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1.
Bone Joint J ; 101-B(11): 1392-1401, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31674241

RESUMO

AIMS: The aim of this study was to estimate the cost-effectiveness of negative-pressure wound therapy (NPWT) in comparison with standard wound management after initial surgical wound debridement in adults with severe open fractures of the lower limb. PATIENTS AND METHODS: An economic evaluation was conducted from the perspective of the United Kingdom NHS and Personal Social Services, based on evidence from the 460 participants in the Wound Management of Open Lower Limb Fractures (WOLLF) trial. Economic outcomes were collected prospectively over the 12-month follow-up period using trial case report forms and participant-completed questionnaires. Bivariate regression of costs (given in £, 2014 to 2015 prices) and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained associated with NPWT dressings. Sensitivity and subgroup analyses were undertaken to assess the impacts of uncertainty and heterogeneity, respectively, surrounding aspects of the economic evaluation. RESULTS: The base case analysis produced an incremental cost-effectiveness ratio of £267 910 per QALY gained, reflecting higher costs on average (£678; 95% confidence interval (CI) -£1082 to £2438) and only marginally higher QALYS (0.002; 95% CI -0.054 to 0.059) in the NPWT group. The probability that NPWT is cost-effective in this patient population did not exceed 27% regardless of the value of the cost-effectiveness threshold. This result remained robust to several sensitivity and subgroup analyses. CONCLUSION: This trial-based economic evaluation suggests that NPWT is unlikely to be a cost-effective strategy for improving outcomes in adult patients with severe open fractures of the lower limb. Cite this article: Bone Joint J 2019;101-B:1392-1401.


Assuntos
Ossos da Extremidade Inferior/lesões , Fraturas Expostas/economia , Tratamento de Ferimentos com Pressão Negativa/economia , Adolescente , Adulto , Idoso , Análise Custo-Benefício , Utilização de Instalações e Serviços , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Anos de Vida Ajustados por Qualidade de Vida , Reoperação/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
2.
Bone Joint J ; 101-B(6): 708-714, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154849

RESUMO

AIMS: This study sought to determine the proportion of older adults with hip fractures captured by a multicentre prospective cohort, the World Hip Trauma Evaluation (WHiTE), whether there was evidence of selection bias during WHiTE recruitment, and the extent to which the WHiTE cohort is representative of the broader population of older adults with hip fractures. PATIENTS AND METHODS: The characteristics of patients recruited into the WHiTE cohort study were compared with those treated at WHiTE hospitals during the same timeframe and submitted to the National Hip Fracture Database (NHFD). RESULTS: Patients recruited to WHiTE were more likely to be admitted from their own home (83.5% vs 80.2%; p < 0.001) and to have a higher median Abbreviated Mental Test Score (AMTS) (9 (interquartile range (IQR) 6 to 10) vs 9 (IQR 5 to 10); p < 0.001) than those who were not recruited. In terms of WHiTE cohort generalizability, participating hospitals included a greater proportion of Major Trauma Centres (47.8% vs 7.8%) and large hospitals (997 (IQR 873 to 1290) vs 707 (459 to 903) beds) with high-volume Emergency Departments (median annual attendances of 43 981 (IQR 37 147 to 54 385) vs 35 964 (IQR 26 229 to 50 551)). However, there were few differences in baseline characteristics between patients in the WHiTE cohort and those recorded in the NHFD. CONCLUSION: There is evidence of a weak selection bias towards recruiting fitter patients within the WHiTE cohort, which will help to put into context the findings of future studies. We conclude that the patients within the WHiTE cohort are representative of the national population of older adults with hip fractures throughout England, Wales, and Northern Ireland. Cite this article: Bone Joint J 2019;101-B:708-714.


