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1.
Med Sci Monit ; 26: e924242, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32788571

RESUMO

BACKGROUND Atherosclerosis is a progressive inflammatory disease that involves a variety of inflammatory and proinflammatory factors, including intercellular adhesion molecule (ICAM)-1. ICAM-1 plays an important role in atherosclerosis by promoting cell adhesion. Mixed lineage kinase domain-like (MLKL), a critical regulator of necroptotic cell death, is indicated to play an important role in atherosclerosis. This study investigated the effects of MLKL on ICAM-1 expression and cell adhesion, thus providing a new direction for the research of atherosclerosis pathogenesis. MATERIAL AND METHODS siRNA-MLKL and pcDNA-MLKL were designed, and the expression of MLKL and ICAM-1 were estimated by real-time polymerase chain reaction at the mRNA level and Western blotting at the protein level. The adhesion of human monocyte cells (THP-1) to human umbilical vein endothelial cells (HUVECs) was examined under immunofluorescence microscopy, and the ability of cell adhesion was evaluated by ImageJ software. RESULTS Overexpression of MLKL greatly enhanced ICAM-1 expression in HUVECs and the adherence of THP-1 cells to HUVECs. Knockdown of MLKL by siRNA dramatically inhibited the expression of ICAM-1 and the adherence of THP-1 cells to HUVECs. MLKL could promote THP-1 adhesion to HUVECs by activating ICAM-1 expression in HUVECs. CONCLUSIONS MLKL can promote THP-1 cell adhesion to HUVECs through up-regulation of ICAM-1 expression in HUVECs. Thus, MLKL might be a useful target for reducing adhesion of monocytes to endothelial cells and atherosclerosis.

2.
Cancer Epidemiol Biomarkers Prev ; 29(5): 1019-1028, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32051196

RESUMO

BACKGROUND: Total antioxidant capacity (TAC) reflects an individual's overall antioxidant intake. We sought to clarify whether higher TAC is associated with lower risks of pancreatic cancer incidence and mortality in the U.S. general population. METHODS: A total of 96,018 American adults were identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. A ferric-reducing ability of plasma score was used to reflect an individual's TAC intake from diet and/or supplements. Cox regression was used to calculate hazard ratios (HR) for pancreatic cancer incidence, and competing risk regression was used to calculate subdistribution HRs for pancreatic cancer mortality. Restricted cubic spline regression was used to test nonlinearity. RESULTS: A total of 393 pancreatic cancer cases and 353 pancreatic cancer-related deaths were documented. Total (diet + supplements) TAC was found to be inversely associated with pancreatic cancer incidence (HR quartile 4 vs. quartile 1 = 0.53; 95% confidence interval, 0.39-0.72; P trend = 0.0002) and mortality (subdistribution HR quartile 4 vs. quartile 1 = 0.52; 95% confidence interval 0.38-0.72; P trend = 0.0003) in a nonlinear dose-response manner (all P nonlinearity < 0.01). Similar results were observed for dietary TAC. No association of supplemental TAC with pancreatic cancer incidence and mortality was found. CONCLUSIONS: In the U.S. general population, dietary but not supplemental TAC level is inversely associated with risks of pancreatic cancer incidence and mortality in a nonlinear dose-response pattern. IMPACT: This is the first prospective study indicating that a diet rich in antioxidants may be beneficial in decreasing pancreatic cancer incidence and mortality.

