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Buck-Gramcko, Dieter, e Toshihiko Ogino. "CONGENITAL MALFORMATIONS OF THE HAND: NON-CLASSIFIABLE CASES". Hand Surgery 01, n.º 01 (janeiro de 1996): 45–61. http://dx.doi.org/10.1142/s0218810496000105.
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Calvert, Wesley. "The isomorphism problem for computable Abelian p-groups of bounded length". Journal of Symbolic Logic 70, n.º 1 (março de 2005): 331–45. http://dx.doi.org/10.2178/jsl/1107298523.
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AbstractTheories of classification distinguish classes with some good structure theorem from those for which none is possible. Some classes (dense linear orders, for instance) are non-classifiable in general, but are classifiable when we consider only countable members. This paper explores such a notion for classes of computable structures by working out a sequence of examples.We follow recent work by Goncharov and Knight in using the degree of the isomorphism problem for a class to distinguish classifiable classes from non-classifiable. In this paper, we calculate the degree of the isomorphism problem for Abelian p-groups of bounded Ulm length. The result is a sequence of classes whose isomorphism problems are cofinal in the hyperarithmetical hierarchy. In the process, new back-and-forth relations on such groups are calculated.
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Ivanov, Atanas, e Vili Stoyanova. "FLUORESCENT IN SITU HYBRIDIZATION AND IMMUNOHISTOCHEMISTRY FOR SUBTYPING “NON-CLASSIFIABLE” RENAL CELL CARCINOMAS". Teacher of the future 31, n.º 4 (5 de junho de 2019): 921–24. http://dx.doi.org/10.35120/kij3104921i.
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Renal tumors account for about 3% of the malignancies in adults. Clear cell subtype renal cell carcinoma (RCC) and papillary RCC are the most common renal tubular epithelial carcinomas and their differentiation is important because they have a different prognosis and are associated with different treatment protocols. In most cases, histological features allow accurate diagnosis of renal cell carcinomas. There are also overlapping morphological findings between certain kidney neoplasms that make their subtyping extremely difficult. Some of them display papillary architecture but also have a clear cell component and it is not clear whether they should be classified as clear cell RCC or papillary RCC. In our study we performed an immunohistochemical and genetic analysis of 24 cases of RCC classified as non-classifiable with mixed papillary and clear cell components treated at Clinic of Urology in University Hospital "St. George "-Plovdiv. The mean age of patients was 54.5 years, and gender distribution: 60% male and 40% female. Based on the results of immunohistochemistry and fluorescence in situ hybridization (FISH), patients were stratified in 2 groups. The first group included 16 of the cases where strong immunoreactivity was found for alfa-methyl coenzyme A racemase (AMACR), with cytokeratin 7 (CK7) being present in 15 of these. In all cases in this group, FISH proved trisomy 7 and 17, in 4-9p deletion, and in 2- 3p deletion. The remaining 8 cases were stratified in the second group - all negative for CK7 and only one positive for AMACR. Genetic analysis showed a lack of trisomy 7 and 17 in all cases, as well as a deletion of 3p and 9p in 7 of them. The combination of immunohistochemical and genetic analyzes allows with a high accuracy to differentiate cases of papillary RCC from those with clear cell RCC.
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Ivanov, A., I. Dechev, P. Antonov, V. Stoyanova, A. Linev e D. Staykov. "Fluorescent in situ hybridization and immunohistochemistry for subtyping “non-classifiable” renal cell carcinomas". European Urology Supplements 17, n.º 11 (outubro de 2018): e2571. http://dx.doi.org/10.1016/s1569-9056(18)33409-2.
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TYTHERLEIGH-STRONG, G., e G. HOOPER. "The Classification of Phocomelia". Journal of Hand Surgery 28, n.º 3 (junho de 2003): 215–17. http://dx.doi.org/10.1016/s0266-7681(02)00392-3.
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We studied 24 patients with 44 phocomelic upper limbs. Only 11 limbs could be grouped in the classification system of Frantz and O’ Rahilly. The non-classifiable limbs were further studied and their characteristics identified. It is confirmed that phocomelia is not an intercalary defect.
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Zeerleder, S., M. Schloesser, M. Redondo, W. A. Wuillemin, W. Engel, M. Furlan e B. Lämmle. "Reevaluation of the Incidence of Thromboembolic Complications in Congenital Factor XII Deficiency". Thrombosis and Haemostasis 82, n.º 10 (1999): 1240–46. http://dx.doi.org/10.1055/s-0037-1614368.
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SummaryTo further elucidate the debated role of hereditary FXII deficiency as a thrombophilic risk factor this follow-up study on 65 subjects out of 12 Swiss families was undertaken (follow-up: 6 yrs). Fifteen severely FXII deficient subjects (FXII:C < 1%), 35 partially FXII deficient subjects (FXII:C ≥ 1-59%), 10 with normal FXII values (FXII:C ≥ 70%), and 5 non-classifiable subjects (FXII:C ≥ 60-69%) were reevaluated. Eight subjects (4 severely and 3 partially FXII deficient, 1 non-classifiable) were newly enrolled. Four instances of deep vein thrombosis, one superficial vein thrombosis and one myocardial infarction were noted in 2 out of 19 severely FXII deficient subjects during a total life-time period of 866.6 patient-years. In 38 partially FXII deficient subjects (1862.8 patient-years) one ischemic cerebrovascular stroke and one superficial vein thrombosis were recorded in 2 individuals. The 10 subjects with normal FXII values (498.2 patient-years) remained thrombosis-free. One superficial vein thrombosis occurred in an unclassifiable woman. None of the 3 different FXII gene defects revealed in our patients was specifically associated with thromboembolic complications. Kaplan-Meier analysis of thrombosis-free survival suggests that hereditary partial (and probably severe) FXII deficiency does not constitute a thrombophilic condition.
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Hutton, Tabitha A., Gabriel K. Innes, Josée Harel, Philippe Garneau, Andrew Cucchiara, Dieter M. Schifferli e Shelley C. Rankin. "Phylogroup and virulence gene association with clinical characteristics of Escherichia coli urinary tract infections from dogs and cats". Journal of Veterinary Diagnostic Investigation 30, n.º 1 (3 de outubro de 2017): 64–70. http://dx.doi.org/10.1177/1040638717729395.
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Escherichia coli isolates from infections outside the gastrointestinal tract are termed extra-intestinal pathogenic E. coli (ExPEC) and can be divided into different subpathotypes; one of these is uropathogenic E. coli (UPEC). The frequency with which UPEC strains cause urinary tract infections in dogs and cats is not well documented. We used an oligonucleotide microarray to characterize 60 E. coli isolates associated with the urinary tract of dogs ( n = 45) and cats ( n = 15), collected from 2004 to 2007, into ExPEC and UPEC and to correlate results with patient clinical characteristics. Microarray analysis was performed, and phylogroup was determined by a quadruplex PCR assay. Isolates that were missing 1 or 2 of the gene determinants representative of a function (capsule, iron uptake related genes, or specific adhesins) were designated as “non-classifiable” by microarray. Phylogroup B2 was positively associated with the UPEC subpathotype ( p < 0.0005) and negatively associated with “non-classifiable” isolates ( p < 0.0005). Phylogroup D was positively associated with ExPEC pathotype ( p = 0.025) and negatively associated with UPEC subpathotype ( p = 0.014). The ExPEC pathotype was positively associated with hospitalization for one or more days ( p = 0.031). The UPEC subpathotype was negatively associated with previous antimicrobial therapy ( p = 0.045) and previous hospitalization within the 3 mo prior to the positive culture ( p = 0.041). The UPEC subpathotype was positively associated with prostatitis ( p = 0.073) and negatively associated with current immunosuppressive therapy ( p = 0.090). Our results indicate that the case history observations may be critically important during the interpretation of laboratory results to encourage judicious use of antimicrobials.
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Drexler, Richard, Alicia Eckhardt, Helena Bode, Katrin Lamszus, Manfred Westphal, Ulrich Schüller e Malte Mohme. "PATH-05 Challenge and clinical relevance of a non-matching classifier output in genome-wide DNA methylation analysis for CNS neoplasms in pediatric and adolescent patients". Neuro-Oncology 24, Supplement_1 (1 de junho de 2022): i159. http://dx.doi.org/10.1093/neuonc/noac079.589.
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Abstract OBJECTIVE: The molecular classification of CNS tumors has revolutionized our understanding of the biological heterogeneity and diversity of tumor subtypes. DNA methylation-based classification allows to discriminate subtypes. Although DNA methylation-based classification can diagnose tumors with high specificity, there are tumors which cannot be classified. We aimed to gain further insight into these challenging cases. METHODS: Overall, 21 patients with a CNS tumor that was non-classifiable (confidence score <0.3), or had a low confidence score (<0.9) using the DNA methylation-based classifier version 11b4, were included. Tumors were re-classified using version (v12.3), and clinical data were analyzed. RESULTS: A total of 21 pediatric and adolescent brain tumors with a calibrated score below 0.9 in the classifier output were identified. Of these, 11 patients (52.4 %) were assigned to the “no matching methylation class” with a score below 0.3. IDH-wild type glioblastoma (23.8 %), ETMR (14.3 %), and DMG (14.3 %) were the most common histological diagnoses. Surgical and clinicopathological features as well as DNA input and tumor purity did not influence the confidence score. Cases with non-classifiable tumors had a significantly longer time until a decision for adjuvant therapy (p<0.01). Application of the latest classifier version v12.3 led to a re-classification of 9 (42.9 %) cases, of which 5 cases (55.6 %) had an improved calibrated score. CONCLUSION: Our study presents unclassifiable cases and the possible clinical impact when waiting for the accurate diagnosis in these challenging cases. Even though DNA methylation profiling significantly contributes to advanced CNS tumor diagnostics, clinicians should be aware of a prolonged interval to treatment initiation, especially for highly malignant brain tumors. Therefore, we would recommend to schedule adjuvant treatment as early as possible, if surgical and histological results are suspicious for this disease.
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Schnegg-Kaufmann, Annatina, Anita Feller, Helen Boldomero, Alicia Rovó, Markus G. Manz, Michael Gregor, Anna Efthymiou et al. "Improvement of Relative Survival in Elderly Patients with Acute Myeloid Leukemia Emerging from Population-Based Cancer Registries in Switzerland from 2001-2013". Blood 130, Suppl_1 (7 de dezembro de 2017): 863. http://dx.doi.org/10.1182/blood.v130.suppl_1.863.863.
