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Hepatic NAD+ levels and NAMPT abundance are unaffected during prolonged high-fat diet consumption in C57BL/6JBomTac miceDall, Morten, Penke, Melanie, Sulek, Karolina, Matz-Soja, Madlen, Holst, Birgitte, Garten, Antje, Kiess, Wieland, Treebak, Jonas T. 02 March 2020 (has links)
Dietary supplementation of nicotinamide adenine dinucleotide (NAD+) precursors has been suggested as a treatment for non-alcoholic fatty liver disease and obesity. In the liver, NAD+ is primarily generated by nicotinamide phosphoribosyltransferase (NAMPT), and hepatic levels of NAMPT and NAD+ have been reported to be dependent on age and body composition. The aim of the present study was to identify time course-dependent changes in hepatic NAD content and NAD+ salvage capacity in mice challenged with a high-fat diet (HFD). We fed 7-week-old C57BL/6JBomTac male mice either regular chow or a 60% HFD for 6, 12, 24, and 48 weeks, and we evaluated time course-dependent changes in whole body metabolism, liver steatosis, and abundance of hepatic NAD-associated metabolites and enzymes. Mice fed a 60% HFD rapidly accumulated fat and hepatic triglycerides with associated changes in respiratory exchange ratio (RER) and a disruption of the circadian feeding pattern. The HFD did not alter hepatic NAD+ levels, but caused a decrease in NADP+ and NADPH levels. Decreased NADP+ content was not accompanied by alterations in NAD kinase (NADK) abundance in HFD-fed mice, but NADK levels increased with age regardless of diet. NAMPT protein abundance did not change with age or diet. HFD consumption caused a severe decrease in protein lysine malonylation after six weeks, which persisted throughout the experiment. This decrease was not associated with changes in SIRT5 abundance. In conclusion, hepatic NAD+ salvage capacity is resistant to long-term HFD feeding, and hepatic lipid accumulation does not compromise the hepatic NAD+ pool in HFD-challenged C57BL/6JBomTac male mice.
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Outcomes of Salvage Arthrodesis and Arthroplasty for Failed Osteochondral Allograft Transplantation of the AnkleGaul, Florian, Barr, Cameron R., McCauley, Julie C., Copp, Steven N., Bugbee, William D. 02 September 2022 (has links)
Background: Osteochondral allograft (OCA) transplantation is a useful treatment for posttraumatic ankle arthritis
in young patients, but failure rates are high and reoperations are not uncommon. The aim of this study was to
evaluate the outcomes of failed ankle OCA transplantation converted to ankle arthrodesis (AA) or total ankle
arthroplasty (TAA).
Methods: We evaluated 24 patients who underwent salvage procedures (13 AA and 11 TAA) after primary failed ankle
OCA transplantation. Reoperations were assessed. Failure of the salvage procedure was defined as an additional surgery
that required a revision AA/TAA or amputation. Evaluation among nonfailing ankles included the American Academy of
Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM), pain, and satisfaction.
Results: In the salvage AA cohort, 3 patients were classified as failures (2 revision AA and 1 amputation). The 10 nonfailing
patients had a mean follow-up of 7.4 years. Eighty-eight percent were satisfied with the procedure, but 63% reported
continued problems with their ankle (eg, pain, swelling, stiffness). Mean pain level was 1.9 and AAOS-FAM core score was
83±13. In the salvage TAA cohort, 2 patients were classified as failures (both revision TAA). The 9 nonfailing patients had
a mean follow-up of 3.8 years. Fifty percent were satisfied with the procedure, but 40% reported continued problems with
their ankle. The mean pain level was 1.3, and the median AAOS-FAM core score was 82±26.
Conclusion: Revision and reoperation rates for salvage procedures following failed OCA transplantation of the ankle are
higher compared to published data for primary AA and TAA procedures. However, we believe OCA transplantation can
serve as an interim procedure for younger patients with advanced ankle joint disease who may not be ideal candidates for
primary AA or TAA at the time of initial presentation.
Level of Evidence: Level IV, case series.
