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1.
Violence Gend ; 11(1): 35-42, 2024 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-38516062

RESUMEN

Fear of crime can influence our view of and experience with the world around us. This can be problematic for individuals seeking physical activity, including from walk commuting. Prior work shows fear is especially evident among women, who report fear of rape and sexual abuse by men as a primary concern. We present the results of a cross-sectional survey (n = 571) where participants were shown images from college campus (n = 4 campuses) depicting different lighting (daytime, nighttime), and entrapment levels (high, low; i.e., able to easily escape if needed, with high entrapment being difficult and low being easy), and using the Qualtrics heat map tool, selected features that stood out to them most. Data were segregated by gender and analyzed to determine similarity of heat maps for the same base image. Heat map images were analyzed using canonical correlation (Rc) to determine the relationship between the two groups; dispersion testing to decipher spatial uniformity within the images; the Structural Similarity Index (SSIM) to characterize the nature of image patterns differences; and, the Breslow-Day Test to specify pattern locations within images. Several heat map images are also presented in the results. Overall, female and male participants appear to "see" different things when imagining walk-commuting (as seen by poor Rc values) and the nature of what they were looking at were different (as seen by poor SSIM values). Female participants tended to focus on areas outside the walking path, such as bushes and dark areas, whereas men's focus was on the path ahead [χ2(1) = 4.29, p = 0.04]. Furthermore, women were more likely to select areas outside the walking path during high entrapment settings [χ2(1) = 15.49, p < 0.001] and at nighttime [χ2(1) = 4.98, p = 0.02]. Our study demonstrates point-of-view differences in female-male walking space assessments. Viewing walking safety through the lens of lived experience could be productive for holistic community walking safety.

3.
Ann Intern Med ; 177(4): 428-438, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38467003

RESUMEN

BACKGROUND: Although calcium and vitamin D (CaD) supplementation may affect chronic disease in older women, evidence of long-term effects on health outcomes is limited. OBJECTIVE: To evaluate long-term health outcomes among postmenopausal women in the Women's Health Initiative CaD trial. DESIGN: Post hoc analysis of long-term postintervention follow-up of the 7-year randomized intervention trial of CaD. (ClinicalTrials.gov: NCT00000611). SETTING: A multicenter (n = 40) trial across the United States. PARTICIPANTS: 36 282 postmenopausal women with no history of breast or colorectal cancer. INTERVENTION: Random 1:1 assignment to 1000 mg of calcium carbonate (400 mg of elemental calcium) with 400 IU of vitamin D3 daily or placebo. MEASUREMENTS: Incidence of colorectal, invasive breast, and total cancer; disease-specific and all-cause mortality; total cardiovascular disease (CVD); and hip fracture by randomization assignment (through December 2020). Analyses were stratified on personal supplement use. RESULTS: For women randomly assigned to CaD versus placebo, a 7% reduction in cancer mortality was observed after a median cumulative follow-up of 22.3 years (1817 vs. 1943 deaths; hazard ratio [HR], 0.93 [95% CI, 0.87 to 0.99]), along with a 6% increase in CVD mortality (2621 vs. 2420 deaths; HR, 1.06 [CI, 1.01 to 1.12]). There was no overall effect on other measures, including all-cause mortality (7834 vs. 7748 deaths; HR, 1.00 [CI, 0.97 to 1.03]). Estimates for cancer incidence varied widely when stratified by whether participants reported supplement use before randomization, whereas estimates on mortality did not vary, except for CVD mortality. LIMITATION: Hip fracture and CVD outcomes were available on only a subset of participants, and effects of calcium versus vitamin D versus joint supplementation could not be disentangled. CONCLUSION: Calcium and vitamin D supplements seemed to reduce cancer mortality and increase CVD mortality after more than 20 years of follow-up among postmenopausal women, with no effect on all-cause mortality. PRIMARY FUNDING SOURCE: National Heart, Lung, and Blood Institute of the National Institutes of Health.


Asunto(s)
Enfermedades Cardiovasculares , Fracturas de Cadera , Neoplasias , Femenino , Humanos , Estados Unidos/epidemiología , Anciano , Calcio/uso terapéutico , Estudios de Seguimiento , Distribución Aleatoria , Calcio de la Dieta , Suplementos Dietéticos , Vitamina D/uso terapéutico , Vitaminas/uso terapéutico , Neoplasias/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/tratamiento farmacológico , Fracturas de Cadera/epidemiología , Fracturas de Cadera/prevención & control
4.
BMC Health Serv Res ; 24(1): 271, 2024 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-38438936

RESUMEN

BACKGROUND: While the social determinants of health (SDOH) have a greater impact on individual health outcomes than the healthcare services a person receives, healthcare providers face barriers to addressing these factors in clinical settings. Previous studies have shown that providers often lack the necessary knowledge and resources to adequately screen for and otherwise assist patients with unmet social needs. This study explores the perceptions and behaviors related to SDOH among healthcare providers in the United States (US). METHODS: This cross-sectional study analyzed data from a 22-item online survey using Reaction Data's research platform of healthcare professionals in the US. Survey items included demographic questions as well as Likert scale questions about healthcare providers' perceptions and behaviors related to SDOH. Descriptive statistics were calculated, and further analyses were conducted using t-tests and analysis of variance. RESULTS: A total of 563 respondents completed the survey, with the majority being male (72.6%), White (81%), and located in urban areas (82.2%). In terms of perceptions, most providers agreed or strongly agreed that SDOH affect the health outcomes of all patients (68.5%), while only 24.1% agreed or strongly agreed that their healthcare setting was set up to address SDOH. In terms of behavior, fewer than half currently screened for SDOH (48.6%) or addressed (42.7%) SDOH in other ways. Most providers (55.7%) wanted additional resources to focus on SDOH. Statistical analyses showed significant differences by gender, with females being more likely than males to prioritize SDOH, and by specialty, with psychiatrists, pediatricians, and family/general medicine practitioners being more likely to prioritize SDOH. CONCLUSION: Most healthcare providers understand the connection between unmet social needs and their patients' health, but they also feel limited in their ability to address these issues. Ongoing efforts to improve medical education and shift the healthcare system to allow for payment and delivery of more holistic care that considers SDOH will likely provide new opportunities for healthcare providers. In addition to what they can do at the institutional and patient levels, providers have the potential to advocate for policy and system changes at the societal level that can better address the root causes of social issues.


Asunto(s)
Educación Médica , Médicos Generales , Femenino , Estados Unidos , Humanos , Masculino , Estudios Transversales , Determinantes Sociales de la Salud , Proyectos de Investigación
5.
Antimicrob Agents Chemother ; 68(3): e0139923, 2024 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-38329330

RESUMEN

Non-clinical antibiotic development relies on in vitro susceptibility and infection model studies. Validating the achievement of the targeted drug concentrations is essential to avoid under-estimation of drug effects and over-estimation of resistance emergence. While certain ß-lactams (e.g., imipenem) and ß-lactamase inhibitors (BLIs; clavulanic acid) are believed to be relatively unstable, limited tangible data on their stability in commonly used in vitro media are known. We aimed to determine the thermal stability of 10 ß-lactams and 3 BLIs via LC-MS/MS in cation-adjusted Mueller Hinton broth at 25 and 36°C as well as agar at 4 and 37°C, and in water at -20, 4, and 25°C. Supplement dosing algorithms were developed to achieve broth concentrations close to their target over 24 h. During incubation in broth (pH 7.25)/agar, degradation half-lives were 16.9/21.8 h for imipenem, 20.7/31.6 h for biapenem, 29.0 h for clavulanic acid (studied in broth only), 23.1/71.6 h for cefsulodin, 40.6/57.9 h for doripenem, 46.5/64.6 h for meropenem, 50.8/97.7 h for cefepime, 61.5/99.5 h for piperacillin, and >120 h for all other compounds. Broth stability decreased at higher pH. All drugs were ≥90% stable for 72 h in agar at 4°C. Degradation half-lives in water at 25°C were >200 h for all drugs except imipenem (14.7 h, at 1,000 mg/L) and doripenem (59.5 h). One imipenem supplement dose allowed concentrations to stay within ±31% of their target concentration. This study provides comprehensive stability data on ß-lactams and BLIs in relevant in vitro media using LC-MS/MS. Future studies are warranted applying these data to antimicrobial susceptibility testing and assessing the impact of ß-lactamase-related degradation.


Asunto(s)
Inhibidores de beta-Lactamasas , beta-Lactamas , Inhibidores de beta-Lactamasas/farmacología , beta-Lactamas/farmacología , Doripenem , Agar , Cromatografía Liquida , Espectrometría de Masas en Tándem , Antibacterianos/farmacología , Penicilinas , Ácido Clavulánico/farmacología , Imipenem/farmacología , Agua , Pruebas de Sensibilidad Microbiana
6.
J Ethnopharmacol ; 323: 117717, 2024 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-38181937

