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1.
Artigo em Inglês | MEDLINE | ID: mdl-31713615

RESUMO

OBJECTIVES: Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) have been increasingly reported in China. Here, a multicentre, longitudinal surveillance study on CR-hvKP is described. METHODS: We retrospectively investigated carbapenem-resistant K. pneumoniae (CRKP) in 56 centres across China during 2015-17 and screened the virulence genes (iucA, iroN, rmpA and rmpA2) for the presence of virulence plasmids. Hypermucoviscosity, serum killing and Galleria mellonella lethality experiments were conducted to identify CR-hvKP among strains with all four virulence genes. Capsule typing, fitness and plasmid features of CR-hvKP were also investigated. RESULTS: A total of 1052 CRKP were collected. Among these, 34.2% (360/1052) carried virulence genes and 72 of them had all four of the virulence genes tested. Fifty-five (76.4%) were considered to be CR-hvKP using the G. mellonella infection model, with KPC-2-producing K64-ST11 being the most common type (80%, 44/55). Prevalence of CR-hvKP differed greatly between regions, with the highest in Henan (25.4%, 17/67) and Shandong (25.8%, 25/97). A significant increase in CR-hvKP among KPC-2-producing ST11 strains was observed, from 2.1% (3/141) in 2015 to 7.0% (23/329) in 2017 (P = 0.045). Alarmingly, compared with classic CRKP, no difference in growth was found among CR-hvKP (P = 0.7028), suggesting a potential risk for dissemination. The hybrid virulence and resistance-encoding plasmid evolved from pLVPK and the resistance plasmid harbouring blaKPC-2, indicating evolution existed between the hypervirulence and hyper-resistance plasmid. CONCLUSIONS: CR-hvKP were more frequently detected than previously assumed, especially among KPC-2-producing ST11. Dissemination of hypervirulence could be extremely rapid due to limited fitness cost. Also, the evolution of resistance genes into hypervirulence plasmids was identified, presenting significant challenges for public health and infection control.

2.
Hum Mol Genet ; 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31600786

RESUMO

We previously identified five SNPs at four susceptibility loci for diffuse large B-cell lymphoma (DLBCL) in individuals of European ancestry through a large genome-wide association study (GWAS). To further elucidate genetic susceptibility to DLBCL, we sought to validate 2 loci at 3q13.33 and 3p24.1 that were suggestive in the original GWAS with additional genotyping. In the meta-analysis (5,662 cases and 9,237 controls) of the four original GWAS discovery scans and three replication studies, the 3q13.33 locus (rs9831894; minor allele frequency [MAF]=0.40) was associated with DLBCL risk (OR=0.83, P=3.62x10-13). rs9831894 is in linkage disequilibrium (LD) with additional variants that are part of a super-enhancer that physically interacts with promoters of CD86 and ILDR1. In the meta-analysis (5,510 cases and 12,817 controls) of the four GWAS discovery scans and four replication studies, the 3p24.1 locus (rs6773363; MAF=0.45) was also associated with DLBCL risk (OR=1.20, P=2.31x10-12). This SNP is 29,426 bp upstream of the nearest gene EOMES and in LD with additional SNPs that are part of a highly lineage-specific and tumor-acquired super-enhancer that shows long-range interaction with AZI2 promoter. These loci provide additional evidence for the role of immune function in the etiology of DLBCL, the most common lymphoma subtype.

4.
Cancer Epidemiol Biomarkers Prev ; 28(10): 1755-1764, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31387967

RESUMO

BACKGROUND: Thyroid cancer incidence is the most rapidly increasing malignancy; rates are three times higher in women than men. Thyroid hormone-disrupting flame-retardant chemicals, including polybrominated diphenyl ethers (PBDE) and polybrominated biphenyls (PBB), may contribute to this trend. METHODS: We investigated the relationship between PBDE/PBB exposure and papillary thyroid cancer (PTC) in 250 incident female papillary thyroid cancer cases and 250 female controls frequency-matched on age. Interviews and postdiagnostic serum samples were collected from 2010 to 2013. Serum samples were analyzed for 11 congeners. We calculated ORs and 95% confidence intervals (95% CI) using single-pollutant logistic regression models for continuous and categorical lipid-adjusted serum concentrations of PBDE/PBB, adjusted for age, alcohol consumption, and education. We applied three multi-pollutant approaches [standard multipollutant regression models, hierarchical Bayesian logistic regression modeling (HBLR), principal components analysis (PCA)] to investigate associations with PBDE/PBB mixtures. RESULTS: In single-pollutant models, a decreased risk was observed at the highest (>90th percentile) versus lowest (

