Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 49
Filtrar
1.
Proc Natl Acad Sci U S A ; 120(2): e2214829120, 2023 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-36595671

RESUMO

Hepatocellular carcinoma (HCC) remains a global health challenge whose incidence is growing worldwide. Previous evidence strongly supported the notion that the circadian clock controls physiological homeostasis of the liver and plays a key role in hepatocarcinogenesis. Despite the progress, cellular and molecular mechanisms underpinning this HCC-clock crosstalk remain unknown. Addressing this knowledge gap, we show here that although the human HCC cells Hep3B, HepG2, and Huh7 displayed variations in circadian rhythm profiles, all cells relied on the master circadian clock transcription factors, BMAL1 and CLOCK, for sustained cell growth. Down-regulating Bmal1 or Clock in the HCC cells induced apoptosis and arrested cell cycle at the G2/M phase. Mechanistically, we found that inhibiting Bmal1/Clock induced dysregulation of the cell cycle regulators Wee1 and p21 which cooperatively contribute to tumor cell death. Bmal1/Clock knockdown caused downregulation of Wee1 that led to apoptosis activation and upregulation of p21 which arrested the cell cycle at the G2/M phase. Collectively, our results suggest that the circadian clock regulators BMAL1 and CLOCK promote HCC cell proliferation by controlling Wee1 and p21 levels, thereby preventing apoptosis and cell cycle arrest. Our findings shed light on cellular impact of the clock proteins for maintaining HCC oncogenesis and provide proof-of-principle for developing cancer therapy based on modulation of the circadian clock.


Assuntos
Carcinoma Hepatocelular , Relógios Circadianos , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/patologia , Fatores de Transcrição ARNTL/genética , Fatores de Transcrição ARNTL/metabolismo , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/metabolismo , Proteínas CLOCK/genética , Ritmo Circadiano/genética , Relógios Circadianos/genética , Proliferação de Células , Ciclo Celular , Divisão Celular , Apoptose
2.
Surg Endosc ; 2024 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-39020117

RESUMO

BACKGROUND: Sleeve gastrectomy has become a gold standard in addressing medically refractory obesity. Robotic platforms are becoming more utilized, however, data on its cost-effectiveness compared to laparoscopy remain controversial (1-3). At NYU Langone Health, many of the bariatric surgeons adopted robotic surgery as part of their practices starting in 2021. We present a retrospective cost analysis of laparoscopic sleeve gastrectomy (LSG) vs. robotic sleeve gastrectomy (RSG) at New York University (NYU) Langone Health campuses. METHODS: All adult patients ages 18-65 who underwent LSG or RSG from 202 to 2023 at NYU Langone Health campuses (Manhattan, Long Island, and Brooklyn) were evaluated via electronic medical records and MBSAQIP 30-day follow-up data. Patients with prior bariatric surgery were excluded. Complication-related ICD-10/CPT codes are collected and readmission costs will be estimated from ICD codes using the lower limit of CMS transparent NYU standard charges (3). Direct charge data for surgery and length of stay cost data were also obtained. Statistical T-test and chi-squared analysis were used to compare groups. RESULTS: Direct operating cost data at NYU Health Campuses demonstrated RSG was associated with 4% higher total charges, due to higher OR charges, robotic-specific supplies, and more post-op ED visits. CONCLUSIONS: RSG was associated with higher overall hospital charges compared to LSG, though there are multiple contributing factors. More research is needed to identify cost saving measures. This study is retrospective in nature, and does not include indirect costs nor reimbursement. Direct operating costs, per contractual agreement with suppliers, are only given as percentages. Data are limited to 30-day follow-up.

