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1.
Am J Physiol Cell Physiol ; 327(2): C387-C402, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38912734

RESUMO

RhoA and its effectors, the transcriptional coactivators myocardin-related transcription factor (MRTF) and serum response factor (SRF), control epithelial phenotype and are indispensable for profibrotic epithelial reprogramming during fibrogenesis. Context-dependent control of RhoA and fibrosis-associated changes in its regulators, however, remain incompletely characterized. We previously identified the guanine nucleotide exchange factor GEF-H1 as a central mediator of RhoA activation in renal tubular cells exposed to inflammatory or fibrotic stimuli. Here we found that GEF-H1 expression and phosphorylation were strongly elevated in two animal models of fibrosis. In the Unilateral Ureteral Obstruction mouse kidney fibrosis model, GEF-H1 was upregulated predominantly in the tubular compartment. GEF-H1 was also elevated and phosphorylated in a rat pulmonary artery banding (PAB) model of right ventricular fibrosis. Prolonged stimulation of LLC-PK1 tubular cells with tumor necrosis factor (TNF)-α or transforming growth factor (TGF)-ß1 increased GEF-H1 expression and activated a luciferase-coupled GEF-H1 promoter. Knockdown and overexpression studies revealed that these effects were mediated by RhoA, cytoskeleton remodeling, and MRTF, indicative of a positive feedback cycle. Indeed, silencing endogenous GEF-H1 attenuated activation of the GEF-H1 promoter. Of importance, inhibition of MRTF using CCG-1423 prevented GEF-H1 upregulation in both animal models. MRTF-dependent increase in GEF-H1 was prevented by inhibition of the transcription factor Sp1, and mutating putative Sp1 binding sites in the GEF-H1 promoter eliminated its MRTF-dependent activation. As the GEF-H1/RhoA axis is key for fibrogenesis, this novel MRTF/Sp1-dependent regulation of GEF-H1 abundance represents a potential target for reducing renal and cardiac fibrosis.NEW & NOTEWORTHY We show that expression of the RhoA regulator GEF-H1 is upregulated in tubular cells exposed to fibrogenic cytokines and in animal models of kidney and heart fibrosis. We identify a pathway wherein GEF-H1/RhoA-dependent MRTF activation through its noncanonical partner Sp1 upregulates GEF-H1. Our data reveal the existence of a positive feedback cycle that enhances Rho signaling through control of both GEF-H1 activation and expression. This feedback loop may play an important role in organ fibrosis.


Assuntos
Fibrose , Fatores de Troca de Nucleotídeo Guanina Rho , Fator de Transcrição Sp1 , Transativadores , Proteína rhoA de Ligação ao GTP , Animais , Fator de Transcrição Sp1/metabolismo , Fator de Transcrição Sp1/genética , Proteína rhoA de Ligação ao GTP/metabolismo , Proteína rhoA de Ligação ao GTP/genética , Fatores de Troca de Nucleotídeo Guanina Rho/metabolismo , Fatores de Troca de Nucleotídeo Guanina Rho/genética , Transativadores/metabolismo , Transativadores/genética , Camundongos , Ratos , Retroalimentação Fisiológica , Masculino , Camundongos Endogâmicos C57BL , Humanos , Transdução de Sinais , Suínos , Fosforilação , Modelos Animais de Doenças , Obstrução Ureteral/metabolismo , Obstrução Ureteral/patologia , Obstrução Ureteral/genética , Ratos Sprague-Dawley , Linhagem Celular , Fatores de Transcrição
2.
J Nutr ; 153(1): 197-207, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36913454

