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1.
Semina cienc. biol. saude ; 45(1): 183-198, jan./jun. 2024. ilus; tab.
Artigo em Português | LILACS | ID: biblio-1554828

RESUMO

O câncer, frequentemente relacionado ao envelhecimento, impulsiona pacientes a buscarem tratamento hospitalar ou métodos alternativos, como plantas medicinais. Este estudo visou avaliar os perfis sociodemográfico e clínico e o consumo de plantas para fins medicinais entre pacientes idosos em tratamento oncológico no Hospital Araújo Jorge (HAJ). Dados de 55 pacientes foram analisados, abrangendo informações sociodemográficas, tipos de câncer, tratamento, a utilização de plantas medicinais, o objetivo de uso, as fontes de informações sobre plantas e se notaram alguma reação adversa após o consumo. A faixa etária mais encontrada foi 61 a 70 anos (67,27%), a maioria dos pacientes eram homens (63,64%), com ensino fundamental incompleto (32,73%), casados (56,36%) e que moram no interior de Goiás (43,64%). Quanto ao tratamento, a maioria realizava quimioterapia (40,00%) e o câncer gástrico foi mais relatado (14,54%). Sobre o uso de plantas medicinais, a maioria relatou simpatizar com o consumo (58,18%), e acredita em sua segurança devido à origem natural (59,37%). Informações sobre o uso de plantas medicinais eram obtidas com amigos, vizinhos e familiares (21,81%). Ao relatar sobre o consumo de plantas medicinais durante a quimioterapia, a maioria não percebeu nenhum efeito (40,63%). Foram citadas 17 plantas, que eram utilizadas no tratamento anticâncer (29,00%) e preparadas como infusões (18,75%) pelo uso das folhas frescas (60,00%), principalmente para uso interno (46,87%). Diante disso, a atenção farmacêutica se mostra vital para guiar pacientes nas práticas seguras e eficazes de consumo. Isso inclui direcionar sobre doses adequadas, efeitos colaterais e interações, garantindo bem-estar e prevenindo riscos à saúde.


Cancer, which is often related to ageing, drives patients to seek hospital treatment or alternative methods such as medicinal plants. This study aimed to evaluate the sociodemographic and clinical profile and the consumption of plants for medicinal purposes among elderly patients undergoing cancer treatment at the Araújo Jorge Hospital (AJH). Data from 55 patients was analyzed, covering sociodemographic information, types of cancer, treatment, the use of medicinal plants, the purpose of use, the source of information about plants and whether they noticed any adverse reactions after consumption. The most common age group was 61 to 70 years (67.27%), the majority of patients were men (63.64%), had incomplete primary education (32.73%), were married (56.36%) and lived in the interior of Goiás (43.63%). With regard to treatment, the majority were undergoing chemotherapy (40,00%) and gastric cancer was the most frequently reported (14.54%). With regard to the use of medicinal plants, the majority were sympathetic to their consumption (58.18%) and believed them to be safe due to their natural origin (59.37%). Information on the use of medicinal plants was obtained from friends, neighbors and family members (21.81%). When reporting on the consumption of medicinal plants during chemotherapy, the majority did not notice any effect (40.63%). Seventeen plants were mentioned, which were used for anticancer treatment (29,00%) and prepared as infusions (18.75%) with fresh leaves (60,00%), mainly for internal use (46.87%). In view of this, pharmaceutical care is vital to guide patients in safe and effective consumption practices. This includes guidance on appropriate doses, side effects and interactions, ensuring well-being and preventing health risks.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais
2.
J Dermatolog Treat ; 35(1): 2360568, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38852942

RESUMO

BACKGROUND: Response rates of approved systemic therapies for cutaneous T-cell lymphoma (CTCL) hover near 30%, suggesting unmet need. This study describes real-world treatment patterns and response rates of extracorporeal photopheresis (ECP) in CTCL patients. METHODS: A chart review was conducted in the United States of adults with CTCL who initiated ECP between January 1, 2017, and February 28, 2019, and received at least three months of ECP treatment as monotherapy or concomitant therapy. Clinical outcomes were collected quarterly for up to 18 months. RESULTS: The 52 patients were predominantly Caucasian. Half were male; median age was 69 years. Most patients had Sézary syndrome (50%) or mycosis fungoides (36.5%). Nearly 40% of patients had stage IV disease; 33% had lymph node involvement. Nineteen patients (36.5%) achieved response (>50% reduction in BSA affected); median time to response was 6.5 months. The percentage of patients rated as at least minimally improved was 59.5% at 6 months (N = 22), 75.0% at 9 months (N = 24), and 60.0% at 12 months (N = 15) after ECP initiation. CONCLUSIONS: Despite the ECP treated population in this study being older and having more advanced-stage disease than recent trials, response rates were comparable. These real-world findings support ECP as an effective treatment option for CTCL patients.


Assuntos
Linfoma Cutâneo de Células T , Fotoferese , Neoplasias Cutâneas , Humanos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Linfoma Cutâneo de Células T/terapia , Linfoma Cutâneo de Células T/patologia , Neoplasias Cutâneas/terapia , Neoplasias Cutâneas/patologia , Estados Unidos , Resultado do Tratamento , Estudos Retrospectivos , Adulto , Idoso de 80 Anos ou mais , Síndrome de Sézary/terapia , Síndrome de Sézary/patologia , Micose Fungoide/terapia , Micose Fungoide/patologia , Estadiamento de Neoplasias
3.
Nihon Shokakibyo Gakkai Zasshi ; 121(6): 497-504, 2024.
Artigo em Japonês | MEDLINE | ID: mdl-38853019

