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1.
Anesth Analg ; 2020 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-32224723

RESUMO

BACKGROUND: The critical question of racial and gender diversity in pediatric anesthesia training programs has not been previously explored. The primary objective of this study was to evaluate trends by race/ethnicity and gender in pediatric anesthesiology fellowship training programs in the United States for the years 2000 to 2018. METHODS: Demographic data on pediatric anesthesiology fellows and anesthesiology residents were obtained from the self-reported data collected for the Journal of the American Medical Association's annual report on Graduate Medical Education for the years 2000 to 2018. Diversity was assessed by calculating the proportions of trainees per year by gender and racial/ethnic groups in pediatric anesthesiology fellowship and anesthesiology residency programs. Logistic regression equations were developed to estimate the annual growth rate of each racial/ethnic groups. RESULTS: The number of pediatric anesthesiology fellows increased from 57 trainees in 2000-2001 to 202 in 2017-2018 at an average rate of 9 fellows per year (95% confidence interval [CI], 8-10). These increases were primarily due to white trainees (54.4%-63.4%) as the proportions of black (7.0%-4.5%), Asian (26.3%-21.3%), and other minority (12.3%-10.9%) trainees have remained low. The number of anesthesiology residents increased from 3950 trainees in 2000-2001 to 5940 in 2017-2018 at an average rate of 99 residents per year (95% CI, 88-111). Within all anesthesiology trainees, these increases were due to white trainees (55.7%-61.3%) as the proportion of black (5.0%-6.0%), Asian (25.8%-24.1%), and other minority trainees (8.2%-8.5%) has remained fairly constant over the time period. Despite the overall lower proportion of female anesthesiology residents (range: 27.0%-37.5%), a steady increase in the number of women in pediatric anesthesiology fellowship programs has reversed the gender imbalance in this population as of 2010. CONCLUSIONS: While historic gains have been made in gender diversity in pediatric anesthesiology, there is persistent underrepresentation of black and Hispanic trainees in pediatric anesthesiology. It appears that their low numbers in anesthesiology residency programs (the reservoir) may be partly responsible. Efforts to increase ethnic/racial diversity in pediatric anesthesiology fellowship and anesthesiology residency training programs are urgently needed.

2.
Int J Low Extrem Wounds ; : 1534734620915360, 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32326799

RESUMO

Physical activity has been recommended by the American Diabetes Association (ADA) as a preventive intervention of diabetes complications. However, there is no study investigating how microvascular control mechanism respond to different walking intensities in people with and without diabetes. The purpose of this study was to assess microvascular control mechanism of the plantar foot in response to various walking speeds and durations in 12 healthy people using spectral analysis of skin blood flow (SBF) oscillations. A 3×2 factorial design, including 3 speeds (3, 6, and 9 km/h) and 2 durations (10 and 20 minutes), was used in this study. Plantar SBF was measured using laser Doppler flowmetry over the first metatarsal head. Borg Rating of Perceived Exertion (RPE) scale and heart rate maximum were used to assess the walking intensity. Wavelet analysis was used to quantify regulations of metabolic (0.0095-0.02 Hz), neurogenic (0.02-0.05 Hz), myogenic (0.05-0.15 Hz), respiratory (0.15-0.4 Hz), and cardiac (0.4-2 Hz) controls. For 10-minute walking, walking at 9 km/h significantly increased the ratio of wavelet amplitudes of metabolic, neurogenic, myogenic, respiratory, and cardiac mechanisms compared with 3 km/h (P < .05). For 20-minute walking, walking at 6 km/h significantly increased the ratio of wavelet amplitudes of metabolic, myogenic, respiratory, and cardiac compared with 3 km/h (P < .05). RPE showed a significant interaction between the speed and duration factors (P < .01). This is the first study demonstrating that different walking speeds and durations caused different plantar microvascular regulations.

