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1.
Sci Rep ; 10(1): 5357, 2020 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-32269245

RESUMO

Syndromes are defined with signs or symptoms that occur together and represent conditions. We use a data-driven approach to identify the deadliest and most death-averse frailty syndromes based on frailty symptoms. A list of 72 frailty symptoms was retrieved based on three frailty indices. We used data from the Health and Retirement Study (HRS), a longitudinal study following Americans aged 50 years and over. Principal component (PC)-based syndromes were derived based on a principal component analysis of the symptoms. Equal-weight 4-item syndromes were the sum of any four symptoms. Discrete-time survival analysis was conducted to compare the predictive power of derived syndromes on mortality. Deadly syndromes were those that significantly predicted mortality with positive regression coefficients and death-averse ones with negative coefficients. There were 2,797 of 5,041 PC-based and 964,774 of 971,635 equal-weight 4-item syndromes significantly associated with mortality. The input symptoms with the largest regression coefficients could be summed with three other input variables with small regression coefficients to constitute the leading deadliest and the most death-averse 4-item equal-weight syndromes. In addition to chance alone, input symptoms' variances and the regression coefficients or p values regarding mortality prediction are associated with the identification of significant syndromes.

2.
Arch Dermatol Res ; 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32266531

RESUMO

There has been an exponential growth in the number of dermatologic procedures performed over the past two decades. This surge in procedural volumes is accompanied by increasing utilization of local anesthetics. A proper technique in administering local anesthesia is necessary to minimize pain and promote comfort, as it is often regarded as the most painful part of cutaneous procedures. Pain is a psychophysiological phenomenon that involves attention, cognitive appraisal, and emotion. Sensory feedback and anxiety are two important aspects of pain perception. This article aims to introduce a novel way that minimizes pain and discomfort associated with local anesthetics. It is the authors' experience that painless injection is achievable by keeping syringes/needles out of sight, proceeding with injection without pre-procedure warning, and engaging patients in a conversation or simple tasks.

3.
Dermatol Clin ; 38(2): 177-183, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115126

RESUMO

The lesbian, gay, bisexual, transgender, and queer or questioning/sexual and gender minority (LGBTQ/SGM) community is a growing population with unique lifestyles, sexual practices, beliefs, health issues, and concerns. Although significant advances have been achieved in recent years to establish better care for LGBTQ/SGM patients, they still face insurmountable stigmatization and health care inequality. Dermatologists play an important role in LGBTQ/SGM patients' well-being because they not only treat their skin conditions, but also help them achieve desirable physical characteristics. This article discusses historical perspectives and current state of LGBTQ/SGM dermatology and attempts to define directions for future research and improvement.

4.
Sci Rep ; 10(1): 2601, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32054866

RESUMO

Composite diagnostic criteria are common in frailty research. We worry distinct populations may be linked to each other due to complicated criteria. We aim to investigate whether distinct populations might be considered similar based on frailty diagnostic criteria. The Functional Domains Model for frailty diagnosis included four domains: physical, nutritive, cognitive and sensory functioning. Health and Retirement Study participants with two or more deficiencies in the domains were diagnosed frail. The survival distributions were analyzed using discrete-time survival analysis. The distributions of the demographic characteristics and survival across the groups diagnosed with frailty were significantly different (p < 0.05). A deficiency in cognitive functioning was associated with the worst survival pattern compared with a deficiency in the other domains (adjusted p < 0.05). The associations of the domains with mortality were cumulative without interactions. Cognitive functioning had the largest effect size for mortality prediction (Odds ratios, OR = 2.37), larger than that of frailty status (OR = 1.92). The frailty diagnostic criteria may take distinct populations as equal and potentially assign irrelevant interventions to individuals without corresponding conditions. We think it necessary to review the adequacy of composite diagnostic criteria in frailty diagnosis.