3.
Surg Endosc ; 37(10): 8064-8071, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37488445

RESUMO

BACKGROUND: New York University Langone Health has three accredited bariatric centers, with 10 different bariatric surgeons. This retrospective analysis compares surgeon techniques in laparoscopic or robotic sleeve gastrectomy (SG) to identify associations with perioperative morbidity and mortality. METHODS: All adults who underwent SG between 2017 and 2021 at NYU Langone Health were evaluated via EMR and MBSAQIP 30-day data. We also surveyed all 10 bariatric surgeons and compared their techniques and total adverse outcomes. Bleeding, SSI, mortality, readmission, and reoperation were specifically sub-analyzed via logistic regression. RESULTS: 86 (2.77%) out of 3,104 patients who underwent SG encountered an adverse event. Lower adverse outcomes were observed with a laparoscopic approach, 40-Fr bougie, buttressing, not oversewing the staple line, using hemostatic agents, stapling 3-cm from pylorus, and no routine UGI series. Lower bleeding rates were observed in a laparoscopic approach, 40-Fr bougie, buttressing, not oversewing the staple line, using hemostatic agents, stapling 3-cm from pylorus, no routine UGI series, and not proceeding with SG if hiatal hernia is present. Lower SSI rates were observed with ViSiGi™ bougie, no hemostatic agents, and routine EGD. Lower readmission rates were observed with 40-Fr bougie, buttressing, not oversewing, and stapling 3-cm from pylorus. Hemostatic agents had higher reoperation rates. It was not feasible to test for mortality given the low incidence. CONCLUSION: Certain surgical techniques in SG among our bariatric surgeons had a significant effect on the rates of adverse outcomes, bleeding, readmission, reoperation, and SSI. Our findings warrant further investigation into these techniques via multivariate regression or prospective design. LIMITATIONS: This study was limited by its retrospective and univariate design. We did not account for interaction. The sample size was small, and follow-up of 30 days was relatively short. We did not include patient characteristics in the model or control for surgeon skill.


Assuntos
Cirurgia Bariátrica , Hemostáticos , Laparoscopia , Obesidade Mórbida , Adulto , Humanos , Estudos Retrospectivos , Cidade de Roma , Cirurgia Bariátrica/métodos , Obesidade Mórbida/cirurgia , Laparoscopia/métodos , Grampeamento Cirúrgico/métodos , Gastrectomia/métodos , Resultado do Tratamento
4.
Surg Endosc ; 37(9): 7254-7263, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37415013

RESUMO

BACKGROUND: New York University Langone Health has three accredited bariatric centers, with altogether ten different bariatric surgeons. This retrospective analysis compares individual surgeon techniques in laparoscopic or robotic Roux-en-Y gastric bypass (RYGB) to identify potential associations with perioperative morbidity and mortality. METHODS: All adult patients who underwent RYGB between 2017 and 2021 at NYU Langone Health campuses were evaluated via electronic medical records and MBSAQIP 30-day follow-up data. We surveyed all ten practicing bariatric surgeons to analyze the relationship between their techniques and total adverse outcomes. Bleeding, SSI, mortality, readmission, and reoperation were specifically sub-analyzed via logistic regression. RESULTS: 54 (7.59%) out of 711 patients who underwent laparoscopic or robotic RYGB encountered an adverse outcome. Lower adverse outcomes were observed with laparoscopic approach, creating the JJ anastomosis first, flat positioning, division of the mesentery, Covidien™ laparoscopic staplers, gold staples, unidirectional JJ anastomosis, hand-sewn common enterotomy, 100-cm Roux limb, 50-cm biliopancreatic limb, and routine EGD. Lower bleeding rates were observed with flat positioning, gold staples, hand-sewn common enterotomy, 50-cm biliopancreatic limb, and routine EGD. Lower readmission rates were observed in laparoscopic, flat positioning, Covidien™ staplers, unidirectional JJ anastomosis, and hand-sewn common enterotomy. Gold staples had lower reoperation rates. Otherwise, there was no statistically significant difference in SSI. CONCLUSION: Certain surgical techniques in RYGB within our bariatric surgery group had significant effects on the rates of total adverse outcomes, bleeding, readmission, and reoperation. Our findings warrant further investigation into the aforementioned techniques via multivariate regression models or prospective study design. LIMITATIONS: This study was limited by the inherent nature of its retrospective and univariate statistical design. We did not account for the interaction between techniques. The sample size of surgeons was small, and follow-up of 30 days was relatively short. We did not include patient characteristics in the model or control for surgeon skill.


Assuntos
Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Adulto , Humanos , Derivação Gástrica/métodos , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Estudos Prospectivos , Cidade de Roma , Laparoscopia/métodos , Resultado do Tratamento
5.
Surg Endosc ; 37(4): 3069-3072, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-35920911

RESUMO

BACKGROUND: Many insurance companies mandate medically supervised weight loss programs (MSWLPs) prior to bariatric surgery. This retrospective study aims to elucidate whether the average 6-month preoperative medical-management period decreases preoperative BMI for those with BMI ≥ 50. METHODS: All adult patients with bariatric consultation at any time at the New York University Langone Health campuses during the period 2015 to 2021 were evaluated via electronic medical records. Only patients with ≥ BMI 50, without previous bariatric surgeries, and those with 6-month insurance-mandated medical visits were included. A paired t-test was performed on the difference in BMI and percent-weight loss among the subjects at least 6 months before surgery and on the day of surgery. RESULTS: Of the 130 patients with BMI ≥ 50, undergoing preoperative 6-month office weigh-ins, the mean difference in BMI was - 1.51 (P < 0.01). The mean total body weight loss was 4.8% (P < 0.01). There were no intraoperative complications nor 30-day complications or mortality in the group. CONCLUSIONS: We found that there was weight loss during the 6-month insurance-mandated medical management prior to surgery, but the amount (4.8%) did not reach the goal target of 10% of body weight. We found that there were no complications and question the need for prolonged delay to surgery.


