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1.
Background
The effect of the changes in the femoral posterior condylar offset (PCO) on anterior–posterior (AP) translation and internal–external (IE) rotation in cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) remains unknown. The purpose of this study was to compare the kinematics in CR and PS TKA with respect to the difference in prosthetic design and PCO change through a computational simulation.Methods
We developed three-dimensional finite element models with the different PCOs of ± 1, ± 2 and ± 3?mm in the posterior direction using CR and PS TKA. We performed the simulation with different PCOs under a deep knee bend condition and evaluated the kinematics for the AP and IE in CR and PS TKA.Results
The more tibiofemoral (TF) translation in the posterior direction was found as PCO translated in posterior direction for both CR and PS TKA compared to the neutral position. However, the change of the AP translation with respect to the PCO change in CR TKA was greater than PS TKA. The more TF external rotation was found as PCO translated in the anterior direction for both CR and PS TKA compared to the neutral position. However, unlike the TF translation, the TF rotation was not influenced by the PCO change in both CR and PS TKA.Conclusion
The PCO magnitude was influenced by a postoperative change in the kinematics in CR TKA although a relatively smaller effect was observed in PS TKA. Hence, surgeons should be aware of the PCO change, especially for CR TKA. 相似文献2.
Yang Hu Hao Nie Hai-Han Yu Chuan Qin Long-Jun Wu Zhou-Ping Tang Dai-Shi Tian 《Autoimmunity reviews》2019,18(5):542-548
Objective
To evaluate the efficacy and safety of rituximab for relapsing-remitting multiple sclerosis.Results
Fifteen studies that collectively included 946 patients were selected for the meta-analysis. Rituximab therapy was associated with the mean annualized relapse rates decreasing by 0.80 (95% confidence interval, 0.45–1.15) and the mean Expanded Disability Status Scale score decreasing by 0.46 (95% confidence interval, 0.05–0.87). The likelihood of patients experiencing a relapse after starting rituximab therapy was only 15% (95% confidence interval, 7%–26%). Although mild-to-moderate adverse events occurred in 29.6% of the patients, there were no severe adverse events.Conclusions and relevance
This systematic review and meta-analysis shows that rituximab is associated with reduced annualized relapse rates and disability levels in patients with relapsing-remitting multiple sclerosis. It is also well tolerated and is not associated with serious adverse events. 相似文献3.
N.D. Clement L.C. Walker K. Merrie M. Bardgett D. Weir J. Holland D.J. Deehan 《The Knee》2019,26(1):258-266
Background
The primary aim of this study was to assess whether patients dissatisfied with both recreational activities and overall outcome were different to those dissatisfied with recreational activities but satisfied with their overall outcome one year after total knee arthroplasty (TKA).Methods
A retrospective cohort consisting of 3324 primary TKA were identified from an established arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form (SF) 12 scores were collected pre-operatively and one year post-operatively. Overall patient satisfaction and satisfaction with recreational activities were assessed at one year.Results
The rate of patient satisfaction with recreational activities (n?=?2672, 80.4%) was significantly (odds ratio (OR) 0.47, 95% confidence intervals (CI) 0.41 to 0.54, p?<?0.001) lower than satisfaction with the overall outcome (n?=?2982, 89.7%). When adjusting for confounding variables older age (OR 1.03, p?=?0.008), increasing BMI (OR 1.05, p?=?0.01) and absence of hypertension (OR 0.66, p?=?0.02) were independent predictors of being dissatisfied with recreational activities in isolation. The one-year components and total WOMAC scores were significant (p?<?0.001) predictors of satisfaction with recreational activities and were reliable with an area under the curve of ≥ 0.82Conclusion
Patients of older age, higher BMI and without hypertension are more likely to be dissatisfied with recreational activities despite being satisfied with their overall outcome. 相似文献4.
