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61.
Tia Chakraborty Eugene Scharf Daniel DeSimone Abdelghani El Rafei Waleed Brinjikji Larry M. Baddour Walter Wilson James M. Steckelberg Jennifer E. Fugate Eelco F.M. Wijdicks Alejandro A. Rabinstein 《Mayo Clinic proceedings. Mayo Clinic》2019,94(6):1024-1032
ObjectiveTo determine how brain magnetic resonance imaging (MRI) findings impact clinical outcomes in patients with infective endocarditis (IE) and to propose a management algorithm for patients with neurologic symptoms who are candidates for valve surgery (VS).Patients and MethodsData from our center were retrospectively reviewed for patients hospitalized with IE between January 1, 2007, and December 31, 2014. Outcomes were postoperative intracerebral hemorrhage (ICH), 6-month mortality, and functional outcome at last follow-up as described by the modified Rankin Scale (mRS) score. Good outcome was defined as an mRS score of 2 or less.ResultsA total of 361 patients with IE were identified, including 127 patients (35%) who had MRI. One hundred twenty-six of 361 patients (35%) had neurologic symptoms, which prompted MRI in 79 of 127 patients (62%); 74 of 79 (94%) had acute or subacute MRI abnormalities. One patient with subarachnoid and multifocal ICH on MRI developed postoperative ICH. Patients with VS despite MRI abnormalities had lower 6-month mortality (odds ratio [OR], 0.17; 95% CI, 0.06-0.48; P<.001) and better functional outcome (OR, 4.43; 95% CI, 1.51-13.00; P=.005). Irrespective of VS, lobar or posterior fossa ICH on MRI was associated with 6-month mortality (OR, 3.58; 95% CI, 1.22-10.50; P=.02) and territorial ischemic stroke was inversely associated with good mRS (OR, 0.29; 95% CI, 0.13-0.66; P=.002). In neurologically asymptomatic patients who had VS, MRI findings did not impact 6-month mortality or functional outcomes.ConclusionMagnetic resonance imaging detects a large number of abnormalities in patients with IE. Preoperative lobar hematoma and large territorial stroke determine outcome irrespective of VS. When indicated, VS increases the odds of a good outcome despite MRI abnormalities. 相似文献
62.
Harun Kundi Jeffrey J. Popma Linda R. Valsdottir Changyu Shen Kamil F. Faridi Duane S. Pinto Robert W. Yeh 《The Canadian journal of cardiology》2018,34(12):1648-1654
Background
We sought to identify nontraditional risk factors coded in administrative claims data and evaluate their ability to improve prediction of long-term mortality in patients undergoing percutaneous mitral valve repair.Methods
Patients undergoing transcatheter mitral valve repair using MitraClip implantation between September 28, 2010, and September 30, 2015 were identified among Medicare fee-for-service beneficiaries. We used nested Cox regression models to identify claims codes predictive of long-term mortality. Four groups of variables were introduced sequentially: cardiac and noncardiac risk factors, presentation characteristics, and nontraditional risk factors.Results
A total of 3782 patients from 280 clinical sites received treatment with MitraClip over the study period. During the follow-up period, 1114 (29.5%) patients died with a median follow-up time period of 13.6 (9.6 to 17.3) months. The discrimination of a model to predict long-term mortality including only cardiac risk factors was 0.58 (0.55 to 0.60). Model discrimination improved with the addition of noncardiac risk factors (c = 0.63, 0.61 to 0.65; integrated discrimination improvement [IDI] = 0.038, P < 0.001), and with the subsequent addition of presentation characteristics (c = 0.67, 0.65 to 0.69; IDI = 0.033, P < 0.001 compared with the second model). Finally, the addition of nontraditional risk factors significantly improved model discrimination (c = 0.70, 0.68 to 0.72; IDI = 0.019, P < 0.001, compared with the third model).Conclusions
Risk-prediction models, which include nontraditional risk factors as identified in claims data, can be used to predict long-term mortality risk more accurately in patients who have undergone MitraClip procedures. 相似文献63.
64.
Disha Mehta Daniela A. Pimentel Maria-Zunilda Núñez Amir Abduljalil Vera Novak 《Metabolism: clinical and experimental》2014
Objective
Microalbuminuria (MA), a marker of renal microvascular disease, is associated with brain atrophy and neurovascular changes in older adults with type 2 diabetes mellitus (DM). We evaluated the relationship between urine albumin-to-creatinine ratio (UACR) and regional brain volumes to determine whether subclinical albuminuria may indicate early structural brain changes in type 2 DM.Materials/Methods
We studied UACR and brain volumes in 85 type 2 DM patients (64.8 ± 8.3 years) and 40 age-matched controls using 3D magnetization prepared rapid acquisition with gradient echo (MP-RAGE) MRI (magnetic resonance imaging) at 3 Tesla. The relationship between UACR and brain volumes was analyzed using the least square models.Results
In DM patients, UACR ≥ 5 mg/g, UACR ≥ 10 mg/g and clinically significant MA (UACR ≥ 17 mg/g [males] and 25 mg/g [females]) were associated with lower gray matter (GM) volume in the frontal lobe (r2adj = 0.2–0.4, P = 0.01–0.05) and UACR ≥ 5 mg/g was also related to global GM atrophy (r2adj = 0.1, P = 0.04), independent of DM duration, glucose levels, HbA1c and hypertension. For UACR ≥ 5 mg/g, a lower global GM volume was related to worse executive function (P = 0.04) in the DM group. No associations were found for UACR (< 5 mg/g) and controls.Conclusions
Subclinical albuminuria (UACR ≥ 5 mg/g) is associated with lower GM volume that has clinical impact on cognitive function in older diabetic patients, and these relationships are independent of DM control and hypertension. Therefore, UACR levels may serve as an additional marker of DM-related brain structural changes. 相似文献65.
66.
Ashwini Ranade Gary J. Young Raul Garcia John Griffith Astha Singhal Jean McGuire 《Journal of the American Dental Association (1939)》2019,150(8):656-663
BackgroundInadequate access to oral health care and palliative care provided in the emergency department (ED) creates a pattern of repeat nontraumatic dental condition (NTDC) ED visits. The authors examined NTDC ED revisits and assessed the determinants associated with these visits in Massachusetts.MethodsThe authors examined NTDC ED revisits in Massachusetts during 2013 using the Massachusetts All-Payer Claims Database. The authors report patient characteristics of those who made a single NTDC ED visit and of those who made NTDC ED revisits within 30 days of the index NTDC ED visit. The authors used a multilevel logistic regression model to examine the determinants associated with NTDC ED repeat visits.ResultsIn 2013, 21.5% of NTDC ED visits were revisits. Men from 26 through 35 years of age who were enrolled in Medicaid and who did not make an outpatient dental office visit within 30 days of the index NTDC ED visit had increased odds of repeat visits.ConclusionsThe sizable proportion of NTDC ED repeat visits indicates that certain patients in Massachusetts experience consistent and systematic barriers in accessing appropriate and timely oral health care.Practical ImplicationsPrioritizing young adults and Medicaid enrollees for ED diversion programs and setting up a formal referral process via connecting patients to dental offices and community health centers after an NTDC ED visit may reduce NTDC ED revisits and provide appropriate oral health care to these patients. 相似文献
67.
Jií Svoboda Petr Boil Jakub Holzer Natlia Luptkov Milan Jarý Bohuslav Maek Petr Dym
ek 《Materials》2022,15(2)
Oxide-dispersion-strengthened (ODS) Fe-Al-Y2O3-based alloys (denoted as FeAlOY) containing 5 vol. % of nano-oxides have a potential to become top oxidation and creep-resistant alloys for applications at temperatures of 1100–1300 °C. Oxide dispersoids cause nearly perfect strengthening of grains; thus, grain boundaries with limited cohesive strength become the weak link in FeAlOY in this temperature range. One of the possibilities for significantly improving the strength of FeAlOY is alloying with appropriate elements and increasing the cohesive strength of grain boundaries. Nearly 20 metallic elements have been tested with the aim to increase cohesive strength in the frame of preliminary tests. A positive influence is revealed for Al, Cr, and Y, whereby the influence of Y is enormous (addition of 1% of metallic Y increases strength by a factor of 2), as it is presented in this paper. 相似文献
68.
难治性贫血与巨幼细胞性贫血骨髓细胞形态学比较分析 总被引:3,自引:0,他引:3
目的比较巨幼细胞性贫血和难治性贫血的细胞形态学特征。方法对41例骨髓增生异常综合征-难治性贫血(M DS-RA)与52例巨幼细胞性贫血(M A)进行形态学比较分析,结果M A红系巨变100%,其它病态造血或有或无。M DS-RA与M A病态造血有相似之处,M A的形态学诊断主要以红系巨变为主:M DS-RA要对病态造血情况进行综合分析,以防误诊。 相似文献
69.
70.
目的检测骨髓增生异常综合征难治性贫血(MDS-RA)患者、慢性再生障碍性贫血患者、巨幼细胞性贫血及正常人血清乳酸脱氢酶(LDH),研究其对MDS预后判定及与再障鉴别的临床意义。方法采用国际血液学标准化委员会介绍的酶法。结果MDS-RA组与正常人组、再障组相比较血清LDH水平明显增高,差异有统计学意义(P〈0.01);再障组与正常人组相比较血清LDH水平无明显差异,差异无统计学意义(P〉0.05)巨幼细胞性贫血患者LDH水平亦明显增高。MDS.RA组中LDH明显增高组中位生存期明显短于LDH增高组,差异有统计学意义(P〈0.01)。结论血清LDH水平可作为MDS与再障鉴别诊断、MDS预后不良的指标,但尚须进一步与巨幼细胞性贫血鉴别。 相似文献