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1.
Yonsei Med J ; 61(5): 431-437, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32390367

RESUMO

Although some information on the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and a few selected cases has been reported, data on the clinical characteristics and outcomes of patients hospitalized therewith in South Korea are lacking. We conducted a retrospective single-center study of 98 consecutive hospitalized patients with confirmed SARS-CoV-2 infection at Yeungnam University Medical Center in Daegu, South Korea. Sixty patients were women (61.2%), and the mean age was 55.4±17.1 years. Thirteen patients (13.3%) were treated in the intensive care unit (ICU). The mean interval from symptom onset to hospitalization was 7.7±4.5 days. Patients who received ICU care were significantly older and were more likely to have diabetes mellitus. The National Early Warning Score on the day of admission was significantly higher in patients requiring ICU care. Acute respiratory distress syndrome (13/13 patients; 100%), septic shock (9/13; 69.2%), acute cardiac injury (9/13; 69.2%), and acute kidney injury (8/13; 61.5%) were more common in patients who received ICU care. All patients received antibiotic therapy, and most (97/98 patients; 99.0%) received antiviral therapy (lopinavir/ritonavir). Hydroxychloroquine was used in 79 patients (80.6%), and glucocorticoid therapy was used in 18 patients (18.4%). In complete blood counts, lymphopenia was the most common finding (40/98 patients; 40.8%). Levels of all proinflammatory cytokines were significantly higher in ICU patients. As of March 29, 2020, the mortality rate was 5.1%. Here, we report the clinical characteristics and laboratory findings of SARS-CoV-2 patients in South Korea up to March 29, 2020.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/patologia , Citocinas/sangue , Combinação de Medicamentos , Feminino , Humanos , Hidroxicloroquina/administração & dosagem , Unidades de Terapia Intensiva , Lopinavir/administração & dosagem , Linfopenia/virologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/patologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Ritonavir/administração & dosagem
2.
J Korean Med Sci ; 35(17): e118, 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32356419

RESUMO

BACKGROUND: Medical professionals who experience patient safety incidents (PSIs) are vulnerable to emotional pain and other difficulties; such individuals are referred to as "second victims." This study quantitatively examines the characteristics of physicians' experiences of PSIs, along with the consequent difficulties and levels of post-traumatic stress disorder (PTSD), and post-traumatic embitterment disorder (PTED) regarding the events. METHODS: An anonymous, self-report online survey was administered to physicians. This collected information regarding PSI characteristics (e.g., type, severity of harm) and impact (e.g., sleep disorder, consideration of career change), as well as participants' socio-demographic characteristics. Meanwhile, to quantitatively assess PSI impacts, PTSD and PTED scales were also administered. PSI characteristics and impacts were analyzed using frequency analysis, and the differing effects of indirect and direct PSI experience regarding consequent difficulties were analyzed using chi-square tests. Factors associated with PTSD and PTED scores were identified using linear regression. RESULTS: Of 895 physicians, 24.6% and 24.0% experienced PSI-induced sleep disorder and eating disorder, respectively. Moreover, 38.9% reported being overly cautious in subsequent similar situations, and 12.6% had considered changing jobs or career. Sleep disorder was significantly more common among participants who directly experienced a PSI (32.8%) than among those with indirect experience (15.3%; P < 0.001). Linear regression showed that indirectly involved physicians had a lower mean PTSD score (by 8.44; 95% confidence interval, -12.28 to -4.60) than directly involved physicians. CONCLUSION: This study found that many physicians experience PSI-induced physical symptoms and behavioral responses, and that the severity of these symptoms varies depending on the type of incident and degree of harm involved. Our findings can provoke more active discussion regarding programs for supporting second victims, and can also encourage the establishing of a system for addressing PSIs that have already occurred, such as through disclosure of PSIs.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32429488

RESUMO

Current medical school education focuses on acquiring appropriate knowledge with relatively little interest in developing the career selection skills of medical students. We investigated medical students' perceptions of career problems and the required types of career counseling programs. Five focus group discussions were held with 23 medical students. The consensual qualitative study method was used to analyze the recorded discussion process. The medical students were more influenced by parents and grades than by subjective choices when deciding on admission to medical school. In future career choices, medical students considered the stability and feasibility of the career and expected quality of life. However, there were several opinions that it is essential to understand oneself. Objective and specific career information was lacking, and meeting with the professor was not very helpful for career counseling. Most medical students expected the effectiveness of the career counseling program but hoped the program would proceed with voluntary participation. Medical students wanted a variety of concrete and objective information, such as specialty information for choosing residency training, trainee hospital information, and post-residency training information in the career counseling program. Most medical students are not ready for career-related problems, therefore making it necessary to develop a career counseling program suitable for them.

