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1.
Medicine (Baltimore) ; 100(32): e26831, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397888

RESUMO

ABSTRACT: Hemifacial spasm (HFS) has been recognized as the frequently occurring disease of cranial nerve. At the same time, several articles indicate that, dystonia results in certain psychological disorders. Consequently, this study aimed to examine the association of preoperative depression and anxiety with HFS severity; meanwhile, the role in microvascular decompression (MVD) outcomes after surgery among adolescent patients was also examined.All cases had been classified as two groups based on MVD outcomes among HFS cases; in addition, the preoperative Hamilton anxiety rating scale (HARS) and the Hamilton depression rating scale (HDRS) scores were compared between patients not and still suffering from spasm. Moreover, the multiple logistic regression model was employed in assessing the relationship between preoperative HARS as well as HDRS scores and outcomes of adolescent cases undergoing MVD.The preoperative HARS and HDRS scores showed positive correlation with Cohen spasm grades in HFS patients. Meanwhile, compared with spasm-free group, patients of persistent spams group had apparently higher preoperative HARS and HDRS scores.Our results suggest that, preoperative anxiety and depression status show close association with HFS severity, and they could also impact the MVD outcomes for adolescent cases.


Assuntos
Ansiedade , Depressão , Espasmo Hemifacial , Período Pré-Operatório , Adolescente , Ansiedade/diagnóstico , Ansiedade/fisiopatologia , Depressão/diagnóstico , Depressão/fisiopatologia , Feminino , Espasmo Hemifacial/diagnóstico , Espasmo Hemifacial/psicologia , Espasmo Hemifacial/cirurgia , Humanos , Modelos Logísticos , Masculino , Cirurgia de Descompressão Microvascular/efeitos adversos , Cirurgia de Descompressão Microvascular/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença
2.
Medicine (Baltimore) ; 100(29): e26662, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398027

RESUMO

BACKGROUND: Postoperative delirium (POD) not only increases the medical burden but also adversely affects patient prognosis. Although some cases of delirium can be avoided by early intervention, there is no clear evidence indicating whether any of these measures can effectively prevent POD in specific patient groups. OBJECTIVE: The aim of this meta-analysis was to compare the efficacy and safety of the existing preventive measures for managing POD. METHODS: The PubMed, OVID (Embase and MEDLINE), Web of Science, and the Cochrane Library databases were searched for articles published before January 2020. The relevant randomized controlled trials (RCTs) were selected based on the inclusion and exclusion criteria. Data extraction and methodological quality assessment were performed according to a predesigned data extraction form and scoring system, respectively. The interventions were compared on the basis of the primary outcome like incidence of POD, and secondary outcomes like duration of delirium and the length of intensive care unit and hospital stay. RESULTS: Sixty-three RCTs were included in the study, covering interventions like surgery, anesthesia, analgesics, intraoperative blood glucose control, cholinesterase inhibitors, anticonvulsant drugs, antipsychotic drugs, sleep rhythmic regulation, and multi-modal nursing. The occurrence of POD was low in 4 trials that monitored the depth of anesthesia with bispectral index during the operation (P < .0001). Two studies showed that supplementary analgesia was useful for delirium prevention (P = .002). Seventeen studies showed that perioperative sedation with α2-adrenergic receptor agonists prevented POD (P = .0006). Six studies showed that both typical and atypical antipsychotic drugs can reduce the incidence of POD (P = .002). Multimodal nursing during the perioperative period effectively reduced POD in 6 studies (P < .00001). Furthermore, these preventive measures can reduce the duration of delirium, as well as the total and postoperative length of hospitalized stay for non-cardiac surgery patients. For patients undergoing cardiac surgery, effective prevention can only reduce the length of intensive care unit stay. CONCLUSION: Measures including intraoperative monitoring of bispectral index, supplemental analgesia, α2-adrenergic receptor agonists, antipsychotic drugs, and multimodal care are helpful to prevent POD effectively. However, larger, high-quality RCTs are needed to verify these findings and develop more interventions and drugs for preventing postoperative delirium.


Assuntos
Delírio/prevenção & controle , Humanos , Complicações Pós-Operatórias/prevenção & controle , Período Pré-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
3.
Nutrients ; 13(7)2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34371947

RESUMO

Nutritional status is well-known to influence patient recovery after resection of head and neck cancer (HNC). The influence of preoperative nutritional status on dysphagia was assessed in patients who underwent surgical resection of HNC along with the assessment of nutritional status during the acute and subacute phases. Eighty-six patients underwent surgical resection and dysphagia assessments (repetitive saliva-swallowing test, water-swallowing test, and functional oral intake scale) and had their tongue pressure assessed five times (before surgery, after 1-2 weeks, and 1, 2, and 3 months after surgery). The nutritional status was assessed according to the body mass index, total protein, and albumin. The prognostic nutritional index was calculated from preoperative data, and the subjects were classified into three groups: Low-risk, Attention and High-risk groups. After surgery, the nutritional status index values were low, and the High-risk group showed significantly lower values in comparison to the other two groups. The water-swallowing test and functional oral intake scale findings were worse than they had been preoperatively until 2 months after surgery, and a significant correlation was noted between the postoperative nutritional status and the presence of dysphagia. The results indicated that the preoperative nutritional status of HNC patients influenced their ability to ingest/swallow, which in turn influenced their nutritional status after HNC resection.