3.
Acad Emerg Med ; 27(6): 487-491, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32056327

RESUMO

OBJECTIVES: The objective was to evaluate if there is an association between patient-physician language concordance and adverse patient outcomes or physician adherence to clinical recommendations for emergency department (ED) patients with chest pain. METHODS: We conducted a retrospective observational study of adult ED chest pain encounters with a troponin order from May 2016 to September 2017 across 15 community EDs. Outcomes were 30-day acute myocardial infarction or all-cause mortality, hospital admission/observation, or noninvasive cardiac testing. To assess patient outcomes, we used the overall cohort. To assess adherence to clinical recommendations, we used a subgroup of patients with a low-risk HEART score. A mixed-effects logistic regression model was used to compare the odds of the outcomes between language concordant and discordant patient-physician pairs, controlling for patient characteristics. RESULTS: Overall, 52,014 ED encounters were included (10,791 low-risk HEART encounters). Of those 6,452 (12.4%) encounters were language discordant and 1.7% in each group had an adverse outcome. Adjusted models demonstrated no increased risk for language discordant ED encounters when comparing adverse outcomes (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.6 to 1.5) for all patients or recommended care (OR = 1.02, 95% CI = 0.87 to 1.2) for low-risk patients. CONCLUSIONS: No associations were found between patient-physician language concordance and outcomes or physician adherence to clinical recommendations for ED patients with chest pain. Accessible and effective interpretation services, combined with a decision support tool with standard clinical recommendations, may have contributed to equitable care.

4.
J Am Heart Assoc ; 9(5): e014940, 2020 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-32079480

RESUMO

Background Noninvasive cardiac tests, including exercise treadmill tests (ETTs), are commonly utilized in the evaluation of patients in the emergency department with suspected acute coronary syndrome. However, there are ongoing debates on their clinical utility and cost-effectiveness. It is important to be able to use ETT results for research, but manual review is prohibitively time-consuming for large studies. We developed and validated an automated method to interpret ETT results from electronic health records. To demonstrate the algorithm's utility, we tested the associations between ETT results with 30-day patient outcomes in a large population. Methods and Results A retrospective analysis of adult emergency department encounters resulting in an ETT within 30 days was performed. A set of randomly selected reports were double-blind reviewed by 2 physicians to validate a natural language processing algorithm designed to categorize ETT results into normal, ischemic, nondiagnostic, and equivocal categories. Natural language processing then searched and categorized results of 5214 ETT reports. The natural language processing algorithm achieved 96.4% sensitivity and 94.8% specificity in identifying normal versus all other categories. The rates of 30-day death or acute myocardial infarction varied (P<0.001) by categories for normal (0.08%), ischemic (1.9%), nondiagnostic (0.77%), and equivocal (0.58%) groups achieving good discrimination (C-statistic, 0.81; 95% CI, 0.7-0.92). Conclusions Natural language processing is an accurate and efficient strategy to facilitate large-scale outcome studies of noninvasive cardiac tests. We found that most patients are at low risk and have normal ETT results, while those with abnormal, nondiagnostic, or equivocal results have slightly higher risks and warrant future investigation.

5.
Chemistry ; 26(37): 8262-8266, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31968144

RESUMO

Free base, zinc and palladium π-extended porphyrins containing fused naphthalenediamide units were employed as photosensitizers in antimicrobial photodynamic therapy (aPDT). Their efficacy, assessed by photophysical and in vitro photobiological studies on Gram-positive bacteria, was found to depend on metal coordination, showing a dramatic enhancement of photosensitizing activity for the palladium complex.


Assuntos
Antibacterianos/farmacologia , Bactérias Gram-Positivas/química , Metaloporfirinas/química , Porfirinas/química , Zinco/química , Antibacterianos/química , Humanos , Metaloporfirinas/farmacologia , Fotoquimioterapia , Fármacos Fotossensibilizantes , Porfirinas/farmacologia
6.
PLoS One ; 14(12): e0225792, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800606

