Increasingly, measures of dietary patterns have been used to capture the complex nature of dietary intake and investigate its association with health. Certain dietary patterns may be important in the ...prevention of chronic disease; however, there are few investigations in adolescents. The aim of this study was to describe the dietary patterns of adolescents and their associations with sociodemographic factors, nutrient intakes, and behavioral and health outcomes. Analysis was conducted using data collected in the 1995 Australian National Nutrition Survey of participants aged 12-18 y who completed a 108-item FFQ (n = 764). Dietary patterns were identified using factor analysis and associations with sociodemographic factors and behavioral and health outcomes investigated. Factor analysis revealed 3 dietary patterns labeled a fruit, salad, cereals, and fish pattern; a high fat and sugar pattern; and a vegetables pattern, which explained 11.9, 5.9, and 3.9% of the variation in food intakes, respectively. The high fat and sugar pattern was positively associated with being male (P < 0.001), the vegetables pattern was positively associated with rural region of residence (P = 0.004), and the fruit, salad, cereals, and fish pattern was inversely associated with age (P = 0.03). Dietary patterns were not associated with socioeconomic indicators. The fruit, salad, cereals, and fish pattern was inversely associated with diastolic blood pressure (P = 0.0025) after adjustment for age, sex, and physical activity in adolescents > or = 16 y. This study suggests that specific dietary patterns are already evident in adolescence and a dietary pattern rich in fruit, salad, cereals, and fish pattern may be associated with diastolic blood pressure in older adolescents.
Supermarkets play a major role in influencing the food purchasing behaviours of most households. Snack food exposures within these stores may contribute to higher levels of consumption and ultimately ...to increasing levels of obesity, particularly within socioeconomically disadvantaged neighbourhoods. We aimed to examine the availability of snack food displays at checkouts, end-of-aisle displays and island displays in major supermarket chains in the least and most socioeconomically disadvantaged neighbourhoods of Melbourne.
Within-store audits of 35 Melbourne supermarkets. Supermarkets were sampled from the least and most socioeconomically disadvantaged suburbs within 30 km of the Melbourne CBD. We measured the availability of crisps, chocolate, confectionery, and soft drinks (diet and regular) at the checkouts, in end-of-aisle displays, and in island bin displays.
Snack food displays were most prominent at checkouts with only five stores not having snack foods at 100% of their checkouts. Snack foods were also present at a number of end-of-aisle displays (at both the front (median 38%) and back (median 33%) of store), and in island bin displays (median number of island displays: 7; median total circumference of island displays: 19.4 metres). Chocolate items were the most common snack food item on display. There was no difference in the availability of these snack food displays by neighbourhood disadvantage.
As a result of the high availability of snack food displays, exposure to snack foods is almost unavoidable in Melbourne supermarkets, regardless of levels of neighbourhood socioeconomic disadvantage. Results of this study could promote awareness of the prominence of unhealthy food items in chain-brand supermarkets outlets.
Abstract Background Patients with non–muscle-invasive bladder cancer with an intermediate or high risk need adjuvant intravesical therapy after surgery. Based largely on meta-analyses of previously ...published results, guidelines recommend using either bacillus Calmette-Guérin (BCG) or mitomycin C (MMC) in these patients. Individual patient data (IPD) meta-analyses, however, are the gold standard. Objective To compare the efficacy of BCG and MMC based on an IPD meta-analysis of randomised trials. Design, setting, and participants Trials were searched through Medline and review articles. The relevant trial investigators were contacted to provide IPD. Measurements The drugs were compared with respect to time to recurrence, progression, and overall and cancer-specific death. Results and limitations Nine trials that included 2820 patients were identified, and IPD were obtained from all of them. Patient characteristics were 71% primary, 54% Ta, 43% T1, 25% G1, 58% G2, and 16% G3, and 7% had prior intravesical chemotherapy. Based on a median follow-up of 4.4 yr, 43% recurred. Overall, there was no difference in the time to first recurrence ( p = 0.09) between BCG and MMC. In the trials with BCG maintenance, a 32% reduction in risk of recurrence on BCG compared to MMC was found ( p < 0.0001), while there was a 28% risk increase ( p = 0.006) for BCG in the trials without maintenance. BCG with maintenance was more effective than MMC in both patients previously treated and those not previously treated with chemotherapy. In the subset of 1880 patients for whom data on progression, survival, and cause of death were available, 12% progressed and 24% died, and, of those, 30% of the deaths were due to bladder cancer. No statistically significant differences were found for these long-term end points. Conclusions For prophylaxis of recurrence, maintenance BCG is required to demonstrate superiority to MMC. Prior intravesical chemotherapy was not a confounder. There were no statistically significant differences regarding progression, overall survival, and cancer-specific survival between the two treatments.
The purpose of this study is to assess the viability of a knee arthroplasty prediction model using 3-view X-rays that helps determine if patients with knee pain are candidates for total knee ...arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), or are not arthroplasty candidates.
Analysis was performed using radiographic and surgical data from a high-volume joint replacement practice. The dataset included 3 different X-ray views (anterior-posterior, lateral, and sunrise) for 2,767 patients along with information of whether that patient underwent an arthroplasty surgery (UKA or TKA) or not. This resulted in a dataset including 8,301 images from 2,707 patients. This dataset was then split into a training set (70%) and holdout test set (30%). A computer vision model was trained using a transfer learning approach. The performance of the computer vision model was evaluated on the holdout test set. Accuracy and multiclass receiver operating characteristic area under curve was used to evaluate the performance of the model.
The artificial intelligence model achieved an accuracy of 87.8% on the holdout test set and a quadratic Cohen’s kappa score of 0.811. The multiclass receiver operating characteristic area under curve score for TKA was calculated to be 0.97; for UKA a score of 0.96 and for No Surgery a score of 0.98 was achieved. An accuracy of 93.8% was achieved for predicting Surgery versus No Surgery and 88% for TKA versus not TKA was achieved.
The artificial intelligence/machine learning model demonstrated viability for predicting which patients are candidates for a UKA, TKA, or no surgical intervention.
Management of the Failed Medial Unicompartmental Knee Arthroplasty Crawford, David A; Berend, Keith R; Lombardi, Adolph V
Journal of the American Academy of Orthopaedic Surgeons,
2018-October-15, 2018-Oct-15, 2018-10-15, 20181015, Letnik:
26, Številka:
20
Journal Article
Recenzirano
With recent design modifications, proper patient selection, and sound surgical technique, medial unicompartmental knee arthroplasty has demonstrated long-term success in the management of ...degenerative joint disease. Nevertheless, complications do occur, most often aseptic loosening, tibial fracture, polyethylene wear, bearing dislocation, disease progression, infection, and unexplained pain. Some failures can be managed with retention of the implant, whereas others require revision to total knee arthroplasty (TKA), possibly including augments and stems. Although outcomes of unicompartmental knee arthroplasty may not match those of a primary TKA, they tend to exceed results of revision of a previous TKA.
The tumor microenvironment (TME) is a complex mixture of cell types whose interactions affect tumor growth and clinical outcome. To discover such interactions, we developed CODEFACS (COnfident ...DEconvolution For All Cell Subsets), a tool deconvolving cell type-specific gene expression in each sample from bulk expression, and LIRICS (Ligand-Receptor Interactions between Cell Subsets), a statistical framework prioritizing clinically relevant ligand-receptor interactions between cell types from the deconvolved data. We first demonstrate the superiority of CODEFACS versus the state-of-the-art deconvolution method CIBERSORTx. Second, analyzing The Cancer Genome Atlas, we uncover cell type-specific ligand-receptor interactions uniquely associated with mismatch-repair deficiency across different cancer types, providing additional insights into their enhanced sensitivity to anti-programmed cell death protein 1 (PD-1) therapy compared with other tumors with high neoantigen burden. Finally, we identify a subset of cell type-specific ligand-receptor interactions in the melanoma TME that stratify survival of patients receiving anti-PD-1 therapy better than some recently published bulk transcriptomics-based methods.
This work presents two new computational methods that can deconvolve a large collection of bulk tumor gene expression profiles into their respective cell type-specific gene expression profiles and identify cell type-specific ligand-receptor interactions predictive of response to immune-checkpoint blockade therapy. This article is highlighted in the In This Issue feature, p. 873.
We systematically investigated the association of 48 SNPS in four vitamin D metabolizing genes CYP27A1, GC, CYP27B1 and CYP24A1 with serum 25-hydroxyvitamin D 25(OH)D and 1,25-dihydroxyvitamin D ...1,25(OH)2D levels and the association of these SNPS and an additional 164 SNPS in eight downstream mediators of vitamin D signaling VDR, RXRA, RXRB, PPAR, NCOA1, NCOA2, NCOA3 and SMAD3 with prostate cancer risk in the 749 incident prostate cancer cases and 781 controls of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. 25(OH)D (all cases and controls) and 1,25(OH)2D (a subset of 150 controls) levels were measured by radioimmunoassay and SNP data were genotyped as part of a genome-wide scan. Among investigated SNPS, only four tag SNPS in GC, the major serum 25(OH)D carrier, were associated with 25(OH)D levels; no SNPS were associated with 1,25(OH)2D levels. None of the 212 SNPS examined were associated with cancer risk overall. Among men in the lowest tertile of serum 25(OH)D (<48.9 nmol/l), however, prostate cancer risk was related to tag SNPS in or near the 3′ untranslated region (UTR) of VDR, with the strongest association for rs11574143 odds ratio (95% confidence interval) for risk allele carriers versus wild-type: 2.49 (1.51–4.11), P = 0.0007; the genotype associations were null among men in tertile 2 and tertile 3. Results from the most comprehensive evaluation of serum vitamin D and its related genes to date suggest that tag SNPS in the 3′ UTR of VDR may be associated with risk of prostate cancer in men with low vitamin D status.
Purpose Patients with high-risk prostate cancer after radical prostatectomy are at risk for death. Adjuvant androgen-deprivation therapy (ADT) may reduce this risk. We hypothesized that the addition ...of mitoxantrone and prednisone (MP) to adjuvant ADT could reduce mortality compared with adjuvant ADT alone. Methods Eligible patients had cT1-3N0 prostate cancer with one or more high-risk factors after radical prostatectomy (Gleason score GS ≥ 8; pT3b, pT4, or pN+ disease; GS 7 and positive margins; or preoperative prostate-specific antigen PSA > 15 ng/mL, biopsy GS score > 7, or PSA > 10 ng/mL plus biopsy GS > 6. Patients with PSA ≤ 0.2 ng/mL after radical prostatectomy were stratified by pT/N stage, GS, and adjuvant radiation plan and randomly assigned to ADT (bicalutamide and goserelin for 2 years) or ADT plus six cycles of MP. The primary end point was overall survival (OS). Median OS was projected to be 10 years in the ADT arm, requiring 680 patients per arm to detect a hazard ratio of 1.30 with 92% power and one-sided α = .05. Results Nine hundred sixty-one eligible intent-to-treat patients were randomly assigned to ADT or ADT + MP from October 1999 to January 2007, when the Data Safety Monitoring Committee recommended stopping accrual as a result of higher leukemia incidence with ADT + MP. Median follow-up was 11.2 years. The 10-year OS estimates were 87% with ADT (expected 50%) and 86% with ADT + MP (hazard ratio, 1.06; 95% CI, 0.79 to 1.43). The 10-year estimate for disease-free survival was 72% for both arms. Prostate cancer was the cause of death in 18% of patients in the ADT arm and 22% in the ADT + MP arm. More patients in the MP arm died of other cancers (36% v 18% in ADT alone arm). Conclusion MP did not improve OS and increased deaths from other malignancies. The DFS and 10-year OS in these patients treated with 2 years of ADT were encouraging compared with historical estimates, although a definitive conclusion regarding value of ADT may not be made without a nontreatment control arm.
At the southern tip of South America, evidence of shellfish toxicity has been recorded in the accounts of early explorers and shipwreck survivors since the late 16th Century. Blooms of the toxic ...dinoflagellate
Alexandrium catenella
were described in the western Magellan Strait in the early 1970s and have since shown a northward progression through Chilean Patagonia, culminating in a catastrophic toxic event around Chiloé Island in 2016. This shift has taken place through coastal areas of extremely sparse human population density, and anthropogenically driven eutrophication is therefore unlikely to be significantly involved, at least in the south. However, human activities – such as salmon cultivation – may play a role in the intensification of blooms in the more densely populated areas of northern Patagonia. In the fjords and channels of Chilean Patagonia, phytoplankton assemblages are shaped by complex interactions between freshwater (FW) run-off and intrusions of subantarctic surface water (SASW). In the context of blooms of
A. catenella
, we review the properties of SASW – transformed in coastal waters into modified subantarctic water (MSAW). FW input is characterized by very low concentrations of dissolved inorganic nitrogen (DIN) and phosphorus (DIP), but relatively high concentrations of silicic acid (DSi); DIN and DIP are instead supplied predominantly by SASW which is severely deficient in DSi. These waters therefore show strong vertical gradients in DIN, DIP and DSi, but also potentially in dissolved trace metals and CO
2
. Large scale shifts in the relative inputs of SASW or FW can modify these vertical gradients, potentially forcing competitive changes in phytoplankton assemblages with latitude, with implications for growth and toxicity of
A. catenella
and other harmful species. The northward shift of blooms of
A. catenella
could be associated with anomalies in the Southern Annular Mode (SAM) that modify the influence of MSAW through variations in FW input to coastal waters. The historical presence of blooms in southern Patagonia and Tierra del Fuego, combined with the strongly contrasting conditions with latitude and depth, mean that southern Chile represents an ideal natural laboratory to study climatic and oceanographic influences on dynamics of
A. catenella
populations.
PDF
