共查询到20条相似文献，搜索用时 31 毫秒
1.
Stephanie M. Cruz Patricio E. Lau Craig G. Rusin Candace C. Style Darrell L. Cass Caraciolo J. Fernandes Timothy C. Lee Christopher J. Rhee Sundeep Keswani Rodrigo Ruano Stephen E. Welty Oluyinka O. Olutoye 《Journal of pediatric surgery》2018,53(1):152-158
Background/purpose
The purpose of this study was to develop a computational algorithm that would predict the need for ECMO in neonates with congenital diaphragmatic hernia (CDH).Methods
CDH patients from August 2010 to 2016 were enrolled in a study to continuously measure cerebral tissue oxygen saturation (cStO2) of left and right cerebral hemispheres. NIRS devices utilized were FORE-SIGHT, CASMED and INVOS 5100, Somanetics. Using MATLAB©, a data randomization function was used to deidentify and blindly group patient's data files as follows: 12 for the computational model development phase (6 ECMO and 6 non-ECMO) and the remaining patients for the validation phase.Results
Of the 56 CDH patients enrolled, 22 (39%) required ECMO. During development of the algorithm, a difference between right and left hemispheric cerebral oxygenation via NIRS (ΔHCO) was noted in CDH patients that required ECMO. Using ROC analysis, a ΔHCO cutoff > 10% was predictive of needing ECMO (AUC: 0.92; sensitivity: 85%; and specificity: 100%). The algorithm predicted need for ECMO within the first 12 h of life and at least 6 h prior to the clinical decision for ECMO with 88% sensitivity and 100% specificity.Conclusion
This computational algorithm of cerebral NIRS predicts the need for ECMO in neonates with CDH.Level of evidence
II 相似文献2.
Stan Janssen Kim Heiwegen Iris ALM van Rooij Horst Scharbatke Jolt Roukema Ivo de Blaauw Sanne MBI Botden 《Journal of pediatric surgery》2018,53(3):508-512
Background
Patients born with a congenital diaphragmatic hernia (CDH) have a high mortality and morbidity. After discharge, complications and long-term morbidity are still encountered. This study describes the factors related to the surgical long-term outcomes in CDH survivors.Methods
A cohort of CDH patients born between 2000 and 2014, with a minimum of two years follow up, were included in this retrospective study. Demographics, CDH specific characteristics, treatment, and long-term surgical outcome were evaluated using multivariate logistic regression analyses.Results
112 patients were included, with a mean follow up of 7.3 years (SD 3.8). The majority had primary repair, but 31% received patch repair. Recurrence was reported in 7% of all patients. However, recurrence risk increased for patients with extracorporeal membrane oxygenation (ECMO) treatment (ORadjusted: 6.3, 95% CI: 1.2–33.9). This risk was highest for patients needing both ECMO and patch repair (OR: 11.2, 95% CI: 2.3–54.1). Small bowel obstructions (SBO) were observed in 20% and was associated with patch repair (ORadjusted: 3.5, 95% CI: 1.2–10.0), but ECMO treatment seemed to reduce this risk (ORadjusted: 0.2, 95% CI: 0.0–1.0). Thoracic deformations (36%) was diagnosed most often after patch repair, especially when ECMO was needed (60%) as well.Conclusions
This retrospective study shows that the incidence of surgical long-term morbidity of CDH is relatively high, with different factors accounting for this. Diaphragmatic hernia recurrence was strongest associated with ECMO treatment in combination with patch repair, while SBO's were associated with patch repair, with an unexpected protective effect of ECMO treatment.Type of study
Retrospective comparative study - Level III evidence. 相似文献3.
