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1.
J Healthc Eng ; 2020: 8857553, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33029339

RESUMO

Data envelopment analysis (DEA) is a powerful nonparametric engineering tool for estimating technical efficiency and production capacity of service units. Assuming an equally proportional change in the output/input ratio, we can estimate how many additional medical resource health service units would be required if the number of hospitalizations was expected to increase during an epidemic outbreak. This assessment proposes a two-step methodology for hospital beds vacancy and reallocation during the COVID-19 pandemic. The framework determines the production capacity of hospitals through data envelopment analysis and incorporates the complexity of needs in two categories for the reallocation of beds throughout the medical specialties. As a result, we have a set of inefficient healthcare units presenting less complex bed slacks to be reduced, that is, to be allocated for patients presenting with more severe conditions. The first results in this work, in collaboration with state and municipal administrations in Brazil, report 3772 beds feasible to be evacuated by 64% of the analyzed health units, of which more than 82% are moderate complexity evacuations. The proposed assessment and methodology can provide a direction for governments and policymakers to develop strategies based on a robust quantitative production capacity measure.


Assuntos
Leitos/provisão & distribução , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Hospitais , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Leitos/estatística & dados numéricos , Betacoronavirus , Engenharia Biomédica , Brasil/epidemiologia , Infecções por Coronavirus/tratamento farmacológico , Eficiência Organizacional/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Determinação de Necessidades de Cuidados de Saúde , Alocação de Recursos , Estatísticas não Paramétricas
2.
AIDS Res Ther ; 17(1): 59, 2020 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-33012282

RESUMO

INTRODUCTION: During the COVID-19 pandemic, hospitals faced increasing pressure, where people living with HIV risked to either acquire SARS-CoV-2 and to interrupt the HIV continuum of care. METHODS: This is a retrospective, observational study. We compared the numbers of medical visits performed, antiretroviral drugs dispensed and the number of new HIV diagnosis and of hospitalizations in a cohort of people living with HIV (PLWH) followed by the Spedali Civili of Brescia between the bimester of the COVID-19 pandemic peak and the bimester of October-November 2019. Data were retrieved from administrative files and from paper and electronic clinical charts. Categorical variables were described using frequencies and percentages, while continuous variables were described using mean, median, and interquartile range (IQR) values. Means for continuous variables were compared using Student's t-tests and the Mann-Whitney test. Proportions for categorical variables were compared using the χ2 test. RESULTS: As of December 31st, 2019, a total of 3875 PLWH were followed in our clinic. Mean age was 51.4 ± 13 years old, where 28% were females and 18.8% non-Italian. Overall, 98.9% were on ART (n = 3834), 93% were viro-suppressed. A total of 1217 and 1162 patients had their visit scheduled at our out-patient HIV clinic during the two bimesters of 2019 and 2020, respectively. Comparing the two periods, we observed a raise of missed visits from 5 to 8% (p < 0.01), a reduction in the number of new HIV diagnosis from 6.4 in 2019 to 2.5 per month in 2020 (p = 0.01), a drop in ART dispensation and an increase of hospitalized HIV patients due to COVID-19. ART regimens including protease inhibitors (PIs) had a smaller average drop than ART not including PIs (16.6 vs 21.6%, p < 0.05). Whether this may be due to the perception of a possible efficacy of PIs on COVID19 is not known. CONCLUSIONS: Our experience highlights the importance of a resilient healthcare system and the need to implement new strategies in order to guarantee the continuum of HIV care even in the context of emergency.


Assuntos
Infecções por Coronavirus/virologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Pneumonia Viral/virologia , Adulto , Fármacos Anti-HIV/administração & dosagem , Antirretrovirais/administração & dosagem , Betacoronavirus/isolamento & purificação , Estudos de Coortes , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Hospitalização , Humanos , Itália/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Saúde Pública , Estudos Retrospectivos , Estatísticas não Paramétricas
3.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32994178

