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1.
Ian J. Stewart Jonathan A. Sosnov Brian D. Snow Augen Batou Jeffrey T. Howard Jud C. Janak Mary Bollinger Kevin K. Chung 《Burns : journal of the International Society for Burn Injuries》2017,43(2):290-296
Background
The long-term health effects of burn are poorly understood. We sought to evaluate the relationship between burn and the subsequent development of hypertension.Methods
Retrospective cohort study of patients admitted to our burn center from 2003 to 2010. Data collected included demographic variables, burn size, injury severity score, presence of inhalation injury, serum creatinine, need for renal replacement therapy, as well as days spent in the hospital, in the intensive care unit and on mechanical ventilation. Data for the subsequent diagnosis of hypertension was obtained from medical records. Cox proportional hazard regression models were performed to determine what factors were associated with hypertension.Results
Of the 711 patients identified, 670 were included for analysis after exclusions. After adjustment, only age (HR 1.06 per one year increase, 95% confidence interval 1.03–1.08; p < 0.001), percentage of total body surface area burned (HR 1.11 per 5% increase, 95% confidence interval 1.04–1.19; p = 0.002) and acute kidney injury (HR 1.68, 95% confidence interval 1.05–2.69; p = 0.03) were associated with hypertension.Conclusion
Burn size is independently associated with the subsequent risk of hypertension in combat casualties. Clinical support for primary prevention techniques to reduce the incidence of hypertension specific to burn patients may be warranted. 相似文献2.
Larry M. Jones Nicholas Deluga Puneet Bhatti Scott R. Scrape John K. Bailey Rebecca A. Coffey 《Burns : journal of the International Society for Burn Injuries》2017,43(2):397-402
Introduction
Resuscitation from burn shock using fresh frozen plasma (FFP) has been described. Critics of FFP resuscitation cite the development of transfusion related acute lung injury (TRALI) as a deterrent to its use. This study examines the occurrence of TRALI with FFP resuscitation of critically ill burned patients.Methods
A retrospective chart review was conducted of severely burned patients who received FFP resuscitation. Data points included age, TBSA, TBSA full thickness, presence of alternate etiologies of acute lung injury, total FFP administered, and signs and symptoms of TRALI as defined per the Canadian Blood Services Consensus Conference.Results
Eighty-three patients met the definition of severe burn and received FFP resuscitation. Of those, 65 met exclusion criteria. Eighteen patients were left for analysis with only one found to have signs and symptoms of TRALI. That patient suffered a 53.5% TBSA burn, received a total of 6228 ml FFP, had no competing etiologies of ALI, and was diagnosed with TRALI within 6 h of completing the FFP transfusion.Conclusion
The possible occurrence of TRALI in burn patients receiving FFP resuscitation should be weighed against the reported benefits of such a resuscitation strategy. 相似文献3.
Ricardo M. Nosé Fabio B. Daga Walton Nosé Niro Kasahara 《Burns : journal of the International Society for Burn Injuries》2017,43(2):424-428
Purpose
To evaluate the efficacy of mannitol solution as a decontamination agent on the chemical burn of the human corneas.Methods
Eight donor corneas from an eye bank were exposed to 25 μl of 2.5% hydrofluoric acid (HF) solution on a filter paper for 20 s. Three eyes were rinsed with 1000 ml of mannitol 20% for 15 min immediately after removal of the filter paper, 3 other were rinsed with sodium chloride (NaCl) 0.9% (1000 ml for 15 min) and two eyes were not rinsed. Microstructural changes were monitored in the time domain by optical coherence tomography (OCT) imaging for 75 min.Results
NaCl reduced the penetration depth to approximately half the thickness of the cornea at 15 min; scattering within the anterior cornea was higher than that for the unrinsed eye. With mannitol, no increased scattering was observed in the posterior part of the corneal stroma within a time period of 1 h after rinsing. OCT images revealed low-scattering intensity within the anterior stroma at the end of the rinsing period.Conclusion
In eye bank human corneas, mannitol proved to be an efficient agent to decontaminate HF burn. 相似文献4.
