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1.
ArXiv ; 2024 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-39070035

RESUMEN

Magnetic Johnson noise is an important consideration for many applications involving precision magnetometry, and its significance will only increase in the future with improvements in measurement sensitivity. The fluctuation-dissipation theorem can be utilized to derive analytic expressions for magnetic Johnson noise in certain situations. But when used in conjunction with commercially available finite element analysis tools, the combined approach is particularly powerful as it provides a practical means to calculate the magnetic Johnson noise arising from conductors of arbitrary geometry and permeability. In this paper, we demonstrate this method to be one of the most comprehensive approaches presently available to calculate thermal magnetic noise. In particular, its applicability is shown to not be limited to cases where the noise is evaluated at a point in space but also can be expanded to include cases where the magnetic field detector has a more general shape, such as a finite size loop, a gradiometer, or a detector that consists of a polarized atomic species trapped in a volume. Furthermore, some physics insights gained through studies made using this method are discussed.

2.
J Neurophysiol ; 132(1): 136-146, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38863430

RESUMEN

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for Parkinson's disease, but its mechanisms of action remain unclear. Detailed multicompartment computational models of STN neurons are often used to study how DBS electric fields modulate the neurons. However, currently available STN neuron models have some limitations in their biophysical realism. In turn, the goal of this study was to update a detailed rodent STN neuron model originally developed by Gillies and Willshaw in 2006. Our design requirements consisted of explicitly representing an axon connected to the neuron and updating the ion channel distributions based on the experimental literature to match established electrophysiological features of rodent STN neurons. We found that adding an axon to the STN neuron model substantially altered its firing characteristics. We then used a genetic algorithm to optimize biophysical parameters of the model. The updated model exhibited spontaneous firing, action potential shape, hyperpolarization response, and frequency-current curve that aligned well with experimental recordings from STN neurons. Subsequently, we evaluated the general compatibility of the updated biophysics by applying them to 26 different STN neuron morphologies derived from three-dimensional anatomical reconstructions. The different morphologies affected the firing behavior of the model, but the updated biophysics were robustly capable of maintaining the desired electrophysiological features. The new STN neuron model developed in this work offers a valuable tool for studying STN neuron firing properties and may find application in simulating STN local field potentials and analyzing the effects of STN DBS.NEW & NOTEWORTHY This study presents an anatomically and biophysically realistic rodent STN neuron model. The work showcases the use of a genetic algorithm to optimize the model parameters. We noted a substantial influence of the axon on the electrophysiological characteristics of STN neurons. The updated model offers a valuable tool to investigate the firing of STN neurons and their modulation by intrinsic and/or extrinsic factors.


Asunto(s)
Potenciales de Acción , Modelos Neurológicos , Neuronas , Núcleo Subtalámico , Núcleo Subtalámico/fisiología , Núcleo Subtalámico/citología , Animales , Neuronas/fisiología , Potenciales de Acción/fisiología , Ratas , Axones/fisiología , Estimulación Encefálica Profunda
3.
Rev Sci Instrum ; 95(4)2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38573050

RESUMEN

A study of the dead layer thickness and quenching factor of a plastic scintillator for use in ultracold neutron (UCN) experiments is described. Alpha spectroscopy was used to determine the thickness of a thin surface dead layer to be 630 ± 110 nm. The relative light outputs from the decay of 241Am and Compton scattering of electrons were used to extract Birks' law coefficient, yielding a kB value of 0.087 ± 0.003 mm/MeV, consistent with some previous reports for other polystyrene-based scintillators. The results from these measurements are incorporated into the simulation to show that an energy threshold of (∼9 keV) can be achieved for the UCNProBe experiment. This low threshold enables high beta particle detection efficiency and the indirect measurement of UCN. The ability to make the scintillator deuterated, accompanied by its relatively thin dead layer, gives rise to unique applications in a wide range of UCN experiments, where it can be used to trap UCN and detect charged particles in situ.

