RESUMEN

Purpose: Stereotactic radiosurgery/radiation therapy (SRS/SRT) increasingly has been used to treat brain metastases. However, the development of distant brain metastases (DBMs) in the untreated brain remains a serious complication. We sought to develop a spatially aware radiomic signature to model the time-to-DBM development in a cohort of patients leveraging pretreatment magnetic resonance imaging (MRI) and radiation therapy treatment planning data including radiation dose distribution maps. Methods and Materials: We retrospectively analyzed a cohort of 105 patients with brain metastases treated by SRS/SRT with pretreatment multiparametric MRI (T1, T1 postcontrast, T2, fluid-attenuated inversion recovery). Three-dimensional radiomic features were extracted from each MRI sequence within 5 isodose regions of interest (ROIs) identified via radiation dose distribution maps and gross target volume (GTV) contours. Clinical features including patient performance status, number of lesions treated, tumor volume, and tumor stage were collected to serve as a baseline for comparison. Cox proportional hazards (CPH) modeling and Kaplan-Meier analysis were used to model time-to-DBM development. Results: CPH models trained using radiomic features achieved a mean concordance index (c-index) of 0.63 (standard deviation [SD], 0.08) compared with a c-index of 0.49 (SD, 0.09) for CPH models trained using clinical factors. A CPH model trained using both radiomic and clinical features achieved a c-index of 0.69 (SD, 0.08). The identified radiomic signature was able to stratify patients into distinct risk groups with statistically significant differences (P = .00007) in time-to-DBM development as measured by log-rank test. Clinical features were unable to do the same. Radiomic features from the peritumoral 50% to 75% isodose ROI and GTV region were most predictive of DBM development. Conclusions: Our results suggest that radiomic features extracted from pretreatment MRI and multiple isodose ROIs can model time-to-DBM development in patients receiving SRS/SRT for brain metastases, outperforming clinical feature baselines. Notably, we believe we are the first to leverage SRS/SRT dose maps for ROI identification and subsequent radiomic analysis of peritumoral and untargeted brain regions using multiparametric MRI. We observed that the peritumoral environment may be implicated in DBM development for SRS/SRT-treated brain metastases. Our preliminary results might enable the identification of patients with predisposition to DBM development and prompt subsequent changes in disease management.

RESUMEN

Critical limb ischemia (CLI) occurs when blood flow is restricted through the arteries, resulting in ulcers, necrosis, and chronic wounds in the downstream extremities. The development of collateral arterioles (i.e. arteriogenesis), either by remodeling of pre-existing vascular networks or de novo growth of new vessels, can prevent or reverse ischemic damage, but it remains challenging to stimulate collateral arteriole development in a therapeutic context. Here, we show that a gelatin-based hydrogel, devoid of growth factors or encapsulated cells, promotes arteriogenesis and attenuates tissue damage in a murine CLI model. The gelatin hydrogel is functionalized with a peptide derived from the extracellular epitope of Type 1 cadherins. Mechanistically, these "GelCad" hydrogels promote arteriogenesis by recruiting smooth muscle cells to vessel structures in both ex vivo and in vivo assays. In a murine femoral artery ligation model of CLI, delivery of in situ crosslinking GelCad hydrogels was sufficient to restore limb perfusion and maintain tissue health for 14 days, whereas mice treated with gelatin hydrogels had extensive necrosis and autoamputated within 7 days. A small cohort of mice receiving the GelCad hydrogels were aged out to 5 months and exhibited no decline in tissue quality, indicating durability of the collateral arteriole networks. Overall, given the simplicity and off-the-shelf format of the GelCad hydrogel platform, we suggest it could have utility for CLI treatment and potentially other indications that would benefit from arteriole development.

