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2.
Surg Innov ; : 15533506211001236, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33745354

RESUMO

Objective. Preoperative imaging in primary hyperparathyroidism (PHPT) is essential for planning of parathyroidectomy-particularly for selection of a minimally invasive approach. The objective of this cohort study was to evaluate the diagnostic precision of 3D virtual neck exploration (3D-VNE), to evaluate its impact on choice of surgical approach, and to document the correlation with long-term outcomes. Methods. 235 consecutive patients with PHPT were studied (January 2014 to December 2018), with 6-month follow-up. 220 patients had a preoperative computed tomography (CT), 172 of these had a 3D-VNE based on the CT, and 226 patients had a Tc-99m sestamibi scan. Results. Sensitivity of exact, per gland, adenoma localization was 57.09% (95% CI: 50.85-63.10%) for nonspecialized radiologist interpretation of CT scan, 58.17% (95% CI: 51.99-64.10%) for Tc-99m sestamibi scan, and 90.21% (95% CI: 85.21-93.64%) for 3D-VNE, and thereby favoring 3D-VNE compared to CT scan alone (OR 34.5, 95% CI: 9.19-290.56%, P < 2.2 × 10-16) and to Tc-99m sestamibi scan (OR 16.25, 95% CI: 6.05-61.42%, P = 3.1 × 10-15). Specificity was 87.38% for CT scan, 86.36% for 3D-VNE, and 90% for Tc-99m sestamibi scan (P > .05). The cure rate was 100%. The long-term recurrence rate (RR) was 2.978%. The RR was 1.324% in the video-assisted parathyroidectomy group of 151 patients and 5.952% in the group of 84 patients with cervicotomy (P = .0459). Conclusion. CT-based 3D-VNE proved to be the most accurate localizing study in PHPT and aided in selecting patients for targeted minimally invasive parathyroidectomy, which was associated with the lower recurrence rate. 3D-VNE could be proposed as a first-line imaging study in patients with PHPT.

3.
Trials ; 22(1): 131, 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33573681

RESUMO

OBJECTIVES: The main objective of this study is to evaluate the effect of intravenous lidocaine on gas exchange and inflammation in acute respiratory distress syndrome due or not to Covid-19 pneumonia. TRIAL DESIGN: This is a prospective monocentric, randomized, quadruple-blinded and placebo-controlled superiority trial. This phase 3 clinical study is based on two parallel groups received either intravenous lidocaine 2% or intravenous NaCl 0.9%. PARTICIPANTS: This study has been conducted at the University Hospitals of Strasbourg (medical and surgical Intensive Care Units in Hautepierre Hospital) since the 4th November 2020. The participants are 18 years-old and older, hospitalized in ICU for a moderate to severe ARDS according to the Berlin definition; they have to be intubated and sedated for mechanical protective ventilation. All participants are affiliated to the French Social security system and a dosage of beta HCG has to be negative for women of child bearing age . For the Covid-19 subgroup, the SARS-CoV2 infection is proved by RT-PCR <7 days before admission and/or another approved diagnostic technique and/or typical CT appearance pneumonia. The data are prospectively collected in e-Case Report Forms and extracted from clinical files. INTERVENTION AND COMPARATOR: The participants are randomised in two parallel groups with a 1:1 ratio. In the experimental group, patients receive intravenous lidocaine 2% (20mg/mL) (from FRESENIUS KABI France); the infusion protocol provide a bolus of 1 mg/kg (ideal weight), followed by 3 mg/kg/h for the first hour, 1.5 mg/kg/h for the second hour, 0.72 mg/kg/h for the next 22 hours and then 0.6 mg/kg/h for 14 days at most or 24 hours after extubation or ventilator-weaning. The patients in the control group receive intravenous NaCl 0.9% (9 mg/mL) (from Aguettant, France) as placebo comparator; the infusion protocol provide a bolus of 0.05 mL/kg (ideal weight), followed by 0.15 mL/kg/h for the first hour, 0.075 mL/kg/h for the second hour, 0.036 mL/kg/h for the next 22 hours, and the 0.03 mL/kg/h for up to 14 days or 24 hours after extubation or ventilator-weaning. Lidocaine level is assessed at H4, D2, D7 and D14 to prevent local anesthetics systemic toxicity. Clinical data and biological samples are collected to assess disease progression. MAIN OUTCOMES: The primary outcome is the evolution of alveolar-capillary gas exchange measured by the PaO2/FiO2 ratio after two days of treatment. The secondary endpoints of the study include the following: Evolution of PaO2/FiO2 ratio at admission and after 21 days of treatment Number of ventilator-free days Anti-inflammatory effects by dosing inflammatory markers at different timepoints (ferritin, bicarbonate, CRP, PCT, LDH, IL-6, Troponin HS, triglycerides, complete blood count, lymphocytes) Anti-thrombotic effects by dosing platelets, aPTT, fibrinogen, D-dimers, viscoelastic testing and identification of all thromboembolic events up to 4 weeks. Plasmatic concentration of lidocaine and albumin Incidence of adverse events like cardiac rhythm disorders, need of vasopressors, any modification of the QRS, QTc or PR intervals every day Ileus recovery time Consumption of hypnotics, opioids, neuromuscular blockers. Lengths of stay in the ICU, incidence of reintubation and complications due to intensive care unit care (mortality until 90 days, pneumothorax, bacterial pneumopathy, bronchospasm, cardiogenic shock, acute renal failure, need of renal dialysis, delirium, atrial fibrillation, stroke (CAM-ICU score), tetraplegia (MCR score)). Incidence of cough and sore throat at extubation or ventilator-weaning and within 24 hours. All these outcomes will be evaluated according to positivity to Sars-Cov-2. RANDOMISATION: The participants who meet the inclusion criteria and have signed written informed consent will be randomly allocated using a computer-generated random number to either intervention group or control group. The distribution ratio of the two groups will be 1:1, with a stratification according to positivity to Sars-Cov-2. BLINDING (MASKING): All participants, care providers, investigator and outcomes assessor are blinded. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): We planned to randomize fifty participants in each group, 100 participants total. TRIAL STATUS: The amended protocol version 2.1 was approved by the Ethics Committee "Comité de Protection des Personnes Sud-Méditerranée II on January 8, 2021 and by the Commission Nationale de l'Informatique et des Libertés (CNIL) on November 10, 2020. The study is currently recruiting participants; the recruitment started in November 2020 and the planned recruitment period is three years. TRIAL REGISTRATION: The trial was registered on clinicaltrials.gov on October 30, 2020 and identified by number NCT04609865 . FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Assuntos
/tratamento farmacológico , Lidocaína/uso terapêutico , Bloqueadores do Canal de Sódio Disparado por Voltagem/uso terapêutico , Administração Intravenosa , /fisiopatologia , Ensaios Clínicos Fase III como Assunto , Estudos de Equivalência como Asunto , Humanos , Inflamação/sangue , Troca Gasosa Pulmonar , Ensaios Clínicos Controlados Aleatórios como Assunto , /fisiopatologia , Resultado do Tratamento
4.
Orthod Fr ; 91(4): 303-321, 2020 Dec 01.
Artigo em Francês | MEDLINE | ID: mdl-33355535

RESUMO

The aim of this systematic review and meta-analysis was to compare self-ligating brackets (SLBs) considered as a whole to conventional brackets (CBs). An electronic search was performed in three databases (PubMed, MEDLINE via Web of Science, Cochrane Library) from their origin up to June 2017. Additional articles were hand searched from January 2006 to June 2017. This meta-analysis was restricted to randomized controlled trials (RCTs) and split mouth design studies (SMDs). No distinction was made between active and passive SLBs. The following variables were investigated : treatment duration, number of visits, alignment rate, rate of space closure, perception of discomfort during the initial phase of treatment, pain experience during wire insertion or removal, bond failure rate, time to ligate in or to untie an archwire, periodontal indices, occlusal outcomes, transverse arch dimensional changes and root resorption. 25 RCTs and 9 SMDs were finally selected. It was more painful to insert or remove a 0.019× 0.025 SS archwire in/from SLBs. It was significantly quicker to insert or remove an archwire from SLBs. There was less bleeding on probing with SLBs 4 or 5 weeks after bonding. All other variables did not exhibit any significant difference between SLBs and CBs. Out of the 31 comparisons between self-ligating and conventional brackets, 9 only revealed statistically significant differences. This meta-analysis contradicts most of the promotional statements put forward by the distributors.


