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61.
Background
We present the results of open reduction and internal fixation of intra-articular calcaneal fractures with Kirschner wires with some modifications.Material and methods
A longitudinal study was done on 37 patients who had fallen from certain heights; the study subjects were predominantly construction workers. Forty-seven fractures of the study subjects were treated using a modified approach that includes incision and some tips in operative technique. Details of modification and their evaluation on the basis of restoration of heel shape with special attention to the lateral wall, radiological assessment of Bohler’s angle, varus and valgus movement of the heel, pain while walking, patient satisfaction assessment upon return to pre-injury work are elaborated in this paper. Duration of study was from January 2000 to May 2011.Results
The fractures healed well with good radiological and functional outcomes, and patients returned to pre-injury work status in 4–6 months.Conclusion
The need to change to the Kocher approach for the treatment of calcaneal fracture with right-angled incision and elevation of the lateral flap is not necessary if the surgical tips showed in this paper are followed meticulously to achieve a good soft tissue outcome initially and, eventually, a good bony radiological and functional outcome. As implants used are very cheap and affordable to workers of low socioeconomic status, the authors have developed this method and presently believe that this method is best for all classes of patients with the said problem. 相似文献62.
Alexis Donneys Daniela M. Weiss Sagar S. Deshpande Salman Ahsan Catherine N. Tchanque-Fossuo Deniz Sarhaddi Benjamin Levi Steven A. Goldstein Steven R. Buchman 《BONE》2013,52(1):318-325
BackgroundMedically based efforts and alternative treatment strategies to prevent or remediate the corrosive effects of radiotherapy on pathologic fracture healing have failed to produce clear and convincing evidence of success. Establishing an effective pharmacologic option to prevent or treat the development of non-unions in this setting could have immense therapeutic potential. Experimental studies have shown that deferoxamine (DFO), an iron-chelating agent, bolsters vascularity and subsequently enhances normal fracture healing when injected locally into a fracture callus in long bone animal models. Since radiotherapy is known to impede angiogenesis, we hypothesized that the pharmacologic addition of DFO would serve to mitigate the effects of radiotherapy on new vessel formation in vitro and in vivo.Materials and MethodsIn vitro investigation of angiogenesis was conducted utilizing HUVEC cells in Matrigel. Endothelial tubule formation assays were divided into four groups: Control, Radiated, Radiated + Low-Dose DFO and Radiated + High-Dose DFO. Tubule formation was quantified microscopically and video recorded for the four groups simultaneously during the experiment. In vivo, three groups of Sprague–Dawley rats underwent external fixator placement and fracture osteotomy of the left mandible. Two groups received pre-operative fractionated radiotherapy, and one of these groups was treated with DFO after fracture repair. After 40 days, the animals were perfused and imaged with micro-CT to calculate vascular radiomorphometrics.ResultsIn vitro, endothelial tubule formation assays demonstrated that DFO mitigated the deleterious effects of radiation on angiogenesis. Further, high-dose DFO cultures appeared to organize within 2 h of incubation and achieved a robust network that was visibly superior to all other experimental groups in an accelerated fashion. In vivo, animals subjected to a human equivalent dose of radiotherapy (HEDR) and left mandibular fracture demonstrated quantifiably diminished μCT metrics of vascular density, as well as a 75% incidence of associated non-unions. The addition of DFO in this setting markedly improved vascularity as demonstrated with 3D angiographic modeling. In addition, we observed an increased incidence of bony unions in the DFO treated group when compared to radiated fractures without treatment (67% vs. 25% respectively).ConclusionOur data suggest that selectively targeting angiogenesis with localized DFO injections is sufficient to remediate the associated severe vascular diminution resulting from a HEDR. Perhaps the most consequential and clinically relevant finding was the ability to reduce the incidence of non-unions in a model where fracture healing was not routinely observed. 相似文献
63.
Deshpande Neha Kamble Parag Kulkarni Shravani Gawande Vandana 《Pharmaceutical Chemistry Journal》2020,53(12):1191-1199
Pharmaceutical Chemistry Journal - A stability indicating RP-HPLC method for the determination of nadolol was developed and validated using Enable C18 (250 mm × 4.6 mm, 5 μm) column with... 相似文献
64.
