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1.
Can J Urol ; 31(3): 11886-11891, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38912941

ABSTRACT

INTRODUCTION: To define the smallest prostate needle biopsy (PNB) template necessary for accurate tissue diagnosis in men with markedly elevated PSA while decreasing procedural morbidity. MATERIALS AND METHODS: We performed a chart review of 80 men presenting with a newly elevated PSA > 100 ng/mL who underwent biopsy (PNB or metastatic site). For patients who underwent a full 12-core biopsy, simulated templates of 2- to 10-cores were generated by randomly drawing subsets of biopsies from their full-template findings. Templates were iterated to randomize core location and generate theoretical smaller template outcomes. Simulated biopsy results were compared to full-template findings to determine accuracy to maximal Grade Group (GG) diagnosis. RESULTS: Amongst those that underwent PNB, 93% had GG 4 or 5 disease. Twenty-two (40%) underwent a full 12-core biopsy, 20 (37%) a 6-core biopsy, and only 8 (15%) had fewer than six biopsy cores sampled at our hospital. Simulated templates with 2-, 4-, 6-, and 8-cores correctly diagnosed prostate cancer in all patients, and accurately identified the maximal GG in 82%, 91%, 95%, and 97% of patients, respectively. The biopsy locations most likely to detect maximal GG were medial mid and base sites bilaterally. A 4-core template of these sites would have accurately detected the maximal GG in 95% of patients relative to a full 12-core template. CONCLUSIONS: In men presenting with PSA > 100 ng/mL, decreasing from a 12-core to a 4-core prostate biopsy template results in universal cancer detection and minimal under-grading while theoretically decreasing procedural morbidity and cost.


Subject(s)
Prostate-Specific Antigen , Prostate , Prostatic Neoplasms , Humans , Male , Prostatic Neoplasms/pathology , Prostate-Specific Antigen/blood , Aged , Middle Aged , Biopsy, Large-Core Needle/methods , Prostate/pathology , Retrospective Studies , Neoplasm Grading , Biopsy, Needle/methods
2.
J Cardiopulm Rehabil Prev ; 43(3): 170-178, 2023 05 01.
Article in English | MEDLINE | ID: mdl-36862021

ABSTRACT

PURPOSE: To optimize recovery and improve prognosis, people who have had an acute cardiac event (ACE) need support to manage their cardiac risk. In 2008, we conducted a randomized controlled trial (RCT) of Beating Heart Problems (BHP) , an 8-wk group program based on cognitive behavioral therapy (CBT) and motivational interviewing (MI), designed to improve behavioral and mental health. This study investigated 14-yr mortality status for RCT participants in order to evaluate the survival impact of the BHP program. METHODS: In 2021, mortality data on 275 participants from the earlier RCT were obtained from the Australian National Death Index. Survival analysis was undertaken to investigate differences in survival for participants in the treatment and control groups. RESULTS: Over the 14-yr follow-up period, there were 52 deaths (18.9%). For those aged <60 yr, there was a significant survival benefit to program participation, with 3% deaths in the treatment group and 13% deaths in the control group ( P = .022). For those aged ≥60 yr, the death rate was identical in both groups (30%). Other significant predictors of mortality included older age, higher 2-yr risk score, lower functional capacity, lower self-rated health, and having no private health insurance. CONCLUSIONS: Participation in the BHP conferred a survival benefit for patients aged <60 yr but not for participants overall. The findings highlight the long-term benefit of behavioral and psychosocial management of cardiac risk through CBT and MI for those who are younger at the time of their first ACE.