Assuntos
Braquetes Ortodônticos , Reabsorção da Raiz , Face , Humanos , Boca , Desenho de Aparelho Ortodôntico , Fios Ortodônticos
5.
J Clin Med ; 9(11)2020 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-33233324

RESUMO

INTRODUCTION: The COVID-19 outbreak had a major impact on healthcare systems worldwide. Our study aims to describe the characteristics and therapeutic emergency mobile service (EMS) management of patients with vital distress due to COVID-19, their in-hospital care pathway and their in-hospital outcome. METHODS: This retrospective and multicentric study was conducted in the six main centers of the French Greater East region, an area heavily impacted by the pandemic. All patients requiring EMS dispatch and who were admitted straight to the intensive care unit (ICU) were included. Clinical data from their pre-hospital and hospital management were retrieved. RESULTS: We included a total of 103 patients (78.6% male, median age 68). In the initial stage, patients were in a critical condition (median oxygen saturation was 72% (60-80%)). In the field, 77.7% (CI 95%: 71.8-88.3%) were intubated. Almost half of our population (45.6%, CI 95%: 37.1-56.9%) had clinical Phenotype 1 (silent hypoxemia), while the remaining half presented Phenotype 2 (acute respiratory failure). In the ICU, a great number had ARDS (77.7%, CI 95% 71.8-88.3% with a PaO2/FiO2 < 200). In-hospital mortality was 33% (CI 95%: 24.6-43.3%). The two phenotypes showed clinical and radiological differences (respiratory rate, OR = 0.98, p = 0.02; CT scan lesion extension >50%, OR = 0.76, p < 0.03). However, no difference was found in terms of overall in-hospital mortality (OR = 1.07, p = 0.74). CONCLUSION: The clinical phenotypes appear to be very distinguishable in the pre-hospital field, yet no difference was found in terms of mortality. This leads us to recommend an identical management in the initial phase, despite the two distinct presentations.

6.
Chin Clin Oncol ; 9(4): 55, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32576020

RESUMO

BACKGROUND: To assess the risks of local and distant failure and overall survival time in patients treated with hypofractionated stereotactic radiotherapy (HFSRT) to the postoperative cavity for brain metastases (BMs) compared with patients treated with adjuvant whole-brain radiation therapy (WBRT). METHODS: Between July 2005 and February 2015, 196 non-randomized patients with 202 resected BMs were treated with post-operative WBRT or HFSRT at a single institution. The propensity score was included as a covariate to compare the interval to local failure, distant brain failure and overall survival time. The matching covariates consisted of the age, Karnofsky performance status, primary disease, number of BMs, extracranial disease status and presence or absence of extracranial metastases. RESULTS: In total, 110 patients (54.5%) received adjuvant WBRT, and 92 HFSRT procedures (45.5%) were delivered after surgery. A Cox model adjusted on the propensity score showed that the brain distant failure was significantly associated with treatment modality. Compared with WBRT, the patients who received HFSRT had a significantly greater risk of developing distant brain recurrence [HR =3.37 (2.13-5.33), P<0.001]. No difference was observed in local failure (HR =1.16, P=0.77) between the groups. In the propensity-matched cohort, the effect of treatment on survival was not significant (P=0.14), but it depended on the time. Within the first 20 months, the patients treated with WBRT had a 2 times higher risk of death than did patients treated with HFSRT [HR =2.17 (1.42-3.32), P=0.0003]. CONCLUSIONS: Compared with the standard WBRT after the resection of BMs, stereotactic radiotherapy to the surgical bed produced a comparable local control rate to that of WBRT with a survival advantage in the first 20 months.

