Zobrazení zdroje stránky Staffordhammond7653

To assess the introduction of telemedicine as an alternative to the traditional face-to-face encounters with vascular surgery patients in the era of the coronavirus disease 2019 (COVID-19) pandemic.<br /><br /> A retrospective review of prospectively collected data on face-to-face and telemedicine interactions was conducted at a multisite health care system from January to August 2020 in vascular surgery patients during the COVID-19 pandemic. The end point is direct patient satisfaction comparison between face-to-face and telemedicine encounters/interactions prior and during the pandemic.<br /><br /> There were 6262 patient encounters from January 1, 2020, to August 6, 2020. Of the total encounters, 790 (12.6%) were via telemedicine, which were initiated on March 11, 2020, after the World Health Organization's declaration of the COVID-19 pandemic. These telemedicine encounters were readily adopted and embraced by both the providers and patients and remain popular as an option to patients for all types of visits. Of these patients, 78.7% rated their overall health care experience during face-to-face encounters as very good and 80.6% of patients rated their health care experience during telemedicine encounters as very good (P= .78).<br /><br /> Although the COVID-19 pandemic has produced unprecedented consequences to the practice of medicine and specifically of vascular surgery, our multisite health care system has been able to swiftly adapt and adopt telemedicine technologies for the care of our complex patients. Most important, the high quality of patient-reported satisfaction and health care experience has remained unchanged.<br /><br />Although the COVID-19 pandemic has produced unprecedented consequences to the practice of medicine and specifically of vascular surgery, our multisite health care system has been able to swiftly adapt and adopt telemedicine technologies for the care of our complex patients. Most important, the high quality of patient-reported satisfaction and health care experience has remained unchanged.<br /><br /> Historically, a positive margin after pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) was associated with decreased survival. In an era when neoadjuvant chemotherapy (NAC) is being used frequently, the prognostic significance of margin status is unclear.<br /><br /> Patients with localized PDAC who received NAC and underwent pancreatectomy from 2011 to 2018 were identified from a single-institution database. Patients with fewer than 2 months of NAC, R2 resection, or fewer than 90 days of follow-up were excluded. A positive margin included tumors within 1 mm of the surgical margin.<br /><br /> Four hundred and sixty-eight patients met inclusion criteria. Median age was 65 years and 53% were female. Preoperative clinical staging demonstrated that most had locally advanced (n= 222 [47%]) or borderline resectable (n= 172 [37%]) disease. Median follow-up was 18.5 months (interquartile range 10.6 to 30.0 months). Median duration of NAC was 119 days (interquartile range 87 to 168 days). FOLFIRINOX was first-line therapy fotients resected after treatment with NAC. Aggressive surgical extirpation in high-volume centers should be considered in selected patients after extensive NAC.The practice of child and adolescent psychiatry is evolving during an unprecedented global health catastrophe, the coronavirus disease 2019 (COVID-19) pandemic. As child and adolescent psychiatrists grapple with COVID-19's enormous medical, educational, social, and economic toll, a mental health crisis is co-occurring. Pre-existing disparities are recognized as contributors to the disproportionate impact of the COVID-19 pandemic on racial and ethnic minorities.1 The magnitude of COVID-19's effects on child and family mental health has yet to be fully revealed. child and adolescent psychiatrists are in a unique position to address this mental health crisis. Child and adolescent psychiatrists must stay up-to-date regarding federal, state, local, and institutional mandates, regulations, and policies informed by the Centers for Disease Control and Prevention2 and other public health institutions, while also navigating the ethical dilemmas unique to child and adolescent psychiatry during the coronavirus era.Trophobiotic interactions occur when phytophagous insects provide a sugary liquid, the honeydew, for ants and obtain defence against predators or parasitoids. The plants may indirectly benefit from an increased ant foraging activity by reducing the herbivorous abundance. These three trophic interactions have been previously studied for several species, but mainly involving plants with extrafloral nectaries, which is a plant structure that also produce attractive substances for ants. Previous studies have reported an ant preference for honeydew over extrafloral nectary content. Therefore, trophobiosis can be an important mediator of ant-plant interactions. In this study, we describe a trophobiotic interaction between Edessa contermina stink bugs and Camponotus blandus ants on the Byrsonima verbascifolia plants occurring in a conservation area of Brazilian savanna. Stink bugs excreted a sugary liquid which was consumed by the ants, and C. blandus ants were observed consuming potential parasitoids. Stink bugs were more abundant in plants containing high food supply and shelter availability. The occurrence of ants depended of the number of inflorescences and trunk circumference of B. verbascifolia. Ant abundance, however, was positively correlated with stink bug abundance and the number of inflorescences. Herbivory was not explained by neither plant architecture nor ant abundance. This high ant activity may benefit plants from a protection against herbivory, but we did not detect this effect during the study period. Hence, the interaction among ants and plants was apparently commensal. We concluded that plant traits were important in ant attraction, but stink bugs foraging also increased ant activity on the plant, but mainly on inflorescences. Therefore, the plant may benefit from an increased defence of inflorescences rather than leaves.