共查询到20条相似文献,搜索用时 15 毫秒
1.
2.
Paul Beamish Madeline Lemke Jennifer Li Elijah Dixon Mauro T. Abraham Roberto Hernandez Alejandro Sean Bennett Guillaume Martel Paul J. Karanicolas 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(8):675-681
Background
Recent advances in care for colorectal liver metastases (CRLM) have lengthened 5-year survival. In this new era, prognostic tools such as the clinical risk score (CRS) for colorectal liver metastases require reevaluation.Methods
Patients undergoing resection for CRLM between 2008 and 2012 at 4 specialty hepatobiliary centers in Canada (N = 740) were stratified by CRS and analyzed in Kaplan–Meier survival curves. Primary outcome of overall survival (OS) and secondary outcome of recurrence-free survival (RFS). Multivariate Cox regression compared CRS to patient factors.Results
Median OS not reached (>60 months), median RFS 16 months. Original CRS strata was a significant (p < 0.001) predictor of both OS (5-year OS: 0; 75%, 1; 71%, 2; 57%, 3; 57%, 4; 46%) and RFS (5-year RFS: 0; 39%, 1; 33%, 2; 21%, 3; 21%, 4; 8%). The presence of extrahepatic colorectal metastatic disease increased recurrence risk (RFS hazard ratio of 1.32 (1.06–1.65)), and the use of intraoperative portal pedicle clamping reduced recurrence risk (RFS hazard ratio of 0.78 (0.61–0.99)).Conclusions
The CRS remains a relevant tool for predicting long-term outcomes for patients undergoing resection of CRLM. Additional factors such as the presence of extrahepatic colorectal metastatic disease and the use of intraoperative portal pedicle clamping may improve the prognostic power of the CRS. 相似文献3.
4.
Mecoli Christopher A. Shah Ami A. Boin Francesco Wigley Fredrick M. Hummers Laura K. 《Clinical rheumatology》2018,37(9):2429-2437
Clinical Rheumatology - Two major complications in scleroderma patients that cause substantial morbidity and mortality are ischemic digital lesions (DL) and pulmonary hypertension (PH). The... 相似文献
5.
Previous reports suggested that gout incidence increased with serum uric acid (sUA) level. In addition to sUA, we aimed to
examine the gender-specific risk factors for incident gout. A prospective study was conducted using data of the MJ Health
Screening Center and outcome database from Taiwan’s National Health Insurance. Cox proportional hazard model was used for
risk analysis of incident gout. During a mean follow-up of 7.31 years for 132,556 individuals aged ≥18 years, 1,606 subjects
(1,341 men and 265 women) with clinical gout were defined. Hyperuricemia (sUA ≥7.7 mg/dL for men or ≥6.6 mg/dL for women)
was the most important risk factor for gout development with a respective hazard ratio of 9.65 (95% confidence level, 8.53–10.9)
for men and 9.28 (7.00–12.3) for women. The age-standardized sUA–gout relationship demonstrated a differential impact of sUA
level on gout incidence between men and women. Metabolic comorbidities of hypertension, obesity, and hyperlipidemia were significantly
associated with gout with respective HR of 1.32 (1.17–1.48), 1.30 (1.15–1.47), and 1.12 (0.99–1.26) for men and 1.34 (1.02–1.77),
2.15 (1.67–2.76), and 1.70 (1.32–2.19) for women. However, the relationship between diabetes and incident gout was not as
prominent. The sex difference of sUA–gout relationship and the association between metabolic comorbidities and incident gout
were demonstrated. Generalizability of these findings to other ethnic population needs further investigation. 相似文献
6.
7.
8.
Comparison of scoring systems for nonvariceal upper gastrointestinal bleeding: a multicenter prospective cohort study
下载免费PDF全文
![点击此处可从《Journal of gastroenterology and hepatology》网站下载免费的PDF全文](/ch/ext_images/free.gif)
Hae Min Yang Seong Woo Jeon Jin Tae Jung Dong Wook Lee Chang Yoon Ha Kyung Sik Park Si Hyung Lee Chang Heon Yang Jun Hyung Park Youn Sun Park Daegu‐Gyeongbuk Gastrointestinal Study Group 《Journal of gastroenterology and hepatology》2016,31(1):119-125
9.
Purpose
The purpose of this study is to provide a web-based calculator predicting complication probabilities of patients undergoing colorectal cancer (CRC) surgery in Germany.Methods
Analyses were based on records of first-time CRC surgery between 2010 and February 2017, documented in the database of the Study, Documentation, and Quality Center (StuDoQ) of the Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), a registry of CRC surgery in hospitals throughout Germany, covering demography, medical history, tumor features, comorbidity, behavioral risk factors, surgical procedures, and outcomes. Using logistic ridge regression, separate models were developed in learning samples of 6729 colon and 4381 rectum cancer patients and evaluated in validation samples of sizes 2407 and 1287. Discrimination was assessed using c statistics. Calibration was examined graphically by plotting observed versus predicted complication probabilities and numerically using Brier scores.Results
We report validation results regarding 15 outcomes such as any major complication, surgical site infection, anastomotic leakage, bladder voiding disturbance after rectal surgery, abdominal wall dehiscence, various internistic complications, 30-day readmission, 30-day reoperation rate, and 30-day mortality. When applied to the validation samples, c statistics ranged between 0.60 for anastomosis leakage and 0.85 for mortality after rectum cancer surgery. Brier scores ranged from 0.003 to 0.127.Conclusions
While most models showed satisfactory discrimination and calibration, this does not preclude overly optimistic or pessimistic individual predictions. To avoid misinterpretation, one has to understand the basic principles of risk calculation and risk communication. An e-learning tool outlining the appropriate use of the risk calculator is provided.10.
