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1.
Medicine (Baltimore) ; 99(2): e18504, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914021

RESUMEN

We aimed to evaluate the clinical significance of bacterial coexistence and the coinfection dynamics between bacteria and respiratory viruses among young children. We retrospectively analyzed clinical data from children aged < 5 years hospitalized with a community-acquired single respiratory viral infection of influenza, adenovirus, or RSV during 2 recent consecutive influenza seasons. Remnant respiratory specimens were used for bacterial PCR targeting Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.A total of 102 children were included; median age was 0.8 years and 44.1% had underlying comorbidities. Overall, 6.8% (7/102) of cases were classified as severe diseases requiring intensive care unit admission and/or mechanical ventilation and ranged from 8.8% for a patient with RSV and 7.6% for those with adenovirus to 0% for those with influenza viruses. The overall viral-bacterial codetection rate was 59.8% (61/102); M catarrhalis was the most frequent (33.3%), followed by H influenzae (31.4%). Influenza cases showed higher bacterial codetection rates (80.0%; 8/10) compared with those with adenoviruses (69.2%; 9/13) and RSV (55.7%; 44/79). S pneumoniae and H influenzae codetections were associated with reduced severity (aOR, 0.24; 95% CI, 0.07-0.89), and reduced risk of wheezing (aOR, 0.36; 95% CI, 0.13-0.98), respectively.We observed the interactions between respiratory viruses and bacteria and the clinical significance of viral-bacterial coexistence in upper airway on disease severity. Future study will be necessary to elucidate the active interactions between different viruses and bacteria and give clues to risk stratified strategy in the management of respiratory infections among young children.


Asunto(s)
Adenoviridae/aislamiento & purificación , Haemophilus influenzae/aislamiento & purificación , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/virología , Infecciones por Adenoviridae/diagnóstico , Infecciones por Adenoviridae/virología , Bacterias/genética , Preescolar , Coinfección/microbiología , Coinfección/virología , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/virología , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , Gripe Humana/diagnóstico , Gripe Humana/virología , Masculino , Prevalencia , Ruidos Respiratorios/diagnóstico , Ruidos Respiratorios/etiología , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Infecciones por Virus Sincitial Respiratorio/virología , Virus Sincitiales Respiratorios/genética , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Staphylococcus aureus/aislamiento & purificación , Streptococcus pneumoniae/aislamiento & purificación , Virus/genética
2.
Medicine (Baltimore) ; 99(2): e18508, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914022

RESUMEN

This is a retrospective evaluated. The objective of this study was to test the interobserver reliability and intraobserver reproducibility of fracture classification with Arbeitsgemeinschaftfür Osteosynthesefragen (AO) system and Fernandez system used by 5 senior orthopedic surgeons.Anteroposterior and lateral radiographs of 160 patients hospitalized for displaced distal radius fracture were examined. Independently, 5 orthopedic surgeons evaluated the radiographs according to 2 different distal radius classification systems (3 types of results). Three statistical tools were used to measure interobserver reliability and intraobserver reproducibility. The intraclass correlation coefficient and kappa coefficient (k) were used to assess both interobserver and intraobserver agreement of AO and Fernandez. Kappa value indicated poor agreement (<0), slight (0-0.20), fair (0.21-0.40), moderate (0.41-0.60), good (0.61-0.80), and perfect (0.81-1.00).The intraobserver reproducibility of AO system (9 types) and Fernandez system were moderate with a value of 0.577 and 0.438. The intraobserver reproducibility of AO system (27 subtypes) was 0.286. The interobserver reliability of AO system (9 types) was moderate with a value of 0.469 and that of Fernandez was moderate with a value of 0.435. The interobserver reliability of AO system (27 subtypes) was 0.299.Neither of the 2 systems can give us a satisfactory agreement between interobserver reliability and intraobserver reproducibility. In AO system, the interobserver reliability and intraobserver reproducibility of the 9 types decreased with the increase of subgroups.


