RESUMEN

OBJECTIVES: This study aimed to investigate the effects of an adhesive bone conduction device (aBCD) in children with congenital single-sided deafness (SSD). Specifically, we examined whether the aBCD elicits improvement in the speech perception ability of children with congenital SSD and whether using this device would adversely affect the horizontal localisation abilities of these children. METHODS: Thirteen school-aged children with SSD and seven children with Normal Hearing (NH) were included in this study. Speech perception in noise was measured using the Mandarin Speech Test Materials and sound localisation performance was evaluated using broadband noise stimuli (0.5-20 kHz), randomly played from seven loudspeakers at different stimulus levels (65-, 70-, and 75-dB SPL). RESULTS: All children with SSD showed inferior speech perception and sound localisation performance compared with children with NH. The aBCD use remarkably improved the speech perception abilities of these children under quiet and noise conditions; however, their sound localisation abilities neither improved nor deteriorated. CONCLUSION: This study reveals the effectiveness and safety of a non-surgical aBCD in paediatric patients with SSD. Our results provide a theoretical basis for early hearing intervention with an aBCD in children with congenital SSD who are temporarily unable to undergo ear surgery. LEVEL OF EVIDENCE: Level 3.

Asunto(s)

Conducción Ósea , Audífonos , Pérdida Auditiva Unilateral , Localización de Sonidos , Percepción del Habla , Humanos , Niño , Conducción Ósea/fisiología , Masculino , Percepción del Habla/fisiología , Femenino , Pérdida Auditiva Unilateral/fisiopatología , Pérdida Auditiva Unilateral/rehabilitación , Pérdida Auditiva Unilateral/congénito , Localización de Sonidos/fisiología , Estudios de Casos y Controles , Resultado del Tratamiento , Adolescente

RESUMEN

This study evaluated the effects of perioperative nutrition management by a multidisciplinary team on nutrition and postoperative complications of patients with esophageal cancer. A total of 239 patients with esophageal cancer who underwent esophagectomy and gastric conduit reconstruction for esophageal or esophagogastric junction cancer between February 2019 and February 2020 were included in the study. They were divided into the experimental group (120 patients) and the control group (119 patients) using the random number table method. Control group patients received routine diet management and experimental group patients received perioperative nutrition management by a multidisciplinary team. The differences of nutriture and postoperative complications between the two groups were compared. At 3 and 7 days after surgery, the experimental group patients had higher total protein and albumin levels (P<0.05), shorter postoperative anal exhaust time (P<0.05), lower incidence of postoperative gastrointestinal adverse reactions, pneumonia, anastomotic fistula, hypoproteinemia (P<0.05), and lower hospitalization costs (P<0.05) than the control group. Nutrition management by a multidisciplinary team effectively improved the nutriture of patients, promoted the rapid recovery of postoperative gastrointestinal function, reduced postoperative complications, and reduced hospitalization costs.

Asunto(s)

Neoplasias Esofágicas , Esofagectomía , Humanos , Esofagectomía/efectos adversos , Esofagectomía/métodos , Neoplasias Esofágicas/cirugía , Complicaciones Posoperatorias/prevención & control , Incidencia , Grupo de Atención al Paciente , Estudios Retrospectivos

RESUMEN

This study evaluated the effects of perioperative nutrition management by a multidisciplinary team on nutrition and postoperative complications of patients with esophageal cancer. A total of 239 patients with esophageal cancer who underwent esophagectomy and gastric conduit reconstruction for esophageal or esophagogastric junction cancer between February 2019 and February 2020 were included in the study. They were divided into the experimental group (120 patients) and the control group (119 patients) using the random number table method. Control group patients received routine diet management and experimental group patients received perioperative nutrition management by a multidisciplinary team. The differences of nutriture and postoperative complications between the two groups were compared. At 3 and 7 days after surgery, the experimental group patients had higher total protein and albumin levels (P<0.05), shorter postoperative anal exhaust time (P<0.05), lower incidence of postoperative gastrointestinal adverse reactions, pneumonia, anastomotic fistula, hypoproteinemia (P<0.05), and lower hospitalization costs (P<0.05) than the control group. Nutrition management by a multidisciplinary team effectively improved the nutriture of patients, promoted the rapid recovery of postoperative gastrointestinal function, reduced postoperative complications, and reduced hospitalization costs.

RESUMEN

There was heterogeneity in the median age of all-cause deaths in Peru during different waves of the coronavirus disease 2019 (COVID-19) pandemic. Before predominance of the Omicron variant, the median age of deaths was lower than normal during the peaks of daily all-cause mortality. However, this increased above normal when the Omicron variant was predominant. The daily patterns of cause-specific deaths related directly and indirectly to COVID-19 in Peru were also investigated. Most excess deaths indirectly related to COVID-19 were caused primarily by diseases of the circulatory system, possibly due to disruption of medical services, and the majority of excess deaths directly related to COVID-19 were caused primarily by COVID-19 and diseases of the respiratory system.

RESUMEN

Background: The ongoing Coronavirus disease of 2019 (COVID-19) pandemic has hit Brazil hard in period of different dominant variants. Different COIVD-19 variants have swept through the region, resulting that the total number of cases in Brazil is the third highest in the world. This study is aimed at investigating the regional heterogeneity of in-hospital mortality of COVID-19 in Brazil and the effects of vaccination and social inequality. Methods: We fitted a multivariate mixed-effects Cox model to a national database of inpatient data in Brazil who were admitted for COVID-19 from February 27, 2020 to March 15, 2022. The in-hospital mortality risks of vaccinated and unvaccinated patients were compared, with adjustment for age, state, ethnicity, education and comorbidities. And the effects of variables to in-hospital mortality were also compared. Stratified analysis was conducted across different age groups and vaccine types. Results: By fitting the multivariate mixed-effects Cox model, we concluded that age was the most important risk factor for death. With regards to educational level, illiterate patients (hazard ratio: 1.63, 95% CI: 1.56-1.70) had a higher risk than those with a university or college degree. Some common comorbidities were more dangerous for hospitalized patients, such as liver disease (HR: 1.46, 95% CI: 1.34-1.59) and immunosuppression (HR:1.32, 95% CI: 1.26-1.40). In addition, the states involving Sergipe (HR: 1.75, 95% CI: 1.46-2.11), Roraima (HR: 1.65, 95% CI: 1.43-1.92), Maranhão (HR: 1.57, 95% CI: 1.38-1.79), Acre (HR: 1.44, 95% CI: 1.12-1.86), and Rondônia (HR: 1.26, 95% CI: 1.10-1.44) in the north and the northeast region tended to have higher hazard ratios than other area. In terms of vaccine protection, vaccination did not significantly reduce mortality among hospitalized patients. Sinovac and AstraZeneca offered different protection in different regions, and no vaccine provided high protection in all regions. Conclusion: The study revealed the regional heterogeneity of in-hospital mortality of Covid-19 in Brazil and the effects of vaccination and social inequality. We found that ethnic concentrations were consistent with higher proportion of death cases relative to population size. White Brazilians had more frequent international travel opportunities. As race revealed the intersection of social connections, we speculated that uneven interactions with residential communities partially contribute to the spread of the epidemic. Additionally, the vaccine showed different protection in different regions. In the northern and northeastern regions, AstraZeneca was much more protective than Sinovac, while Sinovac was more protective for hospitalized patients with varying numbers of comorbidities in the Central-west, Southeast and South regions.

RESUMEN

Due to the abuse of antibiotics, the prevalence of antibiotic resistant Helicobacter pylori strains continues to increase. Therefore, antibiotic resistance assessment is now essential in addition to general H. pylori diagnosis in medical institutions to fulfill clinicians administering effective antibiotic regimens. However, the conventional antibiotic resistance assessment methods, such as in vitro antibiotic susceptibility test and E-test, are skilled-staff dependent and time-consuming. The aim of this study was to establish an easy-operating TaqMan-MGB probe multiplex real-time PCR system for one-step detection of levofloxacin and clarithromycin resistance mutations with concurrent H. pylori infection diagnosis. Through the optimization of primers, probes and reaction buffers, this proposed system could accurately distinguish the recombinant plasmids with different mutation markers. More importantly, the diagnosis results of this detection system exhibited excellent consistence with the gold standard of gastric biopsy and Sanger sequencing on the detection of H. pylori infection and relevant antibiotic resistant strains, the Kappa values of which all exceeded 0.90. In addition, the results of this detection system could also be applied for the prevalence statistics of antibiotic resistance patterns for patients by age, gender and geographical location. This simple and rapid system should be beneficial for clinicians issuing personalized treatments according to the patient's H. pylori strains and avoid the abuse of antibiotics.

Asunto(s)

Antibacterianos/farmacología , Claritromicina/farmacología , Farmacorresistencia Bacteriana Múltiple/genética , Helicobacter pylori/genética , Levofloxacino/farmacología , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Girasa de ADN/genética , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/tratamiento farmacológico , Infecciones por Helicobacter/microbiología , Helicobacter pylori/efectos de los fármacos , Helicobacter pylori/aislamiento & purificación , Humanos , Pruebas de Sensibilidad Microbiana , ARN Ribosómico 16S/genética , ARN Ribosómico 23S/genética

RESUMEN

OBJECTIVE: To investigate the clinical and genetic causes of neonatal unconjugated hyperbilirubinemia. STUDY DESIGN: We included 1412 neonates diagnosed with unconjugated hyperbilirubinemia (total serum bilirubin >95 percentile for age), from the China Neonatal Genomes Project between August 2016 and September 2019, in the current study. Clinical data and targeted panel sequencing data on 2742 genes including known unconjugated hyperbilirubinemia genes were analyzed. RESULTS: Among the 1412 neonates with unconjugated hyperbilirubinemia, 37% had severe unconjugated hyperbilirubinemia, with total serum bilirubin levels that met the recommendations for exchange transfusion. Known clinical causes were identified for 68% of patients. The most common clinical cause in the mild unconjugated hyperbilirubinemia group was infection (17%) and in the severe group was combined factors (21%, with infection combined with extravascular hemorrhage the most common). A genetic variant was observed in 55 participants (4%), including 45 patients with variants in genes associated with unconjugated hyperbilirubinemia and 10 patients with variants that were regarded as additional genetic findings. Among the 45 patients identified with unconjugated hyperbilirubinemia-related variants, the genes were mainly associated with enzyme deficiencies, metabolic/biochemical disorders, and red blood cell membrane defects. G6PD and UGT1A1 variants, were detected in 34 of the 45 patients (76%). CONCLUSIONS: Known clinical causes, which varied with bilirubin levels, were identified in approximately two-thirds of the patients. Genetic findings were identified in 4% of the patients, including in patients with an identified clinical cause, with G6PD and UGT1A1 being the most common genes in which variants were detected.

Asunto(s)

Glucosafosfato Deshidrogenasa , Glucuronosiltransferasa , Hiperbilirrubinemia Neonatal , Bilirrubina , China , Glucosafosfato Deshidrogenasa/genética , Glucuronosiltransferasa/genética , Humanos , Hiperbilirrubinemia/genética , Hiperbilirrubinemia Neonatal/genética , Recién Nacido

RESUMEN

OBJECTIVE: To explore the genetic spectrum of cerebral palsy (CP) in a Chinese pediatric cohort. STUDY DESIGN: This was a retrospective observational study of patients with CP from the Children's Hospital of Fudan University between June 2015 and December 2019. Their clinical data and exome sequencing data were collected and analyzed. RESULTS: A total of 217 patients with CP were enrolled, and genetic variants were identified in 78 subjects (35.9%): 65 patients with single-nucleotide variants (SNVs), 12 patients with copy number variants, and 1 patient with both an SNV and a copy number variant. The genetic diagnosis rates were significantly greater in patients without clinical risk factors than in patients with clinical risk factors (χ2 = 21.705, P = .000) and were significantly greater in patients with a family history than in those without a family history (χ2 = 4.493, P = .034). Variants in genes related to neurologic disorders were the most commonly detected variants, affecting 41 patients (62.1%, 41/66). Among the patients with SNVs detected, the top 12 genes were found to cover 62.1% (41/66) of cases, and 39.4% (26/66) of patients with SNVs had medically actionable genetic findings. CONCLUSIONS: The overall genetic diagnostic rate in this study was 35.9%, and patients without any clinical risk factors or with a family history were more likely to have genetic risk factors. The top 12 genes detected in this study as well as genes related to neurologic disorders or other medically actionable disorders should be noted in the analysis of genetic testing results in patients with CP.

Asunto(s)

Parálisis Cerebral , Exoma , Parálisis Cerebral/genética , Niño , China , Variaciones en el Número de Copia de ADN , Exoma/genética , Humanos , Secuenciación del Exoma

RESUMEN

AIM: Anxiety may be a risk factor for mild cognitive impairment (MCI) but there is a scarcity of data on this association especially from low- and middle-income countries (LMICs). Thus, we investigated the association between anxiety and MCI among older adults residing in six LMICs (China, Ghana, India, Mexico, Russia, South Africa), and the mediational effect of sleep problems in this association. METHODS: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Multivariable logistic regression analysis, meta-analysis, and mediation analysis were conducted to assess associations. RESULTS: The final sample included 32,715 individuals aged ≥50 years with preservation in functional abilities [mean (standard deviation) age 62.1 (15.6) years; 48.3% males]. Country-wise analysis showed a positive association between anxiety and MCI in all countries (OR 1.35-14.33). The pooled estimate based on meta-analysis with random effects was OR=2.27 (95%CI=1.35-3.83). Sleep problems explained 41.1% of this association. CONCLUSIONS: Older adults with anxiety had higher odds for MCI in LMICs. Future studies should examine whether preventing anxiety or addressing anxiety among individuals with MCI can lead to lower risk for dementia onset in LMICs, while the role of sleep problems in this association should be investigated in detail.

Asunto(s)

Disfunción Cognitiva , Países en Desarrollo , Anciano , Ansiedad , China , Disfunción Cognitiva/epidemiología , Estudios Transversales , Femenino , Ghana , Humanos , Vida Independiente , India , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Federación de Rusia , Sudáfrica

RESUMEN

BACKGROUND: To examine the association between self-reported food insecurity and depression in 34,129 individuals aged ≥50 years from six low- and middle-income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa). METHODS: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Self-reported past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations. RESULTS: In total, 34,129 individuals aged ≥50 years [mean (SD) age, 62.4 (16.0) years; 52.1% females] were included in the analysis. Overall, the prevalence of moderate and severe food insecurity was 6.7% and 5.1%, respectively, while the prevalence of depression was 6.0%. Meta-analyses based on countrywise estimates showed that overall, moderate food insecurity (vs. no food insecurity) is associated with a nonsignificant 1.69 (95% confidence interval [CI] = 0.82-3.48) times higher odds for depression, while severe food insecurity is significantly associated with 2.43 (95% CI = 1.65-3.57) times higher odds for depression. CONCLUSIONS: In this large representative sample of older adults from six LMICs, those with severe food insecurity were over two times more likely to suffer from depression (compared with no food insecurity). Utilizing lay health counselors and psychological interventions may be effective mechanisms to reduce depression among food-insecure populations. Interventions to address food insecurity (e.g., supplemental nutrition programs) may reduce depression at the population level but future longitudinal studies are warranted.

Asunto(s)

Depresión , Países en Desarrollo , Anciano , China , Estudios Transversales , Depresión/epidemiología , Femenino , Inseguridad Alimentaria , Ghana/epidemiología , Humanos , India , Masculino , México , Persona de Mediana Edad , Prevalencia , Federación de Rusia , Sudáfrica

RESUMEN

Sarcopenia is a common condition in older people and increasing evidence suggests that it can be considered as a potential risk factor for falls and fractures. However, no studies on this topic from low- and middle-income countries (LMICs) are available. Thus, we assessed this association among older adults from five LMICs (China, India, Ghana, Mexico, and Russia). Community-based, nationally representative, cross-sectional data of the Study on Global Aging and Adult Health were analyzed. Sarcopenia was defined as the presence of low skeletal muscle mass based on indirect population formula, and either slow gait or low handgrip strength. The presence of fall-related injury was ascertained through self-reported information. Multivariable logistic regression analysis and meta-analysis were conducted. The sample consisted of 13,101 individuals aged ≥65 years (mean (SD) age 72.6 (11.3) years; 45% males). The prevalence of fall-related injury was higher among those with sarcopenia than in those without this condition (e.g., Mexico 9.8% vs. 2.7%). Adjusted analyses showed that sarcopenia was associated with a 1.85 (95%CI = 1.24-2.77) times higher odds for fall-related injury, with a low level of between-country heterogeneity. Future studies of longitudinal design may shed light on whether sarcopenia in LMICs may be considered as a risk factor for falls.

Asunto(s)

Accidentes por Caídas , Sarcopenia , Anciano , China , Estudios Transversales , Países en Desarrollo , Femenino , Ghana/epidemiología , Fuerza de la Mano , Humanos , India , Masculino , México/epidemiología , Prevalencia , Federación de Rusia , Sarcopenia/epidemiología

RESUMEN

OBJECTIVES: There is a scarcity of data on the association between mild cognitive impairment (MCI) and falls, especially from low- and middle-income countries (LMICs) where 70% of all older adults reside. Thus, we investigated the association between MCI and fall-related injury among older adults residing in six LMICs (China, Ghana, India, Mexico, Russia, South Africa). DESIGN: Cross-sectional, community-based data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. METHODS: The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria, and information on past 12-month fall-related injury was also collected. Multivariable logistic regression analysis was conducted to assess associations. RESULTS: The analytical sample consisted of 13,623 individuals aged ≥65 years [mean (SD) age 72.3 (10.9) years; 45.6% males]. The prevalence of fall-related injury was higher among those with MCI (6.3%) vs. no MCI (4.1%). After adjustment for potential confounders, MCI was associated with a 1.53 (95%CI = 1.12-2.07) times higher odds for fall-related injury. CONCLUSIONS: MCI was associated with higher odds for fall-related injury among older adults in LMICs. Future studies are warranted to investigate the mechanisms underlying this association and to elucidate whether targeting those with MCI can lead to reduced risk for falls among older adults.

Asunto(s)

Accidentes por Caídas , Disfunción Cognitiva , Anciano , China , Disfunción Cognitiva/epidemiología , Estudios Transversales , Países en Desarrollo , Femenino , Ghana , Humanos , India , Masculino , México/epidemiología , Prevalencia , Factores de Riesgo , Federación de Rusia , Sudáfrica

RESUMEN

PURPOSE: We focus on the problem of scarcity of annotated training data for nucleus recognition in Ki-67 immunohistochemistry (IHC)-stained pancreatic neuroendocrine tumor (NET) images. We hypothesize that deep learning-based domain adaptation is helpful for nucleus recognition when image annotations are unavailable in target data sets. METHODS: We considered 2 different institutional pancreatic NET data sets: one (ie, source) containing 38 cases with 114 annotated images and the other (ie, target) containing 72 cases with 20 annotated images. The gold standards were manually annotated by 1 pathologist. We developed a novel deep learning-based domain adaptation framework to count different types of nuclei (ie, immunopositive tumor, immunonegative tumor, nontumor nuclei). We compared the proposed method with several recent fully supervised deep learning models, such as fully convolutional network-8s (FCN-8s), U-Net, fully convolutional regression network (FCRN) A, FCRNB, and fully residual convolutional network (FRCN). We also evaluated the proposed method by learning with a mixture of converted source images and real target annotations. RESULTS: Our method achieved an F1 score of 81.3% and 62.3% for nucleus detection and classification in the target data set, respectively. Our method outperformed FCN-8s (53.6% and 43.6% for nucleus detection and classification, respectively), U-Net (61.1% and 47.6%), FCRNA (63.4% and 55.8%), and FCRNB (68.2% and 60.6%) in terms of F1 score and was competitive with FRCN (81.7% and 70.7%). In addition, learning with a mixture of converted source images and only a small set of real target labels could further boost the performance. CONCLUSION: This study demonstrates that deep learning-based domain adaptation is helpful for nucleus recognition in Ki-67 IHC stained images when target data annotations are not available. It would improve the applicability of deep learning models designed for downstream supervised learning tasks on different data sets.

Asunto(s)

Antígeno Ki-67 , Humanos , Inmunohistoquímica

RESUMEN

Triptolide, a purified diterpenoid from the herb Tripterygium wilfordii Hook.f., was widely used to treat many diseases. However, the hepatotoxicity of triptolide limited its clinical use. Research showed oxidative stress played an important role in triptolide-induced liver injury. To investigate the effect of vitamin C, which was one of the most effective antioxidants, on triptolide-induced hepatotoxicity and its potential mechanism in mice. In the present study, acute liver injury was induced by intraperitoneal injection of triptolide and vitamin C was orally administered. The results showed treatment with vitamin C prevented the triptolide-induced liver injury by reducing the levels of aspartate transaminase from 286.86 to 192.48 U/mL and alanine aminotransferase from 746.75 to 203.36 U/mL. Histopathological changes of liver corresponded to the same trend. Furthermore, vitamin C also protected the liver against triptolide-induced oxidative stress by inhibiting the generation of malondialdehyde (2.22 to 1.49 nmol/mgprot) and hydrogen peroxide (14.74 to 7.19 mmol/gprot) and restoring the level of total superoxide dismutase (24.32 to 42.55 U/mgprot) and glutathione (7.69 to 13.03 µg/mgprot). These results indicated that vitamin C could protect against triptolide-induced liver injury via reducing oxidative stress, and vitamin C may pose a significant health protection in the clinical use of triptolide.

Asunto(s)

Ácido Ascórbico/uso terapéutico , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Diterpenos/toxicidad , Estrés Oxidativo/efectos de los fármacos , Fenantrenos/toxicidad , Sustancias Protectoras/uso terapéutico , Alanina Transaminasa/sangre , Animales , Aspartato Aminotransferasas/sangre , Enfermedad Hepática Inducida por Sustancias y Drogas/sangre , Compuestos Epoxi/toxicidad , Masculino , Ratones , Ratones Endogámicos C57BL , Sustancias Protectoras/aislamiento & purificación

Asunto(s)

Cateterismo/tendencias , Embolia Pulmonar/tratamiento farmacológico , Terapia Trombolítica/tendencias , Factores de Edad , Cateterismo/métodos , Cateterismo/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Embolia Pulmonar/epidemiología , Terapia Trombolítica/métodos , Terapia Trombolítica/estadística & datos numéricos

RESUMEN

Celastrus orbiculatus is used as a folk medicine in China for the treatment of numerous diseases. The ethyl acetate extract of Celastrus orbiculatus (COE) also displays a wide range of anti-cancer activities in the laboratory. However, the effectiveness of COE-induced autophagy and its mechanism of action in colorectal cancer cells have not been investigated thus far. The present study analyzed the effect of COE on HT-29 cell viability, apoptosis and autophagy using MTT assay, flow cytometry, transmission electron microscopy and western blotting. Additionally, the autophagy inhibitor 3-methyladenine and the autophagy inducer rapamycin were used to further explore the effects of COE-induced autophagy in HT-29 cells. The present study also examined whether the phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K)/Akt/mechanistic target of rapamycin (mTOR)/p70 ribosomal protein S6 kinase (p70S6K) signaling pathway was involved in the regulation of COE-induced autophagy. The results revealed that COE inhibited HT-29 cell proliferation and decreased cell survival in a time- and dose-dependent manner, and that COE possessed the ability to induce both apoptosis and autophagy in HT-29 cells. Furthermore, autophagy and apoptosis induced by COE synergized to inhibit colorectal cancer growth. In addition, COE treatment decreased the phosphorylation of Akt and its downstream effectors mTOR and p70S6K. Taken together, these results demonstrate that both autophagy and apoptosis were activated during COE treatment of HT-29 cells, and that COE-induced autophagy decreases the viability of HT-29 cells via a mechanism that may depend on the PI3K/Akt/mTOR/p70S6K signaling pathway. Furthermore, compounds that induce autophagy administered in combination with COE may be an attractive strategy for enhancing the anti-tumor potency of COE in colorectal cancer.

RESUMEN

BACKGROUND: In-hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. A better understanding of where IHCA occurs in hospitals (intensive care unit [ICU] versus monitored ward [telemetry] versus unmonitored ward) could inform strategies for reducing preventable deaths. METHODS AND RESULTS: This is a retrospective study of adult IHCA events in the Get with the Guidelines-Resuscitation database from January 2003 to September 2010. Unadjusted analyses were used to characterize patient, arrest, and hospital-level characteristics by hospital location of arrest (ICU versus inpatient ward). IHCA event rates and outcomes were plotted over time by arrest location. Among 85 201 IHCA events at 445 hospitals, 59% (50 514) occurred in the ICU compared to 41% (34 687) on the inpatient wards. Compared to ward patients, ICU patients were younger (64±16 years versus 69±14; P<0.001) and more likely to have a presenting rhythm of ventricular tachycardia/ventricular fibrillation (21% versus 17%; P<0.001). In the ICU, mean event rate/1000 bed-days was 0.337 (±0.215) compared with 0.109 (±0.079) for telemetry wards and 0.134 (±0.098) for unmonitored wards. Of patients with an arrest in the ICU, the adjusted mean survival to discharge was 0.140 (0.037) compared with the unmonitored wards 0.106 (0.037) and telemetry wards 0.193 (0.074). More IHCA events occurred in the ICU compared to the inpatient wards and there was a slight increase in events/1000 patient bed-days in both locations. CONCLUSIONS: Survival rates vary based on location of IHCA. Optimizing patient assignment to unmonitored wards versus telemetry wards may contribute to improved survival after IHCA.

