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1.
An. Fac. Cienc. Méd. (Asunción) ; 55(2): 32-39, 20220801.
Artigo em Espanhol | LILACS | ID: biblio-1380303

RESUMO

Introducción: El cáncer diferenciado de tiroides (CDT) se encuentra representado por el carcinoma papilar y el carcinoma folicular. Comprende la gran mayoría (>90%) de todos los cánceres de tiroides. Objetivos: Estratificar el riesgo de recurrencia inicial de los pacientes con CDT. Relacionar la edad, sexo y tamaño tumoral con el riesgo de recurrencia, invasión capsular, ganglionar, vascular y de tejido peritiroideo. Materiales y métodos: Estratificar el riesgo de recurrencia inicial de los pacientes con CDT. Relacionar la edad, sexo y tamaño tumoral con el riesgo de recurrencia, invasión capsular, ganglionar, vascular y de tejido peritiroideo. Resultados: El 87% fueron del sexo femenino. La edad media fue de 43±14 años. Predominó el riesgo de recurrencia bajo en el 49% de los pacientes, seguido del riesgo intermedio (33%) y riesgo alto (18%). El tamaño tumoral ˃1cm confiere mayor riesgo de ser estratificado como riesgo de recurrencia intermedio/alto (OR 5,7 IC 95% 3,6-9). El sexo masculino representó mayor riesgo de invasión ganglionar (OR 2,8 IC 95% 1,2-6,6); la edad ≥55 años lo fue en la invasión vascular (OR 2,1 IC 95% 1,1-4,1); el tamaño >1cm constituyó un mayor riesgo de manera significativa de invasión capsular (OR 10,5 IC 95% 6,5-17), invasión ganglionar (OR 10,2 IC 95% 3,8-26,9), invasión vascular (OR 30,7 IC 95% 4,2-224) e invasión de tejido peritiroideo (OR 5,2 IC 95% 3,3-8,2). Conclusión: El riesgo de recurrencia inicial más frecuente fue el riesgo bajo. El sexo masculino, la edad ≥55años y el tamaño >1cm constituyen factores de riesgo de invasión a estructuras vecinas.


Introduction: Differentiated thyroid cancer (DTC) is represented by papillary carcinoma and follicular carcinoma. It comprises the vast majority (> 90%) of all thyroid cancers. Objectives: Stratify the risk of initial recurrence of patients with DTC. Relate age, sex, and tumor size to the risk of recurrence, capsular, nodal, vascular, and perithyroid tissue invasion. Materials and methods: Observational, descriptive, retrospective, cross-sectional study with an analytical component. A total of 432 patients with a diagnosis of DTC from Hospital de Clínicas, Instituto de Previsión Social and Instituto Nacional del Cáncer between 2011 and 2015 were included. Results: 87% were female. The mean age was 43 ± 14 years. Low recurrence risk predominated in 49% of patients, followed by intermediate risk (33%) and high risk (18%). Male sex, age ≥55 years and tumor size ˃1cm confer a higher risk of being stratified as intermediate / high recurrence risk, but only size> 1cm was significantly (OR 5.7 95% CI 3.6-9). Male sex represented a higher risk of lymph node invasion (OR 3.1 95% CI 1.4-2.8) and vascular invasion (OR 2.3 95% CI 1.1-4.8); age ≥55 years was in the vascular invasion (OR 2.6 95% CI 1.4-4.9); size> 1cm constituted a significantly higher risk of capsular invasion (OR 10.7 95% CI 6.7-17.3), nodal invasion (OR 10.5 95% CI 4-27.7), vascular invasion (OR 33 95% CI 4.5-244) and invasion of perithyroid tissue (OR 5.1 95% CI 3.2-8.1). Conclusion: The most frequent initial recurrence risk was low risk. Male sex, age ≥55 years, and size> 1cm are risk factors for invasion of neighboring structures.


Assuntos
Neoplasias da Glândula Tireoide , Neoplasias da Glândula Tireoide/diagnóstico , Linfonodos , Risco , Estudos Transversais , Fatores de Risco
2.
JAMA ; 328(6): 534-542, 2022 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-35943472

