Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 159
Filtrar
Mais filtros

Bases de dados
Tipo de documento
Intervalo de ano de publicação
1.
Cell ; 177(6): 1436-1447.e12, 2019 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-31150620

RESUMO

Circadian rhythms control organismal physiology throughout the day. At the cellular level, clock regulation is established by a self-sustained Bmal1-dependent transcriptional oscillator network. However, it is still unclear how different tissues achieve a synchronized rhythmic physiology. That is, do they respond independently to environmental signals, or require interactions with each other to do so? We show that unexpectedly, light synchronizes the Bmal1-dependent circadian machinery in single tissues in the absence of Bmal1 in all other tissues. Strikingly, light-driven tissue autonomous clocks occur without rhythmic feeding behavior and are lost in constant darkness. Importantly, tissue-autonomous Bmal1 partially sustains homeostasis in otherwise arrhythmic and prematurely aging animals. Our results therefore support a two-branched model for the daily synchronization of tissues: an autonomous response branch, whereby light entrains circadian clocks without any commitment of other Bmal1-dependent clocks, and a memory branch using other Bmal1-dependent clocks to "remember" time in the absence of external cues.


Assuntos
Fatores de Transcrição ARNTL/fisiologia , Relógios Circadianos/genética , Fatores de Transcrição ARNTL/metabolismo , Animais , Proteínas CLOCK/metabolismo , Relógios Circadianos/fisiologia , Ritmo Circadiano/genética , Comportamento Alimentar/fisiologia , Feminino , Homeostase , Luz , Masculino , Camundongos , Camundongos Knockout , Modelos Animais , Especificidade de Órgãos/fisiologia , Fotoperíodo , Núcleo Supraquiasmático/metabolismo
2.
Cell ; 177(6): 1448-1462.e14, 2019 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-31150621

RESUMO

Mammals rely on a network of circadian clocks to control daily systemic metabolism and physiology. The central pacemaker in the suprachiasmatic nucleus (SCN) is considered hierarchically dominant over peripheral clocks, whose degree of independence, or tissue-level autonomy, has never been ascertained in vivo. Using arrhythmic Bmal1-null mice, we generated animals with reconstituted circadian expression of BMAL1 exclusively in the liver (Liver-RE). High-throughput transcriptomics and metabolomics show that the liver has independent circadian functions specific for metabolic processes such as the NAD+ salvage pathway and glycogen turnover. However, although BMAL1 occupies chromatin at most genomic targets in Liver-RE mice, circadian expression is restricted to ∼10% of normally rhythmic transcripts. Finally, rhythmic clock gene expression is lost in Liver-RE mice under constant darkness. Hence, full circadian function in the liver depends on signals emanating from other clocks, and light contributes to tissue-autonomous clock function.


Assuntos
Fatores de Transcrição ARNTL/fisiologia , Relógios Circadianos/genética , Fígado/metabolismo , Fatores de Transcrição ARNTL/metabolismo , Animais , Proteínas CLOCK/metabolismo , Relógios Circadianos/fisiologia , Ritmo Circadiano/genética , Feminino , Regulação da Expressão Gênica , Homeostase , Luz , Masculino , Camundongos , Camundongos Knockout , Modelos Animais , Especificidade de Órgãos/fisiologia , Fotoperíodo , Núcleo Supraquiasmático/metabolismo
4.
Proc Natl Acad Sci U S A ; 121(28): e2403581121, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38968108

RESUMO

Adverse cardiac outcomes in COVID-19 patients, particularly those with preexisting cardiac disease, motivate the development of human cell-based organ-on-a-chip models to recapitulate cardiac injury and dysfunction and for screening of cardioprotective therapeutics. Here, we developed a heart-on-a-chip model to study the pathogenesis of SARS-CoV-2 in healthy myocardium established from human induced pluripotent stem cell (iPSC)-derived cardiomyocytes and a cardiac dysfunction model, mimicking aspects of preexisting hypertensive disease induced by angiotensin II (Ang II). We recapitulated cytopathic features of SARS-CoV-2-induced cardiac damage, including progressively impaired contractile function and calcium handling, apoptosis, and sarcomere disarray. SARS-CoV-2 presence in Ang II-treated hearts-on-a-chip decreased contractile force with earlier onset of contractile dysfunction and profoundly enhanced inflammatory cytokines compared to SARS-CoV-2 alone. Toward the development of potential therapeutics, we evaluated the cardioprotective effects of extracellular vesicles (EVs) from human iPSC which alleviated the impairment of contractile force, decreased apoptosis, reduced the disruption of sarcomeric proteins, and enhanced beta-oxidation gene expression. Viral load was not affected by either Ang II or EV treatment. We identified MicroRNAs miR-20a-5p and miR-19a-3p as potential mediators of cardioprotective effects of these EVs.


