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The Sepetiba Bay (SB, SE Brazil) is a highly anthropized and industrialized area that has experienced severe environmental degradation in recent decades. This study applies a multiproxy approach to document the response of living benthic foraminifera to environmental stress and to infer the Ecological Quality Status (EcoQS) in SB. Our methodology involved a comprehensive comparison of the density and percentage of benthic foraminiferal species with physicochemical, textural, and geochemical data, specifically the concentrations of potentially toxic elements (PTEs). We also statistically compared two geochemical indices, the pollution load index (PLI) and the potential ecological risk index (PERI), with two ecological indices, the Tolerant Species Index (TSI) and the Exp(H'bc). The TSI and the Exp(H'bc) indices are significantly correlated with the environmental stressors in Sepetiba Bay, namely the PTEs concentrations (As, Cd, Pb, and Zn). The most tolerant species to the enrichment of PTEs and organic matter are Ammonia tepida (Cushman, 1926), Elphidium excavatum (Terquem, 1875), Ammonia buzasi Hayward and Holzmann, 2021 and Ammonia rolshauseni (Cushman and Bermúdez, 1946). The Exp(H'bc) and TSI reveal that most stations located in the inner zone and near the margins of the bay have poor and bad EcoQS, which agrees with the distribution of the environmental stressors. Thus, the current environmental conditions of the inner area of Sepetiba Bay are of great concern. This work also shows that using the TSI and the Exp(H'bc) indices, it is possible to classify EcoQS in transitional coastal environments in the North and South Atlantic transitional waters. This work has relevant scientific and social implications due to its importance in biomonitoring and the management of the coastal regions.
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BACKGROUND AND OBJECTIVES: Existing tools to diagnose spontaneous intracranial hypotension (SIH), namely spinal opening pressure (OP) and brain MRI, have limited sensitivity. We investigated whether evaluation of brain MRI using the Bern score, combined with calculated craniospinal elastance, would aid in diagnosing SIH and provide insight into its pathophysiology. METHODS: A retrospective chart review was performed of patients who underwent brain MRI and pressure-augmented dynamic CT myelography (dCTM) for suspicion of SIH. Two blinded neuroradiologists assigned Bern scores for each brain MRI. OP and incremental pressure changes after intrathecal saline infusion were recorded to calculate craniospinal elastance. The relationship between Bern score, OP, and elastance and whether a leak was found were analyzed. RESULTS: Seventy-two consecutive dCTMs were performed in 53 patients. Twelve CSF-venous fistulae, 2 ruptured meningeal diverticula, 2 dural defects, and 1 dural bleb were found (17/53, 32%). Among patients with imaging-proven CSF leak/fistula, OP was normal in all but 1 patient and was not significantly different in those with a leak compared with those without (15.1 vs 13.6 cm H2O, p = 0.24, A = 0.40). The average Bern score in individuals with a leak was significantly higher than that in those without (5.35 vs 1.85, p < 0.001, A = 0.85), even when excluding pachymeningeal enhancement from the score (3.77 vs 1.57, p = 0.001, A = 0.78). The average elastance in those with a leak was higher than that in those without, but this difference was not statistically significant (2.05 vs 1.20 mL/cm H2O, p = 0.19, A = 0.40). Increased elastance was significantly associated with an increased Bern score (95% CI -0.55 to 0.12, p < 0.01) and was significantly associated with venous distention, pachymeningeal enhancement, prepontine narrowing, and subdural collections, but not a narrowed mamillopontine or suprasellar distance. DISCUSSION: OP is not an effective predictor for diagnosing CSF leak and if used in isolation would result in misdiagnosis of 94% of patients in our cohort. The Bern score was associated with a higher diagnostic yield of dCTM. Elastance was significantly associated with certain components of the Bern score.
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Hipotensão Intracraniana , Humanos , Hipotensão Intracraniana/diagnóstico por imagem , Hipotensão Intracraniana/complicações , Estudos Retrospectivos , Coluna Vertebral , Mielografia , Imageamento por Ressonância Magnética , Vazamento de Líquido Cefalorraquidiano/diagnósticoRESUMO
A voluntary structured reporting template (based on the Bern score) for brain MRI examinations performed for suspected spontaneous intracranial hypotension (SIH) was associated with an increase in reporting of intracranial MRI findings of SIH and a reduction in discordant assessments with respect to a reference reader.
