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1.
Medicine (Baltimore) ; 99(1): e18540, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895791

RESUMO

Infection with influenza virus increases morbidity and mortality in patients with risk factors, including cardiovascular disease (CVD). This study aimed to evaluate factors associated with influenza vaccination coverage in Korean CVD patients.We included 19,599 adults from the 2010 to 2012 Korea National Health and Nutrition Examination Survey. Influenza vaccination rates were compared in subjects with and without CVD. Logistic regression analysis was performed to identify factors associated with influenza vaccination in Korean adults with CVD before and after stratification for age (<65 and ≥65 years).Significantly higher vaccination rates were observed in individuals with CVD than in those without CVD (61.4% vs 31.0%, P < .001). However, young individuals (19-49 years) had decreased influenza vaccination rates, with no difference based on CVD status (20.3% vs 21.6%, P = .859). A lack of private insurance (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.23-0.98) and recent health screening (OR, 4.56; 95% CI, 1.90-10.92) were independent factors for influenza vaccination in CVD patients aged <65 years, whereas female sex (OR, 3.71; 95% CI, 1.24-11.07) and less education (OR, 4.59; 95% CI, 1.27-16.61) were independent factors in CVD patients aged ≥65 years.Improving influenza vaccination coverage for Korean adults with CVD is important, especially in young patients. For young patients with CVD, influenza vaccination status is independently associated with the presence of private insurance and recent health screening. This finding could help establish public health policies to promote influenza vaccination in this population.


Assuntos
Doenças Cardiovasculares/virologia , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Cobertura Vacinal/estatística & dados numéricos , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , República da Coreia/epidemiologia , Fatores de Risco
2.
Radiol Med ; 125(1): 87-97, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31552555

RESUMO

PURPOSE: Radiomic features, clinical and dosimetric factors have the potential to predict radiation-induced toxicity. The aim of this study was to develop prediction models of radiotherapy-induced toxicities in prostate cancer patients based on computed tomography (CT) radiomics, clinical and dosimetric parameters. METHODS: In this prospective study, prostate cancer patients were included, and radiotherapy-induced urinary and gastrointestinal (GI) toxicities were assessed by Common Terminology Criteria for adverse events. For each patient, clinical and dose volume parameters were obtained. Imaging features were extracted from pre-treatment rectal and bladder wall CT scan of patients. Stacking algorithm and elastic net penalized logistic regression were used in order to feature selection and prediction, simultaneously. The models were fitted by imaging (radiomics model) and clinical/dosimetric (clinical model) features alone and in combinations (clinical-radiomics model). Goodness of fit of the models and performance of classifications were assessed using Hosmer and Lemeshow test, - 2log (likelihood) and area under curve (AUC) of the receiver operator characteristic. RESULTS: Sixty-four prostate cancer patients were studied, and 33 and 52 patients developed ≥ grade 1 GI and urinary toxicities, respectively. In GI modeling, the AUC for clinical, radiomics and clinical-radiomics models was 0.66, 0.71 and 0.65, respectively. To predict urinary toxicity, the AUC for radiomics, clinical and clinical-radiomics models was 0.71, 0.67 and 0.77, respectively. CONCLUSIONS: We have shown that CT imaging features could predict radiation toxicities and combination of imaging and clinical/dosimetric features may enhance the predictive performance of radiotoxicity modeling.


Assuntos
Algoritmos , Neoplasias da Próstata/radioterapia , Lesões por Radiação/diagnóstico por imagem , Reto/efeitos da radiação , Tomografia Computadorizada por Raios X/métodos , Bexiga Urinária/efeitos da radiação , Idoso , Área Sob a Curva , Cistite/etiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Proctite/etiologia , Estudos Prospectivos , Curva ROC , Lesões por Radiação/etiologia , Tolerância a Radiação , Dosagem Radioterapêutica , Reto/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem
3.
Gene ; 726: 144168, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-31759986

RESUMO

Methods based around statistics and linear algebra have been increasingly used in attempts to address emerging questions in microarray literature. Microarray technology is a long-used tool in the global analysis of gene expression, allowing for the simultaneous investigation of hundreds or thousands of genes in a sample. It is characterized by a low sample size and a large feature number created a non-square matrix, and by the incomplete rank, that can generate countless more solution in classifiers. To avoid the problem of the 'curse of dimensionality' many authors have performed feature selection or reduced the size of data matrix. In this work, we introduce a new logistic regression-based model to classify breast cancer tumor samples based on microarray expression data, including all features of gene expression and without reducing the microarray data matrix. If the user still deems it necessary to perform feature reduction, it can be done after the application of the methodology, still maintaining a good classification. This methodology allowed the correct classification of breast cancer sample data sets from Gene Expression Omnibus (GEO) data series GSE65194, GSE20711, and GSE25055, which contain the microarray data of said breast cancer samples. Classification had a minimum performance of 80% (sensitivity and specificity), and explored all possible data combinations, including breast cancer subtypes. This methodology highlighted genes not yet studied in breast cancer, some of which have been observed in Gene Regulatory Networks (GRNs). In this work we examine the patterns and features of a GRN composed of transcription factors (TFs) in MCF-7 breast cancer cell lines, providing valuable information regarding breast cancer. In particular, some genes whose αi ∗ associated parameter values revealed extreme positive and negative values, and, as such, can be identified as breast cancer prediction genes. We indicate that the PKN2, MKL1, MED23, CUL5 and GLI genes demonstrate a tumor suppressor profile, and that the MTR, ITGA2B, TELO2, MRPL9, MTTL1, WIPI1, KLHL20, PI4KB, FOLR1 and SHC1 genes demonstrate an oncogenic profile. We propose that these may serve as potential breast cancer prediction genes, and should be prioritized for further clinical studies on breast cancer. This new model allows for the assignment of values to the αi ∗ parameters associated with gene expression. It was noted that some αi ∗ parameters are associated with genes previously described as breast cancer biomarkers, as well as other genes not yet studied in relation to this disease.


Assuntos
Neoplasias da Mama/genética , Regulação Neoplásica da Expressão Gênica/genética , Redes Reguladoras de Genes/genética , Biomarcadores Tumorais/genética , Linhagem Celular Tumoral , Progressão da Doença , Feminino , Perfilação da Expressão Gênica/métodos , Humanos , Modelos Logísticos , Células MCF-7 , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Fatores de Transcrição/genética
4.
Bioresour Technol ; 298: 122495, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31830658

RESUMO

Machine learning has emerges as a novel method for model development and has potential to be used to predict and control the performance of anaerobic digesters. In this study, several machine learning algorithms were applied in regression and classification models on digestion performance to identify determinant operational parameters and predict methane production. In the regression models, k-nearest neighbors (KNN) algorithm demonstrates optimal prediction accuracy (root mean square error = 26.6, with the dataset range of 259.0-573.8), after narrowing prediction coverage by excluding extreme outliers from the validation set. In the classification models, logistic regression multiclass algorithm yields the best prediction accuracy of 0.73. Feature importance reveals that total carbon was the determinant operational parameter. These results demonstrate the great potential of using machine learning algorithms to predict anaerobic digestion performance.


Assuntos
Algoritmos , Aprendizado de Máquina , Anaerobiose , Análise por Conglomerados , Modelos Logísticos
5.
Br J Sports Med ; 54(1): 13-22, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31186258

RESUMO

BACKGROUND: Despite absence of evidence of a clinical benefit of arthroscopic partial meniscectomy (APM), many surgeons claim that subgroups of patients benefit from APM. OBJECTIVE: We developed a prognostic model predicting change in patient-reported outcome 1 year following arthroscopic meniscal surgery to identify such subgroups. METHODS: We included 641 patients (age 48.7 years (SD 13), 56% men) undergoing arthroscopic meniscal surgery from the Knee Arthroscopy Cohort Southern Denmark. 18 preoperative factors identified from literature and/or orthopaedic surgeons (patient demographics, medical history, symptom onset and duration, knee-related symptoms, etc) were combined in a multivariable linear regression model. The outcome was change in Knee injury and Osteoarthritis Outcome Score (KOOS4) (average score of 4 of 5 KOOS subscales excluding the activities of daily living subscale) from presurgery to 52 weeks after surgery. A positive KOOS4 change score constitutes improvement. Prognostic performance was assessed using R2 statistics and calibration plots and was internally validated by adjusting for optimism using 1000 bootstrap samples. RESULTS: Patients improved on average 18.6 (SD 19.7, range -38.0 to 87.8) in KOOS4. The strongest prognostic factors for improvement were (1) no previous meniscal surgery on index knee and (2) more severe preoperative knee-related symptoms. The model's overall predictive performance was low (apparent R2=0.162, optimism adjusted R2=0.080) and it showed poor calibration (calibration-in-the-large=0.205, calibration slope=0.772). CONCLUSION: Despite combining a large number of preoperative factors presumed clinically relevant, change in patient-reported outcome 1 year following meniscal surgery was not predictable. This essentially quashes the existence of 'subgroups' with certain characteristics having a particularly favourable outcome after meniscal surgery. TRIAL REGISTRATION NUMBER: NCT01871272.


Assuntos
Meniscectomia , Medidas de Resultados Relatados pelo Paciente , Lesões do Menisco Tibial/cirurgia , Adolescente , Adulto , Idoso , Dinamarca , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Meniscectomia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Adulto Jovem
6.
Biochem Med (Zagreb) ; 30(1): 010701, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31839721

RESUMO

Introduction: Chronic obstructive pulmonary disease (COPD) is a complex inflammatory condition that can affect haemostasis. This study aimed to determine differences in platelet-related parameters between controls and COPD subjects. The hypothesis was that platelet indices are disturbed in COPD patients, and this would be accompanied by increased C-reactive protein (CRP), fibrinogen (Fbg) and white blood cells (WBC). Therefore, platelet count (Plt), platelet-related parameters - mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (Pct), their ratios (MPV/Plt, MPV/Pct, PDW/Plt, PDW/Pct), platelet to lymphocyte ratio (PLR), Plt index as well as CRP, Fbg and WBC were assessed. Materials and methods: Study included 109 patients with stable COPD and 95 control subjects, recruited at Clinical Department for Lung Diseases Jordanovac, University Hospital Centre Zagreb (Zagreb, Croatia). Complete blood count was performed on Sysmex XN-1000, CRP on Cobas c501, and Fbg on BCS XP analyser. Data were analysed with MedCalc statistical software. Results: Platelet (P = 0.007) and PLR (P = 0.006) were increased, while other platelet indices were decreased in COPD patients compared to controls. Combined model that included PLR, PDW and WBC showed great diagnostic performances, and correctly classified 75% of cases with an AUC of 0.845 (0.788 - 0.892), P < 0.001. Comorbidities (cardiovascular or metabolic diseases) had no effect on investigated parameters, while inhaled corticosteroids/long-acting ß2-agonists (ICS/LABA) therapy increased MPV and PDW values in COPD patients. Conclusion: Platelet indices were altered in COPD patients and they could be valuable as diagnostic markers of COPD development, especially if combined with already known inflammatory markers.


Assuntos
Biomarcadores/sangue , Plaquetas/citologia , Doença Pulmonar Obstrutiva Crônica/patologia , Corticosteroides/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Plaquetas/metabolismo , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/patologia , Estudos de Casos e Controles , Feminino , Volume Expiratório Forçado , Humanos , Leucócitos/citologia , Modelos Logísticos , Linfócitos/citologia , Masculino , Doenças Metabólicas/complicações , Doenças Metabólicas/patologia , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
7.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1445-1449, 2019 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-31838819

RESUMO

Objective: To explore the association of the glycosylated hemoglobin (HbA1c) level at admission with 90 days functional outcome in patients with spontaneous intracerebral hemorrhage (ICH). Methods: Patients admitted to the Department of Neurology, Tongji Hospital from January to December 2017 were prospectively and continuously enrolled in this study. Clinical data were collected at admission and functional outcomes 90 days after ICH were assessed by using the modified RANKIN scale. Univariate and multivariate conditional logistic regression models were constructed. Patients were divided into four groups according to the quartile of HbA1c values. The median value of HbA1c in each group was taken as the substitute value and P for trend was calculated. The logistic regression model was fitted by restricted cubic splines to investigate the association between HbA1c level and outcome of ICH. Results: A total of 345 patients with ICH were enrolled, including 214 with favorable outcomes and 131 with poor outcomes (99 severe disability cases and 32 deaths). The risk of poor 90 days outcomes was significantly associated with HbA1c level at admission indicated by multivariate logistic regression analysis, and the P for trend test was <0.001 (middle-level group vs. low-level group: OR=2.33, 95%CI: 1.07-5.07; high-level group vs. low-level group: OR=2.52, 95%CI: 1.12-5.64; extremely high-level group vs. low-level group: OR=6.80, 95%CI: 3.01-15.34). Results from the restricted cubic spline showed that there was a linear correlation between HbA1c level at admission and poor 90 days outcomes of ICH (χ(2)=14.81, P<0.001; non- linear test: P=0.118). Compared with patients with HbA1c level of 6.5%, the risk of poor outcomes in patients with HbA1c level of <6.5% decreased linearly with the decrease in HbA1c level at admission, and the risk in patients with HbA1c level >6.5% was higher but not significantly. Conclusion: There was correlation between high HbA1c level at admission and 90 days poor outcome of ICH. High HbA1c level is an independent prediction indicator for ICH.


Assuntos
Hemorragia Cerebral/diagnóstico , Diabetes Mellitus/sangue , Hemoglobina A Glicada/metabolismo , Hospitalização/estatística & dados numéricos , Biomarcadores/sangue , Glicemia/metabolismo , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/fisiopatologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Hemoglobina A Glicada/análise , Humanos , Modelos Logísticos , Resultado do Tratamento
8.
BMC Infect Dis ; 19(1): 1016, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31783799

RESUMO

BACKGROUND: Leprosy is a neglected disease that poses a significant challenge to public health in Uganda. The disease is endemic in Uganda, with 40% of the districts in the country affected in 2016, when 42 out of 112 districts notified the National Tuberculosis and Leprosy Program (NTLP) of at least one case of leprosy. We determined the spatial and temporal trends of leprosy in Uganda during 2012-2016 to inform control measures. METHODS: We analyzed quarterly leprosy case-finding data, reported from districts to the Uganda National Leprosy Surveillance system (managed by NTLP) during 2012-2016. We calculated new case detection by reporting district and administrative regions of treatment during this period. New case detection was defined as new leprosy cases diagnosed by the Uganda health services divided by regional population; population estimates were based on 2014 census data. We used logistic regression analysis in Epi-Info version 7.2.0 to determine temporal trends. Population estimates were based on 2014 census data. We used QGIS software to draw choropleth maps showing leprosy case detection rates, assumed to approximate the new case detection rates, per 100,000 population. RESULTS: During 2012-2016, there was 7% annual decrease in reported leprosy cases in Uganda each year (p = 0.0001), largely driven by declines in the eastern (14%/year, p = 0.0008) and central (11%/year, p = 0.03) regions. Declines in reported cases in the western (9%/year, p = 0.12) and northern (4%/year, p = 0.16) regions were not significant. The combined new case detection rates from 2012 to 2016 for the ten most-affected districts showed that 70% were from the northern region, 20% from the eastern, 10% from the western and 10% from the central regions. CONCLUSION: There was a decreasing trend in leprosy new case detection in Uganda during 2012-2016; however, the declining trends were not consistent in all regions. The Northern region consistently identified more leprosy cases compared to the other regions. We recommend evaluation of the leprosy surveillance system to ascertain the leprosy situation.


Assuntos
Hanseníase/diagnóstico , Bases de Dados Factuais , Humanos , Hanseníase/epidemiologia , Modelos Logísticos , Vigilância em Saúde Pública , Estudos Retrospectivos , Análise Espaço-Temporal , Uganda/epidemiologia
9.
Bone Joint J ; 101-B(12): 1542-1549, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31786996

RESUMO

AIMS: Spinal tuberculosis (TB) remains an important concern. Although spinal TB often has sequelae such as myelopathy after treatment, the predictive factors affecting such unfavourable outcomes are not yet established. We investigated the clinical manifestations and predictors of unfavourable treatment outcomes in patients with spinal TB. PATIENTS AND METHODS: We performed a multicentre retrospective cohort study of patients with spinal TB. Unfavourable outcome was defined according to previous studies. The prognostic factors for unfavourable outcomes as the primary outcome were determined using multivariable logistic regression analysis and a linear mixed model was used to compare time course of inflammatory markers during treatment. A total of 185 patients were included, of whom 59 patients had unfavourable outcomes. RESULTS: In multivariate regression analysis, the factors associated with unfavourable outcome were old age (odds ratio (OR) 2.51; 95% confidence interval (CI) 1.07 to 5.86; p = 0.034), acid-fast bacilli (AFB) smear positivity in specimens obtained through biopsy (OR 3.05; 95% CI 1.06 to 8.80; p = 0.039), and elevated erythrocyte sedimentation rate (ESR) at the end of treatment (OR 3.85; 95% CI 1.62 to 9.13; p = 0.002). Patients with unfavourable outcomes had a significant trend toward higher ESR during treatment compared with patients with favourable outcome (p = 0.009). Duration of anti-TB and surgical treatment did not affect prognosis. CONCLUSION: Elevated ESR at the end of treatment could be used as a marker to identify spinal TB patients with a poor prognosis. Patients whose ESR is not normalized during treatment, as well as those with old age and AFB smear positivity, should be aware of unfavourable outcomes. Cite this article: Bone Joint J 2019;101-B:1542-1549.


Assuntos
Antituberculosos/uso terapêutico , Procedimentos Ortopédicos , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/terapia , Adulto , Idoso , Biomarcadores/sangue , Sedimentação Sanguínea , Terapia Combinada , Efeitos Psicossociais da Doença , Feminino , Seguimentos , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Prognóstico , República da Coreia , Estudos Retrospectivos , Resultado do Tratamento , Tuberculose da Coluna Vertebral/sangue
10.
An Bras Dermatol ; 94(6): 704-709, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789266

RESUMO

BACKGROUND: Rosacea may result in emotional distress and anxiety. However, data on the presence of generalized anxiety disorder in rosacea patients are scarce. OBJECTIVE: The aim of the study was to detect the frequency and level of anxiety and depression in patients with rosacea. METHODS: A total of 194 consecutive rosacea patients and 194 age- and sex-matched controls were enrolled. Severity of rosacea was assessed in patients according to the criteria of the National Rosacea Society Ethics Committee. Both patients and controls were evaluated by the Generalized Anxiety Disorder 7-item scale, and severity was measured by the Generalized Anxiety Disorder-Adult. RESULTS: Individuals who were diagnosed with an anxiety and/or depressive disorder were more common in patient group (24.7% vs. 7.2%, p<0,01). Female patients were particularly at risk for having generalized anxiety disorder (OR=2.8; 95% CI 1.15-7.37; p=0.02). STUDY LIMITATIONS: Single center study and limited sample size. CONCLUSIONS: Rosacea patients show greater risk of having anxiety disorders, including generalized anxiety disorder. Female patients, those with lower educational levels, those with phymatous subtype, untreated patients, and patients with prior psychiatric morbidity may be at particular risk for anxiety. It is essential to consider the psychological characteristics of patients to improve their well-being.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/etiologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etiologia , Rosácea/complicações , Rosácea/epidemiologia , Adulto , Análise de Variância , Estudos de Casos e Controles , Estudos Transversais , Escolaridade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Fatores de Risco , Rosácea/psicologia , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Inquéritos e Questionários
11.
Rev Saude Publica ; 53: 102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800913

RESUMO

We analyzed data from the National School-based Health Survey (PeNSE) carried out in Brazil in 2015 (n = 102,072 adolescents) to estimate how much of the individual variance in the prevalence of health behaviors is attributable to the school level. Multilevel logistic regression models were calculated to estimate the variance partitional coefficient (VPC) of the use of drugs, intake of unhealthy food, leisure physical activity and weight-related behaviors. The between-schools variance was significant in all tested models. The highest VPCs were observed when the use of drugs was analyzed (15%-20% of the total variance of smoking and use of illegal drugs). Lower, but still significant, values were observed in the other outcomes. The school context plays an important role in the adolescents' health and should be considered in the design of public policies and actions in public health.


Assuntos
Saúde do Adolescente/estatística & dados numéricos , Comportamentos de Risco à Saúde , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Peso Corporal , Brasil/epidemiologia , Feminino , Preferências Alimentares , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Setor Privado , Setor Público , Fatores de Risco , Fumar/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Consumo de Álcool por Menores/estatística & dados numéricos
12.
Rev Saude Publica ; 53: 103, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800914

RESUMO

OBJECTIVES: To explore the association between adiposity, major depressive disorder and generalized anxiety disorder, and to assess the role of inflammation, diet quality and physical activity in this association. METHODS: We used data from 2,977 individuals from the 1993 Pelotas Cohort (Brazil) who attended the 18- and 22-year follow-ups. We assessed general obesity using body mass index, fat mass index, and abdominal obesity using waist circumference. Major Depressive Disorder and generalized anxiety disorder were assessed using the mini-international neuropsychiatric interview. C-reactive protein and interleukin-6 (IL-6) levels were used as a measure of inflammation; diet quality was estimated using the revised diet quality index, and physical activity was assessed by the International physical activity questionnaire (IPAQ, min/day). The association between adiposity and major depressive disorder and generalized anxiety disorder was assessed using logistic regression, and the natural indirect effect via the mediators was estimated using G-computation. RESULTS: General obesity assessed by body mass index (OR: 2.3; 95% CI:1.13; 4.85), fat mass index (OR: 2.6; 95%CI: 1.37; 4.83), and abdominal obesity (OR: 2.5; 95%CI: 1.18; 5.39) were associated with higher odds of major depressive disorder, whereas major depressive disorder was only associated with obesity assessed by body mass index (OR=1.9; 95% CI: 1.09; 3.46). Obesity and generalized anxiety disorder were not associated. C-reactive protein, diet quality and physical activity did not mediate the effect of obesity on major depressive disorder, and C-reactive protein mediated about 25% of the effect of major depressive disorder on adiposity. CONCLUSIONS: Depression, but not generalized anxiety disorder, is associated with adiposity in both directions, with a stronger evidence for the direction obesity-depression. Inflammation explains part of the effect of major depressive disorder on obesity but not the other way around. Further research should explore other mechanisms that could be involved in the association between obesity and depression.


Assuntos
Adiposidade/fisiologia , Transtornos de Ansiedade/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Dieta , Exercício/psicologia , Obesidade/psicologia , Adolescente , Antropometria , Brasil , Proteína C-Reativa/análise , Estudos de Coortes , Exercício/fisiologia , Feminino , Humanos , Interleucina-6/sangue , Estilo de Vida , Modelos Logísticos , Masculino , Obesidade Abdominal/psicologia , Escalas de Graduação Psiquiátrica , Valores de Referência , Inquéritos e Questionários , Adulto Jovem
13.
BMC Infect Dis ; 19(1): 1043, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31823736

RESUMO

BACKGROUND: The implementation of national antiretroviral therapy (ART) and expanded ART policies results in that more and more HIV-infected patients receive ART in Kunming, Yunnan province, China. At the same time, however, the number of patients, who drop-out from ART, are also increasing. In this study, we explored the factors that may account for drop-out. METHODS: Four hundred and thirty-nine HIV-infected patients, who received or used to receive ART, were recruited in this study. Their age is among 18 and 75. All patients were divided into two group: ART group (187 patients) and drop-out group (252 patients). Appropriate bio-statistics analysis, including univariate analysis and Multivariate analysis, were used to identify factors associated with drop-out. RESULTS: Data from all patients were analyzed. Univariate analysis suggested that the factors associated with drop-out may include age, residential area, educational level, occupation, monthly income, the access to minimum living allowance, HIV transmission route, and living status. On the other hand, factors including area, monthly income, the access to minimum living allowance, and referral methods of follow-up institutions account for drop-out in multivariate analysis. CONCLUSIONS: This study identified a number of factors associated with drop out from ART. Based on our findings,appropriate interventions should be introduced decrease drop-out.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Antirretrovirais/efeitos adversos , China , Feminino , Infecções por HIV/economia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Inquéritos e Questionários , Adulto Jovem
14.
N Engl J Med ; 381(24): 2315-2326, 2019 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-31826340

RESUMO

BACKGROUND: Asciminib is an allosteric inhibitor that binds a myristoyl site of the BCR-ABL1 protein, locking BCR-ABL1 into an inactive conformation through a mechanism distinct from those for all other ABL kinase inhibitors. Asciminib targets both native and mutated BCR-ABL1, including the gatekeeper T315I mutant. The safety and antileukemic activity of asciminib in patients with Philadelphia chromosome-positive leukemia are unknown. METHODS: In this phase 1, dose-escalation study, we enrolled 141 patients with chronic-phase and 9 with accelerated-phase chronic myeloid leukemia (CML) who had resistance to or unacceptable side effects from at least two previous ATP-competitive tyrosine kinase inhibitors (TKIs). The primary objective was to determine the maximum tolerated dose or the recommended dose (or both) of asciminib. Asciminib was administered once or twice daily (at doses of 10 to 200 mg). The median follow-up was 14 months. RESULTS: Patients were heavily pretreated; 70% (105 of 150 patients) had received at least three TKIs. The maximum tolerated dose of asciminib was not reached. Among patients with chronic-phase CML, 34 (92%) with a hematologic relapse had a complete hematologic response; 31 (54%) without a complete cytogenetic response at baseline had a complete cytogenetic response. A major molecular response was achieved or maintained by 12 months in 48% of patients who could be evaluated, including 8 of 14 (57%) deemed to have resistance to or unacceptable side effects from ponatinib. A major molecular response was achieved or maintained by 12 months in 5 patients (28%) with a T315I mutation at baseline. Clinical responses were durable; a major molecular response was maintained in 40 of 44 patients. Dose-limiting toxic effects included asymptomatic elevations in the lipase level and clinical pancreatitis. Common adverse events included fatigue, headache, arthralgia, hypertension, and thrombocytopenia. CONCLUSIONS: Asciminib was active in heavily pretreated patients with CML who had resistance to or unacceptable side effects from TKIs, including patients in whom ponatinib had failed and those with a T315I mutation. (Funded by Novartis Pharmaceuticals; ClinicalTrials.gov number, NCT02081378.).


Assuntos
Antineoplásicos/administração & dosagem , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Niacinamida/análogos & derivados , Pirazóis/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Antineoplásicos/farmacocinética , Relação Dose-Resposta a Droga , Resistencia a Medicamentos Antineoplásicos , Feminino , Seguimentos , Proteínas de Fusão bcr-abl/genética , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mutação , Niacinamida/administração & dosagem , Niacinamida/efeitos adversos , Niacinamida/farmacocinética , Inibidores de Proteínas Quinases/uso terapêutico , Pirazóis/efeitos adversos , Pirazóis/farmacocinética
15.
Anticancer Res ; 39(12): 6807-6811, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810946

RESUMO

BACKGROUND/AIM: Controversy exists between performing limb salvage or amputation to treat osteosarcoma of the upper extremities. Our aim was to review the characteristics associated with limb amputation due to osteosarcoma of the upper extremities. PATIENTS AND METHODS: A descriptive study was performed by querying the National Cancer Database from January 1, 2004 to December 31, 2015. Statistical analysis was performed using chi-squared test and a multivariate logistic regression model. RESULTS: A total of 777 patients diagnosed with osteosarcoma of the upper extremities who underwent surgery met the inclusion criteria. Patients between 61 and 80 years were less likely to undergo limb amputation. Moreover, facilities located in the South Atlantic region, and stage IV of the disease were factors independently positively associated with amputation. CONCLUSION: Patients in facilities located in the South Atlantic region and those with stage IV disease were more likely to undergo amputation.


Assuntos
Amputação/métodos , Neoplasias Ósseas/cirurgia , Salvamento de Membro/métodos , Osteossarcoma/cirurgia , Extremidade Superior/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/patologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Osteossarcoma/patologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Adulto Jovem
16.
Anticancer Res ; 39(12): 6957-6963, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810967

RESUMO

BACKGROUND/AIM: The aim of this study was to delineate clinical criteria to safely select elderly patients who can benefit from adding oxaliplatin to 5-fluoruracil-based neo-adjuvant chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC) management. PATIENTS AND METHODS: This is a single-institutional case-control study on LARC patients who received intensified neo-adjuvant CRT, between January 2007 and December 2014. Data concerning patient characteristics, treatment details and adverse events were reviewed and analyzed in two settings: young patients (<65 years) and elderly (≥65 years). A binary logistic model was applied to analyze the potential interaction between clinical variables and severe toxicity risk. RESULTS: In total, 100 consecutive LARC patients were included. Mean age was 63.6 years and 55% (n=55) of the patients had adult comorbidity evaluation-27 (ACE-27) score ≥1. Most cancers (81%) were lymph node positive at diagnosis. Overall, ≥5 cycles of oxaliplatin were administered to 92 patients (92%). Only 17 patients (17%) reported grade ≥3 toxicity. The elderly group did not experience significantly higher severe toxicity than the young group. ACE-27 score ≥1 was the only variable independently associated with a higher severe toxicity. The 5-year overal survival (OS) rates were 64.1% and 89.2% in the elderly and young cohort, respectively. CONCLUSION: Elderly LARC patients can be safely treated with intensified neo-adjuvant CRT.


Assuntos
Quimiorradioterapia/métodos , Oxaliplatina/uso terapêutico , Neoplasias Retais/terapia , Adulto , Idoso , Estudos de Casos e Controles , Quimiorradioterapia/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Oxaliplatina/efeitos adversos , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
17.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(10): 628-638, dic. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-184790

RESUMO

Background: Studies trying to find the association between vitamin D status and metabolic syndrome (MetS) have led to inconsistent results, and community-based data for individuals living in the Middle East are limited. Objectives: To find out if MetS and its components are associated with vitamin D status among female teachers residing in Yazd city during winter 2015. Materials and methods: A total of 276 female teachers (case group, n = 124 and control group, n = 152) aged 20-60 years were included. Weight, height, waist circumference, blood pressure, daily energy intake, physical activity, serum 25 hydroxy vitamin D (25(OH)D3), fasting blood glucose, triglycerides and high-density lipoprotein cholesterol (HDL-C) levels were assessed. Logistic regression was used to examine the odds ratio of MetS according to vitamin D status. Results: Mean serum 25(OH)D3 was 32.79 ± 18.62 ng/ml and 33.73 ± 20.20, in females with and without MetS, respectively (P > 0.142). Compared to those with 25(OH)D3of < 20 ng/ml, the odds ratio for MetS was 1.01 (95% CI: 0.48-2.13) and 0.95 (95% CI: 0.56-1.60) for those with serum 25(OH)D3 levels of 20-29 ng/ml and ≥ 30 ng/ml, respectively (P trend = 0.84). The association remained insignificant after adjusting for potential confounders. Furthermore, vitamin D status was not associated with MetS components (P > 0.05). Conclusion: Although several studies have claimed the association between vitamin D status and MetS, we could not find a similar connection in a sample of Iranian female teachers. Prospective studies are needed to determine the possible effect of vitamin D in the development of MetS, particularly in the Yazd province


Antecedentes: Los estudios en busca de una asociación entre el estado de vitamina D y el síndrome metabólico (SM) han dado resultados no concluyentes, y los datos sobre comunidades de personas residentes en Oriente Próximo son limitados. Objetivos: Averiguar si existe asociación entre el SM y sus componentes y el estado de vitamina D en profesoras residentes en la ciudad de Yazd durante el invierno de 2015. Materiales y métodos: Se incluyó a un total de 276 profesoras (grupos de casos, n = 124 y grupo de control, n = 152) de 20-60 años de edad. Se determinaron el peso, la talla, el perímetro de la cintura, la presión arterial, la ingesta diaria de energía, la actividad física y los niveles de 25-hidroxivitamina D (25(OH)D3), glucosa en ayunas, triglicéridos y colesterol de las proteínas de alta densidad (C-HDL). Se utilizó regresión logística para determinar la razón de probabilidades de SM en función del estado de vitamina D. Resultados: La concentración sérica media de 25(OH)D3 era de 32,79 ± 18,62 ng/ml y 33,73 ± 20,20 en las mujeres con y sin SM, respectivamente (P > 0,142). En comparación con las que tenían < 20 ng/ml de 25(OH)D3, la razón de probabilidades de SM era 1,01 (IC al 95%, 0,48-2,13) y 0,95 (IC al 95%, 0,56-1,60) en las que tenían valores de 20-29 ng/ml y ≥ 30 ng/ml, respectivamente (tendencia de P = 0,84). La asociación seguía siendo no significativa después del ajuste por posibles factores de confusión. Además, el estado de vitamina D no se asociaba con los componentes del SM (P > 0,05). Conclusión: Aunque varios estudios han informado de una asociación entre el estado de la vitamina D y el SM, no pudimos hallar una relación similar en una muestra de profesoras iraníes. Se necesitan estudios prospectivos para determinar el posible efecto de la vitamina D en el desarrollo del SM, especialmente en la provincia de Yazd


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Vitamina D/administração & dosagem , Síndrome Metabólica/tratamento farmacológico , Deficiência de Vitamina D/dietoterapia , Irã (Geográfico) , Modelos Logísticos , Peso-Estatura , Relação Cintura-Quadril , Pressão Arterial , Pressão Sanguínea , Exercício/fisiologia
18.
Clin Interv Aging ; 14: 2163-2171, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31853176

RESUMO

Purpose: Handgrip strength is a key diagnostic criterion for sarcopenia, and sodium is an essential mineral for muscle contraction. We investigated the association between grip strength and sodium intake using sodium density. Patients and methods: A total of 2982 older adults (aged ≥65 years) from the 2014-2016 Korea National Health and Nutrition Examination Survey were included. Dietary intake was assessed by a 24 hr dietary recall, and grip strength was measured using a digital grip strength dynamometer. Based on the recommendation of the Asian Working Group for Sarcopenia, low grip strength (dynapenia) was defined as <26 kg for men and <18 kg for women. Multivariable logistic regression was performed to estimate the adjusted odds ratio (OR) and 95% confidence interval (CI) and to investigate the association between the quartiles of sodium per calorie (mg/1000 kcal; sodium density) and dynapenia. Results: A total of 577 subjects (19.3%) had dynapenia. Subjects in the second quartile of sodium density had the lowest prevalence of dynapenia and were defined as the reference group. Among women, those in the highest quartile of sodium density showed a significantly higher risk for dynapenia (OR 1.51, 95% CI 1.10-2.07). ORs in the first and third quartiles of sodium density were 1.01 (95% CI 0.74-1.38) and 1.18 (95% CI 0.89-1.58), respectively. However, there was no association between sodium density and dynapenia in men. Conclusion: High sodium density was associated with dynapenia in older women. A balanced diet of minerals is important to preserve muscle strength among older adults.


Assuntos
Força da Mão , Força Muscular , Inquéritos Nutricionais , Sódio , Atividades Cotidianas , Idoso , Estudos Transversais , Feminino , Força da Mão/fisiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Minerais , Força Muscular/fisiologia , Prevalência , República da Coreia , Sarcopenia/epidemiologia
19.
Medicine (Baltimore) ; 98(52): e18421, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876717

RESUMO

The objective of our research was to confirm the prediction role of Grobman model for vaginal birth after cesarean (VBAC) in Chinese pregnant women. In this research, 535 pregnant who had once cesarean delivery and the least once subsequent try to a vaginal labor in Jiaxing of China were involved. The Grobman background factors and five new factors were included. Overall, in total of 456 women had successful VBAC, the success percent was 85.2%. The new background variable "maternal height" was considered as an additional predictor for VBAC. The Grobman model's area under the curve (AUC) was 0.811 (95% CI = 0.751-0.870) and the AUC of this modified model combined 2 new factors was 0.834 (95% CI = 0.781-0.886). Nevertheless, there has no markedly difference between these 2 models of the AUC. In conclusion, the Grobman model was suitable for Chinese pregnant. However, further improvements were needed to make a new predictive model of VBAC success rate for Chinese pregnant women through analyzing the clinical data of vaginal trial delivery after cesarean section.


Assuntos
Nascimento Vaginal Após Cesárea/estatística & dados numéricos , Adulto , Fatores Etários , Índice de Massa Corporal , Cesárea/estatística & dados numéricos , China/epidemiologia , Feminino , Idade Gestacional , Humanos , Modelos Logísticos , Modelos Estatísticos , Gravidez , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos
20.
Braz Oral Res ; 33: e118, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31859707

RESUMO

The objective of this study was to investigate the experience of caries related to social capital and associated factors in adults in large-scale population-based study. A Cross-sectional study was performed in 163 municipalities in the State of São Paulo, Brazil (SBSP-2015). 17,560 people were evaluated, of which 6051 were adults aged 35-44 years. Hierarchical logistic regression analysis was proposed. Outcome variables (decayed teeth, missing teeth and DMFT) and independent variables were included in the model, considering the distal (income and schooling); intermediate (social capital) and proximal levels (sex and ethnicity). Results showed that income up to 1,500 reais - US$ 367.6 in 11/11/2019 - (OR = 1.91;1.75-2.08), schooling up to 8 years (OR = 1.32;1.12-1.56) and non-white ethnicity (OR = 1.54;1.35-1.76) were more likely to have decayed teeth. Income up to 1500 reais (OR = 1.29;1.15-1.44), schooling up to 8 years (OR = 2.13;1.90-2.38), low social capital (OR = 1.84;1.65-2.04), medium social capital (OR = 1.15;1.01-1.30) and females were more likely to have lost teeth (OR = 1.13;1.03-1.23). Schooling up to 8 years (OR = 1.51;1.35-1.69), low social capital (OR = 1.25; 1.14-1.37) and female (OR = 1.40,1.19-1.53) were associated with DMFT. It was concluded that sociodemographic factors and low social capital were associated with the experience of caries, which should be taken into account in the formulation of public policies.


Assuntos
Cárie Dentária/epidemiologia , Capital Social , Adulto , Brasil/epidemiologia , Estudos Transversais , Índice CPO , Feminino , Humanos , Modelos Logísticos , Masculino , Prevalência , Distribuição por Sexo , Fatores Socioeconômicos , Inquéritos e Questionários
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