Assuntos
Cirurgia Bariátrica , Adulto , Humanos , Estudos Retrospectivos , Índice de Massa Corporal , Resultado do Tratamento , Redução de Peso
6.
J Neuroophthalmol ; 42(1): 73-78, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33870951

RESUMO

BACKGROUND: Optical coherence tomography angiography (OCTA) is a new noninvasive imaging modality that provides high resolution images of the optic nerve head and peripapillary retinal capillary vasculature which can be affected by optic nerve or retinal pathologies. High repeatability of peripapillary capillary density measurement using OCTA has been demonstrated in normal eyes and eyes with glaucoma. The purpose of our study was to quantify the repeatability of peripapillary capillary density measurement using OCTA in both normal eyes and eyes with optic atrophy, optic disc edema, and retinal vasculopathy. METHODS: This prospective cross-sectional study enrolled 31 patients (59 eyes) including 16 eyes with optic nerve pathology (7 with disc edema from papilledema and 9 with optic atrophy), 35 eyes with retinal vascular disease, and 8 normal eyes. All eyes were imaged twice (30 minutes apart) with the Optovue AngioVue OCTA instrument to obtain 4.5 × 4.5 mm peripapillary scans. Scans were considered good quality if signal strength was 6 or greater. The OCTA parameters obtained include the radial peripapillary capillary (RPC) density of the whole disc, inside the disc, peripapillary region, and the 4 quadrants of the disc (superior, nasal, inferior, and temporal). A Student's t test was used to compare means. Intraclass correlation coefficient (ICC) was calculated to measure repeatability. RESULTS: Repeatability of RPC density measurements for all regions analyzed demonstrated good to excellent repeatability for the whole cohort {ICC for the whole image was 0.915 (95% confidence interval [CI] = 0.855-0.951)}; ICC for the peripapillary region was 0.945 (95% CI = 0.905-0.969). In the subset of eyes with good image quality (i.e., signal strength ≥ 6), ICC was slightly higher for all regions, with excellent repeatability of the peripapillary region (ICC was 0.971 [95% CI = 0.943-0.986]). Conversely, for eyes with poor image quality scans (i.e., signal strength < 6), ICC was lower, corresponding to moderate to good repeatability for most parameters. For the subset of eyes with optic atrophy, disc edema from papilledema or retinal vasculopathy, all had good to excellent repeatability of the vessel density of the entire disc (ICC values were 0.954 [95% CI = 0.804-0.990], 0.921 [95% CI = 0.711-0.982], and 0.895 [95% CI = 0.788-0.951, respectively]) and of the peripapillary region (ICC values were 0.980 [95% CI = 0.904-0.996], 0.966 [95% CI = 0.854-0.993], and 0.916 [95% CI = 0.827-0.961], respectively). CONCLUSIONS: The peripapillary capillary density measurement obtained using a commercial OCTA instrument is highly repeatable in eyes with optic nerve atrophy, disc edema from papilledema, or retinal vasculopathy.


Assuntos
Atrofia Óptica , Disco Óptico , Papiledema , Estudos Transversais , Angiofluoresceinografia/métodos , Humanos , Disco Óptico/irrigação sanguínea , Estudos Prospectivos , Vasos Retinianos/diagnóstico por imagem , Vasos Retinianos/patologia , Tomografia de Coerência Óptica/métodos
7.
Rapid Commun Mass Spectrom ; 35(15): e9123, 2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-33955039

