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1.
Medicine (Baltimore) ; 99(9): e19252, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118731

RESUMEN

Stroke is a serious disease that can lead to disability and death in adults, and the prediction of functional outcome is important in the management of acute ischemic stroke (AIS). Blood biomarker is a promising technique, for the measurement is fast, cheap and convenient. Visinin-like protein-1 (VILIP-1) is a classic stroke biomarker, thus we tried to investigate the predictive value of VILIP-1 for early functional outcomes of AIS.A total of 70 AIS patients were enrolled in our study. Venous blood samples of all patients were taken at day 3 after admission to the stroke unit, and levels of serum VILIP-1 were analyzed by the use of the enzyme-linked immunosorbent assay. All subjects underwent diffusion weighted imaging (DWI) of the brain MRI scanning at 72 hours after stroke onset, and infarct volumes were calculated. Initial neurological status was evaluated by the National Institutes of Health Stroke Scale (NIHSS) on admission. The short-term functional outcome was graded by the modified Rankin Scale (mRS) at discharge from the hospital. Baseline data between the favorable outcome group and poor outcome group were compared, and univariate and multivariable logistic regression analysis were used to identify risk factors of early functional outcome of AIS.The multivariate logistic regression analysis showed age, initial NIHSS scores and levels of VILIP had a strong association with poor clinical outcomes.Levels of serum VILIP-1 are associated with short-term functional outcomes in patients with AIS.


Asunto(s)
Neurocalcina/sangre , Accidente Cerebrovascular/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Estudios de Cohortes , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/mortalidad , Adulto Joven
2.
Medicine (Baltimore) ; 99(11): e19196, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176046

RESUMEN

BACKGROUND: To explore the role of preoperative prealbumin levels in predicting the prognosis of patients with gastric cancer. METHODS: A total of 989 gastric cancer patients in the Affiliated Tumour Hospital of Harbin Medical University who underwent gastrectomy were included in this retrospective study. The preoperative prealbumin level, clinicopathological data, and follow-up data were recorded. According to the maximum chi-square survival correlation value, the survival of patients with low preoperative prealbumin (<140 mg/L) and high preoperative prealbumin (≥140 mg/L) were compared using the log-rank test and the Cox proportional hazard regression model. RESULTS: Based on the best cut-off value of 140 mg/L, we divided the patients into the lower prealbumin group (<140 mg/L) and the higher prealbumin group (≥140 mg/L). Compared with the higher prealbumin group, the lower prealbumin group were older and had larger tumor volumes, lower hemoglobin (Hb) levels, and more upper gastric cancer tumors. The univariate analysis showed that prealbumin and other clinicopathological factors, including age, hemoglobin, tumor size, macroscopic type, cell differentiation, liver metastasis, operation type, N stage, and T stage, were significant prognostic factors. The multivariable analysis showed that age, prealbumin, macroscopic type, location, T stage, and N stage were independent prognostic factors. CONCLUSIONS: The preoperative prealbumin level was an independent prognostic factor for patients with gastric cancer. The preoperative prealbumin level can be used to predict the prognosis of patients with gastric cancer and guide clinical practice.


Asunto(s)
Biomarcadores de Tumor/sangre , Gastrectomía/mortalidad , Prealbúmina/metabolismo , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , China , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Gastrectomía/métodos , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Cuidados Preoperatorios/métodos , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Neoplasias Gástricas/patología , Análisis de Supervivencia , Resultado del Tratamiento
3.
Medicine (Baltimore) ; 99(12): e19538, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195958

RESUMEN

To evaluate the improvement of radiologist performance in detecting bone metastases at follow up low-dose computed tomography (CT) by using a temporal subtraction (TS) technique based on an advanced nonrigid image registration algorithm.Twelve patients with bone metastases (males, 5; females, 7; mean age, 64.8 ±â€Š7.6 years; range 51-81 years) and 12 control patients without bone metastases (males, 5; females, 7; mean age, 64.8 ±â€Š7.6 years; 51-81 years) were included, who underwent initial and follow-up CT examinations between December 2005 and July 2016. Initial CT images were registered to follow-up CT images by the algorithm, and TS images were created. Three radiologists independently assessed the bone metastases with and without the TS images. The reader averaged jackknife alternative free-response receiver operating characteristics figure of merit was used to compare the diagnostic accuracy.The reader-averaged values of the jackknife alternative free-response receiver operating characteristics figures of merit (θ) significantly improved from 0.687 for the readout without TS and 0.803 for the readout with TS (P value = .031. F statistic = 5.24). The changes in the absolute value of CT attenuations in true-positive lesions were significantly larger than those in false-negative lesions (P < .001). Using TS, segment-based sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the readout with TS were 66.7%, 98.9%, 94.4%, 90.9%, and 94.8%, respectively.The TS images can significantly improve the radiologist's performance in the detection of bone metastases on low-dose and relatively thick-slice CT.


Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Metástasis de la Neoplasia/diagnóstico por imagen , Técnica de Sustracción/instrumentación , Tomografía Computarizada por Rayos X/métodos , Anciano , Algoritmos , Neoplasias Óseas/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia/patología , Valor Predictivo de las Pruebas , Radiólogos/estadística & datos numéricos , Estudios Retrospectivos , Sensibilidad y Especificidad , Análisis y Desempeño de Tareas
4.
Am Surg ; 86(2): 121-126, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167046

RESUMEN

We performed a retrospective study of our large patient cohort aiming to examine the ability to predict postthyroidectomy hypocalcemia. A retrospective review of patients who underwent total or near-total thyroidectomy at our institution between 2008 and 2018 was performed. Postoperative hypocalcemia was defined as Ca level <8.0 mg/dL (reference range: 8.9-10.1 mg/dL) within 30 days of operation. Logistic regression was used to develop models for prediction of the occurrence of postoperative hypocalcemia. Inclusion criteria were met by 1463 patients. Hypocalcemia was documented in 223 patients (15%). Models based on parathyroid hormone (PTH) levels alone had an associated receiver operator characteristic with an areas under the curve (AUC) of 0.79. There was an inverse relationship between time of measurement and PTH levels within the first two hours after thyroidectomy (P < 0.01). When measured two to six hours after closure, the predictive ability of PTH compared favorably (AUC = 0.82) with either earlier (within the first two hours after closure, AUC = 0.79) or later measurement (6-24 hours after closure, AUC = 0.77). When measured between two and six hours postoperatively, PTH < 19 pg/mL had a sensitivity of 90 per cent and negative predictive value of 96 per cent for postoperative hypocalcemia. The model that included the PTH level, concurrently measured total blood calcium level, and time of measurement had an improved predictive ability with an AUC of 0.87. PTH level of 19 pg/mL measured two to six hours after thyroidectomy had a sensitivity of 90 per cent and a negative predictive value of 96 per cent in our cohort. The model including postoperative PTH level, calcium level, and time of measurement may further improve the ability to predict postthyroidectomy hypocalcemia.


Asunto(s)
Hipocalcemia/etiología , Hormona Paratiroidea/sangre , Complicaciones Posoperatorias , Tiroidectomía/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Biomarcadores/sangre , Calcio/sangre , Femenino , Humanos , Hipocalcemia/sangre , Modelos Logísticos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y Especificidad , Factores de Tiempo , Adulto Joven
5.
Am Surg ; 86(2): 83-89, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167053

RESUMEN

The ACS NSQIP Surgical Risk Calculator is designed to estimate the chance of an unfavorable outcome after surgery. Our goal was to evaluate the accuracy of the calculator in our emergency general surgery population. Surgical outcomes were compared to predicted risk. The risk was calculated with surgeon adjustment scores (SASs) of 1 (no adjustment), 2 (risk somewhat higher), and 3 (risk significantly higher than estimate). Two hundred and twenty-seven patients met the inclusion criteria. An SAS of 1 or 2 accurately predicted risk of mortality (5.7% and 8.5% predicted versus 7.9% actual), whereas a risk adjustment of 3 indicated significant overestimation of mortality rate (14.8% predicted). There was good overall prediction performance for most variables with no clear preference for SAS 1, 2, or 3. Poor correlation was seen with SSI, urinary tract infection, and length of stay variables. The ACS NSQIP Surgical Risk Calculator yields valid predictions in the emergency general surgery population, and the data support its use to inform conversations about outcome expectations.


Asunto(s)
Urgencias Médicas , Medición de Riesgo/métodos , Procedimientos Quirúrgicos Operativos/mortalidad , Exactitud de los Datos , Humanos , Tiempo de Internación , Modelos Logísticos , Persona de Mediana Edad , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/mortalidad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Infecciones Urinarias/mortalidad , Heridas y Traumatismos/clasificación , Heridas y Traumatismos/mortalidad , Heridas y Traumatismos/cirugía
6.
Am Surg ; 86(2): 95-103, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167059

RESUMEN

Patients undergoing radical pelvic surgery such as proctectomy or radical cystectomy are at risk of experiencing a variety of complications. Frailty renders patients vulnerable to adverse events. We hypothesize that frailty measured preoperatively using a validated scoring system correlates with increased likelihood of experiencing Clavien-Dindo grade IV complications and 30-day mortality and may be used as a predictive model for patients preoperatively. The NSQIP database was queried for patients who underwent proctectomy or radical cystectomy from 2008 to 2012. Preoperative frailty was calculated using the 11-point modified frailty index (MFI). Patients were scored based on the presence of indicators and categorized into two groups (<3 or ≥3). Major postoperative morbidities and mortality were identified and analyzed in each group. 10,048 proctectomy and cystectomy patients were identified. The MFI was found to be predictive of both 30-day mortality (P < 0.0001) and Clavien-Dindo grade IV complications (P < 0.0001). Receiver operating characteristic analysis demonstrated improved discriminative power of the MFI with the addition of American Society of Anesthesiologists class for both prediction of complications and 30-day mortality. An MFI score of ≥3 is predictive of postoperative morbidity and mortality. Providers should be encouraged to calculate frailty preoperatively to predict adverse outcomes.