Subject(s)
Cognitive Behavioral Therapy , Motivational Interviewing , Humans , Australia
3.
Psychol Med ; 53(15): 7070-7077, 2023 Nov.
Article in English | MEDLINE | ID: mdl-36911997

ABSTRACT

BACKGROUND: The utilisation of massed therapy for treating posttraumatic stress disorder (PTSD) is gaining strength, especially prolonged exposure. However, it is unknown whether massed prolonged exposure (MPE) is non-inferior to standard prolonged exposure (SPE) protocols in the long term. The current study aimed to assess whether MPE was non-inferior to SPE at 12 months post-treatment, and to ascertain changes in secondary measure outcomes. METHODS: A multi-site non-inferiority randomised controlled trial (RCT) compared SPE with MPE in 12 clinics. The primary outcome was PTSD symptom severity (CAPS-5) at 12 months post-treatment commencement. Secondary outcome measures included symptoms of depression, anxiety, anger, disability, and quality of life at 12 weeks and 12 months post-treatment commencement. Outcome assessors were blinded to treatment allocation. The intention-to-treat sample included 138 Australian military members and veterans and data were analysed for 134 participants (SPE = 71, MPE = 63). RESULTS: Reductions in PTSD severity were maintained at 12 months and MPE remained non-inferior to SPE. Both treatment groups experienced a reduction in depression, anxiety, anger, and improvements in quality of life at 12 weeks and 12 months post-treatment commencement. Treatment effects for self-reported disability in the SPE group at 12 weeks were not maintained, with neither group registering significant effects at 12 months. CONCLUSIONS: The emergence of massed protocols for PTSD is an important advancement. The current study provides RCT evidence for the longevity of MPE treatment gains at 12 months post-treatment commencement and demonstrated non-inferiority to SPE. Promisingly, both treatments also significantly reduced the severity of comorbid symptoms commonly occurring alongside PTSD.


Subject(s)
Implosive Therapy , Military Personnel , Stress Disorders, Post-Traumatic , Veterans , Humans , Australia , Follow-Up Studies , Implosive Therapy/methods , Stress Disorders, Post-Traumatic/therapy , Treatment Outcome
4.
Sci Adv ; 9(11): eadf3673, 2023 Mar 17.
Article in English | MEDLINE | ID: mdl-36921048

ABSTRACT

Spin and valley indices represent the key quantum labels of quasi-particles in a wide class of two-dimensional materials and form the foundational elements of the fields of spintronics and valleytronics. Control over these degrees of freedom, therefore, remains the central challenge in these fields. Here, we show that femtosecond laser light combining optical frequency circularly polarized pulse and a terahertz (THz) frequency linearly polarized pulse, a so-called "hencomb" pulse, can generate precisely tailored and 90% pure spin currents for the dichalcogenide WSe2 and >75% pure valley currents for bilayer graphene with gaps greater than 120 millielectron volts (dephasing time, 20 femtoseconds). The frequency of the circular light component and the polarization vector of the THz light component are shown to represent the key control parameters of these pulses. Our results thus open a route toward light control over spin/valley current states at ultrafast times.

5.
Nano Lett ; 22(20): 8037-8044, 2022 Oct 26.
Article in English | MEDLINE | ID: mdl-36252952

ABSTRACT

We introduce a nanomechanical platform for fast and sensitive measurements of the spectrally resolved optical dielectric function of 2D materials. At the heart of our approach is a suspended 2D material integrated into a high Q silicon nitride nanomechanical resonator illuminated by a wavelength-tunable laser source. From the heating-related frequency shift of the resonator as well as its optical reflection measured as a function of photon energy, we obtain the real and imaginary parts of the dielectric function. Our measurements are unaffected by substrate-related screening and do not require any assumptions on the underling optical constants. This fast (τrise ∼ 135 ns), sensitive (noise-equivalent power = 90⁣pW√Hz), and broadband (1.2-3.1 eV, extendable to UV-THz) method provides an attractive alternative to spectroscopic or ellipsometric characterization techniques.

6.
Sci Adv ; 8(37): eabq2021, 2022 Sep 16.
Article in English | MEDLINE | ID: mdl-36103545

ABSTRACT

In the field of femtomagnetism, magnetic matter is controlled by ultrafast laser pulses; here, we show that coupling phonon excitations of the nuclei to spin and charge leads to femto-phono-magnetism, a powerful route to control magnetic order at ultrafast times. With state-of-the-art theoretical simulations of coupled spin, charge, and lattice dynamics, we identify strong nonadiabatic spin-phonon coupled modes that dominate early time spin dynamics. Activating these phonon modes that we show leads to an additional (up to 40% extra) loss of moment in iron-platinum occurring within 40 femtoseconds of the pump laser pulse. Underpinning this enhanced ultrafast loss of spin moment, we identify a physical mechanism in which minority spin current drives an enhanced intersite minority charge transfer, in turn promoting increased on-site spin flips. Our finding demonstrates that the nuclear system, often assumed to play the role of an energy and angular momentum sink, when selectively preexcited, can play a profound role in controlling femtosecond spin dynamics in materials.

7.
Nano Lett ; 21(17): 7123-7130, 2021 Sep 08.
Article in English | MEDLINE | ID: mdl-34410727

ABSTRACT

The coupled spin and valley degrees of freedom in transition metal dichalcogenides (TMDs) are considered a promising platform for information processing. Here, we use a TMD heterostructure MoS2-MoSe2 to study optical pumping of spin/valley polarized carriers across the interface and to elucidate the mechanisms governing their subsequent relaxation. By applying time-resolved Kerr and reflectivity spectroscopies, we find that the photoexcited carriers conserve their spin for both tunneling directions across the interface. Following this, we measure dramatically different spin/valley depolarization rates for electrons and holes, ∼30 and <1 ns-1, respectively, and show that this difference relates to the disparity in the spin-orbit splitting in conduction and valence bands of TMDs. Our work provides insights into the spin/valley dynamics of photoexcited carriers unaffected by complex excitonic processes and establishes TMD heterostructures as generators of spin currents in spin/valleytronic devices.

8.
J Robot Surg ; 15(6): 877-883, 2021 Dec.
Article in English | MEDLINE | ID: mdl-33426577

ABSTRACT

Intra-operatively placed cryopreserved placental tissue allograft (CPTA) has shown promise in expediting the recovery urinary continence (UC) following robot-assisted radical prostatectomy (RARP). In this retrospective review of a prospectively maintained single-surgeon, single-institution RARP database, we compare three groups of patients: historical controls (C; N = 183 men) that received no allograft versus two different CPTA products (total CPTA N = 162 [A1 N = 81; A2 N = 81]). The CPTA product was intra-operatively placed as an onlay over the area of the neurovascular bundles during RARP. CPTA cases had significantly faster median time to UC (A1 = 1.4 months; A2 = 1.45 months) versus controls (1.64 months), p = 0.01. On multivariable analysis, use of A1 (HR 1.55, 95% CI [1.14-2.09], p = 0.005) and use of A2 (HR 1.53, CI [1.11-2.11], p = 0.01) were significantly associated with quicker return of UC. Older age (HR 0.97, CI [0.96-0.99], p = 0.001) and non-organ-confined clinical stage (HR 0.51, CI [0.26-1.0] p = 0.05), were significantly associated with slower return of UC. In a propensity score-matched analysis of 77 CPTA patients with sufficient follow-up versus controls, there was significantly less biochemical recurrence (BCR; p = 0.01). Our study indicates that CPTA use appears to accelerate time to UC in age- and performance status-matched men undergoing RARP without increased risk of BCR.


Subject(s)
Prostatic Neoplasms , Robotic Surgical Procedures , Robotics , Aged , Allografts , Humans , Male , Placenta , Pregnancy , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Recovery of Function , Retrospective Studies , Robotic Surgical Procedures/methods , Treatment Outcome
9.
Eur Urol Focus ; 7(4): 779-787, 2021 Jul.
Article in English | MEDLINE | ID: mdl-32165116