RESUMO

BACKGROUND: Choline, folate, and vitamin B12 are required for growth and development, but there is limited information on the intakes and relationships to biomarkers of status in children. OBJECTIVES: The objective of this study was to determine the choline and B-vitamin intakes and relationship to biomarkers of status in children. METHODS: A cross-sectional study was conducted in children (n = 285, aged 5-6 y) recruited from Metro Vancouver, Canada. Dietary information was collected by using 3 24-h recalls. Nutrient intakes were estimated by using the Canadian Nutrient File and United States Department of Agriculture database for choline. Supplement information was collected by using questionnaires. Plasma biomarkers were quantified by using mass spectrometry and commercial immunoassays, and relationships to dietary and supplement intake were determined by using linear models. RESULTS: Daily dietary intakes of choline, folate, and vitamin B12 were [mean (SD)] 249 (94.3) mg, 330 (120) DFE µg, and 3.60 (1.54) µg, respectively. Top food sources of choline and vitamin B12 were dairy, meats, and eggs (63%-84%) and for folate, were grains, fruits, and vegetables (67%). More than half of the children (60%) were consuming a supplement containing B-vitamins, but not choline. Only 40% of children met the choline adequate intake (AI) recommendation for North America (≥250 mg/d); 82% met the European AI (≥170 mg/d). Less than 3% of children had inadequate folate and vitamin B12 total intakes. Some children (5%) had total folic acid intakes above the North American tolerable upper intake level (UL; >400 µg/d); 10% had intakes above the European UL (>300 µg/d). Dietary choline intake was positively associated with plasma dimethylglycine, and total vitamin B12 intake was positively associated with plasma B12 (adjusted models; P < 0.001). CONCLUSIONS: These findings suggest that many children are not meeting the dietary choline recommendations, and some children may have excessive folic acid intakes. The impact of imbalanced one-carbon nutrient intakes during this active period of growth and development requires further investigation.


Assuntos
Ácido Fólico , Complexo Vitamínico B , Estados Unidos , Humanos , Criança , Vitamina B 12 , Colina , Estudos Transversais , Canadá , Dieta , Biomarcadores
3.
Curr Rheumatol Rep ; 24(9): 269-278, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35809213

RESUMO

PURPOSE OF REVIEW: Pathological roles of macrophage migration inhibitory factor (MIF) have recently been demonstrated in spondyloarthritis (SpA) preclinical models, identifying MIF as a new treatment target for SpA. However, the specific contribution of MIF and therapeutic potential of MIF-targeted therapies to various tissue types affected by SpA are not well delineated. RECENT FINDINGS: MIF and its cognate receptor CD74 are extensively involved in the pathogenesis of SpA including inflammation in the spine, joint, eyes, skin, and gut. The majority of the current evidence has consistently shown that MIF drives the inflammation in these distinct anatomical sites. In preclinical models, genetic deletion or blockade of MIF reduces the severity of inflammation. Although MIF is generally an upstream cytokine which regulates downstream effector cytokines, MIF also intensifies type 3 immunity by promoting helper T 17 (Th17) plasticity. MIF- or CD74-targeted therapies have also reported to be well tolerated in clinical trials for other diseases. Recent findings suggest that MIF-CD74 axis is a new therapeutic target for SpA to improve various clinical features. Clinical trials for MIF- or CD74-targeted therapies for SpA patients are warranted.


Assuntos
Fatores Inibidores da Migração de Macrófagos , Espondilartrite , Humanos , Inflamação , Oxirredutases Intramoleculares
4.
Wound Repair Regen ; 29(4): 642-649, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34021514

RESUMO

The synovial membrane undergoes a variety of structural changes throughout the pathogenesis of osteoarthritis (OA), including the development of fibrosis. Fibroblast-like synoviocytes (FLS) are a heterogenous cell population of the synovium that are suggested to drive the fibrotic response, but the exact mechanisms associated with their activation in OA remain unclear. Once activated, FLS are suggested to acquire a myofibroblast-like phenotype that drives fibrogenesis through excessive extracellular matrix (ECM) component deposition and an enhanced contractile function. In this review, we define FLS in the synovium, discuss how select extracellular or endogenous factors potentially induce their activation in OA, and describe how the activity of myofibroblast-like cells affects the structure of the synovial membrane.


Assuntos
Osteoartrite , Sinoviócitos , Células Cultivadas , Fibroblastos , Fibrose , Humanos , Osteoartrite/patologia , Membrana Sinovial/patologia , Sinoviócitos/patologia , Cicatrização
5.
Proc Natl Acad Sci U S A ; 114(45): E9445-E9454, 2017 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-29078364

RESUMO

Detonation nanodiamonds (NDs) are promising drug delivery and imaging agents due to their uniquely faceted surfaces with diverse chemical groups, electrostatic properties, and biocompatibility. Based on the potential to harness ND properties to clinically address a broad range of disease indications, this work reports the in-human administration of NDs through the development of ND-embedded gutta percha (NDGP), a thermoplastic biomaterial that addresses reinfection and bone loss following root canal therapy (RCT). RCT served as the first clinical indication for NDs since the procedure sites involved nearby circulation, localized administration, and image-guided treatment progress monitoring, which are analogous to many clinical indications. This randomized, single-blind interventional treatment study evaluated NDGP equivalence with unmodified GP. This progress report assessed one control-arm and three treatment-arm patients. At 3-mo and 6-mo follow-up appointments, no adverse events were observed, and lesion healing was confirmed in the NDGP-treated patients. Therefore, this study is a foundation for the continued clinical translation of NDs and other nanomaterials for a broad spectrum of applications.