RESUMO

BACKGROUND AND OBJECTIVES: Postpyloric feeding tube placement is a time-consuming procedure associated with multiple attempts and radiation exposure. Our objective with this study is to compare the time, attempts, and radiation exposure using the electromagnetic versus blind method to place a postpyloric feeding tube in critically ill children. Our hypothesis is that using electromagnetic guidance decreases the procedure time, number of x-rays, and number of attempts, compared to the blind method. METHODS: Eleven pediatric nurses participated in a randomized controlled intention-to-treat study at an academic pediatric medical, surgical, and congenital cardiac ICU. University of Texas Health Epidemiology and Biostatistics generated a randomization sequence with sealed envelopes. A standard (2-sided) F-test of association between the electromagnetic and blind method yielded 40 subjects with 86% power. Data were analyzed with Fisher's exact test for categorical variables and the Wilcoxon rank test for continuous variables, with data documented as median (interquartile range [IQR]). RESULTS: We randomly assigned 52 patients to either the electromagnetic (n = 28) or blind method (n = 24). The number of attempts and radiographs was at a median of 2 (IQR: 1-2.25) using the blind method, compared to the electromagnetic method at a median of 1 (IQR: 1.0-1.0; P = .001). Successful guidance was 96.4% with the electromagnetic method, compared to only 66.7% with the blind technique (P = .008). The total time required was 2.5 minutes (IQR: 2.0-7.25) with the electromagnetic method, compared to 19 minutes (IQR: 9.25-27.0) for the blind method (P = .001). CONCLUSIONS: Electromagnetic guidance is a superior, faster, and overall safer method to place a postpyloric feeding tube in critically ill children.


Assuntos
Intubação Gastrointestinal/métodos , Imãs , Piloro , Adolescente , Adulto , Criança , Pré-Escolar , Estado Terminal , Campos Eletromagnéticos , Nutrição Enteral/métodos , Feminino , Humanos , Análise de Intenção de Tratamento , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Piloro/diagnóstico por imagem , Exposição à Radiação/prevenção & controle , Radiografia Abdominal/estatística & dados numéricos , Estatísticas não Paramétricas , Fatores de Tempo , Adulto Jovem
4.
BMC Public Health ; 20(1): 1468, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993550

RESUMO

BACKGROUND: In Ethiopia, malaria is one of the public health problems, and it is still among the ten top leading causes of morbidity and mortality among under-five children. However, the studies conducted in the country have been inconclusive and inconsistent. Thus, this study aimed to assess factors associated with malaria among under-five children in Ethiopia. METHODS: We retrieved secondary data from the malaria indicator survey data collected from September 30 to December 10, 2015, in Ethiopia. A total of 8301 under-five-year-old children who had microscopy test results were included in the study. Bayesian multilevel logistic regression models were fitted and Markov chain Monte Carlo simulation was used to estimate the model parameters using Gibbs sampling. Adjusted Odd Ratio with 95% credible interval in the multivariable model was used to select variables that have a significant association with malaria. RESULTS: In this study, sleeping under the insecticide-treated bed nets during bed time (ITN) [AOR 0.58,95% CI, 0.31-0.97)], having 2 and more ITN for the household [AOR 0.43, (95% CI, 0.17-0.88)], have radio [AOR 0.41, (95% CI, 0.19-0.78)], have television [AOR 0.19, (95% CI, 0.01-0.89)] and altitude [AOR 0.05, (95% CI, 0.01-0.13)] were the predictors of malaria among under-five children. CONCLUSIONS: The study revealed that sleeping under ITN, having two and more ITN for the household, altitude, availability of radio, and television were the predictors of malaria among under-five children in Ethiopia. Thus, the government should strengthen the availability and utilization of ITN to halt under-five mortality due to malaria.


Assuntos
Saúde da Criança/estatística & dados numéricos , Mosquiteiros Tratados com Inseticida/estatística & dados numéricos , Malária/prevenção & controle , População Rural/estatística & dados numéricos , Teorema de Bayes , Criança , Pré-Escolar , Etiópia , Características da Família , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Análise Multinível , Estatísticas não Paramétricas , Inquéritos e Questionários
5.
Medicine (Baltimore) ; 99(32): e21578, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769905

RESUMO

Impulsivity is a frequent non-motor symptom in Parkinson disease (PD). It comprises psycho-behavioral alterations that negatively impact quality of life. Dopaminergic treatments underpin many impulsive controls disorders however, side effects, such as increased impulsivity, are described also after neurosurgical procedure of deep brain stimulation (DBS). We investigated the effect of deep brain stimulation on psycho-behavioral alterations and quality of life (QoL) in PD patients, analyzing, also, the role of dopaminergic therapies.Twenty idiopathic PD patients with and 20 idiopathic PD patients without DBS were included in the study. All patient underwent to neuropsychological assessment for a screening of executive functions, impulsivity, anxiety and depressive symptoms and QoL.Differences were found between DBS and no DBS groups and in term of dopaminergic therapies. The comparison between 2 groups showed a greater motor and attentional impulsivity in DBS patients. Moreover, this impulsivity worse QoL and interpersonal relationships. The combination of Levodopa and dopamine agonists exerted a great impact on impulsivity behavior.The emergence of postoperative impulsivity seems to be a neurostimulator phenomenon related to the computational role of the subthalamic nucleus in modulation of behavior.


