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International societies have conflicting recommendations on whether bone marrow aspirate/biopsy (BMB) is needed during workup for isolated thrombocytopenia. Our objective was to determine if thrombocytopenia in patients aged ≥60 years is associated with an increased incidence of haematological malignancy. We performed a retrospective population-based cohort study in patients aged ≥60 years between January 1, 2009 to December 31, 2019. Exposed patients had specialist consultation for thrombocytopenia, with platelet count <100 × 109/L, but normal haemoglobin and white blood cell count. Unexposed patients were those who never had specialist consultation for thrombocytopenia and whose platelets were ≥100 × 109/L. The primary outcome was the diagnosis of haematological malignancy using a competing risk of death model. During 4.0 years (IQR 2.2-6.7) of follow-up, 378/4930 exposed (19.1/1000PY, 95% CI 17.1-21.0), and 204/17556 unexposed patients (2.5/1000PY, 95% CI 2.2-2.8) were diagnosed with haematological malignancy (HR 15.5 (95% CI 11.3-21.4, p < 0.0001) in year 1, and 5.3 (95% CI 4.4-6.6, p < 0.0001) in years 2+). This finding persisted in analyses stratified by sex, age, severity, or duration of thrombocytopenia, and treatment with corticosteroids within 2 weeks of consultation. This study found a strong association between isolated thrombocytopenia and haematological malignancy in patients ≥60 years, supporting consideration of diagnostic testing including BMB during outpatient specialist consultation.
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Tight relationships exist in the local Universe between the central stellar properties of galaxies and the mass of their supermassive black hole (SMBH)1-3. These suggest that galaxies and black holes co-evolve, with the main regulation mechanism being energetic feedback from accretion onto the black hole during its quasar phase4-6. A crucial question is how the relationship between black holes and galaxies evolves with time; a key epoch to examine this relationship is at the peaks of star formation and black hole growth 8-12 billion years ago (redshifts 1-3)7. Here we report a dynamical measurement of the mass of the black hole in a luminous quasar at a redshift of 2, with a look back in time of 11 billion years, by spatially resolving the broad-line region (BLR). We detect a 40-µas (0.31-pc) spatial offset between the red and blue photocentres of the Hα line that traces the velocity gradient of a rotating BLR. The flux and differential phase spectra are well reproduced by a thick, moderately inclined disk of gas clouds within the sphere of influence of a central black hole with a mass of 3.2 × 108 solar masses. Molecular gas data reveal a dynamical mass for the host galaxy of 6 × 1011 solar masses, which indicates an undermassive black hole accreting at a super-Eddington rate. This suggests a host galaxy that grew faster than the SMBH, indicating a delay between galaxy and black hole formation for some systems.
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Extracellular DNA (eDNA) is a major component of bacterial biofilms. In this study, we performed a three-dimensional analysis of Leptospira biofilm using advanced imaging by confocal laser scanning microscopy (CLSM) and multi-parameter analysis by COMSTAT 2 software, with quantification of Leptospira and eDNA fluorescence. To investigate the role of eDNA in Leptospira biofilm, we treated Leptospira biflexa biofilms with DNase I enzyme (DNase), which digested eDNA, and compared DNase treated biofilms and controls. There was a significant reduction of the biomass of biofilms treated with DNase, by spectrophotometry and COMSTAT analysis. The multiparameter analysis evidenced for DNase-treated biofilms a significant decrease in the surface area and the average thickness; opposing to a significant augmentation of the surface/biovolume ratio and the roughness coefficient (Ra*), when compared to controls. We analyzed the parameters of DNase-treated biofilms by Pearson's correlation coefficient and found significant positive correlations between biomass and average thickness; biomass and surface area; surface area and average thickness. On the other hand, there were significant negative correlations between Ra* and biomass; Ra* and average thickness; Ra* and surface area. These findings suggest that eDNA digestion results in biofilm instability and alteration of the three-dimensional architecture, justifying the negative correlation between Ra* and the above-mentioned parameters. In conclusion, our study showed that eDNA digestion produced a massive structural loss, instability, and dramatic changes in the three-dimensional architecture of Leptospira biflexa biofilm. These findings contribute to a better understanding of the role of eDNA and highlight the importance of eDNA as a key component in Leptospira biofilms.
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An integrated biological effects study using field transplanted mussels was applied to determine the potential biological effects of an effluent discharge from an aluminium smelter into a Norwegian fjord. Chemical body burden and biological effects were measured in mussels positioned downstream (1, 2, 5, 10 and 20 km) from the aluminium smelters discharge for a period of 6 weeks. A suite of biomarkers, from whole organism to subcellular responses were measured. Chemical concentrations in mussel tissues were low; however, a change in the PAC (polyaromatic compound) profile from high to low pyrogenic influence provided evidence of exposure to the smelter's effluent. Overall, the biological responses observed where greater in the mussels positioned closest to the smelter (1-5 km). Lowest chemical accumulation and biomarker responses were observed in mussels positioned 10 km from the smelter and were considered as the reference field population. Mussels located furthest from the smelter (20 km) exhibited significant biomarker responses and suggested a different contaminant source within the fjord. The integrated biological response index (IBR) was applied and reflected the expected level of exposure to the smelters discharge, with highest IBR calculated in mussels positioned closest to the discharge (1-5 km). Principal component analysis (PCA) also differentiated among mussel groups, with the most impacted located closest to the smelter. Not one chemical factor could explain the biological responses observed in mussels, but the presence of PAH16, PAH41 and metals Mn, Ni and Cr were the main contributors measured to the higher stress seen in the mussels from the 1 and 5 km groups.
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Bivalves , Poluentes Químicos da Água , Animais , Água/análise , Alumínio/análise , Poluentes Químicos da Água/análise , Monitoramento Ambiental , Bivalves/química , Biomarcadores/análiseRESUMO
Abstract This study estimated the length-weight relationships of 16 fish species occurring close to the shores of sandy beaches along the lower Negro River basin, Brazilian Amazon. The specimens were captured for one day each month, in October to November 2016, early in the morning and early evening, using trawl net (20 m taken for standard length (SL - 0.1 cm precision) and total weight (TW - 0.01 g precision). The parameters a and b of the equation WT = a.LTb were estimated. The a values ranged from 0.0018 to 0.0226 and b values ranged from 2.5271 to 3.3244. This study also provides new data on of maximum lengths for six species, Amazonsprattus scintilla, Brycon pesu, Moenkhausia megalops, Pachyurus paucirastrus, Reganella depressa and Trachydoras microstomus, and new reports of the LWRs parameters of 15 fish species.
Resumo Este estudo estimou as relações comprimento-peso de 16 espécies de peixes que ocorrem às margens de praias arenosas ao longo da bacia do baixo Rio Negro, Amazônia brasileira. As espécies foram capturadas durante um dia de cada mês, de outubro a novembro de 2016, no início da manhã e no início da noite, usando rede de cerco (20 m de comprimento e 3,5 m de altura, 5 malha mm entre nós opostos). As medidas foram feitas para comprimento padrão (SL - precisão de 0,1 cm) e peso total (TW - precisão de 0,01 g). Os parâmetros a e b da equação WT = a.LTb foram estimados. Os valores de a variaram de 0,0018 a 0,0226 e os valores de b variaram de 2,5271 a 3,3244. Este estudo também fornece novos dados sobre comprimentos máximos para seis espécies, Amazonsprattus scintilla, Brycon pesu, Moenkhausia megalops, Pachyurus paucirastrus, Reganella depressa e Trachydoras microstomus, e novos reportes dos parâmetros da LWRs de 15 espécies de peixes.
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Animais , Perciformes , Caraciformes , Characidae , Brasil , RiosRESUMO
Abstract This study estimated the lengthweight relationships of 16 fish species occurring close to the shores of sandy beaches along the lower Negro River basin, Brazilian Amazon. The specimens were captured for one day each month, in October to November 2016, early in the morning and early evening, using trawl net (20 m taken for standard length (SL 0.1 cm precision) and total weight (TW 0.01 g precision). The parameters a and b of the equation WT = a.LTb were estimated. The a values ranged from 0.0018 to 0.0226 and b values ranged from 2.5271 to 3.3244. This study also provides new data on of maximum lengths for six species, Amazonsprattus scintilla, Brycon pesu, Moenkhausia megalops, Pachyurus paucirastrus, Reganella depressa and Trachydoras microstomus, and new reports of the LWRs parameters of 15 fish species.
Resumo Este estudo estimou as relações comprimento-peso de 16 espécies de peixes que ocorrem às margens de praias arenosas ao longo da bacia do baixo Rio Negro, Amazônia brasileira. As espécies foram capturadas durante um dia de cada mês, de outubro a novembro de 2016, no início da manhã e no início da noite, usando rede de cerco (20 m de comprimento e 3,5 m de altura, 5 malha mm entre nós opostos). As medidas foram feitas para comprimento padrão (SL - precisão de 0,1 cm) e peso total (TW - precisão de 0,01 g). Os parâmetros a e b da equação WT = a.LTb foram estimados. Os valores de a variaram de 0,0018 a 0,0226 e os valores de b variaram de 2,5271 a 3,3244. Este estudo também fornece novos dados sobre comprimentos máximos para seis espécies, Amazonsprattus scintilla, Brycon pesu, Moenkhausia megalops, Pachyurus paucirastrus, Reganella depressa e Trachydoras microstomus, e novos reportes dos parâmetros da LWRs de 15 espécies de peixes.
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This study estimated the lengthweight relationships of 16 fish species occurring close to the shores of sandy beaches along the lower Negro River basin, Brazilian Amazon. The specimens were captured for one day each month, in October to November 2016, early in the morning and early evening, using trawl net (20 m length and 3.5 m height, 5 mm mesh between opposite knots). Measurements were taken for standard length (SL 0.1 cm precision) and total weight (TW 0.01 g precision). The parameters a and b of the equation WT = a.LTb were estimated. The a values ranged from 0.0018 to 0.0226 and b values ranged from 2.5271 to 3.3244. This study also provides new data on of maximum lengths for six species, Amazonsprattus scintilla, Brycon pesu, Moenkhausia megalops, Pachyurus paucirastrus, Reganella depressa and Trachydoras microstomus, and new reports of the LWRs parameters of 15 fish species.
Este estudo estimou as relações comprimento-peso de 16 espécies de peixes que ocorrem às margens de praias arenosas ao longo da bacia do baixo Rio Negro, Amazônia brasileira. As espécies foram capturadas durante um dia de cada mês, de outubro a novembro de 2016, no início da manhã e no início da noite, usando rede de cerco (20 m de comprimento e 3,5 m de altura, 5 malha mm entre nós opostos). As medidas foram feitas para comprimento padrão (SL - precisão de 0,1 cm) e peso total (TW - precisão de 0,01 g). Os parâmetros a e b da equação WT = a.LTb foram estimados. Os valores de a variaram de 0,0018 a 0,0226 e os valores de b variaram de 2,5271 a 3,3244. Este estudo também fornece novos dados sobre comprimentos máximos para seis espécies, Amazonsprattus scintilla, Brycon pesu, Moenkhausia megalops, Pachyurus paucirastrus, Reganella depressa e Trachydoras microstomus, e novos reportes dos parâmetros da LWRs de 15 espécies de peixes.
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Animais , Peixes/anatomia & histologia , Peixes/crescimento & desenvolvimentoRESUMO
Despite their crucial role in health and disease, our knowledge of immune cells within human tissues remains limited. We surveyed the immune compartment of 16 tissues from 12 adult donors by single-cell RNA sequencing and VDJ sequencing generating a dataset of ~360,000 cells. To systematically resolve immune cell heterogeneity across tissues, we developed CellTypist, a machine learning tool for rapid and precise cell type annotation. Using this approach, combined with detailed curation, we determined the tissue distribution of finely phenotyped immune cell types, revealing hitherto unappreciated tissue-specific features and clonal architecture of T and B cells. Our multitissue approach lays the foundation for identifying highly resolved immune cell types by leveraging a common reference dataset, tissue-integrated expression analysis, and antigen receptor sequencing.
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Linfócitos B , Aprendizado de Máquina , Análise de Sequência de RNA , Análise de Célula Única , Linfócitos T , Transcriptoma , Células Cultivadas , Humanos , Especificidade de ÓrgãosRESUMO
OBJECTIVE: To compare the odds of early and prolonged post-operative opioid use in patients undergoing minimally invasive surgery (MIS) vs open surgery for nephrectomy. METHODS: For opioid-naïve patients in Ontario who underwent nephrectomy for kidney cancer (1994-2017, n = 7900), post-discharge opioid use was determined by prescriptions in the Ontario Drug Benefit database (age ≥65 years) and the Narcotics Monitoring System (all patients from 2012). Early opioid use was defined as ≥1 prescription 1-90 days after surgery. Two separate definitions of prolonged opioid use were examined: (1) prescription(s) for ≥60 days during post-operative days 90-365; (2) ≥1 prescriptions between both of: 1-90 days AND 91-180 days after surgery. Predictors of opioid use were assessed using multivariable generalized estimating equation logistic regression, accounting for surgeon clustering. RESULTS: Overall, 67.4% of patients received early opioid prescriptions; however, prolonged use was low, ranging from 1.6 to 4.4% of patients depending on the definition. In multivariable analysis, open nephrectomy was associated with higher odds of early opioid use compared to MIS nephrectomy (Odds Ratio [OR] 1.36, 95% Confidence Interval [CI] 1.19-1.55). Surgery type was not significantly associated with prolonged opioid use for either definition (OR 1.22, CI 0.79-1.89 and OR 1.06, CI 0.83-1.35). CONCLUSIONS: In this population-level study of patients undergoing nephrectomy for kidney cancer, patients who received open surgery were at increased odds of receiving early post-operative opioids compared to MIS. Prolonged opioid use was low overall and was not significantly with associated with type of surgery.
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Neoplasias Renais , Transtornos Relacionados ao Uso de Opioides , Assistência ao Convalescente , Idoso , Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos , Humanos , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/cirurgia , Nefrectomia , Ontário/epidemiologia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Alta do Paciente , Estudos Retrospectivos , Fatores de RiscoRESUMO
INTRODUCTION: Ankle fractures are among the most common injuries treated by orthopaedic surgeons. Malunion is one of the possible complications, and corrective surgery is often used to avoid long-term disability. However, few studies address medial malleolus malunion and the best revision surgery technique is controversial. We describe a new surgical technique, the "box resection". MATERIAL AND METHODS: We present two cases of medial malleolus malunion with secondary talus lateral translation and syndesmotic incongruence. In order to restore a congruent tibiotalar joint, we performed the described technique. RESULTS: We record significant improvement of AOFAS Score and range of motion in both cases, with resolution of pain symptoms. Postoperative radiographs show a congruent mortise with syndesmosis reduction. CONCLUSION: The box resection allowed immediate talus medial translation to its original position. It is a simple and effective solution, with a good functional outcome.
INTRODUCCIÓN: La consolidación viciosa del maléolo interno es una posible complicación en las fracturas maleolares. Su tratamiento es difícil y controvertido, por el momento no hay una solución estándar. Proponemos una nueva técnica quirúrgica para el tratamiento de estos casos que denominamos "resección en caja". MATERIAL Y MÉTODOS: Presentamos dos casos de consolidación viciosa del maléolo interno, asociados con traslación lateral del astrágalo y incongruencia de la sindesmosis, donde aplicamos la técnica quirúrgica descrita. RESULTADOS: En ambos casos, obtuvimos una mejora significativa en el puntaje AOFAS y en el rango de movilidad, así como en la resolución de las molestias por dolor. Las radiografías muestran mortajas congruentes y anatómicas, con una reducción satisfactoria de la sindesmosis. CONCLUSIÓN: La técnica de "resección en caja" es simple y eficaz produciendo un buen resultado clínico y funcional.