Assuntos
Materiais Biocompatíveis/administração & dosagem , Nanodiamantes/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Sistemas de Liberação de Medicamentos/métodos , Feminino , Humanos , Controle de Infecções Dentárias/métodos , Masculino , Pessoa de Meia-Idade , Nanomedicina/métodos , Tratamento do Canal Radicular/efeitos adversos , Método Simples-Cego , Cicatrização/efeitos dos fármacos
6.
Curr Rheumatol Rep ; 21(6): 23, 2019 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-30980212

RESUMO

PURPOSE OF REVIEW: Fibrosis is a pathological feature of many human diseases that affect multiple organs. The development of anti-fibrotic therapies has been a difficult endeavor due to the complexity of signaling pathways associated with fibrogenic processes, complicating the identification and modulation of specific targets. Evidence suggests that ephrin ligands and Eph receptors are crucial signaling molecules that contribute to physiological wound repair and the development of tissue fibrosis. Here, we discuss recent advances in the understanding of ephrin and Eph signaling in tissue repair and fibrosis. RECENT FINDINGS: Ephrin-B2 is implicated in fibrosis of multiple organs. Intercepting its signaling may help counteract fibrosis. Ephrins and Eph receptors are candidate mediators of fibrosis. Ephrin-B2, in particular, promotes fibrogenic processes in multiple organs. Thus, therapeutic strategies targeting Ephrin-B2 signaling could yield new ways to treat organ fibrosis.


Assuntos
Efrinas/metabolismo , Receptores da Família Eph/metabolismo , Transdução de Sinais/fisiologia , Cicatrização/fisiologia , Animais , Fibrose/metabolismo , Fibrose/patologia , Humanos
8.
J Med Internet Res ; 20(4): e147, 2018 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-29685872

RESUMO

BACKGROUND: Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adoption Trial (DCAT) evaluated whether depression care could be significantly improved by harnessing information and communication technologies to automate routine screening and monitoring of patient symptoms and treatment adherence and allow timely communication with providers. OBJECTIVE: The aim of this study was to compare 6-month outcomes of a technology-facilitated care model with a usual care model and a supported care model that involved team-based collaborative depression care for safety-net primary care adult patients with type 2 diabetes. METHODS: DCAT is a translational study in collaboration with Los Angeles County Department of Health Services, the second largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: usual care, supported care, and technology-facilitated care. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. RESULTS: DCAT enrolled 1406 patients (484 in usual care, 480 in supported care, and 442 in technology-facilitated care), most of whom were Hispanic or Latino and female. Compared with usual care, both the supported care and technology-facilitated care groups were associated with significant reduction in depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate, LSE: usual care=6.35, supported care=5.05, technology-facilitated care=5.16; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.02); decreased prevalence of major depression (odds ratio, OR: supported care vs usual care=0.45, technology-facilitated care vs usual care=0.33; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.007); and reduced functional disability as measured by Sheehan Disability Scale scores (LSE: usual care=3.21, supported care=2.61, technology-facilitated care=2.59; P value: supported care vs usual care=.04, technology-facilitated care vs usual care=.03). Technology-facilitated care was significantly associated with depression remission (technology-facilitated care vs usual care: OR=2.98, P=.04); increased satisfaction with care for emotional problems among depressed patients (LSE: usual care=3.20, technology-facilitated care=3.70; P=.05); reduced total cholesterol level (LSE: usual care=176.40, technology-facilitated care=160.46; P=.01); improved satisfaction with diabetes care (LSE: usual care=4.01, technology-facilitated care=4.20; P=.05); and increased odds of taking an glycated hemoglobin test (technology-facilitated care vs usual care: OR=3.40, P<.001). CONCLUSIONS: Both the technology-facilitated care and supported care delivery models showed potential to improve 6-month depression and functional disability outcomes. The technology-facilitated care model has a greater likelihood to improve depression remission, patient satisfaction, and diabetes care quality.