7.
Ann Pharm Fr ; 78(6): 499-506, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-32565157

RESUMO

Biostatistics are omnipresent in the scientific and medical literature and are an essential skill for any health student. We have developed a practical training tool - GMRC Shiny stats - an interactive application specifically dedicated to medical data statistical analysis. The application has been designed to provide an analysis workflow corresponding to the usual progression of an experienced statistician during data analysis. The most common statistical analyses can be performed (descriptive statistics, inferences according to frequentist methods, survival analyses, correlation, agreement measurements, etc.). GMRC Shiny stats is intuitive and user-friendly and assists students in choosing the most appropriate statistical tests. With all these functionalities, students can learn statistical analysis by doing. Getting involved in the statistical analysis and processing of their own data is likely to improve their biostatistics skills.

8.
Ann Neurol ; 88(4): 688-702, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32588450

RESUMO

OBJECTIVE: Recent studies carried out on amyotrophic lateral sclerosis patients suggest that the disease might initiate in the motor cortex and spread to its targets along the corticofugal tracts. In this study, we aimed to test the corticofugal hypothesis of amyotrophic lateral sclerosis experimentally. METHODS: Sod1G86R and Fezf2 knockout mouse lines were crossed to generate a model that expresses a mutant of the murine Sod1 gene ubiquitously, a condition sufficient to induce progressive motor symptoms and premature death, but genetically lacks corticospinal neurons and other subcerebral projection neurons, one of the main populations of corticofugal neurons. Disease onset and survival were recorded, and weight and motor behavior were followed longitudinally. Hyper-reflexia and spasticity were monitored using electromyographic recordings. Neurodegeneration and gliosis were assessed by histological techniques. RESULTS: Absence of subcerebral projection neurons delayed disease onset, reduced weight loss and motor impairment, and increased survival without modifying disease duration. Absence of corticospinal neurons also limited presymptomatic hyper-reflexia, a typical component of the upper motoneuron syndrome. INTERPRETATION: Major corticofugal tracts are crucial to the onset and progression of amyotrophic lateral sclerosis. In the context of the disease, subcerebral projection neurons might carry detrimental signals to their downstream targets. In its entirety, this study provides the first experimental arguments in favor of the corticofugal hypothesis of amyotrophic lateral sclerosis. ANN NEUROL 2020;88:688-702.

9.
Br J Anaesth ; 124(6): 761-767, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32303379

RESUMO

BACKGROUND: Quality of recovery is an important component of perioperative health status. The 15-item Quality of Recovery (QoR-15) scale is a validated multidimensional questionnaire that measures postoperative quality of recovery. The aim of this study was to translate and assess the psychometric properties of a French version of the QoR-15 scale (QoR-15F) to measure postoperative recovery in French-speaking patients. METHODS: After translation into French of the original English version of the QoR-15 scale, psychometric validation of the QoR-15F scale to measure postoperative quality of recovery was performed. This psychometric validation included validity, reliability, responsiveness, and feasibility. The QoR-15F scale was administered before operation and on Postoperative day 1 in French-speaking patients. Patient-perceived global recovery assessment was measured at Postoperative day 1 using a VAS. RESULTS: We enrolled 150 patients, and 144 completed the study protocol. The completion rate of administered questionnaires was 100%. Pearson (r) correlation between postoperative QoR-15F and the global recovery assessment by the patient was 0.60 (P<0.0001). As expected, there was a significant negative correlation between QoR-15F score and duration of surgery (r=-0.29; P<0.01), duration of PACU stay (r=-0.21; P=0.01), and duration of hospital stay (r=-0.34; P<0.01). Cronbach's alpha was 0.81, split-half alpha was 0.83, and the global test-retest intra-class coefficient was 0.98 (0.95-0.99). CONCLUSIONS: The QoR-15F is a valid and reliable tool to measure postoperative quality of recovery in French-speaking patients. The psychometric properties to measure postoperative quality of recovery were similar to the seminal English version. CLINICAL TRIAL REGISTRATION: NCT03578068.


