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@#BACKGROUND: Hyperkalemia is common among patients in emergency department and is associated with mortality. While, there is a lack of good evaluation and prediction methods for the efficacy of potassium-lowering treatment, making the drug dosage adjustment quite difficult. We aimed to develop a predictive model to provide early forecasting of treating effects for hyperkalemia patients. METHODS: Around 80% of hyperkalemia patients (n=818) were randomly selected as the training dataset and the remaining 20% (n=196) as the validating dataset. According to the serum potassium (K+) levels after the first round of potassium-lowering treatment, patients were classified into the effective and ineffective groups. Multivariate logistic regression analyses were performed to develop a prediction model. The receiver operating characteristic (ROC) curve and calibration curve analysis were used for model validation. RESULTS: In the training dataset, 429 patients had favorable effects after treatment (effective group), and 389 had poor therapeutic outcomes (ineffective group). Patients in the ineffective group had a higher percentage of renal disease (P=0.007), peripheral edema (P<0.001), oliguria (P=0.001), or higher initial serum K+ level (P<0.001). The percentage of insulin usage was higher in the effective group than in the ineffective group (P=0.005). After multivariate logistic regression analysis, we found age, peripheral edema, oliguria, history of kidney transplantation, end-stage renal disease, insulin, and initial serum K+ were all independently associated with favorable treatment effects. CONCLUSION: The predictive model could provide early forecasting of therapeutic outcomes for hyperkalemia patients after drug treatment, which could help clinicians to identify hyperkalemia patients with high risk and adjust the dosage of medication for potassium-lowering.
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Pressure ulcers have been associated with an extended length of hospitalization, sepsis and mortality. Over the last few decades, little has been written about the impact of pressure ulcers on therapeutic outcomes in inpatient physiotherapy services. It is obvious that critically ill patients, who are sedated, ventilated, patients with chronic neurological, musculoskeletal and cardio-respiratory disorders who are bed ridden for prolonged period of time are particularly at risk of developing skin breakdown. This will help in identifying barriers to patient participation and develop strategies to pressure ulcer prevention. We wanted to determine the impact of pressure ulcers on therapeutic outcomes in inpatient physiotherapy services. MethodsThe study was conducted from June 2015 to January 2016. The impact of pressure ulcer on inpatient physiotherapy services was determined by detailed physical assessment, evaluation with Functional Independence Measure score (FIM) and Braden Q Scale. A total 96 subjects were assessed during this time. ResultsThere was statistically significant impact of pressure ulcers on therapeutic outcomes in inpatient physiotherapy services. The FIM takes into consideration self-care, sphincter control, transfers, locomotion, communication social cognition. A poor score denotes poor outcome at discharge. Tissue level assessment was carried out by using Braden Q Scale, a poor score of which again denotes very poor outcome in mobility, activity, sensory perception, moisture, friction – shear, nutrition, tissue perfusion and oxygenation. ConclusionsPressure ulcer is one of the preventable problems; but in majority of cases it becomes the main reason for poor therapeutic outcome.
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Objectives To evaluate the clinical efficacy and safety of hypofractionated radiotherapy for cancer patients with hepatic metastases. Methods From May 2007 to November 2016,45 patients ( male:female=20:25) with inoperable hepatic metastases were enrolled in this investigation. The median age was 58 years old ( range:25-83).The median Karnofsky performance score ( KPS) was 80.Primary colorectal cancer was detected in 14 patients,primary breast cancer in 9 and primary lung cancer in 6 cases. Twenty-one patients had extrahepatic metastases. A total of 52 lesions were treated. Thirty-four cases received radiotherapy for one single lesion. The fractional dose was 45 Gy/3 fractions and 60 Gy/10-15 fractions. The median gross tumor volume (GTV) was 10. 1 cm3(0. 3-175. 2 cm3) and 29. 8 cm3(5. 0-209. 6 cm3) for planning target volume ( PTV).Seventeen CT images were fused with MRI and IMRT was adopted in 43 cases. The median dose of PTV was 60 Gy (40-60 Gy) and 90 Gy (60-132 Gy) for bioequivalent dose (BED). Results The median follow-up time was 23. 5 months and the median survival time was 26. 0 months (95%CI:21.4-30.6 months).The 1-year local control (LC),disease-free survival (DFS) and overall survival ( OS ) were 94%, 27% and 91%, respectively. Six cases died of liver metastases and abnormal liver function. Conclusion Hypofractionated radiotherapy is an efficacious and safe local treatment for inoperable hepatic metastases.