RESUMO

RATIONALE: Detection of 3-quinuclidinol (3Q), a marker for the chemical warfare agent 3-quinuclidinyl benzilate, is very difficult by gas chromatography-mass spectrometry (GC/MS), providing low, broad signals even when analyzed in isolated form. Therefore, a method that can convert 3Q into a substrate with enhanced detectability by GC/MS would be an important tool for its analysis. METHODS: 2,2,2-Trichloroethoxycarbonyl chloride (TrocCl) was used in the derivatization of 3Q in three different soils of varying composition and total organic content (Virginia type A soil, Nebraska EPA standard soil and Ottawa sand) when present at a 10 µg g-1 concentration in each. A direct derivatization protocol and one involving the pre-extraction of the analyte were evaluated for their individual efficiencies and subsequent analysis using electron ionization GC/MS. RESULTS: The practical derivatization of 3Q, when present at low levels (10 µg g-1 ) in three different soil matrices, was found to be rapid (1 h) and to take place smoothly at ambient temperature (and as low as 4°C). The method detection limit was determined to be 30 ng mL-1 for the Virginia type A soil, 49 ng mL-1 for the Nebraska EPA standard soil and 72 ng mL-1 for the Ottawa sand sample. CONCLUSIONS: An expedient and practical derivatization method for 3Q, a chemical warfare degradation product difficult to detect by GC/MS, has been realized using trichloroethyl chloroformate. The reaction provides 3Q-Troc, a derivative with better detectability than 3Q by electron ionization GC/MS such as peak sharpness and a unique mass spectrum for its unambiguous identification.

8.
Ophthalmic Plast Reconstr Surg ; 33(6): 466-470, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27879621

RESUMO

PURPOSE: To characterize patient evaluations of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) surgeons on a popular online physician rating website in an effort to determine which factors play a role in determining the likelihood of a patient recommending an ASOPRS surgeon to family and friends. METHODS: After obtaining approval and access from Healthgrades.com, the website database was searched for 612 U.S.-based ASOPRS members using their name as published on http://www.asoprs.org/ as of May 2015. For each surgeon, the total number of ratings and average ratings were recorded under each category. The evaluator recommendation, defined as the response to the questions of "likelihood of recommending Dr. X to family and friends," constituted the main outcome measure. Variables from each surgeon were compared using unpaired t tests, with statistical significance set at p < 0.05. Correlations were analyzed using Spearman correlation (rs), with coefficients of greater than or equal to 0.40 or less than or equal to -0.40 considered significant. RESULTS: Five-hundred nineteen members (85%) had at least 1 rating while 222 members (36%) had 10 or more ratings. The mean number of ratings for all rated members was 11.4 (range, 1-77; standard deviation [SD] = 11.1) and mean evaluator recommendation score was 4.16 (range, 1-5; SD = 0.79). There was a strong negative correlation between total wait time and evaluator recommendation score (rs = -0.409, p < 0.001). The average number of ratings and rating scores for all categories were not significantly different when comparing male with female members. University-employed members had significantly fewer ratings (8.46; range, 1-52; SD = 9.3) compared with other members (11.9; range, 1-77; SD = 11.3) (p < 0.016). There were no differences in any other rating score when comparing those university-employed members with other members. CONCLUSION: Online patient-reported evaluations of ASOPRS surgeons appear high in many categories. Long wait times correlate strongly with lower recommendation scores. Further study is required to determine how online patient reviews correlate to objective outcome measures, and how these reviews affect surgeon selection by patients.


Assuntos
Internet , Oftalmologistas/normas , Relações Médico-Paciente , Procedimentos de Cirurgia Plástica , Sociedades Médicas , Cirurgiões/normas , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Estados Unidos
9.
J Craniofac Surg ; 28(5): e460-e463, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28665864

RESUMO

PURPOSE: To compare the results of a mechanical 3-dimensional laser scanner for craniofacial measurements of the basicranium to a validated coordinate device. METHODS: Access was granted by the Cleveland Natural History Museum to evaluate the Hamann-Todd Human Osteological Collection for this study. The MicroScribe and the FaroArm were used to gather coordinate data of various bony landmarks measurements including the prosthion, staphylion, hormion, and basion. Seventy-three human skulls were measured and scanned. Distances calculated from the coordinates were tested for agreement using the Bland-Altman test. RESULTS: There were no significant differences in the bias or slope measures between the MicroScribe and the FaroArm. In addition to the univariate test for slope significance, multivariable analysis using age, gender, and race as additional predictors showed no significant difference in any variable (P < 0.05). CONCLUSION: This is the first study demonstrating agreement of the FaroArm in any human skull measurement with the validated MicroScribe digitizer. Compared with the MicroScribe digitizer, the FaroArm allows for 3-dimensional imaging and the ability to store, handle, and view data digitally. Future use of real-time facial measurements using the FaroArm offers potential for improved surgical planning and outcomes.