Asunto(s)
Cistectomía/efectos adversos , Fragilidad/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Proctectomía/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Cistectomía/mortalidad , Cistectomía/estadística & datos numéricos , Bases de Datos Factuales , Femenino , Fragilidad/complicaciones , Fragilidad/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Pelvis/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Proctectomía/mortalidad , Proctectomía/estadística & datos numéricos , Curva ROC , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
7.
Medicine (Baltimore) ; 99(9): e19296, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118744

RESUMEN

OBJECTIVE: The aim of this study was to compare tissue doppler imaging (TDI) and equilibrium radionuclide angiography (ERNA) for detection of right ventricular (RV) dyssynchrony and prediction of the acute response to cardiac resynchronization therapy (CRT). METHODS: This study was approved by the local ethics committee of Huai'an First People's Hospital. Patient consent was not provided due to the use of completely anonymous images from which the individual could not be identified in this study. Thirty-three patients with nonischemic dilated cardiomyopathy underwent both TDI and ERNA before and within 48 hour after CRT implantation. RV dyssynchrony was measured with TDI using the difference in time to peak systolic velocity between the RV free wall and ventricular septum (RV-T). With ERNA, the standard of RV mean phase angle and RV phase standard deviation (RVmPA% and RVPSD%) were assessed. RESULTS: Moderate positive correlations were observed among baseline RVmPA%, RVPSD% and RV-T (r = 0.689 and 0.716, P < .001). Twenty patients (61%) with a reduction of at least 15% in LV end-systolic volume were categorized as acute responders after CRT. Responders showed significant reduction in RVmPA% and RVPSD% after CRT (53.60 ±â€Š4.15% to 43.95 ±â€Š6.88% and 14.00 ±â€Š2.41% to 10.40 ±â€Š1.67%, P < .05), whereas RV-T remained unchanged (50.10 ±â€Š10.28 ms to 49.25 ±â€Š13.64ms, NS). Receiver operating characteristic curve showed that the cut-off value of RV-T was 48.5ms, yielding 65% sensitivity and 77% specificity to predict acute respond to CRT. The cut-off value of RVmPA% was 49.5%, yielding 85% sensitivity and 85% specificity and the cut-off value of RVPSD% was 11.5%, yielding 85% sensitivity and 92% specificity. CONCLUSION: ERNA might be an appropriate alternative to TDI for assessment of RV dyssynchrony. Either RVmPA% or RVPSD% was highly predictive for acute response to CRT.


Asunto(s)
Terapia de Resincronización Cardíaca/normas , Imagen de Acumulación Sanguínea de Compuerta/normas , Cardiopatías/diagnóstico , Función Ventricular Derecha , Anciano , Terapia de Resincronización Cardíaca/métodos , Terapia de Resincronización Cardíaca/estadística & datos numéricos , Femenino , Imagen de Acumulación Sanguínea de Compuerta/métodos , Imagen de Acumulación Sanguínea de Compuerta/estadística & datos numéricos , Cardiopatías/terapia , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC
8.
Zhonghua Fu Chan Ke Za Zhi ; 55(2): 94-99, 2020 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-32146737

RESUMEN

Objective: To explore the relationship between fetal nuchal translucency (NT) in the first trimester and pregnancy outcome. Methods: A prospective cohort study was conducted in Nanjjing Drum Tower Hospital from December 2015 to December 2018, 4 958 singleton pregnant women were enrolled to screen fetal ultrasound structure and serology in the first trimester, ultrasound in the second trimester and neonatus physical examination 28 days after birth. According to the results of NT, 167 cases of fetus with increased NT (≥3.0 mm) and 4 791 cases of normal NT were divided, moreover, 86 cases with isolate increased NT and 81 cases of increased NT combined with structural abnormality. The prognosis of fetuses with different NT thickness was analyzed, and the pregnancy outcome of fetuses with isolate increased NT or combined with structural abnormality were analyzed. In the first trimester, if the fetal structure was abnormal or the serological screening result was high risk, the chromosomal microarray analysis (CMA) would be performed by chorionic villus sampling to determine the prenatal diagnosis. Results: (1) The pregnancy outcome for fetus of normal NT: there were 4 791 cases with normal NT. Totally, 4 726 cases with normal NT and no structural abnormalities were screened out in the firsttrimester. In this group, 5 cases of aneuploidies were diagnosed based on high risk of maternal serum biomarkers and 83 cases of structural abnormalities were screened out in the subsequent ultrasound scan and the neonatal examination. Another 65 cases with normal NT present complicated with structural anomalies were screened out in the first trimester and 4 cases were diagnosed as aneuploidies. (2) The pregnancy outcome for fetus of isolate increased NT: 66 (76.7%, 66/86) cases of isolated increased NT were performed CMA, 3 cases were diagnosed as trisomy 21 and terminated pregnancy. Another 4 cases were terminated pregnancy privately without cytogenetic diagnosis. No further anomalies were found in 79 cases till 6 to 21 months postnatally. (3) The pregnancy outcome for fetus of increased NT with structural anomalies: increased NT present with structural anomalies were screened out by detailed anomaly scan in the first trimester and 32 of them were confirmed as aneuploidies. In this group, 70 cases terminated pregnancy, 2 cases had spontaneous miscarriages and 9 cases had liveborns (1 newborn was found ventricular septal defect). (4) The pregnancy outcome for fetus of increased NT with or without structural anomalies: the percentage of aneuploidies in fetuses with isolated increased NT (3.5%, 3/86) was significantly lower than those with structural abnormalities (39.5%,32/81). The healthy survival rate in fetuses with isolated increased NT (91.9%,79/86) was significantly higher than those with structural abnormalities (9.9%, 8/81). Conclusions: A detailed first-trimester anomaly scan could improve prenatal screening efficiency of birth defects. Compared to the fetuses with increased NT combined with structural abnormalities, the healthy survival rate of fetuses with isolated increased NT based on detailed first-trimester anomaly scan is higher and the percentage of fetal aneuploidies is lower.


