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1.
J Infect Chemother ; 27(1): 76-82, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33051144

RESUMO

INTRODUCTION: The severity of coronavirus disease (COVID-19) in Japanese patients is unreported. We retrospectively examined significant factors associated with disease severity in symptomatic COVID-19 patients (COVID-Pts) admitted to our institution between February 20 and April 30, 2020. METHODS: All patients were diagnosed based on the genetic detection of severe acute respiratory syndrome coronavirus 2. Information on the initial symptoms, laboratory data, and computed tomography (CT) images at hospitalization were collected from the patients' records. COVID-Pts were categorized as those with critical or severe illness (Pts-CSI) or those with moderate or mild illness (Pt-MMI). All statistical analyses were performed using R software. RESULTS: Data from 61 patients (16 Pt-CSI, 45 Pt-MMI), including 58 Japanese and three East Asians, were analyzed. Pt-CSI were significantly older and had hypertension or diabetes than Pt-MMI (P < 0.001, 0.014 and < 0.001, respectively). Serum albumin levels were significantly lower in Pt-CSI than in Pt-MMI (P < 0.001), whereas the neutrophil-to-lymphocyte ratio and C-reactive protein level were significantly higher in Pt-CSI than in Pt-MMI (P < 0.001 and P < 0.001, respectively). In the CT images of 60 patients, bilateral lung lesions were more frequently observed in Pt-CSI than in Pt-MMI (P = 0.013). Among the 16 Pt-CSI, 15 received antiviral therapy, 12 received tocilizumab, five underwent methylprednisolone treatment, six received mechanical ventilation, and one died. CONCLUSIONS: The illness severity of Japanese COVID-Pts was associated with older age, hypertension and/or diabetes, low serum albumin, high neutrophil-to-lymphocyte ratio, and C-reactive protein.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Índice de Gravidade de Doença , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus , Proteína C-Reativa/análise , Infecções por Coronavirus/terapia , Feminino , Humanos , Japão/epidemiologia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Neutrófilos , Pandemias , Pneumonia Viral/terapia , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
Medicine (Baltimore) ; 99(45): e22977, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157940

RESUMO

Dysphagia can occur among patients receiving medical care despite having no history of neurologic disease. The current study aimed to investigate factors contributing to airway invasion among non-neurologically ill patients with dysphagia.This retrospective study included 52 non-neurologically ill patients who complained of swallowing difficulty and consulted the Department of Rehabilitation Medicine for videofluoroscopic swallowing studies between January 2018 and June 2019. Patients were then divided into 2 groups according to the presence of airway invasion (penetration or aspiration) based on videofluoroscopic swallowing study findings, with group 1 (n = 26) consisting of patients with airway invasion and group 2 (n = 26) consisting of those without airway invasion. Demographic information, functional ambulation ability within the past 3 months, presence of community acquired pneumonia (CAP), nutritional status, degree of dehydration, history of intensive care unit stay, history of endotracheal intubation, and videofluoroscopic dysphagia scale were reviewed.Patients with airway invasion exhibited decreased functional ambulation ability, greater incidence of CAP, and lower serum albumin concentration than patients without airway invasion (P < .05). Airway invasion among non-neurologically ill patients was significantly associated with functional ambulation ability [odds ratio (OR), 3.57; 95% confidence interval (CI), 1.14-11.19; P = .03], serum albumin concentration under 3.5 g/dL (OR, 4.90; 95% CI, 1.39-17.32; P = .01), and presence of CAP (OR, 5.06; 95% CI, 1.56-16.44; P = .01). Groups 1 and 2 had a videofluoroscopic dysphagia scale score of 37.18 and 16.17, respectively (P < .05). Moreover, bolus formation, tongue-to-palate contact, premature bolus loss, vallecular residue, coating of pharyngeal wall, and aspiration score differed significantly between both groups (P < .05).Airway invasion among non-neurologically ill patients was related to decreased functional ambulation ability, lower serum albumin concentration, and presence of CAP. The results presented herein can help guide clinical management aimed at preventing airway invasion among non-neurologically ill patients.


