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1.
Am Surg ; 86(2): 116-120, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167042

RESUMEN

Unplanned readmission is often used as a surgical quality metric. A subset of kidney transplant recipients undergos multiple readmissions (MRs), although the incidence and risk factors are not well described. The aim of this study was to evaluate risk factors for MR after deceased donor kidney transplantation. All patients undergoing deceased donor kidney transplantation at a single center over a three-year period were analyzed via retrospective chart review for factors associated with MR. P values <0.05 were considered significant. Of 141 patients, the 30-day readmission rate was 26.2 per cent. MR occurred in 43 (30.5%) patients. Age, race, gender, initial organ function, and dialysis vintage were not associated with MR. Diabetic recipients, those who received basiliximab induction, those with acute rejection, and those with unplanned reoperations were at increased risk for MR. Infection was the most common reason for initial readmission in patients with MR (23.3%). One-year patient survival and death-censored graft survival were reduced for patients with MR. MRs are required for 30 per cent of kidney transplant recipients, primarily because of infection and immunologic causes. Recipients with diabetes and those who have acute rejection are at greatest risk.


Asunto(s)
Trasplante de Riñón/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Basiliximab/efectos adversos , Diabetes Mellitus/epidemiología , Femenino , Rechazo de Injerto/epidemiología , Supervivencia de Injerto , Humanos , Inmunosupresores/efectos adversos , Incidencia , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Análisis de Regresión , Reoperación/efectos adversos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo
2.
Am Surg ; 86(2): 127-133, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167055

RESUMEN

Adrenal neuroblastoma (NB) is a relatively common malignancy in children. The Surveillance, Epidemiology, and End Results database was used to present demographic data and a survival analysis with the aim of making tumor management better. The Surveillance, Epidemiology, and End Results database was used to search pediatric patients (age ≤16 years) with NB from 2004 to 2013. The Kaplan-Meier method was used to calculate the overall survival. And, we used Cox regression analysis to determine hazard ratios for prognostic variables. Independent prognostic factors were selected into the nomogram to predict individual's three-, five-, and seven-year overall survival. The study included a total of 1870 pediatric patients with NB in our cohort. Overall, three-, five-, and seven-year survival rates for adrenal NB were 0.777, 0.701, and 0.665, respectively, whereas the rates for nonadrenal NB were 0.891, 0.859, and 0.832, respectively. The multivariate analysis identified age >1 year, no complete resection (CR)/CR, radiation, and regional/distant metastasis as independent predictors of mortality for adrenal NB. Concordance index of the nomogram was 0.665 (95% confidence interval, 0.627-0.703). Pediatric patients with adrenal NB have significantly worse survival than those with nonadrenal NB. Adrenal NB with age <1 year, treated with surgery, no radiation, and localized tumor leads to a better survival. There was no survival difference for patients to receive CR and no CR.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales/mortalidad , Neuroblastoma/mortalidad , Adolescente , Neoplasias de las Glándulas Suprarrenales/patología , Neoplasias de las Glándulas Suprarrenales/cirugía , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Estimación de Kaplan-Meier , Masculino , Neuroblastoma/patología , Neuroblastoma/cirugía , Nomogramas , Pronóstico , Análisis de Regresión , Programa de VERF/estadística & datos numéricos , Análisis de Supervivencia , Tasa de Supervivencia , Factores de Tiempo
3.
Medicine (Baltimore) ; 99(11): e19492, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176089

RESUMEN

Despite many studies, the molecular mechanisms of hepatocellular carcinoma (HCC) development remain unclear. Thyroid hormone (TH) levels may vary in many chronic diseases including cirrhosis. The aim of this study was to evaluate TH status in patients with cirrhosis and HCC and to investigate the relationship between THs and HCC development.Five hundred seventy-seven patients with cirrhosis who applied to Demiroglu Bilim University, Faculty of Medicine, Gastroenterology Department between 2004 and 2019 were included the study. Three hundred sixty-seven patients who applied to Internal Medicine Unit for general health check-up were included in the study as healthy control group. Demographic, laboratory, and imaging findings of study groups were retrospectively reviewed and recorded from hospital information system.In the cirrhosis group, 252 patients had HCC (43.67%), and 325 patients had non-HCC cirrhosis (56.33%). Free thyroxine (FT4) levels were higher in the control group than in the cirrhotic group but there was no significant difference (P = .501). Thyroid-stimulating hormone (TSH) and FT4 levels were similar between groups, while free triiodothyronine (FT3) levels were significantly different between HCC group, non-HCC cirrhosis group, and control group (P = .299 for TSH, P = .263 for FT4, P < .001 for FT3). FT3 levels were significantly higher in HCC group than non-HCC cirrhosis group, but significantly lower than control group (P < .05).Our study confirmed the presence of hypothyroidism in cirrhosis patients and clearly demonstrated a strong relationship between FT3 levels and HCC development.


