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1.
Int J Orthop Trauma Nurs ; 30: 31-38, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29934253

RESUMO

BACKGROUND: Nurses are involved in delivering care for patients following acute traumatic spinal cord injury throughout the entire care journey. An injury of this type is significant for the individual and their family and can be challenging for nurses delivering care for patients with life changing injuries, especially for nurses new to this setting. There is a lack of research that examines the experience of nurses caring for these patients in the acute setting. METHOD: A hermeneutic phenomenological approach was used to understand the experience of nurses caring for patients in the acute setting who had sustained a traumatic spinal injury with associated neurological deficit. Using the phenomenological approach guided by the insight of Gadamer and Max Van Manen, participants with a broad range of experience were recruited and interviewed. The responses were transcribed into a text and subjected to hermeneutic analysis. Burnard's (1991) 14-step process and the hermeneutic approach were used to interpret and understand the phenomenon of interest. CONCLUSION: The study highlights the experience and challenges of providing care to these individuals. Although patients had significant physical disabilities and were often dependent physically, the nurses' concerns were directed more towards fulfilling their psychological needs. Nurses identified grieving patients and felt their role was to provide realistic hope to motivate them. They felt an internal tension regarding desensitisation towards their patients, but this was often an internal protective mechanism to deal with the significance of the events surrounding these patients. Nurses new to this setting took time to learn the routines and manage the unique challenges effectively. Caring for these patients gave the nurses the opportunity to understand their patients and their families, and appreciate that both groups will fluctuate in their behavior throughout the acute process, as they adjust to grief and loss.


Assuntos
Atitude do Pessoal de Saúde , Recursos Humanos de Enfermagem no Hospital , Padrões de Prática em Enfermagem , Traumatismos da Medula Espinal/enfermagem , Humanos , Entrevistas como Assunto
2.
Vet Res Commun ; 42(1): 19-27, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29204821

RESUMO

Equine grass sickness (EGS) (equine dysautonomia) is a neurodegenerative condition of grazing equines. Pre-mortem diagnosis of EGS is a challenge for practitioners as definitive diagnosis requires ileal/myenteric lymph node biopsies. This study aimed to develop a clinical score that could be used by practitioners to improve the detection of acute or subacute EGS cases in the field. Suspected EGS cases were declared by veterinary practitioners. A case was classified as confirmed positive if ileal or rectal biopsy samples showed neuronal degeneration typical of EGS. A semi-quantitative scoring system, including epidemiological and clinical data, was created to attempt to classify suspected EGS horses into confirmed positive or negative cases. Each variable was weighted based on a boosted regression trees model, while taking into account its clinical relevance. Twenty-eight EGS cases were confirmed by biopsy during the entire study period. The best cut-off value for the score to have a high sensitivity while maximizing specificity was 8, with a sensitivity of 100% and a specificity of 53%. In our dataset, 77% of animals would be correctly classified with this cut-off value of 8. Highest sensitivity was chosen in order to detect the highest number of potential cases. Our score represents an inexpensive and useful tool to aid in the identification of suspected EGS cases in the field and selection for further diagnostics procedures to confirm or rule out the disease. Application of the score to larger populations of animals would be required to further adapt and refine the score.


Assuntos
Doenças dos Cavalos/diagnóstico , Disautonomias Primárias/veterinária , Medicina Veterinária/métodos , Animais , Cavalos , Disautonomias Primárias/diagnóstico , Sensibilidade e Especificidade
3.
Plast Surg (Oakv) ; 25(1): 48-53, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29026812

RESUMO

BACKGROUND: Plastic surgery as a discipline is poorly understood by many, including primary care physicians, nurses, medical students, and the public. These misconceptions affect the specialty in a number of ways, including referral patterns and recruitment of medical students into residency programs. The reason for these commonly held misconceptions has not yet been addressed in the plastic surgery literature. As such, we assessed medical students' knowledge and perceptions of plastic surgery as a discipline and explored factors influencing these opinions. METHODS: To assess medical students' knowledge and perceptions of plastic surgery, we conducted an online survey. A total of 231 medical students responded. Interviews were then conducted with 2 focus groups, in which we explored the survey results and reasons behind these misconceptions. RESULTS: As with previous studies, medical students showed a gap in knowledge with respect to plastic surgery. Although they were generally aware that plastic surgeons perform cosmetic procedures and treat burns, they were largely unaware that plastic surgeons perform hand and craniofacial surgeries. Focus groups revealed that television plays a large role in shaping their ideas of plastic surgery. CONCLUSION: Medical students have a skewed perception of the discipline of plastic surgery, and this is largely influenced by television. Interventions aimed at educating medical students on the matter are recommended, including a greater presence in the preclerkship medical school curriculum.

