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BACKGROUND: Biochemical markers and imaging tests have been used with the aim of stratifying the risk and detecting atrial fibrosis. Speckle-tracking echocardiography (STE) is used for the detection of atrial fibrosis and Gal-3 provides an important prognostic value. The objective of the study was to assess the association between atrial fibrosis markers and serum levels, genetic polymorphisms and genic expression of galectin-3. METHODS: 206 patients with permanent AF and 70 patients with paroxysmal AF were included in the study. Real time PCR (TaqMan) system was used to study SNPs rs4652 and 4644 of the gene LGALS3. Serum levels of Gal-3 were determined by ELISA and STE was performed to assess fibrosis. RESULTS: Mean age of individuals with permanent AF was 66.56 ± 12 years. As for the echocardiography results, those patients showed an decrease in the following parameters peak atrial longitudinal strain (PALS) (p = 0.002) when compared to the same parameters from the paroxysmal AF group of patients. There was a correlation between serum levels of Gal-3 and PALS in the group of patients with permanent AF; the lower the levels of gal-3, the lower the LA strain (r = 0.24; p = 0.01). CONCLUSIONS: Echocardiographic findings showed association with the groups, and with serum levels of Gal-3 in patients with permanent AF. The distribution of allelic and genotypic frequencies, and of the haplotypes of polymorphism LGALS3 rs4652 and rs4644 did not present statistical variation, which suggests that those SNPs are not associated with the AF clinical forms (permanent and paroxysmal).
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Fibrilação Atrial , Humanos , Pessoa de Meia-Idade , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/genética , Galectina 3/genética , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Ecocardiografia/métodos , FibroseRESUMO
Colorectal cancer (CRC) is one of the deadliest cancers worldwide, with the 5 year survival rate in metastatic cases limited to 12%. The design of targeted and effective therapeutics remains a major unmet clinical need in CRC treatment. Carcinoembryonic antigen (CEA), a glycoprotein overexpressed in most colorectal tumors, may constitute a promising molecule for generating novel CEA-targeted therapeutic strategies for CRC treatment. Here, we developed a smart nanoplatform based on chemical conjugation of an anti-CEA single-chain variable fragment (scFv), MFE-23, with PLGA-PEG polymers to deliver the standard 5-Fluorouracil (5-FU) chemotherapy to CRC cells. We confirmed the specificity of the developed CEA-targeted NPs on the internalization by CEA-expressing CRC cells, with an enhance of threefold in the cell uptake. Additionally, CEA-targeted NPs loaded with 5-FU induced higher cytotoxicity in CEA-expressing cells, after 24 h and 48 h of treatment, reinforcing the specificity of the targeted NPs. Lastly, the safety of CEA-targeted NPs loaded with 5-FU was evaluated in donor-isolated macrophages, with no relevant impact on their metabolic activity nor polarization. Altogether, this proof of concept supports the CEA-mediated internalization of targeted NPs as a promising chemotherapeutic strategy for further investigation in different CEA-associated cancers and respective metastatic sites.Authors: Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Maria José] Last name [Silveira]. Author 7 Given name: [Maria José] Last name [Oliveira]. Also, kindly confirm the details in the metadata are correctokAffiliations: Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.ok.
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Neoplasias Colorretais , Nanopartículas , Anticorpos de Cadeia Única , Humanos , Antígeno Carcinoembrionário/metabolismo , Anticorpos de Cadeia Única/uso terapêutico , Fluoruracila/farmacologia , Fluoruracila/uso terapêutico , Neoplasias Colorretais/metabolismo , Nanopartículas/químicaRESUMO
OBJECTIVE: The aim of this study was to determine whether older adults are at higher risk of lasting functional and cognitive decline after surgery, and the impact of decline on survival and healthcare use. SUMMARY BACKGROUND DATA: Patient-centered outcomes after surgery are poorly characterized. METHODS: Using data from the Health and Retirement Study linked with Medicare, we matched older adults (≥65 years) who underwent one of 163 high-risk elective operations (ie, inpatient mortality of ≥1%) with nonsurgical controls between 1992 and 2012. Functional decline was defined as an increase in the number of activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs) requiring assistance from baseline. Cognitive decline was defined by worse response to a test of memory and mental processing from baseline. Using logistic regression, we examined whether surgery was associated with functional and cognitive decline, and whether declines were associated with poorer survival and increased healthcare use. RESULTS: The matched cohort of patients who did not undergo surgery consisted of 3591 (75%) participants compared to 1197 (25%) who underwent surgery. Patients who underwent surgery were at higher risk of functional and cognitive declines [adjusted odds ratio (aOR) 1.52, 95% confidence interval (CI): 1.23-1.87 and aOR 1.32, 95% CI: 1.03-1.71]. Declines were associated with poorer long-term survival [hazard ratio (HR) 1.67, 95% CI: 1.43-1.94 and HR 1.35, 95% CI: 1.15-1.58], and were significantly associated with nearly all measures of increased healthcare utilization (P < 0.001). CONCLUSION: Older adults undergoing high-risk surgery are at increased risk of developing lasting functional and cognitive declines.
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Atividades Cotidianas , Cognição/fisiologia , Disfunção Cognitiva/epidemiologia , Avaliação Geriátrica/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/psicologia , Idoso , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/psicologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Michigan/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/psicologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendênciasRESUMO
BACKGROUND: Erythema nodosum leprosum (ENL) is an acute and systemic inflammatory reaction of leprosy characterised by painful nodules and involvement of various organs. Thalidomide is an immunomodulatory and anti-inflammatory drug currently used to treat this condition. Cereblon (CRBN) protein is the primary target of thalidomide, and it has been pointed out as necessary for the efficacy of this drug in others therapeutics settings. OBJECTIVES: In this study, we aimed to evaluate the influence of CRBN gene variants on the dose of thalidomide as well as its adverse effects during treatment of ENL. METHODS: A total of 103 ENL patients in treatment with thalidomide were included in this study. DNA samples were obtained from saliva and molecular analysis of CRBN gene were performed to investigate the variants rs1620675, rs1672770 and rs4183. Different genotypes of CRBN variants were evaluated in relation to their influence on the dose of thalidomide and on the occurrence of adverse effects. FINDINGS: No association was found between CRBN variants and thalidomide dose variation. However, the genotypes of rs1672770 showed association with gastrointestinal effects (p = 0.040). Moreover, the haplotype DEL/C/T (rs4183/rs1672770/rs1620675) was also associated with gastrointestinal adverse effects (p = 0.015). MAIN CONCLUSIONS: Our results show that CRBN variants affect the treatment of ENH with thalidomide, especially on the adverse effects related to the drug.
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Eritema Nodoso , Hanseníase Virchowiana , Hanseníase Multibacilar , Humanos , Eritema Nodoso/tratamento farmacológico , Eritema Nodoso/genética , Eritema Nodoso/induzido quimicamente , Talidomida/uso terapêutico , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Virchowiana/genética , Hanseníase Virchowiana/induzido quimicamente , Hansenostáticos/uso terapêuticoRESUMO
Peanuts are an important legume for the Northeastern Brazilian market, but their production in this region is low. The present study aimed to evaluate the effect of biofertilizer doses on peanut nodulation and production components, to define the best dose and genotype. The experiment was conducted in a completely randomized block design (DBC) in a 3 x 3 factorial arrangement, with three replications. The treatments consisted of two evaluation factors: 1) Fertilization via different doses of organic fertilizer applied to the substrate (D1 = 0mL; D2 = 500mL; and D3 = 1000mL); and 2) Peanut genotypes (BR-1, UNI43 and UNI08). The following traits were assessed: number of nodules per plant (NNP), number of mature pods (NVM), pod mass per plant (MVP), seed mass per plant (MSP) and root length (CR). Peanut production is affected by fertilization via bovine biofertilizer, mainly for the components NVM, MVP and MSP. Besides, nodulation is a likely conditioner. The 1000mL dose proved to be the best treatment for the traits analyzed, and UNI08 accession, the most responsive material.
