Racial disparities among patients with lung cancer who were recommended operative therapy.

HYPOTHESIS: Health care system and provider biases and differences in patient characteristics are thought to be prevailing factors underlying racial disparities. The influence of these factors on the receipt of care would likely be mitigated among patients who are recommended optimal therapy. We hypothesized that there would be no significant evidence of racial disparities among patients with early-stage lung cancer who are recommended surgical therapy. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study of patients in the Surveillance, Epidemiology, and End Results-Medicare database who were diagnosed with stage I or II lung cancer between January 1, 1992, and December 31, 2002 (follow-up through December 31, 2005). MAIN OUTCOME MEASURES: Receipt of lung resection and overall survival. RESULTS: Among 17,739 patients who were recommended surgical therapy (mean [SD] age, 75 [5] years; 89% white, 6% black), black patients less frequently underwent resection compared with white patients (69% vs 83%, respectively; P < .001). After adjustment, black race was associated with lower odds of receiving surgical therapy (odds ratio = 0.43; 99% confidence interval, 0.36-0.52). Unadjusted 5-year survival rates were lower for black patients compared with white patients (36% vs 42%, respectively; P < .001). After adjustment, there was no significant association between race and death (hazard ratio = 1.03; 99% confidence interval, 0.92-1.14) despite a 14% difference in receipt of optimal therapy. CONCLUSIONS: Even among patients who were recommended surgical therapy, black patients underwent lung resection less often than white patients. Unexpectedly, racial differences in the receipt of optimal therapy did not appear to affect outcomes. These findings suggest that distrust, beliefs and perceptions about lung cancer and its treatment, and limited access to care (despite insurance) might have a more dominant role in perpetuating racial disparities than previously recognized

Comparison of Outcomes of antibiotic Drugs and Appendectomy (CODA) trial: a protocol for the pragmatic randomised study of appendicitis treatment.

INTRODUCTION: Several European studies suggest that some patients with appendicitis can be treated safely with antibiotics. A portion of patients eventually undergo appendectomy within a year, with 10%-15% failing to respond in the initial period and a similar additional proportion with suspected recurrent episodes requiring appendectomy. Nearly all patients with appendicitis in the USA are still treated with surgery. A rigorous comparative effectiveness trial in the USA that is sufficiently large and pragmatic to incorporate usual variations in care and measures the patient experience is needed to determine whether antibiotics are as good as appendectomy. OBJECTIVES: The Comparing Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial for acute appendicitis aims to determine whether the antibiotic treatment strategy is non-inferior to appendectomy. METHODS/ANALYSIS: CODA is a randomised, pragmatic non-inferiority trial that aims to recruit 1552 English-speaking and Spanish-speaking adults with imaging-confirmed appendicitis. Participants are randomised to appendectomy or 10 days of antibiotics (including an option for complete outpatient therapy). A total of 500 patients who decline randomisation but consent to follow-up will be included in a parallel observational cohort. The primary analytic outcome is quality of life (measured by the EuroQol five dimension index) at 4 weeks. Clinical adverse events, rate of eventual appendectomy, decisional regret, return to work/school, work productivity and healthcare utilisation will be compared. Planned exploratory analyses will identify subpopulations that may have a differential risk of eventual appendectomy in the antibiotic treatment arm. ETHICS AND DISSEMINATION: This trial was approved by the University of Washington\u27s Human Subjects Division. Results from this trial will be presented in international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT02800785

The Kidneys and Aldosterone/Mineralocorticoid Receptor System in Salt-Sensitive Hypertension

Strong evidence supports the ability of the aldosterone/mineralocorticoid receptor (MR) system to dominate long-term blood pressure control. It is also increasingly recognized as an important mediator of cardiovascular and renal diseases, particularly in the presence of excessive salt intake. In a subgroup of individuals with metabolic syndrome, adipocyte-derived aldosterone-releasing factors cause inappropriate secretion of aldosterone in the adrenal glands during salt loading, resulting in the development of salt-induced hypertension and cardiac and renal damage. On the other hand, emerging data reveal that aldosterone is not a sole regulator of MR activity. We have identified the signaling crosstalk between MR and small GTPase Rac1 as a novel pathway to facilitate MR signaling. Such a local control system for MR can also be relevant to the pathogenesis of salt-sensitive hypertension, and future studies will clarify the detailed mechanism for the intricate regulation of the aldosterone/MR cascade

Incertitude dans les mesures de courant : un obstacle dans la caractérisation des composants en électronique de puissance

The aim of this paper is to clarify the need for the most accurate current measurement applied to the characterization of the power electronic components. The focus is on the behaviour of the normally used high quality high bandwidth current transformers and other sensors to a fast varying high di/dt test current furnished by a new developed test current generator. In this paper after explaining the new strategy of the test generator, different current transformers are tested and characterized and a detailed comparative experimental study is carried out using a non-inductive shunt as the reference. Finally some general remarks and the necessary precautions and different measurement problems are listed and discussed.Le but de cet article est d'essayer de lever les obstacles rencontrés lors des mesures de courant servant à la caractérisation des composants en électronique de puissance. Nous nous sommes penchés sur les différences entre les réponses de quelques capteurs de haute qualité. Après une brève explication du principe d'un générateur de courant de test spécialement conçu pour cette étude, nous comparons les réponses de plusieurs transformateurs de courant par rapport à un shunt aselfique pris pour référence. Enfin nous abordons les différents aspects concernant les précautions qu'il est nécessaire de prendre pour réaliser ce type de mesure

METAMORPHIC MEMORY BASED BIO-INSPIRED RECONFIGURABLE CELLULAR SYSTEMS

Abstract – Living beings in nature are made up of structurally identical cells, where each cell contains a copy of its DNA, the unique characteristic of the individual. This DNA is like a memory. It remembers and defines the behaviour of the individual and remains constant throughout its life time. An artificial embryonic cell contains a similar memory map where the specific ‘gene ’ it executes determines the functionality of the cell. An electronic system is then constructed by interconnecting a large number of identical cells. Each cell, similarly to nature, executes only a segment (gene) of the DNA and thus they all demonstrate different behaviour. However these cells will collectively determine the characteristic and configuration of the target system. This paper proposes a novel gene selection algorithm that doesn’t use the common address decoding approach and provides easier reconfiguration of systems for a different behaviour

Etude comportementale de la commutation d'un transistor MOSFET de puissance

In this paper, after a review of different works carried on power MOSFET modeling, an interesting approach is presented. This approach is based on the measurements of MOSFET external currents and voltages in a specified switching cell. Different phases are recognized during turn-on and turn-off and related systems of equations are defined to represent the MOSFET behavior. This model needs few parameters, which can be easily determined. Besides, a sensibility study is carried out, in order to determine the model limitations. This study allows furthermore a good understanding of different factors affecting the switching.Le but de ce travail est de présenter une modélisation comportementale d'un MOSFET de puissance en commutation. Après avoir cité les différents travaux effectués dans ce domaine, une approche intéressante du point de vue de l'utilisateur est présentée. Cette approche est basée sur la mesure des grandeurs externes du MOSFET (tensions et courants) dans une cellule de commutation donnée. Diverses phases sont extraites pendant l'ouverture et la fermeture, et les équations électriques relatives à chacune d'entre elles sont données. Le modèle présenté nécessite peu de paramètres ; ceux-ci peuvent de plus être facilement obtenus. Enfin, une étude de sensibilité est menée sur ce modèle, afin de déterminer ses limites de validité. Celle-ci permet en outre une meilleure connaissance des paramètres influant sur la commutation

Cytotoxicity effects of curcumin loaded on chitosan alginate nanospheres on the KMBC-10 spheroids cell line

Purpose: Breast cancer is one of the most lethal types of cancer in women. Curcumin showed therapeutic potential against breast cancer, but applying that by itself does not lead to the associated health benefits due to its poor bioavailability, which appears to be primarily due to poor absorption, rapid metabolism, and rapid elimination. Moreover, poor water solubility of curcumin causes accumulation of a high concentration of curcumin and so decrease its permeability to the cell. Many strategies are employed to reduce curcumin metabolism such as adjuvants and designing novel delivery systems. Therefore, in this study sodium alginate and chitosan were used to synthesize the hydrogels that are known as biocompatible, hydrophilic and low toxic drug delivery systems. Also, folic acid was used to link to chitosan in order to actively targetfolate receptors on the cells. Methods: Chitosan-�-cyclodextrin-TPP-Folic acid/alginate nanoparticles were synthesized and then curcumin was loaded on them. Interaction between the constituents of the particles was characterized by FTIR spectroscopy. Morphological structures of samples were studied by FE-SEM. Release profile of curcumin was determined by dialysis membrane. The cytotoxic test was done on the Kerman male breast cancer (KMBC-10) cell line by using MTT assay. The viability of cells was detected by fluorescent staining. Gene expression was investigated by real- time PCR. Results: The encapsulation of curcumin into nano-particles showed an almost spherical shape and an average particle size of 155 nm. In vitro cytotoxicity investigation was indicated as dose-respond reaction against cancer breast cells after 24 h incubation. On the other hand, in vitro cell uptake study revealed active targeting of CUR-NPs into spheroids. Besides, CXCR4 expression was detected about 30-fold less than curcumin alone. The CUR- NPs inhibited proliferation and increased apoptosis in spheroid human breast cancer cells. Conclusion: Our results showed the potential of NPs as an effective candidate for curcumin delivery to the target tumor spheroids that confirmed the creatable role of folate receptors. © 2021 Afzali et al