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1.
J Endod ; 48(6): 699-706, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35307515

RESUMO

INTRODUCTION: The aims of this observational study were to determine if endodontists' practices in early 2021 experienced changes in patient characteristics compared with a comparable prepandemic period and to determine whether the changes reported during the initial outbreak of coronavirus disease 2019 (COVID-19) in 2020 were reversed 1 year later. METHODS: Demographic, diagnostic, and procedural data of 2657 patient visits from 2 endodontist private offices from March 16 to May 31 in 2019, 2020, and 2021 were included. Bivariate analyses and multiple logistic regression models were used to examine the impact of ongoing COVID-19 pandemic on patient data. RESULTS: Bivariate analyses showed that patients' self-reported pain levels and the number of visits with irreversible pulpitis in 2021 were higher than 2019 (P < .05). Patients' self-reported pain, percussion pain, and palpation pain levels in 2021 were less than 2020 (P < .05). Multiple logistic regression analyses showed that endodontists' practices in 2021 had an increase in the number of nonsurgical root canal treatments (odds ratio [OR] = 1.482; 95% confidence interval [CI], 1.102-1.992), and apicoectomies (OR = 2.662; 95% CI, 1.416-5.004) compared with 2019. Compared with the initial outbreak in 2020, endodontists' practices in 2021 had visits with older patients (OR = 1.288; 95% CI, 1.045-1.588), less females (OR = 0.781; 95% CI, 0.635-.960), more molars (OR = 1.389; 95% CI, 1.065-1.811), and less pain on percussion (OR = 0.438; 95% CI, 0.339-0.566). CONCLUSIONS: The ongoing COVID-19 pandemic was associated with an increase in the number of nonsurgical root canal treatments. Some of the changes observed during the initial outbreak in 2020, including objective pain parameters, returned to normal levels 1 year later.

2.
BMJ Open ; 12(2): e055137, 2022 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-35228287

RESUMO

OBJECTIVES: To examine the temporal patterns of patient characteristics, treatments used and outcomes associated with COVID-19 in patients who were hospitalised for the disease between January and 15 November 2020. DESIGN: Observational cohort study. SETTING: COVID-19 subset of the Optum deidentified electronic health records, including more than 1.8 million patients from across the USA. PARTICIPANTS: There were 51 510 hospitalised patients who met the COVID-19 definition, with 37 617 in the laboratory positive cohort and 13 893 in the clinical cohort. PRIMARY AND SECONDARY OUTCOME MEASURES: Incident acute clinical outcomes, including in-hospital all-cause mortality. RESULTS: Respectively, 48% and 49% of the laboratory positive and clinical cohorts were women. The 50- 65 age group was the median age group for both cohorts. The use of antivirals and dexamethasone increased over time, fivefold and twofold, respectively, while the use of hydroxychloroquine declined by 98%. Among adult patients in the laboratory positive cohort, absolute age/sex standardised incidence proportion for in-hospital death changed by -0.036 per month (95% CI -0.042 to -0.031) from March to June 2020, but remained fairly flat from June to November, 2020 (0.001 (95% CI -0.001 to 0.003), 17.5% (660 deaths /3986 persons) in March and 10.2% (580/5137) in October); in the clinical cohort, the corresponding changes were -0.024 (95% CI -0.032 to -0.015) and 0.011 (95% CI 0.007 0.014), respectively (14.8% (175/1252) in March, 15.3% (189/1203) in October). Declines in the cumulative incidence of most acute clinical outcomes were observed in the laboratory positive cohort, but not for the clinical cohort. CONCLUSION: The incidence of adverse clinical outcomes remains high among COVID-19 patients with clinical diagnosis only. Patients with COVID-19 entering the hospital are at elevated risk of adverse outcomes.


Assuntos
COVID-19 , Adulto , COVID-19/epidemiologia , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , SARS-CoV-2
3.
J Pediatr Surg ; 2022 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-35193755