3.
J Biol Chem ; 295(17): 5564-5576, 2020 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-32213598

RESUMO

Knowledge of the molecular events in mitochondrial DNA (mtDNA) replication is crucial to understanding the origins of human disorders arising from mitochondrial dysfunction. Twinkle helicase is an essential component of mtDNA replication. Here, we employed atomic force microscopy imaging in air and liquids to visualize ring assembly, DNA binding, and unwinding activity of individual Twinkle hexamers at the single-molecule level. We observed that the Twinkle subunits self-assemble into hexamers and higher-order complexes that can switch between open and closed-ring configurations in the absence of DNA. Our analyses helped visualize Twinkle loading onto and unloading from DNA in an open-ringed configuration. They also revealed that closed-ring conformers bind and unwind several hundred base pairs of duplex DNA at an average rate of ∼240 bp/min. We found that the addition of mitochondrial single-stranded (ss) DNA-binding protein both influences the ways Twinkle loads onto defined DNA substrates and stabilizes the unwound ssDNA product, resulting in a ∼5-fold stimulation of the apparent DNA-unwinding rate. Mitochondrial ssDNA-binding protein also increased the estimated translocation processivity from 1750 to >9000 bp before helicase disassociation, suggesting that more than half of the mitochondrial genome could be unwound by Twinkle during a single DNA-binding event. The strategies used in this work provide a new platform to examine Twinkle disease variants and the core mtDNA replication machinery. They also offer an enhanced framework to investigate molecular mechanisms underlying deletion and depletion of the mitochondrial genome as observed in mitochondrial diseases.

4.
Microvasc Res ; 128: 103936, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31670165

RESUMO

BACKGROUND: Various walking speeds and durations in daily life cause different levels of ischemia of plantar tissues. It is unclear what walking speeds and durations significantly affect plantar tissue viability and risks for foot ulcers in non-diabetics and diabetics. OBJECTIVE: The aim of this study was to establish the normal response of plantar skin blood flow to different speeds and durations of walking exercise in non-diabetics that would be needed to quantify impaired responses in diabetics. METHOD: Laser Doppler flowmetry was used to measure plantar skin blood flow of the first metatarsal head in 12 non-diabetics. A 3 × 2 factorial design, including 3 speeds (slow at 3 km/h, moderate at 6 km/h, and fast at 9 km/h) and 2 durations (10 and 20 min), was used in this study. Skin blood flow after walking was expressed as a ratio of skin blood flow before walking. The 3 × 2 two-way analysis of variance (ANOVA) with repeated measures was used to examine the main effects of speeds and durations and their interaction. RESULT: The walking speed significantly affected skin blood flow responses (p < 0.01). Walking at 9 km/h significantly increased plantar skin blood flow (5.71 ±â€¯1.89) compared to walking at 6 km/h (2.1 ±â€¯0.29) and 3 km/h (1.16 ±â€¯0.14), especially at 20-minute walking duration (p < 0.01). The walking duration showed a trend of significance on affecting skin blood flow responses (p = 0.06). There was no significant interaction between walking speeds and durations (p > 0.05). CONCLUSIONS: Our results provide the first evidence that walking speeds affect plantar skin blood flow and a fast walking speed (9 km/h) significantly increases plantar skin blood flow compared to moderate (6 km/h) and slow (3 km/h) walking speeds.

5.
Am J Cardiol ; 125(1): 120-126, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31727261

RESUMO

Atrial fibrillation (AF) has important clinical consequences in hypertrophic cardiomyopathy (HC). Safety and efficacy of the Cox-Maze IV procedure (when combined with ventricular septal myectomy) in patients with obstructive HC and paroxysmal AF is largely unresolved. Records of 395 consecutive HC patients (age 55 ± 13 years) who underwent septal myectomy for heart failure symptoms between 2004 and 2015 were reviewed. Sixty-two patients also had concomitant complete biatrial Cox-Maze IV for a history of symptomatic paroxysmal AF (3.0 ± 3.6 episodes) combined with myectomy comprise the study cohort. Freedom from symptomatic AF recurrences after operation was assessed. Left ventricular outflow gradients were reduced from 81 ± 28 mm Hg preoperatively to 1.2 ± 6.8 mm Hg after operation. At most recent follow-up, 53 patients (85%) were asymptomatic or mildly symptomatic. Freedom from recurrent symptomatic AF after myectomy/Cox-Maze IV was: 85% (95% confidence interval [CI] 73, 92) at 1 year, 69% (95% CI 55, 79) at 3 years, and 64% (95% CI 48, 75) at 5 years, including 34 patients (54%) who have experienced no symptomatic AF episodes for up to 8.2 years following surgery. The only clinical predictor of recurrent AF over follow-up was preoperative transverse left atrial dimension ≥45 mm (p <0.01). In conclusion, biatrial Cox-Maze IV combined with septal myectomy is associated with favorable long-term freedom from symptomatic paroxysmal AF recurrence, as well as from obstructive heart failure symptoms. These data support myectomy/Cox-Maze as an effective management option for the subgroup of HC patients with symptomatic outflow obstruction and paroxysmal AF.


