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1.
MMWR Morb Mortal Wkly Rep ; 69(1): 1-5, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31917782

RESUMO

In May 2018, a study of birth defects in infants born to women with diagnosed human immunodeficiency virus (HIV) infection in Botswana reported an eightfold increased risk for neural tube defects (NTDs) among births with periconceptional exposure to antiretroviral therapy (ART) that included the integrase inhibitor dolutegravir (DTG) compared with other ART regimens (1). The World Health Organization* (WHO) and the U.S. Department of Health and Human Services† (HHS) promptly issued interim guidance limiting the initiation of DTG during early pregnancy and in women of childbearing age with HIV who desire pregnancy or are sexually active and not using effective contraception. On the basis of additional data, WHO now recommends DTG as a preferred treatment option for all populations, including women of childbearing age and pregnant women. Similarly, the U.S. recommendations currently state that DTG is a preferred antiretroviral drug throughout pregnancy (with provider-patient counseling) and as an alternative antiretroviral drug in women who are trying to conceive.§ Since 1981 and 1994, CDC has supported separate surveillance programs for HIV/acquired immunodeficiency syndrome (AIDS) (2) and birth defects (3) in state health departments. These two surveillance programs can inform public health programs and policy, linkage to care, and research activities. Because birth defects surveillance programs do not collect HIV status, and HIV surveillance programs do not routinely collect data on occurrence of birth defects, the related data have not been used by CDC to characterize birth defects in births to women with HIV. Data from these two programs were linked to estimate overall prevalence of NTDs and prevalence of NTDs in HIV-exposed pregnancies during 2013-2017 for 15 participating jurisdictions. Prevalence of NTDs in pregnancies among women with diagnosed HIV infection was 7.0 per 10,000 live births, similar to that among the general population in these 15 jurisdictions, and the U.S. estimate based on data from 24 states. Successful linking of data from birth defects and HIV/AIDS surveillance programs for pregnancies among women with diagnosed HIV infection suggests that similar data linkages might be used to characterize possible associations between maternal diseases or maternal use of medications, such as integrase strand transfer inhibitors used to manage HIV, and pregnancy outcomes. Although no difference in NTD prevalence in HIV-exposed pregnancies was found, data on the use of integrase strand transfer inhibitors in pregnancy are needed to understand the safety and risks of these drugs during pregnancy.


Assuntos
Infecções por HIV/diagnóstico , Defeitos do Tubo Neural/epidemiologia , Complicações Infecciosas na Gravidez/diagnóstico , Adolescente , Adulto , Antirretrovirais/efeitos adversos , Antirretrovirais/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Estados Unidos/epidemiologia , Adulto Jovem
2.
MMWR Morb Mortal Wkly Rep ; 69(3): 67-71, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31971935

RESUMO

Zika virus infection during pregnancy can cause congenital brain and eye abnormalities and is associated with neurodevelopmental abnormalities (1-3). In areas of the United States that experienced local Zika virus transmission, the prevalence of birth defects potentially related to Zika virus infection during pregnancy increased in the second half of 2016 compared with the first half (4). To update the previous report, CDC analyzed population-based surveillance data from 22 states and territories to estimate the prevalence of birth defects potentially related to Zika virus infection, regardless of laboratory evidence of or exposure to Zika virus, among pregnancies completed during January 1, 2016-June 30, 2017. Jurisdictions were categorized as those 1) with widespread local transmission of Zika virus; 2) with limited local transmission of Zika virus; and 3) without local transmission of Zika virus. Among 2,004,630 live births, 3,359 infants and fetuses with birth defects potentially related to Zika virus infection during pregnancy were identified (1.7 per 1,000 live births, 95% confidence interval [CI] = 1.6-1.7). In areas with widespread local Zika virus transmission, the prevalence of birth defects potentially related to Zika virus infection during pregnancy was significantly higher during the quarters comprising July 2016-March 2017 (July-September 2016 = 3.0; October-December 2016 = 4.0; and January-March 2017 = 5.6 per 1,000 live births) compared with the reference period (January-March 2016) (1.3 per 1,000). These findings suggest a fourfold increase (prevalence ratio [PR] = 4.1, 95% CI = 2.1-8.4) in birth defects potentially related to Zika virus in widespread local transmission areas during January-March 2017 compared with that during January-March 2016, with the highest prevalence (7.0 per 1,000 live births) in February 2017. Population-based birth defects surveillance is critical for identifying infants and fetuses with birth defects potentially related to Zika virus regardless of whether Zika virus testing was conducted, especially given the high prevalence of asymptomatic disease. These data can be used to inform follow-up care and services as well as strengthen surveillance.


Assuntos
Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/virologia , Vigilância da População , Complicações Infecciosas na Gravidez/virologia , Infecção por Zika virus/complicações , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Prevalência , Porto Rico/epidemiologia , Estados Unidos/epidemiologia , Ilhas Virgens Americanas/epidemiologia
3.
J Vasc Interv Radiol ; 30(11): 1719-1724, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587943

RESUMO

PURPOSE: To evaluate if sedation with propofol during catheter-directed thrombolysis (CDT) in patients with acute submassive pulmonary embolism (PE) affects survival. MATERIALS AND METHODS: This single-institution, retrospective study identified 136 patients from 2011-2017 who underwent CDT for acute submassive PE. Patients were grouped based on procedural sedation-propofol versus fentanyl and/or midazolam. Groups were compared for differences in baseline characteristics. Primary endpoint was in-hospital mortality. Logistic regression analysis was performed to evaluate for independent variables predictive of mortality. Propensity-matched analysis was also performed. RESULTS: Propofol was given to 18% (n = 25) of patients, and fentanyl and/or midazolam was given to 82% (n = 111) of patients. Mortality was 28% (n = 7) in the propofol group versus 3% (n = 3) in the fentanyl/midazolam group (P = .0003). Patients receiving propofol had 10.4 times the risk of cardiopulmonary arrest or dying during hospitalization compared with patients receiving fentanyl and/or midazolam (95% confidence interval, 2.9-37.3, P = .0003). The number needed to harm was 4 (95% confidence interval, 2.8-6.8). Logistic regression model analysis including Pulmonary Embolism Severity Index score, right-to-left ventricle diameter ratio and age was not predictive of mortality (P = .19). Adding type of sedation made the model predictive of mortality (P < .001). Propensity-matched analysis controlling for baseline differences in age, adjunctive maneuvers, American Society of Anesthesiologists class, and intubation before the procedure revealed that statistical significance between groups remained (P = .01). CONCLUSIONS: Sedation with propofol during CDT for acute submassive PE is associated with increased mortality and should be used with caution.

4.
Environ Int ; 133(Pt A): 105178, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31648162

RESUMO

A total of 20 organophosphate triesters (OPEs), including seven alkyl-OPEs, three chlorinated (Cl)-OPEs, seven aryl-OPEs, and three oligomeric-OPEs were measured in 341 house dust samples collected from 12 countries during the period 2010-2014. OPEs were ubiquitous in indoor dust, and the total concentrations of OPEs (∑OPEs; sum of 20 OPEs) ranged from 49.4 to 249,000 ng/g dry weight (dw). Generally, Cl-OPEs were the predominant compounds (51% of total) in indoor dust samples, with a median concentration of 800 ng/g, followed by alkyl-OPEs (31%), aryl-OPEs (17%), and oligomeric-OPEs (1%), with median concentrations of 480, 270, and 21.9 ng/g, respectively. ∑OPE concentrations in indoor dust from more industrialized countries (South Korea: median, 31,300; Japan: 29,800; and the United States: 26,500 ng/g dw) were one or two orders of magnitude higher than those from less industrialized countries (Greece: 7140, Saudi Arabia: 5310, Kuwait: 4420, Romania: 4110, Vietnam: 1190, China: 1120, Colombia: 374, India: 276, and Pakistan: 138 ng/g dw). Statistically significant positive correlations (0.114 < r < 0.748, p < 0.05) were found among the concentrations of 16 OPEs in dust samples, indicating similar sources of these compounds. The median estimated daily intakes of ΣOPEs via dust ingestion for children and adults were in the ranges of 0.29-64.8 and 0.07-14.9 ng/kg bw/day, respectively.

5.
Environ Sci Pollut Res Int ; 26(28): 28852-28859, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31385247

RESUMO

In this survey, food items were collected from vicinities of Bien Hoa and Da Nang airbase and determined for polychloro-dibenzo-dioxins and polychloro-dibenzo-furans (PCDD/Fs) to assess their accumulation, distribution in the local food items, and risk of PCDD/F exposure through consumption of the local foods. Dioxin compounds were determined using isotope dilution method which is slightly modified from US-EPA method 1613B. The dioxin concentration was the highest in fish followed by eggs, chicken, meat (pork and beef), and vegetables. Particularly, in Bien Hoa airbase, the mean concentrations of dioxin on TEQ and lipid basis (except for vegetables) were 26 pg/g for fish, 13 pg/g for eggs, 20 pg/g for chicken, 4.5 pg/g for meat, and 0.34 pg/g fresh wt for vegetables. In Da Nang airbase, the mean levels of dioxin on TEQ and lipid basis were slightly lower, 12.9 pg/g for fish, 8.7 pg/g for eggs, 5.9 pg/g for chicken, 6.7 pg/g for meat, and 0.17 pg/g for vegetables. It has been interesting to observe that free-range chicken expose to higher level of dioxin than caged chicken. In some free-range chicken, the portion of 2,3,7,8-TCDD was relatively high and implying recent exposure to dioxin.


Assuntos
Dibenzofuranos Policlorados/química , Dibenzofuranos/análise , Dioxinas/análise , Ovos/análise , Contaminação de Alimentos/análise , Bifenilos Policlorados/análise , Dibenzodioxinas Policloradas/análise , Animais , Bovinos , Galinhas , Dibenzofuranos/química , Dioxinas/química , Peixes , Humanos , Carne , Bifenilos Policlorados/química , Dibenzodioxinas Policloradas/química , Verduras , Vietnã
6.
Environ Pollut ; 254(Pt B): 113073, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31454573

RESUMO

Concentrations of unsubstituted and methylated polycyclic aromatic hydrocarbons (PAHs and Me-PAHs) were examined in road dusts from some representative areas with different land-use types in northern Vietnam, providing updated information about the occurrence, sources, and risks of these pollutants in Southeast Asian region. The Vietnamese road dusts were contaminated with low to moderate levels of PAHs and Me-PAHs as compared to those from other countries in the world. Concentrations of PAHs and Me-PAHs (Σ34PAHs) decreased in the order: urban (median 1800; range 1100-5500) ≈ industrial (1300; 550-10,000) > suburban (450; 310-1300) ≈ rural road dust (330; 210-2300 ng g-1), suggesting an urban-rural declining trend and effects of urbanization-industrialization processes in PAH emission extent in Vietnam. The profiles and diagnostic ratios of PAHs and Me-PAHs in our samples revealed that these compounds were mainly derived from pyrogenic sources rather than petrogenic sources. Traffic emissions (e.g., vehicle exhaust, tire debris, and possible leaks of fuels, oils, and lubricants) were estimated as principal sources of PAHs and Me-PAHs, especially in the urban and industrial areas. Other pyrogenic sources (e.g., coal, wood, and biomass combustion) were also existed in the industrial, suburban, and rural areas, reflecting PAH origins from thermal industrial processes, open burning of agricultural by-products, and domestic energy utilization. Persons working outdoors and children in the urban and industrial areas were estimated to receive higher intake doses of PAHs and Me-PAHs, which were one to two orders of magnitude higher than those estimated for other groups. Except for potential cancer risk estimated for the occupational groups in the industrial area under the worst exposure scenarios, the non-cancer and cancer risk levels were generally acceptable; however, more comprehensive risk assessment considering other exposure pathways (e.g., inhalation and diet) is needed.


Assuntos
Monitoramento Ambiental , Poluentes Ambientais/análise , Hidrocarbonetos Policíclicos Aromáticos/análise , Agricultura , Biomassa , Criança , Carvão Mineral , Poeira/análise , Humanos , Medição de Risco , Urbanização , Emissões de Veículos , Vietnã , Madeira/química
7.
Sci Total Environ ; 691: 584-594, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31325858

RESUMO

Siloxanes are organo-silicon compounds containing Si-O-Si linkages and methyl branches. Depending on the structure, siloxanes can be divided into cyclic and linear compounds. Methyl siloxanes with small and medium molecular weights (molecular weights less than 500 g mol-1), are volatile under normal conditions, and hence are referred to as volatile methyl siloxanes (VMSs). VMSs are additive ingredients in many products such as plastics, rubber, personal care products, and household items. This review provides information on the distribution of VMSs in consumer products, indoor air and dust, and their implications for human exposure. VMSs have been used in personal care products and household items at concentrations on the order of hundreds to thousands of micrograms per gram which are the main sources of contamination in the indoor environments. VMSs have been found widely in indoor air and dust. A significant correlation existed between VMS concentrations in indoor air and dust. Among typical VMSs, dodecamethylcylcopentasiloxane (D5) is the major compound found in indoor environments. The human exposure doses to VMSs through dermal absorption, dust ingestion, and inhalation were compiled; Inhalation is a dominant pathway of exposure to VMSs, especially in indoor environments of occupational settings like hair salons. The human exposure doses were higher in children than in adults.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Monitoramento Ambiental , Siloxanas/análise , Humanos
8.
J Anal Methods Chem ; 2019: 3489634, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31205797

RESUMO

An ultrahigh-performance liquid chromatography in combination with high-resolution mass spectrometry Thermo Q-Extractive Focus Orbitrap MS has been introduced for analysis of multiclass pesticides in vegetable samples collected in Hanoi, Vietnam. Multiclass pesticides were separated on the Thermo Hypersil Gold PFP column utilizing a gradient of the mobile phase consisting of 5 mM ammonium formate, 0.1% formic acid in deionized water, and methanol. The target analytes were detected in the full-scan mode on Thermo Scientific Q-Exactive Focus Orbitrap MS for quantitation at the optimum operating conditions. These conditions included, but not limit to, the resolution of 70000 at the full width at half maximum in both positive and negative mode, mass range from 80 to 1000 m/z, and optimized parameters for the heated electrospray ionization source. The identification of the analytes in real samples was based on retention times, mass to charge ratios, mass accuracies, and MS/MS spectra at the confirmation mode with the inclusion list of target analytes. The mass accuracies of target analytes were from -4.14 ppm (dinotefuran) to 1.42 ppm (cinosulfuron) in the neat solvent and from -3.91 ppm (spinosad D) to 1.29 ppm (cinosulfuron) in the matrix-matched solution. Target analytes in the vegetable-based matrix were extracted by the QuEChERS method. Some critical parameters of the analytical method such as linearity, repeatability, limit of detection, and limit of quantitation have been evaluated and implemented. Excellent LOD and LOQ of the developed method were achieved at the range of 0.04-0.85 and 0.13-2.9 µg·kg-1, respectively. Intraday and interday repeatability of the analytical signal (peak area, n=6) of the developed method were below 3% and 10%, correspondingly. The matrix effect, extraction recovery, and overall recovery were fully investigated by spiking experiments. Experimental results demonstrated that the ionization suppression or enhancement was the main contribution on the overall recoveries of target analytes. Finally, the in-house validated method was applied to pesticides screening in vegetables samples in local villages in Hanoi, Vietnam. The concentrations of all target analytes were below limit of quantitation and lower than US-FDA or EU maximum residue levels.

9.
Cardiol Ther ; : 357-364, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31124018

RESUMO

INTRODUCTION: Transcatheter aortic valve replacement (TAVR) has become a widely accepted treatment option for patients with severe aortic stenosis (AS) who are considered intermediate- and high-risk surgical candidates. The purpose of this study was to test the hypothesis that trans-apical TAVR would be associated with increased risk of new-onset intraventricular conduction delay (LBBB or RBBB). METHODS: We conducted a retrospective observational study of consecutive patients undergoing TAVR at a large, single institution. The incidence of new LBBB or RBBB was compared between femoral and apical TAVR patients. Multivariate analysis was performed to account for confounding variables, which included age, gender, CAD, PAD, hypertension, and diabetes. RESULTS: A total of 467 TAVR patients were included in the study, with 283 (60.6%) femoral approach and 184 (39.4%) apical approach. In univariate analysis, the apical approach (when compared to the femoral approach) was associated with a higher incidence of both new-onset LBBB (12.79 vs. 3.40%, p = 0.0002) and RBBB (5.49 vs. 0.81%, p = 0.0039). After controlling for potential confounding variables, the apical approach continued to be associated with a higher incidence of both new-onset LBBB (p = 0.0010) and RBBB (p = 0.0115). There was also a trend towards an association between diabetes and new-onset LBBB (p = 0.0513) in apical TAVR patients. In subgroup analysis, LBBB/RBBB occurring as a result of transapical TAVR was associated with more frequent hospitalizations > 30 days after TAVR, compared to transfemoral TAVR. Other post-procedural complications noted more frequently among patients undergoing transapical TAVR include arrhythmias including atrial fibrillation, peri-procedural myocardial infarction (within 72 h), mortality from unknown cause, and mortality from non-cardiac cause. CONCLUSIONS: Relative to transfemoral TAVR, patients undergoing transapical TAVR are at increased risk for new-onset bundle branch block, peri-procedural myocardial infarction, rehospitalization, TAV-in-TAV deployment, and all-cause mortality at 1 year. Interventional cardiologists and cardiothoracic surgeons alike should take these findings into consideration when choosing which approach is most suitable for patients undergoing TAVR for severe aortic stenosis.

