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2.
Hernia ; 28(1): 33-42, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37776406

RESUMEN

BACKGROUND: To date, there is limited data on the association of active smoking and 30-day wound events following inguinal hernia repair (IHR) with mesh. We aimed to determine if active smoking at the time of IHR with mesh was associated with worse 30-days wound events and additional morbidity outcomes using the Abdominal Core Health Quality Collaborative (ACHQC) database. METHODS: All adult patients undergoing elective, IHR with mesh who had 30-day follow-up data available were identified within the ACHQC database. Smokers were defined as having used nicotine within the 30 days prior to surgery. A 1:1 propensity score matched analysis was performed comparing smokers to non-smokers, controlling for factors previously shown to be associated with postoperative wound events. The effect of smoking on 30-day wound events and additional morbidity outcomes following IHR with mesh was investigated using Chi-square or Fisher's exact test for categorical data and Wilcoxon ranked test for continuous data. RESULTS: A total of 17,543 patients met inclusion criteria; 1855 (11%) were active smokers at the time of minimally invasive IHR with mesh. A total of 3694 patients were used for the matched analysis. There were no statistically significant differences between the non-smokers and smokers with respect to the incidence of surgical site infection (p = 0.10), surgical site occurrences (p = 0.22), or surgical site occurrences requiring procedural intervention (p = 0.64). Non-smokers were significantly more likely to be readmitted to the hospital and had significantly less improvement in all pain domains following IHR with mesh. CONCLUSIONS: Active smoking at the time of IHR with mesh is not associated with worse 30-day wound or additional morbidity and mortality outcomes. Based on these results, preoperative smoking cessation for all patients undergoing IHR may not reduce 30-day morbidity.


Asunto(s)
Hernia Inguinal , Adulto , Humanos , Hernia Inguinal/cirugía , Fumar/efectos adversos , Fumar/epidemiología , Mallas Quirúrgicas/efectos adversos , Herniorrafia/efectos adversos , Herniorrafia/métodos , Incidencia
3.
Hernia ; 26(6): 1625-1633, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36036822

RESUMEN

PURPOSE: Prescribing and consumption of opioids remain highly variable. Using a national hernia registry, we aimed to identify patient and surgery specific factors associated with low and high opioid tablet consumption after inguinal hernia repair. METHODS: This was a retrospective cross-sectional study evaluating patients undergoing elective inguinal hernia repair with 30-day follow-up and patient-reported opioid consumption from March 2019 to March 2021 using the Abdominal Core Health Quality Collaborative. Clinically significant patient demographics, comorbidities, operative details, quality-of-life measurements, and surgeon prescribing data were entered into a multivariable logistic regression model to identify statistically significant predictors of patients who took no opioid tablets or >10 tablets. RESULTS: A total of 1937 patients were analyzed. Operations included 59% laparoscopic or robotic, 35% open mesh, and 6% open non-mesh repairs. Of these patients, 50% reported taking zero, 42% took 1-10, and 8% took ≥10 opioid tablets at 30-day follow-up. Patients who were older (OR 1.55, 95% CI 1.34-1.79, p-value <0.001), ASA ≤ 2 (OR 1.56, 95% CI 1.2-2.01, p-value <0.001), had no preoperative opioid use at baseline (OR 2.29, 95% CI 1.31-4.03, p-value = 0.004), had local anesthetic with general anesthesia (OR 1.39, 95% CI 1.0.5-1.85, p-value = 0.022), or prescribed <7 opioid tablets (OR 2.27, 95% CI 1.96-2.62, p-value <0.001) were more likely to take no opioid tablets. CONCLUSION: Older, healthier, opioid naïve patients with local anesthetic administered during elective inguinal hernia repair are most likely to not require opioids. Surgeon prescribing-arguably the most modifiable factor-independently correlates with both low and high opioid consumption.