Assuntos
Estimulação Encefálica Profunda/normas , Dopaminérgicos/uso terapêutico , Doença de Parkinson/terapia , Núcleo Subtalâmico/fisiopatologia , Idoso , Estimulação Encefálica Profunda/instrumentação , Estimulação Encefálica Profunda/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Qualidade de Vida/psicologia , Estatísticas não Paramétricas , Núcleo Subtalâmico/fisiologia
6.
Medicine (Baltimore) ; 99(32): e21679, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769937

RESUMO

BACKGROUND: Syndesmotic injuries account for a significant number of ankle injuries. There is no consensus regarding the recommended method of treatment. The purpose of this study was to evaluate: METHODS:: This study was performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. The records of 200 patients with ankle fractures who had undergone surgical treatment in our clinics between January 2014 and January 2018 were retrospectively investigated. This retrospective cohort study was approved by the institutional review board in the 2nd Hospital of Jilin University. The primary outcome measure was the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale and the Foot Function Index. Secondary outcome measures included visual analog scale score, complications, range of movement of ankle, reoperations, and radiologic outcomes. For statistical comparison of the clinical and radiologic findings between the 2 groups, we used SPSS, version 21.0 (SPSS, Chicago, IL), statistical software. P Values of < .05 were considered statistically significant. CONCLUSION: The hypothesis was that the SB technique would achieve better functional outcomes as compared to the syndesmotic screw technique after surgery. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5793).


Assuntos
Articulação do Tornozelo/cirurgia , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/normas , Adulto , Idoso , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/anormalidades , Articulação do Tornozelo/diagnóstico por imagem , Estudos de Coortes , Feminino , Seguimentos , Humanos , Imobilização/instrumentação , Imobilização/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/estatística & dados numéricos , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento
7.
Scand J Gastroenterol ; 55(9): 1049-1056, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32749177

RESUMO

BACKGROUND AND AIMS: Diarrhea was not uncommon in patients with coronavirus disease 2019 (COVID-19), but the significance remains undetermined. METHODS: This retrospective study included 157 diarrhea cases form 564 hospitalized COVID-19 patients who were admitted to Wuhan Union Hospital from January 20 to February 29, 2020. Clinical characteristics, the course and the outcome of patients with diarrhea were analyzed. The correlation between diarrhea and fecal presence of coronavirus was also determined. RESULTS: The overall morbidity of diarrhea was 27.8% (157/564) in COVID-19 patients. Among them, 38 cases presented only with diarrhea, and 119 cases in both diarrhea and respiratory symptoms. Patients with diarrhea and respiratory symptoms had higher levels of inflammatory activity, longer hospital stay (27.5 vs. 23.0 vs. 22.0 days, p = .029) and higher odds ratio of mortality (3.2 times and 2.2 times, respectively) than those with diarrhea only or respiratory symptoms only. However, patients with diarrhea had longer time from onset to admission (14.5 days vs. 11.0 days, p = .04), higher positive viral RNA in stool (80.0% vs. 52.4%, p = .016) than those with both diarrhea and respiratory symptoms. CONCLUSIONS: Diarrhea caused by high enteric viral burden may lead to long course and poor outcome in COVID-19 patients. The patients with diarrhea and respiratory symptoms were prone to serious condition, and had worse outcomes. However, the patients with diarrhea alone showed mild illness but delayed health-seeking.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/epidemiologia , Diarreia/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Pneumonia Viral/epidemiologia , Adulto , Idoso , China/epidemiologia , Estudos de Coortes , Comorbidade , Diarreia/fisiopatologia , Diarreia/virologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida
8.
Gene ; 760: 145025, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-32758582

RESUMO

Numerous cell lines for human alveolar rhabdomyosarcoma (ARMS) have been developed and are widely used to study biological processes of this myogenic cancer. The present study investigated the resemblance of commonly used ARMS cell lines to primary tumors in regards to gene expression. RNA-sequencing data was retrieved from published datasets for 4 commonly used ARMS cell lines and 35 ARMS primary tumors. The genes with most variable expression across primary tumors were used to calculate rank-based Spearman's correlation. The observed median correlations ranged from 0.36 to 0.61. RH-41 showed the highest median correlation while KYM-1 was the least correlated cell line. A significant number of genes dysregulated between tumors and non-tumors also exhibited similar expression patterns between tumors and cell lines, including The findings suggest that ARMS cell lines exhibit changes in gene expression compared to primary tumors and may not be completely representative of the disease process.