4.
Indoor Air ; 27(5): 965-976, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28303615

RESUMO

Nationally representative baseline data are presented for rare earth elements (REE), thorium (Th) and uranium (U) in house dust sampled from 1025 urban homes, in units of concentrations (µg g-1 ), loadings (µg m-2 ), and loading rates (ng m-2  d-1 ). Spearman rank correlations indicate that, in addition to outdoor sources, consumer products and building materials can influence indoor dust concentrations of REE, Th, and U. Correlations (P<.01) with numbers of occupants, dogs, and cats suggest soil track-in. Correlations (P<.01) with hardwood floors suggest release of REE additives used in pigments and coatings during daily wear and tear. Concentrations of light REE are elevated in smokers' homes compared to non-smokers' homes (P<.001), suggesting that a key source is "mischmetal," the REE alloy used in cigarette-lighter flints. Indoor sources include geological impurities in raw materials used in consumer products, such as U and Th impurities in bentonite clay used in cat litter, and REE impurities in phosphates used for a variety of applications including dog food and building materials. Median gastric bioaccessibility (pH 1.5) of most REE in dust ranges from about 20% to 29%. Household vacuum samples correlate with fresh dust samples from the same homes (P<.001 for all investigated elements).


Assuntos
Elementos da Série Actinoide/análise , Poluição do Ar em Ambientes Fechados/análise , Poeira/análise , Monitoramento Ambiental , Metais Terras Raras/análise , Animais , Canadá , Cidades , Pisos e Cobertura de Pisos , Habitação , Humanos , Animais de Estimação
5.
Artigo em Inglês | MEDLINE | ID: mdl-30074747

RESUMO

Parks after Dark is a Los Angeles County (County) program that began in 2010 as the primary prevention strategy of the County's Gang Violence Reduction Initiative. It has since evolved into a key County strategy to promote health, safety, equity, and community well-being. Led by the Department of Parks and Recreation (DPR), PAD is a collaboration of multiple County departments as well as community agencies. PAD was designed to be implemented in communities with higher rates of violence, economic hardship, and obesity. On average, PAD communities have greater levels of need across these three areas than Los Angeles County as a whole. PAD parks stay open late on Thursday, Friday, and Saturday evenings in the summer months to offer a variety of free activities for people of all ages. PAD provides recreational activities (e.g., sports clinics, exercise classes, and walking clubs), entertainment (concerts, movies, and talent shows), arts and educational programs (arts and crafts, computer classes, and cultural programs), teen clubs and activities, and health and social service resource fairs. Los Angeles County Sheriff's Department (LASD) Deputy Sheriffs patrol the parks to ensure safety during PAD and participate in activities with community members. The PAD program began in three parks in 2010. In 2012, it expanded to six parks, and in 2015 to nine parks. In 2016, the program was being implemented in 21 parks throughout Los Angeles County.


Assuntos
Promoção da Saúde/métodos , Parques Recreativos , Recreação , Doença Crônica/prevenção & controle , Redução de Custos , Exercício , Humanos , Relações Interinstitucionais , Los Angeles , Obesidade/prevenção & controle , Saúde Pública , Segurança , Socialização , Violência/prevenção & controle
6.
Environ Sci Pollut Res Int ; 24(2): 1553-1564, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27785722

RESUMO

Solubility is a critical component of physicochemical characterisation of engineered nanomaterials (ENMs) and an important parameter in their risk assessments. Standard testing methodologies are needed to estimate the dissolution behaviour and biodurability (half-life) of ENMs in biological fluids. The effect of pH, particle size and crystal form on dissolution behaviour of zinc metal, ZnO and TiO2 was investigated using a simple 2 h solubility assay at body temperature (37 °C) and two pH conditions (1.5 and 7) to approximately frame the pH range found in human body fluids. Time series dissolution experiments were then conducted to determine rate constants and half-lives. Dissolution characteristics of investigated ENMs were compared with those of their bulk analogues for both pH conditions. Two crystal forms of TiO2 were considered: anatase and rutile. For all compounds studied, and at both pH conditions, the short solubility assays and the time series experiments consistently showed that biodurability of the bulk analogues was equal to or greater than biodurability of the corresponding nanomaterials. The results showed that particle size and crystal form of inorganic ENMs were important properties that influenced dissolution behaviour and biodurability. All ENMs and bulk analogues displayed significantly higher solubility at low pH than at neutral pH. In the context of classification and read-across approaches, the pH of the dissolution medium was the key parameter. The main implication is that pH and temperature should be specified in solubility testing when evaluating ENM dissolution in human body fluids, even for preliminary (tier 1) screening.


