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Risks associated with endometrial most cancers throughout individuals along with endometrial hyperplasia: insinuation regarding clinical therapies.
Zealand Clinical Trials Registry ID ACTRN12617000017325 and the Universal Trial Number is U1111-1189-3992. selleck compound © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVES The differential diagnosis of seronegative rheumatoid arthritis (negRA) and psoriasis arthritis (PsA) is often difficult due to the similarity of symptoms and the unavailability of reliable clinical markers. Since chronic inflammation induces major changes in the serum metabolome and lipidome, we tested whether differences in serum metabolites and lipids could aid in improving the differential diagnosis of these diseases. METHODS Sera from negRA and PsA patients with established diagnosis were collected to build a biomarker-discovery cohort and a blinded validation cohort. Samples were analysed by proton nuclear magnetic resonance. Metabolite concentrations were calculated from the spectra and used to select the variables to build a multivariate diagnostic model. RESULTS Univariate analysis demonstrated differences in serological concentrations of amino acids alanine, threonine, leucine, phenylalanine and valine; organic compounds acetate, creatine, lactate and choline; and lipid ratios L3/L1, L5/L1 and L6/L1, but yielded area under the curve (AUC) values lower than 70%, indicating poor specificity and sensitivity. A multivariate diagnostic model that included age, gender, the concentrations of alanine, succinate and creatine phosphate and the lipid ratios L2/L1, L5/L1 and L6/L1 improved the sensitivity and specificity of the diagnosis with an AUC of 84.5%. Using this biomarker model, 71% of patients from a blinded validation cohort were correctly classified. CONCLUSIONS PsA and negRA have distinct serum metabolomic and lipidomic signatures that can be used as biomarkers to discriminate between them. After validation in larger multiethnic cohorts this diagnostic model may become a valuable tool for a definite diagnosis of negRA or PsA patients. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.BACKGROUND AND OBJECTIVES Excessive use of antibiotics has been noted in children with respiratory tract infections in Vietnam, but antibiotic use in hospitalised children is poorly documented. Antibiotic use and direct healthcare costs in children hospitalised with pneumonia in central Vietnam were assessed. METHODS A prospective descriptive study of children under 5 years old admitted with a primary admission diagnosis of 'pneumonia' to the Da Nang Hospital for Women and Children over 1 year. RESULTS Of 2911 children hospitalised with pneumonia, 2735 (94.0%) were classified as 'non-severe' pneumonia by the admitting physician. In total, 2853 (98.0%) children received antibiotics. Intravenous antibiotics were given to 336 (12.3%) children with 'non-severe' and 157/176 (89.2%) children with 'severe' pneumonia; those with 'non-severe' pneumonia accounted for 68.2% (336/493) of intravenous antibiotics given. Only 19.3% (95/493) of children on intravenous antibiotics were stepped down to an oral antibiotic. Cefuroxime was the preferred oral agent, and ceftriaxone was the preferred injectable agent. Hospital admission for oral antibiotics in 'non-severe' pneumonia was a major cost driver, with an average direct cost of US$78.9 per patient, accounting for 54.0% of the total hospitalisation cost in the study cohort. In addition, 336 (12.3%) children with non-severe pneumonia received intravenous antibiotics without indication, accounting for a further 23.2% of hospitalisation costs. CONCLUSION Limiting unnecessary hospitalisation and considering early intravenous to oral step down antibiotic will reduce direct health system costs and morbidity in children with respiratory tract infections in Vietnam. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVE This article summarizes the findings of narrative and systematic literature reviews focused on the relationship between exposure to alcohol marketing and youth drinking, viewed in context of criteria for causality. We also consider the implications of this proposition for alcohol policy and public health. METHOD Our descriptive synthesis of findings is from 11 narrative and systematic reviews using the nine Bradford Hill causality criteria (a) strength of association, (b) consistency, (c) specificity of association, (d) temporality, (e) biological gradient, (f) biological plausibility, (g) coherence, (h) experimental evidence, and (i) analogy. RESULTS Evidence of causality for all nine of the Bradford Hill criteria was found across the review articles commissioned for this supplement and in other previously published reviews. In some reviews, multiple Bradford Hill criteria were met. The reviews document that a substantial amount of empirical research has been conducted in a variety of countries using different but complementary research designs. CONCLUSIONS The research literature available today is consistent with the judgment that the association between alcohol marketing and drinking among young persons is causal.OBJECTIVE This article provides a guide for the behavioral scientist to understand and judge econometric studies of alcohol advertising. METHOD The requirements for causal evidence in an econometric study include an empirical scenario in which alcohol advertising is not affected by alcohol consumption and in which both consumption and advertising are not affected by a common third variable. The articles included in this review were a sampling of older studies to illustrate the problems with these studies and newer studies, not covered by existing reviews, which try to directly address causality. RESULTS The results from many prior studies are suspect by current econometric standards. However, a few newer econometric studies address causality and find a small positive effect of alcohol advertising on consumption. CONCLUSIONS Many prior studies and some newer studies of alcohol advertising in the econometric literature have not addressed causality, and the results from these studies should be considered as descriptive only.
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