共查询到20条相似文献，搜索用时 31 毫秒
1.
Junfang Zhao Pamir Sawo Sander S. Rensen Margriet M.J. Rouflart Alison Winstanley Celien P.H. Vreuls Joanne Verheij Kim M.C. van Mierlo Toine M. Lodewick Victor van Woerden Frank H. van Tiel Ronald M. van Dam Cornelis H.C. Dejong Steven W.M. Olde Damink 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(2):147-154
Background
An inverse relation between chemotherapy-associated liver injury (CALI) and tumour response to chemotherapy has been reported. The aim was to validate these findings, and further investigate the impact of CALI on survival in patients who underwent partial hepatectomy for colorectal liver metastases (CRLM).Methods
Patients who received neoadjuvant chemotherapy and underwent partial hepatectomy for CRLM between 2008 and 2014 were included. Liver and tumour specimens were histologically examined for CALI (steatosis, steatohepatitis, sinusoidal dilatation [SD], nodular regeneration) and tumour regression grade (TRG). TRG 1–2 was defined as complete tumour response.Results
166 consecutive patients were included with a median survival of 30 and 44 months for recurrence-free and overall survival, respectively. Grade 2–3 SD was found in 44 (27%) and TRG 1–2 was observed in 33 (20%) patients. Of studied CALI, only grade 2–3 SD was associated with increased TRG 3–5 (odds ratio 3.99, 95% CI 1.17–13.65, p = 0.027). CALI was not significantly related to survival. TRG 1–2 was associated with prolonged recurrence-free (hazard ratio 0.47, 95% CI 0.25–0.89, p = 0.020) and overall survival (hazard ratio 0.35, 95% CI 0.18–0.68, p = 0.002).Conclusion
CALI was not directly related to survival. CALI was, however, associated with diminished complete tumour response, and diminished complete tumour response, in turn, was associated with decreased survival. 相似文献2.
Paschalis Gavriilidis Robert P. Sutcliffe James Hodson Ravi Marudanayagam John Isaac Daniel Azoulay Keith J. Roberts 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(1):11-19
Objective
This was a systematic review and meta-analysis to compare outcomes between patients undergoing simultaneous or delayed hepatectomy for synchronous colorectal liver metastases.Background
The optimal strategy for treating liver disease among patients with resectable synchronous colorectal liver metastases (CRLM) is unclear. Simultaneous resection of primary tumour and liver metastases may improve patient experience by reducing the number of interventions. However, there are concerns of increased morbidity compared to delayed resections.Methods
A systematic literature search was performed using EMBASE, Medline, Cochrane library and Google scholar databases. Meta-analyses were performed using both random-effects and fixed-effect models. Publication and patient selection bias were assessed with funnel plots and sensitivity analysis.Results
Thirty studies including 5300 patients were identified. There were no statistically significant differences in parameters relating to safety and efficacy between the simultaneous and delayed hepatectomy cohorts. Patients undergoing delayed surgery were more likely to have bilobar disease or undergo major hepatectomy. The average length of hospital stay was six days shorter with simultaneous approach [MD = ?6.27 (95% CI: ?8.20, ?4.34), p < 0.001]. Long term survival was similar for the two approaches [HR = 0.97 (95%CI: 0.88, 1.08), p = 0.601].Conclusion
In selected patients, simultaneous resection of liver metastases with colorectal resection is associated with shorter hospital stay compared to delayed resections, without adversely affecting perioperative morbidity or long-term survival. 相似文献3.