RESUMO

An 86-year-old male patient with sustained virological response of chronic hepatitis type C was diagnosed with hepatocellular carcinoma (HCC) in hepatic segment 3. He was treated with transcatheter arterial chemoembolization (TACE) and radiation therapy because the tumor was located at the edge of the liver and umbilical portion of the portal vein. The value of alpha-fetoprotein (AFP) which is a serological tumor marker decreased, and the tumor size did not increase;however, another tumor was recognized at S3 of the liver 15 months post-TACE. The patient underwent a second TACE, and computed tomography revealed HCC recurrence at S3, S8/4, and S1 of the liver 6 months later. The patient refused to undergo another treatment, but the AFP and Des-γ-carboxy prothrombin values and the tumor size decreased 3 months postrecurrence. Two months after multiple recurrences of HCC, he received the third dose of messenger RNA-based vaccine for severe acute respiratory syndrome coronavirus 2. Tumor regression may occur after an immune-inflammatory response induced by messenger RNA-based vaccine.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Masculino , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/diagnóstico por imagem , Idoso de 80 Anos ou mais , Vacinas contra COVID-19/administração & dosagem , COVID-19/imunologia , COVID-19/prevenção & controle , Vacinação
4.
Philos Trans R Soc Lond B Biol Sci ; 379(1906): 20230233, 2024 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-38853564

RESUMO

Long-term potentiation (LTP)-like activity can be induced by stimulation protocols such as paired associative stimulation (PAS). We aimed to determine whether PAS-induced LTP-like activity (PAS-LTP) of the dorsolateral prefrontal cortex (DLPFC) is associated with cortical thickness and other structural measures impaired in Alzheimer's dementia (AD). We also explored longitudinal relationships between these brain structures and PAS-LTP response after a repetitive PAS (rPAS) intervention. Mediation and regression analyses were conducted using data from randomized controlled trials with AD and healthy control participants. PAS-electroencephalography assessed DLPFC PAS-LTP. DLPFC thickness and surface area were acquired from T1-weighted magnetic resonance imaging. Fractional anisotropy and mean diffusivity (MD) of the superior longitudinal fasciculus (SLF)-a tract important to induce PAS-LTP-were measured with diffusion-weighted imaging. AD participants exhibited reduced DLPFC thickness and increased SLF MD. There was also some evidence that reduction in DLPFC thickness mediates DLPFC PAS-LTP impairment. Longitudinal analyses showed preliminary evidence that SLF MD, and to a lesser extent DLPFC thickness, is associated with DLPFC PAS-LTP response to active rPAS. This study expands our understanding of the relationships between brain structural changes and neuroplasticity. It provides promising evidence for a structural predictor to improving neuroplasticity in AD with neurostimulation. This article is part of a discussion meeting issue 'Long-term potentiation: 50 years on'.


Assuntos
Doença de Alzheimer , Córtex Pré-Frontal Dorsolateral , Potenciação de Longa Duração , Plasticidade Neuronal , Humanos , Doença de Alzheimer/fisiopatologia , Masculino , Idoso , Feminino , Córtex Pré-Frontal Dorsolateral/diagnóstico por imagem , Córtex Pré-Frontal Dorsolateral/fisiopatologia , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Eletroencefalografia , Imageamento por Ressonância Magnética , Córtex Pré-Frontal/fisiopatologia , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/fisiologia
5.
Echocardiography ; 41(6): e15861, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38853674

RESUMO

BACKGROUND: Transesophageal echocardiography (TEE) is primarily used to guide transcatheter structural heart interventions, such as tricuspid transcatheter edge-to-edge repair (TEER). Although TEE has a good safety profile, it is still an invasive imaging technique that may be associated with complications, especially when performed during long transcatheter procedures or on frail patients. The aim of this study was to assess TEE-related complications during tricuspid TEER. METHODS: This is a prospective study enrolling 53 patients who underwent tricuspid TEER for severe tricuspid regurgitation (TR). TEE-related complications were assessed clinically and divided into major (life-threatening, major bleeding requiring transfusions or surgery, organ perforation, and persistent dysphagia) and minor (perioral hypesthesia, < 24 h dysphagia/odynophagia, minor intraoral bleeding and hematemesis not requiring transfusion) RESULTS: The median age of the patient population was 79 years; 43.4% had severe, 39.6% massive, and 17.6% torrential TR. 62.3% of patients suffered from upper gastrointestinal disorders. Acute procedural success (APS) was achieved in 88.7% in a median device time of 36 min. A negative association was shown between APS and lead-induced etiology (r = -.284, p = .040), baseline TR grade (r = -.410, p = .002), suboptimal TEE view (r = -.349, p = .012), device time (r = -.234, p = .043), and leaflet detachment (r = -.496, p < .0001). We did not observe any clinical manifest major or minor TEE-related complications during the hospitalization. CONCLUSIONS: Our study reinforces the good safety profile and efficacy of TEE guidance during tricuspid TEER. Adequate preoperative management and intraprocedural precautions are mandatory in order to avoid serious complications. Furthermore, suboptimal intraprocedural TEE views are associated with lower TR reduction rates. HIGHLIGHTS: Transesophageal echocardiography is a crucial and safe technique for guiding transcatheter structural heart interventions. A mix of mid/deep esophageal and trans gastric views, as well as real-time 3D imaging is generally used to guide the procedure. Adequate preoperative management and intraprocedural precautions are mandatory in order to avoid serious problems. A shorter device time is associated with more rarely probe-related complications. Suboptimal intraprocedural TEE views are associated with lower TR reduction rates.


