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1.
Jing Zhou Lindsey Enewold Shelia H. Zahm Ismail Jatoi Craig Shriver William F. Anderson Diana D. Jeffery Abegail Andaya John F. Potter Katherine A. McGlynn Kangmin Zhu 《American journal of surgery》2013
Background
Studies on the effect of comorbidities on breast cancer operation have been limited and inconsistent. This study investigated whether pre-existing comorbidities influenced breast cancer surgical operation in an equal access health care system.Methods
This study was based on linked Department of Defense cancer registry and medical claims data. The study subjects were patients diagnosed with stage I to III breast cancer during 2001 to 2007. Logistic regression was used to determine if comorbidity was associated with operation type and time between diagnosis and operation.Results
Breast cancer patients with comorbidities were more likely to receive mastectomy (odds ratio [OR] = 1.27; 95% confidence interval [CI], 1.14 to 1.42) than breast conserving surgery plus radiation. Patients with comorbidities were also more likely to delay having operation than those without comorbidities (OR = 1.27; 95% CI, 1.14 to 1.41).Conclusions
In an equal access health care system, comorbidity was associated with having a mastectomy and with a delay in undergoing operation. 相似文献2.
Dhruvil R. Shah Anthony D. Yang Emanual Maverakis Steve R. Martinez 《The Journal of surgical research》2013
Background
We hypothesized that patients in urban areas with intermediate thickness cutaneous melanoma would have higher rates of sentinel lymph node biopsy (SLNB) relative to their rural-dwelling counterparts.Methods
The Surveillance, Epidemiology, and End Results database was queried for patients who underwent surgery for intermediate thickness cutaneous melanoma from 2004–2008. Patients were categorized as coming from urban or rural counties based on a nine-point scale. We used multivariate logistic regression models to predict use of SLNB. Covariates examined included sex, race/ethnicity, age, T stage, tumor histology, tumor location, and ulceration. The likelihood of undergoing SLNB was reported as OR with 95% CI.Results
Of 8441 patients, 8382 (99.3%) had complete information regarding use of SLNB. On multivariate analysis, patients from rural counties had a decreased likelihood of receiving a SLNB (OR 0.87, CI 0.78–0.97; P = 0.014). Additional factors associated with a decreased likelihood of receiving a SLNB included increasing age, Asian/Hispanic/Unknown race, and head and neck or overlapping primary tumor site.Conclusions
Patients in rural areas are less likely to receive a SLNB for intermediate thickness cutaneous melanoma than their urban-dwelling counterparts. 相似文献3.
Background
The prevalence of kidney stone disease is rising along with increasing rates of obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome.Objective
To investigate the associations among the presence and severity of T2DM, glycemic control, and insulin resistance with kidney stone disease.Design, setting, and participants
We performed a cross-sectional analysis of all adult participants in the 2007–2010 National Health and Nutrition Examination Survey (NHANES). A history of kidney stone disease was obtained by self-report. T2DM was defined by self-reported history, T2DM-related medication usage, and reported diabetic comorbidity. Insulin resistance was estimated using fasting plasma insulin (FPI) levels and the homeostasis model assessment of insulin resistance (HOMA-IR) definition. We classified glycemic control using glycosylated hemoglobin A1c (HbA1c) and fasting plasma-glucose levels (FPG).Outcome measurements and statistical analysis
Odds ratios (OR) for having kidney stone disease were calculated for each individual measure of T2DM severity. Logistic regression models were fitted adjusting for age, sex, race/ethnicity, smoking history, and the Quételet index (body mass index), as well as laboratory values and components of metabolic syndrome.Results and limitations
Correlates of kidney stone disease included a self-reported history of T2DM (OR: 2.44; 95% confidence interval [CI], 1.84–3.25) and history of insulin use (OR: 3.31; 95% CI, 2.02–5.45). Persons with FPG levels 100–126 mg/dl and >126 mg/dl had increased odds of having kidney stone disease (OR 1.28; 95% CI, 0.95–1.72; and OR 2.29; 95% CI, 1.68–3.12, respectively). Corresponding results for persons with HbA1c 5.7–6.4% and ≥6.5% were OR 1.68 (95% CI, 1.17–2.42) and OR 2.82 (95% CI, 1.98–4.02), respectively. When adjusting for patient factors, a history of T2DM, the use of insulin, FPI, and HbA1c remained significantly associated with kidney stone disease. The cross-sectional design limits causal inference.Conclusions
Among persons with T2DM, more-severe disease is associated with a heightened risk of kidney stones. 相似文献4.