11.
Dublin S Anderson ML Haneuse SJ Heckbert SR Crane PK Breitner JC McCormick W Bowen JD Teri L McCurry SM Larson EB 《Journal of the American Geriatrics Society》2011,59(8):1369-1375
OBJECTIVES: To determine whether atrial fibrillation (AF) is associated with risk of incident dementia or Alzheimer's disease (AD), beyond its effect on stroke. DESIGN: Prospective cohort study. SETTING: An integrated healthcare delivery system. PARTICIPANTS: A population‐based sample of 3,045 community‐dwelling adults aged 65 and older without dementia or clinical stroke followed from 1994 to 2008. MEASUREMENTS: AF was identified from health plan electronic data using International Classification of Diseases, Ninth Revision, codes from inpatient and outpatient encounters. Covariates came from self‐report, study measures, and health plan data. Participants were screened every 2 years using the Cognitive Abilities Screening Instrument (range 0–100), with detailed neuropsychological and clinical assessment of those scoring less than 86. A multidisciplinary consensus committee determined diagnoses of all‐cause dementia and possible or probable AD using standard research criteria. RESULTS: AF was present in 132 (4.3%) participants at baseline and was diagnosed in 370 (12.2%) more over a mean of 6.8 years of follow‐up; 572 participants (18.8%) developed dementia (449 with AD). The adjusted hazard ratio associated with AF was 1.38 (95% confidence interval (CI)=1.10–1.73) for all‐cause dementia and 1.50 (95% CI=1.16–1.94) for possible or probable AD. Results were similar for participants with and without clinically recognized stroke during follow‐up and in sensitivity analyses examining only probable AD. CONCLUSION: AF is associated with higher risk of developing AD and dementia. Future studies should examine whether specific treatments, including optimal anticoagulation, can decrease this risk. 相似文献
12.
13.
COMBAT is a prospective, multicenter, randomized, blinded clinical study, with crossover design. The main objective is the comparative evaluation of atrio-biventricular versus conventional atrioventricular stimulation (atrio and right ventricle) in patients with heart failure and bradycardia as the primary indication for pacemaker implantation. After successful atrio-biventricular system implantation, patients will be randomized into two groups: group A--atrioventricular conventional pacing and group B--atrio-biventricular pacing. Both groups will be programmed in DDD mode with AV delay optimized by echocardiogram. After 3 months, New York Heart Association functional class, ventricular arrhythmia density and complexity, echocardiography outcomes, 6-min hall walk distance, quality of life and peak oxygen consumption will be assessed in all patients. Then, all patients will crossover to the other pacing regimen, with an additional AV delay adjustment by echo. Patients will be followed up for another 3 months at the end of which all evaluations will be repeated. Patients will then crossover back to their original pacing regimen for a further 3 months. At the end of this 9-month period, patients will be reprogrammed according to their optimal pacing regime. In an extended follow-up, patient survival will be evaluated after 24 months of the optimal pacing therapy. 相似文献
14.
J. Martínek M. iroký Z. Plottová J. Bure A. Hep J. piák 《Diseases of the esophagus》2003,16(3):204-209
Botulinum toxin (BT) injection is an alternative treatment of achalasia. The aim of the study was to examine outcomes of patients treated with BT in the Czech Republic. Since 1997, 49 patients with achalasia have been treated with BT. We prospectively evaluated the effect of BT injection on 41 patients during a median follow-up of 24 months (range 9-62). Esophageal manometry was performed before and at 3-5 months after the injection. In 16 patients, BT was injected from the antegrade angle only (subgroup A), in 15 patients, BT was injected from both retrograde and antegrade angles (subgroup B) and, in 10 patients, BT injection was combined with subsequent balloon dilatation (subgroup C). Immediate clinical response was achieved in 93% of patients. Clinical remission was sustained beyond 3 months in 83% of patients (responders). Fourteen responders (41%) did not experience a relapse during the median of 22 months. Twenty responders (59%) experienced symptomatic relapse approximately 8 months after the injection. Ten relapsers underwent BT reinjection, five (50%) of them were asymptomatic for another 14 months. The remaining five (50%) patients reported a second relapse approximately 6 months after the reinjection. Median duration of the symptom-free period was 11.5 months after the first BT injection, and 10.5 months after the second (P = 0.21). We did not find any significant predictor of a favorable outcome; responders tended to be older and to have a lower basal lower-esophageal-sphincter pressure. Patients in subgroup C were more likely to be in remission at 1 and 2 years as compared with patients in subgroup A. BT injection is an effective treatment of achalasia in the short term. However, almost 70% of patients experience a relapse within 2 years. BT injection should therefore be reserved for patients at risk for more invasive procedures or for patients who prefer this treatment. 相似文献
15.
