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1.
Environ Sci Technol ; 57(40): 14787-14796, 2023 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-37769297

RESUMO

Wildfires have increased in frequency and area burned, trends expected to continue with climate change. Among other effects, fires release pollutants into the atmosphere, representing a risk to human health and downwind terrestrial and aquatic ecosystems. While human health risks are well studied, the ecological impacts to downwind ecosystems are not, and this gap may present a constraint on developing an adequate assessment of the ecological risks associated with downwind wildfire exposure. Here, we first screened the scientific literature to assess general knowledge about pathways and end points of a conceptual model linking wildfire generated pollutants and other materials to downwind ecosystems. We found a substantial body of literature on the composition of wildfire derived pollution and materials in the atmosphere and subsequent transport, yet little observational or experimental work on their effects on downwind ecological end points. This dearth of information raises many questions related to adequately assessing the ecological risk of downwind exposure, especially given increasing wildfire trends. To guide future research, we pose eight questions within the well-established US EPA ecological risk assessment paradigm that if answered would greatly improve ecological risk assessment and, ultimately, management strategies needed to reduce potential wildfire impacts.


Assuntos
Poluentes Atmosféricos , Incêndios , Incêndios Florestais , Humanos , Poluentes Atmosféricos/análise , Ecossistema , Exposição Ambiental
2.
Environ Sci Technol ; 57(50): 21235-21248, 2023 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-38051783

RESUMO

Due in part to climate change, wildfire activity is increasing, with the potential for greater public health impact from smoke in downwind communities. Studies examining the health effects of wildfire smoke have focused primarily on fine particulate matter (PM2.5), but there is a need to better characterize other constituents, such as hazardous air pollutants (HAPs). HAPs are chemicals known or suspected to cause cancer or other serious health effects that are regulated by the United States (US) Environmental Protection Agency. Here, we analyzed concentrations of 21 HAPs in wildfire smoke from 2006 to 2020 at 309 monitors across the western US. Additionally, we examined HAP concentrations measured in a major population center (San Jose, CA) affected by multiple fires from 2017 to 2020. We found that concentrations of select HAPs, namely acetaldehyde, acrolein, chloroform, formaldehyde, manganese, and tetrachloroethylene, were all significantly elevated on smoke-impacted versus nonsmoke days (P < 0.05). The largest median increase on smoke-impacted days was observed for formaldehyde, 1.3 µg/m3 (43%) higher than that on nonsmoke days. Acetaldehyde increased 0.73 µg/m3 (36%), and acrolein increased 0.14 µg/m3 (34%). By better characterizing these chemicals in wildfire smoke, we anticipate that this research will aid efforts to reduce exposures in downwind communities.


Assuntos
Poluentes Atmosféricos , Incêndios Florestais , Acetaldeído , Acroleína , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Exposição Ambiental , Formaldeído , Material Particulado/análise , Fumaça/efeitos adversos , Estados Unidos
3.
Clin Orthop Relat Res ; 481(4): 789-794, 2023 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-36222753

