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1.
Ann Otol Rhinol Laryngol ; : 34894211051229, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34651510

RESUMO

OBJECTIVE: To discuss persistent facial nerve stimulation (FNS) related to repeated electrostatic discharge (ESD) shock following cochlear implantation. METHODS: Single case report with literature review. RESULTS: FNS is a feared complication after cochlear implantation, occurring in approximately 7% of cases, with most patients having anatomic abnormalities. The presented case has no anatomical abnormalities but reported frequent environmental static shock. FNS during the first 1 to 3 seconds of processor attachment caused a significant decrease in the patient's quality of life, requiring subsequent re-implantation with full resolution. CONCLUSIONS: FNS is a complication of cochlear implantation that can cause a great deal of distress and discomfort. Frequent electrostatic discharge (ESD) contributed to device malfunctioning and FNS in a patient with otherwise normal anatomy and should be avoided if possible.

2.
J Pers Med ; 11(10)2021 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-34683179

RESUMO

Iron deficiency anemia (IDA) accounts for most of the anemia in pregnancy, and iron is essential for neurodevelopment. Tics and Tourette's syndrome (TS) are neurodevelopmental disorders that manifest in childhood. A few studies reported an inconclusive association between iron deficiency and tics in children. No study has investigated the relationship between prenatal maternal anemia and tics in children. We aimed to assess the relationship between prenatal anemia exposure and the incidence of tics or TS in offspring. We linked the Taiwan National Health Insurance Research Database to the Maternal and Child Health Database for the analysis and identified 153,854 children with prenatal anemia exposure and 2,014,619 children without prenatal anemia exposure from 2004 to 2016 and followed them through 2017. Cox regression models were applied to compare the risk of tics or TS between the exposed and nonexposed groups. Among the exposed group, 37,832 were exposed at ≤12 weeks of gestational age (GA) and 116,022 at >12 weeks of GA. We observed an increased risk of tics and TS in those exposed at ≤12 weeks compared with the nonexposed group (adjusted hazard ratio (aHR) = 1.23, 95% confidence interval (CI): 1.12-1.34). The result remained consistent after adjusting for birth year, sex, birth order, maternal age, low-income levels, gestational age, birth weight, and alcohol use and smoking during pregnancy (aHR = 1.16, CI: 1.04-1.28). Fetuses exposed to maternal anemia at ≤12 weeks of GA are at high risk of tics or TS. However, this effect was attenuated to insignificance in the sibling comparison. Our study highlights the importance of detection of anemia during pregnancy and proper timing of iron supplementation.

3.
Ann Otol Rhinol Laryngol ; : 34894211053966, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34706584

RESUMO

OBJECTIVES: To report 4 cases of delayed facial palsy (DFP) after pediatric middle ear (ME) surgery and systematically review and analyze the associated literature to evaluate the effects of age on DFP etiology, management, and prognosis. METHODS: Systematic review of PubMed, Cochrane Library, and Embase for articles related to DFP after cochlear implantation (CI) was performed. These articles were assessed for level of evidence, methodological limitations, and number of cases. Meta-analysis was performed to assess the effects of age on DFP incidence. Furthermore, a comprehensive list of all pediatric DFP cases after otologic surgery was assembled through a multi-institutional retrospective review and systematic review of the literature. RESULTS: Twenty-nine articles fit the criteria for inclusion in the meta-analysis. The incidence of DFP after CI was 0.23% and 1.01% for pediatric and adult cases, respectively. This difference was statistically significant (P < .001, odds ratio 4.36). Twenty-three cases, adding to the 4 presented herein, were suitable for a comprehensive list. The mean age was 6.9 years. Average postoperative day of paresis onset was 5.4, with an average maximum House-Brackmann grade of 3.5. All patients obtained full facial recovery after an average of 23.5 days. CONCLUSIONS: The systematic review demonstrates that DFP after pediatric CI is rare and occurs at a significantly lower rate than in adults, further supporting the viral reactivation hypothesis of DFP. The prognosis for pediatric DFP after otologic surgery is excellent, with a high rate of full recovery in a short time frame. However, steroid administration can be considered. LEVEL OF EVIDENCE: IIa.

