RESUMEN
Variability in sea ice conditions, combined with strong couplings to the atmosphere and the ocean, lead to a broad range of complex sea ice dynamics. More in-situ measurements are needed to better identify the phenomena and mechanisms that govern sea ice growth, drift, and breakup. To this end, we have gathered a dataset of in-situ observations of sea ice drift and waves in ice. A total of 15 deployments were performed over a period of 5 years in both the Arctic and Antarctic, involving 72 instruments. These provide both GPS drift tracks, and measurements of waves in ice. The data can, in turn, be used for tuning sea ice drift models, investigating waves damping by sea ice, and helping calibrate other sea ice measurement techniques, such as satellite based observations.
RESUMEN
MicroRNAs are commonly aberrantly expressed in many cancers. Very little is known of their role in T-cell lymphoma, however. We therefore elucidated the complete miRNome of purified T cells from 21 patients diagnosed with Sézary Syndrome (SzS), a rare aggressive primary cutaneous T-cell (CD4(+)) lymphoma. Unsupervised cluster analysis of microarray data revealed that the microRNA expression profile was distinct from CD4(+) T-cell controls and B-cell lymphomas. The majority (104 of 114) of SzS-associated microRNAs (P < .05) were down-regulated and their expression pattern was largely consistent with previously reported genomic copy number abnormalities and were found to be highly enriched (P < .001) for aberrantly expressed target genes. Levels of miR-223 distinguished SzS samples (n = 32) from healthy controls (n = 19) and patients with mycosis fungoides (n = 11) in more than 90% of samples. Furthermore, we demonstrate that the down-regulation of intronically encoded miR-342 plays a role in the pathogenesis of SzS by inhibiting apoptosis, and describe a novel mechanism of regulation for this microRNA via binding of miR-199a* to its host gene. We also provide the first in vivo evidence for down-regulation of the miR-17-92 cluster in malignancy and demonstrate that ectopic miR-17-5p expression increases apoptosis and decreases cell proliferation in SzS cells.
Asunto(s)
Biomarcadores de Tumor/genética , Regulación Neoplásica de la Expresión Génica , MicroARNs/fisiología , Síndrome de Sézary/genética , Apoptosis , Western Blotting , Proliferación Celular , Perfilación de la Expresión Génica , Humanos , Luciferasas/metabolismo , Linfoma de Células B/sangre , Linfoma de Células B/diagnóstico , Linfoma de Células B/genética , MicroARNs/genética , Micosis Fungoide/sangre , Micosis Fungoide/diagnóstico , Micosis Fungoide/genética , Análisis de Secuencia por Matrices de Oligonucleótidos , Pronóstico , ARN Mensajero/genética , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Síndrome de Sézary/sangre , Síndrome de Sézary/diagnóstico , Linfocitos T/metabolismoRESUMEN
This study evaluates a comprehensive classification system for mandibular fractures based on imaging analysis. The AO/ASIF scheme, defining three fracture types (A, B, C), three groups within each type (e.g. A1, A2, A3) and three subgroups within each group (e.g. A1.1, A1.2, A1.3) with increasing severity from A1.1 (lowest) to C3.3 (highest) was used. The mandible is divided into two vertical units (I and V), two lateral horizontal units (II and IV) and one central unit (III) comprising the symphyseal and parasymphyseal region. Type A fractures are non-displaced, type B are displaced and type C are multifragmentary/defect injuries. Groups and subgroups are further defined in the classification system. Two classification sessions using semi-automatic software with 7 and 9 surgeons were performed to evaluate 100 fracture cases in the first session and 50 in the second. Inter-observer reliability and individual rater's accuracy were evaluated by kappa coefficient and latent class analysis, respectively. The analysis of inter-observer agreement for the detailed coding showed kappa coefficients around 0.50 with higher agreement among raters in the vertical units. This system allows standardization of documentation of mandibular fractures, although improvement in the definition of categories and their application is required.
