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1.
Int J Infect Dis ; 90: 97-103, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31639520

RESUMO

BACKGROUND: In December 2018, routine surveillance identified an autochthonous outbreak of dengue fever in Muscat Governorate, Oman, a region previously free of dengue fever. METHODS: Routine surveillance confirmed locally acquired cases in the second week of December, leading to a rapid public health response including case management guidance and epidemiological investigations. The main activity was the vector survey using systematic sampling to assess extent of previously unreported Aedes aegypti presence followed by a campaign aimed to eliminate breeding sites of A. aegypti". RESULTS: During a 5-month period, 343 suspected cases were reported from Muscat Governorate with 122 from the outbreak affected area. Out of 207 probable cases eligible for laboratory testing as per guidelines issued, 59 cases were confirmed. The vector elimination campaign started on January 8, 2019 after a media advocacy using television and social media and concluded on January 23. By the end of campaign, the case load had decreased significantly in the affected area with no reports of locally acquired cases from adjoining areas of Muscat Governorate, indicating no further spread. CONCLUSIONS: Rapid notification and early community-wide, extensive vector control activities effectively contained the autochthonous dengue fever virus outbreak.

2.
Cleft Palate Craniofac J ; 57(1): 5-13, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31248277

RESUMO

OBJECTIVES: To (1) determine the prevalence of nonperialveolar palatal fistula up to age 5 following repair of unilateral cleft lip and palate (UCLP) in the United Kingdom, (2) examine the association of palatoplasty techniques with fistula occurrence, and (3) describe the frequency of fistula repairs and their success. DESIGN: Cross-sectional study. SETTING: All 11 centralized regional cleft centers in the United Kingdom. PARTICIPANTS: Two hundred sixty-eight children born between 2005 and 2007 recruited by Cleft Care UK, a nationwide cross-sectional study of all 5-year-old children born with nonsyndromic UCLP. MAIN OUTCOME MEASURE: Nonperialveolar palatal fistula prevalence up to age 5. RESULTS: Fistulas were found in 72 children (31.3%, 95% confidence interval: 25.4%-37.7%) and had no significant association with palate repair sequences. Twenty-four fistulas were repaired by age 5, 12 of which had data showing 10 (83.3%) successful repairs. CONCLUSION: The prevalence of nonperialveolar fistulas following primary palatoplasty of UCLP in the United Kingdom was higher than previously reported. This information should be part of the preoperative discussion with families. Prospective collection of the presence of fistulas will be necessary before we can associate the occurrence of fistulas with a surgeon, institution, surgical technique, or protocol of care.

3.
Int J Epidemiol ; 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31270549

RESUMO

BACKGROUND: Although physical activity has many known health benefits, its association with lung function in childhood/adolescence remains unclear. We examined the association of physical-activity trajectories between 11 and 15 years with lung function at 15 years in 2266 adolescents. METHODS: A population-based cohort of 14 305 singleton births alive at 1 year was recruited in the UK population-based Avon Longitudinal Study of Parents and Children cohort. Physical activity (counts/minute and moderate-to-vigorous physical activity) was assessed for 7 days using an accelerometer at 11, 13 and 15 years. We identified sex-specific physical-activity trajectories applying K-means for longitudinal data in children with at least two accelerometer measurements (n = 3584). We then estimated the sex-specific associations of these trajectories with post-bronchodilation lung-function parameters using multivariable linear-regression models (n = 2266, 45% boys). RESULTS: Fewer than 7% of participants met the WHO physical-activity recommendations (i.e. daily average of at least 60 minutes of moderate-to-vigorous physical activity). Boys were substantially more active than girls. In both sexes, we identified three distinct physical-activity trajectories ('low': 39.8% boys, 45.8% girls; 'moderate': 42.9% boys, 41.4% girls; and 'high' physical activity: 17.3% boys, 12.8% girls). Girls in the moderate and high physical-activity trajectories had 0.11 L [95% confidence interval (CI): 0.04-0.19] and 0.15 L (95% CI: 0.03-0.26) higher forced vital capacity than their less-active peers. No association was observed in boys. CONCLUSIONS: Higher childhood physical activity relates to higher lung-function levels in adolescent girls. A better understanding of the mechanisms underlying this association should be pursued.

5.
Am J Respir Crit Care Med ; 200(1): 75-83, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30630337

RESUMO

Rationale: Body composition changes throughout life may explain the inconsistent associations reported between body mass index and lung function in children. Objectives: To assess the associations of body weight and composition trajectories from 7 to 15 years with lung function at 15 years and lung function growth between 8 and 15 years. Methods: Sex-specific body mass index, lean body mass index, and fat mass index trajectories were developed using Group-Based Trajectory Modeling on data collected at least twice between 7 and 15 years from 6,964 children (49% boys) in the UK Avon Longitudinal Study of Parents and Children birth cohort. Associations of these trajectories with post-bronchodilation lung function parameters at 15 years and with lung function growth rates from 8 to 15 years were assessed using multivariable linear regression models, stratified by sex, in a subgroup with lung function data (n = 3,575). Measurements and Main Results: For all body mass measures we identified parallel trajectories that increased with age. There was no consistent evidence of an association between the body mass index trajectories and lung function measures. Higher lean body mass index trajectories were associated with higher levels and growth rates of FVC, FEV1, and forced expiratory flow, midexpiratory phase in both sexes (e.g., boys in the highest lean body mass index trajectory had on average a 0.62 L [95% confidence interval, 0.44-0.79; P trend < 0.0001] higher FVC at 15 yr than boys in the lowest trajectory). Increasing fat mass index trajectories were associated with lower levels and growth rates of FEV1 and forced expiratory flow, midexpiratory phase only in boys and lower levels of FEV1/FVC in both sexes. Conclusions: Higher lean body mass during childhood and adolescence is consistently associated with higher lung function at 15 years in both sexes, whereas higher fat mass is associated with lower levels of only some lung function parameters.

6.
J Allergy Clin Immunol ; 143(5): 1783-1790.e11, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30528616

RESUMO

BACKGROUND: Latent class analysis (LCA) has been used extensively to identify (latent) phenotypes of childhood wheezing. However, the number and trajectory of discovered phenotypes differed substantially between studies. OBJECTIVE: We sought to investigate sources of variability affecting the classification of phenotypes, identify key time points for data collection to understand wheeze heterogeneity, and ascertain the association of childhood wheeze phenotypes with asthma and lung function in adulthood. METHODS: We used LCA to derive wheeze phenotypes among 3167 participants in the ALSPAC cohort who had complete information on current wheeze recorded at 14 time points from birth to age 16½ years. We examined the effects of sample size and data collection age and intervals on the results and identified time points. We examined the associations of derived phenotypes with asthma and lung function at age 23 to 24 years. RESULTS: A relatively large sample size (>2000) underestimated the number of phenotypes under some conditions (eg, number of time points <11). Increasing the number of data points resulted in an increase in the optimal number of phenotypes, but an identical number of randomly selected follow-up points led to different solutions. A variable selection algorithm identified 8 informative time points (months 18, 42, 57, 81, 91, 140, 157, and 166). The proportion of asthmatic patients at age 23 to 24 years differed between phenotypes, whereas lung function was lower among persistent wheezers. CONCLUSIONS: Sample size, frequency, and timing of data collection have a major influence on the number and type of wheeze phenotypes identified by using LCA in longitudinal data.

7.
Pediatr Diabetes ; 19(8): 1393-1399, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30175430

RESUMO

BACKGROUND/OBJECTIVE: Type 2 Diabetes (T2DM) is increasing in childhood especially among females and South-Asians. Our objective was to report outcomes from a national cohort of children and adolescents with T2DM 1 year following diagnosis. METHODS: Clinician reported, 1-year follow-up of a cohort of children (<17 years) diagnosed with T2DM reported through the British Paediatric Surveillance Unit (BPSU) (April 2015-April 2016). RESULTS: One hundred (94%) of 106 baseline cases were available for review. Of these, five were lost to follow up and one had a revised diagnosis. Mean age at follow up was 15.3 years. Median BMI standard deviation scores (SDS) was 2.81 with a decrease of 0.13 SDS over a year. HbA1c <48 mmol/mol (UK target) was achieved in 38.8%. logHbA1c was predicted by clinician reported compliance and attendance concerns (ß = 0.12, P = <0.0001) and change in body mass index (BMI) SDS at 1-year (ß = 0.13, P=0.007). In over 50%, clinicians reported issues with compliance and attendance. Mean clinic attendance was 75%. Metformin was the most frequently used treatment at baseline (77%) and follow-up (87%). Microalbuminuria prevalence at 1-year was 16.4% compared to 4.2% at baseline and was associated with a higher HbA1c compared to those without microalbuminuria (60 vs 49 mmol/mol, P = 0.03). CONCLUSIONS: Adherence to treatment and a reduction in BMI appear key to better outcomes a year after T2DM diagnosis. Retention and clinic attendance are concerning. The prevalence of microalbuminuria has increased 4-fold in the year following diagnosis and was associated with higher HbA1c.


Assuntos
Índice de Massa Corporal , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Hemoglobina A Glicada/metabolismo , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Perda de Peso/fisiologia , Adolescente , Idade de Início , Glicemia/análise , Glicemia/metabolismo , Criança , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Masculino , Vigilância da População , Prognóstico , Fatores de Tempo , Reino Unido/epidemiologia , Adulto Jovem
8.
PLoS Med ; 15(8): e1002634, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30086135

RESUMO

BACKGROUND: Observational studies on pubertal timing and asthma, mainly performed in females, have provided conflicting results about a possible association of early puberty with higher risk of adult asthma, possibly due to residual confounding. To overcome issues of confounding, we used Mendelian randomisation (MR), i.e., genetic variants were used as instrumental variables to estimate causal effects of early puberty on post-pubertal asthma in both females and males. METHODS AND FINDINGS: MR analyses were performed in UK Biobank on 243,316 women using 254 genetic variants for age at menarche, and on 192,067 men using 46 variants for age at voice breaking. Age at menarche, recorded in years, was categorised as early (<12), normal (12-14), or late (>14); age at voice breaking was recorded and analysed as early (younger than average), normal (about average age), or late (older than average). In females, we found evidence for a causal effect of pubertal timing on asthma, with an 8% increase in asthma risk for early menarche (odds ratio [OR] 1.08; 95% CI 1.04 to 1.12; p = 8.7 × 10(-5)) and an 8% decrease for late menarche (OR 0.92; 95% CI 0.89 to 0.97; p = 3.4 × 10(-4)), suggesting a continuous protective effect of increasing age at puberty. In males, we found very similar estimates of causal effects, although with wider confidence intervals (early voice breaking: OR 1.07; 95% CI 1.00 to 1.16; p = 0.06; late voice breaking: OR 0.93; 95% CI 0.87 to 0.99; p = 0.03). We detected only modest pleiotropy, and our findings showed robustness when different methods to account for pleiotropy were applied. BMI may either introduce pleiotropy or lie on the causal pathway; secondary analyses excluding variants associated with BMI yielded similar results to those of the main analyses. Our study relies on self-reported exposures and outcomes, which may have particularly affected the power of the analyses on age at voice breaking. CONCLUSIONS: This large MR study provides evidence for a causal detrimental effect of early puberty on asthma, and does not support previous observational findings of a U-shaped relationship between pubertal timing and asthma. Common biological or psychological mechanisms associated with early puberty might explain the similarity of our results in females and males, but further research is needed to investigate this. Taken together with evidence for other detrimental effects of early puberty on health, our study emphasises the need to further investigate and address the causes of the secular shift towards earlier puberty observed worldwide.


Assuntos
Asma/epidemiologia , Puberdade , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Menarca , Análise da Randomização Mendeliana , Pessoa de Meia-Idade , Razão de Chances , Obesidade Pediátrica/epidemiologia , Autorrelato , Reino Unido/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-29995435