4.
Diabetes Metab J ; 44(2): 349-353, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32347027

RESUMO

Since the first case was contracted by coronavirus disease-19 (COVID-19) in Daegu, Korea in February 2020, about 6,800 cases and 130 deaths have been reported on April 9, 2020. Recent studies have reported that patients with diabetes showed higher mortality and they had a worse prognosis than the group without diabetes. In poorly controlled patients with diabetes, acute hyperglycemic crises such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) also might be precipitated by COVID-19. Thus, intensive monitoring and aggressive supportive care should be needed to inadequately controlled patients with diabetes and COVID-19 infection. Here, we report two cases of severe COVID-19 patients with acute hyperglycemic crises in Korea.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Coma Hiperglicêmico Hiperosmolar não Cetótico/etiologia , Pneumonia Viral/complicações , Idoso , Glicemia/análise , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico
5.
Nat Commun ; 11(1): 1860, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-32312952

RESUMO

Ependymal cells (ECs) are multiciliated neuroepithelial cells that line the ventricles of the brain and the central canal of the spinal cord (SC). How ependymal motile cilia are maintained remains largely unexplored. Here we show that zebrafish embryos deficient in Wnt signaling have defective motile cilia, yet harbor intact basal bodies. With respect to maintenance of ependymal motile cilia, plcδ3a is a target gene of Wnt signaling. Lack of Connexin43 (Cx43), especially its channel function, decreases motile cilia and intercellular Ca2+ wave (ICW) propagation. Genetic ablation of cx43 in zebrafish and mice diminished motile cilia. Finally, Cx43 is also expressed in ECs of the human SC. Taken together, our findings indicate that gap junction mediated ICWs play an important role in the maintenance of ependymal motile cilia, and suggest that the enhancement of functional gap junctions by pharmacological or genetic manipulations may be adopted to ameliorate motile ciliopathy.

6.
Kidney Int ; 97(5): 980-994, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32143848

RESUMO

Tissue-resident macrophages have unique tissue-specific functions in maintaining homeostasis and resolving inflammation. However, the repair role and relevant molecules of kidney-resident macrophages after ischemic injury remain unresolved. To this end, mice without kidney-resident R1 macrophages but containing infiltrating monocyte-derived R2 macrophages were generated using differential cellular kinetics following clodronate liposome treatment. When ischemia-reperfusion injury was induced in these mice, late phase repair was reduced. Transcriptomic and flow cytometric analyses identified that V-domain Ig suppressor of T cell activation (VISTA), an inhibitory immune checkpoint molecule, was constitutively expressed in kidney-resident R1 macrophages, but not in other tissue-resident macrophages. Here, VISTA functioned as a scavenger of apoptotic cells and served as a checkpoint to control kidney-infiltrating T cells upon T cell receptor-mediated stimulation. Together these functions improved the repair process after ischemia-reperfusion injury. CD14+ CD33+ mononuclear phagocytes of human kidney also expressed VISTA, which has similar functions to the mouse counterpart. Thus, VISTA is upregulated in kidney macrophages in a tissue-dependent manner and plays a repair role during ischemic injury.

7.
Front Immunol ; 11: 68, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32117240

RESUMO

Uncontrolled activation of transforming growth factor (TGF)-ß results in a wide range of pathologic conditions. Therapeutic interventions to regulate TGF-ß signaling during fibrosis have been developed but the effectiveness is still limited. Here, we show that developmental endothelial locus-1 (Del-1) ameliorates fibrosis in mice by inhibiting αv integrin-mediated activation of TGF-ß. Del-1 bound to αvß6 integrin, an important activator of TGF-ß, and inhibited the binding of αvß6 integrin to the latency-associated peptide (LAP), thereby suppressing αv integrin-mediated activation of TGF-ß. Lack of Del-1 increased colocalization of αv integrin and LAP in the lungs, which was reversed by Del-1 supplementation. The crucial role of Del-1 in regulating TGF-ß activity was recapitulated in a mouse model of fibrosis using an adenovirus expressing inactive TGF-ß1. Del-1 supplementation improved the pathological characteristics of the mice and reduced mortality. Thus, we propose that Del-1 is a negative regulator of TGF-ß activation and a potential anti-fibrotic factor.