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Arachis , Fertilizantes , Animais , Bovinos , Arachis/genética , Brasil , Genótipo , SementesRESUMO
Climate change is a major constraint on the sustainability of the humid tropics, maintaining ecosystem services, food production, and social functioning. Humid tropics play an essential role in C storage and greenhouse gas (GHG) emission reduction. Unfortunately, unplanned economic exploration, human occupation, and lack of knowledge of techniques to maintain ecosystem services negatively affect the humid tropics. In this study, we focused on the mechanisms of GHG emissions, C storage, and their mitigation strategies. This review indicated technologies that can be adopted by farmers in humid tropics to maintain or increase their capacity to store C stocks and reduce GHG emissions. The adoption of climate-smart agriculture technologies and the regulation of ecosystem services markets will accelerate the progress of preserving the humid tropics. Improved management practices, such as proper N fertilizer management and the introduction of N2-fixing legumes, can increase soil C sequestration, providing economic and environmental trade-offs associated with these management strategies. Public and private investments toward knowledge dissemination and technology adoption regarding GHG emissions reduction and soil C storage are needed to allow humid tropics to maintain their critical function of generating environmental and societal benefits.
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Gases de Efeito Estufa , Agricultura , Brasil , Carbono , Sequestro de Carbono , Ecossistema , Fertilizantes , Pradaria , Efeito Estufa , Gases de Efeito Estufa/análise , Humanos , SoloRESUMO
Fertilisation experiments have demonstrated that nutrient availability is a key determinant of biomass production and carbon sequestration in grasslands. However, the influence of nutrients in explaining spatial variation in grassland biomass production has rarely been assessed. Using a global dataset comprising 72 sites on six continents, we investigated which of 16 soil factors that shape nutrient availability associate most strongly with variation in grassland aboveground biomass. Climate and N deposition were also considered. Based on theory-driven structural equation modelling, we found that soil micronutrients (particularly Zn and Fe) were important predictors of biomass and, together with soil physicochemical properties and C:N, they explained more unique variation (32%) than climate and N deposition (24%). However, the association between micronutrients and biomass was absent in grasslands limited by NP. These results highlight soil properties as key predictors of global grassland biomass production and point to serial co-limitation by NP and micronutrients.
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Pradaria , Solo , Biomassa , Carbono , Ecossistema , Micronutrientes , Nitrogênio/análiseRESUMO
BACKGROUND AND OBJECTIVE: The relationship between IPF development and environmental factors has not been completely elucidated. Analysing geographic regions of idiopathic pulmonary fibrosis (IPF) cases could help identify those areas with higher aggregation and investigate potential triggers. We hypothesize that cross-analysing location of IPF cases and areas of consistently high air pollution concentration could lead to recognition of environmental risk factors for IPF development. METHODS: This retrospective study analysed epidemiological and clinical data from 503 patients registered in the Observatory IPF.cat from January 2017 to June 2019. Incident and prevalent IPF cases from the Catalan region of Spain were graphed based on their postal address. We generated maps of the most relevant air pollutant PM2.5 from the last 10 years using data from the CALIOPE air quality forecast system and observational data. RESULTS: In 2018, the prevalence of IPF differed across provinces; from 8.1 cases per 100 000 habitants in Barcelona to 2.0 cases per 100 000 in Girona. The ratio of IPF was higher in some areas. Mapping PM2.5 levels illustrated that certain areas with more industry, traffic and shipping maintained markedly higher PM2.5 concentrations. Most of these locations correlated with higher aggregation of IPF cases. Compared with other risk factors, PM2.5 exposure was the most frequent. CONCLUSION: In this retrospective study, prevalence of IPF is higher in areas of elevated PM2.5 concentration. Prospective studies with targeted pollution mapping need to be done in specific geographies to compile a broader profile of environmental factors involved in the development of pulmonary fibrosis.