RESUMO

Importance: Prior randomized trials have generally shown harm or no benefit of stenting added to medical therapy for patients with symptomatic severe intracranial atherosclerotic stenosis, but it remains uncertain as to whether refined patient selection and more experienced surgeons might result in improved outcomes. Objective: To compare stenting plus medical therapy vs medical therapy alone in patients with symptomatic severe intracranial atherosclerotic stenosis. Design, Setting, and Participants: Multicenter, open-label, randomized, outcome assessor-blinded trial conducted at 8 centers in China. A total of 380 patients with transient ischemic attack or nondisabling, nonperforator (defined as nonbrainstem or non-basal ganglia end artery) territory ischemic stroke attributed to severe intracranial stenosis (70%-99%) and beyond a duration of 3 weeks from the latest ischemic symptom onset were recruited between March 5, 2014, and November 10, 2016, and followed up for 3 years (final follow-up: November 10, 2019). Interventions: Medical therapy plus stenting (n = 176) or medical therapy alone (n = 182). Medical therapy included dual-antiplatelet therapy for 90 days (single antiplatelet therapy thereafter) and stroke risk factor control. Main Outcomes and Measures: The primary outcome was a composite of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. There were 5 secondary outcomes, including stroke in the qualifying artery territory at 2 years and 3 years as well as mortality at 3 years. Results: Among 380 patients who were randomized, 358 were confirmed eligible (mean age, 56.3 years; 263 male [73.5%]) and 343 (95.8%) completed the trial. For the stenting plus medical therapy group vs medical therapy alone, no significant difference was found for the primary outcome of risk of stroke or death (8.0% [14/176] vs 7.2% [13/181]; difference, 0.4% [95% CI, -5.0% to 5.9%]; hazard ratio, 1.10 [95% CI, 0.52-2.35]; P = .82). Of the 5 prespecified secondary end points, none showed a significant difference including stroke in the qualifying artery territory at 2 years (9.9% [17/171] vs 9.0% [16/178]; difference, 0.7% [95% CI, -5.4% to 6.7%]; hazard ratio, 1.10 [95% CI, 0.56-2.16]; P = .80) and 3 years (11.3% [19/168] vs 11.2% [19/170]; difference, -0.2% [95% CI, -7.0% to 6.5%]; hazard ratio, 1.00 [95% CI, 0.53-1.90]; P > .99). Mortality at 3 years was 4.4% (7/160) in the stenting plus medical therapy group vs 1.3% (2/159) in the medical therapy alone group (difference, 3.2% [95% CI, -0.5% to 6.9%]; hazard ratio, 3.75 [95% CI, 0.77-18.13]; P = .08). Conclusions and Relevance: Among patients with transient ischemic attack or ischemic stroke due to symptomatic severe intracranial atherosclerotic stenosis, the addition of percutaneous transluminal angioplasty and stenting to medical therapy, compared with medical therapy alone, resulted in no significant difference in the risk of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. The findings do not support the addition of percutaneous transluminal angioplasty and stenting to medical therapy for the treatment of patients with symptomatic severe intracranial atherosclerotic stenosis. Trial Registration: ClinicalTrials.gov Identifier: NCT01763320.


Assuntos
Implante de Prótese Vascular , Arteriosclerose Intracraniana , Ataque Isquêmico Transitório , AVC Isquêmico , Inibidores da Agregação Plaquetária , Stents , Angioplastia/efeitos adversos , Angioplastia/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Constrição Patológica/complicações , Constrição Patológica/tratamento farmacológico , Constrição Patológica/mortalidade , Constrição Patológica/terapia , Humanos , Arteriosclerose Intracraniana/complicações , Arteriosclerose Intracraniana/tratamento farmacológico , Arteriosclerose Intracraniana/mortalidade , Arteriosclerose Intracraniana/terapia , Ataque Isquêmico Transitório/tratamento farmacológico , Ataque Isquêmico Transitório/etiologia , Ataque Isquêmico Transitório/mortalidade , Ataque Isquêmico Transitório/terapia , AVC Isquêmico/tratamento farmacológico , AVC Isquêmico/etiologia , AVC Isquêmico/mortalidade , AVC Isquêmico/terapia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/efeitos adversos , Inibidores da Agregação Plaquetária/uso terapêutico , Risco , Stents/efeitos adversos , Resultado do Tratamento
5.
Artigo em Inglês | MEDLINE | ID: mdl-35805251

