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1.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-47010

RESUMO

Definimos como transmissão local, a confirmação laboratorial de transmissão do COVID-19 entre pessoas com vínculo epidemiológico comprovado. Os casos que ocorrerem entre familiares próximos ou profissionais de saúde de forma limitada não serão considerados transmissão local. Até o momento, a única área com transmissão local é a China


Assuntos
Síndrome Respiratória Aguda Grave , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/mortalidade
3.
JAMA ; 323(5): 455-465, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-32016309

RESUMO

Importance: The association of home noninvasive positive pressure ventilation (NIPPV) with outcomes in chronic obstructive pulmonary disease (COPD) and hypercapnia is uncertain. Objective: To evaluate the association of home NIPPV via bilevel positive airway pressure (BPAP) devices and noninvasive home mechanical ventilator (HMV) devices with clinical outcomes and adverse events in patients with COPD and hypercapnia. Data Sources: Search of MEDLINE, EMBASE, SCOPUS, Cochrane Central Registrar of Controlled Trials, Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, and Scopus for English-language articles published from January 1, 1995, to November 6, 2019. Study Selection: Randomized clinical trials (RCTs) and comparative observational studies that enrolled adults with COPD with hypercapnia who used home NIPPV for more than 1 month were included. Data Extraction and Synthesis: Data extraction was completed by independent pairs of reviewers. Risk of bias was evaluated using the Cochrane Collaboration risk of bias tool for RCTs and select items from the Newcastle-Ottawa Scale for nonrandomized studies. Main Outcomes and Measures: Primary outcomes were mortality, all-cause hospital admissions, need for intubation, and quality of life at the longest follow-up. Results: A total of 21 RCTs and 12 observational studies evaluating 51 085 patients (mean [SD] age, 65.7 [2.1] years; 43% women) were included, among whom there were 434 deaths and 27 patients who underwent intubation. BPAP compared with no device was significantly associated with lower risk of mortality (22.31% vs 28.57%; risk difference [RD], -5.53% [95% CI, -10.29% to -0.76%]; odds ratio [OR], 0.66 [95% CI, 0.51-0.87]; P = .003; 13 studies; 1423 patients; strength of evidence [SOE], moderate), fewer patients with all-cause hospital admissions (39.74% vs 75.00%; RD, -35.26% [95% CI, -49.39% to -21.12%]; OR, 0.22 [95% CI, 0.11-0.43]; P < .001; 1 study; 166 patients; SOE, low), and lower need for intubation (5.34% vs 14.71%; RD, -8.02% [95% CI, -14.77% to -1.28%]; OR, 0.34 [95% CI, 0.14-0.83]; P = .02; 3 studies; 267 patients; SOE, moderate). There was no significant difference in the total number of all-cause hospital admissions (rate ratio, 0.91 [95% CI, 0.71-1.17]; P = .47; 5 studies; 326 patients; SOE, low) or quality of life (standardized mean difference, 0.16 [95% CI, -0.06 to 0.39]; P = .15; 9 studies; 833 patients; SOE, insufficient). Noninvasive HMV use compared with no device was significantly associated with fewer all-cause hospital admissions (rate ratio, 0.50 [95% CI, 0.35-0.71]; P < .001; 1 study; 93 patients; SOE, low), but not mortality (21.84% vs 34.09%; RD, -11.99% [95% CI, -24.77% to 0.79%]; OR, 0.56 [95% CI, 0.29-1.08]; P = .49; 2 studies; 175 patients; SOE, insufficient). There was no statistically significant difference in the total number of adverse events in patients using NIPPV compared with no device (0.18 vs 0.17 per patient; P = .84; 6 studies; 414 patients). Conclusions and Relevance: In this meta-analysis of patients with COPD and hypercapnia, home BPAP, compared with no device, was associated with lower risk of mortality, all-cause hospital admission, and intubation, but no significant difference in quality of life. Noninvasive HMV, compared with no device, was significantly associated with lower risk of hospital admission, but there was no significant difference in mortality risk. However, the evidence was low to moderate in quality, the evidence on quality of life was insufficient, and the analyses for some outcomes were based on small numbers of studies.