RESUMO

BACKGROUND: Riding off-road vehicles is associated with the risk of injury to the extremities. There are two main types of four-wheel recreational off-road vehicles: quads or all-terrain vehicles (ATVs), which are essentially four-wheel off-road motorcycles, and recreational off-highway vehicles (ROVs), also colloquially referred to as utility terrain vehicles, which have side-by-side seating, higher maximum speeds, and a roll cage. There are multiple orthopaedic society position statements on ATVs, but none on ROVs. Perhaps this is because the injury patterns and differences between the two vehicles have not been elucidated. QUESTIONS/PURPOSES: (1) What patient, vehicle (ROVs versus ATVs), and injury factors are associated with amputation? (2) What are the anatomic location distributions of fractures and amputations by vehicle type? METHODS: Records of all patients in our hospital's billing system who had both a diagnostic code indicating an accident related to an off-road vehicle and one indicating an extremity or pelvic fracture between February 2014 and January 2020 were screened; this resulted in the identification of 328 patients with fractures resulting from off-road vehicle collisions. A total of 16% (51 of 328) of patients were excluded from the analysis because their injury did not involve either an ATV or an ROV; 277 patients were included in the final analysis. The following variables were collected: age at time of the injury, gender, BMI, vehicle type, Gustilo-Anderson type if applicable, amputation level if applicable, anatomic locations of injuries, ethanol level, and drug screen. ATV crashes accounted for 52% (145 of 277) of patients, and ROV crashes accounted for 48% (132 of 277). Patients from ATV crashes did not differ from those in ROV crashes in terms of mean age (24 ± 16 years versus 24 ± 13 years; p = 0.82), BMI (25 ± 7 kg/m 2 versus 26 ± 6 kg/m 2 ; p = 0.18), or gender (79% [114 of 145] men/boys versus 77% [102 of 132]; p = 0.79). Among patients who had a drug or ethanol screen, there was a higher percent of ATV riders who used marijuana (39% [19 of 49] versus 17% [7 of 42]; p = 0.04), but there were no differences in abnormal blood alcohol screen or abnormal nonmarijuana drug screen; however, these results were available in only about one-third of patients (99 of 277 for ethanol and 91 of 277 for drug screen). Statistical analysis was performed using logistic regression analysis for factors associated with amputation, with p values < 0.05 considered significant. RESULTS: After controlling for differences in demographic factors, the stepwise increase in Gustilo-Anderson grade of open fracture (OR 9.8 [95% CI 3.6 to 27.0]; p < 0.001) and ROV vehicle type (OR 15.7 [95% CI 3.6 to 68.5]; p < 0.001) were both associated with amputation. There was no increase in the odds of amputation associated with age (OR 1.0 [95% CI 0.9 to 1.1]; p = 0.81), gender (OR 1.4 [95% CI 0.3 to 5.8]; p = 0.68), or BMI (OR 1.1 [95% CI 0.9 to 1.2]; p = 0.37). The most frequent ATV fractures occurred in the forearm and wrist (22% [45 of 203]), whereas most ROV injuries occurred through the metacarpals (41% [107 of 262] of fractures and 58% [18 of 31] of amputations). CONCLUSION: ROV crashes are associated with a higher odds of amputation when compared with ATV crashes. Because most ROV injuries were in the forearm and below, this likely occurs when upper extremities are crushed and mangled under the roll cage in rollover ROV crashes. Because of this danger, we urge our orthopaedic societies to either update current ATV position statements to include ROVs or release separate statements on ROVs. LEVEL OF EVIDENCE: Level III, prognostic study.


Assuntos
Fraturas Ósseas , Veículos Off-Road , Ferimentos e Lesões , Masculino , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Acidentes de Trânsito , Amputação Cirúrgica , Extremidade Superior , Etanol
4.
Environ Sci Technol ; 56(20): 14272-14283, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36191257

RESUMO

As the climate warms, wildfire activity is increasing, posing a risk to human health. Studies have reported on particulate matter (PM) in wildfire smoke, yet the chemicals associated with PM have received considerably less attention. Here, we analyzed 13 years (2006-2018) of PM2.5 chemical composition data from monitors in California on smoke-impacted days. Select chemicals (e.g., aluminum and sulfate) were statistically elevated on smoke-impacted days in over half of the years studied. Other chemicals, mostly trace metals harmful to human health (e.g., copper and lead), were elevated during particular fires only. For instance, in 2018, lead was more than 40 times higher on smoke days on average at the Point Reyes monitoring station, due mostly to the Camp Fire, burning approximately 200 km away. There was an association between these metals and the combustion of anthropogenic material (e.g., the burning of houses and vehicles). Although still currently rare, these infrastructure fires are likely becoming more common and can mobilize trace metals in smoke far downwind, at levels generally unseen except in the most polluted areas of the country. We hope a better understanding of the chemicals in wildfire smoke will assist in the communication and reduction of public health risks.


Assuntos
Poluentes Atmosféricos , Poluentes Ambientais , Incêndios , Poluentes Atmosféricos/análise , Alumínio , California , Cobre , Exposição Ambiental , Humanos , Material Particulado/análise , Fumaça/análise , Sulfatos
5.
Atmos Environ (1994) ; 284: 1-16, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35775067

RESUMO

It is well known that exposure to ambient O3 can decrease growth in many tree species in the United States (US). Our study reports experimental data from outdoor open-top chamber (OTC) studies that quantify total biomass response changes for seedlings of 16 species native to western and eastern North America, which were exposed to several levels of elevated O3 for one or more years. The primary objective of this study is to establish a reference set of parameters for these seedling exposure-response relationships using a 3-month (92 day) 12-hr W126 O3 metric used by US Environmental Protection Agency and other agencies to assess risk to trees from O3 exposure. We classified the 16 species according to their sensitivity, based on the biomass loss response functions to protect from a 5% biomass loss. The three-month 12-h W126 estimated to result in a 5% biomass loss was 2.5-9.2 ppm-h for sensitive species, 20.8-25.2 ppm-h for intermediate species, and > 28.7 ppm-h for insensitive species. The most sensitive tree species include black cherry, ponderosa pine, quaking aspen, red alder, American sycamore, tulip poplar and winged sumac. These species are ecologically important and widespread across US. The effects of O3 on whole-plant biomass depended on exposure duration and dynamics and on the number of successive years of exposure. These species-specific exposure-response relationships will allow US agencies and other groups to better estimate biomass losses based on ozone exposures in North America and can be used in risk assessment and scenario analyses.