Assuntos
Fraturas do Quadril/epidemiologia , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Estudos Prospectivos , Reino Unido/epidemiologia
3.
Br J Anaesth ; 122(1): 141-149, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30579393

RESUMO

BACKGROUND: Previous studies suggest that dexmedetomidine has a protective effect against local anaesthetic-induced nerve injury in regional nerve blocks. Whether this potentially protective effect exists in the context of diabetes mellitus is unknown. METHODS: A diabetic state was established in adult male Sprague-Dawley rats with intraperitoneal injection of streptozotocin. Injections of ropivacaine 0.5%, dexmedetomidine 20 µg kg-1 (alone and in combination), or normal saline (all in 0.2 ml) were made around the sciatic nerve in control and diabetic rats (n=8 per group). The duration of sensory and motor nerve block and the motor nerve conduction velocity (MNCV) were determined. Sciatic nerves were harvested at post-injection day 7 and assessed with light and electron microscopy or used for pro-inflammatory cytokine measurements. RESULTS: Ropivacaine and dexmedetomidine alone or in combination did not produce nerve fibre damage in control non-diabetic rats. In diabetic rats, ropivacaine induced significant nerve fibre damage, which was enhanced by dexmedetomidine. This manifested with slowed MNCV, decreased axon density, and decreased ratio of inner to outer diameter of the myelin sheath (G ratio). Demyelination, axon disappearance, and empty vacuoles were also found using electron microscopy. An associated increase in nerve interleukin-1ß and tumour necrosis factor-α was also seen. CONCLUSIONS: Ropivacaine 0.5% causes significant sciatic nerve injury in diabetic rats that is greatly potentiated by high-dose dexmedetomidine. Although the dose of dexmedetomidine used in this study is considerably higher than that used in clinical practice, our data suggest that further studies to assess ropivacaine (alone and in combination with dexmedetomidine) use for peripheral nerve blockade in diabetic patients are warranted.


Assuntos
Anestésicos Locais/toxicidade , Dexmedetomidina/toxicidade , Diabetes Mellitus Experimental/complicações , Traumatismos dos Nervos Periféricos/induzido quimicamente , Ropivacaina/toxicidade , Nervo Isquiático/efeitos dos fármacos , Adjuvantes Anestésicos/toxicidade , Animais , Citocinas/biossíntese , Diabetes Mellitus Experimental/fisiopatologia , Neuropatias Diabéticas/etiologia , Neuropatias Diabéticas/fisiopatologia , Sinergismo Farmacológico , Mediadores da Inflamação/metabolismo , Masculino , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Condução Nervosa/efeitos dos fármacos , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Ratos Sprague-Dawley , Nervo Isquiático/lesões
4.
Bone Joint J ; 100-B(11): 1506-1510, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30418053

RESUMO

AIMS: The aim of this study was to estimate economic outcomes associated with deep surgical site infection (SSI) in patients with an open fracture of the lower limb. PATIENTS AND METHODS: A total of 460 patients were recruited from 24 specialist trauma hospitals in the United Kingdom Major Trauma Network. Preference-based health-related quality-of-life outcomes, assessed using the EuroQol EQ-5D-3L and the 6-Item Short-Form Health Survey questionnaire (SF-6D), and economic costs (£, 2014/2015 prices) were measured using participant-completed questionnaires over the 12 months following injury. Descriptive statistics and multivariate regression analysis were used to explore the relationship between deep SSI and health utility scores, quality-adjusted life-years (QALYs), and health and personal social service (PSS) costs. RESULTS: Deep SSI was associated with lower EQ-5D-3L derived QALYs (adjusted mean difference -0.102, 95% confidence interval (CI) -0.202 to 0.001, p = 0.047) and increased health and social care costs (adjusted mean difference £1950; 95% CI £1383 to £5285, p = 0.250) versus patients without deep SSI over the 12 months following injury. CONCLUSION: Deep SSI may lead to significantly impaired health-related quality of life and increased economic costs. Our economic estimates can be used to inform clinical and budgetary service planning and can act as reference data for future economic evaluations of preventive or treatment interventions. Cite this article: Bone Joint J 2018;100-B:1506-10.


Assuntos
Fraturas Expostas/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Extremidade Inferior/lesões , Infecção da Ferida Cirúrgica/economia , Adulto , Análise Custo-Benefício , Feminino , Fixação de Fratura/economia , Fraturas Expostas/epidemiologia , Fraturas Expostas/reabilitação , Fraturas Expostas/cirurgia , Humanos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Medicina Estatal/economia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/reabilitação , Reino Unido/epidemiologia
5.
J Environ Manage ; 224: 69-76, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30031920

