Assessment of cyst content using mean gray value for discriminating endometrioma from other unilocular cysts in premenopausal women

Objective To assess whether the analysis of cyst content using mean gray value (MGV) can discriminate ovarian endometriomas from other unilocular ovarian cysts in premenopausal women. Methods Stored three-dimensional (3D) volumes from 54 unilocular ovarian cysts diagnosed in 50 premenopausal women (mean age, 37 (range, 22–50) years) were analyzed to calculate the MGV from cyst content. Cysts with solid components or septations were excluded. MGV was calculated in all cases with the Virtual Organ Computer-aided AnaLysisTM technique. The Bmode presumptive diagnosis based on the examiner’s subjective impression was also recorded. Results Sixteen of the cysts resolved spontaneously and were given a final clinical diagnosis of hemorrhagic functional cyst, while 38 cysts were removed surgically (diagnosed histologically as seven simple cysts, three hemorrhagic cysts, 20 endometriomas, five mucinous cysts and three paraovarian cysts). B-mode diagnoses were as follows: seven simple cysts, 18 hemorrhagic cysts, 24 endometriomas, three mucinous cysts and two paraovarian cysts. MGV was significantly higher in ovarian endometrioma when compared with all other kinds of cyst. The receiver–operating characteristics curve showed that using an MGV cut-off ≥15.560 had a sensitivity of 85% and a specificity of 76.5% for diagnosing ovarian endometrioma (area under the curve, 0.831; 95% CI, 0.718–0.944). These figures were similar to those for B-mode diagnosis (sensitivity, 90%; specificity, 82%) (McNemar test, P = 1.000). Combining B-mode and MGV gave a sensitivity of 80% and a specificity of 91%. Conclusion Cyst content MGV is higher in ovarian endometrioma than it is in other unilocular ovarian cysts. The diagnostic performance of MGV is similar to that of the examiner’s subjective impression. The combination of both criteria achieves the highest specificit

Proportion of neonatal readmission attributed to length of stay for childbirth: a population-based cohort study

Objective: Most literature on length of stay (LOS) for childbirth focuses on ‘early’ discharge as opposed to ‘optimal’ time of discharge and has conflicting results due to heterogeneous definitions of ‘early’ discharge and differing eligibility criteria for these programmes. We aimed to determine the LOS associated with the lowest neonatal readmission rate following childbirth by examining the incidence pattern of neonatal readmission for different LOS using the Kitagawa decomposition. Design: Retrospective cohort study using administrative hospitalisation data. Setting: Canada (excluding Quebec) from 2003 to 2010. Patients: Term, singleton live births without congenital anomalies. Interventions: LOS for childbirth. Main outcome measure: Neonatal readmissions within 30 days of birth. Results: 1 875 322 live births were included. Neonatal LOS peaked at day 1 (47.3%) after vaginal birth and day 3 (49.3%) following caesarean section; 4.2% of infants were readmitted following vaginal birth and 2.2% after caesarean section. In 2008–2010, most readmissions occurred among infants discharged in the first 2 days (83.8%) following a vaginal birth and among infants discharged in the first 3 days (81.7%) following a caesarean birth. Readmissions increased from 4.1% in 2003–2005 to 4.6% in 2008–2010 among vaginal births and from 2.0% to 2.4% among caesarean births and occurred mostly due to changes in the day-specific readmission rates and not due to reductions in LOS. Conclusions: Patterns of readmission suggest that readmission rates are lowest following a 1–2-day stay following a vaginal birth and a 2–4-day stay following a caesarean birth given the outpatient support in the community

Satisfacao dos profissionais e da comunidade com a estrategia da saude da familia

