29 research outputs found
Nonsteroidal Antiinflammatory Drug Use and Association With Incident Hypertension in Ankylosing Spondylitis.
ObjectiveNonsteroidal antiinflammatory drugs (NSAIDs) increase blood pressure and potentially cardiovascular burden, which may limit their use in ankylosing spondylitis (AS). Our objective was to determine the association of NSAID use with incident hypertension in a longitudinal AS cohort.MethodsAdults with AS were enrolled in a prospective cohort study of patient outcomes and examined every 4-6 months. Hypertension was defined by patient-reported hypertension; antihypertensive medication use; or, on 2 consecutive visits, systolic blood pressure â„140 mm Hg or diastolic blood pressure â„90 mm Hg. Continuous NSAID use was dichotomized based on the validated NSAID index. We assessed the association of NSAID use as a time-varying exposure with the incidence of hypertension using Cox proportional hazards models.ResultsOf the 1,282 patients in the cohort, 628 patients without baseline hypertension had at least 1 year of follow-up and were included in the analysis. Of these, 72% were male, the mean age at baseline was 39 ± 13 years, and 200 patients used NSAIDs continuously. On follow-up, 129 developed incident hypertension. After controlling for other variables, continuous NSAID use was associated with a hazard ratio of 1.12 for incident hypertension (95% confidence interval 1.04-1.20), compared to noncontinuous or no use. The association did not differ in subgroups defined by age, body mass index, biologic use, or disease activity.ConclusionIn our prospective, longitudinal AS cohort, continuous NSAID use was associated with a 12% increased risk for the development of incident hypertension, as compared to noncontinuous or no NSAID use
International Consensus Statement on Rhinology and Allergy: Rhinosinusitis
Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICARâRS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICARâRSâ2021 as well as updates to the original 140 topics. This executive summary consolidates the evidenceâbased findings of the document. Methods: ICARâRS presents over 180 topics in the forms of evidenceâbased reviews with recommendations (EBRRs), evidenceâbased reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICARâRSâ2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidenceâbased management algorithm is provided. Conclusion: This ICARâRSâ2021 executive summary provides a compilation of the evidenceâbased recommendations for medical and surgical treatment of the most common forms of RS
Design, Fabrication, and Dynamic Analysis of a MEMS Ring Resonator Supported by Twin Circular Curve Beams
In this paper, we present a compressive study on the design and development of a MEMS ring resonator and its dynamic behavior under electrostatic force when supported by twin circular curve beams. Finite element analysis (FEA)-based modeling techniques are used to simulate and refine the resonator geometry and transduction. In proper FEA or analytical modeling, the explicit description and accurate values of the effective mass and stiffness of the resonator structure are needed. Therefore, here we outlined an analytical model approach to calculate those values using the first principles of kinetic and potential energy analyses. The natural frequencies of the structure were then calculated using those parameters and compared with those that were simulated using the FEA tool ANSYS. Dynamic analysis was performed to calculate the pull-in voltage, shift of resonance frequency, and harmonic analyses of the ring to understand how the ring resonator is affected by the applied voltage. Additional analysis was performed for different orientations of silicon and assessing the frequency response and frequency shifts. The prototype was fabricated using the standard silicon-on-insulator (SOI)-based MEMS fabrication process and the experimental results for resonances showed good agreement with the developed model approach. The model approach presented in this paper can be used to provide valuable insights for the optimization of MEMS resonators for various operating conditions
Case Control Study of Novel Prognostic Markers and Disease Outcome in Pregnancy/Lactation-associated Breast Carcinoma
A case control study of pregnancy/lactation associated breast carcinoma (PAC) was conducted on 24 test cases with two controls per case, matching age, tumor grade, tumor size and axillary lymph nodes status. During seven years of this study, 6% of all patients with breast cancer had PAC. In this study, 67% of the test cases showed positive axillary lymph nodes compared to 49% in our series of 315 cases of non-pregnancy/non-lactating women with breast carcinoma (p \u3c 0.05). The expression of nine prognostic markers, i.e. ER, PR, p53, C-erbB-2, EGFR, Cathepsin-D, PCNA, DNA ploidy and S-phase fraction, were studied by immunohistochemistry and flow cytometry. Hormone receptor status showed a statistically significant difference between the two groups, i.e. 29% immunoreactivity in test cases compared to 58% in controls with a p value of 0.007. Among p53, C-erbB-2, EGFR and Cathepsin-D in the test group, only EGFR showed a significant correlation, i.e. 33% immunoreactivity in test cases and 19% immunoreactivity in controls (p \u3c 0.05). Higher PCNA positivity was seen in the test group compared to controls, i.e. 35% in test patients and 28% in controls (p \u3c 0.05). Metastasis to bone and liver was a common feature of test patients as compared to controls (p \u3c 0.05). After a median follow-up of 72 months, there was no significant difference in the overall survival (OS) of test cases and controls as 54% deaths were recorded in test patients and 44% in controls at the end of this study (p \u3e 0.05). In summary, in spite of some significant differences in the expression of few prognostic markers, i.e. ER/PR, EGFR, PCNA and metastatic potential, there was no significant difference in the OS of PAC vs. control group if compared stage for stage
Design and Demonstration of a Microelectromechanical System Single-Ring Resonator with Inner Ring-Shaped Spring Supports for Inertial Sensors
This paper presents a novel single-ring resonator design and experimentally demonstrates its dynamic behavior. The proposed ring resonator design is simple and has a solid anchor at its center connected to an outside ring via inner ring-shaped springs. The mode shapes and frequency of the ring resonator were determined numerically and compared with analytical approaches, and the minimum split frequency was observed for the n = 3 mode of vibration. Numerical and analytical methods were used to determine the resonance frequencies, pull-in voltage, resonance frequency shift and harmonic response of the ring resonator for different silicon orientations. The split frequency in the n = 3 mode of vibration increases by the applied DC bias voltage almost by the same amount for all types of silicon. When an AC voltage with a 180-degree phase is applied to two opposite electrodes, the ring has two resonance frequencies in mode n = 2, and when the AC voltage applied to two opposite electrodes is in the same phase, the ring has one resonance frequency regardless of the crystal orientation of silicon. Prototypes were fabricated using a double silicon-on-insulator-based wafer fabrication technique and were tested to verify the resonator performance
Recent Advances in MEMS-Based 3D Hemispherical Resonator Gyroscope (HRG)—A Sensor of Choice
Macro-scale, hemispherical-shaped resonating gyroscopes are used in high-precision motion and navigation applications. In these gyroscopes, a 3D wine-glass, hemispherical-shaped resonating structure is used as the main sensing element. Motivated by the success of macroscale hemispherical shape gyroscopes, many microscale hemispherical-shaped resonators have been produced due to the rapid advancement in semiconductor-based microfabrication technologies. The dynamic performance of hemispherical resonators depends on the degree of symmetry, uniformity of thickness, and surface smoothness, which, in turn, depend on the type of materials and fabrication methods. The main aim of this review paper is to summarize the materials, characterization and fabrication methods reported in the literature for the fabrication of microscale hemispherical resonator gyroscopes (µHRGs). The theory behind the development of HRGs is described and advancements in the fabrication of microscale HRGs through various semiconductor-based fabrication techniques are outlined. The integration of electrodes with the hemispherical structure for electrical transduction using other materials and fabrication methods is also presented. A comparison of different materials and methods of fabrication from the point of view of device characteristics and dynamic performance is discussed. This review can help researchers in their future research and engineers to select the materials and methods for µHRG development
Significance of immunohistochemical c-ErbB-2 product localisation pattern for prognosis in human breast cancer
Breast cancer is an increasingly important cause of illness and death among women. In recent years several novel prognostic determinants of breast cancer have been identified, including c-ErbB-2. In this study, expression of c-ErbB-2 in breast carcinoma was correlated with axillary lymph node metastases and disease outcome. The expression of c-ErbB-2 oncoprotein was analysed in 315 tumor specimens of infiltrating ductal carcinoma of breast. They were categorized according to the modified Bloom and Richardson criteria into three histological grades. These patients also had axillary lymph nodes sampling. The expression of c-ErbB-2 oncoprotein was analysed immunohistochemically. Over expression of c-ErbB-2 were observed in 39.36% tumors. Axillary lymph node metastasis had significant correlation with intensified positivity of c-ErbB-2. C-ErbB-2 positive patients did show resistance to chemotherapy when compared for recurrence and distant metastases following surgery (p\u3c 0.05). At a median follow-up of 48 months in c-ErbB-2 positive patients, the overall survival was 3.0 years and disease free survival was 2.5 years. c-ErbB-2 negative tumor patients showed a far better survival. In this group the overall survival was 4.44 years and the disease free survival was 3.78 years. These findings reinforce the view that c-ErbB-2 immunohistochemical detection is of help in detecting a subgroup of breast carcinoma patients who are at high risk. This may also be of particular relevance in decisions regarding adjuvant chemotherapy to these patients
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Nonsteroidal Antiinflammatory Drug Use and Association With Incident Hypertension in Ankylosing Spondylitis.
ObjectiveNonsteroidal antiinflammatory drugs (NSAIDs) increase blood pressure and potentially cardiovascular burden, which may limit their use in ankylosing spondylitis (AS). Our objective was to determine the association of NSAID use with incident hypertension in a longitudinal AS cohort.MethodsAdults with AS were enrolled in a prospective cohort study of patient outcomes and examined every 4-6 months. Hypertension was defined by patient-reported hypertension; antihypertensive medication use; or, on 2 consecutive visits, systolic blood pressure â„140 mm Hg or diastolic blood pressure â„90 mm Hg. Continuous NSAID use was dichotomized based on the validated NSAID index. We assessed the association of NSAID use as a time-varying exposure with the incidence of hypertension using Cox proportional hazards models.ResultsOf the 1,282 patients in the cohort, 628 patients without baseline hypertension had at least 1 year of follow-up and were included in the analysis. Of these, 72% were male, the mean age at baseline was 39 ± 13 years, and 200 patients used NSAIDs continuously. On follow-up, 129 developed incident hypertension. After controlling for other variables, continuous NSAID use was associated with a hazard ratio of 1.12 for incident hypertension (95% confidence interval 1.04-1.20), compared to noncontinuous or no use. The association did not differ in subgroups defined by age, body mass index, biologic use, or disease activity.ConclusionIn our prospective, longitudinal AS cohort, continuous NSAID use was associated with a 12% increased risk for the development of incident hypertension, as compared to noncontinuous or no NSAID use
Cocaine Use is Associated with More Rapid Clot Formation and Weaker Clot Strength in Acute Stroke Patients.
INTRODUCTION: 1.1.Cocaine use is a known risk factor for stroke and has been associated with worse outcomes. Cocaine may cause an altered coagulable state by a number of different proposed mechanisms, including platelet activation, endothelial injury, and tissue factor expression. This study analyzes the effect of cocaine use on Thrombelastography (TEG) in acute stroke patients.
PATIENT AND METHODS: 1.2.Patients presenting with Acute Ischemic Stroke (AIS) and spontaneous Intracerebral Hemorrhage (ICH) to a single academic center between 2009 and 2014 were prospectively enrolled. Blood was collected for TEG analysis at the time of presentation. Patient demographics and baseline TEG values were compared between two groups: cocaine and non-cocaine users. Multivariable Quantile regression models were used to compare the median TEG components between groups after controlling for the effect of confounders.
RESULTS: 1.3.91 patients were included, 53 with AIS and 38 with ICH. 8 (8.8%) patients were positive for cocaine, 4 (50%) with AIS, and 4 (50%) with ICH. There were no significant differences in age, blood pressure, platelet count, or PT/PTT between the cocaine positive and cocaine negative group. Following multivariable analysis, and adjusting for factors known to influence TEG including stroke subtype, cocaine use was associated with shortened median R time (time to initiate clotting) of 3.8 minutes compared to 4.8 minutes in non-cocaine users (p=0.04). Delta (thrombin burst) was also earlier among cocaine users (0.4 minutes) compared with non-cocaine users (0.5 min, p=0.04). The median MA and G (measurements of final clot strength) were reduced in cocaine users (MA=62.5 mm, G=7.8 dynes/cm2) compared to non-cocaine users (MA=66.5 mm, G=10.1 dynes/cm2; p=0.047, p=0.04, respectively).
CONCLUSION: 1.4.Cocaine users demonstrate more rapid clot formation but reduced overall clot strength based on admission TEG values