Assuntos
Respiração com Pressão Positiva/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/métodos , Serviços de Assistência Domiciliar , Hospitalização , Humanos , Hipercapnia/etiologia , Ventilação não Invasiva/instrumentação , Respiração com Pressão Positiva/instrumentação , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Qualidade de Vida , Respiração Artificial/instrumentação , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(6): e18996, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028410

RESUMO

Upper extremity vein thrombosis (UE-VT) are more and more frequent pathologies and yet little studied. The aim is to describe the clinical and ultrasound features, UE-VT-related diseases, and the prevalence of pulmonary embolism (PE) and associated deaths.All UE-VT patients diagnosed by Doppler-ultrasound in Nantes University Hospital, from January 2015 to December 2017, were included retrospectively. UE-VT suspicion patterns, clinical features, UE-VT topography, and prevalence of PE and death were analyzed.Seven hundred and fifty-five UE-VT were analyzed, including 427 deep thrombosis (UE-DVT) and 328 superficial thrombosis (UE-SVT). In 86.2% (n = 651) UE-VT were related to endovascular devices. Among these thrombosis, one third is in connection with a PICC LINE and one quarter with a peripheral venous line. Forty nine percent (n = 370) of the patients had solid neoplasia or hematological malignancies. An inflammatory or systemic infectious context was found in 40.8% (n = 308) of the cases. The most frequently observed clinical sign at the UE-VT diagnosis was edema (28.6%). Among the UE-SVT it was the presence of an indurated cord (33.2%) and among the UE-DVT the indication of the Doppler-ultrasound was mainly a suspicion of infection on endovascular device (35.1%). In 10.6% (n = 80) of the cases the UE-VT were asymptomatic. The most frequently thrombosed veins were brachial basilic veins (16.7% of all thrombosed segments) followed by jugular (13%) and subclavian (12.3%) veins; 61.3% (n = 463) of UE-VT were in the right upper extremity; 63.3% (n = 478) UE-VT were occlusive. The occurrence of PE is 4% and the death rate is 10.2%, mainly related to the severe comorbidities of patients with UE-VT.UE-VT occurs in particular clinical contexts (hematological malignancies, solid cancers, systemic infections) and in the majority of endovascular devices (86.2%). The occurrence of PE is low.


Assuntos
Braço/irrigação sanguínea , Trombose/diagnóstico , Trombose Venosa/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/etiologia , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Trombose/complicações , Trombose/diagnóstico por imagem , Trombose/mortalidade , Ultrassonografia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/mortalidade
5.
Medicine (Baltimore) ; 99(6): e19063, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028427

RESUMO

BACKGROUND: Severity index and plasma paraquat (PQ) concentration can predict the prognosis of patients with PQ poisoning. However, the better parameter is yet to be systematically investigated and determined. Thus, we conduct this systematic review and meta-analysis to investigate the prognostic value of severity index and plasma PQ concentration in patients with PQ poisoning. METHODS: We searched PubMed, Embase, Web of Science, ScienceDirect, and Cochrane Library to identify all relevant papers that were published up to March 2019. All diagnostic studies that compared severity index and plasma PQ concentration to predict mortality in patients with PQ poisoning were enrolled in this meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) for individual trials were pooled using a random-effect model. We also aggregated heterogeneity testing, sensitivity analysis, and publication bias analysis. RESULTS: Ultimately, seven studies involving 821 patients were included. The pooled OR with a 95% CI of severity index was 24.12 (95% CI: 9.34-62.34, P < .001), with an area under the curve of 0.88 (95% CI: 0.85-0.90), sensitivity of 0.84 (95% CI: 0.74-0.91), and specificity of 0.81 (95% CI: 0.75-0.87). Meanwhile, the pooled OR with 95% CI of plasma PQ concentration was 34.39 (95% CI: 14.69-80.56, P < .001), with an area under the curve of 0.94 (95% CI: 0.91-0.96), sensitivity of 0.86 (95% CI: 0.75-0.93), and specificity of 0.89 (95% CI: 0.76-0.95). Sensitivity analysis demonstrated the stability of the results of our meta-analysis. No significant publication bias was observed in this meta-analysis. CONCLUSION: Overall, this study indicated that severity index and plasma PQ concentration have relatively high-prognostic value in patients with PQ poisoning, and that the sensitivity and specificity of plasma PQ concentration are superior to those of severity index.


Assuntos
Paraquat/envenenamento , Envenenamento/mortalidade , Humanos , Paraquat/sangue , Envenenamento/sangue , Valor Preditivo dos Testes , Índice de Gravidade de Doença
6.
Medicine (Baltimore) ; 99(6): e19073, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028431

RESUMO

BACKGROUND: This systematic review and meta-analysis collected data for evaluating the effect of surgical extent on overall survival (OS) and recurrence-free survival (RFS) in patients with papillary thyroid cancer (PTC). METHODS: We searched the PubMed, Embase, and Cochrane Library databases. The included studies compared two groups of patients with PTC: the total thyroidectomy (TT) group and the lobectomy (LT) group. The combined hazard ratio (HR) was calculated. RESULTS: Thirteen studies were included in the present study. The TT and LT groups had similar OS results (HR = 1.04; 95% CI: 0.90-1.21; P = .60). In the subgroup analysis, the combined HR of the ≤1 cm group and the 1.0 to 2.0 cm group showed that TT had no advantage with regard to OS compared to LT. In the 2.0 to 4.0 cm group, TT provided better OS than LT (HR = 0.88; 95% CI: 0.79-0.99; P = .03). Patients who underwent TT had a better RFS outcome than those who underwent LT (HR = 0.56; 95% CI: 0.41-0.77; P < .0001). In the subgroup analysis, both the ≤1 cm group and >1 cm group that underwent TT were associated with better RFS. CONCLUSIONS: Our meta-analysis suggested that LT increased the risk of recurrence in PTC patients with tumors ≤1.0 cm and in PTC patients with tumors >1.0 cm. More importantly, LT was associated with higher mortality in PTC patients with 2.0 to 4.0 cm tumors. Caution is warranted when LT is performed in this group of patients.


Assuntos
Câncer Papilífero da Tireoide/cirurgia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Intervalo Livre de Doença , Humanos , Análise de Sobrevida , Câncer Papilífero da Tireoide/mortalidade , Neoplasias da Glândula Tireoide/mortalidade
7.
Medicine (Baltimore) ; 99(6): e19093, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028433

RESUMO

Percutaneous biopsy in breast cancer has been associated with an increased risk of malignant cell seeding. However, the importance of these observations remains obscure due to lack of corroborating evidence from clinical studies. We determined whether method of biopsy is associated with breast cancer survival. This hospital registry-based cohort study included 3416 non-metastatic breast cancer patients diagnosed from 1993 to 2011 in a tertiary setting. Factors associated with biopsy methods were assessed. Multivariable Cox regression analysis was used to determine the independent prognostic impact of method of biopsy. Overall, 990 patients were diagnosed by core needle biopsy (CNB), 1364 by fine needle aspiration cytology (FNAC), and 1062 by excision biopsy. Excision biopsy was significantly associated with more favorable tumor characteristics. Radiotherapy modified the prognostic impact of biopsy method (Pinteraction < .001). Following multivariable analysis, excision biopsy was consistently associated with lower risk of mortality compared to FNAC in women receiving adjuvant radiotherapy (adjusted hazard ratio: 0.81, 95%CI: 0.66-0.99), but not in those who did not receive adjuvant radiotherapy (adjusted hazard ratio: 0.87, 95%CI: 0.65-1.17). While the risk of mortality was not different between patients undergoing FNAC and CNB when radiotherapy is administered, in the absence of radiotherapy, CNB was associated with higher risk of mortality than FNAC (adjusted hazard ratio: 1.57, 95%CI: 1.16-2.12). Given that our results contradict with findings of previous clinical studies assessing the prognostic impact of method of biopsy in women with breast cancer, further studies are warranted.


