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1.
Cureus ; 16(4): e57603, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38707036

RESUMO

Background Chikungunya virus (CHIKV) infection poses a significant global health threat, necessitating a deeper understanding of its molecular mechanisms for effective management and treatment. This study aimed to understand the molecular and genetic mechanisms of CHIKV infection by analyzing microarray expression data. Methodology National Center for Biotechnology Information (NCBI) GEO2R with an adjusted p-value cut-off of <0.05 and |log2FC ≥ 1.5| was used to identify the differentially expressed genes involved in CHIKV infection using microarray data from the Gene Expression Omnibus (GEO) database, followed by enrichment analysis, protein-protein interaction (PPI) network construction, and, finally, hub gene identification. Results Analysis of the microarray dataset revealed 25 highly significant differentially expressed genes (DEGs), including 21 upregulated and four downregulated genes. PPI network analysis elucidated interactions among these DEGs, with hub genes such as ACTB and CTNNB1 exhibiting central roles. Enrichment analysis identified crucial pathways, including leukocyte transendothelial migration, regulation of actin cytoskeleton, and thyroid hormone signaling, implicating their involvement in CHIKV infection. Furthermore, the study highlights potential therapeutic targets such as ACTB and CTNNB1, which showed significant upregulation in infected cells. Conclusions These findings underscore the complex interplay between viral infection and host cellular processes, shedding light on novel avenues for diagnostic marker discovery and advancing antiviral strategies. In this study, we shed light on the molecular and genetic mechanisms of CHIKV infection and the potential role of ACTB and CTNNB1 genes.

2.
Pediatr Res ; 2024 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-38575692

RESUMO

BACKGROUND: Beta-thalassemia major (ß-TM) patients are more likely to experience blood glucose intolerance and to date; the blood markers that could evaluate this are debatable. So, this study aimed to assess the roles of glycated hemoglobin A1c (HbA1c) and fructosamine in evaluating glucose intolerance in children with ß-TM and figuring out role of insulin resistance in these patients. METHODS: One hundred children diagnosed with ß-TM and 100 age and sex-matched controls were enrolled. Fasting plasma glucose (FPG), 2-h post-prandial blood glucose (2-h PG), HbA1c, fructosamine, fasting insulin level (FINS), insulin resistance index (HOMA-IR), and insulin sensitivity index (HOMA-IS) were evaluated. RESULTS: FPG and 2-h PG revealed glucose intolerance in 51 patients (51%), 19 of them had diabetes mellitus. HbA1c, fructosamine, FINS, and HOMA-IR showed a high statistically significant increase in patients compared to controls, (P < 0.001). Results revealed fructosamine was more specific in detecting prediabetes state and more sensitive in identifying diabetes mellitus in our patients when compared to HbA1c. CONCLUSIONS: Despite controversies on HbA1c in children with ß-TM, it is still valuable in glucose intolerance detection. Fructosamine showed more sensitivity and specificity. Furthermore, insulin resistance was prevalent in children with ß-TM highlighting the necessity of regular glycemic state evaluation. IMPACT: Glucose intolerance is a common complication in beta thalassemia patients. Conflicting data was reported about the role of HbA1c and fructosamine in evaluating glucose intolerance in thalassemic patients. Fructosamine does not yet have a threshold that may be used to distinguish between patients who have diabetes mellitus and those who do not. Fructosamine was more specific in detecting blood glucose intolerance compared to HbA1c and was more sensitive for diagnosing diabetes mellitus. Insulin resistance was common in patients with beta-thalassemia and often present before the onset of overt diabetes.

