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1.
J Perinat Med ; 52(5): 515-519, 2024 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-38640060

RESUMO

OBJECTIVES: Universal opt-out antenatal screening for Hepatitis C virus (HCV) is not currently recommened and it is recommended that maternity services offer risk-based testing. We aimed to investigate antenatal HCV testing and adherence to testing guidance. METHODS: A cross-sectional survey was circulated to maternity service providers between November-December 2020 which included testing policy, training for healthcare staff, and management of women found to be HCV positive. Descriptive data are presented. RESULTS: A total of 75 questionnaires were returned, representing 48 % of English maternity service providers. 87 % of providers reported offering antenatal HCV risk-based testing. Risk factors used to identify pregnant women for testing varied. Less than 15 % of respondents considered women that were ever homeless or with history of incarceraton or from higher HCV prevalence areas as high risk. CONCLUSIONS: Current antenatal HCV testing practices are inadequate and HCV infection likely goes undiagnosed in pregnancy, especially among vulnerable population groups. In the absence of universal antenatal screening, re-framing antenatal HCV risk-based testing and management as a quality improvement initiative and developing HCV specific pathway guidance for maternity units is required.


Assuntos
Hepatite C , Complicações Infecciosas na Gravidez , Humanos , Feminino , Gravidez , Estudos Transversais , Inglaterra/epidemiologia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/epidemiologia , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Hepatite C/terapia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Serviços de Saúde Materna/normas , Inquéritos e Questionários , Adulto , Diagnóstico Pré-Natal/métodos
2.
Risk Anal ; 44(3): 641-649, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37330987

RESUMO

Retrospective review is a key to designing effective food safety measures. Despite the reported reduction of Salmonella prevalence in poultry products, there has not been a concomitant reduction of the overall incidence of Salmonella illnesses reported to the US Foodborne Diseases Active Surveillance Network (FoodNet) since 1996. However, there have been significant annual trends among Salmonella serotypes. This analysis examines trends in the reported incidence of illness due to poultry- and nonpoultry associated Salmonella serotypes. Overall, the findings indicate declining trends in illness due to the poultry-associated serotypes and increasing trends in illness due to Salmonella serotypes not associated with poultry.


Assuntos
Produtos Avícolas , Aves Domésticas , Animais , Sorogrupo , Inocuidade dos Alimentos , Salmonella
3.
Risk Anal ; 2024 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-38616416

RESUMO

The incidence of human illness due to Salmonella Infantis reported to Foodborne Diseases Active Surveillance Network and the prevalence of Infantis on chicken carcasses reported by the United States Department of Agriculture Food Safety and Inspection Service have increased significantly in the past decade. However, the trends do not appear coincident, as would be expected if the increased prevalence in chicken led to the increase in the incidence of human illness. Salmonella Infantis incidence and prevalence trends are analyzed using penalized B-spline methods for generalized additive regression models. The association between the two time series is analyzed using time-lagged rank-order cross-correlation. Geographic variations in reported incidence and trends are also explored. The increase in human incidence of Salmonella Infantis began circa 2011. The increase in chicken carcass prevalence began circa 2015. A 4-year lag on chicken carcass prevalence maximizes the rank-order cross-correlation with the incidence of illness. While chicken consumption undoubtedly contributes to the incidence of human illness due to Salmonella Infantis, the initial increase in reported illness was likely due to one or more other transmission pathways. Other potential transmission pathways include non-chicken foodborne, waterborne, person-to-person, animal contact, and environmental.

4.
Breast Cancer Res Treat ; 197(1): 149-159, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36331687

RESUMO

PURPOSE: Preeclampsia has been inconsistently associated with altered later life risk of cancer. This study utilizes the Nurses' Health Study 2 (NHS2) to determine if the future risk of breast and non-breast cancers in women who experience preeclampsia is modified by carrying a protective variant of rs2016347, a functional insulin-like growth factor receptor-1 (IGF1R) single nucleotide polymorphism. METHODS: This retrospective cohort study completed within the NHS2 evaluated participants enrolled in 1989 and followed them through 2015, with a study population of 86,751 after exclusions. Cox proportional hazards models both with and without the impact of rs2016347 genotype were used to assess the risk of invasive breast cancer, hormone receptor-positive (HR+) breast cancer, and non-breast cancers. RESULTS: Women with preeclampsia had no change in risk of all breast, HR+ breast, or non-breast cancers when not considering genotype. However, women carrying at least one T allele of rs2016347 had a lower risk of HR+ breast cancer, HR 0.67, 95% CI: 0.47-0.97, P = 0.04, with interaction term P = 0.06. For non-breast cancers as a group, women carrying a T allele had an HR 0.76, 95% CI: 0.53-1.08, P = 0.12, with interaction term P = 0.26. CONCLUSIONS: This retrospective cohort study found that women with preeclampsia who carry a T allele of IGF1R rs2016347 had a reduced future risk of developing HR+ breast cancer, and a reduced but not statistically significant decreased risk of non-breast cancers suggesting a possible role for the IGF-1 axis in the development of cancer in these women.


Assuntos
Neoplasias da Mama , Pré-Eclâmpsia , Gravidez , Feminino , Humanos , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/genética , Neoplasias da Mama/metabolismo , Fator de Crescimento Insulin-Like I , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/genética , Estudos Retrospectivos , Mama/metabolismo , Receptor IGF Tipo 1/genética
5.
Liver Int ; 43(2): 276-291, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36196744

RESUMO

In 2016, the Hepatitis B and C Public Policy Association (HepBCPPA), gathered all the main stakeholders in the field of hepatitis C virus (HCV) to launch the now landmark HCV Elimination Manifesto, calling for the elimination of HCV in the EU by 2030. Since then, many European countries have made progress towards HCV elimination. Multiple programmes-from the municipality level to the EU level-were launched, resulting in an overall decrease in viremic HCV infections and liver-related mortality. However, as of 2021, most countries are not on track to reach the 2030 HCV elimination targets set by the WHO. Moreover, the COVID-19 pandemic has resulted in a decrease in HCV diagnoses and fewer direct-acting antiviral treatment initiations in 2020. Diagnostic and therapeutic tools to easily diagnose and treat chronic HCV infection are now well established. Treating all patients with chronic HCV infection is more cost-saving than treating and caring for patients with liver-related complications, decompensated cirrhosis or hepatocellular carcinoma. It is more important than ever to reinforce and scale-up action towards HCV elimination. Yet, efforts urgently need the dedicated commitment of policymakers at all governmental and policy levels. Therefore, the third EU Policy Summit, held in March 2021, featured EU parliamentarians and other key decision makers to promote dialogue and take strides towards securing wider EU commitment to advance and achieve HCV elimination by 2030. We have summarized the key action points and reported the 'Call-to-Action' statement supported by all the major relevant European associations in the field.


Assuntos
COVID-19 , Hepatite C Crônica , Hepatite C , Neoplasias Hepáticas , Humanos , Hepacivirus , Antivirais/uso terapêutico , Pandemias , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/prevenção & controle , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Neoplasias Hepáticas/tratamento farmacológico
6.
Proc Natl Acad Sci U S A ; 117(24): 13421-13427, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32482858

RESUMO

Although the backlog of untested sexual assault kits in the United States is starting to be addressed, many municipalities are opting for selective testing of samples within a kit, where only the most probative samples are tested. We use data from the San Francisco Police Department Criminalistics Laboratory, which tests all samples but also collects information on the samples flagged by sexual assault forensic examiners as most probative, to build a standard machine learning model that predicts (based on covariates gleaned from sexual assault kit questionnaires) which samples are most probative. This model is embedded within an optimization framework that selects which samples to test from each kit to maximize the Combined DNA Index System (CODIS) yield (i.e., the number of kits that generate at least one DNA profile for the criminal DNA database) subject to a budget constraint. Our analysis predicts that, relative to a policy that tests only the samples deemed probative by the sexual assault forensic examiners, the proposed policy increases the CODIS yield by 45.4% without increasing the cost. Full testing of all samples has a slightly lower cost-effectiveness than the selective policy based on forensic examiners, but more than doubles the yield. In over half of the sexual assaults, a sample was not collected during the forensic medical exam from the body location deemed most probative by the machine learning model. Our results suggest that electronic forensic records coupled with machine learning and optimization models could enhance the effectiveness of criminal investigations of sexual assaults.


