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1.
Yasmine Yousef Etienne St-Louis Robert Baird Emily R. Smith Elena Guadagno Dickens St-Vil Dan Poenaru 《Journal of pediatric surgery》2019,54(4):831-837
Background
The Lancet Commission on Global Surgery highlighted global surgical need but offered little insight into the specific surgical challenges of children in low-resource settings. Efforts to strengthen the quality of global pediatric surgical care have resulted in a proliferation of partnerships between low-and middle-income countries (LMICs) and high-income countries (HICs). Standardized tools able to reliably measure gaps in delivery and quality of care are important aids for these partnerships. We undertook a systematic review (SR) of capacity assessment tools (CATs) focused on needs assessment in pediatric surgery.Methods
A comprehensive search strategy of multiple electronic databases was conducted per PRISMA guidelines without linguistic or temporal restrictions. CATs were selected according to pre-defined inclusion criteria. Articles were assessed by two independent reviewers. Methodological quality of studies was appraised using the COSMIN checklist with 4-point scale.Results
The search strategy generated 16,641 original publications, of which three CATs were deemed eligible. Eligible tools were either excessively detailed or oversimplified. None used weighted scores to identify finer granularity between institutions. No CATs comprehensively included measures of resources, outcomes, accessibility/impact and training.Discussion
The results of this study identify the need for a CAT capable of objectively measuring key aspects of surgical capacity and performance in a weighted tool designed for pediatric surgical centers in LMICs.Type of Study
Systematic Review.Level of Evidence
II. 相似文献2.
Christabel E. Fowler Elia Beniash Yasuo Yamakoshi James P. Simmer Henry C. Margolis 《European journal of oral sciences》2006,114(S1):297-303
An amorphous silica mineralization technique was used to produce inorganic/protein composites to elucidate the structure and mechanism of formation of amelogenin assemblies, which may play an important role in regulating enamel structure during the initial stages of amelogenesis. Full-length recombinant amelogenins from mouse (rM179) and pig (rP172) were investigated along with key degradation products (rM166 and native P148) lacking the hydrophilic C terminus found in parent molecules. The resulting products were examined using transmission electron microscopy and/or small-angle X-ray scattering. Using protein concentrations of 0.1–3 mg ml−1 , large monodisperse spheres of remarkably similar mean diameters were observed using rM179 (124 ± 4 nm) and rP172 (126 ± 7 nm). These spheres also exhibited 'internal structure', comprising nearly spherical monodisperse particles of ≈ 20 nm in diameter. In the presence of rM166, P148, and bovine serum albumin (control), large unstructured and randomly shaped particles (250–1000 nm) were observed. Without added protein, large dense spherical particles of silica (mean ≈ 500 nm) lacking internal structure were produced. These findings demonstrate that full-length amelogenins have the ability to form higher-order structures, whereas amelogenins that lack the hydrophilic C terminus do not. The results also suggest that full-length amelogenin can guide the formation of organized mineralized structures through co-operative interactions between assembling protein and forming mineral. 相似文献
3.
Monica Conciatori Christopher J Stodgell Susan L Hyman Melanie O'Bara Roberto Militerni Carmela Bravaccio Simona Trillo Francesco Montecchi Cindy Schneider Raun Melmed Maurizio Elia Lori Crawford Sarah J Spence Lucianna Muscarella Vito Guarnieri Leonardo D'Agruma Alessandro Quattrone Leopoldo Zelante Daniel Rabinowitz Tiziana Pascucci Stefano Puglisi-Allegra Karl-Ludvig Reichelt Patricia M Rodier Antonio M Persico 《Neuropsychopharmacology》2004,55(4):413-419
BACKGROUND: The HOXA1 gene plays a major role in brainstem and cranial morphogenesis. The G allele of the HOXA1 A218G polymorphism has been previously found associated with autism. METHODS: We performed case-control and family-based association analyses, contrasting 127 autistic patients with 174 ethnically matched controls, and assessing for allelic transmission disequilibrium in 189 complete trios. RESULTS: A, and not G, alleles were associated with autism using both case-control (chi(2) = 8.96 and 5.71, 1 df, p <.005 and <.025 for genotypes and alleles, respectively), and family-based (transmission/disequilibrium test chi(2) = 8.80, 1 df, p <.005) association analyses. The head circumference of 31 patients carrying one or two copies of the G allele displayed significantly larger median values (95.0th vs. 82.5th percentile, p <.05) and dramatically reduced interindividual variability (p <.0001), compared with 166 patients carrying the A/A genotype. CONCLUSIONS: The HOXA1 A218G polymorphism explains approximately 5% of the variance in the head circumference of autistic patients and represents to our knowledge the first known gene variant providing sizable contributions to cranial morphology. The disease specificity of this finding is currently being investigated. Nonreplications in genetic linkage/association studies could partly stem from the dyshomogeneous distribution of an endophenotype morphologically defined by cranial circumference. 相似文献
4.
