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1.
Artigo em Inglês | MEDLINE | ID: mdl-34813371

RESUMO

Purpose: To highlight the various options available for the management of breast cancer diagnosed during pregnancy by describing the investigations, treatment, and outcomes in relation to these women. Methods: This is a narrative review of the literature to describe the issues related to pregnancy and obstetric management in patients with breast cancer. It incorporates a description of six cases of women (aged 29-39 years) with a first-time diagnosis of breast cancer during pregnancy to illustrate a number of issues that need to be considered during different trimesters. Results: Of the six cases, two were diagnosed in each pregnancy trimester. A painless breast mass was the presenting symptom in five cases (83%). In all cases, breast ultrasound was the primary diagnostic imaging procedure. Chest X-ray was performed in 3 (50%) and computed tomography in 2 (33%). A core needle biopsy was performed in all cases, and sentinel lymph node biopsy in 3 (50%) cases. Four women had grade 3 tumor; five had estrogen receptor-positive tumors. Four women had breast surgery during pregnancy. Five women gave birth after the induction of labor and/or cesarean section. In all six cases, a multidisciplinary team was involved in the delivery of health care. Conclusion: Regular breast examinations are needed for all pregnant woman during prenatal visits. Breast ultrasonography should be offered if a breast lump or other symptoms are detected. Breast surgery can be safely performed during all pregnancy trimesters, and some systemic therapeutic agents can be administered safely in the second and third trimesters.

2.
Biofabrication ; 13(4)2021 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-34479229

RESUMO

Microphysiological systems (MPS), comprising human cell cultured in formats that capture features of the three-dimensional (3D) microenvironments of native human organs under microperfusion, are promising tools for biomedical research. Here we report the development of a mesoscale physiological system (MePS) enabling the long-term 3D perfused culture of primary human hepatocytes at scales of over 106cells per MPS. A central feature of the MePS, which employs a commercially-available multiwell bioreactor for perfusion, is a novel scaffold comprising a dense network of nano- and micro-porous polymer channels, designed to provide appropriate convective and diffusive mass transfer of oxygen and other nutrients while maintaining physiological values of shear stress. The scaffold design is realized by a high resolution stereolithography fabrication process employing a novel resin. This new culture system sustains mesoscopic hepatic tissue-like cultures with greater hepatic functionality (assessed by albumin and urea synthesis, and CYP3A4 activity) and lower inflammation markers compared to comparable cultures on the commercial polystyrene scaffold. To illustrate applications to disease modeling, we established an insulin-resistant phenotype by exposing liver cells to hyperglycemic and hyperinsulinemic media. Future applications of the MePS include the co-culture of hepatocytes with resident immune cells and the integration with multiple organs to model complex liver-associated diseases.


Assuntos
Técnicas de Cultura de Células , Hepatócitos , Tecidos Suporte , Humanos , Fígado , Estereolitografia
3.
Cureus ; 13(6): e15373, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34249526

RESUMO

In this report, we present a case series involving four patients placed on the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) protocol for alcohol or sedative-hypnotic withdrawal syndromes, who developed delirium on sustained or increasing symptom-triggered benzodiazepine dosages. In each of the four cases, delirium was not present on admission and resolved in the hospital itself with fixed benzodiazepine tapers. Cases were selected from an electronic medical record database of patients admitted to a United States-based university hospital and placed on CIWA-Ar between 2017 and 2018. This case series illustrates the major limitations of CIWA-Ar including its subjective nature, its susceptibility to inappropriate patient selection, and its requirement for providers to consider alternative etiologies to alcohol and benzodiazepine withdrawal syndromes. These cases demonstrate the necessity of considering other assessment and treatment options such as objective alcohol withdrawal scales, fixed benzodiazepine tapers, and even antiepileptics. An effective systems-based approach to overcoming these challenges may include setting time limits on CIWA-Ar orders within the electronic health record (EHR) system.

