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1.
Medicine (Baltimore) ; 100(22): e25842, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087827

RESUMO

ABSTRACT: To investigate the relationship between urinary cotinine and colorectal neoplasm (CRN).The participants in the health screening cohort of the National Cancer Center who underwent screening colonoscopy between June 2007 and December 2009 were included. A total of 8121 subjects who underwent urinary cotinine measurement within 14 days from the index colonoscopy were included. Cotinine positivity was defined as having a urinary cotinine level ≥50 ng/mL. Follow-up colonoscopy data were collected by reviewing the patients' medical records.Patients were classified according to their urinary cotinine level and self-reported smoking status, and the number of patients with cotinine positivity was 1960 (24.1%). There was no significant difference in the cumulative CRN and advanced CRN (ACRN) risks according to the self-reported smoking status. However, cotinine positivity at the time of index colonoscopy was an independent risk factor for CRN (hazard ratio [HR]= 1.23, P = .006) in follow-up colonoscopy. Moreover, in never- and ex-smokers, cotinine positivity was an independent risk factor for CRN (HR = 1.95, P = .019; HR = 2.12, P = .003, respectively) and ACRN (HR = 8.89, P < .001; HR = 5.03, P = .003) during follow-up colonoscopy. The cumulative incidence of CRN and ACRN was higher in the cotinine-positive never- and ex-smokers than in the cotinine-negative never- and ex-smokers (P < .001 and P = .008, respectively).CRN or ACRN is more likely to occur at follow-up colonoscopy in the urinary cotinine-positive never- and ex-smokers than in the urinary cotinine-negative group. Therefore, urinary cotinine measurements may provide useful information on never- or ex-smokers undergoing screening colonoscopy.


Assuntos
Neoplasias Colorretais/epidemiologia , Cotinina/urina , Fumantes/estatística & dados numéricos , Fumar Tabaco/epidemiologia , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/epidemiologia , Pesos e Medidas Corporais , Colonoscopia/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais
2.
Medicine (Baltimore) ; 100(22): e26121, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087861

RESUMO

ABSTRACT: This community-based study aimed to elucidate whether there is a gender difference in the effect of metabolic syndrome (MetS) and its individual components on an elevated risk for incident colorectal adenoma.A prospective cohort study was conducted by enrolling 59,767 subjects aged 40 years or older between 2001 and 2009 in Keelung, Taiwan, to test this hypothesis, excluding those with a prior history of colorectal cancer and those with colorectal cancer diagnosed at the first screening. Cox proportional hazards regression models were used to assess the effect of MetS in terms of a dichotomous classification, each individual component and the number of components for males and females.Colorectal adenoma was present in 2.7% (n = 652) of male participants and 1.1% (n = 403) of female participants. The prevalence rate of MetS was 26.7% and 23.3% for males and females, respectively. The effect of MetS on colorectal adenoma was statistically significant and similar for the 2 genders, with an adjusted hazard ratio (aHR) of 1.33 (95% CI: 1.13-1.58) in males and 1.33 (95% CI: 1.06-1.66) in females after adjustment for confounders. However, MetS led to higher risk of advanced colorectal adenoma in men than in women. Regarding the effect of each component of MetS on colorectal adenoma, abnormal waist circumference and hypertriglyceridemia led to an elevated risk of colorectal adenoma in both genders. A rising risk of colorectal adenoma among females was noted in those with a moderately higher level of glycemia (100-125 mg/dL, aHR = 1.44, 95% CI: 1.12-1.85). Hypertriglyceridemia and high blood pressure were associated with an increased risk of advance colorectal adenoma in males.Both male and female subjects with MetS had a higher risk of colorectal adenoma. The contributions from individual components of MetS varied by gender. These findings suggest that the possible risk reduction of colorectal adenoma through metabolic syndrome-based lifestyle modifications may differ between genders.


Assuntos
Adenoma/epidemiologia , Neoplasias Colorretais/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Idoso , Pesos e Medidas Corporais , Feminino , Humanos , Hipertensão/epidemiologia , Hipertrigliceridemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Distribuição por Sexo , Taiwan/epidemiologia
3.
Medicine (Baltimore) ; 100(22): e26129, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087863

RESUMO

ABSTRACT: Early detection of arterial hypotension during cesarean delivery under spinal anesthesia is important. This study aims to compare the validity of NexfinTM as beat-to-beat noninvasive blood pressure monitoring with conventional intermittent oscillometric measurement of blood pressure during elective cesarean delivery.This open prospective observational bicentric study was performed between January 2013 and December 2015. We simultaneously recorded arterial blood pressure with both techniques in pregnant women undergoing elective cesarean delivery under spinal anesthesia. The primary outcome was a Bland-Altman analysis of systolic blood pressure measurement comparing NexfinTM and a conventional method. The secondary outcomes were the time to detect the first relevant hypotensive episode and the comparison of both devices using a four-quadrant graph.One hundred and seventy-four parturients completed the study, and 2640 pairs of systolic blood pressure measurements were analyzed. Bias was -10 mmHg with upper and lower limits of agreement of -61 and +41 mmHg. In 73.9% of the cases, the two techniques provided the same information (normotension or hypotension), but the conventional method missed 20.8% of measurements, with NexfinTM detecting 16.2% more hypotensive measurements. The median [25-75 percentiles] duration to detect the first hypotensive measurement was 331 [206-480] seconds for NexfinTM and 440 [300-500] s for intermittent oscillometry (P < .001).The agreement between NexfinTM and an intermittent method for the measurement of systolic blood pressure was not in an acceptable range during cesarean delivery, although NexfinTM may detect hypotension earlier than the standard method.Trial registration: Clinicaltrials.gov identifier: NCT01732133; November 22, 2012.