4.
BMC Urol ; 24(1): 72, 2024 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-38532371

RESUMEN

BACKGROUND: Consolidative resection or cytoreductive radical prostatectomy (CRP) may benefit men with non-organ confined prostate cancer. We report the safety, feasibility, and outcomes of robot-assisted laparoscopic CRP using a single-port (SP) or multi-port (MP) platform. METHODS: We reviewed consecutive men with clinical node positive or metastatic castrate-sensitive prostate cancer who underwent IRB-approved CRP and extended pelvic lymph node dissection using the da Vinci SP or MP Surgical Systems (Intuitive Surgical, Sunnyvale, CA) from 2015-2022. Perioperative data and Clavien-Dindo 90-day complications were recorded. RESULTS: Twenty-four men with a median age of 61 (IQR 56-69) years and prostate-specific antigen of 32.1 (IQR 21.9-62.3) ng/mL were included. Clinical N1, M1, or N1 + M1 disease were detected in 8 (33%), 9 (38%), 7 (29%) patients, respectively. There was no difference in positive margins, 41% vs. 29% (P = 0.67), lymph node yield, 21 (IQR 14-28) vs. 20 (IQR 13.5-21) nodes (P = 0.31), or estimated blood loss, 150 mL (IQR 100-200) vs. 50 mL (IQR 50-125) (P = 0.06), between the MP and SP cohorts, respectively. Hospital length of stay was significantly shorter for the SP group, same-day discharge (IQR 0-0), compared to MP, 1-day (IQR 1-1), P < 0.001. One grade III bowel obstruction and lymphocele occurred in the MP cohort. No major complications occurred in the SP cohort. CONCLUSION: Robot-assisted laparoscopic CRP is safe and feasible for select men with advanced castrate-sensitive prostate cancer.


Asunto(s)
Neoplasias de la Próstata , Procedimientos Quirúrgicos Robotizados , Robótica , Anciano , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos de Citorreducción , Estudios de Factibilidad , Prostatectomía , Neoplasias de la Próstata/patología
5.
Int J Mol Sci ; 25(5)2024 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-38473827

RESUMEN

Alternatively spliced tissue factor (asTF) promotes the progression of pancreatic ductal adenocarcinoma (PDAC) by activating ß1-integrins on PDAC cell surfaces. hRabMab1, a first-in-class humanized inhibitory anti-asTF antibody we recently developed, can suppress PDAC primary tumor growth as a single agent. Whether hRabMab1 has the potential to suppress metastases in PDAC is unknown. Following in vivo screening of three asTF-proficient human PDAC cell lines, we chose to make use of KRAS G12V-mutant human PDAC cell line PaCa-44, which yields aggressive primary orthotopic tumors with spontaneous spread to PDAC-relevant anatomical sites, along with concomitant severe leukocytosis. The experimental design featured orthotopic tumors formed by luciferase labeled PaCa-44 cells; administration of hRabMab1 alone or in combination with gemcitabine/paclitaxel (gem/PTX); and the assessment of the treatment outcomes on the primary tumor tissue as well as systemic spread. When administered alone, hRabMab1 exhibited poor penetration of tumor tissue; however, hRabMab1 was abundant in tumor tissue when co-administered with gem/PTX, which resulted in a significant decrease in tumor cell proliferation; leukocyte infiltration; and neovascularization. Gem/PTX alone reduced primary tumor volume, but not metastatic spread; only the combination of hRabMab1 and gem/PTX significantly reduced metastatic spread. RNA-seq analysis of primary tumors showed that the addition of hRabMab1 to gem/PTX enhanced the downregulation of tubulin binding and microtubule motor activity. In the liver, hRabMab1 reduced liver metastasis as a single agent. Only the combination of hRabMab1 and gem/PTX eliminated tumor cell-induced leukocytosis. We here demonstrate for the first time that hRabMab1 may help suppress metastasis in PDAC. hRabMab1's ability to improve the efficacy of chemotherapy is significant and warrants further investigation.


Asunto(s)
Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Humanos , Tromboplastina , Gemcitabina , Anticuerpos Monoclonales Humanizados/uso terapéutico , Leucocitosis/tratamiento farmacológico , Línea Celular Tumoral , Carcinoma Ductal Pancreático/patología , Neoplasias Pancreáticas/patología , Desoxicitidina/farmacología , Paclitaxel/uso terapéutico
6.
Mov Disord ; 39(3): 539-545, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38321526