RESUMO

BACKGROUND: ABO blood group has been associated with cardiovascular disease and cancer. However, whether ABO blood group is associated with nonalcoholic fatty liver disease (NAFLD) remains unknown. The present study aimed to clarify this issue. METHODS: A hospital-based case-control study was performed in southwestern China. A total of 583 newly ultrasound-diagnosed NAFLD cases and 2068 controls were included. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of developing NAFLD were calculated by multivariate logistic regression. A propensity score was developed for adjustment and matching. RESULTS: The proportions of blood groups A, B, AB and O were 31%, 26%, 8% and 35%, respectively. Non-O blood groups were found to be significantly associated with an increased risk of NAFLD (the fully adjusted OR = 1.51, 95% CI: 1.19, 1.91); moreover, compared with blood group O, the fully adjusted ORs of developing NAFLD were 1.50 (95% CI: 1.13, 1.99) for blood group A, 1.59 (95% CI: 1.19, 2.14) for blood group B, and 1.37 (95% CI: 0.86, 2.18) for blood group AB. Similar results were obtained in both propensity-score-adjusted and propensity-score-matched analyses. No evidence of significant effect modification for the association of ABO blood group with the risk of NAFLD was found (all Pinteraction>0.05). CONCLUSIONS: Non-O blood groups are significantly associated with an increased risk of NAFLD. Our findings provide some epidemiological evidence for a possible role of ABO glycosyltransferase in the pathogenesis of NAFLD. However, these findings need to be validated by future studies.


Assuntos
Sistema ABO de Grupos Sanguíneos , Grupo com Ancestrais do Continente Asiático , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , China/epidemiologia , Comorbidade , Suscetibilidade a Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Razão de Chances , Pontuação de Propensão , Medição de Risco
7.
Adv Mater ; 31(43): e1903687, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31495992

RESUMO

Highly responsive organic image sensors are crucial for medical imaging applications. To enhance the pixelwise photoresponse in an organic image sensor, the integration of an organic photodetector with amplifiers, or the use of a highly responsive organic photodetector without an additional amplifying component, is required. The use of vertically stacked, two-terminal organic photodetectors with photomultiplication is a promising approach for highly responsive organic image sensors owing to their simple two-terminal structure and intrinsically large responsivity. However, there are no demonstrations of an imaging sensor array using organic photomultiplication photodetectors. The main obstacle to a sensor array is the weak-light sensitivity, which is limited by a relatively large dark current. Herein, a highly responsive organic image sensor based on monolithic, vertically stacked two-terminal pixels is presented. This is achieved using pixels of a vertically stacked diode-type organic photodetector with photomultiplication. Furthermore, applying an optimized injection electrode and additionally stacked rectifying layers, this two-terminal device simultaneously demonstrates a high responsivity (>40 A W-1 ), low dark current, and high rectification under illumination. An organic image sensor based on this device with an extremely simple architecture exhibits a high pixel photoresponse, demonstrating a weak-light imaging capability even at 1 µW cm-2 .

8.
Cancer Med ; 8(13): 5939-5947, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31433117

RESUMO

BACKGROUND: Osimertinib yields significant tumor responses and durations of progression-free survival (PFS) in patients with acquired T790M mutations. However, the evidence supporting liquid biopsy-guided treatment is still limited. This study examined the real-world benefits of osimertinib in patients with tissue or plasma T790M mutations. METHODS: From January 2016 to June 2018, a total of 183 non-small-cell lung cancer patients were enrolled. The presence of the T790M mutation was assessed by either tissue or plasma. The PFS, overall survival, and tumor response rates of the patients were calculated and compared with those of previous clinical trials. RESULTS: T790M mutations were detected in 51.5% of the patients, including 64 of 140 (45.7%) who underwent liquid biopsies and 23 of 29 (79.3%) who underwent tumor biopsies. After excluding those in clinical trials, 46 patients received osimertinib, including 33 with positive plasma and 13 with positive tissue results for T790M mutations. The median PFS was 11.3 months (interquartile range: 5.2-NR) in all the T790M-positive patients and 10.1 months (interquartile range: 5.9-NR) in the plasma T790M-positive patients. The overall survival, meanwhile, was not reached, whereas the one-year survival rate was 66.1% in all the patients and 61.4% in those who were plasma T790M-positive. The objective response rate and disease control rate were 37.8% and 91.9% in all the patients and 34.6% and 92.3% in the plasma T790M-positive group, respectively. Using a Cox proportional hazards regression, we determined that male gender was a poor prognostic factor for PFS. CONCLUSIONS: In this retrospective real-world analysis, it was determined that both tissue and plasma T790M mutations can be used to guide treatment with osimertinib. Similar disease control rates and survival durations were observed in comparison to those of phase 3 clinical trials.

9.
J Chem Phys ; 151(4): 044501, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31370542

RESUMO

Singlet fission (SF) converts a singlet exciton into two triplet excitons in two or more electronically coupled organic chromophores, which may then be used to increase solar cell efficiency. Many known SF chromophores are unsuitable for device applications due to chemical instability or low triplet state energies. The results described here show that efficient SF occurs in derivatives of 9,10-bis(phenylethynyl)anthracene (BPEA), which is a highly robust and tunable chromophore. Fluoro and methoxy substituents at the 4- and 4'-positions of the BPEA phenyl groups control the intermolecular packing in the crystal structure, which alters the interchromophore electronic coupling, while also changing the SF energetics. The lowest excited singlet state (S1) energy of 4,4'-difluoro-BPEA is higher than that of BPEA so that the increased thermodynamic favorability of SF results in a (16 ± 2 ps)-1 SF rate and a 180% ± 16% triplet yield, which is about an order of magnitude faster than BPEA with a comparable triplet yield. By contrast, 4-fluoro-4'-methoxy-BPEA and 4,4'-dimethoxy-BPEA have slower SF rates, (90 ± 20 ps)-1 and (120 ± 10 ps)-1, and lower triplet yields, (110 ± 4)% and (168 ± 7)%, respectively, than 4,4'-difluoro-BPEA. These differences are attributed to changes in the crystal structure controlling interchromophore electronic coupling as well as SF energetics in these polycrystalline solids.

10.
J Am Chem Soc ; 141(31): 12236-12239, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31302997

RESUMO

When a molecular electron donor interacts with multiple electron acceptors, quantum coherence can enhance the electron transfer (ET) rate. Here we report photodriven ET rates in a pair of donor-acceptor (D-A) compounds that link one anthracene (An) donor to one or two equivalent 1,4-benzoquinone (BQ) acceptors. Subpicosecond ET from the lowest excited singlet state of An to two BQs is about 2.4 times faster than ET to one BQ at room temperature, but about 5 times faster at cryogenic temperatures. This factor of 2 increase results from a transition from ET to one of two acceptors at room temperature to ET to a superposition state of the two acceptors with correlated system-bath fluctuations at low temperature.

11.
J Phys Chem Lett ; 10(13): 3509-3515, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31188611

RESUMO

Recent advances in two-dimensional electronic spectroscopy (2DES) have enabled identification of fragile quantum coherences in condensed-phase systems near the equilibrium molecular geometry. In general, traditional 2DES cannot measure such coherences associated with photophysical processes that occur at times significantly after the initially prepared state has dephased, such as the evolution of the initial excited state into a charge transfer state. We demonstrate the use of transient two-dimensional electronic spectroscopy (t-2DES) to probe coherences in an electron donor-acceptor dyad consisting of a perylenediimide (PDI) acceptor and a perylene (Per) donor. An actinic pump pulse prepares the lowest excited singlet state of PDI followed by formation of the PDI•--Per•+ ion pair, which is probed at different times following the actinic pulse using 2DES. Analysis of the observed coherences provides information about electronic, vibronic, and vibrational interactions at any time along the reaction coordinate for ion pair formation.