6.
Ann Ig ; 34(2): 156-165, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-33908600

RESUMO

BACKGROUND: Early-life diet plays a crucial role in the development of body weight issues. We therefore investigated the effectiveness of a peer-education intervention, aiming at encouraging the intake of fruits and vegetables and of a healthy mid-morning snack, targeting the mothers of 3-8 years old children attending kindergarten and primary school. STUDY DESIGN: Experimental approach. METHODS: The study involved 924 children (intervention group) and 450 children (control group). The intervention was carried out by organizing three meetings at school with the participation of healthcare professionals, mothers and teachers in a maieutic way. The meetings focused on i) discussing the issues that mothers face with their children's nutrition; ii) possible solutions; iii) identification of "leading mothers" playing as peer-educators. As control a similar intervention targeting only the teachers, without involving the mothers, was also carried out. The effectiveness of such interventions was evaluated by external evaluators, before, the interventions and 3 and 9 months after the interventions. RESULTS: The check, carried out 3 months after the intervention, showed a significant improvement with respect to the mid-morning snack, and the consumption of the main dishes as well as fruits; the check carried out 9 months after the intervention, showed that such improvements were maintained in the case of the mid-morning snack and the fruit intake. No improvement was observed in relation to the control group. CONCLUSIONS: This is the first example of an intervention promoting a healthy diet involving mothers of children attending kindergarten and primary school as peer educators and it actually improved the dietary habits.


Assuntos
Mães , Verduras , Criança , Pré-Escolar , Dieta , Comportamento Alimentar , Feminino , Humanos , Obesidade , Instituições Acadêmicas
7.
Environ Res ; 198: 111317, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33989623

RESUMO

Exposure to ozone has been linked to reproductive outcomes, including preterm birth. In this systematic review, we summarize published epidemiologic cohort and case-control studies examining ozone exposures (estimated on a continuous scale) in early pregnancy (1st and 2nd trimesters (T1, T2)) and preterm birth using ratio measures, and perform a meta-analysis to evaluate the potential relationship between them. Studies were identified by searching PubMed and Web of Science, screened according to predefined inclusion/exclusion criteria, and evaluated for study quality. We extracted study data including effect estimates, confidence limits, study location, study years, ozone exposure assessment method, and mean or median ozone concentrations. Nineteen studies were identified and included, of which 18 examined T1 exposure (17 reported effect estimates), and 15 examined T2 exposure. Random effects meta-analysis was performed in the metafor package, R 3.5.3. The pooled OR (95% CI) for a 10 ppb increase in ozone exposure in T1 was 1.06 (1.03, 1.10) with a 95% prediction interval of 0.95, 1.19; for T2 it was 1.05 (1.02, 1.08) with a 95% prediction interval of 0.95, 1.16. Effect estimates for both exposure periods showed high heterogeneity. In meta-regression analyses of study characteristics, study location (continent) explained some (~20%) heterogeneity for T1 exposure studies, but no characteristic explained a substantial amount of heterogeneity for T2 exposure studies. Increased ozone exposure during early pregnancy is associated with preterm birth across studies.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Ozônio , Nascimento Prematuro , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/análise , Feminino , Humanos , Recém-Nascido , Ozônio/análise , Ozônio/toxicidade , Material Particulado/análise , Gravidez , Resultado da Gravidez , Nascimento Prematuro/induzido quimicamente , Nascimento Prematuro/epidemiologia
8.
Mol Psychiatry ; 22(8): 1096-1109, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28584287

