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1.
Usama Mahmood MD Alexandra L. Hanlon PhD Matthew Koshy MD Robert Buras MD Saranya Chumsri MD Katherine H. Tkaczuk MD Sally B. Cheston MD William F. Regine MD Steven J. Feigenberg MD 《Annals of surgical oncology》2013,20(5):1436-1443
Background
To study national trends in the mastectomy rate for treatment of early stage breast cancer.Methods
We analyzed data from the Surveillance, Epidemiology, and End Results database, including 256,081 women diagnosed with T1–2 N0–3 M0 breast cancer from 2000 to 2008. We evaluated therapeutic mastectomy rates by the year of diagnosis and performed a multivariable logistic regression analyses to determine predictors of mastectomy as the treatment choice.Results
The proportion of women treated with mastectomy decreased from 40.1 to 35.6 % between 2000 and 2005. Subsequently, the mastectomy rate increased to 38.4 % in 2008 (p < 0.0001). Simple logistic regression models demonstrated that mastectomy rates between 2005 and 2008 were moderated by age (p < 0.0001), marital status (p = 0.0230), and geographic location (p < 0.0001). Multivariate logistic regression analysis found that age, race, marital status, geographic location, involvement of multiple regions of the breast, lobular histology, increasing T stage, lymph node positivity, increasing grade, and negative hormone receptor status were independent predictors of mastectomy. Additionally, multivariate analysis confirmed that women diagnosed in 2008 were more likely to undergo mastectomy than women diagnosed in 2005 (odds ratio 1.17, 95 % confidence interval 1.13 to 1.21, p < 0.0001).Conclusions
There is evidence of a reversal in the previously declining national mastectomy rates, with the mastectomy rate reaching a nadir in 2005 and subsequently rising. Further follow-up to confirm this trend and investigation to determine the underlying cause of this trend and its effect on outcomes may be warranted. 相似文献2.
K. Senohradski L. Markovic-Denic A. Lesic V. Bumbasirevic M. Bumbasirevic 《Osteoporosis international》2013,24(5):1759-1763
Summary
Hip fracture incidence in the capital city of Serbia was assessed over a period of 10 years (2000–2009). Crude annual incidence rates increased significantly for all ages and both sexes (p?=?0.002). Age-adjusted rates also showed a steady increase. The mean rate of annual change for age-adjusted rates was 8.6 % (95 %CI 7.5–9.7) in males, 8.0 % (95 %CI 7.4–8.6) in females, and 8.2 % (95 %CI 7.7–8.7) in the total population.Introduction
The aim of this study was to estimate the incidence rate and trend of hip fractures in the population of Belgrade, the capital of Serbia.Methods
Data sources were the official statistics of the Public Health Institute in Belgrade. The patient's age, gender, residence, hospital admission, and diagnosis were registered for each hospital admission. Population estimates were based on census data from 2002 and on published estimates for the intercensus years. The annual incidence (crude) rates and age- and sex-specific incidence rates were calculated with 95 % confidence intervals (CI) and age-adjusted incidence rates for persons over the age of 50 years were computed.Results
A significantly increasing trend of crude incidence rates for all ages was observed in males (p?=?0.002), females (p?=?0.001), and overall (p?=?0.002). The proportion of trochanteric fractures rose significantly with age in women (p?<?0.0001), whereas it decreased nonsignificantly in men ≥70 years (p?=?0.44). The age-adjusted incidence rates (per 100,000 in subjects ≥50 years old) showed a steady increase. The mean rate of annual change for age-adjusted rates was 8.6 % (95 %CI 7.5–9.7) in males, 8.0 % (95 %CI 7.4–8.6) in females, and 8.2 % (95 %CI 7.7–8.7) in the total population.Conclusion
Hip fracture incidence continues to increase. In view of the rapid aging of the population, it is necessary to implement a comprehensive preventive policy in our community. 相似文献3.