Asunto(s)
Feto/diagnóstico por imagen , Medida de Translucencia Nucal/métodos , Resultado del Embarazo , Ultrasonografía Prenatal/métodos , Aneuploidia , Anomalías Congénitas/diagnóstico , Anomalías Congénitas/etiología , Femenino , Humanos , Recién Nacido , Valor Predictivo de las Pruebas , Embarazo , Primer Trimestre del Embarazo , Estudios Prospectivos
9.
Zhonghua Fu Chan Ke Za Zhi ; 55(2): 106-111, 2020 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-32146739

RESUMEN

Objective: To evaluate the efficacy of cell free DNA (cf-DNA) screening in prenatal care by analyzing the follow-up information and pregnancy outcomes. Methods: All cf-DNA cases conducted in Women's Hospital of Nanjing Medical University from August 2011 to December 2017 were enrolled. The general information of the pregnancies, cf-DNA results, confirmatory testing results, and the follow-up results were collected. The pregnancy outcomes were analyzed in cases with low risk cf-DNA results as well as with high risk results for common trisomies, which were trisomy 21 (T21), trisomy 18 (T18), and trisomy 13 (T13). The sensitivity, specificity, positive predictive value and negative predictive value of cf-DNA screening were calculated. Results: (1) A total of 43 615 cf-DNA cases were involved, with 44 cases (0.10%, 44/43 615) test failure results, 314 cases (0.72%, 314/43 571) high risk results for common trisomies and 43 257 cases (99.27%, 43 257/43 571) low risk results. (2) Among 277 cases (88.21%, 277/314) high risk cases were successfully followed up, and 228 cases (82.31%, 228/277) underwent invasive confirmatory prenatal diagnosis. In the low risk results, 36 826 cases (85.13%, 36 826/43 257) were successfully followed up, and 572 (1.55%, 572/36 826) cases were found to have adverse pregnancy outcomes, among which 4 false negative cf-DNA results were confirmed. (3) In the 37 103 successfully followed up cf-DNA cases, the sensitivity for T21, T18, T13 were calculated as 97.96%, 96.67% and 100.00%, respectively; the specificity for T21, T18, T13 were calculated as 99.96%, 99.95% and 99.95%, respectively. The positive predictive value for T21, T18, T13 were calculated as 90.57%, 63.04% and 17.39%, respectively. The negative predictive value for T21, T18, T13 were calculated as 99.99%, 99.98% and 100.00%. Conclusions: Cf-DNA is effective in detecting common trisomies, with a high sensitivity and specificity. However, the follow-up information revealed several potential limitations in current clinical practice, such as a number of cases with high risk results rejected invasive confirmatory testing, as well as the genetic diagnostic results for most low risk cases with an adverse pregnancy outcome aren't obtained. Genetic counseling and the follow-up for all the cf-DNA cases should be emphasized in the future.


Asunto(s)
Ácidos Nucleicos Libres de Células , Trastornos de los Cromosomas/diagnóstico , Diagnóstico Prenatal/métodos , Trisomía/diagnóstico , Trastornos de los Cromosomas/genética , Cromosomas Humanos Par 18/genética , Femenino , Estudios de Seguimiento , Pruebas Genéticas/métodos , Humanos , Valor Predictivo de las Pruebas , Embarazo , Resultado del Embarazo , Sensibilidad y Especificidad , Trisomía/genética , Síndrome de la Trisomía 13 , Síndrome de la Trisomía 18 , Ultrasonografía Prenatal
10.
Medicine (Baltimore) ; 99(10): e19405, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150090

RESUMEN

Advanced gastric cancer has a poor prognosis because of advanced gastric cancer is prone to metastasis. It is urgent for us to find an indicator to predict the prognosis of gastric cancer in a timely fashion. Research has revealed that inflammation has an important role in predicting survival in some cancers. The purpose of this study was to evaluate the significance of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) on the prognosis of metastatic gastric cancer (GC).This was a retrospective review of 110 patients were at presentation diagnosed with stage IV metastatic GC and all patients received palliative chemotherapy between January 2012 and January 2016 at the Affiliated Hospital of Qingdao University. Pretreatment NLR and PLR, as well as clinicopathological characteristics were collected. Patients were divided into high and low groups according to the cutoff values for NLR and PLR. The Kaplan-Meier method was applied to estimate the overall survival (OS) and the Cox proportional hazards model to evaluate the related risk factors for OS. All tests were 2-tailed and a P < .05 was considered to indicate a statistically significant difference.One hundred ten patients were enrolled. Eighty-four patients were men, 24 patients were women, 61 patients were ≥65 years of age, and 49 patients were <65 years of age. The Eastern Cooperative Oncology Group (ECOG) score of most patients (n = 107) ranged from 0 to 1. Ten patients were human epidermal growth factor receptor 2 (HER2)-positive. Seventy-one patients presented with an elevated carcinoembryonic antigen (CEA) level and 49 patients had an elevated Carcinoembryonic 199 (CA-199) level. Fifty-two patients received first-line chemotherapy only. Nineteen patients received third-line or greater chemotherapy. One hundred patients chose dual drug chemotherapy. The median duration of follow-up was 11.6 months. Based on the receiver operating characteristic (ROC) curve, the optimal cut-off value for NLR and PLR was 2.48 and 143.39. Patients with high NLR and high PLR had poor overall survival compared with those who had low NLR and low PLR (P < .001 and P = .013, respectively). In univariate analysis, old age (P = .013), liver metastasis (P = .001), >1 metastatic sites (P = .028), higher NLR (P = .000), and higher PLR (P = .014) were identified as poor prognostic factors associated with OS. Our multivariate analysis had indicated that high NLR (hazard ratio [HR]: 1.617, 95% CI: 1.032-2.525, P = .036) and peritoneal metastasis (HR: 1.547, 95% CI:1.009-2.454, P = .045) was independent prognostic factors for overall survival; however, the PLR was not shown to be an independent prognostic factor.Our study suggested that the pretreatment NLR can be used as significant prognosis biomarker in metastatic gastric cancer patients receiving palliative chemotherapy.


Asunto(s)
Neoplasias Gástricas/mortalidad , Anciano , Biomarcadores de Tumor/sangre , Plaquetas/citología , China , Femenino , Humanos , Linfocitos/citología , Masculino , Metástasis de la Neoplasia , Neutrófilos/citología , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Neoplasias Gástricas/sangre , Neoplasias Gástricas/patología , Análisis de Supervivencia
11.
Medicine (Baltimore) ; 99(10): e19411, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150091

RESUMEN

The effects of the intercondylar notch morphology on predicting anterior crucaite ligament (ACL) injury in males were unknown. We aimed to determine the risk factors of the intercondylar notch on ACL injury, and evaluate the predictive effects of the morphological parameters on ACL injury in males. Sixty-one patients with ACL injury and seventy-eight patients with intact ACLs were assigned to the case group and control group respectively. The notch width (NW), bicondylar width, notch width index (NWI), notch height (NH), notch cross-sectional area (CSA), notch angle (NA) and notch shape were obtained from the magnetic resonance images of male patients. Comparisons were performed between the case and control groups. Logistic regression model and the receiver operating characteristic curve were used to assess the predictive effects of these parameters on ACL injury. The NW, NWI, NH, CSA and NA in the case group were significantly smaller than those in the control group on the coronal magnetic resonance images. The NW and NWI were significantly smaller, while no significant differences of the NH and CSA were found between the 2 groups on the axial images. There was no significant difference in the notch shape between the 2 groups. The maximum value of area under the curve calculated by combining all relevant morphological parameters was 0.966. The ACL injury in males was associated with NW, NH, NWI, CSA, and NA. These were good indicators for predicting ACL injury in males.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/diagnóstico por imagen , Adolescente , Adulto , Huesos/diagnóstico por imagen , Estudios de Casos y Controles , Humanos , Puntaje de Gravedad del Traumatismo , Articulación de la Rodilla/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Valor Predictivo de las Pruebas , Factores de Riesgo , Sensibilidad y Especificidad , Adulto Joven
12.
Medicine (Baltimore) ; 99(11): e19491, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176088

RESUMEN

PROM1 has played a pivotal role in the identification and isolation of tumor stem cells. This study aimed to assess the association between PROM1 promoter methylation and head and neck squamous cell carcinoma (HNSCC), and its diagnostic and prognostic value.Bioinformatic analysis was performed using data from the Cancer Genome Atlas-HNSC and Gene Expression Omnibus datasets.The results showed that PROM1 promoter was hypermethylated in HNSCCs compared with normal head and neck tissues (P = 4.58E-37). The area under the receiver-operating characteristic curve based on methylated PROM1 data was 0.799. In addition, PROM1 hypermethylation independently predicted poor overall survival (hazard ratio [HR]: 1.459, 95% confidence interval [CI]: 1.071-1.987, P = .016) and recurrence-free survival (HR: 1.729, 95% CI: 1.088-2.749, P = .021) in HNSCC patients. Moreover, PROM1 methylation was weakly negatively correlated with its mRNA expression (Pearson r = -0.148, P < .001).In summary, our study reveals that methylated PROM1 might serve as a valuable diagnostic biomarker and predictor of poor survival for HNSCC patients. PROM1 hypermethylation might partially contribute to its downregulation in HNSCC.


