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Antonio Loforte Mariafrancesca Fiorentino Gregorio Gliozzi Carlo Mariani Gianluca Folesani Sofia Martin Suarez Antonio Russo Marco Masetti Luciano Potena Davide Pacini 《Transplantation proceedings》2019,51(9):2962-2966
IntroductionPreoperative liver and renal dysfunction remain surgical risk factors for both postoperative morbidity and mortality. The Model of End-Stage Liver Disease Excluding INR (international normalized ratio), or MELD-XI, score calculation may help as a predictor in patients with advanced heart failure. We analyzed the impact of progressive elevated MELD-XI values among recipients of heart transplant at our institution.MethodsThe data of a total of 425 consecutive adult patients who underwent heart transplantation, between January 2000 and August 2018, have been reviewed and divided into 3 cohorts according to preoperative MELD-XI calculations (MELD-XI < 11; MELD-XI 11-18; and MELD-XI > 18). Early and late outcomes have been analyzed.ResultsPatients with a MELD-XI score > 18 had a more critical clinical condition preoperatively and had a higher risk of early mortality (hazard ratio [HR] 1.45 [1.11-1.67], P < .001). They showed high risk for postoperative dialysis (HR 2.8 [1.5-5.3], P < .001), rethoracothomy for bleeding (HR 2.1 [1.2-4.1], P = .001), prolonged time of mechanical ventilation, time of intensive care unit stay (HR 2.2 [1.3-3.8], P = .005), and graft failure requiring mechanical circulatory support (HR 1.9 [1.1-3.3], P = .003). After risk adjustment per MELD-XI cohort, ischemic dilated cardiomyopathy, redo operation, and cold ischemic time > 240 minutes resulted in being the strongest predictors of early mortality (P < .001). The 5-year and 10-year survival for MELD-XI > 18 cohort was 63% and 47% vs 72% and 59% in the control group (MELD-XI < 18) (log-rank, P < .001).ConclusionsPatients with an elevated preoperative MELD-XI profile presented more comorbidities and significantly lower survival. This suggests the MELD-XI score may provide further insight into appropriate recipient and eventual donor selection. Renal insufficiency and congestive hepatopathy should be properly optimized before heart transplantation. 相似文献
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Waseem Lutfi Matthew J. Schuchert Rajeev Dhupar Chigozirim Ekeke Inderpal S. Sarkaria Neil A. Christie James D. Luketich Olugbenga T. Okusanya 《Clinical lung cancer》2019,20(4):e463-e469
BackgroundSegmentectomy for well-selected early stage non–small-cell lung carcinoma (NSCLC) has been shown to have similar oncologic outcomes and survival to lobectomy. However, these data are based on the presumption that the disease is node negative. Few data exist regarding the risk factors for and the outcomes of patients with disease treated with segmentectomy that is found to be node positive. We sought to determine the risk factors for and outcomes of clinical stage I NSCLC patients who are treated with segmentectomy but are determined to be node positive.Patients and MethodsWe queried patients with clinical stage I NSCLC ≤ 3 cm within the National Cancer Data Base between 2004 and 2014 who were treated with segmentectomy or lobectomy and found to have positive nodes. Kaplan-Meier curves with log-rank tests were used to compare overall survival (OS) between segmentectomy and lobectomy. For comparison only, segmentectomy patients with pathologically node-negative disease were identified to determine predictors of node positivity after segmentectomy via multivariable logistic regression.ResultsA total of 4556 patients with node-positive disease were identified, comprising 115 segmentectomy patients and 4441 lobectomy patients. Multivariable analysis identified increasing tumor size, squamous-cell histology, and increasing number lymph nodes sampled as significant predictors of node positivity after segmentectomy. There was no difference in OS between segmentectomy and lobectomy, with 3-year OS rates of 66.3% and 68.1%, respectively (P = .723).ConclusionThere are discrete risk factors for discovering positive nodes after segmentectomy. Segmentectomy is associated with similar OS compared to lobectomy for clinical stage I NSCLC found to be node positive. 相似文献
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Background
China has witnessed a fast-developing social system in the past decades; meanwhile, its medical education and health-care system still face many challenges. A growing number of exchange programmes are being established to promote mutual awareness of medical education and health-care systems. The cardiovascular visiting programme between Peking University and University of Minnesota was established in 2013. The aim of this study was to investigate participating Chinese students' opinion about differences in medical education and health care between China and the USA.Methods
We interviewed Chinese visiting medical students about the difference in health education and medical system between China and the USA before and after their visit to the USA. The questionnaire was based on three parts: the major difference in medical education; the strongest differences in residency training; and major challenges of medical status in China.Findings
We interviewed 17 Chinese medical students. When comparing various aspects of the Chinese and American health education and medical systems, most students (91%) thought that China's medical education system placed highest value on textbook learning, and all students (100%) believed self-learning to be most important in the USA. Many students (76%) also believed that clinical skill training drew more attention in the USA than in China. Compared with Chinese hospitals, most participants responded that American hospitals obtained the more advanced clinical equipment (76%) and paid more attention to evidence-based treatment (100%), disease prevention (94%), and the importance of a national informationised system (65%). Among the challenges China is facing, amendment of the national medical referral system, improvement in doctor income and freelance policy, and strengthened clinical skills and operations training during fellowships were considered more important and urgent than in the USA.Interpretation
We found various differences between China and the USA with respect to medical education, hospital management, medical insurance, and communication between the patients and doctors. China still faces challenges and gaps in its health education and hospital management system as compared to the USA. As a result, mutual exchange programmes for medical students between China and the USA are beneficial and a crucial way to achieve a global and prosperous medical development in the future. The biggest limitations of this observational study were its small sample size and that it included Chinese students only. More medical students from both China and the USA might be interviewed in the future so as to further explore the difference in the medical education system.Funding
None. 相似文献109.
[目的]探讨观察阶段性教育法在心胸外科学生预防感染知识掌握中的效果。[方法]选取2009年7月~2010年6月于某院心胸外科进行实习的100名临床医学专业学生为研究对象,将其随机分为对照组(常规带教法组)50名和观察组(阶段性教育法组)50名,后将两组学生带教前后的理论知识评分、操作评分、老师对学生平时感染预防意识的评估及学生自我感觉感染预防意识评估进行统计及比较。[结果]经比较,带教后观察组的理论知识评分、操作知识评分均高于对照组,老师对学生平时感染预防意识的评分及学生自我感觉感染预防意识评分显著高于对照组,P﹤0.05或P﹤0.01,有显著性差异或有非常显著性差异。[结论]阶段性教育法在加强心胸外科学生预防感染知识掌握中效果较好,值得推广应用。 相似文献
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Hyun Woo Goo Suvipaporn Siripornpitak Shyh-Jye Chen Oktavia Lilyasari Yu-Min Zhong Haifa Abdul Latiff Eriko Maeda Young Jin Kim I-Chen Tsai Dong Man Seo 《Korean journal of radiology》2021,22(8):1397
The use of pediatric cardiothoracic CT for congenital heart disease (CHD) was traditionally limited to the morphologic evaluation of the extracardiac thoracic vessels, lungs, and airways. Currently, the applications of CT have increased, owing to technological advancements in hardware and software as well as several dose-reduction measures. In the previously published part 1 of the guideline by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group, we reviewed the prerequisite technical knowledge for clinical applications in a user-friendly and vendor-specific manner. Herein, we present the second part of our guideline on contemporary clinical applications of pediatric cardiothoracic CT for CHD based on the consensus of experts from the Asian Society of Cardiovascular Imaging CHD Study Group. This guideline describes up-to-date clinical applications effectively in a systematic fashion. 相似文献