RESUMO

BACKGROUND: We sought to elucidate the degree of variation across centers by calculating center-specific standardized mortality ratios (SMRs) for infants with congenital diaphragmatic hernia (CDH) requiring extracorporeal life support (ECLS). METHODS: The Extracorporeal Life Support Organization (ELSO) registry data (2000-2019) were used to estimate SMRs. Center-specific SMRs and their 95% confidence intervals (CIs) were used to identify centers with mortality as significantly worse (SW), significantly better (SB), or not different (ND) relative to the median standardized mortality rate. RESULTS: We identified 4,223 neonates with CDH from 109 centers. SMRs were risk-adjusted for pre-ECLS case-mix (birthweight, sex, race, 5 min Apgar, blood gases, gestational age, hernia side, prenatal diagnosis, pre-ECLS arrest, and comorbidities). Observed (unadjusted) mortality rates across centers varied substantially (range: 14.3%-90.9%; interquartile range [IQR]: 42.9%-62.1%). Thirteen centers (11.9%) had SB SMRs< 1 (SMR 0.52 to 0.84), 7 centers (6.4%) had SW SMRs>1 (SMR 1.25 to 1.43), and 89 centers (81.7%) had SMRs ND relative to the median SMR rate across all centers (i.e., SMR not different from one). Descriptive analyses demonstrated that SB centers had a lower proportion of cases with renal complications, infectious complications and discontinuation of ECLS owing to complications, as well as differences in pre-ECLS treatments and timing of CDH repair, compared to SW and ND centers. CONCLUSION: This study specifically identified ECLS centers with higher and lower survival for patients with CDH, which may serve as a benchmark for institutional quality improvement. Future studies are needed to identify those specific processes at those centers that leads to favorable outcomes with the goal of improving care globally. LEVEL OF EVIDENCE: Level III.

4.
JAMA Netw Open ; 5(1): e2142046, 2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34982158

RESUMO

Importance: The COVID-19 pandemic has had a distinct spatiotemporal pattern in the United States. Patients with cancer are at higher risk of severe complications from COVID-19, but it is not well known whether COVID-19 outcomes in this patient population were associated with geography. Objective: To quantify spatiotemporal variation in COVID-19 outcomes among patients with cancer. Design, Setting, and Participants: This registry-based retrospective cohort study included patients with a historical diagnosis of invasive malignant neoplasm and laboratory-confirmed SARS-CoV-2 infection between March and November 2020. Data were collected from cancer care delivery centers in the United States. Exposures: Patient residence was categorized into 9 US census divisions. Cancer center characteristics included academic or community classification, rural-urban continuum code (RUCC), and social vulnerability index. Main Outcomes and Measures: The primary outcome was 30-day all-cause mortality. The secondary composite outcome consisted of receipt of mechanical ventilation, intensive care unit admission, and all-cause death. Multilevel mixed-effects models estimated associations of center-level and census division-level exposures with outcomes after adjustment for patient-level risk factors and quantified variation in adjusted outcomes across centers, census divisions, and calendar time. Results: Data for 4749 patients (median [IQR] age, 66 [56-76] years; 2439 [51.4%] female individuals, 1079 [22.7%] non-Hispanic Black individuals, and 690 [14.5%] Hispanic individuals) were reported from 83 centers in the Northeast (1564 patients [32.9%]), Midwest (1638 [34.5%]), South (894 [18.8%]), and West (653 [13.8%]). After adjustment for patient characteristics, including month of COVID-19 diagnosis, estimated 30-day mortality rates ranged from 5.2% to 26.6% across centers. Patients from centers located in metropolitan areas with population less than 250 000 (RUCC 3) had lower odds of 30-day mortality compared with patients from centers in metropolitan areas with population at least 1 million (RUCC 1) (adjusted odds ratio [aOR], 0.31; 95% CI, 0.11-0.84). The type of center was not significantly associated with primary or secondary outcomes. There were no statistically significant differences in outcome rates across the 9 census divisions, but adjusted mortality rates significantly improved over time (eg, September to November vs March to May: aOR, 0.32; 95% CI, 0.17-0.58). Conclusions and Relevance: In this registry-based cohort study, significant differences in COVID-19 outcomes across US census divisions were not observed. However, substantial heterogeneity in COVID-19 outcomes across cancer care delivery centers was found. Attention to implementing standardized guidelines for the care of patients with cancer and COVID-19 could improve outcomes for these vulnerable patients.


Assuntos
COVID-19/epidemiologia , Neoplasias/epidemiologia , Pandemias , População Rural , Vulnerabilidade Social , População Urbana , Idoso , Causas de Morte , Censos , Feminino , Instalações de Saúde , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Razão de Chances , Sistema de Registros , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Análise Espacial , Estados Unidos/epidemiologia
5.
J Pediatr Surg ; 57(1): 158-167, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34711396