Asunto(s)
Hernia Inguinal , Laparoscopía , Humanos , Hernia Inguinal/cirugía , Analgésicos Opioides/uso terapéutico , Herniorrafia/efectos adversos , Estudios Retrospectivos , Anestésicos Locales , Estudios Transversales , Comprimidos , Mallas Quirúrgicas
4.
Arch. esp. urol. (Ed. impr.) ; 75(6): 544-551, Aug. 28, 2022. tab, graf
Artículo en Español | IBECS | ID: ibc-209635

RESUMEN

Introduction and Objectives: Radical prostatectomy has an impact on urinary continence. Many factors are involved in continence. The objective of this study is evaluate the effect of guided Pelvic Floor Exercises prior to robotic radical prostatectomy (RRP) on the rate of urinary incontinence compared with written information. Material and Method: randomized study of 62 patients who are waiting for PRR. They were rondomized in two groups: experimental group (exercises guided by a physiotherapist) or a control group (written information). Primary objective was the continence rate measured by pad test and ICIQ-SF one month after the intervention, Secondary objectives were incontinence severity, quality of life with SF-36 and KHQ questionnaires and the correlation between incontinence and quality of life. Results: We found no differences in continence rate between groups after the intervention. We found differences in “emotional problems” and “personal relationships”, in favor of the control group. There is a correlation between the amount of urine leakage and age, urgency and all the domains of the KHQ questionnaire except general quality of life, as well as in the areas “energy/fatigue” and “social function” of the SF-36. Conclusions: Physiotherapist-guided exercises before RRP do not seem to offer advantages compared to written information, in terms of the incontinence rate and its severity one month after the surgery. Urinary incontinence is correlated with age, urgency, and deterioration in quality of life (AU)


Introducción y Objetivos: La prostatectomía radicaltiene un gran impacto en la continencia urinaria. Muchosfactores intervienen en la continencia. El objetivo de esteestudio es evaluar el efecto en la tasa de incontinencia deorina de los Ejercicios de Suelo Pélvicos guiados previos ala prostatectomía radical robótica (PRR), frente a la información escrita.Material y Método: Ensayo clínico en el que se incluyen 62 pacientes en lista de espera para PRR, aleatorizándolos a un grupo experimental (ejercicios guiados porfisioterapeuta) o control (información escrita). El objetivoprimario fue la tasa de continencia medida por test de compresa y el cuestionario ICIQ-SF al mes de la intervención,Fueron objetivos secundarios, la severidad de incontinencia, la calidad de vida con cuestionarios SF-36 y KHQ, y lacorrelación entre la incontinencia y la calidad de vida.Resultados: No encontramos diferencias en la tasade incontinencia entre los grupos tras la intervención. Encontramos diferencias en “problemas emocionales” y “relaciones personales”, a favor del grupo control. Existe correlación entre la cantidad de las pérdidas de orina y la edad,la urgencia miccional y todos los dominios del cuestionarioKHQ excepto la calidad de vida general, así como en lasáreas “energía/fatiga” y “función social” del SF-36.Conclusiones: Los ejercicios guiados por fisioterapeuta antes de PRR no parecen ofrecer ventajas frente ala información escrita, en la tasa de incontinencia y severidad de la misma al mes de la intervención. La incontinenciade orina se correlaciona con la edad, la urgencia miccionaly el deterioro en la calidad de vida. (AU)


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Anciano , Procedimientos Quirúrgicos Robotizados , Incontinencia Urinaria/etiología , Incontinencia Urinaria/prevención & control , Prostatectomía/métodos , Resultado del Tratamiento , Terapia por Ejercicio , Trastornos del Suelo Pélvico/rehabilitación , Calidad de Vida , Índice de Severidad de la Enfermedad
5.
Rehabilitación (Madr., Ed. impr.) ; 56(1): 47-55, Ene - Mar 2022. tab, graf
Artículo en Español | IBECS | ID: ibc-204888