Masayuki Okuno Claire Gourmard Takashi Mizuno Kiyohiko Omichi Ching-Wei D. Tzeng Yun Shin Chun Jeffrey E. Lee Jean-Nicolas Vauthey Claudius Conrad 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(1):57-63
Background
Risk factors for pathological diaphragmatic invasion from colorectal liver metastases (CRLM) and differences in recurrence patterns and survival between patients with true pathological diaphragmatic invasion versus inflammatory adhesions only remain poorly understood. This study aimed at identifying risk factors for and survival impact of pathological diaphragmatic invasion in patients with CRLM.Methods
Patients with CRLM who underwent hepatectomy with or without diaphragmatic resection from 1998 to 2015 were retrospectively analyzed. Recurrence-free survival (RFS), overall survival (OS), and recurrence patterns were examined according to the presence or absence of pathological invasion.Results
Of 1860 patients, 70 underwent hepatectomy with diaphragmatic resection and 1799 had hepatectomy only. Among the patients with gross diaphragmatic involvement, 15 (21%) had pathological invasion, and 55 (79%) had inflammatory adhesion only. Multiple tumors (p = 0.019) and RAS mutation (p = 0.047) were significantly associated with pathological invasion. Pathological invasion was associated with a higher incidence of peritoneal recurrence (33% vs. 11%, p = 0.041), worse median RFS (6 months vs. 11 months, p = 0.21) and OS (26 months vs. 51 months, p = 0.046) compared to inflammatory adhesion.Conclusion
Multiple tumors and RAS mutant were predictors for pathological diaphragmatic invasion, which was associated with a higher incidence of peritoneal recurrence and worse OS. 相似文献4.
Amber B. Moore J. Elyse Krupp Alyssa B. Dufour Mousumi Sircar Thomas G. Travison Alan Abrams Grace Farris Melissa L.P. Mattison Lewis A. Lipsitz 《The American journal of medicine》2017,130(10):1199-1204
Purpose
Within 30 days of hospital discharge to a skilled nursing facility, older adults are at high risk for death, re-hospitalization, and high-cost health care. The purpose of this study was to examine whether a novel videoconference program called Extension for Community Health Outcomes-Care Transitions (ECHO-CT) that connects an interdisciplinary hospital-based team with clinicians at skilled nursing facilities reduces patient mortality, hospital readmission, skilled nursing facility length of stay, and 30-day health care costs.Methods
We undertook a prospective cohort study comparing cost and health care utilization outcomes between ECHO-CT facilities and matched comparisons from January 2014-December 2014.Results
Thirty-day readmission rates were significantly lower in the intervention group (odds ratio 0.57; 95% CI, 0.34-0.96; P-value .04), as were the 30-day total health care cost ($2602.19 lower; 95% CI, ?$4133.90 to ?$1070.48; P-value <.001) and the average length of stay at the skilled nursing facility (?5.52 days; 95% CI, ?9.61 to ?1.43; P = .001). The 30-day mortality rate was not significantly lower in the intervention group (odds ratio 0.38; 95% CI, 0.11-1.24; P = .11).Conclusion
Patients discharged to skilled nursing facilities participating in the ECHO-CT program had shorter lengths of stay, lower 30-day rehospitalization rates, and lower 30-day health care costs compared with those in matched skilled nursing facilities delivering usual care. ECHO-CT may improve patient transitions to postacute care at lower overall cost. 相似文献5.
Jayanta Samanta Sukhwinder Singh Sunil Arora Gaurav Muktesh Ashutosh Aggarwal Narendra Dhaka Saroj Kant Sinha Vikas Gupta Vishal Sharma Rakesh Kochhar 《Pancreatology》2018,18(8):878-884
Objectives
To study the role of cytokines in prediction of acute lung injury (ALI) in acute pancreatitis.Methods
Levels of TNFα, IL-6, IL-10, IL-8 and IL-1β were measured in 107 patients at presentation and at 72?h in patients who developed acute lung injury. A model was devised to predict development of ALI using cytokine levels and SIRS score.Results
The levels of TNF α (p?<?0.0001), IL-6 (p?<?0.0001), IL-8 (p?<?0.0001) and IL-1β (p?<?0.0001) were significantly higher in the ALI group. IL-10 levels were significantly lower in persistent ALI (p-ALI) than in transient ALI (t-ALI) patients (p?<?0.038). p-ALI group had significant rise of TNFα (p?=?0.019) and IL-1β (p?=?0.001) while t-ALI group had significant rise of only IL-1β (p = 0.044) on day 3 vs day 1. Combined values of IL-6 and IL-8 above 251 pg/ml had sensitivity of 90.9% and a specificity of 100% to predict future development of ALI. Composite marker-I (IL6 ≥ 80 pg/ml + SIRS) yielded sensitivity and specificity of 73% and 98% whereas composite marker-II (IL8 ≥ 100 pg/ml + SIRS) yielded sensitivity and specificity of 73% and 95% to predict future ALI.Conclusions
IL-6 and IL-8 can predict future development of ALI. When they are combined with SIRS, they can be used as comprehensive composite markers. 相似文献6.
