RESUMO
Reconstructive frontal anterior laryngectomy (RFAL) is a partial laryngeal surgery technique for resecting early-stage (T1-T2) glottic squamous cell carcinoma. Indications comprise a lesion of the anterior commissure of the larynx that cannot be adequately exposed by endoscopy, and cases in which radiotherapy is refused or contraindicated. The initial RFAL technique included epiglottoplasty. Here we propose a technique without epiglottoplasty, with the advantage of avoiding need for tracheotomy in most cases. After the first stage of surgical excision, reconstruction consists in placing a vertical brace transepiglottically and below the cricoid. The epiglottis is thus left at its original height and secured in place to prevent flapping in the pharyngolaryngeal lumen. Transverse bracing is then performed through the thyroid wings: one of the key points of this surgery is to control tension to avoid risk of stenosis. The subhyoid muscles are sutured together to achieve satisfactory sealing. This technique offers satisfying functional results and oncological control. The most frequent complications are (1) secondary tracheotomy, which can be avoided by selecting patients who require a primary tracheotomy and optimizing the seal, and (2) stenosis, which can be limited by not bringing the cartilaginous structures too close together during bracing.
RESUMO
There is minimal research on the sport experiences of racialized young women athletes in Canada. When studying racialized groups, an inclusive and meaningful approach to research is necessary because ethnicity and race are integral to understanding identity, diversity, discrimination, and overall experiences in sport. The purpose of this qualitative description study was to explore the identities and body-related sport experiences of racialized young women athletes in a variety of sports in Canada. Eight racialized young women athletes (ages 14-18 years; Mage = 16.63, SD = 1.19) participated in multiple semi-structured one-on-one interviews and reflexive photography. A reflexive thematic analysis was conducted, and three overarching themes were generated that describe the athletes' identities and body-related sport experiences: (a) Who I am vs who they say I am; (b) My unique body in sport; and (c) The importance of representation. From these findings, three critical factors - intersectionality, discrimination, and diversity - are examined that influence the quality of sport experiences for racialized young women athletes in Canada.
Assuntos
Esportes , Humanos , Feminino , Adolescente , Atletas , Canadá , Pesquisa QualitativaRESUMO
Pulmonary arterial hypertension (PAH) is a rare disease that can be caused by (likely) pathogenic germline genomic variants. In addition to the most prevalent disease gene, BMPR2 (bone morphogenetic protein receptor 2), several genes, some belonging to distinct functional classes, are also now known to predispose to the development of PAH. As a consequence, specialist and non-specialist clinicians and healthcare professionals are increasingly faced with a range of questions regarding the need for, approaches to and benefits/risks of genetic testing for PAH patients and/or related family members. We provide a consensus-based approach to recommendations for genetic counselling and assessment of current best practice for disease gene testing. We provide a framework and the type of information to be provided to patients and relatives through the process of genetic counselling, and describe the presently known disease causal genes to be analysed. Benefits of including molecular genetic testing within the management protocol of patients with PAH include the identification of individuals misclassified by other diagnostic approaches, the optimisation of phenotypic characterisation for aggregation of outcome data, including in clinical trials, and importantly through cascade screening, the detection of healthy causal variant carriers, to whom regular assessment should be offered.
Assuntos
Hipertensão Pulmonar , Hipertensão Arterial Pulmonar , Humanos , Aconselhamento Genético/métodos , Hipertensão Arterial Pulmonar/genética , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/genética , Hipertensão Pulmonar/terapia , Mutação , Hipertensão Pulmonar Primária Familiar/diagnóstico , Hipertensão Pulmonar Primária Familiar/genética , Testes Genéticos/métodos , Predisposição Genética para DoençaRESUMO
Progress in skull-base endoscopic surgery has improved our knowledge of olfactory cleft (OC) anatomy. This article presents a review of current knowledge concerning the OC roof: descriptive anatomy, radiological exploration, and endoscopic observation. The OC is a narrow area in the most superior part of the nasal cavity. Its roof is the thinnest structure separating the nasal cavities from the brain; it comprises three superimposed tissues: nasal mucosa, ethmoid cribriform plate (ECP), and dura mater. The ECP comprises the anterior ECP containing the ethmoidal slit (ES) medially and the cribroethmoidal foramen (CEF) laterally; and the posterior ECP, comprising the olfactory foramina. The OC roof is bordered anteriorly by the nasal bone roof, laterally by the lateral ethmoid masses, and posteriorly by the jugum and anterior wall of the sphenoid sinuses. Imaging is crucial for analyzing this wall, providing precise detailed information on conformation and anatomic relations with adjacent structures such as the anterior ethmoidal artery. Understanding OC roof anatomy and correct interpretation of imaging are essential for safety in present-day functional endoscopic sinus surgery and anterior skull-base oncologic surgery.