Assuntos
Ecocardiografia Transesofagiana , Insuficiência da Valva Tricúspide , Valva Tricúspide , Humanos , Ecocardiografia Transesofagiana/métodos , Feminino , Masculino , Estudos Prospectivos , Insuficiência da Valva Tricúspide/cirurgia , Idoso , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/efeitos adversos , Resultado do Tratamento , Idoso de 80 Anos ou mais
6.
Arch Iran Med ; 27(6): 289-297, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38855798

RESUMO

BACKGROUND: Given the significant occurrence of skin cancer in the Middle East and the existing research gap concerning its incidence and trends, this research aimed to study the epidemiology and trend changes of skin cancer in the Golestan province, Northeastern Iran. METHODS: The Golestan Population-based Cancer Registry's (GPCR's) data bank was utilized to gather information on confirmed skin cancer cases in the province during 2005-2018. We used Poisson regression analysis for comparing incidence rates between groups. P values less than 0.05 were considered statistically significant. RESULTS: Of 1690 patients (mean age: 62.05±15.83 years), most were male (60.1%) and resided in urban areas (61.5%). The age-standardized rate (ASR) of non-melanoma and melanoma skin cancer was 8.49 and 0.56 per 100000 persons-year, respectively. A notably higher ASR for non-melanoma skin cancer (NMSC) was observed in men (ASR: 10.60; 95% CI: 9.91-11.29) (P<0.01) and urban residents (ASR: 10.19; 95% CI: 9.52-10.82) (P<0.01). There was no significant difference in the ASR of melanoma skin cancer based on gender (P=0.24) and place of residence (P=0.48). The incidence trend of melanoma (estimated annual percent change [EAPC]: -3.28; 95% CI: -18.54 to 14.83) and NMSC (EAPC: 0.39; 95% CI: -3.99 to 4.97) did not differ significantly. CONCLUSION: During the 14-year study period, the ASR of both types of skin cancer exhibited a consistent pattern, except for NMSC, which showed higher rates among men and urban residents. This should be taken into consideration when formulating preventive and control strategies in the study area.


Assuntos
Melanoma , Sistema de Registros , Neoplasias Cutâneas , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Neoplasias Cutâneas/epidemiologia , Incidência , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Melanoma/epidemiologia , Idoso de 80 Anos ou mais , Distribuição por Sexo , Distribuição por Idade , Adulto Jovem , População Urbana/estatística & dados numéricos , Adolescente , Carcinoma Basocelular/epidemiologia
7.
Arch Iran Med ; 27(6): 323-333, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38855802

RESUMO

BACKGROUND: Elder abuse (EA) is a serious public health issue recognized as a healthcare priority. Personality traits can influence social behaviors. This study aimed to determine the prevalence of self-reported domestic EA and its relationship with personality traits of older people and their family caregivers. METHODS: A cross-sectional study was conducted in 2022. The research population included older people living in the urban community of the Lorestan Province (in the western region of Iran) selected by multistage cluster sampling. In general, 998 older people and their family caregivers were sampled. The data collection tool was a three-part questionnaire: a. demographic characteristics of the older people, b. questionnaire on the incidence of elder abuse, and c. short version of the NEO Five-Factor Inventory-Revised (NEO-FFI-R) for measuring the personality traits of the older people or family caregivers. The statistical software used was Stata 14. RESULTS: The present study reported that the prevalence of EA at home was 37.78%. In the present study, older age, female gender, unmarried/single status, lower education, unemployment, and rented house characteristics were predictors of EA. High agreeableness, high extroversion, and low neuroticism reduce conflict and tension in older people with their relatives and family, which appear to be protective factors against EA. CONCLUSION: Policymakers and health experts should prepare training and screening programs to consider these factors so that older people exposed to EA can be identified more quickly and early interventions can be used to improve their health status and increase their quality of life.


Assuntos
Cuidadores , Abuso de Idosos , Personalidade , Autorrelato , Humanos , Abuso de Idosos/estatística & dados numéricos , Abuso de Idosos/psicologia , Feminino , Masculino , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Idoso , Estudos Transversais , Irã (Geográfico)/epidemiologia , Prevalência , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Inquéritos e Questionários
8.
Eur Rev Med Pharmacol Sci ; 28(10): 3615-3620, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38856137

RESUMO

OBJECTIVE: Arteriovenous fistula (AVF) structures are vital formations used for hemodialysis. Diabetes mellitus (DM) is a critical disease affecting the vascular system. The triglyceride glucose (TyG) index has been shown to be associated with major adverse cardiovascular events in patients with Type 2 DM. In this study, we aimed to investigate the effect of the TyG index on the primary AVF patency of diabetic patients. PATIENTS AND METHODS: Between March 2018 and March 2023, patients with DM who underwent AVF surgery in our clinic due to end-stage renal disease were retrospectively included in this study. The patients who could receive hemodialysis were determined as Group 1, and those who could not were determined as Group 2. RESULTS: A total of 189 patients were included in the study. Those who did not develop AVF primary failure were included in Group 1 [n=138, median age = 59 (22-77) years], and those who did were included in Group 2 [n=51, median age = 63 (20-81) years]. In the multivariate analysis, age >70 years (OR: 0.871, 95% CI: 0.594-0.983, p=0.039), the presence of PAD (OR: 0.582, 95% CI: 0.0.458-0.896, p=0.046), and TyG index (OR: 0.879, 95% CI: 0.591-0.916, p<0.001) were determined as independent predictors for primary AVF failure. CONCLUSIONS: This study demonstrated that the TyG index value, calculated from blood samples taken at the time of hospital admission in hemodialysis patients with diabetes mellitus (DM), is an independent predictor of primary AVF failure following AVF surgery.