RESUMO

Flood Risk Management (FRM) is often essential to reduce the risk of flooding to properties and infrastructure in urban landscapes, but typically degrades the habitats required by many aquatic animals for foraging, refuge and reproduction. This conflict between flood risk management and biodiversity is driven by conflicting directives, such as the EU Floods and Water Framework Directives, and has led to a requirement for synergistic solutions for FRM that integrate river restoration actions. Unfortunately, ecological monitoring and appraisal of combined FRM and river restoration works is inadequate. This paper uses a case study from the River Don in Northern England to evaluate the effects of the FRM and subsequent river restoration works on instream habitat and the associated fish assemblage over an 8-year period. Flood risk management created a homogeneous channel but did not negatively affect fish species composition or densities, specifically brown trout. Densities of adult brown trout were comparable pre and post-FRM, while densities of juvenile bullhead and brown trout increased dramatically post FRM. River restoration works created a heterogeneous channel but did not significantly improve species composition or brown trout density. Species composition post-river restoration works returned to that similar to pre-FRM over a short-term period, but with improved numbers of juvenile bullhead. Although habitat complexity increased after river restoration works, long-term changes in species composition and densities were marginal, probably because the river reset habitat complexity within the time framework of the study.


Assuntos
Inundações , Gestão de Riscos , Animais , Ecossistema , Inglaterra , Peixes , Rios
6.
Skin Res Technol ; 24(4): 642-649, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29736996

RESUMO

BACKGROUND: The purpose of this research is to characterize the effects of mouthwash solutions on oral friction and moisture using a quantitative in vitro approach. MATERIALS AND METHODS: The frictional coefficient of in vitro porcine tongue samples was measured using a magnetic levitation haptic device equipped with a custom tactor designed to mimic human skin. A commercially available moisture meter was used to measure moisture content of the samples. Tongue samples were first tested before treatment, then after application of saliva (either human or artificial), and again after application of 1 of 11 different mouthwash solutions. RESULTS: The data indicate that the samples treated with artificial saliva vs real saliva have comparable friction coefficient and moisture content. Furthermore, the moisture and friction coefficient remain relatively constant for up to 60 minutes after exposure to ambient conditions. Samples treated with artificial saliva have an average friction coefficient in the range of 0.70-0.80. Application of mouthwash solutions produced an average friction coefficient of 0.39-0.49 but retained the high moisture content of the artificial salivary layer. Several mouthwash solutions resulted in statistically significant differences in the friction coefficient relative to each other. CONCLUSION: The results of this study demonstrate that a magnetic levitation device can be an effective tool for in vitro oral tribology and that artificial saliva is an effective substitute for real saliva in extended in vitro experiments. The application of mouthwash generally reduces the coefficient of friction of the tongue samples while preserving a relatively high moisture level, and some mouthwashes reduce friction significantly more than others.


Assuntos
Fricção , Antissépticos Bucais/farmacologia , Saliva Artificial/farmacologia , Saliva/fisiologia , Língua/fisiologia , Animais , Técnicas In Vitro , Suínos , Língua/efeitos dos fármacos
8.
Oncogene ; 35(8): 1066-72, 2016 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-25982277

RESUMO

Semaphorins and their receptors plexins have diverse roles in many cancers affecting tumour growth, metastasis and angiogenesis. Plexin-B1, the receptor for semaphorin4D (Sema4D), has been implicated in prostate cancer where mutation of the gene and overexpression of the protein occur. It is not clear, however, as to which of the several Sema4D-activated signalling pathways downstream of plexin-B1 function in prostate cancer progression. We show here that Sema4D/plexin-B1 increases the expression of androgen-responsive genes and activates the transcriptional activity of the androgen receptor (AR). Activation of plexin-B1 results in phosphorylation of AR at Serine 81, a site that is phosphorylated by nuclear kinases. Cell fractionation and immunocytochemistry studies demonstrated that the proportion of cells with AR in the nucleus increases significantly upon Sema4D treatment. The N-terminal (AF-1) domain of AR, which contains binding sites for transcription regulators, is not required for this response. Depletion of AR suppressed Sema4D-induced anchorage-independent growth of LNCaP and LNCaP-LN3 cells, demonstrating the functional significance of these findings. These results show that Sema4D/plexin-B1 signalling promotes the translocation of AR to the nucleus and thereby enhances AR transcriptional activity. Plexin-B1 is therefore a promising target for cancer therapy, especially in low androgen situations such as those imposed by androgen deprivation therapy.