Yanming Zhou Bin Shi Lupeng Wu Xiaoying Si 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(1):10-15
Background
To assess the published evidence on clinical outcomes following radical antegrade modular pancreatosplenectomy (RAMPS) for adenocarcinoma in the body or tail of the pancreas.Method
PubMed and Chinese Biomedical Literature databases were searched. The results of comparisons between RAMPS and standard retrograde pancreatosplenectomy (SRPS) were analyzed by meta-analytical techniques.Results
The literature search identified 13 observational studies involving 354 patients undergoing RAMPS. The overall morbidity and 30-day mortality was 40% and 0% respectively. The R0 resection rate was 88%; the median number of retrieved lymph nodes was 21; and the median 5-year overall survival rate was 37%. The result of meta-analysis showed that RAMPS was associated with a significantly less intraoperative bleeding [weighted mean difference ?195.2 (95% confidence interval (CI) ?223.27 to ?167.13); P < 0.001], a greater number of retrieved lymph nodes [odds ratio (OR) 6.19 (95% CI 3.72 to 8.67); P < 0.001] and a higher percentage of R0 resection [OR 2.46 (95% CI 1.13 to 5.35); P = 0.02] as compared with SRPS.Conclusion
The current literature provides supportive evidence that RAMPS is a safe and effective procedure for adenocarcinoma in the body or tail of the pancreas, and is oncologically superior to SRPS. 相似文献7.
Yiyin Chen Marjorie Funk Jia Wen Xianghua Tang Guixiang He Hong Liu 《Heart & lung : the journal of critical care》2018,47(1):24-31
Background
Multidisciplinary disease management programs (MDMP) for patients with heart failure (HF) have been delivered, but evidence of their effectiveness in China is limited.Objective
To determine if a MDMP improves quality of life (QoL), physical performance, depressive symptoms, self-care behaviors and mortality or rehospitalization in patients with HF in China.Methods
This is a randomized controlled single center trial in which patients with HF received either MDMP with discharge education, physical training, follow-up visits and telephone calls for 180 days (n = 31) or standard care (SC, n = 31).Results
Compared with SC, QoL, depressive symptoms, and self-care behaviors were significantly improved by MDMP from baseline to 180 days (37% vs 66%, 20% vs 61%, and 8% vs 33%, respectively, all p < 0.001). There were no differences in physical performance and mortality or rehospitalization during follow-up.Conclusions
A HF MDMP can improve QoL, depressive symptoms and self-care behaviors in China. 相似文献8.
Florian Egger David Zweiker Matthias K. Freynhofer Verena Löffler Miklos Rohla Alexander Geppert Serdar Farhan Birgit Vogel Jürgen Falkensammer Johannes Kastner Philipp Pichler Paul Vock Gudrun Lamm Olev Luha Albrecht Schmidt Daniel Scherr Matthias Hammerer Uta C. Hoppe Peter Siostrzonek 《JACC: Cardiovascular Interventions》2018,11(21):2160-2167
Objectives
This study sought to investigate the outcome of high-risk and inoperable patients with severe symptomatic aortic stenosis undergoing transfemoral transcatheter aortic valve replacement (TAVR) in hospitals with (iOSCS) versus without institutional on-site cardiac surgery (no-iOSCS).Background
Current guidelines recommend the use of TAVR only in institutions with a department for cardiac surgery on site.Methods
In this analysis of the prospective multicenter Austrian TAVI registry, 1,822 consecutive high-risk patients with severe symptomatic aortic stenosis undergoing transfemoral TAVR were evaluated. A total of 290 (15.9%) underwent TAVR at no-iOSCS centers (no-iOSCS group), whereas the remaining 1,532 patients (84.1%) were treated in iOSCS centers (iOSCS group).Results
Patients of the no-iOSCS group had a higher perioperative risk defined by the logistic EuroSCORE (20.9% vs. 14.2%; p < 0.001) compared with patients treated in hospitals with iOSCS. Procedural survival was 96.9% in no-iOSCS centers and 98.6% in iOSCS centers (p = 0.034), whereas 30-day survival was 93.1% versus 96.0% (p = 0.039) and 1-year survival was 80.9% versus 86.1% (p = 0.017), respectively. After propensity score matching for confounders procedural survival was 96.9% versus 98.6% (p = 0.162), 93.1% versus 93.8% (p = 0.719) at 30 days, and 80.9% versus 83.4% (p = 0.402) at 1 year.Conclusions
Patients undergoing transfemoral TAVR in hospitals without iOSCS had a significantly higher baseline risk profile. After propensity score matching short- and long-term mortality was similar between centers with and without iOSCS. 相似文献9.
Christian Sturesson Valentinus T. Valdimarsson Erik Blomstrand Sam Eriksson Jan H. Nilsson Ingvar Syk Gert Lindell 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(1):52-58
Background
The liver-first strategy signifies resection of liver metastases before the primary colorectal cancer. The aim of the present study was to compare failure to complete intended treatment and survival in liver-first and classical strategies.Methods
All patients with colorectal cancer and synchronous liver metastases planned for sequential radical surgery in a single institution between 2011 and 2015 were included.Results
A total of 109 patients were presented to a multidisciplinary team conference (MDT) with un-resected colorectal cancer and synchronous liver metastases. Seventy-five patients were planned as liver-first, whereas 34 were recommended the classical strategy. Twenty-six patients (35%) failed to complete treatment in the liver-first group compared to 10 patients in the classical group (P = 0.664). Reason for failure was most commonly disease progression.A total of 91 patients had the primary tumor resected before the liver metastases of which 67 before referral and 24 after allocation at MDT. Median survival after diagnosis in this group was 60 (48–73) months compared to 46 (31–60) months in the group operated with liver-first strategy (n = 49), (P = 0.310).Discussion
Up to 35% of patients with colorectal cancer and synchronous liver metastases do not complete the intended treatment of liver and bowel resections, irrespective of treatment strategy. 相似文献10.
Neil A. Smart Gudrun Dieberg Nicola King 《Journal of the American College of Cardiology》2018,71(9):983-991
Background
When comparing effects of on- versus off-pump coronary artery bypass grafting (CABG), it is important to assess the long-term clinical outcomes. However, most research conducted thus far has concentrated on short-term outcomes and ignored the long-term clinical outcomes, especially the 5-year outcomes of the largest randomized controlled trials.Objectives
The aim of this systematic review and meta-analysis was to investigate the long-term clinical outcomes of on- versus off-pump CABG.Methods
To identify potential studies systematic searches were carried out using various databases. The search strategy included the key concepts of cardiopulmonary bypass AND off-pump AND long term OR 5-year outcomes. This was followed by a meta-analysis investigating mortality, incidence of myocardial infarction, incidence of angina, need for revascularization, and incidence of stroke.Results
Six studies totaling 8,145 participants were analyzed. In the on-pump group mortality was 12.3%, compared with 13.9% in the off-pump group. The odds ratio (OR) for this comparison was 1.16 (95% confidence interval [CI]: 1.02 to 1.32; p = 0.03; 13.9% vs. 12.3%). In contrast, there were no differences in the incidence of myocardial infarction (OR: 1.06: 95% CI: 0.91 to 1.25; p = 0.45; 8.4% vs. 7.9%), incidence of angina (OR: 1.09; 95% CI: 0.75 to 1.57; p = 0.65; 2.3% vs. 2.1%), need for revascularization (OR: 1.15; 95% CI: 0.95 to 1.40; p = 0.16; 5.9% vs. 5.1%), and the incidence of stroke (OR: 0.78; 95% CI: 0.56 to 1.10; p = 0.16; 2.2% vs. 2.8%).Conclusions
Statistically, on-pump CABG appeared to offer superior long-term survival, although the clinical significance of this may be more uncertain. 相似文献11.
