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1.
Med J (Ft Sam Houst Tex) ; (PB 8-21-07/08/09): 74-80, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34449865

RESUMO

INTRODUCTION: Emergency department (ED) utilization continues to climb nationwide resulting in overcrowding, increasing wait times, and a surge in patients with non-urgent conditions. Patients frequently choose the ED for apparent non-emergent medical issues or injuries that after-the-fact could be cared for in a primary care setting. We seek to better understand the reasons why patients choose the ED over their primary care managers. METHODS: We prospectively surveyed patients that signed into the ED at the Brooke Army Medical Center as an emergency severity index of 4 or 5 (non-emergent triage) regarding their visit. We then linked their survey data to their ED visit including interventions, diagnoses, diagnostics, and disposition by using their electronic medical record. We defined their visit to be non-urgent and more appropriate for primary care, or primary care eligible, if they were discharged home and received no computed tomography (CT) imaging, ultrasound, magnetic resonance imaging (MRI), intravenous (IV) medications, or intramuscular (IM) controlled substances. RESULTS: During the 2-month period, we collected data on 208 participants out of a total of 252 people offered a survey (82.5%). There were 92% (n=191) that were primary care eligible within our respondent pool. Most reported very good (38%) or excellent (21%) health at baseline. On survey assessing why they came, inability to get a timely appointment (n=73), and a self-reported emergency (n=58) were the most common reported reasons. Most would have utilized primary care if they had a next-morning appointment available (n=86), but many reported they would have utilized the ED regardless of primary care availability (n=77). The most common suggestion for improving access to care was more primary care appointment availability (n=96). X-rays were the most frequent study (37%) followed by laboratory studies (20%). Before coming to the ED, 38% (n=78) reported trying to contact their primary care for an appointment. Before coming to the ED, 22% (n=46) reported contacting the nurse advice line. Based on our predefined model, 92% (n=191) of our respondents were primary care eligible within our respondent pool. CONCLUSIONS: Patient perceptions of difficulty obtaining appointments appear to be a major component of the ED use for non-emergent visits. Within our dataset, most patients surveyed stated they had difficulty obtaining a timely appointment or self-reported as an emergency. Data suggests most patients surveyed could be managed in the primary care setting.


Assuntos
Serviço Hospitalar de Emergência , Triagem , Agendamento de Consultas , Acesso aos Serviços de Saúde , Humanos , Atenção Primária à Saúde
2.
Int J Mol Sci ; 22(13)2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34206635

RESUMO

White matter tract (WMT) degeneration has been reported to occur following a stroke, and it is associated with post-stroke functional disturbances. White matter pathology has been suggested to be an independent predictor of post-stroke recovery. However, the factors that influence WMT remodeling are poorly understood. Cortisol is a steroid hormone released in response to prolonged stress, and elevated levels of cortisol have been reported to interfere with brain recovery. The objective of this study was to investigate the influence of corticosterone (CORT; the rodent equivalent of cortisol) on WMT structure post-stroke. Photothrombotic stroke (or sham surgery) was induced in 8-week-old male C57BL/6 mice. At 72 h, mice were exposed to standard drinking water ± CORT (100 µg/mL). After two weeks of CORT administration, mice were euthanised and brain tissue collected for histological and biochemical analysis of WMT (particularly the corpus callosum and corticospinal tract). CORT administration was associated with increased tissue loss within the ipsilateral hemisphere, and modest and inconsistent WMT reorganization. Further, a structural and molecular analysis of the WMT components suggested that CORT exerted effects over axons and glial cells. Our findings highlight that CORT at stress-like levels can moderately influence the reorganization and microstructure of WMT post-stroke.