8.
J Patient Saf ; 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32195782

RESUMO

OBJECTIVE: The study aimed to investigate the impacts of patient safety incident (PSI) experienced by the general public. METHODS: We conducted a self-administered online survey, in which we examined the following experiences of the patients and the caregivers: the level of harm induced by PSIs, difficulties due to PSIs, posttraumatic stress disorder (PTSD), and posttraumatic embitterment disorder, etc. A χ test was performed to identify differences in difficulties because of the direct and indirect experience of PSIs. A 1-way analysis of variance was performed to identify the differences in the total PTSD and posttraumatic embitterment disorder scores according to the characteristics of PSIs. RESULTS: Of the survey participants who indirectly experienced PSIs, 27.2% and 29.3% reported that they experienced sleep disorder and eating disorder, respectively. However, of the participants who directly experienced PSIs, 40.7% and 42.6% reported experiencing sleep disorder and eating disorder, respectively. The average PTSD scores of the participants who experienced permanent disability and death were 83.8 points for less than 6 months of elapsed time since the incident, 80.8 points for 6 months to less than 5 years, and 94.7 points for 5 years or more; they did not demonstrate a statistically significant difference (P = 0.217). CONCLUSIONS: This study suggested that the general public who experienced PSIs have numerous difficulties at the time of the incident and the trauma or the resentment of the general public does not quickly regress even if time passes.

9.
Invest Ophthalmol Vis Sci ; 61(3): 4, 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-32150245

RESUMO

Purpose: To investigate the clinical significance of the changes in the macular microvasculature in patients with diabetes mellitus type 2 without diabetic retinopathy. Methods: Fifty-five patients with diabetes mellitus type 2 without diabetic retinopathy and 48 healthy individuals were enrolled in a prospective cross-sectional study. We identified the changes of optical coherence tomography angiography parameters (foveal avascular zone [FAZ] area and circularity, vessel density, and perfusion index) of the 6 × 6-mm macular scan. Correlation and multiple regression analyses were performed between optical coherence tomography angiography parameters and previously known diabetes mellitus type 2-related demographic and systemic characteristics, and serum biochemical markers. Results: FAZ parameters and perfusion index of the superficial and deep vascular plexus showed significant correlation with serum insulin level, and homeostasis model assessment indices. In multiple linear regression analysis, low insulin levels predicted increased FAZ areas in both the superficial (ß = -0.007; P = 0.030) and deep layers (ß = -0.010; P = 0.018) and a decreased perfusion index in the deep layer (ß = 0.003; P = 0.001). Conclusions: The expansion and loss of circularity of the FAZ and the decrease in the perfusion index may be affected by insulin resistance and secretory capacity in patients with diabetes mellitus type 2 with no diabetic retinopathy.

10.
J Patient Saf ; 16(1): 84-89, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32106177

RESUMO

OBJECTIVES: Many countries and organizations have promoted the disclosure of patient safety incidents (DPSI). However, reporting frequency and quality of DPSI fall short of patient and caregiver' expectations. In this study, we examined the attitudes toward DPSI of the general public representing the Korean population. METHODS: Survey questions were developed based on a previous systematic review and qualitative research. Face-to-face interviews using paper-based questionnaires were conducted. We explored attitudes toward DPSI in various scenarios and opinions on methods to facilitate DPSI. RESULTS: Almost all participants answered that it is necessary to disclose major errors (99.9%) and near misses (93.3%). A total of 96.6% (675/699) agreed that "DPSI will lead physicians to pay more attention to patient safety in the future," and 94.1% (658/699) agreed that "DPSI will make patients and their caregivers trust the physician more." Although 79.7% (558/700) agreed that "apology law will limit patients' ability to prove physicians' negligence," 95.4% (668/700) agreed with "I support the introduction of apology law." Moreover, 90.6% (634/700) agreed with "I support the introduction of mandatory DPSI." CONCLUSIONS: This study showed the overwhelmingly positive attitude of the public toward DPSI. The positive opinion of the public about apology law suggests the possibility of introducing the disclosure policy coupled with legislation of apology law in South Korea.