Byoung Hyuck Kim Kyubo Kim Eui Kyu Chie Jeanny Kwon Jin-Young Jang Sun Whe Kim Do-Youn Oh Yung-Jue Bang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(5):421-428
Background
This study aimed to investigate post-recurrence overall survival (PROS) in patients with recurrent extrahepatic cholangiocarcinoma (EHC) and to indicate which groups of patients need active salvage treatments.Methods
We retrospectively reviewed the records of 251 consecutive patients who underwent curative surgery followed by adjuvant chemoradiotherapy for EHC. Among these, 144 patients experienced a recurrence and were included for further analysis.Results
The median PROS was 7 months (range, 1–130). In multivariate analysis, poorly differentiated histology, short disease-free survival, poor performance status, and elevated CA 19-9 were identified as significant prognosticators for poor PROS. Based on this, we stratified study patients into three categories by the number of risk factors: group 1 (0 or 1 factors), group 2 (2 factors) and group 3 (3–4 factors). Median PROS for groups 1, 2, and 3 were 13, 7, and 5 months, respectively (p < 0.001). Group 1 patients showed a significant benefit from salvage treatment, but groups 2 and 3 did not demonstrate clear benefit. In addition, we developed a nomogram to specifically identify individual patient's prognosis.Conclusion
Our simple risk stratification as well as proposed nomogram can classify patients into subgroups with different prognosis and will help facilitate personalized strategies after recurrence. 相似文献12.
Mechteld C. de Jong Rianne C.J. Beckers Victor van Woerden Julie M.L. Sijmons Marc H.A. Bemelmans Ronald M. van Dam Cornelis H.C. Dejong 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(7):631-640
Background
The feasibility of the liver-first approach for synchronous colorectal liver metastases (CRLM) has been established. We sought to assess the short-term and long-term outcomes for these patients.Methods
Outcomes of patients who underwent a liver-first approach for CRLM between 2005 and 2015 were retrospectively evaluated from a prospective database.Results
Of the 92 patients planned to undergo the liver-first strategy, the paradigm could be completed in 76.1%. Patients with concurrent extrahepatic disease failed significantly more often in completing the protocol (67% versus 21%; p = 0.03). Postoperative morbidity and mortality were 31.5% and 3.3% following liver resection and 30.9% and 0% after colorectal surgery. Of the 70 patients in whom the paradigm was completed, 36 patients (51.4%) developed recurrent disease after a median interval of 20.9 months. The median overall survival on an intention-to-treat basis was 33.1 months (3- and 5-year overall survival: 48.5% and 33.1%). Patients who were not able to complete their therapeutic paradigm had a significantly worse overall outcome (p = 0.03).Conclusion
The liver-first approach is feasible with acceptable perioperative morbidity and mortality rates. Despite the considerable overall-survival-benefit, recurrence rates remain high. Future research should focus on providing selection tools to enable the optimal treatment sequence for each patient with synchronous CRLM. 相似文献13.