Assuntos
RNA Mensageiro/genética , Rabdomiossarcoma Alveolar/genética , Transcriptoma/genética , Linhagem Celular Tumoral , Bases de Dados Genéticas , Expressão Gênica/genética , Perfilação da Expressão Gênica/métodos , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Modelos Biológicos , Rabdomiossarcoma Alveolar/metabolismo , Rabdomiossarcoma Alveolar/patologia , Rabdomiossarcoma Embrionário/genética , Rabdomiossarcoma Embrionário/metabolismo , Rabdomiossarcoma Embrionário/patologia , Análise de Sequência de RNA/métodos , Estatísticas não Paramétricas
9.
BMC Bioinformatics ; 21(Suppl 10): 351, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32838730

RESUMO

BACKGROUND: Oscillatory genes, with periodic expression at the mRNA and/or protein level, have been shown to play a pivotal role in many biological contexts. However, with the exception of the circadian clock and cell cycle, only a few such genes are known. Detecting oscillatory genes from snapshot single-cell experiments is a challenging task due to the lack of time information. Oscope is a recently proposed method to identify co-oscillatory gene pairs using single-cell RNA-seq data. Although promising, the current implementation of Oscope does not provide a principled statistical criterion for selecting oscillatory genes. RESULTS: We improve the optimisation scheme underlying Oscope and provide a well-calibrated non-parametric hypothesis test to select oscillatory genes at a given FDR threshold. We evaluate performance on synthetic data and three real datasets and show that our approach is more sensitive than the original Oscope formulation, discovering larger sets of known oscillators while avoiding the need for less interpretable thresholds. We also describe how our proposed pseudo-time estimation method is more accurate in recovering the true cell order for each gene cluster while requiring substantially less computation time than the extended nearest insertion approach. CONCLUSIONS: OscoNet is a robust and versatile approach to detect oscillatory gene networks from snapshot single-cell data addressing many of the limitations of the original Oscope method.


Assuntos
Redes Reguladoras de Genes , Software , Ciclo Celular , Relógios Circadianos/genética , Regulação da Expressão Gênica , Células-Tronco Embrionárias Humanas/metabolismo , Humanos , Análise de Sequência com Séries de Oligonucleotídeos , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Estatísticas não Paramétricas , Fatores de Tempo
10.
PLoS One ; 15(8): e0237736, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817703

RESUMO

AIMS: To assess the impact of two different respiratory rates in hemodynamic, perfusion and ventilation parameters in a pediatric animal model of cardiac arrest (CA). METHODS: An experimental randomized controlled trial was carried out in 50 piglets under asphyxial CA. After ROSC, they were randomized into two groups: 20 and 30 respirations per minute (rpm). Hemodynamic, perfusion and ventilation parameters were measured 10 minutes after asphyxia, just before ROSC and at 5, 15, 30 and 60 minutes after ROSC. Independent medians test, Kruskal-Wallis test and χ2 test, were used to compare continuous and categorical variables, respectively. Spearman's Rho was used to assess correlation between continuous variables. A p-value <0.05 was considered significant. RESULTS: Arterial partial pressure of carbon dioxide (PaCO2) was significantly lower in the 30 rpm group after 15 minutes (41 vs. 54.5 mmHg, p <0.01), 30 minutes (39.5 vs. 51 mmHg, p < 0.01) and 60 minutes (36.5 vs. 48 mmHg, p = 0.02) of ROSC. The percentage of normoventilated subjects (PaCO2 30-50 mmHg) was significantly higher in the 30 rpm group throughout the experiment. pH normalization occurred faster in the 30 rpm group with significant differences at 60 minutes (7.40 vs. 7.34, p = 0.02). Lactic acid levels were high immediately after ROSC in both groups, but were significantly lower in the 20 rpm group at 30 (3.7 vs. 4.7 p = 0.04) and 60 minutes (2.6 vs. 3.6 p = 0.03). CONCLUSIONS: This animal model of asphyxial CA shows that a respiratory rate of 30 rpm is more effective to reach normoventilation than 20 rpm in piglets after ROSC. This ventilation strategy seems to be safe, as it does not cause hyperventilation and does not affect hemodynamics or cerebral tissue perfusion.


Assuntos
Asfixia/terapia , Parada Cardíaca/terapia , Taxa Respiratória/fisiologia , Ventilação/normas , Animais , Pressão Arterial/fisiologia , Asfixia/fisiopatologia , Dióxido de Carbono/metabolismo , Modelos Animais de Doenças , Parada Cardíaca/fisiopatologia , Humanos , Ácido Láctico/metabolismo , Pediatria , Estatísticas não Paramétricas , Suínos/fisiologia
11.
Euro Surveill ; 25(28)2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32700670

RESUMO

Serological reactivity was analysed in plasma from 436 individuals with a history of disease compatible with COVID-19, including 256 who had been laboratory-confirmed with SARS-CoV-2 infection. Over 99% of laboratory-confirmed cases developed a measurable antibody response (254/256) and 88% harboured neutralising antibodies (226/256). Antibody levels declined over 3 months following diagnosis, emphasising the importance of the timing of convalescent plasma collections. Binding antibody measurements can inform selection of convalescent plasma donors with high neutralising antibody levels.


