RESUMO
Background: Recent literature supports minimalist approaches such as splinting for pediatric buckle fractures of the wrist. Uptake of this practice, however, has lagged behind the evidence. Barriers to implementation of this strategy necessitate further investigation, and caregiver and patient preferences represent an obstacle that has not been previously evaluated. This study sought to examine caregiver and patient treatment preferences and factors influencing care decisions for buckle fractures of the wrist. We hypothesized that the majority of caregivers and patients prefer cast immobilization for buckle fractures of the wrist. Methods: A 22-item caregiver survey was created to assess demographics, treatment preferences and influential factors. The survey was completed by a convenience sample of caregivers presenting with patients of any diagnosis to our pediatric orthopaedic clinic. Results: 297 surveys were collected predominantly from mothers (81.2%) caring for 2.4 (SD 1.3) children. Forty-one percent had previously cared for a child with a fracture. Caregivers accompanied patients who were 9.0+/-5.0-years-old, 34% of whom were actively being treated for an orthopaedic injury. Caregiver immobilization preferences for buckle fractures of the wrist were: no preference (43.1%), cast (32.3%) and splint (24.6%). The doctor's recommendation was the most influential factor on this decision while the child's gender was the least of the factors assessed. Those who rated treatment durability and child's activity level higher were associated with a preference for casting, while those who rated comfort higher were associated with a preference for splinting. Discussion: This study is the first to characterize caregiver preferences regarding immobilization devices in the realm of buckle fractures of the wrist. Findings identified that preferences are mixed, with the interest in casting being less than anticipated. Factors influencing caregiver preference include the doctor's recommendation, durability, the patient's activity level, and comfort. Findings can help guide treatment discussions for providers seeking to implement splint-based immobilization strategies.Level of Evidence: III.
Assuntos
Cuidadores , Moldes Cirúrgicos , Tomada de Decisões , Fraturas Ósseas/terapia , Preferência do Paciente , Contenções , Traumatismos do Punho/terapia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e QuestionáriosRESUMO
Herbarium specimens are increasingly recognized as an important resource for conservation science and virtual herbaria are making specimens freely available to a wider range of users than ever before. Few virtual herbaria are designed with conservation use as a primary driver. Exceptionally, Brazil's Reflora Virtual Herbarium (RVH) was created to increase knowledge and conservation of the Brazilian flora. The RVH is closely integrated with the Flora of Brazil 2020 platform on which Brazil's new national Flora is under construction. Both resources are accessible via the Reflora home page and thousands of users move seamlessly between these Reflora resources. To understand how the Reflora resources are currently used and their impact on conservation science, we conducted a literature review and an online survey. We searched for publications of studies in which Reflora resources were used and publications resulting from Brazilian researchers who were part of Reflora's research and mobility program. The survey contained multiple choice questions and questions that required a written response. We targeted Reflora webpage visitors with the survey to capture a wider range of Reflora users than the literature review. Reflora resources were used for a variety of conservation-relevant purposes. Half the 806 scientific publications in which Reflora was cited and 81% of the 1069 survey respondents accessing Reflora resources mentioned conservation-relevant research outputs. Most conservation-relevant uses of the Reflora resources in scientific publications were research rather than implementation focused. The survey of Reflora users showed conservation uses and impacts of virtual herbaria were more numerous and diverse than the uses captured in the literature review. Virtual herbaria are vital resources for conservation science, but they must document use and impacts more comprehensively to ensure sustainability.
Revalorización del Conocimiento sobre Conservación por Medio de Mayor Acceso a la Información Botánica Resumen Los especímenes de los herbarios son reconocidos cada vez más como un recurso importante para la ciencia de la conservación, y, como nunca antes, los herbarios virtuales están poniendo a los especímenes a libre disposición para una gama mucho más amplia de usuarios. Pocos herbarios virtuales están diseñados con el uso para la conservación como conductor primario. Excepcionalmente, se creó el Herbario Virtual Reflora de Brasil (RVH, en inglés) para incrementar el conocimiento y la conservación de la flora brasileña. El RVH está integrado cuidadosamente con la plataforma Flora de Brasil 2020, sobre la cual está bajo construcción la nueva flora nacional de Brasil. Se accede a ambos recursos a través de la página inicial de Reflora y miles de usuarios navegan continuamente entre estos recursos de la página. Para entender cómo se usan actualmente los recursos de Reflora así como su impacto sobre la ciencia de la conservación, realizamos una revisión de la literatura y una encuesta en línea. Buscamos las publicaciones de estudios que usaron los recursos de Reflora y las publicaciones elaboradas por investigadores brasileños que formaron parte del programa de investigación y movilidad de Reflora. La encuesta incluyó preguntas de opción múltiple y preguntas que requerían una respuesta escrita. Enfocamos la encuesta en los visitantes a la página web de Reflora para obtener una gama más amplia de usuarios de Reflora que la que obtendríamos sólo con la revisión de la literatura. Los recursos de Reflora se usaron para una variedad de propósitos relevantes para la conservación. La mitad de las 806 publicaciones científicas en las que se citó a Reflora y el 81% de los 1069 encuestados que acceden a los recursos de Reflora mencionaron resultados de investigación relevantes para la conservación. La mayoría de los usos relevantes para la conservación de los recursos de Reflora en las publicaciones científicas estuvieron más enfocados en la investigación que en la implementación. La encuesta para los usuarios de Reflora mostró que los usos e impactos de los herbarios virtuales fueron más numerosos y diversos que los usos capturados en la revisión de la literatura. Los herbarios virtuales son recursos vitales para la ciencia de la conservación, pero deben documentar su uso y sus impactos exhaustivamente para asegurar su sustentabilidad.