12.
Ann Emerg Med ; 74(2): 216-223, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30955986

RESUMO

STUDY OBJECTIVE: Professional guidelines recommend 72-hour cardiac stress testing after an emergency department (ED) evaluation for possible acute coronary syndrome. There are limited data on actual compliance rates and effect on patient outcomes. Our aim is to describe rates of completion of noninvasive cardiac stress testing and associated 30-day major adverse cardiac events. METHODS: We conducted a retrospective analysis of ED encounters from June 2015 to June 2017 across 13 community EDs within an integrated health system in Southern California. The study population included all adults with a chest pain diagnosis, troponin value, and discharge with an order for an outpatient cardiac stress test. The primary outcome was the proportion of patients who completed an outpatient stress test within the recommended 3 days, 4 to 30 days, or not at all. Secondary analysis described the 30-day incidence of major adverse cardiac events. RESULTS: During the study period, 24,459 patients presented with a chest pain evaluation requiring troponin analysis and stress test ordering from the ED. Of these, we studied the 7,988 patients who were discharged home to complete diagnostic testing, having been deemed appropriate by the treating clinicians for an outpatient stress test. The stress test completion rate was 31.3% within 3 days and 58.7% between 4 and 30 days, and 10.0% of patients did not complete the ordered test. The 30-day rates of major adverse cardiac events were low (death 0.0%, acute myocardial infarction 0.7%, and revascularization 0.3%). Rapid receipt of stress testing was not associated with improved 30-day major adverse cardiac events (odds ratio 0.92; 95% confidence interval 0.55 to 1.54). CONCLUSION: Less than one third of patients completed outpatient stress testing within the guideline-recommended 3 days after initial evaluation. More important, the low adverse event rates suggest that selective outpatient stress testing is safe. In this cohort of patients selected for outpatient cardiac stress testing in a well-integrated health system, there does not appear to be any associated benefit of stress testing within 3 days, nor within 30 days, compared with those who never received testing at all. The lack of benefit of obtaining timely testing, in combination with low rates of objective adverse events, may warrant reassessment of the current guidelines.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Dor no Peito/diagnóstico , Teste de Esforço/normas , Infarto do Miocárdio/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Doença Aguda , Idoso , Dor no Peito/etiologia , Tomada de Decisão Clínica , Serviço Hospitalar de Emergência , Teste de Esforço/métodos , Teste de Esforço/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Mortalidade/tendências , Infarto do Miocárdio/epidemiologia , Revascularização Miocárdica/estatística & dados numéricos , Estudos Observacionais como Assunto , Avaliação de Resultados em Cuidados de Saúde , Alta do Paciente/tendências , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Espanha/epidemiologia , Troponina/sangue
13.
Cancer ; 125(9): 1558-1567, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30620388

RESUMO

BACKGROUND: Hodgkin lymphoma (HL) is a leading cancer diagnosis for adolescents and young adults (AYAs), with an overall 5-year survival rate of >80%. However, to the authors' knowledge, little is known regarding posttreatment patterns of care. In the current study, the authors characterized the use of guideline-recommended services in a cohort of AYA survivors of HL in Kaiser Permanente Southern California. METHODS: Patients with HL who were diagnosed between ages 15 and 39 years between 2000 and 2010 were identified. The authors calculated the number of patients who received recommended short-term care within 2 years after treatment cessation for those who remained enrolled and alive from 2001 through 2015. Use of recommended late-effects screening for breast cancer and cardiovascular disease was examined. Logistic regression was used to evaluate the association between receipt of recommended care and patient, cancer, and treatment characteristics. RESULTS: A total of 354 patients were identified, with a mean age at the time of diagnosis of 26 years (standard deviation, 6.9 years). Approximately 12% of patients had stage I disease, 59% had stage II disease, 17% had stage III disease, and 13% of patients had stage IV disease. Nearly all patients received chemotherapy (95%), 51% received radiotherapy, and 5% received care from a pediatric oncologist. Overall, approximately 49% of patients received recommended short-term care. Of those patients eligible for cardiovascular screening at 10 years posttreatment (60 patients), 53% received at least 1 screening. Of those patients eligible for breast cancer screening (21 patients), approximately 50% underwent at least 1 screening. Regression results indicated that those patients treated by a pediatric oncologist were >3 times as likely to receive recommended short-term care. CONCLUSIONS: The results of the current study highlight gaps in the delivery of posttreatment care to AYA survivors of HL. By determining areas in need of improvement, these findings can guide the development of tailored interventions with which to improve care.


