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In 2010, the Affordable Care Act (ACA) was enacted, with full provisions in effect by 2014, including expanded Medicaid coverage, changes to the marketplace, and contraceptive coverage, but its impact on birth trends, particularly adolescent births, is currently unknown.
We sought to determine whether ACA implementation was associated with changes in adolescent births and whether this differed by insurance type (Medicaid or private insurance).
We used revised 2009-2017 birth certificate data, restricted to resident women with a Medicaid or privately paid singleton birth (N=27,748,028). Segmented regression analysis was used to examine births to adolescent mothers (12-19 years old) before and after the ACA.
There were 27,748,028 singleton births (n=2,013,521 adolescent births) among U.S. residents between 2009 and 2017 in this analytic sample. Adjusted models revealed that the ACA was associated with a 23% significant decrease in odds of an adolescent birth (OR=0.78; 95% CI, 0.77-0.79) for Medicaid-funal, infant, and family health in the United States.
To evaluate the use of intrauterine devices (IUDs) in two young women's hematology clinics and compare adverse events in adolescents with and without inherited bleeding disorders (BDs) DESIGN Retrospective multicenter cohort study from February 2014 through February 2020 SETTING Young women's hematology clinics at Nationwide Children's Hospital in Columbus, Ohio, and Children's Medical Center in Dallas, Texas PARTICIPANTS Female patients evaluated for heavy menstrual bleeding (HMB) who underwent IUD placement INTERVENTIONS AND MAIN OUTCOME MEASURES Rates of IUD expulsion, malposition, and ongoing HMB requiring additional medical treatment RESULTS We identified 43 patients with BDs and 35 patients without BDs who underwent placement of an IUD for HMB. The mean age was 14.9 years (range 11.0-21.4 years) at the time of presentation and 15.8 years (range 11.0-21.4 years) at IUD placement. Those with BDs were younger at the time of IUD insertion. Most patients (90%) had previously failed other methods to control HMB. The annual rate of IUD adverse events was 0.25 per year of use, and all adverse events occurred in the first 20 months after placement. There were no significant differences in adverse IUD events in patients with and without BDs, although those without BDs requested IUD removal more frequently.
In this cohort of adolescent females, the presence of a BD was not associated with a higher IUD expulsion rate. IUD placement should be considered a first-line option for adolescents with BDs who experience HMB.
In this cohort of adolescent females, the presence of a BD was not associated with a higher IUD expulsion rate. IUD placement should be considered a first-line option for adolescents with BDs who experience HMB.
The diagnosis and treatment of vulvovaginitis in children is poorly managed because it is difficult to determine whether the agent causing vulvovaginal inflammation is a single bacterial species.
This study retrospectively evaluated genital microbiological findings in prepubescent girls with vulvovaginitis and then compared the findings to healthy controls without discharge.
This was a retrospective case-control study of 483 prepubescent girls aged 2-10 years with vulvovaginitis and 50 age-matched healthy asymptomatic controls. Data were collected at the Pediatric General Outpatient Unit of the Hospital of the Bezmialem Vakıf University from December 2015 to March 2021.
Of the 483 positive vaginal cultures in the study group, 248 (51.3%) exhibited potential causative agents. Conversely, 8 of 50 (16%) of the vaginal cultures in the control group (P < .001) exhibited potential causative agents. Streptococcus pyogenes was the most frequently detected causative agent of vulvovaginitis in the study group. S. pyogenes was present in specimens from 74 girls (15.8%) with symptoms of vulvovaginitis vs 1 (4.1%) specimen in the control group. Other specific organisms identified in the study group were Escherichia coli (12%), Haemophilus influenzae (5%), Staphylococcus aureus (4.3%), Candida albicans (4.3%), and Streptococcus agalactia (3.3%).
Among prepubescent girls with vulvovaginitis, 51.3% of vaginal cultures exhibited potential causative agents in the study group. Our microbiological data indicated that the most common pathogens were S. pyogenes and E. coli.
Among prepubescent girls with vulvovaginitis, 51.3% of vaginal cultures exhibited potential causative agents in the study group. Our microbiological data indicated that the most common pathogens were S. pyogenes and E. coli.
Intrauterine devices (IUDs) are contraindicated in patients with known uterine anomalies, eliminating an extremely effective contraceptive option. However, data regarding contraceptive desires in these patients are limited to a few case reports.
A 20-year-old nulligravida with a uterus didelphys desired contraception after oral contraceptive pills and an etonogestrel implant failed. Despite extensive counseling, including Centers for Disease Control and Prevention guidelines regarding contraindications for IUD placement in the setting of a uterine anomaly, she desired to proceed with placement of 2 IUDs. Two 13.5-mg levonorgestrel IUDs were successfully placed into each uterine horn.
In select patients with uterine anomalies, IUD placement can be a safe and effective option. This is especially important in adolescents who might be at increased risk for unintended pregnancy and poor obstetric outcomes.
In select patients with uterine anomalies, IUD placement can be a safe and effective option. This is especially important in adolescents who might be at increased risk for unintended pregnancy and poor obstetric outcomes.
Diaper (irritative) dermatitis is commonly encountered in pediatric practice. In severe cases, unusual lesions could mimic other vulvar dermatoses or sexually transmitted infections.
A 4-year-old female refugee with urinary and fecal incontinence was referred for medicolegal evaluation (concern for childhood sexual abuse) due to presence of diffuse vulvar, perineal, and perianal lesions. Evaluation and histology were consistent with pseudoverrucous papules and nodules. Resolution occurred following frequent diaper changes and application of a protective ointment.
Pseudoverrucous papules and nodules are a rare complication of irritative diaper dermatitis with variable appearance. Urinary or fecal incontinence are primary risk factors that should raise suspicion among clinicians when atypical genital or buttocks lesions appear. Biopsy is not always necessary but could be warranted when the diagnosis is uncertain or if childhood sexual abuse is suspected.
Pseudoverrucous papules and nodules are a rare complication of irritative diaper dermatitis with variable appearance. Urinary or fecal incontinence are primary risk factors that should raise suspicion among clinicians when atypical genital or buttocks lesions appear. Biopsy is not always necessary but could be warranted when the diagnosis is uncertain or if childhood sexual abuse is suspected.A growing body of multiscale biomechanical studies has been proposed to highlight the mechanical cues in the development of hepatic fibrosis and cancer. At the cellular level, changes in mechanical microenvironment induce phenotypic and functional alterations of hepatic cells, initiating a positive feedback loop that promotes liver fibrogenesis and hepatocarcinogenesis. Tumor mechanical microenvironment of hepatocellular carcinoma facilitates tumor cell growth and metastasis, and hinders the drug delivery and immunotherapy. At the molecular level, mechanical forces are sensed and transmitted into hepatic cells via allosteric activation of mechanoreceptors on the cell membrane, leading to the activation of various mechanotransduction pathways including integrin and YAP signaling and then regulating cell function. Thus, the application of mechanomedicine concept in the treatment of liver diseases is promising for rational design and cell-specific delivery of therapeutic drugs. This review mainly discusses the correlation between biomechanical cues and liver diseases from the viewpoint of mechanobiology.The therapeutic limitations such as insufficient efficacy, drug resistance, metastasis, and undesirable side effects are frequently caused by the long duration monotherapy based on chemotherapeutic drugs. multiple combinational anticancer strategies such as nucleic acids combined with chemotherapeutic agents, chemotherapeutic combinations, chemotherapy and tumor immunotherapy combinations have been embraced, holding great promise to counter these limitations, while still taking including some potential risks. Nowadays, an increasing number of research has manifested the anticancer effects of phytochemicals mediated by modulating cancer cellular events directly as well as the tumor microenvironment. Specifically, these natural compounds exhibited suppression of cancer cell proliferation, apoptosis, migration and invasion of cancer cells, P-glycoprotein inhibition, decreasing vascularization and activation of tumor immunosuppression. Due to the low toxicity and multiple modulation pathways of these phytochemicaconcept, and action mechanisms of nanosystems with co-delivery of drugs to synergistically improve anticancer efficacy. In addition, the challenges and prospects of how these insights can be translated into clinical benefits are discussed.Timely and accurate assessment and diagnosis are extremely important and beneficial for all diseases, especially for some of the major human disease, such as cancers, cardiovascular diseases, infectious diseases, and neurodegenerative diseases. CPI-0610 datasheet Limited by the variable disease microenvironment, early imperceptible symptoms, complex immune system interactions, and delayed clinical phenotypes, disease diagnosis and treatment are difficult in most cases. Molecular imaging (MI) techniques can track therapeutic drugs and disease sites in vivo and in vitro in a non-invasive, real-time and visible strategies. Comprehensive visual imaging and quantitative analysis based on different levels can help to clarify the disease process, pathogenesis, drug pharmacokinetics, and further evaluate the therapeutic effects. This review summarizes the application of different MI techniques in the diagnosis and treatment of these major human diseases. It is hoped to shed a light on the development of related technologies and fields.
Our study aimed to elucidate the role of metabolites, bacteria, and fungi in rheumatoid arthritis (RA) patients with bone destruction (BD(+)) and identify some biomarkers to predicate bone progression of RA.
Plasma metabolites of the 127 RA patients and 69 healthy controls were conducted by using nontargeted liquid chromatography-mass spectrometry (LC-MS). The gut bacteria and fungi were assessed by 16S rRNA and internal transcribed spacer (ITS).
Compared with RA patients without bone destruction (BD(-)), some metabolites, bacteria, and fungi were altered in BD(+). Seven metabolites were selected as key metabolites for classifying the BD(+) and BD(-) groups with moderate accuracy (AUC=0.71). Metabolites-groups, metabolites-metabolites, and metabolites-clinical factors had a certain correlation, and 7 metabolites were enriched in glycerophospholipid metabolism and L-arginine and proline metabolism pathways. The bacteria and fungi of the BD(+) group showed significant differences in composition and function compared with BD(-) group.