RESUMEN

BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or ventral intermediate nucleus (VIM) are established targets for the treatment of Parkinson's disease (PD) or essential tremor (ET), respectively. However, DBS of the zona incerta (ZI) can be effective for both disorders. VIM DBS is assumed to achieve its therapeutic effect via activation of the cerebellothalamic (CBT) pathway, whereas the activation of the hyperdirect (HD) pathway likely plays a role in the mechanisms of STN DBS. Interestingly, HD pathway axons also emit collaterals to the ZI and red nucleus (RN) and the CBT pathway courses nearby to the ZI. OBJECTIVE: The aim was to examine the ability of ZI DBS to mutually activate the HD and CBT pathways in a detailed computational model of human DBS. METHODS: We extended a previous model of the human HD pathway to incorporate axon collaterals to the ZI and RN. The anatomical framework of the model system also included representations of the CBT pathway and internal capsule (IC) fibers of passage. We then performed detailed biophysical simulations to quantify DBS activation of the HD, CBT, and IC pathways with electrodes located in either the STN or ZI. RESULTS: STN DBS and ZI DBS both robustly activated the HD pathway. However, STN DBS was limited by IC activation at higher stimulus amplitudes. Alternatively, ZI DBS avoided IC activation while simultaneously activating the HD and CBT pathways. CONCLUSIONS: From both neuroanatomical and biophysical perspectives, ZI DBS represents an advantageous target for coupled activation of the HD and CBT pathways. © 2024 International Parkinson and Movement Disorder Society.


Asunto(s)
Estimulación Encefálica Profunda , Temblor Esencial , Enfermedad de Parkinson , Núcleo Subtalámico , Zona Incerta , Humanos , Núcleo Subtalámico/fisiología , Enfermedad de Parkinson/terapia , Temblor Esencial/terapia
7.
Eur Urol Open Sci ; 60: 1-7, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38375345

RESUMEN

Background and objective: Approximately two-thirds of men who undergo primary treatment for prostate cancer (PC) will experience biochemical recurrence (BCR). Salvage robot-assisted radical prostatectomy (sRARP) offers curative treatment in this disease setting and men who choose this option may avoid palliative androgen deprivation therapy (ADT). The purpose of this study was to describe long-term outcomes and patient feedback following sRARP. Methods: We reviewed data for consecutive men with biopsy-proven localized BCR who underwent sRARP and pelvic lymph node dissection at a single tertiary referral center between 2004 and 2021. Perioperative data, Clavien-Dindo complications, and functional outcomes were recorded. The Kaplan-Meier method was used to estimate prostate-specific antigen-free (≥0.2 ng/ml) survival (PSAFS) and metastasis-free survival (MFS). Three Likert-type items (score 1-5) from the validated Surgical Satisfaction Questionnaire-8 were distributed to patients postoperatively. Key findings and limitations: We included 78 men, of whom 72 (92%) had undergone primary radiotherapy and six (8%) had received primary prostate ablation. Median follow-up was 10.1 yr (interquartile range 5.8-12.4). Final pathology identified ≥pT3N0M0 in 35 patients (45%) and positive margins in 23 (29%). The overall complication rate was 50%. Of the 26 (33%) major (grade ≥III) complications, anastomotic stricture (32%) was most common. The estimated 3-, 5-, and 10-yr survival rates were 85.6% and 80.2%, 83.5% for PSAFS (n = 11), and 74.1%, 83.5%, and 70.5% for MFS (n = 23), respectively. At last follow-up, postoperative ADT had been administered to 17 patients (22%), and 39 men (50%) remained alive a decade after sRARP. Continence and potency were maintained in 33/62 (53%) and 1/16 (6%) patients, respectively. Thirty-five respondents (45%) reported median questionnaire scores (≥4) in favor of sRARP. Limitations include the small single-center series and a single query point for patient feedback. Conclusions and clinical implications: Long-term outcomes of sRARP suggest that the technical challenges and morbidity of the procedure are qualified by patient feedback and the opportunity to evade the morbidity and mortality of biochemically recurrent PC. Patient summary: We reviewed the cancer outcomes and side effects of robot-assisted surgical removal of the prostate after treatment failure with radiation or ablation for prostate cancer. We found that this type of treatment has substantial risks and long-term side effects, but the surgery provides an opportunity to cure prostate cancer and/or avoid the consequences of indefinite hormonal treatment. Overall, most men who underwent this surgery were not disappointed with their decision despite the higher risks and consequences.