M.J. Maze K.J. Sharples K.J. Allan M.P. Rubach J.A. Crump 《Clinical microbiology and infection》2019,21(4):437-444
Background
Leptospirosis is under-diagnosed by clinicians in many high-incidence countries, because reference diagnostic tests are largely unavailable. Lateral flow assays (LFA) that use antigen derived from heat-treated whole cell Leptospira biflexa serovar Patoc have the potential to improve leptospirosis diagnosis in resource-limited settings.Objectives
We sought to summarize estimates of sensitivity and specificity of LFA by conducting a systematic review and meta-analysis of evaluations of the accuracy of LFA to diagnose human leptospirosis.Data sources
On 4 July 2017 we searched three medical databases.Study eligibility criteriaArticles were included if they were a study of LFA sensitivity and specificity.Participants
Patients with suspected leptospirosis.Interventions
Nil.Methods
For included articles, we assessed study quality, characteristics of participants and diagnostic testing methods. We estimated sensitivity and specificity for each study against the study-defined case definition as the reference standard, and performed a meta-analysis using a random-effects bivariate model.Results
Our search identified 225 unique reports, of which we included nine (4%) published reports containing 11 studies. We classified one (9%) study as high quality. Nine (82%) studies used reference tests with considerable risk of misclassification. Our pooled estimates of sensitivity and specificity were 79% (95% CI 70%–86%) and 92% (95% CI 85%–96%), respectively.Conclusions
As the evidence base for determining the accuracy of LFA is small and at risk of bias, pooled estimates of sensitivity and specificity should be interpreted with caution. Further studies should use either reference tests with high sensitivity and specificity or statistical techniques that account for an imperfect reference standard. 相似文献5.
Daniele Pastori Tommaso Bucci Massimo Triggiani Paul R.J. Ames Sandro Parrotto Francesco Violi Pasquale Pignatelli Alessio Farcomeni 《Autoimmunity reviews》2019,18(5):519-525
Background
Anticardiolipin antibodies of the immunoglobulin G isotype (IgG aCL) have been suggested as risk factor for arterial and venous thrombosis. No conclusive data in patients with coronary artery disease (CAD) do exist. We investigate the risk of recurrent CAD according to the presence of IgG aCL.Methods
We performed a systematic review and meta-analysis to evaluate the risk of recurrent major adverse cardiac events (MACE) associated with the presence of IgG aCL in patients with CAD. MEDLINE and Cochrane databases were searched. We conducted a meta-analysis of the relative risk (RR) both at 12 and 24?months.Results
We included 11 eligible studies with a total of 2425 patients, 283 IgG aCL+ and 2142 IgG aCL-. The prevalence of IgG aCL+ ranged from 6.1% to 43.3%. A total of 341 cardiac events were reported: 71 (25.1%) in IgG aCL+ and 270 (12.6%) in IgG aCL- patients. We found an increased risk of recurrent MACE in patients with high IgG aCL both at 12 (RR 2.17, 2.5–97.5%CI, 1.54–3.00) and 24?months (RR 2.11, 2.5–97.5%CI, 1.62–2.66). This association was even stronger in patients with juvenile CAD (i.e. <50?years) at both 12 (RR 3.21, 2.5–97.5%CI, 1.74–5.41) and 24?months (RR 3.24, 2.5–97.5%CI, 1.84–5.21).Conclusion
Patients with CAD and elevated IgG aCL have a doubled risk of recurrent MACE at 12 and 24?months. The presence of aCL should be suspected in patients with recurrent CAD events or in patients with juvenile CAD. 相似文献6.