Assuntos
Núcleo Celular/metabolismo , Proteínas do Tecido Nervoso/metabolismo , Neoplasias da Próstata/metabolismo , Receptores Androgênicos/metabolismo , Receptores de Superfície Celular/metabolismo , Antígenos CD/metabolismo , Expressão Gênica , Genes erbB-2 , Humanos , Masculino , Semaforinas/metabolismo , Transdução de Sinais , Células Tumorais Cultivadas
9.
Skin Res Technol ; 22(1): 115-27, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26037842

RESUMO

BACKGROUND/PURPOSE: Skin products such as shower gels have a direct impact on skin health and wellness. Although qualitative haptic characterization through explicit, verbal measures in consumer studies are often sufficient for general comparison on consumer perceived skin feel, a quantitative approach is desired to characterize minute changes in skin condition in response to various skin products. Prior research has sought to characterize the haptic properties of human skin in vitro and in vivo, but very few studies have compared the haptic effects of commercial skin products having relatively similar formulations. In addition, related studies have typically utilized simple, low-precision devices and fixtures. The purpose of this study was to use a precision magnetic levitation haptic device to characterize the frictional properties of human skin in vivo before, during, and after treatment with commercially available shower gels, to capture the entire cycle of consumer experience on skin feel. METHODS: A hybrid force-position control algorithm was used to control a precision magnetic levitation haptic device with silicone tactor to stroke the human skin (on the volar forearm) in vivo. Position and force data were collected from 32 human subjects using eight different commercially available shower gels, while stroking the skin before, during, and after treatment. The data were analyzed to produce coefficients of friction and viscous damping constant, which were used as metrics for comparing the effects of each shower gel type. Other factors investigated include skin test location, order, and subject age and gender. RESULTS: Results showed significant differences between the effects of eight various shower gels, especially after accounting for variance between subjects. Most notably, Shower Gel four with high level of petrolatum, along with Shower Gels five and six with low levels of castoryl maleate (a skin lipid analog), as well as Shower Gel two with high levels of vegetable oils yielded higher skin coefficients of friction 20 min after treatment, indicating higher levels of skin hydration than other shower gels without either high levels of skin beneficial agents or low levels of castoryl maleate. Conversely, Shower Gel eight treatment yielded the lowest skin coefficient of friction both immediately after rinsing and 20 min after treatment. In addition, when applied to the skin as un-lathered gels, Shower Gels six and seven with acrylate polymers yielded viscous damping constants twice that of other gels, while Shower Gel three yielded the lowest. When lathered into foam on skin, Shower Gel eight yielded the highest viscous damping constant, while Shower Gel three, along with Shower Gels one and five yielded lower values than others. CONCLUSION: The results of this study show that different shower gels do have significant measurable differences in their effects on skin properties, and that using a high-precision haptic device can be a useful tool for quantifying the haptic properties of skin in vivo.


Assuntos
Fricção , Géis/administração & dosagem , Magnetismo/instrumentação , Estimulação Física/instrumentação , Fenômenos Fisiológicos da Pele/efeitos dos fármacos , Sabões/administração & dosagem , Administração Cutânea , Adolescente , Adulto , Banhos , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Imãs , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Tato , Viscosidade , Adulto Jovem
10.
Bone Joint Res ; 4(11): 181-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26585304

RESUMO

OBJECTIVES: We wanted to investigate regional variations in the organisms reported to be causing peri-prosthetic infections and to report on prophylaxis regimens currently in use across England. METHODS: Analysis of data routinely collected by Public Health England's (PHE) national surgical site infection database on elective primary hip and knee arthroplasty procedures between April 2010 and March 2013 to investigate regional variations in causative organisms. A separate national survey of 145 hospital Trusts (groups of hospitals under local management) in England routinely performing primary hip and/or knee arthroplasty was carried out by standard email questionnaire. RESULTS: Analysis of 189 858 elective primary hip and knee arthroplasty procedures and 1116 surgical site infections found statistically significant variations for some causative organism between regions. There was a 100% response rate to the prophylaxis questionnaire that showed substantial variation between individual trust guidelines. A number of regimens currently in use are inconsistent with the best available evidence. CONCLUSIONS: The approach towards antibiotic prophylaxis in elective arthroplasty nationwide reveals substantial variation without clear justification. Only seven causative organisms are responsible for 89% of infections affecting primary hip and knee arthroplasty, which cannot justify such widespread variation between prophylactic antibiotic policies. Cite this article: Bone Joint Res 2015;4:181-189.