Assuntos
Depressão/terapia , Diabetes Mellitus Tipo 2/psicologia , Atenção Primária à Saúde/organização & administração , Comorbidade , Depressão/patologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/patologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Qualidade da Assistência à Saúde , Fatores de Tempo
9.
Dig Dis Sci ; 62(1): 224-234, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27822771

RESUMO

BACKGROUND: Colorectal cancer is the second leading cause of cancer-specific death in the USA. Evidence suggests people with mental illness are less likely to receive preventive health services, including cancer screening. We hypothesized that mental illness is a risk factor for non-adherence to colorectal cancer-screening guidelines. METHODS: We analyzed results of the 2007 California Health Interview Survey to test whether mental illness is a risk factor for non-adherence to colorectal cancer-screening recommendations among individuals age 50 or older (N = 15,535). This cross-sectional dataset is representative of California. Screening was defined as either fecal occult blood testing during the preceding year, sigmoidoscopy, or colonoscopy during the preceding 5 years. Mental illness was identified using the Kessler K6 screening tool. Associations were evaluated using weighted multivariate logistic regressions. RESULTS: Mental illness was not associated with colorectal cancer-screening adherence (OR 0.89; 95% CI 0.63-1.25). Risk factors for non-adherence included being female (OR 1.25; 95% CI 1.09-1.44), delaying accessing health care during the previous year (OR 1.89; 95% CI 1.56-2.29). CONCLUSION: Unlike previous studies, this study did not find a relationship between mental illness and colorectal cancer-screening adherence. This could be due to differences in study populations. State-specific healthcare policies involving care coordination for individuals with mental illness could also influence colorectal cancer-screening adherence in California.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Cooperação do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Colonoscopia , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Sangue Oculto , Guias de Prática Clínica como Assunto , Fatores de Risco , Fatores Sexuais , Sigmoidoscopia
10.
Cancer Immunol Immunother ; 65(5): 511-23, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26960932

RESUMO

CpG oligodeoxynucleotides (CpG) potently activate the immune system by mimicking microbial DNA. Conjugation of CpG to chTNT-3, an antibody targeting the necrotic centers of tumors, enabled CpG to accumulate in tumors after systemic delivery, where it can activate the immune system in the presence of tumor antigens. CpG chemically conjugated to chTNT-3 (chTNT-3/CpG) were compared to free CpG in their ability to stimulate the immune system in vitro and reduce tumor burden in vivo. In subcutaneous Colon 26 adenocarcinoma and B16-F10 melanoma models in BALB/c and C57BL/6 mice, respectively, chTNT-3/CpG, free CpG, or several different control constructs were administered systemically. Intraperitoneal injections of chTNT-3/CpG delayed tumor growth and improved survival and were comparable to intratumorally administered CpG. Compared to saline-treated mice, chTNT-3/CpG-treated mice had smaller average tumor volumes by as much as 72% in Colon 26-bearing mice and 79% in B16-bearing mice. Systemically delivered free CpG and CpG conjugated to an isotype control antibody did not reduce tumor burden or improve survival. In this study, chTNT-3/CpG retained immunostimulatory activity of the CpG moiety and enabled delivery to tumors. Because systemically administered CpG rapidly clear the body and do not accumulate into tumors, chTNT-3/CpG provide a solution to the limitations observed in preclinical and clinical trials.


Assuntos
Imunoconjugados/administração & dosagem , Imunoconjugados/imunologia , Imunoterapia/métodos , Neoplasias Experimentais/imunologia , Neoplasias Experimentais/terapia , Animais , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/imunologia , Linhagem Celular , Linhagem Celular Tumoral , Citocinas/imunologia , Citocinas/metabolismo , Feminino , Citometria de Fluxo , Humanos , Imunoconjugados/farmacocinética , Injeções Intralesionais , Injeções Intraperitoneais , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Neoplasias Experimentais/metabolismo , Oligodesoxirribonucleotídeos/administração & dosagem , Oligodesoxirribonucleotídeos/imunologia , Proteínas Recombinantes de Fusão/administração & dosagem , Proteínas Recombinantes de Fusão/imunologia , Análise de Sobrevida , Distribuição Tecidual , Carga Tumoral/efeitos dos fármacos , Carga Tumoral/imunologia
12.
BMC Pulm Med ; 16: 40, 2016 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-26956371