Assuntos
Osso Etmoide , Cavidade Nasal , Humanos , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/cirurgia , Osso Etmoide/anatomia & histologia , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/cirurgia , Endoscopia/métodos , Seio Esfenoidal , Procedimentos Neurocirúrgicos/métodos , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgiaRESUMO
Increasing children's physical activity engagement has short- and long-term health benefits. Developing physical competence is a key component of children's engagement in physical activity. The purpose of our study was to assess if a 12-week home, school, and community-based physical literacy intervention improved the physical competence of children in kindergarten and grade one. Four schools were either assigned to receive the intervention (n = 2 schools) or continue with their usual practice (control sites) (n = 2 schools). Physical competence was evaluated pre- and post-intervention in 103 intervention (41 female) and 83 usual practice (36 female) children using PLAY Fun. PLAY Parent and PLAY Coach tools measured parent and teacher perspectives of children's physical competence, respectively. The intervention effect was assessed with repeated measures MANOVA to evaluate change in physical competence, with alpha set at p < 0.05. Children in both groups improved their locomotor, object control, and overall physical competence (p < 0.05) over the 12-week intervention. There was a significant intervention effect for locomotor and overall physical competence (p < 0.05). Interestingly, parents did not perceive these changes in physical competence (p > 0.05). However, teachers perceived improved physical competence for children in the intervention. Our physical literacy intervention improved the physical competence of children in kindergarten and grade one.
RESUMO
PURPOSE: Sexual health (SH) is an emerging concern in the assessment of quality of life in patients surviving head and neck cancer (HNC). Using data from the French National Prospective VICAN Survey, this study aimed to assess SH deterioration five years after HNC diagnosis and related factors. METHODS: Using univariate and multivariate analyses were performed in the 241 HNC survivors. We studied the factors associated between the sexuality and intimate life of these patients with demographic and medical data from the national epidemiological survey VICAN 5. RESULTS: Sexuality and body image were altered in 78.8% for men and 79.2% for women. This alteration in sexual quality of life affects both men and women. Dissatisfaction with the frequency of sexual intercourse was associated with being treated with radiotherapy (p=0.024), as well as decrease of sexual desire in patients treated with chemotherapy (p=0.044). Fatigue (p=0.002), impaired physical health (p=0.049), and high disease stage (p=0.001) remained significantly associated, after multivariate analysis, with decreased sexual desire. Among these 3 factors negatively influencing sexual quality of life, two are treatable with appropriate management. CONCLUSION: Five years after the diagnosis of HNC, a decrease in sexuality and body image are frequent and significantly impact the quality of life of survivors. These observations imply an adaptation of the management of the professionals involved.
Assuntos
Neoplasias de Cabeça e Pescoço , Saúde Sexual , Masculino , Humanos , Feminino , Estudos Prospectivos , Qualidade de Vida , Comportamento Sexual , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/terapiaRESUMO
OBJECTIVES: Analysis of the quality of sexual life after total laryngectomy (TL) for cancer. MATERIAL AND METHODS: The Cochrane, PubMed, Embase, ClinicalKey and Science Direct databases were searched using the keywords: "total laryngectomy, sexual function, sexual behavior, sexual complications, sexual dysfunction, sexuality, intimacy". The abstracts of 69 articles were read by two of the authors and 24 articles were selected. The main endpoint was the impact of impairment of quality of sexual life after TL for cancer and the methods used to assess this. The secondary endpoints were the type of sexual impairment, associated variables and their treatment. RESULTS: The study population consisted of 1511 TL patients aged 21 to 90 years, with a male/female sex ratio of 7.49. One of the 7 validated Likert scales was used in 79% of the articles to evaluate impairment of sexual quality of life. Impaired quality of sexual life was reported by 47% of patients on average (range, 5-90%). Erectile and ejaculatory function and ejaculatory behavior of male patients decreased after TL. Other impairments comprised decreases in libido, frequency of sexual intercourse and satisfaction. Tracheostomy, advanced disease stage, young age and associated depression were factors for impairment. In all, 23% of patients reported lack of postoperative support in this area. CONCLUSION: The quality of sexual life is severely impacted by TL for cancer. The present data are a source of information and should be taken into account before carrying out TL. A common information tool needs to be developed. There is patient demand for improved management of sexuality.