Asunto(s)
Fracturas Mandibulares/clasificación , Arco Dental/lesiones , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Luxaciones Articulares/clasificación , Mandíbula/anatomía & histología , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/diagnóstico por imagen , Variaciones Dependientes del Observador , Radiografía Panorámica/métodos , Programas Informáticos , Tomografía Computarizada por Rayos X/métodos , Traumatismos de los Dientes/clasificaciónRESUMEN
Between January 1996 and December 2001, 72 out of 354 patients were included in a retrospective study analysing the outcome of repaired orbital wall defects. Selection was dependent on the availability of pre and postoperative CT scans and on ophthalmologic examination. In particular, orthoptical assessment was performed up to 1 year after operation. In 72 patients, 83 orbital wall defects were analysed and allocated to one of five categories. Accuracy and type of reconstruction were assessed in unilateral orbital wall defects (n=61) and compared with functional outcome. Reconstruction was performed by using PDS membrane (39%), calvarian bone (13%), titanium mesh (7%) or a combination of these materials (37%). Postoperatively, 91% of the patients had normal vision without double images within 20 degrees at every gaze. Accuracy of reconstruction correlated with severity of orbital injury and functional outcome. Functional outcome between category II and III fractures showed no significant difference. The medial margin of the lateral infraorbital fissure being preserved (category II fracture) facilitates reconstruction technically. Accuracy of orbital reconstruction is one important factor to obtain best functional outcome, but other determinants like displacement and/or atrophy of intramuscular cone fat should be considered.
Asunto(s)
Procedimientos Quirúrgicos Oftalmológicos/métodos , Órbita/cirugía , Fracturas Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trasplante Óseo , Diplopía/etiología , Femenino , Humanos , Masculino , Membranas Artificiales , Persona de Mediana Edad , Fracturas Orbitales/clasificación , Fracturas Orbitales/complicaciones , Fracturas Orbitales/diagnóstico por imagen , Estudios Retrospectivos , Mallas Quirúrgicas , Tomografía Computarizada por Rayos X , Índices de Gravedad del TraumaRESUMEN
AIM: To investigate tolerability and efficacy of pantoprazole 20 mg, once daily (o.d.), pantoprazole 40 mg o.d., and omeprazole 20 mg o.d., in patients taking nonsteroidal anti-inflammatory drug(s) (NSAIDs). METHODS: Included in this randomized, double-blind, multicenter, parallel-group study were rheumatic patients (>55 yr) on continual NSAIDs and with at least one more recognized risk factor that contributes to the development of gastrointestinal (GI) injury. Study duration was 6 months, and the treatment consisted of pantoprazole 20 mg o.d. (N = 196), pantoprazole 40 mg o.d. (N = 199), or omeprazole 20 mg o.d. (N = 200). Patients took NSAID(s) (except COX-2 inhibitors), had no more than five erosions/petechiae in the upper GI tract, no current peptic ulcers or reflux esophagitis, and had at most moderate intensity GI symptoms. Endoscopy was performed at baseline, 3, and 6 months. The primary end points were lack of "therapeutic failure" and lack of "endoscopic failure" at 6 months. RESULTS: After 6 months, the probabilities to remain in remission were 90% pantoprazole 20 mg o.d., 93% pantoprazole 40 mg o.d., and 89% omeprazole 20 mg o.d. for lack of "therapeutic failure;" 91% pantoprazole 20 mg o.d., 95% pantoprazole 40 mg o.d., and 93% omeprazole 20 mg o.d. for lack of "endoscopic failure." CONCLUSIONS: For patients taking NSAIDs continually, pantoprazole 20 mg o.d., pantoprazole 40 mg o.d., or omeprazole 20 mg o.d. provide equivalent, effective, and well-tolerated prophylaxis against GI lesions, including peptic ulcers.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Antiulcerosos/uso terapéutico , Bencimidazoles/uso terapéutico , Enfermedades Gastrointestinales/inducido químicamente , Enfermedades Gastrointestinales/prevención & control , Omeprazol/análogos & derivados , Omeprazol/uso terapéutico , Enfermedades Reumáticas/tratamiento farmacológico , Sulfóxidos/uso terapéutico , 2-Piridinilmetilsulfinilbencimidazoles , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Antiulcerosos/administración & dosificación , Bencimidazoles/administración & dosificación , Distribución de Chi-Cuadrado , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Omeprazol/administración & dosificación , Pantoprazol , Factores de Riesgo , Estadísticas no Paramétricas , Sulfóxidos/administración & dosificación , Resultado del TratamientoRESUMEN
A case of traumatic diaphragmatic herniation is described in which gross mediastinal shift was caused by a combination of the herniated abdominal organs, purulent exudate, and air. This complex presentation might best be described as a case of gastrocolopyopneumothorax, diagnosis of which was further complicated by the intermittent nature of the herniation.