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Fraturas do Tornozelo , Traumatismos do Tornozelo , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Fixação Interna de Fraturas , Humanos , Tíbia , Resultado do TratamentoRESUMO
This study estimated the length-weight relationships of 16 fish species occurring close to the shores of sandy beaches along the lower Negro River basin, Brazilian Amazon. The specimens were captured for one day each month, in October to November 2016, early in the morning and early evening, using trawl net (20 m taken for standard length (SL - 0.1 cm precision) and total weight (TW - 0.01 g precision). The parameters a and b of the equation WT = a.LTb were estimated. The a values ranged from 0.0018 to 0.0226 and b values ranged from 2.5271 to 3.3244. This study also provides new data on of maximum lengths for six species, Amazonsprattus scintilla, Brycon pesu, Moenkhausia megalops, Pachyurus paucirastrus, Reganella depressa and Trachydoras microstomus, and new reports of the LWRs parameters of 15 fish species.
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Characidae , Caraciformes , Perciformes , Animais , Brasil , RiosRESUMO
Abstract: Introduction: Ankle fractures are among the most common injuries treated by orthopaedic surgeons. Malunion is one of the possible complications, and corrective surgery is often used to avoid long-term disability. However, few studies address medial malleolus malunion and the best revision surgery technique is controversial. We describe a new surgical technique, the «box resection¼. Material and methods: We present two cases of medial malleolus malunion with secondary talus lateral translation and syndesmotic incongruence. In order to restore a congruent tibiotalar joint, we performed the described technique. Results: We record significant improvement of AOFAS Score and range of motion in both cases, with resolution of pain symptoms. Postoperative radiographs show a congruent mortise with syndesmosis reduction. Conclusion: The box resection allowed immediate talus medial translation to its original position. It is a simple and effective solution, with a good functional outcome.
Resumen: Introducción: La consolidación viciosa del maléolo interno es una posible complicación en las fracturas maleolares. Su tratamiento es difícil y controvertido, por el momento no hay una solución estándar. Proponemos una nueva técnica quirúrgica para el tratamiento de estos casos que denominamos «resección en caja¼. Material y métodos: Presentamos dos casos de consolidación viciosa del maléolo interno, asociados con traslación lateral del astrágalo y incongruencia de la sindesmosis, donde aplicamos la técnica quirúrgica descrita. Resultados: En ambos casos, obtuvimos una mejora significativa en el puntaje AOFAS y en el rango de movilidad, así como en la resolución de las molestias por dolor. Las radiografías muestran mortajas congruentes y anatómicas, con una reducción satisfactoria de la sindesmosis. Conclusión: La técnica de «resección en caja¼ es simple y eficaz produciendo un buen resultado clínico y funcional.
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BACKGROUND: Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F) score is frequently used for screening the sarcopenia risk in older people. However, the agreement between SARC-F and loss of ultrasound-derived muscle thickness in hospitalized older cancer patients is unexplored. OBJECTIVE: The primary objective was to evaluate the relationship between the SARC-F score and ultrasound-derived muscle thickness of rectus femoris and vastus intermedius in older hospitalised cancer patients. The secondary objective was to identify the presence of sarcopenia. MEASUREMENTS: A cross-sectional study enrolled forty-one older hospitalised cancer patients ongoing chemotherapy or surgical treatment. Body weight (kg) was measured using a digital scale and height using a portable stadiometer to assess body mass index. SARC-F was performed to assess and classify sarcopenia risk (with (SARC-F: ≥4), without (SARC-F: <4). US-derived muscle thickness of rectus femoris and vastus intermedius was assessed using a portable ultrasound. Relationship between the SARC-F and muscle thickness was tested using Pearson´s correlation and Bland-Altman analyses. RESULTS: Approximately, 46.3% of the patients presented sarcopenia and a lower non-significant muscle thickness of rectus femoris and vastus intermedius (SARC-F ≥4: 18.54±6.28 vs. SARC-F <4: 22.22±9.16 mm, p=0.07). There was a moderate negative correlation between SARC-F and muscle thickness (r=-0.40, p=0.004). Additionally, Bland-Altman plots no found systematic bias risk between SARC-F and ultrasound-derived muscle thickness. CONCLUSIONS: Approximately, 46.3% of older hospitalized cancer patients presented sarcopenia. Additionally, we found a moderate inverse correlation and no systematic bias risk between SARC-F and ultrasound-measured muscle thickness.