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Abstract Introduction: Acute Myeloid Leukaemia (AML) is a rare disease with increasing frequency in the elderly and an emerging impact on health care resources. Trends of classification, incidence, mortality, and survival of AML patients have not yet been reported for Switzerland. Given the demographic ageing, we were mainly interested to investigate whether elderly patients have benefited on a population-based level from the recent changes in AML management. Methods: We performed a population-based, observational analysis of AML cases reported to Cantonal Cancer Registries in Switzerland. Data was aggregated by the National Institute for Epidemiology and Cancer Registration and stratified for the two time-periods 2001-2007/2008-2013. The Swiss Federal Statistics Office provided canton-specific mid-year estimates of the size of the general population and mortality statistics. Data from transplanted patients was provided from the registry of the Swiss Blood Stem Cell Transplant Group . Results: 2'351 new AML cases were registered within the observation time at a median age of 68/67 yrs (range 0-96 yrs). The extrapolated mean annual frequency increased from 275 to 305 AML cases (+10.8%) in the two time periods. In contrast, the age-standardized incidence and mortality rates remained stable (3.0 [95 CI: 2.8-3.2] and 1.9-2.0 [1.8-2.1] per 100'000 person-years, respectively). Incidence was up to 1.4-fold more frequent in males and increased up to 7 fold in patients >75 yrs of age. The fraction of non-classifiable AML cases decreased over time (54.6%/41.8%), but remained high in elderly patients (75-84 yrs: 54.1%, 85+ yrs: 59.1%). As expected, 5-year relative survival (RS) correlated directly with AML risk classes (favorable: 61.7-68.4%, intermediate: 14.9%-27.3%, adverse: 11.4%-20.4%, non-classifiable: 11.4%-14.7%) and inversely with age (<65 yrs: 42.6-42.7%, 65-74 yrs: 5.2%-13.5%, 75-84 yrs: 2-3%; 85+ yrs: 0%). RS improved only modestly in all age classes over time (19.2%/23.3%). Most interestingly, a trend towards improved RS was found in AML patients aged 65-74 yrs (5.2%/13.5%) and with intermediate (20.4%/27.3%) as well as adverse risk (11.4%/ 21.9%). This trend was multifactorial and only partially explained by an increased referral to allogeneic HSCT (1.4%/7%) or inclusion in clinical trials of patients ≥65 yrs. Conclusions: AML incidence remained stable during the observation period, indicating that the 10.8% raise in annual case-frequency is mainly related to population growth and ageing and not to an increase of age-specific risk. AML classification improved over time, but non-classifiable AML cases remained high in elderly patients, suggesting that diagnostics and reporting is less accurate with increasing age. A trend towards improved RS was found in AML patients aged 65-74 yrs and with intermediate as well as adverse risk. These trends were caused by multiple factors and mainly based on the general changes of treatment management of AML patients ≥65 yrs. Survival of elderly AML patients remains dismal. Nevertheless, recent progress in clinical management of elderly AML patients resulted in an emerging improvement of survival on a population-based level in Switzerland. The demographic trend will further increase AML burden and has to be taken into account for structural as well as financial considerations for future health care systems. Disclosures Gregor: AbbVie: Other: Personal Fees; Celgene: Other: Personal Fees, Non-Financial Support; Gilead: Other: Personal Fees; GlaxoSmithKline: Other: Personal Fees; Janssen: Other: Personal Fees, Non-Financial Support; Mundipharma: Other: Personal Fees; Novartis: Other: Personal Fees, Non-Financial Support; Roche: Other: Personal Fees, Non-Financial Support.
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Zwart, J.-A., G. Dyb, TL Holmen, LJ Stovner e T. Sand. "The Prevalence of Migraine and Tension-Type Headaches Among Adolescents in Norway. The Nord-Trøndelag Health Study (Head-Hunt-Youth), A Large Population-Based Epidemiological Study". Cephalalgia 24, n.º 5 (maio de 2004): 373–79. http://dx.doi.org/10.1111/j.1468-2982.2004.00680.x.
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The aim of this study was to examine the prevalence of headache and primary headache disorders like migraine and tension-type headaches among adolescents, and to explore the differences in headache prevalence and frequency by gender and age. This cross-sectional study was conducted in Nord-Trøndelag county, Norway, during the years 1995-97. In total, 8984 (88%) out of 10 202 invited adolescents aged 12-19 years participated in the youth part of the Nord-Trøndelag Health Study [Helseundersøkelsen i Nord-Trøndelag (HUNT)]. The total study population in this study consisted of 8255 individuals after exclusion of invalid questionnaires and students outside the target range of 13-18 years of age. The students completed a comprehensive questionnaire, and one of the questions was whether the students had experienced any headaches during the last 12 months. In addition, 5847 of these students were also subject to an interview in which they were asked whether they had experienced recurring headaches during the last year and, if so, were they classified as migraine (MI), tension-type headache (TTH) or non-classifiable headache. In the total questionnaire-based population, 76.8% reported having had headaches during the last 12 months (69.4% boys and 84.2% girls). Among those who also were interviewed, 29.1% reported having recurrent headaches (21.0% boys and 36.5% girls). The overall 1-year prevalence of migraine was 7%, of tension-type headache 18%, and of non-classifiable headache 4.8%. Higher prevalence rates were found for girls in all age groups and for all headache categories. The overall frequency of recurrent headaches did not vary significantly with age, but girls had significantly more frequent headaches than boys. We concluded that headache in general, and recurrent primary headache disorders like migraine and tension-type headaches, are common somatic complaints among Norwegian adolescents, especially among girls.
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Andrade, Pedro, Maria Manuel Brites e Américo Figueiredo. "Synchronous pyoderma gangrenosum and inflammatory bowel disease, healing after total proctocolectomy". Anais Brasileiros de Dermatologia 87, n.º 4 (agosto de 2012): 637–39. http://dx.doi.org/10.1590/s0365-05962012000400022.
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We present a female patient observed with painful violaceous plaques with central bullae and pustules on the lower limbs, rapidly transformed into ulcers, associated with bloody diarrhea, recurrent oral erosions and hyperthermia in the previous 3 months. Cutaneous biopsy was consistent with pyoderma gangrenosum, and intestinal diagnostic procedures revealed a non-classifiable inflammatory bowel disease with high x-ANCA titers. Soon after admission the patient was submitted to total proctocolectomy following colonic perforation. Complete ulcer healing occurred three months after surgery, without recurrence. Pyoderma gangrenosum is a rare dermatosis frequently associated with inflammatory bowel disease. This case is particularly interesting for the synchronic clinical presentation of cutaneous and intestinal diseases, but also for the prompt regression of the former after total proctocolectomy.
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Schirren, Rebekka, Alexander Novotny, Julia Slotta-Huspenina, Helmut Friess e Daniel Reim. "Novel Histologic Categorization Based on Lauren Histotypes Conveys Prognostic Information for Gastroesophageal Junction Cancers—Analysis from a Large Single Center Cohort in Germany". Cancers 13, n.º 6 (15 de março de 2021): 1303. http://dx.doi.org/10.3390/cancers13061303.
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Adenocarcinoma of the gastroesophageal junction (AEG) ranks among the most common cancers in the Western world with increasing incidence. However, the prognostic influence and applicability of the Lauren classification was not examined in detail before. The purpose of this analysis was to analyze the oncologic outcomes of GE-junction cancer related to the Lauren histotype in a large single center cohort. Data from the prospectively documented database of the Klinikum Rechts der Isar (TUM School of Medicine) for patients undergoing curatively intended oncologic resection for GE-junction cancer between 1984 and 2018 were extracted. Univariate and multivariate regression analyses were performed to identify predictors for overall survival. Kaplan-Meier analyses were done to investigate the survival rates according to the Lauren histotype. After identification of two distinct histologic categories with prognostic implications, propensity score matching (PSM) was performed to balance for confounders and evaluate its oncologic outcomes retrospectively. In the time period indicated, 1710 patients were treated for GE-junction cancer. Exclusion criteria were: R2-resections (n = 134), metastatic disease (n = 296), 30-day mortality (n = 45), Siewert type I (n = 21), and missing/incomplete data (n = 61). Finally, 1153 patients were analyzed. In a multiple variable analysis, age, UICC-stage, all Lauren histotypes, R-stage, and postoperative complications were significant predictors of overall survival. Kaplan Meier analysis demonstrated significant survival differences between intestinal, diffuse, and mixed Lauren-histotypes (p = 0.001 and p = 0.029). Survival rates were comparable between non-classifiable and intestinal Lauren-types (p = 0.16) and between diffuse and mixed types (p = 0.56). When combining non-classifiable, well, and moderately differentiated Lauren-types and combining poorly differentiated intestinal, diffuse, and mixed types, two highly prognostic groups were identified (p < 0.0001). This was confirmed after PSM for possible confounders. The Lauren histotypes demonstrate highly prognostic value after oncologic resection of GE-junction cancer (Siewert type II and type III) in a single center Western patient cohort. A simplified histotype classification based on Lauren subtypes revealed a clear distinction of prognostic groups and should be considered for further evaluation.
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Cady, RK, D. Gutterman, JA Saiers e ME Beach. "Responsiveness of Non-IHS Migraine and Tension-Type Headache to Sumatriptan". Cephalalgia 17, n.º 5 (agosto de 1997): 588–90. http://dx.doi.org/10.1046/j.1468-2982.1997.1705588.x.
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In a long-term efficacy and satiety study, 424 patients were treated with sumatriptan (6 mg sc) for 1,904 migraine attacks. The patients were diagnosed with migraine based on IHS criteria but individual migraine attacks treated in the study were physician diagnosed; not necessarily required to meet IHS criteria. A re-analysis of the treatment response to open label sumatriptan (6 mg sc) indicated that 43 patients had treated at least one migraine that fulfilled IHS criteria for tension-type headache. Analysis of this population revealed they treated 232 headaches. Of these headaches, 114 were classified per IHS criteria as migraine; 76 as tension-type; and 42 as. non-IHS migraine (not classifiable as IHS migraine or IHS tension-type headache). Of the 114 migraines a positive response to sumatriptan occurred in 109 (96%) cases; of the 76 tension-types, 73 responded to sumatriptan (97%); of the 42 non-IHS migraine, 40 (95%) responded to sumatriptan. An equivalent response to sumatriptan among three diagnostic groups of headache supports the concept of a common biologic mechanism involving 5HT1 receptors that spans a range of clinical presentations.
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Severino, Paolo, Andrea D’Amato, Silvia Prosperi, Vincenzo Myftari, Lorenzo Colombo, Elisa Tomarelli, Alice Piccialuti et al. "Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Focus on Coronary Microvascular Dysfunction and Genetic Susceptibility". Journal of Clinical Medicine 12, n.º 10 (21 de maio de 2023): 3586. http://dx.doi.org/10.3390/jcm12103586.
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Among the most common causes of death worldwide, ischemic heart disease (IHD) is recognized to rank first. Even if atherosclerotic disease of the epicardial arteries is known as the leading cause of IHD, the presence of myocardial infarction with non-obstructive coronary artery disease (MINOCA) is increasingly recognized. Notwithstanding the increasing interest, MINOCA remains a puzzling clinical entity that can be classified by distinguishing different underlying mechanisms, which can be divided into atherosclerotic and non-atherosclerotic. In particular, coronary microvascular dysfunction (CMD), classifiable in non-atherosclerotic mechanisms, is a leading factor for the pathophysiology and prognosis of patients with MINOCA. Genetic susceptibility may have a role in primum movens in CMD. However, few results have been obtained for understanding the genetic mechanisms underlying CMD. Future studies are essential in order to find a deeper understanding of the role of multiple genetic variants in the genesis of microcirculation dysfunction. Progress in research would allow early identification of high-risk patients and the development of pharmacological, patient-tailored strategies. The aim of this review is to revise the pathophysiology and underlying mechanisms of MINOCA, focusing on CMD and actual knowledge about genetic predisposition to it.
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Jiang, Shenzhong, Xiaokun Chen, Yinzi Wu, Renzhi Wang e Xinjie Bao. "An Update on Silent Corticotroph Adenomas: Diagnosis, Mechanisms, Clinical Features, and Management". Cancers 13, n.º 23 (6 de dezembro de 2021): 6134. http://dx.doi.org/10.3390/cancers13236134.
