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1.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 19-25, feb. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-ET2-3432

RESUMEN

Objetivo. La correcta identificación en el primer contacto médico de los pacientes con un síndrome coronario agudo (SCA) es esencial. No existe ninguna escala predictiva para el diagnóstico de SCA en los centros de coordinación de emergencias (CCE) que facilite la toma de decisiones al equipo médico. El objetivo primario es construir y validar una escala de estas características. Método. Estudio prospectivo, observacional, unicéntrico, realizado durante 1 año (2016). Se incluyeron los pacientes que consultaron telefónicamente por dolor torácico no traumático en un CCE. Los pacientes incluidos se repartieron en las muestras de derivación y validación de forma aleatoria. La escala predictiva –escala SCARE– se construyó mediante regresión logística, la discriminación y calibración del modelo se realizó con el cálculo del área bajo la curva (ABC) de la característica operativa del receptor y el test de Hosmer-Lemeshow. Resultado. La muestra de derivación incluyó 902 pacientes y 7 de las variables recogidas se relacionaron con un diagnóstico final de SCA: sexo masculino, edad, tabaquismo, dolor torácico de características típicas, primer episodio de dolor torácico, diaforesis y la intuición del médico que realizó la entrevista telefónica. La utilización de la escala desarrollada en los 465 pacientes de la muestra de validación obtuvo un ABC de 0,81 (intervalo de confianza al 95% 0,76-0,87) y el test de Hosmer-Lemeshow fue de 5,18 (p = 0,74). Conclusión. La escala SCARE mostró una correcta discriminación y calibración. Es necesaria una validación externa multicéntrica antes de implementar su uso en los CCE


Background and objective. Correctly identifying patients with acute coronary syndrome (ACS) on first contact is essential, yet emergency dispatchers currently lack a risk scale that can help predict an ACS diagnosis. Our main aim was to develop and validate such a risk scale. Methods. Prospective, observational single-center study in 2016 (January 1 to December 31). We included patients who called our emergency dispatch center to report nontraumatic chest pain. Included patients were randomly assigned to a development or a validation sample. The predictive SCARE scale was built with logistic regression analysis. Discrimination and calibration were analyzed by calculating the area under the receiver operating characteristic curve; calibration was assessed with the Hosmer-Lemeshow test. Results. The development sample included 902 patients. The regression model identified 7 variables associated with a final diagnosis of ACS: male sex, age, smoking, typical pain characteristics, first episode of chest pain, diaphoresis, and physician intuition (the teledispatcher’s suspicion). When we applied the scale in the validation sample of 465 patients the area under the curve was 0.81 (95% CI, 0.76-0.87). The Hosmer-Lemeshow statistic was 5.18 (P=.74). Conclusions. The SCARE scale had good discrimination and calibration properties. The scale should be further validated in an external sample from a multicenter study before it is implemented by emergency dispatch centers


Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Síndrome Coronario Agudo/diagnóstico , Servicios Médicos de Urgencia/métodos , Técnicas de Apoyo para la Decisión , Dolor en el Pecho/diagnóstico , Estudios Prospectivos , Valor Predictivo de las Pruebas , Teléfono/estadística & datos numéricos , Modelos Logísticos , Intuición , Encuestas y Cuestionarios
3.
Am J Orthod Dentofacial Orthop ; 157(2): 148-155.e1, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32005465

