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1.
Mult Scler ; : 1352458520912380, 2020 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-32228208
2.
Mult Scler ; : 1352458520913970, 2020 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-32228287

RESUMO

OBJECTIVES: Likelihood of clinical events occurring within the same anatomical location in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) was retrospectively investigated. METHODS: A total of 236 clinical events in 90 patients with MOGAD from nine referral hospitals were analyzed via logistic regression, and odds ratios (ORs) were calculated. Anatomical lesion location was divided into four groups; optic nerve, spinal cord, cerebral hemisphere, and brainstem/cerebellum. RESULTS: At all locations, there was an increased likelihood of a second attack occurring at the same location as the initial event (cerebral hemisphere OR = 22.14, brainstem/cerebellum OR = 18.4, spinal cord OR = 9.1, and optic nerve OR = 7.8). There was an increased likelihood of a third attack occurring at the same location as the initial event in the optic nerve (OR = 14.9), cerebral hemisphere (OR = 11.7), and spinal cord (OR = 6.7). There were positive trends toward a third clinical event occurring at the same location as the first and/or second events if the event was in the optic nerve (OR = 13.5), cerebral hemisphere (OR = 6.9), or spinal cord (OR = 5.7). CONCLUSIONS: The current study suggests that clinical relapses of MOGAD during early stage tend to recur at the same anatomical locations in the central nervous system.

3.
Med Phys ; 2020 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-32239517

RESUMO

PURPOSE: We present a new framework for theoretical analysis of the noise power spectrum (NPS) of photon-counting x-ray detectors, including simple photon-counting detectors (SPCDs) and spectroscopic x-ray detectors (SXDs), the latter of which use multiple energy thresholds to discriminate photon energies. METHODS: We show that the NPS of SPCDs and SXDs, including spatio-energetic noise correlations, is determined by the joint probability density function (PDF) of deposited photon energies, which describes the probability of recording two photons of two different energies in two different elements following a single photon interaction. We present an analytic expression for this joint PDF and calculate the pre-sampling and digital NPS of CdTe SPCDs and SXDs. We calibrate our charge sharing model using the energy response of a cadmium zinc telluride (CZT) spectroscopic x-ray detector and compare theoretical results with Monte Carlo simulations. RESULTS: Our analysis shows that charge sharing increases pixel signal-to-noise-ratio (SNR), but degrades the zero-frequency signal-to-noise performance of SPCDs and SXDs. In all cases considered, this degradation was greater than 10%. Comparing the pre-sampling NPS with the sampled NPS showed that degradation in zero-frequency performance is due to zero-frequency noise-aliasing induced by charge sharing. CONCLUSIONS: Noise performance, including spatial and energy correlations between elements and energy bins, are described by the joint PDF of deposited energies which provides a method of determining the photon-counting NPS, including including noise-aliasing effects and spatio-energetic effects in spectral imaging. Our approach enables separating noise due to x-ray interactions from that associated with sampling, consistent with cascaded systems analysis of energy-integrating systems. Our methods can be incorporated into task-based assessment of image quality for the design and optimization of spectroscopic x-ray detectors.

4.
Surg Laparosc Endosc Percutan Tech ; 30(2): 137-143, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32141972

RESUMO

BACKGROUND: Robotic surgery can help to identify and preserve the autonomic nerves during total mesorectal excision (TME) compared with open surgery or laparoscopy due to the 3-dimensional image and high dexterity of the robotic system. Therefore, this study aimed to assess voiding and sexual function after robotic TME with autonomic nerve preservation. In particular, we focused on the long-term results in male patients operated by a single experienced surgeon. MATERIALS AND METHODS: We surveyed male patients aged 50 years and below at the time of robotic rectal cancer surgery between November 2011 and July 2018. Patients who died and those who had a recurrence and underwent abdominoperineal resection were excluded. The questionnaire covered the International Prostate Symptom Score (IPSS) and the 5-item version of the International Index of Erectile Function (IIEF-5) for voiding and sexual function, respectively. RESULTS: Thirty-nine patients (median age, 44 y) were surveyed. IPSS and IIEF-5 scores were 5.7±5.3 and 14.7±8.4, respectively. Only 6 patients (15.4%) complained of poor quality of life due to their urinary symptoms. In sexual function, 10 patients (25.6%) complained severe reduction compared with their preoperative status. The average of postoperative days defined from surgery to the questionnaire was 37.8 months. A significant change in the IIEF-5 score was observed between 1 and 2 years postoperatively (5.8±6.9 vs. 16.5±8.8; P=0.027). CONCLUSIONS: As we only included male patients who were operated by a single experienced surgeon, the results of robotic TME with pelvic autonomic nerve preservation showed acceptable data in preserving both voiding and sexual functions. Although related clinical factors for poor functional outcomes was not statistically significant due to the small sample size, we could observe an improvement in sexual function between 1 and 2 years after surgery with long-term functional results.