RESUMO

BACKGROUND: Ventilator-associated respiratory infections (tracheobronchitis, pneumonia) contribute significant morbidity and mortality to adults receiving care in intensive care units (ICU). Administration of broad-spectrum intravenous antibiotics, the current standard of care, may have systemic adverse effects. The efficacy of aerosolized antibiotics for treatment of ventilator-associated respiratory infections remains unclear. Our objective was to conduct a systematic review of the efficacy of aerosolized antibiotics in the treatment of ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT), using the Cochrane Collaboration guidelines. METHODS: We conducted a search of three databases (PubMed, Web of Knowledge and the Cochrane Collaboration) for randomized, controlled trials studying the use of nebulized antibiotics in VAP and VAT that measured clinical cure (e.g., change in Clinical Pulmonary Infection Score) as an outcome measurement. We augmented the electronic searches with hand searches of the references for any narrative review articles as well as any article included in the systematic review. Included studies were examined for risk of bias using the Cochrane Handbook's "Risk of Bias" assessment tool. RESULTS: Six studies met full inclusion criteria. For the systemic review's primary outcome (clinical cure), two studies found clinically and statistically significant improvements in measures of VAP cure while four found no statistically significant difference in measurements of cure. No studies found inferiority of aerosolized antibiotics. The included studies had various degrees of biases, particularly in the performance and detection bias domains. Given that outcome measures of clinical cure were not uniform, we were unable to conduct a meta-analysis. CONCLUSIONS: There is insufficient evidence for the use of inhaled antibiotic therapy as primary or adjuvant treatment of VAP or VAT. Additional, better-powered randomized-controlled trials are needed to assess the efficacy of inhaled antibiotic therapy for VAP and VAT.


Assuntos
Antibacterianos/administração & dosagem , Bronquite/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Traqueíte/tratamento farmacológico , Administração por Inalação , Antibacterianos/uso terapêutico , Bronquite/etiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/etiologia , Humanos , Respiração Artificial/efeitos adversos , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/etiologia , Traqueíte/etiologia , Ventiladores Mecânicos/efeitos adversos
13.
Qual Life Res ; 24(5): 1119-29, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25543270

RESUMO

PURPOSE: We investigated dimensions of low-income minority patient engagement in the context of diabetes-depression care-management with automated telephone assessment (ATA) calls as a facilitator. METHODS: Mixed method analyses (including regression analyses and coding of interviews) were used to examine patient engagement with technology, assess its impact on health outcomes and satisfaction with care, and analyze barriers to engagement. Patient engagement was measured by analyzing patient's ATA call response rates. We then evaluated those results in the context of the outcomes of the broader clinical trial, which compared three study arms. RESULTS: Average completed call rate throughout the study is about 50 % and decreases after 6 months. The biggest barrier to patient engagement is timing. Patient engagement levels differ by baseline depression status and have no significant effect on health outcomes and satisfaction with care at 6, 12, and 18 months. However, from the preliminary clinical trial results, the arm in which the ATA system is implemented has higher satisfaction with depression care than the two control arms. Thus, it is more likely that technology positively affects satisfaction with depression care outcomes through provider engagement rather than patient engagement. CONCLUSIONS: The study's patient engagement results and identified barriers would be useful to aid the design and implementation of future automated screening and monitoring systems to optimize patient engagement. The results also suggest that implementing a technology-supported care-management might not result in outcome disparities among patients with different levels of patient engagement.


Assuntos
Transtorno Depressivo/diagnóstico , Complicações do Diabetes/psicologia , Participação do Paciente , Qualidade de Vida/psicologia , Telefone , Adulto , Idoso , Coleta de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/psicologia , Pobreza/psicologia , Autocuidado
14.
J Gastroenterol Hepatol ; 29(1): 116-20, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24033786

RESUMO

BACKGROUND AND AIM: Chronic hepatitis C virus (HCV) infection is one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide. It is highly prevalent among injection drug users (IDUs) but is often undiagnosed because they represent an underprivileged group that faces multiple barriers to medical care. Here, we report the results of the New Life New Liver Project, which provides targeted HCV screening and education for ex-IDUs in the community. METHODS: Patients were recruited through the social worker networks and referrals by fellow ex-IDUs, and rapid diagnosis was based on point-of-care anti-HCV testing at rehabilitation centers. RESULTS: From 2009 to 2012, we served 234 subjects. One hundred thirty (56%) subjects were anti-HCV positive. The number needed to screen to detect one patient with positive anti-HCV was 1.8 (95% confidence interval, 1.6-2.0). However, only 69 (53%) HCV patients attended subsequent follow-up at regional hospitals, and 26 (20%) received antiviral therapy. Patients who attended follow-up were older, had higher education level and more active disease as evidenced by higher alanine aminotransferase, HCV RNA, and liver stiffness measurement by transient elastography. CONCLUSIONS: Targeted screening in ex-IDUs is effective in identifying patients with HCV infection in the community. Improvement in the referral system and introduction of interferon-free regimens are needed to increase treatment uptake.