RESUMEN

Introducción: En pacientes con artrosis de rodilla se ha identificado un 30% de asociación de dolor de sensibilización central (DSC). El objetivo es analizar la persistencia de DSC en pacientes tras artroplastia de rodilla y su correlación con la intensidad del dolor, funcionalidad y los factores determinantes asociados, además de evaluar la exploración física como instrumento de valoración. Material y métodos: Estudio cuasiexperimental antes-después de pacientes intervenidos de artroplastia total de rodilla. Se analiza la evolución de variables subjetivas (características del dolor, cuestionarios painDETECT, WOMAC y escala visual numérica) y de exploración física (hiperalgesia térmica, alodinia, hipoestesia, algometría y goniometría), tres meses antes y tres y seis meses después de la cirugía mediante el test de ANOVA de medidas repetidas para las cuantitativas y el Q de Cochran para las cualitativas. Se utilizó la prueba de Spearman para la correlación de los cuestionarios, del PD-Q y variables de exploración y para el modelo multivariante del PD-Q con determinantes clínicos. Resultados: Sesenta y siete pacientes completaron el estudio. La evolución de las variables cuantitativas y cualitativas fue significativa, con correlación entre cuestionarios. En el modelo multivariante lineal de PD-Q se obtuvo relación significativa de antecedentes de limitación movilidad en flexión, dolor musculoesquelético crónico y la asociación de depresión y tiempo. Conclusiones: Un porcentaje significativo de pacientes con artrosis de rodilla tras artroplastia persistieron con probable DSC, correlacionándose con intensidad y funcionalidad. La limitación de movilidad y comorbilidad crónica previas podrían ser determinantes de DSC, siendo la exploración y anamnesis, herramientas útiles en consulta.(AU)


IntroductionIn patients with knee osteoarthritis, a group of 30% has been identified with central pain sensitization (CPS). The aim is to analyze the persistence of CPS in patients after knee arthroplasty and its correlation with pain intensity, functionality, determining factors and to evaluate physical examination as an assessment instrument.Material and methodsQuasi-experimental before–after study of patients operated on total knee arthroplasty. The evolution of subjective variables (pain characteristics, painDETECT questionnaire, WOMAC and Numerical Rating Scale) and physical examination (thermal hyperalgesia, allodynia, hypoesthesia, algometry and goniometry) 3 months before and 3 and 6 months after surgery are analysed using repeated measures ANOVA test for the quantitative ones and Cochran's Q for the qualitative ones. Spearmen test was used for the correlation of the questionnaires, the PD-Q and exploration variables and for the multivariate model of the PD-Q with clinical determinants. Results: Sixty-seven patients completed the study. The evolution of the quantitative and qualitative variables was significant, with a correlation between questionnaires. In the linear multivariate model of PD-Q, a significant relationship was obtained from personal history of flexion limitation, chronic musculoskeletal pain and the association between depression and time. Conclusions: A significant percentage of patients with knee osteoarthritis after arthroplasty persisted with probable CPS, correlating with intensity and functionality. The limitation of mobility and previous chronic comorbidity could be determinants of CPS, with anamnesis and exploration being useful tools in consultation.(AU)


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Sensibilización del Sistema Nervioso Central , Artropatías , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/terapia , Artroplastia , Encuestas y Cuestionarios , Examen Físico , Hiperalgesia , Hipoestesia , Rehabilitación , 28573 , Dolor
6.
Hernia ; 26(3): 855-864, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-35039950

RESUMEN

PURPOSE: Post-operative opioid prescriptions contribute to prolonged opioid misuse and abuse. Using a national hernia registry, we aimed to evaluate the effectiveness of a data-driven educational intervention on surgeon prescribing behavior. METHODS: After collecting opioid prescribing and patient consumption data from March 2019-December 2019 in inguinal and umbilical hernia repair, the Abdominal Core Health Quality Collaborative (ACHQC) Opioid Reduction Task Force presented data at a Quality Improvement (QI) Summit to educate surgeons on strategies to minimize opioid prescribing. Surgeons were asked to implement a multimodal pain management approach and were supported with educational tools created by the task force. Prescribing and consumption data after the summit, December 2019-March 2021, were then collected to assess the effectiveness of the QI effort. RESULTS: Registry participation before and after the QI summit increased from 52 to 91 surgeons, with an increase of 353-830 umbilical hernia patients and 976-2447 inguinal hernia patients. After the summit, high (> 10 tablets) surgeon prescribers shifted toward low (≤ 10 tablets) prescribing. Yet, patients consumed less than what was prescribed, with a significant increase in patients consuming ≤ 10 tablets before and after the summit: 79-88% in umbilical hernia (p = 0.01) and 85-94% in inguinal hernia (p < 0.001). CONCLUSIONS: Following an educational QI summit by the ACHQC Opioid Reduction Task Force, high opioid prescribing has shifted toward low. However, patients consume less than prescribed, highlighting the importance of continuing this effort to reduce opioid prescribing.