Assuntos
Derivação Arteriovenosa Cirúrgica , Glicemia , Falência Renal Crônica , Diálise Renal , Triglicerídeos , Humanos , Pessoa de Meia-Idade , Idoso , Feminino , Masculino , Triglicerídeos/sangue , Estudos Retrospectivos , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Adulto , Falência Renal Crônica/terapia , Falência Renal Crônica/sangue , Glicemia/análise , Grau de Desobstrução Vascular , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Biomarcadores/sangue , Adulto Jovem
9.
Langenbecks Arch Surg ; 409(1): 181, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38856758

RESUMO

PURPOSE: Mesopancreas resection is a crucial but difficult procedure when performing pancreaticoduodenectomy. This study evaluated the influence of mesopancreas thickness on surgical outcomes in patients undergoing pancreaticoduodenectomy. METHODS: We measured the thickness of the fat tissue on the right side of the superior mesenteric artery from the dorsal margin of the confluence of the superior mesenteric vein and portal vein to the ventral margin of the left renal vein on preoperative contrast-enhanced computed tomography and defined it as the mesopancreas thickness. We evaluated the correlation between mesopancreas thickness and intraoperative and postoperative variables in 357 patients who underwent pancreaticoduodenectomy. RESULTS: Multivariate analysis revealed that a thick mesopancreas was significantly associated with a long operative time (ß = 10.361; 95% confidence interval, 0.370-20.353, p = 0.042), high estimated blood loss (ß = 36.038; 95% confidence interval, -27.192-99.268, p = 0.013), and a low number of resected lymph nodes (ß = -1.551; 95% confidence interval, -2.662--0.439, p = 0.006). This analysis further revealed that thick mesopancreas was a significant risk factor for overall morbidity (odds ratio 2.170; 95% confidence interval 1.340-3.520, p = 0.002), major morbidity (odds ratio 2.430; 95% confidence interval 1.360-4.340, p = 0.003), and a longer hospital stay (ß = 2.386; 95% confidence interval 0.299-4.474, p = 0.025). CONCLUSION: A thick mesopancreas could predict a longer operation time, higher estimated blood loss, fewer resected lymph nodes, more frequent overall and major morbidities, and a longer hospital stay in patients who underwent pancreaticoduodenectomy more precisely than the body mass index.


Assuntos
Duração da Cirurgia , Neoplasias Pancreáticas , Pancreaticoduodenectomia , Humanos , Pancreaticoduodenectomia/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/patologia , Resultado do Tratamento , Tomografia Computadorizada por Raios X , Estudos Retrospectivos , Adulto , Pâncreas/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Artéria Mesentérica Superior/cirurgia , Artéria Mesentérica Superior/diagnóstico por imagem , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia
10.
Acta Neuropathol ; 147(1): 97, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38856925

RESUMO

Β-site amyloid precursor protein (APP) cleaving enzyme (BACE1) is a crucial protease in the production of amyloid-ß (Aß) in Alzheimer's disease (AD) patients. However, the side effects observed in clinical trials of BACE1 inhibitors, including reduction in brain volume and cognitive worsening, suggest that the exact role of BACE1 in AD pathology is not fully understood. To further investigate this, we examined cerebrospinal fluid (CSF) levels of BACE1 and its cleaved product sAPPß that reflects BACE1 activity in the China Aging and Neurodegenerative Disorder Initiative cohort. We found significant correlations between CSF BACE1 or sAPPß levels and CSF Aß40, Aß42, and Aß42/Aß40 ratio, but not with amyloid deposition detected by 18F-Florbetapir PET. Additionally, CSF BACE1 and sAPPß levels were positively associated with cortical thickness in multiple brain regions, and higher levels of sAPPß were linked to increased cortical glucose metabolism in frontal and supramarginal areas. Interestingly, individuals with higher baseline levels of CSF BACE1 exhibited slower rates of brain volume reduction and cognitive worsening over time. This suggests that increased levels and activity of BACE1 may not be the determining factor for amyloid deposition, but instead, may be associated with increased neuronal activity and potentially providing protection against neurodegeneration in AD.


Assuntos
Doença de Alzheimer , Secretases da Proteína Precursora do Amiloide , Peptídeos beta-Amiloides , Ácido Aspártico Endopeptidases , Encéfalo , Humanos , Secretases da Proteína Precursora do Amiloide/líquido cefalorraquidiano , Secretases da Proteína Precursora do Amiloide/metabolismo , Ácido Aspártico Endopeptidases/líquido cefalorraquidiano , Ácido Aspártico Endopeptidases/metabolismo , Doença de Alzheimer/patologia , Doença de Alzheimer/líquido cefalorraquidiano , Masculino , Idoso , Feminino , Peptídeos beta-Amiloides/líquido cefalorraquidiano , Peptídeos beta-Amiloides/metabolismo , Encéfalo/patologia , Encéfalo/metabolismo , Tomografia por Emissão de Pósitrons , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Cognição/fisiologia , Biomarcadores/líquido cefalorraquidiano , Fragmentos de Peptídeos/líquido cefalorraquidiano , Fragmentos de Peptídeos/metabolismo
11.
Support Care Cancer ; 32(7): 421, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38856947

RESUMO

PURPOSE: Determining whether patients' unrealistic expectations of chemotherapy as a cure were associated with their perception of the disclosure of incurability. METHODS: This prospective study included consecutive patients with pretreated non-small cell lung cancer from four study sites. Patients and their oncologists were asked whether they perceived the disclosure of cancer incurability. Patients were also asked if they thought that chemotherapy was curative. We followed up on whether the deceased patients received specialized palliative care 14 months after their last enrollment. Multiple regression analyses were conducted to examine the association between the expectation of chemotherapy as a cure and patient/oncologist-reported perceptions of the disclosure of incurability. RESULTS: We analyzed 200 patients, 77 (38.5%) of whom had unrealistic expectations of a cure. Based on patients' perceptions, incurability was disclosed to 138 (69.0%) patients, and based on their oncologists' perceptions, incurability was disclosed to 185 (92.5%) patients (patient/oncologist agreements, κ = 0.19). Patients without a perception of the oncologist's disclosure of incurability-regardless of their oncologist's perception-were more likely to have unrealistic expectations of a cure than patients for whom both patient and oncologist perceptions were present. Patients who had unrealistic expectations of chemotherapy as a cure were shown to be significantly less likely to have received specialized palliative care, after adjusting for covariates (adjusted OR, 0.45; 95% CI, 0.23-0.91; p = .027). CONCLUSION: Oncologists' disclosure of incurability was not fully recognized by patients, and expectations of chemotherapy as a cure were associated with patients' perception of the disclosure of incurability.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Cuidados Paliativos , Humanos , Masculino , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/psicologia , Carcinoma Pulmonar de Células não Pequenas/terapia , Feminino , Neoplasias Pulmonares/psicologia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/terapia , Estudos Prospectivos , Pessoa de Meia-Idade , Idoso , Cuidados Paliativos/psicologia , Cuidados Paliativos/métodos , Relações Médico-Paciente , Idoso de 80 Anos ou mais , Análise de Regressão , Revelação da Verdade , Adulto , Antineoplásicos/uso terapêutico
12.
Ann Plast Surg ; 92(6S Suppl 4): S408-S412, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38857005

