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Marcucci, Guido, C. D. Baldus, A. S. Ruppert, M. D. Radmacher, K. Mrózek, S. P. Whitman, J. E. Kolitz et al. "Overexpression of the ERG Gene Is an Adverse Prognostic Factor in Acute Myeloid Leukemia (AML) with Normal Cytogenetics (NC): A Cancer and Leukemia Group B Study (CALGB)." Blood 106, n. 11 (16 novembre 2005): 335. http://dx.doi.org/10.1182/blood.v106.11.335.335.
Abstract (sommario):
Abstract Around 45% of adults with AML have NC and are included in an intermediate-risk group. However, their 5-year (yr) overall survival (OS) rates vary between 24 and 42%, likely due to the prognostic impact of submicroscopic genetic alterations, e.g., mutations in FLT3, CEBPA, MLL and NPM genes and overexpression of BAALC. We recently showed that ERG, an ETS-Related Gene mapped to 21q22, is often overexpressed in AML with unfavorable complex karyotypes, and in a subset of NC AML (PNAS2004;101:3915), suggesting that ERG overexpression contributes to an aggressive phenotype in AML. Here we analyzed ERG expression levels by real-time RT-PCR in pretreatment blood from 84 adults with NC AML, aged <60 yrs, treated on CALGB 9621 and characterized for BAALC expression (Blood2003;102:1613). Patients (pts) were divided into quartiles according to ERG levels and dichotomized into 2 groups: the uppermost quartile of ERG expression values (Q4) and a group comprising 3 lower quartiles (Q1-3), as relapse risk was significantly different for Q4 compared with Q1 (P=.024), Q2 (P=.002) and Q3 (P=.009). The complete remission rates were similar for the 2 groups (76% vs. 83%; P=.532). With a median follow-up of 5.7 yrs, Q4 pts had a worse cumulative incidence of relapse (CIR; P<.001) and OS (P=.011) than Q1-3 pts. For Q4 pts, the estimated 5-yr CIR and OS rates were, respectively, 81% and 19% compared with 33% and 51% for Q1-3 pts. In multivariable models, high ERG expression (Q4) adversely impacted CIR (P<.001), whereas an interaction between ERG and BAALC expression (P=.013) was observed for OS, where Q4 predicted shorter survival only in low BAALC expressers (P=.002; Table 1). Table 1. Multivariable analysis for pts divided into Q4 and Q1-3 groups according to ERG expression Endpoint Variable Hazard ratio (95% CI) P CIR ERG expression (Q4 vs. Q1-3) 3.71 (1.88 to 7.31) <.001 Present vs. absent MLL PTD 2.70 (1.12 to 6.52) .027 OS Interaction ERG of and BAALC .013 - Pts with low BAALC expression, ERG expression (Q4 vs. Q1-3) 5.40 (1.87 to 15.64) .002 - Pts with high BAALC expression, ERG expression (Q4 vs. Q1-3) 1.04 (0.50 to 2.16) .922 Log[WBC] 1.35 (1.07 to 1.70) .012 When ERG expression was evaluated in the context of pts with known FLT3 internal tandem duplication (ITD) status, including those with the very unfavorable FLT3ITD/-genotype, i.e., lacking the FLT3 wild-type allele, a multivariable analysis showed that higher risk of relapse and death was independently predicted by both high ERG expression values (i.e., Q4) (P=.023 and P=.002, respectively) and FLT3 ITD mutations (P≤ .001 and P=.002, respectively). We also used Affymetrix U133 plus 2.0 GeneChips to identify genes differentially expressed (P≤ .001) between Q4 and Q1-3 pts. Q4 pts displayed a signature characterized by overexpression of 63 genes and 49 expressed-sequenced tags. Fourteen genes, including general (GTF2H2) and lineage-specific (BCL11A, HEMGN) transcription regulators and genes involved in cell proliferation (RAB10, GAS5) and apoptosis (IKIP, DAPK), had at least a two-fold difference in expression levels between the Q4 and Q1-3 groups. In conclusion, we show for the first time that ERG overexpression in NC AML constitutes an adverse prognostic factor and is associated with a distinct gene-expression signature.
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Gunderson, Leonard L., Daniel J. Sargent, Joel E. Tepper, Norman Wolmark, Michael J. O'Connell, Mirsada Begovic, Cristine Allmer et al. "Impact of T and N Stage and Treatment on Survival and Relapse in Adjuvant Rectal Cancer". Journal of Clinical Oncology 22, n. 10 (15 maggio 2004): 1785–96. http://dx.doi.org/10.1200/jco.2004.08.173.
Abstract (sommario):
Purpose To determine survival and relapse rates by T and N stage and treatment method in five randomized phase III North American rectal adjuvant studies. Patients and Methods Data were pooled from 3,791 eligible patients enrolled onto North Central Cancer Treatment Group (NCCTG) 79-47-51, NCCTG 86-47-51, US Gastrointestinal Intergroup 0114, National Surgical Adjuvant Breast and Bowel Project (NSABP) R01, and NSABP R02. Surgery alone (S) was the treatment arm in 179 patients. The remaining patients received adjuvant treatment as follows: irradiation (RT) alone (n = 281), RT + fluorouracil (FU) ± semustine bolus chemotherapy (CT; n = 779), RT + protracted venous infusion CT (n = 325), RT + FU ± leucovorin or levamisole bolus CT (n = 1,695), or CT alone (n = 532). Five-year follow-up was available in 94% of surviving patients, and 8-year follow-up, in 62%. Results Overall (OS) and disease-free survival were dependent on TN stage, NT stage, and treatment method. Even among N2 patients, T substage influenced 5-year OS (T1-2, 67%; T3, 44%; T4, 37%; P < .001). Three risk groups of patients were defined: (1) intermediate (T1-2/N1, T3/N0), (2) moderately high (T1-2/N2, T3/N1, T4/N0), and (3) high (T3/N2, T4/N1, T4/N2). For intermediate-risk patients, those receiving S plus CT had 5-year OS rates of 85% (T1-2/N1) and 84% (T3/N0), which was similar to results with S plus RT plus CT (T1-2/N1, 78% to 83%; T3/N0, 74% to 80%). For moderately high-risk lesions, 5-year OS ranged from 43% to 70% with S plus CT, and 44% to 80% with S plus RT plus CT. For high-risk lesions, 5-year OS ranged from 25% to 45% with S plus CT, and 29% to 57% with S plus RT plus CT. Conclusion Different treatment strategies may be indicated for intermediate-risk versus moderately high- or high-risk patients based on differential survival rates and rates of relapse. Use of trimodality treatment for all patients with intermediate-risk lesions may be excessive, since S plus CT resulted in 5-year OS of approximately 85%; however, 5-year disease-free survival rates with S plus CT were 78% (T1-2/N1) and 69%(T3/N0), indicating room for improvement.
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Neben, Kai, Christian Giesecke, Silja Schweizer, Anthony D. Ho e Alwin Krämer. "Centrosome aberrations in acute myeloid leukemia are correlated with cytogenetic risk profile". Blood 101, n. 1 (1 gennaio 2003): 289–91. http://dx.doi.org/10.1182/blood-2002-04-1188.
Abstract (sommario):
Abstract Genetic instability is a common feature in acute myeloid leukemia (AML). Centrosome aberrations have been described as a possible cause of aneuploidy in many human tumors. To investigate whether centrosome aberrations correlate with cytogenetic findings in AML, we examined a set of 51 AML samples by using a centrosome-specific antibody to pericentrin. All 51 AML samples analyzed displayed numerical and structural centrosome aberrations (36.0% ± 16.6%) as compared with peripheral blood mononuclear cells from 21 healthy volunteers (5.2% ± 2.0%; P < .0001). In comparison to AML samples with normal chromosome count, the extent of numerical and structural centrosome aberrations was higher in samples with numerical chromosome changes (50.5% ± 14.2% versus 34.3% ± 12.2%; P < .0001). When the frequency of centrosome aberrations was analyzed within cytogenetically defined risk groups, we found a correlation of the extent of centrosome abnormalities to all 3 risk groups (P = .0015), defined as favorable (22.5% ± 7.3%), intermediate (35.3% ± 13.1%), and adverse (50.3% ± 15.6%). These results indicate that centrosome defects may contribute to the acquisition of chromosome aberrations and thereby to the prognosis in AML.
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Robertson, Sarah E., Nina R. Joyce, Jon A. Steingrimsson, Elizabeth A. Stuart, Denise R. Aberle, Constantine A. Gatsonis e Issa J. Dahabreh. "Comparing Lung Cancer Screening Strategies in a Nationally Representative US Population Using Transportability Methods for the National Lung Cancer Screening Trial". JAMA Network Open 7, n. 1 (30 gennaio 2024): e2346295. http://dx.doi.org/10.1001/jamanetworkopen.2023.46295.
Abstract (sommario):
ImportanceThe National Lung Screening Trial (NLST) found that screening for lung cancer with low-dose computed tomography (CT) reduced lung cancer–specific and all-cause mortality compared with chest radiography. It is uncertain whether these results apply to a nationally representative target population.ObjectiveTo extend inferences about the effects of lung cancer screening strategies from the NLST to a nationally representative target population of NLST-eligible US adults.Design, Setting, and ParticipantsThis comparative effectiveness study included NLST data from US adults at 33 participating centers enrolled between August 2002 and April 2004 with follow-up through 2009 along with National Health Interview Survey (NHIS) cross-sectional household interview survey data from 2010. Eligible participants were adults aged 55 to 74 years, and were current or former smokers with at least 30 pack-years of smoking (former smokers were required to have quit within the last 15 years). Transportability analyses combined baseline covariate, treatment, and outcome data from the NLST with covariate data from the NHIS and reweighted the trial data to the target population. Data were analyzed from March 2020 to May 2023.InterventionsLow-dose CT or chest radiography screening with a screening assessment at baseline, then yearly for 2 more years.Main Outcomes and MeasuresFor the outcomes of lung-cancer specific and all-cause death, mortality rates, rate differences, and ratios were calculated at a median (25th percentile and 75th percentile) follow-up of 5.5 (5.2-5.9) years for lung cancer–specific mortality and 6.5 (6.1-6.9) years for all-cause mortality.ResultsThe transportability analysis included 51 274 NLST participants and 685 NHIS participants representing the target population (of approximately 5 700 000 individuals after survey-weighting). Compared with the target population, NLST participants were younger (median [25th percentile and 75th percentile] age, 60 [57 to 65] years vs 63 [58 to 67] years), had fewer comorbidities (eg, heart disease, 6551 of 51 274 [12.8%] vs 1 025 951 of 5 739 532 [17.9%]), and were more educated (bachelor’s degree or higher, 16 349 of 51 274 [31.9%] vs 859 812 of 5 739 532 [15.0%]). In the target population, for lung cancer–specific mortality, the estimated relative rate reduction was 18% (95% CI, 1% to 33%) and the estimated absolute rate reduction with low-dose CT vs chest radiography was 71 deaths per 100 000 person-years (95% CI, 4 to 138 deaths per 100 000 person-years); for all-cause mortality the estimated relative rate reduction was 6% (95% CI, −2% to 12%). In the NLST, for lung cancer–specific mortality, the estimated relative rate reduction was 21% (95% CI, 9% to 32%) and the estimated absolute rate reduction was 67 deaths per 100 000 person-years (95% CI, 27 to 106 deaths per 100 000 person-years); for all-cause mortality, the estimated relative rate reduction was 7% (95% CI, 0% to 12%).Conclusions and RelevanceEstimates of the comparative effectiveness of low-dose CT screening compared with chest radiography in a nationally representative target population were similar to those from unweighted NLST analyses, particularly on the relative scale. Increased uncertainty around effect estimates for the target population reflects large differences in the observed characteristics of trial participants and the target population.
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Satoko, Morishima, Koichi Kashiwase, Fumihiro Azuma, Toshio Yabe, Aiko Sato-Otsubo, Seishi Ogawa, Takashi Shiina et al. "Impact Of HLA Allele and Haplotype On Acute Graft-Versus-Host Disease and Survival After Hematopoietic Stem Cell Transplantation From Unrelated Donor". Blood 122, n. 21 (15 novembre 2013): 708. http://dx.doi.org/10.1182/blood.v122.21.708.708.
Abstract (sommario):
Abstract Background Although the effect of allele matching of each HLA locus on the clinical outcome of unrelated hematopoietic stem cell transplantation (UR-HSCT) has been characterized, the effect of HLA allele or haplotype (HP) itself has not been well elucidated. The HLA region is recognized as one of the most important genetic regions associated with human disease, especially autoimmune and infectious diseases. We therefore hypothesized that the immunological response and the clinical outcome following UR-HSCT depend not only on HLA allele matching but also on the HLA allele itself or HLA-linked genetic background of the patient and donor. Methods We analyzed 5237 patients who received T-cell-replete bone marrow transplants from serologically HLA-A, -B, and -DR antigen-matched unrelated donors facilitated by the Japan Marrow Donor Program between 1993 and 2008. HLA-A, -B, -C, -DRB1, -DQB1, and -DPB1 alleles were retrospectively genotyped. HLA allele frequencies were calculated by direct counting, and multi-locus HLA HP frequencies were estimated using the maximum-likelihood method with EM algorithm of PyPop software. Patients were stratified by HLA-matching status into a full match (FM) group (12/12-matched, n=733) and a mismatch (MM) group (≤11/12-matched, n=4504). The effect of HLA alleles or HPs with a frequency greater than 5% on acute graft-versus-host disease (aGVHD) and overall survival (OS) was analyzed using a multivariate competing risk regression model. The results are expressed as hazard ratios (HRs) comparing specific allele/haplotype-positive group to -negative group. Results For each allele, the number of HLA alleles significantly associated with aGVHD (p <.01) in the MM group, were as follows: HLA-A (1 of 10), HLA-B (2 of 17), HLA-C (3 of 15), HLA-DRB1 (1 of 17), HLA-DQB1 (1 of 11) and HLA-DPB1 (0 of 10). In contrast, only one HLA-DPB1 allele was significantly associated with aGVHD in the FM group. The following patient and donor HLA alleles were significantly associated with a reduced risk of aGVHD in the MM group: HLA-A*33:03, C*14:03, B*44:03, DRB1*13:02, and DQB1*06:04. These alleles are located on a common HP (HP-P2) in the Japanese population, which showed a similar effect on grade II-IV (n=534; HR 0.79; p=.001) and III-IV (HR 0.70; p=.004) aGVHD. Strong linkage disequilibrium (LD) hampered determination of the allele responsible for the reducing risk of aGVHD. A significant association with an increased risk of grade III-IV aGVHD and a poor OS was observed in patient HLA-B*51:01 (n=756; aGVHD: HR 1.51, p<.001; OS: HR 1.19, p=.003, respectively) and donor HLA-B*51:01 (n=773; HR 1.46, p<.001; HR 1.15, p=.015) , patient HLA-C*14:02 (n=599; HR 1.55, p<.001; HR 1.19, p=.007), and donor HLA-C*15:02 (n=226; HR 1.62, p<.001; HR 1.38, p=.001) in the MM group. HLA-B*51:01 demonstrated strong positive LD with HLA-C*14:02 and -C*15:02. A significant association with an increased risk of grade III-IV aGVHD and a poor OS was also observed in patient HLA-C*14:02-B*51:01 (n=586; HR 1.52, p<.001; HR 1.19; p=.007) and donor HLA-C*15:02-B*51:01 (n=106; HR 1.98, p<.001; HR 1.53, p=.001). HLA-DPB1*04:02 was the only allele associated with an increased risk of grade II-IV aGVHD in the FM group (n=173; HR 1.64; p=.001). HLA-DPB1*04:02 was linked to two distinctive extended HPs, and the effect of these HPs on aGVHD was stronger in the patients with HLA-DRB1*04:05-DQB1*04:01-DPB1*04:02 (n=60; HR 2.15; p<.001) than in those with HLA-DRB1*01:01-DQB1*05:01-DPB1*-DPB1*04:02 (n=125; HR 1.40; p=.035). HLA-DRB1*04:05-DQB1*04:01-DPB1*04:02 was also significantly associated with poor OS in the FM group (HR 1.65; p=.01). HP-P2 showed a tendency to reduce the risk of grade II-IV aGVHD in the FM group (n=119; HR 0.70; p=.075). Conclusion Patient- and donor-specific HLA alleles and HPs themselves contribute to the risk of aGVHD and survival after UR-HSCT. In addition to HLA-B*51:01 being strongly associated with Bechet’s disease, we found this allele to be associated with an increased risk of aGVHD in UR-HSCT. Given that different HLA alleles and HPs were identified in the FM and MM groups, multiple mechanisms, including HLA-mismatch induced alloreactivity, might be involved in the development or exacerbation of aGVHD. These findings suggest that, in addition to HLA-matching status, consideration of patient and donor HLA alleles and haplotypes will provide predictive risk factors for UR-HSCT. Disclosures: No relevant conflicts of interest to declare.
