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1.
Langmuir ; 39(33): 11603-11609, 2023 Aug 22.
Article in English | MEDLINE | ID: mdl-37550248

ABSTRACT

CuO-based nanostructures have been widely investigated in catalysis, sensing, and energy conversion and storage in recent years. The unique properties of these nanostructures are largely related to the morphology and crystallinity of CuO. The controlled deposition of conformal CuO thin films by atomic layer deposition (ALD) has remained challenging until now owing to the limited understanding of the nucleation behavior and growth process. Here, a novel ALD process for copper oxide was developed using copper(II) trifluoroacetylacetonate [Cu(tfacac)2] as the metal precursor. The nucleation and initial growth of a CuO film are strongly dependent on the surface OH concentration. A continuous particulate-like CuO film was grown on OH-abundant pristine SiO2 particles, whereas the surface of the annealed SiO2 particles (presenting mostly isolated OH groups) remained uncoated under the same growth conditions. Moreover, a uniform and conformal CuO film was grown on covalently functionalized CNTs under identical conditions as pristine SiO2 particles. This study provides a strategy for tailoring the structure and the properties of thin films via ALD, which is promising for designing well-tailored nanostructures for various applications.

2.
Chemistry ; 21(42): 14901-10, 2015 Oct 12.
Article in English | MEDLINE | ID: mdl-26307370

ABSTRACT

TiO2 is frequently combined with carbon materials, such as reduced graphene oxide (RGO), to produce composites with improved properties, for example for photocatalytic applications. It is shown that heating conditions significantly affect the interface and photocatalytic properties of TiO2 @C, and that microwave irradiation can be advantageous for the synthesis of carbon-based materials. Composites of TiO2 with RGO or amorphous carbon were prepared from reaction of titanium isopropoxide with benzyl alcohol. During the synthesis of the TiO2 nanoparticles, the carbon is involved in reactions that lead to the covalent attachment of the oxide, the extent of which depends on the carbon characteristics, heating rate, and mechanism. TiO2 is more efficiently stabilized at the surface of RGO than amorphous carbon. Rapid heating of the reaction mixture results in a stronger coupling between the nanoparticles and carbon, more uniform coatings, and smaller particles with narrower size distributions. The more efficient attachment of the oxide leads to better photocatalytic performance.

3.
Langmuir ; 29(27): 8601-8, 2013 Jul 09.
Article in English | MEDLINE | ID: mdl-23758155

ABSTRACT

Development of quantitative theory of adsorption-induced deformation is important, e.g., for enhanced coalbed methane recovery by CO2 injection. It is also promising for the interpretation of experimental measurements of elastic properties of porous solids. We study deformation of mesoporous silica by n-pentane adsorption. The shape of experimental strain isotherms for this system differs from the shape predicted by thermodynamic theory of adsorption-induced deformation. We show that this difference can be attributed to the difference of disjoining pressure isotherm, responsible for the solid-fluid interactions. We suggest the disjoining pressure isotherm suitable for n-pentane adsorption on silica and derive the parameters for this isotherm from experimental data of n-pentane adsorption on nonporous silica. We use this isotherm in the formalism of macroscopic theory of adsorption-induced deformation of mesoporous materials, thus extending this theory for the case of weak solid-fluid interactions. We employ the extended theory to calculate solvation pressure and strain isotherms for SBA-15 and MCM-41 silica and compare it with experimental data obtained from small-angle X-ray scattering. Theoretical predictions for MCM-41 are in good agreement with the experiment, but for SBA-15 they are only qualitative. This deviation suggests that the elastic modulus of SBA-15 may change during pore filling.


Subject(s)
Pentanes/chemistry , Silicon Dioxide/chemistry , Adsorption , Particle Size , Porosity , Surface Properties , Thermodynamics
4.
Nanomaterials (Basel) ; 13(23)2023 Nov 29.
Article in English | MEDLINE | ID: mdl-38063742

ABSTRACT

The integration of metal oxide nanomaterials with mesoporous silica is a promising approach to exploiting the advantages of both types of materials. Traditional synthesis methods typically require multiple steps. This work instead presents a fast, one-step, template-free method for the synthesis of metal oxides homogeneously dispersed within mesoporous silica, including oxides of W, Ti, Nb, Ta, Sn, and Mo. These composites have tunable metal oxide contents, large surface areas, and wide mesopores. The combination of Nb2O5 nanoparticles (NPs) with SiO2 results in an increased surface area and a larger number of acid sites compared to pure Nb2O5 NPs. The surface texture and acidity of the silica-niobia composites can be tuned by adjusting the Nb/Si molar ratio. Moreover, the silica provides protection to the niobia NPs, preventing sintering during thermal treatment at 400 °C. The silica-niobia materials exhibit superior performance as catalysts in the aldol condensation of furfural (Fur) with acetone compared to pure niobia, leading to an up to 62% in product yield. Additionally, these catalysts show remarkable stability, retaining their performance over multiple runs. This work demonstrates the potential of the proposed synthesis approach for preparing more sustainable, high-performance, durable, and stable nanoscale metal oxide-based catalysts with a tunable composition, surface area, and active site density.

