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1.
Artigo em Inglês | MEDLINE | ID: mdl-38977656

RESUMO

OBJECTIVE: To characterize the participant demographics in the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) database compared with the web-portal National Amyotrophic Lateral Sclerosis (ALS) Registry (the Registry). METHODS: Demographics and ALS symptom information were compared between the self-reported registrant data in the Registry web portal (2010-2021) and the latest available PRO-ACT data (updated August 2022), which is a collection of clinical trials data. RESULTS: Greater percentages of younger (≤ 59 years old) but smaller percentages of older (60 + years old) participants were represented in PRO-ACT compared to Registry. Enrollment for minority race groups was greater in the Registry portal data, but race information was largely missing/unknown in PRO-ACT database. Median age at the time of diagnosis and age at the time of symptom onset were significantly higher for Registry enrollees compared to the participants of PRO-ACT. Symptom onset sites were similarly reported, but duration between self-noted symptom onset and diagnosis was slight, but significantly longer for the Registry enrollees (11 vs. 9 months). Hispanic were as likely as non-Hispanic to participate in research studies, based on the Registry data. CONCLUSION: There was a notable difference in the age distribution and minority representation of enrollees between the PRO-ACT and Registry study populations. Age distribution in the PRO-ACT database skewed to a younger and less diverse cohort. Despite the clinical heterogeneity and complex disease mechanism of ALS, identifying the underrepresented demographic niche in the PRO-ACT and Registry study populations can help improve patient participation and criteria for patient selection to enhance generalizability.

2.
J Virol ; : e0068124, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38953379

RESUMO

Serum-neutralizing antibody titers are a critical measure of vaccine immunogenicity and are used to determine flavivirus seroprevalence in study populations. An effective dengue virus (DENV) vaccine must confer simultaneous protection against viruses grouped within four antigenic serotypes. Existing flavivirus neutralization assays, including the commonly used plaque/focus reduction neutralization titer (PRNT/FRNT) assay, require an individual assay for each virus, serotype, and strain and easily become a labor-intensive and time-consuming effort for large epidemiological studies or vaccine trials. Here, we describe a multiplex reporter virus particle neutralization titer (TetraPlex RVPNT) assay for DENV that allows simultaneous quantitative measures of antibody-mediated neutralization of infection against all four DENV serotypes in a single low-volume clinical sample and analyzed by flow cytometry. Comparative studies confirm that the neutralization titers of antibodies measured by the TetraPlex RVPNT assay are similar to FRNT/PRNT assay approaches performed separately for each viral strain. The use of this high-throughput approach enables the careful serological study in DENV endemic populations and vaccine recipients required to support the development of a safe and effective tetravalent DENV vaccine. IMPORTANCE: As a mediator of protection against dengue disease and a serological indicator of prior infection, the detection and quantification of neutralizing antibodies against DENV is an important "gold standard" tool. However, execution of traditional neutralizing antibody assays is often cumbersome and requires repeated application for each virus or serotype. The optimized RVPNT assay described here is high-throughput, easily multiplexed across multiple serotypes, and targets reporter viral particles that can be robustly produced for all four DENV serotypes. The use of this transformative RVPNT assay will support the expansion of neutralizing antibody datasets to answer research and public health questions often limited by the more cumbersome neutralizing antibody assays and the need for greater quantities of test serum.

4.
J Am Chem Soc ; 146(26): 17669-17678, 2024 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-38905328

RESUMO

The genus Mycobacterium includes species such as Mycobacterium tuberculosis, which can cause deadly human diseases. These bacteria have a protective cell envelope that can be remodeled to facilitate their survival in challenging conditions. Understanding how such conditions affect membrane remodeling can facilitate antibiotic discovery and treatment. To this end, we describe an optimized fluorogenic probe, N-QTF, that reports on mycolyltransferase activity, which is vital for cell division and remodeling. N-QTF is a glycolipid probe that can reveal dynamic changes in the mycobacterial cell envelope in both fast- and slow-growing mycobacterial species. Using this probe to monitor the consequences of antibiotic treatment uncovered distinct cellular phenotypes. Even antibiotics that do not directly inhibit cell envelope biosynthesis cause conspicuous phenotypes. For instance, mycobacteria exposed to the RNA polymerase inhibitor rifampicin release fluorescent extracellular vesicles (EVs). While all mycobacteria release EVs, fluorescent EVs were detected only in the presence of RIF, indicating that exposure to the drug alters EV content. Macrophages exposed to the EVs derived from RIF-treated cells released lower levels of cytokines, suggesting the EVs moderate immune responses. These data suggest that antibiotics can alter EV content to impact immunity. Our ability to see such changes in EV constituents directly results from exploiting these chemical probes.