Assuntos
Engenharia , Nanopartículas/química , Nanotecnologia , Tamanho da Partícula , Titânio/química , Óxido de Zinco/química , Meia-Vida , Humanos , Solubilidade , Temperatura Ambiente
7.
Am J Physiol Heart Circ Physiol ; 308(12): H1540-6, 2015 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-25888515

RESUMO

Hypoxia increases the heart rate response to exercise, but the mechanism(s) remains unclear. We tested the hypothesis that the tachycardic effect of hypoxia persists during separate, but not combined, inhibition of ß-adrenergic and muscarinic receptors. Nine subjects performed incremental exercise to exhaustion in normoxia and hypoxia (fraction of inspired O2 = 12%) after intravenous administration of 1) no drugs (Cont), 2) propranolol (Prop), 3) glycopyrrolate (Glyc), or 4) Prop + Glyc. HR increased with exercise in all drug conditions (P < 0.001) but was always higher at a given workload in hypoxia than normoxia (P < 0.001). Averaged over all workloads, the difference between hypoxia and normoxia was 19.8 ± 13.8 beats/min during Cont and similar (17.2 ± 7.7 beats/min, P = 0.95) during Prop but smaller (P < 0.001) during Glyc and Prop + Glyc (9.8 ± 9.6 and 8.1 ± 7.6 beats/min, respectively). Cardiac output was enhanced by hypoxia (P < 0.002) to an extent that was similar between Cont, Glyc, and Prop + Glyc (2.3 ± 1.9, 1.7 ± 1.8, and 2.3 ± 1.2 l/min, respectively, P > 0.4) but larger during Prop (3.4 ± 1.6 l/min, P = 0.004). Our results demonstrate that the tachycardic effect of hypoxia during exercise partially relies on vagal withdrawal. Conversely, sympathoexcitation either does not contribute or increases heart rate through mechanisms other than ß-adrenergic transmission. A potential candidate is α-adrenergic transmission, which could also explain why a tachycardic effect of hypoxia persists during combined ß-adrenergic and muscarinic receptor inhibition.


Assuntos
Antagonistas Adrenérgicos beta/farmacologia , Exercício , Frequência Cardíaca/efeitos dos fármacos , Hipóxia/complicações , Antagonistas Muscarínicos/farmacologia , Receptores Adrenérgicos beta/efeitos dos fármacos , Receptores Muscarínicos/efeitos dos fármacos , Taquicardia/etiologia , Adulto , Ciclismo , Débito Cardíaco , Dinamarca , Tolerância ao Exercício , Humanos , Hipóxia/metabolismo , Hipóxia/fisiopatologia , Masculino , Receptores Adrenérgicos beta/metabolismo , Receptores Muscarínicos/metabolismo , Respiração , Taquicardia/metabolismo , Taquicardia/fisiopatologia , Taquicardia/prevenção & controle , Fatores de Tempo , Adulto Jovem
8.
J Appl Physiol (1985) ; 119(10): 1194-201, 2015 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-25749449

RESUMO

High altitude (HA) exposure facilitates a rapid contraction of plasma volume (PV) and a slower occurring expansion of hemoglobin mass (Hbmass). The kinetics of the Hbmass expansion has never been examined by multiple repeated measurements, and this was our primary study aim. The second aim was to investigate the mechanisms mediating the PV contraction. Nine healthy, normally trained sea-level (SL) residents (8 males, 1 female) sojourned for 28 days at 3,454 m. Hbmass was measured and PV was estimated by carbon monoxide rebreathing at SL, on every 4th day at HA, and 1 and 2 wk upon return to SL. Four weeks at HA increased Hbmass by 5.26% (range 2.5-11.1%; P < 0.001). The individual Hbmass increases commenced with up to 12 days of delay and reached a maximal rate of 4.04 ± 1.02 g/day after 14.9 ± 5.2 days. The probability for Hbmass to plateau increased steeply after 20-24 days. Upon return to SL Hbmass decayed by -2.46 ± 2.3 g/day, reaching values similar to baseline after 2 wk. PV, aldosterone concentration, and renin activity were reduced at HA (P < 0.001) while the total circulating protein mass remained unaffected. In summary, the Hbmass response to HA exposure followed a sigmoidal pattern with a delayed onset and a plateau after ∼3 wk. The decay rate of Hbmass upon descent to SL did not indicate major changes in the rate of erythrolysis. Moreover, our data support that PV contraction at HA is regulated by the renin-angiotensin-aldosterone axis and not by changes in oncotic pressure.