Assuntos
Coito , Neoplasias Laríngeas , Humanos , Masculino , Feminino , Qualidade de Vida , Laringectomia/métodos , Comportamento Sexual , Neoplasias Laríngeas/cirurgiaRESUMO
Physical literacy (PL) is gaining more attention from educational policy-makers, practitioners, and researchers as a way to improve health and wellness outcomes for children and youth. While the development of PL is important for early years children, there is limited attention in the literature that explores the political, cultural, and social discourses imbued in colonialism that implicate how PL is actualized in Indigenous early childhood education (ECE) contexts. This case assemblage explores how the culturally rooted, interdisciplinary, and community-based PL initiative, Nature's Way-Our Way (NWOW), negotiated movement with three early childhood educators in the pilot project with an early childhood education centre (ECEC) in Saskatchewan, Canada. Through postqualitative approaches to research, this case assemblage adopts new materialist methodologies to show how the natural order of knowing in movement was disrupted through moments of rupture generating stories of PL to encompass radical relationality with land. As land becomes a vital and lively part of PL storying, it can function as an important protective factor for Indigenous preschool-aged children's wholistic wellness.
RESUMO
The signaling pathway of the bone morphogenetic protein (BMP)-9 binding to the endothelial receptor BMP receptor type II (BMPR-II), activin receptor-like kinase-1 (ALK1) and the coreceptor endoglin is essential to maintain the pulmonary vascular integrity. Dysregulation of this pathway is implicated in numerous vascular diseases, such as pulmonary arterial hypertension (PAH), hereditary hemorrhagic telangiectasia (HHT) and hepatopulmonary syndrome (HPS). This article aims to provide a comprehensive review of the implication of the BMP-9/BMPR-II/ALK1/endoglin pathway in the pathophysiology of these diseases.
Assuntos
Fator 2 de Diferenciação de Crescimento , Telangiectasia Hemorrágica Hereditária , Humanos , Endoglina , Transdução de Sinais/fisiologia , Pulmão , Telangiectasia Hemorrágica Hereditária/complicaçõesRESUMO
Financial barriers often restrict sport participation among children from low-income families. Schools are thought to offer equitable access to programming, including school sport participation. However, pay-to-play school sport models can inhibit participation among students from low-income households. Recognizing the potential benefits of school sport and realizing the financial barriers to participation, the purpose of this study was to understand the extent to which school sport promotes educational experiences and holistic well-being of Canadian youth from low-income families. A case study was conducted with stakeholders who were supported by funding from a non-profit organization to help cover the costs of school sport registration fees. Data were collected from in-depth interviews with low-income students and their parents, teacher-coaches and school administrators. Three overarching themes were representative of the experiences of school sport participation among low-income students: (1) healthy student-athletes, (2) developing student-athletes in school, for life, and (3) supporting student-athletes as a community. The participants perceived that school sport participation offered holistic health benefits, and developed skills and behaviours that support positive educational experiences and foster life skills. Further, our results highlighted the importance of the school community in supporting low-income students to participate in school sport teams and the need to reframe school sport to better support low-income families.