5.
Hum Fertil (Camb) ; : 1-12, 2021 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-34162302

RESUMO

Risks to gestational surrogates became a concern for public health. In commercial gestational surrogacy arrangements, gestational surrogates are commonly recruited from low- to middle-income countries. Thailand is well known as a surrogacy hub in this regard. However, little is known concerning Thai surrogacy practice and the risks that Thai gestational surrogates experiences. The semi-structured interviews with fifteen Thai women who had been gestational surrogates were conducted over the telephone in Thai between March and May 2020 and lasted approximately 30 minutes. Thematic analysis was applied to analyse the translated interviews. The findings indicated that 'womb for work' was perceived as a surrogacy career among Thai women. 'Womb for work' was defined as a superordinate theme that consisted of three subthemes: (i) gestational surrogacy arrangements in Thailand; (ii) the business model of gestational surrogacy arrangements in Thailand; and (iii) risk experiences of gestational surrogates. Clear deficiencies in surrogacy practice and regulations were identified, which put gestational surrogates at risk, including those associated with embryo transfer, transnational gestational surrogacy, and unsupported pregnancies. This study shows the urgent need to introduce regulations to protect women's health transnationally in this domain more effectively.

6.
Nature ; 593(7860): 580-585, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33981039

RESUMO

Adaptive thermogenesis has attracted much attention because of its ability to increase systemic energy expenditure and to counter obesity and diabetes1-3. Recent data have indicated that thermogenic fat cells use creatine to stimulate futile substrate cycling, dissipating chemical energy as heat4,5. This model was based on the super-stoichiometric relationship between the amount of creatine added to mitochondria and the quantity of oxygen consumed. Here we provide direct evidence for the molecular basis of this futile creatine cycling activity in mice. Thermogenic fat cells have robust phosphocreatine phosphatase activity, which is attributed to tissue-nonspecific alkaline phosphatase (TNAP). TNAP hydrolyses phosphocreatine to initiate a futile cycle of creatine dephosphorylation and phosphorylation. Unlike in other cells, TNAP in thermogenic fat cells is localized to the mitochondria, where futile creatine cycling occurs. TNAP expression is powerfully induced when mice are exposed to cold conditions, and its inhibition in isolated mitochondria leads to a loss of futile creatine cycling. In addition, genetic ablation of TNAP in adipocytes reduces whole-body energy expenditure and leads to rapid-onset obesity in mice, with no change in movement or feeding behaviour. These data illustrate the critical role of TNAP as a phosphocreatine phosphatase in the futile creatine cycle.

7.
Eur Urol Oncol ; 2021 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-33846112

RESUMO

BACKGROUND: While magnetic resonance imaging (MRI)-targeted biopsy (TBx) results in better prostate cancer (PCa) detection relative to systematic biopsy (SBx), the combination of both methods increases clinically significant PCa detection relative to either Bx method alone. However, combined Bx subjects patients to higher number of Bx cores and greater detection of clinically insignificant PCa. OBJECTIVE: To determine if prebiopsy prostate MRI can identify men who could forgo combined Bx without a substantial risk of missing clinically significant PCa (csPC). DESIGN, SETTING, AND PARTICIPANTS: Men with MRI-visible prostate lesions underwent combined TBx plus SBx. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcomes were detection rates for grade group (GG) ≥2 and GG ≥3 PCa by TBx and SBx, stratified by Prostate Imaging-Reporting and Data System (PI-RADS) score. RESULTS AND LIMITATIONS: Among PI-RADS 5 cases, nearly all csPCs were detected by TBx, as adding SBx resulted in detection of only 2.5% more GG ≥2 cancers. Among PI-RADS 3-4 cases, however, SBx addition resulted in detection of substantially more csPCs than TBx alone (7.5% vs 8%). Conversely, TBx added little to detection of csPC among men with PI-RADS 2 lesions (2%) relative to SBx (7.8%). CONCLUSIONS: While combined Bx increases the detection of csPC among men with MRI-visible prostate lesions, this benefit was largely restricted to PI-RADS 3-4 lesions. Using a strategy of TBx only for PI-RADS 5 and combined Bx only for PI-RADS 3-4 would avoid excess biopsies for men with PI-RADS 5 lesions while resulting in a low risk of missing csPC (1%). PATIENT SUMMARY: Our study investigated an optimized strategy to diagnose aggressive prostate cancer in men with an abnormal prostate MRI (magnetic resonance imaging) scan while minimizing the risk of excess biopsies. We used a scoring system for MRI scan images called PI-RADS. The results show that MRI-targeted biopsies alone could be used for men with a PI-RADS score of 5, while men with a PI-RADS score of 3 or 4 would benefit from a combination of MRI-targeted biopsy and systematic biopsy. This trial is registered at ClinicalTrials.gov as NCT00102544.

8.
Eur Urol Oncol ; 4(2): 227-234, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33867045

RESUMO

BACKGROUND: The ability of serial magnetic resonance imaging (MRI) to capture pathologic progression during active surveillance (AS) remains in question. OBJECTIVE: To determine whether changes in MRI are associated with pathologic progression for patients on AS. DESIGN, SETTING, AND PARTICIPANTS: From July 2007 through January 2020, we identified all patients evaluated for AS at our institution. Following confirmatory biopsy, a total of 391 patients who underwent surveillance MRI and biopsy at least once were identified (median follow-up of 35.6 mo, interquartile range 19.7-60.6). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: All MRI intervals were scored using the "Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation" (PRECISE) criteria, with PRECISE scores =4 considered a positive change in MRI. A generalized estimating equation-based logistic regression analysis was conducted for all intervals with a PRECISE score of <4 to determine the predictors of Gleason grade group (GG) progression despite stable MRI. RESULTS AND LIMITATIONS: A total of 621 MRI intervals were scored by PRECISE and validated by biopsy. The negative predictive value of stable MRI (PRECISE score <4) was greatest for detecting GG1 to?=?GG3 disease (0.94 [0.91-0.97]). If 2-yr surveillance biopsy were performed exclusively for a positive change in MRI, 3.7% (4/109) of avoided biopsies would have resulted in missed progression from GG1 to?=?GG3 disease. Prostate-specific antigen (PSA) density (odds ratio 1.95 [1.17-3.25], p?=? 0.01) was a risk factor for progression from GG1 to =GG3 disease despite stable MRI. CONCLUSIONS: In patients with GG1 disease and stable MRI (PRECISE score <4) on surveillance, grade progression to?=?GG3 disease is not common. In patients with grade progression detected on biopsy despite stable MRI, elevated PSA density appeared to be a risk factor for progression to?=?GG3 disease. PATIENT SUMMARY: For patients with low-risk prostate cancer on active surveillance, the risk of progressing to grade group 3 disease is low with a stable magnetic resonance image (MRI) after 2?yr. Having higher prostate-specific antigen density increases the risk of progression, despite having a stable MRI.


Assuntos
Neoplasias da Próstata , Conduta Expectante , Humanos , Imageamento por Ressonância Magnética , Masculino , Gradação de Tumores , Neoplasias da Próstata/diagnóstico por imagem
9.
Compr Psychiatry ; 107: 152236, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33721583

RESUMO

Schizophrenia (SCZ) is an etiologically heterogeneous disease with genetic and environmental risk factors (e.g., Toxoplasma gondii infection) differing among affected individuals. Distinguishing such risk factors may point to differences in pathophysiological pathways and facilitate the discovery of individualized treatments. Toxoplasma gondii (TOXO) has been implicated in increasing the risk of schizophrenia. To determine whether TOXO-positive individuals with SCZ have a different polygenic risk burden than uninfected people, we applied the SCZ polygenic risk score (SCZ-PRS) derived from the Psychiatric GWAS Consortium separately to the TOXO-positive and TOXO-negative subjects with the diagnosis of SCZ as the outcome variable. The SCZ-PRS does not include variants in the major histocompatibility complex. Of 790 subjects assessed for TOXO, the 662 TOXO-negative subjects (50.8% with SCZ) reached a Bonferroni corrected significant association (p = 0.00017, R2 = 0.023). In contrast, the 128 TOXO-positive individuals (53.1% with SCZ) showed no significant association (p = 0.354) for SCZ-PRS and had a much lower R2 (R2 = 0.007). To account for Type-2 error in the TOXO-positive dataset, we performed a random sampling of the TOXO-negative subpopulation (n = 130, repeated 100 times) to simulate equivalent power between groups: the p-value was <0.05 for SCZ-PRS 55% of the time but was rarely (6% of the time) comparable to the high p-value of the seropositive group at p > 0.354. We found intriguing evidence that the SCZ-PRS predicts SCZ in TOXO-negative subjects, as expected, but not in the TOXO-positive individuals. This result highlights the importance of considering environmental risk factors to distinguish a subgroup with independent or different genetic components involved in the development of SCZ.


Assuntos
Esquizofrenia , Toxoplasma , Toxoplasmose , Humanos , Herança Multifatorial , Fatores de Risco , Esquizofrenia/diagnóstico , Esquizofrenia/genética , Toxoplasma/genética , Toxoplasmose/diagnóstico , Toxoplasmose/genética
11.
J Nutr Biochem ; 91: 108598, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33549890

RESUMO

Chronic metabolic diseases are on the rise worldwide and their etiology is multifactorial. Among them, inflammatory components like Tumor Necrosis Factor (TNF), contribute to whole-body metabolic impairment. Caloric Restriction (CR) combats metabolic diseases, but how it reduces inflammation remains understudied. We aimed to evaluate the impact of chronic CR on muscle inflammation, in particular TNF. In our study, 4-week old male Sprague-Dawley rats were fed a high-fat diet (HF, 45% Kcal of fat from lard) ad libitum for 3 months. After estimation of their energy requirement (1 month), they were then divided into three groups: HF ad libitum (OL), weight maintenance with AIN93M (9.5% Kcal from fat; ML, 100% of energy requirement), and caloric restriction (CR, AIN93M with 75% of energy requirement). This dietary intervention continued for six months. At this point, rats were sacrificed and gastrocnemius muscle was collected. CR induced a profound shift in fat and lean mass, and decreased growth factor IGF-1. Muscle qPCR analysis showed a marked decrease in inflammation and TNF (premRNA, mRNA, and protein) by CR, accompanied by Tnf promoter DNA hypermethylation. CR increased expression of histone deacetylase Sirt6 and decreased methyltransferase Suv39h1, together with decreased Tnf promoter and coding region binding of NF- κB and C/EBP-ß. Following miRNA database mining, qPCR analysis revealed that CR downregulated the proinflammatory miR-19b and increased the anti-inflammatory miR-181a and its known targets. Chronic CR is able to regulate muscle-specific inflammation by targeting the NF-κB pathway as well as transcriptional and post-transcriptional regulation of Tnf gene.


Assuntos
Restrição Calórica , Dieta Hiperlipídica , Músculo Esquelético/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Animais , Metilação de DNA , Masculino , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa/genética
12.
Hum Fertil (Camb) ; : 1-15, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33451270

RESUMO

The demand for donated eggs outstrips supply in countries such as Australia where only altruistic egg donation is permitted. We conducted semi-structured interviews with women (n = 18), who had donated eggs in Australia in the last three years, to identify barriers and enablers for altruistic egg donation. Women reported difficulties in accessing trusted information on all aspects of egg donation and limited public awareness about the need for donor eggs. They generally had a good experience of pre-donation counselling and of the care provided by the fertility clinic staff. However, post-donation follow-up was deemed inadequate. Participants offered suggestions for how public education campaigns could enhance awareness about egg donation and how clinics could improve the post-donation experience. The findings indicate that the availability of independent, easily accessible, evidence-based information on egg donation; improved public awareness about the need for donor eggs; and proactive recruitment of donors may increase the local supply of donor eggs. Better clinic follow-up care, including post-donation counselling, would improve donors' experience of altruistic egg donation.

13.
World J Urol ; 39(3): 729-739, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33388878

RESUMO

Focal therapy is growing as an alternative management options for men with clinically localized prostate cancer. Parallel to the increasing popularity of active surveillance (AS) as a treatment for low-risk disease, there has been an increased interest towards providing focal therapy for patients with intermediate-risk disease. Focal therapy can act as a logical "middle ground" in patients who seek treatment while minimizing potential side effects of definitive whole-gland treatment. The aim of the current review is to define the rationale of focal therapy in patients with intermediate-risk prostate cancer and highlight the importance of patient selection in focal therapy candidacy.


Assuntos
Técnicas de Ablação , Neoplasias da Próstata/cirurgia , Técnicas de Ablação/métodos , Ensaios Clínicos como Assunto , Humanos , Masculino , Tratamentos com Preservação do Órgão , Guias de Prática Clínica como Assunto , Medição de Risco
14.
PLoS One ; 16(1): e0245493, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33481842

RESUMO

BACKGROUND: The incidence of gestational breast cancer (GBC) is increasing in high-income countries. Our study aimed to examine the epidemiology, management and outcomes of women with GBC in New South Wales (NSW), Australia. METHODS: A retrospective cohort study using linked data from three NSW datasets. The study group comprised women giving birth with a first-time diagnosis of GBC while the comparison group comprised women giving birth without any type of cancer. Outcome measures included incidence of GBC, maternal morbidities, obstetric management, neonatal mortality, and preterm birth. RESULTS: Between 1994 and 2013, 122 women with GBC gave birth in NSW (crude incidence 6.8/ 100,000, 95%CI: 5.6-8.0). Women aged ≥35 years had higher odds of GBC (adjusted odds ratio (AOR) 6.09, 95%CI 4.02-9.2) than younger women. Women with GBC were more likely to give birth by labour induction or pre-labour CS compared to women with no cancer (AOR 4.8, 95%CI: 2.96-7.79). Among women who gave birth by labour induction or pre-labour CS, the preterm birth rate was higher for women with GBC than for women with no cancer (52% vs 7%; AOR 17.5, 95%CI: 11.3-27.3). However, among women with GBC, preterm birth rate did not differ significantly by timing of diagnosis or cancer stage. Babies born to women with GBC were more likely to be preterm (AOR 12.93, 95%CI 8.97-18.64), low birthweight (AOR 8.88, 95%CI 5.87-13.43) or admitted to higher care (AOR 3.99, 95%CI 2.76-5.76) than babies born to women with no cancer. CONCLUSION: Women aged ≥35 years are at increased risk of GBC. There is a high rate of preterm birth among women with GBC, which is not associated with timing of diagnosis or cancer stage. Most births followed induction of labour or pre-labour CS, with no major short term neonatal morbidity.


Assuntos
Neoplasias da Mama/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Estudos de Coortes , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Recém-Nascido , Trabalho de Parto Induzido , Estadiamento de Neoplasias , New South Wales/epidemiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/patologia , Prognóstico , Estudos Retrospectivos
15.
Trends Biochem Sci ; 46(5): 378-390, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33423940

RESUMO

Virion assembly is an important step in the life cycle of all viruses. For viruses of the Flavivirus genus, a group of enveloped positive-sense RNA viruses, the assembly step represents one of the least understood processes in the viral life cycle. While assembly is primarily driven by the viral structural proteins, recent studies suggest that several nonstructural proteins also play key roles in coordinating the assembly and packaging of the viral genome. This review focuses on describing recent advances in our understanding of flavivirus virion assembly, including the intermolecular interactions between the viral structural (capsid) and nonstructural proteins (NS2A and NS2B-NS3), host factors, as well as features of the viral genomic RNA required for efficient flavivirus virion assembly.


Assuntos
Flavivirus , RNA Viral/genética , Proteínas não Estruturais Virais/genética , Vírion , Montagem de Vírus
16.
J Pain Palliat Care Pharmacother ; 35(1): 38-42, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32960657

RESUMO

Treatment of Central Pain Syndrome (CPS) is known to be extremely challenging. Current therapies are unsatisfactory as patients report only mild to moderate pain relief. We report a case of using ketamine as a patient-controlled analgesia (PCA) for the treatment of CPS. A 58-year-old male with CPS presented with severe generalized body pain refractory to multiple pharmacological interventions. He was started on a basal infusion rate at 0.3 mg/kg/h with a ketamine PCA bolus of 10 mg with a 10-minute lockout period. Over the next 7 days, the basal infusion rate was titrated up to 2.1 mg/kg/h relative to the number of times the patient pressed the PCA. At the end of the trial, the patient reported 0/10 pain with lightheadedness on the first day being the only side effect reported. He was discharged home with his regular pain regimen, with significant decrease in pain over the next few months. Rather than trying to establish a "one size fits all" protocol for ketamine infusions, this case illustrates a shift in pain management focus by allowing patients to self-titrate and demonstrates the potential for using ketamine PCA as a treatment option for CPS.