Assuntos
Corantes Fluorescentes , Mycobacterium tuberculosis , Corantes Fluorescentes/química , Corantes Fluorescentes/síntese química , Mycobacterium tuberculosis/efeitos dos fármacos , Antibacterianos/farmacologia , Antibacterianos/química , Membrana Celular/efeitos dos fármacos , Membrana Celular/metabolismo , Vesículas Extracelulares/química , Vesículas Extracelulares/metabolismo , Humanos
5.
Cancer Radiother ; 28(3): 272-274, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38839523

RESUMO

A 77-year-old transgender man (assigned female sex at birth, gender identity male, i.e. female-to-male) was referred for a palpable mass of the right chest wall. Biopsies revealed invasive lobular breast carcinoma. After discussion by a multidisciplinary tumour board meeting, the patient was treated with total mastectomy, adjuvant hypofractionated radiation therapy, and hormone therapy. At 1.5-year follow-up, there was no sign of recurrence or long-term radiation side effects. To our knowledge, this is the first reported case of adjuvant hypofractionated radiation therapy in a transgender patient with breast cancer.


Assuntos
Neoplasias da Mama , Hipofracionamento da Dose de Radiação , Pessoas Transgênero , Humanos , Idoso , Masculino , Neoplasias da Mama/radioterapia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Mastectomia , Carcinoma Lobular/radioterapia , Carcinoma Lobular/patologia , Radioterapia Adjuvante , Neoplasias da Mama Masculina/radioterapia , Neoplasias da Mama Masculina/patologia , Neoplasias da Mama Masculina/cirurgia
6.
Adv Biol (Weinh) ; : e2300658, 2024 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-38880843

RESUMO

Because aging and internally determined lifespan vary greatly between similar species it is now widely accepted that aging is an evolved trait, resulting in two classes of evolutionary aging theories: aging is programmed by complex biological mechanisms, and aging is not programmed. As recently as 2002 programmed aging is thought to be theoretically impossible. However, genetics discoveries, results of selective breeding, and other direct evidence strongly support the idea that aging creates an evolutionary advantage and that therefore complex biological mechanisms evolved that control aging in mammals and other multiparous organisms. Like life-cycle programs that control reproduction, growth, and menopause the aging program can adjust the aging trait during an individual's life to compensate for temporary or local changes in external conditions that alter the optimum lifespan for a particular species population. Genetics discoveries also strongly support the evolvability concept to the effect that sexually reproducing species can evolve design features that increase their ability to evolve, and that aging is one such feature. Genetics discoveries also prove that biological inheritance involves transmission of organism design information in digital form between parent and descendant of any organism. This has major implications for the evolution process.

7.
Biomimetics (Basel) ; 9(5)2024 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-38786496

RESUMO

Silk and silk derivatives have emerged as a possible alternative in surgical device development, offering mechanical strength, biocompatibility, and environmental sustainability. Through a systematic review following PRISMA guidelines, this study evaluated silk fibroin's application across pre-clinical and clinical settings, focusing on its role as screws and plates for osteofixation. A comprehensive search yielded 245 studies, with 33 subjected to full-text review and 15 ultimately included for qualitative analysis. The findings underscore silk fibroin's superior properties, including its tunable degradation rates and ability to be functionalized with therapeutic agents. In vivo and in vitro studies demonstrated its efficacy in enhancing bone healing, offering improved outcomes in osteofixation, particularly for craniofacial defects. Silk fibroin's remarkable attributes in biodegradation and drug release capabilities underscore its potential to enhance patient care. Ultimately, silk fibroin's integration into surgical practices promises a revolution in patient outcomes and environmental sustainability. Its versatility, coupled with the continuous progress in fabrication techniques, signals a promising horizon for its widespread acceptance in the medical field, potentially establishing a new benchmark in surgical treatment. Further research is expected to solidify the transition of silk products from basic science to patient care, paving the way for widespread use in various surgical applications.

8.
JCO Clin Cancer Inform ; 8: e2300159, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38728613

RESUMO

PURPOSE: We present and validate a rule-based algorithm for the detection of moderate to severe liver-related immune-related adverse events (irAEs) in a real-world patient cohort. The algorithm can be applied to studies of irAEs in large data sets. METHODS: We developed a set of criteria to define hepatic irAEs. The criteria include: the temporality of elevated laboratory measurements in the first 2-14 weeks of immune checkpoint inhibitor (ICI) treatment, steroid intervention within 2 weeks of the onset of elevated laboratory measurements, and intervention with a duration of at least 2 weeks. These criteria are based on the kinetics of patients who experienced moderate to severe hepatotoxicity (Common Terminology Criteria for Adverse Events grades 2-4). We applied these criteria to a retrospective cohort of 682 patients diagnosed with hepatocellular carcinoma and treated with ICI. All patients were required to have baseline laboratory measurements before and after the initiation of ICI. RESULTS: A set of 63 equally sampled patients were reviewed by two blinded, clinical adjudicators. Disagreements were reviewed and consensus was taken to be the ground truth. Of these, 25 patients with irAEs were identified, 16 were determined to be hepatic irAEs, 36 patients were nonadverse events, and two patients were of indeterminant status. Reviewers agreed in 44 of 63 patients, including 19 patients with irAEs (0.70 concordance, Fleiss' kappa: 0.43). By comparison, the algorithm achieved a sensitivity and specificity of identifying hepatic irAEs of 0.63 and 0.81, respectively, with a test efficiency (percent correctly classified) of 0.78 and outcome-weighted F1 score of 0.74. CONCLUSION: The algorithm achieves greater concordance with the ground truth than either individual clinical adjudicator for the detection of irAEs.


Assuntos
Algoritmos , Inibidores de Checkpoint Imunológico , Neoplasias Hepáticas , Humanos , Inibidores de Checkpoint Imunológico/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/imunologia , Estudos Retrospectivos , Fenótipo , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Carcinoma Hepatocelular/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Fígado/patologia , Fígado/efeitos dos fármacos , Fígado/imunologia
9.
Synapse ; 78(4): e22292, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38813758

RESUMO

N-methyl-d-aspartate receptors (NMDARs) at hippocampal excitatory synapses undergo a late postnatal shift in subunit composition, from an initial prevalence of GluN2B subunit incorporation to a later predominance of GluN2A. This GluN2B to GluN2A shift alters NMDAR calcium conductance dynamics and intracellular molecular signaling that are individually regulated by distinct GluN2 signaling domains and temporally align with developmental alterations in dendritic and synaptic plasticity. However, the impacts of individual GluN2B to GluN2A signaling domains on neuronal development remain unknown. Ionotropic and intracellular signaling domains of GluN2 subunits were separated by creating chimeric GluN2 subunits that were expressed in two transgenic mouse lines. Western blot and immunoprecipitation revealed that roughly one third of native synaptic NMDARs were replaced by transformed NMDARs without altering total synaptic NMDAR content. Schaffer collateral synaptic strength was transiently increased in acutely prepared hippocampal slices at just over 3 weeks of age in animals overexpressing the GluN2B carboxy terminus. Long-term potentiation (LTP) induction following lower frequency stimulation was regulated by GluN2 ionotropic signaling domains in an age-dependent manner and LTP maintenance was enhanced by overexpression of the GluN2B CTD in mature animals. After higher frequency stimulation, the induction and maintenance of LTP were increased in young adult animals overexpressing the GluN2B ionotropic signaling domains but reduced in juveniles just over 3 weeks of age. Confocal imaging of green fluorescent protein (GFP)- labeled CA1 pyramidal neurons revealed no alterations in dendritic morphology or spine density in mice expressing chimeric GluN2 subunits. These results illustrate how individual GluN2 subunit signaling domains do or do not control physiological and morphological development of hippocampal excitatory neurons and better clarify the neurobiological factors that govern hippocampal maturation. SIGNIFICANCE STATEMENT: A developmental reduction in the magnitude of hippocampal long-term synaptic potentiation (LTP) and a concomitant improvement in spatial maze performance coincide with greater incorporation of GluN2A subunits into synaptic NMDARs. Corroborating our prior discovery that overexpression of GluN2A-type ionotropic signaling domains enables context-based navigation in immature mice, GluN2A-type ionotropic signaling domain overexpression reduces LTP induction threshold and magnitude in immature mice. Also, we previously found that GluN2B carboxy terminal domain (CTD) overexpression enhances long-term spatial memory in mature mice and now report that the GluN2B CTD is associated with greater amplitude of LTP after induction in mature mice. Thus, the late postnatal maturation of context encoding likely relies on a shift toward GluN2A-type ionotropic signaling and a reduction in the threshold to induce LTP while memory consolidation and LTP maintenance are regulated by GluN2B subunit CTD signaling.