Assuntos
Serviços de Saúde Comunitária , Usuários de Drogas/estatística & dados numéricos , Hepatite C/diagnóstico , Programas de Rastreamento/métodos , Alanina Transaminase , Biomarcadores , Redes Comunitárias , Técnicas de Imagem por Elasticidade , Feminino , Seguimentos , Hepacivirus/genética , Hepacivirus/imunologia , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Hepatite C/prevenção & controle , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Sistemas Automatizados de Assistência Junto ao Leito , RNA Viral , Índice de Gravidade de Doença
15.
Clin Orthop Relat Res ; 472(11): 3495-506, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25113266

RESUMO

BACKGROUND: Despite increased concern for injury during surgical reconstruction of the sternoclavicular joint, to our knowledge there are few studies detailing the vascular relationships adjacent to the joint. QUESTIONS/PURPOSES: We investigated sex differences in the following relationships for sternoclavicular joint reconstruction: (1) safe distance from the posterior surface of the medial clavicle's medial and lateral segments to the major vessels, (2) length of the first costal cartilage and safe distance from the first rib to the internal mammary artery, (3) minimum distance medial to the sternoclavicular joint for optimal hole placement, and (4) safe distance from the manubrium to the great vessels. METHODS: Fifty normal postcontrast CT scans of the chest were reviewed. Means, standard deviations, and 95% CI were calculated for each aforementioned measurement. A t-test was used to determine if a sex difference exists (p≤0.05). RESULTS: At the medial end of the clavicle, the safe distance from the medial segment (first 10 mm) to the major vessels was greater in males than in females (3.5 mm versus 2.4 mm, respectively; 95% CI, 3 mm-4 mm versus 1.7 mm-3 mm, respectively; p=0.014). For the lateral segment (next 10 mm), the distance also was safer in males than in females (3.3 mm versus 1.7 mm, respectively; 95% CI, 2.7 mm-4 mm versus 1.1 mm-2.3 mm, respectively; p<0.001). The mean length of the first costal cartilage also was greater in males (35.8 mm versus 30.1 mm, respectively; 95% CI, 33.8 mm-37.8 mm versus 28.5 mm-31.9 mm, respectively; p<0.001); the distance from the first costochondral joint to the internal mammary artery was safer in males than in females (19.1 mm versus 15.4 mm, respectively; 95% CI, 16.5 mm-21.8 mm versus 13 mm-17.9 mm, respectively; p=0.05). The minimum distance to avoid inadvertent penetration of the sternoclavicular joint was greater in males than in females (16 mm versus 12.3 mm, respectively; 95% CI, 14.6 mm-17.5 mm versus 11 mm-13.6 mm, respectively; p<0.001). The distance to vessels after penetration of the manubrium was not different between males and females (5.6 mm versus 3.9, respectively; 95% CI, 4.4 mm-6.8 mm versus 2.6 mm-5.2 mm, respectively; p=0.06). CONCLUSIONS: This study makes apparent the intimate relationships between vessels and the musculoskeletal structures associated with sternoclavicular reconstruction. Based on our findings, we recommend considering the sex of the patient, using caution when drilling, and protecting essential structures posterior to the joint.


Assuntos
Vasos Sanguíneos/anatomia & histologia , Cartilagem Costal/anatomia & histologia , Cartilagem Costal/diagnóstico por imagem , Articulação Esternoclavicular/anatomia & histologia , Articulação Esternoclavicular/diagnóstico por imagem , Adulto , Feminino , Humanos , Imageamento Tridimensional , Masculino , Artéria Torácica Interna/anatomia & histologia , Artéria Torácica Interna/diagnóstico por imagem , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica/métodos , Radiografia Torácica , Valores de Referência , Estudos Retrospectivos , Caracteres Sexuais , Tomografia Computadorizada por Raios X
16.
Prev Chronic Dis ; 11: E148, 2014 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-25167093

