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INTRODUCTION: We have previously reported that genetically positive patients have a more profound early decrease in provocable left ventricular outflow tract gradient compared to genetically negative patients utilizing mavacamten in the first 12 weeks of therapy. METHODS AND RESULTS: In this current analysis, we found that genetically positive patients have less favorable remodeling as measured by left ventricular wall thickness regression when evaluated long-term as compared to genetically negative patients, despite an overall better early response to mavacamten. The majority of genetically positive patients were maintained on only 2.5 mg of mavacamten due to early robust response. CONCLUSION: We hypothesize that this lower dosing attenuated the long-term benefit of mavacamten in genetically positive patients. We believe that the long-term benefit of mavacamten on positive cardiac remodeling is dose-dependent and not solely related to the magnitude of left ventricular outflow gradient decrease.
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Remodelación Ventricular , Humanos , Remodelación Ventricular/efectos de los fármacos , Remodelación Ventricular/genética , Masculino , Femenino , Estudios de Seguimiento , Persona de Mediana Edad , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Resultado del Tratamiento , Factores de Tiempo , Bencilaminas , Uracilo/análogos & derivadosRESUMEN
OBJECTIVE: The aim of this study was to assess right atrial (RA) function, including RA phase strain, via speckle-tracking echocardiography (STE) in a cohort of systemic lupus erythematosus (SLE) patients with pulmonary arterial hypertension (PAH) and in particular to explore the relationship between RA phase strain and the occurrence of cardiovascular events. METHODS: STE analyses of RA function were evaluated in patients with SLE-PAH and in 33 healthy control subjects. Clinical associations, serum biomarkers, echocardiographic data, survival times, and adverse cardiovascular events were evaluated. RESULTS: A total of 66 patients with SLE-PAH were enrolled; they were divided into two groups based on the occurrence of adverse clinical events. RA phase strain was significantly reduced in patients with events than in patients without events. The endpoint was defined as the combined outcome of all-cause mortality, right heart failure, and rehospitalization due to disease progression. During a mean follow-up of 17.2 ± 9.9 months, 23 patients (35%) reached the endpoint. Compared with patients with RA reservoir strain (RASr) ≥33.45%, patients with RASr < 33.45% had more adverse long-term outcomes (log rank p < .0001). RASr was independently associated with adverse clinical outcomes according to multivariate analysis (p = .010). CONCLUSION: Our data suggest that RA function has prognostic value for SLE-PAH patients, and strain analysis revealed that the worse the RA function is, the worse the prognosis.
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Ecocardiografía , Atrios Cardíacos , Lupus Eritematoso Sistémico , Humanos , Femenino , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/fisiopatología , Masculino , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Pronóstico , Ecocardiografía/métodos , Persona de Mediana Edad , Adulto , Hipertensión Arterial Pulmonar/fisiopatología , Hipertensión Arterial Pulmonar/complicaciones , Hipertensión Arterial Pulmonar/etiología , Hipertensión Arterial Pulmonar/sangre , Función del Atrio Derecho/fisiología , Hipertensión Pulmonar/fisiopatología , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/etiología , Estudios de SeguimientoRESUMEN
INTRODUCTION: Sarcopenia is common in children after liver transplantation (LTx). Resistance training (RT) may be effective in combating sarcopenia. OBJECTIVES: The purpose of the study was to test the feasibility and impact of a 12-week RT program on skeletal muscle mass (SMM), muscle strength, physical performance (PP), and child-parent perspectives about RT. METHODS: Children (6-18 years) post-LTx and healthy controls (HC) underwent progressive RT using resistance bands. SMM and adipose tissue (MRI: abdomen and thigh), muscle strength (handgrip, push-ups, sit-to-stand), and PP (6-minute walk test [6MWT], timed-up-and-down-stair test [TUDS]) were measured before and after 12-weeks of RT. RESULTS: Ten children post-LTx (11.9 ± 3.5 years) and 13 HC (11.7 ± 3.9 years) participated. LTx children significantly increased abdominal SM-index (+4.6% LTx vs. a -2.7% HC; p = 0.01) and decreased visceral adipose tissue-index (-18% LTx vs. -0.8% HC; p = 0.04) compared to HC. No thigh SMI changes were noted. Significant increases in 6MWT distance (LTx; p = 0.04), number of push-ups (p = 0.04), and greater reduction times for TUDS (-10.6% vs. +1.7%; p = 0.05) occurred after 12 weeks. Higher thigh muscle-fat content was associated with worse physical performance. These results were impacted by adherence (≥75% vs. <75%) and family engagement. CONCLUSIONS: RT in children post-LTx is feasible and effective. RT in children post-LTx may alleviate adverse outcomes associated with sarcopenia.
