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1.
Am Surg ; 86(2): 164-170, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167047

RESUMEN

Tumor deposits in colon cancer are related to poor prognosis, whereas the prognostic power of tumor deposits in combination with lymph node metastasis (LNM) is controversial. This study aimed to compare the overall survival between LNM alone and LNM in combination with tumor deposits, and to verify whether the number of tumor deposits can be considered LNM in patients with both LNM and tumor deposits in stage III colon cancer by propensity score matching (PSM). Patients carrying resected stage III adenocarcinoma of colon cancer were identified from the Surveillance, Epidemiology, and End Results database (2010-2015). The Kaplan-Meier method, Cox proportional hazard models and PSM were used. On the whole, 23,168 patients (20,451 (88.3%) with only LNM and 2,717 (11.7%) with both LNM and tumor deposits) were selected. After undergoing PSM, patients with both LNM and tumor deposits showed worse overall survival (hazard ratio = 1.33, 95% confidence interval: 1.20-1.47, P < 0.001). After the number of tumor deposits was added with that of positive regional lymph nodes, patients with both LNM and tumor deposits seemed to have prognostic implications similar to those with LNM alone (hazard ratio = 1.02, 95% confidence interval: 0.93-1.12, P = 0.66). The simultaneous presence of LNM and tumor deposits, as compared with the presence of only LNM, had an association with a worse outcome. Tumor deposits should be considered as LNM in patients with both tumor deposits and LNM in stage III colon cancer.


Asunto(s)
Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Neoplasias del Colon/mortalidad , Neoplasias del Colon/patología , Ganglios Linfáticos/patología , Metástasis Linfática/patología , Adenocarcinoma/secundario , Anciano , Intervalos de Confianza , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Puntaje de Propensión , Modelos de Riesgos Proporcionales , Programa de VERF , Tasa de Supervivencia
2.
J Med Syst ; 44(5): 91, 2020 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-32185510

RESUMEN

Oscillometry blood pressure measurements are commonly used to measure blood pressure for many patients at hospitals, home, and office and they are actively studied recently. These devices generally offer a single blood pressure point and they are not able to indicate the confidence interval of the measured quantity. Therefore, we introduce a novel technique using ensemble-based adaptive methodology to measure confidence interval for oscillometry blood pressure measurements. The ensemble-based adaptive methodology that is used to accurately estimate blood pressure and then measure the confidence interval for the systolic blood pressure and diastolic blood pressure.


Asunto(s)
Algoritmos , Determinación de la Presión Sanguínea , Oscilometría , Presión Sanguínea , Determinación de la Presión Sanguínea/métodos , Intervalos de Confianza , Humanos , Oscilometría/métodos
3.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 40-44, feb. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-185852

RESUMEN

Objetivo. Determinar el impacto pronóstico de la enfermedad pulmonar obstructiva crónica (EPOC) en los pacientes diagnosticados de enfermedad tromboembólica venosa (ETV) en servicios de urgencias (SU) españoles. Método. Análisis secundario del registro ESPHERIA que incluyó pacientes consecutivos con ETV sintomática en 53 SU. Resultados. Se incluyeron 801 pacientes de los que 71 (9%) tenían EPOC, siendo la tromboembolia pulmonar la forma de presentación más frecuente de ETV en este subgrupo de pacientes (77,5% vs 47,1%, p < 0,001). Los pacientes con EPOC tuvieron con más frecuencia disfunción de ventrículo derecho en la angiotomografía pulmonar (18,2% vs 13,1%; p < 0,001) y necesidad de soporte ventilatorio (7% vs 0,5%; p < 0,001). Los pacientes con ETV y EPOC tuvieron mayor incidencia de reingreso o mortalidad en el seguimiento a 180 días [HR 1,52 (IC 95% 1,00-2,29; p = 0,048)], comparados con los pacientes con ETV sin EPOC. Conclusiones. La EPOC tiene impacto pronóstico en los pacientes diagnosticados de ETV en SU españoles, en términos de mortalidad y reingreso hospitalario