Assuntos
Analgesia Controlada pelo Paciente , Ketamina , Humanos , Infusões Intravenosas , Ketamina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico
17.
J Urol ; 205(5): 1352-1360, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33356479

RESUMO

PURPOSE: Active surveillance for patients with low and intermediate risk prostate cancers is becoming a more utilized option in recent years. However, the use of magnetic resonance imaging and imaging-targeted biopsy for monitoring grade progression has been poorly studied in this population. We aim to define the utility of magnetic resonance imaging-targeted biopsy and systematic biopsy in an active surveillance population. MATERIALS AND METHODS: Between July 2007 and January 2020, patients with diagnosed prostate cancer who elected active surveillance were monitored with prostate magnetic resonance imaging, imaging-targeted biopsy and standard systematic biopsy. Patients were eligible for surveillance if diagnosed with any volume Gleason grade 1 disease and select Gleason grade 2 disease. Grade progression (Gleason grade 1 to ≥2 disease and Gleason grade 2 to ≥3 disease) for each biopsy modality was measured at 2 years, 4 years and 6+ years. RESULTS: In total, 369 patients had both magnetic resonance imaging-targeted and systematic biopsy and were surveilled for at least 1 year. At 2 years, systematic biopsy, magnetic resonance imaging-targeted biopsy and combined biopsy (systematic+imaging-targeted) detected grade progression in 44 patients (15.9%), 73 patients (26.4%) and 90 patients (32.5%), respectively. Magnetic resonance imaging-targeted biopsy detected more cancer grade progression compared to systematic biopsy in both the low and intermediate risk populations (p <0.001). Of all 90 grade progressions at the 2-year time point 46 (51.1%) were found by magnetic resonance imaging-targeted biopsy alone and missed by systematic biopsy. CONCLUSIONS: Magnetic resonance imaging-targeted biopsy detected significantly more grade progressions in our active surveillance cohort compared to systematic biopsy at 2 years. Our results provide compelling evidence that prostate magnetic resonance imaging and imaging-targeted biopsy should be included in contemporary active surveillance protocols.


Assuntos
Neoplasias da Próstata/patologia , Conduta Expectante , Idoso , Biópsia , Progressão da Doença , Humanos , Biópsia Guiada por Imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Prospectivos
18.
Gait Posture ; 84: 209-214, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33360644

RESUMO

BACKGROUND: Several studies compared African runners with runners from other places with difference ethnicities to identify biomechanical factors that may contribute to their extraordinary running performance. However, most studies only assessed runners at the elite level. Whether the performance difference was a result of nature or nurture remains unclear. RESEARCH QUESTIONS: This case study aimed to assess the effect of geographical origin and the effect of training on running biomechanics. METHODS: We recruited twenty male runners from two regions (Asian and Africa) at two performance levels (elite and recreational), and asked them to run on an instrumented treadmill at 12 km∙h-1. We measured running kinetics and kinematics parameters, and focused on the parameters that have been shown associated with running performance. We used Friedman test to compare the effect of geographical origin and training on running biomechanics. RESULTS: Compared to recreational runners, elite runners applied higher amount of ground reaction force in both vertical and anterior-posterior directions (P <  0.05, Cohen's d = 1.63-2.03), together with a longer aerial time (P =  0.039, Cohen's d = 1.11). On the other hand, African runners expressed higher vertical stiffness than Asian runners (P =  0.027, Cohen's d = 0.98). However, the increased vertical stiffness in African runners did not lead to a higher vertical loading rate (P >  0.555, Cohen's d < 0.3), which could be a result of a lower footstrike angle during landing (P =  0.012, Cohen's d = 1.36). SIGNIFICANCE: For elite runners, the higher amount of ground reaction force might facilitate a longer aerial time, but could also lead to higher amount of mechanical energy loss. African runners expressed higher vertical stiffness and higher step rate, which might lead to a lower CoM vertical displacement, and furthermore reduce mechanical energy loss.


