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Background & aims Beyond the quantity of carbohydrate intake, further research is needed on the relevance of carbohydrate quality. Thus, we evaluated the association between an a priori defined carbohydrate quality index (CQI) and the incidence of breast cancer (BC) in a Mediterranean cohort study. Methods We used a validated semi-quantitative 136-item food-frequency questionnaire (FFQ) in a prospective follow-up study of 10,812 middle-aged women. ASP5878 research buy We evaluated at baseline the CQI following 4 criteria dietary fiber intake, glycemic index, whole-graintotal-grain carbohydrates ratio and the solid carbohydratetotal carbohydrate ratio. Subjects were classified into quartiles according to the final CQI score. Results During a median follow-up of 11.8 years, we confirmed 101 incident cases of BC. Our study suggests that a higher quality of carbohydrate intake, as measured by the baseline CQI, was associated with a lower risk of BC [HR Q4 vs. Q1 0.39 (95% CI 0.17, 0.87)]. Particularly, a higher whole-graintotal-grain carbohydrates ratio was associated with lower risk of BC [HR T3 vs. T1 0.56 (0.34, 0.90)]. When we stratified by menopausal status, we found an inverse association between CQI and BC in the comparison of extreme quartiles among premenopausal women. Conclusions In this Mediterranean cohort, a better quality of dietary carbohydrate intake showed a significant inverse association with the incidence of BC, which suggests that strategies for cancer prevention should highlight the quality of this macronutrient.Background Basal Cell Carcinoma is the most common tumour and yet much remains to be determined regarding the molecular mechanisms that leads to its development. Hedgehog signal activation is sufficient for BCC induction, but the molecular mediators of BCC growth are not well understood. SoxF transcription factor Sox18 has been identified in human BCC, but its role in growth of the tumour is as yet unknown. Objective To determine if Sox18 is involved in the regulation of Basal Cell Carcinoma growth. Methods We analysed the function of Sox18 by combining a dominant negative Sox18 mouse model, Sox18+/OP with murine BCC RESULTS We determine that Sox18 is ectopically expressed in the epidermal cells of a murine model of Basal Cell Carcinoma. We then show that dominant negative mutation of Sox18 increases the severity of murine Basal Cell Carcinoma. Finally, decreased Hey1 in Sox18+/OP BCC suggests Sox18 may negatively regulate BCC progression via Notch signaling. Conclusions These data suggest that Sox18 is a hedgehog regulated mediator of tumour suppression within Basal Cell Carcinoma epidermis.Background Several studies have shown that the removal of total knee arthroplasty (TKA) from the Centers for Medicare and Medicaid Services (CMS) inpatient-only (IPO) list has caused confusion among surgeons, hospitals, and patients. The purpose of this study is to determine whether similar confusion was present after CMS recently removed total hip arthroplasty (THA) from the IPO list. Methods We surveyed the American Association of Hip and Knee Surgeons membership via an online web-based questionnaire in February 2020. The 12-question form asked about practice type and the impact that having both THA and TKA removed from the IPO list has had on each surgeon's practice. Responses were tabulated and descriptive statistics of each question reported. Results Of the 2847 American Association of Hip and Knee Surgeons members surveyed, 419 responded (14.7% response rate). Three hundred forty-one surgeons (81%) stated that changes to IPO status have increased their practice's administrative burden. Fifty-four percent of surgeons reported that they have needed to obtain preauthorization or appeal a denial of preauthorization for an inpatient total joint arthroplasty at least monthly, while 257 surgeons (61%) have had patients contact their office regarding an unexpected copayment. Despite the commitment of CMS to waiving certain audits for 2 years, 43 respondents (10%) stated they had undergone an audit regarding a patient's inpatient status. Conclusion The removal of THA and TKA from the IPO list continues to be an administrative burden for arthroplasty surgeons and a source of confusion among patients. CMS should provide additional guidance to address surgeons' concerns about preauthorization for inpatient stays, unexpected patient copayments, and CMS audits.Introduction Laryngology is an expanding field with incorporation in resident training nationwide. However, the breadth of training in laryngology reported by residents has not been previously evaluated. This project assesses the variability in laryngology training among otolaryngology residents. Methods A cross sectional, multi-institutional study was performed with an anonymous survey sent to residents and laryngology fellows nationally to assess different laryngology training practices. Results There were 151 responses to the survey with 9.6% response rate. 49 (32.9%) did not have a designated laryngology rotation. 134 (89.3%) had a fellowship-trained laryngologist as part of their institution. The greatest percentage of respondents intended to pursue general ENT (31; 20.7%). PGY5 responses were analyzed for total residency exposure showing, 66.7% of PGY5s received training to identify different types of dysphonic voices through auditory findings alone. 61.9% could interpret a videoflouroscopic swallow study. Regarding surgical cases, 52.4% had been involved in open cricopharyngeal myotomies, 76.2% in endoscopic cricopharyngeal myotomies, and 100% in subglottic stenosis cases. Residents pursuing a career in laryngology and those with a designated laryngology rotation had more exposure to laryngeal surgeries and office-based procedures than their peers. Conclusion Laryngology training and exposure varies across the country. Residents are more familiar with airway than voice and swallowing related pathology. Residents with a designated laryngology rotation and those pursing laryngology fellowships were more likely to have exposure to laryngeal surgery and office-based procedures. Programs with a laryngologist likely had higher response rates so the true laryngology exposure may be more limited than our data suggests.The pandemic of coronavirus SARS-CoV-2 disease affected Northern Italy, spreading from the Bergamo province to the entire country. During reorganization of our emergency department to support patients presenting with coronavirus SARS-CoV-2 disease, we aimed to evaluate whether children play a role in intrahospital spread of the infection.Objective To evaluate the impact of a primary care-based, parent-directed intervention on changes in parent-teen communication, parental beliefs about adolescents, parent and adolescent well-being, adolescent distress, and adolescent positive affect from baseline to 2-month follow-up. Study design In this randomized controlled trial, 120 adolescents (13-15 years of age) scheduled for well visits and their parents were randomized to the strength intervention or control group. The intervention included a booklet highlighting 3 key messages about adolescence, instructions to have a discussion with their teen about each other's strengths, and clinician endorsement. Outcomes were assessed before the well visit and 2 months later. Results Adolescents were 61% female and 65% black. Parents were primarily female (97%); 72% had a 4-year degree or higher. The intervention had a positive impact on adolescent-reported open communication among adolescents with baseline low open communication scores (B = 3.55; P = .005; 95% CI, 1.07-6.03). Adolescents in the intervention group reported a decrease in distress (-1.54 vs 3.78; P = .05; partial eta squared [η2] = 0.038) and increase in positive affect (1.30 vs -3.64; P = .05; η2 = 0.04) compared with control group adolescents. The intervention did not affect parent-reported communication, parental beliefs, or adolescent well-being. Control parents demonstrated a marginal increase in well-being, whereas intervention parents did not (0.82 vs -0.18; P = .07; η2 = 0.029). Conclusions This study highlights the potential impact of primary care-based, universal, low-intensity interventions targeting parents of adolescents on parent-teen communication and important adolescent health outcomes. Trial registration Clinicaltrials.gov NCT03496155.Introduction Summaries of product characteristics (SmPC) of same-substance medications may feature content-related differences. This may cause difficulties regarding informed consent in the case of prescriptions of drugs in the context of the aut-idem regulation. A survey among family doctors (FD) and pharmacists (PH) was conducted in order to evaluate the usage behaviour of SmPCs, sources used to obtain information about drugs and the awareness of the existence of differences between SmPCs of same-substance medications. Methods An exploratory/non-representative, questionnaire- and telephone-based, semi-structured cross-sectional survey was performed (June to August 2018). Results Participation rate of FD and PH was 29.8 % (34/114) and 73.0 % (73/100), respectively. In the previous month, all PH and 82.4 % of FD said that they had used a SmPC at least once (p=0.001). FD used SmPCs 6.4±4.9 and PH 65.0±52.5 times a month (p less then 0.001). In both occupational groups SmPCs were used most frequently to obtain ts, particularly in cases of aut-idem prescriptions of substances for which many same-substance medications with different SmPCs are available. Conclusion Physicians should use SmPCs regularly and keep themselves informed about differences between SmPCs of same-substance medications.Robot-assisted cardiovascular surgery is used to avoid surgeon suffering from X-ray radiation and relieve fatigue caused by long-time standing wearing protective clothing. Its remote surgery can alleviate the lack of experienced doctors in remote areas. Due to the existence of time-delay phenomena, flexible deformation and nonlinearity of interventional instruments, it is difficult to ensure system transparency. This paper analyzes the evaluation index of system transparency. A generalized predictive control (GPC) is developed to suppress the effect of time-varying delay and parameter identification error. Moreover, a terminal sliding mode controller (SMC) is designed to improve the robustness of the system under consideration. Simulation results are provided to show that the proposed control strategy can improve transparency of the remote vascular interventional surgery system.The control performance can be worsened by actuator rate limit, which can result in amplitude attenuation and phase delay in process control. In some extreme situations, actuator rate limit may bring about the system non-convergence. This paper focuses on the control difficulties and solutions of first-order plus time-delay (FOPTD) systems caused by rate limit. The influence of rate limit on stability regions of proportional-integral (PI) controller is analysed. Results show that a small rate limit value can reduce stability regions of PI parameters greatly. The negative correlation between the integral gain and the onset frequency, and the positive correlation between the proportional gain and the onset frequency are conducted. Moreover, the control performance of different PI tuning rules such as Skogestad internal model control, integral gain maximization, delay robustness-constrained optimization and Tyreus-Luyben tuning rules is evidently affected by rate limit. Simulation and experiment results verify that the PI controller tuned by Skogestad internal model control (SIMC) method is less sensitive to the rate limit variation and is more suitable for processes (the normalized dead-time is from 0.
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