3.
Nat Cancer ; 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38658775

RESUMO

In this prospective, interventional phase 1 study for individuals with advanced sarcoma, we infused autologous HER2-specific chimeric antigen receptor T cells (HER2 CAR T cells) after lymphodepletion with fludarabine (Flu) ± cyclophosphamide (Cy): 1 × 108 T cells per m2 after Flu (cohort A) or Flu/Cy (cohort B) and 1 × 108 CAR+ T cells per m2 after Flu/Cy (cohort C). The primary outcome was assessment of safety of one dose of HER2 CAR T cells after lymphodepletion. Determination of antitumor responses was the secondary outcome. Thirteen individuals were treated in 14 enrollments, and seven received multiple infusions. HER2 CAR T cells expanded after 19 of 21 infusions. Nine of 12 individuals in cohorts A and B developed grade 1-2 cytokine release syndrome. Two individuals in cohort C experienced dose-limiting toxicity with grade 3-4 cytokine release syndrome. Antitumor activity was observed with clinical benefit in 50% of individuals treated. The tumor samples analyzed showed spatial heterogeneity of immune cells and clustering by sarcoma type and by treatment response. Our results affirm HER2 as a CAR T cell target and demonstrate the safety of this therapeutic approach in sarcoma. ClinicalTrials.gov registration: NCT00902044 .

4.
Artigo em Inglês | MEDLINE | ID: mdl-38598642

RESUMO

PURPOSE OF REVIEW: This review is focused on diagnostic and management strategies for colonic diverticular bleeding (CDB). It aims to present the current state of the field, highlighting the available techniques, and emphasizing findings that influence the choice of therapy. RECENT FINDINGS: Recent guidelines recommend nonurgent colonoscopy (>24 h) for CDB. However, factors such as a shock index ≥1, which may warrant an urgent colonoscopy, remain under investigation.The standard approach to detecting the source of CDB requires a water-jet scope equipped with a cap. Innovative diagnostic techniques, such as the long-cap and tapered-cap, have proven effective in identifying stigmata of recent hemorrhage (SRH). Furthermore, the water or gel immersion methods may aid in managing massive hemorrhage by improving the visualization and stabilization of the bleeding site for subsequent intervention. Innovations in endoscopic hemostasis have significantly improved the management of CDB. New therapeutic methods such as endoscopic band ligation and direct clipping have substantially diminished the incidence of recurrent bleeding. Recent reports also have demonstrated the efficacy of cutting-edge techniques such as over-the-scope clips, which have significantly improved outcomes in complex cases that have historically necessitated surgical intervention. SUMMARY: Currently available endoscopic diagnostic and hemostatic methods for CDB have evolved with improved outcomes. Further research is necessary to refine the criteria for urgent colonoscopy and to confirm the effectiveness of new endoscopic hemostasis techniques.

5.
Drug Saf ; 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38478349

RESUMO

INTRODUCTION: Drug-drug interactions (DDIs) have potential to cause patient harm, including lowering therapeutic efficacy. This study aimed to (i) determine the prevalence of potential DDIs (pDDIs); clinically relevant DDIs (cDDIs), that is, DDIs that could lead to patient harm, taking into account a patient's individual clinical profile, drug effects and severity of potential harmful outcome; and subsequent actual harm among hospitalized patients and (ii) examine the impact of transitioning from paper-based medication charts to electronic medication management (eMM) on DDIs and patient harms. METHODS: This was a secondary analysis of the control arm of a controlled pre-post study. Patients were randomly selected from three Australian hospitals. Retrospective chart review was conducted before and after the implementation of an eMM system, without accompanying clinical decision support alerts for DDIs. Harm was assessed by an expert panel. RESULTS: Of 1186 patient admissions, 70.1% (n = 831) experienced a pDDI, 42.6% (n = 505) a cDDI and 0.9% (n = 11) an actual harm in hospital. Of 15,860 pDDIs identified, 27.0% (n = 4285) were classified as cDDIs. The median number of pDDIs and cDDIs per 10 drugs were 6 [interquartile range (IQR) 2-13] and 0 (IQR 0-2), respectively. In cases where a cDDI was identified, both drugs were 44% less likely to be co-administered following eMM (adjusted odds ratio 0.56, 95% confidence interval 0.46-0.73). CONCLUSION: Although most patients experienced a pDDI during their hospital stay, less than one-third of pDDIs were clinically relevant. The low prevalence of harm identified raises questions about the value of incorporating DDI decision support into systems given the potential negative impacts of DDI alerts.

