RESUMO
STUDY DESIGN: Cross-sectional survey. OBJECTIVE: To determine the influence of surgeons' level of experience and subspeciality training on the reliability, reproducibility, and accuracy of sacral fracture classification using the Arbeitsgemeinschaft für Osteosynthesefragen Spine Sacral Classification System. SUMMARY OF BACKGROUND DATA: A surgeons' level of experience or subspecialty may have a significant effect on the reliability and accuracy of sacral classification given various levels of comfort with imaging assessment required for accurate diagnosis and classification. METHODS: High-resolution computerized tomography (CT) images from 26 cases were assessed on two separate occasions by 172 investigators representing a diverse array of surgical subspecialities (general orthopedics, neurosurgery, orthopedic spine, orthopedic trauma) and experience (<5, 5-10, 11-20, >20âyrs). Reliability and reproducibility were calculated with Cohen kappa coefficient (k) and gold standard classification agreement was determined for each fracture morphology and subtype and stratified by experience and subspeciality. RESULTS: Respondents achieved an overall kâ=â0.87 for morphology and kâ=â0.77 for subtype classification, representing excellent and substantial intraobserver reproducibility, respectively. Respondents from all four practice experience groups demonstrated excellent interobserver reliability when classifying overall morphology (kâ=â0.842/0.850, Assessment 1/Assessment 2) and substantial interobserver reliability in overall subtype (kâ=â0.719/0.751) in both assessments. General orthopedists, neurosurgeons, and orthopedic spine surgeons exhibited excellent interobserver reliability in overall morphology classification and substantial interobserver reliability in overall subtype classification. Surgeons in each experience category and subspecialty correctly classified fracture morphology in over 90% of cases and fracture subtype in over 80% of cases according to the gold standard. Correct overall classification of fracture morphology (Assessment 1: Pâ=â0.024, Assessment 2: Pâ=â0.006) and subtype (P2â<â0.001) differed significantly by years of experience but not by subspecialty. CONCLUSION: Overall, the Arbeitsgemeinschaft für Osteosynthesefragen spine sacral classification system appears to be universally applicable among surgeons of various subspecialties and levels of experience with acceptable reliability, reproducibility, and accuracy.Level of Evidence: 4.
Assuntos
Cirurgiões , Vértebras Torácicas , Estudos Transversais , Humanos , Variações Dependentes do Observador , Reprodutibilidade dos TestesRESUMO
Human accidents with spiders of the genus Loxosceles are an important health problem affecting thousands of people worldwide. Patients evolve to severe local injuries and, in many cases, to systemic disturbances as acute renal failure, in which cases antivenoms are considered to be the most effective treatment. However, for antivenom production, the extraction of the venom used in the immunization process is laborious and the yield is very low. Thus, many groups have been exploring the use of recombinant Loxosceles toxins, particularly phospholipases D (PLDs), to produce the antivenom. Nonetheless, some important venom activities are not neutralized by anti-PLD antibodies. Astacin-like metalloproteases (ALMPs) are the second most expressed toxin acting on the extracellular matrix, indicating the importance of its inclusion in the antigen's formulation to provide a better antivenom. Here we show the construction of a hybrid recombinant immunogen, called LgRec1ALP1, composed of hydrophilic regions of the PLD and the ALMP toxins from Loxosceles gaucho. Although the LgRec1ALP1 was expressed as inclusion bodies, it resulted in good yields and it was effective to produce neutralizing antibodies in mice. The antiserum neutralized fibrinogenolytic, platelet aggregation and dermonecrotic activities elicited by L. gaucho, L. laeta, and L. intermedia venoms, indicating that the hybrid recombinant antigen may be a valuable source for the production of protective antibodies against Loxosceles ssp. venoms. In addition, the hybrid recombinant toxin approach may enrich and expand the alternative antigens for antisera production for other venoms.
Assuntos
Anticorpos Neutralizantes/farmacologia , Antivenenos/farmacologia , Diester Fosfórico Hidrolases/toxicidade , Venenos de Aranha/toxicidade , Animais , Antivenenos/metabolismo , Edema/induzido quimicamente , Edema/tratamento farmacológico , Humanos , Masculino , Metaloproteases/metabolismo , Camundongos Endogâmicos BALB C , Necrose/induzido quimicamente , Necrose/tratamento farmacológico , Diester Fosfórico Hidrolases/metabolismo , Agregação Plaquetária/efeitos dos fármacos , Coelhos , Proteínas Recombinantes/metabolismo , Proteínas Recombinantes/farmacologia , Venenos de Aranha/metabolismo , AranhasRESUMO
É feita uma análise crítica da situaçäo do bioterismo no Brasil - e países em desenvolvimento em geral - em comparaçäo com o que existe nos países desenvolvidos em geral - em comparaçäo com o que existe nos países desenvolvidos. Säo discutidas as causas da situaçäo dos biotérios na grande maioria dos centros de pesquisa e o significado desta situaçäo quanto à qualidade de animais de laboratório e, por extensäo, à validade da investigaçäo biológica, apontando-se, ao mesmo tempo, caminhos para superar os problemas