333 research outputs found
A chylothorax modern kezelésének bizonyítékalapú áttekintése
Absztrakt
A chylothorax napjainkban rendszerint műtéti vagy baleseti szövődmény, ritkábban
daganat következménye. Prospektív vagy randomizált vizsgálatok hiányában a
bizonyítékalapú kezelés személyes tapasztalaton, ideálisan a retrospektív
elemzések ismeretében történik. A szerzők célja a chylothorax modern kezelésének
áttekintése. A PubMed adatbázist „chylothorax” kulcsszóra szűrték az elmúlt tíz
év közleményei között, kiemelve az összehasonlító értékeléseket. A módszerek és
ajánlások kritikai elemzésekor a szerzők együttes 39 éves klinikai
tapasztalatukra támaszkodtak. A konzervatív kezelés sikere az etiológiától
függően nagy szórást mutat (3–90%). A non- és szemi-invazív intervenciós
eljárások sikerrátája 50–100% közötti. Eredménytelen konzervatív kezeléskor a
sebészi kezelés, elsősorban a ductus thoracicus lekötése jelenti a standard
terápiát. Ezen beavatkozások sikerességi aránya 64–100% közötti, a
morbiditási/mortalitási mutató elérheti a 25%-ot. A kezelést konzervatívan kell
megkezdeni, majd egy lépcsőzetes agresszivitású terápia ajánlott, amelyben a
beteg állapota és a drénvolumen irányítják a döntéshozatalt. Az intervenciós
radiológiai eljárások biztonságosak, sikeresek és helyet kaptak a konzervatív és
műtéti megoldások mellett. Orv. Hetil., 2016, 157(2),
43–51
INDIVIDUALITY OF CENTRE OF BODY MOVEMENT AT WALK AND TROT WITHIN THE HAFLINGER BREED
Kinematic measurements of fourteen Haflinger horses without lameness, walking and trotting on a treadmill were taken to document the location of the centre of the body (CB), defined as the centre between markers on the head, on the withers, on the sacral bone and on the lateral wall of all four hooves in relation to the sacral bone marker. During walk and trot, there are three dimensional CB position (x: forward-backward, y: side-to-side, and z: up and down). For each horse minimum of eight motion cycles were considered in walk as well as in trot. For all three axes, mean CB location, its standard deviation and its 95% confidence interval (CI) were calculated. For statistical analysis, Shapiro-Wilk test and Spearman’s correlation test were carried out. Mean body mass was 463±42 kg, CI (439, 487); mean height at the withers was 131±5 cm, CI (128, 134); mean height at the sacrum was 128 ± 2 cm, CI (127, 130). Mean CBx was in front of the sacrum (walk 74±2 cm, CI (72, 75); trot 73±2 cm, CI (72, 74); walk vs trot p=0.008). Mean CBz was below the sacrum (-71±2 cm, CI (-73, -70) in walk; -69 ± 2 cm, CI (-70, -68) in trot; walk vs trot p=0.001). Positive correlations were found between MeanCBx and trunk length in walk and trot, which could highlight the biomechanical importance of the trunk as it plays a crucial role in deceleration and acceleration. The analysis of the body location centre may be used to identify differences between horses of the same breed, and thus support evaluation of the quality of the horse during locomotion
Trigger and readout electronics for the STEREO experiment
The STEREO experiment will search for a sterile neutrino by measuring the
anti-neutrino energy spectrum as a function of the distance from the source,
the ILL nuclear reactor. A dedicated electronic system, hosted in a single
microTCA crate, was designed for this experiment. It performs triggering in two
stages with various selectable conditions, processing and readout via UDP/IPBUS
of 68 photomultiplier signals continuously digitized at 250 MSPS. Additionally,
for detector performance monitoring, the electronics allow on-line calibration
by driving LED synchronously with the data acquisition. This paper describes
the electronics requirements, architecture and the performances achieved.Comment: Topical Workshop on Electronics for Particle Physics (TWEPP) 2015,
Lisboa. 9 pages, 9 figure
Tompa pancreastrauma diagnózisa és kezelése = Diagnosis and management of blunt pancreatic trauma
Absztrakt:
A torzó szerveinek sérüléseiről, ezek kezeléséről mostanra kiterjedt irodalom és
letisztult protokollok állnak rendelkezésre. A hasnyálmirigy ez alól kivételt
képez. A pancreas tompa vagy áthatoló sérülései meglehetősen ritkák, részben
emiatt ez idáig nem született a témában magas szintű evidencián alapuló kezelési
ajánlás. Áttekintést adunk az utóbbi évtizedek releváns közleményeinek
következtetéseiről mind a felnőttkori, mind a gyermekkori pancreassérülések
kapcsán. Rendszerezzük az eddigi osztályozásokat és ezek megbízhatóságát. A