Assuntos
Corticosterona/administração & dosagem , Gliose/metabolismo , Gliose/patologia , Vias Neurais/efeitos dos fármacos , Acidente Vascular Cerebral/metabolismo , Substância Branca/efeitos dos fármacos , Substância Branca/fisiologia , Animais , Axônios/metabolismo , Corpo Caloso/efeitos dos fármacos , Corpo Caloso/metabolismo , Corpo Caloso/patologia , Modelos Animais de Doenças , Progressão da Doença , Suscetibilidade a Doenças , Gliose/tratamento farmacológico , Gliose/etiologia , Imuno-Histoquímica , Masculino , Camundongos , Bainha de Mielina/efeitos dos fármacos , Bainha de Mielina/metabolismo , Oligodendroglia/efeitos dos fármacos , Oligodendroglia/metabolismo , Estresse Fisiológico/efeitos dos fármacos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia
3.
Sci Rep ; 11(1): 14812, 2021 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285338

RESUMO

Near-infrared spectroscopy (NiRS) is a relatively new technology of brain imaging with its potential in the assessment of cerebrovascular health only recently discovered. Encouraging early results suggest that NiRS can be used as an inexpensive and portable cerebrovascular health tracking device using a recently proposed pulse relaxation function (PReFx). In this paper, we propose a new NiRS timing index, [Formula: see text], of cerebrovascular health. [Formula: see text] is a novel use of the NiRS technology. [Formula: see text] is motivated by the previously proved relationship of the timing of the reflected wave with vascular resistance and compliance in the context of pressure waveforms. We correlated both [Formula: see text] and PReFx against age, a non-exercise cardiorespiratory fitness (CRF) index, and two existing indices of cerebrovascular health, namely transcranial Doppler (TCD) augmentation index, [Formula: see text], and magnetic resonance imaging (MRI) blood flow pulsatility index, [Formula: see text]. The [Formula: see text] correlations with Age, CRF, [Formula: see text] and [Formula: see text] all are significant, i.e., [Formula: see text] ([Formula: see text]), [Formula: see text] ([Formula: see text]), [Formula: see text] ([Formula: see text]) and [Formula: see text] ([Formula: see text]), respectively. PReFx, however, did not have significant correlations with any of the vascular health factors. The proposed timing index is a reliable indicator of cerebrovascular aging factors in the NiRS waveform.


Assuntos
Aptidão Cardiorrespiratória/fisiologia , Rigidez Vascular , Adulto , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espectroscopia de Luz Próxima ao Infravermelho , Ultrassonografia Doppler Transcraniana
4.
Front Neurol ; 12: 585189, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33841293

RESUMO

Cognitive impairment is a common and disruptive outcome for stroke survivors, which is recognized to be notoriously difficult to treat. Previously, we have shown that low oxygen post-conditioning (LOPC) improves motor function and limits secondary neuronal loss in the thalamus after experimental stroke. There is also emerging evidence that LOPC may improve cognitive function post-stroke. In the current study we aimed to explore how exposure to LOPC may improve cognition post-stroke. Experimental stroke was induced using photothrombotic occlusion in adult, male C57BL/6 mice. At 72 h post-stroke animals were randomly assigned to either normal atmospheric air or to one of two low oxygen (11% O2) exposure groups (either 8 or 24 h/day for 14 days). Cognition was assessed during the treatment phase using a touchscreen based paired-associate learning assessment. At the end of treatment (17 days post-stroke) mice were euthanized and tissue was collected for subsequent histology and biochemical analysis. LOPC (both 8 and 24 h) enhanced learning and memory in the 2nd week post-stroke when compared with stroke animals exposed to atmospheric air. Additionally we observed LOPC was associated with lower levels of neuronal loss, the restoration of several vascular deficits, as well as a reduction in the severity of the amyloid-beta (Aß) burden. These findings provide further insight into the pro-cognitive benefits of LOPC.

5.
Hum Pathol ; 110: 62-72, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32920035

RESUMO

Thyroid cancer therapy is increasingly tailored to patients' risk of recurrence and death, placing renewed importance on pathologic parameters. The International Collaboration on Cancer Reporting (ICCR), an organization promoting evidence-based, internationally agreed-upon standardized pathology data sets, is the ideal conduit for the development of a pathology reporting protocol aimed at improving the care of patients with thyroid carcinomas. An international expert panel reviewed each element of thyroid pathology reporting. Recommendations were made based on the most recent literature and expert opinion.The data set uses the most recent World Health Organization (WHO) classification for the purpose of a more clinically and prognostically relevant nomenclature. One example is the restriction of the term minimally invasive follicular carcinoma to tumors with capsular invasion only. It reinforces the already established criteria for blood vessel invasion adopted by the most recent WHO classification and Armed Forces Institute of Pathology fascicle. It emphasizes the importance of the extent of blood vessel invasion and extrathyroid extension to better stratify patients for appropriate therapy. It is the first data set that requires pathologists to use the more recently recognized prognostically powerful parameters of mitotic activity and tumor necrosis. It highlights the importance of assessing nodal disease volume in predicting the risk of recurrence.The ICCR thyroid data set provides the tools to generate a report that will guide patient treatment in a more rational manner aiming to prevent the undertreatment of threatening malignancies and spare patients with indolent tumors the morbidity of unnecessary therapy. We recommend its routine use internationally for reporting thyroid carcinoma histology.