Assuntos
Período de Recuperação da Anestesia , Nível de Saúde , Qualidade de Vida , Inquéritos e Questionários/normas , Traduções , França , Humanos , Tempo de Internação/estatística & dados numéricos , Psicometria , Reprodutibilidade dos Testes
10.
Am J Transplant ; 20(9): 2437-2448, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32185866

RESUMO

The aim of this study was to produce a prognostic model to help predict posttransplant survival in patients transplanted with grade-3 acute-on-chronic liver failure (ACLF-3). Patients with ACLF-3 who underwent liver transplantation (LT) between 2007 and 2017 in 5 transplant centers were included (n = 152). Predictors of 1-year mortality were retrospectively screened and tested on a single center training cohort and subsequently tested on an independent multicenter cohort composed of the 4 other centers. Four independent pretransplant risk factors were associated with 1-year mortality after transplantation in the training cohort: age ≥53 years (P = .044), pre-LT arterial lactate level ≥4 mml/L (P = .013), mechanical ventilation with PaO2 /FiO2  ≤ 200 mm Hg (P = .026), and pre-LT leukocyte count ≤10 G/L (P = .004). A simplified version of the model was derived by assigning 1 point to each risk factor: the transplantation for Aclf-3 model (TAM) score. A cut-off at 2 points distinguished a high-risk group (score >2) from a low-risk group (score ≤2) with 1-year survival of 8.3% vs 83.9% respectively (P < .001). This model was subsequently validated in the independent multicenter cohort. The TAM score can help stratify posttransplant survival and identify an optimal transplantation window for patients with ACLF-3.

11.
J Sleep Res ; 29(4): e12993, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32048384

RESUMO

French general practitioners (GPs) are known to widely prescribe medications to treat insomnia despite their negative effects. GPs' easy access to self-medication may affect their mental representation of sleep and hypnotics, and subsequently their professional behaviour. Our aim was to examine the association between GPs' personal hypnotic drug consumption habits and their management of patients with sleep disturbances. A randomized sample of Alsatian GPs participated in a survey based on questionnaires including the Pittsburgh Sleep Quality Index, the Dysfunctional Beliefs About Sleep in 10 questions to characterize sleep, and an evaluation of their management strategies regarding sleep for both patients and themselves. Two-hundred and forty-nine GPs were included (response rate of 51%). Demographics of the GPs' samples were representative of those of the Alsatian GP population. Fifteen percent of the survey respondents met insomnia criteria. For the management of their own sleep disturbances, 14.3% of GPs were taking hypnotic drugs and 8.7% were taking anxiolytics, with greater drug consumption in the insomnia group. In a multivariate analysis, GPs who personally consumed these medications prescribed significantly more of them to patients, whereas their insomnia status had less impact. Other factors such as gender and type of practice were not associated with a higher prescription rate. Our results indicate that GPs' personal drug consumption can have a significant impact on the management of their patients, therefore suggesting that actions towards GPs' health improvement may also benefit their patients and the public.

12.
Sci Rep ; 10(1): 2638, 2020 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-32060316

RESUMO

Nocturnal Legs Cramps are a frequent disorder, which have a negative impact on quality of life, particularly among patients over 60 years old. Lifestyle factors such as alcohol consumption have been shown to be associated with Nocturnal Leg Cramps. This study aimed to explore the association between nocturnal leg cramps and a sedentary lifestyle among elderly patients. A case-control study was conducted with a Bayesian approach for sensitivity analysis. Patients over 60 years old consulting their family doctor were recruited in the Alsace region, France. Cases were matched with controls free from cramps for age, sex, medical history and medications known to trigger cramps. The level of physical activity was assessed using the Dijon Physical Activity Score (DPAS). We performed univariate and multivariate analyses adjusting for alcohol consumption. 272 participants were matched into 136 pairs. 11% of all were sedentary persons. Adjusting for alcohol consumption, we observed an association between Nocturnal Leg Cramps and a sedentary lifestyle OR = 9.84 (95% credibility interval [1.74; 101.9]; posterior probability 99.68%). Our findings represent an additional argument to promote physical activity to patients over 60 years old. They also highlight the need to develop and evaluate physical activity interventions in the treatment of Nocturnal Legs Cramps.