Assuntos
Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Septo Interventricular/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia , Septo Interventricular/diagnóstico por imagem , Adulto Jovem
6.
Zookeys ; 876: 125-141, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31592218

RESUMO

A new species of the rare ant genus Metapone, Metapone murphyi sp. nov., is described based on museum material consisting of a single nest series (workers, queens, and males) collected from a decayed coconut palm stump on Pulau Sakra, previously an offshore island south of mainland Singapore. Workers can be distinguished from other named congeners mainly by the following characters: 1) subpetiolar lamella subrectangular; 2) short median longitudinal ventral subpetiolar edge and roundly obtuse posteroventral subpetiolar angle; 3) outer margin of posterior subpetiolar face in posteroventral view forming a continuous, U-shaped, translucent, laminate carina; and 4) petiole subtrapezoidal in dorsal view with extended blunt tooth-like posterolateral corners. Detailed description and illustrations of male genitalia of the genus are given for the first time. The key to Asian species of Metapone is updated to include the new species.

7.
BMC Musculoskelet Disord ; 20(1): 264, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151391

RESUMO

BACKGROUND: Foot orthoses are widely used to manage plantar heel pain (PHP). However, the evidence concerning the effect of foot orthoses on PHP is not conclusive. The study aims to identify the characteristics of patients with PHP likely to achieve a positive outcome after customized foot orthoses and to verify the concept that patients who respond positively to anti-pronation taping would achieve a positive prognosis after wearing foot orthoses for six months. METHODS: This is a prospective observational cohort study. Seventy-four patients with PHP underwent a baseline examination and received anti-pronation taping to their painful feet. The taping effects on pain and function were assessed at the 7-day follow-up visit. Then, all patients received an intervention for their PHP with customized foot orthoses for six months. Outcome was assessed with a numeric pain rating scale, the patient-specific functional scale, the foot function index, and the global rating of perceived change. Significant reduction of pain, increase of function, and perception of a meaningful improvement were considered a positive response. RESULTS: Of 74 patients, 49 had a positive response to the customized foot orthosis treatment. Five predictors were identified: (1) the average pain intensity decreased by over 1.5 points with taping, (2) the range of ankle plantarflexion > 54 degrees, (3) the strength of ankle plantarflexors on the symptomatic side was equal to or stronger than that on the other side, (4) the range of hip internal rotation < 39 degrees, and (5) the range of hip external rotation > 45 degrees. The presence of three or more predictors increased the rate of achieving positive outcome from 66 to 89%. CONCLUSIONS: The predictors of customized foot orthosis outcome in patients with PHP are related to several physical measures of a lower extremity. Findings of the study can be used to screen and select patients with PHP for foot orthosis intervention. Moreover, patients who respond positively to anti-pronation taping would also benefit from the customized foot orthoses. However, since there was no control group in the current study, it is inappropriate to draw conclusions about the effectiveness of the foot orthoses treatment. TRIAL REGISTRATION: The trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12617000119392 ).