RESUMO

Due to the threat of colorectal cancer (CRC) to health, Taiwan included the fecal occult blood test (FOBT) under preventive health services in 2010. We examined the factors that affect the diagnosis of people with positive FOBT results. Data were retrospectively collected from the CRC screening database. In the model predicting factors that affect the diagnosis of 89,046 people with positive FOBT results, the risks of disease in the CRC group were lower in medical institutions that conducted follow-up examinations in regions such as Northern Taiwan compared to that in Eastern Taiwan (p = 0.013); they were lower in the age group of 50 to 65 years than those in the age group of 71 to 75 years (p < 0.001, p = 0.016), and lower in the outpatient medical units that conducted follow-up examinations than those in the inpatient medical units by 0.565 times (p < 0.001, 95% CI: 0.493-0.647). Factors affecting the diagnosis of patients with positive FOBT results were gender, the region of the medical institution, medical unit for follow-up examinations, age, screening site, family history, type of follow-up examinations, and follow-up time. Therefore, the identification of characteristics of patients with positive FOBT results and the promotion of follow-up examination are important prevention strategies for CRC.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Sangue Oculto , Fatores Etários , Idoso , Neoplasias Colorretais/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Estudos Retrospectivos , Risco , Fatores Sexuais , Taiwan
6.
Front Immunol ; 13: 905585, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35812442

RESUMO

Background: In Hungary, the pandemic waves in late 2021 and early 2022 were dominated by the Delta and Omicron SARS-CoV-2 variants, respectively. Booster vaccines were offered with one or two doses for the vulnerable population during these periods. Methods and Findings: The nationwide HUN-VE 2 study examined the effectiveness of primary immunization, single booster, and double booster vaccination in the prevention of Covid-19 related mortality during the Delta and Omicron waves, compared to an unvaccinated control population without prior SARS-CoV-2 infection during the same study periods. The risk of Covid-19 related death was 55% lower during the Omicron vs. Delta wave in the whole study population (n=9,569,648 and n=9,581,927, respectively; rate ratio [RR]: 0.45, 95% confidence interval [CI]: 0.44-0.48). During the Delta wave, the risk of Covid-19 related death was 74% lower in the primary immunized population (RR: 0.26; 95% CI: 0.25-0.28) and 96% lower in the booster immunized population (RR: 0.04; 95% CI: 0.04-0.05), vs. the unvaccinated control group. During the Omicron wave, the risk of Covid-19 related death was 40% lower in the primary immunized population (RR: 0.60; 95% CI: 0.55-0.65) and 82% lower in the booster immunized population (RR: 0.18; 95% CI: 0.16-0.2) vs. the unvaccinated control group. The double booster immunized population had a 93% lower risk of Covid-19 related death compared to those with only one booster dose (RR: 0.07; 95% CI. 0.01-0.46). The benefit of the second booster was slightly more pronounced in older age groups. Conclusions: The HUN-VE 2 study demonstrated the significantly lower risk of Covid-19 related mortality associated with the Omicron vs. Delta variant and confirmed the benefit of single and double booster vaccination against Covid-19 related death. Furthermore, the results showed the additional benefit of a second booster dose in terms of SARS-CoV-2 infection and Covid-19 related mortality.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Imunização Secundária , SARS-CoV-2 , Fatores Etários , Idoso , COVID-19/mortalidade , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Humanos , Hungria/epidemiologia , Risco , Cobertura Vacinal
9.
Front Endocrinol (Lausanne) ; 13: 937871, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35903279

RESUMO

Objective: Research data suggest that patients with Hashimoto's thyroiditis may increase the risk of cancer. However, existing research is inconsistent with this view. Therefore, to investigate the effect of Hashimoto's thyroiditis on the risk of developing cancer, we conducted this study. Methods: We searched the PubMed and Embase databases from database establishment until March 2022. After rigorous literature screening by two authors, 23 studies that met the inclusion criteria were identified, and the required data were independently extracted. Results: We retrieved 3591 records, and after the screening, 11 case-control studies and 12 cohort studies were included in the analysis. Data analysis suggested that patients with Hashimoto's thyroiditis had an increased risk of developing breast cancer, urogenital cancer, digestive organs cancer, hematologic cancer, and a low risk of respiratory cancers. Conclusions: This systematic review and meta-analysis showed that patients with HT may have a significantly increased risk of thyroid cancer, breast cancers, lung cancer, digestive system cancer, urogenital cancers, blood cancers, and prolactinoma people without HT. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD 42022320741.


Assuntos
Neoplasias da Mama , Doença de Hashimoto , Neoplasias da Glândula Tireoide , Estudos de Casos e Controles , Feminino , Doença de Hashimoto/complicações , Doença de Hashimoto/epidemiologia , Humanos , Risco , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/etiologia
10.
Ned Tijdschr Geneeskd ; 1662022 06 22.
Artigo em Holandês | MEDLINE | ID: mdl-35899708

RESUMO

Risk communication is often seen as summarizing the results of epidemiological research in layman's terms, assuming that this information is sufficient for citizens to make choices. However, many people struggle to understand and make sense of the numbers in which risks are expressed. People also generally do not have an epidemiological view of their health, but use their own experiences and ideas about health and disease that determine how they understand information. Other aspects play a role than just the probability and severity of a negative event such as an illness. It is therefore not surprising that people sometimes make different choices than health professionals. For effective risk communication, it is important to communicate this information in understandable numerical formats, such as natural frequencies. However, this is not enough. Effective risk communication also relates to taking into account the risk perception of citizens or patients.