OBJETIVO: Analisar as limitações e os pontos positivos da Estratégia de Saúde da Família na perspectiva dos profissionais da saúde e da comunidade. MÉTODOS: Estudo realizado entre os meses de junho e agosto de 2009, na cidade de Vespasiano, MG, localizada na região Sudeste do Brasil. Para avaliar a Estratégia de Saúde da Família (ESF), foi aplicado questionário em 77 profissionais da saúde e 293 cuidadores de crianças menores de cinco anos. Variáveis como o treinamento das equipes de saúde, acesso da comunidade aos serviços prestados pelas equipes de ESF, comunicação com os pacientes, a atenção prestada à criança e as informações de saúde passadas aos cuidadores foram alguns dos pontos de interesse da investigação. Análises de regressão logística foram utilizadas para se avaliar a significância estatística das variáveis estudadas, bem como os valores de odds ratio e intervalo de confiança. RESULTADOS: A maioria dos profissionais relatou que seus treinamentos foram insuficientes em quantidade, conteúdo e metodologia utilizada. Os cuidadores e profissionais identificaram semelhantes limitações da Estratégia de Saúde da Família (os serviços inacessíveis à comunidade, falta de treinamento e número insuficiente de profissionais) e também pontos fortes semelhantes (a comunicação entre agentes comunitários e comunidade, fornecimento de informações educacionais e foco na atenção à criança). Como recomendações para a melhoria do programa foram apontados: a necessidade de mais médicos e especialistas, treinamentos em maior quantidade e qualidade e melhoria na marcação de consultas. A satisfação dos cuidadores foi relacionada aos benefícios ofertados, como as visitas dos profissionais às casas (OR 5,8; IC95% 2,8;12,1), boa relação entre comunidade e profissionais (OR 4,8; IC95% 2,5;9,3) e foco na saúde da família (OR 4,1; IC95% 1,6;10,2). Problemas como número insuficiente de profissionais (OR 0,3; IC95% 0,2;0,6), dificuldade de acesso aos serviços prestados pela ESF (OR 0,2; IC95% 0,1;0,4) e qualidade ruim dos serviços ofertados (OR 0,3; IC95% 0,1;0,6) foram relacionados à insatisfação da comunidade com a ESF. De uma maneira geral, a maioria dos cuidadores (62%) mostraram estar satisfeitos com os serviços prestados pela ESF. CONCLUSÕES: Identificar as limitações e os pontos positivos da ESF pode gerar uma valiosa informação, que auxiliará na melhoria dessa estratégia para a atenção primária no Brasil.OBJETIVO: Analizar las limitaciones y los puntos positivos de la Estrategia de Salud de la Familia en la perspectiva de los profesionales de la salud y de la comunidad. MÉTODOS: Estudio realizado entre los meses de Junio y Agosto de 2009, en la ciudad de Vespasiano, MG, localizada en el la región sureste de Brasil. Para evaluar la Estrategia de la Salud de la Familia (ESF), se aplicó cuestionario en 77 profesionales de la salud y 293 cuidadores de niños menores de cinco años. Las Variables, entrenamiento de los grupos de salud, acceso de la comunidad a los servicios suministrados por los grupos de ESF, comunicación con los pacientes, la atención suministrada al niño y las informaciones de salud entregadas a los cuidadores, fueron algunos de los puntos de interés de la investigación. Los análisis de regresión logística se utilizaron para evaluar la significancia estadística de las variables estudiadas, así como los valores de odds ratio (OR) e intervalo de confianza (IC). RESULTADOS: La mayoría de los profesionales mencionó que sus entrenamientos fueron insuficientes en cantidad, contenido y metodología utilizada. Los cuidadores y profesionales identificaron limitaciones semejantes de la ESF (los servicios inaccesibles a la comunidad, falta de entrenamiento e insuficiente número de profesionales) y también semejantes puntos fuertes (la comunicación entre agentes comunitarios y comunidad, suministro de informaciones educativas y énfasis en la atención del niño). Como recomendaciones para mejorar el programa fueron señalados: la necesidad de más médicos y especialistas, entrenamientos en mayor cantidad y calidad y mejoría al concertar cita con médicos. La satisfacción de los cuidadores fue relacionada con los beneficios ofertados, como las visitas de los profesionales a las casas (OR 5,8; IC95% 2,8;12,1), buena relación entre comunidad y profesionales (OR 4,8; IC95% 2,5;9,3) y, énfasis en la salud de la familia (OR 4,1; IC 95% 1,6; 10,2). Problemas como insuficiente número de profesionales (OR 0,3; IC95% 0,2;0,6), dificultad en el acceso a los servicios suministrados por la ESF (OR 0,2; IC95% 0,1;0,4) y mala calidad de los servicios ofertados (OR 0,3; IC95% 0,1;0,6) se relacionaron con la insatisfacción de la comunidad con la ESF. De una forma general, la mayoría de los cuidadores (62%) mostraron estar satisfechos con los servicios suministrados por la ESF. CONCLUSIONES: Identificar las limitaciones y los puntos positivos de la ESF puede generar una información valiosa que ayudará en la mejoría de ésta estrategia de atención primaria en Brasil.OBJECTIVE: To analyze the strengths and limitations of the Family Health Strategy from the perspective of health care professionals and the community. METHODS: Between June-August 2009, in the city of Vespasiano, Minas Gerais State, Southeastern Brazil, a questionnaire was used to evaluate the Family Health Strategy (ESF) with 77 healthcare professionals and 293 caregivers of children under five. Health care professional training, community access to health care, communication with patients and delivery of health education and pediatric care were the main points of interest in the evaluation. Logistic regression analysis was used to obtain odds ratios and 95% confidence intervals as well as to assess the statistical significance of the variables studied. RESULTS: The majority of health care professionals reported their program training was insufficient in quantity, content and method of delivery. Caregivers and professionals identified similar weaknesses (services not accessible to the community, lack of healthcare professionals, poor training for professionals) and strengths (community health worker-patient communications, provision of educational information, and pediatric care). Recommendations for improvement included: more doctors and specialists, more and better training, and scheduling improvements. Caregiver satisfaction with the ESF was found to be related to perceived benefits such as community health agent household visits (OR 5.8, 95%CI 2.8;12.1), good professional-patient relationships (OR 4.8, 95%CI 2.5;9.3), and family-focused health (OR 4.1, 95%CI 1.6;10.2); and perceived problems such as lack of personnel (OR 0.3, 95%CI 0.2;0.6), difficulty with access (OR 0.2, 95%CI 0.1;0.4), and poor quality of care (OR 0.3, 95%CI 0.1;0.6). Overall, 62% of caregivers reported being generally satisfied with the ESF services. CONCLUSIONS: Identifying the limitations and strengths of the Family Health Strategy from the healthcare professional and caregiver perspective may serve to advance primary community healthcare in Brazil

