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1.
BMJ ; 368: l6670, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-31911452

RESUMO

Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient's values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.


Assuntos
Neoplasias/diagnóstico , Medição de Risco/métodos , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide , Biópsia/métodos , Testes de Química Clínica , Diagnóstico Diferencial , Humanos , Achados Incidentais , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia
2.
Chemosphere ; 238: 124620, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31472354

RESUMO

Particulate toxic species, such as polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs), polycyclic aromatic hydrocarbons (PAHs) and heavy metals may have significant health risks. This study investigated characteristics, sources and health risks of all three classes of toxic species in PM2.5 (particles with aerodynamic diameter ≤2.5 µm) samples collected at an industrial area in Changzhou, a big city in the Yangtze Delta region of China. Fourteen heavy metals altogether constituted 2.87% of PM2.5 mass, with Fe, Al and Zn as the major elements. Principal component analysis (PCA) suggested that heavy metals came from four sources: vehicles, industry, crustal dust, mixed coal combustion and industrial process. The daily average concentration of 18 PAHs was 235.29 ng/m3, accounting for 0.21% of PM2.5 mass. The dominant PAHs were high molecular weight ones, contributing 73.5% to the total PAHs. Diagnostic analyses indicated that sources of PAHs included vehicle/coal combustion and petroleum emissions, wherein diesel emission played a more important role than gasoline emission. PCA showed that the largest contributor of PAHs was vehicle exhaust mixed with coal combustion, followed by three industry-related sources. Total concentration of 17 PCDD/Fs varied between 3.14 and 37.07 pg/m3, with an average of 14.58 pg/m3. The 10 PCDFs accounted for 70.5% of total concentration of 17 PCDD/Fs. Health risk assessments showed that the carcinogenic risk of heavy metals was acceptable, while risks from PAHs and PCDD/Fs cannot be ignored. Back trajectory analysis indicated that local/regional transported air masses from northern China was the major source areas of the toxic species.


Assuntos
Exposição por Inalação/efeitos adversos , Metais Pesados/análise , Neoplasias/induzido quimicamente , Material Particulado/efeitos adversos , Dibenzodioxinas Policloradas/análise , Hidrocarbonetos Policíclicos Aromáticos/análise , Medição de Risco/métodos , Adulto , Poluentes Atmosféricos/análise , Carcinógenos/análise , Criança , China , Monitoramento Ambiental , Feminino , Humanos , Indústrias , Exposição por Inalação/análise , Masculino , Material Particulado/administração & dosagem , Dibenzodioxinas Policloradas/efeitos adversos , Hidrocarbonetos Policíclicos Aromáticos/efeitos adversos , Estações do Ano , Emissões de Veículos/análise
3.
Chemosphere ; 238: 124604, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31450113

RESUMO

Accurate in silico predictions of chemical substance ecotoxicity has become an important issue in recent years. Most conventional methods, such as the Ecological Structure-Activity Relationship (ECOSAR) model, cluster chemical substances empirically based on structural information and then predict toxicity by employing a log P linear regression model. Due to empirical classification, the prediction accuracy does not improve even if new ecotoxicity test data are added. In addition, most of the conventional methods are not appropriate for predicting the ecotoxicity on inorganic and/or ionized compounds. Furthermore, a user faces difficulty in handling multiple Quantitative Structure-Activity Relationship (QSAR) formulas with one chemical substance. To overcome the flaws of the conventional methods, in this study a new method was developed that applied unsupervised machine learning and graph theory to predict acute ecotoxicity. The proposed machine learning technique is based on the large AIST-MeRAM ecotoxicity test dataset, a software program developed by the National Institute of Advanced Industry Science and Technology for Multi-purpose Ecological Risk Assessment and Management, and the Molecular ACCess System (MACCS) keys that vectorize a chemical structure to 166-bit binary information. The acute toxicity of fish, daphnids, and algae can be predicted with good accuracy, without requiring log P and linear regression models in existing methods. Results from the new method were cross-validated and compared with ECOSAR predictions and show that the new method provides better accuracy for a wider range of chemical substances, including inorganic and ionized compounds.