Assuntos
Adaptação Fisiológica/fisiologia , Altitude , Volume Sanguíneo/fisiologia , Índices de Eritrócitos/fisiologia , Atividade Motora/fisiologia , Adulto , Feminino , Hemoglobinas/fisiologia , Humanos , Cinética , Masculino , Adulto Jovem
9.
Scand J Med Sci Sports ; 25(1): e20-7, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24646113

RESUMO

Several techniques assessing cardiac output (Q) during exercise are available. The extent to which the measurements obtained from each respective technique compares to one another, however, is unclear. We quantified Q simultaneously using four methods: the Fick method with blood obtained from the right atrium (Q(Fick-M)), Innocor (inert gas rebreathing; Q(Inn)), Physioflow (impedance cardiography; Q(Phys)), and Nexfin (pulse contour analysis; Q(Pulse)) in 12 male subjects during incremental cycling exercise to exhaustion in normoxia and hypoxia (FiO2 = 12%). While all four methods reported a progressive increase in Q with exercise intensity, the slopes of the Q/oxygen uptake (VO2) relationship differed by up to 50% between methods in both normoxia [4.9 ± 0.3, 3.9 ± 0.2, 6.0 ± 0.4, 4.8 ± 0.2 L/min per L/min (mean ± SE) for Q(Fick-M), Q(Inn), QP hys and Q(Pulse), respectively; P = 0.001] and hypoxia (7.2 ± 0.7, 4.9 ± 0.5, 6.4 ± 0.8 and 5.1 ± 0.4 L/min per L/min; P = 0.04). In hypoxia, the increase in the Q/VO2 slope was not detected by Nexfin. In normoxia, Q increases by 5-6 L/min per L/min increase in VO2, which is within the 95% confidence interval of the Q/VO2 slopes determined by the modified Fick method, Physioflow, and Nexfin apparatus while Innocor provided a lower value, potentially reflecting recirculation of the test gas into the pulmonary circulation. Thus, determination of Q during exercise depends significantly on the applied method.


Assuntos
Débito Cardíaco/fisiologia , Teste de Esforço/métodos , Exercício/fisiologia , Hipóxia/fisiopatologia , Consumo de Oxigênio/fisiologia , Adulto , Cateterismo Cardíaco/métodos , Cardiografia de Impedância/métodos , Humanos , Masculino , Óxido Nitroso/análise , Análise de Onda de Pulso/métodos , Adulto Jovem
10.
Br J Anaesth ; 113(3): 452-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24508985

RESUMO

BACKGROUND: Phenylephrine and ephedrine affect frontal lobe oxygenation ([Formula: see text]) differently when assessed by spatially resolved near infrared spectroscopy. We evaluated the effect of phenylephrine and ephedrine on extra- vs intra-cerebral blood flow and on [Formula: see text]. METHODS: In 10 healthy males (age 20-54 yr), phenylephrine or ephedrine was infused for an ∼20 mm Hg increase in mean arterial pressure. Cerebral oxygenation (SavO2) was calculated from the arterial and jugular bulb oxygen saturations. Blood flow in the internal carotid artery (ICAf) and blood flow in the external carotid artery (ECAf) were assessed by duplex ultrasonography. Invos-5100c (SinvosO2) and Foresight (SforeO2) determined [Formula: see text] while forehead skin oxygenation (SskinO2) was assessed. RESULTS: Phenylephrine reduced SforeO2 by 6.9% (95% confidence interval: 4.8-9.0%; P<0.0001), SinvosO2 by 10.5 (8.2-12.9%; P<0.0001), and ECAf (6-28%; P=0.0001), but increased ICAf (5-21%; P=0.003) albeit with no consequence for SskinO2 or SavO2. In contrast, SforeO2 was maintained with administration of ephedrine while SinvosO2 and SavO2 decreased [by 3.1 (0.7-4.5%; P=0.017) and 2.1 (0.5-3.3%; P=0.012)] as arterial carbon dioxide pressure decreased (P=0.003). ICAf was stable and ECAf increased by 11 (4-18%; P=0.005) with administration of ephedrine while SskinO2 did not change. CONCLUSIONS: The effect of phenylephrine on ScO2 is governed by a decrease in external carotid blood flow since it increases cerebral blood flow as determined by flow in the internal carotid artery. In contrast, ScO2 is largely maintained with administration of ephedrine because blood flow to extracerebral tissue increases.


