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41.
Peter Lovrics MD Nicole Hodgson MD Mary Ann O’Brien PhD Lehana Thabane PhD Sylvie Cornacchi MSc Angela Coates MEd Barbara Heller MD Susan Reid MD Kenneth Sanders MD Marko Simunovic MD 《Annals of surgical oncology》2014,21(7):2181-2187
Background
Gaps in breast cancer (BC) surgical care have been identified. We have completed a surgeon-directed, iterative project to improve the quality of BC surgery in South-Central Ontario.Methods
Surgeons performing BC surgery in a single Ontario health region were invited to participate. Interventions included: audit and feedback (A&F) of surgeon-selected quality indicators (QIs), workshops, and tailoring interviews. Workshops and A&F occurred yearly from 2005–2012. QIs included: preoperative imaging; preoperative core biopsy; positive margin rates; specimen orientation labeling; intraoperative specimen radiography of nonpalpable lesions; T1/T2 mastectomy rates; reoperation for positive margins; sentinel lymph node biopsy (SLNB) rates, number of sentinel lymph nodes; and days to receive pathology report. Semistructured tailoring interviews were conducted to identify facilitators and barriers to improved quality. All results were disseminated to all surgeons performing breast surgery in the study region.Results
Over 6 time periods, 1,828 BC charts were reviewed from 12 hospitals (8 community and 4 academic). Twenty-two to 40 participants attended each workshop. Sustained improvement in rates of positive margins, preoperative core biopsies, specimen orientation labeling, and SLNB were seen. Mastectomy rates and overall axillary staging rates did not change, whereas time to receive pathology report increased. The tailoring interviews concerning positive margins, SLNB, and reoperation for positive margins identified facilitators and barriers relevant to surgeons.Conclusions
This surgeon-directed, regional project resulted in meaningful improvement in numerous QIs. There was consistent and sustained participation by surgeons, highlighting the importance of integrating the clinicians in a long-term, iterative quality improvement strategy in BC surgery. 相似文献42.
Matteo Corvino Antonio Tessitore Carlo Minganti Marko Sibila 《Journal of Sports Science and Medicine》2014,13(2):297-303
The aim of this study was to investigate the effect of three different court dimensions on the internal and external load during small-sided handball games. Six male amateur handball players took part in this study and participated in three different 8-min 3vs3 (plus goalkeepers) small-sided handball games (each repeated twice). The three court dimensions were 12×24m, 30×15m and 32×16m. Through Global Positioning System devices (SPI pro elite 15Hz, GPSports) and video analysis, the following parameters were recorded: cyclic and acyclic movements (distance covered and number of technical actions executed), heart rate, and rating of perceived exertion (RPE). Total distance travelled increased with court dimensions (885.2m ± 66.6m in 24×12m; 980.0m ± 73.4m in 30×15m; 1095.0m ± 112.9m in 32×16m, p < 0.05). The analysis of distance covered in the four speed zones (0–1.4 m·s-1; 1.4–3.4 m·s-1; 3.4–5.2 m·s-1; >5.2 m·s-1) highlighted substantial differences: playing with the 30×15m court in comparison to the 24×12m, the players covered less distance in the first speed zone (p = 0.012; ES = 0.70) and more distance in the second (p = 0.049; ES = 0.73) and third (p = 0.012; ES = 0.51) speed zones. Statistical differences were also found between the 24×12m and 32×16m courts: the players covered more distance in the second and third speed zones (p = 0.013, ES = 0.76; p = 0.023 ES = 0.69) with the 32×16m court in comparison to the 24×12m. There was no significant effect of court dimensions on the technical parameters (number of team actions, passes, piston movements toward goal and defensive activities), the number of specific handball jumps and changes of direction, and the time spent in the different heart rate zones. Considering the average data of all the experimental conditions together (24×12m, 30×15m, 32×16m), a pronounced statistical difference was highlighted between the values in first two HR zones and the last two (p < 0.05; large ES). The rating of perceived exertion was significantly higher during the drill with the 32×16m court compared with the 24×12m one (p < 0.05; ES = 2.34). Our findings indicate that changing court dimensions during small-sided handball games can be used to manipulate both external and internal loads on the players.
Key points
- To cover the specific game demands, more specific training methodologies have been developed in many sport games.
- Specific game exercises may provide a useful conditioning stimulus, together with technical and tactical training components.
- Changing court dimensions during small-sided handball games can be used to manipulate both external and internal loads on the players.
- The high ratio of cyclic activity per minute and the high HR values recorded during SSHGs make this type of drills extremely useful for aerobic power training.
43.
Jelena Nedeljkovi?-Trailovi? Sa?a Trailovi? Radmila Resanovi? Dragan Mili?evi? Milijan Jovanovic Marko Vasiljevic 《Toxins》2015,7(4):1174-1191
The aim of our study was to determine the efficacy of three different adsorbents, inorganic (modified zeolite), organic (esterified glucomannans) and mixed (inorganic and organic components, with the addition of enzymes), in protecting broilers from the toxic effects of ochratoxin A in feed. Broilers were fed diets containing 2 mg/kg of ochratoxin A (OTA) and supplemented with adsorbents at the recommended concentration of 2 g/kg for 21 days. The presence of OTA led to a notable reduction in body weight, lower weight gain, increased feed conversion and induced histopathological changes in the liver and kidneys. The presence of inorganic, organic and mixed adsorbents in contaminated feed only partially reduced the negative effects of OTA on the broiler performances. Broilers that were fed with adsorbent-supplemented feed reached higher body weight (17.96%, 19.09% and 13.59%), compared to the group that received only OTA. The presence of adsorbents partially alleviated the reduction in feed consumption (22.68%, 12.91% and 10.59%), and a similar effect was observed with feed conversion. The applied adsorbents have also reduced the intensity of histopathological changes caused by OTA; however, they were not able to prevent their onset. After the withdrawal of the toxin and adsorbents from the feed (21–42 days), all previously observed disturbances in broilers were reduced, but more remarkably in broilers fed with adsorbents. 相似文献
44.