Assuntos
Angiotensina II , COVID-19 , Células-Tronco Pluripotentes Induzidas , Dispositivos Lab-On-A-Chip , Miócitos Cardíacos , Humanos , Angiotensina II/farmacologia , Apoptose/efeitos dos fármacos , COVID-19/virologia , COVID-19/metabolismo , Citocinas/metabolismo , Vesículas Extracelulares/metabolismo , Células-Tronco Pluripotentes Induzidas/metabolismo , MicroRNAs/metabolismo , MicroRNAs/genética , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/virologia , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/patologia , SARS-CoV-2/fisiologia
5.
Nature ; 581(7808): 288-293, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32433618

RESUMO

The hydrogen isotopes deuterium (D) and tritium (T) have become essential tools in chemistry, biology and medicine1. Beyond their widespread use in spectroscopy, mass spectrometry and mechanistic and pharmacokinetic studies, there has been considerable interest in incorporating deuterium into drug molecules1. Deutetrabenazine, a deuterated drug that is promising for the treatment of Huntington's disease2, was recently approved by the United States' Food and Drug Administration. The deuterium kinetic isotope effect, which compares the rate of a chemical reaction for a compound with that for its deuterated counterpart, can be substantial1,3,4. The strategic replacement of hydrogen with deuterium can affect both the rate of metabolism and the distribution of metabolites for a compound5, improving the efficacy and safety of a drug. The pharmacokinetics of a deuterated compound depends on the location(s) of deuterium. Although methods are available for deuterium incorporation at both early and late stages of the synthesis of a drug6,7, these processes are often unselective and the stereoisotopic purity can be difficult to measure7,8. Here we describe the preparation of stereoselectively deuterated building blocks for pharmaceutical research. As a proof of concept, we demonstrate a four-step conversion of benzene to cyclohexene with varying degrees of deuterium incorporation, via binding to a tungsten complex. Using different combinations of deuterated and proteated acid and hydride reagents, the deuterated positions on the cyclohexene ring can be controlled precisely. In total, 52 unique stereoisotopomers of cyclohexene are available, in the form of ten different isotopologues. This concept can be extended to prepare discrete stereoisotopomers of functionalized cyclohexenes. Such systematic methods for the preparation of pharmacologically active compounds as discrete stereoisotopomers could improve the pharmacological and toxicological properties of drugs and provide mechanistic information related to their distribution and metabolism in the body.


Assuntos
Benzeno/química , Técnicas de Química Sintética , Cicloexenos/química , Cicloexenos/síntese química , Deutério/química , Preparações Farmacêuticas/química , Preparações Farmacêuticas/síntese química , Bases de Dados de Compostos Químicos , Cinética , Estrutura Molecular , Estereoisomerismo , Tetrabenazina/análogos & derivados , Tetrabenazina/síntese química , Tetrabenazina/química , Tungstênio/química
6.
PLoS Pathog ; 19(8): e1011596, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37603565

RESUMO

SARS-CoV-2 (CoV2) infected, asymptomatic individuals are an important contributor to COVID transmission. CoV2-specific immunoglobulin (Ig)-as generated by the immune system following infection or vaccination-has helped limit CoV2 transmission from asymptomatic individuals to susceptible populations (e.g. elderly). Here, we describe the relationships between COVID incidence and CoV2 lineage, viral load, saliva Ig levels (CoV2-specific IgM, IgA and IgG), and ACE2 binding inhibition capacity in asymptomatic individuals between January 2021 and May 2022. These data were generated as part of a large university COVID monitoring program in Ohio, United States of America, and demonstrate that COVID incidence among asymptomatic individuals occurred in waves which mirrored those in surrounding regions, with saliva CoV2 viral loads becoming progressively higher in our community until vaccine mandates were established. Among the unvaccinated, infection with each CoV2 lineage (pre-Omicron) resulted in saliva Spike-specific IgM, IgA, and IgG responses, the latter increasing significantly post-infection and being more pronounced than N-specific IgG responses. Vaccination resulted in significantly higher Spike-specific IgG levels compared to unvaccinated infected individuals, and uninfected vaccinees' saliva was more capable of inhibiting Spike function. Vaccinees with breakthrough Delta infections had Spike-specific IgG levels comparable to those of uninfected vaccinees; however, their ability to inhibit Spike binding was diminished. These data are consistent with COVID vaccines having achieved hoped-for effects in our community, including the generation of mucosal antibodies that inhibit Spike and lower community viral loads, and suggest breakthrough Delta infections were not due to an absence of vaccine-elicited Ig, but instead limited Spike binding activity in the face of high community viral loads.


Assuntos
Formação de Anticorpos , COVID-19 , Idoso , Humanos , COVID-19/epidemiologia , SARS-CoV-2 , Saliva , Universidades , Infecções Irruptivas , Imunoglobulina A , Imunoglobulina G , Imunoglobulina M
7.
Nature ; 2024 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-39242951
8.
Nature ; 2024 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-39271924
9.
Nature ; 2024 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-39294288
10.
Mol Cell Proteomics ; 22(11): 100655, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37793502

RESUMO

Molecular clocks and daily feeding cycles support metabolism in peripheral tissues. Although the roles of local clocks and feeding are well defined at the transcriptional level, their impact on governing protein abundance in peripheral tissues is unclear. Here, we determine the relative contributions of local molecular clocks and daily feeding cycles on liver and muscle proteomes during the active phase in mice. LC-MS/MS was performed on liver and gastrocnemius muscle harvested 4 h into the dark phase from WT, Bmal1 KO, and dual liver- and muscle-Bmal1-rescued mice under either ad libitum feeding or time-restricted feeding during the dark phase. Feeding-fasting cycles had only minimal effects on levels of liver proteins and few, if any, on the muscle proteome. In contrast, Bmal1 KO altered the abundance of 674 proteins in liver and 80 proteins in muscle. Local rescue of liver and muscle Bmal1 restored ∼50% of proteins in liver and ∼25% in muscle. These included proteins involved in fatty acid oxidation in liver and carbohydrate metabolism in muscle. For liver, proteins involved in de novo lipogenesis were largely dependent on Bmal1 function in other tissues (i.e., the wider clock system). Proteins regulated by BMAL1 in liver and muscle were enriched for secreted proteins. We found that the abundance of fibroblast growth factor 1, a liver secreted protein, requires BMAL1 and that autocrine fibroblast growth factor 1 signaling modulates mitochondrial respiration in hepatocytes. In liver and muscle, BMAL1 is a more potent regulator of dark phase proteomes than daily feeding cycles, highlighting the need to assess protein levels in addition to mRNA when investigating clock mechanisms. The proteome is more extensively regulated by BMAL1 in liver than in muscle, and many metabolic pathways in peripheral tissues are reliant on the function of the clock system as a whole.


Assuntos
Relógios Circadianos , Ritmo Circadiano , Animais , Camundongos , Fatores de Transcrição ARNTL/genética , Fatores de Transcrição ARNTL/metabolismo , Cromatografia Líquida , Relógios Circadianos/genética , Ritmo Circadiano/genética , Fator 1 de Crescimento de Fibroblastos/metabolismo , Fígado/metabolismo , Músculos/metabolismo , Proteoma/metabolismo , Espectrometria de Massas em Tandem
11.
Nano Lett ; 24(37): 11537-11543, 2024 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-39236216

RESUMO

The potential of high entropy oxides (HEOs) as high-performance energy storage materials and catalysts has been mainly understood through their bulk structures. However, the importance of their surfaces, which may play an even more critical role, remains largely unknown. In this study, we employed advanced scanning transmission electron microscopy to investigate the atomic-scale structural and chemical responses of CeYLaHfTiZrOx HEOs to high-temperature redox environments. Our observations reveal dynamic elemental and structural reconstructions in the surface of HEOs under different gas environments, contrasting with the high stability of the bulk structure. Notably, the surfaces of HEO particles consistently exhibit abundant oxygen vacancies, regardless of the redox environment. These findings indicate that HEOs offer distinct advantages in facilitating chemical and electrochemical reactions, relying on oxygen vacancies. Our results also suggest that the exceptional performance of HEOs in energy storage applications arises from surface structural and chemical adaptability.