Assuntos
Carcinoma/patologia , Neoplasias Epiteliais e Glandulares/patologia , Patologia Clínica/normas , Projetos de Pesquisa/normas , Neoplasias da Glândula Tireoide/patologia , Humanos , Recidiva Local de Neoplasia/patologia
6.
Hum Pathol ; 110: 73-82, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32687943

RESUMO

Standardized pathologic reporting for cancers improves patient care and prognostic determination. However, access in many countries is limited. To address this issue, the International Collaboration on Cancer Reporting (ICCR), a not-for-profit organization, has the mission to develop and disseminate standardized data sets for global use. Within endocrine organs, the parathyroid gland has rarely been included in formal pathologic data sets. Utilizing an expert international panel of eleven members, an evidence-based data set was developed for parathyroid carcinoma and atypical parathyroid neoplasms. This data set consists of sixteen core (required) elements viewed as essential for documentation of these conditions. Characterizing parathyroid carcinomas and atypical neoplasms begins with correlative clinical information, the operative procedure, specimens submitted, and site of the disease. The pathologic features essential to document include parathyroid weight, size, classification, and, when a carcinoma, the tumor grade. Histologic grade of parathyroid carcinoma incorporates other core elements including necrosis, mitotic count, perineural invasion, and lymphovascular invasion. Documenting the extent of disease locally into adjacent organs, regionally, and distally is critical for staging. Pathologic staging is now included as part of the American Joint Committee on Cancer 8th edition and is included in this data set. Ancillary studies should be recorded when performed as noncore elements. Standardized pathologic data sets for endocrine organs including the parathyroid gland are now available through the ICCR website. These essential resources enhance international standardization for documenting these rare tumors for both patient care and future guidelines.


Assuntos
Conjuntos de Dados como Assunto , Neoplasias das Paratireoides/patologia , Patologia Clínica/normas , Humanos , Estadiamento de Neoplasias/normas
7.
J Arthroplasty ; 36(5): 1832-1845.e1, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33288388

RESUMO

BACKGROUND: Total knee arthroplasty is the standard surgical treatment for end-stage osteoarthritis. Although widely accepted as a successful procedure, approximately 30% of patients are not satisfied due to non-optimal postoperative outcomes. Clinical decision support tools that are able to accurately predict post-surgery outcomes would assist in providing individualized advice or services to help alleviate possible issues, resulting in significant benefits to both the healthcare system and individuals. METHODS: Five databases (Ovid Medline, Ovid EMBASE, CINAHL complete, Cochrane Library, and Scopus) were searched for the key phrases "knee replacement" or "knee arthroplasty" and "decision support tool," "decision tool," "predict∗ tool," "predict∗ model," "algorithm" or "nomogram." Searches were limited to peer-reviewed journal articles published between January 2000 and June 2019. Reference lists of included articles were examined. Authors came to a consensus on the final list of included articles. RESULTS: Eighteen articles were included for review. Most models reported low predictive success and inability to externally validate. Both candidate and final predictor variables were inconsistent between studies. Only 1 model was considered strongly predictive (AUROC >0.8), and only 2 studies were able to externally validate their developed model. In general, models that performed well used large patient numbers, were tested on similar demographics, and used either nonlinear input transformations or a completely nonlinear model. CONCLUSION: Some models do show promise; however, there remains the question of whether the reported predictive success can continue to be replicated. Furthermore, clinical applicability and interpretation of predictive tools should be considered during development.