Assuntos
Ecotoxicologia/métodos , Aprendizado de Máquina , Poluentes Químicos da Água/toxicidade , Poluição Química da Água/análise , Animais , Simulação por Computador , Daphnia/efeitos dos fármacos , Peixes , Modelos Lineares , Modelos Teóricos , Relação Quantitativa Estrutura-Atividade , Medição de Risco/métodos , Software , Poluentes Químicos da Água/química
4.
Medicine (Baltimore) ; 98(50): e18322, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852121

RESUMO

BACKGROUND: Drug induced liver injury (DILI) is an increasing cause of acute liver injury especially with increasing need for pharmacotherapy of widening comorbidities amongst our ever-aging population. Uncertainty however remains regarding both acceptable and widely agreeable diagnostic algorithms as well a clear understanding of mechanistic insights that most accurately underpins it. In this review, we have explored the potential role of emerging novel markers of DILI and how they could possibly be integrated into clinical care of patients. METHODS: We explored PUBMED and all other relevant databases for scientific studies that explored potential utility of novel biomarkers of DILI, and subsequently carried out a narrative synthesis of this data. As this is a narrative review with no recourse to patient identifiable information, no ethics committee's approval was sought or required. RESULTS: Novel biomarkers such as microRNA-122 (miR-122) profiles, high mobility group box-1 (HMGB1), glutamate dehydrogenase (GLDH), and cytokeratin-18 (K-18), amongst others do have the potential for reducing diagnostic uncertainties associated with DILI. CONCLUSION: With the increasing validation of some of the novel liver biomarkers such as K-18, mir-122, HMGB-1, and GLDH, there is the potential for improvement in the diagnostic uncertainty commonly associated with cases of DILI.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Glutamato Desidrogenase/análise , Proteína HMGB1/análise , Queratina-18/análise , MicroRNAs/análise , Medição de Risco/métodos , Biomarcadores/análise , Humanos
5.
Medicine (Baltimore) ; 98(50): e18196, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852076

RESUMO

This study aimed at investigating the prevalence of anxiety and depression, and their risk factors as well as their correlation with prognosis in refractory or relapsed (R/R) acute myeloid leukemia (AML) patients.A total of 180 R/R AML patients were enrolled and their anxiety and depression were assessed by Hospital Anxiety and Depression Scale (HADS) before treatment. Besides, HADS was also evaluated in 180 de novo AML patients prior treatment and 180 healthy controls (HCs), respectively.Both the HADS-Anxiety and HADS-Depression scores were increased in R/R AML patients compared with de novo AML patients and HCs (all P < .001). Meanwhile, the prevalence of anxiety and depression was 53.9% and 45.6% in R/R AML patients, which were also greatly higher compared with de novo AML patients and HCs (all P < .01). Regarding risk factors, higher Eastern Cooperative Oncology Group score and lines of salvage therapy were correlated with anxiety and depression in R/R AML patients (all P < .05). Furthermore, anxiety and depression were associated with shorter overall survival (OS) in R/R AML patients (all P < .05), while no association of different degrees of anxiety and depression with OS was observed (all P > .05).Anxiety and depression are highly prevalent and implicated in the management and prognosis of R/R AML.


Assuntos
Ansiedade/etiologia , Depressão/epidemiologia , Leucemia Mieloide Aguda/complicações , Indução de Remissão/métodos , Medição de Risco/métodos , Ansiedade/epidemiologia , China/epidemiologia , Terapia Combinada , Depressão/etiologia , Feminino , Seguimentos , Humanos , Incidência , Leucemia Mieloide Aguda/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco
6.
Braz J Cardiovasc Surg ; 34(5): 535-541, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719007

RESUMO

INTRODUCTION: Metabolic syndrome (MetS) is defined as an association between diabetes, hypertension, obesity and dyslipidemia and an increased risk of cardiovascular disease. Mitral annular calcification (MAC) is associated with several cardiovascular disorders, including coronary artery disease, atrial fibrillation (AF), heart failure, ischemic stroke and increased mortality. The CHA2DS2-VASc score is used to estimate thromboembolic risk in AF. However, the association among MAC, MetS and thromboembolic risk is unknown and was evaluated in the current study. METHODS: The study group consisted of 94 patients with MAC and 86 patients with MetS. Patients were divided into two groups: those with and those without MAC. RESULTS: Patients with MAC had a higher MetS rate (P<0.001). In patients with MAC, the CHA2DS2-VASc scores and the rate of cerebrovascular accident and AF were significantly higher compared to those without MAC (P<0.001, for both parameters). The results of the multivariate regression analysis showed that history of smoking, presence of MetS and high CHA2DS2-VASc scores were associated with the development of MAC. ROC curve analyses showed that CHA2DS2-VASc scores were significant predictors for MAC (C-statistic: 0.78; 95% CI: 0.706-0.855, P<0.001). Correlation analysis indicated that MAC was positively correlated with the presence of MetS and CHA2DS2-VASc score (P=0.001, r=0.264; P<0.001, r=0.490). CONCLUSION: We have shown that CHA2DS2-VASc score and presence of MetS rates were significantly higher in patients with MAC compared without MAC. Presence of MAC was correlated with CHA2DS2-VASc score, presence of MetS, AF and left atrial diameter and negatively correlated with left ventricular ejection fraction.