RESUMO
OBJECTIVES: To better understand the role of pharmacists in patient education and counselling: describe the perception of knowledge exchange (KE) between asthma/pulmonary arterial hypertension patients and pharmacists (hospital/community) according to four dimensions (4C-typology): cure (C1), care (C2); coordination/supply chain (C3), characteristics of the pathophysiology/disease mechanisms (C4); factors correlated with KE. METHODS: A mixed methods approach was used. Part A: data from semi-structured patient interviews were processed (thematic analysis), and a questionnaire developed. Part B: completed patient questionnaires were processed by correspondence factor analysis. RESULTS: KE (4C-typology) was correlated with pathology, disease severity, disease duration, age, hospital/community pharmacist. Patients expected pharmacists to provide C2/C3 services. KE with pharmacists covered C1/C2/C3, and with physicians, C1/C2/C4. While patients perceived KE as a means of self-learning to improve self-care skills, the two-way nature meant it provided specific experiential information feedback to pharmacists. CONCLUSIONS: This 4C-typology provides a holistic framework for optimising the pharmacists' role in education and counselling of patients with chronic diseases.
Assuntos
Asma , Serviços Comunitários de Farmácia , Hipertensão Arterial Pulmonar , Humanos , Farmacêuticos/psicologia , Educação de Pacientes como Assunto , Asma/terapia , Aconselhamento , Papel Profissional , Atitude do Pessoal de SaúdeRESUMO
Lung transplantation (LTx) is the last-resort treatment for end-stage respiratory insufficiency, whatever its origin, and represents a steadily expanding field of endeavor. Major developments have been impelled over the years by painstaking efforts at LTx centers to improve donor and recipient selection, and multifaceted attempts have been made to meet the challenges raised by surgical management, perioperative care, and long-term medical complications. The number of procedures has increased, leading to improved post-LTx prognosis. One consequence of these multiple developments has been a pruning away of contraindications over time, which has, in some ways, complicated the patient selection process. With these considerations in mind, the Francophone Pulmonology Society (Société de Pneumology de Langue Française [SPLF]) has set up a task force to produce up-to-date working guidelines designed to assist pulmonologists in managing end-stage respiratory insufficiency, determining which patients may be eligible for LTx, and appropriately timing LTx-center referral. The task force has examined the most recent literature and evaluated the risk factors that continue to limit patient survival after LTx. Ideally, the objectives of LTx are to prolong life while improving quality of life. The guidelines developed by the task force apply to a limited resource and are consistent with the ethical principles described below.
Assuntos
Transplante de Pulmão , Insuficiência Respiratória , Humanos , Qualidade de Vida , Transplante de Pulmão/métodos , França/epidemiologia , Contraindicações , Insuficiência Respiratória/etiologiaRESUMO
Matched pre-during pandemic comparison (160 children) revealed a substantial reduction in physical activity (p < 0.001, rrb = 0.83), environmental participation (p = 0.046, rrb = 0.16), movement valuation (p < 0.001, rrb = 0.61), and parent perceptions of children's physical literacy (p < 0.001, rrb = 0.56). Examining physical activity trajectories, higher pre-pandemic physical literacy protected children from pandemic related activity decline. Emerging from the pandemic, interventions should address children's eroded belief in movement and consider physical literacy levels of children in individualizing movement opportunities for restoration of activity levels. Novelty: A substantial reduction in physical activity was associated with children who had lower physical literacy and resulted in reductions in children's valuation of movement.
Assuntos
COVID-19 , COVID-19/prevenção & controle , Criança , Exercício Físico , Humanos , Alfabetização , Pandemias/prevenção & controle , PaisRESUMO
Atomic force microscopy (AFM) nanoxerography was successfully used to direct the assembly of colloidal nanodiamonds (NDs) containing nitrogen-vacancy (NV) centres on electrostatically patterned surfaces. This study reveals that the number of deposited NDs can be controlled by tuning the surface potentials of positively charged dots on a negatively charged background written by AFM in a thin PMMA electret film, yielding assemblies down to a unique single-photon emitter with very good selectivity. The mechanisms of the ND directed assembly are attested by numerical simulations. This robust deterministic nano-positioning of quantum emitters thus offers great opportunities for ultimate applications in nanophotonics for quantum technologies.