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With the introduction of 2017 World Health Organization (WHO) classification of endocrine tumors, T-PIT can serve as a complementary tool for identification of silent corticotroph adenomas (SCAs) in some cases if the tumor is not classifiable by pituitary hormone expression in pathological tissue samples. An increase of the proportion of SCAs among the non-functioning pituitary adenomas (NFPAs) has been witnessed under the new rule with the detection of T-PIT-positive ACTH-negative SCAs. Studies of molecular mechanisms related to SCA pathogenesis will provide new directions for the diagnosis and management of SCAs. A precise pathological diagnosis can help clinicians better identify SCAs. Understanding clinical features in the context of the pathophysiology of SCAs is critical for optimal management. It could provide information on appropriate follow-up time and aid in early recognition and treatment of potentially aggressive forms. Management approaches include surgical, radiation, and/or medical therapies.
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Alvarez-Mon, Miguel Angel, Laura de Anta, Maria Llavero-Valero, Guillermo Lahera, Miguel A. Ortega, Cesar Soutullo, Javier Quintero, Angel Asunsolo del Barco e Melchor Alvarez-Mon. "Areas of Interest and Attitudes towards the Pharmacological Treatment of Attention Deficit Hyperactivity Disorder: Thematic and Quantitative Analysis Using Twitter". Journal of Clinical Medicine 10, n.º 12 (17 de junho de 2021): 2668. http://dx.doi.org/10.3390/jcm10122668.
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We focused on tweets containing hashtags related to ADHD pharmacotherapy between 20 September and 31 October 2019. Tweets were classified as to whether they described medical issues or not. Tweets with medical content were classified according to the topic they referred to: side effects, efficacy, or adherence. Furthermore, we classified any links included within a tweet as either scientific or non-scientific. We created a dataset of 6568 tweets: 4949 (75.4%) related to stimulants, 605 (9.2%) to non-stimulants and 1014 (15.4%) to alpha-2 agonists. Next, we manually analyzed 1810 tweets. In the end, 481 (48%) of the tweets in the stimulant group, 218 (71.9%) in the non-stimulant group and 162 (31.9%) in the alpha agonist group were considered classifiable. Stimulants accumulated the majority of tweets. Notably, the content that generated the highest frequency of tweets was that related to treatment efficacy, with alpha-2 agonist-related tweets accumulating the highest proportion of positive consideration. We found the highest percentages of tweets with scientific links in those posts related to alpha-2 agonists. Stimulant-related tweets obtained the highest proportion of likes and were the most disseminated within the Twitter community. Understanding the public view of these medications is necessary to design promotional strategies aimed at the appropriate population.
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Falavigna, Asdrubal, Alisson Roberto Teles, Maíra Cristina Velho, Viviane Maria Vedana, Roberta Castilhos da Silva, Thaís Mazzocchin, Maira Basso e Gustavo Lisbôa de Braga. "Prevalence and impact of headache in undergraduate students in Southern Brazil". Arquivos de Neuro-Psiquiatria 68, n.º 6 (dezembro de 2010): 873–77. http://dx.doi.org/10.1590/s0004-282x2010000600008.
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OBJECTIVE: To determine the prevalence, characteristics and impact of headache among university students. METHOD: The criteria established by the International Headache Society were used to define the primary headache subtypes and the Migraine Disability Assessment Questionnaire (MIDAS), to assess the disability. The students were then grouped into six categories: [1] migraine; [2] probable migraine; [3] tension-type headache; [4] probable tension-type headache; [5] non-classifiable headache; [6] no headache. RESULTS: Of all undergraduate students interviewed, 74.5% had at least one headache episode in the last three months. Regarding disability, there was a significant difference between the headache types (p<0.0001). In the post-hoc analysis, migraine was the headache type with most reported disability. CONCLUSION: Headache is a highly prevalent condition among the students at the University of Caxias do Sul. This disease may have a major impact on the students' lives and in some cases, ultimately lead to educational failure.
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Andoh, Benjamin. "The Evolution of the Role of the Police with Special Reference to Social Support and the Mental Health Statutes". Medicine, Science and the Law 38, n.º 4 (outubro de 1998): 347–53. http://dx.doi.org/10.1177/002580249803800412.
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The role of the police at their formation centred around law enforcement (crime detection and apprehension of criminals) and crime prevention in order to maintain the peace. That role has been changing to keep pace with socio-economic developments. Thus, it has expanded to include the provision of social support. However, law enforcement, crime prevention and provision of social support often overlap. Also, though some studies have shown that much police time is spent on non-crime-fighting activities, other studies have found that lower-rank officers in general see their main role as fighting crime. That apart, the police have always had a role to play under the various mental health statutes: referring mentally disordered people to hospital, retaking absconders from mental hospitals, escorting patients from hospital or prison to court and vice versa, which are all tasks classifiable as provision of social support. Because of the complexity of his work today, the policeman may be described as an ‘all-purpose public servant’.
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De Hert, Marc, Dominique Van Eyck, Linda Hanssens, Hendrik Peuskens, Erik Thys, Martien Wampers, Andre Scheen e Jozef Peuskens. "Oral glucose tolerance tests in treated patients with schizophrenia." European Psychiatry 21, n.º 4 (junho de 2006): 224–26. http://dx.doi.org/10.1016/j.eurpsy.2005.05.011.
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AbstractObjectiveA recent consensus conference has proposed guidelines for the monitoring for diabetes in patients with schizophrenia and also identifies the need of long-term prospective studies.MethodsA large scale prospective study on metabolic risks of antipsychotic medication is currently ongoing. At baseline, patients get a full laboratory screening, ECG and an oral glucose tolerance test (OGTT). Baseline data on 100 non-diabetic patients at study inclusion and stable on medication for at least 6 months are presented.ResultsGlucose abnormalities are found in 22% of patients at baseline. A monitoring protocol based only on fasting glucose would not have detected 63.6% of these patients with classifiable glucose abnormalities in our sample. Fasting insulin and measures for insulin resistance have a high predictive value for abnormalities late in the OGTT.ConclusionsAlready at baseline, metabolic problems are frequently present in patients with schizophrenia treated with antipsychotics. Adding assessment of fasting insulin in a monitoring protocol improves detection of glucose abnormalities late in an OGTT.
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Francisco, Corrêia e Feiden. "Classification of Areas Suitable for Fish Farming Using Geotechnology and Multi-Criteria Analysis". ISPRS International Journal of Geo-Information 8, n.º 9 (4 de setembro de 2019): 394. http://dx.doi.org/10.3390/ijgi8090394.
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This study proposed a method for identifying areas appropriate for fish farming in ground-excavated ponds using data obtained from public institutions. The method was applied to three cities located in the central-southern region of Paraná State, Brazil. In order to select appropriate areas, a geographic information system (GIS) was created using data from a digital elevation model (DEM), as well as data on soil occupation and type. A variable reclassification model (VRM) was created, and the analytic hierarchy process (AHP) method was applied to establish weights for a multi-criteria assessment of the factors. Non-classifiable areas and areas with constraints were identified and removed from the analysis. The sites classified as highly suitable or suitable represented 33.270.79 ha (18.71% of the total area), while the restricted areas represented 54,427.91 ha (30.60% of the total area). This method may represent a useful tool for decision making in the context of regional planning and may be used in the establishment of public policy and in the allocation of resources for aquaculture development.
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Leménager, Paul, Yves-Kenol Franck, Florine Corlin, Nicolas Bouscaren, Mathieu Nacher e Antoine Adenis. "Aetiological and morphological spectrum of cardiomyopathies in French Guiana: a retrospective study". Open Heart 7, n.º 1 (maio de 2020): e001206. http://dx.doi.org/10.1136/openhrt-2019-001206.
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IntroductionCardiomyopathies are a heterogeneous heart diseases group in terms of morphology and aetiology. Hypothesising a tropical specificity and given an absence of data in French Guiana, the primary objective of our study was to describe morphologies and aetiologies of cardiomyopathies observed at Cayenne General Hospital.MethodsA cross-sectional study was conducted in Cayenne Hospital from 1 January 2009 to 1 June 2014 in the hospital database. Only patients with the definition of the European Society of Cardiology (ESC) were included, based on the first transthoracic ultrasonography found during the study period. Medical files were consulted.ResultsWith 182 patients included, the prevalence of cardiomyopathies among heart diseases was estimated at 4.3% (95% CI 3.7% to 4.9%). Twelve patients had a familial or genetic aetiology (6.6%) and 170 a non-familial or non-genetic aetiology (93.4%). The morphological spectrum was: dilated for 114 patients (62.6%), hypertrophic for 27 (14.8%), unclassified for 1 (0.5%) and non-classifiable for 13 (7.1%). This group was constituted of patients with a systolic and/or diastolic functional impairment without morphological abnormality. The aetiological spectrum found 184 aetiologies including: 70.9% undetermined, 8.7% infectious (with 6.5% chagasic and 0.5% related with human immunodeficiency virus) and 6.0% with toxins.ConclusionsCardiomyopthies are a common and severe clinical problem. The frequency of infectious aetiologies and dilated impairment are arguments for cardiomyopathies with tropical particularities. However, the preponderance of undetermined aetiologies justifies the development of further research programmes.
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Harrison, David J., e John E. Doe. "The modification of cancer risk by chemicals". Toxicology Research 10, n.º 4 (12 de julho de 2021): 800–809. http://dx.doi.org/10.1093/toxres/tfab064.
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Abstract Advances in understanding of the process of carcinogenesis have undermined the concept of chemicals being classifiable as either carcinogens or non-carcinogens. Elements of carcinogenesis are happening all the time and a proportion of cancers cannot be prevented, the ‘bad luck hypothesis’. Although the proportion that can be prevented is disputed, it is important to continue efforts to reduce it. Factors that increase cancer risk have been grouped into intrinsic factors that cannot be modified, and endogenous and exogenous factors that can be modified. Chemicals are exogenous factors that can be modified by risk management measures. Chemicals can alter three key rates that influence cancer risk: cell division, mutation rate per cell division, transformation rate of mutated cells to cancer. These rates can form the basis of a dynamic cancer risk model, a generic, adverse outcome pathway for carcinogenesis where chemicals are considered for their ability to modify cancer risk rather than simply whether they are classed as carcinogens or non-carcinogens. This allows the development of different strategies for assessing cancer risk that use a range of data sources and are not dependent on using long-term bioassays and epidemiology to identify carcinogens. The framework will also allow difficult questions such as the effect of less than lifetime exposures and the effect of exposures to more than one chemical to be addressed.
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Shaw, Keely A., Gordon A. Zello, Brian Bandy, Jongbum Ko, Leandy Bertrand e Philip D. Chilibeck. "Dietary Supplementation for Para-Athletes: A Systematic Review". Nutrients 13, n.º 6 (11 de junho de 2021): 2016. http://dx.doi.org/10.3390/nu13062016.
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The use of dietary supplements is high among athletes and non-athletes alike, as well as able-bodied individuals and those with impairments. However, evidence is lacking in the use of dietary supplements for sport performance in a para-athlete population (e.g., those training for the Paralympics or similar competition). Our objective was to examine the literature regarding evidence for various sport supplements in a para-athlete population. A comprehensive literature search was conducted using PubMed, SPORTDiscus, MedLine, and Rehabilitation and Sports Medicine Source. Fifteen studies met our inclusion criteria and were included in our review. Seven varieties of supplements were investigated in the studies reviewed, including caffeine, creatine, buffering agents, fish oil, leucine, and vitamin D. The evidence for each of these supplements remains inconclusive, with varying results between studies. Limitations of research in this area include the heterogeneity of the subjects within the population regarding functionality and impairment. Very few studies included individuals with impairments other than spinal cord injury. Overall, more research is needed to strengthen the evidence for or against supplement use in para-athletes. Future research is also recommended on performance in para-athlete populations with classifiable impairments other than spinal cord injuries.