5.
Transl Oncol ; 12(11): 1425-1431, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31401335

RESUMO

Epidermal growth factor receptor- tyrosine kinase inhibitors (EGFR-TKI) are recommended first-line therapy for advanced non-small cell lung cancer (NSCLC) with sensitizing EGFR mutations. It is of clinical interest to identify concurrent genetic mutations in NSCLC patients with EGFR mutations in the hopes of discovering predictive biomarkers towards EGFR-TKI treatment. We retrospectively analyzed a cohort of patients with advanced EGFR mutant NSCLC who underwent treatment with first generation TKIs at our hospital by a multi-gene panel via next generation sequencing. A total of 33 patients with mutant EGFR were enrolled. Up to 26 (78.8%) patients had at least one concomitant genetic alteration coexisting with mutant EGFR. Among the concomitant genetic alterations discovered, TP53 mutation was most common (n = 10,30.3%), followed by CDK4 (n = 8, 24.2%) and CDKN2A (n = 7, 21.2%)copy number variation (CNV). Progression-free survival was shorter in patients with concomitant FGFR3 mutation (1.6 vs. 12.6 months, P = .003) and CDKN2A CNV loss (6.5 vs. 13.4months, P = .019). Patients with any concomitant genetic alterations also had significant worse overall survival (24.1 vs. 40.8 months, P = .029). In summary, our study revealed an unfavorable association between concomitant genetic mutations and treatment response towards EGFR-TKI. FGFR3 mutation and CDKN2A CNV loss may be potential predictive markers for treatment outcome and warrant further investigation.

6.
Environ Sci Technol ; 53(19): 11560-11568, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31448917

RESUMO

We developed a new dynamic model to characterize how light and nitrogen regulate the cellular processes of photosynthetic microalgae leading to transient changes in the production of neutral lipids, carbohydrates, and biomass. Our model recapitulated the versatile neutral lipid synthesis pathways via (i) carbon reuse from carbohydrate metabolism under nitrogen sufficiency and (ii) fixed carbon redirection under nitrogen depletion. We also characterized the effects of light adaptation, light inhibition hysteresis, and nitrogen limitation on photosynthetic carbon fixation. The formulated model was calibrated and validated with experimental data of Dunaliella viridis cultivated in a lab-scale photobioreactor (PBR) under various light (low/moderate/high) and nitrogen (sufficient/limited) conditions. We conducted the identifiability, uncertainty, and sensitivity analyses to verify the model reliability using the profile likelihood method, the Markov chain Monte Carlo (MCMC) technique, and the extended Fourier Amplitude Sensitivity Test (eFAST). Our model predictions agreed well with experimental observations and suggested potential model improvement by incorporating a lipid degradation mechanism. The insights from our model-driven analysis helped improve the mechanistic understanding of transient algae growth and bioproducts formation under environmental variations and could be applied to optimize biofuel and biomass production.


Assuntos
Microalgas , Biomassa , Metabolismo dos Lipídeos , Lipídeos , Nitrogênio , Reprodutibilidade dos Testes
7.
J Chin Med Assoc ; 82(8): 628-634, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31305342

RESUMO

BACKGROUND: Previous studies have reported an increased risk of cavities in diabetic patients with pulmonary tuberculosis (PTB), which may be associated with poor glycemic control. Cavities have a negative impact on PTB treatment outcomes; however, the possible interaction of other potentially confounding diabetes-related variables regarding pulmonary cavities have not been fully evaluated. METHODS: We conducted a retrospective cohort study of diabetic patients with culture-proven PTB. The patients' chest X-rays (CXRs) and computed tomography (CT) scans were reviewed to assess the effects of clinical factors, glycosylated hemoglobin (HbA1c) levels, and antidiabetic agents on cavitary lesions. RESULTS: Among 128 diabetic PTB patients, those with pulmonary cavities on CXRs and CT scans presented younger ages, lack of metformin treatment, and significantly higher HbA1c levels than those without cavities. Multivariate logistic regression analysis revealed significantly higher HbA1c levels in patients with cavities than in those without cavities on CXRs (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.12-1.61) and CT scans (OR, 1.36; 95% CI, 1.13-1.64). Patients with multiple cavities had significantly higher HbA1c levels than those with a single cavity on CT scans (p = 0.002). No significant differences in other variables, including metformin treatment, were noted between the groups. CONCLUSION: This study suggests that despite multiple potential confounding variables, including metformin use, poor glycemic control is still the dominant risk factor for cavitary lesions in diabetic patients with PTB. Efforts to improve glycemic control in diabetic PTB patients may be of considerable value in facilitating antimycobacterial treatment.

8.
J Clin Med ; 8(5)2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31108871

RESUMO

BACKGROUND: Lung cancer misdiagnosed as tuberculosis (TB) is not rare, but the factors associated with early diagnosis revision remain unclear. METHODS: We screened the cases with TB notification from 2007 to 2018 and reviewed those with misdiagnosis with a revised diagnosis to lung cancer. We analyzed the factors associated with early diagnosis revision (≤1 months) and early obtained pathology (≤1 months) using multivariable Cox regression. RESULTS: During the study period, 45 (0.7%) of 6683 patients were initially notified as having TB, but later diagnosed with lung cancer. The reasons for the original impression of TB were mostly due to image suspicion (51%) and positive sputum acid-fast stain (AFS) (27%). Using multivariable Cox proportional regression, early diagnosis revision was associated with obtaining the pathology early, lack of anti-TB treatment, and negative sputum AFS. Furthermore, the predictors for early obtained pathology included large lesion size (>3 cm), presence of a miliary radiological pattern, no anti-TB treatment, and a culture-negative result when testing for nontuberculous mycobacteria (NTM) using multivariable Cox regression. CONCLUSION: In patients who are suspected to have TB but no mycobacterial evidence is present, lung cancer should be kept in mind and pathology needs to be obtained early, especially for those with small lesions, radiological findings other than the miliary pattern, and a culture positive for NTM.

9.
Medicine (Baltimore) ; 98(8): e14463, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813149

RESUMO

BACKGROUND: Complications related to concurrent chemoradiotherapy (CCRT) such as acute radiation-induced esophagitis (ARIE) may cause significant morbidity and unplanned treatment delays in patients with advanced non-small cell lung cancer (NSCLC). We designed a prospective randomized study to assess the impact of glutamine (GLN) supplementation in preventing CCRT-induced toxicities of advanced NSCLC patients. METHODS: From September 2014 to September 2015, 60 patients diagnosed with NSCLC were included to the study. Thirty patients (50%) received prophylactic powdered GLN orally at a dose of 10 g/8 h. The prescribed radiation dose to the planning target volume was 30 Gy in 2-Gy fractions. The endpoints were radiation-induced esophagitis, mucositis, body weight loss, overall survival and progression-free survival. RESULTS: The 60 patients with NSCLC included 42 men and 18 women with a mean age ±â€Šstandard deviation of 60.3 years ±â€Š18.2 (range, 44-78 years).At a median follow-up of 26.4 months (range 10.4-32.2), all patients tolerated GLN well. A administration of GLN was associated with a decrease in the incidence of grade 2 or 3 ARIE (6.7% vs 53.4% for Gln+ vs Gln-; P = .004). GLN supplementation appeared to significantly delay ARIE onset for 5.8 days (18.2 days vs 12.4 days; P = .027) and reduced incidence of weight loss (20% vs 73.3%; P = .01). DISCUSSION: Our study suggests a beneficial effect of oral glutamine supplementation for the prevention from radiation-induced injury and body weight loss in advanced NSCLC patients who receiving CCRT.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Esofagite/prevenção & controle , Glutamina/administração & dosagem , Neoplasias Pulmonares/terapia , Lesões por Radiação/prevenção & controle , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Quimiorradioterapia/efeitos adversos , Suplementos Nutricionais , Esofagite/epidemiologia , Esofagite/etiologia , Feminino , Humanos , Incidência , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Lesões por Radiação/epidemiologia , Dosagem Radioterapêutica , Análise de Sobrevida
10.
Eur J Surg Oncol ; 45(2): 125-133, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30360987

RESUMO

BACKGROUND: The preliminary experience and learning curve of robotic nipple sparing mastectomy (R-NSM) in the management of breast cancer were analyzed and reported. METHODS: The medical records of patients who underwent R-NSM for breast cancer during the period of March 2017 to June 2018 were collected from the same surgeon in a single institute. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, and operation time were prospective collected. Learning curve of R-NSM was evaluated and analyzed by the cumulative sum (CUSUM) plot method. RESULTS: A total of 39 consecutive R-NSM procedures from 35 patients were analyzed. The time needed for "docking", "R-NSM", and "R-NSM and immediate prosthesis breast reconstruction (IPBR)" decreased after cases experience accumulated, and in mature phase procedures could finished within 10 min, 100mins, and 240 min, separately. In CUSUM plots analysis of learning curve, the cases needed to decrease operation time for "docking", "R-NSM", and "total time for R-NSM and IPBR" were 13th, 13th, and 12th procedures separately. Mastectomy weight and lymph node metastasis were factors related to operation time. The rate of total nipple areolar complex necrosis for R-NSM was 0%. One (2.9%, 1/35) R-NSM procedure was found to have positive margin involved in the final pathologic check-up. No implant loss, or local recurrence was observed during a mean follow-up of 8.6 ±â€¯4.5 (1.3-16.7) months. CONCLUSION: From our preliminary experience, R-NSM and IPBR (or R-NSM alone) is a safe procedure, and the operation time needed significantly decrease after cases experience accumulated.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/educação , Mastectomia/métodos , Mamilos , Procedimentos Cirúrgicos Robóticos/educação , Adulto , Idoso , Neoplasias da Mama/patologia , Competência Clínica , Feminino , Humanos , Curva de Aprendizado , Metástase Linfática , Mamoplastia/métodos , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Taiwan , Resultado do Tratamento
11.
Skinmed ; 16(6): 379-383, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30575505

RESUMO

Exposure to ultraviolet light is a recognized modifiable risk factor for melanoma. Melanoma patients were more likely to practice sun-protective behaviors after their diagnosis. But it is not known how long these sun-protective behaviors will sustain. We aim to evaluate if sun-protective behaviors and likelihood of recent sunburn differ according to time elapsed since the melanoma diagnosis using the U.S. National Health and Nutrition Examination Survey (NHANES) database. Data in the NHANES cycle years 2003-2006 and 2010-2012 were analyzed. The relationship of sun-protective behaviors and likelihood of sunburns with the time since a melanoma diagnosis was evaluated and also adjusted for possible confounding factors such as age, gender, and skin reaction to the sun. A total of 34 participants with previous melanoma provided responses to their current sun-protective behaviors and recent occurrence of sunburns. The control group consisted of 13,871 participants who never had any diagnoses of malignancies. The control and the non-recent diagnosis groups were more likely to have sunburns but less likely to engage in consistent sun-protective behaviors compared to the recent diagnosis group. A multivariate regression model showed a 1.17 increased odds of having a recent sunburn for each additional year elapsed since a melanoma diagnosis ( p = 0.046). In our study, those with a melanoma diagnosis in the non-recent past were more likely to have sunburns and less likely to sun protect. More can definitely be done to educate and cultivate sun-protective behaviors among the U.S. population.


Assuntos
Comportamentos Relacionados com a Saúde , Melanoma/prevenção & controle , Melanoma/psicologia , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Cutâneas/prevenção & controle , Neoplasias Cutâneas/psicologia , Queimadura Solar/prevenção & controle , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Inquéritos Nutricionais , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico
12.
Dalton Trans ; 47(43): 15565-15573, 2018 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-30346021

RESUMO

A series of five-membered ring aluminum complexes bearing thiol-Schiff base ligands were synthesized, and their application in the ring-opening polymerization of ε-caprolactone (CL) was investigated. The complexes exhibited dramatically higher catalytic activity than the six-membered ring S2AlMe2 complex (approximately 4- to 10-fold higher) and the five-membered ring L5-PhAlMe2 complex (approximately 7- to 19-fold higher). Moreover, a shorter induction period was observed when the five-membered ring aluminum complexes bearing thiol-Schiff base ligands were used compared with the other types of aluminum complexes bearing Schiff base ligands. The electron-withdrawing groups enhanced the catalytic activity of the Al complexes compared with the electron donating groups. The thiol-Schiff base ligand and the five-membered ring aluminum catalysis had a synergistic effect that was stronger than the combination of their individual effects.