Assuntos
Raquianestesia/efeitos adversos , Determinação da Pressão Arterial/métodos , Cesárea/métodos , Hipotensão/induzido quimicamente , Hipotensão/diagnóstico , Adulto , Índice de Apgar , Pressão Arterial , Determinação da Pressão Arterial/normas , Monitores de Pressão Arterial , Pesos e Medidas Corporais , Feminino , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes
4.
Clin Interv Aging ; 16: 1095-1104, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34163153

RESUMO

Purpose: Mid-upper arm circumference (MUAC) is a simple, noninvasive anthropometric indicator. This study evaluated the applicability of MUAC as an alternative screening instrument to appendicular skeletal muscle mass index (ASMI) for detecting sarcopenia, and determined the optimal MUAC cutoff values. Patients and Methods: A total of 4509 subjects ≥50 years of age from the West China Health and Aging Trend study were included in the present study. ASM was measured by bioelectrical impedance analysis. MUAC, calf circumference (CC), and grip strength were evaluated and the Short Physical Performance Battery and 3-m timed up-and-go test were administered. Low muscle mass was diagnosed based on Asian Working Group for Sarcopenia 2019 (AWGS2019) and updated European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Results: ASMI was positively correlated with MUAC in both men (r=0.726, P<0.001) and women (r=0.698, P<0.001). The area under the receiver operating characteristic curve (AUC) for MUAC as an indicator of low muscle mass in men and women was 0.86 (95% confidence interval [CI]: 0.85-0.88) and 0.85 (95% CI: 0.84-0.86), respectively, according to AWGS2019 criteria; and 0.86 (95% CI: 0.85-0.88) and 0.86 (95% CI: 0.85-0.88), respectively, according to EWGSOP2 criteria. Optimal MUAC cutoff values for predicting low muscle mass were ≤28.6 cm for men and ≤27.5 cm for women. There was no significant difference between the AUCs of MUAC and CC in men according to the 2 reference standards (P=0.809), whereas the AUC of CC was superior to that of MUAC in women according to AWGS2019 (P<0.001) and EWGSOP2 (P=0.008) criteria. Conclusion: MUAC is strongly correlated with ASMI among community-dwelling middle-aged and older adults in China. MUAC can be used as a simple screening instrument to ASMI for diagnosing sarcopenia, especially in men.


Assuntos
Antropometria/métodos , Braço/fisiologia , Músculo Esquelético/fisiologia , Sarcopenia/diagnóstico , Idoso , Envelhecimento/fisiologia , Área Sob a Curva , Pesos e Medidas Corporais , China , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Curva ROC
5.
Acta Orthop Traumatol Turc ; 55(3): 239-245, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100365

RESUMO

OBJECTIVE: The aim of this study was to compare the effect of Gap Balancing (GB) versus Measured Resection (MR) techniques on the early clinical and radiological results of Total Knee Arthroplasty (TKA). METHODS: In this prospective study, 99 patients (99 knees) who underwent unilateral TKA between March 2018 and January 2019 were randomly allocated to one of two groups: The GP group, TKA with GB technique (19 male, 31 female; mean age = 55.9 ±16.5) and the MR group, TKA with MR technique (19 male, 30 female; mean age = 54.2 ± 18.7). Patients in both groups were comparable in terms of the demographic and clinical data. The angle of cutting block to PCA and Cutting Thickness of the Medial and Lateral Condyle (CTMC, CTLC) were intraoperatively measured. In radiographic analysis, Preoperative Mechanical Femorotibial Angle (Pre-mFTA), Postoperative Mechanical Femorotibial Angle (Post-mFTA), and joint line changes were examined. Femoral component Rotation Angle (FCRA) was also measured by computed tomography. In gait analysis, the spatiotemporal parameters (walking speed, step length, and single support time) and kinematics parameters (flexion angle, extension angle, and transversal rotation) were collected at 12 months postoperatively. Furthermore, Western Ontario and McMaster Universities Arthritis Index (WOMAC) were performed at 12 months after surgery. RESULTS: CTMC and CTLC were both significantly higher in GB group than in the MR group (9.8±2.0 mm vs 8.5 ± 1.2 mm; 7.9 ± 1.8mm vs 6.8 ± 1.4mm; P = 0.001, P = 0.002, respectively). Angle of cutting block to PCA was statistically lower in GB group than in the MR group (1.7 ± 1.5° vs 3.1 ± 0.5 °; P < 0.001). FCRA is greater in the GB group compared to the MR group, but the difference did not reach statistical significance (1.2 ± 2.8 ° vs 0.7 ± 2.0 °; P > 0.05). Although post-mFTA significantly improved compared with pre-mFTA in both groups, no significant difference was observed in the changes of post-mFTA between the two groups (0.9 ± 1.7° vs 0.3 ± 1.8°, P > 0.05). No significant differences were determined between the two groups in spatiotemporal gait parameters including walking speed, step length, and single support time. The sagittal max knee flexion range was significantly larger in the GB group than in the MR group (49.27 ± 5.24 ° vs 45.99 ± 8.21 °, P < 0.05). The flexion range did not reach the level of the control group. There was no significant difference between the two groups in WOMAC at 12 months follow-up (P > 0.05). CONCLUSION: Evidence from this study has revealed GB and MR techniques have both little effect on early clinical results of TKA. Nonetheless, GB technique can provide better knee flexion in the early postoperative gait status compared with MR technique. LEVEL OF EVIDENCE: Level I, Therapeutic Study.