Assuntos
Cefalometria/métodos , Processamento de Imagem Assistida por Computador/instrumentação , Imageamento Tridimensional/métodos , Lasers , Base do Crânio/diagnóstico por imagem , Base do Crânio/patologia , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
10.
Popul Health Metr ; 14: 34, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27757070

RESUMO

BACKGROUND: Organizations working in conflict-affected areas have a need to monitor and evaluate their programs, however this is often difficult due to the logistical challenges of conflict areas. Lot quality assurance sampling may be a suitable method of assessing programs in these situations. METHODS: We conducted a secondary data analysis of information collected during Medair's routine program management functions. Medair's service area in West Darfur, Sudan was divided into seven supervisory areas. Using the available population information, a sampling frame was developed and interviews were conducted from randomly selected caretakers of children in each supervisory area every six months over 19 months. A survey instrument with questions related to key indicators for immunizations and maternal, newborn, and child health was used for the interviews. Based on Medair's goals for each indicator, decision rules were calculated for the indicators; these decision rules determined which supervisory areas and indicators performed adequately in each assessment period. Pearson's chi-squared tests, adjusted for the survey design using STATA "svy: tab" commands, were used to detect overall differences in coverage in this analysis. RESULTS: The coverage of tetanus toxoid vaccination among pregnant women increased from 47.2 to 69.7 % (p value = 0.046), and births attended by a skilled health professional increased from 35.7 to 52.7 % (p value = 0.025) from the first to last assessment periods. Measles vaccinations declined from 72.0 to 54.1 % (p value = 0.046). The estimated coverage for the proportion of women receiving a postpartum dose of vitamin A (54.7 to 61.3 %, p value = 0.44); pregnant women receiving a clean delivery kit (54.6 to 47.1 %, p value = 0.49); and pentavalent vaccinations (49.7 to 42.1 %, p value = 0.28) did not significantly change. CONCLUSIONS: Lot quality assurance sampling was a feasible method for Medair staff to evaluate and optimize primary health programs in a conflict-affected area. Medair managers were able to collect, analyze, and disseminate data to staff alongside the routine work of the organization. These results suggest LQAS may be used in other complex humanitarian emergencies in which there are logistical challenges and limited resources.


Assuntos
Conflitos Armados , Amostragem para Garantia da Qualidade de Lotes/métodos , Serviços de Saúde Materno-Infantil , Avaliação de Programas e Projetos de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde , Vacinação , Adulto , Criança , Parto Obstétrico/métodos , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Sarampo/prevenção & controle , Gravidez , Complicações na Gravidez/prevenção & controle , Atenção Primária à Saúde , Estudos de Amostragem , Sudão , Tétano/prevenção & controle , Vitamina A/administração & dosagem , Adulto Jovem
11.
Harm Reduct J ; 12: 28, 2015 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-26337832

RESUMO

BACKGROUND: Kabul has over 12,000 people who inject drugs (PWID), most of them heroin users, and opioid substitution therapy has recently been introduced as an effective method to reduce opioid use. We aimed to evaluate a pilot Opioid Substitution Therapy Pilot Program (OSTPP) in Kabul, Afghanistan, particularly to (1) describe characteristics of the participants enrolled in the program and (2) identify factors associated with client retention in the OSTPP. FINDINGS: Two cross-sectional surveys evaluated participants attending the OSTPP at baseline (n = 83) and 18 months after (n = 57). Questionnaires assessed socio-demographic, drug use behavior, and general and mental health factors. After 18 months, 57 participants remained in the OSTPP. Participants lost to follow-up were younger (p < 0.01) and married (p < 0.01) and had no family contact (p < 0.01). Participants at 18 months reported no criminal activity in the last month and only two (3.5 %) reported heroin use in the last month, constituting significant decreases from baseline. CONCLUSIONS: While preliminary results are promising, further evaluation is needed to determine the feasibility of implementing OSTPP in this setting and effectiveness in reducing injection risk behaviors in Afghanistan.


Assuntos
Perda de Seguimento , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/reabilitação , Abuso de Substâncias por Via Intravenosa/reabilitação , Adolescente , Adulto , Afeganistão , Estudos Transversais , Feminino , Humanos , Masculino , Projetos Piloto , Inquéritos e Questionários , Adulto Jovem
12.
Postgrad Med J ; 90(1059): 3-7, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23964131

