96 research outputs found
Dengue Vaccines Regulatory Pathways: A Report on Two Meetings with Regulators of Developing Countries
Richard Mahoney and colleagues summarize two recent meetings convened by the Pediatric Dengue Vaccine Initiative and the Developing Countries' Vaccine Regulators Network on regulatory issues that need to be addressed before licensing dengue vaccines
Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy
Background
A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets.
Methods
Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis.
Results
A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001).
Conclusion
We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty
Characteristics of physical activity programs in the Brazilian primary health care system
Subluxação da mandíbula para abordagem de bifurcação carotídea alta em paciente com parotidite por contraste iodado: relato de caso e revisão de literatura
Comparison of apical and coronal extrusions using reciprocating and rotary instrumentation systems
Diversity of Staphylococcus aureus Isolates in European Wildlife
Staphylococcus aureus is a well-known colonizer and cause of infection among
animals and it has been described from numerous domestic and wild animal
species. The aim of the present study was to investigate the molecular
epidemiology of S. aureus in a convenience sample of European wildlife and to
review what previously has been observed in the subject field. 124 S. aureus
isolates were collected from wildlife in Germany, Austria and Sweden; they
were characterized by DNA microarray hybridization and, for isolates with
novel hybridization patterns, by multilocus sequence typing (MLST). The
isolates were assigned to 29 clonal complexes and singleton sequence types
(CC1, CC5, CC6, CC7, CC8, CC9, CC12, CC15, CC22, CC25, CC30, CC49, CC59, CC88,
CC97, CC130, CC133, CC398, ST425, CC599, CC692, CC707, ST890, CC1956, ST2425,
CC2671, ST2691, CC2767 and ST2963), some of which (ST2425, ST2691, ST2963)
were not described previously. Resistance rates in wildlife strains were
rather low and mecA-MRSA isolates were rare (n = 6). mecC-MRSA (n = 8) were
identified from a fox, a fallow deer, hares and hedgehogs. The common cattle-
associated lineages CC479 and CC705 were not detected in wildlife in the
present study while, in contrast, a third common cattle lineage, CC97, was
found to be common among cervids. No Staphylococcus argenteus or
Staphylococcus schweitzeri-like isolates were found. Systematic studies are
required to monitor the possible transmission of human- and livestock-
associated S. aureus/MRSA to wildlife and vice versa as well as the possible
transmission, by unprotected contact to animals. The prevalence of S.
aureus/MRSA in wildlife as well as its population structures in different
wildlife host species warrants further investigation
Cross platform analysis of methylation, miRNA and stem cell gene expression data in germ cell tumors highlights characteristic differences by tumor histology
Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases
Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics
Treatment of diabetic mice with undenatured whey protein accelerates the wound healing process by enhancing the expression of MIP-1α, MIP-2, KC, CX3CL1 and TGF-β in wounded tissue
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