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1.
PLoS One ; 15(10): e0240155, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33021982

RESUMO

No studies of the current status of treatment options are available for ankylosing spondylitis (AS) patients in South Korea. This study assesses the current status of AS treatment trends using a nationwide database. This study was conducted using a Korean National Health Insurance System (KNHIS) dataset from 2006 to 2016. We randomly extracted 50% of the total number of patients registered as As patients in the KNHIS. The distribution of the number of patients according to age and gender was analyzed each year. The types and combination methods of drugs used during the study period were estimated yearly. Between 2006 and 2016, the number of AS patients increased linearly by an average of 9% annually, 6372 in 2006 to 15188 in 2016. The study found that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) was the most commonly prescribed pharmacological treatment option, followed by disease-modifying anti-rheumatic drugs (DMARDs) and then biologics. Biologics such as tumor necrosis factor alpha (TNF-α) inhibitors increased from 10% to 35% consistently for 10 years. In terms of combination therapy, DMARDs + NSAIDs accounted for almost 90% of treatments in 2006, but decreased by 65% in 2016. The use of biologics and NSAIDs increased from 3% to 28%. Prescriptions for dual therapies and mono therapies largely dominated prescription habits, accounted for up to approximately 80% of treatments. Among 10- to 14-year-old patients, there was no triple therapy, dual and triple therapies decreased gradually for those 60 and older, and the ratio of conservative treatments has increased. This study shows how South Korea reflects changes in AS treatment trends, along with the emergence of TNF-α inhibitors that are effective in treating AS. Research on clinical outcomes for AS treatments will be needed on following these drug changes.

2.
Sci Rep ; 10(1): 16266, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004986

RESUMO

Physical activity (PA) is one of the most important modifiable factors associated with fracture risk. However, the association between interval changes in PA and the risk of fracture remains unknown. We investigated the risk of fracture development according to interval changes in PA in middle aged and older individuals. In this nationwide cohort study of adults aged ≥ 40 years, more than 4.9 million individuals without fractures within the last year who underwent two consecutive national health screenings in Korea from 2009 to 2012 were identified. The risk of fracture between 2013 and 2016 according to interval changes in regular PA was prospectively analyzed. Compared to individuals with a continuous lack of PA, those with a decrease in PA (0.41/1000 person-years (PY) decrease in incidence rate (IR); adjusted hazard ratio (aHR) 0.975; 95% confidence interval (CI) 0.964-0.987), increase in PA (1.8/1000 PY decrease in IR; aHR 0.948; 95% CI 0.937-0.959), and continuous PA (3.58/1000 PY decrease in IR; aHR 0.888; 95% CI 0.875-0.901) had a significantly reduced risk of fracture. Interval changes in regular PA were associated with risk of fracture. Individuals who engaged in continuous regular PA exhibited the maximum protective benefit against fracture.

3.
Diabetes ; 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917775

RESUMO

Leptin influences food intake by informing the brain about the status of body fat stores. Rare LEP mutations associated with congenital leptin deficiency cause severe early-onset obesity that can be mitigated by administering leptin. However, the role of genetic regulation of leptin in polygenic obesity remains poorly understood. We performed an exome-based analysis in up to 57,232 individuals of diverse ancestries to identify genetic variants that influence adiposity-adjusted leptin concentrations. We identify five novel variants, including four missense variants, in LEP, ZNF800, KLHL31, and ACTL9, and one intergenic variant near KLF 14 The missense variant Val94Met (rs17151919) in LEP was common in individuals of African ancestry only and its association with lower leptin concentrations was specific to this ancestry (P=2x10-16, n=3,901). Using in vitro analyses, we show that the Met94 allele decreases leptin secretion. We also show that the Met94 allele is associated with higher BMI in young African-ancestry children but not in adults, suggesting leptin regulates early adiposity.

4.
J Am Chem Soc ; 142(30): 13201-13209, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32628842

RESUMO

By combining single-molecule fluorescence microscopy with traditional electrochemical methods, herein we report on the investigation of the electrocatalytic kinetics of two-electron (2e) pathway of oxygen reduction reaction (ORR) on a single Fe3O4 nanoparticle. The kinetic parameters for two-electron ORR process are successfully derived at the single-particle level, and a potential dependence of dynamic heterogeneity among individual nanoparticles is revealed. Furthermore, the performance stability of individual Fe3O4 nanoparticles for 2e ORR process is studied. This study deepens our understanding to the electrocatalytic ORR process, especially the 2e pathway at single-molecule and single-particle levels.