Assuntos
Transtornos de Deglutição/fisiopatologia , Aspiração Respiratória/fisiopatologia , Idoso , Infecções Comunitárias Adquiridas/fisiopatologia , Feminino , Fluoroscopia , Humanos , Masculino , Limitação da Mobilidade , Pneumonia/fisiopatologia , Estudos Retrospectivos , Albumina Sérica/análise , Gravação em Vídeo
3.
Medicine (Baltimore) ; 99(42): e22774, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080747

RESUMO

Elevated serum lactate dehydrogenase (LDH) was commonly reported in COVID-19 patients. However, the relationship between LDH and the incidence of severe cases has not been characterized in those patients.We retrospectively analyzed the characteristics of patients from a designated isolation medical center for COVID-19 patients diagnosed from February 6 to March 1. Variables accessed within 48 hours on admission were compared between patients with and without the severe disease. Logistic model analyses were performed to examine the prognostic value of LDH for predicting severe disease.52 (28.6%) patients later developed severe disease. Comparing to non-severe cases, severe cases had a higher level of serum LDH (321.85 ±â€Š186.24 vs 647.35 ±â€Š424.26, P < .001), neutrophils (5.42 ±â€Š3.26 vs 9.19 ±â€Š6.33, P < .001), and C-reactive protein (38.63 ±â€Š43.14 vs 83.20 ±â€Š51.01, P < .001). The patients with severe disease tended to be male (44.6% vs 80.8%, P < .001), lower level of serum albumin (31.41 ±â€Š6.20 vs 27.18 ±â€Š5.74, P < .001), and SpO2 (96.30 ±â€Š2.75 vs 92.37 ±â€Š8.29, P < .001). In the multivariate analysis model, LDH and sex remained independent risk factors for severe disease. The serum LDH predicted severe cases with an area under the curve (AUC) of 0.7999. A combination of serum LDH and sex predicted severe cases with an AUC of 0.849. A combination of serum LDH accessed on admission and sex had a better predictive performance than the serum LDH (P = .0238).Serum LDH on admission combined with sex is independently associated with severe disease in COVID-19.


Assuntos
Infecções por Coronavirus/fisiopatologia , L-Lactato Desidrogenase/sangue , Pneumonia Viral/fisiopatologia , Adulto , Idoso , Betacoronavirus , Proteína C-Reativa/análise , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Oxigênio/sangue , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise , Índice de Gravidade de Doença , Fatores Sexuais , Fumar/epidemiologia
4.
Medicine (Baltimore) ; 99(40): e22337, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019410

RESUMO

At present, glycated hemoglobin (HbA1c) and glycated albumin (GA) are used to evaluate glycemic control in diabetic patients, but they cannot reflect insulin deficiency and/or insulin resistance.We investigated the feasibility of using estimated average glucose to fasting plasma glucose ratio (eAG/fPG ratio) to estimate insulin resistance in young adult diabetes. A total of 387 patients with type 2 diabetes were included and were stratified into 2 groups based on median values of the glycemic index ratio: the GA/A1c ratio <2.09 (n = 91) and ≥2.09 (n = 296); the eAG/fPG ratio <1.69 (n = 155) and ≥1.69 (n = 232). HbA1c, GA, fructosamine, insulin, and C-peptide levels were measured. The ratio of GA to HbA1c was calculated, and the homeostasis model assessment of ß-cell function and insulin resistance were determined. The homeostasis model assessment of insulin resistance level was significantly associated with the eAG/fPG ratio, but not with the ratio of GA to HbA1c, GA, HbA1c, and fructosamine levels. The ratio of estimated average glucose to fasting plasma glucose level correlates with insulin resistance in young adult diabetes.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Jejum/metabolismo , Resistência à Insulina/fisiologia , Adolescente , Adulto , Peptídeo C/sangue , Criança , Feminino , Frutosamina/sangue , Hemoglobina A Glicada/análise , Índice Glicêmico , Humanos , Insulina/sangue , Masculino , Albumina Sérica/análise , Adulto Jovem
5.
PLoS One ; 15(8): e0237543, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776978

RESUMO

Sickle cell disease (SCD) impacts liver and kidney function as well as skin integrity. These complications, as well as the hyperinflammatory state of SCD, could affect serum albumin. Serum albumin has key roles in antioxidant, anti-inflammatory and antithrombotic pathways and maintains vascular integrity. In SCD, these pathways modulate disease severity and clinical outcomes. We used three independent SCD adult cohorts to assess clinical predictors of serum albumin as well its association with mortality. In 2553 SCD adult participants, the frequency of low (<35 g/L) serum albumin was 5%. Older age and lower hemoglobin (P <0.001) were associated with lower serum albumin in all three cohorts. In age and hemoglobin adjusted analysis, higher liver enzymes (P <0.05) were associated with lower serum albumin. In two of the three cohorts, lower kidney function as measured by Glomerular Filtration Rate (P<0.001) was associated with lower serum albumin. Lower serum albumin predicted higher risk of tricuspid regurgitation velocity ≥ 2.5 m/s (OR = 1.1 per g/L, P ≤0.01). In all three cohorts, patients with low serum albumin had higher mortality (adjusted HR ≥2.9, P ≤0.003). This study confirms the role of serum albumin as a biomarker of disease severity and prognosis in patients with SCD. Albumin as a biomarker and possible mediator of SCD severity should be studied further.


Assuntos
Anemia Falciforme/mortalidade , Biomarcadores/sangue , Hemoglobinas/análise , Albumina Sérica/análise , Adulto , Anemia Falciforme/sangue , Anemia Falciforme/patologia , Estudos de Coortes , Feminino , Humanos , Masculino , Prognóstico , Taxa de Sobrevida
6.
PLoS One ; 15(8): e0237793, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822383

RESUMO

PURPOSE: It has been demonstrated that, for various types of cancer, the pretreatment albumin/alkaline phosphatase ratio (AAPR) was a prognostic factor. Therefore, in order to determine AAPR's prognostic effect on cancer, the meta-analysis was hereby performed. PATIENTS AND METHODS: The relevant studies conducted before November 10, 2019, were comprehensively searched in Web of Science, PubMed, and Embase. HRs(hazard ratios) with related 95%CIs(confidence intervals) were adopted to estimate AAPR's prognostic impact on overall survival (OS) & disease-free survival (DFS). RESULTS: Our meta-analysis involved thirteen cohort studies, which included 5,204 cases of 8 types. The results of this meta-analysis indicated that higher AAPR was corrected with better OS (pooled HR = 0.52; 95%CI = 0.47-0.58; P<0.001) and DFS (pooled HR = 0.55; 95%CI = 0.47-0.66; P<0.001). Subgroup analysis on OS was based on the cancer system, treatment methods, and cutoff value. Moreover, higher AAPR was statistically in associated with lighter infiltration (pooled OR = 0.79; 95%CI = 0.73-0.85; P<0.001), no lymph nodes metastasis (pooled OR = 0.89; 95%CI = 0.83-0.95; P = 0.001), and no distant metastasis (pooled OR = 0.92; 95%CI = 0.86-0.99; P = 0.028). CONCLUSION: Higher AAPR was related to better prognosis of cancer, and in cancer therapy, AAPR could be taken as a promising marker of prognosis. It might help physicians to select the most appropriate treatments by evaluating the current status of patients with cancer. Future multicenter prospective clinical trials were required to verify its applications.


Assuntos
Fosfatase Alcalina/sangue , Neoplasias/diagnóstico , Albumina Sérica/análise , Biomarcadores Tumorais/sangue , Intervalo Livre de Doença , Humanos , Neoplasias/sangue , Neoplasias/terapia , Prognóstico
7.
Nat Commun ; 11(1): 3820, 2020 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-32732919

RESUMO

Supercentenarians (those aged ≥110 years) are approaching the current human longevity limit by preventing or surviving major illness. Identifying specific biomarkers conducive to exceptional survival might provide insights into counter-regulatory mechanisms against aging-related disease. Here, we report associations between cardiovascular disease-related biomarkers and survival to the highest ages using a unique dataset of 1,427 oldest individuals from three longitudinal cohort studies, including 36 supercentenarians, 572 semi-supercentenarians (105-109 years), 288 centenarians (100-104 years), and 531 very old people (85-99 years). During follow-up, 1,000 participants (70.1%) died. Overall, N-terminal pro-B-type natriuretic peptide (NT-proBNP), interleukin-6, cystatin C and cholinesterase are associated with all-cause mortality independent of traditional cardiovascular risk factors and plasma albumin. Of these, low NT-proBNP levels are statistically associated with a survival advantage to supercentenarian age. Only low albumin is associated with high mortality across age groups. These findings expand our knowledge on the biology of human longevity.


Assuntos
Envelhecimento/sangue , Biomarcadores/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Albumina Sérica/análise , Inquéritos e Questionários/estatística & dados numéricos , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Feminino , Humanos , Longevidade/fisiologia , Estudos Longitudinais , Masculino , Análise Multivariada , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida
8.
Obesity (Silver Spring) ; 28(10): 1815-1825, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32602202