Objective. To determine the impact of chronic obstructive pulmonary disease (COPD) on prognosis in patients diagnosed with venous thromboembolic disease (VTED) in Spanish emergency departments. Methods. Secondary analysis of data from the ESPHERIA (Spanish acronym for Risk Profile of Patients VTED Attended in Spanish Emergency Departments) registry. Results. A total of 801 patients, 71 (9%) with COPD, were included. Pulmonary thromboembolism was recorded in 77.%% of the patients with COPD (vs in 47.1% of patients without COPD; P<.001). Patients with COPD had evidence of right ventricular dysfunction on computed tomography angiography more often than other VTED patients (18.2% vs 13.1%; P<.001) and more often required ventilatory support (7% vs 0.5%; P<.001). VTED patients with COPD also had a higher rate of readmission or mortality at 180 days (hazard ratio, 1.52; 95% CI, 1.00-2.29; P = .048)] than patients without COPD. Conclusions. COPD affects the prognosis of patients diagnosed with VTED in Spanish emergency departments as evidenced by hospital readmission and mortality


Asunto(s)
Humanos , Masculino , Anciano , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Tromboembolia Venosa , Tromboembolia Venosa/complicaciones , Pronóstico , Servicios Médicos de Urgencia , Estudios de Cohortes , Intervalos de Confianza , Readmisión del Paciente , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Análisis Multivariante
6.
J Sports Sci ; 38(5): 534-541, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31952463

RESUMEN

This study examined the associations between socioeconomic status (SES) and musculoskeletal (MSF) and cardiorespiratory fitness (CRF) in youth.  The sample consisted of boys and girls between 3-15 years.  SES was categorized utilizing family-income-to-poverty ratio (FIPR).  All analyses were standardized for age and sex.  For each test of physical fitness, SES was used to estimate mean fitness test percentile and 95% confidence intervals, controlling for race/ethnicity and physical activity.  Odds ratios were calculated for the likelihood of having low fitness by SES category.  In general, the high SES group had a better composite MSF, body composition, and CRF profiles than low and moderate SES groups.  Statistically significant differences were identified for relative grip strength, plank, body mass index, and cardiovascular endurance time (all p < 0.05).  Additionally, the odds of low/poor MSF fitness were 1.7 and 1.6 times higher in the low and moderate SES groups (respectively) compared to the children from high SES families.  The moderate SES group had an odds of poor CRF 1.6 times higher than the high SES group as well.  Children and adolescents from high SES families tend to have higher mean fitness and were less likely to have low/poor fitness.


Asunto(s)
Aptitud Física , Clase Social , Adolescente , Composición Corporal , Capacidad Cardiovascular , Niño , Preescolar , Intervalos de Confianza , Ejercicio , Femenino , Fuerza de la Mano , Humanos , Masculino , Fenómenos Fisiológicos Musculoesqueléticos , Encuestas Nutricionales , Oportunidad Relativa
7.
N Engl J Med ; 382(4): 309-317, 2020 01 23.
Artículo en Inglés | MEDLINE | ID: mdl-31971676

RESUMEN

BACKGROUND: In September 2015, the United Kingdom introduced the multicomponent meningococcal group B vaccine (4CMenB, Bexsero) into its publicly funded national immunization program at a reduced two-dose priming schedule for infants, with a 12-month booster. METHODS: Using data from enhanced national surveillance of invasive meningococcal disease in England, we evaluated the effect of vaccination on the incidence of meningococcal group B disease during the first 3 years of the program. The effect of vaccination was assessed by comparing the observed incidence of disease with the expected incidence based on the incidence during the 4-year prevaccination period in equivalent cohorts and with the use of disease trends in cohorts of children younger than 5 years of age who were not eligible to receive the vaccine. Vaccine effectiveness was estimated with the use of the indirect screening method. RESULTS: 4CMenB uptake in England remained consistently high; data from the first 3 months of 2018 showed that 92.5% of children had completed the primary immunizations by their first birthday and 87.9% had received all three doses by 2 years. From September 2015 through August 2018, the incidence of meningococcal group B disease in England (average annual birth cohort, approximately 650,000 infants) was significantly lower in vaccine-eligible cohorts than the expected incidence (63 observed cases as compared with 253 expected cases; incidence rate ratio, 0.25; 95% confidence interval [CI], 0.19 to 0.36), with a 75% reduction in age groups that were fully eligible for vaccination. The adjusted vaccine effectiveness against meningococcal group B disease was 52.7% (95% CI, -33.5 to 83.2) with a two-dose priming schedule for infants and 59.1% (95% CI, -31.1 to 87.2) with a two-dose priming schedule plus a booster at 1 year). Over the 3-year period, there were 169 cases of meningococcal group B disease in the vaccine-eligible cohorts, and an estimated 277 cases (95% CI, 236 to 323) were prevented. CONCLUSIONS: The 4CMenB program was associated with continued positive effect against meningococcal group B disease in children in England, and protection after three doses of the vaccine was sustained for at least 2 years. (Funded by Public Health England.).


