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Sertorio ES, Colugnati FAB, Denhaerynck K, De Smet S, Medina JOP, Reboredo MM, De Geest S, Sanders-Pinheiro H, On Behalf Of The Adhere Brazil Study Team. Factors Associated With Physical Inactivity of Recipients of a Kidney Transplant: Results From the ADHERE BRAZIL Multicenter Study. Phys Ther 2024:pzae058. [PMID: 38591795 DOI: 10.1093/ptj/pzae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 11/27/2023] [Accepted: 04/05/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Physical activity is recommended for recipients of a kidney transplant. However, ADHERE BRAZIL study found a high prevalence (69%) of physical inactivity in Brazilian recipients of a kidney transplant. To tackle this behavior, a broad analysis of barriers is needed. This study aimed to identify factors (patient and transplant center levels) associated with physical inactivity among recipients of a kidney transplant. METHODS This was a subproject of the ADHERE BRAZIL study, a cross-sectional, multicenter study of 1105 recipients of a kidney transplant from 20 kidney transplant centers. Using a multistage sampling method, patients were proportionally and randomly selected. Applying the Brief Physical Activity Assessment questionnaire, patients were classified as physically active (≥150 min/wk) or physically inactive (<150 min/wk). On the basis of an ecological model, 34 factors associated with physical inactivity were analyzed by sequential logistic regression. RESULTS At the patient level, physical inactivity was associated with smoking (odds ratio = 2.43; 95% CI = 0.97-6.06), obesity (odds ratio = 1.79; 95% CI = 1.26-2.55), peripheral vascular disease (odds ratio = 3.18; 95% CI = 1.20-8.42), >3 posttransplant hospitalizations (odds ratio = 1.58; 95% CI = 1.17-2.13), family income of >1 reference salary ($248.28 per month; odds ratio = 0.66; 95% CI = 0.48-0.90), and student status (odds ratio = 0.58; 95% CI = 0.37-0.92). At the center level, the correlates were having exercise physiologists in the clinical team (odds ratio = 0.54; 95% CI = 0.46-0.64) and being monitored in a teaching hospital (undergraduate students) (odds ratio = 1.47; 95% CI = 1.01-2.13). CONCLUSIONS This study identified factors associated with physical inactivity after kidney transplantation that may guide future multilevel behavioral change interventions for physical activity. IMPACT In a multicenter sample of recipients of a kidney transplant with a prevalence of physical inactivity of 69%, we found associations between this behavior and patient- and center-level factors. At the patient level, the chance of physical inactivity was positively associated with smoking, obesity, and patient morbidity (peripheral vascular disease and hospitalization events after kidney transplantation). Conversely, a high family income and a student status negatively correlated with physical inactivity. At the center level, the presence of a dedicated professional to motivate physical activity resulted in a reduced chance of physical inactivity. A broad knowledge of barriers associated with physical inactivity can allow us to identify patients at a high risk of not adhering to the recommended levels of physical activity.
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Affiliation(s)
- Emiliana S Sertorio
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil, and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Fernando A B Colugnati
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil, and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Kris Denhaerynck
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Stefan De Smet
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Jose O P Medina
- Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Maycon M Reboredo
- School of Medicine, Federal University of Juiz de Fora, Minas Gerais, Brazil, and Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Helady Sanders-Pinheiro
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil, and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
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Jung JJ, Cheun JH, Kim SY, Koh J, Ryu JM, Yoo TK, Shin HC, Ahn SG, Park S, Lim W, Nam SE, Park MH, Kim KS, Kang T, Lee J, Youn HJ, Kim YS, Yoon CI, Kim HK, Moon HG, Han W, Cho N, Kim MK, Lee HB. Omission of Breast Surgery in Predicted Pathologic Complete Response after Neoadjuvant Systemic Therapy: A Multicenter, Single-Arm, Non-inferiority Trial. J Breast Cancer 2024; 27:61-71. [PMID: 38433091 PMCID: PMC10912576 DOI: 10.4048/jbc.2023.