Assuntos
Anticorpos Neutralizantes/sangue , Betacoronavirus/imunologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/terapia , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Adolescente , Adulto , Idoso , Anticorpos Neutralizantes/uso terapêutico , Especificidade de Anticorpos , Doadores de Sangue/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Inglaterra , Humanos , Imunização Passiva/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Estatísticas não Paramétricas , Fatores de Tempo , Adulto Jovem
13.
PLoS One ; 15(7): e0233761, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702026

RESUMO

In decision-making situations individuals rarely have complete information available to select the best option and often show decisional randomness, i.e. given the same amount of knowledge individuals choose different options at different times. Dysfunctional processes resulting in altered decisional randomness can be considered a target process for psychiatric disorders, yet these processes remain poorly understood. Advances in computational modeling of decision-making offer a potential explanation for decisional randomness by positing that decisions are implemented in the brain through accumulation of noisy evidence, causing a generally less preferred option to be chosen at times by chance. One such model, the linear ballistic accumulator (LBA), assumes that individuals accumulate information for each option independently over time and that the first option to reach a threshold will be selected. To investigate the mechanisms of decisional randomness, we applied the LBA to a decision-making task in which risk and expected value (EV) were explicitly signaled prior to making a choice, and estimated separate drift rates for each of the four task stimuli (representing high and low EV and high and low risk). We then used the fitted LBA parameters to predict subject response rates on held-out trials for each of the 6 possible stimulus pairs. We found that choices predicted by LBA were correlated with actual choices across subjects for all stimulus pairs. Taken together, these findings suggest that sequential sampling models can account for decisional randomness on an explicit probabilistic task, which may have implications for understanding decision-making in healthy individuals and in psychiatric populations.


Assuntos
Biologia Computacional/métodos , Tomada de Decisões/fisiologia , Modelos Neurológicos , Modelos Psicológicos , Probabilidade , Assunção de Riscos , Processos Estocásticos , Adolescente , Distribuição de Qui-Quadrado , Comportamento de Escolha , Retroalimentação Psicológica , Feminino , Jogo de Azar , Jogos Experimentais , Humanos , Masculino , Modelos Econômicos , Satisfação Pessoal , Valores Sociais , Estatísticas não Paramétricas , Adulto Jovem
14.
PLoS One ; 15(7): e0235347, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645033

RESUMO

In most temperate fruit trees, fruits are located on one-year old shoots. In Prunus species, flowers and fruits are born in axillary position along those shoots. The axillary bud fate and branching patterns are thus key components of the cultivar potential fruit production. The objective of this study was to analyze the branching and bearing behaviors of 1-year-old shoots of apricot cultivars and clones genetically closely related. Shoot structures were analyzed in terms of axillary bud fates using hidden semi-Markov chains and compared depending on the genotype, year and shoot length. The shoots were composed of three successive zones containing latent buds (basal zone), central flower buds (median zone) and vegetative buds (distal zone), respectively. The last two zones contained few associated flower buds. The zones length (in number of metamers) and occurrence strongly depended on shoot development in the two successive years. With decrease in the number of metamers per shoot, the last two zones become shorter or may not develop. While the number of metamers of the basal and distal zones and the number of associated flower buds correlated to the number of metamers of the shoot, the number of metamers of the median zone and the transition probability from the median to the distal zone were cultivar specific.


Assuntos
Modelos Biológicos , Brotos de Planta/fisiologia , Prunus armeniaca/genética , Prunus armeniaca/fisiologia , Flores/fisiologia , Frutas/fisiologia , Genótipo , Cadeias de Markov , Estatísticas não Paramétricas
15.
PLoS One ; 15(7): e0235314, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645051

RESUMO

OBJECTIVES: 1) Determine the effects of old age on sensorimotor responses to a fatiguing work-like task. 2) Explore how old age influences the relationships between task fatigability, everyday perceptions of fatigability, and sensorimotor function. METHODS: Healthy young (N = 17, 9W) and older (N = 13, 10W) adults completed the Pittsburgh Fatigability Scale to assess everyday perceptions of physical (PF) and mental fatigability and performed a repetitive tapping task to fatigue. Before and after the task, grip strength was assessed using a hand-grip dynamometer and touch-pressure sensitivity was measured (shoulder, hand) using Semmes-Weinstein monofilaments. RESULTS: Older, but not young adults, had increased touch-pressure sensitivity at the shoulder after fatigue (interaction, p = 0.007). No changes in grip strength were observed (p>0.05). Task fatigability was not different between young and old adults (p>0.05). Having less task fatigability was associated with lower PF, higher grip strength, and higher touch-pressure sensitivity at the hand (ρ = 0.37-0.58, p<0.05), with the hand sensation association also observed in the old adult subgroup (ρ = 0.56, p = 0.046). CONCLUSIONS: With old age, there were fatigue-related alterations to sensory but not physical function. While task fatigability was associated with perceptual, physical, and sensory features, sensory features appear to have a more important role with old age.