Assuntos
Conservação dos Recursos Naturais , Brasil , Inquéritos e QuestionáriosRESUMO
Regulators of chromatin structure and gene expression contribute to tumor formation and progression. The co-repressor CoREST1 regulates the localization and activity of associated histone modifying enzymes including lysine specific demethylase 1 (LSD1) and histone deacetylase 1 (HDAC1). Although several CoREST1 associated proteins have been reported to enhance breast cancer progression, the role of CoREST1 in breast cancer is currently unclear. Here we report that knockdown of CoREST1 in the basal-type breast cancer cell line, MDA-MB-231, led to significantly reduced incidence and diminished size of tumors compared to controls in mouse xenograft studies. Notably, CoREST1-depleted cells gave rise to tumors with a marked decrease in angiogenesis. CoREST1 knockdown led to a decrease in secreted angiogenic and inflammatory factors, and mRNA analysis suggests that CoREST1 promotes expression of genes related to angiogenesis and inflammation including VEGF-A and CCL2. CoREST1 knockdown decreased the ability of MDA-MB-231 conditioned media to promote endothelial cell tube formation and migration. Further, tumors derived from CoREST1-depleted cells had reduced macrophage infiltration and the secretome of CoREST1 knockdown cells was deficient in promoting macrophage migration and macrophage-mediated angiogenesis. Taken together, these findings reveal that the epigenetic regulator CoREST1 promotes tumorigenesis in a breast cancer model at least in part through regulation of gene expression patterns in tumor cells that have profound non-cell autonomous effects on endothelial and inflammatory cells in the tumor microenvironment.
Assuntos
Carcinogênese/patologia , Comunicação Celular , Neoplasias Mamárias Animais/metabolismo , Neoplasias Mamárias Animais/patologia , Proteínas do Tecido Nervoso/metabolismo , Proteínas Repressoras/metabolismo , Animais , Carcinogênese/metabolismo , Linhagem Celular Tumoral , Movimento Celular , Proteínas Correpressoras , Modelos Animais de Doenças , Feminino , Regulação Neoplásica da Expressão Gênica , Técnicas de Silenciamento de Genes , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Ativação de Macrófagos , Macrófagos/metabolismo , Neoplasias Mamárias Animais/irrigação sanguínea , Neoplasias Mamárias Animais/genética , Camundongos , Neovascularização Patológica/metabolismo , Proteínas do Tecido Nervoso/genética , Proteínas Repressoras/genética , Células Estromais/metabolismo , Células Estromais/patologia , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
OBJECTIVE: To assess whether parent training in behavioral intervention, combined with a 16-session nutrition and activity education program, would improve weight loss relative to nutrition and activity education alone in adolescents and young adults with Down syndrome. STUDY DESIGN: Twenty-one patients with Down syndrome aged 13-26 years with a body mass index ≥ 85 th percentile were enrolled and randomized to a 6-month nutrition and activity education intervention (n = 10) or to a nutrition and activity education+behaviorial intervention (n = 11), and followed for 6 months after the active intervention period (1-year follow-up). The primary outcome measure was body weight; secondary outcomes included percentage body fat by bioelectric impedance; intake of fruits, vegetables, and energy-dense low-nutrient snack food (treats) by 3-day food record; and moderate/vigorous physical activity by accelerometry. RESULTS: At 6 months, mean body weight in the nutrition and activity education+behavioral intervention group was 3.2 kg lower than that in the nutrition and activity education group (95% CI, 1.0-5.5 kg; P = .005). Mean group differences were sustained at 1 year (3.6 kg; 95% CI, 1.4-5.9 kg; P = .002). At 6 months, moderate/vigorous physical activity time increased by an average of 18 minutes/day compared with baseline in the nutrition and activity education+behavioral intervention group (P = .01) and decreased by 7 minutes/day in the nutrition and activity education group (P = .30). These changes were largely maintained at 1 year, but were not statistically significant. Vegetable intake in the nutrition and activity education+behavioral intervention group exceeded that in the nutrition and activity education group by a mean of 1.6 servings at 1 year (P = .009), but not at 6 months. No between-group differences were observed for percentage body fat or consumption of fruits or treats. CONCLUSION: Parent-supported behavioral intervention appears to be a successful adjunct to a 6-month nutrition education intervention in achieving weight loss in adolescents and young adults with Down syndrome.
Assuntos
Síndrome de Down/fisiopatologia , Poder Familiar , Apoio Social , Redução de Peso , Tecido Adiposo , Adolescente , Adulto , Composição Corporal , Índice de Massa Corporal , Peso Corporal , Síndrome de Down/psicologia , Comportamento Alimentar , Feminino , Frutas , Comportamentos Relacionados com a Saúde , Educação em Saúde , Humanos , Masculino , Pais , Resultado do Tratamento , Verduras , Adulto JovemRESUMO
OBJECTIVE: To assess the mortality experience of participants in the Third Harvard Growth Study (1922-1935) who provided ≥ 8 years of growth data. STUDY DESIGN: A total of 1877 participants provided an average of 10.5 body mass index measurements between age 6 and 18 years. Based on these measurements, the participants were classified as ever overweight or ever >85th percentile for height in childhood. Age at peak height velocity was used to indicate timing of overweight relative to puberty. Relative risks of all-cause and cause-specific mortality according to measures of childhood growth were estimated using Cox proportional hazards survival analysis. RESULTS: For women, ever being overweight in childhood increased the risks of all-cause and breast cancer death; the risk of death from ischemic heart disease was increased in men. Men with a first incidence of overweight before puberty were significantly more likely to die from ischemic heart disease; women in the same category were more likely to die from all causes and from breast cancer. CONCLUSION: We find evidence of long-term effects of having ever been overweight, with some evidence that incidence before puberty influences the pattern of risk.