Assuntos
Comunicação , Pessoal de Saúde , Humanos , Probabilidade , Risco
11.
Sci Rep ; 12(1): 12184, 2022 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-35842465

RESUMO

A range of self-report questionnaires were developed to quantify one's risk-taking (RT) tendency. Exploring people's perceived risk level associated with negative risk behaviors is essential to develop a better understanding and intervention policies for RT. In the present study, we proposed a 2 × 10-item scale, namely, the general risk-taking questionnaire (GRTQ), to evaluate RT tendency and risk attitude among the general population by measuring people's engagement in and perceptions toward 10 commonly known risky behaviors. A total of 2984 adults residing in 10 prefectures in Japan (age range = 20-59, 53.12% female) provided valid responses to an online survey. Apart from the factor analysis procedures, multivariate negative binomial regression models have been applied to investigate the relationship between RT engagement and perception. We obtained two identical factors, namely, personal risk and relational risk, for both scales of the GRTQ. Increased levels of RT engagement were found in younger, male, nonmarried, nonparent and urban respondents. Despite an overall negative correlation between RT engagement and perception, our model revealed a weaker linkage in the younger population for relational risk behaviors. Overall, we showed evidence that the GRTQ is an easy-to-administer, valid and reliable measure of RT for future clinical research.


Assuntos
Atitude , Assunção de Riscos , Adulto , Análise Fatorial , Feminino , Humanos , Masculino , Risco , Inquéritos e Questionários , Adulto Jovem
12.
Front Immunol ; 13: 904682, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35844507

RESUMO

Background: Primary Sjögren's syndrome (pSS) and breast cancer are a highly prevalent autoimmune disease and malignancy, respectively, both occurring predominantly in females. Whether there is a link between these two diseases is uncertain. We conducted a systematic review and meta-analysis to investigate the risk, incidence, and mortality of breast cancer in patients with pSS. Methods: We systematically searched Embase, PubMed, and Web of Science on January 31, 2022 to identify the study that assessed risk, incidence, or mortality of breast cancer in pSS. The fixed or random-effects models were applied to pool the effect estimates based on heterogeneity measured by Cochran's Q-test and Higgins' I2. Results: Ten studies involving 725,805 participants and 64,836 pSS patients were included in our analysis. The pooled result showed that, overall, pSS was not associated with the risk (SIR=0.92, 95%CI: 0.66-1.29, P=0.646) and mortality (HR = 0.78, 95%CI: 0.26-2.34, P = 0.664) of breast cancer; however, when stratified by geographic region, we found that patients with pSS in Asian countries (SIR=1.32, 95%CI: 1.10-1.58, P=0.003) and Argentina (SIR=3.76, 95%CI: 1.04-9.45, P=0.019) had an elevated risk of breast cancer, while pSS in Europe was associated with a reduced risk (SIR=0.61, 95%CI: 0.51-0.73, P<0.001). The pooled result from 28,635 female pSS patients indicated that the incidence of breast cancer was 2.15 (95% CI: 1.33-3.50) per 1000 person/years. Conclusion: This study suggests that there may be geographical differences in the association between pSS and breast cancer risk; patients with pSS in European countries are associated with a lower risk of breast cancer, while Asia and Argentina are the opposite. Future research is needed to further characterize the effect of pSS on breast cancer risk and the pathophysiological mechanisms underlying this association to unravel the complex relationship between the two.


Assuntos
Doenças Autoimunes , Neoplasias da Mama , Síndrome de Sjogren , Doenças Autoimunes/complicações , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Feminino , Humanos , Incidência , Risco , Síndrome de Sjogren/complicações , Síndrome de Sjogren/epidemiologia
13.
Sci Rep ; 12(1): 12997, 2022 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-35906381