5.
Artigo em Inglês | MEDLINE | ID: mdl-32219649

RESUMO

Burial is applied to dispose of livestock carcasses due to its convenience and cost efficiency despite concerns about groundwater contamination by leachate from burial pits. In particular, the burial method has caused debates about groundwater contamination sources around on-farm livestock burial sites because of pre- and coexisting contamination from livestock production and agriculture. To assess the causes of groundwater contamination around poultry burial pits that were constructed after an outbreak of avian influenza in 2010-11 in Korea, hydrochemical data of groundwater samples from monitoring wells (MWs, n = 14) and household wells (HWs, n = 30) were monitored to differentiate contamination sources. Hydrochemical data indicated that groundwater from MWs is characterized by higher enrichments of inorganic constituents including electrical conductivity (EC), NH4, Ca, Mg, K, SO4, HCO3, Fe(Total), and Mn(Total), but lower concentrations of DO than groundwater from HWs. The combined use of the principal component analysis (PCA) and K-means cluster analysis (KCA) indicated that groundwater in seven MWs was affected by leachate. The parameters such as NH4, Ca, Mg, K, SO4, HCO3, Fe(Total), and Mn(Total) are expected to be useful to identify the impact of leachate on groundwater in agricultural areas. This study suggests that (1) regional hydrochemical characteristics should be assessed to distinguish the effect of livestock burial leachate from other contamination sources and (2) the combined use of PCA and KCA is effective to identify the weakened impact of leachate leakage among overlapping multiple sources and processes of groundwater contamination.

6.
Arch Gynecol Obstet ; 301(4): 955-962, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32140809

RESUMO

PURPOSE: Preeclampsia is associated with abnormal invasion of the trophoblast through decidua and subsequently altered remodeling of the maternal spiral arteries and endothelial dysfunction. This phenomenon is explained by the dysregulation of various kinds of vascular factors and proteases. The purpose of this study was to compare the circulating levels of sFlt-1, cathepsin B, and cystatin C in preeclamptic and normotensive pregnancies. STUDY DESIGN: Sixty-two pregnant women were enrolled in this prospective study. Twenty women were preeclamptic and 42 were normotensive. Serum levels of sFlt-1, cathepsin B, and cystatin C were measured using an enzyme-linked immunosorbent assay kit. RESULTS: Circulating levels of sFlt-1, cathepsin B, and cystatin C were significantly higher in preeclamptic than in normotensive pregnant women (p < 0.001; p = 0.017; p = 0.003). Preeclamptic women with severe features demonstrated significantly higher levels of cathepsin B (p = 0.05). Serum sFlt-1 and cystatin C levels were positively correlated with elevated systolic and diastolic blood pressure. The levels of cathepsin B were positively correlated with alanine and aspartate aminotransferase. The amount of 24 h proteinuria was positively, but non-significantly correlated with sFlt-1 and cystatin C. CONCLUSIONS: In addition to sFlt-1 levels, the serum levels of cathepsin B and cystatin C significantly change when preeclampsia develops. These markers are associated with severity markers of elevated blood pressure and liver injury in preeclampsia.

7.
Tissue Eng Part A ; 2020 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-32122268

RESUMO

Erectile dysfunction caused by damage to the cavernous nerve is a common complication of radical prostatectomy for patients with localized prostate cancer. Various studies have investigated repair of damaged tissue and prevention of fibrosis in the corpus cavernosum using stem cell therapy. However, stem cell therapy has limitations, including insufficient nutrient and oxygen supply to transplanted stem cells. This study investigated whether stem cell/oxygen-releasing hollow microparticles (HPs) had therapeutic effect on erectile dysfunction in a rat model of bilateral cavernous nerve injury (BCNI). Therapeutic effects were observed in the BCNI model at 1, 2, and 4 weeks postcavernous nerve injury. Erectile function further improved after treatment with stem cell/oxygen-releasing HP system compared with treatment with only stem cells at 4 weeks. Stem cell/oxygen-releasing HP system increased cyclic guanosine monophosphate (cGMP) level and neuronal nitric oxide synthase (nNOS), endothelial nitric oxide synthase (eNOS), α-smooth muscle actin (α-SMA), and muscarinic acetylcholine receptor 3 (M3) expression while decreasing fibrosis and apoptosis in the corpus cavernosum. Our results clearly show that stem cell survival increases around transplanted stem cell/oxygen-releasing hybrid system site. Taken together, an oxygen-releasing HP system supported prolonged stem cell survival, sustaining the paracrine effect of the stem cells, and consequently enhancing erectile function. These findings show promise with regard to prolonged stem cell survival in stem cell applications for various diseases and types of tissue damage. Impact statement In this study, we used an oxygen-releasing hollow microparticles (HPs) system with stem cells to attempt to overcome certain limitations of stem cell therapy, including insufficient nutrient and oxygen supplies for transplanted stem cells. Our results demonstrated that a stem cell/oxygen-releasing HP hybrid system could further improve erectile function, cyclic guanosine monophosphate (cGMP) level, and NOS level in a bilateral cavernous nerve injury rat model through prolonged stem cell survival. Our data suggest that a stem cell/oxygen-releasing HP system is a promising clinical treatment option for postprostatectomy erectile dysfunction. Furthermore, this system may be relevant in different disease therapies and regenerative medicine.

8.
Korean J Radiol ; 21(4): 413-421, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32193889

RESUMO

OBJECTIVE: A widely applicable, non-invasive screening method for non-alcoholic fatty liver disease (NAFLD) is needed. We aimed to develop and validate an index combining computed tomography (CT) and routine clinical data for screening for NAFLD in a large cohort of adults with pathologically proven NAFLD. MATERIALS AND METHODS: This retrospective study included 2218 living liver donors who had undergone liver biopsy and CT within a span of 3 days. Donors were randomized 2:1 into development and test cohorts. CTL-S was measured by subtracting splenic attenuation from hepatic attenuation on non-enhanced CT. Multivariable logistic regression analysis of the development cohort was utilized to develop a clinical-CT index predicting pathologically proven NAFLD. The diagnostic performance was evaluated by analyzing the areas under the receiver operating characteristic curve (AUC). The cutoffs for the clinical-CT index were determined for 90% sensitivity and 90% specificity in the development cohort, and their diagnostic performance was evaluated in the test cohort. RESULTS: The clinical-CT index included CTL-S, body mass index, and aspartate transaminase and triglyceride concentrations. In the test cohort, the clinical-CT index (AUC, 0.81) outperformed CTL-S (0.74; p < 0.001) and clinical indices (0.73-0.75; p < 0.001) in diagnosing NAFLD. A cutoff of ≥ 46 had a sensitivity of 89% and a specificity of 41%, whereas a cutoff of ≥ 56.5 had a sensitivity of 57% and a specificity of 89%. CONCLUSION: The clinical-CT index is more accurate than CTL-S and clinical indices alone for the diagnosis of NAFLD and may be clinically useful in screening for NAFLD.

9.
Korean J Radiol ; 21(4): 471-482, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32193895

RESUMO

OBJECTIVE: We aimed to determine the optimized image-based surrogate endpoints (IBSEs) in targeted therapies for glioblastoma through a systematic review and meta-analysis of phase III randomized controlled trials (RCTs). MATERIALS AND METHODS: A systematic search of OVID-MEDLINE and EMBASE for phase III RCTs on glioblastoma was performed in December 2017. Data on overall survival (OS) and IBSEs, including progression-free survival (PFS), 6-month PFS (6moPFS), 12-month PFS (12moPFS), median PFS, and objective response rate (ORR) were extracted. Weighted linear regression analysis for the hazard ratio for OS and the hazard ratios or odds ratios for IBSEs was performed. The associations between IBSEs and OS were evaluated. Subgroup analyses according to disease stage (newly diagnosed glioblastoma versus recurrent glioblastoma), types of test treatment, and types of response assessment criteria were performed. RESULTS: Twenty-three phase III RCTs published between 2000 and 2017, including 8387 patients, met the inclusion criteria. OS showed strong correlations with PFS (standardized ß coefficient [R] = 0.719), 6moPFS (R = 0.647), and 12moPFS (R = 0.638). OS showed no correlations with median PFS and ORR. In subgroup analysis according to types of therapies, PFS showed the highest correlations with OS in targeted therapies for cell cycle pathways (R = 0.913) and growth factor receptors and their downstream pathways (R = 0.962). 12moPFS showed the highest correlation with OS in antiangiogenic therapy (R = 0.821). The response assessment in neuro-oncology criteria provided higher correlation coefficients between OS and IBSEs than the Macdonald criteria. CONCLUSION: Overall, PFS is an optimized IBSE in targeted therapies for glioblastoma; however, 12moPFS is optimal in antiangiogenic therapy.

10.
Sci Rep ; 10(1): 5309, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32210330

RESUMO

Poor oral health is not only associated with diabetes and cardiovascular disease but adverse pregnancy outcomes. However the influence of dental caries on pregnancy is unknown. The aim of this study was to evaluate the association between dental caries and adverse pregnancy outcomes and the effect of treatment for dental caries on adverse pregnancy outcomes. Primiparas who delivered a singleton between January 1, 2010 and December 31, 2014 and underwent both general health examination and oral health examination during a National Korea Health Screening Examination within 1 year of pregnancy were eligible. The data of the women who met the inclusion criteria were linked to the data of their offspring contained within the National Korea Health Screening Program for Infants and Children database. Among 120,622 women who delivered during the study period, 28,623 (23.7%) women had dental caries. Among them, 4,741 (16.6%) women were treated for dental caries after diagnosis. In a multivariable analysis, women with dental caries had an increased risk of delivering large-for-gestational-age infants (odds ratio, 1.15; 95% confidence interval, 1.07, 1.23) compared to those without dental caries. When women with dental caries were divided on the basis of the treatment of dental caries, women with dental caries but no treatment had an increased risk of delivering large-for-gestational-age infants (odds ratio, 1.15; 95% confidence interval, 1.06, 1.24); conversely, there was no increased risk in women with dental caries and treatment compared with those without. Dental caries and its treatment were not associated with preterm birth and preeclampsia. Untreated dental caries was not associated with preterm birth or preeclampsia but with the risk of delivering large-for-gestational-age infants. These whole observation may be attributed to the various characteristics of mothers who develop dental caries are not treated.

11.
Biomolecules ; 10(3)2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32213959

RESUMO

Prostaglandin (PG) A2, one of cyclopentenone PGs, is known to induce activation of apoptosis in various cancer cells. Although PGA2 has been reported to cause activation of apoptosis by altering the expression of apoptosis-related genes, the role of p53, one of the most critical pro-apoptotic genes, on PGA2-induced apoptosis has not been clarified yet. To address this issue, we compared the apoptosis in HCT116 p53 null cells (HCT116 p53-/-) to that in HCT116 cells containing the wild type p53 gene. Cell death induced by PGA2 was associated with phosphorylation of histone H2A variant H2AX (H2AX), activation of caspase-3 and cleavage of poly(ADP-ribose) polymerase 1 in HCT116 cells. Induction of apoptosis in PGA2-treated cells was almost completely prevented by pretreatment with a pan-caspase inhibitor, z-VAD-Fmk, or an inhibitor of protein synthesis, cycloheximide. While PGA2 induced apoptosis in HCT116 cells, phosphorylation of p53 and transcriptional induction of p53-target genes such as p21WAF1, PUMA, BAX, NOXA, and DR5 occurred. Besides, pretreatment of pifithrin-α (PFT-α), a chemical inhibitor of p53's transcriptional activity, interfered with the induction of apoptosis in PGA2-treated HCT116 cells. Pretreatment of NU7441, a small molecule inhibitor of DNA-activated protein kinase (DNA-PK) suppressed PGA2-induced phosphorylation of p53 and apoptosis as well. Moreover, among target genes of p53, knockdown of DR5 expression by RNA interference, suppressed PGA2-induced apoptosis. In the meanwhile, in HCT116 p53-/- cells, PGA2 induced apoptosis in delayed time points and with less potency. Delayed apoptosis by PGA2 in HCT116 p53-/- cells was also associated with phosphorylation of H2AX but was not inhibited by either PFT- or NU7441. Collectively, these results suggest the following. PGA2 may induce p53-dependent apoptosis in which DNA-PK activates p53, and DR5, a transcriptional target of p53, plays a pivotal role in HCT116 cells. In contrast to apoptosis in HCT116 cells, PGA2 may induce apoptosis in a fashion of less potency, which is independent of p53 and DNA-PK in HCT116 p53-/- cells.

12.
Sci Rep ; 10(1): 4250, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32144360

RESUMO

We aimed to develop and validate a multiparametric MR radiomics model using conventional, diffusion-, and perfusion-weighted MR imaging for better prognostication in patients with newly diagnosed glioblastoma. A total of 216 patients with newly diagnosed glioblastoma were enrolled from two tertiary medical centers and divided into training (n = 158) and external validation sets (n = 58). Radiomic features were extracted from contrast-enhanced T1-weighted imaging, fluid-attenuated inversion recovery, diffusion-weighted imaging, and dynamic susceptibility contrast imaging. After radiomic feature selection using LASSO regression, an individualized radiomic score was calculated. A multiparametric MR prognostic model was built using the radiomic score and clinical predictors. The results showed that the multiparametric MR prognostic model (radiomics score + clinical predictors) exhibited good discrimination (C-index, 0.74) and performed better than a conventional MR radiomics model (C-index, 0.65, P < 0.0001) or clinical predictors (C-index, 0.66; P < 0.0001). The multiparametric MR prognostic model also showed robustness in external validation (C-index, 0.70). Our results indicate that the incorporation of diffusion- and perfusion-weighted MR imaging into an MR radiomics model to improve prognostication in glioblastoma patients improved its performance over that achievable using clinical predictors alone.

13.
Pediatr Emerg Care ; 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32195983

RESUMO

PURPOSE: To show the efficacy of cartoon as a distraction technique in suturing a child patient in the emergency room. METHODS: We studied children aged 2 to 8 years who had sustained a facial laceration 3 cm or less that required suturing from September 2015 to November 2016. We used local anesthesia and attempted to place the sutures without sedation while showing the children cartoons instead. If the first attempt failed, 1 more attempt was made. The patients were divided into 3 groups: success, success on second attempt, and failure. Age, location and size of the wound, and scores on the FACES Pain Rating Scale (FPS) before and after local anesthesia were recorded. RESULTS: The study included 106 children. Cartoon distraction was most effective for those aged 3 to 6 years (4.6 ± 1.9 years). The second-attempt group tended to be older, whereas the failure group was much younger (mean age, 7.4 ± 1.0 vs 2.7 ± 1.8 years). The FPS-R score differed widely among the groups. The success group tended to have a low score before and after local anesthetic injection (4.1 ± 2.0 and 3.1 ± 1.3), whereas the second-attempt and failure groups had much higher scores after injection (8.0 ± 1.7 and 8.8 ± 0.8; 5.2 ± 2.6 and 9.3 ± 0.8). CONCLUSIONS: Cartoon distraction techniques can reduce the treatment duration and number of assistants, which also makes it appropriate for the emergency room. In addition, our results indicate that the pre-/post-local injection FPS score is a good predictor of success.