Wei Li Long Li Daniil Minigalin Hong Wu 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(6):530-537
Background
Both mesohepatectomy (MH) and extended hepatectomy (EH) can be performed for centrally located hepatocellular carcinoma (HCC). In this study, the long-term prognosis of these surgical approaches was assessed in patients with HCC.Methods
A retrospective review was undertaken of 171 HCC patients who underwent anatomic hepatectomy for centrally located HCC between January 2005 and January 2016 in West China Hospital, Sichuan University. The impact of the surgical methods on prognosis was assessed for these patients by multivariable regression analysis. In addition, the patients in the MH group were matched in a 1:2 ratio with EH controls.Results
In non-adjusted models, patients in the MH group had similar overall survival (OS, p = 0.066) and disease free survival (DFS, p = 0.654) compared to EH patients. After adjusting for all identified confounders, MH patients showed better OS in comparison with patients in the EH group (p = 0.001), while the DFS was similar. In the propensity score-matched (PSM) subset, patients in MH group had better OS (p = 0.033) but similar DFS (p = 0.328) compared to patients in the EH group.Conclusion
Anatomic MH can be recommended as a reasonable surgical option in selected patients with centrally located HCC. 相似文献14.
Laëtitia Courtin-Tanguy Olivier Turrini Damien Bergeat Stéphanie Truant Benjamin Darnis Jean R. Delpero Jean Y. Mabrut Nicolas Regenet Laurent Sulpice 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(5):405-410
Background
Although the peri-operative mortality following pancreaticoduodenectomy (PD) for distal cholangiocarcinoma (DCC) has decreased, the post-operative morbidity remains high. The aim of this study was to evaluate the impact of factors that may affect the long term survival for patients with DCC following PD.Methods
All patients who underwent PD for DCC between January 2000 and December 2015 in 5 tertiary referral centers underwent retrospective medical record review. Factors likely to influence overall (OS) and disease-free (DFS) survivals were assessed by univariate and multivariate analysis.Results
A total of 201 on 217 patients who underwent PD for DCC were included for further analysis. The median OS was 39 months, with actuarial survival rates at 1, 3, and 5 years of 85%, 53% and 39%. Recurrence occurred in 123 (61%) patients. The median DFS was 16 months, with actuarial survival rates at 1, 3 and 5 years of 60%, 37% and 28%. Following multivariate analysis, peri-operative blood transfusions (PBT) were associated to worse OS (HR = 2.25 [1.31–3.85], P = 0.003) and DFS (HR = 2.08 [1.24–3.5], P = 0.005).Conclusion
This study confirms the negative impact of PBT on the oncologic result following PD for DCC. 相似文献15.
Oana Mirea Efstathios D. Pagourelias Jurgen Duchenne Jan Bogaert James D. Thomas Luigi P. Badano Jens-Uwe Voigt 《JACC: Cardiovascular Imaging》2018,11(1):25-34
Objectives
The purpose of this study was to compare the accuracy of vendor-specific and independent strain analysis tools to detect regional myocardial function abnormality in a clinical setting.Background
Speckle tracking echocardiography has been considered a promising tool for the quantitative assessment of regional myocardial function. However, the potential differences among speckle tracking software with regard to their accuracy in identifying regional abnormality has not been studied extensively.Methods
Sixty-three subjects (5 healthy volunteers and 58 patients) were examined with 7 different ultrasound machines during 5 days. All patients had experienced a previous myocardial infarction, which was characterized by cardiac magnetic resonance with late gadolinium enhancement. Segmental peak systolic (PS), end-systolic (ES) and post-systolic strain (PSS) measurements were obtained with 6 vendor-specific software tools and 2 independent strain analysis tools. Strain parameters were compared between fully scarred and scar-free segments. Receiver-operating characteristic curves testing the ability of strain parameters and derived indexes to discriminate between these segments were compared among vendors.Results
The average strain values calculated for normal segments ranged from ?15.1% to ?20.7% for PS, ?14.9% to ?20.6% for ES, and ?16.1% to ?21.4% for PSS. Significantly lower values of strain (p < 0.05) were found in segments with transmural scar by all vendors, with values ranging from ?7.4% to ?11.1% for PS, ?7.7% to ?10.8% for ES, and ?10.5% to ?14.3% for PSS. Accuracy in identifying transmural scar ranged from acceptable to excellent (area under the curve 0.74 to 0.83 for PS and ES and 0.70 to 0.78 for PSS). Significant differences were found among vendors (p < 0.05). All vendors had a significantly lower accuracy to detect scars in the basal segments compared with scars in the apex (p < 0.05).Conclusions
The accuracy of identifying regional abnormality differs significantly among vendors. 相似文献16.