4.
Front Med (Lausanne) ; 8: 745006, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34651001

RESUMO

Study Objectives: Smoking and sleep are modifiable factors associated with the chronic kidney diseases. However, the interaction of smoking and sleep on the renal function are still unclear. Therefore, we aimed to evaluate the interactive impacts of smoking and sleep on the renal function. Methods: Data were obtained from the National Health and Nutrition Examination Survey. The study population were categorized into nine subgroups by smoking (smoking every day, sometimes, and non-smokers recently) and sleep duration (short duration ≤ 6 h, normal duration 6-9 h, and longer duration ≥ 9 h on the weekdays). Results: The study group with a short sleep duration had significantly higher serum cotinine and hydrocotinine levels compared with the other two sleep groups. After adjusting the demographic characteristics (age, race, body mass index, and marital status), sleep quality (snoring or breathing cessation), and comorbidities (diabetes mellitus, hypertension, high cholesterol, anemia, congestive heart failure, coronary heart disease, and stroke), non-smokers with short or long sleep duration had significant lower estimated glomerular filtration rate (eGFR) levels than the study group who smoked every day and slept ≤ 6 h. The effects of sleep duration on eGFR levels varied with smoking status. For the study group smoking every day, eGFR levels increased as sleep duration decreased, whereas for the study group smoking sometimes, eGFR levels increased as sleep duration increased. The U-shaped effects of eGFR levels were observed among non-smokers whose normal sleep duration was associated with better eGFR levels. Normal sleep duration was an important protective factor of the renal function for non-smokers than smokers. Conclusions: The effects of sleep duration on eGFR levels varied with smoking status. Normal sleep duration was a protective factor and more crucial for non-smokers than for smokers.

5.
J Vasc Access ; : 11297298211045505, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34524025

RESUMO

BACKGROUND: Quantitative physical examination (PE) indicators, including palpable pulsatility length and outflow scores, can be used to quantify stenosis severity at hemodialysis vascular access sites. It is known that the risk of high-shear-related thrombosis is increased when the minimal luminal diameter (MLD) of stenosis decreases. At present, MLD is measured using sonography or angiography. This study sought to determine the relationship between quantitative PE indicators and MLD and report their diagnostic performance in detecting patients with stenosis at a high risk of thrombosis. METHODS: We performed a retrospective case-control study using routinely collected data. We used the post-stenosis palpable pulsatility length (sPPL) and pulse-and-thrill based outflow score to assess the severity of AVF inflow and outflow stenosis, respectively. We recorded paired quantitative PE indicators and MLD before and after angioplasty in patients enrolled over a 4-month period. RESULTS: A total of 249 paired PE indicators and MLD measurements were obtained from 163 patients. A receiver operating characteristic curve analysis showed that an MLD cutoff value of <1.55 mm and an MLD of <1.95 mm discriminated sPPL = 0 and PESOS (physical examination significant outflow stenosis)/1- of the outflow score, respectively, from all other measurements, with the area under the curve values of 0.8922 and 0.9618, respectively. With sPPL = 0 and PESOS/1- of the outflow score as diagnostic tools to detect inflow stenosis with an MLD of ⩽1.5 mm and outflow stenosis with an MLD of ⩽1.9 mm at vascular access sites, sensitivity = 86.00% and 88.46%; specificity = 97.67% and 92.11%; positive predictive values of 97.73% and 92.00% and negative predictive values of 85.71% and 88.61%, respectively, were observed. CONCLUSIONS: Our preliminary results showed that physical examination can potentially be a diagnostic tool in detecting patients with stenosis who are at a high risk of thrombosis at hemodialysis vascular access sites with high diagnostic accuracy.