Assuntos
Transtornos de Deglutição/etiologia , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/cirurgia , Estado Nutricional , Idoso , Deglutição , Ingestão de Alimentos , Feminino , Neoplasias de Cabeça e Pescoço/fisiopatologia , Humanos , Masculino , Avaliação Nutricional , Complicações Pós-Operatórias , Período Pós-Operatório , Período Pré-Operatório , Pressão , Estudos Prospectivos , Língua
4.
Nutrients ; 13(7)2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34371859

RESUMO

Almost two in three patients who are aged 75 years and older and scheduled for surgery for colorectal cancer (CRC) are undernourished. Despite evidence that perioperative nutritional management can improve patients outcomes, international guidelines are still insufficiently applied in current practice. In this stepped-wedge cluster-randomized study of five surgical hospitals, we included 147 patients aged 70 years or older with scheduled abdominal surgery for CRC between October 2013 and December 2016. In the intervention condition, an outreach team comprising a geriatrician and a dietician visited patients and staff in surgical wards to assist with the correct application of guidelines. Evaluation, diagnosis, and prescription (according to nutritional status) were considered appropriate and strictly consistent with guidelines in 39.2% of patients in the intervention group compared to only 1.4% in the control group (p = 0.0002). Prescription of oral nutritional supplements during the perioperative period was significantly improved (41.9% vs. 4.1%; p < 0.0001). However, there were no benefits of the intervention on surgical complications or adverse events. A possible benefit of hospital stay reduction will need to be confirmed in further studies. This study highlights the importance of the implementation of quality improvement interventions into current practice for the perioperative nutritional management of older patients with CRC.


Assuntos
Avaliação Geriátrica/métodos , Desnutrição/terapia , Terapia Nutricional/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/complicações , Neoplasias Colorretais/fisiopatologia , Neoplasias Colorretais/cirurgia , Suplementos Nutricionais , Feminino , Humanos , Masculino , Desnutrição/complicações , Política Nutricional , Terapia Nutricional/normas , Estado Nutricional , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/normas , Período Pré-Operatório , Melhoria de Qualidade , Resultado do Tratamento
5.
Bone Joint J ; 103-B(8): 1358-1366, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34334050

RESUMO

AIMS: This study used an artificial neural network (ANN) model to determine the most important pre- and perioperative variables to predict same-day discharge in patients undergoing total knee arthroplasty (TKA). METHODS: Data for this study were collected from the National Surgery Quality Improvement Program (NSQIP) database from the year 2018. Patients who received a primary, elective, unilateral TKA with a diagnosis of primary osteoarthritis were included. Demographic, preoperative, and intraoperative variables were analyzed. The ANN model was compared to a logistic regression model, which is a conventional machine-learning algorithm. Variables collected from 28,742 patients were analyzed based on their contribution to hospital length of stay. RESULTS: The predictability of the ANN model, area under the curve (AUC) = 0.801, was similar to the logistic regression model (AUC = 0.796) and identified certain variables as important factors to predict same-day discharge. The ten most important factors favouring same-day discharge in the ANN model include preoperative sodium, preoperative international normalized ratio, BMI, age, anaesthesia type, operating time, dyspnoea status, functional status, race, anaemia status, and chronic obstructive pulmonary disease (COPD). Six of these variables were also found to be significant on logistic regression analysis. CONCLUSION: Both ANN modelling and logistic regression analysis revealed clinically important factors in predicting patients who can undergo safely undergo same-day discharge from an outpatient TKA. The ANN model provides a beneficial approach to help determine which perioperative factors can predict same-day discharge as of 2018 perioperative recovery protocols. Cite this article: Bone Joint J 2021;103-B(8):1358-1366.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Artroplastia do Joelho , Redes Neurais de Computação , Osteoartrite do Joelho/cirurgia , Alta do Paciente , Idoso , Feminino , Previsões , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Período Pré-Operatório
6.
Ann Ital Chir ; 92: 283-292, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34312330

RESUMO

BACKGROUND/OBJECTIVE: In this study, we aimed to determine the relationship between HALP score and postoperative complications (According to Clavien-Dindo classification 3 and above), in patients with colo-rectal cancer who underwent curative surgical resection and to determine its clinical value in predicting prognosis. METHODS: 279 patients who underwent curative surgery for colorectal cancer between 2015-2018 were included in the study. The HALP value was calculated by dividing the product of hemoglobin (g/L), albumin (g/L), lymphocytes (/ L) by the number of platelets (/ L). In order to generate a cut off value for the HALP value, ROC analysis and ROC curve were created. The patients were divided into two groups according to survival, and cut off value was found by ROC analysis: Group 1 (Low HALP) and Group 2 (High HALP). Demographic, clinical characteristics, intraoperative , postoperative results and mean survival were compared between the groups. RESULTS: The patients were divided into two groups according to cut off value of 15.73. Group 1 consisted of 113 patients; Group 2 consisted of 166 patients. Average age was similar in the groups (62vs61, p:0.480). Patients in Group 1 received more neoadjuvant therapy (31%vs21%, p:0.064). CEA levels were higher in Group 1 (7.6vs4.3 p:0.034). Mucinous adenocarcinoma histological type was more common in Group 1 (24%vs13% ,p:0.040). Pathological grade poorly differentiated was more common in Group 1 (27%vs13%). Postoperative outcomes was similar to groups We found the HALP score as a risk factor for survival in multivariate analysis (HR=0.8552 95% (CI:0.6575-1.1125, p:0.007). If the HALP value is below 15.73, it is assumed that the average survival is 28 months with 45.4% sensitivity and 66.938% specificity. CONCLUSION: Our results showed that the HALP score is closely related to clinic pathological features and is an independent prognostic factor for survival. Its value in estimating mean survival is limited. KEY WORDS: Colorectal cancer, HALP score, Immunity, Nutrition.