5.
Int J Cancer ; 131(5): 1059-70, 2012 Sep 01.
Article in English | MEDLINE | ID: mdl-22025034

ABSTRACT

Early pregnancy and multiparity are known to reduce the risk of women to develop breast cancer at menopause. Based on the knowledge that the differentiation of the breast induced by the hormones of pregnancy plays a major role in this protection, this work was performed with the purpose of identifying what differentiation-associated molecular changes persist in the breast until menopause. Core needle biopsies (CNB) obtained from the breast of 42 nulliparous (NP) and 71 parous (P) postmenopausal women were analyzed in morphology, immunocytochemistry and gene expression. Whereas in the NP breast, nuclei of epithelial cells were large and euchromatic, in the P breast they were small and hyperchromatic, showing strong methylation of histone 3 at lysine 9 and 27. Transcriptomic analysis performed using Affymetrix HG_U133 oligonucleotide arrays revealed that in CNB of the P breast, there were 267 upregulated probesets that comprised genes controlling chromatin organization, transcription regulation, splicing machinery, mRNA processing and noncoding elements including XIST. We concluded that the differentiation process induced by pregnancy is centered in chromatin remodeling and in the mRNA processing reactome, both of which emerge as important regulatory pathways. These are indicative of a safeguard step that maintains the fidelity of the transcription process, becoming the ultimate mechanism mediating the protection of the breast conferred by full-term pregnancy.


Subject(s)
Biomarkers/metabolism , Breast/cytology , Breast/metabolism , Cell Differentiation , Chromatin Assembly and Disassembly/genetics , Epithelial Cells/metabolism , Postmenopause/genetics , Aged , Female , Gene Expression Profiling , Humans , Middle Aged , Oligonucleotide Array Sequence Analysis , Parity/genetics , Pregnancy , RNA, Messenger/genetics , Real-Time Polymerase Chain Reaction , Reverse Transcriptase Polymerase Chain Reaction
6.
Angew Chem Int Ed Engl ; 51(44): 11053-7, 2012 Oct 29.
Article in English | MEDLINE | ID: mdl-23023805

ABSTRACT

There's something in the air … A nanocomposite consisting of well-dispersed SnO(2) and Pt nanoparticles on reduced graphene oxide (see the high-resolution TEM image) exhibited very high responses to hydrogen at concentrations between 0.5 and 3% in air, with response times of 3-7 s and recovery times of 2-6 s. The sensor was prepared by a straightforward microwave-assisted non-aqueous sol-gel approach.

7.
Langmuir ; 27(24): 14940-6, 2011 Dec 20.
Article in English | MEDLINE | ID: mdl-22060183

ABSTRACT

In this work, we compare experimental results to molecular simulation results of volatile organic compound (VOC) adsorption on nonporous silica. We adopted an effective model for the rough solid surface, obtained by a temperature annealing scheme, plus an experimental/simulation nitrogen adsorption tuning process over the silica energetic oxygen parameter. The measurement/prediction of selected VOCs, specifically, n-pentane and methylcyclohexane, is presented in terms of adsorption isotherms, with an emphasis on the angle distribution analysis of the three studied probe molecules with respect to the same modeled surface.