Assuntos
Artroplastia do Joelho , Sistemas de Apoio a Decisões Clínicas , Osteoartrite , Humanos
8.
J Acad Nutr Diet ; 121(5): 925-930, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33309592

RESUMO

BACKGROUND: The risk of malnutrition in patients with cancer is well documented. However, screening to identify patients at risk in ambulatory cancer centers is not standardized nor uniform. The 2-question Malnutrition Screening Tool (MST) is validated in the ambulatory oncology setting and endorsed by the Academy of Nutrition and Dietetics. OBJECTIVE: To test the feasibility of operationalizing and standardizing malnutrition risk assessment across 2 large ambulatory cancer centers by embedding the MST into the electronic health record (EHR) with the goal of identifying and quantifying the prevalence of malnutrition risk in outpatient settings. DESIGN: A Quality Assurance Performance Improvement project was conducted to evaluate malnutrition screening practices by leveraging the EHR. Work standards were developed, implemented, and evaluated to assess the feasibility of utilizing de-identified MST data, entered as discrete variables in an EHR flowsheet, to track monthly MST completion rates and to identify and quantify patients being treated for cancer scoring at risk for impaired nutritional status. PARTICIPANTS/SETTING: Data from 2 large adult ambulatory community cancer centers in the upper Midwest were collected between April 2017 and December 2018. RESULTS: Over a 20-month period, the average monthly MST completion rate was 74%. Of those with completed MST screens, the average percentage of patients identified at nutritional risk (MST score ≥2) was 5% in medical oncology and 12% in radiation oncology. CONCLUSION: It is feasible to (1) integrate and standardize data collection of the MST into existing EHR flowsheets and (2) identify and quantify patients at risk for malnutrition on a consistent basis.


Assuntos
Assistência Ambulatorial/métodos , Registros Eletrônicos de Saúde , Desnutrição/diagnóstico , Avaliação Nutricional , Vigilância da População/métodos , Estudos de Viabilidade , Humanos , Desnutrição/etiologia , Oncologia/métodos , Neoplasias/complicações , Medição de Risco
9.
J Clin Pathol ; 73(10): 681-685, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32601067

RESUMO

This review article summarises systems for categorisation of diagnostic errors in pathology and cytology with regard to diagnostic accuracy and the published information on human factors (HFs) in pathology to date. A 12-point event-based checklist for errors of diagnostic accuracy in histopathology and cytopathology is proposed derived from Dupont's 'Dirty Dozen' HF checklist, as used in the aerospace industry for aircraft maintenance. This HF checklist comprises 12 HFs; (1) Failure of communication. (2) Complacency. (3) Lack of knowledge. (4) Distractions. (5) Lack of teamwork. (6) Fatigue. (7) Lack of resources. (8) Pressure. (9) Lack of assertiveness. (10) Stress. (11) Norms. (12) Lack of awareness. The accompanying article explains practical examples of how each of these 12 HFs may cause errors in diagnostic accuracy in pathology. This checklist could be used as a template for analysis of accuracy and risk of diagnostic error in pathology either retrospectively 'after the event' or prospectively at the time of diagnosis. There is a need for further evaluation and validation of this proposed 12-point HF checklist and similar systems for categorisation of diagnostic errors and diagnostic accuracy in pathology based on HF principles.


Assuntos
Biologia Celular/normas , Lista de Checagem/instrumentação , Citodiagnóstico/normas , Erros de Diagnóstico , Patologia Clínica/normas , Humanos
10.
Cancer Cytopathol ; 128(12): 917-927, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32543764

RESUMO

Thyroid fine-needle aspiration cytology (FNA) and histopathology can be subjective areas of medical diagnosis and subject to different interpretations. On the basis of the authors' personal experience, 12 recommendations with potential to improve clinical decision making, ensure quality, and reduce diagnostic error in thyroid FNAC and histopathology are presented. 1) use a standardized reporting terminology for thyroid FNAC; 2) understand and explain to service users the limitations of cytology and the standardized thyroid FNAC reporting terminology used; 3) the cytopathologist should review all relevant clinical and ultrasound findings, if feasible; 4) include the risk of malignancy in all FNAC reports if feasible; 5) collect data to calculate the local institutional risk of malignancy for FNAC if feasible; 6) accept that nondiagnostic FNAC will include small numbers of carcinomas; 7) use rapid on-site evaluation and/or educational sessions for aspirators if the nondiagnostic aspiration rate is high; 8) know the diagnostic pitfalls of both cytology and histopathology; 9) use special immunohistochemical and molecular techniques that are evidence-based; 10) make use of second opinions, either in-house or interinstitutional; 11) multidisciplinary discussion of cases before surgery or therapy is invaluable; and, finally, 12) manage patient and clinician expectations of thyroid cytology and histopathology. These 12 recommendations may assist in quality-improvement initiatives and may reduce diagnostic errors in thyroid cytology and histopathology. Thyroid multidisciplinary case discussion remains the principal, overarching method for error reduction and for providing high-quality clinical decision making.