Lisa Martin Michelle Byrnes Sarah McGarry Suzanne Rea Fiona Wood 《Burns : journal of the International Society for Burn Injuries》2017,43(1):76-83
Introduction
Visible scarring after burn causes social challenges which impact on interpersonal connection. These have health impacts which may worsen outcomes for burn patients and reduce the potential for posttraumatic growth (PTG).Aim
The aim of the study was to investigate adult burn survivors’ experiences of interpersonal relationships as potential barriers to posttraumatic recovery following hand or face burns.Method
This qualitative study explored patient experiences of interpersonal situations. A purposive sample (n = 16) who had visible burn scarring were interviewed more than two years after their burn.Results
Emotional barriers included the fear of rejection, feelings of self-consciousness, embarrassment and humiliation. Situational barriers included inquisitive questions, comments and behaviours of others. Responses depended on the relationship with the person, how they were asked and the social situation. Active coping strategies included positive reframing, humour, changing the self, and pre-empting questions. Avoidant coping strategies included avoidance of eye contact, closed body language, hiding scars, and learning to shut down conversations.Conclusion
Emotional and situational barriers reduced social connection and avoidant coping strategies reduced the interaction of people with burns with others. Active coping strategies need to be taught to assist with social reintegration. This highlights the need for peer support, family support and education, and social skills training. 相似文献5.
Introduction
Tamsulosin is an α-1A-specific blocker inducing selective relaxation of ureteral smooth muscle and inhibition of ureteral spasms leading to ureteral dilatation that can facilitates retrograde ureterorenoscopy (URS).Objective
To assess the efficacy of tamsulosin in improving the outcome of URS management of lower ureteral stones.Patients and methods
This prospective, randomised, controlled, clinical trial was carried out between June 2011 and December 2014. It included 98 patients with lower ureteral stones scheduled for treatment with URS. Before URS, patients were randomly divided into 2 groups; study group including 51 patients, in which pre-URS daily oral dose of tamsulosin 0.4 mg tab, for 1 week, was given and control group including 47 patients who received no additional therapy rather than standard analgesic on demand. The URS outcomes were evaluated and compared between both groups.Results
The demographic and stone characteristics were comparable between both groups. The mean URS time was significantly shorter in study group than in control group (52.0 ± 14.9 min vs. 71.0 ± 17.3 min; p = 0.039). Of the 98 patients, 89 (90.81%) had a successful URS procedures. The success rate was 94.1% (98/51) in study group compared 89.2% (58/65) in the control group, with statistically significant difference (p = 0.045). The major complications occurred in 4.25% of patients in control group but in only 1.96% of those received tamsulosin (p = 0.034).Conclusion
Post-tamsulosin ureteroscopy was easier and safer; leading to significantly increased stone-free rates and fewer complications. 相似文献6.
Roberto Eljaiek Christophe Heylbroeck Marc-Jacques Dubois 《Burns : journal of the International Society for Burn Injuries》2017,43(1):17-24
Objective
The objective was to systematically review the literature summarizing the effect on mortality of albumin compared to non-albumin solutions during the fluid resuscitation phase of burn injured patients.Data sources
We searched MEDLINE, EMBASE and CENTRAL and the content of two leading journals in burn care, Burns and Journal of Burn Care and Research.Study selection
Two reviewers independently selected randomized controlled trials comparing albumin vs. non-albumin solutions for the acute resuscitation of patients with >20% body surface area involvement.Data extraction
Reviewers abstracted data independently and assessed methodological quality of the included trials using predefined criteria.Data synthesis
A random effects model was used to assess mortality. We identified 164 trials of which, 4 trials involving 140 patients met our inclusion criteria. Overall, the methodological quality of the included trials was fair. We did not find a significant benefit of albumin solutions as resuscitation fluid on mortality in burn patients (relative risk (RR) 1.6; 95% confidence interval (CI), 0.63–4.08). Total volume of fluid infusion during the phase of resuscitation was lower in patients receiving albumin containing solution ?1.00 ml/kg/%TBSA (total body surface area) (95% CI, ?1.42 to ?0.58).Conclusion
The pooled estimate demonstrated a neutral effect on mortality in burn patients resuscitated acutely with albumin solutions. Due to limited evidence and uncertainty, an adequately powered, high quality trial could be required to assess the impact of albumin solutions on mortality in burn patients. 相似文献7.