Asunto(s)
Fracturas del Radio/clasificación , Fracturas del Radio/diagnóstico por imagen , Reproducibilidad de los Resultados , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Cirujanos Ortopédicos , Radiografía/métodos , Estudios Retrospectivos , Adulto Joven
3.
Medicine (Baltimore) ; 99(2): e18517, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914024

RESUMEN

Atrial fibrillation (AF) is an important complication of acute myocardial infarction (AMI). The association between AF and serum lipid profile is unclear and statin use for lowering the incidence of new-onset AF remains controversial. The objective of this study was to investigate whether statins confer a beneficial effect on AF after AMI.Data available in the Taiwan National Health Insurance Research Database on 32886 AMI patients between 2008 and 2011 were retrospectively analyzed. Total 27553 (83.8%) had complete 1-yr follow-up data. Cardiovascular outcomes were analyzed based on the baseline characteristics and AF type (existing, new-onset, or non-AF). AF groups had significantly higher incidence of heart failure (HF), stroke, all-cause death, and major adverse cardiac and cerebrovascular event (MACCE) after index AMI (all P < .05). In contrast, myocardial re-infarction (re-MI) was not significantly different among the three groups (P = .95). Statin use tended to be associated with lower risk of new-onset AF after AMI (HR: 0.935; 95% confidence interval (CI): 0.877-0.998; P = .0427).Existing AF and new-onset AF subgroups had similar cardiovascular outcomes after AMI and were both inferior to the non-AF group. Statin tended to reduce new-onset AF after AMI.


Asunto(s)
Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/prevención & control , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Infarto del Miocardio/complicaciones , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/fisiopatología , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Estudios Retrospectivos , Accidente Cerebrovascular/complicaciones , Taiwán/epidemiología
4.
Medicine (Baltimore) ; 99(2): e18539, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914027

RESUMEN

The purpose of this study was to determine the factors associated with parenteral nutrition-associated liver disease (PNALD) in infants who underwent surgery for necrotizing enterocolitis (NEC) and followed up the postoperative outcomes for long term parenteral nutrition (PN).This study included a retrospective review of 87 infants with NEC and managed surgically from July 2007 to May 2017 at the Children's Hospital, Chongqing Medical University. Clinical data and procedure information were collected and analyzed.Among the infants included, 16.1% of patients developed PNALD. Multivariable logistic regression analysis revealed progressive clinical deterioration (OR, 5.47; 95% CI, 1.10-26.96; P = .037) was independent risk factor for PNALD whereas congenital heart disease (OR, 0.068; 95% CI, 0.008-0.55; P = .012) presentation served as a protective factor.The current data suggested the distinct disease process for cardiac patients with NEC, which might help in the prevention and treatment of PNALD for patients with NEC.


Asunto(s)
Enterocolitis Necrotizante/complicaciones , Enterocolitis Necrotizante/cirugía , Hepatopatías/etiología , Nutrición Parenteral/efectos adversos , Enterocolitis Necrotizante/dietoterapia , Enterocolitis Necrotizante/mortalidad , Femenino , Edad Gestacional , Cardiopatías Congénitas/epidemiología , Cardiopatías Congénitas/mortalidad , Humanos , Enfermedad Iatrogénica/epidemiología , Enfermedad Iatrogénica/prevención & control , Incidencia , Lactante , Recién Nacido , Hepatopatías/diagnóstico , Hepatopatías/epidemiología , Masculino , Estudios Retrospectivos , Factores de Riesgo
5.
Medicine (Baltimore) ; 99(2): e18545, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914029

RESUMEN

This study aimed to determine the impact of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) on the prognosis of nasopharyngeal carcinoma (NPC) before and after intensity modulated radiotherapy (IMRT).Pre/post-treatment and changes in inflammatory biomarker levels of 207 patients who were diagnosed with NPC and received IMRT between January 2012 and December 2014 were analyzed, and the cellular biomarker analyses were from patient blood. ROC (receiver operating characteristic) analysis was used to decide the optimal cutoff values of NLR and changes in NLR (ΔNLR) and PLR (ΔPLR). The Kaplan-Meier and logarithmic rank methods were used to compare overall survival times between groups. Univariate analysis was used to investigate the effects of age, gender, histology, Karnofsky performance score (KPS), TNM stage, clinical stage, course of disease and lymphocyte, neutrophil and platelet counts as well as alkaline phosphatase (ALP) levels on the prognosis of NPC. The independent predictors of OS were determined by Cox multivariate regression analysis.The optimal cut-off values of NLR, PLR, ΔNLR and ΔPLR were 2.49, 155.82, 1.80, and 100.00, respectively. These were used to classify patients into high (NLR > 2.49) and low NLR groups (NLR < 2.49); high (PLR>155.82) and low (PLR < 155.82) PLR groups; high (ΔNLR>1.80) and low ΔNLR groups (ΔNLR < 1.80); high (ΔPLR > 100.00) and low ΔPLR groups (ΔPLR < 100.00). TNM stage, clinical stage and ALP levels were highly correlated with high NLR and PLR. Cox multivariate regression analysis suggested that the ΔNLR (HR = 2.89, 95% CI: 1.33∼2.78) was independent of the characteristics for NPC.As a novel inflammatory index, ΔNLR appears to have some predictive power for the prognosis of patients with NPC.


Asunto(s)
Linfocitos/efectos de la radiación , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Neutrófilos/efectos de la radiación , Radioterapia de Intensidad Modulada/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Fosfatasa Alcalina/sangre , Recuento de Células Sanguíneas , Plaquetas/patología , Plaquetas/efectos de la radiación , Femenino , Humanos , Linfocitos/patología , Masculino , Persona de Mediana Edad , Carcinoma Nasofaríngeo/mortalidad , Carcinoma Nasofaríngeo/patología , Neoplasias Nasofaríngeas/mortalidad , Neoplasias Nasofaríngeas/patología , Estadificación de Neoplasias/métodos , Neutrófilos/patología , Valor Predictivo de las Pruebas , Pronóstico , Radioterapia de Intensidad Modulada/métodos , Estudios Retrospectivos
6.
Isr Med Assoc J ; 22(1): 8-12, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927798

RESUMEN

BACKGROUND: Heart failure centers with specialized nurse-supervised management programs have been proposed to improve prognosis. The Heart Failure Center in Beit Shemesh, Israel, is located within a large primary care facility. The specialist team supervised the managememt of patients both within the frame of the center and while they were hospitalized. OBJECTIVES: To evaluate the health services utilization by heart failure patients treated at a heart failure center and their clinical outcome. METHODS: In this retrospective study, we compared the clinical outcome of patients treated at a heart failure center to patients who received the standard care in 2013-2014. The clinical outcome included primary care visits, emergency room visits, hospitalizations, and death. RESULTS: The study comprised 430 heart failure patients; 82 were treated at the heart failure center and 348 under standard care. At baseline, no significant differences were seen in clinical parameters between the groups. Healthcare utilization was higher among the study group. No significant changes in healthcare utilization were found. During follow-up, patients treated in a heart failure center were more likely to get recommended heart failure medications. Mortality was significantly lower in patients treated in the heart failure center compared with those receiving standard care 3.6% vs. 24%, respectively (P = 0.001), hazard ratio 0.19, 95% confidence interval 0.06-0.62, P = 0.005. CONCLUSIONS: Joint management of heart failure by primary clinics and a specialized community heart failure center reduced mortality. There was no decrease in healthcare utilizations among heart failure center patients, despite the reduction in mortality.


Asunto(s)
Centros Comunitarios de Salud/estadística & datos numéricos , Insuficiencia Cardíaca/terapia , Anciano , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Estudios Retrospectivos
7.
Isr Med Assoc J ; 22(1): 13-16, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927799

RESUMEN

BACKGROUND: During Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) the surgeon operates exclusively through a single vaginal entry point, leaving no external scarring. OBJECTIVES: To evaluate the learning curve of vNOTES hysterectomy by experienced gynecologists based on surgical times and short-term outcomes. METHODS: A retrospective study was conducted of the first 25 vNOTES hysterectomy surgeries performed from July to December 2018 at Rambam Health Care Campus by a single surgeon. The primary outcome was hysterectomy time. Secondary outcomes included intra-operative bleeding, length of hospitalization, postoperative pain, and need for analgesia. Socio-demographic and clinical data were retrieved from patient electronic medical charts. RESULTS: Median age was 64.5 years (range 40-79). Median hysterectomy time was 38 minutes (range 30-49) from the first cut until completion. Comparisons between median hysterectomy time in the first 10 hysterectomies and in the 15 subsequent procedures demonstrated a significant decrease in median total time: 45 minutes (range 41-49) vs. 32 minutes (range 30-38), respectively (P = 0.024). The median estimated intraoperative blood loss decreased from 100 ml (range 70-200) in the first 10 hysterectomies to 40 ml (range 20-100) in the subsequent procedures (P = 0.011). CONCLUSIONS: vNOTES hysterectomy is feasible by an experienced gynecologist, with an exponential improvement in surgical performance in a short period as expressed by the improvement in hysterectomy time, low complication rates, negligible blood loss, minimal post-surgical pain, fast recovery, and short hospitalization. vNOTES allows easier and safer access to adnexal removal compared to conventional vaginal surgery.


Asunto(s)
Ginecología/educación , Histerectomía Vaginal/educación , Curva de Aprendizaje , Cirugía Endoscópica por Orificios Naturales/educación , Adulto , Anciano , Femenino , Humanos , Histerectomía Vaginal/métodos , Persona de Mediana Edad , Cirugía Endoscópica por Orificios Naturales/métodos , Tempo Operativo , Estudios Retrospectivos , Resultado del Tratamiento
8.
Isr Med Assoc J ; 22(1): 17-21, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927800

RESUMEN

BACKGROUND: Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) is associated with decreased perioperative morbidity and mortality. OBJECTIVES: To report the outcomes of EVAR among patients older than 80 years of age. METHODS: In this retrospective study, we reviewed patients older than 80 years of age who underwent elective EVAR at our institution between 2007 and 2017. The demographics, perioperative morbidity and mortality, and long-term results are reported. RESULTS: During the study period, 444 patients underwent elective EVAR for AAAs. Among them 128 patients (29%) were > 80 years of age. Mean age was 84 ± 3.4 (range 80-96) years, and 110 patients (86%) were male. The EVAR was technically successful in 127 patients (99%) and there were intraoperative mortalities. Within 30 days of the surgery, nine patients (7%) died. Major and minor adverse events occurred in 26 (20%) and 59 (46%) patients, respectively. Factors associated with increased risk of perioperative morbidity and mortality included chronic kidney disease, peripheral artery disease, and the existence of three or more co-morbidities. CONCLUSIONS: EVAR in the elderly can be performed with a high rate of success; however, it is associated with a substantial rate of morbidity and mortality, particularly when patients present with multiple co-morbidities. When performing EVAR in this population group, the risk of rupture must be considered opposed to the life expectancy of these patients and the risk of perioperative morbidity and mortality.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Procedimientos Endovasculares/efectos adversos , Factores de Edad , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/mortalidad , Procedimientos Endovasculares/mortalidad , Femenino , Humanos , Masculino , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento
9.
Isr Med Assoc J ; 22(1): 43-47, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927805

RESUMEN

BACKGROUND: Temporary abdominal closure (TAC) surgical technique relates to a procedure in which the post-surgical abdominal wall remains open in certain indications. The Bogota bag (BB) technique is a tension-free TAC method that covers the abdominal contents with a sterilized fluid bag. There are very few reports of pediatric patients treated with this technique. OBJECTIVES: To describe our institution's 15 years of experience using the BB technique on pediatric patients. METHODS: A retrospective cohort study describing our experience treating patients with BB was conducted. The medical files of 17 pediatric patients aged 0-18 years were reviewed. RESULTS: Between January 2000 and December 2014, 17 patients were treated with BB at our medical center (6 females, median age 12 years). Indications for BB were a need for a surgical site re-exploration, mechanical inability for primary abdominal closure, and high risk for ACS development. Median BB duration was 5 days and median bag replacement was 2 days. Median ICU length of stay (LOS) was 10 days and hospital LOS was 27 days. The ICU admission and BB procedure was tolerated well by 6 patients who were discharged home without complications. Of the remaining 11 patients, 6 patients died during the admission (35%) and the others presented with major complications not related to the BB but to the patient's primary disease. CONCLUSIONS: This report represents the largest series of children treated with BB. The technique is simple to perform, inexpensive, and has very few complications.


Asunto(s)
Técnicas de Cierre de Herida Abdominal , Abdomen/cirugía , Pared Abdominal/cirugía , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos
10.
Isr Med Assoc J ; 22(1): 53-59, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927807

RESUMEN

BACKGROUND: Primary retroperitoneal neoplasms (PRN) arise from diverse retroperitoneal tissues. Soft tissue sarcomas (STS) comprise the majority and are well studied. Other non-sarcomatous PRN are very rare and less familiar. OBJECTIVES: To evaluate the clinicopathologic and radiologic features of non-sarcomatous PRN, as well as the outcome of complete tumor resection (TR). METHODS: Retrospective data were collected on consecutive patients (June 2006 to January 2015) who underwent resection of retroperitoneal lesions at our department. Final pathology of non-sarcomatous PRN was included. RESULTS: The study population included 36 patients (26% with PRN). PRN were neurogenic (17%), fat-containing (3%), and cystic (6%). The preoperative diagnosis was correct in only 28%. All patients underwent TR via laparotomy (72%) or laparoscopy (28%), for mean operative time of 120 ± 46 minutes. En bloc organ resection was performed in 11%. Complete TR was achieved in 97%. Intra-operative spillage occurred in 8%. Intra-operative, 90-day postoperative complications, and mortality rates were 11%, 36%, and 0%, respectively. The mean length of stay was 6.5 ± 5.5 days. The median overall survival was 53 ± 4.9 months. CONCLUSIONS: Familiarity with radiologic characteristics of PRN is important for appropriate management. Counter to STS, other PRN are mostly benign and have an indolent course. Radical surgery is not required, as complete TR confers good prognosis. Expectant management is reserved for small, asymptomatic, benign neoplasms.


Asunto(s)
Neoplasias Retroperitoneales/diagnóstico , Anciano , Femenino , Ganglioneuroma/diagnóstico , Ganglioneuroma/diagnóstico por imagen , Ganglioneuroma/patología , Ganglioneuroma/cirugía , Humanos , Lipoma/diagnóstico , Lipoma/diagnóstico por imagen , Lipoma/patología , Lipoma/cirugía , Masculino , Persona de Mediana Edad , Neurilemoma/diagnóstico , Neurilemoma/diagnóstico por imagen , Neurilemoma/patología , Neurilemoma/cirugía , Neurofibroma/diagnóstico , Neurofibroma/diagnóstico por imagen , Neurofibroma/patología , Neurofibroma/cirugía , Paraganglioma/diagnóstico , Paraganglioma/diagnóstico por imagen , Paraganglioma/patología , Paraganglioma/cirugía , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/patología , Neoplasias Retroperitoneales/cirugía , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
11.
Quintessence Int ; 51(2): 118-126, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31942573

RESUMEN

OBJECTIVE: Marginal bone loss (MBL), a prognostic parameter for implant success, is associated with implant- and patient-related variables. The purpose of this study was to analyze the effects of the crown-to-implant ratio and independent factors of implant diameter, implant length, implant type, location, and platform switching on distal and mesial MBLs at the 6-, 12-, 24-, and 36-month recall sessions of single crown implant-supported restorations. METHOD AND MATERIALS: Radiographic and clinical data of patients treated with single crown implants were collected. MBL was measured at the baseline and recall sessions on panoramic radiographs. The crown-to-implant ratio was calculated by dividing the length of the crown by that of the dental implant. RESULTS: The crown-to-implant ratio had a moderately positive correlation with distal MBL at the 6-month recall session (P < .05, r = 0.469) and a weakly positive correlation at the 12- (P < .05, r = 0.220), 24- (P < .05, r = 0.214), and 36- (P < .05, r = 0.250) month recall sessions. Distal and mesial MBL did not significantly differ among the four implant types at any recall session (P > .05). The crown-to-implant ratio had no significant correlation with mesial MBL at the 12-, 24-, or 36-month recall session (P > .05), and a moderately positive correlation at the 6-month recall session (P < .001, r = 0.434). CONCLUSIONS: MBL was similar among different implant types in the short and medium terms. There was a positive correlation between distal MBL and the crown-to-implant ratio.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Coronas , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Estudios de Seguimiento , Humanos , Estudios Retrospectivos
12.
Quintessence Int ; 51(2): 128-141, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31942574

RESUMEN

OBJECTIVES: The aim of this study was to determine the influence of patient-related systemic factors, local bone and intraoral factors, and implant-related factors on peri-implant marginal bone loss (MBL). METHOD AND MATERIALS: The following data were collected from patients who received dental implants and were recalled for examinations at least 3 years after treatment completion: medical history, age, sex, habits, periodontal health, implant size and surface, surgical procedure, prosthesis type, implant failure, Plaque Index, and oral hygiene. MBL was investigated using both baseline and follow-up panoramic radiographs. RESULTS: The study included 1,126 dental implants placed in 304 patients (185 [60.9%] women and 119 [39.1%] men). The mean age was 54.30 ± 13.52 years (range 22 to 83 years). The mean follow-up period was 58.8 ± 11.2 months. The MBL was observed in 271 (24.1%) implants, of which 160 (14.2%) were ≤ 2 mm and 111 (9.9%) were > 2 mm. Respective mean MBL values on mesial and distal sides were 0.42 ± 1.03 mm and 0.42 ± 1.02 mm. Of the implants, 19 (1.7%) were lost, leading to an implant success rate of 98.3%. Age, history of hysterectomy, history of periodontitis, oral hygiene, abrasions, smoking, implant location, implant surface, implant length, surgical procedure type, and prosthesis type were all found to be statistically significant for MBL (P < .05). Certain combinations of these factors resulted in increased MBL. CONCLUSION: In the present study, local factors had more significant effects on MBL than did systemic factors, and combinations of these factors had greater effects on MBL.


Asunto(s)
Pérdida de Hueso Alveolar , Enfermedades Óseas Metabólicas , Implantes Dentales , Adulto , Anciano , Anciano de 80 o más Años , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Radiografía Panorámica , Estudios Retrospectivos , Adulto Joven
14.
Anaesthesia ; 75 Suppl 1: e134-e142, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31903562

RESUMEN

The impact of the use of loop diuretics to prevent cumulative fluid balance in non-oliguric patients is uncertain. This is a retrospective study to estimate the association of time-averaging loop diuretic exposure in a large population of non-cardiac, critically ill patients with a positive fluid balance (> 5% of body weight). The exposure was loop diuretic and the main outcomes were 28-day mortality, severe acute kidney injury and successful mechanical ventilation weaning. Time-fixed and daily time-varying variables were evaluated with a marginal structural Cox model, adjusting bias for time-varying exposure and the presence of time-dependent confounders. A total of 14,896 patients were included. Patients receiving loop diuretics had better survival (unadjusted hazard ratio 0.56, 95%CI 0.39-0.81 and baseline variables adjusted hazard ratio 0.53, 95%CI 0.45-0.62); after full adjusting, loop diuretics had no association with 28-day mortality (full adjusted hazard ratio 1.07, 95%CI 0.74-1.54) or with reducing severe acute kidney injury occurrence during intensive care unit stay - hazard ratio 1.05 (95%CI 0.78-1.42). However, we identified an association with prolonged mechanical ventilation (hazard ratio 1.59, 95%CI 1.35-1.89). The main results were consistent in the sub-group analysis for sepsis, oliguria and the study period (2002-2007 vs. 2008-2012). Also, equivalent doses of up to 80 mg per day of furosemide had no significant association with mortality. After adjusting for time-varying variables, the time average of loop diuretic exposure in non-cardiac, critically ill patients has no association with overall mortality or severe acute kidney injury; however, prolonged mechanical ventilation is a concern.


Asunto(s)
Cuidados Críticos/métodos , Diuréticos/uso terapéutico , Equilibrio Hidroelectrolítico , Lesión Renal Aguda/prevención & control , Enfermedad Crítica , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Análisis de Supervivencia
16.
Anticancer Res ; 40(1): 405-412, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31892594

RESUMEN

BACKGROUND/AIM: To evaluate the outcomes of curative resection for Borrmann type IV gastric cancer through an analysis of the clinical, surgical and pathological data and through identifying which of these prognostic factors are associated with survival. PATIENTS AND METHODS: We retrospectively analyzed 2798 patients who had undergone excision of the primary lesion and 122 patients with type IV gastric cancer undergoing curative resection (R0 or 1) at Yokohama City University Hospital and Kanagawa Cancer Center between November 1995 and May 2016. RESULTS: Borrmann type IV gastric cancer had more advanced and unfavorable clinicopathological factors compared to other types. The 5-year overall survival rate was 28%, and the median survival was 21.8 months. The overall survival rate was influenced by the depth of invasion, lymph node metastasis, peritoneal lavage cytology (CY), stage and intraoperative blood loss. Of these, independent prognostic factors were intraoperative blood loss (<400 vs. ≥400 ml, risk ratio 1.64; p=0.045) and CY (0 vs. 1, risk ratio 2.25; p=0.004). CONCLUSION: The control of intraoperative bleeding had a positive impact on the survival of patients receiving curative resection for Borrmann type IV gastric cancer.


Asunto(s)
Pérdida de Sangre Quirúrgica , Cuidados Intraoperatorios , Neoplasias Gástricas/cirugía , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Recurrencia Local de Neoplasia/patología , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Resultado del Tratamiento
17.
Anticancer Res ; 40(1): 427-433, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31892597

RESUMEN

BACKGROUND/AIM: The role of anti-PD1/PD-L1 therapy (IO) in NSCLC harboring driver mutations is questionable. This study aimed to examine the efficacy of IO in patients with non-small cell lung cancer (NSCLC) with a KRAS mutation (KRAS+). PATIENTS AND METHODS: We retrospectively identified NSCLC patients harboring KRAS mutation treated with IO in our Institution. We analyzed the results in comparison to non-KRAS patients. RESULTS: Among 328 consecutive KRAS+ NSCLC patients, 43 (13.1%) received IO in our Institution. In parallel 117 non-KRAS NSCLC patients treated with IO were selected for comparison. The baseline characteristics were similar between the two groups. No significant difference was observed between KRAS+ and non-KRAS patients in terms of mPFS (4.6 vs. 3.3 months, p=0.58) or OS (8.1 vs. 13.0 months, p=0.38). CONCLUSION: KRAS mutations seem to be irrelevant for selecting patients for IO that could be therefore considered an effective therapy for NSCLC patients, independently of KRAS status.


Asunto(s)
Antígeno B7-H1/antagonistas & inhibidores , Carcinoma de Pulmón de Células no Pequeñas/genética , Carcinoma de Pulmón de Células no Pequeñas/terapia , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/terapia , Mutación/genética , Receptor de Muerte Celular Programada 1/antagonistas & inhibidores , Proteínas Proto-Oncogénicas p21(ras)/genética , Anciano , Antígeno B7-H1/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Receptor de Muerte Celular Programada 1/metabolismo , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento
18.
Anticancer Res ; 40(1): 459-464, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31892601

RESUMEN

BACKGROUND/AIM: This study compared the dose distributions of carbon ion radiotherapy (C-ion RT) and intensity-modulated radiotherapy (IMRT) in patients with locally advanced hepatocellular carcinoma (LAHCC). PATIENTS AND METHODS: A retrospective analysis was conducted in 10 consecutive patients with LAHCC who had undergone C-ion RT. The dose-volume histogram parameters of clinical plans using C-ion RT at 60 Gy and simulated plans using IMRT at 60 Gy and 50 Gy were compared. We measured the percentage of the normal liver volume that received at least 5 Gy (V5), 10 Gy (V10), 20 Gy (V20), 30 Gy (V30), 40 Gy (V40), and 50 Gy (V50). RESULTS: The V5, V10, V20, and the mean liver dose were significantly lower in patients who received 60 Gy of C-ion RT than in those who received 50 or 60 Gy of IMRT. CONCLUSION: C-ion RT exhibits a better liver dose distribution than IMRT in patients with LAHCC.


Asunto(s)
Carcinoma Hepatocelular/radioterapia , Radioterapia de Iones Pesados , Neoplasias Hepáticas/radioterapia , Radioterapia de Intensidad Modulada , Carcinoma Hepatocelular/diagnóstico por imagen , Relación Dosis-Respuesta en la Radiación , Humanos , Hígado/patología , Hígado/efectos de la radiación , Neoplasias Hepáticas/diagnóstico por imagen , Estadificación de Neoplasias , Dosificación Radioterapéutica , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Carga Tumoral
19.
Bone Joint J ; 102-B(1): 108-116, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31888356

RESUMEN

AIMS: Limited evidence is available on mid-term outcomes of robotic-arm assisted (RA) partial knee arthroplasty (PKA). Therefore, the purpose of this study was to evaluate mid-term survivorship, modes of failure, and patient-reported outcomes of RA PKA. METHODS: A retrospective review of patients who underwent RA PKA between June 2007 and August 2016 was performed. Patients received a fixed-bearing medial or lateral unicompartmental knee arthroplasty (UKA), patellofemoral arthroplasty (PFA), or bicompartmental knee arthroplasty (BiKA; PFA plus medial UKA). All patients completed a questionnaire regarding revision surgery, reoperations, and level of satisfaction. Knee Injury and Osteoarthritis Outcome Scores (KOOS) were assessed using the KOOS for Joint Replacement Junior survey. RESULTS: Mean follow-up was 4.7 years (2.0 to 10.8). Five-year survivorship of medial UKA (n = 802), lateral UKA (n = 171), and PFA/BiKA (n = 35/10) was 97.8%, 97.7%, and 93.3%, respectively. Component loosening and progression of osteoarthritis (OA) were the most common reasons for revision. Mean KOOS scores after medial UKA, lateral UKA, and PFA/BiKA were 84.3 (SD 15.9), 85.6 (SD 14.3), and 78.2 (SD 14.2), respectively. The vast majority of the patients reported high satisfaction levels after RA PKA. Subgroup analyses suggested tibial component design, body mass index (BMI), and age affects RA PKA outcomes. Five-year survivorship was 98.4% (95% confidence interval (CI) 97.2 to 99.5) for onlay medial UKA (n = 742) and 99.1% (95% CI 97.9 to 100) for onlay medial UKA in patients with a BMI < 30 kg/m2 (n = 479). CONCLUSION: This large single-surgeon study showed high mid-term survivorship, satisfaction levels, and functional outcomes in RA UKA using metal-backed tibial onlay components. In addition, favourable results were reported in RA PFA and BiKA. Cite this article: Bone Joint J 2020;102-B(1):108-116.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Prótesis de la Rodilla/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/métodos , Índice de Masa Corporal , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Medición de Resultados Informados por el Paciente , Falla de Prótesis , Reoperación/estadística & datos numéricos , Estudios Retrospectivos
20.
Bone Joint J ; 102-B(1): 72-81, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31888363

RESUMEN

AIMS: The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with early death. METHODS: This was a retrospective cohort study of consecutive patients referred to the orthopaedic department at a UK trauma centre with a proximal femoral metastasis (PFM) over a seven-year period (2010 to 2016). The study group were compared to a matched control group of non-metastatic hip fractures. Minimum follow-up was one year. RESULTS: There was a 90-day mortality of 46% in patients with metastatic hip fractures versus 12% in controls (89/195 and 24/192, respectively; p < 0.001). Mean time to surgery was longer in symptomatic metastases versus complete fractures (9.5 days (SD 19.8) and 3.4 days (SD 11.4), respectively; p < 0.05). Albumin, urea, and corrected calcium were all independent predictors of early mortality and were used to generate a simple tool for predicting 90-day mortality, titled the Metastatic Early Prognostic (MEP) score. An MEP score of 0 was associated with the lowest risk of death at 30 days (14%, 3/21), 90 days (19%, 4/21), and one year (62%, 13/21). MEP scores of 3/4 were associated with the highest risk of death at 30 days (56%, 5/9), 90 days (100%, 9/9), and one year (100%, 9/9). Neither age nor primary cancer diagnosis was an independent predictor of mortality at 30 and 90 days. CONCLUSION: This score could be used to predict early mortality and guide perioperative counselling. The delay to surgery identifies a potential window to intervene and correct these abnormalities with the aim of improving survival. Cite this article: Bone Joint J. 2020;102-B(1):72-81.


Asunto(s)
Neoplasias Femorales/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/metabolismo , Estudios de Casos y Controles , Femenino , Neoplasias Femorales/secundario , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Escocia/epidemiología , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Tiempo de Tratamiento
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