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1.
J Environ Manage ; 330: 117140, 2023 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-36603252

RESUMEN

Natural resource governance is inherently complex owing to the socio-ecological systems in which it is embedded. Working arrangements have been fundamentally transformed throughout the COVID-19 pandemic with potential negative impacts on trust-based social networks foundational to resource management and transboundary governance. To inform development of a post-pandemic new-normal in resource management, we examined trust relationships using the Laurentian Great Lakes of North America as a case study. 82.9% (n = 97/117) of Great Lakes fishery managers and scientists surveyed indicated that virtual engagement was effective for maintaining well-established relationships during the pandemic; however, 76.7% (n = 89/116) of respondents indicated in-person engagement to be more effective than virtual engagement for building and maintaining trust. Despite some shortcomings, virtual or remote engagement presents opportunities, such as: (1) care and nurturing of well-established long-term relationships; (2) short-term (1-3 years) trust maintenance; (3) peer-peer or mentor-mentee coordination; (4) supplemental communications; (5) producer-push knowledge dissemination; and, if done thoughtfully, (6) enhancing diversity, equity, and inclusion. Without change, pre-pandemic trust-based relationships foundational to cooperative, multinational, resource management are under threat.


Asunto(s)
COVID-19 , Humanos , COVID-19/epidemiología , Pandemias , Confianza , Recursos Naturales , Conservación de los Recursos Naturales
2.
Mol Genet Metab ; 132(4): 234-243, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33642210

RESUMEN

BACKGROUND: Recent years have witnessed a considerable increase in clinical trials of new investigational agents for Fabry disease (FD). Several trials investigating different agents are currently in progress; however, lack of standardisation results in challenges to interpretation and comparison. To facilitate the standardisation of investigational programs, we have developed a common framework for future clinical trials in FD. METHODS AND FINDINGS: A broad consensus regarding clinical outcomes and ways to measure them was obtained via the Delphi methodology. 35 FD clinical experts from 4 continents, representing 3389 FD patients, participated in 3 rounds of Delphi procedure. The aim was to reach a consensus regarding clinical trial design, best treatment comparator, clinical outcomes, measurement of those clinical outcomes and inclusion and exclusion criteria. Consensus results of this initiative included: the selection of the adaptative clinical trial as the ideal study design and agalsidase beta as ideal comparator treatment due to its longstanding use in FD. Renal and cardiac outcomes, such as glomerular filtration rate, proteinuria and left ventricular mass index, were prioritised, whereas neurological outcomes including cerebrovascular and white matter lesions were dismissed as a primary or secondary outcome measure. Besides, there was a consensus regarding the importance of patient-related outcomes such as general quality of life, pain, and gastrointestinal symptoms. Also, unity about lysoGb3 and Gb3 tissue deposits as useful surrogate markers of the disease was obtained. The group recognised that cardiac T1 mapping still has potential but requires further development before its widespread introduction in clinical trials. Finally, patients with end-stage renal disease or renal transplant should be excluded unless a particular group for them is created inside the clinical trial. CONCLUSION: This consensus will help to shape the future of clinical trials in FD. We note that the FDA has, coincidentally, recently published draft guidelines on clinical trials in FD and welcome this contribution.


Asunto(s)
Ensayos Clínicos como Asunto , Terapia de Reemplazo Enzimático , Enfermedad de Fabry/tratamiento farmacológico , Riñón/metabolismo , Adulto , Consenso , Técnica Delphi , Enfermedad de Fabry/genética , Enfermedad de Fabry/metabolismo , Enfermedad de Fabry/patología , Femenino , Globósidos/uso terapéutico , Glucolípidos/uso terapéutico , Humanos , Isoenzimas/genética , Riñón/efectos de los fármacos , Riñón/patología , Masculino , Persona de Mediana Edad , Calidad de Vida , Esfingolípidos/uso terapéutico , Resultado del Tratamiento , Trihexosilceramidas/uso terapéutico , alfa-Galactosidasa/genética
3.
Br J Surg ; 108(4): 441-447, 2021 04 30.
Artículo en Inglés | MEDLINE | ID: mdl-33615351