Assuntos
Artroplastia do Joelho , Osso e Ossos , Articulação do Joelho , Osteoartrite do Joelho , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Pesos e Medidas Corporais/métodos , Osso e Ossos/patologia , Osso e Ossos/cirurgia , Feminino , Análise da Marcha/métodos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/cirurgia , Avaliação de Resultados em Cuidados de Saúde/métodos , Amplitude de Movimento Articular , Análise Espaço-Temporal , Tomografia Computadorizada por Raios X/métodos
6.
Int J Mol Sci ; 22(11)2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34071774

RESUMO

Visceral adipose tissue (VAT) metabolic profiling harbors the potential to disentangle molecular changes underlying obesity-related dysglycemia. In this study, the VAT exometabolome of subjects with obesity and different glycemic statuses are analyzed. The subjects (n = 19) are divided into groups according to body mass index and glycemic status: subjects with obesity and euglycemia (Ob+NGT, n = 5), subjects with obesity and pre-diabetes (Ob+Pre-T2D, n = 5), subjects with obesity and type 2 diabetes under metformin treatment (Ob+T2D, n = 5) and subjects without obesity and with euglycemia (Non-Ob, n = 4), used as controls. VATs are incubated in culture media and extracellular metabolite content is determined by proton nuclear magnetic resonance (1H-NMR). Glucose consumption is not different between the groups. Pyruvate and pyroglutamate consumption are significantly lower in all groups of subjects with obesity compared to Non-Ob, and significantly lower in Ob+Pre-T2D as compared to Ob+NGT. In contrast, isoleucine consumption is significantly higher in all groups of subjects with obesity, particularly in Ob+Pre-T2D, compared to Non-Ob. Acetate production is also significantly lower in Ob+Pre-T2D compared to Non-Ob. In sum, the VAT metabolic fingerprint is associated with pre-diabetes and characterized by higher isoleucine consumption, accompanied by lower acetate production and pyruvate and pyroglutamate consumption. We propose that glucose metabolism follows different fates within the VAT, depending on the individuals' health status.


Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Gordura Intra-Abdominal/metabolismo , Metaboloma , Metabolômica , Obesidade/metabolismo , Estado Pré-Diabético/metabolismo , Tecido Adiposo/metabolismo , Adulto , Idoso , Biomarcadores , Pesos e Medidas Corporais , Diabetes Mellitus Tipo 2/etiologia , Suscetibilidade a Doenças , Metabolismo Energético , Feminino , Humanos , Masculino , Metabolômica/métodos , Pessoa de Meia-Idade , Modelos Biológicos , Adulto Jovem
7.
Medicine (Baltimore) ; 100(19): e25890, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106644

RESUMO

BACKGROUND: Regular physical exercise is recommended for lowering the risk of coronary events and all-cause mortality. However, there is a variety of exercise options, and their relative effectiveness and hierarchy remain unclear. Herein, we present a systematic review and meta-analysis protocol that aims to compare the impact of different types of physical activity on the risk of sudden cardiac death. METHODS AND ANALYSIS: English language articles reporting on randomized controlled trials will be searched in MEDLINE, Cochrane Library, CINAHL, and PubMed databases by two reviewers. A snowball approach will be used for literature retrieval. Reviewers will independently screen the literature, extract data, evaluate study quality and risk of bias, and perform a meta-analysis. In the presence of heterogeneity, a random effects model will be used for meta-analysis; otherwise, a fixed effect model will be used. ETHICS AND DISSEMINATION: This study is a secondary analysis and does not require ethical review. The results of this study will be disseminated through peer-reviewed publications, journals, and academic conferences and other forms of exchange. SYSTEMATIC REVIEW REGISTRATION NUMBER: INPLASY202140033.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Exercício Físico , Fatores Etários , Pesos e Medidas Corporais , Doenças Cardiovasculares/epidemiologia , Comorbidade , Grupos de Populações Continentais , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Fatores Sexuais , Fatores de Tempo
8.
Medicine (Baltimore) ; 100(19): e25891, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106645

RESUMO

BACKGROUND: : Published studies investigating enteral nutrition's effect on serum inflammatory factors and the cardiac function of malnourished elderly patients with heart failure (HF) are of poor quality, with small sample sizes, and involve a homogeneous population. Therefore, in order to provide new medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the relationship between enteral nutrition and serum levels of inflammatory factors and cardiac function in elderly patients with HF. METHODS: : The protocol was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement guidelines. Electronic databases including Web of Science, Embase, PubMed, Wanfang, Data, Scopus, Science Direct, Cochrane Library will be searched in April 2021 by 2 independent reviewers. The primary outcome is body mass index, triceps skin fold thickness, upper arm muscle circumference, serum total protein, albumin, and hemoglobin's change in index; secondary outcomes include left ventricular ejection fraction, B-type natriuretic peptide, interleukin-6, C-reactive protein, and tumor necrosis factor-α. The risk of bias assessment of the included studies was performed by 2 authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). We will perform meta-analysis using Review Manager Software. RESULTS: : The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings. CONCLUSION: : Its findings will provide helpful evidence for the application of enteral nutrition in elderly patients with HF. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/RTYBP.


Assuntos
Nutrição Enteral/métodos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Mediadores da Inflamação/sangue , Desnutrição/dietoterapia , Desnutrição/epidemiologia , Índice de Massa Corporal , Pesos e Medidas Corporais , Testes de Função Cardíaca , Humanos , Desnutrição/sangue , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
9.
Medicine (Baltimore) ; 100(19): e25927, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106660

RESUMO

ABSTRACT: The time required to intubate the cecum varies. The aim of this study was to determine whether demographic and anthropometric factors, such as body mass index (BMI), percent body fat, muscle mass, and fat mass, affect the cecal intubation time (CIT) during complete colonoscopy.A retrospective chart review of 1229 patients (aged 40-80 years) was performed. These patients underwent average-risk screening colonoscopies performed by expert gastroenterologists at Health Check-up Center, Seoul National University Bundang Hospital, during a health check-up. We collected data on age, sex, BMI, percent body fat, muscle mass, fat mass, history of prior abdominal or pelvic surgery, CIT, and bowel preparation quality (Boston Bowel Preparation Scale [BBPS] score).Of the 1229 patients, 62% were men. The mean age was 55 years, and the mean BMI was 24 kg/m2. The median CIT was 5 min. The patients were categorized into two groups according to CIT: easy colonoscopy (CIT ≤ 10 min) and difficult colonoscopy (CIT > 10 min). In univariate analysis, CIT was prolonged by the following factors: older age, poor bowel preparation, lower BMI, lower percent body fat, and less fat mass. Multivariate analysis showed that anthropometric indices including BMI, percent body fat, muscle mass, and fat mass were not significant factors for CIT. Older age (≥ 70 years) (odds ratio [OR]: 2.272, 95% confidence interval [CI]: 1.056-4.890, P = .036) and poor bowel preparation (BBPS score ≤ 5) (OR: 3.817, 95% CI: 1.866-7.808, P = .000) were found to be correlated with difficult colonoscopy.Our study suggests that anthropometric indices including BMI, percent body fat, muscle mass, and fat mass are not associated with significantly different CIT. Furthermore, sex and prior abdominal or pelvic surgery are not useful factors for a prolonged CIT. Older age (≥ 70 years) and poor bowel preparation (BBPS score ≤ 5) are significant variables predicting the CIT of expert gastroenterologists.


Assuntos
Ceco , Colonoscopia/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Índice de Massa Corporal , Pesos e Medidas Corporais , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Fatores de Tempo
10.
Medicine (Baltimore) ; 100(22): e26111, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087858

RESUMO

ABSTRACT: Gram-negative bacteremia is a major cause of death among hematology inpatients who require heavy-dose chemotherapy and hematopoietic stem cell transplantation. Gram-negative bacillus (GNB) is more likely to be detected when the oral health is poor. However, there is a dearth of studies on the relationship between oral assessment and prevalence of GNB in hematology inpatients.This retrospective study aimed to evaluate the relationship between the original point-rating system for oral health examinations (point-oral exam) and the prevalence of GNB in hematology inpatients at the hematology ward of the Yamanashi University Hospital. GNB was detected by cultivating samples from the sputum and blood of each patient.A total of 129 subjects underwent a medical checkup and point-oral exam. The sputum and blood culture results of 55 patients were included in this study. The total points of patients positive for GNB (n = 25, 45.5%) were significantly higher than those who were negative for GNB (total score: median, 25th, 75th, percentile; 6 [4, 7] vs 2 [1, 4]; P = .00016). Based on the receiver operating characteristic analysis, a cutoff score of 5 proved to be most useful to detect GNB.An oral evaluation with a cutoff value of 5 or higher in the point-oral exam might indicate the need for a more thorough oral management to prevent the development of systemic infections from GNB.


Assuntos
Infecções por Bactérias Gram-Negativas/epidemiologia , Neoplasias Hematológicas/epidemiologia , Saúde Bucal/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Hemocultura , Índice de Massa Corporal , Pesos e Medidas Corporais , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Escarro/microbiologia
11.
West J Emerg Med ; 22(2): 389-393, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33856327

RESUMO

INTRODUCTION: Emergency department (ED) patients are frequently ventilated with excessively large tidal volumes for predicted body weight based on height, which has been linked to poorer patient outcomes. We hypothesized that supplying tape measures to respiratory therapists (RT) would improve measurement of actual patient height and adherence to a lung-protective ventilation strategy in an ED-intensive care unit (ICU) environment. METHODS: On January 14, 2019, as part of a ventilator-associated pneumonia prevention bundle in our ED-based ICU, we began providing RTs with tape measures and created a best practice advisory reminding them to record patient height. We then retrospectively collected data on patient height and tidal volumes before and after the intervention. RESULTS: We evaluated 51,404 tidal volume measurements in 1,826 patients over the 4 year study period; of these patients, 1,579 (86.5%) were pre-intervention and 247 (13.5%) were post-intervention. The intervention was associated with a odds of the patient's height being measured were 10 times higher post-intervention (25.1% vs 3.2%, P <0.05). After the bundle was initiated, we observed a significantly higher percentage of patients ventilated with mean tidal volumes less than 8 cubic centimeters per kilogram (93.9% vs 84.5% P < 0.05). CONCLUSION: Patients in an ED-ICU environment were ventilated with a lung-protective strategy more frequently after an intervention reminding RTs to measure actual patient height and providing a tape measure to do so. A significantly higher percentage of patients had height measured rather than estimated after the intervention, allowing for more accurate determination of ideal body weight and calculation of lung-protective ventilation volumes. Measuring all mechanically ventilated patients' height with a tape measure is an example of a simple, low-cost, scalable intervention in line with guidelines developed to improve the quality of care delivered to critically ill ED patients.


