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It seems reasonable that people would want to maximize various aspects of life if they were given the opportunity to do so, whether it's the pleasure they feel, how intelligent they are, or how much personal freedom they have. In actuality, people around the world seem to aspire for more moderate levels of these and other traits, according to findings published in Psychological Science, a journal of the Association for Psychological Science.
"Our research shows that people's sense of perfection is surprisingly modest," says psychological scientist Matthew J. Hornsey of the University of Queensland, first author on the research. "People wanted to have positive qualities, such as health and happiness, but not to the exclusion of other darker experiences – they wanted about 75% of a good thing."
Furthermore, people said, on average, that they ideally wanted to live until they were 90 years old, which is only slightly higher than the current average life expectancy. Even when participants imagined that they could take a magic pill guaranteeing eternal youth, their ideal life expectancy increased by only a few decades, to a median of 120 years old. And when people were invited to choose their ideal IQ, the median score was about 130 – a score that would classify someone as smart, but not a genius.
The data also revealed that participants from holistic cultures – those that value notions of contradiction, change, and context – chose ideal levels of traits that were consistently lower than those reported by participants from nonholistic cultures.
"Interestingly, the ratings of perfection were more modest in countries that had traditions of Buddhism and Confucianism," says Hornsey. "This makes sense — these Eastern philosophies and religions tend to place more emphasis on the notion that seemingly contradictory forces coexist in a complementary, interrelated state, such that one cannot exist without the other."
In one study, Hornsey and colleagues analyzed data from a total of 2,392 participants in Australia, Chile, China, Hong Kong, India, Japan, Peru, Russia, and the United States. The researchers classified China, Hong Kong, India, and Japan as holistic cultures, predominantly influenced by religions or philosophies (such as Buddhism, Hinduism, or Taoism) that emphasize a more holistic worldview. They classified the other five regions – Australia, Chile, Peru, Russia, and the United States – as nonholistic cultures.
Participants in each region received a questionnaire translated into their native language. In response to a series of questions, participants reported their ideal level of intelligence; they also reported how long they would choose to live under normal circumstance and how long they would choose to live if they could take a magic pill ensuring eternal youth.
Using a scale that ranged from 0 (none) to 100 (maximum), participants indicated their ideal levels of health, individual freedom, happiness, pleasure, and self-esteem. They used the same scale to rate ideal levels of societal characteristics, such as morality, equality of opportunity, technological advancement, and national security.
In general, participants tended to rate their ideal levels of individual characteristics to be about 70-80%, although there was some variation across the traits. For example, many more participants chose to maximize health than chose to maximize happiness. Participants' ideals were also relatively modest for both intelligence and longevity, even when there were no limits on the levels they could choose.
The researchers found that participants in holistic cultures reported lower ideal levels for each individual trait than did participants who lived in nonholistic cultures.
A second study with 5,650 participants in 27 countries produced a similar pattern of results. Importantly, this study showed that participants from the Philippines and Indonesia – regions that are collectivist but not holistic – reported ideal levels of individual traits that were similar to those of participants from other nonholistic countries. This finding suggests that the difference between holistic and nonholistic cultures is unlikely to be explained by differences in collectivism.
In both studies, the researchers found no crosscultural differences in ideal levels of societal characteristics.
"This principle of maximization is threaded through many prominent philosophical and economic theories," Hornsey notes. "But our data suggest that people have much more complex, blended notions of perfection, ones that embrace both light and dark."
Co-authors on the research include Paul G. Bain (University of Bath), Emily Ann Harris (University of Queensland), Nadezhda Lebedeva (National research University), Emiko S. Kashima (LaTrobe University), Yanjun Guan (Durham University Business School), Roberto González (Pontificia Universidad Católica de Chile), Sylvia X. Chen (Hong Kong Polytechnic University), and Sheyla Blumen (Pontificia Universidad Católica del Perú).
Chilean data collection was supported by the Centre for Social Conflict and Cohesion Studies (FONDAP15130009) and the Center for Intercultural and Indigenous Research (FONDAP15110006). Russian data collection was supported by a subsidy granted by the government of the Russian Federation for implementation of the Global Competitiveness Program.
Alternanthera mosaic virus (AltMV) is a typical member of the Potexvirus genus in its morphology and genome structure; still it exhibits a number of unique features. They allow this virus to be considered a promising object for biotechnology. Virions and virus-like particles (VLPs) of AltMV are stable in a wide range of conditions, including sera of laboratory animals. AltMV VLPs can assemble at various pH and ionic strengths. Furthermore, AltMV virions and VLPs demonstrate high immunogenicity, enhancing the immune response to the target antigen thus offering the possibility of being used as potential adjuvants. Recently, for the first time for plant viruses, we showed the structural difference between morphologically similar viral and virus-like particles on AltMV virions and VLPs. In this review, we discuss the features of AltMV virions, AltMV VLP assembly, and their structure and properties, as well as the characteristics of AltMV isolates, host plants, infection symptoms, AltMV isolation and purification, genome structure, viral proteins, and AltMV-based vectors.
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A 22-year-old woman presented with worsening vision loss and headaches. A diagnosis of acromegaly was confirmed after detection of an invasive pituitary macroadenoma and biochemical testing. Despite two attempts of surgical debulking of the tumour and administration of long-acting octreotide and cabergoline, growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels were uncontrolled. The patient experienced persistent headaches despite surgery, gamma knife radiation and ventriculoperitoneal shunt placement; she was then enrolled in the ACCESS trial (ClinicalTrials.gov identifier, NCT01995734). Pasireotide (Signifor; Signifor LAR) was initiated, which led to reduced GH and IGF-1 levels and resolution of her intractable headaches. This highlights the use of monthly pasireotide in resolving headaches and improved biochemical control in a patient with acromegaly. We postulate that the headaches improved due to an analgesic and/or anti-inflammatory effect mediated by somatostatin receptors targeted by pasireotide. This may represent an additional benefit of pasireotide and requires further investigation.
Pyoderma gangrenosum (PG) coexisting with Cogan's syndrome (CS) is uncommon, although cutaneous manifestations are known to develop in CS. A middle-aged white female patient had chronic relapsing PG requiring ciclosporin and prednisolone. Despite receiving optimal doses of ciclosporin and prednisolone, she developed acute vestibulo-auditory symptoms as a result of CS. Ciclosporin was switched to methotrexate and prednisolone was increased. However, she continued to develop acute scleritis, requiring methylprednisolone pulses, and still had further flares of PG. Her methotrexate was held off when she developed severe pneumonia and she then received a trial of intravenous immunoglobulins (IVIG) for her recurrent leg ulcers. Unfortunately, she failed to respond to IVIG. Her ulcers eventually responded to six doses of monthly intravenous cyclophosphamide induction. Although CS is not an antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis, we used pulse cyclophosphamide, based on the experience of cyclophosphamide efficacy in severe ANCA-associated vasculitis (AAV). Following induction, both diseases currently remain under control with azathioprine as maintenance treatment.
We report a case of severe lupus myocarditis with rapid, acute deterioration to cardiogenic shock and multiorgan failure, highlighting the importance of early identification and treatment of acute presentations in patients with systemic lupus erythematosus. A 31-year-old woman with previously diagnosed subacute cutaneous lupus erythematosus initially presented with abdominal pain and frank per-rectal bleeding. She deteriorated rapidly with type 1 respiratory failure and acute kidney injury requiring dialysis secondary to acute cardiac failure with a prolonged intensive care unit admission, over a month. A significantly elevated troponin, global hypokinesia on echocardiogram and normal coronary artery angiogram and cardiac MRI lead to the diagnosis of acute lupus myocarditis as the cause for the cardiogenic shock. She was treated with high-dose corticosteroids and eventually made a full recovery, with cardiac function returning to normal.