8.
J Pediatr Gastroenterol Nutr ; 78(1): 77-84, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38291697

RESUMEN

BACKGROUND: Clinical disease activity associated with inflammatory bowel disease (IBD) can place physical limitations on youths' activities of daily living. In turn, functional limitations potentially contribute to youths' heightened experience of IBD-induced intrusions on a wide range of routine and valued activities (i.e., illness intrusiveness), which can increase their risk for depressive symptoms. The present study examined the contributions of clinical disease activity, functional disability, and illness intrusiveness to depressive symptoms in youth with IBD. METHODS: Youth (N = 180) completed the Functional Disability Inventory (FDI), Illness Intrusiveness Scale-Child (IIS-C), and Children's Depression Inventory-2 (CDI-2). Physicians completed the Physicians Global Assessment of disease activity (PGA). RESULTS: Results revealed a mediating effect for functional disability in the association between disease activity and depressive symptoms (PGA → FDI → CDI-2); illness intrusiveness mediated the association between functional disability and depressive symptoms (i.e., FDI → IIS-C → CDI-2). Serial mediation revealed that clinical disease activity conferred an indirect effect on youth depressive symptoms through the sequential effects of functional disability and illness intrusiveness (i.e., PGA → FDI → IIS-C → CDI-2). CONCLUSIONS: Taken together, these findings indicate that youth who encounter more physical limitations as a function of clinical disease activity are more likely to experience an amplified sense of IBD-related intrusions on their ability to participate in meaningful activities. In turn, heightened illness intrusiveness increases the likelihood of depressive symptoms. Clinical interventions that help youth maintain adequate functional ability in the face of IBD disease activity and encourage involvement in positively valued activities could decrease the negative impact of IBD on youths' emotional adjustment.


Asunto(s)
Depresión , Enfermedades Inflamatorias del Intestino , Adolescente , Humanos , Niño , Depresión/etiología , Depresión/diagnóstico , Actividades Cotidianas , Enfermedades Inflamatorias del Intestino/diagnóstico , Probabilidad
9.
Urology ; 183: e325-e327, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37951362

RESUMEN

BACKGROUND: Population-based practice patterns in the United States reveal continent diversions are only performed in 8%-10.4% of patients.1-4 Ideally, for patients undergoing radical cystectomy the choice of urinary diversion should be influenced by clinical factors and patient preference, with discussions surrounding quality of life. Unfortunately, receipt of continent diversion has been shown to be influenced by a plethora of other factors such as surgeon preference/training, geography, socioeconomic status, gender, and hospital volume.1-3 Thus, by providing detailed instruction and long-term follow-up, we hope to mitigate some of these disparities by changing the perceptions regarding feasibility and complications of continent diversions. OBJECTIVE: To provide step-by-step instruction and to report long-term clinical outcomes in bladder cancer patients receiving an Indiana pouch continent cutaneous urinary diversion (CCUD) after robot-assisted radical cystectomy. DESIGN, SETTING, AND PARTICIPANTS: After Institutional Review Board approval, a prospectively maintained bladder cancer database was queried for patients with T1-T4, N0-N1, M0 bladder cancer undergoing radical cystectomy with CCUD at a tertiary referral center from 2004 to 2020. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Complications at 30- and 90-day were recorded according to the Clavien-Dindo classification. Continence rates were recorded by chart review. RESULTS AND LIMITATIONS: A total of 97 patients were included with a median follow-up of 93months. Clinically, 91.8% had ≤T2 disease and 29.9% received neoadjuvant chemotherapy. The median length of surgery was 8.0 hours, length of hospital stay was 8.3days, and urinary continence rate was 99.0%. The overall complication rate was 73.2% and 76.5% at 30- and 90-day, respectively. The major complication rate (Clavien III-V) was 17.5% at 30-day and 22.7% at 90-day. The most common major complications were abdominal infection and uretero-colonic stricture. The readmission rate was 21.4% and median overall survival was 108months. CONCLUSION: CCUD provides exceptional functional outcomes with acceptable complication rates compared to other diversion types. CCUD is a reliable reconstructive option and with this step-by-step video as a reference, we hope it will be offered to more patients.