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Sarcopenia/diagnóstico , Coxa da Perna/diagnóstico por imagem , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
Estudio anatómico descriptivo de las diferentes vías de abordaje de astrágalo, con documentación fotográfica, utilizando técnica en 3 dimensiones. Este estudio tiene como objetivo evaluar puntos de referencia macroscópicos, planos anatómicos, estructuras en riesgo, campo de visualización y posible aplicabilidad de cada vía de abordaje para ayudar a la toma de decisiones en el momento de la planificación quirúrgica ante una fractura de astrágalo. Dieciocho especímenes frescos y 2 inyecciones con látex en la arteria poplítea fueron estudiados realizando 2 veces cada vía de abordaje con documentación fotográfica. Este estudio propone la necesidad de realizar una correcta planificación prequirúrgica para elegir la mejor vía de abordaje en cada caso y la importancia de realizar, en la gran mayoría de casos, la vía combinada para conseguir una reducción correcta
Descriptive anatomical study of the different surgical approaches to the talus with photographic documentation using a 3-dimensional technique. The objective of this study is to evaluate macroscopic reference points, anatomical planes, structures at risk, field of visualization and possible applicability of each approach to help decision-making at the time of surgical planning in the event of a fracture of the talus. Eighteen fresh specimens and two specimens injected with black latex through the popliteal artery were dissected, performing each surgical approach twice with photographic documentation. This study highlights the need for correct pre-surgical planning to choose the best approach in each case and the importance of a combined approach in the vast majority of cases to achieve a correct reduction
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Humanos , Tálus/cirurgia , Ossos do Tarso/lesões , Fixação de Fratura/métodos , Procedimentos Ortopédicos/métodos , Tálus/anatomia & histologia , Tálus/lesões , Imageamento Tridimensional/métodos , Técnicas In Vitro/métodosRESUMO
PURPOSE: Despite the evidence on the role of gravity stress test to access the instability of other ankle injuries, there is limited literature regarding gravity stress on the lateral ankle ligament's insufficiency. The objective of our study was to objectively measure the tibiotalar angular movement under gravity stress after progressive sectioning of the lateral ankle ligaments. METHODS: We performed sequential sectioning of the anterior talofibular (ATFL), calcaneofibular (CFL), and posterior talofibular ligaments (PTFL) in twelve ankle specimens. Under gravity stress, we measured the angular movement of the talus in relation to the tibia. The measuring device is based on a three-axis gyroscope and accelerometer. RESULTS: Comparing to the intact condition, the plantar flexion increased on average 1.78° (95% confidence interval [CI] 1.15;2.42), 5.13° (95%CI 3.10;7.16) and 8.63° (95%CI 6.05;11.22), the rotation increased by 1.00° (95 CI -0.51;2.51), 3.68° (95%CI 1.97;5.40) and 15.62° (95%CI 10.09;21.14), and the varus increased 2.89° (95% CI 1.39, 4.39), 8.12° (95% CI 5.16, 11.07) and 11.68° (95% CI 7.91, 15.46), after sectioning the ATFL, CFL, and PTFL, respectively. The overall changes were statistically significant. CONCLUSIONS: There was a significant tibiotalar laxity after sectioning of lateral ankle ligaments when the foot position is influenced only by gravity. The tibiotalar angular displacement was significant when the CFL and PTFL were cut which suggests that the gravity test could be used to assess combined lateral ankle ligament injury. This evidence might be a step forward in the development of lateral ankle ligaments gravity stress tests. LEVEL OF EVIDENCE: 5 (cadaver study).
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Descriptive anatomical study of the different surgical approaches to the talus with photographic documentation using a 3-dimensional technique. The objective of this study is to evaluate macroscopic reference points, anatomical planes, structures at risk, field of visualization and possible applicability of each approach to help decision-making at the time of surgical planning in the event of a fracture of the talus. Eighteen fresh specimens and two specimens injected with black latex through the popliteal artery were dissected, performing each surgical approach twice with photographic documentation. This study highlights the need for correct pre-surgical planning to choose the best approach in each case and the importance of a combined approach in the vast majority of cases to achieve a correct reduction.