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1.
Ultrasound Med Biol ; 48(1): 91-97, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34702643

RESUMO

The purpose of this study was to test the diagnostic performance of 3-D power Doppler ultrasound (3-D-PD) with the virtual organ computer-aided analysis (VOCAL) technique in the detection of prostate cancers (PCa). A total of 99 male patients referred for needle prostate biopsy owing to elevated serum prostate-specific antigen or abnormal direct rectal examination were prospectively included. The transrectal 3-D-PD-VOCAL quantitative vascularity parameters of vascularization index (VI), flow index and vascularization/flow index (VFI) were obtained before biopsy and compared with histopathologic results. We evaluated the predictive values for the detection of clinically significant PCa in the foci from different zones and the discrimination among various cancer grades. 3-D-PD-VOCAL discriminated malignant from benign foci, with cutoff values of 27.4% for VI, 38.2 for flow index and 8.6 for VFI. All parameters had higher areas under the curve in detecting lesions in the peripheral zone than in the transition zone (p < 0.05). VI and VFI had better diagnostic performance in detecting clinically significant PCa than flow index (p < 0.05). The area under the curve, sensitivity, specificity and accuracy in detecting clinically significant PCa were, for the VI and VFI respectively, 95% and 95%, 86% and 94%, 87% and 76%, and 87% and 85%. 3-D-PD-VOCAL initially demonstrated favorable performance in detecting PCa. Further, larger-sample studies based on prostatectomy specimens are needed to evaluate the exact usefulness of the technique.

2.
Front Microbiol ; 12: 738690, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34733256

RESUMO

Pseudomonas aeruginosa is a ubiquitous gram-negative bacterium in the environment and a leading cause of nosocomial infections worldwide. Therefore, it is listed by the WHO as a human pathogen that urgently needs the development of new antibacterial drugs. Recent findings have demonstrated that eukaryote-type Ser/Thr protein kinases play a vital role in regulating various bacterial physiological processes by catalyzing protein phosphorylation. Stk1 has proven to be a Ser/Thr protein kinase in P. aeruginosa. However, the regulatory roles of Stk1 have not yet been revealed. Thus, we constructed a stk1 knockout mutant (∆stk1) from the P. aeruginosa PAO1 strain and employed a Tandem Mass Tag (TMT) labeling-based quantitative proteomic strategy to characterize proteome-wide changes in response to the stk1 knockout. In total, 620 differentially expressed proteins, among which 288 proteins were upregulated and 332 proteins were downregulated, were identified in ∆stk1 compared with P. aeruginosa PAO1. A detailed bioinformatics analysis of these differentially expressed proteins was performed, including GO annotation, protein domain profile, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, subcellular localization and enrichment analysis. Notably, the downregulation of type IV pilus-related proteins and upregulation of T6SS-H1-related proteins were found in the ∆stk1 strain, and the results were corroborated by quantitative PCR at the mRNA level. Further experiments confirmed that the loss of stk1 weakens bacterial twitching motility and promotes a growth competition advantage, which are, respectively, mediated by type IV pilus-related proteins and T6SS-H1-related proteins. These findings contribute to a better understanding of the physiological role of Stk1, and proteomic data will help further investigations of the roles and mechanisms of Stk1 in P. aeruginosa, although the detailed regulation and mechanism of Stk1 still need to be revealed.

3.
Adv Sci (Weinh) ; : e2103926, 2021 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-34825527

RESUMO

With the development of society, energy shortage and environmental problems have become more and more outstanding. Solar energy is a clean and sustainable energy resource, potentially driving energy conversion and environmental remediation reactions. Thus, solar-driven chemistry is an attractive way to solve the two problems. Photothermal chemistry (PTC) is developed to achieve full-spectral utilization of the solar radiation and drive chemical reactions more efficiently under relatively mild conditions. In this review, the mechanisms of PTC are summarized from the aspects of thermal and non-thermal effects, and then the interaction and synergy between these two effects are sorted out. In this paper, distinguishing and quantifying these two effects is discussed to understand PTC processes better and to design PTC catalysts more methodically. However, PTC is still a little far away from practical. Herein, several key points, which must be considered when pushing ahead with the engineering application of PTC, are proposed, along with some workable suggestions on the practical application. This review provides a unique perspective on PTC, focusing on the synergistic effects and pointing out a possible direction for practical application.

4.
Planta ; 254(5): 103, 2021 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-34674051

RESUMO

MAIN CONCLUSION: This study leads to advances in the field of heat tolerance among different plant species. We concluded that a coordinated, increased antioxidant defense system enabled white clover to reduce heat-induced oxidative damage. The rise in global ambient temperature has a wide range of effects on plant growth, and, therefore, on the activation of various molecular defenses before the appearance of heat damage. Elevated temperatures result in accelerated generation of reactive oxygen species (ROS), causing an imbalance between ROS production and the ability of scavenging systems to detoxify and remove the reactive intermediates. The aim of this study was to determine the role of antioxidant defense systems in the alleviation of heat stress (HS) consequences in white clover (Trifolium repens L.), which is cultivated worldwide. We evaluated how temperature and time parameters contribute to the thermotolerance of white clover at different growth stages. We revealed HS protection in white clover from 37 to 40 °C, with 40 °C providing the greatest protection of 3-day-old seedlings and 28-day-old adult plants. Heat-provoked oxidative stress in white clover was confirmed by substantial changes in electrolyte leakage, malondialdehyde (MDA), and chlorophyll content, as well as superoxide anion (O2·-) and hydrogen peroxide (H2O2) production. Furthermore, superoxide dismutase (SOD) and ascorbate peroxidase (APX) as well as a high level of GSH non-enzymatic antioxidant were the most responsive, and were associated with acquired thermotolerance through the regulation of ROS generation. We demonstrated, by studying protoplast transient gene expression, direct genetic evidence of endogenous antioxidant-related genes that confer HS tolerance in white clover. Our present study clearly establishes that oxidative stress ensues from HS, which triggers the induction of antioxidant defense systems for ROS scavenging in white clover.


Assuntos
Antioxidantes , Trifolium , Resposta ao Choque Térmico , Peróxido de Hidrogênio , Medicago , Estresse Oxidativo , Trifolium/genética
5.
Inflammation ; 2021 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-34674097

RESUMO

Nonalcoholic steatohepatitis (NASH) is the inflammatory subtype of nonalcoholic fatty liver disease (NAFLD), which can lead to liver fibrosis and cirrhosis. Bile acid levels are correlated with markers of hepatic injury in NASH, suggesting a possible role for bile acids in the progression of NAFLD. Here, we examined the role of deoxycholic acid (DCA) in driving steatotic hepatocytes to pyroptosis, a pro-inflammatory form of programmed cell death. HepG2 cells were stimulated with odium oleate and sodium palmitate for modeling steatotic hepatocytes and then treated with DCA alone or in combination with a specific mitophagy agonist, carbonyl cyanide 3-chlorophenylhydrazone (CCCP). Our results showed that DCA dose-dependently induced a pro-inflammatory response in steatotic hepatocytes but had no significant effect on lipid accumulation. Moreover, activation of the NLRP3 inflammasome and pyroptosis were triggered by DCA. Expression levels of the mitophagy markers PTEN-induced kinase 1 (PINK1) and E3 ubiquitin ligase Parkin were significantly diminished by DCA, whereas induction of mitophagy by CCCP prevented DCA-induced inflammatory response and restored the pyroptosis. Collectively, our data showed that DCA-induced pyroptosis involves the inhibition of PINK1-mediated mitophagy and the activation of the NLRP3 inflammasome. These findings provide insight into the association of DCA with mitophagy, pyroptosis, and inflammation in NASH.

6.
Implement Sci Commun ; 2(1): 119, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666841

RESUMO

BACKGROUND: Colorectal cancer (CRC) screening for average risk adults age 45 and older continues to be underutilized in the USA. One factor consistently associated with CRC screening completion is clinician recommendation. Understanding the barriers and facilitators of clinical adoption of emerging CRC screening strategies is important in developing effective intervention strategies to improve CRC screening rates. We aimed to develop a questionnaire based on the Theoretical Domains Framework (TDF) to assess determinants of clinical adoption of novel CRC screening strategies, using the multi-target stool DNA test (mt-sDNA; Cologuard®) as an example, and test the psychometric properties of this questionnaire on a sample of US clinicians. METHODS: A web survey was administered between November and December 2019 to a national panel of clinicians including primary care clinicians (PCCs) and gastroenterologists (GIs) to assess 10 TDF constructs with 55 items. Confirmatory factor analysis (CFA) was used to examine whether the a priori domain structure was supported by the data. Discriminant validity of domains was tested with Heterotrait-Monotrait ratio (HTMT). Internal consistency for each scale was assessed using Cronbach's alpha. Criterion validity was assessed with self-reported mt-sDNA use and mt-sDNA recommendation as the outcomes. RESULTS: Complete surveys were received from 814 PCCs and 159 GIs (completion rate, 24.7% of 3299 PCCs and 29.6% of 538 GIs). Providers were excluded from analysis if they indicated not recommending CRC screening to average-risk patients (final N = 973). The final questionnaire consisted of 38 items covering 5 domains: (1) knowledge; (2) skills; (3) identity and social influence; (4) optimism, beliefs about consequences, and intentions; and (5) environmental context and resources. CFA results confirmed a reasonable fit (CFI = 0.948, SRMR = 0.057, RMSEA = 0.080). The domains showed sufficient discriminant validity (HTMT < 0.85), good internal consistency (McDonald's omega > 0.76), and successfully differentiated providers who reported they had ordered mt-sDNA from those who never ordered mt-sDNA and differentiated providers who reported routinely recommending mt-sDNA from those who reported not recommending mt-sDNA. CONCLUSIONS: Findings provide initial evidence for the validity and internal consistency of this TDF-based questionnaire in measuring potential determinants of mt-sDNA adoption for average-risk CRC screening. Further investigation of validity and reliability is needed when adapting this questionnaire to other novel CRC screening strategy contexts.

7.
Nanomedicine ; 39: 102467, 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34610478

RESUMO

Various drug delivery strategies to improve cancer therapeutic efficacy have been actively investigated. One major challenge is to improve the targeting ability. Here elaborately designed nanocarriers (NCs) named as Tf-5-ALA-PTX-NCs are demonstrated to address this problem. In this nanostructure, paclitaxel (PTX) and 5-aminolevulinic acid (5-ALA) were co-encapsulated within magnetic nanocarriers to achieve synergistic chemotherapy and photodynamic therapy, while transferrin (Tf) was conjugated with modified copolymer Pluronic P123 and embedded in the surface of the nanocarriers, which endows nanocarriers with Tf targeting and magnetic targeting to enhance the anti-tumor outcome. Results demonstrated that Tf-5-ALA-PTX-NCs significantly enhanced the targeting drug delivery to MCF-7 cells and synergistically induced apoptosis and death of MCF-7 cells in vitro and highly efficient tumor ablation in vivo. Intriguingly, Tf-5-ALA-PTX-NCs have a controllable "on/off" switch to enhance the drug release. The dual-targeted nanocarriers would be a promising versatile anti-tumor drug delivery and imaging-guided cancer chemo-photodynamic synchronization therapy strategy.

8.
Gut Microbes ; 13(1): 1972746, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34530693

RESUMO

Activation of the NOX4/NLRP3 inflammasome pathway has been associated with fibrosis in other organs. An imbalance in intestinal bacteria is an important driving factor of liver fibrosis through the liver-gut axis. This study aimed to explore whether the effect of ursolic acid (UA) on liver fibrosis was associated with the NOX4/NLRP3 inflammasome pathways and intestinal bacteria. Wild-type (WT), NLRP3-/-, and NOX4-/- mice and AP-treated mice were injected with CCI4 and treated with or without UA. The intestinal contents of the mice were collected and analyzed by 16S rRNA sequencing. UA alleviated liver fibrosis, which manifested as decreases in collagen deposition, liver injury, and the expression of fibrosis-related factors, and the expression of NOX4 and NLRP3 was significantly inhibited by UA treatment. Even after CCI4 injection, liver damage and fibrosis-related factors were significantly decreased in NLRP3-/-, NOX4-/-, and AP-treated mice. Importantly, the expression of NLRP3 was obviously inhibited in NOX4-/- and AP-treated mice. In addition, the diversity of intestinal bacteria and the abundance of probiotics in NLRP3-/- and NOX4-/- mice was significantly higher than those in WT mice, while the abundance of harmful bacteria in NLRP3-/- and NOX4-/- mice was significantly lower than that in WT mice. The NOX4/NLRP3 inflammasome pathway plays a crucial role in liver fibrosis and is closely associated with the beneficial effect of UA. The mechanism by which the NOX4/NLRP3 inflammasome pathway is involved in liver fibrosis may be associated with disordered intestinal bacteria.

9.
Mar Drugs ; 19(9)2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34564175

RESUMO

Aging is a biological process that occurs under normal conditions and in several chronic degenerative diseases. Bioactive natural peptides have been shown to improve the effects of aging in cell and animal models and in clinical trials. However, few reports delve into the enormous diversity of peptides from marine organisms. This review provides recent information on the antiaging potential of bioactive peptides from underused marine resources, including examples that scavenge free radicals in vitro, inhibit cell apoptosis, prolong the lifespan of fruit flies and Caenorhabditis elegans, suppress aging in mice, and exert protective roles in aging humans. The underlying molecular mechanisms involved, such as upregulation of oxidase activity, inhibition of cell apoptosis and MMP-1 expression, restoring mitochondrial function, and regulating intestinal homeostasis, are also summarized. This work will help highlight the antiaging potential of peptides from underused marine organisms which could be used as antiaging foods and cosmetic ingredients in the near future.

10.
Mater Sci Eng C Mater Biol Appl ; 129: 112351, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34579877

RESUMO

Phototherapy has attracted increasing attention in cancer therapy owing to its non-invasive nature, high spatiotemporal selectivity, and negligible side effects. However, a single photosensitizer often exhibits poor photothermal conversion efficiency or insufficient reactive oxygen species (ROS) productivity. Even worse, the ROS can be consumed by tumor overexpressed reductive glutathione, resulting in severely compromised phototherapy. In this paper, we prepared a MnII-coordination driven dual-photosensitizers co-assemblies (IMCP) for imaging-guided self-enhanced PDT/PTT. Specifically, a photothermal agent indocyanine green (ICG), a photodynamic agent chlorin e6 (Ce6), and a transition metal ion (MnII/III) were chosen to synthesize the nanodrug via coordination-driven co-assembly. The as-prepared IMCP exhibited extremely high photosensitizer payload (96 wt%), excellent physiological stability, and outstanding tumor accumulation. Moreover, the existence of MnII not only assists the nanostructure formation but also could competitively coordinate with GSH to minimize the unnecessary ROS consumption, thus improving PDT efficiency. Meanwhile, benefiting from the intrinsic fluorescence, photoacoustic imaging ability of photosensitizers, and the MRI contrast potential of MnII/III, IMCP exhibited superior imaging potential for guiding tumor phototherapy. By changing the excitation wavelength suitably, IMCP could realize the switch between PTT and PDT. In short, the dual-PSs co-assembled nanotheranostic has great potential for multi-modal imaging guided phototherapy.


Assuntos
Nanopartículas , Neoplasias , Fotoquimioterapia , Humanos , Verde de Indocianina , Imagem Multimodal , Neoplasias/tratamento farmacológico , Fármacos Fotossensibilizantes/uso terapêutico , Fototerapia
11.
NPJ Digit Med ; 4(1): 140, 2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34548621

RESUMO

While there is significant enthusiasm in the medical community about the use of artificial intelligence (AI) technologies in healthcare, few research studies have sought to assess patient perspectives on these technologies. We conducted 15 focus groups examining patient views of diverse applications of AI in healthcare. Our results indicate that patients have multiple concerns, including concerns related to the safety of AI, threats to patient choice, potential increases in healthcare costs, data-source bias, and data security. We also found that patient acceptance of AI is contingent on mitigating these possible harms. Our results highlight an array of patient concerns that may limit enthusiasm for applications of AI in healthcare. Proactively addressing these concerns is critical for the flourishing of ethical innovation and ensuring the long-term success of AI applications in healthcare.