RESUMO

OBJECTIVE: Experts have proposed core curriculum components for international emergency medicine (IEM) fellowships. This study examined perceptions of program directors (PDs) and fellows on whether IEM fellowships cover these components, whether their perspectives differ and the barriers preventing fellowships from covering them. METHODS: From 1 November 2011 to 30 November 2011, a survey was administered to PDs, current fellows and recent graduates of the 34 US IEM fellowships. Respondents quantified their fellowship experience in six proposed core curriculum areas: emergency medicine (EM) systems development, EM education, humanitarian assistance, public health, emergency medical services and disaster medicine. Analysis was performed regarding what per cent of programmes fulfil the six curriculum areas. A paired t test determined the difference between PDs' and fellows' responses. Agreement between PDs and fellows within the same programme was determined using a κ statistic. RESULTS: Only 1/18 (6%) (according to fellows) to 2/24 (8%) (according to PDs) of programmes expose fellows to all six components. PDs consistently reported higher exposure than fellows. The difference in mean score between PDs and fellows was statistically significant (p<0.05) in three of the 6 (50%) core curriculum elements: humanitarian aid, public health and disaster medicine. Per cent agreement between PDs and fellows within each programmes ranged from poor to fair. CONCLUSIONS: While IEM fellowships have varying structure, this study highlights the importance of further discussion between PDs and fellows regarding delineation and objectives of core curriculum components. Transparent curricula and open communication between PDs and fellows may reduce differences in reported experiences.


Assuntos
Escolha da Profissão , Medicina de Emergência , Bolsas de Estudo , Diretores Médicos , Currículo , Medicina de Emergência/educação , Feminino , Grupos Focais , Humanos , Masculino , Sociedades Médicas , Estados Unidos
13.
BMJ Case Rep ; 17(5)2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38719266

RESUMO

Abnormal cystic lymphangioma is a rare, benign tumour of lymphatic origin that often presents with subtle clinical symptoms. A man in his 20s sought medical attention for a progressively tender mass located in the right lower quadrant. Following ultrasound and CT imaging, surgical pathology confirmed the presence of abnormal cystic lymphangioma. This case is noteworthy because of the patient's young age and the retroperitoneal location. An exploratory laparotomy was performed, mitigating the risk of recurrence. In the future, if imaging identifies a cystic mass, consideration of abnormal cystic lymphangioma within the differential diagnosis is imperative. Despite its predominantly subtle symptoms and non-malignant nature, the mass effect by the abnormal cystic lymphangioma can compromise surrounding structures. Overall, clinicians confronted with a cystic mass should adopt a comprehensive diagnostic approach, encompassing abnormal cystic lymphangioma in the differential diagnosis due to its unknown and complex nature.


Assuntos
Linfangioma Cístico , Neoplasias Retroperitoneais , Tomografia Computadorizada por Raios X , Humanos , Masculino , Neoplasias Retroperitoneais/cirurgia , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Linfangioma Cístico/diagnóstico , Linfangioma Cístico/cirurgia , Linfangioma Cístico/diagnóstico por imagem , Diagnóstico Diferencial , Adulto , Ultrassonografia , Laparotomia/métodos
14.
J Forensic Sci ; 69(4): 1256-1267, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38647068

RESUMO

Pinacolyl alcohol (PA), a key forensic marker for the nerve agent Soman (GD), is a particularly difficult analyte to detect by various analytical methods. In this work, we have explored the reaction between PA and 1,1'-carbonyldiimidazole (CDI) to yield pinacolyl 1H-imidazole-1-carboxylate (PIC), a product that can be conveniently detected by gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-high-resolution mass spectrometry (LC-HRMS). Regarding its GC-MS profile, this new carbamate derivative of PA possesses favorable chromatographic features such as a sharp peak and a longer retention time (RT = 16.62 min) relative to PA (broad peak and short retention time, RT = 4.1 min). The derivative can also be detected by LC-HRMS, providing an avenue for the analysis of this chemical using this technique where PA is virtually undetectable unless present in large concentrations. From a forensic science standpoint, detection of this low molecular weight alcohol signals the past or latent presence of the nerve agent Soman (GD) in a given matrix (i.e., environmental or biological). The efficiency of the protocol was tested separately in the analysis and detection of PA by EI-GC-MS and LC-HRMS when present at a 10 µg/mL in a soil matrix featured in the 44th PT and in a glycerol-rich liquid matrix featured in the 48th Official Organization for the Prohibition of Chemical Weapons (OPCW) Proficiency Test when present at a 5 µg/mL concentration. In both scenarios, PA was successfully transformed into PIC, establishing the protocol as an additional tool for the analysis of this unnatural and unique nerve agent marker by GC-MS and LC-HRMS.


