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51.
Juan Marco FigueiraGonalves Rafael Golpe Cristbal Esteban Miguel ngel GarcíaBello Nagore BlancoCid Amaia Aramburu Ignacio GarcíaTalavera María Dolores MartínMartínez Adrian BaezaRuiz Andrea ExpsitoMarrero 《The clinical respiratory journal》2022,16(7):504
BackgroundChronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition, in which taking into consideration clinical phenotypes and multimorbidity is relevant to disease management. Network analysis, a procedure designed to study complex systems, allows to represent connections between the distinct features found in COPD.MethodsNetwork analysis was applied to a cohort of patients with COPD in order to explore the degree of connectivity between different diseases, taking into account the presence of two phenotypic traits commonly used to categorize patients in clinical practice: chronic bronchitis (CB+/CB−) and the history of previous severe exacerbations (Ex+/Ex−). The strength of association between diseases was quantified using the correlation coefficient Phi (ɸ).ResultsA total of 1726 patients were included, and 91 possible links between 14 diseases were established. Although the four phenotypically defined groups presented a similar underlying comorbidity pattern, with special relevance for cardiovascular diseases and/or risk factors, classifying patients according to the presence or absence of CB implied differences between groups in network density (mean ɸ: 0.098 in the CB− group and 0.050 in the CB+ group). In contrast, between‐group differences in network density were small and of questionable significance when classifying patients according to prior exacerbation history (mean ɸ: 0.082 among Ex− subjects and 0.072 in the Ex+ group). The degree of connectivity of any given disease with the rest of the network also varied depending on the selected phenotypic trait. The classification of patients according to the CB−/CB+ groups revealed significant differences between groups in the degree of conectivity between comorbidities. On the other side, grouping the patients according to the Ex−/Ex+ trait did not disclose differences in connectivity between network nodes (diseases).ConclusionsThe multimorbidity network of a patient with COPD differs according to the underlying clinical characteristics, suggesting that the connections linking comorbidities between them vary for different phenotypes and that the clinical heterogeneity of COPD could influence the expression of latent multimorbidity. Network analysis has the potential to delve into the interactions between COPD clinical traits and comorbidities and is a promising tool to investigate possible specific biological pathways that modulate multimorbidity patterns. 相似文献
52.
Mora Murri Eduardo García-Fuentes José Manuel García-Almeida Lourdes Garrido-Sánchez María Dolores Mayas Rosa Bernal Francisco J. Tinahones 《Obesity surgery》2010,20(3):363-368
Background
The prevalence of morbid obesity has seen an increase in developed countries over recent years. Bariatric surgery is almost the only effective strategy for treating super morbidly obese patients. The objective of the study was to evaluate the effects of bariatric surgery on the evolution of the main variables related to diabetes and obesity, especially insulin resistance, parameters of oxidative stress, and inflammatory markers in the early stage after surgery. 相似文献53.
54.
Dolores Paul 《Journal of Medical Imaging and Radiation Sciences》2009,40(3):90-99
Health service delivery within Canada must be safe, effective, efficient, appropriate, and acceptable. The time has arrived to examine whether new models of practice for diagnostic imaging should be explored, especially when the population is growing and service provider numbers are shrinking. This article provides a literature review of recent Canadian and international initiatives that have brought focus to the role of the medical radiological technologist in light of changing workforce characteristics, population demographics, and technological advancements. A review of numerous studies and surveys indicates that common triggers exist to initiate change, and key strategies are required to sustain that momentum of change. Within the article, comparisons are drawn from the advanced practice roles currently established internationally, as well as a comparative review of similar experiences in nursing practice. The road to change will require strong partnerships between radiological technologists, radiologists, health care administrators, and patient communities. 相似文献
55.
The involvement of the renin-angiotensin system gene polymorphisms in coronary heart disease 总被引:1,自引:0,他引:1
Hernández Ortega E Medina Fernández-Aceituno A Rodríguez Esparragón FJ Hernández Perera O Melián Nuez F Delgado Espinosa A Fíuza Pérez D Anabitarte Prieto A Rodríguez Pérez JC 《Revista espa?ola de cardiología》2002,55(2):92-99
INTRODUCTION AND OBJECTIVES: Previous studies angiotensin-converting enzyme gene insertion/deletion polymorphism ACE (I/D), angiotensinogen gene polymorphism, and angiotensin II AT1 receptor polymorphism in relation to coronary heart disease controversial results. This study was designed to analyze the association between these gene polymorphisms and the first coronary event in individuals residing on Grand Canary Island, Spain. PATIENTS AND METHOD: Case-control study. Case subjects (n = 304) were recruited at the first coronary event; age-matched controls (n = 315) were randomly selected from the Grand Canary population. Participants were examined for the usual risk factors. Blood samples were obtained for biochemical analyses and DNA extraction. Genotyping was performed by PCR and restriction analysis. RESULTS: Neither ACE (I/D) nor AT1 receptor polymorphism was associated with coronary heart disease, whereas the frequency distribution of AGT M235T genotypes among patients and control subjects (TT: 29% and 19%; MT: 48% and 50%; MM: 22% and 31%, respectively) was statistically different (p = 0.003). Multiple logistic regression analysis identified the TT genotype of the angiotensinogen gene (OR = 1.9; 95% CI 1.1-3.4), diabetes (OR = 4.4; 95% CI 2.0-9.4) and hypertension (OR = 2.1; 95% CI 1.3-3.3) as risk factors predicting the coronary event. CONCLUSIONS: Our results provide no evidence of an association between ACE (I/D) or AT1 receptor polymorphism and coronary heart disease. However, homozygosity for the T allele of the angiotensinogen gene, diabetes and hypertension independently place individuals at higher risk of experiencing a coronary event on Grand Canary Island. 相似文献
56.