11.
Eur J Nutr ; 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32055962

RESUMO

PURPOSE: Growing evidence shows that nutrient metabolism affects inflammatory bowel diseases (IBD) development. Previously, we showed that deficiency of indoleamine 2,3-dioxygenase 1 (Ido1), a tryptophan-catabolizing enzyme, reduced the severity of dextran sulfate sodium (DSS)-induced colitis in mice. However, the roles played by intestinal microbiota in generating the differences in disease progression between Ido1+/+ and Ido1-/- mice are unknown. Therefore, we aimed to investigate the interactions between the intestinal microbiome and host IDO1 in governing intestinal inflammatory responses. METHODS: Microbial 16s rRNA sequencing was conducted in Ido1+/+ and Ido1-/- mice after DSS treatment. Bacteria-derived tryptophan metabolites were measured in urine. Transcriptome analysis revealed the effects of the metabolite and IDO1 expression in HCT116 cells. Colitis severity of Ido1+/+ was compared to Ido1-/- mice following fecal microbiota transplantation (FMT). RESULTS: Microbiome analysis through 16S-rRNA gene sequencing showed that IDO1 deficiency increased intestinal bacteria that use tryptophan preferentially to produce indolic compounds. Urinary excretion of 3-indoxyl sulfate, a metabolized form of gut bacteria-derived indole, was significantly higher in Ido1-/- than in Ido1+/+ mice. Transcriptome analysis showed that tight junction transcripts were significantly increased by indole treatment in HCT116 cells; however, the effects were diminished by IDO1 overexpression. Using FMT experiments, we demonstrated that bacteria from Ido1-/- mice could directly attenuate the severity of DSS-induced colitis. CONCLUSIONS: Our results provide evidence that a genetic defect in utilizing tryptophan affects intestinal microbiota profiles, altering microbial metabolites, and colitis development. This suggests that the host and intestinal microbiota communicate through shared nutrient metabolic networks.

12.
Br J Ophthalmol ; 2020 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-32071035

RESUMO

BACKGROUND/AIMS: To evaluate the age-related risk of steroid-induced ocular hypertension by analysing intraocular pressure (IOP) changes after intravitreal dexamethasone (DEX, Ozurdex) implant injection. METHODS: A retrospective observational study was conducted among patients (n=455; 570 eyes) who had received DEX injection. IOP was measured prior to injection and after 1 week and 1, 2, 3, 6 and 12 months. Results were divided into seven categories based on patient age: 16-30, 31-40, 41-50, 51-60, 61-70, 71-80 and 81-90 years. The IOP elevation rate was compared among the groups. RESULTS: The IOP elevation rate was 42.9% in patients aged ≤30 years (35.3%, 28.3%, 14.9%, 12.2%, 8.4% and 9.1% in the 31-40, 41-50, 51-60, 61-70, 71-80 and 81-90 groups, respectively). Regardless of how IOP was measured, there was an increasing trend in the incidence of IOP elevation with decreasing age. Furthermore, there was a significant stepwise increase in the OR with decreasing age groups. After the 51-60 group was set as the reference point, the ORs (95% CIs) were 5.048 (1.436 to 17.747), 3.671 (1.101 to 12.238), 2.538 (1.043 to 6.178), 0.947 (0.431 to 2.078), 0.713 (0.312 to 1.626) and 0.646 (0.137 to 3.048) in the ≤30, 31-40, 41-50, 61-70, 71-80 and 81-90 groups, respectively. CONCLUSION: The rate of adverse elevations in IOP after steroid use was significantly lower in older patients than in younger patients. Therefore, caution is required when prescribing steroids to younger patients (<51 years).

13.
Invest Ophthalmol Vis Sci ; 61(1): 3, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31995154

RESUMO

Purpose: The purpose of this study was to investigate the expression of death ligands in the lacrimal glands (LGs), identify upstream factors that regulate their expression, and determine the functional roles of these factors in the pathogenesis of dry eye disease (DED). Methods: For DED experiment, ex vivo coculture system with LG and in vivo murine model using a controlled environment chamber were utilized. C57BL/6 mice and hypoxia-inducible factor (HIF)-1α conditional knockout (CKO) mice were used. Immunohistochemical staining, polymerase chain reaction, and immunoblotting were performed to determine levels of death ligands including tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) in DED-induced LGs. Additionally, acinar cell and CD45+ cell apoptosis was determined with neutralizing TRAIL treatment. Results: Desiccating stress significantly increased HIF-1α expression in LG-acinar cells. Furthermore, HIF-1α deficiency significantly enhanced the infiltration of CD45+ inflammatory cells in LG and induced LG-acinar cell death. Meanwhile, only TRAIL expression was increased in DED-LG, but abrogated in HIF-1α CKO. Interestingly, the main source of TRAIL was the CD45- LG-acinar cells, but not CD45+ immune cells after DED induction. Using ex vivo coculture system, we confirmed LG-induced apoptosis of immune cells via HIF-1α-mediated TRAIL secretion following DED. Consistent with ex vivo, the insufficiency of HIF-1α and TRAIL enhanced recruitment of inflammatory cells to the LG and subsequently exacerbated ocular surface damage in DED mice. Conclusions: Our findings offer novel insight into the regulatory function of acinar cell-derived TRAIL in limiting inflammatory damage and could be implicated in the development of potential therapeutic strategies for DED.


Assuntos
Dacriocistite/metabolismo , Síndromes do Olho Seco/metabolismo , Regulação da Expressão Gênica/fisiologia , Subunidade alfa do Fator 1 Induzível por Hipóxia/fisiologia , Aparelho Lacrimal/metabolismo , Ligante Indutor de Apoptose Relacionado a TNF/genética , Animais , Apoptose , Técnicas de Cocultura , Dacriocistite/patologia , Modelos Animais de Doenças , Síndromes do Olho Seco/patologia , Ensaio de Imunoadsorção Enzimática , Citometria de Fluxo , Immunoblotting , Marcação In Situ das Extremidades Cortadas , Aparelho Lacrimal/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Técnicas de Cultura de Órgãos , Reação em Cadeia da Polimerase em Tempo Real
14.
Artigo em Inglês | MEDLINE | ID: mdl-31893329

RESUMO

This study investigates whether immigrant status is a risk factor for developing dementia and having undiagnosed dementia, as well as the role of limited English proficiency (LEP) as a mediator in the association. Data were drawn from the 2011 wave of the National Health and Aging Trends Study. The sample consisted of 7385 adults aged 65 years and older (6567 U.S.-born and 818 foreign-born). Step-wise logistic regression analyses were performed. Older immigrants had 70% greater odds of having dementia compared to U.S.-born participants. Among those with dementia (n = 1920), older immigrants showed 119% higher odds of being undiagnosed compared to the U.S.-born. Mediation analyses showed that the total effects of immigrant status on dementia and undiagnosed dementia explained by LEP were 87.6% and 56.1%, respectively. It is important to tailor dementia education and interventions to the immigrant population with LEP.

15.
Gut ; 69(2): 283-294, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31471351

RESUMO

OBJECTIVE: Cerebral amyloidosis and severe tauopathy in the brain are key pathological features of Alzheimer's disease (AD). Despite a strong influence of the intestinal microbiota on AD, the causal relationship between the gut microbiota and AD pathophysiology is still elusive. DESIGN: Using a recently developed AD-like pathology with amyloid and neurofibrillary tangles (ADLPAPT) transgenic mouse model of AD, which shows amyloid plaques, neurofibrillary tangles and reactive gliosis in their brains along with memory deficits, we examined the impact of the gut microbiota on AD pathogenesis. RESULTS: Composition of the gut microbiota in ADLPAPT mice differed from that of healthy wild-type (WT) mice. Besides, ADLPAPT mice showed a loss of epithelial barrier integrity and chronic intestinal and systemic inflammation. Both frequent transfer and transplantation of the faecal microbiota from WT mice into ADLPAPT mice ameliorated the formation of amyloid ß plaques and neurofibrillary tangles, glial reactivity and cognitive impairment. Additionally, the faecal microbiota transfer reversed abnormalities in the colonic expression of genes related to intestinal macrophage activity and the circulating blood inflammatory monocytes in the ADLPAPT recipient mice. CONCLUSION: These results indicate that microbiota-mediated intestinal and systemic immune aberrations contribute to the pathogenesis of AD in ADLPAPT mice, providing new insights into the relationship between the gut (colonic gene expression, gut permeability), blood (blood immune cell population) and brain (pathology) axis and AD (memory deficits). Thus, restoring gut microbial homeostasis may have beneficial effects on AD treatment.