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/13/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE Advances in chemotherapeutic and targeted agents have increased pathologic complete response (pCR) rates after neoadjuvant systemic therapy (NST). Vacuum-assisted biopsy (VAB) has been suggested to accurately evaluate pCR. This study aims to confirm the non-inferiority of the 5-year disease-free survival of patients who omitted breast surgery when predicted to have a pCR based on breast magnetic resonance imaging (MRI) and VAB after NST, compared with patients with a pCR who had undergone breast surgery in previous studies. METHODS The Omission of breast surgery for PredicTed pCR patients wIth MRI and vacuum-assisted bIopsy in breaST cancer after neoadjuvant systemic therapy (OPTIMIST) trial is a prospective, multicenter, single-arm, non-inferiority study enrolling in 17 tertiary care hospitals in the Republic of Korea. Eligible patients must have a clip marker placed in the tumor and meet the MRI criteria suggesting complete clinical response (post-NST MRI size ≤ 1 cm and lesion-to-background signal enhancement ratio ≤ 1.6) after NST. Patients will undergo VAB, and breast surgery will be omitted for those with no residual tumor. Axillary surgery can also be omitted if the patient was clinically node-negative before and after NST and met the stringent criteria of MRI size ≤ 0.5 cm. Survival and efficacy outcomes are evaluated over five years. DISCUSSION This study seeks to establish evidence for the safe omission of breast surgery in exceptional responders to NST while minimizing patient burden. The trial will address concerns about potential undertreatment due to false-negative results and recurrence as well as improved patient-reported quality of life issues from the omission of surgery. Successful completion of this trial may reshape clinical practice for certain breast cancer subtypes and lead to a safe and less invasive approach for selected patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05505357. Registered on August 17, 2022. Clinical Research Information Service Identifier: KCT0007638. Registered on July 25, 2022.
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Affiliation(s)
- Ji-Jung Jung
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Ho Cheun
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Soo-Yeon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jiwon Koh
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Kyung Yoo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Chul Shin
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seho Park
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woosung Lim
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sang-Eun Nam
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Min Ho Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ku Sang Kim
- Department of Breast Surgery, Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Taewoo Kang
- Department of Surgery, Pusan National University, School of Medicine, Busan, Korea
- Busan Cancer Center and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jeeyeon Lee
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Jo Youn
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, Korea
| | - Yoo Seok Kim
- Department of Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Chang Ik Yoon
- Division of Breast Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyoon Kim
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
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Pereira Santana DC, Abbehusen Couto L, de Santana Passos-Soares J, Caló de Aquino Xavier F, Alves Mesquita R, Aragão Felix F, da Silva TA, Weege Nonaka CF, Muniz Alves P, Rodrigues Ferreira C, Libório-Kimura TN, Castro de Oliveira Moreira L, Câmara J, Alfaia Silva C, de Mendonça EF, do Lago Costa N, Rebelo Pontes HA, Lacerda de Souza L, Freire de Castro Lisboa J, Pina Godoy G, Azevedo Lins de Holanda L, Domingues Martins M, Varvaki Rados P, Schmidt TR, de Almeida Freitas R, Batista de Souza L, Freitas de Morais E, Vargas PA, Ajudarte Lopes M, Alves Quixabeira Oliveira G, Nunes Dos Santos J, Gomes Henriques ÁC. Sociodemographic and clinical characterization of cases of 1,103 non-syndromic and 66 syndromic odontogenic keratocyst: a Brazilian multicenter study. Clin Oral Investig 2023; 27:6951-6959. [PMID: 37855921 DOI: 10.1007/s00784-023-05313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES This multicenter study aimed to evaluate cases of non-syndrome and syndromic odontogenic keratocyst, as well as cases of recurrence within these two groups. METHODS This descriptive, analytical, retrospective cross-sectional study evaluated the sex, age and presence of multiple lesions in 1,169 individuals seen at 10 Brazilian oral and maxillofacial pathology centers. Of these, 1,341 odontogenic keratocysts were analyzed regarding clinical diagnosis, size, site, imaging appearance, signs and symptoms, type of biopsy, treatment, and recurrence. RESULTS There was a similar distribution by sex. The median age of non-syndromic and syndromic patients was 32 and 17.5 years, respectively. The posterior mandible was the site most affected by small and large lesions in both groups and in recurrent cases. Unilocular lesions were more frequent, also in recurrent cases. Mainly small lesions showed this imaging appearance. Signs and symptoms were absent in most cases. Conservative treatment was the most frequent modality in all age groups, regardless of the patient's condition and recurrence. Recurrences were uncommon. CONCLUSION This study showed a higher frequency of non-syndromic keratocysts in the population. Clinicopathological features related to the involvement of multiple sites, age, and recurrence may differ between syndromic and non-syndromic cases. Furthermore, we found an association between lesion size and some clinical features and between the time interval to recurrence and the syndromic spectrum. CLINICAL RELEVANCE To contribute to a better understanding of the distribution and association between clinical, imaging, and sociodemographic characteristics in each spectrum of the lesion.
