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1.
Clin Orthop Surg ; 12(1): 120-129, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32117548

RESUMO

Background: Platelet-rich plasma (PRP) is a plasma component of autologous blood containing a high concentration of platelets. PRP is used to promote healing of damaged tissues. However, there are not many studies on the composition and expression patterns of active proteins in PRP. The purpose of this study was to identify unknown factors that contribute to tissue healing by proteomic analysis of proteins in PRP. Methods: Three men in their 30s with no basal disease participated in this study. All identified proteins were classified for tissue healing-related functions on the basis of the gene ontology analysis of adhesion molecule with Ig-like domain 2 (AmiGO2). PRP was prepared by using the ACP kit and GPS III kit. Results: We identified a total of 125 proteins related to wound healing, along with three proteins for angiogenesis involved in wound healing, two proteins for fibroblast migration, four proteins for collagen biosynthesis process, two proteins for glycosaminoglycan biosynthesis process, and 13 proteins for glycosaminoglycan binding. So, in addition to the growth factors that have been already known to be involved in tissue healing, 25 new proteins were identified. Conclusions: We identified the unknown proteins associated with tissue healing in PRP. Our findings may serve as a foundation for the establishment of basic medical evidence for PRP applications.

2.
Clin Neuropathol ; 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32194024

RESUMO

AIM: This study aimed to investigate the survival and prognostic factors for anaplastic glioma, and whether the updated 2016 WHO classification had superior ability to predict survival. MATERIALS AND METHODS: Between January 2001 and December 2013, 113 consecutive patients were diagnosed with anaplastic glioma based on the 2007 WHO classification. We re-classified their diagnoses in accordance with the 2016 WHO classification. The Kaplan-Meier method, multivariate Cox proportional regression analysis, and a time-dependent receiver operating characteristic curve were used for the analysis. RESULTS: The median overall survival was 48.4 months among all patients, and 21.5 months for the anaplastic astrocytoma, IDH wild-type (AAw) group. The median progression-free survival was 31.8 months among all patients and 16.4 in the AAw group. Age, MGMT promoter methylation status, deep tumor location, and resection extent were associated with overall survival and progression-free survival. CONCLUSION: We found that the 2016 WHO classification of central nervous system tumors had superior ability to predict survival in cases of anaplastic glioma, as compared to the 2007 WHO classification.
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3.
Eur Radiol ; 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-32152744

RESUMO

OBJECTIVE: To compare the diagnostic performance of contrast-enhanced CT with that of MRI in the detection of cartilage invasion in patients with laryngo-hypopharyngeal cancer. METHODS: A systematic literature search in the Ovid-MEDLINE and EMBASE databases was performed for studies reporting diagnostic accuracy of CT and/or MRI in detecting cartilage invasion from laryngo-hypopharyngeal cancer between 2000 and 2018. The pooled sensitivity and specificity, and their 95% confidence intervals were calculated for CT and MRI using bivariate random effects modeling. Subgroup and meta-regression analyses were performed. Indirect comparison was also performed by univariable meta-regression. RESULT: Fourteen articles including 776 patients were included in the systematic review and meta-analysis: eight for CT, and six for MRI. CT and MRI showed pooled sensitivities of 66% (95% CI, 49-80%) and 88% (95% CI, 79-93%), and pooled specificities of 90% (95% CI, 82-94%) and 81% (95% CI, 76-84%), respectively. MRI showed significantly higher sensitivity than CT (p = 0.02). The specificities showed no statistically significant difference between CT and MRI (p = 0.39). The CT studies showed heterogeneity and a threshold effect, while MRI showed neither heterogeneity nor threshold effect. In the meta-regression analysis for CT, the type of cartilage analyzed (thyroid only vs. thyroid/cricoid/arytenoid, p < 0.001) was a significant factor influencing the heterogeneity in the diagnostic performance of the CT studies. CONCLUSIONS: In conclusion, MRI has significantly higher sensitivity than CT for detecting cartilage invasion in patients with laryngo-hypopharyngeal cancer, without a significant difference in the specificity. KEY POINTS: • MRI has significantly higher sensitivity than CT for detecting cartilage invasion in patients with laryngo-hypopharyngeal cancer.

4.
BMC Cancer ; 20(1): 29, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924170

RESUMO

BACKGROUND: To evaluate radiomics analysis in neuro-oncologic studies according to a radiomics quality score (RQS) system to find room for improvement in clinical use. METHODS: Pubmed and Embase were searched up the terms radiomics or radiogenomics and gliomas or glioblastomas until February 2019. From 189 articles, 51 original research articles reporting the diagnostic, prognostic, or predictive utility were selected. The quality of the methodology was evaluated according to the RQS. The adherence rates for the six key domains were evaluated: image protocol and reproducibility, feature reduction and validation, biologic/clinical utility, performance index, a high level of evidence, and open science. Subgroup analyses for journal type (imaging vs. clinical) and biomarker (diagnostic vs. prognostic/predictive) were performed. RESULTS: The median RQS was 11 out of 36 and adherence rate was 37.1%. Only 29.4% performed external validation. The adherence rate was high for reporting imaging protocol (100%), feature reduction (94.1%), and discrimination statistics (96.1%), but low for conducting test-retest analysis (2%), prospective study (3.9%), demonstrating potential clinical utility (2%), and open science (5.9%). None of the studies conducted a phantom study or cost-effectiveness analysis. Prognostic/predictive studies received higher score than diagnostic studies in comparison to gold standard (P < .001), use of calibration (P = .02), and cut-off analysis (P = .001). CONCLUSIONS: The quality of reporting of radiomics studies in neuro-oncology is currently insufficient. Validation is necessary using external dataset, and improvements need to be made to feature reproducibility, demonstrating clinical utility, pursuits of a higher level of evidence, and open science.

5.
Eur Radiol ; 30(1): 523-536, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31350588

RESUMO

OBJECTIVES: To evaluate radiomics studies according to radiomics quality score (RQS) and Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) to provide objective measurement of radiomics research. MATERIALS AND METHODS: PubMed and Embase were searched for studies published in high clinical imaging journals until December 2018 using the terms "radiomics" and "radiogenomics." Studies were scored against the items in the RQS and TRIPOD guidelines. Subgroup analyses were performed for journal type (clinical vs. imaging), intended use (diagnostic vs. prognostic), and imaging modality (CT vs. MRI), and articles were compared using Fisher's exact test and Mann-Whitney analysis. RESULTS: Seventy-seven articles were included. The mean RQS score was 26.1% of the maximum (9.4 out of 36). The RQS was low in demonstration of clinical utility (19.5%), test-retest analysis (6.5%), prospective study (3.9%), and open science (3.9%). None of the studies conducted a phantom or cost-effectiveness analysis. The adherence rate for TRIPOD was 57.8% (mean) and was particularly low in reporting title (2.6%), stating study objective in abstract and introduction (7.8% and 16.9%), blind assessment of outcome (14.3%), sample size (6.5%), and missing data (11.7%) categories. Studies in clinical journals scored higher and more frequently adopted external validation than imaging journals. CONCLUSIONS: The overall scientific quality and reporting of radiomics studies is insufficient. Scientific improvements need to be made to feature reproducibility, analysis of clinical utility, and open science categories. Reporting of study objectives, blind assessment, sample size, and missing data is deemed to be necessary. KEY POINTS: • The overall scientific quality and reporting of radiomics studies is insufficient. • The RQS was low in demonstration of clinical utility, test-retest analysis, prospective study, and open science. • Room for improvement was shown in TRIPOD in stating study objective in abstract and introduction, blind assessment of outcome, sample size, and missing data categories.


Assuntos
Imagem por Ressonância Magnética/métodos , Neoplasias/diagnóstico por imagem , Qualidade da Assistência à Saúde/estatística & dados numéricos , Projetos de Pesquisa/normas , Tomografia Computadorizada por Raios X/métodos , Humanos , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes
6.
Arthroscopy ; 36(2): 411-418, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31883709

RESUMO

PURPOSE: To evaluate preoperative diagnostic rates for panlabral tear using imaging studies or physical examinations and to evaluate clinical outcomes after arthroscopic stabilization procedures with 2 different patient surgical positions. METHODS: Patients who underwent arthroscopic stabilization for recurrent anterior shoulder instability with panlabral tear and were followed up for at least 2 years were included. A panlabral tear was defined as labral tear involving at least 270° of the glenoid surface on arthroscopic examination. All patients underwent preoperative magnetic resonance (MR) imaging or MR arthrography and physical examinations including anterior apprehension, posterior jerk, and compressive rotation tests. The clinical outcomes were assessed by the American Shoulder and Elbow Surgeons, Rowe, and visual analog scale for pain scores, and recurrence rate. According to patient position during surgery, patients were divided into group I (beach chair position) and group II (lateral decubitus position). RESULTS: Forty-eight patients (24 in group I and 24 in group II) were enrolled. Preoperative MR imaging or MR arthrography detected only 18.8% of panlabral tears. No patient had positive findings on all 3 physical examination tests for panlabral tear. Clinical outcomes were significantly improved after operation (American Shoulder and Elbow Surgeons score: 58.4 ± 6.2 preoperatively, 85.2 ± 6.4 at the final, P < .001; Rowe score: 49.0 ± 12.2 preoperatively, 86.8 ± 9.1 at the final, P < .001) and postoperative recurrence was occurred in 1patient (2%). No differences were found in clinical outcomes and recurrence rate (4% vs 0%) according to patient positioning, despite the larger number of suture anchors used in group II (6.2 ± 1.5 in group I, 7.6 ± 1.1 in group II, P < .001). CONCLUSIONS: It remained difficult to preoperatively diagnose panlabral tear using standard physical examinations and imaging studies. Nevertheless, arthroscopic stabilization procedures for patients with panlabral tear provided satisfactory clinical outcomes with a low recurrence rate. Patient position during surgery did not alter clinical outcomes and recurrence rate, despite the use of different numbers of suture anchors. LEVEL OF EVIDENCE: Level III, Retrospective comparative therapeutic trial.