Hypoglycaemia is a well-documented 'stroke mimic'. The literature documents numerous case reports of patients presenting with focal neurological deficits subsequently attributed to hypoglycaemia. The significant majority of these cases are found in patients with pre-existing diabetes. We present case histories of two patients with no history of diabetes presenting to secondary care with reactive hypoglycaemia causing transient symptoms that were responsible for referral as a possible transient ischaemic attack. Although uncommon, metabolic disturbances such as hypoglycaemia should be considered in all patients presenting as a suspected stroke, even if they are not known to have diabetes.
Cognitive–behavioural therapy is a first-line treatment for post-traumatic stress disorder (PTSD), but it is difficult to implement in disaster settings. We report the case of an 80-year-old Japanese woman, who was diagnosed with PTSD after the 2011 triple disaster (earthquake, tsunami and nuclear plant accident) in Fukushima. Her recovery was greatly enhanced by the social support she received while living in Idobata-Nagaya community housing, established by Soma city in Fukushima, where residents could naturally discuss their traumatic experiences. Habituation to traumatic memories and processing of cognitive aspects of the psychological trauma, which are therapeutic mechanisms of trauma-focused psychotherapies, spontaneously occurred in this setting. The details of this case support the effectiveness of Idobata Nagaya as a provider of psychological first aid, an evidence-informed approach to assist children, adolescents, adults and families in the aftermath of a disaster.
Non-ketotic hyperglycaemia (NKH) is the most common metabolic cause of hemichorea-hemiballismus (HC-HB) and an often-reversible condition. A 68-year-old man presented to the emergency department with a severe hyperglycaemic episode and altered mental status. He was treated appropriately and discharged home after his blood glucose levels were normal with an improvement of mental status. Four weeks after the discharge, he returned with flailing movements of bilateral upper and lower limbs. MRI of the brain revealed hyperintensities of the bilateral putamen on T1-weighted imaging. The patient's symptoms improved with a combination of amantadine, clonazepam and tetrabenazine. Several hypotheses involving gemistocytes, calcification and petechial haemorrhage were proposed in support of imaging abnormalities in the striatum. Dopamine-depleting agents and neuroleptics are used in the treatment of chorea. It is recommended to try a dose of tetrabenazine in patients with NKH-induced HC-HB if no improvement is appreciated with initial treatment of glycaemic control.
A 45-year-old man presented 4 months after ABOi renal transplantation with febrile illness and bicytopenia necessitating cessation of mycophenolate mofetil. Dengue non-structural protein 1 antigen (NS1 Ag) test was positive. Lowest total leucocyte count was 3.1x109/L and platelet count was 14x109/L. As fever subsided, patient became tachypneic with abdominal distention and hypotension. Ultrasonographic evaluation revealed ascites, gall bladder wall oedema and bilateral pleural effusion consistent with dengue capillary leak syndrome. He developed massive ascites with abrupt weight gain of 4 kg within 24 hours and worsening renal dysfunction. Patient was deteriorating rapidly in spite of adequate supportive care and we gave a trial of intravenous immunoglobulin (0.5 g/kg/day) for 5 days. Patient improved from day 2, and by day 3, he became haemodynamically stable and recovered completely. Patient was stable at discharge and is on regular follow-up.
Description
Intercostal artery (ICA) pseudoaneurysm related to tube thoracostomy drainage procedure is not commonly encountered.1 But when haemothoraces develops due to pseudoaneurysms, they could be timely detected by CT with CT angiography (CTA) and treated via transarterial embolisation with mini coils.2 3 We report the case of a 9-year-old female child with medullobalstoma involving her brain and spine who was admitted for scheduled chemotherapy. She developed progressive dyspnoea (with oxygen saturation80%) and a right pleural effusion was noted. Subsequently, a right-sided thoracentesis with pigtail catheter insertion was performed. After thoracentesis, her respiratory pattern improved with decreased fluid drained from the pigtail catheter and thus the pigtail was removed. However, her shortness of breath with decreased breath sounds over the right lung fields recurred the next day. Repeat thoracentesis revealed bloody fluid. CT with CTA showed right haemothorax with active bleeding from the...
Intracellular symmetry breaking plays a key role in wide range of biological processes, both in single cells and in multicellular organisms. An important class of symmetry-breaking mechanisms relies on the cytoplasm/membrane redistribution of proteins that can autocatalytically promote their own recruitment to the plasma membrane. We present an analytical construction and a comprehensive parametric analysis of stable localized patterns in a reaction-diffusion model of such a mechanism in a spherical cell.
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TUESDAY, June 19, 2018 -- The prevalence of obesity and severe obesity among U.S. youth was 17.8 and 5.8 percent, respectively, in 2013 to 2016, according to a study published in the June 19 issue of the Journal of the American Medical...
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TUESDAY, June 19, 2018 -- Switching electronic health record (EHR) systems can result in increased efficiency and productivity gains, but there are significant costs associated with the switch, according to an article published in Medical...
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TUESDAY, June 19, 2018 -- Firearm victimization is associated with increased levels of distress, according to a research letter published online June 19 in the Annals of Internal Medicine. Rose M.C. Kagawa, Ph.D., M.P.H., from the University of...
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TUESDAY, June 19, 2018 -- In older adults there is a J-shaped association between alcohol and mortality, according to a study published online June 19 in PLOS Medicine. Andrew T. Kunzmann, Ph.D., from Queen's University Belfast in the United...
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Direct position determination (DPD) methods are known to have many advantages over the traditional two-step localization method, especially for low signal-to-noise ratios (SNR) and/or short data records. Howev...
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To the Editor: Chi et al (1) are to be commended for conducting the first randomized trial on the use of hyperthermia (HT) with radiation therapy (RT) versus RT alone for painful bone metastases (1). The study was terminated at the first interim analysis after accrual of 57 of a planned 152 eligible patients, owing to perceived superiority of the HT arm and slow recruitment. They reported complete pain relief (CR) rates within 3 months of treatment as 58.6% in the HT + RT group versus 32.1% in the RT-alone group (P = .045).
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To the Editor: We would like to thank Drs McClelland III and Jaboin for their letter regarding our article on the prevalence of financial toxicity among radiation oncology patients (1). We have demonstrated that approximately one quarter of surveyed patients experienced financial toxicity and that radiation oncologists are concerned that this emerging toxicity will negatively affect their patients (2).
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Due to an error, the list of authors did not include all those who contributed to the article entitled: "Proceedings of the National Cancer Institute Workshop on Charged Particle Radiobiology, Int J Radiat Oncol Biol Phys 2018;100:816-831." Authors listed in this erratum are the co-authors of this article.
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"If we [sic] can see further, it is by standing on the shoulders of giants."Sir Isaac Newton
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To the Editor: We read with interest the truly commendable survey-based study by Palmer et al (1) examining the financial toxicity of radiation therapy (RT). They found that 22% of surveyed patients experienced financial toxicity after RT, with African-American race, Medicaid insurance, and annual household income <$84,000 among the groups with the greatest financial toxicity rates (1). However, the role of patient race/ethnicity in financial toxicity is unsurprising; both previous work and the current American Society for Radiation Oncology-sponsored journal Advances in Radiation Oncology series "Disparities in Radiation Oncology in North America" have indicated that key aspects of disparities in RT access for vulnerable populations (eg, African-Americans, Native Americans, Hispanic-Americans, North Americans living in Appalachia) are longstanding socioeconomic barriers that disproportionately hinder these underrepresented minorities with cancer, making them less likely than white cancer patients to receive guideline-concordant care (2-6).