6.
Otolaryngol Head Neck Surg ; : 1945998211041948, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34464219

RESUMO

Auricular reconstruction with autologous rib cartilage involves using a soft tissue envelope to cover the cartilage framework. In patients with a low hairline, hair-bearing skin may be incorporated on the reconstructed ear, creating a difficult and conspicuous aesthetic problem. A retrospective chart review was conducted to summarize and share the experience of using the Candela GentleMax Pro 755-nm alexandrite laser system (Candela Corp) in children following auricular reconstruction. Nine patients received laser hair removal via the alexandrite laser system with good results. The number of completed sessions ranged from 1 to 5. The procedures were completed without the need for premedication or procedural sedation. Laser hair removal with an alexandrite laser system was safe, fast, and effective. With multistage auricular reconstruction, it was feasible to incorporate laser hair removal between the stages.

7.
Artigo em Inglês | MEDLINE | ID: mdl-34360123

RESUMO

BACKGROUND: The theory of planned behaviour (TPB) explanation of smoking cessation intentions consists of gender differences. The purpose of this study is to adopt the extended TPB to discuss factors influencing the smoking cessation intentions of young adult volunteer soldiers and to further compare the respective factors for both genders. METHODS: This is a cross-sectional study. Data were collected from 139 and 165 male and female volunteer soldiers who smoked, respectively. Research participants completed a self-administered questionnaire that comprised items pertaining to the participants' demographic characteristics, smoking behaviours, smoking cessation experiences, social environments, and TPB variables. RESULTS: Subjective norms (friends) are a positive key factor for young adult male (ß = 0.033, p = 0.012) and female (ß = 0.076, p < 0.001) volunteer soldiers' smoking cessation intentions, and perceived behavioural control is a key factor for male young (ß = 0.226, p = 0.040) adult volunteer soldiers' smoking cessation intention. The extended TPB accounted for 27.9% and 53.2% of the variance in the intention to quit smoking in the male and female volunteer soldiers, respectively. CONCLUSIONS: We suggest that smoking cessation strategies can reinforce gender-specific intervention strategies to assist young adult volunteer soldiers in smoking cessation.


Assuntos
Militares , Abandono do Hábito de Fumar , Estudos Transversais , Feminino , Humanos , Intenção , Masculino , Teoria Psicológica , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
8.
Nat Med ; 27(9): 1536-1543, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34341578

RESUMO

Gemcitabine-cisplatin (GP) chemotherapy is the standard first-line systemic treatment for recurrent or metastatic nasopharyngeal carcinoma (RM-NPC). In this international, double-blind, phase 3 trial (ClinicalTrials.gov identifier: NCT03581786), 289 patients with RM-NPC and no previous chemotherapy for recurrent or metastatic disease were randomized (1/1) to receive either toripalimab, a monoclonal antibody against human programmed death-1 (PD-1), or placebo in combination with GP every 3 weeks for up to six cycles, followed by monotherapy with toripalimab or placebo. The primary endpoint was progression-free survival (PFS) as assessed by a blinded independent review committee according to RECIST v.1.1. At the prespecified interim PFS analysis, a significant improvement in PFS was detected in the toripalimab arm compared to the placebo arm: median PFS of 11.7 versus 8.0 months, hazard ratio (HR) = 0.52 (95% confidence interval (CI): 0.36-0.74), P = 0.0003. An improvement in PFS was observed across key subgroups, including PD-L1 expression. As of 18 February 2021, a 40% reduction in risk of death was observed in the toripalimab arm compared to the placebo arm (HR = 0.603 (95% CI: 0.364-0.997)). The incidence of grade ≥3 adverse events (AEs) (89.0 versus 89.5%), AEs leading to discontinuation of toripalimab/placebo (7.5 versus 4.9%) and fatal AEs (2.7 versus 2.8%) was similar between the two arms; however, immune-related AEs (39.7 versus 18.9%) and grade ≥3 infusion reactions (7.5 versus 0.7%) were more frequent in the toripalimab arm. In conclusion, the addition of toripalimab to GP chemotherapy as a first-line treatment for patients with RM-NPC provided superior PFS compared to GP alone, and with a manageable safety profile.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma Nasofaríngeo/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Adulto , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Antígeno B7-H1/antagonistas & inibidores , Antígeno B7-H1/genética , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Desoxicitidina/análogos & derivados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/imunologia , Carcinoma Nasofaríngeo/patologia , Recidiva Local de Neoplasia/imunologia , Recidiva Local de Neoplasia/patologia , Intervalo Livre de Progressão
9.
Otolaryngol Head Neck Surg ; : 1945998211029836, 2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34311620