7.
Am J Sports Med ; 47(14): 3483-3490, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31718248

RESUMO

BACKGROUND: All-suture anchors are increasingly being used in rotator cuff repair. However, there are debates on the micromotion of all-suture anchors. PURPOSE: To perform rotator cuff repair on patients with rotator cuff tears and different shoulder bone mineral densities (BMDs) and investigate (1) where the anchor is located under the cortex, (2) if there is any anchor migration settling during follow-up, and (3) if structural outcome differs according to shoulder BMD. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively investigated 88 patients who underwent arthroscopic single-row repair for small- to medium-sized rotator cuff tears (age [mean ± SD], 58.8 ± 7.1 years) from 712 cases of rotator cuff tendon repair between November 2015 and February 2018. Inclusion criteria were as follows: use of an all-suture anchor; preoperative shoulder BMD; and magnetic resonance imaging (MRI) conducted preoperatively, 2 days after surgery, and 10 months after surgery. Patients were excluded from the study if they underwent open rotator cuff repair (n = 118), got surgery with a double-row technique (n = 178), underwent surgery with anchors other than the all-suture type (n = 273), received anchor insertion in sites other than the greater tuberosity owing to concomitant procedures such as biceps tenodesis and subscapularis repair (n = 29), did not take preoperative shoulder BMD (n = 15), had more than a large-size tear (n = 6), and were lost to follow-up (n = 5). After compression of the all-suture anchor during surgery, the strands were pulled multiple times to ensure that the anchor was fixed onto the bone with appropriate tension. BMD was measured before surgery. Depth to anchor (DA), anchor settling, and repaired rotator cuff integrity were measured with MRI. Patients were categorized into 3 groups: group A (BMD, <0.4 g/cm2; n = 31), group B (BMD, 0.4-0.6 g/cm2; n = 32), and group C (BMD, >0.6 g/cm2; n = 25). A total of 65 patients had follow-up MRI. On the basis of rotator cuff tendon integrity, patients were categorized into either a sufficient thickness group (group S, Sugaya classification grade II or lower; n = 44) or an insufficient thickness group (group I, Sugaya classification grade III or higher; n = 21). RESULTS: On time-zero MRI, the DA differed significantly among groups (group A, 3.62 ± 2.02 mm; group B, 5.18 ± 2.13 mm; group C, 6.30 ± 3.34 mm) (P = .001). The DA was deeper in patients with a higher BMD at time zero (r = 0.374; P = .001), but the DA did not differ at follow-up MRI (mean, 10.3 months after surgery). On follow-up MRI, anchor settling tended to increase with deeper time-zero DA (r = 0.769; P < .001). Anchor settling was significantly different among groups (group A, 1.33 ± 1.08 mm; group B, 2.78 ± 1.99 mm; group C, 3.81 ± 2.19 mm) (P = .001). The proportion of patients with sufficient thickness in each group did not show a statistical difference (group A, 70.8%; group B, 72.7%; group C, 57.9%) (P = .550). CONCLUSION: In conclusion, this study confirmed that the postoperative site of anchor insertion in arthroscopic single-row rotator cuff repair with all-suture anchors was located farther from the cortex in patients with higher shoulder BMD and closer to the subcortical bone in patients with lower BMD. On follow-up MRI, no further settling occurred past a certain distance from the cortex, and there was no significant difference in anchor depth or integrity of the rotator cuff tendon based on shoulder BMD. Therefore, minimal settling in the all-suture anchor did not show clinical significance.

8.
Sci Rep ; 9(1): 16630, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31719555

RESUMO

This study investigated the characteristics of patients with urolithiasis visiting an emergency department based on a national database system in Korea. This study spanned a period of three years from January 1, 2014 to December 31, 2016. A retrospective census was conducted using the National Emergency Department Information System for urolithiasis patients. Patient data, including age, sex, insurance type, emergency department visit date and time, discharge date and time, emergency department treatment result, visit flow, and hospitalization route, were extracted and analyzed. Overall, 103,981, 112,083, and 120,647 patients/year during the 2014-2016 study period visited an emergency department with a diagnosis related to urolithiasis. Total monthly emergency department visits ranged from 35,927 in August (highest) to 24,008 in February. Overall, 13.2% of patients were hospitalized and the hospitalization rate was stable (estimated annual percent change) over the study period. Patients aged <9 years or ≥70 years and those with medical aid had higher hospitalization rates. A higher number of visits occurred in the hot season, on weekends, and in the 6 a.m. and 8 p.m. time slots. This nationwide study revealed that the percentage of patients visiting an emergency department with urolithiasis was higher in August, in the early morning, and at weekends.