12.
Br J Cancer ; 111(6): 1021-46, 2014 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-25117809

RESUMO

Cell-line misidentification and contamination with microorganisms, such as mycoplasma, together with instability, both genetic and phenotypic, are among the problems that continue to affect cell culture. Many of these problems are avoidable with the necessary foresight, and these Guidelines have been prepared to provide those new to the field and others engaged in teaching and instruction with the information necessary to increase their awareness of the problems and to enable them to deal with them effectively. The Guidelines cover areas such as development, acquisition, authentication, cryopreservation, transfer of cell lines between laboratories, microbial contamination, characterisation, instability and misidentification. Advice is also given on complying with current legal and ethical requirements when deriving cell lines from human and animal tissues, the selection and maintenance of equipment and how to deal with problems that may arise.


Assuntos
Pesquisa Biomédica/normas , Linhagem Celular/microbiologia , Equipamentos e Provisões/normas , Mycoplasma , Segurança/normas , Animais , Pesquisa Biomédica/ética , Linhagem Celular/classificação , Criopreservação/normas , Meios de Cultura/normas , Contaminação de Equipamentos/prevenção & controle , Instabilidade Genômica , Humanos , Mycoplasma/isolamento & purificação , Fenótipo , Controle de Qualidade , Manejo de Espécimes/métodos , Manejo de Espécimes/normas , Reino Unido
13.
Eur J Cancer Care (Engl) ; 23(2): 263-73, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24134506

RESUMO

While physical activity is beneficial for men with prostate cancer, too few perform sufficient activity for such benefit. This study examined perceptions of men with prostate cancer of their barriers and facilitators to physical activity, and how androgen deprivation therapy (ADT) may influence these perceptions. Two focus groups were conducted, involving six ADT and eight non-ADT patients respectively. Data were transcribed verbatim and themes developed using a general inductive thematic approach. Facilitators to physical activity common to both groups of cancer survivors included clinician and spousal involvement, with pre-existing co-morbidities and increased age cited as barriers by both groups. The ADT subgroup cited personal involvement as a facilitator to physical activity, with fatigue, reduced motivation and a relative lack of specific advice from their clinician as additional barriers. The non-ADT subgroup had no additional facilitators to physical activity but cited time constraints as a barrier. These results highlight the important role that cancer clinicians and spouses play in promoting physical activity for men with prostate cancer and how ADT may influence their other facilitators and barriers. As physical activity is beneficial for prostate cancer survivors, especially those on ADT, cancer clinicians should regularly discuss physical activity with their patients.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Atitude Frente a Saúde , Exercício , Fadiga , Atividade Motora , Neoplasias da Próstata/tratamento farmacológico , Fatores Etários , Idoso , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/psicologia , Pesquisa Qualitativa , Qualidade de Vida , Cônjuges
14.
Bone Joint Res ; 2(9): 200-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24049140

RESUMO

OBJECTIVES: We aimed to determine the effect of surgical approach on the histology of the femoral head following resurfacing of the hip. METHODS: We performed a histological assessment of the bone under the femoral component taken from retrieval specimens of patients having revision surgery following resurfacing of the hip. We compared the number of empty lacunae in specimens from patients who had originally had a posterior surgical approach with the number in patients having alternative surgical approaches. RESULTS: We found a statistically significant increase in the percentage of empty lacunae in retrieval specimens from patients who had the posterior approach compared with other surgical approaches (p < 0.001). CONCLUSIONS: This indicates that the vascular compromise that occurs during the posterior surgical approach does have long-term effects on the bone of the femoral head, even if it does not cause overt avascular necrosis. Cite this article: Bone Joint Res 2013;2:200-5.

