RESUMO
BACKGROUND: This study sought to define duplex ultrasound (DUS) velocity criteria predicting ≥70% stenosis in superior mesenteric artery (SMA) stents by correlating in-stent peak systolic velocity (PSV) with computed tomographic angiography (CTA) measurements of percent stenosis. METHODS: A retrospective review of 109 patients undergoing SMA stenting between 2003 and 2018 was conducted at a single institution. Thirty-seven surveillance duplex ultrasound studies were found to have a CTA performed within 30 days of study completion. Bare metal (nâ¯=â¯20) and covered stents (nâ¯=â¯17) were included. Velocities were paired to in-stent restenosis (ISR) measured by mean vessel diameter reduction on SMA centerline reconstructions from CTA. Receiver operating characteristic (ROC) curves was generated and logistic regression models for ≥70% ISR probability were used to define velocity criteria in the stented SMA. RESULTS: At a PSV of 300 cm/sec, the sensitivity is 100% and specificity 80% for a ≥70% in-stent SMA stenosis. At a PSV of 400 cm/sec, the sensitivity and positive predictive value (PPV) is 63% and the specificity and negative predictive value (NPV) is 90%. A PSV of 450 cm/sec was consistent with the highest specificity (100%) and PPV (100%) but lower sensitivity (50%) and NPV (87.9%). One patient with a PSV of 441 cm/sec on surveillance DUS died from complications of acute-on-chronic mesenteric ischemia. CONCLUSIONS: A PSV of 400 cm/sec on mesenteric DUS can predict ≥70% ISR with high sensitivity and should be considered as a diagnostic threshold for SMA in-stent restenosis.
Assuntos
Procedimentos Endovasculares/instrumentação , Artéria Mesentérica Superior/diagnóstico por imagem , Isquemia Mesentérica/terapia , Oclusão Vascular Mesentérica/terapia , Stents , Ultrassonografia Doppler Dupla , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Doença Crônica , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Artéria Mesentérica Superior/fisiopatologia , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Circulação Esplâncnica , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
The phyllosphere--the aerial surfaces of plants, including leaves--is a ubiquitous global habitat that harbors diverse bacterial communities. Phyllosphere bacterial communities have the potential to influence plant biogeography and ecosystem function through their influence on the fitness and function of their hosts, but the host attributes that drive community assembly in the phyllosphere are poorly understood. In this study we used high-throughput sequencing to quantify bacterial community structure on the leaves of 57 tree species in a neotropical forest in Panama. We tested for relationships between bacterial communities on tree leaves and the functional traits, taxonomy, and phylogeny of their plant hosts. Bacterial communities on tropical tree leaves were diverse; leaves from individual trees were host to more than 400 bacterial taxa. Bacterial communities in the phyllosphere were dominated by a core microbiome of taxa including Actinobacteria, Alpha-, Beta-, and Gammaproteobacteria, and Sphingobacteria. Host attributes including plant taxonomic identity, phylogeny, growth and mortality rates, wood density, leaf mass per area, and leaf nitrogen and phosphorous concentrations were correlated with bacterial community structure on leaves. The relative abundances of several bacterial taxa were correlated with suites of host plant traits related to major axes of plant trait variation, including the leaf economics spectrum and the wood density-growth/mortality tradeoff. These correlations between phyllosphere bacterial diversity and host growth, mortality, and function suggest that incorporating information on plant-microbe associations will improve our ability to understand plant functional biogeography and the drivers of variation in plant and ecosystem function.
Assuntos
Ecossistema , Florestas , Consórcios Microbianos/fisiologia , Filogenia , Folhas de Planta/microbiologia , Plantas/microbiologia , PanamáRESUMO
INTRODUCTION: The Fundamentals of Laparoscopic Surgery program is an educational program developed by the Society of American Gastrointestinal Endoscopic Surgeons, which includes a handson skills training component, a cognitive component, and an assessment component for laparoscopic surgery. Its main objective is to provide surgical residents and practicing surgeons with the opportunity to learn fundamental skills and obtain the theoretical knowledge required to perform laparoscopic surgery, guaranteeing a better performance in the operating room, and thus, improving patient security. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of telesimulation for teaching the Fundamentals of Laparosopic Surgery program in Colombia. MATERIALS AND METHODS: Twenty participants (ten general surgeons and ten general surgery residents) in two cities in Colombia participated in eight weekly telesimulation sessions. Fundamentals of Laparoscopic Surgery scores were obtained for each participant before the telesimulation sessions (pre-test scores) and after telesimulation training was completed (post-test scores). RESULTS: Using scoring parameters developed by the Society of American Gastrointestinal Endoscopic Surgeons, we found a significant improvement between pre-test and post-test scores. All the participants passed the skills component of the course. CONCLUSION: This study evidences the effectiveness of telesimulation to improve the laparoscopic skills of the participants who had no previous knowledge of the Fundamentals of Laparoscopic Surgery program, which guaranteed obtaining the necessary score for approving the practical component of the program.
Assuntos
Simulação por Computador , Educação a Distância , Laparoscopia/educação , Telemedicina , Competência Clínica , Colômbia , Currículo , Educação Médica Continuada , Avaliação Educacional , Cirurgia Geral/educação , Humanos , Cooperação Internacional , Internato e Residência , Laparoscopia/métodos , Ontário , Avaliação de Programas e Projetos de Saúde , Desempenho Psicomotor , Técnicas de Sutura/educação , Interface Usuário-ComputadorRESUMO
Introducción. El programa "Fundamentos de Cirugía Laparoscópica" es un módulo educativo desarrollado por la Society of American Gastrointestinal Endoscopic Surgeons, que incluye el desarrollo de habilidades prácticas y conocimientos teóricos en cirugía laparoscópica. Su misión principal es brindar a los residentes de las áreas quirúrgicas, y a los cirujanos en general, una herramienta adicional en su formación, para aprender los fundamentos y el conocimiento teórico necesario para la práctica de la cirugía laparoscópica, lo que garantizará un mejor desempeño en las salas de cirugía y, por ende, mayor seguridad para los pacientes. Objetivo. Evaluar la efectividad de la telesimulación para enseñar el componente práctico del programa "Fundamentos de Cirugía Laparoscópica" en Colombia. Materiales y métodos. Veinte participantes (10 cirujanos generales y 10 residentes de cirugía general) de dos ciudades de Colombia, participaron en ocho sesiones (una semanal) de entrenamiento en "Fundamentos de Cirugía Laparoscópica" mediante telesimulación. Se les hizo un examen práctico antes de las telesimulaciones, y un examen teórico y práctico, al final de las ocho sesiones. Resultados. Utilizando parámetros numéricos definidos por la Society of American Gastrointestinal Endoscopic Surgeons, se encontró diferencias significativas el examen previo y el posterior. El 100 % de los participantes aprobaron el componente práctico del programa. Conclusiones. Este estudio demuestra la efectividad de la telesimulación para mejorar las habilidades laparoscópicas de participantes sin conocimiento previo del programa "Fundamentos de Cirugía Laparoscópica", lo que garantizó obtener el puntaje necesario para aprobar la sección práctica del programa.
Introduction: The Fundamentals of Laparoscopic Surgery program is an educational program developed by the Society of American Gastrointestinal Endoscopic Surgeons, which includes a hands-on skills training component, a cognitive component, and an assessment component for laparoscopic surgery. Its main objective is to provide surgical residents and practicing surgeons with the opportunity to learn fundamental skills and obtain the theoretical knowledge required to perform laparoscopic surgery, guaranteeing a better performance in the operating room, and thus, improving patient security. Objective: The purpose of this study was to evaluate the effectiveness of telesimulation for teaching the Fundamentals of Laparosopic Surgery program in Colombia. Materials and methods: Twenty participants (ten general surgeons and ten general surgery residents) in two cities in Colombia participated in eight weekly telesimulation sessions. Fundamentals of Laparoscopic Surgery scores were obtained for each participant before the telesimulation sessions (pre-test scores) and after telesimulation training was completed (post-test scores). Results: Using scoring parameters developed by the Society of American Gastrointestinal Endoscopic Surgeons, we found a significant improvement between pre-test and post-test scores. All the participants passed the skills component of the course. Conclusion: This study evidences the effectiveness of telesimulation to improve the laparoscopic skills of the participants who had no previous knowledge of the Fundamentals of Laparoscopic Surgery program, which guaranteed obtaining the necessary score for approving the practical component of the program.
Assuntos
Laparoscopia , Exercício de Simulação , Cirurgia Geral , ColômbiaRESUMO
Ecologists and conservation biologists have historically used species-area and distance-decay relationships as tools to predict the spatial distribution of biodiversity and the impact of habitat loss on biodiversity. These tools treat each species as evolutionarily equivalent, yet the importance of species' evolutionary history in their ecology and conservation is becoming increasingly evident. Here, we provide theoretical predictions for phylogenetic analogues of the species-area and distance-decay relationships. We use a random model of community assembly and a spatially explicit flora dataset collected in four Mediterranean-type regions to provide theoretical predictions for the increase in phylogenetic diversity - the total phylogenetic branch-length separating a set of species - with increasing area and the decay in phylogenetic similarity with geographic separation. These developments may ultimately provide insights into the evolution and assembly of biological communities, and guide the selection of protected areas.