9.
Br J Cancer ; 121(3): 230-236, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31292534

RESUMO

BACKGROUND: Immune cells in the tumour microenvironment play an essential role in tumorigenesis. This study aimed to evaluate the immunoregulatory protein expression of breast cancer and reveal their prognostic role. METHODS: Expression of 10 immune markers (PD-1/PD-L1/PD-L2/IDO/TIM-3/OX40/OX40L/B7-H2/ B7-H3/B7-H4) with known/possible clinical relevance was identified in stromal tumour-infiltrating lymphocytes or tumour tissue of stage I-III breast cancer patients. RESULTS: A total of 392 patients, including 271(69.1%) luminal A, 36(9.2%) luminal B, 32(8.2%) HER2-positive and 53(13.5%) triple negative disease, were included. Expression of PD-1 and PD-L1 was higher in HER2-positive and triple negative disease. By contrast, expression of TIM-3, OX40 and OX40L were higher in luminal disease. We devised an immune recurrence score (IRS) using seven markers with prognostic value (B7-H2/B7-H3/B7-H4/OX40/OX40L/PD-L1/PD-L2). Patients were classified as high-risk (7.9%), intermediate-risk (67.6%), or low-risk (24.5%). In the multivariate analysis, IRS low-risk (adjusted HR 0.14, p = 0.001) and intermediate-risk (adjusted HR 0.32, p = 0.002) had significantly lower risk of recurrence compared with high-risk. The prognostic role of IRS was maintained in both luminal A and non-luminal A patients. CONCLUSIONS: This study identified immunoregulatory protein expression of breast cancer patients using 10 immune markers. In addition, we devised an IRS which may predict recurrence in stage I-III breast cancer patients.

10.
J Shoulder Elbow Surg ; 28(12): 2334-2342, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31300369

RESUMO

BACKGROUND: Rapidly destructive arthropathy (RDA) of the shoulder is rare. Consequently, there are very few studies that have reported the characteristic findings of this disease. This study aimed to analyze the clinical, radiographic, and histologic features of patients with RDA of the shoulder. METHODS: In total, 9 cases (8 patients) were enrolled in this study. All patients were elderly women, with a mean age of 72.7 years (range, 57-78 years). The mean duration of symptoms was 4.1 months (range, 1.2-5.9 months). Reverse total shoulder arthroplasty and total shoulder arthroplasty were performed in 5 cases with massive rotator cuff tears and 4 without them, respectively. RESULTS: The mean duration of radiologically evident joint destruction after negative results on radiography was 3.1 months (range, 1.0-5.9 months). On plain radiography, humeral head flattening and collapse that appeared like cut grass were observed (100%). Relatively good preservation of the glenoid with a normal joint space was observed in 7 cases, whereas glenoid erosion was observed in 2 (22.2%). T1-weighted magnetic resonance imaging showed a subchondral fracture (100%) of low signal intensity with associated bone marrow edema. Histologically, chronic inflammation of the synovium and osteocytes in the lacunae, as well as callus formation, were observed along the subchondral fracture. CONCLUSION: Flattening and collapse of the humeral head within an average of 4 months of symptom onset are characteristic of RDA of the shoulder. Bone marrow edema, joint effusion, and subchondral fracture on magnetic resonance imaging and fracture fragments and callus formation on histopathologic analysis were observed. Glenoid erosion was observed in 2 cases with arthrosis progression.


Assuntos
Doenças da Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Artropatias/patologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/patologia , Idoso , Artroplastia do Ombro , Doenças da Medula Óssea/complicações , Edema/complicações , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/patologia , Cavidade Glenoide/diagnóstico por imagem , Humanos , Cabeça do Úmero/diagnóstico por imagem , Artropatias/complicações , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Radiografia
11.
Neuroradiology ; 61(11): 1261-1272, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31289886