RESUMEN

BACKGROUND: Complicated intra-abdominal infections (cIAIs) are associated with significant morbidity and mortality. The aim of this study was to describe the clinical characteristics of patients with cIAI in a multicentre study and to develop clinical prediction models (CPMs) to help identify patients at risk of mortality or relapse. METHODS: A multicentre observational study was conducted from August 2016 to February 2017 in the UK. Adult patients diagnosed with cIAI were included. Multivariable logistic regression was performed to develop CPMs for mortality and cIAI relapse. The c-statistic was used to test model discrimination. Model calibration was tested using calibration slopes and calibration in the large (CITL). The CPMs were then presented as point scoring systems and validated further. RESULTS: Overall, 417 patients from 31 surgical centres were included in the analysis. At 90 days after diagnosis, 17.3 per cent had a cIAI relapse and the mortality rate was 11.3 per cent. Predictors in the mortality model were age, cIAI aetiology, presence of a perforated viscus and source control procedure. Predictors of cIAI relapse included the presence of collections, outcome of initial management, and duration of antibiotic treatment. The c-statistic adjusted for model optimism was 0.79 (95 per cent c.i. 0.75 to 0.87) and 0.74 (0.73 to 0.85) for mortality and cIAI relapse CPMs. Adjusted calibration slopes were 0.88 (95 per cent c.i. 0.76 to 0.90) for the mortality model and 0.91 (0.88 to 0.94) for the relapse model; CITL was -0.19 (95 per cent c.i. -0.39 to -0.12) and - 0.01 (- 0.17 to -0.03) respectively. CONCLUSION: Relapse of infection and death after complicated intra-abdominal infections are common. Clinical prediction models were developed to identify patients at increased risk of relapse or death after treatment, these now require external validation.


Asunto(s)
Reglas de Decisión Clínica , Infecciones Intraabdominales/etiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Femenino , Humanos , Infecciones Intraabdominales/diagnóstico , Infecciones Intraabdominales/tratamiento farmacológico , Infecciones Intraabdominales/mortalidad , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Recurrencia , Factores de Riesgo
4.
Lupus ; 27(10): 1687-1696, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30041577

RESUMEN

The relationship between serum concentration of complement C4 ([C4]) and C4 gene copy number (GCN) was investigated in 56 systemic lupus erythematosus (SLE) patients and 33 age and sex-matched controls in a Western Australian population. C4A and C4B gene copy numbers (C4A & B GCN) together with the presence or absence of the ≈6.4-kb human endogenous retroviral element type K (hereafter HERV-K) in intron 9 were estimated by two TaqMan™ real-time PCR (RT-PCR) assays that measured total C4 and HERV-K GCNs, respectively. There was good correlation between the two methods; however, the HERV-K GCN method showed a positive bias (≈6%) relative to the C4A & B total GCN. Despite individual variation, excellent correlation between total C4 GCN and mean [C4] per GCN was observed for both the SLE and control cohorts ( R2 = 88% and R2 = 99%, respectively). It was noted that serum [C4] was significantly lower in the SLE patients than the controls ( p = 0.006) despite there being no difference between C4A and C4B GCN in both cohorts. The data therefore confirm previous reports that the C4A genes are preferentially associated with the presence of the HERV-K insertion relative to C4B genes and does not support the hypothesis that low [C4] in SLE is explained by low C4A GCNs. There was no evidence also that the presence of the HERV-K insertion in C4 genes influenced [C4]. This study supports the view that low [C4] in SLE patients is due to consumption rather than deficient synthesis related to lower C4A & B GCN.


Asunto(s)
Complemento C4a/genética , Complemento C4b/genética , Dosificación de Gen , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/genética , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Elementos Transponibles de ADN , ADN Viral/genética , Regulación hacia Abajo , Retrovirus Endógenos/genética , Femenino , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Humanos , Lupus Eritematoso Sistémico/diagnóstico , Masculino , Persona de Mediana Edad , Fenotipo , Factores de Riesgo , Australia Occidental
5.
Allergy ; 71(9): 1256-63, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27240281

RESUMEN

The prevalence of allergic conditions has continuously increased in the last few decades in Westernized countries. A dysbiotic gut microbiome may play an important role in the development of allergic diseases. Genetic, environmental, and dietary factors may alter the commensal microbiota leading to inflammatory dysregulation of homeostasis. Murine and human studies have begun to elucidate the role of the microbiota in the pathogenesis of atopic diseases including asthma, atopic dermatitis, and food allergies. However, the role of the microbiome in most eosinophilic gastrointestinal diseases (EGIDs) is not yet known. This review provides an overview of what is currently known about the development of tolerance from both molecular and clinical standpoints. We also look at the gut-specific microbiome and its role in atopic conditions with the hope of applying this knowledge to the understanding, prevention, and treatment of EGIDs, particularly EoE.


