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1.
Artículo en Inglés | MEDLINE | ID: mdl-39277705

RESUMEN

BACKGROUND: Scant data exists on the impacts of prostate radiation on ejaculatory function. We performed a systematic review and meta-analysis to assess ejaculatory outcomes in men after prostate radiation. METHODS: We queried PubMed, Embase, and Web of Science to identify 17 articles assessing ejaculatory function post-radiation. The primary outcome was anejaculation rate and secondary outcomes included ejaculatory volume (EV), ejaculatory discomfort, and mean decline in ejaculatory function scores (EFS). We assessed study quality with the Newcastle-Ottawa scale. We calculated pooled proportions using inverse variance and random effects models. RESULTS: We identified 17 observational studies with 2156 patients reporting ejaculatory profiles post-radiation. Seven studies utilized external beam radiation therapy, 7 brachytherapy, 1 stereotactic RT and 2 utilized either external or brachytherapy. Ten studies reported an anejaculation rate. Pooled proportion of patients having anejaculation, decreased EV and EjD were 18% (95% CI, 11-36%), 85% (95% CI, 81-89%) and 24% (95% CI, 16-35%), respectively. Five studies reported decline in EFS post-radiation. CONCLUSIONS: Patients receiving radiation treatment may experience significant changes in their ejaculation, such as the absence of ejaculation, reduced EV, and EjD. It is important to counsel them about these potential side effects.

2.
J Affect Disord ; 365: 359-363, 2024 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-39154984

RESUMEN

BACKGROUND: Although there are a few first-line treatment options for bipolar depression, none are rapid-acting. A new rTMS protocol, Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT®), has been shown to have a rapid antidepressant effect in major depressive disorder (MDD). We examined the preliminary safety, tolerability, and efficacy of SAINT for the treatment of depression in a small sample of persons with treatment-resistant bipolar I disorder. METHODS: Participants with treatment-resistant bipolar I disorder currently experiencing moderate to severe depression were treated with open-label SAINT. Resting-state functional MRI (fMRI) was used to generate individualized treatment targets for each participant based on the region of the left dorsolateral prefrontal cortex most anticorrelated with the subgenual anterior cingulate cortex. Participants were treated with 10 iTBS sessions daily, with 50-min intersession intervals, for up to 5 consecutive days. The primary outcome was change in Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to immediate follow-up after treatment. RESULTS: We treated 10 participants and found a mean reduction of 16.9 in MADRS scores, with a 50 % response rate and 40 % remission rate immediately following treatment. 60 % of participants met remission criteria within the 1-month period following treatment. No serious adverse events, manic episodes, or cognitive side effects were observed. LIMITATIONS: Our study has a limited sample size and larger samples are needed to confirm safety and efficacy. CONCLUSIONS: SAINT has shown preliminary feasibility, safety, tolerability, and efficacy in treating treatment-resistant bipolar I depression. Double-blinded sham-controlled trials with larger samples are needed to confirm safety and efficacy.


Asunto(s)
Trastorno Bipolar , Estudios de Factibilidad , Imagen por Resonancia Magnética , Estimulación Magnética Transcraneal , Humanos , Trastorno Bipolar/terapia , Masculino , Femenino , Adulto , Persona de Mediana Edad , Estimulación Magnética Transcraneal/métodos , Estimulación Magnética Transcraneal/efectos adversos , Resultado del Tratamiento , Trastorno Depresivo Resistente al Tratamiento/terapia , Giro del Cíngulo/diagnóstico por imagen , Escalas de Valoración Psiquiátrica , Depresión/terapia , Corteza Prefontal Dorsolateral
3.
J Urol ; : 101097JU0000000000004188, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-39088547

RESUMEN

INTRODUCTION AND OBJECTIVES: Several factors influence recurrence after urethral stricture repair. The impact of socioeconomic factors on stricture recurrence after urethroplasty is poorly understood. This study aims to assess the impact that social deprivation, an area-level measure of disadvantage, has on urethral stricture recurrence after urethroplasty. METHODS: We performed a retrospective review of patients undergoing urethral reconstruction by surgeons participating in a collaborative research group. Home zip code was used to calculate Social Deprivation Indices (SDI; 0-100), which quantifies the level of disadvantage across several sociodemographic domains collected in the American Community Survey. Patients without zip code data were excluded from the analysis. The Cox Proportional Hazards model was used to study the association between SDI and the hazard of functional recurrence, adjusting for stricture characteristics as well as age and body mass index. RESULTS: Median age was 46.0 years with a median follow up of 367 days for the 1452 men included in the study. Patients in the fourth SDI quartile (worst social deprivation) were more likely to be active smokers with traumatic and infectious strictures compared to the first SDI quartile. Patients in the fourth SDI quartile had 1.64 times the unadjusted hazard of functional stricture recurrence vs patients in the first SDI quartile (95% CI 1.04-2.59). Compared to anastomotic ± excision, substitution only repair had 1.90 times the unadjusted hazard of recurrence. The adjusted hazard of recurrence was 1.08 per 10-point increase in SDI (95% CI 1.01-1.15, P = .027). CONCLUSIONS: Patient social deprivation identifies those at higher risk for functional recurrence after anterior urethral stricture repair, offering an opportunity for preoperative counseling and postoperative surveillance. Addressing these social determinants of health can potentially improve outcomes in reconstructive surgery.

4.
Mol Cancer Ther ; : OF1-OF16, 2024 Aug 16.
Artículo en Inglés | MEDLINE | ID: mdl-39150446

RESUMEN

Improvement of outcome in patients with pancreatic ductal adenocarcinoma (PDAC) requires exploration of novel therapeutic targets. Thus far, most studies of PDAC therapies, including those inhibiting small ubiquitin-like modifications (SUMOylation), have focused on PDAC epithelial cell biology, yet SUMOylation occurs in a variety of cell types. The mechanisms by which SUMOylation impacts PDAC in the context of its tumor microenvironment are poorly understood. We used clinically relevant orthotopic PDAC mouse models to investigate the effect of SUMOylation inhibition using a specific, clinical-stage compound, TAK-981. In contrast to its inhibition of PDAC cell proliferation in vitro, the survival benefit conferred by TAK-981 in vivo is dependent on the presence of T cells, suggesting that induction of adaptive antitumor immunity is an important antitumor effect of SUMOylation inhibition in vivo. To understand how this adaptive antitumor immunity is promoted, we investigated how SUMOylation inhibition in vivo alters major cell types/subtypes and their communications in the PDAC tumor microenvironment by performing transcriptomic analyses at single-cell resolution, which allowed mapping of cells in our orthotopic mouse model to cells in human PDAC tumors based on gene expression profiles. Findings are further validated by flow cytometry, immunofluorescence, IHC, western blots, and qPCR. The single-cell transcriptome dataset provided here suggests several combination strategies to augment adaptive immune responses that are necessary for durable disease control in patients with PDAC.

5.
Nat Commun ; 15(1): 7515, 2024 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-39209820

RESUMEN

Aging is characterized by chronic systemic inflammation and metabolic changes. We compare the metabolic status of B cells from young and elderly donors and found that aging is associated with higher oxygen consumption rates, and especially higher extracellular acidification rates, measures of oxidative phosphorylation and of anaerobic glycolysis, respectively. Importantly, this higher metabolic status, which reflects age-associated expansion of pro-inflammatory B cells, is found associated with higher secretion of lactate and autoimmune antibodies after in vitro stimulation. B cells from elderly individuals induce in vitro polarization of CD4+ T cells from young individuals into pro-inflammatory CD4+ T cells through metabolic pathways mediated by lactate, which can be inhibited by targeting lactate enzymes and transporters, as well as signaling pathways supporting anaerobic glycolysis. Lactate also induces immunosenescent B cells that are glycolytic, express transcripts for multiple pro-inflammatory molecules, and are characterized by a higher metabolic status. These results altogether may have relevant clinical implications and suggest alternative targets for therapeutic interventions in the elderly and patients with inflammatory conditions and diseases.


Asunto(s)
Envejecimiento , Linfocitos B , Linfocitos T CD4-Positivos , Glucólisis , Inmunidad Humoral , Ácido Láctico , Humanos , Ácido Láctico/metabolismo , Inmunidad Humoral/efectos de los fármacos , Glucólisis/efectos de los fármacos , Anciano , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/efectos de los fármacos , Linfocitos T CD4-Positivos/metabolismo , Envejecimiento/inmunología , Adulto , Linfocitos B/inmunología , Linfocitos B/efectos de los fármacos , Linfocitos B/metabolismo , Masculino , Femenino , Persona de Mediana Edad , Adulto Joven , Fosforilación Oxidativa/efectos de los fármacos , Voluntarios Sanos , Factores de Edad
6.
J Med Internet Res ; 26: e56500, 2024 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-39167785

RESUMEN

BACKGROUND: Large language models including GPT-4 (OpenAI) have opened new avenues in health care and qualitative research. Traditional qualitative methods are time-consuming and require expertise to capture nuance. Although large language models have demonstrated enhanced contextual understanding and inferencing compared with traditional natural language processing, their performance in qualitative analysis versus that of humans remains unexplored. OBJECTIVE: We evaluated the effectiveness of GPT-4 versus human researchers in qualitative analysis of interviews with patients with adult-acquired buried penis (AABP). METHODS: Qualitative data were obtained from semistructured interviews with 20 patients with AABP. Human analysis involved a structured 3-stage process-initial observations, line-by-line coding, and consensus discussions to refine themes. In contrast, artificial intelligence (AI) analysis with GPT-4 underwent two phases: (1) a naïve phase, where GPT-4 outputs were independently evaluated by a blinded reviewer to identify themes and subthemes and (2) a comparison phase, where AI-generated themes were compared with human-identified themes to assess agreement. We used a general qualitative description approach. RESULTS: The study population (N=20) comprised predominantly White (17/20, 85%), married (12/20, 60%), heterosexual (19/20, 95%) men, with a mean age of 58.8 years and BMI of 41.1 kg/m2. Human qualitative analysis identified "urinary issues" in 95% (19/20) and GPT-4 in 75% (15/20) of interviews, with the subtheme "spray or stream" noted in 60% (12/20) and 35% (7/20), respectively. "Sexual issues" were prominent (19/20, 95% humans vs 16/20, 80% GPT-4), although humans identified a wider range of subthemes, including "pain with sex or masturbation" (7/20, 35%) and "difficulty with sex or masturbation" (4/20, 20%). Both analyses similarly highlighted "mental health issues" (11/20, 55%, both), although humans coded "depression" more frequently (10/20, 50% humans vs 4/20, 20% GPT-4). Humans frequently cited "issues using public restrooms" (12/20, 60%) as impacting social life, whereas GPT-4 emphasized "struggles with romantic relationships" (9/20, 45%). "Hygiene issues" were consistently recognized (14/20, 70% humans vs 13/20, 65% GPT-4). Humans uniquely identified "contributing factors" as a theme in all interviews. There was moderate agreement between human and GPT-4 coding (κ=0.401). Reliability assessments of GPT-4's analyses showed consistent coding for themes including "body image struggles," "chronic pain" (10/10, 100%), and "depression" (9/10, 90%). Other themes like "motivation for surgery" and "weight challenges" were reliably coded (8/10, 80%), while less frequent themes were variably identified across multiple iterations. CONCLUSIONS: Large language models including GPT-4 can effectively identify key themes in analyzing qualitative health care data, showing moderate agreement with human analysis. While human analysis provided a richer diversity of subthemes, the consistency of AI suggests its use as a complementary tool in qualitative research. With AI rapidly advancing, future studies should iterate analyses and circumvent token limitations by segmenting data, furthering the breadth and depth of large language model-driven qualitative analyses.


Asunto(s)
Investigación Cualitativa , Humanos , Masculino , Adulto , Persona de Mediana Edad , Análisis de Datos , Investigadores/psicología , Investigadores/estadística & datos numéricos , Anciano
7.
JAMA Netw Open ; 7(7): e2424131, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-39042404

RESUMEN

Importance: Micromobility, the use of small vehicles (primarily scooters and bicycles), has become a standard transportation method in the US. Despite broad adoption of electric micromobility vehicles, there is a paucity of data regarding the injury profiles of these vehicles, particularly in the US. Objective: To characterize micromobility injury trends in the US, identify demographic characteristic differences in users of electric and conventional vehicles, and identify factors associated with hospitalization. Design, Setting, and Participants: This cross-sectional study queried the National Electronic Injury Surveillance System, a comprehensive database that collates injury data associated with consumer products from emergency departments across the US to provide national estimates, from calendar year 2017 to 2022. Data on micromobility vehicle injuries (bicycles, scooters, electric bicycles [e-bicycles], and electric scooters [e-scooters]) were obtained. Main Outcomes and Measures: Trends in injury and hospitalization counts, injury characteristics, and factors associated with hospitalization. Results: From 2017 to 2022, the US recorded 2 499 843 bicycle (95% CI, 1 948 539-3 051 147), 304 783 scooter (95% CI, 232 466-377 099), 45 586 e-bicycle (95% CI, 17 684-73 488), and 189 517 e-scooter (95% CI, 126 101-252 932) injuries. The median age of the riders was 28 (IQR, 12-51) years; 72% were male, 1.5% Asian, 13% Black, 12% Hispanic, and 49% White. Annual e-bicycle and e-scooter injuries increased from 751 (95% CI, 0-1586) to 23 493 (95% CI, 11 043-35 944) and injuries increased from 8566 (95% CI, 5522-11 611) to 56 847 (95% CI, 39 673-74 022). Compared with conventional vehicles, electric vehicle accidents involved older individuals (median age, 31 vs 27 years; P < .001) and a higher proportion of Black riders (25% vs 12%; P < .001). Helmet use was less in electric vehicle incidents compared with conventional vehicles (43% vs 52%; P = .02), and injuries were more common in urban settings (83% vs 71%; P = .008). Age-adjusted odds of hospitalization among all Black individuals compared with White individuals was 0.76 (95% CI, 0.59-0.98; P = .04). Conclusions and Relevance: In this cross-sectional study of micromobility vehicles, an increased number of injuries and hospitalizations was observed with electric vehicles compared with conventional vehicles from 2017 to 2022. These findings suggest the need for change in educational policies, infrastructure, and law to recenter on safety with the use of micromobility vehicles.


Asunto(s)
Accidentes de Tránsito , Ciclismo , Hospitalización , Humanos , Masculino , Femenino , Estudios Transversales , Adulto , Persona de Mediana Edad , Adolescente , Ciclismo/lesiones , Ciclismo/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto Joven , Niño , Accidentes de Tránsito/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Heridas y Lesiones/epidemiología , Anciano , Motocicletas/estadística & datos numéricos , Preescolar
8.
Urol Pract ; 11(4): 678-683, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38899674

RESUMEN

INTRODUCTION: Patient perceptions of physician reimbursement commonly differ from actual reimbursement. This study aims to improve health care cost transparency and trust between patients, physicians, and the health care system by evaluating patient perceptions of Medicare reimbursement for artificial urinary sphincter (AUS) placement. METHODS: We identified patients who underwent AUS placement at a single institution from 2014 to 2023. After obtaining informed consent, we administered a telephone survey to ask patients about their perceptions of Medicare reimbursement for AUS surgery and the amount they felt the physician should be compensated. RESULTS: Sixty-four patients were enrolled and completed the survey. On average, patients estimated Medicare physician reimbursement to be $18,920, 25 times the actual average procedure reimbursement. Once informed that the actual amount was $757.52, 97% of respondents felt that the reimbursement was "somewhat lower" (13%) or "much lower" (84%) than what they considered fair. The average amount that patients felt the physician should be paid was $8,844, 12 times the actual average procedure reimbursement. Fifty-four percent of patients estimated their physician's reimbursement to be higher than what they later reported as being "fair," representing a presurvey belief that their physician was overpaid. CONCLUSIONS: Patient perceptions of physician reimbursement for AUS are vastly different than the actual amount paid. The discordance between patient perception and actual reimbursement could impact how patients view health care costs and the relationship with their provider.


Asunto(s)
Medicare , Esfínter Urinario Artificial , Humanos , Medicare/economía , Estados Unidos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Anciano de 80 o más Años , Encuestas y Cuestionarios , Reembolso de Seguro de Salud , Percepción
9.
Urology ; 2024 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-38942394

RESUMEN

OBJECTIVE: To determine whether early versus delayed autotransplantation are associated with adverse outcomes in patients undergoing renal autotransplantation. METHODS: Patients who underwent renal autotransplantation from June 2012 to September 2022 were divided into 2 groups based on timing of autotransplant in relation to initial intervention or diagnosis (early cohort: ≤1-year; delayed cohort: >1-year). Primary outcomes were perioperative complications, aborted surgery, renal function (glomerular filtration rate [GFR]), and postoperative complications at most recent follow-up. RESULTS: Autotransplantation patients (N = 72) were predominantly female (68%) and White (54%), with a median age of 49 years. Ninety percentage of patients had undergone previous interventions, including stenting (40%) and nephrostomy tubes (49%), primarily for obstruction (64%). Early versus delayed cohorts had median preoperative disease durations of 143 (IQR 83-222) versus 673 days (IQR 529-1703, P <.001), with similar median follow-up times (879 vs 818 days, P = .8). Groups were similar in demographics and comorbidities. There were no significant differences in rates of aborted surgery (15% vs 4.2%, P = .3), perioperative complications (15% vs 17%, P > .9), long-term complications (49% vs 48%, P > .9), or changes in GFR (median change +3 vs +4, P = .7). Outcomes were comparable across preoperative disease durations ranging from 6 to 24 months. These findings were confirmed following adjustments for sex, body mass index, American Society of Anesthesiologists classification, race, preoperative creatinine levels, laterality, gastroesophageal reflux disease, diabetes, hypertension, nephrolithiasis, hyperlipidemia, history of colon surgery, urologic surgery, abdominal surgery, and prior interventions in separate logistic models. CONCLUSION: Disease duration before autotransplantation does not influence outcomes, offering reassurance for clinical decision-making in complex cases.

10.
Cancer Res Commun ; 4(7): 1834-1849, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38856710

RESUMEN

Glioblastoma (GBM) is the most common malignant primary brain tumor and remains incurable. Previous work has shown that systemic administration of Decitabine (DAC) induces sufficient expression of cancer-testis antigens (CTA) in GBM for targeting by adoptive T-cell therapy in vivo. However, the mechanisms by which DAC enhances immunogenicity in GBM remain to be elucidated. Using New York esophageal squamous cell carcinoma 1 (NY-ESO-1) as a representative inducible CTA, we demonstrate in patient tissue, immortalized glioma cells, and primary patient-derived gliomaspheres that basal CTA expression is restricted by promoter hypermethylation in gliomas. DAC treatment of glioma cells specifically inhibits DNA methylation silencing to render NY-ESO-1 and other CTA into inducible tumor antigens at single-cell resolution. Functionally, NY-ESO-1 T-cell receptor-engineered effector cell targeting of DAC-induced antigen in primary glioma cells promotes specific and polyfunctional T-cell cytokine profiles. In addition to induction of CTA, DAC concomitantly reactivates tumor-intrinsic human endogenous retroviruses, interferon response signatures, and MHC-I. Overall, we demonstrate that DAC induces targetable tumor antigen and enhances T-cell functionality against GBM, ultimately contributing to the improvement of targeted immune therapies in glioma. SIGNIFICANCE: This study dissects the tumor-intrinsic epigenetic and transcriptional mechanisms underlying enhanced T-cell functionality targeting decitabine-induced cancer-testis antigens in glioma. Our findings demonstrate concomitant induction of tumor antigens, reactivation of human endogenous retroviruses, and stimulation of interferon signaling as a mechanistic rationale to epigenetically prime human gliomas to immunotherapeutic targeting.


Asunto(s)
Antígenos de Neoplasias , Neoplasias Encefálicas , Decitabina , Retrovirus Endógenos , Epigénesis Genética , Glioma , Humanos , Antígenos de Neoplasias/inmunología , Antígenos de Neoplasias/genética , Decitabina/farmacología , Decitabina/uso terapéutico , Glioma/inmunología , Glioma/genética , Retrovirus Endógenos/genética , Neoplasias Encefálicas/inmunología , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patología , Metilación de ADN , Línea Celular Tumoral , Análisis de la Célula Individual , Regulación Neoplásica de la Expresión Génica , Proteínas de la Membrana/genética , Proteínas de la Membrana/metabolismo , Regiones Promotoras Genéticas , Glioblastoma/inmunología , Glioblastoma/genética , Glioblastoma/patología
11.
J Manag Care Spec Pharm ; 30(5): 480-489, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38701025

RESUMEN

BACKGROUND: Rituximab (RTX) is an anti-CD20 monoclonal antibody that is used to treat various conditions in cancer, rheumatoid arthritis (RA), and multiple sclerosis (MS). Although RTX has been used in the United States for almost 3 decades, questions remain regarding its real-world utilization and effectiveness. OBJECTIVE: To describe the state of observational research and real-world evidence evaluating RTX in oncology, RA, and off-label use in MS. METHODS: A broad search was conducted in MEDLINE, Embase, and CINAHL covering the period of January 2010 to June 2022. Two reviewers independently screened all identified records for each disease category (cancer, RA, MS) beginning with title review, followed by abstract, and full-text review to identify relevant publications to include in the final analysis. Data were extracted and summarized for each disease based on overall trends, similarities, and differences across included studies and stratified by disease state. RESULTS: A total of 260 studies met eligibility criteria, with 79 studies for the RA cohort, 144 for cancer, and 37 for MS. Across all disease cohorts, most studies (n = 189; 72.7%) were retrospective. 171 (65.8%) studies used hospital or electronic health record data as their data source and 65 (23.2%) used registry databases. Most studies (n = 153; 58.8%) assessed the effectiveness of RTX measured by disease-specific endpoints, followed by safety (n = 60; 23.1%), treatment patterns (n = 32; 12.3%), and descriptive analyses assessing treatment adherence and economic burden of disease (n = 16; 6.2%). Although safety was not the primary outcome for most studies, the majority of studies across all disease states still reported some form of safety measure. Conclusive statements on RTX's benefit varied across disease states, with MS having the most (n = 30; 81.1%) studies suggesting the drug's positive benefit. There were limited studies assessing RTX use, associated economic burden, and biosimilar switching. CONCLUSIONS: The findings underscore the need for health care providers to better understand the treatment landscape and utilization of RTX, particularly in terms of patient selection, timing of initiation, and long-term outcomes. Real-world evidence can help support health care decisions and treatment using rituximab.


Asunto(s)
Artritis Reumatoide , Esclerosis Múltiple , Neoplasias , Rituximab , Humanos , Esclerosis Múltiple/tratamiento farmacológico , Rituximab/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Neoplasias/tratamiento farmacológico , Antirreumáticos/uso terapéutico , Resultado del Tratamiento , Estudios Observacionales como Asunto , Uso Fuera de lo Indicado
12.
Neurourol Urodyn ; 43(7): 1523-1533, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38594889

RESUMEN

PURPOSE: Overactive bladder (OAB) syndrome significantly impairs quality of life, often necessitating pharmacological interventions with associated risks. The fragility of OAB trial outcomes, as measured by the fragility index (FI: smallest number of event changes to reverse statistical significance) and quotient (FQ: FI divided by total sample size expressed as a percentage), is critical yet unstudied. MATERIALS AND METHODS: We conducted a systematic search for randomized controlled trials on OAB medications published between January 2000 and August 2023. Inclusion criteria were trials with two parallel arms reporting binary outcomes related to OAB medications. We extracted trial details, outcomes, and statistical tests employed. We calculated FI and FQ, analyzing associations with trial characteristics through linear regression. RESULTS: We included 57 trials with a median sample size of 211 participants and a 12% median lost to follow-up. Most studies investigated anticholinergics (37/57, 65%). The median FI/FQ was 5/3.5%. Larger trials were less fragile (median FI 8; FQ 1.0%) compared to medium (FI: 4; FQ 2.5%) and small trials (FI: 4; FQ 8.3%). Double-blinded studies exhibited higher FQs (median 2.9%) than unblinded trials (6.7%). Primary and secondary outcomes had higher FIs (median 5 and 6, respectively) than adverse events (FI: 4). Each increase in 10 participants was associated with a +0.19 increase in FI (p < 0.001). CONCLUSIONS: A change in outcome for a median of five participants, or 3.5% of the total sample size, could reverse the direction of statistical significance in OAB trials. Studies with larger sample sizes and efficacy outcomes from blinded trials were less fragile.


Asunto(s)
Ensayos Clínicos Controlados Aleatorios como Asunto , Vejiga Urinaria Hiperactiva , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Vejiga Urinaria Hiperactiva/fisiopatología , Vejiga Urinaria Hiperactiva/diagnóstico , Humanos , Resultado del Tratamiento , Antagonistas Colinérgicos/efectos adversos , Antagonistas Colinérgicos/uso terapéutico
13.
Urol Case Rep ; 54: 102717, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38617183

RESUMEN

Nutcracker Syndrome (NCS) is characterized by entrapment of the left renal vein, leading hematuria, flank pain, and proteinuria. We evaluated the efficacy of renal autotransplantation as a curative treatment for NCS through a review and case report. 55 patients from 18 studies were analyzed, with a combined 91% success rate of symptom resolution or improvement post-autotransplantation. In our case report, a 25-year-old man with severe NCS received laparoscopic nephrectomy and autotransplant, resulting in symptom resolution at 3.1 years follow up. Further research should confirm these findings and refine patient selection criteria and surgical techniques.

14.
J Expo Sci Environ Epidemiol ; 34(4): 709-717, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38548929

RESUMEN

BACKGROUND: Lead (Pb) in house dust contributes significantly to blood lead levels (BLLs) in children which may result in dire health consequences. Assessment of house dust Pb in the United States, relationships with Pb in soil and paint, and residential factors influencing Pb concentrations are essential to probing drivers of house dust Pb exposure. OBJECTIVE: Pb concentrations in vacuum-collected house dust are characterized across 346 homes participating in the American Health Homes Survey II (AHHS II), a US survey (2018-2019) evaluating residential Pb hazards. Connections between house dust Pb and soil Pb, paint Pb, and other residential factors are evaluated, and dust Pb concentration data are compared to paired loading data to understand Pb hazard standard implications. RESULTS: Mean and median vacuum dust Pb concentrations were 124 µg Pb g-1 and 34 µg Pb g-1, respectively. Vacuum-collected dust concentrations and dust wipe Pb loading rates were significantly correlated within homes (α < 0.001; r ≥ 0.4). At least one wipe sample exceeded current house dust Pb loading hazard standards (10 µg ft-2 or 100 µg Pb ft-2 for floors and windowsills, respectively) in 75 of 346 homes (22%). House dust Pb concentrations were correlated with soil Pb (r = 0.64) and Pb paint (r = 0.57). Soil Pb and paint Pb were also correlated (r = 0.6). IMPACT: The AHHS II provides a window into the current state of Pb in and around residences. We evaluated the relationship between house dust Pb concentrations and two common residential Pb sources: soil and Pb-based paint. Here, we identify relationships between Pb concentrations from vacuum-collected dust and paired Pb wipe loading data, enabling dust Pb concentrations to be evaluated in the context of hazard standards. This relationship, along with direct ties to Pb in soil and interior/exterior paint, provides a comprehensive assessment of dust Pb for US homes, crucial for formulating effective strategies to mitigate Pb exposure risks in households.


Asunto(s)
Polvo , Exposición a Riesgos Ambientales , Vivienda , Plomo , Pintura , Suelo , Polvo/análisis , Plomo/análisis , Plomo/sangre , Pintura/análisis , Humanos , Estados Unidos , Suelo/química , Exposición a Riesgos Ambientales/análisis , Contaminantes del Suelo/análisis , Monitoreo del Ambiente/métodos , Contaminación del Aire Interior/análisis , Encuestas y Cuestionarios , Niño
15.
Nat Commun ; 15(1): 1906, 2024 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-38503774

RESUMEN

Identifying key patterns of tactics implemented by rival teams, and developing effective responses, lies at the heart of modern football. However, doing so algorithmically remains an open research challenge. To address this unmet need, we propose TacticAI, an AI football tactics assistant developed and evaluated in close collaboration with domain experts from Liverpool FC. We focus on analysing corner kicks, as they offer coaches the most direct opportunities for interventions and improvements. TacticAI incorporates both a predictive and a generative component, allowing the coaches to effectively sample and explore alternative player setups for each corner kick routine and to select those with the highest predicted likelihood of success. We validate TacticAI on a number of relevant benchmark tasks: predicting receivers and shot attempts and recommending player position adjustments. The utility of TacticAI is validated by a qualitative study conducted with football domain experts at Liverpool FC. We show that TacticAI's model suggestions are not only indistinguishable from real tactics, but also favoured over existing tactics 90% of the time, and that TacticAI offers an effective corner kick retrieval system. TacticAI achieves these results despite the limited availability of gold-standard data, achieving data efficiency through geometric deep learning.


Asunto(s)
Rendimiento Atlético , Rendimiento Atlético/fisiología , Investigación Cualitativa , Fútbol
16.
JAMA Netw Open ; 7(3): e245537, 2024 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-38551567

RESUMEN

This cross-sectional study estimates the number of average-risk colorectal cancer screening­eligible individuals in the US since the US Preventive Services Task Force updated its recommendations in 2021.


Asunto(s)
Neoplasias Colorrectales , Detección Precoz del Cáncer , Humanos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Servicios Preventivos de Salud
17.
JAMA Surg ; 159(5): 586-588, 2024 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-38381444

RESUMEN

This cross-sectional study investigates injury trends associated with electric bicycles in the US from 2017 to 2022.