Asunto(s)
Hernia Inguinal , Hernia Umbilical , Analgésicos Opioides/uso terapéutico , Hernia Inguinal/cirugía , Hernia Umbilical/cirugía , Herniorrafia , Humanos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/cirugía , Pautas de la Práctica en Medicina , Sistema de Registros
7.
Rehabilitacion (Madr) ; 56(1): 47-55, 2022.
Artículo en Español | MEDLINE | ID: mdl-34256947

RESUMEN

INTRODUCTION: In patients with knee osteoarthritis, a group of 30% has been identified with central pain sensitization (CPS). The aim is to analyze the persistence of CPS in patients after knee arthroplasty and its correlation with pain intensity, functionality, determining factors and to evaluate physical examination as an assessment instrument. MATERIAL AND METHODS: Quasi-experimental before-after study of patients operated on total knee arthroplasty. The evolution of subjective variables (pain characteristics, painDETECT questionnaire, WOMAC and Numerical Rating Scale) and physical examination (thermal hyperalgesia, allodynia, hypoesthesia, algometry and goniometry) 3 months before and 3 and 6 months after surgery are analysed using repeated measures ANOVA test for the quantitative ones and Cochran's Q for the qualitative ones. Spearmen test was used for the correlation of the questionnaires, the PD-Q and exploration variables and for the multivariate model of the PD-Q with clinical determinants. RESULTS: Sixty-seven patients completed the study. The evolution of the quantitative and qualitative variables was significant, with a correlation between questionnaires. In the linear multivariate model of PD-Q, a significant relationship was obtained from personal history of flexion limitation, chronic musculoskeletal pain and the association between depression and time. CONCLUSIONS: A significant percentage of patients with knee osteoarthritis after arthroplasty persisted with probable CPS, correlating with intensity and functionality. The limitation of mobility and previous chronic comorbidity could be determinants of CPS, with anamnesis and exploration being useful tools in consultation.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Dolor Crónico , Osteoartritis de la Rodilla , Artroplastia de Reemplazo de Rodilla/efectos adversos , Sensibilización del Sistema Nervioso Central , Humanos , Osteoartritis de la Rodilla/cirugía , Dimensión del Dolor
8.
Food Chem ; 352: 129370, 2021 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-33652199

RESUMEN

As the worldwide population continues to rise, so does global demand for agricultural production. This scenario of uncertain food supply is exacerbated by the high salinization of soils worldwide, a serious constraint to crop productivity. In this context, there is an increasing need for alternative sustainable crops. Halophytes are thought to be a promising alternative food source due to their natural ability to grow in saline soils and their multiple potential uses in the food industry. In this study, the protein and fatty acid content of the halophyte Halimione (Atriplex) portulacoides (L.) was studied in different saline conditions. Although more studies are needed to explore the nutritional properties of H. portulacoides, the data presented here suggest that this halophyte should be considered as a promising food crop for saline agriculture.


Asunto(s)
Chenopodiaceae/química , Ácidos Grasos/análisis , Proteínas de Plantas/análisis , Salinidad , Plantas Tolerantes a la Sal/química , Suelo/química
9.
Heliyon ; 6(10): e05237, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33102858

RESUMEN

Koelreuteria paniculata is a deciduous tree, popular in temperate regions for its ornamental value, which accumulates unusual cyanolipids in its seeds. The seed oil of this plant is rich in the unusual cis-11-eicosenoic fatty acid (20:1, or gondoic acid), a monounsaturated oil of interest to the oleochemical industry. In higher plants, de novo fatty acid biosynthesis takes place in the plastids, a process that is terminated by hydrolysis of the thioester bond between the acyl moiety and the ACP by acyl-ACP thioesterases. The specificity of acyl-ACP thioesterases is fundamental in controlling the fatty acid composition of seed oil. To determine the mechanisms involved in fatty acid biosynthesis in K. paniculata seeds, we isolated, cloned and sequenced two cDNAs encoding acyl-ACP thioesterases in this plant, KpFatA and KpFatB. Both of them were expressed heterologously in Escherichia coli and characterized with different acyl-ACP substrates. The K. paniculata FatB2 displayed unusual substrate specificity, so that unlike most FatB2 type enzymes, it displayed preference for oleoyl-ACP instead of palmitoyl-ACP. This specificity was consistent with the changes in E. coli and N. benthamiana fatty acid composition following heterologous expression of this enzyme. KpFatB also showed certain genetic divergence relative to other FatB-type thioesterases and when modelled, its structure revealed differences at the active site. Together, these results suggest that this thioesterase could be a new class of FatB not described previously.