Asunto(s)
Tracto Gastrointestinal/inmunología , Tracto Gastrointestinal/microbiología , Hipersensibilidad Inmediata/etiología , Microbiota , Factores de Edad , Animales , Exposición a Riesgos Ambientales/efectos adversos , Esofagitis Eosinofílica/diagnóstico , Esofagitis Eosinofílica/etiología , Esofagitis Eosinofílica/metabolismo , Esofagitis Eosinofílica/terapia , Tracto Gastrointestinal/metabolismo , Humanos , Hipersensibilidad Inmediata/diagnóstico , Hipersensibilidad Inmediata/metabolismo , Hipersensibilidad Inmediata/terapia , Especificidad de Órganos/inmunología
6.
J Inherit Metab Dis ; 38(3): 495-503, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25112389

RESUMEN

Pompe disease is a rare, progressive lysosomal storage disorder for which enzyme therapy (ERT) became available in 2006. Four years earlier, the IPA/Erasmus MC survey, an international longitudinal prospective survey, was established to collect information on the natural course of the disease and its burden on patients. The survey is a collaboration between Erasmus MC University Medical Center and the International Pompe Association (IPA) and comprises an annual questionnaire that was specifically designed to assess the symptoms and problems of the disease. Here we review our results of over 10 years of follow-up, and discuss the survey's contribution to the field. Tracking 408 Pompe patients between 2002 and 2013, the cumulative data reveals the broad range of clinical manifestations that interfere with patients' lives. The survey allowed us to quantify the rate of disease progression and the positive effects of ERT on patients' quality of life, fatigue, and participation in daily life. Furthermore, it showed for the first time that survival is reduced in adult Pompe disease and improved by ERT. Our results show that a patient survey can serve as a valuable and reliable tool for obtaining quantifiable information on the natural course of a rare disease and on the effects of therapy in a large cohort over a very long time. Most importantly, by working with patient reported outcomes, the survey provides the data that is truly relevant to the patient and complementary to clinical datasets.


Asunto(s)
Terapia de Reemplazo Enzimático/métodos , Enfermedad del Almacenamiento de Glucógeno Tipo II/tratamiento farmacológico , Evaluación del Resultado de la Atención al Paciente , Participación del Paciente , alfa-Glucosidasas/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Fatiga , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Calidad de Vida , Autoinforme , Adulto Joven
7.
Mol Ecol ; 23(3): 561-74, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24330274

RESUMEN

Both environmental and genetic influences can result in phenotypic variation. Quantifying the relative contributions of local adaptation and phenotypic plasticity to phenotypes is key to understanding the effect of environmental variation on populations. Identifying the selective pressures that drive divergence is an important, but often lacking, next step. High gene flow between high- and low-altitude common frog (Rana temporaria) breeding sites has previously been demonstrated in Scotland. The aim of this study was to assess whether local adaptation occurs in the face of high gene flow and to identify potential environmental selection pressures that drive adaptation. Phenotypic variation in larval traits was quantified in R. temporaria from paired high- and low-altitude sites using three common temperature treatments. Local adaptation was assessed using Q(ST)-F(ST) analyses, and quantitative phenotypic divergence was related to environmental parameters using Mantel tests. Although evidence of local adaptation was found for all traits measured, only variation in larval period and growth rate was consistent with adaptation to altitude. Moreover, this was only evident in the three mountains with the highest high-altitude sites. This variation was correlated with mean summer and winter temperatures, suggesting that temperature parameters are potentially strong selective pressures maintaining local adaptation, despite high gene flow.