Eric J. Koch Clotilde Bongrand Brittany D. Bennett Susannah Lawhorn Silvia Moriano-Gutierrez Marko Pende Karim Vadiwala Hans-Ulrich Dodt Florian Raible William Goldman Edward G. Ruby Margaret McFall-Ngai 《Proceedings of the National Academy of Sciences of the United States of America》2020,117(44):27578
45.
Neurotrophic factor intervention restores auditory function in deafened animals 总被引:16,自引:0,他引:16 下载免费PDF全文
Shinohara T Bredberg G Ulfendahl M Pyykkö I Olivius NP Kaksonen R Lindström B Altschuler R Miller JM 《Proceedings of the National Academy of Sciences of the United States of America》2002,99(3):1657-1660
A primary cause of deafness is damage of receptor cells in the inner ear. Clinically, it has been demonstrated that effective functionality can be provided by electrical stimulation of the auditory nerve, thus bypassing damaged receptor cells. However, subsequent to sensory cell loss there is a secondary degeneration of the afferent nerve fibers, resulting in reduced effectiveness of such cochlear prostheses. The effects of neurotrophic factors were tested in a guinea pig cochlear prosthesis model. After chemical deafening to mimic the clinical situation, the neurotrophic factors brain-derived neurotrophic factor and an analogue of ciliary neurotrophic factor were infused directly into the cochlea of the inner ear for 26 days by using an osmotic pump system. An electrode introduced into the cochlea was used to elicit auditory responses just as in patients implanted with cochlear prostheses. Intervention with brain-derived neurotrophic factor and the ciliary neurotrophic factor analogue not only increased the survival of auditory spiral ganglion neurons, but significantly enhanced the functional responsiveness of the auditory system as measured by using electrically evoked auditory brainstem responses. This demonstration that neurotrophin intervention enhances threshold sensitivity within the auditory system will have great clinical importance for the treatment of deaf patients with cochlear prostheses. The findings have direct implications for the enhancement of responsiveness in deafferented peripheral nerves. 相似文献
46.
47.
Steffi Silling Ulrike Wieland Marko Werner Herbert Pfister Anja Potthoff Alexander Kreuter 《Emerging infectious diseases》2014,20(1):142-145
Human papillomavirus (HPV) XS2 was isolated from warts on an immunosuppressed patient. After HPV vaccination, the warts resolved. HPVXS2 was also found in warts and normal skin of HIV-positive patients and rarely in HIV-negative controls. Further studies should elucidate the mechanisms that lead to wart clearance. 相似文献
48.
49.
Giuseppe De Luca Arnoud W. J. van’t Hof Kurt Huber C. Michael Gibson Francesco Bellandi Hans-Richard Arntz Mauro Maioli Marko Noc Simona Zorman Gioel Gabrio Secco Uwe Zeymer H. Mesquita Gabriel Ayse Emre Donald Cutlip Tomasz Rakowski Maryann Gyongyosi Dariusz Dudek 《Heart and vessels》2014,29(1):15-20
Despite mechanical reperfusion, the outcome is still unsatisfactory in elderly patients with ST-segment elevation myocardial infarction (STEMI). The vast majority of studies have been conducted without extensive use of glycoprotein (Gp) IIb–IIIa inhibitors, which have been associated with improved perfusion and survival. Thus the aim of the current study was to evaluate the impact of age on the angiographic and clinical outcome patients with STEMI undergoing primary angioplasty with Gp IIb–IIIa inhibitors. Our population is represented by a total of 1,662 patients undergoing primary angioplasty for STEMI included in 11 randomized trials comparing early versus late administration of Gp IIb–IIIa inhibitors. Myocardial perfusion was evaluated by myocardial blush grade and ST-segment resolution. Follow-up data were collected between 30 days and 1 year after primary angioplasty. A total of 231 (13.9 %) patients were older than 75 years. Elderly patients showed a larger prevalence of female gender, hypertension, and diabetes, more advanced Killip class at presentation and longer time to treatment, but a smaller prevalence of smoking. All patients were treated with GP IIb–IIIa inhibitors. Elderly patients showed a significantly impaired postprocedural thrombolysis in myocardial infarction (TIMI) flow (TIMI 0–2: 17.7 vs 10.3 %, P = 0.002) and myocardial perfusion (myocardial blush grade 0–1: 38.3 vs 26.5 %, P = 0.001), and higher prevalence of distal embolization (19.2 vs 9.8 %, P < 0.001), whereas no difference was observed in terms of ST-segment resolution. At follow-up, elderly patients showed a significantly higher mortality (3.2 vs 11.0 %, hazard ratio (HR) (95 % confidence interval (CI)) = 3.78 (2.31–6.16), P < 0.001), which was confirmed after adjustment for baseline confounding factors (HR (95 % CI) = 5.01 (2.63–9.55), P < 0.0001). This study showed that among patients with STEMI undergoing primary angioplasty, advanced age is an independent predictor of mortality after primary angioplasty. Higher rates of distal embolization and poor myocardial perfusion, in addition to the worse risk profile, contribute toward explaining the impact of aging on mortality. 相似文献
50.
Björn Löppenberg Christian von Bodman Marko Brock Florian Roghmann Joachim Noldus Rein Jüri Palisaar 《Quality of life research》2014,23(10):2743-2756