10.
Plant Sci ; 272: 117-130, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29807582

RESUMEN

In the present study, we describe the molecular and biochemical characterization of sunflower (Helianthus annuus L.) enolase (ENO, EC 4.2.1.11) proteins, which catalyze the formation of phosphoenolpyruvate, the penultimate intermediate in the glycolytic pathway. We cloned and characterized three cDNAs encoding different ENO isoforms from developing sunflower seeds. Studies using fluorescently tagged ENOs confirmed the predicted subcellular localization of ENO isoforms: HaENO1 in the plastid while HaENO2 and HaENO3 were found in the cytosol. The cDNAs were used to express the corresponding 6(His)-tagged proteins in Escherichia coli. The proteins were purified to electrophoretic homogeneity, using immobilized metal ion affinity chromatography, and biochemically characterized. Recombinant HaENO1 and HaENO2, but not HaENO3 were shown to have enolase activity, in agreement with data obtained with the Arabidopsis homolog proteins. Site directed mutagenesis of several critical amino acids was used to attempt to recover enolase activity in recombinant HaENO3, resulting in very small increases that were not additive. A kinetic characterization of the two active isoforms showed that pH had similar effect on their velocity, that they had similar affinity for 2-phosphoglycerate, but that the kcat/Km of the plastidial enzyme was higher than that of the cytosolic isoform. Even though HaENO2 was always the most highly expressed transcript, the levels of expression of the three ENO genes were remarkably distinct in all the vegetative and reproductive tissues studied. This indicates that in seeds the conversion of 2-phosphoglycerate to phosphoenolpyruvate takes place through the cytosolic and the plastidial pathways therefore both routes could contribute to the supply of carbon for lipid synthesis. The identity of the main source of carbon during the period of stored products synthesis is discussed.


Asunto(s)
Helianthus/enzimología , Fosfopiruvato Hidratasa/metabolismo , Semillas/crecimiento & desarrollo , Citosol/enzimología , Glucosa-6-Fosfato/metabolismo , Helianthus/genética , Helianthus/crecimiento & desarrollo , Helianthus/metabolismo , Metabolismo de los Lípidos , Fosfoenolpiruvato/metabolismo , Fosfopiruvato Hidratasa/genética , Fosfopiruvato Hidratasa/fisiología , Filogenia , Plastidios/enzimología , Conformación Proteica , Reacción en Cadena en Tiempo Real de la Polimerasa , Semillas/enzimología , Semillas/metabolismo , Alineación de Secuencia , Análisis de Secuencia de ADN , Transcriptoma
11.
Int J Organ Transplant Med ; 9(1): 20-25, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29531643

RESUMEN

BACKGROUND: Umbilical hernias are common in patients with end-stage liver disease undergoing liver transplantation. Management of those persisting at the time of liver transplantation is important to define. OBJECTIVE: To evaluate the long-term results of patients undergoing simultaneous primary umbilical hernia repair (UHR) at the time of liver transplantation at a single institution. METHODS: Retrospective chart review was performed on patients undergoing simultaneous UHR and liver transplantation from 2010 through 2016. 30-day morbidity and mortality outcomes and long-term hernia recurrence were investigated. RESULTS: 59 patients had primary UHR at the time of liver transplantation. All hernias were reducible with no overlying skin breakdown or leakage of ascites. 30-day morbidity and mortality included 5 (8%) superficial surgical site infections, 1 (2%) deep surgical site infection, and 7 (12%) organ space infections. Unrelated to the UHR, 10 (17%) patients had an unplanned return to the operating room, 16 (27%) were readmitted within 30 days of their index operation, and 1 (2%) patient died. With a mean follow-up of 21.8 months, 7 (18%) patients experienced an umbilical hernia recurrence. CONCLUSION: Despite the high perioperative morbidity associated with the transplant procedure, concurrent primary UHR resulted in an acceptable long-term recurrence rate with minimal associated morbidity.