RESUMO

PURPOSE: The peritumoral non-enhancing region (NER) is frequently not removed during the surgical resection of glioblastoma, with most recurrences occurring within the original treatment field. This study determined whether radiomics analysis of the NER can predict local recurrence and overall survival in patients with glioblastoma. METHODS: Preoperative magnetic resonance imaging (MRI) scans from 83 consecutive patients with glioblastoma were retrospectively reviewed and grouped into training (n = 59) and test sets (n = 24). A total of 6472 radiomic features were extracted from contrast-enhanced T1-weighted and fluid-attenuated inversion recovery images and from fractional anisotropy (FA) and normalized cerebral blood volume (CBV) maps. A diagnostic model to predict 6-month progression was tested using the area under the receiver operating characteristics curve (AUC) and compared with the single parameters of FA and CBV. A survival model was tested using Harrell's C-index and compared with clinical models that included age, sex, Karnofsky performance score, and extent of surgical resection. RESULTS: Four FA features and six CBV features were selected for the diagnostic model; no features were extracted from conventional MRI. Combined FA and CBV radiomics showed better predictive value for local progression (AUC, 0.79; 95% CI, 0.67-0.90) than single imaging radiomics (AUC, 0.70-0.76) or single imaging parameters (AUC, 0.51-0.54). The combined model (C-index, 0.87) improved prognostication when added to clinical models (C-index, 0.72). CONCLUSION: Radiomics features using FA and CBV in the NER have the potential to improve prediction of local progression and overall survival in patients with glioblastoma.

12.
BMC Musculoskelet Disord ; 20(1): 270, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31153372

RESUMO

BACKGROUND: It is difficult to diagnose the pathology of the long head of the biceps tendon (LHBT) clinically. This study aimed to determine the diagnostic value of standard non-enhancing magnetic resonance imaging (MRI) for detecting LHBT pathology and identify the most useful diagnostic signs on MRI. METHODS: A total of 554 patients with preoperative 3-Tesla (3 T) MRI who underwent arthroscopic surgery for rotator cuff tears were retrospectively enrolled. Abnormal signs of LHBT on MRI included diameter change, contour irregularity, and alteration of signal intensity. Arthroscopic findings were classified according to tear progress and used as a reference standard: Type I, normal tendon; Type II, hourglass-shaped hypertrophic tendon with fraying extending into the bicipital groove; Type III, partial tear involving less than 50% of tendon width at the intraarticular region without fraying in the bicipital groove; Type IV, partial tear involving more than 50% of tendon width and extending into the bicipital groove; and Type V, complete tear (cutoff) of the tendon. Using receiver operating characteristic, prediction accuracies of MRI findings were assessed compared to those of arthroscopic findings. RESULTS: Arthroscopic findings showed LHBT pathology in 124 (22.4%) cases. High diagnostic efficacy was achieved when 'at least 2 abnormal signs' was set as diagnostic criteria (sensitivity: 77.9%; specificity: 93.7%; positive predictive value: 76.3%). Types II and III lesions showed the highest sensitivities (36.8 and 66.7%, respectively) in abnormal alteration of signal intensity in the parasagittal view while Type IV showed the highest sensitivity (82.3%) in diameter change in axial view. Interobserver agreements were substantial to almost perfect, with kappa value of 0.69-0.81. CONCLUSIONS: The standard non-enhancing 3 T MRI had a high diagnostic value in preoperative detection of LHBT pathology. Its accuracy was increased when diagnostic criterion was set as '2 or more abnormal signs (diameter change, contour irregularity, and alteration of signal intensity)'. The single diagnostic sign with the highest sensitivity was alteration of signal intensity in the parasagittal view.


Assuntos
Artroscopia , Imagem por Ressonância Magnética , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/diagnóstico por imagem , Humanos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Retrospectivos , Manguito Rotador/patologia , Sensibilidade e Especificidade , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/patologia , Articulação do Ombro/cirurgia
13.
J Clin Med ; 8(6)2019 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-31212806

RESUMO

We investigated the clinical value of whole blood procalcitonin using point of care testing, quick sequential organ failure assessment score, C-reactive protein and lactate in emergency department patients with suspected infection and assessed the accuracy of the whole blood procalcitonin test by point-of-care testing. Participants were randomly selected from emergency department patients who complained of a febrile sense, had suspected infection and underwent serum procalcitonin testing. Whole blood procalcitonin levels by point-of-care testing were compared with serum procalcitonin test results from the laboratory. Participants were divided into two groups-those with bacteremia and those without bacteremia. Sensitivity, specificity, positive predictive value, negative predictive value of procalcitonin, lactate and Quick Sepsis-related Organ Failure Assessment scores were investigated in each group. Area under receiving operating curve of C-reactive protein, lactate and procalcitonin for predicting bacteremia and 28-day mortality were also evaluated. Whole blood procalcitonin had an excellent correlation with serum procalcitonin. The negative predictive value of procalcitonin and lactate was over 90%. Area under receiving operating curve results proved whole blood procalcitonin to be fair in predicting bacteremia or 28-day mortality. In the emergency department, point-of-care testing of whole blood procalcitonin is as accurate as laboratory testing. Moreover, procalcitonin is a complementing test together with lactate for predicting 28-days mortality and bacteremia for patients with suspected infection.