Assuntos
Fenômenos Biomecânicos/fisiologia , Corrida/fisiologia , Adulto , Humanos , Masculino
19.
Urology ; 144: 164-170, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32679272

RESUMO

OBJECTIVE: To evaluate the efficacy of combined MRI-targeted plus systematic 12-core biopsy (Cbx) to aid in the selection of patients for active surveillance (AS). METHODS: From July 2007 to January 2020, patients with Gleason Grade Group (GG) 1 or GG 2 prostate cancer were referred to our center for AS consideration. All patients underwent an MRI and confirmatory combined MRI-targeted plus systematic biopsy (Cbx), and AS outcomes based on Cbx results were compared. Cox regression was used to identify predictors of AS failure, defined as progression to ≥ GG3 disease on follow-up biopsies. RESULTS: Of 579 patients referred for AS, 79.3% (459/579) and 20.7% (120/579) had an initial diagnosis of GG1 and GG2 disease, respectively. Overall, 43.2% of patients (250/579) were upgraded on confirmatory Cbx, with 19.2% (111/579) upgraded to ≥ GG3. For the 226 patients followed on AS, 32.7% (74/226) had benign, 45.6% (103/226) had GG1, and 21.7% (49/226) had GG2 results on confirmatory Cbx. In total, 28.8% (65/226) of patients eventually progressed to ≥ GG3, with a median time to AS failure of 89 months. The median time from confirmatory Cbx to AS failure for the negative, GG1, and GG2 groups were 97, 97, and 32 months, respectively (p < .001). On multivariable regression, only age (hazard ratio 1.06 [1.02-1.11], p < .005) and GG on confirmatory Cbx (hazard ratio 2.75 [1.78-4.26], p < .005) remained as positive predictors of AS failure. CONCLUSION: The confirmatory combined MRI-targeted plus systematic biopsy provides useful information for the risk stratification of patients at the time of AS enrollment.

20.
J Urol ; 204(6): 1229-1235, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32716685

RESUMO

PURPOSE: We identified baseline imaging and clinical characteristics of patients that may improve risk stratification among patients being evaluated for active surveillance. MATERIALS AND METHODS: From July 2007 to January 2020 patients referred to our institution for prostate cancer were evaluated and those who remained on active surveillance were identified. Men underwent multiparametric magnetic resonance imaging upon entry into our active surveillance protocol during which baseline demographic and imaging data were documented. Patients were then followed and outcomes, specifically progression to Gleason Grade Group (GG)3 or greater disease, were recorded. RESULTS: Of the men placed on active surveillance 344 had at least 1 PI-RADS score documented. For those with an index lesion PI-RADS category of 5, 33% (17/51) had progression to GG3 or greater on active surveillance with a median time to progression of 31 months. When comparing the progression-free survival times and progression rates in each category, PI-RADS category was found to be associated with progression to GG3 or greater on active surveillance (p <0.01). On univariable analysis factors associated with progression included an index lesion PI-RADS category of 5, prostate specific antigen density and the size of the largest lesion. On multivariable analysis only PI-RADS category of 5 and prostate specific antigen density were associated with progression on active surveillance. CONCLUSIONS: PI-RADS lesion categories at baseline multiparametric magnetic resonance imaging during active surveillance enrollment can be used to predict cancer progression to GG3 or greater on active surveillance. This information, along with other clinical data, can better assist urologists in identifying and managing patients appropriate for active surveillance.


Assuntos
Imagem por Ressonância Magnética Intervencionista/estatística & dados numéricos , Imageamento por Ressonância Magnética Multiparamétrica/estatística & dados numéricos , Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Conduta Expectante/estatística & dados numéricos , Idoso , Biópsia com Agulha de Grande Calibre/estatística & dados numéricos , Progressão da Doença , Humanos , Biópsia Guiada por Imagem/estatística & dados numéricos , Calicreínas/sangue , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/estatística & dados numéricos , Intervalo Livre de Progressão , Estudos Prospectivos , Próstata/patologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/mortalidade , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fatores de Tempo
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