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1.
Anticancer Res ; 39(11): 6283-6290, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704858

RESUMO

BACKGROUND/AIM: The usefulness of C-reactive protein-to-albumin ratio (CAR) as a predictive indicator for clinically-relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) is unclear. We performed a retrospective analysis to identify reliable inflammatory indicators for prediction of CR-POPF after PD. PATIENTS AND METHODS: We enrolled 160 consecutive patients who underwent PD. Multivariate logistic regression analysis was performed. The areas under curves (AUCs) were compared with the discriminatory ability of inflammatory indicators, namely, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet count multiplied by C-reactive protein (P-CRP), and CAR. RESULTS: The AUC for CAR on POD 3 to predict CR-POPF was 0.782 (p<0.001) and higher than that for CRP (0.773), NLR (0.652), PLR (0.504), and P-CRP (0.703). Multivariate analysis revealed that CAR on POD 3 was an independent predictive indicator of CR-POPF. CONCLUSION: CAR on POD 3 is a reliable predictor of CR-POPF after PD.


Assuntos
Proteína C-Reativa/análise , Fístula Pancreática/sangue , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/sangue , Albumina Sérica/análise , Idoso , Amilases/análise , Biomarcadores/sangue , Feminino , Humanos , Modelos Logísticos , Contagem de Linfócitos , Masculino , Neutrófilos/citologia , Pâncreas/patologia , Ductos Pancreáticos/patologia , Fístula Pancreática/diagnóstico , Fístula Pancreática/etiologia , Contagem de Plaquetas , Complicações Pós-Operatórias/diagnóstico , Curva ROC , Estudos Retrospectivos
2.
Anticancer Res ; 39(11): 6347-6353, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704866

RESUMO

BACKGROUND/AIM: The aim of this study was to determine the significance of immunonutritional and physical index in the assessment of risk associated with pancreaticoduodenectomy (PD) in the elderly. PATIENTS AND METHODS: This study enrolled 92 patients who underwent PD. They were divided into 2 groups: Group A included patients 79 years and younger (n=79) and Group B patients 80 years and older (n=13). Among 37 patients, physical function and body composition were also evaluated. RESULTS: Significantly higher neutrophil-lymphocyte ratio, lower prognostic nutritional index (PNI), and controlling nutritional score were observed in Group B. Muscle strength and walking ability were significantly impaired in Group B, although there was no significant difference in body composition. Age was not correlated with the incidence of postoperative complications, overall survival or recurrence-free survival by univariate and multivariate analysis. CONCLUSION: PD is justified for the elderly, with acceptable morbidity and prognosis. However, immunonutritional status and physical function are significantly impaired; thus, appropriate case selection and active nutritional support are required for the elderly.


Assuntos
Limitação da Mobilidade , Força Muscular , Estado Nutricional , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Neoplasias dos Ductos Biliares/cirurgia , Composição Corporal , Comorbidade , Neoplasias Duodenais/cirurgia , Feminino , Humanos , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Avaliação Nutricional , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/mortalidade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Medição de Risco , Albumina Sérica/análise
3.
Medicine (Baltimore) ; 98(48): e18219, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770284

RESUMO

BACKGROUND: The prognostic value of C-reactive protein/albumin ratio (CAR) in pancreatic cancer remains controversial. This study aimed to determine the potential role of CAR as a prognostic indicator in pancreatic cancer. METHODS: A comprehensive literature search up to December 2018 was conducted using PubMed, Web of Science, and other databases. The hazard ratio (HR) with 95% confidence interval (CI) was employed to quantitatively assess CAR as a prognostic indicator in patients with pancreatic cancer. RESULTS: Eleven studies with 2047 pancreatic cancer patients were selected for the analysis. Ten out of 11 studies included only Asian patients. The pooled results showed that a higher CAR value was significantly associated with a poor overall survival of pancreatic cancer patients (random-effects model: HR = 1.86; 95% CI = 1.53-2.26). Sensitivity analysis indicated the stability of the overall pooled results. Subgroup analysis and meta-regression analysis revealed that the country under study, cut-off value of CAR, treatment of patients, and the period of follow-up did not affect the prognostic value of CAR in pancreatic cancer patients (P > .05). No publication bias was noted across the studies (P = .933). CONCLUSION: This meta-analysis suggests that CAR is associated with the survival of pancreatic cancer patients of Asian ethnicity, and a higher CAR may be a potential prognostic indicator in pancreatic cancers.


