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Paolo De Simone Paola Carrai Lidiana Baldoni Stefania Petruccelli Laura Coletti Luca Morelli Franco Filipponi 《Liver transplantation》2005,11(9):1080-1085
We report the results of a retrospective review of the outpatient pretransplantation workup for United Network for Organ Sharing (UNOS) 3 patients adopted at a liver transplantation (LT) center and illustrate the efficiency indicators used for quality evaluation and cost-analysis. A single-center, pre-LT evaluation workup was performed on an outpatient basis at a cost per patient evaluation of 2,770 Euros (). Objective measures were: the number of patients admitted to and excluded from each phase of the algorithm; the rate of patients admitted to pre-LT evaluation out of the total of referred patients (the referral efficiency rate); the rate of waitlisted patients out of those admitted to pre-LT evaluation (the evaluation efficiency rate); the rate of waitlisted patients out of those referred for LT (the process efficiency rate); and the cost per waitlisted patient, as the ratio of the cost per patient evaluation to the evaluation efficiency rate. From January 1, 1996, to October 1, 2004, 1,837 patients were referred for LT on an outpatient basis. Based on preemptive evaluation of the available clinical data, 412 patients (22.4%) were excluded from pre-LT evaluation and 1,425 (77.6%) were admitted to preliminary consultation. Among these, 603 (42.3%) were excluded from and 822 (57.7%) were admitted to pre-LT evaluation with a referral efficiency rate of 44.7% (822 of 1,837). Out of the patients evaluated for LT, 484 were waitlisted with a cost-utility and evaluation efficiency rate of 58.8% each (484 of 822). Of the 1,837 patients originally addressed for LT 484 were waitlisted, yielding a process efficiency rate of 26.3% (484 of 1,837) and a cost per waitlisted patient of 4,710.8. In conclusion, the 3 indicators allowed monitoring of the efficiency of the pre-LT evaluation algorithm. The current process efficiency rate at our center is low (26.3%), but avoiding early referrals we might increase it to 31.6%, with a 12% net saving on costs per waitlisted patient (from 4,710.8 to 4,165.4). 相似文献
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乳腺管状小叶癌(Tubulolobular carcinoma,TLC)最初是被作为小叶癌的管状变型。作者总结了27例TLC的组织学、免疫表型和临床特征,并与纯小管癌和经典型小叶癌进行了比较。此组患者年龄43-79岁(中位年龄60岁)。1例双侧乳腺受累,5例病变为多灶性。肿瘤直径0.5-2.5cm,色灰褐,质硬。组织学观察:TLC的肿瘤细胞形成管状和条索状两种结构模式并相互混杂,且两者比例相当(统称为管状小叶模式)。 相似文献
5.
Germline mutations of the CDKN2 gene in UK melanoma families 总被引:4,自引:1,他引:4
Harland M; Meloni R; Gruis N; Pinney E; Brookes S; Spurr NK; Frischauf AM; Bataille V; Peters G; Cuzick J; Selby P; Bishop DT; Bishop JN 《Human molecular genetics》1997,6(12):2061-2067
Germline mutations in CDKN2 on chromosome 9p21, which codes for the cyclin
D kinase inhibitor p16, and more rarely, mutations in the gene coding for
CDK4, the protein to which p16 binds, underlie susceptibility in some
melanoma families. We have sequenced all exons of CDKN2 and analysed the
CDK4 gene for mutations in 27 UK families showing evidence of
predisposition to melanoma. Five different germline mutations in CDKN2 were
found in six families. Three of the mutations (Met53Ile, Arg24Pro and
23ins24) have been reported previously. We have identified two novel CDKN2
mutations (88delG and Ala118Thr) which are likely to be associated with the
development of melanoma, because of their co-segregation with the disease
and their likely functional effect on the CDKN2 protein. In binding assays
the protein expressed from the previously described mutation, Met53Ile, did
not bind to CDK4/CDK6, confirming its role as a causal mutation in the
development of melanoma. Ala118Thr appeared to be functional in this assay.