RESUMO

RATIONALE: Puberty may influence lung function, but the precise role of pubertal height growth in lung development is unclear. OBJECTIVES: To examine associations of timing of puberty and peak velocity of pubertal height growth with lung function in adolescence and early-adulthood. METHODS: Longitudinal analyses of repeat height measurements from age 5-20 years for a British birth cohort with 4,772 males and 4,849 females were conducted to characterise height growth trajectories, and derive pubertal age and peak height velocity using the validated SuperImposition by Translation and Rotation (SITAR) model. Association of these estimates with pre-bronchodilator and post-bronchodilator spirometry measures: FEV1; FVC; FEV1/FVC; FEF25-75 at age 15 and 24 years were investigated using multivariable regression models adjusted for lung function at age 8 years, height and age at time of outcome measurements, and potential confounders. MEASUREMENTS AND MAIN RESULTS: Later pubertal age and greater peak velocity were associated with higher FEV1 and FVC at 24 years in both sexes. A 1-year advanced pubertal age was associated with a 263 ml higher FVC (95% confidence interval: 167, 360) for males (n=567), 100 ml (50, 150) for females (n=990). A 1-cm/year increase in peak velocity was associated with 145 ml (56, 234) and 50 ml (2, 99) increase in FVC for males and females respectively. No associations were found with FEV1/FVC. CONCLUSIONS: Later onset and greater peak velocity of height growth in puberty are associated with increased FEV1 and FVC in young adults but there was no evidence of dysanapsis of pubertal lung growth.

10.
Int Urol Nephrol ; 50(7): 1257-1261, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29931662

RESUMO

PURPOSE: The published literature shows controversies with regard to the treatment of choice for longer stricture. Augmented anastomotic urethroplasty (AAU) was described for long bulbar urethral strictures with an extended area of narrowing and fibrosis, the technique combines the advantages of both anastomosis and graft substitution. We aimed to compare the dorsal and ventral strip anastomosis in the AAU. METHODS: A retrospective Review was conducted at the Department of Urology, Sohag University Hospital; we included adult patients with long bulbar urethral strictures (> 2 cm) who underwent dorsal or ventral strip AAU. Patients were followed at 1, 3, 6, and 12 months postoperatively for subjective improvements. The statistical analysis was carried with SPSS software version 24 for windows. RESULTS: At the end of follow-up, stricture recurrence occurred in 5 (12.5%) in ventral strip group compared to 6 (23.1%) in dorsal group, the difference was not statistically significant (p = 0.5). With regard to safety outcomes, there was no statistically significant difference between both groups in any of the postoperative complications, except post-void dribbling which showed higher incidence in dorsal strip group (p < 0.001). CONCLUSIONS: In conclusion, both dorsal strip and ventral strip techniques are feasible for long bulbar urethral strictures with comparable postoperative efficacy outcomes and high success rate.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/transplante , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Idoso , Anastomose Cirúrgica/métodos , Estudos de Coortes , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Estreitamento Uretral/diagnóstico por imagem
11.
Int J Health Geogr ; 17(1): 4, 2018 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-29444675

RESUMO

BACKGROUND: Aedes-borne diseases as dengue, zika, chikungunya and yellow fever are an emerging problem worldwide, being transmitted by Aedes aegypti and Aedes albopictus. Lack of up to date information about the distribution of Aedes species hampers surveillance and control. Global databases have been compiled but these did not capture data in the WHO Eastern Mediterranean Region (EMR), and any models built using these datasets fail to identify highly suitable areas where one or both species may occur. The first objective of this study was therefore to update the existing Ae. aegypti (Linnaeus, 1762) and Ae. albopictus (Skuse, 1895) compendia and the second objective was to generate species distribution models targeted to the EMR. A final objective was to engage the WHO points of contacts within the region to provide feedback and hence validate all model outputs. METHODS: The Ae. aegypti and Ae. albopictus compendia provided by Kraemer et al. (Sci Data 2:150035, 2015; Dryad Digit Repos, 2015) were used as starting points. These datasets were extended with more recent species and disease data. In the next step, these sets were filtered using the Köppen-Geiger classification and the Mahalanobis distance. The occurrence data were supplemented with pseudo-absence data as input to Random Forests. The resulting suitability and maximum risk of establishment maps were combined into hard-classified maps per country for expert validation. RESULTS: The EMR datasets consisted of 1995 presence locations for Ae. aegypti and 2868 presence locations for Ae. albopictus. The resulting suitability maps indicated that there exist areas with high suitability and/or maximum risk of establishment for these disease vectors in contrast with previous model output. Precipitation and host availability, expressed as population density and night-time lights, were the most important variables for Ae. aegypti. Host availability was the most important predictor in case of Ae. albopictus. Internal validation was assessed geographically. External validation showed high agreement between the predicted maps and the experts' extensive knowledge of the terrain. CONCLUSION: Maps of distribution and maximum risk of establishment were created for Ae. aegypti and Ae. albopictus for the WHO EMR. These region-specific maps highlighted data gaps and these gaps will be filled using targeted monitoring and surveillance. This will increase the awareness and preparedness of the different countries for Aedes borne diseases.