Assuntos
Pesos e Medidas Corporais , Serviço Hospitalar de Emergência , Unidades de Terapia Intensiva , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Respiração Artificial , Volume de Ventilação Pulmonar/fisiologia , Estatura , Pesos e Medidas Corporais/métodos , Pesos e Medidas Corporais/normas , Estado Terminal/terapia , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pacotes de Assistência ao Paciente , Melhoria de Qualidade , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Respiração Artificial/normas , Estudos Retrospectivos
12.
J Neuroimaging ; 31(3): 560-568, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33817887

RESUMO

BACKGROUND AND PURPOSE: Magnetic resonance imaging (MRI) is essential in the diagnosis of pharmacoresistant epilepsy (PRE), because patients with lesions detected by MRI have a better prognosis after surgery. Focal cortical dysplasia (FCD) is one of the most frequent etiologies of PRE but can be difficult to identify by MRI. Voxel-based morphometric analysis programs, like the Morphometric Analysis Program (MAP), have been developed to help improve MRI detection. Our objective was to evaluate the clinical usefulness of MAP in patients with PRE and an apparently normal MRI. METHODS: We studied 70 patients with focal PRE and a nonlesional MRI. The 3DT1 sequence was processed with MAP, obtaining three z-score maps. Patients were classified as MAP+ if one or more z-score maps showed a suspicious area of brightness, and MAP- if the z-score maps did not show any suspicious areas. For MAP+ cases, a second-look MRI was performed with a dedicated inspection based on the MAP findings. The MAP results were correlated with the epileptogenic zone. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS: Thirty-one percent of patients were classified as MAP+ and 69% were MAP-. Results showed a sensitivity of 0.57, specificity of 0.8, PPV of 0.91, and NPV of 0.35. In 19% of patients, an FCD was found in the second-look MRI after MAP. CONCLUSIONS: MAP was helpful in the detection of lesions in PRE patients with a nonlesional MRI, which could have important repercussions for the clinical management and postoperative prognosis of these patients.


Assuntos
Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Epilepsia Resistente a Medicamentos/cirurgia , Epilepsia/patologia , Imageamento por Ressonância Magnética/métodos , Malformações do Desenvolvimento Cortical do Grupo I/patologia , Malformações do Desenvolvimento Cortical/diagnóstico por imagem , Adolescente , Adulto , Pesos e Medidas Corporais , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Mapeamento Encefálico/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Molecules ; 26(7)2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33915895

RESUMO

Hyperthyroidism, which is characterized by increased circulating thyroid hormone levels, alters the body's metabolic and systemic hemodynamic balance and directly influences renal function. In this study, the urinary proteome of patients with hyperthyroidism was characterized using an untargeted proteomic approach with network analysis. Urine samples were collected from nine age-matched patients before and after carbimazole treatment. Differences in the abundance of urinary proteins between hyperthyroid and euthyroid states were determined using a 2D-DIGE coupled to MALDI-TOF mass spectrometry. Alterations in the abundance of urinary proteins, analyzed via Progenesis software, revealed a statistically significant difference in abundance in a total of 40 spots corresponding to 32 proteins, 25 up and 7 down (≥1.5-fold change, ANOVA, p ≤ 0.05). The proteins identified in the study are known to regulate processes associated with cellular metabolism, transport, and acute phase response. The notable upregulated urinary proteins were serotransferrin, transthyretin, serum albumin, ceruloplasmin, alpha-1B-glycoprotein, syntenin-1, and glutaminyl peptide cyclotransferase, whereas the three notable downregulated proteins were plasma kallikrein, protein glutamine gamma-glutamyl transferase, and serpin B3 (SERPINB3). Bioinformatic analysis using ingenuity pathway analysis (IPA) identified the dysregulation of pathways associated with cellular compromise, inflammatory response, cellular assembly, and organization and identified the involvement of the APP and AKT signaling pathways via their interactions with interleukins as the central nodes.