Addition of sulphonylurea to metformin does not relevantly change body weight: a prospective observational cohort study (ZODIAC‐39)
下载免费PDF全文
![点击此处可从《Diabetes, obesity & metabolism》网站下载免费的PDF全文](/ch/ext_images/free.gif)
Dennis Schrijnders MD MSc Raiza Wever MD MSc Nanne Kleefstra MD PhD Sebastiaan T. Houweling MD PhD Kornelis J. J. van Hateren MD PhD Geertruida H. de Bock Henk J. G. Bilo Klaas H. Groenier PhD Gijs W. D. Landman MD PhD 《Diabetes, obesity & metabolism》2016,18(10):973-979
16.
Jean-Fran?ois Etard Mamadou Saliou Sow Sandrine Leroy Abdoulaye Touré Bernard Taverne Alpha Kabinet Keita Philippe Msellati NFally Magassouba Sylvain Baize Hervé Raoul Suzanne Izard Cécé Kpamou Laura March Ibrahima Savane Moumié Barry Eric Delaporte 《The Lancet infectious diseases》2017,17(5):545-552
17.
Hunziker PR Imsand C Keller D Hess N Barbosa V Nietlispach F Liel-Cohen N Weyman AE Pfisterer M Buser P 《Journal of the American College of Cardiology》2002,39(4):702-709
OBJECTIVES: We sought to assess the ability of a new noninvasive method to quantify atherosclerosis severity and to examine its power to predict cardiovascular events. BACKGROUND: Drug prevention of cardiovascular events is effective but costly, leading to a debate about who should receive this treatment. Patient selection is often based on surrogate markers, but quantification of atherosclerosis severity is desirable. METHODS: Atherosclerosis severity was quantified by determination of specific aortic wall elastance in transthoracic echocardiography, applying the biomechanics of pulse wave propagation. After validating the method in 52 patients by measuring aortic plaque burden in transesophageal echo directly, another 336 patients were prospectively studied by monitoring atherosclerotic events at one year and comparing the results with conventional risk stratification. RESULTS: Specific aortic elastance was well correlated with plaque burden (p < 0.0001) and largely independent of confounding variables. Specific aortic elastance predicted the primary end point of "atherosclerotic death, myocardial infarction or stroke" at one year (p < 0.0002). Event rate at one year in the lowest specific elastance tertile was 1.8% (CI 0.0% to 4.3%), in the middle tertile 5.4% (CI 1.1% to 9.7%) and in the highest tertile 12.7% (CI 6.3% to 19%). Secondary end points supported these findings. Stepwise multivariate analysis identified specific aortic elastance, prior atherosclerotic events and left ventricular ejection fraction as independent risk predictors. Specific elastance was of incremental value to clinically identified variables. CONCLUSIONS: Bedside measurement of specific aortic elastance allows assessment of atherosclerosis severity. It predicts the risk for future atherosclerotic events beyond conventional risk factors, promising better targeting of pharmacologic prevention and improved cost effectiveness. 相似文献
18.
19.
Fernando C. Abro Sabrina Araujo de Frana Igor R. L. B. de Abreu Joo Carlos das Neves Pereira Emílio C. del Massa Andra Oliver Maria Gabriela C. Cavalcante 《Journal of thoracic disease》2021,13(9):5439
BackgroundIn Low-Middle Income Countries (LMICs), resource optimization and infrastructure availability are recurrently in debate. In order to assist the development and implementation of guidelines, LMICs often exemplify from High-Income Countries protocols. At the final, it will be: content adaption is often needed. In this study, we demonstrated the preliminary analysis of the Brazilian experience by adapting the ERAS® Protocol for thoracic surgery patients (PROSM).MethodsPatients’ data were extracted from the surgical group database that operated in the city of Sao Paulo. Patients’ data were organized for analysis after the institution’s ethics committee gave their approval. Patients’ variables were analyzed and compared to a control group. Subgroup analysis included patients without ICU Admission.ResultsPROSM patients had reduced ICU length of stay (LOS) (Mean of 0.3±0.58 days, 1.2±1.65 days, P=0.001), Hospital LOS (Mean of 1.6±1.32 days, 3.9±3.25 days, P=0.001) and Chest Drain duration (Median 1.0±1.00 days, 3.0±3.00 days, P=0.001). Analyses of patients that were not admitted to the ICU demonstrated reduced Hospital LOS and Chest drain duration. Cost analysis, such as procedure, daily, and post-surgical costs were also significantly lower towards PROSM group.ConclusionsThis study revealed important aspects for improvement of the delivered care quality and opportunity for expenditure management. We expect to assist more countries to improve knowledge under the implementation of enhanced protocols. 相似文献