Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.211.661
Filtrar
1.
Curr Oncol ; 28(3): 2007-2013, 2021 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-34073214

RESUMO

The COVID-19 situation is a worldwide health emergency with strong implications in clinical oncology. In this viewpoint, we address two crucial dilemmas from the ethical dimension: (1) Is it ethical to postpone or suspend cancer treatments which offer a statistically significant benefit in quality of life and survival in cancer patients during this time of pandemic?; (2) Should we vaccinate cancer patients against COVID-19 if scientific studies have not included this subgroup of patients? Regarding the first question, the best available evidence applied to the ethical principles of Beauchamp and Childress shows that treatments (such as chemotherapy) with clinical benefit are fair and beneficial. Indeed, the suspension or delay of such treatments should be considered malefic. Regarding the second question, applying the doctrine of double-effect, we show that the potential beneficial effect of vaccines in the population with cancer (or those one that has had cancer) is much higher than the potential adverse effects of these vaccines. In addition, there is no better and less harmful known solution.


Assuntos
COVID-19/prevenção & controle , Tomada de Decisão Clínica/ética , Neoplasias/tratamento farmacológico , Seleção de Pacientes/ética , Tempo para o Tratamento/ética , Antineoplásicos/administração & dosagem , COVID-19/epidemiologia , COVID-19/imunologia , COVID-19/virologia , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/efeitos adversos , Humanos , Oncologia/ética , Neoplasias/imunologia , Neoplasias/mortalidade , Neoplasias/psicologia , Pandemias/prevenção & controle , Qualidade de Vida , Fatores de Risco , SARS-CoV-2/imunologia , Fatores de Tempo , Vacinação/efeitos adversos , Vacinação/ética
2.
Sci Rep ; 11(1): 11485, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34075094

RESUMO

In the wake of the COVID-19 pandemic, it has been mandated to keep enlarged distances from others. We interviewed 136 German subjects over five weeks from the end of March to the end of April 2020 during the first wave of infections about their preferred interpersonal distance (IPD) before, during, and after the COVID-19 pandemic. In response to the pandemic, subjects adapted to distance requirements and preferred a larger IPD. This enlarged IPD was judged to partially persist after the pandemic crisis. People anticipated keeping more IPD to others even if there was no longer any risk of a SARS-CoV-2 infection. We also sampled two follow-up measurements, one in August, after the first wave of infections had been flattened, and one in October 2020, at the beginning of the second wave. Here, we observed that IPD varied with the incidence of SARS-CoV-2 within Germany. Overall, our data indicated that adaptation to distance requirements might happen asymmetrically. Preferred IPD rapidly adapted in response to distance requirements, but an enlargement of IPD may partially linger after the COVID-19 pandemic-crisis. We discuss our findings in light of proxemic theory and as an indicator for socio-cultural adaptation beyond the course of the pandemic.


Assuntos
Adaptação Psicológica , COVID-19/psicologia , Distanciamento Físico , Isolamento Social/psicologia , Adolescente , Adulto , Teorema de Bayes , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Medo , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Modelos Psicológicos , Pandemias/prevenção & controle , Estigma Social , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo , Adulto Jovem
4.
J Korean Med Sci ; 36(21): e157, 2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34060263

RESUMO

Understanding the long-term kinetics of antibodies in coronavirus disease 2019 (COVID-19) is essential in interpreting serosurvey data. We investigated the antibody response one year after infection in 52 mildly symptomatic patients with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, using three commercial immunoassays and a surrogate virus neutralization test (sVNT) kit. Anti-N pan-immunoglobulin (Ig), anti-S IgG, and anti-S1 IgG were detected in 43 (82.7%), 44 (84.6%), and 30 (57.7%), respectively. In 49 (94.2%), the antibody could be detected by either anti-N pan-Ig or anti-S IgG assay. In the sVNT, 30 (57.7%) had positive neutralizing activity. Despite waning immunity, SARS-CoV-2 antibodies can be detected up to one year after infection, even in mild COVID-19 patients.


Assuntos
Anticorpos Antivirais/sangue , COVID-19/imunologia , SARS-CoV-2/imunologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Testes de Neutralização , Kit de Reagentes para Diagnóstico , Fatores de Tempo , Adulto Jovem
5.
J Korean Med Sci ; 36(21): e158, 2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34060264

RESUMO

The antibody titer of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was observed in 289 healthy healthcare workers who had completed the second dose of the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine. Antibody tests were performed using both the automated electrochemiluminescence immunoassay (ECLIA) and the chromatographic lateral flow immunoassay (LFIA). All subjects had antibodies against the receptor binding domain of the spike protein of SARS-CoV-2 only one week after completing the vaccination, and the antibody titer became significantly higher after another week (P < 0.001). Since there was a large amount of antibody formation within two weeks after completion of vaccination, the less sensitive method, LFIA, also showed high sensitivity. There was no significant difference between whole blood and serum in detecting SARS-CoV-2 antibodies after vaccination. This is an early study of vaccinations among Koreans and is expected to contribute to the establishment of national guidelines on COVID-19 vaccination.


Assuntos
Anticorpos Antivirais/sangue , Vacinas contra COVID-19/imunologia , COVID-19/prevenção & controle , Pessoal de Saúde , SARS-CoV-2/imunologia , Vacinação , Humanos , Imunoensaio , Medições Luminescentes , Fatores de Tempo
6.
J BUON ; 26(2): 303-305, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34076972

RESUMO

COVID-19 pandemic has obviously affected patients' behavior towards seeking medical help as well as physicians' decision in the management of emergencies. Our recent experience as surgeons at a COVID-19 referral hospital revealed cases which share an alerting characteristic: the delay in appropriate management. Unfortunately for COVID-19 negative patients a "coronacentric" health system has been adopted. In view of measures applied to avoid spread of the disease, a significant delay in patients' presentation as well as in their in-hospital management is observed. We present cases where delay in appropriate management affected the patients' outcome and underline the fact that balancing between COVID-19 safety measures and a patient who needs urgent treatment can be very challenging and stressful.


Assuntos
Abscesso Abdominal/cirurgia , Teste para COVID-19 , COVID-19/diagnóstico , Atenção à Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Tempo para o Tratamento , Abscesso Abdominal/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Apendicite/diagnóstico , Apendicite/cirurgia , COVID-19/prevenção & controle , COVID-19/transmissão , Progressão da Doença , Evolução Fatal , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Tempo de Internação , Abscesso Hepático/diagnóstico , Abscesso Hepático/terapia , Masculino , Megacolo/diagnóstico , Megacolo/cirurgia , Pessoa de Meia-Idade , Segurança do Paciente , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
JAMA ; 325(22): 2262-2272, 2021 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-34077499

RESUMO

Importance: Continuous glucose monitoring (CGM) has been shown to be beneficial for adults with type 2 diabetes using intensive insulin therapy, but its use in type 2 diabetes treated with basal insulin without prandial insulin has not been well studied. Objective: To determine the effectiveness of CGM in adults with type 2 diabetes treated with basal insulin without prandial insulin in primary care practices. Design, Setting, and Participants: This randomized clinical trial was conducted at 15 centers in the US (enrollment from July 30, 2018, to October 30, 2019; follow-up completed July 7, 2020) and included adults with type 2 diabetes receiving their diabetes care from a primary care clinician and treated with 1 or 2 daily injections of long- or intermediate-acting basal insulin without prandial insulin, with or without noninsulin glucose-lowering medications. Interventions: Random assignment 2:1 to CGM (n = 116) or traditional blood glucose meter (BGM) monitoring (n = 59). Main Outcomes and Measures: The primary outcome was hemoglobin A1c (HbA1c) level at 8 months. Key secondary outcomes were CGM-measured time in target glucose range of 70 to 180 mg/dL, time with glucose level at greater than 250 mg/dL, and mean glucose level at 8 months. Results: Among 175 randomized participants (mean [SD] age, 57 [9] years; 88 women [50%]; 92 racial/ethnic minority individuals [53%]; mean [SD] baseline HbA1c level, 9.1% [0.9%]), 165 (94%) completed the trial. Mean HbA1c level decreased from 9.1% at baseline to 8.0% at 8 months in the CGM group and from 9.0% to 8.4% in the BGM group (adjusted difference, -0.4% [95% CI, -0.8% to -0.1%]; P = .02). In the CGM group, compared with the BGM group, the mean percentage of CGM-measured time in the target glucose range of 70 to 180 mg/dL was 59% vs 43% (adjusted difference, 15% [95% CI, 8% to 23%]; P < .001), the mean percentage of time at greater than 250 mg/dL was 11% vs 27% (adjusted difference, -16% [95% CI, -21% to -11%]; P < .001), and the means of the mean glucose values were 179 mg/dL vs 206 mg/dL (adjusted difference, -26 mg/dL [95% CI, -41 to -12]; P < .001). Severe hypoglycemic events occurred in 1 participant (1%) in the CGM group and in 1 (2%) in the BGM group. Conclusions and Relevance: Among adults with poorly controlled type 2 diabetes treated with basal insulin without prandial insulin, continuous glucose monitoring, as compared with blood glucose meter monitoring, resulted in significantly lower HbA1c levels at 8 months. Trial Registration: ClinicalTrials.gov Identifier: NCT03566693.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/tratamento farmacológico , Controle Glicêmico/métodos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Idoso , Intervalos de Confiança , Diabetes Mellitus Tipo 2/sangue , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Período Pós-Prandial , Tamanho da Amostra , Fatores de Tempo , Resultado do Tratamento
8.
JAMA ; 325(22): 2273-2284, 2021 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-34077502

RESUMO

Importance: Continuous glucose monitoring (CGM) is recommended for patients with type 1 diabetes; observational evidence for CGM in patients with insulin-treated type 2 diabetes is lacking. Objective: To estimate clinical outcomes of real-time CGM initiation. Design, Setting, and Participants: Exploratory retrospective cohort study of changes in outcomes associated with real-time CGM initiation, estimated using a difference-in-differences analysis. A total of 41 753 participants with insulin-treated diabetes (5673 type 1; 36 080 type 2) receiving care from a Northern California integrated health care delivery system (2014-2019), being treated with insulin, self-monitoring their blood glucose levels, and having no prior CGM use were included. Exposures: Initiation vs noninitiation of real-time CGM (reference group). Main Outcomes and Measures: Ten end points measured during the 12 months before and 12 months after baseline: hemoglobin A1c (HbA1c); hypoglycemia (emergency department or hospital utilization); hyperglycemia (emergency department or hospital utilization); HbA1c levels lower than 7%, lower than 8%, and higher than 9%; 1 emergency department encounter or more for any reason; 1 hospitalization or more for any reason; and number of outpatient visits and telephone visits. Results: The real-time CGM initiators included 3806 patients (mean age, 42.4 years [SD, 19.9 years]; 51% female; 91% type 1, 9% type 2); the noninitiators included 37 947 patients (mean age, 63.4 years [SD, 13.4 years]; 49% female; 6% type 1, 94% type 2). The prebaseline mean HbA1c was lower among real-time CGM initiators than among noninitiators, but real-time CGM initiators had higher prebaseline rates of hypoglycemia and hyperglycemia. Mean HbA1c declined among real-time CGM initiators from 8.17% to 7.76% and from 8.28% to 8.19% among noninitiators (adjusted difference-in-differences estimate, -0.40%; 95% CI, -0.48% to -0.32%; P < .001). Hypoglycemia rates declined among real-time CGM initiators from 5.1% to 3.0% and increased among noninitiators from 1.9% to 2.3% (difference-in-differences estimate, -2.7%; 95% CI, -4.4% to -1.1%; P = .001). There were also statistically significant differences in the adjusted net changes in the proportion of patients with HbA1c lower than 7% (adjusted difference-in-differences estimate, 9.6%; 95% CI, 7.1% to 12.2%; P < .001), lower than 8% (adjusted difference-in-differences estimate, 13.1%; 95% CI, 10.2% to 16.1%; P < .001), and higher than 9% (adjusted difference-in-differences estimate, -7.1%; 95% CI, -9.5% to -4.6%; P < .001) and in the number of outpatient visits (adjusted difference-in-differences estimate, -0.4; 95% CI, -0.6 to -0.2; P < .001) and telephone visits (adjusted difference-in-differences estimate, 1.1; 95% CI, 0.8 to 1.4; P < .001). Initiation of real-time CGM was not associated with statistically significant changes in rates of hyperglycemia, emergency department visits for any reason, or hospitalizations for any reason. Conclusions and Relevance: In this retrospective cohort study, insulin-treated patients with diabetes selected by physicians for real-time continuous glucose monitoring compared with noninitiators had significant improvements in hemoglobin A1c and reductions in emergency department visits and hospitalizations for hypoglycemia, but no significant change in emergency department visits or hospitalizations for hyperglycemia or for any reason. Because of the observational study design, findings may have been susceptible to selection bias.


Assuntos
Técnicas Biossensoriais/métodos , Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Adulto , Técnicas Biossensoriais/instrumentação , Automonitorização da Glicemia/estatística & dados numéricos , Intervalos de Confiança , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Hemoglobina A Glicada/análise , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Hipoglicemia/sangue , Hipoglicemia/diagnóstico , Hipoglicemia/epidemiologia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Números Necessários para Tratar , Pontuação de Propensão , Estudos Retrospectivos , Viés de Seleção , Fatores de Tempo , Resultado do Tratamento
9.
Sci Rep ; 11(1): 11537, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078980

RESUMO

Prolonged use of tight-fitting PPE, e.g., by COVID-19 healthcare workers leads to skin injuries. An important contributor is the shear exerted on the skin due to static friction at the skin-PPE interface. This study aims to develop an optimised wax-oil lubricant that reduces the friction, or shear, in the skin-PPE contact for up to four hours. Lubricants with different wax-oil combinations were prepared using beeswax, paraffin wax, olive oil, and mineral oil. In-vivo friction measurements involving seven participants were conducted by sliding a polydimethylsiloxane ball against the volar forearms to simulate the skin-PPE interface. The maximum static coefficient of friction was measured immediately and four hours after lubricant application. It was found that the coefficient of friction of wax-oil lubricants is mainly governed by the ratio of wax to oil and the thermal stability and morphology of the wax. To maintain long-term lubricity, it is crucial to consider the absorption of oil into the PPE material. The best performing lubricant is a mixture of 20 wt% beeswax, 40 wt% olive oil, and 40 wt% mineral oil, which compared to unlubricated skin, provides 87% (P = 0.0006) and 59% (P = 0.0015) reduction in instantaneous and 4-h coefficient of friction, respectively.


Assuntos
Lubrificantes/química , Lubrificantes/farmacologia , Equipamento de Proteção Individual/efeitos adversos , Pele/efeitos dos fármacos , Ceras , Adulto , COVID-19 , Feminino , Antebraço/fisiologia , Humanos , Masculino , Óleo Mineral/química , Azeite de Oliva/química , Fatores de Tempo , Ceras/química
10.
JAMA ; 325(22): 2322, 2021 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-34100869
13.
Medicine (Baltimore) ; 100(22): e26056, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087847

RESUMO

ABSTRACT: Elderly patients who undergo major abdominal surgery are being in increasing numbers. Intensive care unit (ICU) survival is critical for surgical decision-making process. Activities of daily living (ADL) are associated with clinical outcomes in the elderly. We aimed to investigate the relationship between ADL and postoperative ICU survival in elderly patients following elective major abdominal surgery.We conducted a retrospective cohort study involving patients aged ≥65 years admitted to the surgical intensive care unit (SICU) following elective major abdominal surgery. Data from all patients were extracted from the electronic medical records. The Barthel Index (BI) was used to assess the level of dependency in ADL at the time of hospital admission.ICU survivors group had higher Barthel Index (BI) scores than non-survivors group (P < .001). With the increase of BI score, postoperative ICU survival rate gradually increased. The ICU survivals in patients with BI 0-20, BI 21-40, BI 41-60, BI 61-80 and BI 81-100 were 55.7%, 67.6%, 72.4%, 83.3% and 84.2%, respectively. In logistic regression, The Barthel Index (BI) was significantly correlated with the postoperative ICU survival in elderly patients following elective major abdominal surgery (OR = 1.33, 95% CI: 1.20-1.47, P = .02). The area under the receiver operating characteristic (ROC) curve of Barthel Index in predicting postoperative ICU survival was 0.704 (95% CI, 0.638-0.771). Kaplan-Meier survival curve in BI≥30 patients and BI < 30 patients showed significantly different.Activity of daily living upon admission was associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery. The Barthel Index(BI) ≥30 was associated with increased postoperative ICU survival. For the elderly with better functional status, they could be given more surgery opportunities. For those elderly patients BI < 30, these results provide useful information for clinicians, patients and their families to make palliative care decisions.


Assuntos
Atividades Cotidianas , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Período Pós-Operatório , Prognóstico , Fatores de Risco , Fatores de Tempo
14.
Medicine (Baltimore) ; 100(22): e26163, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087875

RESUMO

ABSTRACT: The premise of this study is that spoken word recognition and object knowledge are impaired in semantic variant primary progressive aphasia (PPA) (svPPA) and are spared in logopenic variant (lvPPA) and nonfluent agrammatic primary progressive aphasia (nfaPPA) at disease onset. Over time, however, there may be heterogeneity in these abilities in lvPPA and nfaPPA. We hypothesized that individuals with svPPA would demonstrate poorer performance on baseline spoken word recognition and object knowledge than those with lvPPA and nfaPPA) as documented in the literature, but that rates of decline over time on spoken word recognition and object knowledge would be similar in all 3 PPA variants because these become less distinguishable with disease progression.The aim of this study was to investigate longitudinal patterns of decline in spoken word recognition and object knowledge across PPA variants.Ninety-five individuals with PPA completed the Semantic Word Picture Matching and Semantic Associates tests at baseline to establish expected performance in these areas. Thirty-five individuals completed follow-up testing.The distributions of trichotomized mean rates of decline in object knowledge were similar for lvPPA and svPPA (P = .05). There were weak negative correlations between symptom duration and baseline scores on Semantic Word Picture Matching (r[37] = -0.399, P = .01), and baseline scores on Semantic Associates (r[37] = -0.394, P = .01) in lvPPA.Degradation of spoken word recognition and object knowledge occurs over time in lvPPA. Further investigation of the receptive language deficits in PPA is warranted to characterize language changes that lessen the distinctions between PPA variants with disease progression.


Assuntos
Afasia Primária Progressiva/patologia , Vocabulário , Fatores Etários , Idoso , Escolaridade , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Fatores Sexuais , Fatores de Tempo
15.
BMJ Open ; 11(6): e046641, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34083341

RESUMO

STUDY OBJECTIVES: To investigate the association between admission blood glucose levels and 28-day mortality as well as in-hospital complications in older patients with incident acute myocardial infarction (AMI) undergoing modern treatment. METHODS: From a German population-based regional MI registry, 5530 patients (2016 women), aged 65-84 years, hospitalised with an incident AMI between 1 January 2009 and 31 December 2016 were included in the study. Multivariable logistic regression models were used to assess the associations between admission blood glucose and 28-day mortality as well as in-hospital complications after AMI. Analyses stratified according to age, diabetes and type of infarction (ST-elevation MI (STEMI)/non-STEMI) were conducted. RESULTS: The adjusted ORs for the association between admission blood glucose and 28-day mortality in young-old (65-74 years) and old (75-84 years) patients with AMI were 1.40 (95% CI: 1.21 to 1.62) and 1.21 (95% CI: 0.98 to 1.50) per 1 SD increase in admission blood glucose, respectively. Furthermore, higher admission blood glucose was related to case fatality irrespective of the diabetes status and type of infarction only in the under-75 group. For the patients aged 75-84 years, it was only true for those without diabetes and STEMI. Admission blood glucose was also associated with major cardiac complications in both age groups. CONCLUSION: Admission blood glucose was significantly associated with 28-day case fatality in patients with AMI aged 65-74 years but not 75-84 years; furthermore, in both age groups there was an increased risk of major complications. It seems that admission glucose may play a rather minor role in terms of case fatality in higher aged patients with AMI.


Assuntos
Infarto do Miocárdio , Idoso , Glicemia , Feminino , Hospitalização , Humanos , Prognóstico , Sistema de Registros , Fatores de Risco , Fatores de Tempo
16.
Medicina (Kaunas) ; 57(5)2021 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-34066782

RESUMO

Background and Objectives: Affective disorders, namely bipolar (BDs) and depressive disorders (DDs) are characterized by high prevalence and functional impairment. From a dimensional point of view, BDs and DDs can be considered as psychopathological entities lying on a continuum. A delay in treatment initiation might increase the burden associated with affective disorders. The aim of this study is to analyze the correlates of a long duration of untreated illness (DUI) in these conditions. Materials and Methods: Subjects with BDs and DDs, both in- and outpatients, were recruited. Long DUI was defined according to previous research criteria as >2 years for BDs or >1 year for DDs. Socio-demographic, clinical and psychopathological characteristics of the recruited subjects were collected. Bivariate analyses were performed to compare subjects with a long and short DUI (p < 0.05). Results: In our sample (n = 61), 34.4% of subjects presented a long DUI. A long DUI was significantly associated with longer overall illness duration (p = 0.022) and a higher rate of psychiatric (p = 0.048) and physical comorbidities (p = 0.023). As for psychopathological features, depressive symptoms were more severe in the long DUI subgroup, as demonstrated by a higher score at the Clinical Global Impression-severity of depression (p = 0.012) item and at the anxiety/depression factor of the Positive and Negative Syndrome Scale (p = 0.041). Furthermore, subjects with a long DUI displayed more severe disruption of circadian rhythms, as evaluated by the Biological Rhythms Interview for Assessment in Neuropsychiatry total (p = 0.044) and social domain (p = 0.005) scores and by the Hamilton Depression Rating Scale diurnal variation items (18a: p = 0.029, 18b: p = 0.047). Conclusions: A long DUI may underpin higher clinical severity, as well as worse illness course and unfavorable prognosis in affective disorders. Intervention strategies targeting comorbidities, depressive symptoms and circadian rhythms may decrease disease burden in subjects with a long DUI.


Assuntos
Ritmo Circadiano , Depressão , Comorbidade , Depressão/epidemiologia , Humanos , Transtornos do Humor/epidemiologia , Fatores de Tempo
17.
BMC Plant Biol ; 21(1): 256, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34088272

RESUMO

BACKGROUND: Pears and apples are both perennial deciduous trees of the Rosaceae family, and both are important economic fruit trees worldwide. The emergence of many varieties in the market has been mostly domesticated from wild to cultivated and regulated by the differential expression of genes. However, the molecular process and pathways underlying this phenomenon remain unclear. Four typical wild and cultivar pear and apple trees at three developmental stages were used in our study to investigate the molecular process at the transcriptome level. RESULT: Physiological observations indicated the obvious differences of size, weight, sugar acid content and peel color in wild and cultivar fruit among each developmental stage. Using next-generation sequencing based RNA-seq expression profiling technology, we produced a transcriptome in procession of a large fraction of annotated pear and apple genes, and provided a molecular basis underlying the phenomenon of wild and cultivar fruit tree differences. 5921 and 5744 differential expression genes were identified in pear and apple at three developmental stages respectively. We performed temporal and spatial differential gene expression profiling in developing fruits. Several key pathways such as signal transduction, photosynthesis, translation and many metabolisms were identified as involved in the differentiation of wild and cultivar fruits. CONCLUSION: In this study, we reported on the next-generation sequencing study of the temporal and spatial mRNA expression profiling of pear and apple fruit trees. Also, we demonstrated that the integrated analysis of pear and apple transcriptome, which strongly revealed the consistent process of domestication in Rosaceae fruit trees. The results will be great influence to the improvement of cultivar species and the utilization of wild resources.