6.
J Imaging ; 10(3)2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38535144

RESUMO

Chest X-ray (CXR) imaging plays a pivotal role in diagnosing various pulmonary diseases, which account for a significant portion of the global mortality rate, as recognized by the World Health Organization (WHO). Medical practitioners routinely depend on CXR images to identify anomalies and make critical clinical decisions. Dramatic improvements in super-resolution (SR) have been achieved by applying deep learning techniques. However, some SR methods are very difficult to utilize due to their low-resolution inputs and features containing abundant low-frequency information, similar to the case of X-ray image super-resolution. In this paper, we introduce an advanced deep learning-based SR approach that incorporates the innovative residual-in-residual (RIR) structure to augment the diagnostic potential of CXR imaging. Specifically, we propose forming a light network consisting of residual groups built by residual blocks, with multiple skip connections to facilitate the efficient bypassing of abundant low-frequency information through multiple skip connections. This approach allows the main network to concentrate on learning high-frequency information. In addition, we adopted the dense feature fusion within residual groups and designed high parallel residual blocks for better feature extraction. Our proposed methods exhibit superior performance compared to existing state-of-the-art (SOTA) SR methods, delivering enhanced accuracy and notable visual improvements, as evidenced by our results.

7.
J Clin Pharmacol ; 64(1): 30-44, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37565528

RESUMO

Unfractionated heparin (UFH) is a commonly used anticoagulant for pediatric patients undergoing extracorporeal membrane oxygenation (ECMO), but evidence is lacking on the ideal dosing. We aimed to (1) develop a population pharmacokinetic (PK) model for UFH, measured through anti-factor Xa assay; (2) optimize UFH starting infusions and dose titrations through simulations; and (3) explore UFH exposure-clinical outcomes relationship. Data from 218 patients admitted to Utah's Primary Children's Hospital were retrospectively collected. A 1-compartment PK model with time-varying clearance (CL) adequately described UFH PK. Weight on CL and volume of distribution and ECMO circuit change on CL were significant covariates. The typical estimates for initial CL and first-order rate constant to reach steady-state CL were 0.57 L/(h·10 kg) and 0.02/h. Comparable to non-ECMO patients, the typical steady-state CL was 0.81 L/(h·10 kg). Simulations showed that a 75 IU/kg UFH bolus dose followed by starting infusions of 25 and 20 IU/h/kg for patients aged younger than 6 years and 6 years or older, respectively, achieved the therapeutic target in 56.6% of all patients, whereas only 3.1% exceeded the target. The proposed UFH titration schemes achieved the target in more than 90% of patients while less than 0.63% were above the target after 24 and 48 hours of treatment. The median intensive care unit survival time in patients within and below the target at 24 hours was 136 and 66 hours, respectively. In conclusion, PK model of UFH was developed for pediatric patients on ECMO. The proposed UFH dosing scheme attained the anti-factor Xa target rapidly and safely.


Assuntos
Oxigenação por Membrana Extracorpórea , Heparina , Humanos , Criança , Idoso , Heparina/efeitos adversos , Estudos Retrospectivos , Anticoagulantes/efeitos adversos , Testes de Coagulação Sanguínea
8.
Hematol Oncol ; 42(1): e3222, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37740931