RESUMO

INTRODUCTION: The prevalence of comorbid diabetes and depression is high, especially in low-income Hispanic or Latino patients. The complex mix of factors in safety-net care systems impedes the adoption of evidence-based collaborative depression care and results in persistent disparities in depression outcomes. The Diabetes-Depression Care-Management Adoption Trial examined whether the collaborative depression care model is an effective approach in safety-net clinics to improve clinical care outcomes of depression and diabetes. METHODS: A sample of 964 patients with diabetes from 5 safety-net clinics were enrolled in a quasi-experimental study that included 2 arms: usual care, in which primary medical providers and staff translated and adopted evidence-based depression care; and supportive care, in which providers of a disease management program delivered protocol-driven depression care. Because the study design established individual treatment centers as separate arms, we calculated propensity scores that interpreted the probability of treatment assignment conditional on observed baseline characteristics. Primary outcomes were 5 depression care outcomes and 7 diabetes care measures. Regression models with propensity score covariate adjustment were applied to analyze 6-month outcomes. RESULTS: Compared with usual care, supportive care significantly decreased Patient Health Questionnaire-9 scores, reduced the number of patients with moderate or severe depression, improved depression remission, increased satisfaction in care for patients with emotional problems, and significantly reduced functional impairment. CONCLUSION: Implementing collaborative depression care in a diabetes disease management program is a scalable approach to improve depression outcomes and patient care satisfaction among patients with diabetes in a safety-net care system.


Assuntos
Transtorno Depressivo/terapia , Diabetes Mellitus/terapia , Disparidades em Assistência à Saúde , Hispânico ou Latino/psicologia , Provedores de Redes de Segurança , Comorbidade , Pesquisa Comparativa da Efetividade , Prestação Integrada de Cuidados de Saúde , Transtorno Depressivo/epidemiologia , Diabetes Mellitus/epidemiologia , Prática Clínica Baseada em Evidências , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , América Latina/etnologia , Modelos Lineares , Los Angeles , Masculino , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente , Equipe de Assistência ao Paciente , Sistema de Registros , Pesquisa Translacional Biomédica , Resultado do Tratamento
17.
BMC Surg ; 14: 102, 2014 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-25481088

RESUMO

BACKGROUND: The anterior cruciate ligament (ACL) is one of four major ligaments in the knee that provide stability during physical activity. A tear in the ACL is characterized by joint instability that leads to decreased activity, knee dysfunction, reduced quality of life and a loss of muscle mass and strength. While rehabilitation is the standard-of-care for return to daily function, additional surgical reconstruction can provide individuals with an opportunity to return to sports and strenuous physical activity. Over 200,000 ACL reconstructions are performed in the United States each year, and rehabilitation following surgery is slow and expensive. One possible method to improve the recovery process is the use of intramuscular testosterone, which has been shown to increase muscle mass and strength independent of exercise. With short-term use of supraphysiologic doses of testosterone, we hope to reduce loss of muscle mass and strength and minimize loss of physical function following ACL reconstruction compared to standard-of-care alone. METHODS/DESIGN: This study is a double-blinded randomized control trial. Men 18-50 years of age, scheduled for ACL reconstruction are randomized into two groups. Participants randomized to the testosterone group receive intramuscular testosterone administration once per week for 8 weeks starting 2 weeks prior to surgery. Participants randomized to the control group receive a saline placebo intramuscularly instead of testosterone. Lean mass, muscle strength and physical function are measured at 5 time points: 2 weeks pre-surgery, 1 day pre-surgery, and 6, 12, 24 weeks post-surgery. Both groups follow standard-of-care rehabilitation protocol. DISCUSSION: We believe that testosterone therapy will help reduce the loss of muscle mass and strength experienced after ACL injury and reconstruction. Hopefully this will provide a way to shorten the rehabilitation necessary following ACL reconstruction. If successful, testosterone therapy may also be used for other injuries involving trauma and muscle atrophy. TRIAL REGISTRATION: NCT01595581, REGISTRATION: May 8, 2012.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Força Muscular/efeitos dos fármacos , Músculo Esquelético/efeitos dos fármacos , Testosterona/administração & dosagem , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior/reabilitação , Método Duplo-Cego , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiologia , Período Perioperatório , Recuperação de Função Fisiológica , Adulto Jovem
18.
J Am Dent Assoc ; 155(1): 39-47, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38054916

