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51.
Incidence of human papillomavirus‐related oropharyngeal cancer and outcomes after chemoradiation in a population of heavy smokers 下载免费PDF全文
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Bibiana Escobar Pilar Taurá Graciela Martínez-Palli Constatino Fondevila Jaume Balust Joan Beltrán Javier Fernández Juan Carlos García-Pagán Juan Carlos García-Valdecasas 《World journal of surgery》2014,38(4):927-935
Introduction
In patients with advanced cirrhosis, stressful stimuli may reveal a silent reduced cardiac performance. During liver transplantation (LT), graft reperfusion strongly stresses the heart and may unmask latent myocardial dysfunction.Aim
The objective of this study was to assess heart response to acutely increased preload after liver graft reperfusion and correlate this response with preoperative data and outcome.Methods
Preoperative clinical, echocardiographic, and hemodynamic data, and patient outcome were retrospectively recorded for 235 liver recipients who had no known cardiac disease. Myocardial dysfunction was defined as less than 10 % increase of stroke volume after graft reperfusion (non-responder).Results
We found 84 (35.7 %) non-responder patients. The non-responders showed higher Model for end-stage liver disease scores (p = 0.046), left atrial diameter (LAD) (p = 0.040), hepatic vein pressure gradient (p = 0.055), and hyperdynamic state than responders. The percentages of patients with hyponatremia (p = 0.048) and alcohol etiology (p = 0.025) were also higher among non-responders. Independent predictors of inadequate cardiac response in the multivariate analysis were low preoperative systemic vascular resistance (SVRI) [odds ratio (OR) 3.09, 95 % CI 1.15–4.82; p = 0.027] and enlargement of LAD (OR 2.08, 95 % CI 1.49–2.74; p = 0.044). Non-response was associated with higher rates of early cardiovascular events [hazard ratio (HR) 2.84, 95 % CI 1.09–4.22; p = 0.039] and higher length of intensive care unit stay (p = 0.038). No differences were found in 1-year survival rates.Conclusions
Latent cardiac dysfunction among LT recipients, considered to be abnormal stroke volume response to unclamping of portal vein, is very prevalent. SVRI and LAD were independent predictors of inadequate responses. This condition deserves special attention since it may aggravate the early postoperative course of LT. 相似文献54.
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Daniel Torres-Lagares Concha Recio-Lora Gabriel Castillo-Dalí Gonzalo Ruiz-de-León-Hernández Pilar Hita-Iglesias Maria A. Serrera-Figallo Juan J. Segura-Egea José L Gutiérrez-Pérez 《Medicina oral, patología oral y cirugía bucal》2014,19(4):e403-e408
Introduction: The aim of this article was to study the influence of anxiety (both state and trait) in postoperative recovery after extraction of third molar together, to establish the role of each of the aspects of anxiety in the results you obtained in an independent and complementary way.
Material and Methods: We performed a prospective study of a consecutive series of 88 patients who underwent lower third molar extractions. Before being provided with any information about the operation, patients were asked to complete the Spielberger State-Trait Anxiety Inventory-Trait and State. We have evaluated postoperative swelling and pain, patients completed a 10-point visual analog scale (VAS) at home each day (at approximately the same time of day as the operation) until day 8 after surgery, when the sutures were removed.
Results: Regarding postoperative variables between positive and negative trait anxiety groups, consumption of analgesic drugs was higher in positive trait anxiety group in a statistically significant way, while these differences were detected only on specific occasions regarding pain and swelling.
Discussion: In the present study, anxiety was taken into account and showed a significant effect in explaining postoperative pain and taking analgesics.
Key words:Anxiety, satisfaction, third molar surgery, Spielberger state-trait anxiety inventory. 相似文献
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Ildefonso Espigado Fátima de la Cruz‐Vicente Omar J. BenMarzouk‐Hidalgo Irene Gracia‐Ahufinger Jose R. Garcia‐Lozano Manuela Aguilar‐Guisado Jose M. Cisneros Alvaro Urbano‐Ispizua Pilar Perez‐Romero 《Transplant international》2014,27(12):1253-1262
The aim of this study was to characterize timing, kinetic, and magnitude of CMV‐specific immune response after hematopoietic stem cell transplantation (HSCT) and its ability to predict CMV replication and clinical outcomes. Using cell surface and intracellular cytokine staining by flow cytometry, CMV‐specific T‐cell response was measured in blood, while CMV viral load and chimerism were determined by real‐time PCR. Patients that reconstituted CMV‐specific T‐cell response within 6 weeks after Allo‐SCT showed a more robust immune response (CD8+: 0.7 cells/μl vs. 0.3/μl; P‐value = 0.01), less incidence of CMV replication (33% vs. 89.5%; P‐value = 0.007), reduced viral loads (1.81 log copies/ml vs. 0 copies/ml; P‐value = 0.04), and better overall survival (72%; CI: 0.53–0.96 vs. 42% CI: 0.24–0.71; P‐value = 0.07) than patients with a delayed immune reconstitution. Viremic patients had significantly higher transplant‐related mortality than nonviremic patients after 1 year (33% CI: 0.15–0.52 vs. 0% CI: 0.05–0.34; P‐value = 0.01). Risk factors independently associated with viral replication were receptor pretransplant CMV‐positive serostatus (P‐value = 0.02) and acquiring CMV‐specific T‐cell response after 6 weeks post‐transplantation (P‐value = 0.009). In conclusion, timing of acquiring a positive CMV‐specific T‐cell immune response after transplantation may identify patients with different risk for viral replication and different clinical outcomes, including survival. 相似文献
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Andreu Fernández-Codina Cristina Berastegui Iago Pinal-Fernández María Guadalupe Silveira Manuel López-Meseguer Víctor Monforte Alfredo Guillén-del Castillo Carmen Pilar Simeón-Aznar Vicent Fonollosa-Plà Joan Solé Carlos Bravo-Masgoret Antonio Román-Broto 《Joint, bone, spine : revue du rhumatisme》2018,85(1):79-84