Assuntos
Calcinose/complicações , Doenças das Valvas Cardíacas/complicações , Síndrome Metabólica/complicações , Valva Mitral , Tromboembolia/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Calcinose/fisiopatologia , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Volume Sistólico/fisiologia , Tromboembolia/fisiopatologia
7.
Medicine (Baltimore) ; 98(46): e17510, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725605

RESUMO

Due to the complexity of Crohn's disease (CD), it is difficult to predict disease course with a single stratification factor or biomarker. A logistic regression (LR) model has been proposed by Guizzetti et al to stratify patients with CD-related surgical risk, which could help decision-making on disease treatment. However, there are no reports on relevant studies on Chinese population. The aim of the study is to present and validate a novel surgical predictive model to facilitate therapeutic decision-making for Chinese CD patients. Data was extracted from retrospective full-mode electronic medical records, which contained 239 CD patients and 1524 instances. Two sub-datasets were generated according to different attribute selection strategies, both of which were split into training and testing sets randomly. The imbalanced data in the training sets was addressed by synthetic minority over-sampling technique (SMOTE) algorithm before model development. Seven predictive models were employed using 5 popular machine learning algorithms: random forest (RF), LR, support vector machine (SVM), decision tree (DT) and artificial neural networks (ANN). The performance of each model was evaluated by accuracy, precision, F1-score, true negative (TN) rate, and the area under the receiver operating characteristic curve (AuROC). The result revealed that RF outperformed all other baseline models on both sub-datasets. The 10 leading risk factors for CD-related surgery returned from RF for attribute ranking were changes of radiology, presence of a fistula, presence of an abscess, no infliximab use, enteroscopy findings, C-reactive protein, abdominal pain, white blood cells, erythrocyte sedimentation rate and platelet count. The proposed machine learning model can accurately predict the risk of surgical intervention in Chinese CD patients, which could be used to tailor and modify the treatment strategies for CD patients in clinical practice.


Assuntos
Doença de Crohn/diagnóstico , Doença de Crohn/cirurgia , Técnicas de Apoio para a Decisão , Endoscopia do Sistema Digestório/estatística & dados numéricos , Modelos Anatômicos , Adulto , Algoritmos , Área Sob a Curva , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , China , Árvores de Decisões , Feminino , Humanos , Modelos Logísticos , Aprendizado de Máquina/estatística & dados numéricos , Masculino , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Máquina de Vetores de Suporte
9.
Z Gerontol Geriatr ; 52(Suppl 4): 222-228, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31620876