Tim Jancelewicz Mary E. Brindle Matthew T. Harting Elizabeth A. Tolley Max R. Langham Pamela A. Lally Ankush Gosain Stephanie A. Storgion David W. Kays 《Journal of pediatric surgery》2018,53(10):1890-1895
Background
A means for early postnatal stratification of ECMO risk in CDH newborns could be used to comparatively assess the utilization and outcomes of ECMO use between centers. While multiple CDH mortality risk calculators are available, no validated tool exists specifically for prediction of ECMO use. The purpose of this study was to derive and validate an ECMO risk stratification model.Methods
The study population was obtained from CDH Study Group registry for the period between 2007 and 2016. Only centers offering ECMO were included. The cohort was restricted to ECMO candidates and then divided into derivation and validation sets. Using all relevant perinatal predictors in the registry, univariate analysis was performed for the composite outcome of ECMO use or death without ECMO use. The model was derived using the derivation cohort with multivariable logistic regression and automatic stepwise forward selection (P?<?0.05 for qualifying variables), and a c-statistic was obtained. The model was then tested on the validation cohort. Sample reuse validation and bootstrap validation were performed. The validated model was then tested for accuracy on CDH subgroups.Results
There were 1992 patients in the derivation cohort. Four significant variables were identified in the final ECMO risk model: 1-min and 5-min Apgar scores and highest and lowest post-ductal partial pressure of CO2 during the first 24?h of life. The model c-statistic was 0.824 which was confirmed with cross-validation and bootstrap optimism correction. The validation cohort c-statistic was 0.823 (N?=?993). The model had good discrimination for left and right CDH, inborn and outborn patients, patients born before and after 2011, and high and low volume centers. The model performed significantly better for postnatally diagnosed patients.Conclusions
This study represents proof-of-concept that a risk model can accurately estimate the probability of ECMO use in CDH newborns. This stratification could assist centers as a metric for assessment of ECMO usage and outcomes. Refinement and prospective validation of this model should be carried out prior to clinical application.Level of Evidence
3. 相似文献4.
Yigit S. Guner Matthew T. Harting Kelly Fairbairn Patrick T. Delaplain Lishi Zhang Yanjun Chen Mustafa H. Kabeer Peter Yu John P. Cleary James E. Stein Charles Stolar Danh V. Nguyen 《Journal of pediatric surgery》2018,53(11):2092-2099
Purpose
Previous studies comparing extracorporeal membrane oxygenation (ECMO) modality for congenital diaphragmatic hernia (CDH) have not accounted for confounding by indication. We therefore hypothesized that using a propensity score (PS) approach to account for selection bias may identify outcome differences based on ECMO modality for infants with CDH.Methods
We utilized ELSO Registry data (2000–2016). Patients with CDH were divided to either venoarterial (VA) or venovenous (VV) ECMO. Patients were matched by PS to control for nonrandom treatment assignment. Subgroup analyses were conducted based on timing of CDH repair relative to ECMO. Primary analysis was the “intent-to-treat” cohort based on the initial ECMO mode. Mortality was the primary outcome, and severe neurologic injury (SNI) was a secondary outcome.Results
PS matching (3:1) identified 3304 infants (VA?=?2470, VV?=?834). In the main group, mortality was not different between VA and VV ECMO (OR?=?1.01, 95% CI: 0.86–1.18) and there was no difference in SNI between VA and VV (OR?=?0.80; 95% CI: 0.63–1.01). For the pre-ECMO CDH repair subgroup, 175 VA cases were matched to 70 VV. In these neonates, mortality was higher for VV compared to VA (OR?=?2.10, 95% CI: 1.19–3.69), without any difference in SNI (OR?=?1.48; 95% CI: 0.59–3.71). For the subgroup that did not have pre-ECMO CDH repair, 2030 VA cases were matched to 683 VV cases. In this subgroup, VV was associated with 27% lower risk of SNI relative to VA (OR?=?0.73, 95% CI: 0.56–0.95) without any difference in mortality (OR?=?0.94, 95% CI: 0.79–1.11).Conclusion
This study revalidates that ECMO mode does not significantly affect mortality or SNI in infants with CDH. In the subset of infants who require pre-ECMO CDH repair, VA favors survival, whereas, in the subgroup of infants that did not have pre-ECMO CDH repair, VV favors lower rates of SNI. We conclude that neither mode appears consistently superior across all situations, and clinical judgment should remain a multifactorial decision.Level of evidence
Level III. 相似文献5.