Assuntos
Cromatografia Gasosa-Espectrometria de Massas , Soman , Soman/análise , Soman/análogos & derivados , Humanos , Cromatografia Líquida , Imidazóis/química , Agentes Neurotóxicos/análise , Agentes Neurotóxicos/química , Toxicologia Forense/métodos , Substâncias para a Guerra Química/análise , Espectrometria de Massas/métodos , Propanóis/química , Propanóis/análise
15.
Br J Ophthalmol ; 107(6): 790-794, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-35074784

RESUMO

BACKGROUND: The COVID-19 pandemic has significantly changed practice of medicine and patient care worldwide. The impact of the pandemic on patients with uveitis is unknown. We developed the COVID-19 Practice Patterns Study Group to evaluate the effect of the pandemic on uveitis patient care. METHODS: This is a multicentre, cross-sectional survey of uveitis specialists practising worldwide. A web-based survey was distributed through the mailing lists of international uveitis societies to assess modifications in patient care, and use of immunomodulatory therapies (IMTs),aswell as considerations regarding COVID-19 vaccination. RESULTS: A diverse group consisting of 187 uveitis specialists from six continents participated in this survey. Most of these experts noted a disruption in clinical management of patients, including clinic closures or decrease in volume, patients missing in-person visits due to the fear of infection and difficulties obtaining laboratory testing. Most participants initiated (66.8%) and continued (93.3%) IMTs based on clinical presentation and did not modify their use of immunosuppressives. In cases of reported exposure to COVID-19 infection, most participants (65.3%) recommended no change in IMTs. However, 73.0% of the respondents did recommend holding all or select IMTs in case of COVID-19 infection. COVID-19 vaccine was recommended universally by almost all the specialists and 52% stated that they would counsel patients regarding the decreased immunogenicity and effectiveness of the vaccine in immunocompromised patients. CONCLUSIONS: Uveitis patient care has changed significantly since the beginning of the pandemic. The recommendations will continue to evolve as new data on IMTs and vaccination become available.


Assuntos
COVID-19 , Uveíte , Humanos , COVID-19/epidemiologia , Vacinas contra COVID-19 , Pandemias/prevenção & controle , Estudos Transversais , Uveíte/diagnóstico , Assistência ao Paciente
16.
J Forensic Sci ; 68(6): 1923-1931, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37578282

RESUMO

The benzylation of three low molecular weight N,N-disubstituted ethanolamines related to chemical warfare agents (CWAs) to furnish derivatives with improved gas chromatography-mass spectrometry (GC-MS) profiles is described. Due to their low molecular weight and polar nature, N,N-disubstituted ethanolamines are notoriously difficult to detect by routine GC-MS analyses during Organisation for the Prohibition of Chemical Weapons (OPCW) proficiency tests (PTs), particularly in scenarios when they are present at low levels (~1-10 ppm) amidst more abundant interferences. Our studies revealed that the optimal derivatization conditions involved the treatment of the ethanolamine with benzyl bromide in the presence of an inorganic base (e.g., Na2 CO3 ) in dichloromethane at 55°C for 2 h. This optimized set of conditions was then successfully applied to the derivatization of N,N-dimethylethanolamine, N,N-diethylethanolamine and N,N-diisopropylethanolamine present separately at 1 and 10 µg/mL concentrations in a glycerol-rich matrix sample featured in the 48th OPCW PT. The benzylated derivatives of the three ethanolamines possessed retention times long enough to clear the massive glycerol-containing matrix interferences. The protocol herein is introduced as an alternative method for derivatization of these CWA and pharmaceutically important species and should find broad applicability in laboratories where routine forensic analysis is carried out.

17.
J Forensic Sci ; 68(6): 2138-2152, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37568257

RESUMO

Detection of illicit drugs in the environment, particularly in soils, often suggests the present or past location of a clandestine production center for these substances. Thus, development of efficient methods for the analysis and detection of these chemicals is of paramount importance in the field of chemical forensics. In this work, a method involving the extraction and retrospective confirmation of fentanyl, acetylfentanyl, thiofentanyl, and acetylthiofentanyl using trichloroethoxycarbonylation chemistry in a high clay-content soil is presented. The soil was spiked separately with each fentanyl at two concentrations (1 and 10 µg/g) and their extraction accomplished using ethyl acetate and aqueous NH4 OH (pH ~ 11.4) with extraction recoveries ranging from ~56% to 82% for the high-concentration (10 µg/g) samples while ranging from ~68% to 83% for the low-concentration (1 µg/g) samples. After their extraction, residues containing each fentanyl were reacted with 2,2,2-trichloroethoxycarbonyl chloride (Troc-Cl) to generate two unique and predictable products from each opioid that can be used to retrospectively confirm their presence and identity using EI-GC-MS. The method's limit of detection (MDL/LOD) for Troc-norfentanyl and Troc-noracetylfentanyl were estimated to be 29.4 and 31.8 ng/mL in the organic extracts. In addition, the method's limit of quantitation for Troc-norfentanyl and Troc-noracetylfentanyl were determined to be 88.2 and 95.5 ng/mL, respectively. Collectively, the results presented herein strengthen the use of chloroformate chemistry as an additional chemical tool to confirm the presence of these highly toxic and lethal substances in the environment.


