil did not impede intraoperative frozen-section histopathologic analysis, which facilitated accurate clinical management in all patients. For 19 (28%) patients, the preoperative treatment plan based on bronchoscopy, needle biopsy, and positron emission tomography findings changed after VATS excision. CONCLUSION: Microcoil localization of small peripheral lung nodules enabled fluoroscopically guided VATS resection of 97% of the nodules, with a low rate of intervention (3%) for procedural complications.
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Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Radiografia Intervencionista , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Distribuição de Qui-Quadrado , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
BACKGROUND: The recent emphasis on anatomic reconstruction of the anterior cruciate ligament (ACL) is well supported by clinical and biomechanical research. Unfortunately, the location of the native femoral footprint can be difficult to see at the time of surgery, and the accuracy of current techniques to perform anatomic reconstruction is unclear. PURPOSE: To use 3-dimensional magnetic resonance imaging (3D MRI) to prospectively evaluate patients with torn ACLs before and after reconstruction and thereby assess the accuracy of graft position on the femoral condyle. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Forty-one patients with unilateral ACL tears were recruited into the study. Each patient underwent 3D MRI of both the injured and uninjured knees before surgery. The contralateral (uninjured) knee was used to define the patient's native footprint. Patients then underwent ACL reconstruction, and the injured knee underwent reimaging after surgery. The location and percentage overlap of the reconstructed femoral footprint were compared with the patient's native footprint. RESULTS: The center of the native ACL femoral footprint was a mean 12.0 ± 2.6 mm distal and 9.3 ± 2.2 mm anterior to the apex of the deep cartilage. The position of the reconstructed graft was significantly different, with a mean distance of 10.8 ± 2.2 mm distal ( P = .02) and 8.0 ± 2.3 mm anterior ( P = .01). The mean distance between the center of the graft and the center of the native ACL femoral footprint (error distance) was 3.6 ± 2.6 mm. Comparing error distances among the 4 surgeons demonstrated no significant difference ( P = .10). On average, 67% of the graft overlapped within the native ACL femoral footprint. CONCLUSION: Despite contemporary techniques and a concerted effort to perform anatomic ACL reconstruction by 4 experienced sports orthopaedic surgeons, the position of the femoral footprint was significantly different between the native and reconstructed ACLs. Furthermore, each surgeon used a different technique, but all had comparable errors in their tunnel placements.
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Reconstrução do Ligamento Cruzado Anterior/métodos , Fêmur/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Cartilagem/cirurgia , Feminino , Fêmur/cirurgia , Humanos , Imageamento Tridimensional , Articulação do Joelho/cirurgia , Masculino , Estudos Prospectivos , Transplantes/cirurgiaRESUMO
Scenarios that limit global warming to below 2 °C by 2100 assume significant land-use change to support large-scale carbon dioxide (CO2) removal from the atmosphere by afforestation/reforestation, avoided deforestation, and Biomass Energy with Carbon Capture and Storage (BECCS). The more ambitious mitigation scenarios require even greater land area for mitigation and/or earlier adoption of CO2 removal strategies. Here we show that additional land-use change to meet a 1.5 °C climate change target could result in net losses of carbon from the land. The effectiveness of BECCS strongly depends on several assumptions related to the choice of biomass, the fate of initial above ground biomass, and the fossil-fuel emissions offset in the energy system. Depending on these factors, carbon removed from the atmosphere through BECCS could easily be offset by losses due to land-use change. If BECCS involves replacing high-carbon content ecosystems with crops, then forest-based mitigation could be more efficient for atmospheric CO2 removal than BECCS.
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BACKGROUND: Epithelioid "aggressive" osteoblastoma (EOB) is a rare and more aggressive subtype of osteoblastoma (OB) with a higher recurrence rate, greater risk of malignant transformation, larger size, and greater intraoperative blood loss. The present case report illustrates that preoperative angioembolization of an EOB can be safely performed with low intraoperative blood loss. CASE DESCRIPTION: A 21-year-old male patient presented to our institution with a 4-month history of neck discomfort, radicular pain in the proximal right arm, and mild weakness of the right biceps and triceps muscles. Imaging was suggestive of EOB, and computed tomography-guided biopsy confirmed the diagnosis. The patient underwent same-day preoperative angioembolization of the major feeding vessels and subsequent complete tumor resection. During the procedure, he experienced minimal blood loss and did not require blood transfusion. CONCLUSIONS: EOB is a highly vascular primary bony lesion. To minimize intraoperative blood loss, preoperative angioembolization should be considered in the treatment of cervical spine EOB.