Deshpande LM Fritsche TR Jones RN 《Diagnostic microbiology and infectious disease》2004,49(4):231-236
The SENTRY Antimicrobial Surveillance Program was initiated in 1997 as a global network for the longitudinal tracking of antimicrobial resistance and has incorporated a molecular typing protocol to detect and monitor emerging resistances in participant medical centers. Isolates with similar resistance profiles and patient demographics that were temporally related or those exhibiting emerging resistance phenotypes were routinely compared. Isolates were initially analyzed using the automated Riboprinter Microbial Characterization System (Qualicon, Inc., Wilmington, DE). Isolates with identical ribotype patterns were further characterized by pulsed field gel electrophoresis. During 2001, a total of 647 bacterial isolates were processed using this typing protocol; 36% were Staphylococcus aureus with multidrug-resistant, mupirocin- or quinupristin/dalfopristin-resistant phenotypes. Five ribotypes were predominant in this species with some occurring on more than one continent (184.5), whereas others were restricted to a single geographic region (893.2). Among S. aureus, 51 clusters demonstrating dissemination among patients were identified (31 medical centers). Twenty-three outbreaks/clusters were found among Enterobacteriaceae producing either extended-spectrum beta-lactamases or demonstrating resistance to fluoroquinolones. Carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter spp. strains were also analyzed, some of which produced metallo-beta-lactamase enzymes. Clusters of carbapenem-resistant Acinetobacter were identified in Argentina and Israel, whereas metallo-beta-lactamase-producing P. aeruginosa epidemic strains were observed in Italy (three sites) and Brazil. The coupling of molecular epidemiologic investigations with global surveillance such as the SENTRY program adds significant value to participating medical centers and has proven to be effective in tracking changing trends and distribution of resistance genotypes both locally and globally. 相似文献
65.
Translational treatment paradigm for managing non‐unions secondary to radiation injury utilizing adipose derived stem cells and angiogenic therapy 下载免费PDF全文
Alexis Donneys MD MS Jordan T. Blough BS Noah S. Nelson BS Joseph E. Perosky MS Sagar S. Deshpande BS Stephen Y. Kang MD Peter A. Felice MD Christian Figueredo BS Jonathan R. Peterson BS Kenneth M. Kozloff PhD Benjamin Levi MD Douglas B. Chepeha MD Steven R. Buchman MD 《Head & neck》2016,38(Z1):E837-E843
66.
Tumoral calcinosis (TC) is a distinct pathologic entity of obscure etiology, characterized by soft tissue calcium deposition. We analyzed 64 cases retrieved from surgical records over the last 15 years, to assess the disease pattern and recognize the various stages of the evolution of this lesion. In our study, most patients were women (53/64 cases), 47 of whom were postmenopausal, aged 51-70 years, belonging to lower socioeconomic strata, and involved with household chores. The hip was the most frequently affected site. Repeated trauma probably triggered calcium chelation and deposition at this site. Histologically, 10 cases belonged to stage II and 54 cases to stage III. Fully developed lesions showed chips of calcium surrounded by thick fibrosis, mimicking calcified parasite like the Guinea worm. Precursor lesions seen at the periphery of the main lesion suggests a possible etiological role for trauma. Postmenopausal hormonal imbalance, along with poor nutrition and repeated trauma led to TC in our women population. Awareness of its evolution can lead to a better understanding of the disease with possible therapeutic implications. 相似文献
67.
Background
Asthma is an expensive chronic lung disease that affects 7% of U.S. adults and results in as many as 1.8 million emergency department (ED) visits each year. Pharmacists play an important role in managing asthma, including assessing control and monitoring disease progression, educating the patient about the disease and associated treatments, and ensuring safe and cost-effective medication use. However, comprehensive studies that account for the complex relationships between factors impacting asthma-related ED visits are lacking in the adult asthma population.Objective
To explore the complex relationships between asthma control, medication use, co-morbid conditions, minority status, environment and asthma-related ED visits using a path analysis approach.Methods and materials
Data for this study were obtained from the 2012 Behavioral Risk Factor Surveillance System's Asthma Call Back Survey. Current asthmatics 18 and older were included in the sample. Path analysis was used to evaluate the direct effects of the independent variables on asthma-related ED visits, as well as the indirect effects mediated through asthma control, health status, and daily use of inhaled corticosteroids.Results
Having controlled asthma (β = ?0.153, p < 0.01) and good health status (β = ?0.133, p < 0.01) were associated with significantly fewer ED visits. Good health status was associated with daily use of inhaled corticosteroids, which in turn was associated with better asthma control. Hispanic ED use was mediated by asthma control (β = ?0.067, p < 0.05), while African American ED use was mediated by health status (β = 0.050, p < 0.05).Conclusion
These findings suggest that there may be race/ethnicity specific factors that may be targeted to reduce asthma-related ED visits in minority populations. 相似文献68.