Assuntos
Vítimas de Crime , Ciências Forenses/economia , Aplicação da Lei/métodos , Delitos Sexuais , Manejo de Espécimes/economia , Adulto , Análise Custo-Benefício , Vítimas de Crime/estatística & dados numéricos , DNA/análise , Bases de Dados de Ácidos Nucleicos , Feminino , Ciências Forenses/estatística & dados numéricos , Humanos , Aprendizado de Máquina , Masculino , São Francisco , Delitos Sexuais/estatística & dados numéricos , Manejo de Espécimes/estatística & dados numéricos
7.
Hum Reprod ; 37(5): 1083-1094, 2022 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-35362533

RESUMO

STUDY QUESTION: Is the increased future cardiovascular risk seen in women with endometriosis or polycystic ovary syndrome (PCOS) mitigated by functional insulin-like growth factor-1 receptor (IGF1R) single-nucleotide polymorphism (SNP) rs2016347 as previously shown in women with hypertensive disorders of pregnancy? SUMMARY ANSWER: This cohort study found that women with endometriosis or PCOS who carry a T allele of IGF1R SNP rs2016347 had a reduced future risk of developing cardiovascular disease (CVD) and associated risk factors, with risk reduction dependent on cohort era. WHAT IS KNOWN ALREADY: Women with endometriosis or PCOS have been shown to have an increased future risk of CVD and associated risk factors with limited predictive ability. STUDY DESIGN, SIZE, DURATION: This retrospective cohort study took place in the Nurses' Health Study 2 (NHS2), which enrolled 116 430 participants in 1989 who were followed through 2015. The study population was analyzed in its entirety, and subdivided into entry (pre-1989) and after entry (post-1989) exposure cohorts. All NHS2 participants were eligible for inclusion in the study, 9599 (8.2%) were excluded for missing covariates. PARTICIPANTS/MATERIALS, SETTING, METHODS: The NHS2 enrolled female registered nurses from 14 different states who ranged in age from 25 to 42 years at study entry. Data were collected from entry and biennial questionnaires, and analysis conducted from November 2020 to June 2021. Cox proportional hazard models were used to assess risk of CVD, hypertension (HTN), hypercholesterolemia (HC) and type 2 diabetes, both with and without genotyping for rs2016347. MAIN RESULTS AND THE ROLE OF CHANCE: While women without endometriosis or PCOS, as a whole, demonstrated no impact of genotype on risk in either cohort, women with endometriosis carrying a T allele had a lower risk of CVD (hazard ratio (HR), 0.48; 95% CI, 0.27-0.86, P = 0.02) and HTN (HR, 0.80; 95% CI, 0.66-0.97, P = 0.03) in the pre-1989 cohort, while those in the post-1989 cohort had a decrease in risk for HC (HR, 0.76; 95% CI, 0.62-0.94, P = 0.01). Women with PCOS in the post-1989 cohort showed a significant protective impact of the T allele on HTN (HR, 0.44; 95% CI, 0.27-0.73, P = 0.002) and HC (HR, 0.62; 95% CI, 0.40-0.95, P = 0.03). LIMITATIONS, REASONS FOR CAUTION: Data on specific endometriosis lesion locations or disease stage, as well as on PCOS phenotypes were lacking. In addition, data on systemic medical treatments beyond the use of oral contraceptives were missing, and these treatments may have confounded the results. WIDER IMPLICATIONS OF THE FINDINGS: These findings implicate systemic dysregulation of the insulin-like growth factor-1 axis in the development of HTN, HC and clinical CVD in endometriosis and PCOS, suggesting a common underlying pathogenetic mechanism. STUDY FUNDING/COMPETING INTEREST(S): The NHS2 infrastructure for questionnaire data collection was supported by National Institute of Health (NIH) grant U01CA176726. This work was also supported in part by NIH and National Cancer Institute grant U24CA210990; as well, research effort and publication costs were supported by the Elizabeth MA Stevens donor funds provided to the Buck Institute for Research on Aging. The authors declare they have no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Endometriose , Síndrome do Ovário Policístico , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/genética , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Endometriose/complicações , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Fator de Crescimento Insulin-Like I , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/epidemiologia , Síndrome do Ovário Policístico/genética , Gravidez , Receptor IGF Tipo 1 , Estudos Retrospectivos , Fatores de Risco
8.
Anesth Analg ; 134(4): 713-723, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-34871190