Efficacy of rituximab in an aggressive form of multicentric Castleman disease associated with immune phenomena 总被引:4,自引:0,他引:4
Ocio EM Sanchez-Guijo FM Diez-Campelo M Castilla C Blanco OJ Caballero D San Miguel JF 《American journal of hematology》2005,78(4):302-305
Multicentric Castleman disease (MCD) is an uncommon lymphoproliferative disorder for which the best therapeutic option is not yet well established. Immune-related disorders are rare complications of MCD. We report on an MCD case in a 23-year-old patient with extensive abdominal involvement and associated immune hemolytic anemia and Raynaud phenomenon. He was negative for human immunodeficiency virus (HIV) and human herpesvirus-8 (HHV-8). After 8 courses of the anti-CD20 monoclonal antibody (rituximab), the patient achieved complete remission. Interestingly, Raynaud phenomenon disappeared under treatment and no new hemolytic events occurred. Anti-CD20 antibody treatment could be an attractive therapeutic approach for MCD, mainly when immune-related disorders are associated. 相似文献
57.
Mateos MV Hernández JM Hernández MT Gutiérrez NC Palomera L Fuertes M Garcia-Sanchez P Lahuerta JJ de la Rubia J Terol MJ Sureda A Bargay J Ribas P Alegre A de Arriba F Oriol A Carrera D García-Laraña J García-Sanz R Bladé J Prósper F Mateo G Esseltine DL van de Velde H San Miguel JF 《Haematologica》2008,93(4):560-565
58.
Otto G. Thilenius MD PhD FACC Dolores Vitullo MD Saroja Bharati MD FACC Julia Luken MD John J. Lamberti MD FACC Constantine Tatooles MD FACC Maurice Lev MD FACC Ian Carr MD Rene A. Arcilla MD FACC 《The American journal of cardiology》1979,44(7):1339-1343
Clinical and angiographic or autopsy data, or both, on three children with a subdivided left atrium (cor triatriatum) and an associated endocardial cushion defect are reviewed. (One child had ostium primum defect, and two had complete atrioventricular [A-V] canal.) A fourth patient demonstrates the difficulties in differentiating subdivided left atrium from supravalve mitral stenosis in the presence of an endocardial cushion defect. The clinical findings are greatly influenced by the endocardial cushion defect. A pressure gradient between the pulmonary wedge and (left or right) ventricular end-diastolic pressures in patients with an endocardial cushion defect indicates pulmonary venous obstruction and should alert one to the possibility of these combined lesions. The exact diagnosis is made with injections of angiographic contrast medium into the proximal and distal left atrial chambers, to document the respective relations of the pulmonary veins, left atrial appendage and A-V valves to these atrial chambers. All three patients with an endocardial cushion defect and a subdivided left atrium had an associated patent ductus arteriosus. The common association of subdivided left atrium with intracardiac, pulmonary venous and aortic anomalies is again demonstrated. 相似文献
59.
Pardo A Durández R Hernández M Pizarro A Hombrados M Jiménez A Planas R Quintero E 《The American journal of gastroenterology》2002,97(6):1535-1542
OBJECTIVE: Upper GI bleeding (UGIB) is a common medical emergency that leads to a high consumption of medical resources and costs. We aimed to analyze the influence of physician specialty on the costs of nonvariceal UGIB care. METHODS: We retrospectively assessed 350 nonvariceal UGIB episodes that were primarily cared for by gastroenterologists (n = 142), internists (n = 67), or surgeons (n = 141). Gastroenterologists followed evidence-based clinical protocols that included early endoscopy and early hospital discharge for uncomplicated bleeding. A risk score system was used to control for severity of illness. Linear regression analyses were performed to find out predictors of costs and the influence of specialist care on length of stay (LOS). RESULTS: The overall mean hospital cost was significantly lower in patients cared for by gastroenterologists (EUR 1,630) than in those managed by internists (EUR 3,745, p < 0.001) or surgeons (EUR 2,513, p < 0.05). The mean LOS was the variable with highest influence on total cost. Patients cared for by gastroenterologists had a mean LOS significantly shorter (7.3 days) than that of those treated by internists (16.2 days, p < 0.001) or surgeons (11 days, p < 0.001). Hospital costs and LOS differences were maintained when adjusting for severity of illness. In caring for low risk patients, nongastroenterologists had a higher probability of having a hospital stay longer than 4 days (odds ratio = 18.4, Cl = 4.6-73.6, p < 0.001). CONCLUSION: The implementation of specific evidence-based protocols by gastroenterologists reduces length of hospital stay and saves medical costs in patients with nonvariceal UGIB, especially those at low risk. 相似文献
60.