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Cultural forests of the Southern Nuu-chah-nulth: historical ecology and salvage archaeology on Vancouver Island's West CoastEarnshaw, Jacob Thomas Kinze 09 May 2016 (has links)
Cedar, represented by Western redcedar (Thuja plicata) and Yellow Cedar (Chamaecyparis nootkatensis) was known as the “Tree of Life” to the Nuu-chah-nulth on Vancouver Island’s west coast, and most other groups of the Pacific Northwest. This thesis investigates the Culturally Modified Trees (CMTs), or more specifically Tapered Bark Strips (TBS), created through the extraction of cedar bark removed for all manner of material goods. CMTs are now the most common archaeological site type within British Columbia. Current regional chronologies have inherent biases that make interpretations difficult. The chronologies created through Archaeological Impact Assessments (AIAs) are weighted heavily to the contact period and the highest frequency of use corresponds with indigenous population collapse rather than peak. Investigations are made into the true distribution of existing CMT features.
This thesis details the survey of 16 recent old growth cedar clearcuts which found extensive unrecorded CMT features that have recently been logged throughout the southern Nuu-chah-nulth study region. Half of all TBS scars in exposed stumps were found embedded within healed trees, otherwise invisible to archaeologists. Comparing all AIA report dates (surveyed prior to logging activity) with all post-impact assessments surveys it was found the latter contain a greater and older distribution of scarring events corresponding to high First Nations populations before the contact period. The study also compares CMT chronologies with local histories, investigates the antiquity of Northwest Coast CMTs and the indigenous management of cedar trees to maximize bark harvests. The findings of this research hint at the expanded extent of anthropogenic forests in the Northwest Coast, the inadequate recording and heritage protections of CMTs, and what it all means for Aboriginal Land Rights in British Columbia. / Graduate / 0324 0740 0329 / kinze.earnshaw@gmail.com
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Comparative in vitro analysis of a balanced electrolyte solution versus an unbalanced electrolyte solution, for processing of residual pump blood using cell saver for patients undergoing elective cardiac surgeryPillay, Krishnan January 2016 (has links)
Submitted in fulfillment for the degree of Master of Technology, Clinical Technology: Cardiovascular Perfusion, Durban University of Technology, Durban, South Africa, 2016. / Introduction:
A large volume of residual haemodilute blood remains in the cardiopulmonary bypass (CPB) circuit after termination of the bypass. It is common practice in many centres to process residual pump blood with an autologus cell salvage system (ACSS), thereby producing a re-suspended red blood cell (RBC) concentrate and attenuating the need for donor blood RBC concentrate. It has also become standard practice to wash donor pack red blood cells (PRBC) before adding it to neonate cardiopulmonary circuits (Swindell et al., 2007). Manufactures of ACSS recommend 0.9% sodium chloride (NaCl) as a wash solution for processing salvaged blood. Previous studies have demonstrated that washing PRBC with normal saline results in acid-base (Huber et al., 2013) and electrolyte derangements (Varghese et al., 2007). Infusion of normal saline in healthy volunteers also results in significant changes in osmolality (Williams et al., 1999). The use of normal saline as a wash solution in processing residual CPB blood requires investigation.
Aims and Objectives:
This was a prospective, quantitative in vitro investigation to analyze and compare the quality of residual pump blood post CPB that had been washed with either an unbalanced electrolyte solution (0.9% normal saline) or a balanced electrolyte solution (Balsol®). Both are crystalloid solutions. The primary objective of the present study was to measure and compare the pH, electrolytes, metabolites, osmolality and strong ion difference (SID) of residual pump blood to the pH, electrolytes, metabolites, osmolality and SID of processed cell saver blood, which was washed with either 0.9% normal saline or Balsol® solution. The secondary objective was to measure and compare protein levels (albumin and total protein) in residual pump blood to protein levels in processed cell saver blood, that is washed with either 0.9% normal saline or Balsol® solution. The final objective was to determine the volume, haematocrit and haemoglobin yield post cell saver processing, from the input volume of residual pump blood when washed with either 0.9% normal saline or Balsol® solution. This was the first study of this nature done in the South African population group.