Asunto(s)
Adaptación Fisiológica/genética , Altitud , Flujo Génico , Rana temporaria/genética , Temperatura , Animales , Genética de Población , Modelos Genéticos , Fenotipo , Carácter Cuantitativo Heredable , Escocia , Selección Genética
8.
J Viral Hepat ; 20(12): 858-66, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24304455

RESUMEN

Anaemia frequently complicates peginterferon/ribavirin therapy for chronic hepatitis C infection. Better prediction of anaemia, ribavirin dose reduction or erythropoietin (EPO) need, may enhance patient management. Inosine triphosphatase (ITPA) genetic variants are associated with ribavirin-induced anaemia and dose reduction; however, their impact in real-life clinic patient cohorts remains to be defined. We studied 193 clinic patients with chronic hepatitis C infection of mixed viral genotype (genotype 1/4 n = 123, genotype 2/3, n = 70) treated with peginterferon/ribavirin. Patients were genotyped for ITPA polymorphisms rs1127354 and rs7270101 using Taqman primers. Hardy-Weinberg equilibrium was present. Estimated ITPA deficiency was graded on severity (0-3, no deficiency/mild/moderate/severe, n = 126/40/24/3, respectively). Multivariable models tested the association with anaemia at 4 weeks of treatment [including decline in haemoglobin (g/dL); haemoglobin <10 g/dL and haemoglobin decline >3 g/dL]; ribavirin dose reduction and EPO use and explored sustained viral response (SVR) to peginterferon/ribavirin. More severe ITPA deficiency was associated with less reduction in haemoglobin level (P <0.001; R(2) = 0.34), less ribavirin dose reduction (OR 0.42; (95% CI = 0.23-0.77); P = 0.005) and less EPO use [OR 0.53; (0.30-0.94); P = 0.029]. ITPA deficiency was associated with SVR [OR: 1.70; (1.02-2.83); P = 0.041] independently of clinical covariates (adjusted R(2) = 0.31). In this clinical cohort, ITPA deficiency helped predict the risk of on-treatment anaemia, ribavirin dose reduction, need for EPO support and was associated with SVR. For patients on HCV regimens including peginterferon/ribavirin, testing for ITPA deficiency may have clinical utility.


Asunto(s)
Anemia/inducido químicamente , Anemia/epidemiología , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Errores Innatos del Metabolismo/diagnóstico , Pirofosfatasas/deficiencia , Ribavirina/efectos adversos , Anciano , Quimioterapia Combinada/efectos adversos , Quimioterapia Combinada/métodos , Femenino , Humanos , Interferones/uso terapéutico , Masculino , Persona de Mediana Edad , Ribavirina/uso terapéutico , Resultado del Tratamiento
9.
J Viral Hepat ; 20(11): 745-60, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24168254

RESUMEN

Emerging data indicate that all-oral antiviral treatments for chronic hepatitis C virus (HCV) will become a reality in the near future. In replacing interferon-based therapies, all-oral regimens are expected to be more tolerable, more effective, shorter in duration and simpler to administer. Coinciding with new treatment options are novel methodologies for disease screening and staging, which create the possibility of more timely care and treatment. Assessments of histologic damage typically are performed using liver biopsy, yet noninvasive assessments of histologic damage have become the norm in some European countries and are becoming more widespread in the United States. Also in place are new Centers for Disease Control and Prevention (CDC) initiatives to simplify testing, improve provider and patient awareness and expand recommendations for HCV screening beyond risk-based strategies. Issued in 2012, the CDC recommendations aim to increase HCV testing among those with the greatest HCV burden in the United States by recommending one-time testing for all persons born during 1945-1965. In 2013, the United States Preventive Services Task Force adopted similar recommendations for risk-based and birth-cohort-based testing. Taken together, the developments in screening, diagnosis and treatment will likely increase demand for therapy and stimulate a shift in delivery of care related to chronic HCV, with increased involvement of primary care and infectious disease specialists. Yet even in this new era of therapy, barriers to curing patients of HCV will exist. Overcoming such barriers will require novel, integrative strategies and investment of resources at local, regional and national levels.


Asunto(s)
Antivirales/administración & dosificación , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/tratamiento farmacológico , Tamizaje Masivo/métodos , Guías de Práctica Clínica como Asunto , Administración Oral , Centers for Disease Control and Prevention, U.S. , Hepatitis C Crónica/prevención & control , Humanos , Hígado/patología , Estados Unidos
10.
Mol Ecol ; 22(14): 3737-51, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23692266