Subject(s)
Air Pollution/prevention & control , Cyclohexanes/chemistry , Models, Molecular , Pentanes/chemistry , Silicon Dioxide/chemistry , Volatile Organic Compounds/chemistry , Adsorption , Cyclohexanes/metabolism , Models, Chemical , Nitrogen/chemistry , Oxygen/chemistry , Pentanes/metabolism , Silicon Dioxide/metabolism , Surface Properties , Temperature , Volatile Organic Compounds/metabolism
8.
ACS Appl Mater Interfaces ; 13(19): 22077-22097, 2021 May 19.
Article in English | MEDLINE | ID: mdl-33951905

ABSTRACT

Hydrogen is a fuel with a potentially zero-carbon footprint viewed as a viable alternative to fossil fuels. It can be produced in a large scale via electrochemical water splitting using electricity derived from renewable sources, but this would require highly active, inexpensive, and stable hydrogen evolution reaction (HER) catalysts to replace the Pt benchmark. Transition-metal phosphides (TMPs) are potential Pt replacements owing to their generally high activity as well as versatility as HER catalysts for different pH media. This review summarizes the recent progress in the development of TMP HER electrocatalysts, focusing on the strategies that have been recently explored to tune the activity in acidic, neutral, and basic media. These strategies are the doping of TMPs with metal and nonmetal elements, fabrication of multimetallic phosphide phases, and construction of multicomponent heterostructures comprising TMPs and another component such as a different TMP or a metal oxide/hydroxide. The synthetic methods utilized to design the catalysts are also presented. Finally, the challenges still remaining and future research directions are discussed.

9.
Curr Med Res Opin ; 37(4): 597-604, 2021 04.
Article in English | MEDLINE | ID: mdl-33535846

ABSTRACT

OBJECTIVE: The objective of this study was to describe and compare health care resource utilization (HCRU) and disease modifying treatment (DMT) use among US adults <65 years with multiple sclerosis (MS), across commercial and Medicare Advantage plans. METHODS: Medical and pharmacy claims data from commercial and Medicare Advantage with Part D (MAPD) plans were extracted for MS patients age 18 - 64 identified between 1 January 2014 and 31 May 2017. Comparisons were made between commercial and MAPD enrollees for all-cause HCRU and DMT use over 1 year, overall and by 5 year age groups. RESULTS: A total of 28,427 MS patients were identified; two-thirds (67%) had commercial coverage. MAPD patients had statistically significantly higher mean counts of all-cause inpatient, emergency room (ER) and ambulatory visits compared to commercial patients. The significant differences were evident in all age groups ≥30 years, except for ER visits in the 40-44 and 60-64 age groups. MAPD patients had statistically significantly lower prevalence of DMT use compared to commercial patients in all age groups starting at ≥35 years. CONCLUSION: MAPD patients had a higher burden of medical HCRU compared to their commercially insured counterparts, most likely due primarily to their more advanced disease state and higher level of MS-related disability. Reasons for lower prevalence of DMT use among MAPD patients may include their more advanced disease state, older age and higher prevalence of comorbid conditions compared with commercially insured patients, as well as more restrictive formularies for MAPD vs. commercial plans. These findings suggest that there may be an opportunity for recently approved DMTs indicated for active secondary progressive MS to fulfill an unmet need for treatment among MS patients <65 years without contraindicated comorbid conditions who are enrolled in MAPD plans. Novel therapies under development to delay progression may help keep MS patients of working age in the work force.


Subject(s)
Medicare Part C , Medicare Part D , Multiple Sclerosis , Adolescent , Adult , Aged , Humans , Multiple Sclerosis/drug therapy , Multiple Sclerosis/epidemiology , Patient Acceptance of Health Care , Retrospective Studies , United States/epidemiology
10.
Neurol Ther ; 10(2): 887-904, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34392498

ABSTRACT

INTRODUCTION: Critical gaps exist in the understanding of the continuum of multiple sclerosis (MS) progression, particularly with regard to the patient experience prior to and during the transition from relapsing-remitting MS (RRMS) to secondary-progressive MS (SPMS) stages. To date, there are no clear diagnostic criteria in the determination of the clinical transition. We report here the use of patient experience data to support the development of a qualitative conceptual model of MS that describes the patient journey of transition from active-relapsing disease to progressive MS. METHODS: The study used a single-encounter, multicenter, qualitative observational study design that included a targeted literature review and individual, in-depth interviews with adult patients with a clinically confirmed diagnosis of SPMS and their adult care partners. Descriptions of symptoms and impacts of RRMS and SPMS were extracted from the literature review and used to support development of the interview guide and conceptual model. RESULTS: Participants described a slow progression in terms of change in symptoms over time, including both the development of new symptoms and the worsening of existing symptoms. CONCLUSIONS: The conceptual model of the transitionary period from RRMS to SPMS expands the current understanding of the progression of MS from the patient and care partner perspectives.

11.
J Med Econ ; 24(1): 46-53, 2021.
Article in English | MEDLINE | ID: mdl-33297816

ABSTRACT

AIMS: In clinical trials, disability progression in multiple sclerosis (MS) is measured by the Kurtzke expanded disability status scale (EDSS), which is not captured in routine clinical care in the U.S. This study developed a claims-based disability score (CDS) based on the EDSS for assigning MS disability level in a U.S. claims database. METHODS: This retrospective cohort study of patients with MS in the U.S., utilized adjudicated health plan claims data linked to electronic medical records (EMRs) data. Patients were identified between 1 January 2012 and 31 December 2016 and indexed on the first date of MS diagnosis. The CDS was developed to assign disability level at baseline using claims and ambulatory EMR records observed over the 1-year baseline period. All-cause healthcare costs were assessed by baseline disability level to validate the CDS. RESULTS: In total, 45,687 patients were identified in claims (full sample) and 1,599 linked to EMR (core sample). Over half of patients in both samples were classified with mild disability at baseline. Adjusted healthcare costs in patients with moderate and severe disability were 15% (p<.0001) and 20% higher, respectively, than in patients with mild disability at baseline in the full sample. Disease-modifying therapy (DMT) costs accounted for 89%, 82%, and 78% of outpatient pharmacy costs in patients with mild, moderate, and severe disability, respectively. CONCLUSIONS: The CDS is the first claims-based measure of MS disability utilizing data from EMR. This novel measure advances the opportunity to examine outcomes by disability accumulation in the absence of standard markers of disease progression. Although formal validation of the CDS was not possible due to lack of available EDSS in the EMR, the economic burden results align with prior publications and show that healthcare costs increase with increasing disability. Future validation studies of the CDS are warranted.


Subject(s)
Multiple Sclerosis , Cost of Illness , Databases, Factual , Health Care Costs , Humans , Multiple Sclerosis/drug therapy , Retrospective Studies
12.
J Am Heart Assoc ; 10(20): e020474, 2021 10 19.
Article in English | MEDLINE | ID: mdl-34612065

ABSTRACT

Background Sacubitril/valsartan, a first-in-class angiotensin receptor neprilysin inhibitor, received US Food and Drug Administration approval in 2015 for heart failure with reduced ejection fraction (HFrEF). Our objective was to describe the sacubitril/valsartan initiation rate, associated characteristics, and 6-month follow-up dosing among veterans with HFrEF who are renin-angiotensin-aldosterone system inhibitor (RAASi) naïve. Methods and Results Retrospective cohort study of veterans with HFrEF who are RAASi naïve defined as left ventricular ejection fraction (LVEF) ≤40%; ≥1 in/outpatient heart failure visit, first RAASi (sacubitril/valsartan, angiotensin-converting enzyme inhibitor [ACEI]), or angiotensin-II receptor blocker [ARB]) fill from July 2015 to June 2019. Characteristics associated with sacubitril/valsartan initiation were identified using Poisson regression models. From July 2015 to June 2019, we identified 3458 sacubitril/valsartan and 29 367 ACEI or ARB initiators among veterans with HFrEF who are RAASi naïve. Sacubitril/valsartan initiation increased from 0% to 26.5%. Sacubitril/valsartan (versus ACEI or ARB) initiators were less likely to have histories of stroke, myocardial infarction, or hypertension and more likely to be older and have diabetes mellitus and lower LVEF. At 6-month follow-up, the prevalence of ≥50% target daily dose for sacubitril/valsartan, ACEI, and ARB initiators was 23.5%, 43.2%, and 47.1%, respectively. Conclusions Sacubitril/valsartan initiation for HFrEF in the Veterans Administration increased in the 4 years immediately following Food and Drug Administration approval. Sacubitril/valsartan (versus ACEI or ARB) initiators had fewer baseline cardiovascular comorbidities and the lowest proportion on ≥50% target daily dose at 6-month follow-up. Identifying the reasons for lower follow-up dosing of sacubitril/valsartan could support guideline recommendations and quality improvement strategies for patients with HFrEF.