5.
Clin Infect Dis ; 2020 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-32507882

RESUMO

BACKGROUND: Neonatal herpes simplex virus infection (nHSV) leads to severe morbidity and mortality, but national incidence is uncertain. Florida regulations require that healthcare providers report cases, and clinical laboratories report test results when herpes simplex virus (HSV) is detected. We estimated nHSV incidence using laboratory-confirmed provider-reported cases and electronic laboratory reports (ELR) stored separately from provider-reported cases. Mortality was estimated using provider-reported cases, ELR, and vital statistics death records. METHODS: For 2011-2017, we reviewed: provider-reported cases (infants <60 days of age with HSV infection confirmed by culture or polymerase chain reaction (PCR)), ELR of HSV-positive culture or PCR results in the same age group, and death certificates containing International Classification of Disease, Tenth Revision, codes for herpes infection: P35.2, B00.0-B00.9, and A60.0-A60.9. Provider-reported cases were matched against ELR reports. Death certificates were matched with provider and ELR reports. Chapman's capture-recapture method was used to estimate nHSV incidence and mortality. Mortality from all three sources was estimated using log-linear modelling. RESULTS: Providers reported 114 nHSV cases and ELR identified 197 nHSV cases. Forty-six cases were common to both datasets, leaving 265 unique nHSV reports. Chapman's estimate suggests 483 (95% C.I. 383-634) nHSV cases occurred (31.5 infections per 100,000 live births). nHSV deaths were reported by providers (n=9), ELR (n=18), and vital statistics (n=31), totaling 34 unique reports. Log-linear modeling estimates 35.8 fatal cases occurred (95% CI 34-40). CONCLUSIONS: Chapman's estimates using data collected over 7 years in Florida, conclude nHSV infections occurred at a rate of 1 per 3000 live births.

6.
Medicine (Baltimore) ; 99(7): e19266, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049868

RESUMO

Despite many clinical trials on cervical epidural steroid injections, the indications for and long-standing outcomes of this treatment remain controversial. We evaluated the outcomes and indications for transforaminal cervical epidural steroid injection (TCESI) in patients with moderate to severe disability.We prospectively gathered data from patients with 1 or 2-level cervical degenerative disease (herniated disc, foraminal stenosis) with moderate to severe disability (3.5 < initial visual analog scale < 6.5, 15 < Neck Disability Index < 35) and greater than 12 weeks of pain, despite conservative treatment. Patients with persistent disability and those who desired surgical intervention underwent decompression surgery. The clinical and demographic characteristics were compared between groups.Of the 309 patients who underwent TCESI, 221 (72%) did not receive surgical treatment during the 1-year follow-up period. The remaining 88 patients (28%) underwent surgery at a mean of 4.1 months after initial TCESI. Patients who underwent injection alone showed a significant decrease in disability and pain that persisted until the 1-year follow-up visit (P < .05). In patients who underwent surgery, the mean disability and pain scores after injection did not decrease for several months, although the scores significantly decreased up to 1 year after surgery (P < .05).The TCESI significantly decreased pain and disability in the moderate to severe disability group up to 1 year after injection. We recommend cervical TCESI as an initial treatment with moderate to severe disability patients.


Assuntos
Vértebras Cervicais , Dexametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Degeneração do Disco Intervertebral/tratamento farmacológico , Feminino , Humanos , Injeções Epidurais , Degeneração do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
7.
ACS Appl Mater Interfaces ; 12(5): 6328-6335, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-31944102

RESUMO

To obtain high catalytic properties, finely modulating the electronic structure and active sites of catalysts is important. Herein, we report the design and economical synthesis of Pd@Pt core-shell nanoparticles for high productivity in the direct synthesis of hydrogen peroxide. Pd@Pt core-shell nanoparticles with a partially covered Pt shell on a Pd cube were synthesized using a simple direct seed-mediated growth method. The synthesized Pd@Pt core-shell nanoparticles were composed of high index faceted Pt on the corners and edges, while the Pd-Pt alloy was located on the terrace area of the Pd cubes. Because of the high-indexed Pt and Pd-Pt alloy sites, the synthesized concave Pd@Pt7 nanoparticles exhibited both high H2 conversion and H2O2 selectivity compared with Pd cubes.