RESUMO

CACNA1C, encoding the Cav1.2 subunit of L-type Ca2+ channels, has emerged as one of the most prominent and highly replicable susceptibility genes for several neuropsychiatric disorders. Cav1.2 channels play a crucial role in calcium-mediated processes involved in brain development and neuronal function. Within the CACNA1C gene, disease-associated single-nucleotide polymorphisms have been associated with impaired social and cognitive processing and altered prefrontal cortical (PFC) structure and activity. These findings suggest that aberrant Cav1.2 signaling may contribute to neuropsychiatric-related disease symptoms via impaired PFC function. Here, we show that mice harboring loss of cacna1c in excitatory glutamatergic neurons of the forebrain (fbKO) that we have previously reported to exhibit anxiety-like behavior, displayed a social behavioral deficit and impaired learning and memory. Furthermore, focal knockdown of cacna1c in the adult PFC recapitulated the social deficit and elevated anxiety-like behavior, but not the deficits in learning and memory. Electrophysiological and molecular studies in the PFC of cacna1c fbKO mice revealed higher E/I ratio in layer 5 pyramidal neurons and lower general protein synthesis. This was concurrent with reduced activity of mTORC1 and its downstream mRNA translation initiation factors eIF4B and 4EBP1, as well as elevated phosphorylation of eIF2α, an inhibitor of mRNA translation. Remarkably, systemic treatment with ISRIB, a small molecule inhibitor that suppresses the effects of phosphorylated eIF2α on mRNA translation, was sufficient to reverse the social deficit and elevated anxiety-like behavior in adult cacna1c fbKO mice. ISRIB additionally normalized the lower protein synthesis and higher E/I ratio in the PFC. Thus this study identifies a novel Cav1.2 mechanism in neuropsychiatric-related endophenotypes and a potential future therapeutic target to explore.


Assuntos
Canais de Cálcio Tipo L/efeitos dos fármacos , Canais de Cálcio Tipo L/metabolismo , Animais , Ansiedade , Comportamento Animal/efeitos dos fármacos , Cálcio/metabolismo , Canais de Cálcio Tipo L/genética , Modelos Animais de Doenças , Fator de Iniciação 2 em Eucariotos/genética , Fator de Iniciação 2 em Eucariotos/metabolismo , Fatores de Iniciação em Eucariotos/genética , Fatores de Iniciação em Eucariotos/metabolismo , Predisposição Genética para Doença/genética , Hipocampo/metabolismo , Humanos , Camundongos , Camundongos Knockout , Neurônios/metabolismo , Prosencéfalo/metabolismo , Células Piramidais/metabolismo , Comportamento Social
9.
Mol Psychiatry ; 22(12): 1735-1745, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28194001

RESUMO

Genetic factors significantly influence susceptibility for substance abuse and mood disorders. Rodent studies have begun to elucidate a role of Cav1.3 L-type Ca2+ channels in neuropsychiatric-related behaviors, such as addictive and depressive-like behaviors. Human studies have also linked the CACNA1D gene, which codes for the Cav1.3 protein, with bipolar disorder. However, the neurocircuitry and the molecular mechanisms underlying the role of Cav1.3 in neuropsychiatric phenotypes are not well established. In the present study, we directly manipulated Cav1.3 channels in Cav1.2 dihydropyridine insensitive mutant mice and found that ventral tegmental area (VTA) Cav1.3 channels mediate cocaine-related and depressive-like behavior through a common nucleus accumbens (NAc) shell calcium-permeable α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (CP-AMPAR) mechanism that requires GluA1 phosphorylation at S831. Selective activation of VTA Cav1.3 with (±)-BayK-8644 (BayK) enhanced cocaine conditioned place preference and cocaine psychomotor activity while inducing depressive-like behavior, an effect not observed in S831A phospho-mutant mice. Infusion of the CP-AMPAR-specific blocker Naspm into the NAc shell reversed the cocaine and depressive-like phenotypes. In addition, activation of VTA Cav1.3 channels resulted in social behavioral deficits. In contrast to the cocaine- and depression-related phenotypes, GluA1/A2 AMPARs in the NAc core mediated social deficits, independent of S831-GluA1 phosphorylation. Using a candidate gene analysis approach, we also identified single-nucleotide polymorphisms in the CACNA1D gene associated with cocaine dependence in human subjects. Together, our findings reveal novel, overlapping mechanisms through which VTA Cav1.3 mediates cocaine-related, depressive-like and social phenotypes, suggesting that Cav1.3 may serve as a target for the treatment of neuropsychiatric symptoms.