Ji Shizhao Zheng Yongjun Zhang Lisen Luo pengfei Zheng Xiaopeng Wang Guangyi Zhu Shihui Hu Xiaoyan Xiao Shichu Xia Zhaofan 《Burns : journal of the International Society for Burn Injuries》2017,43(1):206-214
Background
The shortage of autologous skin sources not only adds difficulty to the repair of extremely large-area deep burn wounds but affects the healing quality. The aim of the present study is to explore an ideal method for repairing large-areas burn wounds with low scar formation.Methods
Between 2002 and 2014, we used grafting of small auto- and cryopreserved allo-skin to repair large-area residual burn wounds in wounds after 21 days 21 patients, and after early excision in 17 patients. The wound healing rate and quality were observed.Results
The skin expansion rate was 1:9–1:16, and the mean area of wounds repaired after three weeks was 64.8 ± 7.3%TBSA, the wound healing rate was 91.8 ± 3.7%. The mean area of the early excision group was 65.9 ± 9.8 TBSA, where the healing rate was 94.5 ± 5.6%. After small auto- and cryopreserved allograft skin grafting, the epidermis of the auto-skin gradually replaced the allo-epidermis, and the allo-dermis persisted for a prolonged period. The dermal collagen fibers at the allo-skin grafting sites were well arranged. At 1–2-year follow-up, observation showed that the Vancouver Scar Scale total score was 4·304 ± 2·363, and we did not discern significant contracture and dysfunction in the large joints of the four extremities.Conclusions
Small auto- and cryopreserved allograft skin grafting of small auto- and allo-skin not only raised the graft expansion rate but offers a stable wound healing rate. This new technique may provide an option for repair of large-area deep burn wounds. 相似文献8.
Laquanda T. Knowlin Lindsay B. Stanford Bruce A. Cairns Anthony G. Charles 《Burns : journal of the International Society for Burn Injuries》2017,43(2):366-373
Introduction
Burns cause physiologic changes in multiple organ systems in the body. Burn mortality is usually attributable to pulmonary complications, which can occur in up to 41% of patients admitted to the hospital after burn. Patients with preexisting comorbidities such as chronic lung diseases may be more susceptible. We therefore sought to examine the impact of preexisting respiratory disease on burn outcomes.Methods
A retrospective analysis of patients admitted to a regional burn center from 2002–2012. Independent variables analyzed included basic demographics, burn mechanism, presence of inhalation injury, TBSA, pre-existing comorbidities, smoker status, length of hospital stay, and days of mechanical ventilation. Bivariate analysis was performed and Cox regression modeling using significant variables was utilized to estimate hazard of progression to mechanical ventilation and mortality.Results
There were a total of 7640 patients over the study period. Overall survival rate was 96%. 8% (n = 672) had a preexisting respiratory disease. Chronic lung disease patients had a higher mortality rate (7%) compared to those without lung disease (4%, p < 0.01). The adjusted Cox regression model to estimate the hazard of progression to mechanical ventilation in patients with respiratory disease was 21% higher compared to those without respiratory disease (HR = 1.21, 95% CI = 1.01–1.44). The hazard of progression to mortality is 56% higher (HR = 1.56, 95% CI = 1.10–2.19) for patients with pre-existing respiratory disease compared to those without respiratory disease after controlling for patient demographics and injury characteristics.Conclusion
Preexisting chronic respiratory disease significantly increases the hazard of progression to mechanical ventilation and mortality in patients following burn. Given the increasing number of Americans with chronic respiratory diseases, there will likely be a greater number of individuals at risk for worse outcomes following burn. 相似文献9.
Nicolò Maria Buffi Giovanni Lughezzani Rodolfo Hurle Massimo Lazzeri Gianluigi Taverna Giorgio Bozzini Riccardo Bertolo Enrico Checcucci Francesco Porpiglia Nicola Fossati Giorgio Gandaglia Alessandro Larcher Nazareno Suardi Francesco Montorsi Giuliana Lista Giorgio Guazzoni Alexandre Mottrie 《European urology》2017,71(6):945-951
10.
Mathieu Fontaine Jacques Latarjet Jacqueline Payre Jean-Charles Poupelin François Ravat 《Burns : journal of the International Society for Burn Injuries》2017,43(2):337-342
Introduction
The severe pain related to repeated burn dressing changes at bedside is often difficult to manage. However these dressings can be performed at bedside on spontaneously breathing non-intubated patients using powerful intravenous opioids with a quick onset and a short duration of action such as alfentanil. The purpose of this study is to demonstrate the efficacy and safety of the protocol which is used in our burn unit for pain control during burn dressing changes.Patients and methods
Cohort study began after favorable opinion from local ethic committee has been collected. Patient’s informed consent was collected. No fasting was required. Vital signs for patients were continuously monitored (non-invasive blood pressure, ECG monitoring, cutaneous oxygen saturation, respiratory rate) all over the process. Boluses of 500 (±250) mcg IV alfentanil were administered. A continuous infusion was added in case of insufficient analgesia. Adverse reactions were collected and pain intensity was measured throughout the dressing using a ten step verbal rating scale (VRS) ranging from 0 (no pain) to 10 (worst pain conceivable).Results
100 dressings (35 patients) were analyzed. Median age was 45 years and median burned area 10%. We observed 3 blood pressure drops, 5 oxygen desaturations (treated with stimulation without the necessity of ventilatory support) and one episode of nausea. Most of the patients (87%) were totally conscious during the dressing and 13% were awakened by verbal stimulation. Median total dose of alfentanil used was 2000 μg for a median duration of 35 min. Pain scores during the procedure were low or moderate (VRS mean = 2.0 and maximal VRS = 5). Median satisfaction collected 2 h after the dressing was 10 on a ten step scale.Conclusion
Pain control with intravenous alfentanil alone is efficient and appears safe for most burn bedside repeated dressings in hospitalized patients. It achieves satisfactory analgesia during and after the procedure. It is now our standard analgesic method to provide repeated bedside dressings changes for burned patients. 相似文献11.
A. Abdulkadir M. Ahmed B.M. Abubakar I.E. Suleiman I. Yusuf I.M. Imam A.A Sule U.M. Tela H.M Dogo A.M. Yakasai B.M. Musa 《The African Journal of Urology》2017,23(3):228-239
Introduction
The Global signi?cance of schistosomiasis started waning over the years owing to its eradication in most developed societies, until the reawaking of global attention and it now occupies a prominent place amongst the neglected tropical diseases (NTD). The aim of our study was to accurately estimate the prevalence of schistosomiasis in Nigeria, and its six geo-political zones.Subjects and methods
We utilized electronic databases to search and select studies on prevalence across the geographical zones between 1994 and 2015. STATA 10 Random effects meta-analysis of observational studies was used to generate our estimates.Result
Sixty-seven studies met the inclusion criteria. The uni?ed pooled population studied was 47,440 (n = 14,888 persons). The pooled prevalence]) of Schistosoma haematobium infestation was, for all regions = 34.7% (31.0–38.5) (95% con?dence interval [CI)).Conclusion
Schistosomal infestations remain hyperendemic in Nigeria. Nigeria must, therefore, expedite the execution of resolution WHA66.12 adopted by the World Health Assembly on NTD. 相似文献12.
Laura Pompermaier Ingrid Steinvall Mats Fredrikson Johan Thorfinn Folke Sjöberg 《Burns : journal of the International Society for Burn Injuries》2017,43(1):157-161
Introduction
As widely reported, the progress in burn care during recent decades has reduced the hospital mortality. The effect of the burns on long-term outcome has not received so much attention, and more study is indicated. The aim of this retrospective study was to investigate the long-time survival among patients who had been treated for burns.Methods
We studied 1487 patients who were discharged alive from the Linköping University Hospital Burn Centre during the period 1993 until the end of December 2012. We used Cox's regression analysis to study the effect of burns on long-term survival after adjustment for different factors.Results
Age and a full-thickness burn were significantly associated with mortality after discharge (p < 0.001), whereas percentage of total body surface area burned (TBSA %), need for mechanical ventilation, and gender were not. Less than 1% of the patients with burns (13/1487) died within 30 days of discharge and a total of 176/1487 (12%) died during follow-up.Conclusion
Age and full-thickness burns reduce the long-time survival after discharge from the Burn Centre, whereas the effect of TBSA% and need for artificial ventilation ends with discharge 相似文献13.
Elza H.T. Anami Elisangela F. Zampar Marcos T. Tanita Lucienne T.Q. Cardoso Tiemi Matsuo Cintia Magalhães C. Grion 《Burns : journal of the International Society for Burn Injuries》2017,43(2):350-356
Objectives
To analyze the direct costs of treating critically ill patients in the intensive care unit of a center specializing in treating burns.Methods
This is a prospective cohort study of 180 patients from May 2011 to May 2013. Clinical and demographic data were collected in addition to data for the calculation of severity scores. The costs related to daily clinical and surgical treatment were evaluated until hospital outcome. The costs were grouped into five blocks: Clinical support, Drugs and blood products, Medical procedures, Specific burn procedures and Hospital fees. The level of significance was set at 5%.Results
There was a predominance of males, 131 (72.8%). The mean age of the patients was 42.0 ± 15.3 years and the mean burned body surface area was 27.9 ± 17%. The median length of stay in intensive care beds was 15.0 (interquartile range IQR: 7.0–24.8) days and the median hospital stay was 23.0 (IQR: 14.0–34.0) days. The mean daily cost was US$ 1330.48 (standard error of the mean SE = 38.36) and the mean total cost of hospitalization was US$ 39,594.90 (SE: 2813.11). The drugs and blood products block accounted for the largest fraction of the total costs (US$ 18,086.09; SE 1444.55). There was a difference in the daily costs of survivors and non survivors (US$ 1012.89; SE: 29.38 and US$ 1866.11, SE: 36.43, respectively, P < 0.001).Conclusion
The direct costs of the treatment of burn patients at the study center were high. The drugs and blood products block presented the highest mean total and daily costs. Non surviving patients presented higher costs. 相似文献14.
Madhur Nayan Michael A.S. Jewett Ali Hosni Lynn Anson-Cartwright Philippe L. Bedard Malcolm Moore Aaron R. Hansen Peter Chung Padraig Warde Joan Sweet Martin O’Malley Eshetu G. Atenafu Robert J. Hamilton 《European urology》2017,71(1):120-127
Background
Patients on surveillance for clinical stage I (CSI) testicular cancer are counseled regarding their baseline risk of relapse. The conditional risk of relapse (cRR), which provides prognostic information on patients who have survived for a period of time without relapse, have not been determined for CSI testicular cancer.Objective
To determine cRR in CSI testicular cancer.Design, setting, and participants
We reviewed 1239 patients with CSI testicular cancer managed with surveillance at a tertiary academic centre between 1980 and 2014.Outcome measurements and statistical analysis
cRR estimates were calculated using the Kaplan-Meier method. We stratified patients according to validated risk factors for relapse. We used linear regression to determine cRR trends over time.Results and limitations
At orchiectomy, the risk of relapse within 5 yr was 42.4%, 17.3%, 20.3%, and 12.2% among patients with high-risk nonseminomatous germ cell tumor (NSGCT), low-risk NSGCT, seminoma with tumor size ≥3 cm, and seminoma with tumor size <3 cm, respectively. However, for patients without relapse within the first 2 yr of follow-up, the corresponding risk of relapse within the next 5 yr in the groups was 0.0%, 1.0% (95% confidence interval [CI] 0.3–1.7%), 5.6% (95% CI 3.1–8.2%), and 3.9% (95% CI 1.4–6.4%). Over time, cRR decreased (p ≤ 0.021) in all models. Limitations include changes to surveillance protocols over time and few late relapses.Conclusions
After 2 yr, the risk of relapse on surveillance for CSI testicular cancer is very low. Consideration should be given to adapting surveillance protocols to individualized risk of relapse based on cRR as opposed to static protocols based on baseline factors. This strategy could reduce the intensity of follow-up for the majority of patients.Patient summary
Our study is the first to provide data on the future risk of relapse during surveillance for clinical stage I testicular cancer, given a patient has been without relapse for a specified period of time. 相似文献15.