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Poluentes Atmosféricos , Poluição do Ar , Fibrose Pulmonar Idiopática , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Humanos , Fibrose Pulmonar Idiopática/epidemiologia , Fibrose Pulmonar Idiopática/etiologia , Estudos Prospectivos , Estudos RetrospectivosRESUMO
BACKGROUND: Canadian palliative care (PC) philosophy seeks to support individuals in a person-centered and sensitive manner. Unfortunately, philosophy does not necessarily translate into practice and this divide may leave patients without appropriate care at the end of life, causing distress for some families. The primary goal of the study was to identify key factors affecting perceptions of quality PC from the perspective of informal caregivers and decision makers (e.g., program managers) and to understand how their experiences within the health care system may have influenced their perceptions. METHODS: Nine caregivers and 11 decision makers from Yukon Territory, British Columbia, Alberta, Ontario, & Nova Scotia shared their experiences in PC via interview or focus group. Audio recordings were transcribed verbatim and qualitatively analyzed for themes. RESULTS: Three themes emerged, including the Caregiver as Anchor, Bewildering System, and Patient, Caregiver, and Family-Centered Care. While these results resembled other studies on caregivers and individuals receiving PC, the present study also uncovered systemic concerns. There was agreement between the two participant groups across most subthemes, however only caregivers reported feelings of being trapped by the health care system and a general lack of respect from health care professionals. Additionally, caregivers stressed the importance of preserving some sort of normalcy in daily life despite the individual's illness. CONCLUSIONS: Caregivers are critical. The health care system expects them to help a great deal, but they often do not feel supported or respected and the system is lacking the capacity and resources to meet their needs while they are grieving loss and struggling to meet demands.
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Cuidadores , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Tomada de Decisões , Humanos , Ontário , Cuidados PaliativosRESUMO
The Program for Biodiversity Research (PPBio) is an innovative program designed to integrate all biodiversity research stakeholders. Operating since 2004, it has installed long-term ecological research sites throughout Brazil and its logic has been applied in some other southern-hemisphere countries. The program supports all aspects of research necessary to understand biodiversity and the processes that affect it. There are presently 161 sampling sites (see some of them at Supplementary Appendix), most of which use a standardized methodology that allows comparisons across biomes and through time. To date, there are about 1200 publications associated with PPBio that cover topics ranging from natural history to genetics and species distributions. Most of the field data and metadata are available through PPBio web sites or DataONE. Metadata is available for researchers that intend to explore the different faces of Brazilian biodiversity spatio-temporal variation, as well as for managers intending to improve conservation strategies. The Program also fostered, directly and indirectly, local technical capacity building, and supported the training of hundreds of undergraduate and graduate students. The main challenge is maintaining the long-term funding necessary to understand biodiversity patterns and processes under pressure from global environmental changes.
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Biodiversidade , Ecossistema , Brasil , Conservação dos Recursos Naturais , Humanos , ConhecimentoRESUMO
Older adults with multimorbidity face difficulty accessing healthcare in the COVID era. Palliative care referral may be appropriate to provide additional support for symptoms, advance care planning, or caregiver distress. Since COVID, many palliative care providers have become more accessible through telehealth; however, older adults may have challenges with technology and require caregiver involvement to use. In the inpatient setting, palliative consult teams have assumed a greater role in daily communication with families who cannot visit the patient and in providing emotional support to front-line colleagues. Busy primary clinicians have embraced these efforts, but challenges remain to sustaining these changes.