Joerg Heil MD Geraldine Rauch MD Akos Z. Szabo MD Carlos A. Garcia-Etienne MD Michael Golatta MD Christoph Domschke MD Mahyar Badiian MD Peter Kern MD Florian Schuetz MD Markus Wallwiener MD Christof Sohn MD Hubertus Fries MD Gunter von Minckwitz MD Andreas Schneeweiss MD Mahdi Rezai MD 《Annals of surgical oncology》2013,20(12):3839-3846
Purpose
Analysis of mastectomy rates in breast cancer patients diagnosed between 2006 and 2010 in Germany with focus on impact of breast magnetic resonance imaging (MRI), immediate breast reconstruction (IBR) rates, and hospital volume as possible influencing factors of mastectomy rates.Methods
Data of a voluntary monitored benchmarking project were used to evaluate mastectomy trends across time in an unselected cohort of breast cancer patients. We used univariate and multivariate logistic regression analysis to identify predictive factors of mastectomy.Results
A total of 142.863 cases were included into the analysis. There was an overall decrease of 5.9 % (95 % confidence interval 5.1–6.7) in mastectomy trend from 36.5 % in 2006 to 30.6 % in 2010 (P < 0.0001). Known predictive factors were confirmed. Breast MRI (odds ratio 1.42, 95 % confidence interval 1.36–1.47) and small hospitals (<150 cases per year) seem to favor mastectomy. IBR was not associated with mastectomy rates.Conclusions
Mastectomy rates in comparable health systems differ. Performance of preoperative breast MRI and hospital volume seem to be independent influencing factors for mastectomy rates. 相似文献4.
Shyh-Kuan Tai MD PhD Wing-Yin Li MD Muh-Hwa Yang MD PhD Pen-Yuan Chu MD Yi-Fen Wang MD PhD Peter Mu-Hsin Chang MD 《Annals of surgical oncology》2013,20(11):3568-3574
Background
Neck management for cN0 neck remains controversial for T1–2 oral tongue and buccal squamous cell carcinoma (SCC). Increased tumor thickness and perineural invasion (PNI) are two pathologic features that correlated with cervical lymph node (LN) metastasis and poor survival. However, the relationships between these two features remain unclear.Methods
Detailed histologic reevaluation under hematoxylin and eosin staining was performed in tumors of 212 consecutive patients with T1–2, cN0 oral tongue and buccal SCC. The interrelationships between the impacts of tumor thickness and PNI on cervical LN metastasis and disease-specific survival (DSS) were analyzed.Results
Increased tumor thickness (>6 mm) correlated with higher LN metastasis and poor 5-year DSS rates in univariate analysis. However, only PNI independently predicted both in multivariate analysis (P = 0.004 and P = 0.039, respectively). When stratified by PNI status, increased tumor thickness did not correlate with higher LN metastasis rate in either PNI-negative or PNI-positive groups (P = 0.337 and P = 0.730). Compared to patients with thin tumors (≤6 mm), patient with thick tumors revealed significantly higher LN metastasis rate (41.9 vs. 16.4 %, P = 0.001) and lower 5-year DSS rate (77.5 vs. 93.7 %, P = 0.006) only at the presence of PNI.Conclusions
PNI can be a major determinant for higher LN metastasis and poor 5-year DSS rates associated with increased tumor thickness in T1–2 oral tongue and buccal SCC. Careful evaluation of PNI should be mandatory in routine pathologic examination, aside from the measurement of tumor thickness. 相似文献5.
Nancy N. Maserejian Vatche A. Minassian Shan Chen Susan A. Hall John B. McKinlay Sharon L. Tennstedt 《International urogynecology journal》2014,25(6):775-782
Introduction and hypothesis
The objective of this analysis was to describe urinary incontinence (UI) incidence and persistence over 5 years in association with treatment status, sociodemographic, medical, and lifestyle factors, in a racially/ethnically diverse population-based female sample.Methods
The Boston Area Community Health Survey enrolled 3,201 women aged 30-79 years of black, Hispanic, and white race/ethnicity. Five-year follow-up was completed by 2,534 women (conditional response rate 83.4 %), allowing population-weighted estimates of UI incidence and persistence rates. Predictors of UI were determined using multivariate logistic regression models.Results
Incidence of UI at least monthly was 14.1 % and weekly 8.9 %. Waist circumference at baseline and increasing waist circumference over 5-year follow-up were the most robust predictors of UI incidence in multivariate models (P?≤?0.01). Among 475 women with UI at baseline, persistence was associated with depression symptoms [monthly UI, odds ratio (OR)?=?2.39, 95 % confidence interval (CI) 1.14–5.02] and alcohol consumption (weekly UI, OR?=?3.51, 95 % CI 1.11–11.1). Among women with weekly UI at baseline, 41.7 % continued to report weekly UI at follow-up, 14.1 % reported monthly UI, and 44.2 % had complete remission. Persistence of UI was not significantly higher (58.2 % vs. 48.0 %, chi-square P?=?0.3) among untreated women. Surgical or drug treatment for UI had little impact on estimates for other risk factors or for overall population rates of persistence or remission.Conclusions
Women with higher gains in waist circumference over time were more likely to develop UI, but waist circumference was not predictive of UI persistence. UI treatments did not affect associations for other risk factors. Additional research on the role of alcohol intake in UI persistence is warranted. 相似文献6.