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Lin, Huaxin. "Classification of Simple Tracially AF C*-Algebras". Canadian Journal of Mathematics 53, n.º 1 (1 de fevereiro de 2001): 161–94. http://dx.doi.org/10.4153/cjm-2001-007-8.
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AbstractWe prove that pre-classifiable (see 3.1) simple nuclear tracially AF C*-algebras (TAF) are classified by their K-theory. As a consequence all simple, locally AH and TAF C*-algebras are in fact AH algebras (it is known that there are locally AH algebras that are not AH). We also prove the following Rationalization Theorem. Let A and B be two unital separable nuclear simple TAF C*- algebras with unique normalized traces satisfying the Universal Coefficient Theorem. If A and B have the same (ordered and scaled) K-theory and K0(A)+ is locally finitely generated, then A ⊗ Q ≅ B ⊗ Q, where Q is the UHF-algebra with the rational K0. Classification results (with restriction on K0 - theory) for the above C*-algebras are also obtained. For example, we show that, if A and B are unital nuclear separable simple TAF C*-algebras with the unique normalized trace satisfying the UCT and with K1(A) = K1(B), and A and B have the same rational (scaled ordered) K0, then A ≅ B. Similar results are also obtained for some cases in which K0 is non-divisible such as K0(A) = Z[1/2].
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Schiller, Katharina, Veronika Schiller, Aline Kortas, Gabriele Unterholzner, Sabine Raffler, Mareike Schimmel e Markus Rauchenzauner. "Primary Headache Is Related to Reduced Health-Related Quality of Life in Children with Epilepsy". Healthcare 12, n.º 4 (7 de fevereiro de 2024): 426. http://dx.doi.org/10.3390/healthcare12040426.
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Headache is a frequent comorbidity in patients with epilepsy. Data are sparse regarding the distribution of headache types in children with epilepsy (CWE). We aimed to assess the prevalence of primary headache types and their influence on health-related quality of life (QoL) in CWE. CWE filled out a validated headache questionnaire to assess migraine (MIG), tension-type headache (TTH), trigeminal–autonomic cephalalgia (TAC), or, if the criteria were not fulfilled, non-classifiable headache (NCH). QoL was measured using both patient and parent versions of a validated questionnaire. Of 119 CWE (59 female; 11.5 ± 3.1 y), headache was found in 46 (38.7%). Sixteen (34.8%) patients showed MIG, 9 (19.6%) patients TTH, and 21 (45.7%) patients described NCH. More girls reported headache (χ2 = 5.4, p = 0.02) when compared to boys. Overall, QoL was reduced in patients with headache from both the patients’ and parents’ points of view (70.8% [39.6; 87.5] vs. 77.0% [46.9; 95.8], p = 0.002; 71,9% [33.3; 87.5] vs. 78,1% [54.2; 95.8], p = 0.003). Headache is common among CWE with MIG as the most prevalent primary headache type and higher rates in female patients. Importantly, patients and their parents perceive a reduced overall QoL when suffering from headache.
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Zanardi, R., F. Attanasio, C. De Cesare, V. Fazio e C. Colombo. "Resistance or pseudo-resistance?" European Psychiatry 65, S1 (junho de 2022): S370—S371. http://dx.doi.org/10.1192/j.eurpsy.2022.941.
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Introduction Treatment-Resistant Depression continues to represent a great challenge for clinicians. Objectives We investigated patients with history of resistance, assessing prognostic factors, response to treatments, and remission over time. Methods We recruited 202 unipolar and bipolar depressed inpatients. According to anamnestic backgrounds, patients were assigned to: A) Non-resistant : responders, with no characteristics of resistance in the current episode. B) Resistant: resistant to two antidepressant trials of adequate doses and duration. C) Pseudo-resistant : non-responders, not classifiable as Resistant because of inadequate trials. During hospitalization, patients were treated by clinical judgment, following a rehabilitation program. Results Table 1 Non-resistant (111) Resistant (54) Pseudo-resistant (35) p-value Age 59.1±11.9 63.0±12.6 57.0±11.3 0.036* Episodes of illness 3.8±2.1 4.0±1.9 3.0±1.8 0.036* Personality disorders 27.0% 18.9% 48.6% 0.009** Therapies: 0.014** SSRI 62.4% 40.4% 69.7% SNRI 19.8% 42.3% 15.1% TCA 17.8% 17.3% 15.1% Augmentation 24.3% 38.9% 17.1% 0.05** Remission 76.5% 59.5% 81.2% CvsB:0.045** CvsA:0.587** On the day of admission, non-responders were 44.5% of the sample, but 39.3% of them did not meet the Resistant criteria, defining the Pseudo-resistant group. Pseudo-resistant differed from others by younger age, fewer illness episodes, higher rate of personality disorders, and different therapies during hospitalization [Fig.1,2,3]. Pseudo-resistant remission rate, significantly greater than Resistant one, was comparable to Non-resistant [Tab.1]. *Kruskal-Wallis Test **Chi-Squared Test Conclusions This study outlines a new group of depressed patients that, apparently drug-resistant, displays the same outcome as responders when treated with first-line drugs during hospitalization, certainly taking benefit from the psychoeducational program. Quick recognition of these patients could be crucial to giving optimal care. Disclosure No significant relationships.
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Ignacio, Gregorio, Francisco Tripp, Petty Rodríguez, Mario Martínez, Concepción Martínez, Elsa Ávila, Severiano Baltazar, Alva Zaragoza, Silvia Rivas e Eduardo E. Reynoso. "Non Hodgkin Lymphoma (NHL) Distribution and Clinical Characteristics in a Mexican Registry with High Frequency of T Cell NHL: A Descriptive Study on Behalf of Mexican Hematology Study Group (MHSG)." Blood 110, n.º 11 (16 de novembro de 2007): 4407. http://dx.doi.org/10.1182/blood.v110.11.4407.4407.
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Abstract Background: Among the NHL, B Cells NHL are more frequent than T Cells NHL (6%) as described in USA & European reports. The highest frequencies of T Cell NHL have been reported in Japan with 9% and India with 12%. In a Mexican retrospective study we found a T Cell NHL frequency of 13%. Objective: To corroborate the patterns and frequency of B and T cell lymphomas in Mexico. Methods: The registry of lymphoid neoplasms was created based on the WHO classification. The Lymphoma subtype analysis was prepared in two periods: retrospectively from 2002 to December 2005 and prospectively from January to December 2006. The data recorded were: age, sex, cell type (B o T), NHL frequency, primary site, stage and prognostic index (IPI and FLIPI). Results: In the first group 2375 Lymphomas were included: 2122 B Cell NHL (89.34%) and 253 T-cell lymphomas 253 (10.6%). B-cell NHL: gender 55.17% male and 44.66 female, median age of 55.21 years Age >60 years 45.7%; 62% III–IV stage. After applying the FLIPI index, the patients were divided into three risk groups: low (8.4% of cases), intermediate (81%), and high (10.6%). The distribution of patients in IPI risk groups was 15.7%, 76%, and 8.3% of cases classified as low, intermediate, and high risk The frequencies of B cell lymphoma were: 49% DLBCL, 15% Follicular Lymphoma, 5.35% CLL/SLL, 1.6% Mantle cell Lymphoma, 0.9% Follicular Center Lymphoma, 1.6% Marginal Zone B Lymphoma, 6.1% MALT, 1.6% Burkitt Lymphoma. T cell lymphomas were distributed in: Peripheral T Cell 253 (46.36%), Cutaneous Anaplastic 42 (16.09%), T/NKcell 35 (13.40%), Lymphoblastic 28 (6.16%), T non classifiable 10 (3.83%). The second group included 344 lymphomas; 309 (89.82%) B Cell NHL and 31 (10.01%) T cell Lymphomas. Gender 51.7 male and 48.3 female, medium age 57.79 years (SD 16.09); . >60 years 44%. After applying the FLIPI index the distribution of patients was 24.5% with intermedium risk and 9.5.8% high risk. Patients were divided into three IPI risk groups: Low 69.2% Intermediate 23% and high risk 7.8%. The frequencies of B cell lymphomas subtype were: DLBCL 168 (52.3%), Follicular 58(18.4%), CLL/SLL 19 (6.14%), Mantle Cell 10 (3.2%), Follicle Center Lymphoma (0.9%), Marginal Zone B 4 (1.2%), MALT 14 (4.5%), Burkitt’s Lymphoma 5 (1.6%). The T Cell Lymphoma subgroup frequencies were: T Cell Peripheral 7 (22.5%), Cutaneous Anaplastic 5 (16.1%), N/K cell 4 (12.9), Lymphoblastic 3 (9.6%), T lymphoma non classifiable 6 (19%). Conclusions: We confirmed a high incidence of T cell NHL in consecutive registries in Mexico. In the B cell subgroup it seems to be a difference where the DLBCL has a higher frequency and the CLL/SLL subgroup the lowest compared with other series. These differences in frequency might be explained by ethnic characteristics, however we need more epidemiological and viral studies, looking for Epstein Barr virus.
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Seiffert, Alexander P., Adolfo Gómez-Grande, Laura Alonso-Gómez, Antonio Méndez-Guerrero, Alberto Villarejo-Galende, Enrique J. Gómez e Patricia Sánchez-González. "Differences in Striatal Metabolism in [18F]FDG PET in Parkinson’s Disease and Atypical Parkinsonism". Diagnostics 13, n.º 1 (20 de dezembro de 2022): 6. http://dx.doi.org/10.3390/diagnostics13010006.
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Neurodegenerative parkinsonisms affect mainly cognitive and motor functions and are syndromes of overlapping symptoms and clinical manifestations such as tremor, rigidness, and bradykinesia. These include idiopathic Parkinson’s disease (PD) and the atypical parkinsonisms, namely progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), multiple system atrophy (MSA) and dementia with Lewy body (DLB). Differences in the striatal metabolism among these syndromes are evaluated using [18F]FDG PET, caused by alterations to the dopaminergic activity and neuronal loss. A study cohort of three patients with PD, 29 with atypical parkinsonism (10 PSP, 6 CBD, 2 MSA, 7 DLB, and 4 non-classifiable), and a control group of 25 patients with normal striatal metabolism is available. Standardized uptake value ratios (SUVR) are extracted from the striatum, and the caudate and the putamen separately. SUVRs are compared among the study groups. In addition, hemispherical and caudate-putamen differences are evaluated in atypical parkinsonisms. Striatal hypermetabolism is detected in patients with PD, while atypical parkinsonisms show hypometabolism, compared to the control group. Hemispherical differences are observed in CBD, MSA and DLB, with the latter also showing statistically significant caudate–putamen asymmetry (p = 0.018). These results indicate disease-specific metabolic uptake patterns in the striatum that can support the differential diagnosis.
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Martin, Jessica C., David T. J. Liley, A. Simon Harvey, Levin Kuhlmann, Jamie W. Sleigh e Andrew J. Davidson. "Alterations in the Functional Connectivity of Frontal Lobe Networks Preceding Emergence Delirium in Children". Anesthesiology 121, n.º 4 (1 de outubro de 2014): 740–52. http://dx.doi.org/10.1097/aln.0000000000000376.