12.
Pediatr Obes ; 13(2): 127-129, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-28207196
13.
Hernia ; 21(6): 941-949, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-28840354

RESUMEN

PURPOSE: Parastomal hernias are challenging to manage, and an optimal repair has yet to be defined. An open, modified, retromuscular Sugarbaker technique has recently been described in the literature as a technically feasible approach to parastomal hernia repair. This study evaluates our initial institutional experience with parastomal hernia repair with the aforementioned technique with respect to safety and durability. METHODS: All patients who underwent an open, modified retromuscular Sugarbaker parastomal hernia repair from 2014 through 2016 at our institution were identified. Patient characteristics, hernia variables, operative details, and 30-day and medium-term outcomes were abstracted from the Americas Hernia Society Quality Collaborative database. Outcomes of interest included 30-day wound morbidity, mesh-related complications, and hernia recurrence. RESULTS: Thirty-eight patients met inclusion criteria. 20 (53%) patients presented to our institution for management of a recurrent parastomal hernia. 35 (92%) patients had a concurrent midline incisional hernia with a mean total hernia width of 15.1 cm and mean defect size of 353 cm2. Thirty-day wound morbidity rate was 13%. At a mean of follow-up of 13 months (range 4-30), the hernia recurrence rate was 11%. Three patients (8%) experienced mesh erosion into the stoma bowel, leading to stoma necrosis, bowel obstruction, and/or perforation which required reoperation at day 8, 12, and 120 days, respectively. CONCLUSIONS: The outcomes of the retromuscular Sugarbaker technique for the management of parastomal hernias have been disappointing at our institution, with a concerning rate of serious mesh-related complications. This operation, as originally described, needs further study before widespread adoption with a particular focus on the technique of mesh placement, the most appropriate mesh selection, and the long-term rate of mesh erosion.


Asunto(s)
Herniorrafia/métodos , Hernia Incisional/cirugía , Estomas Quirúrgicos , Anciano , Femenino , Humanos , Hernia Incisional/etiología , Masculino , Persona de Mediana Edad , Estomía , Reoperación , Estudios Retrospectivos , Mallas Quirúrgicas , Resultado del Tratamiento
14.
Hernia ; 21(4): 495-503, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28631104

RESUMEN

INTRODUCTION: While several patient and operative variables have been shown to be associated with an increased risk of postoperative wound events, the association between surgical hat type worn by surgeons and postoperative wound events remains controversial. The purpose of this study is to investigate the association between type of surgical hat worn by surgeons and the incidence of postoperative wound events following ventral hernia repair using the Americas Hernia Society Quality Collaborative database. METHODS: All surgeons who input at least ten patients with 30-day follow-up into the AHSQC were identified. These surgeons were sent a survey asking them to identify the type of surgical hat they wear in the operating room. The association of the type of surgical hat worn, patient variables, and operative factors with 30-day wound events was investigated using multivariate logistic regression. RESULTS: A total of 68 surgeons responded to the survey, resulting in 6210 cases available for analysis. The type of surgical hat worn by surgeons was not found to be associated with an increased risk of 30-day surgical site infections or surgical site occurrences requiring procedural intervention. CONCLUSION: Our study is the first study to directly compare the association of surgical hat type with postoperative wound events. There is no association between the type of surgical hat worn and the incidence of postoperative wound events following ventral hernia repair. Our findings suggest that surgical hate type may be chosen at the discretion of operating room personnel without fear of detriment to their patients.


Asunto(s)
Hernia Ventral/cirugía , Herniorrafia/efectos adversos , Vestimenta Quirúrgica , Infección de la Herida Quirúrgica/epidemiología , Anciano , Bases de Datos Factuales , Femenino , Herniorrafia/instrumentación , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
15.
Child Care Health Dev ; 42(2): 278-87, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26728419