Asunto(s)
Carcinoma Hepatocelular/complicaciones , Hipotiroidismo/complicaciones , Cirrosis Hepática , Neoplasias Hepáticas/complicaciones , Hormonas Tiroideas/sangre , Adulto , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Carcinoma Hepatocelular/sangre , Estudios de Casos y Controles , Progresión de la Enfermedad , Femenino , Humanos , Hipotiroidismo/sangre , Neoplasias Hepáticas/sangre , Masculino , Persona de Mediana Edad , Análisis de Regresión , Pruebas de Función de la Tiroides
4.
Artículo en Español | PAHO-IRIS | ID: phr-51930

RESUMEN

[RESUMEN]. Objetivo. Determinar las asociaciones existentes entre las características sociodemográficas y la prevalencia del consumo actual de tabaco en Costa Rica, según los resultados de la Encuesta Global de Tabaquismo en Adultos (GATS). Métodos. Estudio epidemiológico, observacional de tipo transversal con representación nacional (n = 8607), que utilizó las variables sociodemográficas incluidas en la GATS realizada durante 2015. Se diseñó un modelo de regresión logística para predecir la influencia de esas variables en el consumo actual de tabaco. La variable dependiente es el consumo actual de tabaco considerando los determinantes sociales disponibles en la encuesta: género, nivel educativo, zona de residencia, edad y la composición del hogar. Resultados. El modelo de regresión logística demuestra que ser mujer (OR = 0,29; P < 0,01), tener 65 años y más (OR = 0,61; P = 0,02), vivir en zona rural (OR = 0,63; P < 0,01) y vivir con otras personas (OR = 0,68; P < 0,01), en particular con niños de 15 años o menos (OR = 0,55; P < 0,01), son factores protectores del consumo de tabaco. El consumo de tabaco disminuye de forma significativa con el aumento de la riqueza medida por los artefactos en la casa en las mujeres, pero no en los hombres. Completar la educación secundaria es un factor protector en las personas de 15-34 años (OR = 0,47; P < 0,01), aunque no en las personas de 35 años y más. Conclusiones. Existe una asociación entre las variables sociodemográficas disponibles en la encuesta GATS Costa Rica realizada en el 2015 y el consumo actual de tabaco. Intervenciones a nivel familiar y comunal podrían contribuir a que los consumidores abandonen el tabaquismo.


[ABSTRACT]. Objective. To determine the associations between sociodemographic characteristics and the current prevalence of tobacco use in Costa Rica, based on the results of the Global Adult Tobacco Survey (GATS). Methods. Cross-sectional observational epidemiological study, country-wide (n = 8607), that used the sociodemographic variables included in GATS 2015. A logistic regression model was designed to predict the impact of those variables on current tobacco use. The dependent variable is current tobacco use, considering the social determinants available in the survey: sex, educational level, area of residence, age, and household composition. Results. The logistic regression model shows that being female (OR = 0.29; P < 0.01), being 65 years old and over (OR = 0.61; P = 0.02), living in a rural area (OR = 0.63; P < 0.01), and living with other people (OR = 0.68; P < 0.01), in particular with children 15 years old or under (OR = 0.55; P < 0.01), are protective factors against tobacco use. Tobacco use declines significantly with increased wealth, as measured by household items, in women but not in men. Completing secondary education is a protective factor in people 15-34 years old (OR = 0.47; P < 0.01) but not in people 35 and over. Conclusions. There is an association between the sociodemographic variables found in the GATS Costa Rica survey carried out in 2015 and current tobacco use. Interventions at the family and community levels could help consumers give up smoking.


[RESUMO]. Objetivo. Determinar as associações existentes entre as características sociodemográficas e a prevalência do consumo presente de tabaco na Costa Rica, segundo os resultados da Pesquisa Global sobre Tabagismo em Adultos (Global Adult Tobacco Survey – GATS). Métodos. Trata-se de um estudo epidemiológico observacional transversal com representatividade nacional (n = 8.607) com o uso das variáveis sociodemográficas estudadas na GATS realizada em 2015. Usou-se um modelo de regressão logística para predizer a influência das variáveis estudadas no consumo presente de tabaco. A variável dependente foi o consumo presente de tabaco levando em consideração os determinantes sociais disponíveis na pesquisa: gênero, nível de escolaridade, área de residência, idade e composição do domicílio. Resultados. Observou-se, no modelo de regressão logística, que ser do sexo feminino (OR 0,29; P < 0,01), ter 65 anos ou mais (OR 0,61; P = 0,02), residir na zona rural (OR 0,63; P < 0,01) e viver em um domicílio com outras pessoas (OR 0,68; P < 0,01), sobretudo com crianças menores de 15 anos (OR 0,55; P < 0,01), são fatores de proteção contra o consumo de tabaco. O consumo de tabaco diminui de forma significativa com o aumento da renda (medida de acordo com o número de serviços e utilidades domésticas) apenas entre as mulheres. Ter o ensino médio completo é um fator de proteção na faixa etária entre 15 e 34 anos (OR 0,47; P < 0,01), mas não entre as pessoas acima de 35 anos. Conclusões. Existe uma associação entre as variáveis sociodemográficas estudadas na GATS de 2015 e o consumo presente de tabaco na Costa Rica. Intervenções realizadas ao nível da família e da comunidade poderiam contribuir para a cessação do tabagismo.


Asunto(s)
Uso de Tabaco , Adulto , Factores Epidemiológicos , Análisis de Regresión , Costa Rica , Uso de Tabaco , Factores Epidemiológicos , Análisis de Regresión , Factores Epidemiológicos , Análisis de Regresión
5.
Braz Oral Res ; 34: e009, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32049110

RESUMEN

The sense of coherence (SOC) is a measure of global orientation regarding the ability of individuals to cope with stressful situations. The aim of the present study was to evaluate the association between SOC and quality of life (QoL) and clinical and sociodemographic characteristics among survivors of oral, oropharynx, hypopharynx, or larynx cancer. A cross-sectional study was conducted with 90 cancer patients in follow up at the Santa Maria University Hospital in southern Brazil who had completed conformal 3D radiotherapy at least three months earlier. QoL was assessed using the University of Washington Quality of Life (UW-QOL) questionnaire and SOC was measured using the Brazilian version of the SOC-13 questionnaire. Data on socio-demographic characteristics and the disease were obtained from patients' charts. Oral clinical conditions were also evaluated. Associations between exploratory variables and mean UW-QOL scores were evaluated through Poisson regression and the results were presented as rate ratios (RR) and 95% confidence intervals (CI). The mean overall UW-QOL score was 67.90 (± 18.71). Moderate and high SOC scores were associated with higher mean UW-QOL scores, that is, individuals with a stronger SOC demonstrated better QoL, (p < 0.05). Regarding the clinical variables, individuals with advanced stage cancer and those with hyposalivation and trismus had poorer QoL (p < 0.05). Patients with a greater SOC reported a better quality of life. Our findings show the importance of focusing on psychosocial factors, which can alleviate the impact caused by the disease and improve the QoL of these patients.


Asunto(s)
Carcinoma de Células Escamosas/psicología , Neoplasias de Cabeza y Cuello/psicología , Calidad de Vida/psicología , Sentido de Coherencia , Anciano , Carcinoma de Células Escamosas/patología , Estudios Transversales , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Valores de Referencia , Análisis de Regresión , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Trismo/psicología , Xerostomía/psicología
6.
Medicine (Baltimore) ; 99(6): e18776, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028390

RESUMEN

Liangshan Yi Autonomous Prefecture in Southwest China has a high human immunodeficiency virus (HIV) prevalence rate. This study examined the changing modes of HIV transmission among women with new HIV infections and explored the spatial heterogeneities in the factors associated with heterosexual transmission in this minority region.The data consisting of women with new HIV infections from 2011 to 2014 were collected from multiple sources. New infections were identified by BED capture enzyme immunoassay. The Bayesian hierarchical model was used to estimate the proportion of women with new HIV infections via heterosexual transmission across all townships in the Prefecture. A geographically weighted regression (GWR) model was utilized to investigate spatial variations in the sociodemographic characteristics associated with the changing modes of HIV transmission.An analytical sample of 927 women with new HIV infections was constructed and utilized to investigate the changing mode of HIV transmission. The rate of heterosexual transmission among women with new HIV infections in 2011 was below 20%. However, by 2014 this rate dramatically increased to nearly 80%. Among sociodemographic characteristics, GWR results revealed significant ethnic differences in heterosexual HIV transmission between Yi women and women in other ethnic groups, with Yi women demonstrating a lower risk of infection through heterosexual transmission. However, such ethnic differences were observed only in 30% of the townships in the Prefecture. Moreover, having a primary education decreased the odds of heterosexual transmission, which was observed in about 56% of the townships. Also, being involved in occupations other than agriculture or animal husbandry and being single or married decreased the odds of HIV infection through heterosexual contact among women, which did not significantly vary across the Prefecture.Heterosexual transmission was the predominant mode of HIV transmission among women in the Prefecture, and this transformation was clearly marked by a fast-growing trend and a spatial diffusion pattern. Spatial variations also existed in sociodemographic factors that were associated with the changing modes of HIV transmission.


Asunto(s)
Infecciones por VIH/epidemiología , Conducta Sexual , Adulto , China/epidemiología , Bases de Datos Factuales , Demografía , Femenino , Infecciones por VIH/transmisión , Humanos , Prevalencia , Análisis de Regresión , Factores Socioeconómicos , Salud de la Mujer
7.
Sci Total Environ ; 713: 136688, 2020 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-32019034

RESUMEN

This is a national scale study of spatial oral and pharynx cancer mortality and incidence clusters in the contiguous U.S.A. Spatial and space-time analyses of incidence and mortality rates of oral and pharynx cancers in the contiguous U.S.A. were done at the county resolution, using mortality data for the years 2000-2014 and incidence data for 2001-2015. The disease surveillance software SaTScan™ is used to identify significant cancer clusters that are non-random. In addition to a cluster analysis, regression analysis was used to adjust cancer incidence and mortality for several covariates or risk factors. This is the first study of the contiguous U.S.A. for oral and pharynx cancer in which mortality and incidence rates are studied together. The geographic clustering for mortality is somewhat different from the clustering for incidence. There exist several significant clusters in the contiguous U.S.A., both for oral and pharynx cancer incidence and for mortality. Some of the significant clusters persisted even after adjusting for several key risk factors. These clusters areas suggest a need for further investigation to identify some local concerns or needs to further address such cancer types in those specific sites. We identified statistically significant spatial and space-time clusters of oral and pharynx cancer for mortality and also for incidence in the contiguous US at the county resolution. The most important risk factors for oral cancer incidence are diabetes, alcohol drinking, and obesity, while the top risk factors for mortality are race, cervical cancer, diabetes, and alcohol drinking.


Asunto(s)
Neoplasias Faríngeas , Análisis por Conglomerados , Humanos , Incidencia , Neoplasias Faríngeas/mortalidad , Análisis de Regresión , Estados Unidos/epidemiología
8.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 55(2): 98-103, 2020 Feb 09.
Artículo en Chino | MEDLINE | ID: mdl-32074670

RESUMEN

Objective: To analyze the correlation between the age and the cone-beam CT (CBCT) images of the third and fourth cervical vertebrae in female skeletal class Ⅰ patients aged between 9 and 17 years, and to establish a quantitative evaluation method for calculating the age. Methods: CBCT images of 108 female skeletal class Ⅰ patients aged between 9 and 17 years were collected from Qingdao Stomatological Hospital from September, 2017 to March, 2019. The two-dimensional linear values (AH: height of anterior edge of vertebral body; H: height of middle part of vertebral body; PH: height of posterior edge of vertebral body; AP: width of vertebral body), the two-dimensional linear ratio values (AH/PH, AH/AP, AH/H, H/AP, H/PH, PH/AP) and the three-dimensional volume values of the third vertical vertebrae (C3) and the fourth vertical vertebrae (C4) were measured. By Exponential transformation of measurements and multiple linear regression analysis, the optimal index for evaluating age were screened, and the fitting degree of multiple linear regression equation (R(2)) and the accuracy of age estimation (SEE) were compared. CBCT images of 27 female skeletal class Ⅰ patients aged from 9 to 17 years were added from Qingdao Stomatological Hospital between April, 2019 and July, 2019, by which the accuracy of the regression equation was verified. Results: Multiple linear regression equation for age estimation based on two-dimensional linear indexes was as follows: Y=-113.928+33.743×e(AH)(3)(/100)+58.844×e(PH)(4)(/100)+20.590×e(AP)(4)(/100)( "e" was a natural constant, e≈2.718), R(2)=0.745, SEE=1.31. Multiple linear regression equation for age estimation based on two-dimensional linear ratio indexes was as follows: Y=-0.076-2.284×e(A)H(3)/PH(3)+3.227×e(A)H(3)/AP(3)+2.149×e(A)H(3)/H(3)+1.961×e(A)H(4)/H(4), R(2)=0.576, SEE=1.70. Multiple linear regression equation of age estimation by the volume index was as follows: Y=-16.828+22.184×e(V)(3)(/10 000), R(2)=0.555, SEE=1.71. The data of 27 new patients were tested. The CBCT measurement index of C3 and C4 vertebral bodies inferred the fitting degree (R(2)) and accuracy (SEE) of the equation of the age estimation. The two-dimensional linear value was superior to the two-dimensional linear ratio and the latter was superior to the three-dimensional volume value. The standard error of the estimate about them was 1.74, 2.00 and 2.37, respectively. Conclusions: The two-dimensional linear index of CBCT images of C3 and C4 could be used to estimate the age of 9 to 17-year-old female skeletal class Ⅰ patients, and the accuracy of the method was higher than that of two-dimensional ratio index and three-dimensional volume index.


Asunto(s)
Vértebras Cervicales/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico , Adolescente , Niño , Femenino , Humanos , Análisis Multivariante , Análisis de Regresión
9.
Health Qual Life Outcomes ; 18(1): 8, 2020 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910863

RESUMEN

BACKGROUND: Acute leukemia (AL) not only impairs the quality of life (QOL) of patients, but also affects that of their family caregivers (FCs). Studies on QOL of AL patients and their FCs are limited. This study aimed to evaluate the QOL of AL patients and their FCs, and to explore the factors associated with QOL of patients and of FCs. METHODS: A multicenter cross-sectional study was conducted. The QOL of 196 patient-FC dyads was assessed. The Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu) was used for patients, and the 36-item Short-Form Health Survey (SF-36) was used for FCs. Independent-samples t-tests or one-way analysis of variance were used to compare QOL subscale scores between groups with different sociodemographic/clinical characteristics. Multiple regression analysis was conducted to identify the factors associated with QOL of AL patients and their FCs. RESULTS: The total FACT-Leu score for AL patients was 76.80 ± 16.44, and the physical component summary (PCS) and mental component summary (MCS) scores for FCs were 64.67 ± 15.44 and 52.50 ± 13.49, respectively. All QOL subscales for patients (t = 12.96-34.73, p < 0.001) and FCs (t = 2.55-14.36, p < 0.05), except role emotional (t = - 0.01, p = 0.993), were lower than those reported in previous studies. Sex, employment, and chemotherapy were significantly associated with total FACT-Leu score in AL patients (p < 0.05). Age, sex, marital status, education, employment, and relationship to patients were significantly associated with SF-36 PCS or MCS (p < 0.05). CONCLUSIONS: AL patients and their FCs both have lower QOL than the population in previous studies. These findings suggest that not only AL patients' physical and mental health but also overall family QOL should be assessed. Interventions supporting patient-FC dyads should be developed to improve their QOL.


Asunto(s)
Cuidadores/psicología , Leucemia Mieloide Aguda/psicología , Calidad de Vida , Adulto , Anciano , China , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Encuestas y Cuestionarios
10.
Braz Oral Res ; 33: e124, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31994597

RESUMEN

This study aimed to assess the association of demographic conditions, socioeconomic status, clinical variables, and psychosocial factors with the number of filled teeth in adolescents from public schools. This cohort study comprised 1,134 12-year-old adolescents enrolled in public schools in Santa Maria, Brazil, in 2012. They were followed-up in 2014, where 743 individuals were reassessed (follow-up rate of 65.52%) for the number of filled teeth. Data were collected via dental examinations and structured interviews. Demographic and socioeconomic characteristics were collected from parents or legal guardians. The psychosocial factor comprised students' subjective measurement of happiness (Brazilian version of the Subjective Happiness Scale - SHS). Dental examinations were performed to assess the number of filled teeth through decay, missing, and filled teeth index (DMF-T). Unadjusted and adjusted Poisson regression analyses were performed to assess the association between baseline variables and filled teeth at follow-up. The number of filled teeth in 2012 and 2014 were 193 (17.02%) and 235 (31.63%), respectively. The incidence of filled teeth in 2014 was 42 (5.65%). Adolescents with untreated dental caries, those who visited the dentist in the last 6 months, those that exhibited being happier, and those who had filled teeth at baseline were associated with a higher number of filled teeth at follow-up. We conclude that the number of filled teeth in adolescents was influenced by clinical and psychosocial factors, emphasizing the need to focus on oral health policies in individuals with higher disease burden and those who feel psychologically inferior.


Asunto(s)
Encuestas de Salud Bucal/estadística & datos numéricos , Restauración Dental Permanente/estadística & datos numéricos , Sector Público/estadística & datos numéricos , Instituciones Académicas/estadística & datos numéricos , Estudiantes/estadística & datos numéricos , Adolescente , Brasil/epidemiología , Niño , Estudios de Cohortes , Caries Dental/epidemiología , Caries Dental/terapia , Servicios de Salud Dental/estadística & datos numéricos , Restauración Dental Permanente/psicología , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Análisis de Regresión , Factores Socioeconómicos , Estudiantes/psicología
11.
Int Heart J ; 61(1): 60-66, 2020 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-31956143

RESUMEN

Transcatheter aortic valve implantation (TAVI) using a transfemoral approach under local anesthesia with conscious sedation (LACS) is becoming an increasingly common TAVI strategy. However, patients who are awake during the TAVI procedure can experience stress, anxiety, and pain, even when LACS is used. Clinical hypnotherapy is an anxiolytic intervention that can be beneficial for patients undergoing invasive surgery. This study aimed to assess the perioperative outcomes of adjunctive hypnotherapy undergoing transfemoral TAVI with LACS.Consecutive patients (n = 143) with symptomatic severe aortic stenosis who underwent transfemoral TAVI with LACS only (n = 107) or with LACS and hypnotherapy (n = 36) between January 2015 and April 2016 were retrospectively included in the study. The clinical outcomes were compared between the two groups. The LACS with hypnotherapy group had a significantly shorter length of stay in the intensive care unit (ICU; LACS only versus LACS with hypnotherapy: 4.0 (4.0-5.5) days versus 3.0 (3.0-5.0) days, P < 0.01). Moreover, the use of anesthetics (propofol and remifentanil) and norepinephrine was significantly lower in the LACS with hypnotherapy group (e.g., for propofol, LACS only versus LACS with hypnotherapy: 96.4 ± 104.7 mg versus 15.0 ± 31.8 mg, P < 0.001). The multiple regression analysis showed that being male, hypnotherapy, and the composite complication score were independently associated with the length of stay in the ICU.The adjunctive hypnotherapy on LACS among transfemoral TAVI patients may facilitate perioperative management. However, a prospective randomized study is necessary to confirm the efficacy of hypnotherapy among TAVI patients.


Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Sedación Consciente/métodos , Hipnosis/métodos , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Anciano , Anciano de 80 o más Años , Anestesia Local , Femenino , Humanos , Masculino , Norepinefrina/administración & dosificación , Periodo Perioperatorio , Complicaciones Posoperatorias , Propofol/administración & dosificación , Estudios Prospectivos , Análisis de Regresión , Remifentanilo/administración & dosificación , Estudios Retrospectivos , Resultado del Tratamiento
12.
Int Heart J ; 61(1): 96-102, 2020 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-31956152

RESUMEN

Heart failure (HF) is associated with aberrant skeletal muscle impairments, which are closely linked to the severity of HF. A low level of brain-derived neurotrophic factor (BDNF), a myokine produced in the skeletal muscle, is known to be involved in reduced exercise capacity and poor prognosis in HF. However, little is known about the factors or conditions of skeletal muscle associated with BDNF levels. We investigated the association between serum BDNF levels and the skeletal muscle mass and function in HF patients (n = 60, 63 ± 13 years) and age-matched controls (n = 29, 61 ± 16 years). The serum BDNF level was significantly lower in the HF patients compared to the controls (24.9 ± 0.9 versus 28.6 ± 1.3, P = 0.021). In a univariate analysis, BDNF was significantly correlated with the peak oxygen uptake, estimated glomerular filtration rate, 10-m gait speed, and muscle strength, but not with the body mass index or lean mass in the HF group. A multiple linear regression analysis revealed that BDNF was independently associated with muscle strength (ß-coefficient = 2.80, 95%CI: 1.89-11.8, P = 0.008). Serum BDNF levels were associated with exercise capacity and skeletal muscle function, but not with muscle mass. These novel findings may suggest that BDNF production is controlled by muscle function and activity and consequently regulates exercise capacity, highlighting the importance of adequate training regarding skeletal muscle in HF patients.


Asunto(s)
Factor Neurotrófico Derivado del Encéfalo/sangre , Insuficiencia Cardíaca/fisiopatología , Músculo Esquelético/fisiopatología , Anciano , Índice de Masa Corporal , Estudios de Casos y Controles , Ejercicio/fisiología , Femenino , Barrera de Filtración Glomerular , Insuficiencia Cardíaca/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular , Análisis de Regresión
13.
Zhonghua Yi Xue Za Zhi ; 100(1): 32-36, 2020 Jan 07.
Artículo en Chino | MEDLINE | ID: mdl-31914555

RESUMEN

Objective: To investigate the correlation between social support, resilience, self-esteem and post-traumatic stress disorder (PTSD) in intensive care unit (ICU) nurses. Methods: A total of 717 ICU nurses from 24 provinces conducted these questionnaires (Chinese version of Impact of Event Scale-Revised(IES-R), Social Support Rate Score(SSRS), Cannor-Davidson Resilience(CD-RISC) and Self-Esteem Scale(SES)). There were 101 males and 616 females, with an average age of (30±5) years. With the aim to investigate PTSD impact factors, the ICU nurses were divided into the PTSD positive group (IES-R>35) and PTSD negative group (IES-R<35). The correlation between IES-R and other scales were analyzed with linear regression analysis. Results: In this investigation, 414 nurses were screened with PTSD and 303 nurses without. IES-R score was negatively correlated with SSRS, CD-RISC and SES (r=-0.275, -0.202, -0.709, all P<0.05). Multivariate regression analysis showed that ICU clinical experience was an independent risk factor for PTSD, and SES Score, SSRS Score and physical health status were protective factors. SES partially mediated the association of SSRS with IES-R, and the mediating effect were 51.5%. The area under characteristic curve (ROC) showed that SSRS score, CD-RISC score, SES score and PTSD risk score Logit (P) for prediction of PTSD was 0.629, 0.604, 0.831 and 0.848, respectively. Conclusions: Social support, physical health and self-esteem are protective factors of PTSD, while ICU clinical experience is a risk factor. SES partially mediated the association of SSRS with IES-R.


Asunto(s)
Trastornos por Estrés Postraumático , Adulto , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Análisis de Regresión , Apoyo Social , Encuestas y Cuestionarios
14.
Pharm Res ; 37(3): 38, 2020 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-31965333

RESUMEN

PURPOSE: Asthma is a prevalent lung disorder that cause heavy burdens globally. Inhalation medicaments can relieve symptoms, improve lung function and, thus, the quality of life. However, it is well-documented that patients often do not get the prescribed dose out of an inhaler and the deposition of drug is suboptimal, due to incorrect handling of the device and wrong inhalation technique. This study aims to design and fabricate an acoustic dry powder inhaler (ADPI) for monitoring inhalation flow and related drug administration in order to evaluate whether the patient receives the complete dose out of the inhaler. METHODS: The devices were fabricated using 3D printing and the impact of the acoustic element geometry and printing resolution on the acoustic signal was investigated. Commercial Foradil (formoterol fumarate) capsules were used to validate the availability of the ADPI for medication dose tracking. The acoustic signal was analysed with Partial-Least-Squares (PLS) regression. RESULTS: Indicate that specific acoustic signals could be generated at different air flow rates using a passive acoustic element with specific design features. This acoustic signal could be correlated with the PLS model to the air flow rate. A more distinct sound spectra could be acquired at higher printing resolution. The sound spectra from the ADPI with no capsule, a full capsule and an empty capsule are different which could be used for medication tracking. CONCLUSIONS: This study shows that it is possible to evaluate the medication quality of inhaled medicaments by monitoring the acoustic signal generated during the inhalation process.


Asunto(s)
Asma/tratamiento farmacológico , Broncodilatadores/química , Inhaladores de Polvo Seco/instrumentación , Fumarato de Formoterol/química , Impresión Tridimensional , Acústica , Administración por Inhalación , Asma/fisiopatología , Broncodilatadores/administración & dosificación , Sistemas de Liberación de Medicamentos/instrumentación , Diseño de Equipo/instrumentación , Fumarato de Formoterol/administración & dosificación , Humanos , Análisis de los Mínimos Cuadrados , Pulmón/metabolismo , Monitoreo Fisiológico/instrumentación , Polvos/química , Polvos/farmacología , Análisis de Regresión , Sonido
15.
Plast Reconstr Surg ; 145(2): 251e-262e, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985611

RESUMEN

BACKGROUND: The authors refine their anatomical patient selection criteria with a novel midclavicular-to-inframammary fold measurement for nipple-sparing mastectomy performed through an inframammary approach. METHODS: Retrospective review was performed of all nipple-sparing mastectomies performed through an inframammary approach. Exclusion criteria included other mastectomy incisions, staged mastectomy, previous breast operation, and autologous reconstruction. Preoperative anatomical measurements for each breast, clinical course, and specimen weight were obtained. RESULTS: One hundred forty breasts in 79 patients were analyzed. Mastectomy weight, but not sternal notch-to-nipple distance, was strongly correlated with midclavicular-to-inframammary fold measurement on linear regression (R = 0.651; p < 0.001). Mastectomy weight was not correlated with ptosis. Twenty-five breasts (17.8 percent) had ischemic complications: 16 (11.4 percent) were nonoperative and nine (6.4 percent) were operative. Those with mastectomy weights of 500 g or greater were nine times more likely to have operative ischemic complications than those with mastectomy weights less than 500 g (p = 0.0048). Those with a midclavicular-to-inframammary fold measurement of 30 cm or greater had a 3.8 times increased incidence of any ischemic complication (p = 0.00547) and a 9.2 times increased incidence of operative ischemic complications (p = 0.00376) compared with those whose midclavicular-to-inframammary fold measurement was less than 30 cm. CONCLUSIONS: Breasts undergoing nipple-sparing mastectomy by means of an inframammary approach with midclavicular-to-inframammary fold measurement greater than or equal to 30 cm are at higher risk for having ischemic complications, warranting consideration for a staged approach or other incision. The midclavicular-to-inframammary fold measurement is useful for assessing the entire breast and predicting the likelihood of ischemic complications in inframammary nipple-sparing mastectomies. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Asunto(s)
Neoplasias de la Mama/cirugía , Isquemia/etiología , Mastectomía/métodos , Pezones/cirugía , Tratamientos Conservadores del Órgano/métodos , Adulto , Anciano , Femenino , Humanos , Incidencia , Isquemia/epidemiología , Modelos Logísticos , Mastectomía/efectos adversos , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/efectos adversos , Complicaciones Posoperatorias/etiología , Análisis de Regresión , Factores de Riesgo
16.
Plast Reconstr Surg ; 145(2): 360e-367e, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985640

RESUMEN

BACKGROUND: Carpal tunnel release is one of the most common procedures in hand surgery. There is only scarce evidence regarding whether platelet inhibitors increase the risk of developing postoperative hemorrhage in carpal tunnel release. METHODS: This is a multicenter, propensity score-matched study including 635 carpal tunnel releases in 497 patients. Multivariate regression models were adjusted with the propensity score, which was developed to mitigate differences in patients with and without platelet inhibition with acetylsalicylic acid. Propensity score matching provides results close to the statistical quality of randomized controlled trials. The primary study endpoint was postoperative bleeding complication, defined as acute bleeding leading to reoperation or hematoma leading to physician visit. Patient satisfaction, functional outcome measured with the Boston Carpal Tunnel Questionnaire, and onset of surgical-site infection were also analyzed. RESULTS: Bleeding complications were observed in 56 procedures (8.8 percent). After propensity score matching, there was no significant difference between the patients with and without acetylsalicylic acid treatment (p = 0.997). History of thyroid disease (p = 0.035) and of rheumatoid arthritis (p = 0.026) were independent risk factors, whereas higher body mass index might have a beneficial effect (p = 0.006). Patients with postoperative bleeding had significantly impaired functional outcome as measured with the Boston Carpal Tunnel Questionnaire (p = 0.026). Median satisfaction in the investigated study population was 10 of 10 points and did not differ significantly between the antiplatelet and the non-antiplatelet cohorts (p = 0.072) CONCLUSION:: Carpal tunnel release under platelet inhibition with acetylsalicylic acid is safe and can be performed without interruption of such medication. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Asunto(s)
Aspirina/efectos adversos , Síndrome del Túnel Carpiano/cirugía , Inhibidores de Agregación Plaquetaria/efectos adversos , Hemorragia Posoperatoria/inducido químicamente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente/estadística & datos numéricos , Hemorragia Posoperatoria/prevención & control , Puntaje de Propensión , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo
17.
Braz Oral Res ; 33: e119, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31939499

RESUMEN

The aim of this study was to assess the occurrence of erosive tooth wear (ETW) among 15-19-year-old South Brazilian adolescents, regarding prevalence, extent, severity, intraoral distribution, and sociodemographic risk indicators. A population-based cross-sectional survey was conducted in Santa Maria, southern Brazil, and included a representative sample of 15-19-year-old adolescents. Data collection included the application of a questionnaire and a clinical examination. A questionnaire was sent to the parents/legal guardians of the selected students, containing questions on demographic information, socioeconomic characteristics, and living conditions. After tooth cleaning and drying, all erupted permanent teeth were clinically assessed by two calibrated examiners, and classified according to the Basic Erosive Wear Examination (BEWE). The association between explanatory variables and the outcomes (ETW prevalence and extent) was assessed using Poisson regression models (both unadjusted and adjusted). A total of 1,197 adolescents were included in the study (participation rate of 72.3%). The overall prevalence of ETW was 57%. Severe ETW affected 16% of the sample. Overall, this adolescent population presented 13.3 affected surfaces, and 8.34 affected teeth. In the risk assessment analysis, gender, skin color, socioeconomic status, and family income were significantly associated with ETW. Boys, white adolescents, and those with higher socioeconomic status were more affected by ETW. This population-based cross-sectional study revealed that the prevalence of ETW was high, and that it was associated with sociodemographic variables in this South Brazilian population of adolescents.


Asunto(s)
Erosión de los Dientes/epidemiología , Adolescente , Distribución por Edad , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Prevalencia , Análisis de Regresión , Factores de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Factores Sexuales , Factores Socioeconómicos , Encuestas y Cuestionarios
18.
Chemosphere ; 242: 125289, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31896204

RESUMEN

Selenium (Se) and zinc (Zn) are essential microelements for humans with crucial biological functions. In this study, we determined Se and Zn concentrations in soils and rice grains on Hainan Island and investigated how their spatial distributions are related to soil mineral elements, topography, and vegetation coverage. Overall, the concentrations of Se and Zn in soils were higher than the background values for Chinese soil; the Se concentrations in rice grains were higher than the threshold value for Se deficiency in grains, but Zn concentrations were lower than the proposed critical concentration. Both Spearman's correlation and stepwise regression analysis showed that the concentrations of soil Fe and Ca significantly affected soil Se and Zn: a difference of 1 g kg-1 in soil Fe changed soil Se by 2.820 µg kg-1 and soil Zn by 0.785 mg kg-1, respectively, while a difference of 1 g kg-1 in soil Ca changed soil Se by 3.249 µg kg-1 and soil Zn by 0.356 mg kg-1, respectively. For rice grains, Se and Zn concentrations decreased with increasing elevation; every 100 m increase in elevation could decrease Se by 0.022 mg kg-1 and Zn by 0.912 mg kg-1. Moreover, the impact of Fe and Ca on soil Zn was relatively strong in the northeast region, while the influence of elevation on rice grain Se was more significant in the central region. The findings contribute to a better understanding of factors driving the distribution of Se and Zn in soils and crops.


Asunto(s)
Grano Comestible/química , Monitoreo del Ambiente/métodos , Oryza/química , Selenio/análisis , Suelo/química , Zinc/análisis , Altitud , Calcio/análisis , China , Humanos , Hierro/análisis , Islas , Análisis de Regresión , Análisis Espacial
19.
J Photochem Photobiol B ; 203: 111768, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31931383

RESUMEN

In vitro callus cultures of Verbena officinalis L. were maintained on solid Murashige and Skoog medium, enriched with 1 mg dm-3 BA and 1 mg dm-3 IBA under LED lights (red, blue, red/blue 70%/30%), in darkness and under control fluorescent lamps. The measurements of 2 phenylpropanoid glycosides (verbascoside and isoverbascoside) and 23 phenolic acids were performed in methanolic extracts from the biomass collected after 2-, 3- and 4-week growth cycles using the HPLC-DAD method. The presence of verbascoside, isoverbascoside and additionaly 7 phenolic acids (protocatechuic, chlorogenic, vanillic, caffeic, ferulic, o-coumaric and m-coumaric acids) was confirmed in all extracts. Blue and red/blue lights stimulated the accumulation of verbascoside (max. of 6716 and 6023 mg 100 g-1 DW after a 4-week growth cycle) and isoverbascoside (max. 333 and 379 mg 100 g-1 DW also after 4 weeks). The maximum amounts of verbascoside and isoverbascoside were respectively 1.8- and 7.0-fold higher than under the control conditions. Phenolic acids were accumulated in different amounts, and the maximum total amounts ranged from 36 to 65 mg 100 g-1 DW. LED lights also stimulated their accumulation in comparison with darkness and control. The main phenolic acids included: m-coumaric acid (max. 39 mg 100 g-1 DW), ferulic acid (max. 12 mg 100 g-1 DW), and protocatechuic acid (max. 13 mg 100 g-1 DW). Additionally, the quantities of photosynthetic pigments (chlorophyll a, b and carotenoids) were estimated in acetonic extracts using spectrophotometry. Red/blue light stimulated the biosynthesis of pigments (max. total content 287 µg g-1 FW after 4-week growth cycles). This is the first study describing the effect of LED lights on the production of phenylpropanoid glycosides and phenolic acids in V. officinalis callus cultures. Very high amounts of verbascoside and isoverbascoside are interesting from a practical point of view.


Asunto(s)
Glucósidos/metabolismo , Hidroxibenzoatos/metabolismo , Luz , Fenoles/metabolismo , Verbena/metabolismo , Biomasa , Carotenoides/análisis , Clorofila/análisis , Clorofila A/análisis , Cromatografía Líquida de Alta Presión , Glucósidos/análisis , Hidroxibenzoatos/análisis , Fenoles/análisis , Fotosíntesis/efectos de la radiación , Análisis de Componente Principal , Análisis de Regresión , Espectrofotometría
20.
Mar Pollut Bull ; 150: 110779, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31910526

RESUMEN

This study was concerned with spatial analysis of mercury (Hg) in sediment samples of the USA coastal areas using more accurate and stable hybrid approaches compared to the conventional methods. An ensemble of simulated annealing along with least angle regression (SA-LAR) was applied for selection of predictors in spatial analysis. The latest algorithm was efficient with resultant RMSE and R2 of 0.066 and 0.705 compared to 0.099 and 0.571 for the traditional method of recursive feature elimination (RFE) approach. Using Cu, Pb and As as selected variables, it was tried to improve the spatial forecasting of Hg with either a hybrid of generalized boosted regression and ordinary kriging (GBROK) or inverse distance weighting (GBRIDW). According to the results, the variance explained by cross validation (VECV) was improved from 7.52% and 9.76% for IDW and OK to 40.41% and 41.94% for the GBRIDW and GBROK methods, respectively.


Asunto(s)
Monitoreo del Ambiente/métodos , Mercurio , Oligoelementos , Contaminación del Agua/estadística & datos numéricos , Análisis de Regresión , Análisis Espacial
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