RESUMEN

ETHNOPHARMACOLOGICAL RELEVANCE: Nerium oleander is used to treat liver-associated chronic metabolic diseases in traditional medicinal systems across the globe. The hepatoprotective effects of oleander are mentioned in Indian and Chinese traditional medicinal literature. AIM OF THE STUDY: The present study aimed to investigate the cellular mechanisms behind the hepatoprotective effects of a non-toxic dose of oleander (NO). MATERIALS AND METHODS: The hepatoprotective effects of NO were tested against lipopolysaccharide (LPS)-treated HepG2 cells. Oxidative stress response was studied using cellular enzymatic assays, and gene expression was analyzed using qRT-PCR. HepG2 cells were pretreated with TAK-242 (pharmacological inhibitor of TLR4) to decipher the anti-inflammatory mechanisms of NO. Cell-free metabolites were analyzed using GCMS and were subjected to pathway enrichment analysis. RESULTS: NO reduced systemic inflammation, serum lipid peroxidation byproducts, and glucose without affecting serum transaminase levels and hepatic histopathological features. NO attenuated the inflammation-induced loss of antioxidant enzyme activities and mRNA expressions of toll-like receptor-4 (TLR4)/nuclear factor κß (NFκß)-dependent inflammatory genes. In TAK-242 pretreated cells, LPS was unable to induce inflammatory and oxidative responses. However, NO treatment in TAK-242 pretreated cells with LPS stimulation further reduced the signs of inflammation and improved hepatoprotective activities. A comparative analysis of the intracellular global metabolome from HepG2 cells with and without NO treatment indicated NO-mediated favorable modulation of intracellular metabolic pathways that support cytoprotective activities. CONCLUSION: NO protects HepG2 cells from LPS-induced oxidative and inflammatory injury. The hepatoprotective effects of NO are mediated by a TLR4-independent process and through a favorable modulation of the intracellular global metabolome that supports cytoprotection.


Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Nerium , Sulfonamidas , Humanos , Lipopolisacáridos/toxicidad , Lipopolisacáridos/metabolismo , Receptor Toll-Like 4/genética , Receptor Toll-Like 4/metabolismo , Citoprotección , Antioxidantes/farmacología , Antioxidantes/metabolismo , Inflamación/inducido químicamente , Inflamación/tratamiento farmacológico , Metaboloma
7.
J Neurooncol ; 166(1): 89-98, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38175460

RESUMEN

INTRODUCTION: Glioblastoma (GBM) is the most common central nervous system malignancy in adults. Despite decades of developments in surgical management, radiation treatment, chemotherapy, and tumor treating field therapy, GBM remains an ultimately fatal disease. There is currently no definitive standard of care for patients with recurrent glioblastoma (rGBM) following failure of initial management. OBJECTIVE: In this retrospective cohort study, we set out to examine the relative effects of bevacizumab and Gamma Knife radiosurgery on progression-free survival (PFS) and overall survival (OS) in patients with GBM at first-recurrence. METHODS: We conducted a retrospective review of all patients with rGBM who underwent treatment with bevacizumab and/or Gamma Knife radiosurgery at Roswell Park Comprehensive Cancer Center between 2012 and 2022. Mean PFS and OS were determined for each of our three treatment groups: Bevacizumab Only, Bevacizumab Plus Gamma Knife, and Gamma Knife Only. RESULTS: Patients in the combined treatment group demonstrated longer post-recurrence median PFS (7.7 months) and median OS (11.5 months) compared to glioblastoma patients previously reported in the literature, and showed improvements in total PFS (p=0.015), total OS (p=0.0050), post-recurrence PFS (p=0.018), and post-recurrence OS (p=0.0082) compared to patients who received either bevacizumab or Gamma Knife as monotherapy. CONCLUSION: This study demonstrates that the combined use of bevacizumab with concurrent stereotactic radiosurgery can have improve survival in patients with rGBM.


Asunto(s)
Neoplasias Encefálicas , Glioblastoma , Radiocirugia , Adulto , Humanos , Bevacizumab/uso terapéutico , Glioblastoma/radioterapia , Glioblastoma/tratamiento farmacológico , Radiocirugia/efectos adversos , Estudios Retrospectivos , Neoplasias Encefálicas/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Resultado del Tratamiento
8.
J Neural Eng ; 21(1)2024 02 06.
Artículo en Inglés | MEDLINE | ID: mdl-38211344

RESUMEN

Deep brain stimulation (DBS) using Medtronic's Percept™ PC implantable pulse generator is FDA-approved for treating Parkinson's disease (PD), essential tremor, dystonia, obsessive compulsive disorder, and epilepsy. Percept™ PC enables simultaneous recording of neural signals from the same lead used for stimulation. Many Percept™ PC sensing features were built with PD patients in mind, but these features are potentially useful to refine therapies for many different disease processes. When starting our ongoing epilepsy research study, we found it difficult to find detailed descriptions about these features and have compiled information from multiple sources to understand it as a tool, particularly for use in patients other than those with PD. Here we provide a tutorial for scientists and physicians interested in using Percept™ PC's features and provide examples of how neural time series data is often represented and saved. We address characteristics of the recorded signals and discuss Percept™ PC hardware and software capabilities in data pre-processing, signal filtering, and DBS lead performance. We explain the power spectrum of the data and how it is shaped by the filter response of Percept™ PC as well as the aliasing of the stimulation due to digitally sampling the data. We present Percept™ PC's ability to extract biomarkers that may be used to optimize stimulation therapy. We show how differences in lead type affects noise characteristics of the implanted leads from seven epilepsy patients enrolled in our clinical trial. Percept™ PC has sufficient signal-to-noise ratio, sampling capabilities, and stimulus artifact rejection for neural activity recording. Limitations in sampling rate, potential artifacts during stimulation, and shortening of battery life when monitoring neural activity at home were observed. Despite these limitations, Percept™ PC demonstrates potential as a useful tool for recording neural activity in order to optimize stimulation therapies to personalize treatment.


Asunto(s)
Estimulación Encefálica Profunda , Epilepsia , Temblor Esencial , Enfermedad de Parkinson , Humanos , Tálamo , Epilepsia/diagnóstico , Epilepsia/terapia , Enfermedad de Parkinson/terapia , Temblor Esencial/diagnóstico , Temblor Esencial/terapia
9.
Ital J Dermatol Venerol ; 159(1): 4-10, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37997319

RESUMEN

Honeybees are becoming increasingly familiar to the general population due to the growing popularity of backyard and amateur beekeeping. Although bee venom produces reactions ranging from mild local irritation to life-threatening anaphylaxis, it is also used for life-saving desensitization immunotherapy in those with severe reactions to bee stings. The use of honeybee venom for immunotherapy has increased due to an enhanced interest in natural therapeutics. Recently, honeybee venom has been administered as a successful, safe, and cost-effective treatment for rheumatoid arthritis, back pain, and skin diseases. During the past two decades, studies have tested honeybee venom's efficacy for treating various skin disorders, including atopic dermatitis, wound healing, and psoriasis. We will review bee venom from multiple perspectives, including its medical applications and mechanisms for dermatological pathologies.


Asunto(s)
Anafilaxia , Venenos de Abeja , Mordeduras y Picaduras de Insectos , Humanos , Abejas , Animales , Venenos de Abeja/uso terapéutico , Mordeduras y Picaduras de Insectos/complicaciones , Mordeduras y Picaduras de Insectos/terapia , Apiterapia , Anafilaxia/terapia , Resultado del Tratamiento
10.
JAMA Pediatr ; 178(1): 45-54, 2024 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-37983037

RESUMEN

Importance: Children born at less than 29 weeks' gestation are at risk of behavioral difficulties. This may be due in part to the lack of transplacental supply of docosahexaenoic acid (DHA), a key fatty acid with structural and functional roles in the brain. Objective: To determine whether meeting the neonatal DHA requirement through supplementation is associated with improved behavioral functioning of children born at less than 29 weeks' gestation. Design, Setting and Participants: This was a follow-up of children from 10 Australian participating centers in a multi-center, blinded, parallel group randomized clinical trial of infants born at less than 29 weeks' gestation conducted from June 2012 and September 2015, excluding those with additional fatty acid supplementation or major congenital or chromosomal abnormalities. Follow-up took place from August 2018 to May 2021. Parents of surviving children who had not withdrawn from the original trial were invited to complete questionnaires when the child turned 5 years' corrected age. Interventions: Infants were randomized to receive daily enteral emulsions providing 60 mg/kg/d of DHA or a soy-oil emulsion (with no DHA) from within the first 3 days of enteral feeding until 36 weeks' postmenstrual age or discharge home, whichever occurred first. Main Outcomes and Measures: The primary outcome of this follow-up was parent-rated behavior and emotional functioning as indicated by the Total Difficulties score of the Strengths and Difficulties Questionnaire. Parents also completed questionnaires about their child's behavioral manifestations of executive functioning, as well as a range of health outcomes to assess potential longer-term side effects of DHA intervention. Results: Primary outcome data were available for 731 children (76% of 958 surviving eligible children; 361 in the intervention group and 370 in the control group). Of these 731, 452 (47%) were female, and the mean (SD) corrected age at follow-up was 5.4 (0.5) years. Following imputation for missing data, the mean Total Difficulties score was the same in both groups (intervention group, n = 465; mean [SD], 11.8 [6.3]; control group, n = 493; mean [SD], 11.8 [6.0]; mean difference adjusted for sex, gestational age stratum, and hospital, 0.01; 95% CI, -0.87 to 0.89; P = .98). There was no evidence for differences between the groups in any secondary outcomes of behavior, executive functioning, or health. Conclusions and Relevance: In this follow-up of a randomized clinical trial, enteral DHA supplementation at the equivalent of the estimated in utero dose for infants born at less than 29 weeks' gestation did not improve behavioral functioning at age 5 years. There were no indications of adverse effects with DHA supplementation. Trial Registration: Australian New Zealand Clinical Trial Registry: ACTRN12612000503820.


Asunto(s)
Ácidos Docosahexaenoicos , Recien Nacido Prematuro , Preescolar , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Australia , Suplementos Dietéticos , Estudios de Seguimiento , Edad Gestacional
11.
J Nutr ; 154(2): 491-497, 2024 02.
Artículo en Inglés | MEDLINE | ID: mdl-38110180

RESUMEN

BACKGROUND: Modification of the nitrate (NO3)-nitrite (NO2)-nitric oxide (NO) pathway can be induced by oral intake of inorganic NO3 (NIT) or NO3-rich products, such as beetroot juice (BRJ). OBJECTIVES: The primary aim of this study was to evaluate the plasma changes in betaine, choline, trimethylamine (TMA), trimethylamine N-oxide (TMAO), and NO3/NO2 (NOx) concentrations over 4 h after single oral ingestion of NIT or BRJ. The flow-mediated skin fluorescence (FMSF) method was applied to measure the changes in nicotinamide adenine dinucleotide reduced form (NADH) in response to transient ischemia and reperfusion. We hypothesized that various sources of NO3 may differently affect endothelial and mitochondrial functions in healthy human subjects. METHODS: In a randomized crossover trial, 8 healthy young adults ingested 800 mg NO3 from either NIT or BRJ on 2 separate days with ≥3 d apart. Venous blood samples were collected every hour, and FMSF determination was applied bihourly. RESULTS: Plasma betaine and choline concentrations peaked at 1 h after BRJ ingestion, and remained significantly higher than baseline values at all time points (P < 0.001 and P < 0.001, compared to preingestion values). Over time, BRJ was more effective in increasing NOx compared with NIT (fixed-trial effect P < 0.001). Baseline fluorescence decreased after both NIT and BRJ consumption (fixed-time effect P = 0.005). Transient ischemia and reperfusion response increased because of NO3 consumption (fixed-time effect P = 0.003), with no differences between trials (P = 0.451; P = 0.912; P = 0.819 at 0, 2, and 4 h, respectively). CONCLUSIONS: Acute ingestion of BRJ elevated plasma betaine and choline, but not TMA and TMAO. Moreover, plasma NOx levels were higher in the BRJ trial than in the NIT trial. Various sources of NO3 positively affected endothelial and mitochondrial functions. This trial was registered at clinicaltrials.gov as NCT05004935.


Asunto(s)
Beta vulgaris , Metilaminas , Nitratos , Adulto Joven , Humanos , Betaína/farmacología , Dióxido de Nitrógeno/farmacología , Jugos de Frutas y Vegetales , Nitritos , Óxido Nítrico/metabolismo , Antioxidantes/farmacología , Isquemia , Colina/farmacología , Suplementos Dietéticos , Estudios Cruzados , Presión Sanguínea , Método Doble Ciego
12.
Photodiagnosis Photodyn Ther ; 45: 103949, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38161039

RESUMEN

SIGNIFICANCE: Photodynamic therapy (PDT) and photothermal therapy (PTT) show promise as cancer treatments, but challenges in generating large ablative volumes for deep-seated tumours persist. Using simulations, this study investigates combined PDT and PTT to increase treatment volumes, including the impact of a temperature-dependent PDT dose on the treatment volume radius. APPROACH: A finite-element model, using the open-source SfePy package, was developed to simulate combined interstitial photothermal and photodynamic treatments. Results compared an additive dose model to a temperature-dependent dose model with enhanced PDT dosimetry and examined typical clinical scenarios for possible synergistic effects. RESULTS: Findings revealed that the temperature-dependent dose model could significantly expand the damage radius compared to the additive model, depending on the tissue and drug properties. CONCLUSIONS: Characterizing synergistic effects of PDT and PTT could enhance treatment planning. Future work is ongoing to implement additional variables, such as photosensitizer photobleaching, and spatial and temporally varying oxygenation.


Asunto(s)
Neoplasias , Fotoquimioterapia , Humanos , Fármacos Fotosensibilizantes/uso terapéutico , Fotoquimioterapia/métodos , Fototerapia/métodos , Temperatura , Neoplasias/tratamiento farmacológico
13.
J Sex Med ; 21(2): 90-116, 2024 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-38148297

RESUMEN

BACKGROUND: In 1999, 1 year after the approval of the first oral phosphodiesterase type 5 (PDE5) inhibitor for the treatment of erectile dysfunction (ED), the first Princeton Consensus Conference was held to address the clinical management of men with ED who also had cardiovascular disease. These issues were readdressed in the second and third conferences. In the 13 years since the last Princeton Consensus Conference, the experience with PDE5 inhibitors is more robust, and recent new data have emerged regarding not only safety and drug-drug interactions, but also a potential cardioprotective effect of these drugs. AIM: In March 2023, an interdisciplinary group of scientists and practitioners met for the fourth Princeton Consensus Guidelines at the Huntington Medical Research Institutes in Pasadena, California, to readdress the cardiovascular workup of men presenting with ED as well as the approach to treatment of ED in men with known cardiovascular disease. METHOD: A series of lectures from experts in the field followed by Delphi-type discussions were developed to reach consensus. OUTCOMES: Consensus was reached regarding a number of issues related to erectile dysfunction and the interaction with cardiovascular health and phosphodiesterase-5 inhibitors. RESULTS: An algorithm based on recent recommendations of the American College of Cardiology and American Heart Association, including the use of computed tomography coronary artery calcium scoring, was integrated into the evaluation of men presenting with ED. Additionally, the issue of nitrate use was further considered in an algorithm regarding the treatment of ED patients with coronary artery disease. Other topics included the psychological effect of ED and the benefits of treating it; the mechanism of action of the PDE5 inhibitors; drug-drug interactions; optimizing use of a PDE5 inhibitors; rare adverse events; potential cardiovascular benefits observed in recent retrospective studies; adulteration of dietary supplements with PDE5 inhibitors; the pros and cons of over-the-counter PDE5 inhibitors; non-PDE5 inhibitor therapy for ED including restorative therapies such as stem cells, platelet-rich plasma, and shock therapy; other non-PDE5 inhibitor therapies, including injection therapy and penile prostheses; the issue of safety and effectiveness of PDE5 inhibitors in women; and recommendations for future studies in the field of sexual dysfunction and PDE5 inhibitor use were discussed. CLINICAL IMPLICATIONS: Algorithms and tables were developed to help guide the clinician in dealing with the interaction of ED and cardiovascular risk and disease. STRENGTHS AND LIMITATIONS: Strengths include the expertise of the participants and consensus recommendations. Limitations included that participants were from the United States only for this particular meeting. CONCLUSION: The issue of the intersection between cardiovascular health and sexual health remains an important topic with new studies suggesting the cardiovascular safety of PDE5 inhibitors.


Asunto(s)
Enfermedades Cardiovasculares , Disfunción Eréctil , Masculino , Humanos , Femenino , Inhibidores de Fosfodiesterasa 5/efectos adversos , Enfermedades Cardiovasculares/tratamiento farmacológico
14.
J Natl Cancer Inst ; 2023 Dec 07.
Artículo en Inglés | MEDLINE | ID: mdl-38060289

RESUMEN

As the burden of cancers impacting low and middle-income countries (LMICs) is projected to increase, formation of strategic partnerships between institutions in high-income countries and LMIC institutions may serve to accelerate cancer research, clinical care, and training. As the United States (US) National Cancer Institute (NCI) and its Center for Global Health continue to encourage cancer centers to join its global mission, academic cancer centers in the US have increased their global activities. In 2015, the Helen Diller Family Comprehensive Cancer Center (HDFCCC) at the University of California, San Francisco (UCSF) responded to the call for international partnership in addressing the global cancer burden through the establishment of the Global Cancer Program (GCP) as a priority initiative. In developing the GCP, we galvanized institutional support to foster sustained, bi-directional, equitable, international partnerships in global cancer control. Our focus and intent in disseminating this manuscript is to share experiences and lessons learned from the perspective of a US-based, NCI-designated cancer center and to provide a roadmap for other high-income institutions seeking to strategically broaden their missions and address the complex challenges of global cancer control. Herein, we review the formative evaluation, governance, strategic planning, investments in career development, funding sources, program evaluation, and lessons learned. Reflecting on the evolution of our program during the first five years, we observed in our partners a powerful shift towards locally driven priority setting, reduced dependency, and an increased commitment to research as a path to improve cancer outcomes in resource-constrained settings.

15.
Skinmed ; 21(5): 330-335, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37945358

RESUMEN

Xeroderma pigmentosum (XP) is a rare autosomal recessive disease; relatively mild XP patients are sometimes designated as having pigmented xerodermoid or xerodermoid pigmentosum (XP-V), a variant of XP. It is commonly associated with many long-standing skin conditions and tumors, including malignancies, management of which is necessary to prevent the progress of the disease. The objective of the study was to report the use of a number of innovative therapeutic and prophylactic treatments, beyond surgery, such as topical 5-fluorouracil, topical imiquimod, other topical immunomodulators, or photodynamic therapy, in treating skin eruptions and their complications in XP patients. This was a prospective therapeutic interventional study in which 50 patients with XP-V were evaluated. Age of subjects ranged from 2 to 50 years with a mean age of 18 years. This study was divided into two parts. In part one, patients were treated by applying topical zinc sulfate 25% twice daily on entire face for 2 months, then once daily for several months or years. In another instance, two women were treated with heat dermabrasion with needle diathermy on the entire face under local anesthesia, followed by application of trichloroacetic acid 35% peeling in a single session. In part two, topical podophyllin 25% was used as therapy for 18 patients, all of whom had XP complications, such as keratoacanthoma, basal cell carcinomas and squamous cell cancers.1 Podophyllin was applied to the lesions until complete resolution was documented. All patients treated with topical zinc sulfate 25% responded well as determined by clearance of actinic keratoses (ActK) and small malignant lesions, minimization of pigmented freckles, prevention of new lesions, and ceased progress of eruptions. Heat dermabrasion administered in a single session resulted in the clearance of pigmented freckles, ActK, and small tumors, and cessation of new eruptions during follow-up that continued for up to 6 years.


Asunto(s)
Queratosis Actínica , Melanosis , Neoplasias Cutáneas , Xerodermia Pigmentosa , Humanos , Femenino , Adolescente , Preescolar , Niño , Adulto Joven , Adulto , Persona de Mediana Edad , Xerodermia Pigmentosa/complicaciones , Xerodermia Pigmentosa/tratamiento farmacológico , Xerodermia Pigmentosa/patología , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/prevención & control , Ácido Tricloroacético/uso terapéutico , Sulfato de Zinc/uso terapéutico , Dermabrasión , Calor , Podofilino/uso terapéutico
16.
Skinmed ; 21(5): 337-340, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37945359

RESUMEN

Xeroderma pigmentosum (XP) is a rare autosomal recessive disease; relatively mild XP patients are sometimes designated as having pigmented xerodermoid or xerodermoid pigmentosum (XP-V), a variant of XP. It is commonly associated with many long-standing skin conditions and tumors, including malignancies, management of which is necessary to prevent the progress of the disease. The objective of the study was to evaluate an innovative therapeutic treatment, beyond surgery, surgical excision, cryotherapy, electrocautery and curettage, or Mohs surgery, for the management of skin tumors in XP.This was a prospective therapeutic interventional study comprising 50 patients with XP-V. Age of subjects ranged from 2 to 50 years, with a mean age of 18 years. Several measures were evaluated in part one of this study, and a number of others (as reviewed in part one) were successful in prophylaxis of skin tumors in XP as well as in treating earlier stigmata of XP; however, these measures were notably less successful in treating well-developed skin tumors in XP patients, and 18 of the 50 patients evaluated in part one had well-developed tumors (total 22 lesions) refractory to treatments. Podophyllin 25% in 100-mL tincture of benzoin was applied topically to lesions until complete resolution was documented in 18 patients with XP complications, such as keratoacanthoma (KA), basal cell carcinoma, or squamous cell carcinoma. Topical podophyllin 25% in benzoin was a less destructive alternative treatment for skin cancer and KA in XP patients.


Asunto(s)
Carcinoma Basocelular , Queratoacantoma , Neoplasias Cutáneas , Xerodermia Pigmentosa , Humanos , Adolescente , Preescolar , Niño , Adulto Joven , Adulto , Persona de Mediana Edad , Xerodermia Pigmentosa/complicaciones , Xerodermia Pigmentosa/patología , Xerodermia Pigmentosa/terapia , Benzoína , Podofilino , Neoplasias Cutáneas/complicaciones , Reparación del ADN
17.
Int J Dermatol ; 2023 Nov 28.
Artículo en Inglés | MEDLINE | ID: mdl-38013499

RESUMEN

Honey possesses antibacterial, anti-inflammatory, and healing properties that benefit wound healing and tissue regeneration. For centuries, honey has been utilized in traditional medicine as a binder or vehicle for creams and lotions and also for therapeutic purposes. The overuse of antibiotics and antimicrobial agents leading to drug resistance has emphasized the resurgence of honey's application in wound care. For many dermatological disorders, there is an interest in developing therapeutics with fewer side effects than traditional therapies and enhanced wound healing abilities to expedite tissue regeneration. This paper reviews the properties and components of honey that contribute to its wound-healing-based applications, the types of honey employed in medicine, and its dermatological applications. Based on the evidence from case reports, clinical trials, and in vitro studies, honey has been characterized as a safe, cost-effective, and readily available treatment option for many skin conditions, including microbial infections, atopic dermatitis, psoriasis, necrotizing fasciitis, ulcers, as well as thermal and other types of wounds.

18.
PLoS One ; 18(10): e0286228, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37796915

RESUMEN

Seagrass beds are disappearing at a record pace despite their known value to our oceans and coastal communities. Simultaneously, our coastlines are under the constant pressure of climate change which is impacting their chemical, physical and biological characteristics. It is thus pertinent to evaluate and record habitat use so we can understand how these different environments contribute to local biodiversity. This study evaluates the assemblages of fish found at five Zostera beds in Southern California using environmental DNA (eDNA) metabarcoding. eDNA is a powerful biodiversity monitoring tool that offers key advantages to conventional monitoring. Results from our eDNA study found 78 species of fish that inhabit these five beds around Southern California representing embayment, open coastal mainland and open coastal island settings. While each bed had the same average number of species found throughout the year, the composition of these fish assemblages was strongly site dependent. There were 35 fish that were found at both open coast and embayment seagrass beds, while embayment seagrass sites had 20 unique fish and open coast sites had 23 unique fish. These results demonstrate that seagrass fish assemblages are heterogenous based on their geographic positioning and that marine managers must take this into account for holistic conservation and restoration efforts.