RESUMO

OBJECTIVE: To determine the incidence of auditory neuropathy spectrum disorder (ANSD) and its risk factors among the neonatal intensive care unit (NICU) population from 2009 to 2018 in the Pediatric Health Information System database. STUDY DESIGN: Retrospective national database review. SETTING: Population-based study. METHODS: The Pediatric Health Information System database was queried to identify patients ≤18 years old with NICU admission and ANSD diagnosis. Patient demographics, jaundice diagnosis, use of mechanical ventilation, extracorporeal membrane oxygenation, furosemide, and/or aminoglycosides were extracted. Multivariable linear regression was used to assess trends in incidence. Chi-square analysis was used to assess differences between patients with and without ANSD. Logistic regression was used to assess factors associated with ANSD. RESULTS: From 2009 to 2018, there was an increase in (1) NICU admissions from 14,079 to 24,851 (P < .001), (2) total ANSD diagnoses from 92 to 1847 (P = .001), and (3) annual total number of patients with ANSD and NICU admission increased from 4 to 16 (P = .005). There was strong correlation between the increases in total number of NICU admissions and total ANSD diagnoses over time (R = 0.76). The average ANSD incidence was 0.052% with no statistically significant change over 10 years. When compared with all NICU admissions, children with ANSD had a higher association with use of furosemide (P < .001) and ventilator (P < .001). CONCLUSION: Despite a statistically significant increase in NICU admissions and total ANSD diagnosis, the incidence of ANSD in the NICU population has not increased from 2009 to 2018. Furosemide and mechanical ventilator use were associated with increased likelihood of ANSD.

10.
Laryngoscope ; 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233033

RESUMO

OBJECTIVE(S): To describe cochlear implantation (CI) outcomes, with speech perception, auditory, language, and parent-reported auditory and speech behaviors, in children with an enlarged vestibular aqueduct (EVA) and incomplete partition type 2 (IP-II) and compare to control children without inner ear malformations (IEMs) and to determine cerebrospinal fluid gusher rates and effect on outcomes. STUDY DESIGN: Systematic review and meta-analysis. METHODS: MEDLINE, Embase, Cochrane, and CINAHL databases were searched from inception to February 2020. Studies reporting relevant outcomes in children with EVA or EVA + IP-II and controls without IEMs undergoing CI were included. Mean differences in speech perception, auditory, and language scores between cases and controls were meta-analyzed. Gusher rates were determined by proportion meta-analyses. RESULTS: Of 214 identified articles, 42 met inclusion criteria, evaluating 775 cases and 2,191 controls. Of -cases, 578 (74.6%) had EVA and 197 (25.4%) had EVA + IP-II. Cases showed a significant improvement in speech perception, auditory and language performance, comparable to controls. Parent-reported auditory and speech production behaviors outcomes were positive among cases and comparable to controls. Pooled gusher proportions in EVA and EVA + IP-II cases were 27.7% (95% CI: 17.6-39.1) and 48.6% (95% CI: 28.6-69.0), respectively, with a proportion difference of 20.9% (95% CI: 11.0-30.1). Gusher occurrence did not impact speech perception or language outcomes. CONCLUSION: Outcomes in children with EVA or EVA + IP-II undergoing CI are favorable and largely comparable to outcomes in children with hearing loss undergoing CI without IEMs. Intraoperative gusher is more prevalent among children with EVA + IP-II as compared to iEVA. Gusher does not influence speech perception and language development outcomes. LEVEL OF EVIDENCE: NA Laryngoscope, 2021.