Methodology:
In this investigation in a series of forty patients (n=40) undergoing elective cardiac surgery with CPB, the first twenty patients were allocated to the NaCl control group (n=20) and the second twenty patients were allocated to the Balsol® interventional group (n=20). The extracorporeal circuit consisted of a standard integral hollow fibre membrane oxygenator and tubing that was primed with 1500-1800 millilitres of balanced crystalloid solution (Balsol®), for both the control group and the interventional group, and addition of 5000 iu heparin. The balanced crystalloid solution (Balsol®) is the approved standard CPB priming solution for all cardiac procedures at Inkosi Albert Luthuli Central Hospital.
This setup was used with the Stockert S5 roller pump heart lung machine. The operations were performed as per protocol with standard non-pulsatile CPB and hypothermia was maintained at 28 – 32 ºC (core) and haemodilution (haematocrit 20 % to 30 %). A standard flow rate of 2.4 L/min/m² was used. Cardio protection consisted of either cold Blood Cardioplegia using the Buckberg 4:1 ratio, being four parts blood to one part cardioplegia (with the 35ml of 20 % Dextrose + 1 gram Magnesium Sulphate added per 500ml), or 20ml/kg cold St Thomas II cardioplegia (with addition of 10ml of 8.5% NaHCO3 + 100mg lignocain per litre). Topical cooling was achieved with ice cold 0.9 % saline. Maintenance fluid used during CPB was Balsol® for both the control and the interventional groups. Calcium, potassium and sodium bicarbonate was administered as required during CPB to correct deficits for both groups. Weaning of CPB was performed after re-warming to a rectal temperature of at least 35 ºC for both study groups.
Immediately on termination of CPB a blood sample was taken from the sampling manifold of the CPB circuit for pre wash analysis. Residual pump blood was then flushed out with one litre of Balsol® solution for both groups and collected into the Medtronic autolog cell saver reservoir to be processed. In the control study group 0.9% NaCl was used as the wash solution and in the interventional study group Balsol® solution was used as the wash solution. After processing of the salvaged blood is complete, a blood sample was taken for post wash analysis. Clinical data recorded for pre and post wash samples included: pH, pCO2, pO2, [K+], [Na+], [Cl-], [Ca2+], lactate, glucose, [HCO3-], TCO2, haematocrit, haemoglobin (GEM 4000® premier™ blood gas analyser) blood volume (Medtronic autolog) and SID (calculated as per equation). Inorganic phosphate, total magnesium, albumin, total protein (Siemens Advia 1800 blood gas analyser) and osmolality (Gonotech osmometer) were also measured.
Results:
There was a highly significant decrease (p < 0.05) within the NaCl group after washing with pCO2 (28.3 ± 2.9 vs. <6.0 ± 0.0), [K+] (4.5 ± 0.5 vs. 1.0 ± 0.7), total magnesium (1.7 ± 0.7 vs. 0.29 ± 0), ionized calcium (1.0 ± 0.09 vs. 0.1 ± 0.03), inorganic phosphate (0.9 ± 0.4 vs. 0.09 ± 0.04) and SID (27.1 ± 2.1 vs. 18.4 ± 2.2). There was a highly significant increase (p < 0.05) within the NaCl group after washing with pH (7.5 ± 0.1 vs. 7.7 ± 0.1), [Na+] (132.9 ± 3.2 vs. 146.3 ± 1.9), [Cl-] (107.8 ± 3.1 vs. 127.4 ± 2.1) and osmolaltity (256.9 ± 38.4 vs. 296.2 ± 57.5).
There were highly significant decrease (p < 0.05) within the Balsol® group after washing with pCO2 (30.15 ± 6.0 vs. 18.9 ± 4.9), [Na+] (134.7 ± 2.2 vs. 125.6 ± 1), [Cl-] (108.8 ± 2.7 vs. 100.2 ± 1.4), ionized calcium (0.9 ± 0.1 vs. 0.02 ± 0.04), inorganic phosphate (0.8 ± 0.2 vs. 0.1 ± 0.024) and osmolality (288.8 ± 20.6 vs. 272.8 ± 19.9). There were highly significant increase (p < 0.05) within the Balsol® group after washing with pH (7.5 ± 0.1 vs. 7.7 ± 0.1), [K+] (4.2 ± 0.4 vs 4.6 ± 0.3). Total magnesium and SID were similar after washing within the Balsol® group. Albumin and total protein revealed similar significant decreases within both groups after washing.
