172 research outputs found
Towards 'Trade Policy Analysis 2.0': From National Comparative Advantage to Firm-Level Trade Data
Evaluation of necessity and efficiency of nonoperative vs operative management in polytrauma patients with hepatic injuries
Clinica Chirurgie N1 „N.Anestiadi”, Clinica ATI „V.Ghereg”, USMF „N.Testemițanu” , CNȘPMU, Chișinău, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Material şi metodă: S-au cercetat 2 loturi de traumatism hepatic (TH): I lot-nonperator (n=46), II lot-operator (n=14) prin suturare, criteriul de includere
fiind TH închis de gr. I-III AAST. În ambele loturi au prevalat bărbații 5:1 vs 6:1. 100% traumatism asociat, mai frecvent toracele 75,4% vs 65%,
locomotor înregistrându-se în jumătate din cazuri (47,8%vs50%). Rata de deces a constituit 6,52% (n=3) vs 6,52% (n=1) din cauza traumatismului
cerebral (GCS=10,67±2,08 vs 9). Rezultate: În lotul I instabili hemodinamic din cauza leziunilor asociate au fost 15 (32,61%) vs 2 (14,28%). Severitatea
TH în ambele loturi a fost dominată de gr. II-III, doar 6% fiind gr. I, cu medii ISS și RTS similare. USG-FAST a fost pozitivă la câte 40%. Volumul de
hemoperitoneu a fost 275±221 vs 271±112 ml. Laparoscopia diagnostică pentru concretizarea tacticii s-a efectuat în 15(32,6%) vs 6(42,86%). Valori
crescute ale transaminazelor hepatice se înregistrează la câte 70% pacienți cu medii 3,61±4,1 vs 3,33±3,11mmol/l, dar cu menținere la a 5 zi în I lot
doar la 29% cu media 2,34±2,86, iar în lotul II la 50% cu media 3,89±2,87. În lotul I n-au fost complicații specifice precoce, în lotul II au constituit
14,28% (n=3) – supurația plăgii, biliragie, abces subfrenic, ultimul necesitând relaparotomie. Durata de spitalizare a fost 13,07±14,08 vs 18,07 ±11,5 zile.
Concluzii: Leziunile hepatice de gr. I-III pot fi rezolvate nonoperator. Laparoscopia nu este instrumentul necesar argumentării tacticii nonoperatorii,
aceasta efectuându-se mai frecvent în lotul operat, instabili hemodinamic prevalând în cel nonoperator. Raportul diminuării enzimelor de citoliză
relevă doar o traumatizare suplimentară a țesutului hepatic după actul operator. Prezența complicațiilor specifice precoce în lotul operat confirma
inutilitatea laparotomiilor nonterapeutice, argumentând avantajul abordării nonoperatorii.Material and method: 2 groups of patients with hepatic injuries (HI) were studied: Ist group – nonoperativelly (n=46), IInd group – surgically (n=14)
by suturing, as inclusion criteria – HI of I-III degrees AAST. In both groups men prevailed 5:1 vs 6:1. 100% associated trauma, more frequent thorax
75,4% vs 65%, musculo-skeletal system recorded in half of cases (47,8% vs 50%). Death rate was 6,52% (n=3) vs 6,52% (n=1) due to brain injury
(GCS=10,67±2,08 vs 9).Results: In the Ist group hemodinamically unstable were 15 (32,61%) vs 2 (14,28%) due to associated injuries. II -III degree injuries
prevailed in both groups, only 6% of Ist degree with similar ISS and RTS. In both groups positive FAST was in 40%. The volume of hemoperitoneum
was 275±221 vs 271±112ml. Diagnostic laparoscopy in problematic patients was carried out in 15 (32,6%) vs 6 (42,86%). High values of aminopherases
were established in 70% in both groups with median values 3,61±4,1 vs 3,33±3,11mmol/l, but persisting in the 5th day in Ist group only 29%, median
value 2,34±2,86, and 50% in IInd group, median 3,89±2,87. In Ist group no early specific complications occurred, in the IInd group were 14,28% (n=3)
– wound suppuration, bile leakage, subdiaphragmatic abscess which required relaparotomy. Mean hospital stay was 13,07± 14,08 vs 18,07 ±11,5 days.