RESUMO

Venetoclax, a potent BCL-2 inhibitor, is currently under development for treatment of t(11;14) Multiple myeloma (MM). The objective of this research was to investigate the exposure-response relationships of venetoclax for a phase 1/2 study evaluating venetoclax monotherapy or in combination with dexamethasone in relapsed or refractory MM. A total of 117 patients receiving venetoclax at 300, 600, 800, 900, or 1200 mg were included in the analysis. The impact of venetoclax exposures on efficacy (objective response rate [ORR], progression-free survival [PFS] and overall survival [OS]) as well as safety (treatment-emergent adverse effects (grade ≥3) of neutropenia, infection, and any grade of serious treatment-emergent adverse effects) was evaluated. In the t(11;14)-positive subpopulation, venetoclax exposure relationships to PFS and OS indicated a trend of longer PFS and OS with higher exposures. Moreover, logistic regression analyses for clinical response (ORR and ≥VGPR rate) demonstrated a statistically significant (p < 0.05) relationship with exposure. Evaluation of the exposure-safety relationships demonstrated a lack of a relationship between venetoclax exposures (AUCavg ) and grade ≥3 infections, grade ≥3 neutropenia, grade ≥3 treatment-emergent adverse events or any grade serious treatment-emergent adverse events. These findings support further study of venetoclax at 800 mg QD dose in combination with dexamethasone in the t(11;14)-positive patient population where increased efficacy was observed without an increase in safety events.Clinical Trial: NCT01794520 registered 20 February 2013.


Assuntos
Compostos Bicíclicos Heterocíclicos com Pontes , Mieloma Múltiplo , Neutropenia , Sulfonamidas , Humanos , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/etiologia , Resultado do Tratamento , Biomarcadores , Neutropenia/induzido quimicamente , Dexametasona , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
9.
Br J Clin Pharmacol ; 90(3): 748-758, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-37855131

RESUMO

AIMS: Renal insufficiency is a common comorbidity in patients with haematological malignancies. This study aimed to assess how end-stage renal disease (ESRD) might affect the pharmacokinetics of venetoclax, a Bcl-2 inhibitor, in participants with ESRD undergoing haemodialysis. METHODS: Venetoclax was administered as a single 100-mg dose to 6 female participants with ESRD (estimated glomerular filtration rate <15 mL/min) both prior to haemodialysis and between haemodialysis days and 7 healthy female participants with normal renal function (estimated glomerular filtration rate >90 mL/min). Intensive pharmacokinetic and protein binding samples were collected from all participants. Arterial and venous samples were collected from ESRD participants during haemodialysis to assess the effect of haemodialysis on venetoclax pharmacokinetics. Pharmacokinetic parameters were estimated using noncompartmental methods. RESULTS: There was no difference in plasma venetoclax concentrations between arterial and venous samples, suggesting that haemodialysis did not affect the pharmacokinetics of venetoclax. The fraction unbound (fu ) of venetoclax was ~2-fold higher for participants with ESRD compared to participants with normal renal function. The unbound maximum plasma concentration and area under the plasma concentration-time curve from time 0 to 48 h were comparable between ESRD and normal function groups. The mean half-life ranged from 10.4 to 12.2 h across groups, demonstrating that ESRD did not affect the half-life of venetoclax. No new safety signals were observed during this study. CONCLUSION: ESRD and dialysis do not alter unbound venetoclax plasma concentrations. No pharmacokinetics driven dose adjustment is needed for patients with renal insufficiency.


Assuntos
Compostos Bicíclicos Heterocíclicos com Pontes , Falência Renal Crônica , Insuficiência Renal , Humanos , Feminino , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Diálise Renal , Sulfonamidas , Área Sob a Curva
10.
Surg Laparosc Endosc Percutan Tech ; 34(1): 80-86, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38134380

RESUMO

OBJECTIVE: The present study aimed to compare intraoperative and postoperative outcomes of laparoscopic-assisted distal gastrectomy versus totally laparoscopic distal gastrectomy (TLDG) Billroth I (BI) for gastric cancer and to assess the impact of the initial introduction phase of TLDG BI anastomosis. PATIENTS AND METHODS: The study analyzed the prospectively collected data of patients who underwent laparoscopic distal gastrectomy BI from 2014 to 2021 at Seoul National University Hospital. RESULTS: Among 1116 patients, laparoscopic-assisted distal gastrectomy BI was performed in 566 patients and TLDG BI was performed in 550 patients. The total laparoscopic arm had a faster mean operative time (190 vs 208 min; P < 0.001) and a shorter postoperative hospital stay (7.4 vs 7.9 d; P < 0.001). Local complications were higher in the total laparoscopic group (17.6% vs 9.9%; P = 0.008) during the early introduction phase. CONCLUSION: The total laparoscopic approach for BI reconstruction is safe and effective with faster operative time, shorter hospital stays, and less wound infection, but it may be associated with an increase in postoperative surgical complications and hospital stay in the early introduction phase.