Yu Li Peizhun Du Yangbing Zhou Qiushi Cheng Dong Chen Dongsheng Wang Teng Sun Jinzhe Zhou Rajan Patel 《The Journal of surgical research》2014
Background
There is no consensus as to the impact of lymph node micrometastases (LNMM) on survival of patients with gastric cancer. The aim of this analysis was to investigate the prognostic significance of LNMM in patients with histologic node-negative gastric cancer.Methods
We searched relevant studies from PubMed, Embase, and the Cochrane Library (1966–2013.5), used software STATA 12.0 to pool the outcomes of each study. Mantel-Haenszel and Inverse Variance methods were used in a fixed effect model and a random effect model, respectively. The hazard ratios (HR) and odds risk (OR) at their 95% confidence intervals (CIs) were used as measures to investigate the prognostic importance of LNMM, by searching for a correlation between the clinical pathologic features and LNMM.Results
Our analysis of 18 eligible studies revealed that patients with LNMM had an increased likelihood of having a worse 5-y survival rate (HR 2.81; 95% CI:1.96–4.02). Subgroup analyses showed a more significant result for patients in pT1-2N0 (HR 3.52; 95% CI 1.88–6.62). The analyses also revealed that (OR 1.32; 95% CI 1.17–1.48), lymphatic invasion (OR 2.21; 95% CI 1.42–3.44) and venous invasion (OR 1.41; 95% CI 1.08–1.85) were associated with the occurrence of LNMM.Conclusions
There is a positive correlation between LNMM and an unfavorable surgical outcome in gastric cancer. Undifferentiated histologic findings, lymphatic invasion, and venous invasion are high risk factors for the occurrence of LNMM. 相似文献5.
Dhruvil R. Shah Anthony D. Yang Emanual Maverakis Steve R. Martinez 《The Journal of surgical research》2013
Background
Guidelines recommend that patients with melanoma metastatic to the sentinel lymph node (SLN) undergo a completion lymphadenectomy (CLND) of the affected lymph node basin. We have previously reported on decreased use of SLN biopsy among elderly patients. We hypothesized that elderly patients with SLN metastases would have lower rates of CLND relative to their younger counterparts.Methods
The Surveillance, Epidemiology, and End Results database was queried for patients who underwent SLN biopsy for intermediate thickness cutaneous melanoma (Breslow thickness 1.01 mm–4.00 mm) from 2004 to 2008 and were found to have SLN metastasis. Patients were categorized according to age by decade. We then used multivariate logistic regression models to predict receipt of CLND. Additional covariates included sex, race/ethnicity, T stage, tumor histology, tumor location, and ulceration. The likelihood of receiving a CLND was reported as OR with 95% CI; significance was set at P ≤ 0.05.Results
Entry criteria were met by 765 patients. Of these, 548 (71.6%) patients underwent CLND. On multivariate analysis, patients in the age groups 70–79 y old (OR 0.39, CI 0.20–0.78; P = 0.007) and ≥80 y old (OR 0.27, CI 0.12–0.61; P = 0.001) were less likely to undergo CLND than the youngest age group (1–39 y old).Conclusions
Elderly patients with SLN metastasis are less likely to receive CLND than their younger counterparts. A multi-center randomized clinical trial evaluating the potential survival benefit of CLND is ongoing. Further research to assess reasons why the elderly are less likely to receive CLND are needed. 相似文献6.
Robert H. Hollis Carla N. Holcomb Javier A. Valle Burke P. Smith Aerin J. DeRussy Laura A. Graham Joshua S. Richman Kamal M.F. Itani Thomas M. Maddox Mary T. Hawn 《American journal of surgery》2016,212(5):814-822
Background
We evaluated coronary angiography use among patients with coronary stents suffering postoperative myocardial infarction (MI) and the association with mortality.Methods
Patients with prior coronary stenting who underwent inpatient noncardiac surgery in Veterans Affairs hospitals between 2000 and 2012 and experienced postoperative MI were identified. Predictors of 30-day post-MI mortality were evaluated.Results
Following 12,096 operations, 353 (2.9%) patients had postoperative MI and 58 (16.4%) died. Post-MI coronary angiography was performed in 103 (29.2%) patients. Coronary angiography was not associated with 30-day mortality (odds ratio [OR]: .70, 95% CI: .35–1.42). Instead, 30-day mortality was predicted by revised cardiac risk index ≥3 (OR 1.91, 95% CI: 1.04–3.50) and prior bare metal stent (OR 2.12, 95% CI: 1.04–4.33).Conclusions
Less than one-third of patients with coronary stents suffering postoperative MI underwent coronary angiography. Significant predictors of mortality were higher revised cardiac risk index and prior bare metal stent. These findings highlight the importance of comorbidities in predicting mortality following postoperative MI. 相似文献7.
Perceived barriers to mammography among underserved women in a Breast Health Center Outreach Program
Oluwadamilola M. Fayanju Susan Kraenzle Bettina F. Drake Masayoshi Oka Melody S. Goodman 《American journal of surgery》2014
Background
To investigate perceived barriers to mammography among underserved women, we asked participants in the Siteman Cancer Center Mammography Outreach Registry–developed in 2006 to evaluate mobile mammography's effectiveness among the underserved–why they believed women did not get mammograms.Methods
The responses of approximately 9,000 registrants were analyzed using multivariable logistic regression. We report adjusted odds ratios (OR) and 95% confidence intervals (CI) significant at 2-tailed P values less than .05.Results
Fears of cost (40%), mammogram-related pain (13%), and bad news (13%) were the most commonly reported barriers. Having insurance was associated with not perceiving cost as a barrier (OR .44, 95% CI .40 to .49), but with perceiving fear of both mammogram-related pain (OR 1.39, 95% CI 1.21 to 1.60) and receiving bad news (OR 1.38, 95% CI 1.19 to 1.60) as barriers.Conclusion
Despite free services, underserved women continue to report experiential and psychological obstacles to mammography, suggesting the need for more targeted education and outreach in this population. 相似文献8.
Kenneth G. Nepple Andrew J. Stephenson Dorina Kallogjeri Jeff Michalski Robert L. Grubb III Seth A. Strope Jennifer Haslag-Minoff Jay F. Piccirillo Jay P. Ciezki Eric A. Klein Chandana A. Reddy Changhong Yu Michael W. Kattan Adam S. Kibel 《European urology》2013
Background
Medical comorbidity is a confounding factor in prostate cancer (PCa) treatment selection and mortality. Large-scale comparative evaluation of PCa mortality (PCM) and overall mortality (OM) restricted to men without comorbidity at the time of treatment has not been performed.Objective
To evaluate PCM and OM in men with no recorded comorbidity treated with radical prostatectomy (RP), external-beam radiation therapy (EBRT), or brachytherapy (BT).Design, setting, and participants
Data from 10 361 men with localized PCa treated from 1995 to 2007 at two academic centers in the United States were prospectively obtained at diagnosis and retrospectively reviewed. We identified 6692 men with no recorded comorbidity on a validated comorbidity index. Median follow-up after treatment was 7.2 yr.Intervention
Treatment with RP in 4459 men, EBRT in 1261 men, or BT in 972 men.Outcome measurements and statistical analysis
Univariate and multivariate Cox proportional hazards regression analysis, including propensity score adjustment, compared PCM and OM for EBRT and BT relative to RP as reference treatment category. PCM was also evaluated by competing risks analysis.Results and limitations
Using Cox analysis, EBRT was associated with an increase in PCM compared with RP (hazard ratio [HR]: 1.66; 95% confidence interval [CI], 1.05–2.63), while there was no statistically significant increase with BT (HR: 1.83; 95% CI, 0.88–3.82). Using competing risks analysis, the benefit of RP remained but was no longer statistically significant for EBRT (HR: 1.55; 95% CI, 0.92–2.60) or BT (HR: 1.66; 95% CI, 0.79–3.46). In comparison with RP, both EBRT (HR: 1.71; 95% CI, 1.40–2.08) and BT (HR: 1.78; 95% CI, 1.37–2.31) were associated with increased OM.Conclusions
In a large multicenter series of men without recorded comorbidity, both forms of radiation therapy were associated with an increase in OM compared with surgery, but there were no differences in PCM when evaluated by competing risks analysis. These findings may result from an imbalance of confounders or differences in mortality related to primary or salvage therapy. 相似文献9.