Ian D. Davis Wanling Xie Carmel Pezaro Frede Donskov J. Connor Wells Neeraj Agarwal Sandy Srinivas Takeshi Yuasa Benoit Beuselinck Lori A. Wood D. Scott Ernst Ravindran Kanesvaran Jennifer J. Knox Allan Pantuck Sadia Saleem Ajjai Alva Brian I. Rini Jae-Lyun Lee Daniel Y.C. Heng 《European urology》2017,71(6):970-978
Background
We hypothesized that changes in International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic category at start of second-line therapy (2L) for metastatic renal cell carcinoma (mRCC) might predict response.Objective
To assess outcomes of 2L according to type of therapy and change in IMDC prognostic category.Design, setting, and participants
We performed a retrospective review of the IMDC database for mRCC patients who received first-line (1L) VEGF inhibitors (VEGFi) and then 2L with VEGFi or mTOR inhibitors (mTORi). IMDC prognostic categories were defined before each line of therapy (favorable, F; intermediate, I; poor, P). Data were analyzed for 1516 patients, of whom 89% had clear cell histology.Intervention
All included patients received targeted therapy for mRCC.Outcome measurements and statistical analysis
Overall survival (OS), time to treatment failure, and response to 2L were analyzed using Cox or logistic regression.Results and limitations
At start of 2L, 60% of patients remained in the same prognostic category; 9.0% improved (3% I → F; 6% P → I); 31% deteriorated (15% F → I or P; 16% I → P). Patients with the same or better IMDC prognostic category had a longer time to treatment failure if they remained on VEGFi compared to those who switched to mTORi (adjusted hazard ratio [AHR] ranging from 0.33 to 0.78, adjusted p < 0.05). Patients who deteriorated from F to I appeared more likely to benefit from switching to mTORi (median OS 16.5 mo, 95% confidence interval [CI] 12.0–19.0 for VEGFi; 20.2 mo, 95% CI 14.3–26.1 for mTORi; AHR 1.53, 95% CI 1.04–2.24; adjusted p = 0.03).Conclusions
Changes in IMDC prognostic category predict the subsequent clinical course for patients with mRCC and provide a rational basis for selection of subsequent therapy.Patient summary
The pattern of treatment failure might help to predict what the next treatment should be for patients with metastatic renal cell carcinoma. 相似文献16.
Martijn G. Schouten Marloes van der Leest Morgan Pokorny Martijn Hoogenboom Jelle O. Barentsz Les C. Thompson Jurgen J. Fütterer 《European urology》2017,71(6):896-903
Background
Knowledge of significant prostate (sPCa) locations being missed with magnetic resonance (MR)- and transrectal ultrasound (TRUS)-guided biopsy (Bx) may help to improve these techniques.Objective
To identify the location of sPCa lesions being missed with MR- and TRUS-Bx.Design, setting, and participants
In a referral center, 223 consecutive Bx-naive men with elevated prostate specific antigen level and/or abnormal digital rectal examination were included. Histopathologically-proven cancer locations, Gleason score, and tumor length were determined.Intervention
All patients underwent multi-parametric MRI and 12-core systematic TRUS-Bx. MR-Bx was performed in all patients with suspicion of PCa on multi-parametric MRI (n = 142).Outcome measurements and statistical analysis
Cancer locations were compared between MR- and TRUS-Bx. Proportions were expressed as percentages, and the corresponding 95% confidence intervals were calculated.Results and limitations
In total, 191 lesions were found in 108 patients with sPCa. From these lesion 74% (141/191) were defined as sPCa on either MR- or TRUS-Bx. MR-Bx detected 74% (105/141) of these lesions and 61% (86/141) with TRUS-Bx. TRUS-Bx detected more lesions compared with MR-Bx (140 vs 109). However, these lesions were often low risk (39%). Significant lesions missed with MR-Bx most often had involvement of dorsolateral (58%) and apical (37%) segments and missed segments with TRUS-Bx were located anteriorly (79%), anterior midprostate (50%), and anterior apex (23%).Conclusions
Both techniques have difficulties in detecting apical lesions. MR-Bx most often missed cancer with involvement of the dorsolateral part (58%) and TRUS-Bx with involvement of the anterior part (79%).Patient summary
Both biopsy techniques miss cancer in specific locations within the prostate. Identification of these lesions may help to improve these techniques. 相似文献17.