Assuntos
Elétrons , Solo , Cromatografia Gasosa-Espectrometria de Massas/métodos , Argila , Estudos Retrospectivos , Fentanila/análise
18.
Nat Chem ; 15(6): 764-772, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37217789

RESUMO

The venerable 1,3-dipolar cycloaddition has been widely used in organic synthesis for the construction of various heterocycles. However, in its century-long history, the simple and omnipresent aromatic phenyl ring has remained a stubbornly unreactive dipolarophile. Here we report 1,3-dipolar cycloaddition between aromatic groups and diazoalkenes, generated in situ from lithium acetylides and N-sulfonyl azides. The reaction results in densely functionalized annulated cyclic sulfonamide-indazoles that can be further converted into stable organic molecules that are important in organic synthesis. The involvement of aromatic groups in the 1,3-dipolar cycloadditions broadens the synthetic utility of diazoalkenes, a family of dipoles that have been little explored so far and are otherwise difficult to access. The process described here provides a route for the synthesis of medicinally relevant heterocycles and can be extended to other arene-containing starting materials. Computational examination of the proposed reaction pathway revealed a series of finely orchestrated bond-breaking and bond-forming events that ultimately lead to the annulated products.

19.
Cureus ; 15(3): e35825, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37033512

RESUMO

We describe the case of a patient with extranodal marginal zone mucosa-associated lymphoid tissue (MALT) lymphoma of the gallbladder discovered incidentally after elective cholecystectomy. A 76-year-old female with a history of non-Hodgkin's lymphoma of the right breast and rectal cancer stage Tis requiring trans-anal excision presented with chronic intermittent abdominal pain. Computed tomography (CT) scan showed multiple calcified gallstones impacted in the gallbladder, with no evidence of enlarging lymphadenopathy indicating an elective cholecystectomy. The intra- and post-operative courses were unremarkable, but pathology review revealed immunohistochemistry positive for CD20 and BCL-2 with a Ki67 proliferation index of 5%, which was diagnostic of extranodal marginal zone MALT lymphoma of the gallbladder. The patient was followed up by a medical oncologist, and after extensive discussion, the decision was made to continue observation with close monitoring without systemic chemotherapy given the asymptomatic presentation. We also examined the pertinent literature to MALT lymphoma of the gallbladder and discussed theories suggested for its pathophysiology.

20.
Nutr Clin Pract ; 37(1): 130-136, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34994478

RESUMO

BACKGROUND: Heart failure (HF) is highly prevalent, whereas malnutrition is generally associated with poorer hospital outcomes, and it is not uncommon in patients with HF. Prior studies of the effect of malnutrition on HF outcomes are limited in size and quality. This study aims to elucidate the association between malnutrition and hospital length of stay (LOS), mortality, and discharge destination in patients with HF. METHODS: This is a retrospective review of medical records for inpatients admitted with a primary diagnosis of HF in 2018. Patients with HF and severe protein-calorie malnutrition were compared with those without malnutrition. A two-sided t-test was conducted between patients who have HF with and without malnutrition on hospital outcomes. Multivariate logistic regression was developed to identify potential predictors of malnutrition. A propensity score was calculated for each patient and matched cases (malnutrition with nonmalnutrition) to balance covariates and reduce bias. RESULTS: For N = 7079, the median age was 75 years, with 15.79% having severe malnutrition. Overall mortality was 5.57% (394 deceased) . There were significant associations between malnutrition and both mortality (relative risk, 2.22; P < 0.001) and LOS (10 vs 5 days, P < 0.001) in patients with HF. Significantly fewer patients with malnutrition were discharged home (odds ratio, 0.41; P < 0.001). CONCLUSION: Patients with HF and malnutrition have higher risk for mortality, increased LOS in the hospital, and decreased chance of being discharged home. Continued study of this population is required to better predict which patients with malnutrition will respond to nutrition interventions.


Assuntos
Insuficiência Cardíaca , Desnutrição , Idoso , Estudos de Coortes , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Tempo de Internação , Desnutrição/complicações , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Pontuação de Propensão , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA