检索结果-内蒙古大学图书馆

CRANIOVERTEBRAL JUNCTION TUBERCULOSIS: A NEW COMPREHENSIVE THERAPEUTIC STRATEGY

NEUROSURGERY 2008年第5期63卷 946-955页

作者： Teegala, Ramesh Kumar, Pradyuth Kale, Shashank S. Sharma, Bhawani S. All India Inst Med Sci CNC Dept Neurosurg New Delhi 110029 India ELURU Alluri Sita Ramaraju Acad Med Sci Hosp Dept Neurosurg W Godavari India

OBJECTIVE: To establish a scoring system and management algorithm for patients with diagnosed craniovertebral junction tuberculosis. The specific goals were: 1) to avoid new neurological deficits;2) to avoid morbidity and compromise in the quality of life associated with prolonged, rigid, cumbersome external immobilization, such as with a sternal occipital mandibular immobilizer brace and halo traction;and 3) to prevent sudden death. METHODS: All patients diagnosed with craniovertebral junction tuberculosis were studied prospectively over a 3-year period. The initial severity of the disease was evaluated with clinicoradiological grading, and patients were divided into 3 grades. Overall performance status was assessed with disability scoring. Patients with Grade 1 and 2 severity were managed conservatively. Grade 3 patients underwent transoral decompression and posterior fixation. The patients' neurological recovery was evaluated every 4 weeks with disability scoring, along with x-rays, for the initial 3 months and every 2 months thereafter. RESULTS: Of 71 patients, there were 27 Grade 1, thirty-six Grade 2, and 8 Grade 3 patients. Children and young adults comprised 70% of the study population. All Grade 3 patients underwent early surgery. Five Grade 1 and 2 patients (8%) required delayed surgery for reducible atlantoaxial dissociation. The remaining 58 patients (82%) were effectively managed conservatively. The mean follow-up duration was 18.5 +/- 6.2 months. There was no mortality. CONCLUSION: Use of our proposed scoring system and management protocol allowed both speedy recovery and early mobilization. All patients had good clinicoradiological outcomes regardless of the grade.

关键词： Craniovertebral junction Craniovertebral junction tuberculosis scoring system management guidelines Potts spine Tuberculosis

来源：评论

学校读者我要写书评

暂无评论

Febrile neutropenia management in cancer patients receiving anti-cancer agents' treatment: Deepening the search to offer the best care. A critical review follow-up

引用

CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY 2020年 153卷 103042-103042页

作者： Casanovas-Blanco, Meritxell Serrahima-Mackay, Anna Hosp Clin Barcelona C Villarroel 170 Barcelona 08036 Spain

Introduction: Febrile neutropenia is a common complication in cancer patients. Emergency departments are in most countries the unique entry point to tertiary care. However, some challenges restrain emergency department professionals from complying with the protocol. Objective: To update the published review in 2018: "Critical review of emergency department management of chemotherapy complications in cancer patients", and explore improvement opportunities. Methods: MEDLINE, TROVE and SCOPUS databases were used to conduct a broad electronic literature search. Out of 74 articles yielded, nine responding to our questions were selected. Conclusions: Febrile neutropenia management in cancer patients still represents a challenge for emergency departments that have difficulties to comply with international guidelines. It is critical to identify the best venue and which professionals to manage the target population. Appropriate care pathways and a more efficient tool to classify low and high risk patients, would improve clinical outcomes, while costs would be reduced.

关键词： Emergency department Chemotherapy secondary effects febrile neutropenia management guidelines Clinical pathway

来源：评论

学校读者我要写书评

暂无评论

management of Tarsal Navicular Stress Fractures Conservative Versus Surgical Treatment: A Meta-Analysis

引用

AMERICAN JOURNAL OF SPORTS MEDICINE 2010年第5期38卷 1048-1053页

作者： Torg, Joseph S. Moyer, James Gaughan, John P. Boden, Barry P. Temple Univ Dept Orthoped Surg Philadelphia PA 19122 USA Temple Univ Sch Med Philadelphia PA 19122 USA Temple Univ Biostat Consulting Ctr Philadelphia PA 19122 USA Orthopaed Ctr Rockville MD USA