K.H. Tijani C.C. Anunobi A.O. Adeyomoye T.O. Alabi A.O. Lawal N.O. Akanmu R.W. Ojewola O.O. Soriyan 《The African Journal of Urology》2017,23(1):14-19
Introduction
In Western and Asian literature, the measurement of percentage free prostate specific antigen (%fPSA) has been known to enhance the predictive role of total prostate specific antigen (tPSA) in early prostate cancer (Ca-P) detection. Relationship between the tPSA and Ca-P are known to be influenced by race. To the best of our knowledge, the relationship between %fPSA and Ca-P has not been studied in sub-Saharan Africa using current established biopsy protocol.Objective
To evaluate the usefulness of %fPSA in indigenous West African men and determine the appropriate cut-off values that may be used as indication for prostate biopsy in men with tPSA of 4–10 ng/ml.Subjects and methods
A total 169 consecutive patients with tPSA of 4–10 ng/ml with non-suspicious findings on digital rectal examination (DRE) had a transrectal ultrasound (TRUS) guided 10-core prostate biopsy. The technique of PSA analysis was the Access hybritech assay technique using the Beckman's Access autoimmuno analyser. The rates of prostate cancer in different %fPSA ranges were evaluated. Receiver operating characteristic curve (ROC) was used to evaluate the efficiency of %fPSA in the diagnosis of prostate cancer.Results
A reduction %fPSA was associated with a higher detection rate of Ca-P. There was a 62% prevalence of Ca-P with %fPSA ≤ 10% while there was a zero prevalence in patients with fPSA above 20%. At a %fPSA cut off of 20% the sensitivity and specificity were 100% and 45%, respectively. Using the ROC curve, the area under the curve (AUC) was 0.76 while the ROC decision plot showed that a %fPSA cut off 15% was associated with the highest ability to discriminate between benign and malignant diseases.Conclusion
The %fPSA is an effective discriminating tool in determining the need for prostate biopsy in indigenous West African men with PSA 4–10 ng/ml. A cut off of 15% was associated with the highest performance. 相似文献18.
Anne-Françoise Rousseau Pierre Damas Pierre Delanaye Etienne Cavalier 《Burns : journal of the International Society for Burn Injuries》2017,43(1):176-181
Objective
Bone changes are increasingly described after burn. How bone markers could help to detect early bone changes or to screen burn patients at higher risk of demineralization is still not made clear. We performed an observational study assessing the changes in serum bone markers after moderate burn.Methods
Adults admitted in the first 24 h following burn extended on >10% body surface area were included. Serum levels of collagen type 1 cross-linked C-telopeptide (CTX), tartrate-resistant acid phosphatase 5b (TRAP), type 1 procollagen N-terminal (P1NP) and bone alkaline phosphatase (b-ALP) were measured at admission and every week during the first month. Data are expressed as median [min-max].Results
Bone markers were measured in 20 patients: 18 men, 2 women (including one post-menopausal). Age was 46 [19–86] years old, burn surface area reached 15 [7–85] %. Twelve patients completed the study. All biomarkers mainly remained into normal ranges during evolution. A huge variability was observed regarding biomarkers evolution. Patient's evolution was not linear and could fluctuate from a decrease to an increase of blood concentrations. There was not necessarily a consistency between the two formation or the two resorption markers. Variations observed between two consecutive measurements were lesser than the accepted critical difference in almost one third of the cases.Conclusions
Considering available data, role and interest of bone markers in management of burn related bone disease remain unclear. 相似文献19.
Introduction
With the increasing trend of antibiotic resistance, the management of urinary tract infection (UTI) is likely to become complicated, and there is a need for continuous surveillance of antibiotic susceptibility of uropathogens.Objective
This study aimed to assess the current antimicrobial susceptibility pattern in the common uropathogens isolated from outpatients and hospitalized (<72 h).Subjects and methods
This was a prospective observational study examining urinary isolates from patients aged ≥18 years. Urine samples were collected from 494 consecutive outpatient adults, clinically-suspected cases of urinary tract infections. Bacterial identification and antimicrobial susceptibility testing were carried out using the VITEK® 2 Compact kit of bioMérieux.Results
The observed prevalence of UTI was (132/494) 26.7%, 95% CI [22.9%; 30.9%]. Among the 147 organisms isolated from 132 patients, more than 90% (133) were Gram-negative bacteria. Imipenem appeared as the most active drug, with less than 3% resistance of isolates. Amikacin and cefotaxim were in general active with susceptibility rate of 70% and 67% of isolates, respectively. However cefixim was the most active oral drug tested (61%). Trimethoprim/sulfamethoxazole, nalidixic acid and fluoroquinolons were the less active drug displaying a resistance rate of 73%, 69% and 60% respectively.Conclusion
Trimethoprim/sulfamethoxazole, nalidixic acid and fluoroquinolons should no longer be used as empirical treatments of UTI in Dakar. Alternatives must be recommended, such as cefixim the most active oral drugs available in this country. 相似文献20.
Boris Gershman Holly K. Van Houten Jeph Herrin Daniel M. Moreira Simon P. Kim Nilay D. Shah R. Jeffrey Karnes 《European urology》2017,71(1):55-65