Subject(s)
Aminobutyrates/therapeutic use , Biphenyl Compounds/therapeutic use , Heart Failure , Valsartan/therapeutic use , Veterans , Aldosterone , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Heart Failure/diagnosis , Heart Failure/drug therapy , Heart Failure/epidemiology , Humans , Renin-Angiotensin System , Retrospective Studies , Stroke Volume , Tetrazoles/therapeutic use , Ventricular Function, Left
13.
Curr Med Res Opin ; 36(2): 179-188, 2020 02.
Article in English | MEDLINE | ID: mdl-31469001

ABSTRACT

Objective: Targeted care management for hospitalized patients with acute decompensated heart failure (ADHF) with reduced or preserved ejection fraction (HFrEF/HFpEF) who are at higher risk for post-discharge mortality may mitigate this outcome. However, identification of the most appropriate population for intervention has been challenging. This study developed predictive models to assess risk of 30 day and 1 year post-discharge all-cause mortality among Medicare patients with HFrEF or HFpEF recently hospitalized with ADHF.Methods: A retrospective study was conducted using the 100% Centers for Medicare Services fee-for-service sample with complementary Part D files. Eligible patients had an ADHF-related hospitalization and ICD-9-CM diagnosis code for systolic or diastolic heart failure between 1 January 2010 and 31 December 2014. Data partitioned into training (60%), validation (20%) and test sets (20%) were used to evaluate the three model approaches: classification and regression tree, full logistic regression, and stepwise logistic regression. Performance across models was assessed by comparing the receiver operating characteristic (ROC), cumulative lift, misclassification rate, the number of input variables and the order of selection/variable importance.Results: In the HFrEF (N = 83,000) and HFpEF (N = 123,644) cohorts, 30 day all-cause mortality rates were 6.6% and 5.5%, respectively, and 1 year all-cause mortality rates were 33.6% and 29.5%. The stepwise logistic regression models performed best across both cohorts, having good discrimination (test set ROC of 0.75 for both 30 day mortality models and 0.74 for both 1 year mortality models) and the lowest number of input variables (18-34 variables).Conclusions: Post-discharge mortality risk models for recently hospitalized Medicare patients with HFrEF or HFpEF were developed and found to have good predictive ability with ROCs of greater than or equal to 0.74 and a reasonable number of input variables. Applying this risk model may help providers and health systems identify hospitalized Medicare patients with HFrEF or HFpEF who may benefit from more targeted care management.


Subject(s)
Heart Failure/mortality , Medicare , Risk Assessment , Stroke Volume/physiology , Aged , Aged, 80 and over , Female , Heart Failure/physiopathology , Hospitalization , Humans , Male , Patient Discharge , Retrospective Studies , United States
14.
J Sex Med ; 6(6): 1549-1560, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19473457

ABSTRACT

INTRODUCTION: Sexual distress is an important component of diagnostic criteria for sexual dysfunctions, but little is known about the factors associated with sexual distress in women with low sexual desire. AIM: To investigate the correlates of sexual distress in women with self-reported low sexual desire. METHODS: The Prevalence of Female Sexual Problems Associated with Distress and Determinants of Treatment Seeking study was a cross-sectional, nationally representative, mailed survey of U.S. adult women. There were 31,581 respondents (response rate 63.2%) to the 42-item questionnaire that measured sexual function, sexual distress, demographic, and health-related factors. Multivariable logistic regression was used to explore the correlates of distress. MAIN OUTCOME MEASURES: Low sexual desire was defined as a response of "never" or "rarely" to the question, "How often do you desire to engage in sexual activity?" Sexual distress was measured with the Female Sexual Distress Scale (range 0-48), with a score of 15 or higher indicating presence of distress. RESULTS: Of 10,429 women with low desire, 2,868 (27.5%) had sexual distress (mean age 48.6 years, 81% with a current partner). Women without distress were 10 years older on average, and 44% had a current partner. Having a partner was strongly related to distress (odds ratio 4.6, 95% confidence interval 4.1-5.2). Other correlates were age, race, current depression, anxiety, lower social functioning, hormonal medication use, urinary incontinence, and concurrent sexual problems (arousal or orgasm). Dissatisfaction with sex life was more common in women with low desire and distress (65%) than in those without distress (20%). CONCLUSIONS: Age has a curvilinear relationship with distress, and the strongest correlate of sexual distress was having a current partner. Sexual distress and dissatisfaction with sex life are strongly correlated. Distress is higher in women with low sexual desire in a partner relationship; further research on this factor is needed.