RESUMEN

Recent and historical species' associations with climate can be inferred using molecular markers. This knowledge of population and species-level responses to climatic variables can then be used to predict the potential consequences of ongoing climate change. The aim of this study was to predict responses of Rana temporaria to environmental change in Scotland by inferring historical and contemporary patterns of gene flow in relation to current variation in local thermal conditions. We first inferred colonization patterns within Europe following the last glacial maximum by combining new and previously published mitochondrial DNA sequences. We found that sequences from our Scottish samples were identical to (92%), or clustered with, the common haplotype previously identified from Western Europe. This clade showed very low mitochondrial variation, which did not allow inference of historical colonization routes but did allow interpretation of patterns of current fine-scale population structure without consideration of confounding historical variation. Second, we assessed fine-scale microsatellite-based patterns of genetic variation in relation to current altitudinal temperature gradients. No population structure was found within altitudinal gradients (average FST=0.02), despite a mean annual temperature difference of 4.5 °C between low- and high-altitude sites. Levels of genetic diversity were considerable and did not vary between sites. The panmictic population structure observed, even along temperature gradients, is a potentially positive sign for R. temporaria persistence in Scotland in the face of a changing climate. This study demonstrates that within taxonomic groups, thought to be at high risk from environmental change, levels of vulnerability can vary, even within species.


Asunto(s)
ADN Mitocondrial/genética , Rana temporaria/genética , Rana temporaria/fisiología , Animales , Clima , Cambio Climático , Variación Genética , Genética de Población , Haplotipos , Repeticiones de Microsatélite , Datos de Secuencia Molecular , Escocia
11.
J Fish Biol ; 82(2): 600-17, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23398071

RESUMEN

Two previously described lacustrine cisco Coregonus spp. morphs [i.e. a small (<300 mm fork length, L(F)), low-gillraker (≤44) morph and a large (≥300 mm L(F) ), high-gillraker (≥45) morph] from Great Slave Lake, NT, Canada, were found to be synonymous with cisco Coregonus artedi. Geometric body shape did not differ between the two size classes nor could they be differentiated by 24 size-corrected linear measurements, indicating that the two groups had similar phenotypes. Strong, positive correlations between all linear characters and geometric centroid size (a composite variable of fish body length, mass and age) suggested that body morphology changed with age as fish grew. Total gillraker number (N(GR)) increased with L(F) according to: N(GR) = 36.3 + 0.034L(F). Differences in gillraker number and phenotype with age and size were explained by shifts in habitat and trophic resource use. Relative abundance within 0-30, 30-60, 60-90 and >90 m depth strata differed between size classes suggesting that morphology changed when fish shifted their habitat as they grew older. Large C. artedi had lower δ(13)C and slightly higher δ(15)N, indicating greater reliance on pelagic prey resources (i.e. more or larger zooplankton, such as Mysis spp.), compared to small C. artedi, which relied slightly more on benthic prey. Gillraker shape and number have always been used as key diagnostic characters in coregonine taxonomy; based on the findings presented here, ontogenetic shifts should be accounted for in resulting classifications.


Asunto(s)
Dieta/veterinaria , Ecosistema , Salmonidae/anatomía & histología , Salmonidae/fisiología , Factores de Edad , Animales , Tamaño Corporal , Cadena Alimentaria , Fenotipo , Densidad de Población , Salmonidae/crecimiento & desarrollo
12.
Rev Sci Instrum ; 94(4)2023 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38081276

RESUMEN

A new shattered pellet injection system was designed and built to perform disruption mitigation experiments on ASDEX Upgrade. The system can inject pellets with diameters of 1, 2, 4, or 8 mm with variable lengths over a range of L/D ratios of ∼0.5-1.5. By using helium or deuterium as propellant gas, the pellets can be accelerated to speeds between 60 and 750 m/s. The velocity range slightly depends on the pellet mass. The injection system is capable of preparing three pellets in separate barrels at the same time. Once accelerated by the propellant gas pulse, the pellets travel through one of three parallel flight tubes. Each flight tube is separated into three sections with increasing diameters of 12, 14, and 16 mm. Two gaps between the sections allow for removal of the propellant gas by expansion into two separate expansions tanks (0.3 and 0.035 m3), pellet observation in the first gap and the torus gate valve in the second. Each flight tube end is equipped with an exchangeable shatter head with different shatter angles, square or circular cross-section, and different lengths. The gas preparation and control systems allow highly automated pellet generation for precision of the pellet composition and an excellent reproducibility of shattered pellet experiments.