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COVID-19 , Cuidadores , Comunicação , Multimorbidade , Cuidados Paliativos/psicologia , Telemedicina , Planejamento Antecipado de Cuidados , Idoso , Tomada de Decisões , HumanosRESUMO
Soil nitrogen (N) availability is critical for grassland functioning. However, human activities have increased the supply of biologically limiting nutrients, and changed the density and identity of mammalian herbivores. These anthropogenic changes may alter net soil N mineralization (soil net Nmin ), that is, the net balance between N mineralization and immobilization, which could severely impact grassland structure and functioning. Yet, to date, little is known about how fertilization and herbivore removal individually, or jointly, affect soil net Nmin across a wide range of grasslands that vary in soil and climatic properties. Here we collected data from 22 grasslands on five continents, all part of a globally replicated experiment, to assess how fertilization and herbivore removal affected potential (laboratory-based) and realized (field-based) soil net Nmin . Herbivore removal in the absence of fertilization did not alter potential and realized soil net Nmin . However, fertilization alone and in combination with herbivore removal consistently increased potential soil net Nmin. Realized soil net Nmin , in contrast, significantly decreased in fertilized plots where herbivores were removed. Treatment effects on potential and realized soil net Nmin were contingent on site-specific soil and climatic properties. Fertilization effects on potential soil net Nmin were larger at sites with higher mean annual precipitation (MAP) and temperature of the wettest quarter (T.q.wet). Reciprocally, realized soil net Nmin declined most strongly with fertilization and herbivore removal at sites with lower MAP and higher T.q.wet. In summary, our findings show that anthropogenic nutrient enrichment, herbivore exclusion and alterations in future climatic conditions can negatively impact soil net Nmin across global grasslands under realistic field conditions. This is an important context-dependent knowledge for grassland management worldwide.
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Nitrogênio , Solo , Animais , Ecossistema , Fertilização , Pradaria , Herbivoria , Humanos , Nitrogênio/análiseRESUMO
This article aimed to identify the scientific evidence about the educational strategies used to promote prenatal health. This is a systematic meta-synthesis. Analysis of published studies revealed the emergence of two central thematic categories: methodological strategies for the educational activities and; educational tools to promote prenatal health. The most used strategy was health education with pregnant women or couples, using conversation circles and focus groups as methods to target the public. The strategies and educational tools used to promote maternal health in prenatal care seek to anchor the expanded concept of health and to contribute to the construction of varied models of health education.
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Educação em Saúde/organização & administração , Cuidado Pré-Natal/organização & administração , Feminino , Humanos , Obstetrícia/normas , Gravidez , Desenvolvimento de ProgramasRESUMO
This article describes a simple method for painting an artificial iris for the manufacturing of an ocular prosthesis with dark and light tones, both with excellent esthetic results. The challenge of choosing colors around the pupil and medium zone during painting is aided by the application of Newton's color wheel theory. This technique provides a safer choice of color during the painting procedure by using a mixture of ceramic pigments.
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Cerâmica , Olho Artificial , Iris , Pigmentação em Prótese/métodos , Cor , Estética , HumanosRESUMO
Children with single-ventricle disease experience high mortality and complex care. In other life-limiting childhood illnesses, paediatric palliative care may mitigate maternal stress. We hypothesised that early palliative care in the single-ventricle population may have the same benefit for mothers. In this pilot randomised trial of early palliative care, mothers of infants with prenatal single-ventricle diagnoses completed surveys measuring depression, anxiety, coping, and quality of life at a prenatal visit and neonatal discharge. Infants were randomised to receive early palliative care - structured evaluation, psychosocial/spiritual, and communication support before surgery - or standard care. Among 56 eligible mothers, 40 enrolled and completed baseline surveys; 38 neonates were randomised, 18 early palliative care and 20 standard care; and 34 postnatal surveys were completed. Baseline Beck Depression Inventory-II and State-Trait Anxiety Index scores exceeded normal pregnant sample scores (mean 13.76±8.46 versus 7.0±5.0 and 46.34±12.59 versus 29.8±6.35, respectively; p=0.0001); there were no significant differences between study groups. The early palliative care group had a decrease in prenatal to postnatal State-Trait Anxiety Index scores (-7.6 versus 0.3 in standard care, p=0.02), higher postnatal Brief Cope Inventory positive reframing scores (p=0.03), and a positive change in PedsQL Family Impact Module communication and family relationships scores (effect size 0.46 and 0.41, respectively). In conclusion, these data show that mothers of infants with single-ventricle disease experience significant depression and anxiety prenatally. Early palliative care resulted in decreased maternal anxiety, improved maternal positive reframing, and improved communication and family relationships.
