Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 36.190
Filtrar
2.
Sci Rep ; 11(1): 17791, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493750

RESUMO

The purpose of this study is to explore whether uric acid (UA) can independently act as a prognostic factor and critical marker of the 2019 novel corona virus disease (COVID-19). A multicenter, retrospective, and observational study including 540 patients with confirmed COVID-19 was carried out at four designated hospitals in Wuhan. Demographic, clinical, laboratory data were collected and analyzed. The primary end point was in-hospital death of patients with COVID-19. The concentration of admission UA (adUA) and the lowest concentration of uric acid during hospitalization (lowUA) in the dead patients were significantly lower than those in the survivors. Multivariate logistic regression analysis showed the concentration of lowUA (OR 0.986, 95% CI 0.980-0.992, p < 0.001) was able to independently predict the risk of in-hospital death. The mean survival time in the low-level group of lowUA was significantly lower than other groups. When lowUA was ≤ 166 µmol/L, the sensitivity and specificity in predicting hospital short-term mortality were 76.9%, (95% CI 68.5-85.1%) and 74.9% (95% CI 70.3-78.9%). This retrospective study determined that the lowest concentration of UA during hospitalization can be used as a prognostic indicator and a marker of disease severity in severe patients with COVID-19.


Assuntos
COVID-19/mortalidade , Ácido Úrico/sangue , Adulto , Idoso , Biomarcadores/sangue , COVID-19/sangue , COVID-19/diagnóstico , China/epidemiologia , Estudos de Viabilidade , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença
3.
Crit Care ; 25(1): 328, 2021 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496940

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-Cov2 virus has become the greatest health and controversial issue for worldwide nations. It is associated with different clinical manifestations and a high mortality rate. Predicting mortality and identifying outcome predictors are crucial for COVID patients who are critically ill. Multivariate and machine learning methods may be used for developing prediction models and reduce the complexity of clinical phenotypes. METHODS: Multivariate predictive analysis was applied to 108 out of 250 clinical features, comorbidities, and blood markers captured at the admission time from a hospitalized cohort of patients (N = 250) with COVID-19. Inspired modification of partial least square (SIMPLS)-based model was developed to predict hospital mortality. Prediction accuracy was randomly assigned to training and validation sets. Predictive partition analysis was performed to obtain cutting value for either continuous or categorical variables. Latent class analysis (LCA) was carried to cluster the patients with COVID-19 to identify low- and high-risk patients. Principal component analysis and LCA were used to find a subgroup of survivors that tends to die. RESULTS: SIMPLS-based model was able to predict hospital mortality in patients with COVID-19 with moderate predictive power (Q2 = 0.24) and high accuracy (AUC > 0.85) through separating non-survivors from survivors developed using training and validation sets. This model was obtained by the 18 clinical and comorbidities predictors and 3 blood biochemical markers. Coronary artery disease, diabetes, Altered Mental Status, age > 65, and dementia were the topmost differentiating mortality predictors. CRP, prothrombin, and lactate were the most differentiating biochemical markers in the mortality prediction model. Clustering analysis identified high- and low-risk patients among COVID-19 survivors. CONCLUSIONS: An accurate COVID-19 mortality prediction model among hospitalized patients based on the clinical features and comorbidities may play a beneficial role in the clinical setting to better management of patients with COVID-19. The current study revealed the application of machine-learning-based approaches to predict hospital mortality in patients with COVID-19 and identification of most important predictors from clinical, comorbidities and blood biochemical variables as well as recognizing high- and low-risk COVID-19 survivors.