There was a highly significant difference (p < 0.05) in the change between groups after washing in all the variables measured, except for pH, inorganic phosphate, lactate, glucose, albumin, total protein, haematocrit, haemoglobin, and blood volume. Total carbon dioxide and [HCO3-] were not compared because they were incalculable by blood gas analyser in the NaCl group.
Conclusion:
This investigation concluded that the balanced electrolyte solution Balsol® used for washing residual CPB blood results in a re-suspended RBC concentrate, with an osmolality and electrolyte profile that is superior compared to washing residual CPB blood with 0.9% NaCl solution. / M
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La chasse aux trésors subaquatiques : portrait d'une industrie marginale à l'ère de l'internetCourchesne, Stéphanie 12 1900 (has links)
En marge des recherches archéologiques traditionnelles, nous retrouvons aujourd’hui des compagnies privées qui contractent des accords et obtiennent des permis leur donnant le droit de prélever des objets à des fins lucratives sur les vestiges archéologiques submergés. Ces pratiques commerciales causent une controverse vive et enflammée au sein du monde archéologique. Le principal point de litiges concerne la mise en vente des objets extraits lors de fouille. La mise en marché du patrimoine archéologique éveille les fibres protectionnistes. Cela incite certains organismes à poser des gestes pour la protection du patrimoine. C’est le cas pour l’UNESCO qui fait la promotion depuis 2001 d’une Convention pour la protection du patrimoine submergé. Malgré tous les arguments à l’encontre des compagnies de « chasse aux trésors », cette Convention est loin de faire l’unanimité des gouvernements à travers le monde, qui ne semblent pas prêts à rendre ces pratiques illégales.
Les méthodes utilisées par ces compagnies semblent aussi représenter un point de friction avec les archéologues. Toutefois, la connaissance de leurs pratiques sur le terrain semble très incomplète. De plus, contrairement à une certaine idée préconçue, ces compagnies ne sont pas des « pilleurs de tombes » œuvrant sous le couvert de l’anonymat, mais bien des compagnies dûment enregistrées, œuvrant en toute légalité et passant même des contrats avec les gouvernements.
Ce mémoire a donc pour objectif de mettre en lumière les actions réelles des compagnies de chasse aux trésors subaquatiques en regardant leurs méthodes et leur fonctionnement, tels qu’on les voit dans les 10 dernières années. Pour mieux conceptualiser les pratiques de ces compagnies, nous nous interrogerons sur le rapport entre légalité et éthique et, plus précisément, sur l’éthique commerciale et archéologique. / Beyond the pole of traditional underwater archaeology, we find an industry composed of commercial companies that enter into contractual agreements and obtain permits which allow them to take objects from submerged sites for financial gain. Their practices create a lively and often heated controversy in the archaeological community. The principal disagreement concerns the sale of objects from sites. The marketing of archaeological heritage awakens protective instincts and actions for the protection of heritage, such as UNESCO’s campaign begun in 2001 for the adoption of a Convention on the protection of Underwater Cultural Heritage (Unesco.org 2001). Despite all the arguments against « treasure hunting » companies, the Convention is far from being universally accepted by sovereign governments, who do not seem prepared to make the companies’ practices illegal.
The methods used by the companies are also a source of friction with archaeologists. However, knowledge of their field methods seems rather incomplete, and contrary to some preconceived notions, these companies are not « grave robbers » working under the dark, but indeed duly registered companies working in full legality and even entering into contractual agreements with governments.
This thesis aims to shed light on the activities of the underwater treasure hunting industry by studying their methods and operations as they have developed in the last ten years. In order to conceptualise the companies’ practices, we look at the relation between archaeological and business ethics.
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Mesianismus v abrahamovských náboženstvích: Náboženské očekávání a jeho význam pro mezináboženský dialog / Messianism in Abrahamic Religions: Religious Expectations and Its Importance for Interreligious DialogueKrál, Lukáš January 2014 (has links)
Diploma work abstract I based my work on the research of messianic topic in holy texts of Abrahamaic religions, what means an research on TNK (Old Testament), New Testament and Quran (including the early islamic tradition). I tried to bring a frame of a possible common dialogue based on the shared religious expectation towards common world ethos.