Asunto(s)
Procedimientos Quirúrgicos Robotizados , Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Humanos , Cistectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Calidad de Vida , Derivación Urinaria/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/complicaciones , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología
10.
IEEE Trans Biomed Eng ; 71(1): 307-317, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37535481

RESUMEN

OBJECTIVE: Biophysical models of neural stimulation are a valuable approach to explaining the mechanisms of neuronal recruitment via applied extracellular electric fields. Typically, the applied electric field is estimated via a macroscopic finite element method solution and then applied to cable models as an extracellular voltage source. However, the field resolution is limited by the finite element size (typically 10's-100's of times greater than average neuronal cross-section). As a result, induced charges deposited onto anatomically realistic curved membrane interfaces are not taken into consideration. However, these details may alter estimates of the applied electric field and predictions of neural tissue activation. METHODS: To estimate microscopic variations of the electric field, data for intra-axonal space segmented from 3D scanning electron microscopy of the mouse brain genu of corpus callosum were used. The boundary element fast multipole method was applied to accurately compute the extracellular solution. Neuronal recruitment was then estimated via an activating function. RESULTS: Taking the physical structure of the arbor into account generally predicts higher values of the activating function. The relative integral 2-norm difference is 90% on average when the entire axonal arbor is present. A large fraction of this difference might be due to the axonal body itself. When an isolated physical axon is considered with all other axons removed, the relative integral 2-norm difference between the single-axon solution and the complete solution is 25% on average. CONCLUSION: Our result may provide an explanation as to why Deep Brain Stimulation experiments typically predict lower activation thresholds than commonly used FEM/Cable model approaches to predicting neuronal responses to extracellular electrical stimulation. SIGNIFICANCE: These results may change methods for bi-domain neural modeling and neural excitation.


Asunto(s)
Axones , Neuronas , Animales , Ratones , Axones/fisiología , Neuronas/fisiología , Estimulación Eléctrica/métodos , Modelos Neurológicos
11.
J Neural Eng ; 20(4)2023 07 19.
Artículo en Inglés | MEDLINE | ID: mdl-37429285

RESUMEN

Objective.The motor hyperdirect pathway (HDP) is a key target in the treatment of Parkinson's disease with deep brain stimulation (DBS). Biophysical models of HDP DBS have been used to explore the mechanisms of stimulation. Built upon finite element method volume conductor solutions, such models are limited by a resolution mismatch, where the volume conductor is modeled at the macro scale, while the neural elements are at the micro scale. New techniques are needed to better integrate volume conductor models with neuron models.Approach.We simulated subthalamic DBS of the human HDP using finely meshed axon models to calculate surface charge deposition on insulting membranes of nonmyelinated axons. We converted the corresponding double layer extracellular problem to a single layer problem and applied the well-conditioned charge-based boundary element fast multipole method (BEM-FMM) with unconstrained numerical spatial resolution. Commonly used simplified estimations of membrane depolarization were compared with more realistic solutions.Main result.Neither centerline potential nor estimates of axon recruitment were impacted by the estimation method used except at axon bifurcations and hemispherical terminations. Local estimates of axon polarization were often much higher at bifurcations and terminations than at any other place along the axon and terminal arbor. Local average estimates of terminal electric field are higher by 10%-20%.Significance. Biophysical models of action potential initiation in the HDP suggest that axon terminations are often the lowest threshold elements for activation. The results of this study reinforce that hypothesis and suggest that this phenomenon is even more pronounced than previously realized.


Asunto(s)
Estimulación Encefálica Profunda , Enfermedad de Parkinson , Núcleo Subtalámico , Humanos , Núcleo Subtalámico/fisiología , Estimulación Encefálica Profunda/métodos , Axones/fisiología , Neuronas/fisiología , Enfermedad de Parkinson/terapia
12.
AJNR Am J Neuroradiol ; 44(8): 951-958, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-37414455