Assuntos
Regulação da Expressão Gênica no Desenvolvimento/fisiologia , Regulação da Expressão Gênica de Plantas/fisiologia , Malus/genética , Pyrus/genética , RNA-Seq/métodos , Frutas/crescimento & desenvolvimento , RNA de Plantas , Especificidade da Espécie , Fatores de Tempo
18.
Clin Orthop Surg ; 13(2): 135-143, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34094003

RESUMO

Background: Increased 30-day mortality rates have been reported for patients with hip fractures and a concurrent diagnosis of coronavirus disease 19 (COVID-19) infection. Due to nosocomial spread of infection and the variable incubation period with the virus, follow-up past 30 days after injury is required to evaluate the true mortality amongst these patients. We aim to assess 120-day mortality rates in hip fracture patients with COVID-19 infection and compare this to hip fracture patients without COVID-19 infection presenting during the same time period. Methods: This is a retrospective multicenter review of all patients aged ≥ 60 years admitted with a fractured neck of femur between March 5 and April 5, 2020, at nine U.K. trauma units. COVID-19 status, demographic data, comorbidities, and date of death (if applicable) were collected. Results: Data were collected for 265 hip fracture patients. Forty-six patients (17.4%) tested positive for COVID-19 infection. There were no significant differences in age or Charlson comorbidity score between those with or without COVID-19. Those with COVID-19 infection were more likely to be male (p = 0.01). Patients with COVID-19 had a 30-day mortality of 35% versus 10% in patients without (p < 0.01). One hundred twenty-day mortality was also greater in those with COVID-19 infection at 63% compared to those without at 17% (p < 0.01). Previous history of myocardial infarction was the only independent factor that showed to increase mortality rate (p = 0.03). Subgroup analysis also revealed significantly increased mortality rates at 120 days in men (27% vs. 67%), women (14% vs. 59%), and those undergoing surgery (56% vs. 30%). Conclusions: We report a significantly increased mortality rate at 30 and 120 days after injury in an already high-risk cohort of surgical patients. With nearly half of patients being diagnosed with COVID-19 at 14 days or greater following admission, this study highlights the importance of taking appropriate measures to decrease the incidence of nosocomial infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in hip fracture patients.


Assuntos
COVID-19/mortalidade , Fraturas do Quadril/mortalidade , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Estudos Retrospectivos , SARS-CoV-2 , Fatores de Tempo , Reino Unido/epidemiologia
19.
Nat Commun ; 12(1): 3324, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34083540

RESUMO

Elucidating the timescale of the evolution of Alphaproteobacteria, one of the most prevalent microbial lineages in marine and terrestrial ecosystems, is key to testing hypotheses on their co-evolution with eukaryotic hosts and Earth's systems, which, however, is largely limited by the scarcity of bacterial fossils. Here, we incorporate eukaryotic fossils to date the divergence times of Alphaproteobacteria, based on the mitochondrial endosymbiosis that mitochondria evolved from an alphaproteobacterial lineage. We estimate that Alphaproteobacteria arose ~1900 million years (Ma) ago, followed by rapid divergence of their major clades. We show that the origin of Rickettsiales, an order of obligate intracellular bacteria whose hosts are mostly animals, predates the emergence of animals for ~700 Ma but coincides with that of eukaryotes. This, together with reconstruction of ancestral hosts, strongly suggests that early Rickettsiales lineages had established previously underappreciated interactions with unicellular eukaryotes. Moreover, the mitochondria-based approach displays higher robustness to uncertainties in calibrations compared with the traditional strategy using cyanobacterial fossils. Further, our analyses imply the potential of dating the (bacterial) tree of life based on endosymbiosis events, and suggest that previous applications using divergence times of the modern hosts of symbiotic bacteria to date bacterial evolution might need to be revisited.


Assuntos
Alphaproteobacteria/classificação , Alphaproteobacteria/genética , Eucariotos/classificação , Eucariotos/genética , Evolução Molecular , Fósseis , Animais , Cianobactérias/classificação , Cianobactérias/genética , Fósseis/história , Fósseis/microbiologia , Genoma Bacteriano , Genoma Mitocondrial , História Antiga , Mitocôndrias/genética , Mitocôndrias/microbiologia , Modelos Biológicos , Modelos Genéticos , Filogenia , Rickettsiales/classificação , Rickettsiales/genética , Simbiose/genética , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...