Assuntos
Articulação do Tornozelo/fisiopatologia , Fita Atlética , Órtoses do Pé , Manejo da Dor/instrumentação , Dor/diagnóstico , Adulto , Feminino , Calcanhar , Humanos , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Medição da Dor , Prognóstico , Pronação/fisiologia , Estudos Prospectivos , Resultado do Tratamento
8.
J Neurol Neurosurg Psychiatry ; 90(11): 1193-1200, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31217172

RESUMO

OBJECTIVES: Previous studies have demonstrated a strong latitudinal gradient in multiple sclerosis (MS) prevalence. Herein, we present a meta-analysis of the latitudinal gradient of MS prevalence including studies published since our 2011 review, seeking to assess the latitudinal gradient and whether it has changed since our previous analysis. METHODS: Studies published up to December 2018 were located via Embase, Web of Knowledge and PubMed, using standardised search terms; data were extracted from peer-reviewed studies and these studies added to those from our previous analysis. Where age-specific data were available, prevalence estimates were age-/sex-standardised to the 2009 European population. Prevalence estimates were adjusted for study prevalence year and ascertainment methods. The latitudinal association with MS prevalence was assessed by meta-regression. RESULTS: A total of 94 studies met inclusion criteria, yielding 230 new prevalence points and 880 altogether with those from the prior study. There was a significant positive gradient in time-corrected MS prevalence with increasing latitude (5.27/100 000 per degree latitude), attenuating slightly to 4.34/100 000 on age-standardisation, these associations persisting on adjustment for ascertainment method. Of note, the age-standardised gradient was consistently significantly enhanced from our previous study, regardless of whether it was as-measured, time-corrected or adjusted for ascertainment methods. Certain areas, such as the Scandinavian and Atlantic Coast/Central Europe regions, showed changes in MS prevalence gradient over time, but other regional gradients were similar. CONCLUSIONS: This new meta-analysis confirms that MS prevalence is still strongly positively associated with increasing latitude and that the gradient is increasing, suggesting that potentially modifiable environmental factors, such as sun exposure, are still strongly associated with MS risk.

9.
Am J Cardiol ; 124(1): 113-121, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31027655

RESUMO

Advances in treatment options for hypertrophic cardiomyopathy (HC) have proven effective in many patients for promoting favorable long-term outcomes. Whether this expectation is similar for patients with the most extreme expression of massive left ventricular (LV) hypertrophy, a particularly aggressive form of the disease is unresolved. Of 1,766 consecutive HC patients presenting to Tufts HC Institute (2004 to 2015), 92 were identified with extreme LV wall thickness (30 to 48 mm), and compared with 1,674 HC patients with less marked hypertrophy (13 to 29 mm). Follow-up assessment was over 5.3 ± 3.4 years. Patients with massive LV hypertrophy (n = 92) had higher sudden death event rates (3.0%/year) than did patients with lesser hypertrophy (0.8%/year; p <0.001). In 16 of the 92 patients (17%), potentially lethal ventricular tachyarrhythmia were successfully aborted by primary prevention implantable cardioverter defibrillator (ICD) therapy at 30 ± 13 years (n = 11), or by resuscitated cardiac arrest with external defibrillation (n = 5) and later by secondary prevention interventions (n = 3); no patient experienced arrhythmic sudden death. Aborted sudden death events (3.0%/year) exceeded HC-related mortality by 7-fold (n = 2; 0.4%/year; p <0.001). European Society of Cardiology risk score would have failed to identify 60% of patients with arrhythmic sudden death events, leaving them exposed to sudden death without ICDs. In addition, 35 patients required surgical myectomy for progressive heart failure due to LV outflow obstruction (improved to NYHA I/II in 30). Eighty-eight (96%) of the 92 patients have survived to age 38 ± 14 years (23% ≥ 50 years). All-cause mortality did not differ from an age and gender-matched general population (p = 0.62). In conclusion, in this referral-based population, patients with the most extreme expression of HC are at increased arrhythmic sudden death risk reliably prevented with prophylactic ICDs. Progressive heart failure secondary to outflow obstruction was reversible with surgical myectomy. Despite extreme phenotypic expression, with contemporary treatment interventions young HC patients have an opportunity to achieve extended survival with good quality of life.