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Hipotensão Intracraniana , Humanos , Hipotensão Intracraniana/diagnóstico por imagem , Imageamento por Ressonância Magnética , Neuroimagem , Encéfalo/diagnóstico por imagemRESUMO
Using benthic foraminifera, we evaluate the ecological quality status (EcoQS) of transitional waters of the Guanabara Bay (SE Brazil) by applying the diversity-based index exp (H'bc) and the sensitivity-based Foram-AMBI for the first time in South America. The Guanabara Bay was selected for this study as it is one of the largest transitional ecosystems in the State of Rio de Janeiro and has been severely impacted by anthropogenic activities. Concentrations of potentially toxic elements (PTEs) were assessed by sequential chemical extraction in three phases (i.e., dissolved in water, adsorbed on organic matter, and Mn oxy-hydroxides). Total organic carbon, total nitrogen, and stable isotope (δ13C and δ15N) signatures of organic matter were analyzed to trace environmental stress. The Ammonia/Elphidium ratio suggests hypoxic conditions at most of the sampled sites. Principal component analysis identifies the first component as environmental stress underlying organic matter and PTE enrichment (in all three phases), which is positively related to Foram-AMBI and negatively to exp (H'bc). The exp (H'bc) and Foram-AMBI indices reveal that stations near the Governador Island and Niterói margin have the worst EcoQS, showing medium to extreme pollution. Additionally, Foram-AMBI and exp (H'bc) provide a congruent EcoQS classification for â¼64% of the sites. Although these results are promising, they suggest that a significant effort should be made to obtain better knowledge of foraminiferal ecological requirements to employ benthic foraminifera as a biomonitoring and management method.
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Foraminíferos , Poluentes Químicos da Água , Sedimentos Geológicos/análise , Ecossistema , Baías , Brasil , Monitoramento Ambiental/métodos , Poluentes Químicos da Água/toxicidade , Poluentes Químicos da Água/análiseRESUMO
BACKGROUND: Neurofibromatosis 1 (NF1) is a common autosomal dominant syndrome with complete penetrance and highly variable expressivity. The cutaneous neurofibroma (Cnf) and plexiform neurofibroma (Pnf), café-au-lait spots, and freckle-like lesions are common in NF1, but many other manifestations can occur. We aimed to evaluate head circumference, height, weight, body mass index (BMI), head circumference-to-height ratio (HCHR) and waist-hip ratio (WHR) in adult NF1 Brazilian individuals versus a paired control group and investigate their correlation with the presence of clinically visible Pnfs, and number of "skin neurofibromas" (Snf), which include both cutaneous and subcutaneous neurofibromas. METHODS: A case-control study was conducted with 168 individuals, 84 with NF1 and 84 without NF1, paired by sex and age. Head circumference and anthropometric measurements, Snf quantification, evaluation of clinically visible Pnf and familial inheritance were accessed. RESULTS: Prevalence of macrocephaly was significantly higher in NF1 women. Height and weight were significantly lower in both males and females with NF1. HCHR was higher in the NF1 group than in the control group for both sexes. BMI was significantly lower in men with NF1. Waist and hip circumferences were significantly reduced in NF compared with the controls, but the mean WHR was significantly lower only in NF1 women. No correlation was found between the Snf and head circumference and anthropometric measurements, sex or family history. The presence and larger size of clinically visible plexiform neurofibromas were associated with normal stature (p = 0.037 and p = 0.003, respectively). CONCLUSIONS: NF1 individuals have increased prevalence of macrocephaly, short stature, low BMI, and reduced abdominal fat. There is no relation between head circumference and anthropometric data with family history, or neurofibromas.