VKS Kalyani Ashutosh Dayal Vidya Chelerkar Madan Deshpande Anwesha Chakma 《Indian journal of ophthalmology》2020,68(11):2435
Purpose:To assess the impact of primary glaucoma of varying severity and duration on psychosocial functioning and quality of life of patients.Methods:A cross-sectional observational study was carried on 200 patients attending the glaucoma clinic of a tertiary care hospital in western India. After obtaining approval from the institutional ethics committee, written informed consent was taken. All patients underwent a thorough ophthalmic examination. Those with primary glaucoma were classified as per Hodapp–Parrish–Anderson criteria and asked to respond to the National Eye Institute Visual Function Questionnaire (NEIVFQ)-25 questionnaire. Responses were analyzed statistically.Results:Overall mean NEIVFQ 25 composite score was 74.4 ± 18.6. Mean scores were 87.0 (SD 7.2) for mild, 75.9 (SD 8.1) for moderate, and 47.0 (SD 13.7) for severe glaucoma groups. Lower scores were associated with males. Driving (62.2, SD 34.6) and ocular pain (63.5, SD 18.7) were maximally affected while color vision (90.1, SD 18.7) and social health (86.7, SD 20.1) were least affected. The duration of treatment had no effect on mean composite scores with impaired scores seen even in newly diagnosed cases. Age of the patient negatively correlated with NEIVFQ 25 composite score.Conclusion:With disease progression, the psychosocial functioning of the patients is negatively affected. This effect is irrespective of treatment duration and newly diagnosed cases can have impaired Quality of life scores. Quantification of psychosocial status along with education and counseling for all patients may play a definitive role in customizing treatment and providing patients with a better quality of Life. 相似文献
69.
Andrew X. Zhu MD Darrell R. Borger MD Yuhree Kim MD David Cosgrove MD Aslam Ejaz MD Sorin Alexandrescu MD Ryan Thomas Groeschl MD Vikram Deshpande MD James M. Lindberg MD Cristina Ferrone MD Christine Sempoux MD Thomas Yau MD Ronnie Poon MD Irinel Popescu MD Todd W. Bauer MD T. Clark Gamblin MD Jean Francois Gigot MD Robert A. Anders MD Timothy M. Pawlik MD MPH PhD 《Annals of surgical oncology》2014,21(12):3827-3834
Background
The molecular alterations that drive tumorigenesis in intrahepatic cholangiocarcinoma (ICC) remain poorly defined. We sought to determine the incidence and prognostic significance of mutations associated with ICC among patients undergoing surgical resection.Methods
Multiplexed mutational profiling was performed using nucleic acids that were extracted from 200 resected ICC tumor specimens from 7 centers. The frequency of mutations was ascertained and the effect on outcome was determined.Results
The majority of patients (61.5 %) had no genetic mutation identified. Among the 77 patients (38.5 %) with a genetic mutation, only a small number of gene mutations were identified with a frequency of >5 %: IDH1 (15.5 %) and KRAS (8.6 %). Other genetic mutations were identified in very low frequency: BRAF (4.9 %), IDH2 (4.5 %), PIK3CA (4.3 %), NRAS (3.1 %), TP53 (2.5 %), MAP2K1 (1.9 %), CTNNB1 (0.6 %), and PTEN (0.6 %). Among patients with an IDH1-mutant tumor, approximately 7 % were associated with a concurrent PIK3CA gene mutation or a mutation in MAP2K1 (4 %). No concurrent mutations in IDH1 and KRAS were noted. Compared with ICC tumors that had no identified mutation, IDH1-mutant tumors were more often bilateral (odds ratio 2.75), while KRAS-mutant tumors were more likely to be associated with R1 margin (odds ratio 6.51) (both P < 0.05). Although clinicopathological features such as tumor number and nodal status were associated with survival, no specific mutation was associated with prognosis.Conclusions
Most somatic mutations in resected ICC tissue are found at low frequency, supporting a need for broad-based mutational profiling in these patients. IDH1 and KRAS were the most common mutations noted. Although certain mutations were associated with ICC clinicopathological features, mutational status did not seemingly affect long-term prognosis. 相似文献70.