Background
The purpose of this retrospective cohort study was to investigate the influence of parameters of malalignment on knee function 5?years post TKA and, additionally, to explore alterations in patellar height after TKA.Methods
All 661 patients undergoing TKA between 2010 and 2011 were considered for inclusion. Preoperative and 1-year postoperative short-leg radiographs were assessed for malalignment parameters: coronal tibial angle (cTA), sagittal tibial angle (sTA), femoral flexion angle (FFA) and mediolateral tibial mismatch. Patellar height was measured using the modified Insall-Salvati ratio. We determined improvements in knee function utilizing the Knee Society Score (Function score, KSS-F), Oxford Knee Score (OKS) and Algofunctional index (AI). Influences of malalignment parameters were analyzed univariate and selected (p?<?0.10) for multivariate linear regression analysis. Inter-observer reproducibility was assessed by test–retest analysis of 30 randomly selected radiographs and calculation of an intra-class correlation coefficient (ICC) for all radiographic parameters.Results
Three-hundred and four patients were included. Multivariate regression showed degrees of cTA malalignment to be significantly associated with only the KSS-F (β?=?? 3.52). Correction of coronal deformity was stronger associated with knee function (KSS-F β?=?2.81; AI β?=?? 0.36). Patellar height was significantly reduced after TKA (1.51 vs 1.44). Decrease of patellar height was weakly associated with the OKS (β?=?10.69). ICC scores were: cTA 0.81, sTA 0.57, IS 0.72, FFA 0.75.Conclusion
Postoperative coronal tibial plate alignment and correction of preoperative coronal deformity are associated with improved knee function 5?years post TKA. Decrease in patellar height was weakly associated with knee function. Short-leg radiography can be a sufficient screening tool for prosthesis alignment. 相似文献7.
Peter Scalia Marie-Anne Durand Julia L. Berkowitz Nithya P. Ramesh Marjan J. Faber Jan A.M. Kremer Glyn Elwyn 《Patient education and counseling》2019,102(5):817-841
Objective
To determine the effect of encounter patient decision aids (PDAs) as evaluated in randomized controlled trials (RCTs) and conduct a narrative synthesis of non-randomized studies assessing feasibility, utility and their integration into clinical workflows.Methods
Databases were systematically searched for RCTs of encounter PDAs to enable the conduct of a meta-analysis. We used a framework analysis approach to conduct a narrative synthesis of non-randomized studies.Results
We included 23 RCTs and 30 non-randomized studies. Encounter PDAs significantly increased knowledge (SMD?=?0.42; 95% CI 0.30, 0.55), lowered decisional conflict (SMD= -0.33; 95% CI -0.56, -0.09), increased observational-based assessment of shared decision making (SMD?=?0.94; 95% CI 0.40, 1.48) and satisfaction with the decision-making process (OR?=?1.78; 95% CI 1.19, 2.66) without increasing visit durations (SMD= -0.06; 95% CI -0.29, 0.16). The narrative synthesis showed that encounter tools have high utility for patients and clinicians, yet important barriers to implementation exist (i.e. time constraints) at the clinical and organizational level.Conclusion
Encounter PDAs have a positive impact on patient-clinician collaboration, despite facing implementation barriers.Practical implications
The potential utility of encounter PDAs requires addressing the systemic and structural barriers that prevent adoption in clinical practice. 相似文献8.
Background
A large majority of anterior cruciate ligament (ACL) injuries are non-contact, most often occurring during a landing or change of direction. Recent research indicates that cognitive factors may be involved in non-contact ACL injuries. The aim of this study was to determine if a game-situation perceptual–cognitive load leads to altered landing kinematics in physically fatigued female athletes.Methods
Nineteen female recreational athletes were recruited to perform a series of jumping and landing trials. In a first phase, eight trials were performed in an isolated condition and eight were performed while participants performed a perceptual–cognitive task. Before a second identical phase, participants underwent a muscular fatigue protocol. Knee-joint kinematics were recorded and compared between conditions using paired t-tests.Results
Muscle fatigue led to statistically significant increases in peak knee abduction and peak internal knee rotation as well as a decrease in maximum knee flexion, when comparing conditions without the perceptual–cognitive task. The perceptual–cognitive task had no statistically significant effect on any knee rotations, either pre- or post-fatigue. However, a subgroup of 12 athletes showed a significant increase in knee abduction in the presence of the perceptual–cognitive task, only in the fatigued condition.Conclusion
A perceptual–cognitive task combined with muscle fatigue alters knee kinematics of landing for a subset of recreational athletes, potentially increasing the risk of ACL rupture. Further studies are necessary to confirm this finding and to identify characteristics of at-risk individuals to target them for injury prevention protocols. 相似文献9.