Stefano Elia Gianluca Guggino Davide Mineo Gianluca Vanni Antonello Gatti Tommaso Claudio Mineo 《European journal of cardio-thoracic surgery》2005,28(2):312-7; discussion 317
OBJECTIVE: To verify the feasibility and compare the results of thoracoscopic sympathectomy under local anaesthesia (LA) and spontaneous breathing vs. general anaesthesia (GA) with one-lung ventilation. METHODS: Two groups of consecutive patients underwent one stage bilateral T2-T3 thoracoscopic sympathectomy under LA (n=15) and GA (n=30) by the same surgical team for treatment of primary palmar hyperhidrosis. The groups were homogeneous for relevant demographic, physiological and clinical data, including pulmonary function. In both groups, patient's satisfaction was evaluated 24h after surgery by a simple interview and scored into five grades (1=very poor to 5=excellent), while quality of life (QOL) was evaluated by SF-36 and Nottingham's Health Profile questionnaires before and 6 months after surgery. A cost comparison between groups concerning devices, drugs, global in operating room time, medical personnel and hospital stay was also carried out. RESULTS: No operative mortality was recorded. The overall in operating room time for the whole bilateral procedure under LA was 63.55+/-10.58 vs. 86.05+/-5.75 under GA (P<0.01) and temperature increased in all patients from a baseline of 25.42+/-0.56 up to 32.15+/-0.84 degrees C. All patients undergone LA were discharged the same day after a chest roentgenogram and a short stay in the outpatient clinic. Among them three patients (20%) experienced a minimal (<30%) pneumothorax that required no treatment, while five (33.3%) had a trunk compensatory sweating that spontaneously resolved on the long run. Patients undergoing GA were discharged after a mean stay of 1.38+/-0.6 days. Among these, eight (26.6%) had prolonged trunk compensatory sweating that did not persist longer than 3 months. At a follow-up of 7.16+/-2.97 months, QOL was significantly improved with no difference between groups. The overall rate of satisfaction was greater in the LA group (P<0.05). CONCLUSIONS: In our study, awake one stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis could be safely and effectively performed as an outpatient procedure in patients refusing GA. Postoperative quality of life was equal to that in patients undergone the same procedure under GA, while patient satisfaction was better and cost were significantly reduced. 相似文献
5.
Steven Elia Peter Liu Carol Chrusciel Alan Hilgenberg Charrisios Skourtis Demetrios Lappas 《Journal canadien d'anesthésie》1989,36(1):2-8
Global coronary blood flow and metabolism were measured in seven patients on the first postoperative day following coronary
revascularization to test the hypothesis that tracheal extubation produces adverse haemodynamic responses akin to those observed
during tracheal intubation. Regional coronary flow and metabolic measurements were made in five of the seven patients. Extubation
from a continuous positive airway pressure (CPAP) of 5 cm H2O was associated with a statistically significant rise in cardiac index from 3.44 ± 0.23 L · min-1 · m-2 to 3.73 ± 0.15L·min-1 ·m-2 related to an increase in stroke index, without significant changes in heart rate, mean arterial and pulmonary capillary
wedge pressure. Consequently the changes in myocardial oxygen consumption (8.52 ± 0.55 to 8.85 ± 0.93 ml · min-1) and coronary blood flow (172 ± 18 to 179 ± 17 ml·min-1) were less prominent than those reported during intubation, where substantial rises in myocardial oxygen consumption and
coronary flow occurred. Two patients experienced cardiac lactate production but there were no changes in systemic or coronary
haemodynamics, nor were there clinical or electrocardiographic signs of ischaemia. We conclude that extubation does not appear
to be associated with adverse systemic or coronary haemodynamic responses in patients following coronary bypass grafting.
However, the revascularized myocardium may remain vulnerable to anaerobic metabolism in the immediate postoperative period.