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Affiliation(s)
| | - Larissa Abbehusen Couto
- School of Dentistry, Postgraduation Program in Dentistry and Health, Federal University of Bahia, Salvador, Brazil
| | - Johelle de Santana Passos-Soares
- Department of Social and Pediatric Dentistry, School of Dentistry da Federal, Postgraduation Program in Dentistry and Health, University of Bahia, Salvador, Brazil
| | - Flávia Caló de Aquino Xavier
- Surgical Pathology Service, School of Dentistry, Postgraduation Program in Dentistry and Health, Federal University of Bahia, Salvador, Brazil
| | - Ricardo Alves Mesquita
- Department of Dental Clinical Practice, Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda Aragão Felix
- Department of Dental Clinical Practice, Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Tarcília Aparecida da Silva
- Department of Dental Clinical Practice, Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | | - Jeconias Câmara
- Department of Pathology and Forensic Medicine (DPML), Federal University of Amazonas, Manaus, Brazil
| | - Caroline Alfaia Silva
- Department of Pathology and Forensic Medicine (DPML), Federal University of Amazonas, Manaus, Brazil
| | | | - Nádia do Lago Costa
- Laboratory of Oral Pathology, School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | | | - Lucas Lacerda de Souza
- Oral Pathology Service, João de Barros, Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | | | - Gustavo Pina Godoy
- Department of Clinical and Preventive Dentistry, Federal University of Pernambuco, Recife, Brazil
| | | | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Pantelis Varvaki Rados
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Tuany Rafaeli Schmidt
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Lélia Batista de Souza
- Postgraduate Program in Dental Sciences, Federal University of Rio Grande Do Norte, Natal, Brazil
| | | | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | | | - Jean Nunes Dos Santos
- Surgical Pathology Service, School of Dentistry, Postgraduation Program in Dentistry and Health, Federal University of Bahia, Salvador, Brazil
| | - Águida Cristina Gomes Henriques
- Surgical Pathology Service, School of Dentistry, Postgraduation Program in Dentistry and Health, Federal University of Bahia, Salvador, Brazil.
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Na SJ, Oh DK, Park S, Lee YJ, Hong SB, Park MH, Ko RE, Lim CM, Jeon K. The Association Between Tachycardia and Mortality in Septic Shock Patients According to Serum Lactate Level: A Nationwide Multicenter Cohort Study. J Korean Med Sci 2023; 38:e313. [PMID: 37846786 PMCID: PMC10578996 DOI: 10.3346/jkms.2023.38.e313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/15/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND This study aimed to evaluate whether the effect of tachycardia varies according to the degree of tissue perfusion in septic shock. METHODS Patients with septic shock admitted to the intensive care units were categorized into the tachycardia (heart rate > 100 beats/min) and non-tachycardia (≤ 100 beats/min) groups. The association of tachycardia with hospital mortality was evaluated in each subgroup with low and high lactate levels, which were identified through a subpopulation treatment effect pattern plot analysis. RESULTS In overall patients, hospital mortality did not differ between the two groups (44.6% vs. 41.8%, P = 0.441), however, tachycardia was associated with reduced hospital mortality rates in patients with a lactate level ≥ 5.3 mmol/L (48.7% vs. 60.3%, P = 0.030; adjusted odds ratio [OR], 0.59, 95% confidence interval [CI], 0.35-0.99, P = 0.045), not in patients with a lactate level < 5.3 mmol/L (36.5% vs. 29.7%, P = 0.156; adjusted OR, 1.39, 95% CI, 0.82-2.35, P = 0.227). CONCLUSION In septic shock patients, the effect of tachycardia on hospital mortality differed by serum lactate level. Tachycardia was associated with better survival in patients with significantly elevated lactate levels.