Assuntos
Transtornos da Transição Sono-Vigília/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Estudos de Casos e Controles , Exercício Físico , Feminino , França/epidemiologia , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Comportamento Sedentário
13.
Transplant Proc ; 51(10): 3375-3384, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31733791

RESUMO

OBJECTIVE: To study patient survival and glycemic control before and after lung transplantation (LTx) according to the diabetes status in patients submitted to an organized management of diabetes mellitus (DM) at the Strasbourg University Hospital, France. MATERIAL AND METHODS: Two hundred and sixty-seven LTx recipients were included retrospectively and analyzed according to diabetes status: pretransplant diabetes, new-onset diabetes mellitus after transplant (NODAT) or no diabetes. Organized DM management was coordinated by a diabetologist trained in DM management before and after transplantation and included pretransplant screening, a close monitoring of glycemia after transplant and optimized treatment before and after LTx. RESULTS: DM was well-controlled after transplantation: mean glycosylated hemoglobin and fasting blood glucose levels after LTx were 5.8 ± 0.2% and 5.4 ± 0.1 mmol/L respectively, in pretransplant DM patients and 5.7 ± 0.1% and 5.6 ± 0.2 mmol/L respectively, in NODAT patients. The overall median survival time was 8.3 ± 1.9 years. Pretransplant DM increased the risk of mortality (1.82-fold increase; 95% confidence interval, 1.08-3.06; P = .02) in LTx recipients. CONCLUSIONS: Organized management of diabetes achieved very satisfactory glycemic control in both pretransplant DM and NODAT patients. However, no specific protocols have been created for managing DM following LTx. As DM continues to become an increasing comorbidity in LTx, there exist a significant need of studies in this area.


Assuntos
Glicemia/análise , Diabetes Mellitus/sangue , Hemoglobina A Glicada/análise , Transplante de Pulmão/mortalidade , Complicações Pós-Operatórias/sangue , Adulto , Diabetes Mellitus/etiologia , Diabetes Mellitus/mortalidade , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco
14.
Open Forum Infect Dis ; 6(9): ofz308, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31660397

RESUMO

Background: Infective endocarditis (IE) remains a severe disease with a high mortality rate. Therefore, guidelines encourage the setup of a multidisciplinary group in reference centers. The present study evaluated the impact of this "Endocarditis Team" (ET). Methods: We conducted a monocentric observational study at Strasbourg University Hospital, Strasbourg, France, between 2012 and 2017. The primary end point was in-hospital mortality. Secondary end points were 6-month and 1-year mortality, surgery rate, time to surgical procedure, duration of effective antibiotic therapy, length of in-hospital stay, and sequelae. We also assessed predictors of in-hospital mortality. Results: We analyzed 391 episodes of IE. In the post-ET period, there was a nonsignificant decrease in in-hospital mortality (20.3% vs 14.7%, respectively; P = .27) and sequelae, along with a significant reduction in time to surgery (16.4 vs 10.3 days, respectively; P = .049), duration of antibiotic therapy (55.2 vs 47.2 days, respectively; P < .001), and length of in-hospital stay (40.6 vs 31.9 days, respectively; P < .01). In a multivariate analysis, the post-ET period was positively associated with survival (odds ratio, 0.45; 95% confidence interval, 0.20-0.96; P = .048). Conclusions: This multidisciplinary approach exerted a positive impact on the management of IE and should be considered in all hospitals managing IE.

15.
Orthop Traumatol Surg Res ; 105(6): 1137-1141, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31471259

RESUMO

INTRODUCTION: In routine practice, it is often necessary to use shorter screws in L5 than L4. The present study measured L5 versus L4 vertebral pedicles, to guide surgical strategy. MATERIAL AND METHOD: CT or MRI scans for 95 patients were analyzed. Radiographic measurements (anteroposterior diameter (APD), pedicle length (PL) and pedicle width (PW)) were taken by a spine surgeon. Statistical analysis used R 3.4.3 software. RESULTS: Ninety-five patients were included: 48 female (50.53%), 47 male (49.47%); mean age, 57 years (range, 19-85 years). Univariate analysis found a strong correlation between right and left PL values in L4 and L5. Right and left values were pooled, obtaining a mean L4 PL of 55.34mm (range, 54.23-56.45mm) and L5 PL of 51.80mm (44.81-58.80) and L4 PW of 10.48mm (10.06-10.91) and L5 PW of 9.90mm (7.43-12.39). Multivariate analysis disclosed significant effects of age and gender, with greater age and male gender associated with greater anteroposterior vertebral diameter. Mean anteroposterior vertebral length was significantly shorter in L5 than L4 by 3.57mm (range, 4.08-3.06mm). DISCUSSION: Anteroposterior pedicle length was shorter in L5 than L4, in line with the literature. This answers the surgeon's question: "Should pedicle screws be shorter in L5 than L4?". From these results, it seems logical to use an L5 screw that is 5mm shorter than in L4, to secure good intra-body screw fixation.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Parafusos Pediculares , Radiografia/métodos , Fusão Vertebral/métodos , Osteofitose Vertebral/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Variação Anatômica , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteofitose Vertebral/cirurgia , Adulto Jovem
16.
Behav Processes ; 168: 103944, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31472169