Assuntos
Doença de Alzheimer/microbiologia , Doença de Alzheimer/terapia , Transplante de Microbiota Fecal , Microbioma Gastrointestinal/fisiologia , Doença de Alzheimer/metabolismo , Animais , Comportamento Animal , Doença Crônica , Modelos Animais de Doenças , Humanos , Inflamação/microbiologia , Intestinos/microbiologia , Memória de Curto Prazo , Camundongos Transgênicos , Permeabilidade , Placa Amiloide/microbiologia , Placa Amiloide/patologia , Aprendizagem Espacial , Proteínas tau/análise
16.
Gerontologist ; 60(2): 250-258, 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-31618436

RESUMO

BACKGROUND AND OBJECTIVES: In response to the dearth of information on cognitive health in older ethnic minorities, in the present study, we examined factors associated with self-rated cognitive health (SRCH) in older Korean Americans. Drawing from the World Health Organization's framework of social determinants of health, we examined how a broad spectrum of factors might influence the way in which older Korean Americans perceive and evaluate their own cognitive health. RESEARCH DESIGN AND METHODS: Using data from the Study of Older Korean Americans (SOKA; N = 2,061, mean age = 73.2), a series of hierarchical linear regression models of SRCH was tested with sequential entry of predictors: (1) Mini-Mental State Examination (MMSE) score of cognitive status, (2) demographic variables, (3) physical and mental health status, (4) health behaviors, and (5) socio-cultural and community factors. RESULTS: In addition to cognitive screening outcomes, each set of variables made a significant contribution to the predictive model of SRCH. Positive ratings of cognitive health were observed among older individuals with greater education, good physical and mental health, involvement in regular exercise, and socio-cultural resources (social networks, acculturation, and family solidarity). DISCUSSION AND IMPLICATIONS: The SRCH of older adults goes beyond cognitive screening outcomes, suggesting a need to incorporate the various sources of social determinants when seeking to promote the cognitive health of older populations.

17.
Ophthalmology ; 127(3): 357-368, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31732228

RESUMO

PURPOSE: To investigate the role of sex on retinal nerve fiber layer (RNFL) thickness at 768 circumpapillary locations based on OCT findings. DESIGN: Population-based cross-sectional study. PARTICIPANTS: We investigated 5646 eyes of 5646 healthy participants from the Leipzig Research Centre for Civilization Diseases (LIFE)-Adult Study of a predominantly white population. METHODS: All participants underwent standardized systemic assessments and ocular imaging. Circumpapillary RNFL (cRNFL) thickness was measured at 768 points equidistant from the optic nerve head using spectral-domain OCT (Spectralis; Heidelberg Engineering, Heidelberg, Germany). To control ocular magnification effects, the true scanning radius was estimated by scanning focus. Student t test was used to evaluate sex differences in cRNFL thickness globally and at each of the 768 locations. Multivariable linear regression and analysis of variance were used to evaluate individual contributions of various factors to cRNFL thickness variance. MAIN OUTCOME MEASURES: Difference in cRNFL thickness between males and females. RESULTS: Our population consisted of 54.8% females. The global cRNFL thickness was 1 µm thicker in females (P < 0.001). However, detailed analysis at each of the 768 locations revealed substantial location specificity of the sex effects, with RNFL thickness difference ranging from -9.98 to +8.00 µm. Females showed significantly thicker RNFLs in the temporal, superotemporal, nasal, inferonasal, and inferotemporal regions (43.6% of 768 locations), whereas males showed significantly thicker RNFLs in the superior region (13.2%). The results were similar after adjusting for age, body height, and scanning radius. The superotemporal and inferotemporal RNFL peaks shifted temporally in females by 2.4° and 1.9°, respectively. On regions with significant sex effects, sex explained more RNFL thickness variance than age, whereas the major peak locations and interpeak angle explained most of the RNFL thickness variance unexplained by sex. CONCLUSIONS: Substantial sex effects on cRNFL thickness were found at 56.8% of all 768 circumpapillary locations, with specific patterns for different sectors. Over large regions, sex was at least as important in explaining the cRNFL thickness variance as was age, which is well established to have a substantial impact on cRNFL thickness. Including sex in the cRNFL thickness norm could therefore improve glaucoma diagnosis and monitoring.

18.
Biol Psychiatry ; 87(4): 318-327, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31870495

RESUMO

Since the development of cellular and myelin stains, anatomy has formed the foundation for understanding circuitry in the human brain. However, recent functional and structural studies using magnetic resonance imaging have taken the lead in this endeavor. These innovative and noninvasive approaches have the advantage of studying connectivity patterns under different conditions directly in the human brain. They demonstrate dynamic and structural changes within and across networks linked to normal function and to a wide range of psychiatric illnesses. However, these indirect methods are unable to link networks to the hardwiring that underlies them. In contrast, anatomic invasive experimental studies can. Following a brief review of prefrontal cortical, anterior cingulate, and striatal connections and the different methodologies used, this article discusses how data from anatomic studies can help inform how hardwired connections are linked to the functional and structural networks identified in imaging studies.

