Background & aimsTo determine the trends of self-reported non-adherence rates among adults taking Type 2 medicines (T2D) medicines between 2017 and 2019 and to identify the patterns for the frequently reported reasons for non-adherence in the United States.Methods & resultsData from the National Health and Wellness Survey, a self-administered, internet-based cross-sectional survey of US adults from 2017 to 2019 was used. Non-adherence was measured using the self-reported Medication Adherence Reasons Scale (MAR-Scale). Frequencies were used to identify the reasons for non-adherence for insulin and non-insulin therapies for T2D.Data were obtained from 2983 respondents in 2017, 5416 in 2018, and 5268 in 2019. Based on the MAR-Scale, the self-reported medication non-adherence rate was 25% in 2017, 21% in 2018, and 27% in 2019. The most common reason for non-adherence across all the three years was simple forgetfulness, yet patients reported the lowest mean number of days missing medication for that reason. Though less frequently reported, non-adherence lasted longer when patient did not know how to take their medicines, cost was a reason, or had concerns about the long term effects of the medicines.ConclusionsWith no significant improvement in adherence with T2D medicines over time, regardless of better awareness and extensive diabetes education, focus should be on individualized non-adherence reasons-based interventions. 相似文献
BackgroundThe fluctuations within stride time series (i.e., stride time variability and complexity) during running exhibit long-range correlation. Detecting the breakdown of the long-range correlation was proposed for monitoring the occurrence of running-related injuries during running. However, the stride time fluctuations were only measured from the unilateral side. In addition, the reliability of the stride time fluctuations of within-subject repeated measures remains largely unknown, particularly during exhaustive running.PurposesThis study investigated between-side and between-day reliabilities of the stride time variability and complexity of right and left sides during an exhaustive running.MethodsThe stride time variability and complexity of bilateral sides were obtained while 24 healthy participants performed a 31-minute treadmill running at their individual anaerobic threshold speed. Seven of the 24 participants performed the treadmill running test twice at two different days 5–7 days apart. Limits of agreement (LoA) and intraclass correlation coefficient (ICC) were respectively used to assess the absolute and relative between-side and between-day reliabilities.ResultsThe stride time variability and complexity of right and left sides were highly symmetrical (LoA: (-0.500%, 0.459%) and (-0.052, 0.051), respectively; ICC: 0.94 (0.87, 0.97) and 0.98 (0.95, 0.99), respectively). The overall stride time variability and complexity revealed good between-day reliability (LoA: (-1.044%, 0.724%) and (-0.067, 0.115), respectively; ICC: 0.78 (0.45, 0.92) and 0.81 (0.48, 0.93), respectively). However, the segmented stride time complexity showed poor between-day reliability (ICCs<0.40).ConclusionThe findings demonstrated that the stride time series showed equivalent fluctuations between right and left sides and good between-day reliability in fluctuations during exhaustive running. Given the poor between-day reliability in the segmented stride time series, stride time series during exhaustive running could be collected from either right or left side and should be processed as an overall in the future. 相似文献
Cancer-associated fibroblasts (CAFs), major components of the tumor microenvironment (TME), promote tumor growth and metastasis and inhibit the anti-tumor immune response. We previously constructed a DNA vaccine expressing human FAPα, which is highly expressed by CAFs, to target these cells in the TME, and observed limited anti-tumor effects in the 4T1 breast cancer model. When the treatment time was delayed until tumor nodes formed, the anti-tumor effect of the vaccine completely disappeared. In this study, to improve the safety and efficacy, we constructed a new FAPα-targeted vaccine containing only the extracellular domain of human FAPα with a tissue plasminogen activator signal sequence for enhanced antigen secretion and immunogenicity. The number of CAFs was more effectively reduced by CD8+ T cells induced by the new vaccine. This resulted in decreases in CCL2 and CXCL12 expression, leading to a significant decrease in the ratio of myeloid-derived suppressor cells in the TME. Moreover, when mice were treated after the establishment of tumors, the vaccine could still delay tumor growth. To facilitate the future application of the vaccine in clinical trials, we further optimized the gene codons and reduced the homology between the vaccine and the original sequence, which may be convenient for evaluating the vaccine distribution in the human body. These results indicated that the new FAPα-targeted vaccine expressing an optimized secreted human FAPα induced enhanced anti-tumor activity by reducing the number of FAPα+ CAFs and enhancing the recruitment of effector T cells in the 4T1 tumor model mice. 相似文献
Background:Arsenic trioxide (ATO) is widely applied to treat acute promyelocytic leukemia (APL). To elucidate metabolism and toxicity of arsenic, we analyzed time course of arsenic species in red blood cells (RBCs) of APL patients.
Methods:Nine APL patients received ATO (0.16 mg/kg/day) through 18-h infusion. Blood was collected before daily administration (days 2 to 9), and at different time points on day 8. Inorganic arsenic (iAs), monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) were detected by HPLC-ICP-MS.
Results:Arsenic species reached Cmax at 18 h on day 8. Arsenicals gradually accumulated during days 2 to 9, whereas their percentages remained almost constant. The general trend in red blood cells (RBCs) was iAs > MMA > DMA. MMA was consistently the predominant methylated arsenic metabolite in RBCs. iAs, MMA, and tAs (tAs = iAs + DMA + MMA) concentrations (P < 0.0001), MMA/DMA ratios (P = 0.0016) and iAs% (P = 0.0013) were higher in RBCs than in plasma.
Conclusions:Time course of arsenic species reveal kinetic characteristic of ATO metabolites in RBCs. Arsenic species accumulated with administration frequency. Arsenic species in RBCs were remarkably different from those in plasma. Time course of arsenic species in RBCs is important in ATO clinical application. 相似文献
BackgroundPartial hepatectomy has been used to treat patients with resectable hepatocellular carcinoma (HCC) which spontaneously ruptured. It is still controversial as to whether emergency partial hepatectomy (EmPH) should be carried out at the time of rupture, or the patients should initially be managed by operative or non-operative treatment to stop the bleeding, followed by staged early or delayed partial hepatectomy when the patient's condition becomes stable.MethodsConsecutive 10-year patients with ruptured HCC managed at our center were included in this study. Patients who underwent partial hepatectomy were further subdivided into the EmPH group, the staged early partial hepatectomy (SEPH) group, and the staged delayed partial hepatectomy (SDPH) group. Univariate and multivariate analyses of factors affecting overall survival(OS) were conducted before and after propensity score matching analyses amongst the included patients. OS, postoperative mortality, recurrence free survival (RFS), and peritoneal metastatic rates were compared. The risk factors of peritoneal metastases were determined using the COX regression analysis.ResultsThe 130 patients who underwent partial hepatectomy were subdivided into the EmPH group (surgery at the time of rupture, n = 30), the SEPH group (surgery ≤ 8 days of rupture, n = 67), and the SDPH group (surgery > 8 days of rupture, n = 33). The remaining 86 patients underwent non-surgical treatment. Partial hepatectomy was an independent predictor of better OS (HR 2.792, P < 0.001). For resectable HCC, the 30-day mortality, OS, and RFS were similar between the EmPH group, and the staged partial hepatectomy (SPH) group which included the patients who underwent SEPH and SDPH. The SEPH group had significantly better OS and RFS. Multivariate COX regression analysis demonstrated that SDPH was strongly associated with postoperative peritoneal dissemination (OR 28.775, P = 0.003).ConclusionPartial hepatectomy provided significantly better survival than non-surgical treatment for patients who presented with ruptured HCC. Early partial hepatectomy within 8 days of rupture which included EmPH (carefully selected) and SEPH, resulted in significantly less patients with peritoneal dissemination and better long-term survival outcomes (especially RFS) than SDPH. 相似文献
BackgroundThe fractal dynamics of gait variability in people with Parkinson’s disease has been studied by applying the detrended fluctuation analysis (DFA) to short time series (<200 strides). However, DFA is sensitive to time series length, and it is unclear if DFA results from short time series are reliable and if they reflect the fractal dynamics of longer time series.Research questionIs DFA reliable when applied to short time series?MethodsWe applied DFA to stride time series from five 3-min trials and one 15-min trial in 12 people with Parkinson’s disease, 14 healthy older adults and 14 healthy young adults walking overground. Within each group, intraclass correlations (ICC 3,1) were performed to assess the reliability of i) the five 3-min trials together, ii) each 3-min trials to the 15-min trial, and iii) the first 150 strides from the 15-min trial to the full 15-min trial.ResultsOur three main findings are that 1) stride time α-DFA values are not consistent from trial-to-trial for short stride time series, 2) stride time α-DFA values from each 3-min trials are not consistent when compared to stride time α-DFA values from a 15-min trial, and 3) stride time α-DFA values from the first 150 strides of the 15-min trial are not consistent when compared to α-DFA values from the full 15-min trial.SignificanceOur results confirm that α-DFA values from 3-min walking trials are not reliable, and that they do not reflect the scale invariant properties of longer time series. This suggests that previous studies assessing the fractal dynamics of gait variability from about 3-min walking must be interpreted with caution. A major clinical implication is that DFA cannot be used to study gait in people unable to perform 500 strides continuously. 相似文献