Assuntos
Hipertireoidismo/metabolismo , Proteoma , Proteômica , Adulto , Biomarcadores , Pesos e Medidas Corporais , Biologia Computacional/métodos , Feminino , Humanos , Hipertireoidismo/etiologia , Hipertireoidismo/terapia , Masculino , Pessoa de Meia-Idade , Mapeamento de Interação de Proteínas , Mapas de Interação de Proteínas , Proteômica/métodos , Eletroforese em Gel Diferencial Bidimensional
14.
Int J Mol Sci ; 22(6)2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33808720

RESUMO

Using a murine model of chronic ischemic cardiomyopathy caused by an old myocardial infarction (MI), we have previously found that three doses of 1 × 106 c-kit positive cardiac cells (CPCs) are more effective than a single dose of 1 × 106 cells. The goal of this study was to determine whether the beneficial effects of three doses of CPCs (1 × 106 cells each) can be fully replicated by a single combined dose of 3 × 106 CPCs. Mice underwent a 60-min coronary occlusion; after 90 days of reperfusion, they received three echo-guided intraventricular infusions at 5-week intervals: (1) vehicle × 3; (2) one combined dose of CPCs (3 × 106) and vehicle × 2; or (3) three doses of CPCs (1 × 106 each). In the combined-dose group, left ventricular ejection fraction (LVEF) improved after the 1st CPC infusion, but not after the 2nd and 3rd (vehicle) infusions. In contrast, in the multiple-dose group, LVEF increased after each CPC infusion; at the final echo, LVEF averaged 35.2 ± 0.6% (p < 0.001 vs. the vehicle group, 27.3 ± 0.2%). At the end of the study, the total cumulative change in EF from pretreatment values was numerically greater in the multiple-dose group (6.6 ± 0.6%) than in the combined-dose group (4.8 ± 0.8%), although the difference was not statistically significant (p = 0.08). Hemodynamic studies showed that several parameters of LV function in the multiple-dose group were numerically greater than in the combined-dose group (p = 0.08 for the difference in LVEF). Compared with vehicle, cardiomyocyte cross-sectional area was reduced only in the multiple-dose group (-32.7%, 182.6 ± 15.1 µm2 vs. 271.5 ± 27.2 µm2, p < 0.05, in the risk region and -28.5%, 148.5 ± 12.1 µm2 vs. 207.6 ± 20.5 µm2, p < 0.05, in the noninfarcted region). LV weight/body weight ratio and LV weight/tibia length ratios were significantly reduced in both cell treated groups vs. the vehicle group, indicating the attenuation of LV hypertrophy; however, the lung weight/body weight ratio was significantly reduced only in the multiple-dose group, suggesting decreased pulmonary congestion. Taken together, these results indicate that in mice with chronic ischemic cardiomyopathy, the beneficial effects of three doses of CPCs on LV function and hypertrophy cannot be fully replicated with a single dose, notwithstanding the fact that the total number of cells delivered with one or three doses is the same. Thus, it is the multiplicity of doses, and not the total number of cells, that accounts for the superiority of the repeated-dose paradigm. This study supports the idea that the efficacy of cell therapy in heart failure can be augmented by repeated administrations.


Assuntos
Cardiomiopatias/etiologia , Dosagem de Genes , Isquemia Miocárdica/complicações , Miócitos Cardíacos/metabolismo , Proteínas Proto-Oncogênicas c-kit/genética , Animais , Biomarcadores , Biópsia , Pesos e Medidas Corporais , Cardiomiopatias/diagnóstico , Cardiomiopatias/metabolismo , Cardiomiopatias/terapia , Células Cultivadas , Modelos Animais de Doenças , Ecocardiografia , Fibrose , Testes de Função Cardíaca , Hemodinâmica , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/metabolismo , Hipertrofia Ventricular Esquerda/patologia , Camundongos , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/patologia , Isquemia Miocárdica/etiologia , Proteínas Proto-Oncogênicas c-kit/metabolismo
15.
BMC Ecol Evol ; 21(1): 58, 2021 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882837

RESUMO

BACKGROUND: Morphological convergence is a fundamental aspect of evolution, allowing for inference of the biology and ecology of extinct species by comparison with the form and function of living species as analogues. The thylacine (Thylacinus cynocephalus), the iconic recently extinct marsupial, is considered a classic example of convergent evolution with the distantly related placental wolf or dog, though almost nothing is actually known regarding its ecology. This lack of data leads to questions regarding the degree of convergence with, and the similarity of, the functional ecology of the thylacine and the wolf/dog. Here, we examined the cranium of the thylacine using 3D geometric morphometrics and two quantitative tests of convergence to more precisely determine convergent analogues, within a phylogenetically informed dataset of 56 comparative species across 12 families of marsupial and placental faunivorous mammals. Using this dataset, we investigated patterns of correlation between cranial shape and diet, phylogeny, and relative prey size across these terrestrial faunivores. RESULTS: We find a correlation between cranial, facial, and neurocranial shape and the ratio of prey-to-predator body mass, though neurocranial shape may not correlate with prey size within marsupials. The thylacine was found to group with predators that routinely take prey smaller than 45% of their own body mass, not with predators that take subequal-sized or larger prey. Both convergence tests find significant levels of convergence between the thylacine and the African jackals and South American 'foxes', with lesser support for the coyote and red fox. We find little support for convergence between the thylacine and the wolf or dog. CONCLUSIONS: Our study finds little support for a wolf/dog-like functional ecology in the thylacine, with it instead being most similar to mid-sized canids such as African jackals and South American 'foxes' that mainly take prey less than half their size. This work suggests that concepts of convergence should extend beyond superficial similarity, and broader comparisons can lead to false interpretations of functional ecology. The thylacine was a predator of small to mid-sized prey, not a big-game specialist like the placental wolf.