19.
Int J Chron Obstruct Pulmon Dis ; 14: 2767-2775, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31819409

RESUMO

Objective: Chronic obstructive pulmonary disease (COPD) acute exacerbations are significant causes of morbidity and mortality. "Frequent exacerbator" phenotypes are considered a distinct subgroup and this phenotype has a negative effect on lung function, quality of life, activity, hospital admission, and mortality. We assess inhaler handling technique and adherence, and evaluate risk factors associated with frequent exacerbations in COPD patients. Methods: This study was a cross-sectional, case-control study. We prospectively enrolled 189 COPD patients from Yeungnam University Hospital from January 2018 to November 2018. Subjects were tested regarding their inhaler technique in face-to-face interviews with an advanced practice nurse of inhaler upon study entry. Frequency of moderate to severe COPD exacerbations were reviewed via electronic medical records during 12 months prior to study entry. Frequent exacerbations were defined as ≥2 moderate to severe exacerbations in the prior 12 months. Multivariate logistic regression was performed to identify risk factors for frequent exacerbations. Results: Among 189 COPD patients, 50 (26.5%) were frequent exacerbators. Based on univariate analyses, body mass index (BMI) < 25 kg/m2, lower forced expiratory volume in 1 s (FEV1), higher mMRC, lower feeling of satisfaction with the inhaler, and any critical errors were potential risk factors for frequent exacerbations. Multivariate logistic regression analyses revealed that BMI < 25 kg/m2 (OR, 2.855, 95% CI, 1.247-6.534; p=0.013), higher mMRC (OR, 1.625, 95% CI, 1.072-2.463; p=0.022), and any critical error (OR, 2.020, 95% CI, 1.021-3.999; p=0.044) were risk factors. Conclusion: Any critical error, BMI < 25 kg/m2 and high mMRC are independent risk factors for frequent exacerbations in COPD patients. Careful monitoring and education around inhaler devices, particularly in frequent exacerbators, are important components of COPD treatment.

20.
Sci Rep ; 9(1): 19535, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31862963

RESUMO

Secondary macular hole(MH) formation after vitrectomy is rare and its risk factors and pathogenesis are not clearly understood. This retrospective study was conducted to identify the risk factors of this complication and assess outcomes at 2 tertiary centres. The primary outcomes were the clinical characteristics associated with development of secondary MH, which included the primary diagnosis for initial vitrectomy, features on optical coherence tomography, and adjuvant surgical techniques used during the initial surgery. Secondary outcomes included the change in best-corrected visual acuity(BCVA), clinical factors associated with the need for re-operations for MH closure and prognostic factors for the visual outcomes. Thirty-eight eyes out of 6,354 cases (incidence 0.60%) developed secondary MH after undergoing vitrectomy for various vitreoretinal disorders over an 11-year period, most frequently after initial surgery for retinal detachment(RD) (9 eyes) and secondary epiretinal membrane (6 eyes). The mean age was 57.1 years (range: 17.8-76.7), and the mean follow-up was 51.1 months (range: 6.8 to 137.6). Prior to secondary MH formation, development of ERM was the most common OCT feature (19 eyes, 50%), and no cases of cystoid macular oedema (CME) were observed. A greater proportion of eyes with secondary MH had long axial lengths (32% ≥26 mm vs 5% of eyes ≤22 mm). MH closure surgery was performed in 36 eyes and closure was achieved in 34 (success rate 94%, final BCVA 20/86), with ≥3-line visual gain in 18 cases. BCVA at MH onset (OR = 0.056, P = 0.036), BCVA at post-MH surgery month 3 (OR = 52.671, P = 0.011), and axial length ≥28 mm (OR = 28.487, P = 0.030) were associated with ≥3-line visual loss; a history of macula-off RD (OR = 27.158, P = 0.025) was associated with the need for multiple surgeries for MH closure. In conclusion, secondary MH occurs rarely but most commonly after vitrectomy for RD. Patients with axial length ≥28 mm and poor BCVA at 3 months post-operation may have limited visual prognosis; those with a history of macula-off RD may require multiple surgeries for hole closure.

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