14.
Cancer Biomark ; 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32176621

RESUMO

BACKGROUND: To investigate the feasibility of cerebrospinal fluid (CSF) CYFRA 21-1 levels as a therapeutic monitoring biomarker in leptomeningeal carcinomatosis (LMC) patients undergoing ventriculo-lumbar perfusion (VLP) chemotherapy. METHODS: The levels of CYFRA 21-1 in 42 CSF samples from 15 LMC patients were analyzed using an electrochemiluminescence immunoassay. Samples were collected at individual time points during VLP chemotherapy. Therapeutic outcomes were measured as improvements in the Karnofsky Performance Status (KPS) score and decreasing intracranial pressure (ICP) as the main endpoint of VLP chemotherapy. Changes in CSF CYFRA 21-1 levels, protein levels, and cytology results were also investigated. We subsequently evaluated whether these changes were correlated with KPS score and ICP. RESULTS: The CSF CYFRA 21-1 levels at individual time points were associated with KPS score and ICP. The KPS scores (p= 0.007) and ICP (p= 0.018) of patients with high CSF CYFRA 21-1 levels were significantly different from those of patients with low CSF CYFRA 21-1 levels. By contrast, CSF protein levels and cytological responses were not significantly associated with KPS scores and ICP. CONCLUSIONS: CSF CYFRA 21-1 may have utility as a therapeutic monitoring biomarker to design personalized therapeutic strategies in LMC patients undergoing VLP chemotherapy.

15.
Ann Coloproctol ; 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32178491

RESUMO

Clostridium difficile infection (CDI) after ileostomy reversal is rare, and few reports in the available literature describe this condition. Diagnosis of CDI after ileostomy reversal is challenging because symptoms such as diarrhea observed in these patients can occur frequently after surgery. However, CDI can be fatal, and early diagnosis and prompt treatment are important. We describe two patients with a positive C. difficile toxin assay result on stool cultures performed after ileostomy reversal. Clinical progression differed between these patients: the patient who presented with severe CDI and shock was successfully treated following a prolonged intensive care unit stay for management of vital signs and underwent hemodialysis. The other patient showed symptoms of mild colitis; however, we could not confirm whether diarrhea was associated with CDI or with the usual postoperative state. To our knowledge, this is one of the few cases reported in the literature describing CDI after ileostomy reversal.

16.
Artigo em Inglês | MEDLINE | ID: mdl-32183085

RESUMO

This study was designed to verify the effectiveness of smart gardens by improving indoor air quality (IAQ) through the installation of an indoor garden with sensor-based Internet-of-Things (IoT) technology that identifies pollutants such as particulate matter. In addition, the study aims to introduce indoor gardens for customized indoor air cleaning using the data and IoT technology. New apartments completed in 2016 were selected and divided into four households with indoor gardens installed and four households without indoor gardens. Real-time data and data on PM2.5, CO2, temperature, and humidity were collected through an IoT-based IAQ monitoring system. In addition, in order to examine the effects on the health of occupants, the results were analyzed based on epidemiological data, prevalence data, current maintenance, and recommendation criteria, and were presented and evaluated as indices. The indices were classified into a comfort index, which reflects the temperature and humidity, an IAQ index, which reflects PM2.5 and CO2, and an IAQ composite index. The IAQ index was divided into five grades from "good" to "hazardous". Using a scale of 1 to 100 points, it was determined as follows: "good (0-20)", "moderate (21-40)", "unhealthy for sensitive group (41-60)", "bad (61-80)", "hazardous (81-100)". It showed an increase in the "good" section after installing the indoor garden, and the "bad" section decreased. Additionally, the comfort index was classified into five grades from "very comfortable" to "very uncomfortable". In the comfort index, the "uncomfortable" section decreased, and the "comfortable" section increased after the indoor garden was installed.

17.
Artigo em Inglês | MEDLINE | ID: mdl-32185916

RESUMO

BACKGROUND: The purpose of this study was to evaluate the long-term survival rates of very elderly (age ≥80) critically ill patients admitted to a medical intensive care unit (MICU) at a regional tertiary-care hospital in Korea. METHODS: We retrospectively analyzed data from patients who survived after discharged from the MICU of our hospital. Survival rates at 90 days, 1 year, 2 years, and 3 years were assessed between patients age ≥80 and those age <80. Survival status was evaluated using the National Health Insurance Service data. RESULTS: A total of 468 patients were admitted, 286 (179 males, 97 females; mean age, 70.18±13.2) of whom survived and were discharged soon after their treatment. Among these patients, 69 (24.1%) were age ≥80 and 217 (75.9%) were age <80. The 90-day, 1-year, 2-year, and 3-year survival rates of patients age ≥80 were significantly lower than those in patients age <80 (50.7%, 31.9%, 15.9% and 14.5% vs. 68.3%, 54.4%, 45.6%, and 40.1%, respectively) (p<0.01). The Kaplan-Meier survival curves showed significantly lower survival rates in patients age ≥80 than in those age <80 (p=0.001). CONCLUSION: The poor rates of long-term survival in very elderly (age ≥80) and critically ill patients admitted to an ICU should be considered while managing and treating them.

18.
Artigo em Inglês | MEDLINE | ID: mdl-32185917

RESUMO

BACKGROUND: Infectious conditions may increase the risk of venous thromboembolism. The purpose of this study was to evaluate the risk factor for combined infectious disease and its influence on mortality in patients with pulmonary embolism (PE). METHODS: Patients with PE diagnosed based on spiral computed tomography findings of the chest were retrospectively analyzed. They were classified into two groups: patients who developed PE in the setting of infectious disease or those with PE without infection based on review of their medical charts. RESULTS: Of 258 patients with PE, 67 (25.9%) were considered as having PE combined with infectious disease. The sites of infections were the respiratory tract in 52 patients (77.6%), genitourinary tract in three patients (4.5%), and hepatobiliary tract in three patients (4.5%). Underlying lung disease (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.926-7.081; p<0.001), bed-ridden state (OR, 2.84; 95% CI, 1.390-5.811; p=0.004), and malignant disease (OR, 1.867; 95% CI, 1.017-3.425; p=0.044) were associated with combined infectious disease in patients with PE. In-hospital mortality was higher in patients with PE combined with infectious disease than in those with PE without infection (24.6% vs. 11.0%, p=0.006). In the multivariate analysis, combined infectious disease (OR, 4.189; 95% CI, 1.692-10.372; p=0.002) were associated with non-survivors in patients with PE. CONCLUSION: A substantial portion of patients with PE has concomitant infectious disease and it may contribute a mortality in patients with PE.

19.
Ann Otol Rhinol Laryngol ; : 3489420913592, 2020 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-32186395

RESUMO

OBJECTIVES: To identify whether combination therapy with mucolytics and proton pump inhibitors (PPIs) leads to faster and more effective symptomatic relief in patients with laryngopharyngeal reflux (LPR). METHODS: Patients diagnosed as LPR with a reflux symptom index (RSI) ≥ 13 and a reflux finding score (RFS) ≥ 7 were enrolled in this prospective study. Patients were randomly allocated to control (PPI only) or experimental (PPI + mucolytics) groups and changes in RSI and RFS values were assessed at 1- and 3-month follow-up. RESULTS: One hundred sixteen patients were randomly allocated into either the control group (n = 59) or the experimental group (n = 57). The RSI and RFS scores significantly decreased in both groups (all P < .001) after 1 month of treatment; however, there was no significant difference in RSI change between groups (P = .223). After 3 months of treatment, there remained no significant difference in RSI change between groups (P = .592). CONCLUSIONS: Combination therapy with mucolytics and PPI compared to PPI alone did not lead to faster or more effective symptomatic relief in LPR patients.

20.
Sci Total Environ ; 720: 137565, 2020 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-32145628

RESUMO

Although multiple sclerosis (MS) has been the leading cause of neurologically-induced disability in young adults, risk factors for the relapse and acute aggravation of MS remain unclear. A few studies have suggested a possible role of temperature changes on the relapse and acute aggravation of MS. We investigated the association between short-term exposure to wide diurnal temperature ranges (DTRs) and acute exacerbation of MS requiring an emergency department (ED) visit. A total of 1265 patients visited EDs for acute aggravation of MS as the primary disease in Seoul between 2008 and 2014 from the national emergency database. We conducted a conditional logistic regression analysis of the time-stratified case-crossover design to compare DTRs on the ED visit days for MS and those on control days matched according to the day of the week, month, and year. We examined possible associations with other temperature-related variables (ambient temperature, between-day temperature change, and sunlight hours). Short-term exposure to wide DTRs immediately increased the risk of ED visits for MS. Especially, 2-day average (lag0-1) DTR levels on the day of and one day prior to ED visits exhibited the strongest association (an 8.81% [95% CI: 3.46%-14.44%] change in the odds ratio per 1 °C increase in the DTR). Other temperature-related variables were not associated with MS aggravation. Our results suggest that exposure to wider DTR may increase the risk of acute exacerbation of MS. Given the increasing societal burden of MS and the increasing temperature variability due to climate change, further studies are required.

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