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Abstract Background: This study aimed to characterize the electroencephalogram in children who emerged with emergence delirium (ED) compared with children without ED using methods that involved the assessment of cortical functional connectivity. Methods: Children aged 5 to 15 yr had multichannel electroencephalographic recordings during induction and emergence from anesthesia during minor surgical procedures. Of these, five children displayed ED after sevoflurane anesthesia. Measures of cortical functional connectivity previously used to evaluate anesthetic action in adults were compared between ED and age-, sex-, and anesthetic-matched non-ED children during emergence from anesthesia. Results: At the termination of sevoflurane anesthesia, the electroencephalogram in both ED and control patients showed delta frequency slowing and frontally dominant alpha activity, followed by a prolonged state with low-voltage, fast frequency activity (referred to as an indeterminate state). In children with ED, arousal with delirious behavior and a variety of electroencephalogram patterns occurred during the indeterminate state, before the appearance of normal wake or sleep patterns. The electroencephalogram in children without ED progressed from the indeterminate state to classifiable sleep or drowsy states, before peaceful awakening. Statistically significant differences in frontal lobe functional connectivity were identified between children with ED and non-ED. Conclusions: ED is associated with arousal from an indeterminate state before the onset of sleep-like electroencephalogram patterns. Increased frontal lobe cortical functional connectivity observed in ED, immediately after the termination of sevoflurane anesthesia, will have important implications for the development of methods to predict ED, the design of preventative strategies, and efforts to better understand its pathophysiology.
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TUCKER-DROB, ROBIN D. "Weak equivalence and non-classifiability of measure preserving actions". Ergodic Theory and Dynamical Systems 35, n.º 1 (13 de agosto de 2013): 293–336. http://dx.doi.org/10.1017/etds.2013.40.
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AbstractAbért and Weiss have shown that the Bernoulli shift ${s}_{\Gamma } $ of a countably infinite group $\Gamma $ is weakly contained in any free measure preserving action $\boldsymbol{a}$ of $\Gamma $. Proving a conjecture of Ioana, we establish a strong version of this result by showing that ${\boldsymbol{s}}_{\Gamma } \times \boldsymbol{a}$ is weakly equivalent to $\boldsymbol{a}$. Using random Bernoulli shifts introduced by Abért, Glasner, and Virag, we generalize this to non-free actions, replacing ${\boldsymbol{s}}_{\Gamma } $ with a random Bernoulli shift associated to an invariant random subgroup, and replacing the product action with a relatively independent joining. The result for free actions is used along with the theory of Borel reducibility and Hjorth’s theory of turbulence to show that, on the weak equivalence class of a free measure preserving action, the equivalence relations of isomorphism, weak isomorphism, and unitary equivalence are not classifiable by countable structures. This in particular shows that there are no free weakly rigid actions, that is, actions whose weak equivalence class and isomorphism class coincide, answering negatively a question of Abért and Elek. We also answer a question of Kechris regarding two ergodic theoretic properties of residually finite groups. A countably infinite residually finite group $\Gamma $ is said to have property ${\text{EMD} }^{\ast } $ if the action ${\boldsymbol{p}}_{\Gamma } $ of $\Gamma $ on its profinite completion weakly contains all ergodic measure preserving actions of $\Gamma $, and $\Gamma $ is said to have property $\text{MD} $ if $\boldsymbol{\iota} \times {\boldsymbol{p}}_{\Gamma } $ weakly contains all measure preserving actions of $\Gamma $, where $\boldsymbol{\iota} $ denotes the identity action on a standard non-atomic probability space. Kechris has shown that ${\text{EMD} }^{\ast } $ implies $\text{MD} $ and asked if the two properties are actually equivalent. We provide a positive answer to this question by studying the relationship between convexity and weak containment in the space of measure preserving actions.
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Yu, Christopher, Benjamin M. Moore, Irina Kotchetkova, Rachael L. Cordina e David S. Celermajer. "Causes of death in a contemporary adult congenital heart disease cohort". Heart 104, n.º 20 (17 de abril de 2018): 1678–82. http://dx.doi.org/10.1136/heartjnl-2017-312777.
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ObjectiveThe life expectancy of patients with congenital heart disease (CHD) has significantly improved with advances in their paediatric medical care. Mortality patterns are changing as a result. Our study aims to describe survival and causes of death in a contemporary cohort of adult patients with CHD.MethodsWe reviewed 3068 patients in our adult CHD database (age ≥16 years, seen at least once in our centre between 2000 and 2015), and documented the number and causes of death, via Australia’s National Death Index. Survival and mortality patterns were analysed by complexity of CHD and by underlying congenital diagnosis.ResultsOur cohort comprised 3068 adult patients (53% male). The distribution of patients (per the Bethesda classification) was 47% simple, 34% moderate and 18% complex (1% not classifiable). Over a median follow-up of 6.2 years (IQR 3.5–10.4), 341 patients (11%) died with an incidence of 0.4 deaths/100 patient years (py). Survival was significantly worse with increasing complexity of CHD (p<0.001); mortality rate in the simple group was 0.3 deaths/100 py with a median age of death 70 years, and in the complex group was 1.0 death/100 py with a median age of death 34 years. Overall, non-cardiac causes of death outnumbered cardiac causes, at 54% and 46%, respectively. The leading single cause of death was heart failure (17%), followed by malignancy (13%). Simple adult CHD patients mostly died due to non-cardiac causes such as malignancy. Perioperative mortality only accounted for 5% of deaths.ConclusionsPremature death is common in adults with CHD. Although heart failure remains the most common cause of death, in the contemporary era in a specialist CHD centre, non-cardiac related deaths outnumber cardiac deaths, particularly in those with simple CHD lesions.
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Smith, Carr J., Thomas A. Perfetti, A. Wallace Hayes e Sir Colin Berry. "Obesity as a Source of Endogenous Compounds Associated With Chronic Disease: A Review". Toxicological Sciences 175, n.º 2 (24 de março de 2020): 149–55. http://dx.doi.org/10.1093/toxsci/kfaa042.
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Abstract In 2014, it was estimated that more than 1.9 billion adults were overweight with over 600 million classifiable as obese. Approximately two-thirds of U.S. adults over 20 years of age are currently overweight with about 35% classified as obese, a figure thought likely to reach 42% by 2030 in those over 18 years of age. Adipose cells from stored body fat secrete estrogen and a very large number (> 500) of biologically active substances termed adipokines, in addition to inducing, by other cell-driven effects, pathological alterations in insulin pathways. The U.S. National Cancer Institute reports that exposure to the hormone disrupting and proinflammatory effects of excess adipose tissue are associated with an increased risk for 11 different cancers. Obesity is also associated with a number of serious non-neoplastic conditions including metabolic syndrome and type 2 diabetes; menstrual cycle irregularities and lowered fertility (men and women); and abnormal bone morphology in a subset of female patients. In men hypogonadism, low testosterone levels, benign prostatic hyperplasia, and lowered sperm counts have been reported. In developed countries, the endogenous adverse health burden associated with obesity is only matched, quantitatively and qualitatively, by the exogenous toxicity of cigarette smoking. The investigation of possible hormonal and/or proinflammatory effects of chemicals should include an assessment of the profound endocrine alterations associated with obesity.
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Romano, A., C. Mondino, M. Viola e P. Montuschi. "Immediate Allergic Reactions to β-Lactams: Diagnosis and Therapy". International Journal of Immunopathology and Pharmacology 16, n.º 1 (janeiro de 2003): 19–23. http://dx.doi.org/10.1177/039463200301600103.
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β-Lactams are the antibiotics which most frequently provoke adverse reactions mediated by specific immunological mechanisms. These reactions, classifiable as immediate or non-immediate, can be produced by the four classes of β-lactams (penicillins, cephalosporins, carbapenems and monobactams) currently available, which share a common β-lactam ring structure. Immediate reactions occur within the first hour after drug administration and are characterized by urticaria, angioedema, rhinitis, bronchospasm, and anaphylactic shock. Immediate reading skin tests are the quickest and most reliable method for demonstrating the presence of β-lactam specific IgE antibodies. It is crucial to use in diagnosis the suspected β-lactams themselves, particularly cephalosporins, in addition to penicillin determinants. Serum specific IgE assays can be used as complementary tests. Negative test results should be interpreted in light of the time elapsed from the last exposure to the responsible β-lactam. In fact, both in vivo and in vitro test sensitivity is known to decrease over time. In some diagnostic work-ups, patients with a positive history and negative skin and in vitro tests with classic reagents undergo a controlled administration of the suspected β-lactam. The management of immediate allergic reactions should take into consideration their severity and type. Adrenaline is the drug of choice in the treatment of anaphylactic shock. In addition to adrenaline, corticosteroids and antihistamines should be administered. Histamine H1 receptor antagonists are the mainstay of the treatment of immediate allergic reactions such as urticaria, rhinitis and conjunctivitis.
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Zucchelli, Gemma, Roberto Moretto, Daniele Rossini, Sara Lonardi, Sabina Murgioni, Giuseppe Tonini, Samanta Cupini et al. "Oligometastatic colorectal cancer: Prognostic implications of tumor load, role of locoregional treatments, and of first-line therapy intensification—A pooled analysis of TRIBE and TRIBE2 studies by GONO." Journal of Clinical Oncology 38, n.º 4_suppl (1 de fevereiro de 2020): 12. http://dx.doi.org/10.1200/jco.2020.38.4_suppl.12.
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12 Background: According to the ESMO guidelines a metastatic spread involving up to 2 or occasionally 3 sites with 5 or sometimes more metastases (mts) is defined as oligometastatic disease (OMD) and the possibility to offer locoregional treatments (LRTs) should be carefully considered. Tumor load and treatment’s objective (cytoreduction vs disease control) are included among factors affecting the choice of the intensity of the upfront chemotherapy (CT). Nevertheless, no data from clinical trials adopting this definition are currently available, so that the prognostic effect of tumor load, the impact of LRTs and the magnitude of benefit from the CT-intensification in OMD remain unclear. Here we assess the effect of FOLFOXIRI/bev compared to doublets (FOLFOX or FOLFIRI)/bev and the impact of LRTs according to tumor load (OMD vs non-OMD) in a pooled analysis of two randomized phase III studies (TRIBE and TRIBE2). Methods: Subgroup analyses for ORR, PFS and OS were performed according to tumor load at baseline. OMD was defined as up to 5 mts, up to 3 mts in one organ, up to 3 affected organs, mts size ≤ 3 cm, absence of ascites and peritoneal, bone and central nervous system mts. Results: Among 1187 patients (pts) enrolled, 1158 were classifiable: 126 as OMD (11%) and 1032 as non-OMD (89%). Pts with OMD had longer PFS (14.3 vs 10.5 months (mos); p < 0.01) and OS (44.3 vs 24.0 mos; p < 0.01) compared with those with non-OMD. These results were confirmed in multivariable models (p < 0.01). Also among pts who underwent LRTs with curative intent during first line (N = 202), those with OMD at baseline (N = 35) reported longer OS than those with non-OMD (59.6 vs 50.6 mos; p = 0.04). The benefit provided by FOLFOXIRI/bev compared to doublets/bev was confirmed in the OMD subgroup with no interaction effect between treatment arm and tumor load in terms of ORR, PFS and OS (p for interaction = 0.10, 0.58 and 0.23, respectively). Conclusions: OMD is confirmed as a positive prognostic factor and is associated with a higher magnitude of long-term benefit from LRTs than non-OMD. The positive impact of the intensification of the upfront CT is independent of tumor load.