Assuntos
Dendritos , Hipocampo , Camundongos Transgênicos , Plasticidade Neuronal , Receptores de N-Metil-D-Aspartato , Animais , Receptores de N-Metil-D-Aspartato/metabolismo , Receptores de N-Metil-D-Aspartato/genética , Hipocampo/metabolismo , Hipocampo/crescimento & desenvolvimento , Hipocampo/fisiologia , Dendritos/fisiologia , Dendritos/metabolismo , Camundongos , Plasticidade Neuronal/fisiologia , Potenciação de Longa Duração/fisiologia , Transmissão Sináptica/fisiologia , Potenciais Pós-Sinápticos Excitadores/fisiologia , Transdução de Sinais/fisiologia , Camundongos Endogâmicos C57BL , Masculino
10.
Front Endocrinol (Lausanne) ; 15: 1282231, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38756999

RESUMO

Introduction: Cigarettes containing nicotine (Nic) are a risk factor for the development of cardiovascular and metabolic diseases. We reported that Nic delivered via injections or e-cigarette vapor led to hepatic steatosis in mice fed with a high-fat diet. High-fructose corn syrup (HFCS) is the main sweetener in sugar-sweetened beverages (SSBs) in the US. Increased consumption of SSBs with HFCS is associated with increased risks of non-alcoholic fatty liver disease (NAFLD). Nicotinamide riboside (NR) increases mitochondrial nicotinamide adenine dinucleotide (NAD+) and protects mice against hepatic steatosis. This study evaluated if Nic plus Coca-Cola™ (Coke) with HFCS can cause hepatic steatosis and that can be protected by NR. Methods: C57BL/6J mice received twice daily intraperitoneal (IP) injections of Nic or saline and were given Coke (HFCS), or Coke with sugar, and NR supplementation for 10 weeks. Results: Our results show that Nic+Coke caused increased caloric intake and induced hepatic steatosis, and the addition of NR prevented these changes. Western blot analysis showed lipogenesis markers were activated (increased cleavage of the sterol regulatory element-binding protein 1 [SREBP1c] and reduction of phospho-Acetyl-CoA Carboxylase [p-ACC]) in the Nic+Coke compared to the Sal+Water group. The hepatic detrimental effects of Nic+Coke were mediated by decreased NAD+ signaling, increased oxidative stress, and mitochondrial damage. NR reduced oxidative stress and prevented mitochondrial damage by restoring protein levels of Sirtuin1 (Sirt1) and peroxisome proliferator-activated receptor coactivator 1-alpha (PGC1) signaling. Conclusion: We conclude that Nic+Coke has an additive effect on producing hepatic steatosis, and NR is protective. This study suggests concern for the development of NAFLD in subjects who consume nicotine and drink SSBs with HFCS.