Assuntos
Laparoscopia , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirurgia , Gastroenterostomia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Gastrectomia , Resultado do Tratamento , Estudos Retrospectivos
11.
Cureus ; 15(11): e48276, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38058350

RESUMO

Despite the established efficacy of iron chelation therapy in transfusion-induced iron-overloaded patients, there is no universal agreement regarding the choice of an optimal chelating regimen. Deferasirox (DFX) and deferiprone (DFP) are two oral iron chelators, and combination usage demonstrated effectiveness as an alternative to monotherapies in patients with a limited response to monotherapy. The present systematic review aimed to assess the evidence regarding the outcomes of combined DFP and DFX in iron-overloaded patients. An online search was conducted in PubMed, Scopus, Web of Science, and CENTRAL databases. Interventional and observational studies that assessed the outcomes of combined DFP and DFX in iron-overloaded patients were included. Eleven studies (12 reports) were considered in this meta-analysis. The studies included dual iron chelation strategies for a number of diagnoses. Single-arm studies (n =7) showed a reduction of serum ferritin, which reached the level of statistical significance in three studies. Likewise, most studies reported a numerical reduction in liver iron concentration (LIC) and increased cardiac MRI-T2* values after chelating therapy. Alternatively, comparative studies showed no significant difference in post-treatment serum ferritin between DFX plus DFP and DFX/DFP plus deferoxamine (DFO). The adherence to combination therapy was good to average in nearly 66.7-100% of the patients across four studies. One study reported a poor adherence rate. The combined regimen was generally tolerable, with no reported incidence of serious adverse events among the included studies. In conclusion, the DFP and DFX combination is a safe and feasible option for iron overload patients with a limited response to monotherapy.

13.
Pharmacoecon Open ; 7(6): 975-985, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37917310

RESUMO

INTRODUCTION: Immunocompromised (IC) adults are at increased risk of developing herpes zoster (HZ) and HZ-related complications due to therapy or underlying disease. This study evaluated the cost effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in hematopoietic stem cell transplant (HSCT) recipients and other IC adults aged ≥ 18 years in the United States (US). METHODS: A static Markov model simulated cohorts of IC individuals using a 1-year cycle length and 30-year time horizon to estimate the cost effectiveness of RZV. Inputs were sourced from clinical trial results and publicly available sources/literature. Modeled populations included US adult HSCT recipients (base case), patients with human immunodeficiency virus (HIV), patients with breast cancer, patients with Hodgkin's lymphoma, and renal transplant recipients. The model reported societal costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity and threshold analyses were conducted. RESULTS: In the base case of 19,671 US adult HSCT recipients, RZV resulted in total societal cost savings of US$0.1 million and 109 incremental QALYs versus no vaccine. RZV was a 'dominant strategy' versus no vaccine because vaccination resulted in cost savings with QALY gains. RZV was also cost saving in renal transplant recipients, and cost effective at a willingness-to-pay threshold of US$100,000 per QALY gained in patients with HIV, breast cancer, and Hodgkin's lymphoma, with ICERs of US$33,268, US$67,682, and US$95,972 per QALY gained, respectively, versus no vaccine. CONCLUSIONS: Model results show RZV is potentially cost saving for the prevention of HZ in US adult HSCT recipients and US adults with selected immunocompromising conditions, and cost effective for others, supporting the use of RZV to prevent HZ and HZ-related complications in IC adults.