Assuntos
Biópsia/métodos , Neoplasias da Mama/diagnóstico , Adulto , Biópsia/efeitos adversos , Biópsia por Agulha Fina/efeitos adversos , Biópsia por Agulha Fina/métodos , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/métodos , Mama/patologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros , Análise de Sobrevida
8.
Medicine (Baltimore) ; 99(6): e19099, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028435

RESUMO

We determined the clinical effectiveness and long-term outcomes in patients with distal biliary obstruction (DBO) secondary to pancreatic carcinoma (PC) who were treated by self-expanded metallic stent (SEMS) insertion with or without high-intensity focused ultrasound (HIFU) ablation.From January 2014 to December 2018, consecutive patients with DBO secondary to PC underwent SEMS insertion with or without HIFU ablation in our center. The long-term outcomes were compared between the 2 groups.During the included period, 75 patients underwent SEMS insertion with (n = 34) or without (n = 41) HIFU ablation in our center. SEMS insertion was successfully performed in all patients. Liver function was significantly improved after SEMS insertion in both groups. An average of 2.9 HIFU treatment sessions per patient were performed. Twenty patients (stent + HIFU group: 7; stent-only group: 13) experienced stent dysfunction (P = .278). The clinical response rate to HIFU ablation was 79.4%. The median stent patency was significantly longer in the stent with HIFU group than in the stent-only group (175 vs 118 days, P = .005). The median survival was significantly longer in the stent with HIFU group compared with the stent-only group (211 versus 136 days, P = .004). An Eastern Cooperative Oncology Group (ECOG) Performance Status of 3 (hazard ratio: 0.300; P = .002) and subsequent HIFU ablation (hazard ratio: 0.508; P = .005) were associated with prolonged survival.HIFU ablation following stent insertion can prolong the stent patency and survival for patients with DBO secondary to PC.


Assuntos
Colestase/etiologia , Ablação por Ultrassom Focalizado de Alta Intensidade , Neoplasias Pancreáticas/complicações , Implantação de Prótese , Stents , Idoso , Colestase/cirurgia , Feminino , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/mortalidade , Modelos de Riscos Proporcionais , Implantação de Prótese/métodos , Estudos Retrospectivos , Análise de Sobrevida
9.
Isr Med Assoc J ; 22(2): 75-78, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32043322

RESUMO

BACKGROUND: The treatment of elderly patients with advanced stage ovarian carcinoma is challenging due to a high morbidity. OBJECTIVES: To evaluate the clinical course and outcome of elderly patients with advanced stage ovarian carcinoma receiving neoadjuvant chemotherapy (NACT). METHODS: A retrospective study of all patients with stage IIIC and IV ovarian carcinoma receiving NACT in one medical center (between 2005 and 2017). The study group criteria age was above 70 years. The control group criteria was younger than 70 years old at diagnosis. Demographics and treatment outcomes were compared between groups. Primary outcomes were progression-free survival (PFS) and overall survival (OS). RESULTS: Overall, 105 patients met the inclusion criteria, 71 patients (67.6%) were younger than 70 years and 34 patients (32.4%) older. Rates of interval cytoreduction were significantly higher in younger patients (76.1% vs. 50.0%, P = 0.01). Of those who underwent interval cytoreduction, no difference was found in rates of optimal debulking between groups (83.35% vs. 100%, P = 0.10). Using a Kaplan-Meier survival analysis, no significant differences were observed between groups in PFS or OS, P > 0.05. Among the elderly group alone, patients who underwent interval cytoreduction had significantly longer PFS than those without surgical intervention (0.4 ± 1.7 vs. 19.3 ± 19.4 months, P = 0.001). CONCLUSIONS: Elderly patients with ovarian carcinoma who received NACT undergo less interval cytoreduction than younger patients, with no difference in PFS and OS. However, among the elderly, interval cytoreduction is associated with significantly higher PFS.