RESUMO

In the terrestrial crustacean Armadillidium vulgare, a large size range exists in natural populations within which males and females could potentially mate. Because of continuous growth far beyond sexual maturity, the largest individuals can be nearly ten times the live mass of the smallest sexually mature individuals. In this study, we explored the influence of male and female body mass on the mating behaviour and success. Starting with a representative panel of males and females in which females are significantly larger than males in average, we followed the sexual behaviour of 23 groups of 20 mixed-sex virgin animals under conditions comparable with natural field situation during the early breeding season. We found a correlation between paired individuals showing an assortative pairing. During pairing male stimulates female and duration of stimulation is determinant for pairing follow-up: efficient stimulation is correlated with female size and not with male size. In consequence, pairs in mating show a reversed size dimorphism between male and female where female are about 20% smaller. Largest females were not mated. During copulation behaviour, the quantity of sperm transferred is positively correlated with copulation duration. Stored sperm can be used for immediate breeding by the female and stored in the spermatheca for future breeding. The last option allows to largest females in the field to continue breeding without additional mating, avoiding the lack of availability of large males able to stimulate them efficiently.


Assuntos
Tatus/crescimento & desenvolvimento , Peso Corporal , Impulso (Psicologia) , Comportamento Sexual Animal , Animais , Tamanho Corporal , Correlação de Dados , Feminino , Masculino , Fatores Sexuais , Comportamento Sexual Animal/fisiologia , Contagem de Espermatozoides
17.
Presse Med ; 48(7-8 Pt 1): e209-e215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31421945

RESUMO

AIM: Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP. METHOD: This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented. RESULTS: From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care. PERSPECTIVE: This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey.


Assuntos
Continuidade da Assistência ao Paciente , Unidades Hospitalares/organização & administração , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Padrões de Prática Médica , Qualidade da Assistência à Saúde/organização & administração , Adulto , Atitude do Pessoal de Saúde , Cuidadores/organização & administração , Cuidadores/normas , Barreiras de Comunicação , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Arquitetura de Instituições de Saúde/normas , França , Conhecimentos, Atitudes e Prática em Saúde , Número de Leitos em Hospital , Unidades Hospitalares/normas , Humanos , Entrevistas como Assunto , Satisfação no Emprego , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Equipe de Assistência ao Paciente/normas , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Estudos Retrospectivos , Inquéritos e Questionários
18.
Nat Immunol ; 20(8): 1059-1070, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31308541

RESUMO

Dysfunction of virus-specific CD4+ T cells in chronic human infections is poorly understood. We performed genome-wide transcriptional analyses and functional assays of CD4+ T cells specific for human immunodeficiency virus (HIV) from HIV-infected people before and after initiation of antiretroviral therapy (ART). A follicular helper T cell (TFH cell)-like profile characterized HIV-specific CD4+ T cells in viremic infection. HIV-specific CD4+ T cells from people spontaneously controlling the virus (elite controllers) robustly expressed genes associated with the TH1, TH17 and TH22 subsets of helper T cells. Viral suppression by ART resulted in a distinct transcriptional landscape, with a reduction in the expression of genes associated with TFH cells, but persistently low expression of genes associated with TH1, TH17 and TH22 cells compared to the elite controller profile. Thus, altered differentiation is central to the impairment of HIV-specific CD4+ T cells and involves both gain of function and loss of function.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Expressão Gênica/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Células Th1/patologia , Células Th17/patologia , Perfilação da Expressão Gênica , Infecções por HIV/virologia , Humanos , Receptores CXCR5/metabolismo , Células Th1/citologia , Células Th1/imunologia , Células Th17/citologia , Células Th17/imunologia , Carga Viral/efeitos dos fármacos , Replicação Viral/efeitos dos fármacos
19.
J Gynecol Obstet Hum Reprod ; 48(8): 657-662, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31276845