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Megalencefalia , Neurofibroma Plexiforme , Neurofibroma , Neurofibromatoses , Neurofibromatose 1 , Neoplasias Cutâneas , Adulto , Brasil/epidemiologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Neurofibromatose 1/genética , Neoplasias Cutâneas/patologiaRESUMO
STUDY DESIGN: Retrospective Database Study. OBJECTIVE: Investigate utilization of bone morphogenetic protein (BMP-2) between 2004 and 2014. SUMMARY OF BACKGROUND DATA: The utilization, particularly off-label utilization, of BMP-2 has been controversial and debated in the literature. Given the concerns regarding cancer and potential complications, the risk benefit profile of BMP must be weighed with each surgical case. The debate regarding the costs and potential side effects of BMP-2 compared with autologous iliac crest bone harvest has continued. METHODS: The National Inpatient Sample (NIS) database was queried for the use of BMP-2 (ICD-9-CM 84.52) between 2004 and 2014 across 44 states. The NIS database represents a 20% sample of discharges, weighted to provide national estimates. BMP-2 utilization rates in spine surgery fusion procedures were calculated as a fraction of the total number of thoracic, lumbar, and sacral spinal fusion surgeries performed each year. RESULTS: Between 2004 and 2014, BMP-2 was utilized in 927,275 spinal fusion surgeries. In 2004, BMP-2 was utilized in 28.3% of all cases (N=48,613). The relative use of BMP-2 in spine fusion surgeries peaked in 2008 at 47.0% (N=112,180). Since then, it has continued to steadily decline with an endpoint of 23.6% of cases in 2014 (N=60,863). CONCLUSIONS: Throughout the United States, the utilization of BMP-2 in thoracolumbar fusion surgeries increased from 28.3% to 47.0% between 2004 and 2008. However, from 2008 to 2014, the utilization of BMP-2 in thoracolumbar spine fusion surgeries decreased significantly from 47.0% to 23.4%. While this study provides information on the utilization of BMP-2 for the entire United States over an 11-year period, further research is needed to the determine the factors affecting these trends.
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Proteína Morfogenética Óssea 2 , Fusão Vertebral , Proteína Morfogenética Óssea 2/uso terapêutico , Humanos , Região Lombossacral , Estudos Retrospectivos , Fusão Vertebral/métodos , Estados UnidosRESUMO
Rhabdomyosarcoma is a malignant soft tissue sarcoma of primitive mesenchymal cells, showing varying degrees of striated skeletal muscle cell differentiation. It is a very common cancer of childhood and adolescence, but rarely seen in the adult population. Here, we present a case of a 33-year-old male presented with a poorly differentiated desmin positive alveolar rhabdomyosarcoma in the left arm. The prognosis of alveolar rhabdomyosarcoma in adults is very poor, frequently detected at advanced stages or with metastases. The alveolar subtype in particular has been found to have a more aggressive course with a high rate of metastasis. Recent studies have shown that using pediatric treatment guidelines resulted in better survival outcomes and local control, but the survival rates are still below that of the pediatric population. Newer studies are looking into using specific molecular markers for more targeted therapy in hopes of further improving survival rates in the adult population.
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Carcinoma , Rabdomiossarcoma , Sarcoma , Neoplasias de Tecidos Moles , Adulto , Criança , Humanos , MasculinoRESUMO
BACKGROUND: List prices of tumor necrosis factor (TNF) inhibitors drastically increased during the last decade, but previous research has shown that half of these increases were offset by rising manufacturer discounts. It remains unclear to what extent manufacturers' discounts have offset increases in list prices of each self-administered injectable TNF inhibitor. Evaluating trends in net prices and discounts at the product level will be paramount in understanding the role of competition in the biologic market. OBJECTIVES: To (a) describe product-level changes in net prices of each self-administered injectable TNF inhibitor available in 2007-2019 and (b) quantify to what extent manufacturer discounts have offset increases in list prices. METHODS: We obtained 2007-2019 pricing data for etanercept, adalimumab, certolizumab, and golimumab from the investment firm SSR Health, which uses company-reported sales to estimate net prices and discounts for brand products manufactured by publicly traded companies. For each drug and year, we calculated annual costs of treatment for patients with rheumatoid arthritis based on list and net prices and discounts in Medicaid and other payers. RESULTS: From 2007-2019, list prices of etanercept and adalimumab increased by 293% and 295%, respectively; however, discounts offset 47% and 45% of these increases, leading to net price increases of 171% and 203%. List prices of golimumab and certolizumab increased by 183% and 182%, respectively, but with discounts offsetting 58% and 59% of these increases, net prices increased by 103% and 109%. Net prices of golimumab started to decrease after 2016, while net prices of adalimumab and certolizumab experienced their first drop in 2019. Across the study period, discounts in Medicaid and in other payers increased, respectively, from 21% to 85% and 6% to 32% for etanercept; from 26% to 88% and 19% to 35% for adalimumab; from 28% to 63% and 22% to 46% for golimumab; and from 29% to 83% and 27% to 47% for certolizumab. CONCLUSIONS: Despite growing manufacturer discounts, net prices of self-administered injectable TNF inhibitors still increased at a mean annual rate of 9.6% in 2007-2019. This led to net prices tripling for adalimumab and more than doubling for etanercept, golimumab, and certolizumab. DISCLOSURES: This study was funded by the Myers Family Foundation. Hernandez is funded by the National Heart, Lung and Blood Institute (grant number K01HL142847). Funding sources had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Hernandez has served on Pfizer's scientific advisory board. The other authors have nothing to disclose.
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Antirreumáticos/uso terapêutico , Custos de Medicamentos/tendências , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab/administração & dosagem , Adalimumab/economia , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/economia , Antirreumáticos/administração & dosagem , Etanercepte/administração & dosagem , Etanercepte/economia , Humanos , Injeções , Autoadministração , Estados UnidosRESUMO
The Santos Estuary (SE Brazil) is a coastal ecosystem with a high ecological importance and has been strongly impacted by human activities over the last century. A multiproxy analysis of sediment core dated by 137Cs, 210Pb and 226Ra activities and based on sediment geochemistry and benthic foraminifera is here used to reconstruct the environmental changes and the variations of the Palaeo-Ecological Quality Status (Palaeo-EcoQS) during the last ~120 years. The Palaeo-EcoQS was reconstructed by applying the diversity index Exp(H'bc) based on the benthic foraminiferal fauna. Specifically, the Ecological Quality Ratio (EQR) allowed to assess the Palaeo-EcoQS during the last ~120 years using local reference conditions. Based on our data, the pre-industrial period (~1883-1902) represents the reference conditions with "Good" Palaeo-EcoQS. The ~1902-1972 period coincides with the beginning of industrial operations and intensification of coastal urbanization leading to a deterioration of the environmental quality and Palaeo-EcoQS shifting to "Moderate" conditions. Dredging operations in 1972 led to increase the influences of adjacent sea that ultimately resulted in a "Good" Palaeo-EcoQS persisting up to the 1990s. Despite the preservation actions and recovery programs, the 1993-2012 period was characterized by an overall deterioration of the environmental conditions. Indeed, the reconstructed "Poor" to "Bad" Palaeo-EcoQS suggest the ineffectiveness of the remediation actions. This work confirmed that benthic foraminifera are reliable to evaluate EcoQS and Palaeo-EcoQS in estuarine ecosystems. Based on the present findings and previous studies showing the potential of fossil foraminifera to define in situ reference conditions, we recommend the inclusion of foraminifera in the list of biological quality elements within legislations concerning transitional and marine habitats.