RESUMO

BACKGROUND: Preeclampsia (PE) manifesting as hypertension and organ injury is mediated by vascular dysfunction. In biological fluids, extracellular vesicles (EVs) containing microRNA (miRNA), protein, and other cargo released from the placenta may serve as carriers to propagate injury, altering the functional phenotype of endothelial cells. PE has been consistently correlated with increased levels of placenta-derived EVs (pEVs) in maternal circulation. However, whether pEVs impaired endothelial cell function remains to be determined. In this study, we hypothesize that pEVs from pregnant women with severe PE (sPE) impair endothelial function through altered cell signaling. METHODS: We obtained plasma samples from women with sPE (n = 14) and normotensive pregnant women (n = 15) for the isolation of EVs. The total number of EV and pEV contribution was determined by quantifying immunoreactive EV-cluster of designation 63 (CD63) and placental alkaline phosphatase (PLAP) as placenta-specific markers, respectively. Vascular endothelial functional assays were determined by cell migration, electric cell-substrate impedance sensing in human aortic endothelial cells (HAECs), and wire myography in isolated blood vessels, preincubated with EVs from normotensive and sPE women. RESULTS: Plasma EV and pEV levels were increased in sPE when compared to normotensive without a significant size distribution difference in sPE (108.8 ± 30.2 nm) and normotensive-EVs (101.3 ± 20.3 nm). Impaired endothelial repair and proliferation, reduced endothelial barrier function, reduced endothelial-dependent vasorelaxation, and decreased nitrite level indicate that sPE-EVs induced vascular endothelial dysfunction. Moreover, sPE-EVs significantly downregulated endothelial nitric oxide synthase (eNOS and p-eNOS) when compared to normotensive-EV. CONCLUSIONS: EVs from sPE women impair endothelial-dependent vascular functions in vitro.


Assuntos
Vesículas Extracelulares , Pré-Eclâmpsia , Biomarcadores/metabolismo , Células Endoteliais/metabolismo , Endotélio/metabolismo , Vesículas Extracelulares/metabolismo , Feminino , Humanos , Placenta , Gravidez
9.
Breast Cancer Res ; 22(1): 81, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736587

RESUMO

BACKGROUND: Previous studies have identified and validated a risk-associated Active transcriptome phenotype commonly expressed in the cancer-adjacent and histologically normal epithelium, stroma, and adipose containing peritumor microenvironment of clinically established invasive breast cancers, conferring a 2.5- to 3-fold later risk of dying from recurrent breast cancer. Expression of this Active transcriptome phenotype has not yet been evaluated in normal breast tissue samples unassociated with any benign or malignant lesions; however, it has been associated with increased peritumor adipocyte composition. METHODS: Detailed histologic and transcriptomic (RNAseq) analyses were performed on normal breast biopsy samples from 151 healthy, parous, non-obese (mean BMI = 29.60 ± 7.92) women, ages 27-66 who donated core breast biopsy samples to the Komen Tissue Bank, and whose average breast cancer risk estimate (Gail score) at the time of biopsy (1.27 ± 1.34) would not qualify them for endocrine prevention therapy. RESULTS: Full genome RNA sequencing (RNAseq) identified 52% (78/151) of these normal breast samples as expressing the Active breast phenotype. While Active signature genes were found to be most variably expressed in mammary adipocytes, donors with the Active phenotype had no difference in BMI but significantly higher Gail scores (1.46 vs. 1.18; p = 0.007). Active breast samples possessed 1.6-fold more (~ 80%) adipocyte nuclei, larger cross-sectional adipocyte areas (p < 0.01), and 0.5-fold fewer stromal and epithelial cell nuclei (p < 1e-6). Infrequent low-level expression of cancer gene hotspot mutations was detected but not enriched in the Active breast samples. Active samples were enriched in gene sets associated with adipogenesis and fat metabolism (FDR q ≤ 10%), higher signature scores for cAMP-dependent lipolysis known to drive breast cancer progression, white adipose tissue browning (Wilcoxon p < 0.01), and genes associated with adipocyte activation (leptin, adiponectin) and remodeling (CAV1, BNIP3), adipokine growth factors (IGF-1, FGF2), and pro-inflammatory fat signaling (IKBKG, CCL13). CONCLUSIONS: The risk-associated Active transcriptome phenotype first identified in cancer-adjacent breast tissues also occurs commonly in healthy women without breast disease who do not qualify for breast cancer chemoprevention, and independently of breast expressed cancer-associated mutations. The risk-associated Active phenotype appears driven by a pro-tumorigenic adipocyte microenvironment that can predate breast cancer development.


