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INTRODUCTION: Studies show that tobacco use among sexual and gender minority (SGM) populations is disproportionately higher than heterosexual or cisgender populations. However, few studies have examined tobacco use among SGM subgroups by race/ethnicity or associations between SGM-specific discrimination and connection to SGM identity and tobacco use. METHODS: This study analysed survey data from 11 313 SGM (gay, lesbian, bisexual, other sexual minority or gender minority) young adults in the USA and reported current cigarette, e-cigarette, other tobacco (cigar, smokeless tobacco, hookah) and polytobacco use. We used multinomial logistic regression to estimate associations between (a) SGM subgroup, race/ethnicity, SGM-specific discrimination and SGM identity connection and (b) each tobacco use outcome (vs never use of tobacco). We conducted postestimation testing to assess predicted probabilities of tobacco use against the sample average. RESULTS: Lesbian females (particularly black lesbian females) had higher-than-average probability of polytobacco use. White bisexual and lesbian participants had higher-than-average probability of cigarette and e-cigarette use, respectively. Higher levels of discrimination were associated with polytobacco use. Higher levels of identity connectedness were protective against certain tobacco use behaviours among gender minority participants and participants with high levels of discrimination experience. CONCLUSIONS: We found variations in tobacco use by SGM subgroups overall and by race/ethnicity. Discrimination may be a risk factor for certain tobacco use behaviours. However, SGM identity connectedness may be protective against tobacco use among gender minority individuals and individuals experiencing SGM-specific discrimination. These findings can inform targeted approaches to reach SGM subgroups at greater risk of tobacco use.
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Unlocking the potential of personalized medicine in point-of-care settings requires a new generation of biomarker and proteomic assays. Ideally, assays could inexpensively perform hundreds of quantitative protein measurements in parallel at the bedsides of patients. This goal greatly exceeds current capabilities. Furthermore, biomarker assays are often challenging to translate from benchtop to clinic due to difficulties achieving and assessing the necessary selectivity, sensitivity, and reproducibility. To address these challenges, we developed an efficient (<5â min), robust (comparatively lower CVs), and inexpensive (decreasing reagent use and cost by >70 %) immunoassay method. Specifically, the immunoblot membrane is dotted with the sample and then developed in a vortex fluidic device (VFD) reactor. All assay steps-blocking, binding, and washing-leverage the unique thin-film microfluidics of the VFD. The approach can accelerate direct, indirect, and sandwich immunoblot assays. The applications demonstrated include assays relevant to both the laboratory and the clinic.
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Microfluídica , Proteômica , Aceleração , Humanos , Imunoensaio , Reprodutibilidade dos TestesRESUMO
The Virus BioResistor (VBR) is a biosensor capable of rapid and sensitive detection of small protein disease markers using a simple dip-and-read modality. For example, the bladder cancer-associated protein DJ-1 (22 kDa) can be detected in human urine within 1.0 min with a limit of detection (LOD) of 10 pM. The VBR uses engineered virus particles as receptors to recognize and selectively bind the protein of interest. These virus particles are entrained in a conductive poly(3,4-ethylenedioxythiophene) or PEDOT channel. The electrical impedance of the channel increases when the target protein is bound by the virus particles. But VBRs exhibit a sensitivity that is inversely related to the molecular weight of the protein target. Thus, large proteins, such as IgG antibodies (150 kDa), can be undetectable even at high concentrations. We demonstrate that the electrochemical overoxidation of the VBR's PEDOT channel increases its electrical impedance, conferring enhanced sensitivity for both small and large proteins. Overoxidation makes possible the detection of two antibodies, undetectable at a normal VBR, with a limit of detection of 40 ng/mL (250 pM), and a dynamic range for quantitation extending to 600 ng/mL.