RESUMO
Hepatopulmonary syndrome (HPS) is a pulmonary vascular disease induced by portal hypertension that is characterized by dilation of the pulmonary capillaries and right-to-left shunting, leading to gas exchange abnormalities. While dysregulation of several endothelial cell (EC)-derived angiocrine factors and the development of HPS have been associated, the field is currently lacking in mechanistic understanding on how they contribute to disease initiation, perpetuation, and worsening. Although substantial progress has been made in the description of clinical characteristics and outcomes, no specific targeting therapy has been shown to have a long-term effect on the evolution of HPS; only liver transplantation can lead full or partial reversibility of the syndrome. This article aims to provide a comprehensive review of the clinical and epidemiological definitions of HPS and to describe its experimental models as well as recent advances in understanding the pathophysiology of the disease, with specific focus on BMP-9 and its signaling pathway.
Assuntos
Síndrome Hepatopulmonar , Hipertensão Portal , Transplante de Fígado , Pneumopatias , Síndrome Hepatopulmonar/diagnóstico , Síndrome Hepatopulmonar/epidemiologia , Síndrome Hepatopulmonar/etiologia , Humanos , Hipertensão Portal/terapia , PrevalênciaRESUMO
Pulmonary arterial hypertension describes a group of diseases characterised by raised pulmonary vascular resistance, resulting from vascular remodelling in the pre-capillary resistance arterioles. Left untreated, patients die from right heart failure. Pulmonary vascular remodelling involves all cell types but to date the precise roles of the different cells is unknown. This study investigated differences in basal gene expression between pulmonary arterial hypertension and controls using both human pulmonary microvascular endothelial cells and human pulmonary artery smooth muscle cells. Human pulmonary microvascular endothelial cells and human pulmonary artery smooth muscle cells from pulmonary arterial hypertension patients and controls were cultured to confluence, harvested and RNA extracted. Whole genome sequencing was performed and after transcript quantification and normalisation, we examined differentially expressed genes and applied gene set enrichment analysis to the differentially expressed genes to identify putative activated pathways. Human pulmonary microvascular endothelial cells displayed 1008 significant (p ≤ 0.0001) differentially expressed genes in pulmonary arterial hypertension samples compared to controls. In human pulmonary artery smooth muscle cells, there were 229 significant (p ≤ 0.0001) differentially expressed genes between pulmonary arterial hypertension and controls. Pathway analysis revealed distinctive differences: human pulmonary microvascular endothelial cells display down-regulation of extracellular matrix organisation, collagen formation and biosynthesis, focal- and cell-adhesion molecules suggesting severe endothelial barrier dysfunction and vascular permeability in pulmonary arterial hypertension pathogenesis. In contrast, pathways in human pulmonary artery smooth muscle cells were mainly up-regulated, including those for fatty acid metabolism, biosynthesis of unsaturated fatty acids, cell-cell and adherens junction interactions suggesting a more energy-driven proliferative phenotype. This suggests that the two cell types play different mechanistic roles in pulmonary arterial hypertension pathogenesis and further studies are required to fully elucidate the role each plays and the interactions between these cell types in vascular remodelling in disease progression.
RESUMO
The level of knowledge about a direct link between sleep-related breathing disorders and pre-capillary pulmonary hypertension (PH) is low and there is a chicken and egg question to know which disease causes the other. On one hand, sleep-related breathing disorders are considered as a cause of group 3 PH, in the subgroup of patients with hypoxemia without lung disease. Indeed, isolated sleep-related breathing disorders can lead to mild pre-capillary PH on their own, although this is rare for obstructive sleep apnea and difficult to establish for obesity-hypoventilation syndrome, the evolution towards PH being observed especially in the presence of respiratory comorbidities. The hemodynamic improvement under treatment with continuous positive airway pressure or non-invasive ventilation also argues for a causal link between pre-capillary PH and sleep-related breathing disorders. On the other hand, patients followed for pre-capillary PH, particularly pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension, develop more sleep-related breathing disorders than the general population, especially sleep hypoxemia, central sleep apnea in patients with severe PH and obstructive sleep apnea in older patients with higher body mass index. The main objective of this article is therefore to answer two main questions, which will then lead us to discuss the bilateral link between these diseases: are sleep-related breathing disorders independent risk factors for pre-capillary PH and does pre-capillary PH induce sleep-related breathing disorders? In other words, who is the chicken and who is the egg?