Assuntos
Camundongos Endogâmicos C57BL , Niacinamida , Nicotina , Compostos de Piridínio , Animais , Compostos de Piridínio/farmacologia , Camundongos , Niacinamida/análogos & derivados , Niacinamida/farmacologia , Masculino , Hepatopatia Gordurosa não Alcoólica/prevenção & controle , Hepatopatia Gordurosa não Alcoólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/patologia , Hepatopatia Gordurosa não Alcoólica/etiologia , Fígado Gorduroso/prevenção & controle , Fígado Gorduroso/metabolismo , Fígado Gorduroso/induzido quimicamente , Xarope de Milho Rico em Frutose/efeitos adversos , Fígado/metabolismo , Fígado/efeitos dos fármacos , Fígado/patologia , Estresse Oxidativo/efeitos dos fármacos
11.
Artigo em Inglês | MEDLINE | ID: mdl-38717430

RESUMO

Objective: Amyotrophic lateral sclerosis (ALS) is an incurable, progressive neurodegenerative disease with a significant health burden and poorly understood etiology. This analysis assessed the narrative responses from 3,061 participants in the Centers for Disease Control and Prevention's National ALS Registry who answered the question, "What do you think caused your ALS?" Methods: Data analysis used qualitative methods and artificial intelligence (AI) using natural language processing (NLP), specifically, Bidirectional Encoder Representations from Transformers (BERT) to explore responses regarding participants' perceptions of the cause of their disease. Results: Both qualitative and AI analysis methods revealed several, often aligned themes, which pointed to perceived causes including genetic, environmental, and military exposures. However, the qualitative analysis revealed detailed themes and subthemes, providing a more comprehensive understanding of participants' perceptions. Although there were areas of alignment between AI and qualitative analysis, AI's broader categories did not capture the nuances discovered using the more traditional, qualitative approach. The qualitative analysis also revealed that the potential causes of ALS were described within narratives that sometimes indicate self-blame and other maladaptive coping mechanisms. Conclusions: This analysis highlights the diverse range of factors that individuals with ALS consider as perceived causes for their disease. Understanding these perceptions can help clinicians to better support people living with ALS (PLWALS). The analysis highlights the benefits of using traditional qualitative methods to supplement or improve upon AI-based approaches. This rapidly evolving area of data science has the potential to remove barriers to accessing the rich narratives of people with lived experience.

12.
Neurosurgery ; 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38771088

RESUMO

BACKGROUND AND OBJECTIVES: Despite comprising half of medical students, women represent only 29.6% of neurosurgery applicants and 17% of residents, suggesting a "leak" in the career pipeline for women neurosurgeons. Surveys persistently show that neurosurgery programs identify United States Medical Licensing Examination (USMLE®) Step 1 score and letters of recommendation (LORs) as the most important factors in selecting applicants to interview. A previous study in neurosurgery found no differences in LORs. However, multiple studies in other specialties have demonstrated implicit gender bias in LORs, which may influence resident selection. Our objective is to evaluate neurosurgery residency LORs for evidence of implicit gender bias. METHODS: Retrospective analysis of LORs for interviewed neurosurgery applicants at a single institution during the 2014 to 2020 National Residency Matching Program (NRMP®) match cycles. Letters were evaluated using Linguistic Inquiry & Word Count (LIWC) software (Pennebaker Conglomerates), and additional applicant data were obtained from candidate applications. LIWC (Pennebaker Conglomerates) output data included custom dictionary categories and terms that were analyzed using Prism 10 and Rstudio. RESULTS: Two hundred eighteen applications were reviewed for a total of 827 letters. LIWC (Pennebaker Conglomerates) analysis showed significant differences in word count (331 vs 297, difference = 34, 95% CI: 9-61, P = .008). LORs for applicants who were men were more likely to mention Alpha Omega Alpha Honor Medical Society (1.17 vs 0.778, difference = 0.4, 95% CI: 0.13-0.67, P = .023). USMLE® Step 1 scores were significantly lower for women (241 vs 247, difference = 6, 95% CI: 2-10, P = .004). There was no significant difference between letters for men and women for all categories evaluated in the linguistic evaluation. CONCLUSION: LORs are vital to the neurosurgical residency application process. The data exhibit some differences between the men and women applicants but few differences in their LORs, consistent with the results of the previous neurosurgical study.