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Prochaska, Judith J., Erin A. Vogel, Amy Chieng, Matthew Kendra, Michael Baiocchi, Sarah Pajarito e Athena Robinson. "A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study". Journal of Medical Internet Research 23, n. 3 (23 marzo 2021): e24850. http://dx.doi.org/10.2196/24850.
Abstract (sommario):
Background Misuse of substances is common, can be serious and costly to society, and often goes untreated due to barriers to accessing care. Woebot is a mental health digital solution informed by cognitive behavioral therapy and built upon an artificial intelligence–driven platform to deliver tailored content to users. In a previous 2-week randomized controlled trial, Woebot alleviated depressive symptoms. Objective This study aims to adapt Woebot for the treatment of substance use disorders (W-SUDs) and examine its feasibility, acceptability, and preliminary efficacy. Methods American adults (aged 18-65 years) who screened positive for substance misuse without major health contraindications were recruited from online sources and flyers and enrolled between March 27 and May 6, 2020. In a single-group pre/postdesign, all participants received W-SUDs for 8 weeks. W-SUDs provided mood, craving, and pain tracking and modules (psychoeducational lessons and psychotherapeutic tools) using elements of dialectical behavior therapy and motivational interviewing. Paired samples t tests and McNemar nonparametric tests were used to examine within-subject changes from pre- to posttreatment on measures of substance use, confidence, cravings, mood, and pain. Results The sample (N=101) had a mean age of 36.8 years (SD 10.0), and 75.2% (76/101) of the participants were female, 78.2% (79/101) were non-Hispanic White, and 72.3% (73/101) were employed. Participants’ W-SUDs use averaged 15.7 (SD 14.2) days, 12.1 (SD 8.3) modules, and 600.7 (SD 556.5) sent messages. About 94% (562/598) of all completed psychoeducational lessons were rated positively. From treatment start to end, in-app craving ratings were reduced by half (87/101, 86.1% reporting cravings in the app; odds ratio 0.48, 95% CI 0.32-0.73). Posttreatment assessment completion was 50.5% (51/101), with better retention among those who initially screened higher on substance misuse. From pre- to posttreatment, confidence to resist urges to use substances significantly increased (mean score change +16.9, SD 21.4; P<.001), whereas past month substance use occasions (mean change −9.3, SD 14.1; P<.001) and scores on the Alcohol Use Disorders Identification Test-Concise (mean change −1.3, SD 2.6; P<.001), 10-item Drug Abuse Screening Test (mean change −1.2, SD 2.0; P<.001), Patient Health Questionnaire-8 item (mean change 2.1, SD 5.2; P=.005), Generalized Anxiety Disorder-7 (mean change −2.3, SD 4.7; P=.001), and cravings scale (68.6% vs 47.1% moderate to extreme; P=.01) significantly decreased. Most participants would recommend W-SUDs to a friend (39/51, 76%) and reported receiving the service they desired (41/51, 80%). Fewer felt W-SUDs met most or all of their needs (22/51, 43%). Conclusions W-SUDs was feasible to deliver, engaging, and acceptable and was associated with significant improvements in substance use, confidence, cravings, depression, and anxiety. Study attrition was high. Future research will evaluate W-SUDs in a randomized controlled trial with a more diverse sample and with the use of greater study retention strategies. Trial Registration ClinicalTrials.gov NCT04096001; http://clinicaltrials.gov/ct2/show/NCT04096001.
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Vollbrecht, Hanna, Vineet Arora, Sebastian Otero, Kyle Carey, David Meltzer e Valerie G. Press. "Evaluating the Need to Address Digital Literacy Among Hospitalized Patients: Cross-Sectional Observational Study". Journal of Medical Internet Research 22, n. 6 (4 giugno 2020): e17519. http://dx.doi.org/10.2196/17519.
Abstract (sommario):
Background Technology is a potentially powerful tool to assist patients with transitions of care during and after hospitalization. Patients with low health literacy who are predisposed to poor health outcomes are particularly poised to benefit from such interventions. However, this population may lack the ability to effectively engage with technology. Although prior research studied the role of health literacy in technology access/use among outpatients, hospitalized patient populations have not been investigated in this context. Further, with the rapid uptake of technology, access may no longer be pertinent, and differences in technological capabilities may drive the current digital divide. Thus, characterizing the digital literacy of hospitalized patients across health literacy levels is paramount. Objective We sought to determine the relationship between health literacy level and technological access, use, and capability among hospitalized patients. Methods Adult inpatients completed a technology survey that asked about technology access/use and online capabilities as part of an ongoing quality of care study. Participants’ health literacy level was assessed utilizing the 3-question Brief Health Literacy Screen. Descriptive statistics, bivariate chi-squared analyses, and multivariate logistic regression analyses (adjusting for age, race, gender, and education level) were performed. Using Bonferroni correction for the 18 tests, the threshold P value for significance was <.003. Results Among 502 enrolled participants, the mean age was 51 years, 71.3% (358/502) were African American, half (265/502, 52.8%) were female, and half (253/502, 50.4%) had at least some college education. Over one-third (191/502, 38.0%) of participants had low health literacy. The majority of participants owned devices (owned a smartphone: 116/173, 67.1% low health literacy versus 235/300, 78.3% adequate health literacy, P=.007) and had used the Internet previously (143/189, 75.7% low health literacy versus 281/309, 90.9% adequate health literacy, P<.001). Participants with low health literacy were more likely to report needing help performing online tasks (133/189, 70.4% low health literacy versus 135/303, 44.6% adequate health literacy, P<.001). In the multivariate analysis, when adjusting for age, race, gender, and education level, we found that low health literacy was not significantly associated with a lower likelihood of owning smartphones (OR: 0.8, 95% CI 0.5-1.4; P=.52) or using the internet ever (OR: 0.5, 95% CI 0.2-0.9; P=.02). However, low health literacy remained significantly associated with a higher likelihood of needing help performing any online task (OR: 2.2, 95% CI 1.3-3.6; P=.002). Conclusions The majority of participants with low health literacy had access to technological devices and had used the internet previously, but they were unable to perform online tasks without assistance. The barriers patients face in using online health information and other health information technology may be more related to online capabilities rather than to technology access. When designing and implementing technological tools for hospitalized patients, it is important to ensure that patients across digital literacy levels can both understand and use them.
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Li, Shan, Xianglu Zhu, Lin Zhu, Xin Hu e Shujuan Wen. "Associations between serum carotenoid levels and the risk of non-Hodgkin lymphoma: a case–control study". British Journal of Nutrition 124, n. 12 (30 aprile 2020): 1311–19. http://dx.doi.org/10.1017/s000711452000152x.
Abstract (sommario):
AbstractLimited studies have investigated the effects of serum carotenoids on the risk of non-Hodgkin lymphoma (NHL), and the findings have been inconclusive. This study aims to assess the association between serum total or specific carotenoid levels and NHL risk. This 1:1 matched, hospital-based case–control study enrolled 512 newly diagnosed (within 1 month) NHL patients and 512 healthy controls who were matched by age (±5 years) and sex in Urumqi, China. Serum carotenoid levels were measured by HPLC. Conditional logistic regression showed that higher serum total carotenoid levels and their subtypes (e.g. α-carotene, β-carotene, β-cryptoxanthin and lycopene) were dose-dependently associated with decreased NHL risk. The multivariable-adjusted OR and their 95 % CI for NHL risk for quartile 4 (v. quartile 1) were 0·31 (95 % CI 0·22, 0·48; Pfor trend < 0·001) for total carotenoids, 0·52 (95 % CI 0·33, 0·79; Pfor trend: 0·003) for α-carotene, 0·63 (95 % CI 0·42, 0·94; Pfor trend: 0·031) for β-carotene, 0·73 (95 % CI 0·49, 1·05; Pfor trend: 0·034) for β-cryptoxanthin and 0·51 (95 % CI 0·34, 0·75; Pfor trend: 0·001) for lycopene. A null association was observed between serum lutein + zeaxanthin and NHL risk (OR 0·89, 95 % CI 0·57, 1·38; Pfor trend: 0·556). Significant interactions were observed after stratifying according to smoking status, and inverse associations were more evident among current smokers than past or never smokers for total carotenoids, α-carotene and lycopene (Pfor heterogeneity: 0·047, 0·042 and 0·046). This study indicates that higher serum carotenoid levels might be inversely associated with NHL risk, especially among current smokers.
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Shi, Qiuling, Xin Shelley Wang, James M. Reuben, Evan N. Cohen, Loretta A. Williams, Tito R. Mendoza, Mary L. Sailors, Venus M. Ilagan e Charles S. Cleeland. "Chemotherapy-induced peripheral neuropathy in multiple myeloma patients undergoing maintenance therapy." Journal of Clinical Oncology 31, n. 15_suppl (20 maggio 2013): 9646. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.9646.
Abstract (sommario):
9646 Background: After 3-months autologous stem cell transplant (AuSCT), a percentage of multiple myeloma (MM) patients during maintenance therapy continue to experience a complex of symptoms related to peripheral neuropathy. This longitudinal study examined these self-reported neuropathy symptoms and identified circulating inflammatory markers associated with high neuropathy-related symptoms. Methods: MM patients (N=51) rated symptom severity on 0-10 scale via the M. D. Anderson symptom Inventory (MDASI) weekly from 3 to 9 months post AuSCT during maintenance therapy. Patient also rated pain on hand or foot in routine clinic visit. A panel of pro- and anti-inflammatory cytokines, receptors, chemokines was evaluated on serum samples by Luminex. Mixed effect analysis was used to describe the changes on cytokines and symptom outcomes across time. Trajectory analysis identified patients that persistently reported higher or lower symptom severity overtime. Results: During the study period, there was no significant reduction on pain in general or on hand/foot, or change in neuropathic symptoms such as numbness/tingling and muscle weakness. Among a third (33%) of patients who was consistently in high pain (mean 5.5), MIP-1a (p=.001) and MCP-1 (p=.032) showed significant decrease. Approximately 40 % had persistently high numbness/tingling (mean 5.2) across the observation period. Compared to low symptom group patients, this high numbness group had significantly higher IL-6 (p=.019) and TNF-alpha (p=.006). High muscle weakness (mean 3.1) was for 69% of the sample. This group had significantly higher CRP (p=.005) and TNF-alpha (p=.001). Conclusions: This is the first longitudinal study that tracked persistent neuropathy-related symptoms for MM patients post AuSCT. Approximately one third reported painful neuropathy, either from induction therapy or ongoing maintenance therapy. High levels of these neuropathy symptoms were associated with higher levels of specific pro-inflammatory markers. This study provided rationale for examining the effectiveness of anti-inflammation as mechanism driven intervention on peripheral neuropathy in this cohort of MM patients.
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Liu, Bennett M., Kelley Paskov, Jack Kent, Maya McNealis, Soren Sutaria, Olivia Dods, Christopher Harjadi, Nate Stockham, Andrey Ostrovsky e Dennis P. Wall. "Racial and Ethnic Disparities in Geographic Access to Autism Resources Across the US". JAMA Network Open 6, n. 1 (23 gennaio 2023): e2251182. http://dx.doi.org/10.1001/jamanetworkopen.2022.51182.
Abstract (sommario):
ImportanceWhile research has identified racial and ethnic disparities in access to autism services, the size, extent, and specific locations of these access gaps have not yet been characterized on a national scale. Mapping comprehensive national listings of autism health care services together with the prevalence of autistic children of various races and ethnicities and evaluating geographic regions defined by localized commuting patterns may help to identify areas within the US where families who belong to minoritized racial and ethnic groups have disproportionally lower access to services.ObjectiveTo evaluate differences in access to autism health care services among autistic children of various races and ethnicities within precisely defined geographic regions encompassing all serviceable areas within the US.Design, Setting, and ParticipantsThis population-based cross-sectional study was conducted from October 5, 2021, to June 3, 2022, and involved 530 965 autistic children in kindergarten through grade 12. Core-based statistical areas (CBSAs; defined as areas containing a city and its surrounding commuter region), the Civil Rights Data Collection (CRDC) data set, and 51 071 autism resources (collected from October 1, 2015, to December 18, 2022) geographically distributed into 912 CBSAs were combined and analyzed to understand variation in access to autism health care services among autistic children of different races and ethnicities. Six racial and ethnic categories (American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or other Pacific Islander, and White) assigned by the US Department of Education were included in the analysis.Main Outcomes and MeasuresA regularized least-squares regression analysis was used to measure differences in nationwide resource allocation between racial and ethnic groups. The number of autism resources allocated per autistic child was estimated based on the child’s racial and ethnic group. To evaluate how the CBSA population size may have altered the results, the least-squares regression analysis was run on CBSAs divided into metropolitan (&gt;50 000 inhabitants) and micropolitan (10 000-50 000 inhabitants) groups. A Mann-Whitney U test was used to compare the model estimated ratio of autism resources to autistic children among specific racial and ethnic groups comprising the proportions of autistic children in each CBSA.ResultsAmong 530 965 autistic children aged 5 to 18 years, 83.9% were male and 16.1% were female; 0.7% of children were American Indian or Alaska Native, 5.9% were Asian, 14.3% were Black or African American, 22.9% were Hispanic or Latino, 0.2% were Native Hawaiian or other Pacific Islander, 51.7% were White, and 4.2% were of 2 or more races and/or ethnicities. At a national scale, American Indian or Alaska Native autistic children (β = 0; 95% CI, 0-0; P = .01) and Hispanic autistic children (β = 0.02; 95% CI, 0-0.06; P = .02) had significant disparities in access to autism resources in comparison with White autistic children. When evaluating the proportion of autistic children in each racial and ethnic group, areas in which Black autistic children (&gt;50% of the population: β = 0.05; &lt;50% of the population: β = 0.07; P = .002) or Hispanic autistic children (&gt;50% of the population: β = 0.04; &lt;50% of the population: β = 0.07; P &lt; .001) comprised greater than 50% of the total population of autistic children had significantly fewer resources than areas in which Black or Hispanic autistic children comprised less than 50% of the total population. Comparing metropolitan vs micropolitan CBSAs revealed that in micropolitan CBSAs, Black autistic children (β = 0; 95% CI, 0-0; P &lt; .001) and Hispanic autistic children (β = 0; 95% CI, 0-0.02; P &lt; .001) had the greatest disparities in access to autism resources compared with White autistic children. In metropolitan CBSAs, American Indian or Alaska Native autistic children (β = 0; 95% CI, 0-0; P = .005) and Hispanic autistic children (β = 0.01; 95% CI, 0-0.06; P = .02) had the greatest disparities compared with White autistic children.Conclusions and RelevanceIn this study, autistic children from several minoritized racial and ethnic groups, including Black and Hispanic autistic children, had access to significantly fewer autism resources than White autistic children in the US. This study pinpointed the specific geographic regions with the greatest disparities, where increases in the number and types of treatment options are warranted. These findings suggest that a prioritized response strategy to address these racial and ethnic disparities is needed.
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Moravcová, Katarína, Martina Karbanová, Maxi Pia Bretschneider, Markéta Sovová, Jaromír Ožana e Eliška Sovová. "Comparing Digital Therapeutic Intervention with an Intensive Obesity Management Program: Randomized Controlled Trial". Nutrients 14, n. 10 (10 maggio 2022): 2005. http://dx.doi.org/10.3390/nu14102005.
Abstract (sommario):
In this study, we evaluated whether the digital program Vitadio achieves comparable results to those of an intensive in-person lifestyle intervention in obesity management. This is a 12-month prospective, randomized controlled trial. Obese patients with insulin resistance, prediabetes or type 2 diabetes were included. The intervention group (IG) used Vitadio. The control group (CG) received a series of in-person consultations. Body weight and various metabolic parameters were observed and analyzed with ANOVA. The trial is ongoing and the presented findings are preliminary. Among 100 participants (29% men; mean age, 43 years; mean BMI, 40.1 kg/m2), 78 completed 3-month follow-up, and 51 have completed the 6-month follow-up so far. Participants significantly (p < 0.01) reduced body weight at 3 months (IG: −5.9 ± 5.0%; CG: −4.2 ± 5.0%) and 6 months (IG: −6.6±6.1%; CG: −7.1 ± 7.1%), and the difference between groups was not significant. The IG achieved favorable change in body composition; significant improvement in TAG (−0.6 ± 0.9 mmol/l, p < 0.01), HDL (0.1 ± 0.1%, p < 0.05), HbA1c (−0.2 ± 0.5%, p < 0.05) and FG (−0.5 ± 1.5 mmol/l, p < 0.05); and a superior (p = 0.02) HOMA-IR reduction (−2.5 ± 5.2, p < 0.01). The digital intervention achieved comparable results to those of the intensive obesity management program. The results suggest that Vitadio is an effective tool for supporting patients in obesity management and diabetes prevention.
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Mota, Jorge, Maria Paula Santos e José Carlos Ribeiro. "Differences in Leisure-Time Activities According to Level of Physical Activity in Adolescents". Journal of Physical Activity and Health 5, n. 2 (marzo 2008): 286–93. http://dx.doi.org/10.1123/jpah.5.2.286.
