RESUMEN
OBJECTIVE: Early adversity, such as adverse childhood experiences (ACEs), is a risk factor for the development of substance use disorder (SUD). ACEs are associated with earlier initiation of substance use. This study examined the relationship between ACEs and age of initiation of substance use using survival analysis. It is hypothesized that individuals with higher ACEs will have an earlier age of initiation. METHOD: Participants were recruited from the University of Kentucky's Laboratory for Human Behavioral Pharmacology. Participants were 18 years or older, English speaking, and actively engaged in substance use. Participants were not in substance abuse treatment nor were they seeking treatment. ACE scores were calculated, and age of substance use initiation was recorded. A Cox proportional hazard model was used to examine the effect of ACE score on age of substance use initiation. RESULTS: A total of 107 participants completed the study. An average number of 2.3 ACEs (SD = 2.2) were endorsed with 24% of participants reporting 4 or more ACEs. Higher ACE scores were associated with cigarette smoking and non-medical prescription opioid use onset ( hazard ratio (HR) = 1.14, 95% CI=1.02-1.28, p = 0.02, and HR=1.19, 95% CI = 1.04-1.37, p = 0.01, respectively. CONCLUSIONS: A significant association was found between higher ACE scores and earlier initiation of cigarette and non-medical prescription opioid use, consistent with prior research. Primary prevention of ACEs, screening for ACEs during childhood, and interventions for ACEs if detected, may help to reduce the risk of substance use/SUD in adulthood.
Asunto(s)
Experiencias Adversas de la Infancia , Maltrato a los Niños , Trastornos Relacionados con Sustancias , Humanos , Niño , Analgésicos Opioides , Trastornos Relacionados con Sustancias/epidemiología , Análisis de SupervivenciaRESUMEN
OBJECTIVE: The purpose of this study was to determine the effectiveness with which radiologists can use computer-aided detection (CADe) to detect cancer missed at screening. MATERIALS AND METHODS: An observer study was performed to measure the ability of radiologists to detect breast cancer on mammograms with and without CADe. The images in the study were from 300 analog mammographic examinations. In 234 cases the mammograms were read clinically as normal and free of cancer for at least 2 subsequent years. In the other 66 cases, cancers were missed clinically. In 256 cases, current and previous mammograms were available. Eight radiologists read the dataset and recorded a BI-RADS assessment, the location of the lesion, and their level of confidence that the patient should be recalled for diagnostic workup for each suspicious lesion. Jackknife alternative free-response receiver operating characteristic analysis was used. RESULTS: The jackknife alternative free-response receiver operating characteristic figure of merit was 0.641 without aid and 0.659 with aid (p = 0.06; 95% CI, -0.001 to 0.036). The sensitivity increased 9.9% (95% CI, 3.4-19%) and the callback rate 12.1% (95% CI, 7.3-20%) with CADe. Both increases were statistically significant (p < 0.001). Radiologists on average ignored 71% of correct computer prompts. CONCLUSION: Use of CADe can increase radiologist sensitivity 10% with a comparable increase in recall rate. There is potential for CADe to have a bigger clinical impact because radiologists failed to recognize a correct computer prompt in 71% of missed cancer cases [corrected].
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Diagnóstico por Computador , Errores Diagnósticos/prevención & control , Mamografía , Femenino , Humanos , Curva ROC , Sensibilidad y EspecificidadRESUMEN
This article reviews the current state of diagnosis and treatment of soft tissue sarcomas. Etiology, staging, imaging, tissue sampling, and current treatment are all reviewed using updated references. Current standards for surgical treatment are emphasized and the future directions of treatment addressed.
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Sarcoma/cirugía , Diagnóstico por Imagen , Humanos , Neoplasias Pulmonares/secundario , Estadificación de Neoplasias , Pronóstico , Radioterapia Adyuvante , Neoplasias Retroperitoneales/diagnóstico , Neoplasias Retroperitoneales/terapia , Sarcoma/tratamiento farmacológico , Sarcoma/patología , Sarcoma/radioterapia , Resultado del TratamientoRESUMEN
Diabetic muscle infarction, also known as diabetic myonecrosis, is an uncommon neuromuscular complication of longstanding diabetes. It usually involves the thigh or calf muscles. Patients typically present with severe pain in the affected area. This complication is more often seen in middle-aged diabetic patients with poorly controlled glycemia. We describe a 38-year-old female Type 1 diabetic patient who developed acute neck pain 3 weeks following islet transplantation.
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Diabetes Mellitus Tipo 1/cirugía , Trasplante de Islotes Pancreáticos/efectos adversos , Músculos del Cuello/patología , Dolor de Cuello/patología , Necrosis/patología , Osteomielitis/patología , Complicaciones Posoperatorias/patología , Adulto , Antibacterianos/uso terapéutico , Diabetes Mellitus Tipo 1/patología , Doxiciclina/uso terapéutico , Femenino , Humanos , Nafcilina/uso terapéutico , Dolor de Cuello/tratamiento farmacológico , Osteomielitis/tratamiento farmacológico , Complicaciones Posoperatorias/tratamiento farmacológicoRESUMEN
Adult human bone marrow (ABM) is an important source of hematopoietic stem cells for transplantation in the treatment of malignant and nonmalignant diseases. However, in contrast to the recent progress that has been achieved with umbilical cord blood, methods to expand ABM stem cells for therapeutic applications have been disappointing. In this study, we describe a novel culture method that uses human brain endothelial cells (HUBECs) and that supports the quantitative expansion of the most primitive measurable cell within the adult bone marrow compartment, the nonobese diabetic/severe combined immunodeficient (NOD/SCID) repopulating cell (SRC). Coculture of human ABM CD34(+) cells with brain endothelial cells for 7 days supported a 5.4-fold increase in CD34(+) cells, induced more than 95% of the CD34(+)CD38(-) subset to enter cell division, and produced progeny that engrafted NOD/SCID mice at significantly higher rates than fresh ABM CD34(+) cells. Using a limiting dilution analysis, we found the frequency of SRCs within fresh ABM CD34(+) cells to be 1 in 9.9 x 10(5) cells. Following HUBEC culture, the estimated frequency of SRCs increased to 1 in 2.4 x 10(5) cells. All mice that received transplants of HUBEC-cultured cells showed B-lymphoid and myeloid differentiation, indicating that a primitive hematopoietic cell was preserved during culture. Noncontact HUBEC cultures also maintained SRCs at a level comparable to contact HUBEC cultures, suggesting that cell-to-cell contact was not required. These data demonstrate that human brain endothelial cells possess a unique hematopoietic activity that increases the repopulating capacity of adult human bone marrow.
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Encéfalo/citología , Trasplante de Células Madre Hematopoyéticas , Células Madre Hematopoyéticas/citología , Adulto , Animales , División Celular , Células Cultivadas/trasplante , Técnicas de Cocultivo , Ensayo de Unidades Formadoras de Colonias , Endotelio/citología , Supervivencia de Injerto , Humanos , Ratones , Ratones Endogámicos NOD , Ratones SCID , Trasplante HeterólogoRESUMEN
We tested the ability of human cells from different hematopoietic tissues to generate graft versus host disease-like syndrome (GVHD) in sublethally irradiated non-obese diabetic/severe combined immunodeficient (NOD/SCID) mice. Tissue sources of human hematopoietic cells were: (1) bone marrow (BM), (2) nonmobilized peripheral blood (PB), (3) mobilized peripheral blood stem-progenitor cells (PBSC), and (4) cord blood (CB). To avoid interindividual donor variation, part of this study was done using BM, PB, and PBSC donated by a single healthy adult volunteer. A total of 179 NOD/SCID mice received graded human hematopoietic cell doses [5-500 x 10(6) mononuclear cells (MNC), containing 2-325 x 10(6) CD3(+) T cells, per mouse] from individual donors. Mice were observed for the development of GVHD and sacrificed 60 days after transplantation (earlier if ill). Mice were analyzed quantitatively by flow cytometry for human hematopoietic cell types and histologically, especially for human T lymphocytes infiltrating BM. No mouse transplanted with the tested doses of human CB or BM cells developed GVHD (experimentally defined as >10% human T lymphocytes infiltrating the mouse BM). For PB and PBSC, the frequencies of death, death with GVHD, and GVHD were directly related to the dose and source of human cells. Because PB cells contaminate harvested BM, the results from infused BM and PB were next combined for further analysis (BM/PB). The relative risks (hazard ratios estimated from the proportional hazards model) for death with GVHD, for each 10 human T cell dose increase, were 1.15 for BM/PB (p < 0.0001) and 1.47 for PBSC (p < 0.0001). In this in vivo xenogeneic model, the average T cell from human PBSC generated GVHD more potently than did the average T cell from human BM/PB, and the average CB T cell had a much lower GVHD potential. These results suggest that the potential for clinical GVHD from an HLA-disparate donor graft is likely to be quantitatively dependent both on the total number of T lymphocytes in the donor graft and the tissue source of the graft. Quantitative criteria for optimal T cell content of allogeneic donor hematopoietic grafts from different sources are discussed.