Asunto(s)
Antígeno AC133/genética , Predisposición Genética a la Enfermedad , Neoplasias de Cabeza y Cuello/genética , Recurrencia Local de Neoplasia/genética , Carcinoma de Células Escamosas de Cabeza y Cuello/genética , Grupo de Ascendencia Continental Asiática , Biomarcadores de Tumor/genética , China/epidemiología , Minería de Datos , Supervivencia sin Enfermedad , Femenino , Regulación Neoplásica de la Expresión Génica , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Carcinoma de Células Escamosas de Cabeza y Cuello/mortalidad , Análisis de Supervivencia
13.
Medicine (Baltimore) ; 99(11): e19494, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176090

RESUMEN

As detection rates of non-albicans Candida species are increasing, determining their pathogen profiles and antifungal susceptibilities is important for antifungal treatment selection. We identified the antifungal susceptibility patterns and predictive factors for mortality in candidemia.A multicenter retrospective analysis of patients with at least 1 blood culture positive for Candida species was conducted. Candida species were classified into 3 groups (group A, Candia albicans; group B, Candida tropicalis, and Candida parasilosis; group C, Candida glabrata and Candida krusei ) to analyze the susceptibility patterns, first-line antifungal administered, and mortality. Univariate and multivariate comparisons between outcomes were performed to identify mortality risk factors.In total, 317 patients were identified, and 136 (42.9%) had recorded mortality. Echinocandin susceptibility was higher for group A than group B (111/111 [100%] vs 77/94 [81.9%], P < .001). Moreover, group A demonstrated higher fluconazole susceptibility (144/149 [96.6%] vs 39/55 [70.9%], P < .001) and lower mortality (68 [45.3%] vs 34 [61.8%], P = .036) than those of group C. In the multivariate analysis, the sequential organ failure assessment score (odds ratio OR 1.351, 95% confidence interval 1.067-1.711, p = 0.013) and positive blood culture on day 7 of hospitalization (odds ratio 5.506, 95% confidence interval, 1.697-17.860, P = .004) were associated with a higher risk of mortality.Patients with higher sequential organ failure assessment scores and sustained positive blood cultures have an increased risk of mortality.


Asunto(s)
Antifúngicos/uso terapéutico , Candida/efectos de los fármacos , Candidemia/tratamiento farmacológico , Farmacorresistencia Fúngica , Fluconazol/uso terapéutico , Anciano , Antifúngicos/farmacología , Candidemia/mortalidad , Femenino , Fluconazol/farmacología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Valor Predictivo de las Pruebas , República de Corea , Estudios Retrospectivos , Factores de Riesgo
14.
Medicine (Baltimore) ; 99(11): e19504, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176094

RESUMEN

F-fluoro-2-deoxy-D-glucose positron emission tomography integrated with computed tomography (F-FDG PET/CT) has been proved to be practical in detecting occult malignant lesions. However, the evidence of its utility in detecting early recurrence after resection of pancreatic ductal adenocarcinoma (PDAC) is lacking. Therefore, the primary aim of the present study is to evaluate the diagnostic value of F-FDG PET/CT in the early postoperative period after radical resection of PDAC.This retrospective study included 32 patients who had F-FDG PET/CT scan within 6 months after radical resection of PDAC between January 2010 and December 2018.In total, 10 positive PET results were found at surgical margins of remnant pancreas, 12 at locoregional lymph nodes, 5 at distant areas, with the corresponding mean maximum standard uptake value (SUVmax) of 5.8 ±â€Š1.1, 5.9 ±â€Š0.9, and 6.4 ±â€Š0.7, respectively. The median follow-up time was 23.5 months (range: 8-75 months), and the median survival time was 39.5 months (95% confidence interval: 14.6-64.4 months) for the entire cohort. Patients with positive PET findings at either locoregional lymph nodes or distant areas obtained significantly poorer overall survival (OS) than those without increased FDG uptake at the corresponding areas (P = .003 and P < .001, respectively). Whereas comparisons of OS between patients with or without increased FDG uptake at the surgical margin of remnant pancreas presented no statistically difference (P = .742).The early application of F-FDG PET/CT after radical resection of PDAC could stratify the prognosis of patients well by detecting occult early recurrence at locoregional lymph nodes and distant areas efficiently.


Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/cirugía , China , Femenino , Fluorodesoxiglucosa F18 , Humanos , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Tomografía Computarizada por Tomografía de Emisión de Positrones , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Radiofármacos , Estudios Retrospectivos , Análisis de Supervivencia
15.
Medicine (Baltimore) ; 99(11): e19509, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176096

RESUMEN

Transthyretin amyloid (ATTR) amyloidosis is a rare systemic disorder characterized by amyloid deposits formed by misfolded monomers of the transthyretin. Gastrointestinal (GI) manifestations are common in ATTR amyloidosis; however, their pathogenesis is not fully elucidated. In the present study, we aim to evaluate the diagnostic role of fecal calprotectin (FC) in ATTR amyloidosis patients with GI manifestations.We recruited 21 consecutive ATTR amyloidosis patients and 42 sex and age-matched healthy controls. The presentation of GI symptoms and the severity of peripheral neuropathy were evaluated. Colonoscopy and FC assessment were performed in all subjects.Mean levels of FC in ATTR amyloidosis patients (184 µg/g [30-430]) were significantly higher thаn those of controls (40 µg/g [30-70]), P < .001. Receiver operating characteristic curve analysis indicated a FC cut-off level of 71 µg/g, which differentiates ATTR amyloidosis with GI manifestations from healthy subjects with 91% sensitivity, 100% specificity, 100% positive predictive value, 95% negative predictive value and 97% overall accuracy. FC values were significantly associated with the presence of neutrophilic granulocytic infiltration in the colonic mucosa (P = .002), with the presence of amyloid deposits in rectal mucosa (P = .007) and the presence of diarrhea (P = .046).FC levels are elevated in patients with ATTR amyloidosis with GI manifestations, which suggests an inflammatory component in the pathogenesis of the disease. The presence of elevated FC concentrations could help gastroenterologists to include ATTR amyloidosis in their diagnostic work-up.