Purpose: This study was conducted to provide a statistical analysis of previously reported tarsal navicular stress fracture studies regarding the outcomes and effectiveness of conservative and surgical management. Study Design: Systematic review. Methods: A systematic review of the published literature was conducted utilizing MEDLINE through Ovid, PubMed, ScienceDirect, and EBSCOhost. Reports of studies that provided the type of tarsal navicular stress fracture (ie, complete or incomplete), type of treatment, result of that treatment, and the time required to return to full activity were selected for analysis. Using a mixed generalized linear model with study as a random effect and treatment as a fixed effect, cases were separated and compared based on 3 different types of treatment: conservative, weightbearing permitted (WBR);conservative, non-weightbearing (NWB);and surgical treatment. The outcome of the treatment was recorded as either successful or unsuccessful based on radiographic and/or clinical healing of the fracture and time from onset of treatment to return to activity. Results: There was no statistically significant difference between NWB conservative treatment and surgical treatment regarding outcome (P = .6441). However, there is a statistical trend favoring NWB management (96% successful outcomes) over surgery (82% successful outcomes). Weightbearing as a conservative treatment was shown to be significantly less effective than either NWB (P = .0001) or surgical treatment (P < .0003). Conclusion: Non-weightbearing conservative management should be considered the standard of care for tarsal navicular stress fractures. The authors could find no advantage for surgical treatment compared with NWB immobilization. However, there is a statistical trend favoring NWB over surgery. Rest or immobilization with weightbearing was inferior to both other treatments analyzed. The authors concluded that conservative NWB management is the standard of care for initial tr

关键词： tarsal navicular stress fractures outcomes management guidelines treatment

来源：评论

学校读者我要写书评

暂无评论

ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee

引用

JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY 2017年第5期14卷 587-595页

作者： Tessler, Franklin N. Middleton, William D. Grant, Edward G. Hoang, Jenny K. Berland, Lincoln L. Teefey, Sharlene A. Cronan, John J. Beland, Michael D. Desser, Terry S. Frates, Mary C. Hammers, Lynwood W. Hamper, Ulrike M. Langer, Jill E. Reading, Carl C. Scoutt, Leslie M. Stavros, A. Thomas Univ Alabama Birmingham Dept Radiol Birmingham AL 35294 USA Washington Univ Sch Med Mallinckrodt Inst Radiol St Louis MO USA Univ Southern Calif Dept Radiol Keck Sch Med Los Angeles CA USA Duke Univ Sch Med Dept Radiol Durham NC USA Brown Univ Dept Diagnost Imaging Providence RI 02912 USA Stanford Univ Med Ctr Dept Radiol Stanford CA 94305 USA Brigham & Womens Hosp Dept Radiol 75 Francis St Boston MA 02115 USA Hammers Healthcare Imaging New Haven CT USA Yale Sch Med Dept Internal Med New Haven CT USA Johns Hopkins Univ Sch Med Dept Radiol & Radiol Sci Baltimore MD USA Univ Penn Dept Radiol Philadelphia PA 19104 USA Mayo Clin Dept Radiol Coll Med Rochester MN USA Yale Univ Dept Radiol & Biomed Imaging New Haven CT USA Univ Texas Hlth Sci Ctr San Antonio Dept Radiol San Antonio TX 78229 USA

Thyroid nodules are a frequent finding on neck sonography. Most nodules are benign;therefore, many nodules are biopsied to identify the small number that are malignant or require surgery for a definitive diagnosis. Since 2009, many professional societies and investigators have proposed ultrasound-based risk stratification systems to identify nodules that warrant biopsy or sonographic follow-up. Because some of these systems were founded on the BI-RADS (R) classification that is widely used in breast imaging, their authors chose to apply the acronym TI-RADS, for Thyroid Imaging, Reporting and Data System. In 2012, the ACR convened committees to (1) provide recommendations for reporting incidental thyroid nodules, (2) develop a set of standard terms (lexicon) for ultrasound reporting, and (3) propose a TI-RADS on the basis of the lexicon. The committees published the results of the first two efforts in 2015. In this article, the authors present the ACR TI-RADS Committee's recommendations, which provide guidance regarding management of thyroid nodules on the basis of their ultrasound appearance. The authors also describe the committee's future directions.

