Endoscopic pilonidal sinus treatment versus total excision with primary closure for sacrococcygeal pilonidal sinus disease in the pediatric population

Purpose: To evaluate the effectiveness and safety of Endoscopic Pilonidal Sinus Treatment (EPSiT) in the pediatric population and compare it with excision followed by primary closure (EPC) regarding intra- and postoperative outcomes. Methods: A retrospective analysis of all patients with chronic sacrococcygeal pilonidal sinus submitted to EPSiT and EPC during a 12-month period in our institution was performed. Data concerning patients' demographics and surgical outcomes were collected and compared between the two groups. Results: We analyzed a total of 21 cases that underwent EPSiT and 63 cases of EPC, both groups with similar demographic characteristics. Operative time was similar for both groups (30 vs. 38 min; p > 0.05). No major intraoperative complications were reported. Wound infection rate was lower for EPSiT ((5.2% [n = 1] vs. 20.0% [n = 12]); p > 0.05). Healing time was similar for both groups (28 vs. 37.5 days). Recurrence occurred in 18,9% (n = 15), with 2 cases (10.5%) reported in the EPSiT group versus 13 (21.6%) in EPC. There were no differences between groups regarding postoperative complications, complete wound healing and recurrence rates or healing time (p > 0.05). Conclusions: Our results suggest that EPSiT is as viable as excision followed by primary closure in the management of sacrococcygeal pilonidal sinus in the pediatric population

Propriedades Métricas da Escala Aachen Aphasia Test

No contexto atual do exercício da profissão de enfermagem, com exigência crescente a nível de eficácia, eficiência e prática baseada na evidência, torna-se imperativa a utilização de instrumentos de avaliação e medida, devidamente validados para as populações que assistem e avaliam. O objetivo deste estudo foi conhecer as propriedades métricas da escala Aachen Aphasia Test (AAT), aplicada a pessoas que sofreram um Acidente Vascular Cerebral (AVC). Foi realizada uma revisão sistemática da literatura, através de bases de dados eletrónicas, nos últimos 5 anos. Selecionaram-se 4 artigos que cumpriam os critérios, relacionados com a temática. Pouca informação foi obtida relacionada com as propriedades métricas da AAT. Apenas um dos artigos aborda informações exatas e referentes às propriedades métricas da sua adaptação para a versão Portuguesa, que de acordo com os autores consultados são robustas, comparáveis às da versão Alemã. Os restantes estudos recorrem a este instrumento como padrão na comparação com outros instrumentos

Ultraprecise single-molecule localization microscopy enables in situ distance measurements in intact cells

Single-molecule localization microscopy (SMLM) has the potential to quantify the diversity in spatial arrangements of molecules in intact cells. However, this requires that the single-molecule emitters are localized with ultrahigh precision irrespective of the sample format and the length of the data acquisition. We advance SMLM to enable direct distance measurements between molecules in intact cells on the scale between 1 and 20 nm. Our actively stabilized microscope combines three-dimensional real-time drift corrections and achieves a stabilization of <1 nm and localization precision of ∼1 nm. To demonstrate the biological applicability of the new microscope, we show a 4- to 7-nm difference in spatial separations between signaling T cell receptors and phosphatases (CD45) in active and resting T cells. In summary, by overcoming the major bottlenecks in SMLM imaging, it is possible to generate molecular images with nanometer accuracy and conduct distance measurements on the biological relevant length scales

Population-based Bayesian regularization for microstructural diffusion MRI with NODDIDA.

PURPOSE:Information on the brain microstructure can be probed by Diffusion Magnetic Resonance Imaging (dMRI). Neurite Orientation Dispersion and Density Imaging with Diffusivities Assessment (NODDIDA) is one of the simplest microstructural model proposed. However, the estimation of the NODDIDA parameters from clinically plausible dMRI acquisition is ill-posed, and different parameter sets can describe the same measurements equally well. A few approaches to resolve this problem focused on developing better optimization strategies for this non-convex optimization. However, this fundamentally does not resolve ill-posedness. This article introduces a Bayesian estimation framework, which is regularized through knowledge from an extensive dMRI measurement set on a population of healthy adults (henceforth population-based prior). METHODS:We reformulate the problem as a Bayesian maximum a posteriori estimation, which includes as a special case previous approach using non-informative uniform priors. A population-based prior is estimated from 35 subjects of the MGH Adult Diffusion data (Human Connectome Project), acquired with an extensive acquisition protocol including high b-values. The accuracy and robustness of different approaches with and without the population-based prior is tested on subsets of the MGH dataset, and an independent dataset from a clinically comparable scanner, with only clinically plausible dMRI measurements. RESULTS:The population-based prior produced substantially more accurate and robust parameter estimates, compared to the conventional uniform priors, for clinically feasible protocols, without introducing any evident bias. CONCLUSIONS:The use of the proposed Bayesian population-based prior can lead to clinically feasible and robust estimation of NODDIDA parameters without changing the acquisition protocol

Vinculação da Mulher como Preditor da Dor Durante o Parto e Após o Nascimento: um Estudo Observacional Prospectivo