14.
Open Res Eur ; 3: 8, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37886228

RESUMO

A cluster of eleven research and innovation projects, funded under the same call of the EU's H2020 programme, are developing breakthrough and game-changing renewable energy technologies that will form the backbone of the energy system by 2030 and 2050 are, at present, at an early stage of development. These projects have joined forces at a collaborative workshop, entitled ' Low-TRL Renewable Energy Technologies', at the 10th Sustainable Places Conference (SP2022), to share their insights, present their projects' progress and achievements to date, and expose their approach for exploitation and market uptake of their solutions.

15.
Endocrinol Diabetes Metab ; 6(6): e453, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37743677

RESUMO

BACKGROUND AND AIM: Low serum Vitamin D levels have been associated with diabetic nephropathy (DN). Our study aimed to analyse the serum levels of vitamin D in patients suffering from DN and the subsequent changes in serum vitamin D levels as the disease progresses. METHODS: PubMed, Embase, SCOPUS and Web of Science were searched using keywords such as '25 hydroxyvitamin D' and 'diabetic nephropathy'. We included observational studies that reported the association between the serum 25 hydroxy vitamin D levels and diabetic nephropathy without restriction to age, gender, and location. R Version 4.1.2 was used to perform the meta-analysis. The continuous outcomes were represented as mean difference (MD) and standard deviation (SD) and dichotomous outcomes as risk ratios (RR) with their 95% confidence interval (CI). RESULTS: Twenty-three studies were included in our analysis with 7722 patients. Our analysis revealed that vitamin D was significantly lower in diabetic patients with nephropathy than those without nephropathy (MD: -4.32, 95% CI: 7.91-0.74, p-value = .0228). On comparing diabetic patients suffering from normoalbuminuria, microalbuminuria, or macroalbuminuria, we found a significant difference in serum vitamin D levels across different groups. Normoalbuminuria versus microalbuminuria showed a MD of -1.69 (95% CI: -2.28 to -1.10, p-value = .0002), while microalbuminuria versus macroalbuminuria showed a MD of (3.75, 95% CI: 1.43-6.06, p-value = .0058), proving that serum vitamin D levels keep declining as the disease progresses. Notwithstanding, we detected an insignificant association between Grade 4 and Grade 5 DN (MD: 2.29, 95% CI: -2.69-7.28, p-value = .1862). CONCLUSION: Serum Vitamin D levels are lower among DN patients and keep declining as the disease progresses, suggesting its potential benefit as a prognostic marker. However, on reaching the macroalbuminuria stage (Grades 4 and 5), vitamin D is no longer a discriminating factor.


Assuntos
Diabetes Mellitus , Nefropatias Diabéticas , Humanos , Nefropatias Diabéticas/etiologia , Vitamina D , Albuminúria/etiologia
16.
RSC Adv ; 13(38): 26380-26391, 2023 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-37671342

RESUMO

The rapid increase in energy consumption around the world is the main challenge that compromises and affects the environment. Electricity generation, which mainly depends on fossil fuels, produces around 80% of CO2 emissions released into the atmosphere. Renewables are a remarkable alternative for energy production. However, they are intermittent sources of energy. Liquid air energy storage (LAES) is a medium-to large-scale energy system used to store and produce energy, and recently, it could compete with other storage systems (e.g., compressed air and pumped hydro), which have geographical constraints, affect the environment, and have a lower energy density than that of LAES. However, the low efficiency, high payback periods, and profit values of LAES hamper its commercialization. LAES is premature to be fully studied because lack of actual operating conditions and results from large plants, which affect the techno-economic predictions, in turn, affecting technology commercialization. Furthermore, the off-design conditions are not fully covered although it is a crucial step in system performance evaluation. To this end, the current mini-review sheds light on the LAES design, history, types, limitations, and the associated techno-economic analysis. In addition, state-of-the-art modelling tools are widely explained with benefits and shortage. Furthermore, LAES integration with other systems is explained widely, as it was found to boost the system performance and increase the profit with lower payback periods.