Assuntos
Tomada de Decisão Clínica/métodos , Citodiagnóstico/métodos , Erros de Diagnóstico/prevenção & controle , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Biópsia por Agulha Fina , Humanos , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia
11.
J Interpers Violence ; : 886260520917506, 2020 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-32389063

RESUMO

Perpetration of relational aggression, which is estimated to occur in 60% to 90% of relationships, has been demonstrated to have lasting negative effects both systemically and for its victims. Relational aggression has also been demonstrated to be impacted, in part by impulsivity, stress mind-set, and mindfulness. The present study examined a path analysis model of the relation between mindfulness and relational aggression, utilizing impulsivity as the mediating variable. Furthermore, the present study incorporated an examination of the potential moderating effects of stress mind-set on the relation between impulsivity and relational aggression. Three hundred eighty-three participants were recruited from across the United States, using Facebook ads. Participants completed online questionnaires assessing key study variables. We hypothesized that the negative urgency aspect of impulsivity would mediate the relation between the five facets of mindfulness and relational aggression, and further that this relationship would be moderated by stress mind-set, such that a stress mind-set which conceptualizes stress as negative would make the relation between impulsivity and relational aggression stronger. We hypothesized that the negative urgency aspect of impulsivity would mediate the relation between mindfulness and relational aggression. Furthermore, we hypothesized that the relation between impulsivity and aggression would be moderated by stress mind-set. Results indicated that the negative urgency component of impulsivity mediated the relation between all five facets of mindfulness and perpetration of relational aggression. Furthermore, stress mind-set moderated the relation between negative urgency and relational aggression, such that a lower stress mind-set was related to a stronger association between negative urgency and aggression. Implications for clinical intervention and future research efforts are discussed.

12.
Endoscopy ; 52(6): 454-461, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32162287

RESUMO

BACKGROUND: A novel fork-tip fine-needle biopsy (FNB) needle has recently been introduced for endoscopic ultrasound (EUS)-guided sampling. The aim of this study was to compare the performance of fork-tip FNB histology and standard fine-needle aspiration (FNA) cytology in the diagnosis of solid pancreatic masses. METHODS: A randomized crossover study was performed in patients referred for EUS-guided sampling. Three passes were taken with each needle in a randomized order. Only samples reported as diagnostic of malignancy were considered positive. The primary end point was the sensitivity of diagnosis of malignancy. Secondary end points included the amount of sample obtained, ease of diagnosis, duration of tissue sampling, pathologist viewing time, and cost. RESULTS: 108 patients were recruited. Median age was 69 years (range 30 - 87) and 57 were male; 85.2 % had a final diagnosis of malignancy. There were statistically significant differences in sensitivity (82 % [95 % confidence interval (CI) 72 % to 89 %] vs. 71 % [95 %CI 60 % to 80 %]), accuracy (84 % [95 %CI 76 % to 91 %] vs. 75 % [95 %CI 66 % to 83 %]), proportion graded as a straightforward diagnosis (69 % [95 %CI 60 % to 78 %] vs. 51 % [95 %CI 41 % to 61 %]), and median pathology viewing time (188 vs. 332 seconds) (P < 0.001) between FNB and FNA needles, respectively. There was no significant difference in cost between an FNB or FNA strategy. CONCLUSION: The diagnostic performance of the fork-tip FNB needle was significantly better than that of FNA; it was associated with ease of diagnosis, shorter pathological viewing times, and was cost neutral.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Pancreáticas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Endossonografia , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas , Neoplasias Pancreáticas/diagnóstico por imagem
13.
Endosc Int Open ; 7(10): E1281-E1287, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31579710