Subject(s)
Depressive Disorder, Major/etiology , Sexual Dysfunctions, Psychological/psychology , Adult , Antidepressive Agents/therapeutic use , Depressive Disorder, Major/drug therapy , Depressive Disorder, Major/epidemiology , Female , Health Status , Humans , Middle Aged , Personal Satisfaction , Prevalence , Quality of Life/psychology , Risk Factors , Severity of Illness Index , Sexual Dysfunctions, Psychological/diagnosis , Sexual Dysfunctions, Psychological/epidemiology , Surveys and Questionnaires
15.
Oncol Rep ; 21(6): 1483-7, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19424627

ABSTRACT

MCF-10F human breast epithelial cells when transformed with 17-beta-estradiol (E2) give rise to highly invasive C5 cells that generate adenocarcinomas in SCID mice. From these tumors, cell lines such as C5-A6-T6 and C5-A8-T8 have been derived. Variable patterns of chromatin supraorganization have been demonstrated for these cells during the transformation/tumorigenesis progress, when assessing chromatin entropy by image analysis in Feulgen-stained preparations. Since epigenetic dysregulation might contribute to the chromatin textural repatterning in transformed MCF-10F cells, the association of the variable chromatin packing states with global DNA methylation was investigated in these cells after their treatment with restriction enzymes followed by Feulgen staining and chromatin entropy evaluation by image analysis. The results indicate that although -CmCGG- sequences may affect chromatin supraorganization in some of the analyzed cell types (perhaps due to localized hypermethylation), not all the chromatin condensation patterns in these cells with transformation and/or tumorigenesis are associated with DNA methylation (e.g. E2 cells). Chromatin supraorganization remodeling in C5-A6-T6 and C5-A8-T8 cells may be attained by different mechanisms, with C5-A6-T6 chromatin packing states perhaps being associated with local DNA hypermethylation or other epigenetic factors, and C5-A8-T8 likely being associated with global DNA hypomethylation, as reported in the literature for other cell types. Thus, we assume that a variable epigenetic modulation affecting the higher-order packing states of chromatin in the estrogen-transformed MCF-10F cell model could be evident with the chromatin entropy study by image analysis.


Subject(s)
Breast Neoplasms/genetics , Cell Transformation, Neoplastic/drug effects , Epigenesis, Genetic/drug effects , Estradiol/pharmacology , Gene Expression Regulation, Neoplastic/drug effects , Restriction Mapping/methods , Rosaniline Dyes , Staining and Labeling/methods , Cell Line, Transformed , Cell Line, Tumor , Cell Transformation, Neoplastic/genetics , Chromatin Assembly and Disassembly/drug effects , DNA Methylation/drug effects , Deoxyribonuclease HpaII/metabolism , Entropy , Female , Humans , Image Processing, Computer-Assisted
16.
ESC Heart Fail ; 6(5): 1085-1087, 2019 10.
Article in English | MEDLINE | ID: mdl-31268222

ABSTRACT

In this observational analysis from the Practice Innovation and Clinical Excellence Registry®, we examined changes in guideline-directed medical therapies relative to changes in symptom severity in ambulatory patients with heart failure with reduced ejection fraction, finding change in medication more often occurring when patients were changing their New York Heart Association symptom severity, rather than during periods of stable symptoms. Additionally, despite being available for a year during the time of our analysis, the use of sacubitril/valsartan was extremely low, and most often added in the context of worsening symptoms, not how this drug was studied and not how the guidelines articulate its use.


Subject(s)
Aminobutyrates/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , Heart Failure/drug therapy , Tetrazoles/therapeutic use , Adrenergic beta-Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Biphenyl Compounds , Diuretics/therapeutic use , Drug Combinations , Heart Failure/diagnosis , Heart Failure/physiopathology , Humans , Practice Guidelines as Topic , Registries , Severity of Illness Index , Stroke Volume/drug effects , Stroke Volume/physiology , Treatment Outcome , Valsartan , Ventricular Dysfunction, Left/physiopathology
17.
ESC Heart Fail ; 6(4): 784-792, 2019 08.
Article in English | MEDLINE | ID: mdl-31268631