RESUMO

Hormone replacement therapy (HRT) is widely used to relieve menopausal symptoms; however, it remains unclear whether the use of HRT was associated with gastric cancer. We conducted a systematic review and meta-analysis to synthesize available evidence. This study followed the PRISMA guideline to report meta-analysis. PubMed, Embase, and Cochrane library were searched from conception through 23 February 2022. Eligible studies reporting risk of gastric cancer after HRT were screened and accessed by two independent reviewers. Random-effects meta-analysis was used to calculate pooled risk estimate as relative risk (RR, 95% CI). Pre-established review protocol was registered in PROSPERO (CRD42021281260). Among the 1095 articles identified, we included 11 studies with 1,919,089 women in this meta-analysis. The combined risk estimate (RR, 0.72; 95% CI 0.64-0.81; I2 = 2%) indicated that the use of HRT was associated with a 28% reduction in risk of gastric cancer compared with those who had no HRT exposure. The narrow prediction interval (0.62-0.84) for gastric cancer risk suggested a low between-study variance. In subgroup analysis defined by HRT formulation, there were reduction in risks of gastric cancer after the use of estrogen-only therapy (Pooled RR, 0.63; 95% CI 0.51-0.77, I2 = 0%) and estrogen-progestin therapy (Pooled RR, 0.70; 95% CI 0.57-0.87; I2 = 0%), as compared with non-users. In this systematic review and meta-analysis, the use of HRT was associated with a reduced gastric cancer risk regardless of HRT formulation. Further investigations are warranted to confirm underlying mechanisms.


Assuntos
Terapia de Reposição de Estrogênios , Neoplasias Gástricas , Terapia de Reposição de Estrogênios/métodos , Estrogênios , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Risco , Neoplasias Gástricas/induzido quimicamente , Neoplasias Gástricas/epidemiologia
14.
J Sports Med Phys Fitness ; 62(8): 1023-1028, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35860968

RESUMO

BACKGROUND: The Grooved Pegboard Test (GPT) is a widely adopted test to evaluate manual dexterity. A factor that could influence the cognitive process is physical and mental stress, which could be controlled by respiration. Stress can be monitored through heart variability. Consequently, the present study's objective was to investigate the association between the breath relaxation technique and the GPT and correlate the findings with stress parameters. METHODS: One hundred fourteen participants were recruited. Stress level test, GPT, and breathing exercise for relaxation were performed. Spearman test was adopted to evaluate the correlation, while the Friedman Test and the Dunn Test and the Mann-Whitney Test were performed to detect statistical differences. RESULTS: Correlation existed between GPT and age (r=-0.02), height (r=0.22), weight (r=0.21), and handgrip (r=0.21). The Friedman and Dunn's post-test resulted in significant differences in group 1 and 2 between GPT baseline vs. GPT rest (P<0.01) and GPT baseline vs. GPT relax in group 1 (P<0.01) and group 2 (P<0.0001). CONCLUSIONS: A breath relaxation technique does not influence the GPT, and even not significantly, physical stress increases the time to complete the GPT. Instead, high mental stress, stress resistance, and heart frequency decrease the time to complete the GPT.


Assuntos
Força da Mão , Humanos , Risco
15.
Medicina (Kaunas) ; 58(7)2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35888613

RESUMO

Background and Objectives: In the presence of a persistent endodontic lesion or endodontic failure, the alternative for the recovery of the dental element is endodontic retreatment or endodontic surgery, which consists in the surgical removal of the root apices with retrograde closure of the endodontium. The objective of this systematic review and meta-analysis was to provide an updated value of the Risk Ratio between the two types of treatment in order to offer to clinicians who propose a non-surgical endodontic retreatment or an endodontic surgery a direct comparison. Materials and Methods: The revision was performed according to PRISMA indications: three databases (PubMed, Scopus and Cochrane register) were consulted through the use of keywords relevant to the revision topic: surgical endodontic retreatment, endodontic retreatment, apicoectomy. This search produced 7568 records which, after eliminating duplicates and applying the inclusion and exclusion criteria, resulted in a total of seven included articles. The meta-analyses were conducted by applying fixed-effects models, given the low percentage of heterogeneity. In addition, trial sequency analysis (TSA) was performed for the analysis of the statistical power of the results and GRADE for the quality of the evidence. Results: The results of the meta-analyses' data report an aggregate risk ratio (RR) between non-surgical endodontic retreatment and surgical endodontic retreatment of: 1.05 [0.74, 1.47] at one year of follow-up; RR 2.22 [1.45, 3.41] at two years of follow-up; an RR 1.08 [0.73 1.62] for a follow-up period of 3-4 years; and an RR 0.92 [0.53, 1.61] for a follow-up period of 8-10 years. Conclusions: The results of the present meta-analysis show that in the long term, the risk of failure is identical for the two groups, and there is only a slightly higher risk of failure for non-surgical endodontic retreatments, when only two years of follow-up are considered.


Assuntos
Retratamento , Humanos , Risco
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