关键词： Thyroid nodule thyroid cancer management guidelines ultrasound

来源：评论

学校读者我要写书评

暂无评论

Do physicians treat symptomatic osteoarthritis patients properly? Results of the AMICA experience

引用

SEMINARS IN ARTHRITIS AND RHEUMATISM 2005年第1期35卷 38-42页

作者： Sarzi-Puttini, P Cimmino, MA Scarpa, R Caporali, R Parazzini, F Zaninelli, A Atzeni, F Marcolongo, R L Scco Univ Hosp Rheumatol Unit Milan Italy Univ Genoa DIMI Chair Rheumatol Genoa Italy Univ Naples Federico II Chair Rheumatol Naples Italy Univ Pavia Chair Rheumatol I-27100 Pavia Italy IRCCS Policlin S Matteo Pavia Italy Ist Ric Farmacol Mario Negri Div Epidemiol Milan Italy Univ Siena Inst Rheumatol I-53100 Siena Italy

OBJECTIVE The main objective of the AMICA project was to photograph the Italian scenario of osteoarthritis (OA) and its treatment in general and specialty practice. The study was designed to evaluate their prescription modalities to determine whether they matched the recently proposed treatment guidelines for OA (ACR 2000;EULAR 2000;APS 2002). METHODS The study involved 2764 general practitioners (GPs) and 316 specialists who enrolled a total of 25,589 patients with OA of the hand, knee, and hip. RESULTS Pharmacological treatment alone was prescribed to 55% of the patients seen by GPs, 25% of those seen by rheumatologists, 8% of those seen by orthopedic surgeons, and 17% of those seen by physical medicine specialists (GPs versus specialists, P < 0.001). Specialists often prescribed a combined pharmacological and nonpharmacological approach (rheumatologists 51%, orthopedic surgeons 66%, physical medicine specialists 76%). Concomitant comorbidities and their treatment do not seem to influence OA prescription modalities except for peptic ulcer and anticoagulant therapy. The presence of peptic ulcer was associated with a reduction in NSAID prescriptions (OR 0.61, Cl 0.53 to 0.69) and more frequent use of Coxibs (OR 1.15, Cl 1.03 to 1.28) and simple analgesics (OR 1.42;Cl 1.26 to 1.61), as well as physical therapy. NSAIDs and Coxibs also were less frequently prescribed if patients were receiving anticoagulant therapy (NSAIDs OR 0.86, Cl 0.70 to 1.06;Coxibs: OR 0.77;Cl 0.64 to 0.93). Gastroprotective therapy was more frequently used in patients treated with NSAIDs, Coxibs, and analgesics. There was no significant difference in therapies prescribed for patients with hypertension or cardiac disease (myocardial infarction and/or angina pectoris). CONCLUSIONS The published guidelines appear to be properly used by most of the physicians in terms of the pharmacological approach;however, the increased use of Coxibs has not reduced the amount of prescribed gastroprotection. No sp

关键词： osteoarthritis pain risk factors management guidelines

来源：评论

学校读者我要写书评

暂无评论

ASC-US and HPV testing in women aged 40 years and over

引用

DIAGNOSTIC CYTOPATHOLOGY 2004年第5期31卷 358-361页

作者： Bruner, KS Davey, DD Univ Kentucky Med Ctr Dept Pathol & Lab Med Lexington KY 40536 USA

High-risk human papillomavirus (HPV) DNA triage is commonly performed for cervical cytology specimens interpreted as atypical squamous cells of undetermined significance (ASC-US), but little is known about testing results in women greater than or equal to40 yr of age. The extent to which clinical,follow-up after HPV testing reflects the most recent management guidelines is unknown also. Data from 108 patients greater than or equal to40 yr of age with concurrent (93 patients) or recent (15 patients) ASC-US interpretations and HPV testing were reviewed. Twenty-five (23.1%) of these patients were positive for high-risk HPV The HPV+ rate was higher in women with a current interpretation of ASC-US (26.9%) compared with those with a previous ASC-US result (0%). Many patients were not managed exactly according to the "2001 Consensus guidelines for the management of Women with Cervical Cytologic Abnormalities." The majority (52.6%) of women with HPV+ ASC-US did not receive colposcopy in our institution, and 41.3% of women with HPV- ASC-US received follow-up testing within 8 mo. These results show the potential for inadequate evaluation of women with HPV+ ASC-US, as well as unnecessary early repeat cytology in HPV- ASC-US patients. Therefore, additional clinician education and reminders to correlate cytology and HPV test results may be warranted to optimize patient care. (C) 2004 Wiley-Liss, Inc.