Purpose
Propofol injection is known to cause distressing pain, and various methods have been used to decrease this pain. We investigated the efficacy of the lidocaine + metoclopramide and lidocaine + ketamine combinations on modulating propofol injection pain.Methods
Ninety ASA I/II patients aged 20–60 years were randomly assigned to three groups to receive lidocaine 20 mg (group L), lidocaine 20 mg + metoclopramide 10 mg (group LM), or lidocaine 20 mg + ketamine 5 mg (group LK), respectively, with venous occlusion for 1 min using a forearm tourniquet. Propofol 0.5 mg/kg was subsequently administered into a dorsal hand vein, and pain was assessed during its injection using a verbal rating score. The results were analyzed statistically with analysis of variance, the chi-square test, and the Wilcoxon rank sum test, where appropriate. The significance level was set at p < 0.05.Results
The incidence of pain was rated to be significantly less in patients in groups LM (40 %) and LK (6.7 %) than in those in group L (83.3 %) (p = 0.001 and p < 0.001, respectively). The pain score [median (range)] was also significantly less in patients in groups LM [0 (0–3)] and LK [0 (0–2)] than in those in group L [2 (0–3)] (p = 0.001 for both groups).Conclusion
The lidocaine–ketamine combination is most effective for decreasing the pain on propofol injection. 相似文献7.
Manfred Odermatt Najaf Siddiqi Rose Johns Danilo Miskovic Omar Khan Jim Khan Amjad Parvaiz 《Surgery today》2014,44(11):2045-2051
Purpose
To compare the outcomes of colonic splenic flexure tumours treated by extended right colectomy versus left colectomy.Methods
Stage I–III splenic flexure tumours, treated either by extended right colectomy or left colectomy between 1996 and 2011, were identified in a prospective database, and the short- and long-term outcomes compared. The survival analyses were performed using the Kaplan–Meier method and adjusted using a Cox-proportional hazard model.Results
A total of 30 (44 %) splenic flexure tumours were resected by left colectomy and 38 (56 %) by right colectomy. Emergency operations were more common (74 versus 20 %, p < 0.001) in the right colectomy group. In the univariate analysis, the 5-year overall survival (55 % for right colectomy versus 60 % for left colectomy, p = 0.197) and 5-year recurrence-free survival (41 versus 54 %, p = 0.180, respectively) showed a trend towards a non-significant survival benefit for left colectomy. However, when adjusted for age, gender, ASA classification, tumour stage, urgency and year of surgery, this trend disappeared.Conclusion
Patients undergoing extended right or left colectomy for splenic flexure tumours seemed to have comparable short- and long-term outcomes. 相似文献8.
Michael Kranzfelder Ralf Gertler Alexander Hapfelmeier Helmut Friess Marcus Feith 《Surgical endoscopy》2013,27(10):3530-3538
Background
Esophagectomy is a challenging operation with considerable potential for postoperative complications, including chylothorax.Methods
Because no randomized controlled trial or metaanalysis is available to clarify the incidence of chylothorax in esophageal cancer surgery, the authors analyzed their own institutional data for 1,856 patients and performed a systematic review using the MEDLINE database (9,794 patients) to identify risk factors, compare success rates of therapeutic approaches, and investigate long-term outcomes.Results
The overall institutional chylothorax rate was 2 % (n = 39). Reoperation was performed for 69 % of the patients. No significant difference was noted between the transthoracic and transhiatal approaches. Regression analysis showed neoadjuvant treatment (odds ratio [OR], 0.302; p = 0.001) and tumor type (OR, 0.304; p = 0.002) to be independent risk factors. The systematic review included 12 studies. Chylothorax occurred for 2.6 % of the patients. Treatment favored reoperation in five studies (70–100 %) and a conservative approach in four studies (58–72 %), with equal mortality rates. No significant difference was found between the transthoracic and transhiatal approaches.Conclusion
Chylothorax rates are low in high-volume centers (2–3 %). No significant difference was noted between the transthoracic and transhiatal approaches. Neoadjuvant treatment and tumor type were shown to be independent risk factors. Treatment concept (reoperation vs conservative treatment) did not affect long-term survival. 相似文献9.