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Técnicas Biossensoriais , Compostos Bicíclicos Heterocíclicos com Pontes , Humanos , Imunoglobulina G , Limite de Detecção , PolímerosRESUMO
OBJECTIVE: The primary objectives of the study were to describe the association between cardiac manifestations and in-hospital mortality among children with hemolytic uremic syndrome. STUDY DESIGN: Using the Pediatric Health Information System database, this retrospective, multicenter, cohort study identified the first hemolytic uremic syndrome-related inpatient visit among children ≤18 years (years 2004-2018). The frequency of selected cardiac manifestations and mortality rates were calculated. Multivariate analysis identified the association of specific cardiac manifestations and the risk of in-hospital mortality. RESULTS: Among 3915 patients in the analysis, 238 (6.1%) had cardiac manifestations. A majority of patients (82.8%; n = 197) had 1 cardiac condition and 17.2% (n = 41) had ≥2 cardiac conditions. The most common cardiac conditions was pericardial disease (n = 102), followed by congestive heart failure (n = 46) and cardiomyopathy/myocarditis (n = 34). The percent mortality for patients with 0, 1, or ≥2 cardiac conditions was 2.1%, 17.3%, and 19.5%, respectively. Patients with any cardiac condition had an increased odds of mortality (OR, 9.74; P = .0001). In additional models, the presence of ≥2 cardiac conditions (OR, 9.90; P < .001), cardiac arrest (OR, 38.25; P < .001), or extracorporeal membrane oxygenation deployment (OR, 11.61; P < .001) were associated with increased risk of in-hospital mortality. CONCLUSIONS: This study identified differences in in-hospital mortality based on the type of cardiac manifestations, with increased risk observed for patients with multiple cardiac involvement, cardiac arrest, and extracorporeal membrane oxygenation deployments.
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Cardiopatias/epidemiologia , Síndrome Hemolítico-Urêmica/epidemiologia , Pré-Escolar , Estudos de Coortes , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Parada Cardíaca/epidemiologia , Mortalidade Hospitalar , Humanos , Lactente , Masculino , América do Norte/epidemiologia , Estudos RetrospectivosRESUMO
The 2018 Nobel Prize in Chemistry recognized in vitro evolution, including the development by George Smith and Gregory Winter of phage display, a technology for engineering the functional capabilities of antibodies into viruses. Such bacteriophages solve inherent problems with antibodies, including their high cost, thermal lability, and propensity to aggregate. While phage display accelerated the discovery of peptide and protein motifs for recognition and binding to proteins in a variety of applications, the development of biosensors using intact phage particles was largely unexplored in the early 2000s. Virus particles, 16.5 MDa in size and assembled from thousands of proteins, could not simply be substituted for antibodies in any existing biosensor architectures.Incorporating viruses into biosensors required us to answer several questions: What process will allow the incorporation of viruses into a functional bioaffinity layer? How can the binding of a protein disease marker to a virus particle be electrically transduced to produce a signal? Will the variable salt concentration of a bodily fluid interfere with electrical transduction? A completely new biosensor architecture and a new scheme for electrical transduction of the binding of molecules to viruses were required.This Account describes the highlights of a research program launched in 2006 that answered these questions. These efforts culminated in 2018 in the invention of a biosensor specifically designed to interface with virus particles: the Virus BioResistor (VBR). The VBR is a resistor consisting of a conductive polymer matrix in which M13 virus particles are entrained. The electrical impedance of this resistor, measured across 4 orders of magnitude in frequency, simultaneously measures the concentration of a target protein and the ionic conductivity of the medium in which the resistor is immersed. Large signal amplitudes coupled with the inherent simplicity of the VBR sensor design result in high signal-to-noise ratio (S/N > 100) and excellent sensor-to-sensor reproducibility. Using this new device, we have measured the urinary bladder cancer biomarker nucleic acid deglycase (DJ-1) in urine samples. This optimized VBR is characterized by extremely low sensor-to-sensor coefficients of variation in the range of 3-7% across the DJ-1 binding curve down to a limit of quantitation of 30 pM, encompassing 4 orders of magnitude in concentration.
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Bacteriófago M13/isolamento & purificação , Técnicas Biossensoriais/métodos , Anticorpos/imunologia , Bacteriófago M13/química , Bacteriófago M13/imunologia , Bacteriófago M13/metabolismo , Biomarcadores Tumorais/urina , Técnicas Biossensoriais/instrumentação , Compostos Bicíclicos Heterocíclicos com Pontes/química , Eletrodos , Humanos , Limite de Detecção , Nanofios/química , Neoplasias/diagnóstico , Biblioteca de Peptídeos , Polímeros/química , Proteína Desglicase DJ-1/urina , Técnicas de Microbalança de Cristal de Quartzo , Reprodutibilidade dos Testes , Razão Sinal-RuídoRESUMO
Mind-body practices such as yoga and meditation are often believed to instill a "quiet ego," entailing less self-enhancement. In two experiments, however, Gebauer et al. (2018) demonstrated that mind-body practices may actually increase self-enhancement, particularly because such practices become self-central bases for self-esteem. We conducted preregistered replications of both of Gebauer et al.'s experiments. Experiment 1 was a field study of Canadian yoga students (N = 97), and Experiment 2 was a multiwave meditation intervention among Canadian university students (N = 300). Our results supported Gebauer et al.'s original conclusions that mind-body practices increase self-enhancement. Although the self-centrality effects were not clearly replicated in either experiment, we found evidence that measurement and sampling differences may explain this discrepancy. Moreover, an integrative data analysis of the original and the replication data strongly supported all of Gebauer et al.'s conclusions. In short, we provide new evidence against the ego-quieting perspective and in support of the self-centrality interpretation of mind-body practices.