关键词： atypical squamous cells human papillomavirus management guidelines cervical cytology Papanicolaou test dysplasia

来源：评论

学校读者我要写书评

暂无评论

The right tools at the right time

引用

CHEST 2006年第1期130卷 29S-40S页

作者： Humbert, Marc Univ Paris Sud Hop Antoine Beclere APHP Serv Pneumol & Reanimat Resp F-92140 Clamart France

Asthma is underdiagnosed and undertreated or inappropriately treated, even though approximately 300 million people worldwide currently have the disease. While asthma in most patients can be controlled using currently available medications, in practice this rarely happens. Despite the wide availability of treatment guidelines, there are clear discrepancies between recommendations and the reality of treatment. There is excessive use of relief medications, particularly among patients with moderate-to-severe persistent asthma, coupled with a marked underuse of inhaled corticosteroids (ICS). This underuse by patients is likely to be related to anxiety about side effects and a misunderstanding about asthma. Many patients overestimate their degree of control and have a perceived lack of need for medication. Early therapeutic intervention, with optimal antiinflammatory therapy and a stepwise approach, has a positive impact on long-term outcomes, achieving suppression of airway inflammation, prompt symptom control, and restoration of pulmonary function. Even at low doses, ICS rapidly improve clinical symptoms and measures of lung function, while their long-term use markedly reduces the frequency and severity of exacerbations and asthma mortality. Although ICS monotherapy achieves successful control of persistent asthma in a significant proportion of patients, add-on therapy with a long-acting beta(2)-agonist provides control for most patients with moderate-to-severe persistent asthma. Fixed combination inhalers (ICS plus a long-acting beta(2)-agonist) have become popular, but these have drawbacks and there is the potential for overuse. In conclusion, ICS are the cornerstone of therapy for persistent asthma of all degrees of severity in adults and children, and early therapeutic intervention is recommended for optimal long-term outcome.

关键词： add-on therapy asthma early intervention inhaled corticosteroids management guidelines

来源：评论

学校读者我要写书评

暂无评论

Human-induced changes on fine-scale genetic structure in Ulmus laevis Pallas wetland forests at its SW distribution limit

引用

PLANT ECOLOGY 2013年第2期214卷 317-327页

作者： Venturas, Martin Fuentes-Utrilla, Pablo Ennos, Richard Collada, Carmen Gil, Luis Univ Politecn Madrid GENFOR Grp Invest Genet & Fisiol Forestal Dept Silvopascicultura ETSI Montes E-28040 Madrid Spain Univ Edinburgh Inst Evolutionary Biol Edinburgh EH9 9JT Midlothian Scotland

Human activities have deeply transformed the Mediterranean landscape for millennia. Wetland and riverbed vegetation are among the most affected ecosystems because of the value of these areas for agriculture, due to their rich soil and water availability. This has caused the fragmentation, population reduction, and extinction of many species. We focus our study on Ulmus laevis Pallas, an endangered tree species in the Iberian Peninsula, as an extreme example of these formations. We study the diversity and fine-scale spatial genetic structure of two human disturbed wetland populations with chloroplast markers and nuclear microsatellites. We evaluate their recovery possibilities, and how they will be affected by future aridification and water table depletion. Our results show that although these populations have suffered bottlenecks and have low genetic diversity, they maintain the same diversity levels as the European populations. Despite the low genetic variation that could contribute to inbreeding problems in the future, we discuss that the main threat of the species is habitat destruction. Finally, we propose some management and conservation policies to ameliorate these effects.