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Vértebras Cervicais/cirurgia , Osteoblastoma/cirurgia , Sarcoma/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Perda Sanguínea Cirúrgica/fisiopatologia , Embolização Terapêutica/métodos , Humanos , Masculino , Osteoblastoma/diagnóstico , Sarcoma/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto JovemRESUMO
This study was planned to compare the computed tomographic detectability of lung nodules in three ventilatory conditions: total lung capacity, high-frequency ventilation, and total lung deflation. In an ex vivo lung model, 44 nodules were simulated. Using computed tomography (CT) scans, nodules were detected and compared to the actual number and excised under CT guidance. Simulated nodules measured 6.2 +/- 2.1 mm and demonstrated an attenuation of 175 +/- 14 HU. Observer confidence was highest at total lung capacity (5.00 +/- 0.00), in comparison to high-frequency ventilation and total lung deflation (4.69 +/- 0.78, 4.94 +/- 0.27, p = .24). The kappa score for total lung capacity, high-frequency ventilation, and total lung deflation was 1.00, 0.96, and 0.98, respectively, indicating a very high interrater reliability. Although surgical devices generated a substantial artifact, 90% of nodules were excised. Thus, although total lung capacity produces the highest confidence level, all three of the ventilatory techniques examined have similar detection of subcentimeter pulmonary nodules using computed tomography scans.
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Pulmão/patologia , Atelectasia Pulmonar/patologia , Toracoscopia/métodos , Tomografia Computadorizada por Raios X , Animais , Artefatos , Feminino , Ventilação em Jatos de Alta Frequência , Técnicas In Vitro , Pulmão/diagnóstico por imagem , Variações Dependentes do Observador , Atelectasia Pulmonar/diagnóstico por imagem , Respiração Artificial , Suínos , Toracoscopia/estatística & dados numéricos , Volume de Ventilação Pulmonar , Capacidade Pulmonar TotalRESUMO
BACKGROUND: The delivery of end-of-life care in nursing homes is challenging. This situation is of concern as 20% of the population die in this setting. Commonly reported reasons include limited access to medical care, inadequate clinical leadership and poor communication between nursing home and medical staff. Education for nursing home staff is suggested as the most important way of overcoming these obstacles. OBJECTIVES: To identify educational interventions to enhance end-of-life care for nursing home staff and to identify types of study designs and outcomes to indicate success and benchmark interventions against recent international guidelines for education for palliative and end-of-life care. DESIGN: Thirteen databases and reference lists of key journals were searched from the inception of each up to September 2014. Included studies were appraised for quality and data were synthesised thematically. RESULTS: Twenty-one studies were reviewed. Methodological quality was poor. Education was not of a standard that could be expected to alter clinical behaviour and was evaluated mainly from the perspectives of staff: self-reported increase in knowledge, skills and confidence delivering care rather than direct evidence of impact on clinical practice and patient outcomes. Follow-up was often short term, and despite sound economic arguments for delivering effective end-of-life care to reduce burden on the health service, no economic analyses were reported. CONCLUSIONS: There is a clear and urgent need to design educational interventions that have the potential to improve end-of-life care in nursing homes. Robust evaluation of these interventions should include impact on residents, families and staff and include economic analysis.
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Casas de Saúde , Recursos Humanos de Enfermagem/educação , Assistência Terminal/normas , Humanos , Qualidade da Assistência à SaúdeRESUMO
Platinum microcoils were placed in porcine lungs to determine the feasibility for use as a lung nodule marker. Using computed tomography (CT) guidance, the microcoils were successfully deployed in 17 out of 19 attempts. Coil deployment depth ranged from 7 mm to 34 mm below the pleural surface. Moderate pneumothorax was detected after 3 of 19 microcoil insertions. No hemothorax or significant pulmonary hemorrhage was noted. Fluoroscopic guided thoracoscopic resection was successful in 10 of 12 attempts. Platinum microcoils can be safely and easily deployed into the lung parenchyma with minimal complication risk, and can be used to guide subsequent thoracoscopic wedge resection.
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Neoplasias Pulmonares/diagnóstico por imagem , Nódulo Pulmonar Solitário/diagnóstico por imagem , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X , Animais , Feminino , Fluoroscopia , SuínosRESUMO
OBJECTIVES: To explore perceptions of the current practice and future potential of advanced practitioners (APs) from the perspectives of different professional groups in Wales UK. DESIGN: A qualitative study consisting of nine focus group interviews. METHODS: Initially verbatim transcriptions of each focus group interviews were analysed thematically before themes were merged to represent perceptions for the whole data set. PARTICIPANTS: Data were gathered from a total of 67 stakeholders--including APs from a variety of professional groups (eg, nursing, physiotherapy, paramedics) as well as managers, workforce developers, educators and medical staff who have a role developing and supporting APs in practice. RESULTS: The results are presented in four themes: (1) demand, policy context and future priorities, (2) role clarity and standardisation, (3) agreement and understanding of the role and (4) interprofessional working. The context within which current and future AP roles were considered was influenced by inexorable demands for healthcare and the requirements to meet health policy priorities. Developing AP roles were hampered currently by a lack of shared understanding and 'joined-up' working between different groups such as medical practitioners, managers, commissioners and educators. CONCLUSIONS: For the AP role to flourish more 'joined-up' thinking, support and development opportunities are required between APs, managers, senior clinicians, commissioners and educators. Working together to plan and deliver education, innovation and service delivery is of prime importance to meeting ever increasing complex health needs. This will ensure that future APs are adequately prepared and supported to reach their full potential and help deliver necessary innovations in current models of care delivery.