14.
Proc Biol Sci ; 291(2021): 20240021, 2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38628119

RESUMO

Conventional life-history theory predicts that energy-demanding events such as reproduction and migration must be temporally segregated to avoid resource limitation. Here, we provide, to our knowledge, the first direct evidence of 'itinerant breeding' in a migratory bird, an incredibly rare breeding strategy (less than 0.1% of extant bird species) that involves the temporal overlap of migratory and reproductive periods of the annual cycle. Based on GPS-tracking of over 200 female American woodcock, most female woodcock (greater than 80%) nested more than once (some up to six times) with short re-nest intervals, and females moved northwards on average 800 km between first and second nests, and then smaller distances (ca 200+ km) between subsequent nesting attempts. Reliance on ephemeral habitat for breeding, ground-nesting and key aspects of life history that reduce both the costs of reproduction and migration probably explain the prevalence of this rare phenotype in woodcock and why itinerant breeding so rarely occurs in other bird species.


Assuntos
Charadriiformes , Características de História de Vida , Animais , Feminino , Estações do Ano , Reprodução , Aves , Ecossistema , Migração Animal
15.
Res Dev Disabil ; 149: 104729, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38636251

RESUMO

BACKGROUND: Cultural-based literature focusing on Asian autistic immigrants living in Western countries is very limited. AIMS: The present study is a quality improvement exercise aiming to fill the gap by investigating the employment needs of and barriers for Chinese autistic youth and young adults in Ontario, Canada. METHODS & PROCEDURES: 71 individuals diagnosed with autism and 24 diagnosed with other mental illnesses, aged 12-29, participated in an online survey regarding their work readiness, work skills, interests, health and cultural concerns. Analyses were conducted to compare the autistic group and the mental health group. OUTCOMES & RESULTS: Results show that the autistic sample has inferior (1) work habits related skills, (2) work style related skills, (3) level of independence, (4) skills to perform routine daily activities, (5) interpersonal skills at work, and (6) ability to tolerate visual and moving stimuli in the work environment. It is also found that the autistic group has more symptoms of depression, anxiety, and autism than that of the non-autistic group. CONCLUSIONS & IMPLICATIONS: The study shed light into the unique needs and barriers of Chinese autistic young adults and the service gap in supporting their transition to employment.


Assuntos
Transtorno do Espectro Autista , Emprego , Humanos , Masculino , Feminino , Transtorno do Espectro Autista/psicologia , Transtorno do Espectro Autista/reabilitação , Adolescente , Adulto , Adulto Jovem , Ontário , Criança , Povo Asiático/psicologia , China , Atividades Cotidianas , Depressão/psicologia , Depressão/epidemiologia , Ansiedade/psicologia , Habilidades Sociais , Avaliação das Necessidades , População do Leste Asiático
16.
Sci Rep ; 14(1): 8060, 2024 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-38580682

RESUMO

Using a virtual reality social experiment, participants (N = 154) experienced being at the table during a decision-making meeting and identified the best solutions generated. During the meeting, one meeting participant repeated another participant's idea, presenting it as his own. Although this idea stealing was clearly visible and audible, only 30% of participants correctly identified who shared the idea first. Subsequent analyses suggest that the social environment affected this novel form of inattentional blindness. Although there was no experimental effect of team diversity on noticing, there was correlational evidence of an indirect effect of perceived team status on noticing via attentional engagement. In sum, this paper extends the inattentional blindness phenomenon to a realistic professional interaction and demonstrates how features of the social environment can reduce social inattention.