Francis J. Ha Samia R. Toukhsati James D. Cameron Rosie Yates David L. Hare 《Heart & lung : the journal of critical care》2018,47(1):54-60
Background
Exercise confidence predicts exercise adherence in heart failure (HF) patients. The association between simple tests of functional capacity on exercise confidence are not known.Objectives
To evaluate the association between a single 6-min walk test (6MWT) and exercise confidence in HF patients.Methods
Observational study enrolling HF outpatients who completed the Cardiac Depression Scale and an Exercise Confidence Survey at baseline and following the 6MWT. Paired t-test was used to compare repeated-measures data, while Repeated Measures Analysis of Covariance was used for multivariate analysis.Results
106 HF patients were enrolled in the study (males, 82%; mean age, 64 ± 12 years). Baseline Exercise Confidence was inversely associated with age (p < 0.01), NYHA class (p < 0.001), and depression (p < 0.001). The 6MWT was associated with an improvement in Exercise Confidence (F(1,92) = 5.0, p = 0.03) after adjustment for age, gender, HF duration, NYHA class and depression.Conclusions
The 6MWT is associated with improved exercise confidence in HF patients. 相似文献17.
Georgios A. Margonis Kazunari Sasaki Nikolaos Andreatos Manijeh Zargham Pour Nannan Shao Mounes Aliyari Ghasebeh Stefan Buettner Efstathios Antoniou Christopher L. Wolfgang Matthew Weiss Ihab R. Kamel Timothy M. Pawlik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(9):808-817
Background
Although experimental data strongly support the pro-tumorigenic role of postoperative liver regeneration, this hypothesis has not been clinically investigated. We aimed to examine the impact of liver regeneration determined by volumetric imaging on recurrence following resection of colorectal liver metastasis (CRLM).Methods
Resected liver volume was subtracted from total liver volume (TLV) to define postoperative remnant liver volume (RLVp). Early and late kinetic growth rates (KGR) were defined as the postoperative increases in liver volume within 2–3 and 8–10 months from surgery, respectively, divided by the corresponding time interval.Results
Median early and late KGR was 2.6%/month (IQR: ?0.9 to 12.3) and 1.0%/month (IQR: ?0.64 to 2.91), respectively. Late KGR predicted intrahepatic recurrence after 1 year from surgery (AUC 0.677, P = 0.011). Specifically, patients with a late KGR ≥1% had a higher cumulative risk of recurrence compared with patients with a KGR <1% (P = 0.038). In multivariate analysis, KGR ≥1% independently predicted recurrence (P = 0.027).Discussion
A KGR ≥1% during the late regeneration phase was associated with increased risk of intrahepatic recurrence. These data may inform the timing of adjuvant therapy administration and focus surveillance strategies for high-risk patients. 相似文献18.