Assuntos
Adipócitos/patologia , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Adipócitos/metabolismo , Adulto , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/metabolismo , Carcinogênese/metabolismo , Carcinogênese/patologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/genética , Obesidade/metabolismo , Obesidade/patologia , Fenótipo , Prognóstico , Transcriptoma
10.
Genome Res ; 26(9): 1170-7, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27435932

RESUMO

Each year in the United States, thousands of cases of sudden and unexpected deaths of infants, children, and young adults are assigned an undetermined cause of death after postmortem investigation and autopsy. Heritable genetic variants have been suggested as the cause of up to a third of sudden death (SD) cases. Elucidation of the genetic variants involved in SD cases is important to not only help establish cause and manner of death of these individuals, but to also aid in determining whether familial genetic testing should be considered. Previously, these types of postmortem screenings have not been a feasible option for most county medical examiners' and coroners' offices. We sequenced full exons of 64 genes associated with SD in the largest known cohort (351) of infant and young SD decedents using massively parallel sequencing at <$600 per sample. Genetic variants were assessed through literature review and clinical evaluation by a multidisciplinary consortium of experts. Thirteen individuals (3.7%), eight infants (2.8% of those <1 yr of age) and five children/young adults (7.0% of those >1 yr of age), were found to have a reportable genetic variant contributing to SD. These percentages represent an estimate lower than those previously reported. Overall yields and results likely vary between studies due to differences in evaluation techniques and reporting. Additionally, we recommend ongoing assessment of data, including nonreported novel variants, as technology and literature continually advance. This study demonstrates a strategy to implement molecular autopsies in medicolegal investigations of young SD decedents.


Assuntos
Cardiomiopatias/genética , Morte Súbita/epidemiologia , Testes Genéticos , Variação Genética , Adolescente , Adulto , Autopsia , Cardiomiopatias/diagnóstico , Cardiomiopatias/mortalidade , Criança , Pré-Escolar , Morte Súbita/etiologia , Morte Súbita/patologia , Diagnóstico , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estados Unidos , Adulto Jovem
11.
J Pharmacol Exp Ther ; 361(3): 429-440, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28442583

RESUMO

Phosphoinositide 3-kinases (PI3K) are key signaling enzymes regulating cellular survival, development, and function. Expression of the PI3Kδ isoform is largely restricted to leukocytes and it plays a key role in immune cell development and function. Seletalisib is a novel small-molecule inhibitor of PI3Kδ that was evaluated in biochemical assays, cellular assays of adaptive and innate immunity, and an in vivo rat model of inflammation. Our findings show that seletalisib is a potent, ATP-competitive, and selective PI3Kδ inhibitor able to block protein kinase B (AKT) phosphorylation following activation of the B-cell receptor in a B-cell line. Moreover, seletalisib inhibited N-formyl peptide-stimulated but not phorbol myristate acetate-stimulated superoxide release from human neutrophils, consistent with a PI3Kδ-specific activity. No indications of cytotoxicity were observed in peripheral blood mononuclear cells (PBMCs) or other cell types treated with seletalisib. Findings from cellular assays of adaptive immunity demonstrated that seletalisib blocks human T-cell production of several cytokines from activated T-cells. Additionally, seletalisib inhibited B-cell proliferation and cytokine release. In human whole blood assays, seletalisib inhibited CD69 expression upon B-cell activation and anti-IgE-mediated basophil degranulation. Seletalisib showed dose-dependent inhibition in an in vivo rat model of anti-CD3-antibody-induced interleukin 2 release. Collectively, these data characterize seletalisib as a selective PI3Kδ inhibitor and potential therapeutic candidate for the treatment of B-cell malignancies and autoimmune diseases driven by dysregulated proinflammatory cytokine secretion.