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Affiliation(s)
- Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Hyeon Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Lawson McLean A. Prognostic significance of baseline thyroid variables in IDH-wildtype glioblastoma patients treated with regorafenib. J Neurooncol 2023; 164:267-268. [PMID: 37561357 PMCID: PMC10462530 DOI: 10.1007/s11060-023-04408-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
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Heo S, Yu JY, Kang EA, Shin H, Ryu K, Kim C, Chegal Y, Jung H, Lee S, Park RW, Kim K, Hwangbo Y, Lee JH, Park YR. Development and Verification of Time-Series Deep Learning for Drug-Induced Liver Injury Detection in Patients Taking Angiotensin II Receptor Blockers: A Multicenter Distributed Research Network Approach. Healthc Inform Res 2023; 29:246-255. [PMID: 37591680 PMCID: PMC10440200 DOI: 10.4258/hir.2023.29.3.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES The objective of this study was to develop and validate a multicenter-based, multi-model, time-series deep learning model for predicting drug-induced liver injury (DILI) in patients taking angiotensin receptor blockers (ARBs). The study leveraged a national-level multicenter approach, utilizing electronic health records (EHRs) from six hospitals in Korea. METHODS A retrospective cohort analysis was conducted using EHRs from six hospitals in Korea, comprising a total of 10,852 patients whose data were converted to the Common Data Model. The study assessed the incidence rate of DILI among patients taking ARBs and compared it to a control group. Temporal patterns of important variables were analyzed using an interpretable timeseries model. RESULTS The overall incidence rate of DILI among patients taking ARBs was found to be 1.09%. The incidence rates varied for each specific ARB drug and institution, with valsartan having the highest rate (1.24%) and olmesartan having the lowest rate (0.83%). The DILI prediction models showed varying performance, measured by the average area under the receiver operating characteristic curve, with telmisartan (0.93), losartan (0.92), and irbesartan (0.90) exhibiting higher classification performance. The aggregated attention scores from the models highlighted the importance of variables such as hematocrit, albumin, prothrombin time, and lymphocytes in predicting DILI. CONCLUSIONS Implementing a multicenter-based timeseries classification model provided evidence that could be valuable to clinicians regarding temporal patterns associated with DILI in ARB users. This information supports informed decisions regarding appropriate drug use and treatment strategies.
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Affiliation(s)
- Suncheol Heo
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul,
Korea
| | - Jae Yong Yu
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul,
Korea
| | - Eun Ae Kang
- Medical Informatics Collaborative Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul,
Korea
| | - Hyunah Shin
- Healthcare Data Science Center, Konyang University Hospital, Daejeon,
Korea
| | - Kyeongmin Ryu
- Healthcare Data Science Center, Konyang University Hospital, Daejeon,
Korea
| | - Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Seoul,
Korea
| | - Yebin Chegal
- Department of Statistics, Korea University, Suwon,
Korea
| | - Hyojung Jung
- Healthcare AI Team, National Cancer Center, Goyang,
Korea
| | - Suehyun Lee
- Healthcare Data Science Center, Konyang University Hospital, Daejeon,
Korea
| | - Rae Woong Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Seoul,
Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul,
Korea
| | - Yul Hwangbo
- Healthcare AI Team, National Cancer Center, Goyang,
Korea
| | - Jae-Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul,
Korea
| | - Yu Rang Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul,
Korea
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Lindsay JO, Picker N, Kromer D, Smyth M, Patel H. The incidence of remission and indicators of inadequate response to advanced therapy in patients with ulcerative colitis: results from medical charts in the United Kingdom. Curr Med Res Opin 2023; 39:681-689. [PMID: 36951899 DOI: 10.1080/03007995.2023.2194782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE A considerable proportion of patients with moderate-to-severe ulcerative colitis (UC) treated with advanced therapies do not achieve remission, even after one year of treatment, and suboptimal response to advanced therapies is frequently observed in clinical practice. This study aims to analyze clinical practice data in the United Kingdom (UK) and assess the rates of clinical remission and inadequate response with advanced therapies among patients with UC. METHODS This retrospective chart review included patients with UC who initiated a new advanced therapy (i.e., adalimumab, infliximab, golimumab, tofacitinib, or vedolizumab) between January 2017 and September 2019 from eight clinics across the UK. At least 12 months of data before and after starting an advanced therapy were required. Remission was assessed using components of the Mayo score. Inadequate response was defined by therapeutic adjustment or emergency treatment. RESULTS Among 238 patients included (female: 46.6%; median age: 42.0 years; median follow-up: 28.8 months), 178 patients (74.8%) were biologic-naïve. At 12 months, 87 patients (53.9%) had achieved remission (median time to remission: 7.6 months); although 29 (33.3%) among them had required therapeutic modifications to achieve remission. At 12 months, 105 patients (44.3%) had at least one indicator of an inadequate response (median time to first indicator of inadequate response: 18.0 months). CONCLUSIONS Nearly half of patients did not achieve remission, and almost half of included patients had an inadequate response within 1 year after treatment initiation. More effective therapies are needed to effectively treat UC.