Assuntos
Assistência Ambulatorial , Sobreviventes de Câncer/estatística & dados numéricos , Doença de Hodgkin/epidemiologia , Doença de Hodgkin/reabilitação , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Assistência Ambulatorial/normas , Assistência Ambulatorial/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Feminino , Doença de Hodgkin/psicologia , Humanos , Masculino , Participação do Paciente/estatística & dados numéricos , Sobrevivência , Adulto Jovem
14.
Chempluschem ; 84(9): 1432-1438, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31944060

RESUMO

Singlet and triplet excited-state dynamics of anthanthrene and anthanthrone derivatives in solution are studied. Triisopropylsilyl- (TIPS) or H-terminated ethynyl groups are used to tune the singlet and triplet energies to enable their potential applications in singlet fission and triplet fusion processes. Time-resolved optical and electron paramagnetic resonance (EPR) spectroscopies are used to obtain a mechanistic understanding of triplet formation. The anthanthrene derivatives form triplet states efficiently at a rate (ca. 107  s-1 ) comparable to radiative singlet fluorescence processes with approximately 30 % triplet yields, despite their large S1 -T1 energy gap (>1 eV) and the lack of carbonyl groups. In contrast, anthanthrone has a higher triplet yield (50±10 %) with a faster intersystem crossing rate (2.7 × 108  s-1 ) because of the n-π* character of the S1 ←S0 transition. Analysis of time-resolved spin-polarized EPR spectra of these compounds reveals that the triplet states are primarily generated by the spin-orbit-induced intersystem crossing mechanism. However, at high concentrations, the EPR spectrum of the 4,6,10,14-tetrakis(TIPS-ethynyl)anthanthrene triplet state shows a significant contribution from a non-Boltzmann population of the ms =0 spin sublevel, which is characteristic of triplet formation by singlet fission.

15.
J Am Chem Soc ; 140(45): 15140-15144, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30372052

RESUMO

Singlet fission (SF) in two or more electronically coupled organic chromophores converts a high-energy singlet exciton into two low-energy triplet excitons, which can be used to increase solar cell efficiency. Many known SF chromophores are unsuitable for device applications due to chemical instability and low triplet state energies. The results described here show that efficient SF occurs in polycrystalline thin films of 9,10-bis(phenylethynyl)anthracene (BPEA), a commercial dye that has singlet and triplet energies of 2.40 and 1.11 eV, respectively, in the solid state. BPEA crystallizes into two polymorphs with space groups C2/ c and Pbcn, which undergo SF with kSFA = (109 ± 4 ps)-1 and kSFB = (490 ± 10 ps)-1, respectively. The high triplet energy and efficient SF evidenced from the 180 ± 20% triplet yield make BPEA a promising candidate for enhancing solar cell performance.

16.
J Am Chem Soc ; 140(43): 14474-14480, 2018 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-30289699

RESUMO

[4]Chrysaorene, a fully conjugated carbocyclic coronoid, is shown to be a low-bandgap π-conjugated system with a distinct open-shell character. The system shows good chemical stability and can be oxidized to well-defined radical cation and dication states. The cavity of [4]chrysaorene acts as an anion receptor toward halide ions with a particular selectivity toward iodides ( Ka = 207 ± 6 M-1). The interplay between anion binding and redox chemistry is demonstrated using a 1H NMR analysis in solution. In particular, a well-resolved, paramagnetically shifted spectrum of the [4]chrysaorene radical cation is observed, providing evidence for the inner binding of the iodide. The radical cation-iodide adduct can be generated in thin solid films of [4] chrysaorene by simple exposure to diiodine vapor.