Susan M. Sharpe MD Erik Liederbach BS Tomasz Czechura MPH Catherine Pesce MD David J. Winchester MD Katharine Yao MD 《Annals of surgical oncology》2014,21(9):2920-2927
Background
Rates of bilateral mastectomy (BM) have increased, but the impact on length of stay (LOS), readmission rate, 30-day mortality, and time to adjuvant therapy is unknown.Methods
Using the National Cancer Data Base, we selected 390,712 non-neoadjuvant AJCC stage 0–III breast cancer patients who underwent either unilateral mastectomy (UM) or BM from 2003 to 2010 with and without reconstruction. We used chi-square and logistic regression models for the analysis.Results
A total of 315,278 patients (81 %) had UM, and 75,437 (19 %) had BM; 97,031 (25 %) underwent reconstruction. The number of median days from diagnosis to UM increased from 19 days in 2003 to 28 days in 2010, and for BM, increased from 21 to 31 days (p < 0.001). BM was independently associated with a longer time to surgery when adjusting for patient, facility, and tumor factors and reconstruction (OR 1.11; 95 % CI 1.07–1.15; p < 0.001). Reconstructed patients were twice as likely to have a longer time to surgery (OR 2.07; 95 % CI 2.01–2.14; p < 0.001). The median LOS was 1 day (range 0–184 days) for UM versus 2 (range 0–182) for BM (p < 0.001); 30-day mortality and readmission rates were not different between BM and UM. The median number of days from diagnosis to definitive chemotherapy, hormonal therapy, and radiation therapy was significantly greater in the BM group.Conclusions
Delays to surgical and adjuvant treatment are significantly longer for BM irrespective of reconstruction, and these delays have increased over the study period. These findings can be used by clinicians to counsel patients on BM. 相似文献10.
Alberto Di Leo Corrado Pedrazzani Maria Bencivenga Arianna Coniglio Fausto Rosa Paolo Morgani Daniele Marrelli Alberto Marchet Luca Cozzaglio Simone Giacopuzzi Guido Alberto Massimo Tiberio Giovanni Battista Doglietto Giovanni Vittimberga Franco Roviello Francesco Ricci 《Annals of surgical oncology》2014,21(8):2594-2600
Purpose
The purpose of the present study was to analyze clinicopathologic features and long-term prognosis of gastric stump cancer (GSC) arising in the remnant stomach 5 years or later after partial gastrectomy for benign disease.Methods
We reviewed the results of 176 patients resected with curative intent for GSC at 8 Italian centers belonging to the Italian Research Group for Gastric Cancer (GIRCG). The median (range) follow-up time for surviving patients was 71.2 (6–207) months.Results
One hundred forty-six patients were men, the mean age at the time of diagnosis was 69.2 years, and the great majority (167 cases) underwent Billroth II reconstruction. R0 resection was achieved in 158 (90 %) patients, and in 94 (53 %) lymph node dissection was ≥D2. Postoperative mortality and complication rates were 6.2 and 43.2 %, respectively. T1 tumor was diagnosed in 45 (25 %) cases. Lymph node metastases were evident in 86 patients (49 %). Thirteen patients had involvement of the jejunal mesentery nodes (pJN+); five cases were T2–T3 and eight cases were T4. Overall 5-year survival rate was 53.1 %. Five-year survival rates were 68.1, 37.8, and 33.1 % for pT1, pT2-3, and pT4 tumors, respectively (P = 0.001). Five-year survival rate was 56.5 % for node-negative tumors (pN0), 32.3 % for tumors with nodal metastases without involvement of jejunal mesentery nodes (pN+), and 17.1 % for tumors with involvement of jejunal mesentery nodes (pJN+) (P = 0.002).Conclusions
Our study suggests that an aggressive surgical approach can achieve a satisfactory outcome in GSC. 相似文献11.
Takeshi Hashimoto Yoshio Ohno Jun Nakashima Tatsuo Gondo Makoto Ohori Masaaki Tachibana 《World journal of urology》2013,31(4):953-958
Purpose
Preoperative elevation of markers of systemic inflammation is associated with a poor outcome in several cancers. The purpose of this study was to evaluate the prognostic significance of preoperative systemic inflammatory markers in patients with non-metastatic upper urinary tract cancer (UUTC).Methods
The records of 84 patients with non-metastatic UUTC who had undergone nephroureterectomy were reviewed, and the associations between preoperative clinical variables and recurrence-free survival (RFS) were analyzed by univariate and multivariate analyses.Results
Clinical tumor stage, neutrophil count, and neutrophil-to-lymphocyte ratio were significantly associated with RFS in univariate analysis. Multivariate analysis showed that clinical T stage (hazard ratio [HR], 3.009; 95 % confidence interval [CI], 1.149–9.321; p = 0.024) and neutrophil count (HR, 3.521; 95 % CI, 1.423–9.108; p = 0.007) were independent predictors of RFS. The 3-year RFS in patients with a neutrophil count <4,000/μL was significantly higher than that in patients with a neutrophil count ≥4,000/μL (82.9 vs. 51.0 %, p = 0.004). Based on clinical T stage (T2 or less vs. T3 or greater) and neutrophil count (<4,000 vs. ≥4,000/μL), patients were stratified into 3 groups: low, intermediate, and high risk groups. RFS rates were significantly different between the 3 groups (p = 0.0005).Conclusions
Preoperative neutrophil count was an independent predictor of RFS in patients with non-metastatic UUTC. Stratification of patients based on neutrophil count and clinical T stage may be valuable for preoperative patient counseling and identifying patients with poor prognosis who may be candidates for neoadjuvant chemotherapy. 相似文献12.
Tseng-Cheng Chen MD Pei-Jen Lou MD PhD Jenq-Yuh Ko MD PhD Tsung-Lin Yang MD PhD Wu-Chia Lo MD Ya-Ling Hu RN MSc Cheng-Ping Wang MD 《Annals of surgical oncology》2011,18(2):497-504
Background
The impact of submandibular gland (SMG) preservation during neck dissection on the survival of patients with early-stage oral squamous-cell carcinoma (OSCC) remains undocumented.Methods
The medical records of all patients with early-stage OSCC (stage I and II) who underwent wide excision of the primary tumor and simultaneous neck dissection between 1999 and 2006 at our facility were retrospectively reviewed.Results
We analyzed 408 patients, including 33 patients with and 375 patients without SMG preservation. The 5-year disease-free and overall survival rates were 78.8% and 90.9% for the patients with SMG preservation and 75.4% and 90.4% for the patients without SMG preservation, and these differences were not statistically significant (P = 0.79, P = 0.99, respectively). Similar survival rates between patients with and without SMG preservation were observed in those with oral tongue squamous-cell carcinoma (SCC) and with buccal SCC. Patients with T2 OSCC with SMG preservation had significantly lower 5-year disease-free survival rate than those without SMG preservation (P = 0.02), but overall survival rates were similar between these two groups.Conclusions
Preservation of the SMG during neck dissection may be oncologically safe in patients with T1 OSCC, but the feasibility of SMG preservation seems less clear for T2 OSCC. 相似文献13.
Aras Emre Canda MD Selman Sokmen MD Cem Terzi MD Cigdem Arslan MD Ilhan Oztop MD Bulent Karabulut MD Deniz Ozzeybek MD Sulen Sarioglu MD Mehmet Fuzun MD 《Annals of surgical oncology》2013,20(4):1082-1087
Introduction
The purpose of our study was to evaluate the perioperative complications, toxicity, mortality rates after cytoreductive surgery (CRS), and effects of hyperthermic intraperitoneal chemotherapy (HIPEC) used in the treatment of peritoneal surface malignancies.Methods
Between September 2007 and March 2012, we performed 118 CRS and HIPEC with the closed abdominal technique on 115 patients with peritoneal carcinomatosis (PC). Systemic toxicities were graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 criteria and were analyzed from a prospectively collected database.Results
The mean age of patients was 53.4 (range, 20–82) years; 76.3 % were female. PC was synchronous to primary cancer in 53.4 % of patients, metachronous in 41.5 %, and recurrent in 5.1 % of the patients. PCI was ≥15 in 53.4 % of the patients, and CC-0 cytoreduction was achieved in 68.5 % of the patients. Perioperative mortality was observed in 9 (7.6 %) patients. A total of 98 complications were observed in 46 (39.0 %) patients, and 4 patients underwent 6 reoperations for perioperative surgical complications. We observed toxicity in 25.4 % of the patients, nephrotoxicity in 18.6 %, and hematological toxicity in 13.6 % of patients. No significant difference was observed among age, gender, PCI and CC scores, origin of the primary tumor, and occurrence of toxicity and surgical complications. Prolonged operation times resulted in higher complication and/or toxicity rates (P < 0.01).Conclusions
Cytoreductive surgery and HIPEC is a combined treatment strategy for peritoneal surface malignancies with acceptable complication and toxicity rates. 相似文献14.
Elizabeth M. Widen Gladys Strain Wendy C. King Wenwen Yu Susan Lin Bret Goodpaster John Thornton Anita Courcoulas Alfons Pomp Dympna Gallagher 《Obesity surgery》2014,24(6):847-854
Background
Few studies have validated bioelectrical impedance analysis (BIA) following bariatric surgery.Methods
We examined agreement of BIA (Tanita 310) measures of total body water (TBW) and percent body fat (%fat) before (T0) and 12 months (T12) after bariatric surgery, and change between T0 and T12 with reference measures: deuterium oxide dilution for TBW and three-compartment model (3C) for %fat in a subset of participants (n?=?50) of the Longitudinal Assessment of Bariatric Surgery-2.Results
T0 to T12 median (IQR) change in deuterium TBW and 3C %fat was ?6.4 L (6.4 L) and ?14.8 % (13.4 %), respectively. There were no statistically significant differences between deuterium and BIA determined TBW [median (IQR) difference: T0 ?0.1 L (7.1 L), p?=?0.75; T12 0.2 L (5.7 L), p?=?0.35; Δ 0.35 L(6.3 L), p?=?1.0]. Compared with 3C, BIA underestimated %fat at T0 and T12 [T0 ?3.3 (5.6), p?<?0.001; T12 ?1.7 (5.2), p?=?0.04] but not change [0.7 (8.2), p?=?0.38]. Except for %fat change, Bland-Altman plots indicated no proportional bias. However, 95 % limits of agreement were wide (TBW 15–22 L, %fat 19–20 %).Conclusions
BIA may be appropriate for evaluating group level response among severely obese adults. However, clinically meaningful differences in the accuracy of BIA between individuals exist. 相似文献15.
Yann Philippe Charles Julia Bouchaïb Axel Walter Sébastien Schuller Erik André Sauleau Jean-Paul Steib 《European spine journal》2012,21(10):1950-1956
Purpose
Idiopathic scoliosis can lead to sagittal imbalance. The relationship between thoracic hyper- and hypo-kyphotic segments, vertebral rotation and coronal curve was determined. The effect of segmental sagittal correction by in situ contouring was analyzed.Methods
Pre- and post-operative radiographs of 54 scoliosis patients (Lenke 1 and 3) were analyzed at 8 years follow-up. Cobb angles and vertebral rotation were determined. Sagittal measurements were: kyphosis T4–T12, T4–T8 and T9–T12, lordosis L1–S1, T12–L2 and L3–S1, pelvic incidence, pelvic tilt, sacral slope, T1 and T9 tilt.Results
Thoracic and lumbar curves were significantly reduced (p = 0.0001). Spino-pelvic parameters, T1 and T9 tilt were not modified. The global T4–T12 kyphosis decreased by 2.1° on average (p = 0.066). Segmental analysis evidenced a significant decrease of T4–T8 hyperkyphosis by 6.6° (p = 0.0001) and an increase of segmental hypokyphosis T9–T12 by 5.0° (p = 0.0001). Maximal vertebral rotation was located at T7, T8 or T9 and correlated (r = 0.422) with the cranial level of the hypokyphotic zone (p = 0.003). This vertebra or its adjacent levels corresponded to the coronal apex in 79.6 % of thoracic curves.Conclusions
Lenke 1 and 3 curves can show normal global kyphosis, divided in cranial hyperkyphosis and caudal hypokyphosis. The cranial end of hypokyphosis corresponds to maximal rotation. These vertebrae have most migrated anteriorly and laterally. The sagittal apex between segmental hypo- and hyper-kyphosis corresponds to the coronal thoracic apex. A segmental sagittal imbalance correction is achieved by in situ contouring. The concept of segmental imbalance is useful when determining the levels on which surgical detorsion may be focused. 相似文献16.
Study design
A genetic association meta-analysis of estrogen receptor α gene (ERα) polymorphisms with idiopathic scoliosis.Objective
To determine whether the ERα gene polymorphisms correlate with idiopathic scoliosis.Summary of background data
Idiopathic scoliosis represents a complex genetic trait under the influence of multiple predisposition genes. Several studies showed that single nucleotide polymorphism (SNP) in ERα was associated with idiopathic scoliosis, but the results from some studies were conflicting.Methods
We searched PubMed, EMBASE, and Cochrane CENTRAL databases from January 1994 to January 2014. All the case–control studies included should mainly study the relationship between XbaI A/G, PvuII T/C polymorphisms and the susceptibility of idiopathic scoliosis.Results
A total of 299 articles were found, six of which fulfilled the inclusion criteria after being assessed by two reviewers. A pooled odds ratio (OR) with 95 % confidence interval (95 % CI) was calculated to assess the associations. Subgroup meta-analyses were performed according to ethnicity. Overall, ERα Xbal A/G polymorphism was not associated with risk of idiopathic scoliosis (G versus A, OR 1.07, 95 % CI 0.88–1.30, P = 0.51; AG versus AA, OR 1.03, 95 % CI 0.89–1.21, P = 0.67; GG versus AA, OR 1.12, 95 % CI 0.72–1.73, P = 0.61; AG/GG versus AA, OR 1.05, 95 % CI 0.91–1.22, P = 0.49; GG versus AG/AA, OR 1.10, 95 % CI 0.75–1.63, P = 0.62). ERα PvuII T/C polymorphism was also not associated with risk of idiopathic scoliosis under five models (C versus T, OR 0.93, 95 % CI 0.75–1.14, P = 0.48; TC versus TT, OR 0.99, 95 % CI 0.80–1.23, P = 0.93; CC versus TT, OR 1.05, 95 % CI 0.80–1.39, P = 0.72; TC/CC versus TT, OR 1.01, 95 % CI 0.83–1.23, P = 0.93; CC versus TC/TT, OR 1.05, 95 % CI 0.82–1.33, P = 0.72).Conclusion
ERα Xbal and ERα PvuII polymorphisms are not obviously associated with risk of idiopathic scoliosis. 相似文献17.
Cheng CT Tsai CY Hsu JT Vinayak R Liu KH Yeh CN Yeh TS Hwang TL Jan YY 《Annals of surgical oncology》2011,18(6):1606-1614
Background
Surgical outcomes of multiorgan resection (MOR) for T4 gastric carcinoma reported in the literature are widely variable. We herein report a large surgical series of T4 gastric carcinoma.Methods
One hundred seventy-nine patients with cT4 gastric carcinoma were recruited onto the study. Patient characteristics, surgical strategy and related complications, long-term survival, and prognostic factors of T4 gastric carcinoma were analyzed.Results
Of 179 cT4 gastric carcinoma, there were 57 cT4 (pT3) with MOR, 91 pT4 with MOR, and 31 cT4 without MOR. pT4 with MOR were more likely to be associated with nodal metastasis, cellular dedifferentiation, and lymphoperineural infiltration compared to those of pT0–3 (P < 0.01 for all). For 91 pT4 with MOR, their surgical mortality and morbidity rates were 4.4 and 28.6%, respectively; their 1-, 3-, and 5-year overall survival rates were 55.2, 22.4, and 12.2%, respectively. The long-term survival of cT4 (pT3) with MOR was superior to pT4 with MOR (P = 0.006) and cT4 without MOR (P = 0.004). There was a striking difference between pT4 with MOR, R0 and pT4 with MOR, and R1 or R2 (P = 0.007). By means of multivariate analysis, lymph node status, liver invasion, and positive surgical margin were independent prognostic factors.Conclusions
Aggressive surgical management of pT4 gastric carcinoma should be limited to patients without adverse prognostic factors such as advanced nodal involvement and pancreatic invasion. 相似文献18.
Background
To evaluate how to correctly manage thyroid nodules showing inadequate cytology after ultrasound (US)-guided fine-needle aspiration biopsy (US-FNAB).Materials and Methods
A total of 393 thyroid nodules with inadequate cytology in 351 patients (M:F = 40:311, mean age: 49.3 years) with surgery or follow-up US-FNAB for at least 1 year were included in this study. Among them, 293 (74.6%) were benign and 100 (25.4%) were malignant on final reference results. Clinical characteristics and US features were reviewed and compared.Results
Malignancy rates (39.5%) of nodules having suspicious US feature were significantly higher than those (10.9%) of nodules without any suspicious US feature (P < .001). Malignancy rates of solid nodules, mainly solid nodules, and mainly cystic nodules were 29.2, 16.7, and 9.5%, respectively, with significant differences (P = .016). Malignancy rates of nodules assessed as suspicious malignant to probably benign in composition are: 39.1–12.8% (P < .001) in solid nodules, 42.1–9.2% (P = .001) in mainly solid nodules, and 50.0–5.3% (P = .04) in mainly cystic nodules.Conclusions
In nodules with inadequate cytology, follow-up US can be considered over repeat aspiration if there are no suspicious US features present, especially in mainly cystic nodules. 相似文献19.
H. P. Dimai A. Svedbom A. Fahrleitner-Pammer H. Resch C. Muschitz H. Thaler M. Szivak K. Amrein F. Borgström 《Osteoporosis international》2014,25(9):2297-2306
Summary
Only few studies have been published hitherto on country-specific incidence of distal forearm fracture. In the prevailing study, incidences were estimated, and trend analyses were performed for the entire Austrian population aged ≥50á. Incidence decreased significantly in women, but not in men, over the past 12 years of observation.Introduction
To estimate incidence of distal forearm fracture and assess incidence trends in the entire Austrian population aged ≥50á from 1989–2010 for inpatient fractures and from 1999 to 2010 for all fractures.Methods
The number of inpatient forearm fractures was obtained from the Austrian Hospital Discharge Register (AHDR) for the entire population aged ≥50á from 1989 to 2010. Total number of distal forearm fractures was modeled using patient-level data on 36,327 patients with distal forearm fractures. Crude and age-standardized incidence rates (cases per 100,000) were estimated in 5-year age intervals. To analyze the change in incidence over time, average annual changes expressed as incidence rate ratios (IRR) were calculated.Results
For all distal forearm fractures, age-standardized incidence in women in 1999 and 2009 were estimated at 709 (95 % CI 675–743) and 607 (578–637), respectively. The age-standardized incidences in men the same years were estimated at 171 (156–185) and 162 (151–174), respectively. IRR analyses showed a significant decrease in women (?1.1 %, p?0.01) but not in men (?0.8 %, p?>?0.05) over the last 12 years (1999–2010).Conclusion
Incidence of distal forearm fracture in the entire Austrian population is comparable to hip fracture incidence which is known to be among the highest worldwide. However, trend analyses reveal a significant decrease for all distal forearm fractures in women, but not in men, over the last 12 years. 相似文献20.
Elena Ioana Braicu MD Radoslav Chekerov MD Rolf Richter PhD Carmen Pop Dipl. Med. Mani Nassir Dipl. Med. Hanna Loefgren Florin Stamatian MD PhD Mustafa Zelal Muallem MD Christina Hall PhD Christina Fotopoulou MD PhD Jalid Sehouli MD PhD Klaus Pietzner MD 《Annals of surgical oncology》2014,21(3):955-962