Ronald M. Lazar Marykathryn A. Pavol Tobias Bormann Michael G. Dwyer Carlye Kraemer Roseann White Robert Zivadinov Jeffrey C. Wertheimer Angelika Thöne-Otto Lisa D. Ravdin Richard Naugle Dawn Mechanic-Hamilton William S. Garmoe Anthony Y. Stringer Heidi A. Bender Samir R. Kapadia Susheel Kodali Alexander Ghanem Martin B. Leon 《JACC: Cardiovascular Interventions》2018,11(4):384-392
Objectives
The authors sought to determine baseline neurocognition before transcatheter aortic valve replacement (TAVR) and its correlations with pre-TAVR brain imaging.Background
TAVR studies have not shown a correlation between diffusion-weighted image changes and neurocognition. The authors wanted to determine the extent to which there was already impairment at baseline that correlated with cerebrovascular disease.Methods
SENTINEL (Cerebral Protection in Transcatheter Aortic Valve Replacement) trial patients had cognitive assessments of attention, processing speed, executive function, and verbal and visual memory. Z-scores were based on normative means and SDs, combined into a primary composite z-score. Brain magnetic resonance images were obtained pre-TAVR on 3-T scanners with a T2 fluid-attenuated inversion recovery (FLAIR) sequence. Scores ≤?1.5 SD below the normative mean (7th percentile) were considered impairment. Paired t tests compared within-subject scores, and chi-square goodness-of-fit compared the percentage of subjects below ?1.5 SD. Correlation and regression analyses assessed the relationship between neurocognitive z-scores and T2 lesion volume.Results
Among 234 patients tested, the mean composite z-score was ?0.65 SD below the normative mean. Domain scores ranged from ?0.15 SD for attention to ?1.32 SD for executive function. On the basis of the ≥1.5 SD normative reference, there were significantly greater percentages of impaired scores in the composite z-score (13.2%; p = 0.019), executive function (41.9%; p < 0.001), verbal memory (p < 0.001), and visual memory (p < 0.001). The regression model between FLAIR lesion volume and baseline cognition showed statistically significant negative correlations.Conclusions
There was a significant proportion of aortic stenosis patients with impaired cognition before TAVR, with a relationship between baseline cognitive function and lesion burden likely attributable to longstanding cerebrovascular disease. These findings underscore the importance of pre-interventional testing and magnetic resonance imaging in any research investigating post-surgical cognitive outcomes in patients with cardiovascular disease. 相似文献19.
James S. Ware Almudena Amor-Salamanca Upasana Tayal Risha Govind Isabel Serrano Joel Salazar-Mendiguchía Jose Manuel García-Pinilla Domingo A. Pascual-Figal Julio Nuñez Gonzalo Guzzo-Merello Emiliano Gonzalez-Vioque Alfredo Bardaji Nicolas Manito Miguel A. López-Garrido Laura Padron-Barthe Elizabeth Edwards Nicola Whiffin Roddy Walsh Pablo Garcia-Pavia 《Journal of the American College of Cardiology》2018,71(20):2293-2302
Background
Alcoholic cardiomyopathy (ACM) is defined by a dilated and impaired left ventricle due to chronic excess alcohol consumption. It is largely unknown which factors determine cardiac toxicity on exposure to alcohol.Objectives
This study sought to evaluate the role of variation in cardiomyopathy-associated genes in the pathophysiology of ACM, and to examine the effects of alcohol intake and genotype on dilated cardiomyopathy (DCM) severity.Methods
The authors characterized 141 ACM cases, 716 DCM cases, and 445 healthy volunteers. The authors compared the prevalence of rare, protein-altering variants in 9 genes associated with inherited DCM. They evaluated the effect of genotype and alcohol consumption on phenotype in DCM.Results
Variants in well-characterized DCM-causing genes were more prevalent in patients with ACM than control subjects (13.5% vs. 2.9%; p = 1.2 ×10?5), but similar between patients with ACM and DCM (19.4%; p = 0.12) and with a predominant burden of titin truncating variants (TTNtv) (9.9%). Separately, we identified an interaction between TTN genotype and excess alcohol consumption in a cohort of DCM patients not meeting ACM criteria. On multivariate analysis, DCM patients with a TTNtv who consumed excess alcohol had an 8.7% absolute reduction in ejection fraction (95% confidence interval: ?2.3% to ?15.1%; p < 0.007) compared with those without TTNtv and excess alcohol consumption. The presence of TTNtv did not predict phenotype, outcome, or functional recovery on treatment in ACM patients.Conclusions
TTNtv represent a prevalent genetic predisposition for ACM, and are also associated with a worse left ventricular ejection fraction in DCM patients who consume alcohol above recommended levels. Familial evaluation and genetic testing should be considered in patients presenting with ACM. 相似文献20.
Valentinus T. Valdimarsson Ingvar Syk Gert Lindell Agneta Norén Bengt Isaksson Per Sandström Magnus Rizell Bjarne Ardnor Christian Sturesson 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(5):441-447