Assuntos
Envelhecimento/fisiologia , Fadiga/fisiopatologia , Atividade Motora/fisiologia , Extremidade Superior/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Fadiga Mental/fisiopatologia , Pessoa de Meia-Idade , Percepção , Pressão , Estatísticas não Paramétricas , Análise e Desempenho de Tarefas , Tato/fisiologia , Adulto Jovem
16.
Br J Radiol ; 93(1113): 20200552, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32614611

RESUMO

OBJECTIVE: T2 blackout (TBO) effect, which is a common finding in the brains of multiple sclerosis (MS) patients and older population that are imaged for other reasons on diffusion weighted imagings (DWI) and apparent diffusion coefficient (ADC) map show the existence of paramagnetic materials in the tissue. Because iron is known to accumulate in especially deep gray matter (DGM) structures in MS brains, we aimed to investigate the relationship between TBO and clinico-radiological parameters that may be iron-related in MS. METHODS: We retrospectively reviewed the latest MR images of MS patients on 3 Tesla MR scanner between 2018 and 2019. TBO existence and severity on DWI-ADC was assessed by two radiologists and its correlation with several outcomes of MS was investigated. RESULTS: No significant relationship was found between TBO and gender, subtype of MS whereas TBO was positively correlated with parameters such as black-hole lesions, cortical atrophy, duration of disease, age and extended disability status scale (EDSS) score. CONCLUSIONS: TBO shows correlation with the conditions which were revealed to be associated with iron accumulation in the brain of MS patients in the literature. Therefore, we concluded that TBO and its severity in DGM may represent iron accumulation in MS brains. ADVANCES IN KNOWLEDGE: TBO effect as a frequent imaging finding in daily practice may be used as predictor of the disease course of MS due to possible effects of iron accumulation in brain and thereby may be useful in modifying treatment strategies.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Imagem de Difusão por Ressonância Magnética/métodos , Ferro/metabolismo , Esclerose Múltipla/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/metabolismo , Variações Dependentes do Observador , Estudos Retrospectivos , Estatísticas não Paramétricas , Adulto Jovem
17.
Br J Radiol ; 93(1113): 20200321, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32628097

RESUMO

OBJECTIVE: Pituitary macroadenomas (PAs) are usually defined as benign intracranial tumors. However, they may present local aggressive course. High Ki67 labelling index (LI) values have been related to an aggressive tumor behavior. A recent clinicopathological classification of PA based on local invasiveness and proliferation indexes, divided them in groups with different prognosis. We evaluated the utility of conventional MRI (cMRI) and diffusion-weighted imaging (DWI), in predicting the Ki67- LI according the clinicopathological classification. METHODS: 17 patients (12 M and 5 F) who underwent surgical removal of a PA were studied. cMRI features, quantification of T1W and T2W signal intensity, degree of contrast uptake (enhancement ratio, ER) and apparent diffusion coefficient (ADC) values were evaluated by using a 3 T scan. Statistics included Mann-Whitney test, Spearman's test, and receiver operating characteristic analysis. A value of p ≤ 0.05 was considered significant for all the tests. RESULTS: Negative correlations were observed between Ki-67 LI, ADCm (ρ = - 0.67, p value = 0.005) and ER values (ρ = -0.62; p = 0.008). ER values were significantly lower in the proliferative PA group (p = 0.028; p = 0.017). ADCm showed sensitivity and specificity of 90 and 85% respectively into predict Ki67-LI value. A value of ADCm ≤0, 711 x 10-6 mm2 emerged as a cut-off of a value of Ki67-LI ≥ 3%. CONCLUSION: Adding quantitative measures of ADC values to cMRI could be used routinely as a non-invasive marker of specific predictive biomarker of the proliferative activity of PA. ADVANCES IN KNOWLEDGE: Routinely use of DWI on diagnostic work-up of pituitary adenomas may help in establish the likely biological aggressive lesions.