Assuntos
Artéria Carótida Externa/efeitos dos fármacos , Artéria Carótida Externa/metabolismo , Efedrina/farmacologia , Lobo Frontal/efeitos dos fármacos , Oxigênio/metabolismo , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Adrenérgicos/farmacologia , Adulto , Lobo Frontal/irrigação sanguínea , Lobo Frontal/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Adulto Jovem
11.
Colorectal Dis ; 16(7): O223-33, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24373460

RESUMO

AIM: Advances in the treatment of rectal cancer have made it possible to perform complex rectal cancer surgery (COMP-RCS) in patients with primary advanced rectal cancer penetrating beyond the total mesorectal excision planes and in patients with locally recurrent rectal cancer. The aim of this study was to examine health-related quality of life (HRQoL) before and during the first 2 years after COMP-RCS. METHOD: Between 2001 and 2008, 180 patients were treated with COMP-RCS at Aarhus University Hospital. HRQoL was assessed preoperatively and 3, 6, 12, 18 and 24 months after surgery using three questionnaires. The results were compared with those for patients treated with standard rectal cancer surgery (STAN-RCS) and with data from the general Danish population (NORM-data). RESULTS: One hundred and twenty-two (68%) patients responded to the questionnaires. Of these 80 (66%) with disease-free survival for 2 years after surgery were included in the main analysis. The lowest level of functioning and the highest degree of symptoms were reported preoperatively. The majority of the HRQoL scales improved or remained stable during the first postoperative year; a decrease was observed for body image only. One year after surgery, HRQoL in patients treated with COMP-RSC was comparable to that for patients treated with STAN-RCS. Lower levels were found for physical and emotional role functioning, compared with NORM-data. CONCLUSION: Patients treated with COMP-RCS experienced improvement in HRQoL in the first year after surgery. One year after surgery, HRQoL was similar to that of patients treated with STAN-RCS. Compared with NORM-data, lower levels were found for physical and emotional role functioning.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Qualidade de Vida , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Período Pós-Operatório , Estudos Prospectivos , Neoplasias Retais/mortalidade , Inquéritos e Questionários
12.
Indoor Air ; 23(6): 506-14, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23621316

RESUMO

Phthalates have been used extensively as plasticizers to improve the flexibility of polymers, and they also have found many industrial applications. They are ubiquitous in the environment and have been detected in a variety of environmental and biological matrices. The goal of this study was to develop a method for the determination of 17 phthalate esters in house dust. This method involved sonication extraction, sample cleanup using solid phase extraction, and isotope dilution GC/MS/MS analysis. Method detection limits (MDLs) and recoveries ranged from 0.04 to 2.93 µg/g and from 84 to 117%, respectively. The method was applied to the analysis of phthalates in 38 paired household vacuum samples (HD) and fresh dust (FD) samples. HD and FD samples compared well for the majority of phthalates detected in house dust. Data obtained from 126 household dust samples confirmed the historical widespread use of bis(2-ethylhexyl) phthalate (DEHP), with a concentration range of 36 µg/g to 3840 µg/g. Dibutyl phthalate (DBP), benzyl butyl phthalate (BzBP), diisononyl phthalate (DINP), and diisodecyl phthalate (DIDP) were also found in most samples at relatively high concentrations. Another important phthalate, diisobutyl phthalate (DIBP), was detected at a frequency of 98.4% with concentrations ranging from below its MDL of 0.51 µg/g to 69 µg/g.


Assuntos
Poeira/análise , Ácidos Ftálicos/análise , Cromatografia Gasosa-Espectrometria de Massas , Habitação , Controle de Qualidade , Extração em Fase Sólida
13.
Colorectal Dis ; 15(7): e365-72, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23458368