Arg24Pro appeared to bind to CDK6, but not to CDK4. No mutations were
detected in exon 2 of CDK4, suggesting that causal mutations in this gene
are uncommon. The penetrance of these mutant CDKN2 genes is not yet
established, nor is the risk of non-melanoma cancer to gene carriers.
相似文献
6.
Skin tumors induced in mice by initiation-promotion (2 microg DMBA-2 microg
TPA) protocols were found to be under multigenic control. Eighty- one N2
mice from the cross (BALB/cAnPt x SENCARA/Pt)F1 x SENCARA/Pt that were
either solidly resistant (no papillomas) or highly susceptible (> or = 7
papillomas/mouse) were subjected to a 'genome scan' using 89 microsatellite
markers to check for associations with susceptible and resistant
phenotypes. A locus on Chr 5 (Skts4) was found to control the
susceptibility of SENCARA/Pt mice and the resistance of BALB/cAnPt mice to
papilloma formation. In addition, higher than expected linkage scores were
seen for the markers D9Mit271, D11Mit268 and D12Mit56. Further work is
required to establish whether genes determining papilloma formation are
located in these regions of the genome. In general, no evidence was seen
for loss of heterozygosity in microsatellite markers on Chrs 5, 9 and 11 in
17 microdissected papillomas from (BALB/c x SENCARA)F1 hybrid mice.
相似文献
7.
Pietro Ciccorossi Anna Maria Maina Filippo Oliveri Stefania Petruccelli Gioacchino Leandro Piero Colombatto Francesco Moriconi Franco Mosca Franco Filipponi Ferruccio Bonino Maurizia Rossana Brunetto 《Liver international》2007,27(5):612-619
BACKGROUND: Early identification of patients at a higher risk of rapidly progressive recurrent hepatitis post liver transplantation (LT) could help to tailor antiviral therapy. METHODS: We studied the correlation between early post-LT viral load and the histological and clinical outcomes of 49 consecutive patients (34 males, median age 55 years) in whom viraemia was monitored at days 0, 1, 7, 30, 180 and 365 after LT. RESULTS: Hepatitis C recurred at histology in 38 of 42 (90.5%) patients. Early viral load after LT was higher in patients with rapidly progressive hepatitis C recurrence (day 7 median HCV-RNA levels: 5.84 vs 4.93 Log(10) IU/ml, P=0.003). Day 7 HCV-RNA levels >/=2.5 x 10(5) IU/ml, donor age >60 years and rejection episodes were independently associated with progression to cirrhosis within one year post-LT [P=0.018, odds ratio (OR) 27.59; P=0.043, OR 13.85 and P=0.048, OR 9.95, respectively]. Day 7 viraemia and rejection episodes were independently associated with 5-years survival. Day 7 viraemia, in combination with acute hepatitis and/or donor age, showed 80% sensitivity, 94% specificity and 90.5% diagnostic accuracy to identify severe recurrence. CONCLUSIONS: Early post-LT HCV-RNA correlates with the severity of hepatitis C recurrence and in combination with donor age (>60 years) and rejections, identifies patients with a high risk of severe recurrence and candidates of cost-effective pre-emptive antiviral therapy. 相似文献
8.
Phillip Staibano Mitch Winemaker Danielle Petruccelli Justin de Beer 《The Journal of arthroplasty》2014
Lower extremity osteoarthritis with concomitant low-back pain (LBP) may obscure a clinician’s ability to properly evaluate the status of hip or knee osteoarthritis and subsequent total joint arthroplasty (TJA) candidacy. A prospective cohort study was conducted to determine prevalence and severity of preoperative LBP among TJA patients, and the effect of TJA on alleviating LBP. Preoperative moderate to worst imaginable LBP pain on the Oswestry Disability Index (ODI) was significantly higher among hips compared to knees (28.8% vs. 16.1%, P < 0.0001). Compared to knees, hips also saw significant ODI improvement from preoperative to one-year postoperative. TJA candidates with considerable preoperative LBP should be counselled that TJA outcome may be impaired by the coexistence of spine disease, and that residual spine pain may continue following otherwise successful TJA. 相似文献
9.