Assuntos
Marsupiais , Lobos , Animais , Pesos e Medidas Corporais , Cães , Feminino , Filogenia , Gravidez , Crânio
16.
Medicine (Baltimore) ; 100(9): e24682, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655932

RESUMO

ABSTRACT: We aimed to compare two-dimension transthoracic echocardiogram (2D-TTE) and three-dimension transthoracic echocardiogram (3D-TTE) measurements of the aortic annular diameter using multi-detector CT (MDCT) as a gold standard.This prospective observational study included 50 consecutive patients who came to the cardiology department, Al-Azhar University Hospital, New Damietta, for MDCT coronary angiography. The study was carried out in the period from July 2016 until February 2017. All patients were subjected to informed consent, clinical history, physical examination, transthoracic echocardiography 2D and 3D, and MDCT.The aortic annular areas measured by MDCT and 3D-TTE were significantly larger than areas by 2D-TTE. A good correlation (r = 0.82) was observed between the areas obtained by 3D-TTE and MDCT; however, the correlation between the values by 2D-TTE and MDCT was rough (r = 0.30). Eccentricity Index (EI) values in 28% of the patients were greater than 0.1, that is, the aortic annulus was elliptical.Accuracy of aortic annular diameter measurement by 3D-TTE was superior to that by 2D-TTE. Three-D TTE and MDCT revealed that the shape of the aortic annulus was elliptical in 28% to 30% respectively of study subjects. There is a strong concordance between the minimum and the maximum diameter determine by 3D-TTE and MDCT.


Assuntos
Valvopatia Aórtica/diagnóstico por imagem , Pesos e Medidas Corporais/métodos , Ecocardiografia Tridimensional/estatística & dados numéricos , Ecocardiografia/estatística & dados numéricos , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Adulto , Aorta/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes
17.
Acta Orthop Traumatol Turc ; 55(1): 62-66, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33650514

RESUMO

OBJECTIVE: This study aimed to compare 2 methods of ulnar variance (UV) measurement (the perpendicular method and the circular method) and to determine whether UV changed based on the demographic characteristics (sex and age). METHODS: UV was measured on bilateral wrist radiographs of 124 patients (62 men, 62 women; mean age=48.5 years; range=18-79 years) who had no history of trauma, congenital wrist anomaly, previous wrist surgery, and wrist osteoarthritis by a single radiologist with 4 years of experience. All measurements were made on standardized radiographic images using 2 methods: the perpendicular method and the circular method. All the patients were then divided into groups based on sex and age, and the study population was determined by selecting a similar number of patients for each sex and age group. RESULTS: The mean UV of the right and left wrists was measured as 0.33 (range=-4.3 to 5.7) mm by the perpendicular method and as 0.034 (range=-5 to 5.7) mm by the circular method. A significant difference was determined between the 2 measurement methods (p<0.001). There was a statistically significant difference between sex and UV values in the left wrist measurements by both methods (p<0.05). A significant correlation was found between the UV and age in both right and left side measurements, indicating a statistically significant difference between the methods (p<0.001). CONCLUSION: The results of our study demonstrated significant differences in the UV measurement between the 2 methods. Furthermore, UV measurement may change based on age and sex. These differences should be considered in the treatment planning of patients with wrist disorders. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Assuntos
Pesos e Medidas Corporais , Radiografia , Ulna/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Fatores Etários , Análise de Variância , Antropometria , Variação Biológica da População , Pesos e Medidas Corporais/métodos , Pesos e Medidas Corporais/estatística & dados numéricos , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Radiografia/normas , Valores de Referência , Estudos Retrospectivos , Fatores Sexuais
18.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 48(1): 14-20, ene.-mar. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-201985

RESUMO

INTRODUCCIÓN: Nuestro trabajo tiene como objetivo aumentar la eficiencia del cribado de aneuploidías del primer trimestre de la gestación mediante la creación de modelos predictivos que sirvan para identificar gestantes en riesgo de desarrollar sobrepeso u obesidad en el tercer trimestre e instaurar medidas preventivas de obesidad a partir de ellos. MÉTODOS: Estudio observacional de tipo ambispectivo realizado en atención primaria, en el que se han recogido un total de 380 registros correspondientes a otros tantos embarazos. Se han muestreado 6 centros de salud con las variables siguientes: edad en la gestación, proteína A placentaria asociada al embarazo (PAPP-A) (mU/ml), gonadotropina coriónica humana (b-HCG) (ng/ml), semana de recogida de la muestra para el cribado de primer trimestre, índice de masa corporal (IMC) a las 12 y a las 28 semanas de gestación, TSH a las 12 semanas de gestación, presión arterial sistólica (PAS), presión arterial diastólica (PAD) y presión arterial media (PAM) a las 12 y a las 28 semanas de gestación. Se recodificó la variable IMC a las 28 semanas, clasificando a las embarazadas en peso normal (IMC<25), sobrepeso (IMC 25-29,99) y obesas (IMC≥30). El IMC a las 28 semanas recodificada fue la variable resultado del modelo de regresión logística ordinal. Utilizamos el estudio ANOVA de varios factores para discernir diferencias entre las presiones arteriales. Se aceptó un error alfa del 5%. RESULTADOS: Las medianas de la PAPP-A y de b-HCG medidas en el primer trimestre son menores de manera progresiva en los grupos de gestantes con normopeso, sobrepeso y obesidad observadas en el tercer trimestre. Estos valores son predictores del peso en el tercer trimestre (regresión logística ordinal) (PAPP-A: p = 0,022; b-HCG: p = 0,002). Ninguna gestante desarrolló preeclampsia. Las PAS, PAD y PAM en el tercer trimestre fueron significativamente diferentes (ANOVA de varios factores; p < 0,05). DISCUSIÓN: La regresión logística ordinal demuestra que la disminución de los valores observada de PAPP-A y de b-HCG en el primer trimestre es predictora del grado de obesidad de forma significativa y gradual en una muestra de gestantes normotensas. No hemos querido confeccionar un modelo de regresión ordinal incluyendo el IMC de las 12 semanas por la colinealidad interna que aportaría al estar basada la variable resultado en él. El efecto predictor de la b-HCG es más homogéneo que el de la PAPP-A para el estado de sobrepeso y obesidad