Assuntos
Neoplasias Colorretais , Hemoglobinas/análise , Contagem de Linfócitos , Contagem de Plaquetas , Albumina Sérica/análise , Plaquetas , Neoplasias Colorretais/sangue , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Humanos , Linfócitos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos
7.
CMAJ Open ; 9(3): E777-E787, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34285057

RESUMO

BACKGROUND: The identification of frailty before complex and invasive procedures may have relevance for prognostic and recovery purposes, to optimally inform patients, caregivers and clinicians about perioperative risk and postoperative care needs. The aim of this study was to estimate the prevalence of frailty and describe the associated clinical course and outcomes of patients referred for nonemergent cardiac surgery. METHODS: A prospective cohort of patients aged 50 years and older referred for nonemergent cardiac surgery in Alberta, Canada, from November 2011 to March 2014 were screened preoperatively for frailty, defined as a Clinical Frailty Scale (CFS) score of 5 or greater. Postoperatively, patients were followed by telephone to assess CFS score, health services use and vital status. The primary outcome was all-cause hospital mortality. Secondary outcomes included health services use, hospital discharge disposition, 1-year health-related quality of life and all-cause 5-year mortality. RESULTS: The cohort (n = 529) had a mean age of 67 (standard deviation [SD] 9) years; 25.9% were female, and the prevalence of frailty was 9.6% (n = 51; 95% confidence interval [CI] 7.3%-12.5%). Frail patients were older (median age 75, interquartile range [IQR] 65-80 v. 67, IQR 60-73, yr; p < 0.001), were more likely to be female (51.0% v. 23.2%; p < 0.001), had a higher mean EuroSCORE II (8, SD 3 v. 5, SD 3; p < 0.001) and received combined coronary artery bypass grafting and valve procedures more frequently (29.4% v. 15.9%; p = 0.02) than nonfrail patients. Postoperatively, frail patients had a longer median duration of stay in the cardiovascular intensive care unit (median difference 2.2, 95% CI 1.60-2.79) and hospital (median difference 9.3, 95% CI 8.2-10.3). Hospital mortality was 9.8% among frail patients and 1.0% among nonfrail patients (adjusted hazard ratio 3.84, 95% CI 0.90-16.34). INTERPRETATION: Preoperative frailty was present in 10% of patients and was associated with a higher risk of morbidity and greater health services use. Preoperative frailty has important implications for the postoperative clinical course and resource utilization of patients undergoing cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Fragilidade/epidemiologia , Cardiopatias/epidemiologia , Cardiopatias/cirurgia , Período Pré-Operatório , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alberta/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Eletivos , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Cardiopatias/etiologia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
8.
Anticancer Res ; 41(8): 4005-4011, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34281865

RESUMO

BACKGROUND: This study evaluated the prognostic value of preoperative immunoinflammatory scores and 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET) for patients undergoing salvage esophagectomy to identify suitable candidates for surgery. PATIENTS AND METHODS: Twenty-five patients undergoing salvage esophagectomy were included. The prognostic value of the preoperative C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and maximum standardized FDG uptake value (SUVmax) were investigated. RESULTS: Multivariate analysis demonstrated high CAR to be an independent prognostic factor for overall survival (p=0.013). CAR had no association with clinicopathological variables, whereas the SUVmax was significantly positively associated with tumor aggressiveness. Multivariate analysis using residual tumor and the combination of CAR and SUVmax revealed both residual tumor (p=0.009) and high CAR/high SUVmax (p=0.016) to be independent prognostic factors for overall survival. CONCLUSION: Preoperative evaluation of CAR as an immunoinflammatory indicator and SUVmax as a marker of tumor aggressiveness will be useful to identify suitable candidates for this high-risk surgery.


Assuntos
Proteína C-Reativa/análise , Neoplasias Esofágicas , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons , Albumina Sérica/análise , Idoso , Biomarcadores/sangue , Plaquetas , Neoplasias Esofágicas/sangue , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/terapia , Esofagectomia , Feminino , Humanos , Inflamação/sangue , Inflamação/diagnóstico por imagem , Inflamação/terapia , Estimativa de Kaplan-Meier , Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Terapia de Salvação
9.
J Orthop Surg Res ; 16(1): 415, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193239