Assuntos
Atenção , Roubo , Humanos , Cognição , Cegueira , Percepção Visual
17.
Ann Plast Surg ; 92(4S Suppl 2): S228-S233, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38556679

RESUMO

BACKGROUND: The recent proposed alterations to the Centers for Medicare and Medicaid Services regulations, although subsequently reversed on August 21, 2023, have engendered persistent concerns regarding the impact of insurance policies on breast reconstruction procedures coverage. This study aimed to identify factors that would influence women's preferences regarding autologous breast reconstruction to better understand the possible consequences of these coverage changes. METHODS: A survey of adult women in the United States was conducted via Amazon Mechanical Turk to assess patient preferences for breast reconstruction options, specifically deep inferior epigastric perforator (DIEP) and transverse rectus abdominis myocutaneous (TRAM) flap surgery. The Cochrane-Armitage test evaluated trends in flap preferences concerning incremental out-of-pocket payment increases. RESULTS: Of 500 total responses, 485 were completed and correctly answered a verification question to ensure adequate attention to the survey, with respondents having a median (interquartile range) age of 26 (25-39) years. When presented with the advantages and disadvantages of DIEP versus TRAM flaps, 78% of respondents preferred DIEP; however, as DIEP's out-of-pocket price incrementally rose, more respondents favored the cheaper TRAM option, with $3804 being the "indifference point" where preferences for both procedures converged (P < 0.001). Notably, respondents with a personal history of breast reconstruction showed a higher preference for DIEP, even at a $10,000 out-of-pocket cost (P = 0.04). CONCLUSIONS: Out-of-pocket cost can significantly influence women's choices for breast reconstruction. These findings encourage a reevaluation of emergent insurance practices that could potentially increase out-of-pocket costs associated with DIEP flaps, to prevent cost from decreasing equitable patient access to most current reconstructive options.


Assuntos
Neoplasias da Mama , Mamoplastia , Retalho Miocutâneo , Retalho Perfurante , Idoso , Adulto , Feminino , Humanos , Estados Unidos , Medicare , Mamoplastia/métodos , Retalho Miocutâneo/transplante , Reto do Abdome/transplante , Artérias Epigástricas/transplante , Cobertura do Seguro , Neoplasias da Mama/cirurgia , Retalho Perfurante/cirurgia , Estudos Retrospectivos
18.
Ann Am Thorac Soc ; 21(6): 949-960, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38507612

RESUMO

Rationale: Apneic individuals have reduced airway caliber during sleep. The biomechanical changes in upper airway anatomy contributing to this airway narrowing are largely unknown. Objectives: We sought to investigate the state-dependent (wake vs. sleep) biomechanical behavior of the upper airway soft-tissue and craniofacial structures. Methods: Upper airway magnetic resonance imaging was performed in 15 sleep-deprived control subjects (apnea-hypopnea index, <5; 0.3 ± 0.5 events per hour) and 12 sleep-deprived apneic subjects (apnea-hypopnea index, ⩾5; 35.2 ± 18.1 events per hour) during wake and sleep and analyzed for airway measures and soft-tissue/mandibular movement. Results: In the retropalatal region, control subjects showed sleep-dependent reductions (P ⩽ 0.037) in average cross-sectional airway area (CSA), minimum CSA, and anteroposterior and lateral dimensions. Apneic subjects showed sleep-dependent reductions (P ⩽ 0.002) in average CSA, minimum CSA, and anteroposterior and lateral dimensions. In the retroglossal region, control subjects had no sleep-dependent airway reductions. However, apneic subjects had sleep-dependent reductions in minimal CSA (P = 0.001) and lateral dimensions (P = 0.014). Control subjects only showed sleep-dependent posterior movement of the anterior-inferior tongue octant (P = 0.039), whereas apneic subjects showed posterior movement of the soft palate (P = 0.006) and all tongue octants (P ⩽ 0.012). Sleep-dependent medial movement of the lateral walls was seen at the retropalatal minimum level (P = 0.013) in control subjects and at the retropalatal and retroglossal minimum levels (P ⩽ 0.017) in apneic subjects. There was posterior movement of the mandible in apneic subjects (P ⩽ 0.017). Conclusions: During sleep, control and apneic subjects showed reductions in retropalatal airway caliber, but only the apneic subjects showed retroglossal airway narrowing. Reductions in anteroposterior and lateral airway dimensions were primarily due to posterior soft palate, tongue and mandibular movement and to medial lateral wall movement. These data provide important initial insights into obstructive sleep apnea pathogenesis.