RESUMEN

BACKGROUND: Few children with obesity who are referred for weight management end up enroled in treatment. Factors enabling enrolment are poorly understood. Our purpose was to explore reasons for and facilitators of enrolment in paediatric weight management from the parental perspective. METHODS: Semi-structured interviews were conducted with parents of 10- to 17-year-olds who were referred to one of four Canadian weight management clinics and enroled in treatment. Interviews were audio-recorded and transcribed verbatim. Manifest/inductive content analysis was used to analyse the data, which included the frequency with which parents referred to reasons for and facilitators of enrolment. RESULTS: In total, 65 parents were interviewed. Most had a child with a BMI ≥95th percentile (n = 59; 91%), were mothers (n = 55; 85%) and had completed some post-secondary education (n = 43; 66%). Reasons for enrolment were related to concerns about the child, recommended care and expected benefits. Most common reasons included weight concern, weight loss expectation, lifestyle improvement, health concern and need for external support. Facilitators concerned the referral initiator, treatment motivation and barrier control. Most common facilitators included the absence of major barriers, parental control over the decision to enrol, referring physicians stressing the need for specialized care and parents' ability to overcome enrolment challenges. CONCLUSIONS: Healthcare providers might optimize enrolment in paediatric weight management by being proactive in referring families, discussing the advantages of the recommended care to meet treatment expectations and providing support to overcome enrolment barriers.


Asunto(s)
Padres/psicología , Obesidad Infantil/psicología , Derivación y Consulta , Programas de Reducción de Peso , Adolescente , Adulto , Actitud Frente a la Salud , Canadá/epidemiología , Niño , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Selección de Paciente , Obesidad Infantil/prevención & control
16.
Mol Phylogenet Evol ; 79: 92-105, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24952319

RESUMEN

The fine-leaved Loliinae is one of the temperate grass lineages that is richest in number of evolutionary switches from perennial to annual life-cycle, and also shows one of the most complex reticulate patterns involving distinct diploid and allopolyploid lineages. Eight distinct annual lineages, that have traditionally been placed in the genus Vulpia and in other fine-leaved ephemeral genera, have apparently emerged from different perennial Festuca ancestors. The phenotypically similar Vulpia taxa have been reconstructed as polyphyletic, with polyploid lineages showing unclear relationships to their purported diploid relatives. Interspecific and intergeneric hybridization is, however, rampant across different lineages. An evolutionary analysis based on cloned nuclear low-copy GBSSI (Granule-Bound Starch Synthase I) and multicopy ITS (Internal Transcribed Spacer) sequences has been conducted on representatives of most Vulpia species and other fine-leaved lineages, using Bayesian consensus and agreement trees, networking split graphs and species tree-based approaches, to disentangle their phylogenetic relationships and to identify the parental genome donors of the allopolyploids. Both data sets were able to reconstruct a congruent phylogeny in which Vulpia was resolved as polyphyletic from at least three main ancestral diploid lineages. These, in turn, participated in the origin of the derived allopolyploid Vulpia lineages together with other Festuca-like, Psilurus-like and some unknown genome donors. Long-distance dispersal events were inferred to explain the polytopic origin of the Mediterranean and American Vulpia lineages.


Asunto(s)
Evolución Molecular , Duplicación de Gen , Poaceae/clasificación , Poliploidía , Teorema de Bayes , ADN de Plantas/genética , ADN Espaciador Ribosómico/genética , Filogenia , Poaceae/genética , Análisis de Secuencia de ADN , Almidón Sintasa/genética
17.
Rev. Soc. Andal. Traumatol. Ortop. (Ed. impr.) ; 31(1): 55-59, ene.-jun. 2014. ilus
Artículo en Español | IBECS | ID: ibc-126251

RESUMEN

El objetivo de este artículo es mostrar una alternativa técnica en el tratamiento de la rotura aguda del tendón rotuliano mediante un injerto trifascicular de tendón de Aquiles. La técnica, indicada inicialmente en roturas crónicas, se presenta gráficamente desde el abordaje destacando los puntos clave de la cirugía. Los resultados a corto y medio plazo son satisfactorios con ausencia de síntomas y un buen balance articular, por lo que puede ser una técnica de elección para futuros pacientes seleccionados previamente


The aim of this paper is to show an alternative technique in the management of an acute rupture of the patellar tendon using a trifascicular achilles tendon allograft as augmentation. The technique, which was fi rstly indicated in chronic ruptures, is described accurately with pictures and highlighting pearls during the surgery. Results at short and medium term appear to be satisfactory due to almost total loss of pain and good balance of the knee, thus it may be considered as an elective technique for selected patients