RESUMO

OBJECTIVE: The objective of this study was to determine the prevalence and identify risk factors for obstetric anal sphincter injuries (OASIS), and to determine the prevalence of episiotomy and whether it is protective for the posterior perineum. STUDY DESIGN: This is a retrospective case-control study carried out in a level 2 maternity unit and a level 3 maternity unit between 1 January 2006 and 31 December 2015. The sample population included all vaginal deliveries at term of a living singleton foetus in cephalic presentation. The case group comprised patients with an OASIS. The control group comprised patients without OASIS. Statistical analysis was subdivided into descriptive and inferential parts. RESULTS: 42,626 patients were included in the study of whom 496 were cases of OASIS, i.e. a rate of 1.2%. The overall episiotomy rate was 10.0%, which reflects a restrictive practice. Episiotomy doesn't appear to be a statistically significant protective factor for OASIS (OR=0.89-95%CI [0.68-1.16]). The principal independent risk factors for OASIS were nulliparity (ORa=4.19-95%CI [3.03-5.84] - p<0.001), previous caesarean (ORa=5.59-95%CI [3.68-8.44] - p<0.001), uterine fundal height greater than 32cm (ORa=1.35-95%CI [1.03-1.77] - p=0.03), gestational or pre-pregnancy diabetes (ORa=1.76-95%CI [1.22-2.46] - p=0.002), birthweight of more than 3500g (ORa=1.48-95%CI [1.17-1.87] - p=0.001), assisted delivery (ORa=1.81-95%CI [1.18-2.86] - p=0.007), and use of a second instrument or obstetrical manoeuvre (ORa=1.93-95%CI [1.05-3.30] - p=0.02). CONCLUSION: Episiotomy doesn't appear to be a statistically significant protective factor on the perineal prognosis. A deeper understanding of the factors which promote OASIS and greater awareness of them would improve the perineal prognosis of parturient women.


Assuntos
Canal Anal/lesões , Parto Obstétrico/efeitos adversos , Parto Obstétrico/estatística & dados numéricos , Episiotomia/estatística & dados numéricos , Lacerações/epidemiologia , Complicações do Trabalho de Parto , Adulto , Canal Anal/cirurgia , Peso ao Nascer/fisiologia , Índice de Massa Corporal , Episiotomia/métodos , Feminino , Humanos , Recém-Nascido , Lacerações/etiologia , Lacerações/prevenção & controle , Masculino , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/prevenção & controle , Paridade/fisiologia , Períneo/lesões , Períneo/cirurgia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/cirurgia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
20.
Gigascience ; 8(6)2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31185495

RESUMO

BACKGROUND: With the decreasing cost of sequencing and the rapid developments in genomics technologies and protocols, the need for validated bioinformatics software that enables efficient large-scale data processing is growing. FINDINGS: Here we present GenPipes, a flexible Python-based framework that facilitates the development and deployment of multi-step workflows optimized for high-performance computing clusters and the cloud. GenPipes already implements 12 validated and scalable pipelines for various genomics applications, including RNA sequencing, chromatin immunoprecipitation sequencing, DNA sequencing, methylation sequencing, Hi-C, capture Hi-C, metagenomics, and Pacific Biosciences long-read assembly. The software is available under a GPLv3 open source license and is continuously updated to follow recent advances in genomics and bioinformatics. The framework has already been configured on several servers, and a Docker image is also available to facilitate additional installations. CONCLUSIONS: GenPipes offers genomics researchers a simple method to analyze different types of data, customizable to their needs and resources, as well as the flexibility to create their own workflows.


Assuntos
Genômica/métodos , Software , Metilação de DNA , Epigenômica/métodos , Humanos , Metagenômica/métodos , Análise de Sequência de DNA/métodos , Análise de Sequência de RNA/métodos
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