Assuntos
Cardiomiopatia Hipertrófica/patologia , Cardiomiopatia Hipertrófica/terapia , Adolescente , Adulto , Cardiomiopatia Hipertrófica/mortalidade , Criança , Estudos de Coortes , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
10.
Am J Cardiol ; 122(8): 1409-1420, 2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30107902

RESUMO

Hypertrophic cardiomyopathy (HC) has historically been characterized as a disease of substantial left ventricular hypertrophy, often associated with dynamic left ventricular outflow tract obstruction. However, we have recently encountered patients with subaortic obstruction and only minimal basal septal thickness, raising important management implications. Thereby, we sought to characterize the natural history and treatment strategies for this under-recognized subgroup of HC patients with dynamic obstruction. Of 1,591 consecutive patients with a HC diagnosis, 113 (7%) were identified with outflow obstruction due to elongated mitral valve leaflets producing systolic anterior motion and septal contact typical of HC (gradient, 84 ± 29 mm Hg at rest or with exercise), with maximal ventricular septal thickness ≤15 mm, including 14 patients with only 10 to 12 mm. In addition to the mechanism of outflow obstruction, other evidence supporting a HC diagnosis prominently included: positive HC family history and/or pathogenic sarcomere mutation, arrhythmic sudden death event, typical histopathology of septal muscle, and characteristic mitral valve and papillary muscle anomalies. Over 3.8 ± 3.5 years, 41 patients (36%) developed severe heart failure including 36 who have undergone myectomy associated with reconstruction of the outflow tract and mitral valve apparatus, resulting in relief of gradient without iatrogenic ventricular septal defect or mitral valve replacement. Postoperatively, all 36 patients have survived with symptom relief to New York Heart Association classes I/II. In conclusion, these observations expand the HC clinical profile and phenotype to include an under-appreciated subgroup in which disease expression includes outflow obstruction due primarily to an elongated mitral valve, associated with only minimal (or normal) ventricular septal thickness. Such HC patients can develop marked functional limitation amenable to an operative strategy that effectively relieved symptoms due to outflow obstruction, but without mitral valve replacement.


Assuntos
Cardiomiopatia Hipertrófica/patologia , Obstrução do Fluxo Ventricular Externo/patologia , Septo Interventricular/patologia , Adulto , Idoso , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Meios de Contraste , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fenótipo , Estudos Retrospectivos , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Septo Interventricular/diagnóstico por imagem
11.
Sci Rep ; 8(1): 12868, 2018 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-30150711

RESUMO

The TMPRSS2:ERG gene fusion is the most prevalent early driver gene activation in prostate cancers of European ancestry, while the fusion frequency is much lower in Africans and Asians. The genomic characteristics and mechanisms for patients lacking ERG fusion are still unclear. In this study, we systematically compared the characteristics of gene fusions, somatic mutations, copy number alterations and gene expression signatures between 201 ERG fusion positive and 296 ERG fusion negative prostate cancer samples. Both common and group-specific genomic alterations were observed, suggesting shared and different mechanisms of carcinogenesis in prostate cancer samples with or without ERG fusion. The genomic alteration patterns detected in ERG-negative group showed similarities with 77.5% of tumor samples of African American patients. These results emphasize that genomic and gene expression features of the ERG-negative group may provide a reference for populations with lower ERG fusion frequency. While the overall expression patterns were comparable between ERG-negative and ERG-positive tumors, we found that genomic alterations could affect the same pathway through distinct genes in the same pathway in both groups of tumor types. Altogether, the genomic and molecular characteristics revealed in our study may provide new opportunities for molecular stratification of ERG-negative prostate cancers.


Assuntos
Regulação Neoplásica da Expressão Gênica , Neoplasias da Próstata/genética , Neoplasias da Próstata/metabolismo , Regulador Transcricional ERG/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Metilação de DNA , Deleção de Genes , Perfilação da Expressão Gênica , Variação Genética , Genômica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Proteínas de Fusão Oncogênica/genética , Proteínas de Fusão Oncogênica/metabolismo , Neoplasias da Próstata/diagnóstico , Transdução de Sinais , Regulador Transcricional ERG/genética
12.
Open Ophthalmol J ; 12: 104-109, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30008972