Asunto(s)
Programas de Inmunización , Infecciones Meningocócicas/prevención & control , Vacunas Meningococicas/inmunología , Neisseria meningitidis Serogrupo B , Preescolar , Intervalos de Confianza , Inglaterra/epidemiología , Humanos , Esquemas de Inmunización , Inmunización Secundaria , Incidencia , Lactante , Recién Nacido , Infecciones Meningocócicas/epidemiología , Medicina Estatal , Resultado del Tratamiento , Reino Unido
9.
Br J Radiol ; 93(1108): 20190558, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31957473

RESUMEN

OBJECTIVE: To build and validate a CT radiomic model for pre-operatively predicting lymph node metastasis in early cervical carcinoma. METHODS AND MATERIALS: A data set of 150 patients with Stage IB1 to IIA2 cervical carcinoma was retrospectively collected from the Nanfang hospital and separated into a training cohort (n = 104) and test cohort (n = 46). A total of 348 radiomic features were extracted from the delay phase of CT images. Mann-Whitney U test, recursive feature elimination, and backward elimination were used to select key radiomic features. Ridge logistics regression was used to build a radiomic model for prediction of lymph node metastasis (LNM) status by combining radiomic and clinical features. The area under the receiver operating characteristic curve (AUC) and κ test were applied to verify the model. RESULTS: Two radiomic features from delay phase CT images and one clinical feature were associated with LNM status: log-sigma-2-0 mm-3D_glcm_Idn (p = 0.01937), wavelet-HL_firstorder_Median (p = 0.03592), and Stage IB (p = 0.03608). Radiomic model was built consisting of the three features, and the AUCs were 0.80 (95% confidence interval: 0.70 ~ 0.90) and 0.75 (95% confidence intervalI: 0.53 ~ 0.93) in training and test cohorts, respectively. The κ coefficient was 0.84, showing excellent consistency. CONCLUSION: A non-invasive radiomic model, combining two radiomic features and a International Federation of Gynecology and Obstetrics stage, was built for prediction of LNM status in early cervical carcinoma. This model could serve as a pre-operative tool. ADVANCES IN KNOWLEDGE: A noninvasive CT radiomic model, combining two radiomic features and the International Federation of Gynecology and Obstetrics stage, was built for prediction of LNM status in early cervical carcinoma.


Asunto(s)
Ganglios Linfáticos/diagnóstico por imagen , Metástasis Linfática/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Neoplasias del Cuello Uterino/diagnóstico por imagen , Área Bajo la Curva , Intervalos de Confianza , Femenino , Humanos , Modelos Logísticos , Ganglios Linfáticos/patología , Persona de Mediana Edad , Periodo Preoperatorio , Curva ROC , Estudios Retrospectivos , Estadísticas no Paramétricas , Neoplasias del Cuello Uterino/patología
10.
Int J Radiat Oncol Biol Phys ; 106(3): 556-563, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-31707122

RESUMEN

PURPOSE: Surgery is standard treatment for rectal cancer, but neoadjuvant chemoradiation therapy (CRT) may result in clinical complete response (cCR) in select patients, allowing for nonsurgical management (NSM). Prospective studies of NSM strategies are sparse, however, and long-term data on quality of life (QoL) are limited. We conducted a single-arm phase 2 trial of high-dose CRT for NSM of distal rectal cancer; we report secondary long-term patient-reported outcomes (PROs), local regrowth, and overall survival in patients managed nonsurgically. METHODS AND MATERIALS: Fifty-one patients with resectable, T2 or T3, N0-N1, low adenocarcinoma received 65 Gy (intensity modulated radiation therapy, brachytherapy boost) and oral tegafur-uracil. Patients with cCR 6 weeks after treatment (clinical examination, magnetic resonance imaging, biopsy) were referred for observation and followed closely with clinical examination, endoscopy, positron emission tomography/computed tomography, and PROs for 5 years. Overall colorectal cancer-specific QoL and specific symptom scores were evaluated at baseline and in follow-up and compared between time points. Local regrowth was estimated using cumulative incidence and overall survival using Kaplan-Meier estimates. RESULTS: Forty patients achieved cCR after treatment; 29 were in follow-up at 24 months, 21 at 36 months, and 20 at 60 months. PRO questionnaire completion rates were 90% at 24 months, 100% at 36 months, and 85% at 60 months for patients still in follow-up. Average QoL score did not differ between baseline (median 11.1) and 24 months (13.7), 48 months (11.1), or 60 months (6.9). Only rectal bleeding deteriorated from baseline, with bowel- and bladder-related symptom scores otherwise unchanged in follow-up. At median follow-up of 5.0 years, local regrowth rate and overall survival were 31% (95% confidence interval, 15%-47%) and 85% (95% confidence interval, 75%-97%), respectively. CONCLUSIONS: Long-term follow-up after NSM of distal rectal cancer showed excellent general colorectal cancer QoL and local symptom scores. Our study results indicate that high-dose CRT followed by organ preservation might be an alternative to standard treatment.