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Trasplante de Hígado , Fuerza Muscular , Entrenamiento de Fuerza , Sarcopenia , Humanos , Masculino , Trasplante de Hígado/efectos adversos , Proyectos Piloto , Sarcopenia/etiología , Niño , Femenino , Adolescente , Pronóstico , Estudios de Casos y Controles , Estudios de Seguimiento , Entrenamiento de Fuerza/métodos , Músculo Esquelético/fisiopatología , Complicaciones Posoperatorias , Servicios de Atención de Salud a DomicilioAsunto(s)
Vacuna BCG , Neoplasias de la Vejiga Urinaria , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Humanos , Vacuna BCG/administración & dosificación , Vacuna BCG/uso terapéutico , Administración Intravesical , Estudios de Seguimiento , Invasividad Neoplásica , Adyuvantes Inmunológicos/administración & dosificación , Adyuvantes Inmunológicos/uso terapéutico , Resultado del TratamientoRESUMEN
PURPOSE: To compare the postoperative outcomes following implantation of KERATACx ring segments (Imperial Medical Technologies Europe GmbH) in patients having eccentric keratoconus with three different topographic patterns. METHODS: This retrospective cohort study was conducted at Maadi Eye Subspeciality Center, Cairo, Egypt. The study included patients with keratoconus who had implantation of KERATACx ring segments. Three groups were segregated based on topographic keratoconus patterns using the Sirius CSO Topographer (CSO Italia): type I ectasia where the cone coincides with the corneal flat axis, type II ectasia in which the cone coincides with neither the steep nor the flat axis and lies between the two axes, and type II ectasia for cones coinciding with the corneal steep axis. The visual and topographic outcomes were compared preoperatively and postoperatively for the three enrolled groups. RESULTS: This study enrolled 92 eyes of 92 patients and had a mean ± standard deviation follow-up of 16.9 ± 9.2 months. The patients' medical records revealed that night vision complaints and halos around the light were experienced the most by the type III ectasia group (31.25%). For the type III ectasia group, four topographic indices and one visual parameter did not show statistically significant differences between the preoperative and postoperative data (inferior-superior difference at 2- and 4-mm diameter, coma aberration, higher order aberrations, and uncorrected distance visual acuity), contrary to the type I and II ectasia groups, which showed significant improvements in all evaluated parameters. CONCLUSIONS: The type III morphological pattern of ectasia is the least likely to benefit from KERATACx ring segments implantation. [J Refract Surg. 2024;40(9):e625-e634.].
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Sustancia Propia , Topografía de la Córnea , Queratocono , Prótesis e Implantes , Implantación de Prótesis , Agudeza Visual , Humanos , Queratocono/cirugía , Queratocono/fisiopatología , Estudios Retrospectivos , Agudeza Visual/fisiología , Masculino , Femenino , Sustancia Propia/cirugía , Sustancia Propia/patología , Adulto , Adulto Joven , Estudios de Seguimiento , Refracción Ocular/fisiología , Adolescente , Resultado del Tratamiento , Periodo PosoperatorioRESUMEN
PURPOSE: To report 12-month visual and refractive outcomes following topography-guided femtosecond laser-assisted laser in situ keratomileusis (LASIK) for myopia and compound myopic astigmatism correction. METHODS: This prospective, single-center observational study was conducted in an outpatient clinical practice at the Stanford University Byers Eye Institute in Palo Alto, California. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, 5% and 25% contrast sensitivity CDVA, and manifest refraction following topography-guided femtosecond laser-assisted LASIK were assessed. Refractive measurements were used to perform a vector analysis. RESULTS: Sixty eyes of 30 patients (mean age: 32.8 ± 7.0 years; range: 23 to 52 years) undergoing topography-guided LASIK for the correction of myopia and compound myopic astigmatism were analyzed. Mean postoperative UDVA was -0.09 ± 0.10 logarithm of the minimum angle of resolution (logMAR) at 12 months. Mean preoperative CDVA was -0.09 ± 0.09 and -0.13 ± 0.08 logMAR at postoperative 12 months. At 12 months, 26.9% of eyes had gained one or more lines of postoperative UDVA compared to baseline CDVA. Mean pre-operative 5% contrast sensitivity CDVA was 0.68 ± 0.07 and 0.64 ± 0.12 logMAR at 12 months (P = .014) following LASIK. CONCLUSIONS: Topography-guided LASIK for myopia and myopic astigmatism correction provided excellent visual and refractive outcomes that were predictable, precise, and stable up to 12 months postoperatively. [J Refract Surg. 2024;40(9):e595-e603.].