13.
J Viral Hepat ; 19(5): 332-40, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22497812

RESUMEN

Low-density lipoprotein cholesterol (LDL-C) levels and interleukin 28B (IL28B) polymorphism are associated with sustained viral response (SVR) to peginterferon/ribavirin (pegIFN/RBV) for chronic hepatitis C (CHC) infection. IL28B has been linked with LDL-C levels using a candidate gene approach, but it is not known whether other genetic variants are associated with LDL-C, nor how these factors definitively affect SVR. We assessed genetic predictors of serum lipid and triglyceride levels in 1604 patients with genotype 1 (G1) chronic hepatitis C virus (HCV) infection by genome-wide association study and developed multivariable predictive models of SVR. IL28B polymorphisms were the only common genetic variants associated with pretreatment LDL-C level in Caucasians (rs12980275, P = 4.7 × 10(-17), poor response IL28B variants associated with lower LDL-C). The association was dependent on HCV infection, IL28B genotype was no longer associated with LDL-C in SVR patients after treatment, while the association remained significant in non-SVR patients (P < 0.001). LDL-C was significantly associated with SVR for heterozygous IL28B genotype patients (P < 0.001) but not for homozygous genotypes. SVR modelling suggested that IL28B heterozygotes with LDL-C > 130 mg/dL and HCV RNA ≤600 000 IU/mL may anticipate cure rates >80%, while the absence of these two criteria was associated with an SVR rate of <35%. IL28B polymorphisms are the only common genetic variants associated with pretreatment LDL-C in G1-HCV. LDL-C remains significantly associated with SVR for heterozygous IL28B genotype patients, where LDL-C and HCV RNA burden may identify those patients with high or low likelihood of cure with pegIFN/RBV therapy.


Asunto(s)
Antivirales/administración & dosificación , LDL-Colesterol/sangre , Hepacivirus/clasificación , Hepatitis C Crónica/tratamiento farmacológico , Interferones/administración & dosificación , Interleucinas/genética , Polimorfismo Genético , Adulto , Femenino , Estudios de Asociación Genética , Genotipo , Hepacivirus/genética , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/virología , Humanos , Masculino , Persona de Mediana Edad , Ribavirina/administración & dosificación , Resultado del Tratamiento , Carga Viral
14.
J Viral Hepat ; 18(4): e134-43, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21108699

RESUMEN

Previous studies of chronic hepatitis C virus (HCV) treatment have demonstrated variations in response among racial and ethnic groups including poorer efficacy rates among African American and Hispanic patients. The individualized dosing efficacy vs flat dosing to assess optimaL pegylated interferon therapy (IDEAL) trial enrolled 3070 patients from 118 United States centres to compare treatment with peginterferon (PEG-IFN) alfa-2a and ribavirin (RBV) and two doses of PEG-IFN alfa-2b and RBV. This analysis examines treatment response among the major racial and ethnic groups in the trial. Overall, sustained virologic response (SVR) rates were 44% for white, 22% for African American, 38% for Hispanic and 59% for Asian American patients. For patients with undetectable HCV RNA at treatment week 4, the positive predictive value of SVR was 86% for white, 92% for African American, 83% for Hispanic and 89% for Asian American patients. The positive predictive values of SVR in those with undetectable HCV RNA at treatment week 12 ranged from 72% to 81%. Multivariate regression analysis using baseline characteristics demonstrated that treatment regimen was not a predictor of SVR. Despite wide-ranging SVR rates among the different racial and ethnic groups, white and Hispanic patients had similar SVR rates. In all groups, treatment response was largely determined by antiviral activity in the first 12 weeks of treatment. Therefore, decisions regarding HCV treatment should consider the predictive value of the early on-treatment response, not just baseline characteristics, such as race and ethnicity.


Asunto(s)
Antivirales/administración & dosificación , Etnicidad , Hepatitis C Crónica/tratamiento farmacológico , Grupos Raciales , Adulto , Femenino , Hepacivirus/aislamiento & purificación , Humanos , Interferón alfa-2 , Interferón-alfa/administración & dosificación , Masculino , Persona de Mediana Edad , Polietilenglicoles/administración & dosificación , Proteínas Recombinantes , Ribavirina/administración & dosificación , Resultado del Tratamiento , Estados Unidos , Carga Viral
15.
Opt Express ; 19(6): 4902-7, 2011 Mar 14.
Artículo en Inglés | MEDLINE | ID: mdl-21445126

RESUMEN

We demonstrate supercontinuum generation in a photonic crystal fiber with all-normal group velocity dispersion. Pumping a short section of this fiber with compressed pulses from a compact amplified fiber laser generates a 200 nm bandwidth continuum with typical self-phase-modulation characteristics. We demonstrate that the supercontinuum is compressible to a duration of 26 fs. It therefore has a high degree of coherence between all the frequency components, and is a single pulse in the time domain. A smooth, flat spectrum spanning 800 nm is achieved using a longer piece of fiber.