18.
ACS Appl Mater Interfaces ; 10(38): 32736-32746, 2018 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-30180542

RESUMO

Energy consumption is always a major issue hindering the universal application of membrane-based filtration system. We herein demonstrated a low-energy-consumption microfiltration system that can be operated under ambient pressure while a great metal ion rejection rate (>95%) accompanied by a high permeate flux (100 L/m2h) was concurrently reached. This achievement was closely correlated to the enhanced metal ion adsorption by grafted carboxyl groups at the cellulose filter paper through esterification. Adsorbed metal ions consequently enhanced Donnan exclusion effect and therefore high rejection rate was achieved. Rejection rate of modified membrane was strongly correlated to the formation constant of associated carboxyl group to metal ions. Our results would be important for developing low-energy-consumption filtration systems for water and wastewater treatment application.

19.
Ther Adv Med Oncol ; 10: 1758835918797589, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30263066

RESUMO

Introduction: Brain metastases (BM) are common in advanced non-small cell lung cancer (NSCLC), and the prognosis is poor with few therapeutic options. This study evaluated the efficacy of three epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in preventing and treating BM in patients with EGFR mutation-positive advanced NSCLC. Methods: Patients with EGFR mutation-positive advanced NSCLC who visited a tertiary referral center from 1 December 2013 to 30 November 2017 were analyzed retrospectively. They received gefitinib, erlotinib, or afatinib until disease progression, death, or intolerable adverse events. The cumulative incidence of subsequent BM of initial non-BM patients, progression-free survival (PFS), and overall survival (OS) of the BM and non-BM patients were estimated and compared using the Kaplan-Meier and log-rank tests. Results: 306 NSCLC patients were enrolled, with 116, 75, and 115 receiving first-line gefitinib, erlotinib, and afatinib, respectively. The afatinib group had a better PFS [12.7 versus 9.8 months; hazard ratio (HR) 0.59, p = 0.001] and OS (39.1 versus 22.0 months; HR 0.64, p = 0.035) than the gefitinib group. Afatinib tended to provide better BM prevention than gefitinib (BM cumulative incidence, HR 0.49; 95% confidence interval 0.34-0.71, p < 0.001) according to a Cox model adjusted for possible confounders. Patients with initial BM had a shorter PFS (p < 0.001) and OS (p = 0.015) than those without initial BM. Among the former, there were no differences in median PFS (p = 0.34) and median OS (p = 0.46) in the three EGFR-TKI groups. Conclusions: Our data suggested that, compared with gefitinib, afatinib provided better benefits significantly in terms of PFS and OS. Both had the same effectiveness in preventing subsequent BM.

20.
Am J Manag Care ; 24(6): e196-e199, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29939510

RESUMO

OBJECTIVES: An epidemic of opioid overuse has resulted in nationwide efforts to decrease prescribing, but there is concern that implementing these recommendations will cause patients who are accustomed to opioids for chronic pain to be dissatisfied with care. STUDY DESIGN: Retrospective cohort study of satisfaction scores for patients prescribed opioids for noncancer chronic pain for at least 6 consecutive months from 2009 to 2014. METHODS: We used mixed effects regression to examine the association between opioid dose reduction and the frequency of unfavorable patient satisfaction scores. Subgroup analysis compared the effect of dose reduction on satisfaction scores for encounters between patients and their assigned primary care provider (PCP) versus encounters between patients and an unassigned provider. RESULTS: Included were 2492 encounters involving patients with high-dose chronic opioid use for noncancer pain. A reduction in opioid prescribing occurred in 29% of encounters, and most of these resulted in favorable satisfaction scores (86.4%). After adjustment, the odds of an unfavorable score in the dose reduction group were just marginally higher and not significant (odds ratio [OR], 1.31; 95% CI, 1.00-1.73). Stratified by different encounter types, opioid dose reduction was not associated with unfavorable scores for visits with an assigned PCP (OR, 1.16; 95% CI, 0.79-1.70), but the odds of an unfavorable score were higher for encounters with an unassigned provider (OR, 1.50; 95% CI, 1.01-2.23). CONCLUSIONS: Overall, reducing opioid use for chronic pain is not associated with lower patient satisfaction scores, but encounters with unassigned providers may be associated with slightly lower satisfaction when opioids are reduced.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Satisfação do Paciente , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , California , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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