Early and late complications associated with transcatheter occlusion of secundum atrial septal defect

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Effects of high-impact exercise on the physical properties of bones of ovariectomized rats fed to a high-protein diet

The aim of this study was to evaluate the effects of high-impact physical exercise as a prophylactic and therapeutic means in osteopenic bones of rats submitted to ovariectomy and protein diet intake. A total of 64 Wistar rats were divided into eight groups (n=8 each), being: OVX, ovx, standard diet and sedentary; OVXE, ovx, standard diet and jump; OVXP, ovx, high-protein diet and sedentary; and OVXEP, ovx, high-protein diet and jump; SH, sham, standard diet and sedentary; SHE, sham, standard diet and jump; SHP, sham, high-protein diet and sedentary; and SHEP, sham, high-protein diet and jump. OVX surgery consists of ovariectomy, and sham was the control surgery. The jumping protocol consisted of 20 jumps/day, 5days/week. The bone structure was evaluated by densitometry, mechanical tests, histomorphometric, and immunohistochemical analyses. A high-protein diet resulted in increased bone mineral density (P=.049), but decreased maximal load (P=.026) and bone volume fraction (P=.023). The benefits of physical exercise were demonstrated by higher values of the maximal load in the trained groups compared to the sedentary groups (P<.001). The sham groups had decreased immunostaining of osteocalcin (P=.004) and osteopontin (P=.010) compared to ovx groups. However, the high-protein diet (P=.005) and jump exercise (P=.017) resulted in lower immunostaining of osteopontin compared to the standard diet and sedentary groups, respectively. In this experimental model, it was concluded that ovariectomy and a high-fat diet can negatively affect bone tissue and the high-impact exercise was not enough to suppress the deleterious effects caused by the protein diet and ovariectomy

Estudo biomecânico de ossos de ratas alimentadas com dieta hiperlipídica

O objetivo deste estudo foi avaliar os efeitos da alimentação hiperlipídica sobre o tecido ósseo de ratas. Cinquenta e duas ratas Wistar, pós-desmame, foram divididas em duas fases experimentais: estudo com ratas em crescimento (n=20) e estudo com ratas ovariectomizadas (n=32). Na primeira fase, as ratas foram divididas em 2 grupos: ração padrão (SD) e ração hiperlipídica (HFD), tendo duração de 5 semanas. Na segunda fase, as ratas foram divididas igualmente em 4 grupos: ração padrão e cirurgia simulada (SD-SH); ração padrão e ovariectomia (SD-OVX); ração hiperlipídica e cirurgia simulada (HFD-SH); ração hiperlipídica e ovariectomia (HFD-OVX). O período total do experimento foi de 18 semanas, sendo que na quinta semana foi realizado o procedimento cirúrgico. Após eutanásia os ossos foram retirados. Os fêmures foram analisados por expressão gênica dos genes PPAR-γ, Runx2, RANKL e Catepsina-K e as tíbias foram analisadas por microtomografia computadorizada, densitometria óssea e ensaios mecânicos. Na fase de crescimento, a dieta hiperlipídica promoveu aumento da expressão de PPAR-γ e DMO, e não alterou dados microestruturais e mecânicos. Na fase de castração, foi possível observar que a dieta hiperlipídica causou aumento da expressão de PPAR-γ e diminuição da expressão de Runx-2. Além disso, a dieta promoveu diminuição da DMO e espessura trabecular, embora não tenha modificado a resistência mecânica. Concluiu-se com o estudo que, durante o crescimento, a dieta hiperlipídica não causou alterações significantes aos ossos, mas após deficiência estrogênica foi capaz de exercer efeitos deletérios ao esqueleto

An empirical analysis of conviction patterns, change over the life-course and external influences in relation to sexual offending behaviour

This PhD uses statistical analysis and qualitative interviews to analyse behaviour patterns in the context of causal theories of sexual offending and desistance from it, with a particular emphasis on socio-cultural reasons why people offend, stop offending, or offend at different points in life. This research makes an original contribute to the literature in a number of ways. There are six main findings from this research that contribute to the literature in this area. One of the key findings is that there is substantial heterogeneity of offending behaviour amongst sexual offenders, suggesting that there is no one-size-fits-all approach for prevention, intervention or management. There was support in the research for a link between sexual offending and prolific non-sexual offending, but this only appeared to be one of several different sexual offending pathways. Other groups of offenders displayed considerable specialism in their offending (in terms of type of sexual offence and the fact that they had often only been convicted of sexual offences). This was magnified by the finding that offending rates were generally lower for sexual convictions than for other convictions: in fact, the vast majority of people in the dataset only had convictions for one sexual offence. There was evidence from the qualitative interviews that adverse life events were a contributory factor to sexual offending, and the thesis has found that there is support for both psychological and socio-cultural causes (including gender-based elements), as well as an interaction between the two. It also suggested that there is evidence that sexual offending is not stable over the life-course, and that situational factors appear to be important in terms of determining behavioural change. Implications for prevention, intervention and management of sexual offenders are discussed

Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort

background: In italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. the aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery. methods: a database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. the primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. the results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i. results: a total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). group a versus group B showed a significantly lower risk of postoperative duration of stay &gt;6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P &lt; 0.001). a mean postoperative duration of stay difference of 0.86 days was detected between groups. no difference was recorded between the two groups for all the other endpoints. conclusion: this study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery

Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

background current evidence concerning bowel preparation before elective colorectal surgery is still controversial. this study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation. methods a prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. the primary endpoints were AL, SSIs, and OM. all the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI). results compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23-2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10-1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25-0.79; p = .008). conclusions MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP