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We used aerosol mass spectrometry coupled with tunable synchrotron photoionization to measure radical and closed-shell species associated with particle formation in premixed flames and during pyrolysis of butane, ethylene, and methane. We analyzed photoionization (PI) spectra for the C7H7 radical to identify the isomers present during particle formation. For the combustion and pyrolysis of all three fuels, the PI spectra can be fit reasonably well with contributions from four radical isomers: benzyl, tropyl, vinylcyclopentadienyl, and o-tolyl. Although there are significant experimental uncertainties in the isomeric speciation of C7H7, the results clearly demonstrate that the isomeric composition of C7H7 strongly depends on the combustion or pyrolysis conditions and the fuel or precursors. Fits to the PI spectra using reference curves for these isomers suggest that all of these isomers may contribute to m/z 91 in butane and methane flames, but only benzyl and vinylcyclopentadienyl contribute to the C7H7 isomer signal in the ethylene flame. Only tropyl and benzyl appear to play a role during pyrolytic particle formation from ethylene, and only tropyl, vinylcyclopentadienyl, and o-tolyl appear to participate during particle formation from butane pyrolysis. There also seems to be a contribution from an isomer with an ionization energy below 7.5 eV for the flames but not for the pyrolysis conditions. Kinetic models with updated and new reactions and rate coefficients for the C7H7 reaction network predict benzyl, tropyl, vinylcyclopentadienyl, and o-tolyl to be the primary C7H7 isomers and predict negligible contributions from other C7H7 isomers. These updated models provide better agreement with the measurements than the original versions of the models but, nonetheless, underpredict the relative concentrations of tropyl, vinylcyclopentadienyl, and o-tolyl in both flames and pyrolysis and overpredict benzyl in pyrolysis. Our results suggest that there are additional important formation pathways for the vinylcyclopentadienyl, tropyl, and o-tolyl radicals and/or loss pathways for the benzyl radical that are currently unaccounted for in the present models.
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OBJECTIVE: To investigate whether gastric bypass before pregnancy is associated with reduced risk of pre-eclampsia. DESIGN: Nationwide matched cohort study. SETTING: Swedish national health care. POPULATION: A total of 843 667 singleton pregnancies without pre-pregnancy hypertension were identified in the Swedish Medical Birth Register between 2007 and 2014, of which 2930 had a history of gastric bypass and a pre-surgery weight available from the Scandinavian Obesity Surgery Registry. Two matched control groups (pre-surgery and early-pregnancy body mass index [BMI]) were propensity score matched separately for nulliparous and parous births, to post-gastric bypass pregnancies (npre-surgery-BMI = 2634:2634/nearly-pregnancy-BMI = 2766:2766) on pre-surgery/early-pregnancy BMI, diabetes status (pre-surgery/pre-conception), maternal age, early-pregnancy smoking status, educational level, height, country of birth, delivery year and history of pre-eclampsia. MAIN OUTCOME MEASURES: Pre-eclampsia categorised into any, preterm onset (<37+0 weeks) and term onset (≥37+0 weeks). RESULTS: In post-gastric bypass pregnancies, mean pre-surgery BMI was 42.9 kg/m2 and mean BMI loss between surgery and early pregnancy was 14.0 kg/m2 (39 kg). Post-gastric bypass pregnancies had lower risk of pre-eclampsia compared with pre-surgery BMI-matched controls (1.7 versus 9.7 per 100 pregnancies; hazard ratio [HR] 0.21, 95% CI 0.15-0.28) and early-pregnancy BMI-matched controls (1.9 versus 5.0 per 100 pregnancies; HR 0.44, 95% CI 0.33-0.60). Although relative risks for pre-eclampsia for post-gastric bypass pregnancies versus pre-surgery matched controls was similar, absolute risk differences (RD) were significantly greater for nulliparous women (RD -13.6 per 100 pregnancies, 95% CI -16.1 to -11.2) versus parous women (RD -4.4 per 100 pregnancies, 95% CI -5.7 to -3.1). CONCLUSION: We found that gastric bypass was associated with lower risk of pre-eclampsia, with the largest absolute risk reduction among nulliparous women. TWEETABLE ABSTRACT: In this large study including two comparison groups matched for pre-surgery or early-pregnancy BMI, gastric bypass was associated with lower risk of pre-eclampsia.
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Cirurgia Bariátrica/efeitos adversos , Derivação Gástrica/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Pré-Eclâmpsia/epidemiologia , Adulto , Cirurgia Bariátrica/métodos , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Pré-Eclâmpsia/etiologia , Gravidez , Pontuação de Propensão , Fatores de Risco , SuéciaRESUMO
We have developed a strategy for distinguishing between small-angle X-ray scattering (SAXS) from gas-phase species and newly formed nanoparticles in mixed gas- and particle-phase reacting flows. This methodology explicitly accounts for temperature-dependent scattering from gases. We measured SAXS in situ in a sooting linear laminar partially premixed co-flow ethylene/air diffusion flame. The scattering signal demonstrates a downward curvature as a function of the momentum transfer (q) at q values of 0.2-0.57 Å-1. The q-dependent curvature is consistent with the Debye equation and the independent-atom model for gas-phase scattering. This behavior can also be modeled using the Guinier approximation and could be characterized as a Guinier knee for gas-phase scattering. The Guinier functional form can be fit to the scattering signal in this q range without a priori knowledge of the gas-phase composition, enabling estimation of the gas-phase contribution to the scattering signal while accounting for changes in the gas-phase composition and temperature. We coupled the SAXS measurements with in situ temperature measurements using coherent anti-Stokes Raman spectroscopy. This approach to characterizing the gas-phase SAXS signal provides a physical basis for distinguishing among the contributions to the scattering signal from the instrument function, flame gases, and nanoparticles. The results are particularly important for the analysis of the SAXS signal in the q range associated with particles in the size range of 1-6 nm.
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OBJECTIVE: Studies on pregnancy outcomes in psoriatic arthritis (PsA) are scarce and typically of small size. Available studies have reported conflicting results. The aim of this study was to describe maternal and infant pregnancy outcomes among women with PsA compared with women without PsA. DESIGN: Nationwide cohort study. SETTING: Nationwide Swedish registers. POPULATION: A total of 41 485 singleton pregnancies in 1997-2014, of which 541 pregnancies were identified with PsA exposure and 40 944 pregnancies were unexposed. METHODS: By linkage of national health and population register data, we obtained information on individual pregnancies and compared outcomes among pregnancies with PsA and non-PsA pregnancies. Relative risks were estimated by odds ratios (ORs) with 95% CIs using a generalised linear regression model with generalised estimating equations. Adjustments were made for maternal factors and calendar year of birth. MAIN OUTCOME MEASURES: Maternal and infant pregnancy outcomes. RESULTS: Pregnancies to women with PsA had increased risks of preterm birth (adjusted OR 1.63; 95% CI 1.17-2.28), elective and emergency caesarean deliveries (adjusted OR 1.47; 95% CI 1.10-1.97 and adjusted OR 1.43; 95% CI 1.08-1.88, respectively) compared with non-PsA pregnancies. No increased risks were observed for pre-eclampsia, stillbirth or other infant outcomes apart from preterm birth. CONCLUSION: The majority of women with PsA have uneventful pregnancies with respect to adverse outcomes. In the present study, we found increased risks of preterm birth and caesarean delivery compared with non-PsA pregnancies. TWEETABLE ABSTRACT: Women with psoriatic arthritis have uneventful pregnancies but are at increased risk of preterm birth and caesarean delivery.
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Artrite Psoriásica/fisiopatologia , Cesárea/estatística & dados numéricos , Obesidade/epidemiologia , Sistema de Registros/estatística & dados numéricos , Fumantes/estatística & dados numéricos , Adolescente , Adulto , Artrite Psoriásica/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Recém-Nascido , Masculino , Obesidade/fisiopatologia , Razão de Chances , Paridade , Gravidez , Resultado da Gravidez , Suécia/epidemiologia , Adulto JovemRESUMO
Many oxygenated hydrocarbon species formed during combustion, such as furans, are highly toxic and detrimental to human health and the environment. These species may also increase the hygroscopicity of soot and strongly influence the effects of soot on regional and global climate. However, large furans and associated oxygenated species have not previously been observed in flames, and their formation mechanism and interplay with polycyclic aromatic hydrocarbons (PAHs) are poorly understood. We report on a synergistic computational and experimental effort that elucidates the formation of oxygen-embedded compounds, such as furans and other oxygenated hydrocarbons, during the combustion of hydrocarbon fuels. We used ab initio and probabilistic computational techniques to identify low-barrier reaction mechanisms for the formation of large furans and other oxygenated hydrocarbons. We used vacuum-UV photoionization aerosol mass spectrometry and X-ray photoelectron spectroscopy to confirm these predictions. We show that furans are produced in the high-temperature regions of hydrocarbon flames, where they remarkably survive and become the main functional group of oxygenates that incorporate into incipient soot. In controlled flame studies, we discovered â¼100 oxygenated species previously unaccounted for. We found that large alcohols and enols act as precursors to furans, leading to incorporation of oxygen into the carbon skeletons of PAHs. Our results depart dramatically from the crude chemistry of carbon- and oxygen-containing molecules previously considered in hydrocarbon formation and oxidation models and spearhead the emerging understanding of the oxidation chemistry that is critical, for example, to control emissions of toxic and carcinogenic combustion by-products, which also greatly affect global warming.
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Poluentes Atmosféricos/análise , Incêndios , Furanos/química , Hidrocarbonetos/química , Oxigênio/química , Aerossóis/análise , Carbono/análise , Biologia Computacional/métodos , Espectrometria de Massas/métodos , Estrutura Molecular , Espectroscopia Fotoeletrônica/métodos , Hidrocarbonetos Policíclicos Aromáticos/análise , Fumaça/análise , Fuligem/análiseRESUMO
OBJECTIVE: To study the association between total and early pregnancy (<22 completed weeks) weight gain and risk of stillbirth, stratified by early-pregnancy body mass index (BMI). DESIGN: Population-based cohort study. SETTING: Stockholm-Gotland Region, Sweden. POPULATION: Pregnant women with singleton births (n = 160 560). METHODS: Pregnancy weight gain was standardised into gestational age-specific z-scores. For analyses of total pregnancy weight gain, a matched design with an incidence density sampling approach was used. Findings were also contrasted with current Institute of Medicine (IOM) weight gain recommendations. MAIN OUTCOME MEASURES: Stillbirth defined as fetal death at ≥22 completed weeks of gestation. RESULTS: For all BMI categories, there was no statistical association between total or early pregnancy weight gain and stillbirth within the range of a weight gain z-score of -2.0 SD to +2.0 SD. Among normal-weight women, the adjusted odds ratio of stillbirth for lower (-2.0 to -1.0 SD) and higher (+1.0 to +1.9 SD) total weight gain was 0.85 (95% CI; 0.48-1.49) and 1.03 (0.60-1.77), respectively, as compared with the reference category. Further, there were no associations between total or early pregnancy weight gain and stillbirth within the range of weight gain currently recommended by the IOM. For the majority of the BMI categories, the point estimates at the extremes of weight gain values (<-2.0SD and ≥2.0 SD) suggested protective effects of low weight gain and increased risks of high weight gain, but estimates were imprecise and not statistically significant. CONCLUSION: We found no associations between total or early pregnancy weight gain and stillbirth across the range of weight gain experienced by most women. TWEETABLE ABSTRACT: There was no association between weight gain during pregnancy and stillbirth among most women.
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Morte Fetal/etiologia , Idade Gestacional , Ganho de Peso na Gestação , Natimorto/epidemiologia , Adulto , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Gravidez , Fatores de Risco , Suécia/epidemiologia , Adulto JovemRESUMO
We and others have previously identified microRNAs (miRNAs) with pathological roles in animal models of asthma, where miR-146a and miR-155 have been described to play important roles in inflammatory responses. To date, few studies have investigated miRNA expression in human asthmatics. In the current study, significantly lower levels of miR-155 were detected in cell-free sputum from allergic asthmatics compared to healthy controls. Induced sputum isolated from allergic asthmatics in and out of pollen season revealed that miR-155 expression, but not miR-146a, is reduced in lymphocytes in season compared to post-season. In contrast, miR-155 was found to increase, whereas miR-146a decreased in PBMCs and cell-free PBMC culture media upon T cell receptor stimulation via αCD3/CD28 in both allergic asthmatics and healthy controls. Our findings suggest that miR-155 is differentially expressed ex vivo in airways of allergic asthmatics compared to healthy controls, which may have implications in the local immune response in allergic asthma.
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Asma/genética , Asma/imunologia , Citocinas/imunologia , MicroRNAs/genética , Sistema Respiratório/imunologia , Escarro/citologia , Adulto , Alérgenos/imunologia , Asma/patologia , Eosinófilos/citologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
We present a critical evaluation of photoionization efficiency (PIE) measurements coupled with aerosol mass spectrometry for the identification of condensed soot-precursor species extracted from a premixed atmospheric-pressure ethylene/oxygen/nitrogen flame. Definitive identification of isomers by any means is complicated by the large number of potential isomers at masses likely to comprise particles at flame temperatures. This problem is compounded using PIE measurements by the similarity in ionization energies and PIE-curve shapes among many of these isomers. Nevertheless, PIE analysis can provide important chemical information. For example, our PIE curves show that neither pyrene nor fluoranthene alone can describe the signal from C16H10 isomers and that coronene alone cannot describe the PIE signal from C24H12 species. A linear combination of the reference PIE curves for pyrene and fluoranthene yields good agreement with flame-PIE curves measured at 202 u, which is consistent with pyrene and fluoranthene being the two major C16H10 isomers in the flame samples, but does not provide definite proof. The suggested ratio between fluoranthene and pyrene depends on the sampling conditions. We calculated the values of the adiabatic-ionization energy (AIE) of 24 C16H10 isomers. Despite the small number of isomers considered, the calculations show that the differences in AIEs between several of the isomers can be smaller than the average thermal energy at room temperature. The calculations also show that PIE analysis can sometimes be used to separate hydrocarbon species into those that contain mainly aromatic rings and those that contain significant aliphatic content for species sizes investigated in this study. Our calculations suggest an inverse relationship between AIE and the number of aromatic rings. We have demonstrated that further characterization of precursors can be facilitated by measurements that test species volatility.
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We have measured photoionization-efficiency curves for pyrene, fluoranthene, chrysene, perylene, and coronene in the photon energy range of 7.5-10.2 eV and derived their photoionization cross-section curves in this energy range. All measurements were performed using tunable vacuum ultraviolet (VUV) radiation generated at the Advanced Light Source synchrotron at Lawrence Berkeley National Laboratory. The VUV radiation was used for photoionization, and detection was performed using a time-of-flight mass spectrometer. We measured the photoionization efficiency of 2,5-dimethylfuran simultaneously with those of pyrene, fluoranthene, chrysene, perylene, and coronene to obtain references of the photon flux during each measurement from the known photoionization cross-section curve of 2,5-dimethylfuran.
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The aim of this study was to estimate and compare genetic trends in Swedish Red cattle using a full multiple-trait (MT) model and trait-group-wise models for female fertility, udder health and protein yield. Field data for maiden heifers from 1989 and cows with a first and second lactation between 1990 and 2007 were included. (Co)variance components were estimated prior to prediction of breeding values. The estimated genetic trends were clearly favourable for protein yield and udder conformation, and in most cases neutral to favourable for clinical mastitis and calving to first insemination. In maiden heifers, the trends were neutral for number of inseminations per service period. Unfavourable genetic trends were estimated for number of inseminations in the first two lactations, but the trends seemed less unfavourable from evaluations within trait groups compared with when using the full MT model. Excluding maiden heifer data affected genetic trends less than using trait-group-wise analyses instead of a full MT model. Unfavourable genetic trends in functional traits may be missed unless the traits are evaluated in a MT model including traits under strong selection.
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Bovinos/fisiologia , Fertilidade , Lactação , Glândulas Mamárias Animais/fisiopatologia , Proteínas do Leite/metabolismo , Modelos Genéticos , Característica Quantitativa Herdável , Animais , Bovinos/genética , Indústria de Laticínios , Feminino , Mastite Bovina/genética , Mastite Bovina/patologia , FenótipoRESUMO
Adipose tissue produces multiple mediators that modulate the immune response. Adiponectin is an adipocyte-derived cytokine that exhibits metabolic and anti-inflammatory effects. Adiponectin acts through binding to adiponectin receptor 1 and 2 (AdipoR1/AdipoR2). AdipoR1 is ubiquitously expressed, whereas AdipoR2 is restricted to skeletal muscle and liver. AdipoR1 expression has been reported on a small percentage of T cells; nevertheless, it is still unknown whether Foxp3(+) regulatory T cells (Tregs) express AdipoR1. Recently, it has been shown that Tregs accumulate in adipose tissue and that they play a potential role in modulating adipose tissue inflammation. Our aim was to evaluate AdipoR1 expression in adipose tissue-resident Tregs and to evaluate the effect of weight gain on this expression. Male C57BL/6 mice were fed with a high-fat diet for 14 weeks (to develop overweight) or 21 weeks (to develop obesity). Mice on a standard diet were used as age-matched controls. Helios expression was evaluated as a marker to discriminate thymic-derived from peripherally induced Tregs. The majority of Tregs in both adipose tissue and the spleen expressed Helios. Adipose tissue Tregs expressed higher levels of AdipoR1 than Tregs in the spleen. AdipoR1 expression on adipose tissue Helios(+) Tregs was negatively correlated with epididymal fat. Overall, we show that AdipoR1 is expressed on adipose tissue-resident Tregs, mainly Helios(+) Tregs, and that this expression is dependent on weight and fat accumulation. Because both adiponectin and Tregs play roles in anti-inflammatory mechanisms, our data propose a new mechanism through which weight gain might alter immunoregulation.
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Tecido Adiposo/metabolismo , Obesidade/imunologia , Receptores de Adiponectina/biossíntese , Linfócitos T Reguladores/imunologia , Aumento de Peso/imunologia , Tecido Adiposo/citologia , Tecido Adiposo/imunologia , Animais , Peso Corporal/imunologia , Proteínas de Ligação a DNA/metabolismo , Dieta Hiperlipídica , Inflamação/imunologia , Inflamação/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Baço/citologia , Baço/imunologia , Baço/metabolismo , Fatores de Transcrição/metabolismoRESUMO
BACKGROUND: To present an overview of patient-reported sexual toxicity in sexually active long-term prostate cancer survivors treated with radiation therapy. METHODS: We used patient-reported outcomes from a study-specific questionnaire surveying symptoms after prostate cancer radiation therapy. Data from 518 men treated at the Sahlgrenska University Hospital in Sweden from 1993 to 2006 were analysed. The men had undergone primary or salvage external beam radiation therapy (EBRT) or EBRT combined with high-dose rate brachytherapy (BT). We also used information from 155 non-treated reference men from the general population with no history of prostate cancer, matched for age and residency. RESULTS: Median time from treatment to follow-up was 5 years (range: 1-14 years). Among the 16 investigated symptoms on erectile function, libido, orgasm, and seminal fluid, 9 symptoms in the primary EBRT group and 10 in both the salvage EBRT and the EBRT+BT groups were statistically significantly more prevalent in survivors than in reference men. Erectile dysfunction was influenced by both age and time to follow-up, whereas symptoms relating to orgasm and seminal fluid were influenced by time to follow-up only. Not being sexually active was almost one and a half times as common in survivors as in reference men. CONCLUSIONS: The presented symptom profiles can help to develop personalized therapy for prostate cancer through a better understanding of which radiation-induced toxicities to be addressed in the clinic and can also assist in identifying suitable interventions for existing symptoms.
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Disfunção Erétil/epidemiologia , Neoplasias da Próstata/radioterapia , Lesões por Radiação/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Lesões por Radiação/etiologia , Sobreviventes , Resultado do TratamentoRESUMO
The incidence of lymphedema (LE) related to treatment of women's cancer (breast and gynecologic) is as high as 40%. Treatment of LE varies around the world but was decades ago initially based on programs including manual lymph drainage (MLD), compression, skin care and easy exercise. With accumulating evidence and experience, it is time to consider if altering these treatment principles is needed. Based on accumulating evidence, we suggest less emphasis on manual lymph drainage and more on early diagnosis, compression, weight control and exercise for improvement of strength and circulation.
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Linfedema/terapia , Neoplasias/complicações , Peso Corporal , Drenagem , Detecção Precoce de Câncer , Medicina Baseada em Evidências , Exercício Físico , Feminino , Seguimentos , Humanos , Linfedema/etiologiaRESUMO
A breeding scheme using genomic selection and an indicator trait for environmental impact (EI) was studied to find the most effective recording strategy in terms of annual monetary genetic gain and breakeven price for the recording of indicator traits. The breakeven price shows the investment space for developing a recording system for an indicator trait. The breeding goal consisted of three traits milk production, functional trait and environmental impact with economic values of 83, 82 and -83, respectively. The first scenario included only breeding goal traits and no indicator traits (NoIT). The other scenarios included all three breeding goal traits and one indicator trait (IT) for EI. The indicator traits were recorded on a large scale (stayability after first lactation and stature), medium scale (live weight and greenhouse gases (GHG) measured in the breath of the cow during milking) or small scale (residual feed intake and total enteric methane measured in a respiration chamber). In the scenario with stayability, the genetic gain in EI was over 11% higher than it was in NoIT. The breakeven price of recording stayability was 8 per record. Stayability is easy to record in the national milk recording system, and its use as an indicator trait for EI would not generate any additional recording costs. Therefore, stayability would be a good indicator trait to use to mitigate EI. The highest genetic gain in EI (23% higher compared to NoIT) was achieved when the GHG measured in the breath of the cow was used as indicator trait. The breakeven price for this indicator trait was 29 per record in the reference population. Ideally the recording of a specific indicator trait for EI would take place when: (i) the genetic correlation between the IT and EI is high; and (ii) the number of phenotypic records for the indicator trait is high enough to achieve a moderately high reliability of direct genomic values.
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Bovinos/genética , Indústria de Laticínios/métodos , Meio Ambiente , Leite , Animais , Cruzamento/métodos , Bovinos/metabolismo , Indústria de Laticínios/economia , Genótipo , Metano/metabolismo , FenótipoRESUMO
BACKGROUND: Concern exists regarding gallstones as an adverse event of very-low-calorie diets (VLCDs; <800 kcal per day). OBJECTIVE: To assess the risk of symptomatic gallstones requiring hospital care and/or cholecystectomy in a commercial weight loss program using VLCD or low-calorie diet (LCD). DESIGN: A 1-year matched cohort study of consecutively enrolled adults in a commercial weight loss program conducted at 28 Swedish centers between 2006 and 2009. A 3-month weight loss phase of VLCD (500 kcal per day) or LCD (1200-1500 kcal per day) was followed by a 9-month weight maintenance phase. Matching (1:1) was performed by age, sex, body mass index, waist circumference and gallstone history (n=3320:3320). Gallstone and cholecystectomy data were retrieved from the Swedish National Patient Register. RESULTS: One-year weight loss was greater in the VLCD than in the LCD group (-11.1 versus -8.1 kg; adjusted difference, -2.8 kg, 95% CI -3.1 to -2.4; P<0.001). During 6361 person-years, 48 and 14 gallstones requiring hospital care occurred in the VLCD and LCD groups, respectively, (152 versus 44/10 000 person-years; hazard ratio, 3.4, 95% CI 1.8-6.3; P<0.001; number-needed-to-harm, 92, 95% CI 63-168; P<0.001). Of the 62 gallstone events, 38 (61%) resulted in cholecystectomy (29 versus 9; hazard ratio, 3.2, 95% CI 1.5-6.8; P=0.003; number-needed-to-harm, 151, 95% CI 94-377; P<0.001). Adjusting for 3-month weight loss attenuated the hazard ratios, but the risk remained higher with VLCD than LCD for gallstones (2.5, 95% CI 1.3-5.1; P=0.009) and became borderline for cholecystectomy (2.2, 95% CI 0.9-5.2; P=0.08). CONCLUSION: The risk of symptomatic gallstones requiring hospitalization or cholecystectomy, albeit low, was 3-fold greater with VLCD than LCD during the 1-year commercial weight loss program.
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Restrição Calórica/efeitos adversos , Colecistectomia , Cálculos Biliares/etiologia , Obesidade/dietoterapia , Programas de Redução de Peso , Adulto , Estudos de Casos e Controles , Colecistectomia/estatística & dados numéricos , Estudos de Coortes , Ingestão de Energia , Feminino , Seguimentos , Cálculos Biliares/epidemiologia , Cálculos Biliares/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Suécia/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Redução de PesoRESUMO
BACKGROUND: Mortality prediction is important in intensive care. The Simplified Acute Physiology Score (SAPS) II is a tool for predicting such mortality. However, the original SAPS II is poorly calibrated to current intensive care unit (ICU) populations because it draws on data, which is more than 20 years old. We aimed to improve the calibration of SAPS II using data from the Norwegian Intensive Care Registry (NIR). This is the first recalibration of SAPS II for Nordic data. METHODS: A first-level customization was applied to improve calibration of the original SAPS II model (Model A). NIR data used covered more than 90% of adult patients admitted to ICUs in Norway from 2008 to 2010 (n = 30712). RESULTS: The modified SAPS II, Model B, outperformed the original Model A with respect to calibration. Model B gave more accurate predictions of mortality than Model A (Hosmer-Lemeshow's C: 22.01 vs. 689.07; Brier score: 0.120 vs. 0.131; Cox's calibration regression: α = -0.093 vs. -0.747, ß = 0.921 vs. 0.735, (α|ß = 1) = -0.009 vs. -0.630). The standardized mortality ratio was 0.73 [95% confidence interval (CI) of 0.70-0.76] for Model A and 0.99 (95% CI of 0.95-1.04) for Model B. Discrimination was good for both models (area under receiver operating characteristic curve = 0.83 for both models). CONCLUSIONS: As expected, Model B is better calibrated than Model A, and both models have similar uniformity of fit and equal discrimination. Introducing Model B into Norwegian ICUs may improve precision in decision-making. Units will have a more realistic benchmark for the assessment of ICU performance. Mortality risk estimates from Model B are better than previous SAPS II estimates have been.
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Cuidados Críticos , Estado Terminal/mortalidade , Mortalidade Hospitalar , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Calibragem , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Noruega/epidemiologia , Prognóstico , Sistema de RegistrosRESUMO
The overall objective of this study was to assess the use of in-line recorded milkability information from dairy herds with conventional milking parlors (CMP) and from herds with automatic milking systems (AMS) for genetic evaluation. Some genetic parameters were previously studied on AMS data for 2,053 Swedish Holstein (SH) and 1,749 Swedish Red (SR) cows in 19 herds. These data were combined in the present paper with milkability information from 74 herds with CMP, including 11,123 SH cows and 7,554 SR cows. Genetic parameters were estimated for the CMP data and genetic correlations were estimated between milkability traits measured in the 2 systems. Average flow rate and milking time were derived and used as similar milkability traits for both systems, whereas box time was used only for AMS herds. Estimated heritabilities were in the range from 0.24 to 0.49. Even though the traits were differently defined in the 2 milking systems, the corresponding traits recorded in AMS and CMP were genetically closely related (0.93-1.00). Similarly, close genetic relationships were shown between milkability traits in different lactations in both breeds (0.93-0.99). Thus, it should be possible to treat milkability traits in different lactations and from different milking systems as the same traits in genetic evaluations. The various milkability traits were also highly genetically correlated, indicating that the inclusion of just one trait in the genetic selection program would efficiently select for milkability without the need to consider all measures. Comparisons of repeatability and random regression models, combining all information from the 2 systems for genetic evaluation, were done to find the most suitable model for genetic evaluation purposes. Even though the random regression models were favored in the formal model tests to evaluate suitability, correlation coefficients between test-days within lactation were high (0.7-0.8) and small differences in breeding values resulted among different models. That would indicate that a few test-days per cow would produce accurate breeding values for milkability.
Assuntos
Criação de Animais Domésticos , Bovinos/genética , Bovinos/fisiologia , Indústria de Laticínios/métodos , Seleção Genética , Animais , Cruzamento , Feminino , Leite , Modelos BiológicosRESUMO
The objective of this study was to quantify the genetic variation in normal and atypical progesterone profiles and investigate if this information could be useful in an improved genetic evaluation for fertility for dairy cows. The phenotypes derived from normal profiles included cycle length traits, including commencement of luteal activity (C-LA), interluteal interval, luteal phase length. and interovulatory interval. In total, 44,977 progesterone test-day records were available from 1,612 lactations on 1,122 primiparous and multiparous Holstein-Friesian cows from Ireland, the Netherlands, Sweden, and the United Kingdom. The atypical progesterone profiles studied were delayed cyclicity, prolonged luteal phase, and cessation of cyclicity. Variance components for the atypical progesterone profiles were estimated using a sire linear mixed model, whereas an animal linear mixed model was used to estimate variance components for the cycle length traits. Heritability was moderate for delayed cyclicity (0.24 ± 0.05) and C-LA (0.18 ± 0.04) but low for prolonged luteal phase (0.02 ± 0.04), luteal phase length (0.08 ± 0.05), interluteal interval (0.08 ± 0.14), and interovulatory interval (0.03 ± 0.04). No genetic variation was detected for cessation of cyclicity. Commencement of luteal activity, luteal phase length, and interovulatory interval were moderately to strongly genetically correlated with days from calving to first service (0.35 ± 0.12, 0.25 ± 0.14, and 0.76 ± 0.24, respectively). Delayed cyclicity and C-LA are traits that can be important in both genetic evaluations and management of fertility to detect (earlier) cows at risk of compromised fertility. Delayed cyclicity and C-LA were both strongly genetically correlated with milk yield in early lactation (0.57 ± 0.14 and 0.45 ± 0.09, respectively), which may imply deterioration in these traits with selection for greater milk yield without cognizance of other traits.