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Hochdosischemotherapie bei HodentumorenKrusch, Andreas 24 November 2000 (has links)
Die Hochdosischemotherapie (HDCT) wurde als Therapiestrategie zur Verbesserung des Therapieansprechens bei Patienten mit rezidivierten und/oder refraktären Keimzelltumoren entwickelt. Im Zeitraum von August 1989 bis September 1995 wurden insgesamt 150 Patienten mit rezidivierten und/oder refraktären Keimzelltumoren in konsekutive Therapieprotokolle mit einer konventionell-dosierten Chemotherapie gefolgt von einem Zyklus HDCT mit Carboplatin in der Dosierung 1500-2000 mg/m², Etoposide in der Dosierung 1200-2400 mg/m² und Ifosfamid in der Dosierung 0-10 g/m² eingeschlossen und retrospektiv ausgewertet. Nach einem medianen Follow-up von 55 Monaten (Spanne 21-88 Monate) lebten 51/150 (34%) Patienten und waren tumorfrei. Das berechnete ereignisfreie Überleben lag bei 29%, das Gesamtüberleben bei 39%. Die Bedeutung von Prognosefaktoren für das Therapieansprechen auf HDCT wurden prospektiv bestätigt. Persistierende Toxizitäten traten bei gut einem Drittel der Langzeitüberlebenden auf. Die intensivierte Behandlung mit HDCT resultierte in einem signifikanten Anteil an Langzeitüberlebenden bei Patienten mit rezidivierten und/oder refraktären Keimzelltumoren. Klinische Studien zur prospektiven Evaluierung der HDCT als frühe Therapieintervention scheinen gerechtfertigt. / High-dose chemotherapy (HDCT) has evolved as a strategy to improve treatment outcome in patients with relapsed and/or refractory germ cell tumors. Between August 1989 and September 1995, 150 consecutive patients with relapsed and/or refractory germ cell tumors were treated with conventional-dose salvage chemotherapy followed by one cycle of HDCT with carboplation 1500-2000 mg/m², etoposide 1200-2400 mg/m² and ifosfamide 0-10 g/m² and were retrospetively analysed. With a median follow-up time of 55 month (range 21-88 month) 51/150 (34%) patients were alive and disease free. The projected event-free and overall survival are 29% and 39% respectively. The relevance of prognostic variables for long-term survival after HDCT were prospectively confirmed. Persisting toxicities occured in approximately one third of long-term survivors. Treatment intensification with HDCT resulted in a significant proportion of long-term survivors in patients with relapsed and/or refractory germ cell tumors. Trials to prospetively evaluate HDCT as an early intervention in these patients semm justified.
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Fatores prognósticos clínicos, histopatológicos e biomoleculares na recidiva loco-regional do carcinoma epidermóide de língua e soalho submetido à cirurgia de resgate: estudo de 28 casos / Clinicals, histopathologicals and biomolecular prognostic factors in the recurrence squamous cell carcinoma of oral tongue and floor of mouth: study of 28 casesChedid, Helma Maria 06 October 2015 (has links)
Introdução: O carcinoma epidermóide de cabeça e pescoço tem na cirurgia e na radioterapia, as principais modalidades terapêuticas iniciais. Nas recidivas loco-regionais, a cirurgia é a escolha padrão de tratamento. Objetivos: Identificação de fatores prognósticos clínicos, histopatológicos e biomoleculares e a avaliação da sobrevida após cirurgia de resgate. Casuística e Métodos: Estudo retrospectivo de pacientes submetidos a tratamento cirúrgico inicial, com revisão de variáveis histopatológicas e expressão imunohistoquímica de VEGF, ciclina d1 e EGF-R no tumor inicial e no resgate. Das recidivas, 10 eram de estádio clínico precoce (I e II) e 18, avançado (III e IV). O período de seguimento médio foi de 33,4 meses. Resultados: A comparação das variáveis histológicas e dos marcadores moleculares no tumor inicial e na recidiva não apresentou alterações estatisticamente significantes. A sobrevida global após cirurgia de resgate foi superior nas recidivas com diagnóstico após seis meses (p=0,02). Conclusões: Os achados sugerem que a expressão de VEGF superior a 75% é fator preditivo para controle da doença após a recidiva. A sobrevida entre o tempo decorrido do tratamento inicial e a recidiva foi estatisticamente significante / Introduction: The usual management of squamous cell carcinoma (SCC) head and neck is the surgery