Assuntos
Inibidores Enzimáticos/química , Inibidores Enzimáticos/farmacologia , Inibidores de Fosfoinositídeo-3 Quinase , Piridinas/química , Piridinas/farmacologia , Quinolinas/química , Quinolinas/farmacologia , Animais , Células Cultivadas , Classe I de Fosfatidilinositol 3-Quinases , Relação Dose-Resposta a Droga , Humanos , Leucócitos Mononucleares/efeitos dos fármacos , Leucócitos Mononucleares/enzimologia , Masculino , Fosfatidilinositol 3-Quinases/metabolismo , Ratos , Ratos Endogâmicos Lew , Ratos Wistar
12.
Cancer Causes Control ; 28(10): 1027-1032, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28822014

RESUMO

PURPOSE: Hypertension in pregnancy has been associated with decreased future risk of breast cancer in many but not all studies. In the Marin Women's Study, pregnancy-induced hypertension was shown to interact with the T allele of a functional IGF1R gene variant, rs2016347, to result in lower breast density, as well as decreased breast cancer risk. Our objective was to explore these findings in a larger sample of women from the California Teachers Study (CTS). METHODS: The CTS cohort consists of over 130,000 female educators. DNA was available from a nested case-control study, which included 2,030 non-Hispanic white women who developed breast cancer and 1,552 controls. The current study included all participants from the case-control group with a self-reported history of preeclampsia (80 cases/57 controls). RESULTS: Comparing TT to GG genotypes revealed adjusted odds ratios of 0.38 (CI 0.13, 1.14) for all invasive breast cancers, 0.26 (CI 0.07, 0.89) for hormone receptor-positive (HR+) breast cancers, 0.15 (CI 0.04, 0.56) for those with age at first birth (AFB) < 30, and 0.10 (CI 0.02, 0.49) for those with AFB < 30 and HR+ breast cancers. Trend analysis yielded p values of 0.09, 0.03, 0.005, and 0.004 respectively, suggesting a biological effect for each T allele. CONCLUSION: Study findings indicate that the T allele of IGF1R variant rs2016347 is associated with a significant reduction in breast cancer risk in women with a history of preeclampsia, most marked for HR+ breast cancer and in women with AFB < 30.


Assuntos
Neoplasias da Mama/genética , Pré-Eclâmpsia/genética , Receptores de Somatomedina/genética , Idoso , Neoplasias da Mama/epidemiologia , California/epidemiologia , Estudos de Casos e Controles , Feminino , Variação Genética , Genótipo , Humanos , Pessoa de Meia-Idade , Pré-Eclâmpsia/epidemiologia , Gravidez , Receptor IGF Tipo 1 , Fatores de Risco
13.
Am J Perinatol ; 34(7): 716-721, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28030871

RESUMO

Objective Our aims were to evaluate whether there is an inverse association between body mass index (BMI) and umbilical artery pH and to investigate the contribution of intraoperative hypotension on the umbilical artery pH. Study Design We conducted a retrospective cohort study of all women with a nonanomalous singleton at 37 to 41 weeks who underwent a scheduled cesarean delivery under spinal anesthesia at our facility from January 2006 to March 2012. The primary outcome was the proportion of patients in each BMI category with arterial cord pH < 7.10. Intraoperative blood pressure data were compared across BMI categories. Results In total, 717 mother-infant pairs met enrollment criteria. Mean arterial pH was significantly lower in women with elevated BMI (p = 0.014), notably with BMI ≥ 40 kg/m2. Baseline blood pressure increased linearly with increasing BMI (p < 0.001), however, so did the maximum drop in all blood pressure parameters (p < 0.001). After adjusting for potential confounders, including blood pressure, there was no longer an association between cord pH and BMI (p = 0.72). Conclusion For women undergoing a scheduled cesarean delivery under spinal anesthesia, umbilical artery pH is lower in women with BMI ≥40 kg/m2. Relative hypotension after spinal anesthesia is more pronounced with increasing BMI and may explain this effect.