14.
J Shoulder Elbow Surg ; 28(9): 1707-1715, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31053388

RESUMO

BACKGROUND: Few studies have assessed the outcomes of staged bilateral arthroscopic rotator cuff repair (ARCR). This study aimed to determine the influencing factors related to the outcomes of patients who underwent staged bilateral ARCR and to verify an optimal interval for performing the second rotator cuff repair in staged bilateral ARCR. METHODS: We analyzed 166 shoulders that underwent staged bilateral ARCR. The average interval between the first- and second-side surgical procedures was 21.9 ± 19.7 months. The minimum follow-up period was 2 years. RESULTS: Clinical outcomes and retear rates were not significantly different according to the order of surgical procedures, sex, arm dominance, age, and tear size (P > .05 for all). The cutoff value for the optimal interval between the first and second surgical procedures for the University of California, Los Angeles score and American Shoulder and Elbow Surgeons score was 9 months, with the area under the curve equal to 0.815 (P < .001) for the University of California, Los Angeles score and 0.806 (P < .001) for the American Shoulder and Elbow Surgeons score. The group with an interval of 9 months or less between the first- and second-side surgical procedures showed significantly inferior clinical outcomes and a higher retear rate (35%) compared with the group with an interval greater than 9 months (retear rate, 10%) (P < .05). CONCLUSION: Staged bilateral ARCR resulted in significant improvements in clinical outcomes regardless of the order of surgical procedures, sex, arm dominance, age, and tear size. To optimize clinical outcomes of staged bilateral ARCR, second-side surgery should be delayed until 9 months after the first-side surgical procedure.


Assuntos
Artroscopia/métodos , Lesões do Manguito Rotador/cirurgia , Tempo para o Tratamento , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Recidiva , Escala Visual Analógica
15.
Breast Cancer Res Treat ; 176(2): 453-460, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31028608

RESUMO

PURPOSE: Although controversial, obesity and underweight may have a negative impact on breast cancer outcome. However, the relationship between body mass index (BMI) and breast cancer outcomes according to tumor subtype and menopausal status remains unclear. METHODS: This study investigated the association between BMI and breast cancer outcome in stage I-III breast cancer patients. The relationships were further evaluated according to tumor subtype and menopausal status. RESULTS: A total of 5919 patients, 3475 (58.7%) hormone receptor (HR)(+) human epidermal growth factor receptor 2 (HER2)(-), 608 (10.3%) HR(+)HER2(+), 621 (10.5%) HR(-)HER2(+), and 1079 (18.2%) HR(-)HER2(-) were included. Underweight and obesity had a negative impact on relapse-free survival but did not affect overall survival. Importantly, the prognostic role of BMI was different according to tumor subtype and menopausal status. In HR(+)HER2(-) patients, underweight was associated with poor relapse-free survival and overall survival in pre-menopausal women. In contrast, obesity had negative impact on relapse-free survival and overall survival in HR(+)HER2(-) post-menopausal patients. Underweight may have a negative prognostic role in HR(+)HER2(+) patients. However, BMI did not impact the outcome of HR(-)HER2(+) and HR(-)HER2(-) patients. CONCLUSIONS: The impact of BMI on breast cancer outcome was dependent on tumor subtype and menopausal status. In HR(+)HER2(-) patients, underweight and obesity had a negative prognostic role in pre-menopausal and post-menopausal women, respectively. These findings in Asian population should be further evaluated and compared in Western population.


Assuntos
Neoplasias da Mama/patologia , Obesidade/epidemiologia , Receptor ErbB-2/metabolismo , Receptores de Esteroides/metabolismo , Magreza/epidemiologia , Índice de Massa Corporal , Neoplasias da Mama/metabolismo , Feminino , Humanos , Estadiamento de Neoplasias , Obesidade/complicações , Obesidade/metabolismo , Pré-Menopausa , Prognóstico , Análise de Sobrevida , Magreza/complicações , Magreza/metabolismo
16.
Clin Orthop Relat Res ; 477(2): 403-413, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30664044