RESUMO

Background: Dynamic Contour Tonometry (DCT) is touted to be the most accurate tonometer for Intraocular Pressure (IOP) measurement. Non-Contact "air puff" Tonometry (NCT) may be the most commonly used tonometer for screening of IOP. Elevated IOP is important to exclude in patients presenting with headache or vision loss. Objective: To determine the agreement between DCT and NCT. Methods: The IOP of adult patients 50 years of age or older presenting with headache or vision loss for possible temporal artery biopsy were prospectively recorded. NCT and DCT measurements were obtained within thirty minutes. The right eye IOP measurements were compared with paired t-test, and Bland- Altman plot analysis. The left eye IOP measurements were subsequently analyzed for confirmation of results. Results: There were 106 subjects with complete right eye data, and 104 subjects with complete left eye data. The average age was 72 years, and 70% were female. The NCT IOP was on average 3.9 mm Hg lower in the right eye, and 3.5 mm Hg lower in the left eye compared with DCT. (p<.001) In the right eye the Bland-Altman analysis showed the 95% agreement interval between the two tonometers was -2.5 to 10.4 mmHg and in the left eye -3.0 to 9.9 mmHg. Conclusion: The IOP from NCT and DCT should not be used interchangeably because their level of disagreement includes clinically important discrepancies of up to 10 mm Hg.

13.
Mol Ecol Resour ; 2018 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-29673082

RESUMO

DNA barcodes are useful for species discovery and species identification, but obtaining barcodes currently requires a well-equipped molecular laboratory and is time-consuming, and/or expensive. We here address these issues by developing a barcoding pipeline for Oxford Nanopore MinION™ and demonstrating that one flow cell can generate barcodes for ~500 specimens despite the high basecall error rates of MinION™ reads. The pipeline overcomes these errors by first summarizing all reads for the same tagged amplicon as a consensus barcode. Consensus barcodes are overall mismatch-free but retain indel errors that are concentrated in homopolymeric regions. They are addressed with an optional error correction pipeline that is based on conserved amino acid motifs from publicly available barcodes. The effectiveness of this pipeline is documented by analysing reads from three MinION™ runs that represent three different stages of MinION™ development. They generated data for (i) 511 specimens of a mixed Diptera sample, (ii) 575 specimens of ants and (iii) 50 specimens of Chironomidae. The run based on the latest chemistry yielded MinION™ barcodes for 490 of the 511 specimens which were assessed against reference Sanger barcodes (N = 471). Overall, the MinION™ barcodes have an accuracy of 99.3%-100% with the number of ambiguous bases after correction ranging from <0.01% to 1.5% depending on which correction pipeline is used. We demonstrate that it requires ~2 hr of sequencing to gather all information needed for obtaining reliable barcodes for most specimens (>90%). We estimate that up to 1,000 barcodes can be generated in one flow cell and that the cost per barcode can be

14.
Quant Imaging Med Surg ; 8(2): 135-150, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29675355

RESUMO

Background: In vivo imaging of the complex cascade of events known to be pivotal elements in the healing of cutaneous wounds is a difficult but essential task. Current techniques are highly invasive, or lack the level of vascular and structural detail required for accurate evaluation, monitoring and treatment. We aimed to use an advanced optical coherence tomography (OCT)-based angiography (OCTA) technique for the non-invasive, high resolution imaging of cutaneous wound healing. Methods: We used a clinical prototype OCTA to image, identify and track key vascular and structural adaptations known to occur throughout the healing process. Specific vascular parameters, such as diameter and density, were measured to aid our interpretations under a spatiotemporal framework. Results: We identified multiple distinct, yet overlapping stages, hemostasis, inflammation, proliferation, and remodeling, and demonstrated the detailed vascularization and anatomical attributes underlying the multifactorial processes of dermatologic wound healing. Conclusions: OCTA provides an opportunity to both qualitatively and quantitatively assess the vascular response to acute cutaneous damage and in the future, may help to ascertain wound severity and possible healing outcomes; thus, enabling more effective treatment options.

15.
Phys Ther Sport ; 31: 58-67, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29655069

RESUMO

OBJECTIVES: To develop a clinical prediction rule (CPR) to identify patients with plantar heel pain (PHP) likely to benefit from biomechanical anti-pronation taping (BAPT). DESIGN: A prospective cohort study. SETTING: An outpatient rehabilitation department in a general hospital. PARTICIPANTS: Seventy-five patients with PHP. MAIN OUTCOME MEASURES: After completing a series of physical examinations, all patients received BAPT and were evaluated with a numeric rating scale for pain intensity, the patient-specific functional scale and foot function index (FFI) for function, and the global rating of change for perceived improvement. RESULTS: Twenty-eight patients achieved a successful outcome. A CPR with 6 significant variables was identified by a multivariate logistic regression: FFI score less than 33.3, hip adduction angle of the most affected side was greater than the contralateral side, ankle plantarflexors and hip abductors on the most affected side were not weaker than those on the contralateral side, ankle invertors on the most affected side were weaker than the contralateral side, and having more than 2 painful sites in the low back and lower extremity regions. If 5 or more of the 6 predictors were presented, the probability of success increased from 37% to 80%. CONCLUSIONS: A CPR has been developed to identify patients with PHP likely to benefit from BAPT.


Assuntos
Fita Atlética , Fasciíte Plantar/terapia , Calcanhar/fisiopatologia , Manejo da Dor , Pronação , Adulto , Fenômenos Biomecânicos , Técnicas de Apoio para a Decisão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Estudos Prospectivos
16.
Artigo em Inglês | MEDLINE | ID: mdl-29447310

RESUMO

The aim of this retrospective study was to examine the histories of 100 patients with 170 implants that were consecutively treated and reported in a previous study to identify which patient and implant factors might have affected the outcomes of therapy. Patient factors included history of periodontitis, hypertension, cardiac problems, rheumatoid arthritis, smoking, and penicillin allergy. Implant factors included whether the prosthesis was cemented or screw retained and initial bone loss (≤ 50% or > 50% of implant length). Frequency of maintenance visits (≤ 3 months or > 3 months) were recorded, as was patient age (≤ 60 years or > 60 years). On the patient level, only postoperative maintenance (≤ 3 months) showed a statistically significant effect on radiographic bone gain (RBG) compared to patients with > 3 months maintenance frequency. Nondiabetic patients showed a trend toward soft tissue gain. On an implant level, screw-retained prostheses demonstrated a statistically significant RBG compared to those with cement-retained prostheses. Significant favorable differences were seen in all outcomes when evaluating presurgical bone level loss (> 50% of the implant length). Further studies with larger groups of patients are necessary to substantiate the findings in this report.


Assuntos
Implantes Dentários/efeitos adversos , Planejamento de Prótese Dentária , Peri-Implantite/terapia , Adulto , Idoso , Perda do Osso Alveolar , Cimentos Dentários , Humanos , Pessoa de Meia-Idade , Peri-Implantite/etiologia , Radiografia Dentária , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
17.
Compend Contin Educ Dent ; 39(1): 20-25; quiz 26, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29293007

RESUMO

Periodontal probing around natural teeth and dental implants remains an efficient and non-invasive method to diagnose loss of attachment, determine presence of diseases, monitor marginal recession, and evaluate positive treatment outcomes. Risks of probing around natural teeth and dental implants include inaccurate measurements, bacteria inoculation, spread of disease, and damage to the implant surface. Improper probing can lead to undiagnosed or overdiagnosed diseases. Some clinicians have questioned the value versus the risk of probing around implants. This article discusses the risks and advantages of probing around teeth and dental implants and suggests methods of probing intended to enable more accurate evaluation of periodontal and peri-implant conditions.


Assuntos
Implantes Dentários , Índice Periodontal , Guias como Assunto , Humanos , Medição de Risco
18.
Mol Ecol Resour ; 18(3): 490-501, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29314756

RESUMO

Biologists frequently sort specimen-rich samples to species. This process is daunting when based on morphology, and disadvantageous if performed using molecular methods that destroy vouchers (e.g., metabarcoding). An alternative is barcoding every specimen in a bulk sample and then presorting the specimens using DNA barcodes, thus mitigating downstream morphological work on presorted units. Such a "reverse workflow" is too expensive using Sanger sequencing, but we here demonstrate that is feasible with an next-generation sequencing (NGS) barcoding pipeline that allows for cost-effective high-throughput generation of short specimen-specific barcodes (313 bp of COI; laboratory cost <$0.50 per specimen) through next-generation sequencing of tagged amplicons. We applied our approach to a large sample of tropical ants, obtaining barcodes for 3,290 of 4,032 specimens (82%). NGS barcodes and their corresponding specimens were then sorted into molecular operational taxonomic units (mOTUs) based on objective clustering and Automated Barcode Gap Discovery (ABGD). High diversity of 88-90 mOTUs (4% clustering) was found and morphologically validated based on preserved vouchers. The mOTUs were overwhelmingly in agreement with morphospecies (match ratio 0.95 at 4% clustering). Because of lack of coverage in existing barcode databases, only 18 could be accurately identified to named species, but our study yielded new barcodes for 48 species, including 28 that are potentially new to science. With its low cost and technical simplicity, the NGS barcoding pipeline can be implemented by a large range of laboratories. It accelerates invertebrate species discovery, facilitates downstream taxonomic work, helps with building comprehensive barcode databases and yields precise abundance information.


Assuntos
Formigas/genética , Invertebrados/genética , Animais , Formigas/classificação , Biodiversidade , Classificação/métodos , Código de Barras de DNA Taxonômico/métodos , Bases de Dados Genéticas , Invertebrados/classificação , Análise de Sequência de DNA , Fluxo de Trabalho
19.
Am J Med ; 131(6): e235-e239, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29353047

RESUMO

BACKGROUND: Surgical myectomy reverses heart failure symptoms in the vast majority of obstructive hypertrophic cardiomyopathy patients. However, a small subgroup fails to experience sustained postoperative improvement despite relief of obstruction. Clinical profile of such patients has not been well defined. METHODS: Consecutive obstructive hypertrophic cardiomyopathy patients undergoing myectomy at Tufts Medical Center for drug-refractory New York Heart Association III/IV heart failure symptoms, 2004 to 2017, were followed postoperatively for 2.5 ± 2.8 years and assessed for outcome. RESULTS: Of the 503 patients, there were 4 postoperative deaths (0.8%); 480 patients (96%) had sustained improvement to New York Heart Association classes I or II (responders), but 19 (3.8%) developed advanced symptoms (classes III or IV) in the absence of obstruction (nonresponders). Compared with responders, nonresponders were younger (40 ± 13 vs 53 ± 14 years; P < .001) and had greater septal thickness (25 ± 9 vs 20 ± 4 mm; P < .001). Massive hypertrophy (≥30 mm) was 5-fold more common in nonresponders (P < .01). Seven nonresponders developed systolic dysfunction (ejection fraction 20%-47%), 2 days to 6.1 years postoperatively. Four nonresponders underwent heart transplant 3.4 to 9.2 years after myectomy, and 2 others have been listed. CONCLUSIONS: Surgical myectomy is highly effective at reversing heart failure symptoms in the vast majority of patients with obstructive hypertrophic cardiomyopathy. However, a small minority experience persistent functional limitation despite surgical relief of outflow obstruction. Predictors of adverse postoperative course were substantial/massive septal thickness and youthful age. Patients who failed to respond symptomatically to myectomy were considered for advanced heart failure treatment, including heart transplantation.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Hipertrófica/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adulto , Cardiomiopatia Hipertrófica/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Resultado do Tratamento
20.
Zootaxa ; 4532(3): 301-340, 2018 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-30647352

RESUMO

The true diversity of the Asian ant genus Rhopalomastix Forel is poorly understood. We use an integrated approach to review the known species and subspecies of Rhopalomastix in Southeast Asia. Based on morphology and supporting DNA evidence, we recognize six species. We raise two subspecies of R. rothneyi Forel to species rank (R. johorensis Wheeler stat. n, R. javana Wheeler stat. n.), synonymize R. janeti Donisthorpe (syn. nov.) with R. johorensis, and describe four new species from Singapore: R. glabricephala sp. n., R. murphyi sp. n., R. striata sp. n., and R. tenebra sp. n. All six species found in Southeast Asia are distinct from each other based on morphology; morphological delimitation of these species is further supported by and congruent with mOTUs generated from objective clustering of short fragment COI barcodes using the best close match criteria. Different castes and sexes of most species are described, including redescriptions of the queen of R. javana and male of R. johorensis. A key to the Southeast Asian species based on the worker caste is also provided. Variation among sympatric and also geographically distant populations, and the possibilities of cryptic species, are discussed.


Assuntos
Formigas , Código de Barras de DNA Taxonômico , Animais , Formigas/genética , DNA , Masculino , Singapura
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