RESUMO

AIM: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option with curative intent for selected patients with peritoneal carcinomatosis (PC). CRS and HIPEC have been implemented in Denmark at a single centre since 2006. Six years of data on these patients were analysed. METHOD: Patients with PC from colorectal or appendiceal cancer, pseudomyxoma peritonei or malignant peritoneal mesothelioma referred to the single national HIPEC centre were prospectively registered from June 2006 to July 2012. Morbidity, 30-day mortality and long-term survival of patients who underwent CRS and HIPEC were analysed. RESULTS: In total, 80 patients underwent CRS and HIPEC. PC originated from colorectal cancer in 34 patients, pseudomyxoma peritonei in 29, appendiceal cancer in 13 and malignant peritoneal mesothelioma in four patients. Thirty-two patients had one or more complications during the hospital stay. The 30-day mortality rate was 1.3%. The predicted 2-, 3- and 5-year survival was 60%, 47% and 38% in patients with PC from colorectal cancer, and 100%, 93% and 73% in pseudomyxoma peritonei patients. CONCLUSION: CRS and HIPEC is a safe procedure when centralized as in Denmark. Favourable long-term outcome was achieved in selected patients with PC from colorectal cancer and pseudomyxoma peritonei. Short-term and long-term outcomes were comparable to results from international centres.


Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Carcinoma/terapia , Hipotermia Induzida , Neoplasias Intestinais/patologia , Neoplasias Pulmonares/terapia , Mesotelioma/terapia , Mitomicina/uso terapêutico , Neoplasias Peritoneais/terapia , Peritônio/cirurgia , Pseudomixoma Peritoneal/terapia , Adulto , Idoso , Neoplasias do Apêndice/patologia , Carcinoma/secundário , Neoplasias Colorretais/patologia , Terapia Combinada , Dinamarca , Feminino , Humanos , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/secundário , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
Br J Surg ; 100(2): 285-92, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23124619

RESUMO

BACKGROUND: The outcome of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) depends on the extent of peritoneal carcinomatosis. The role of laparoscopy in the preoperative assessment of extent of peritoneal carcinomatosis in potential candidates for cytoreductive surgery and HIPEC was evaluated in a consecutive series. METHODS: Patients with peritoneal carcinomatosis from colorectal cancer or appendiceal cancer, pseudomyxoma peritonei or peritoneal mesothelioma referred to a single, national HIPEC centre were included prospectively between June 2006 and January 2012. From September 2010, preoperative evaluation also included a laparoscopy in patients deemed amenable to cytoreductive surgery and HIPEC after radiological evaluation, apart from those with pseudomyxoma peritonei with massive amounts of mucin. RESULTS: In the period before laparoscopic evaluation, 70 patients underwent laparotomy of whom 39 (56 per cent) completed cytoreductive surgery and HIPEC. After the introduction of laparoscopic assessment, diagnostic laparoscopy was planned in 45 patients and successful in 43. The laparoscopic evaluation excluded 18 patients from surgery because of extensive disease, among other reasons. Laparoscopy was uneventful and associated with no deaths. Twenty-seven patients were considered amenable to cytoreductive surgery and HIPEC based on laparoscopic findings, of whom 17 completed this treatment; the disease was unresectable in the remaining ten patients. Of 13 patients who were not eligible for laparoscopic evaluation and were subjected to cytoreductive surgery plus HIPEC, 11 completed the procedure. The overall completion rate of cytoreductive surgery and HIPEC increased to 70 per cent (28 of 40) after the introduction of laparoscopic evaluation. CONCLUSION: Diagnostic laparoscopy was valuable in preoperative evaluation of the extent of peritoneal carcinomatosis, and improved patient selection for cytoreductive surgery and HIPEC.


Assuntos
Neoplasias do Apêndice , Quimioterapia do Câncer por Perfusão Regional/métodos , Neoplasias Colorretais , Hipertermia Induzida/métodos , Laparoscopia/métodos , Neoplasias Peritoneais/terapia , Adulto , Idoso , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/secundário , Estudos Prospectivos , Resultado do Tratamento
15.
Neuroimage ; 61(4): 884-8, 2012 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-22709820

RESUMO

The neurobiology underlying obesity is not fully understood. The neurotransmitter serotonin (5-HT) is established as a satiety-generating signal, but its rewarding role in feeding is less well elucidated. From animal experiments there is now evidence that the 5-HT(4) receptor (5-HT(4)R) is involved in food intake, and that pharmacological or genetic manipulation of the receptor in reward-related brain areas alters food intake. Here, we used positron emission tomography in humans to examine the association between cerebral 5-HT(4)Rs and common obesity. We found in humans a strong positive association between body mass index and the 5-HT(4)R density bilaterally in the two reward 'hot spots' nucleus accumbens and ventral pallidum, and additionally in the left hippocampal region and orbitofrontal cortex. These findings suggest that the 5-HT(4)R is critically involved in reward circuits that regulate people's food intake. They also suggest that pharmacological stimulation of the cerebral 5-HT(4)R may reduce reward-related overeating in humans.