konzervatív vagy operatív kezelési terv adekvát felállításához alkalmazott
klasszifikációkat sorra vesszük a betegvizsgálattól a diagnosztikai leleteken át
a szövődményekig. A pancreassérülések kezelési elvei egyelőre nem alapulnak sem
prospektív, sem randomizált vizsgálatokon. A fellelhető tanulmányok csak
retrospektív, alacsony esetszámú betegcsoportokat dolgoznak fel, vagy
esetismertetések, illetve ezek áttekintései (4. vagy 5. szintű evidencia). Ennek
ellenére konszenzus alakult ki arról, hogy a Wirsung-vezeték érintettségén
múlik, hogy alacsony vagy magas rizikójú sérülésről van-e szó; a klasszifikációk
is ezt a logikát követik. Intakt fő pancreasvezeték esetén stabil betegnél
konzervatív kezelés javasolt. Amennyiben ductussérülés kimutatható,
felnőttkorban javasolt a perkután, endoszkópos vagy laparotomiás megközelítés
ennek ellátására. A gyermekkori sérülések kezeléséről sokkal ellentmondásosabb
ajánlások láttak napvilágot. Számos érv hozható fel a nem operatív és az
operatív kezelés oldalán és ellene is, ennek feloldása még várat magára. Orv
Hetil. 2018; 159(2): 43–52.
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Abstract:
The management of thoracic and abdominal organ injuries has very thorough and
extensive literature, including evidence-based protocols. Pancreatic trauma
stands as an exception. Blunt or penetrating trauma of the pancreas is rather
rare (less than 2% of all trauma cases, approximately 3–12% of all abdominal
trauma), leading to the lack of high-level evidences regarding its treatment.
Damage of the pancreas parenchyma can cause substantial morbidity and mortality,
therefore it is essential to separate cases where conservative treatment
suffices from those that need surgical approach. This study aims to review the
conclusions of relevant articles of the past decades concerning the management
of both adult and childhood pancreatic trauma. Classifications and their
reliability are revised. We enlist scaling systems that can help in making
decision whether to operate or to treat conservatively, from physical
examination to diagnostic measures and complications. To date, the treatment
principles of pancreatic trauma are not based either on prospective or on
randomised trials. The database search of studies retrieved only retrospective
and/or small case cohorts, case reports and expert opinions (levels 4 and 5 of
evidence). However, it is a generally accepted conviction that the damage of the
main pancreatic duct determines if the pancreatic injury is of low or high
grade. Available classifications are based on the same principle. Conservative
treatment is feasible given that the patient is hemodinamically stable and the
pancreatic duct is unimpaired. If duct lesion is discovered, adult cases are to
be treated with minimally invasive (percutaneous or endoscopic) measures or
surgically (including reconstruction, resection and drainage). The management of
childhood injuries has controversial literature. Many arguments can be
enumerated on the operative as also on the non-operative approach, this
confusion is to be clarified in the future. The highest morbidity rates are
derived from the late diagnosis of the pancreatic duct, while increased
mortality is seen in the polytrauma patient groups. Levels 1–2 evidence-based
recommendations are needed, but planning of strong trials is critically limited
due to the small number of cases and the heterogeneity of the relevant patient
groups. Orv Hetil. 2018; 159(2): 43–52
A sphere fitting approach to determine the hip joint centre of the horse
Accurate identification of the hip joint centre (HJC) is crucial for the correct estimation of knee and hip joint loads and kinematics, which is particularly relevant in orthopaedic surgery and musculoskeletal modelling. Several methods have been described for calculation of the HJC in humans, however, no studies have used these methods in the horse despite a similar need for improved evaluation of hip joint biomechanics in rehabilitation and musculoskeletal modelling. This preliminary study uses the commonly used functional method (least-squares sphere fit) to determine the HJC in three equid cadavers. Bone pins with reflective markers attached were drilled into the tuber coxae (TC), tuber ischium (TI), tuber sacrale (TS), greater trochanter (GT), third trochanter (TT) and lateral femoral condyle (FC) of the uppermost limb of the cadavers positioned in lateral recumbency. Three repetitions of passive movements consisting of pro-and retraction, ab- and adduction and circumduction were performed. The HJC was calculated using a least-squares sphere fitting method and presented as a distance from the TC based on a percentage of the TC to TI vector magnitude. Mean (± standard deviation) of the HJC is located 52.4% (± 3.9) caudally, 0.2% (± 6.5) dorsally, and 19.8% (± 4.2) medially from the TC. This study is the first to quantify the HJC in horses ex vivo using a functional method. Further work (in vivo and imaging) is required to validate the findings of the present study