Assuntos
COVID-19/mortalidade , Mortalidade Hospitalar/tendências , Aprendizado de Máquina/normas , Índice de Gravidade de Doença , COVID-19/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Prognóstico , Respiração Artificial/estatística & dados numéricos , Medição de Risco/métodos , Fatores de Risco
5.
Tex Heart Inst J ; 48(3)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34383956

RESUMO

Mitochondrial disease comprises a wide range of genetic disorders caused by mitochondrial dysfunction. Its rarity, however, has limited the ability to assess its effects on clinical outcomes. To evaluate this relationship, we collected data from the 2016 National Inpatient Sample, which includes data from >7 million hospital stays. We identified 705 patients (mean age, 22 ± 20.7 yr; 54.2% female; 67.4% white) whose records included the ICD-10-CM code E88.4. We also identified a propensity-matched cohort of 705 patients without mitochondrial disease to examine the effect of mitochondrial disease on major adverse cardiovascular events, including all-cause in-hospital death, cardiac arrest, and acute congestive heart failure. Patients with mitochondrial disease were at significantly greater risk of major adverse cardiovascular events (odds ratio [OR]=2.42; 95% CI, 1.29-4.57; P=0.005), systolic heart failure (OR=2.37; 95% CI, 1.08-5.22; P=0.027), and all-cause in-hospital death (OR=14.22; 95% CI, 1.87-108.45; P<0.001). These findings suggest that mitochondrial disease significantly increases the risk of inpatient major adverse cardiovascular events.


Assuntos
Doenças Cardiovasculares/epidemiologia , Pacientes Internados , Doenças Mitocondriais/complicações , Pontuação de Propensão , Medição de Risco/métodos , Adulto , Doenças Cardiovasculares/etiologia , Estudos Transversais , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças Mitocondriais/epidemiologia , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos , Adulto Jovem
6.
Isr Med Assoc J ; 23(8): 501-505, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392626

RESUMO

BACKGROUND: Multiple myeloma (MM) affects the long bones in 25% of patients. The advent of positron-emission tomography/computed tomography (PET/CT) scanners offers the possibility of both metabolic and radiographic information and may help determine fracture risk. To the best of our knowledge, no published study correlates these two factors with long bone fractures. OBJECTIVES: To evaluate the impact of PET/CT on fracture risk assessment in multiple myeloma patients. METHODS: We identified all bone marrow biopsy proven multiple myeloma patients from 1 January 2010 to 31 January 2015 at a single institution. We prospectively followed patients with long bone lesions using PET/CT scan images. RESULTS: We identified 119 patients (59 males/60 females) with 256 long bone lesions. Mean age at diagnosis was 58 years. The majority of lesions were in the femur (n=150, 59%) and humerus (n=84, 33%); 13 lesions in 10 patients (8%) required surgery for impending (n=4) or actual fracture (n=9). Higher median SUVmax was measured for those with cortical involvement (8.05, range 0-50.8) vs. no involvement (5.0, range 2.1-18.1). SUVmax was found to be a predictor of cortical involvement (odds ratio = 1.17, P = 0.026). No significant correlation was found between SUVmax and pain or fracture (P = 0.43). CONCLUSIONS: Improved medical treatment resulted improvement in 8% of patients with an actual or impending fracture. The orthopedic surgeons commonly use the Mirels classification for long bone fracture prediction. Adding PET/CT imaging to study in myeloma long bone lesions did not predict fracture risk directly but suggested it indirectly by cortical erosion.


Assuntos
Fraturas do Fêmur , Fraturas do Úmero , Mieloma Múltiplo , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Medição de Risco/métodos , Biópsia/métodos , Medula Óssea/patologia , Osso Cortical/diagnóstico por imagem , Osso Cortical/patologia , Feminino , Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Fluordesoxiglucose F18/farmacologia , Fixação de Fratura/métodos , Fixação de Fratura/estatística & dados numéricos , Humanos , Fraturas do Úmero/diagnóstico , Fraturas do Úmero/etiologia , Fraturas do Úmero/cirurgia , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico por imagem , Mieloma Múltiplo/patologia , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos/farmacologia , Estudos Retrospectivos
7.
Nutrients ; 13(8)2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34444917