RESUMO

Background and study aims Pancreatic neuroendocrine tumors (PanNETs) outcomes are dependent upon grading by Ki67. This study compared endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) to fine-needle aspiration (FNA) in assessing PanNETs. Patients and methods All pancreatic histology for PanNET between January 2009 and June 2017 was included if EUS sampling was performed prior to surgical resection. Ki67 and grade from FNA and FNB samples was compared to surgical histology using correlation coefficient and kappa values. Subgroup analysis was performed for purely solid lesions, lesions < 2 cm and FNB needle type. Results One hundred sixity-four patients had PanNET of which 57 underwent surgical resection. Thirty-five lesions underwent FNA and 26 FNB (4 had both) confirming PanNET. 23/ of 35 FNA samples reported Ki67/grading compared to all 26 FNB samples ( P  = 0.0006). Compared to surgical histology, Ki67 on FNA correlated poorly overall (r = -0.08), in solid lesions (r = -0.102) and lesions < 2 cm (r = -0.149) whereas FNB correlated moderately overall (r = 0.65), in solid lesions (r = 0.64) and lesions < 2 cm (r = 0.61). Tumor grade showed poor agreement (kappa) with FNA overall (0.026), in solid lesions (0.044) and lesions < 2 cm (0.00) whereas FNB showed moderate-good agreement overall (0.474), in solid lesions (0.58) and lesions < 2 cm (0.745). Fork-tip FNB needles Ki67 showed strong correlation with surgical histology (r = 0.788) compared to reverse bevel FNB needles (r = 0.521). Both FNB needles showed moderate agreement with tumor grade. Conclusion FNB samples were significantly more likely than FNA to provide adequate material for Ki67/grading and showed a closer match to surgical histology. FNB needle types require prospective investigation.

14.
Nutr Clin Pract ; 34(6): 858-868, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31549444

RESUMO

Registered dietitian nutritionists (RDNs), like other healthcare professionals, are often searching for ways to improve their skills and advance their practice. One way RDNs have expanded their skills is by learning to place small bowel feeding tubes (SBFTs). However, it is also important that staffing RDNs to place SBFTs makes sense for their institution and their patient population. Although it is unknown how many RDNs place SBFTs, feeding tube placements by RDNs have been in practice for almost 2 decades, and it is within the RDN scope of practice. This article is a review of the literature, including indications for SBFT, possible benefits of RDNs placing SBFTs, development and maintenance of an RDN-led SBFT program, and assessment of clinical and institutional outcomes for this procedure.


Assuntos
Nutrição Enteral/métodos , Intubação Gastrointestinal/métodos , Nutricionistas/organização & administração , Competência Clínica , Nutrição Enteral/economia , Custos de Cuidados de Saúde , Instalações de Saúde , Humanos , Intestino Delgado , Intubação Gastrointestinal/economia , Nutricionistas/educação , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto
15.
Sci Rep ; 9(1): 8557, 2019 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-31189918

RESUMO

Microglia play a central role in modulating synaptic structure and physiology, learning and memory processes. They exhibit morphological changes to perform these roles, therefore the morphological study of microglia can help to understand their functionality. Many promising methods are proposed to automatically segment the blood vessels or reconstruct the neuronal morphology. However, they often fail to accurately capture microglia organizations due to the striking structural differences. This requires a more sophisticated approach of reconstruction taking into account the varying nature of branch structures and soma sizes. To this end, we propose an automated method to reconstruct microglia, and quantify their features from 2D/3D image datasets. We first employ multilevel thresholding to segment soma volumes(3D)/areas(2D) and recognize foreground voxels/pixels. Seed points sampled from the foreground, are connected to form the skeleton of the branches via the tracing process. The reconstructed data is quantified and written in SWC standard file format. We have applied our method to 3D image datasets of microglia, then evaluated the results using ground truth data, and compared them to those achieved via the state-of-the-art methods. Our method outperforms the others both in accuracy and computational time.