Asunto(s)
Neuropatías Amiloides Familiares/diagnóstico , Enfermedades Gastrointestinales/diagnóstico , Complejo de Antígeno L1 de Leucocito/metabolismo , Adulto , Anciano , Neuropatías Amiloides Familiares/metabolismo , Biomarcadores/metabolismo , Estudios de Casos y Controles , Colonoscopía , Heces/química , Femenino , Enfermedades Gastrointestinales/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos
16.
Medicine (Baltimore) ; 99(11): e19510, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176097

RESUMEN

Performing a head-up tilt test can be of great value for the diagnosis of vasovagal syncope. The European Society of Cardiology recommends a drug challenge phase duration of 15 to 20 minutes, with either Isoprenaline or Nitroglycerin administration.We sought to investigate the outcome of a ten-minute active phase with Nitroglycerin in patients suspected of vasovagal syncope and determine the percentage of loss in the positivity rate, using this short duration approach.We consecutively enrolled patients presenting with syncope undergoing the head-up tilt test (HUTT), with a clinical suspicion of vasovagal syncope between the years 2009 to 2019. The HUTT consisted of 2 successive phases: passive and active. During the passive phase, the patients were tilted at 70° for 20 minutes. If negative, the test was continued after administration of 0.4 mg sublingual Nitroglycerin. Applying the (VASIS) Vasovagal Syncope International Study classification of the vasovagal syncope international study and comparing for age and gender, positive responses were categorized into 3 types.A number of 306 patients (age = 43.5 +/-20.3; male = 140 [45.7%]) with suspected vasovagal syncope, undergoing HUTT, were enrolled in the years of 2009 to 2019. Of those, 245 (80.2%) presented a positive test, with 200 patients (82.0%) during the being positive during the active phase of the test. The results were as follows: 116 subjects (47.2%) presented with a mixed response (VASIS I), 52 (21.3%) showed a cardio inhibitory response (VASIS II), and 77 (31.5%) displayed a vasodepressor response (VASIS III). We found no relationship between the type of syncope with neither gender, nor age of the patient. Three minutes represented the median time to positivity, after Nitroglycerine administration. The time distribution showed a peak incidence appearing between minutes 3 and 5, ranging from 1 to 20 minutes. Only 3 patients tested positive after minute 10.Shortening the active phase to 10 minutes would result in a positivity rate loss of 1.5%.


Asunto(s)
Nitroglicerina/administración & dosificación , Síncope Vasovagal/diagnóstico , Pruebas de Mesa Inclinada , Vasodilatadores/administración & dosificación , Administración Sublingual , Adulto , Esquema de Medicación , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Factores de Tiempo
17.
Medicine (Baltimore) ; 99(11): e19512, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176098

RESUMEN

To investigate the relationships between grip strengths and self-care activities in stroke patients using a non-linear support vector machine (SVM).Overall, 177 inpatients with poststroke hemiparesis were enrolled. Their grip strengths were measured using the Jamar dynamometer on the first day of rehabilitation training. Self-care activities were assessed by therapists using Functional Independence Measure (FIM), including items for eating, grooming, dressing the upper body, dressing the lower body, and bathing at the time of discharge. When each FIM item score was ≥6 points, the subject was considered independent. One thousand bootstrap grip strength datasets for each independence and dependence in self-care activities were generated from the actual grip strength. Thereafter, we randomly assigned the total bootstrap datasets to 90% training and 10% testing datasets and inputted the bootstrap training data into a non-linear SVM. After training, we used the SVM algorithm to predict a testing dataset for cross-validation. This validation procedure was repeated 10 times.The SVM with grip strengths more accurately predicted independence or dependence in self-care activities than the chance level (mean ±â€Šstandard deviation of accuracy rate: eating, 0.71 ±â€Š0.04, P < .0001; grooming, 0.77 ±â€Š0.03, P < .0001; upper-body dressing, 0.75 ±â€Š0.03, P < .0001; lower-body dressing, 0.72 ±â€Š0.05, P < .0001; bathing, 0.68 ±â€Š0.03, P < .0001).Non-linear SVM based on grip strengths can prospectively predict self-care activities.


Asunto(s)
Evaluación de la Discapacidad , Fuerza de la Mano , Paresia/rehabilitación , Autocuidado , Rehabilitación de Accidente Cerebrovascular , Anciano , Femenino , Humanos , Aprendizaje Automático , Masculino , Paresia/fisiopatología , Alta del Paciente , Valor Predictivo de las Pruebas
18.
Medicine (Baltimore) ; 99(11): e19524, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176104

RESUMEN

The clinical significance of poor nutritional status in patients with peripartum cardiomyopathy (PPCM) is not clearly understood. Prognostic nutritional index (PNI) is a simple nutritional assessment tool, which was first demonstrated to be valuable in patients with colorectal surgeries. We aimed to investigate the predictive value of PNI in patients with PPCM.A total of 92 patients diagnosed with PPCM were enrolled in this study. PNI was calculated using the following formula: 10 × serum albumin value (g/dL) + 0.005 × total lymphocyte count. The primary endpoint was defined as composite adverse cardiac events that included cardiac death or hospitalization due to worsening heart failure (HF). Cardiac death, hospitalization due to worsening HF, and persistent left ventricular (LV) systolic dysfunction were evaluated, respectively, as secondary endpoints.Primary composite endpoint was higher in the lower PNI group. After adjusting for other risk factors, PNI was found to be as an independent predictor of primary composite endpoint (odds ratio 0.805; 95% confidence interval 0.729-0.888; P < .001). In addition, PNI was significantly associated with secondary endpoints; persistent LV systolic dysfunction as well as cardiac death.This study identified nutritional status assessed by the PNI seems to be a novel predictor of adverse cardiovascular outcomes in patients with PPCM.


Asunto(s)
Cardiomiopatías/diagnóstico , Estado Nutricional , Diagnóstico Prenatal , Trastornos Puerperales/diagnóstico , Adulto , Biomarcadores , Cardiomiopatías/sangre , Cardiomiopatías/mortalidad , Cardiomiopatías/fisiopatología , Femenino , Humanos , Valor Predictivo de las Pruebas , Embarazo , Trastornos Puerperales/sangre , Trastornos Puerperales/mortalidad , Trastornos Puerperales/fisiopatología , Factores de Riesgo , Análisis de Supervivencia
19.
Medicine (Baltimore) ; 99(11): e19460, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176078

RESUMEN

Transient ischemic attack (TIA) is often recurrent, and about one-third of patients will progress to cerebral infarction. Rapidly identifying high-risk patients is pivotal to prevent the development of cerebral infarction. Therefore, this study aimed to evaluate the value of ABCD score, ABCD score combined with magnetic resonance diffusion weighted imaging (DWI) and intracranial arterial magnetic resonance angiography (MRA) in predicting cerebral infarction after 2 to 30 days of transient ischemic attack (TIA).182 patients with TIA from August 2011 to August 2014 were enrolled as study subjects, and their clinical data, test results of DWI and MRA were collected. The incidence of cerebral infarction was observed at 2 days, 7 days and 30 days after TIA in patients with TIA, through scoring according to the 7-point ABCD score method proposed by Johnston. The relationship between ABCD score, performances of DWI and MRA and the early incidence of cerebral infarction after TIA was analyzed. The accuracy rating of ABCD score and ABCD + DWI + MRA score used for predicting the early incidence of cerebral infarction after TIA were compared with each other.The incidence of cerebral infarction after TIA was 19 cases (10.4%) in 2 days, 42 cases (23.1%) in 7 days, 56 cases (30.8%) in 30 days respectively. For the ABCD score of incidence of cerebral infarction 2 to 30 days after TIA, that of those with high risk was higher than that with medium risk, and that with the medium risk was higher than that with low risk (P < .05). The area under the curve of ABCD + DWI + MRA score and ABCD score predicting the incidence of cerebral infarction was: in 2 days: 0.782 and 0.748, in 7 days: 0.839 and 0.801, in 30 days: 0.780 and 0.757, P < .05.Compared with ABCD score, ABCD score combined with DWI and MRA can further improve the accuracy of prediction for cerebral infarction after TIA.


Asunto(s)
Ataque Isquémico Transitorio/complicaciones , Accidente Cerebrovascular/etiología , China/epidemiología , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Incidencia , Ataque Isquémico Transitorio/diagnóstico por imagen , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/epidemiología
20.
Medicine (Baltimore) ; 99(11): e19477, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176079

RESUMEN

We assessed the predictive value of serum ammonia level on admission for the 28-day mortality of patients with sepsis.We retrospectively included septic patients admitted to the emergency department of West China Hospital, Sichuan University and The Fourth People's Hospital of Zigong city from June 2017 to May 2018. Patients were divided into 2 groups according to 28-day survival. Comparisons of serum ammonia level and sequential organ failure assessment (SOFA) score were made between 2 groups. Multivariate logistic regression models were employed to determine independent risk factors affecting 28-day mortality rate, and receiver operating characteristic (ROC) curve was also used to evaluate the efficacy of risk factors.Total of 316 patients were included into the study, 221 survived to 28 days and 95 were died before 28 days. The 28-day mortality rate was 30.06%. Multivariate logistic regression analyses revealed that the ammonia level, C reactive protein, SOFA score, and the leukocyte were independent risk factors for the 28-day mortality rate. In predicting the 28-day mortality rate, the SOFA score presented an area under the ROC curve (AUC) of 0.815, and the ammonia levels presented the AUC of 0.813.The ammonia level, C reactive protein, SOFA score, and the leukocyte are independent risk factors for 28-day mortality rate in septic patients. Moreover, the serum ammonia and SOFA score have similar predictive values. The serum ammonia level is also a suitable early indicator for prognostic evaluation of patients with sepsis as well.


Asunto(s)
Amoníaco/sangre , Servicio de Urgencia en Hospital , Sepsis/sangre , Sepsis/mortalidad , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , China/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia
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