13.
Medicine (Baltimore) ; 97(33): e11845, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30113476

RESUMO

Hip fracture is an important health care issue in the elderly. Postoperative pulmonary complications occur in 4% of patients after hip fracture surgery. However, previous research is limited regarding pulmonary rehabilitation in this group. In this study, we present clinical evidence regarding the impact of a comprehensive pulmonary rehabilitation program in elderly hip fracture patients after hip surgery.We designed a nonrandomized, Quasi-experimental study, comparing 2 sequential time periods in the same center. Elderly patients (≥65 years) with a new hip fracture from February 1, 2014 to December 31, 2015 and who were willing to undergo a postoperative pulmonary rehabilitation program were enrolled. The pulmonary rehabilitation program started on January 1, 2015. Patients who refused rehabilitation or did not receive a surgical intervention were excluded. Patients received either standard care (standard care group) or standard care plus the postoperative rehabilitation program (intervention group).A total of 240 patients (163 women and 77 men) were enrolled, including 138 in the standard care group and 102 in the intervention group. The intervention group had a significantly lower incidence of pneumonia (6 patients, 5.9%) compared to the standard care group (19 patients, 13.9%). An age >80 years, cancer status, and not undergoing the postoperative pulmonary rehabilitation program were factors associated with a higher risk of pneumonia. In multivariate analysis, age >80 years, history of stroke/cancer, thrombocytopenia, and hyperglycemia (>200 mg/dL) were identified as risk factors for pneumonia.The incidence of pneumonia was lower in the elderly patients with hip fractures who received the postoperative pulmonary rehabilitation program after surgery. This is the first trial to demonstrate the effect of a postoperative pulmonary rehabilitation program in hip surgery patients.


Assuntos
Artroscopia , Fraturas do Quadril/cirurgia , Pneumonia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Terapia Respiratória/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Pacientes Internados , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Pneumonia/epidemiologia , Pneumonia/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
15.
Int J Dermatol ; 57(5): 541-546, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29479666

RESUMO

INTRODUCTION: Rosacea is a common chronic facial skin disease. A multiethnic society such as Singapore provides an opportunity to evaluate the demographic characteristics and their impact on clinical outcome in rosacea. AIMS: The aim of this study was to evaluate characteristics and outcome of rosacea in a multiracial population in Singapore. METHODS: Records of all rosacea patients between January 2009 and December 2013 were retrospectively retrieved from the electronic medical records (EMR). Descriptive analysis was performed to understand the characteristics of patients with rosacea. Multivariate logistic regression was used to evaluate the associations between the various variables and types of rosacea as well as the clinical outcome. RESULTS: A total of 1340 patients were identified. The mean age at presentation was 42.8 years with a female predominance (65%). Most of the patients had erythematotelangiectatic rosacea (ETR) (56.3%) followed by papulopustular rosacea (PPR) (37%). With multinomial logistic regression, controlling for age, gender, and known triggers, Indians and Caucasians were more likely to have PPR compared to ETR (OR: 3.4, P = 0.01 and OR: 2.1, P = 0.01 respectively). Patients who had phymatous rosacea are also more likely to be older males (OR: 3.82 95% CI 1.64-8.92, P = 0.002). CONCLUSION: The epidemiology and outcome of rosacea among local patients were studied. Rosacea is more common among certain racial groups such as Chinese, Caucasian, and other races. The clinical subtypes also seem to be related to races of certain skin colors and might be related to varied natural intrinsic responses to the sun among different racial groups.


Assuntos
Dermatoses Faciais/diagnóstico , Dermatoses Faciais/epidemiologia , Rosácea/diagnóstico , Rosácea/epidemiologia , Adulto , Distribuição por Idade , Idoso , Anti-Infecciosos/uso terapêutico , Estudos de Coortes , Grupos de Populações Continentais , Bases de Dados Factuais , Gerenciamento Clínico , Dermatoses Faciais/tratamento farmacológico , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Rosácea/tratamento farmacológico , Índice de Gravidade de Doença , Distribuição por Sexo , Singapura/epidemiologia , Centros de Atenção Terciária
16.
Asia Pac J Clin Oncol ; 14(5): e283-e288, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29124886

RESUMO

AIM: Lung cancer is typically categorized into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC comprises of the majority of lung cancer with a poor prognosis in advanced cases. Transcriptional profiling studies, including microarrays and RNA-sequencing studies, have significantly enriched our knowledge of gene expression patterns in NSCLC. A recent transcriptional profiling study identified high prevalence of CBX3/HP1-gamma upregulation in human NSCLC samples. CBX3/HP1-gamma is an isoform of the heterochromatin protein 1 family, which plays a role in heterochromatin formation and is linked to cancer. METHODS: We examined lung cancer samples from our hospital using immunohistochemistry for CBX3/HP1-gamma staining. We also analyzed publicly available databases of NSCLC transcriptional profiling to validate our results. RESULTS: We identified a high prevalence (77.2%) of samples with positive CBX3/HP1-gamma staining by immunohistochemistry in NSCLC patient samples. Independently, we queried a publicly available dataset (GSE40419) containing RNA-seq data from 77 patients. Upregulation of CBX3/HP1-gamma in tumor samples was present in 60.2% of the patients. A similar correlation was also observed in the The Cancer Genome Atlas (TCGA) database. Interestingly, we discovered a highly significant association between positive CBX3/HP1-gamma staining and EGFR mutation in our patient samples (40 of 42 patients, P < 0.001). Treatment of EGFR mutant NSCLC cell lines with the EGFR inhibitor gefitinib failed to yield a change in CBX/HP1-gamma expression, suggesting that CBX/HP1-gamma expression may be independent of EGFR downstream signaling. CONCLUSION: We report a significant upregulation of CBX3/HP1-gamma in NSCLC patients, and also a possible relationship between CBX3/HP1-gamma expression and EGFR mutation.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/metabolismo , Proteínas Cromossômicas não Histona/biossíntese , Neoplasias Pulmonares/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Receptores ErbB/genética , Feminino , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Mutação , Regulação para Cima
17.
PLoS One ; 12(10): e0187032, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29073254

RESUMO

INTRODUCTION: This study aimed to determine the effect of combining positive airway pressure (PAP) therapy and mandibular advancement device (MAD) in patients with severe obstructive sleep apnea (OSA) who were pressure intolerant for PAP and were unresponsive to MAD. METHODS: This retrospective study reviewed the medical records of severe OSA patients with apnea-hypopnea index (AHI) ≥ 30/hr who were diagnosed between October 1, 2008 and June 30, 2014. Patients were initially treated with 2 weeks of PAP, and those who were intolerant to high-pressure PAP (≥15 cm H2O) were switched to 12 weeks of MAD, which is a monobloc designed at 75% of maximum protrusion. Patients who had high residual AHI (≥15/hr) on MAD underwent 12 weeks of combination therapy (CT) with MAD and CPAP and were enrolled in the present study. Enrolled subjects who completed the 12-week CT were followed-up until June 30, 2016. RESULTS: A total of 14 male patients were included. All three treatments effectively reduced AHI, oxygen desaturation index (ODI), and total sleep time with SpO2 <90% (% TST-SpO2<90%) compared to pretreatment values. The residual AHI and ODI on CT was lower than that on MAD or PAP. The residual % TST-SpO2<90% was lower than that on MAD and similar to that on PAP. The therapeutic pressure on CT was on average 9.2 cm H2O lower than that on PAP. For the 11 patients who completed CT, only CT reduced ESS compared to pretreatment value. No treatment had significant impact on % slow wave sleep or overnight change of blood pressure. For patients who completed CT, the average usage was 5.9±1.7 hr/night at 12th week and 6.4±1.5 hr/night at a median follow-up of 36.5-months. CONCLUSIONS: Combining MAD and CPAP showed additive effects on reducing AHI and ODI, and lowered the therapeutic pressures.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Avanço Mandibular/instrumentação , Apneia Obstrutiva do Sono/terapia , Pressão Sanguínea , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico por imagem , Apneia Obstrutiva do Sono/fisiopatologia , Tomografia Computadorizada por Raios X , Falha de Tratamento
18.
ACS Appl Mater Interfaces ; 9(40): 35279-35286, 2017 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-28891282

RESUMO

This study developed flexible light-emitting diodes (LEDs) with warm white and neutral white light. A simple ultraviolet flip-chip sticking process was adopted for the pumping source and combined with polymer and quantum dot (QD) films technology to yield white light. The polymer-blended flexible LEDs exhibited higher luminous efficiency than the QD-blended flexible LEDs. Moreover, the polymer-blended LEDs achieved excellent color-rendering index (CRI) values (Ra = 96 and R9 = 96), with high reliability, demonstrating high suitability for special applications like accent, down, or retrofit lights in the future. In places such as a museum, kitchen, or surgery room, its high R9 and high CRI characteristics can provide high-quality services.

19.
PLoS One ; 12(6): e0179750, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28628646

RESUMO

SETTING: Diabetes mellitus (DM) may increase risk of pulmonary tuberculosis (PTB) and influence its radiological manifestations. OBJECTIVE: To evaluate the impact of glycemic status on radiological findings of PTB in diabetic patients. METHODS: Between January 2010 and December 2015, chest radiographs (CXRs) in consecutive 214 DM patients with culture-proved PTB and 123 available thoracic computed tomography (CT) scans were enrolled. An equal number of non-DM patients with similar demographics was included as the control group. Glycemic status was assessed by glycosylated hemoglobin (HbA1c), and a cutoff of 8% was used to further investigate radiological features of diabetic PTB. Two radiologists and one pulmonologist reviewed the chest images independently. RESULTS: Compared with non-DM patients, primary PTB pattern and extensive disease on CXRs as well as primary PTB pattern, large non-cavitary nodule, more than one cavity in a single lesion, unusual location, and all lobe involvement of lesions on thoracic CT scans were more common in DM patients. Furthermore, diabetics with HbA1c > 8% were more likely to exhibit unusual findings (P < 0.001), far advanced extensive lesions (P < 0.001) on CXRs, lymphadenopathy (P = 0.028), more than one cavity in a single lesion (P < 0.001) and all lobe involvement (P = 0.041) on thoracic CT scans. CONCLUSIONS: Glycemic status influenced radiological manifestations of diabetic PTB. Given an increased risk of atypical radiological presentations of PTB in DM patients, physicians should be alert and pay more attention to those with poor glycemic control.


Assuntos
Diabetes Mellitus Tipo 2/patologia , Hemoglobina A Glicada/análise , Tuberculose Pulmonar/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico por imagem , Adulto Jovem
20.
J Vis Exp ; (124)2017 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-28654054

RESUMO

The optimal design and operation of photosynthetic bioreactors (PBRs) for microalgal cultivation is essential for improving the environmental and economic performance of microalgae-based biofuel production. Models that estimate microalgal growth under different conditions can help to optimize PBR design and operation. To be effective, the growth parameters used in these models must be accurately determined. Algal growth experiments are often constrained by the dynamic nature of the culture environment, and control systems are needed to accurately determine the kinetic parameters. The first step in setting up a controlled batch experiment is live data acquisition and monitoring. This protocol outlines a process for the assembly and operation of a bench-scale photosynthetic bioreactor that can be used to conduct microalgal growth experiments. This protocol describes how to size and assemble a flat-plate, bench-scale PBR from acrylic. It also details how to configure a PBR with continuous pH, light, and temperature monitoring using a data acquisition and control unit, analog sensors, and open-source data acquisition software.


Assuntos
Reatores Biológicos/microbiologia , Luz , Microalgas/crescimento & desenvolvimento , Modelos Biológicos , Fotossíntese , Temperatura , Biocombustíveis , Concentração de Íons de Hidrogênio , Cinética
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