5.
Environ Res ; 177: 108597, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31401375

RESUMO

BACKGROUND: Land use regression (LUR) models have been widely used to estimate air pollution exposures at high spatial resolution. However, few LUR models were developed for rapidly developing urban cores, which have substantially higher densities of population and built-up areas than the surrounding areas within a city's administrative boundary. Further, few studies incorporated vertical variations of air pollution in exposure assessment, which might be important to estimate exposures for people living in high-rise buildings. OBJECTIVE: A LUR model was developed for the urban core of Lanzhou, China, along with a model of vertical concentration gradients in high-rise buildings. METHODS: In each of four seasons in 2016-2017, NO2 was measured using Ogawa badges for 2 weeks at 75 ground-level sites. PM2.5 was measured using DataRAM for shorter time intervals at a subset (N = 38) of the 75 sites. Vertical profile measurements were conducted on 9 stories at 2 high-rise buildings (N = 18), with one building facing traffic and another facing away from traffic. The average seasonal concentrations of NO2 and PM2.5 at ground level were regressed against spatial predictors, including elevation, population, road network, land cover, and land use. The vertical variations were investigated and linked to ground-level predictions with exponential models. RESULTS: We developed robust LUR models at the ground level for estimated annual averages of NO2 (R2: 0.71, adjusted R2: 0.67, and Leave-One-Out Cross Validation (LOOCV) R2: 0.64) and PM2.5 (R2: 0.77, adjusted R2: of 0.73, and LOOCV R2: 0.67) in the urban core of Lanzhou, China. The LUR models for the estimated seasonal averages of NO2 showed similar patterns. Vertical variation of NO2 and PM2.5 differed by windows orientation with respect to traffic, by season or by time of a day. Vertical variation functions incorporated the ground-level LUR predictions, in a form that could allow for exposure assessment in future epidemiological investigations. CONCLUSIONS: Ground-level NO2 and PM2.5 showed substantial spatial variations, explained by traffic and land use patterns. Further, vertical variation of air pollution levels is significant under certain conditions, suggesting that exposure misclassification could occur with traditional LUR that ignores vertical variation. More studies are needed to fully characterize three-dimensional concentration patterns to accurately estimate air pollution exposures for residents in high-rise buildings, but our LUR models reinforce that concentration heterogeneity is not captured by the limited government monitors in the Lanzhou urban area.

6.
Chemosphere ; 237: 124412, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31376695

RESUMO

BACKGROUND: The association between multiple metal concentrations and gestational diabetes mellitus (GDM) is poorly understood. METHODS: A total of 776 women with GDM and an equal number of controls were included in the study. Concentrations of metals in participants' blood (nickel (Ni), arsenic (As), cadmium (Cd), antimony (Sb), thallium (Tl), mercury (Hg), lead (Pb)) were measured using inductively coupled plasma-mass. We used unconditional logistical regression models to estimate the associations between metals and GDM. We also employed weighted quantile sum (WQS) regression and principal components analysis (PCA) to examine metal mixtures in relation to GDM. RESULTS: An increased risk of GDM was associated with As (OR = 1.49, 95% CI: 1.11, 2.01 for the 2nd tertile vs. the 1st tertile) and Hg (OR = 1.43, 95% CI: 1.09, 1.88 for the 3rd tertile vs. the 1st tertile). In WQS analysis, the WQS index was significantly associated with GDM (OR = 1.20, 95% CI: 1.02, 1.41). The major contributor to the metal mixture index was Hg (69.2%), followed by Pb (12.8%), and As (11.3%). Based on PCA, the second principal component, which was characterized by Hg, Ni, and Pb, was associated with an increased risk of GDM (OR = 1.46, 95% CI: 1.02, 2.08 for the highest quartile vs. the lowest quartile). CONCLUSIONS: Our study results suggest that high metal levels are associated with an increased risk of GDM, and this increased risk is mainly driven by Hg and, to a lesser extent, by Ni, Pb, and As.