16.
BJOG ; 117(9): 1074-9, 2010 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-20497415

RESUMEN

OBJECTIVE: Expedited partner treatment (EPT) for uncomplicated Chlamydia trachomatis at the pharmacy is an alternative approach to partner notification that has not yet been evaluated within the UK. The aim of this study was to evaluate EPT for partners using pharmacies in Lothian. DESIGN: A pilot study over 18 months. SETTING: Selected healthcare settings and community pharmacies in Lothian, Scotland, UK. POPULATION: Sexual partners of index cases with uncomplicated C. trachomatis. METHODS: Index cases with uncomplicated C. trachomatis were given a pharmacy voucher to pass onto sexual partners. Partners could redeem vouchers for free treatment (azithromycin) at one of 90 pharmacies in the area. MAIN OUTCOME MEASURES: The main outcome measure was the proportion of vouchers redeemed. Secondary outcomes included patient satisfaction, as determined at a telephone follow-up of a subgroup of female index cases from one study site, 1 month later. RESULTS: In total 577 vouchers were issued to chlamydia-positive index patients of mean age 22.9 years (range 15-47 years). A total of 231 vouchers were redeemed (40%), at a median of 2 days after issue. Only 4% of partners attended a clinic for treatment. Most index patients surveyed reported that partners were satisfied with this method of treatment (48 out of 55; 87%). CONCLUSIONS: Expedited partner treatment for uncomplicated chlamydia at a pharmacy is a popular choice, and increases options on where, when and how partners are treated.


Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Infecciones por Chlamydia/tratamiento farmacológico , Chlamydia trachomatis , Farmacias/estadística & datos numéricos , Parejas Sexuales , Adolescente , Adulto , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Satisfacción Personal , Proyectos Piloto , Escocia , Adulto Joven
17.
Ann Rheum Dis ; 68(12): 1827-32, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19054820

RESUMEN

BACKGROUND: Comprehensive multisystem clinical assessment using the Birmingham Vasculitis Activity score (BVAS) is widely used in therapeutic studies of systemic vasculitis. Extensive use suggested a need to revise the instrument. The previous version of BVAS has been revised, according to usage and reviewed by an expert committee. OBJECTIVE: To modify and validate version 3 of the BVAS in patients with systemic vasculitis. METHODS: The new version of BVAS was tested in a prospective cross-sectional study of patients with vasculitis. RESULTS: The number of items was reduced from 66 to 56. The subscores for new/worse disease and persistent disease were unified. In 313 patients with systemic vasculitis, BVAS(v.3) correlated with treatment decision (Spearman's r(s) = 0.66, 95% CI 0.59 to 0.72), BVAS1 of version 2 (r(s) = 0.94, 95% CI 0.92 to 0.96), BVAS2 of version 2 in patients with persistent disease (r(s) = 0.60, 95% CI 0.21 to 0.83), C-reactive protein levels (r(s) = 0.43, 95% CI 0.31 to 0.54), physician's global assessment (r(s) = 0.91, 95% CI 0.89 to 0.93) and vasculitis activity index (r(s) = 0.88, 95% CI 0.86 to 0.91). The intraclass correlation coefficients for reproducibility and repeatability were 0.96 (95% CI 0.95 to 0.97) and 0.96 (95% CI 0.92 to 0.97), respectively. In 39 patients assessed at diagnosis and again at 3 months, the BVAS(v.3) fell by 17 (95% CI 15 to 19) units (p<0.001, paired t test). CONCLUSION: BVAS(v.3) demonstrates convergence with BVAS(v.2), treatment decision, physician global assessment of disease activity, vasculitis activity index and C-reactive protein. It is repeatable, reproducible and sensitive to change. The new version of BVAS is validated for assessment of systemic vasculitis.