ABSTRACT

AIMS: Guidelines for management of patients with heart failure with mid-range ejection fraction [HFmrEF; left ventricular EF (LVEF) 41-49%] do not exist. Disagreement exists whether HFmrEF should be considered a distinct group. The aim of this study is to examine characteristics of patients with HFmrEF with HF with reduced EF (HFrEF; LVEF ≤ 40%) or preserved EF (HFpEF; LVEF ≥ 50%). METHODS AND RESULTS: We examined data collected in the American College of Cardiology's National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence (PINNACLE) Registry® for first HF patient visits between 1 May 2008 and 30 June 2016. Analysis was performed using ANOVA F-tests (or Kruskal-Wallis tests for non-normally distributed variables) for continuous parameters and χ2 tests for nominal covariates at the first diagnosed HF visit. Given the NCDR PINNACLE Registry® is a US-based registry, we opted to define HFmrEF as per the US guidelines, which define HFmrEF as LVEF 41-49% in contrast to European guidelines, which define HFmrEF as LVEF 40-49%. Among 1 103 386 patients with available data, 36.1% (N = 398 228) had HFrEF, 7.5% (N = 82 292) had HFmrEF, and 56.5% (N = 622 866) had HFpEF. Compared with patients with HFrEF or HFpEF, patients with HFmrEF had more prevalent coronary and peripheral artery disease and more history of myocardial infarction, percutaneous coronary intervention, or coronary artery bypass surgery (all P < 0.001). Patients with HFmrEF were also more likely to have atrial fibrillation/flutter, diabetes, and chronic kidney disease and to have a history of tobacco use (both P < 0.001). Among those with EF assessment prior to this analysis, only 4.8% (N = 1032) previously had HFrEF that improved to HFmrEF; 32.9% (N = 7072) had HFpEF previously and progressed to HFmrEF. Those patients who transitioned from HFpEF to HFmrEF had considerably more complex profiles and were less aggressively managed compared with those who remained with HFmrEF (all P < 0.001). CONCLUSIONS: In this large descriptive analysis, patients with HFmrEF had an atherothrombotic phenotype distinct from other forms of HF. Interventions aimed at treating coronary ischaemia and addressing prevalent risk factors may play a particularly important role in the management of patients with HFmrEF.


Subject(s)
Heart Failure/physiopathology , Stroke Volume , Aged , Aged, 80 and over , Female , Heart Failure/complications , Heart Failure/diagnosis , Heart Failure/therapy , Humans , Male , Middle Aged , Practice Guidelines as Topic , Prospective Studies , Registries , United States
18.
Circ Heart Fail ; 12(11): e005691, 2019 11.
Article in English | MEDLINE | ID: mdl-31718321

ABSTRACT

BACKGROUND: US guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF), who tolerate an ACEI (angiotensin-converting enzyme inhibitor) or ARB (angiotensin II receptor blocker), be switched to sacubitril/valsartan to reduce morbidity and mortality. We compared characteristics and healthcare utilization between Veterans with HFrEF who were switched to sacubitril/valsartan versus maintained on an ACEI or ARB. METHODS: retrospective cohort study of treated HFrEF (July 2015-June 2017) using Veterans Affairs data. The index date was the first fill for sacubitril/valsartan and if none, for an ACEI or ARB. Treated HFrEF was defined by (1) left ventricular ejection fraction ≤40%, (2) ≥1 in/outpatient HF encounter, and (3) ≥1 ACEI or ARB fill, all within 1-year preindex. Poisson regression models were used to compare baseline characteristics and 1:1 propensity score-matched adjusted 4-month follow-up healthcare utilization between sacubitril/valsartan switchers and ACEI or ARB maintainers. RESULTS: Switchers (1612; 4.2%) were less likely than maintainers (37 065; 95.8%) to have a history of myocardial infarction or hypertension, and more likely to be black, have a lower left ventricular ejection fraction, and higher preindex healthcare utilization. Switchers were less likely to experience follow-up all-cause hospitalizations (11.2% versus 14.0%; risk ratio 0.80 [95% CI, 0.65-0.98], P value 0.035). CONCLUSIONS: Few Veterans with treated HFrEF were switched to sacubitril/valsartan within the first 2 years of Food and Drug Administration approval. Sacubitril/valsartan use was associated with a lower risk for all-cause hospitalizations at 4 months follow-up. Reasons for lack of guideline-recommended sacubitril/valsartan initiation warrant investigation and may reveal opportunities for HFrEF care optimization.


Subject(s)
Aminobutyrates/therapeutic use , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Drug Substitution , Heart Failure/drug therapy , Protease Inhibitors/therapeutic use , Stroke Volume , Tetrazoles/therapeutic use , Ventricular Function, Left , Veterans Health Services , Aged , Aminobutyrates/adverse effects , Angiotensin II Type 1 Receptor Blockers/adverse effects , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Biphenyl Compounds , Disease Progression , Drug Combinations , Female , Health Status , Heart Failure/diagnosis , Heart Failure/mortality , Heart Failure/physiopathology , Hospitalization , Humans , Male , Middle Aged , Neprilysin/antagonists & inhibitors , Protease Inhibitors/adverse effects , Recovery of Function , Retrospective Studies , Risk Factors , Tetrazoles/adverse effects , Time Factors , Treatment Outcome , United States , United States Department of Veterans Affairs , Valsartan
19.
Biochim Biophys Acta ; 1773(12): 1732-46, 2007 Dec.
Article in English | MEDLINE | ID: mdl-17604135