Pour savoir si comme ľintubation, ľextubation de la trachée provoque des perturbations hémodynamiques, on a mesuré le métabolisme
et la circulation coronarienne globale chez sept patients, au lendemain ďun pontage aorto-coronarien. On a aussi calculé les
valeurs régionales de ces mêmes variables pour cinq ďentre eux. Ľindex cardiaque de 3.44 ± 0.23 L · min-1 · m-2 sous pression positive en respiration spontanée (CPAP) de 5 cm. H2O s’est élevé à 3.73 ± 0.15 L · min-1 · m-2 post-extubation avec une augmentation significative du volume ďéjection. La fréquence cardiaque et les pressions artérielles
moyennes et capillaires pulmonaires n’ont pas changé. Ainsi ľaugmentation de la consommation ďoxygène du myocarde de 8.52
± 0.55 à 8.85 ± 0.93 ml · min-1 et celle du flot coronarien de 172 ± 18 à 179 ± 17 ml · min-1 ont été moindres que celles, importantes, déjà observées lors de ľintubation. On a noté chez deux patients une production
de lactate par le myocarde, sans changement de ľhémodynamic systémique et coronarienne non plus que de signe clinique ou électrocardiographique
ďischémie. Donc, après un pontage coronarien, ľextubation ne semble pas causer ďeffet néfaste sur les circulations systémique
et coronarienne, toutefois, le myocarde revascularisé peut demeurer sensible au métabolisme anaérobique. 相似文献
6.
Silvia Miano Oliviero Bruni Vincenzo Leuzzi Maurizio Elia Elisabetta Verrillo Raffaele Ferri 《Clinical neurophysiology》2004,115(4):938-945
OBJECTIVE: Sleep disturbances are frequent in Angelman syndrome (AS); however, beside the few studies which have investigated sleep disorders in AS by means of questionnaires, to our knowledge, no systematic polysomnographic recordings have been carried out in AS patients. The present study represents the first attempt to study sleep patterns of AS by polysomnography, to evaluate the influences of sleep on the paroxysmal electroencephalogram (EEG) patterns of AS and to assess the eventual age-related changes of sleep architecture and of sleep EEG abnormalities in children and adolescents with AS. METHODS: Fifteen children with AS (7 males and 8 females, mean age 7.2 years, range 3-16 years), attending the Sleep Center of the Department of Child Neurology and Psychiatry of the University of Rome 'La Sapienza' and the Sleep Research Centre of the Oasi Institute (IRCCS) of Troina were included and subdivided into two subgroups by age: subgroup 1, aged 3-5 years, and subgroup 2, aged 9-17 years. Two control groups of age-matched normal subjects were also included: one aged less than 8 years and another aged more than 8 years; additionally, two other groups of age-matched children with epilepsy and mental retardation of different origin, one aged less and one aged more than 9 years were taken into consideration. The statistical comparison between the sleep parameters obtained from the patients and those from the other groups was carried out by means of the non-parametric Kruskal-Wallis ANOVA and the Mann-Whitney U test. RESULTS: The most frequent EEG abnormality found in AS patients appeared to be the 2-3 c/s poorly defined spike/waves complexes. This pattern was influenced by sleep stages; the duration of the runs showed an increasing length with sleep deepening from sleep stage 1 to slow-wave sleep (SWS). Moreover, the 2-3 c/s bursts activity present in sleep stage 2 showed a slowing to 1-2 c/s during SWS. Regarding sleep architecture, in subjects with AS aged <8 year there was a significant reduction in sleep efficiency as compared to normal controls, while the percentage and duration of REM sleep was significantly lower and the percentage of SWS was significantly higher. REM sleep time was reduced in AS subjects aged >8 years than in normal controls. The comparison between AS groups and mental retardation with epilepsy groups did not show significant differences. CONCLUSIONS: Similarly to other types of genetically determined mental retardation syndromes, also subjects with AS seems to show important abnormalities of their sleep polysomnographic patterns. SIGNIFICANCE: This is the first study which reports, in detail, these abnormalities and opens a new path for further insight into the knowledge of additional sleep-related disturbances which are reported in sleep questionnaires by the caregivers of AS subjects. 相似文献
7.
Alfonso Fasano Antonio E Elia Arianna Guidubaldi Pietro A Tonali Anna Rita Bentivoglio 《Movement disorders》2007,22(4):564-566
We report a case of cervical dystonia occurring in a 33-year-old without personal history of movement disorder but with family history of essential tremor, primigravid, primiparous woman at 1 weeks' amenorrhea, resolved completely after delivery in the course of 3 months. Dystonia never recurred in the following 5 years. Several neurological disorders are known to occur or worsen during pregnancy. As far as we know, this is the second reported case of dystonia occurring during pregnancy, thus confirming that dystonia gravidarum represents a new entity and should be considered in women of reproductive age affected by dystonia, especially when presenting with rapid-onset cervical dystonia. 相似文献
8.