17.
Vaccine ; 41(37): 5360-5367, 2023 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-37541822

RESUMO

INTRODUCTION: Recombinant zoster vaccine (RZV) is recommended in the US for prevention of herpes zoster (HZ) in adults aged ≥50 years. Vaccination rates remain suboptimal for adults 50-59 years compared with adults ≥50 years overall. The objective of this study was to model changes in outcomes associated with improved RZV vaccination coverage in US adults 50-59 years. METHODS: A multicohort Markov model compared a scenario using real-world vaccination coverage for US adults 50-59 years in 2020 versus scenarios assuming higher coverage. Outcomes, based on a lifetime horizon, included HZ cases and complications avoided, quality-adjusted life-years (QALY), and costs. Model inputs included HZ epidemiology, RZV vaccine efficacy, coverage, adverse events, and costs, based on published literature and US sources. Some inputs were updated from previous models, including real-world estimates of RZV coverage, series completion, and reflecting longer-term data on waning of vaccine efficacy. The model utilized a cohort size of 42,756,488 individuals based on the 2020 US population census. RESULTS: The model projected that increasing RZV coverage in adults 50-59 years from 7.3 % to 14.6 % (to coverage for adults 60-64 years in 2020) would avoid an additional 504,468 HZ cases, 42,077 postherpetic neuralgia cases, and 56,247 cases of other HZ-associated complications. The increase in vaccine coverage would result in higher vaccination-related costs of $1,172,411,566, but the avoided HZ cases and complications would be expected to result in direct cost savings of $721,973,386 and indirect cost savings of $593,497,480 from avoided productivity loss. Overall, a gain of 5,230 discounted QALYs and cost savings of $143,059,299 from a societal perspective would be realized. CONCLUSION: Modestly higher RZV coverage in US adults 50-59 years could reduce the clinical burden associated with HZ and may result in societal cost savings. These findings demonstrate the potential value of increasing RZV vaccination in this population.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Neuralgia Pós-Herpética , Adulto , Humanos , Vacina contra Herpes Zoster/efeitos adversos , Análise Custo-Benefício , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Neuralgia Pós-Herpética/epidemiologia , Neuralgia Pós-Herpética/prevenção & controle , Vacinação , Vacinas Sintéticas , Herpesvirus Humano 3
18.
Sci Rep ; 13(1): 14061, 2023 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-37640716

RESUMO

In today's data-driven digital culture, there is a critical demand for optimized solutions that essentially reduce operating expenses while attempting to increase productivity. The amount of memory and processing time that can be used to process enormous volumes of data are subject to a number of limitations. This would undoubtedly be more of a problem if a dataset contained redundant and uninteresting information. For instance, many datasets contain a number of non-informative features that primarily deceive a given classification algorithm. In order to tackle this, researchers have been developing a variety of feature selection (FS) techniques that aim to eliminate unnecessary information from the raw datasets before putting them in front of a machine learning (ML) algorithm. Meta-heuristic optimization algorithms are often a solid choice to solve NP-hard problems like FS. In this study, we present a wrapper FS technique based on the sparrow search algorithm (SSA), a type of meta-heuristic. SSA is a swarm intelligence (SI) method that stands out because of its quick convergence and improved stability. SSA does have some drawbacks, like lower swarm diversity and weak exploration ability in late iterations, like the majority of SI algorithms. So, using ten chaotic maps, we try to ameliorate SSA in three ways: (i) the initial swarm generation; (ii) the substitution of two random variables in SSA; and (iii) clamping the sparrows crossing the search range. As a result, we get CSSA, a chaotic form of SSA. Extensive comparisons show CSSA to be superior in terms of swarm diversity and convergence speed in solving various representative functions from the Institute of Electrical and Electronics Engineers (IEEE) Congress on Evolutionary Computation (CEC) benchmark set. Furthermore, experimental analysis of CSSA on eighteen interdisciplinary, multi-scale ML datasets from the University of California Irvine (UCI) data repository, as well as three high-dimensional microarray datasets, demonstrates that CSSA outperforms twelve state-of-the-art algorithms in a classification task based on FS discipline. Finally, a 5%-significance-level statistical post-hoc analysis based on Wilcoxon's signed-rank test, Friedman's rank test, and Nemenyi's test confirms CSSA's significance in terms of overall fitness, classification accuracy, selected feature size, computational time, convergence trace, and stability.