ABSTRACT

Both estrogen receptors (ER) alpha (ERalpha) and beta (ERbeta) are localized in the nucleus, plasma membrane, and mitochondria, where they mediate the different physiological effects of estrogens. It has been observed that the relative subcellular localization of ERs is altered in several cancer cells. We have demonstrated that MCF-10F cells, the immortal and non-tumorigenic human breast epithelial cells (HBEC) that are ERalpha-negative and ERbeta-positive, are transformed in vitro by 17beta-estradiol (E(2)), generating highly invasive cells that are tumorigenic in severe combined immunodeficient mice. E(2)-transformed MCF-10F (trMCF) cells exhibit progressive loss of ductulogenesis, invasive (bsMCF) and tumorigenic (caMCF) phenotypes. Immunolocalization of ERbeta by confocal fluorescent microscopy and electron microscopy revealed that ERbeta is predominantly localized in mitochondria of MCF-10F and trMCF cells. Silencing ERbeta expression with ERbeta-specific small interference RNA (siRNA-ERbeta) markedly diminishes both nuclear and mitochondrial ERbeta in MCF-10F cells. The ERbeta shifts from its predominant localization in the mitochondria of MCF-10F and trMCF cells to the nucleus of bsMCF cells, becoming predominantly nuclear in caMCF cells. Furthermore, we demonstrated that the mitochondrial ERbeta in MCF-10F cells is involved in E(2)-induced expression of mitochondrial DNA (mtDNA)-encoded respiratory chain (MRC) proteins. This is the first report of an association of changes in the subcellular localization of ERbeta with various stages of E(2)-induced transformation of HBEC and a functional role of mitochondrial ERbeta in mediating E(2)-induced MRC protein synthesis. Our findings provide a new insight into one of the potential roles of ERbeta in human breast cancer.


Subject(s)
Cell Nucleus/metabolism , Cell Transformation, Neoplastic/drug effects , Epithelial Cells/pathology , Estrogen Receptor beta/metabolism , Estrogens/pharmacology , Mitochondria/metabolism , Mitochondrial Proteins/biosynthesis , Animals , Breast/drug effects , Breast/pathology , Cell Line , Cell Nucleus/drug effects , Electron Transport/drug effects , Electron Transport Complex IV/metabolism , Epithelial Cells/drug effects , Female , Gene Silencing/drug effects , Humans , Mice , Mitochondria/drug effects , Mitochondria/enzymology , Mitochondria/ultrastructure , Nitriles/pharmacology , Propionates/pharmacology , Protein Transport/drug effects , Subcellular Fractions
20.
Obstet Gynecol ; 112(5): 970-8, 2008 Nov.
Article in English | MEDLINE | ID: mdl-18978095

ABSTRACT

OBJECTIVE: To estimate the prevalence of self-reported sexual problems (any, desire, arousal, and orgasm), the prevalence of problems accompanied by personal distress, and to describe related correlates. METHODS: The 31,581 female respondents aged 18 years and older were from 50,002 households sampled from a national research panel representative of U.S. women. Correlates of each distressing sexual problem were evaluated using multiple logistic regression techniques. RESULTS: The age-adjusted point prevalence of any sexual problem was 43.1% and 22.2% for sexually related personal distress (defined as a score of at least 15 on Female Sexual Distress Scale). Any distressing sexual problem (defined as reporting both a sexual problem and sexually related personal distress, Female Sexual Distress Scale score of at least 15) occurred in 12.0% of respondents and was more common in women aged 45-64 years (14.8%) than in younger (10.8%) or older (8.9%) women. Correlates of distressing sexual problems included poor self-assessed health, low education level, depression, anxiety, thyroid conditions, and urinary incontinence. CONCLUSION: The prevalence of distressing sexual problems peaked in middle-aged women and was considerably lower than the prevalence of sexual problems. This underlines the importance of assessing the prevalence of sexually related personal distress in accurately estimating the prevalence of sexual problems that may require clinical intervention. LEVEL OF EVIDENCE: III.


Subject(s)
Mood Disorders/epidemiology , Sexual Dysfunction, Physiological/epidemiology , Sexual Dysfunctions, Psychological/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Health Surveys , Humans , Middle Aged , Mood Disorders/complications , Prevalence , Quality of Life , Sexual Dysfunction, Physiological/psychology , Sexual Dysfunctions, Psychological/complications , United States/epidemiology , Young Adult
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