The SUMMIT trial: a field comparison of buprenorphine versus methadone maintenance treatment.

This prospective patient-preference study examined the effectiveness in practice of methadone versus buprenorphine maintenance treatment and the beliefs of subjects regarding these drugs. A total of 361 opiate-dependent individuals (89% of those eligible, presenting for treatment over 2 years at a drug service in England) received rapid titration then flexible dosing with methadone or buprenorphine; 227 patients chose methadone (63%) and 134 buprenorphine (37%). Participants choosing methadone had more severe substance abuse and psychiatric and physical problems but were more likely to remain in treatment. Survival analysis indicated those prescribed methadone were over twice as likely to be retained (hazard ratio for retention was 2.08 and 95% confidence interval [CI] = 1.49-2.94 for methadone vs. buprenorphine), However, those retained on buprenorphine were more likely to suppress illicit opiate use (odds ratio = 2.136, 95% CI = 1.509-3.027, p < .001) and achieve detoxification. Buprenorphine may also recruit more individuals to treatment because 28% of those choosing buprenorphine (10% of the total sample) stated they would not have accessed treatment with methadone

In-Hospital and Long-Term Prognosis after Spontaneous Intracerebral Hemorrhage among Young Adults Aged 18-65 Years

BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) accounts for 10%-15% of all strokes and has an estimated annual incidence of 5/100,000 in young adults. Limited data on prognosis after ICH in young adults are available. We aimed to identify prognostic predictors after ICH among adults aged 18-65 years. METHODS: We retrospectively selected all patients with ICH from a prospective single-center registry of adults with first stroke before 65 years between 1997 and 2002. We recorded in-hospital mortality as well as mortality and recurrent stroke after discharge until December 1, 2018. For in-hospital analysis, we compared patients that died in-hospital versus patients discharged alive. For long-term analysis, we compared patients that died in follow-up versus patients still alive. Independent prognostic predictors were identified using multivariate analyses. RESULTS: Among 161 patients included, 24 (14.9%) died in-hospital. Among in-hospital survivors, 5-year survival was 92.0%, 10-year survival 78.1%, and 15-year survival 62.0%. After median follow-up of 17 years, 47.4% of patients died, 18 patients had ischemic stroke, and 6 recurrent ICH. Regarding in-hospital prognosis, coma at admission (OR .02 [.00-.11]) was independent predictor for mortality whereas alcoholic habits (OR 12.32 [1.82-83.30]) was independent predictor for survival. An increasing age (OR 1.08 [1.03-1.12]), higher blood glucose levels (OR 1.01 [1.00-1.01]), and hypertension (OR 2.21 [1.22-4.00]) were independent predictors of long-term mortality after ICH. CONCLUSIONS: Alcoholic habits may influence in-hospital survival after ICH in young adults. Long-term mortality in young adults seems to be lower than in elderly and was predicted by higher blood glucose levels and hypertension.info:eu-repo/semantics/publishedVersio

Espondilolise e espondilolistese ístmica de grau I no adolescente: Análise retrospectiva de 30 casos

Objectivo: a espondilolise e a espondilolistese ístmica grau I são causas de lombalgia nos adolescentes e associam-se a fractura de fadiga da pars interarticularis por movimentos repetidos de hiperextensão. Na literatura não existe consenso quanto aos benefícios do tratamento cirúrgico nestes doentes, muitas vezes atletas, e a controvérsia prolonga-se sobre qual a melhor técnica cirúrgica. Os autores descrevem a técnica cirúrgica que sistematicamente utilizam e analisam os resultados obtidos.Material e métodos: retrospectivamente, entre 2004 e 2013, foram avaliados 30 adolescentes, 12 com lise ístmica e 18 com espondilolistese ístmica grau I, operados pelo mesmo cirurgião. A reconstituição ístmica foi feita com autoenxerto de ilíaco e fixação pedicular posterior temporária. Avalia-se a taxa de consolidação, complicações, dor (VAS), função (ODI) e o grau de satisfaçãoResultados: a idade média foi 16.3 anos (13-18) e o seguimento 23.5 meses (14-48). Ocorreu consolidação em 100% dos casos. O VAS médio reduziu de 7.48 para 0.38 (p<0.0001) e, funcionalmente, o ODI médio melhorou de 38.55% para 1.59% (p<0.0001), de disfunção moderada para mínima. A todos os doentes foi retirado o material após 1 ano de reconstituição ístmica. No total, 63.3% dos doentes eram desportistas e todos retomaram o nível prévio. Não se verificou progressão da listese nem complicações significativas. Os doentes encontram-se satisfeitos e repetiriam o tratamento.Conclusão: as técnicas de artrodese obtêm bons resultados clínicos mas implicam perda de mobilidade segmentar e doença do nível adjacente. Comparativamente com técnicas dinâmicas, a técnica preconizada pelos autores permite não só a reconstituição ístmica eficaz como revela resultados superiores a médio prazo, o que supera a necessidade de segunda intervenção para extração do material. A reconstituição ístmica com autoenxerto e fixação pedicular posterior temporária na espondilolise ou espondilolistese ístmica grau I obteve excelentes resultados clínicos e elevada taxa de consolidação. Esta técnica é defendida pelos autores mesmo em atletas de alta competição

Novel types of anti-ecloud surfaces

In high power RF devices for space, secondary electron emission appears as the main parameter governing the multipactor effect and as well as the e-cloud in large accelerators. Critical experimental activities included development of coatings with low secondary electron emission yield (SEY) for steel (large accelerators) and aluminium (space applications). Coatings with surface roughness of high aspect ratio producing the so-call secondary emission suppression effect appear as the selected strategy. In this work a detailed study of the SEY of these technological coatings and also the experimental deposition methods (PVD and electrochemical) are presented. The coating-design approach selected for new low SEY coatings include rough metals (Ag, Au, Al), rough alloys (NEG), particulated and magnetized surfaces, and also graphene like coatings. It was found that surface roughness also mitigate the SEY deterioration due to aging processes.Comment: 4 pages, contribution to the Joint INFN-CERN-EuCARD-AccNet Workshop on Electron-Cloud Effects: ECLOUD'12; 5-9 Jun 2012, La Biodola, Isola d'Elba, Italy; CERN Yellow Report CERN-2013-002, pp.153-15

Fertility preservation in ovarian tumours

A considerable number of patients with a cancer diagnosis are of childbearing age and have not satisfied their desire for a family. Despite ovarian cancer (OC) usually occurring in older patients, 3%–14% are diagnosed at a fertile age with the overall 5-year survival rate being 91.2% in women ≤44 years of age when it is found at 1A–B stage. In this scenario, testing the safety and the efficacy of fertility sparing strategies in OC patients is very important overall in terms of quality of life. Unfortunately, the lack of randomised trials to validate conservative approaches does not guarantee the safety of fertility preservation strategies. However, evidence-based data from descriptive series suggest that in selected cases, the preservation of the uterus and at least one part of the ovary does not lead to a high risk of relapse. This conservative surgery helps to maintain organ function, giving patients of childbearing age the possibility to preserve their fertility. We hereby analysed the main evidence from the international literature on this topic in order to highlight the selected criteria for conservative management of OC patients, including healthy BRCA mutations carriers

Sequenciação Total do Genoma no Instituto Ricardo Jorge: um virar de página na Microbiologia Clínica

comunicação oral, CO5Esta comunicação tem como objectivo divulgar à comunidade médico-científica o impacto significativo que a WGS, agora disponível no Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), terá em termos de Microbiologia Clínica.N/

Quantum Cosmology in Scalar-Tensor Theories With Non Minimal Coupling

Quantization in the minisuperspace of non minimal scalar-tensor theories leads to a partial differential equation which is non separable. Through a conformal transformation we can recast the Wheeler-DeWitt equation in an integrable form, which corresponds to the minimal coupling case, whose general solution is known. Performing the inverse conformal transformation in the solution so found, we can construct the corresponding one in the original frame. This procedure can also be employed with the bohmian trajectories. In this way, we can study the classical limit of some solutions of this quantum model. While the classical limit of these solutions occurs for small scale factors in the Einstein's frame, it happens for small values of the scalar field non minimally coupled to gravity in the Jordan's frame, which includes large scale factors.Comment: latex, 18 page

Pharyngolaryngeal Foreign Body as Cause of Disphonia

A ingestão acidental e a impactação de corpos estranhos na via aerodigestiva é uma urgência otorrinolaringológica comum. Nos adultos, as espinhas são os corpos estranhos mais frequentemente impactados. Uma anamnese e uma observação cuidadosas são de extrema importância. Os sintomas incluem odinofagia, disfagia, tosse persistente, alteração da voz, sialorreia e menos frequentemente uma complicação respiratória. As espinhas impactam mais frequentemente numa localização supra-hioideia. Locais menos frequentes de impactação são a hipotaringe, a região cricofaríngea e o esófago, sendo o diagnóstico mais difícil a estes níveis. A migração extra-luminal ocorre raramente, sendo mais frequente na presença de uma espinha. Atendendo a sua forma, este é o corpo estranho que mais facilmente migra e como tal, é o que apresenta maior taxa de complicações. Nesta situação, é necessário um elevado lndice de suspeição, sendo a realização de TC fundamental. Os autores apresentam um caso de migração de uma espinha ao nível da banda ventricular laringea e um algoritmo para o diagnóstico e tratamento de corpos estranhos perfurantes e migrantes.info:eu-repo/semantics/publishedVersio

QED vacuum between an unusual pair of plates

We consider the photon field between an unusual configuration of infinite parallel plates: a perfectly conducting plate $(\epsilon\to\infty)$ and an infinitely permeable one $\mu\to\infty)$. After quantizing the vector potential in the Coulomb gauge, we obtain explicit expressions for the vacuum expectation values of field operators of the form $_0$ and $<{\hat B}_i{\hat B}_j>_0$. These field correlators allow us to reobtain the Casimir effect for this set up and to discuss the light velocity shift caused by the presence of plates (Scharnhorst effect \cite{Scharnhorst,Barton,BarScharn}) for both scalar and spinor QED.Comment: Latex, 16 pages, no figure

ECG wave detector and delineation with wavelets

Proceedings of the International Conference on Computational Intelligence in Medicine Healthcare, CIMED 2005, Costa da Caparica, June 29 - July 1, 2005Efficient R wave detection is a crucial preprocessing step of most of the ECG signal analysis . Likewis e, ECG delineation comprising P wave and QRS complex, is required for ECG processing, namely in High- Resolution Electrocardiography (HR-ECG). We have performed R wave detection using the Mexican Hat wavelet and achieved a sensibility Se=97.77 % and a positive prediction P+=99.46%. Our data is HR-ECG and the delineation process occurs in two steps: wavelet detection and application of the Task Force (Breithardt et al.)1 detection rules