RESUMO

BACKGROUND: Recent studies indicate that, in addition to antibody production, lymphocyte responses to SARS-CoV-2 may play an important role in protective immunity to COVID-19 and a percentage of the general population may exhibit lymphocyte memory due to unknown/asymptomatic exposure to SARS-CoV-2 or cross-reactivity to other more common coronaviruses pre-vaccination. Total joint replacement (TJR) candidates returning to elective surgeries (median age 68 years) may exhibit similar lymphocyte and/or antibody protection to COVID-19 prior to vaccination METHODS: In this retrospective study, we analyzed antibody titters, lymphocyte memory, and inflammatory biomarkers specific for the Spike and Nucleocapsid proteins of the SARS-CoV-2 virus in a cohort of n=73 returning TJR candidates (knees and/or hips) pre-operatively. RESULTS: Peripheral blood serum of TJR candidate patients exhibited a positivity rate of 18.4% and 4% for IgG antibodies specific for SARS-CoV-2 nucleocapsid and spike proteins, respectively. 13.5% of TJR candidates exhibited positive lymphocyte reactivity (SI > 2) to the SARS-CoV-2 nucleocapsid protein and 38% to the spike protein. SARS-CoV-2 reactive lymphocytes exhibited a higher production of inflammatory biomarkers (i.e., IL-1ß, IL-6, TNFα, and IL-1RA) compared to non-reactive lymphocytes. CONCLUSIONS: A percentage of TJR candidates returning for elective surgeries exhibit pre-vaccination positive SARS-CoV-2 antibodies and T cell memory responses with associated pro-inflammatory biomarkers. This is an important parameter for understanding immunity, risk profiles, and may aid pre-operative planning. TRIAL REGISTRATION: Retrospectively registered.


Assuntos
Artroplastia de Substituição , COVID-19/imunologia , Inflamação/metabolismo , Linfócitos/imunologia , SARS-CoV-2/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Período Pré-Operatório , Estudos Retrospectivos
10.
J Cardiothorac Surg ; 16(1): 198, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34284809

RESUMO

BACKGROUND: Poor glycemic control has been associated with an increased risk of wound complications after various types of operations. However, it remains unclear how hemoglobin A1c (HbA1c) and preoperative glycemia can be used in clinical decision-making to prevent sternal wound complications (SWC) following off-pump coronary artery bypass grafting (OPCAB). METHODS: We conducted a retrospective study of 1774 consecutive patients who underwent OPCAB surgery between January 2010 and November 2016. A new four-grade classification for SWC was used. The associations of HbA1c and preoperative glycemia with incidence and grade of SWC were analysed using logistic regression analysis and proportional odds models, respectively. RESULTS: During a median follow-up of 326 days (interquartile range (IQR) 21-1261 days), SWC occurred in 133/1316 (10%) of non-diabetes and 82/458 (18%) of diabetes patients (p < 0.001). Higher HbA1c was significantly associated with a higher incidence of SWC (odds ratio, OR 1.24 per 1% increase, 95% confidence interval, CI 1.04;1.48, p = 0.016) as well as a higher grade of SWC (OR 1.25, 95% CI 1.06;1.48, p = 0.010). There was no association between glycemia and incidence (p = 0.539) nor grade (p = 0.607) of SWC. Significant modifiers of these effects were found: HbA1c was associated with SWC in diabetes patients younger than 70 years (OR 1.41, 95% CI 1.17;1.71, p < 0.001), whereas it was not in those older than 70 years. Glycemia was associated with SWC in patients who underwent non-urgent surgery (OR 2.48, 95% CI 1.26;4.88, p = 0.009), in diabetes patients who received skeletonised grafts (OR 4.83, 95% CI 1.28;18.17, p = 0.020), and in diabetes patients with a BMI < 30 (OR 2.19, 95% CI 1.01;4.76, p = 0.047), whereas it was not in the counterparts of these groups. CONCLUSIONS: Under certain conditions, HbA1c and glycemia are associated SWC following OPCAB. These findings are helpful in planning the procedure with minimal risk of SWC.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Tomada de Decisões , Diabetes Mellitus/epidemiologia , Hemoglobina A Glicada/metabolismo , Idoso , Biomarcadores/sangue , Glicemia/metabolismo , Comorbidade , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/sangue , Feminino , Humanos , Incidência , Masculino , Razão de Chances , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento
11.
Nutrients ; 13(6)2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34205251

RESUMO

Quadriceps muscle atrophy following total knee arthroplasty (TKA) can be caused by tourniquet-induced ischemia-reperfusion (IR) injury, which is often accompanied by oxidative stress and inflammatory responses. n-3 long-chain polyunsaturated fatty acids (LCPUFAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), exert antioxidant and anti-inflammatory effects against IR injury, whereas n-6 LCPUFAs, particularly arachidonic acid (AA), exhibit pro-inflammatory effects and promote IR injury. This study aimed to examine whether preoperative serum EPA + DHA levels and the (EPA + DHA)/AA ratio are associated with oxidative stress immediately after TKA. Fourteen eligible patients with knee osteoarthritis scheduled for unilateral TKA participated in this study. The levels of serum EPA, DHA, and AA were measured immediately before surgery. Derivatives of reactive oxygen metabolites (d-ROMs) were used as biomarkers for oxidative stress. The preoperative serum EPA + DHA levels and the (EPA + DHA)/AA ratio were found to be significantly negatively correlated with the serum d-ROM levels at 96 h after surgery, and the rate of increase in serum d-ROM levels between baseline and 96 h postoperatively. This study suggested the preoperative serum EPA + DHA levels and the (EPA + DHA)/AA ratio can be negatively associated with oxidative stress immediately after TKA.