12.
J Agric Food Chem ; 69(40): 12002-12011, 2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34590865

RESUMO

Xylitol is a widely used natural sweetener for the reduction of excessive sugar consumption. However, concerns of xylitol consumption existed as it is a highly permeable substance in the colon that could cause diarrhea and other adverse symptoms. To assess the relationship between xylitol dosage and diarrhea, especially the influences of diarrhea on physiological characteristics, the immune system, and gut microbiota in rats, the control, low-dose (L), medium-dose (M), and high-dose (H) groups were fed with 0, 1, 3, and 10% of xylitol, respectively, correspondingly for 15 days, followed by a 7-day recovery. Only medium- and high-dose xylitol would cause diarrhea in rats. Quantitative imaging of colonic tissue and the expression levels of proinflammatory factors revealed a higher degree of immune responses in the rats from H groups but statistically stable in M groups, despite that light diarrhea was observed. A shift of the gut microbiota composition was observed in the rats from H groups, including significant decreases of genera Ruminococcaceae and Prevotella and a notable increase and colonization of Bacteroides, accompanied with changes of short-chain fatty acid production. Tolerance and adaptation to xylitol consumption were observed in a dose-dependent manner. Our findings demonstrate that diarrhea caused by the high dosage of xylitol can exert distinctive changes on gut microbiota and lay the foundation to explore the mechanism underlying the shift in gut microbiota composition.


Assuntos
Microbioma Gastrointestinal , Animais , Diarreia , Ácidos Graxos Voláteis , Intestinos , Ratos , Xilitol
13.
ACS Appl Mater Interfaces ; 13(37): 43925-43936, 2021 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-34499485

RESUMO

Chemodynamic therapy (CDT) that utilizes Fenton-type reactions to convert endogenous hydrogen peroxide (H2O2) into hydroxyl radicals (•OH) is a promising strategy in anticancer treatment, but the overexpression of glutathione (GSH) and limited endogenous H2O2 make the efficiency of CDT unsatisfactory. Here, an intelligent nanoplatform CuO2@mPDA/DOX-HA (CPPDH), which induced the depletion of GSH and the self-supply of H2O2, was proposed. When CPPDH entered tumor cells through the targeting effect of hyaluronic acid (HA), a release of Cu2+ and produced H2O2 were triggered by the acidic environment of lysosomes. Then, the Cu2+ was reduced by GSH to Cu+, and the Cu+ catalyzed H2O2 to produce •OH. The generation of •OH could be distinctly enhanced by the GSH depletion and H2O2 self-sufficiency. Besides, an outstanding photothermal therapy (PTT) effect could be stimulated by NIR irradiation on mesoporous polydopamine (mPDA). Meanwhile, mPDA was an excellent photoacoustic reagent, which could monitor the delivery of nanocomposite materials through photoacoustic (PA) imaging. Moreover, the successful delivery of doxorubicin (DOX) realized the integration of chemotherapy, PTT, and CDT. This strategy could solve the problem of insufficient CDT efficacy caused by the limited H2O2 and overexpression of GSH. This multifunctional nanoplatform may open a broad path for self-boosting CDT and synergistic therapy.

14.
Environ Sci Technol ; 55(19): 12871-12881, 2021 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-34559513

RESUMO

Airborne microplastics (MPs) are receiving increasing attention due to their ubiquitous nature and the potential human health consequences resulting from inhalation. The limited data for airborne MP concentrations vary widely among studies (∼4 orders of magnitude), but comparisons are tenuous due to the inconsistent collection and detection/enumeration methodologies among studies. Herein, we used uniform methodologies to obtain comparable airborne MP concentration data to assess MP exposure intensity in five Chinese megacities. Airborne MP concentrations in northern cities (358 ± 132 items/m3) were higher than those in southeast cities (230 ± 94 items/m3) but of a similar order of magnitude, unlike previous studies. The majority (94.7%) of MPs found in air samples were smaller than 100 µm, and the main shape of airborne MPs was fragments (88.2%). Polyethylene, polyester, and polystyrene were the dominant polymers comprising airborne MPs. No consistent relationships were detected between airborne MP concentration and typical socioeconomic indices, and the spatial and diurnal patterns for airborne MPs were different from various components of air quality indices (PM2.5, PM10, etc.). These findings reflect the contrasting source/generation dynamics between airborne MPs and other airborne pollutants. Maximum annual exposure of humans to airborne MPs was estimated in the range of 1-2 million/year in these megacities, highlighting the need for additional research examining the human health risks from the inhalation of airborne MPs.