RESUMO

BACKGROUND: Risk stratification of older patients in the emergency department (ED) is seen as a promising and efficient solution for handling the increase in demand for geriatric emergency medicine. Previously, the predictive validity of commonly used tools for risk stratification, such as the identification of seniors at risk (ISAR), have found only limited evidence in German geriatric patient samples. Given that the adverse outcomes in question, such as rehospitalization, nursing home admission and mortality, are substantially associated with cognitive impairment, the potential of the short portable mental status questionnaire (SPMSQ) as a tool for risk stratification of older ED patients was investigated. OBJECTIVE: To estimate the predictive validity of the SPMSQ for a composite endpoint of adverse events (e.g. rehospitalization, nursing home admission and mortality). METHOD: This was a prospective cohort study with 260 patients aged 70 years and above, recruited in a cardiology ED. Patients with a likely life-expectancy below 24 h were excluded. Follow-up examinations were conducted at 1, 3, 6 and 12 month(s) after recruitment. RESULTS: The SPMSQ was found to be a significant predictor of adverse outcomes not at 1 month (area under the curve, AUC 0.55, 95% confidence interval, CI 0.46-0.63) but at 3 months (AUC 0.61, 95% CI 0.54-0.68), 6 months (AUC 0.63, 95% CI 0.56-0.70) and 12 months (AUC 0.63, 95% CI 0.56-0.70) after initial contact. CONCLUSION: For longer periods of observation the SPMSQ can be a predictor of a composite endpoint of adverse outcomes even when controlled for a range of confounders. Its characteristics, specifically the low sensitivity, make it unsuitable as an accurate risk stratification tool on its own.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Avaliação Geriátrica , Programas de Rastreamento/métodos , Admissão do Paciente/estatística & dados numéricos , Medição de Risco/métodos , Idoso , Cuidados Críticos , Feminino , Serviços de Saúde para Idosos , Hospitalização , Humanos , Masculino , Alta do Paciente/estatística & dados numéricos , Estudos Prospectivos , Medição de Risco/normas
10.
Isr Med Assoc J ; 21(10): 671-675, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599509

RESUMO

BACKGROUND: Recently, Israel established the first national-level adult cardiac surgery database, which was linked to the Society of Thoracic Surgeons (STS). OBJECTIVES: To validate and compare the STS predicted risk of mortality (PROM) to logistic EuroSCORE I (LESI) and EuroSCORE II (ESII) in Israeli patients undergoing cardiac surgery. METHODS: We retrospectively studied 1279 consecutive patients who underwent cardiac surgeries with a calculable PROM. Data were prospectively entered into our database and used to calculate PROM, LESI, and ESII. Scores were normalized and correlated using linear regression and Pearson's test. To examine model calibration, we plotted the total observed versus expected mortality for each score and across five risk-score subgroups. Model discrimination was assessed by measuring the area under the receiver operating curves. RESULTS: The observed 30-day operative mortality was 1.95%. The median (IQ1; IQ3) PROM, LESI, and the ESII scores were 1.45% (0.69; 3.22), 4.54% (2.28; 9.27), and 1.88% (1.18; 3.54), respectively, with observed over expected ratios of 0.63 (95% confidence interval [95%CI] 0.42-0.93), 0.59 (95%CI 0.40-0.87), and 0.24 (95%CI 0.17-0.36), respectively, (STS vs. ESII P = 0.36, STS vs. LESI P = 0.0001). There was good correlation among all scores. All models overestimated mortality. Model discrimination was high and similar for all three scores. Model calibration of the STS, PROM, and ESII were more accurate than the LESI, particularly in higher risk subgroups. CONCLUSIONS: All scores overestimated mortality. In Israeli patients, the STS, PROM, and ESII risk-scores were more reliable metrics than LESI, particularly in higher risk patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Gestão de Riscos/métodos , Gestão de Riscos/estatística & dados numéricos , Idoso , Bases de Dados Factuais , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença , Sociedades Médicas , Cirurgia Torácica
11.
J Surg Oncol ; 120(7): 1276-1283, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31602665

RESUMO

OBJECTIVE: To develop a nomogram to estimate the probability of positive sentinel lymph node (+SLN) for patients with thin melanoma and to characterize its potential impact on sentinel lymph node biopsy (SLNB) rates. METHODS: Patients diagnosed with thin (0.5-1.0 mm) melanoma were identified from the National Cancer Database 2012 to 2015. A multivariable logistic regression model was used to examine factors associated with +SLN, and a nomogram to predict +SLN was constructed. Nomogram performance was evaluated and diagnostic test statistics were calculated. RESULTS: Of the 21 971 patients included 10 108 (46.0%) underwent SLNB, with a 4.0% +SLN rate. On multivariable analysis, age, Breslow thickness, lymphovascular invasion, ulceration, and Clark level were significantly associated with SLN status. The area under the receiver operating curve was 0.67 (95% confidence interval, 0.65-0.70). While 15 249 (69.4%) patients had either T1b tumors or T1a tumors with at least one adverse feature, only 2846 (13.0%) had a nomogram predicted probability of a +SLN ≥5%. Using this cut-off, the indication for a SLNB in these patients would be reduced by 81.3% as compared to the American Joint Committee on Cancer 8th edition staging criteria. CONCLUSIONS: The risk predictions obtained from the nomogram allow for more accurate selection of patients who could benefit from SLNB.