RESUMO

INTRODUCTION: The healthcare costs for treatment of community-acquired decubitus ulcers accounts for $11.6 billion in the United States annually. Patients with stage 3 and 4 decubitus ulcers are often treated inefficiently prior to reconstructive surgery while physicians attempt to optimize their condition (debridement, fecal/urinary diversion, physical therapy, nutrition, and obtaining durable medical goods). We hypothesized that hospital costs for inpatient optimization of decubitus ulcers would significantly differ from outpatient optimization costs, resulting in significant financial losses to the hospital and that transitioning optimization to an outpatient setting could reduce both total and hospital expenditures. In this study, we analyzed and compared the financial expenditures of optimizing patients with decubitus ulcers in an inpatient setting versus maximizing outpatient utilization of resources prior to reconstruction. METHODS: Encounters of patients with stage 3 or 4 decubitus ulcers over a 5-year period were investigated. These encounters were divided into two groups: Group 1 included patients who were optimized totally inpatient prior to reconstructive surgery; group 2 included patients who were mostly optimized in an outpatient setting and this encounter was a planned admission for their reconstructive surgery. Demographics, comorbidities, paralysis status, and insurance carriers were collected for all patients. Financial charges and reimbursements were compared among the groups. RESULTS: Forty-five encounters met criteria for inclusion. Group 1's average hospital charges were $500,917, while group 2's charges were $134,419. The cost of outpatient therapeutic items for patient optimization prior to wound closure was estimated to be $10,202 monthly. When including an additional debridement admission for group 2 patients (average of $108,031), the maximal charges for total care was $252,652, and hospital reimbursements were similar between group 1 and group 2 ($65,401 vs $50,860 respectively). CONCLUSIONS: The data derived from this investigation strongly suggests that optimizing patients in an outpatient setting prior to decubitus wound closure versus managing the patients totally on an inpatient basis will significantly reduce hospital charges, and hence costs, while minimally affecting reimbursements to the hospital.


Assuntos
Úlcera por Pressão , Humanos , Úlcera por Pressão/economia , Úlcera por Pressão/terapia , Úlcera por Pressão/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Assistência Ambulatorial/economia , Estudos Retrospectivos , Estados Unidos , Custos de Cuidados de Saúde/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Hospitalização/economia , Procedimentos de Cirurgia Plástica/economia , Procedimentos de Cirurgia Plástica/métodos , Melhoria de Qualidade/economia , Adulto , Idoso de 80 Anos ou mais
13.
Otol Neurotol ; 45(6): 651-655, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38865721

RESUMO

OBJECTIVE: To understand the impact on speech perception for patients experiencing Advanced Bionics V1 series Ultra and Ultra 3D cochlear implant failure. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary academic center. PATIENTS: Adult patients implanted with V1 series devices. INTERVENTIONS: Device integrity and speech perception testing. MAIN OUTCOME MEASURES: consonant-nucleus-consonant and AzBio in quiet speech recognition scores. RESULTS: At our institution, 116 V1 series cochlear implants were placed in 114 patients. Thirteen devices in prelingual patients were excluded, leaving 103 (89%) for final analysis. Forty-eight (46.6%) devices were considered as failed using the company provided EFI analysis tool. There were 36 (65.5%) of the remaining 55 devices that consistently tested within normal range; the remainder lost to follow-up with unknown status. Among the 48 device failures, 29 were revised and 19 patients were not revised. Among those not revised, 11 self-opted for observation (57.9%). Observed patients, despite impedance changes meeting failure criteria, had no subjective or objective changes in speech perception. Sentence testing scores for failure patients who elected observation (82.9 ± 11.4%) were significantly higher at failure compared with those opting for revision (55 ± 22.8%, p = 0.006). For those undergoing revision surgery, significant improvement in post-activation scores was noted as compared with time of failure with a mean improvement of 12.9% (p = 0.002, n = 24) for consonant-nucleus-consonant word scores and 17.2% (p = 0.001, n = 19) for AzBio in quiet scores. CONCLUSIONS: Proactive monitoring using EFI identifies a higher rate of Ultra Series V1 device failure than previously reported. However, about 20% of these patients may not have subjective change in hearing or objective decline in test scores and could be observed. Should performance worsen, reimplantation provides significant improvement in speech recognition.