INTRODUCTION: Labour is considered to be one of the most painful and significant experiences in a woman's life. The aim of this study was to examine whether women's attachment style is a predictor of the pain experienced throughout labour and post-delivery. MATERIAL AND METHODS:Thirty-two pregnant women were assessed during the third trimester of pregnancy and during labour. Adult attachment was assessed with the Adult Attachment Scale ' Revised. The perceived intensity of labour pain was measured using a visual analogue scale for pain in the early stage of labour, throughout labour and post-delivery. RESULTS:Women with an insecure attachment style reported more pain at 3 cm of cervical dilatation (p < 0.05), before the administration of analgesia (p < 0.01) and post-delivery (p < 0.05) than those securely attached. In multivariate models, attachment style was a significant predictor of labour pain at 3 cm of cervical dilatation and before the first administration of analgesia but not of the perceived pain post-delivery. DISCUSSION: These findings confirm that labour pain is influenced by relevant psychological factors and suggest that a woman's attachment style may be a risk factor for greater pain during labour. CONCLUSION:Future studies in the context of obstetric pain may consider the attachment style as an indicator of individual differences in the pain response during labour. This may have important implications in anaesthesiology and to promote a relevant shift in institutional practices and therapeutic procedures

Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach (with video)

BACKGROUND:An isolated transgastric port has some limitations in performing transluminal endoscopic cholecystectomy. However, transvesical access to the peritoneal cavity has recently been reported to be feasible and safe.OBJECTIVE:To assess the feasibility and the technical benefits of transgastric and transvesical combined approach to overcome the limitations of isolated transgastric ports.DESIGN:We created a transgastric and transvesical combined approach to perform cholecystectomy in 7 consecutive anesthetized female pigs. The transgastric access was achieved after perforation and dilation of the gastric wall with a needle knife and with a balloon, respectively. Under cystoscopic control, an ureteral catheter, a guidewire, and a dilator of the ureteral sheath were used to place a transvesical 5-mm overtube into the peritoneal cavity. By using a gastroscope positioned transgastrically and a ureteroscope positioned transvesically, we carried out cholecystectomy in all animals.RESULTS:Establishment of transvesical and transgastric accesses took place without complications. Under a carbon dioxide pneumoperitoneum controlled by the transvesical port, gallbladder identification, cystic duct, and artery exposure were easily achieved in all cases. Transvesical gallbladder grasping and manipulation proved to be particularly valuable to enhance gastroscope-guided dissection. With the exclusion of 2 cases where mild liver-surface hemorrhage and bile leak secondary to the sliding of cystic clips occurred, all remaining cholecystectomies were carried out without incidents.LIMITATIONS:Once closure of the gastric hole proved to be unreliable when using endoclips, the animals were euthanized; necropsy was performed immediately after the surgical procedure.CONCLUSIONS:A transgastric and transvesical combined approach is feasible, and it was particularly useful to perform a cholecystectomy through exclusive natural orifices

Resolving degeneracy in diffusion MRI biophysical model parameter estimation using double diffusion encoding

Purpose: Biophysical tissue models are increasingly used in the interpretation of diffusion MRI (dMRI) data, with the potential to provide specific biomarkers of brain microstructural changes. However, it has been shown recently that, in the general Standard Model, parameter estimation from dMRI data is ill‐conditioned even when very high b‐values are applied. We analyze this issue for the Neurite Orientation Dispersion and Density Imaging with Diffusivity Assessment (NODDIDA) model and demonstrate that its extension from single diffusion encoding (SDE) to double diffusion encoding (DDE) resolves the ill‐posedness for intermediate diffusion weightings, producing an increase in accuracy and precision of the parameter estimation. Methods: We analyze theoretically the cumulant expansion up to fourth order in b of SDE and DDE signals. Additionally, we perform in silico experiments to compare SDE and DDE capabilities under similar noise conditions. Results: We prove analytically that DDE provides invariant information non‐accessible from SDE, which makes the NODDIDA parameter estimation injective. The in silico experiments show that DDE reduces the bias and mean square error of the estimation along the whole feasible region of 5D model parameter space. Conclusions: DDE adds additional information for estimating the model parameters, unexplored by SDE. We show, as an example, that this is sufficient to solve the previously reported degeneracies in the NODDIDA model parameter estimation

Pathotypic diversity of Hyaloperonospora brassicae collected from Brassica oleracea

Downy mildew caused by Hyaloperonospora brassicae is an economically destructive disease of brassica crops in many growing regions throughout the world. Specialised pathogenicity of downy mildews from different Brassica species and closely related ornamental or wild relatives has been described from host range studies. Pathotypic variation amongst Hyaloperonospora brassicae isolates from Brassica oleracea has also been described; however, a standard set of B. oleracea lines that could enable reproducible classification of H. brassicae pathotypes was poorly developed. For this purpose, we examined the use of eight genetically refined host lines derived from our previous collaborative work on downy mildew resistance as a differential set to characterise pathotypes in the European population of H. brassicae. Interaction phenotypes for each combination of isolate and host line were assessed following drop inoculation of cotyledons and a spectrum of seven phenotypes was observed based on the level of sporulation on cotyledons and visible host responses. Two host lines were resistant or moderately resistant to the entire collection of isolates, and another was universally susceptible. Five lines showed differential responses to the H. brassicae isolates. A minimum of six pathotypes and five major effect resistance genes are proposed to explain all of the observed interaction phenotypes. The B. oleracea lines from this study can be useful for monitoring pathotype frequencies in H. brassicae populations in the same or other vegetable growing regions, and to assess the potential durability of disease control from different combinations of the predicted downy mildew resistance genes

Vinhos que pensam - parte ii|iii: utilização da condutividade elétrica aparente do solo na instalação e gestão das culturas: exemplificação na vinha

Vinhos que pensam - parte ii|iii: utilização da condutividade elétrica aparente do solo na instalação e gestão das culturas: exemplificação na vinh

Vinhos que pensam - parte i|iii: gestão do vigor vegetativo da vinha a partir de sensores ativos multiespectrais próximos

Vinhos que pensam - parte i|iii: gestão do vigor vegetativo da vinha a partir de sensores ativos multiespectrais próximo