Assuntos
Aedes , Mapeamento Geográfico , Mosquitos Vetores , Organização Mundial da Saúde , Animais , Culicidae , Dengue/diagnóstico , Dengue/epidemiologia , Previsões , Humanos , Região do Mediterrâneo/epidemiologia , Especificidade da Espécie , Febre Amarela/diagnóstico , Febre Amarela/epidemiologia
12.
Int. braz. j. urol ; 44(1): 163-171, Jan.-Feb. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-892955

RESUMO

ABSTRACT Purpose To evaluate the surgical outcome and predictors of failure of substitution urethroplasty using either dorsal onlay buccal mucosal (BM) graft or ventral onlay penile skin flap (PS) for anterior urethral stricture ≥ 8cm. Patients and methods Between March 2010 and January 2016, 50 patients with anterior urethral stricture ≥ 8 cm were treated at our hospital. The surgical outcome and success rate were assessed. The predictors of failure were analyzed using multivariate analysis. Failure was considered when subsequent urethrotomy or urethroplasty were needed. Results Dorsal onlay BM graft was carried out in 24 patients, while PS urethroplasty in 26 patients. There was no significant difference between both groups regarding patients demographics, stricture characteristics or follow-up period. One case in the BM group was lost during follow-up. Stricture recurrence was detected in 7 (30.4%) patients out of BM group while in 6 (23.1%) patients out of PS group (p value= 0.5). No significant differences between both groups regarding overall early and late complications were observed. Occurrence of early complications and the stricture length were the only predictors of failure in univariate analysis, while in multivariate analysis the occurrence of early complications was only significant. Conclusion On short-term follow-up, both dorsal onlay BM graft and ventral onlay PS flap urethroplasty have similar success rates. However, BM graft has a potential advantage to reduce operative time and is also technically easier. The surgeon should avoid early local complications as they represent a higher risk for failure.

13.
Int Braz J Urol ; 44(1): 163-171, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29211404

RESUMO

PURPOSE: To evaluate the surgical outcome and predictors of failure of substitution urethroplasty using either dorsal onlay buccal mucosal (BM) graft or ventral onlay penile skin flap (PS) for anterior urethral stricture ≥ 8cm. PATIENTS AND METHODS: Between March 2010 and January 2016, 50 patients with anterior urethral stricture ≥ 8 cm were treated at our hospital. The surgical outcome and success rate were assessed. The predictors of failure were analyzed using multivariate analysis. Failure was considered when subsequent urethrotomy or urethroplasty were needed. RESULTS: Dorsal onlay BM graft was carried out in 24 patients, while PS urethroplasty in 26 patients. There was no significant difference between both groups regarding patients demographics, stricture characteristics or follow-up period. One case in the BM group was lost during follow- up. Stricture recurrence was detected in 7 (30.4%) patients out of BM group while in 6 (23.1%) patients out of PS group (p value= 0.5). No significant differences between both groups regarding overall early and late complications were observed. Occurrence of early complications and the stricture length were the only predictors of failure in univariate analysis, while in multivariate analysis the occurrence of early complications was only significant. CONCLUSION: On short-term follow-up, both dorsal onlay BM graft and ventral onlay PS flap urethroplasty have similar success rates. However, BM graft has a potential advantage to reduce operative time and is also technically easier. The surgeon should avoid early local complications as they represent a higher risk for failure.