Asunto(s)
ADN Ambiental , Zosteraceae , Animales , ADN Ambiental/genética , Zosteraceae/genética , Código de Barras del ADN Taxonómico , Ecosistema , Biodiversidad , Peces/genética , Monitoreo del Ambiente/métodos
19.
BMJ Open ; 13(9): e076507, 2023 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-37739459

RESUMEN

BACKGROUND: Intention-to-treat analyses of the Omega-3 to Reduce the Incidence of Prematurity (ORIP) trial found that omega-3 (n-3) fatty acid supplementation reduces the risk of prematurity in the subgroup of women with a singleton pregnancy and low n-3 status early in pregnancy, but not overall. However, results may have been influenced by less-than-optimal compliance. OBJECTIVES: To identify predictors of compliance with n-3 supplementation and determine treatment effects among compliers. DESIGN: Exploratory analyses of a multicentre-blinded randomised trial. SETTING: 6 tertiary care centres in Australia. PARTICIPANTS: 5328 singleton pregnancies. INTERVENTIONS: Daily capsules containing 900 mg n-3 long-chain polyunsaturated fatty acids or vegetable oil, consumed from before 20 weeks gestation until 34 weeks gestation. OUTCOME MEASURES: Early preterm (<34 weeks gestation) and preterm birth (<37 weeks gestation). Women were considered compliant if they reported missing less than a third of their allocated capsules in the previous week during a mid-pregnancy appointment. RESULTS: Among 2654 singleton pregnancies in the n-3 intervention group, 1727 (65%) were deemed compliant with supplementation. Maternal characteristics associated with compliance included age, years of full-time education, consuming alcohol but not smoking in the 3 months leading up to pregnancy, fewer previous births and taking dietary supplements at enrolment. Based on complier average causal effects, n-3 supplementation reduced the risk of preterm birth in compliers (relative risk=0.76; 95% CI 0.60 to 0.97), but not early preterm birth (relative risk=0.80; 95% CI 0.44 to 1.46). Consistent with intention-to-treat analyses, the lack of an overall effect on early preterm birth in compliers appeared to be due to beneficial effects in women with low n-3 status at enrolment but not women with replete status. CONCLUSIONS: Results in compliers were similar to those from intention-to-treat analyses, suggesting that non-compliance was not a major factor in explaining outcomes from the ORIP trial. TRIAL REGISTRATION NUMBER: ACTRN12613001142729.


Asunto(s)
Ácidos Grasos Omega-3 , Nacimiento Prematuro , Recién Nacido , Femenino , Embarazo , Humanos , Cápsulas , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/prevención & control , Australia/epidemiología , Suplementos Dietéticos , Ácidos Grasos
20.
Rev Endocr Metab Disord ; 24(6): 1011-1029, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37665480

RESUMEN

Bariatric surgery is associated with a postoperative reduction of 25(OH) vitamin D levels (25(OH)D) and with skeletal complications. Currently, guidelines for 25(OH)D assessment and vitamin D supplementation in bariatric patients, pre- and post-surgery, are still lacking. The aim of this work is to analyse systematically the published experience on 25(OH)D status and vitamin D supplementation, pre- and post-surgery, and to propose, on this basis, recommendations for management. Preoperatively, 18 studies including 2,869 patients were evaluated. Prevalence of vitamin D insufficiency as defined by 25(OH)D < 30 ng/mL (75 nmol/L) was 85%, whereas when defined by 25(OH)D < 20 ng/mL (50 nmol/L) was 57%. The median preoperative 25(OH)D level was 19.75 ng/mL. After surgery, 39 studies including 5,296 patients were analysed and among those undergoing either malabsorptive or restrictive procedures, a lower rate of vitamin D insufficiency and higher 25(OH)D levels postoperatively were observed in patients treated with high-dose oral vitamin D supplementation, defined as ≥ 2,000 IU/daily (mostly D3-formulation), compared with low-doses (< 2,000 IU/daily). Our recommendations based on this systematic review and meta-analysis should help clinical practice in the assessment and management of vitamin D status before and after bariatric surgery. Assessment of vitamin D should be performed pre- and postoperatively in all patients undergoing bariatric surgery. Regardless of the type of procedure, high-dose supplementation is recommended in patients after bariatric surgery.


Asunto(s)
Cirugía Bariátrica , Deficiencia de Vitamina D , Humanos , Vitamina D , Deficiencia de Vitamina D/tratamiento farmacológico , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/etiología , Suplementos Dietéticos , Vitaminas/uso terapéutico
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