RESUMO

There is a lack of knowledge about malnutrition and risk of malnutrition upon admission and after discharge in older medical patients. This study aimed to describe prevalence, risk factors, and screening tools for malnutrition in older medical patients. In a prospective observational study, malnutrition was evaluated in 128 older medical patients (≥65 years) using the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment-Short Form (MNA-SF) and the Eating Validation Scheme (EVS). The European Society of Clinical Nutrition (ESPEN) diagnostic criteria from 2015 were applied for diagnosis. Agreement between the screening tools was evaluated by kappa statistics. Risk factors for malnutrition included polypharmacy, dysphagia, depression, low functional capacity, eating-related problems and lowered cognitive function. Malnutrition or risk of malnutrition were prevalent at baseline (59-98%) and follow-up (30-88%). The baseline, follow-up and transitional agreements ranged from slight to moderate. NRS-2002 and MNA-SF yielded the highest agreement (kappa: 0.31 (95% Confidence Interval (CI) 0.18-0.44) to 0.57 (95%CI 0.42-0.72)). Prevalence of risk factors ranged from 17-68%. Applying ESPEN 2015 diagnostic criteria, 15% had malnutrition at baseline and 13% at follow-up. In conclusion, malnutrition, risk of malnutrition and risk factors hereof are prevalent in older medical patients. MNA-SF and NRS-2002 showed the highest agreement at baseline, follow-up, and transitionally.


Assuntos
Avaliação Geriátrica/métodos , Desnutrição/epidemiologia , Programas de Rastreamento/métodos , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/etiologia , Avaliação Nutricional , Estado Nutricional , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco/métodos , Fatores de Risco
9.
Ann Clin Lab Sci ; 51(4): 451-460, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34452883

RESUMO

OBJECTIVE: To reduce the incidence of Opioid Use Disorder (OUD), multiple guidelines recommend assessing the risk of OUD prior to prescribing oral opioids. Although subjective risk assessments are available to help classify subjects at risk for OUD, we are aware of no clinically validated objective risk assessment tools. An objective risk assessment based on genetics may help inform shared decision-making prior to prescribing short-duration oral opioids. METHODS: A multicenter, observational cohort of adults exposed to prescription oral opioids for 4-30 days was conducted to determine the performance of an OUD classifier derived from machine learning (ML). From this cohort, the demographics of the U.S. adult opioid-prescribed population were used to create a blinded, random, representative group of subjects (n=385) for analysis to accurately estimate the performance characteristics in the intended use population. Genotyping was performed via a qualitative SNP microarray on DNA extracted from buccal samples. RESULTS: In the study subjects, the classifier demonstrated 82.5% sensitivity (95% confidence intervals: 76.1%-87.8%) and 79.9% specificity (73.7-85.2%), with no statistically significant differences in clinical performance observed based on gender, age, length of follow-up from opioid exposure, race, or ethnicity. CONCLUSION: This study demonstrates an ML classifier may provide additional objective information regarding a patient's risk of developing OUD. This information may enable subjects and healthcare providers to make more informed decisions when considering the use of oral opioids.


Assuntos
Analgésicos Opioides/efeitos adversos , Marcadores Genéticos , Aprendizado de Máquina , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Medição de Risco/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/genética , Transtornos Relacionados ao Uso de Opioides/patologia , Prognóstico , Estudos Prospectivos , Estados Unidos/epidemiologia , Adulto Jovem
10.
Medicine (Baltimore) ; 100(31): e26766, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397822

RESUMO

ABSTRACT: Over-expression of vitronectin (VN) is associated with tumorigenesis. The present study aimed to evaluate the prognostic value of VN expression in gastric cancer.The least absolute shrinkage and selection operator analysis was performed to screen the hub gene from The Cancer Genome Atlas gastric cancer patients with complete follow-up data, and 347 patients were finally included. Moreover, 102 patients were enrolled from the Affiliated Fuzhou First Hospital of Fujian Medical University. VN expression in paired gastric cancer and adjacent gastric normal tissues was detected using immunohistochemistry, and the clinicopathological significance of VN expression was evaluated. The prognostic significance of VN expression in gastric cancer patients was evaluated using by Kaplan-Meier method and Cox regression analysis and confirmed using Oncomine.VN was the prognosis relative gene which screened by The Cancer Genome Atlas dataset. Moreover, we identified the VN expression in an external dataset by immunohistochemistry. The result demonstrated that VN expression was remarkedly elevated in gastric cancer tissues (P < .001). High VN expression correlated with higher pathological Tumor-Node-Metastasis stage, and poorer survival outcomes. Cox regression analysis showed that VN expression was independently predictive of overall survival (OS) and disease-free survival (P = .004, P < .001, respectively). A prognostic risk score for OS was built based on VN expression. A meta-analysis from Oncomine datasets revealed that significantly lower VN mRNA levels in gastric cancer correlated with poorer OS.VN expression could be a prognostic marker of gastric cancer.