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Foraminíferos , Brasil , Ecossistema , Monitoramento Ambiental , Estuários , Sedimentos GeológicosRESUMO
Triple-negative breast cancer (TNBC) cells are deficient in estrogen, progesterone and ERBB2 receptor expression, presenting a particularly challenging therapeutic target due to their highly invasive nature and relatively low response to therapeutics. There is an absence of specific treatment strategies for this tumor subgroup, and hence TNBC is managed with conventional therapeutics, often leading to systemic relapse. In terms of histology and transcription profile these cancers have similarities to BRCA-1-linked breast cancers, and it is hypothesized that BRCA1 pathway is non-functional in this type of breast cancer. In this review article, we discuss the different receptors expressed by TNBC as well as the diversity of different signaling pathways targeted by TNBC therapeutics, for example, Notch, Hedgehog, Wnt/b-Catenin as well as TGF-beta signaling pathways. Additionally, many epidermal growth factor receptor (EGFR), poly (ADP-ribose) polymerase (PARP) and mammalian target of rapamycin (mTOR) inhibitors effectively inhibit the TNBCs, but they face challenges of either resistance to drugs or relapse. The resistance of TNBC to conventional therapeutic agents has helped in the advancement of advanced TNBC therapeutic approaches including hyperthermia, photodynamic therapy, as well as nanomedicine-based targeted therapeutics of drugs, miRNA, siRNA, and aptamers, which will also be discussed. Artificial intelligence is another tool that is presented to enhance the diagnosis of TNBC.
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Inteligência Artificial , Neoplasias de Mama Triplo Negativas , Feminino , Humanos , Recidiva Local de Neoplasia , Inibidores de Poli(ADP-Ribose) Polimerases , Poli(ADP-Ribose) Polimerases , Receptores de Superfície Celular , Transdução de Sinais , Neoplasias de Mama Triplo Negativas/diagnóstico , Neoplasias de Mama Triplo Negativas/metabolismo , Neoplasias de Mama Triplo Negativas/terapiaRESUMO
BACKGROUND: This article presents a break-even analysis for intraoperative Betadine lavage for the prevention of infection in total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: Protocol costs, baseline infection rates after arthroplasty, and average revision costs were obtained from institutional records and the literature. The break-even analysis determined the absolute risk reduction (ARR) in infection rate required for cost effectiveness. RESULTS: At our institutional price of $2.54, dilute (0.35%) Betadine lavage would be cost effective if initial infection rates of both TKA (1.10%) and THA (1.63%) have an ARR of 0.01%. At a hypothetical lowest cost of $0.50, the ARR is so low as to be immediately cost effective. At a hypothetical high price of $40.00, Betadine is cost effective with ARRs of 0.16% (TKA) and 0.13% (THA). CONCLUSION: Intraoperative Betadine lavage, at typical institutional prices, can be highly cost effective in reducing infection after joint arthroplasty.
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Artroplastia de Quadril/economia , Artroplastia do Joelho/economia , Povidona-Iodo/economia , Irrigação Terapêutica/economia , Artroplastia de Quadril/efeitos adversos , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Infecções Relacionadas à Prótese/economia , Infecções Relacionadas à Prótese/prevenção & controleRESUMO
Protein coronas form on the surfaces of nanomaterials in biological fluids. This layer of proteins affects the properties of nanomaterials, altering their behavior and masking engineered functionality. The use of nonfouling moieties reduces or prevents corona formation; however, these ligands typically complicate functionalization. We present here a surface modification strategy for silica nanoparticles using specific molar ratios of zwitterionic and amine moieties. Through proper balance of ligands, we were able to generate particles that featured reactive "handles", while retaining nonfouling properties, high hemocompatibility, and low cytotoxicity.
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Teste de Materiais , Nanopartículas/química , Coroa de Proteína/química , Dióxido de Silício , Animais , Humanos , Camundongos , Células NIH 3T3 , Dióxido de Silício/metabolismo , Dióxido de Silício/farmacologiaRESUMO
BACKGROUND: Lipomatous neurofibroma (Lnf) is a histopathological variant with adipocytes noted among cells of cutaneous neurofibromas. We aimed to investigate the prevalence and clinicopathological features of Lnfs of neurofibromatosis 1 (NF1)-associated cutaneous neurofibromas and to review the literature systematically. We also evaluated the expression of leptin (a hormone involved in lipid metabolism) in neurofibromas to better understand the pathogenesis of Lnfs. METHODS: A prospective histologic study was conducted on 229 cutaneous neurofibromas from 85 NF1 individuals. Leptin expression was immunohistochemically evaluated in 111 cutaneous neurofibromas. To systematically review the literature, two authors independently performed literature searches without year restriction. RESULTS: Forty (17.5%) neurofibromas were lipomatous. Lnfs were significantly larger lesions and associated with females. Eighteen (7.9%) of all neurofibromas had multinucleated floret-like giant cells, and these were associated with Lnfs. All neurofibromas expressed leptin. We systematically reviewed 13 articles. Three large studies investigated Lnfs mainly in sporadic neurofibromas and suggested that 0.3% to 8.0% of tumors (NF1 and sporadic) are Lnfs. CONCLUSION: In NF1, Lnfs are common, mainly in larger tumors and women. All cutaneous NF1-neurofibromas express leptin. It is unknown if the expression of leptin accounts for the lipomatous variant, but it may have a role in the pathogenesis of cutaneous neurofibroma.