Emily A. Partridge Marcus G. Davey Matthew Hornick Kevin C. Dysart Aliza Olive Robert Caskey James T. Connelly Holly L. Hedrick William H. Peranteau Alan W. Flake 《Journal of pediatric surgery》2018,53(8):1453-1460
Background
Extracorporeal membrane oxygenation (ECMO) is commonly required in neonates with congenital diaphragmatic hernia (CDH) complicated by pulmonary hypertension (PH). ECMO carries significant risk, and is contraindicated in the setting of extreme prematurity or intracranial hemorrhage. Pumpless arteriovenous ECMO (P-ECMO) may represent an alternative for respiratory support. The present study summarizes our initial experience with P-ECMO in a lamb model of CDH.Study design
Surgical creation of CDH was performed at 65–75 days' gestation. At term (135–145 days), lambs were delivered into the P-ECMO circuit. Three animals were maintained on a low-heparin infusion protocol (target ACT 160–180) and three animals were maintained with no systemic heparinization.Results
Animals were supported by the circuit for 380.7 +/? 145.6 h (range, 102–504 h). Circuit flow rates ranged from 97 to 208 ml/kg/min, with adequacy of organ perfusion demonstrated by stable serum lactate levels (3.0 +/? 1.7) and pH (7.4 +/? 0.3). Necropsy demonstrated no evidence of thrombogenic complications.Conclusion
Pumpless extracorporeal membrane oxygenation achieved support of CDH model lambs for up to three weeks. This therapy has the potential to bridge neonates with decompensated respiratory failure to CDH repair with no requirement for systemic anticoagulation, and may be applicable to patients currently precluded from conventional ECMO support. 相似文献6.
Carmen Mesas Burgos Björn Frenckner Matias Luco Matthew T. Harting Pamela A. Lally Kevin P. Lally 《Journal of pediatric surgery》2018,53(1):113-117
Background
Right-sided congenital diaphragmatic hernias (CDH) and bigger defect sizes have been associated with poorer outcomes.Aim
The aim of this study was to evaluate right- and left-sided CDH in terms of size, survival, associated anomalies, and morbidity.Material and methods
We used information from a multicenter, multinational database including patients with CDH born between 2007 and 2015. All infants with data on defect side were included for this analysis. We compared differences in outcomes between right- and left-sided CDH. Further analysis on the association between side, size of the defect, and outcome was performed.Results
A total of 3754 cases of CDH were entered in the registry between January 2007 and September 2015, with an overall survival of 71%. Of those, 598 (16%) were right-sided and 3156 left-sided, with a survival rate of 67% and 72%, respectively. Right-sided CDH had a larger proportion of C and D defects (p < 0.001 and 0.04, respectively). Survival rates for the same size defect were similar, independent of the side of the defect. Multivariable logistic regression analysis with survival as dependent variable identified a significant correlation with defect size, but not side.Conclusions
The higher proportion of large defects (C & D) in right-sided CDH, not the side itself, accounts for the reported poorer survival in right-sided CDH.Level of evidence
Level I for a prognosis study – This is a high-quality, prospective cohort study with 99% of patients followed to the study end point (death or discharge). 相似文献7.
Emily H. Steen Timothy C. Lee Adam M. Vogel Sara C. Fallon Caraciolo J. Fernandes Candace C. Style Mariatu A. Verla Swathi Balaji Oluyinka O. Olutoye Sundeep G. Keswani 《Journal of pediatric surgery》2019,54(1):50-54
Background
The benefits to early repair (< 72?h postcannulation) of infants with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO) are increasingly recognized. Yet it is not known if even earlier repair (< 24?h) results in comparable or improved patient outcomes. The goal of this study was to compare “super-early” (< 24?h) to early repair (24-72?h) of CDH patients on ECMO.Methods
A retrospective review of infants with CDH placed on ECMO (2004–2017; n?=?72) was performed. Data collected on the patients repaired while on ECMO within 72?h of cannulation (n?=?33) included pre- and postnatal disease severity stratification variables and postnatal outcomes. Comparison groups were those patients repaired within 24?h of cannulation (n?=?14) and those repaired between 24 and 72?h postcannulation (n?=?19).Results
Patients undergoing “super-early” (< 24?h) repair had an average survival of 71.4% compared to the average survival of 59.7% in the early repair group. Pre- and postnatal variables predicting disease severity were not significantly different between the groups. Mean hospital stays, ventilator days, and cannulation days were statistically similar between the groups.Conclusions
Repair of patients with CDH patients on ECMO at less than 24?h postcannulation achieves outcomes that are comparable to those of repair between 24 and 72?h. While the present data suggest that there is not a “too early” time point for CDH repair on ECMO, larger multicenter studies are needed to validate our findings and determine the overall benefits.Type of study
Retrospective comparative study.Level of evidence
Level III. 相似文献8.
Heather B. Howell Christiana Farkouh-Karoleski Marilyn Weindler Rakesh Sahni 《Journal of pediatric surgery》2018,53(11):2100-2104
Background
Infants with congenital diaphragmatic hernia (CDH) are at risk for growth failure because of inadequate caloric intake and high catabolic stress. There is limited data on resting energy expenditure (REE) in infants with CDH.Aims
To assess REE via indirect calorimetry (IC) in term infants with CDH who are no longer on respiratory support and nearing hospital discharge with advancing post-conceptional age and to assess measured-to-predicted REE using predictive equations.Methods
A prospective cohort study of term infants with CDH who were no longer on respiratory support and nearing hospital discharge was conducted to assess REE via IC and caloric intake. Baseline characteristics and hospital course data were collected. Three day average caloric intake around time of IC testing was calculated. Change in REE with advancing post-conceptional age and advancing post-natal age was assessed. The average measured-to-predicted REE was calculated for the cohort using predictive equations [22].Results
Eighteen infants with CDH underwent IC. REE in infants with CDH increased with advancing postconceptional age (r2?=?0.3, p?<?0.02). The mean REE for the entire group was 53.2 +/? 10.9?kcal/kg/day while the mean caloric intake was 101.2 +/? 17.4?kcal/kg/day. The mean measured-to-predicted ratio for the cohort was in the normal metabolic range (1.10 +/? 0.17) with 50% of infants considered hypermetabolic and 11% of infants considered hypo-metabolic.Conclusions
Infant survivors of CDH repair who are without respiratory support at time of neonatal hospital discharge have REE, as measured by indirect calorimetry, that increases with advancing post-conceptional age and that is within the normal metabolic range when compared to predictive equations.Level of Evidence
III 相似文献9.
Matthew Wong Janette Reyes Eveline Lapidus-Krol Monping Chiang Tilman Humpl Malikah Al-Faraj Greg Ryan Priscilla P.L. Chiu 《Journal of pediatric surgery》2018,53(5):918-924
Prenatal observed/expected lung–to-head ratio (O/E LHR) by ultrasound correlates with postnatal mortality for congenital diaphragmatic hernia (CDH) patients. The aim of this study is to determine if O/E LHR correlates with pulmonary hypertension (PH) outcomes for CDH patients.
Methods
A single center retrospective chart review was performed for CDH neonates from January 1, 2006, to December 31, 2015, (REB #1000053124) to include prenatal O/E LHR, liver position, first arterial blood gas, repair type, echocardiogram (ECHO), and lung perfusion scan (LPS) results up to 5 years of age.Results
Of 153 newborns, 123 survived (80.4%), 58 (37.9%) had prenatal O/E LHR, and 42 (27.5%) had postnatal ECHO results. High mortality risk neonates (O/E LHR ≤ 45%) correlated with higher right ventricular systolic pressure (RVsp) at birth. Generally PH resolved by age 5 years. LPS results did not change over time (p > 0.05) regardless of initial PH severity, suggesting that PH resolution did not correlate with increased ipsilateral lung perfusion to offload the right ventricle.Conclusion
Prenatal prognostic markers correlated with initial PH severity for CDH newborns, but PH resolved over time despite fixed perfusion bias to the lungs. These results suggest favorable PH outcomes for CDH patients who survive beyond infancy.Type of Study
Retrospective Cohort Study.Level of Evidence
3b 相似文献10.
Ali Kamran Benjamin Zendejas Farokh R. Demehri Bharath Nath David Zurakowski Charles J. Smithers 《Journal of pediatric surgery》2018,53(11):2087-2091
Purpose
To identify technical modifications concerning factors that may lower the risk of recurrence following thoracoscopic repair of congenital diaphragmatic hernia (CDH).Methods
All CDH patients who underwent thoracoscopic repair from April 2003 to September 2017 were retrospectively reviewed. Some of the more recently treated patients underwent technically modified repairs with underlay and overlay buttresses.Results
Sixty-eight patients underwent thoracoscopic repair of a diaphragmatic hernia that presented either neonatally (n?=?52) or beyond the neonatal period (> 1?month) (n?=?16). At our institution, the minimally invasive surgical approach is considered for clinically stable CDH patients, who are likely to have type A or B defects. 21 patients had a sac-type defect. Forty-seven patients with type A defect had primary closure, buttressed in 6 cases. In 21 patients, the type B defect was repaired with a patch, buttressed in 11 patients. Median follow-up was 36?months (IQR 9–45). Recurrence occurred in 13 patients (overall 19% recurrence rate); all had a neonatally presented defect (25% vs. 0%, p?=?0.03). Patients with a sac-type defect had a lower recurrence rate than patients with no hernia sac (5% vs. 26%, p?=?0.05). Recurrence complicated 7 of 47 (15%) patients after primary closure and 6 of 21 (29%) patients with patch repair; none of the 17 cases with buttressed repairs had a recurrence.Conclusions
Due to a higher rate of recurrence following thoracoscopic CDH repair compared to the standard open approach, we suggest a sandwich-type buttress repair with underlay and overlay components for both primary and patch repairs.Level of Evidence
Level III cohort study. 相似文献11.
Jason O. Robertson Cory N. Criss Lily B. Hsieh Niki Matsuko Josh S. Gish Rodrigo A. Mon Kevin N. Johnson Ronald B. Hirschl George B. Mychaliska Samir K. Gadepalli 《Journal of pediatric surgery》2018,53(4):629-634
Purpose
For the last seven years, our institution has repaired infants with CDH that require ECMO early after cannulation. Prior to that, we attempted to decannulate before repair, but repaired on ECMO if we were unable to wean after two weeks. This study compares those strategies.Methods
From 2002 to 2016, 65 infants with CDH required ECMO. 67.7% were repaired on ECMO, and 27.7% were repaired after decannulation. Data were compared between patients repaired ≤ 5 days after cannulation (“early protocol”, n = 30) and > 5 days after cannulation or after de-cannulation (“late protocol”, n = 35). We used Cox regression to assess differences in outcomes between groups.Results
Survival for the early and late protocol groups was 43.3% and 68.8%, respectively (p = 0.0485). For patients that were successfully decannulated before repair, survival was 94.4%. Moreover, the early repair protocol was associated with prolongation of ECMO (16.8 ± 7.4 vs. 12.6 ± 6.8 days, p = 0.0216).After multivariate regression, the early repair protocol was an independent predictor of both mortality (HR = 3.48, 95% CI = 1.28–9.45, p = 0.015) and days on ECMO (IRR = 1.39, 95% CI = 1.07–1.79, p = 0.012). All bleeding occurred in patients repaired on ECMO (29.5%, 13/44).Conclusions
Our data suggest that protocolized CDH repair early after ECMO cannulation may be associated with increased mortality and prolongation of ECMO. However, early repair is not necessarily harmful for those patients who would otherwise be unable to wean from ECMO before repair. Further work is needed to better move towards individualized patient care.Type of study
Treatment Study.Level of evidence
Level III. 相似文献12.
Stan Janssen Kim Heiwegen Iris ALM van Rooij Janielle van Alfen-van der Velden Ivo de Blaauw Sanne MBI Botden 《Journal of pediatric surgery》2019,54(3):445-448
Background
Congenital diaphragmatic hernia (CDH) is a rare birth defect with a high mortality and morbidity. Nonscrotal testes (NST) are the most reported genital anomaly in boys. Both defects have known associated anomalies, but little is known about the association between CDH and NST. This study evaluates this association and the location of the NST in a large cohort of male CDH survivors. Moreover, we analyzed possible associative factors for NST in CDH patients.Methods
A cohort of CDH patients, born between January 2000 and March 2014 and treated in a high volume expertise center, was evaluated retrospectively. Boys with a minimum follow-up of 18 months were included. The patients were evaluated for testes location, performed orchidopexy, and possible associative factors such as birth weight, gestational age, other congenital anomalies and CDH characteristics (surgical treatment, approach and ECMO).Results
Seventy-five CDH patients were included. Twenty-seven (36%) were diagnosed with NST, of which 22 (29%) received orchidopexy. In 54 patients (72%) there were reports on testes location at birth and location was known for all patients at the age of 18 months, although side of NST was unknown in four. The location of the NST was mostly ipsilateral to the CDH (n = 20, 87%), of which eight (35%) had a bilateral NST with a unilateral CDH. There were no significant differences in birth weight, gestational age, and CDH specific characteristics in patients with or without NST.Conclusion
This study shows a strong association between CDH and NST, with a prevalence of 36%. However, no specific characteristics of the CDH were related to the NST. The testes of all male CDH patients should be thoroughly evaluated in the first year of their life, to ensure a proper and timely treatment.Level of evidence
Level IV; case series. 相似文献13.
Loren Berman Jordan Jackson Kristen Miller Rebecca Kowalski Paul Kolm Francois I. Luks 《Journal of pediatric surgery》2018,53(8):1592-1599
Background
Pediatric surgeons frequently offer prenatal consultation for congenital pulmonary airway malformation (CPAM) and congenital diaphragmatic hernia (CDH); however, there is no evidence-based consensus to guide prenatal decision making and counseling for these conditions. Eliciting feedback from experts is integral to defining best practice regarding prenatal counseling and intervention.Methods
A Delphi consensus process was undertaken using a panel of pediatric surgeons identified as experts in fetal therapy to address current limitations. Areas of discrepancy in the literature on CPAM and CDH were identified and used to generate a list of content and intervention questions. Experts were invited to participate in an online Delphi survey. Items that did not reach first-round consensus were broken down into additional questions, and consensus was achieved in the second round.Results
Fifty-four surgeons (69%) responded to at least one of the two survey rounds. During round one, consensus was reached on 54 of 89 survey questions (61%), and 45 new questions were developed. During round two, consensus was reached on 53 of 60 survey questions (88%).Conclusions
We determined expert consensus to establish guidelines regarding perinatal management of CPAM and CDH. Our results can help educate pediatric surgeons participating in perinatal care of these patients.Level of Evidence
V. 相似文献14.
Carmen Mesas Burgos Björn Frenckner Matias Luco Matthew T Harting Pamela A Lally Kevin P Lally 《Journal of pediatric surgery》2019,54(4):651-655
Aim
To compare outcomes between prenatally and postnatally diagnosed CDH in a large multicenter database of prospectively collected data and evaluate factors associated with poorer outcome for prenatally diagnosed CDH.Material and Methods
We used information from the multicenter, multinational CDH Study Group database on patients born between 2007 and 2015. We compared differences between prenatally and postnatally diagnosed CDH with respect to survival, side, size, ECMO needs, associated major cardiac malformations and liver position.Results
3746 cases of CDH were entered in the registry between 2007 and 2015, with an overall survival of 71%. Of those, 68% had a prenatal diagnosis. Survival rates were significantly better in the postnatally diagnosed group, 83 vs 65%. There was a higher proportion of bigger defect sizes, C and D, in the prenatally diagnosed group, but the survival rates were similar when patients were stratified by defect size. The rate of ECMO utilization was higher overall in the prenatally diagnosed group, 33 vs 22%, but it was similar within similar defect sizes. Right-sided defects are more commonly missed at prenatal screening than left-sided CDH, 53 vs 35% (p?<?0.0001).Conclusions
Prenatally diagnosed CDH is associated with larger defect sizes compared to those with a postnatal diagnosis, and consequently have higher morbidity and mortality. Right-sided CDH are more often missed at prenatal ultrasound. The increasing rate of prenatal detection requires a clear understanding of accurate risk stratification, in order to counsel families and to provide appropriate perinatal management.Level of Evidence
I for a Prognosis Study – This is a high-quality, prospective cohort study with 99% of patients followed to the study end point (death or discharge). 相似文献15.
Hesham Mostafa Zakaria Lara Massie Azam Basheer David Boyce-Fappiano Erinma Elibe Lonni Schultz Ian Lee Brent Griffith Farzan Siddiqui Victor Chang 《The spine journal》2018,18(10):1798-1803
Background Context
The current standard of care for prediction of survival of cancer staging is based on TNM staging. However, for patients with spinal metastasis, who all have identical stage IV disease, identifying accurate prognostic markers of survival would allow better treatment stratification between more aggressive treatment strategies or palliation. Analytical morphometrics enables physicians to quantify patient frailty by measuring lean muscle mass. Morphometrics also predicts survival in patients with lung cancer metastases to the spine.Purpose
Our study evaluates whether morphometrics is predictive of survival in patients with breast cancer spinal metastasis.Design
This is an observational retrospective cohort study.Patient Sample
This study includes female patients with breast cancer spinal metastases and patients who have undergone stereotactic body radiation therapy.Outcome Measures
Overall survival was the primary outcome measure.Methods
Morphometric measurements of the psoas muscle were taken using computed tomography scans of the lumbar spine. We then stratified patients into tertiles based on the psoas muscle area.Results
We identified 118 patients, with a median survival of 104 days (95% confidence interval [CI]=73–157 days). Overall survival was not associated with age, chemotherapy, or number of levels radiated. Patients in the lowest tertile of psoas size had significantly shorter survival compared with the highest tertile (68 days versus 148 days, hazard ratio 1.76 [95% CI=1.08–2.89], p=.024). The shorter survival was also true for the lowest tertile versus the middle tertile (68 days versus 167 days, hazard ratio 1.95 [95% CI=1.19–3.19], p=.007). Kaplan-Meier survival curves were used to visually illustrate the differences in survival between different tertiles.Conclusions
Morphometric analysis of the psoas muscle size in patients with breast cancer metastases to the spine was effective in identifying patients at risk of shorter survival. Further research is needed to validate these results, as well as to see if these methodologies can be applied to other cancer histologies. 相似文献16.
Carmen Mesas Burgos Marcus G. Davey John S. Riley Huimin Jia Alan W. Flake William H. Peranteau 《Journal of pediatric surgery》2018,53(9):1681-1687
Background
Lung and pulmonary vascular maldevelopment in congenital diaphragmatic hernia (CDH) results in significant morbidity and mortality. Retinoic acid (RA) and imatinib have been shown to improve pulmonary morphology following prenatal administration in the rat nitrofen-induced CDH model. It remains unclear if these changes translate into improved function. We evaluated the effect of prenatal RA and imatinib on postnatal lung function, structure, and pulmonary artery (PA) blood flow in the rat CDH model.Methods
Olive oil or nitrofen was administered alone or in combination with RA or imatinib to pregnant rats. Pups were assessed for PA blood flow by ultrasound and pulmonary function/morphology following delivery, intubation, and short-term ventilation.Results
Neither RA nor imatinib had a negative effect on lung and body growth. RA accelerated lung maturation indicated by increased alveoli number and thinner interalveolar septa and was associated with decreased PA resistance and improved oxygenation. With the exception of a decreased PA pulsatility index, no significant changes in morphology and pulmonary function were noted following imatinib.Conclusion
Prenatal treatment with RA but not imatinib was associated with improved pulmonary morphology and function, and decreased pulmonary vascular resistance. This study highlights the potential of prenatal pharmacologic therapies, such as RA, for management of CDH. 相似文献17.
Sanjeev Aggarwal Christina Shanti Joseph Lelli Girija Natarajan 《Journal of pediatric surgery》2019,54(3):439-444
Aim
To evaluate echocardiographic indices of pulmonary vascular resistance and right ventricular (RV) function in predicting death or ECMO in congenital diaphragmatic hernia (CDH).Methods
In this single center study, early (< 48?h) echocardiograms of neonates with CDH (n?=?47) were reviewed by a single reader for the ratio of tricuspid regurgitant velocity to velocity time integral at the pulmonary valve (TRV/VTIpv), TRV2/VTIpv, RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE). Receiver operating characteristic curves were generated for each parameter to obtain optimal cutoff values.Results
Infants who died or received ECMO (n?=?30) had significantly higher TRV/VTIpv and TRV2/VTIpv, and lower VTIpv, RV FAC and TAPSE, compared to the 17 survivors without ECMO. For TRV2/VTIpv and TRV/VTI at cutoffs of 1.3 and 0.38 respectively, the sensitivities were 92.3 (95% CI 75–99.1%) and 96 (95% CI 80.4–99.9%), specificities were 78.6 (49.2–95.4%) and 71.4 (42–91.6%), positive predictive values were 89 (75–95.6%) and 86.2 (73.2–93.5%) and negative predictive values were 84.6 (58.5–95.5%) and 90.9 (58.7–98.6%).Conclusion
Early echocardiographic evidence of pulmonary hypertension and RV dysfunction predicts outcome in CDH. Further studies utilizing these indices to guide therapeutic decision-making are warranted.Level of evidence
Level 1 for diagnostic study 相似文献18.