Assuntos
Carcinoma Epitelial do Ovário , Quimioterapia Adjuvante/métodos , Procedimentos Cirúrgicos de Citorredução/estatística & dados numéricos , Neoplasias Ovarianas , Fatores Etários , Idoso , Carcinoma Epitelial do Ovário/mortalidade , Carcinoma Epitelial do Ovário/patologia , Carcinoma Epitelial do Ovário/terapia , Intervalo Livre de Doença , Feminino , Humanos , Israel/epidemiologia , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Intervalo Livre de Progressão , Estudos Retrospectivos , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(5): e18935, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000408

RESUMO

The effect of frailty on short and long term results of interventional treatment of coronary heart disease is not well defined. The evaluation of frailty may be helpful in appointment of most suitable treatment option and timing of patient follow-up. The frailty syndrome in daily practice of interventional cardiology ward (FRAPICA) study objective is to evaluate prognostic capability of the Fried frailty scale and instrumental activities of daily living scale (IADL) in elderly patients with symptomatic coronary heart disease.This is a single center, prospective, observational study. Patients aged ≥65 years are eligible. The objectives are to report Fried frailty scale and IADL scale dispersion before hospital discharge and to assess predictive impact of both scores. The endpoints are: success of interventional treatment, its complications (procedure related myocardial infarction, dye-induced renal function deterioration, loss of blood), 3-year mortality, either all-cause and cardiovascular, re-infarction, re-intervention, stroke, new-onset heart failure, any hospital readmission, and a combination of all above mentioned. Secondary analyses will focus on distinct clinical patient presentations, sub-classifications of frailty for modeling of long-term risk.FRAPICA trial will improve understanding of the associations between frailty syndrome, cardiovascular system diseases, their invasive treatment, and short and long-term outcomes. It will allow for more individualized assessment of risk and will identify new goals for interventions. (ClinicalTrials.gov Identifier NCT03209414).


Assuntos
Doença das Coronárias/diagnóstico , Fragilidade/diagnóstico , Estudos Observacionais como Assunto , Atividades Cotidianas , Idoso , Doença das Coronárias/complicações , Doença das Coronárias/mortalidade , Doença das Coronárias/terapia , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/mortalidade , Fragilidade/terapia , Avaliação Geriátrica , Humanos , Seleção de Pacientes
11.
Medicine (Baltimore) ; 99(5): e18942, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000414

RESUMO

This study analyzed independent risk factors that could improve the qSOFA scoring system among sepsis patients.This retrospective study evaluated 821 patients (2015-2016) who fulfilled the 2001 International Sepsis Definitions Conference diagnostic criteria. Patients were classified based on their survival outcomes after 28 days, and the predictive values of various predictive scores at admission were compared.The independent risk factors for 28-day mortality were fibrinogen, plasma lactic acid, albumin, oxygenation index, and procalcitonin level >0.5 ng/mL (all P < .05). The "PqSOFA" score combined the qSOFA score with procalcitonin, which provided an area under the curve value of 0.751 (95% CI: 0.712-0.790) for predicting 28-day mortality. A cut-off score of 2 points provided sensitivity of 83.2%, specificity of 54.9%, negative predictive value (NPV) of 33.03%, positive predictive value (PPV) of 92.47%, positive-likelihood ratio (PLR) of 1.85, and negative-likelihood ratio (NLR) of 0.31. The area under the curve for predicting 28-day mortality was significantly greater for the PqSOFA score than for the qSOFA score (Z = 7.019, P < .0001). The PqSOFA score was comparable to the SOFA and APACHE II scores.The PqSOFA score independently predicted poor short-term outcomes among high-risk sepsis patients.


Assuntos
Sepse/diagnóstico , Doença Aguda , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Sepse/mortalidade , Sepse/terapia , Índice de Gravidade de Doença
12.
Medicine (Baltimore) ; 99(5): e18959, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000421