<br /><br /> Isolated dissection of the superior mesenteric artery (SMA) is increasingly diagnosed; the conservative treatment appears to be the best option when blood supply is maintained. However, some patients require a more invasive attitude, due to acute or chronic ischemic complication. Multidisciplinary care within a health-care network improves medical and surgical support. We present a case of chronic complication of isolated SMA dissection requiring a revascularization, followed by bowel resection.<br /><br /> A 49-year-old man presented abdominal pain secondary to necrotizing enterocolitis of unknown cause. An isolated small bowel resection with immediate restoration of continuity was first performed to remove the necrotic tissue. The patient developed post-ischemic exudative enteropathy and small intestinal bacterial overgrowth (SIBO). Re-examination of the first computed tomography (CT) scan revealed an isolated dissection of the SMA that had not been diagnosed. The patient was then successfully treated by superior mesenteric revascularization, and after recovering, he underwent small bowel resection for chronic ischemia.<br /><br /> SMA revascularization has to be performed in case of SMA dissection complicated of bowel ischemia. Enteropathy is a rare complication of chronic mesenteric ischemia requiring digestive and vascular management in a dedicated health-care team.<br /><br />SMA revascularization has to be performed in case of SMA dissection complicated of bowel ischemia. Enteropathy is a rare complication of chronic mesenteric ischemia requiring digestive and vascular management in a dedicated health-care team.We present the case of a young patient who sustained a gunshot wound to the abdomen initially treated with laparotomy and repair of small bowel, splenic vein and diaphragmatic injuries. Subsequent computed tomography (CT) performed for hemodynamic instability demonstrated a pseudoaneurysm involving the aorta and proximal celiac artery, with an associated aortocaval fistula. An attempt at transperitoneal repair of these injuries was aborted due to extensive inflammatory changes in the region encountered during exposure. Subsequently, a hybrid repair was performed. This consisted of exclusion of the aortic and celiac artery pseudoaneurysm using an endovascular aortic cuff (22 × 39 mm, Cook Medical) via infrarenal aortic access, surgical ligation of the celiac artery branches, and revascularization via bypass from the infrarenal aortic access site arteriotomy to the common hepatic artery.<br /><br /> We aimed to describe the operative outcomes following open aortoiliac/femoral graft reconstruction for bilateral kissing-stent (KS) occlusion.<br /><br /> This is a bicentric, retrospective, observational cohort study. Between September 2007 and December 2019, 205 patients were treated with KS for aortoiliac reconstruction. Only those who had bilateral KS occlusion with subsequent aortoiliac/femoral graft replacement were included in this analysis. Primary outcomes were early (&lt;30days) and late survival, postoperative (&lt;30days) complications, and patency rates.<br /><br /> Nine patients (male, n=7) were analyzed. The patient's mean age was 60±5years (range 55-62). Median delay from initial KS procedure was 36months (interquartile range [IQR] 19-252). On admission, all patients presented with a worse Rutherford class compared to their initial pre-KS clinical presentation. Aortobifemoral bypass was performed in 5 patients, and aortobi-iliac reconstruction in 4 patients. There were no perioperative deaths and only 1 new case of erectile dysfunction occurred. At a median follow-up time of 24months (IQR 12-54), primary patency rate was 88.9%.<br /><br /> Open aortic reconstruction after KS occlusion was feasible and effective. [https://www.selleckchem.com/products/mmp-9-in-1.html MMP-9-IN-1 mw] Endovascular repair for aortoiliac obstructive disease may be pursued as first-line treatment even in complex lesions.<br /><br />Open aortic reconstruction after KS occlusion was feasible and effective. Endovascular repair for aortoiliac obstructive disease may be pursued as first-line treatment even in complex lesions.<br /><br /> Bilaterally absent pupillary light reflexes (PLR) or N20 waves of short-latency evoked potentials (SSEPs) are recommended by the 2015 ERC-ESICM guidelines as robust, first-line predictors of poor neurological outcome after cardiac arrest. However, recent evidence shows that the false positive rates (FPRs) of these tests may be higher than previously reported. We investigated if testing accuracy is improved when combining PLR/SSEPs with malignant electroencephalogram (EEG), oedema on brain computed tomography (CT), or early status myoclonus (SM).<br /><br /> Post-hoc analysis of ProNeCA multicentre prognostication study. We compared the prognostic accuracy of the ERC-ESICM prognostication strategy vs. that of a new strategy combining ≥2 abnormal results from any of PLR, SSEPs, EEG, CT and SM. We also investigated if using alternative classifications for abnormal SSEPs (absent-pathological vs. bilaterally-absent N20) or malignant EEG (ACNS-defined suppression or burst-suppression vs. unreactive burst-suppression or status epilepticus) improved test sensitivity.<br /><br /> We assessed 210 adult comatose resuscitated patients of whom 164 (78%) had poor neurological outcome (CPC 3-5) at six months. FPRs and sensitivities of the ≥2 abnormal test strategy vs. the ERC-ESICM algorithm were 0[0-8]% vs. 7 [1-18]% and 49[41-57]% vs. 63[56-71]%, respectively (p &lt; .0001). Using alternative SSEP/EEG definitions increased the number of patients with ≥2 concordant test results and the sensitivity of both strategies (67[59-74]% and 54[46-61]% respectively), with no loss of specificity.<br /><br /> In comatose resuscitated patients, a prognostication strategy combining ≥2 among PLR, SSEPs, EEG, CT and SM was more specific than the 2015 ERC-ESICM prognostication algorithm for predicting 6-month poor neurological outcome.<br /><br />In comatose resuscitated patients, a prognostication strategy combining ≥2 among PLR, SSEPs, EEG, CT and SM was more specific than the 2015 ERC-ESICM prognostication algorithm for predicting 6-month poor neurological outcome.