Asunto(s)
Adenocarcinoma/terapia , Quimioradioterapia Adyuvante/métodos , Tratamientos Conservadores del Órgano/métodos , Medición de Resultados Informados por el Paciente , Calidad de Vida , Neoplasias del Recto/terapia , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/secundario , Anciano , Braquiterapia/métodos , Intervalos de Confianza , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Dosificación Radioterapéutica , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología
11.
Mol Biol Evol ; 37(1): 280-290, 2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31638157

RESUMEN

Confidence intervals (CIs) depict the statistical uncertainty surrounding evolutionary divergence time estimates. They capture variance contributed by the finite number of sequences and sites used in the alignment, deviations of evolutionary rates from a strict molecular clock in a phylogeny, and uncertainty associated with clock calibrations. Reliable tests of biological hypotheses demand reliable CIs. However, current non-Bayesian methods may produce unreliable CIs because they do not incorporate rate variation among lineages and interactions among clock calibrations properly. Here, we present a new analytical method to calculate CIs of divergence times estimated using the RelTime method, along with an approach to utilize multiple calibration uncertainty densities in dating analyses. Empirical data analyses showed that the new methods produce CIs that overlap with Bayesian highest posterior density intervals. In the analysis of computer-simulated data, we found that RelTime CIs show excellent average coverage probabilities, that is, the actual time is contained within the CIs with a 94% probability. These developments will encourage broader use of computationally efficient RelTime approaches in molecular dating analyses and biological hypothesis testing.


Asunto(s)
Evolución Molecular , Técnicas Genéticas , Animales , Intervalos de Confianza , Humanos
12.
Int J Radiat Oncol Biol Phys ; 106(2): 320-328, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-31669562

RESUMEN

PURPOSE: Oral mucositis (OM) is a frequent and painful sequela of concomitant chemoradiation (CRT) used for the treatment of head and neck cancer (HNC) for which there is no effective intervention. This randomized, placebo-controlled study evaluated the efficacy of a novel, mucoadhesive topical tablet formulation of clonidine in mitigating CRT-induced OM in patients with HNC. METHODS AND MATERIALS: Patients with HNC undergoing adjuvant radiation therapy (60-66 Gy; 5 × 1.8-2.2 Gy/wk) with concomitant platinum-based chemotherapy received daily local clonidine at 50 µg (n = 56), 100 µg (n = 65), or placebo (n = 62) via a topical mucobuccal tablet starting 1 to 3 days before and continuing during treatment. The primary endpoint was the incidence of severe OM (severe OM [SOM], World Health Organization grade 3/4). RESULTS: SOM developed in 45% versus 60% (P = .06) of patients treated with clonidine compared with placebo and occurred for the first time at 60 Gy as opposed to 48 Gy (median; hazard ratio, 0.75 [95% confidence interval, 0.484-1.175], P = .21); median time to onset was 45 versus 36 days. Opioid analgesic use, mean patient-reported mouth and throat soreness, and CRT compliance were not significantly different between treatment arms. Adverse events were reported in 90.8% versus 98.4%, nausea in 49.6% versus 71.0%, dysphagia in 32.8% versus 48.4%, and reversible hypotension in 6.7% versus 1.6% of patients on clonidine versus placebo, respectively. CONCLUSIONS: Although the primary endpoint was not met, the positive trends of OM-associated outcomes suggest that the novel mucoadhesive tablet delivery of clonidine might favorably affect the course and severity of CRT-induced SOM and support further evaluation.


Asunto(s)
Quimioradioterapia/efectos adversos , Clonidina/administración & dosificación , Neoplasias de Cabeza y Cuello/radioterapia , Protectores contra Radiación/administración & dosificación , Carcinoma de Células Escamosas de Cabeza y Cuello/radioterapia , Estomatitis/prevención & control , Administración Bucal , Adulto , Anciano , Analgésicos Opioides/administración & dosificación , Clonidina/efectos adversos , Intervalos de Confianza , Trastornos de Deglución/etiología , Método Doble Ciego , Esquema de Medicación , Femenino , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Placebos/administración & dosificación , Protectores contra Radiación/efectos adversos , Dosificación Radioterapéutica , Estomatitis/etiología , Comprimidos , Adulto Joven
13.
Int J Radiat Oncol Biol Phys ; 106(2): 255-260, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-31654784

RESUMEN

PURPOSE: Whole brain radiation therapy (WBRT) remains a commonly used cancer treatment, although controversy exists regarding the optimal dose/fractionation to optimize intracranial tumor control and minimize resultant cognitive deficits. METHODS AND MATERIALS: NCCTG N107C [Alliance]/CEC.3 randomized 194 patients with brain metastases to either stereotactic radiosurgery alone or WBRT after surgical resection. Among the 92 patients receiving WBRT, sites predetermined the dose/fractionation that would be used for all patients treated at that site (either 30 Gy in 10 fractions or 37.5 Gy in 15 fractions). Analyses were performed using Kaplan-Meier estimates, log rank tests, and Fisher's exact tests. RESULTS: Among 92 patients treated with surgical resection and adjuvant WBRT, 49 were treated with 30 Gy in 10 fractions (53%), and 43 were treated with 37.5 Gy in 15 fractions (47%). Baseline characteristics, including cognitive testing, were well balanced between groups with the exception of primary tumor type (lung cancer histology was more frequent with protracted WBRT: 72% vs 45%, P = .01), and 93% of patients completed the full course of WBRT. A more protracted WBRT dose regimen (37.5 Gy in 15 fractions) did not significantly affect time to cognitive failure (hazard ratio [HR], 0.9; 95% confidence interval [CI], 0.6-1.39; P = .66), surgical bed control (HR, 0.52 [95% CI, 0.22-1.25], P = .14), intracranial tumor control (HR, 0.56 [95% CI, 0.28-1.12], P = .09), or overall survival (HR, 0.72 [95% CI, 0.45-1.16], P = .18). Although there was no reported radionecrosis, there is a statistically significant increase in the risk of at least 1 grade ≥3 adverse event with 37.5 Gy in 15 fractions versus 30 Gy in 10 fractions (54% vs 31%, respectively, P = .03). CONCLUSIONS: This post hoc analysis does not demonstrate that protracted WBRT courses reduce the risk of cognitive deficit, improve tumor control in the hypoxic surgical cavity, or otherwise improve the therapeutic ratio. Adverse events were significantly higher with the lengthened course of WBRT. For patients with brain metastases where WBRT is recommended, shorter course hypofractionated regimens remain the current standard of care.


Asunto(s)
Neoplasias Encefálicas/radioterapia , Trastornos del Conocimiento/prevención & control , Irradiación Craneana/normas , Mejoramiento de la Calidad , Radiocirugia/normas , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/cirugía , Intervalos de Confianza , Irradiación Craneana/efectos adversos , Fraccionamiento de la Dosis de Radiación , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Radiocirugia/efectos adversos , Radioterapia Ayuvante/efectos adversos , Radioterapia Ayuvante/normas
14.
Int J Radiat Oncol Biol Phys ; 106(3): 485-492, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-31610251