Assuntos
Afeto/fisiologia , Canais de Cálcio Tipo L/metabolismo , Cocaína/farmacologia , Inibidores da Captação de Dopamina/farmacologia , Núcleo Accumbens/metabolismo , Área Tegmentar Ventral/metabolismo , Afeto/efeitos dos fármacos , Animais , Canais de Cálcio Tipo L/genética , Transtornos Relacionados ao Uso de Cocaína/metabolismo , Condicionamento Psicológico/efeitos dos fármacos , Condicionamento Psicológico/fisiologia , Depressão/metabolismo , Modelos Animais de Doenças , Estudos de Associação Genética , Humanos , Masculino , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Atividade Motora/efeitos dos fármacos , Atividade Motora/fisiologia , Núcleo Accumbens/efeitos dos fármacos , Densidade Pós-Sináptica/efeitos dos fármacos , Densidade Pós-Sináptica/metabolismo , Receptores de AMPA/metabolismo , Comportamento Social , Área Tegmentar Ventral/efeitos dos fármacos
10.
Dis Esophagus ; 30(11): 1-8, 2017 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-28881905

RESUMO

The treatment of esophageal perforation (EP) remains a significant clinical challenge. While a number of investigators have previously documented efficient approaches, these were mostly single-center experiences reported prior to the introduction of newer technologies: specifically endoluminal stents. This study was designed to document contemporary practice in the diagnosis and management of EP at multiple institutions around the world and includes early clinical outcomes. A five-year (2009-2013) multicenter retrospective review of management and outcomes for patients with thoracic or abdominal esophageal perforation was conducted. Demographics, etiology, diagnostic modalities, treatments, subsequent early outcomes as well as morbidity and mortality were captured and analyzed. During the study period, 199 patients from 10 centers in the United States, Canada, and Europe were identified. Mechanisms of perforation included Boerhaave syndrome (60, 30.1%), iatrogenic injury (65, 32.6%), and penetrating trauma (25, 12.6%). Perforation was isolated to the thoracic segment alone in 124 (62.3%), with 62 (31.2%) involving the thoracoabdominal esophagus. Mean perforation length was 2.5 cm. Observation was selected as initial management in 65 (32.7%), with only two failures. Direct operative intervention was initial management in 65 patients (32.6%), while 29 (14.6%) underwent esophageal stent coverage. Compared to operative intervention, esophageal stent patients were significantly more likely to be older (61.3 vs. 48.3 years old, P < 0.001) and have sustained iatrogenic mechanisms of esophageal perforation (48.3% vs.15.4%). Secondary intervention requirement for patients with perforation was 33.7% overall (66). Complications included sepsis (56, 28.1%), pneumonia (34, 17.1%) and multi-organ failure (23, 11.6%). Overall mortality was 15.1% (30). In contemporary practice, diagnostic and management approaches to esophageal perforation vary widely. Despite the introduction of endoluminal strategies, it continues to carry a high risk of mortality, morbidity, and need for secondary intervention. A concerted multi-institutional, prospectively collected database is ideal for further investigation.


Assuntos
Perfuração Esofágica/cirurgia , Esofagoscopia/métodos , Adulto , Idoso , Canadá , Perfuração Esofágica/etiologia , Esofagoscopia/efeitos adversos , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Stents , Resultado do Tratamento , Estados Unidos
11.
Acta Orthop Belg ; 82(2): 491-196, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-29119889

RESUMO

The ACCIS hip system has been marketed with a unique bearing surface which the manufacturers claim to reduce wear below the level of other MoM bearings and consequently less metal ion release. The cobalt-chrome-molybdenum alloy is heat treated to reduce the number and size of block carbides and the surface is modified with titanium-niobium-nitride to create a ceramic-like surface. We present our experience with ACCIS. 148 surgical procedures were carried out in 126 patients using the ACCIS hip resurfacing (77) or large head MOM total hip replacement(71). Patients were followed up with regular clinical and radiological assessment. In addition, metal ion levels were obtained. There have been 27 revision procedures carried out for a variety of indications with a current revision rate of 18%. Seven failures could not be attributed to the prosthesis itself, still leaving a failure rate of 13.5%. The mean survival time of these is 33 months, ranging from 1 to 72 months. 13 revisions were -performed for pain and revision demonstrated poor cup integration. 7 were revised because of high ion levels but this was patient choice despite remaining asymptomatic. Whilst the testing phases indicated benefits in wear characteristics, this is not apparent in our group. We have demonstrated an unacceptably high revision rate due to unknown causes and have ceased implanting the ACCIS.