ABSTRACT

BACKGROUND: Neoadjuvant androgen ablation (neoadjuvant androgen deprivation therapy [NADT]) is used prior to radical prostatectomy, contrary to guidelines, but its long-term effects on quality of life is unknown. OBJECTIVE: To determine the effect of NADT on patient's long-term recovery following surgery. DESIGN, SETTING, AND PARTICIPANTS: From March 2011 to August 2013, 5808 men with newly diagnosed prostate were followed up to 24 mo. A cohort of men who received NADT prior to robotic-assisted laparoscopic prostatectomy (RALP; n=51) was compared 1:3 with a matched group that underwent RALP only (n=153). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Patients were matched on Charlson comorbidities, biopsy Gleason score, and node status on final pathology. The Kruskall-Wallis test was used to compare the groups on their bowel, urinary, sexual, and hormonal domains of the 26-item Expanded Prostate Cancer Index Composite at baseline and at 1, 3, 6, 12, 18, and 24 mo postoperatively. RESULTS AND LIMITATIONS: The urinary irritative, urinary incontinence, and bowel domains were similar in the two groups during the 24 mo (p=0.832, 0.901, and 0.732, respectively). In the hormonal domain, the NADT group did worse (p<0.001). The sexual domain was also worse for the NADT group. However, when accounting for nerve sparing, there was no significant difference in sexual outcomes between the two groups (p=0.069). CONCLUSIONS: Patients who received NADT prior to RALP do not have worse sexual function, but have worse hormonal scores for up to 2yr after surgery. PATIENT SUMMARY: Neoadjuvant androgen deprivation therapy (NADT) is administered prior to robotic-assisted laparoscopic prostatectomy (RALP), contrary to clinical guidelines. NADT may not have worse sexual function outcomes up to 2yr after RALP.


Subject(s)
Prostatic Neoplasms , Urinary Incontinence , Androgen Antagonists/therapeutic use , Androgens/therapeutic use , Humans , Leuprolide/therapeutic use , Male , Neoadjuvant Therapy/methods , Prostate/pathology , Prostatectomy/methods , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Quality of Life , Urinary Incontinence/surgery
10.
J Gerontol A Biol Sci Med Sci ; 75(11): 2037-2041, 2020 10 15.
Article in English | MEDLINE | ID: mdl-32556267

ABSTRACT

SRT1720, a sirtuin1-activator, and metformin (MET), an antidiabetic drug, confer health and life-span benefits when administered individually. It is unclear whether combination of the two compounds could lead to additional benefits. Groups of 56-week-old C57BL/6J male mice were fed a high-fat diet (HFD) alone or supplemented with either SRT1720 (2 g/kg food), a high dose of MET (1% wt/wt food), or a combination of both. Animals were monitored for survival, body weight, food consumption, body composition, and rotarod performance. Mice treated with MET alone did not have improved longevity, and life span was dramatically reduced by combination of MET with SRT1720. Although all groups of animals were consuming similar amounts of food, mice on MET or MET + SRT1720 showed a sharp reduction in body weight. SRT1720 + MET mice also had lower percent body fat combined with better performance on the rotarod compared to controls. These data suggest that co-treatment of SRT1720 with MET is detrimental to survival at the doses used and, therefore, risk-benefits of combining life-span-extending drugs especially in older populations needs to be systematically evaluated.


Subject(s)
Heterocyclic Compounds, 4 or More Rings/pharmacology , Longevity/drug effects , Metformin/pharmacology , Animals , Body Composition , Body Weight , Diet, High-Fat , Heterocyclic Compounds, 4 or More Rings/administration & dosage , Male , Metformin/administration & dosage , Mice , Mice, Inbred C57BL , Models, Animal , Sirtuin 1
11.
Aust J Prim Health ; 26(3): 222-226, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32340663

ABSTRACT

Australia's federal, state, territory and local governments all have responsibilities, often overlapping, for policy and delivery of primary mental health care to postpartum women. Identification and treatment of postpartum distress is carried out by a broad range of professionals from diverse disciplines. Although there is evidence to show that anxiety and stress are important aspects of postpartum distress, substantially greater emphasis has been given to identification and treatment of depression. In addition, relatively little attention has been given to incorporating positive and negative social experiences in healthcare policy and practice. This study aimed to extend the postpartum literature by: (1) comparing the levels of depression, anxiety and stress (i.e. distress indicators) in a non-clinical sample of postpartum mothers to those in the general non-clinical population; (2) comparing the prevalence of anxiety and stress to that of depression in postpartum mothers; and (3) examining the consequences of negative social exchange, alongside perceived social support, on postpartum distress indicators. A self-report survey was completed by 242 postpartum women assessing levels of perceived social support, frequency of negative social exchange and distress indicators. Postpartum mothers were found to have significantly higher depression, anxiety and stress than the general population, and had anxiety and stress levels that were similar in severity to depression. In addition, both negative social exchanges and perceived social support were found to be important for postpartum depression, anxiety and stress. These findings suggest that Australia's primary postpartum mental health care policy and practice guidelines, delivered through a broad range of professionals, may benefit from giving anxiety and stress equal weight to depression and by embracing the important effects, for good and for ill, of positive and negative social interactions.


Subject(s)
Anxiety/epidemiology , Depression, Postpartum/epidemiology , Mothers/psychology , Mothers/statistics & numerical data , Postpartum Period/psychology , Stress, Psychological/epidemiology , Adolescent , Adult , Female , Humans , Interdisciplinary Communication , Social Support , Surveys and Questionnaires , Victoria/epidemiology , Young Adult
12.
Nat Commun ; 11(1): 871, 2020 Feb 13.
Article in English | MEDLINE | ID: mdl-32054855

ABSTRACT

Optically driven spin transport is the fastest and most efficient process to manipulate macroscopic magnetization as it does not rely on secondary mechanisms to dissipate angular momentum. In the present work, we show that such an optical inter-site spin transfer (OISTR) from Pt to Co emerges as a dominant mechanism governing the ultrafast magnetization dynamics of a CoPt alloy. To demonstrate this, we perform a joint theoretical and experimental investigation to determine the transient changes of the helicity dependent absorption in the extreme ultraviolet spectral range. We show that the helicity dependent absorption is directly related to changes of the transient spin-split density of states, allowing us to link the origin of OISTR to the available minority states above the Fermi level. This makes OISTR a general phenomenon in optical manipulation of multi-component magnetic systems.

13.
Protein Eng Des Sel ; 32(6): 277-288, 2019 12 31.
Article in English | MEDLINE | ID: mdl-31868219

ABSTRACT

Native state aggregation is an important concern in the development of therapeutic antibodies. Enhanced knowledge of mAb native state aggregation mechanisms would permit sequence-based selection and design of therapeutic mAbs with improved developability. We investigated how electrostatic interactions affect the native state aggregation of seven human IgG1 and IgG4P mAb isotype pairs, each pair having identical variable domains that are different for each set of IgG1 and IgG4P constructs. Relative aggregation propensities were determined at pH 7.4, representing physiological conditions, and pH 5.0, representing commonly used storage conditions. Our work indicates that the net charge state of variable domains relative to the net charge state of the constant domains is predominantly responsible for the different native state aggregation behavior of IgG1 and IgG4P mAbs. This observation suggests that the global net charge of a multi domain protein is not a reliable predictor of aggregation propensity. Furthermore, we demonstrate a design strategy in the frameworks of variable domains to reduce the native state aggregation propensity of mAbs identified as being aggregation-prone. Importantly, substitution of specifically identified residues with alternative, human germline residues, to optimize Fv charge, resulted in decreased aggregation potential at pH 5.0 and 7.4, thus increasing developability.


Subject(s)
Amino Acid Substitution , Immunoglobulin G/chemistry , Immunoglobulin G/genetics , Protein Aggregates/genetics , Protein Engineering , Static Electricity , Immunoglobulin G/metabolism , Models, Molecular , Protein Conformation
14.
Heart Lung Circ ; 28(12): 1812-1818, 2019 Dec.
Article in English | MEDLINE | ID: mdl-30755370

ABSTRACT

BACKGROUND: Past studies have found that depression is an independent predictor of death in patients after acute myocardial infarction (AMI). Our aim was to investigate whether the adverse effect upon mortality of depression, including mild levels, persisted up to 25 years. METHODS: We used an historical design to study patients who had been consecutively admitted to hospital after transmural AMI during the 1980s and enrolled in an exercise training trial. The Beck Depression Inventory (BDI) was administered to 188 patients in the third week after hospital admission. Scores were trichotomised and classified as low (0-5), mild (6-9) or moderate to severe (≥10) depression. The Australian National Death Index was used to determine mortality status. Cox proportional-hazards modelling was undertaken to determine the relationship between the trichotomised BDI-I scores and all-cause mortality over five time periods up to 25 years. RESULTS: The mean age of patients was 54.15 years. One hundred fourteen (114) (60.4%) had low or no depression, 47 (25.2%) mild depression and 27 (14.3%) moderate to severe depression. The mortality status of 185 (98.4%) patients was established. Depression was a significant predictor of death, independently of age and severity of myocardial infarction, at 5, 10 and 15 years but not at 20 or 25 years. Patients with mild depression had greater mortality than those with low or moderate to severe depression. CONCLUSIONS: Early identification of depression, including milder levels, is important since patients remain at increased risk for many years. They require ongoing monitoring and appropriate treatment.


Subject(s)
Depression , Myocardial Infarction , Adult , Aged , Depression/mortality , Depression/psychology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Infarction/mortality , Myocardial Infarction/psychology , Prospective Studies , Risk Assessment , Risk Factors
15.
Acta Crystallogr B Struct Sci Cryst Eng Mater ; 75(Pt 6): 1069-1075, 2019 Dec 01.
Article in English | MEDLINE | ID: mdl-32830686

ABSTRACT

Hodgesmithite, ideally (Cu,Zn)6Zn(SO4)2(OH)10·3H2O, is a new copper zinc sulfate mineral from the Block 14 Opencut, Broken Hill, New South Wales, Australia. Electron microprobe analysis provided the empirical formula Cu4.84,Zn2.16,Cd0.04[(SO4)1.89,(SiO4)0.12]2.01(OH)9.82·3.15H2O based on 21 oxygen atoms per formula unit. Hodgesmithite is trigonal, space group P3, with a = 8.1905 (12), c = 7.0990 (14) Å, V = 412.43 (12) Å3 and Z = 1. The crystal structure of hodgesmithite, R1 = 0.0272 for 5145 reflections with Fo > 4σ(Fo) measured with synchrotron X-ray radiation (λ = 0.71080 Å), contains interrupted sheets of edge-sharing Cu(O,OH)6 octahedra in the (001) plane. Every seventh octahedral site is vacant and capped by a ZnO4 tetrahedron and an SO4 tetrahedron which are attached to the sheet above and below this position. The sheets are additionally decorated on one side by SO4 tetrahedra that share a vertex incident to three Cu-O(apical) bonds. Interstitial H2O groups lie between the sheets. ZnO4 tetrahedra share vertices with SO4 tetrahedra from the adjacent sheet to provide linkage between the sheets in the c direction.