associated or not to post surgical radiotherapy. Salvage surgery is the first therapeutic option for recurrent tumors. Objective: The identification of prognostic factors and to assess survival interval after salvage surgery for SCC. Methods: Retrospective analysis of patients treated with surgery and review of histopathological variables and immunohistochemical expression of VEGF, EGF-R and Ciclina in the initial tumor and salvage surgery. Twenty eight patients were submitted salvage surgery with 10 were staged as early tumors (I and II) and 18 as advanced ones (III and IV). The average follow-up was 33.4 months. Results: The comparison of histopathologicals variables in the initial tumor and loco regional recurrence no statistically significant changes. Survival after salvage surgery was 70% in cases with recurrences diagnosed after six months of follow-up (p=0.02). Conclusions: The findings suggest that variables immunohistopathologicals in loco regional recurrence were of minor importance in prognosis. The time between the initial treatment and recurrence loco regional was independent variable of survival
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Ressecção abdominoperineal do reto após falha do tratamento radioquimioterápico do carcinoma anal / Abdominoperineal resection of the rectum after failure of chemoradiation therapy for anal carcinomaCorrêa, José Humberto Simões 11 May 2012 (has links)
INTRODUÇÃO: O tratamento padrão do Carcinoma Epidermoide do Ânus (CEDA) é a quimiorradioterapia ou radioterapia exclusiva. Os pacientes em que a terapêutica conservadora falha são tratados com Ressecção Abdominoperineal do Reto (RAP) de resgate. OBJETIVOS: Avaliar a sobrevivência com a RAP de resgate no CEDA, identificando os descritores favoráveis para sobrevivência maior e as características do agrupamento de variáveis relacionadas a descritores independentes de risco para mortalidade. MÉTODOS: Foram levantados dados através de 111 prontuários de portadores de CEDA, tratados inicialmente com quimiorradioterapia combinada ou radioterapia exclusiva e submetidos à RAP no período de outubro de 1982 a janeiro de 2011. RESULTADOS: A média de idade foi de 58 anos, 93 (83,8%) pacientes eram do sexo feminino e 80 (72,1%) da raça branca. O estadio cT3-4 compôs 66,7% e cN0 39,6% da casuística. A RAP foi indicada por persistência da doença (PD) em 61 (55%) pacientes e por recidiva (RD) em 50 (45%) pacientes. A ressecção cirúrgica sem resíduos tumorais (R0) foi realizada em 86 (77,5%) pacientes. O tempo médio de permanência hospitalar pós-operatório foi de 14 dias. A morbidade cirúrgica foi de 64,9%, sendo 78,3% dela devida às complicações da região perineal. Recidiva após RAP ocorreu em 68 (61,2%) pacientes, sendo 40 (58,8%) no primeiro ano do pós-operatório, a maioria locorregional (78%; 53/68). A mediana do seguimento foi de 16 meses (1,2-60 meses). Na análise multivariada, cirurgia R0 (p<0,001), invasão perineural vascular e/ou linfática negativa (p<0,0001) e linfonodo negativo na peça cirúrgica (p=0,03) foram estatisticamente associados à maior sobrevivência. CONCLUSÕES: A taxa de sobrevivência global estimada em cinco anos foi de 24,5%, com mediana de sobrevivência de 32 meses. O subgrupo de pacientes submetidos a cirurgias R0 em cujas peças cirúrgicas não foram encontrados invasão perineural vascular e/ou linfática nem linfonodos comprometidos apresentou taxa de sobrevivência estimada em três e cinco anos de 74,4% e 55,0%, respectivamente, com mediana de sobrevivência de 87 meses. Não houve diferença significativa entre pacientes que evoluíram com PD ou RD. Identificou-se a cirurgia R1-2, invasão perineural vascular e/ou linfática e linfonodo positivo na peça cirúrgica como fatores preditivos independentes de mortalidade / INTRODUCTION: The standard treatment for epidermoid carcinoma of the anus (ECA) is the association of chemotherapy (QT) and radiotherapy or exclusive radiotherapy (RT). When conservative treatment fails, patients are submitted to abdominoperineal resection of the rectum (APR). OBJECTIVES: To assess survival with salvage APR in ECA, identifying the most favorable independent descriptors for longer survival and the characteristics of the group of independent variables for mortality risk. METHODS: Data were