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P. B. Olthof A. K. E. Elfrink E. Marra E. J. T. Belt P. B. van den Boezem K. Bosscha E. C. J. Consten M. den Dulk P. D. Gobardhan J. Hagendoorn T. N. T. van Heek J. N. M. IJzermans J. M. Klaase K. F. D. Kuhlmann W. K. G. Leclercq M. S. L. Liem E. R. Manusama H. A. Marsman J. S. D. Mieog S. J. Oosterling G. A. Patijn W. te Riele R.-J. Swijnenburg H. Torrenga P. van Duijvendijk M. Vermaas N. F. M. Kok D. J. Grünhagen Dutch Hepato Biliary Audit Group 《The British journal of surgery》2020,107(7):917-926
43.
MJ Hwang A Bhangu CE Webster DM Bowley MX Gannon SS Karandikar 《Annals of the Royal College of Surgeons of England》2014,96(5):343-347
Introduction
In 2009 the Department of Health instructed McKinsey & Company to provide advice on how commissioners might achieve world class National Health Service productivity. Asymptomatic inguinal hernia repair was identified as a potentially cosmetic procedure, with limited clinical benefit. The Birmingham and Solihull primary care trust cluster introduced a policy of watchful waiting for asymptomatic inguinal hernia, which was implemented across the health economy in December 2010. This retrospective cohort study aimed to examine the effect of a change in clinical commissioning policy concerning elective surgical repair of asymptomatic inguinal hernias.Methods
A total of 1,032 patients undergoing inguinal hernia repair in the 16 months after the policy change were compared with 978 patients in the 16 months before. The main outcome measure was relative proportion of emergency repair in groups before and after the policy change. Multivariate binary logistic regression was used to adjust the main outcome for age, sex and hernia type.Results
The period after the policy change was associated with 59% higher odds of emergency repair (3.6% vs 5.5%, adjusted odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.03–2.47). In turn, emergency repair was associated with higher odds of adverse events (4.7% vs 18.5%, adjusted OR: 3.68, 95% CI: 2.04–6.63) and mortality (0.1% vs 5.4%, p<0.001, Fisher’s exact test).Conclusions
Introduction of a watchful waiting policy for asymptomatic inguinal hernias was associated with a significant increase in need for emergency repair, which was in turn associated with an increased risk of adverse events. Current policies may be placing patients at risk. 相似文献44.
Arthur K.E. Elfrink Sanne Nieuwenhuizen M. Petrousjka van den Tol Mark C. Burgmans Warner Prevoo Marielle M.E. Coolsen Peter B. van den Boezem Otto M. van Delden Jeroen Hagendoorn Gijs A. Patijn Wouter K.G. Leclercq Mike S.L. Liem Arjen M. Rijken Cornelis Verhoef Koert F.D. Kuhlmann Simeon J.S. Ruiter Dirk J. Grünhagen Joost M. Klaase Esther C.J. Consten 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2021,23(6):827-839
BackgroundCombining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation.MethodsIn this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery.ResultsOf 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy.ConclusionSignificant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy. 相似文献
45.
Dunselman P.; Liem A. H.; Verdel G.; Kragten H.; Bosma A.; Bernink P.; on behalf of the FEMINA Study Group of the Working Group on Cardiovascular Research The Netherlands 《European heart journal》1997,18(11):1755-1764
AIMS: The study aimed to compare the addition of felodipine to metoprolol,and of the replacement of metoprolol by felodipine, with continuationof metoprolol, in patients with angina pectoris despite optimalbeta-blockade. METHODS AND RESULTS: The study was double-blind, parallel, randomized and controlled,and comprised 363 patients from 27 outpatient cardiology clinicsin the Netherlands. The patients had angina and positive bicycleexercise tests despite optimal beta-blockade (resting heartrate <65 beats . min1). Randomization was to threetreatment groups: continuation of metoprolol (control), additionof felodipine to metoprolol, and replacement of metoprolol byfelodipine. Exercise tests were repeated after 2 and 5 weeks.The main outcome measure was: exercise result after 5 weeks,compared with baseline, between-group comparison of changesvs control. There were no significant differences in exerciseduration and onset of chest pain vs control. The addition offelodipine increased time until 1 mm ST depression (43 s, 95%confidence interval 2065 s), and decreased both ST depressionat highest comparable work load (0·46 mm, 95% confidenceinterval 0·190·72), and maximal ST depression(0·49 mm, 95% confidence interval 0·230·74).Exercise results after replacement of metoprolol by felodipinewere not different from control, apart from a significant increasein rate pressure product. Significantly more patients experiencedadverse events in the felodipine monotherapy group. CONCLUSION: Combination of metoprolol and felodipine is to be preferredto felodipine monotherapy in patients who have signs and symptomsof myocardial ischaemia despite optimal beta-blockade. 相似文献
46.
To evaluate the significance of inducible sustained ventricular tachycardia (VT) in patients with coronary artery disease and relatively preserved cardiac function, 33 patients who met the following criteria were studied; documented nonsustained VT but no history of life-threatening arrhythmia, inducible sustained VT at electrophysiologic study, and implantation of a cardioverter-defibrillator. Eighteen patients developed clinical sustained VT within 2 years. By univariate analysis, left ventricular ejection fraction (EF) and the cycle length of induced VT were associated with clinical VT occurrence. By multivariate analysis, however, EF was the only independent predictor. Among 23 patients with EF 40% (P <.01). In coronary artery disease patients with relatively preserved EF, the incidence of clinical VT is considerably low even though sustained VT is inducible. Inducible VT is therefore not appropriate for risk stratification in this patient population. 相似文献
47.
Zijlstra F.; de Boer M. J.; Beukema W. P.; Liem A. L.; Reiffers S.; Huysmans D.; Hoorntje J. C. A.; Suryapranata H.; Simoons M. L. 《European heart journal》1996,17(3):382-387
The comparative efficacy of thrombolytic drugs and primary angioplastyfor acute myocardial infarction have recently been studied,but long-term follow-up data have not yet been reported. Weconducted a randomized trial involving 301 patients with acutemyocardial infarction; 152 patients were randomized to primaryangioplasty and 149 to intravenous streptokinase. Left ventricularfunction was assessed with a radionuclide technique both athospital discharge and at the end of the follow-up period. Follow-updata were collected after a mean (± SD) of 31 ±9 months. Total medical costs were calculated. At the end ofthe follow-up period, 5% of the angioplasty patients had diedfrom a cardiac cause compared to 11% of the patients randomizedto intravenous streptokinase, P=0·031. Cardiac deathor a non-fatal reinfarction occurred in 7% of angioplasty patientscompared to 28% of streptokinase patients, P0·001. Therewas a sustained benefit of angioplasty compared to streptokinaseon left ventricular function. The total medical costs in thetwo groups were similar. Coronary anatomy (patency and singleor multivessel disease), infarct location and previous myocardialinfarction were important determinants of clinical outcome andcosts. After 31±9 months of follow-up, primary angioplasty comparedto intravenous streptokinase results in a lower rate of cardiacdeath and reinfarction, a better left ventricular ejection fraction,and no increase in total medical costs. (Eur Heart J 1996; 17: 382387) 相似文献
48.
Identification of glial filament protein and vimentin in the same intermediate filament system in human glioma cells. 总被引:10,自引:1,他引:10 下载免费PDF全文
E Wang J G Cairncross R K Liem 《Proceedings of the National Academy of Sciences of the United States of America》1984,81(7):2102-2106
We have used a human glioma cell line (U-251MG) to study the expression and cytoplasmic organization of vimentin (decamin) and the glial filament protein (GFP). Four clones of the parental U-251 cultures were isolated and found to express GFP from 1-2% to 99% of the cells in the population. Double immunofluorescence microscopy with antibodies to vimentin and GFP has shown that, in all four clonal cell lines, vimentin-containing filaments are expressed in most cells as an organized network and, in GFP-positive cells, GFP and vimentin are associated with the same filament network. Immunoelectron microscopy with specific antibodies labeled with colloidal gold particles of various sizes shows that GFP and vimentin are localized in the same filaments. These findings confirm in vitro studies of the copolymerization of subunits of different biochemical nature into the same intermediate filament and suggest the in vivo probability of the coassembly of GFP and vimentin from a possible soluble pool of monomers. 相似文献
49.
Maria Elissavet Metska Vania May Ling Liem Azin Parsa Jan Harm Koolstra Paul Rudolf Wesselink Ahmet Rifat Ozok 《Journal of endodontics》2014
Introduction
The primary aim of this study was to compare the precision of root canal length determination on cone-beam computed tomographic (CBCT) scans and periapical radiographs (PAs) with the actual root canal length. The secondary aim was to examine the influence of tooth type on root canal length measurements as assessed on CBCT scans and PAs.Methods
In total, 40 root canals of 33 teeth (molars, premolars, canines, and incisors) out of 5 dentate maxillas of human cadavers were included. Root canal length measurement was performed by a consensus panel (2 examiners) on CBCT scans (3D Accuitomo 170; J Morita, Kyoto, Japan) and digital PAs. After straight-line access opening, a #15 file was fixated in every root canal at the length measured on CBCT scans. All teeth were extracted, and the root canal containing the file was uncovered. Measurements made on images taken with a digital camera (AxioCam; Carl Zeiss, Sliedrecht, The Netherlands) linked to a stereozoom microscope (Stemi SV6, Carl Zeiss) were used as the actual root canal length.Results
When all roots were examined together, it was not clear which method is better for all types of teeth. For root canals of anterior teeth, there was no significant difference between the 2 methods. For root canals of posterior teeth, CBCT images gave results significantly closer to the actual root canal length in comparison with PAs (t value = −1.96; critical value is 1.74 with a significance level of 0.05).Conclusions
Root canal length measurements of posterior maxillary teeth were more accurate when assessed by CBCT images than PAs. 相似文献50.