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Gatto, Antonio, Serenella Angelici, Claudia Di Pangrazio, Lorenzo Nanni, Danilo Buonsenso, Filomena Valentina Paradiso e Antonio Chiaretti. "The Fakir Child: Clinical Observation or Invasive Treatment?" Pediatric Reports 12, n.º 3 (29 de outubro de 2020): 103–7. http://dx.doi.org/10.3390/pediatric12030023.
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Accidental swallowing of foreign bodies is a common problem among the pediatric population (6 months to 3 years), especially if the foreign body (FB) presents a sharp end that could potentially lead to perforation of the gastrointestinal (GI) tract, resulting in infection and complications. We report the case of a 2-year-old, admitted to the Emergency Department of our hospital after ingesting two FBs classifiable as sharp objects, specifically two metal nails, both approximately 4-cm long, which had been swallowed in one go, as reported by the parents. The patient had been previously admitted to another hospital in the same region, where the Emergency Department (ED) doctors took an X-ray to confirm the ingestion. The foreign bodies ingestion was thus confirmed, and they were, according to their report, located in the GI tract over the stomach. The patient has been monitored through all of his stay in the hospital and the progression of the foreign bodies has been documented with serial X-rays. Since neither clinical nor radiological signs of perforation were present, putting the FBs in the small bowel, a non-operative expectant management was followed. After 4 days of admission, the patient had passed one of the two FBS and later on the second one, without any complication. Thereafter the patient was discharged. The management of sharp gastrointestinal foreign objects ingestion is still debated, and the data of the current literature are poor. A number of case reports and small case series describe successful conservative management for the majority of ingested sharp objects. According to the literature data, our report confirms that the ingestion of sharp objects and relatively big objects in a baby can be successfully non-operatively managed, even despite the age of the patient and though the FBs are multiple.
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Walters, Ronald Stewart, Lisa M. Kidin, Joyce Roquemore, Victoria S. Jordan e Douglas Browning. "Thirty-day all-cause readmission rate at a cancer center as a quality of care measure." Journal of Clinical Oncology 30, n.º 34_suppl (1 de dezembro de 2012): 247. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.247.
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247 Background: Recently, a 30-day all-cause readmission rate has been proposed as a measure of quality of care. Readmissions are assumed to reflect failure by the discharging physician, hospital, or post acute care. These rates are generally easily calculated from available administrative data, and classifiable as "related to the previous discharge diagnosis" or not. Present on admission modifiers may enhance classification and assignment to "preventable" or "non-preventable," "expected or non-expected." This methodology is not generally applicable to the oncology population. The experience with one major cancer center is presented as an example of the limitations of such an approach. Methods: We analyzed 52,097 oncology admissions in an all-payer population that occurred between January 2010 and January 2012. Results: A mean of 32.5% (n=16,918) were readmitted within 30 days, compared to a "peer" group in the database of the University Health Consortium, median of 15%. The attached graph demonstrates the stability of this proportion. Leukemia, lymphoma, stem cell patients (46%), all patients with intense medical needs and frequent readmissions, n=7,635, were the largest subgroup. 42% (n=7,099) were readmissions for chemotherapy or immunotherapy, both planned and expected, and 11% (n=1,803) due to neutropenic fever, pneumonia, or sepsis, all common in this population and neither unexpected nor usually preventable. The most preventable, unexpected, and unplanned readmissions were for postoperative infection, dehydration, and urinary tract infection, accounting for 3.6% (n=609). Thus, the majority of readmissions were planned, expected, or not preventable. Conclusions: In a cancer population at an academic cancer hospital, the majority of readmission are not only planned, but also expected for this population of patients and should not be construed as representative of a quality of care issue. Proper stratification and classification of readmissions is essential to the interpretation of such a measure.
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Inoue, K., H. Imamura, Y. Kimura, K. Fujitani, Y. Miyake, J. Matuyama, M. Tatsumi, T. Shimokawa, Y. Kurokawa e H. Furukawa. "A randomized phase III trial to determine the efficacy of postoperative antimicrobial prophylaxis in gastric cancer surgery (OGSG0501)". Journal of Clinical Oncology 27, n.º 15_suppl (20 de maio de 2009): e15576-e15576. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e15576.
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e15576 Background: In Japan, antimicrobial prophylaxis (AMP) is typically administered for 3 to 4 days postoperatively in gastric cancer surgery. This far exceeds the recommended 24h or less laid out by the Centers for Disease Control (CDC) guidelines for the prevention of surgical-site infections, after a clean-contaminated operation. Methods: A multicenter randomized phase III trial was designed to evaluate the effect of postoperative AMP in gastric cancer surgery. Patients (pts) were required to have histologically proven gastric cancer which was curable by distal gastrectomy, be classifiable as ASA 1 or 2, and have adequate organ function. Pts were randomized to: (A) perioperative AMP (cefazolin 1g, at <30min before incision, every 3h intraoperative supplements) plus postoperative AMP (cefazolin 1g, twice daily for 2 postoperative days) or (B) perioperative AMP alone. Pts were stratified by institution and ASA. The primary endpoint was the incidence of surgical site infection (SSI). With 171 pts per arm, this study had 80% power to demonstrate non-inferiority with 5% margin of peri-AMP alone and 0.05 1-sided alpha. Results: 355 patients were recruited (A: 179, B: 176) in 7 centers between June 2005 and December 2007. The surgical-site infection rate was 9.0 percent (16 of 178) for peri-/post AMP and 4.5 percent (8 of 176) for peri-AMP alone, with no significant differences (Fisher's exact test: P=0.14, RR=1.98 [95%CI, 0.89–4.44]), but showing a significant non-inferiority (P<0.001). The remote site infection rate was 3.4 percent (6 of 178) for peri-/post AMP and 5.1 percent (9 of 175) for peri-AMP alone, with no significant differences (P=0.44, RR=0.66 [95%CI, 0.25- 1.70]). Conclusions: This multicenter randomized phase III trial confirms that postoperative AMP is unnecessary in patients undergoing distal gastrectomy for gastric cancer. No significant financial relationships to disclose.
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Greenfield, Michael D., e Todd E. Shelly. "Satellites and Transients: Ecological Constraints On Alternative Mating Tactics in Male Grasshoppers". Behaviour 109, n.º 3-4 (1989): 200–220. http://dx.doi.org/10.1163/156853989x00231.
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AbstractAlternative tactics of male mating behaviour, broadly classifiable as "dominant/ territorial" versus "subordinate/non-territorial", have now been described for numerous species. Furthermore, across diverse taxa the mating tactics of subordinate/non-territorial males often appear as one of two distinct types, satellite or transient behaviour. Despite general recognition of this dichotomy, though, little effort has been made to identify the circumstances under which one of these behaviours is adopted over the other. We compared the mating systems of two congeneric species of desert grasshoppers (genus Ligurotettix) to investigate specifically the role of resource dispersion in shaping the behaviour of subordinate males. The utility of the comparative approach derives from two basic similarities between the species: both Ligurotettix coquilletti and Ligurotettix planum feed almost exclusively on a single host plant species, and the majority of males in both species defend individual host plants to gain access to females. However, the two species are associated with host plants that are dispersed very differently; i.e., L. coquilletti encounter a small number of large plants and L. planum a large number of small ones. In L. coquilletti, subordinate males, individuals noted by their lack of success in aggression and in obtaining matings, were characterized as satellites that remained silent on host plants defended by territorial males. Subordinate males in L. planum, however, were transients that sang regularly but moved frequently among different host plants. We propose that this behavioural discrepancy results from (1) the large difference between the number of potential female encounter sites (i.e., individual host plants) available to the males of the two species and (2) the large difference between the sizes of resource patches defended by the two species, which influences the ability of dominant males to eject subordinates.
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Sato, Mariko, Prachi Sharma, Pournima Navalkele, Jody Pathare, Zied Abdullae, Ken Aldape e John Crawford. "METB-15. ROLE OF DNA METHYLATION PROFILING IN THE MANAGEMENT OF PEDIATRIC CENTRAL NERVOUS SYSTEM TUMORS: A SINGLE INSTITUTIONAL SERIES". Neuro-Oncology 26, Supplement_4 (18 de junho de 2024): 0. http://dx.doi.org/10.1093/neuonc/noae064.256.
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Abstract BACKGROUND DNA methylation profiling has now been integrated into the WHO classification of CNS tumors and serves as confirmatory means to diagnose CNS tumors in conjunction with genetic sequencing/microarray analysis. The practical impact on patient care in the retrospective and prospective settings is less known. METHODS Methylation analysis was performed on a cohort of previously and newly diagnosed children with CNS tumors at Children’s Hospital Orange County from 2022-2023. Data regarding histologic diagnosis, integrated molecular diagnosis, methylation classification, timing of result completion and functional impact of methylation results on patient diagnosis/management was evaluated. RESULTS Forty patients (21 boys, ages 5 weeks-17 years) with previously diagnosed (N=11) or newly diagnosed (N=21) CNS tumors were evaluated by methylation analysis at one or more institutions. The most common tumor types were diffuse type pediatric high-grade glioma (N=6) and ependymoma PFA (n=4). Methylation analysis revealed no match in two cases (ALK-EML4 fusion embryonal tumor and recurrent low grade glioneuronal tumor) and had insufficient DNA extraction in one patient with low grade glioneuronal spinal cord tumor. Among the 5 tumors with duplicate methylation analyses at two institutions, three Ependymoma PFA subgroups were concordant while two showed differing classifications (diffuse type pediatric high-grade glioma RTK1 subtype vs. non- classifiable and medulloblastoma group 4 vs. non-WNT, non-SHH). In patients with previously diagnosed CNS tumors, methylation either led to a change in classification or modification of diagnosis in 7 out of 11 patients. The average time from surgery to the receipt of methylation results for newly diagnosed patients was 24 days (range 4-90 days). CONCLUSION Methylation analysis was beneficial in both the previously diagnosed and newly diagnosed setting in patients with previously difficult to classify tumors following conventional molecular analysis. Changes in tumor classification or modifications in diagnosis were observed in the majority of patients.
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Drexler, Richard, Alicia Eckhardt, Helena Bode, Krystian Fita, Katrin Lamszus, Manfred Westphal, Lasse Dührsen, Ulrich Schüller e Malte Mohme. "PATH-47. THE CHALLENGE AND THERAPEUTIC RELEVANCE OF A NON-MATCHING CLASSIFIER OUTPUT USING GENOME-WIDE DNA METHYLATION FOR CLINICAL ROUTINE". Neuro-Oncology 24, Supplement_7 (1 de novembro de 2022): vii161. http://dx.doi.org/10.1093/neuonc/noac209.620.