12.
J Am Chem Soc ; 146(3): 2167-2173, 2024 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-38214166

RESUMO

Due to the large multi-elemental space desired for property screening and optimization, high-entropy alloys (HEAs) hold greater potential over conventional alloys for a range of applications, such as structural materials, energy conversion, and catalysis. However, the relationship between the HEA composition and its local structural/elemental configuration is not well understood, particularly in noble-metal-based HEA nanomaterials, hindering the design and development of nano-HEAs in energy conversion and catalysis applications. Herein, we determined precise atomic-level structural and elemental arrangements in model HEAs composed of RhPtPdFeCo and RuPtPdFeCo to unveil their local characteristics. Notably, by changing just one constituent element in the HEA (Rh to Ru), we found dramatic changes in the elemental arrangement from complete random mixing to a local single elemental ordering feature. Additionally, we demonstrate that the local ordering in RuPtPdFeCo can be further controlled by varying the Ru concentration, allowing us to toggle between local Ru clustering and distinct heterostructures in multicomponent systems. Overall, our study presents a practical approach for manipulating local atomic structures and elemental arrangements in noble-metal-based HEA systems, which could provide in-depth knowledge to mechanistically understand the functionality of noble-metal-based HEA nanomaterials in practical applications.

13.
J Am Chem Soc ; 146(34): 23909-23922, 2024 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-39137357

RESUMO

Platinum exhibits desirable catalytic properties, but it is scarce and expensive. Optimizing its use in key applications such as emission control catalysis is important to reduce our reliance on such a rare element. Supported Pt nanoparticles (NPs) used in emission control systems deactivate over time because of particle growth in sintering processes. In this work, we shed light on the stability against sintering of Pt NPs supported on and encapsulated in Al2O3 using a combination of nanocrystal catalysts and atomic layer deposition (ALD) techniques. We find that small amounts of alumina overlayers created by ALD on preformed Pt NPs can stabilize supported Pt catalysts, significantly reducing deactivation caused by sintering, as previously observed by others. Combining theoretical and experimental insights, we correlate this behavior to the decreased propensity of oxidized Pt species to undergo Ostwald ripening phenomena because of the physical barrier imposed by the alumina overlayers. Furthermore, we find that highly stable catalysts can present an abundance of under-coordinated Pt sites after restructuring of both Pt particles and alumina overlayers at a high temperature (800 °C) in C3H6 oxidation conditions. The enhanced stability significantly improves the Pt utilization efficiency after accelerated aging treatments, with encapsulated Pt catalysts reaching reaction rates more than two times greater than those of a control supported Pt catalyst.

14.
J Pediatr ; 272: 114092, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38734134

RESUMO

OBJECTIVE: To identify factors associated with overtreatment of presumed urinary tract infection (UTI) among children with spina bifida using such criteria. STUDY DESIGN: A retrospective review of children with spina bifida (age <21 years) evaluated in the Emergency Department (ED) at a single institution was performed. Patients with a urinalysis (UA) performed who were reliant on assisted bladder emptying were included. The primary outcome was overtreatment, defined as receiving antibiotics for presumed UTI but ultimately not meeting spina bifida UTI criteria (≥2 urologic symptoms plus pyuria and urine culture growing >100k CFU/mL). The primary exposure was whether the components of the criteria available at the time of the ED visit (≥2 urologic symptoms plus pyuria) were met when antibiotics were initiated. RESULTS: Among 236 ED encounters, overtreatment occurred in 80% of cases in which antibiotics were initiated (47% of the entire cohort). Pyuria with <2 urologic symptoms was the most important factor associated with overtreatment (OR 9.6). Non-Hispanic White race was associated with decreased odds of overtreatment (OR 0.3). CONCLUSIONS: Overtreatment of presumed UTI among patients with spina bifida was common. Pyuria, which is not specific to UTI in this population, was the main driver of overtreatment. Symptoms are a cornerstone of UTI diagnosis among children with spina bifida, should be collected in a standardized manner, and considered in a decision to treat.


