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1.
J Am Heart Assoc ; 9(8): e015069, 2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-32299291

RESUMO

Background It is unclear how recurrent pregnancy loss (RPL) impacts disease risk and whether there is a difference in risk between women with or without a live birth before RPL (primary versus secondary RPL). We investigated the disease risk following RPL, and whether there was a difference between primary and secondary RPL. Methods and Results Using population-wide healthcare registries from Denmark, we identified a cohort of 1 370 896 ever-pregnant women aged 12 to 40 years between 1977 and 2016. Of this cohort, 10 691 (0.77%) fulfilled the criteria for RPL (50.0% primary RPL). Average follow-up was 15.8 years. Incidence rate ratios were calculated in a phenome-wide manner. Diagnoses related to assessment and diagnosis of RPL and those appearing later in life were separated using a mixture model. Primary RPL increased the risk of subsequent cardiovascular disorders, including atherosclerosis, cerebral infarction, heart failure, and pulmonary embolism, as well as systemic lupus erythematosus, chronic obstructive pulmonary disease, anxiety, and obsessive-compulsive disorder. Women with secondary RPL had no increased risk of cardiovascular disorders. However, we observed an increased risk of gastrointestinal disorders such as irritable bowel syndrome and intestinal malabsorption, as well as mental disorders and obstetric complications. Conclusions RPL is a risk factor for a spectrum of disorders, which is different for primary and secondary RPL. Screening following RPL explains some associations, but the remaining findings suggest that RPL influences or shares cause with cardiovascular disorders, autoimmune disorders, and mental disorders. Research into the pathophysiology of RPL and later diseases merits further investigation.

2.
Eur Urol Oncol ; 3(1): 73-79, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31591037

RESUMO

BACKGROUND: Presence of lymph node metastases (LNM) is an important prognostic factor for cancer-specific survival (CSS) in patients with upper tract urothelial carcinoma (UTUC). In various neoplasms, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) is an established modality for preoperative lymph node (LN) staging. In UTUC, the diagnostic value of FDG-PET/CT for LN staging is unknown. OBJECTIVE: To determine the diagnostic value of FDG-PET/CT for LN staging in patients with UTUC. DESIGN, SETTING, AND PARTICIPANTS: Data of 152 patients with UTUC who underwent FDG-PET/CT followed by surgical treatment in eight centers between 2007 and 2017 were retrospectively collected. Patients receiving neoadjuvant chemotherapy were excluded. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: FDG-PET/CT results were compared with histopathology after lymph node dissection (LND). Recurrence-free survival (RFS), CSS, and overall survival (OS) were analyzed using Kaplan-Meier estimates, and compared for patients with and without suspicious LNs on FDG-PET/CT. RESULTS AND LIMITATIONS: We included 117 patients, of whom 62 underwent LND. Seventeen patients had LNM at histopathological evaluation. Sensitivity and specificity of FDG-PET/CT for diagnosis of LNM were 82% (95% confidence interval [CI]: 57-96) and 84% (95% CI: 71-94), respectively. RFS was significantly worse in patients with LN-positive FDG-PET/CT than in those with LN-negative FDG-PET/CT (p=0.03). CSS (p=0.11) and OS (p=0.5) were similar between groups. This study is limited by its retrospective design and by its sample size. Our results warrant further validation. CONCLUSIONS: FDG-PET/CT has 82% sensitivity and 84% specificity for the detection of LNM in patients with UTUC. Presence of suspicious LNs on FDG-PET/CT is associated with worse RFS. PATIENT SUMMARY: In patients with upper tract urothelial cancer, positron emission tomography with computed tomography (PET/CT) scans can detect lymph node metastases with noteworthy accuracy. Presence of suspicious lymph nodes on 18F-fluorodeoxyglucose PET/CT is associated with worse recurrence-free survival.

3.
Urology ; 137: 91-96, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31843623

RESUMO

OBJECTIVE: To examine whether photodynamic diagnosis (PDD) in addition to flexible cystoscopy in the outpatient clinic can reduce risk of tumor recurrence in patients with previous nonmuscle invasive bladder cancer. PDD is an optical technique that enhances the visibility of pathologic tissue and helps guidance tumor resection. METHODS: From February 2016 to December 2017, 699 patients from 3 urologic departments in Denmark were enrolled in a randomized controlled trial. Four months after transurethral resection of bladder tumor patients were randomized 1:1 to either an intervention group (hexaminolevulinate was instilled in the bladder before flexible cystoscopy with PDD video cystoscope) or a control group (white light flexible cystoscope), only. Primary endpoint was tumor recurrence within 8 months from the randomization. Secondary outcomes were numbers of procedures in general anesthesia, time to the first recurrence, differences in tumor size, risk of tumor progression, and identification of carcinoma in situ. RESULTS: A total of 351 patients were allocated to the intervention group (flexible PDD), and 348 to the control group (flexible white light). Throughout the following 8 months after randomization, only 117 patients in the intervention group had at least 1 tumor recurrence compared to 143 patients in the control group (P = .049). Odds ratio of 0.67 (P = .02, 95% CI: 0.48-0.95) correlates with a tumor reduction of 33% in favor of the intervention group. CONCLUSION: Use of PDD in a routine surveillance cystoscopy first time after transurethral resection of bladder tumor for nonmuscle invasive bladder cancer reduces subsequent risk of tumor recurrence compared to WL cystoscopy alone.


Assuntos
Ácido Aminolevulínico/análogos & derivados , Carcinoma in Situ , Cistoscopia , Recidiva Local de Neoplasia , Neoplasias da Bexiga Urinária , Bexiga Urinária/diagnóstico por imagem , Idoso , Ácido Aminolevulínico/farmacologia , Carcinoma in Situ/patologia , Carcinoma in Situ/cirurgia , Cistoscopia/instrumentação , Cistoscopia/métodos , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Fármacos Fotossensibilizantes/farmacologia , Reprodutibilidade dos Testes , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
4.
Artigo em Inglês | MEDLINE | ID: mdl-31821017

RESUMO

Traditional microfabrication techniques suffer from several disadvantages, including the inability to create truly three-dimensional (3D) architectures, expensive and time-consuming processes when changing device designs, and difficulty in transitioning from prototyping fabrication to bulk manufacturing. 3D printing is an emerging technique that could overcome these disadvantages. While most 3D printed fluidic devices and features to date have been on the millifluidic size scale, some truly microfluidic devices have been shown. Currently, stereolithography is the most promising approach for routine creation of microfluidic structures, but several approaches under development also have potential. Microfluidic 3D printing is still in an early stage, similar to where polydimethylsiloxane was two decades ago. With additional work to advance printer hardware and software control, expand and improve resin and printing material selections, and realize additional applications for 3D printed devices, we foresee 3D printing becoming the dominant microfluidic fabrication method. Expected final online publication date for the Annual Review of Analytical Chemistry, Volume 13 is June 12, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

5.
Sex Transm Infect ; 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31628248

RESUMO

An estimated 350 million cases of STIs occur globally each year. In Sweden, Chlamydia is the most common STI with approximately 30 000 cases annually, disproportionally affecting youth. National surveys report low condom use among youth. Smartphone coverage is high among this tech-savvy group. In collaboration with youth, we developed an interactive smartphone application comprising games, peer experiences and information snippets to promote condom use. OBJECTIVES: To evaluate in a randomised controlled trial, the effectiveness of this smartphone application to improve condom use among youth in Stockholm, Sweden. METHODS: This two-arm, individually randomised controlled trial was implemented through the Youth Health Clinics (YHC) in Stockholm, Sweden. Youth aged 18-23 years, who owned a smartphone and had ≥2 sexual partners during the past 6 months were eligible. The intervention delivered the interactive elements described above over 180 days. The control group received a 'dummy' application. Both groups received standard of care at the YHC. The primary outcome was proportion of consistent (100%) self-reported condom use at 6 months. Secondary outcomes included self-reported number of partners, occurrence of STIs/pregnancy and STI tests during the study period. An intention-to-treat approach was used. RESULTS: 214 and 219 youth were randomised to the intervention and control groups, respectively. Consistent condom use was reported for 32/214 (15.0%) in the intervention group and for 35/219 (16.0%) in the control group (OR 0.9, 95% CI 0.5 to 1.6). No significant differences in secondary outcomes were seen. CONCLUSION: We were unable to detect an effect of the intervention. Future research should focus on targeting different subgroups within the overall risk group, with tailored mHealth interventions. The potential for such interventions in settings where sexual health services are unavailable should be evaluated. TRIAL REGISTRATION NUMBER: ISRCTN13212899.

6.
Electrophoresis ; 40(21): 2853-2859, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31373007

RESUMO

Preterm birth (PTB) related health problems take over one million lives each year, and currently, no clinical analysis is available to determine if a fetus is at risk for PTB. Here, we describe the preparation of a key PTB risk biomarker, thrombin-antithrombin (TAT), and characterize it using dot blots, MS, and microchip electrophoresis (µCE). The pH for fluorescently labeling TAT was also optimized using spectrofluorometry and spectrophotometry. The LOD of TAT was measured in µCE. Lastly, TAT was combined with six other PTB risk biomarkers and separated in µCE. The ability to make and characterize TAT is an important step toward the development of an integrated microfluidic diagnostic for PTB risk.

7.
Anal Chem ; 91(11): 7418-7425, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31056901

RESUMO

This work demonstrates for the first time the creation of microchip electrophoresis devices with ∼50 µm cross-sectional dimensions by stereolithographic 3D printing and their application in the analysis of medically significant biomarkers related to risk for preterm birth (PTB). We determined that device current was linear with applied potential up to 800 V (620 V/cm). We optimized device and separation conditions using fluorescently labeled amino acids as a model system and compared the performance in our 3D printed microfluidic devices to that in other device materials commonly used for microchip electrophoresis analysis. We demonstrated for the first time microchip electrophoresis in a 3D printed device of three PTB biomarkers, including peptides and a protein, with suitable separation characteristics. Limits of detection for microchip electrophoresis in 3D printed microfluidic devices were also determined for PTB biomarkers to be in the high picomolar to low nanomolar range.

8.
Methods Mol Biol ; 1972: 175-184, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30847791

RESUMO

An unmet need exists for a clinical diagnostic to determine preterm birth (PTB) risk. Such an assessment is possible with high sensitivity and specificity using a panel of nine biomarkers. An integrated microfluidic analysis system for these biomarkers is being developed which includes microchip electrophoresis (µCE) separation. A t-shaped microchip device can be used to test the µCE portion of this integrated system to find appropriate separation conditions. These t-shaped microchips can be fabricated using photolithographically patterned Si templates and hot embossing. PTB biomarkers can be fluorescently labeled using an amine-reactive dye prior to µCE. The µCE conditions established using this t-shaped device should be useful in developing a complete integrated microfluidic system for PTB risk assessment.


Assuntos
Biomarcadores/análise , Eletroforese em Microchip/instrumentação , Eletroforese em Microchip/métodos , Corantes Fluorescentes/química , Nascimento Prematuro/diagnóstico , Eletrodos , Humanos , Silício/química
9.
Psychiatry Res ; 279: 155-171, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30878305

RESUMO

Bulimia Nervosa (BN) is a serious eating disorder, which affects 0.8-2.9% of the young population. The etiology is unknown and biomarkers would support in understanding the pathophysiology of BN, and in identifying BN patients that may benefit from medical treatment. This systematic review aims to answer whether (a) BN deviate from healthy controls in terms of serotonin (5-HT) biomarkers in blood, and whether (b) blood-based 5-HT biomarkers could be used to tailor psychopharmacological treatment in BN. A literature search using PubMed, PsycINFO and Embase was done using the following search terms: "Bulimia Nervosa" AND "serotonin" AND "blood" OR "plasma" OR "serum". 32 studies were included in this systematic review. Several biomarkers and challenge tests were identified and all studies described an association with BN and dysregulation of the 5-HT system compared to healthy controls. Several studies pointed to an association also to borderline symptoms in BN. BN deviate from healthy controls in terms of 5-HT biomarkers in blood supporting an abnormal 5-HT system in BN. 5-HT biomarkers and associated methods could be used to tailor treatment in BN although as yet, most tests described are unpractical for bedside use.

10.
Anal Bioanal Chem ; 411(21): 5405-5413, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30382326

RESUMO

Preterm birth (PTB) is defined as birth before the 37th week of pregnancy and results in 15 million early deliveries worldwide every year. Presently, there is no clinical test to determine PTB risk; however, a panel of nine biomarkers found in maternal blood serum has predictive power for a subsequent PTB. A significant step in creating a clinical diagnostic for PTB is designing an automated method to extract and purify these biomarkers from blood serum. Here, microfluidic devices with 45 µm × 50 µm cross-section channels were 3D printed with a built-in polymerization window to allow a glycidyl methacrylate monolith to be site-specifically polymerized within the channel. This monolith was then used as a solid support to attach antibodies for PTB biomarker extraction. Using these functionalized monoliths, it was possible to selectively extract a PTB biomarker, ferritin, from buffer and a human blood serum matrix. This is the first demonstration of monolith formation in a 3D printed microfluidic device for immunoaffinity extraction. Notably, this work is a crucial first step toward developing a 3D printed microfluidic clinical diagnostic for PTB risk.


Assuntos
Dispositivos Lab-On-A-Chip , Gravidez/sangue , Nascimento Prematuro , Impressão Tridimensional/instrumentação , Biomarcadores/sangue , Feminino , Humanos , Recém-Nascido , Polimerização
11.
Electrophoresis ; 39(18): 2300-2307, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29683528

RESUMO

Preterm birth (PTB) is responsible for over one million infant deaths annually worldwide. Often, the first and only indication of PTB risk is the onset of early labor. Thus, there is an urgent need for an early PTB risk diagnostic that is inexpensive, reliable, and robust. Here, we describe the development of a microchip electrophoresis (µCE) method for separating a mixture of six PTB protein and peptide biomarkers present in maternal blood serum. µCE devices were photografted with a poly(ethylene glycol) diacrylate surface coating to regulate EOF and reduce nonspecific analyte adsorption. Separation conditions including buffer pH, buffer concentration, and applied electric field were varied to improve biomarker peak resolution while minimizing deleterious effects like Joule heating. In this way, it was possible to separate six PTB biomarkers, the first µCE separation of this biomarker panel. LODs were also measured for each of the six PTB biomarkers. In the future, this µCE separation can be integrated with upstream maternal blood serum sample preparation steps to yield a complete PTB risk diagnosis microdevice.


Assuntos
Biomarcadores/sangue , Proteínas Sanguíneas/análise , Eletroforese em Microchip/métodos , Peptídeos/sangue , Nascimento Prematuro/sangue , Feminino , Humanos , Concentração de Íons de Hidrogênio , Limite de Detecção , Polietilenoglicóis/química , Gravidez , Soro/química , Propriedades de Superfície
12.
BMC Public Health ; 18(1): 216, 2018 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-29402241

RESUMO

BACKGROUND: Genital Chlamydia trachomatis infection is a major public health problem worldwide affecting mostly youth. Sweden introduced an opportunistic screening approach in 1982 accompanied by treatment, partner notification and case reporting. After an initial decline in infection rate till the mid-90s, the number of reported cases has increased over the last two decades and has now stabilized at a high level of 37,000 reported cases in Sweden per year (85% of cases in youth). Sexual risk-taking among youth is also reported to have significantly increased over the last 20 years. Mobile health (mHealth) interventions could be particularly suitable for youth and sexual health promotion as the intervention is delivered in a familiar and discrete way to a tech savvy at-risk population. This paper presents a protocol for a randomized trial to study the effect of an interactive mHealth application (app) on condom use among the youth of Stockholm. METHODS: 446 youth resident in Stockholm, will be recruited in this two arm parallel group individually randomized trial. Recruitment will be from Youth Health Clinics or via the trial website. Participants will be randomized to receive either the intervention (which comprises an interactive app on safe sexual health that will be installed on their smart phones) or a control group (standard of care). Youth will be followed up for 6 months, with questionnaire responses submitted periodically via the app. Self-reported condom use over 6 months will be the primary outcome. Secondary outcomes will include presence of an infection, Chlamydia tests during the study period and proxy markers of safe sex. Analysis is by intention to treat. DISCUSSION: This trial exploits the high mobile phone usage among youth to provide a phone app intervention in the area of sexual health. If successful, the results will have implications for health service delivery and health promotion among the youth. From a methodological perspective, this trial is expected to provide information on the strength and challenges of implementing a partially app (internet) based trial in this context. TRIAL REGISTRATION: ISRCTN 13212899, date of registration June 22, 2017.


Assuntos
Preservativos/estatística & dados numéricos , Promoção da Saúde/métodos , Aplicativos Móveis , Sexo Seguro , Comportamento Sexual/psicologia , Saúde Sexual , Telemedicina , Adolescente , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/prevenção & controle , Protocolos Clínicos , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Assunção de Riscos , Smartphone , Suécia/epidemiologia , Adulto Jovem
13.
Anal Bioanal Chem ; 410(3): 933-941, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28799040

RESUMO

We have developed multichannel integrated microfluidic devices for automated preconcentration, labeling, purification, and separation of preterm birth (PTB) biomarkers. We fabricated multilayer poly(dimethylsiloxane)-cyclic olefin copolymer (PDMS-COC) devices that perform solid-phase extraction (SPE) and microchip electrophoresis (µCE) for automated PTB biomarker analysis. The PDMS control layer had a peristaltic pump and pneumatic valves for flow control, while the PDMS fluidic layer had five input reservoirs connected to microchannels and a µCE system. The COC layers had a reversed-phase octyl methacrylate porous polymer monolith for SPE and fluorescent labeling of PTB biomarkers. We determined µCE conditions for two PTB biomarkers, ferritin (Fer) and corticotropin-releasing factor (CRF). We used these integrated microfluidic devices to preconcentrate and purify off-chip-labeled Fer and CRF in an automated fashion. Finally, we performed a fully automated on-chip analysis of unlabeled PTB biomarkers, involving SPE, labeling, and µCE separation with 1 h total analysis time. These integrated systems have strong potential to be combined with upstream immunoaffinity extraction, offering a compact sample-to-answer biomarker analysis platform. Graphical abstract Pressure-actuated integrated microfluidic devices have been developed for automated solid-phase extraction, fluorescent labeling, and microchip electrophoresis of preterm birth biomarkers.


Assuntos
Hormônio Liberador da Corticotropina/análise , Eletroforese em Microchip/instrumentação , Ferritinas/análise , Nascimento Prematuro/diagnóstico , Extração em Fase Sólida/instrumentação , Biomarcadores/análise , Hormônio Liberador da Corticotropina/sangue , Eletroforese em Microchip/métodos , Desenho de Equipamento , Ferritinas/sangue , Corantes Fluorescentes/análise , Humanos , Nascimento Prematuro/sangue , Extração em Fase Sólida/métodos
14.
BMC Health Serv Res ; 17(1): 730, 2017 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-29141635

RESUMO

BACKGROUND: Chlamydia trachomatis testing is offered to youth in Sweden, through a network of Youth Health Clinics, free at the point of care, in an attempt to bring down the prevalence and incidence of the infection. Nevertheless, infections rates have continued to rise during the past two decades and re-testing rates among youth for Chlamydia trachomatis has been reported to be high in Stockholm County. A few literature reports suggest that testing for sexually transmitted infections and the test result itself can have an undesirable impact on the sexual behaviour for the individual, i.e. increase sexual risk-taking. METHODS: This qualitative study aimed to explore the motives for repeated testing for Chlamydia trachomatis among youth using the services of the Youth Health Clinics in Stockholm, and how testing affects their subsequent risk-taking. We interviewed 15 repeat testers aging 18-22 years. RESULTS: Our main findings were that the fear of social stigma related to infecting a peer was a major driver of the re-testing process. The repetitive testing process, the test result, and the encounter with personnel did not decrease sexual risk-taking among this group. CONCLUSIONS: While testing and treatment services are an important part of Chlamydia trachomatis prevention it must not take the focus away from primary prevention strategies. Testing should be encouraged, but not to the exclusion of risk reduction measures. The testing services must be complemented with stronger emphasis on safe sex, especially for those who attend the clinics repeatedly, otherwise the easy accessible testing services risk counteracting its own purpose. Future research should focus on developing and evaluating youth appropriate interventions to increase condom use, taking into consideration factors which youth perceive as important to drive this behaviour change.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Parceiros Sexuais/psicologia , Sexo sem Proteção/psicologia , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/prevenção & controle , Busca de Comunicante , Cultura , Feminino , Humanos , Incidência , Masculino , Motivação , Grupo Associado , Prevalência , Pesquisa Qualitativa , Estigma Social , Suécia/epidemiologia , Adulto Jovem
15.
Analyst ; 143(1): 224-231, 2017 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-29136068

RESUMO

Biomarkers are often present in complex biological fluids like blood, requiring multiple, slow sample preparation steps that pose limitations in simplifying analysis. Here we report integrated immunoaffinity extraction and separation devices for analysis of preterm birth biomarkers in a human blood serum matrix. A reactive polymer monolith was used for immobilization of antibodies for selective extraction of target preterm birth biomarkers. Microfluidic immunoaffinity extraction protocols were optimized and then integrated with microchip electrophoresis for separation. Using these integrated devices, a ∼30 min analysis was carried out on low nanomolar concentrations of two preterm birth biomarkers spiked in a human serum matrix. This work is a promising step towards the development of an automated, integrated platform for determination of preterm birth risk.


Assuntos
Biomarcadores/sangue , Eletroforese em Microchip , Dispositivos Lab-On-A-Chip , Nascimento Prematuro , Anticorpos Imobilizados , Feminino , Humanos , Recém-Nascido , Gravidez
16.
Scand J Urol ; 51(2): 120-123, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28266904

RESUMO

OBJECTIVE: This multicenter study investigated whether the use of narrow-band imaging (NBI) in flexible cystoscopy could improve diagnostics to a degree where clinical management was relevantly changed. MATERIALS AND METHODS: From May 2014 to June 2015, 955 patients were enrolled at three Danish urological departments. Patients had either hematuria (n = 483) or known recurrent non-muscle-invasive bladder cancer (NMIBC) (n = 472). High-definition (HD) cystoscopy was performed in white light (WL) and a preliminary clinical decision was made. Then, a second cystoscopy was performed in NBI and a conclusive clinical decision was made. A difference between the two decisions that had a clinical impact on the patient was considered clinically relevant. RESULTS: Pathology was found in 216 WL cystoscopies, and additional pathology in 15 NBI cystoscopies (6.9%). Based on NBI, pathology was suspected in 23 patients (3.1%) in whom a WL cystoscopy revealed no tumor. In total, NBI changed the clinical decision relevantly in 1.9% of the patients. In hematuria patients, the calculated sensitivities of both NBI and WL were identically high, whereas sensitivity in patients with known NMIBC was significantly higher in NBI compared to WL (NBI: 100.0% vs WL: 83.2%, p < .05). NBI had a lower specificity compared to WL, especially in follow-up cystoscopies (NBI: 86.5% vs WL: 92.1, p < .05). CONCLUSION: NBI can be a useful tool in clinical decision making as a supplement to WL because it yields a significantly higher detection rate than WL cystoscopy alone. This is particularly relevant in patients with known recurrent NMIBC.


Assuntos
Cistoscopia/métodos , Hematúria/diagnóstico por imagem , Imagem de Banda Estreita , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Hematúria/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Sensibilidade e Especificidade , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/patologia , Adulto Jovem
17.
Urology ; 102: 138-142, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27894979

RESUMO

OBJECTIVE: To compare findings in NBI to findings in WL and PDD in a high-risk patient population. MATERIALS AND METHODS: A total of 171 patients were included in the study from 4 different urology departments in Denmark and Norway. Patients were scheduled for a PDD-guided transurethral tumor resection or cystoscopy-guided biopsy in accordance with Danish guidelines, on the suspicion of primary or concomitant CIS. All patients were examined with WL cystoscopy followed by both NBI and PDD before biopsy. RESULTS: A total of 136 patients were biopsied due to findings with suspicion of CIS in at least 1 modality (482 biopsies with a mean of 3.5 biopsies per patient). Analysis at patient level showed that NBI and PDD had a significantly higher sensitivity regarding identification of CIS and dysplasia compared with WL (NBI: 95.7%, PDD: 95.7% vs WL: 65.2%, P < .05). Specificity was not significantly different between the 3 methods (NBI: 52.0%, PDD: 48.0%, and WL: 56.8%). When analyzed per biopsy, NBI and PDD had a significantly higher sensitivity than WL (NBI: 72.7% and PDD: 78.2% vs WL: 52.7%, P < .05), whereas the positive predictive values were not significantly different (NBI: 23.7%, PDD: 22.2%, and WL: 19.0%). CONCLUSION: NBI was found to be a valid alternative to PDD regarding diagnosis of CIS and flat dysplasia.


Assuntos
Carcinoma in Situ/diagnóstico por imagem , Carcinoma in Situ/cirurgia , Cistectomia , Cistoscopia , Luz , Imagem de Banda Estreita , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Uretra , Adulto Jovem
18.
PLoS One ; 11(9): e0163597, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27676175

RESUMO

BACKGROUND: Widespread testing and screening for genital Chlamydia trachomatis is often advocated as an important method to halt the epidemic. Sweden has long tradition of opportunistic screening services. Nevertheless infections rates have continued to rise over the past two decades, despite increased access to testing and treatment services. METHODS: In this retrospective cohort study we describe the testing behavior for genital Chlamydia trachomatis among youth in Stockholm County, with a focus on repeated testing. Specifically we (a) study positivity rates among single and repeat testers, we (b) estimate the incidence of repeat testing and the rates of infection in repeat testing episodes, and we (c) estimate time to repeat testing and factors associated with repeat testing. All youth (aged ≥12 and <26) that tested for Chlamydia trachomatis in one of 33 Youth Health Clinics in Stockholm County between 1 January 2010 and 31 December 2012 were included in the study. RESULTS: The cohort comprised a total of 65,951 individuals who did 119,699 tests during the study period. 42% of youth were repeat testers, the incidence of repeat testing was 35.0/100 person years. The overall baseline prevalence was 7.9%. Positivity rates of baseline tests among repeat testers were nearly twice as high among single testers of either sex. These were 17.1% and 9.8% among male repeat and single testers respectively. The corresponding rates for women were 9.4% and 4.3%. Positivity rates among repeat tests did not decline compared to the overall baseline positivity. Baseline test result and sex significantly influenced the occurrence of repeat testing. CONCLUSION: Among repeat testers we found high rates of Chlamydia trachomatis both at baseline and at repeat tests which suggests the possibility that this group might be continuing to engage in unsafe sexual practices. Given the extent of repeat testing and the high positivity rates on repeat testing, further research among this group is required to inquire into reasons for repeated testing.

19.
Bioorg Med Chem ; 24(16): 3752-7, 2016 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-27338657

RESUMO

Veratrum californicum, commonly referred to as corn lily or Californian false hellebore, grows in high mountain meadows and produces the steroidal alkaloid cyclopamine, a potent inhibitor of the Hedgehog (Hh) signaling pathway. The Hh pathway is a crucial regulator of many fundamental processes during vertebrate embryonic development. However, constitutive activation of the Hh pathway contributes to the progression of various cancers. In the present study, a direct correlation was made between the extraction efficiency for cyclopamine from root and rhizome by eight methods, and the associated biological activity in Shh-Light II cells using the Dual-Glo® Luciferase Assay System. Alkaloid recovery ranged from 0.39 to 8.03mg/g, with ethanol soak being determined to be the superior method for obtaining biologically active cyclopamine. Acidic ethanol and supercritical extractions yielded degraded or contaminated cyclopamine with lower antagonistic activity towards Hh signaling.


Assuntos
Alcaloides de Veratrum/farmacologia , Veratrum/química , Biomassa , Linhagem Celular , Cromatografia Líquida de Alta Pressão , Proteínas Hedgehog/antagonistas & inibidores , Proteínas Hedgehog/metabolismo , Transdução de Sinais/efeitos dos fármacos , Alcaloides de Veratrum/isolamento & purificação
20.
Gynecol Endocrinol ; 32(8): 625-628, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26891977

RESUMO

Corifollitropin, a long-acting follicle-stimulating hormone (FSH) analogue used for in vitro fertilization (IVF), does not allow individualization of dosage, and the ovarian response is similar to around 300 IU of daily recombinant FSH. This has raised concerns about the risk of ovarian hyperstimulation syndrome (OHSS) when used in standard patients. We administered corifollitropin selectively to patients with anticipated low to moderate ovarian response based on antimüllerian hormone levels in the lower quartile. The end points were oocyte distribution and occurrence of OHSS in women with AMH ≤15 pmol/L. The study included a cohort of 368 patients treated in 599 cycles. Post hoc the cohort was subdivided according to AMH. With increasing baseline AMH, the number of oocytes increased from a mean of 2.7 (range 0-8 with AMH <3 pmol/L) to 6.3 (range 0-15 with AMH 10-15 pmol/L) oocytes. Cancellations of retrievals and transfers decreased significantly with increasing AMH. Overall, the ongoing live pregnancy rate per started cycle was 15.2%. None developed OHSS. No cycles were cancelled or needed triggering of ovulation using a GnRH agonist due to risk of OHSS. Selective use of corifollitropin in patients with AMH in the lower quartile is a safe and appropriate way of optimising stimulation.


Assuntos
Hormônio Antimülleriano/sangue , Fertilização In Vitro/métodos , Hormônio Foliculoestimulante Humano/uso terapêutico , Indução da Ovulação/métodos , Taxa de Gravidez , Adulto , Estudos de Coortes , Feminino , Hormônio Foliculoestimulante Humano/efeitos adversos , Humanos , Síndrome de Hiperestimulação Ovariana/induzido quimicamente , Gravidez , Resultado do Tratamento
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