S. Hagel K. Ludewig M.W. Pletz J. Frosinski A. Moeser M. Wolkewitz P. Gastmeier S. Harbarth F.M. Brunkhorst M. Kesselmeier A. Scherag 《Clinical microbiology and infection》2019,21(4):462-468
Objectives
To evaluate whether a hospital-wide infection control programme (ICP) is effective at reducing the burden of healthcare-associated infections (HAIs) and associated severe sepsis/septic shock or death (severe HAIs).Methods
Prospective, quasi-experimental study with two surveillance periods (September 2011 to August 2012; May 2013 to August 2014). Starting October 2012, the ICP included hand hygiene promotion and bundle implementation for common HAIs. We applied segmented mixed-effects Poisson regression and multi-state models. We reported adjusted incidence rate ratios (aIRR) and adjusted hazard ratios (aHR) with 95% confidence intervals (CI).Results
Overall, 62 154 patients were under surveillance, with 1568 HAIs identified in 1170 patients (4.3 per 100 admissions) in the first and 2336 HAIs identified in 1711 patients (4.9 per 100 admissions) in the second surveillance period. No differences were found in the overall HAI incidence rates between the periods in the general wards (aIRR 1.29, 95% CI 0.78–2.15) and intensive care units (ICUs) (aIRR 0.59, 95% CI 0.27–1.31). However, the HAI incidence rate was declining in the ICUs after starting the ICP (aIRR 0.98, 95% CI 0.97–1.00 per 1-week increment), in contrast to general wards (aIRR 1.01, 95% CI 1.00–1.02). A reduction in severe HAIs (aIRR 0.13, 95% CI 0.05–0.32) and a lower probability of HAI-associated in-hospital deaths (aHR 0.56, 95% CI 0.31–0.99) were observed in the second period in the ICUs.Conclusions
There was no overall reduction in HAIs after implementation of the ICP. However, there was a significant reduction in severe HAIs in ICUs. Whether this difference was a consequence of the ICP or improvement in HAI case management is not clear. 相似文献10.
K.K.W. To C.C.Y. Yip C.Y.W. Lai C.K.H. Wong D.T.Y. Ho P.K.P. Pang A.C.K. Ng K.-H. Leung R.W.S. Poon K.-H. Chan V.C.C. Cheng I.F.N. Hung K.-Y. Yuen 《Clinical microbiology and infection》2019,25(3):372-378
Objectives
Automated point-of-care molecular assays have greatly shortened the turnaround time of respiratory virus testing. One of the major bottlenecks now lies at the specimen collection step, especially in a busy clinical setting. Saliva is a convenient specimen type that can be provided easily by adult patients. This study assessed the diagnostic validity, specimen collection time and cost associated with the use of saliva.Methods
This was a prospective diagnostic validity study comparing the detection rate of respiratory viruses between saliva and nasopharyngeal aspirate (NPA) among adult hospitalized patients using Xpert® Xpress Flu/RSV. The cost and time associated with the collection of saliva and nasopharyngeal specimens were also estimated.Results
Between July and October 2017, 214 patients were recruited. The overall agreement between saliva and NPA was 93.3% (196/210, κ 0.851, 95% CI 0.776–0.926). There was no significant difference in the detection rate of respiratory viruses between saliva and NPA (32.9% (69/210) versus 35.7% (75/210); p 0.146). The overall sensitivity and specificity were 90.8% (81.9%–96.2%) and 100% (97.3%–100%), respectively, for saliva, and were 96.1% (88.9%–99.2%) and 98.5% (94.7%–99.8%), respectively, for NPA. The time and cost associated with the collection of saliva were 2.26-fold and 2.59-fold lower, respectively, than those of NPA.Conclusions
Saliva specimens have high sensitivity and specificity in the detection of respiratory viruses by an automated multiplex Clinical Laboratory Improvement Amendments-waived point-of-care molecular assay when compared with those of NPA. The use of saliva also reduces the time and cost associated with specimen collection. 相似文献11.
B. Pertzov N. Eliakim-Raz H. Atamna A.Z. Trestioreanu D. Yahav L. Leibovici 《Clinical microbiology and infection》2019,25(3):280-289
Objectives
The pleiotropic effect of hydroxymethylglutaryl-CoA reductase inhibitors (statins) might have a beneficial effect in sepsis through several mechanisms. The aim was to assess the efficacy and safety of statins, compared with placebo, for the treatment of sepsis in adults.Methods
We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2017, Issue 12), OVID MEDLINE (from 1966 to January 2018), Embase (Ovid SP, from 1974 to January 2018), and LILACS (from 1986 to January 2018). We also searched the trial registries ISRCTN and ClinicalTrials.gov to January 2018. The eligibility criteria were randomized controlled trials comparing the treatment of statins versus placebo in adult patients who were hospitalized due to sepsis. Participants were adults (16 years and older) hospitalized because of sepsis or who developed sepsis during admission. Interventions were treatment with hydroxymethylglutaryl-CoA reductase inhibitors (statins) versus no treatment or placebo. We performed a systematic review of all randomized controlled trials published until January 2018, assessing the efficacy and safety of statins in sepsis treatment. Two primary outcomes were assessed: 30-day overall mortality and deterioration to severe sepsis during management. Secondary outcomes were hospital mortality, need for mechanical ventilation and drug related adverse events.Results
Fourteen trials evaluating 2628 patients were included. Statins did not reduce 30-day all-cause mortality neither in all patients (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.83–1.10), nor in a subgroup of patients with severe sepsis (RR 0.97, 95% CI 0.84–1.12). The certainty of evidence for both outcomes was high. There was no change in the rate of adverse events between study arms (RR 1.24, 95% CI 0.94 to 1.63). The certainty of evidence for this outcome was high.Conclusions
The use of statin therapy in adults for the indication of sepsis is not recommended. 相似文献12.
Salman Nazary-Moghadam Mahyar Salavati Ali Esteki Behnam Akhbari Sohrab Keyhani Afsaneh Zeinalzadeh 《The Knee》2019,26(1):88-96
Background
Several investigations have studied gait variability of individuals with anterior cruciate ligament (ACL) deficiency; however, the effect of dual-tasking on the gait variability of these individuals remained unclear. The aim of the present study was to determine the effect of gait speed and dual-tasking on knee flexion–extension variability in subjects with and without ACL deficiency.Methods
The knee flexion–extension Lyapunov exponent (LyE) was measured in 22 ACL-deficient (Mean±SD) (25.95?±?4.69?years) and 22 healthy subjects (24.18?±?3.32?years). They walked at three levels of gait speed in isolation or concurrently with a cognitive task.Results
Repeated-measure analyses of variance (ANOVAs) demonstrated that the interaction of group by gait speed was statistically significant. As the gait speed increased from low to high, the knee flexion–extension LyE significantly decreased for the subjects with ACL deficiency (effect size: 0.57, P?=?0.01). The interaction of group by cognitive load was not statistically significant (P?=?0.07). In addition, the ACL-deficient subjects had statistically slower reaction times than healthy subjects during the dual-task compared with the single-task condition.Conclusions
The ACL-deficient and healthy individuals had a tendency to maintain safe gait. It seems that the ACL-deficient subjects sacrificed the cognitive task more than the healthy individuals to pay more attention toward gait. Additionally, it seems that the gait speed was more challenging than cognitive load on the stride-to-stride variability in the individuals with ACL deficiency. 相似文献13.
Kasper Skriver Gravesen Thomas Kallemose Lars Blønd Anders Troelsen Kristoffer Weisskirchner Barfod 《The Knee》2019,26(1):20-25
Background
To evaluate the trends in treatment of patellar dislocation in the Danish population as a whole from 1996 to 2014 and evaluate the incidence of persistent morbidity after Medial Patellofemoral Ligament Reconstruction (MPFL-R).Methods
This epidemiological study was performed by retrospectively searching the Danish National Patients Registry from 1996 to 2014. The study investigated the trends in surgery performed on patients with patellar dislocations and the risk of persistent patellar morbidity (PPM) with an eight-year follow-up. PPM was defined as a new patella-related contact to the healthcare system more than a year after surgery.Results
From 1996 to 2014, a total of 1956 MPFL-R were performed in Denmark. In 2014, MPFL-R constituted 75% of all patella-stabilizing surgery and was performed on almost 10% of patients with patellar dislocation. The mean risk of PPM eight years after surgery was 20.9% (18.3–23.4%), and young patients aged 10–17 showed the highest risk of 28.9% (23.7–33.7%).The risk of PPM over time was significantly higher for other patella-stabilizing surgery (33.8%) and patients receiving conservative treatment (29.4%) compared to MPFL-R.Conclusions
A rapid rise in the use of MPFL-R was found from 2005 to 2014, constituting 75% of all patella-stabilizing surgery in 2014. The overall risk of persistent patellar morbidity within eight years after MPFL-R was 21%. MPFL-R was found to give a significantly lower risk of PPM over time as compared to other patella-stabilizing surgery and conservative treatment. 相似文献14.
Background
While surgical reconstruction restores mechanical stability following anterior cruciate ligament (ACL) rupture, many experience early-onset osteoarthritis despite surgery. Neurophysiological changes are hypothesized to contribute to knee osteoarthritis progression. Proprioceptive deficits have been reported following ACL injury/reconstruction; however, vibration perception threshold (VPT) has been less studied. This study explored relationships between pain, VPT, proprioception, function, and strength following ACL-reconstruction.Methods
Twenty individuals (27?±?6 years; 10 males) (standard deviation) status-post ACL-reconstruction were compared with a control group. Measurements included VPT, proprioception (threshold to detect passive movement), pain, function (Knee Outcome Survey (KOS)) and isometric quadriceps strength. Group differences were assessed using Mann-Whitney U tests, side-to-side differences with Wilcoxon Signed Rank tests, and associations evaluated using Spearman correlations.Results
The ACL-reconstruction group had minor functional deficits (15?±?11%) and resting pain (1.8?±?1.7). Impaired VPT and proprioception (hypoesthesia) were demonstrated on surgical compared to contralateral and control limbs (p?≤?0.008). Proprioception was significantly different between contralateral and control knees, but not VPT. Surgical knee proprioceptive deficits and VPT deficits were positively correlated (ρ?=?0.462, p?=?0.047) but not in controls (ρ?=??0.042, p?=?0.862). Strength was negatively correlated to pain (ρ?=??0.589; p?=?0.006), but not to KOS scores, proprioception or VPT (p?≥?0.099).Conclusion
Proprioceptive deficits following ACL injury have been ascribed to loss of afferent input from the torn ligament. Alternatively, multi-modality as well as contralateral sensory deficits suggest a spinal/supraspinal source of neurophysiological findings which may predispose to early osteoarthritis.Level of evidence
III. 相似文献15.
Cedric Maillot Anthony Leong Ciara Harman Alberto Morelli Richard Mospan Justin Cobb Charles Rivière 《The Knee》2019,26(1):106-114
Background
The kinematic alignment (KA) technique for total knee arthroplasty (TKA) is an emerging implant positioning philosophy that aims to restore constitutional knee anatomy to improve knee kinematics. At present, the KA technique aims to reconstruct native femorotibial (FT) joint alignment, however there is still insufficient consideration towards the inter-individual trochlear anatomy variability. Poor trochlear restoration may compromise clinical outcomes. Our study aimed at assessing the anatomical relationship between the native trochlea and other FT anatomical parameters.Methods
Fifty-eight preoperative CT scans of low-grade knee arthritic patients were segmented to create 3D bone models. The FT and the PF anatomical parameters were measured using in-house software. Values were compared between different groups of lower limb and FT joint line (JL) orientation, and correlations between FT and PF anatomical parameters were assessed.Results
We were unable to detect any significant correlation between groove orientation (frontal and axial) or groove radius and either the hip–knee–ankle (HKA), or the lateral distal femoral (LDFA), or the medial proximal tibial (MPTA), or the FTJL-mechanical axis (FTJLMAA) Angles. When considering the correlation within sub-groups of limb or JL orientation, we only found a positive correlation (r?=?0.464, p?=?0.022) in the varus lower limb (HKA?≤?180°) sub-group between groove frontal orientation and LDFA.Conclusion
Our study shows that the determination of several limb, knee, and JL parameters is of poor value to predict individual trochlea anatomy. This raises the issue of how to improve femoral component design to achieve individualised FT and PF anatomical restoration with KATKA.Level of evidence
Level 1 – computational study. 相似文献16.
G. De Vlieger C. Ingels P.J. Wouters Y. Debaveye I. Vanhorebeek J. Wauters A. Wilmer M.P. Casaer G. Van den Berghe 《Clinical microbiology and infection》2019,25(3):359-364
Objective
In the EPaNIC RCT (N=4640), postponing the administration of parenteral nutrition (PN) to beyond 1 week in the intensive care unit (ICU) (late-PN) reduced the number of ICU-acquired infections and the costs for antimicrobial drugs compared with initiation of PN within 24–48 hours of admission (early-PN). In a secondary analysis, we hypothesize that late-PN reduces the odds to acquire an invasive fungal infection (IFI) in the ICU.Methods
The impact of late-PN (N=2328) versus early-PN (N=2312) on acquired IFI and on the likelihood to acquire an IFI over time was assessed in univariable and multivariable analyses. Subsequently, we performed multivariable analyses to assess the effect of the mean total daily administered calories from admission until day 3, day 5, and day 7 on the likelihood over time of acquiring an IFI.Results
Fewer late-PN patients acquired an IFI compared with early-PN patients (77/2328 versus 112/2312) (p 0.008). After adjusting for risk factors, the odds to acquire an IFI and the likelihood of acquiring an IFI at any time were lower in late-PN (adjusted odds ratio 0.66, 95% CI 0.48–0.90, p 0.009; adjusted hazard ratio (HRadj) 0.70, 95% CI 0.52–0.93, p 0.02). Larger caloric amounts from admission until day 7 were associated with a higher likelihood to acquire an IFI over time (HRadj 1.09, 95% CI 1.02–1.16, p 0.009).Conclusion
Postponing PN to beyond 1 week and smaller caloric amounts until day 7 in the ICU reduced ICU-acquired IFIs and the likelihood to develop an IFI over time. 相似文献17.
Jinyi Yuan Biwen Mo Zhuang Ma Yuan Lv Shih-Lung Cheng Yanping Yang Zhaohui Tong Renguang Wu Shenghua Sun Zhaolong Cao Jufang Wu Demei Zhu Liwen Chang Yingyuan Zhang 《Journal of microbiology, immunology, and infection》2019,52(1):35-44
Background/Purpose
Nemonoxacin is a novel nonfluorinated quinolone with excellent in vitro activity against most pathogens in community-acquired pneumonia (CAP), especially Gram-positive isolates. The purpose of this study was to assess the efficacy and safety of nemonoxacin compared with levofloxacin in patients with CAP.Methods
A phase 3, multicenter, randomized (2:1) controlled trial was conducted in adult CAP patients receiving nemonoxacin 500 mg or levofloxacin 500 mg orally once daily for 7–10 days. Clinical, microbiological response and adverse events were assessed. Non-inferiority was determined in terms of clinical cure rate of nemonoxacin compared with that of levofloxacin in a modified intention-to-treat (mITT) population. NCT registration number: NCT01529476.Results
A total of 527 patients were randomized and treated with nemonoxacin (n = 356) or levofloxacin (n = 171). The clinical cure rate at test-of-cure visit was 94.3% (300/318) for nemonoxacin and 93.5% (143/153) for levofloxacin in the mITT population [difference (95% CI), 0.9% (?3.8%, 5.5%)]. The microbiological success rate was 92.1% (105/114) for nemonoxacin and 91.7% (55/60) for levofloxacin in the bacteriological mITT population [difference (95% CI), 0.4% (?8.1%, 9.0%)]. The incidence of adverse events (AEs) was comparable between nemonoxacin (33.1%, 118/356) and levofloxacin (33.3%, 57/171) (P > 0.05).Conclusion
Nemonoxacin 500 mg once daily for 7–10 days is as effective and safe as levofloxacin for treating adult CAP patients in terms of clinical cure rates, microbiological success rates, and safety profile.ClinicalTrials.gov identifier: NCT01529476. 相似文献18.
Silvia Freira Helena Fonseca Geoffrey Williams Marta Ribeiro Fernanda Pena Maria do Céu Machado Marina Serra Lemos 《Patient education and counseling》2019,102(4):718-725
Objective
To compare motivational interviewing (MI) with conventional care regarding the health-related quality-of-life (HRQoL) of adolescents with overweight/obesity.Methods
RCT with parallel design, involving two groups: intervention group (MI group [MIG]) and control group (conventional intervention group [CIG]). The intervention included three 30-minute interviews 3 months apart.Outcome
Change in Pediatric Quality of Life Inventory (PedsQL) scores. A mixed repeated-measures analysis of variance was used to assess group versus time interactions.Results
Eighty-three participants finished the protocol (82% girls). MIG participants showed a significant average increase (+4.7) on the Psychosocial (t[41] = -2.388, p = .022, d = .37) and Emotional Subscales (+5.1) (t[41] = 5.733, p < .001, d = .88). CIG participants showed a significant average decrease on the Psychosocial (-6.1) (t[40] = 5.733, p < .001, d = .90), Emotional (-14.1) (t[40] = 7.249, p < .001, d = 1.13) and Social Subscales (-3.8) (t[40] = 3.782, p = .001, d = .59) and on the Total Score (–4.4) (t[40] = 3.535, p = .001, d = .55)Conclusion
MI improved HRQoL among overweight adolescents participating in a weight management program.Practice implications
MI increases HRQoL and has the potential to benefit weight management programs for adolescents. 相似文献19.
E.M. Harding-Esch S.S. Fuller S.-L.C. Chow A.V. Nori M.A. Harrison M. Parker O. Piepenburg M.S. Forrest D.G. Brooks R. Patel P.E. Hay N. Fearnley M.J. Pond J.K. Dunbar P.D. Butcher T. Planche C.M. Lowndes S.T. Sadiq 《Clinical microbiology and infection》2019,25(3):380.e1-380.e7
Objectives
Rapid and accurate sexually transmitted infection diagnosis can reduce onward transmission and improve treatment efficacy. We evaluated the accuracy of a 15-minute run-time recombinase polymerase amplification–based prototype point-of-care test (TwistDx) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG).Methods
Prospective, multicentre study of symptomatic and asymptomatic patients attending three English sexual health clinics. Research samples provided were additional self-collected vulvovaginal swab (SCVS) (female participants) and first-catch urine (FCU) aliquot (female and male participants). Samples were processed blind to the comparator (routine clinic CT/NG nucleic acid amplification test (NAAT)) results. Discrepancies were resolved using Cepheid CT/NG GeneXpert.Results
Both recombinase polymerase amplification and routine clinic NAAT results were available for 392 male and 395 female participants. CT positivity was 8.9% (35/392) (male FCU), 7.3% (29/395) (female FCU) and 7.1% (28/395) (SCVS). Corresponding NG positivity was 3.1% (12/392), 0.8% (3/395) and 0.8% (3/395). Specificity and positive predictive values were 100% for all sample types and both organisms, except male CT FCU (99.7% specificity (95% confidence interval (CI) 98.4–100.0; 356/357), 97.1% positive predictive value (95% CI 84.7–99.9; 33/34)). For CT, sensitivity was ≥94.3% for FCU and SCVS. CT sensitivity for female FCU was higher (100%; 95% CI, 88.1–100; 29/29) than for SCVS (96.4%; 95% CI, 81.7–99.9; 27/28). NG sensitivity and negative predictive values were 100% in FCU (male and female).Conclusions
This prototype test has excellent performance characteristics, comparable to currently used NAATs, and fulfils several World Health Organization ASSURED criteria. Its rapidity without loss of performance suggests that once further developed and commercialized, this test could positively affect clinical practice and public health. 相似文献20.
Kamal Eldeirawi Colin Kunzweiler Shannon Zenk Patricia Finn Sharmilee Nyenhuis Natalya Rosenberg Victoria Persky 《Annals of allergy, asthma & immunology》2019,122(3):289-295