Assuntos
Antibacterianos , Sobretratamento , Disrafismo Espinal , Infecções Urinárias , Humanos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/diagnóstico , Infecções Urinárias/complicações , Disrafismo Espinal/complicações , Estudos Retrospectivos , Feminino , Antibacterianos/uso terapêutico , Masculino , Criança , Pré-Escolar , Adolescente , Lactente , Serviço Hospitalar de Emergência , Urinálise
15.
Exp Physiol ; 109(3): 405-415, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37847495

RESUMO

Mechanical load is one of the main determinants of cardiac structure and function. Mechanical load is studied in vitro using cardiac preparations together with loading protocols (e.g., auxotonic, isometric). However, such studies are often limited by reductionist models and poorly simulated mechanical load profiles. This hinders the physiological relevance of findings. Living myocardial slices have been used to study load in vitro. Living myocardial slices (LMS) are 300-µm-thick intact organotypic preparations obtained from explanted animal or human hearts. They have preserved cellular populations and the functional, structural, metabolic and molecular profile of the tissue from which they are prepared. Using a three-element Windkessel (3EWK) model we previously showed that LMSs can be cultured while performing cardiac work loops with different preload and afterload. Under such conditions, LMSs remodel as a function of the mechanical load applied to them (physiological load, pressure or volume overload). These studies were conducted in commercially available length actuators that had to be extensively modified for culture experiments. In this paper, we demonstrate the design, development and validation of a novel device, MyoLoop. MyoLoop is a bioreactor that can pace, thermoregulate, acquire and process data, and chronically load LMSs and other cardiac tissues in vitro. In MyoLoop, load is parametrised using a 3EWK model, which can be used to recreate physiological and pathological work loops and the remodelling response to these. We believe MyoLoop is the next frontier in basic cardiovascular research enabling reductionist but physiologically relevant in vitro mechanical studies.


Assuntos
Reatores Biológicos , Coração , Animais , Humanos , Miocárdio , Projetos de Pesquisa
16.
J Org Chem ; 89(11): 8005-8010, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38804706

RESUMO

Trace palladium in synthetic materials can be rapidly and inexpensively semiquantified by a catalysis-based fluorometric method that converts resorufin allyl ether to resorufin. However, whether sulfur compounds would interfere with this method has not been systematically studied. Herein, we show that although thiourea in solution interferes with quantification, sulfide, thiol, and thiocarbamate do not. The fluorometric method can also detect palladium bound to sulfur-based scavenger resin and outperform inductively coupled plasma mass spectrometry for detecting trace palladium in ibuprofen.


Assuntos
Fluorometria , Ibuprofeno , Paládio , Paládio/química , Ibuprofeno/química , Ibuprofeno/análise , Catálise , Fluorometria/métodos , Estrutura Molecular , Compostos de Enxofre/química , Compostos de Enxofre/análise
17.
Sensors (Basel) ; 24(17)2024 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-39275743

RESUMO

Inertial measurement units (IMU) are increasingly utilized to capture biomechanical measures such as joint kinematics outside traditional biomechanics laboratories. These wearable sensors have been proven to help clinicians and engineers monitor rehabilitation progress, improve prosthesis development, and record human performance in a variety of settings. The Valor IMU aims to offer a portable motion capture alternative to provide reliable and accurate joint kinematics when compared to industry gold standard optical motion capture cameras. However, IMUs can have disturbances in their measurements caused by magnetic fields, drift, and inappropriate calibration routines. Therefore, the purpose of this investigation is to validate the joint angles captured by the Valor IMU in comparison to an optical motion capture system across a variety of movements. Our findings showed mean absolute differences between Valor IMU and Vicon motion capture across all subjects' joint angles. The tasks ranged from 1.81 degrees to 17.46 degrees, the root mean squared errors ranged from 1.89 degrees to 16.62 degrees, and interclass correlation coefficient agreements ranged from 0.57 to 0.99. The results in the current paper further promote the usage of the IMU system outside traditional biomechanical laboratories. Future examinations of this IMU should include smaller, modular IMUs with non-slip Velcro bands and further validation regarding transverse plane joint kinematics such as joint internal/external rotations.


Assuntos
Extremidade Inferior , Dispositivos Eletrônicos Vestíveis , Humanos , Fenômenos Biomecânicos/fisiologia , Extremidade Inferior/fisiologia , Masculino , Articulações/fisiologia , Amplitude de Movimento Articular/fisiologia , Feminino , Adulto , Extremidade Superior/fisiologia , Movimento/fisiologia , Adulto Jovem
18.
Nano Lett ; 23(16): 7442-7448, 2023 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-37566785

RESUMO

The catalytic performance of atomically dispersed catalysts (ADCs) is greatly influenced by their atomic configurations, such as atom-atom distances, clustering of atoms into dimers and trimers, and their distributions. Scanning transmission electron microscopy (STEM) is a powerful technique for imaging ADCs at the atomic scale; however, most STEM analyses of ADCs thus far have relied on human labeling, making it difficult to analyze large data sets. Here, we introduce a convolutional neural network (CNN)-based algorithm capable of quantifying the spatial arrangement of different adatom configurations. The algorithm was tested on different ADCs with varying support crystallinity and homogeneity. Results show that our algorithm can accurately identify atom positions and effectively analyze large data sets. This work provides a robust method to overcome a major bottleneck in STEM analysis for ADC catalyst research. We highlight the potential of this method to serve as an on-the-fly analysis tool for catalysts in future in situ microscopy experiments.

