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101.
Anirban Gupta David Chang Kimberley E. Steele Michael A. Schweitzer Jerome Lyn-Sue Anne O. Lidor 《Journal of gastrointestinal surgery》2008,12(12):2119-2124
Introduction Paraesophageal hernia (PEH) repair is a technically challenging operation. These patients are typically older and have more
co-morbidities than patients undergoing anti-reflux operations for gastroesophageal reflux disease (GERD), and these factors
are usually cited as the reason for worse outcomes for PEH patients. Clinically, it would be useful to identify potentially
modifiable variables leading to improved outcomes.
Methods We performed a retrospective analysis of a representative sample from 37 states, using the Nationwide Inpatient Sample database
over a 5-year period (2001–2005). Patients undergoing any anti-reflux operation with or without hiatal hernia repair were
included, and comparison was made based on primary diagnoses of PEH or GERD. Exclusion criteria were diagnosis codes not associated
with reflux disease or diaphragmatic hernia, emergency admissions, and age <18. Primary outcome was in-hospital mortality.
Two sets of multivariate analyses were performed; one set adjusting for pre-treatment variables (age, gender, race, Charlson
Comorbidity Index, hospital teaching status, hospital volume of anti-reflux surgery, calendar year) and a second set adjusting
further for post-operative complications (splenectomy, esophageal laceration, pneumothorax, hemorrhage, cardiac, pulmonary,
and thromboembolic events, (VTE)).
Results Of the 23,458 patients, 6,706 patients had PEH. PEH patients are older (60.4 vs. 49.1, p < 0.001) and have significantly more co-morbidities than GERD patients. On multivariate analysis, adjusting for pre-treatment
variables, PEH patients are more likely to die and have significantly worse outcomes than GERD patients. However, further
adjustment for pulmonary complications, VTE, and hemorrhage eliminates the mortality difference between PEH and GERD patients,
while adjustment for cardiac complications or pneumothorax did not eliminate the difference.
Conclusions While PEH patients have worse post-operative outcomes than GERD patients, we note that differences in mortality are explained
by pulmonary complications, VTE, and hemorrhage. The impact of hemorrhagic complications on this group underscores the importance
of careful dissection. Additionally, age and co-morbidities alone should not preclude a patient from PEH repair; rather, attention
should be focused on peri-operative optimization of pulmonary status and prophylaxis of thromboembolic events. 相似文献
102.
Genevieve B. Melton Kimberley E. Steele Michael A. Schweitzer Anne O. Lidor Thomas H. Magnuson 《Journal of gastrointestinal surgery》2008,12(2):250-255
Although Roux-en-Y gastric bypass surgery (RYGBP) is safe and effective at achieving weight loss in the majority of severely
obese patients, a subset fails to achieve expected weight loss outcomes. Factors associated with poor weight loss are not
well defined. Patients undergoing open RYGBP using a standardized surgical technique and clinical pathway by a single surgeon
at a dedicated bariatric center were reviewed. Suboptimal weight loss was defined as failure to lose at least 40% excess body
weight by 12 months postoperatively. Of 555 consecutive patients who underwent RYGBP from 1999 to 2004, a 12-month follow-up
was available for the 495 (89%). Suboptimal weight loss occurred in 55 (11%) and was associated on unadjusted bivariate analysis
with increased body mass index (BMI; p = 0.0002), diabetes mellitus (p = 0.0002), Medicaid insurance (p = 0.04), and male sex (p = 0.01). On adjusted multivariate analysis, increased BMI (p = 0.003), diabetes (p = 0.002), and male gender (p = 0.04) were associated with suboptimal weight loss, but type of insurance (p = 0.11) was not. Medicaid patients were younger (p = 0.01) and had higher BMI (p = 0.0002). Suboptimal weight loss after RYGBP appears to be associated with greater BMI, male sex, and diabetes but not type
of insurance. This study may help identify patients who could benefit from increased perioperative education and counseling
or selection of procedures with greater malabsorption.
Presented at the 48th Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington DC, May 19–24, 2007. 相似文献
103.
Jeffrey H. Shuhaiber Kimberley Goldsmith Stephen R. Large Steven Tsui 《European journal of cardio-thoracic surgery》2008,33(5):849-855
Objective: Allograft rejection continues to be one of the most common causes of mortality after heart transplantation. We investigated if perioperative use of antifibrinolytics such as aprotinin and tranexamic acid can decrease the rate of rejection after heart transplant and their effect on transfusion. Methods: A retrospective analysis was conducted on the data from patients who received a first heart transplant at Papworth Hospital between 2000 and 2005. Transplant registry and audit data were used for the study. Rejection biopsy results and treatment were used to designate rejection episodes as mild (grades 1A, 1B or 2 untreated) or severe (grades 2 treated, grades 3 and 4). The relationship between antifibrinolytics and rejection episodes was assessed using univariate and multiple Poisson regression. Kaplan–Meier methods and Kruskal–Wallis tests, respectively, were used to analyse survival/time to first rejection and transfusion. Results: There were 225 patients who underwent a first heart transplant between January 2000 and December 2005. Of these, 101 patients (44.9%) had received aprotinin, 63 (28.0%) tranexamic acid, 2 (0.9%) both (aprotinin and tranexamic acid) and 59 (26.2%) no antifibrinolytics. There was no difference in time to first rejection by antifibrinolytic treatment (p = 0.20). There was no difference in the rate of treated rejection per 100 patient-days between aprotinin and tranexamic acid groups between 0 and 3 months post-transplant, (0.6 in both), but aprotinin had a small clinical effect when compared to no treatment (0.6 vs 0.8, p = 0.54). Between 4 and 6 months, the treated and severe rejection rates were lower in the patients receiving aprotinin as compared to those receiving tranexamic acid, but these differences again did not reach statistical significance (0.1 vs 0.3, p = 0.14, 0.2 vs 0.4, p = 0.18). Aprotinin was associated with higher postoperative blood loss and transfusion requirements in the subgroup of patients that had a ventricular assist device, prior sternotomy or anticoagulant therapy. Conclusions: The use of aprotinin in heart transplant surgery may be associated with a small decrease in the incidence of treated/severe rejection within 6 months of transplantation. The perioperative use of antifibrinolytics did not influence time to first rejection or reduce blood transfusion. 相似文献
104.
Distortion product emissions (DPEs) are intimately linked to normal outer hair cell function. Outer hair cell function is itself intimately linked with normal auditory thresholds. We sought to correlate frequency-specific DPE measurements with auditory thresholds, in seven frequency regions from 700 Hz to 6 kHz, in each of 21 ears. Eleven of these ears had thresholds below 25 dB SPL at every test frequency, whereas 10 ears demonstrated some degree of purely sensorineural hearing loss. An analysis of the correlation between DPE measurements and sensory thresholds suggests that DPE measures can predict frequency-specific auditory thresholds to within 10 dB over a range of sensory thresholds from 0 dB SPL to 60 dB SPL. Distortion product emissions promise to provide an objective, non-invasive measure of sensory thresholds. The clinical value of DPE measurement is enhanced by that fact that it is brief and requires minimal subject participation. A clinical test based on the DPE measurement will not displace conventional audiometry or auditory brain stem response measurement. It promises to provide new information about cochlear function to both the clinician and auditory physiologist. 相似文献
105.
Kathleen M. Griffiths Helen Christensen Kimberley Evans 《Disease Management & Health Outcomes》2002,10(4):205-214
Although the advantages of disseminating health information on the world wide web are well recognized, there has been considerable concern about the quality of online information. There has also been some debate as to whether organizations with a vested interest in a product, such as pharmaceutical companies, can provide balanced and appropriate information on the web. However, there is very little published information about the content, quality or impact of pharmaceutical websites. This paper considers the issues, arguments and empirical evidence for and against the practice of direct-to-consumer advertising by pharmaceutical companies. It also describes a selected set of pharmaceutical company sites that provide consumer information about major public health problems or about health conditions corresponding to frequently used search engine terms. The pharmaceutical sites surveyed were characterized both by positive attributes (such as a breadth and depth of information, specification of medication adverse effects, and inclusion of potentially useful consumer aids such as symptom diaries and screening tests) and negative features (such as failure to disclose authorship and scientific sources, failure to provide clear and accessible information about the absolute and relative efficacy of the treatments mentioned, and absence of an editorial board or independent review process).We note that these attributes are not necessarily indicative of the quality of the content or the utility of websites and argue that there is a need for systematic studies comparing the accuracy of the content of pharmaceutical sites and nonpharmaceutical sites. Such studies would need to be conducted by content experts using evidence-based information as a gold standard. Many consumers are not in a position to assess the quality of the content of pharmaceutical sites and do not place a high level of trust in pharmaceutical companies. We suggest that it might be in the interests of the companies to encourage the independent review and certification of their sites. A consortium of companies could contribute funds to an independent authority that in turn could contract third party content evaluators to undertake quality assessments of pharmaceutical sites. In the future, initiatives such as the MedCERTAIN collaboration might provide consumers with certification information on a range of health sites including pharmaceutical websites. Not only would such evaluations provide a means for consumers to identify high quality sites, they might also assist pharmaceutical companies to optimize the quality and credibility of the health information they provide on the web. 相似文献
106.
Kimberley M. Mallan Ottmar V. Lipp Marilia Libera 《International journal of psychophysiology》2008,69(1):9-17
Affect modulates the blink startle reflex in the picture-viewing paradigm, however, the process responsible for reflex modulation during conditional stimuli (CSs) that have acquired valence through affective conditioning remains unclear. In Experiment 1, neutral shapes (CSs) and valenced or neutral pictures (USs) were paired in a forward (CS-->US) manner. Pleasantness ratings supported affective learning of positive and negative valence. Post-acquisition, blink reflexes were larger during the pleasant and unpleasant CSs than during the neutral CS. Rather than affect, attention or anticipatory arousal were suggested as sources of startle modulation. Experiment 2 confirmed that affective learning in the picture-picture paradigm was not affected by whether the CS preceded the US. Pleasantness ratings and affective priming revealed similar extents of affective learning following forward, backward or simultaneous pairings of CSs and USs. Experiment 3 utilized a backward conditioning procedure (US-->CS) to minimize effects of US anticipation. Again, blink reflexes were larger during CSs paired with valenced USs regardless of US valence implicating attention rather than anticipatory arousal or affect as the process modulating startle in this paradigm. 相似文献
107.
Liyang Tang Hatim A. Alsulaim Joseph K. Canner Gregory P. Prokopowicz Kimberley E. Steele 《Surgery for obesity and related diseases》2018,14(7):943-950
Background
As the vertical sleeve gastrectomy (VSG) becomes increasingly popular, its effect on postoperative micronutrient levels, such as thiamine, becomes more important. We previously found a 1.8% prevalence of thiamine deficiency in bariatric patients before surgery.Objective
The aims of this study were to determine the prevalence of thiamine deficiency at our center after VSG and to explore possible predictors of postoperative thiamine levels.Setting
University hospital, United States.Methods
A retrospective chart review was performed on 147 bariatric patients between 18- and 65-years old who underwent VSG between April 2011 and February 2015. Demographic characteristics, preoperative body mass index (BMI), obesity-associated co-morbidities, alcohol intake, smoking habits, insurance type, calendar year of the procedure, occurrence of postoperative complications, and compliance with postoperative nutrition and follow-up appointment guidelines were extracted from clinical charts. We defined thiamine deficiency as<78 nM on any lab draw within 1 year after the VSG. The χ2, Fisher exact, and Mann-Whitney U tests, and multivariate logistic regression models were created to analyze the association of the above factors with thiamine deficiency after a VSG.Results
Of 147 patients, 105 met inclusion criteria and were analyzed, of whom 27 (25.7%) had thiamine deficiency. Overall median age was 42 years (interquartile ratio: 36, 49). The majority of patients were either African Americans or Caucasian (47.6% and 44.8%, respectively), female (77.1%), and compliant with vitamins (81.0%). The overall mean preoperative BMI was 46.4 kg/m2. Patients with thiamine deficiency were more likely to be African American (66.7%, P = .024), have a larger preoperative BMI (P = .026), and to report repetitive episodes of nausea (59.3%, P = .002) and vomiting (44.4%, P = .001) at any of their postoperative appointments within 1 year after surgery. Compliance with vitamins did not differ between those with or without thiamine deficiency (70.4%, 84.6%, P = .10). After controlling for all factors, African American race (odds ratio [OR] 3.9, P = .019), higher preoperative BMI (OR 1.13, P = .001), nausea (OR 3.81, P = .02), and vomiting (OR 3.49, P = .032) were independent risk factors for the development of thiamine deficiency.Conclusions
We found an alarmingly high prevalence of thiamine deficiency in postoperative SG patients. This disorder may have serious consequences including Wernicke encephalopathy; hence, it is important to identify predictive demographic, postoperative, and behavioral factors so that appropriate measures can be taken to prevent thiamine deficiency in VSG patients. 相似文献108.
Kimberley D. Curtin Eun-Young Lee Lira Yun John C. Spence 《International journal of behavioral medicine》2018,25(5):548-557
Purpose
To examine associations between physical activity contexts and health and fitness perceptions among Korean adults and youth.Method
Data were from the Korean Survey on Citizens’ Sports Participation in 2015. Korean youth (N?=?832; Mage?=?14.7) and adults (N?=?6719; Mage?=?41.3) were included in the hierarchical logistic and linear regressions. Youth physical activity was examined in school-based (i.e., school-based and after-school/Saturday school sports) and out of school (i.e., organized sports) settings. Adults who met the World Health Organization (WHO) physical activity guidelines or not, and participated in structured (e.g., sport) and unstructured (e.g., walking) physical activity were compared. The outcome variables were self-reported health and fitness. Gender interactions between physical activity and all outcomes were examined for the adult sample only.Results
No associations existed between physical activity and perceived health or fitness among youth. Adults who met the WHO guidelines, or participated in structured physical activity showed higher odds of reporting good health. Unstructured physical activity was associated with lower odds of reporting good health. Positive perceptions of fitness were more likely to be reported by males who met physical activity guidelines compared to females.Conclusions
For youth, the potential benefit of physical activity, regardless of contexts, may be more apparent for psychological health than perceived physical health, and school should be used as a venue to promote physical activity. For adults, structured physical activity and achieving the WHO physical activity guidelines may be suggested for perceptions of overall health.109.
The 22q11.2 deletion syndrome is the most common microdeletion syndrome. Although once thought to be separate disorders, cardiac anomalies, abnormal face, thymic hypoplasia, cleft palate, hypocalcemia, and chromosome 22 deletions (CATCH 22); DiGeorge syndrome; velocardiofacial syndrome; and conotruncal anomaly face syndrome are now known to be part of the same 22q11.2 deletion syndrome. Diagnosis of this syndrome is extremely challenging because of wide variability in phenotypic presentations. When the deletion is suspected, genetic testing is typically ordered. Conventional karyotyping is only capable of detecting a small percentage of chromosome deletions. However, fluorescence in situ hybridization (FISH) is capable of detecting many deletions and microdeletions. This article discusses the pathophysiology and presentation of chromosome 22q11.2 deletion syndrome. The use of FISH as a diagnostic tool is also described, including the FISH process, its use, and its accuracy and reliability in the diagnosis of chromosome 22q11.2 deletion syndrome in the fetus and/or newborn. 相似文献
110.
Kinon BJ Zhang L Millen BA Osuntokun OO Williams JE Kollack-Walker S Jackson K Kryzhanovskaya L Jarkova N;and the HBBI Study Group 《Journal of clinical psychopharmacology》2011,31(3):349-355
The primary objective of this study was to test the hypothesis that 1 or more dose levels of LY2140023 monohydrate, an oral prodrug of the potent metabotropic glutamate (mGlu) 2/3 receptor agonist LY404039, given to patients with schizophrenia for 4 weeks would demonstrate significantly greater efficacy than placebo. The HBBI study was a multicenter, randomized, double-blind, parallel, placebo- and active-controlled trial. Male and female patients aged 18 to 65 years who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for schizophrenia were randomized in a 2:2:2:2:2:1 ratio to receive 5-, 20-, 40-, or 80-mg LY2140023 monohydrate twice daily, placebo twice daily, or placebo (am) and 15 mg of olanzapine (pm) daily. Efficacy was defined as the change from baseline on the Positive and Negative Syndrome Scale (PANSS) total score assessed at 4 weeks. The primary analysis did not show that any of the 4 LY2140023 monohydrate doses were more efficacious than placebo as measured by the PANSS total score. Similarly, olanzapine did not significantly separate from placebo. A higher-than-anticipated treatment effect (14.6-point improvement) in the placebo group was observed on PANSS total score. LY2140023 monohydrate was generally well tolerated, although 4 patients reported the serious adverse event of convulsion. LY2140023 monohydrate-treated patients showed little change in dopamine-related adverse events and weight. The results of the HBBI study are considered to be inconclusive because LY2140023 monohydrate and the active control olanzapine did not separate from placebo in the treatment of patients with acutely exacerbated schizophrenia. Additional efficacy, safety, and tolerability testing are needed. 相似文献