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Astigmatismo , Topografía de la Córnea , Queratomileusis por Láser In Situ , Láseres de Excímeros , Miopía , Refracción Ocular , Cirugía Asistida por Computador , Agudeza Visual , Humanos , Queratomileusis por Láser In Situ/métodos , Agudeza Visual/fisiología , Astigmatismo/cirugía , Astigmatismo/fisiopatología , Estudios Prospectivos , Miopía/cirugía , Miopía/fisiopatología , Refracción Ocular/fisiología , Adulto , Masculino , Femenino , Adulto Joven , Láseres de Excímeros/uso terapéutico , Persona de Mediana Edad , Cirugía Asistida por Computador/métodos , Sensibilidad de Contraste/fisiología , Resultado del Tratamiento , Estudios de SeguimientoRESUMEN
BACKGROUND: Hemodialysis requires reliable, recurrent access to the circulatory system. Central venous tunneled dialysis catheters (TDC) are frequently used for patients receiving hemodialysis as a bridge to permanent vascular access or as a final option. TDC are prone to complications such as infection and dysfunction. OBJECTIVES: To assess the prevalence and predictors of TDC dysfunction in a cohort of chronic hemodialysis patients. METHODS: This single-center, retrospective study was based on data from an electronic database of chronic hemodialysis patients during 5 years of follow-up. RESULTS: A total of 625 TDC were inserted in 361 patients, of which 234 (37.4%) were replaced due to dysfunction. The main insertion site was the right internal jugular vein. Diabetes mellitus was an important predictor of TDC dysfunction and was significantly correlated with TDC extraction. Chronic anticoagulation and antiplatelet treatment did not affect the rate of TDC dysfunction or replacement. CONCLUSIONS: TDC use for chronic dialysis patients is increasing and dysfunction is a major problem. In our study, we highlighted the high prevalence of TDC dysfunction and the need for further research to improve hemodialysis access as well as TDC patency and function.
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Cateterismo Venoso Central , Catéteres de Permanencia , Diálisis Renal , Humanos , Diálisis Renal/métodos , Diálisis Renal/efectos adversos , Estudios Retrospectivos , Masculino , Femenino , Prevalencia , Persona de Mediana Edad , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/métodos , Catéteres de Permanencia/efectos adversos , Anciano , Venas Yugulares , Catéteres Venosos Centrales/efectos adversos , Falla de Equipo/estadística & datos numéricos , Factores de Riesgo , Fallo Renal Crónico/terapia , Fallo Renal Crónico/epidemiología , Israel/epidemiología , Estudios de SeguimientoRESUMEN
Deceased donor organs for transplantation are costly. Expenses include donor assessment, pre-operative care of acceptable donors, surgical organ recovery, preservation and transport, and other costs. US Organ Procurement Organizations (OPOs) serve defined geographic areas in which each OPO has exclusive organ recovery responsibilities including detailed reporting of costs. We sought to determine the costs of procuring deceased donor livers by examining reported organ acquisition costs from OPO cost reports. Using 6 years of US OPO cost report data for each OPO (2013-2018), we determined the average cost of recovering a viable (i.e., transplanted) liver for each of the 51 independent US OPOs. We examined predictors of these costs including the number of livers procured, the percent of nonviable livers, direct procurement costs, coordinator salaries, professional education, and local cost of living. A cost curve estimated the relationship between the cost of livers and the number of locally procured livers. The average cost of procured livers by individual OPO-year varied widely from $11 393 to $65 556 (average $31 659) over the six study years. An increase in the overall number of procured livers was associated with lower direct costs, administrative, and procurement overhead costs, but this association differed for imported livers. Cost per local liver decreased linearly for each additional liver, while importing more livers was only cost saving until 200 livers, with imported livers costing more ($39K vs. $31.7K). The largest predictor of variation in cost was the aggregate of direct costs (e.g., hospital costs) to recover the organ (57%). Cost increases were 2.5% per year (+$766/year). This information may be valuable in determining how OPOs might improve service to transplant centers and the patients they serve.
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Trasplante de Hígado , Donantes de Tejidos , Obtención de Tejidos y Órganos , Humanos , Obtención de Tejidos y Órganos/economía , Trasplante de Hígado/economía , Donantes de Tejidos/provisión & distribución , Estados Unidos , Costos de la Atención en Salud/estadística & datos numéricos , Pronóstico , Masculino , Estudios de SeguimientoRESUMEN
PURPOSE: To describe our experience over 6 years using a new high-density polyethylene-based spherical integrated porous orbital implants (Oculfit). METHODS: This is an observational retrospective case series study analyzing all cases requiring Oculfit implants between February 2015 and September 2021. Clinical information regarding the population included, the characteristics of the implant, and the outcomes and complications during the follow-up were noted. The success of the implant was defined according to anatomical and functional parameters. RESULTS: The study analyzed 90 cases of anophthalmic patients. The main causes for enucleation or evisceration were ocular decompensations (36.7%) and neoplasms (27.8% uveal melanoma and 7.8% retinoblastoma). Anatomical success was identified in 63 (70.0%) cases, functional success in 79 (87.8%) and complete success (anatomical + functional) in 61 (67.7%) cases. Factors associated with the functional success were age and exposure of the primary orbital implant. Complications appeared in 11 (12.2%) cases, which were completely resolved without sequelae in 4 (4.4%). Orbital explant was required in 5 (5.6%) cases. CONCLUSION: In our experience, Oculfit can be considered a useful alternative among the currently available options for orbital implants and has a good efficacy/safety profile.