Asunto(s)
Dolor en el Pecho/etiología , Hernia Diafragmática/complicaciones , Traumatismos Torácicos/complicaciones , Heridas Punzantes/complicaciones , Adulto , Dolor en el Pecho/diagnóstico por imagen , Hernia Diafragmática/diagnóstico por imagen , Hernia Diafragmática/cirugía , Humanos , Masculino , Mediastino , Neumotórax/diagnóstico por imagen , Neumotórax/etiología , Neumotórax/cirugía , Radiografía , Traumatismos Torácicos/diagnóstico por imagen , Traumatismos Torácicos/cirugía , Toracotomía , Heridas Punzantes/diagnóstico por imagen , Heridas Punzantes/cirugíaRESUMEN
BACKGROUND AND PURPOSE: Waiting lists for radiotherapy have become longer over the past years. Apart from the psychological distress for the patient we are concerned about tumour growth during this waiting time, which may worsen prognosis. The purpose of this pilot study was to investigate tumour growth in the waiting time and to obtain an indication of its clinical consequences for patients with oropharyngeal carcinoma. A tumour control probability (TCP) model was applied to evaluate consequences for outcome. METHODS AND MATERIALS: Increase in tumour volume was measured for 13 patients with oropharyngeal carcinoma by outlining the tumour on the diagnostic as well as on the treatment planning CT scan. Waiting time was defined as time between histopathological diagnosis and start of radiotherapy. For each tumour we calculated the increase in tumour volume and the tumour doubling time. The potential increase in TCP was calculated for each tumour for the situation without treatment delay. RESULTS: The mean increase in tumour volume was 70%. The mean waiting time was 56 days. Expected TCP with incorporation of delay was 47%, without delay it might have been 63-66%. CONCLUSION: This study shows tumour progression during the time between the diagnostic CT scan and the treatment planning CT scan in oropharyngeal cancer. As a consequence of waiting time, which allows tumour volume increase, there may be an average control loss of 16-19 % for these tumours during the total waiting time before radiotherapy.
Asunto(s)
Carcinoma de Células Escamosas/radioterapia , Modelos Estadísticos , Neoplasias Orofaríngeas/radioterapia , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Biológicos , Neoplasias Orofaríngeas/diagnóstico por imagen , Neoplasias Orofaríngeas/patología , Evaluación de Resultado en la Atención de Salud , Proyectos Piloto , Radioterapia Asistida por Computador , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Listas de EsperaRESUMEN
Olindias sambaquiensis, known as agua viva, is an endemic hydromedusa that is distributed from latitude 23 degrees to 42 degrees south in the southwestern Atlantic Ocean and is known to cause severe stings. This is the first report of the use of vinegar in disarming O sambaquiensis nematocysts and includes preliminary observations on its use in managing the stings of hydromedusae.
Asunto(s)
Ácido Acético/administración & dosificación , Mordeduras y Picaduras/prevención & control , Venenos de Cnidarios/envenenamiento , Escifozoos , Animales , Mordeduras y Picaduras/terapia , Crioterapia , Primeros Auxilios/métodos , HumanosRESUMEN
New trends in home intravenous therapy for the pediatric population are being developed. One trend in particular is proving to be both exciting and promising. This trend is the use of intravenous immunoglobulin in the homecare setting. This article explores the most commonly seen disorders and treatments using this specific intravenous prescription. Safe nursing practice and future trends also are discussed.
Asunto(s)
Enfermería en Salud Comunitaria/tendencias , Terapia de Infusión a Domicilio/tendencias , Inmunoglobulinas Intravenosas , Enfermería Pediátrica/tendencias , Niño , HumanosAsunto(s)
Dermatosis del Pie/patología , Xantogranuloma Juvenil/patología , Adulto , Humanos , MasculinoRESUMEN
In an effort to provide a meaningful community-based nursing experience for the students of William Rainey Harper College, a project was developed with the Community Economic Development Association of Cook County, Illinois to link second-year nursing students and clients in a Head Start program. The goals were designed to meet the needs of both the students and the Head Start clients. The students provided a portion of the health service plan for the Head Start families, and at the same time they received a comprehensive community/family learning experience. Throughout the second year of the nursing program the students followed their assigned family utilizing a unique integration of pediatric and psychiatric nursing concepts. The article will outline the project from development to completion of the first year of student involvement. It will address successes, failures, and changes made in the second year of the program.
Asunto(s)
Enfermería en Salud Comunitaria/educación , Conducta Cooperativa , Intervención Educativa Precoz , Bachillerato en Enfermería , Preescolar , Humanos , IllinoisRESUMEN
The mechanisms by which thyroid hormone (triiodothyronine (T3)) and a thyromimetic, 2-amino-3-(3,5-dibromo-4-[4-hydroxy-3-(6-oxo-1,6-dihydro-pyridazin -3-ylmethyl)-phenoxyl]-phenyl)propionic acid (L-94901), lower plasma low density lipoprotein (LDL) cholesterol and raise plasma high density lipoprotein (HDL) cholesterol levels was investigated in thyroidectomized and sham-operated rats. Thyroidectomy resulted in a 77% increase in plasma LDL cholesterol, a 60% decrease in plasma triglycerides, and a modest reduction in HDL cholesterol. Daily oral dosing with T3 (10-170 nmol/kg) or L94901 (100-1000 nmol/kg) for 7 days decreased plasma LDL cholesterol in thyroidectomized rats by 60-80%, respectively. This reduction in LDL cholesterol was accompanied by a dose-dependent increase in HDL cholesterol levels of up to 60%. Thus, the ratio of LDL to HDL was decreased from 1.01 to 0.12 after treatment with L-94901 and to 0.25 after dosing with T3. In sham-operated animals, T3 and L-94901 lowered LDL cholesterol by 61 and 46%, respectively, and increased HDL cholesterol by 25 and 53%, respectively. Immunoblotting analysis of liver membranes prepared from thyroidectomized or sham-operated rats demonstrated that LDL receptor protein levels were increased by up to eight-fold. Northern blotting analysis revealed similar large increases in hepatic LDL receptor mRNA levels that accounted for the increases in LDL receptor protein levels. Hepatic 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase mRNA, protein, and activity were increased 2- to 3-fold. The T3- and L-94901-mediated increases in serum HDL levels were associated with 2- to 3-fold increases in apo A-I mRNA levels. In contrast with most other hypocholesterolemic agents, T3 and L-94901 significantly increase HDL cholesterol levels in addition to decreasing LDL cholesterol levels due to induction of hepatic apo A-I and LDL receptor gene expression.
Asunto(s)
Apolipoproteína A-I/genética , Colesterol/sangre , Hidroximetilglutaril-CoA Reductasas/genética , Propionatos/farmacología , Piridazinas/farmacología , Receptores de LDL/genética , Triyodotironina/farmacología , Animales , Anticolesterolemiantes/farmacología , Regulación de la Expresión Génica/efectos de los fármacos , Hígado/efectos de los fármacos , Hígado/metabolismo , Masculino , Imitación Molecular , ARN Mensajero/genética , ARN Mensajero/metabolismo , Ratas , Ratas Sprague-Dawley , TiroidectomíaRESUMEN
OBJECTIVE: To evaluate the safety and efficacy of intranasal diamorphine as an analgesic for use in children in accident and emergency (A&E). METHODS: A prospective, randomised clinical trial with consecutive recruitment of patients aged between 3 and 16 years with clinically suspected limb fractures. One group received 0.1 mg/kg intranasal diamorphine, and the other group received 0.2 mg/kg intramuscular morphine. At 0, 5, 10, 20, and 30 minutes pain scores, Glasgow coma score, and peripheral oxygen saturations were recorded; parental acceptability was assessed at 30 minutes. RESULTS: 58 children were recruited, with complete data collection in 51 (88%); the median summed decrease in pain score was better for intranasal diamorphine than intramuscular morphine (9 v 8), though this was not significant (P = 0.4, Mann-Whitney U test). The episode was recorded as "acceptable" in all parents whose child received intranasal diamorphine, compared with only 55% of parents in the intramuscular morphine group (P < 0.0001, Fisher's exact test). There was no incidence of decreased peripheral oxygen saturation or depression in the level of consciousness in any patient. CONCLUSIONS: Intranasal diamorphine is an effective, safe, and acceptable method of analgesia for children requiring opiates in the A & E department.
Asunto(s)
Analgésicos Opioides/administración & dosificación , Heroína/administración & dosificación , Administración Intranasal , Adolescente , Niño , Preescolar , Fracturas Óseas/terapia , Humanos , Inyecciones Intramusculares , Morfina/administración & dosificación , Dimensión del Dolor , Estudios ProspectivosRESUMEN
OBJECTIVE: To see if the alkalinisation of lignocaine caused a reduction in the pain of injection for digital nerve blockade. METHODS: The study was a prospective randomised double blind study with each patient acting as their own control. During the study period, all patients aged 16 years and over presenting to the accident and emergency department with a condition requiring digital nerve blockade were considered for inclusion in the study. Each patient received an injection of both alkalinised and non-alkalinised lignocaine. The pain of each injection was then assessed on a visual analogue scale. RESULTS: 98 patients were entered in the study. The mean difference in pain scores between the non-alkalinised and alkalinised injections was 0.739, P < 0.001, 95% confidence interval 0.47 to 1.01. CONCLUSIONS: Alkalinisation of lignocaine reduces the pain of injection for digital nerve blockade.
Asunto(s)
Anestésicos Locales/efectos adversos , Lidocaína/efectos adversos , Bloqueo Nervioso/efectos adversos , Dolor/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anestésicos Locales/química , Química Farmacéutica , Método Doble Ciego , Humanos , Concentración de Iones de Hidrógeno , Lidocaína/química , Persona de Mediana Edad , Dimensión del Dolor , Estudios ProspectivosRESUMEN
Midfacial injuries are a common reason for attendance at Accident and Emergency (A&E) departments. A&E staff find these injuries difficult to assess due to limited undergraduate training in maxillofacial examination and early tissue oedema which may mask asymmetry. Patients are therefore referred for 'facial views' radiographs and commonly three views (OM15, OM30, lateral face) are taken for screening. We reviewed prospectively 137 consecutive patients over a 5-month period to determine whether one view (OM15) was sufficient to make a diagnosis in addition to clinical examination. Eighty-three per cent of patients had an accurate diagnosis from just the one view, representing a potential saving of 55 per cent of films taken. There were no fractures missed. The sensitivity was 87.5 per cent and the specificity was 83 per cent. We would suggest the introduction of a single-view facial radiograph as a safe method of screening for midfacial fracture in A&E patients where the clinical diagnosis is uncertain and provided there is no cervical injury. This would reduce costs by reducing films taken by over 50 per cent and patients' exposure to radiation.
Asunto(s)
Huesos Faciales/lesiones , Fracturas Óseas/diagnóstico por imagen , Análisis Costo-Beneficio , Huesos Faciales/diagnóstico por imagen , Humanos , Estudios Prospectivos , Radiografía , Sensibilidad y EspecificidadRESUMEN
The case is reported of a 35 year old heroin addict presenting with acute confusion which was later found to be due to meningococcal meningitis. Other than his altered mental state, the only abnormal finding on examination was a mild pyrexia.
Asunto(s)
Confusión/etiología , Heroína , Meningitis Meningocócica/complicaciones , Trastornos Relacionados con Sustancias/complicaciones , Adulto , Diagnóstico Diferencial , Servicio de Urgencia en Hospital , Humanos , Masculino , Meningitis Meningocócica/diagnóstico , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
The case is described of a man who feigned being struck by a vehicle, leading to an unnecessary major trauma response by the ambulance service and hospital. Suspicion that the patient suffered from Munchausen syndrome was confirmed by later investigation. Accident and emergency staff should file details of such patients on the department computer records system, where available, so that staff are alerted automatically to their presence, and share this information with neighbouring hospitals. All such patients should be treated according to ATLS guidelines until injury is ruled out, as for any other patient.
Asunto(s)
Síndrome de Munchausen , Accidentes de Tránsito , Adulto , Servicio de Urgencia en Hospital , Humanos , Masculino , Sistemas de Registros Médicos ComputarizadosRESUMEN
The effect of insulin on expression of CCAAT/enhancer binding protein (C/EBP) alpha, beta, and delta was investigated in fully-differentiated 3T3-L1 adipocytes. Treatment of adipocytes with insulin stimulated rapid dephosphorylation of C/EBP alpha, and repressed the expression of C/EBP alpha within 2-4 h, with > 90% suppression occurring at 24 h. While insulin induced expression of C/EBP beta and C/EBP delta within 1 h and caused a > 20-fold increase by 4 h, expression returned to nearly pretreatment levels by 24 h. The insulin concentration dependence of these effects was consistent with involvement of the insulin receptor. Gel shift analysis revealed that 6 h of insulin treatment decreased the binding of nuclear C/EBP alpha while increasing binding of nuclear C/EBP beta and C/EBP delta. The reciprocal effects of insulin on the steady-state levels of C/EBP transcription factors can be accounted for kinetically and quantitatively by changes in their mRNA levels, which can be accounted for by effects on gene transcription. The effects of insulin on adipocyte gene transcription (e.g. GLUT4) may be mediated, at least in part, by down-regulation of C/EBP alpha and/or its dephosphorylation.
Asunto(s)
Adipocitos/metabolismo , Proteínas de Unión al ADN/genética , Insulina/fisiología , Proteínas Musculares , Proteínas Nucleares/genética , Transcripción Genética , Células 3T3 , Adipocitos/citología , Secuencia de Aminoácidos , Animales , Proteínas Potenciadoras de Unión a CCAAT , Diferenciación Celular , Regulación hacia Abajo , Regulación de la Expresión Génica , Transportador de Glucosa de Tipo 4 , Ratones , Datos de Secuencia Molecular , Proteínas de Transporte de Monosacáridos/genética , Oligonucleótidos/metabolismo , Unión Proteica , ARN Mensajero/genética , ARN Mensajero/metabolismoRESUMEN
Glucocorticoid agonists, i.e. dexamethasone or triamcinolone acetonide, rapidly induce expression of CCAAT/enhancer-binding protein (C/EBP) delta and repress expression of C/EBP alpha in fully differentiated 3T3-L1 adipocytes. Within 30 min of glucocorticoid treatment, the cellular level of C/EBP delta rises dramatically, increasing > 100-fold within 6 h. Concurrently, the level of C/EBP alpha decreases, reaching a minimum within 4 h. The dexamethasone concentration dependence and steroid specificity of these responses suggest that both processes are mediated by the glucocorticoid receptor. The reciprocal effects of dexamethasone on the steady-state levels of C/EBP alpha and C/EBP delta can be accounted for kinetically and quantitatively by changes in their mRNA levels and by the transcription rates of their respective genes. The glucocorticoid-induced changes in expression of the C/EBP isoforms are correlated with the transcriptional activation of the SCD1 gene, an adipocyte gene known to be transactivated by C/EBP isoforms. Glucocorticoids also regulate expression of the C/EBP isoforms in vivo. Within 4 h of administration of dexamethasone or triamcinolone acetonide to adult rats, expression of C/EBP delta is induced in white adipose tissue while expression of C/EBP alpha is repressed. Like the response in 3T3-L1 adipocytes, the effects of dexamethasone on C/EBP alpha in white adipose tissue are rapid and transient.