RESUMO

OBJECTIVE: This study aims to explore the indicators for severity of coronavirus disease 2019 (COVID-19) in young patients between the ages of 18 and 40 years. METHODS: This retrospective cohort study included 65 consecutively admitted patients with COVID-19 who were between 18 and 40 years old in Zhongnan Hospital of Wuhan University in Wuhan, China. Among them, 53 were moderate cases, and 12 were severe or critical cases. Epidemiological, clinical, and laboratory characteristics and treatment data were collected. A multivariate logistic regression analysis was implemented to explore risk factors. RESULTS: The patients with severe/critical cases had obviously higher BMI (average 29.23 vs. 22.79 kg/m2 ) and lower liver computed tomography value (average 50.00 vs. 65.00 mU) than the group of moderate cases. The patients with severe/critical cases had higher fasting glucose, alanine aminotransferase, aspartate aminotransferase, and creatinine compared with patients with moderate cases (all P < 0.01). More severe/critical cases (58.33% vs. 1.92%) had positive urine protein levels. The severe/critical cases also experienced a significant process of serum albumin decline. Logistic regression analysis showed that male sex, high BMI (especially obesity), elevated fasting blood glucose, and urinary protein positivity were all risk factors for young patients with severe COVID-19. CONCLUSIONS: Obesity is an important predictor of COVID-19 severity in young patients. The main mechanism is related to damage of the liver and kidney.


Assuntos
Fatores Etários , Betacoronavirus , Infecções por Coronavirus/sangue , Obesidade/sangue , Pneumonia Viral/sangue , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Glicemia/análise , Índice de Massa Corporal , China/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Creatinina/sangue , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/virologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise , Adulto Jovem
9.
Aliment Pharmacol Ther ; 52(2): 359-370, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32519782

RESUMO

BACKGROUND: We conducted a prospective study using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) to determine whether sustained virological response (SVR) by direct-acting anti-viral (DAA) drugs suppresses hepatocarcinogenesis in patients with hepatitis C virus (HCV) infection. AIM: To use serial Gd-EOB-MRI to assess the impact of DAAs on hepatocarcinogenesis. METHODS: Between February 2008 and December 2018, 1083 consecutive patients with HCV infection underwent Gd-EOB-MRI. Of these, 719 patients were enrolled, including 210 patients in the 'Non-DAA group', who did not receive DAAs before the introduction of DAAs, and 509 patients in the 'DAA group', who achieved SVR after the introduction of DDAs. Factors associated with hepatocarcinogenesis were analysed by a Cox proportional hazard model. In addition, hepatocarcinogenesis was classified into two types, 'multistep' and 'de novo', on the basis of Gd-EOB-MRI findings. Factors associated with each type were analysed by Fine and Gray proportional hazards models. RESULTS: Hepatocarcinogenesis was observed in 67 of 719 (9.3%) patients. Factors associated with hepatocarcinogenesis were male gender, albumin-bilirubin (ALBI) grade 2 or 3, Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3) ≥5%, the presence of nonhypervascular hypointense nodules (NHHNs) and Non-DAA group. Of 67 patients, multistep hepatocarcinogenesis occurred in 58 patients (86.6%) and de novo hepatocarcinogenesis occurred in nine patients (13.4%). Factors associated with multistep hepatocarcinogenesis were male gender and Non-DAA group. CONCLUSION: The eradication of HCV by DAA therapy reduces multistep hepatocarcinogenesis.


Assuntos
Antivirais/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/etiologia , Hepatite C/complicações , Hepatite C/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/etiologia , Idoso , Bilirrubina/sangue , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/virologia , Meios de Contraste , Feminino , Seguimentos , Gadolínio DTPA , Hepatite C/diagnóstico por imagem , Hepatite C/virologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/virologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Albumina Sérica/análise , Caracteres Sexuais , Resposta Viral Sustentada , alfa-Fetoproteínas/análise
10.
Ulus Travma Acil Cerrahi Derg ; 26(4): 580-585, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32589247

RESUMO

BACKGROUND: This study aims to demonstrate the sensitivity and specificity of C-reactive protein to plasma albumin (CRP/ALB) ratio in predicting morbidity and mortality in patients operated for colorectal cancer followed up in the intensive care unit by comparing it with current scoring systems. METHODS: The data of patients who underwent surgery for colorectal cancer and hospitalized in the intensive care unit between 2015-2018 with available data were retrospectively analyzed in this study. The CRP/ALB ratio, the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) prepared for both gastrointestinal and colorectal surgery, and the Association of Coloproctology of Great Britain and Ireland (ACPGBI-CRC) scoring system prepared for colorectal patients, were compared to determine their success in predicting mortality and morbidity. RESULTS: A total of 119 patients were included in this study. Mortality was observed in nine patients and morbidity was observed in 38 patients. When compared with P-POSSUM, which is the only scoring system showing morbidity, the CRP/ALB ratio was found to have a high prediction accuracy. The C reactive protein to plasma albumin ratio values was found to have lower power than P-POSSUM, CR-POSSUM and ACPGBI-CRC. CONCLUSION: Although scoring systems are useful in predicting morbidity and mortality in colorectal patients, they are difficult to use in practice since they include many parameters. that the findings obtained in this study suggest that the CRP/ALB ratio, which can be calculated without any additional cost, may help the clinician predict mortality and especially morbidity.