RESUMO

BACKGROUND: Previous studies have assessed the prevalence and nature of traumatic injuries due to legal intervention in adults. The purpose of this study is to characterize and understand legal intervention trauma in children. METHODS: The National Trauma Data Bank (NTDB) was queried from 2007 to 2015. Patients (0-18 years old) who sustained injuries due to legal intervention were compared to those injured from other causes in the general NTDB population. Descriptive statistics were used to characterize the study population. Multivariate logistic regression models were utilized to predict firearm trauma and mortality. RESULTS: 622 patients sustained injuries involving legal intervention. Compared to general NTDB pediatric population, those who sustained legal intervention injuries were more likely to be older (age 16.5 vs. 10.6, p < 0.01), male (91.96% vs. 34.95%, p < 0.01), test positive for illegal drugs (64.64% vs. 38.35%, p < 0.01) or alcohol (26.36% vs. 17.25%, p < 0.01), and be African-American (44.37% vs. 17.00%, p < 0.01), Latino (22.82% vs. 15.10%, p < 0.01), or Native American (0.96% vs.. 0.94%, p < 0.01). Logistic regression models identified an 11% increased odds (95% CI 1.02-1.21, p = 0.02) of death among African-Americans when compared to other racial groups receiving legal intervention trauma. African-American status was associated with a 12% increased odds (95% CI 1.02-1.22, p = 0.01) of firearm trauma when compared to other racial groups receiving legal intervention trauma. CONCLUSION: Legal intervention-related pediatric trauma disproportionately affects the African-American population. This is particularly pronounced in cases of firearm related injuries. LEVEL OF EVIDENCE: III.


Assuntos
Armas de Fogo , Ferimentos por Arma de Fogo , Adolescente , Adulto , Afro-Americanos , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
6.
J Surg Res ; 270: 245-251, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34710705

RESUMO

BACKGROUND: Congenital diaphragmatic hernia (CDH) is a morbid and potentially fatal condition that challenges providers. The aim of this study is to compare outcomes in neonates with prenatally diagnosed CDH that are inborn (delivered in the institution where definitive care for CDH is provided) versus outborn. METHODS: Prenatally diagnosed CDH cases were identified from the Congenital Diaphragmatic Hernia Study Group (CDHSG) database between 2007 and 2019. Using risk adjustment based on disease severity, we compared inborn versus outborn status using baseline risk and multivariable logistic regression models. The primary endpoint was mortality and the secondary endpoint was need for extracorporeal life support (ECLS). RESULTS: Of 4195 neonates with prenatally diagnosed CDH, 3087 (73.6%) were inborn and 1108 (26.4%) were outborn. There was no significant difference in birth weight, gestational age, or presence of additional congenital anomalies. There was no difference in mortality between inborn and outborn infants (32.6% versus 33.8%, P = 0.44) or ECLS requirement (30.9% versus 31.5%, P = 0.73). Among neonates requiring ECLS, outborn status was a risk factor for mortality (OR 1.51, 95% CI 1.13-2.01, P = 0.006). After adjusting for post-surgical defect size, which is not known prenatally, outborn status was no longer a risk factor for mortality for infants requiring ECLS. CONCLUSIONS: Risk of mortality and need for ECLS for inborn CDH patients is not different to outborn infants. Future studies should be directed to establishing whether highest risk infants are at risk for worse outcomes based on center of birth.


Assuntos
Oxigenação por Membrana Extracorpórea , Hérnias Diafragmáticas Congênitas , Idade Gestacional , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
7.
J Endod ; 48(1): 102-108, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34626613

RESUMO

INTRODUCTION: The first outbreak of coronavirus disease 2019 (COVID-19) in the United States resulted in a nationwide closure of dental offices that created an oral health crisis. The aim of this observational study was to analyze and compare the characteristics of patients who visited 2 private endodontics offices from March 16 to May 31, 2020, compared with the same period in 2019. METHODS: Demographic, diagnostic, and procedural data of 1520 (693 in 2020 and 827 in 2019) patient visits were collected. Bivariate and multiple logistic regression analyses were used to assess the impact of the COVID-19 outbreak on patient-related variables. RESULTS: Bivariate analyses showed that the number of patient visits decreased in April and May 2020 (P < .0001). In 2020, patients' self-reported pain level was higher, they were more frequently diagnosed with pulp necrosis and acute apical abscess, and they received more incisions for drainage (P < .05). Multiple logistic regression analyses showed that the COVID-19 outbreak was associated with less visits for older patients (>49.5 years) (odds ratio [OR] = 0.720; 95% confidence interval [CI], 0.573-0.906), more patients with kidney diseases (OR = 2.690; 95% CI, 1.143-6.331), higher levels of pain on percussion (OR = 2.277; 95% CI, 1.718-3.016), less cases with previously initiated treatment (OR = 0.242; 95% CI, 0.080-0.731), less periapical diagnoses of asymptomatic apical periodontitis (OR = 0.510; 95% CI, 0.306-0.849), and a higher number of nonsurgical root canal treatments (OR = 2.073; 95% CI, 1.397-3.074) and apicoectomies (OR = 2.799; 95% CI, 1.367-5.729). CONCLUSIONS: These findings show that the public health burden of endodontic infections was more intense during the initial outbreak of COVID-19.


