RESUMO
OBJECTIVES: The aim of the study was to assess neurodevelopmental outcomes among children with biliary atresia (BA) surviving with their native liver at ages 3 to 12 years and evaluate variables that associate with neurodevelopment. METHODS: Participants (ages 3-12 years) in a prospective, longitudinal, multicenter study underwent neurodevelopmental testing with Weschler Preschool and Primary Scale of Intelligence, 3rd edition (WPPSI-III, ages 3-5 years) and Weschler Intelligence Scale for Children, 4th edition (WISC-IV, ages 6-12 years). Continuous scores were analyzed using Kolmogorov-Smironov tests compared with a normal distribution (meanâ=â100â±â15). Effect of covariates on Full-Scale Intelligence Quotient (FSIQ) was analyzed using linear regression. RESULTS: Ninety-three participants completed 164 WPPSI-III (mean age 3.9) and 51 WISC-IV (mean age 6.9) tests. WPPSI-III FSIQ (104â±â14, Pâ<â0.02), Verbal IQ (106â±â14, Pâ<â0.001), and General Language Composite (107â±â16, Pâ<â0.001) distributions were shifted higher compared with test norms. WISC-IV FSIQ (105â±â12, Pâ<â0.01), Perceptual Reasoning Index (107â±â12, Pâ<â0.01), and Processing Speed Index (105â±â10, Pâ<â0.02) also shifted upwards. In univariate and multivariable analysis, parent education (Pâ<â0.01) was a significant predictor of FSIQ on WPPSI-III and positively associated with WISC-IV FSIQ. Male sex and higher total bilirubin and gamma glutamyl transferase (GGT) predicted lower WPPSI-III FSIQ. Portal hypertension was predictive of lower WISC-IV FSIQ. CONCLUSIONS: This cohort of children with BA and native liver did not demonstrate higher prevalence of neurodevelopmental delays. Markers of advanced liver disease (higher total bilirubin and GGT for age ≤5 years; portal hypertension for age ≥6) correlate with lower FSIQ and may identify a vulnerable subset of patients who would benefit from intervention.
Assuntos
Atresia Biliar/psicologia , Transtornos do Neurodesenvolvimento/epidemiologia , Atresia Biliar/sangue , Atresia Biliar/patologia , Bilirrubina/sangue , Criança , Desenvolvimento Infantil , Pré-Escolar , Escolaridade , Feminino , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/psicologia , Fígado/patologia , Estudos Longitudinais , Masculino , Transtornos do Neurodesenvolvimento/etiologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Escalas de Wechsler , gama-Glutamiltransferase/sangueRESUMO
BACKGROUND: Abnormal chronic kidney disease-mineral and bone disorder (CKD-MBD) markers have been associated with adverse outcomes in hemodialysis (HD) patients. Dialysate calcium concentration (D-Ca) likely influences serum calcium and phosphorus levels. Optimal D-Ca level remains unclear. We hypothesized that higher D-Ca is associated with cardiovascular events and mortality among Japanese HD patients. METHODS: Enrollment data of chronic HD patients in the prospective observational study JDOPPS, phases 1-5 (1999-2015), provided exposures and covariates. All-cause mortality, non-arrhythmic cardiovascular events (NonAR-CVE), or their composites were analyzed by D-Ca, and divided into 2.5, 2.75, and 3.0 mEq/L. To minimize confounding by indication, analyses were restricted to facilities in which at least 90% of patients received the same D-Ca prescription. Association of D-Ca level with outcomes was evaluated in Cox models stratified by phase and accounting for facility clustering. Covariates describing patient demographics, comorbidities, laboratory values, CKD-MBD therapy, and facility attributes provided adjustment. RESULTS: Of 9,201 patients included, 25.0% had D-Ca of 2.5 mEq/L; 6.8% D-Ca 2.75; and 68.2% D-Ca 3.0. Median follow-up time was 2.03 years. D-Ca was not associated with all-cause mortality, with hazards ratios for 2.5 vs. 3.0 mEq/L of 0.90 and 95% CI (0.73-1.11), nor with other outcomes. One effect modification occurred, protective for lower D-Ca on NonAR-CVE in the absence of cardiovascular comorbidities (p = 0.032), although corresponding D-Ca effects were not significant after multiple comparisons adjustment (p = 0.261 [D-Ca 2.5] and 0.125 [D-Ca 2.75]). CONCLUSION: Lowering D-Ca level below 3.0 mEq/L seems not to have a meaningful effect on patient outcomes.
Assuntos
Cálcio/análise , Distúrbio Mineral e Ósseo na Doença Renal Crônica/metabolismo , Diálise Renal , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Distúrbio Mineral e Ósseo na Doença Renal Crônica/tratamento farmacológico , Distúrbio Mineral e Ósseo na Doença Renal Crônica/mortalidade , Feminino , Humanos , Japão/epidemiologia , Pessoa de Meia-Idade , Padrões de Prática Médica , Estudos Prospectivos , Diálise Renal/mortalidade , Resultado do TratamentoRESUMO
Femoroacetabular impingement (FAI) is a condition in which subtle deformities of the femoral head and acetabulum (hip socket) result in pathological abutment during hip motion. FAI is a common cause of hip pain and can lead to acetabular cartilage damage and osteoarthritis. For some patients with FAI, surgical intervention is indicated, and it can improve quality of life and potentially delay the onset of osteoarthritis. For other patients, however, surgery is contraindicated because significant cartilage damage has already occurred. Unfortunately, current imaging modalities (X-rays and conventional MRI) are subjective and lack the sensitivity to distinguish these two groups reliably. In this paper, we describe the pairing of T2* mapping data (an investigational, objective MRI sequence) and a spatial proportional odds model for surgically obtained ordinal outcomes (Beck's scale of cartilage damage). Each hip in the study is assigned its own spatial dependence parameter, and a Dirichlet process prior distribution permits clustering of said parameters. Using the fitted model, we produce a six-color, patient-specific predictive map of the entire acetabular cartilage. Such maps will facilitate patient education and clinical decision making. Copyright © 2017 John Wiley & Sons, Ltd.