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Adaptação Psicológica , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/anormalidades , Relações Mãe-Filho/psicologia , Mães/psicologia , Cuidados Paliativos/psicologia , Estresse Psicológico/terapia , Adulto , Feminino , Seguimentos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/psicologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Recém-Nascido , Cuidados Paliativos/métodos , Gravidez , Escalas de Graduação Psiquiátrica , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Fatores de TempoRESUMO
Influenza morbidity and mortality can be severe and costly. Vaccination rates remain suboptimal in cancer patients due to provider- and patient-related factors. The objective of this study was to evaluate whether low-cost provider- and patient-focused interventions would increase influenza vaccination rates at the University of Michigan Comprehensive Cancer Center (UMCCC). This quality improvement project included all patients without documentation of influenza vaccination prior to their first outpatient appointment during the 2011-2012 and 2012-2013 influenza seasons. The multi-stepped intervention included provider and patient reminders. Influenza vaccination rates were compiled using CPT-4 codes. Same-day (with appointment) vaccination rates during the intervention seasons were compared to historical (2005-2011 seasons) controls; vaccination rates were also compared to contemporary control population at the University of Michigan Health System (UMHS). Reasons for non-adherence with vaccination were explored. The cumulative same-day vaccination rate in eligible adults was 10.1 % (2011-2012) and 9.4 % (2012-2013) compared to an average 6.9 % during influenza seasons 2005-2011. Based on logistic regression analysis, there was a 37.6 % (95 % CI 35-40.3 %) and 56.1 % (95 % CI 40.9-73 %) relative increase in the adult vaccination rate associated with the intervention, with 399 and 697 additional vaccinations, respectively, for each season. During the 2012-2013 season, the UMCCC adult vaccination rate was higher compared to the remainder of that of the UMHS. The intervention was well accepted by providers. Reasons for no vaccination were provider- and patient-related. Increasing provider and patient awareness with a simple, inexpensive intervention was associated with higher influenza vaccination rates at a large academic cancer center. The intervention is permanently implemented during influenza seasons.
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Institutos de Câncer , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Vacinação/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estações do AnoRESUMO
Even with the advances in molecular or automated methods for detection of red blood cells of interest (such as reticulocytes or parasitized cells), light microscopy continues to be the gold standard especially in laboratories with limited resources. The conventional method for determination of parasitemia and reticulocytemia uses a Miller reticle, a grid with squares of different sizes. However, this method is prone to errors if not used correctly and counts become inaccurate and highly time-consuming at low frequencies of target cells. In this report, we outline the correct guidelines to follow when using a reticle for counting, and present a new counting protocol that is a modified version of the conventional method for increased accuracy in the counting of low parasitemias and reticulocytemias. Am. J. Hematol. 91:852-855, 2016. © 2016 Wiley Periodicals, Inc.
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Parasitemia/diagnóstico , Plasmodium , Reticulócitos/parasitologia , Contagem de Eritrócitos/métodos , Humanos , Métodos , Microscopia/métodos , Parasitemia/sangue , Plasmodium/citologia , Sensibilidade e EspecificidadeRESUMO
Congenital erythrocytosis (CE), or congenital polycythemia, represents a rare and heterogeneous clinical entity. It is caused by deregulated red blood cell production where erythrocyte overproduction results in elevated hemoglobin and hematocrit levels. Primary congenital familial erythrocytosis is associated with low erythropoietin (Epo) levels and results from mutations in the Epo receptor gene (EPOR). Secondary CE arises from conditions causing tissue hypoxia and results in increased Epo production. These include hemoglobin variants with increased affinity for oxygen (HBB, HBA mutations), decreased production of 2,3-bisphosphoglycerate due to BPGM mutations, or mutations in the genes involved in the hypoxia sensing pathway (VHL, EPAS1, and EGLN1). Depending on the affected gene, CE can be inherited either in an autosomal dominant or recessive mode, with sporadic cases arising de novo. Despite recent important discoveries in the molecular pathogenesis of CE, the molecular causes remain to be identified in about 70% of the patients. With the objective of collecting all the published and unpublished cases of CE the COST action MPN&MPNr-Euronet developed a comprehensive Internet-based database focusing on the registration of clinical history, hematological, biochemical, and molecular data (http://www.erythrocytosis.org/). In addition, unreported mutations are also curated in the corresponding Leiden Open Variation Database.