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Implantes Orbitales , Polietileno , Humanos , Implantes Orbitales/efectos adversos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adulto , Niño , Adolescente , Preescolar , Porosidad , Adulto Joven , Diseño de Prótesis , Anciano de 80 o más Años , Complicaciones Posoperatorias/epidemiología , Enucleación del Ojo , Estudios de Seguimiento , Resultado del Tratamiento , Evisceración del Ojo , Implantación de Prótesis/métodos , Implantación de Prótesis/efectos adversosRESUMEN
PURPOSE: To evaluate radiographic lacrimal gland (LG) volume and dimensions in Ahmed glaucoma valve (AGV)- versus trabeculectomy-treated eyes and contralateral non-treated eyes. METHODS: In this retrospective cohort study, 1616 medical records acquired between 2010 and 2020 were examined. In AGV-treated (group 1) eyes, there were 19 patients with records sufficient for radiological LG evaluation, and in trabeculectomy-treated (group 2) eyes, there were 18. The hospital workstation software was used to assess high-resolution computed tomography (HRCT) scans conducted under standard protocol using a 128 SL Optima CT 660 scanner. The software (Vitrea™) was used to perform semi-quantitative volumetric measurements. LG dimensions were obtained in the axial and reformatted coronal planes on each side, and four measures were generated using the widest LG tip-to-tip diameters in two planes: coronal length, coronal width (CW), axial length (AL), and axial width. RESULTS: The time interval between surgery and HRCT imaging was 50.97 ± 26.25 months. Group 1 had significantly lower LG volume than group 2 (594.11 ± 259.45 vs. 933.67 ± 294.09 mm3, P = 0.001). When compared to non-treated eyes, AGV-treated eyes had lower LG volume (P = 0.065) while trabeculectomy-treated eyes had higher LG volume (P = 0.031). Further, group 1 had decreased length and width in both the axial and coronal planes as compared to group 2, with AL and CW being significantly different (P < 0.05). CONCLUSIONS: AGV and trabeculectomy had varied impacts on LG volume and dimensions despite being conducted in the same quadrant. HRCT appears to be effective in analysing AGV position, which may be related to LG volumetric and dimensional issues.
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Implantes de Drenaje de Glaucoma , Glaucoma , Presión Intraocular , Aparato Lagrimal , Trabeculectomía , Humanos , Estudios Retrospectivos , Trabeculectomía/métodos , Masculino , Femenino , Persona de Mediana Edad , Glaucoma/cirugía , Glaucoma/fisiopatología , Anciano , Presión Intraocular/fisiología , Aparato Lagrimal/diagnóstico por imagen , Aparato Lagrimal/cirugía , Aparato Lagrimal/patología , Tomografía Computarizada por Rayos X , Adulto , Tamaño de los Órganos , Estudios de Seguimiento , Anciano de 80 o más AñosRESUMEN
The evaluation of living kidney donor candidates is a complex and lengthy process. Donor candidates face geographic and socioeconomic barriers to completing donor evaluation. Inequities in access to living donations persist. With a growing demand for kidney transplants and a shortage of living donors, transplant centers are more permissive of accepting less-than-ideal donor candidates. Donors have an increased lifetime risk of kidney failure, but the absolute risk increase is small. Efforts are needed to support donor candidates to complete donor nephrectomy safely and efficiently and receive optimal follow-up care to prevent risk factors for kidney disease and detect complications early. In this article, the authors address key elements of donor kidney evaluation, including current living donation policy requirements and transplant center practices. The authors present a simplified comprehensive practical approach to help guide providers in completing donor evaluation and follow-up care with best outcomes possible.
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Trasplante de Riñón , Donadores Vivos , Nefrectomía , Humanos , Donadores Vivos/provisión & distribución , Selección de Donante , Estudios de Seguimiento , Factores de RiesgoRESUMEN
OBJECTIVE: To determine survival to discharge and neurological outcomes on long-term follow-up of pediatric patients attended for out of-hospital cardiac arrest (OHCA). METHODS: Retrospective study based on an ongoing OHCA registry. Patients aged 16 years or younger were included. Futile resuscitation attempts were excluded. Neurological outcome on hospital discharge and on follow-up was based on variables in the Pediatric Cerebral Performance Category (PCPC) scale. Cases from January 1, 2008, through December 31, 2019, were extracted, and 2 surveys were carried out in May 2021 and January 2023. Patient follow-up time ranged from 1 to 13 years. RESULTS: Of the 13 778 patients in the registry, we found 277 (2.0%) who were aged 16 years or younger. One hundred thirty-seven patients (49.5%) were transported to a hospital, and spontaneous circulation was restored in 99 (35.7%). Thirty-six patients (13%) were discharged. The median (interquartile range) follow-up time was 2172 (978-3035) days. Thirty-one of these patients (86.1%) were alive at follow-up, 3 had died, and 2 were lost to follow-up. Neurological outcomes had worsened in 2 and improved in 6 patients. The neurological outcome of 27 of the 31 patients with complete follow-up data (87.1%) was good (PCPC scores of 1 or 2). CONCLUSIONS: In spite of the low incidence of shockable rhythm in pediatric OHCA, survival with a good neurological outcome is comparable to survival in adults. Children who are discharged after OHCA maintained or improved their neurological function over the long term.
OBJETIVO: Conocer la supervivencia al alta y la evolución neurológica tras seguimiento a largo plazo de pacientes pediátricos atendidos por parada cardíaca extrahospitalaria. METODO: Estudio retrospectivo basado en un registro continuo de parada cardiaca extrahospitalaria. Se incluyeron los pacientes pediátricos (edad menor o igual a 16 años). Se excluyeron reanimaciones consideradas fútiles. Se tomaron como variables resultado el estado neurológico al alta hospitalaria y al seguimiento de los pacientes, siguiendo el modelo de la Pediatric Cerebral Performance Category. El periodo fue del 1 de enero de 2008 al 31 de diciembre de 2019. Se realizaron dos encuestas, en mayo del 2021 y enero del 2023 con un periodo de seguimiento entre 1 y 13 años. RESULTADOS: De los 13.778 pacientes, 277 (2,0%) eran menores de 16 años; 137 (49,5%) trasladados al hospital, 99 de ellos (35,7%) con recuperación de circulación espontánea. Recibieron el alta hospitalaria 36 pacientes (13%). En el seguimiento, mediana (RIC) de 2.172 [978-3.035] días, 31 pacientes (86,1%) seguían con vida, 3 pacientes fallecieron y en dos casos no obtuvimos información. Dos pacientes sufrieron un empeoramiento del estado neurológico y 6 mejoraron. Finalmente, 27 de los 31 pacientes (87,1%) que completaron el seguimiento tenían una buena situación neurológica (PCPC1-2). CONCLUSIONES: A pesar de presentar una incidencia baja, la supervivencia con buen estado neurológico al alta hospitalaria de la parada cardiorrespiratoria extrahospitalaria pediátrica es comparable a la del adulto. Los pacientes pediátricos que recibieron el alta hospitalaria tras una parada cardiorrespiratoria extrahospitalaria mantuvieron o mejoraron su estado neurológico en el seguimiento a largo plazo.
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Paro Cardíaco Extrahospitalario , Sistema de Registros , Humanos , Paro Cardíaco Extrahospitalario/mortalidad , Paro Cardíaco Extrahospitalario/terapia , Niño , Estudios Retrospectivos , Masculino , Femenino , Preescolar , Adolescente , Lactante , España/epidemiología , Reanimación Cardiopulmonar/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Estudios de Seguimiento , Tasa de Supervivencia , Factores de TiempoRESUMEN
PURPOSE: The aim of the study was to determine outcomes after heart transplantation for cytomegalovirus (CMV) mismatched patients (D+/R-) who underwent a surveillance and preemptive therapy protocol, compared to nonmismatch patients. METHODS: A review of patient records from January 2010 to December 2020 with follow-up to October 2023 was done. The protocol consisted weekly surveillance with CMV PCR starting 4 weeks after transplant continuing up until the patient seroconverts or up to 3 months posttransplant if the patient does not seroconvert. Valganciclovir was given for 2 weeks to those who seroconverted. RESULTS: Two hundred and twenty-one patients were included, and 23% were mismatched patients. Overall survival was not different between CMV groups (p = NS). Causes of death and morbidities were also not significantly different (p = NS). Sixty-six percent of mismatch patients seroconverted, and there was also a significantly older donor age in the seroconverted patients compared to nonseroconverted patients (41 ± 11 vs. 29 ± 12 years, p < 0.005), indicating a higher risk donor profile. A multivariate Cox regression including donor age showed that there was no increase in mortality in the seroconverted mismatches compared to nonmismatch patients (p = NS). CONCLUSIONS: There is no significant increased mortality or morbidity using a CMV surveillance and preemptive therapy protocol. The effect of donor age on seroconversion of mismatches requires further validation.
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Antivirales , Infecciones por Citomegalovirus , Citomegalovirus , Supervivencia de Injerto , Trasplante de Corazón , Humanos , Trasplante de Corazón/efectos adversos , Trasplante de Corazón/mortalidad , Infecciones por Citomegalovirus/prevención & control , Infecciones por Citomegalovirus/virología , Infecciones por Citomegalovirus/epidemiología , Femenino , Masculino , Citomegalovirus/aislamiento & purificación , Estudios de Seguimiento , Adulto , Pronóstico , Estudios Retrospectivos , Antivirales/uso terapéutico , Factores de Riesgo , Rechazo de Injerto/prevención & control , Rechazo de Injerto/etiología , Rechazo de Injerto/mortalidad , Tasa de Supervivencia , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Donantes de Tejidos/provisión & distribuciónRESUMEN
BACKGROUND: Radical mastectomy remains the cornerstone procedure for the treatment of breast cancer (BC). However, traditional radical surgeries often lead to complications such as local numbness, pulling sensations, and atrophy of the pectoralis major muscle. In contrast, BC radical surgeries that preserve more tissue have shown potential in reducing these complications. This retrospective study aims to analyze case data from our institution, focusing on the methods of surgeries that preserve more tissue and evaluating the safety and reliability of the follow-up results. METHODS: A retrospective observational study was conducted on cases diagnosed with BC between May 2018 and July 2019 at our institution. The cases were divided into three different surgical groups and followed up for a period of 5 years. The follow-up results were then discussed within each group. RESULTS: A total of 315 cases diagnosed with BC underwent regular follow-ups. The statistical analysis revealed an average age of 45 years and an average tumor size slightly over 2.2 cm, with early-stage BC (Stage I and II) accounting for 90.2% of the cases. The overall survival (OS) and disease-free survival times in the group undergoing total mastectomy with tissue preservation were comparable to those in the traditional radical mastectomy group and the breast-conserving plus radiotherapy group. Moreover, the complication rate, particularly the incidence of chest wall numbness and pulling sensations, was lower in the total mastectomy with tissue preservation group compared to the traditional radical mastectomy group. The overall average follow-up time was 64.4 months, with a recurrence and metastasis rate of 15.6% and an OS rate of 92.7%. CONCLUSION: Based on our follow-up results, total mastectomy with more tissue preservation demonstrates comparable efficacy to breast-conserving surgery and traditional radical mastectomy. It can reduce some complications associated with traditional radical mastectomy and is beneficial for subsequent immediate and delayed breast reconstruction. This approach may be suitable for most patients with early to mid-stage breast cancer who do not wish to undergo breast-conserving surgery.
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Neoplasias de la Mama , Recurrencia Local de Neoplasia , Humanos , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Estudios Retrospectivos , Adulto , Tejido Subcutáneo/patología , Tejido Subcutáneo/cirugía , Mastectomía/métodos , Estudios de Seguimiento , Anciano , Estadificación de NeoplasiasRESUMEN
INTRODUCTION: Beyond our population growing older and living longer, there is an increased risk of developing a cognitive disorder. Standardized screening during a routine visit in primary care may be ideal for early detection of mild cognitive impairment (MCI) and follow-up for cognitive changes. AIM: This quality improvement (QI) project aimed to determine the impact of implementing the Mini-Cog© quick screening for early dementia detection to identify and follow up on the cognitive impairment of older adults in a primary care clinic setting. METHODS: Implementation started in February 2024 in a primary care clinic in Southern California. Data was collected for this project over a total of 16 weeks. This QI project implemented a routine cognitive screening using the Mini-Cog©. Cognitive impairment was identified, and if indicated by the Mini-Cog© scores, follow-up for a cognitive assessment and care plan services were initiated. Data were obtained from the project site's electronic medical record on a total sample size of 471 participants (n = 382 in the pre-implementation group and n = 89 in the post-implementation group). RESULTS: Pearson's chi-square test indicated a statistically significant improvement in the identification rate of cognitive impairment, increasing from 11.8% (n = 45 out of 382) at pre-implementation to 34.8% (n = 31 out of 89) at post-implementation, and specifically, mild cognitive impairment increased from zero identified in pre-implementation to 12.4% (n = 11 out of 89) post-implementation. Lastly, follow-up rates improved from 91.1% (n = 41 out of 45) to 100% (n = 31 out of 31) in post-implementation, and clinical significance was evident based on the phi-coefficient (φ = 0.196), indicating a small effect size and a 100% follow-up rate. CONCLUSIONS: The findings of this project suggest older adults should receive cognitive screenings to help identify early cognitive impairment and increase follow-up for further evaluation, treatment, and advanced care planning.
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Disfunción Cognitiva , Atención Primaria de Salud , Mejoramiento de la Calidad , Humanos , Disfunción Cognitiva/diagnóstico , Proyectos Piloto , Femenino , Anciano , Masculino , California , Anciano de 80 o más Años , Tamizaje Masivo/métodos , Demencia/diagnóstico , Persona de Mediana Edad , Estudios de SeguimientoRESUMEN
Background: Although there is consistent evidence that smoking is a risk factor associated with tuberculosis (TB), whether smoking cessation improves treatment outcomes and reduces the risk of TB recurrence remains understudied. Methods: We conducted a prospective cohort study with a seven-year follow-up in China. We recruited newly-diagnosed TB patients and classified them as non-smokers, ex-smokers, and current smokers. Current smokers were invited to participate in a smoking cessation intervention programme. We used a Cox proportional hazards model to assess the risk of death among TB patients and the risk of recurrence among successfully treated patients. Results: In total, 634 (79.2%) patients completed anti-TB treatments and 115 (14.4%) patients died. We confirmed the existence of a dose-response relationship between smoking frequency and the risk of TB recurrence (the slope of the fitted line >0; P < 0.05). Compared to those who continued smoking, the risk of death and recurrent TB for the patients who quit smoking during treatment decreased. The HR of mortality for smokers who smoked 30 or more cigarettes was 2.943 (95% confidence interval (CI) = 1.035-8.368), while the HR of mortality for those who smoked 30 or more cigarettes, but quit during treatment was 2.117 (95% CI = 1.157-3.871). However, the risk of recurrence remained high for ex-smokers who had a smoking history of 25 years or more. Conclusions: Our study provides further evidence supporting the World Health Organization's call for co-management of smoking and other risk factors as part of routine TB treatment.
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Recurrencia , Cese del Hábito de Fumar , Tuberculosis , Humanos , Cese del Hábito de Fumar/estadística & datos numéricos , China/epidemiología , Masculino , Femenino , Estudios Prospectivos , Adulto , Persona de Mediana Edad , Estudios de Seguimiento , Tuberculosis/mortalidad , Tuberculosis/prevención & control , Factores de Riesgo , Antituberculosos/uso terapéutico , Anciano , Fumar/epidemiología , Modelos de Riesgos Proporcionales , Adulto JovenRESUMEN
BACKGROUND: Thoracoscopic-guided thoracic paravertebral nerve block (TG-TPVB) and thoracoscopic-guided intercostal nerve block (TG-INB) are two postoperative analgesia technology for thoracic surgery. This study aims to compared the analgesic effect of TG-TPVB and TG-INB after uniportal video-asssited thoracic surgery (UniVATS). METHODS: Fifty-eight patients were randomly allocated to the TG-TPVB group and the TG-INB group. The surgical time of nerve block, the visual analog scale (VAS) scores, the consumption of sufentanil and the number of patient-controlled intravenous analgesic (PCIA) presses within 24 h after surgery, the incidence of adverse reactions were compared between the two groups. RESULTS: The VAS scores were significantly lower during rest and coughing at 2, 6, 12, and 24 h in the TG-TPVB group than in the TG-INB group (P < 0.05). The consumption of sufentanil and the number of PCIA presses within 24 h after surgery were significantly lower in the TG-TPVB group than in the TG-INB group (P < 0.001).The surgical time of nerve block was significantly shorter in the TG-TPVB group than in the TG-INB group (P < 0.001). The incidence of bleeding at the puncture point was lower in the TG-TPVB group than that in the TG-INB group (P < 0.05). CONCLUSION: TG-TPVB demonstrated superior acute pain relieve after uniVATS, shorter surgical time and non-inferior adverse effects than TG-INB.
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Nervios Intercostales , Bloqueo Nervioso , Dolor Postoperatorio , Cirugía Torácica Asistida por Video , Humanos , Femenino , Masculino , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Persona de Mediana Edad , Cirugía Torácica Asistida por Video/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Estudios Prospectivos , Estudios de Seguimiento , Anciano , Pronóstico , Adulto , Toracoscopía/métodos , Toracoscopía/efectos adversos , Dimensión del DolorRESUMEN
PURPOSE: Conventional minimally invasive surgery requires mini-laparotomy to extract the pathological specimen. However, by using a natural orifice as the delivery route, natural orifice specimen extraction (NOSE) surgery avoids the need for a large incision. This study analyzed the short-term outcome of NOSE compared with conventional mini-laparotomy (CL) for colorectal cancer surgery. METHODS: We conducted a retrospective analysis of 1,189 patients who underwent surgery for primary colorectal cancer between the cecum and upper rectum. Propensity score analyses were applied to the NOSE and CL groups in a 1:1 matched cohort. RESULTS: After propensity score matching, each group included 201 patients. The NOSE group and CL group did not differ significantly in terms of baseline characteristics. Postoperative morbidity and mortality rates were comparable. Compared with the CL group, the NOSE group experienced a shorter time to first flatus (1.6 ± 0.8 vs. 2.0 ± 1.2 days, p < 0.001), first stool (2.7 ± 1.5 vs. 4.1 ± 1.9, p < 0.001), liquid diet (2.3 ± 1.3 vs. 3.6 ± 1.8 days, p < 0.001), soft diet (3.9 ± 2.0 vs. 5.2 ± 1.9 days, p < 0.001) and a shorter hospital stay (5.1 ± 3.5 vs. 7.4 ± 4.8 days, p < 0.001). The NOSE group exhibited lower mean pain intensity and lower highest pain intensity on postoperative days 1, 2, and 3. CONCLUSION: NOSE has several advantages over conventional mini-laparotomy following minimally invasive surgery for colon cancer. These advantages include reduced time to oral intake, shorter hospital stays, and less postoperative pain. NOSE can be adopted and applied to highly selective patients without additional risk of short-term complications.
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Neoplasias Colorrectales , Procedimientos Quirúrgicos Mínimamente Invasivos , Cirugía Endoscópica por Orificios Naturales , Puntaje de Propensión , Humanos , Femenino , Masculino , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/patología , Estudios Retrospectivos , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Anciano , Cirugía Endoscópica por Orificios Naturales/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios de Seguimiento , Pronóstico , Tiempo de Internación/estadística & datos numéricos , Laparotomía/métodosRESUMEN
PURPOSE: Invasive Listeria monocytogenes infection is rare, but can lead to life-threatening complications among high-risk patients. Our aim was to assess characteristics and follow-up of adults hospitalized with invasive L. monocytogenes infection. METHODS: A retrospective observational cohort study was conducted at a national referral center between 2004 and 2019. Patients with proven invasive listeriosis, defined by the European Centre for Disease Prevention and Control criteria, were included. Data collection and follow-up were performed using the hospital electronic system, up until the last documented visit. The primary outcome was in-hospital all-cause mortality, secondary outcomes included residual neurological symptoms, brain abscess occurrence, and requirement for intensive care unit (ICU) admission. RESULTS: Altogether, 63 cases were identified (57.1% male, median age 58.8 ± 21.7 years), and 28/63 developed a complicated disease course (44.4%). At diagnosis, 38/63 (60.3%) presented with sepsis, 54/63 (85.7%) had central nervous system involvement, while 9/63 (14.3%) presented with isolated bacteremia. Frequent clinical symptoms included fever (53/63, 84.1%), altered mental state (49/63, 77.8%), with immunocompromised conditions apparent in 56/63 (88.9%). L. monocytogenes was isolated from blood (37/54, 68.5%) and cerebrospinal fluid (48/55, 87.3%), showing in vitro full susceptibility to ampicillin and meropenem (100% each), gentamicin (86.0%) and trimethoprim/sulfamethoxazole (97.7%). In-hospital all-cause mortality was 17/63 (27.0%), and ICU admission was required in 28/63 (44.4%). At discharge, residual neurological deficits (11/46, 23.9%) and brain abscess formation (6/46, 13.0%) were common. CONCLUSION: Among hospitalized adult patients with comorbidities, invasive L. monocytogenes infections are associated with high mortality and neurological complications during follow-up.
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Hospitalización , Listeria monocytogenes , Listeriosis , Humanos , Masculino , Femenino , Persona de Mediana Edad , Listeriosis/mortalidad , Listeriosis/microbiología , Listeriosis/epidemiología , Listeriosis/tratamiento farmacológico , Listeria monocytogenes/patogenicidad , Listeria monocytogenes/aislamiento & purificación , Listeria monocytogenes/efectos de los fármacos , Estudios Retrospectivos , Anciano , Hungría/epidemiología , Adulto , Hospitalización/estadística & datos numéricos , Estudios de Seguimiento , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Bacteriemia/microbiología , Bacteriemia/mortalidad , Bacteriemia/epidemiología , Bacteriemia/tratamiento farmacológico , Anciano de 80 o más Años , Sepsis/microbiología , Sepsis/mortalidad , Sepsis/epidemiología , Sepsis/tratamiento farmacológico , Mortalidad HospitalariaRESUMEN
BACKGROUND: Although red meat consumption has been associated with risk of atherosclerotic coronary artery disease and stroke, no prospective study has examined this with the risk of chronic limb-threatening ischemia (CLTI). METHODS: In a prospective study of 63,257 Chinese in Singapore, who were aged 45-74 years old at recruitment, diet was assessed via a validated semi-quantitative food frequency questionnaire. Incident CLTI cases were ascertained via linkage with nationwide hospital records for lower extremity amputation or angioplasty for peripheral arterial disease. Multivariable Cox models were used to examine associations between quartiles of meat intake and CLTI risk. RESULTS: After a mean follow-up of 18.8 years, there were 1069 cases of CLTI. Higher intake of red meat intake was associated with increased risk of CLTI in a stepwise manner. Comparing extreme quartiles of red meat intake, the hazard ratio (HR) for the association with CLTI risk was 1.24 [95% confidence interval (CI) = 1.03-1.49; P-trend = 0.02]. In stratified analysis, red meat intake had a stronger association with CLTI risk among those without diabetes [HR (95% CI) comparing extreme quartiles = 1.41 (1.10-1.80); P-trend = 0.03] than among those with diabetes at baseline [HR (95% CI) comparing extreme quartiles = 1.04 (0.79-1.38); P-trend = 0.05] (P-interaction = 0.03). Otherwise, the associations were not different by sex, BMI, smoking status, hypertension, alcohol consumption, or history of cardiovascular diseases. Using a theoretical model in substitution analysis that substituted three servings per week of red meat with poultry or fish/shellfish, the relative risk of CLTI was reduced by 13-14%. CONCLUSIONS: Consumption of red meat was associated with higher CLTI risk in this Asian cohort. Substituting red meat with poultry or fish/shellfish may reduce this risk.