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Abstract DNA methylation-based classification of central nervous system tumours has been increasing in importance for routine clinical workups and offers novel opportunities in discriminating subtypes which could lead to a more customized therapy. However, there are still unclassifiable entities for which defining an effective therapeutic regimen is challenging. The aim of our study was to gain further insight in these challenging cases. We included 81 patients with a calibrated score below 0.9 in the classifier output, who underwent surgery for a tumour of the central nervous system (CNS). 47 patients had a different output using the classifier version v11b4 when compared to their histological diagnosis. Of these, 41 patients (87.2 %) did not have any diagnosis from the methylation classifier (“no matching methylation class”). Surgical and clinicopathological features as well as DNA input had no impact on the calibrated score. Cases with non-classifiable tumors had a significantly longer time until a decision for adjuvant therapy and these cases were presented more often in neurooncological tumor boards (p< 0.01). Further analyses in 23 glioblastoma patients revealed comparable results for the overall survival, but a significantly shorter progression-free survival in cases with a discrepancy between the histological and classifier diagnosis. Application of the latest classifier version v12.5 enabled classification in 67.9% of cases, resulting in re-classification with a high calibrated score (> 0.9) in 25.7% of the tumors. Taken together, our study presents unclassifiable cases and the possible clinical impact when waiting for the accurate diagnosis in these challenging cases. Even though DNA methylation profiling significantly contributes to advanced CNS tumour diagnostics, clinicians should be aware of a prolonged interval to treatment initiation, especially for highly malignant brain tumours. Therefore, we would recommend to schedule adjuvant treatment as early as possible if surgical and histological results are suspicious for this disease.
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Amin, Manik A., e Nikolaos Trikalinos. "Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) of gastrointestinal (GI) tract: A single institution experience." Journal of Clinical Oncology 38, n.º 4_suppl (1 de fevereiro de 2020): 633. http://dx.doi.org/10.1200/jco.2020.38.4_suppl.633.
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633 Background: MiNENs are heterogeneous group of rare tumors and represent less than 1% of all GI malignancies. These are pathologically classifiable according to neuroendocrine component into low grade, intermediate grade and high grade MiNENs but and managed based upon non-neuroendocrine component rather than true NENs. They have poor prognosis and less is known about treatment options. Methods: We identified 34 cases of MiNENs from 1/1/2000 to 1/1/2018 from Siteman Cancer Registry Database at Siteman Cancer Center, Washington University, St. Louis. Treatment and follow up information was obtained from medical charts of patients. Results: Of 34 identified cases of MiNENs, our database showed equal distribution of MiNENs in male and female patients (N = 17 each). Site of origin included appendix (N = 14), colon (N = 10), esophageal (N = 2), stomach (N = 3), rectum (N = 3), small intestine (N = 1) and ampulla of Vater (N = 1) locations. Histology was high grade (N = 22), intermediate grade (N = 8), low grade (N = 3) and unknown (1). Twenty nine (85%) underwent surgical resection with curative intent and 13 (40%) patients were disease free at five years of follow up. Disease was localized in 15 patients (44%) and distant metastasis were reported in 13 patients (40%). Ten out of 15 patient with localized disease were disease free with combined modality therapy of surgery and chemotherapy. Most common chemotherapy regimen used in the metastatic setting was FOLFOX (11), 5FU/capecitabine (3), and carboplatin plus etoposide (5). Next generation sequencing analysis was available on limited patients which showed MMR proficient (3), MMR deficiency (1), BRAF V600E mutation (1) and KRAS wild type (1). Conclusions: MiNENs of GI tract are rare and aggressive tumors and represent a distinct entity. Surgical resection whenever possible offers curative option. Our database of GI MiNENs showed efficacy with commonly used GI chemotherapy regimens. Patients with low grade tumor histology had better survival as compared to moderately and poorly differentiated tumors. Genomic testing through NGS would be recommended for personalized treatment decisions given poor prognosis in these patients.
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Bolt, Toki Anna, Claudia Pauligk, Dominique Werner, Frank Mayer, Ralf Dieter Hofheinz, Nils Homann, Kim Luley e Salah-Eddin Al-Batran. "The association of objective response and overall survival in patients with inoperable or metastatic gastric and esophagogastric junction (EGJ) cancer: A pooled analysis of individual patient data from first-line clinical trials." Journal of Clinical Oncology 31, n.º 15_suppl (20 de maio de 2013): 4095. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.4095.
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4095 Background: The aim of the study is to determine whether the achievement of an objective response to first-line chemotherapy is prognostic of patient’s outcome in gastric/EGJ adenocarcinoma. Methods: Individual patient (pts) data from prospective first-line trials conducted by a single study group were used. Patients received platin/5-FU based chemotherapy with or without docetaxel. Responses were evaluated according to WHO criteria in all trials. Response data, patients’ characteristics (age, sex, entity, histological type, primary location, ECOG PS, and type and number of metastatic sites), type of chemotherapy, and overall survival data were analyzed. Results: 612 pts were included. Median age was 66 yrs; 31.5% had ECOG status 0, 58.3% ECOG 1, and 9.8% ECOG 2 & 3. Gastric primaries were found in 44.4% and EGJ in 35.8% of pts (19.7% were overlapping/not evaluable). According to Lauren classification, 36.8% had intestinal, 32.4% diffuse, and 8.5% mixed types (22.4% were not classifiable). 64.5% had positive non-regional lymph nodes (LN) involvement, 14.1% LN involvement without other metastases, 33.3% had peritoneal carcinomatosis, 44.0% liver and 16.7% lung metastases. Response rates were complete (CR) in 3.1%, partial (PR) in 36.4%, stable disease (SD) in 34.5%, and progressive disease (PD) in 15.0% pts (10.9% were not evaluable). Overall response rate (OR; CR + PR) was 39.5%. Median overall survival times in pts with CR vs PR vs SD vs PD were 37.9 vs 14.7 vs 10.9 vs 5.2 months, respectively; p=1.26 x 10-33). OR (CR or PR) also strongly predicted OS (16.7 vs 8.1 months in pts with vs no OR, p=1.08 x 10-17). OR remained the strongest predictor of OS in the multivariate analysis (p=6.55 x 10-7) including all baseline criteria mentioned above followed by ECOG PS (p=0.048) and the presence of non-regional LN as the only site of metastasis (p=0.034). Conclusions: The achievement of an objective response is the strongest predictor of survival in pts with gastric and EGJ cancer and could serve as a surrogate marker if validated.
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Polivenok, Igor V., Frank J. Molloy, Christian L. Gilbert, Mark Danton, Ali Dodge-Khatami, Sri O. Rao, John P. Breinholt, Marcelo Cardarelli, Jamie S. Penk e William M. Novick. "Results of international assistance for a paediatric heart surgery programme in a single Ukrainian centre". Cardiology in the Young 29, n.º 3 (28 de fevereiro de 2019): 363–68. http://dx.doi.org/10.1017/s1047951118002457.
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AbstractBackgroundSurgery for CHD has been slow to develop in parts of the former Soviet Union. The impact of an 8-year surgical assistance programme between an emerging centre and a multi-disciplinary international team that comprised healthcare professionals from developed cardiac programmes is analysed and presented.Material and methodsThe international paediatric assistance programme included five main components – intermittent clinical visits to the site annually, medical education, biomedical engineering support, nurse empowerment, and team-based practice development. Data were analysed from visiting teams and local databases before and since commencement of assistance in 2007 (era A: 2000–2007; era B: 2008–2015). The following variables were compared between periods: annual case volume, operative mortality, case complexity based on Risk Adjustment for Congenital Heart Surgery (RACHS-1), and RACHS-adjusted standardised mortality ratio.ResultsA total of 154 RACHS-classifiable operations were performed during era A, with a mean annual case volume by local surgeons of 19.3 at 95% confidence interval 14.3–24.2, with an operative mortality of 4.6% and a standardised mortality ratio of 2.1. In era B, surgical volume increased to a mean of 103.1 annual cases (95% confidence interval 69.1–137.2, p<0.0001). There was a non-significant (p=0.84) increase in operative mortality (5.7%), but a decrease in standardised mortality ratio (1.2) owing to an increase in case complexity. In era B, the proportion of local surgeon-led surgeries during visits from the international team increased from 0% (0/27) in 2008 to 98% (58/59) in the final year of analysis.ConclusionsThe model of assistance described in this report led to improved adjusted mortality, increased case volume, complexity, and independent operating skills.
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Hallam, S., M. Bickley, L. Phelan, M. Dilworth e DM Bowley. "Does declared surgeon specialist interest influence the outcome of emergency laparotomy?" Annals of The Royal College of Surgeons of England 102, n.º 6 (julho de 2020): 437–41. http://dx.doi.org/10.1308/rcsann.2020.0098.
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Introduction In the UK, general surgeons must demonstrate competency in emergency general surgery before obtaining a certificate of completion of training. Subsequently, many consultants develop focused elective specialist interests which may not mirror the breadth of procedures encountered during emergency practice. Recent National Emergency Laparotomy Audit analysis found that declared surgeon special interest impacted emergency laparotomy outcomes, which has implications for emergency general surgery service configuration. We sought to establish whether local declared surgeon special interest impacts emergency laparotomy outcomes. Methods Adult patients having emergency laparotomy were identified from our prospective National Emergency Laparotomy Audit database from May 2016 to May 2019 and categorised as colorectal or oesophagogastric according to operative procedure. Outcomes included 30-day mortality, return to theatre and length of stay. Binomial logistic regression was used to identify any association between declared consultant specialist interest and outcomes. Results Of 600 laparotomies, 358 (58.6%) were classifiable as specialist procedures: 287 (80%) colorectal and 71 (20%) oesophagogastric. Discordance between declared specialty and operation undertaken occurred in 25% of procedures. For colorectal emergency laparotomy, there was an increased risk of 30-day mortality when performed by a non-colorectal consultant (unadjusted odds ratio 2.34; 95% confidence interval 1.10–5.00; p = 0.003); however, when adjusted for confounders within multivariate analysis declared surgeon specialty had no impact on mortality, return to theatre or length of stay. Conclusion Surgeon-declared specialty does not impact emergency laparotomy outcomes in this cohort of undifferentiated emergency laparotomies. This may reflect the on-call structure at Birmingham Heartlands Hospital, where a colorectal and oesophagogastric consultant are paired on call and provide cross-cover when needed.
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López-Granados, Francisca, M. Teresa Gómez-Casero, José M. Peña-Barragán, Montserrat Jurado-Expósito e Luis García-Torres. "Classifying Irrigated Crops as Affected by Phenological Stage Using Discriminant Analysis and Neural Networks". Journal of the American Society for Horticultural Science 135, n.º 5 (setembro de 2010): 465–73. http://dx.doi.org/10.21273/jashs.135.5.465.
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In Spain, water for agricultural use represents about 85% of the total water demand, and irrigated crop production constitutes a major contribution to the country's economy. Field studies were conducted to evaluate the potential of multispectral reflectance and seven vegetation indices in the visible and near-infrared spectral range for discriminating and classifying bare soil and several horticultural irrigated crops at different dates. This is the first step of a broader project with the overall goal of using satellite imagery with high spatial and multispectral resolutions for mapping irrigated crops to improve agricultural water use. On-ground reflectance data of bare soil and annual herbaceous crops [garlic (Allium sativum), onion (Allium cepa), sunflower (Helianthus annuus), bean (Vicia faba), maize (Zea mays), potato (Solanum tuberosum), winter wheat (Triticum aestivum), melon (Cucumis melo), watermelon (Citrillus lanatus), and cotton (Gossypium hirsutum)], perennial herbaceous crops [alfalfa (Medicago sativa) and asparagus (Asparagus officinalis)], deciduous trees [plum (Prunus spp.)], and non-deciduous trees [citrus (Citrus spp.) and olive (Olea europaea)] were collected using a handheld field spectroradiometer in spring, early summer, and late summer. Three classification methods were applied to discriminate differences in reflectance between the different crops and bare soil: stepwise discriminant analysis, and two artificial neural networks: multilayer perceptron (MLP) and radial basis function. On any of the sampling dates, the highest degree of accuracy was achieved with the MLP neural network, showing 89.8%, 91.1%, and 96.4% correct classification in spring, early summer, and late summer, respectively. The classification matrix from the MLP model using cross-validation showed that most crops discriminated in spring and late summer were 100% classifiable. For future works, we would recommend acquiring two multispectral satellite images taken in spring and late summer for monitoring and mapping these irrigated crops, thus avoiding costly field surveys.