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We present auditory outcomes from a single-institution experience of children with skull base and brain tumors treated with proton therapy.
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To the Editor: We thank Yilmaz et al for their insights and questions concerning our recent publication (1, 2). The combination of radiation therapy and immune checkpoint inhibition (ICI) is hypothesized to augment the immune system's anti-tumor response; however, the optimal timing and sequencing of therapy remains a subject of continued investigation (3). While ICI alone without central nervous system (CNS)-directed radiation has previously been reported to provide some therapeutic efficacy in patients with brain metastases, the kinetics with which ICI administration results in immunomodulation in the CNS requires further evaluation (4-6).
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Advanced sinonasal malignancies require aggressive local treatment regimens (1). In particular, when patients insist on organ or vision preservation, these malignancies should be treated with intensified multimodal approaches.
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Brain metastases from a primary extracranial malignancy are a very common problem in cancer patients, with an estimated 170,000 new cases per year in the US (1). While whole-brain radiation therapy (WBRT) was the mainstay of treatment for patients with multiple brain metastases for many years, concern has grown in recent years over the adverse effects of WBRT on neurocognition and quality of life (2). Consequently, various approaches are being explored to either mitigate the effect of WBRT (eg, memantine, hippocampal-sparing IMRT) or replace this treatment modality entirely (eg, stereotactic radiosurgery, chemotherapy).
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Damage to the hypothalamic-pituitary (HP) complex in children treated for brain tumors (BT) is frequent. It can be caused by tumor itself, surgery or by cranial irradiation. In a population-based study, we analysed frequency of HP dysfunction in 10-year survivors of childhood BT, treated with cranial RT.
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We become what we behold. We shape our tools and then our tools shape us.–Marshall McLuhan
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Facial growth deformity following treatment for head and neck cancer in pediatric patients is a common and severe late effect occurring in 60% of the patient population. However, the differences in growth deformity for different treatment modalities in head and neck rhabdomyosarcoma have not been analyzed yet. The purpose of this study was to quantify and compare facial growth deformity in children with orbital RMS following different treatment modalities with inherently different radiation dose distributions.
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To the Editor: Currently, immune checkpoint inhibitors (ICI) are one of the most appealing topics, and it is important and essential to work on concurrent usage of ICIs and radiation therapy. In the March 2018 issue of the International Journal of Radiation Oncology, Biology, Physics, Chen et al published a truly appealing, and one of the largest, retrospective series in the literature (1). We read the article with great interest, yet 3 main issues are identified in the article that need further clarification for the understanding of the paper.
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First, total maxillectomy with orbital exenteration should generally be indicated for this patient (1). The occurrence of eye-related problems after surgery, such as eye movement disorders and double vision, cannot be completely avoided, even if the eyeball is preserved anatomically. In addition, postoperative radiation therapy, which is necessary for this patient, could induce eye-related problems, because the inferior one-half of eyeball, at least, and the optic nerve, will be irradiated.
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To the Editor: We thank Roos et al for their interest in and comments on our article regarding combined hyperthermia (HT) and radiation therapy (RT) for patients with painful bone metastases (1, 2). We acknowledge that the analysis was limited by small patient population size. However, an individual centralized randomization process corresponding at the starting point to time of progression was standardized. The preset interim analysis time and rule of early termination by data safety monitoring committee were followed according to protocol and were regularly monitored by institution and health regulatory authorities for clinical testing.
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Data on the efficacy and timing of palliative radiation (RT) in pediatric patients is limited. We hypothesized palliative treatment within the last 30 days of life may not provide substantial benefit to patients and can be associated with cost and healthcare visits.
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After increasing interest in Proton therapy (PT) for the management of childhood cancer, the aim of this study was to examine feasibility and outcome of PT for childhood ependymomas in a prospective registry.
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Purpose: Breast cancer is a heterogeneous disease and not all patients respond equally to adjuvant radiotherapy. Predictive biomarkers are needed to select patients who will benefit from the treatment and spare others the toxicity and burden of radiation. Experimental Design: We first trained and tested an intrinsic radiosensitivity gene signature to predict local recurrence after radiotherapy in three cohorts of 948 patients. Next, we developed an antigen processing and presentation-based immune signature by maximizing the treatment interaction effect in 129 patients. To test their predictive value, we matched patients treated with or without radiotherapy in an independent validation cohort for clinicopathologic factors including age, ER status, HER2 status, stage, hormone-therapy, chemotherapy, and surgery. Disease specific survival (DSS) was the primary endpoint. Results: Our validation cohort consisted of 1,439 patients. After matching and stratification by the radiosensitivity signature, patients who received radiotherapy had better DSS than patients who did not in the radiation-sensitive group (hazard ratio [HR]=0.68, P=0.059, n=322), while a reverse trend was observed in the radiation-resistant group (HR=1.53, P=0.059, n=202). Similarly, patients treated with radiotherapy had significantly better DSS in the immuneeffective group (HR=0.46, P=0.0076, n=180), with no difference in DSS in the immunedefective group (HR=1.27, P=0.16, n=348). Both signatures were predictive of radiotherapy benefit (Pinteraction=0.007 and 0.005). Integration of radiosensitivity and immune signatures further stratified patients into three groups with differential outcomes for those treated with or without radiotherapy (Pinteraction=0.003). Conclusions: The proposed signatures have the potential to select patients who are most likely to benefit from radiotherapy.
Purpose: Cancer-associated fibroblasts (CAFs) in the tumor microenvironment (TME) play a central role in tumor progression. We investigated whether CAFs can regulate tumor-infiltrating lymphocytes (TILs) and their role in tumor immunosuppression. Experimental Design: 140 cases of esophageal cancer were analyzed for CAFs and CD8+or forkhead box protein 3 (FoxP3+) TILs by immunohistochemistry. We analyzed cytokines using murine or human fibroblasts and cancer cells. Murine-derived fibroblasts and cancer cells were also inoculated into BALB/c or BALB/c-nu/numice, and the tumors treated with recombinant interleukin 6 (IL-6) or anti-IL-6 antibody. Results: CD8+TILs and CAFs were negatively correlated in intra-tumoral tissues (P< 0.001), while FoxP3+TILs were positively correlated (P< 0.001) in esophageal cancers. Co-cultured Colon26 cancer cells and fibroblasts resulted in accelerated tumor growth in BALB/c mice, along with decreased CD8+and increased FoxP3+TILs, compared with cancer cells alone. In vitro, IL-6 was highly secreted in both murine and human cancer cell/fibroblast co-cultures. IL-6 significantly increased Colon26 tumor growth in immune-competent BALB/c (P< 0.001) with fewer CD8+TILs than untreated tumors (P< 0.001), whereas no difference in BALB/c-nu/numice. In contrast, FoxP3+TILs increased in IL-6-treated tumors (P< 0.001). IL-6 antibody blockade of tumors co-cultured with fibroblasts resulted not only in regression of tumor growth but also in the accumulation of CD8+TILs in intra-tumoral tissues. Conclusions:CAFs regulate immunosuppressive TIL populations in the TME via IL-6. IL-6 blockade, or targeting CAFs, may improve pre-existing tumor immunity and enhance the efficacy of conventional immunotherapies.
