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81.
Dana Bliuc Nguyen D Nguyen Tuan V Nguyen John A Eisman Jacqueline R Center 《Journal of bone and mineral research》2013,28(11):2317-2324
After fracture there is increased risk of refracture and premature mortality. These outcomes, particularly premature mortality following refracture, have not previously been studied together to understand overall mortality risk. This study examined the long‐term cumulative incidence of subsequent fracture and total mortality with mortality calculated as a compound risk and separated according to initial and refracture. Community‐dwelling participants aged 60+ years from Dubbo Osteoporosis Epidemiology Study with incident fractures, followed prospectively for further fractures and deaths from 1989 to 2010. Subsequent fracture and mortality ascertained using cumulative incidence competing risk models allowing four possible outcomes: death without refracture; death following refracture; refracture but alive, and event‐free. There were 952 women and 343 men with incident fracture. Within 5 years following initial fracture, 24% women and 20% men refractured; and 26% women and 37% men died without refracture. Of those who refractured, a further 50% of women and 75% of men died, so that total 5‐year mortality was 39% in women and 51% in men. Excess mortality was 24% in women and 27% in men. Although mortality following refracture occurred predominantly in the first 5 years post–initial fracture, total mortality (post‐initial and refracture) was elevated for 10 years. Most of the 5‐year to 10‐year excess mortality was associated with refracture. The long‐term (>10 years) refracture rate was reduced, particularly in the elderly as a result of their high mortality rate. The 30% alive beyond 10 years postfracture were at low risk of further adverse outcomes. Refractures contribute substantially to overall mortality associated with fracture. The majority of the mortality and refractures occurred in the first 5 years following the initial fracture. However, excess mortality was observed for up to 10 years postfracture, predominantly related to that after refracture. © 2013 American Society for Bone and Mineral Research. 相似文献
82.
Patrick L. Wagner MD Frances Austin MD Ugwuji Maduekwe MD Arun Mavanur MD Lekshmi Ramalingam MD Heather L. Jones PA Matthew P. Holtzman MD Steven A. Ahrendt MD Amer H. Zureikat MD James F. Pingpank MD Herbert J. Zeh MD David L. Bartlett MD Haroon A. Choudry MD 《Annals of surgical oncology》2013,20(4):1056-1062
Background
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) are frequently used to treat appendiceal carcinomatosis. Some patients require multivisceral resection because of the volume of disease. It is unclear whether extent of CRS impacts survival in appendiceal carcinomatosis.Methods
We analyzed 282 patients undergoing attempted CRS/HIPEC for appendiceal carcinomatosis. Patients were defined as having undergone Extensive CRS (n = 60) if they had >3 organ resections or >2 anastomoses; a subgroup of Extreme CRS patients (n = 10) had ≥5 organ resections and ≥3 anastomoses. Kaplan–Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting outcomes.Results
Relative to the comparison group, patients undergoing Extensive CRS had a higher median peritoneal carcinomatosis index, operative duration, blood loss, and length of stay. No difference in completeness of cytoreduction, severe morbidity, or 60-day mortality was evident. Subgroup analysis of 10 patients undergoing extreme CRS likewise revealed no increase in severe morbidity or mortality. Median progression-free (PFS) and overall survival (OS) were 23.5 and 74 months in the comparison group; 18.5 (p = 0.086) and 51 (p = 0.85) months in the Extensive CRS group; and 40 months and not reached in the Extreme CRS subgroup. In a multivariable analysis, extent of CRS was not independently associated with PFS or OS.Conclusions
Extensive CRS is associated with greater OR time, blood loss, and length of stay, but is not associated with higher morbidity, mortality, or inferior oncologic outcomes in patients with appendiceal carcinomatosis. 相似文献83.
April Saval PA 《The journal of spinal cord medicine》2013,36(4):394-397
Background/Objective: Intrathecal baclofen (ITB) has been shown to be an effective treatment for severe spasticity of spinal or cerebral origin. Although most patients respond well to an ITB trial, there are often difficulties in achieving and/or maintaining such effectiveness with ITB pump treatment. There are few published guidelines for dosing efficacy and no studies looking at the effect of concentration of ITB on spasticity management.Methods: Case series of 3 adults with severe spasticity treated with ITB pump: a 44-year-old man with C7 tetraplegia using a 40-mL Medtronic SynchroMed II pump with 500-μg/mL concentration; a 35-year-old woman with traumatic brain injury with right spastic hemiplegia using a 18-mL Medtronic SynchroMed EL pump with 2,000-μg/mL concentration; and a 43-year-old woman with spastic diplegic cerebral palsy using a 40-mL Medtronic SynchroMed II pump with 2,000-μg/mL concentration.Results: After reducing ITB concentrations in the pump, either as part of a standard protocol for dye study to assess the integrity of pump and catheter system or secondary to plateau in therapeutic efficacy, patients experienced temporary, significant reduction in spasticity based on range of motion, Modified Ashworth scores, and verbal feedback.Conclusions: Decreasing the concentration of ITB seems to affect spasticity control. Further research in this area is needed for those patients with refractory spasticity to optimize efficacy of ITB therapy. 相似文献
84.
Roxann Roberson-Nay Erin C. Berenz Ron Acierno Trinh Luong Tran Lam Tu Trung Nguyen Thanh Tam Tran Tuan La Thi Buoi Tran Thu Ha Tran Duc Thach Ananda B. Amstadter 《Psychiatry research》2013
The association between trauma exposure and panic attacks has received increased attention over the past decade, with mounting evidence suggesting an overlapping etiologic pathway. This study examined the incidence of new onset panic attacks in 775 Vietnamese individuals in the 2–3 months following Typhoon Xangsane. Pre-typhoon (Wave 1) and post-typhoon (Wave 2) assessments were conducted, allowing for consideration of factors occurring prior to the typhoon in addition to typhoon-relevant responding. Of the 775 participants, 11.6% (n=90) met criteria for lifetime panic attack pre-typhoon and 2.8% (n=22) met post-typhoon panic attack criteria. Individuals with pre-typhoon panic were significantly older and reported less education compared to the no-panic group. Individuals in both panic groups were more likely to screen positive on a Wave1 psychiatric screening measure, endorse greater typhoon exposure and prior traumatic event exposure and were significantly more likely to meet DSM-IV criteria for posttraumatic stress disorder (PTSD) and major depression (MDD) post-typhoon compared with persons reporting no history of panic attacks. Pre and post-typhoon panic exhibited similar patterns across variables and both panic conditions were associated with the development of PTSD and MDD, suggesting that persons experiencing panic attacks may represent a vulnerable population in need of early intervention services. 相似文献
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87.
Binge-like ethanol exposure on postnatal days (PD) 4-9 in rodents causes cerebellar cell loss and impaired acquisition of conditioned responses (CRs) during "short-delay" eyeblink classical conditioning (ECC), using optimal (280-350 ms) interstimulus intervals (ISIs). We extended those earlier findings by comparing acquisition of delay ECC under two different ISIs. From PD 4 to 9, rats were intubated with either 5.25 g/kg of ethanol (2/day), sham intubated, or were not intubated. They were then trained either as periadolescents (about PD 35) or as adults (>PD 90) with either the optimal short-delay (280-ms) ISI, a long-delay (880-ms) ISI, or explicitly unpaired CS and US presentations. Neonatal binge ethanol treatment significantly impaired acquisition of conditioning at both ages regardless of ISI, and deficits in the acquisition and expression of CRs were comparable across ISIs. These deficits are consistent with the previously documented ethanol-induced damage to the cerebellar-brainstem circuit essential for Pavlovian ECC. 相似文献
88.
WHO's Service Availability and Readiness Assessment of primary health care services of commune health centers in a rural district of Northern Vietnam
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Nguyen Van Huy Nguyen Van Thanh Ngo Tri Tuan Nguyen Thi Thu Ha Luu Ngoc Hoat Nguyen Minh Hoang Do Mai Hoa 《The International journal of health planning and management》2018,33(1):202-211
The objective of this study was to assess the availability and readiness of the primary health care (PHC) services of commune health centers (CHCs) in Quoc Oai, a rural district of Northern Vietnam based on the World Health Organization's Service Availability and Readiness Assessment (SARA) tool. The study was done in 2 steps. First, the heads of the 21 CHCs of Quoc Oai district were interviewed using SARA, a quantitative survey, and the responses were then validated by direct observations of each facility. The results showed that although the average number of health staffs in each CHC met the national standards (at least 5 staffs per CHC), its allocation within each CHC was not properly met because some CHCs had only 2 health staffs. Several health equipment and facilities were not fully available in many CHCs, and although the majority of the PHC services were available at the CHCs, their readiness remained limited. Several significant correlates between the availability of health care workers and the availability of the facilities and the PHC services were observed, suggesting that they depend upon and affect one another in the health system. Using the SARA‐based inventory, the study helps health managers and policy makers to prioritize efforts and allocate resources more appropriately. To be effective, attention should be given to how to make facilities, services, and human resources for health ready for PHC activities—more investment and support from the system (from higher to lower level) and the government. 相似文献
89.
Hu YF Tai CT Lin YJ Chang SL Lo LW Wongcharoen W Udyavar AR Tuan TC Chen SA 《Pacing and clinical electrophysiology : PACE》2007,30(12):1506-1510
BACKGROUND: The anatomical differences with age may raise difficulty in determining the proper positioning of the transseptal puncture site in the therapeutic left heart catheterization. This study investigated whether age affects the fluoroscopy-guided transseptal puncture in the catheter ablation of atrial fibrillation. METHODS AND RESULTS: Fifty patients (52 +/- 12 years, 35 men) who underwent ablation for paroxysmal/persistent atrial fibrillation were included. The patients were divided into two groups according to their age (cut-point 50 y/o): young group (n = 20) and old group (n = 30). In the 30 degrees right anterior oblique view (RAO), the width between the transseptal puncture site and coronary sinus ostium (H (N-CSO)) was longer in old-age group (14.4 +/- 9.4 vs 10.9 +/- 10.4 mm, P = 0.034). In the 60 degrees left anterior oblique view (LAO) view, the angle of the direction of the transseptal needle (N-angle) was less in the old-age group (56.0 +/- 10.0 degrees vs 58.4 +/- 9.8 degrees , P = 0.041). The ratio of the transseptal puncture site-coronary sinus ostium (CSO) distance over the distance between the superior vena cava-right atrial junction and CSO (V(N-CSO)/V(J-CSO)) was significantly higher in the old-age group (0.73 +/- 0.12 vs 0.63 +/- 0.2, P = 0.009). CONCLUSION: The transseptal puncture site in the RAO view moved higher and more posterior and the transseptal puncture angle in the LAO view decreased with age. These findings highlight the influence of age on the atrial anatomy and transseptal puncture site. 相似文献
90.
Henry Tan Chor Lip Tan Jih Huei Yuzaidi Mohama Rizal Imran Alwi Tuan Nur'' Azmah Tuan Mat 《中华创伤杂志(英文版)》2020,23(4):207-210
Malaysia has one of the highest total numbers of COVID-19 infections amongst the Southeast Asian nations, which led to the enforcements of the Malaysian “Movement Control Order” to prohibit disease transmission. The overwhelming increasing amount of infections has led to a major strain on major healthcare services. This leads to shortages in hospital beds, ventilators and critical personnel protective
equipment. This article focuses on the critical adaptations from a general surgery department in Malaysia which is part of a Malaysian tertiary hospital that treats COVID-19 cases. The core highlights of these strategies enforced during this pandemic are: (1) surgery ward and clinic decongestions; (2) deferment of elective surgeries; (3) restructuring of medical personnel work force; (4) utilization of online applications for tele-communication; (5) operating room (OR) adjustments and patient screening; and (6)continuing medical education and updating practices in context to COVID-19. These adaptations were important for the continuation of emergency surgery services, preventing transmission of COVID-19
amongst healthcare workers and optimization of medical personnel work force in times of a global pandemic. In addition, an early analysis on the impact of COVID-19 pandemic and lockdown measures in Malaysia towards the reduction in total number of elective/emergent/trauma surgeries performed is described in this article. 相似文献