Assuntos
Microplásticos , Poluentes Químicos da Água , China , Cidades , Monitoramento Ambiental , Humanos , Plásticos , Poluentes Químicos da Água/análise
15.
J Hum Hypertens ; 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535756

RESUMO

We assessed the association of hypertension with markers of inflammation and infection in a rural and disadvantaged Indian population. In a case-control study, we age- and gender-matched 300 cases with hypertension to 300 controls without hypertension. Blood pressure was measured according to a strict protocol. We measured markers of inflammation and infection including serum high-sensitivity C-reactive protein (hs-CRP), blood lymphocyte count, serum homocysteine, tooth loss, overcrowding and exposure to fecal contamination. Multivariable conditional logistic regression was used to determine their association with hypertension. Median serum hs-CRP was 42% greater in cases than controls, while median serum homocysteine was 10% greater. In multivariable conditional logistic regression, elevated homocysteine (OR 1.75, 95% CI 1.09-2.82), greater lymphocyte count (OR 1.49, 95% CI 1.01-2.01) and exposure to fecal contamination, defined as a distance from the field used for toilet purposes to the household of ≤50 m (OR 2.38, 95% CI 1.07-5.29), were independently associated with hypertension in this rural population. In separate analyses for each gender, elevated hs-CRP (OR 2.62, 95% CI 1.04-6.58) was associated with hypertension in men, whereas edentulism (OR 4.75, 95% CI 1.62-13.96) was associated with greater odds of hypertension in women. Our findings demonstrate specific associations between hypertension and markers of inflammation and infection including hs-CRP, homocysteine, lymphocyte count, edentulism and exposure to fecal contamination. Thus, strategies aimed at reducing inflammation and infection may reduce the burden of hypertension in such settings of disadvantage in rural India.

17.
Front Med (Lausanne) ; 8: 690825, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34395474

RESUMO

Background: Esophageal vein rebleeding is a life-threatening complication of liver cirrhosis. However, the role of non-invasive methods that were developed to evaluate the severity of chronic liver disease, especially in rebleeding, remains unclear. Aims: To evaluate the performance of liver stiffness and non-invasive fibrosis scores in predicting esophageal vein rebleeding in hepatitis B virus (HBV) cirrhotic patients. Methods: A prospective analysis of 194 HBV patients between 2017 and 2021 was performed. Receiver operating characteristic (ROC) curves and time-dependent ROC curves were used to assess the power for predicting rebleeding with non-invasive fibrosis score and liver stiffness. Results: During the median follow-up time of 68.28 weeks, 55 patients experienced rebleeding. In the entire cohort, the area under the ROC curve for liver stiffness measurement (LSM) predicting for rebleeding was 0.837, with a cut-off value of 17.79 kPa, and the time-dependent ROC curve also showed stable prediction performance of LSM. The predictive ability of the non-invasive fibrosis score was less than that of LSM, and there were statistical differences. Moreover, patients using non-selective beta-blockers and HBV DNA-negative patients experienced significantly reduced rebleeding. Conclusions: Compared with non-invasive fibrosis scores, LSM can more simply and accurately predict rebleeding events of hepatitis B liver cirrhosis.