Luis Requena Evaristo Sánchez Yus Esther Jiménez Elia Roo 《Journal of cutaneous pathology》1994,21(6):541-548
Cutaneous carcinoma histopathologically resembling nasopharyngeal carcinoma has been termed lymphoepithelioma-like carcinoma of the skin. We present an additional example of this rare cutaneous neoplasm that was located on the left temple of an 83-year-old woman. Serology for Epstein-Barr virus was negative, and exploration of the nasopharyngeal region disclosed no abnormalities. Histopathologically, the neoplasm consisted of a relatively well-circumscribed, dermal-hypodermal nodule composed of irregular aggregates of epithelial cells with vesicular nuclei, some of them in mitosis, and scant cytoplasm. A dense lymphocytic infiltrate was present within the neoplastic aggregates, obscuring the epithelial component, and at scanning magnification, the lesion closely resembled cutaneous lymphoma or pseudolymphoma. There was local sebaceous differentiation. Immunohistochemistry showed positivity in the epithelial component for AE1/AE3 and AEB-903 cytokeratins and negativity for 8–18 cylokeratins. The inflammatory infiltrate was positive for leukocyte common antigen, UCHL-1, L-26, Leu-22, and OPD-4 in variable proportions. Scattered cells within this inflammatory infiltrate were also positive for S-100 protein, vimentin, HAM-56, and MAC-387. In situ hybridization investigations for the presence of Epstein-Barr virus genomic DNA yielded negative results. Lymphoepithelioma-like carcinoma of the skin is a distinct cutaneous neoplasm of unknown histogenesis, although some foci of adnexal differentiation have been found in some specimens. The possibility of cutaneous metastasis from occult nasopharyngeal carcinoma should be ruled out.
Requena L, Sánchez Yus E, Jiménez E, Roo E. Lymphoepithelioma-like carcinoma of the skin: A light-microscopic and immunohistochemical study. 相似文献
Requena L, Sánchez Yus E, Jiménez E, Roo E. Lymphoepithelioma-like carcinoma of the skin: A light-microscopic and immunohistochemical study. 相似文献
9.
The efficacy on bodyweight and the acceptability of a three month treatment with dexfenfluramine (Isoméride), combined with a prescribed diet, were evaluated in 336 women followed by a gynecologist for overweight. These women were divided into three groups, those in the sexually active age group (80%) and perimenopausal and post-menopausal women (20%) and had the following characteristics: mean bodyweight 80.2 +/- 0.6 kg; excess bodyweight 35.0 +/- 0.5% of theoretical ideal weight, mean bodyweight index = 30.6 +/- 0.2 kg/m2. Simultaneously with the weight loss, a study of the change in gynecological symptoms was carried out at each consultation and for each group. Investigation of the bodyweight showed that 80% of the patient who followed the treatment for three months lost weight, the mean loss being 7.2 kg or 41.9% of the initial excess weight. Simultaneously with this loss of weight, there was an improvement in the gynecological symptoms in all three groups. These symptoms included those seen in the premenstrual phase (sexually active age group) and menopause-related symptoms in the perimenopausal and post menopausal groups. The acceptability and safety of Isomeride were also confirmed in this study. 相似文献
10.
Isidoro Di Carlo Elia Pulvirenti Adriana Toro Giuseppe Corsale 《World journal of surgery》2009,33(3):520-525
Background Laparoscopic cholecystectomy is now indisputably the gold standard for managing most gallbladder diseases. However, subversion
of the Calot triangle anatomy cannot always be managed by laparoscopy and often requires a laparotomy conversion. This report
discusses our patients treated with our personal technique.
Methods Patients undergoing subtotal cholecystectomy performed by the same surgeon with a personal technique from January 1999 to
December 2007 were considered for the present study. Sex, age, symptoms, co-morbidities, diagnostic modality, time between
hospitalization and surgery, length of postsurgical hospitalization, morbidity and mortality, and follow-up were assessed.
Results Four men and six women, aged 23 to 88 years, were included. Every patient had symptoms of acute cholecystitis. Four patients
had had symptoms for an average of 2.5 days and six for an average of 5.1 h. All patients were studied by ultrasonography,
and seven underwent computed tomography. The operation was performed within 48 h in all patients. The average hospital stay
from surgery to discharge was different for patients who underwent primary open cholecystectomy (10 days, range 5–16 days)
and those having a conversion after a laparoscopic attempt (7.8 days, range 4–16 days). During the postoperative period only
one patient presented a self-limiting biliary leak. No postoperative mortality occurred. At follow-up, any recurrences of
stone in the biliary tract or newly formed pouch were recorded.
Conclusions The results suggest that this new approach can be considered effective in every instance of subversion of the normal anatomy
of Calot’s triangle. 相似文献