Assuntos
Adenoma/diagnóstico por imagem , Antígeno Ki-67/análise , Imagem por Ressonância Magnética/métodos , Neoplasias Hipofisárias/diagnóstico por imagem , Adenoma/química , Adenoma/patologia , Adenoma/cirurgia , Núcleo Celular/química , Proliferação de Células , Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Invasividade Neoplásica , Neoplasias Hipofisárias/química , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Curva ROC , Sensibilidade e Especificidade , Estatísticas não Paramétricas
18.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(6): 364-373, jun.-jul. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-193361

RESUMO

Hay controversia sobre la realización de laringoscopia preoperatoria (LP) en cirugía de tiroides. Las recomendaciones, basadas en estudios observacionales, varían entre unas publicaciones y otras. El objetivo del estudio es conocer la prevalencia de parálisis laríngea hallada en LP de pacientes a los que se realizó tiroidectomía en enfermedad benigna y maligna. Se realizó la revisión sistemática con 29 artículos incluidos para el estudio cualitativo y metaanálisis de 13 artículos en los que pudieron obtenerse los datos para evaluar el mismo efecto (LP realizada en todos los pacientes incluidos; se recoge a los pacientes con parálisis laríngea preoperatoria, figura el número total de pacientes y pueden asignarse las parálisis preoperatorias a los grupos de histología posoperatoria maligna o benigna). La prevalencia agrupada de parálisis preoperatoria en enfermedad benigna fue del 1,1% (IC del 95%, 0,7 a 1,7%; I2 71%) y en enfermedad maligna 6,3% (IC del 95%, 3,8 a 9,4%; I2 85%). La prevalencia es significativamente superior entre pacientes con enfermedad maligna con un efecto estimado RR 5,66, IC del 95%, 2,48, 12,88. Los estudios analizados presentan sesgos que será necesario corregir en investigaciones futuras, eliminando los sesgos de cegamiento en la selección y asignación de pacientes o en la técnica de laringoscopia empleada. La LP en cirugía de tiroides evalúa posibles trastornos de motilidad laríngea. La prevalencia de la parálisis laríngea en enfermedad de tiroides hallada en la LP en pacientes con diagnóstico posoperatorio de enfermedad maligna es más elevada que en el grupo de enfermedad benigna. Esta información es necesaria para interpretar la señal de neuromonitorización intraoperatoria y tomar decisiones


There is controversy regarding the performance of preoperative laryngoscopy (LP) in thyroid surgery, with different recommendations being made, based on observational studies, in various publications. The aim of the study was to know the prevalence of laryngeal paralysis found in the LPs of patients who underwent thyroidectomy in benign and malignant pathology. A systematic review was carried out with 29 articles included for the qualitative study and a meta-analysis of 13 articles in which the data could be obtained to evaluate the same effect (in all patients in which an LP was carried out, those with preoperative laryngeal paralysis were included, and assigned to malignant or benign postoperative histology groups). The pooled prevalence of preoperative paralysis in benign pathology was 1.1% (95% CI 0.7 to 1.7%, 71% I2) and in 6.3% malignant pathology (95% CI 3.8 to 9.4%; I2 85%). The prevalence was significantly higher among patients with malignant pathology with an estimated effect RR 5.66, 95% CI, 2.48, 12.88. The studies analyzed present biases that will need to be corrected in future research, eliminating blinding biases in the selection and allocation of patients or in the laryngoscopy technique used. The LP in thyroid surgery evaluates possible disorders of laryngeal motility. The prevalence of laryngeal paralysis in thyroid pathology found in LPs in patients with a postoperative diagnosis of malignant pathology was higher than in the benign pathology group. This information is necessary for interpreting the intraoperative neuromonitoring signal and for making informed decisions


Assuntos
Humanos , Paralisia das Pregas Vocais/diagnóstico por imagem , Paralisia das Pregas Vocais/epidemiologia , Tireoidectomia/métodos , Estatísticas não Paramétricas , Viés
19.
Cir. pediátr ; 33(3): 131-136, jul. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-193555

RESUMO

OBJETIVO: Analizar si la aplicación de la cirugía laparoscópica en el tratamiento de la estenosis pieloureteral (EPU) ha sido beneficiosa para el paciente pediátrico. MATERIAL Y MÉTODO: Hemos revisado de forma retrospectiva las historias clínicas de todos aquellos pacientes intervenidos de EPU desde enero de 1997 hasta diciembre de 2017. Se excluyeron las que tuvieron seguimiento menor a 6 meses, y las cirugías videoasistidas. Se han comparado la cirugía abierta con la cirugía laparoscópica. Se han recogido los siguientes datos: abordaje quirúrgico, necesidad y tipo de derivación urinaria, tiempo quirúrgico, estancia media, complicaciones, tasa de reestenosis. Los parámetros ecográficos y del renograma diurético también han sido recogidos. RESULTADOS: Se han analizado 328 pieloplastias, 142 se realizaron laparoscópicamente. La tasa de éxito global ha sido del 96,6%, existiendo un 11,9% de complicaciones, sin existir diferencias significativas entre la cirugía abierta y la laparoscópica. En el 97,5% de las cirugías, la orina se derivó mediante catéter nefroureteral externo, catéter doble J o catéter tipo Salle, existiendo diferencias entre cirugía abierta y laparoscópica. El tiempo quirúrgico medio fue significativamente superior en la cirugía laparoscópica. La estancia media fue menor en el grupo de cirugía laparoscópica de forma significativa. CONCLUSIÓN: La vía de abordaje no es un factor que influya en el éxito de la cirugía de la EPU, por ello pensamos que la cirugía laparoscópica es la técnica de elección en pacientes pediátricos