Assuntos
Tomada de Decisões , Melanoma/patologia , Nomogramas , Medição de Risco/métodos , Linfonodo Sentinela/patologia , Neoplasias Cutâneas/patologia , Idoso , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Melanoma/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/cirurgia
12.
J Drugs Dermatol ; 18(10): 980-984, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584775

RESUMO

Background: The incidence of cutaneous squamous cell carcinoma (cSCC) is increasing likely due to improved detection and a growing elderly population. Although the prognosis of cSCC is excellent with complete surgical excision, many patients who go on to develop metastasis are initially classified as low-risk. The most commonly used staging systems, American Joint Committee on Cancer (AJCC) and Brigham Women's Hospital (BWH), have low sensitivity and low positive predictive value for predicting metastasis. A gene expression profile test (cSCC-GEP) is in development to identify patients with cSCC at high risk for metastasis and death. Objective: To determine the impact of cSCC-GEP test results on management decisions made by dermatologists for cSCC patients. Design, Setting, and Participants: 402 dermatologists attending a national dermatology conference completed an online survey designed to determine the impact of cSCC-GEP test results on management decisions in a variety of clinical situations. Participants answered a series of questions related to three cSCC patient vignettes, each featuring different patient and lesion characteristics. Main Outcomes and Measures: Proportion of dermatologists who would recommend radiation, chemotherapy/immunotherapy, or sentinel lymph node biopsy (SLNBx) for each patient vignette (without cSCC-GEP results, with a lower risk result, or with a higher risk result). The effect of the test results on the follow-up intervals recommended by dermatologists was also examined. Results: In the majority of vignettes, a lower risk cSCC-GEP test result led to a statistically significant decrease in the proportion of dermatologists who would recommend radiation, chemotherapy/immunotherapy, SLNBx, or quarterly follow-up. Conversely, a higher risk cSCC-GEP result significantly altered management toward increased intensity (more recommendations for radiation, chemotherapy/immunotherapy, SLNBx, or quarterly follow-up) in all vignettes. Conclusions and Relevance: The results of a cSCC-GEP test appear to significantly impact decisions made by dermatologists regarding subsequent management, SLNBx, and follow-up intervals for patients with cSCC. J Drugs Dermatol. 2019;18(10):980-984.


Assuntos
Carcinoma de Células Escamosas/terapia , Tomada de Decisão Clínica/métodos , Dermatologia/métodos , Perfilação da Expressão Gênica , Neoplasias Cutâneas/terapia , Adulto , Assistência ao Convalescente/métodos , Idoso , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Dermatologistas/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Medição de Risco/métodos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Inquéritos e Questionários/estatística & dados numéricos
13.
Medicine (Baltimore) ; 98(39): e17105, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574809

RESUMO

We aimed to determine the accuracy and failure of OAK device, an automated screening, for the assessment of fall risk in a prospective cohort of healthy adults aged over 65 years. The algorithm for fall risk assessment of the centers for disease control and prevention (CDC) was used as reference standard. Of the 183 individuals recruited, the CDC algorithm classified 80 as being at moderate/high risk and 103 at low risk of falling. OAK device failure incidence was 4.9% (confidence interval [CI] upper limit 7.7%), below the preset threshold for futility-early termination of the study (i.e., not above 15%). The OAK device showed a sensitivity of 84% and a specificity of 67% (receiver operating characteristic [ROC] area 82%; 95% confidence interval [CI] 76-88%), not reaching the preplanned target sensitivity (not lower than 85%). Diagnostic accuracy was not far from the sensitivity levels similar to those obtained with other fall risk assessment. However, some limitations can be considered.ClinicalTrials.gov identifier: NCT02655796.