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Vipparla, Raja Silvan, Raji Tejas Naidu, Susan Cherian e Suresh S. Shettigar. "Molecular Subtyping of Invasive Breast Carcinoma by Immunohistochemistry and Five-Year Survival Study". Annals of Pathology and Laboratory Medicine 8, n.º 9 (30 de setembro de 2021): A214–224. http://dx.doi.org/10.21276/apalm.3064.
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Background: Global gene expression profiling for Invasive breast carcinoma (IBC) has identified intrinsic subtypes of IBC with differing clinical outcomes and response to therapy. As genotyping assays are limited by availability and cost, we have used Immunohistochemistry (IHC) surrogates to classify IBC into molecular subtypes.
Methods: Representative tumor blocks of 158 surgical specimens of IBC between 2007 to 2017, were selected and IHC done for ER, PR, Her2, Ki67, CK 5/6 and EGFR. The cases were classified into 7 Molecular subtypes (Luminal A, Luminal B, Luminal HER2PR+, Luminal HER2PR-, HER2Enriched, Basal like (BLBC) and non classifiable (NCBC) and correlated with clinico-pathological findings. Five- year survival rate was calculated for patients diagnosed between 2007 to 2013.
Result: The most common subtype was Luminal A (31.0%), followed by Luminal B (25.3%), NCBC (14.6%) and HER2 enriched (13.3%). Among post-menopausal women, common subtypes were Luminal A (33.8%) and Luminal B (24.4%). Among premenopausal women, most cases were NCBC (27.8%) and BLBC (22.2%). 61.2% of Luminal A were Grade2 and 22.4% were Grade 1. Many cases of Luminal B and HER2 positive cases were of Grade3 (45.0%) and (57.1%) respectively. Of the triple-negative category (BLBC & NCBC), 73% were Grade3 with statistically significant correlation (p value < 0.001). Most of these cases were in Tumor stage T2 (70%), followed by T1 (22.3%). Nodal metastasis was seen in 39.6% and 65% respectively of Luminal A and Luminal B subtypes. Distant metastases on follow-up were present in 15.8%, which included HER2 enriched subtype (28.5%), followed by BLBC (20.0%) and NCBC (17.4%). Luminal A cases, had better survival accounting for 88% of all survivors.
Conclusion: Molecular subtyping of IBC using IHC was useful to understand the clinicopathological distinctiveness of each subtype.
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Sittaro, Fabian, Christopher Hutengs, Sebastian Semella e Michael Vohland. "A Machine Learning Framework for the Classification of Natura 2000 Habitat Types at Large Spatial Scales Using MODIS Surface Reflectance Data". Remote Sensing 14, n.º 4 (10 de fevereiro de 2022): 823. http://dx.doi.org/10.3390/rs14040823.
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Anthropogenic climate and land use change is causing rapid shifts in the distribution and composition of habitats with profound impacts on ecosystem biodiversity. The sustainable management of ecosystems requires monitoring programmes capable of detecting shifts in habitat distribution and composition at large spatial scales. Remote sensing observations facilitate such efforts as they enable cost-efficient modelling approaches that utilize publicly available datasets and can assess the status of habitats over extended periods of time. In this study, we introduce a modelling framework for habitat monitoring in Germany using readily available MODIS surface reflectance data. We developed supervised classification models that allocate (semi-)natural areas to one of 18 classes based on their similarity to Natura 2000 habitat types. Three machine learning classifiers, i.e., Support Vector Machines (SVM), Random Forests (RF), and C5.0, and an ensemble approach were employed to predict habitat type using spectral signatures from MODIS in the visible-to-near-infrared and short-wave infrared. The models were trained on homogenous Special Areas of Conservation that are predominantly covered by a single habitat type with reference data from 2013, 2014, and 2016 and tested against ground truth data from 2010 and 2019 for independent model validation. Individually, the SVM and RF methods achieved better overall classification accuracies (SVM: 0.72–0.93%, RF: 0.72–0.94%) than the C5.0 algorithm (0.66–0.93%), while the ensemble classifier developed from the individual models gave the best performance with overall accuracies of 94.23% for 2010 and 80.34% for 2019 and also allowed a robust detection of non-classifiable pixels. We detected strong variability in the cover of individual habitat types, which were reduced when aggregated based on their similarity. Our methodology is capable to provide quantitative information on the spatial distribution of habitats, differentiate between disturbance events and gradual shifts in ecosystem composition, and could successfully allocate natural areas to Natura 2000 habitat types.
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Herrera, Marytere, Arturo Miranda, Fernando Javier Villalobos Peña, IVAN LYRA-GONZALEZ, German Caderillo-Ruiz, Dr Consuelo Diaz e Erika Ruiz Garcia. "Prognostic Nutritional Index as a predictive factor of survival in patients with gastric cancer in a Mexican population." Journal of Clinical Oncology 37, n.º 4_suppl (1 de fevereiro de 2019): 85. http://dx.doi.org/10.1200/jco.2019.37.4_suppl.85.
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85 Background: Gastric cancer is a health problem that is gaining great relevance because despite the multidisciplinary treatment the clinical outcomes are not encouraging; with a diversified prognosis, considering that the results are not only influenced by tumor properties, but also by the patient's condition in an integral way, especially by the nutritional and immunological state. In this study we studied the prognostic nutritionalindex (PNI) as predictive value of survival in patients with gastric cancer. Methods: This is a observational study, 251 patients with diagnosis of gastric adenocarcinoma with locally advanced disease (confirmed by computed tomography (CT)) were analyzed from January 2010 to June 2016. Patients with locally advanced disease confirmed by laparoscopy were taken to radical surgery. Those patients who were taken to laparoscopy and who have been documented metastatic disease, were treated only in a palliative form (chemotherapy, radiotherapy, palliative care). Results: In the analysis of survival through the curves of Kaplan-Meier, and the test log-rank, it was found that patients with a larger tumor size pathological (PT) (3/4/unclassifiable vs 1/2) had an average survival of 25.5 versus 55.5 months (P = < 0.0001). With advanced pathological stages (EP) (III/IV/non-classifiable vs. complete pathological response/I/II) reaching a survival average of 20.4 versus 59.1 months (P = < 0.0001). In the multivariate analysis, it was found that the EP (Hazard radio [HR]: 1.54, confidence interval 95% [CI]: 1.323-1.810, p = < 0.0001) and having received adjuvant chemotherapy (HR: 0332, CI 95%: 0.217-0.508, p = < 0.0001), were independently associated with the overall survival. Conclusions: This study demonstrates that low levels of PNI are associated with advanced diseases and, therefore, worse prognosis, with a tendency towards a decrease in overall survival.
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Hou, Xiaoxiao, Hongliang Liu, Shuzhen Wei, Zhongfeng Ding, Feng Sang, Yanfang Zhao, Yuling Dong et al. "Roseomonas selenitidurans sp. nov., isolated from urban soil, and emended description of Roseomonas frigidaquae". International Journal of Systematic and Evolutionary Microbiology 70, n.º 11 (1 de novembro de 2020): 5937–42. http://dx.doi.org/10.1099/ijsem.0.004496.
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An aerobic, non-motile, Gram-stain-negative, pink, convex, coccobacilli-shaped, mesophilic bacterium, designated strain BU-1T, was isolated from an urban soil sample from Zibo city, Shandong province, PR China. The strain grew at 20–37 °C (optimum, 30 °C), pH 5–10 (optimum, pH 7) and growth occurred with 0–2 % (w/v) NaCl (optimally with 0.5 %). The results of phylogenetic analysis based on 16S rRNA gene sequences indicated that BU-1T was closely related to members of the genus Roseomonas and had highest 16S rRNA gene sequence similarities with Roseomonas frigidaquae JCM 15073T (97.8 %), Roseomonas tokyonensis JCM 14634T (96.9 %), Roseomonas stagni JCM 15034T (96.5 %), and Roseomonas riguiloci JCM 17520T (95.9 %). BU-1T also formed a subcluster with R. frigidaquae JCM 15073T and R. stagni JCM 15034T in phylogenetic trees based on genomic sequences. The genome size of BU-1T was 5.79 Mb and the DNA G+C content was 71.7 %. ANI, dDDH and AAI values between BU-1T and R. frigidaquae JCM 15073T were 84.0, 27.2 and 86.7 %, respectively. Furthermore, the genome of BU-1T contained 5446 predicted protein coding genes and 4945 (90.8%) of them had classifiable functions. BU-1T contained Q-10 as the main ubiquinone. The predominant fatty acids (>10 %) were summed feature 3, summed feature 8 and C16:0. The polar lipid profile contained diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, phosphatidylcholine and five unidentified aminolipids. Combined data from phenotypic, phylogenetic and chemotaxonomic studies indicated that strain BU-1T is a representative of a novel species of the genus Roseomonas . Since strain BU-1T can reduce highly toxic selenite [Se(IV)] to low toxicity elemental selenium [Se(0)], the name Roseomonas selenitidurans sp. nov. is proposed. The type strain is BU-1T (=KACC 21750T =GDMCC 1.1776T).
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Khillan, R., G. S. Sidhu, C. Axiotis e A. Braverman. "Role of fine needle aspiration (FNA) cytology in assessment of cervical lymphadenopathy". Journal of Clinical Oncology 27, n.º 15_suppl (20 de maio de 2009): e19525-e19525. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e19525.
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e19525 Background: The ability of FNA specimens to provide a definitive lymphoma diagnosis is controversial. Otolaryngolists routinely employ FNA for cervical lymph nodes which may have arisen from head and neck carcinomas, since incisional procedures may interfere with potentially curative surgery. Methods: The charts of 176 patients referred to the Kings County Hospital Center since 1996 for confirmed lymphoma were reviewed. All patients with cervical adenopathy are initially referred to the Otolaryngology service for biopsy, which is routinely FNA. Results: Of the 123 patients for whom pathological data was available, 37 had initial FNAs; 10 more FNAs (total 47) were done when the first was not diagnostic. Cervical adenopathy was the presentation in 27 of 37 patients (73%), 6 of whom also had disseminated adenopathy. Upper aerodigestive tract (UAT) fiberoscopy had been negative in 16 and not performed in 7. The FNA specimens contained interpretable material in 42 of 47 cases (89%). Five FNA specimens were diagnostic of lymphoma (11%), but the type was classifiable in only one. Thus, 32 initial FNA specimens were not diagnostic, nor were 10 repeat FNA's on the same patients. Of the 32 patients who initially had non-diagnostic FNAs, a lymphoma diagnosis and classification was ultimately established by a single excisional lymph node biopsy. Lymphoma diagnosis was delayed in 19 patients because of FNA by 10–941 days; median 38, mean 68 days. Conclusions: Though 90% were not diagnostic, FNA was routinely, and sometimes repeatedly performed in patients with cervical adenopathy, most of whom had no evidence of UAT neoplasms, and some of whom had disseminated adenopathy. Significant delays in diagnosis were the result. Decisions concerning biopsy technique in patients with cervical adenopathy should be made in the context of clinical presentation. No significant financial relationships to disclose.