Assuntos
COVID-19 , Endodontia , Periodontite Periapical , Surtos de Doenças , Humanos , Periodontite Periapical/epidemiologia , SARS-CoV-2
8.
J Pediatr Surg ; 57(4): 732-738, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34872731

RESUMO

BACKGROUND: Blunt cerebrovascular injury (BCVI) is a rare finding in trauma patients. The previously validated BCVI (Denver and Memphis) prediction model in adult patients was shown to be inadequate as a screening option in injured children. We sought to improve the detection of BCVI by developing a prediction model specific to the pediatric population. METHODS: The National Trauma Databank (NTDB) was queried from 2007 to 2015. Test and training datasets of the total number of patients (885,100) with complete ICD data were used to build a random forest model predicting BCVI. All ICD features not used to define BCVI (2268) were included within the random forest model, a machine learning method. A random forest model of 1000 decision trees trying 7 variables at each node was applied to training data (50% of the dataset, 442,600 patients) and validated with test data in the remaining 50% of the dataset. In addition, Denver and Memphis model variables were re-validated and compared to our new model. RESULTS: A total of 885,100 pediatric patients were identified in the NTDB to have experienced blunt pediatric trauma, with 1,998 (0.2%) having a diagnosis of BCVI. Skull fractures (OR 1.004, 95% CI 1.003-1.004), extremity fractures (OR 1.001, 95% 1.0006-1.002), and vertebral injuries (OR 1.004, 95% CI 1.003-1.004) were associated with increased risk for BCVI. The BCVI prediction model identified 94.4% of BCVI patients and 76.1% of non-BCVI patients within the NTDB. This study identified ICD9/ICD10 codes with strong association to BCVI. The Denver and Memphis criteria were re-applied to NTDB data to compare validity and only correctly identified 13.4% of total BCVI patients and 99.1% of non BCVI patients. CONCLUSION: The prediction model developed in this study is able to better identify pediatric patients who should be screened with further imaging to identify BCVI. LEVEL OF EVIDENCE: Retrospective diagnostic study-level III evidence.


Assuntos
Traumatismo Cerebrovascular , Fraturas Cranianas , Ferimentos não Penetrantes , Adulto , Traumatismo Cerebrovascular/diagnóstico , Traumatismo Cerebrovascular/epidemiologia , Criança , Humanos , Aprendizado de Máquina , Estudos Retrospectivos , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/epidemiologia
9.
Am Surg ; 87(11): 1752-1759, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34758653

RESUMO

BACKGROUND: Well-differentiated liposarcoma (WDLPS) is a low-grade soft tissue sarcoma with a propensity for local recurrence. The necessity of obtaining microscopically free surgical margins (R0) to minimize local recurrence is not clear. This study evaluates recurrence-free survival (RFS) of extremity WDLPS in relation to resection margin status. METHODS: A retrospective review of adult patients with primary extremity WDLPS at seven US institutions from 2000 to 2016 was performed. Patients with recurrent tumors or incomplete resection (R2) were excluded. Clinicopathologic factors were analyzed to assess impact on local RFS. RESULTS: 97 patients with primary extremity WDLPS were identified. The majority of patients had deep, lower extremity tumors. Mean tumor size was 18.2±8.9cm. Patients were treated with either radical (76.3%) or excisional (23.7%) resections; 64% had R0 and 36% had microscopically positive (R1) resection margins. Ten patients received radiation therapy with no difference in receipt of radiation between R0 vs R1 groups. Thirteen patients (13%) developed a local recurrence with no difference in RFS between R0 vs R1 resection. Five-year RFS was 59.5% for R0 vs 85.2% for R1. Only one patient died of disease after developing dedifferentiation and distant metastasis despite originally having an R0 resection. DISCUSSION: In this large multi-institutional study of surgical resection of extremity WDLPS, microscopically positive margins were not associated with an increased risk of recurrence. Positive microscopic margin resection for extremity WDLPS may yield similar rates of local control while avoiding a radical approach to obtain microscopically negative margins.