Assuntos
Implante Coclear , Implantes Cocleares , Percepção da Fala , Humanos , Percepção da Fala/fisiologia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Idoso , Implante Coclear/métodos , Falha de Prótese , Idoso de 80 Anos ou mais
14.
Otol Neurotol ; 45(6): e472-e477, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38865724

RESUMO

OBJECTIVES: To investigate the quality of life (QOL) of adult Mandarin-speaking Chinese Americans after cochlear implantation (CI) using the cross-culturally adapted Chinese Cochlear Implant Quality of Life-10 (CIQOL-10) Global. STUDY DESIGN: Cross-sectional. SETTING: Tertiary care neurotology practice in New York City. PATIENTS: Thirty adult Mandarin-speaking Chinese Americans (22.8-89.4 yr, mean 48.9 yr) with prelingual (12) or postlingual (18) deafness who underwent CI between 1995 and 2020. All patients were at least 1 year from CI activation. INTERVENTION: CI. MAIN OUTCOMES MEASURES: Chinese CIQOL-10 Global score. RESULTS: There were no detectable differences in mean Chinese CIQOL-10 Global scores between the prelingual (mean 51.9, SD 11.0) and postlingual (mean 44.0, SD 16.4) cohorts (p = 0.1; 95% CI, -2.3 to 18.1; Hedges' g = 0.5). Comparison of the overall cohort (mean 47.1, SD 14.8) with previously published CIQOL-10 Global scores of English-speaking American CI users (mean 51.5, SD 10.4) demonstrated a significant difference (p = 0.02; 95% CI, 0.4-8.4; Hedges' g = 0.4). For the overall cohort, multivariable analysis demonstrated that combined household income (p = 0.007, ß = 7.4; 95% CI, 0.7-14.0) was positively associated with Chinese CIQOL-10 Global scores. CONCLUSIONS: This study is the first to evaluate QOL after CI in Mandarin-speaking Chinese American adults. The CIQOL-10 Global scores of Mandarin-speaking Chinese Americans CI users are significantly worse than those of English-speaking American CI users. Combined household income may be positively associated with QOL in the Mandarin-speaking Chinese American CI population. More resources are needed to assess outcomes and support rehabilitation in this population.


Assuntos
Asiático , Implante Coclear , Qualidade de Vida , Humanos , Masculino , Asiático/psicologia , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Estudos Transversais , Idoso de 80 Anos ou mais , Adulto Jovem , Surdez/cirurgia , Surdez/psicologia , Implantes Cocleares
15.
Asian J Endosc Surg ; 17(3): e13331, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38866420

RESUMO

INTRODUCTION: Previous studies have not evaluated the surgical difficulty of minimally invasive distal pancreatectomy for pancreatic cancer in elderly patients. Therefore, we aimed to investigate the effect of elderly age on the perioperative outcomes of minimally invasive distal pancreatectomy, focusing on surgical difficulty. METHODS: This single-center retrospective study included patients who underwent minimally invasive distal pancreatectomy for pancreatic cancer at Kansai Rosai Hospital between September 2012 and December 2023. Perioperative outcomes were investigated between the elderly (>75 years) and non-elderly (≤75 years) groups. RESULTS: Fifty-six patients were included: 26 and 30 in the elderly and non-elderly groups, respectively. The median operative time was significantly shorter in the elderly group than in the non-elderly group (324 vs. 414 min, p = .022), but other surgical outcomes were not significantly different including oncological factors. The median difficulty score was similar between the elderly and non-elderly groups (6 vs. 7, respectively; p = .699). The incidences of postoperative complications and pancreatic fistulas were not significantly different in the elderly and non-elderly groups (23% vs. 43%, p = .159, and 19% vs. 36%, p = .236, respectively), even though analyzed in subgroups with low-to-intermediate or high difficulty score. CONCLUSIONS: The safety and feasibility of minimally invasive distal pancreatectomy for pancreatic cancer were not significantly different between elderly and non-elderly patients, even when surgical difficulty was considered. This surgical procedure can be safe and feasible for elderly patients.


Assuntos
Estudos de Viabilidade , Pancreatectomia , Neoplasias Pancreáticas , Humanos , Pancreatectomia/métodos , Estudos Retrospectivos , Neoplasias Pancreáticas/cirurgia , Idoso , Feminino , Masculino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Fatores Etários , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Laparoscopia/métodos
16.
JACC Cardiovasc Interv ; 17(11): 1325-1336, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38866455

RESUMO

BACKGROUND: Conduction disturbances requiring a permanent pacemaker (PPM) are a frequent complication of transcatheter aortic valve replacement (TAVR) with few reports of rates, predictors, and long-term clinical outcomes following implantation of the third-generation, balloon-expandable SAPIEN 3 (S3) transcatheter heart valve (THV). OBJECTIVES: The aim of this study was to investigate the rates, predictors, and long-term clinical outcomes of PPM implantation following TAVR with the S3 THV. METHODS: The current study included 857 patients in the PARTNER 2 S3 registries with intermediate and high surgical risk without prior PPM, and investigated predictors and 5-year clinical outcomes of new PPM implanted within 30 days of TAVR. RESULTS: Among 857 patients, 107 patients (12.5%) received a new PPM within 30 days after TAVR. By multivariable analysis, predictors of PPM included increased age, pre-existing right bundle branch block, larger THV size, greater THV oversizing, moderate or severe annulus calcification, and implantation depth >6 mm. At 5 years (median follow-up 1,682.0 days [min 2.0 days, max 2,283.0 days]), new PPM was not associated with increased rates of all-cause mortality (Adj HR: 1.20; 95% CI: 0.85-1.70; P = 0.30) or repeat hospitalization (Adj HR: 1.22; 95% CI: 0.67-2.21; P = 0.52). Patients with new PPM had a decline in left ventricular ejection fraction at 1 year that persisted at 5 years (55.1 ± 2.55 vs 60.4 ± 0.65; P = 0.02). CONCLUSIONS: PPM was required in 12.5% of patients without prior PPM who underwent TAVR with a SAPIEN 3 valve in the PARTNER 2 S3 registries and was not associated with worse clinical outcomes, including mortality, at 5 years. Modifiable factors that may reduce the PPM rate include bioprosthetic valve oversizing, prosthesis size, and implantation depth.