15.
Folia Primatol (Basel) ; 84(3-5): 201-19, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23880733

RESUMO

Strepsirhines comprise 10 living or recently extinct families, ≥50% of extant primate families. Their phylogenetic relationships have been intensively studied, but common topologies have only recently emerged; e.g. all recent reconstructions link the Lepilemuridae and Cheirogaleidae. The position of the indriids, however, remains uncertain, and molecular studies have placed them as the sister to every clade except Daubentonia, the preferred sister group of morphologists. The node subtending Afro-Asian lorisids has been similarly elusive. We probed these phylogenetic inconsistencies using a test data set including 20 strepsirhine taxa and 2 outgroups represented by 3,543 mtDNA base pairs, and 43 selected morphological characters, subjecting the data to maximum parsimony, maximum likelihood and Bayesian inference analyses, and reconstructing topology and node ages jointly from the molecular data using relaxed molecular clock analyses. Our permutations yielded compatible but not identical evolutionary histories, and currently popular techniques seem unable to deal adequately with morphological data. We investigated the influence of morphological characters on tree topologies, and examined the effect of taxon sampling in two experiments: (1) we removed the molecular data only for 5 endangered Malagasy taxa to simulate 'extinction leaving a fossil record'; (2) we removed both the sequence and morphological data for these taxa. Topologies were affected more by the inclusion of morphological data only, indicating that palaeontological studies that involve inserting a partial morphological data set into a combined data matrix of extant species should be interpreted with caution. The gap of approximately 10 million years between the daubentoniid divergence and those of the other Malagasy families deserves more study. The apparently contemporaneous divergence of African and non-daubentoniid Malagasy families 40-30 million years ago may be related to regional plume-induced uplift followed by a global period of cooling and drying.


Assuntos
DNA Mitocondrial/genética , Filogenia , Strepsirhini/anatomia & histologia , Strepsirhini/genética , Animais , Evolução Biológica , Espécies em Perigo de Extinção , Evolução Molecular , Fósseis , Strepsirhini/classificação
16.
Ann R Coll Surg Engl ; 94(7): 476-80, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23031764

RESUMO

INTRODUCTION: The use of imaging and laparoscopy in patients with right iliac fossa pain as tools to make or exclude a diagnosis of appendicitis is at the discretion of the clinician. We sought to establish a consensus of opinion on this matter by surveying professional bodies for laparoscopic surgery in France, Italy and the US. METHODS: A survey was sent to members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the French Society for Endoscopic Surgery (SFCE) and the Italian Society for Endoscopic Surgery (SICE). The survey asked about management of both male and female patients presenting with right iliac fossa pain and what operative strategy the respondents would pursue should they find a macroscopically normal appendix at laparoscopy. RESULTS: A total of 364 responses were returned from the three groups. The responses from SAGES showed computed tomography to be the preferred modality for investigating patients with right iliac fossa pain, irrespective of sex. Both SFCE and SICE preferred the use of diagnostic laparoscopy, especially in the female patient group. The majority of all respondents stated that they would remove a macroscopically normal appendix at laparoscopy. CONCLUSIONS: Laparoscopy remains a potent tool in the management of appendicitis. However, the dilemma of when to remove a macroscopically normal appendix remains. Our study shows that removal of the appendix in this instance would be supported by an international consensus.


Assuntos
Apendicectomia , Apendicite/diagnóstico , Apendicite/cirurgia , Apêndice/cirurgia , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Apêndice/patologia , Inglaterra , Feminino , França , Pesquisas sobre Serviços de Saúde , Humanos , Laparoscopia , Masculino , Estados Unidos
17.
Int J Nurs Stud ; 48(6): 681-8, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21185559

RESUMO

BACKGROUND: Ventilator associated pneumonia remains an important concern in the intensive care unit (ICU). An increasing body of evidence shows that mortality and morbidity can be reduced by implementing a range of preventive strategies, including optimizing oral hygiene. AIM: The aim of this feasibility study was to test two oral hygiene strategies on the effects of microbial colonization of dental plaque with respiratory pathogens (primary outcome) and incidence of ventilator associated pneumonia (secondary outcome). METHODS: A single blind randomised comparative study was conducted in a 20-bed adult intensive care unit in a university hospital. Patients with an expected duration of mechanical ventilation more than 48 h were eligible. Patients were randomised to one of three study regimens (Group A control, second hourly oral rinse with sterile water, Group B sodium bicarbonate mouth wash second hourly, and Group C twice daily irrigations with chlorhexidine 0.2% aqueous oral rinse and second hourly irrigations with sterile water). All study options included cleaning with a toothbrush and non foaming toothpaste. RESULTS: Data from a total of 109 patients were analyzed. Group A 43, Group B 33 and Group C 33 (mean age: 58 ± 17 years, simplified acute physiology score II: 44 ± 14 points). On admission no significant differences were found between groups for all clinical data. While Group B showed a greater trend to reduction in bacterial colonization no significant differences could be demonstrated at Day 4 of admission (p=0.302). The incidence of ventilator associated pneumonia was evenly spread between Groups B and C (5%) while Group A was only 1%. CONCLUSIONS: While a number of studies have advocated the use of various mouth rinses in reducing colonization of dental plaque a standardized oral hygiene protocol which includes the use of mechanical cleaning with a toothbrush may be a factor in the reduction of colonization of dental plaque with respiratory pathogens. This feasibility study provides data to inform future adequately powered studies.