Assuntos
Raquianestesia/efeitos adversos , Pressão Sanguínea , Sangue Fetal/química , Hipotensão/etiologia , Obesidade/fisiopatologia , Adulto , Alabama , Gasometria , Índice de Massa Corporal , Cesárea/efeitos adversos , Feminino , Humanos , Monitorização Intraoperatória , Análise Multivariada , Gravidez , Análise de Regressão , Estudos Retrospectivos , Artérias Umbilicais/fisiologia , Adulto Jovem
14.
J Anesth ; 31(1): 44-50, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27743120

RESUMO

PURPOSE: Intrathecal morphine provides superior pain control for patients undergoing cesarean delivery when compared to intravenous opioid patient-controlled analgesia. However, no study has assessed the overall cost associated with each modality as a primary outcome. The aim of this study is to determine the overall cost of each modality for the first 24 h post cesarean delivery. METHODS: Charts of patients undergoing cesarean delivery at our institution from January 1, 2014 to December 31, 2014 were reviewed. Patients receiving intrathecal morphine were compared to patients undergoing general anesthesia and receiving intravenous opioid patient-controlled analgesia for post-procedure analgesia. The primary outcome measured was total cost of each modality for the first 24 h after delivery. Secondary outcomes included post-procedure pain scores, time to removal of the Foley catheter, need for rescue medications, and adverse events. RESULTS: There was a significant difference in total cost of intrathecal morphine when compared to intravenous opioid patient-controlled analgesia ($51.14 vs. $80.16, p < 0.001). Average pain scores between 0-1 h (0 vs. 5, p < 0.001) and 1-6 h (2.5 vs. 3.25, p < 0.001) were less in the intrathecal morphine group. The intrathecal morphine group received more ketorolac (p < 0.001) and required more rescue opioids (p = 0.042). There were no significant differences in documented adverse events. CONCLUSIONS: The use of intrathecal morphine for post-cesarean pain control leads to a significant cost savings for the first 24 h when compared to intravenous opioid patient-controlled analgesia. Patients also experienced less pain and were not at increased risk for adverse events.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/economia , Cesárea , Morfina/administração & dosagem , Morfina/economia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/economia , Adulto , Analgésicos Opioides/uso terapêutico , Estudos de Coortes , Redução de Custos , Feminino , Humanos , Injeções Intravenosas/economia , Injeções Espinhais/economia , Morfina/uso terapêutico , Medição da Dor/efeitos dos fármacos , Dor Pós-Operatória/psicologia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento
16.
Fish Shellfish Immunol ; 51: 64-69, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26873875

RESUMO

The bulbus arteriosus is the most anterior chamber of the teleost heart. The present study aimed to establish the presence, and to provide semi-quantitative information on the abundance, of several immune and cell-cycle proteins in the bulbus arteriosus of healthy Atlantic salmon (Salmo salar L.). Using immunohistochemistry, lymphocyte-like cells were identified in the bulbus arteriosus using antibodies to CD3ε and MHC class IIß. Few PCNA positive cells were identified in post-smolt fish as compared to moderate levels of staining in fresh water fry. Interestingly no staining was evident in adult fish (1-3 kg), thus there was a loss of cells expressing cell-cycle regulatory proteins with ontogeny/progressive life-history stages. Eosinophilic granulocytes (EGCs) were identified in the bulbus arteriosus using TNFα and HIF1α antibodies. Anti-caspase 3 immune-reaction identified a strong endothelial cytoplasmic staining in the bulbus arteriosus. Taken together, the immunolocalization of immune-related molecules (CD3, MHC class II and TNFα), cell-cycle regulatory proteins (PCNA and HIF1α) and apoptosis markers (TUNEL, caspase 3) suggest that the bulbus arteriosus may have an immune component within its functional repertoire.