Assuntos
Estenose da Valva Aórtica , Valva Aórtica , Estimulação Cardíaca Artificial , Próteses Valvulares Cardíacas , Marca-Passo Artificial , Desenho de Prótese , Sistema de Registros , Substituição da Valva Aórtica Transcateter , Humanos , Masculino , Feminino , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Substituição da Valva Aórtica Transcateter/instrumentação , Fatores de Risco , Idoso , Fatores de Tempo , Idoso de 80 Anos ou mais , Resultado do Tratamento , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/mortalidade , Valva Aórtica/cirurgia , Valva Aórtica/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Medição de Risco , Arritmias Cardíacas/terapia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Estados Unidos/epidemiologia
17.
JACC Cardiovasc Interv ; 17(11): 1340-1351, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38866457

RESUMO

BACKGROUND: The etiology of transcatheter aortic valve (TAV) degeneration is poorly understood, particularly noncalcific mechanisms. OBJECTIVES: The authors sought to investigate noncalcific and calcific mechanisms of TAV degeneration and evaluate their impact on leaflet function by bench testing, imaging, and histology. METHODS: TAV explants were obtained from the EXPLANT THV registry and clinical institutions. Hydrodynamic assessment was performed using a heart valve pulse duplicator system under physiological conditions. Micro-computed tomography, high-resolution photography, high speed video, and hematoxylin and eosin staining were used to evaluate the morphological appearance, leaflet kinematics, and calcium burden of TAVs. RESULTS: A total of 14 explants were evaluated: 10 self-expanding CoreValve/Evolut TAVs (Medtronic), 3 balloon-expandable SAPIEN 3 TAVs (Edwards Lifesciences), and 1 mechanically expandable Lotus TAV (Boston Scientific). The median patient age at explantation was 73.0 years (Q1-Q3: 64.5-80.0 years), with a time to explantation of 4 years 1 month (1 year 5 months to 4 years 11 months). Six TAV explants were found to have leaflet calcification (162.4 mm3; 58.8-603.0 mm3), and 8 had no calcification detectable by micro-computed tomography and histology. All samples had impaired leaflet kinematics. There was no significant difference in the hydrodynamic mean gradient between calcified (47.2 mm Hg; 26.6-74.1 mm Hg) and noncalcified (27.6 mm Hg; 15.2-36.7 mm Hg; P = 0.28) TAVs. Leaflet calcification had a weak but nonsignificant association with the hydrodynamic mean gradient (r = 0.42; P = 0.14). CONCLUSIONS: TAV function can be severely impacted by noncalcific and calcific mechanisms of tissue degeneration. Importantly, functional stenosis can occur in TAVs in the absence of obvious and significant calcification.


Assuntos
Valva Aórtica , Calcinose , Próteses Valvulares Cardíacas , Hidrodinâmica , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Substituição da Valva Aórtica Transcateter , Microtomografia por Raio-X , Humanos , Idoso , Valva Aórtica/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Valva Aórtica/patologia , Calcinose/fisiopatologia , Calcinose/diagnóstico por imagem , Calcinose/patologia , Calcinose/cirurgia , Feminino , Idoso de 80 Anos ou mais , Masculino , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/efeitos adversos , Pessoa de Meia-Idade , Fatores de Tempo , Remoção de Dispositivo , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Hemodinâmica , Fenômenos Biomecânicos , Teste de Materiais , Gravação em Vídeo
18.
Biol Pharm Bull ; 47(6): 1128-1135, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38866521

RESUMO

Medication waste may be caused by medication oversupply; however, the degree of medication oversupply in Japan is unclear. This study aimed to quantify the degree of oversupply of chronic disease medications per patient, the proportion of oversupplied patients, and the excess days and costs of the oversupplied medications in Japan. This retrospective nationwide cohort study using a large insurance claims database from Japan was conducted in patients aged ≥55 years who received one or a combination of the following five classes of medications dispensed in FY 2019: third-generation calcium antagonists, angiotensin 2 receptor blockers, statins, dipeptidyl peptidase-4 inhibitors, and biguanides. Medications with the same ingredient having the same specification were treated as the same medication. Medication oversupply was defined as a medication possession ratio (MPR) during persistence >1.0. The proportions of oversupplied patients and excessively oversupplied patients with ≥30 excess days/year were approximately 16 and 1-2% for all drug classes, respectively. Three-quarters of the oversupplied patients had fewer excess day (≤14/year), and the median oversupplied medication cost was less than 1000 yen/year for all classes. However, there was a patient with oversupplied medication estimated as 983 excess days per year and a patient with oversupplied medication costs of nearly 90000 yen per year. Using the MPR and excess days as indicators, it is necessary to accelerate estimation of the oversupply per patient, as well as the development of patient intervention strategies and a national system to reduce medication oversupply.


Assuntos
Custos de Medicamentos , Humanos , Japão , Idoso , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Doença Crônica/tratamento farmacológico , Idoso de 80 Anos ou mais , Adesão à Medicação/estatística & dados numéricos , Bases de Dados Factuais
19.
Neuropathol Appl Neurobiol ; 50(3): e12991, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38867123

RESUMO

AIMS: The aggregation and deposition of amyloid-ß (Aß) peptides in the brain is thought to be the initial driver in the pathogenesis of Alzheimer's disease (AD). Aside from full-length Aß peptides starting with an aspartate residue in position 1, both N-terminally truncated and elongated Aß peptides are produced by various proteases from the amyloid precursor protein (APP) and have been detected in brain tissues and body fluids. Recently, we demonstrated that the particularly abundant N-terminally truncated Aß4-x peptides are generated by ADAMTS4, a secreted metalloprotease that is exclusively expressed in the oligodendrocyte cell population. In this study, we investigated whether ADAMTS4 might also be involved in the generation of N-terminally elongated Aß peptides. METHODS: We used cell-free and cell-based assays in combination with matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF) and electrochemiluminescence sandwich immunoassays to identify and quantify N-terminally elongated Aß peptide variants. Antibodies against these Aß variants were characterised by peptide microarrays and employed for the immunohistochemical analyses of human brain samples. RESULTS: In this study, we discovered additional ADAMTS4 cleavage sites in APP. These were located N-terminal to Asp-(1) in the Aß peptide sequence between residues Glu-(-7) and Ile-(-6) as well as Glu-(-4) and Val-(-3), resulting in the release of N-terminally elongated Aß-6-x and Aß-3-x peptides, of which the latter serve as a component in a promising Aß-based plasma biomarker. Aß-6/-3-40 peptides were detected in supernatants of various cell lines and in the cerebrospinal fluid (CSF), and ADAMTS4 enzyme activity promoted the release of Aß-6/-3-x peptides. Furthermore, by immunohistochemistry, a subset of AD cases displayed evidence of extracellular and vascular localization of N-terminally elongated Aß-6/-3-x peptides. DISCUSSION: The current findings implicate ADAMTS4 in both the pathological process of Aß peptide aggregation and in the early detection of amyloid pathology in AD.


Assuntos
Proteína ADAMTS4 , Doença de Alzheimer , Peptídeos beta-Amiloides , Encéfalo , Humanos , Doença de Alzheimer/metabolismo , Doença de Alzheimer/patologia , Proteína ADAMTS4/metabolismo , Peptídeos beta-Amiloides/metabolismo , Encéfalo/metabolismo , Encéfalo/patologia , Idoso , Masculino , Feminino , Idoso de 80 Anos ou mais
20.
Rev Neurol ; 78(12): 335-341, 2024 Jun 16.
Artigo em Espanhol | MEDLINE | ID: mdl-38867682

RESUMO

INTRODUCTION: High intensity focal ultrasound (HIFU) thalamotomy is a novel treatment for refractory tremor. This study aims to compare the reduction in tremor intensity and adverse effects of treatment between patients younger and older than 70 years of age. PATIENTS AND METHODS: All the patients with refractory essential tremor treated with HIFU between March 2021 and March 2023 were included consecutively. Various demographic and clinical variables were analysed, including age and the items on the Clinical Rating Scale for Tremor (CRST). Cerebral vascular pathology was quantified using the Fazekas scale. Outcomes and adverse effects were compared between the patients aged 70 years or younger, and those older than 70 years. RESULTS: Ninety patients were included, and 50 of them were over 70 years old. Prior to treatment, the CRST A + B score was 20.4 ± 5.7 among those under 70 years of age, and 23.3 ± 5.1 in those older (p = 0.013). At six months after treatment, the mean was 3.8 ± 5.1 and 4.8 ± 4.5, respectively (p = 0.314). We found no significant differences in the CRST C score (2.8 ± 4.1 and 3.5 ± 4.8, p = 0.442). There were also no significant differences between the patients with vascular pathology (Fazekas = 1) and those without (4.6 ± 7.3 and 4.3 ± 4, p = 0.832). There were no differences in the presence of adverse effects between the groups based on age and vascular pathology. CONCLUSIONS: Contrary to traditional opinion, older patients do not have a poorer response or a higher rate of adverse effects after HIFU treatment.


TITLE: Talamotomía unilateral con ultrasonidos focales de alta intensidad en pacientes con temblor esencial refractario: un estudio comparativo entre pacientes menores y mayores de 70 años.Introducción. La talamotomía con ultrasonidos focales de alta intensidad (HIFU) es un tratamiento novedoso para el temblor refractario. El objetivo de este estudio es comparar la reducción en la intensidad del temblor y los efectos adversos del tratamiento entre pacientes menores y mayores de 70 años. Pacientes y métodos. Se incluyó consecutivamente a todos los pacientes con temblor esencial refractario tratados con HIFU entre marzo de 2021 y marzo de 2023. Se analizaron diferentes variables demográficas y clínicas, incluyendo la edad y los apartados de la Clinical Rating Scale for Tremor (CRST). Se cuantificó la patología vascular cerebral mediante la escala de Fazekas. Se compararon los resultados y los efectos adversos entre los grupos de edad de 70 años o menos y de más de 70 años. Resultados. Se incluyó a 90 pacientes, 50 de ellos de más de 70 años. Previamente al tratamiento, la CRST A + B era de 20,4 ± 5,7 en los menores de 70 años y de 23,3 ± 5,1 en los mayores (p = 0,013). A los seis meses tras el tratamiento, la media fue de 3,8 ± 5,1 y 4,8 ± 4,5, respectivamente (p = 0,314). No hallamos diferencias significativas en la CRST C (2,8 ± 4,1 y 3,5 ± 4,8, p = 0,442). Tampoco hubo diferencias significativas entre pacientes con patología vascular (Fazekas = 1) y sin ella (4,6 ± 7,3 y 4,3 ± 4, p = 0,832). No hubo diferencias en la presencia de efectos adversos entre los grupos de edad y de patología vascular. Conclusiones. En contra de lo tradicionalmente concebido, los pacientes de mayor edad no tienen una peor respuesta ni una mayor tasa de efectos adversos tras el tratamiento con HIFU.


Assuntos
Tremor Essencial , Tálamo , Humanos , Tremor Essencial/terapia , Tremor Essencial/cirurgia , Tremor Essencial/diagnóstico por imagem , Idoso , Masculino , Feminino , Tálamo/diagnóstico por imagem , Tálamo/cirurgia , Pessoa de Meia-Idade , Fatores Etários , Idoso de 80 Anos ou mais , Ablação por Ultrassom Focalizado de Alta Intensidade/efeitos adversos , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Resultado do Tratamento , Estudos Retrospectivos , Adulto
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