Jim C. Hu Giorgio Gandaglia Pierre I. Karakiewicz Paul L. Nguyen Quoc-Dien Trinh Ya-Chen Tina Shih Firas Abdollah Karim Chamie Jonathan L. Wright Patricia A. Ganz Maxine Sun 《European urology》2014
Background
Robot-assisted radical prostatectomy (RARP) remains controversial, and no improvement in cancer control outcomes has been demonstrated over open radical prostatectomy (ORP).Objective
To examine population-based, comparative effectiveness of RARP versus ORP pertaining surgical margin status and use of additional cancer therapy.Design, setting, and participants
This was a retrospective observational study of 5556 RARP and 7878 ORP cases from 2004 to 2009 from Surveillance Epidemiology and End Results–Medicare linked data.Intervention
RARP versus ORP.Outcome measurements and statistical analysis
Propensity-based analyses were performed to minimize treatment selection biases. Generalized linear regression models were computed for comparison of RP surgical margin status and use of additional cancer therapy (radiation therapy [RT] or androgen deprivation therapy [ADT]) by surgical approach.Results and limitations
In the propensity-adjusted analysis, RARP was associated with fewer positive surgical margins (13.6% vs 18.3%; odds ratio [OR]: 0.70; 95% confidence interval [CI], 0.66–0.75), largely because of fewer RARP positive margins for intermediate-risk (15.0% vs 21.0%; OR: 0.66; 95% CI, 0.59–0.75) and high-risk (15.1% vs 20.6%; OR: 0.70; 95% CI, 0.63–0.77) disease. In addition, RARP was associated with less use of additional cancer therapy within 6 mo (4.5% vs 6.2%; OR: 0.75; 95% CI, 0.69–0.81), 12 mo (OR: 0.73; 95% CI, 0.62–0.86), and 24 mo (OR: 0.67; 95% CI, 0.57–0.78) of surgery. Limitations include the retrospective nature of the study and the absence of prostate-specific antigen levels to determine biochemical recurrence.Conclusions
RARP is associated with improved surgical margin status relative to ORP for intermediate- and high-risk disease and less use of postprostatectomy ADT and RT. This has important implications for quality of life, health care delivery, and costs.Patient summary
Robot-assisted radical prostatectomy (RP) versus open RP is associated with fewer positive margins and better early cancer control because of less use of additional androgen deprivation and radiation therapy within 2 yr of surgery. 相似文献10.
E. Boselli L. Bouvet T. Rimmelé D. Chassard B. Allaouchiche 《Annales fran?aises d'anesthèsie et de rèanimation》2009
Objective
The objective of this systematic review was to assess the effect of preoperative rather than after umbilical cord clamping antimicrobial prophylaxis for caesarean delivery on maternal and neonatal infectious postoperative morbidity.Study design
Meta-analysis.Methods
Three electronic databases (Pubmed, Cochrane Central Register of Randomized Controlled Trials and Embase) were searched without language restriction and retrieved 201 potentially relevant trials. Five randomized controlled trials (n = 1108) studying the timing of antimicrobial prophylaxis for caesarean section were included. The quality of included trials was assessed on the modified Oxford validity scale.Results
Preoperative administration of antibiotics (n = 456) rather than after cord clamping (n = 563) provides a significant reduction in the incidence of endometritis (Odds Ratio (OR) 0.59 [95% Confidence Interval (CI) 0.35–0.98]) and of total maternal infectious morbidity (OR 0.51 [95% CI 0.32–0.82]). This benefit was not observed regarding the incidence of wound infection (Peto OR 0.58 [95% CI 0.29–1.16]), neonatal infection (Peto OR 1.06 [95% CI 0.57–1.96]), neonatal sepsis workup (OR 1.02 [95% CI 0.67–1.54]), neonatal documented sepsis (Peto OR 0.93 [95% CI 0.43–2.02]) or neonatal intensive care unit admission (OR 0.97 [95% CI 0.61–1.56]). No significant heterogeneity was observed between the included studies.Conclusion
This meta-analysis provides strong evidence that the preoperative rather than after cord clamping administration of antimicrobial prophylaxis for caesarean delivery provides a reduction in the incidence of endometritis and maternal total infectious morbidity without affecting the incidence of wound infection and neonatal infectious morbidity. 相似文献11.
Objective
To compare the outcomes of patients undergoing damage control laparotomy (DCL) for intra-abdominal sepsis vs intra abdominal haemorrhage. We hypothesize that patients undergoing DCL for sepsis will have a higher rate of septic complications and a lower rate of primary fascial closure.Settings and patients
Retrospective study of patients undergoing DCL from December 2006 to November 2009. Data are presented as medians and percentages where appropriate.Results
111 patients were identified (55 men), 79 with sepsis and 32 with haemorrhage. There was no difference in age (63 vs 62 years), body mass index (BMI, 27 vs 28), diabetes mellitus (13% vs 9%), or duration of initial operation (125 vs 117 min). Patients with sepsis presented with a lower serum lactate (2.2 vs 4.7 mmol/L, p < 0.01), base deficit (4.0 vs 8.0, p ≤ 0.01) and ASA score (3.0 vs 4.0, p < 0.01). There was no statistical difference in overall morbidity (81% vs 66), mortality (19% vs 22%), intra-abdominal abscess (18% vs 16%), deep wound infection (9% vs 9%), enterocutaneous fistula (ECF) (8% vs 6%) and primary fascial closure (58% vs 59%). Multivariable analysis demonstrated that intra-abdominal abscess (OR 4.26, 95% CI 1.06–19.32), higher base deficit (OR 1.14, 95% CI 1.00–1.31) and more abdominal explorations (OR 1.54, 95% CI 1.23–2.07) were associated with lack of primary fascial closure, but BMI (OR 1.00, 95% CI 0.94–1.07), ECF (OR 2.02, 95% CI 0.23–19.98), wound infection (OR 0.93, 95% CI 0.15–5.27), amount of crystalloids infused within the first 24 h (OR 1.00, 95% CI 0.99–1.00) and intra-abdominal sepsis (OR 1.14, 95% CI 0.35–3.80) were not.Conclusions
There was an equivalent rate of septic complications and primary fascial closure rates regardless of cause for DCL. Intra-abdominal abscess, worse base deficit and higher number of abdominal explorations were independently associated with the lack of primary fascial closure. 相似文献12.
Background/purpose
The incidence of infantile hypertrophic pyloric stenosis (IHPS) in Sweden decreased dramatically during the 1990s. The aim of the study was to examine IHPS risk factors and the possible change in them as the incidence declined.Methods
This is a case–control study including 3608 surgically treated IHPS cases and 17588 matched controls during 1973–2008. Cases were identified in the Swedish National Patient Register and data on possible risk factors were collected from the Swedish Medical Birth Register. The association between study variables and IHPS was analyzed using conditional logistic regression for the whole study period and separately for periods with high and low IHPS incidences.Results
Prematurity (OR, 2.54; 95% CI, 2.06–3.14), caesarean delivery (OR, 1.67; 95% CI, 1.51–1.86), maternal smoking (OR, 1.82; 95% CI, 1.53–2.16), and young maternal age (< 20 yrs) (OR, 1.42; 95% CI, 1.17–1.73) were associated with an increased IHPS risk. Birth order 2 (OR, 0.78; 95% CI, 0.71–0.85) or more was associated with a lower IHPS risk. ORs for smoking increased at low incidence rate.Conclusion
We report caesarean section, prematurity, primiparity, young maternal age, and smoking as significant IHPS risk factors. The impact of smoking was higher during periods with a low incidence. 相似文献13.