Assuntos
Artroplastia do Joelho , Ácidos Graxos Insaturados/sangue , Estresse Oxidativo/fisiologia , Projetos Piloto , Período Pré-Operatório , Idoso , Ácido Araquidônico/sangue , Artroplastia do Joelho/efeitos adversos , Atrofia/etiologia , Ácidos Docosa-Hexaenoicos/sangue , Ácido Eicosapentaenoico/sangue , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Músculo Quadríceps/patologia , Espécies Reativas de Oxigênio/sangue , Traumatismo por Reperfusão/sangue , Traumatismo por Reperfusão/complicações
12.
Int J Cancer ; 149(6): 1332-1340, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34109628

RESUMO

In the SIOP Wilms' tumor (WT) studies, preoperative chemotherapy is used as primary treatment, and tumors are classified thereafter by pathologists. Completely necrotic WTs (CN-WTs) are classified as low-risk tumors. The aim of the study was to evaluate whether a subset of regressive type WTs (RT-WTs) (67%-99% chemotherapy-induced changes [CIC]) showing an exceptionally good response to preoperative chemotherapy had comparably excellent survivals as CN-WTs, and to establish a cut-off point of CIC that could define this subset. The study included 2117 patients with unilateral, nonanaplastic WTs from the UK-CCLG and GPOH-WT studies (2001-2020) treated according to the SIOP-WT-2001 protocol. There were 126 patients with CN-WTs and 773 with RT-WTs, stages I-IV. RT-WTs were subdivided into subtotally necrotic WTs (>95% CIC) (STN-WT96-99) (124 patients) and the remaining of RT-WT (RR-WT67-95) (649 patients). The 5-year event-free survival (EFS) and overall survival (OS) for CN-WTs were 95.3% (±2.1% SE) and 97.3% (±1.5% SE), and for RT-WTs 85.7% (±1.14% SE, P < .01) and 95.2% (±0.01% SE, P = .59), respectively. CN-WT and STN-WT96-99 groups showed significantly better EFS than RR-WT67-95 (P = .003 and P = .02, respectively), which remained significantly superior when adjusted for age, local stage and metastasis at diagnosis, in multivariate analysis, whereas OS were superimposable (97.3 ± 1.5% SE for CN-WT; 97.8 ± 1.5% SE for STN-WT96-99; 94.7 ± 1.0% SE for RR-WT67-95). Patients with STN-WT96-99 share the same excellent EFS and OS as patients with CN-WTs, and although this was achieved by more treatment for patients with STN-WT96-99 than for patients with CN-WT, reduction in postoperative treatment of these patients may be justified.


Assuntos
Tratamento Farmacológico/métodos , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/patologia , Tumor de Wilms/tratamento farmacológico , Tumor de Wilms/patologia , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Análise Multivariada , Estadiamento de Neoplasias , Período Pré-Operatório , Prognóstico , Análise de Sobrevida , Resultado do Tratamento , Reino Unido
13.
Medicine (Baltimore) ; 100(24): e26311, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128870

RESUMO

ABSTRACT: Pancreatectomy is an invasive surgery that is sometimes associated with complications. New-onset diabetes mellitus sometimes develops after partial pancreatectomy and severely affects the patient's quality of life. This study aimed to develop a preoperative prediction model of new-onset diabetes mellitus after partial pancreatectomy, which will help patients and surgeons to achieve more easily better common decisions on regarding whether to perform partial pancreatectomy. This retrospective cohort study analyzed medical records of patients who underwent partial pancreatectomy (total pancreatectomy excluded) from April 1, 2008, to February 28, 2016, which were available in the database provided by Medical Data Vision Co., Ltd. (Tokyo, Japan). The predictors were preoperative age, body mass index, hemoglobin A1c level, blood glucose level, and indication for partial pancreatectomy. The outcome was the development of new-onset diabetes mellitus at 1 to 12 months after partial pancreatectomy. We used a logistic regression model and calculated the scores of each predictor. To determine test performance, we assessed discrimination ability using the receiver operating characteristic curve and calibration with a calibration plot and the Hosmer-Lemeshow test. We also performed internal validation using the bootstrap method. Of 681 patients, 125 (18.4%) had new-onset diabetes mellitus after partial pancreatectomy. The developed prediction model had a possible range of 0 to 46 points. The median score was 13, and the interquartile range was 9 to 22. The C-statistics of the receiver operating characteristic curve on the score to predict the outcome was .70 (95% confidence interval [CI], .65-.75). Regarding the test performance, the Hosmer-Lemeshow test was not significant (P = .17), and calibration was good. In the bootstrapped cohorts, the C-statistics was .69 (95% CI, .62-.76). We developed a preoperative prediction model for new-onset diabetes mellitus after partial pancreatectomy. This would provide important information for surgeons and patients when deciding whether to perform partial pancreatectomy.