collected from the medical records of 111 patients with ECA, initially treated with QT/RT or exclusive RT and later submitted to APR, from October 1982 to January 2011. RESULTS: Their mean age was 58 years, 93 (83.8%) patients were female, and 80 (72.1%) were Caucasian. The cT3-4 stage represented 66.7% of the case series and cN0, 39.6%. The APR was indicated due to persistence of disease (PD) in 61 (55%) patients and recurrence of disease (RD) in 50 (45%) patients. Surgical resection without residual tumor (R0) was performed in 86 (77.5%) patients. The mean postoperative hospital length of stay was 14 days. Surgical morbidity was 64.9%, of which, 78.3% related to perineal infection. Recurrence after APR was observed in 68 (61.2%) patients, 40 (58,8%; 40/68) of whom in the first postoperative year, mostly locoregional (78%; 53/68). The median follow-up was 16 months (1.2 - 60 months). On multivariate analysis, R0 surgery (p<0.001), absence of perineural and/or lymphovascular invasion (p<0.0001) and negative lymph node status in the surgical specimen (p=0.03) were associated with increased survival. CONCLUSION: Estimated overall survival rate in 5 years was 24.5%, with median survival of 32 months. There was no significant difference in survival after APR in patients who had PD or RD after conservative treatment. The subgroup of patients who underwent R0 and whose surgical specimen showed absence perineural and/or lymphovascular invasion and negative lymph nodes had an estimated survival rate at 3 and 5 years of 74,4% and 55,0%, respectively, with a median survival of 87 months. The following were identified as independent predictors of mortality: R1-2 surgery; presence perineural and/or lymphovascular invasion; and positive lymph node in the surgical specimen
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Timber supply and economic impact of mountain pine beetle salvage strategiesMoreira-Munoz, Simon 05 1900 (has links)
To address the scale mountain pine beetle (MPB) outbreak in British Columbia, salvage has become fully integrated with timber supply strategies. The objective of this thesis is to assess the economic impact of different salvage strategies depending on different attack levels, decay rates, and stakeholder discount rates. The study area is located in N.E. British Columbia where the MPB has not yet reached its peak and where susceptible to attack stands account for 40% of the area. Salvage strategies were modelled with a timber supply model (Woodstock) which uses a linear programming type II optimization approach. Performance of the model was assessed over a range of indicators such as NPV, profit, salvage proportion, species composition, inventory levels, and non-recoverable volume. Sensitivity analyses were conducted on harvest flow, discount rate, and ending inventory. The model was very sensitive to the intensity of attack and less sensitive to the decay level. The high level of attack resulted in large volume losses, mostly as un-salvaged inventory.
Although allowable annual cut (AAC) uplifts have an economic benefit, they do not necessarily maximize the salvage of pine. Non-pine species are an important component of the salvage and these species are also essential for the future timber supply. If the objective is to ensure quality and quantity of the future forest, policies have to complement AAC uplifts by strongly encouraging the salvage of mainly pine-leading stands and management options that minimize the “by-catch” of non-pine species and minimize destruction of advanced regeneration during salvage. However, this has an opportunity cost for the private industry where the objective is to maximize profit. If the salvage strategy focuses on decreasing the impact on cash flows, achieving desirable ending inventory levels, avoiding salvage of stands after shelf-life, and reducing impact on non-attack species, then the current harvest level will likely lead to a mid-term timber supply fall-down. Using the fibre for bioenergy production is an alternative if managing for bioenergy can be integrated into harvest operations. However, unlike mill residues, the bioenergy supply has to fully account for harvest and transportation costs of dead wood to the mill.
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