Robert Karlsson Markus Aly Mark Clements Lilly Zheng Jan Adolfsson Jianfeng Xu Henrik Grönberg Fredrik Wiklund 《European urology》2014
Background
A rare but recurrent missense mutation (G84E, rs138213197) in the gene homeobox B13 (HOXB13) was recently reported to be associated with hereditary prostate cancer.Objective
To explore the prevalence and penetrance of HOXB13 G84E in a general population.Design, setting, and participants
G84E and 14 additional HOXB13 polymorphisms were genotyped in two population-based, Swedish, case-control samples (Cancer of the Prostate in Sweden [CAPS] and Stockholm-1) comprising 4693 controls and 5003 prostate cancer cases. CAPS collected data on patients and population controls nationally between 2001 and 2003. Stockholm-1 collected data on biopsy-positive patients and biopsy-negative controls in the Stockholm area between 2005 and 2007.Outcome measurements and statistical analysis
The outcome was pathologically verified prostate cancer. Relative and absolute risks among HOXB13 G84E mutation carriers were explored, as was the combined impact on disease risk of G84E and a polygenic score based on 33 established, common, low-risk variants.Results and limitations
HOXB13 G84E was observed in 1.3% of population controls and was strongly associated with prostate cancer risk (CAPS: odds ratio [OR]: 3.4; 95% confidence interval [CI], 2.2–5.4; Stockholm-1: OR: 3.5; 95% CI, 2.4–5.2). The strongest association was observed for young-onset (OR: 8.6; 95% CI, 5.1–14.0) and hereditary (OR: 6.6; 95% CI, 3.3–12.0) prostate cancer. Haplotype analyses supported that G84E is a founder mutation. G84E carriers have an estimated 33% (95% CI, 23–46) cumulative risk to age 80 yr of prostate cancer, compared to 12% (95% CI, 11–13) among noncarriers. For G84E carriers within the top quartile of a polygenic score of established susceptibility variants, the cumulative risk was estimated at 48% (95% CI, 36–64).Conclusions
HOXB13 G84E is prevalent in >1% of the Swedish population and is associated with a 3.5-fold increased risk of prostate cancer. One-third of G84E carriers will be diagnosed with prostate cancer, which has implications for surveillance in mutation carriers. 相似文献14.
Zhiqiang Wang Jiru Zhang Zhou Cheng Xianhua Li Zhenjun Wang Chuanxin Liu Zongtao Xie 《The Journal of surgical research》2014
Background
Video-assisted thoracic surgery (VATS) has been widely applied in the treatment of lung cancer. However, few studies have focused on the clinical factors predicting the major postoperative complications.Methods
Clinical data from 525 patients who underwent resection of primary lung cancer with VATS from January 2007–August 2011 were retrospectively analyzed. Risk factors related to major postoperative complications were assessed by univariate and multivariate analyses with logistic regression.Results
Major complications occurred in 36 (6.86%) patients, of which seven died (1.33%) within 30 d, postoperatively. Major complications included respiratory failure, hemothorax, myocardial infarction, heart failure, bronchial fistula, cerebral infarction, and pulmonary embolism. Univariate and multivariate logistic regression analyses demonstrated that age >70 y (odds ratio [OR], 2.105; 95% confidence interval [CI] 1.205–3.865), forced expiratory volume during the first second expressed as a percentage of predicted ≤70% (OR, 2.106; 95% CI 1.147–3.982) combined with coronary heart disease (OR, 2.257; 95% CI 1.209–4.123) were independent prognostic factors for major complications.Conclusions
Age >70 and forced expiratory volume during the first second expressed as a percentage of predicted ≤70% combined with coronary heart disease are independent prognostic factors for postoperative major complications. Patients in these groups should undergo careful preoperative evaluation and perioperative management. 相似文献15.
P. Ruangkanchanasetr Bancha Satirapoj S. Bunnag A. Vongwiwatana N. Premasathian Y. Avihingsanon 《Transplantation proceedings》2014
Background
Obesity is a risk factor for cardiovascular disease and cardiovascular mortality in renal transplant recipients (RTRs). There are limited studies of prevalence and associated factors of obesity in Asian RTRs.Methods
A cross-sectional study was conducted from July to December 2012 in 4 kidney transplant centers in Bangkok, Thailand. Obesity was diagnosed based on the International Obesity Taskforce-proposed classification. At risk of obesity, obese I, and obese II were defined as having a body mass index (BMI) of 23–24.9 kg/m2, 25–29.9 kg/m2, and ≥30 kg/m2, respectively.Results
Of 263 recipients studied, 50 (19.0%), 70 (26.6%), and 17 (6.5%) were at risk of obesity, obese I, and obese II, respectively. The prevalence of obesity was 12.6% in the 1st year, was 28.6% in the first 3 years, and rose to 39.7% after 3 years after transplantation. Age (odds ratio [OR], 1.04; 95% CI, 1.01–1.07), systolic blood pressure ≥130/85 mm Hg (OR, 2.82; 95% CI, 1.51–5.26), number of antihypertensive medications (OR, 1.99; 95% CI, 1.42–2.79), fasting plasma glucose (OR, 1.03; 95% CI, 1.01–1.04,) and high-density lipoprotein (HDL) cholesterol (OR, 0.96; 95% CI, 0.94–0.98) were associated with obesity. Compared with 100 RTRs with normal BMI, obese patients tended to have higher prevalence of chronic kidney disease (OR, 1.59; 95% CI, 0.89–2.83).Conclusions
The study demonstrates the high prevalence of obesity in Thai RTRs especially after 3 years after transplantation. Obesity is more prevalent with advanced age and variable components of metabolic syndrome in the RTR population. Obese RTRs had significantly higher blood pressure and required more antihypertensive medication when compared with RTRs with normal BMI. 相似文献16.
Background
Roux-en-Y choledochojejunostomy and duct-to-duct anastomosis are potential methods for biliary reconstruction in liver transplantation (LT) for recipients with primary sclerosing cholangitis (PSC). However, there is controversy over which method yields superior outcomes. The purpose of this study was to evaluate the outcomes of duct-to-duct versus Roux-en-Y biliary anastomosis in patients undergoing LT for PSC.Methods
Studies comparing Roux-en-Y versus duct-to-duct anastomosis during LT for PSC were identified based on systematic searches of 9 electronic databases and multiple sources of gray literature.Results
The search identified 496 citations, including 7 retrospective series, and 692 patients met eligibility criteria. The use of duct-to-duct anastomosis was not associated with a significant difference in clinical outcomes, including 1-year recipient survival rates (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.65–1.60; P = .95), 1-year graft survival rates (OR, 1.11; 95% CI, 0.72–1.71; P = .64), risk of biliary leaks (OR, 1.23; 95% CI, 0.59–2.59; P = .33), risk of biliary strictures (OR, 1.99; 95% CI, 0.98–4.06; P = .06), or rate of recurrence of PSC (OR, 0.94; 95% CI, 0.19–4.78; P = .94).Conclusions
There were no significant differences in 1-year recipient survival, 1-year graft survival, risk of biliary complications, and PSC recurrence between Roux-en-Y and duct-to-duct biliary anastomosis in LT for PSC. 相似文献17.
The incidence and outcomes of acute kidney injury amongst patients admitted to a level I trauma unit
Purpose
This study aimed to identify the incidence and outcomes of patients with trauma related acute kidney injury (AKI), as defined by RIFLE criteria, at a single level I trauma centre and trauma ICU.Methods
We performed a retrospective observational study of 666 patients admitted to a trauma ICU from a level I trauma unit from March 2008 to March 2011. We conducted multivariable logistic regression to identify independent predictors for AKI and mortality.Results
The overall incidence of AKI was 15% (n = 102). Median injury severity score (ISS) was 25 (inter quartile range [IQR] 16–34) and mean age was 39 (SD 16.3) in the AKI group. Thirteen patients (13%) were referred with rhabdomyolysis associated renal Failure. Overall mortality in the AKI group was 57% (n = 58) but was significantly lower in the rhabdomyolysis Failure group (23% versus 64%; p = 0.012). AKI was independently associated with older age, base excess (BE) < −12 (odd ratio [OR] 22.9, 95% confidence interval [CI] 1.89–276.16), IV contrast administration (OR 2.7 95% CI 1.39–5.11) and blunt trauma (OR 2.2 95% CI 1.04–4.71). AKI was an independent predictor of mortality (OR 8.5, 95% CI 4.51–15.95). Thirty-nine (38%) patients required renal replacement therapy.Conclusions
AKI in critically ill trauma patients is an independent risk factor for mortality and is independently associated with increasing age and low BE. Renal replacement therapy utilisation is high in this group and represents a significant health care cost burden. 相似文献18.
Surgical management of esophageal diverticulum: a review of the Nationwide Inpatient Sample database
Michael T. Onwugbufor Augustine C. Obirieze Gezzer Ortega Delenya Allen Edward E. Cornwell III Terrence M. Fullum 《The Journal of surgical research》2013
Background
Esophageal diverticulum is rare in the United States. The mainstay treatment of symptomatic esophageal diverticulum is surgical correction. Much of the available information regarding esophageal diverticulum and its surgical management has been derived from small studies and institutional reviews. Our study objective was to investigate the demographics, perioperative conditions, and predictors of outcomes after surgical treatment of acquired esophageal diverticulum using a nationally representative database.Methods
A retrospective review using the Nationwide Inpatient Sample database from 2000–2009 was performed for patients with acquired esophageal diverticulum. The patients were stratified into Zenker's diverticulum (ZD) or non-Zenker’s diverticulum (NZD) subgroups. The covariates retrieved included age, gender, ethnicity, insurance type, and Charlson comorbidity index. A multivariate analysis was performed to determine the predictors of postoperative morbidity. Discharge-level weights were applied.Results
Overall, a total of 4253 patients met our inclusion criteria, 3197 (75%) with ZD and 1056 (25%) with NZD. In the ZD group, the mean age was 73 ± 12.3 y, and most were men (55%) and white (67%). The mean length of stay was 5.82 ± 8.08 d, and the mortality rate was 1.2%. The most common complication was septicemia or sepsis (2.0%). The black patients had higher odds of postoperative morbidity than the white patients (odds ratio [OR] 2.29, 95% confidence interval [CI] 1.02–5.17). The risk of overall postoperative morbidity was 52% greater for women (OR 1.52, 95% CI 1.01–2.29). An increasing Charlson comorbidity index was an independent predictor of morbidity. In the NZD group, the mean age was 69 ± 13.9 y, and most were also men (51%) and white (63%). The mean length of stay was 8.13 ± 10.56 d, and the mortality rate was 1.6%. The most common complication was air leak (3.1%). The black and Hispanic patients had higher odds of postoperative morbidity than the white patients (OR 1.97, 95% CI 1.05–3.72 and OR 2.37, 95% CI 1.06–5.30, respectively). An increasing Charlson comorbidity index was an independent predictor of morbidity. Compared with laparoscopy, the risk of developing postoperative morbidity was higher with the thoracotomy procedure (OR 7.45, 95% CI 1.11–50.18).Conclusions
Using a nationally representative database, our study found that female gender, black race, and the presence of comorbidities were associated with increased postoperative morbidity among patients with ZD. Among the patients with NZD, black and Hispanic patients had worse postoperative morbidity than the white patients, and the presence of comorbidities was associated with increased postoperative morbidity. Thoracotomy for the correction of NZD was associated with increased postoperative morbidity compared with the laparoscopic approach. 相似文献19.
Gloria R. SueDonald R. Lannin M.D. Alexander F. AuDeepak Narayan M.D. Anees B. Chagpar 《American journal of surgery》2013
Background
Factors influencing the treatment of ductal carcinoma in situ with mastectomy and reconstruction are poorly understood.Methods
A retrospective cohort study of 196 patients presenting to one institution was performed.Results
Forty-seven patients (24.0%) were treated with mastectomy, while 149 (76.0%) underwent breast-conserving surgery. Of the mastectomy patients, 28 (59.6%) elected for reconstruction. On bivariate analysis, patients who opted for mastectomy were younger than those treated with breast-conserving surgery (median age, 51.8 vs 56.5 years; P = .017) and had higher grade tumors (50.0% vs 34.6% grade 3, P = .009). Among patients treated with mastectomy, those who opted for reconstruction were younger than those forgoing reconstruction (49.4 vs 56.9 years, P = .024). Race, ductal carcinoma in situ tumor size, and histologic subtype were not associated with the decision to pursue mastectomy or reconstruction (P > .05 for all).Conclusions
In patients with ductal carcinoma in situ, the decision to pursue mastectomy and reconstruction appears to be driven by younger patient age and higher tumor grade. 相似文献20.
Jesse D. Sammon Khurshid R. Ghani Pierre I. Karakiewicz Naeem Bhojani Praful Ravi Maxine Sun Shyam Sukumar Vincent Q. Trinh Keith J. Kowalczyk Simon P. Kim James O. Peabody Mani Menon Quoc-Dien Trinh 《European urology》2013