Assuntos
Algoritmos , Rastreamento de Células , Imageamento Tridimensional , Microglia/citologia , Animais , Masculino , Camundongos , Camundongos Transgênicos
16.
Proc Natl Acad Sci U S A ; 116(20): 9941-9946, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31028139

RESUMO

Poly(ADP-ribose) polymerase 1 (PARP-1) is a multidomain multifunctional nuclear enzyme involved in the regulation of the chromatin structure and transcription. PARP-1 consists of three functional domains: the N-terminal DNA-binding domain (DBD) containing three zinc fingers, the automodification domain (A), and the C-terminal domain, which includes the protein interacting WGR domain (W) and the catalytic (Cat) subdomain responsible for the poly(ADP ribosyl)ating reaction. The mechanisms coordinating the functions of these domains and determining the positioning of PARP-1 in chromatin remain unknown. Using multiple deletional isoforms of PARP-1, lacking one or another of its three domains, as well as consisting of only one of those domains, we demonstrate that different functions of PARP-1 are coordinated by interactions among these domains and their targets. Interaction between the DBD and damaged DNA leads to a short-term binding and activation of PARP-1. This "hit and run" activation of PARP-1 initiates the DNA repair pathway at a specific point. The long-term chromatin loosening required to sustain transcription takes place when the C-terminal domain of PARP-1 binds to chromatin by interacting with histone H4 in the nucleosome. This long-term activation of PARP-1 results in a continuous accumulation of pADPr, which maintains chromatin in the loosened state around a certain locus so that the transcription machinery has continuous access to DNA. Cooperation between the DBD and C-terminal domain occurs in response to heat shock (HS), allowing PARP-1 to scan chromatin for specific binding sites.


Assuntos
Poli(ADP-Ribose) Polimerase-1/metabolismo , Animais , Cromatina/metabolismo , Drosophila , Ativação Enzimática , Histonas/metabolismo , Domínios Proteicos , Ativação Transcricional
17.
Sci Rep ; 9(1): 4551, 2019 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-30872619

RESUMO

Automated cell nucleus segmentation is the key to gain further insight into cell features and functionality which support computer-aided pathology in early diagnosis of diseases such as breast cancer and brain tumour. Despite considerable advances in automated segmentation, it still remains a challenging task to split heavily clustered nuclei due to intensity variations caused by noise and uneven absorption of stains. To address this problem, we propose a novel method applicable to variety of histopathological images stained for different proteins, with high speed, accuracy and level of automation. Our algorithm is initiated by applying a new locally adaptive thresholding method on watershed regions. Followed by a new splitting technique based on multilevel thresholding and the watershed algorithm to separate clustered nuclei. Finalized by a model-based merging step to eliminate oversegmentation and a model-based correction step to improve segmentation results and eliminate small objects. We have applied our method to three image datasets: breast cancer stained for hematoxylin and eosin (H&E), Drosophila Kc167 cells stained for DNA to label nuclei, and mature neurons stained for NeuN. Evaluated results show our method outperforms the state-of-the-art methods in terms of accuracy, precision, F1-measure, and computational time.


Assuntos
Algoritmos , Neoplasias da Mama/patologia , Núcleo Celular/patologia , Drosophila melanogaster/citologia , Interpretação de Imagem Assistida por Computador/métodos , Neurônios/patologia , Animais , Automação , Neoplasias da Mama/metabolismo , Núcleo Celular/metabolismo , Drosophila melanogaster/metabolismo , Amarelo de Eosina-(YS)/metabolismo , Feminino , Hematoxilina/metabolismo , Humanos , Neurônios/metabolismo , Coloração e Rotulagem
18.
Sci Rep ; 9(1): 4841, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30890719

RESUMO

In the current study, we were interested in investigating whether Low oxygen post-conditioning (LOPC) was capable of limiting the severity of stroke-induced secondary neurodegeneration (SND). To investigate the effect of LOPC we exposed adult male C57/BL6 mice to photothrombotic occlusion (PTO) of the motor and somatosensory cortex. This is known to induce progressive neurodegeneration in the thalamus within two weeks of infarction. Two days after PTO induction mice were randomly assigned to one of four groups: (i) LOPC-15 day exposure group; (ii) a LOPC 15 day exposure followed by a 15 day exposure to normal atmosphere; (iii) normal atmosphere for 15 days and (iv) normal atmosphere for 30 days (n = 20/group). We observed that LOPC reduced the extent of neuronal loss, as indicated by assessment of both area of loss and NeuN+ cell counts, within the thalamus. Additionally, we identified that LOPC reduced microglial activity and decreased activity within the excitotoxic signalling pathway of the NMDAR axis. Together, these findings suggest that LOPC limits neuronal death caused by excitotoxicity in sites of secondary damage and promotes neuronal survival. In conclusion, this work supports the potential of utilising LOPC to intervene in the sub-acute phase post-stroke to restrict the severity of SND.


