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51.
《Respiratory investigation》2019,57(3):207-212
BackgroundWhile advanced age has been suggested as a prognostic factor in patients with tuberculosis, the characteristics associated with a poor outcome in elderly patients have remained unclear. The aim of this systematic review was to describe the risk factors for a poor outcome in elderly patients with tuberculosis.MethodsWe identified 1255 studies published between 1919 and 2017 from the PubMed database by using combinations of the keywords “tuberculosis [Title/Abstract]” and “elderly [Title/Abstract]”. Full texts of the studies that met the inclusion criteria were further evaluated by two independent investigators.Resultseven retrospective cohort studies were included in this systematic review. More advanced age, comorbidities, and nutritional status were likely to be prognostic factors in Taiwan (aging country) and Japan (super-aged country), while human immunodeficiency virus infection and severe tuberculosis were associated with a poor outcome in low-income countries. Two studies from Taiwan investigated the prognostic factors of tuberculosis-specific death and non-tuberculosis-specific death separately, but no significant differences were found in the factors between the two types of death.ConclusionsThe prognostic factors of tuberculosis in elderly patients varied according to the income levels of the countries. The factors in Taiwan and Japan were mainly associated with host factors, irrespective of the cause of death, which may reflect senile deterioration due to old age. 相似文献
52.
《Anales de pediatría (Barcelona, Spain : 2003)》2014,80(6):398.e1-398.e5
The current literature increasingly associates the presence of symptoms of ADHD in both physical and psychological and sexual child abuse. This implies the need for greater accuracy in the differential diagnosis, as until a few years ago, post-traumatic stress disorder was considered the reference symptoms for this type of case. Thus, it is necessary to define and conceptualize an increasingly broad and detailed world of sequels and consequences, where ADHD may be related to the psychological damage suffered by child abuse. Furthermore, the particular vulnerability of children with ADHD can, in turn, become a factor of risk that needs to be considered by the professionals who care for this type of patient. 相似文献
53.
Vincent Gaudiani G. Michael Deeb Jeffrey J. Popma David H. Adams Thomas G. Gleason John V. Conte George L. Zorn James B. Hermiller Stan Chetcuti Mubashir Mumtaz Steven J. Yakubov Neal S. Kleiman Jian Huang Michael J. Reardon 《The Journal of thoracic and cardiovascular surgery》2017,153(6):1293-1301.e1
Objective
Explore causes and timing of death from the CoreValve US Pivotal High-Risk Trial.Methods
An independent clinical events committee adjudicated causes of death, followed by post hoc hierarchical classification. Baseline characteristics, early outcomes, and causes of death were evaluated for 3 time periods (selected based on threshold of surgical 30-day mortality and on the differences in the continuous hazard between the 2 groups): early (0-30 days), recovery (31-120 days), and late (121-365 days).Results
Differences in the rate of death were evident only during the recovery period (31-120 days), whereas 15 patients undergoing transcatheter aortic valve replacement (TAVR) (4.0%) and 27 surgical aortic valve replacement (SAVR) patients (7.9%) died (P = .025). This mortality difference was largely driven by higher rates of technical failure, surgical complications, and lack of recovery following surgery. From 0 to 30 days, the causes of death were more technical failures in the TAVR group and lack of recovery in the SAVR group. Mortality in the late period (121-365 days) in both arms was most commonly ascribed to other circumstances, comprising death from medical complications from comorbid disease.Conclusions
Mortality at 1 year in the CoreValve US Pivotal High-Risk Trial favored TAVR over SAVR. The major contributor was that more SAVR patients died during the recovery period (31-121 days), likely affected by the overall influence of physical stress associated with surgery. Similar rates of technical failure and complications were observed between the 2 groups. This suggests that early TAVR results can improve with technical refinements and that high-risk surgical patients will benefit from reducing complications. 相似文献54.