Abstract (sommario):
Background:The main goals of this study were: (1) to examine the relationship between physical activity (PA) involvement and other leisure activities in a sample of Portuguese youth and (2) to analyze gender differences in PA and leisure-time activity structure.Methods:The sample comprised 1123 adolescents that were classified according to PA levels as active (n = 589) and nonactive (n = 534). A questionnaire assessing leisure-time activities was used.Results:Girls were significantly more engaged in social leisure, dutiful, and individual artistic activities during leisure time, whereas boys were more involved in sports and computer and TV viewing activities. Significant associations between PA and social leisure were found in girls (r = .18, P ≤ .001) and boys (r = .13, P ≤ .01) after adjustment for age. The same was found between level of PA and sports engagement during leisure (girls: r = .56, P ≤ .001; boys: r = .51, P ≤ .001). In girls (r = .10, P ≤ .05), but not in boys, a statistically significant association was found between PA and individual artistic activities.Conclusions:This study has certain implications for health-related PA promotion efforts. Our data give additional reinforcement to the importance of organized and nonorganized sports/PA during leisure time for overall levels of PA in adolescents.
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HSU, C. N., J. Y. WANG, C. D. TSENG, J. J. HWANG, P. R. HSUEH e C. S. LIAU. "Clinical features and predictors for mortality in patients with infective endocarditis at a university hospital in Taiwan from 1995 to 2003". Epidemiology and Infection 134, n. 3 (20 ottobre 2005): 589–97. http://dx.doi.org/10.1017/s0950268805005224.
Abstract (sommario):
The clinical features and microbiological characteristics of 315 patients with definite or possible infective endocarditis (IE) from January 1995 to December 2003 were evaluated. There were 187 males and 128 females with a mean age of 51 years (range, 1 month to 92 years). Ninety-three patients (30%) had a diagnosis of valvular heart disease and 24 (8%) had received prosthetic valve replacement. Blood culture was negative in 62 patients (20%). Staphylococci (91 patients, 32%), including methicillin-susceptible Staphylococcus aureus (15%), methicillin-resistant S. aureus (11%), and coagulase-negative staphylococci (6%), were the most commonly encountered pathogens followed by viridans group streptococci (77 patients, 24%). Eight patients (25%) had various neurological, renal, embolic, and cardiac complications. Patients with neurological complications [odds ratio (OR) 8·175, P<0·001], nosocomial IE (OR 6·661, P<0·001), underlying malignancy (OR 4·993, P<0·001), elevated serum creatinine level (OR 3·132, P=0·001), or elevated WBC count (>15000/mm3) (OR 2·537, P=0·007) were at significantly increased risk of mortality. This study found mortality from IE was associated with several factors, among which neurological complications were the most hazardous. Patients with more than one risk factor had poorer prognosis. These results suggest the need for more aggressive management in patients with IE when multiple risk factors for mortality are identified.
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SINGH, MAN, e HIDEKI MATSUOKA. "EFFECT OF IONIC SIZES OF HALIDE ANIONS OF POTASSIUM SALTS ON SURFACE AND INTERFACIAL TENSIONS OF BENZENE AND WATER INTERFACES FOR MUTUAL MIXING". Surface Review and Letters 16, n. 05 (ottobre 2009): 743–47. http://dx.doi.org/10.1142/s0218625x09013219.
Abstract (sommario):
Surface tension (γ, mN/m) of potassium halide salts with water and interfacial tension (IFT) (±0.01 mN/m) of benzene interfaces with water are reported at 298.15 K temperature. The 0.1, 0.5 and 1.0 mol kg-1 potassium fluoride ( KF ), chloride ( KCl ), bromide ( KBr ) and potassium iodide ( KI ) solutions were studied. The KCl, KBr, KF and KI increased the surface tension by 5.2, 4.0, 3.1 and 3.0%, respectively, with salt–water interaction influence by anionic sizes. The surface tension of water from air–water to benzene–water interfaces is decreased by 51% due to the benzene–water mutual interaction with dipolar and π-conjugation. The KI, KF, KCl and KBr salts decrease the IFT by 63, 61, 61 and 56%, respectively, because of larger differences in sizes of the anions and the K + with individual salt. The KI developed stronger interactions with an induced potential of a large sized I - anion that held the water engaged and integrated the aqueous phase with higher interfacial tension. The dipolar and π-conjugation interaction model is proposed with biphasic systems.
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Hu, Qiaoyun, Haofei Wang, Philippe Goloub, Zhengqiang Li, Igor Veselovskii, Thierry Podvin, Kaitao Li e Mikhail Korenskiy. "The characterization of Taklamakan dust properties using a multiwavelength Raman polarization lidar in Kashi, China". Atmospheric Chemistry and Physics 20, n. 22 (17 novembre 2020): 13817–34. http://dx.doi.org/10.5194/acp-20-13817-2020.
Abstract (sommario):
Abstract. The Taklamakan desert is an important dust source for the global atmospheric dust budget and a cause of the dust weather in East Asia. The characterization of Taklamakan dust in the source region is still very limited. To fill this gap, the DAO (dust aerosol observation) was conducted in April 2019 in Kashi, China. The Kashi site is about 150 km from the western rim of the Taklamakan desert and is strongly impacted by desert dust aerosols, especially in spring time, i.e., April and May. According to sun–sky photometer measurements, the aerosol optical depth (at 500 nm) varied in the range of 0.07–4.70, and the Ångström exponent (between 440 and 870 nm) in the range of 0.0–0.8 in April 2019. In this study, we provide the first profiling of the 2α+3β+3δ parameters of Taklamakan dust based on a multiwavelength Mie–Raman polarization lidar. For Taklamakan dust, the Ångström exponent related to the extinction coefficient (EAE, between 355 and 532 nm) is about 0.01 ± 0.30, and the lidar ratio is found to be 45 ± 7 sr (51 ± 8–56 ± 8 sr) at 532 (355) nm. The particle linear depolarization ratios (PLDRs) are about 0.28–0.32 ± 0.07 at 355 nm, 0.36 ± 0.05 at 532 nm and 0.31 ± 0.05 at 1064 nm. Both lidar ratios and depolarization ratios are higher than the typical values of Central Asian dust in the literature. The difference is probably linked to the fact that observations in the DAO campaign were collected close to the dust source; therefore, there is a large fraction of coarse-mode and giant particles (radius >20 µm) in the Taklamakan dust. Apart from dust, fine particles coming from local anthropogenic emissions and long-range transported aerosols are also non-negligible aerosol components. The signatures of pollution emerge when dust concentration decreases. The polluted dust (defined by PLDR532≤0.30 and EAE355-532≥0.20) is featured with reduced PLDRs and enhanced EAE355−532 compared to Taklamakan dust. The mean PLDRs of polluted dust generally distributed in the range of 0.20–0.30. Due to the complexity of the nature of the involved pollutants and their mixing state with dust, the lidar ratios exhibit larger variabilities compared to those of dust. The study provides the first reference of novel characteristics of Taklamakan dust measured by Mie–Raman polarization lidar. The data could contribute to complementing the dust model and improving the accuracy of climate modeling.
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Leon-Ferre, Roberto Antonio, Mei-Yin Polley, Heshan Liu, Judith A. Gilbert, Victoria Cafourek, David W. Hillman, Ahmed Elkhanany et al. "Prognostic value of histopathology, stromal tumor infiltrating lymphocytes (sTILs) and adjuvant chemotherapy (AdjCT) in early stage triple negative breast cancer (TNBC)." Journal of Clinical Oncology 35, n. 15_suppl (20 maggio 2017): 533. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.533.
Abstract (sommario):
533 Background: Current guidelines define TNBC as complete absence of estrogen (ER) and progesterone receptor (PR), without HER2 amplification. However, the prognostic impact of clinical and histopathological factors, sTILs, and AdjCT in TNBC meeting these strict criteria is unknown. Methods: From a cohort of 9985 women who underwent upfront surgery for M0 breast cancer (BC) at Mayo Clinic Rochester from 1985-2012, 1159 pts with ER negative or low (≤10%) BC were identified for central ER/PR/HER2 staining and HER2 FISH (IHC2+ only) to select those with TNBC by modern definitions. Cox proportional hazards models were used to assess the impact of clinicopathological variables on invasive disease-free (IDFS) and overall survival (OS). Results: Tumors from 605 pts (median age 56.3 yrs) met criteria for TNBC (ER < 1%, PR < 1% and HER2 0, 1 or 2+ and FISH negative). 51% were T1, 65% N0, 88% grade 3, and 75% had Ki67 > 15%. Histologically, 39% were anaplastic, 26% invasive ductal, 16% medullary, 8% metaplastic, 6% apocrine and 5% others. Median sTILs was 20% (0-90%). 55% pts received AdjCT [21% anthracycline (A), 19% A + taxane, and 15% other]. Median follow-up for IDFS and OS were 7.4 and 10.6 yrs, respectively. Multivariate analyses demonstrated that higher N stage (p < 0.01), lower sTILs (p = 0.01) and no AdjCT (p < 0.01) were independently associated with worse IDFS and OS. Histology (medullary subtype) was associated with better IDFS in univariate (HR 0.56, 95% CI, 0.35-0.89) but not in multivariate analyses, once sTILs were accounted for. Among systemically untreated pts (n = 182), higher N (p < 0.01) and lower sTILs (p = 0.04) were associated with worse IDFS. For systemically untreated T1N0 pts (n = 111), the 5-yr IDFS was 70% (95% CI, 61-81) [T1a: 83% (95% CI, 63-100), T1b: 68% (95% CI, 52-88) and T1c: 67% (95% CI, 55-83)], compared to 78% (95% CI, 68-84) for T1N0 pts treated with AdjCT. Conclusions: In TNBC pts, N stage, sTILs and receipt of AdjCT were independently prognostic for IDFS and OS. sTILs remained prognostic for IDFS in systemically untreated TNBC. In N0 TNBC, the risk of recurrence or death was substantial in the absence of chemotherapy, even for those with T1 tumors.
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Мицура, Е. Ф., e Л. И. Волкова. "Prevalence and Annual Dynamics of Hemolytic Anemia in Children in the Republic of Belarus in 2005-2020". Гематология. Трансфузиология. Восточная Европа, n. 4 (29 dicembre 2021): 488–94. http://dx.doi.org/10.34883/pi.2021.7.4.010.
Abstract (sommario):
Цель исследования. Оценить распространенность и годовую динамику гемолитических анемий (ГА) у детей в Республике Беларусь за период с 2005 по 2020 г. Материалы и методы. Использованы данные официальной статистической отчетности Республики Беларусь с 2005 по 2020 г. Учитывались следующие показатели в целом и отдельно по областям и возрастным группам: количество выявленных случаев ГА в детском и подростковом возрасте (0-17 лет), впервые выявленные случаи ГА в текущем году, количество детей с ГА, состоящих на диспансерном учете (ДУ) на конец года. Для расчета интенсивных показателей (на 100 тыс. детского населения) использованы данные о половозрастной структуре населения Республики Беларусь из статистических бюллетеней Национального статистического комитета. Результаты. В Республике Беларусь за 16-летний период (с 2005 по 2020 г.) зарегистрировано 4043 случая ГА (ежегодно от 200 до 328) у детей и подростков, впервые выявлено 522 случая (от 21 до 51 за год), на конец года состоит на ДУ у гематолога от 167 до 301 пациента в возрасте от 0 до 18 лет. Средняя заболеваемость ГА за анализируемый период составила 1,79 на 100 тыс. детского населения, причем наибольшая заболеваемость ГА отмечена в Гродненской, Витебской и Минской областях, наименьшая - в городе Минске, Брестской и Могилевской областях. Динамика количества впервые выявленных случаев ГА была стабильна, среднегодовой темп прироста заболеваемости ГА за оцениваемый период составил 0,03±0,05 случая в год (р>0,05). Тенденция к некоторому повышению заболеваемости (р≤0,1) присутствовала в городе Минске (р=0,09) и в Гомельской области (р=0,1). Впервые выявленные случаи ГА регистрируются преимущественно у детей раннего возраста: на первом году жизни (69,6%; заболеваемость 11,0 на 100 000 населения в данной возрастной группе) и в возрасте 1-4 лет (15,9%; заболеваемость 2,5 на 100 000). Выводы. За проанализированный 16-летний период заболеваемость ГА в детском возрасте остается относительно стабильной, данное заболевание выявляется в большинстве случаев (85,5%) в возрасте до 4 лет. Полученные результаты могут применяться в работе врачейпедиатров и детских гематологов. The purpose of the study was to assess the prevalence and annual dynamics of hemolytic anemias (HA) in children in the Republic of Belarus for the period from 2005 to 2020. Materials and methods. The data of the official statistical reporting of the Republic of Belarus from 2005 to 2020 were used. The following indicators were analyzed as a whole and separately by regions and age groups: the number of detected cases of HA in childhood and adolescence (0-17 years), newly diagnosed cases of HA in the current year, the number of children with HA registered at the dispensary follow-up for the end of the year. To calculate the intensive indicators (per 100,000 children’s population), data on the sex and age structure of the population of the Republic of Belarus from the statistical bulletins of the National Statistical Committee were used. Results. In the Republic of Belarus, over a 16-year period (from 2005 to 2020), 4043 cases of HA were registered (annually from 200 to 328) in children and adolescents, 522 cases were newly diagnosed (from 21 to 51 per year), 167 to 301 patients aged 0 to 18 years were seen at the dispensary follow- up for the end of the year. The average incidence of HA for the analyzed period was 1.79 per 100,000 children’s population, and the highest incidence was noted in Grodno, Vitebsk and Minsk regions, the lowest - in the city of Minsk, Brest and Mogilev regions. The dynamics of newly diagnosed cases of HA was stable, the average annual rate of increase in the incidence of HA for the estimated period was 0.03±0.05 cases per year (p>0.05). The trend towards a slight increase in morbidity (p≤0.1) was present in the city of Minsk (p=0.09) and in the Gomel region (p=0.1). Newly diagnosed cases of HA were recorded mainly in young children: in the first year of life (69.6%; incidence 11.0 per 100,000 population in this age group) and at the age of 1-4 years (15.9%; incidence 2.5 per 100,000). Conclusion. Over the analyzed 16-year period, the incidence of HA in childhood remains relatively stable, these diseases are detected in most cases (85.5%) at the age of 0 to 4 years. The obtained results can be applied in the work of pediatricians and pediatric hematologists.
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Hosseinzadeh, Shayan, Ata M. Kiapour, Daniel A. Maranho, Seyed Alireza Emami, Gabriela Portilla, Young-Jo Kim e Eduardo N. Novais. "The metaphyseal fossa surrounding the epiphyseal tubercle is larger in hips with moderate and severe slipped capital femoral epiphysis than normal hips". Journal of Children's Orthopaedics 14, n. 3 (1 giugno 2020): 184–89. http://dx.doi.org/10.1302/1863-2548.14.200010.
Abstract (sommario):
Purpose To compare the 3D morphology of the metaphyseal fossa among mild, moderate and severe stable slipped capital femoral epiphysis (SCFE) and normal hips. Methods We identified pelvic CT of 51 patients (55% male; mean 12.7 years (sd 1.9; 8-15)) with stable SCFE. In all, 16 of 51 hips (31%) had mild, 14 (27%) moderate and 21 (41%) severe SCFE. A total of 80 patients (50% male; mean age 11.5 years (sd 2.3; 8 to 15)) with normal hips who underwent pelvic CT due to abdominal pain made up the control cohort. CT scans were segmented, and the femur was reformatted using 3D software. We measured the metaphyseal fossa depth, width, length and surface area after the epiphysis was subtracted from the metaphysis in the 3D model. Results The metaphyseal fossa width was significantly larger in severe (adjusted difference: 6.9%; 95% confidence interval (CI) 2.1 to 11.8; p = 0.001), moderate (6.5%; 95% CI 0.8 to 12.2; p = 0.02) and mild SCFE (6.2%; 95% CI 0.8 to 11.6; p = 0.01), in comparison with normal hips. Severe SCFE showed larger fossa length compared with mild SCFE (6.8%; 95% CI 0.6 to 13.0; p = 0.02) and normal hips (6.0%; 95% CI 1.4 to 10.6; p = 0.004). The fossa surface area was larger in severe (3.5%; 95% CI 1.3 to 5.7; p < 0.001) and moderate SCFE (2.7%; 95% CI 0.1 to 5.2; p = 0.03) when compared with normal hips. There were no differences in fossa depth between SCFE and normal hips. Conclusion The metaphyseal fossa is wider and more extensive but not deeper in hips with moderate and severe SCFE in comparison with normal hips. Although hips with severe SCFE had larger length and surface area than mild SCFE hips, further research is needed to clarify whether enlargement of the metaphyseal fossa is a consequence of slip progression. Level of Evidence III
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Revanasiddappa, Hosakere Doddarevanna, e M. A. Veena. "Highly sensitive spectrophotometric methods for the determination of olanzapine". Ecletica Quimica 33, n. 3 (29 settembre 2008): 47–51. http://dx.doi.org/10.26850/1678-4618eqj.v33.3.2008.p47-51.