RESUMEN

PURPOSE: Older patients undergoing radiation therapy (RT) for pelvic malignancies are at increased risk for pelvic fracture, which is associated with significant morbidity and mortality. RT techniques such as brachytherapy or intensity modulated RT (IMRT) allow for more conformal dose distributions, but it is not known whether the risk for pelvic fracture varies by RT modality. METHODS AND MATERIALS: This observational cohort study involved 28,354 patients ≥65 years old, treated with RT for pelvic malignancies. We evaluated the relative risk of pelvic fracture by type of RT when accounting for baseline factors. To test for nonspecific effects, we also evaluated risk of nonpelvic fractures in the same population. RESULTS: The 5-year incidence of pelvic fractures was 12.7% (95% confidence interval [CI], 11.6%-13.8%), 11.8% (10.8%-12.8%), and 3.7% (3.4%-4.0%) for patients with gastrointestinal, gynecologic, and prostate cancer, respectively. On multivariable analysis, being treated with IMRT (hazard ratio, 0.85; 95% CI, 0.73-0.99) or brachytherapy therapy alone (hazard ratio, 0.43; 95% CI, 0.34-0.54) was associated with a reduced hazard for pelvic fractures compared with 3D conformal radiation therapy in female patients. In contrast, there was no association with RT modality and the hazard for nonpelvic fractures among females. There was no significant association between pelvic fractures and IMRT or brachytherapy for male patients. White race, advanced age, and higher comorbidity were associated with an increased hazard for pelvic fracture. CONCLUSIONS: IMRT and brachytherapy were associated with a reduced risk of pelvic fractures in older women undergoing RT for pelvic malignancies. Pelvic insufficiency fracture risk should be considered when treating with pelvic RT.


Asunto(s)
Braquiterapia/efectos adversos , Fracturas Óseas/etiología , Huesos Pélvicos/lesiones , Neoplasias Pélvicas/radioterapia , Radioterapia Conformacional/efectos adversos , Factores de Edad , Anciano , Estudios de Cohortes , Intervalos de Confianza , Grupo de Ascendencia Continental Europea , Femenino , Fracturas Óseas/epidemiología , Neoplasias Gastrointestinales/radioterapia , Neoplasias de los Genitales Femeninos/radioterapia , Humanos , Incidencia , Masculino , Huesos Pélvicos/efectos de la radiación , Neoplasias de la Próstata/radioterapia , Radioterapia de Intensidad Modulada/efectos adversos , Análisis de Regresión , Riesgo , Factores Sexuales
15.
Int J Radiat Oncol Biol Phys ; 106(3): 475-484, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-31580930

RESUMEN

PURPOSE: To estimate the overall rate, symptomatic proportion, and most common sites of pelvic insufficiency fracture (PIF) after external beam radiation therapy for gynecologic cancers based on posttreatment computed tomography, magnetic resonance imaging, positron emission tomography, or bone scintigraphy. METHODS AND MATERIALS: A systematic search of databases (PubMed and EMBASE) was performed (CRD42019125679). The pooled summary of overall PIF and the proportion of symptomatic cases were calculated using the random-effects model weighted by the inverse variance. A multivariate meta-regression was performed to evaluate potential sources of heterogeneity regarding PIF fractures. RESULTS: Twenty-one studies met the inclusion criteria (total 3929 patients). Five hundred four patients developed PIF, translating to an overall rate of 14% (95% confidence interval, 10%-18%, based on 21 studies). Among these cases with PIF, the proportion of symptomatic patients was 61% (95% confidence interval, 52%-69%, based on 14 studies). The total number of PIFs was 704 (mean, 1.72 PIFs per each patient to develop PIF, based on 14 studies). More recent series (P = .0074) and the use of intensity modulated radiation therapy (P = .0299) were associated with lower fracture rates. The most common fracture sites were sacroiliac joint (39.7%), body of the sacrum (33.9%), pubis (13%), lumbar vertebra (7%), iliac bone (2.8%), acetabulum (2.1%), and femoral head/neck (1.5%). The median time to fracture was 7.1 to 19 months after radiation therapy. CONCLUSIONS: The incidence of PIF after radiation therapy for gynecologic cancers is high (14%), with the majority affecting the sacral bone or joint (73.6%), although this risk appears to be lower with intensity modulated radiation therapy. Posttreatment bone surveillance is warranted in this population because nearly 40% of patients were asymptomatic at the time of PIF diagnosis.