Fast approach for unsteady flow routing in complex river networks based on performance graphs

We present a new model for unsteady flow routing through dendritic and looped river networks based on performance graphs. The model builds upon the application of Hydraulic Performance Graph (HPG) to unsteady flow routing introduced by Gonzalez-Castro (2000) and adopts the Volume Performance Graph (VPG) introduced by Hoy and Schmidt (2006). The HPG of a channel reach graphically summarizes the dynamic relation between the flow through and the stages at the ends of the reach under gradually varied flow (GVF) conditions, while the VPG summarizes the corresponding storage. Both, the HPG and VPG are unique to a channel reach with a given geometry and roughness, and can be computed decoupled from unsteady boundary conditions by solving the GVF equation for all feasible conditions in the reach. Hence, in the proposed approach, the performance graphs can be used for different boundary conditions without the need to recompute them. Previous models based on the performance graph concept were formulated for routing through single channels or channels in series. The new approach expands on the use of HPG/VPGs and adds the use of rating performance graphs for unsteady flow routing in dentritic and looped networks. We exemplify the applicability of the proposed model to subcritical unsteady flow routing through a looped network and contrast its simulation results with those from the well-known unsteady HEC-RAS model. Our results show that the present extension of application of the HPG/VPGs appears to inherit the robustness of the HPG routing approach in Gonzalez-Castro (2000). The unsteady flow model based on performance graphs presented here can be extended to include supercritical flows.Keywords: Looped network, Hydraulic routing, Modeling, Simulation, Unsteady flow, Dendritic network, River hydraulics, Flooding, Flow routingKeywords: Looped network, Hydraulic routing, Modeling, Simulation, Unsteady flow, Dendritic network, River hydraulics, Flooding, Flow routin

Mechanisms of tissue uptake and retention of paclitaxel-coated balloons: impact on neointimal proliferation and healing

Background: The efficacy of paclitaxel-coated balloons (PCB) for restenosis prevention has been demonstrated in humans. However, the mechanism of action for sustained drug retention and biological efficacy following single-time drug delivery is still unknown. Methods and results The pharmacokinetic profile and differences in drug concentration (vessel surface vs arterial wall) of two different paclitaxel coating formulations (3 µg/mm2) displaying opposite solubility characteristics (CC=crystalline vs AC=amorphous) were tested in vivo and compared with paclitaxel-eluting stents (PES). Also, the biological effect of both PCB formulations on vascular healing was tested in the porcine coronary injury model. One hour following balloon inflation, both formulations achieved similar arterial paclitaxel levels (CC=310 vs AC=245 ng/mg; p=NS). At 24 h, the CC maintained similar tissue concentrations, whereas the AC tissue levels declined by 99% (p<0.01). At this time point, arterial levels were 20-fold (CC) and 5-fold (AC) times higher compared to the PES group (p<0.05). At 28 days, arterial levels retained were 9.2% (CC) and 0.04% (AC, p<0.01) of the baseline levels. Paclitaxel concentration on the vessel surface was higher in the CC at 1 (CC=36.7% vs AC=13.1%, p<0.05) and 7 days (CC=38.4% vs AC=11%, p<0.05). In addition, the CC induced higher levels of neointimal inhibition, fibrin deposition and delayed healing compared with the AC group. Conclusions: The presence of paclitaxel deposits on the vessel surface driving diffusion into the arterial tissue in a time-dependent fashion supports the mechanism of action of PCB. This specific pharmacokinetic behaviour influences the patterns of neointimal formation and healing

Contamination of Fresh Produce by Microbial Indicators on Farms and in Packing Facilities: Elucidation of Environmental Routes