Assuntos
Acidentes por Quedas , Teste de Esforço/métodos , Programas de Rastreamento/métodos , Medição de Risco/métodos , Idoso , Desenho de Equipamento , Falha de Equipamento , Teste de Esforço/instrumentação , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade
14.
J Surg Oncol ; 120(7): 1154-1161, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31578743

RESUMO

BACKGROUND: Postoperative adjuvant chemotherapy is not indicated for T1N1M0/T2N0M0/T3N0M0 gastric cancer. However, approximately 10% to 30% of these patients experience recurrence and metastasis. METHODS: Among 658 patients with gastric cancer who received gastrectomy with curative intent, 130 T1N1M0/T2N0M0 and 73 T3N0M0 patients were enrolled. Overall survival (OS) and relapse-free survival (RFS) were analyzed based on TP53 codon 72 polymorphisms Arg/Arg, Arg/Pro, and Pro/Pro. The hazard ratio (HR) for each subgroup was compared by TP53 codon 72 polymorphisms. RESULTS: Of the 189 patients for whom polymorphism analysis results were available, the 5- and 10-year OS was 84.9% and 65.1%, respectively. The 5- and 10-year RFS was 81.8% and 65.4%, respectively. When the study cohort was divided into two groups according to polymorphism status (ie, "Arg/Arg and Arg/Pro" vs Pro/Pro), both the OS (HR, 2.799; 95% confidence interval [CI], 1.071-7.315; P = .036) and RFS (HR, 2.639; 95% CI, 1.025-6.794; P = .044) of the Pro/Pro group were significantly lower than those for the Arg/Arg and Arg/Pro groups across the entire observation period. CONCLUSIONS: The TP53 codon 72 Pro/Pro polymorphism may isolate a relatively high-risk patient group in T1N1M0/T2N0M0/T3N0M0 gastric cancer.


Assuntos
Adenocarcinoma/cirurgia , Gastrectomia/efeitos adversos , Recidiva Local de Neoplasia/diagnóstico , Polimorfismo de Nucleotídeo Único , Medição de Risco/métodos , Neoplasias Gástricas/cirurgia , Proteína Supressora de Tumor p53/genética , Adenocarcinoma/genética , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Códon , Feminino , Seguimentos , Predisposição Genética para Doença , Genótipo , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/genética , Estadiamento de Neoplasias , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologia , Taxa de Sobrevida
15.
J Surg Oncol ; 120(7): 1126-1136, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31578753

RESUMO

BACKGROUND AND OBJECTIVES: Albumin-bilirubin (ALBI) score was shown to correlate with liver function and tumor recurrence after hepatectomy for hepatocellular carcinoma (HCC). The aim of this study was to assess the prognostic value of ALBI grade in liver transplantation (LT) patients with HCC. METHODS: Pre-LT available independent predictors of recurrence-free survival (RFS) and microvascular tumor invasion (MVI) were determined in 123 patients with HCC. RESULTS: Posttransplant HCC recurrence rates were 10.5%, 15.9%, and 68.2% in ALBI grade 1, 2, and 3, respectively (P < .001). Along with serum α-fetoprotein (AFP) and C-reactive protein (CRP) levels, ALBI grades 1 or 2 was identified as an independent predictor of RFS (hazard ratio, 3.52; 95% confidence interval [CI], 1.577-7.842; P = .002). Furthermore, ALBI grade 3 proved to be the strongest indicator of MVI (odds ratio, 11.59; 95% CI, 3.412-39.381; P < .001). A novel oncological risk score-based on AFP, CRP, and ALBI grade provided the best discriminative capacity (c-statistic 0.806) in selecting liver recipients with low oncological risk profile. CONCLUSION: Preoperative ALBI grade seems to be valuable for refinement of oncological risk stratification at LT for HCC.


Assuntos
Bilirrubina/metabolismo , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Transplante de Fígado/mortalidade , Recidiva Local de Neoplasia/patologia , Medição de Risco/métodos , Albumina Sérica/metabolismo , Adulto , Idoso , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/cirurgia , Tomada de Decisão Clínica , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/metabolismo , Recidiva Local de Neoplasia/cirurgia , Cuidados Pré-Operatórios , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida
16.
Medicine (Baltimore) ; 98(42): e17544, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626117

RESUMO

The protective role of serum total bilirubin, a widely recognized antioxidant, has been approved by numerous updating studies. However, regarding the effect of high serum total bilirubin level (STBL) in arteriosclerotic cardiovascular disease (ASCVD) are conflicting in different sources of data. We, therefore, performed this meta-analysis to evaluate the influence of STBL on risk of ASCVD.Four databases were used to identify the literature with a date of search of January, 2019. Finally, a total of 20 studies had been adopted. ASCVD was defined as acute coronary syndrome, stable angina, coronary revascularization, atherosclerotic stroke or transient ischemic attack, and peripheral arterial disease (PAD). All relevant data were collected from studies meeting the inclusion criteria.A total of 20 published studies (323,891 cases) met the inclusion criteria. The meta-analysis revealed that, in studies excluding heterogeneity, STBL was significantly positively related to in-hospital cardiovascular mortality (odds ratio [OR] 2.82, 95% confidence interval [CI] 1.83-4.36, Z = 4.69, P < .001) and major adverse cardiac events (OR 1.88, 95% CI 1.414-2.491, Z = 4.36, P < .001), also negatively associated with prognosis of acute myocardial infarction, pooled hazard ratio (HR) = 0.804 (95% CI 0.700-0.923, Z = 3.08, P = .002). The correlation similarity was also reflected in terms of patients with stroke (HR 0.78, 95% CI 0.70-0.88, Z = 4.24, P = .003). Combined analysis revealed that lower STBL was significantly associated with PAD, pooled OR = 0.91 (95% CI 0.85-0.98, Z = 2.39, P = .017). In general analysis, a conclusion can be drawn, that higher STBL was significantly negative correlated with cardiovascular disease, pooled HR = 0.83 (95% CI 0.73-0.94, Z = 3.02, P = .003).Higher STBL significantly improved the prognosis of ASCVD; furthermore, STBL was an important factor in the long-term prognosis of vascular-related disease prevention and can be used as a predictor in vascular-related disease risk prediction.


Assuntos
Aterosclerose/sangue , Bilirrubina/sangue , Doenças Cardiovasculares/sangue , Adulto , Idoso , Aterosclerose/mortalidade , Doenças Cardiovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Medição de Risco/métodos , Fatores de Risco
17.
Medicine (Baltimore) ; 98(43): e17537, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651856

RESUMO

Neutrophil-to-lymphocyte ratio (NLR) serves as a strong prognostic indicator for patients suffering from various diseases. Neutrophil activation promotes the recruitment of a number of different cell types that are involved in acute and chronic inflammation and are associated with cancer treatment outcome. Measurement of NLR, an established inflammation marker, is cost-effective, and it is likely that NLR can be used to predict the development of metabolic syndrome (MS) at an early stage. MS scores range from 1 to 5, and an elevated MS score indicates a greater risk for MS. Monitoring NLR can prevent the risk of MS.A total of 34,013 subjects were enrolled in this study. The subjects (score 0-5) within the 6 groups were classified according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria, and all anthropometrics, laboratory biomarkers, and hematological measurements were recorded. For the 6 groups, statistical analysis and receiver operating characteristic (ROC) curves were used to identify the development of MS.Analysis of the ROC curve indicated that NLR served as a good predictor for MS. An MS score of 1 to 2 yielded an acceptable discrimination rate, and these rates were even higher for MS scores of 3 to 5 (P < .001), where the prevalence of MS was 30.8%.NLR can be used as a prognostic marker for several diseases, including those associated with MS.


Assuntos
Linfócitos/metabolismo , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Neutrófilos/metabolismo , Medição de Risco/métodos , Adulto , Biomarcadores/sangue , Feminino , Humanos , Contagem de Linfócitos , Masculino , Síndrome Metabólica/etiologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco
18.
Medicine (Baltimore) ; 98(43): e17699, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651901

RESUMO

The purpose of this study was to verify the usefulness of machine learning (ML) for selection of risk factors and development of predictive models for patients with sarcopenia.We collected medical records from Korean postmenopausal women based on Korea National Health and Nutrition Examination Surveys. A training data set compiled from simple survey data was used to construct models based on popular ML algorithms (e.g., support vector machine, random forest [RF], and logistic regression).A total of 4020 patients ≥65 years of age were enrolled in this study. The study population consisted of 1698 (42.2%) male and 2322 (57.8%) female patients. The 10 most important risk factors in men were body mass index (BMI), red blood cell (RBC) count, blood urea nitrogen (BUN), vitamin D, ferritin, fiber intake (g/d), primary diastolic blood pressure, white blood cell (WBC) count, fat intake (g/d), age, glutamic-pyruvic transaminase, niacin intake (mg/d), protein intake (g/d), fasting blood sugar, and water intake (g/d). The 10 most important risk factors in women were BMI, water intake (g/d), WBC, RBC count, iron intake (mg/d), BUN, high-density lipoprotein, protein intake (g/d), fiber consumption (g/d), vitamin C intake (mg/d), parathyroid hormone, niacin intake (mg/d), carotene intake (µg/d), potassium intake (mg/d), calcium intake (mg/d), sodium intake (mg/d), retinol intake (µg/d), and age. A receiver operating characteristic (ROC) curve analysis found that the area under the ROC curve for each ML model was not significantly different within a gender.The most cost-effective method in clinical practice is to make feature selection using RF models and expert knowledge and to make disease prediction using verification by several ML models. However, the developed prediction model should be validated using additional studies.


Assuntos
Aprendizado de Máquina , Medição de Risco/métodos , Sarcopenia/epidemiologia , Idoso , Estudos Transversais , Feminino , Humanos , Inquéritos Nutricionais , Pós-Menopausa , República da Coreia/epidemiologia , Fatores de Risco
19.
Medicine (Baltimore) ; 98(42): e17568, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626123

RESUMO

BACKGROUND: The aim of this study was to investigate the risk and peak time of post-traumatic hydrocephalus (PTH) in traumatic brain injury (TBI) patients with traumatic subarachnoid hemorrhage (SAH), compared to TBI patients without traumatic SAH. METHODS: In this retrospective population-based cohort study, the data was extracted from Longitudinal Health Insurance Database from 2000 to 2010 in Taiwan. A total of 23,775 TBI patients who had a first event TBI during 2000 to 2010 were included and divided into TBI with SAH (TBI-S) group and TBI without SAH (TBI-NS) group. We focused on analyzing the PTH in both groups within 2 years after brain injury. Competing risk regression models were performed to assess the risk of developing PTH in the TBI-S group compared to the TBI-NS group. RESULTS: Comparing to the TBI-NS group, there was a significantly higher cumulative incidence of PTH in the TBI-S group during the 2-year follow-up period. The adjusted hazard ratio (HR) of PTH in TBI-S group within 2 years was between 2.90-3.47, and the highest estimates were obtained within 6 months after injury (HR = 3.47, 95% CI: 2.43-4.94). The occurrence percentage of PTH was highest during 0-3rd month follow-up periods (1.95% in TBI-S group; 0.48% in TBI-NS group). CONCLUSIONS: The peak time of PTH occurrence was noted during 0-3rd month post brain injury. Traumatic SAH patients had an approximate 3-fold risk of developing PTH, comparing to TBI patients without traumatic SAH.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Hidrocefalia/epidemiologia , Vigilância da População/métodos , Medição de Risco/métodos , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Hidrocefalia/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
20.
Medicine (Baltimore) ; 98(42): e17576, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626126

RESUMO

Studies have found that the measurement of body composition can be used to identify the gestational diabetes mellitus (GDM) risk in pregnant women. However, few studies focused on the relationship between body composition and GDM development in low GDM risk population. Thus, the objective of this study was to examine the association between body composition and the development of GDM in pregnant women with low risk of gestational diabetes.A retrospective case-control study was conducted. We reviewed the medical records of 3965 pregnant women who had body composition measurement from March, 2016 to May, 2018 in our hospital. Their sociodemographic, clinical data, and body composition information were collected from medical record. Multiple logistic regression analyses were used.A total of 2698 subjects were eligible for the study. The mean age of the gravidas was 30.95 ±â€Š4.01 years old. Of all gravidas, 462 had gestational diabetes. Percentage body fat was the strongest risk factor for gestational diabetes after adjusting pre-pregnancy body mass index (BMI) (odds ratio = 1.786, 95% confidence interval = 1.112-2.866, P = .02). The age and extracellular water/intracellular water ratio were independently associated with gestational diabetes.Percentage body fat was the strongest risk factor for gestational diabetes after adjusting pre-pregnancy BMI. Assessment of body composition may provide important guidance to identify gestational diabetes in pregnant women with low gestational diabetes risk.


Assuntos
Constituição Corporal , Diabetes Gestacional/epidemiologia , Ganho de Peso na Gestação , Medição de Risco/métodos , Adulto , Estudos de Casos e Controles , China/epidemiologia , Diabetes Gestacional/etiologia , Diabetes Gestacional/fisiopatologia , Feminino , Humanos , Incidência , Gravidez , Estudos Retrospectivos , Fatores de Risco
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