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Adipócitos/patologia , Neurofibroma/patologia , Neurofibromatose 1/patologia , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurofibroma/epidemiologia , Neurofibromatose 1/complicações , Prevalência , Neoplasias Cutâneas/epidemiologia , Adulto JovemRESUMO
BACKGROUND: This article presents a break-even analysis for preoperative Staphylococcus aureus colonization screening and decolonization protocols in total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: Protocol costs, baseline infection rates after arthroplasty, and average revision costs were obtained from institutional records and the literature. The break-even analysis determined the absolute risk reduction (ARR) in infection rate required for cost-effectiveness. RESULTS: S aureus nasal screening ($144.07) was cost effective when initial infection rates of TKA (1.10%) and THA (1.63%) had an ARR of 0.56% and 0.45%, respectively. The most inexpensive decolonization treatment ($5.09) was cost effective with an ARR of 0.02% for both TKA and THA. The most expensive decolonization option ($37.67) was cost effective with ARRs of 0.15% (TKA) and 0.12% (THA). CONCLUSION: Preoperative S aureus decolonization can be highly cost effective, whereas colonization screening requires excessively high reductions in infection rate.
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Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/economia , Staphylococcus aureus , Infecção da Ferida Cirúrgica/economia , Artroplastia de Quadril/economia , Artroplastia do Joelho/economia , Análise Custo-Benefício , Humanos , Programas de Rastreamento/economia , Modelos Econômicos , Mupirocina/administração & dosagem , Mupirocina/economia , Infecções Estafilocócicas/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
BACKGROUND: The semi-arid environments harbor nearly 40% of biodiversity, and half of indigenous cultures of Mexico. Thousands of communities settled in these areas depend on agriculture and using wild biodiversity for their subsistence. Water, soil, and biodiversity management strategies are therefore crucial for people's life. The tajos, from Sierra Gorda, are important, poorly studied, biocultural systems established in narrow, arid alluvial valleys. The systems are constructed with stone-walls for capturing sediments, gradually creating fertile soils in terraces suitable for agriculture in places where it would not be possible. We analyzed biocultural, ecological, economic and technological relevance of the artificial oasis-like tajos, hypothesizing their high capacity for maintaining agricultural and wild biodiversity while providing resources to people. METHODS: We conducted our research in three sections of the Mezquital-Xichú River, in three communities of Guanajuato, Mexico. Agroforestry management practices were documented through semi-structured and in-depth qualitative interviews. Vegetation composition of local forests and that maintained in tajos was sampled and compared. RESULTS: Tajos harbor high agrobiodiversity, including native varieties of maize and beans, seven secondary crops, 47 native and 25 introduced perennial plant species. Perennial plants cover on average 26.8% of the total surface of plots. Tajos provide nearly 70% of the products required by households' subsistence and are part of their cultural identity. CONCLUSIONS: Tajos are heritage of TEK and land management forms of pre-Columbian Mexican and Mediterranean agricultural techniques, adapting and integrating modern agricultural practices. Tajos are valuable biocultural systems adapted to local semiarid conditions and sources of technology for similar areas of the World.