Purpose: Triple-negative breast cancer (TNBC) is a clinically aggressive disease with poor prognosis. Conventional chemotherapeutics are generally able to shrink the tumor mass, but often fail to completely eradicate cancer stem-like cells (CSCs) that are responsible for high risk of relapse and frequent metastases. In this study, we examined thermal sensibility of CSCs, developed an approach that enabled concurrent elimination of both the bulk of cancer cells and CSCs, and investigated the underlying mechanism. Experimental Design: We designed a platform consisting of gold nanoparticle-coated porous silicon microparticle (AuPSM) that was also loaded with docetaxel micelles (mDTX) to enable concurrent killing of the bulk of cancer cells by released mDTX and CSCs by mild hyperthermia upon stimulation of AuPSM with near infrared. In addition, we examined the role of heat shock proteins in sensitizing CSC killing. Finally, we applied mDTX-loaded AuPSM to treat mice with SUM159 and 4T1 orthotopic tumors, and evaluated tumor growth and tumor metastasis. Results: MDA-MB-231 and SUM159 TNBC cells treated with mDTX-loaded AuPSM and mild hyperthermia displayed significantly reduced efficiencies in mammosphere formation than those treated with mDTX alone or mild hyperthermia alone. Combination treatment also completely inhibited SUM159 orthotopic tumor growth and 4T1 tumor metastasis. Mechanistically, DTX treatment suppressed expression of heat shock protein 27 in cancer cells including the CSCs, rendering cells sensitive to mild hyperthermia. Conclusions:Our results indicate that chemotherapy sensitizes CSC to mild hyperthermia. We have developed an effective therapeutic approach to eliminate therapy-resistant cells in TNBC.
Purpose: There are conflicting results concerning the prognostic value of the CpG island methylator phenotype (CIMP) in non-metastatic colon cancer (CC) patients. We studied this phenotype in stage III CC characterized for mismatch repair (MMR), RAS and BRAF status and treated with adjuvant FOLFOX-based regimen. Experimental Design: Tumor samples of 1907 patients enrolled in the PETACC-8 adjuvant phase 3 trial were analyzed. The method used was methylation-specific PCR where CIMP+ status was defined by methylation of at least three of the five following genes: IGF2, CACNA1G, NEUROG1, SOCS1, and RUNX3. Association between CIMP status and overall survival (OS), disease-free survival (DFS), and survival after recurrence (SAR), was assessed by Cox model adjusted for prognostic factors and treatment arm (FOLFOX4 ± cetuximab). Results: CIMP status was successfully determined in 1867 patients (97.9%): 275 (14.7%) tumors were CIMP+. Compared to CIMP- patients, CIMP+ patients were more frequently older (p=0.002), females (p=0.04), with right-sided (p<0.0001), grade 3-4 (p<0.0001), pN2 (p=0.001), dMMR (p<0.0001), BRAF mutated (p<0.0001), and RAS wild-type (p<0.0001) tumors. In multivariate analysis, CIMP+ status was associated with shorter OS (HR: 1.46; 95%CI 1.02 - 1.94; p=0.04) and SAR (HR: 1.76; 95%CI 1.20 - 2.56; p<0.0004); but not DFS (HR: 1.15 95%CI 0.86 - 1.54; p=0.34). A non-significant trend of detrimental effect of cetuximab was observed in patients with CIMP+ tumors for OS, DFS, and SAR. Conclusions: In a large cohort of well-defined stage III CC patients, CIMP+ phenotype is associated with a shorter OS and SAR but not to DFS.
Expression patterns of programmed death ligand 1 correlate with different microenvironments and patient prognosis in hepatocellular carcinoma
Expression patterns of programmed death ligand 1 correlate with different microenvironments and patient prognosis in hepatocellular carcinoma, Published online: 20 June 2018; doi:10.1038/s41416-018-0144-4
Expression patterns of programmed death ligand 1 correlate with different microenvironments and patient prognosis in hepatocellular carcinomaIncreased sensitivity to apoptosis upon endoplasmic reticulum stress-induced activation of the unfolded protein response in chemotherapy-resistant malignant pleural mesothelioma
Increased sensitivity to apoptosis upon endoplasmic reticulum stress-induced activation of the unfolded protein response in chemotherapy-resistant malignant pleural mesothelioma, Published online: 20 June 2018; doi:10.1038/s41416-018-0145-3
Increased sensitivity to apoptosis upon endoplasmic reticulum stress-induced activation of the unfolded protein response in chemotherapy-resistant malignant pleural mesotheliomaClinical Implant Dentistry and Related Research, EarlyView.
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Clinical Implant Dentistry and Related Research, EarlyView.
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Improved understanding of pathogen survival in the stream environment is needed to enhance existing predictive models of stream pathogen populations. Further, the increasing use of thermal springs for bathing ...
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Spore counting in probiotic Bacillus cultures using dipicolinic acid (DPA) as a marker was studied for developing a rapid and simple detection method. The newly developed method is based on the fluorescence enhan...
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The aim of study was to isolate, characterize and analyse the protein profiles of Myoviridae-like bacteriophages obtained from M. haemolytica using MALDI TOF mass spectrometry. The material consisted of the M. ha...
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International Journal for Numerical Methods in Biomedical Engineering, EarlyView.
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International Journal for Numerical Methods in Biomedical Engineering, EarlyView.
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Rhodiola crenulata is a Tibetan native herbal plant belonging to the family of Crassulaceae, which produces the pharmaceutical icariside D2 with the activities of inhibiting angiotensin-converting enzyme and killing leukemia cancer cells. In this study, we functionally characterized a novel UDP-glycosyltransferase (RcUGT1) that converted tyrosol to specifically produce icariside D2 from R. crenulata at molecular and biochemical levels. RcUGT1 was highly expressed in flowers and roots, while the icariside D2 content was much higher in stems than that in other organs, suggesting the potential translocation of icariside D2 from flowers and roots to stems. The high production of icariside D2 in stems provided a reasonable suggestion to farmers to harvest stems instead of roots for icariside D2 production. Enzymatic assays of recombinant RcUGT1 indicated that it converted tyrosol to specifically form icariside D2, with the values of Km 0.97±0.10 mM, Vmax 286±8.26 pKat/mg, Kcat 0.01552 s−1, and Kcat/Km 159.55 s−1 M−1. Functional identification of RcUGT1 facilitated the icariside D2 production through metabolic engineering in plants or synthetic biology in microbes.
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ANZ Journal of Surgery, EarlyView.
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ANZ Journal of Surgery, EarlyView.
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ANZ Journal of Surgery, EarlyView.
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ANZ Journal of Surgery, EarlyView.
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ANZ Journal of Surgery, EarlyView.
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ANZ Journal of Surgery, EarlyView.
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Epilepsia, EarlyView.
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Epilepsia, EarlyView.
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Epilepsia, EarlyView.
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Epilepsia, EarlyView.
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Epilepsia, EarlyView.
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Epilepsia, EarlyView.
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Epilepsia, EarlyView.
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Developmental Psychobiology, EarlyView.
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Developmental Psychobiology, EarlyView.
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Developmental Psychobiology, EarlyView.
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British Journal of Clinical Pharmacology, Volume 84, Issue 7, Page 1395-1396, July 2018.
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British Journal of Clinical Pharmacology, Volume 84, Issue 7, Page 1397-1398, July 2018.
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British Journal of Clinical Pharmacology, EarlyView.
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British Journal of Clinical Pharmacology, EarlyView.
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Diagnostic Cytopathology, Volume 46, Issue 7, Page 559-560, July 2018.
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Acta Neurologica Scandinavica, EarlyView.
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Acta Neurologica Scandinavica, EarlyView.
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Acta Neurologica Scandinavica, EarlyView.
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Acta Neurologica Scandinavica, EarlyView.
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Early and accurate diagnosis is the key to improving survival in cirrhotic patients with ascitic fluid infection.
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Experimental Physiology, EarlyView.
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Cancer Science, EarlyView.
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Cancer Science, EarlyView.
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Cancer Science, EarlyView.
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Cancer Science, EarlyView.
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Cancer Science, EarlyView.
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Cancer Science, EarlyView.
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Cancer Science, EarlyView.
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Clinical Genetics, EarlyView.
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Cancer Cytopathology, Volume 126, Issue 6, Page 365-370, June 2018.
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Cancer Cytopathology, Volume 126, Issue 6, Page 371-372, June 2018.
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Academic Emergency Medicine, EarlyView.
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Academic Emergency Medicine, EarlyView.
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Journal Name: Biological Chemistry
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Journal Name: Biological Chemistry
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Journal Name: Biological Chemistry
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Journal Name: Biological Chemistry
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Journal Name: Biological Chemistry
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Journal Name: Biological Chemistry
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Journal Name: Biological Chemistry
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Journal Name: Biological Chemistry
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Journal Name: Biological Chemistry
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Journal Name: Biological Chemistry
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Journal Name: Biological Chemistry
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Journal Name: Biological Chemistry
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Journal Name: Biological Chemistry
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Clinical Oral Implants Research, EarlyView.
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Clinical Oral Implants Research, EarlyView.
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European Journal of Immunology, EarlyView.
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Alimentary Pharmacology &Therapeutics, EarlyView.
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Cancer, EarlyView.
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Cancer, Volume 124, Issue 13, Page 2673-2673, July 1, 2018.
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Cancer, Volume 124, Issue 13, Page 2661-2670, July 1, 2018.
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Cancer, Volume 124, Issue 13, Page 2671-2672, July 1, 2018.
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Cancer, EarlyView.
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Cancer, EarlyView.
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Cancer, EarlyView.
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Cancer, EarlyView.
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Cancer, EarlyView.
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Cancer, EarlyView.
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Cancer, EarlyView.
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Alimentary Pharmacology &Therapeutics, EarlyView.
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Alimentary Pharmacology &Therapeutics, EarlyView.
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Alimentary Pharmacology &Therapeutics, EarlyView.
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Alimentary Pharmacology &Therapeutics, EarlyView.
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Alimentary Pharmacology &Therapeutics, EarlyView.
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International Endodontic Journal, EarlyView.
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Advanced Materials, EarlyView.
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Advanced Materials, EarlyView.
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Advanced Materials, EarlyView.
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Advanced Materials, EarlyView.
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Advanced Materials, EarlyView.
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Advanced Materials, EarlyView.
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Advanced Materials, EarlyView.
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Advanced Materials, EarlyView.
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Advanced Materials, EarlyView.
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Advanced Materials, EarlyView.
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Advanced Materials, EarlyView.
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Advanced Materials, EarlyView.
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Advanced Materials, EarlyView.
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Advanced Materials, Volume 30, Issue 25, June 20, 2018.
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Advanced Materials, Volume 30, Issue 25, June 20, 2018.
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Advanced Materials, Volume 30, Issue 25, June 20, 2018.
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Advanced Materials, Volume 30, Issue 25, June 20, 2018.
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Clinical and Translational Science, EarlyView.
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Q-type C2H2 transcription factors (TF) play crucial roles in the plant response to stress, often leading to regulation of downstream genes required for tolerance to these challenges. An infestation-responsive ...
https://ift.tt/2I4QGVy
Nephroblastomatosis is an uncommon pathologic process characterized by the presence of persistent embryonic nephrogenic rests. Progression to Wilms tumour occurs in an estimated 35% of patients. Cure rates are...
https://ift.tt/2K6vun2
The objective of this study was to analyse intraspecific sequence variation of Atlantic cod mitochondrial DNA, based on a comprehensive collection of completely sequenced mitochondrial genomes.
https://ift.tt/2I4QrtC
Digestive Endoscopy, EarlyView.
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Digestive Endoscopy, EarlyView.
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Digestive Endoscopy, EarlyView.
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The impact of regional nodal irradiation (RNI) on locoregional recurrence (LRR) and any disease recurrence (DR) in women with node-positive breast cancer who receive neoadjuvant systemic therapy (NAT) is unknown.
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Functional imaging of tumor and normal tissue physiology provides novel opportunities to further optimize radiation therapy (RT) treatments by identifying refined critical structures and biological target volumes (BTVs) within the tumor for preferential targeting. Advances in functional imaging and adaptive RT techniques have the potential to lead to the development of improved dose–response relationships for normal tissues and RT treatments that are tailored to individual patients. In this "Oncology Scan" for the special issue on Imaging in Radiation Oncology, members of the physics editorial team discuss 3 thought-provoking articles that reflect recent and noteworthy advances in the combined use of functional imaging and adaptive RT to exploit heterogeneity in tumor and normal tissue biology.
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We report on patient-specific quantitative changes in longitudinal sulfur colloid SPECT/CT as a function of regional radiation dose distributions to normal liver in a cohort of hepatocellular carcinoma patients. Dose-response thresholds and slopes varied with baseline liver function metrics, and extreme values were found in patients with fatal hepatotoxicity. Dose-response modeling of normal liver in individual HCC patients has potential to characterize in vivo radiosensitivity, identify high risk subgroups, and personalize treatment planning dose constraints.
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Chemical Biology &Drug Design, EarlyView.
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Chemical Biology &Drug Design, EarlyView.
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Chemical Biology &Drug Design, EarlyView.
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Chemical Biology &Drug Design, EarlyView.
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Cognitive Science, EarlyView.
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Cognitive Science, EarlyView.
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Cognitive Science, EarlyView.
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Cognitive Science, EarlyView.
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BJS, Volume 105, Issue 8, Page 930-932, July 2018.
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European Journal of Neuroscience, EarlyView.
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European Journal of Neuroscience, EarlyView.
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European Journal of Neuroscience, EarlyView.
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European Journal of Neuroscience, EarlyView.
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European Journal of Neuroscience, EarlyView.
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European Journal of Neuroscience, EarlyView.
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European Journal of Neuroscience, EarlyView.
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European Journal of Neuroscience, Volume 47, Issue 11, Page i-iii, June 2018.
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European Journal of Neuroscience, Volume 47, Issue 11, Page 1385-1400, June 2018.
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Esophagogastroduodenoscopy (EGD) and colonoscopy are common outpatient gastrointestinal endoscopic procedures that frequently use sedation. We aimed to identify a protocol that combines safety with cost effectiveness.
https://ift.tt/2M3HO4V
Long-term use of tenofovir disoproxil fumarate (TDF) reduces bone mineral density (BMD). Tenofovir alafenamide (TAF), a new prodrug of tenofovir, has shown non-inferior efficacy to TDF in patients with chronic hepatitis B virus (HBV) infection, with improved bone effects at 48 weeks. We performed a randomized trial to evaluate the bone safety of TAF compared with TDF over 2 years, assessing baseline risk factors for bone loss, were evaluated after 2 years of treatment.
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Food Science &Nutrition, EarlyView.
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Food Science &Nutrition, EarlyView.
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Food Science &Nutrition, EarlyView.
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Food Science &Nutrition, EarlyView.
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Food Science &Nutrition, EarlyView.
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Food Science &Nutrition, EarlyView.
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Advanced Healthcare Materials, EarlyView.
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Advanced Healthcare Materials, EarlyView.
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Advanced Healthcare Materials, EarlyView.
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Advanced Healthcare Materials, EarlyView.
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Advanced Healthcare Materials, EarlyView.
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To evaluate the impact of parental weight status and offspring cardiorespiratory fitness on the risk of obesity among Chinese children.
https://ift.tt/2K6NIFd
To compare white matter microstructure in children and adolescents with single ventricle who underwent the Fontan procedure with healthy controls, and to explore the association of white matter injury with cognitive performance as well as patient and medical factors.
https://ift.tt/2I53dZb
[Posted 06/19/2018] AUDIENCE: Risk Manager, Surgery, Patient, Cardiology ISSUE: The FDA continues to evaluate information from several sources and based on new information, the Endologix AFX with Strata device is at greater risk for a Type III...
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Multiple sclerosis (MS) is the most common non-traumatic condition that leads to disability among young individuals. It is associated with demyelination, inflammation, and neurodegeneration within the central ...
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Hepatitis C (HCV) diagnosis and care is a major challenge for people who use illicit drugs, and is characterised by low rates of testing and treatment engagement globally. New approaches to fostering engagemen...
https://ift.tt/2MEiEen
[Posted 06/19/2018] AUDIENCE: Risk Manager, Surgery, Patient, Cardiology ISSUE: The FDA continues to evaluate information from several sources and based on new information, the Endologix AFX with Strata device is at greater risk for a Type III...
https://ift.tt/2t5EAqH
We describe a beamline setup meant to carry out rapid two-dimensional x-ray fluorescence and x-ray microdiffraction mapping of single crystal or powder samples using either Laue (polychromatic radiation) or powder (monochromatic radiation) diffraction. The resulting maps give information about strain, orientation, phase distribution, and plastic deformation.
https://ift.tt/2JZ3nTK
Here, we present a protocol to measure the vascular leakage induced by intradermal administration of permeability promoting agents into the murine skin. This technique can be used to determine the ability of molecules to promote or inhibit vascular leakage or to study the molecular mechanisms that regulate vascular permeability.
https://ift.tt/2MGjpU7
TUESDAY, June 19, 2018 -- A machine-learning algorithm can predict hypotension during surgery based on high-fidelity arterial pressure waveform analysis, according to a study published online June 11 in Anesthesiology. Feras Hatib, Ph.D., from...
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TUESDAY, June 19, 2018 -- Conservative measures to control reflux have limited effect on signs of gastroesophageal reflux (GER) in preterm infants, and pharmacologic treatments should be used sparingly, according to a clinical report published...
https://ift.tt/2JYKEHO
TUESDAY, June 19, 2018 -- Robotic and minimally invasive (mini) approaches to mitral surgery are associated with high rates of mitral repair, although robotic patients have longer procedural time, according to a study published online June 18 in...
https://ift.tt/2JRwRqD
TUESDAY, June 19, 2018 -- Mental health seems to be declining among Americans of low relative socioeconomic position, according to a study published online June 18 in the Proceedings of the National Academy of Sciences. Noreen Goldman, D.Sc., from...
https://ift.tt/2M6I0At
TUESDAY, June 19, 2018 -- A substantial proportion of women older than 60 years may experience moderate-to-severe vasomotor symptoms (msVMS), according to a study published online May 7 in Menopause. Paru S. David, M.D., from the Mayo Clinic in...
https://ift.tt/2MFuSn2
TUESDAY, June 19, 2018 -- Recent-onset diabetes is associated with more than a two-fold greater increase in risk of pancreatic cancer (PC) than long-standing diabetes in African-Americans and Latinos, according to a study published online June 18 in...
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TUESDAY, June 19, 2018 -- From 2008 to 2012 there was a decrease in overall rates of cardiac stress testing in Medicare beneficiaries, though rates were consistently higher for patients with chronic kidney disease (CKD) than those without CKD,...
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TUESDAY, June 19, 2018 -- Participants in the Supplemental Nutrition Assistance Program (SNAP) have less improvement in American Heart Association (AHA) diet scores than other U.S. adults, according to a study published online June 15 in JAMA...
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TUESDAY, June 19, 2018 -- For adults with chronic obstructive pulmonary disease (COPD), acute exacerbations are associated with increased risk of myocardial infarction and ischemic stroke, according to a study published online May 3 in the Annals of...
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TUESDAY, June 19, 2018 -- In a case report published online June 18 in BMJ Case Reports, a tattoo-related complication causing an inflammatory myopathy is described in an immunosuppressed patient. William Thomas Wilson, from NHS Greater Glasgow and...
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We present here an application for a standard immunological technique (CFSE stained OT-I proliferation) intended to rapidly monitor adjuvant-mediated cytotoxic T lymphocyte (CTL) generation in vivo. This fast estimation of CTL capacities is useful for the development of prophylactic vaccines against intracellular pathogens as well as therapeutic cancer vaccines.
https://ift.tt/2K1YCfr
On 18 July 64 AD, the great fire of Rome destroyed much of the ancient city, starting in the slums in the southern part and rapidly spreading north.1 The Emperor Nero was long blamed for the disaster but there is little evidence that he actually set the fire. However, he was displeased by the architectural design of the ancient Rome and the disaster provided a welcome opportunity for him to change the city building codes.
Fast forward 2000 years; the Rome criteria today are considered the global 'gold standard' for the diagnosis and categorisation of functional GI disorders (FGID) including the IBS and functional dyspepsia (FD), and Rome IV was released to acclaim in 2016.2 The Rome criteria are consensus and expert opinion based and anatomical region or structure focused (eg, oesophageal disorders, gastroduodenal disorders, bowel disorders, centrally mediated pain disorders and anorectal disorders)2 rather than...
Local excision (LE) is currently one of the most effective methods used in cases of large benign polyps, not suitable for endoscopic treatment, or early-stage neoplasms. LE is also alternative to anterior rectal resection in selected patients suffering from major comorbidities and limits for major abdominal procedure. Furthermore, LE results in less pain, reduced impact on bowel function, shorter duration of hospital stay, and lower rates of morbidity, mortality and stoma creation. In particular, early data on transanal minimally invasive surgery (TAMIS) are promising, but they come from single centre case series related to small groups of patients and more data are needed to draw a final conclusion on the safety of this novel approach for transanal resection.
A 62-year-old woman, following a positive faecal occult blood test and with unremarkable medical history, was admitted to hospital for excision of a large flat neoplastic lesion. Endoscopic biopsy demonstrated a tubular adenoma with high-grade dysplasia and was decided to proceed with surgical excision by TAMIS. After surgery, short-term outcomes revealed prolonged activated partial thromboplastin time, undetectable factor XII activity, fever, and partial dehiscence of rectal wall defect suture. Cross-mixing studies of patient plasma show no correction in either the immediate or incubated activated partial thromboplastin time, indicating the presence of an acquired factor XII inhibitor. Activated partial thromboplastin time and factor XII improved in the following weeks without any specific therapy in addition to antibiotic therapy.
This is the first report in which acquired inhibitor of coagulation factor XII is associated with a specific surgical procedure. This case has shown how trans-anal excision of rectal lesions, even when performed by minimally invasive means such as in case of TAMIS, is not free of complications. We consider the acute infection, resulting from early dehiscence of the suture, the trigger in an abnormal immune response, and inhibitor development.
The rate, prognostic impacts, and predisposing factors of major vascular complications (MVCs) in patients underwent venoarterial extracorporeal membrane oxygenation (VA-ECMO) by surgical cut-down are poorly un...
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Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 5, Page 203-211, June 2018.
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Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 5, Page 167-168, June 2018.
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Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 5, Page 182-193, June 2018.
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Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 5, Page 194-202, June 2018.
https://ift.tt/2K3thG4
Introduction
The wish to quit or take time out of medical training appears to be related, at least in part, to a strong desire for supportive working and learning environments. However, we do not have a good understanding of what a supportive culture means to early career doctors, and how perceptions of support may influence career decision making. Our aim was to explore this in UK Foundation doctors.
MethodsThis was a qualitative study using semistructured interviews incorporating a narrative inquiry approach for data collection. Interview questions were informed by the literature as well as data from two focus groups. Interviews were carried out in two UK locations. Initial data coding and analysis were inductive, using thematic analysis. We then used the lens of Perceived Organizational Support (POS) to group themes and aid conceptual generalisability.
ResultsTwenty-one interviews were carried out. Eleven interviewees had applied for specialty training, while ten had not. Support from senior staff and colleagues influenced participants' job satisfaction and engagement. Positive relationships with senior staff and colleagues seemed to act as a buffer, helping participants cope with challenging situations. Feeling valued (acknowledgement of efforts, and respect) was important. Conversely, perceiving a poor level of support from the organisation and its representatives (supervisors and colleagues) had a detrimental impact on participants' intentions to stay working within the National Health Service (NHS).
ConclusionOverall, this is the first study to explore directly how experiences in early postgraduate training have a critical impact on the career intentions of trainee/resident doctors. We found perceived support in the early stages of postgraduate training was critical to whether doctors applied for higher training and/or intended to stay working in the NHS. These findings have transferable messages to other contexts struggling to recruit and retain junior doctors.
Introduction
Heart failure with reduced ejection fraction (HFrEF) is defined as the clinical diagnosis of heart failure (HF) and ejection fraction (EF) ≤40%, which is a severe public healthcare issue and brings a heavy social and economic burden for patients with HFrEF. Chinese herbal medicine (CHM) has a long history in treating HF. Questions concerning the efficacy and acceptability of CHM-related interventions in adult patients with HFrEF led us to use the method of systematic review and network meta-analysis to integrate direct and indirect evidence to create hierarchies for all CHM.
Methods and analysisNine medical databases, including PubMed, EMBASE (OVID), the Cochrane Library, Google Scholar, Web of Science, CNKI, VIP, Wanfang Database and CBM will be searched from the date of database inception to June 2015 (updated to March 2017) without language and publication status restriction. Completely randomised controlled trials (RCTs) comparing CHM or CHM plus routine treatment with CHM, CHM plus routine treatment, routine treatment, no treatment or placebo for adults with HFrEF will be examined. Our primary outcomes will include all-cause mortality, HF-related death, all-cause rehospitalisation, HF-related rehospitalisation and acceptability (discontinuation due to any adverse events during treatment). Secondary outcomes will include response rate, mean value or mean difference from baseline of surrogate indexes. We will perform the Bayesian network meta-analyses (NMA) for the most frequently reported primary or secondary outcome and the acceptability outcome, if available. Meta-regression, subgroup analyses and sensitivity analyses will be conducted based on prespecified effect modifiers to assess the robustness of the findings.
DisseminationThe results of this NMA will provide useful information about the effectiveness and acceptability of CHM in adults with HFrEF, which will also have implications for clinical practice and further research. Findings will be disseminated through peer-reviewed journal publication and conference presentations.
PROSPERO registration numberCRD42016053854.
Objectives
Many smokers use e-cigarettes and licensed nicotine replacement therapy (NRT), often in an attempt to reduce their cigarette consumption. We estimated how far changes in prevalence of e-cigarette and NRT use while smoking were accompanied by changes in cigarette consumption at the population level.
DesignRepeated representative cross-sectional population surveys of adults aged 16+ years in England.
MethodsWe used Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling of monthly data between 2006 and 2016 from the Smoking Toolkit Study. Prevalence of e-cigarette use and NRT use in current smokers, and specifically for smoking reduction and temporary abstinence, were input variables. Mean daily cigarette consumption was the dependent variable. Analyses involved adjustment for mass media expenditure and tobacco-control policies.
ResultsNo statistically significant associations were found between changes in use of e-cigarettes (β –0.012, 95% CI –0.026 to 0.002) or NRT (β 0.015, 95% CI –0.026 to 0.055) while smoking and daily cigarette consumption. Neither did we find clear evidence for an association between e-cigarette use (β –0.010, 95% CI –0.025 to 0.005 and β 0.011, 95%–0.027 to 0.004) or NRT use (β 0.006, 95%–0.030 to 0.043 and β 0.022, 95%–0.020 to 0.063) specifically for smoking reduction and temporary abstinence, respectively, and changes in daily cigarette consumption.
ConclusionIf use of e-cigarettes and licensed NRT while smoking acted to reduce cigarette consumption in England between 2006 and 2016, the effect was likely very small at a population level.
Objectives
Hospitalisations for serious infections are common among middle age and older adults and frequently used as study outcomes. Yet, few studies have evaluated the performance of diagnosis codes to identify serious infections in this population. We sought to determine the positive predictive value (PPV) of diagnosis codes for identifying hospitalisations due to serious infections among middle age and older adults.
Setting and participantsWe identified hospitalisations for possible infection among adults >=50 years enrolled in the Tennessee Medicaid healthcare programme (2008–2012) using International Classifications of Diseases, Ninth Revision diagnosis codes for pneumonia, meningitis/encephalitis, bacteraemia/sepsis, cellulitis/soft-tissue infections, endocarditis, pyelonephritis and septic arthritis/osteomyelitis.
DesignMedical records were systematically obtained from hospitals randomly selected from a stratified sampling framework based on geographical region and hospital discharge volume.
MeasuresTwo trained clinical reviewers used a standardised extraction form to abstract information from medical records. Predefined algorithms served as reference to adjudicate confirmed infection-specific hospitalisations. We calculated the PPV of diagnosis codes using confirmed hospitalisations as reference. Sensitivity analyses determined the robustness of the PPV to definitions that required radiological or microbiological confirmation. We also determined inter-rater reliability between reviewers.
ResultsThe PPV of diagnosis codes for hospitalisations for infection (n=716) was 90.2% (95% CI 87.8% to 92.2%). The PPV was highest for pneumonia (96.5% (95% CI 93.9% to 98.0%)) and cellulitis (91.1% (95% CI 84.7% to 94.9%)), and lowest for meningitis/encephalitis (50.0% (95% CI 23.7% to 76.3%)). The adjudication reliability was excellent (92.7% agreement; first agreement coefficient: 0.91). The overall PPV was lower when requiring microbiological confirmation (45%) and when requiring radiological confirmation for pneumonia (79%).
ConclusionsDischarge diagnosis codes have a high PPV for identifying hospitalisations for common, serious infections among middle age and older adults. PPV estimates for rare infections were imprecise.
Objectives
To explore the prevalence, perpetrator characteristics and the correlates of child abuse in Kathmandu, Nepal.
MethodsFor this cross-sectional study, we translated the internationally validated questionnaire developed by the International Society for Prevention of Child Abuse and Neglect, Child Abuse Screening Tool-Child Home into Nepali. We added questions on descriptive information about students and their family to the questionnaire. We recruited students from 20 schools selected randomly—2 from each of the 10 electoral constituencies of Kathmandu district. In each school, we administered the questionnaires to the students in a classroom selected randomly. To assess the correlates, we ran multilevel multivariable logistic regression models, stratified by schools.
ResultsAmong the 962 students, 88.88% had experience of at least one form of abuse throughout their lifetime. Psychological abuse was the most prevalent form of abuse (previous year: 75.19%; lifetime: 76.15%) followed by physical abuse, exposure to violence, neglect and sexual abuse. Adults were the most common perpetrators of child abuse (37.55%). The correlates identified in this study mostly aligned with the global literature on correlates of abuse. Female students were more likely to report neglect (previous year: adjusted OR (AOR) 1.50, 95% CI 1.10 to 2.04; lifetime: AOR 1.49, 95% CI 1.10 to 2.02), but no gender difference was observed with other forms of abuse. Students living with a single parent had a greater likelihood of exposure to violence (previous year: AOR 2.55, 95% CI 1.31 to 4.94; lifetime: AOR 2.77, 95% CI 1.39 to 5.53), neglect (previous year: AOR 2.01, 95% CI 1.10 to 3.69; lifetime: AOR 2.08, 95% CI 1.14 to 3.81) and sexual abuse (previous year: AOR 3.03, 95% CI 1.45 to 6.37; lifetime: AOR 2.49, 95% CI 1.21 to 5.14).
