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1.
Ann Oncol ; 33(10): 1052-1060, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35764271

RESUMO

BACKGROUND: In the phase II multicohort CheckMate 142 study, nivolumab plus low-dose (1 mg/kg) ipilimumab provided robust and durable clinical benefit with a manageable safety profile in previously treated patients with microsatellite instability-high/mismatch repair-deficient (MSI-H/dMMR) metastatic colorectal cancer (mCRC) at 13.4- and 25.4-month median follow-up (Overman MJ, Lonardi S, Wong KYM et al. Durable clinical benefit with nivolumab plus ipilimumab in DNA mismatch repair-deficient/microsatellite instability-high metastatic colorectal cancer. J Clin Oncol. 2018;36:773-779. Overman MJ, Lonardi S, Wong KYM, et al. Nivolumab plus low-dose ipilimumab in previously treated patients with microsatellite instability-high/mismatch repair deficient metastatic colorectal cancer: long-term follow-up. J Clin Oncol. 2019;37:635). Here, we present results from the 4-year follow-up of these patients. PATIENTS AND METHODS: Patients received nivolumab (3 mg/kg) plus low-dose (1 mg/kg) ipilimumab every 3 weeks (four doses) followed by nivolumab (3 mg/kg) every 2 weeks until disease progression. Primary endpoint was investigator-assessed objective response rate (ORR; as per RECIST version 1.1). RESULTS: A total of 119 patients were treated; 76% had ≥2 prior lines of therapy. Median follow-up was 50.9 months (range 46.9-62.7 months). Median duration of therapy was 24.9 months [95% confidence interval (CI) 15.8-33.2 months]. Investigator-assessed ORR increased from 55% (95% CI 45% to 64%) at 13.4 months to 65% (95% CI 55% to 73%) at 50.9 months with a disease control rate of 81% (95% CI 72% to 87%). The complete response rate increased from 3% at 13.4 months to 13% at 50.9 months. Partial responses were observed in 52% of patients; 21% had stable disease, and 12% had progressive disease. Median time to response was 2.8 months (range 1.1-37.1 months), and median duration of response was not reached (range 1.4+ to 58.0+ months). At data cut-off, 37 (48%) patients had ongoing responses. Median progression-free survival was not reached [95% CI 38.4 months-not estimable (NE)], and median overall survival was not reached (95% CI NE). Grade 3-4 treatment-related adverse events (TRAEs) were observed in 32% of patients; 13% of patients had any-grade TRAEs leading to discontinuation. CONCLUSIONS: The results confirm long-term benefit of nivolumab plus low-dose ipilimumab for previously treated patients with MSI-H/dMMR mCRC. The safety profile was manageable with no new safety signals.


Assuntos
Neoplasias do Colo , Neoplasias Colorretais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Colo/tratamento farmacológico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Reparo de Erro de Pareamento de DNA/genética , Seguimentos , Humanos , Ipilimumab , Instabilidade de Microssatélites , Nivolumabe/uso terapêutico
2.
Med J Malaysia ; 77(6): 730-735, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36448392

RESUMO

INTRODUCTION: Dizziness is a common complaint by patients, yet it always presents as a diagnostic challenge to the attending clinician. An accurate diagnosis is essential to correctly administer the precise treatment regime, alleviate the symptoms, and improve the quality-of-life of patients who present with dizziness. A specialised vestibular clinic with a holistic approach of meticulous history-taking, complete physical examination, a collection of audiovestibular test battery, and facilities for vestibular rehabilitation was set up to assist in the management of these patients. This study aims to investigate the effect of vestibular clinic intervention on the symptoms and qualityof- life of patients who were managed in the vestibular clinic. MATERIALS AND METHODS: A total of 64 new patients who were managed in the vestibular clinic were selected and the validated Malay - Vestibular Rehabilitation Benefit Questionnaire (My-VRBQ) was completed during the first and follow-up visits to measure the changes in symptoms and quality-of-life before and after receiving care at the vestibular clinic. RESULTS: Our study showed that there was a positive effect of vestibular clinic intervention on the symptoms and quality-of-life of patients who were managed by the vestibular clinic. Statistically significant improvements were seen in the total My-VRBQ scores, symptoms scores, and quality-of-life scores. The subscale scores of dizziness, anxiety, and motion-provoked dizziness also showed statistically significant improvement among the patients who received care at the vestibular clinic. CONCLUSION: This indicates that the vestibular clinic was an essential part of the work-up, diagnosis, and treatment of patients with dizziness; and a specialised vestibular clinic was able to bring about positive outcomes in the symptoms and quality-of-life of patients with balance disorders.


Assuntos
Tontura , Qualidade de Vida , Humanos , Tontura/diagnóstico , Tontura/etiologia , Tontura/terapia , Malásia , Instituições de Assistência Ambulatorial , Ansiedade/etiologia
3.
Med J Malaysia ; 76(6): 870-875, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34806675

RESUMO

INTRODUCTION: Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) is effective in treating acute ischaemic stroke. Our primary objective is to assess the outcome of these acute ischaemic stroke (AIS) patients after IV alteplase with the modified Rankin scale (mRS). METHODS: This is a cross-sectional study in which patients receiving IV alteplase in Hospital Universiti Sains Malaysia, from January 2017 to April 2020 were recruited. Demographical data, National Institutes of Health Stroke Scale (NIHSS) scores, door-to-needle time were recorded. Modified Rankin scale (mRS) scores were evaluated at 90 days after initial therapy. Good and poor functional outcomes were defined as 0-2 and 3-6, respectively. RESULTS: A total of 30 patients were included in the study with a mean age of 59±11.47 years old. 76.7% of them were male and the rest were female. From the study, onset-toneedle time was 197.47±51.74 minutes, whereas door-toneedle time was 120.93±53.63 minutes. Seventeen (56.3%) patients achieved a favourable score of 0-2 on the mRS at 90 days after treatment. Haemorrhagic transformation occurred in eight (26.7%) of the patients with a mortality rate of 13.3%. CONCLUSION: 56.7% of our patients showed improvement in the mRS at 90 days post thrombolysis for AIS. Higher baseline NIHSS scores and diabetes mellitus were associated with poorer functional outcomes after thrombolysis.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Ativador de Plasminogênio Tecidual , Idoso , Isquemia Encefálica/complicações , Isquemia Encefálica/tratamento farmacológico , Estudos Transversais , Feminino , Hospitais , Humanos , AVC Isquêmico/tratamento farmacológico , Malásia , Masculino , Pessoa de Meia-Idade , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento
4.
Nutr Metab Cardiovasc Dis ; 28(8): 856-863, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29853430

RESUMO

BACKGROUND AND AIM: Despite a growing body of evidence from Western populations on the health benefits of Dietary Approaches to Stop Hypertension (DASH) diets, their applicability in South East Asian settings is not clear. We examined cross-sectional associations between DASH diet and cardio-metabolic risk factors among 1837 Malaysian and 2898 Philippines participants in a multi-national cohort. METHODS AND RESULTS: Blood pressures, fasting lipid profile and fasting glucose were measured, and DASH score was computed based on a 22-item food frequency questionnaire. Older individuals, women, those not consuming alcohol and those undertaking regular physical activity were more likely to have higher DASH scores. In the Malaysian cohort, while total DASH score was not significantly associated with cardio-metabolic risk factors after adjusting for confounders, significant associations were observed for intake of green vegetable [0.011, standard error (SE): 0.004], and red and processed meat (-0.009, SE: 0.004) with total cholesterol. In the Philippines cohort, a 5-unit increase in total DASH score was significantly and inversely associated with systolic blood pressure (-1.41, SE: 0.40), diastolic blood pressure (-1.09, SE: 0.28), total cholesterol (-0.015, SE: 0.005), low-density lipoprotein cholesterol (-0.025, SE: 0.008), and triglyceride (-0.034, SE: 0.012) after adjusting for socio-demographic and lifestyle groups. Intake of milk and dairy products, red and processed meat, and sugared drinks were found to significantly associated with most risk factors. CONCLUSIONS: Differential associations of DASH diet and dietary components with cardio-metabolic risk factors by country suggest the need for country-specific tailoring of dietary interventions to improve cardio-metabolic risk profiles.


Assuntos
Glicemia/metabolismo , Pressão Sanguínea , Abordagens Dietéticas para Conter a Hipertensão , Dislipidemias/dietoterapia , Transtornos do Metabolismo de Glucose/dietoterapia , Hipertensão/dietoterapia , Lipídeos/sangue , Síndrome Metabólica/dietoterapia , Adolescente , Adulto , Biomarcadores/sangue , Dislipidemias/sangue , Dislipidemias/epidemiologia , Comportamento Alimentar , Feminino , Transtornos do Metabolismo de Glucose/sangue , Transtornos do Metabolismo de Glucose/epidemiologia , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Malásia/epidemiologia , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Valor Nutritivo , Filipinas/epidemiologia , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
5.
Hong Kong Med J ; 24(3): 226-237, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29888706

RESUMO

INTRODUCTION: Newborn screening is important for early diagnosis and effective treatment of inborn errors of metabolism (IEM). In response to a 2008 coroners' report of a 14-year-old boy who died of an undiagnosed IEM, the OPathPaed service model was proposed. In the present study, we investigated the feasibility of the OPathPaed model for delivering expanded newborn screening in Hong Kong. In addition, health care professionals were surveyed on their knowledge and opinions of newborn screening for IEM. METHODS: The present prospective study involving three regional hospitals was conducted in phases, from 1 October 2012 to 31 August 2014. The 10 steps of the OPathPaed model were evaluated: parental education, consent, sampling, sample dispatch, dried blood spot preparation and testing, reporting, recall and counselling, confirmation test, treatment and monitoring, and cost-benefit analysis. A fully automated online extraction system for dried blood spot analysis was also evaluated. A questionnaire was distributed to 430 health care professionals by convenience sampling. RESULTS: In total, 2440 neonates were recruited for newborn screening; no true-positive cases were found. Completed questionnaires were received from 210 respondents. Health care professionals supported implementation of an expanded newborn screening for IEM. In addition, there is a substantial need of more education for health care professionals. The majority of respondents supported implementing the expanded newborn screening for IEM immediately or within 3 years. CONCLUSION: The feasibility of OPathPaed model has been confirmed. It is significant and timely that when this pilot study was completed, a government-led initiative to study the feasibility of newborn screening for IEM in the public health care system on a larger scale was announced in the Hong Kong Special Administrative Region Chief Executive Policy Address of 2015.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Erros Inatos do Metabolismo/diagnóstico , Triagem Neonatal/métodos , Diagnóstico Precoce , Feminino , Hong Kong , Humanos , Recém-Nascido , Masculino , Erros Inatos do Metabolismo/terapia , Projetos Piloto , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Inquéritos e Questionários
6.
Psychooncology ; 26(2): 255-261, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27061966

RESUMO

BACKGROUND: Most women with advanced breast cancer (ABC) show little distress, but about one in ten show persistent distress over time. It remains unclear if meanings ascribed by patients to ABC differentiate these distress trajectories. STUDY AIMS: This qualitative study (a) compared illness meanings of ABC between women with persistent psychological distress and those with low/transient distress, and (b) examined how illness meanings might influence coping strategies. METHODS: The sample was drawn from a prior quantitative study exploring psychological distress trajectories following ABC diagnosis. Overall, 42 Cantonese- or Mandarin-speaking Chinese women diagnosed with locally advanced or metastatic ABC were recruited based on their distress trajectory status (low-stable, transient, or persistent distress). Interviews were recorded, transcribed, and analyzed following grounded theory approach using simultaneous analysis. RESULTS: Women with persistent distress viewed their diagnosis as another blow in life, the illness was global, permeating every aspect of their life. Maladaptive rumination and thought suppression were common responses to illness demands. These women had poor social support. A sense of demoralization stood out in their narratives. In contrast, women with transient/low-stable distress encapsulated the illness, with minimum impacts of their life. They did not evidence dysfunctional repetitive thoughts. Living in a supportive environment, they were able to accept and/or live in the present-moment. CONCLUSIONS: Rumination, thought suppression, social constraints, and pre-existing exposure to life stress may be potential risks for chronic distress in response to advanced breast cancer. Persistent and transient distress responses to cancer may have different underpinnings. Copyright © 2016 John Wiley & Sons, Ltd.


Assuntos
Neoplasias da Mama/psicologia , Qualidade de Vida/psicologia , Resiliência Psicológica , Estresse Psicológico/psicologia , Adaptação Psicológica , Adulto , Povo Asiático/psicologia , Sobreviventes de Câncer/psicologia , China , Feminino , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Apoio Social
7.
Hong Kong Med J ; 23(4): 381-6, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28684649

RESUMO

INTRODUCTION: There is a paucity of local data on neonatal outcomes of preterm/very-low-birth-weight infants in Hong Kong. This study aimed to evaluate the survival rate on discharge and morbidity of preterm/very-low-birth-weight infants (≤29+6 weeks and/or birth weight <1500 g) over a decade at Queen Mary Hospital in Hong Kong, so as to provide centre-specific data for prenatal counselling and to benchmark these results against the Vermont Oxford Network. METHODS: Standardised perinatal/neonatal data were collected for infants with gestational age of 23+0 to 29+6 weeks and/or birth weight of <1500 g who were born at Queen Mary Hospital between 1 January 2005 and 31 December 2014. These data were compared with all neonatal centres in the Vermont Oxford Network in 2013. The Chi squared test was used to compare the categorical Queen Mary Hospital data with that of Vermont Oxford Network. A two-tailed P value of <0.05 was considered statistically significant. RESULTS: The overall survival rate on discharge from Queen Mary Hospital for 449 infants was significantly higher than that of the Vermont Oxford Network (87% versus 80%; P=0.0006). The morbidity-free survival at Queen Mary Hospital (40%) was comparable with the Vermont Oxford Network (44%). At Queen Mary Hospital, 86% of infants had respiratory distress syndrome, 40% bronchopulmonary dysplasia, 44% patent ductus arteriosus, 7% severe intraventricular haemorrhage, 5% necrotising enterocolitis, 10% severe retinopathy of prematurity, 10% late-onset sepsis, and 84% growth failure on discharge. Rates of respiratory distress syndrome, intraventricular haemorrhage, necrotising enterocolitis, and severe retinopathy of prematurity were similar in the two populations. At Queen Mary Hospital, significantly more infants had bronchopulmonary dysplasia (P=0.011), patent ductus arteriosus (P=0.015), and growth failure (P=0.0001) compared with the Vermont Oxford Network. In contrast, rate of late-onset sepsis was significantly lower at Queen Mary Hospital than the Vermont Oxford Network (P=0.0002). CONCLUSIONS: Mortality rate and most of the morbidity rates of our centre compare favourably with international standards, but rates of bronchopulmonary dysplasia and growth failure are of concern. A regular benchmarking process is crucial to audit any change in clinical outcomes after implementation of a local quality improvement project.


Assuntos
Mortalidade Infantil , Doenças do Prematuro/mortalidade , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Distribuição de Qui-Quadrado , Feminino , Idade Gestacional , Hong Kong , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Taxa de Sobrevida
9.
Phys Rev Lett ; 116(1): 018101, 2016 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-26799044

RESUMO

Self-organized critical states (SOCs) and stochastic oscillations (SOs) are simultaneously observed in neural systems, which appears to be theoretically contradictory since SOCs are characterized by scale-free avalanche sizes but oscillations indicate typical scales. Here, we show that SOs can emerge in SOCs of small size systems due to temporal correlation between large avalanches at the finite-size cutoff, resulting from the accumulation-release process in SOCs. In contrast, the critical branching process without accumulation-release dynamics cannot exhibit oscillations. The reconciliation of SOCs and SOs is demonstrated both in the sandpile model and robustly in biologically plausible neuronal networks. The oscillations can be suppressed if external inputs eliminate the prominent slow accumulation process, providing a potential explanation of the widely studied Berger effect or event-related desynchronization in neural response. The features of neural oscillations and suppression are confirmed during task processing in monkey eye-movement experiments. Our results suggest that finite-size, columnar neural circuits may play an important role in generating neural oscillations around the critical states, potentially enabling functional advantages of both SOCs and oscillations for sensitive response to transient stimuli.


Assuntos
Encéfalo/fisiologia , Modelos Neurológicos , Rede Nervosa/fisiologia , Neurônios/fisiologia , Relógios Biológicos , Humanos , Processos Estocásticos
10.
Colorectal Dis ; 18(6): O206-9, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26880360

RESUMO

AIM: It is controversial whether a high or low ligation of the inferior mesenteric artery (IMA) is superior. The former allows an extended lymph node clearance whereas the latter preserves the distal vascular supply via the left colic artery (LCA). Apical lymph node dissection of the IMA (ALMA) harvests nodal tissue along the IMA proximal to the LCA whilst performing a low ligation. This anatomically replicates the oncological benefit of high ligation and the vascular preservation of low ligation. Our study evaluates the nodal yield of ALMA and the short-term outcome of this technique. METHOD: We retrospectively studied 19 patients with sigmoid or rectal cancer who underwent curative surgical resection with ALMA. All ALMAs were performed with a standard technique previously described (Kobayashi et al., Surg Endosc 2005, 20:563-9; Sekimoto et al. Surg Endosc 2010, 25:861-6) . The lymph node yield from the dissection (the ALMA specimen) was compared with the total lymph node yield. Data on the LCA anatomy, time required to perform ALMA, complications and postoperative recovery were evaluated. RESULTS: ALMA was successful in 18 patients. Median postoperative hospitalization was 5 (2-26) days without ALMA-related morbidity or mortality. The median lymph node yield was 20 (9-41) and a median of 14.3 (0-80)% were harvested with ALMA. Two patients not having neoadjuvant chemoradiotherapy had fewer than 12 lymph nodes, excluding nodes harvested from ALMA. The average time required for ALMA was 18 min. CONCLUSION: ALMA is a safe and feasible technique, allowing extended lymphadenectomy without sacrificing the LCA. In this small group of patients none were upstaged due to cancerous involvement of the proximal nodes.


Assuntos
Excisão de Linfonodo/métodos , Linfonodos/patologia , Artéria Mesentérica Inferior/cirurgia , Neoplasias Retais/cirurgia , Neoplasias do Colo Sigmoide/cirurgia , Idoso , Colo/irrigação sanguínea , Colo/cirurgia , Feminino , Humanos , Ligadura , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/patologia , Estudos Retrospectivos , Neoplasias do Colo Sigmoide/patologia , Resultado do Tratamento
11.
Proc Natl Acad Sci U S A ; 110(34): 13717-22, 2013 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-23898198

RESUMO

Optimizing paths on networks is crucial for many applications, ranging from subway traffic to Internet communication. Because global path optimization that takes account of all path choices simultaneously is computationally hard, most existing routing algorithms optimize paths individually, thus providing suboptimal solutions. We use the physics of interacting polymers and disordered systems to analyze macroscopic properties of generic path optimization problems and derive a simple, principled, generic, and distributed routing algorithm capable of considering all individual path choices simultaneously. We demonstrate the efficacy of the algorithm by applying it to: (i) random graphs resembling Internet overlay networks, (ii) travel on the London Underground network based on Oyster card data, and (iii) the global airport network. Analytically derived macroscopic properties give rise to insightful new routing phenomena, including phase transitions and scaling laws, that facilitate better understanding of the appropriate operational regimes and their limitations, which are difficult to obtain otherwise.


Assuntos
Algoritmos , Modelos Teóricos , Polímeros/metabolismo , Teoria de Sistemas , Aviação , Internet , Ferrovias
13.
Qual Life Res ; 24(6): 1565-74, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25394895

RESUMO

PURPOSE: To investigate how the response labels of the 5-level EQ-5D (EQ-5D-5L) items are interpreted and used by English-speaking Chinese and non-Chinese Singaporeans, as a means to assessing whether those items are cross-culturally equivalent health-status measures in this Asian population. METHODS: In face-to-face interviews, Chinese, Malay and Indian visitors to a primary care institution in Singapore were asked to rate the relative severity conveyed by EQ-5D-5L response labels, each containing the keyword of 'no(t),' 'slight(ly),' 'moderate(ly),' 'severe(ly),' or 'unable'/'extreme(ly),' using a 0-100 numerical rating scale. Participants were also asked to describe 25 hypothetical health states using the EQ-5D-5L response labels. Differences between Chinese and Malay/Indian participants in label interpretation and selection were examined using multivariate regression analysis to adjust for participant characteristics. RESULTS: The differences in adjusted mean severity scores for individual EQ-5D-5L labels between Chinese (n = 148) and non-Chinese (Malay: n = 53; Indian: n = 56) participants ranged from 0.0 to 9.0. The relative severity of the labels to the participants supported the ordinality of the EQ-5D-5L response labels and was similar across ethnic groups. Chinese and non-Chinese participants selected similar response labels to describe each hypothetical health state, with the adjusted odds ratios of selecting any type of the five response labels for non-Chinese versus Chinese participants ranging from 0.92 to 1.15 (p > 0.05 for all). CONCLUSIONS: The EQ-5D-5L items are likely to generate equivalent health outcomes between English-speaking Chinese and non-Chinese Singaporeans.


Assuntos
Povo Asiático , Nível de Saúde , Qualidade de Vida , Inquéritos e Questionários , Adulto , Comparação Transcultural , Feminino , Indicadores Básicos de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Psicometria , Pesquisa Qualitativa , Reprodutibilidade dos Testes , Singapura
16.
Psychooncology ; 22(12): 2831-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24038545

RESUMO

BACKGROUND: Anxiety and depression (distress) over the first year following the initial adjuvant therapy for advanced breast cancer (ABC) remain poorly documented in non-Caucasian populations. This study describes trajectories of distress and their determinants in Chinese women with ABC. METHODS: Of the 228 Chinese women newly diagnosed with ABC recruited from six oncology units, 192 completed an interview before their first course of chemotherapy (baseline) and follow-up interviews at 1.5, 3, 6, and 12 months thereafter. At baseline, participants were assessed for supportive care needs, psychological distress, physical symptom distress, optimism, and cancer-related rumination. At follow-up, participants completed the measure of psychological distress. Latent growth mixture modeling was used to identify trajectory patterns of distress. Multinominal logistic regression was used to identify predictors of trajectory patterns adjusted for demographic and medical characteristics. RESULTS: Four distinct trajectories of anxiety and depression were identified. Most women showed low-stable levels of anxiety (68%) and depression (68%), but one in 11 women were chronically anxious (9%) and depressed (9%). Optimism, negative cancer-related rumination, and physical symptom distress predicted both anxiety and depression trajectories. Psychological needs predicted anxiety trajectories. Women in the low-stable distress group reported high optimism, low psychological supportive care needs, low physical symptom distress, and low negative cancer-related rumination. CONCLUSION: Most women with ABC did not experience psychological distress over 12 months following diagnosis of ABC. Preventive interventions should focus on women at risk of high persistent distress and reducing rumination, providing emotional support, and managing physical symptoms.


Assuntos
Transtornos de Ansiedade/psicologia , Ansiedade/psicologia , Povo Asiático/psicologia , Neoplasias da Mama/psicologia , Depressão/psicologia , Transtorno Depressivo/psicologia , Estresse Psicológico/psicologia , Adaptação Psicológica , Adulto , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Progressão da Doença , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Pessoa de Meia-Idade , Modelos Psicológicos , Análise Multivariada , Avaliação das Necessidades , Estadiamento de Neoplasias , Apoio Social
17.
Phys Rev E ; 107(6-1): 064302, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37464697

RESUMO

We investigated the dynamical behaviors of bimodular continuous attractor neural networks, each processing a modality of sensory input and interacting with each other. We found that when bumps coexist in both modules, the position of each bump is shifted towards the other input when the intermodular couplings are excitatory and is shifted away when inhibitory. When one intermodular coupling is excitatory while another is moderately inhibitory, temporally modulated population spikes can be generated. On further increase of the inhibitory coupling, momentary spikes will emerge. In the regime of bump coexistence, bump heights are primarily strengthened by excitatory intermodular couplings, but there is a lesser weakening effect due to a bump being displaced from the direct input. When bimodular networks serve as decoders of multisensory integration, we extend the Bayesian framework to show that excitatory and inhibitory couplings encode attractive and repulsive priors, respectively. At low disparity, the bump positions decode the posterior means in the Bayesian framework, whereas at high disparity, multiple steady states exist. In the regime of multiple steady states, the less stable state can be accessed if the input causing the more stable state arrives after a sufficiently long delay. When one input is moving, the bump in the corresponding module is pinned when the moving stimulus is weak, unpinned at intermediate stimulus strength, and tracks the input at strong stimulus strength, and the stimulus strengths for these transitions increase with the velocity of the moving stimulus. These results are important to understanding multisensory integration of static and dynamic stimuli.


Assuntos
Modelos Neurológicos , Redes Neurais de Computação , Teorema de Bayes
18.
Nat Commun ; 14(1): 2510, 2023 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-37130854

RESUMO

Simulating physical dynamics to solve hard combinatorial optimization has proven effective for medium- to large-scale problems. The dynamics of such systems is continuous, with no guarantee of finding optimal solutions of the original discrete problem. We investigate the open question of when simulated physical solvers solve discrete optimizations correctly, with a focus on coherent Ising machines (CIMs). Having established the existence of an exact mapping between CIM dynamics and discrete Ising optimization, we report two fundamentally distinct bifurcation behaviors of the Ising dynamics at the first bifurcation point: either all nodal states simultaneously deviate from zero (synchronized bifurcation) or undergo a cascade of such deviations (retarded bifurcation). For synchronized bifurcation, we prove that when the nodal states are uniformly bounded away from the origin, they contain sufficient information for exactly solving the Ising problem. When the exact mapping conditions are violated, subsequent bifurcations become necessary and often cause slow convergence. Inspired by those findings, we devise a trapping-and-correction (TAC) technique to accelerate dynamics-based Ising solvers, including CIMs and simulated bifurcation. TAC takes advantage of early bifurcated "trapped nodes" which maintain their sign throughout the Ising dynamics to reduce computation time effectively. Using problem instances from open benchmark and random Ising models, we validate the superior convergence and accuracy of TAC.

19.
Acta Cardiol ; 78(7): 828-837, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37694719

RESUMO

OBJECTIVES: Acute heart failure (AHF) hospitalisation is associated with 10% mortality. Outpatient based management (OPM) of AHF appeared effective in observational studies. We conducted a pilot randomised controlled trial (RCT) comparing OPM with standard inpatient care (IPM). METHODS: We randomised patients with AHF, considered to need IV diuretic treatment for ≥2 days, to IPM or OPM. We recorded all-cause mortality, and the number of days alive and out-of-hospital (DAOH). Quality of life, mental well-being and Hope scores were assessed. Mean NHS cost savings and 95% central range (CR) were calculated from bootstrap analysis. Follow-up: 60 days. RESULTS: Eleven patients were randomised to IPM and 13 to OPM. There was no statistically significant difference in all-cause mortality during the index episode (1/11 vs 0/13) and up to 60 days follow-up (2/11 vs 2/13) [p = .86]. The OPM group accrued more DAOH {47 [36,51] vs 59 [41,60], p = .13}. Two patients randomised to IPM (vs 6 OPM) were readmitted [p = .31]. Hope scores increased more with OPM within 30 days but dropped to lower levels than IPM by 60 days. More out-patients had increased total well-being scores by 60 days (p = .04). OPM was associated with mean cost savings of £2658 (95% CR 460-4857) per patient. CONCLUSIONS: Patients with acute HF randomised to OPM accrued more days alive out of hospital (albeit not statistically significantly in this small pilot study). OPM is favoured by patients and carers and is associated with improved mental well-being and cost savings.


Assuntos
Insuficiência Cardíaca , Pacientes Ambulatoriais , Humanos , Projetos Piloto , Redução de Custos , Insuficiência Cardíaca/terapia , Hospitalização
20.
Neural Comput ; 24(5): 1147-85, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22295986

RESUMO

Experimental data have revealed that neuronal connection efficacy exhibits two forms of short-term plasticity: short-term depression (STD) and short-term facilitation (STF). They have time constants residing between fast neural signaling and rapid learning and may serve as substrates for neural systems manipulating temporal information on relevant timescales. This study investigates the impact of STD and STF on the dynamics of continuous attractor neural networks and their potential roles in neural information processing. We find that STD endows the network with slow-decaying plateau behaviors: the network that is initially being stimulated to an active state decays to a silent state very slowly on the timescale of STD rather than on that of neuralsignaling. This provides a mechanism for neural systems to hold sensory memory easily and shut off persistent activities gracefully. With STF, we find that the network can hold a memory trace of external inputs in the facilitated neuronal interactions, which provides a way to stabilize the network response to noisy inputs, leading to improved accuracy in population decoding. Furthermore, we find that STD increases the mobility of the network states. The increased mobility enhances the tracking performance of the network in response to time-varying stimuli, leading to anticipative neural responses. In general, we find that STD and STP tend to have opposite effects on network dynamics and complementary computational advantages, suggesting that the brain may employ a strategy of weighting them differentially depending on the computational purpose.


Assuntos
Memória/fisiologia , Redes Neurais de Computação , Plasticidade Neuronal/fisiologia , Neurônios/fisiologia , Sinapses/fisiologia , Encéfalo/fisiologia , Simulação por Computador , Rede Nervosa/fisiologia , Processamento de Sinais Assistido por Computador
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