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41.
Bo Yang Elizabeth L. Norton Terry Shih Linda Farhat Xiaoting Wu Whitney E. Hornsby Karen M. Kim Himanshu J. Patel G. Michael Deeb 《The Journal of thoracic and cardiovascular surgery》2019,157(4):1313-1321.e2
Objective
To compare perioperative and long-term outcomes in patients undergoing hemiarch and aggressive arch replacement for acute type A aortic dissection (ATAAD).Methods
From 1996 to 2017, we compared outcomes of hemiarch (n = 322) versus aggressive arch replacements (zones 2 and 3 arch replacement with implantation of 2-4 arch branches, n = 150) in ATAAD. Indications for aggressive arch were arch aneurysm >4 cm or intimal tear in the aortic arch that was not resectable by hemiarch replacement, or dissection of arch branches with malperfusion.Results
Patients in the aggressive arch group were significantly younger (mean age: 57 vs 61 years old) and had significantly longer hypothermic circulatory arrest, cardiopulmonary bypass, and aortic crossclamp times. There were no significant differences in perioperative outcomes between hemiarch and aggressive arch groups, including 30-day mortality (5.3% vs 7.3%, P = .38) and postoperative stroke rate (7% vs 7%, P = .96). Over 15 years, Kaplan–Meier survival was similar between hemiarch and aggressive arch groups (log-rank P = .55, 10-year survival 70% vs 72%). Given death as a competing factor, incidence rates of reoperation over 15 years (2.1% vs 2.0% per year, P = 1) and 10-year cumulative incidence of reoperation (14% vs 12%, P = .89) for arch and distal aorta pathology were similar between the 2 groups.Conclusions
Both hemiarch and aggressive arch replacement are appropriate approaches for select patients with ATAAD. Aggressive arch replacement should be considered for an arch aneurysm >4 cm or an intimal tear at the arch unable to be resected by hemiarch replacement, or dissection of the arch branches with malperfusion. 相似文献42.
Aasha I. Hoogland Hailey W. Bulls Brian D. Gonzalez Brent J. Small Lianqi Liu Joseph Pidala Heather S.L. Jim Asmita Mishra 《Journal of pain and symptom management》2019,57(5):952-960.e1
Context
Quality of life (QoL) is increasingly recognized as an important outcome of cancer treatment. Previous studies have examined clinical predictors of QoL, but with the increasing prevalence of wearable sensors that monitor sleep and activity patterns, further investigation into whether these behaviors are predictive of post-treatment QoL is now feasible. Among patients receiving aggressive cancer treatment such as hematopoietic cell transplantation (HCT), analysis of circadian rhythms (24-hour patterns of sleep and activity) via wearable sensors is limited.Objective
To evaluate the relationship between overall QoL and circadian rhythms in patients receiving allogeneic HCT.Methods
Patients wore an ActiGraph GT3X (Pensacola, FL) activity monitor for at least 72 hours before the initiation of conditioning chemotherapy and transplantation and completed a QoL (Functional Assessment of Cancer Therapy-General [FACT-G]) assessment. QoL assessments were also completed 1, 3, and 6 months after HCT.Results
Patients (n = 45, M age = 55) were mostly male (66%) with a total FACT-G score of 80.96 (SD = 16.05) before HCT. Mixed models revealed robust cross-sectional associations between overall QoL and multiple circadian rhythmicity parameters, including durations of high physical activity, overall circadian rhythmicity, and earlier starts of daily activity (P's < .01). Recovery of QoL after transplant was predicted by longer pre-transplant durations of high physical activity (P = .04) and earlier evening retirement (P = .04).Conclusion
Our findings suggest that wearable sensor information is a promising method of predicting recovery of QoL after HCT. Additional studies are needed to confirm these findings in a larger sample. 相似文献43.
M. Corral-Blanco V.C. Prudencio-Ribera M.E. Jarrín-Estupiñán R. Alonso-Moralejo V. Pérez-González J.C. Meneses-Pardo A. Hermira-Anchuelo A. De Pablo-Gafas 《Transplantation proceedings》2019,51(2):380-382
Background
Pulmonary hypertension (PH) is a comorbidity associated with interstitial lung disease (ILD). The purpose of this study was to evaluate the influence of PH on intrahospital mortality in lung transplantation (LT) for ILD.Methods
We conducted a retrospective cohort study of 66 patients who underwent LT for ILD at the 12 de Octubre University Hospital (Madrid, Spain) from October 2008 to June 2014. PH was defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg on right-sided heart catheterization and intrahospital mortality as any death taken place after the transplantation of patients not being discharged.Results
We retrospectively analyzed data of 66 patients; they were stratified by the presence or absence of PH before LT. Twenty-seven patients (41%) had PH. The PH group had a lower diffusing capacity of carbon monoxide (DLCO), carbon monoxide transfer coefficient (KCO), and 6-minute walk distance test (6MWT) and a higher total lung capacity (TLC), modified medical research council dyspnea scale (mMRC), and lung allocation score (LAS) than the non-PH group. Patients with PH more often underwent double lung transplantation (DLT; 59%) than single lung transplantation (SLT).Intrahospital mortality was 13% (9/66). No significant differences were observed in Kaplan-Meier survival curves for the PH and non-PH groups with a median survival time of 46 days versus 33 days (IQR 26–74; log-rank P = .056); however, the postoperative length of stay in the hospital was greater in the PH group.Conclusions
In our cohort, pulmonary hypertension was not related to early mortality in lung transplantation recipients for interstitial lung diseases. 相似文献44.
Birgitte Lerbæk Rikke Jørgensen Jørgen Aagaard Julie Nordgaard Niels Buus 《Archives of Psychiatric Nursing》2019,33(2):174-181
Background
Life expectancy of people with severe mental illness (SMI) is greatly shortened compared to the general population, and despite extensive research, this issue is unsolved. Although it is widely recognised that people with SMI need support from health care services to manage health related issues, profound health inequalities exist within provision of health care. The aim of this study was to examine how mental health care professionals accounted for their actions and responsibilities related to managing physical health issues among people with SMI.Methods
Three focus groups were conducted with 22 mental health care professionals, employed at three mental health care locations. Participants' situated accounts were subjected to discourse analysis.Results
Participants accounted for actions and responsibilities in three typical ways; 1) by positioning people with SMI as difficult to motivate and actively resisting intervention, 2) by positioning people with SMI as so impaired that intervention was futile, and 3) by arguing they are undertreated for physical conditions and might have physical illnesses that staff are not aware of because of prominent mental illness. These discursive strategies seemed to legitimise situations where participants described not responding to physical health issues, and to downplay potential trouble in situations where participants described not succeeding in facilitating lifestyle changes or promoting compliance to treatment of physical conditions.Discussion and conclusion
Mental health care professionals need to increase their awareness of latent discriminating attitudes towards people with SMI. Such attitudes are suggested to reinforce barriers for people with SMI receiving physical health care. 相似文献45.
Brian Darrith Nicholas B. Frisch Matthew W. Tetreault Michael P. Fice Chris N. Culvern Craig J. Della Valle 《The Journal of arthroplasty》2019,34(2):221-227
Background
Although some prior work supports the safety of same-day arthroplasty performed in a hospital, concerns remain when these procedures are performed in a free-standing ambulatory surgery center. The purpose of this study is to compare 90-day complication rates between matched cohorts that underwent inpatient vs outpatient arthroplasty at an ambulatory surgery center.Methods
A single-surgeon cohort of 243 consecutive patients who underwent outpatient arthroplasty was matched with 243 inpatients who had the same procedure. One-to-one nearest-neighbor matching with respect to gender, age, American Society of Anesthesiologists Score, and body mass index was utilized. The 486 primary arthroplasties included 178 unicondylar knees (36.6%), 146 total hips (30.0%), 92 total knees (18.9%), and 70 hip resurfacings (14.5%). Ninety-day outcomes including reoperation, readmission, unplanned clinic or emergency department visits, and major and minor complications were compared using a 2-sample proportions test.Results
The 2 cohorts were similar in distribution of demographic variables, demonstrating successful matching. The inpatient and outpatient cohorts both had readmission rates of 2.1% (P = 1.0). With the number of subjects studied, there were no statistically significant differences in rates of major complications (2.1% vs 2.5%, P = 1.0), minor complications (7.0% vs 7.8%, P = .86), reoperations (0.4% vs 2.1%, P = .22), emergency department visits (1.6% vs 2.5%, P = .52), or unplanned clinic visits (3.3% vs 5.8%, P = .19).Conclusion
This study suggests that arthroplasty procedures can be performed safely in an ambulatory surgery center among appropriately selected patients without an increased risk of complications. 相似文献46.
Katherine M. Stenson Benjamin O. Patterson Matthew Joe Grima Jorg L. De Bruin Peter J.E. Holt Ian Loftus 《Journal of vascular surgery》2019,69(1):53-62.e1
Background
Endovascular aneurysm sealing (EVAS) represents a novel approach to the treatment of abdominal aortic aneurysms. It uses polymer technology to achieve an anatomic seal within the sac of the aneurysm. This cohort study reports the early clinical outcomes, technical refinements, and learning curve during the initial EVAS experience at a single institution.Methods
Results from 150 consecutive EVAS cases for intact, infrarenal abdominal aortic aneurysms are reported here. These cases were undertaken between March 2013 and July 2015. Preoperative, perioperative, and postoperative data were collected for each patient prospectively.Results
The median age of the cohort was 76.6 years (interquartile range, 70.2-80.9 years), and 87.3% were male. Median aneurysm diameter was 62.0 mm (IQR, 58.0-69.0 mm). Adverse neck morphology was seen in 69 (46.0%) patients, including aneurysm neck length <10 mm (17.3%), neck diameter >32 mm or <18 mm (8.7%), and neck angulation >60 degrees (15.3%). Median follow-up was 687 days (IQR, 463-897 days); 37 patients (24.7%) underwent reintervention. The rates of unresolved endoleak are 1.3% type IA, 0.7% type IB, and 2.7% type I. There were no type III endoleaks. There have been seven secondary ruptures in this cohort; all but one of these patients survived after reintervention. Only one rupture occurred in an aneurysm that had been treated within the manufacturer's instructions for use (IFU).Conclusions
The rate of unresolved endoleaks is satisfactorily low. The incidence of secondary rupture is of concern; however, when the IFU are adhered to, the rate is very low. The results of this study suggest that working within the IFU yields better clinical results. 相似文献47.
Lindsay A. Weiner Adam C. Richardson Semhar Z. Tewelde 《The Journal of emergency medicine》2019,56(4):e43-e46
Background
Spontaneous spinal and intracranial subdural hematomas are rarely reported, especially occurring simultaneously. Anticoagulation use has been associated with spontaneous hemorrhages. Prompt diagnosis is required to prevent permanent neurological sequelae. In this case report, we describe a spontaneous spinal and intracranial subdural hematoma in a woman taking warfarin and initially presenting with severe vaginal pain.Case Report
A 42-year-old woman who had a history of mechanical valve replacement and was therefore taking warfarin, came to an emergency department for relief of severe vaginal pain. Mild concurrent lumbar pain increased concern about spinal pathology, so magnetic resonance imaging of her spine was performed. It revealed a subdural hematoma extending from L1–S1 with arachnoiditis, which suggested intracranial pathology, though the patient had no complaint of a headache. Computed tomography of her brain demonstrated a large right subdural hemorrhage with midline shift. Subsequent imaging revealed no aneurysm or source of the intracranial bleeding. We concluded that the patient experienced spontaneous anticoagulation-related intracranial hemorrhage resulting in lumbar subdural hematoma and arachnoiditis with referred vaginal pain.Why Should an Emergency Physician Be Aware of This?
Pelvic, vaginal, or perineal pain may be the presenting symptom in patients with lower spinal pathology. It is important to consider causes other than gynecological ones in the differential diagnosis of these patients, as well as to be cognizant of the relationship between spinal and intracranial subdural hemorrhages. In patients with back pain or radiating lumbar pain, especially coupled with neurological effects, clinicians should consider spinal subdural hemorrhage and arachnoiditis to expedite imaging studies and treatment of these rare entities. 相似文献48.
David C. Johnson Steven S. Raman Sohrab A. Mirak Lorna Kwan Amirhossein M. Bajgiran William Hsu Cleo K. Maehara Preeti Ahuja Izak Faiena Aydin Pooli Amirali Salmasi Anthony Sisk Ely R. Felker David S.K. Lu Robert E. Reiter 《European urology》2019,75(5):712-720
Background
Multiparametric magnetic resonance imaging (mpMRI) undoubtedly affects the diagnosis and treatment of localized prostate cancer (CaP). However, clinicians need a better understanding of its accuracy and limitations in detecting individual CaP foci to optimize management.Objective
To determine the per-lesion detection rate for CaP foci by mpMRI and identify predictors of tumor detection.Design, setting, and participants
We carried out a retrospective analysis of a prospectively managed database correlating lesion-specific results from mpMRI co-registered with whole-mount pathology (WMP) prostatectomy specimens from June 2010 to February 2018. Participants include 588 consecutive patients with biopsy-proven CaP undergoing 3-T mpMRI before radical prostatectomy at a single tertiary institution.Outcome measurements and statistical analysis
We measured mpMRI sensitivity in detecting individual CaP and clinically significant (any Gleason score ≥7) CaP foci and predictors of tumor detection using multivariate analysis.Results and limitations
The final analysis included 1213 pathologically confirmed tumor foci in 588 patients with primarily intermediate- (75%) or high-risk (12%) CaP. mpMRI detected 45% of all lesions (95% confidence interval [CI] 42–47%), including 65% of clinically significant lesions (95% CI 61–69%) and nearly 80% of high-grade tumors. Some 74% and 31% of missed solitary and multifocal tumors, respectively, were clinically significant. The majority of missed lesions were small (61.1% ≤1 cm); 28.3% were between 1 and 2 cm, and 10.4% were >2 cm. mpMRI missed at least one clinically significant focus in 34% of patients overall, and in 45% of men with multifocal lesions. On multivariate analysis, smaller, low-grade, multifocal, nonindex tumors with lower prostate-specific antigen density were more likely to be missed. Limitations include selection bias in a prostatectomy cohort, lack of specificity data, an imperfect co-registration process, and uncertain clinical significance for undetected lesions.Conclusions
mpMRI detects less than half of all and less than two-thirds of clinically significant CaP foci. The moderate per-lesion sensitivity and significant proportion of men with undetected tumor foci demonstrate the current limitations of mpMRI.Patient summary
Magnetic resonance imaging of the prostate before surgical removal for prostate cancer finds less than half of all individual prostate cancer tumors. Large, solitary, aggressive tumors are more likely to be visualized on imaging. 相似文献49.
Objectives: Personality Disorders (PDs) are associated with a multitude of negative consequences. The negative PD effects on health can be even more burdensome for older adults given the physical and social functioning changes that occur with age; however, the majority of research examining the influence of PDs focuses on younger adults. The present study seeks to investigate the relationship between PDs and physical health-related quality of life (PHRQoL) in adults over the age of 50.
Methods: Data for 16,884 adults ages 50 and older from the 2001–2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were analyzed. Multiple linear regression models were analyzed to investigate the relationships of seven PDs and participants’ PHRQoL.
Results: All PDs except histrionic and avoidant PD had statistically significant negative associations with PHRQoL scores, indicating that respondents diagnosed with PDs were expected to have lower PHRQoL than those without PDs, after controlling for sociodemographic characteristics. When psychosocial covariates were added to the model, only dependent, obsessive-compulsive and paranoid PDs were significantly related to PHRQoL score.
Conclusions: For adults ages 50 and older, a diagnosis of PD was weakly associated with lower PHRQoL scores for three PDs, however this is unlikely to be a causal association. The strength of the relationship between PDs and PHRQoL varies by type of PD. Given the higher rates of functional and social changes that occur with age, future research should focus on potential causes of worse physical health among older adults with PDs. 相似文献
50.
Maryam Boumezrag Sormeh Harounzadeh Hamza Ijaz Angeline Johny Lorna Richards Yan Ma Maxine A. Le Saux Paige Kulie Caitlin Davis Andrew C. Meltzer 《The American journal of emergency medicine》2019,37(2):304-307