19.
Ophthalmology ; 130(9): 983-992, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37169261

RESUMO

PURPOSE: To quantify trends in ophthalmology practice consolidation in the United States. DESIGN: A retrospective cross-sectional study. PARTICIPANTS: Providers in the Centers for Medicare and Medicaid Services (CMS) National Downloadable File with a primary specialty designation of ophthalmology. METHODS: We used the CMS database to determine national practice consolidation trends in ophthalmology on individual physician and group practice levels and analyzed by region, sex, and years spent in practice. We used the Cochran-Armitage test to determine the statistical significance of practice size differences between 2015 and 2022. MAIN OUTCOME MEASURES: Temporal practice size trends for physicians and practices in ophthalmology and regional, sex-specific, and age-related trends. RESULTS: Between 2015 and 2022, the number of ophthalmologists decreased from 17 656 to 17 615 (-0.2%), whereas the number of practices decreased from 7149 to 5890 (-18%). The percentage of ophthalmologists in practices of 1 to 2 members decreased from 35% to 28%, whereas those in groups of 50 or more increased from 7% to 11%. The percentage of practices with 1 to 2 members decreased from 75% to 71%, and those with 50 or more increased from 0.2% to 0.4%. Consolidation trends were significant on individual ophthalmologist (P < 0.001) and group practice (P < 0.001) levels. All regions, sexes, and subgroups of years spent in practice demonstrated consolidation (P < 0.001). The Northeast showed the greatest increase in groups of 50 or more physicians (+7%) between 2015 and 2022. Proportionally fewer female than male ophthalmologists were associated with practice sizes of 1 to 2 members in 2015 (29% and 36%, respectively) and 2022 (23% and 30%, respectively). Proportionally fewer ophthalmologists with 0 to 10 years of experience in practice were associated with practice sizes of 1 to 2 members than those with more than 30 years in practice in 2015 (18% and 48%, respectively) and 2022 (14% and 40%, respectively). CONCLUSIONS: Ophthalmology has undergone practice consolidation from 2015 to 2022. A decrease in the proportion of physicians affiliated with smaller practice sizes seems to have occurred. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.


Assuntos
Oftalmologistas , Oftalmologia , Idoso , Humanos , Masculino , Feminino , Estados Unidos , Estudos Retrospectivos , Estudos Transversais , Medicare
20.
Pediatr Dev Pathol ; 26(2): 106-114, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36755427

RESUMO

BACKGROUND: Mucosal biopsies in eosinophilic esophagitis (EoE) can exhibit lamina propria (LP) fibrosis, which may portend stenotic complications; however, the histologic diagnosis of LP fibrosis is subjective. We sought to assess and improve the consistency of LP fibrosis diagnosis among our pathologist group. METHODS: At a large pediatric hospital, 25 esophageal biopsy slides from 19 patients (16 with EoE) exhibiting a wide spectrum of LP area, artifacts, and fibrosis severity were scanned into whole-slide images. Staff pediatric pathologists (n = 8) separate from the authors classified each biopsy by LP adequacy and fibrosis severity 1 month before and after completion of an educational tutorial. Consensus was defined as >70% agreement. RESULTS: At baseline, 16/25 (64%) cases reached consensus for no fibrosis (n = 3), fibrosis (n = 7), or inadequate LP (n = 6); agreement was fair (α = 0.34). Post-tutorial, 13/25 (52%) cases reached consensus for no fibrosis (n = 2), fibrosis (n = 7), or inadequate LP (n = 4); agreement was again fair (α = 0.33). There was moderate agreement in grading of fibrosis severity (α = 0.54). CONCLUSION: We document only fair-to-moderate agreement in the diagnosis of esophageal LP fibrosis and adequacy in a large pediatric pathologist group despite targeted education, highlighting a challenge in incorporating this feature into EoE research and clinical decision-making.


Assuntos
Esofagite Eosinofílica , Humanos , Criança , Biópsia/métodos , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/patologia , Mucosa/patologia , Mucosa Esofágica/patologia , Fibrose
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA