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1.
Cir. Esp. (Ed. impr.) ; 100(10): 635-640, oct. 2022. ilus, tab
Artículo en Inglés | IBECS | ID: ibc-208275

RESUMEN

Introduction Endoscopic resection offers advantages over surgical resection for early colorectal cancer (ECC). However, there might be a presumed risk of recurrence. We aimed to determine the risk of recurrence after endoscopic removal of ECC. Methods A single-centre series of endoscopic resections for ECC. Patients were stratified according to four risk factors: positive resection margins, Haggitt 4, lymphatic/vascular invasion and tumour budding. Results We included 127 patients. Haggitt classification was grade 4 in 54.0%. Positive margins were found in 43 (33.9%), 16 (12.6%) had lymphatic or vascular invasion, and 5 (4.0%) had high grade budding. In 82 (64.5%) endoscopic excision was the definitive treatment, 45 (35.4%) underwent surgery. Six patients (13.3%) had residual tumour on specimen and/or node metastases. Postoperative complications occurred in ten (22.2%). At a median follow-up of 63 months, none of the 82 patients treated with endoscopic resection alone had recurrence. After stratifying patients according to risk factors, those who had residual tumour also had ≥2 risk factors. Conclusions Endoscopic follow up might be a valid option for patients with ECC. A risk-adjusted management seems prudent (AU)


Introducción La resección endoscópica ofrece claras ventajas frente a la cirugía en el tratamiento del cáncer de colon inicial (ECC). Sin embargo, existe un riesgo de recurrencia tanto a nivel del lecho de polipectomía como a nivel ganglionar. El objetivo del estudio es determinar el riesgo de recurrencia tras la resección endoscópica del ECC. Métodos Serie retrospectiva unicéntrica de resecciones endoscópicas de ECC. Se analizaron cuatro factores de riesgo en la pieza de polipectomía: el margen de resección afecto, Haggitt 4, invasión linfovascular y la presencia de budding tumoral. Resultados Se incluyeron 127 pacientes: Haggitt 4 en el 54%, margen de resección afecto en el 33,9%, infiltración linfática o vascular en el 12,6% y budding tumoral de alto grado en el 4%. En 82 pacientes (64,5%), la resección endoscópica fue el tratamiento definitivo. En 45 (35,4%) se realizó una colectomía oncológica. Seis pacientes (13,3%) presentaron tumor residual en el lecho de la polipectomía y/o a nivel de los ganglios linfáticos. La morbilidad postoperatoria fue del 22% y la mortalidad del 0%. Tras un seguimiento medio de 63 meses, ninguno de los 82 pacientes del grupo de polipectomía presentó recurrencia tumoral. Tras dividir a los pacientes según el número de factores de riesgo presentes, aquellos que presentaron tumor residual en la pieza de colectomía presentaban a su vez ≥ 2 factores de riesgo. Conclusiones El seguimiento endoscópico puede ser una opción válida en los pacientes con ECC. El manejo de estos pacientes debe ajustarse al riesgo individual, en función del número de factores de riesgo (AU)


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Detección Precoz del Cáncer , Neoplasias Colorrectales/diagnóstico por imagen , Endoscopía , Estudios Retrospectivos , Estudios Longitudinales , Estudios de Seguimiento , Factores de Riesgo
2.
JAMA Netw Open ; 5(9): e2231790, 2022 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-36107425

RESUMEN

Importance: Relatively little is known about the persistence of symptoms in patients with COVID-19 for more than 1 year after their acute illness. Objective: To assess the health outcomes among hospitalized COVID-19 survivors over 2 years and to identify factors associated with increased risk of persistent symptoms. Design, Setting, and Participants: This was a longitudinal cohort study of patients who survived COVID-19 at 2 COVID-19-designated hospitals in Wuhan, China, from February 12 to April 10, 2020. All patients were interviewed via telephone at 1 year and 2 years after discharge. The 2-year follow-up study was conducted from March 1 to April 6, 2022. Statistical analysis was conducted from April 20 to May 5, 2022. The severity of disease was defined by World Health Organization guideline for COVID-19. Exposures: COVID-19. Main Outcomes and Measures: The main outcome was symptom changes over 2 years after hospital discharge. All patients completed a symptom questionnaire for evaluation of symptoms, along with a chronic obstructive pulmonary disease assessment test (CAT) at 1-year and 2-year follow-up visits. Results: Of 3988 COVID-19 survivors, a total of 1864 patients (median [IQR] age, 58.5 [49.0-68.0] years; 926 male patients [49.7%]) were available for both 1-year and 2-year follow-up visits. The median (IQR) time from discharge to follow-up at 2 years was 730 (719-743) days. At 2 years after hospital discharge, 370 patients (19.8%) still had symptoms, including 224 (12.0%) with persisting symptoms and 146 (7.8%) with new-onset or worsening of symptoms. The most common symptoms were fatigue, chest tightness, anxiety, dyspnea, and myalgia. Most symptoms resolved over time, but the incidence of dyspnea showed no significant change (1-year vs 2-year, 2.6% [49 patients] vs 2.0% [37 patients]). A total of 116 patients (6.2%) had CAT total scores of at least 10 at 2 years after discharge. Patients who had been admitted to the intensive care unit had higher risks of persistent symptoms (odds ratio, 2.69; 95% CI, 1.02-7.06; P = .04) and CAT scores of 10 or higher (odds ratio, 2.83; 95% CI, 1.21-6.66; P = .02). Conclusions and Relevance: In this cohort study, 2 years after hospital discharge, COVID-19 survivors had a progressive decrease in their symptom burden, but those with severe disease during hospitalization, especially those who required intensive care unit admission, had higher risks of persistent symptoms. These results are related to the original strain of the virus, and their relevance to infections with the Omicron variant is not known.


Asunto(s)
COVID-19 , COVID-19/epidemiología , COVID-19/terapia , China/epidemiología , Estudios de Cohortes , Disnea/epidemiología , Estudios de Seguimiento , Hospitalización , Humanos , Estudios Longitudinales , Masculino , Evaluación de Resultado en la Atención de Salud , SARS-CoV-2 , Sobrevivientes
4.
Ophthalmic Surg Lasers Imaging Retina ; 53(9): 506-513, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36107627

RESUMEN

Fluid in neovascular age-related macular degeneration is often used to assess patient response to anti-vascular endothelial growth factor therapy. Various studies theorize that early residual fluid (ERF), noted as persistence of intraretinal fluid and subretinal fluid after the anti-vascular endothelial growth factor loading phase (LP), may be predictive of visual outcomes. This meta-analysis examined the existing literature on the relationship between ERF and long-term visual acuity (VA) and found that those who were fluid-free after the LP tended to have the highest VA gains overall. Early intraretinal fluid appeared to be associated with reduced VA gains, whereas the impact of early sub-retinal fluid was more debated. For those with ERF, monthly or more frequent dosing regimens following the LP appeared most optimal for VA. As most studies in this review were post hoc analyses, this highlights the need for real-world studies investigating ERF and its effect on visual outcomes in neovascular age-related macular degeneration. [Ophthalmic Surg Lasers Imaging Retina 2022;53:506-513.].


Asunto(s)
Degeneración Macular , Ranibizumab , Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab , Factores de Crecimiento Endotelial/uso terapéutico , Estudios de Seguimiento , Humanos , Inyecciones Intravítreas , Degeneración Macular/tratamiento farmacológico , Ranibizumab/uso terapéutico , Tomografía de Coherencia Óptica/métodos , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular
5.
PLoS One ; 17(9): e0274271, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36107876

RESUMEN

BACKGROUND: Both albuminuria and depression are associated with cardiovascular disease, reflecting low-grade systemic inflammation and endothelial dysfunction. They share risk factors including weight, blood pressure, smoking and blood glucose levels. This longitudinal study aimed to examine bidirectional associations between depression symptoms, indexed by the Hospital Anxiety and Depression scale (HADS), and the inflammation marker albuminuria. METHODS: 2909 persons provided urine samples in both the second (HUNT2, 1995-97) and third wave (HUNT3, 2006-2008) of the Trøndelag Health Survey, Norway. We used a generalized linear regression model (GLM) and ANOVA to assess the association between albuminuria levels (exposure HUNT2) with depression symptoms (outcome in HUNT3); and between depression symptoms (exposure HUNT2) with albuminuria (outcome HUNT3). Depression symptoms were measured with the HADS Depression Scale, analyzed utilising the full 7 items version and analyses restricted to the first 4 items (HADS-D and HADS-4). We accounted for confounders including baseline individual levels of the exposure variables. RESULTS: In this 10-years follow-up study, we found no statistical evidence for an association between baseline depression symptoms and subsequent albuminuria, nor between baseline albuminuria and subsequent depression symptoms. For albuminuria, only 0.04% was explained by prior depression, and for depression, only 0.007% was explained by previous albuminuria levels. The results were essentially the same for the shorter HADS-4 measure. CONCLUSION: There does not appear to be a longitudinal association between albuminuria and depression measured by the HADS.


Asunto(s)
Albuminuria , Depresión , Albuminuria/epidemiología , Glucemia , Estudios de Cohortes , Depresión/complicaciones , Depresión/epidemiología , Estudios de Seguimiento , Humanos , Inflamación , Estudios Longitudinales , Proyectos de Investigación
7.
BMC Neurol ; 22(1): 351, 2022 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-36109690

RESUMEN

BACKGROUND: Cerebral vasospasm (CVS) is a leading cause of morbidity and mortality in patients after aneurysmal subarachnoid hemorrhage (aSAH). Endovascular treatment, including intraarterial infusion of drugs with vasodilation effects, and balloon- and stentriever angioplasty, are helpful but may achieve only short-term effects. There is a clinical need for long-lasting treatment of refractory recurrent vasospasm. We report our experience in stent implantation as a treatment for recurrent severe post-SAH vasospasm. METHODS: A retrospective analysis of our institutional database of 883 patients with SAH, managed between January 2010 and December 2021, was performed. Six patients were identified as having received intracranial stenting in the context of post-SAH cerebral vasospasm. All patients were initially treated with intra-arterial infusion of nimodipine and/or milrinone. Self-expanding intracranial stents were implanted during endovascular aneurysm treatment to enable access despite impaired perfusion (Group 1) or as a bail-out strategy after failed intraarterial drug infusion or mechanical treatment (Group 2). All stented patients received dual antiplatelet therapy (DAPT) for 6 months. RESULTS: Nine vessels in six patients with severe post-SAH vasospasm were stented. The stents were deployed in 16 vessel segments. All attempted implantations were technically successful. All patients demonstrated radiographic and clinical improvement of the vessel narrowing. No recurrent vasospasm or permanent vessel occlusion of the stented vessels was encountered. A thrombus formation in a Group 1 patient resolved under 4 mg eptifibatide IA infusion. During long-term angiographic follow-up, neither in-stent stenosis nor stent occlusion was found. CONCLUSIONS: Endovascular implantation of self-expanding stents is a potential ultima ratio strategy for patients with severe refractory post-SAH cerebral vasospasm. Stents with reduced thrombogenicity (avoiding DAPT) and bioabsorbable self-expanding stents might further advance this concept.


Asunto(s)
Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Vasoespasmo Intracraneal , Aneurisma de la Aorta Abdominal/complicaciones , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/efectos adversos , Eptifibatida/uso terapéutico , Estudios de Seguimiento , Humanos , Milrinona/uso terapéutico , Nimodipina/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Estudios Retrospectivos , Stents/efectos adversos , Vasoespasmo Intracraneal/diagnóstico por imagen , Vasoespasmo Intracraneal/etiología , Vasoespasmo Intracraneal/terapia
8.
BMJ Open ; 12(9): e056236, 2022 09 14.
Artículo en Inglés | MEDLINE | ID: mdl-36104136

RESUMEN

OBJECTIVES: To determine the associated factors for discontinuation of statin use 1 year after discharge in patients who survived from acute coronary syndrome (ACS) in China. SETTINGS: 75 hospitals across China. DESIGN: A cohort follow-up study. PARTICIPANTS: The study included 10 337 patients with ACS hospitalised in 2007-2010 and discharged with statins from 75 hospitals in China in the Clinical Pathways for Acute Coronary Syndromes in China Study-Phase 2 (CPACS-2), who were followed-up at 6 and 12 months postdischarge. PRIMARY OUTCOME MEASURES: The primary outcome was the discontinuation of statin use defined as not in current use of statin at either 6-month or 12-month follow-up. RESULTS: Multivariable logistic regression model showed that patients who did not have cholesterol measurement (adjusted OR=1.29; 95% CI: 1.10 to 1.50) and patients with either higher (1.27; 1.13 to 1.43) or lower dose of statin (1.22; 1.07 to 1.40), compared with those with standard dose, were more likely to discontinue the use of statin. In addition, patients on the CPACS-2 intervention pathway (adjusted OR=0.83; 95% CI: 0.74 to 0.94), patients with medical insurance (0.75; 0.67 to 0.85), history of hypertension (0.83; 0.75 to 0.92), high low-density lipoprotein cholesterol (0.70; 0.57 to 0.87) at the baseline, prior statin use (0.73; 0.63 to 0.84), use of atorvastatin (0.78; 0.70 to 0.88) and those who underwent percutaneous coronary intervention or coronary artery bypass grafting during hospitalisation (0.47; 0.43 to 0.53) were less likely to discontinue statin use. The 1-year statin discontinuation rate decreased from 29.5% in 2007-2008 to 17.8% in 2010 (adjusted OR=0.60; 95% CI: 0.51 to 0.70). CONCLUSION: Implementing clinical pathway, enhancing medical insurance coverage, strengthening health education in both physicians and patients, using statin at standard dosage may help improve the adherence to statin use after discharge in Chinese patients with ACS. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12609000491268).


Asunto(s)
Síndrome Coronario Agudo , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Síndrome Coronario Agudo/tratamiento farmacológico , Cuidados Posteriores , Australia , Estudios de Seguimiento , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Alta del Paciente
9.
BMC Public Health ; 22(1): 1762, 2022 09 16.
Artículo en Inglés | MEDLINE | ID: mdl-36114528

RESUMEN

BACKGROUND: We investigated the impact of weight change on mortality in a population-based cohort setting. METHODS: We conducted two weight measurements for 5436 participants aged ≥ 30 years with an approximate 3-year interval. Based on their weight change, we categorized participants to: > 5% weight loss, 3-5% weight loss, stable weight (± < 3%), 3-5% weight gain, > 5% weight gain. We followed participants for mortality annually up to March 20th 2018. We applied the multivariable Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of weight change categories for all-cause, cardiovascular (CV), and cancer mortality, considering stable weight as reference. The Cox models was adjusted for age, sex, educational level, body mass index, smoking status, hypertension, hypercholesterolemia, diabetes, and cardiovascular disease (CVD) at baseline. RESULTS: During a median follow-up of 14.4 years, 629 deaths (247 CV and 126 cancer deaths) have occurred. Over 5% weight loss and gain were associated with increased risk of all-cause mortality in multivariable analysis with HRs of 1.47 [95% CI: 1.17-1.85] and 1.27 [1.02-1.57], respectively; however, a 3-5% loss or gain did not alter the risk of all-cause mortality significantly. These significant risks for wight change > 5% were not modified by the presence of diabetes, obesity, and smoking status; however, the unfavorable impact of weight change on mortality events was more prominent in those older than > 65 years (P-value for interaction: 0.042). After excluding those with history of CVD, diabetes, and cancer during the weight measurements period, these associations significantly attenuated (HR: 1.29 [0.89-1.87] for > 5% weight loss and 1.12 [0.84-1.50] for > 5% weight gain). Additionally, a > 5% weight loss was also associated with about 60% higher risk for CV mortality (HR: 1.62 [1.15-2.28]), and a 3-5% weight loss was associated with about 95% higher risk of cancer mortality (HR: 1.95 [1.13-3.38]). CONCLUSIONS: Our findings showed a U-shaped association across weight change categories for all-cause mortality risk with over 5% weight gain and loss causing higher risk. Moreover, weight loss can have adverse impact on CV and cancer mortality events.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus , Neoplasias , Adulto , Estudios de Seguimiento , Glucosa , Humanos , Irán/epidemiología , Lípidos , Neoplasias/complicaciones , Sobrepeso/complicaciones , Factores de Riesgo , Aumento de Peso , Pérdida de Peso
10.
BMC Pregnancy Childbirth ; 22(1): 710, 2022 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-36115950

RESUMEN

BACKGROUND: Prenatal prescription of standard iron supplements to prevent iron deficiency appears not to be appropriate for all women and their children, as some women may be at risk of iron deficiency and others at risk of iron excess early in pregnancy. The present study aimed to assess whether prenatal iron supplementation adapted to the needs of each pregnant woman affects their child's neurodevelopment. METHODS: Follow-up of a community-based RCT involving 503 mother-child pairs. Non-anaemic pregnant women recruited in Tarragona (Spain) early in pregnancy were prescribed a daily iron dose based on their initial haemoglobin levels: Stratum 1 (Hb = 110-130 g/L, 80 or 40 mg/d of iron) and Stratum 2 (Hb > 130 g/L, 40 or 20 mg/d of iron). Women receiving 40 mg/d were considered the control group in each Strata. The child's neurodevelopment was assessed at 40 days of age using the Bayley Scales of Infant Development-III (BSID-III). Adjusted multiple regression models were used. RESULTS: Multiple regression analyses showed no association between the intervention and control group within each Strata on the BSID-III scores on any of the developmental scales in children, including cognitive, language, and motor development: Stratum 1 (ß 1.46, 95%CI -2.15, 5.07; ß 1.30, 95%CI -1.99, 4.59; and ß 2.04, 95%CI -3.88, 7.96, respectively) and Stratum 2 (ß -4.04, 95%CI -7.27, 0.80; ß -0.36, 95%CI -3.47, 2.75; and ß -3.76, 95%CI -9.30, 1.78, respectively). CONCLUSIONS: In non-anaemic women in early pregnancy, no differences were found in the cognitive, language and motor development of children at 40 days of age between the dose of iron tested in each case -adjusted to initial Hb levels- compared to the dose of the control group. Further studies are guaranteed to confirm our findings. TRIAL REGISTRATION: The ECLIPSES study was registered at www.clinicaltrialsregister.eu as EudraCT number 2012-005,480-28.


Asunto(s)
Anemia Ferropénica , Complicaciones Hematológicas del Embarazo , Anemia Ferropénica/prevención & control , Suplementos Dietéticos , Femenino , Estudios de Seguimiento , Hemoglobinas/análisis , Humanos , Hierro , Embarazo , Complicaciones Hematológicas del Embarazo/prevención & control , Vitaminas
11.
Eur J Cancer ; 174: 243-250, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-36067617

RESUMEN

BACKGROUND: Smoldering multiple myeloma (SMM) is a heterogeneous disease in terms of progression to myeloma (MM), but its standard of care continues to be observation. METHODS: The QuiRedex phase 3 trial initiated in 2007 included 119 high-risk patients with SMM randomized to treatment or observation. Treatment consisted of nine 4-week induction cycles (lenalidomide [Rd], 25 mg on days 1-21 plus dexamethasone, 20 mg on days 1-4 and 12-15), followed by maintenance (R, 10 mg on days 1-21) for up to 2 years. The primary end-point was time to progression (TTP) to myeloma based on per protocol population. Secondary end-points were overall survival (OS), response rate, and safety. An update of the trial after a long-term follow-up is presented here. This trial was registered with ClinicalTrials.gov (NCT00480363). FINDINGS: After a median follow-up time of 12.5 years (range: 10.4-13.6), the median TTP to MM was 2.1 years in the observation arm and 9.5 years in the Rd arm (HR: 0.28, 95% CI: 0.18-0.44, p < 0.0001). The median OS was 8.5 years in the abstention arm and not reached in the Rd group (HR: 0.57, 95% CI: 0.34-0.95, p = 0.032). Patients who progressed received optimized treatments according to the standards of care, and the OS from progression was comparable in both arms (p = 0.96). INTERPRETATION: This analysis confirms that early treatment with Rd for high-risk SMM translates into a sustained benefit in both TTP and OS. FUNDING: Pethema (Spanish Program for the Treatment of Hematologic Diseases), Spain.


Asunto(s)
Mieloma Múltiple , Mieloma Múltiple Quiescente , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Dexametasona/efectos adversos , Estudios de Seguimiento , Humanos , Lenalidomida/uso terapéutico , Mieloma Múltiple/tratamiento farmacológico , Mieloma Múltiple Quiescente/tratamiento farmacológico , Mieloma Múltiple Quiescente/etiología , Tiamina
12.
Eur Rev Med Pharmacol Sci ; 26(17): 6283-6289, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36111929

RESUMEN

OBJECTIVE: Obesity is a chronic metabolic disease declared as the 21st century pandemic by the World Health Organization. Obesity has become an alarming situation for society, and it has to be treated. If the appropriate criteria are met by patients, bariatric surgery is an effective treatment method that provides weight loss in a short time. There are no definitive criteria regarding which groups of patients and characteristics may benefit most from bariatric surgery. In this study, we evaluate whether serum basal cortisol levels can predict successful outcomes of bariatric surgery and whether there is any difference in outcome between diabetic and non-diabetic patients. PATIENTS AND METHODS: This observational study included 244 obese patients who had undergone laparoscopic sleeve gastrectomy (LSG). Preoperative and postoperative 6-month weight, body mass index (BMI), serum basal cortisol, fasting plasma glucose, 1-mg dexamethasone suppression test (DST) results, and Type 2 Diabetes Mellitus (T2D) history were recorded. We analyzed the patients first by dividing them into two groups as excessive weight loss (%EWL) ≥50% and %EWL< 50%, and then into two groups as diabetic and nondiabetic patients. RESULTS: The mean age of patients with %EWL≥ 50% was found to be statistically significantly lower than that of patients with %EWL< 50% [39 (19-60) vs. 47 (36-61) years; p=0.046]. While there was no significant difference in basal cortisol values (p=0.513), DST results were statistically significantly lower in patients with %EWL≥ 50% than patients with %EWL< 50% [0.6 (0.1-2.1) vs. 0.8 (0.7-1.1); p=0.040]. CONCLUSIONS: In obese patients undergoing LSG, serum basal cortisol level may not predict the success of operation. However, the result of 1 mg DST may predict the operation success.


Asunto(s)
Cirugía Bariátrica , Diabetes Mellitus Tipo 2 , Laparoscopía , Obesidad Mórbida , Glucemia , Dexametasona , Diabetes Mellitus Tipo 2/cirugía , Estudios de Seguimiento , Humanos , Hidrocortisona , Laparoscopía/efectos adversos , Obesidad/etiología , Obesidad/cirugía , Obesidad Mórbida/cirugía , Estudios Retrospectivos , Pérdida de Peso
13.
BMC Musculoskelet Disord ; 23(1): 868, 2022 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-36114570

RESUMEN

BACKGROUND: Hybrid total hip replacement (THR) is commonly used in the management of proximal femur fractures in elderly individuals. However, in the context of the revision, the literature on hybrid THR is limited, and differences in the long-term survival outcomes reported in the literature are obvious. This retrospective study aimed to evaluate the long-term survival of hybrid THR for failed proximal femoral nail antirotation (PFNA) in elderly individuals aged ≥ 75 years. METHODS: An observational cohort of 227 consecutive individuals aged ≥ 75 years who experienced hybrid THRs following prior primary PFNAs was retrospectively identified from the Joint Surgery Centre, the First Affiliated Hospital, Sun Yat-sen University. Implant survival was estimated using the Kaplan-Meier method. The primary end point was the implant survivorship calculated using the Kaplan-Meier method with revision for any reason as the end point; secondary end points were the function score measured using the modified Harris Hip Score (mHHS) and the incidence of main orthopaedic complications. RESULTS: In total, 118 individuals (118 THRs) were assessed as available. The median follow-up was 10 (3-11) years. The 10-year survivorship with revision for any reason as the endpoint was 0.914 (95% confidence interval [CI], 0.843-0.960). The most common indication for revision was aseptic loosening (70.0%), followed by periprosthetic fracture (30.0%). At the final follow-up, the median functional score was 83.6 (79.0-94.0). Among the 118 patients included in this study, 16 experienced 26 implant-related complications. The overall incidence of key orthopaedic complications was 13.5% (16/118). CONCLUSION: For patients aged ≥ 75 years old with prior failed PFNAs, hybrid THR may yield satisfactory long-term survival, with good functional outcomes and a low rate of key orthopaedic complications.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Fémur , Estudios de Seguimiento , Humanos , Reoperación , Estudios Retrospectivos
14.
Arch Osteoporos ; 17(1): 125, 2022 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-36114901

RESUMEN

Denosumab leads to improvements in BMD levels and is a well-tolerated agent according to results of randomized controlled studies but results in real-life setting are important to evaluate drug adherence and real-life efficiency. In this study, we present the results of 305 patients that were treated with denosumab in our clinic. INTRODUCTION: The long-term efficacy of anti-osteoclastic drugs in treatment of osteoporosis is well known. Denosumab, a novel human monoclonal antibody, is an anti-osteoclastic agent that has been shown to lead to reductions in vertebral, nonvertebral, and hip fracture risk in randomized and observational studies. Real-life data of this agent is increasing. In this study, we presented our real-life data about the 2-year follow-up of patients under denosumab treatment. METHODS: Osteoporotic patients who were treated with at least one denosumab injection between 2014 and 2020 years were included. Clinical and demographic data, bone turnover markers, and radiological reports (bone mineral densitometry (BMD), vertebral x-ray) were obtained from patient files retrospectively. RESULTS: A total of 305 patients (f/m: 275/30, 68.1 ± 11.05 years) were included. The median injection number was 4 (1-10). Two hundred seventy-three patients (89.8%) were persistent on treatment at the 12th month; 175 patients (57.3%) were persistent at 24th month. Sixty-eight patients (22%) were not using denosumab anymore, 55 of the patients were not continuing by doctor desicion and 13 were not continuing due to patient-related causes. Median BMD levels significantly increased from 0.809 (0.2-1.601, IQR: 0.136) to 0.861 (0.517-1.607, IQR: 0.14) in L1-L4 and from 0.702 (0.349-0.997, IQR: 0.125) to 0.745 (0.508-1.008, IQR: 0.137) in femur area at the 24th month of treatment. An improvement of 8.04% in L1-L4 BMD and 4.5% in femur neck BMD levels at the 24th month of treatment was observed. There was a significant decrease in bone turnover markers at the 24th month of treatment. CONCLUSION: In our group of patients under denosumab treatment, 53% of persistence was found at 24 months and associated with improvement in BMD levels without any significant side effects except one case with urticarial reaction. Denosumab leads to improvements in BMD levels and is a well-tolerated agent in a real-life setting comparable to results of randomized controlled studies in patients with different comorbidities.


Asunto(s)
Conservadores de la Densidad Ósea , Osteoporosis Posmenopáusica , Anticuerpos Monoclonales , Densidad Ósea , Remodelación Ósea , Denosumab/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Osteoporosis Posmenopáusica/tratamiento farmacológico , Estudios Retrospectivos
15.
Iran J Med Sci ; 47(5): 468-476, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36117576

RESUMEN

Background: Alcohol consumption in pregnancy is associated with an increased risk of cardiovascular abnormalities, but the mechanisms are unknown. This study evaluated the impact of ethanol exposure on the offspring's aorta structural, functional, and molecular alterations on postnatal (PN) both on days 21 and 90. Methods: This experimental study was conducted at Urmia University of Medical Sciences (Urmia, Iran) in 2019. Twenty Pregnant Wistar rats on the seventh day of Gestation Day (GD) were randomly divided into two groups: control and ethanol-treated groups (n=10 per group). From the seventh day of GD throughout lactation, rats in the ethanol group were fed binge alcohol (4.5 g/Kg body weight) once daily. Systemic hemodynamic variables in the offspring were analyzed using waveform contour analysis 90 days after birth. On postnatal days (PN) 21 and 90, aorta wall histological alterations and the level of inflammatory factors were assessed in the aorta of male offspring. The statistical differences were examined via an independent samples t test. P<0.05 was considered to be statistically significant. Results: The results revealed that offspring in the ethanol group had higher systolic, diastolic, mean arterial pressure, and dicrotic pressure than the control group (P<0.001). The level of aorta tissue tumor necrosis factor (TNF)-α, intercellular adhesion molecule (ICAM)-1, nuclear factor (NF)-κ, and endothelin-1 were significantly higher in the ethanol offspring group than in the control group (P<0.001). Histopathological changes such as total aorta thickness, tunica media, tunica adventitia, elastin fiber thickness, fiber interval, and elastin/media ratio significantly increased in the aorta of the offspring of the ethanol group compared to the control group 21 and 90 days after birth. Conclusion: Our findings suggest that prenatal and early postnatal ethanol exposure-induced cardiovascular abnormalities are, in part, due to predisposing the aorta to atherosclerosis, which was mediated through the aorta wall remodeling and inflammation process.


Asunto(s)
Elastina , Endotelina-1 , Animales , Aorta , Moléculas de Adhesión Celular , Etanol/efectos adversos , Femenino , Estudios de Seguimiento , Hemodinámica , Masculino , Embarazo , Ratas , Ratas Wistar , Factores de Necrosis Tumoral
16.
Int J Hyperthermia ; 39(1): 1158-1163, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36049885

RESUMEN

OBJECTIVE: To study long-term effects in patients treated with microwave ablation (MWA) for symptomatic uterine fibroids and investigate fibroid characteristics predictive of successful treatment. METHOD: Women who received MWA treatment for uterine fibroids in a previous study were included. A total of 16 patients underwent contrast enhanced MRI before treatment, postoperatively at 6 months and at long-term follow-up, to assess volumes of treated fibroids (n = 42). Long-term MRI was performed between 16 and 36 months after treatment [median 22 months, interquartile range (IQR) 18.5-27]. Validated questionnaires for evaluation of uterine fibroid symptoms and menstrual bleeding (UFS-QoL and PBAC) were used to assess long-term effects on symptoms. The degree of shrinkage was correlated to vascularization and T2 signal intensity (SI) at preoperative MRI and location of fibroids according to the FIGO classification, using the Mann-Whitney U test. RESULTS: Most patients (82%) reported improvement up to 3 years after treatment. Out of 42 treated fibroids, 35 (83%) continued to shrink over time with median relative volume reduction of 77% (IQR 39-95). For eight fibroids (19%) which showed low vascularization on the pretreatment MRI, there was less shrinkage compared to well-vascularized fibroids (p = 0.01). Most fibroids (79%) showed iso- to hyperintense T2 signal on preoperative MRI and showed a higher grade of shrinkage than hypointense fibroids (p = 0.02). CONCLUSION: After microwave treatment improvement is maintained for most patients up to 36 months and most fibroids showed continuous shrinkage. Preoperative vascularization, high T2 SI and submucosal location predicted continuous volume reduction. However, to confirm this, larger studies are needed.


Asunto(s)
Ultrasonido Enfocado de Alta Intensidad de Ablación , Leiomioma , Neoplasias Uterinas , Femenino , Estudios de Seguimiento , Humanos , Leiomioma/diagnóstico por imagen , Leiomioma/cirugía , Microondas/uso terapéutico , Calidad de Vida , Resultado del Tratamiento
18.
Dtsch Med Wochenschr ; 147(18): 1187-1194, 2022 09.
Artículo en Alemán | MEDLINE | ID: mdl-36070736

RESUMEN

Infarction-related cardiogenic shock is the most severe complication of an acute coronary syndrome, that still bears a high mortality up to 50 % and wastes a lot of resources of an intensive care unit, especially if extracorporeal assist devices are used.In contrast to the adverse short-term outcome, patients fare a surprisingly well in the long range, both for survival and quality of life. Same as for the acute disease, which needs specific cardiologic and intensive care measures, long-term follow-up care needs a lot of medical and lifestyle interventions and treatments to obtain the best possible result for the patients. Since there is good evidence for cardiologic therapies from randomized controlled trials, high quality data to treat long-term sequalae of the stay on intensive care unit, are sparse.Overall, follow-up care of survivors of infarction related cardiogenic shock includes the best available treatment of the coronary artery disease, intensified heart failure therapy of left and right heart dysfunction and evaluation for the risk of sudden cardiac death and treatment of sequelae of the intensive-care-unit stay.


Asunto(s)
Síndrome Coronario Agudo , Choque Cardiogénico , Síndrome Coronario Agudo/complicaciones , Estudios de Seguimiento , Humanos , Calidad de Vida , Choque Cardiogénico/etiología , Choque Cardiogénico/terapia
19.
Sci Rep ; 12(1): 15393, 2022 Sep 13.
Artículo en Inglés | MEDLINE | ID: mdl-36100639

RESUMEN

The objective of this study was to conduct a 2-year follow-up of individuals having unsatisfactory reports of Pap smears and to analyze the contributing factors. This was a retrospective study at a medical center that performed about 5000-6000 Pap smears annually in Eastern Taiwan. Women who had unsatisfactory results due to scant cellularity between January 1, 2015-December 31, 2016, were included in this study. The control group comprised age-matched women with normal Pap smears at a 1:4 ratio, during the same period. The clinical characteristics and the 2-year outcomes were followed. Patients who were unavailable for follow-up assessments or who had insufficient clinical information were excluded. Student's t-test and chi-square test were used for continuous and categorical variables, respectively. Statistical significance was defined as a p-value < 0.05. A total of 887 Pap smears were included. A total of 717 and 170 women had normal Pap and unsatisfactory Pap tests, respectively. After excluding women who were unavailable for follow-up, the final analysis included 248 and 67 women with normal and unsatisfactory Pap tests, respectively. The mean age was not significantly different between the two groups (49.97 ± 10.69 and 51.61 ± 11.28 years in the unsatisfactory Pap and control groups, respectively [p > 0.05]). The percentage of menopause and vaginal discharge were significantly different between the two groups. Multivariate analysis revealed that premenopausal status, increased discharge were associated with the risk of unsatisfactory Pap tests. Of the 67 women with unsatisfactory Pap tests, all tested negative for any malignancies at a 2-year follow-up assessment. Women with increased vaginal discharge and without menopause were at an increased risk of having an unsatisfactory Pap test. Our results indicate that an unsatisfactory Pap smear due to scant cellularity might not increase the risk of intraepithelial neoplasia or cancer after 2 years. Further, large-scale studies with longer follow-up periods are required.


Asunto(s)
Neoplasias del Cuello Uterino , Excreción Vaginal , Estudios de Casos y Controles , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Prueba de Papanicolaou , Estudios Retrospectivos , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/patología
20.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 47(8): 1016-1024, 2022 Aug 28.
Artículo en Inglés, Chino | MEDLINE | ID: mdl-36097769

RESUMEN

OBJECTIVES: The patients with mild traumatic brain injury (mTBI) accounts for more than 80% of the patients with brain injury. Most patients with mTBI have no abnormalities in CT examination. Therefore, most patients choose to self-care and recover rather than seeking medical treatment. In fact, mTBI may result in persistent cognitive decline and neurobehavioral dysfunction. In addition, changes occurred in neurochemistry, metabolism, and cells after injury may cause changes in cerebral blood flow (CBF), which is one of the causes of secondary injury and slow brain repair. This study aims to evaluate the changes of CBF with the progression of the disease in patients with mTBI based on arterial spin labeling (ASL) magnetic resonance imaging technology. METHODS: In the outpatient or emergency department of the Second Affiliated Hospital of Wenzhou Medical University, 43 mTBI patients were collected as an mTBI group, and 43 normal subjects with age, gender, and education level matching served as a control group. They all received clinical neuropsychology and cognitive function evaluation and magnetic resonance imaging. In the mTBI group, 22 subjects were followed up at acute phase, 1 month, 3 months, and 12 months. Based on the control group, the abnormal regions of CBF in the whole brain of mTBI patients were analyzed. The abnormal regions were taken as the regions of interest (ROI). The correlation of the values of the CBF in ROIs with clinical indications, cognitive function, and the changes of CBF in ROI at each time point during the follow-up were analyzed. RESULTS: Compared with the control group, the CBF in the bilateral dorsolateral superior frontal gyrus and auxiliary motor areas in the cortical region, as well as the right putamen, caudate nucleus, globus pallidus, and parahippocampus in the subcutaneous regions in the acute phase of the mTBI group were significantly increased (all P<0.01, TFCE-FWE correction). The analysis results of correlation of CBF with neuropsychology and cognitive domain showed that in the mTBI group, whole brain (r=0.528, P<0.001), right caudate nucleus (r=0.512, P<0.001), putamen (r=0.486, P<0.001), and globus pallidus (r=0.426, P=0.006) values of the were positively correlated with Backward Digit Span Test (BDST) score (reflectting working memory ability), and the right globus pallidus CBF was negatively correlated with the Post-Traumatic Stress Disorder Cheeklist-CivilianVersion (PCL-C) score (r=-0.402, P=0.010). Moreover, the follow-up study showed that abnormal CBF in these areas had not been restored. The correlation of CBF was negatively correlated with PCL-C and BDST at 1 months, 3 months, and 12 months (all P>0.05). CONCLUSIONS: The elevated CBF value is one of the stress characteristics of brain injury in the mTBI patients at the acute phase. There is abnormal elevation of CBF values in multiple cortex or subcortical areas. Multi-time point studies show that there is no obvious change of CBF in abnormal areas, suggesting that potential clinical treatment is urgently needed for the mTBI patients.


Asunto(s)
Conmoción Encefálica , Lesiones Encefálicas , Conmoción Encefálica/complicaciones , Conmoción Encefálica/diagnóstico por imagen , Circulación Cerebrovascular/fisiología , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética/métodos , Espectroscopía de Resonancia Magnética , Marcadores de Spin
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