Assuntos
Proteína C-Reativa/análise , Neoplasias Colorretais , Albumina Sérica/análise , Neoplasias Colorretais/sangue , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/mortalidade , Humanos , Estudos Retrospectivos , Índice de Gravidade de Doença
11.
Medicine (Baltimore) ; 99(22): e20274, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481394

RESUMO

Sepsis is a life-threatening disease in the intensive care unit (ICU). The current diagnostic criteria for sequential organ failure assessment (SOFA) scores do not reflect the current understanding of sepsis. We developed a novel and convenient score to aid early prognosis.Retrospective multivariable regression analysis of 185 infected emergency ICU (EICU) patients was conducted to identify independent variables associated with death, to develop the new "STAPLAg" score; STAPLAg was then validated in an internal cohort (n = 106) and an external cohort (n = 78) and its predictive efficacy was compared with that of the initial SOFA score.Age, and initial serum albumin, sodium, PLR, troponin, and lactate tests in the emergency department were independent predictors of death in infected EICU patients, and were used to establish the STAPLAg score (area under the curve [AUC] 0.865). The initial SOFA score on admission was predictive of death (AUC 0.782). Applying the above categories to the derivation cohort yielded mortality risks of 7.7% for grade I, 56.3% for grade II, and 75.0% for grade III. Internal (AUC 0.884) and external (AUC 0.918) cohort validation indicated that the score had good predictive power.The STAPLAg score can be determined early in infected EICU patients, and exhibited better prognostic capacity than the initial SOFA score on admission in both internal and external cohorts. STAPLAg constitutes a new resource for use in the clinical diagnosis of sepsis and can also predict mortality in infected EICU patients. REGISTRATION NUMBER:: ChinCTR-PNC-16010288.


Assuntos
Escore de Alerta Precoce , Unidades de Terapia Intensiva , Escores de Disfunção Orgânica , Sepse/diagnóstico , Fatores Etários , Idoso , Feminino , Humanos , Ácido Láctico/sangue , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Prognóstico , Estudos Retrospectivos , Sepse/sangue , Sepse/mortalidade , Albumina Sérica/análise , Sódio/sangue , Troponina/sangue
12.
Medicine (Baltimore) ; 99(21): e20234, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481298

RESUMO

BACKGROUND: The prevalence of chronic kidney disease (CKD) has been rapidly increasing and has become one of the most concerned global health problems. It is of good importance to improve therapeutic efficiency of CKD and delay disease progression to end stage renal disease (ESRD). Traditional Chinese Medicine (TCM) is a widely used complementary therapy for patients with CKD. The aim of this study is to evaluate whether basic treatment combined with Chinese herbs mixture Qi Gui Yi Shen decoction could achieve better therapeutic effect on CKD patients. METHODS: To determine whether traditional Chinese medicine Qi Gui Yi Shen decoction could achieve better therapeutic effect, we will conduct a randomized controlled trial. A total of 100 CKD patients that meet the inclusion criteria will be enrolled and divided into 2 groups: Qi Gui Yi Shen group (QGYS group) and placebo group. Each group will receive 6-monthly basic treatment in combination with TCM or placebo 3 times per day. Efficacy of Qi Gui Yi Shen decoction is evaluated by analyzing renal function and TCM symptoms, other efficacy assessments include serum level of PAI-I, expression of transforming growth factor beta1 (TGF-beta1). Routine blood count, plasma albumin (ALB), and alanine transaminase (ALT) are evaluated as side effect and safety profile. DISCUSSION: The results from the clinical trial will provide evidence for the effectiveness and safety of Qi Gui Yi Shen Decoction as a treatment for CKD patients. Furthermore, this will propose a new theory and method for CKD treatment. TRIAL REGISTRATION: Registered with Chinese Clinical Trials Registry at www.chictr.org. (Registration number: ChiCTR1900021622) on 1 March 2019.


Assuntos
Terapia Combinada/métodos , Medicina Tradicional Chinesa/métodos , Insuficiência Renal Crônica/tratamento farmacológico , Adolescente , Adulto , Idoso , Alanina Transaminase/sangue , Estudos de Casos e Controles , Progressão da Doença , Feminino , Humanos , Falência Renal Crônica/prevenção & controle , Masculino , Medicina Tradicional Chinesa/efeitos adversos , Pessoa de Meia-Idade , Placebos/administração & dosagem , Prevalência , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Segurança , Albumina Sérica/análise , Fator de Crescimento Transformador beta1/sangue , Adulto Jovem
13.
Medicine (Baltimore) ; 99(23): e20595, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502031

RESUMO

BACKGROUND: Inconsistent findings have been reported regarding the association of C-reactive protein to albumin ratio (CAR) with survival outcome in patients with pancreatic cancer. We conducted the current meta-analysis to assess the prognostic utility of elevated baseline CAR in predicting overall survival (OS) in pancreatic cancer patients. METHODS: A comprehensively literature search was performed in the PubMed and Embase database until February 10, 2019. Studies evaluating the association between pretreatment CAR and OS among pancreatic cancer were selected. Study quality was evaluated by using the Newcastle-Ottawa Scale. RESULTS: Nine retrospective studies involving 1534 pancreatic cancer patients were identified. A meta-analysis using a random-effect model indicated that elevated CAR was associated with poor OS (hazard ratio 1.98; 95% confidence interval 1.58-2.48). Subgroup analysis produced similar prognostic values for OS in different geographical regions, sample sizes, thresholds of CAR, treating methods, and Newcastle-Ottawa Scale points. CONCLUSION: Elevated pretreatment CAR may independently predict poor OS in pancreatic cancer patients. Pretreatment CAR is possibly a simple and cost-effective blood-derived indicator for predicting survival outcome in patients with pancreatic cancer.


Assuntos
Proteína C-Reativa/análise , Neoplasias Pancreáticas/mortalidade , Albumina Sérica/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Intervalo Livre de Doença , Humanos , Pessoa de Meia-Idade , Neoplasias Pancreáticas/sangue , Estudos Retrospectivos
14.
Diabetes Res Clin Pract ; 165: 108233, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32497744

RESUMO

Prediabetes (intermediate hyperglycemia) consists of two abnormalities, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) detected by a standardized 75-gram oral glucose tolerance test (OGTT). Individuals with isolated IGT or combined IFG and IGT have increased risk for developing type 2 diabetes (T2D) and cardiovascular disease (CVD). Diagnosing prediabetes early and accurately is critical in order to refer high-risk individuals for intensive lifestyle modification. However, there is currently no international consensus for diagnosing prediabetes with HbA1c or glucose measurements based upon American Diabetes Association (ADA) and the World Health Organization (WHO) criteria that identify different populations at risk for progressing to diabetes. Various caveats affecting the accuracy of interpreting the HbA1c including genetics complicate this further. This review describes established methods for detecting glucose disorders based upon glucose and HbA1c parameters as well as novel approaches including the 1-hour plasma glucose (1-h PG), glucose challenge test (GCT), shape of the glucose curve, genetics, continuous glucose monitoring (CGM), measures of insulin secretion and sensitivity, metabolomics, and ancillary tools such as fructosamine, glycated albumin (GA), 1,5- anhydroglucitol (1,5-AG). Of the approaches considered, the 1-h PG has considerable potential as a biomarker for detecting glucose disorders if confirmed by additional data including health economic analysis. Whether the 1-h OGTT is superior to genetics and omics in providing greater precision for individualized treatment requires further investigation. These methods will need to demonstrate substantially superiority to simpler tools for detecting glucose disorders to justify their cost and complexity.


Assuntos
Glicemia/análise , Transtornos do Metabolismo de Glucose/diagnóstico , Hemoglobina A Glicada/análise , Estado Pré-Diabético/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Automonitorização da Glicemia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Criança , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Frutosamina/sangue , Intolerância à Glucose/sangue , Transtornos do Metabolismo de Glucose/sangue , Teste de Tolerância a Glucose , Humanos , Hiperglicemia/diagnóstico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Albumina Sérica/análise , Adulto Jovem
15.
Clin Exp Hypertens ; 42(8): 692-699, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-32530318