Assuntos
Prótese de Quadril , Próteses Articulares Metal-Metal , Falha de Prótese , Artroplastia de Quadril , Humanos , Metais , Desenho de Prótese , Reoperação
12.
Cytotherapy ; 16(8): 1048-58, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24726657

RESUMO

BACKGROUND: The use of bone marrow-derived mesenchymal stromal cells (MSCs) as a cellular therapy for various diseases, such as graft-versus-host disease, diabetes, ischemic cardiomyopathy and Crohn's disease, has produced promising results in early-phase clinical trials. However, for widespread application and use in later phase studies, manufacture of these cells must be cost-effective, safe and reproducible. Current methods of manufacturing in flasks or cell factories are labor-intensive, involve a large number of open procedures and require prolonged culture times. METHODS: We evaluated the Quantum Cell Expansion System for the expansion of large numbers of MSCs from unprocessed bone marrow in a functionally closed system and compared the results with a flask-based method currently in clinical trials. RESULTS: After only two passages, we were able to expand a mean of 6.6 × 10(8) MSCs from 25 mL of bone marrow reproducibly. The mean expansion time was 21 days, and cells obtained were able to differentiate into all three lineages: chondrocytes, osteoblasts and adipocytes. The Quantum was able to generate the target cell number of 2.0 × 10(8) cells in an average of 9 fewer days and in half the number of passages required during flask-based expansion. We estimated that the Quantum would involve 133 open procedures versus 54,400 in flasks when manufacturing for a clinical trial. Quantum-expanded MSCs infused into an ischemic stroke rat model were therapeutically active. CONCLUSIONS: The Quantum is a novel method of generating high numbers of MSCs in less time and at lower passages when compared with flasks. In the Quantum, the risk of contamination is substantially reduced because of the substantial decrease in open procedures.


Assuntos
Células da Medula Óssea/citologia , Técnicas de Cultura de Células , Terapia Baseada em Transplante de Células e Tecidos , Células-Tronco Mesenquimais/citologia , Animais , Reatores Biológicos , Diferenciação Celular/genética , Linhagem da Célula , Humanos , Transplante de Células-Tronco Mesenquimais , Ratos
13.
J Orthop Trauma ; 38(10): 571-575, 2024 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-39325055

RESUMO

OBJECTIVES: Does marijuana smoking increase the risk of surgical site infection (SSI) after open reduction and internal fixation of fractures? DESIGN: Retrospective. SETTING: Single academic level 1 trauma center in Southern California. PATIENT SELECTION CRITERIA: Adult patients who underwent open treatment for closed fractures between January 2009 and December 2021, had hardware placed, and had at least 6 months of postoperative follow-up. OUTCOME MEASURES AND COMPARISONS: Risk factors associated with the development of SSI were compared between current inhalational marijuana users and nonmarijuana users. RESULTS: Complete data were available on 4802 patients after exclusion of 82 who did not have a complete variable set. At the time of surgery, 24% (1133 patients) were current users of marijuana. At the final follow-up (minimum 6 months), there was a 1.6% infection rate (75 patients). The average age of the infection-free group was 46.1 ± 23.1 years, and the average age of the SSI group was 47.0 ± 20.3 (P = 0.73) years. In total, 2703 patients (57%) in the infection-free group were male compared with 48 (64%) in the SSI group (P = 0.49). On multivariate analysis, longer operative times (OR 1.002 [95% CI, 1.001-1.004]), diabetic status (OR 2.084 [95% CI, 1.225-3.547]), and current tobacco use (OR 2.493 [95% CI, 1.514-4.106]) (P < 0.01 for all) were associated with an increased risk of SSI; however, current marijuana use was not (OR 0.678 [95% CI, 0.228-2.013], P = 0.48). CONCLUSIONS: Tobacco use, diabetes, and longer operative times were associated with the development of SSI after open reduction and internal fixation of fractures; however, marijuana smoking was not shown to be associated with the development of SSI. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fixação Interna de Fraturas , Fumar Maconha , Infecção da Ferida Cirúrgica , Humanos , Masculino , Estudos Retrospectivos , Feminino , Infecção da Ferida Cirúrgica/epidemiologia , Pessoa de Meia-Idade , Fumar Maconha/efeitos adversos , Fumar Maconha/epidemiologia , Adulto , Fatores de Risco , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , California/epidemiologia , Redução Aberta , Estudos de Coortes
14.
JBJS Case Connect ; 14(3)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-39186576

RESUMO

CASE: We present a case of a 39-year-old woman at 23 weeks gestation who sustained traumatic both-column acetabular fracture and protrusio acetabuli, managed with initial traction and delayed total hip arthroplasty (THA) until after cesarean section delivery. CONCLUSION: Initial skeletal traction with subsequent delayed THA may be a viable treatment option in select pregnant female patients who sustain both-column acetabular fractures. Interdisciplinary collaboration is necessary to optimize maternal-fetal health and provide patient education of procedural risk to enable informed decision making.