10.
Chemosphere ; 224: 428-436, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30831493

RESUMO

Road dust samples collected from some representative areas in northern Vietnam were examined to determine the occurrence of multiple classes of organic micro-pollutants. Of 942 target compounds screened, 105 organic pollutants originating from different sources such as traffic, household, agricultural, and industrial activities, were detected at least once in our samples. Concentrations of total organic pollutants in the road dusts ranged from 7.8 to 170 µg g-1, with a median value of 28 µg g-1. Overall contamination levels were the highest in samples from an urban area, followed by those from an industrial park, a suburban area, and a rural commune, suggesting environmental impacts of urbanization and industrialization. The most predominant pollutants found in the road dusts were n-alkanes, polycyclic aromatic hydrocarbons (PAHs), and current-use chemicals such as phthalate plasticizers and pharmaceutical and personal care products (PPCPs), whereas, industrial chemicals and pesticides were detected at relatively low levels. Persons occupationally exposed to road dusts (e.g., street sweepers, vendors, and traffic policemen) were estimated to receive the highest daily intake doses of dust-bound organic pollutants that were one to two orders of magnitude greater than those received by general population. No serious human health risk associated with ingestion of contaminated road dusts was observed in this study. However, levels of some phthalates were higher than related environmental quality guidelines in terms of ecological risk. More comprehensive and detailed risk assessment of organic pollutants in road dusts should be conducted, especially for highly urbanized and industrialized areas in developing countries.


Assuntos
Poeira/análise , Monitoramento Ambiental/métodos , Poluentes Ambientais/análise , Praguicidas/análise , Plastificantes/análise , Hidrocarbonetos Policíclicos Aromáticos/análise , Agricultura , Ecologia , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Medição de Risco , Vietnã
11.
MMWR Morb Mortal Wkly Rep ; 68(2): 31-36, 2019 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-30653484

RESUMO

Prevalence of gastroschisis, a serious birth defect of the abdominal wall resulting in some of the abdominal contents extending outside the body at birth, has been increasing worldwide (1,2). Gastroschisis requires surgical repair after birth and is associated with digestive and feeding complications during infancy, which can affect development. Recent data from 14 U.S. states indicated an increasing prevalence of gastroschisis from 1995 to 2012 (1). Young maternal age has been strongly associated with gastroschisis, but research suggests that risk factors such as smoking, genitourinary infections, and prescription opioid use also might be associated (3-5). Data from 20 population-based state surveillance programs were pooled and analyzed to assess age-specific gastroschisis prevalence during two 5-year periods, 2006-2010 and 2011-2015, and an ecologic approach was used to compare annual gastroschisis prevalence by annual opioid prescription rate categories. Gastroschisis prevalence increased only slightly (10%) from 2006-2010 to 2011-2015 (prevalence ratio = 1.1, 95% confidence interval [CI] = 1.0-1.1), with the highest prevalence among mothers aged <20 years. During 2006-2015, the prevalence of gastroschisis was 1.6 times higher in counties with high opioid prescription rates (5.1 per 10,000 live births; CI = 4.9-5.3) and 1.4 times higher where opioid prescription rates were medium (4.6 per 10,000 live births; CI = 4.4-4.8) compared with areas with low prescription rates (3.2 per 10,000 live births; CI = 3.1-3.4). Public health research is needed to understand factors contributing to the association between young maternal age and gastroschisis and assess the effect of prescription opioid use during pregnancy on this pregnancy outcome.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Fenômenos Ecológicos e Ambientais , Gastrosquise/epidemiologia , Adulto , Distribuição por Idade , Analgésicos Opioides/efeitos adversos , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Gastrosquise/etnologia , Humanos , Recém-Nascido , Mães/estatística & dados numéricos , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
12.
Cureus ; 10(9): e3294, 2018 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-30443464

RESUMO

Gluteal augmentation may be performed using a variety of techniques, including implant-based, autologous fat grafting, local flaps, impermanent filler injection, or, as in this case, by way of permanent filler injection with free-silicone. Of these, free-silicone injections carry one of the highest complication rates, specifically regarding migration of the filler material from the native injection site and induction of painful reactive soft tissue changes at the new filler location. A radiologist providing this diagnosis may assist the clinician, who often cannot obtain a history of illicit silicone injection for gluteal augmentation unless the suspicion is raised. Presented here is a case of painful filler migration to the knee with granuloma formation after free-silicone gluteal injection.

13.
Chemosphere ; 212: 330-336, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30145424

RESUMO

In this study, three typical cyclic siloxanes (CSis) were found in hair care products, indoor dust and indoor air samples at hair salons in Hanoi, Vietnam. The total concentrations of CSis in three kinds of hair care products ranged from 8.77 to 515 µg g-1. The mean and median concentrations of CSis in dust samples collected at hair salons were 671 and 654 µg g-1, respectively. The total concentrations of CSis in indoor air samples collected at the hair salons ranged from 415 to 2610 ng m-3 (mean: 1030; median: 849 ng m-3, respectively). Among three cyclic siloxanes mentioned in this study, decamethylcyclopentasiloxane (D5) was found at the highest level in all categories of samples. D5 had also a strong correlation between indoor dust and indoor air from hair salons (the coefficient of determination (R2): 0.852); meanwhile dodecamethylcyclohexasiloxane (D6) and octamethylcyclotetrasiloxane (D4) had good correlations (R2 = 0.618 and 0.585, respectively). This result indicates that hair care products are main emission source of cyclic siloxanes in indoor environments at the hair salons. The average exposure doses to total SCis through both of dust ingestion and inhalation were estimated to be 103 and 79.5 ng kg-bw-1 day-1 for women and men, respectively. These levels were higher than those reported for some Asian countries. This is among the most comprehensive investigations on the emission sources and distributions of cyclic siloxanes in indoor dust and indoor air at hair salons in Vietnam.


Assuntos
Poluição do Ar em Ambientes Fechados/análise , Exposição Ambiental/análise , Cabelo , Siloxanas/análise , Análise Espacial , Adulto , Poeira/análise , Humanos , Siloxanas/química , Vietnã
14.
ISA Trans ; 72: 110-121, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28992943

RESUMO

A perturbed cooperative-state feedback (PSF) strategy is presented for the control of interconnected systems in this paper. The subsystems of an interconnected system can exchange data via the communication network that has multiple connection topologies. The PSF strategy can resolve both issues, the sensor data losses and the communication network breaks, thanks to the two components of the control including a cooperative-state feedback and a perturbation variable, e.g., ui=Kijxj+wi. The PSF is implemented in a decentralized model predictive control scheme with a stability constraint and a non-monotonic storage function (ΔV(x(k))≥0), derived from the dissipative systems theory. Numerical simulation for the automatic generation control problem in power systems is studied to illustrate the effectiveness of the presented PSF strategy.

15.
J Nucl Med ; 59(1): 38-43, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28637802

RESUMO

The goal of this study was to characterize the relationship between tumor uptake of 64Cu-DOTA-trastuzumab as measured by PET/CT and standard, immunohistochemistry (IHC)-based, histopathologic classification of human epidermal growth factor receptor 2 (HER2) status in women with metastatic breast cancer (MBC). Methods: Women with biopsy-confirmed MBC and not given trastuzumab for 2 mo or more underwent complete staging, including 18F-FDG PET/CT. Patients were classified as HER2-positive (HER2+) or -negative (HER2-) based on fluorescence in situ hybridization (FISH)-supplemented immunohistochemistry of biopsied tumor tissue. Eighteen patients underwent 64Cu-DOTA-trastuzumab injection, preceded in 16 cases by trastuzumab infusion (45 mg). PET/CT was performed 21-25 (day 1) and 47-49 (day 2) h after 64Cu-DOTA-trastuzumab injection. Radiolabel uptake in prominent lesions was measured as SUVmax Average intrapatient SUVmax (pt) was compared between HER2+ and HER2- patients. Results: Eleven women were HER2+ (8 immunohistochemistry 3+; 3 immunohistochemistry 2+/FISH amplified), whereas 7 were HER2- (3 immunohistochemistry 2+/FISH nonamplified; 4 immunohistochemistry 1+). Median pt for day 1 and day 2 was 6.6 and 6.8 g/mL for HER 2+ and 3.7 and 4.3 g/mL for HER2- patients (P < 0.005 either day). The distributions of pt overlapped between the 2 groups, and interpatient variability was greater for HER2+ than HER2- disease (P < 0.005 and 0.001, respectively, on days 1 and 2). Conclusion: By 1 d after injection, uptake of 64Cu-DOTA-trastuzumab in MBC is strongly associated with patient HER2 status and is indicative of binding to HER2. The variability within and among HER2+ patients, as well as the overlap between the HER2+ and HER2- groups, suggests a role for 64Cu-DOTA-trastuzumab PET/CT in optimizing treatments that include trastuzumab.


Assuntos
Anticorpos Monoclonais Humanizados/metabolismo , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Compostos Organometálicos/metabolismo , Adulto , Idoso , Transporte Biológico , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Receptor ErbB-2/metabolismo , Trastuzumab
16.
Anal Chem ; 89(17): 9491-9501, 2017 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-28795574

RESUMO

Thirty-five melamine-formaldehyde (MF) monolithic materials with bimodal pore distributions were synthesized in fused silica capillaries by catalyst-free polycondensation, starting with an aqueous MF precondensate, using acetonitrile as the macroporogen and a variety of aliphatic polyethers and triblock copolymeric surfactants as porogens and mesoporogens, respectively. By varying the prepolymer composition and the type and molecular weight of the polymeric porogen components, a library of porous monolithic materials was produced, covering a range of meso- and macroporous properties. A multivariate evaluation revealed that the amount of surfactant was the strongest contributor to specific surface area and pore volume and to the inversely related mesopore size, whereas the macropore dimensions were controlled mainly by the amount of aliphatic polyether porogen. One of these capillary monoliths, chosen based on the combination of meso- and macropores providing optimal percolative flow and accessible surface area, was synthesized in the presence of N-Fmoc and O-Et protected phosphoserine and phosphotyrosine to prepare molecularly imprinted monoliths with surface layers selective for phosphopeptides. These imprinted monoliths were characterized alongside nonimprinted monoliths by a variety of techniques and finally evaluated by liquid chromatography-mass spectrometry in the capillary format to assess their abilities to trap and release phosphorylated amino acids and peptides from partly aqueous media. Selective enrichment of phosphorylated targets was demonstrated, suggesting that these materials could be useful as trapping media in affinity-based phosphoproteomics.


Assuntos
Impressão Molecular/métodos , Fosfopeptídeos/química , Triazinas/química , Celiprolol , Modelos Moleculares , Estrutura Molecular , Transição de Fase , Conformação Proteica
17.
Chemosphere ; 184: 1117-1124, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28672692

RESUMO

Earlier studies have reported the occurrence of cyclic and linear siloxanes in personal care and household products. Nevertheless, there is a lack of information on the occurrence of siloxanes in indoor air. In this study, four cyclic and six linear siloxanes were measured in 97 indoor air samples collected from various micro-environments in four cities in northern, Vietnam, during September 2016 to January 2017. The total concentrations of siloxanes (TSi) in particulate and gas phases ranged from 141 to 7220 µg g-1 (mean: 1880) and 23.8-1580 ng m-3 (mean: 321), respectively. The total concentrations of cyclic siloxanes (TCSi), linear siloxanes (TLSi), and TSi in indoor air were 1.91-1500 ng m-3, 21.8-817 ng m-3, and 41.8-1950 ng m-3, respectively. The highest mean concentration of siloxanes was found in indoor air from hair salons in Hanoi. The concentrations of siloxanes in air collected from homes in Hanoi were higher than those from other smaller cities such as Bacninh, Thaibinh, and Tuyenquang. The human exposures to siloxanes through inhalation were estimated for various age groups based on the measured concentrations. The mean inhalation exposure doses to total siloxanes for infants, toddlers, children, teenagers, and adults were 352, 219, 188, 132, and 95.9 ng kg-bw-1 d-1, respectively.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Exposição Ambiental/estatística & dados numéricos , Siloxanas/análise , Adolescente , Adulto , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Criança , Pré-Escolar , Cidades , Meio Ambiente , Exposição Ambiental/análise , Cabelo/química , Produtos Domésticos , Humanos , Lactente , Exposição por Inalação/análise , Exposição por Inalação/estatística & dados numéricos , Masculino , Vietnã
18.
Matern Child Health J ; 21(10): 1949-1960, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28710700

RESUMO

Introduction A practice-based care coordination (CC) model was developed by Louisiana's Title V Children's Special Health Services (CSHS) program to meet the overwhelming needs of the New Orleans post-Katrina population. The pilot clinic demonstrated an improvement in medical home (MH) capacity over the course of 3 months. The purpose of the current study is to evaluate the replicability of the model and sustainability of MH improvement over at least 2 years, while identifying factors that may modify the effect of the intervention. Methods The CSHS CC model utilizing a practice based care coordinator was implemented in 15 academic primary care pediatric clinics. Increase in MH capacity was determined using the MH Index-Short Version (MHI-SV) tool. Results The analysis of the MHI-SV scores for the ten clinics with >2 years of data demonstrated a significant improvement with each of the ten MHI-SV indicators. The mean clinic MHI-SV score improved from 19.70 to 34.15 on a scale of 10-50. Characteristics associated with the greatest MHI score improvement were rural geographic location, having an electronic health record, and using social workers or nurses as care coordinators. Characteristics associated with lower MHI scores were physician or care coordinator turnover and using stand-alone databases rather than tracking CC activities within the central patient record. Conclusion This study provides a flexible framework for implementing CC services in pediatric, family medicine, and medicine-pediatric practices, and demonstrates the value of CC as a driver for improvement in medical home capacity.


Assuntos
Serviços de Saúde da Criança/organização & administração , Crianças com Deficiência , Equipe de Assistência ao Paciente , Assistência Centrada no Paciente/métodos , Pré-Escolar , Feminino , Humanos , Masculino , Modelos Organizacionais , Nova Orleans , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade
19.
Pediatr Crit Care Med ; 18(9): e388-e394, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28640009

RESUMO

OBJECTIVES: The objectives of this study were to: 1) evaluate the prevalence of augmented renal clearance in critically ill pediatric patients using vancomycin clearance; 2) derive the pharmacokinetic model that best describes vancomycin clearance in critically ill pediatric patients; and 3) correlate vancomycin clearance with creatinine clearance estimated by modified Schwartz or Cockcroft-Gault. DESIGN: Retrospective, two-center, cohort study from 2003 to 2016. SETTING: Clinical drug monitoring services in the PICUs at two tertiary care, teaching hospitals. PATIENTS: Children from 1 to 21 years old. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Identify patients with augmented renal clearance (vancomycin clearance ≥ 130 mL/min/1.73 m used as definition of augmented renal clearance). Derive final population-based pharmacokinetic model and estimate individual patient pharmacokinetic parameters. Compare estimated glomerular filtration rate (modified Schwartz or Cockcroft-Gault depending on age < or ≥ 17 yr) with vancomycin clearance. Augmented renal clearance was identified in 12% of 250 total subjects. The final population-based pharmacokinetic model for vancomycin clearance (L/hr) was 0.118 × weight (e). Median vancomycin clearance in those with versus without augmented renal clearance were 141.3 and 91.7 mL/min/1.73 m, respectively (p < 0.001). By classification and regression tree analysis, patients who were more than 7.9 years old were significantly more likely to experience augmented renal clearance (17% vs 4.6% in those ≤ 7.9 yr old; p = 0.002). In patients with augmented renal clearance, 79% of 29 had vancomycin trough concentrations less than 10 µg/mL, compared with 52% of 221 in those without augmented renal clearance (p < 0.001). Vancomycin clearance was weakly correlated to the glomerular filtration rate estimated by the modified Schwartz or Cockcroft-Gault method (Spearman R = 0.083). CONCLUSIONS: Augmented renal clearance was identified in one of 10 critically ill pediatric patients using vancomycin clearance, with an increase of approximately 50 mL/min/1.73 m in those with augmented renal clearance. As augmented renal clearance results in subtherapeutic antibiotic concentrations, optimal dosing is essential in those exhibiting augmented renal clearance.


Assuntos
Antibacterianos/farmacocinética , Estado Terminal , Modelos Teóricos , Vancomicina/farmacocinética , Adolescente , Biomarcadores/metabolismo , Criança , Pré-Escolar , Creatinina/metabolismo , Cuidados Críticos , Monitoramento de Medicamentos , Feminino , Taxa de Filtração Glomerular , Humanos , Lactente , Modelos Lineares , Masculino , Taxa de Depuração Metabólica , Estudos Retrospectivos , Adulto Jovem
20.
Sci Total Environ ; 601-602: 1695-1701, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-28628971

RESUMO

Phthalates are used as plasticizers to impart flexibility of plastics. Because of their toxicity, human exposure to phthalates is a concern. Little is known on the occurrence of and inhalation exposure to phthalates in indoor air. In this study, ten phthalates were measured in 97 indoor air samples collected from Northern Vietnam during September 2016 to January 2017. The mean concentrations of total phthalates (i.e., sum of ten phthalates) in particulate and gas phases ranged from 95.2 to 13,100µgg-1 and from 57.0 to 14,900ngm-3, respectively. In bulk indoor air samples (i.e., gas plus particulate phase), the mean concentration of total phthalates ranged from 106 to 16,000ngm-3 (mean: 1040ngm-3). Diethyl phthalate (DEP) was found at the highest concentration in indoor air at a concentration range of below the method quantitation limit (MQL) to 12,400ngm-3 (mean: 376). Among various microenvironments, indoor air collected from hair salons contained the highest concentrations of phthalates (range: 596 to 16,000ngm-3). Among the four northern Vietnamese cities studied, the highest concentrations of phthalates were found in indoor air samples from Hanoi. The calculated mean inhalation exposure doses to phthalates for infants, toddlers, children, teenagers, and adults were 780, 485, 416, 292, and 213ngkg-bw-1d-1, respectively.


Assuntos
Poluição do Ar em Ambientes Fechados/análise , Monitoramento Ambiental , Ácidos Ftálicos/análise , Adolescente , Adulto , Criança , Pré-Escolar , Cidades , Humanos , Lactente , Exposição por Inalação , Medição de Risco , Vietnã
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