Assuntos
Neoplasias Gástricas/sangue , Vitronectina/análise , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/sangue , Distribuição de Qui-Quadrado , Humanos , Estimativa de Kaplan-Meier , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Medição de Risco/métodos , Medição de Risco/normas , Medição de Risco/estatística & dados numéricos , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/fisiopatologia , Vitronectina/sangue
11.
Medicine (Baltimore) ; 100(31): e26819, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397842

RESUMO

ABSTRACT: Recently, activities of daily living (ADL) were identified as a prognostic factor among elderly patients with heart disease; however, a specific association between ADL and prognosis after cardiac and aortic surgery is not well established. We aimed to clarify the impact of ADL capacity at discharge on prognosis in elderly patients after cardiac and aortic surgery.This retrospective cohort study included 171 elderly patients who underwent open operation for cardiovascular disease in a single center (median age: 74 years; men: 70%). We used the Barthel Index (BI) as an indicator for ADL. Patients were classified into 2 groups according to the BI at discharge, indicating a high (BI ≥ 85) or low (BI < 85) ADL status. All-cause mortality and unplanned readmission events were observed after discharge.Thirteen all-cause mortality and 44 all-cause unplanned readmission events occurred during the median follow-up of 365 days. Using Kaplan-Meier analysis, a low ADL status was determined to be significantly associated with all-cause mortality and unplanned readmission. In the multivariable Cox proportional hazard models, a low ADL status was an independent predictor of all-cause mortality and unplanned readmission after adjusting for age, sex, length of hospital stay, and other variables (including preoperative status, surgical parameter, and postoperative course).A low ADL status at discharge predicted all-cause mortality and unplanned readmission in elderly patients after cardiac and aortic surgery. A comprehensive approach from the time of admission to postdischarge to improve ADL capacity in elderly patients undergoing cardiac and aortic surgery may improve patient outcomes.


Assuntos
Atividades Cotidianas , Procedimentos Cirúrgicos Cardiovasculares , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Assistência ao Convalescente/métodos , Assistência ao Convalescente/organização & administração , Idoso , Doenças Cardiovasculares/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Procedimentos Cirúrgicos Cardiovasculares/métodos , Procedimentos Cirúrgicos Cardiovasculares/mortalidade , Feminino , Humanos , Japão/epidemiologia , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Masculino , Desempenho Físico Funcional , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco
12.
Medicine (Baltimore) ; 100(31): e26826, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397846

RESUMO

ABSTRACT: To develop a new prognostic model for the overall survival of patients with clear cell metastatic renal cell carcinoma (mRCC) using Korean Renal Cancer Study Group (KRoCS) database and compared it with 2 renowned prognostic models: the Memorial Sloan Kettering Cancer Center (MSKCC) and the international metastatic renal cell carcinoma database consortium (IMDC) models.Data of 790 patients diagnosed with mRCC and receiving targeted therapy as their first-line treatment were pooled to this study. Data from 4 hospitals (n = 619) were used to develop the new model and those from other 5 hospitals (n = 171) were used for external validation. After detecting prognostic factors in multivariable Cox proportional-hazards regression analysis, patients were classified into 3 risk groups, favorable (0), intermediate (1-2), and poor (3 and more) by the number of prognostic factors.Seven variables such as more than 2 metastasis sites, no prior nephrectomy, Eastern Cooperative Oncology Group performance status ≥2, low hemoglobin, high serum corrected calcium, high neutrophil, high serum alkaline phosphatase were identified as prognostic factors for poor overall survival. Also, risk groups were categorized into 3 groups; median overall survival was 61.1 months in favorable, 26.5 months in intermediate, and 6.8 months in poor group. KRoCS ranked the first in all 3 statistical parameters including akaike information criterion (AIC), concordance index and generalized R2 among other prognostic models.We developed the KRoCS model and validated it externally with demonstrating its superiority over MSKCC and IMDC models. The KRoCS model can provide useful information for counseling patients with clear cell mRCC regarding life-expectancy.


Assuntos
Carcinoma de Células Renais , Expectativa de Vida , Modelos Estatísticos , Terapia de Alvo Molecular/métodos , Planejamento de Assistência ao Paciente/normas , Medição de Risco , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Melhoria de Qualidade , Reprodutibilidade dos Testes , República da Coreia/epidemiologia , Medição de Risco/métodos , Medição de Risco/normas , Fatores de Risco , Análise de Sobrevida
13.
Sci Rep ; 11(1): 16587, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34400735

RESUMO

The rapid spread of the COVID-19 pandemic has raised huge concerns about the prospect of a major health disaster that would result in a huge number of deaths. This anxiety was largely fueled by the fact that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the disease, was so far unknown, and therefore an accurate prediction of the number of deaths was particularly difficult. However, this prediction is of the utmost importance for public health authorities to make the most reliable decisions and establish the necessary precautions to protect people's lives. In this paper, we present an approach for predicting the number of deaths from COVID-19. This approach requires modeling the number of infected cases using a generalized logistic function and using this function for inferring the number of deaths. An estimate of the parameters of the proposed model is obtained using a Particle Swarm Optimization algorithm (PSO) that requires iteratively solving a quadratic programming problem. In addition to the total number of deaths and number of infected cases, the model enables the estimation of the infection fatality rate (IFR). Furthermore, using some mild assumptions, we derive estimates of the number of active cases. The proposed approach was empirically assessed on official data provided by the State of Qatar. The results of our computational study show a good accuracy of the predicted number of deaths.


Assuntos
Algoritmos , COVID-19/mortalidade , Previsões/métodos , SARS-CoV-2/patogenicidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/virologia , Teste para COVID-19/estatística & dados numéricos , Criança , Pré-Escolar , Simulação por Computador , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Pandemias/estatística & dados numéricos , Catar/epidemiologia , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação , Adulto Jovem
14.
Medicine (Baltimore) ; 100(32): e26485, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397870

RESUMO

ABSTRACT: Percutaneous nephrolithotomy (PCNL) is commonly used for the treatment of upper urinary calculi in clinical setting, and fever is a common complication after PCNL. It is necessary to evaluate the risk factors of fever in patients undergoing PCNL, to provide insights into the management of PCNL.Patients who underwent PCNL in our hospital from January 2018 to August 2020 were included. The clinical data of postoperative fever and no fever patients were collected and assessed. Logistic regression analyses were conducted to analyze the risk factors for fever in patients undergoing PCNL.A total of 276 patients undergoing PCNL were included, the incidence of postoperative fever for patients undergoing PCNL was 19.39%. No significant differences in the gender, body mass index, alcohol drinking, smoking, hypertension, hyperlipidemia, intraoperative blood infusion, length of hospital stay between fever patients, and no fever patients were found (all P > .05). There were significant differences in the age, diabetes, size of stones, duration of surgery between fever patients, and no fever patients (all P < .05). Age ≥60 years (odds ratio [OR] 2.143, 95% confidence interval [CI] 1.101∼3.264), diabetes (OR 2.218, 95% CI 1.176∼4.642), size of stone ≥2 cm (OR 1.428, 95%CI 1.104∼2.055), duration of surgery ≥100 minutes (OR 1.334, 95% CI 1.015∼1.923) were the risk factors for fever in patients with PCNL (all P < .05). Escherichia coli (48.44%), Staphylococcus aureus (18.75%), and Candida albicans (10.93%) were the top 3 pathogenic bacteria of urine culture.Fever is one of the common complications after PCNL. Patients with high-risk factors should be given full attentions and take corresponding preventive measures targeted on risks.