XU Tian WANG Wei ZHAI Lin ZHANG Yun Feng ZHOU Hong Zhi WU Xin Min LI Ai Hong XIE Li Li NING Xiao Jin JI Yu Teng WANG Hong Mei KE Kai Fu 《Biomedical and environmental sciences : BES》2017,30(3)
Objective We aim to explore the potential association between serum gamma-glutamyl transferase levels and functional outcome after aneurysmal subarachnoid hemorrhage in a Chinese population. Methods A total of 386 aneurysmal subarachnoid hemorrhage patients were included in the study from September 2007 to February 2015. Baseline serum gamma-glutamyl transferase levels and 6-month follow-up functional outcomes were determined. A poor outcome was defined as a modified ranking scale score of ≥ 3. The multivariable logistic model was used to analyze the relationship between serum gamma-glutamyl transferase and clinical outcomes after aneurysmal subarachnoid hemorrhage. Results The adjusted poor outcome rates of patients with gamma-glutamyl transferase levels of 30 U/L, 30-50 U/L and ≥ 50 U/L were 16.7%, 19.6%, and 34.4%, respectively(P 0.01). The age-sex and multivariable adjusted odds ratios(95% confidence intervals) of poor prognosis comparing the top group(≥ 50 U/L) with the lowest group( 30 U/L) were 5.76(2.74-12.13), 6.64(2.05-21.52), and 6.36(1.92-21.02). A significant linear trend existed between gamma-glutamyl transferase level and aneurysmal subarachnoid hemorrhage prognosis. This association was also observed among nondrinkers. Conclusion Patients with higher gamma-glutamyl transferase levels were more likely to have a poor prognosis. Serum gamma-glutamyl transferase can be considered to be an independent predictor of functional outcomes after aneurysmal subarachnoid hemorrhage. 相似文献
55.
Gong Long Zhiyuan Fang Tang Xiangsheng Yang Feng Ma Haoning Hao Qingying Yi Ping Tan Mingsheng 《Orthopaedic Surgery》2021,13(8):2255
ObjectiveTo determine the asymmetry in the paraspinal muscle before pregnancy and evaluate its association with pregnancy‐associated lumbopelvic pain (LPP).MethodsThis was a prospective case–control study conducted from January 2017 and December 2018. A total of 171 subjects (mean age ± SD, 27.4 ± 5.8 years) were finally divided into the LBP group, PGP group, and no LPP group. Each subject was asked to follow a standardized clinical imaging protocol before the pregnancy. The area of muscles (multifidus, erector spinae, and psoas muscles) on the axial slice at mid‐disc of L4–L5 and L5–S1 were segmented and then the cross‐sectional area (CSA) of a particular muscle was measured by outlining the innermost fascial border surrounding each muscle. The mean value of F‐CSA''s ratio to T‐CSA (F/T CSA) was used to determine whether the bilateral paraspinal muscle was asymmetrical. Total muscle CSA (T‐CSA) represents the sum of CSA of interested three muscles. The signal intensity can distinguish fat and muscle tissue in a different range. Based on this, functional CSA (F‐CSA), represented by fat‐free area, was evaluated quantitively by excluding the signal of the deposits of intramuscular fat. Total muscle CSA (T‐CSA), functional CSA (F‐CSA), and the ratio of F‐CSA to T‐CSA (F/T CSA) were measured unilaterally and compared between groups. Logistic regression was performed to determine the risk factors for pregnancy‐associated LPP. The Pearson correlation coefficient was performed to test the relationship between asymmetry in F/T‐CSA and pain rating.ResultsA total of 124 subjects (72.5%) (28.5 ± 5.2 years) had LPP during pregnancy. Forty‐eight (38.7%) individuals had low back pain (LBP) and 76 (61.3%) had pelvic girdle pain (PGP). Seventy‐six women (44.4%) were determined to have asymmetry in paraspinal muscle according to the definition in this methods section. The duration of follow‐up was 24 months postpartum. A total of 39 (31.5%) women unrecovered from LPP. F/T‐CSA was significantly decreased for LBP in the PGP group than in the and control group (0.03 ± 0.02 vs 0.05 ± 0.03 vs 0.12 ± 0.05, P < 0.001). Meanwhile, significant differences were detected in both groups (all P < 0.001). In patients with LBP, the level of paraspinal asymmetry, represented by the difference in F/T‐CSA, was positively correlated with pain scores (r = 0.52, P < 0.01). However, no statistically significant correlation between pain scores and paraspinal asymmetry was found in PGP (r = 0.42, P > 0.05). Asymmetry in the paraspinal muscle (adjusted OR = 1.5), LBP (adjusted OR = 1.6), LPP in a previous pregnancy (adjusted OR = 1.4), sick leave ≥90 days (adjusted OR = 1.2), and heavy labor (adjusted OR = 1.2) were risk factors for the unrecovered LPP during pregnancy.ConclusionsAsymmetrical muscular compositions could lead to abnormal biomechanics for the segmental motions. Lateral‐directed physical training and stretching may help decrease the occurrence and severity of this condition. 相似文献
56.