16.
J Robot Surg ; 13(2): 261-265, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30003407

ABSTRACT

Since its inception, robot-assisted radical prostatectomy (RARP) has developed into a familiar surgical modality with improved perioperative outcomes including decreased hospital stay for localized prostate cancer patients. Experience with outpatient RARP has been reported as early as 2010. In this study, we evaluate the safety and feasibility of outpatient RARP by comparing perioperative outcomes between patients undergoing outpatient RARP to patients discharged on the day following surgery. This is a single-institution retrospective cohort study. Patients with localized disease who underwent RARP without pelvic lymph node dissection from September 2017 to January 2018 were included. T tests and Chi-squared analysis were used to compare demographic and perioperative characteristics of patients who were discharged on the same day of surgery (outpatient RARP) to patients discharged on the day after surgery (inpatient RARP). Of the 51 patients included in the study, 26 underwent outpatient RARP while 25 underwent inpatient RARP. There was no significant difference in mean age (61.4 vs 65.8 years, p = 0.05), BMI (27.1 vs 28.3 kg/m2, p = 0.35), ethnicity, tobacco use (8 vs 15%, p = 0.41), PSA (8.7 vs 8.4 ng/dL, p = 0.77), biopsy Gleason score distribution, prostate size (51.8 vs 57.7 cc, p = 0.26) or preoperative hemoglobin (14.3 vs 13.4 g/dL, p = 0.06), respectively. There was no significant difference between operative time (95.3 vs 101 min, p = 0.16), EBL (52.8 vs 66.5 cc, p = 0.08), postoperative change in hemoglobin (- 1 vs - 1.1 g/dL, p = 0.62), pathologic stage distribution or complication rate (4 vs 8%, p = 0.58) between patients who underwent outpatient vs inpatient RARP, respectively. Outpatient RARP offers similar or improved perioperative outcomes when compared to inpatient RARP. We advocate outpatient RARP as a safe and feasible alternative to inpatient RARP for appropriately selected prostate cancer patients. Furthermore, we introduce an outpatient model that can be applied to other institutions seeking to implement outpatient RARP.


Subject(s)
Ambulatory Care/methods , Outpatients , Patient Safety , Prostatectomy/methods , Prostatic Neoplasms/surgery , Robotic Surgical Procedures/methods , Aged , Cohort Studies , Feasibility Studies , Humans , Inpatients , Male , Middle Aged , Retrospective Studies , Treatment Outcome
17.
J Trauma Stress ; 31(3): 401-409, 2018 06.
Article in English | MEDLINE | ID: mdl-29958337

ABSTRACT

Although effective posttraumatic stress disorder (PTSD) treatments are available, outcomes for veterans with PTSD are relatively modest. Previous researchers have identified subgroups of veterans with different response trajectories but have not investigated whether PTSD symptom clusters (based on a four-factor model) have different patterns of response to treatment. The importance of this lies in the potential to increase treatment focus on less responsive symptoms. We investigated treatment outcomes by symptom cluster for 2,685 Australian veterans with PTSD. We used Posttraumatic Stress Disorder Checklist scores obtained at treatment intake, posttreatment, and 3- and 9-month follow-ups to define change across symptom clusters. Repeated measures effect sizes indicated that arousal and numbing symptoms exhibited the largest changes between intake and posttreatment, dRM = -0.61 and dRM = -0.52, respectively, whereas avoidance and intrusion symptoms showed more modest reductions, dRM = -0.36 and dRM = -0.30, respectively. However, unlike the other symptom clusters, the intrusions cluster continued to show significant changes between posttreatment and 3-month follow-up, dRM = -0.21. Intrusion and arousal symptoms also showed continued changes between 3- and 9-month follow-ups although these effects were very small, dRM = -0.09. Growth curve model analyses produced consistent findings and indicated modest initial changes in intrusion symptoms that continued posttreatment. These findings may reflect the longer time required for emotional processing, relative to behavioral changes in avoidance, numbing, and arousal, during the program; they also reinforce the importance of prioritizing individual trauma-focused therapy directly targeting intrusions as the core component of programmatic treatment.


Subject(s)
Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapy , Veterans/psychology , Aged , Alcoholism/etiology , Anxiety/etiology , Apathy , Arousal , Australia , Avoidance Learning , Depression/etiology , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Symptom Assessment , Time Factors
18.
J Robot Surg ; 12(4): 679-685, 2018 Dec.
Article in English | MEDLINE | ID: mdl-29556868

ABSTRACT

To compare perioperative outcomes in the three most common partial nephrectomy modalities: robotic (RPN), laparoscopic (LPN), and open (OPN), matched for nephrometry scores. Patients aged 16-85 who underwent RPN, LPN, or OPN from 2007 to 2014 for localized renal carcinoma within our healthcare system were enrolled. Age, sex, body mass index, and Charlson Comorbidity Index (CCI) as well as perioperative outcomes of estimated blood loss (EBL), length of hospital stay (LOS), ischemia time (IT), change in eGFR, positive margin rate, operative time (OT), and emergency room visit rates were compared between RPN, LPN, and OPN using the R.E.N.A.L nephrometry score. A total of 862 patients underwent partial nephrectomy (523 LPN, 176 OPN, and 163 RPN). Patients who underwent OPN were significantly older, and had higher nephrometry scores and CCI. When matched for nephrometry scores, minimally invasive (LPN and RPN) compared to OPN had lower EBL (< 0.0001), shorter LOS (< 0.0001), shorter IT (< 0.001), and less change in eGFR (< 0.001), particularly in nephrometry scores higher than 8 (0.0099). Comparing RPN with LPN, RPN had significantly shorter OT in all nephrometry scores (< 0.001); shorter IT and LOS in nephrometry scores higher than 7. Our study suggests that minimally invasive partial nephrectomy may have superior outcomes to OPN when matched by nephrometry scores, particularly at higher scores and for RPN. This finding may contribute to a surgeon's decision in the approach to partial nephrectomy.


Subject(s)
Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Laparoscopy/methods , Nephrectomy/methods , Robotic Surgical Procedures/methods , Adolescent , Adult , Aged , Aged, 80 and over , Blood Loss, Surgical , Body Mass Index , Female , Glomerular Filtration Rate , Humans , Length of Stay , Male , Margins of Excision , Middle Aged , Operative Time , Severity of Illness Index , Treatment Outcome , Young Adult
19.
Cell Metab ; 27(3): 667-676.e4, 2018 03 06.
Article in English | MEDLINE | ID: mdl-29514072

ABSTRACT

The role in longevity and healthspan of nicotinamide (NAM), the physiological precursor of NAD+, is elusive. Here, we report that chronic NAM supplementation improves healthspan measures in mice without extending lifespan. Untargeted metabolite profiling of the liver and metabolic flux analysis of liver-derived cells revealed NAM-mediated improvement in glucose homeostasis in mice on a high-fat diet (HFD) that was associated with reduced hepatic steatosis and inflammation concomitant with increased glycogen deposition and flux through the pentose phosphate and glycolytic pathways. Targeted NAD metabolome analysis in liver revealed depressed expression of NAM salvage in NAM-treated mice, an effect counteracted by higher expression of de novo NAD biosynthetic enzymes. Although neither hepatic NAD+ nor NADP+ was boosted by NAM, acetylation of some SIRT1 targets was enhanced by NAM supplementation in a diet- and NAM dose-dependent manner. Collectively, our results show health improvement in NAM-supplemented HFD-fed mice in the absence of survival effects.


Subject(s)
Dietary Supplements , Healthy Aging/metabolism , Liver , NAD/metabolism , Niacinamide/pharmacology , Animals , Diet, High-Fat , Disease Models, Animal , Fatty Liver/drug therapy , Inflammation/drug therapy , Liver/drug effects , Liver/metabolism , Longevity , Mice, Inbred C57BL , Niacinamide/administration & dosage , Oxidative Stress/drug effects , Sirtuin 1/metabolism
20.
Nano Lett ; 18(3): 1842-1848, 2018 03 14.
Article in English | MEDLINE | ID: mdl-29424230

ABSTRACT

Laser pulses induce spin-selective charge flow that we show to generate dramatic changes in the magnetic structure of materials, including a switching of magnetic order from antiferromagnetic (AFM) to transient ferromagnetic (FM) in multisub-lattice systems. The microscopic mechanism underpinning this ultrafast switching of magnetic order is dominated by spin-selective charge transfer from one magnetic sublattice to another. Because this spin modulation is purely optical in nature (i.e., not mediated indirectly via the spin-orbit interaction) this is one of the fastest means of manipulating spin by light. We further demonstrate this mechanism to be universally applicable to AFM, FM, and ferri-magnets in both multilayer and bulk geometry and provide three rules that encapsulate early-time magnetization dynamics of multisub-lattice systems.

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