RESUMEN

INTRODUCTION: A prospective randomized study was undertaken to compare conventional study model-based manual Peer Assessment Rating (PAR) scoring with computer-based automated scoring using scanned study models or intraoral scanning. METHODS: The sample consisted of 67 patients, mean age 15.03 (range 11-37) years. Sixty-seven patients underwent alginate impression-taking and intraoral scanning (CS 3600; Carestream Dental, Stuttgart, Germany) at a single appointment in a randomized order. For each patient, a weighted PAR score was calculated manually by a calibrated examiner using study models and a PAR ruler (conventional group), and automatically using Carestream Dental CS Model+ software and data from scanned study models (indirect digital group) or intraoral scans (direct digital group). All procedures were timed, and each patient completed a binary questionnaire relating to their experience. RESULTS: There were no significant differences between methods for calculated mean weighted PAR score (P = 0.68). Mean (standard deviation) chairside time for impression-taking was 5.35 (± 1.16) minutes and for intraoral scanning, 7.76 (± 2.76) minutes (P <0.05). Mean (standard deviation) times taken to calculate weighted PAR scores were 2.86 (± 0.96), 5.58 (± 2.33), and 4.58 (± 2.18) minutes for conventional, indirect digital, and direct digital groups, respectively (P >0.05). A total of 61 patients (91%) preferred intraoral scanning to impression-taking. CONCLUSIONS: Automated PAR scoring using cast study models or intraoral scanning is valid, though both methods take longer than conventional scoring. Patients prefer intraoral scanning to impression-taking. REGISTRATION: ClinicalTrials.gov (NCT03405961). PROTOCOL: The protocol was not published before study commencement.


Asunto(s)
Diseño Asistido por Computador , Técnica de Impresión Dental , Adolescente , Adulto , Niño , Modelos Dentales , Humanos , Imagen Tridimensional , Estudios Prospectivos , Programas Informáticos , Adulto Joven
4.
Am J Orthod Dentofacial Orthop ; 157(2): 156-164.e17, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32005466

RESUMEN

INTRODUCTION: The objective of this systematic review was to assess the available evidence in the literature for the effects of fixed orthodontic retainers on periodontal health. METHODS: The following databases were searched up to August 31, 2019: Medline, EMBASE, the Cochrane Oral Health Group's Trials Register, CENTRAL, ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. Randomized controlled trials (RCTs), controlled clinical trials, cohort studies of prospective and retrospective design, and cross-sectional studies reporting on periodontal measurements of patients who received fixed retention after orthodontic treatment were eligible for inclusion. The quality of the included RCTs was assessed per the revised Cochrane risk of bias tool for randomized trials (RoB 2.0), whereas the risk of bias of the included cohort studies was assessed using the Risk Of Bias In Nonrandomized Studies of Interventions tool. A modified version of the Newcastle-Ottawa scale was used for cross-sectional studies. RESULTS: Eleven RCTs, 4 prospective cohort studies, 1 retrospective cohort study, and 13 cross-sectional studies fulfilled the inclusion criteria. The quality of evidence was low for most of the included studies. In contrast to the general consensus, 2 RCTs, 1 prospective cohort study, and 2 cross-sectional studies reported poorer periodontal conditions in the presence of a fixed retainer. The results of the included studies comparing different types of fixed retainers were heterogeneous. CONCLUSIONS: According to the currently available literature, orthodontic fixed retainers seem to be a retention strategy rather compatible with periodontal health, or at least not related to severe detrimental effects on the periodontium.


Asunto(s)
Retenedores Ortodóncicos , Enfermedades Periodontales , Estudios Transversales , Humanos , Estudios Prospectivos , Estudios Retrospectivos
5.
J Assoc Physicians India ; 68(2): 61-66, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009365

RESUMEN

Background: Considering the prevailing concerns about extrapyramidal symptoms (EPS) associated with oral prochlorperazine, this study was conducted to assess the safety of oral prochlorperazine (in recommended dose/duration) in the management of acute dizziness. Effectiveness was also assessed in the Indian real-world setting. Methods: A prospective, multicentric, single-arm observational study was conducted across 20 centers in India. Data from 500 patients were analyzed. Patients presenting with a complaint of dizziness, receiving prochlorperazine (Stemetil® MD-5 mg, t.i.d.) as per the routine clinical practice were enrolled. Safety and effectiveness at Week-1, compared to baseline, were assessed. Results: The mean (SD) age of the population was 43.3 (11.93) years with a marginally higher proportion of women (women: 52.2% Vs men 47.8%). The mean (SD) dose of prochlorperazine was 14.9 (0.24) mg/day. Only three patients (0.006%) reported adverse drug reactions (headache, asthenia, somnolence) during the conduct of the study, which were mild in severity and were completely resolved. Further, a significant reduction in the number of episodes of dizziness was noted at the end of Week-1(p<.0001). Moreover, improvement in the number of episodes from baseline to Week-1 was significant for nausea, vomiting, lightheadedness, and headache. Conclusion: Prochlorperazine was well-tolerated in the management of acute dizziness when administered at a mean dose of 14.9 mg/day, and mean duration of 7.2 days. Additionally, prochlorperazine was effective in providing significant symptomatic relief from dizziness and associated vomiting and nausea.