7.
J Thorac Oncol ; 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31437531

RESUMO

INTRODUCTION: Recent studies have indicated that the presence of ground-glass opacity (GGO) components is associated with favorable survival. The purpose of this study was to reveal the prognostic value of GGO components and differences in prognostic factors for part-solid and solid lesions in invasive stage I NSCLC. METHODS: The cases of 2010 patients with completely resected invasive pathological stage I NSCLC were reviewed according to the eighth edition of the TNM classification. Patients were categorized into the pure-GGO, part-solid, and solid groups based on consolidation-to-tumor ratio. Cox multivariate proportional hazard analyses were conducted to identify independent prognostic factors in each group. RESULTS: Of the 2010 patients, 146 (7.3%) were in the pure-GGO group, 732 (36.4%) were in the part-solid group, and 1132 (56.3%) were in the solid group. Cox multivariate analyses revealed that GGO absence was a strong independent risk factor for worse recurrence-free survival (p < 0.001). For the pure-GGO group, there was no recurrence in spite of the invasive stage. For the part-solid group, visceral pleural invasion could not predict recurrence-free survival in general (p = 0.514) or in each tumor size group (for tumors size ≤1 cm, p = 0.664; for tumors size >1 to 2 cm, p = 0.456; for tumors size >2 to 3 cm, p = 0.900; and for tumors size >3 to 4 cm, p = 0.397). For the solid group, adenocarcinoma subtype was not a prognostic factor for recurrence-free survival in general (p = 0.162) or in each tumor size group (for tumors size ≤ 2 cm, p = 0.092; for tumors size >2 to 3 cm, p = 0.330; and for tumors size >3 to 4 cm, p = 0.885). CONCLUSIONS: The presence of GGO components was a strong predictor in patients with invasive pathological stage I NSCLC. Risk factors were distinct in the part-solid and solid groups. There was no prognostic value of visceral pleural invasion in the part-solid group. Adenocarcinoma subtype did not have prognostic value in the solid group.

8.
J Vasc Surg Venous Lymphat Disord ; 7(5): 685-692, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31421837

RESUMO

OBJECTIVE: Venous ablation (VA) is the recommended treatment of superficial venous insufficiency affecting the lower extremities. The safety and efficacy of the procedure in octogenarians have not been well studied. We postulate that VA in octogenarians is as safe and effective as in younger age groups. METHODS: A retrospective single-center review of consecutive patients undergoing VA using radiofrequency in an outpatient office was performed. Patients, imaging, and procedural characteristics were reviewed from the medical records. A telephone survey inquiring about intensity of symptoms on a numeric rating scale of 0 to 10 before and after treatment was conducted. Patients were divided into three groups based on age: <65 years, 65 to 79 years, and ≥80 years. Clinical success was defined by patients' reporting improvement or resolution of symptoms and was reported per leg. Technical success was defined by vein closure on duplex ultrasound and was reported per vein. Patients and outcomes were compared between the three groups using χ2 or analysis of variance test in SAS software (SAS Institute, Cary, NC). RESULTS: There were 362 patients who underwent 627 VAs in 512 legs. Octogenarians constituted 9.4% of the patient population and were more likely to have cardiovascular comorbidities. Octogenarians were significantly more likely to have advanced venous disease as determined by the Clinical, Etiology, Anatomy, and Pathophysiology classification compared with younger patients (P = .005). On ultrasound, younger patients had significantly larger vein diameters (P = .04) and longer reflux times (P < .001). There was no significant difference in the types of veins (P = .08) or the mean number of veins (P = .37) treated in the three groups; however, there was a trend toward younger patients' requiring more adjunctive procedures (P = .1). The clinical success (P = .86), technical success (P = .19), and complications (P = .36) were not different between octogenarians and younger patients. The survey results demonstrated similar findings with no difference in pain improvement (P = .27) or recurrence (P = .36). CONCLUSIONS: Octogenarians treated with VA present at a more advanced clinical stage compared with younger patients but have less severe ultrasound findings. VA is safe and effective in all age groups. Age should not be used to deny patients VA.