Asunto(s)

Reanimación Cardiopulmonar , Paro Cardíaco/epidemiología , Unidades de Cuidados Intensivos , Sistema de Registros , Taquicardia Ventricular/epidemiología , Fibrilación Ventricular/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Paro Cardíaco/mortalidad , Paro Cardíaco/terapia , Mortalidad Hospitalaria , Unidades Hospitalarias , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia , Taquicardia Ventricular/terapia , Telemetría , Estados Unidos/epidemiología , Fibrilación Ventricular/terapia

RESUMEN

OBJECTIVES: The most common complication of herpes zoster (HZ) is postherpetic neuralgia (PHN), a persistent pain that can substantially affect quality of life (QoL). This analysis aimed to evaluate predictors of PHN in HZ patients. METHODS: A pooled analysis of prospective cohort studies of HZ patients aged ≥ 50 years from North America (Canada), Latin America (Brazil, Mexico, and Argentina), and Asia (Taiwan, South Korea, and Thailand) was performed. Patients within 14 days of rash onset were included. The incidence of PHN was defined as a worst pain score of ≥ 3, persisting/appearing at >90 days after rash onset. Socio-demographics, HZ disease characteristics, treatment, pain-related interference with activities of daily living, and health-related QoL were assessed. RESULTS: Of 702 patients with HZ, 148 (21.1%) developed PHN. Similar risks of PHN were observed across geographic regions. On multivariate analysis, older age, greater severity of pain at rash onset, employment status, walking problems at enrollment, and pain interference affecting social relationships were significantly associated with the development of PHN. CONCLUSIONS: In addition to older age and severe acute pain, this study suggests that impaired physical and social functioning from acute zoster pain may play a role in the development of PHN in this prospective cohort study of HZ patients from North and Latin America and Asia.

Asunto(s)

Herpes Zóster/epidemiología , Neuralgia Posherpética/epidemiología , Actividades Cotidianas , Anciano , Argentina/epidemiología , Brasil/epidemiología , Canadá/epidemiología , Exantema/epidemiología , Femenino , Humanos , Incidencia , Masculino , México/epidemiología , Persona de Mediana Edad , Análisis Multivariante , Dimensión del Dolor , Estudios Prospectivos , Calidad de Vida , República de Corea/epidemiología , Taiwán/epidemiología , Tailandia/epidemiología

RESUMEN

STUDY OBJECTIVES: We tested whether providing adults with obstructive sleep apnea (OSA) with daily Web-based access to their positive airway pressure (PAP) usage over 3 mo with or without a financial incentive in the first week improves adherence and functional outcomes. SETTING: Academic- and community-based sleep centers. PARTICIPANTS: One hundred thirty-eight adults with newly diagnosed OSA starting PAP treatment. INTERVENTIONS: Participants were randomized to: usual care, usual care with access to PAP usage, or usual care with access to PAP usage and a financial incentive. PAP data were transmitted daily by wireless modem from the participants' PAP unit to a website where hours of usage were displayed. Participants in the financial incentive group could earn up to $30/day in the first week for objective PAP use ≥ 4 h/day. MEASUREMENTS AND RESULTS: Mean hours of daily PAP use in the two groups with access to PAP usage data did not differ from each other but was significantly greater than that in the usual care group in the first week and over 3 mo (P < 0.0001). Average daily use (mean ± standard deviation) during the first week of PAP intervention was 4.7 ± 3.3 h in the usual care group, and 5.9 ± 2.5 h and 6.3 ± 2.5 h in the Web access groups with and without financial incentive respectively. Adherence over the 3-mo intervention decreased at a relatively constant rate in all three groups. Functional Outcomes of Sleep Questionnaire change scores at 3 mo improved within each group (P < 0.0001) but change scores of the two groups with Web access to PAP data were not different than those in the control group (P > 0.124). CONCLUSIONS: Positive airway pressure adherence is significantly improved by giving patients Web access to information about their use of the treatment. Inclusion of a financial incentive in the first week had no additive effect in improving adherence.

Asunto(s)

Presión de las Vías Aéreas Positiva Contínua/estadística & datos numéricos , Renta , Internet , Motivación , Cooperación del Paciente/estadística & datos numéricos , Apnea Obstructiva del Sueño/economía , Apnea Obstructiva del Sueño/terapia , Presión de las Vías Aéreas Positiva Contínua/economía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente/psicología , Polisomnografía , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento