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1.
Chin J Integr Med ; 28(4): 312-318, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34874517

RESUMO

OBJECTIVE: To explore the effect of Shenmai Injection (SMI) on the long-term prognosis of patients with chronic heart failure (CHF). METHODS: The Hospital Information System was used to extract data of CHF patients, and the retrospective cohort study was conducted for analysis. In non-exposed group, standardized Western medicine treatment and Chinese patent medicine or decoction were applied without combination of SMI while in the exposed group, SMI were applied for more than 7 days. Evaluation indicators are followed with New York Heart Association functional classification (NYHA classification), left ventricular ejection fraction (LVEF), N-terminal brain natriuretic peptide precursor (NT-ProBNP), cardiogenic death and heart failure (HF) readmission. Statistical analysis includes Kaplan-Meier analysis and Cox regression which are used to explore the relationship between SMI and outcome events. RESULTS: A total of 1,211 eligible CHF patients were involved and finally 1,047 patients were followed up successfully. After treatment, the cases of NYHA classification decline in the exposed and non-exposed groups accounted for 64.30% and 43.45%, respectively; the improvement values of LVEF were 8.89% and 7.91%, respectively; the improvement values of NT-ProBNP were 909 pg/mL and 735 pg/mL, respectively. After exposure on SMI, the rates of cardiogenic death and HF readmission reduced from 15.43% to 10.18% and 38.93% to 32.37%. According to Kaplan-Meier analysis, the log-rank P value of SMI and cardiogenic death was 0.014, while the counterpart of SMI and HF readmission was 0.025. Cox regression analysis indicated that for cardiogenic death, age, cardiomyopathy, diabetes, and NYHA classification were risk factors while ß-blockers, aldosterone receptor antagonists, Chinese patent medicine/decoction and SMI were protective factors. Likewise, for HF readmission, age, cardiomyopathy, and NYHA classification were risk factors while SMI was a protective factor. CONCLUSION: Combination with SMI on the standardized Western medicine treatment can effectively reduce cardiogenic mortality and readmission rate in CHF patients, and thereby improve the long-term prognosis.


Assuntos
Insuficiência Cardíaca , Função Ventricular Esquerda , Biomarcadores , Combinação de Medicamentos , Medicamentos de Ervas Chinesas , Seguimentos , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Prognóstico , Estudos Retrospectivos , Volume Sistólico
2.
Mil Med Res ; 9(1): 32, 2022 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-35715833

RESUMO

BACKGROUND: Due to the outbreak and rapid spread of coronavirus disease 2019 (COVID-19), more than 160 million patients have become convalescents worldwide to date. Significant alterations have occurred in the gut and oral microbiome and metabonomics of patients with COVID-19. However, it is unknown whether their characteristics return to normal after the 1-year recovery. METHODS: We recruited 35 confirmed patients to provide specimens at discharge and one year later, as well as 160 healthy controls. A total of 497 samples were prospectively collected, including 219 tongue-coating, 129 stool and 149 plasma samples. Tongue-coating and stool samples were subjected to 16S rRNA sequencing, and plasma samples were subjected to untargeted metabolomics testing. RESULTS: The oral and gut microbiome and metabolomics characteristics of the 1-year convalescents were restored to a large extent but did not completely return to normal. In the recovery process, the microbial diversity gradually increased. Butyric acid-producing microbes and Bifidobacterium gradually increased, whereas lipopolysaccharide-producing microbes gradually decreased. In addition, sphingosine-1-phosphate, which is closely related to the inflammatory factor storm of COVID-19, increased significantly during the recovery process. Moreover, the predictive models established based on the microbiome and metabolites of patients at the time of discharge reached high efficacy in predicting their neutralizing antibody levels one year later. CONCLUSIONS: This study is the first to characterize the oral and gut microbiome and metabonomics in 1-year convalescents of COVID-19. The key microbiome and metabolites in the process of recovery were identified, and provided new treatment ideas for accelerating recovery. And the predictive models based on the microbiome and metabolomics afford new insights for predicting the recovery situation which benefited affected individuals and healthcare.


Assuntos
COVID-19 , Microbioma Gastrointestinal , Seguimentos , Humanos , Metabolômica , RNA Ribossômico 16S/genética
3.
Sci Rep ; 12(1): 10763, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35750795

RESUMO

The present study aimed to identify risk factors for visual field progression in newly diagnosed exfoliation glaucoma patients. Prospective nonrandomized cohort study. The study included patients with newly diagnosed exfoliation glaucoma. All patients were followed for at least 3 years with reliable visual fields. Both risk factors at inclusion and during the 3-year follow-up were considered. For inclusion, five reliable visual fields were needed. Exfoliation glaucoma was defined based on the European Glaucoma Society guidelines. Visual field evaluation was performed using the 24-2 strategy of Humphrey field analysis. Outcomes: Visual field progression. Three different approaches were used: mean deviation, visual field index, and guided progression analysis. Independent variables were tested first in a univariate linear or regression model. The significant variables were retested in a multivariate linear or logistic regression model. The results were different for the MD, VFI and GPA models. The only variable that showed a significant association in the three models was age (p = 0.004; p = 0.006; p = 0.04). Significant variables in the two models were IOP at diagnosis (p = 0.02; p = 0.04), IOP reduction in absolute terms (p = 0.006; p = 0.003), IOP reduction in relative terms (%) (p = 0.04; p = 0.009) and number of medicines (p = 0.02; p = 0.002). Significant variables in one model were family history (p = 0.04), smoking (p = 0.03), cataract surgery (p = 0.04) and SLT treatment (p ≤ 0.001). Exfoliation glaucoma is a fast progressive glaucoma. Age at diagnosis must be considered. Significant IOP reduction must be achieved to slow down progress in exfoliation glaucoma. The use of SLT treatment should be advised in exfoliation glaucoma patients.


Assuntos
Síndrome de Exfoliação , Glaucoma , Estudos de Coortes , Progressão da Doença , Síndrome de Exfoliação/diagnóstico , Síndrome de Exfoliação/epidemiologia , Seguimentos , Glaucoma/diagnóstico , Glaucoma/epidemiologia , Humanos , Pressão Intraocular , Estudos Prospectivos , Fatores de Risco , Suécia , Transtornos da Visão/diagnóstico , Testes de Campo Visual , Campos Visuais
4.
BMC Ophthalmol ; 22(1): 280, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35751042

RESUMO

BACKGROUND: To assess the visual and refractive outcomes of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) concurrent with accelerated cross-linking (LASIK Xtra) compared with conventional FS-LASIK (convLASIK) for high myopia in Chinese individuals. METHODS: In this prospective, randomized, fellow-eye comparison study, 25 patients with high myopia were treated randomly with LASIK Xtra in one eye and convLASIK in the other. A 24-month follow-up was conducted, and the main outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE) and corneal tomography. RESULTS: The UDVA was 0.09 ± 0.15 logMAR in the LASIK Xtra group, which was significantly worse than that in the convLASIK group 1 day postoperatively (P = .001), but the difference became nonsignificant from 1 week after surgery. The efficacy index was 0.88 ± 0.18 in the LASIK Xtra eyes and 0.99 ± 0.13 in the convLASIK eyes at 24 months (P = .028). Throughout the follow-up period, a slight myopic shift in the MRSE and keratometry values were observed in both groups without significant intergroup differences. The coefficient of determination was 0.9982 in the LASIK Xtra eyes and 0.9987 in the convLASIK eyes. The corneal density was significantly higher, and demarcation lines were visible in the first 6 months in LASIK Xtra eyes, but both signs of cross-linking gradually disappeared during follow-up. No severe complications were detected in either group. CONCLUSIONS: LASIK Xtra showed comparable safety and predictability with convLASIK for high myopia in Chinese, but lower efficacy and no greater stability was observed up to 24-month follow-up.


Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , China , Seguimentos , Humanos , Lasers de Excimer/uso terapêutico , Miopia/diagnóstico , Estudos Prospectivos , Refração Ocular , Resultado do Tratamento
5.
BMC Psychiatry ; 22(1): 428, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35751076

RESUMO

BACKGROUND: ADHD is common in psychiatric populations. This study aimed to compare clinical characteristics in adults with and without ADHD who presented with self-harm, and to compare later risk of suicidal behaviour within 6 months. METHODS: Eight hundred four adults presented with self-harm (with and without suicidal intent) at psychiatric emergency services at three Swedish hospitals. Persons with a discharge ICD-10 diagnosis F90.0-F90.9 or a prescription for ADHD medication were considered to have ADHD (n = 93). Medical records were reviewed for evidence of subsequent suicide attempts (SA) within 6 months; suicides were identified by national register. RESULTS: Recent relationship problems were more prevalent in the ADHD group. While the index episodes of those with ADHD were more often non-suicidal, and actual SAs more often rated as impulsive, medical lethality at presentation did not differ in attempters with and without ADHD. Subsequent SAs (fatal or non-fatal) were observed in 29% of the ADHD group and 20% in all others (P = .005). A logistic regression model showed elevated risk of suicidal behaviour during follow-up in the ADHD group (OR = 1.70, CI 1.05-2.76), although a final regression model suggested that this association was partly explained by age and comorbid emotionally unstable personality disorder. CONCLUSIONS: Findings highlight the need for clinicians to take self-harm seriously in adults with ADHD.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Comportamento Autodestrutivo , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Seguimentos , Humanos , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/psicologia , Ideação Suicida , Tentativa de Suicídio/psicologia
6.
Alcohol Clin Exp Res ; 46(6): 1050-1061, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35753040

RESUMO

BACKGROUND: Surveys of changes in drinking during the COVID-19 pandemic have primarily relied on retrospective self-report. Further, most such surveys have not included detailed measures of alcohol use patterns, such as beverage-specific consumption, nor measures of alcohol use disorder (AUD) symptoms that would allow a comprehensive understanding of changes in alcohol use. METHODS: Data from 1819 completed interviews from the N14C follow-up survey to the 2019 to 2020 National Alcohol Survey (N14) were conducted between January 30 and March 28, 2021. Questions on alcohol use from the Graduated Frequency series, beverage-specific quantity and frequency, and DSM-5 AUD items were asked in both surveys and used to estimate changes from pre-pandemic drinking to drinking during the pandemic. Analyses focus on changes in these measures over time and comparisons between key subgroups defined by gender, race/ethnicity, and age. RESULTS: Key findings include particularly large increases in drinking and AUD for African Americans and women, reduced drinking and heavy drinking prevalence among men and White respondents, and a concentration of increased drinking and AUD among respondents aged 35 to 49. Increases in alcohol use were found to be driven particularly by increases in drinking frequency and the consumption of spirits. CONCLUSIONS: Results confirm prior findings of overall increases and subgroup-specific changes, and importantly, provide detailed information on the patterns of change across major socio-demographic subgroups. Substantial increases in the prevalence of DSM-5 moderate to severe AUDs are a novel finding that is of particular concern.


Assuntos
Alcoolismo , COVID-19 , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , COVID-19/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pandemias , Estudos Retrospectivos
8.
BJS Open ; 6(3)2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35754193

RESUMO

INTRODUCTION: Phaeochromocytomas are rare tumours with a recurrence after open surgery ranging between 6-23 per cent. Long-term follow-up studies after laparoscopic surgery for phaeochromocytoma are lacking. The aim of this study was to look at the long-term oncological outcome of a consecutive series of patients from a single centre undergoing laparoscopic surgery for a phaeochromocytoma. METHODS: Demographic data on all patients with an adrenal tumour or paraganglioma were prospectively kept on a database between September 1999 and December 2017. Electronic hospital records, including imaging from a national linked archiving and communication system, were reviewed for patients with a phaeochromocytoma in November 2021. RESULTS: During the study interval 135 patients with a phaeochromocytoma were operated on in the unit, of which 118 (87.4 per cent) were attempted laparoscopically. Five (4.2 per cent) were converted to open surgery, whereas 117 had a potentially curative operation. There was no peri- or postoperative mortality. At a median follow-up of 10 (interquartile range 6-12.9) years, only 3 (2.6 per cent) patients died from metastatic phaeochromocytoma. One further patient developed lymph node metastases, which were removed at open surgery. No patient had a local recurrence and the only significant predictor of recurrence was the presence of lymph node metastases (P < 0.001). Two patients developed a contralateral adrenal phaeochromocytoma, while one of these also had a paraganglioma. The Kaplan-Meier estimate of phaeochromocytoma-free survival was 96 per cent (95 per cent c.i. 92.2 to 98.8) at 5 years and 92 per cent (95 per cent c.i. 86.7 to 97.3) at 10 years. CONCLUSION: This study demonstrates that long-term oncological outcomes of laparoscopic surgery for patients with a phaeochromocytoma are at least as good as that with an open operation.


Assuntos
Neoplasias das Glândulas Suprarrenais , Laparoscopia , Paraganglioma , Feocromocitoma , Neoplasias das Glândulas Suprarrenais/cirurgia , Seguimentos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Metástase Linfática , Paraganglioma/cirurgia , Feocromocitoma/cirurgia
9.
Front Immunol ; 13: 918896, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35757764

RESUMO

Background: Effective and safe vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are critical to controlling the COVID-19 pandemic and will remain the most important tool in limiting the spread of the virus long after the pandemic is over. Methods: We bring pioneering contributions on the maintenance of the immune response over a year on a real-life basis study in 1,587 individuals (18-90 yrs, median 39 yrs; 1,208 female/379 male) who underwent vaccination with two doses of CoronaVac and BNT162b2 booster after 6-months of primary protocol. Findings: Elevated levels of anti-spike IgG antibodies were detected after CoronaVac vaccination, which significantly decreased after 80 days and remained stable until the introduction of the booster dose. Heterologous booster restored antibody titers up to-1·7-fold, changing overall seropositivity to 96%. Titers of neutralising antibodies to the Omicron variant were lower in all timepoints than those against Delta variant. Individuals presenting neutralising antibodies against Omicron also presented the highest titers against Delta and anti-Spike IgG. Cellular immune response measurement pointed out a mixed immune profile with a robust release of chemokines, cytokines, and growth factors on the first month after CoronaVac vaccination followed by a gradual reduction over time and no increase after the booster dose. A stronger interaction between those mediators was noted over time. Prior exposure to the virus leaded to a more robust cellular immune response and a rise in antibody levels 60 days post CoronaVac than in individuals with no previous COVID-19. Both vaccines were safe and well tolerated among individuals. Interpretation: Our data approach the effectiveness of CoronaVac association with BNT162b2 from the clinical and biological perspectives, aspects that have important implications for informing decisions about vaccine boosters. Funding: Fiocruz, Brazil.


Assuntos
COVID-19 , Vacinas , Anticorpos Neutralizantes , Brasil , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Ensaios Clínicos Fase IV como Assunto , Feminino , Seguimentos , Humanos , Imunoglobulina G , Masculino , Pandemias , SARS-CoV-2
10.
Medicine (Baltimore) ; 101(25): e29234, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35758350

RESUMO

ABSTRACT: Whether a fish-rich diet is positively associated with cognitive function after stroke remains unclear; thus, the present study investigated the relationship between them.The present study was part of a prospective multicenter study, in which 920 individuals (609 males, mean age, 62.78 ±â€Š11.79 years) were included from November 2013 to December 2015. The cognitive function of the patients was evaluated, and the diagnosis of poststroke cognitive impairment (PSCI) was made during their stay in the hospital. A subgroup of 439 patients from a single center was followed up for 4 to 6 years and was reassessed for cognitive function.According to the diagnostic criteria, the PSCI prevalence was lower in the fish-rich diet group (P < .05). After adjusting for demographic and clinical variables by logistic regression, patients with a habit of consuming a fish-rich diet had a lower risk of developing PSCI than patients without a fish-rich diet (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.46-0.95). When MMSE score was considered the cognitive function outcome variable, the long-term cognitive function of the fish-rich diet group was better (28 [26-30] vs 27 [25-29], P < .01), but the statistical results were not significant after correcting for the related confounding factors (ß: 0.13; 95% CI: -0.99-1.25; P = .82).There was a negative relationship between consuming a fish-rich diet and the prevalence of PSCI, and there was no statistically significant difference in the relationship of a fish-rich diet on long-term cognitive function after stroke, which requires further study.


Assuntos
Disfunção Cognitiva , Acidente Vascular Cerebral , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Estudos Transversais , Dieta , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia
11.
Artigo em Inglês | MEDLINE | ID: mdl-35682506

RESUMO

Background: Dietary habits, food intake and oral health are important factors for general health. The aim of these present study was to assess the association between implant-supported fixed oral rehabilitation and glycemia, by monitoring HbA1c values before and after implant-supported prostheses (ISP) delivery to diabetic individuals. Methods: Retrospective, cohort study based on dental records. All treatments were performed by experienced oral and maxillofacial surgeons and experienced prosthodontists. Inclusion criteria: ISP delivery, diagnosis of diabetes in the medical files, consecutive individuals. Variables included-primary outcome-differences (delta) in HbA1c values prior to implant placement and one year after ISP delivery, early implant failure (EIF). Confounding factors included age, gender, physical status, smoking, implant jaw location, implant length, implant width, total implant count per individual. Results: Statistically significant (p < 0.01) decrease in HbA1c from 7.10 ± 1.09% to 6.66 ± 1.02% following ISP delivery was recorded. The mean HbA1c delta was 0.44 ± 0.73%, where 39.0% of the patients had a significant improvement (delta decrease > 0.5%). Univariate and multivariate model using logistic regression at individual level showed that initial high HbA1c levels was the only factor positively predicting improvement (OR = 1.96, CI [1.22, 3.14], p < 0.01). Univariate model at implant level demonstrated that implants placed in the anterior maxilla also contributed to significant improvement in HbA1c values. Multivariate analysis at implant level was similar to individual level. Number of missing teeth did not affect the results significantly. Conclusion: ISP delivery to partially or completely edentulous diabetic individuals may improve HbA1c balance. The mechanism awaits future elucidation.


Assuntos
Arcada Edêntula , Estudos de Coortes , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Seguimentos , Hemoglobina A Glicada , Controle Glicêmico , Humanos , Arcada Edêntula/reabilitação , Arcada Edêntula/cirurgia , Próteses e Implantes , Estudos Retrospectivos , Resultado do Tratamento
12.
Eur Rev Med Pharmacol Sci ; 26(11): 4123-4130, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35731085

RESUMO

OBJECTIVE: There are studies discussing the lung CT abnormalities persisting 3-4 months after COVID-19 pneumonia. Very few studies have evaluated the radiological changes in longer perspective, especially in patients with a severe form of the disease. The aim of our study was to show and qualify the persistent CT changes and to evaluate the dynamics of their evolution in convalescent patients after discharge from hospital post moderate and severe COVID-19 pneumonia. PATIENTS AND METHODS: We retrospectively analyzed the lung involvement at acute phase and follow-up time of 6 months in 6 patients with COVID-19 pneumonia using high resolution computer tomography. RESULTS: Radiological changes in the course of SARS-CoV-2 infection persisted in all patients 6 months after the first CT examination. CONCLUSIONS: Our study confirms that the period of 3 months is too short for the follow-up CT examination in patients recovered after severe or moderate COVID-19 pneumonia.


Assuntos
COVID-19 , COVID-19/diagnóstico por imagem , Seguimentos , Humanos , Pulmão/diagnóstico por imagem , Alta do Paciente , Estudos Retrospectivos , SARS-CoV-2 , Tomografia Computadorizada por Raios X/métodos
13.
Diving Hyperb Med ; 52(2): 78-84, 2022 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-35732278

RESUMO

INTRODUCTION: Technical diving is increasing in popularity in Finland, and therefore the number of decompression illness (DCI) cases is also increasing among technical divers. Although hyperbaric oxygen treatment (HBOT) remains the standard of care, there are anecdotal reports of technical divers treating mild DCI symptoms themselves and not seeking a medical evaluation and possible recompression therapy. This study aimed to make an epidemiologic inventory of technical diving-related DCI symptoms, to establish the incidence of self-treatment and to determine the apparent effectiveness of different treatment methods. METHODS: A one-year prospective survey with online questionnaires was conducted. Fifty-five experienced and highly trained Finnish technical divers answered the survey and reported their diving activity, DCI symptoms, symptom treatment, and treatment outcome. RESULTS: Of the reported 2,983 dives, 27 resulted in symptoms of DCI, which yielded an incidence of 91 per 10,000 dives in this study. All of the reported DCI symptoms were mild, and only one diver received HBOT. The most common self-treatments were oral hydration and rest. First aid oxygen (FAO2) was used in 21% of cases. Eventually, none of the divers had residual symptoms. CONCLUSIONS: The incidence of self-treated DCI cases was 27 times higher than that of HBO-treated DCI cases. There is a need to improve divers' awareness of the importance of FAO2 and other recommended first aid procedures and to encourage divers to seek medical attention in case of suspected DCI.


Assuntos
Doença da Descompressão , Mergulho , Descompressão/efeitos adversos , Doença da Descompressão/epidemiologia , Doença da Descompressão/etiologia , Doença da Descompressão/terapia , Mergulho/efeitos adversos , Finlândia/epidemiologia , Seguimentos , Humanos , Incidência , Estudos Prospectivos
14.
Artigo em Inglês | MEDLINE | ID: mdl-35732338

RESUMO

OBJECTIVE: Women suffering from mental health problems require varied needs of mental health service utilisation. Transition between general practitioner and mental health services use are available through the Better Access Scheme initiative, for those in need of treatment. The study's aim was to identify trajectories of mental health service utilisation by Australian women. DESIGN: The Australian Longitudinal Study on Women's Health data linked to the administrative medical claims dataset were used to identify subgroups of women profiled by their mental health service use from 2006 to 2013. Latent growth mixture model is a statistical method to profile subgroups of individuals based on their responses to a set of observed variables allowing for changes over time. Latent class groups were identified, and used to examine predisposing factors associated with patterns of mental health service use change over time. SETTING: This study was conducted in Australia. PARTICIPANTS: National representative sample of women of born in 1973-1978, who were aged between 28 and 33 years at the start of our study period. RESULTS: Six latent class trajectories of women's mental health service use were identified over the period 2006-2013. Approximately, one-quarter of the sample were classified as the most recent users, while approximate equal proportions were identified as either early users, late/low user or late-high users. Additional, subgroups were defined as the consistent-reduced user and the late-high users, over time. Only 7.2% of the sample was classified as consistent high users who potentially used the services each year. CONCLUSION: These findings suggest that use of the Better Access Scheme mental health services through primary care was varied over time and may be tailored to each individual's needs for the treatment of depressive symptoms.


Assuntos
Saúde Mental , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Austrália , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade
15.
Sci Rep ; 12(1): 10512, 2022 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-35732687

RESUMO

To assess association between migraines and development of ocular motor cranial nerve palsy (CNP) and finding risk factors using the National Sample Cohort database from the Korea National Health Insurance Service. Data was analyzed from 4,234,341 medical screening examinees aged 20-90 years in 2009. Cox proportional hazard regression analysis was used to the adjusted hazard ratios (HR) for ocular motor CNP according to presence of migraine. Subgroup analysis was performed to evaluate effect of other factors on association of migraine with ocular motor CNP. A total of 5806 participants (0.14% of subjects) developed ocular motor CNP and were assigned to CNP group, 4,048,018 were assigned to control group, with an average of 8.22 ± 0.93 years of follow-up. Incidence of ocular motor CNP increased in migraine group compared to control. After adjusting potential confounding variables, HR for ocular motor CNP was 1.166 (confidence interval [CI] 1.013-1.343) in migraine group. Subgroups of relatively younger age less than 65 years (HR = 1.267, 95% CI 1.067-1.504), male gender (HR = 1.228, 95% CI 1.000-1.122), smokers (HR 1.426, 95% CI 1.127-1.803), and diabetes mellitus patients (HR = 1.378, 95% CI 1.045-1.378) showed a stronger association between migraines and development of ocular motor CNP. Our population-based cohort study demonstrated a significant association between presence of migraines and incidence of ocular motor CNP. Especially, relatively younger age, males, smokers, and diabetes patients with migraines could have a higher risk of developing ocular motor CNP.


Assuntos
Doenças dos Nervos Cranianos , Diabetes Mellitus , Transtornos de Enxaqueca , Estudos de Coortes , Doenças dos Nervos Cranianos/complicações , Seguimentos , Humanos , Incidência , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/epidemiologia , Fatores de Risco
16.
Sci Rep ; 12(1): 10551, 2022 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-35732790

RESUMO

Primary mediastinal B-cell lymphoma (PMBL) is currently curable in 85-95% of patients. Treatment regimens frequently used include RCHOP ± radiotherapy, DAEPOCH-R, or occasionally more intensive protocols. Here we present results of treatment of 124 patients with PMBL over a period between 2004 and 2017 with the use of a protocol designed for aggressive B-cell lymphoma GMALL/B-ALL/NHL2002 including 6 cycles of alternating immunochemotherapy with intermediate-dose methotrexate in each cycle, and reduced total doxorubicin dose (100 mg/m2 for whole treatment). Majority of patients (77%) received consolidative radiotherapy. A median (range) age of patients was 30 (18-59) years, and 60% were female. With a median (range) follow up of 9 (1-17) years, 5-year overall survival (OS) and 5-year progression free survival (PFS) were 94% and 92%, respectively. Positron emission tomography-computed tomography (PET-CT) results at the end of chemotherapy were predictive for outcome: OS and PFS at 5 year were 96% and 94% in PET-CT negative patients, respectively, and 70% and 70% in PET-CT-positive patients (p = 0.004 for OS, p = 0.01 for PFS). Eight (6%) patients had recurrent/refractory disease, however, no central nervous system (CNS) relapse was observed. Acute toxicity included pancytopenia grade 3/4, neutropenic fever, and treatment related mortality rate of 0.8%. Second malignancies and late cardiotoxicity occurred in 2.4% and 2.4% of patients, respectively. Intensive alternating immunochemotherapy protocol GMALL/B-ALL/NHL2002 is curative for more than 90% of PMBL patients and late toxicity in young patients is moderated. The attenuated dose of doxorubicin and intermediate dose of methotrexate may contribute to low incidence of late cardiotoxicity and effective CNS prophylaxis.


Assuntos
Linfoma de Células B , Linfoma Difuso de Grandes Células B , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cardiotoxicidade/etiologia , Ciclofosfamida/uso terapêutico , Doxorrubicina/efeitos adversos , Feminino , Seguimentos , Humanos , Linfoma de Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Rituximab/uso terapêutico , Vincristina/uso terapêutico
17.
BMC Musculoskelet Disord ; 23(1): 600, 2022 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-35733205

RESUMO

BACKGROUND: Patellofemoral OA is a strong risk factor for progression to generalized whole knee OA, but it is unknown whether involvement of the patellofemoral joint in early radiographic OA (ROA) is associated with risk of undergoing future knee arthroplasty. This is clinically relevant because patellofemoral OA likely requires a different treatment approach than tibiofemoral OA, and identifying prognostic factors for future arthroplasty might assist clinicians with prioritizing and guiding early interventions that could improve long-term outcomes. Therefore, we evaluated association of baseline patellofemoral or tibiofemoral ROA with undergoing knee arthroplasty over 10 years. METHODS: Using the multicenter Cohort Hip and Cohort Knee (CHECK) study, we acquired three views of radiographs in both knees of individuals aged 45-65 years with complaints of knee symptoms in at least one knee. From baseline radiographs, we categorized each knee as having one of four patterns of ROA: no ROA, isolated patellofemoral ROA, isolated tibiofemoral ROA, or combined ROA. We evaluated the 10-year relative hazard for undergoing going arthroplasty, based on baseline ROA pattern, using Cox proportional hazard models, adjusting for age, sex body mass index, and pain severity. RESULT: Our sample (n = 842) included 671 (80%) women and had mean (SD) age 56 (5) years, and BMI 26.3 (4.0) kg/m2. Arthroplasties were undertaken in 44/1678 knees. In comparison to having no ROA at baseline, adjusted hazard ratios (aHR) for arthroplasty were highest for combined ROA (aHR 14.2 [95% CI 5.8, 34.6]) and isolated patellofemoral ROA (aHR 12.7 [5.6, 29.0]). Isolated tibiofemoral ROA was not significantly associated with arthroplasty (aHR 2.9 [0.6, 13.6]). CONCLUSIONS: In a sample of middle-aged individuals with complaints in one or both knees, the 10-year relative hazard for undergoing arthroplasty, compared to no ROA, was increased when OA involved the patellofemoral joint, regardless of whether it was isolated to the patellofemoral joint or occurred in combination with tibiofemoral OA. Further research is needed to confirm this association and to clarify the causal mechanism of this relationship. However, our results provide preliminary evidence that identifying patellofemoral ROA may be a clinically useful prognostic indicator in early knee OA.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Articulação Patelofemoral , Artroplastia do Joelho/efeitos adversos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia
18.
BMC Musculoskelet Disord ; 23(1): 602, 2022 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-35733210

RESUMO

BACKGROUND: To evaluate the incidence and risk factors of postoperative distal adding-on in patients with Lenke 5C adolescent idiopathic scoliosis (AIS). More accurate selection criteria for the lower instrumented vertebra (LIV) should be confirmed to prevent distal adding-on. METHODS: Forty-six patients with Lenke 5C AIS who underwent posterior fusion were enrolled in the study. Patients were allocated into adding-on and no adding-on groups. Demographic data, clinical data, and radiographic parameters were recorded and compared. RESULTS: Postoperative distal adding-on occurred in eight patients (17.4%) during follow-up. Demographic data, clinical data, and baseline radiographic parameters of the two groups were not significantly different. The postoperative thoracolumbar (TL) or lumbar (L) Cobb angle, LIV translation, and LIV + 1 translation were higher in the adding-on group than those in the no adding-on group, while the postoperative coronal imbalance of the adding-on group was lower than that of the no adding-on group. The level difference of last barely touched vertebra (LBTV) and last substantial touched vertebra (LSTV) with LIV were higher in the adding-on group than in the no adding-on group. CONCLUSION: Postoperative TL/L curve, postoperative LIV translation, postoperative LIV + 1 translation, and postoperative coronal imbalance were determined as risk factors for postoperative distal adding-on in patients with Lenke 5C AIS. Moreover, LIV selection of LBTV-1 or LSTV-1 may cause a higher risk of postoperative distal adding-on.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Adolescente , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento
19.
Pathol Oncol Res ; 28: 1610391, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35721327

RESUMO

Follow-up includes ongoing contact with and health education of the patient, surveillance and control of the adverse effects of surgery, oncological therapies or radiotherapy, screening of metachronous cancers, and comprehensive (physical, psychological and social) patient rehabilitation, which may be enhanced by a healthy lifestyle. Primary attention should be paid to early detection and, when needed, curative treatment of local/regional tumour recurrences. Similarly, with the hope of curative solution, it is important to recognize the entity of a low-mass and relatively indolent recurrence or metastasis (oligometastasis); however, there is still no need to investigate distant metastases by routine diagnostic imaging or assess tumour markers. Below there is a list of possible sources of support, with respect to adjuvant hormone therapy continued during long-term care, social support resources, pivotal points and professional opportunities for physical and mental rehabilitation. Individual solutions for specific issues (breast cancer risk/genetic mutation, pregnancy) are provided by constantly widening options. Ideally, a complex breast cancer survivorship programme is practised by a specially trained expert supported by a cooperative team of oncologists, surgeons, breast radiologists, social workers, physiotherapists, psycho-oncologists and psychiatrists. The approach of follow-up should be comprehensive and holistic.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Reabilitação Psiquiátrica , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Feminino , Seguimentos , Humanos , Oncologia , Recidiva Local de Neoplasia/diagnóstico
20.
Retina ; 42(7): 1330-1337, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35723921

RESUMO

PURPOSE: To compare between oral and intravenous (IV) ultrawide-field fluorescein angiography in pediatric patients with a history of prematurity of retinopathy or prematurity. METHODS: Pediatric patients (<18 year old; n = 107 patients) who underwent ultrawide-field fluorescein angiography for retinopathy of prematurity were categorized into oral and IV fluorescein angiography (FA) groups. Quality of FA images was graded on the order of retinal vessels visible. Reported outcomes were proportions of graded FA images, peak fluorescein intensity, and the time to first dye appearance and to reach peak fluorescence. RESULTS: Image quality analysis revealed that 91.5% of IV FA images had excellent image quality compared with only 55.6% of oral FA images (P < 0.01). There were still 83.3% of oral-contrast images with good or excellent image quality. The average time required for first dye appearance and peak fluorescence were significantly shorter in the IV FA group than in the oral FA group (P < 0.01). Peak intensity was greater in the IV group (141.41 ± 29.09) than in the oral group (111.25 ± 45.68; P < 0.01). Adverse reaction rates were similar between the two groups (P = 0.22). CONCLUSION: Ultrawide-field fluorescein angiography provides excellent-quality imaging of the retina in the pediatric population. Overall, oral FA is still an effective and useful alternative to IV FA in children with prematurity history.


Assuntos
Retinopatia da Prematuridade , Adolescente , Criança , Fluoresceína , Angiofluoresceinografia/métodos , Seguimentos , Humanos , Recém-Nascido , Vasos Retinianos , Retinopatia da Prematuridade/diagnóstico
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