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51.
Ma WY Li HY Pei D Hsia TL Lu KC Tsai LY Wei JN Su CC 《Journal of diabetes and its complications》2012,26(4):296-300
BackgroundTo evaluate the relationship between hemoglobin A1c variability and all-cause mortality in type 2 diabetic patients.MethodsThis was a retrospective cohort study in type 2 diabetic patients followed for at least 2 years between 2003 and 2009. A1C variability was determined from the standard deviation or coefficient of variation of serial A1C values (A1CSD or A1CCV). Subjects were categorized into either the high or low A1C variability group according to their A1CCV median. Hazard ratios (HRs) of various factors for all-cause mortality were determined from Cox's proportional hazard models.ResultsA total of 881 subjects (422 men, 459 women) were included and 73 (8.3%) died during follow-up. The follow-up period was 4.7 ± 2.3 years. All-cause mortality was higher in subjects with high A1CCV (11.0% vs. 5.4%, p = 0.002). In the Kaplan–Meier failure curve, subjects with higher A1CCV demonstrated a trend of higher mortality (p = 0.1). In multivariate Cox's proportional hazards models, A1CSD and A1CCV significantly predicted all-cause mortality with an HR of 1.987 (p = 0.02) and 1.062 (p = 0.013), respectively, after adjusting for age, gender, body mass index, duration of diabetes, mean systolic blood pressure, use of antihypertensives and statins, mean LDL-cholesterol, smoking status, chronic kidney disease, and mean A1C values (A1CMEAN). The ability of A1CSD and A1CCV to predict all-cause mortality was more evident in subjects with relatively low A1CMEAN.ConclusionsA1C variability is an important risk factor for all-cause mortality in type 2 diabetic patients. 相似文献
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Meng-Ying Hsieh Oi-Wa Chan Jainn-Jim Lin Kuang-Lin Lin Shao-Hsuan Hsia Huei-Shyong Wang Cheng-Hsun Chiu 《Brain & development》2013
Background: Guillain–Barré syndrome and myasthenia gravis both lead to muscle weakness but the two combined is uncommon. Detection of these entities can help identify forms of autoimmune neuromuscular diseases that may respond to immunotherapy. This report sought to characterize the clinical features of these two entities when combined. Methods: This report is of a case of combined Guillain–Barré syndrome and myasthenia gravis. The clinical features were analyzed and correlated to those published in English literature from 1960 to 2012. Ten reports and 12 cases, including the present case, were reviewed. Results: There were 12 patients (4 women and 8 men), aged 17 to 84 years, with combined Guillain–Barré syndrome and myasthenia gravis. Four had post-infectious Guillain–Barré syndrome followed by the development of myasthenia gravis concurrently or concomitantly within one month. All cases had symptoms of ptosis and areflexia. The other common presentations were limb weakness, oculobulbar weakness, and respiratory involvement. Functional outcome was mentioned in 10 patients and seven had good outcome (Hughes scale ?2). Conclusion: Detection of ptosis with or without ophthalmoplegia, distribution of limb weakness, and reflex can help in recognizing combined Guillain–Barré syndrome and myasthenia gravis. The early recognition of this combination of peripheral nervous and neuro-muscular junction inflammation is important for initial treatment and prognosis. 相似文献
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Po-Hong Liu MD Yun-Hsuan Lee MD Cheng-Yuan Hsia MD Chia-Yang Hsu MD Yi-Hsiang Huang MD PhD Yi-You Chiou MD Han-Chieh Lin MD Teh-Ia Huo MD 《Annals of surgical oncology》2014,21(6):1825-1833
Background
The long-term survival in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) who received surgical resection (SR) or transarterial chemoembolization (TACE) remains unclear. We compared the efficacy of SR and TACE by using a propensity score analysis.Methods
A total of 247 and 181 HCC patients with PVTT undergoing SR and TACE, respectively, were evaluated. One hundred eight pairs of matched patients were selected from each treatment arm by using a propensity score analysis.Results
Of all patients, the estimated 1-, 3-, and 5-year survival rates of patients receiving SR and TACE were 85 versus 60 %, 68 versus 42 %, and 61 versus 33 %, respectively (p < 0.001). Patients selected for SR were significantly younger and had better liver functional reserve, performance status, and smaller tumor burden. In the propensity model, the survival benefit of SR remained significant. The estimated 1-, 3-, and 5-year survival rates of patients receiving SR and TACE were 84 versus 71 %, 69 versus 50 %, and 59 versus 35 %, respectively (p = 0.004). The two groups of patients in the propensity score analysis were similar in baseline characteristics. In the Cox proportional hazards model, patients receiving TACE had a 2.044-fold increased risk of mortality compared with patients receiving SR (95 % confidence interval: 1.284–3.252, p = 0.003).Conclusions
For either unselected patients or patients in the propensity model, SR provides significantly better long-term survival than TACE. SR should be considered as a priority treatment in this subgroup of HCC patients. 相似文献59.
Macey L. Murray Yingfen Hsia Karen Glaser Emily Simonoff Declan G. M. Murphy Philip J. Asherson Hanna Eklund Ian C. K. Wong 《Psychopharmacology》2014,231(6):1011-1021
Rationale
Autism spectrum disorders (ASDs) affect 1 % of children, having significant impact on health and social outcomes. Psychotropic medication use by individuals with ASD in the USA increased over time, and polypharmacy occurred in >50 % of those prescribed. In the UK, no psychotropic drugs are approved in ASDs, and little is known about patterns of pharmacological treatment in the ASD population and associated co-morbidities.Methods
We used The Health Improvement Network, a nationally representative primary care database, to assess the prevalence of ASD diagnoses, psychotropic drug prescribing and neuropsychiatric co-morbidities of 0–24 year olds between 1992 and 2008.Results
ASD prevalence increased 65-fold from 0.01 % (1992) to 0.50 % (2008). Psychotropic drugs were prescribed to 29 % (1,619/5,651) of the ASD cohort; the most prescribed drugs were sleep medication (9.7 % of prescribed patients), psychostimulants (7.9 %) and antipsychotics (7.3 %). More patients were given psychostimulants and sleep medications over time from 1.5–6.3 % and 2.2–5.9 % respectively. Thirty-seven per cent of the cohort had ≥1 record of a neuropsychiatric co-morbidity, the most common being developmental difficulties and learning disabilities (12.6 %), behavioural, conduct and personality disorders (11.1 %) and attention deficit hyperactivity disorder (7.5 %).Conclusions
British physicians are more conservative in prescribing practice than American colleagues. However, use of psychostimulants and antipsychotics is much higher in those with ASD than in the general population. Polypharmacy was seen in 34 % of prescribed patients in 2008. Additional studies examining use, efficacy, and long-term safety of antipsychotics and psychostimulants in autistic individuals are warranted. 相似文献60.