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Agricultura , Biodiversidade , Agricultura Florestal , Conservação dos Recursos Naturais , Ecologia , MéxicoRESUMO
Semiautonomous robotic technology has been introduced to optimize accuracy of bone preparation, implant positioning, and soft tissue balance in unicompartmental knee arthroplasty (UKA), with the expectation that there will be a resultant improvement in implant durability and survivorship. Currently, roughly one-fifth of UKAs in the US are being performed with robotic assistance, and it is anticipated that there will be substantial growth in market penetration of robotics over the next decade. First-generation robotic technology improved substantially implant position compared to conventional methods; however, high capital costs, uncertainty regarding the value of advanced technologies, and the need for preoperative computed tomography (CT) scans were barriers to broader adoption. Newer image-free semiautonomous robotic technology optimizes both implant position and soft tissue balance, without the need for preoperative CT scans and with pricing and portability that make it suitable for use in an ambulatory surgery center setting, where approximately 40% of these systems are currently being utilized. This article will review the robotic experience for UKA, including rationale, system descriptions, and outcomes.
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Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , HumanosRESUMO
BACKGROUND: Takotsubo cardiomyopathy (TC) can resemble acute anterior ST-elevation myocardial infarction. Most studies have examined TC in Asians and Caucasians (non-African Americans [AA]), while very few cases have been reported in AA. We aimed to assess the electrocardiographic features of TC in AA patients and compare them to non-AA TC patients. METHODS: We retrospectively compared electrocardiograms of 52 AA and 47 non-AA patients diagnosed with TC. All patients met the modified Mayo Clinic criteria for the diagnosis of TC. Information collected included PR interval, QRS duration and amplitude, QT interval in milliseconds (msec) adjusted for heart rate (QTc), ST-segment deviation at the J point in limb and precordial leads (≥1 mm), ST elevation (≥1 mm), and T-wave inversion (≥0.5 mm). RESULTS: T-wave inversion was more prevalent on presentation among AA patients (82% vs 48% in non-AA; P < 0.01), whereas ST depression was more common among non-AA (21% vs 7% in AA; P = 0.05). T-wave inversions in AA patients were frequent in both limb and precordial leads, whereas T-wave inversions in non-AA were limited to precordial leads. The average QTc upon presentation in AA was longer than non-AA (491 msec in AA vs 456 msec in non-AA; P < 0.01) as was the maximum average QTc during index hospitalization (527 msec in AA vs 497 msec in non-AA, P = 0.03). CONCLUSION: In patients presenting with TC, AA patients more frequently present with diffuse T-wave inversions and a more prolonged QTc, whereas non-AA patients more often present with ST depressions. AA patients also more frequently present with T-wave inversions diffusely, whereas non-AA patients present with T-wave inversions more limited to the precordial leads.
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Negro ou Afro-Americano , Eletrocardiografia , Cardiomiopatia de Takotsubo/etnologia , Cardiomiopatia de Takotsubo/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Background This study aimed to identify and select informative Simple Sequence Repeat (SSR) markers that may be linked to resistance to important groundnut diseases such as Early Leaf Spot, Groundnut Rosette Disease, rust and aflatoxin contamination. To this end, 799 markers were screened across 16 farmer preferred and other cultivated African groundnut varieties that are routinely used in groundnut improvement, some with known resistance traits. Results The SSR markers amplified 817 loci and were graded on a scale of 1 to 4 according to successful amplification and ease of scoring of amplified alleles. Of these, 376 markers exhibited Polymorphic Information Content (PIC) values ranging from 0.06 to 0.86, with 1476 alleles detected at an average of 3.7 alleles per locus. The remaining 423 markers were either monomorphic or did not work well. The best performing polymorphic markers were subsequently used to construct a dissimilarity matrix that indicated the relatedness of the varieties in order to aid selection of appropriately diverse parents for groundnut improvement. The closest related varieties were MGV5 and ICGV-SM 90704 and most distant were Chalimbana and 47-10. The mean dissimilarity value was 0.51, ranging from 0.34 to 0.66. Discussion Of the 376 informative markers identified in this study, 139 (37%) have previously been mapped to the Arachis genome and can now be employed in Quantitative Trait Loci (QTL) mapping and the additional 237 markers identified can be used to improve the efficiency of introgression of resistance to multiple important biotic constraints into farmer-preferred varieties of Sub-Saharan Africa.