Spectral Energy Distributions of Be and Other Massive Stars
We present spectrophotometric data from 0.4 to 4.2 microns for bright,
northern sky, Be stars and several other types of massive stars. Our goal is to
use these data with ongoing, high angular resolution, interferometric
observations to model the density structure and sky orientation of the gas
surrounding these stars. We also present a montage of the H-alpha and
near-infrared emission lines that form in Be star disks. We find that a
simplified measurement of the IR excess flux appears to be correlated with the
strength of emission lines from high level transitions of hydrogen. This
suggests that the near-IR continuum and upper level line fluxes both form in
the inner part of the disk, close to the star.Comment: 2010, PASP, 122, 37
Association of cerebral small vessel disease burden with brain structure and cognitive and vascular risk trajectories in mid-to-late life
We characterize the associations of total cerebral small vessel disease (SVD) burden with brain structure, trajectories of vascular risk factors, and cognitive functions in mid-to-late life. Participants were 623 community-dwelling adults from the Whitehall II Imaging Sub-study with multi-modal MRI (mean age 69.96, SD = 5.18, 79% men). We used linear mixed-effects models to investigate associations of SVD burden with up to 25-year retrospective trajectories of vascular risk and cognitive performance. General linear modelling was used to investigate concurrent associations with grey matter (GM) density and white matter (WM) microstructure, and whether these associations were modified by cognitive status (Montreal Cognitive Asessment [MoCA] scores of < 26 vs. ≥ 26). Severe SVD burden in older age was associated with higher mean arterial pressure throughout midlife (β = 3.36, 95% CI [0.42-6.30]), and faster cognitive decline in letter fluency (β = -0.07, 95% CI [-0.13--0.01]), and verbal reasoning (β = -0.05, 95% CI [-0.11--0.001]). Moreover, SVD burden was related to lower GM volumes in 9.7% of total GM, and widespread WM microstructural decline (FWE-corrected p < 0.05). The latter association was most pronounced in individuals who demonstrated cognitive impairments on MoCA (MoCA < 26; F3,608 = 2.14, p = 0.007). These findings highlight the importance of managing midlife vascular health to preserve brain structure and cognitive function in old age
White matter hyperintensities classified according to intensity and spatial location reveal specific associations with cognitive performance.
White matter hyperintensities (WMHs) on T2-weighted images are radiological signs of cerebral small vessel disease. As their total volume is variably associated with cognition, a new approach that integrates multiple radiological criteria is warranted. Location may matter, as periventricular WMHs have been shown to be associated with cognitive impairments. WMHs that appear as hypointense in T1-weighted images (T1w) may also indicate the most severe component of WMHs. We developed an automatic method that sub-classifies WMHs into four categories (periventricular/deep and T1w-hypointense/nonT1w-hypointense) using MRI data from 684 community-dwelling older adults from the Whitehall II study. To test if location and intensity information can impact cognition, we derived two general linear models using either overall or subdivided volumes. Results showed that periventricular T1w-hypointense WMHs were significantly associated with poorer performance in the trail making A (p = 0.011), digit symbol (p = 0.028) and digit coding (p = 0.009) tests. We found no association between total WMH volume and cognition. These findings suggest that sub-classifying WMHs according to both location and intensity in T1w reveals specific associations with cognitive performance
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