Assuntos
Proteínas de Ciclo Celular/genética , Proteínas de Peixes/genética , Miocárdio/citologia , Salmo salar/imunologia , Animais , Apoptose , Proteínas de Ciclo Celular/metabolismo , Proteínas de Peixes/metabolismo , Coração/fisiologia , Imuno-Histoquímica/veterinária , Miocárdio/imunologia
17.
Risk Anal ; 36(8): 1589-98, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26709453

RESUMO

Retrospective review is a key to designing effective food safety measures. The analysis examines trends in the reported incidence of illness due to bacterial pathogens commonly transmitted by food in the United States during 1996-2013 with and without specifying a model form for trend. The findings indicate early declines in reported incidence followed by a period of no significant trend for Campylobacter, Listeria, Shiga toxin-producing Escherichia coli O157, and Yersinia. The results are inconclusive about whether there is no trend or an increasing trend for Salmonella. While Shigella exhibits a continuous decline, Vibrio exhibits a continuous increase. Overall, the findings indicate a lack of evidence for continuous reduction in illness due to bacterial pathogens commonly transmitted by food in the United States during 1996-2013.


Assuntos
Contaminação de Alimentos/estatística & dados numéricos , Doenças Transmitidas por Alimentos/epidemiologia , Bactérias , Microbiologia de Alimentos , Inocuidade dos Alimentos , Humanos , Incidência , Vigilância da População , Estudos Retrospectivos , Estados Unidos/epidemiologia
18.
Environ Microbiol ; 17(2): 257-77, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25142751

RESUMO

Since a key requirement of known life forms is available water (water activity; aw ), recent searches for signatures of past life in terrestrial and extraterrestrial environments have targeted places known to have contained significant quantities of biologically available water. However, early life on Earth inhabited high-salt environments, suggesting an ability to withstand low water-activity. The lower limit of water activity that enables cell division appears to be ∼ 0.605 which, until now, was only known to be exhibited by a single eukaryote, the sugar-tolerant, fungal xerophile Xeromyces bisporus. The first forms of life on Earth were, though, prokaryotic. Recent evidence now indicates that some halophilic Archaea and Bacteria have water-activity limits more or less equal to those of X. bisporus. We discuss water activity in relation to the limits of Earth's present-day biosphere; the possibility of microbial multiplication by utilizing water from thin, aqueous films or non-liquid sources; whether prokaryotes were the first organisms able to multiply close to the 0.605-aw limit; and whether extraterrestrial aqueous milieux of ≥ 0.605 aw can resemble fertile microbial habitats found on Earth.


Assuntos
Divisão Celular , Ecossistema , Meio Ambiente Extraterreno , Células Procarióticas/fisiologia , Microbiologia da Água , Água , Archaea/citologia , Ascomicetos/citologia , Ascomicetos/fisiologia , Bactérias/citologia , Exobiologia , Células Procarióticas/citologia , Salinidade , Cloreto de Sódio
20.
Risk Anal ; 35(12): 2172-82, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26033352

RESUMO

Recently, there has been considerable interest in developing risk-based sampling for food safety and animal and plant health for efficient allocation of inspection and surveillance resources. The problem of risk-based sampling allocation presents a challenge similar to financial portfolio analysis. Markowitz (1952) laid the foundation for modern portfolio theory based on mean-variance optimization. However, a persistent challenge in implementing portfolio optimization is the problem of estimation error, leading to false "optimal" portfolios and unstable asset weights. In some cases, portfolio diversification based on simple heuristics (e.g., equal allocation) has better out-of-sample performance than complex portfolio optimization methods due to estimation uncertainty. Even for portfolios with a modest number of assets, the estimation window required for true optimization may imply an implausibly long stationary period. The implications for risk-based sampling are illustrated by a simple simulation model of lot inspection for a small, heterogeneous group of producers.


Assuntos
Medição de Risco/métodos , Bem-Estar do Animal , Animais , Simulação por Computador , Administração Financeira , Análise de Perigos e Pontos Críticos de Controle , Humanos , Modelos Teóricos , Plantas Comestíveis , Alocação de Recursos
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