Abstract (sommario):
Highly sensitive and selective spectrophotometric methods (A and B) were developed for the determination of micro amounts of olanzapine (OLZ). Method A (direct method) is based on the oxidation of olanzapine with a known excess of iodine monochloride (ICl) in an acidic medium. Under the same condition, thymol blue was iodinated by unreacted ICl, and the absorbance of uniodinated thymol blue was measured at 536 nm. The decrease in ICl concentration is a measure of drug concentration. In method B (indirect method), oxidation of OLZ by a known excess of Ce(IV) in sulfuric acid medium followed by the reaction of unreacted Ce(IV) with leuco crystal violet (LCV) to crystal violet (CV), which is measured in an acetate buffer medium ( pH 4.9) at 580 nm. These methods obey the Beer’s law in the concentration range of 0.2-1.6 μg mL-1 (method A) and 0.1-1.4 μg mL-1 (method B). The developed procedures have been successfully applied to the determination of OLZ in pure and in dosage forms. The results exhibit no interference from the presence of excipients. The reliability of the methods was established by parallel determination of OLZ against the reference method.
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Bennett, Derrick A., Huaidong Du, Fiona Bragg, Yu Guo, Neil Wright, Ling Yang, Zheng Bian et al. "Physical activity, sedentary leisure-time and risk of incident type 2 diabetes: a prospective study of 512 000 Chinese adults". BMJ Open Diabetes Research & Care 7, n. 1 (dicembre 2019): e000835. http://dx.doi.org/10.1136/bmjdrc-2019-000835.
Abstract (sommario):
ObjectiveAim to examine the independent and joint associations of physical activity (PA) and sedentary leisure-time (SLT) with risk of diabetes and assess the extent to which these associations were mediated by adiposity.Research design and methodsThe prospective China Kadoorie Biobank recruited ~512 000 adults from 10 diverse areas across China. Self-reported PA was estimated based on type, frequency and duration of specific types of PA, covering four domains (occupation, leisure, household and commuting). SLT was defined as hours per day spent watching television, reading or playing card games. Stratified Cox proportional hazards models were used to estimate adjusted HRs (aHRs) for PA and SLT associated with incident diabetes. Analyses were stratified by age-at-risk (5-year intervals), sex and region and adjusted for household income, education, alcohol consumption, smoking, fresh fruit intake, self-reported general health status, family history of diabetes and body mass index (BMI) status. Analyses of total PA, occupational and non-occupational PA and SLT were mutually adjusted for each other, as appropriate.ResultsAfter ~9 years of follow-up, there were 14 940 incident diabetes cases among 460 736 participants without prior diabetes or cardiovascular diseases at baseline. The mean (SD) age at baseline was 51 (10.6) years, 59% were women and 43% resided in urban areas. Overall, the mean BMI was 23.5 (3.3) kg/m2, which differed by ~0.5 kg/m2 among individuals in the highest compared with the lowest PA and SLT groups. PA was inversely associated the risk of diabetes 16% (aHR: 0.84, 95% CI 0.81 to 0.88) lower in top than bottom fifth. After further adjustment for BMI this was attenuated to 0.99 (95% CI 0.98 to 1.00). SLT was positively associated with diabetes and each 1 hour per day higher usual level was associated with aHR of 1.13 (95% CI 1.09 to 1.17) for diabetes, attenuated to 1.05 (95% CI 1.01 to 1.09) after further adjustment for BMI.ConclusionsAmong Chinese adults, higher levels of PA and lower levels of SLT were associated with lower risks of diabetes with no evidence of effect modification by each other. These associations appeared to arise mainly through adiposity.
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Mavromatis, Kreton, Konstantinos Aznaouridis, Ibhar Al Mheid, Emir Veledar, Saurabh Dhawan, Jonathan R. Murrow, Zohreh Forghani et al. "Circulating Proangiogenic Cell Activity Is Associated with Cardiovascular Disease Risk". Journal of Biomolecular Screening 17, n. 9 (10 agosto 2012): 1163–70. http://dx.doi.org/10.1177/1087057112454919.
Abstract (sommario):
Vascular injury mobilizes bone marrow–derived proangiogenic cells into the circulation, where these cells can facilitate vascular repair and new vessel formation. We sought to determine the relationship between a new biomarker of circulating bone marrow–derived proangiogenic cell activity, the presence of atherosclerotic cardiovascular disease (CVD) and its risk factors, and clinical outcomes. Circulating proangiogenic cell activity was estimated using a reproducible angiogenic colony-forming unit (CFU-A) assay in 532 clinically stable subjects aged 20 to 90 years and ranging in the CVD risk spectrum from those who are healthy without risk factors to those with active CVD. CFU-A counts increased with the burden of CVD risk factors ( p < 0.001). CFU-A counts were higher in subjects with symptomatic CVD than in those without ( p < 0.001). During follow-up of 232 subjects with CVD, CFU-A counts were higher in those with death, myocardial infarction, or stroke than in those without (110 [70–173] vs 84 [51–136], p = 0.01). Therefore, we conclude that circulating proangiogenic cell activity, as estimated by CFU-A counts, increases with CVD risk factor burden and in the presence of established CVD. Furthermore, higher circulating proangiogenic cell activity is associated with worse clinical outcome in those with CVD.
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Giovanelli, Nicola, Paolo Taboga, Enrico Rejc, Bostjan Simunic, Guglielmo Antonutto e Stefano Lazzer. "Effects of an Uphill Marathon on Running Mechanics and Lower-Limb Muscle Fatigue". International Journal of Sports Physiology and Performance 11, n. 4 (maggio 2016): 522–29. http://dx.doi.org/10.1123/ijspp.2014-0602.
Abstract (sommario):
Purpose:To investigate the effects of an uphill marathon (43 km, 3063-m elevation gain) on running mechanics and neuromuscular fatigue in lower-limb muscles.Methods:Maximal mechanical power of lower limbs (MMP), temporal tensiomyographic (TMG) parameters, and muscle-belly displacement (Dm) were determined in the vastus lateralis muscle before and after the competition in 18 runners (age 42.8 ± 9.9 y, body mass 70.1 ± 7.3 kg, maximal oxygen uptake 55.5 ± 7.5 mL · kg−1 · min−1). Contact (tc) and aerial (ta) times, step frequency (f), and running velocity (v) were measured at 3, 14, and 30 km and after the finish line (POST). Peak vertical ground-reaction force (Fmax), vertical displacement of the center of mass (Δz), leg-length change (ΔL), and vertical (kvert) and leg (kleg) stiffness were calculated.Results:MMP was inversely related with race time (r = –.56, P = .016), tc (r = –.61, P = .008), and Δz (r = –.57, P = .012) and directly related with Fmax (r = .59, P = .010), ta (r = .48, P = .040), and kvert (r = .51, P = .027). In the fastest subgroup (n = 9) the following parameters were lower in POST (P < .05) than at km 3: ta (–14.1% ± 17.8%), Fmax (–6.2% ± 6.4%), kvert (–17.5% ± 17.2%), and kleg (–11.4% ± 10.9%). The slowest subgroup (n = 9) showed changes (P < .05) at km 30 and POST in Fmax (–5.5% ± 4.9% and –5.3% ± 4.1%), ta (–20.5% ± 16.2% and –21.5% ± 14.4%), tc (5.5% ± 7.5% and 3.2% ± 5.2%), kvert (–14.0% ± 12.8% and –11.8% ± 10.0%), and kleg (–8.9% ± 11.5% and –11.9% ± 12%). TMG temporal parameters decreased in all runners (–27.35% ± 18.0%, P < .001), while Dm increased (24.0% ± 35.0%, P = .005), showing lower-limb stiffness and higher muscle sensibility to the electrical stimulus.Conclusions:Greater MMP was related with smaller changes in running mechanics induced by fatigue. Thus, lower-limb power training could improve running performance in uphill marathons.
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Rutley, B. D., e R. J. Hudson. "Seasonal energetic parameters of free-grazing bison (Bison bison)". Canadian Journal of Animal Science 80, n. 4 (1 dicembre 2000): 663–71. http://dx.doi.org/10.4141/a99-114.
Abstract (sommario):
Seasonal energetic parameters of yearling bison were estimated using the bite-count and single marker methods (fieldtrials) during each solstice and equinox between June 1994 and December 1995. To calibrate the marker method and to provide a controlled estimate of seasonal requirements, balance trials were conducted in metabolism crates during winter solstice 1994 and summer solstice 1995 (pen trials). In pen trials, actual metabolizable energy (ME) intake was lower (P < 0.01) during winter (528 ± 51 kJ W−0.75 d−1) than in summer (917 ± 69 kJ W−0.75 d−1). Similarly, in field trials, estimated ME intakes were lower for both bite count (P < 0.01) and marker methods (P < 0.05) during winter (819 ± 375, 146 ± 105 kJ W−0.75 d−1) than summer (1977 ± 186, 408 ± 53 kJ W−0.75 d−1), respectively. Estimated ME requirements (actual intake, pen trials) were 532 ± 178 kJ W−0.75 d−1 in winter and 956 ± 107 kJ W−0.75 d−1 in summer. In field trials, estimated ME requirements (marker method) ranged from 146 ± 22 kJ W−0.75 d−1 (December 1994) to 478 ± 45 kJ W−0.75 d−1 (June 1995). Seasonal variation (P < 0.05) in total digesta turnover time (46.4 ± 1.4 h, December 1994; 24.9 ± 2.7 h, June 1995) was related more consistently to seasonal differences in transit time (18.2 ± 1.2 h, 4.0 ± 0.8 h, respectively) than differences in reticulo-rumen and lower tract turnover time. Bison exhibited strong seasonal differences in energetic parameters like other northern wild ruminants. Key words: Bison, seasonality, metabolizable energy requirements, intake, excretion parameters, grazing
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Borrelli, Melissa, Adele Corcione, Roberto Rongo, Elena Cantone, Iris Scala, Dario Bruzzese, Stefano Martina, Pietro Strisciuglio, Ambrosina Michelotti e Francesca Santamaria. "Obstructive Sleep Apnoea in Children with Down Syndrome: A Multidisciplinary Approach". Journal of Personalized Medicine 13, n. 1 (28 dicembre 2022): 71. http://dx.doi.org/10.3390/jpm13010071.
Abstract (sommario):
A comprehensive evaluation of obstructive sleep apnoea (OSA) may allow for the development of more efficient management of Down syndrome (DS). We aimed to evaluate the effect of a multidisciplinary approach to DS with OSA. A total of 48 DS children aged 4–12 years were prospectively investigated with nasal endoscopy, orthodontic examination, and overnight polygraphy (PG); the Italian Child Sleep Habits Questionnaire (CSHQ-IT) was filled out by the mothers. The total CSHQ-IT score was 63 (96% of children reporting sleep problems). The major ear, nose, and throat characteristics were enlarged palatine tonsils (62%), adenoid tonsils (85%), and chronic rhinosinusitis (85%). DS children showed orthognathic profile in 68% of cases, class I relationship in 63%, and cross-bite in 51%. PG revealed OSA in 67% of cases (37% mild, 63% moderate–severe). The oxygen desaturation index (ODI) was higher in the group with OSA (5.2) than with non-OSA (1.3; p < 0.001). The ODI was higher (p = 0.001) and SpO2 lower (p = 0.03) in children with moderate–severe OSA than with mild OSA. The apnoea–hypopnea index (AHI) and percentage time with SpO2 < 90% were higher in DS children with grade III than with grade I or II adenoids (5 vs. 1, p = 0.04, and 1.2 vs. 0.1, p = 0.01, respectively). No significant correlations were found between PG and the total CSHQ-IT score or orthodontic data. However, children showing associated cross-bite, grade III adenoids and size 3 or 4 palatine tonsils showed higher AHI and ODI than those without (p = 0.01 and p = 0.04, respectively). A coordinated multidisciplinary approach with overnight PG is a valuable tool when developing diagnostic protocols for OSA in DS.
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Gonzalez Velez, Miguel, Narjust Duma, Larysa Jessica Sanchez, Ramya Undamatla, Jose Ruiz Mino e Martin Gutierrez. "Predictors of recurrence in stage I/II colorectal cancer: Analysis of a single institution’s experience for over 24 years." Journal of Clinical Oncology 34, n. 4_suppl (1 febbraio 2016): 534. http://dx.doi.org/10.1200/jco.2016.34.4_suppl.534.
Abstract (sommario):
534 Background: Surgical resection remains a mainstay of treatment for localized colorectal cancer (CRC). However, up to 35% of patients (pts) develop recurrence with a significant decrease in overall survival. The aim of this study was to evaluate clinical characteristics and specific predictors of recurrence for stage I/II CRC Methods: We performed a retrospective analysis of 2310 pts diagnosed with stage I/II CRC at our institution between 1990 and 2013, with a minimum follow up of 24 months. Tumor characteristics and recurrence data were studied. Cox regression was used for statistical analysis. Results: Of the 2310 pts, recurrence was identified in 276 (12%) pts, of which 88 (32%) pts had early recurrence ( < 1 year). Median time of recurrence was 625 days. 210 (76%) pts had local recurrence while 66 (24%) pts had distal recurrence, with liver being the main site of distant metastasis. Males had a higher recurrence rate than females (16% vs. 7%, p < 0.0001). When comparing recurrence pts (R) with non-recurrence (NR) pts, Hispanics were more prevalent in the R group (13% vs 8%, p < 0.01). R pts were more likely to have rectal and poorly differentiated tumors (33% vs. 13%, p < 0.0001; 23% vs. 14%, p < 0.0001, respectively). Mucinous adenocarcinomas were more prevalent in the R group (16% vs. 9%, p < 0.0005). In multivariate analysis: male sex (OR: 1.24, 95% CI: 1.21-1.56, p < 0.001), rectal tumors (OR: 4.2, 95% CI: 3.14-5.06, p < 0.001), tumor size (OR: 2.55, 95% CI: 1.31-4-51, p < 0.01), and positive margins (OR: 3.6, 95% CI: 2.13-5.21, p < 0.04) were independent predictors for recurrence. K-ras (+) status was a predictor of recurrence by univariate analysis. Age, race, and histologic grade were not predictors of recurrence. Pts with early recurrence had a lower median overall survival compared to pts that developed recurrence after 1 year, 37 months (95% CI: 26.6-49.6) vs. 59 months (95% CI: 42.4-74.3), p < 0.04. Conclusions: Pts with recurrence were more likely to have rectal and poorly differentiated tumors. Poorer survival was observed in pts with early recurrence. These findings could serve as important prognostic information and may help identify the pts that would benefit from aggressive surveillance after treatment.
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Mantilla, M. J., G. Rodríguez Salas, A. M. Santos, V. Navarro-Compán, I. Rueda, J. C. Santacruz Devia, J. G. Ballesteros et al. "AB1069 GENDER DIFFERENCES IN PRESENTATION, CLASSIFICATION, AND DISEASE ACTIVITY OF SPONDYLOARTHRITIS: RESULTS FROM GESPA COLOMBIAN COHORT". Annals of the Rheumatic Diseases 82, Suppl 1 (30 maggio 2023): 1755.3–1756. http://dx.doi.org/10.1136/annrheumdis-2023-eular.3922.