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Objective To evaluate the clinical efficacy and safety of CT-guided 125 I seed implantation in the treatment of recurrent head and neck tumors after radiotherapy. Methods Clinical data of 101 patients who received CT-guided radioactive 125 I seed implantation for recurrent head and neck cancer after radiotherapy from 2007 to 2015 were retrospectively analyzed. The median accumulated dose of external radiotherapy was 66 Gy and the median dose after seed implantation (D90) was 117 Gy. The local progression-free survival and overall survival were analyzed by Kaplan-Meier method. Univariate analysis was performed by log-rank test and multivariate analysis was conducted by using Cox regression model. Results The median follow-up time was 12. 2 months. The 5-year local progression-free survival rate was 26. 6％.The 5-year overall survival rate was 15. 5％. Univariate analysis demonstrated that age,pathological type,implantation site,lesion volume,D90 and short-term efficacy were correlated with local control,and KPS score,lesion volume ,D90,and short-term efficacy were associated with survival (all P<0. 05). Multivariate analysis revealed that pathological type,lesion volume ,D90 and short-term efficacy were independent factors related to local control (P= 0. 000, 0. 002,0. 003 and 0. 014).In terms of the adverse events,skin/ mucosal ulceration was observed in 25. 7％ and pain occurred in 13. 9％ of all patients. No correlation was noted between the adverse events and dose.Conclusions CT-guided radioactive 125 I seed implantation is an efficacious and safe treatment of recurrent head and neck tumors after radiotherapy. Non-squamous carcinoma,small lesion volume and high dose (D90) indicate excellent local control.
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Objective To observe the objective response rate, survival and safety of radiotherapy combined with Iressa for patients with locally advanced non-small cell lung cancer ( NSCLC) unsuitable for surgery or concurrent chemoradiotherapy. Methods The patients with locally advanced NSCLC unsuitable for surgery or concurrent chemoradiotherapy were recruited and received thoracic intensity-modulated radiotherapy ( IMRT) combined with Iressa 250 mg daily. Results A total of 30 patients were enrolled between July 2014 and March 2017. Twenty-nine patients were analyzed. At 1 month after radiotherapy,the complete response (CR) was 0,partial response (PR) was 21(72％),stable disease (SD) was 6(21％), progressive disease (PD) was 2(7％),the disease control rate (CR+PR+SD) was 93％,and the objective response rate was 72％. The median follow-up time was 25 months. Fourteen ( 48％) patients died,and 15 (52％) survived. Twenty-three (79％) patients obtained PD including local progression in 18(62％) and distant metastasis in 14(48％). The median survival time (MST) was 26 months and the median PFS was 11 months. The 1-year OS and PFS were 79％ and 44％,and the 2-year OS and PFS were 55％ and 18％. Univariate analysis demonstrated that smoking history and disease stage were influencing factors for OS ( P=0. 035,0. 031) . Moreover, disease stage, the primary tumor diameter, the volume of GTV and PTV were influencing factors for PFS (P=0. 000,0. 016,0. 039,0. 030). Multivariable analysis revealed that disease stage and the volume of PTV were independent prognostic factors for PFS (P=0. 000,0. 012).Two patients ( 7％) developed grade 3 acute adverse events and 7 ( 24％) experienced grade 2 acute irradiation pneumonitis. Conclusions For patients with locally advanced NSCLC unsuitable for surgery or concurrent chemoradiotherapy,IMRT combined with Iressa yields high objective response rate and well tolerance. The long-term clinical efficacy remains to be validated.
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Objective To explore the effect of Shexiang baoxin Pillls on super‐elder patients with myocardial infarction ,and observe and analyze its prognosis .Methods Two hundred super‐elder patients with myocardial infarction were selected in the hos‐pital from December 2013 to November 2014 ,they were randomly divided into control group(n=100) and observation group(n=100) .The control group used conventional drug treatment ,and the observation group treated with Shexiang baoxin pillls on the ba‐sis of the control group .Three months wasr a treatment period .To observe the clinical therapeutic effect ,echocardiography was used to detected the left ventricular wall thickness ,left ventricular end‐diastolic diameter (LVEDD) ,left ventricular ejection fraction (LVEF) before and after treatment .Observed 6 minutes walking distance .Total cholesterol (TC) ,blood lipid ,low density lipopro‐tein (LDL‐C) ,c‐reactive protein (CRP) ,and other indicators were detected .Results The total effective rate of the observation group was [72 .00% (72/100)] was higher than the control group [65 .00% (65/100)] ,P<0 .05 .The re‐hospitalization rate of the observation group was [23 .00% (23/100)] was lower than the control group [34 .00% (34/100)] ,P<0 .05 .The left ventricular posterior wall thickness and LVEDD of the observation group after treatment were(10 .12 ± 0 .40)mm and(49 .11 ± 1 .39)mm , which were lower than the control group after treatment [(11 .06 ± 0 .52)mm and (51 .36 ± 1 .46)mm] ,LVEF (% ) of the observa‐tion group after treatment was (0 .51 ± 0 .12)% ,which was higher than the control group after treatment (0 .47 ± 0 .11)% ,all P<0 .05 .TC ;LDL‐C and CRP of the observation group after treatment were (5 .19 ± 0 .32) mmol/L ,(2 .83 ± 0 .30) mmol/L and (54 . 11 ± 4 .83) mg/L ,they were lower than the control group after treatment [(5 .48 ± 0 .37) mmol/L ,(3 .10 ± 0 .33) mmol/L and (62 . 38 ± 4 .36) mg/L] ,all P<0 .05 .6 min walking distance of the observation group after treatment was (376 .38 ± 19 .41)m ,it was higher than the control group after treatment(331 .04 ± 22 .18)m ,P<0 .05 .The complications of the observing group[38 .00% (38/100)] was lower than the control group after treatment 47 .00% (47/100) ,P<0 .05 .Conclusion There is better clinical effect on super‐elder patients with myocardial infarction by Shexiang baoxin Pillls ,which can reduce hospitalization rates again ,improve left heart function and blood lipid levels ,reduce complications .
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ObjectiveTo evaluate the therapeutic efficiency and outcomes of vertical condensation of warm gutta-percha obturation using the four-handed technique.MethodsA split-tooth model constructed with lateral grooves and depressions was used to compare vertical condensation of warm gutta-percha obturation with and without the four-handed technique.Respectively 10 times of obturation were done in the four-handed group and the independent operation group.The operation time and defect replication quality were recorded.Evaluation of defect replication quality was on an ordinal scale 0 to 2 grade based on how much each defect was replicated.The results were statistically analyzed.ResultsThere were signiticant differences in treatment time between the four-handed group and theindependent operation group,as well as in treatment outcomes between two groups.ConclusionsUse of the four-handed technique can improve therapeutic efficiency and outcomes of vertical condensation of warm gutta-percha obturation.
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A pesquisa teve como objetivo geral verificar a relação entre desfecho terapêutico e momentos transferenciais que tenham ocorrido ao longo dos processos de psicoterapia breve analisados. Para embasar teoricamente o conceito de transferência, foram utilizados textos de Sigmund Freud e Melanie Klein. Trata-se de uma pesquisa exploratória e documental de caráter qualitativo. Analisaram-se 17 prontuários de pacientes, entre 20 e 40 anos, que foram atendidos em um serviço-escola de 2002 até 2006. Foi realizado o processo de análise temática que precedeu a categorização. Com base na leitura de 262 sessões de psicoterapia, selecionaram-se momentos transferenciais relevantes de cada caso analisado e criaram-se categorias de transferências. O manejo da transferência realizado pelos estagiários parece ter tido relação direta com o desfecho terapêutico dos atendimentos. Em 13 dos 17 prontuários, mesmo tendo havido obtenção do foco proposto, os pacientes foram encaminhados para processos de psicoterapia longa.
This research aims to verify if there is relationship between the therapeutic outcome and the transference moments that have occurred over the processes of psychotherapy shortly analyzed. To a theoretically support of foundation of the concept of transfer, were used texts of Sigmund Freud and Melanie Klein. This is an exploratory research and a documentary qualitative in nature. Were analyzed records of 17 patients who were treated in a clinic-school in 2002 until 2006, individuals between 20 and 40 years. Was realized the review process thematic what preceding the classification. From the reading of 262 sessions of psychotherapy, were selected the most important moments of transference of each case analyzed and then, created categories of transfer. The handling of the transfer, done by trainees, seems to have had direct relationship with the therapeutic outcome of the cases examined. In 13 of 17 cases, patients were sent for the long psychotherapy process, even with successful treatment.
La investigación busca verificar la relación entre el resultado terapéutico y los momentos transferenciales que hayan sucedido a lo largo de los procesos de psicoterapia breve analizados. Para fundamentar teóricamente el concepto de transferencia, se utilizaron textos de Sigmund Freud y Melanie Klein. Se trata de una investigación exploratoria y documental de carácter cualitativo. Se analizaron 17 historias clínicas de pacientes entre 20 y 40 años, atendidos en una clínica-escuela desde el año 2002 al 2006. Fue realizado el proceso de análisis temático que precedió a la categorización. A partir de la lectura de 262 sesiones de psicoterapia, se seleccionaron momentos transferenciales relevantes de cada caso analizado y se crearon tipos de transferencia. El manejo de transferencias realizado por el personal en prácticas, parece haber tenido relación directa con el resultado terapéutico de los casos analizados y, en 13 de los 17 casos, incluso con la obtención del objetivo propuesto, los pacientes fueron encaminados hacia procesos de psicoterapia larga.
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Humans , Adult , Psychotherapeutic Processes , Psychotherapy, Brief , Transference, Psychology , Medical RecordsABSTRACT
BACKGROUND: Langerhans' cell histiocytosis is a proliferative histiocytic disorder of unknown cause formerly referred to histiocytosis X, with pathologic characteristics of abnormal proliferation of histiocytes which belong to the mononuclear phagocytes. The clinical manifestations range in severity from solitary lytic bone lesions to fatal multisystem disease, typically with indolent clinical courses. The authors reported here, the clinical features and therapeutic outcomes of Langerhans' cell histiocytosis according to stage and prognostic features. METHODS: We reviewed the medical records of 38 cases with Langerhans' cell histiocytosis confirmed by biopsy from March 1983 to March 1998 in Severance hospital for disease course, treatment, and late sequelae. RESULTS: 1) Median age of the patients was 3 years-old, and the male to female ratio was 2.2:1. 2) Fifteen cases were less than 2 years of age, 21 had soft tissue involvements, 10 had more than 4 organ involvement, and 8 had involved organ dysfunction. 3) As for the clinical stages, 19 cases were in stage I, 9 in stage II, 4 in stage III, and 6 in stage IV. As for the pathologic stages, 15 had monostic disease, 2 had polyostic disease, and 21 had multisytemic disease. 4) The incidence of more than 4 organ involvement in cases or = 2 years [53.3% (8/15) vs 8.7% (2/23), P=0.004], and the incidence of organ dysfunction in cases or = 2 years [33.3% (5/15) vs 3% (3/23)], indicating that cases or = 15 years. There was a significant correlation between the presence of more than 4 organ involvement and organ dysfunction (P=0.041). 5) The response rate of all cases was 71% (27 cases), and the response rate of 25 cases who received chemotherapy was 60% (15 cases). There was no difference in the response rate according to the type of chemotherapy. Overall survival rate was 63.4% at 50 months, disease-free survival rate was 56.7% at 24 months. The disease free survival rate was significantly lower in cases younger than 2 years of age than cases older than 2 years of age (P=0.047), in cases with 4 or more organs involvement than 3 or less (P=0.0002), in cases with evidence of organ dysfunction than without evidence of organ dysfunction (P=0.082), and in cases with soft tissue involvement than with only bone involvement (P=0.043). There was significant differences in disease free survival rate according to clinical stage (P=0.001). The overall survival and disease free survival rate of the cases older than 15 years of age were similar to those of the cases younger than 15 years of age were similar to those of the cases younger than 15 years of age. 6) Five cases died during follow-up periods, organ involvement, and organ dysfunction were found to be important prognostic factors, and cases with lesions limited to skeletal system showed more than 90% of survival rate. In the future, clinical investigation enrolled with more cases about the difference of clinical features and therapeutic outcomes between adult patients and pediatric patients should be warranted.
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Adult , Child, Preschool , Female , Humans , Male , Biopsy , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Histiocytes , Histiocytosis , Histiocytosis, Langerhans-Cell , Incidence , Medical Records , Phagocytes , Survival RateABSTRACT
OBJECTIVE: To compare the effects of early and late treatment and to evaluate the contributing factors for the therapeutic outcome in cerebral palsy children. METHOD: Three hundred twenty four children with delayed development including cerebral palsy who were admitted to the Department of Rehabilitation at Yonsei University Medical Center from January 1992 to December 1995 were studied. They were divided into two groups according to the initiation of treatment: early and late treatment groups. Early treatment was defined as treatment started at or before 6 months and the late treatment was after 6 months. They were also divided into groups according to the diagnosis, responsiveness to treatment and initial motor quotient. And then the motor developments during the follow-up period between each groups were compared as the effects of treatment. RESULTS: The development of the motor milestone was faster in the early treatment group than in the late treatment group. The group which initially showed a higher motor quotient had a higher response rate to the treatment and a faster development of the motor milestone than the group with a lower motor quotient. CONCLUSION: These results suggest that the initiation of treatment and the severity of delayed development are important contributing factors for an outcome of treatment.
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Child , Humans , Academic Medical Centers , Cerebral Palsy , Diagnosis , Follow-Up Studies , RehabilitationABSTRACT
PURPOSE: The prognosis of non-Hodgkins lymphoma (NHL) in elderly patients seems to be poorer than that in patients aged less than 60 years. This may be due to the lower tolerance for combination chemotherapy in the elderly. Aggressive combination chemo-therapy, which is the treatment of choice in intermediate and high grade NHL of adulthood, may be associated with unpredictab1y severe and lethal toxicity and worsened quality of life in the elderly. We investigated the treatment responses, toxicities and prognostic factors of NHL in elderly patients treated with combination chemotherapy. MATERIALS AND METHODS: We treated 116 elderly (>60 yrs) patients with NHL between January 1986 and June 1996 with adriamycin-containing regimens, such as CHOP (cyclo- phosphamide, adriamycin, vincristine, prednisolone), BACOP (bleomycin, adriamycin, cyclophosphamide, vincristine, prednisolone), and mBACOP (methotrexate, bleomycin, adriamycin, cyclophosphamide, vincristine, prednisolone). Patients in this study ranged from 60 to 81 (median 67) years of age. Fifty-five percent of patients were in stage I or II and the rest (45%) were in stage III or IV. The histologic grade was predominantly (91%) of intermediate and high grade type. RESULTS: The treatment responses were complete (CR) in 55% and partial (PR) in 25%. The median durstion of CR was 32 (3-132) months. The CR rate was significantly higher in patients treated with RDI (relative dose intensity) > 75% than that in the patients treated with RDI 75% vs 75%). CONCLUSION: Our data suggests that achievement of the CR after combination chemotherpy is the most important prognostic factor in the elderly patients with NHL. Suboptimal chemotherapy (RDI<75%) reduced the complete remission rate without reducing the likelihood of developing severe toxicities. Optimal chemotherapy with supportive cares involving the use of hematopoietic growth factors may be needed to improve the treatment response and the survival in the elderly patients with aggressive NHL.