11.
Ann Otol Rhinol Laryngol ; : 34894211024051, 2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34109843

RESUMO

OBJECTIVE: Microtia reconstruction is technically challenging due to the intricate contours of the ear. It is common practice to use a two-dimensional tracing of the patient's normal ear as a template for the reconstruction of the affected side. Recent advances in three-dimensional (3D) surface scanning and printing have expanded the ability to create surgical models preoperatively. This study aims to describe a simple and affordable process to fabricate patient-specific 3D ear models for use in the operating room. STUDY DESIGN: Applied basic research on a novel 3D optical scanning and fabrication pathway for microtia reconstruction. SETTING: Tertiary care university hospital. METHODS: Optical surface scanning of the patient's normal ear was completed using a smartphone with facial recognition capability. The Heges application used the phone's camera to capture the 3D image. The 3D model was digitally isolated and mirrored using the Meshmixer software and printed with a 3D printer (MonopriceTM Select Mini V2) using polylactic acid filaments. RESULTS: The 3D model of the ear served as a helpful intraoperative reference and an adjunct to the traditional 2D template. Collectively, time for imaging acquisition, editing, and fabrication was approximately 3.5 hours. The upfront cost was around $210, and the recurring cost was approximately $0.35 per ear model. CONCLUSION: A novel, low-cost approach to fabricate customized 3D models of the ear is introduced. It is feasible to create individualized 3D models using currently available consumer technology. The low barrier to entry raises the possibility for clinicians to incorporate 3D printing into various clinical applications.

12.
Int J Bioprint ; 7(2): 332, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33997432

RESUMO

The global prevalence of respiratory diseases caused by infectious pathogens has resulted in an increased demand for realistic in-vitro alveolar lung models to serve as suitable disease models. This demand has resulted in the fabrication of numerous two-dimensional (2D) and three-dimensional (3D) in-vitro alveolar lung models. The ability to fabricate these 3D in-vitro alveolar lung models in an automated manner with high repeatability and reliability is important for potential scalable production. In this study, we reported the fabrication of human triple-layered alveolar lung models comprising of human lung epithelial cells, human endothelial cells, and human lung fibroblasts using the drop-on-demand (DOD) 3D bioprinting technique. The polyvinylpyrrolidone-based bio-inks and the use of a 300 mm nozzle diameter improved the repeatability of the bioprinting process by achieving consistent cell output over time using different human alveolar lung cells. The 3D bioprinted human triple-layered alveolar lung models were able to maintain cell viability with relative similar proliferation profile over time as compared to non-printed cells. This DOD 3D bioprinting platform offers an attractive tool for highly repeatable and scalable fabrication of 3D in-vitro human alveolar lung models.

13.
J Clin Med ; 10(5)2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33801167

RESUMO

Transoral robotic surgery (TORS) has been used for treating pharyngeal and laryngeal cancers for many years. However, the application of neoadjuvant chemotherapy (NACT) before TORS, the sparing rate of adjuvant irradiation after TORS, and the long-term oncologic/functional outcomes of TORS are seldom reported. From September 2014 to May 2018, 30 patients with clinical T1 to T3 cancers of oropharynx (7), larynx (3), and hypopharynx (20) were prospectively recruited for TORS in a tertiary referral medical center. Twelve (40%) patients had clinical early stage (I or II) disease, and 18 (60%) patients had late-stage (III or IV) disease. All 30 patients were suggested to receive TORS with neck dissection. Cisplatin-based NACT was given to 11 patients before the surgery, and it led to a 100% reduction in tumor size. Only 40% of patients needed adjuvant irradiation with a mean dosage of 5933 cGY after TORS. After a mean follow up of 38.9± 14.7 months, the Kaplan-Meier method estimated 5-year disease-specific survival, and organ preservation was 86.3% and 96.2%, respectively. Twenty-five patients were alive without tracheostomy and tube feeding. We found that NACT is a potential method for facilitating tumor resection and TORS effectively de-escalated adjuvant irradiation with a satisfactory 5-year survival and functional outcomes.

14.
PLoS One ; 16(3): e0248434, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33705494

RESUMO

PURPOSE: Reading comprehension is closely associated with word recognition, particularly at the early stage of reading development. This association is reflected in children with reading difficulties (RD) who demonstrate poor reading comprehension along with delayed word recognition or reduced recognition accuracy. Although the neural mechanisms underlying reading comprehension and word recognition are well studied, few has investigated the white matter (WM) structures that the two processes potentially share. METHODS: To explore the issue, behavioral scores (word recognition & reading comprehension) and diffusion spectrum imaging (DSI) were acquired from Chinese-speaking children with RD and their age-matched typically developing children. WM structures were measured with generalized fractional anisotropy and normalized quantitative anisotropy to optimize fiber tracking precision. RESULTS: The children with RD performed significantly poorer than the typically developing children in both behavioral tasks. Between group differences of WM structure were found in the right superior temporal gyrus, the left medial frontal gyrus, the left medial frontal gyrus, and the left caudate body. A significant association between reading comprehension and Chinese character recognition and the DSI indices were found in the corpus callosum. The findings demonstrated the microstructural difference between children with and without reading difficulties go beyond the well-established reading network. Further, the association between the WM integrity of the corpus callosum and the behavioral scores reveals the involvement of the WM structure in both tasks. CONCLUSION: It suggests the two reading-related skills have partially overlapped neural mechanism. Associating the corpus callosum with the reading skills leads to the reconsideration of the right hemisphere role in the typical reading process and, potentially, how it compensates for children with reading difficulties.


Assuntos
Corpo Caloso , Imagem de Difusão por Ressonância Magnética , Dislexia , Leitura , Substância Branca , Grupo com Ancestrais do Continente Asiático , Criança , China , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/fisiopatologia , Dislexia/diagnóstico por imagem , Dislexia/fisiopatologia , Feminino , Humanos , Masculino , Substância Branca/diagnóstico por imagem , Substância Branca/fisiopatologia
15.
Sci Rep ; 11(1): 5699, 2021 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-33707591

RESUMO

Arteriovenous fistula (AVF) is prone to early dysfunction and relates to poor outcome. However, little is known about the role of early AVF dysfunction as an independent risk factor for death in hemodialysis patients. A retrospective cohort study was performed using data of patients who underwent initial AVF surgery at a single institution. Demographic, clinical, biochemistry and AVF parameters were extracted from the electronic records, and the association between these variables and mortality was analyzed by Cox proportional hazards model. A total of 501 patients on hemodialysis (63.4 ± 12.7 years, 57.3% male) were included, and the median observation period was 3.66 years. In multivariate analysis, early failure of AVF (hazard ratio (95% confidence interval): 1.54 (1.06-2.24); p = 0.023) was associated with overall mortality but not cardiovascular mortality. Other identified predictors of overall mortality included older age, peripheral artery disease (PAD), cardiomegaly, higher white blood cell (WBC) count and corrected calcium level, and lower total cholesterol level, while predictors of cardiovascular mortality included older age, coronary artery disease (CAD), PAD and lower hemoglobin level. In conclusion, patients with early AVF failure were associated with increased risk of overall mortality.