Asunto(s)
Índice de Severidad de la Enfermedad , Vasculitis/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/diagnóstico , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/tratamiento farmacológico , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vasculitis/tratamiento farmacológico , Adulto Joven
18.
Science ; 167(3918): 688-90, 1970 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-17781547

RESUMEN

Lunar bulk sample 10084,85 (< 1 mm size dust), and samples from rocks 10017,17 (fine grained, vesicular), 10046,17 (breccia), 10057,59 (fine grained, vesicular, top surface), 10057,60 (fine grained, vesicular, interior), and 10058,24 (medium grained, not vesicular) have been investigated by (57)Fe Mössbauer spectroscopy. Iron metal and the Fe(2+) minerals ilmenite, pyroxene, troilite, and iron containing glass have been identified. An iron line of sample 10084,85 (originally sealed in nitrogen) showed no significant intensity change when the sample was exposed to air. The antiferromagnetic transition in several lunar ilmenites at 57(0) +/- 2 degrees K corresponds to stoichiometric FeTiO,. Magneticallv separated 10057 showed troilite and somne metallic iron.

19.
Science ; 243(4896): 1346-51, 1989 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-2493678

RESUMEN

The x-ray crystal structure of recombinant human renin has been determined. Molecular dynamics techniques that included crystallographic data as a restraint were used to improve an initial model based on porcine pepsinogen. The present agreement factor for data from 8.0 to 2.5 angstroms (A) is 0.236. Some of the surface loops are poorly determined, and these disordered regions border a 30 A wide solvent channel. Comparison of renin with other aspartyl proteinases shows that, although the structural cores and active sites are highly conserved, surface residues, some of which are critical for specificity, vary greatly (up to 10A). Knowledge of the actual structure, as opposed to the use of models based on related enzymes, should facilitate the design of renin inhibitors.


Asunto(s)
Proteínas Recombinantes , Renina , Ácido Aspártico Endopeptidasas , Fármacos Cardiovasculares/farmacología , Endopeptidasas/metabolismo , Humanos , Modelos Moleculares , Pepsina A/metabolismo , Conformación Proteica , Proteínas Recombinantes/metabolismo , Renina/metabolismo
20.
Br J Nutr ; 102(3): 361-9, 2009 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-19216812

RESUMEN

The present study involved a comparative analysis of the effects of purified flaxseed lignans, secoisolariciresinol diglucoside (SDG) and its aglycone metabolite (SECO), in hyperlipidaemic rats. For hypercholesterolaemia, female Wistars (six rats per group) were fed a standard or 1 % cholesterol diet and orally administered 0, 3 or 6 mg SDG/kg or 0, 1.6 or 3.2 mg SECO/kg body weight once daily for 4 weeks. Hypertriacylglycerolaemia was induced in male Sprague-Dawley rats (ten rats per group) by supplementing tap water with 10 % fructose. These rats were orally administered 0, 3 or 6 mg SDG/kg body weight once daily for 2 weeks. Fasting blood samples (12 h) were collected predose and at the end of the dosing period for serum lipid analyses. Rats were killed and livers rapidly excised and sectioned for lipid, mRNA and histological analyses. Chronic administration of equimolar amounts of SDG and SECO caused similar dose-dependent reductions in rate of body-weight gain and in serum total and LDL-cholesterol levels and hepatic lipid accumulation. SDG and SECO failed to alter hepatic gene expression of commonly reported regulatory targets of lipid homeostasis. SDG had no effect on serum TAG, NEFA, phospholipids and rate of weight gain in 10 % fructose-supplemented rats. In conclusion, our data suggest that the lignan component of flaxseed contributes to the hypocholesterolaemic effects of flaxseed consumption observed in humans. Future studies plan to identify the biochemical mechanism(s) through which flaxseed lignans exert their beneficial effects and the lignan form(s) responsible.


Asunto(s)
Butileno Glicoles/farmacología , Lino , Glucósidos/farmacología , Hiperlipidemias/dietoterapia , Lignanos/farmacología , Lípidos/análisis , Hígado/metabolismo , Animales , Secuencia de Bases , Peso Corporal/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Femenino , Fructosa/administración & dosificación , Expresión Génica , Hiperlipidemias/metabolismo , Hiperlipidemias/patología , Lípidos/sangre , Hígado/química , Hígado/patología , Masculino , Modelos Animales , Datos de Secuencia Molecular , Distribución Aleatoria , Ratas , Ratas Sprague-Dawley , Ratas Wistar
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