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Pessoal Técnico de Saúde/psicologia , Relações Interprofissionais , Competência Profissional/normas , Papel Profissional/psicologia , Grupos Focais , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , País de GalesRESUMO
For several decades, ventilation-perfusion scintigraphy has been the main imaging modality used in the evaluation of patients with suspected acute pulmonary embolism (PE). Recently, various investigators have suggested that spiral CT pulmonary angiography should replace scintigraphy in the assessment of patients whose symptoms are suggestive of acute PE. This article discusses the role of the various imaging modalities in the diagnosis of acute PE and suggests a diagnostic imaging algorithm based on current evidence in the literature.
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Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada Espiral , Relação Ventilação-Perfusão , Doença Aguda , Humanos , Pulmão/diagnóstico por imagem , Radiografia Torácica , Cintilografia , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Little research has been completed to assess the numbers of infection prevention and control personnel employed or optimal size and composition of infection control teams. METHODS: Acute national health hospital organizations in England were requested to provide information about the numbers of infection prevention and control personnel employed and weekly hours contributed by each occupational group under the United Kingdom's Freedom of Information legislation. The relationship between capacity of the infection prevention and control workforce, size of the inpatient population, and routinely collected surveillance data for health care-associated infection were explored. RESULTS: There were 137 (85%) National Health Service (NHS) hospital organizations that responded. The number of infection prevention and control nurses ranged from 1-16 per organization. A total of 46 (33.6%) reported that they received no clinical microbiology sessions, and for 11 (8%) input was inadequate. An antibiotic pharmacist was reported to be employed in 107 (78.1%) organizations. Few infection prevention and control teams reported receiving the following: 1. managerial support, 2. being represented on committees where decisions about resource allocation were made, or 3. assistance with administration. CONCLUSION: Despite the priority that infection prevention and control have received in the United Kingdom over the last 10 years, many infection prevention and control teams appear underresourced.
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Infecção Hospitalar/prevenção & controle , Medicina de Emergência , Pessoal de Saúde/estatística & dados numéricos , Controle de Infecções/organização & administração , Infecção Hospitalar/epidemiologia , Inglaterra , Monitoramento Epidemiológico , Humanos , Recursos HumanosRESUMO
Supraspinatus muscle atrophy and fatty infiltration are two distinct muscle abnormalities which can be seen after a chronic massive tear or suprascapular neuropathy. Isolated supraspinatus muscle denervation due to suprascapular nerve injury after shoulder dislocation is extremely rare. We report on a patient who developed isolated supraspinatus muscle atrophy and fatty infiltration after traumatic anterior shoulder instability. Possible explanations and etiologies of this rare condition are discussed in this report.
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PURPOSE: To report radiological and pathological response to neo-adjuvant radiotherapy for extremity and trunk soft-tissue sarcomas. MATERIALS/METHODS: Fifty patients were identified retrospectively. All patients had MRI imaging pre and post neo-adjuvant external beam radiotherapy. Tumor volumes were measured in 3D on T1 Gadolinium enhanced sequences. Pathological treatment response was quantified in terms of percentage of treatment-related necrosis for each case. RESULTS: Histopathologic responses to treatment varied from 0% to 100%. The median pathological treatment response was 67.5% for low-grade sarcomas and 50% for high-grade sarcomas. The median decrease in tumor volume was 13.8% for non-myxoid low-grade sarcomas, 82.1% for myxoid liposarcomas and <1% for high-grade sarcomas. A partial response on MRI (volume reduction ≥50%) was highly predictive of a good pathological response (p<0.001). Patients with stable disease on imaging or volumetric progression had wide ranging pathological responses. CONCLUSIONS: Soft-tissue sarcomas show significant pathological treatment responses in the form of hyaline fibrosis, necrosis and granulation tissue. Despite this, there is minimal early volumetric response to radiation, especially for high-grade tumors. Although radiological partial response was predictive of pathological response, the significance of radiological progression was unclear. Myxoid liposarcoma tumor type was predictive of both pathological and radiological tumor response.