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951.
《Allergologia et immunopathologia》2020,48(2):175-181
BackgroundAtopic dermatitis (AD) is the most common chronic skin disease in childhood. There is no definitive test for diagnosing AD. The Hanifin-Rajka criteria (HRC) and The United Kingdom Working Party criteria (UKC) are the most used in the literature. It is aimed to evaluate the clinical efficacy of HRC and UKC in pediatric age.MethodsChildren diagnosed AD in the pediatric allergy clinic were enrolled. Patients with skin problems other than AD were involved as controls. All participants were evaluated for HRC and UKC at the time of diagnosis. Clinical diagnosis by the pediatric allergist was determined as the gold standard.Results200 children with AD and 90 controls were enrolled in the study. Median (interquartile range, IQR) age of AD patients was 13.5 (7–36) months. There was no significant difference in age and sex between groups (p = 0.11 and p = 0.34, respectively). The HRC were superior to the UKC for sensitivity, negative predictive value, kappa and accuracy rate (94% vs. 72%, 84% vs. 60%, 0.68 vs. 0.56 and 87 vs. 78, respectively). On the other hand, specificity and positive predictive value of UKC were better than those of HRC (92% vs. 71% and 95% vs. 88%, respectively).ConclusionHRC seem to be better in diagnosing AD than UKC for young children. Further studies are needed to evaluate comparableness of HRC and UKC for AD in childhood in order to generate an international consensus for clinical trials. 相似文献
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Antithrombotic therapy and bleeding events after aortic valve replacement with a novel bioprosthesis
Robert J.M. Klautz Michiel D. Vriesendorp Francois Dagenais Louis Labrousse Vinayak Bapat Michael G. Moront Martin Misfeld Elizabeth Gearhart A. Pieter Kappetein Joseph F. Sabik 《The Journal of thoracic and cardiovascular surgery》2021,161(1):66-75.e4
ObjectiveSeveral recent-generation surgical tissue valves have been found to have bleeding rates exceeding rates recommended by regulatory bodies. We explored bleeding events using data from the Pericardial Surgical Aortic Valve Replacement (PERIGON) Pivotal Trial for the Avalus valve (Medtronic, Minneapolis, Minn) to examine whether this end point remains relevant for the evaluation of bioprostheses.MethodsPatients (n = 1115) underwent aortic valve replacement. Bleeding and thromboembolic event episodes in patients within 3 years postimplant were analyzed for frequency, timing, and severity, focusing on patients taking antiplatelet/anticoagulant medications at the time of the event. Clinical and hemodynamic outcomes are also reported.ResultsAt 3 years, the Kaplan-Meier cumulative probability estimate of all-cause death was 7.2% (cardiac, 3.6%; valve-related, 1.1%). The Kaplan-Meier cumulative probability estimates of all and major hemorrhage were 8.7% and 5.2%, respectively. Ninety-nine bleeding events occurred in 86 patients: most occurred >30 days postsurgery. Among the 51 late major bleeds, in 5 cases the patients were taking anticoagulant/antiplatelet medication for prophylaxis after surgical aortic valve replacement at the time of the event, whereas the remaining patients were taking medications for other reasons. Age (hazard ratio, 1.035; 95% confidence interval, 1.004-1.068), peripheral vascular disease (hazard ratio, 2.135; 95% confidence interval, 1.106-4.122), renal dysfunction (hazard ratio, 1.920; 95% confidence interval, 1.055-3.494), and antithrombotic medication use at the time of the event (hazard ratio, 1.417; 95% confidence interval, 1.048-1.915) were associated with late bleeds (major and minor).ConclusionsOverall clinical outcomes demonstrated low mortality and few complications except for major bleeding. Most bleeding events occurred >30 days after surgery and in patients taking antiplatelet and/or anticoagulation for indications other than postimplant prophylaxis. 相似文献
955.
Angela Sala-Hernández Pablo Granero Castro Eva Montalvá Orón Javier Maupoey Ibáñez Rafael García-Domínguez José Bueno Lledó Jose Luís Ibáñez Cirión Rafael López Andújar 《Cirugía espa?ola》2019,97(1):27-33
Introduction
The good results obtained with the implementation of ambulatory laparoscopic cholecystectomy programs have led to the expansion of the initial inclusion criteria. The main objective was to evaluate the results and the degree of satisfaction of the patients included in a program of laparoscopic cholecystectomy without admission, with expanded criteria.Methods
Observational study of a cohort of 260 patients undergoing ambulatory laparoscopic cholecystectomy between April 2013 and March 2016 in a third level hospital. We classified the patients into 2 groups based on compliance with the initial inclusion criteria of the outpatient program. Group I (restrictive criteria) includes 164 patients, while in group ii (expanded criteria) we counted 96 patients. We compared the surgical time, the rate of failures in ambulatory surgery, rate of conversion, reinterventions and mortality and the satisfaction index.Results
The overall success rate of ambulatory laparoscopic cholecystectomy was 92.8%. The most frequent cause of unexpected income was for medical reasons. There was no statistically significant difference between the 2 groups for total surgery time, the rate of conversion to open surgery and the number of major postoperative complications Do not demostrate differences in surgical time, nor in the number of perioperative complications (major complications 1,2%), or the number of failures in ambulatory surgery, nor the number of readmissions between both groups. There was no death. 88.5% of patients completed the survey, finding no differences between both groups in the patient satisfaction index. The overall score of the process was significantly better in group ii (P=.023).Conclusions
Ambulatory laparoscopic cholecystectomy is a safe procedure with a good acceptance by patients with expanded criteria who were included in the surgery without admission program. 相似文献956.
Nikolaos Giagkou MD MPhil Maria I. Maraki PhD Mary Yannakoulia PhD Mary H. Kosmidis PhD Efthimios Dardiotis MD PhD Georgios M. Hadjigeorgiou MD PhD Paraskevi Sakka MD PhD Eva Ntanasi MSc Costas A. Anastasiou PhD Georgia Xiromerisiou MD PhD Leonidas Stefanis MD PhD Nikolaos Scarmeas MD PhD Maria Stamelou MD 《Movement disorders》2020,35(10):1802-1809
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Veronika Rypdal Mia Glerup Nils Thomas Songstad Geir Bertelsen Terje Christoffersen Ellen D. Arnstad Kristiina Aalto Lillemor Berntson Anders Fasth Troels Herlin Maria Ekelund Suvi Peltoniemi Peter Toftedal Susan Nielsen Sanna Leinonen Regitze Bangsgaard Rasmus Nielsen Marite Rygg Marek Zak 《Ophthalmology》2021,128(4):598-608
958.
Beau Toskich Lucas L. Vidal Matthew T. Olson Jason T. Lewis Jordan D. LeGout David M. Sella S. Ali Montazeri Zlatko Devcic Andrew R. Lewis Greg T. Frey Charles A. Ritchie Ricardo Paz-Fumagalli Kristopher P. Croome Tushar C. Patel 《Journal of vascular and interventional radiology : JVIR》2021,32(4):518-526.e1
PurposeTo evaluate the pathologic outcomes of hepatocellular carcinoma (HCC) treated with Yttrium-90 radiation segmentectomy using glass microspheres prior to liver transplantation and explore parameters associated with pathologic necrosis.Materials and MethodsA single-institution retrospective analysis of HCC patients who received radiation segmentectomy prior to liver transplantation from November 2016 to May 2020 was performed. Patients were included if the treatment angiosome encompassed the entire tumor and could be correlated with available gross pathology. Archived histology slides were reviewed for percentage of pathologic necrosis. Thirty-three patients with 37 tumors were evaluated. The median tumor size was 2.3 cm (range, 1–6.7 cm).ResultsAll tumors received a single treatment. The median time from radiation segmentectomy to transplantation was 206 days (range, 58–550 days). Objective response per Modified Response Evaluation Criteria in Solid Tumors (mRECIST) was 92% (complete response, 76%; partial response, 16%). A total of 68% (n = 25) of tumors demonstrated ≥99% pathologic necrosis. Complete pathologic necrosis was present in 53% and 75% of tumors treated with >190 Gy (n = 18) and >500 Gy (n = 8) single-compartment Medical Internal Radiation Dose, respectively. Complete response per mRECIST, posttreatment angiosome T1 hypointensity, dose >190 Gy, microsphere specific activity >297 Bq, and a longer time between treatment and transplant were associated with ≥99% tumor necrosis (P < .05). No posttransplant tumor recurrences occurred within a median follow-up of 604 days (range, 138–1,223 days).ConclusionsRadiation segmentectomy can serve as an ablative modality for the treatment of HCC prior to liver transplant. 相似文献
959.
《Journal of the American College of Radiology》2020,17(5):568-573
As of January 2020, clinical decision support needs to be implemented across US health systems for advanced diagnostic imaging services. This article reviews the history, importance, and hurdles of clinical decision support and discusses a few pearls and pitfalls regarding its implementation. 相似文献
960.