Abstract (sommario):
BackgroundSpondyloarthritis (SpA) is a chronic inflammatory rheumatic disorder composed of axial (AxSpA) and peripheral (pSpA) disease. AxSpA is further subdivided into radiographic AxSpA (r-AxSpA) and non-radiographic AxSpA (r-AxSpA). Historically, SpA was mostly a male disease. However, actual disease awareness has changed the approach, allowing women to be included to a greater extent.ObjectivesFew studies have explored the male and female disease features in Latin American population. The aim of this study was to examine the clinical presentation, disease onset characteristics, metrology, HLA frequency, and clinical characteristics of male and female SpA patients.MethodsWe used a cohort of Colombian SpA patients from 1990 to the current day. Patients were evaluated by rheumatologists, filled out validated questionaries, and were classified according to the Assessment of SpondyloArthritis International Society (ASAS) classification criteria at the time of diagnosis. Using the available information, patients enrolled before to 2011 were reclassified according to ASAS. We compared the features of both genders and used SPSS 26.0 to conduct statistical analysis.ResultsIn this study, 469 SpA patients from a Colombian SpA cohort were included. There were 164 (34.9%) females and 305 (65.1%) males total. There were no statistically significant differences in ASAS classification; 61.2% of females and 50.6% of males had AxSpA, P = 0.3. However, nr-AxSpA was more prevalent among females (20.6%) than males (13.3%), P = 0.01. In all groups the frequency of HLA-B15 was comparable (15.9% vs. 11.2%, P = 0.1). And the prevalence of HLA-B27 was greater in men than in women (52.4% vs. 33.3%, P < 0.01). The symptoms at the onset of the disease had similar distribution in both sexes (table 1). Enthesopathy was more prevalent among women than males (82.4% vs. 72.4%, P = 0.02). but no arthritis, uveitis, psoriasis, and inflammatory bowel disease (table 1).In males, disease onset was more acute (40.7% vs. 27.3%, P = 0.04). Age at beginning of the disease was 32 (24.5 – 41.1) years for females and 24.89 (20.5 – 31.7) years for males (P < 0.01). The time to diagnosis (in months) was 39 (11.5 – 126) for females and 13 (3 – 71) for males (P < 0.01). Women had more functional impairment measured by BASFI, disease activity measured by BASDAI, and self-reported illness activity than men, although men had a higher C-reactive protein (CRP) (P < 0.01) (Table 1).ConclusionNr-AxSpA is more frequent in women than in men, although radiographic disease is more prominent in men. The prevalence of HLA-B27 is higher in men with SpA. Males are older at the onset of the disease and were diagnosed sooner than females. Females had more disease activity as measured by BASDAI and functional impairment as measured by BASFI, whereas males have lower CRP levels.Table 1.FemaleMaleP valueTotal164305Age at symptoms onset, median (IQR)32 (24.5 – 41.1)25 (20.5 – 31.7)0.00HLA-B2750 (33.1%)140 (52.4%)0.12HLA-B1524 (15.9%)30 (11.2%)0.12SpA ClassificationAxial101 (61.2%)156 (50.6%)0.27Peripheral53 (32.1%)127 (41.2%)0.73Not classified11 (6.7%)15 (8.1%)0.71r-AxSpA67 (40.6%)115 (37.3%)0.01nr-AxSpA34 (20.6%)41 (13.3%)0.01Symptoms at disease onsetArthritis39 (23.6%)102 (33.2%)0.03Enthesopathy10 (6.1%)16 (5.2%)0.70Lumbar pain69 (41.8%)112 (36.5%)0.26Buttock pain6 (3.6%)6 (2%)0.27Various initial symptoms38 (23%)67 (21.8%)0.76Enthesitis history136 (82.4%)223 (72.4%)0.02Dactylitis history34 (20.6%)51 (16.6%)0.28Arthritis history107 (64.8%)217 (70.5%)0.21Uveitis history16 (9.7%)29 (9.4%)0.92CRP0.3 (0.1 - 1.2)0.7 (0.3 - 6)<0.01BASFI5.7 (3.8 - 7.2)5 (2.7 - 6.8)0.01BASDAI6.2 (4.6 - 7.8)5.2 (3.1 - 7.2)0.00ASAS: Assessment of Spondyloarthritis international Society; CRP: C-reactive protein; BASFI: Bath ankylosing Spondyloarthritis Functional index; BASDAI: Bath ankylosing Spondyloarthritis Disease Activity Index.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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Hicken, Margaret T., John Dou, Kiarri N. Kershaw, Yongmei Liu, Anjum Hajat e Kelly M. Bakulski. "Racial and Ethnic Residential Segregation and Monocyte DNA Methylation Age Acceleration". JAMA Network Open 6, n. 11 (29 novembre 2023): e2344722. http://dx.doi.org/10.1001/jamanetworkopen.2023.44722.
Abstract (sommario):
ImportanceNeighborhood segregation and poverty may be important drivers of health inequities. Epigenomic factors, including DNA methylation clocks that may mark underlying biological aging, have been implicated in the link between social factors and health.ObjectiveTo examine the associations of neighborhood segregation and poverty with 4 DNA methylation clocks trained to capture either chronological age or physiological dysregulation.Design, Setting, and ParticipantsThis cohort study uses data from the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal study that started in 2000 to 2002, with follow-up in 2002 to 2004, 2004 to 2005, 2005 to 2007, and 2010 to 2012. In 2000 to 2002, adults who identified as White or Black race or Hispanic or Chinese ethnicity in 6 US sites (Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; Northern Manhattan, New York; and St. Paul, Minnesota) were sampled for recruitment. A random subsample of 4 sites (Maryland, North Carolina, New York, and Minnesota) were selected for inclusion in the MESA epigenomics ancillary study at examination 5 (2010-2012). Participants who identified as White or Black race or Hispanic ethnicity, were aged 45 to 84 years, and did not have clinical cardiovascular disease were included in this analysis. Data were analyzed from May 2021 to October 2023.ExposureInformation on 2000 census tract poverty and Getis-Ord G statistic segregation of Hispanic residents, non-Hispanic Black residents, or non-Hispanic White residents were linked to participant addresses at examination 1 (2000-2002).Main Outcomes and MeasuresAt examination 5, DNA methylation was measured in purified monocytes. DNA methylation age acceleration was calculated using 4 clocks trained on either chronological age or physiological dysregulation. Linear regressions were used to test associations.ResultsA total of 1102 participants (mean [SD] age, 69.7 [9.4] years; 562 [51%] women) were included, with 348 Hispanic participants, 222 non-Hispanic Black participants, and 533 non-Hispanic White participants. For non-Hispanic Black participants, living in tracts with greater segregation of Black residents was associated with GrimAge DNA methylation age acceleration, a clock designed to capture physiological dysregulation. A 1-SD increase in segregation was associated with 0.42 (95% CI, 0.20-0.64) years age acceleration (P &lt; .001); this association was not observed with other clocks. This association was particularly pronounced for participants living in high poverty tracts (interaction term, 0.24; 95% CI, 0.07-0.42; P = .006). In the overall sample, census tract poverty level was associated with GrimAge DNA methylation age acceleration (β = 0.45; 95% CI, 0.20-0.71; adjusted P = .005).Conclusions and RelevanceThese findings suggest that epigenomic mechanisms may play a role in the associations of segregated and poor neighborhoods with chronic conditions.
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Matthews, Marc R., Sara Calder, Areta Kowal-Vern, Philomene Spadafore, Karen J. Richey e Kevin N. Foster. "531 The Effect of Burn Wound Size on Caloric Requirements: A Correlation of Nutritional Changes to the Clinical State". Journal of Burn Care & Research 42, Supplement_1 (1 aprile 2021): S113—S114. http://dx.doi.org/10.1093/jbcr/irab032.181.
Abstract (sommario):
Abstract Introduction Caloric intake has been a vital component for burn wound healing and recovery. The hypothesis was that caloric requirements are based on injury severity & post-burn week as predicated by indirect calorimetry (IC)/predictive equations. Methods This was a retrospective chart review of 115 burn patients (2012–2017). Caloric requirements were determined by the Curreri equation [which includes % total body surface area (TBSA)] and IC for a 5-week period provided mainly by enteral nutrition. Patients received supplements and total parenteral nutrition as needed. Results The mean ±sd age was 43±18 years, 41±18 % TBSA, Body Mass Index of 28±7 kg/m2, and mortality of 26 (23%). The major mechanisms of injury were flame/flash/explosions. There were 59 (51%) of patients with < 40 % TBSA burns, [median Injury Severity Score (ISS) 9; Apache score 14], and 56 (49%) with ≥40 % TBSA (median ISS 25; Apache score 21), p < .0001. The Respiratory Quotient (RQ) had a median of 0.94 (range 0.79 to 1.02). The median number of surgeries for the < 40 % TBSA group was 5 versus 12 for the ≥40 % TBSA, p < .0001. The Injury Factor did not differ from weeks 1–5 (1.8 for < 40 % TBSA and 2.0 for the ≥ 40 % TBSA). The Curreri equation calculation for this study was a median 3640 (range 2161–5950) calories. The Curreri equation resulted in significantly increased caloric recommendations for the ≥ 40 %TBSA compared to the < 40 %TBSA patients, p < .0001. The < 40 %TBSA group had caloric requirements ranging between 1500- 2700 calories compared to the ≥ 40 %TBSA group, whose calories ranged between 2000–3700. The total daily caloric recommendations were also significantly increased in the ≥40 %TBSA compared to the < 40 %TBSA patients. The maximum levels of resting energy expenditure (REE) from IC, total daily calories recommended by the dietitian and average calories ranged between 3000–4500 in the < 40 %TBSA group and 3600–6700 in the ≥ 40 %TBSA group. The caloric recommendations increased for all patients from week 1 to week 3 and leveled off during weeks 4–5. Conclusions Patient caloric requirements were dependent not only on the severity of the burn injury but also the post-burn hospitalization during which surgeries, debridement/grafting, and infectious complications occurred. They increased until the third week post-burn and leveled off in the recovery period. The study caloric recommendations and requirements were consistent with the REE and Curreri equation assessments.
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Cadranel, J., M. Beau-Faller, A. Mauguen, S. Lizard, J. Madelaine, A. Lansiaux, J. Prétet, A. Madroszyk, C. Chouaid e F. Morin. "Biological and clinical prognostic factors in patients with advanced non-small-cell cancer (NSCLC) treated by erlotinib: Preliminary results of the ERMETIC cohort". Journal of Clinical Oncology 27, n. 15_suppl (20 maggio 2009): 8079. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.8079.
Abstract (sommario):
8079 Background: Although it has been suggested that results of EGFR-IHC, EGFR-FISH and EGFR and KRAS mutations are predictive of EGFR-TKIs efficacy, they are not used in clinical practice. ERMETIC is a French NCI granted prospective study aiming to facilitate implementation of these biomarkers in France. Methods: After a preliminary phase of validation in 16 French centers, these biomarkers were studied in available tumor specimens collected from all consecutive NSCLC patients (pts) treated by erlotinib, for the first time. Patients were followed-up until progression or death. Demographic, clinical, pathological characteristics and biomarkers were studied by Cox model as predictors of progression free survival (PFS) and overall survival (OS). Results: 493 of the 530 enrolled pts between 02/07 and 03/08 are included in this analysis, among whom at least 357 (72%) tumor specimens were collected. 88% were Caucasians, 32% females; median age was 62 (33–93); 15% were never smoker, 67% former and 15% active. 18% were PS0, 51% PS1 and 31% PS2–3. 92% pts were metastatic and 66% had adenocarcinoma (ADC). Erlotinib (150 mg in 98% of pts) was given as first-, second- and third-or-more-line in 10, 45, 42% of pts, respectively. 94% of pts had received previous platin-based chemotherapy. With a 11.5 months (mo.) median of follow-up, PFS was 2.4 mo. and OS 5.6 mo., with a 30% 1-year OS. Clinical factors independently associated with shorter OS were: PS1 and PS2–3 (HR=1.79 and 4.3, p<.0001); histology other than ADC and squamous cell (HR=1.44 and 1.03, p=.05); 2 sites of metastasis and more (HR=1.60 and 1.82, p<.0001) and former and active smoking (HR=1.49 and 2.12, p=.002). In multivariate analysis, line of treatment was not prognostic. Conclusions: The study confirmed in a large cohort of advanced NSCLC treated by erlotinib the independent value of several prognostic factors. Prognostic values of EGFR-IHC, EGFR-FISH and EGFR and KRAS mutations will be reported at the meeting. [Table: see text]
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Yogo, Norihiro, Katherine Shihadeh, Heather Young, Susan L. Calcaterra, Bryan C. Knepper, William J. Burman, Philip S. Mehler e Timothy C. Jenkins. "Intervention to Reduce Broad-Spectrum Antibiotics and Treatment Durations Prescribed at the Time of Hospital Discharge: A Novel Stewardship Approach". Infection Control & Hospital Epidemiology 38, n. 5 (6 marzo 2017): 534–41. http://dx.doi.org/10.1017/ice.2017.10.
Abstract (sommario):
OBJECTIVEFor most common infections requiring hospitalization, antibiotic treatment is completed after hospital discharge. Postdischarge therapy is often unnecessarily broad spectrum and prolonged. We developed an intervention to improve antibiotic selection and shorten treatment durations.DESIGNSingle center, quasi-experimental retrospective cohort studyMETHODSPatients prescribed oral antibiotics at hospital discharge before (July 2012–June 2013) and after (October 2014–February 2015) an intervention consisting of (1) institutional guidance for oral step-down antibiotic selection and duration of therapy and (2) pharmacy audit of discharge prescriptions with real-time prescribing recommendations to providers. The primary outcomes measured were total prescribed duration of therapy and use of antibiotics with broad gram-negative activity (ie, fluoroquinolones or amoxicillin-clavulanate).RESULTSOverall, 300 cases from the preintervention period and 200 cases from the intervention period were included. Compared with the preintervention period, the use of antibiotics with broad gram-negative activity decreased during the intervention (51% vs 40%; P=.02), particularly fluoroquinolones (38% vs 25%; P=.002). The total duration of therapy decreased from a median of 10 days (interquartile range [IQR], 7–13 days) to 9 days (IQR, 6–13 days) but did not reach statistical significance (P=.13). However, the duration prescribed at discharge declined from 6 days (IQR, 4–10 days) to 5 days (IQR, 3–7 days) (P=.003). During the intervention, there was a nonsignificant increase in the overall appropriateness of discharge prescriptions from 52% to 66% (P=.15).CONCLUSIONSA multifaceted intervention to optimize antibiotic prescribing at hospital discharge was associated with less frequent use of antibiotics with broad gram-negative activity and shorter postdischarge treatment durations.Infect Control Hosp Epidemiol 2017;38:534–541
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Catzen, Hannah Z., Christopher Kobe, Paul Abrahamse, Kevin C. Ward, Sarah T. Hawley e Christine M. Veenstra. "Communication and fear of recurrence in colorectal cancer survivors and their partners." JCO Oncology Practice 19, n. 11_suppl (novembre 2023): 502. http://dx.doi.org/10.1200/op.2023.19.11_suppl.502.
Abstract (sommario):
502 Background: Little is known about how colorectal (CRC) survivors and their partners communicate about cancer or about their fears of recurrence. CRC survivors who are discordant with their partner in communication about cancer and fear of recurrence may have worse health-related quality of life (HrQoL), but this is not known. Methods: From 2019-2020 we surveyed survivors of stage III CRC diagnosed 2014-2018 at an academic cancer center, a community oncology practice, and the Georgia cancer registry, and their domestic partners. We measured dyadic communication about cancer using the 23-item Lewis Mutuality and Interpersonal Sensitivity Scale (MIS). To measure fear of recurrence, we asked survivors and partners 3 questions about how often worry about recurrence has a negative psychosocial impact in their life. We measured survivors’ HrQoL using the PROMIS-29+2 profile, v 2.1. We used bivariate analyses and multivariable logistic regressions to 1) compare paired survivor and partner responses to individual items about communication in the MIS and compare fear of recurrence scores, 2) describe characteristics of dyads who were discordant in communication and fear of recurrence, 3) assess associations between survivors’ HrQoL and discordance in communication and fear of recurrence. Results: 501/986 eligible survivors returned surveys (51% response rate). 428 survivors (86%) had a partner; 311 partners (73%) returned surveys. We analyzed data from 307 paired survivor-partner dyads. Survivors were mostly > age 50 (88%), male (64%), white (77%) and had at least some college education (77%). 6/23 MIS items (23%) evoked discordant responses in ≥30% of dyads (Table). Most dyads were concordant in responses to fear of recurrence questions. Greater dyadic discordance in communication and fear of recurrence was differentially associated (p<0.05) with some survivor factors and partner factors (communication: female survivor gender and greater partner education; recurrence: younger survivor age). Worse survivor HRQoL was associated with greater discordance in fear of recurrence (p<0.01) but not with discordance in communication (p=0.55). Conclusions: There is dyadic discordance in communication about negative feelings, sadness, and fear about the cancer. Dyadic discordance in fear of recurrence is associated with worse survivor HRQoL. Clinicians should be aware of and acknowledge negative feelings and fear during surveillance.[Table: see text]
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Kuendgen, Andrea, Michael Lauseker, Alan F. List, Pierre Fenaux, Aristoteles Giagounidis, Nancy Brandenburg, Jay Backstrom, Axel Glasmacher, Joerg Hasford e Ulrich Germing. "Lenalidomide Treatment Is Not Related to AML Progression Risk but Is Associated with a Survival Benefit in RBC Transfusion-Dependent Patients with IPSS Low- or Int-1-Risk MDS with del5q: Results From a Comparative Study". Blood 118, n. 21 (18 novembre 2011): 119. http://dx.doi.org/10.1182/blood.v118.21.119.119.
Abstract (sommario):
Abstract Abstract 119 Background: Lenalidomide (LEN) treatment resulted in RBC transfusion independence for ≥ 8 wks in 51–67% of patients (pts) and cytogenetic response in 25–73% of pts with lower-risk MDS and del5q in 2 large multicenter trials (MDS-003 and -004) (List A et al. NEJM 2006;355:1456–65; Fenaux P et al. Blood 2011; doi:10.1182/blood-2011-01-330126). However, these studies were either single-arm or allowed early crossover to LEN, thus data on the influence of LEN on AML progression and overall survival (OS) is lacking. Aims: To assess the risk of AML progression and death in LEN-treated MDS-003 and -004 pts vs untreated MDS pts with del5q from a large multicenter registry, and to determine relevant risk factors. Methods: Data from 459 MDS pts with del5q entered into local or regional MDS registries were retrospectively collected from 9 centers (Europe, USA, Australia) using a uniform minimal data set. Eligible pt controls had IPSS Low-/Int-1-risk MDS and were RBC transfusion-dependent (≥ 1 unit/8 wks), reflecting the relevant inclusion criteria for both trials, and received best supportive care only including ESAs. Incidence of AML progression was assessed using a cumulative incidence estimator in the presence of competing risk (ie, death), and considering left truncation (LT) for the LEN cohort. OS was assessed using a cumulative probability estimator considering LT. Cox proportional hazards (PH) models with LT were used to assess the impact of LEN treatment and baseline factors (ie, age, sex, cytogenetics, bone marrow [BM] blast %, transfusion burden, no. of cytopenias, hemoglobin [Hgb] level [g/dL], and platelet and neutrophil counts) on risk of AML progression and death. LT is a statistical method to correct for different starting points of follow-up (ie, date of first LEN dose in clinical trial pts vs date of diagnosis in registry pts). Results: We analyzed 295 LEN-treated and 125 untreated pts. Baseline characteristics of treated (at first LEN dose) vs untreated (at diagnosis) pts were similar: mean age 65.0 vs 66.2 yrs; female sex 71% vs 68%; IPSS Low-/Int-1-risk 43%/57% vs 43%/57%. Median observation time was 4.3 vs 4.6 yrs. Baseline RBC transfusion burden was higher in the LEN cohort (median [range] units/8 wks: 6 [1–25] vs 2 [1–10]). Two- and 5-yr cumulative AML incidences were 7% and 23% for LEN vs 12% and 20% for the untreated cohort. Two- and 5-yr cumulative OS probabilities were 90% and 54% for LEN vs 74% and 41% for the untreated cohort. Median time to AML progression has not been reached for either cohort. Median OS was 5.2 yrs (95% CI 4.5–5.9) for LEN-treated vs 3.8 yrs (95% CI 2.9–4.8) for untreated pts. In the final Cox PH models, LEN treatment (hazard ratio [HR].939; p =.860) and 1 cytogenetic abnormality (abn) in addition to del5q (HR 1.111; p =.755) did not increase the risk of AML progression. Significant factors associated with an increased risk of AML progression were complex cytogenetics (del5q plus > 1 abn; HR 3.627; p =.002), BM blasts 5–10% (HR 2.215; p =.016), and higher transfusion burden (HR 1.097 [10% increase in risk per unit at baseline]; p =.029); higher Hgb levels were associated with a reduced risk (HR.857; p =.054). Regarding survival, LEN treatment was associated with a reduced risk of death (HR.597; p =.012). Other factors associated with decreased mortality were higher Hgb levels (HR.883; p =.028), higher platelet counts (HR.999; p =.035), and female sex (HR.598; p =.002). Higher transfusion burden (HR 1.056; p =.037) and age (HR 1.049; p <.001) increased the risk of death. In separate Cox PH models considering IPSS risk (Int-1 vs Low) and transfusion dependency for AML progression and OS, as well as age and sex for OS only, IPSS Int-1-risk was associated with an increased risk of AML progression (HR 1.689; p =.041) but not with an increased risk of death (HR 1.056; p =.723). Findings for LEN treatment when considering IPSS risk were similar to the final Cox PH models that considered individual covariates (AML progression: HR.892, p =.741; OS: HR.545; p =.003). Results were similar when Cox PH models were reanalyzed without LT. Conclusions: In this retrospective analysis of RBC transfusion-dependent pts with lower-risk MDS and del5q, LEN treatment was not associated with a higher risk of AML progression but led to a survival benefit vs untreated pts, despite a higher transfusion burden in the LEN cohort. Other significant risk factors for AML progression and death are consistent with previous findings in MDS pts. Disclosures: Kuendgen: Celgene Corporation: Honoraria. List:Celgene Corporation: Consultancy, Honoraria, Research Funding. Fenaux:Merck: Honoraria; Johnson & Johnson: Honoraria; Amgen: Honoraria, Research Funding; Roche: Honoraria, Research Funding; Celgene Corporation: Honoraria, Research Funding; Cephalon: Honoraria; Novartis: Honoraria. Giagounidis:Celgene Corporation: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Brandenburg:Celgene Corporation: Employment, Equity Ownership. Backstrom:Celgene Corporation: Employment, Equity Ownership. Glasmacher:Celgene Corporation: Employment, Equity Ownership. Hasford:Celgene Corporation: Research Funding. Germing:Celgene Corporation: Honoraria, Research Funding.
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Humphrey, J. A., A. Woods e A. H. N. Robinson. "The epidemiology and trends in the surgical management of calcaneal fractures in England between 2000 and 2017". Bone & Joint Journal 101-B, n. 2 (febbraio 2019): 140–46. http://dx.doi.org/10.1302/0301-620x.101b2.bjj-2018-0289.r3.
Abstract (sommario):
Aims This paper documents the epidemiology of adults (aged more than 18 years) with a calcaneal fracture who have been admitted to hospital in England since 2000. Secondary aims were to document whether publication of the United Kingdom Heel Fracture Trial (UK HeFT) influenced the proportion of patients admitted to hospital with a calcaneal fracture who underwent surgical treatment, and to determine whether there has been any recent change in the surgical technique used for these injuries. Patients and Methods In England, the Hospital Episode Statistics (HES) data are recorded annually. Between 2000/01 and 2016/17, the number of adults admitted to an English NHS hospital with a calcaneal fracture and whether they underwent surgical treatment was determined. Results During this 17-year period, 62 858 patients were admitted to hospital with a calcaneal fracture. The male-to-female ratio was 2.66:1. The mean annual incidence was 10.5/100 000 for men and 3.8/100 000 for women. The results of the UK HeFT were published in July 2014. The percentage of patients admitted with a calcaneal fracture undergoing internal fixation was 7.31% (3792/51 859) before and 7.38% (534/7229) after its publication. This difference was not statistically significant (p = 0.94). Since 2015, there has been a significant increase in the percentage of calcaneal fractures treated by closed reduction and internal fixation, as opposed to open reduction and internal fixation, from 7.7% (292/3792) to 13.29% (71/534) (p < 0.001). Conclusion This study documents the epidemiology and trends in surgical treatment of calcaneal fractures in England. We established that surgeons did not change their practice in terms of offering surgery to these patients in response to the results of the UK HeFT. There has been a significant (p < 0.001) increase in the number of calcaneal fractures being treated surgically using less invasive procedures.
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Vizek, M., C. K. Pickett e J. V. Weil. "Interindividual variation in hypoxic ventilatory response: potential role of carotid body". Journal of Applied Physiology 63, n. 5 (1 novembre 1987): 1884–89. http://dx.doi.org/10.1152/jappl.1987.63.5.1884.
Abstract (sommario):
There is considerable interindividual variation in ventilatory response to hypoxia in humans but the mechanism remains unknown. To examine the potential contribution of variable peripheral chemorecptor function to variation in hypoxic ventilatory response (HVR), we compared the peripheral chemoreceptor and ventilatory response to hypoxia in 51 anesthetized cats. We found large interindividual differences in HVR spanning a sevenfold range. In 23 cats studied on two separate days, ventilatory measurements were correlated (r = 0.54, P less than 0.01), suggesting stable interindividual differences. Measurements during wakefulness and in anesthesia in nine cats showed that although anesthesia lowered the absolute HVR it had no influence on the range or the rank of the magnitude of the response of individuals in the group. We observed a positive correlation between ventilatory and carotid sinus nerve (CSN) responses to hypoxia measured during anesthesia in 51 cats (r = 0.63, P less than 0.001). To assess the translation of peripheral chemoreceptor activity into expiratory minute ventilation (VE) we used an index relating the increase of VE to the increase of CSN activity for a given hypoxic stimulus (delta VE/delta CSN). Comparison of this index for cats with lowest (n = 5, HVR A = 7.0 +/- 0.8) and cats with highest (n = 5, HVR A = 53.2 +/- 4.9) ventilatory responses showed similar efficiency of central translation (0.72 +/- 0.06 and 0.70 +/- 0.08, respectively). These results indicate that interindividual variation in HVR is associated with comparable variation in hypoxic sensitivity of carotid bodies. Thus differences in peripheral chemoreceptor sensitivity may contribute to interindividual variability of HVR.
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Moran, Sergio V., Francisco Montiel, Guillermo Acuña, Jeanette Vergara, Manuel J. Irarrazaval, Gustavo Maturana e Juan Dubernet. "Cephradine and cefazolin plasma levels during cardiac surgery". Perfusion 1, n. 1 (gennaio 1986): 41–45. http://dx.doi.org/10.1177/026765918600100105.
Abstract (sommario):
A prospective, randomized, double-blind study was carried out to evaluate two prophylactic regimes in patients undergoing cardiac surgery with cardiopulmonary bypass. Antibiotic plasma levels were measured in fifty consecutive adult patients undergoing valve and coronary surgery. They were divided into two comparable groups of 25 patients, each matched in age, sex, type of operation and duration of cardiopulmonary bypass. Group 1 received 1 g of cephradine with the anaesthetic premedication, 1 g in the prime of the oxygenator and 1 g every six hours during the first 72 hours of the postoperative course. Group 2 received cefazolin following the same protocol except that they received 1 g every eight hours during the postoperative course. There were no allergic or toxic reactions and no infections up to two months follow-up in both groups. Antibiotic plasma levels were significantly higher (p < 0·001) in the cefazolin group in four out of five sampling periods. Antibiotic plasma levels for group 1 versus group 2 were as follows: initial level 11·7 ± 5.2 mcg/ml vs 31 4 ± 35·4 mcg/ml. During cardiopulmonary bypass 26·6 ± 9·5 mcg/ml vs 51·7 ± 21 ·1 mcg/ml. Final levels 13·6 ± 7·0 mcg/ml vs 32·2 ± 17·8 mcg/ml. Baseline levels 2·7 ± 2·3 mcg/ml vs 6·· ± 7·7 mcg/ml and peak level 44·0 ± 16·2 mcg/ml vs 51·2 ± 23·4 mcg/ml (NS). The results of this study demonstrate that cefazolin achieved significantly higher plasma levels during the different phases of the operation and early postoperative period. Also, cefazolin and cephradine levels are above the minimal inhibitory concentrations for the gram positive and gram negative susceptible bacteria, except for the basal levels obtained by cephradine. The favourable pharmacokinetic characteristics of cefazolin, makes it a good choice for prophylactic use during cardiac surgery.
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Metzger Filho, Otto, Giuseppe Viale, Lorenzo Trippa, Tianyu Li, Denise A. Yardley, Ingrid A. Mayer, Vandana Gupta Abramson et al. "HER2 heterogeneity as a predictor of response to neoadjuvant T-DM1 plus pertuzumab: Results from a prospective clinical trial." Journal of Clinical Oncology 37, n. 15_suppl (20 maggio 2019): 502. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.502.
Abstract (sommario):
502 Background: HER2 targeted therapy without chemotherapy may be insufficient to completely eradicate a HER2+ cancer in cases of significant intratumor HER2 heterogeneity (ITH-HER2). Methods: We conducted a single-arm phase II study enrolling centrally confirmed HER2+ breast cancer. Pts received 6 cycles of T-DM1 plus Pertuzumab before surgery. Central ITH-HER2 was assessed on baseline ultrasound-guided core biopsies from 2 distinct areas of each tumor (3 cores/site). ITH-HER2 was defined as at least one of the six areas demonstrating either 1) HER2 positivity by FISH in > 5% and < 50% of tumor cells (i.e., CAP guideline) or 2) an area of tumor that tested HER2 negative. The primary objective is the association between pathologic complete response (pCR) and ITH, stratified by ER status. pCR defined as residual cancer burden (RCB) 0. Results: 164 pts with centrally confirmed HER2+ tumors were enrolled from 1/2015 to 1/2018. 2 pts withdrew consent. Median tumor size by imaging was 2.8 cm (IQR 2.1-3.8cm); 111 (69%) were ER+ and 51 (32%) ER-. 8 pts discontinued tx (6 due to disease progression, 2 due to toxicity). 49% of pts had a pCR (RCB-0), 14% RCB-I, 26% RCB-II and 11% RCB-III. Higher rates of RCB-0 were seen in ER- (65%) versus ER+ (42%). ITH-HER2 was detected in 10% (16/157) of evaluable cases. No pCR was observed among cases classified as heterogeneous (RCB-I 25%, RCB-II 25%, RCB-III 50%). The study met its primary endpoint by demonstrating a significant association between ITH-HER2 and pCR stratified by ER status (p < .0001). Secondary analysis also demonstrated a significant association between ITH-HER2 and pathologic response defined as RCB 0 or I (OR = 5.6, p = 0.004). Exploratory analysis revealed higher rates of RCB-0 among tumors centrally classified as HER2 3+ (56% [66/118]) versus HER2 2+ (27% [10/37]), (OR = 3.4, p = 0.002). The association of ITH-HER2 and pCR was maintained when stratifying by ER status and HER2 IHC (2+ vs. 3+), (p = 0.002). Conclusions: ITH-HER2 assessed by routine pathology evaluation is a strong predictor of pCR to a dual-HER2 targeted therapy regimen. If validated, ITH-HER2 may need to be considered in selection of pts for HER2-targeted regimens without chemotherapy in the curative setting. Clinical trial information: NCT02326974.
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Bradley, L. A., D. D. Johnson, G. E. Palomaki, J. E. Haddow, N. H. Robertson e R. M. Ferrie. "Hereditary haemochromatosis mutation frequencies in the general population". Journal of Medical Screening 5, n. 1 (1 marzo 1998): 34–36. http://dx.doi.org/10.1136/jms.5.1.34.
Abstract (sommario):
Objectives This study aims to expand our knowledge of the general population frequency of two mutations, C282Y and H63D, identified in the candidate gene for hereditary haemochromatosis, and to determine whether the testing can be performed using routinely obtained cheek-brush (buccal) samples. Setting Banked buccal lysate samples, randomised and coded for anonymity, from a cohort of couples who underwent prenatal cystic fibrosis screening in Maine. Methods A multiplex ARMS test was performed on buccal cell lysates to identify the two mutations. Results Genotype frequencies found among the 1001 subjects studied (502 women, 499 men) were: seven C282Y homozygotes, 22 C282Y/H63D compound heterozygotes, 97 C282Y heterozygotes, 17 H63D homozygotes, 246 H63D heterozygotes, and 612 individuals with no detectable mutation. The allele frequencies for C282Y and H63D were 0.066 and 0.151, respectively. Conclusions Observed genotype frequencies in Maine are consistent with expectations and with consensus data from five smaller studies. Combined mutational analysis data indicate that homozygosity for C282Y (the genotype found in about 85% of subjects with diagnosed hereditary haemochromatosis) occurs in 51 per 10 000 white subjects of northern European heritage; the corresponding total hereditary haemochromatosis prevalence of about 60 per 10 000 is consistent with previous estimates. The study also confirms that H63D would not be useful in general population screening for hereditary haemochromatosis.
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Averina, I. I., M. Yu Mironenko, L. A. Glushko, S. A. Donakanyan e L. A. Bokeria. "Left heart remodeling as a risk factor for atrial fibrillation in patients after surgery of acquired heart defects". Russian Journal of Cardiology 28, n. 7 (16 luglio 2023): 5323. http://dx.doi.org/10.15829/1560-4071-2023-5323.
Abstract (sommario):
Aim. To identify risk factors for atrial fibrillation (AF) in patients with aortic and mitral defects after surgical treatment.Material and methods. A total of 112 patients with aortic and mitral defects (excluding patients with mitral stenosis) were examined: 90 men and 22 women aged 18 to 72 years (median age, 51(35;57) years). Patients were examined initially before and after surgery (in terms of 8-14 days and after 12-36 months). The peak left atrial (LA) longitudinal strain (PALS) was determined at LA reservoir phase. The following endpoints were chosen: the presence of AF and atrial flutter (AFL) in the shortand long-term period after surgery, repeated hospitalization for arrhythmias. Patients were divided into 2 groups: group 1 — patients with a favorable prognosis, group 2 — patients with AF and AFL after surgery. The mean values were compared by the independent Student’s t test, while the rank sum — by the Mann-Whitney test. ROC analysis was used.Results. Baseline LA volume index (LAVI) >44,4 ml/m2 increased the risk of AF after surgery (AUC=0,6±0,07, p<0,05, relative risk (RR) — 2,34 (confidence interval (CI), 0,8-6,88). LA volumes were within the normal range in the group without arrhythmias. A decrease in the initial threshold level of LA PALS <27,5% increased the risk of AF as in the shortand long-term postoperative period (AUC=0,659±0,08, p<0,01, RR — 1,19 (CI, 3,38-31,4). In the AF group, PALS decreased after surgery and did not increase in the long-term period (28±7,5% at baseline, 19±6,2% after surgery, 21±8,3% in the long-term period, (p=0,04 and p=0, 23, respectively). Left ventricular ejection fraction affected the AF development only in the early period after surgery (AUC=0,71±0,049, p<0,008, RR — 2,21 (CI, 1,27-3,87).Conclusion. The development of AF was influenced by LAVI, LA PALS, while in the early postoperative surgery period — ejection fraction.