Assuntos
Encéfalo/metabolismo , Obesidade/metabolismo , Receptores 5-HT4 de Serotonina/metabolismo , Recompensa , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Ingestão de Alimentos/fisiologia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Adulto Jovem
16.
Br J Sports Med ; 46(11): 770-9, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22685119

RESUMO

Challenging environmental conditions, including heat and humidity, cold, and altitude, pose particular risks to the health of Olympic and other high-level athletes. As a further commitment to athlete safety, the International Olympic Committee (IOC) Medical Commission convened a panel of experts to review the scientific evidence base, reach consensus, and underscore practical safety guidelines and new research priorities regarding the unique environmental challenges Olympic and other international-level athletes face. For non-aquatic events, external thermal load is dependent on ambient temperature, humidity, wind speed and solar radiation, while clothing and protective gear can measurably increase thermal strain and prompt premature fatigue. In swimmers, body heat loss is the direct result of convection at a rate that is proportional to the effective water velocity around the swimmer and the temperature difference between the skin and the water. Other cold exposure and conditions, such as during Alpine skiing, biathlon and other sliding sports, facilitate body heat transfer to the environment, potentially leading to hypothermia and/or frostbite; although metabolic heat production during these activities usually increases well above the rate of body heat loss, and protective clothing and limited exposure time in certain events reduces these clinical risks as well. Most athletic events are held at altitudes that pose little to no health risks; and training exposures are typically brief and well-tolerated. While these and other environment-related threats to performance and safety can be lessened or averted by implementing a variety of individual and event preventative measures, more research and evidence-based guidelines and recommendations are needed. In the mean time, the IOC Medical Commission and International Sport Federations have implemented new guidelines and taken additional steps to mitigate risk even further.


Assuntos
Altitude , Regulação da Temperatura Corporal/fisiologia , Temperatura Baixa/efeitos adversos , Temperatura Alta/efeitos adversos , Esportes , Aclimatação/fisiologia , Doença da Altitude/prevenção & controle , Desempenho Atlético/fisiologia , Clima Frio/efeitos adversos , Desidratação/prevenção & controle , Exercício/fisiologia , Congelamento das Extremidades/prevenção & controle , Instalações de Saúde/provisão & distribução , Transtornos de Estresse por Calor/prevenção & controle , Humanos , Hipotermia/prevenção & controle , Transtornos Respiratórios/prevenção & controle , Fatores de Risco
17.
J Appl Physiol (1985) ; 112(12): 2027-36, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22461443

RESUMO

It was investigated if athletes subjected to 4 wk of living in normobaric hypoxia (3,000 m; 16 h/day) while training at 800-1,300 m ["live high-train low" (LHTL)] increase muscular and systemic capacity for maintaining pH and K(+) homeostasis as well as intense exercise performance. The design was double-blind and placebo controlled. Mean power during 30-s all-out cycling was similar before and immediately after LHTL (650 ± 31 vs. 628 ± 32 W; n = 10) and placebo exposure (658 ± 22 vs. 660 ± 23 W; n = 6). Supporting the performance data, arterial plasma pH, lactate, and K(+) during submaximal and maximal exercise were also unaffected by the intervention in both groups. In addition, muscle buffer capacity (in mmol H(+)·kg dry wt(-1)·pH(-1)) was similar before and after in both the LHTL (140 ± 12 vs. 140 ± 16) and placebo group (145 ± 2 vs. 140 ± 3). The expression of sarcolemmal H(+) transporters (Na(+)/H(+) exchanger 1, monocarboxylate transporters 1 and 4), as well as expression of Na(+)-K(+) pump subunits-α(1), -α(2), and -ß(1) was also similar before and after the intervention. In conclusion, muscular and systemic capacity for maintaining pH and K(+) balance during exercise is similar before and after 4 wk of placebo-controlled normobaric LHTL. In accordance, 30-s all-out sprint ability was similar before and after LHTL.