Asunto(s)
Ciclismo , Hospitalización , Humanos , Ciclismo/lesiones , Hospitalización/estadística & datos numéricos , Masculino , Femenino , Adulto , Traumatismos por Electricidad , Persona de Mediana Edad , Adulto Joven , Adolescente
18.
Chemphyschem ; 25(10): e202400071, 2024 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-38372591

RESUMEN

We investigate ion formation in hydrated formic acid (FA) clusters upon collision with electrons of variable energy, focusing on electron ionization at 70 eV (EI) and low-energy (1.5-15 eV) electron attachment (EA). To uncover details about the composition of neutral clusters, we aim to elucidate the ion formation processes in FAM ⋅ WN clusters initiated by interaction with electrons and determine the extent of cluster fragmentation. EI predominantly produces protonated [FAm+H]+ ions, and in FA-rich clusters, the stable ring structures surrounding H3O+ ions are formed. In contrast, EA leads to a competition between the formation of intact [FAm ⋅ Wn]- and dissociated [FAm ⋅ Wn-H]- fragment ions, influenced by the cluster size, level of hydration, and electron energy. Our findings reveal a predisposition of low-energy EA towards forming [FAm ⋅ Wn]-, while higher electron energies tend to favor the formation of [FAm ⋅ Wn-H]- due to intracluster ion-molecule reactions. The comparison of positive and negative ion spectra suggests that the mass spectra of FA-rich clusters may indicate their actual size and composition. On the other hand, the more weakly bound water evaporation from the clusters depends strongly on the ionization. Thus, for the hydrated clusters, the neutral cluster size can hardly be estimated from the mass spectra.

19.
BMJ Case Rep ; 17(2)2024 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-38378585

RESUMEN

Rectal squamous cell carcinoma is an exceedingly rare form of rectal cancer, with limited data available regarding its presentation and effective treatment. Rectal cancer occurring during pregnancy is uncommon as well. This is a case of metastatic rectal squamous cell carcinoma presenting in a 22-week pregnant, female patient in her early 30s. The patient was treated with 5-fluorouracil and cisplatin and delivered a healthy male child born via uncomplicated vaginal delivery at 35 weeks. This article demonstrates that despite the rare nature of this cancer, in the already rare context of pregnancy, effective and safe treatment is possible with a multidisciplinary team.


Asunto(s)
Carcinoma de Células Escamosas , Neoplasias del Recto , Embarazo , Niño , Humanos , Masculino , Femenino , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Recto/patología , Carcinoma de Células Escamosas/patología , Fluorouracilo/uso terapéutico , Resultado del Tratamiento , Cisplatino/uso terapéutico
20.
PLOS Glob Public Health ; 4(2): e0002851, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38354206

RESUMEN

Both migrants and young people experience disproportionately high rates of HIV acquisition and poor access to HIV prevention and treatment services. To develop effective interventions and reach epidemic control, it is necessary to understand the barriers and facilitators to accessing HIV services among migrant youth. We conducted a scoping review to identify these factors for migrant youth ages 15-24, globally. We conducted a PRISMA-concordant scoping review using keyword searches in PUBMED and Web of Science for peer-reviewed primary literature published between January 2012 and October 2022. We included studies that investigated barriers and facilitators to accessing services for migrant youth participants. We used the Socio-Ecological Model as an analytical framework. The 20 studies meeting the inclusion criteria spanned 10 countries, of which 80% (n = 16) were low- and middle-income countries. Study methods included were quantitative (40%), qualitative (55%), and mixed methods (5%). Six studies included refugee youth (30%), 6 included migrant worker youth (30%), 3 included immigrant youth (15%), 2 included rural migrant youth (10%), and 1 included immigrants and refugees. The remainder represented unspecified migrant youth populations (10%). At the individual level, education level and fear of infection acted as barriers and facilitators to HIV services. At the relationship level, social support and power in relationships acted as barriers and facilitators to HIV services. At the community level, barriers to HIV services included discrimination and stigma, while community and religious outreach efforts facilitated access to HIV services. At the structural level, barriers to HIV services included stigmatizing social norms, lack of health insurance, and legal barriers. Migrant youth face significant, unique barriers to accessing HIV services. However, facilitators exist that can be leveraged to enable access. Future implementation science research, enabling policies, and adapted programmatic interventions should prioritize migrant youth as a distinctive sub-population to receive targeted HIV services.

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