Marcus D. Jarboe Samir K. Gadepalli Joseph T. Church Meghan A. Arnold Ronald B. Hirschl George B. Mychaliska 《Journal of pediatric surgery》2018,53(1):159-162
Purpose
The Avalon dual-lumen venovenous catheter has several advantages, but placement techniques and management have not been adequately addressed in the pediatric population. We assessed our institutional outcomes and complications using the Avalon catheter in children.Methods
We reviewed all pediatric patients who had Avalon catheters placed for respiratory failure at our institution, excluding congenital heart disease patients, from April 2009 to March 2016. All patients were managed using our standard ECMO protocol, and cannula position was followed by daily chest x-ray and intermittent echocardiography (ECHO). Data included demographics, diagnosis, PRISM3 predicted mortality, ECMO duration, complications, and survival. The primary outcome was the need for catheter repositioning.Results
Twenty-five patients were included, with mean age 8.3 ± 6.9 years and 15 ± 22 days of ECMO support. Overall survival was 68% (17/25). Fourteen patients (56%) underwent placement with fluoroscopy in addition to ultrasound and ECHO, primarily after 2013. Overall, thirteen patients (52%) had problems with cannula malposition. 9 of these (69%) required cannula repositioning. Three of 14 (21%) cannulas placed with fluoroscopy required repositioning, compared to 7/11 (64%) placed without fluoroscopy (p = 0.05).Conclusions
Complications are common with the Avalon catheter in children. Safe percutaneous access requires ultrasound guidance, and use of intraoperative fluoroscopy in addition to echocardiography decreases malposition rates.Level of evidence
IV (Prognosis study). 相似文献19.
Michael G. Fehlings So Kato Lawrence G. Lenke Hiroaki Nakashima Narihito Nagoshi Christopher I. Shaffrey Kenneth M.C. Cheung Leah Carreon Mark B. Dekutoski Frank J. Schwab Oheneba Boachie-Adjei Khaled M. Kebaish Christopher P. Ames Yong Qiu Yukihiro Matsuyama Benny T. Dahl Hossein Mehdian Ferran Pellisé-Urquiza Sigurd H. Berven 《The spine journal》2018,18(10):1733-1740
Background Context
Significant variability in neurologic outcomes after surgical correction for adult spinal deformity (ASD) has been reported. Risk factors for decline in neurologic motor outcomes are poorly understood.Purpose
The objective of the present investigation was to identify the risk factors for postoperative neurologic motor decline in patients undergoing complex ASD surgery.Study Design/Setting
This is a prospective international multicenter cohort study.Patient Sample
From September 2011 to October 2012, 272 patients undergoing complex ASD surgery were prospectively enrolled in a multicenter, international cohort study in 15 sites.Outcome Measures
Neurologic decline was defined as any postoperative deterioration in American Spinal Injury Association lower extremity motor score (LEMS) compared with preoperative status.Methods
To identify risk factors, 10 candidate variables were selected for univariable analysis from the dataset based on clinical relevance, and a multivariable logistic regression analysis was used with backward stepwise selection.Results
Complete datasets on 265 patients were available for analysis and 61 (23%) patients showed a decline in LEMS at discharge. Univariable analysis showed that the key factors associated with postoperative neurologic deterioration included older age, lumbar-level osteotomy, three-column osteotomy, and larger blood loss. Multivariable analysis revealed that older age (odds ratio [OR]=1.5 per 10 years, 95% confidence interval [CI] 1.1–2.1, p=.005), larger coronal deformity angular ratio [DAR] (OR=1.1 per 1 unit, 95% CI 1.0–1.2, p=.037), and lumbar osteotomy (OR=3.3, 95% CI 1.2–9.2, p=.022) were the three major predictors of neurologic decline.Conclusions
Twenty-three percent of patients undergoing complex ASD surgery experienced a postoperative neurologic decline. Age, coronal DAR, and lumbar osteotomy were identified as the key contributing factors. 相似文献20.
Yangyang R. Yu Jennifer L. Carpenter Annalyn S. DeMello Sundeep G. Keswani Darrell L. Cass Oluyinka O. Olutoye Adam M. Vogel James A. Thomas Cole Burgman Caraciolo J. Fernandes Timothy C. Lee 《Journal of pediatric surgery》2018,53(5):1060-1064