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1.
Artículo en Inglés | MEDLINE | ID: mdl-32360237

RESUMEN

PURPOSE: Tongue cancer is often associated with pain and perineural invasion. The purpose of the present study was to determine the association between tongue pain and otalgia and the microscopic identification of perineural invasion (PNI) in patients with squamous cell carcinoma of the tongue (SCCOT). PATIENTS AND METHODS: A retrospective cohort study was performed of patients with a diagnosis of SCCOT from January 2013 through June 2019. Patients without a history of head and neck cancer, who had SCCOT diagnosed and treated surgically by a single surgeon, were included in the present study. The primary predictor variables were tongue pain and otalgia (presence vs absence of both). Other variables included patient demographic data and TNM stage. The primary outcome variable was the histologic presence of PNI. A χ2 analysis was performed to test for any significant associations between pain, T stage, and overall stage in relation to PNI outcome. Multivariate logistic regression analysis was used to control for cancer staging variables when testing the association between pain and PNI. RESULTS: The sample included 128 subjects, of whom 76 were men. Their mean age was 60 years. Most patients (n = 97; 75.8%) complained of tongue pain and a few (n = 50; 39.1%) complained of otalgia. The patients with otalgia had a 3.15 times greater odds of PNI when controlling for T stage (P = .016) and 3.68 times greater odds of PNI when controlling for overall stage (P = .007). Increasing T stage and overall stage-with the exception of stage II-were also significantly associated with PNI (P ≤ .05). CONCLUSIONS: Our study has demonstrated a statistically significant association between preoperative otalgia and PNI in a consecutive group of patients presenting with newly diagnosed SCCOT.

2.
Artículo en Inglés | MEDLINE | ID: mdl-32353259

RESUMEN

PURPOSE: Prophylactic tracheotomy has traditionally been performed during composite mandibular resection of oral cavity cancer to avoid postoperative airway compromise. The purpose of the present study was to measure the frequency and identify the factors associated with an increased or a decreased risk of an adverse airway event (AAE) within 30 days postoperatively. PATIENTS AND METHODS: A retrospective cohort study of patients who had undergone composite mandibular resection for oral cancer from 2006 to 2018 was conducted at the University of Tennessee Medical Center. The primary predictor variable was composite resection with or without immediate flap reconstruction. The primary outcome variable was realization of a 30-day AAE, defined as the requirement for tracheotomy for any reason, emergent endotracheal reintubation at any time during the postoperative admission, or prolonged (>48 hours) postoperative endotracheal intubation. The secondary outcome variable was the inpatient length of stay. Descriptive and bivariate statistics were used to compare the patients with and without an AAE for demographic, confounding, and clinical characteristics. RESULTS: A total of 114 patients were identified through retrospective medical record review. The prevalence of AAEs in the sample was 8.8% (10 of 114). None of the 49 patients without immediate flap reconstruction developed an AAE. Of the 65 patients who had undergone flap reconstruction, 10 (15.4%) developed an AAE. The χ2 analysis revealed a significantly greater rate of AAEs when flap reconstruction was implemented (P < .05). Also, a significantly greater rate of AAEs was found in the group requiring resection of the floor of the mouth with bilateral neck dissections and immediate flap reconstruction compared with all other flap reconstruction groups (P < .05). CONCLUSIONS: A composite resection involving the floor of the mouth with bilateral neck dissection and flap reconstruction should receive strong consideration for prophylactic tracheotomy to avoid an AAE.

3.
J Perinatol ; 2020 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-32424335

RESUMEN

OBJECTIVE: To compare clonidine versus phenobarbital as adjunctive therapy in infants who failed monotherapy with morphine for neonatal abstinence syndrome (NAS). STUDY DESIGN: Prospective, randomized, open-label study of infants ≥ 35 weeks' gestation. Infants received clonidine or phenobarbital per protocol. Primary outcome was morphine treatment days. Secondary outcomes were inpatient adjunctive days, length of stay (LOS), triple therapy, safety, and readmission rates. RESULTS: A total of 25 infants were treated with clonidine (n = 14) or phenobarbital (n = 11). Mean morphine treatment duration was significantly longer with clonidine (34.4 days, SD = 10.6) compared with phenobarbital (25.5 days, SD = 7.3, p = 0.026). The clonidine group also had higher inpatient adjunctive days (mean: 33.8 days [SD = 14.3] vs. 22 days [SD = 12.6], p = 0.042) and LOS (mean: 41.8 days [SD = 10.9] vs. 31 days [SD = 10]; p = 0.018) compared with phenobarbital. CONCLUSIONS: Phenobarbital, as adjunctive therapy, led to significantly shorter duration of morphine therapy, inpatient adjunctive days, and length of stay compared with clonidine.

4.
Surgeon ; 2020 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-32340800

RESUMEN

BACKGROUND: and Purpose: Currently, dexmedetomidine versus propofol has primarily been studied in medical and cardiac surgery patients with outcomes indicating safe and effective sedation. The purpose of this study was to assess the efficacy of dexmedetomidine versus propofol for prolonged sedation in trauma and surgical patients. METHODS: This was a single-center prospective study conducted in the Trauma/Surgical Intensive Care Unit (ICU) at a Level I academic trauma center. It included patients 18 years of age or older requiring mechanical ventilation who were randomly assigned based on unit bed location to receive either dexmedetomidine or propofol. The primary outcome was duration of mechanical ventilation. Secondary outcomes included mortality; proportion of time in target sedation; incidence of delirium, hypotension, and bradycardia; and ICU and hospital length of stay (LOS). RESULTS: A total of 57 patients were included. Baseline characteristics were similar between groups. There was no significant difference in duration of mechanical ventilation (median [IQR]) between the dexmedetomidine (78.5[125] hours) and propofol (105[130] hours; p = 0.15) groups. There was no difference between groups in ICU mortality, ICU and hospital LOS, or incidence of delirium. Safety outcomes were also similar. Patients in the dexmedetomidine group spent a significantly greater percentage of time in target sedation (98[8] %) compared to propofol group (92[10] %; p = 0.02). CONCLUSIONS: Our results suggest that, similar to medical and cardiac surgery patients, dexmedetomidine and propofol are safe and effective sedation agents in critically ill trauma and surgical patients; however, dexmedetomidine achieves target sedation better than propofol for this specific population.

5.
Adv Mind Body Med ; 34(1): 8-16, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32277749

RESUMEN

Context: Mortality associated with cardiovascular disease is significantly higher in African Americans compared with people of other ethnicities, with hypertension being the single most significant risk factor in this population. Underdiagnosis and undertreatment of hypertension is common. Although cardiovascular lifestyle education and self-management programs are available for the general public, many African Americans prefer to learn about health-promoting activities through interactive programs led by church ministries. Objective: This study examined the influence of adding a faith-based protocol using creative musical expression as a catalyst for improving retention, engagement, and positive health outcomes for African Americans participating in a 1-y, lifestyle skills program for reducing cardiovascular risk factors. Design: The study was a randomized, controlled trial. Setting: The study occurred at Rodman Street Missionary Baptist Church (Pittsburgh, PA, USA). Participants: Participants were African Americans with at least 2 of the following medical conditions: high blood pressure, elevated cholesterol and/or triglycerides, heart attack, angina, stroke, irregular heartbeats, palpitations, shortness of breath, dizziness or fainting, diabetes, and tobacco use. Intervention: Intervention and control groups both participated every other week in one 45-min structured cardiovascular risk reduction educational session over the course of 1 year. During alternative weeks, sessions comprised blood pressure checks, coupled with individualized support discussions focused on challenges and identified obstacles to adherence. In addition to the aforementioned sessions, the intervention group participated in a novel gospel music program with weekly, 45-minute vocal and instrumental sessions. Outcome Measures: Outcome measures include retention, attendance, systolic and diastolic blood pressures, weight, body mass index, hip measurement, and waist measurement as well as the Short Form-12 (SH-12) Health Survey. Results: Subjects in the intervention group demonstrated a statistically significant 83.3% retention rate in the course of 1 year compared with only 54.3% for the control group (cardiovascular lifestyle education sessions alone). Six dropouts were noted in the intervention group in sharp contrast to 16 dropouts in the control group. Participants in the intervention group were 4.21 times more likely to complete the program than the control group. A significant difference was also noted for attendance, which was higher for the intervention group (21.33 sessions for the intervention group vs 17.95 sessions for the control group). Statistically significant systolic blood pressure reductions noted in both groups were sustained 6 mo postprogram conclusion. In addition, a statistically significant pre-between post-between group improvement in SF-12 Physical Component Scores was noted for intervention subjects in sharp contrast with controls who actually demonstrated worsening scores. Conclusions: The addition of a gospel music program as a catalyst for increase engagement in a sustainable, healthy lifestyle program warrants further consideration and additional study in African American churches.

6.
Can J Vet Res ; 84(2): 131-137, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32255908

RESUMEN

Photobiomodulation is an accepted regenerative medicine treatment modality used to stimulate tissue repair, mediate inflammation, and improve mobility in humans and animals. The objective of this study was to assess the influence of laser power and wavelength, coat length and color, and shaving on in-vivo photon delivery by therapeutic laser in dogs. Forty-seven dogs of various breeds and coat colors (17 black, 15 brown, and 15 white) and with varying coat lengths were assessed with 2 commercially available veterinary lasers. Photons were delivered to the lateral aspect of the inguinal fold and calcaneal tendon, with direct penetration through the dermis, as well as dermis and tendon, as measured with a thermopile laser sensor. Significant impacts on laser transmission were noted for laser power (P = 0.001), wavelength (P < 0.002), coat color (P < 0.001), and shaved coat (P < 0.001). Percent transmission was higher for a class IV 810/980 nm wavelength laser at 0.5 W than for a class IIIb 904 nm laser (P < 0.001). There was a significant difference between transmission of photons among white, brown, and black coats, with less transmission noted with increasing coat pigment (P < 0.001). Transmission was greater at higher power levels (3 W, 5 W) Results showed significant differences in laser transmission for all variables assessed, with the exception of coat length, which was not a significant predictor of laser transmission. As transmission was significantly reduced in darker and unshaved areas, higher power lasers may be necessary for darker pigmented dogs and shaving of hair is recommended before laser therapy.

7.
Surgeon ; 2020 Mar 23.
Artículo en Inglés | MEDLINE | ID: mdl-32213291

RESUMEN

BACKGROUND: Delirium is common in patients admitted to the surgical trauma intensive care unit (ICU), and the risk factors for these patients differ from medical patients. Given the morbidity and mortality associated with delirium, efforts to prevent it may improve patient outcomes, but previous efforts pharmacologically have been limited by side effects and insignificant results. We hypothesized that scheduled quetiapine could reduce the incidence of delirium in this population. METHODS: The study included 71 adult patients who were at high-risk for the development of delirium (PRE-DELIRIC Score ≥50%, history of dementia, alcohol misuse, or drug abuse). Patients were randomized to receive quetiapine 12.5 mg every 12 h for delirium or no pharmacologic prophylaxis within 48 h of admission to the ICU. The primary end point was the incidence of delirium during admission to the ICU. Secondary end points included time to onset of delirium, ICU and hospital length of stay (LOS), ICU and hospital mortality, duration of mechanical ventilation, and adverse events. RESULTS: The incidence of delirium during admission to the ICU was 45.5% (10/22) in the quetiapine group and 77.6% (38/49) in the group that did not receive pharmacological prophylaxis. The mean time to onset of delirium was 1.4 days for those who did not receive prophylaxis versus 2.5 days for those who did (p = 0.06). The quetiapine group significantly reduced ventilator duration from 8.2 days to 1.5 days (p = 0.002). CONCLUSIONS: The findings suggested that scheduled, low-dose quetiapine is effective in preventing delirium in high-risk, surgical trauma ICU patients.

8.
Nurs Health Sci ; 2019 Nov 18.
Artículo en Inglés | MEDLINE | ID: mdl-31736225

RESUMEN

The purpose of this study was to report a secondary analysis of data collected through a primary study. The primary study was a, randomized, control trial that used a team-designed (nursing, speech language hearing, engineering, communication sciences, and biostatistics), nurse-led, electronic communication intervention (Speak for Myself Voice) and measured patient outcomes of symptoms of anxiety and depression in five intensive care units at a regional, magnet-status, academic medical center. A secondary analysis of data using the Hospital Anxiety and Depression scale is reported here. The extant literature supports patient expressions of frustration, anger, anxiety, and depression when unable to communicate. This secondary analysis study report adds information about Hospital Anxiety and Depression subscales in the communication-vulnerable population. Implications include emerging awareness of potential feelings of depression and anxiety in patients who are receiving mechanical ventilation or who are unable to verbally communicate for any reason (e.g. obstruction, trauma, head and neck cancer) in the intensive care unit.

9.
Open Forum Infect Dis ; 6(6): ofz220, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31211161

RESUMEN

Background: Acute decompensated heart failure (ADHF) can be confused with other conditions that cause dyspnea. Patients with ADHF are often simultaneously treated for community-acquired pneumonia (CAP), even when evidence for infection is lacking. We hypothesized that the fluid and sodium content of potentially unnecessary intravenous antibiotic (IVAB) therapy could worsen outcomes of ADHF patients. Methods: We reviewed 144 ADHF patients at low risk of pneumonia based on diagnostic findings and clinical documentation. The primary end point was length of stay. Secondary outcomes were mortality, readmission rates, amount of diuretic received, and fluid volume and quantity of sodium administered as part of IVAB therapy. Results: Of the 144 admissions reviewed, 88 did not and 56 did receive IVAB. IVAB-treated patients received an average of 1.7 L of additional fluid (230 mL/d) and 9311 mg of additional sodium (1381 mg/d) as a result of IVAB therapy. Length of stay was longer in the IVAB arm (6.6 days) compared with the no-IVAB arm (3.0 days; P < .001). Patients required more furosemide in the IVAB arm (930 mg) compared with the no-IVAB arm (320 mg; P < .001). Patients who received IVAB were also 2.51 times more likely to be readmitted compared with patients who did not receive IVAB (P = .04). Conclusions: ADHF patients who received IVAB without evidence of infection had longer lengths of stay, required more diuretics, and were more likely to be readmitted compared with ADHF patients not exposed to IVAB. ADHF patients are a promising target of antibiotic stewardship interventions.

11.
Am J Pathol ; 189(5): 989-998, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30735627

RESUMEN

Light chain-associated amyloidosis is characterized by the extracellular deposition of amyloid fibrils in abdominothoracic organs, skin, soft tissue, and peripheral nerves. Phagocytic cells of the innate immune system appear to be ineffective at clearing the material; however, human light chain amyloid extract, injected subcutaneously into mice, is rapidly cleared in a process that requires neutrophil activity. To better elucidate the phagocytosis of light chain fibrils, a potential method of cell-mediated dissolution, amyloid-like fibrils were labeled with the pH-sensitive dye pHrodo red and a near infrared fluorophore. After injecting this material subcutaneously in mice, optical imaging was used to quantitatively monitor phagocytosis and dissolution of fibrils concurrently. Histologic evaluation of the residual fibril masses revealed the presence of CD68+, F4/80+, ionized calcium binding adaptor molecule 1- macrophages containing Congo red-stained fibrils as well as neutrophil-associated proteins with no evidence of intact neutrophils. These data suggest an early infiltration of neutrophils, followed by extensive phagocytosis of the light chain fibrils by macrophages, leading to dissolution of the mass. Optical imaging of this novel murine model, coupled with histologic evaluation, can be used to study the cellular mechanisms underlying dissolution of synthetic amyloid-like fibrils and human amyloid extracts. In addition, it may serve as a test bed to evaluate investigational opsonizing agents that might serve as therapeutic agents for light chain-associated amyloidosis.


Asunto(s)
Amiloide/fisiología , Amiloidosis/patología , Macrófagos/fisiología , Imagen Óptica/métodos , Fagocitosis , Animales , Femenino , Macrófagos/citología , Ratones
12.
Infect Dis Ther ; 8(1): 113-118, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30673991

RESUMEN

INTRODUCTION: The microbial epidemiology differs between infective endocarditis (IE) patients with and without a history of injection drug use. We set out to determine the prevalence and microbial epidemiology of infective endocarditis in our region, the Southeastern USA, to determine if any changes need to be made in empiric antimicrobial treatment. METHODS: The electronic medical record was reviewed for patients with IE between January 2013 and July 2017, which revealed 299 cases. The cases were then sorted between patients with and without a history of injection drug use. The growth of their initial set of blood cultures and side of cardiac involvement were then recorded. Statistical analyses were run on the data sets. RESULTS: There were statistically significant effects associated with both methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas species infections occurring more often in individuals with active injection drug use, while streptococcus and enterococcus infections were more likely to occur in the population of individuals who do not inject drugs. CONCLUSION: In IE patients who use or are suspected of injection drug use, first-line broad-spectrum antibiotics with excellent MRSA and Pseudomonas coverage are essential.

13.
Rehabil Nurs ; 44(4): 230-235, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-29794570

RESUMEN

PURPOSE: This study reports the findings of a study about sensation-seeking or high-risk/challenging sports in persons who have disabilities. DESIGN: Exploratory, cross-sectional, and descriptive. METHODS: Two hundred and twenty-three recruitment e-mails were sent to potential participants. Data were collected through Qualtrics. FINDINGS: Mean score for Contextual Sensation Seeking Questionnaire for Skiing and Snowboarding (M = 30.21, SD = 8.18) was significantly lower than a sample of able-bodied skiers and snowboarders, t(239) = 2.75, p = .006. Mean for impulsive sensation seeking was lower than the same sample of able-bodied athletes cited in a previous study, t(240) = 4.56, p = .001. Means for the Zuckerman Kuhlman Personality Questionnaire subscales were impulsivity (M = 1.98, SD = 4.05) and sensation seeking (M = 6.75, SD = 2.68). CONCLUSIONS: This group scored lower in sensation seeking compared to able-bodied high-risk/challenging sports activities participants. Sensation seeking is not a motivating factor in this sample. CLINICAL RELEVANCE: Nurses could encourage rehabilitation patients to engage in challenging activities for personal and group mastery.


Asunto(s)
Personas con Discapacidad/psicología , Asunción de Riesgos , Adulto , Ciclismo/psicología , Estudios Transversales , Personas con Discapacidad/rehabilitación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Motivación , Participación del Paciente/psicología , Esquí/psicología , Encuestas y Cuestionarios , Deportes Acuáticos/psicología
14.
Proc Natl Acad Sci U S A ; 115(46): E10839-E10848, 2018 11 13.
Artículo en Inglés | MEDLINE | ID: mdl-30377267

RESUMEN

Amyloidosis is a malignant pathology associated with the formation of proteinaceous amyloid fibrils that deposit in organs and tissues, leading to dysfunction and severe morbidity. More than 25 proteins have been identified as components of amyloid, but the most common form of systemic amyloidosis is associated with the deposition of amyloid composed of Ig light chains (AL). Clinical management of amyloidosis focuses on reducing synthesis of the amyloid precursor protein. However, recently, passive immunotherapy using amyloid fibril-reactive antibodies, such as 11-1F4, to remove amyloid from organs has been shown to be effective at restoring organ function in patients with AL amyloidosis. However, 11-1F4 does not bind amyloid in all AL patients, as evidenced by PET/CT imaging, nor does it efficiently bind the many other forms of amyloid. To enhance the reactivity and expand the utility of the 11-1F4 mAb as an amyloid immunotherapeutic, we have developed a pretargeting "peptope" comprising a multiamyloid-reactive peptide, p5+14, fused to a high-affinity peptide epitope recognized by 11-1F4. The peptope, known as p66, bound the 11-1F4 mAb in vitro with subnanomolar efficiency, exhibited multiamyloid reactivity in vitro and, using tissue biodistribution and SPECT imaging, colocalized with amyloid deposits in a mouse model of systemic serum amyloid A amyloidosis. Pretreatment with the peptope induced 11-1F4 mAb accumulation in serum amyloid A deposits in vivo and enhanced 11-1F4-mediated dissolution of a human AL amyloid extract implanted in mice.


Asunto(s)
Amiloidosis/metabolismo , Amiloidosis/terapia , Anticuerpos Monoclonales/fisiología , Amiloide/metabolismo , Proteínas Amiloidogénicas/metabolismo , Animales , Anticuerpos Biespecíficos/inmunología , Anticuerpos Monoclonales/inmunología , Cadáver , Epítopos/metabolismo , Humanos , Cadenas Ligeras de Inmunoglobulina/inmunología , Ratones , Péptidos/metabolismo , Tomografía Computarizada por Tomografía de Emisión de Positrones , Unión Proteica , Proteína Amiloide A Sérica/metabolismo , Distribución Tisular , Resultado del Tratamiento
15.
Am Surg ; 84(7): 1240-1245, 2018 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-30064596

RESUMEN

A multimodality approach to enhance recovery after bowel surgery is demonstrated to reduce complications and decrease patient length of stay (LOS). This study evaluates the factors that influence patient LOS within a formal enhanced recovery protocol. From January 2014 to December 2016, all consecutive patients admitted to one ward, who had undergone bowel resection and were enrolled in an enhanced recovery protocol, were evaluated prospectively. We entered every patient's data into the American College of Surgeons Risk Calculator (ACSRC) to compare predicted versus actual outcomes. Statistical analysis of clinical factors, patient participation, and outcomes compared with the overall LOS was performed. Of 670 bowel resections performed during the study period, a total of 127 (19%) patients met the criteria and were analyzed for comorbidities, type of surgery, complications, and participation in recovery protocols. The median length of stay (mLOS) for all patients was 4.0 days (1.8-24.6 days). Factors influencing mLOS included laparoscopic versus open surgery (P = 0.006), COPD (P = 0.003), missing 24 hours of ambulation (P < 0.001), use of patient-controlled analgesia (P = 0.011), and diagnosis of insulin-dependent diabetes mellitus (P = 0.041). Increasing the use of morphine equivalents (MEs) increased mLOS beyond the ACSRC estimate (P = 0.003). Developing a major complication increased mLOS by 8.5 times the ACSRC estimate. CONCLUSION: A multimodality approach to enhance surgical recovery after bowel surgery decreases the LOS. The surgical approach, participation in ambulation, insulin-dependent diabetes mellitus, and COPD influenced the overall LOS. Increasing use of morphine equivalents and developing a complication increased mLOS beyond the ACSRC preoperative risk estimates.


Asunto(s)
Colectomía , Procedimientos Quirúrgicos Electivos , Laparoscopía , Tiempo de Internación , Adulto , Anciano , Anciano de 80 o más Años , Colectomía/métodos , Conversión a Cirugía Abierta , Procedimientos Quirúrgicos Electivos/métodos , Femenino , Adhesión a Directriz , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
16.
Obstet Gynecol ; 131(4): 696-699, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29528934

RESUMEN

OBJECTIVE: To assess whether there was a significant trend in the number of women as first, last, and coauthors in two U.S. journals of obstetrics and gynecology over the past 15 years and to assess whether this publication rate was commensurate with the percentage of women in the academic specialty. METHODS: This retrospective study identified the gender of first and last authors of original research articles for the years 2000, 2005, 2010, and 2015. We determined trends in publication rates of authorship and coauthorship by pairing the gender of the first and last authors. We selected a subset of the data to compare the percentages of women authors with MDs at U.S. academic institutions with the nationally reported percentages of women faculty in the specialty. RESULTS: The journals yielded 2,699 articles for analysis. The percentage of articles written by women as first authors increased from 37% in 2000 to 71% in 2015 and, as last authors, increased from 26% in 2000 to 49% in 2015. Paired as coauthors, women published at a rate of 11% in 2000 to 38% in 2015. The analysis of a subset of 1,621 articles showed that as first authors, women published at a rate equal to or above the percentage of women in academics, but as last authors published fewer articles than expected. CONCLUSION: Women published more articles over time, kept pace or exceeded their faculty percentages as first authors, lagged behind these percentages as last authors, and as coauthors eventually surpassed the publication rate of male coauthors.


Asunto(s)
Autoria , Publicaciones Periódicas como Asunto/tendencias , Médicos Mujeres/estadística & datos numéricos , Bibliometría , Femenino , Ginecología , Humanos , Masculino , Obstetricia , Publicaciones Periódicas como Asunto/estadística & datos numéricos , Estudios Retrospectivos , Factores Sexuales , Estados Unidos
17.
Amyloid ; 25(2): 93-100, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29571269

RESUMEN

INTRODUCTION: Multiple myeloma (MM) and light chain monoclonal gammopathy of undetermined significance (LCMGUS) are plasma cell disorders associated with the secretion of monoclonal free light-chain (LC) proteins. Due to the high concentrations of LC in circulation, both of these populations are at risk for developing LC-associated amyloidosis (AL) - a protein misfolding disease characterized by the deposition of LC protein fibrils in organs and tissues, leading to dysfunction and significant morbidity. At present, accurate identification of subjects at risk for developing amyloidosis is not possible, but with the advent of novel, amyloid-targeted therapies, identification of pre-symptomatic individuals is of clinical import. METHODS: To address this, a competition assay has been developed to discern LC proteins with enhanced amyloidogenic potential. Numerous factors that may influence the efficacy of the assay have been evaluated to yield optimal conditions. RESULTS: Using a panel of nine patient-derived LC, we have demonstrated that amyloid-associated LC inhibited the recruitment of a biotinyl-λ6 variable domain by homologous amyloid-like fibrils significantly more than MM LC (p < .01). CONCLUSION: The assay accurately discriminated AL from MM patient populations, suggesting that it may aid in the identification of patients with monoclonal gammopathies who have an increased risk of developing amyloidosis.


Asunto(s)
Bioensayo/métodos , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/diagnóstico , Mieloma Múltiple/diagnóstico , Paraproteinemias/diagnóstico , Proteínas Amiloidogénicas/metabolismo , Humanos , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/metabolismo , Mieloma Múltiple/metabolismo , Paraproteinemias/metabolismo
18.
Issues Ment Health Nurs ; 39(6): 482-489, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29446661

RESUMEN

The Appalachian South is disproportionately affected by HIV/AIDS. Partly due to the negative connotation that this disease carries in religiously conservative areas, HIV-related stigma remains a critical barrier to HIV care in the South. However, spirituality is a well-documented, effective coping mechanism among persons living with HIV/AIDS (PLWH). The purpose of this study was to examine the relationship between HIV-related stigma and spiritual well-being among a sample of PLWH (n = 216) in Appalachian counties of Tennessee and Alabama using the HIV Stigma Scale and the Spiritual Well-being Scale. Overall, disclosure of HIV status was the most highly reported stigma concern. Women reported higher levels of stigma and religious well-being than men. While existential well-being was negatively correlated with stigma, no significant overall correlation was found between religious well-being and stigma. Our findings reveal the importance of defining theology and differentiating between cultural religious conditioning and internalized beliefs.


Asunto(s)
Infecciones por VIH/psicología , Estigma Social , Espiritualidad , Adaptación Psicológica , Adolescente , Adulto , Anciano , Alabama , Región de los Apalaches , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tennessee , Adulto Joven
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