Assuntos
Bovinos/genética , Bovinos/metabolismo , Variação Genética , Progesterona/metabolismo , Animais , Ciclo Estral/genética , Ciclo Estral/fisiologia , Europa (Continente) , Feminino , Fertilidade/genética , Testes Genéticos , Lactação/genética , Modelos Lineares , Paridade , GravidezRESUMO
It is well documented that resistance exercise can be performed by patients with breast cancer-related arm lymphedema. The aim of this pilot study was to evaluate the feasibility and safety of a 12-week self-administered weight lifting program for arm and shoulder, and its influence on arm lymphedema status, upper extremity muscle strength, and disability. Twenty-three patients with breast cancer-related arm lymphedema performed the program 3 times/week. The weight resistance levels were individually adjusted for shoulder flexion and adduction, and elbow extension and flexion corresponding to a repetition range of 8-12 repetition maximum. A log book was used to evaluate adherence to the program, wearing of compression sleeve and perceived exertion. Measurements were performed before a 2-week control period without intervention, and before and after intervention, and with arm volume measurements every fortnight to check for adverse events. Results revealed no significant changes during the control period. Adherence to the intervention program was excellent, and two adverse events were registered during the first weeks. After intervention, an increase of shoulder and arm strength (measured by an isometric muscle strength device) was found in all exercises (p = 0.001-0.003). A reduction of excess volume was shown, in ml (p = 0.03) and percentage (p = 0.005), measured by water displacement method. A tendency towards reduction (p = 0.07) of fat tissue in the upper arm (n = 10) in both arms was found measured by MRI. In this pilot study, we concluded that a home-based weight-lifting program performed by patients with breast cancer-related arm lymphedema is feasible and safe providing that the program includes regular follow-up for safety.
Assuntos
Neoplasias da Mama/complicações , Terapia por Exercício , Serviços de Assistência Domiciliar , Linfedema/terapia , Levantamento de Peso , Adulto , Braço , Neoplasias da Mama/terapia , Estudos de Viabilidade , Feminino , Humanos , Linfedema/etiologia , Linfedema/patologia , Pessoa de Meia-Idade , Força Muscular , Cooperação do Paciente , Projetos Piloto , Resultado do TratamentoRESUMO
BACKGROUND: The objective of this study is to provide comprehensive overviews of patient-reported urinary symptoms for long-term prostate cancer survivors treated with radiation therapy and for untreated, healthy men. METHODS: We performed a population-based cross-sectional study using a study-specific postal questionnaire assessing symptoms among 1007 men consecutively treated at the Sahlgrenska University Hospital, Göteborg, Sweden from 1993-2006 (primary or salvage external beam radiation therapy (EBRT) or EBRT and high-dose rate brachytherapy). We also randomly recruited 350 non-pelvic-irradiated matched control men from the Swedish Total Population Register. Symptom prevalence and prevalence ratios were computed. RESULTS: Survey participation rate was 89% (874/985) for eligible survivors and 73% (243/332) for eligible controls. Median time from treatment to follow-up was 5 years (range, 1-14 years). Among the 21 investigated symptoms reflecting obstruction, frequency, urgency, pain and incontinence, we found significantly higher prevalence compared with controls for 9 symptoms in the EBRT group, 10 in the EBRT+brachytherapy group and 5 in the salvage EBRT group. The prevalence for a majority of the symptoms was stable over time. CONCLUSION: The presented toxicity profiles provide a thorough understanding of patient-reported urinary symptoms that can assist in developing personalised therapy for prostate cancer.