9.
J Surg Res ; 245: 81-88, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31404894

RESUMO

BACKGROUND: Delayed emergency department (ED) LOS has been associated with increased mortality and increased hospital length of stay (LOS) for various patient populations. Trauma patients often require significant effort in evaluation, workup, and disposition; however, patient and hospital characteristics associated with increased LOS in the ED for trauma patients remain unclear. METHODS: The Trauma Quality Improvement Project database (2014-2016) was queried for all adult blunt trauma patients. Patients discharged from the ED to the operating room were excluded. Univariate and multivariable linear regression analysis was conducted to identify independent predictors of ED LOS, controlling for patient characteristics (age, gender, race, insurance status), hospital characteristics (teaching status, ACS trauma verification level, geographic region), abbreviated injury scale and comorbid status. RESULTS: 412,000 patients met inclusion criteria for analysis. When controlling for covariates, an increase in age by 1 y resulted in 0.63 increased minutes in the ED (P < 0.001). In multivariable linear regression controlling for injury severity and comorbid conditions, non-white race groups, university status, and northeast region were associated with increased ED LOS. Black and Hispanic patients spent on average 41 and 42 more minutes, respectively, in the ED room when compared with white patients (P < 0.001). Patients seen at University hospitals spent 52 more minutes in the ED when compared with community hospitals, whereas patients at nonteaching hospitals spent 31 fewer minutes (P < 0.001). Patients seen in the Midwest spent the least amount of time in the ED, with patients in the South, West, and Northeast spending 45, 36, and 89 more minutes, respectively (P < 0.001). Non-Medicaid patients at level 1 trauma centers and those requiring intensive care admission had significantly decreased ED LOS. Medicaid patients took the longest to move through the ED with Medicare, BlueCross, and Private insurance outpacing them by 17, 23, and 23 min, respectively (P < 0.001). ACS level 1 trauma centers moved patients through the ED fastest, whereas ACS level II trauma centers and level III trauma centers moved patients through 50 and 130 min slower when compared with ACS level 1 trauma centers (P < 0.001). CONCLUSIONS: ED LOS varied significantly by patient and hospital characteristics. Medicaid patients and those patients at university hospitals were associated with significantly higher ED LOS, whereas ACS trauma verification level status had strong correlation with ED LOS. These results may allow targeted quality improvement programs to enhance ED LOS.

10.
IEEE Trans Cybern ; 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31403454

RESUMO

In this paper, we study the distributed Nash equilibrium (NE) seeking problem for a class of aggregative games with players described by uncertain perturbed nonlinear dynamics. To seek the NE, each player needs to construct a distributed algorithm based on information of its cost function and the exchanging information obtained from its neighbors. By combining the internal model principle and the average consensus technique, we propose a distributed gradient-based algorithm for the players. This paper not only assures the NE seeking of aggregative games but also achieves the disturbance rejection of external disturbances.

11.
J Neurosurg ; : 1-11, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277071

RESUMO

OBJECTIVE: Intracranial epidermoid tumors are slow-growing, histologically benign tumors of epithelial cellular origin that can be symptomatic because of their size and mass effect. Neurosurgical resection, while the treatment of choice, can be quite challenging due to locations where these lesions commonly occur and their association with critical neurovascular structures. As such, subtotal resection (STR) rather than gross-total resection (GTR) can often be performed, rendering residual and recurrent tumor potentially problematic. The authors present a case of a 28-year-old man who underwent STR followed by aggressive repeat resection for regrowth, and they report the results of the largest meta-analysis to date of epidermoid tumors to compare recurrence rates for STR and GTR. METHODS: The authors conducted a systemic review of PubMed, Web of Science, and the Cochrane Collaboration following the PRISMA guidelines. They then conducted a proportional meta-analysis to compare the pooled recurrence rates between STR and GTR in the included studies. The authors developed fixed- and mixed-effect models to estimate the pooled proportions of recurrence among patients undergoing STR or GTR. They also investigated the relationship between recurrence rate and follow-up time in the previous studies using linear regression and natural cubic spline models. RESULTS: Overall, 27 studies with 691 patients met the inclusion criteria; of these, 293 (42%) underwent STR and 398 (58%) received GTR. The average recurrence rate for all procedures was 11%. The proportional meta-analysis showed that the pooled recurrence rate after STR (21%) was 7 times greater than the rate after GTR (3%). The average recurrence rate for studies with longer follow-up durations (≥ 4.4 years) (17.4%) was significantly higher than the average recurrence rate for studies with shorter follow-up durations (< 4.4 years) (5.7%). The cutoff point of 4.4 years was selected based on the significant relationship between the recurrence rate of both STR and GTR and follow-up durations in the included studies (p = 0.008). CONCLUSIONS: STR is associated with a significantly higher rate of epidermoid tumor recurrence compared to GTR. Attempts at GTR should be made during the initial surgery with efforts to optimize success. Surgical expertise, as well as the use of adjuncts, such as intraoperative MRI and neuromonitoring, may increase the likelihood of completing a safe GTR and decreasing the long-term risk of recurrence. The most common surgical complications were transient cranial nerve palsies, occurring equally in STR and GTR cases when reported. In all postoperative epidermoid tumor cases, but particularly following STR, close follow-up with serial MRI, even years after surgery, is recommended.

12.
Artigo em Inglês | MEDLINE | ID: mdl-31272748

RESUMO

OBJECTIVE: Temporal changes in the risk of postoperative death following cardiac surgery are uncharacterized. We aimed to quantify the duration of postoperative phase with elevated risk of death in patients who underwent cardiac surgery and were discharged to home and destinations other than home. METHOD: We conducted a retrospective cohort study of 6894 patients who underwent cardiac surgery between 2008 and 2016 at a tertiary care center in the United States. Logistic regression models with restricted cubic splining along the days since hospital discharge were fitted for risk of death in patients who were discharged to home and those discharged to destinations other than home. The splining curves were analyzed to quantify the duration of postoperative high-risk phase in each cohort. RESULTS: Mortality rate was significantly higher in the nonhome cohort compared with those discharged to home at 365 days following hospital discharge (9.3% vs 2.1%; P < .001). Discharge to destinations other than home was an independent predictor of late death (hazard ratio, 1.36; 95% confidence interval, 1.15-1.61; P < .001). Analysis of restricted cubic splining curves demonstrated that the postoperative phase with elevated risk of death persisted for 80.3 days in nonhome discharge cohorts, whereas a comparable phase was nonexistent in patients who went home. Predictors of nonhome discharge were identified, with combination of preoperative and postoperative variables yielding C statistics of 0.83. CONCLUSIONS: Hospital discharges to locations other than home following cardiac surgery were associated with an increased risk of late mortality. The postoperative high-risk phase persisted for 80 days in patients who were discharged to locations other than home, supporting the use of 90-day outcome measures as quality metrics. Predictors of discharge to locations other than home were identified, and this may aid in selective intervention to reduce the risk of death in this vulnerable patient population.

13.
Ecotoxicol Environ Saf ; 182: 109453, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31349105

RESUMO

Telomeres are DNA-protein structures that protect chromosome ends from degradation and fusion, which are shortened by oxidative stress, for example air pollution including benzene, toluene, Coke Oven Emissions (COEs), and so on. As a biomarker of health and disease, telomere length is associated with cardiovascular, diabetes and cancers. The aim of this study was to estimate the effects of COEs exposure on telomere length and the benchmark dose (BMD) of COEs. A total of 542 coke oven workers and 235 healthy controls without exposure to toxicants were recruited. Quantitative PCR was used to determine the telomere length in human peripheral blood leukocytes DNA. Propensity scoring was used to match coke oven workers to healthy controls. Linear regression models and trend tests were used to the relationship between COEs exposure and telomere length. Telomere length in COEs exposed group 0.764 (0.536, 1.092) was significantly shorter than that in the control group 1.064(0.762, 1.438), (P < 0.001). There were significantly dose-response relationships between COEs exposure and telomere damage with telomere length as a biomarker. A BMDL value lower than the present occupational exposure limits (OELs) of COEs exposure was evaluated using the BMD approach in coke oven workers. Our results suggested that shorter telomere length is related to occupational exposure to COEs and the level of COEs exposure lower than the current national OELs in China and many other countries could induce telomere damage.