Asunto(s)
Antieméticos , Mareo , Proclorperazina , Antieméticos/efectos adversos , Antieméticos/uso terapéutico , Mareo/tratamiento farmacológico , Femenino , Humanos , India , Masculino , Proclorperazina/efectos adversos , Proclorperazina/uso terapéutico , Estudios Prospectivos , Vómitos
6.
Medicine (Baltimore) ; 99(6): e19031, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028416

RESUMEN

The study was designed to verify if mini-fluid challenge test is more reliable than dynamic fluid variables in predicting stroke volume (SV) and arterial pressure fluid responsiveness during spine surgery in prone position with low-tidal-volume ventilation.Fifty patients undergoing spine surgery in prone position were included. Fluid challenge with 500 mL of colloid over 15 minutes was given. Changes in SV and systolic blood pressure (SBP) after initial 100 mL were compared with SV, pulse pressure variation (PPV), SV variation (SVV), plethysmographic variability index (PVI), and dynamic arterial elastance (Eadyn) in predicting SV or arterial pressure fluid responsiveness (15% increase or greater).An increase in SV of 5% or more after 100 mL predicted SV fluid responsiveness with area under the receiver operating curve (AUROC) of 0.90 (95% confidence interval [CI], 0.82 to 0.99), which was significantly higher than that of PPV (0.71 [95% CI, 0.57 to 0.86]; P = .01), and SVV (0.72 [95% CI, 0.57 to 0.87]; P = .03). A more than 4% increase in SBP after 100 mL predicted arterial pressure fluid responsiveness with AUROC of 0.86 (95% CI, 0.71-1.00), which was significantly higher than that of Eadyn (0.52 [95% CI, 0.33 to 0.71]; P = .01).Changes in SV and SBP after 100 mL of colloid predicted SV and arterial pressure fluid responsiveness, respectively, during spine surgery in prone position with low-tidal-volume ventilation.


Asunto(s)
Presión Sanguínea , Monitoreo Intraoperatorio/métodos , Posicionamiento del Paciente , Médula Espinal/cirugía , Volumen Sistólico , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pletismografía/métodos , Posición Prona , Estudios Prospectivos , Adulto Joven
7.
J Assoc Physicians India ; 68(2): 16-18, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009355

RESUMEN

Introduction: Given the increasing prevalence of chronic kidney disease (CKD) in tuberculosis (TB) endemic areas, a merging of CKD and TB epidemics could have significant public health implications, especially in low to middle income countries like India, which is experiencing rapid increase in CKD prevalence. The aim of this study is to analyze the prevalence of TB in patients with CKD. Methods: A prospective study was done on 160 patients with CKD at Safdarjung Hospital, New Delhi, both with and without dialysis. The patients were investigated to detect any form of TB. Results: 22 patients showed evidence of tubercular infection (13.7%). Of these 22 subjects, 17 had extra-pulmonary and only 5 had pulmonary TB. TB infection was more prevalent among the patients on dialysis (18) than those who were not on dialysis (4). Conclusion: Therefore, we infer that TB is more common in patients of CKD and patients of CKD need to be screened for TB more so due to their over lapping signs and symptoms.


Asunto(s)
Insuficiencia Renal Crónica/epidemiología , Tuberculosis/epidemiología , Humanos , India/epidemiología , Prevalencia , Estudios Prospectivos , Tuberculosis Pulmonar
8.
J Assoc Physicians India ; 68(2): 31-34, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009359

RESUMEN

Background: Coronary artery disease (CAD) is the leading cause of mortality and morbidity in present days. Recent epidemiological and clinical evidences suggest that serum uric acid can be one of the useful markers in assessing the risk of mortality in acute myocardial infarction. Objective: To find out the association in serum uric acid level and Killip classes and ejection fraction. Methodology: It was an observational prospective study. 100 patients of acute myocardial infarction were enrolled and physical examination with special reference to Killip classification, ECG, 2D- Echocardiogram, Serum uric acid and all routine investigations were carried out on 0, 3rd and 7th day. Serum uric acid and Killip class and ejection fractions on day 0, day 3 and day 7 were compared. Results: In this present study majority of the patients were in the age group of >50 years (68%). There was statistically significant increase in uric acid levels with increasing Killip class on day 0, day 3 and day 7. Mean serum uric acid level was 4.4 mg/dl in Killip class I, 7.01 mg/dl in class II, 8.29 mg/dl in class III, and 9.87 mg/ dl in class IV on day 0; 4.46 mg/dl in Killip class I, 7.09 mg/dl in class II, 8.53 mg/ dl in class III, and 9.43 mg/dl in class IV on day 3; 4.72 mg/dl in Killip class I, 6.62 mg/dl in class II, on day 7. There was statistically significant negative correlation (p-value 0.0009, 0.001, 0.0326 at day 0, 3 & 7) between serum uric acid levels and ejection fraction at all the three occasions i.e. day 0, day 3 and day 7. Conclusion: The present study concludes that serum uric acid level have significant association with Killip class, left ventricular failure and mortality i.e. higher the serum uric acid, higher the Killip class, more severe left ventricular dysfunction and higher the mortality.The present study concludes that serum uric acid level have significant association with Killip class, left ventricular failure and mortality i.e. higher the serum uric acid, higher the Killip class, more severe left ventricular dysfunction and higher the mortality.


Asunto(s)
Infarto del Miocardio/diagnóstico , Ácido Úrico/sangre , Humanos , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Disfunción Ventricular Izquierda
9.
J Assoc Physicians India ; 68(2): 39-42, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009361

RESUMEN

Background: Pulmonary complications are one of the most common causes of postoperative morbidity and mortality after coronary artery bypass graft (CABG) surgery. There is paucity of data of CABG in abnormal pulmonary function tests (PFT) in Indian population. Objectives: To study correlation of PFT with clinical outcome in patients undergoing CABG. Methods: Three hundred seventy patients aged 35 to 65 years who underwent CABG between May 2015 and November 2016 and ready to participate were included for this prospective observational study. Each patient was subjected to detailed clinical history, clinical examination and PFT. Primary outcome measures were post CABG ventilator stay, intensive care unit (ICU) stay, and hospital stay. Fisher's exact tests was used to compare qualitative data whereas Mann-Whitney U test was used to find the significant difference between quantitative variables. Results: Higher percentage of patients whose forced expiratory volume in one second (FEV1) was abnormal had longer ventilator stay, ICU stay and hospital stay as compared patients whose FEV1 was normal. Restrictive disease, obstructive disease, and mixed disease patients had longer ventilator stay, ICU stay and hospital stay as compared patients whose spirometry was normal. Conclusion: Abnormal PFT was independent strong predictor of prolonged ventilation, longer length of ICU and hospital stay.


Asunto(s)
Puente de Arteria Coronaria , Unidades de Cuidados Intensivos , Pruebas de Función Respiratoria , Adulto , Anciano , Humanos , Tiempo de Internación , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Espirometría
10.
J Assoc Physicians India ; 68(2): 43-47, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009362

RESUMEN

Bacterial meningitis remains a disease with devastating attack rates and growing drug resistance among causative bacteria. Early diagnosis and timely management has an implication on the prognosis and outcome. However, lack of laboratory facilities, travel time for the sample to reach the laboratory and the laborious laboratory methods may result in deferment in precise treatment resulting in avoidable morbidity and mortality. Such delays can be avoided by determining CSF sugar in the emergency room using bedside glucometers, which can assist in crucial decision-making on the use of antibiotics in suspected patients. We aimed to test the accuracy of CSF glucose estimation using glucometers in detecting bacterial meningitis. This single-centred, prospective, comparative study was conducted in 50 consecutive patients suspected with CNS infections. Lumbar puncture for CSF collection was performed to test for glucose by boththe laboratory evaluation and a glucometer. Logistic regression analysis was performed to understand the relationship between culture-proven bacterial meningitis with established independent variables. The mean CSF glucose value using the conventional laboratory technique was 98.97 ± 61.10 mg/dL, and with glucometer was 109.59 ± 67.85 mg/dL. There was no significant difference (p=0.4613) among the mean glucose levels by the two methods. A statistically significant association was noted between bacterial meningitis and CSF glucose using the conventional technique (OR, 0.976; 95% CI, 0.957-0.993; p=0.0165), and CSF glucose using the glucometer (OR, 0.975; 95% CI, 0.956-0.996; p=0.0066). Bedside glucose testing from CSF fluid may be an alternative to laboratory plasma glucose measurement.


Asunto(s)
Glucosa/metabolismo , Meningitis Bacterianas/diagnóstico , Bacterias , Pruebas Hematológicas , Humanos , India , Estudios Prospectivos
11.
BMJ ; 368: l6775, 2020 01 31.
Artículo en Inglés | MEDLINE | ID: mdl-32005673

RESUMEN

The studyDambha-Miller H, Day AJ, Strelitz J, et al. Behaviour change, weight loss and remission of Type 2 diabetes: a community-based prospective cohort study. Diabet Med 2019. doi:10.1111/dme.14122This project was funded by the NIHR Health Technology Assessment Programme (project number 08/116/300) as well as the Wellcome Trust (grant number: G061895), the Epidemiology Unit programme (MC_UU_12015/4), and the National Health Service R&D support funding.To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000841/weight-loss-after-type-2-diabetes-diagnosis-boosts-chance-of-remission.


Asunto(s)
Diabetes Mellitus Tipo 2 , Pérdida de Peso , Peso Corporal , Humanos , Estudios Prospectivos , Medicina Estatal
14.
Medicine (Baltimore) ; 99(5): e18994, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000438

RESUMEN

Many lifelong smokers establish smoking habits during young adulthood. A university can be an effective setting for early smoking cessation. We evaluated long-term predictors of smoking cessation among smokers in a university setting.We longitudinally followed a cohort of smokers enrolled in a university smoking cessation program in Seoul, South Korea. Sociodemographic factors, smoking-related variables, and changes in smoking habits were assessed during 6-week visit sessions and follow-up telephone interviews conducted 1 year or more later.A total of 205 participants were followed up (mean follow-up duration: 27.1 months). Cessation rates were 47.3% at the end of the visit sessions and 28.8% at follow-up. The long-term persistent smoking rate was significantly higher among individuals with peers who smoked (odds ratio [OR] = 8.64; 95% confidence interval [CI] = 1.75, 42.80), with family members who smoked (OR = 3.28; 95% CI = 1.20, 9.00), and who smoked 10 to 19 cigarettes/day (OR = 4.83; 95% CI = 1.49, 15.69). Conversely, persistent smoking was less likely among those who attended the program regularly (OR = 0.84 per visit; 95% CI = 0.72, 0.99) and attempted quitting more frequently (OR = 0.93 per attempt; 95% CI = 0.87, 0.99). Use of smoking cessation medications (varenicline or bupropion) was not significantly associated with long-term quitting (OR = 0.71; 95% CI = 0.26, 1.93).Peer influences were the strongest predictors of failure in long-term cessation among smokers who attempted to quit. Similarly, the existence of smokers in the family was negatively associated with successful quitting. Regular attendance at a smoking cessation program and a high number of attempts to quit were positively associated with successful quitting. Targeting peer and family smoking groups together rather than targeting individual smokers alone, implementing active cessation programs encouraging regular attendance, and providing comprehensive antismoking environments might be effective strategies in a university setting.


Asunto(s)
Cese del Hábito de Fumar/estadística & datos numéricos , Adulto , Femenino , Humanos , Estudios Longitudinales , Masculino , Estudios Prospectivos , República de Corea , Encuestas y Cuestionarios , Universidades
15.
Medicine (Baltimore) ; 99(5): e19017, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000446

RESUMEN

O-(2-[F]fluoroethyl)-L-tyrosine positron-emission tomography/computed tomography (F-FET PET/CT) is well known in brain tumor management. Our study aimed to identify the prognostic value of F-FET PET/CT in high-grade gliomas (HGG) according the current 2016 World Health Organization (WHO) classification.Patients with histologically proven WHO 2016 HGG were prospectively included. A dynamic F-FET PET/CT was performed allowing to obtain 2 static PET frames (static frame 1: 20-40 minutes and static frame 2: 2-22 minutes). We analyzed static parameters (standard uptake value [SUV]max, SUVmean, SUVpeak, TBRmax, TBRmean, tumoral lesion glycolysis, and metabolic tumoral volume) for various isocontours (from 10% to 90%). PET parameters, clinical features, and molecular biomarkers were compared with progression-free survival (PFS) and overall survival (OS) in univariate and multivariate analysis.Twenty-nine patients were included (grade III n = 3, grade IV n = 26). Mean PFS and OS were, respectively, 8.8 and 13.9 months. According to univariate analysis, SUVmean, SUVpeak, TBRmax, and TBRmean were significantly correlated with OS. In static 1 analysis, TBRmax seemed to be the best OS prognostic parameter (P = .004). In static 2 analysis, TBRmean was the best parameter (P = .01). In static 1 analysis, only SUVpeak was significant (P = .05) for PFS. Good performance status (PS < 2; P < .0001) and extent of resection (P = .019) identified the subgroup of patients with the best OS. Only TBRmax (P = .026) and extent of resection (P = .025) remained significant parameters in multivariate analysis.Our data suggested that high TBRmax seemed to be the most significant OS independent prognostic factor in patients with newly diagnosed HGG.


Asunto(s)
Glioma/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Medios de Contraste , Femenino , Glioma/patología , Glioma/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Pronóstico , Estudios Prospectivos , Radiofármacos , Tasa de Supervivencia , Tirosina/análogos & derivados
16.
Rev Med Liege ; 75(2): 130-135, 2020 Feb.
Artículo en Francés | MEDLINE | ID: mdl-32030940

RESUMEN

The «Prospective Comparison of ARNI with ARB Global Outcomes in HF with Preserved Ejection Fraction¼ (PARAGON HF) trial is a multicenter, randomized, double-blind study comparing the incidence of heart failure hospitalization and cardiovascular mortality in patients with heart failure with preserved ejection fraction (HFpEF) treated with sacubitril/valsartan (Entresto®) versus valsartan alone. After a median follow-up of 35 months, the primary endpoint was reduced by 13 % in the sacubitril/valsartan group compared to the valsartan group (relative risk: 0.87, 95 % IC: 0.753-1.005, p = 0.058). Despite this lack of significance, the incidence of hospitalizations for heart failure was reduced (RR 0.85, 95 % CI: 0.72-1.00), whereas no benefit was observed on cardiovascular mortality. A subgroup analysis suggested that women and patients with an intermediate ejection fraction could get more benefit from the treatment. Concerning secondary criteria, a significant improvement in quality of life and in heart failure symptoms was observed in the group sacubitril/valsartan. There was a greater incidence of arterial hypotension and angioneurotic edema, but a lower incidence of hyperkalemia in the group sacubitril/valsartan.


Asunto(s)
Antagonistas de Receptores de Angiotensina , Insuficiencia Cardíaca , Hospitalización , Volumen Sistólico , Método Doble Ciego , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Humanos , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento
17.
Lancet ; 395(10221): 350-360, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-32007170

RESUMEN

BACKGROUND: Improved markers of prognosis are needed to stratify patients with early-stage colorectal cancer to refine selection of adjuvant therapy. The aim of the present study was to develop a biomarker of patient outcome after primary colorectal cancer resection by directly analysing scanned conventional haematoxylin and eosin stained sections using deep learning. METHODS: More than 12 000 000 image tiles from patients with a distinctly good or poor disease outcome from four cohorts were used to train a total of ten convolutional neural networks, purpose-built for classifying supersized heterogeneous images. A prognostic biomarker integrating the ten networks was determined using patients with a non-distinct outcome. The marker was tested on 920 patients with slides prepared in the UK, and then independently validated according to a predefined protocol in 1122 patients treated with single-agent capecitabine using slides prepared in Norway. All cohorts included only patients with resectable tumours, and a formalin-fixed, paraffin-embedded tumour tissue block available for analysis. The primary outcome was cancer-specific survival. FINDINGS: 828 patients from four cohorts had a distinct outcome and were used as a training cohort to obtain clear ground truth. 1645 patients had a non-distinct outcome and were used for tuning. The biomarker provided a hazard ratio for poor versus good prognosis of 3·84 (95% CI 2·72-5·43; p<0·0001) in the primary analysis of the validation cohort, and 3·04 (2·07-4·47; p<0·0001) after adjusting for established prognostic markers significant in univariable analyses of the same cohort, which were pN stage, pT stage, lymphatic invasion, and venous vascular invasion. INTERPRETATION: A clinically useful prognostic marker was developed using deep learning allied to digital scanning of conventional haematoxylin and eosin stained tumour tissue sections. The assay has been extensively evaluated in large, independent patient populations, correlates with and outperforms established molecular and morphological prognostic markers, and gives consistent results across tumour and nodal stage. The biomarker stratified stage II and III patients into sufficiently distinct prognostic groups that potentially could be used to guide selection of adjuvant treatment by avoiding therapy in very low risk groups and identifying patients who would benefit from more intensive treatment regimes. FUNDING: The Research Council of Norway.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Aprendizaje Profundo , Anciano , Biomarcadores de Tumor/metabolismo , Estudios de Cohortes , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/terapia , Detección Precóz del Cáncer/métodos , Eosina Amarillenta-(YS)/metabolismo , Femenino , Hematoxilina/metabolismo , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos
18.
Br J Radiol ; 93(1106): 20190886, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-31912757

RESUMEN

OBJECTIVE: To describe the posterior labral lesions and labrocapsular abnormalities of the shoulder on sonoarthrography and to compare these findings with MR arthrography results. METHODS: 82 shoulders were initially evaluated with ultrasonography and MRI and then were examined with sonoarthrography and MR arthrography following intraarticular injection of diluted gadolinium solution. The ultrasonography images were prospectively evaluated for the presence of posterior labral tear, sublabral cleft, and posterior capsular abnormalities by two radiologists. The diagnostic accuracy of sonoarthrography in the detection of posterior labral tears and posterior labrocapsular variants was compared with that of MR arthrography. RESULTS: In sonoarthrographic examinations of 82 shoulders, 5 and 6 posterior labral tears were identified by Observer 1 and 2, respectively. Moreover, 6 and 7 posterior sublabral clefts, and 2 and 3 posterior synovial folds were identified by Observer 1 and 2, respectively. All the 82 patients were examined with MR arthrography; however, only 14 patients underwent arthroscopic examination. No significant difference was found among the 82 patients with regard to age, gender, and the prevalence of posterior labral tear, posterior labral cleft, and posterior synovial fold (p > 0.05). Interobserver variability showed substantial agreement between the sonoarthrographic and MR arthrographic results of the posterior labrocapsular structures (κ = 0.71, p < 0.05). CONCLUSION: Posterior labral tears and posterior synovial folds of the shoulder joint can be evaluated non-invasively by sonoarthrography. ADVANCES IN KNOWLEDGE: Variations and pathologies of posterior labrocapsular structures of the glenohumeral joint are relatively uncommon.Direct (MR) arthrography is the gold-standard imaging modality to evaluate of posterior labrocapsular abnormalities of the glenohumeral joint.Sonoarthrography of the glenohumeral joint may be utilized in clinical practice in patients with contraindications to (MRI).


Asunto(s)
Artrografía/métodos , Lesiones del Hombro/diagnóstico , Adolescente , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Imagen Multimodal/métodos , Estudios Prospectivos , Rotura Espontánea , Luxación del Hombro/diagnóstico , Articulación del Hombro , Ultrasonografía , Adulto Joven
19.
Int J Oral Maxillofac Implants ; 35(35): 197-206, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31923303

RESUMEN

PURPOSE: Numerous approaches have been proposed for the treatment of peri-implantitis, but to date, none has been identified as the most effective. This study compared the efficacy of implantoplasty and glycine air polishing for the surgical treatment of peri-implantitis. MATERIALS AND METHODS: This prospective, randomized, parallel-group trial included 31 patients presenting with 42 implants with peri-implantitis. Patients underwent surgical treatment by implantoplasty (test group, n = 22) or glycine air polishing (control group, n = 20). Clinical parameters (Plaque Index), bleeding on probing (BOP), suppuration on probing (SOP), probing pocket depth (PPD), relative attachment level (RAL), and mucosal recession were assessed before surgery (baseline), and at 3 months and 6 months after surgery. Bone loss was recorded at baseline and 6 months. Two composite outcomes were also evaluated, according to the following definitions: (1) mean PPD reduction ≥ 0.5 mm + no further loss of bone; (2) PPD ≤ 5 mm, absence of BOP/SOP, and no additional mean bone loss ≥ 0.5 mm. RESULTS: Plaque Index remained low (< 0.5) in both groups for the duration of the study. Mean BOP, SOP, PPD, and RAL were greatly reduced at 3 months in both groups, and remained low between 3 months and 6 months. Bone loss was stable in the implantoplasty group, and slight bone gain (0.5 mm) was observed in the glycine air-polishing group. There were no significant differences between the two groups in any parameter, and composite treatment outcomes were similar in both groups, irrespective of the definition. CONCLUSION: Within the limitations of this 6-month follow-up study, implantoplasty is as effective as glycine air polishing for the surgical treatment of peri-implantitis.


Asunto(s)
Abrasión Dental por Aire , Glicina , Periimplantitis , Estudios de Seguimiento , Glicina/administración & dosificación , Humanos , Periimplantitis/cirugía , Índice Periodontal , Estudios Prospectivos , Resultado del Tratamiento
20.
Medicine (Baltimore) ; 99(4): e18961, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977913

RESUMEN

This study explored whether sympathovagal modulation assessed through frequency domains of heart rate variability (HRV) can indicate sepsis in patients with suspected infection.In total, 370 consecutive adult patients with suspected infection admitted to the emergency department were enrolled in this single-center cohort study. A continuous 10-minute electrocardiography for HRV analysis was recorded immediately for these patients after inclusion. Patients were stratified into non-sepsis and sepsis groups based on a sepsis-related organ failure assessment score of ≥2 that met the Third International Consensus Definitions for Sepsis. Seven frequency domains of HRV were compared between these 2 groups.Compared with the non-sepsis group (n = 98), the sepsis group (n = 272) had a significantly lower incidence of respiratory tract infection, higher total power, higher very-low-frequency component, higher high-frequency (HF) component, higher normalized HF component, lower normalized low-frequency (LF) component, and lower LF component/HF component ratio (LF/HF). Multiple logistic regression model identified HF component (odds ratio [OR] = 0.994; 95% confidence interval [CI], 0.990-0.999) and LF/HF (OR = 0.494; 95% CI, 0.423-0.578) as significant variables associated with sepsis. The area under receiver operating characteristic curves of HF component and LF/HF was 0.741 (95% CI, 0.685-0.797) and 0.930 (95% CI, 0.900-0.960), respectively, in identifying sepsis in patients with suspected infection.Tilted sympathovagal balance toward increased vagal activity and depressed sympathetic modulation, assessed by the HF component and LF/HF, may indicate sepsis in patients with suspected infection.


Asunto(s)
Frecuencia Cardíaca , Sepsis/diagnóstico , Nervio Vago/fisiopatología , Anciano , Estudios de Casos y Controles , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Estudios Prospectivos , Sensibilidad y Especificidad , Sepsis/fisiopatología
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