16.
Epidemiol Psychiatr Sci ; 30: e14, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33583471

RESUMO

AIMS: Although the relationship between attention-deficit/hyperactivity disorder (ADHD) and transport accidents has been shown, there is limited information on the relationship between medication and dose-response effects and transport accident risk. This study aims to determine whether young people with ADHD, including adolescents, are more prone to transport accidents than those without, and the extent to which methylphenidate (MPH) prescription in these patients reduces the risk. METHODS: We identified 114 486 patients diagnosed with ADHD from Taiwan's National Health Insurance Research Database from 1997 to 2013. Using a Cox regression model, we compared the risk of transport accidents between ADHD and non-ADHD groups and estimated the effect of MPH on accidents. Furthermore, we applied a self-control case-series analysis to compare the risk of accidents during the medication periods with the same patients' non-medication periods. RESULTS: Male ADHD patients had a higher risk of transport accidents than non-ADHD individuals (adjusted hazard ratio [aHR] = 1.24, [95% confidence interval (CI) 1.10-1.39]), especially for those comorbid with epilepsy, oppositional defiant disorder/conduct disorder (ODD/CD), and intellectual disabilities (ID). Female ADHD patients showed no relationship, except for comorbid with autism spectrum disorder (ASD) or ID. We found a reduced risk of transport accidents in patients with ADHD with MPH medication than those without MPH, with a plausible dose-response relationship (aHR of 0.23 to 0.07). A similar pattern was found in self-controlled case-series analysis. CONCLUSIONS: Male patients with ADHD, especially those comorbid with epilepsy, ODD/CD, or ID, were at high risk of transport accidents. Female patients, when comorbid with ASD or ID, also exhibited a higher risk of accidents. MPH treatment lowered the accident risk with a dose-response relationship.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/efeitos adversos , Metilfenidato/efeitos adversos , Vigilância da População/métodos , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/epidemiologia , Estudos de Casos e Controles , Estimulantes do Sistema Nervoso Central/uso terapêutico , Estudos de Coortes , Comorbidade , Transtorno da Conduta/epidemiologia , Feminino , Humanos , Deficiência Intelectual/epidemiologia , Masculino , Metilfenidato/uso terapêutico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores Sexuais
17.
Am Surg ; : 3134821989053, 2021 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-33517705
18.
Otolaryngol Head Neck Surg ; 164(3): 662-666, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32894992

RESUMO

OBJECTIVES: To compare the efficacy of aural foreign body (FB) extractions among medical care settings and determine if certain methods of extraction resulted in higher failure rates and procedural complications. STUDY DESIGN: Case series with chart review. SETTING: Emergency departments (EDs), urgent cares (UCs), pediatric primary care providers (PCPs), and otolaryngologists (ENTs). METHODS: A total of 366 pediatric patients with EAC foreign bodies at a tertiary children's hospital and associated satellite clinics. RESULTS: The ED/UCs (17.46%), PCPs (75.22%), and ENTs (94.54%) exhibited highly variable success rates for pediatric aural FB extractions. Complications were considerably higher for attempts by ED/UCs (22.22%) as compared with PCPs (2.61%) and those of unclear etiology (2.73% of all attempts). Use of balloon-tipped catheters and adhesive-tipped probes (eg, cyanoacrylate/superglue) for FB extraction exhibited 0% success rates with high severity of complications. CONCLUSION: Our statistics provide an example in which ED/UCs had higher failure rates at pediatric aural FB removals when compared with PCPs and ENTs. If a single provider (PCP or ED/UC) fails to retrieve an aural FB or if the provider is not comfortable conducting the procedure, then referral to an ENT is preferable to another PCP or ED/UC. Our evidence reveals that balloon-tipped catheters and adhesive-tipped probes for FB removal in the pediatric population are prone to failure and higher rates/severity of complications.


Assuntos
Orelha , Corpos Estranhos/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Resultado do Tratamento
19.
Clin Exp Nephrol ; 25(1): 80-86, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32852664

RESUMO

BACKGROUND: Percutaneous transluminal angioplasty (PTA) has generally replaced surgical procedures to treat arteriovenous fistula (AVF) dysfunction, but the predictors of post-intervention patency are highly variable. This study aimed to determine predictors of primary patency following PTA of dysfunctional AVF. MATERIALS AND METHODS: Retrospective analysis of first-time PTA of 307 AVF in 307 patients (171 males, mean age 64.3 ± 12.4 years). Demographic, clinical, anatomical and medication variables were reviewed and subjected to univariate and multivariate Cox regression analysis. RESULTS: The post-intervention primary patency rates at 6, 12, 24, and 36 months were 76.3%, 58.3%, 43.2%, and 38.2%, respectively. The higher aortic arch calcification (AAC) grade patients were older, had higher incidence of comorbidities and cardiomegaly, and younger AVF age, but their dialysis vintage term was shorter and diastolic blood pressure was lower, and the maximum diameter of balloon angioplasty was mostly ≤ 6 mm, and had lower phosphorus level and less calcium-containing phosphate binder use. In multivariate Cox proportional hazard analysis, the presence of higher AAC grade [hazard ratio (95% confidence interval): (1.46 (1.02-2.09); p = 0.037)] and stenosis at upper arm [1.76 (1.16-2.67); p = 0.008] were associated with shorter post-intervention primary patency. CONCLUSION: In conclusion, higher AAC grade and anatomic factor related to the location of AVF (upper arm) were the important predictors of AVF dysfunction after PTA. These results could assist in tailoring surveillance programs and performing appropriate interventions for risky AVF.


Assuntos
Angioplastia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Diálise Renal , Calcificação Vascular/fisiopatologia , Grau de Desobstrução Vascular , Idoso , Angioplastia/métodos , Aorta Torácica , Braço/irrigação sanguínea , Vasos Sanguíneos/patologia , Constrição Patológica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Calcificação Vascular/complicações
20.
Laryngoscope ; 131(6): E2080-E2088, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33258484

RESUMO

OBJECTIVES/HYPOTHESIS: To further clinically characterize lingual hamartomas, and to consolidate literature by analyzing clinical presentation, diagnostic evaluation, treatment, and outcomes. STUDY DESIGN: Retrospective chart review and literature review. METHODS: Case series from 1989 to 2020 at a tertiary pediatric center; follow-up ranging from 2 months to 12 years. Patient demographics, clinical presentations, physical examination findings, surgical pathology, operative methods, pre-operative imaging, and follow-up. A review of English-language literature from 1945 to 2020 was conducted. RESULTS: Seven patients (four male, three female) with nine lingual hamartomas were identified. Average age at surgical excision was 7.9 months (SD 3.5 months, range 3 to 14 months). Follow-up ranged from 2 months to 12 years, with all patients having no recurrence. Physical examination identified five pedunculated hamartomas and two sessile hamartomas. One patient had a neck CT, one had neck ultrasound, and two had facial MRIs. CT and ultrasounds confirmed presence of cervical thyroid. MRI suggested no muscular invasion for one patient, whereas motion artifact obscured findings for the other patient. Most patients who presented with dysphagia or poor weight gain achieved post-surgical improvement. The present cases combined with the literature review identified 57 patients with 63 lingual hamartomas. CONCLUSIONS: Lingual hamartomas appear as hypovascular pedunculated masses near the foramen cecum. There is no demographic predisposition, and most are identified during infancy. Imaging is not necessary, unless there is concern for lingual thyroid, in which case thyroid ultrasound should be performed. Surgical excision is curative, with dysphagia resolution and low likelihood for recurrence. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2080-E2088, 2021.


Assuntos
Hamartoma/diagnóstico , Hamartoma/terapia , Neoplasias da Língua/diagnóstico , Neoplasias da Língua/terapia , Diagnóstico por Imagem , Feminino , Humanos , Lactente , Masculino
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