Assuntos
Exercício/fisiologia , Músculo Esquelético/fisiologia , Potássio/metabolismo , Adulto , Altitude , Bicarbonatos/metabolismo , Dióxido de Carbono/metabolismo , Método Duplo-Cego , Teste de Esforço/métodos , Feminino , Homeostase/fisiologia , Humanos , Concentração de Íons de Hidrogênio , Hipóxia/metabolismo , Hipóxia/fisiopatologia , Ácido Láctico/metabolismo , Lantânio/metabolismo , Masculino , Músculo Esquelético/metabolismo , Consumo de Oxigênio/fisiologia , ATPase Trocadora de Sódio-Potássio/metabolismo , Análise e Desempenho de Tarefas
19.
Mycotoxin Res ; 28(3): 181-90, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23606126

RESUMO

Fusarium mycotoxins such as deoxynivalenol (DON) can occur in cereals conjugated to glucose and probably also to other sugars. These conjugates, which are often referred to as "masked mycotoxins", will not be detected with routine analytical techniques. Furthermore, it is suspected that the parent toxin may again be released after hydrolysis in the digestive tracts of animals and humans. Today, our knowledge of the occurrence of these compounds in cereal grains is limited. In this paper, a LC-MS/MS method for the simultaneous determination of DON, deoxynivalenol-3-ß-D-glucoside (DON-3-glucoside), 3 acetyl-DON, nivalenol, fusarenon-X, diacetoxyscirpenol, HT-2 toxin, and T-2 toxin in naturally (n = 48) and artificially (n = 30) contaminated cereal grains (wheat, barley, oat, rye triticale) is reported. The method has also been applied to whole fresh maize plant intended for production of maize silage (n = 10). The samples were collected from the harvest years 2006-2010, The results show that DON-3-glucoside and DON co-occurred in cereal grains and, especially in several of the highly contaminated samples, the concentration of the glucoside can be relatively high, corresponding to over 37 % of the DON concentration. The DON-3-glucoside levels in both the naturally and in the artificially grain inoculated with Fusarium were second only to DON, and were generally higher than those of the other tested trichothecenes, which were found at low concentrations in most samples, in many cases even below the detection limit of the method. This argues for the importance of taking DON-3-glucoside into account in the ongoing discussion within the European Community concerning exposure re-evaluations for setting changed values for the tolerable intake for DON. Our results indicate that, in the naturally contaminated grains and in the Fusarium infested cereal grains (winter and spring wheat, oat, triticale), the concentration level of DON-3-glucoside is positively correlated to the DON content. When the DON concentration is high, then the content of DON-3-glucoside will most probably also be high and vice versa.


Assuntos
Grão Comestível/química , Contaminação de Alimentos/análise , Fusarium/metabolismo , Glucosídeos/análise , Tricotecenos/análise , Zea mays/química , Avena/microbiologia , Cromatografia Líquida , Dinamarca , Grão Comestível/microbiologia , Microbiologia de Alimentos , Hordeum/microbiologia , Espectrometria de Massas , Secale/microbiologia , Triticum/microbiologia , Zea mays/microbiologia
20.
Colorectal Dis ; 14(9): 1076-83, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22107085

RESUMO

AIM: The study was conducted in a dedicated centre treating the majority of Danish patients with intended curative total pelvic exenteration for primary advanced (PARC) or locally recurrent (LRRC) rectal cancer. We compared PARC and LRRC and analysed postoperative morbidity and mortality, and long-term outcome. METHOD: There were 90 consecutive patients (PARC/LRRC 50/40) treated between January 2001 and October 2010, recorded on a prospectively maintained database. RESULTS: The median age was 63 (32-75) years with a gender ratio of 7 women to 83 men. All patients were American Society of Anesthesiologists level I or II. Sacral resection was performed in five patients with PARC and 15 with LRRC (P=0.002). R0 resection was achieved in 33 (66%) patients with PARC and in 15 (38%) with LRRC, R1 resection in 17 (34%) with PARC and 20 (50%) with LRRC and R2 resection in five (13%) with LRRC. R0 resection was more frequent in PARC (P=0.007). Forty-four (49%) patients had no postoperative complications. Fifty-five major complications were registered. Two (2.2%) patients died within 30 days, and the total in-hospital mortality was 5.6%. The median follow-up was 12 (0.4-91) months. The 5-year survival was 46% for PARC and 17% for LRRC (P=0.16). CONCLUSION: Pelvic exenteration is associated with considerable morbidity but low mortality in an experienced centre. Pelvic exenteration can improve long-term survival, especially for patients with PARC. However, pelvic exenteration is also justified for patients with LRRC.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Exenteração Pélvica , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/cirurgia , Adulto , Idoso , Fístula Anastomótica/epidemiologia , Feminino , Hérnia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Exenteração Pélvica/mortalidade , Pneumonia/epidemiologia , Estudos Prospectivos , Sepse/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Análise de Sobrevida , Resultado do Tratamento
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