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1.
Anaesthesia ; 75(1): 54-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31531978

RESUMO

Patients eligible for emergency laparotomy who do not proceed to surgery are not as well characterised as patients who do proceed to surgery. We studied patients eligible for laparotomy, as defined by National Emergency Laparotomy Audit criteria, from August 2015 to October 2016. We analysed the association of individual variables with survival and two composite scores: P-POSSUM and a general survival model. Out of 314 patients, 214 (68%) underwent laparotomy and 100 (32%) did not. Median (IQR [range]) follow-up was 1.3 (0.1-1.8 [0.0-2.5]) years for the cohort, 1.5 (1.1-2.0 [0.0-2.6]) years after laparotomy and 0.0 (0.0-1.1 [0.0-2.2]) years without laparotomy. There were 126/314 (40%) deaths in the follow-up period, 52/214 (24%) deaths after laparotomy and 74/100 (74%) deaths without surgery. Ninety out of 126 deaths (71%) were within one month of hospital admission. Patient variables were different for the two groups, which when combined in the general survival model generated background median (IQR [range]) life expectancies of 12 (6-21 [0-49]) and 4 (2-6 [0-36]) years, respectively, p < 0.0001. 'Poor fitness' precluded laparotomy in 74/100 (74%) patients. The decision to not operate involved a consultant less often than the decision to operate: 66/100 (66%) vs. 178/214 (83%), p = 0.001. Our study supports the contention that survival beyond 30 postoperative days could be predicted reasonably accurately. Survival in patients who did not have laparotomy was shorter than expected. Emergency laparotomy might have prolonged survival in some patients.


Assuntos
Laparotomia/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Idoso , Estudos de Coortes , Emergências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Reino Unido
2.
Int J Prosthodont ; 33(1): 22-28, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31860910

RESUMO

PURPOSE: To evaluate the clinical performance of endodontically treated (ET) teeth restored with two different marginal forms of lithium disilicate glass-ceramic (LDG ceramic) onlays. MATERIALS AND METHODS: A total of 120 posterior teeth were prepared for onlays after ET. The occlusal surfaces of the teeth were removed 1.5 to 2 mm anatomically. Different marginal forms were employed depending on the thickness of the residual axis wall of each tooth: In Group S, a 1-mm shoulder was prepared when the remaining axis wall was > 2 mm (n = 50), and in Group B, a 20- to 30-degree bevel was prepared when the remaining axis wall was ≤ 2 mm (n = 70). The access of the pulp chamber was filled with resin, and 1.5 to 2 mm of the box morphology of the pulp chamber was preserved. The pressed LDG ceramic was applied to the fabricated onlays. The teeth and restorations were checked after 6, 12, and 24 months. All available restored teeth were assessed using modified United States Public Health Service criteria. RESULTS: During the observation period, no tooth fracture occurred. Neither tooth cracks nor secondary caries were observed in Group S or Group B. The 2-year survival rate of the teeth was 100%. Five fractured onlays were observed in Group S in the molar region, while all onlays in Group B were intact (P < .05). The survival rate of the onlays was 95.83%. CONCLUSION: The results demonstrate that LDG ceramic onlays can preserve ET posterior teeth with a highly satisfactory outcome, though the marginal form may affect the survival rate of the onlay.


Assuntos
Porcelana Dentária , Restaurações Intracoronárias , Cerâmica , Falha de Restauração Dentária , Seguimentos
3.
BJOG ; 127(1): 58-68, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31541495

RESUMO

OBJECTIVES: To estimate long-term cervical intraepithelial neoplasia grade 3 (CIN3) risks associated with different triage strategies for human papillomavirus positive (HPV+) women with a view to reducing unnecessary referrals. DESIGN: The ARTISTIC trial cohort was recruited in Manchester in 2001-03 and was followed up for CIN3 and cancer notification through national registration until December 2015. RESULTS: The 10-year cumulative risk of CIN3+ was much higher for women with HPV16/18 infection (19.4%, 95% CI 15.8-23.8% with borderline/low-grade cytology and 10.7%, 95% CI 8.3-13.9% with normal cytology) than for those with other HPV types (7.3%, 95% CI 5.4-9.7% with borderline/low-grade cytology and 3.2%, 95% CI 2.2-4.5% with normal cytology). Among the 379 women with normal to low-grade cytology and new HPV infection, the 10-year cumulative CIN3+ risk was 2.9% (95% CI 1.6-5.2%). CONCLUSIONS: The CIN3 risk is confined to women with persistent type-specific HPV so partial genotyping test assays identifying HPV16/18 as a minimum are essential for efficient risk stratification. Immediate referral to colposcopy for HPV+ women with borderline or low-grade cytology and referral after a year if still HPV+ with normal cytology may be unnecessary. Low-grade lesions can safely be retested to identify those with persistent HPV. Recall intervals of 1 year for HPV16/18 and 2 years for other high-risk HPVs are justified for women with normal cytology and might also be considered for women with borderline/low-grade cytology. The minimal risk of invasive cancer that has progressed beyond stage 1A must be weighed against the advantages for patients and the NHS of reducing the number of referrals to colposcopy. TWEETABLE ABSTRACT: Cervical screening would be better for women and cheaper for the NHS if women with HPV and normal to low-grade cytology were retested after a year or two when many infections will have cleared.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Infecções por Papillomavirus/diagnóstico , Triagem , Neoplasias do Colo do Útero/diagnóstico , Adulto , Distribuição por Idade , Idoso , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/virologia , Detecção Precoce de Câncer , Inglaterra/epidemiologia , Feminino , Seguimentos , Papillomavirus Humano 16 , Papillomavirus Humano 18 , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Fatores de Risco , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Adulto Jovem
5.
Gut ; 69(1): 112-121, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30981990

RESUMO

BACKGROUND AND AIMS: Serrated polyposis syndrome (SPS) is associated with an increased risk of colorectal cancer (CRC). International guidelines recommend surveillance intervals of 1-2 years. However, yearly surveillance likely leads to overtreatment for many. We prospectively assessed a surveillance protocol aiming to safely reduce the burden of colonoscopies. METHODS: Between 2013 and 2018, we enrolled SPS patients from nine Dutch and Spanish hospitals. Patients were surveilled using a protocol appointing either a 1-year or 2-year interval after each surveillance colonoscopy, based on polyp burden. Primary endpoint was the 5-year cumulative incidence of CRC and advanced neoplasia (AN) during surveillance. RESULTS: We followed 271 SPS patients for a median of 3.6 years. During surveillance, two patients developed CRC (cumulative 5-year incidence 1.3%[95% CI 0% to 3.2%]). The 5-year AN incidence was 44% (95% CI 37% to 52%), and was lower for patients with SPS type III (26%) than for patients diagnosed with type I (53%) or type I and III (59%, p<0.001). Most patients were recommended a 2-year interval, and those recommended a 2-year interval were not at increased risk of AN: AN incidence after a 2-year recommendation was 15.6% compared with 24.4% after a 1-year recommendation (OR 0.57, p=0.08). CONCLUSION: Risk stratification substantially reduced colonoscopy burden while achieving CRC incidence similar to previous studies. AN incidence is considerable in SPS patients, but extension of surveillance intervals was not associated with increased AN in those identified as low-risk by the protocol. We identified SPS type III patients as low-risk group that might benefit from even less frequent surveillance. TRIAL REGISTRATION NUMBER: The study was registered on http://www.trialregister.nl; trial-ID NTR4609.


Assuntos
Polipose Adenomatosa do Colo/diagnóstico , Neoplasias Colorretais/diagnóstico , Polipose Adenomatosa do Colo/epidemiologia , Polipose Adenomatosa do Colo/cirurgia , Idoso , Estudos de Coortes , Colonoscopia/métodos , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Sobremedicalização/prevenção & controle , Sobremedicalização/estatística & dados numéricos , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Vigilância da População/métodos , Prevalência , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia
6.
Gut ; 69(1): 103-111, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31023832

RESUMO

OBJECTIVE: We assessed the effect of surgical resection of colorectal cancer (CRC) on perioperative plasma vitamin D (25OHD) and C-reactive protein (CRP) level. We investigated the relationship between circulating vitamin D level and CRC survival. DESIGN: We sequentially sampled 92 patients undergoing CRC resection, and measured plasma 25OHD and CRP. For survival analyses, we assayed 25OHD and CRP in two temporally distinct CRC patient cohorts (n=2006, n=2100) and investigated the association between survival outcome, circulating vitamin D and systemic inflammatory response. RESULTS: Serial sampling revealed a postoperative fall (mean 17.3 nmol/L; p=3.6e-9) in plasma 25OHD (nadir days 1-2). CRP peaked 3-5 days postoperatively (143.1 mg/L; p=1.4e-12), yet the postoperative fall in 25OHD was independent of CRP. In cohort analyses, 25OHD was lower in the 12 months following operation (mean=48.8 nmol/L) than preoperatively (54.8 nmol/L; p=1.2e-5) recovering after 24 months (52.2 nmol/L; p=0.002). Survival analysis in American Joint Committee on Cancer stages I-III demonstrated associations between 25OHD tertile and CRC mortality (HR=0.69; 95% CI 0.46 to 0.91) and all-cause mortality (HR=0.68; 95% CI 0.50 to 0.85), and was independent of CRP. We observed interaction effects between plasma 25OHD and rs11568820 genotype (functional VDR polymorphism) with a strong protective effect of higher 25OHD only in patients with GG genotype (HR=0.51; 95% CI 0.21 to 0.81). We developed an online tool for predicted survival (https://apps.igmm.ed.ac.uk/mortalityCalculator/) that incorporates 25OHD with clinically useful predictive performance (area under the curve 0.77). CONCLUSIONS: CRC surgery induces a fall in circulating 25OHD. Plasma 25OHD level is a prognostic biomarker with low 25OHD associated with poorer survival, particularly in those with rs11568820 GG genotype. A randomised trial of vitamin D supplementation after CRC surgery has compelling rationale.


Assuntos
Biomarcadores Tumorais/sangue , Neoplasias Colorretais/cirurgia , Vitamina D/análogos & derivados , Idoso , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Neoplasias Colorretais/sangue , Neoplasias Colorretais/genética , Feminino , Seguimentos , Predisposição Genética para Doença , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Prognóstico , Receptores de Calcitriol/genética , Análise de Sobrevida , Síndrome de Resposta Inflamatória Sistêmica/sangue , Vitamina D/sangue
7.
Gut ; 69(1): 42-51, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31036757

RESUMO

BACKGROUND AND AIMS: Prenatal and early life bacterial colonisation is thought to play a major role in shaping the immune system. Furthermore, accumulating evidence links early life exposures to the risk of developing IBD later in life. We aimed to assess the effect of maternal IBD on the composition of the microbiome during pregnancy and on the offspring's microbiome. METHODS: We prospectively examined the diversity and taxonomy of the microbiome of pregnant women with and without IBD and their babies at multiple time points. We evaluated the role of maternal IBD diagnosis, the mode of delivery, antibiotic use and feeding behaviour on the microbiome composition during early life. To assess the effects of IBD-associated maternal and infant microbiota on the enteric immune system, we inoculated germ-free mice (GFM) with the respective stool and profiled adaptive and innate immune cell populations in the murine intestines. RESULTS: Pregnant women with IBD and their offspring presented with lower bacterial diversity and altered bacterial composition compared with control women and their babies. Maternal IBD was the main predictor of the microbiota diversity in the infant gut at 7, 14, 30, 60 and 90 days of life. Babies born to mothers with IBD demonstrated enrichment in Gammaproteobacteria and depletion in Bifidobacteria. Finally, GFM inoculated with third trimester IBD mother and 90-day infant stools showed significantly reduced microbial diversity and fewer class-switched memory B cells and regulatory T cells in the colon. CONCLUSION: Aberrant gut microbiota composition persists during pregnancy with IBD and alters the bacterial diversity and abundance in the infant stool. The dysbiotic microbiota triggered abnormal imprinting of the intestinal immune system in GFM.


Assuntos
Microbioma Gastrointestinal/imunologia , Doenças Inflamatórias Intestinais/microbiologia , Complicações na Gravidez/microbiologia , Efeitos Tardios da Exposição Pré-Natal/microbiologia , Imunidade Adaptativa , Adulto , Animais , Bactérias/classificação , Bactérias/isolamento & purificação , Disbiose/imunologia , Disbiose/microbiologia , Transplante de Microbiota Fecal/métodos , Fezes/microbiologia , Feminino , Seguimentos , Trato Gastrointestinal/imunologia , Trato Gastrointestinal/microbiologia , Vida Livre de Germes , Humanos , Recém-Nascido , Doenças Inflamatórias Intestinais/imunologia , Masculino , Troca Materno-Fetal , Gravidez , Complicações na Gravidez/imunologia , Efeitos Tardios da Exposição Pré-Natal/imunologia , Estudos Prospectivos
8.
J Oral Rehabil ; 47(1): 67-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31359446

RESUMO

Long-term follow-up of oral implant therapy seldom report all biological and technical complications. The objective of this study was to evaluate the long-term (9-15 years) outcome after dental implant therapy, assess survival and complication rates. In addition, to identify the risk indicators of these complications at patient and implant levels. Patients (n = 376) treated with dental implants (n = 1095) between 1999 and 2005 at a specialist clinic in Stockholm, Sweden, were included. Longitudinal data were collected retrospectively from digital dental records. A subset of the included patient underwent a clinical examination at the 9-15 years follow-up (n = 163). Chi-square tests, Kaplan-Meier analyses and the general estimating equations (GEE) procedure were adopted for multilevel analyses. The cumulative implant survival rate up to 15 years was 82.6% (SE 4.1%). The prevalences of biological and technical complications at patient level were 52% and 32%, respectively. In total, 763 complications occurred, 65% of patients experienced at least one complications. Implant loss occurred significantly more frequently in subjects with a history of treated severe periodontitis Stage III-IV (P = .008) and in cases when complications were registered during implant surgery (P = .010). Smoking was a significant risk indicator for peri-implantitis (P = .006). The long-term implant survival and complication rates at patient level were 83% and 79%, respectively. Implant loss was significantly more frequent for subjects with a history of treated severe periodontitis and if complication was registered during implant surgery. Smoking was a significant risk indicator for peri-implantitis.


Assuntos
Implantes Dentários , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Seguimentos , Humanos , Estudos Retrospectivos , Suécia
9.
Int Endod J ; 53(1): 5-18, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31397907

RESUMO

AIM: To evaluate and compare the influence of various predictors on outcomes of apexification using either mineral trioxide aggregate (MTA) or calcium hydroxide (CH) in permanent immature anterior teeth with necrotic pulps and periapical lesions of adults. METHODOLOGY: Ninety immature teeth with necrotic pulps and periapical lesions on adult patients (aged 18-40 years) were treated with MTA (45 teeth) or CH (45 teeth) between 2015 and 2018. Patients of both groups were recalled for follow-up examinations after the first intervention at 1,3,6 and 12 months for the first year, every 6 months for the second year and every year thereafter until the end of the study (median 32.3 months). The treatment outcome based on clinical and radiographic criteria was assessed by calibrated examiners and dichotomized as 'healed+healing' or 'not healed'. The age, gender, stage of root development, preoperative signs and symptoms of apical periodontitis and size of periapical lesion were recorded. The cumulative success proportion and mean time were analysed with the Kaplan-Meier test. The generalized logrank statistic was used to describe prognostic clinical variables. Fisher's exact test was applied for the evaluation of the healing rates. RESULTS: Thirty-nine of the 45 teeth treated with MTA were available for recall. Of these, 29 teeth (74%) revealed calcific apical barrier formation with complete resolution of periapical lesions, 7 teeth (18%) were healing, and 3 teeth (8%) had persistent disease. Thirty-four of the 45 teeth in the CH group were available for recall. Of these, 27 teeth (79%) had complete healing of periapical lesions and had calcific barrier formation, 4 teeth (12%) were healing, and the remaining 3 teeth (9%) had not healed. The survival rate of teeth treated with MTA was similar to the survival rates observed in teeth treated with CH (90% and 91%, respectively, P > 0.05). The generalized logrank statistic revealed that the cumulative success rate of both materials was not significantly different (P > 0.05). None of the tested predictors had an influence on the treatment outcomes of teeth in both groups (P > 0.05). CONCLUSIONS: Apexification with both MTA and CH was associated with similar treatment outcomes. MTA may be proposed as a material for apexification treatment in immature teeth of adult patients due to the shorter treatment time associated with its use.


Assuntos
Materiais Restauradores do Canal Radicular , Adolescente , Adulto , Compostos de Alumínio , Compostos de Cálcio , Combinação de Medicamentos , Seguimentos , Humanos , Óxidos , Estudos Prospectivos , Silicatos , Ápice Dentário , Resultado do Tratamento , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-31815978

RESUMO

This retrospective study evaluated the long-term response of periodontal tissues and survival rate of teeth with advanced attachment loss and pathologic migration in 21 periodontitis patients treated with combined periodontal and orthodontic treatment. All anterior migrated teeth were in function at the end of 10 to 15 years of maintenance. Residual probing depths and clinical attachment levels improved after treatment and remained stable through the follow-up. A total of 55 hopeless teeth were lost during active therapy, as well as 6 molars over the course of the supportive periodontal therapy (for nonperiodontal reasons). In highly compliant patients, all migrated teeth with initial unfavorable prognosis showed long-term clinical stability.


Assuntos
Periodontite , Perda de Dente , Seguimentos , Humanos , Dente Molar , Prognóstico , Estudos Retrospectivos
11.
Artigo em Inglês | MEDLINE | ID: mdl-31815979

RESUMO

The modified apically repositioned flap (MARF) technique has been previously published as a successful method to increase the zone of attached gingiva with numerous advantages, such as simplicity, predictability, and long-term stability. However, this technique has only been used in areas with at least 0.5 mm of attached gingiva, presurgically. In the current study, the MARF technique was utilized in 21 sites (teeth) with no attached gingiva and only mucosa comprising the marginal tissue. The long-term follow-up results over the course of 1 to 11 years (average follow-up: 3.2 years) show a statistically significant increase of 3.6 ± 0.8 mm for keratinized tissue and of 2.21 ± 0.83 mm for attached gingiva, and no increases in probing depths or marginal tissue recession. These results indicate that the MARF procedure has generated keratinized tissue and attached gingiva in areas with a presurgical absence of these tissues.


Assuntos
Gengiva , Retração Gengival , Seguimentos , Gengivoplastia , Estudos Retrospectivos , Retalhos Cirúrgicos
12.
Artigo em Inglês | MEDLINE | ID: mdl-31815982

RESUMO

Soft tissue augmentation procedures are crucial to obtain a successful outcome in implant therapy. The aim of this case series was to describe the 1-year clinical outcomes of a porcine-derived acellular dermal matrix for buccal mucosal thickness augmentation at osseointegrated single implants with facial peri-implant soft tissue deficiencies. Ten patients were included and treated with a prosthetic and surgical approach that combined a coronally advanced flap and a dermal matrix. Results showed the possibility to obtain an increase in buccal soft tissue thickness of 1.2 ± 0.18 mm at single implant sites in the esthetic area.


Assuntos
Derme Acelular , Implantes Dentários , Animais , Seguimentos , Humanos , Mucosa Bucal , Retalhos Cirúrgicos , Suínos , Resultado do Tratamento
13.
Artigo em Inglês | MEDLINE | ID: mdl-31815984

RESUMO

The goal of this study was to evaluate the influence of gingival phenotype (GPh) on the clinical outcomes of coronally advanced flap (CAF). In this prospective study, 24 gingival recessions (recession type RT1 class or Miller Classes I and II) in 21 patients were treated with CAF alone. Patients were classified as having thin, medium, thick, or very thick GPh using a color-coded probe. At 6 months, the lowest mean root coverage (mRC; 60.4% ± 28.8%) and complete root coverage (CRC; 25%) were found in patients with thin GPh compared to patients with medium (mRC: 86.4% ± 17.6%; CRC: 60%), thick (mRC: 93.3% ± 14.9%; CRC: 83.3%), and very thick (mRC: 86.7% ± 26.7%; CRC: 80%) GPh. Regression analysis showed a statistically significant difference (P < .05) between thin and thick/very thick GPh in the likelihood of achieving CRC. Higher RES values were observed in patients with thick and very thick GPh (8.2 ± 1.5 and 8.4 ± 1.4, respectively), while thin GPh was related to the lowest RES score (6.3 ± 2.2). CAF performed in patients with thick or very thick GPh resulted in superior clinical and esthetic outcomes than thin and medium GPh. In particular, thin GPh was associated with the lowest mRC, CRC, and root coverage esthetic scores.


Assuntos
Tecido Conjuntivo , Retração Gengival , Seguimentos , Gengiva , Humanos , Fenótipo , Estudos Prospectivos , Raiz Dentária , Resultado do Tratamento
14.
Artigo em Inglês | MEDLINE | ID: mdl-31815985

RESUMO

Eight patients with 38 Miller Class I, II, and III gingival recession defects were treated using an acellular bovine dermal matrix graft (Primatrix, Integra) under a coronal positioned flap. There was a significant 2.43-mm reduction in defect depth, 85.96% mean root coverage, and 65.79% complete root coverage at the 6-month follow-up. Patients reported a significant improvement in perceived esthetics as well as trends for reduced dentinal hypersensitivity, minimal postoperative pain, and overall satisfaction with the procedure. The favorable clinical outcomes and oral biocompatibility would benefit from comparative trials to evaluate the material against contemporary grafting techniques.


Assuntos
Gengiva , Retração Gengival , Animais , Bovinos , Tecido Conjuntivo , Seguimentos , Xenoenxertos , Humanos , Projetos Piloto , Raiz Dentária , Resultado do Tratamento
16.
N Engl J Med ; 382(2): 111-119, 2020 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-31733181

RESUMO

BACKGROUND: The timing and indications for surgical intervention in asymptomatic patients with severe aortic stenosis remain controversial. METHODS: In a multicenter trial, we randomly assigned 145 asymptomatic patients with very severe aortic stenosis (defined as an aortic-valve area of ≤0.75 cm2 with either an aortic jet velocity of ≥4.5 m per second or a mean transaortic gradient of ≥50 mm Hg) to early surgery or to conservative care according to the recommendations of current guidelines. The primary end point was a composite of death during or within 30 days after surgery (often called operative mortality) or death from cardiovascular causes during the entire follow-up period. The major secondary end point was death from any cause during follow-up. RESULTS: In the early-surgery group, 69 of 73 patients (95%) underwent surgery within 2 months after randomization, and there was no operative mortality. In an intention-to-treat analysis, a primary end-point event occurred in 1 patient in the early-surgery group (1%) and in 11 of 72 patients in the conservative-care group (15%) (hazard ratio, 0.09; 95% confidence interval [CI], 0.01 to 0.67; P = 0.003). Death from any cause occurred in 5 patients in the early-surgery group (7%) and in 15 patients in the conservative-care group (21%) (hazard ratio, 0.33; 95% CI, 0.12 to 0.90). In the conservative-care group, the cumulative incidence of sudden death was 4% at 4 years and 14% at 8 years. CONCLUSIONS: Among asymptomatic patients with very severe aortic stenosis, the incidence of the composite of operative mortality or death from cardiovascular causes during the follow-up period was significantly lower among those who underwent early aortic-valve replacement surgery than among those who received conservative care. (Funded by the Korean Institute of Medicine; RECOVERY ClinicalTrials.gov number, NCT01161732.).


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Tratamento Conservador , Idoso , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/terapia , Doenças Assintomáticas/terapia , Doenças Cardiovasculares/mortalidade , Feminino , Seguimentos , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Complicações Pós-Operatórias/mortalidade
17.
Int J Prosthodont ; 33(1): 29-38, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31860911

RESUMO

PURPOSE: To compare the optical effects of an immediately placed anodized pink-neck implant and abutment vs a conventional gray implant and abutment in relation to soft tissue thickness 6 months after the restoration was completed. MATERIALS AND METHODS: Forty patients with a hopeless maxillary anterior tooth received an immediate implant and an immediate provisional or custom healing abutment after flapless extraction. Participants were randomized to receive either a conventional titanium implant (control) or a pink-neck implant (test). All patients then received two identical CAD/CAM titanium abutments (one conventional gray, delivered first, and one anodized to appear pink, delivered 3 weeks after) and a zirconia crown. A spectrophotometer was used to record the color of the peri-implant mucosa and gingiva 3 weeks after delivery of each abutment and 6 months after the final restoration was delivered. The color difference between the two sites was calculated (ΔL*, Δa*, Δb*), and correlations with soft tissue thickness, change in ridge dimension, and implant position were assessed. RESULTS: Irrespective of the randomization group, changing the abutments from gray to pink showed a change in color between the peri-implant mucosa and the natural gingiva. Patients with a thin gingival biotype showed a statistically significant color change (P = .00089) in the a* axis, meaning that the gingiva appeared more pink (Δa*). No significant correlation between the soft tissue color and buccolingual collapse, vertical recession, or implant position was observed in either group. CONCLUSION: The difference in color observed between the peri-implant mucosa and the gingiva was considerable in all groups. Anodized pink implants and abutments could reduce the difference in the red aspect (Δa*) of the peri-implant mucosa compared to the adjacent gingiva in patients with a thin biotype.


Assuntos
Dente Suporte , Implantes Dentários para Um Único Dente , Cor , Coroas , Seguimentos , Gengiva , Humanos , Titânio
18.
APMIS ; 128(1): 25-34, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31628820

RESUMO

Eradication failure of Helicobacter pylori infection could play a causal role in progression of gastric disorders. In this study, infection with H. pylori was followed in gastric biopsies of symptomatic adult patients at two phases during 1-year period. Analyses were done to show association of therapeutic regimens with the refractory infection, changes in sequence types (STs) and minimum inhibitory concentration (MIC) values, and progression of histopathological changes. Infection with H. pylori was confirmed in 32.3% (57/170) of the patients. Persistent infection with H. pylori was confirmed in 14 out of the 25 patients (56%) who participated at the second phase of the study. A difference between primary and secondary resistance rates to clarithromycin (49% vs 64.3%), metronidazole (76.36% vs 100%), and ciprofloxacin (45% vs 57.1%) was detected. Although the re-emerged strains in patients with refractory infection did not show alteration in STs, their MIC50 values showed twofold increases for clarithromycin and ciprofloxacin. While ciprofloxacin containing regimens were more successful, failure of metronidazole containing regimens was detected in 77% of the patients. Consequently, inappropriate medication has an impact on refractory H. pylori infection, which could cause to a rise in resistance levels to antibiotics and progression of pathological disorders.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/patologia , Helicobacter pylori/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Biópsia , Ciprofloxacino/farmacologia , Claritromicina/farmacologia , Feminino , Seguimentos , Técnicas Histológicas , Humanos , Concentração Inibidora 50 , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Estômago/microbiologia , Estômago/patologia
19.
BMJ ; 367: l6377, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852659

RESUMO

OBJECTIVE: To explore associations between different frequencies of arts engagement and mortality over a 14 year follow-up period. DESIGN: Prospective cohort study. PARTICIPANTS: English Longitudinal Study of Ageing cohort of 6710 community dwelling adults aged 50 years and older (53.6% women, average age 65.9 years, standard deviation 9.4) who provided baseline data in 2004-05. INTERVENTION: Self reported receptive arts engagement (going to museums, art galleries, exhibitions, the theatre, concerts, or the opera). MEASUREMENT: Mortality measured through data linkage to the National Health Service central register. RESULTS: People who engaged with receptive arts activities on an infrequent basis (once or twice a year) had a 14% lower risk of dying at any point during the follow-up (809/3042 deaths, hazard ratio 0.86, 95% confidence interval 0.77 to 0.96) compared with those who never engaged (837/1762 deaths). People who engaged with receptive arts activities on a frequent basis (every few months or more) had a 31% lower risk of dying (355/1906 deaths, 0.69, 0.59 to 0.80), independent of demographic, socioeconomic, health related, behavioural, and social factors. Results were robust to a range of sensitivity analyses with no evidence of moderation by sex, socioeconomic status, or social factors. This study was observational and so causality cannot be assumed. CONCLUSIONS: Receptive arts engagement could have a protective association with longevity in older adults. This association might be partly explained by differences in cognition, mental health, and physical activity among those who do and do not engage in the arts, but remains even when the model is adjusted for these factors.


Assuntos
Arte , Participação da Comunidade/estatística & dados numéricos , Mortalidade/tendências , Idoso , Cognição , Inglaterra/epidemiologia , Exercício , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Humanos , Longevidade , Estudos Longitudinais , Masculino , Saúde Mental , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medicina Estatal
20.
Medicine (Baltimore) ; 98(50): e16627, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852061

RESUMO

BACKGROUND: The purpose of our study is to compare the outcomes and effectiveness of MED vs OLD for lumbar disc herniation. OBJECTIVES: To identify the functional outcomes in terms of ODI score, VAS score complications in terms of intraoperative blood loss, use of general anesthesia, and morbidity in terms of total hospital stay between MED and OLD. METHODS: In our randomized prospective study we analyzed 60 patients with clinical signs and symptoms with 2 weeks of failed conservative treatment plus MRI or CT scan findings of lumbar disc herniation who underwent MED and OLD. The study was undertaken from November 2017 to January 2019 at Guangzhou Medical University of Second Affiliated Hospital, department of orthopedic surgery in spinal Unit, Guangzhou, China. Patients were divided into 2 groups i.e. who underwent MED group and the OLD group then we compared the preoperative and postoperative ODI and VAS score, duration of total hospital stay, intraoperative blood loss, and operation time. RESULTS: We evaluated 60 patients. Among them, 30 underwent MED (15 female and 15 male) and 30 underwent OLD 14 male 16 female. Surgical and anesthesia time was significantly shorter, blood loss and hospital stay were significantly reduced in patients having MED than OLD (<0.005). The improvement in the ODI in both groups was clinically significant and statistically (P < .005) at postoperative 1st day (with greater improvement in the MED group), at 6 weeks (P > .005), month 6 (>0.005) statistically no significant. The clinical improvement was similar in both groups. VAS and ODI scores improved significantly postoperatively in both groups. However, the MED group was superior to the OLD group with less time in bed, shorter operation time, less blood loss which is clinically and statistically significant (P < .05). CONCLUSIONS: The standard surgical treatment of lumbar disc herniation has been open discectomy but there has been a trend towards minimally invasive procedures. MED for lumbar spine disc herniation is a well-known but developing field, which is increasingly spreading in the last few years. The success rate of MED is about approximately 90%. Both methods are equally effective in relieving radicular pain. MED was superior in terms of total hospital stay, morbidity, and earlier return to work and anesthetic exposure, blood loss, intra-op time comparing to OLD. MED is a safe and effective alternative to conventional OLD for patients with lumbar disc herniation.


Assuntos
Discotomia/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Microcirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
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