Assuntos
Regras de Decisão Clínica , Diabetes Mellitus/etiologia , Pancreatectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Medição de Risco/métodos , Idoso , Índice de Massa Corporal , Feminino , Hemoglobina A Glicada/análise , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Período Pré-Operatório , Qualidade de Vida , Curva ROC , Estudos Retrospectivos , Fatores de Risco
14.
Medicine (Baltimore) ; 100(25): e26214, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160385

RESUMO

ABSTRACT: To investigate the relationship between the changes in circulating CD45RO+T lymphocyte subsets following neoadjuvant therapy for rectal cancer in patients with locally advanced rectal cancer.The clinicopathological data of 185 patients with rectal cancer who received neoadjuvant therapy in the General Surgery Department of Beijing Chaoyang Hospital affiliated to Capital Medical University from June 2015 to June 2017 were analyzed. Venous blood samples were collected 1 week before neoadjuvant therapy and 1 week before surgery, and the expression of CD45RO+T was detected by flow cytometry. The receiver operating characteristic curve analysis was used to determine the optimal cut-off point of CD45RO+ratio. Log-rank test and multivariate Cox regression were used to analyze the overall survival rate (OS) and disease-free survival rate (DFS) associated with CD45RO+ratio.Circulating CD45RO+ratio of 1.07 was determined as the optimal cut-off point and CD45RO+ratio-high was associated with lower tumor regression grade grading (P = .031), T stage (P = .001), and tumor node metastasis (TNM) stage (P = .012). The 3-year DFS and OS rate in the CD45RO+ratio-high group was significantly higher than that in the CD45RO+ratio-low group (89.2% vs 60.1%, P<.001; 94.4% vs 73.2%, P<.001). The multivariate Cox analysis revealed that elevated CD45RO+ratio was an independent factor for better DFS (OR, 0.339; 95% CI, 0.153-0.752; P = .008) and OS (OR, 0.244; 95% CI,0.082-0.726; P = .011).Circulating CD45RO+ratio could predict the tumor regression grade of neoadjuvant therapy for rectal cancer, as well as long-term prognosis. These findings could be used to stratify patients and develop alternative strategies for adjuvant therapy.


Assuntos
Quimiorradioterapia Adjuvante/métodos , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Retais/terapia , Subpopulações de Linfócitos T/imunologia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Separação Celular , Colonoscopia , Ciclofosfamida/uso terapêutico , Intervalo Livre de Doença , Doxorrubicina/uso terapêutico , Citometria de Fluxo , Seguimentos , Humanos , Antígenos Comuns de Leucócito/metabolismo , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/imunologia , Estadiamento de Neoplasias , Oxaliplatina/uso terapêutico , Prednisona/uso terapêutico , Período Pré-Operatório , Protectomia , Prognóstico , Radioterapia de Intensidade Modulada , Neoplasias Retais/sangue , Neoplasias Retais/imunologia , Neoplasias Retais/mortalidade , Reto/diagnóstico por imagem , Reto/patologia , Reto/cirurgia , Estudos Retrospectivos , Taxa de Sobrevida , Subpopulações de Linfócitos T/metabolismo , Vindesina/uso terapêutico
15.
Medicine (Baltimore) ; 100(25): e26437, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160435

RESUMO

ABSTRACT: Recent studies have shown that some inflammatory markers are associated with the prognosis of solid tumors. This study aims to evaluate the prognosis of glioma patients with or without adjuvant treatment using the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR).All patients who were diagnosed with gliomas at the first and second affiliated hospital of Guangxi Medical University between 2011 and 2020 were included in this study. The optimal cutoff value of SII, NLR, and PLR was determined by X-tile software program. We stratified patients into several groups and evaluated the progression-free survival (PFS) and overall survival (OS) of SII, NLR, and PLR during the period of pre-surgical, con-chemoradiotherapy, and post-treatments. Multivariate Cox regression analyses were performed to detect the relationships between OS, PFS, and prognostic variables.A total of 67 gliomas patients were enrolled in the study. The cutoff values of SII, NLR, and PLR were 781.5 × 109/L, 2.9 × 109/L, and 123.2 × 109/L, respectively. Patients who are pre-SII < 781.5 × 109/L had better PFS (P = .027), but no difference in OS. In addition, patients who had low pre-NLR (<2.9 × 109/L) meant better OS and PFS. PLR after adjuvant treatments (post-PLR) was significantly higher than pre-PLR (P = .035). Multivariate analyses revealed that pre-SII, pre-NLR were independent prognostic factors for OS (pre-SII: HR 1.002, 95% CI: 1.000-1.005, P = .030 and pre-PLR: HR 0.983, 95% CI: 0.973-0.994, P = .001), while pre-PLR was an independent factor for PFS (HR 0.989, 95% CI: 0.979-1.000, P = .041).High pre-SII or high pre-NLR could be prognostic markers to identify glioma patients who had a poor prognosis.


Assuntos
Plaquetas/imunologia , Neoplasias Encefálicas/terapia , Glioma/terapia , Linfócitos/imunologia , Procedimentos Neurocirúrgicos , Neutrófilos/imunologia , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/imunologia , Neoplasias Encefálicas/mortalidade , Quimiorradioterapia/métodos , Feminino , Glioma/sangue , Glioma/imunologia , Glioma/mortalidade , Humanos , Inflamação/sangue , Inflamação/diagnóstico , Inflamação/imunologia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Contagem de Plaquetas , Período Pré-Operatório , Prognóstico , Intervalo Livre de Progressão , Valores de Referência , Estudos Retrospectivos , Adulto Jovem
16.
Eur J Vasc Endovasc Surg ; 62(1): 74-80, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34112572

RESUMO

OBJECTIVE: Inflammation is an early feature of acute limb ischaemia (ALI), hence the potential prognostic significance of inflammatory biomarkers. This study aimed to assess the value of pre-operative inflammatory biomarkers, specifically the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR), for predicting an adverse outcome after revascularisation for ALI. METHODS: All patients submitted to lower limb revascularisation for Rutherford IIa or IIb ALI at the authors' institution between 2009 and 2019 were screened retrospectively. Pre-operative NLR and PLR were analysed, along with other known prognostic factors. Primary outcome was the composite endpoint of 30 day death or amputation. RESULTS: A total of 345 patients were included, 84 of whom suffered the primary outcome (24.3%). The median follow up was 23.1 months (3.1 - 52.2). Higher age (OR 1.05 per year increase, 95% CI 1.01 - 1.09), diabetes (OR 2.63, 95% CI 1.14 - 6.06), Rutherford grade IIb vs. IIa (OR 5.51, 95% CI 2.11 - 14.42), higher NLR (OR 1.28 per unit increase, 95% CI 1.12 - 1.47), and fasciotomy need (OR 3.44, 95% CI 1.14 - 10.34) were independently associated with 30 day death or amputation, whereas pre-operative statin or anticoagulant medication were associated with a risk reduction (OR 0.23, 95% CI 0.53 - 0.96 and OR 0.20, 95% CI 0.05 - 0.84, respectively). PLR did not show an independent effect on this population. Pre-operative NLR presented a good discriminative ability (AUC 0.86, 95% CI 0.82 - 0.90). A cut off NLR level ≥ 5.4 demonstrated a 90.5% sensitivity and 73.6% specificity for 30 day death or amputation. Kaplan-Meier analysis showed that patients with pre-operative NLR ≥ 5.4 had significantly lower 30 day, six month and one year amputation free survival when compared with those with NLR < 5.4 (64.8 ± 4.0%, 44.1 ± 4.1%, and 37.5 ± 4.1% vs. 98.5 ± 0.9%, 91.9 ± 2.0%, and 85.9 ± 2.5%, log rank p < .001). CONCLUSION: In this study, higher pre-operative NLR was associated with 30 day death or amputation following intervention for Rutherford grade IIa or IIb ALI. NLR potentially stands as a simple, widely available and inexpensive biomarker that can refine decision making and possibly contribute to ALI morbidity and mortality reduction.


Assuntos
Isquemia/mortalidade , Linfócitos , Neutrófilos , Doenças Vasculares Periféricas/mortalidade , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Anticoagulantes/uso terapêutico , Biomarcadores/sangue , Plaquetas , Tomada de Decisão Clínica , Terapia Combinada/métodos , Terapia Combinada/estatística & dados numéricos , Extremidades/irrigação sanguínea , Extremidades/cirurgia , Fasciotomia/estatística & dados numéricos , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Inflamação/diagnóstico , Inflamação/imunologia , Isquemia/sangue , Isquemia/imunologia , Isquemia/terapia , Estimativa de Kaplan-Meier , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/sangue , Doenças Vasculares Periféricas/imunologia , Doenças Vasculares Periféricas/terapia , Contagem de Plaquetas , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Resultado do Tratamento
17.
J Wound Ostomy Continence Nurs ; 48(4): 339-344, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34186553

RESUMO

PURPOSE: The purpose of this study was to investigate the relationship and to determine potential usefulness of serum albumin as a biomarker for predicting postoperative diabetic foot ulcer (DFU) healing. DESIGN: A retrospective study. SUBJECTS AND SETTING: The sample comprised 266 inpatients with type 2 diabetes receiving care in The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Among them, 174 had DFUs and underwent surgery for foot DFUs including amputation, skin grafting, and flap procedures. A comparison group consisted of 92 inpatients without a DFU or surgery. METHODS: The association between healing and preoperative albumin levels was analyzed via a logistic regression model and receiver operating characteristic (ROC) curve. RESULTS: The albumin value of patients with DFU grade 3 or more (3.23 ± 0.58 g/dL) was lower than that of patients with DFU grade 1-2 (3.58 ± 0.5 g/dL), and both were lower than that of the comparison group (3.89 ± 0.3 g/dL). Patients with a DFU with hypoalbuminemia (<3.5 g/dL) had a 2.5-fold higher risk of nonhealing at postoperative 28 days than patients with normal levels (odds ratio = 3.51; 95% confidence interval, 1.75-7.06; P < .001). For patients with a DFU overall, the ROC curve showed a preoperative albumin cutoff of 3.44 g/dL for DFU wound healing. CONCLUSIONS: For patients with a DFU undergoing surgery, preoperative serum albumin may be used as a biomarker for predicting postoperative healing.


Assuntos
Pé Diabético/terapia , Albumina Sérica/análise , Cicatrização , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , China , Diabetes Mellitus Tipo 2 , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos
18.
Jt Dis Relat Surg ; 32(2): 279-289, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145802

RESUMO

OBJECTIVES: In this study, we present the use of case specific three-dimensional (3D) printed plastic models and custom-made acetabular implants in orthopedic surgery. MATERIALS AND METHODS: Between March 2018 and September 2020, surgeries were simulated using plastic models manufactured by 3D printers on the two patients with pilon fractures. Also, custom-made acetabular implants were used on two patients with an acetabular bone defect for the revision of total hip arthroplasty (THA). RESULTS: More comfortable surgeries were experienced in pilon fractures using preoperative plastic models. Similarly, during the follow-up period, the patients that applied custom-made acetabular implants showed a fixed and well-positioning in radiographic examination. These patients did not experience any surgical complications and achieved an excellent recovery. CONCLUSION: Preoperative surgical simulation with 3D printed models can increase the comfort of fracture surgeries. Also, custom-made 3D printed acetabular implants can perform an important task in patients treated with revision THA surgery due to severe acetabular defects.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/instrumentação , Prótese de Quadril , Impressão Tridimensional , Fraturas da Tíbia/cirurgia , Acetábulo/diagnóstico por imagem , Adulto , Idoso , Simulação por Computador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Período Pré-Operatório , Desenho de Prótese , Reoperação , Fraturas da Tíbia/diagnóstico por imagem , Turquia
19.
Jt Dis Relat Surg ; 32(2): 340-346, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145809

RESUMO

OBJECTIVES: This study aims to evaluate the diagnostic value of complete blood count (CBC) parameters in patients with peripheral nerve sheath tumors (PNSTs). PATIENTS AND METHODS: A total of 181 patients (83 males, 98 females; median age: 44 years; range, 15 to 83 years) who underwent surgical treatment for PNSTs in our tertiary oncology center between January 2010 and December 2019 were retrospectively analyzed. Eighty-two patients were diagnosed with a neurofibroma, 79 with a schwannoma, and 20 with a malignant PNST (MPNST). The patient group was evaluated as malignant (n=20) and benign (n=161). Age- and sex-matched patients admitted to our outpatient clinic of orthopedic and traumatology with non-specific symptoms other than tumor, infection, fracture, and rheumatological or hematological diseases were included as the control group (n=165). Data including age, sex, definitive histopathological diagnosis, and pre-treatment CBC values were obtained from the hospital records. Pre-treatment CBC values such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were calculated for both malignant and benign groups and control groups. Diagnostic values of NLR, PLR, and LMR between PNST groups were assessed using the receiver operating characteristic (ROC) curve analysis. RESULTS: Neurofibroma, schwannoma, and MNPST groups had significantly higher median NLR, compared to the control group (p<0.001), while the median LMR was significantly lower in these groups (p<0.05). However, the median PLR was higher only in the MPNST group, compared to the control group (p<0.001). Post-hoc analyses revealed that median NLR, PLR, and LMR ratios were similar in PNST groups, compared to the control group. In addition, the median NLR, PLR, and LMR ratios were similar between malignant and benign patient groups. The highest area under the curve (AUC) was found for NLR (AUC=0.756) and LMR (AUC=0.716) in the MPNST group. CONCLUSION: Our study results suggest that NLR, PLR, and LMR may have an added value in the early diagnosis of PNSTs and are valuable for differentiating patients from healthy individuals, although their value in differential diagnosis is still unclear.


Assuntos
Contagem de Células Sanguíneas , Neoplasias da Bainha Neural/sangue , Neoplasias da Bainha Neural/diagnóstico , Neurilemoma/sangue , Neurilemoma/diagnóstico , Neurofibroma/sangue , Neurofibroma/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Plaquetas , Estudos de Casos e Controles , Detecção Precoce de Câncer , Feminino , Humanos , Linfócitos , Masculino , Pessoa de Meia-Idade , Monócitos , Neoplasias da Bainha Neural/patologia , Neutrófilos , Nervos Periféricos , Período Pré-Operatório , Curva ROC , Estudos Retrospectivos , Adulto Jovem
20.
Acta Orthop ; 92(4): 431-435, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33977828

RESUMO

Background and purpose - Proton-pump inhibitors (PPI) have previously been associated with an increased risk of infections such as community-acquired pneumonia, gastrointestinal infections and central nervous system infection. Therefore, we evaluated a possible association between proton-pump inhibitor use and prosthetic joint infection (PJI) in patients with total hip arthroplasty (THA), because they can be stopped perioperatively or switched to a less harmful alternative.Patients and methods - A cohort of 5,512 primary THAs provided the base for a case-cohort design; cases were identified as patients with early-onset PJI. A weighted Cox proportional hazard regression model was used for the study design and to adjust for potential confounders.Results - There were 75 patients diagnosed with PJI of whom 32 (43%) used PPIs perioperatively compared with 75 PPI users (25%) in the control group of 302 patients. The risk of PJI was 2.4 times higher (95% CI 1.4-4.0) for patients using PPI. This effect remained after correction for possible confounders.Interpretation - The use of PPIs was associated with an increased risk of developing PJI after THA. Hence, the use of a PPI appears to be a modifiable risk factor for PJI.


Assuntos
Artroplastia de Quadril/métodos , Complicações Pós-Operatórias/induzido quimicamente , Infecções Relacionadas à Prótese/induzido quimicamente , Inibidores da Bomba de Prótons/efeitos adversos , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Período Pré-Operatório
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