Wei-Ting Liao Huey-Ling You Chee-Yin Chai Chih-Hung Lee Cheng-Che E. Lan Shun-Jen Chang Chu-Ling Yu Hsin-Su Yu 《Journal of dermatological science》2018,89(2):191-197
Background
Patients with arsenic-induced Bowen’s disease (As-BD) are at risk of developing invasive cancers in the skin, lung, and urinary bladder. However, a longitudinal follow-up study on the association between As-BD and invasive cancers is still lacking.Objectives
This study aims to investigate the underlying molecular mechanisms of this malignant progression in the skin and internal organs.Methods
This is a biopsy-based follow-up study. We tested the DNA histograms, Cyclin D1 (CCND1) protein expression and CCND1 promoter DNA methylation in 40 pathologically confirmed specimens from As-BD patients to correlate with individual’s invasive cancer occurrence in the 5-year follow-up.Results
Flow cytometric DNA histogram analysis of skin specimens showed aneuploid (n = 15), G2/M arrest (n = 22), and normal (n = 3) DNA histograms. No patients with normal DNA histograms developed invasive cancers, whereas 13 developed invasive cancers in the aneuploid group and 2 developed invasive cancers in the G2/M arrest group. The aneuploid group showed a high risk of invasive cancer development. In all assessed aneuploid specimens, the CCND1 promoter hypomethylation was observed. Statistically, percentage of un-methylation more than 55.85% among 17 detected CpG sites showed extremely high predictive power in the occurrence of invasive arsenical cancers. Furthermore, the un-methylation at -56 and -54 bp CpG sites was statistically significantly associated with invasive arsenical cancer development (p = 1.29 × 10?5).Conclusions
As-BD lesions showing an aneuploid DNA histogram had a high risk of invasive cancer development. Un-methyaltion at -56 and -54 bp CpG in the CCND1 promoter serves as a predictor for invasive progression in As-BD patients. 相似文献57.
R. Schennach-Wolff F. SeemüllerM. Obermeier T. MesserG. Laux H. PfeifferD. Naber L.G. SchmidtW. Gaebel J. KlosterkötterI. Heuser W. MaierM.R. Lemke E. RütherG. Buchkremer M. GastparM. Jäger H.J. MöllerM. Riedel 《European psychiatry》2011,26(5):284
Background
Purpose of this study was to assess subjective well-being in schizophrenia inpatients and to find variables predictive for response and remission of subjective well-being.Method
The subjective well-being under neuroleptic treatment scale (SWN-K) was used in 232 schizophrenia patients within a naturalistic multicenter trial. Early response was defined as a SWN-K total score improvement of 20% and by at least 10 points within the first 2 treatment weeks, response as an improvement in SWN-K total score of at least 20% and by at least 10 points from admission to discharge and remission in subjective well-being as a total score of more or equal to 80 points at discharge. Logistic regression and CART analyses were used to determine valid predictors of subjective well-being outcome.Results
Twenty-nine percent of the patients were detected to be SWN-K early responders, 40% fulfilled criteria for response in subjective well-being and 66% fulfilled criteria for remission concerning subjective well-being. Among the investigated predictors, SWN-K early improvement and the educational status were significantly associated with SWN-K response. The SWN-K total score at baseline showed a significant negative predictive value for response. Baseline SWN-K total score, PANSS global subscore, and side effects as well as the educational status were found to be significantly predictive for remission.Conclusions
Depressive symptoms should be radically treated and side effects closely monitored to improve the patient's subjective well-being. The important influence of subjective well-being on overall treatment outcome could be underlined. 相似文献58.
Stanley Fan MB BChir MA FRCP Catherine Lane MB BChir MRCP Sally Punzalan BSc RN 《Journal of Renal Care》2010,36(2):90-95
Introduction: Monitoring of peritoneal dialysis (PD) peritonitis can be difficult for visually impaired patients. PeriScreen strips measure leukocyte esterase activity and this might be a useful objective test that can be performed by patients at home. Methods: A prospective study of 138 episodes of peritonitis was undertaken. Effluent samples were analysed for white cell count (WCC) and PeriScreen score on days 3 and 5. Co‐morbidity data were collated from these patients. Results: Effluent WCC and PeriScreen results were found to correlate with the gold standard assessment of microbiology WCC count. A positive PeriScreen result on day 5 predicted that the episode of peritonitis would relapse after treatment with a sensitivity of 80% but with a poor specificity of 45%. Patients who cleared or relapsed their peritonitis could not be differentiated based on their burden of co‐morbidity, Karnofsky scores, age, dialysis vintage or infective organism. Conclusion: PeriScreen strip analysis correlated with microscopic WCC of PD. However, analysis of PD effluent on day 5 of treatment is not a good test to risk stratify patients for relapsing peritonitis. 相似文献
59.
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