Assuntos
Acetábulo , Fraturas Ósseas , Humanos , Feminino , Gravidez , Adulto , Acetábulo/lesões , Acetábulo/cirurgia , Fraturas Ósseas/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Artroplastia de Quadril , Cesárea , Tração/métodos , Complicações na Gravidez/cirurgia , Complicações na Gravidez/terapia
15.
Artigo em Inglês | MEDLINE | ID: mdl-38833726

RESUMO

INTRODUCTION: Hip fractures are life-changing injuries with associated one-year mortality up to 30%. Five locations in the world have been termed "blue zones," where the longevity of the population is markedly higher than that of surrounding areas and there are 10 times more centenarians. The United States has one blue zone (Loma Linda, California), which is believed to be because of the lifestyle of the Seventh-day Adventist population living there. We hypothesized that patients from the blue zone experience low-energy, frailty-driven, osteoporotic hip fractures later in life and an increased postinjury longevity relative to non-blue zone control subjects. METHODS: A review of patients treated for hip fracture between January 2010 and August 2020 from a single institution was conducted. Demographic data were collected, and the end point of mortality was assessed using death registry information, queried in April 2024. Groups were divided into blue zone and non-blue zone. Statistical analysis was conducted with P < 0.05 considered significant. RESULTS: Complete data were available for 1,032 patients. The blue zone cohort sustained low-energy hip fractures 12 years later in life (83.2 versus 71.1, P < 0.01). Propensity score matching was used to account for this difference. After propensity score matching, age, body mass index, American Society of Anesthesiologists score, surgery performed, sex, mechanism, ethnicity, diabetes, chronic obstructive pulmonary disease, CHF, chronic kidney disease grade, dementia, surgical time, and drug/tobacco/marijuana use were similar between groups. Blue zone patients had lower mortality at both 1 and 2 years postoperatively (12% versus 24%, P = 0.03 and 20% versus 33%, P = 0.03, respectively), had more hypertension (76% versus 62%, P = 0.03), reported lower alcohol use (7% versus 20%, P < 0.01), and included more Seventh-day Adventists (64% versus 15%, P < 0.01). CONCLUSION: The blue zone lifestyle affected the onset of frailty and delayed osteoporotic hip fracture by 12 years in this propensity-matched cohort study. Postoperative mortality was also markedly lower in the blue zone cohort.

16.
bioRxiv ; 2023 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-36993453

RESUMO

Free-choice paradigms such as two-bottle choice (2BC) are commonly used to characterize ethanol consumption and preference of rodent models used to study alcohol use disorder (AUD). However, these assays are limited by low temporal resolution that misses finer patterns of drinking behavior, including circadian drinking patterns that are known to vary with age and sex and are affected in AUD pathogenesis. Modern, cost-effective tools are becoming widely available that could elucidate these patterns, including open-source, Arduino-based home-cage sipper devices. We hypothesized that adaptation of these home-cage sipper devices would uncover distinct age- and sex-related differences in temporal drinking patterns. To test this hypothesis, we used the sipper devices in a continuous 2BC paradigm using water and ethanol (10%; v/v) for 14 days to measure drinking patterns of male and female adolescent (3-week), young adult (6-week), and mature adult (18-week) C57BL/6J mice. Daily grams of fluid consumption were manually recorded at the beginning of the dark cycle, while home-cage sipper devices continuously recorded the number of sips. Consistent with prior studies, females consumed more ethanol than males, and adolescent mice consumed the most out of any age group. Correlation analyses of manually recorded fluid consumption versus home-cage sipper activity revealed a statistically significant prediction of fluid consumption across all experimental groups. Sipper activity was able to capture subtle circadian differences between experimental groups, as well as distinct individual variation in drinking behavior among animals. Blood ethanol concentrations were significantly correlated with sipper data, suggesting that home-cage sipper devices can accurately determine individual timing of ethanol consumption. Overall, our studies show that augmenting the 2BC drinking paradigm with automated home-cage sipper devices can accurately measure ethanol consumption across sexes and age groups, revealing individual differences and temporal patterns of ethanol drinking behavior. Future studies utilizing these home-cage sipper devices will further dissect circadian patterns for age and sex relevant to the pathogenesis of AUD, as well as underlying molecular mechanisms for patterns in ethanol consumption. Highlights: Female mice consume more ethanol than males in a continuous access paradigmAdolescent male and female mice consume more ethanol than young or mature adult miceAutomated home-cage sipper devices accurately measure ethanol consumptionDevices reveal sex- and age-dependent differences in circadian drinking patternsDevices reveal distinct individual variation in circadian drinking patterns.