Assuntos
Poluentes Ocupacionais do Ar/análise , Coque/análise , Exposição Ocupacional/análise , Telômero/efeitos dos fármacos , Adolescente , Adulto , Poluentes Ocupacionais do Ar/toxicidade , Benchmarking , Biomarcadores/análise , Estudos de Casos e Controles , China , Coque/toxicidade , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Estresse Oxidativo/efeitos dos fármacos , Estresse Oxidativo/genética , Telômero/ultraestrutura , Adulto Jovem
14.
Sci Total Environ ; 690: 853-866, 2019 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-31302550

RESUMO

1,4-Dioxane has historically been used to stabilize chlorinated solvents and more recently has been found as a contaminant of numerous consumer and food products. Once discharged into the environment, its physical and chemical characteristics facilitate migration in groundwater, resulting in widespread contamination of drinking water supplies. Over one-fifth of U.S. public drinking water supplies contain detectable levels of 1,4-dioxane. Remediation efforts using common adsorption and membrane filtration techniques have been ineffective, highlighting the need for alternative removal approaches. While the data evaluating human exposure and health effects are limited, animal studies have shown chronic exposure to cause carcinogenic responses in the liver across multiple species and routes of exposure. Based on this experimental evidence, the U.S. Environmental Protection Agency has listed 1,4-dioxane as a high priority chemical and classified it as a probable human carcinogen. Despite these health concerns, there are no federal or state maximum contaminant levels for 1,4-dioxane. Effective public health policy for this emerging contaminant requires additional information about human health effects, chemical interactions, environmental fate, analytical detection, and treatment technologies. This review highlights the current state of knowledge, key uncertainties, and data needs for future research on 1,4-dioxane.

15.
BMC Microbiol ; 19(1): 162, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299904

RESUMO

BACKGROUND: Linezolid-resistant enterococci pose great challenges in clinical practice. The aim of this study is to study the mechanisms underlying the resistance and genetic environment of antimicrobial resistance gene of linezolid-resistant enterococci. RESULTS: The linezolid MICs of 16 enterococci were 4 mg/L to 16 mg/L. Four strains belonged to multi-drug resistant (MDR) bacteria. The sequence types (STs) of 13 enterococci strains performed WGS were diverse: 3 ST476, 1 ST86, ST116, ST480, ST59, ST416, ST21, ST67, ST16, ST585 and ST18. None of them carried multi-drug resistance gene cfr. Only one strain had the G2658 T mutation of target 23S rRNA gene. Thirteen (13/16, 81.3%) strains harbored the novel oxazolidinone resistance gene optrA. WGS analysis showed that the optrA gene was flanked by sequence IS1216E insertion in 13 strains, and optrA was adjacent to transposons Tn558 in two strains and Tn554 in one strain. The optrA gene was identified to be co-localized with fexA, the resistance genes mediated florfenicol resistance in 13 strains, and ermA1, the resistance genes mediated erythromycin resistance in 9 strains, indicating that linezolid-resistant strains may be selected due to non-oxazolidinone antibiotics (i.e. macrolides and florfenicol) usage. CONCLUSION: Our findings demonstrate the high diversity of optrA-carrying genetic platforms. The mobile genetic elements (MGEs) may play an important role in the dissemination of optrA into the enterococci isolates of human origin. The genetic evidence of transferable feature and co-selection of optrA should be gave more attention in clinical practice.

16.
Ann Surg Oncol ; 26(8): 2367-2374, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31187360

RESUMO

BACKGROUND: The value of adjuvant therapy for esophageal squamous cell carcinoma (ESCC) has been controversial, at least partially due to the lack of efficient criteria for selecting suitable patients. This study aimed to explore the existence of parameters related to lymph node (LN) status that can predict the value of adjuvant therapy in ESCC. METHODS: The study included 298 patients with ESCC who had undergone radical esophagectomy with lymphadenectomy. Adjuvant therapy was defined as reception of adjuvant chemotherapy, radiotherapy, or chemoradiotherapy. For the study, LN ratio (LNR), total number of resected LNs (TLNs), and pN stage were selected for Cox regression analyses, including their correlations and prognostic values for survival. Log-rank tests were used to compare the survival rates of the patients with and without adjuvant therapy stratified by pN stage, TLNs, LNR, or their combinations. RESULTS: The independent prognostic factors for survival were TLNs, LNR, and pN stage. Whereas pN stage was significantly related to TLNs and LNR, TLNs were not correlated with LNR. The survival rates between the patients with and those without adjuvant therapy stratified by pN stage, TLNs, or LNR did not differ significantly. We used the median values of TLNs and LNR to group the patients into four groups. The patients in the group with fewer TLNs and higher LNR who had undergone adjuvant therapy showed a significantly better survival than those without adjuvant therapy (p = 0.030). CONCLUSIONS: In contrast to TLNs, LNR, and pN stage as single factors, the combination of TLNs and LNR can predict the value of adjuvant therapy.

17.
BMC Infect Dis ; 19(1): 508, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182038

RESUMO

BACKGROUND: In China multidrug-resistant bacteria pose a considerable threat to public health. Antimicrobial resistance has weakened the effectiveness of many medicines widely used today. Thus, discovering new antibacterial drugs is paramount in the effort to treat emerging drug-resistant bacteria. METHODS: Eravacycline, tigecycline and other clinical routine antibiotics were tested by reference broth micro-dilution method against 336 different strains collected from 11 teaching hospitals in China between 2012 and 2016. These isolates included Enterobacteriaceae, non-fermentative, Staphylococcus spp., Enterococcus, and a number of fastidious organisms. The strains involved in this study possess the most important drug resistance characteristics currently known in China. Drug resistant bacteria such as those producing extended spectrum ß-lactamases (ESBL) and carbapenemases (KPC-2 and NDM-1), and those exhibiting colistin resistance (mcr-1) and tigecycline were included in this study. Additionally, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), ß-lactamase positive Haemophilus influenzae, and penicillin resistant Streptococcus pneumoniae (PRSP) were also included. RESULTS: Eravacycline exhibited good efficacy against all the strains tested, especially for organisms with ESBLs, carbapenemases, and mcr-1 gene compared with tigecycline and other antibiotics tested. The MIC values of eravacycline against carbapenemase producing Enterobacteriaceae and OXA-23-producing A. baumannii were much lower than the MIC values of other antibiotics. MRSA, VRE, ß-lactamase positive Haemophilus influenza, and PRSP were sensitive to eravacycline in every strain tested. Furthermore, in most strains tested, the MICs of eravacycline were two to four-fold lower than the MICs of tigecycline. CONCLUSIONS: Eravacycline has shown potent antibacterial activity against common and clinically important antibiotic-resistant pathogens. The MIC distribution of eravacycline was generally lower than that of tigecycline which demonstrates that this new drug is potentially more effective than the existing medications.


Assuntos
Acinetobacter baumannii/isolamento & purificação , Antibacterianos/farmacologia , Enterobacteriaceae/isolamento & purificação , Tetraciclinas/farmacologia , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/enzimologia , Proteínas de Bactérias/metabolismo , China , Farmacorresistência Bacteriana/efeitos dos fármacos , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/enzimologia , Hospitais de Ensino , Humanos , Testes de Sensibilidade Microbiana , beta-Lactamases/metabolismo
18.
Cancer Causes Control ; 30(8): 889-900, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31165419

RESUMO

PURPOSE: To conduct a pooled analysis assessing the association of blood transfusion with risk of non-Hodgkin lymphoma (NHL). METHODS: We used harmonized data from 13 case-control studies (10,805 cases, 14,026 controls) in the InterLymph Consortium. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression, adjusted for study design variables. RESULTS: Among non-Hispanic whites (NHW), history of any transfusion was inversely associated with NHL risk for men (OR 0.74; 95% CI 0.65-0.83) but not women (OR 0.92; 95% CI 0.83-1.03), pheterogeneity = 0.014. Transfusion history was not associated with risk in other racial/ethnic groups. There was no trend with the number of transfusions, time since first transfusion, age at first transfusion, or decade of first transfusion, and further adjustment for socioeconomic status, body mass index, smoking, alcohol use, and HCV seropositivity did not alter the results. Associations for NHW men were stronger in hospital-based (OR 0.56; 95% CI 0.45-0.70) but still apparent in population-based (OR 0.84; 95% CI 0.72-0.98) studies. CONCLUSIONS: In the setting of a literature reporting mainly null and some positive associations, and the lack of a clear methodologic explanation for our inverse association restricted to NHW men, the current body of evidence suggests that there is no association of blood transfusion with risk of NHL.


Assuntos
Transfusão de Sangue , Linfoma não Hodgkin/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Adulto Jovem
19.
Med Phys ; 46(9): 3799-3811, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31247134

RESUMO

PURPOSE: Currently, four-dimensional (4D) cone-beam computed tomography (CBCT) requires a 3-4 min full-fan scan to ensure usable image quality. Recent advancements in sparse-view 4D-CBCT reconstruction have opened the possibility to reduce scan time and dose. The aim of this study is to provide a common framework for systematically evaluating algorithms for 4D-CBCT reconstruction from a 1-min scan. Using this framework, the AAPM-sponsored SPARE Challenge was conducted in 2018 to identify and compare state-of-the-art algorithms. METHODS: A clinically realistic CBCT dataset was simulated using patient CT volumes from the 4D-Lung database. The selected patients had multiple 4D-CT sessions, where the first 4D-CT was used as the prior CT, and the rest were used as the ground truth volumes for simulating CBCT projections. A GPU-based Monte Carlo tool was used to simulate the primary, scatter, and quantum noise signals. A total of 32 CBCT scans of nine patients were generated. Additional qualitative analysis was performed on a clinical Varian and clinical Elekta dataset to validate the simulation study. Participants were blinded from the ground truth, and were given 3 months to apply their reconstruction algorithms to the projection data. The submitted reconstructions were analyzed in terms of root-mean-squared-error (RMSE) and structural similarity index (SSIM) with the ground truth within four different region-of-interests (ROI) - patient body, lungs, planning target volume (PTV), and bony anatomy. Geometric accuracy was quantified as the alignment error of the PTV. RESULTS: Twenty teams participated in the challenge, with five teams completing the challenge. Techniques involved in the five methods included iterative optimization, motion-compensation, and deformation of the prior 4D-CT. All five methods rendered significant reduction in noise and streaking artifacts when compared to the conventional Feldkamp-Davis-Kress (FDK) algorithm. The RMS of the three-dimensional (3D) target registration error of the five methods ranged from 1.79 to 3.00 mm. Qualitative observations from the Varian and Elekta datasets mostly concur with those from the simulation dataset. Each of the methods was found to have its own strengths and weaknesses. Overall, the MA-ROOSTER method, which utilizes a 4D-CT motion model for temporal regularization, had the best and most consistent image quality and accuracy. CONCLUSION: The SPARE Challenge represents the first framework for systematically evaluating state-of-the-art algorithms for 4D-CBCT reconstruction from a 1-min scan. Results suggest the potential for reducing scan time and dose for 4D-CBCT. The challenge dataset and analysis framework are publicly available for benchmarking future reconstruction algorithms.

20.
Ecotoxicol Environ Saf ; 181: 428-434, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31220783

RESUMO

The evidence is increasing that prenatal air pollutant exposure contributes to elevated oxidative stress in children, but the underlying mechanism is unclear. A pilot study was conducted in China to explore the associations between prenatal ambient air pollution exposure and superoxide dismutase 2 (SOD2) promoter methylation in maternal and cord blood. After detection and analyses, SOD2 promoter methylation levels in umbilical cord blood were elevated as maternal SOD2 promoter methylation levels increased. In addition, the SOD2 promoter methylation levels in umbilical cord blood were positively associated with the particulate matter 10 (PM10) exposure concentrations during the entire pregnancy and the second trimester. In maternal peripheral blood, the SOD2 promoter methylation levels were positively associated with the exposure concentrations of PM10 (during the entire pregnancy and the second trimester) and nitrogen dioxide (NO2) (during the first trimester of pregnancy), whereas the levels were negatively associated with the exposure concentrations of NO2 during the third trimester of pregnancy. Additionally, interaction analyses revealed that the maternal SOD2 promoter methylation level and sulfur dioxide (SO2) exposure (during the entire pregnancy and the third trimester), as well as NO2 exposure (during the third trimester of pregnancy), had an interaction effect on the SOD2 promoter methylation level in umbilical cord blood. Furthermore, mediation analysis revealed that the associations between SOD2 promoter methylation in umbilical cord blood and PM10 exposure during the entire pregnancy and the second trimester were partly mediated by maternal SOD2 promoter methylation. In conclusion, prenatal exposure to air pollutants was significantly associated with SOD2 promoter methylation levels in umbilical cord blood, and this association may be affected by SOD2 promoter methylation levels in maternal peripheral blood. These associations may be one of the mechanisms by which prenatal air pollutant exposure leads to oxidative stress in newborns.


Assuntos
Poluição do Ar/análise , Metilação de DNA , Sangue Fetal/química , Exposição Materna , Superóxido Dismutase/genética , Poluentes Atmosféricos/sangue , China , Feminino , Humanos , Recém-Nascido , Masculino , Projetos Piloto , Gravidez , Regiões Promotoras Genéticas , Fatores de Risco , Superóxido Dismutase/sangue
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