18.
Prev Med Rep ; 24: 101508, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34401220

RESUMO

Colorectal cancer (CRC) screening continues to be underutilized in the United States. A better understanding of existing barriers is critical for improving uptake of, and adherence to, CRC screening. Using data from a population-based panel survey, we examined barriers to utilization of three commonly used screening options (FIT/gFOBT, mt-sDNA, and screening colonoscopy) and assessed differences by socio-demographic characteristics, healthcare access, and health status. Data were obtained from a questionnaire developed by the authors and implemented through a U.S. national panel survey conducted in November 2019. Among 5,097 invited panelists, 1,595 completed the survey (31.3%). Analyses were focused on individuals ages 50-75 at average risk for CRC. Results showed that among respondents who reported no prior CRC screening with FIT/gFOBT, mt-sDNA, or colonoscopy, the top barriers were lack of knowledge (FIT/gFOBT: 42.1%, mt-sDNA: 44.9%, colonoscopy: 34.7%), lack of provider recommendation (FIT/gFOBT: 32.1%, mt-sDNA: 27.3%, colonoscopy: 18.6%), and suboptimal access (FIT/gFOBT: 20.8%, mt-sDNA: 17.8%, colonoscopy: 26%). Among participants who had used one or two of the screening options, the top barriers to FIT/gFOBT and mt-sDNA were lack of provider recommendation (31.6% & 37.5%) and lack of knowledge (24.6% & 25.6%), while for colonoscopy top barriers were psychosocial barriers (31%) and lack of provider recommendation (22.7%). Differences by sex, race/ethnicity, income level, and health status were observed. Our research identified primary barriers to the utilization of three endorsed CRC screening options and differences by patient characteristics, highlighting the importance of improving CRC screening education and considering patient preferences in screening recommendations.

19.
Front Med (Lausanne) ; 8: 698502, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34336902

RESUMO

Background: Soluble CD163 (sCD163) is a scavenger receptor membrane protein expressed almost exclusively on Kupffer cells and other macrophages. It was found to be associated with the severity of liver cirrhosis. The aim of the present study was to determine whether the novel biomarker sCD163 predicts outcomes in patients with decompensated cirrhosis. Materials and Methods: A single-center, observational, prospective study with 345 decompensated cirrhosis patients was conducted in the Gastroenterology Department between January 2017 and December 2020. Their plasma samples were tested by enzyme-linked immunosorbent assay (ELISA) for sCD163 within 24 hours of admission. These patients were followed up at 28 days, 3 months and 6 months. The independent risk factors were identified with uni- and multivariate logistic regression analyses. We evaluated the predictive performance of the new scoring system (including sCD163) and the original scoring system. Results: The sCD163 level was significantly higher in non-surviving patients than in surviving patients. Positive associations were found between sCD163 levels and the Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD) and albumin-bilirubin (ALBI) scores. Logistic regression confirmed that sCD163 was an independent risk factor for 28-day, 3-month, and 6-month mortality. The areas under the receiver operating characteristic curves (AUROCs) of the use of sCD163 for the prediction of 28-day, 3-month, and 6-month mortality were relatively higher (AUROCs: 0.856; 0.823 and 0.811, respectively). The AUROCs of the new scores obtained by adding sCD163 to the original scoring systems (CTP + sCD163, MELD + sCD163 and ALBI + sCD163) showed that the new scoring systems had better predictive performance than the original scoring systems at all time points (P < 0.001). Conclusion: sCD163 is a prognostic predictor of short-term and long-term outcomes in decompensated cirrhosis patients. Accordingly, the addition of sCD163 to the original clinical scoring systems improved their prognostic performance.

20.
Patient Educ Couns ; 2021 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-34340846

RESUMO

OBJECTIVE: We examined patient preferences regarding colorectal cancer (CRC) screening decision-making and factors associated with these preferences among screening-eligible US adults. METHODS: Through a national survey of 1595 US adults ages 40-75 (response rate: 31.3%), we measured general medical decision-making and CRC screening decision-making preferences (0-100, 100 = highest desire for involvement) and preferred control level over three CRC screening decisions (whether to screen, what method to use, and when to screen). Analyses focused on respondents aged 45-75 at average CRC risk (N = 1062). RESULTS: Respondents expressed strong desire for involvement in general medical decision-making and CRC screening decision-making (Mean = 68.1, 64.4). Over half of respondents reported preferring having equal control as their providers over whether to screen, what method to use, and when to screen. Women and people with higher education expressed higher desire for involvement in general medical decision-making. For CRC screening decision-making, variations exist in preferred level of involvement and control by race/ethnicity, educational attainment, insurance status, and recency of routine checkup. CONCLUSION: Most respondents preferred a collaborative process of CRC screening decision-making, while variations existed across subgroups. PRACTICE IMPLICATIONS: Providers should assess patients' values and preferences and involve them in CRC screening decision-making at a level they are comfortable with.

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