OBJECTIVE: To analyze whether the application of laparoscopic surgery in the treatment of pyeloureteral junction obstruction (PUJO) has been beneficial for pediatric patients. MATERIALS AND METHODS: Medical records of all patients undergoing PUJO surgery from January 1997 to December 2017 were retrospectively reviewed. Patients with < 6-month follow-up and patients undergoing video-assisted surgery were excluded. Open surgery was compared with laparoscopic surgery. The following data were collected: surgical approach, need for and type of urinary diversion, operating time, mean hospital stay, complications, and restenosis rate. Ultrasound and diuretic renogram parameters were also retrieved. RESULTS: 328 Anderson-Hynes pyeloplasties were analyzed, 142 of which had been performed laparoscopically. Overall success rate was 96.6%, and complication rate was 11.9%. No significant differences were noted between open and laparoscopic surgery. In 97.5% of surgeries, urine was diverted using an external nephroureteral catheter, a double J stent, or a Salle stent, with significant differences between open and laparoscopic surgery. Mean operating time was significantly longer in laparoscopic surgery. Mean hospital stay was significantly shorter in the laparoscopic surgery group. CONCLUSION: Surgical approach does not play a role in PUJO surgery success. Therefore, in our view, laparoscopic surgery should be the technique of choice in pediatric patients


Assuntos
Humanos , Masculino , Feminino , Lactente , Procedimentos Cirúrgicos Urológicos/métodos , Obstrução Ureteral/cirurgia , Uretra/cirurgia , Laparoscopia , Estreitamento Uretral/cirurgia , Estudos Retrospectivos , Cuidados Pós-Operatórios/métodos , Estatísticas não Paramétricas , Tempo de Internação
20.
Ann Surg ; 272(2): 199-205, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675481

RESUMO

OBJECTIVE: The aim of this retrospective study was to compare portal vein embolization (PVE) and radiologica simultaneous portohepatic vein embolization (RASPE) for future liver remnant (FLR) growth in terms of feasibility, safety, and efficacy. SUMMARY OF BACKGROUND DATA: After portal vein embolization (PVE), 15% of patients remain ineligible for hepatic resection due to insufficient hypertrophy of the FLR. RASPE has been proposed to induce FLR growth. MATERIALS AND METHODS: Between 2016 and 2018, 73 patients were included in the study. RASPE was proposed for patients with a ratio of FLR to total liver volume (FLR/TLV) of <25% (RASPE group). This group was compared to patients who underwent PVE for a FLR/TLV <30% (PVE group). Patients in the 2 groups were matched for age, sex, type of tumor, and number of chemotherapy treatments. FLR was assessed by computed tomography before and 4 weeks after the procedure. RESULTS: The technical success rate in both groups was 100%. Morbidity post-embolization, and the time between embolization and surgery were similar between the groups. In the PVE group, the FLR/TLV ratio before embolization was 31.03% (range: 18.33%-38.95%) versus 22.91% (range: 16.55-32.15) in the RASPE group (P < 0.0001). Four weeks after the procedure, the liver volume increased by 28.98% (range: 9.31%-61.23%) in the PVE group and by 61.18% (range: 23.18%-201.56%) in the RASPE group (P < 0.0001). Seven patients in the PVE group, but none in the RASPE group, had postoperative liver failure (P = 0.012). CONCLUSIONS: RASPE can be considered as "radiological associating liver partition and portal vein ligation for staged hepatectomy." RASPE induced safe and profound growth of the FLR and was more efficient than PVE. RASPE also allowed for extended hepatectomy with less risk of post-operative liver failure.


Assuntos
Embolização Terapêutica/métodos , Hepatectomia/métodos , Hepatomegalia/prevenção & controle , Neoplasias Hepáticas/cirurgia , Veia Porta/cirurgia , Cirurgia Assistida por Computador/métodos , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Intervalo Livre de Doença , Feminino , França , Hepatectomia/mortalidade , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
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