Assuntos
Bactérias/crescimento & desenvolvimento , Boca/microbiologia , Higiene Bucal , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Respiração Artificial , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/microbiologia
18.
Prostate ; 71(6): 649-58, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-20949546

RESUMO

BACKGROUND: Class 3 semaphorins are secreted proteins that act as guidance cues for migrating cells via their transmembrane receptors plexins and neuropilins. Semaphorins have a role in cancer affecting tumor progression both directly, and indirectly by affecting angiogenesis. METHODS: The expression of semaphorins and their receptors in prostate cancer cell lines and tissue was determined by RT-PCR, Western blotting and immunohistochemistry. The effect of Sema3E on prostate cancer cell lines was determined by adhesion assays and transwell migration assays. RESULTS: Semaphorins and their receptors, plexins and neuropilins, are widely co-expressed in prostate cancer cell lines and tissue with a significant overexpression of Sema3E in tumor tissue. Sema3E affected integrin-mediated adhesion to fibronectin of prostate cancer cells, and inhibited their motility. Expression of Sema3C was upregulated and Sema3A and Sema3E were down regulated in prostate cells by hypoxia, consistent with an additional role for Sema3A and 3E as anti-angiogenic factors in prostate cancer. CONCLUSIONS: Semaphorin 3E is aberrantly expressed in prostate cancer and affects adhesion and motility of prostate cancer cells, indicating a role for the Sema3E/PlexinD1 signaling pathway in prostate cancer and identifying a new possible target for therapy.


Assuntos
Moléculas de Adesão Celular/biossíntese , Proteínas do Tecido Nervoso/biossíntese , Neuropilinas/biossíntese , Neoplasias da Próstata/metabolismo , Semaforinas/biossíntese , Adesão Celular/fisiologia , Moléculas de Adesão Celular/genética , Moléculas de Adesão Celular/metabolismo , Linhagem Celular Tumoral , Movimento Celular/fisiologia , Humanos , Imuno-Histoquímica , Masculino , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , Neuropilinas/genética , Neuropilinas/metabolismo , Neoplasias da Próstata/genética , Neoplasias da Próstata/patologia , RNA Neoplásico/química , RNA Neoplásico/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Semaforinas/genética , Semaforinas/metabolismo , Transdução de Sinais
19.
HIV Med ; 10(4): 253-6, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19187173

RESUMO

OBJECTIVE: The aim of the study was to describe the characteristics of young people with vertically acquired HIV diagnosed aged > or =13 years. METHODS: A retrospective review of HIV diagnoses reported to well-established national paediatric and adult HIV surveillance systems in the United Kingdom/Ireland was conducted. RESULTS: Forty-two young people with vertically acquired HIV diagnosed aged > or =13 years were identified; 23 (55%) were female, 40 (95%) were black African and 36 (86%) were born in sub-Saharan Africa. The median age at HIV diagnosis was 14 years (range, 13-20 years). Half of the patients presented with symptoms; the remainder were screened for HIV following diagnosis of a relative. The median CD4 count at diagnosis was 210 cells/microL (range, 0-689 cells/microL), 12 patients (29%) were diagnosed with AIDS at HIV diagnosis or subsequently, and 34 (81%) started combination antiretroviral therapy (ART), most (31 of 34) within a year of diagnosis. CONCLUSION: A small number of young people with vertically acquired HIV survive childhood without ART and are diagnosed at age > or =13 years in the United Kingdom/Ireland. Half of the patients were asymptomatic, highlighting the importance of considering HIV testing for all offspring of HIV-infected women, regardless of age or symptoms. Increased awareness among clinicians and parents is required to reduce delayed presentation with advanced disease and to avoid onward transmission as these young people become sexually active.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Infecções por HIV/transmissão , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Vigilância da População , Adolescente , África ao Sul do Saara/etnologia , Grupo com Ancestrais do Continente Africano , Distribuição por Idade , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Irlanda/epidemiologia , Masculino , Estudos Retrospectivos , Reino Unido/epidemiologia , Adulto Jovem
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