19.
Aquac Nutr ; 2023: 6572421, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37398630

RESUMO

Efforts have been made to find alternatives to fish meal (FM), as the sustainability of aquaculture depends on it. Insect meal (IM) is a potential candidate to partially replace FM, being more sustainable and economically viable. In this experimental trial, three diets were tested with different yellow mealworm incorporation: a control diet with no IM, a diet with an inclusion of 10% IM (Ins10), and a diet with an incorporation of 20% IM (Ins20). The diets were tested on 10.5 g meagre for 47 days. The results showed that an IM inclusion higher than 10% affected both growth (2.6 vs. 2.2) and FCR (1.5 vs. 1.9) of meagre juveniles. However, this reduction in growth did not result from lower protein retention or changes in muscle fibre area or density. Little differences were observed in the activity of pancreatic and intestinal enzymes except for aminopeptidase total activity which was higher in the control and Ins10 compared to Ins20 (3847 vs. 3540 mU/mg protein), suggesting no limitations in protein synthesis. Also, the alkaline phosphatase intestinal maturation index was higher in the control group compared to the IM groups (437 vs. 296). On the contrary, several differences were also found in the proteolytic activity in the hepatic and muscle tissues of meagre juveniles fed the Ins10 diet. The inclusion of IM had no impact on intestine histomorphology but changes were detected in the enterocytes of fish from control and Ins10 which showed hypervacuolization and nucleus misplacement compared to the Ins20 treatment. Nevertheless, a higher percentage of Vibrionaceae was recorded for meagre fed on the Ins20 diet. Since no signs of inflammation were observed in the distal intestine, this suggests IM incorporation could have had an important impact on intestinal health due to its antimicrobial properties. This is supported by an increase in the haematocrit in the treatments where IM was added (20 to 25%). In conclusion, incorporations of IM at percentages up to 10% do not seem to have a negative impact on meagre performance at this age but can enhance the fish immune system and protection against intestinal inflammation.

20.
Micromachines (Basel) ; 14(7)2023 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-37512735

RESUMO

A uniform and highly porous reduced graphene oxide/poly-2-aminobenzene-1-thiol multi-layer (R-GO/P2ABT-ML) nanocomposite was synthesized and characterized. The uniform layer structure and porosity of the nanocomposite, combined with its conductivity, make it an ideal candidate for use as a pseudo supercapacitor. To enhance the capacitance behavior, a porous ball structure polypyrrole (PB-Ppy) was incorporated into the nanocomposite. When tested at 0.2 A/g, the capacitance values of the R-GO/P2ABT-ML and R-GO/P2ABT-ML/PB-Ppy were found to be 19.6 F/g and 92 F/g, respectively, indicating a significant increase in capacitance due to the addition of PB-Ppy. The energy density was also found to increase from 1.18 Wh.kg-1 for R-GO/P2ABT-ML to 5.43 Wh.kg-1 for R-GO/P2ABT-ML/PB-Ppy. The stability of the supercapacitor was found to be significantly enhanced by the addition of PB-Ppy. The retention coefficients at 100 and 500 charge cycles for R-GO/P2ABT-ML/PB-Ppy were 95.6% and 85.0%, respectively, compared to 89% and 71% for R-GO/P2ABT-ML without PB-Ppy. Given the low cost, mass production capability, and easy fabrication process of this pseudo capacitor, it holds great potential for commercial applications. Therefore, a prototype of this supercapacitor can be expected to be synthesized soon.

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