Asunto(s)
Fracturas Óseas/epidemiología , Fracturas Espontáneas/epidemiología , Neoplasias de los Genitales Femeninos/radioterapia , Huesos Pélvicos/lesiones , Intervalos de Confianza , Femenino , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/etiología , Fracturas Espontáneas/diagnóstico por imagen , Fracturas Espontáneas/etiología , Neoplasias de los Genitales Femeninos/diagnóstico por imagen , Humanos , Huesos Pélvicos/efectos de la radiación , Radioterapia de Intensidad Modulada , Análisis de Regresión
16.
World Neurosurg ; 133: e31-e61, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31415895

RESUMEN

BACKGROUND: The association between matrix metalloproteinase 9 (MMP-9) gene -1562C/T (rs3918242) polymorphism and the susceptibility of ischemic stroke (IS) has been investigated. However, results were ambiguous and inconsistent. Therefore, we performed this study to better assess the potential relationship between rs3918242 polymorphism and susceptibility risk of IS. METHODS: We included case-control studies concerning the relationship between the rs3918242 polymorphism and IS, and odds ratios with corresponding 95% confidence intervals were used to describe the associations. Furthermore, meta-regression analyses, heterogeneity, cumulative analyses, sensitivity analyses, and publication bias were examined. RESULTS: A total of 19 studies were included for analysis. Significant associations with the risk of IS were detected for the rs3918242 polymorphism in overall population, Asians, and whites. When available data were stratified by gender, we found a significant correlation with the risk of IS in both males and females. Further subgroup analysis by the subtypes of IS showed that the rs3918242 polymorphism was significantly correlated with the risk of patients with large artery atherosclerosis. When stratified by age, we found that the rs3918242 polymorphism was significantly correlated with the risk of IS in patients both aged ≥65 years and >65 years. Both the diabetes and the nondiabetes subgroups reached significant results, and in an analysis stratified by smoking status, an increased risk of IS was associated with smoking. CONCLUSIONS: The rs3918242 polymorphism may be a susceptible predictor of susceptibility of IS. Further large-scale studies are needed to verify the results of our findings.


Asunto(s)
Isquemia Encefálica/genética , Metaloproteinasa 9 de la Matriz/genética , Polimorfismo de Nucleótido Simple , Adulto , Distribución por Edad , Anciano , Aterosclerosis/epidemiología , Isquemia Encefálica/enzimología , Isquemia Encefálica/epidemiología , Estudios de Casos y Controles , Fumar Cigarrillos/epidemiología , Comorbilidad , Intervalos de Confianza , Diabetes Mellitus/epidemiología , Grupos Étnicos , Femenino , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Embolia Intracraneal/epidemiología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Distribución por Sexo
17.
Int J Radiat Oncol Biol Phys ; 106(1): 157-166, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31580929

RESUMEN

PURPOSE: Previous studies have found that patients with head and neck cancer (HNC) with a higher relative hazard for recurrence versus competing mortality (ω+ ratio) are more likely to benefit from intensive therapy. Nomograms to predict this ratio (ω scores) can be useful to guide clinical management; however, comorbidity and other risk factors are frequently lacking from trial samples. METHODS AND MATERIALS: In this study of 7117 US veterans, we evaluated the ability of a ω score nomogram developed from clinical trial data to stratify patients with HNC treated with radiation therapy by their relative risk of cancer progression versus competing mortality. We then fit generalized competing event models to determine the effect of comorbidity and other covariates on the ω+ ratio. RESULTS: The ω score was effective in stratifying patients with HNC according to their risk for cancer recurrence relative to competing mortality, especially among patients aged >70 years. Patients with ω score ≥0.80 were more likely to receive intensive therapy compared with patients with a ω score <0.80 (66 vs. 54%; P < .001). On multivariable generalized competing event regression, T2-4 category (relative hazard ratio [RHR], 1.08; 95% confidence interval [CI], 1.01-1.16), N2-3 category (RHR, 1.07; 95% CI, 1.01-1.15), and being employed (RHR, 1.11; 95% CI, 1.03-1.20) were associated with increased ω+ ratio, and increasing age (RHR, 0.83; 95% CI, 0.78-0.89), Charlson comorbidity index ≥2 (RHR, 0.85; 95% CI, 0.79-0.91), being a current smoker (RHR, 0.90; 95% CI, 0.84-0.96), and lower body mass index (RHR, 0.89; 95% CI, 0.84-0.95) were associated with a decreased ω+ ratio. CONCLUSIONS: The ω scores are effective in stratifying patients with HNC and are correlated with the intensity of treatment given. The ω scores incorporating comorbidity and other risk factors could help identify patients with HNC most likely to benefit from intensive therapy.