Assuntos
Braço , Perna (Membro) , Lipossarcoma/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Neoplasias de Tecidos Moles/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Braço/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Perna (Membro)/cirurgia , Lipossarcoma/mortalidade , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Estudos Retrospectivos , Fatores de Risco , Neoplasias de Tecidos Moles/mortalidade
10.
J Drugs Dermatol ; 20(8): 901-904, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397194

RESUMO

Anti-epidermal growth factor receptor (EGFR) antibodies and anti-programmed cell death 1 protein (PD-1) antibodies have been used separately to treat metastatic cutaneous squamous cell carcinoma (cSCC). While two anti-EGFR antibodies have similar clinical activity, cetuximab is administered weekly, whereas panitumumab is administered every two weeks. This report details findings using panitumumab in combination with anti-PD-1 antibody in patients with relapsed refractory cSCC. Three consecutive patients with poor performance status and rapidly progressive recurrent cutaneous squamous cell carcinoma (cSCC) of the face or scalp signed informed consent to receive an anti-PD-1 antibody with the option to add panitumumab were there inadequate response. After 2, 5, and 7 cycles of anti-PD-1 antibody treatment, respectively, panitumumab was added and the combination was continued for 27, 7, and 5 cycles, respectively. Fatigue, rash, and hypomagnesemia were reported, consistent with expectations for either agent alone. All three patients achieved durable complete response. The favorable clinical outcomes support further evaluation of the combination of anti-PD1 and anti-EGFR antibodies to control refractory cSCC of the face or scalp. J Drugs Dermatol. 2021;20(8):901-904. doi:10.36849/JDD.6175.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Panitumumabe/uso terapêutico , Neoplasias Cutâneas , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Humanos , Recidiva Local de Neoplasia , Neoplasias Cutâneas/tratamento farmacológico , Carcinoma de Células Escamosas de Cabeça e Pescoço/tratamento farmacológico
11.
BMJ Open ; 11(8): e051588, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362806

RESUMO

OBJECTIVE: To examine age, gender, and temporal differences in baseline characteristics and clinical outcomes of adult patients hospitalised with COVID-19. DESIGN: A cohort study using deidentified electronic medical records from a Global Research Network. SETTING/PARTICIPANTS: 67 456 adult patients hospitalised with COVID-19 from the USA; 7306 from Europe, Latin America and Asia-Pacific between February 2020 and January 2021. RESULTS: In the US cohort, compared with patients 18-34 years old, patients ≥65 had a greater risk of intensive care unit (ICU) admission (adjusted HR (aHR) 1.73, 95% CI 1.58 to 1.90), acute respiratory distress syndrome(ARDS)/respiratory failure (aHR 1.86, 95% CI 1.76 to 1.96), invasive mechanical ventilation (IMV, aHR 1.93, 95% CI, 1.73 to 2.15), and all-cause mortality (aHR 5.6, 95% CI 4.36 to 7.18). Men appeared to be at a greater risk for ICU admission (aHR 1.34, 95% CI 1.29 to 1.39), ARDS/respiratory failure (aHR 1.24, 95% CI1.21 to 1.27), IMV (aHR 1.38, 95% CI 1.32 to 1.45), and all-cause mortality (aHR 1.16, 95% CI 1.08 to 1.24) compared with women. Moreover, we observed a greater risk of adverse outcomes during the early pandemic (ie, February-April 2020) compared with later periods. In the ex-US cohort, the age and gender trends were similar; for the temporal trend, the highest proportion of patients with all-cause mortality were also in February-April 2020; however, the highest percentages of patients with IMV and ARDS/respiratory failure were in August-October 2020 followed by February-April 2020. CONCLUSIONS: This study provided valuable information on the temporal trends of characteristics and outcomes of hospitalised adult COVID-19 patients in both USA and ex-USA. It also described the population at a potentially greater risk for worse clinical outcomes by identifying the age and gender differences. Together, the information could inform the prevention and treatment strategies of COVID-19. Furthermore, it can be used to raise public awareness of COVID-19's impact on vulnerable populations.


Assuntos
COVID-19 , Adolescente , Adulto , Estudos de Coortes , Feminino , Saúde Global , Hospitalização , Humanos , Unidades de Terapia Intensiva , Masculino , Pandemias , Respiração Artificial , SARS-CoV-2 , Adulto Jovem
12.
JCO Clin Cancer Inform ; 5: 904-911, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34464160

RESUMO

PURPOSE: Severe and febrile neutropenia present serious hazards to patients with cancer undergoing chemotherapy. We seek to develop a machine learning-based neutropenia prediction model that can be used to assess risk at the initiation of a chemotherapy cycle. MATERIALS AND METHODS: We leverage rich electronic medical records (EMRs) data from a large health care system and apply machine learning methods to predict severe and febrile neutropenic events. We outline the data curation process and challenges posed by EMRs data. We explore a range of algorithms with an emphasis on model interpretability and ease of use in a clinical setting. RESULTS: Our final proposed model demonstrates an out-of-sample area under the receiver operating characteristic curve of 0.865 (95% CI, 0.830 to 0.891) in the prediction of neutropenic events on the basis of only 20 clinical features. The model validates known risk factors and offers insight into potential novel clinical indicators and treatment characteristics that elevate risk. It relies on factors that are directly extractable from EMRs, provided a tool can be easily integrated into existing workflows. A cost-based analysis provides insight into optimal risk thresholds and offers a framework for tailoring algorithms to individual hospital needs. CONCLUSION: A better understanding of neutropenic risk on an individual level enables a more informed approach to patient monitoring and treatment decisions.


Assuntos
Aprendizado de Máquina , Neutropenia , Algoritmos , Registros Eletrônicos de Saúde , Humanos , Neutropenia/induzido quimicamente , Neutropenia/diagnóstico , Neutropenia/epidemiologia , Fatores de Risco
13.
JAMA Oncol ; 2021 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-34137799

RESUMO

Importance: COVID-19 is a life-threatening illness for many patients. Prior studies have established hematologic cancers as a risk factor associated with particularly poor outcomes from COVID-19. To our knowledge, no studies have established a beneficial role for anti-COVID-19 interventions in this at-risk population. Convalescent plasma therapy may benefit immunocompromised individuals with COVID-19, including those with hematologic cancers. Objective: To evaluate the association of convalescent plasma treatment with 30-day mortality in hospitalized adults with hematologic cancers and COVID-19 from a multi-institutional cohort. Design, Setting, and Participants: This retrospective cohort study using data from the COVID-19 and Cancer Consortium registry with propensity score matching evaluated patients with hematologic cancers who were hospitalized for COVID-19. Data were collected between March 17, 2020, and January 21, 2021. Exposures: Convalescent plasma treatment at any time during hospitalization. Main Outcomes and Measures: The main outcome was 30-day all-cause mortality. Cox proportional hazards regression analysis with adjustment for potential confounders was performed. Hazard ratios (HRs) are reported with 95% CIs. Secondary subgroup analyses were conducted on patients with severe COVID-19 who required mechanical ventilatory support and/or intensive care unit admission. Results: A total of 966 individuals (mean [SD] age, 65 [15] years; 539 [55.8%] male) were evaluated in this study; 143 convalescent plasma recipients were compared with 823 untreated control patients. After adjustment for potential confounding factors, convalescent plasma treatment was associated with improved 30-day mortality (HR, 0.60; 95% CI, 0.37-0.97). This association remained significant after propensity score matching (HR, 0.52; 95% CI, 0.29-0.92). Among the 338 patients admitted to the intensive care unit, mortality was significantly lower in convalescent plasma recipients compared with nonrecipients (HR for propensity score-matched comparison, 0.40; 95% CI, 0.20-0.80). Among the 227 patients who required mechanical ventilatory support, mortality was significantly lower in convalescent plasma recipients compared with nonrecipients (HR for propensity score-matched comparison, 0.32; 95% CI, 0.14-0.72). Conclusions and Relevance: The findings of this cohort study suggest a potential survival benefit in the administration of convalescent plasma to patients with hematologic cancers and COVID-19.

14.
J Surg Res ; 267: 48-55, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34130238

RESUMO

INTRODUCTION: Unintentional falls are a leading cause of pediatric traumatic injury. This study evaluates clinical outcomes of fall-related injuries in children under the age of 10. METHODS: The National Trauma Database was queried for children who experienced an unintentional fall. Patients were stratified by age in two groups: 1-5 and 6-10 years old. The primary outcome was post discharge extension of care, defined as transfer to skilled nursing facility or rehabilitation center after discharge from the hospital. Descriptive statistics and a multivariable logistic regression analysis were used to compare the two groups. RESULTS: From 2009 to 2016, a total of 8,277 pediatric patients experienced an unintentional fall, with 93.6% of patients being discharged home. Falls were more common in younger children, with greater odds of post discharge extension of care. Predictors of increased associated risk of extended medical care included intracranial hemorrhage (OR 1.05, 95% CI 1.03-1.06) and thoracic injuries (OR 1.03, 95% CI 1.00-1.1.05) (P< 0.05). Mortality in pediatric patients suffering unintentional falls was a rare event occurring in 0.7% of cases in children 1-5 years old and 0.4% of children 6-10 years old. CONCLUSION: The majority of children experiencing an unintentional fall are discharged home, with mortality being very rare. However, younger age is prone to more severe and serious injury patterns. Intracranial hemorrhage and thoracic injury were a predictor of need for extended medical care.


Assuntos
Acidentes por Quedas , Hemorragias Intracranianas , Traumatismos Torácicos , Ferimentos e Lesões , Assistência ao Convalescente , Criança , Pré-Escolar , Humanos , Lactente , Morbidade , Alta do Paciente , Ferimentos e Lesões/epidemiologia
15.
Ann Transl Med ; 9(8): 628, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33987326

RESUMO

BACKGROUND: Acquired radioresistant cells exhibit many characteristic changes which may influence cancer progression and further treatment options. The purpose of this study is to investigate the changes of radioresistant human epidermal growth factor receptor 2 (HER2)-positive breast cancer cells on both phenotypic and molecular levels. METHODS: We established an acquired radioresistant cell line from its parental NF639 cell line (HER2-positive) by fractionated radiation and assessed changes in cellular morphology, proliferation, migration, anti-apoptosis activity, basal reactive oxygen species (ROS) level and energy metabolism. RNA-sequencing (RNA-seq) was also used to reveal the potential regulating genes and molecular mechanisms associated with the acquired changed phenotypes. Real-time PCR was used to validate the results of RNA-seq. RESULTS: The NF639R cells exhibited increased radioresistance and enhanced activity of proliferation, migration and anti-apoptosis, but decreased basal ROS. Two main energy metabolism pathways, mitochondrial respiration and glycolytic, were also upregulated. Furthermore, 490 differentially expressed genes were identified by RNA-seq. Enrichment analysis based on Gene Ontology and Kyoto Encyclopedia of Genes and Genomes showed many differently expressed genes were significantly enriched in cell morphology, proliferation, migration, anti-apoptosis, antioxidation, tumor stem cells and energy metabolism and the signaling cascades such as the transforming growth factor-ß, Wnt, Hedgehog, vascular endothelial growth factor, retinoic acid-inducible gene I (RIG-I)-like receptor, Toll-like receptor and nucleotide oligomerization domain (NOD)-like receptor were significantly altered in NF639R cells. CONCLUSIONS: In clinical radiotherapy, repeat radiotherapy for short-term recurrence of breast cancer may result in enhanced radioresistance and promote malignant progression. Our research provided hints to understand the tumor resistance to radiotherapy de novo and recurrence with a worse prognosis following radiotherapy.

17.
Sci Rep ; 11(1): 10369, 2021 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-33990645

RESUMO

Multiportal video-assisted thoracic surgery (VATS) for major lung resection causes less immunochemokine production compared to thoracotomy. Whether uniportal VATS is similarly associated with lower early postoperative circulating levels of immunochemokines compared to multiportal VATS have not been studied. Selected patients who received uniportal or multiportal VATS major lung resection were recruited. Blood samples were collected preoperatively and on postoperative days 1 and 3 for enzyme linked immunosorbent assay of serum levels of Tissue Inhibitor of Metalloproteinase (TIMP)-1, Insulin Growth Factor Binding Protein (IGFBP)-3, and Matrix Metalloproteinase (MMP)-9. A linear mixed-effects models were used to analyze the effects of uniportal VATS on the postoperative circulating chemokine levels. From March 2014 to April 2017, 68 consecutive patients consented for the prospective study and received major lung resection by either uniportal VATS (N = 29) or multiportal VATS (N = 39) were identified. Uniportal VATS major lung resection was associated with lower post-operative levels of TIMP-1 and MMP-9 compared to multiportal VATS after controlling for the effects of the corresponding baseline level and the time of follow-up measurement. No difference was observed for the level of IGFBP-3. Less immunochemokine disturbances was observed after uniportal VATS major lung resection compared to multiportal VATS.


Assuntos
Quimiocinas/sangue , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Cirurgia Torácica Vídeoassistida/efeitos adversos , Idoso , Biomarcadores/sangue , Biomarcadores/metabolismo , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Quimiocinas/metabolismo , Feminino , Humanos , Inflamação/sangue , Inflamação/diagnóstico , Inflamação/imunologia , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/metabolismo , Neoplasias Pulmonares/cirurgia , Masculino , Metaloproteinase 9 da Matriz/sangue , Metaloproteinase 9 da Matriz/metabolismo , Pessoa de Meia-Idade , Pneumonectomia/métodos , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/imunologia , Estudos Prospectivos , Índice de Gravidade de Doença , Cirurgia Torácica Vídeoassistida/métodos , Inibidor Tecidual de Metaloproteinase-1/sangue , Inibidor Tecidual de Metaloproteinase-1/metabolismo
18.
Sensors (Basel) ; 21(8)2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33918707

RESUMO

Facile and efficient early detection of cancer is a major challenge in healthcare. Herein we developed a novel sensor made from a polycarbonate (PC) membrane with nanopores, followed by sequence-specific Oligo RNA modification for early gastric carcinoma diagnosis. In this design, the gastric cancer antigen CA72-4 is specifically conjugated to the Oligo RNA, thereby inhibiting the electrical current through the PC membrane in a concentration-dependent manner. The device can determine the concentration of cancer antigen CA72-4 in the range from 4 to 14 U/mL, possessing a sensitivity of 7.029 µAU-1mLcm-2 with a linear regression (R2) of 0.965 and a lower detection limit of 4 U/mL. This device has integrated advantages including high specificity and sensitivity and being simple, portable, and cost effective, which collectively enables a giant leap for cancer screening technologies towards clinical use. This is the first report to use RNA aptamers to detect CA72-4 for gastric carcinoma diagnosis.


Assuntos
Carcinoma , Neoplasias Gástricas , Antígenos Glicosídicos Associados a Tumores , Biomarcadores Tumorais , Antígeno Carcinoembrionário , Análise Custo-Benefício , Detecção Precoce de Câncer , Humanos , Neoplasias Gástricas/diagnóstico
19.
J Surg Res ; 263: 14-23, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33621745

RESUMO

BACKGROUND: Neonates receiving extracorporeal life support (ECLS) for congenital diaphragmatic hernia (CDH) require prolonged support compared with neonates with other forms of respiratory failure. Hemolysis is a complication that can be seen during ECLS and can lead to renal failure and potentially to worse outcomes. The purpose of this study was to identify risk factors for the development of hemolysis in CDH patients treated with ECLS. METHODS: The Extracorporeal Life Support Organization database was used to identify infants with CDH (2000-2015). The primary outcome was hemolysis (plasma-free hemoglobin >50 mg/dL). Potentially associated variables were identified in the data set. Descriptive statistics and a series of nested multivariable logistic regression models were used to identify associations between hemolysis and demographic, pre-ECLS, and on-ECLS factors. RESULTS: There were 4576 infants with a mortality of 52.5%. The overall mean rate of hemolysis was 10.5% during the study period. In earlier years (2000-2005), the hemolysis rates were 6.3% and 52.7% for roller versus centrifugal pumps, whereas in later years (2010-2015), they were 2.9% and 26.5%, respectively. The fully adjusted model demonstrated that the use of centrifugal pumps was a strong predictor of hemolysis (odds ratio: 6.67, 95% confidence interval: 5.14-8.67). In addition, other risk factors for hemolysis included low 5-min Apgar score, on-ECLS complications (renal, metabolic, and cardiovascular), and duration of ECLS. CONCLUSIONS: In our cohort of CDH patients receiving ECLS over 15 y, the use of centrifugal pumps increased over time, along with the rate of hemolysis. Patient- and treatment-level risk factors were identified contributing to the development of hemolysis.


Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Hemólise , Hérnias Diafragmáticas Congênitas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Índice de Apgar , Estudos de Coortes , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Hemoglobinas/análise , Hérnias Diafragmáticas Congênitas/mortalidade , Mortalidade Hospitalar , Humanos , Recém-Nascido , Masculino , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Fatores de Tempo
20.
ASAIO J ; 67(2): 113-120, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33512912

RESUMO

The management of infants with congenital diaphragmatic hernia (CDH) receiving extracorporeal life support (ECLS) is complex. Significant variability in both practice and prevalence of ECLS use exists among centers, given the lack of evidence to guide management decisions. The purpose of this report is to review existing evidence and develop management recommendations for CDH patients treated with ECLS. This article was developed by the Extracorporeal Life Support Organization CDH interest group in cooperation with members of the CDH Study Group and the Children's Hospitals Neonatal Consortium.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Hérnias Diafragmáticas Congênitas/terapia , Consenso , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
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