ABSTRACT To improve food safety on farms, it is critical to quantify the impact of environmental microbial contamination sources on fresh produce. However, studies are hampered by difficulties achieving study designs with powered sample sizes to elucidate relationships between environmental and produce contamination. Our goal was to quantify, in the agricultural production environment, the relationship between microbial contamination on hands, soil, and water and contamination on fresh produce. In 11 farms and packing facilities in northern Mexico, we applied a matched study design: composite samples (n � 636, equivalent to 11,046 units) of produce rinses were matched to water, soil, and worker hand rinses during two growing seasons. Microbial indicators (coliforms, Escherichia coli, Enterococcus spp., and somatic coliphage) were quantified from composite samples. Statistical measures of association and correlations were calculated through Spearman’s correlation, linear regression, and logistic regression models. The concentrations of all microbial indicators were positively correlated between produce and hands ( � range, 0.41 to 0.75; P � 0.01). When E. coli was present on hands, the handled produce was nine times more likely to contain E. coli (P � 0.05). Similarly, when coliphage was present on hands, the handled produce was eight times more likely to contain coliphage (P � 0.05). There were relatively low concentrations of indicators in soil and water samples, and a few sporadic significant associations were observed between contamination of soil and water and contamination of produce. This methodology provides a foundation for future field studies, and results highlight the need for interventions surrounding farmworker hygiene and sanitation to reduce microbial contamination of farmworkers’ hands. IMPORTANCE This study of the relationships between microbes on produce and in the farm environment can be used to support the design of targeted interventions to prevent or reduce microbial contamination of fresh produce with associated reductions in foodborne illness. KEYWORDS environmental microbiology, food-borne pathogens, produc

Risk for Fomite-Mediated Transmission of SARS-CoV-2 in Child Daycares, Schools, Nursing Homes, and Offices.

Severe acute respiratory syndrome coronavirus 2 can persist on surfaces, suggesting possible surface-mediated transmission of this pathogen. We found that fomites might be a substantial source of transmission risk, particularly in schools and child daycares. Combining surface cleaning and decontamination with mask wearing can help mitigate this risk

Development and validation of a method for precise dating of female puberty in laboratory rodents: The puberty ovarian maturation score (Pub-Score)

Puberty is a key developmental event whose primary regulatory mechanisms remain poorly understood. Precise dating of puberty is crucial for experimental (preclinical) studies on its complex neuroendocrine controlling networks. In female laboratory rodents, external signs of puberty, such as vaginal opening (VO) and epithelial cell cornification (i.e., first vaginal estrus, FE), are indirectly related to the maturational state of the ovary and first ovulation, which is the unequivocal marker of puberty. Whereas in rats, VO and FE are almost simultaneous with the first ovulation, these events are not so closely associated in mice. Moreover, external signs of puberty can be uncoupled with first ovulation in both species under certain experimental conditions. We propose herein the Pubertal Ovarian Maturation Score (Pub-score), as novel, reliable method to assess peripubertal ovarian maturation in rats and mice. This method is founded on histological evaluation of pre-pubertal ovarian maturation, based on antral follicle development, and the precise timing of first ovulation, by retrospective dating of maturational and regressive changes in corpora lutea. This approach allows exact timing of puberty within a time-window of at least two weeks after VO in both species, thus facilitating the identification and precise dating of advanced or delayed puberty under various experimental conditions

Growth factor-enriched autologous plasma improves wound healing after surgical debridement in odontogenic necrotizing fasciitis: a case report

<p>Abstract</p> <p>Background</p> <p>Odontogenic necrotizing fasciitis of the neck is a fulminant infection of odontogenic origin that quickly spreads along the fascial planes and results in necrosis of the affected tissues. It is usually polymicrobial, occurs frequently in immunocompromised patients, and has a high mortality rate.</p> <p>Case presentation</p> <p>A 69-year old Mexican male had a pain in the maxillar right-canine region and a swelling of the submental and submandibular regions. Our examination revealed local pain, tachycardia, hyperthermia (39°C), and the swelling of bilateral submental and submandibular regions, which also were erythematous, hyperthermic, crepitant, and with a positive Godet sign. Mobility and third-degree caries were seen in the right mandibular canine. Bacteriological cultures isolated <it>streptococcus pyogenes </it>and <it>staphylococcus aureus</it>. The histopathological diagnosis was odontogenic necrotizing fasciitis of the submental and submandibular regions. The initial treatment was surgical debridement and the administration of antibiotics. After cultures were negative, the surgical wound was treated with a growth factor-enriched autologous plasma eight times every third day until complete healing occurred.</p> <p>Conclusions</p> <p>The treatment with a growth factor-enriched autologous plasma caused a rapid healing of an extensive surgical wound in a patient with odontogenic necrotizing fasciitis. The benefits were rapid tissue regeneration, an aesthetic and a functional scar, and the avoidance of further surgery and possible complications.</p