RESUMO

BACKGROUND: One potential advantage of arthroscopic shoulder surgery over open approaches is accelerated recovery; however, the functional recovery period of daily activities for specific movements after arthroscopic rotator cuff repair has not yet been reported, to our knowledge. QUESTIONS/PURPOSES: (1) After arthroscopic rotator cuff repair, when are patients able to perform low-level and high-level front-of-body motion, low-level and high-level behind-the-back motion, strength-related activities, and sports/leisure activities? (2) How do tear size, arm dominance, and retear affect performance of these activities? (3) When does the UCLA score cross above 80% in each UCLA score component (28 points)? METHODS: A 2-year prospective study of 135 patients who underwent arthroscopic rotator cuff repair was performed (45 in small-sized, 45 in medium-sized, and 45 in large-to-massive-sized groups). The mean age was 60 years. Thirty-one and 104 shoulders were nondominant and dominant shoulders, respectively. Twenty-seven shoulders showed retear on MRI taken 9 months after surgery. We evaluated the functional recovery periods using the questionnaire and the UCLA scores and assessed influencing factors such as tear size, arm dominance, and retear. The patients were asked to fill out a questionnaire at 1, 2, 3, 6, 9, 12, 15, 18, and 24 months after surgery. The questionnaire evaluated front-of-the-body, behind-the-back, general, simple strength-related, and sports/leisure activities. Based on the UCLA evaluation, the functional recovery period was defined as the time required to achieve a score > 80% in each UCLA score component. RESULTS: Patients experienced recovery of low-level and high-level ROM front-of-the-body, high-level ROM behind-the-back, simple strength-related, and sports/leisure activities within 2 ± 1, 3 ± 2, 9 ± 0, 10 ± 2, and 14 ± 3 months, respectively, after surgery. Two patients with large-to-massive tears did not gain the recovery of high-level ROM behind-the-back, simple strength-related, and sports/leisure activities. Patients with large-to-massive tears were delayed from some activities compared with patients with small tears (10 ± 0 versus 7 ± 1 for washing back, p = 0.010; 11 ± 0 versus 10 ± 0 for lifting 5 kg, p = 0.020; 15 ± 0 versus 13 ± 0 for sports/leisure). Arm dominance was not associated with functional recovery. Patients with retears, compared with intact healing, had a longer time to return to washing hair (3 ± 2 versus 3 ± 1, p = 0.007), combing (4 ± 3 versus 2 ± 1, p = 0.002), washing the back (10 ± 3 versus 8 ± 3, p = 0.034), and sports/leisure (15 ± 3 versus 14 ± 3, p = 0.010). UCLA score in 134 patients reached 28 points, corresponding to the functional recovery period at 6 ± 3 months. One patient did not reach > 28 points on the UCLA score. CONCLUSIONS: It took patients an average of 14 months to recover their daily motion after surgery. Tear size and retear affected only the recovery period of high-level motion activities and sports/leisure. This study was believed to serve as a guideline to inform patients about functional recovery after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Atividades Cotidianas , Artroscopia , Volta ao Esporte , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Idoso , Artroscopia/efeitos adversos , Fenômenos Biomecânicos , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Recidiva , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/diagnóstico , Lesões do Manguito Rotador/fisiopatologia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
17.
Neuro Oncol ; 21(3): 404-414, 2019 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-30107606

RESUMO

BACKGROUND: Pseudoprogression is a diagnostic challenge in early posttreatment glioblastoma. We therefore developed and validated a radiomics model using multiparametric MRI to differentiate pseudoprogression from early tumor progression in patients with glioblastoma. METHODS: The model was developed from the enlarging contrast-enhancing portions of 61 glioblastomas within 3 months after standard treatment with 6472 radiomic features being obtained from contrast-enhanced T1-weighted imaging, fluid-attenuated inversion recovery imaging, and apparent diffusion coefficient (ADC) and cerebral blood volume (CBV) maps. Imaging features were selected using a LASSO (least absolute shrinkage and selection operator) logistic regression model with 10-fold cross-validation. Diagnostic performance for pseudoprogression was compared with that for single parameters (mean and minimum ADC and mean and maximum CBV) and single imaging radiomics models using the area under the receiver operating characteristics curve (AUC). The model was validated with an external cohort (n = 34) imaged on a different scanner and internal prospective registry data (n = 23). RESULTS: Twelve significant radiomic features (3 from conventional, 2 from diffusion, and 7 from perfusion MRI) were selected for model construction. The multiparametric radiomics model (AUC, 0.90) showed significantly better performance than any single ADC or CBV parameter (AUC, 0.57-0.79, P < 0.05), and better than a single radiomics model using conventional MRI (AUC, 0.76, P = 0.012), ADC (AUC, 0.78, P = 0.014), or CBV (AUC, 0.80, P = 0.43). The multiparametric radiomics showed higher performance in the external validation (AUC, 0.85) and internal validation (AUC, 0.96) than any single approach, thus demonstrating robustness. CONCLUSIONS: Incorporating diffusion- and perfusion-weighted MRI into a radiomics model improved diagnostic performance for identifying pseudoprogression and showed robustness in a multicenter setting.

18.
J Shoulder Elbow Surg ; 28(4): 731-741, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30503179

RESUMO

HYPOTHESIS: We hypothesized that a new method considering the humeral head would distinguish rotator cuff tears (RCTs) and osteoarthritis (OA) better than the critical shoulder angle (CSA). METHODS: A total of 1011 patients were tested in this study and divided into 4 groups: those with RCTs (n = 493), those with OA (n = 73), those with anterior instability (n = 361), and those with adhesive capsulitis (n = 84). The CSA and new radiologic parameters including the humeral head were measured in the true anterior-to-posterior view: the Y angle connecting the lower end of the glenoid (LG), the center of the humeral head (CH), and the upper end of the glenoid (UG); the G angle connecting UG, CH, and the lateral tip of the acromion; the YG angle connecting LG, CH, and the lateral tip of the acromion; and the R angle connecting UG, LG, and CH. RESULTS: The CSA and G angle were the largest in the RCT group (34.2° and 70.4°, respectively; P < .001) and the smallest in the OA group (29.8° and 61.7°, respectively; P < .001). The Y angle was the largest in the OA group (82.8°, P < .001). The R angle in the RCT group (52.9°) was significantly larger than that in the OA group, which was the smallest among the groups (48.0°; P < .001). The CSA was correlated with the G and YG angles in the RCT group, whereas the CSA was correlated with the Y, G, and R angles in the OA group (P < .05). The CSA showed the highest correlation with the size of RCTs (correlation coefficient = 0.138). CONCLUSION: The Y, G, and R angles reflected the lesions of RCTs or OA. The CSA showed good correlations with the new radiologic parameters, and it had the highest correlation coefficient with the size of RCTs.


Assuntos
Bursite/diagnóstico por imagem , Cabeça do Úmero/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Osteoartrite/diagnóstico por imagem , Lesões do Manguito Rotador/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Articulação do Ombro/diagnóstico por imagem , Adulto Jovem
19.
Am J Emerg Med ; 37(1): 45-47, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29779678

RESUMO

INTRODUCTION: This study aimed to analyze the characteristics, etiology, and treatment of a series of patients with spontaneous perirenal hemorrhage (Wunderlich syndrome [WS]). METHODS: We retrospectively reviewed the records of 26 patients hospitalized for WS in a tertiary urological center between 2011 and 2018. All patients were evaluated for perirenal hemorrhage observed on computed tomography (CT) in the emergency department. Clinical variables (age, underlying diseases, symptoms, shock, and hospitalization period), laboratory test results, and radiological and pathological results were reviewed. RESULTS: The series included 28 events from 26 patients with a mean follow-up period of 20.2 ±â€¯18.0 months. Flank pain was most common symptoms (92%). Twelve patients (46%) had visible renal lesions and associated hematoma and 14 only showed perirenal hematoma. In six patients with shock (systolic blood pressure < 90 mm Hg), 2 underwent emergency angioembolization. Twelve patients (46%) underwent exploration and total nephrectomy. In the final diagnosis, 4 cases of renal cell carcinoma, 3 of angiomyolipoma, 4 of simple renal cyst, 2 of acquired cystic kidney disease, 4 of sarcoma or other malignancy, 4 of chronic pyelonephritis, and 5 of idiopathic WS were observed. Patient age was associated with prediction of renal cell carcinoma in the patients with WS. CONCLUSION: Renal masses are the main cause of WS, and CT is the diagnostic procedure of choice. Old age is a possible risk factor for renal cell carcinoma in etiology of WS. Surgical treatment is preferred in patients diagnosed with renal malignancy and in cases of hemodynamic instability.


Assuntos
Dor no Flanco/patologia , Hemorragia/patologia , Nefropatias/patologia , Adulto , Fatores Etários , Idoso , Feminino , Dor no Flanco/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Nefropatias/complicações , Nefropatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nefrectomia , Estudos Retrospectivos , Choque , Tomografia Computadorizada por Raios X
20.
J Korean Med Sci ; 33(39): e254, 2018 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-30250414

RESUMO

Background: According to domestic studies, patients visiting the emergency departments (ED) with acute toxic exposure comprise 0.68%-5.5% of all ED patients, with various causes and motives. The purpose of this study is to investigate the clinical and social characteristics of patients with toxic exposure visiting the ED. Methods: This study spanned a period of five years, from January 1, 2009 to December 31, 2013. The data were extracted using the National Emergency Department Information System (NEDIS) and The Korea Health Insurance Review and Assessment Service (HIRA). Results: From the HIRA database, during the study period (2009-2013); 310,159 (2009), 289,829 (2010), 288,906 (2011), 285,514 (2012), and 279,575 (2013) patients, respectively, visited EDs with diagnoses related to exposure to toxic substances. The number of patients who presented with acute toxic exposure compared to all ED visits significantly decreased consistently (7.8%, 6.9%, 6.0%, 5.0%, 4.1%) over 5 years. Regarding the cause of toxic exposure, substances other than drugs accounted for the largest percentage, and increased annually. Acetylcysteine was the most commonly prescribed antidote, and patients in their 40s and 50s showed the most frequent visits. The monthly distribution was highest in July-September, and higher in January than in other months. Conclusion: This study found that the percentage of patients visiting the ED is decreasing, the exposure to quasi-drugs was the most common, and the exposure to antipsychotic drugs was the most frequent.


Assuntos
Seguro Saúde , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Programas Nacionais de Saúde , República da Coreia , Estudos Retrospectivos
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