Asunto(s)

RESUMEN

Critical limb ischemia (CLI) occurs when blood flow is restricted through the arteries, resulting in ulcers, necrosis, and chronic wounds in the downstream extremities. The development of collateral arterioles (i.e. arteriogenesis), either by remodeling of pre-existing vascular networks or de novo growth of new vessels, can prevent or reverse ischemic damage, but it remains challenging to stimulate collateral arteriole development in a therapeutic context. Here, we show that a gelatin-based hydrogel, devoid of growth factors or encapsulated cells, promotes arteriogenesis and attenuates tissue damage in a murine CLI model. The gelatin hydrogel is functionalized with a peptide derived from the extracellular epitope of Type 1 cadherins. Mechanistically, these "GelCad" hydrogels promote arteriogenesis by recruiting smooth muscle cells to vessel structures in both ex vivo and in vivo assays. In a murine femoral artery ligation model of CLI, delivery of in situ crosslinking GelCad hydrogels was sufficient to restore limb perfusion and maintain tissue health for 14 days, whereas mice treated with gelatin hydrogels had extensive necrosis and autoamputated within 7 days. A small cohort of mice receiving the GelCad hydrogels were aged out to 5 months and exhibited no decline in tissue quality, indicating durability of the collateral arteriole networks. Overall, given the simplicity and off-the-shelf format of the GelCad hydrogel platform, we suggest it could have utility for CLI treatment and potentially other indications that would benefit from arteriole development.

RESUMEN

Self-healing polymers such as poly(ethylene-co-methacrylic acid) ionomers (PEMAA) can heal themselves immediately after a projectile puncture which in turn lowers environmental pollution from replacement. In this study, the thermal-mechanical properties and self-healing response of a library of 15 PEMAA copolymers were studied to understand the effects of the ionic content (Li, Na, Zn, Mg) and neutralization percentage (13 to 78%) on the results. Differential scanning calorimetry (DSC), dynamic mechanical analysis (DMA), and tensile testing were used to study the thermo-mechanical properties of PEMAA copolymers while the self-healing response was studied using the projectile test. Puncture sites were observed using scanning electron microscopy (SEM) and the healing efficiency was quantitatively measured using the water leakage test. Five different self-healing responses were observed and correlated to ionic content and neutralization. At high neutralization, divalent neutralizing ions (Zn and Mg) that have stronger ionic interactions exhibited brittle responses during projectile testing. PEMAA samples neutralized with Mg and Li at low concentrations had a higher healing efficiency than PEMAA samples neutralized with Zn and Na at low neutralization. The PEMAA copolymers with higher tensile stress and two distinct peaks in the graph of loss factor versus temperature that indicate the presence of sufficient ionic aggregate clusters had improved healing efficiency. By increasing the neutralization percentage from 20% to 70%, the tensile strength and modulus of the samples increased and their self-healability generally increased. Among the investigated samples, the copolymer with ~50% neutralization by Li salt showed the highest healing efficiency (100%). Overall, the strength and elastic response required for successful self-healing responses in PEMAA copolymers are shown to be governed by the choice of ion and the amount of neutralization.

RESUMEN

The search for materials with better performance, longer service life, lower environmental impact, and lower overall cost is at the forefront of polymer science and material engineering. This has led to the development of self-healing polymers with a range of healing mechanisms including capsular-based, vascular, and intrinsic self-healing polymers. The development of self-healable systems has been inspired by the healing of biological systems such as skin wound healing and broken bone reconstruction. The goal of using self-healing polymers in various applications is to extend the service life of polymers without the need for replacement or human intervention especially in restricted access areas such as underwater/underground piping where inspection, intervention, and maintenance are very difficult. Through an industrial and scholarly lens, this paper provides: a) an overview of self-healing polymers; b) classification of different self-healing polymers and polymer-based composites; c) mechanical, thermal, and electrical analysis characterization; d) applications in coating, composites, and electronics; e) modeling and simulation; and f) recent development in the past 20 years. This review highlights the importance of healable polymers for an economically and environmentally sustainable future, the most recent advances in the field, and current limitations in fabrication, manufacturing, and performance.

Asunto(s)

RESUMEN

INTRODUCTION: Vascular endothelial cells respond to a variety of biophysical cues such as shear stress and substrate stiffness. In peripheral vasculature, extracellular matrix (ECM) stiffening alters barrier function, leading to increased vascular permeability in atherosclerosis and pulmonary edema. The effect of ECM stiffness on blood-brain barrier (BBB) endothelial cells, however, has not been explored. To investigate this topic, we incorporated hydrogel substrates into an in vitro model of the human BBB. METHODS: Induced pluripotent stem cells were differentiated to brain microvascular endothelial-like (BMEC-like) cells and cultured on hydrogel substrates of varying stiffness. Cellular changes were measured by imaging, functional assays such as transendothelial electrical resistance (TEER) and p-glycoprotein efflux activity, and bulk transcriptome readouts. RESULTS: The magnitude and longevity of TEER in iPSC-derived BMEC-like cells is enhanced on compliant substrates. Quantitative imaging shows that BMEC-like cells form fewer intracellular actin stress fibers on substrates of intermediate stiffness (20 kPa relative to 1 and 150 kPa). Chemical induction of actin polymerization leads to a rapid decline in TEER, agreeing with imaging readouts. P-glycoprotein activity is unaffected by substrate stiffness. Modest differences in RNA expression corresponding to specific signaling pathways were observed as a function of substrate stiffness. CONCLUSIONS: iPSC-derived BMEC-like cells exhibit differences in passive but not active barrier function in response to substrate stiffness. These findings may provide insight into BBB dysfunction during neurodegeneration, as well as aid in the optimization of more complex three-dimensional neurovascular models utilizing compliant hydrogels. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12195-021-00706-8.

RESUMEN

Fabrication of microfluidic devices by photolithography generally requires specialized training and access to a cleanroom. As an alternative, 3D printing enables cost-effective fabrication of microdevices with complex features that would be suitable for many biomedical applications. However, commonly used resins are cytotoxic and unsuitable for devices involving cells. Furthermore, 3D prints are generally refractory to elastomer polymerization such that they cannot be used as master molds for fabricating devices from polymers (e.g. polydimethylsiloxane, or PDMS). Different post-print treatment strategies, such as heat curing, ultraviolet light exposure, and coating with silanes, have been explored to overcome these obstacles, but none have proven universally effective. Here, we show that deposition of a thin layer of parylene, a polymer commonly used for medical device applications, renders 3D prints biocompatible and allows them to be used as master molds for elastomeric device fabrication. When placed in culture dishes containing human neurons, regardless of resin type, uncoated 3D prints leached toxic material to yield complete cell death within 48 hours, whereas cells exhibited uniform viability and healthy morphology out to 21 days if the prints were coated with parylene. Diverse PDMS devices of different shapes and sizes were easily cast from parylene-coated 3D printed molds without any visible defects. As a proof-of-concept, we rapid prototyped and tested different types of PDMS devices, including triple chamber perfusion chips, droplet generators, and microwells. Overall, we suggest that the simplicity and reproducibility of this technique will make it attractive for fabricating traditional microdevices and rapid prototyping new designs. In particular, by minimizing user intervention on the fabrication and post-print treatment steps, our strategy could help make microfluidics more accessible to the biomedical research community.

Asunto(s)

RESUMEN

In vitro models of the human central nervous system (CNS), particularly those derived from induced pluripotent stem cells (iPSCs), are becoming increasingly recognized as useful complements to animal models for studying neurological diseases and developing therapeutic strategies. However, many current three-dimensional (3D) CNS models suffer from deficits that limit their research utility. In this work, we focused on improving the interactions between the extracellular matrix (ECM) and iPSC-derived neurons to support model development. The most common ECMs used to fabricate 3D CNS models often lack the necessary bioinstructive cues to drive iPSC-derived neurons to a mature and synaptically connected state. These ECMs are also typically difficult to pattern into complex structures due to their mechanical properties. To address these issues, we functionalized gelatin methacrylate (GelMA) with an N-cadherin (Cad) extracellular peptide epitope to create a biomaterial termed GelMA-Cad. After photopolymerization, GelMA-Cad forms soft hydrogels (on the order of 2 kPa) that can maintain patterned architectures. The N-cadherin functionality promotes survival and maturation of single-cell suspensions of iPSC-derived glutamatergic neurons into synaptically connected networks as determined by viral tracing and electrophysiology. Immunostaining reveals a pronounced increase in presynaptic and postsynaptic marker expression in GelMA-Cad relative to Matrigel, as well as extensive colocalization of these markers, thus highlighting the biological activity of the N-cadherin peptide. Overall, given its ability to enhance iPSC-derived neuron maturity and connectivity, GelMA-Cad should be broadly useful for in vitro studies of neural circuitry in health and disease.

Asunto(s)

RESUMEN

HYPOTHESIS: Confinement causes a change in the amount of surfactant adsorbed and in the adsorption morphology. EXPERIMENTS: Two cationic surfactants, tetradecyltrimethylammonium bromide (TTAB) and cetylpyridinium chloride (CPC) were adsorbed at the silica-water interface. Atomic force microscopy (AFM) force curves were measured on 50 nm and 80 nm wide trenches. Force curves were also measured on silica pillars, and the results were quantified based on distance from the edge. FINDINGS: Trenches: Adsorbed surfactants films in 50 nm and 80 nm trenches showed the same break-through values. However, compared to unconfined values, TTAB in trenches had decreased break-through and adhesion forces while CPC in trenches had increased break-through and adhesion forces, indicating that surfactant identity varies the confinement effect. Pillars: Near the edge, few surfactants adsorb, and those that do extend in the direction normal to the surface. While the experimental data agree qualitatively with previous coarse-grained molecular dynamic simulations, the length scales at which the phenomena are detected differ by ~ half-order of magnitude. Specifically, experimental data show measurable effects on adsorbed surfactant morphology at a distance from the edge 10-20 times the length of a surfactant molecule after accounting for the ~8 nm size of the probe.

RESUMEN

PURPOSE OF REVIEW: Stem cells are exquisitely sensitive to biophysical and biochemical cues within the native microenvironment. This review focuses on emerging strategies to manipulate neural cell behavior using these influences in three-dimensional (3D) culture systems. RECENT FINDINGS: Traditional systems for neural cell differentiation typically produce heterogeneous populations with limited diversity rather than the complex, organized tissue structures observed in vivo. Advancements in developing engineering tools to direct neural cell fates can enable new applications in basic research, disease modeling, and regenerative medicine. SUMMARY: This review article highlights engineering strategies that facilitate controlled presentation of biophysical and biochemical cues to guide differentiation and impart desired phenotypes on neural cell populations. Specific highlighted examples include engineered biomaterials and microfluidic platforms for spatiotemporal control over the presentation of morphogen gradients.

RESUMEN

Morphogens are biological molecules that alter cellular identity and behavior across both space and time. During embryonic development, morphogen spatial localization can be confined to small volumes in a single tissue or permeate throughout an entire organism, and the temporal effects of morphogens can range from fractions of a second to several days. In most cases, morphogens are presented as a gradient to adjacent cells within tissues to pattern cell fate. As such, to appropriately model development and build representative multicellular architectures in vitro, it is vital to recapitulate these gradients during stem cell differentiation. However, the ability to control morphogen presentation within in vitro systems remains challenging. Here, we describe an innovative platform using channels patterned within thick, three-dimensional hydrogels that deliver multiple morphogens to embedded cells, thereby demonstrating exquisite control over both spatial and temporal variations in morphogen presentation. This generalizable approach should have broad utility for researchers interested in patterning in vitro tissue structures. © 2019 by John Wiley & Sons, Inc.

Asunto(s)

RESUMEN

Rheological properties of the solution of an extended surfactant, sodium alkoxy sulfate (C8-(PO)4-(EO)1-SO4Na), are investigated as a function of the presence of various paraffinic oils over a range of salt conditions in the Winsor III microemulsion region at oil fractions where the microemulsion is "oil-starved". The addition of as small as 3 vol % alkane to 2 wt % surfactant solutions at salt concentrations where the oil-water interfacial tension is minimized induces a sudden shift in the rheological behavior. The solution viscosity increases by 5 orders of magnitude, with solid-like behaviors (G' > G″) being observed in the entire frequency region investigated (0.01-100 rad/s). Commonly, in the cases where wormlike micelles are present in the solution, alkanes are believed to be solubilized in the core of micelles, leading to a radial growth of the cylindrical part of the wormlike micelle, resulting in a drop of end-cap energy (EC) and micelle length and a reduction in viscosity. In this study, however, the addition of oil causes the formation of wormlike micelles. The viscosity of solubilized-oil samples does, however, decrease with an increase in incorporated oil volume. We hypothesize that this "abnormal oleo-responsive" viscoelastic behavior is related to a spacer of intermediate hydrophilicity, that is, polypropylene oxide (PO) segment of the alkoxy sulfate, being inserted between the hydrophobic tail and hydrophilic head (the ethoxylated sulfate segment) of the extended surfactant. The addition of a small amount of oil likely extends the PO moiety and increases the tail length of the surfactant in the aggregates as well as reducing the headgroup size, driving the formation of wormlike micelles from a solution that initially had a viscosity consistent with the absence of such structures.

RESUMEN

The process of cell differentiation in a developing embryo is influenced by numerous factors, including various biological molecules whose presentation varies dramatically over space and time. These morphogens regulate cell fate based on concentration profiles, thus creating discrete populations of cells and ultimately generating large, complex tissues and organs. Recently, several in vitro platforms have attempted to recapitulate the complex presentation of extrinsic signals found in nature. However, it has been a challenge to design versatile platforms that can dynamically control morphogen gradients over extended periods of time. To address some of these issues, we introduce a platform using channels patterned in hydrogels to deliver multiple morphogens to cells in a 3D scaffold, thus creating a spectrum of cell phenotypes based on the resultant morphogen gradients. The diffusion coefficient of a common small molecule morphogen, retinoic acid (RA), was measured within our hydrogel platform using Raman spectroscopy and its diffusion in our platform's geometry was modeled using finite element analysis. The predictive model of spatial gradients was validated in a cell-free hydrogel, and temporal control of morphogen gradients was then demonstrated using a reporter cell line that expresses green fluorescent protein in the presence of RA. Finally, the utility of this approach for regulating cell phenotype was demonstrated by generating opposing morphogen gradients to create a spectrum of mesenchymal stem cell differentiation states.

Asunto(s)

RESUMEN

The human dopamine (DA) transporter (hDAT) mediates clearance of DA. Genetic variants in hDAT have been associated with DA dysfunction, a complication associated with several brain disorders, including autism spectrum disorder (ASD). Here, we investigated the structural and behavioral bases of an ASD-associated in-frame deletion in hDAT at N336 (∆N336). We uncovered that the deletion promoted a previously unobserved conformation of the intracellular gate of the transporter, likely representing the rate-limiting step of the transport process. It is defined by a "half-open and inward-facing" state (HOIF) of the intracellular gate that is stabilized by a network of interactions conserved phylogenetically, as we demonstrated in hDAT by Rosetta molecular modeling and fine-grained simulations, as well as in its bacterial homolog leucine transporter by electron paramagnetic resonance analysis and X-ray crystallography. The stabilization of the HOIF state is associated both with DA dysfunctions demonstrated in isolated brains of Drosophila melanogaster expressing hDAT ∆N336 and with abnormal behaviors observed at high-time resolution. These flies display increased fear, impaired social interactions, and locomotion traits we associate with DA dysfunction and the HOIF state. Together, our results describe how a genetic variation causes DA dysfunction and abnormal behaviors by stabilizing a HOIF state of the transporter.

Asunto(s)

RESUMEN

Three-dimensional (3D) brain organoids derived from human pluripotent stem cells (hPSCs), including human embryonic stem cells (hESCs) and induced pluripotent stem cells (iPSCs), have become a powerful system to study early development events and to model human disease. Cerebral organoids are generally produced in static culture or in a culture vessel with active mixing, and the two most widely used systems for mixing are a large spinning flask and a miniaturized multi-well spinning bioreactor (also known as Spin Omega (SpinΩ)). The SpinΩ provides a system that is amenable to drug testing, has increased throughput and reproducibility, and utilizes less culture media. However, technical limitations of this system include poor stability of select components and an elevated risk of contamination due to the inability to sterilize the device preassembled. Here, we report a new design of the miniaturized bioreactor system, which we term Spinfinity (Spin∞) that overcomes these concerns to permit long-term experiments. This updated device is amenable to months-long (over 200 days) experiments without concern of unexpected malfunctions.

RESUMEN

Force curves collected using an atomic force microscope (AFM) in the presence of adsorbed surfactants are often used to draw conclusions about adsorbed film packing, rigidity, and thickness. However, some noteworthy features of such force curve characteristics have yet to be thoroughly investigated and explained. In this work, we collected force curves from tetradecyltrimethylammonium bromide films adsorbed on highly oriented pyrolytic graphite (HOPG), silica, and silica that had been hydrophobized by functionalization with dichlorodimethyl silane. Breakthrough events in the force curves from several different trials were compared to show that the breakthrough distance, often reported as the adsorbed film thickness, increased with concentration below the critical micelle concentration (CMC) but was approximately 3.5 nm on all surfaces between 2× and 10× CMC; an unexpected result because of the different surface chemistries for the three surfaces. We employed an AFM probe with a different force constant ( k) value as well as a colloidal probe and the breakthrough distance remained approximately 3.5 nm in all cases. Gradient mapping, a variant of force mapping, was also implemented on the three surfaces and resulted in a new technique for visualizing adsorbed surfactant in situ. The resulting maps showed patches of adsorbed surfactant below the CMC and revealed that with increasing concentration, the size of the patches increased resulting in full coverage near and above the CMC. These results are, to our knowledge, the first time force mapping has been used to spatially track patches of adsorbed surfactant. Finally, layers of surfactants on an AFM tip were investigated by collecting a force map on a single AFM tip using the tip of a separate AFM probe. A breakthrough event was observed between the tips, indicating that a layer of surfactant was present on at least one, if not both tips.