Assuntos
Proteína C-Reativa/análise , Neoplasias Pancreáticas , Albumina Sérica/análise , Grupo com Ancestrais do Continente Asiático , Humanos , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/etnologia , Neoplasias Pancreáticas/mortalidade , Valor Preditivo dos Testes , Prognóstico
4.
Medicine (Baltimore) ; 98(43): e17394, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651841

RESUMO

Child-Pugh (CP) grade A patients with early stage hepatocellular carcinoma (HCC) are candidates for curative surgery, while some patients still have a poor outcome. The aim of this study was to investigate the prognostic values of 2 new evaluation models for liver function, named albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grades, in CP grade A patients with HCC.In this retrospective cohort study, we reviewed 134 cases of CP grade A patients with hepatitis B-associated HCC who underwent radical surgery. ALBI and PALBI grades were calculated based on preoperative serologic examinations. Overall survival (OS) and recurrence-free survival (RFS) were estimated by Kaplan-Meier curve and Cox regression. The prognostic performances of the models were estimated by using the concordance index (C-index).During a median follow-up time of 27 months, 27.6% (37/134) of patients died and 26.1% (35/134) experienced recurrence. Kaplan-Meier analyses showed that ALBI and PALBI grades were significantly associated with OS and RFS. Multivariate analyses further revealed that both ALBI and PALBI grades were independent predictors for survival. Furthermore, the prognostic values of the combination of tumor size with ALBI (C-index = 0.754, 95% confidence interval [CI]: 0.675-0.849) or with PALBI (C-index = 0.762, 95% CI: 0.664-0.844) may be comparable with both Barcelona Clinic Liver Cancer and Cancer of Liver Italian Program staging systems.The ALBI and PALBI grades, in particular the combination with tumor size, are effective models for discriminating survival in CP grade A patients with HCC.


Assuntos
Bilirrubina/sangue , Plaquetas/metabolismo , Carcinoma Hepatocelular/mortalidade , Hepatectomia/mortalidade , Neoplasias Hepáticas/mortalidade , Albumina Sérica/análise , Adulto , Biomarcadores Tumorais/sangue , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/virologia , Feminino , Hepatite B/complicações , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
5.
Transplant Proc ; 51(8): 2750-2754, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31563245

RESUMO

BACKGROUND AND AIMS: Postoperative hypoalbuminemia, especially following liver transplantation, can lead to adverse multisystem effects and even death. We investigated the relationship between postoperative albumin levels and organ failure (assessed using Sequential Organ Failure Assessment [SOFA] scores). METHODS: Sixty liver transplant recipients admitted to the intensive care unit (ICU) from 2012 to 2015 were retrospectively divided into 2 groups: lower albumin (LA) (n=28) and higher albumin (HA) (n=32), using whether serum albumin level fell below 3.0 g/dL during the first postoperative week as the stratifying factor. The SOFA scores (primary endpoint) and associated complications (ascites amount, rejection, re-intubation, abdominal re-operation, thrombosis), additional treatment (dialysis, pleural effusion drainage), and duration of ICU stay (secondary endpoints) of the 2 groups were compared. RESULTS: Average serum albumin levels were significantly different between HA and LA groups (3.6 [3.4-3.8] vs 3.1 [2.9-3.3], respectively, P<.05), although the amounts of albumin infused in the 2 groups during the first postoperative week were not different (HA vs LA: 42 [30-71] vs 40 [30-58], respectively, P=.37). Mean daily SOFA scores were not significantly different between the HA and LA groups (8.3 [6.6-9.0] vs 7.2 [6.3-8.6], P=.73), although the HA group had lower mean cardiovascular SOFA sub-scores than the LA group (0.1 [0-0.4] vs 0.4 [0-1.3], P=.032). There were no significant differences between the groups with regard to complication rates and duration of ICU and hospital stays. CONCLUSIONS: Serum albumin level might not influence cumulative organ function, but it decreases the amount of hemodynamic support required in liver transplant recipients.


Assuntos
Rejeição de Enxerto/sangue , Transplante de Fígado , Albumina Sérica/análise , Adulto , Feminino , Sobrevivência de Enxerto/fisiologia , Humanos , Hipoalbuminemia/etiologia , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Período Pós-Operatório , Estudos Retrospectivos
6.
J Vet Intern Med ; 33(5): 1995-2004, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31496004