关键词： Ulmus laevis Spatial genetic structure Endangered species Conservation Wetland forests management guidelines

来源：评论

学校读者我要写书评

暂无评论

Bank re-erosion action to promote sediment supply and channel diversification: Feedback from a restoration test on the Rhine

引用

RIVER RESEARCH AND APPLICATIONS 2022年第5期38卷 975-987页

作者： Chardon, Valentin Schmitt, Laurent Clutier, Anne Univ Strasbourg CNRS UMR LIVE 7362 Strasbourg France Ctr Ingenieurie Hydraul CIH Elect France EDF Le Bourget Du Lac France

River regulation alters hydrological and sediment regimes and consequently affects habitat complexity and dynamics, biodiversity and ecosystem services. Although channel bank erosion is a key geomorphological process supplying alluvial channels with coarse sediments and diversifying aquatic and riparian habitats, banks have often been stabilized to limit erosion risk to human activities and facilities. The objective of this paper is to assess the effects, and their sustainability, of bank protection removal on a 300-m long reach of the Old Rhine (France/Germany) to promote sediment supply, channel diversification and a rehabilitation of fluvial morpho-sedimentary processes. This action was combined with the construction of two island groynes to locally increase bank erosion processes. Yearly detailed monitoring was implemented over 6 years, including classical bathymetric surveys, airborne topo-bathymetric and terrestrial LiDAR, and bed grain-size and bedload tracking. Following a Q(15) flood, the restoration induced a weak sediment supply. The restoration diversified habitats due to the implementation of the two island groynes, inducing bank scouring and the creation of new macroforms, as well as local bed grain-size diversification and fining. The cross-sectional diversity of the restored water channel was close to the regularization engineering phase. Channel bedform diversification persisted 6 years due to the persistence of the two island groynes. The action induced the rehabilitation of fluvial forms, in a static manner, rather than the rehabilitation of fluvial morpho-sedimentary processes, which raises questions about the sustainability of the benefits of such management actions in terms of fluvial functionality and naturality.

关键词： bank re-erosion geomorphological monitoring island groynes large-river restoration management guidelines Rhine River

来源：评论

学校读者我要写书评

暂无评论

Anticoagulation and Spine Surgery

引用

GLOBAL SPINE JOURNAL 2020年第1-Sup期10卷 53S-64S页

作者： Porto, Guilherme B. F. Wessell, Jeffrey Alvarado, Anthony Arnold, Paul M. Buchholz, Avery L. Med Univ South Carolina Charleston SC 29425 USA Univ Kansas Kansas City KS USA Carle Illinois Coll Med Urbana IL USA Carle Fdn Hosp Urbana IL USA Univ Virginia Charlottesville VA USA

Study Design: Literature review. Objective: Preoperative management of therapeutic anticoagulation in spine surgery is critical to minimize risk of thromboembolic events yet prevent postsurgical complications. Limited research is available, and most guidelines are based on drug half-lives. We aim to clarify current guidelines and available evidence for safe practice of spine surgery in this patient population. Methods: A literature search in PubMed was done encompassing comprehensive search terms to locate published literature on anticoagulation and spine surgery. Predefined inclusion and exclusion criteria were applied and data extraction was performed. Results: A total of 17 articles met the final inclusion criteria. Of these, 12 articles were retrospective chart reviews, 3 were prospective observational studies, and 2 were systematic reviews. Current practice suggests holding warfarin until international normalized ratio <1.4, anti-Xa drugs for 48 to 72 hours, 12 to 24 hours for low-molecular-weight heparin, and 4 to 24 hours for heparin, before surgery. Antiplatelet agents can be stopped for 1 to 3 days prior to operation (81-500 mg) but must be stopped for 1 week for doses >1 g/d. For Plavix, 5 to 7 days of discontinuation advised to prevent complications. Conclusions: This review provides an overview of main anticoagulation agents seen in preoperative setting for spine patients. Although data is mixed and no true randomized control trials are available, there is growing evidence suggesting the aforementioned guidelines are needed to optimize anticoagulation in setting of spine surgery. Further studies are needed to elucidate risk of complications while operating under therapeutic levels of anticoagulation for a variety of comorbid conditions.

关键词： spine surgery and perioperative anticoagulation antiplatelet agents blood loss surgical postoperative hematoma management guidelines

来源：评论

学校读者我要写书评

暂无评论

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案：

请选择收藏分类：

通借通还

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：