Assuntos
Mucosa Bucal/transplante , Pênis , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos , Adulto , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Estreitamento Uretral/patologia
14.
Biochim Biophys Acta Proteins Proteom ; 1866(1): 2-10, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28734978

RESUMO

The Arabidopsis thaliana gene encoding CYP71A16 is part of the gene cluster for the biosynthesis and modification of the triterpenoid marneral. Previous investigations of A. thaliana have revealed that CYP71A16 catalyzes marneral oxidation, while it also can accept marnerol as substrate. The aim of the present study was to investigate functional properties of CYP71A16 in vitro. For this purpose, heterologous expression of a N-terminally modified version of CYP71A16 was established in Escherichia coli, which yielded up to 50mgL-1 recombinant enzyme. The enzyme was purified and activity was reconstituted in vitro with different redox partners. A heterologous bacterial redox partner system consisting of the flavodoxin YkuN from Bacillus subtilis and the flavodoxin reductase Fpr from E. coli clearly outperformed the cytochrome P450 reductase ATR2 from A. thaliana in supporting the CYP71A16-mediated hydroxylation of marnerol. Substrate binding experiments with CYP71A16 revealed a dissociation constant KD of 225µM for marnerol. CYP71A16 catalyzed the hydroxylation of marnerol to 23-hydroxymarnerol with a KM of 142µM and a kcat of 3.9min-1. Furthermore, GC/MS analysis revealed an as of yet unidentified overoxidation product of this in vitro reaction. This article is part of a Special Issue entitled: Cytochrome P450 biodiversity and biotechnology, edited by Erika Plettner, Gianfranco Gilardi, Luet Wong, Vlada Urlacher, Jared Goldstone.


Assuntos
Proteínas de Arabidopsis/metabolismo , Arabidopsis/enzimologia , Bacillus subtilis/enzimologia , Sistema Enzimático do Citocromo P-450/metabolismo , Proteínas de Escherichia coli/metabolismo , Ferredoxina-NADP Redutase/metabolismo , Flavodoxina/metabolismo , Triterpenos/metabolismo , Sequência de Aminoácidos , Arabidopsis/química , Proteínas de Arabidopsis/genética , Bacillus subtilis/química , Fatores de Transcrição Hélice-Alça-Hélice Básicos/genética , Fatores de Transcrição Hélice-Alça-Hélice Básicos/metabolismo , Clonagem Molecular , Sistema Enzimático do Citocromo P-450/genética , Escherichia coli/genética , Escherichia coli/metabolismo , Proteínas de Escherichia coli/genética , Ferredoxina-NADP Redutase/genética , Flavodoxina/genética , Expressão Gênica , Vetores Genéticos/química , Vetores Genéticos/metabolismo , Hidroxilação , Cinética , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Especificidade por Substrato
15.
Adv Data Anal Classif ; 12(4): 827-840, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30931011

RESUMO

Combining multiple classifiers, known as ensemble methods, can give substantial improvement in prediction performance of learning algorithms especially in the presence of non-informative features in the data sets. We propose an ensemble of subset of kNN classifiers, ESkNN, for classification task in two steps. Firstly, we choose classifiers based upon their individual performance using the out-of-sample accuracy. The selected classifiers are then combined sequentially starting from the best model and assessed for collective performance on a validation data set. We use bench mark data sets with their original and some added non-informative features for the evaluation of our method. The results are compared with usual kNN, bagged kNN, random kNN, multiple feature subset method, random forest and support vector machines. Our experimental comparisons on benchmark classification problems and simulated data sets reveal that the proposed ensemble gives better classification performance than the usual kNN and its ensembles, and performs comparable to random forest and support vector machines.

16.
Otol Neurotol ; 38(8): 1165-1173, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28806327

RESUMO

OBJECTIVE: To assess postoperative quality of life (QOL) and other patient-reported outcomes following surgery for vestibular schwannoma. STUDY DESIGN: Cross-sectional retrospective case review using postal questionnaires. SETTING: Tertiary referral center. PATIENTS: Five hundred consecutive patients undergoing surgery for vestibular schwannoma. INTERVENTION(S): Patients undergoing surgery via the translabyrinthine approach (excluding neurofibromatosis type 2) under the senior author, with a minimum of 5 years follow-up, were included. MAIN OUTCOME MEASURE(S): QOL was assessed using the Short Form 36 (SF-36) questionnaire and a disease-specific survey to assess patients' subjective outcomes. RESULTS: The SF-36 scores in this group were significantly lower than the general UK population, though 24% of respondents reported a subjective improvement in overall QOL. Tumors larger than 4 cm were related to a reduced SF-36 total mental component score (p = 0.037). Increased age at time of surgery correlated with a reduced physical component of QOL (correlation coefficient = -0.26) and an improved mental component (correlation coefficient = 0.26). Subjective reports of postoperative symptoms and return to work, driving and social activities were similar to other published studies. 35% of patients reported vivid dreams or nightmares following surgery; the first reported incidence of this phenomenon in a large group of vestibular schwannoma patients. CONCLUSIONS: Generic measures of QOL in patients following translabyrinthine surgery for vestibular schwannoma do not always match subjective reports, reflecting the complexity of QOL assessment and the range of outcomes in this group. Increased time since surgery appears to be associated with an improvement in mental health.


Assuntos
Neurilemoma/cirurgia , Neuroma Acústico/cirurgia , Qualidade de Vida , Acústica , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Neurofibromatose 2 , Estudos Retrospectivos , Comportamento Social , Inquéritos e Questionários , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
17.
World J Urol ; 35(8): 1241-1246, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28013344

RESUMO

OBJECTIVES: To compare the intraoperative surgeon perspective for detection of residual fragments (RFs) after percutaneous nephrolithotomy (PNL) with postoperative NCCT. METHODS: A prospective study of adult patients who underwent PNL between March and September 2014 was conducted. Stone complexity was evaluated using the Guy's stone score (GSS). All patients were evaluated by pre- and postoperative NCCT. After the procedure, the surgeon had been asked whether there were residual stones or not. The sensitivity, specificity and predictive values were tested against postoperative NCCT. Predictors of accurate intraoperative assessment were determined using univariate and multivariate statistical analyses. RESULTS: The study included 306 consecutive patients. The surgeons reported no residual stones in 236 procedures; of whom 170 (72%) were reported stone-free by NCCT. On the other hand, 65 out of 70 procedures (93%) reported with residual stones by the surgeons were true by NCCT. The sensitivity was 50% and the NPV was 72%, while the specificity was 97% and the PPV was 93%. On multivariate analysis, only lower GSS (p < 0.001) was independently associated with true negative surgeon opinion. CONCLUSIONS: Although there was a high surgeon ability to detect post-PNL residual stones, postoperative imaging is mandatory because of the high false negative rates and low NPV. The surgeon opinions can be judged only in stones with lower GSS. The NPV could be enhanced if a consistent definition of clinically significant RFs is introduced.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adulto , Feminino , Humanos , Cuidados Intraoperatórios , Cálculos Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
CNS Neurol Disord Drug Targets ; 16(7): 789-799, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27978795

RESUMO

INTRODUCTION: There is an unmet need to develop better treatments for acute ischemic stroke (AIS). Desmoteplase is a vampire bat saliva-derived analogue of human tissue plasminogen activator. It has higher fibrin selectivity and a longer half-life, compared to alteplase. We performed this metaanalysis to investigate the safety and efficacy of desmoteplase in AIS. METHOD: A computer literature search (PubMed, EMBASE, CENTRAL, Scopus, Web of science, and clinicaltrials.gov) was carried out. Data were extracted from eligible records and analyzed using RevMan software (version 5.3 for windows). Safety and efficacy endpoints were pooled as odds ratios (ORs) for the two groups. RESULT: Five randomized trials (n=821 patients) were pooled in the final analysis. The overall effect size favored desmoteplase over placebo in terms of reperfusion 4 to 24 hours posttreatment (OR 1.49, 95% CI [1.02, 2.19]). However, the pooled effect size did not favor either of the two groups in terms of good clinical outcome at 90 days (OR 1.16, 95% CI [0.86, 1.55]). Neither of the primary safety outcomes differed significantly between the two groups (symptomatic intracranial hemorrhage: OR 1.29, 95% CI [0.53, 3.16] and mortality within 90 days: OR 1.20, 95% CI [0.73, 1.97]). CONCLUSION: Current evidence suggests a favorable reperfusion effect for desmoteplase within 3 to 9 hours after AIS. Further large randomized trials, using a moderate dose between 90 µg/kg and 125 µg/kg, are required to translate this successful reperfusion into better clinical and quality of life outcomes for AIS patients.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Ativadores de Plasminogênio/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Isquemia Encefálica/complicações , Humanos , Ativadores de Plasminogênio/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
19.
Int Urol Nephrol ; 49(1): 49-53, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27785747

RESUMO

PURPOSE: To evaluate the necessity of chronic alkali therapy in non-complicated orthotopic ileal neobladders with normal renal function. MATERIALS AND METHODS: This is a prospective study that included 200 male patients who underwent radical cystectomy and ileal W neobladder for invasive bladder carcinoma between January 1993 and December 2013. The studied patients included 100 consecutive patients who were maintained on regular alkali therapy since surgery and 100 consecutive patients who stopped the use of alkali treatment after initial 3 months postoperative with minimum postoperative observation time of 1 year. All patients had satisfactory function of the reservoirs with normal upper tract. The patients were subjected to blood analysis for creatnine, electrolytes, pH and bicarbonate and urine chemical analysis. The study also included 40 healthy male age-matched volunteers who served as a control group. RESULTS: Both groups were comparable as regard age, BMI, follow-up period and surgical technique. There were no significant differences between both groups as regard serum creatnine, electrolytes blood pH and bicarbonate and the mean values were within normal range; however, the neobladder patients are still toward the acidotic side in comparison to healthy volunteers. Also there were no significant differences between both groups of patients as regard urine pH and excretion of electrolytes, calcium, phosphorus and creatnine. CONCLUSION: Patients with non-complicated ileal neobladders with normal upper tract who were not maintained on alkali prophylaxis for long period have a compensated acid base status. Therefore, the prolonged alkali prophylaxis is not mandatory.


Assuntos
Acidose/prevenção & controle , Carcinoma/cirurgia , Bicarbonato de Sódio/administração & dosagem , Estruturas Criadas Cirurgicamente/efeitos adversos , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos , Acidose/sangue , Acidose/etiologia , Idoso , Cistectomia , Seguimentos , Humanos , Concentração de Íons de Hidrogênio , Íleo/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Bicarbonato de Sódio/sangue , Urinálise
20.
Urology ; 96: 80-84, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27417920

RESUMO

OBJECTIVE: To characterize the standard physical, chemical, and microscopic characteristics of urine in patients with noncomplicated orthotopic ileal neobladders. MATERIALS AND METHODS: This is a prospective study that included 100 male patients who underwent radical cystectomy and ileal neobladder between 1993 and 2013. All included patients were in a good health and having satisfactory function of the reservoirs with normal upper tract with a minimum 1-year postoperative follow-up. We excluded patients with oncological failure, those with diversion-related complications, those who were maintained on clean intermittent catheterization, or those who have symptoms of urinary tract infection. Patients with medical diseases that may affect urine properties (eg, diabetes mellitus) or receiving special medications (eg, diuretics, alkali therapy, or antibiotics) were also excluded. The patients were subjected to urine analysis, blood chemistry, pH, and blood gases; the results were compared to a control group of 40 normal male volunteers. RESULTS: Urine analysis in diverted patients showed higher urine pH than in control group but it is still acidic. Pyuria, proteinuria, hematuria, and positive culture were significantly higher in diverted patients. The chemical analysis showed lower urinary calcium, phosphorus, and creatinine contents in diverted patients than in the control group. Serum creatinine was significantly higher in diverted patients, whereas blood pH and bicarbonate were lower, but these values are within normal. CONCLUSION: Urine from uncomplicated orthotopic ileal reservoirs is acidic. Pyuria, proteinuria, minor degrees of microscopic hematuria, and positive nitrite reaction are normal findings. We also have normal findings for lower urinary calcium, phosphorus, and creatinine contents in patients.


Assuntos
Cistectomia , Íleo/transplante , Complicações Pós-Operatórias/urina , Neoplasias da Bexiga Urinária/cirurgia , Coletores de Urina , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Urinálise/métodos
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