INTRODUCTION: This study aims to improve the efficiency of aneuploidy screening in the first trimester of pregnancy by creating predictive models that serve to identify pregnant women at risk of becoming overweight or obese in the third trimester and to using them to implement preventive measures of obesity. METHODS: An ambispective, observational, primary care study was conducted in which a total of 380 records corresponding to as many pregnancies were collected. Samples were collected from patients of 6 health centres, in order to determine the following variables: age at gestation, pregnancy-associated plasma protein A (PAPP-A) (mU/ml), human chorionic gonadotropin (b-HCG) (ng/ml), sample collection week for first trimester screening, body mass index at 12 and 28 weeks gestation (BMI), TSH at 12 weeks gestation, and systolic, diastolic, and mean arterial blood pressure (SBP, DBP, and MBP, respectively) at 12 and 28 weeks gestation. The BMI variable was recoded at 28 weeks, classifying pregnant women as normal weight (BMI<25), overweight (BMI 25-29.99), or obese (BMI≥30). The recoded BMI at 28 weeks was the variable resulting from the ordinal logistic regression model. An ANOVA study of several factors was used to discern differences between arterial pressures. A 5% alpha error was accepted. RESULTS: The PAPP-A and b-HCG medians measured in the first trimester are progressively lower in the groups of pregnant women with normal weight, overweight, and obesity observed in the third trimester. These values are predictors of the weight in the third trimester (ordinal logistic regression) (PAPP-A: P=.022; b-HCG: P=.002). No pregnant woman developed pre-eclampsia. The SBP, DBP, and MBP in the third trimester were significantly different (ANOVA in several factors; P<.05). DISCUSSION: The ordinal logistic regression demonstrates that the decrease in the observed values of PAPP-A and b-HCG in the first trimester is a predictor of the level of significant and gradual obesity in a sample of normotensive pregnant women. An ordinal regression model including the 12-week BMI was not made due to the internal collinearity that it would provide if the result variable was based on it. The predictive effect of b-HCG is more homogeneous than that of PAPP-A for the level of overweight and obesity


Assuntos
Humanos , Feminino , Gravidez , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Biomarcadores/análise , Obesidade/fisiopatologia , Ganho de Peso na Gestação/fisiologia , Proteínas da Gravidez/análise , Gonadotropina Coriônica/análise , Terceiro Trimestre da Gravidez/fisiologia , Primeiro Trimestre da Gravidez/fisiologia , Programas de Rastreamento/métodos , Pesos e Medidas Corporais/estatística & dados numéricos , Índice de Massa Corporal
20.
Medicine (Baltimore) ; 100(5): e23371, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592823

RESUMO

ABSTRACT: The aim of this study is to evaluate the association between body mass index (BMI) and cardio-metabolic risk factors and to determine the optimal BMI cut-off values in male and female subjects in Wuhan, China.We conducted a retrospective cross-sectional analysis of 20218 adult subjects (aged 18-85 years, 12717 men of them) who had health examinations at the health management center of Tongji Hospital of Wuhan in 2017. Multivariate logistic regression analysis was preformed to calculate the odds ratios (ORs) of cardio-metabolic risk factors. Receiver operating characteristic curve was used to determine the area under the receiver operating characteristic curve and optimal cut-off values for BMI predictive of cardio-metabolic risk factors.Of the 20218 participants, the percentage of males with overweight and obesity was as twice as that of females and the prevalence of hypertension, diabetes mellitus (DM), dyslipidemia, and hyperuricemia was significantly higher in males than females (27.18% vs 17.69%, 7.88% vs 4.16%, 41.97% vs 15.20%, and 34.50% vs 9.93%, respectively). Multivariate logistic regression analysis showed that higher BMI was a significant risk factor for hypertension (OR:1.27, 95% confidence intervals [CI]: 1.25-1.29), DM (OR:1.25, 95% CI:1.22-1.28), dyslipidemia (OR:1.26, 95% CI:1.25-1.28), and hyperuricemia (OR:1.25, 95% CI:1.23-1.27) after adjusting for age in both sexes. But in overweight or obesity status, females had higher ORs for hypertension and DM, and lower ORs for dyslipidemia than that in males. The optimal cut-off values of BMI for the presence of cardio-metabolic risk factors were among 24.25 to 25.35 kg/m2 in males, which were higher than in females among 22.85 to 23.45 kg/m2.The association between BMI and cardio-metabolic risk factors is different by gender. It is necessary to determine appropriate threshold for overweight status in men and women separately.


Assuntos
Índice de Massa Corporal , China , Fatores de Risco de Doenças Cardíacas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Pesos e Medidas Corporais , China/epidemiologia , Estudos Transversais , Feminino , Hemoglobina A Glicada , Humanos , Lipídeos/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Ácido Úrico/sangue , Adulto Jovem
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