RESUMO

The outcomes of minimally invasive thoracoscopic pulmonary segmentectomy for non-small cell lung cancer (NSCLC) still need to be defined. This study aimed to investigate the feasibility and effectiveness of thoracoscopic pulmonary segmentectomy in patients with early peripheral NSCLC.This was a retrospective study of patients with early peripheral NSCLC admitted between January 2013 and January 2017. Patients were divided into the segmentectomy and lobectomy groups (40/group), according to the surgery they underwent. Blood loss, operation time, removal of drainage tube time, inflammatory response after operation, postoperative complications, postoperative lung function, local recurrence, and survival were compared.Blood loss and removal of drainage tube time were not significantly different between the 2 groups (all P > .05). Operation time in the segmentectomy group was longer than in the lobectomy group (P < .001). The postoperative interleukin-6, procalcitonin, and C-reactive protein changes in the segmentectomy group were significantly lower than in the lobectomy group (all P < .001). The pulmonary function at 2 weeks was significantly reduced in the 2 groups (all P < .001), but it was better in the segmentectomy group than in the lobectomy group (all P < .05). The 1- and 3-year local recurrence disease-free, and overall survival rates were not significantly different between the 2 groups (P > .05). The multivariable analysis could not identify any factor associated with local recurrence or survival (all P > .05).Thoracoscopic pulmonary segmentectomy and lobectomy are both acceptable for the treatment of early peripheral NSCLC, but segmentectomy was associated with lower postoperative inflammation and better postoperative pulmonary function than lobectomy.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Toracoscopia , Adulto , Idoso , Biomarcadores Tumorais/sangue , Perda Sanguínea Cirúrgica , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Drenagem , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Duração da Cirurgia , Complicações Pós-Operatórias , Testes de Função Respiratória , Estudos Retrospectivos , Taxa de Sobrevida
13.
Rev Med Liege ; 75(2): 130-135, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-32030940

RESUMO

The «Prospective Comparison of ARNI with ARB Global Outcomes in HF with Preserved Ejection Fraction¼ (PARAGON HF) trial is a multicenter, randomized, double-blind study comparing the incidence of heart failure hospitalization and cardiovascular mortality in patients with heart failure with preserved ejection fraction (HFpEF) treated with sacubitril/valsartan (Entresto®) versus valsartan alone. After a median follow-up of 35 months, the primary endpoint was reduced by 13 % in the sacubitril/valsartan group compared to the valsartan group (relative risk: 0.87, 95 % IC: 0.753-1.005, p = 0.058). Despite this lack of significance, the incidence of hospitalizations for heart failure was reduced (RR 0.85, 95 % CI: 0.72-1.00), whereas no benefit was observed on cardiovascular mortality. A subgroup analysis suggested that women and patients with an intermediate ejection fraction could get more benefit from the treatment. Concerning secondary criteria, a significant improvement in quality of life and in heart failure symptoms was observed in the group sacubitril/valsartan. There was a greater incidence of arterial hypotension and angioneurotic edema, but a lower incidence of hyperkalemia in the group sacubitril/valsartan.


Assuntos
Antagonistas de Receptores de Angiotensina , Insuficiência Cardíaca , Hospitalização , Volume Sistólico , Método Duplo-Cego , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Humanos , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
14.
Medicine (Baltimore) ; 99(5): e18438, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000356

RESUMO

Burkitt lymphoma (BL), an aggressive malignancy, brings a prognosis varying among children, adolescents, and adults. Most of previous retrospective studies of BL focused on a part of population. This study aimed to find the leading prognostic factors in BL among patients of different age groups. World Health Organization classification of lymphoid neoplasms in 2008 and revision in 2016 were used as diagnostic criteria for BL. We compared the laboratory results and clinical manifestations in 2 age groups by Kaplan-Meier survival analysis. Our study strongly indicated that age >14 years and lactate dehydrogenase >570 U/L were 2 powerful prognostic factors for BL. The results indicated that poor prognosis may be for the poor tolerance and low dose of drugs in adolescents and adults.


Assuntos
Linfoma de Burkitt/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
15.
Medicine (Baltimore) ; 99(5): e18666, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000373

RESUMO

Ovarian cancer has the highest mortality among gynecological cancers. Although ovarian cancer usually responds well to chemotherapy, most patients still have a poor prognosis. EIF2B5 is a crucial molecule in posttranscriptional modifications involved in tumor progression, and here we investigated the prognostic role of EIF2B5 in ovarian cancer. We examined the differential expression of EIF2B5 mRNA in ovarian cancer by exploring The Cancer Genome Atlas (TCGA) database. The chi square test was used to identify a clinical correlation. Survival analysis and Cox regression model were performed to determine the association between EIF2B5 expression and overall survival (OS) in ovarian cancer patients. As a result, Low EIF2B5 expression was found in ovarian cancer tissues and correlated with survival status. Survival analysis showed that ovarian cancer patients with low EIF2B5 expression had a short OS. Moreover, Cox regression analysis indicated that low EIF2B5 expression was an independent risk factor for a poor prognosis in ovarian cancer. Additionally, according to gene set enrichment analysis, mesenchymal transition, angiogenesis, coagulation, and bile acid metabolism were differentially enriched in ovarian cancer with high EIF2B5 expression. In conclusion, Low EIF2B5 expression is an independent risk factor for a poor prognosis in ovarian cancer patients.


Assuntos
Fator de Iniciação 2B em Eucariotos/metabolismo , Neoplasias Ovarianas/metabolismo , Biomarcadores Tumorais/metabolismo , China/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/mortalidade , Prognóstico
16.
MMWR Morb Mortal Wkly Rep ; 69(5): 125-129, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32027630

RESUMO

Increased prevalence of illicitly manufactured fentanyl and fentanyl analogs has contributed substantially to overdose deaths in the United States (1-3). On October 26, 2015, CDC issued a Health Advisory regarding rapid increases in deaths involving fentanyl. This CDC Health Advisory has been updated twice to address increases in fentanyl and fentanyl analog overdoses and their co-occurrence with nonopioids (4). Deaths involving carfentanil, an analog reportedly 10,000 times more potent than morphine and 100 times more potent than fentanyl, were first reported in Florida, Michigan, and Ohio in 2016 and described in an August 2016 CDC Health Advisory (1,5). Carfentanil is used to rapidly immobilize large animals in veterinary medicine and has no U.S. approved therapeutic use in humans. Carfentanil's street price per dose is likely lower than that of heroin. During 2016 and 2017, an outbreak of carfentanil-involved fatal overdoses in Florida emerged, and the Medical Examiner jurisdiction serving Sarasota, Manatee, and DeSoto counties (the Sarasota area) was the outbreak epicenter. This report describes toxicology profiles, sociodemographic information, and geographic distributions of carfentanil-involved fatal overdoses (carfentanil deaths) in the Sarasota area compared with those in the rest of Florida (i.e., all Florida counties excluding Sarasota area) from January 2016 to December 2017. The Sarasota area accounted for 19.0% of 1,181 statewide carfentanil deaths that occurred during this time and experienced a peak in carfentanil deaths preceding the larger Florida outbreak. The report of a single carfentanil death from August to December 2017 (compared with 73 reported deaths during the same period in 2016) appeared to mark the end of the outbreak in the area. The threat of such rapid, intense fatal overdose outbreaks highlights the need for accelerated reporting, reliable data sharing systems, and novel proactive surveillance to support targeted prevention and response efforts by public health and safety organizations (6).


Assuntos
Surtos de Doenças , Overdose de Drogas/mortalidade , Fentanila/análogos & derivados , Adulto , Feminino , Fentanila/envenenamento , Florida/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade
18.
Lancet ; 395(10221): 350-360, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32007170

RESUMO

BACKGROUND: Improved markers of prognosis are needed to stratify patients with early-stage colorectal cancer to refine selection of adjuvant therapy. The aim of the present study was to develop a biomarker of patient outcome after primary colorectal cancer resection by directly analysing scanned conventional haematoxylin and eosin stained sections using deep learning. METHODS: More than 12 000 000 image tiles from patients with a distinctly good or poor disease outcome from four cohorts were used to train a total of ten convolutional neural networks, purpose-built for classifying supersized heterogeneous images. A prognostic biomarker integrating the ten networks was determined using patients with a non-distinct outcome. The marker was tested on 920 patients with slides prepared in the UK, and then independently validated according to a predefined protocol in 1122 patients treated with single-agent capecitabine using slides prepared in Norway. All cohorts included only patients with resectable tumours, and a formalin-fixed, paraffin-embedded tumour tissue block available for analysis. The primary outcome was cancer-specific survival. FINDINGS: 828 patients from four cohorts had a distinct outcome and were used as a training cohort to obtain clear ground truth. 1645 patients had a non-distinct outcome and were used for tuning. The biomarker provided a hazard ratio for poor versus good prognosis of 3·84 (95% CI 2·72-5·43; p<0·0001) in the primary analysis of the validation cohort, and 3·04 (2·07-4·47; p<0·0001) after adjusting for established prognostic markers significant in univariable analyses of the same cohort, which were pN stage, pT stage, lymphatic invasion, and venous vascular invasion. INTERPRETATION: A clinically useful prognostic marker was developed using deep learning allied to digital scanning of conventional haematoxylin and eosin stained tumour tissue sections. The assay has been extensively evaluated in large, independent patient populations, correlates with and outperforms established molecular and morphological prognostic markers, and gives consistent results across tumour and nodal stage. The biomarker stratified stage II and III patients into sufficiently distinct prognostic groups that potentially could be used to guide selection of adjuvant treatment by avoiding therapy in very low risk groups and identifying patients who would benefit from more intensive treatment regimes. FUNDING: The Research Council of Norway.


Assuntos
Neoplasias Colorretais/diagnóstico , Aprendizado Profundo , Idoso , Biomarcadores Tumorais/metabolismo , Estudos de Coortes , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/terapia , Detecção Precoce de Câncer/métodos , Amarelo de Eosina-(YS)/metabolismo , Feminino , Hematoxilina/metabolismo , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
19.
Anticancer Res ; 40(1): 491-499, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892604

RESUMO

This article is a narrative review of recent epidemiological findings regarding ultraviolet-B (UVB) dose or exposure, serum 25-hydroxyvitamin D [25(OH)D] concentrations, vitamin D supplementation, and genetic variations in 25(OH)D concentration for incidence, survival, and mortality rates of overall and breast, colorectal, and prostate cancer. According to ecological studies, solar UVB doses are inversely correlated with incidence/mortality rates for about 20 cancer types. Observational studies support a role of higher 25(OH)D concentrations in reducing risk of breast and colorectal cancer incidence and mortality rates but, for prostate cancer, in increasing incidence rates while reducing mortality rates. Mendelian randomization studies offer little support for vitamin D in reducing cancer risk. Their primary limitation is that they only investigate small variations in genetically predicted 25(OH)D concentration near the population mean value. The secondary analyses from the VITAL clinical trial indicated significant reductions from 2000 IU/d of vitamin D3 supplementation in all-cancer incidence and mortality rates for selected subgroups. Thus, Hill's criteria for causality in a biological system are now largely satisfied for supporting the claim that vitamin D reduces the risk of cancer incidence and death.


Assuntos
Neoplasias/epidemiologia , Vitamina D/metabolismo , Suplementos Nutricionais , Humanos , Neoplasias/sangue , Neoplasias/mortalidade , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Vitamina D/sangue
20.
Medicine (Baltimore) ; 99(4): e18974, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977914

RESUMO

We aimed to develop a nomogram based on a population-based cohort to estimate the individualized overall survival (OS) for patients with nasopharyngeal carcinoma (NPC) and compare its predictive value with that of the traditional staging system.Data for 3693 patients with NPC were extracted from the Surveillance, Epidemiology, and End Results dataset and randomly divided into two sets: training (n = 2585) and validation (n = 1108). On the basis of multivariate Cox regression analysis, a nomogram was constructed to predict the 3-, 5-, and 10-year survival probability for a patient. The performance of the nomogram was quantified with respect to discrimination, calibration, and clinical utility.In the training set, age, sex, race, marital status, histological type, T stage, N stage, M stage, radiotherapy, and chemotherapy were selected to develop a nomogram for predicting the OS probability based on the multivariate Cox regression model. The nomogram was generally more discriminative compared with the American Joint Committee on Cancer 7th staging system. Calibration plots exhibited an excellent consistency between the observed probability and the nomogram's prediction. Categorical net classification improvement and integrated discrimination improvement suggested that the predictive accuracy of the nomogram exceeded that of the classic staging system. With respect to decision curve analyses, the nomogram exhibited preferable net benefit gains than the staging system across a wide range of threshold probabilities.This proposed nomogram exhibits an excellent performance with regard to its predictive accuracy, discrimination capability, and clinical utility, and thus can be used as a convenient and reliable tool for prognosis prediction in patients with NPC.


Assuntos
Carcinoma Nasofaríngeo/mortalidade , Nomogramas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Melhoria de Qualidade , Programa de SEER/estatística & dados numéricos , Adulto Jovem
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