RESUMO

BACKGROUND: The cause of low serum vitamin D concentrations in dogs with chronic inflammatory enteropathy (CIE) is not well understood. OBJECTIVE: Improve understanding of pathogenesis of low serum vitamin D concentrations in dogs with CIE by comparing several clinical, clinicopathologic, and histologic variables between CIE dogs with low and normal serum 25-hydroxyvitamin D concentrations (25[OH]D). ANIMALS: Fifteen dogs with CIE and low serum 25[OH]D concentrations; 15 dogs with CIE and normal serum 25(OH)D concentrations. METHODS: Prospective cohort study. Clinical and clinicopathologic variables were compared between groups. Correlations between serum 25(OH)D concentration and histopathologic variables were assessed. RESULTS: Dogs with CIE and low serum 25(OH)D concentrations had higher canine chronic enteropathy clinical activity index scores (P = .003), lower serum α-tocopherol (P < .001), cholesterol (P < .001), and albumin (P < .001) concentrations and higher serum C-reactive protein (P = .004) concentrations compared to CIE dogs with normal serum 25(OH)D concentrations. Serum concentrations of vitamin D-binding protein (VDBP) were not different between groups (P = .91). Duodenal morphologic and inflammatory histopathological scores (P = .002 and P = .004, respectively) and total histopathological scores in duodenum and combined duodenum and ileum negatively correlated with serum 25(OH)D concentration. CONCLUSIONS AND CLINICAL IMPORTANCE: The pathogenesis of low serum vitamin D concentrations in dogs with CIE is likely multifactorial. Fat malabsorption deserves further study in dogs with low serum vitamin D concentration and CIE. Loss of VDBP does not appear to be an important cause of low serum vitamin D concentration in dogs with CIE.


Assuntos
Doenças do Cão/patologia , Doenças Inflamatórias Intestinais/veterinária , Vitamina D/análogos & derivados , Animais , Proteína C-Reativa/análise , Colesterol/sangue , Estudos de Coortes , Doenças do Cão/sangue , Cães , Feminino , Doenças Inflamatórias Intestinais/sangue , Doenças Inflamatórias Intestinais/patologia , Masculino , Estudos Prospectivos , Albumina Sérica/análise , Tocoferóis/sangue , Vitamina D/sangue , Proteína de Ligação a Vitamina D/sangue
7.
Eur Arch Otorhinolaryngol ; 276(11): 3221-3230, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31401760

RESUMO

PURPOSE: We designed this retrospective study to identify predictive value of prognostic nutritional index (PNI) and albumin-globulin ratio (AGR) in nasopharyngeal cancer patients (NPC). METHODS: 95 non-metastatic NPC patients were included in the study. AGR was calculated as the absolute counts between albumin and globulin measurements. (Globulin values were obtained via excluding albumin counts from total protein counts). PNI was calculated using the following formula: [10 × serum albumin value (g/dL) + 0.005 × total lymphocyte count] in the peripheral blood (per mm3). RESULTS: The statistically significant cutoff value of PNI was identified as 45.45 (area under the curve (AUC): 0.636, p = 0.03) for overall survival. The 5-year OS rate for patients with PNI ≤ 45.45 and PNI > 45.45 were 52.9% and 79.0%, respectively. There were statistically significant difference between groups (p = 0.03).The statistically significant cutoff value of AGR was identified as 1.19 (AUC: 0.689, p < 0.01) for overall survival. The 5-year OS rate for patients with AGR ≤ 1.19 and AGR > 1.19 were 57.7% and 82.0%. There were statistically significant differences between the groups (p = 0.04). 5-year OS rate was 42.9% in the high-risk group (low-PNI and low-AGR patients), it was 80.3% in the intermediate group (low PNI and high AGR or high PNI and low AGR) and it was 80.9% in low-risk group (high PNI and high AGR) (p = 0.004). In the multivariate analysis, age and PNI were independent prognostic factors for poorer OS (HR 2.70, 95% CI 1.091-6.719, p = 0.32 and HR 2.44, 95% CI 1.009-5.940, p = 0.48). CONCLUSIONS: Low PNI is independent prognostic factor for poorer OS. Patients with low-PNI and low-AGR have worse survival than patients with high PNI and high AGR.


Assuntos
Globulinas/análise , Contagem de Linfócitos/métodos , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Avaliação Nutricional , Albumina Sérica/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/sangue , Carcinoma Nasofaríngeo/diagnóstico , Carcinoma Nasofaríngeo/mortalidade , Carcinoma Nasofaríngeo/patologia , Neoplasias Nasofaríngeas/sangue , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/mortalidade , Neoplasias Nasofaríngeas/patologia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Turquia/epidemiologia
8.
Clin Lab ; 65(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31414767

RESUMO

BACKGROUND: The C-reactive protein to albumin ratio (CAR) is a novel inflammation index that has recently been used as a marker for poor prognosis or mortality in various patient groups. This study aimed to evaluate the association between the CAR and 30-day mortality in patients with hepatitis B virus-related decompensated cirrhosis (HBV-DeCi). METHODS: This was a retrospective cohort study of 113 patients who had been diagnosed with HBV-DeCi. Univariate and multivariate regression models were used to determine risk factors for mortality. RESULTS: The CAR was observed to be significantly higher in the non-surviving patients compared to the surviving patients. Moreover, the CAR was positively correlated with the model for end-stage liver disease (MELD) score and Child-Pugh score. In multivariate analysis, the CAR and the MELD score were independent prognostic factors for HBV-DeCi patients. CONCLUSIONS: A high CAR value at admission can serve as an independent predictor of 1-month mortality in patients with HBV-DeCi.