Assuntos
Imageamento por Ressonância Magnética , Orofaringe , Estudo de Prova de Conceito , Apneia Obstrutiva do Sono , Humanos , Masculino , Feminino , Orofaringe/diagnóstico por imagem , Orofaringe/fisiopatologia , Pessoa de Meia-Idade , Fenômenos Biomecânicos , Adulto , Apneia Obstrutiva do Sono/fisiopatologia , Estudos de Casos e Controles , Polissonografia , Sono/fisiologia , Língua/diagnóstico por imagem , Língua/fisiopatologia , Palato Mole/diagnóstico por imagem , Palato Mole/fisiopatologia
19.
Int J Mol Sci ; 25(5)2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38474119

RESUMO

There is extensive coverage in the existing literature on implant-associated lymphomas like anaplastic large-cell lymphoma, but breast implant-associated squamous cell carcinoma (BIA-SCC) has received limited scholarly attention since its first case in 1992. Thus, this study aims to conduct a qualitative synthesis focused on the underexplored association between breast implants and BIA-SCC. A systematic review was conducted utilizing the PubMed, Web of Science, and Cochrane databases to identify all currently reported cases of BIA-SCC. Additionally, a literature review was performed to identify potential biochemical mechanisms that could lead to BIA-SCC. Studies were vetted for quality using the NIH quality assessment tool. From an initial pool of 246 papers, 11 met the quality criteria for inclusion, examining a total of 14 patients aged between 40 and 81 years. BIA-SCC was found in a diverse range of implants, including those with smooth and textured surfaces, as well as those filled with saline and silicone. The condition notably manifested a proclivity for aggressive clinical progression, as evidenced by a mortality rate approximating 21.4% within a post-diagnostic interval of six months. Our literature review reveals that chronic inflammation, driven by various external factors such as pathogens and implants, can initiate carcinogenesis through epigenetic modifications and immune system alterations. This includes effects from exosomes and macrophage polarization, showcasing potential pathways for the pathogenesis of BIA-SCC. The study highlights the pressing need for further investigation into BIA-SCC, a subject hitherto inadequately addressed in the academic sphere. This necessitates the urgency for early screening and intervention to improve postoperative outcomes. While the review is confined by its reliance on case reports and series, it serves as a valuable reference for future research endeavors.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Linfoma Anaplásico de Células Grandes , Mamoplastia , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Implantes de Mama/efeitos adversos , Implante Mamário/efeitos adversos , Mamoplastia/efeitos adversos , Neoplasias da Mama/patologia , Linfoma Anaplásico de Células Grandes/patologia
20.
Behav Pharmacol ; 35(2-3): 79-91, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38451022

RESUMO

Remarkable performance improvements occur at the end of the third postnatal week in rodents tested in various tasks that require navigation according to spatial context. While alterations in hippocampal function at least partially subserve this cognitive advancement, physiological explanations remain incomplete. Previously, we discovered that developmental modifications to hippocampal glutamatergic α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors in juvenile rats was related to more mature spontaneous alternation behavior in a symmetrical Y-maze. Moreover, a positive allosteric modulator of AMPA receptors enabled immature rats to alternate at rates seen in older animals, suggesting an excitatory synaptic limitation to hippocampal maturation. We then validated the Barnes maze for juvenile rats in order to test the effects of positive AMPA receptor modulation on a goal-directed spatial memory task. Here we report the effects of the AMPA receptor modulator, CX614, on spatial learning and memory in the Barnes maze. Similar to our prior report, animals just over 3 weeks of age display substantial improvements in learning and memory performance parameters compared to animals just under 3 weeks of age. A moderate dose of CX614 enabled immature animals to move more directly to the goal location, but only after 1 day of training. This performance improvement was observed on the second day of training with drug delivery or during a memory probe trial performed without drug delivery after the second day of training. Higher doses created more search errors, especially in more mature animals. Overall, CX614 provided modest performance benefits for immature rats in a goal-directed spatial memory task.


Assuntos
Receptores de AMPA , Aprendizagem Espacial , Ratos , Animais , Ácido alfa-Amino-3-hidroxi-5-metil-4-isoxazol Propiônico/farmacologia , Memória Espacial , Cognição
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