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Meditação , Yoga , Canadá , Humanos , Autoimagem , EstudantesRESUMO
DJ-1, a 20.7 kDa protein, is overexpressed in people who have bladder cancer (BC). Its elevated concentration in urine allows it to serve as a marker for BC. However, no biosensor for the detection of DJ-1 has been demonstrated. Here, we describe a virus bioresistor (VBR) capable of detecting DJ-1 in urine at a concentration of 10 pM in 1 min. The VBR consists of a pair of millimeter-scale gold electrodes that measure the electrical impedance of an ultrathin (≈ 150-200 nm), two-layer polymeric channel. The top layer of this channel (90-105 nm in thickness) consists of an electrodeposited virus-PEDOT (PEDOT is poly(3,4-ethylenedioxythiophene)) composite containing embedded M13 virus particles that are engineered to recognize and bind to the target protein of interest, DJ-1. The bottom layer consists of spin-coated PEDOT-PSS (poly(styrenesulfonate)). Together, these two layers constitute a current divider. We demonstrate here that reducing the thickness of the bottom PEDOT-PSS layer increases its resistance and concentrates the resistance drop of the channel in the top virus-PEDOT layer, thereby increasing the sensitivity of the VBR and enabling the detection of DJ-1. Large signal amplitudes coupled with the inherent simplicity of the VBR sensor design result in high signal-to-noise (S/N > 100) and excellent sensor-to-sensor reproducibility characterized by coefficients of variation in the range of 3-7% across the DJ-1 binding curve down to a concentration of 30 pM, near the 10 pM limit of detection (LOD), encompassing four orders of magnitude in concentration.
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Bacteriófago M13/química , Biomarcadores Tumorais/urina , Técnicas Biossensoriais , Proteína Desglicase DJ-1/urina , Neoplasias da Bexiga Urinária/urina , Humanos , Fatores de TempoRESUMO
OBJECTIVES: The prevalence of psychiatric disease in patients with eosinophilic esophagitis (EoE) is not fully characterized. We aimed to determine the prevalence of psychiatric disease and centrally acting medication use in a cohort of children and adults with EoE and evaluated whether psychiatric disease affects the EoE clinical presentation. METHODS: We conducted a retrospective study of newly diagnosed cases with EoE at the University of North Carolina from 2002 to 2018. Psychiatric comorbidities and relevant treatments were extracted from the medical records. The demographic and clinical features of patients with EoE with and without psychiatric diagnoses, and those with and without psychiatric medication use, were compared. RESULTS: Of 883 patients (mean age 26.6 years, 68% men, 79% white), 241 (28%) had a psychiatric comorbidity. The most common diagnosis was anxiety (23%) followed by depression (17%); 28% of patients were treated pharmacologically. There were 45 patients (5%) treated pharmacologically without a psychiatric diagnosis for chronic pain syndromes, insomnia, and/or epilepsy. Cases with EoE with a psychiatric diagnosis were more likely to be women, white, and 18 years or older and to have a longer symptom duration before diagnosis. DICUSSION: Psychiatric comorbidities were common in EoE, seen in a third of adults and more than 1 in 7 children, and with similar proportions receiving a prescription medication. These illnesses affected the EoE presentation because psychiatric comorbidities were more likely in older, female, and white patients with a longer duration of symptoms preceding diagnosis.
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Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo/epidemiologia , Esofagite Eosinofílica/epidemiologia , Psicotrópicos/uso terapêutico , Adolescente , Adulto , Distribuição por Idade , Transtornos de Ansiedade/tratamento farmacológico , Benzodiazepinas/uso terapêutico , Dor no Peito/fisiopatologia , Criança , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Comorbidade , Transtornos de Deglutição/fisiopatologia , Transtorno Depressivo/tratamento farmacológico , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/fisiopatologia , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Feminino , Gabapentina/uso terapêutico , Azia/fisiopatologia , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Convulsões/tratamento farmacológico , Convulsões/epidemiologia , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Distribuição por Sexo , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto JovemRESUMO
Ebstein anomaly is a rare CHD known for its wide spectrum of presentation with the age of diagnosis dependent on the malformation's severity. Here, the authors describe a case of delayed diagnosis of Ebstein anomaly, secondary to lack of medical attention, which resulted in severe tricuspid regurgitation and pulmonary hypertension. Furthermore, the case was complicated by a unique pulmonary venous abnormality.
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Anomalia de Ebstein , Cardiopatias Congênitas , Insuficiência da Valva Tricúspide , Anomalia de Ebstein/diagnóstico , Anomalia de Ebstein/diagnóstico por imagem , Humanos , Lactente , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnósticoRESUMO
Biochar has been proposed as a soil amendment in agricultural applications due to its advantageous adsorptive properties, high porosity, and low cost. These properties allow biochar to retain soil nutrients, yet the effects of biochar on bacterial growth remain poorly understood. To examine how biochar influences microbial metabolism, Escherichia coli was grown in a complex, well-defined media and treated with either biochar or activated carbon. The concentration of metabolites in the media were then quantified at several time points using NMR spectroscopy. Several metabolites were immediately adsorbed by the char, including l-asparagine, l-glutamine, and l-arginine. However, we find that biochar quantitatively adsorbs less of these metabolic precursors when compared to activated carbon. Electron microscopy reveals differences in surface morphology after cell culture, suggesting that Escherichia coli can form biofilms on the surfaces of the biochar. An examination of significant compounds in the tricarboxylic acid cycle and glycolysis reveals that treatment with biochar is less disruptive than activated carbon throughout metabolism. While both biochar and activated carbon slowed growth compared to untreated media, Escherichia coli in biochar-treated media grew more efficiently, as indicated by a longer logarithmic growth phase and a higher final cell density. This work suggests that biochar can serve as a beneficial soil amendment while minimizing the impact on bacterial viability. In addition, the experiments identify a mechanism for biochar's effectiveness in soil conditioning and reveal how biochar can alter specific bacterial metabolic pathways.
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Escherichia coli , Metabolômica , Carvão Vegetal , SoloRESUMO
Mechano-activated chemistry is a powerful tool for remodeling of synthetic polymeric materials, however, few reactions are currently available. Here we show that using piezochemical reduction of a CuII -based pre-catalyst, a step-growth polymerization occurs via the copper catalyzed azide-alkyne cycloaddition (CuAAC) reaction to form a linear polytriazole. Furthermore, we show that a linear polymer can be crosslinked mechanochemically using the same chemistry to form a solid organogel. We envision that this chemistry can be used to harness mechanical energy for constructive purposes in polymeric materials.
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Human papilloma virus (HPV) infection is now recognized as a major risk factor for the development of oropharyngeal head and neck cancers, specifically HPV type 16. HPV-16 positive oropharyngeal cancer may in fact represent a distinct disease entity which is associated with improved prognosis and survival (National Cancer Institute, 2016). In this study, we examined the characteristics of patients with early stage HPV-16 positive oropharyngeal squamous cell carcinoma and their post-operative course contrasting the findings to patients with HPV-16 negative tumors. Overall, it was noted that 30-day readmissions and surgical site infections are not affected by the HPV status of the tumor. Robotic surgery is used more frequently with patients who were positive for the HPV infection, and the data suggest that there is a trend toward shorter length of hospital stays as well as a difference in postoperative complications.
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Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/fisiopatologia , Papillomavirus Humano 16/isolamento & purificação , Neoplasias Orofaríngeas/etiologia , Neoplasias Orofaríngeas/fisiopatologia , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/virologia , Feminino , Florida/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/epidemiologia , Neoplasias Orofaríngeas/cirurgia , Neoplasias Orofaríngeas/virologia , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
The endoplasmic reticulum (ER) is the primary intracellular organelle responsible for protein and lipid biosynthesis, protein folding and trafficking, calcium homeostasis, and several other vital processes in cell physiology. Disturbance in ER function results in ER stress and subsequent activation of the unfolded protein response (UPR). The UPR up-regulates ER chaperones, reduces protein translation, and promotes clearance of cytotoxic misfolded proteins to restore ER homeostasis. If this vital process fails, the cell will be signaled to enter apoptosis, resulting in cell death. Sustained ER stress also can trigger an inflammatory response and exacerbate oxidative stress, both of which contribute synergistically to tissue damage. Studies performed over the past decade have implicated ER stress in a broad range of human diseases, including neurodegenerative diseases, cancer, diabetes, and vascular disorders. Several of these diseases also entail retinal dysfunction and degeneration caused by injury to retinal neurons and/or to the blood vessels that supply retinal cells with nutrients, trophic and homeostatic factors, oxygen, and other essential molecules, as well as serving as a conduit for removal of waste products and potentially toxic substances from the retina. Collectively, such injuries represent the leading cause of blindness world-wide in all age groups. Herein, we summarize recent progress on the study of ER stress and UPR signaling in retinal biology and discuss the molecular mechanisms and the potential clinical applications of targeting ER stress as a new therapeutic approach to prevent and treat neuronal degeneration in the retina.
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Estresse do Retículo Endoplasmático/fisiologia , Estresse Oxidativo/fisiologia , Degeneração Retiniana/fisiopatologia , Resposta a Proteínas não Dobradas/fisiologia , Humanos , Transdução de Sinais/fisiologia , eIF-2 Quinase/fisiologiaRESUMO
Angiotensin receptor neprilysin inhibitor is the standard of care for systolic heart failure in adults. In addition, its use in adults with failing systemic right ventricles and diastolic heart failure is promising. This study reports our experience with this drug for protein-losing enteropathy secondary to Fontan failure in pediatrics.
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Past meta-analyses of the effects of priming on overt behavior have not examined whether the effects and processes of priming behavioral or nonbehavioral concepts (e.g., priming action through the word go and priming religion through the word church) differ, even though these possibilities are important to our understanding of concept accessibility and behavior. Hence, we meta-analyzed 351 studies (224 reports and 862 effect sizes) involving incidental presentation of behavioral or nonbehavioral primes, a neutral control group, and at least one behavioral outcome. Our random-effects analyses, which used the correlated and hierarchical effects model with robust variance estimation (Pustejovsky & Tipton, 2021; Tanner-Smith et al., 2016), revealed a moderate priming effect (d = 0.37) that remained stable across behavioral and nonbehavioral primes and across different methodological procedures and adjustments for possible inclusion/publication biases (e.g., sensitivity analyses from Mathur & VanderWeele, 2020; sensitivity analyses from Vevea & Woods, 2005). Although the findings suggest that associative processes explain both the effects of behavioral and nonbehavioral primes, lowering the value of a behavior weakened the effect only when the primes were behavioral. These findings support the possibility that even though both types of primes activate associations that promote behavior, behavioral (vs. nonbehavioral) primes may provide a greater opportunity for goals to control the effect of the primes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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The sandwich format immunoassay is generally more sensitive and specific than more common assay formats, including direct, indirect, or competitive. A sandwich assay, however, requires two receptors to bind non-competitively to the target analyte. Typically, pairs of antibodies (Abs) or antibody fragments (Fabs) that are capable of forming a sandwiching with the target are identified through a slow, guess-and-check method with panels of candidate binding partners. Additionally, sandwich assays that are reliant on commercial antibodies can suffer from changes to reagent quality outside the researchers' control. This report presents a reimagined and simplified phage display selection protocol that directly identifies sandwich binding peptides and Fabs. The approach yielded two sandwich pairs, one peptide-peptide and one Fab-peptide sandwich for the cancer and Parkinson's disease biomarker DJ-1. Requiring just a few weeks to identify, the sandwich pairs delivered apparent affinity that is comparable to other commercial peptide and antibody sandwiches. The results reported here could expand the availability of sandwich binding partners for a wide range of clinical biomarker assays.
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Bacteriófagos , Biblioteca de Peptídeos , Ensaio de Imunoadsorção Enzimática/métodos , Bacteriófagos/metabolismo , Anticorpos , Peptídeos/metabolismo , BiomarcadoresRESUMO
BACKGROUND: The Graded Redefined Assessment of Strength, Sensation, and Prehension (GRASSP V1.0) was developed in 2010 as a 3-domain assessment for upper extremity function after tetraplegia (domains: Strength, Sensibility, and Prehension). A remote version (rGRASSP) was created in response to the growing needs of the field of Telemedicine. OBJECTIVE: The purpose of this study was to assess the psychometric properties of rGRASSP, establishing concurrent validity and inter-rater reliability. METHODS: Individuals with tetraplegia (n = 61) completed 2 visits: 1 in-person and 1 remote. The first visit was completed in-person to administer the GRASSP, and the second visit was conducted remotely to administer the rGRASSP. The rGRASSP was scored both by the administrator of the rGRASSP (Examiner 1), and a second assessor (Examiner 2) to establish inter-rater reliability. Agreement between the in-person and remote GRASSP evaluations was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman agreement plots. RESULTS: The remote GRASSP demonstrated excellent concurrent validity with the GRASSP (left hand intraclass correlation coefficient (ICC) = .96, right ICC = .96). Concurrent validity for the domains was excellent for strength (left ICC = .96, right ICC = .95), prehension ability (left ICC = .94, right ICC = .95), and prehension performance (left ICC = .92, right ICC = .93), and moderate for sensibility (left ICC = .59, right ICC = .68). Inter-rater reliability for rGRASSP total score was high (ICC = .99), and remained high for all 4 domains. Bland-Altman plots and limits of agreements support these findings. CONCLUSIONS: The rGRASSP shows strong concurrent validity and inter-rater reliability, providing a psychometrically sound remote assessment for the upper extremity in individuals with tetraplegia.
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Traumatismos da Medula Espinal , Humanos , Reprodutibilidade dos Testes , Quadriplegia , Extremidade Superior , Sensação/fisiologiaRESUMO
BACKGROUND AIMS: Early-stage HCC can be treated with thermal ablation or stereotactic body radiation therapy (SBRT). We retrospectively compared local progression, mortality, and toxicity among patients with HCC treated with ablation or SBRT in a multicenter, US cohort. APPROACH RESULTS: We included adult patients with treatment-naïve HCC lesions without vascular invasion treated with thermal ablation or SBRT per individual physician or institutional preference from January 2012 to December 2018. Outcomes included local progression after a 3-month landmark period assessed at the lesion level and overall survival at the patient level. Inverse probability of treatment weighting was used to account for imbalances in treatment groups. The Cox proportional hazard modeling was used to compare progression and overall survival, and logistic regression was used for toxicity. There were 642 patients with 786 lesions (median size: 2.1 cm) treated with ablation or SBRT. In adjusted analyses, SBRT was associated with a reduced risk of local progression compared to ablation (aHR 0.30, 95% CI: 0.15-0.60). However, SBRT-treated patients had an increased risk of liver dysfunction at 3 months (absolute difference 5.5%, aOR 2.31, 95% CI: 1.13-4.73) and death (aHR 2.04, 95% CI: 1.44-2.88, p < 0.0001). CONCLUSIONS: In this multicenter study of patients with HCC, SBRT was associated with a lower risk of local progression compared to thermal ablation but higher all-cause mortality. Survival differences may be attributable to residual confounding, patient selection, or downstream treatments. These retrospective real-world data help guide treatment decisions while demonstrating the need for a prospective clinical trial.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Radiocirurgia , Adulto , Humanos , Carcinoma Hepatocelular/radioterapia , Estudos Retrospectivos , Radiocirurgia/efeitos adversos , Neoplasias Hepáticas/radioterapia , Seleção de PacientesRESUMO
Spinodal architected materials with tunable anisotropy unify optimal design and manufacturing of multiscale structures. By locally varying the spinodal class, orientation, and porosity during topology optimization, a large portion of the anisotropic material space is exploited such that material is efficiently placed along principal stress trajectories at the microscale. Additionally, the bicontinuous, nonperiodic, unstructured, and stochastic nature of spinodal architected materials promotes mechanical and biological functions not explicitly considered during optimization (e.g., insensitivity to imperfections, fluid transport conduits). Furthermore, in contrast to laminated composites or periodic, structured architected materials (e.g., lattices), the functional representation of spinodal architected materials leads to multiscale, optimized designs with clear physical interpretation that can be manufactured directly, without special treatment at spinodal transitions. Physical models of the optimized, spinodal-embedded parts are manufactured using a scalable, voxel-based strategy to communicate with a masked stereolithography (m-SLA) 3D printer.