Conclusions: Hepatic injuries of Ist-IIIrd degrees can be solved nonoperativelly. Laparoscopy is not the appropriate tool for reasoning NOM selection;
it was applied more frequent in the operated group, hemodinamically unstable prevailing in nonoperative group. The reduction rate of aminopheras
values reveals just an extra trauma to the hepatic parenchyma during surgery. The presence of early specific complications in the operated group confirms
the uselessness of nontherapeutic laparotomy, but argues on the advantages of nonoperative management
The Impact of Mixing Modes on Reliability in Longitudinal Studies
Mixed-mode designs are increasingly important in surveys, and large longitudinal studies are progressively moving to or considering such a design. In this context, our knowledge regarding the impact of mixing modes on data quality indicators in longitudinal studies is sparse. This study tries to ameliorate this situation by taking advantage of a quasi-experimental design in a longitudinal survey. Using models that estimate reliability for repeated measures, quasi-simplex models, 33 variables are analyzed by comparing a single-mode CAPI design to a sequential CATI-CAPI design. Results show no differences in reliabilities and stabilities across mixed modes either in the wave when the switch was made or in the subsequent waves. Implications and limitations are discussed. </jats:p
Conclusions of nonoperative management in blunt splenic injuries
USMF “N. Testemiţanu”, Clinica Chirurgie Nr.1 “N. Anestiadi”, Clinica ATI „V. Ghereg”, Chişinău, Republica Moldova, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Material şi metode: Studiul prospectiv(2008-2011) – 60 traumatizați cu Leziuni Lienale(LL ) închise; B:F/2:1, vârsta medie 39.97±20,35ani; RTS=7,66±0,5;
ISS=19,06±8,95. S-a efectuat: USG(100%) de primă intenție în diagnosticarea hemoperitoneului, TC(80%), laparoscopia(20,27%). În 21(35%) cazuri LL
a fost izolată, în 39(65%) – asociată. Rezultate: 13(21,66%) pacienți cu PAs≤80mmHg – 11 politraumatizați cu LL: gr.II(7) și III(5) şi fracturi pelviene,
2 pacienți cu LL izolată s-au stabilizat prin repleție volemică fără suport vasotensiv. Trei politraumatizați cu Glasgow ≤12p. şi LL gr.II(2), gr.III(1), (în
2 cazuri instabili hemodinamic) au fost soluționați nonoperator. Severitatea LL(AAST): gr.I-9(15%), gr.II-24(40%), gr.III-25(41,67%), gr.IV-2(3,33%),
cele severe constituind 45%. Hemoperitoneul în LL gr.III a constituit 581,25±158,88ml (400-1000ml), în gr.II – 67,65±113,11ml (p<0,001). Volumul
hemotransfuziei în LL gr.III asociate cu locomotor şi/sau torace a fost semnificativ mai mare vs pacienții cu gr.III izolat (648,67±49ml vs 283,33±51ml;
p<0,001), iar în gr.II asociat valoarea hemotransfuziei a fost 452,5±379ml în raport cu 0 transfuzii în cele izolate (p<0,05). Eşec s-a înregistrat în 6(10%) cazuri: în 5(8,3%) din cauza LL cu hemoperitoneu 1400±200ml (gr.III(2) cu ruptură în doi timpi, gr.IV(2) izolată cu hemoragie prelungită, gr.II(1) cu
pseudoanevrism lienal) şi una(1,66%) din cauza perforației jejunului, splina fiind păstrată. Concluzii: LL de gr.I-III izolate, cât şi asociate pot fi rezolvate
cu succes, cele de gr.IV necesită o monitorizare complexă riguroasă. Scăderea hematocritului şi hemotransfuziile prelungite la politraumatizați nu pot
prezice nereuşita MNO. Volumul şi extinderea hemoperitoneului poate fi un criteriu orientativ de prognostic al eşecului MNO, însă la volume mai
mari de 500ml. Lipsa conştiinței nu este un criteriu de evitare a MNO, laparoscopia în aceste condiții ar putea concretiza reuşita opțiunii.Material and methods: Prospective study(2008-2011) on 60 patients with blunt Splenic Injuries(SI): M:F/2:1, mean age 39,27±20,35 years, 21(35%)-isolated
SI, 39(65%)- associated, RTS=7,66±0,5; ISS=19,06±8,95. Diagnostic tools: USG in 100%, CT in 48(80%), laparoscopy in 16(20,27%); Results:
13(21,66%) patients with SBP≤80mmHg: 11 polytrauma patients–IInd degree 7, IIIrd dgr.–5 (SI with pelvic trauma), 2 patients with isolated SI, all
were stabilized by fluid perfusions, without vasoactive support. 3 polytrauma patients: II nd dgr.-2, III rd dgr.-1, with GCS≤12p. were successfully treated
nonoperatively. The severity of SI(AAST) revealed: Istdgr.-9(15%), IInddgr.- 24(40%), IIIrddgr.-25(41,67%), IVthdgr.-2(3.33%), IIIrd degree prevailed,
severe injuries being determined in 45%. Hemoperitoneum volume in IIIrd dgr. SI was 581,25±158,88(400-1000ml), in IInddgr.- 67,65±113,11ml
(p<0,001). The blood transfusion volume in IIIrddgr. associated SI with thorax or musculo-skeletal trauma was significantly higher vs isolated SI
(648,67±49ml vs 283,33±51ml, p<0,001), while in IInddgr. associated SI the average volume of blood transfusion was 452,5±379ml in contrast to 0
transfusions in isolated SI(p<0,05). NOM failure reported in 6(10%) cases: in 5(8,3%) because of SI with hemoperitoneum 1400±200ml (IIIrddgr.