Assuntos
Febre/epidemiologia , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
15.
Medicine (Baltimore) ; 100(32): e26773, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397880

RESUMO

ABSTRACT: Delayed recovery (DR) is very commonly seen in the patients undergoing laparoscopic radical biliary surgery, we aimed to investigate the potential risk factors of DR in the patients undergoing radical biliary surgery, to provide evidences into the management of DR.Patients who underwent radical biliary surgery from January 1, 2018 to August 31, 2020 were identified. The clinical characteristics and treatment details of DR and no-DR patients were compared and analyzed. Multivariable logistic regression analyses were conducted to identify the potential influencing factors for DR in patients with laparoscopic radical biliary surgery.We included a total of 168 patients with laparoscopic radical biliary surgery, the incidence of postoperative DR was 25%. There were significant differences on the duration of surgery, duration of anesthesia, and use of intraoperative combined sevoflurane inhalation (all P < .05), and there were not significant differences on American Society of Anesthesiologists, New York Heart Association, tumor-lymph node- metastasis, and estimated blood loss between DR group and control group (all P > .05). Multivariable logistic regression analyses indicated that age ≥70 years (odd ratio [OR] 1.454, 95% confidence interval [CI] 1.146-1.904), body mass index ≥25 kg/m2 (OR 1.303, 95% CI 1.102-1.912), alcohol drinking (OR 2.041, 95% CI 1.336-3.085), smoking (OR 1.128, 95% CI 1.007-2.261), duration of surgery ≥220 minutes (OR 1.239, 95% CI 1.039-1.735), duration of anesthesia ≥230 minutes (OR 1.223, 95% CI 1.013-1.926), intraoperative combined sevoflurane inhalation (OR 1.207, 95% CI 1.008-1.764) were the independent risk factors for DR in patients with radical biliary surgery (all P < .05).It is clinically necessary to take early countermeasures against various risk factors to reduce the occurrence of DR, and to improve the prognosis of patients.


Assuntos
Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/prevenção & controle , Medição de Risco/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , China/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
16.
Medicine (Baltimore) ; 100(32): e26890, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397911

RESUMO

ABSTRACT: Studies on perioperative cardiac arrest in Chinese hospitals have rarely been retrieved from international journals. This survey evaluated the incidence, causes, and outcomes of perioperative cardiac arrests in a Chinese tertiary general hospital between July 2013 and December 2020. The incidence of cardiac arrest within 24 hours of anesthesia administration was retrospectively identified using an anesthesia database in Liaocheng People's Hospital. During the study period, there were 118,152 anesthetics. Data collected included patient characteristics, surgical procedures (elective or emergency), American Society of Anesthesiologists (ASA) physical status score, type of surgery, anesthesia technique, and outcome. Cardiac arrests were grouped into one of 3 groups: totally anesthesia-related, partially anesthesia-related, or anesthesia-unrelated. In total, 41 cardiac arrests (3.5:10,000) and 26 deaths (2.2:10,000) were found. Major risk factors for cardiac arrest were children under 1 year, adults between 19 and 65 years, and the elderly (>80 years) (P < .001), male patients (P = .02), emergency surgery (P < .001), and ASA grade V patients without anesthesia (P = .009). There were 19 anesthesia-related cardiac arrests (1.6:10,000) - 2 were totally related, and 17 were partially related to anesthesia. There were 9 anesthesia-related deaths (0.8:10,000), all of which were partially related to anesthesia. Perioperative cardiac arrests were correlated with age, gender, ASA grade and surgical procedures. The 2 most important patient factors leading to cardiac arrest were hemorrhagic shock from trauma and septic shock, respectively.


Assuntos
Parada Cardíaca/epidemiologia , Medição de Risco/métodos , Procedimentos Cirúrgicos Operatórios , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
17.
Medicine (Baltimore) ; 100(32): e26934, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397941

RESUMO

ABSTRACT: To investigate the association of sleep disturbance with calcium regulatory hormones, disease severity and health index among the patients with ankylosing spondylitis (AS).There were 104 AS patients enrolled in the cross-sectional study, and their sleep quality was recorded. Serum levels of calcium, parathyroid hormone, vitamin D3 and calcitonin were measured. We evaluated patient's disease activity, functional ability, patient's global assessment, physical mobility, radiographic damage and health index. Blood ESR and CRP levels were tested.Sleep quality was positively correlated with serum calcitonin levels (r = 0.260, P = .008). Bad sleep and advanced radiographic damage were found among the AS patients with detectable serum calcitonin levels (P < .05). Sleep quality was significantly correlated with disease duration, CRP, BASDAI, ASDAS-ESR, ASDAS-CRP, BASFI, BAS-G, BASMI and ASAS-HI among the AS patients (all P < .05). Female gender, longer disease duration, higher ASDAS-CRP and serum calcitonin levels (OR [95% CI] = 3.210 [1.012-10.181], P = .048) were independent factors associated with bad sleep. Inflammation, disease activity, functional ability, patient's global assessment and cervical rotation were useful in predicting bad sleep among the AS patients, and ASDAS-CRP was the best predictor (AUC = 0.772, P < .001).Serum calcitonin levels was elevated in the AS patients with bad sleep, and may participate in the pathophysiology of sleep disturbance. Bad sleep was associated with female gender, longer disease duration, higher inflammation, disease activity, functional impairment, mobility restriction, poor patient's global assessment and health index in AS. ASDAS-CRP was best in predicting bad sleep.


Assuntos
Calcitonina/sangue , Nível de Saúde , Medição de Risco/métodos , Transtornos do Sono-Vigília/etiologia , Sono/fisiologia , Espondilite Anquilosante/fisiopatologia , Adulto , Biomarcadores/sangue , Estudos Transversais , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/fisiopatologia , Espondilite Anquilosante/sangue , Espondilite Anquilosante/complicações , Taiwan
18.
Medicine (Baltimore) ; 100(29): e26491, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398005

RESUMO

ABSTRACT: Hepatocellular carcinoma (HCC) is 1 of the deadliest malignancies worldwide. Despite significant advances in diagnosis and treatment, the mortality rate from HCC persists at a substantial level. Construction of a prognostic model that can reliably predict HCC patients' overall survival is urgently needed.Two RNA-seq dataset (the Cancer Genome Atlas and International Cancer Genome Consortium) and 1 microarray dataset (GSE14520) were included in our study. RNA-binding proteins (RBPs) in HCC patients was examined by differentially expressed genes analysis, functional enrichment analysis and protein-protein interaction network analysis. Subsequently, the Cancer Genome Atlas dataset was randomly divided into training and testing cohort with a prognostic model developed in the training cohort. In order to evaluate the prognostic value of the model, a comprehensive survival assessment was conducted.Five RBPs (ribosomal protein L10-like, enhancer of zeste homolog 2 (EZH2), peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PPARGC1A), zinc finger protein 239, interferon-induced protein with tetratricopeptide repeats 1) were used to construct the model. The model accurately predicted the prognosis of liver cancer patients in both the training cohort and validation cohort. HCC patients could be assigned into a high-risk group and a low-risk group by this model, and the overall survival of these 2 groups was significantly different (P  < .05). Furthermore, the risk scores obtained by this model were highly correlated with immune cell infiltration.The prognostic model helps to identify HCC patients at high risk of mortality, which optimizes decision-making for individualized treatment.


Assuntos
Carcinoma Hepatocelular/complicações , Prognóstico , Proteínas com Motivo de Reconhecimento de RNA/análise , Área Sob a Curva , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/mortalidade , Estudos de Coortes , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/mortalidade , Modelos de Riscos Proporcionais , Curva ROC , Medição de Risco/métodos , Medição de Risco/normas , Medição de Risco/estatística & dados numéricos , Análise de Sobrevida
19.
Oxid Med Cell Longev ; 2021: 5633514, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34457116

RESUMO

This study sought to perform integrative analysis of the immune/methylation/autophagy landscape on breast cancer prognosis and single-cell genotypes. Breast Cancer Recurrence Risk Score (BCRRS) and Breast Cancer Prognostic Risk Score (BCPRS) were determined based on 6 prognostic IMAAGs obtained from the TCGA-BRCA cohort. BCRRS and BCPRS, respectively, were used to construct a risk prediction model of overall survival and progression-free survival. Predictive capacity of the model was evaluated using clinical data. Analysis showed that BCRRS is associated with a high risk of stroke. In addition, PPI and drug-ceRNA networks based on differences in BCPRS were constructed. Single cells were genotyped through integrated scRNA-seq of the TNBC samples based on clustering results of BCPRS-related genes. The findings of this study show the potential regulatory effects of IMAAGs on breast cancer tumor microenvironment. High AUCs of 0.856 and 0.842 were obtained for the OS and PFS prognostic models, respectively. scRNA-seq analysis showed high expression levels of adipocytes and adipose tissue macrophages (ATMs) in high BCPRS clusters. Moreover, analysis of ligand-receptor interactions and potential regulatory mechanisms were performed. The LINC00276&MALAT1/miR-206/FZD4-Wnt7b pathway was also identified which may be useful in future research on targets against breast cancer metastasis and recurrence. Neural network-based deep learning models using BCPRS-related genes showed that these genes can be used to map the tumor microenvironment. In summary, analysis of IMAAGs, BCPRS, and BCRRS provides information on the breast cancer microenvironment at both the macro- and microlevels and provides a basis for development of personalized treatment therapy.


Assuntos
Autofagia , Biomarcadores Tumorais/análise , Neoplasias da Mama/patologia , Metilação de DNA , Análise de Célula Única/métodos , Acidente Vascular Cerebral/patologia , Microambiente Tumoral/imunologia , Neoplasias da Mama/genética , Neoplasias da Mama/imunologia , Neoplasias da Mama/terapia , Terapia Combinada , Feminino , Seguimentos , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Redes Reguladoras de Genes , Genótipo , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/imunologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Prognóstico , Medição de Risco/métodos , Acidente Vascular Cerebral/genética , Acidente Vascular Cerebral/imunologia , Acidente Vascular Cerebral/terapia , Taxa de Sobrevida , Transcriptoma
20.
Sci Rep ; 11(1): 17331, 2021 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-34462494

RESUMO

This time-to-event study examines social factors associated with health-seeking and diagnosis of 165 COVID-19 cases in response to the pandemic spread in Shaanxi Province, China. In particular, we investigate the differential access to healthcare in terms of delayed time from symptom onset to first medical visit and subsequently to diagnosis by factors such as sex, age, travel history, and type of healthcare utilization. We show that it takes more time for patients older than 60 (against those under 30) to seek healthcare after developing symptoms (+ 2.5 days, [Formula: see text]), surveillance on people with living or travel history to Wuhan helps shorten the time to the first doctor visit (- 0.8 days) and diagnosis (- 2.2 days, [Formula: see text]). A delay cut is associated with the adoption of intermediary and large hospitals rather than community-based care as primary care choices (- 1.6 days, [Formula: see text] and - 2.2 days, [Formula: see text]). One unit increase of healthcare workers per 1000 people saves patients 0.5 days ([Formula: see text]) for diagnosis from the first doctor visit and 0.6 days ([Formula: see text]) in total. Our analysis of factors associated with the time delay for diagnosis may provide a better understanding of the health-seeking behaviors of patients and the diagnosis capacity of healthcare providers during the COVID-19 pandemic.


Assuntos
COVID-19/diagnóstico , Diagnóstico Tardio/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Medição de Risco/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Comportamento de Busca de Ajuda , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...