Asunto(s)
Humanos , Trasplante Homólogo/métodos , Ligamento Rotuliano/trasplante , Luxación de la Rótula/cirugía , Recuperación de la Función/fisiología , Resultado del Tratamiento , Tendón Calcáneo/trasplante , Selección de Paciente , Traumatismos de la Rodilla/cirugía
18.
Talanta ; 116: 33-8, 2013 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-24148369

RESUMEN

A rapid duplex ELISA for the simultaneous determination of two of the most widely used organophosphorous insecticides in tangerine juices is described. To accomplish this aim, two individual enzyme-linked immunosorbent assays for chlorpyrifos and fenthion pesticides were integrated into one ELISA test. The strategy uses 96-well plates with specific wells coated with the corresponding haptenized conjugate. The optimized duplex ELISA was accomplished within 40 min achieving a detection limit of 0.20±0.04 µg/L and 0.50±0.06 µg/L, for chlorpyrifos and fenthion, respectively in tangerine juice samples. The determination of residues of both pesticides was carried out by simple sample dilution, without any extra sample clean-up procedure. Results of testing precision, stability, and selectivity demonstrated that the assay provided reliable analytical performances for the simultaneous determination of residues of chlorpyrifos and fenthion in fruit juice samples below the established European maximum residue limits (MRL). In addition, the accuracy and reliability of this duplex bioanalytical method is demonstrated by analyzing blind spiked juice samples and the results, correlated well with those achieved using a well-established GC/MS method (recoveries between 95% and 106%).


Asunto(s)
Bebidas/análisis , Cloropirifos/aislamiento & purificación , Citrus/química , Ensayo de Inmunoadsorción Enzimática/métodos , Fentión/aislamiento & purificación , Frutas/química , Insecticidas/aislamiento & purificación , Ensayo de Inmunoadsorción Enzimática/normas , Cromatografía de Gases y Espectrometría de Masas , Haptenos/química , Límite de Detección , Reproducibilidad de los Resultados
19.
J Sports Med Phys Fitness ; 53(3): 312-8, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23715257

RESUMEN

AIM: Between-set rest intervals (RI) may be determined using exercise-recovery-ratio (ERR) or fixed periods. The study investigated the influence of different ERR and fixed RI on the training volume in sessions aiming for hypertrophy with upper-body exercises recruiting different muscle mass (bench press-BP and triceps extension-TE). METHODS: Sixteen men (25±2 years, 78±6 kg, 178±5 cm) with previous experience in resistance training performed 5 sets of maximum repetitions in each exercise with five RI protocols (RR1:3 [I3]; ERR1:5 [I5]; ERR1:7 [I7]; increasing ERR [IP] (1:3-1:5-1:7-1:9); 2-min fixed [2F]) in a counterbalanced design. The number of repetitions and work volume (load x repetitions) in each set and along the sessions (load x repetitions x sets) were compared across the RI protocols. RESULTS: The maximum repetitions decreased along with the sets in both exercises, but TE had lower percent decrease compared to BP, due to a longer time to perform the sets and therefore longer absolute rest time (P<0.05). The I3 exhibited the lowest repetitions sustainability (P<0.05). The training volume in I7, IP and 2F was always higher than I3 and I5 (P>0.05). However the absolute RI in 2F (~2 min) was shorter than in I7 and IP (~3 min), which reduced the total duration of the training session. CONCLUSION: Determining between-set RI based on ERR instead of using fixed intervals does not enable more work to be done in multiple-set/high intensity resistance training sessions.


Asunto(s)
Esfuerzo Físico/fisiología , Entrenamiento de Fuerza , Descanso/fisiología , Adulto , Humanos , Masculino , Factores de Tiempo
20.
Appl Radiat Isot ; 73: 32-43, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23268207

RESUMEN

Accurate dating of samples by alpha spectrometry presupposes that the dated system behaved as closed and that no allochthonous (232)Th was provided to the system. Therefore the selection of appropriate samples is a fundamental task that will determine the reliability and accuracy or not of the results. In this paper, by means of a thorough characterisation, those petrological and chemical variables that allow the preselection of the most suitable samples to be dated have been identified and used to calculate the sample quality index.

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