Asunto(s)
Neoplasias de Cabeza y Cuello/radioterapia , Recurrencia Local de Neoplasia , Nomogramas , Selección de Paciente , Carcinoma de Células Escamosas de Cabeza y Cuello/radioterapia , Factores de Edad , Anciano , Comorbilidad , Intervalos de Confianza , Progresión de la Enfermedad , Empleo , Femenino , Neoplasias de Cabeza y Cuello/clasificación , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Radioterapia de Intensidad Modulada , Análisis de Regresión , Factores de Riesgo , Fumadores , Carcinoma de Células Escamosas de Cabeza y Cuello/clasificación , Carcinoma de Células Escamosas de Cabeza y Cuello/mortalidad , Delgadez/complicaciones , Veteranos/estadística & datos numéricos
19.
Medicine (Baltimore) ; 98(51): e17897, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31860947

RESUMEN

Parkinson disease (PD) is the second most common neurodegenerative disease which affects population older than 65 years. Tremor represents one of the main symptomatic triads in PD, particularly in rest state.We enrolled 41 idiopathic PD patients, to validate the assessment of tremor symptoms.To be enrolled in the study, patients had to fulfill the movement disorder society clinical diagnostic criteria for PD.We used an innovative home-made, low-cost device, able to quantify the frequency and amplitude of rest tremor and stress conditionOur results confirmed the presence of tremor during muscular effort in a significant number of patients and the influence of emotional stress.We suppose that this new device should be validated in clinical practice as a support of differential diagnosis and therapeutic management of PD patients.


Asunto(s)
Técnicas Biosensibles/instrumentación , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/diagnóstico , Temblor/diagnóstico , Anciano , Anciano de 80 o más Años , Técnicas Biosensibles/métodos , Estudios de Cohortes , Intervalos de Confianza , Diseño de Equipo , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Neurodegenerativas/diagnóstico , Enfermedades Neurodegenerativas/tratamiento farmacológico , Estudios Retrospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Temblor/etiología
20.
Medicine (Baltimore) ; 98(51): e17936, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31860948

RESUMEN

Clearance of the hepatitis B surface antigen (HBsAg) is the ultimate aim of treatment for patients with chronic hepatitis B (CHB) infection. Genetic, factor age, and gender were reported to be involved in the clearance of HBsAg. However, the rate of HBsAg seroclearance in CHB patients is still low globally and few of the single-nucleotide polymorphism (SNP) had been identified to associated with HBsAg seroclearance in CHB patients.Recently, 3 associated SNPs (rs7944135, rs171941, and rs6462008) were reported in the clearance of HBsAg in the Korean population. However, these SNPs have not been investigated in the CHB Taiwanese population. In present study, these 3 SNPs were genotyped in 2565 Taiwanese CHB patients including 493 CHB patients with HBsAg seroclearance and 2072 without HBsAg seroclearance.We observed that SNP rs7944135 was solely associated with HBsAg seroclearance. Subjects with the AA genotype at rs7944135 of macrophage-expressed gene 1 had a higher susceptibility to HBsAg clearance, compared to those with the AG or GG genotype under the genotypic model (odds ratio [OR] = 1.76. 95% confidence interval [CI] = 1.14-2.72, P = .045). Furthermore, we found a 1.74-fold increased risk of acquiring HBsAg seroclearance associated with the AA genotype compared to AG + GG of rs7944135 under the recessive model (OR = 1.74. 95% CI = 1.13-2.66, P = .014). According to the cumulative fraction curve with the log-rank test revealed that patients with the AA genotype of rs7944135 showed higher susceptibility to occur HBsAg seroclearance (P = .039) and HBV DNA undetectable (P = .0074) compared to those with the AG or GG genotype.This study examined the associations of 3 SNPs (rs7944135, rs171941, and rs6462008) with HBsAg seroclearance, and we identified that rs7944135 is solely associated with HBsAg seroclearance in Taiwanese CHB patients.


Asunto(s)
Regulación de la Expresión Génica , Antígenos de Superficie de la Hepatitis B/genética , Virus de la Hepatitis B/genética , Hepatitis B Crónica/genética , Polimorfismo de Nucleótido Simple/genética , Adulto , Estudios de Cohortes , Intervalos de Confianza , ADN Viral/análisis , ADN Viral/genética , Femenino , Genotipo , Antígenos de Superficie de la Hepatitis B/inmunología , Hepatitis B Crónica/inmunología , Hepatitis B Crónica/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Polimorfismo de Nucleótido Simple/inmunología , Estudios Retrospectivos , Pruebas Serológicas/métodos , Taiwán
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