Assuntos
Neurônios/metabolismo , Oxigênio/metabolismo , Acidente Vascular Cerebral/metabolismo , Tálamo/metabolismo , Animais , Isquemia Encefálica/metabolismo , Isquemia Encefálica/patologia , Contagem de Células , Morte Celular/fisiologia , Modelos Animais de Doenças , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microglia/metabolismo , Microglia/patologia , Degeneração Neural/metabolismo , Degeneração Neural/patologia , Neurônios/patologia , Receptores de N-Metil-D-Aspartato/metabolismo , Transdução de Sinais/fisiologia , Acidente Vascular Cerebral/patologia , Tálamo/patologia
19.
Endoscopy ; 51(11): 1044-1050, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30654396

RESUMO

BACKGROUND: Stents are frequently placed in patients with biliary obstruction due to a mass in the head of the pancreas. The impact of plastic or self-expandable metal stents (SEMSs) on endoscopic ultrasound (EUS)-guided tissue sampling is unclear. This study aimed to assess, using strict pathological criteria, whether stents impair fine-needle aspiration (FNA) or fine-needle biopsy (FNB). METHODS: All patients with a solid mass in the head of the pancreas who underwent EUS-guided tissue sampling between 2010 and 2016 at our unit were included. Factors with possible impact on diagnostic performance were analyzed using logistic regression. Analysis was performed using both strict (malignant only) and less strict (suspicious for malignancy) cutoffs. RESULTS: Of 631 individuals undergoing 698 procedures, 535 (84.8 %) had a final diagnosis of malignancy, 141 had SEMS, 149 had plastic stents, and 341 had no stent. Using strict criteria, SEMS were associated with an increased occurrence of incorrect diagnosis of EUS tissue sampling, with an odds ratio (OR) of 1.96 (95 % confidence interval [CI] 1.24 - 3.10). Increasing tumor size (OR 0.72, 95 %CI 0.59 - 0.87), increasing number of passes (OR 0.84, 95 %CI 0.72 - 0.99), and fork-tip biopsy needle (OR 0.52, 95 %CI 0.31 - 0.86) were independently associated with a decrease in incorrect diagnosis. Repeat tissue sampling was more common with SEMSs (10.2 %) than with plastic stents (2.9 %) or no stents (4.5 %) (P < 0.02). CONCLUSION: SEMS use had a negative impact on tissue diagnosis in pancreatic head masses, whereas use of a fork-tip biopsy needle and increasing number of passes were independently associated with improved accuracy.


Assuntos
Colestase/cirurgia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Endossonografia/métodos , Pâncreas/diagnóstico por imagem , Pancreatopatias/diagnóstico , Implantação de Prótese/métodos , Stents , Adulto , Colestase/diagnóstico , Colestase/etiologia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pâncreas/cirurgia , Pancreatopatias/complicações , Plásticos , Reprodutibilidade dos Testes , Estudos Retrospectivos
20.
Entropy (Basel) ; 21(6)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-33267329

RESUMO

This paper studies index coding with two senders. In this setup, source messages are distributed among the senders possibly with common messages. In addition, there are multiple receivers, with each receiver having some messages a priori, known as side-information, and requesting one unique message such that each message is requested by only one receiver. Index coding in this setup is called two-sender unicast index coding (TSUIC). The main goal is to find the shortest aggregate normalized codelength, which is expressed as the optimal broadcast rate. In this work, firstly, for a given TSUIC problem, we form three independent sub-problems each consisting of the only subset of the messages, based on whether the messages are available only in one of the senders or in both senders. Then, we express the optimal broadcast rate of the TSUIC problem as a function of the optimal broadcast rates of those independent sub-problems. In this way, we discover the structural characteristics of TSUIC. For the proofs of our results, we utilize confusion graphs and coding techniques used in single-sender index coding. To adapt the confusion graph technique in TSUIC, we introduce a new graph-coloring approach that is different from the normal graph coloring, which we call two-sender graph coloring, and propose a way of grouping the vertices to analyze the number of colors used. We further determine a class of TSUIC instances where a certain type of side-information can be removed without affecting their optimal broadcast rates. Finally, we generalize the results of a class of TSUIC problems to multiple senders.

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