8.
Nature ; 577(7790): 359-363, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31942056

RESUMO

The impact of topological defects associated with grain boundaries (GB defects) on the electrical, optical, magnetic, mechanical and chemical properties of nanocrystalline materials1,2 is well known. However, elucidating this influence experimentally is difficult because grains typically exhibit a large range of sizes, shapes and random relative orientations3-5. Here we demonstrate that precise control of the heteroepitaxy of colloidal polyhedral nanocrystals enables ordered grain growth and can thereby produce material samples with uniform GB defects. We illustrate our approach with a multigrain nanocrystal comprising a Co3O4 nanocube core that carries a Mn3O4 shell on each facet. The individual shells are symmetry-related interconnected grains6, and the large geometric misfit between adjacent tetragonal Mn3O4 grains results in tilt boundaries at the sharp edges of the Co3O4 nanocube core that join via disclinations. We identify four design principles that govern the production of these highly ordered multigrain nanostructures. First, the shape of the substrate nanocrystal must guide the crystallographic orientation of the overgrowth phase7. Second, the size of the substrate must be smaller than the characteristic distance between the dislocations. Third, the incompatible symmetry between the overgrowth phase and the substrate increases the geometric misfit strain between the grains. Fourth, for GB formation under near-equilibrium conditions, the surface energy of the shell needs to be balanced by the increasing elastic energy through ligand passivation8-10. With these principles, we can produce a range of multigrain nanocrystals containing distinct GB defects.

9.
Stat Med ; 39(3): 207-219, 2020 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-31846099

RESUMO

Latent class analysis (LCA) has been effectively used to cluster multiple survey items. However, causal inference with an exposure variable, identified by an LCA model, is challenging because (1) the exposure variable is unobserved and harbors the uncertainty of estimating parameters in the LCA model and (2) confounding bias adjustments need to be done with the unobserved LCA-driven exposure variable. In addition to these challenges, complex survey design features and survey weights must be accounted for if they are present. Our solutions to these issues are to (1) assess point estimates with the expected estimating function approach and (2) modify the survey design weights with LCA-based propensity scores. This paper aims to introduce a statistical procedure to apply the estimating equation approach to assessing the effects of LCA-driven cause in complex survey data using an example of the National Health and Nutrition Examination Survey.

10.
Matern Child Health J ; 24(2): 213-221, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31848926

RESUMO

OBJECTIVES: Ectopic pregnancy is an important adverse pregnancy outcome that is under-surveilled. Emergency department (ED) data can help provide insight on the trends of ectopic pregnancy incidence in the United States (US). METHODS: Data from the largest US all-payer ED database, the Healthcare Cost and Utilization Project Nationwide ED Sample, were used to identify trends in the annual ratio of ED ectopic pregnancy diagnoses to live births during 2006-2013, and the annual rate of diagnoses among all pregnancies during 2006-2010. Diagnoses were identified through International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes and CPT codes. RESULTS: The overall ratio of weighted ED visits with an ectopic pregnancy diagnosis during 2006-2013 was 12.3 per 1000 live births. This ratio increased significantly from 2006 to 2013, from 11.0 to 13.7 ectopic pregnancies per 1000 live births, with no inflections in trend. The rate of ectopic pregnancy diagnoses per 1000 pregnancies increased during 2006-2010, from 7.0 to 8.3, with no inflections in trend. Females of all age groups experienced increases, though increases were less pronounced with increasing age. All geographic regions experienced increases, with increases being most pronounced in the Northeast. CONCLUSIONS: Our study suggests that ED ectopic pregnancy diagnoses may be increasing in the US, although the drivers of these increases are not clear. Our results highlight the need for national measures of total pregnancies, stratified by pertinent demographic variables, to evaluate trends in pregnancy-related conditions among key populations.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Gravidez Ectópica/diagnóstico , Adolescente , Adulto , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Gravidez , Gravidez Ectópica/epidemiologia , Prevalência , Estados Unidos/epidemiologia
11.
JAMA Netw Open ; 2(9): e1910584, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31483470

RESUMO

Importance: Diagnostic low-dose ionizing radiation has great medical benefits; however, its increasing use has raised concerns about possible cancer risks. Objective: To examine the risk of cancer after diagnostic low-dose radiation exposure. Design, Setting, and Participants: This population-based cohort study included youths aged 0 to 19 years at baseline from South Korean National Health Insurance System claim records from January 1, 2006, to December 31, 2015. Exposure to diagnostic low-dose ionizing radiation was classified as any that occurred on or after the entry date, when the participant was aged 0 to 19 years, on or before the exit date, and at least 2 years before any cancer diagnosis. Cancer diagnoses were based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Data were analyzed from March 2018 to September 2018. Main Outcomes and Measures: The primary analysis assessed the incidence rate ratios (IRRs) for exposed vs nonexposed individuals using the number of person-years as an offset. Results: The cohort included a total of 12 068 821 individuals (6 339 782 [52.5%] boys). There were 2 309 841 individuals (19.1%) aged 0 to 4 years, 2 951 679 individuals (24.5%) aged 5 to 9 years, 3 489 709 individuals (28.9%) aged 10 to 14 years, and 3 317 593 individuals (27.5%) aged 15 to 19 years. Of these, 1 275 829 individuals (10.6%) were exposed to diagnostic low-dose ionizing radiation between 2006 and 2015, and 10 792 992 individuals (89.4%) were not exposed. By December 31, 2015, 21 912 cancers were recorded. Among individuals who had been exposed, 1444 individuals (0.1%) received a cancer diagnosis. The overall cancer incidence was greater among exposed individuals than among nonexposed individuals after adjusting for age and sex (IRR, 1.64 [95% CI, 1.56-1.73]; P < .001). Among individuals who had undergone computed tomography scans in particular, the overall cancer incidence was greater among exposed individuals than among nonexposed individuals after adjusting for age and sex (IRR, 1.54 [95% CI, 1.45-1.63]; P < .001). The incidence of cancer increased significantly for many types of lymphoid, hematopoietic, and solid cancers after exposure to diagnostic low-dose ionizing radiation. Among lymphoid and hematopoietic cancers, incidence of cancer increased the most for other myeloid leukemias (IRR, 2.14 [95% CI, 1.86-2.46]) and myelodysplasia (IRR, 2.48 [95% CI, 1.77-3.47]). Among solid cancers, incidence of cancer increased the most for breast (IRR, 2.32 [95% CI, 1.35-3.99]) and thyroid (IRR, 2.19 [95% CI, 1.97-2.20]) cancers. Conclusions and Relevance: This study found an association of increased incidence of cancer with exposure to diagnostic low-dose ionizing radiation in a large cohort. Given this risk, diagnostic low-dose ionizing radiation should be limited to situations in which there is a definite clinical indication.

13.
Mol Nutr Food Res ; 63(22): e1900226, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31432628

RESUMO

SCOPE: Insulin resistance (IR) and inflammation are hallmarks of type 2 diabetes (T2D). The nod-like receptor pyrin domain containing-3 (NLRP3) inflammasome is a metabolic sensor activated by saturated fatty acids (SFA) initiating IL-1ß inflammation and IR. Interactions between SFA intake and NLRP3-related genetic variants may alter T2D risk factors. METHODS: Meta-analyses of six Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium (n = 19 005) tested interactions between SFA and NLRP3-related single-nucleotide polymorphisms (SNPs) and modulation of fasting insulin, fasting glucose, and homeostasis model assessment of insulin resistance. RESULTS: SFA interacted with rs12143966, wherein each 1% increase in SFA intake increased insulin by 0.0063 IU mL-1 (SE ± 0.002, p = 0.001) per each major (G) allele copy. rs4925663, interacted with SFA (ß ± SE = -0.0058 ± 0.002, p = 0.004) to increase insulin by 0.0058 IU mL-1 , per additional copy of the major (C) allele. Both associations are close to the significance threshold (p < 0.0001). rs4925663 causes a missense mutation affecting NLRP3 expression. CONCLUSION: Two NLRP3-related SNPs showed potential interaction with SFA to modulate fasting insulin. Greater dietary SFA intake accentuates T2D risk, which, subject to functional validation, may be further elaborated depending on NLRP3-related genetic variants.

14.
Ann Epidemiol ; 36: 26-32, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31405718

RESUMO

PURPOSE: We investigated the association between county-level trends in opioid prescribing rates, a proxy for opioid misuse, and rates of reported gonorrhea (GC) among males in the United States. METHODS: We used linear mixed-model regression analyses to evaluate the association between county-level trends in opioid prescribing rates and rates of reported GC among males during 2010-2015. RESULTS: There was a positive association between trends in county-level opioid prescribing rates and rates of GC among males (ß = 0.068, 95% confidence interval [CI] = 0.030, 0.105) during 2010-2015. However, the magnitude of this association decreased significantly over time in counties where opioid prescribing rates decreased (ß = -0.018, 95% CI = -0.030, -0.006) and remained stable (ß = -0.020, 95% CI = -0.038, -0.002) but was unchanged in counties where opioid prescribing rates increased (ß = -0.029, 95% CI = -0.058, 0.001). CONCLUSIONS: During 2010-2015, we found a positive association between increases in county-level opioid prescribing rates, a proxy for opioid misuse, and rates of reported GC among males especially in counties most affected by the opioid crisis. Integrating sexual health with opioid misuse interventions might be beneficial in addressing the GC burden in the United States.


Assuntos
Overdose de Drogas/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Gonorreia/epidemiologia , Padrões de Prática Médica/tendências , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Assunção de Riscos , Comportamento Sexual , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Governo Local , Masculino , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Uso Indevido de Medicamentos sob Prescrição/tendências , Distribuição por Sexo , Estados Unidos/epidemiologia
15.
BMJ ; 366: l4292, 2019 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345923

RESUMO

OBJECTIVE: To investigate whether the genetic burden of type 2 diabetes modifies the association between the quality of dietary fat and the incidence of type 2 diabetes. DESIGN: Individual participant data meta-analysis. DATA SOURCES: Eligible prospective cohort studies were systematically sourced from studies published between January 1970 and February 2017 through electronic searches in major medical databases (Medline, Embase, and Scopus) and discussion with investigators. REVIEW METHODS: Data from cohort studies or multicohort consortia with available genome-wide genetic data and information about the quality of dietary fat and the incidence of type 2 diabetes in participants of European descent was sought. Prospective cohorts that had accrued five or more years of follow-up were included. The type 2 diabetes genetic risk profile was characterized by a 68-variant polygenic risk score weighted by published effect sizes. Diet was recorded by using validated cohort-specific dietary assessment tools. Outcome measures were summary adjusted hazard ratios of incident type 2 diabetes for polygenic risk score, isocaloric replacement of carbohydrate (refined starch and sugars) with types of fat, and the interaction of types of fat with polygenic risk score. RESULTS: Of 102 305 participants from 15 prospective cohort studies, 20 015 type 2 diabetes cases were documented after a median follow-up of 12 years (interquartile range 9.4-14.2). The hazard ratio of type 2 diabetes per increment of 10 risk alleles in the polygenic risk score was 1.64 (95% confidence interval 1.54 to 1.75, I2=7.1%, τ2=0.003). The increase of polyunsaturated fat and total omega 6 polyunsaturated fat intake in place of carbohydrate was associated with a lower risk of type 2 diabetes, with hazard ratios of 0.90 (0.82 to 0.98, I2=18.0%, τ2=0.006; per 5% of energy) and 0.99 (0.97 to 1.00, I2=58.8%, τ2=0.001; per increment of 1 g/d), respectively. Increasing monounsaturated fat in place of carbohydrate was associated with a higher risk of type 2 diabetes (hazard ratio 1.10, 95% confidence interval 1.01 to 1.19, I2=25.9%, τ2=0.006; per 5% of energy). Evidence of small study effects was detected for the overall association of polyunsaturated fat with the risk of type 2 diabetes, but not for the omega 6 polyunsaturated fat and monounsaturated fat associations. Significant interactions between dietary fat and polygenic risk score on the risk of type 2 diabetes (P>0.05 for interaction) were not observed. CONCLUSIONS: These data indicate that genetic burden and the quality of dietary fat are each associated with the incidence of type 2 diabetes. The findings do not support tailoring recommendations on the quality of dietary fat to individual type 2 diabetes genetic risk profiles for the primary prevention of type 2 diabetes, and suggest that dietary fat is associated with the risk of type 2 diabetes across the spectrum of type 2 diabetes genetic risk.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etiologia , Dieta/efeitos adversos , Gorduras na Dieta/efeitos adversos , Adulto , Alelos , Diabetes Mellitus Tipo 2/genética , Feminino , Estudo de Associação Genômica Ampla , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco
16.
Am J Hum Genet ; 105(1): 15-28, 2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31178129

RESUMO

Circulating levels of adiponectin, an adipocyte-secreted protein associated with cardiovascular and metabolic risk, are highly heritable. To gain insights into the biology that regulates adiponectin levels, we performed an exome array meta-analysis of 265,780 genetic variants in 67,739 individuals of European, Hispanic, African American, and East Asian ancestry. We identified 20 loci associated with adiponectin, including 11 that had been reported previously (p < 2 × 10-7). Comparison of exome array variants to regional linkage disequilibrium (LD) patterns and prior genome-wide association study (GWAS) results detected candidate variants (r2 > .60) spanning as much as 900 kb. To identify potential genes and mechanisms through which the previously unreported association signals act to affect adiponectin levels, we assessed cross-trait associations, expression quantitative trait loci in subcutaneous adipose, and biological pathways of nearby genes. Eight of the nine loci were also associated (p < 1 × 10-4) with at least one obesity or lipid trait. Candidate genes include PRKAR2A, PTH1R, and HDAC9, which have been suggested to play roles in adipocyte differentiation or bone marrow adipose tissue. Taken together, these findings provide further insights into the processes that influence circulating adiponectin levels.


Assuntos
Adiponectina/genética , Tecido Adiposo/patologia , Exoma/genética , Predisposição Genética para Doença , Lipídeos/análise , Obesidade/etiologia , Polimorfismo de Nucleotídeo Único , Tecido Adiposo/metabolismo , Adolescente , Adulto , Afro-Americanos/genética , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Hispano-Americanos/genética , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/patologia , Fenótipo , Locos de Características Quantitativas , Adulto Jovem
17.
Sex Transm Dis ; 46(7): 446-451, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31194716

RESUMO

BACKGROUND: Sexually transmitted diseases, including chlamydia and gonorrhea, cause of pelvic inflammatory disease (PID) and infertility. We estimated the prevalence of infertility and infertility health care seeking. METHODS: We analyzed self-reported lifetime infertility and infertility health care-seeking in women aged 18 to 49 years in the 2013 and 2015 National Health and Nutrition Examination Surveys. Weighted prevalence of infertility and infertility health care seeking, prevalence ratios (PRs), and 95% confidence intervals (CIs) were calculated. RESULTS: Among 2626 eligible women, 13.8% had self-reported infertility (95% CI, 12.3-15.3) with higher prevalence by age: 960, 18 to 29 years (PR, 6.4%; 95% CI, 4.8-8.0); 799, 30 to 39 years (PR, 14.8%; 95% CI, 12.2-17.3); and 867, 40 to 49 years (PR, 20.8%; 95% CI, 17.2-24.4). Non-Hispanic white women (PR, 15.4%; 95% CI, 13.0-17.8; n = 904) and non-Hispanic black women (PR, 12.9%; 95% CI, 10.3-15.5; n = 575) had the highest infertility prevalences. Women reporting PID treatment (n = 122) had higher infertility prevalence (PR, 24.2%; 95% CI, 16.2-32.2) than women without PID treatment (PR, 13.3%; 95% CI, 11.6-15.0; n = 2,485), especially among 18- to 29-year-old women (PR, 3.8; 95% CI, 1.8-8.0). Of 327 women with infertility, 60.9% (95% CI, 56.1-65.8) sought health care. Women without health care insurance sought care less frequently than women with insurance. CONCLUSIONS: In a nationally representative sample, 13.8% of reproductive-age women reported a history of infertility, of whom 40% did not access health care. Self-reported PID was associated with infertility, especially in young women. Annual chlamydia and gonorrhea screening to avert PID may reduce the burden of infertility in the United States.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Infertilidade/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Doença Inflamatória Pélvica/epidemiologia , Doenças Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , Autorrelato , Estados Unidos/epidemiologia , Adulto Jovem
18.
ACS Nano ; 13(6): 6531-6539, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31072094

RESUMO

Both self-healable conductors and stretchable conductors have been previously reported. However, it is still difficult to simultaneously achieve high stretchability, high conductivity, and self-healability. Here, we observed an intriguing phenomenon, termed "electrical self-boosting", which enables reconstructing of electrically percolative pathways in an ultrastretchable and self-healable nanocomposite conductor (over 1700% strain). The autonomously reconstructed percolative pathways were directly verified by using microcomputed tomography and in situ scanning electron microscopy. The encapsulated nanocomposite conductor shows exceptional conductivity (average value: 2578 S cm-1; highest value: 3086 S cm-1) at 3500% tensile strain by virtue of efficient strain energy dissipation of the self-healing polymer and self-alignment and rearrangement of silver flakes surrounded by spontaneously formed silver nanoparticles and their self-assembly in the strained self-healing polymer matrix. In addition, the conductor maintains high conductivity and stretchability even after recovered from a complete cut. Besides, a design of double-layered conductor enabled by the self-bonding assembly allowed a conducting interface to be located on the neutral mechanical plane, showing extremely durable operations in a cyclic stretching test. Finally, we successfully demonstrated that electromyogram signals can be monitored by our self-healable interconnects. Such information was transmitted to a prosthetic robot to control various hand motions for robust interactive human-robot interfaces.

19.
World Neurosurg ; 129: e191-e198, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31121370

RESUMO

OBJECTIVE: In thoracolumbar (TL) burst fractures, vertebral body height loss (VBHL) indicates the degree of instability and constitutes one of the decision criteria for surgical treatment. However, the relative reliability and variability of different measurement techniques for VBHL are unknown. We compared the reliability of different methods used to assess VBHL. METHODS: A total of 144 patients with TL burst fractures were included, and lateral radiographs were taken twice at an interval of 2 weeks, which were examined by 3 observers. The measurement methods used included the anterior/posterior vertebral body height compression ratio (APCR), anterior height compression percentage (AHCP), and anterior/posterior vertebral body height compression ratio percentage. To compare the accuracy of measurements according to vertebral degeneration, subjects were divided into 2 groups based on the median age of 50 years. RESULTS: In intraobserver comparisons, the APCR method showed a higher inter- and intraclass correlation coefficient (ICC) (>0.714) compared with the other methods. In interobserver comparisons, the ICC of the APCR (>0.793) was excellent. In intraobserver comparisons of the aged >50-years group, only the APCR method showed an excellent ICC (>0.753), whereas the AHCP method showed a fair to good ICC, and the anterior/posterior vertebral body height compression ratio percentage method had the lowest ICC. In interobserver comparisons of the aged >50-years group, the APCR and AHCP methods showed excellent ICCs. In the aged ≤50-years group, all 3 methods showed similar fair to good ICC values. CONCLUSIONS: Based on comparative reliability analyses, we recommend the APCR method as the first-line technique and the AHCP as an alternative technique for measuring VBHL in TL burst fractures.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Vértebras Torácicas/lesões , Adulto Jovem
20.
Sci Rep ; 9(1): 6736, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043656

RESUMO

The aim of this study is to determine the relationship between AS and subsequent depression. This study was conducted using a nationwide dataset available in Korean National Health Insurance System (KNHIS). We identified 11,465 newly diagnosed AS patients and 57,325 patients without AS in the ratio of 1:5 matched by sex, age, and index date, between 2010 and 2014. We investigated any latent characteristics in the patients' demographic information and chronic comorbidities that could trigger a depression when diagnosed with AS. By comparing the cohort data, the hazard ratio of developing subsequent depression in AS patients was calculated and adjusted based on several risk factors. Despite the adjustment of demographic variables and chronic comorbidities, the risk of depression was 2.21 times higher in the AS cohort than in the control group. Multivariate analysis showed that AS patients with female gender, old age and low-income status showed higher risks of developing depression. Additionally, the presence of chronic comorbidities including diabetes mellitus, hypertension, hyperlipidemia, cancer, stroke, and chronic kidney disease increased the patients' risk of depression. The AS patients with stroke were reported to have the highest risk of depression. This population-based cohort study showed that AS significantly increased the subsequent risk of developing depression. Moreover, the development of a depression is influenced by certain demographic variables and different chronic comorbidities.

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