RESUMEN

BACKGROUND AND PURPOSE: Traumatic brachial plexus injuries are uncommon but can be debilitating. Early diagnosis is critical. Most patients undergo CT after trauma. We sought to identify correlative CT findings of supraclavicular brachial plexus injuries to discern who may require further evaluation with MR imaging and to measure multireviewer performance for their interpretations. MATERIALS AND METHODS: We identified all MR imaging examinations of the brachial plexus from our institution from January 2010 to January 2021 and included those performed for trauma. We excluded patients with penetrating or infraclavicular injuries and without preceding CTA of the neck or CT of the cervical spine. The cohort of 36 cases and 50 controls remained for analysis and were assessed for 6 findings: scalene muscle edema/enlargement, interscalene fat pad effacement, first rib fracture, cervical spine lateral mass/transverse process fracture, extra-axial cervical spinal hemorrhage, and cervical spinal cord eccentricity, forming a reference key. A resident physician and 2 neuroradiologists (blinded to the MR imaging) independently reviewed each CT scan for these findings. We measured agreement (Cohen κ) between observers and against the reference key. RESULTS: Interscalene fat pad effacement (sensitivity, specificity, 94.44%, 90.00%; OR = 130.33; P < .001) and scalene muscle edema/enlargement (sensitivity, specificity, 94.44%, 88.00%; OR = 153.00; P < .001) correlated significantly with brachial plexus injury. Agreement between observers and the key was almost perfect for those findings and fractures (pooled κ ≥ 0.84; P < .001). Agreement between observers was variable (κ = 0.48-0.97; P < .001). CONCLUSIONS: CT can accurately predict brachial plexus injuries, potentially enabling earlier definitive evaluation. High interobserver agreement suggests that findings are consistently learned and applied.


Asunto(s)
Plexo Braquial , Heridas no Penetrantes , Humanos , Estudios Retrospectivos , Plexo Braquial/diagnóstico por imagen , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Vértebras Cervicales/lesiones
13.
BMC Gastroenterol ; 23(1): 65, 2023 Mar 09.
Artículo en Inglés | MEDLINE | ID: mdl-36894870

RESUMEN

BACKGROUND: Current quantitative approaches to assess chronic liver disease (CLD) severity have limitations. Further, portal vein thrombosis (PVT) pre-liver transplant (LT) is a major contributor to morbidity in CLD; the means of detecting and/or predicting PVT are limited. We sought to explore whether plasma coagulation factor activity levels can serve as a substitute for prothrombin time/international normalized ratio (PT/INR) in the Model for End-stage Liver Disease (MELD), and/or help assess the risk of PVT. METHODS: Plasma activity levels of Factor V (FV), Factor VIII (FVIII), Protein C (PC), and Protein S (PS) and the concentrations of D-dimer, sP-selectin, and asTF were assessed in two cohorts of CLD patients (ambulatory, n = 42; LT, n = 43). RESULTS: FV and PC activity levels strongly correlated with MELD scores, which enabled the development of a novel scoring system based on multiple linear regressions of the correlations of FV and PC activity with MELD-Na that substitutes PT/INR. Six-month and 1-year follow-up revealed that our novel approach was non-inferior to MELD-Na at predicting mortality. A significant inverse correlation between FVIII activity levels and PVT was found in the LT cohort (p = 0.010); FV and PS activity levels were in-trend (p = 0.069, p = 0.064). We developed a logistic regression-based compensation score to identify patients at risk of PVT. CONCLUSIONS: We demonstrate that FV and PC activity levels may be used to replace PT/INR in MELD scoring. We also show the potential of using the combination of FV, FVIII, and PS activity levels to assess the risk of PVT in CLD.


Asunto(s)
Enfermedad Hepática en Estado Terminal , Hepatopatías , Trombosis de la Vena , Humanos , Vena Porta/patología , Cirrosis Hepática , Enfermedad Hepática en Estado Terminal/complicaciones , Enfermedad Hepática en Estado Terminal/cirugía , Índice de Severidad de la Enfermedad , Hepatopatías/complicaciones , Hepatopatías/patología , Factores de Coagulación Sanguínea/metabolismo , Trombosis de la Vena/diagnóstico
14.
Artículo en Inglés | MEDLINE | ID: mdl-36968188

RESUMEN

The long-term impact of prekindergarten programs is an important consideration given the trend of dedicating more resources to these programs. However, long-term impact of prekindergarten programs is not well-understood and recent studies have shown preschool effectiveness can vary across states and programs. A state run prekindergarten program in New Mexico was examined using propensity score matching to minimize selection bias. The research revealed a number of long-term impacts corresponding with prekindergarten participation for the cohort including a 9.7 percentage point increase in high school graduation rates and improved reading and math proficiency at third, sixth, and eighth grades. Considerations for future research and challenges in implementing prekindergarten programs are discussed.