RESUMEN

The fabrication of engineered vascularized tissues and organs requiring sustained, controlled perfusion has been facilitated by the development of several pump systems. Currently, researchers in the field of tissue engineering require the use of pump systems that are in general large, expensive, and generically designed. Overall, these pumps often fail to meet the unique demands of perfusing clinically useful tissue constructs. Here, we describe a pumping platform that overcomes these limitations and enables scalable perfusion of large, three-dimensional hydrogels. We demonstrate the ability to perfuse multiple separate channels inside hydrogel slabs using a preprogrammed schedule that dictates pumping speed and time. The use of this pump system to perfuse channels in large-scale engineered tissue scaffolds sustained cell viability over several weeks.

Asunto(s)

RESUMEN

The effect of simultaneous alignment of polyethylene (PE) lamellae and graphene nanoplatelets (GnP) on the thermal conductivity (k) of PE-GnP composites is investigated. Measurements reveal a large increase of 1100% in k of the aligned PE-GnP composite using 10 wt% GnPs relative to unoriented pure PE. The rate of increase of k with applied strain for the pure PE-GnP composite with 10 wt% GnP is found to be almost a factor of two higher than the pure PE sample, pointing to the beneficial effect of GnP alignment on k enhancement. Aligned GnPs are further found to be 3 times as effective in enhancing k as in the randomly oriented configuration. Enhancement in k is correlated with the alignment of PE lamellae and GnPs through wide-angle X-ray scattering and polarized Raman spectroscopy. At the maximum applied strain of 400% and using 10 wt% GnPs, a composite k of 5.9 W mK-1 is achieved. These results demonstrate the great potential of simultaneous alignment effects in achieving high k polymer composites.

RESUMEN

Mixtures of fumed fractal metal oxide nanoparticles (np's) dispersed in water, at a solution pH where one species is positively charged and the other is negatively charged, form yield stress gels at volume fractions as low as 1.5%, due to electrostatic heteroaggregation into networks as confirmed by small-angle neutron scattering. These gels exhibit a measurable yield stress and an apparent viscosity that follows a power law relationship with shear rate. Rotational and oscillatory shear rheology is presented for binary mixtures of fumed silica, fumed alumina, and fumed titania in aqueous dispersions. Gels were characterized at various particle concentrations, solution pHs, mixture ratios, and salt concentrations. The strength of the gel network, as evaluated by the storage modulus and yield stress, is maximized when the mixture contains a mixture of particles with an approximately equal, but opposite, number of charged groups.

RESUMEN

Robust data on hepatitis C virus (HCV) population prevalence are essential to inform national HCV services. In 2016, we undertook a survey to estimate HCV prevalence among the adult population in Ireland. We used anonymised residual sera available at the National Virus Reference Laboratory. We selected a random sample comprising persons ≥ 18 years with probability proportional to the general population age-sex distribution. Anti-HCV and HCV Ag were determined using the Architect anti-HCV and HCV Ag assays. Fifty-three of 3,795 specimens were seropositive (age-sex-area weighted seroprevalence 0.98% (95% confidence interval (CI): 0.73-1.3%)). Thirty-three specimens were HCV-antigen and antibody-positive (age-sex-area weighted prevalence of chronic infection 0.57% (95% CI: 0.40-0.81%)). The prevalence of chronic infection was higher in men (0.91%; 95% CI: 0.61-1.4%), in specimens from the east of the country (1.4%; 95%CI: 0.99-2.0%), and among persons aged 30-39 years and 40-49 years (1.1% (95% CI: 0.59-2.0%) and 1.1% (95% CI: 0.64-1.9%) respectively). Ireland ranks at the lower end of the spectrum of prevalence of chronic HCV infection internationally. Men born between 1965 and 1984 from the east of the country have the highest rate of chronic HCV infection.

Asunto(s)