Assuntos
Proteína C-Reativa/análise , Hepatite B Crônica/complicações , Cirrose Hepática/complicações , Albumina Sérica/análise , Adulto , Idoso , Feminino , Hepatite B Crônica/mortalidade , Humanos , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
9.
Ann Biol Clin (Paris) ; 77(4): 407-414, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418702

RESUMO

Like all proteins, plasma albumin can undergo glycation to produce glycated albumin. This glycation will change the structure and therefore functionalities of albumin. Because of its accessibility, its high concentration and its half-life the glycation of albumin is greater than that of haemoglobin. Laboratory measurement of glycated albumin is possible. The value of glycated albumin reflects the glycaemic balance over a period of 3 weeks, and shows its interest in cases where the determination of HbA1c is impossible or deficient. It also seems that the glycated albumin has a prognostic interest in the chronic kidney disease patients dialyzed or not. In some patients, the assay of glycated albumin could replace measurement of fructosamines and provide additional information to HbA1c values.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Monitorização Fisiológica/métodos , Albumina Sérica/análise , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/diagnóstico , Hemoglobina A Glicada/análise , Hemoglobina A Glicada/metabolismo , Humanos , Valor Preditivo dos Testes , Prognóstico , Diálise Renal , Albumina Sérica/metabolismo
10.
Rev Invest Clin ; 71(4): 255-264, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448783

RESUMO

Background: Intradialytic oral nutrition (ION) has been shown to improve many clinical outcomes, including lowering mortality, in hemodialysis (HD) patients. Despite the benefits, ION is underused in many countries. Objective: The objective of our study was to determine the perception of health-care professionals (HCP) in our environment of the use of ION in patients undergoing HD. Methods: Survey applied to HCP in Mexico who worked or had worked in an HD unit in their locality. Results: From 272 HCP who answered the survey, 74.3% believed that the use of ION has at least one beneficial effect; of these, the most frequently mentioned were an improvement in quality of life (QoL) (54.7%) followed by an improvement in serum albumin (37.9%) and muscle anabolism (31.6%). However, 49% consider that its use involves some risks. Of the respondents, 22% reported that their HD units allowed patients to consume food or supplements during HD sessions; the main reason given to forbid the introduction of food or supplements was the clinic's policy (41%). Conclusions: The personnel surveyed heterogeneous opinions regarding ION, but most believe that it may improve the QoL or the nutritional status of the patients. Nevertheless, the use of ION is uncommon in our country as it is against the internal regulations of most HD units.


Assuntos
Suplementos Nutricionais , Pessoal de Saúde/estatística & dados numéricos , Estado Nutricional , Diálise Renal/métodos , Adulto , Atitude do Pessoal de Saúde , Criança , Estudos Transversais , Humanos , México , Qualidade de Vida , Albumina Sérica/análise , Inquéritos e Questionários
11.
Medicine (Baltimore) ; 98(34): e16713, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441844

RESUMO

To evaluate the nutritional status of children with chronic kidney disease (CKD) before dialysis via a series of indexes, and investigate the prognostic impact of nutritional status in these patients assessed by the Prognostic Nutritional Index (PNI).Fifty-four children with CKD before dialysis were enrolled in this study. The nutritional status was evaluated by different indexes, including dietary intake, anthropometry data and biochemical parameters. Additionally, PNI is calculated as 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (/mm). Glomerular filtration rate (GFR) of patients with different PNI scores was followed up.Thirty-four patients (63.0%) experienced unreasonable dietary intake, and the patients with CKD stage 4 were characterized by lower energy intake. The height was the most affected anthropometry parameter. Additionally, 46 patients (85.2%) suffered from anemia. The serum albumin of 42 patients (77.8%) was <35 g/L, while 34 cases (63.0%) had increased cholesterol and triglyceride. According to the PNI scores, the patients were divided into 3 groups: high-PNI (PNI ≥ 38), middle-PNI (35 ≤ PNI < 38), and low-PNI (PNI < 35). Of the 54 patients, the PNI was <35 in 29 (53.7%) and ≥38 in 13 (24.1%). The patients with CKD stage 4 were belonged to the low-PNI group. At follow-up, GFR decreased significantly in patients with low-PNI scores compared with the high-PNI group (P < .05).Malnutrition, as a common complication of CKD, has a prognostic impact in children with CKD before dialysis, as assessed by the PNI score.


Assuntos
Avaliação Nutricional , Estado Nutricional/fisiologia , Insuficiência Renal Crônica/fisiopatologia , Pesos e Medidas Corporais , Criança , Ingestão de Energia , Feminino , Taxa de Filtração Glomerular , Hemoglobinas/análise , Humanos , Estimativa de Kaplan-Meier , Lipídeos/sangue , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise
12.
Int J Hyperthermia ; 36(1): 841-853, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31452408

RESUMO

Purpose: To compare the predictive value of albumin-bilirubin (ALBI) grade, platelet-ALBI (PALBI) grade and Child-Turcotte-Pugh (CTP) class in patients with large hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) combined with microwave ablation (TACE-MWA). Methods: A total of 349 consecutive HCC patients (89.1% male; mean [± SD] age 53.4 ± 12.27 years) from three medical centers, who underwent TACE-MWA for up to 3 HCCs with maximum diameters of 5.1-8.0 cm between January 2000 and June 2018, were investigated. Overall survival (OS) and progression-free survival (PFS) were analyzed. The prognostic performances of ALBI grade, PALBI grade and CTP class were compared. Results: TACE procedures were performed using lobaplatin (20-50 mg), epirubicin (30-60 mg), lipiodol (5-25 mL) and gelatin sponge particles (350-560 µm). The end point of the TACE procedure was stasis of blood flow in the feeder artery. The median follow-up duration was 28.0 months, the median OS was 28.0 months (95% confidence interval [CI] 23.55-32.45 months), and the median PFS was 4.8 months (95% CI 4.26-5.34 months). Patients with a ablation margin size of 11-15 mm experienced better PFS than those with a margin size of 6-10 or 0-5 mm (median, 6.5 versus [vs] 4.0 vs 2.3 months; p < .001). PALBI grade demonstrated significantly greater area under the curve values than ALBI grade or CTP class in predicting 1-, 3- and 5-year OS. Conclusions: PALBI grade provided better predictive value than ALBI grade or CTP class in patients with large HCCs after TACE-MWA.


Assuntos
Técnicas de Ablação , Bilirrubina/sangue , Plaquetas , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Neoplasias Hepáticas/terapia , Micro-Ondas/uso terapêutico , Albumina Sérica/análise , Índice de Gravidade de Doença , Adulto , Idoso , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/diagnóstico por imagem , Feminino , Humanos , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Braz J Cardiovasc Surg ; 34(4): 436-443, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454197

RESUMO

OBJECTIVE: To investigate the effect of continuous lung ventilation with low tidal volume on oxidation parameters, such as thiol/disulphide homeostasis and albumin-adjusted ischemia-modified albumin (AAIMA), during cardiopulmonary bypass (CBP) in coronary artery bypass grafting (CABG). METHODS: Seventy-four patients who underwent elective CABG with CPB were included in the study. Blood samples were taken in the preoperative period, 10 minutes after CPB, and six and 24 hours postoperatively. Patients were assigned to the continuous ventilation group (Group 1, n=37) and the non-ventilated group (Group 2, n=37). The clinical characteristics, thiol/disulphide homeostasis, ischemia-modified albumin (IMA), and AAIMA levels of the patients were compared. RESULTS: A significant difference was found between the groups regarding native thiol, total thiol, and IMA levels at the postoperative 24th hour (P=0.030, P=0.031, and P=0.004, respectively). There was no difference between the groups in terms of AAIMA. AAIMA levels returned to preoperative levels in Groups 1 and 2, at the 6th and 24th postoperative hours, respectively. Length of hospital stay was significantly shorter in Group 1 (P<0.001) than in Group 2. CONCLUSION: Continuous ventilation during CPB caused an increase in native and total thiol levels, an earlier return of AAIMA levels, and shorter hospital stay. Continuous ventilation may reduce the negative effects of CPB on myocardium (Table 2, Figure 1, and Reference 31).


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Dissulfetos/sangue , Respiração Artificial , Albumina Sérica/análise , Compostos de Sulfidrila/sangue , Idoso , Antioxidantes , Biomarcadores/sangue , Ponte Cardiopulmonar/métodos , Ponte de Artéria Coronária , Método Duplo-Cego , Feminino , Homeostase/fisiologia , Humanos , Lesão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Albumina Sérica Humana
14.
Oncology ; 97(6): 334-340, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31466068

RESUMO

BACKGROUND/AIM: Lenvatinib (LEN) has been developed for the treatment of unresectable hepatocellular carcinoma (u-HCC). We aimed to elucidate the relative change in hepatic reserve function early following LEN treatment in affected patients. MATERIALS/METHODS: From March 2018 to April 2019, 123 u-HCC patients (median age 71 years; male:female ratio 95:28; Child-Pugh score 5:6:7 = 65:50:8; modified albumin-bilirubin [mALBI] grade 1:2a:2b:3 = 44:28:50:1, Barcelona Clinic Liver Cancer stage A:B:C = 1:49:73) were enrolled. Relative changes in hepatic reserve function at 2 and 4 weeks after starting LEN were retrospectively evaluated. RESULTS: The median survival was 11.3 months. The Child-Pugh score declined from the start to 4 weeks after commencing LEN (score 5:6:7:8:9:≥10 = 65:50:8:0:0:0 vs. 50:39:22:8:0:4, p < 0.001). A comparison among ALBI scores at the start of LEN and those at 2 and 4 weeks revealed significant relative changes (-2.36 ± 0.45 to -2.20 ± 0.49 at 2 weeks, -2.15 ± 0.50 at 4 weeks, p < 0.001, Bonferroni method), while there was no significant difference between those at 2 and 4 weeks (p= 0.210, Bonferroni method). Assessments of relative changes of ALBI score in patients divided by mALBI grade 1, 2a, and 2b or more showed a significant decline in score regardless of grade (-2.82 ± 0.17 to -2.53 ± 0.34, p < 0.001; -2.46 ± 0.10 to -2.31 ± 0.33, p = 0.017; and -1.90 ± 0.26 to -1.75 ± 0.42, p= 0.009, respectively). CONCLUSION: Decline in hepatic function is common in the early stage (≤4 weeks, especially within 2 weeks) after introducing LEN. It is important to introduce molecular targeting agent drugs for u-HCC in patients with better hepatic function, who show transarterial catheter chemoembolization failure, as much as possible, along with consideration of the negative influence of LEN on the early response of hepatic function.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Fígado/fisiopatologia , Compostos de Fenilureia/uso terapêutico , Quinolinas/uso terapêutico , Idoso , Bilirrubina/sangue , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/fisiopatologia , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/fisiopatologia , Masculino , Estudos Retrospectivos , Albumina Sérica/análise
15.
J Vet Intern Med ; 33(5): 2005-2013, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31381203

RESUMO

BACKGROUND: Protein-losing enteropathy (PLE) because of chronic inflammatory enteropathy (CIE) in dogs is often treated with a combination of glucocorticoids and second-line immunosuppressant (SLI). This combined approach might not be necessary in all dogs. HYPOTHESIS/OBJECTIVES: To describe diagnostic features and outcomes of dogs with PLE treated with glucocorticoids alone (group P) or with glucocorticoids and SLI (group S). ANIMALS: Thirty-one dogs with PLE. MATERIAL AND METHODS: Retrospective analysis of signalment data from diagnostic procedures, treatment, and outcome of dogs with CIE/PLE (from 2015 to 2017), using the hospital's digital case database. Dogs with hypoalbuminemia and CIE were included. Because of a stepwise treatment algorithm, dogs were allocated to group P or S. Time to serum albumin concentrations ≥20 g/L and survival data were collected. Dogs were additionally categorized by their albumin and cobalamin serum concentrations. Multivariate and univariate analysis as well as Pearson's correlation and Kaplan-Maier survival analysis were performed. RESULTS: Seventeen dogs were included in group P and 14 in group S. World Small Animal Veterinary Association score of the duodenum was different between groups (P = .05), but none of the other examined data. Median time until serum albumin reached >20 g/L was 13 days. Median survival time after start of treatment was 85 days (range, 13-463 days) in group P and 166 days (range, 8-390 days) in group S. CONCLUSION AND CLINICAL IMPORTANCE: No routine diagnostic test was predictive of clinical response, treatment group, or outcome. Glucocorticoid treatment alone can be appropriate in dogs with PLE.


Assuntos
Doenças do Cão/diagnóstico , Doenças do Cão/tratamento farmacológico , Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Enteropatias Perdedoras de Proteínas/veterinária , Animais , Cães , Quimioterapia Combinada , Enteropatias Perdedoras de Proteínas/diagnóstico , Enteropatias Perdedoras de Proteínas/tratamento farmacológico , Estudos Retrospectivos , Albumina Sérica/análise , Análise de Sobrevida , Resultado do Tratamento , Vitamina B 12/sangue
16.
Medicine (Baltimore) ; 98(29): e16064, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335668

RESUMO

OBJECTIVE: This meta-analysis evaluates the prognosis value of C-reactive protein to albumin ratio (CAR) in colorectal cancer. METHODS: Embase, PubMed, and Web of Science were searched. Pooled hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs) were used as effective values. RESULTS: A total of 6 studies with 1942 patients were included in this study. Pooled results revealed that elevated pretreatment CAR was related with poorer overall survival (OS) (HR: 2.09, 95%CI: 1.78-2.45, P < .001) in colorectal cancer. CONCLUSION: Elevated CAR was associated with poor prognosis in colorectal cancer. Thus CAR might be used as a prognostic system and classification of colorectal patients in clinical potential.


Assuntos
Proteína C-Reativa/análise , Neoplasias Colorretais , Albumina Sérica/análise , Neoplasias Colorretais/sangue , Neoplasias Colorretais/diagnóstico , Humanos , Prognóstico
17.
Dement Geriatr Cogn Disord ; 47(4-6): 233-242, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31315125

RESUMO

BACKGROUND: Serum albumin and hemoglobin levels are independently associated with subsequent cognitive deterioration in older adults. This prospective study used repeated measures analysis to identify aging trajectories in serum albumin and hemoglobin levels and investigated if these trajectories were associated with incident disabling dementia among community-dwelling older Japanese. METHODS: A total of 2,005 adults aged 65-90 years participated in annual geriatric health assessments during the period from June 2002 through July 2017; the total number of observations was 9,330. A review of a municipal database of the Japanese public long-term care insurance system identified 1,999 of 2,005 adults without dementia at baseline, 278 (13.9%) of whom developed disabling dementia during the follow-up period (June 2002 through December 2017). RESULTS: We identified three trajectory patterns (high, moderate, and low) for serum albumin and hemoglobin levels for the age period 65 through 90 years. After controlling for potential confounders, participants with moderate and low trajectories for serum albumin level had hazard ratios of 1.27 (95% confidence interval 0.94-1.72) and 2.07 (1.37-3.11), respectively, for the development of incident disabling dementia, with the high trajectory group as reference. The respective hazard ratios for hemoglobin level were 1.31 (0.93-1.85) and 1.58 (1.04-2.40), respectively. CONCLUSION: Dementia risk was higher for individuals with low trajectories for serum albumin and hemoglobin levels. This finding highlights the importance of interventions that improve nutritional status and control relevant diseases in middle-aged and older adults with low serum albumin and hemoglobin levels.


Assuntos
Demência/sangue , Hemoglobinas/análise , Estudos Prospectivos , Albumina Sérica/análise , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Biomarcadores/sangue , Bases de Dados Factuais , Pessoas com Deficiência , Feminino , Avaliação Geriátrica , Humanos , Vida Independente , Japão , Masculino , Modelos de Riscos Proporcionais , Medição de Risco
18.
Oncology ; 97(5): 277-285, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307035

RESUMO

BACKGROUND/AIM: We evaluated clinical factors related to improved prognosis of unresectable hepatocellular carcinoma patients (u-HCC), who were treated with tyrosine kinase inhibitor (TKI) sequential therapy, including lenvatinib (LEN). MATERIALS/METHODS: We enrolled 84 u-HCC cases treated with TKIs including LEN from March 2018 to January 2019 (median age 71 years, 63 males, Child-Pugh score (CPS) 5/6/7 = 62/21/1, tumor-node-metastasis stage of Liver Cancer Study Group of Japan 6th (TNM-LCSGJ) II/III/IVa/IVb = 12/30/5/37, Barcelona Clinic Liver Cancer stage B/C = 33:51). Clinical findings at introduction of the initial TKI were retrospectively evaluated. RESULTS: The median albumin-bilirubin (ALBI) score at introduction of the initial TKI (sorafenib [SOR]/LEN = 80/4) was -2.56, and the past number of transarterial catheter chemoembolization was 3 (IQR: 2-5) (second-line: regorafenib [REG]/LEN/SOR = 31/49/4, third-line: LEN/REG = 31:1). The total period of administration with TKIs showed a good relationship with overall survival (OS) (r = 0.946, 95% confidence interval [CI]: 0.918-0.965, p < 0.001). The prognosis of the entire cohort was good (estimated median survival time: 46.4 months, 1-/2-/3-year OS rate [OSR] = 87.7/63.0/57.2%). A modified-ALBI grade (mALBI) of 2b (ALBI score >-2.27) was the only significant factor at the start of the initial TKI for poor prognosis (hazard ratio 2.319, 95% CI: 1.064-5.052, p = 0.034), while CPS (≥6) was not. Although there was no significant difference in TNM-LCSGJ (p = 0.213), the prognosis of patients with mALBI 1/2a (n = 66) showed better prognosis as compared to those with mALBI 2b (n = 18) (1-year/2-year/3-year OSR = 89.1/69.8/66% vs. 82.4/47.1/23.5%, p = 0.029). CONCLUSION: Good hepatic function (mALBI 1/2a) at introduction of the initial TKI is a requirement for improved prognosis of u-HCC undergoing TKI sequential therapy.


Assuntos
Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Compostos de Fenilureia/uso terapêutico , Inibidores de Proteínas Quinases/uso terapêutico , Quinolinas/uso terapêutico , Idoso , Bilirrubina/sangue , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Prognóstico , Albumina Sérica/análise
19.
Int J Surg ; 69: 32-42, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31319230

RESUMO

OBJECTIVES: To evaluate prognostic significance of albumin-to-alkaline phosphatase ratio (AAPR) for patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC) by a propensity score-matching (PSM) analysis. METHODS: This PSM study was conducted on the prospectively-maintained database in our institution between December 2013 and March 2015. Overall survival analyses and further subgroup analyses were both performed to distinguish the differences in postoperative survival between patients stratified by an optimal cutoff of AAPR. Multivariable Cox proportional hazards regression models were established to determine the independent prognostic factors. RESULTS: There were 390 patients with operable NSCLCs included. An AAPR of 0.57 was identified as the optimal cutoff regarding to postoperative survival. Both overall survival (OS) and disease-free survival (DFS) in patients with AAPR≤0.57 were significantly shortened compared to those in patient with AAPR>0.57 (Log-rank P < 0.001). Patients with AAPR≤0.57 had significantly lower rates of OS and DFS than those of patients with AAPR>0.57 (P < 0.001). These differences still remained significant after subgroup analyses and PSM analyses. Multivariate analyses on the entire cohort and the PSM cohort commonly indicated that low preoperative AAPR could be an independent prognostic factor for unfavorable OS and DFS of resected NSCLCs. CONCLUSIONS: AAPR can serve as a novel risk stratification tool to refine prognostic prediction for surgical NSCLC. It may help surgeons to screen high-surgical-risk patients and further formulate individualized treatment schemes.


Assuntos
Fosfatase Alcalina/sangue , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pontuação de Propensão , Albumina Sérica/análise , Idoso , Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos
20.
Int J Rehabil Res ; 42(3): 249-255, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31274638

RESUMO

Factors associated with functional recovery after stroke may differ by age demographics because the aging process leads to various regressive changes. The aim of this study was to identify factors related to functional recovery in Japanese patients with convalescent stroke stratified by age. A multicenter retrospective observational study was conducted in 243 patients from six convalescent inpatient rehabilitation wards. Participants were categorized into three groups: 40-64, 65-74, and ≥75 years. Demographic data, laboratory data, physical function, and cognitive function were collected upon admission, and outcome measures were represented using the relative gain of the Functional Independence Measure (FIM effectiveness) during hospitalization. Stepwise multivariate logistic analysis was performed to identify the significant factors for functional recovery in each group. In the 40-64 years group, stroke type [odds ratio (OR), 10.38; 95% confidence interval (CI), 2.22-48.59], spatial neglect (OR, 7.61; 95% CI, 2.07-28.00), and memory disorder (OR, 4.68; 95% CI, 1.08-20.30) were shown to be significant factors. In the 65-74 years group, only memory disorder (OR, 3.42; 95% CI, 1.19-9.81) was significant. In the ≥75 years group, low albumin level (OR, 3.35; 95% CI, 1.05-10.67), severe motor impairment (OR, 5.11; 95% CI, 1.14-22.97), and memory disorder (OR, 4.34; 95% CI, 1.43-13.23) were significantly related to poor functional recovery. In conclusions, the findings showed that there were different trends among the factors related to poststroke functional recovery among the three age groups.


Assuntos
Envelhecimento/fisiologia , Hospitalização , Recuperação de Função Fisiológica/fisiologia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Avaliação da Deficiência , Feminino , Humanos , Japão , Masculino , Transtornos da Memória/fisiopatologia , Transtornos da Memória/reabilitação , Pessoa de Meia-Idade , Limitação da Mobilidade , Transtornos da Percepção/fisiopatologia , Transtornos da Percepção/reabilitação , Estudos Retrospectivos , Albumina Sérica/análise
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