ConclusionsOver 88% of students reported experiencing child abuse in the home in one or more forms throughout their lifetime. Delineating the reasons for the high burden and its implications are important topics for future research.
Introduction
There is significant international interest in the economic impacts of persistent inequities in morbidity and mortality. However, very few studies have quantified the costs associated with unfair and preventable ethnic/racial inequities in health. The proposed study will investigate inequities in health between the indigenous Māori and non-Māori adult population in New Zealand (15 years and older) and estimate the economic costs associated with these differences.
Methods and analysisThe study will use national collections data that is held by government agencies in New Zealand including hospitalisations, mortality, outpatient consultations, laboratory and pharmaceutical claims, and accident compensation claims. Epidemiological methods will be used to calculate prevalences for Māori and non-Māori, by age-group, gender and socioeconomic deprivation (New Zealand Deprivation Index) where possible. Rates of 'potentially avoidable' hospitalisations and mortality as well as 'excess or under' utilisation of healthcare will be calculated as the difference between the actual rate and that expected if Māori were to have the same rates as non-Māori. A prevalence-based cost-of-illness approach will be used to estimate health inequities and the costs associated with treatment, as well as other financial and non-financial costs (such as years of life lost) over the person's lifetime.
Ethics and disseminationThis analysis has been approved by the University of Auckland Human Participants Research Committee (Ref: 018621). Dissemination of findings will occur via published peer-reviewed articles, presentations to academic, policy and community-based stakeholder groups and via social media.
Objective
Stress has major socioeconomic implications for all spheres of employment. It is a trigger for depression, and affects absenteeism, turnover, productivity, morale and suicide. Positive or negative cognitive stress appraisal can be a self-care strategy that affects workers' ability to cope with stress. This study examined cognitive stress appraisal among workers and identified related individual and environmental factors.
DesignCross-sectional study using self-administered postal questionnaires.
SettingCompanies located in two metropolitan areas of Japan (Tokyo and Kanagawa prefectures).
Participants2311 employees of 48 companies in metropolitan areas in Japan. In total, 341 questionnaires were returned (response rate: 14.8%), 337 of which were suitable for analysis (effective response rate: 98.8%).
Primary measuresCognitive stress appraisal was assessed using the Japanese version of the Perceived Stress Scale (PSS). Potential variables related to stress appraisal included demographic, individual and environmental factors. Multiple regression analysis was used to identify factors related to cognitive stress appraisal.
ResultsParticipants' mean±SD age was 42.8±11.7 years, and two-thirds were male. The mean±SD PSS score was 25.8±6.2. The multiple regression analysis controlled for age, sex and depression showed that those with poorer economic status (β=0.171, p<0.001), lower electronic health (eHealth) literacy (β=–0.113, p=0.012), higher traditional organisational climate (β=0.131, p=0.004) and lower perceived social support (β=–0.205, p<0.001) experienced significantly higher levels of negatively perceived stress.
ConclusionsThe results show individual and environmental factors related to cognitive stress appraisal among workers. An effective strategy to improve mental health among workers may involve an interprofessional approach by public health nurses and health practitioners that includes enhanced self-coping skills using individual workers' eHealth literacy, improvement of organisational climates in workplaces and community-based social support.
Objective
To explore the impact of a training intervention on obstetric anal sphincter injuries' (OASIS) detection rate.
DesignProspective quality improvement interventional study.
SettingSix secondary and tertiary maternity units in Palestine.
PopulationWomen having singleton vaginal births ≥23 weeks' gestation or babies weighing ≥500 g (n=22 922). Caesarean births (n=5431), multiple gestations (n=443) and vaginal births of unregistered perineum status (n=800) were excluded.
InterventionsTraining programme for enhancing OASIS detection was conducted between 31 January and 31 December 2015. International experts delivered 2-day standardisation workshop teaching OASIS diagnosis and repair to each maternity unit. They also provided additional training to three research fellows employed in three of the maternity units. This was followed by 13-week period of data collection (phase 1). Research fellows then delivered training intervention over 15-week interval (phase 2), including theoretical teaching and 'onsite' training in perineal trauma assessment within the six maternity units. Finally, 13-week postintervention observation (phase 3) followed.
Primary outcome measureOASIS rates were used as surrogate for OASIS recognition. OASIS rates were compared between different phases and between the two maternity unit groups (research fellow and non-research fellow based) using Pearson's ² test.
ResultsA total 22 922 women were included. Among primiparous women, OASIS rate was higher in phase 2 (2.8%, p<0.001) and phase 3 (3.1%, p<0.001) than phase 1 (0.5%). However, no significant differences were detected in the rates of severe OASIS (third-degree 3c and fourth-degree tears) between phase 1 and 2 (0.5% vs 0.3%), because this would have required at least 103 women with severe OASIS to be included in each phase. Among parous women, OASIS rate was significantly higher in phase 2 (0.6%, p=0.002) but not in phase 3 (0.4%, p=0.071) compared with phase 1 (0.2%). Research fellows' maternity units showed higher OASIS rates among primiparous women in phase 2 (3.6% vs 1.4%, p=0.001) and phase 3 (4.3% vs 0.8%, p<0.001) than non-research fellows' maternity units.
ConclusionsThis work is basically an epidemiological study which has identified the prevalence of perineal lacerations and their severity on a large sample of women representative of an entire geographical ethnic region. The quality improvement intervention improved OASIS detection mainly in the research fellows' maternity units. Regular mandatory national programmes in obstetric perineal trauma assessment and management by local champions are essential to mitigate the risk of missing significant degrees of trauma.
Objectives
We aimed to evaluate the relation of total homocysteine (tHcy) concentrations with systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels, and examine the possible modifiers in the association among a general population of Chinese adults.
DesignA cross-sectional study.
SettingThe study was conducted within 21 communities in Lianyungang of Jiangsu province, China.
ParticipantsA total of 26 648 participants aged ≥35 years and with no antihypertensive drug use were included in the final analysis.
ResultsOverall, there was a positive association between tHcy concentrations and SBP (per 5 μmol/L tHcy increase: adjusted β=0.45 mm Hg; 95% CI 0.29 to 0.61) or DBP levels (per 5 μmol/L tHcy increase: adjusted β=0.47 mm Hg; 95% CI 0.35 to 0.59). Compared with participants with tHcy <10 μmol/L, significantly higher SBP levels were found in those with tHcy concentrations of 10 to <15 (adjusted β=0.80 mm Hg; 95% CI 0.32 to 1.28) and ≥15 µmol/L (adjusted β=1.79 mm Hg; 95% CI 1.20 to 2.37; p for trend <0.001). Consistently, significantly higher DBP levels were found in participants with tHcy concentrations of 10 to <15 (adjusted β=0.86 mm Hg; 95% CI 0.49 to 1.22) and ≥15 µmol/L (adjusted β=2.01 mm Hg; 95% CI 1.57 to 2.46; p for trend <0.001), respectively as compared with those with <10 μmol/L. Furthermore, a stronger association between tHcy and SBP (p for interaction=0.009) or DBP (p for interaction=0.067) was found in current alcohol drinkers.
ConclusionSerum tHcy concentrations were positively associated with both SBP and DBP levels in a general Chinese adult population. The association was stronger in current alcohol drinkers.