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Bases de Dados Genéticas , Predisposição Genética para Doença , Mutação , Policitemia/congênito , Receptores da Eritropoetina/genética , Hipóxia Celular/genética , Eritropoetina/metabolismo , Humanos , Internet , Policitemia/genética , Policitemia/metabolismo , Transdução de Sinais/genéticaRESUMO
INTRODUCTION: Advance care planning (ACP) aims to ensure that patients receive goal-concordant care (GCC), which is especially important for racially or ethnically minoritized populations at greater risk of poor end-of-life outcomes. However, few studies have evaluated the impact of advance directives (i.e., formal ACP) or goals-of-care conversations (i.e., informal ACP) on such care. This study aimed to examine the relationship between each of formal and informal ACP and goal-concordant end-of-life care among older Americans and to determine whether their impact differed between individuals identified as White, Black, or Hispanic. METHODS: We conducted a retrospective cohort study using 2012-2018 data from the biennial Health and Retirement Study. We examined the relationships of interest using two, separate multivariable logistic regression models. Model 1 regressed a proxy report of GCC on formal and informal ACP and sociodemographic and health-related covariates. Model 2 added interaction terms between race/ethnicity and the two types of ACP. RESULTS: Our sample included 2048 older adults. There were differences in the proportions of White, Black, and Hispanic decedents who received GCC (83.1%, 75.3%, and 71.3%, respectively, p < 0.001) and in the use of each type of ACP by racial/ethnic group. In model 1, informal compared with no informal ACP was associated with higher odds of GCC (adjusted odds ratio = 1.38 [95% confidence interval, 1.05-1.82]). In model 2, Black decedents who had formal ACP were more likely to receive GCC than those who did not, but there were no statistically significant differences between decedents of different racial/ethnic groups who had no ACP, informal ACP only, or both types of ACP. CONCLUSIONS: Our results build on previous work by indicating the importance of incorporating goals-of-care conversations into routine healthcare for older adults and encouraging ACP usage among racially and ethnically minoritized populations who use ACP tools at lower rates.
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Planejamento Antecipado de Cuidados , Negro ou Afro-Americano , Hispânico ou Latino , População Branca , Humanos , Planejamento Antecipado de Cuidados/estatística & dados numéricos , Masculino , Feminino , Idoso , Hispânico ou Latino/estatística & dados numéricos , Estudos Retrospectivos , População Branca/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Assistência Terminal/estatística & dados numéricos , Idoso de 80 Anos ou mais , Estados Unidos , Diretivas Antecipadas/estatística & dados numéricos , Diretivas Antecipadas/etnologia , BrancosRESUMO
Cardiovascular disease and cancer constitute the most prevalent illnesses worldwide. Cancer patients show an increased risk of coronary artery disease not only due to shared cardiovascular risk factors, a pro-inflammatory and prothrombotic state induced by cancer itself, the cardiovascular toxicity of cancer therapy, or rarely, due to extrinsic compression of a coronary artery by the primary tumor or a metastatic lesion. Here, we present the case of a 59-year-old man with squamous cell carcinoma of the lung presented with asymptomatic diffuse ST segment depression and troponin T increase. Echocardiography revealed a large mass adjacent to the right atrium, atrioventricular groove, and basal segment of the anterior wall of the left ventricle, which the computed tomography scan showed to encase and probably compress the anterior descending coronary artery. Thus, the patient was diagnosed with acute coronary syndrome due to anterior descendent coronary artery compression by a neoplastic lung mass.