(2)-delayed splenic rupture, IVthdgr.(2)-isolated SI with prolonged bleeding, IInddgr.(1)-lienal pseudoaneurism) and 1(1,66%) failure case caused
by jejunal rupture, the spleen being preserved.Conclusions: Both isolated and associated Ist-IIIrddgr. SI can be treated nonoperatively, IVthdgr. SI
requiring close and complex monitoring. Reduction of haematocrit and expanded blood transfusions in polytrauma patients could not predict NOM
failure. The volume and extent of hemoperitoneum could serve as a failure index of NOM when it exceeds 500ml. Lack of awareness is not a criterion
to avoid NOM, laparoscopy reflecting the success of the option
Assessing embryo development using swept source optical coherence tomography
A detailed assessment of embryo development would assist biologists with selecting the most suitable embryos for transfer leading to higher pregnancy rates. Currently, only low resolution microscopy is employed to perform this assessment. Although this method delivers some information on the embryo surface morphology, no specific details are shown related to its inner structure. Using a Master-Slave Swept-Source Optical Coherence Tomography (SS-OCT), images of bovine embryos from day 7 after fertilization were collected from different depths. The dynamic changes inside the embryos were examined, in detail and in real-time from several depths. To prove our ability to characterize the morphology, a single embryo was imaged over 26 hours. The embryo was deprived of its life support environment, leading to its death. Over this period, clear morphological changes were observed
Modelling Effects of Tariff Liberalisation on India’s Key Export Sectors: Analysis of the EU–India Free Trade Agreement
Trade agreements are increasingly being negotiated between developed and emerging economy partners. An example is the EU–India Free Trade Agreement (FTA) for which negotiations began in 2007. There has been a debate on the potential effects of the proposed FTA and how this can impact on India’s key export sectors. Our study addresses this aspect from a global computable general equilibrium (CGE) modelling perspective. Using the Global Trade Analysis Project (GTAP) framework, we analyse trade and welfare impacts of the proposed FTA between the EU and India. Two scenarios are modelled: first, complete and immediate elimination of tariff on all goods traded and second, selective tariff elimination on textiles, wearing apparel and leather goods—products in which India has a comparative advantage. Results under both scenarios show that India enjoys positive welfare effects though there is a possibility of trade diversion. Under scenario 1, India loses due to a negative terms of trade (ToT) effect. Under scenario 2, with selective sectoral liberalisation, gains are mainly concentrated in the textiles, wearing apparel and leather sectors. There is a positive output effect from change in demand for factors of production, suggesting that the proposed FTA could lead to relocation of labour-intensive production to India
An Integrated TCGA Pan-Cancer Clinical Data Resource to Drive High-Quality Survival Outcome Analytics
For a decade, The Cancer Genome Atlas (TCGA) program collected clinicopathologic annotation data along with multi-platform molecular profiles of more than 11,000 human tumors across 33 different cancer types. TCGA clinical data contain key features representing the democratized nature of the data collection process. To ensure proper use of this large clinical dataset associated with genomic features, we developed a standardized dataset named the TCGA Pan-Cancer Clinical Data Resource (TCGA-CDR), which includes four major clinical outcome endpoints. In addition to detailing major challenges and statistical limitations encountered during the effort of integrating the acquired clinical data, we present a summary that includes endpoint usage recommendations for each cancer type. These TCGA-CDR findings appear to be consistent with cancer genomics studies independent of the TCGA effort and provide opportunities for investigating cancer biology using clinical correlates at an unprecedented scale. Analysis of clinicopathologic annotations for over 11,000 cancer patients in the TCGA program leads to the generation of TCGA Clinical Data Resource, which provides recommendations of clinical outcome endpoint usage for 33 cancer types
Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas
This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing
molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin
Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context
Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts
Spatial Organization and Molecular Correlation of Tumor-Infiltrating Lymphocytes Using Deep Learning on Pathology Images
Beyond sample curation and basic pathologic characterization, the digitized H&E-stained images
of TCGA samples remain underutilized. To highlight this resource, we present mappings of tumorinfiltrating lymphocytes (TILs) based on H&E images from 13 TCGA tumor types. These TIL
maps are derived through computational staining using a convolutional neural network trained to
classify patches of images. Affinity propagation revealed local spatial structure in TIL patterns and
correlation with overall survival. TIL map structural patterns were grouped using standard
histopathological parameters. These patterns are enriched in particular T cell subpopulations
derived from molecular measures. TIL densities and spatial structure were differentially enriched
among tumor types, immune subtypes, and tumor molecular subtypes, implying that spatial
infiltrate state could reflect particular tumor cell aberration states. Obtaining spatial lymphocytic
patterns linked to the rich genomic characterization of TCGA samples demonstrates one use for
the TCGA image archives with insights into the tumor-immune microenvironment
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