RESUMO

BACKGROUND: Studies on risk factors affecting tooth retention after endodontic treatment in dental school settings are limited. Understanding these factors is crucial for preserving teeth. The aim of this retrospective study was to evaluate patient- and tooth-level risk factors associated with the survival of endodontically treated teeth. METHODS: Electronic health records of patients who underwent endodontic treatment at the School of Dental Medicine at the University of Pennsylvania from 2017 through 2020 were analyzed. Patient-level factors included age, sex, American Society of Anesthesiologists Physical Status Classification, smoking history, diabetes status, and amoxicillin allergy. Tooth-level factors included position, presence of restorations, and periodontal conditions with preprosthetic treatments. RESULTS: The results of this study indicate that the patient-level factors significantly associated with tooth retention included age, sex, American Society of Anesthesiologists Physical Classification Status, and amoxicillin allergy. Tooth-level factors such as core buildup, full-coverage crown, healthy periodontium, and scaling and root planing were also associated with higher survival rates. Mandibular premolars had higher survival rates than mandibular molars. CONCLUSIONS: This investigation revealed that the tooth retention rate of endodontically treated teeth was 96.2% after initial root canal treatment, 92.4% for nonsurgical re-treatment, and 97.8% for surgical re-treatment. PRACTICAL IMPLICATIONS: The tooth retention of the endodontic treatment was associated with healthy periodontium, tooth structure, tooth position, tooth restoration, and the patient's overall health.


Assuntos
Hipersensibilidade , Dente não Vital , Humanos , Estudos Retrospectivos , Dente não Vital/terapia , Coroas , Tratamento do Canal Radicular/efeitos adversos , Tratamento do Canal Radicular/métodos , Fatores de Risco , Amoxicilina , Hipersensibilidade/etiologia
19.
Hawaii J Health Soc Welf ; 83(10): 274-278, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39371581

RESUMO

A 2-year-old boy tested positive for SARS-CoV-2 and, after 30 days of mild-moderate respiratory symptoms, suddenly deteriorated and required extracorporeal membrane oxygenation. Lung biopsy was performed with findings consistent with organizing pneumonia. He received intensive therapy with high-dose methylprednisolone, intravenous immune globulin, rituximab, and plasmapheresis without improvement. He died after 85 days hospitalization. This case highlights unique presentations of COVID-19 and reaffirms the concept that, while rare in Hawai'i, pediatric COVID-19 is an ongoing problem and that severe, even fatal, disease can occur.


Assuntos
COVID-19 , SARS-CoV-2 , Humanos , COVID-19/complicações , Masculino , Pré-Escolar , Evolução Fatal , Havaí , Metilprednisolona/uso terapêutico , Oxigenação por Membrana Extracorpórea/métodos , Pneumonia em Organização
20.
Clin Pharmacol Ther ; 115(2): 231-238, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-37926939

RESUMO

Children with asthma and obesity are more likely to have lower vitamin D levels, but the optimal replacement dose is unknown in this population. The objective of this study is identifying a vitamin D dose in children with obesity-related asthma that safely achieves serum vitamin D levels of ≥ 40 ng/mL. This prospective multisite randomized controlled trial recruited children/adolescents with asthma and body mass index ≥ 85% for age/sex. Part 1 (dose finding), evaluated 4 oral vitamin D regimens for 16 weeks to identify a replacement dose that achieved serum vitamin D levels ≥ 40 ng/mL. Part 2 compared the replacement dose calculated from part 1 (50,000 IU loading dose with 8,000 IU daily) to standard of care (SOC) for 16 weeks to identify the proportion of children achieving target serum 25(OH)D level. Part 1 included 48 randomized participants. Part 2 included 64 participants. In Part 1, no SOC participants achieved target serum level, but 50-72.7% of participants in cohorts A-C achieved the target serum level. In part 2, 78.6% of replacement dose participants achieved target serum level compared with none in the SOC arm. No related serious adverse events were reported. This trial confirmed a 50,000 IU loading dose plus 8,000 IU daily oral vitamin D as safe and effective in increasing serum 25(OH)D levels in children/adolescents with overweight/obesity to levels ≥ 40 ng/mL. Given the critical role of vitamin D in many conditions complicating childhood obesity, these data close a critical gap in our understanding of vitamin D dosing in children.


Assuntos
Asma , Obesidade Infantil , Deficiência de Vitamina D , Adolescente , Criança , Humanos , Vitamina D , Colecalciferol/efeitos adversos , Estudos Prospectivos , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/tratamento farmacológico , Obesidade Infantil/complicações , Obesidade Infantil/tratamento farmacológico , Obesidade Infantil/induzido quimicamente , Vitaminas , Asma/tratamento farmacológico , Suplementos Nutricionais
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