17.
Ir J Psychol Med ; 40(2): 254-261, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-33272340

RESUMO

BACKGROUND: Attention-deficit/Hyperactivity Disorder (ADHD) is the single most frequent reason for attendance at Child and Adolescent Mental Health Services (CAMHS) in Ireland. Research has suggested that parents of children with ADHD experience more parenting stress than parents of non-clinical controls, yet routine treatment for ADHD rarely addresses parental well-being. Mindfulness-based interventions (MBIs) have been found to result in a reduction in parental stress. METHOD: An adapted Mindfulness-Based Stress Reduction (MBSR) intervention was delivered to parents (n = 23) of children with ADHD recruited from CAMHS and ADHD Ireland. RESULTS: Following the intervention a significant improvement was documented within the social relationships domain of quality of life (WHOQOL-BREF) and a significant reduction on the child hyperactivity scale of the Strengths and Difficulties (SDQ) questionnaire. CONCLUSION: This pilot study suggests that an MBSR intervention is both feasible and effective for parents whose children have ADHD. Larger scale studies need to be conducted before inclusion in routine CAMHS.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Atenção Plena , Adolescente , Criança , Humanos , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Estudos de Viabilidade , Projetos Piloto , Qualidade de Vida , Pais/psicologia
18.
Environ Sci Process Impacts ; 25(6): 1049-1066, 2023 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-37232758

RESUMO

Wildfire activity is increasing in the continental U.S. and can be linked to climate change effects, including rising temperatures and more frequent drought conditions. Wildfire emissions and large fire frequency have increased in the western U.S., impacting human health and ecosystems. We linked 15 years (2006-2020) of particulate matter (PM2.5) chemical speciation data with smoke plume analysis to identify PM2.5-associated nutrients elevated in air samples on smoke-impacted days. Most macro- and micro-nutrients analyzed (phosphorus, calcium, potassium, sodium, silicon, aluminum, iron, manganese, and magnesium) were significantly elevated on smoke days across all years analyzed. The largest percent increase was observed for phosphorus. With the exception of ammonium, all other nutrients (nitrate, copper, and zinc), although not statistically significant, had higher median values across all years on smoke vs. non-smoke days. Not surprisingly, there was high variation between smoke impacted days, with some nutrients episodically elevated >10 000% during select fire events. Beyond nutrients, we also explored instances where algal blooms occurred in multiple lakes downwind from high-nutrient fires. In these cases, remotely sensed cyanobacteria indices in downwind lakes increased two to seven days following the occurrence of wildfire smoke above the lake. This suggests that elevated nutrients in wildfire smoke may contribute to downwind algal blooms. Since cyanobacteria blooms can be associated with the production of cyanotoxins and wildfire activity is increasing due to climate change, this finding has implications for drinking water reservoirs in the western United States, and for lake ecology, particularly alpine lakes with otherwise limited nutrient inputs.


Assuntos
Poluentes Atmosféricos , Incêndios Florestais , Humanos , Estados Unidos , Poluentes Atmosféricos/análise , Ecossistema , Material Particulado/análise , Fumaça/análise
19.
Opt Express ; 20(16): 17393-401, 2012 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-23038292

RESUMO

Optical fibers have become ubiquitous tools for the creation, propagation, manipulation, and detection of light. However, while the intensity of light propagating through the fiber can increase or decrease along the length through amplification or attenuation, respectively, the properties of the fiber itself generally do not, thus removing an opportunity to further control the behavior of light and performance of fiber-based devices. Shown here are optical fibers that exhibit significant changes in their longitudinal optical properties, specifically a tailored longitudinal numerical aperture change of about 12% over less than 20 meters of length. This is about 1900 times greater than previously reported. The Brillouin gain coefficient was found to decrease by over 6 dB relative to a standard commercial single mode fiber. Next generation analogs are expected to exhibit more than a 10 dB reduction in SBS gain using larger, yet still reasonably manufacturable gradients over practical lengths.

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