Background
Overweight and obesity prevalence is rapidly rising in developing countries. The reading and understanding of nutrition information on food packages has been shown to improve food choices and instill healthy eating habits in individuals.Objective
The aim of this study was to describe the prevalence of food label usage and understanding among urban and rural adults in Zimbabwe and its association with demographic and socio economic factors.Methods
A cross sectional study was conducted on 320 adults (147 urban and 173 rural) using a validated questionnaire adapted from previous similar studies. Data were analysed using SPSS-17 statistical software.Results
A high proportion (77.2%) of the respondents read food labels. Food label reading differed significantly by educational status (p<0.05), employment status (p<0.05) and locality (p<0.05). Only 40.9% of food label readers mostly understood the information on the food labels. More urban shoppers (86.1%) read food labels than their rural counterparts (66.7%). A significant number of participants (80.6%) indicated they would like to be educated on the meaning of food labels and 80.3% preferred the nutrition information on food labels to be simplified.Conclusion
The study found above average reported reading of nutrition information on food labels with partial understanding. Efforts should be made to determine how all consumers could be made to understand the nutrition information on food labels and use it effectively in decision making. 相似文献10.
Cónsole GM Jurado SB Petruccelli M Carino M Calandra RS Gómez Dumm CL 《Neuroendocrinology》2002,75(5):316-325
Inhibition of prolactin (PRL) secretion has been previously shown in pituitaries from male and female hamsters exposed to short photoperiods. The purpose of the present study was to analyze the possible quantitative immunohistochemical and ultrastructural changes of PRL cells in male golden hamsters undergoing regression and spontaneous recrudescence, correlating the morphological findings with circulating PRL levels. Thus, adult male golden hamsters were exposed for 8, 16, 22 and 28 weeks to either short photoperiods (SP: 6 h light, 18 h darkness) or long photoperiods (LP: 14 h light, 10 h darkness). Pituitaries were processed for both light and electron microscopy, and serum levels of PRL were assessed by radioimmunoassay (RIA). Volume density (VD = cell area/reference area) and cell density (CD = number of cells/reference area) of lactotropes were measured with an image analysis system (Imaging Technology, Software Optimas 5.2). One hundred lactotropes were recorded for measuring several ultrastructural parameters. When analyzing the lactrotrope cell population from animals submitted to SP, the VD and CD were found to be significantly (p < 0.05) diminished with respect to those of the groups submitted to LP at weeks 8, 16 and 22. However, at week 28 a spontaneous recrudescence appeared. The lactotropes from animals submitted to LP for 8, 16, 22 and 28 weeks exhibited numerous large electrondense secretory granules. The rough endoplasmic reticulum (RER) presented some flat cisternae and numerous free ribosomes. Animals submitted to SP for 8 weeks showed a number of medium and large secretory granules, and the RER exhibited mainly numerous free ribosomes. In those animals submitted to SP for 16 and 22 weeks, lactotropes were found smaller and showed small and medium-sized secretory granules decreased in number. The Golgi complex exhibited some immature granules and dilated cisternae, while the RER did not present differences with respect to the 8-week SP group. The hamsters submitted to SP for 28 weeks presented medium and large secretory granules, and the RER exhibited dilated irregular cisternae. The ultrastructural morphometric parameters showed a decrease (p < 0.05) in the number of secretory granules and exocytotic profiles, as well as a diminution (p < 0.05) in the areas of Golgi complex, RER, secretory granules, and individual mean area of secretory granule during the 16 and 22 weeks of SP. Serum PRL levels were severely reduced under SP. This decrease was greater at 16 weeks than at 8 weeks of exposure. When hamsters were kept for 22 weeks under SP, PRL levels started their recovery. Thus, at the end of the experiment, the PRL values returned to near those of LP group. In summary, we found quantitative immunohistochemical and ultrastructural, as well as biochemical changes that suggest an inhibition of synthesis, storage and release of PRL in male golden hamsters submitted to SP, with a spontaneous recrudescence appearing at the end of the study. 相似文献