15.
J Pediatr Psychol ; 48(4): 386-395, 2023 04 20.
Artículo en Inglés | MEDLINE | ID: mdl-36728708

RESUMEN

OBJECTIVE: Illness uncertainty is a salient experience for caregivers of children with disorders/differences of sex development (DSD) presenting with ambiguous genitalia; however, no validated measure of illness uncertainty exists for this unique population. Thus, the current study aimed to preliminarily identify the factor structure of the Parental Perception of Uncertainty Scale (PPUS) in caregivers of children with DSD presenting with ambiguous genitalia and examine the convergent validity of the PPUS. METHODS: Participants included 115 caregivers (Mage = 32.12 years, SD = 6.54; 57% mothers) of children (<2-year-olds) diagnosed with DSD participating in a larger, longitudinal study. Caregivers completed the PPUS as well as self-report measures of anxious, depressive, and posttraumatic stress symptoms. An exploratory factor analysis was conducted. RESULTS: Exploratory factor analysis results indicated that a 23-item 1-factor solution was the most parsimonious and theoretically sound factor structure (α = 0.92). Convergent validity analyses demonstrated further support for the use of the 23-item 1-factor solution over the original PPUS factor structure. CONCLUSION: These results demonstrate the preliminary clinical and research utility of the PPUS with caregivers of children with DSD presenting with ambiguous genitalia. The PPUS may benefit from further refinement through qualitative research and item adaptation to capture uncertainties unique to DSD presenting with ambiguous genitalia. In addition, future research should replicate the proposed factor structure using confirmatory factor analysis with a separate, larger sample of caregivers of children with DSD to confirm the factor structure.


Asunto(s)
Trastornos del Desarrollo Sexual , Femenino , Humanos , Niño , Preescolar , Incertidumbre , Estudios Longitudinales , Trastornos del Desarrollo Sexual/diagnóstico , Ansiedad/diagnóstico , Padres
16.
Sensors (Basel) ; 23(3)2023 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-36772407

RESUMEN

Long-wave infrared (LWIR) emissions of laser-induced plasma on solid potassium chloride and acetaminophen tablet surfaces were studied using both a one-dimensional (1-D) linear array detection system and, for the first time, a two-dimensional (2-D) focal plane array (FPA) detection system. Both atomic and molecular infrared emitters in the vicinity of the plasma were identified by analyzing the detected spectral signatures in the infrared region. Time- and space-resolved long-wave infrared emissions were also studied to assess the temporal and spatial behaviors of atomic and molecular emitters in the plasma. These pioneer temporal and spatial investigations of infrared emissions from laser-induced plasma would be valuable to the modeling of plasma evolutions and the advances of the novel LWIR laser-induced breakdown spectroscopy (LIBS). When integrated both temporally (≥200 µs) and spatially using a 2-D FPA detector, the observed intensities and signal-to-noise-ratio (SNR) of single-shot LWIR LIBS signature emissions from intact molecules were considerably enhanced (e.g., with enhancement factors up to 16 and 3.76, respectively, for a 6.62 µm band of acetaminophen molecules) and, in general, comparable to those from the atomic emitters. Pairing LWIR LIBS with conventional ultraviolet-visible-near infrared (UV/Vis/NIR) LIBS, a simultaneous UV/Vis/NIR + LWIR LIBS detection system promises unprecedented capability of in situ, real-time, and stand-off investigation of both atomic and molecular target compositions to detect and characterize a range of chemistries.

17.
Brain Struct Funct ; 228(2): 353-365, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36708394

RESUMEN

The hyperdirect pathway (HDP) represents the main glutamatergic input to the subthalamic nucleus (STN), through which the motor and prefrontal cerebral cortex can modulate basal ganglia activity. Further, direct activation of the motor HDP is thought to be an important component of therapeutic deep brain stimulation (DBS), mediating the disruption of pathological oscillations. Alternatively, unintended recruitment of the prefrontal HDP may partly explain some cognitive side effects of DBS therapy. Previous work describing the HDP has focused on non-human primate (NHP) histological pathway tracings, diffusion-weighted MRI analysis of human white matter, and electrophysiology studies involving paired cortical recordings with DBS. However, none of these approaches alone yields a complete understanding of the complexities of the HDP. As such, we propose that generative modeling methods hold promise to bridge anatomy and physiology results, from both NHPs and humans, into a more detailed representation of the human HDP. Nonetheless, numerous features of the HDP remain to be experimentally described before model-based methods can simulate corticosubthalamic activity with a high degree of scientific detail. Therefore, the goals of this review are to examine the experimental evidence for HDP projections from across the primate neocortex and discuss new data which are required to improve the utility of anatomical and biophysical models of the human corticosubthalamic system.


Asunto(s)
Estimulación Encefálica Profunda , Neocórtex , Núcleo Subtalámico , Animales , Humanos , Estimulación Encefálica Profunda/métodos , Ganglios Basales , Primates
18.
J Psychosom Res ; 164: 111095, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-36495755

RESUMEN

OBJECTIVE: Illness stigma, or perceived stigma related to a chronic health condition, is pervasive among youth with inflammatory bowel disease (IBD). However, no studies exist examining the psychometric properties of illness stigma measures in this population. Using a modified version of the Child Stigma Scale originally developed for youth with epilepsy, the current study investigated the factor structure and validity of this adapted measure (i.e., Stigma Scale - Child; SS-C) in youth with IBD. METHODS: Factor analyses were conducted to determine the most parsimonious factor structure for the adapted 8-item Stigma Scale - Child in a sample of 180 youth with IBD. Correlations were conducted to assess convergent validity, and a multiple regression was conducted to further evaluate the measure's predictive validity of child depressive symptoms. RESULTS: The most parsimonious model for the SS-C is a one-factor solution with an error covariance between the two items assessing concealment/disclosure of IBD diagnosis. CONCLUSIONS: The SS-C is a psychometrically sound illness stigma measure in pediatric IBD that demonstrates strong convergent validity with psychosocial adjustment factors such as thwarted belongingness, illness uncertainty, and illness intrusiveness, as well as strong predictive validity with youth depressive symptoms. The SS-C is a viable option for use as a brief screener in youth with IBD across clinical and research settings.


Asunto(s)
Enfermedades Inflamatorias del Intestino , Adolescente , Humanos , Niño , Enfermedades Inflamatorias del Intestino/psicología , Estigma Social , Revelación , Psicometría , Análisis Factorial , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
19.
J Clin Psychol Med Settings ; 30(1): 238-247, 2023 03.
Artículo en Inglés | MEDLINE | ID: mdl-35668287

RESUMEN

Inflammatory bowel disease (IBD) presents physical and emotional challenges for families and imposes significant lifestyle intrusions on both youth and parents. The present study examined the effects of IBD disease activity and youth illness intrusiveness on depressive symptoms in adolescents, and the moderating influence of parent illness intrusiveness on these associations. Adolescents and parents completed measures of illness intrusiveness; youth completed a measure of depressive symptoms. Physicians provided estimates of IBD disease activity. Mediation analysis revealed an IBD disease activity → youth intrusiveness → youth depressive symptoms indirect effect. Moderated mediation analyses revealed this indirect effect to be greater among youth whose parents endorsed more IBD-related intrusions. Youth encountering greater activity disruptions related to IBD are vulnerable to depressive symptoms. When parents also experience IBD-induced intrusions, youth are at even greater risk for depressive symptoms. Clinical implications are discussed within the context of youths' and parents' experiences of IBD.


Asunto(s)
Depresión , Enfermedades Inflamatorias del Intestino , Humanos , Adolescente , Depresión/complicaciones , Depresión/psicología , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/psicología , Emociones , Padres/psicología , Índice de Severidad de la Enfermedad
20.
J Am Coll Health ; 71(4): 1167-1174, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-34242532

RESUMEN

OBJECTIVE: To examine the relative contribution of transition readiness (i.e., healthcare self-management) to health-related quality of life (HRQoL) among emerging adult (EA) college students without a chronic medical condition (CMC).Participants: College students (n = 2372; Mage = 19.32, SD = 1.26) from a Midwestern university.Methods: Participants completed online measures of demographics, HRQoL, and transition readiness.Results: Hierarchical regression analyses found transition readiness accounted an additional 3-4% of the variability in mental and physical HRQoL (p < .001), beyond demographic factors. 11.3% of EAs reported overall mastery of transition readiness, with navigating health insurance being the weakest area.Conclusions: Findings support the consensus that transition readiness is relevant to HRQoL for all EAs, including those without a CMC. EAs without a CMC demonstrate relatively weak transition readiness skills. Primary and university-based healthcare might consider programs supporting transition readiness and HRQoL among underresourced EAs.


Asunto(s)
Calidad de Vida , Transición a la Atención de Adultos , Humanos , Adulto , Estudiantes , Universidades , Enfermedad Crónica , Encuestas y Cuestionarios
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