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We aimed to investigate the association between erectile dysfunction and severity of cardiovascular morbidity and to assess clinical responses to tadalafil of patients in different cardiovascular risk groups. Between November 2019 and August 2020, a total of 258 male patients aged 45–70 years with ED were included. They were divided into three groups according to the Framingham risk score: low-risk (n: 86, 33.3%), intermediate-risk (n: 103, 39.9%) and high-risk (n: 69, 26.8%). At admission, all domains of the International Index of Erectile Function score were worse in high-risk group compared to other risk groups (p < .001). After a 12-week follow-up, a more significant improvement was observed in all domains of erectile function in all risk groups, but high-risk group had lower sexual scores (p < .001). The lowest rate for complete responsiveness to tadalafil was observed in the high-risk group (37.7%). The rate of failure in complete responsiveness was found to be 4.127 times greater with higher Framingham score and 3.102 times greater with higher erectile dysfunction severity at admission. Our preliminary findings show that more severe sexual disorders are observed in high-risk patients with cardiovascular morbidity. Individualised treatment may be important in high-risk group since they may benefit less from tadalafil, and failure in complete responsiveness can be more common in this group. 相似文献
94.
Matthias Meyer Lukas Parik Felix Greimel Tobias Renkawitz Joachim Grifka Markus Weber 《The Journal of arthroplasty》2021,36(5):1533-1542
BackgroundModels for risk stratification and prediction of outcome, such as the Charlson Comorbidity Index (CCI), the Elixhauser Comorbidity Method (ECM), the 5-factor modified Frailty Index (mFI-5), and the Hospital Frailty Risk Score (HFRS) have been validated in orthopedic surgery. The aim of this study is to compare the predictive power of these models in total hip and knee replacement.MethodsIn a retrospective analysis of 8250 patients who had undergone total joint replacement between 2011 and 2019, CCI, ECM, mFI-5, and HFRS were calculated for each patient. Receiver operating characteristic curve plots were generated and the area under the curve (AUC) was compared between each score with regard to adverse events such as transfusion, surgical, medical, and other complications. Multivariate logistic regression models were used to assess the relationship among risk stratification models, demographic factors, and postoperative adverse events.ResultsIn prediction of surgical complications, HFRS performed best (AUC: 0.719, P < .001), followed by ECM (AUC: 0.578, P < .001), mFI-5 (AUC: 0.564, P = .003), and CCI (AUC: 0.555, P = .012). With regard to medical complications, other complications, and transfusion, HFRS also was superior to ECM, mFI-5, and CCI. Multivariate logistic regression analyses revealed HFRS as an independent risk stratification model associated with all captured adverse events (P ≤ .001).ConclusionThe HFRS is superior to current risk stratification models in the context of total joint replacement. As the HRFS derives from routinely collected administrative data, healthcare providers can identify at-risk patients without additional effort or expense. 相似文献
95.
Maohe Wang Singh Prince Yong Tang Xiang Zhong Shasha Chen Guisen Li Li Wang Wei Wang 《Renal failure》2021,43(1):500
BackgroundMacroscopic hematuria after wasp sting has been reported in Asia to occur before acute kidney injury (AKI), and is often used by clinicians as a sign indicating the need for intensive care and blood purification therapy. However, there is no study on the clinical characteristics and prognosis of this symptom.MethodsThe clinical data of 363 patients with wasp sting admitted to Suining Central Hospital from January 2016 to December 2018 were retrospectively analyzed. At admission, the poisoning severity score (PSS) was used as the criterion for severity classification. According to the presence of macroscopic hematuria, the patients were divided into macroscopic hematuria and non-macroscopic hematuria group.ResultsOf the 363 wasp sting patients, 219 were male and 144 were female, with a mean age of 55.9 ± 16.3 years. Fifty-one (14%) had macroscopic hematuria, 39 (10.7%) had AKI, 105 (28.9%) had rhabdomyolysis, 61 (16.8%) had hemolysis, 45 (12.4%) went on to received hemodialysis, and 14 (3.9%) died. The incidence of AKI in macroscopic hematuria group was 70.6%, and oliguric renal failure accounted for 72.2%. Patients with macroscopic hematuria had significantly higher PSS (2.2 ± 0.5 vs. 1.1 ± 0.3, p < .001).ConclusionMacroscopic hematuria can be regarded as a surrogate marker of deteriorating clinical outcome following wasp stings. In wasp sting patients with symptoms of macroscopic hematuria or serum LDH higher than 463.5 u/L upon admission, the risk of AKI increases significantly, therefore hemodialysis should be considered. The PSS is helpful in early assessment of the severity of wasp sting patients. 相似文献
96.
PurposeThis study aimed to investigate the association between clinical factors and temporary changes in functional performance in patients undergoing hemodialysis.MethodsThis was a retrospective, longitudinal observational study conducted from 2015 to 2017. Eight-two patients undergoing hemodialysis in the outpatient clinic were enrolled. Functional performance was measured using the Karnofsky Performance Status (KPS) scale. Collected data for analysis included demographics, laboratory parameters, and KPS scale scores. All participants were grouped into a high KPS cluster and a low KPS cluster based on dynamic changes in KPS scales from 2015 to 2017.ResultsParticipants in the high KPS cluster demonstrated an approximate trend, and those in the low KPS cluster demonstrated a low pattern. By stepwise selection model analysis, age (OR 1.12, 95% CI 1.03–1.23, p = 0.011), serum BUN (OR 1.08, 95% CI 1.02–1.16, p = 0.015), calcium levels (OR 3.24, 95% CI 1.2–8.73, p = 0.02), and beta-2-microglobulin (OR > 1.0, CI >1.00-<1.01, p = 0.031) showed risk for the low KPS cluster. Male sex (OR 0.20, 95% CI 0.04–0.96, p = 0.045) and albumin level (OR 0.02, 95% CI 0–0.4, p = 0.009) showed a low risk for the low KPS cluster.ConclusionsA different trajectory pattern was observed between the high and low KPS clusters in a 3-year period. Risk factors for the low KPS cluster were age, serum BUN, calcium, and beta-2-microglobulin levels. Male sex and serum albumin levels reduced the risk for the low KPS cluster. 相似文献
97.
Julia M. Grottenthaler Annette Konzelmann Anette Stiegler Clemens Hinterleitner Sarah M. Bott Thomas Klag Christoph R. Werner Martina Hinterleitner Alfred Königsrainer Anil Batra Nisar P. Malek Silvio Nadalin Christoph P. Berg 《Transplant international》2021,34(11):2257-2265
Alcohol abuse after liver transplantation can seriously impact graft and patient survival. However, to date, there is no defined standard procedure to identify patients consuming alcohol after liver transplantation. The aim of this study was to analyze the diagnostic value and clinical impact of routinely measured urinary ethyl glucuronide (uEtG) – a metabolite of ethanol – in patients after liver transplantation. Data of 362 consecutive patients after liver transplantation who visited the University Hospital of Tuebingen for outpatient follow-up were analyzed. Forty-eight patients (13%) displayed positive uEtG results. The uEtG positive group contained significantly more patients with pretransplant alcoholic liver disease. However, two thirds of the uEtG positive patients had no history of pretransplant alcoholic liver disease. Several clinical parameters were significantly associated with positive uEtG. In order to enable a more cost-effective application of uEtG in the future, a clinical risk score was developed (specificity 0.95). In conclusion, routine testing for uEtG reveals a considerable percentage of patients practicing alcohol intake after liver transplantation. Application of our proposed risk score could help focusing uEtG testing on patients at risk. 相似文献
98.
Eva Schrezenmeier Lukas J. Lehner Marina Merkel Manuel Mayrdorfer Wiebke Duettmann Marcel G. Naik Felix Fröhlich Lutz Liefeldt Mareen Pigorsch Frank Friedersdorff Danilo Schmidt Matthias Niemann Nils Lachmann Klemens Budde Fabian Halleck 《Transplant international》2021,34(4):732-742
The number of patients returning to dialysis after graft failure increases. Surprisingly, little is known about the clinical and immunological outcomes of this cohort. We retrospectively analyzed 254 patients after kidney allograft loss between 1997 and 2017 and report clinical outcomes such as mortality, relisting, retransplantations, transplant nephrectomies, and immunization status. Of the 254 patients, 49% had died 5 years after graft loss, while 27% were relisted, 14% were on dialysis and not relisted, and only 11% were retransplanted 5 years after graft loss. In the complete observational period, 111/254 (43.7%) patients were relisted. Of these, 72.1% of patients were under 55 years of age at time of graft loss and only 13.5% of patients were ≥65 years. Age at graft loss was associated with relisting in a logistic regression analysis. In the complete observational period, 42 patients (16.5%) were retransplanted. Only 4 of those (9.5%) were ≥65 years at time of graft loss. Nephrectomy had no impact on survival, relisting, or development of dnDSA. Patients after allograft loss have a high overall mortality. Immunization contributes to long waiting times. Only a very limited number of patients are retransplanted especially when ≥65 years at time of graft loss. 相似文献
99.
《The Foot》2021
BackgroundSeveral outcome scores are used to assess the outcome of ankle surgery, but many are not validated and there is currently no ‘gold-standard’. Consequently, there is demand to develop a new ‘gold-standard’ score to assess ankle surgery. The study aim was to review existing scores to develop and validate a new patient-reported outcome measure (PROM) to assess the outcome of operative ankle surgery.MethodsThe questionnaire items covered three areas: pain, symptoms and activity. The scale was reviewed by a patient group, resulting in the Oswestry Ankle score (Os-Ankle). The Os-Ankle was validated using a cohort of 206 patients at both pre-operative and post-operative stages of ankle surgery. Patients provided two other outcome scores, the scores currently used at our centre: the Manchester-Oxford Foot Questionnaire (MOxFQ) and the Veterans Rand-12 (VR-12). Factor analysis and Rasch were determined to assess the psychometric testing and design of the Os-Ankle score. A follow up paper assesses the validity of the Os-Ankle against two existing scores.ResultsResults of the factor and Rasch analysis suggested that 12-items should be removed. The remaining 18-items fitted the Rasch model well, suggesting good internal consistency.ConclusionA new ankle PROM, the Os-Ankle, was successfully developed and demonstrated good psychometric testing. The Os-Ankle evaluates pain, symptoms and activities and results in a single score. The Os-Ankle has been validated in our follow up paper, and is ready to be implemented by ankle clinicians to monitor clinical outcomes. With the publication of two back to back papers, it will allow for further engage with other clinicians and other centres.Level of evidenceLevel II, prospective comparative study. 相似文献
100.
目的:研究三入路和传统前内侧技术确立股骨骨道的位置、长度和冠状面角度以及前交叉韧带重建的早期疗效。方法:2018年12月到2019年6月收集36例诊断为单纯前交叉韧带断裂而且接受手术的患者,患者均有明确膝关节扭伤史,共分为两组,其中16例采用三入路技术钻取股骨骨道重建前交叉韧带,其中男11例,女5例,平均年龄(30.13±6.54)岁,受伤时间7~60(30.19±15.78) d;20例采用传统前内侧入路技术钻取股骨骨道重建前交叉韧带,其中男15例,女5例,平均年龄(30.80±8.60)岁,受伤时间7~60(27.35±15.50) d。通过CT三维重建技术评估钻取的股骨骨道,采用膝关节Lysholm评分评估患者膝关节功能。结果:所有患者手术切口术后都达到Ⅰ期愈合,术中均未出现股骨骨道破裂,血管神经损伤、移植物通过困难及静脉血栓等情况。36例患者获得门诊随访,随访时间9~15(12.00±2.83)个月。采用CT三维重建评估两组患者股骨骨道,股骨骨道位置运用四分法描述为,三入路组:股骨外髁的下(27.83±1.97)%,后(25.57±3.20)%;传统入路组:股骨外髁的下(28.38±3.21)%,后(26.23±3.20)%。骨道长度,三入路组:全长(35.20±5.52) mm,粗骨道长(23.20±2.07) mm;传统入路组:全长(34.60±4.26) mm,粗骨道长(22.56±2.50) mm。冠状面角度,三入路组(47.93±5.98)°;传统入路组(41.78±6.62)°。膝关节Lysholm评分,三入路组:术前57.81±6.23;末次随访97.00±2.48;传统入路组:术前57.15±8.76,末次随访97.30±2.68,手术前后差异有统计学意义,组间差异无统计学意义。结论:两种方式所钻取的股骨骨道的位置均在前交叉韧带的解剖止点范围内,三入路法钻取的股骨骨道相对传统前内侧入路法来说冠状面角度较大,形成的骨道长度、两种手术方式的术后早期疗效、手术时间均无差异,但是三入路法的手术视野更宽阔清晰,而且对于术中钻取股骨骨道时需要的屈膝角度要明显小于传统入路技术,降低了手术的难度。 相似文献