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Peerenboom, Rayne, Sarah Ackroyd, Chuanhong Liao, Aarthi Koripelly e Nita Lee. "Abstract B117: Disparities in non-surgical admissions for survivors of cervical cancer: Understanding morbidity and survivorship needs through hospital admissions". Cancer Epidemiology, Biomarkers & Prevention 32, n. 1_Supplement (1 gennaio 2023): B117. http://dx.doi.org/10.1158/1538-7755.disp22-b117.
Abstract (sommario):
Abstract Purpose: To utilize data on hospital admissions among patients with cervical cancer during treatment and long-term surveillance to better understand disease and treatment related burdens, explore inpatient utilization of services, and identify risk factors for admission. Methods: Retrospective chart review was performed on patients treated for cervical cancer from 2014 to 2020 at a single academic institution. Clinical, demographic and treatment information and hospital admission characteristics were collected. Discharge diagnoses were grouped and summarized with descriptive statistics. Univariate and multivariate regression were used to examine associations between patient characteristics and likelihood of admission. Results: Of 366 patients identified, 188 (51%) were admitted to the hospital for cancer or treatment-related reasons excluding planned admissions for initial treatment, in the median follow-up period of 3.6 years (IQR 1.4-6.4), with a median number of 2 admissions (IQR 1-4) and median length of stay 4 days (IQR 2-7). Of those admitted, 65 (35%) had discharge diagnoses belonging to more than one clinical category. The five most common discharge diagnoses were gastrointestinal problems (40%), genitourinary problems (35%), infection (35%), pain control (21%), and vaginal bleeding (19%). A significant proportion of admitted patients underwent inpatient interventions including imaging (68%), surgical procedures (57%), antibiotics (52%), transfusion of blood products (40%), and interventional radiology procedures (28%) and utilized supportive and specialty care including case management (53%), physical therapy (40%), occupational therapy (36%), social work (36%), nutrition (31%), and palliative care (23%). On univariate analysis, Black patients (OR 3.0, p<.001), uninsured patients (OR 5.2, p<.001), those with lower performance status (OR 1.7, p<.001), higher stage (OR 2.9, p<.001), patients who received radiation or chemoradiation (OR 3.9, p<.001), and those with recurrence (OR 5.1, p<.001) were more likely to be hospitalized after completion of treatment. On multivariate analysis, odds of admission were higher among Black patients (aOR 2.4, p<.01), uninsured patients (aOR 2.7, p<.05), those with lower performance status (aOR 2.7, p<.05), and those with recurrence (aOR 5.5, p<.001). Conclusion: Patients with cervical cancer represent a high-risk population frequently hospitalized after initial treatment, due to disease and treatment-related toxicities. Black patients, uninsured patients, those with recurrence, and those with lower performance status faced higher odds of admission, possibly reflecting higher survivorship burden. Comprehensive, team-based approaches to address complex symptom burden are needed for this high risk group. Patient-reported outcomes and needs assessments should also be considered to design programming to address complex needs in this patient population. Citation Format: Rayne Peerenboom, Sarah Ackroyd, Chuanhong Liao, Aarthi Koripelly, Nita Lee. Disparities in non-surgical admissions for survivors of cervical cancer: Understanding morbidity and survivorship needs through hospital admissions [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B117.
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Polonskaya, Ya V., E. V. Kashtanova, E. M. Stakhneva, V. S. Shramko, E. V. Sadovski, L. V. Shcherbakova, A. D. Khudyakova e Yu I. Ragino. "The level of adipokines in young people with hypertension and abdominal obesity". "Arterial’naya Gipertenziya" ("Arterial Hypertension") 29, n. 1 (14 novembre 2022): 51–57. http://dx.doi.org/10.18705/1607-419x-2022-28-6-51-57.
Abstract (sommario):
Objective. To investigate the adipokine blood profile in young people with hypertension (HTN) and abdominal obesity (AO). Design and methods. In total. 530 people were included in the study, including 267 people with HTN, of which 169 had AO. In the control group (without HTN) there were 263 people comparable to the study group by gender and age. Among them there were 106 people with AO. The blood levels of adiponectin, adipsin, lipocalin-2, resistin and plasminogen activator inhibitor-1 (PAI-1) were determined in all examined patients by multiplex analysis. Statistical data processing was carried out with the use of SPSS 13.0 program. Results. The levels of adiponectin and lipocalin-2 were lower in the group of HTN patients by 1,46 (p < 0,01) and 1,14 times (p < 0,05), respectively. The level of adipsin in HTN patients was significantly higher (p < 0,01) by 19,14 % compared to the control. The levels of resistin and PAI- did not differ in the control group and the group with HTN. Adiponectin level was 1,35 times lower (p < 0,05) in the group with AO compared to those without AO, the other indicators did not differ in the AO group and controls. In the HTN group, higher levels of PAI-1 were found in the subgroup with AO. When comparing the subgroup without HTN and without AO with the subgroup with HTN and AO, a significant decrease in concentration of adiponectin and lipocalin-2 was found. For the subgroups with AO, a decrease in adiponectin levels and an increase in adipsin levels (p < 0,01) were found in HTN patients. No statistically significant difference was found for the remaining indicators. The relative chance of early onset HTN was associated with the decrease in adiponectin and lipocalin-2 levels, and with the increase in adipsin levels, regardless of gender, age and the presence of AO. Conclusions. Thus, an increased level of adipsin and a reduced level of adiponectin and lipocalin-2 can serve as potential biomarkers indicating a high probability of developing early HTN in people under 45 years of age.
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Fukahori, Masaru, Yoshinobu Okabe, Mototsugu Shimokawa, Taiga Otsuka, Futa Koga, Yujiro Ueda, Junichi Nakazawa et al. "Efficacy of second-line chemotherapy after standard combination chemotherapy in patients with metastatic pancreatic cancer: The results from the NAPOLEON study." Journal of Clinical Oncology 38, n. 4_suppl (1 febbraio 2020): 661. http://dx.doi.org/10.1200/jco.2020.38.4_suppl.661.
Abstract (sommario):
661 Background: Gemcitabine plus nab-paclitaxel (GnP) and FOLFIRINOX (FFX) have been established as standard first-line combination chemotherapy (CTx) for patients with metastatic pancreatic cancer (MPC). However, the efficacy of second-line CTx and the significance of combination CTx in clinical practice are unclear. We therefore investigated the efficacy of second-line CTx in patients with MPC. Methods: Data were collected from CTx-naive MPC patients treated with first-line combination CTx at 14 hospitals in the Kyushu area of Japan from December 2013 to June 2018. The median overall survival (mOS) from second-line treatment was compared between patients who received second-line CTx (CT group) and those who received best supportive care (BSC group). Furthermore, in the CT group, the mOS was compared between the patients who received combination CTx and those who received mono-CTx. To control potential bias in the selection of second-line treatment, we also conducted a propensity score-adjusted analysis. Results: A total of 255 patients received GnP or FFX as first-line CTx. Of these, there were 156 (61%) in the CT group and 77 (30%) in the BSC group. The number of patients who received FFX/GnP as first-line CTx was 79 (51%)/77 (49%) in the CT group and 15 (20%)/62 (80%) in the BSC group, respectively (P < 0.01). The mOS in the CT group was significantly longer than that in the BSC group (5.2 vs. 2.7 months; hazard ratio [HR] 0.42; 95% confidence interval [CI] 0.31-0.57; p < 0.01 and 5.2 vs. 2.6 months; adjusted HR 0.39; 95% CI 0.28-0.55; p < 0.01). In the CT group, 89 (57%) patients received combination CTx, and 67 (43%) received mono-CTx. There was no significant difference in the mOS between the combination CTx and mono-CTx patients (5.5 vs. 4.4 months; HR 0.88; 95% CI 0.62-1.26; p = 0.88 and 5.6 vs. 4.4 months; adjusted HR 0.85; 95% CI 0.56-1.30; p = 0.47). Conclusions: Among patients with MPC receiving second-line treatment, the CT group had a significantly longer mOS than the BSC group, but combination CTx conferred no improvement in the survival duration compared with mono-CTx.
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Chi, Stephen, Seunghwan Kim, Matthew Reuter, Katharine Ponzillo, Debra Parker Oliver, Randi Foraker, Kevin Heard et al. "Advanced Care Planning for Hospitalized Patients Following Clinician Notification of Patient Mortality by a Machine Learning Algorithm". JAMA Network Open 6, n. 4 (18 aprile 2023): e238795. http://dx.doi.org/10.1001/jamanetworkopen.2023.8795.
Abstract (sommario):
ImportanceGoal-concordant care is an ongoing challenge in hospital settings. Identification of high mortality risk within 30 days may call attention to the need to have serious illness conversations, including the documentation of patient goals of care.ObjectiveTo examine goals of care discussions (GOCDs) in a community hospital setting with patients identified as having a high risk of mortality by a machine learning mortality prediction algorithm.Design, Setting, and ParticipantsThis cohort study took place at community hospitals within 1 health care system. Participants included adult patients with a high risk of 30-day mortality who were admitted to 1 of 4 hospitals between January 2 and July 15, 2021. Patient encounters of inpatients in the intervention hospital where physicians were notified of the computed high risk mortality score were compared with patient encounters of inpatients in 3 community hospitals without the intervention (ie, matched control).InterventionPhysicians of patients with a high risk of mortality within 30 days received notification and were encouraged to arrange for GOCDs.Main Outcomes and MeasuresThe primary outcome was the percentage change of documented GOCDs prior to discharge. Propensity-score matching was completed on a preintervention and postintervention period using age, sex, race, COVID-19 status, and machine learning-predicted mortality risk scores. A difference-in-difference analysis validated the results.ResultsOverall, 537 patients were included in this study with 201 in the preintervention period (94 in the intervention group; 104 in the control group) and 336 patients in the postintervention period. The intervention and control groups included 168 patients per group and were well-balanced in age (mean [SD], 79.3 [9.60] vs 79.6 [9.21] years; standardized mean difference [SMD], 0.03), sex (female, 85 [51%] vs 85 [51%]; SMD, 0), race (White patients, 145 [86%] vs 144 [86%]; SMD 0.006), and Charlson comorbidities (median [range], 8.00 [2.00-15.0] vs 9.00 [2.00 to 19.0]; SMD, 0.34). Patients in the intervention group from preintervention to postintervention period were associated with being 5 times more likely to have documented GOCDs (OR, 5.11 [95% CI, 1.93 to 13.42]; P = .001) by discharge compared with matched controls, and GOCD occurred significantly earlier in the hospitalization in the intervention patients as compared with matched controls (median, 4 [95% CI, 3 to 6] days vs 16 [95% CI, 15 to not applicable] days; P &lt; .001). Similar findings were observed for Black patient and White patient subgroups.Conclusions and RelevanceIn this cohort study, patients whose physicians had knowledge of high-risk predictions from machine learning mortality algorithms were associated with being 5 times more likely to have documented GOCDs than matched controls. Additional external validation is needed to determine if similar interventions would be helpful at other institutions.
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Liu, KeXin, YaQian Xu, ChaoYi Ma, Na Yu, FaBing Tan, Yi Li, YaXin Bai et al. "Efficacy of a Virtual 3D Simulation–Based Digital Training Module for Building Dental Technology Students’ Long-Term Competency in Removable Partial Denture Design: Prospective Cohort Study". JMIR Serious Games 12 (5 aprile 2024): e46789-e46789. http://dx.doi.org/10.2196/46789.
Abstract (sommario):
Abstract Background Removable partial denture (RPD) design is crucial to long-term success in dental treatment, but shortcomings in RPD design training and competency acquisition among dental students have persisted for decades. Digital production is increasing in prevalence in stomatology, and a digital RPD (D-RPD) module, under the framework of the certified Objective Manipulative Skill Examination of Dental Technicians (OMEDT) system reported in our previous work, may improve on existing RPD training models for students. Objective We aimed to determine the efficacy of a virtual 3D simulation–based progressive digital training module for RPD design compared to traditional training. Methods We developed a prospective cohort study including dental technology students at the Stomatology College of Chongqing Medical University. Cohort 1 received traditional RPD design training (7 wk). Cohort 2 received D-RPD module training based on text and 2D sketches (7 wk). Cohort 3 received D-RPD module pilot training based on text and 2D sketches (4 wk) and continued to receive training based on 3D virtual casts of real patients (3 wk). RPD design tests based on virtual casts were conducted at 1 month and 1 year after training. We collected RPD design scores and the time spent to perform each assessment. Results We collected the RPD design scores and the time spent to perform each assessment at 1 month and 1 year after training. The study recruited 109 students, including 58 (53.2%) female and 51 male (56.8%) students. Cohort 1 scored the lowest and cohort 3 scored the highest in both tests (cohorts 1-3 at 1 mo: mean score 65.8, SD 21.5; mean score 81.9, SD 6.88; and mean score 85.3, SD 8.55, respectively; P<.001; cohorts 1-3 at 1 y: mean score 60.3, SD 16.7; mean score 75.5, SD 3.90; and mean score 90.9, SD 4.3, respectively; P<.001). The difference between cohorts in the time spent was not statistically significant at 1 month (cohorts 1-3: mean 2407.8, SD 1370.3 s; mean 1835.0, SD 1329.2 s; and mean 1790.3, SD 1195.5 s, respectively; P=.06) but was statistically significant at 1 year (cohorts 1-3: mean 2049.16, SD 1099.0 s; mean 1857.33, SD 587.39 s; and mean 2524.3, SD 566.37 s, respectively; P<.001). Intracohort comparisons indicated that the differences in scores at 1 month and 1 year were not statistically significant for cohort 1 (95% CI –2.1 to 13.0; P=.16), while cohort 3 obtained significantly higher scores 1 year later (95% CI 2.5-8.7; P=.001), and cohort 2 obtained significantly lower scores 1 year later (95% CI –8.8 to –3.9; P<.001). Conclusions Cohort 3 obtained the highest score at both time points with retention of competency at 1 year, indicating that progressive D-RPD training including virtual 3D simulation facilitated improved competency in RPD design. The adoption of D-RPD training may benefit learning outcomes.
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M, Harrell, Myers M, Aita S, Taylor S, Beach J, Calamia M e Hill B. "A-206 “Mittenberg-Type formula for Identifying Feigned ADHD Using WAIS-IV”". Archives of Clinical Neuropsychology 35, n. 6 (28 agosto 2020): 1001. http://dx.doi.org/10.1093/arclin/acaa068.206.
Abstract (sommario):
Abstract Objective This study utilized logistic regression to determine whether performance patterns on the WAIS-IV subtests could differentiate between genuine-effort and simulated ADHD groups. Method Participants were 355 college students (55.3%% female; 65.7% Caucasian, 23.9% African American, 4.2% Asian; age range 17–51 years, Mage = 20.93 years, SD = 4.63; 76.4% no psychological diagnosis) who completed the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). Mean FSIQ for control group was 102.35 and 87.48 for the simulator group. Eighty participants (22.5%) simulated ADHD symptoms, while 276 participants (77.5%) provided genuine effort. Results A logistic regression analysis was performed with known group as the dependent variable and WAIS-IV subtest scaled scores as predictor variables. The final model of five predictor variables (Similarities, Information, Digit Span, Symbol Search, and Coding) significantly predicted group status (χ2 = 140.91, df = 5, N = 355, p < .001). The model accounted for 33% to 50% of the variance (Cox and Snell R2 = .33; Nagelkerke R2 = .50) in performance classification with overall 86% of individuals correctly predicted to their known group. At a cut value of .65 the sensitivity was 69.6% and the specificity was 90.6%. A cut value of.55 the sensitivity was 53.2% and the specificity was at 94.6%. Conclusions These findings are consistent with prior research suggesting discriminant function analysis derived from clinical measures (e.g., WAIS-IV) can be useful as embedded validity measures in distinguishing suspicious and genuine performance. Sensitivity, specificity, and predictive power of the WAIS-IV subtests were acceptable at 5% and 10% false positive rates.
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Van Bentum, R., M. Baniaamam, B. Kinaci-Tas, J. Van de Kreeke, P. J. Visser, E. Serné, M. Nurmohamed e I. Van der Horst-Bruinsma. "AB0728 MICROVASCULAR CHANGES OF THE RETINA IN ANKYLOSING SPONDYLITIS, AND THE ASSOCIATION WITH CARDIOVASCULAR DISEASE – THE EYE FOR A HEART STUDY." Annals of the Rheumatic Diseases 79, Suppl 1 (giugno 2020): 1658.2–1659. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4416.
Abstract (sommario):
Background:Patients with ankylosing spondylitis (AS) have an increased risk at cardiovascular disease (CVD). Microvasculature changes might precede overt CVD, but have been poorly studied in AS. The small vessels of the retina are accessible for non-invasive visualization, and microvascular changes (retinal arteriolar narrowing, venular widening, loss of tortuosity) are described in association with CVD in other diseases.Objectives:The aim of this study was to compare the retinal microvasculature of AS patients with healthy controls, and to assess gender differences.Methods:A cross-sectional, case-control study comparing AS patients (fulfilling the modified New York criteria, Rheumatology outpatient clinic of Reade and Amsterdam UMC) with healthy controls (EMIF-AD PreClinAD cohort of the Dutch Twins Register(1)), men:women=1:1. Most important inclusion criteria were: age 50-75 years, diabetes mellitus was excluded. All subjects underwent Optical Coherence Tomography Angiography and fundus photography (≥1 eye), analyzed with Singapore I Vessel Assessment software (Table 2). Differences between AS and controls were evaluated with generalised estimating equations (GEE), adjusted for demographics and cardiovascular risk, and stratified for gender.Results:In total, 59 AS patients (mean disease duration 36 years) and 105 controls were included. Controls were significantly older than patients, but did not differ in cardiovascular profile (Table 1). Patients had a significantly lower retinal arteriolar tortuosity (β-0.1;p=0.02), and higher vessel density (β 0.5,p=0.02), than controls (Table 2). Also, male AS patients showed a lower arteriovenular ratio compared to male controls (β -0.03,p=0.04). There were no differences between women with and without AS. In AS, a high disease activity was associated with a wider (unfavorable) venular diameter (p=0.05), whereas biologic use showed a wider (more favorable) arteriolar diameter (p<0.01).Conclusion:This study detected several retinal microvascular changes, in AS patients compared to controls, of which some are associated with CVD based on previous studies. Some changes were only observed in male-, but not in female, patients. A new finding was an increased capillary density in AS, of which the association with CVD-risk has not yet been studied before.References:[1]Konijnenberg E et al. The EMIF-AD PreclinAD study: study design and baseline cohort overview. Alzheimers Res Ther. 2018; 10:75.Table 1.Patient characteristics AS (n=57) and controls (n=105)ASControlspGender, women (%)30 (51)52 (50)nsAge, mean yrs (SD)60 (6)68 (4)<0.01Smoking currently, yes (%)11 (19)8 (8)0.06Body mass index, mean (SD)26 (4)26 (3)nsHypertension, yes (%)23 (39)39 (37)nsDyslipidemia, yes (%)9 (15)18 (17)nsCardiovascular disease history, yes (%)9 (15)15 (14)nsNSAIDS (%)24 (41)6 (6)<0.01Biological (mostly TNF inhibitor)* (%)29 (49)0 (0)<0.01AS Disease Activity Score, mean (SD)2.1 ±0.9Table 2.Retinal vascular parameters, differences AS and Control subjectsCrudeAdjusted for:Age, gender, BMI smoking, hypertension, dyslipidemiaRetinal vascular parametersβ(95%CI)pβ(95%CI)pDiameterArteriolar1.6(-2.0, 5.2)0.37-0.2(-4.8, 4.4)0.92Venular5.4(-0.66, 11.5)0.082.5(-5.4, 10.4)0.53Arteriovenular ratio-0.01(-0.03, 0.01)0.43-0.01(-0.03, 0.02)0.65TortuosityArteriolar-0.05(-0.12, 0.03)0.19-0.1(-0.2, -0.01)0.02ComplexityFractal dimension0.01(0.00, 0.03)0.040.0(-0.02, 0.02)0.88Vessel DensityInner ring0.8(0.5, 1.1)<0.0010.5(0.1, 0.9)0.02Outer ring0.7(0.4, 1.0)<0.0010.2(-0.2, 0.6)0.42Disclosure of Interests:Rianne van Bentum: None declared, Milad Baniaamam: None declared, Buket Kinaci-Tas: None declared, Jacoba van de Kreeke: None declared, Pieter Jelle Visser: None declared, Erik Serné: None declared, Michael Nurmohamed Grant/research support from: Not related to this research, Consultant of: Not related to this research, Speakers bureau: Not related to this research, Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma
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Rohrbaugh, Roger T., Andrew R. Weaver, Scott P. Greiner e Scott A. Bowdridge. "1 A survey of anthelmintic resistance in Angus bulls participating in centralized performance tests in Appalachia". Journal of Animal Science 98, Supplement_2 (1 novembre 2020): 56–57. http://dx.doi.org/10.1093/jas/skz397.129.
Abstract (sommario):
Abstract Parasitism in weaned calves and anthelmintic resistance can negatively impact performance and reduce profitability. To better understand anthelmintic resistance, bulls were evaluated for fecal egg count (FEC) at performance test facilities in Virginia and West Virginia. Over a two-year period, 532 Angus bull calves were tested at bull development facilities in Wardensville, WV (n = 274), Culpeper, VA (n = 167), and Wytheville, VA (n = 91). Fecal samples were collected upon arrival and 14 d later, representing the warm-up or transition period. At arrival, bulls were treated with either albendazole (Wardensville) or moxidectin (both VA tests). Data were analyzed via the general linear model of SAS with fixed effects of station and year. Correlation analysis of arrival FEC and transition ADG was analyzed using the correlation procedure in SAS. The average FEC reduction (FECR) in bulls at Wardensville was 98%; whereas, FECR at Culpeper and Wytheville was 46% and 16% respectively. Average FEC of bulls at Wytheville, Culpeper and Wardensville were different (P < 0.05) after treatment and had a FEC of 133, 51, 3 eggs/g, respectively. Transition ADG favored bulls from Wardensville and Culpeper (2.43 and 2.31 kg/d; P > 0.05) where bulls at Wytheville had lower ADG compared to either station (1.03 kg/d; P < 0.01). Correlation between arrival FEC and transition ADG was negative for bulls in Wardensville (-0.22; P = 0.0003). This same response was not observed at other stations. Lack of a correlation was most likely due to infection level being so low that abundant feed resources masked effects of parasitism, or parasitism was so great that all cattle transitioned poorly. Nonetheless, these data clearly demonstrate the efficacy of albendazole in significantly reducing fecal egg output in bull calves and identify potential resistance to moxidectin.
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Togeiro, S., L. S. Oliveira, T. M. Guimaraes, G. P. Luz, G. Coelho, L. N. Badke, S. Tufik e L. Bittencourt. "0663 The Longterm Effect of CPAP Compared to Mandibular Advancement Device on Metabolic Profile in Mild Obstructive Sleep Apnea". Sleep 43, Supplement_1 (aprile 2020): A253. http://dx.doi.org/10.1093/sleep/zsaa056.659.
Abstract (sommario):
Abstract Introduction Moderate and severe Obstructive Sleep Apnea (OSA) have been independently associated to dyslipidemia with controversial results of improvement with CPAP. Less evidence exists regarding this issue in mild OSA. A current treatment for mild OSA is Mandibular Advancement Device (MAD), however its effectiveness on metabolic profile needs to be compared to CPAP.Our aim was to compare MAD with CPAP and no treatment on metabolic profile during one year in mild OSA. Methods Cross sectional analyses included 79 mild OSA patients randomized in CPAP group (n: 31), MAD group (n. 25) and Control group (n: 23). Metabolic profile was investigated before and after 6 and months. Results Mean age: 47± 9 years, BMI: 28±3.7 kg/m AHI: 9.5±2.9/h. There were no differences in anthropometric data, total cholesterol (TCT) HDL-C, LDL-C, Triglycerides (TC) and glycated Hemoglobin (Hb1c) among groups. MAD and CPAP reduced AHI at 6 and 12 months (9.3 ± 5.2 to 4.2 ± 9.1 to 3.8 ± 12.6 / 10.0 ± 4.6 to 1.2 ± 9.9 to 1.7 ± 14.2, p: 0.01 respectively). BMI did not change in groups at 6 and 12 months. MAD adherence was higher than CPAP at 6 months (5.8 ± 2.8 hs/day vs 3.8 ± 3.0 hs/day; p: 0.01) and 12 months 5.7 ± 2.7 hs/day vs 3.8 ± 3.4 hs/day; p: 0.01). Despite of lower adherence than MAD, CPAP was effective in reduce TCT and LDL- CT at 6 and 12 months (Intention to treat analyses TCT: 189.3±51.4 mg/dl to 186.1±51.4 mg/dl to 174.6±51 mg/dl; p: 0.03 / 112.8±48.7 mg/dl to 110.5±48.7 mg/dl to 95.8±48.7mg/dl; p: 0.03 respectively), however HDL-C, TG and Hbc didn′t change. Conclusion Long term CPAP treatment was effective in reducing cholesterol in mild OSA. Support Associação Fundo Incentivo à Psicobiologia (AFIP) CAPES
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Amarasooriya, Melanie, Gregory Ian Bain, Tom Roper, Kimberley Bryant, Karim Iqbal e Joideep Phadnis. "Complications After Distal Biceps Tendon Repair: A Systematic Review". American Journal of Sports Medicine 48, n. 12 (24 febbraio 2020): 3103–11. http://dx.doi.org/10.1177/0363546519899933.
Abstract (sommario):
Background: Distal biceps tendon injuries typically occur in the dominant arm of men in their fourth decade of life. Surgical repair restores flexion and supination strength, resulting in good functional outcome. The complication profile of each surgical approach and fixation technique has not been widely studied in the literature. Purpose: To report the rate of complications after repair of complete distal biceps ruptures, to classify them according to surgical approach and fixation technique, and to analyze risk factors and outcomes of the individual complications. Study Design: Systematic review. Methods: Studies published in English on primary repair of the distal biceps between January 1998 and January 2019 were identified. Data on complications were extracted and classified as major and minor for analysis. A quantitative synthesis of data was done to compare the complication rates between (1) limited anterior incision, extensile anterior incision, and double incision and (2) 4 fixation methods. Results: Seventy-two articles including 3091 primary distal biceps repairs were identified. The overall complication rate was 25% (n = 774). The major complication rate was 4.6% (n = 144) and included a 1.6% (n = 51) rate of posterior interosseous nerve injury; 0.3% (n = 10), median nerve injury; 1.4% (n = 43), rerupture; and a 0.1% (n = 4), synostosis. Brachial artery injury, ulnar nerve injury, compartment syndrome, proximal radius fracture, and chronic regional pain syndrome occurred at a rate of <0.1% each. The majority of nerve injuries resolved with an expectant approach. The minor complication rate was 20.4% (n = 630). The most common complication was lateral cutaneous nerve injury (9.2%, n = 283). An extensile single incision was associated with a higher rate of superficial radial nerve injury when compared to limited single incision(6% vs 2.1%, P = .002). Limited anterior single incision technique had a higher rate of lateral antebrachial cutaneous nerve injury compared to extensile single incision. (9.7% vs 5.2%, P = .03). Synostosis occurred only with double incision. Fixation technique had no significant effect on rerupture rate and posterior interosseous nerve injury rate. Conclusion: This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6%. This study provides valuable data with regard to the choice of technique, surgical approach, and rate of complications, which is essential for surgical planning and patient consent. Registration: CRD42017074066 (PROSPERO).
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Remien, Kailey A., Justin Z. Amarin, Christopher M. Horvat, Ryan A. Nofziger, Christopher K. Page-Goertz, James B. Besunder, Brittany K. Potts, Michael L. Forbes, Natasha Halasa e Jonathan H. Pelletier. "Admissions for Bronchiolitis at Children’s Hospitals Before and During the COVID-19 Pandemic". JAMA Network Open 6, n. 10 (26 ottobre 2023): e2339884. http://dx.doi.org/10.1001/jamanetworkopen.2023.39884.
Abstract (sommario):
ImportanceThe COVID-19 pandemic has been associated with a transient decrease in bronchiolitis hospitalizations compared with prepandemic patterns, but current effects remain unknown.ObjectiveTo analyze changes in patterns of bronchiolitis admissions at US children’s hospitals during the 2020-2023 bronchiolitis seasons compared with the 2010-2019 seasons.Design, Setting, and ParticipantsThis retrospective cross-sectional study used data from 41 US children’s hospitals in the Pediatric Health Information System database. Bronchiolitis has winter-predominant seasonality, so hospitalizations were grouped according to bronchiolitis season (from July through June). This study included all patients aged younger than 2 years admitted with a diagnosis of bronchiolitis between July 1, 2010, and June 30, 2023. Bronchiolitis seasons from July through June between 2010-2011 and 2019-2020 were classified as the prepandemic era, and seasons between 2020-2021 and 2022-2023 were classified as the pandemic era. Data analysis was performed from July 1, 2010, through June 30, 2023.ExposuresAdmission date.Main Outcomes and MeasuresThe primary outcome was number of hospitalizations for bronchiolitis by season and month. Monthly admission counts from the prepandemic era were transformed into time series and used to train seasonal ensemble forecasting models. Forecasts were compared to monthly admissions during the pandemic era.ResultsIn this study, there were 400 801 bronchiolitis admissions among 349 609 patients between July 1, 2010, and June 30, 2023. The median patient age was 6 (IQR, 2-12) months; 58.7% were boys and 43.7% were White. Hospitalizations increased gradually during the prepandemic era (median, 29 309 [IQR, 26 196-34 157]), decreased 69.2% (n = 9030) in the 2020-2021 season, and increased 75.3% (n = 51 397) in the 2022-2023 season. Patients in the pandemic era were older than those in the prepandemic era (median, 7 [IQR, 3-14] vs 6 [2-12] months; P &lt; .001). Intensive care unit (ICU) admissions increased from 32.2% (96 245 of 298 535) in the prepandemic era to 36.7% (37 516 of 102 266) in the pandemic era (P &lt; .001). The seasonality of bronchiolitis admissions changed during the pandemic era. Admissions peaked in August 2021 (actual 5036 vs 943 [95% CI, 0-2491] forecasted) and November 2022 (actual 10 120 vs 5268 [95% CI, 3425-7419] forecasted). These findings were unchanged in sensitivity analyses excluding children with complex chronic conditions and excluding repeat admissions. In a sensitivity analysis including all viral lower respiratory tract infections in children aged younger than 5 years, there were 66 767 admissions in 2022-2023 vs 35 623 (31 301-41 002) in the prepandemic era, with the largest increase in children aged 24 to 59 months.Conclusions and RelevanceThe findings of this cross-sectional study suggest that bronchiolitis hospitalizations decreased transiently and then increased markedly during the COVID-19 pandemic era. Patients admitted during the pandemic era were older and were more likely to be admitted to an ICU. These findings suggest that bronchiolitis seasonality has not yet returned to prepandemic patterns, and US hospitals should prepare for the possibility of atypical timing again in 2023.
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Mason, Gina, Victoria Dionisos, Taylor Christiansen, Daniel Dickstein, Mary Carskadon e Jared Saletin. "0218 Changes in sleep architecture and topography of sleep EEG slow wave activity following acute wake extension in early adolescence". SLEEP 46, Supplement_1 (1 maggio 2023): A96. http://dx.doi.org/10.1093/sleep/zsad077.0218.
Abstract (sommario):
Abstract Introduction A progression of peak sleep EEG slow wave activity (SWA; EEG power 0.5-4Hz) from posterior to anterior expression reflects brain development. Further, increased EEG SWA after extended wakefulness is a marker of sleep pressure. However, it is unclear whether recovery sleep SWA in later youth is expressed in a similar scalp topography as typical sleep. Using experimental wake-extension, we investigated homeostatic changes in sleep architecture and SWA topography in early adolescence. Methods Twenty-two young adolescents (M±SD: 12.03±1.14y, 12F) participated in two consecutive laboratory stays after at least a week of at-home actigraphy-monitored stabilization (9.5h in bed). A baseline night (BSL; 9.5h 21:00-06:30) was followed by wake-extension (WE) to 02:30 and a 4h recovery sleep opportunity (RS; 02:30-06:30), each monitored by polysomnography including a 25-channel EEG array. The current analyses examined R&K sleep architecture at BSL and RS. SWA in RS was compared to the first 4h of BSL in two ways: (1) absolute NREM power (µV2); (2) an index (TI) of the topographical distribution of midline SWA (FPz-AFz-Fz-FCz-Cz-CPz-Pz-POz-Oz) providing a score of 1 to 9 indicating frontal to occipital peak distribution. Results WE significantly altered RS sleep architecture, including an increase in slow-wave sleep (%TST) versus BSL (M±SD BSL: 26.76±5.69%, RS: 51.65±7.83%, t(21)=-17.09, p<.001, d=-3.65). SWA was also significantly greater in RS (channel-averaged SWA BSL: 11883.50±5142.17 µV2, RS: 18955.82±7451.20 µV2, t(21)=-8.67, p<.001) with 22/25 individual electrodes meeting Bonferroni-corrected significance (ps<.001). Finally, we observed a small frontal shift (t(21)=2.39, p=.027, d=.51) of maximal SWA in RS (TI: 4.46±2.58; i.e., FCz/Cz) compared to BSL (5.32±2.78, i.e., Cz/CPz). Conclusion These data indicate robust sleep homeostasis in young adolescents after wake extension, expressed as increased SWA across the scalp. The findings also add to existing literature by indicating that SWA topography may also be sensitive to homeostatic challenge. Specifically, a baseline centroparietal locus of maximal SWA typical to this age became more frontocentral in recovery sleep. This anterior shift may reflect a homeostatic need over developmentally sensitive prefrontal cortex. Next steps will assess how individual responses may reflect a child’s neurodevelopment (e.g., inattention symptoms) or manifested behavior after wake extension and recovery sleep. Support (if any) K01MH109854, P20GM139743, R01HD103655