RESUMO

BACKGROUND: The exaggerated morning blood pressure surge (MS) is a risk factor for cardiovascular diseases. Inflammation is associated with the pathogenesis of hypertension. We aimed to investigate the association between fibrinogen, albumin, fibrinogen to albumin ratio (FAR), and exaggerated MS, and which of those variables is a better predictor for identifying an exaggerated MS in newly diagnosed treatment-naive hypertensive patients. MATERIAL AND METHODS: The study included 249 treatment-naive patients who were newly diagnosed with hypertension in both clinical and ambulatory blood pressure (BP) monitoring measurements. Morning BP was defined as the mean of BPs measured during the first 2 hours after wake-up. The lowest BP was defined as the mean of 3 BP measurements focused on the lowest nighttime computations. The MS was calculated as the morning systolic BP minus the lowest systolic BP. Fibrinogen and albumin levels were measured from venous blood. FAR was obtained by dividing the fibrinogen to the albumin. RESULTS: Patients with higher-value MS had a higher fibrinogen, FAR, and a lower albumin than those with low-value MS. MS was positively correlated with fibrinogen and FAR, and negatively correlated with albumin (for all, p < .001). Fibrinogen, albumin, and FAR were independent predictors of exaggerated MS. FAR was a more powerful predictor than fibrinogen (p < .001) and albumin (p = .02) in determining exaggerated MS. CONCLUSION: Patients with exaggerated MS had a higher fibrinogen and FAR, and a lower albumin level than those without exaggerated MS. FAR may be a better predictor than fibrinogen and albumin for determining exaggerated MS.


Assuntos
Pressão Sanguínea , Fibrinogênio/análise , Hipertensão/diagnóstico , Albumina Sérica/análise , Idoso , Monitorização Ambulatorial da Pressão Arterial , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
16.
PLoS One ; 15(6): e0234042, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32492062

RESUMO

BACKGROUND: To elucidate the possible effect of various systemic factors on intraocular pressure (IOP) using a dataset from a health examination program database in Japan. METHODS: This cross-sectional study included 1569 subjects selected from the 2287 subjects who comprised the database. Various systemic parameters including age, sex, height, body weight, waist circumference, percent body fat, blood pressure (BP), pulse rate, body mass index, 28 blood examination values, intimal medial thicknesses of both carotid arteries, and intraocular pressure (IOP) values measured by non-contact tonometry in both eyes were collected. The possible correlation between the IOP and other parameters was assessed initially by univariate analyses followed by multivariate analyses. RESULTS: Stepwise multivariate analyses, which included all parameters extracted by the univariate analyses (p<0.1) and sex, identified the same six parameters as indicators of the IOP values for each right and left IOP model. Among the parameters, age (r = -0.05 and -0.04/year for right and left IOPs, respectively) was associated negatively and the percent body fat (r = 0.06 and 0.05/%), systolic BP (r = 0.02 and 0.03/mmHg), pulse rate (r = 0.03 and 0.03/counts/minutes), albumin (r = 1.12 and 1.00/g/dL), and hemoglobin A1c (r = 0.38 and 0.44/%) were associated positively with the IOP in each eye. CONCLUSIONS: Older age was associated with low IOP, while factors reflecting the metabolic syndrome were associated with high IOP in our study population.


Assuntos
Pressão Intraocular/fisiologia , Tecido Adiposo , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Índice de Massa Corporal , Estudos Transversais , Feminino , Hemoglobina A Glicada/análise , Frequência Cardíaca , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Albumina Sérica/análise
17.
Medicine (Baltimore) ; 99(20): e20159, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443331

RESUMO

Postoperative delirium (PD), characterized by acute onset of global impairment in consciousness and cognition, is a common complication following major surgeries and is often associated with adverse outcomes. Because of the multiple comorbidities of the patient along with extensive nature of the surgery, patients undergoing surgery for bone metastases may be prone to developing PD. However, no study exists regarding PD in patients who undergo surgery for bone metastases.Two hundred seventy six patients with mean age of 64 years (range, 16-94) who underwent surgery for bone metastases were reviewed. The diagnosis of PD was made by the psychiatrist, according to fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Possible perioperative clinic-pathologic factors that may be associated with the development of PD were investigated.Among the 276 patients, 9% (n = 25) developed PD. On multivariate logistic regression analysis, history of psychiatric disorders (odds ratio [OR] = 9.63; 95% confidence interval [CI] 1.78-21.74, P = .004), high preoperative serum C-reactive protein (CRP) level (OR = 1.17; 95% CI 1.06-1.29, P = .001), low preoperative serum albumin level (OR = 0.13; 95% CI 0.03-0.48, P = 0.002), and high dose of opioid analgesics received in the immediate postoperative period (OR = 1.05; 95% CI 1.01-1.07, P = .001) were independently associated with the development of PD. Patients with PD had lower survival (log rank, P = .001) than patients without PD.Incidence of PD is considerable in patients undergoing surgery for bone metastases. History of psychiatric disorders, preoperative serum albumin and CRP levels, and the dose of postoperative opioid analgesics are associated with the development of PD.


Assuntos
Neoplasias Ósseas/cirurgia , Delírio/etiologia , Metástase Neoplásica/patologia , Idoso , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Neoplasias Ósseas/secundário , Proteína C-Reativa/análise , Cognição/efeitos dos fármacos , Cognição/fisiologia , Comorbidade , Delírio/epidemiologia , Delírio/mortalidade , Delírio/psicologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise
19.
Surgery ; 168(2): 287-296, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32340719

RESUMO

BACKGROUND: The curative treatment of perihilar cholangiocarcinomas and centrally located intrahepatic cholangiocarcinomas often requires major hepatectomy preceded by portal vein embolization. This strategy, however, is associated with a high rate of dropouts before operation or failure of resection at the time of operative exploration. We aimed to identify predictors of unresectability (dropout or failure of resection) after portal vein embolization for centrally located cholangiocarcinoma, including perihilar cholangiocarcinomas and intrahepatic cholangiocarcinomas. METHOD: All patients undergoing portal vein embolization for a planned resection of a centrally located cholangiocarcinoma between 2000 and 2018 in our center were evaluated retrospectively. Predictors of unresectability were determined under intention-to-treat conditions, based on clinical, biologic, and radiologic data collected before portal vein embolization. RESULTS: Eighty-eight consecutive patients scheduled for portal vein embolization before operative exploration were included, 56 of whom (64%) underwent curative resection and 32 (36%) of whom were not resected, including those who did not undergo exploration (n = 11) and those operated on but not resected (n = 21). The most common cause of unresectability was tumor progression (62%). A psoas muscle index <500 mm2/m2 (P = .04), high body mass index (P = .023), and low serum albumin level (P = .007) were associated with unresectabilty on multivariate analysis. A composite score including these variables (cutoffs determined after receiver operating characteristic curve analysis) was proposed and achieved accurate discrimination regarding unresectability (area under the curve = 0.82, P < .001). CONCLUSION: Predictors of unresectability after portal vein embolization for centrally located cholangiocarcinoma were identified, with sarcopenic overweight patients having a greater risk of unresectability. This preoperative score enables a fairly accurate prediction of unresectability in a given patient. These simple, objective, and inexpensive parameters should be considered in all patients with centrally located cholangiocarcinoma scheduled to undergo portal vein embolization.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/cirurgia , Embolização Terapêutica , Seleção de Pacientes , Veia Porta , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Progressão da Doença , Feminino , Hepatectomia , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Sobrepeso/complicações , Estudos Retrospectivos , Sarcopenia/complicações , Albumina Sérica/análise
20.
BMC Oral Health ; 20(1): 122, 2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32316955

RESUMO

BACKGROUND: The association between dental status and mortality in community-dwelling older adults has been documented by several studies. The aim of this study was to analyze the contribution of self-assessed chewing ability, number of remaining teeth and serum albumin levels to mortality and the interactions between the three factors. METHODS: A 20-year follow-up study was conducted with 666 subjects aged 80 years (from 1996 to 2017) who resided in the 8 areas served by one health center in Iwate Prefecture. Health check-ups including physical fitness measurements were conducted at a meeting place or gymnasium. Medical interview and blood sampling were conducted by physician. Oral examination was examined by dentist. The number of remaining teeth, serum albumin levels, and self-assessed chewing ability were used as predictors of mortality. RESULTS: Among the 608 subjects (233 men and 375 women) included in this study, only 12 subjects (1.97%) survived after 20 years of follow-up. For men, dental status and serum levels of albumin were significantly associated with mortality. The hazard ratios of self-assessed chewing ability calculated by item response theory analysis and the inability to chew at least one food adjusted for serum albumin and tooth conditions were statistically significant in men. When adjusted by health status evaluated by blood tests, self-assessed chewing ability was statistically significant in men. According to path analysis, self-assessed chewing ability and serum albumin independently affected mortality in men. CONCLUSION: Masticatory dysfunction may be an important risk factor for mortality in men, even though it was self-assessed. Retaining chewing ability might be a useful predictor of longevity in older male adults.


Assuntos
Mastigação , Mortalidade/tendências , Saúde Bucal/estatística & dados numéricos , Albumina Sérica/análise , Perda de Dente/epidemiologia , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Japão/epidemiologia , Expectativa de Vida , Masculino , Perda de Dente/fisiopatologia
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