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Affiliation(s)
- James O Lindsay
- Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
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Nguyen TP, Stirling C, Kitsos G, Nichols L, Chandra RV, Rehman S, Smith K, Mosley I, Lai L, Asadi H, Dubey A, Froelich J, Thrift AG, Gall S. Barriers and facilitators to more timely treatment of aneurysmal subarachnoid haemorrhage across two tertiary referral centres in Australia: A thematic analysis. Australas Emerg Care 2022:S2588-994X(22)00003-3. [PMID: 35125318 DOI: 10.1016/j.auec.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/20/2021] [Accepted: 01/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Delays in treatment of aSAH appear to be common but the causes are not well understood. We explored facilitators and barriers to timely treatment of aSAH. METHODS We used a multiple case study with cases of aSAH surviving> 1 day identified prospectively. We conducted semi-structured interviews with the patient, their next-of-kin and health professionals involved in the case. Within-case analysis identified barriers and facilitators in 4 phases (pre-hospital, presentation, transfer, in-hospital) followed by thematic analysis across cases using a case-study matrix. RESULTS Twenty-seven cases with 90 interviewees yielded five themes related to facilitators or barriers of timely treatment. "Early recognition" led to urgent response. "Accessibility to health care" depended on patient's location, transport, and environmental conditions. Good "Coordination" between and within health services was a key facilitator. "Complexity" of patient's condition affected time to treatment in multiple time periods. "Availability of resources" was identified most frequently during the diagnostic and treatment phases as both barrier and facilitator. CONCLUSIONS The identified themes may be modifiable at the patient/health professional level and health system level and may improve timely treatment of aSAH through targeted interventions, subsequently contributing to improve morbidity and mortality of patients with aSAH.
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Min JY, Kim YM, Kim DW, Kim JW, Kim JK, Mo JH, Shin JM, Cho KS, Kwak S, Shin SH. Risk Model Establishment of Endoscopic Sinus Surgery for Patients with Chronic Rhinosinusitis: a Multicenter Study in Korea. J Korean Med Sci 2021; 36:e264. [PMID: 34664801 PMCID: PMC8524236 DOI: 10.3346/jkms.2021.36.e264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Endoscopic sinus surgery (ESS) is the mainstay treatment for refractory chronic rhinosinusitis (CRS). Since various factors may contribute to the surgical outcome, it is challenging for physicians to predict surgical outcomes. The aim of study was to analyze the prognostic factors of postoperative outcomes and to establish the prediction model with the risk factors that impact the postoperative outcomes. METHODS Medical records of CRS patients who underwent ESS at 9 institutions in 2005, 2010, and 2016 were retrospectively reviewed. We classified the patients into 2 groups based on postoperative objective endoscopic outcomes. Demographics, nose-specific symptoms, olfactory function, eosinophil counts in blood (EoB) and nasal tissue (EoT), and Lund-Mackay CT score (LMS) were collected. Univariate and multivariate analyses were performed and established a prediction equation for postoperative endoscopic objective outcomes. RESULTS In total (n = 1,249), 27.0% were not satisfied under postoperative endoscopic examination. Of 10 variables, LMS (> 5), sinus dominancy (maxillary sinus and ethmoid sinus), EoB (> 210), and EoT (> 100) were statistically significant in univariate analysis (P < 0.05, all). In multivariate analysis, EoT (> 100) and LMS (> 5) were significantly associated with poor postoperative outcome. Furthermore, 5 significant variables were employed to establish the risk model of postoperative outcomes and P (the value of prediction probability) = 1 / (1 + exp [-0.392 + 1.088 × EoT (> 100) + 0.123 × mean LMS (> 5) - 0.366 × sinus dominancy (maxillary) + 0.064 × sinus dominancy (similar) + 0.200 × EoB (4%) + 0.344 × EoB (> 210)] was developed. CONCLUSION Tissue eosinophil count and radiographic severity predispose to a poorer outcome of ESS and the risk model established may be helpful to predict postoperative outcomes of ESS.
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Affiliation(s)
- Jin-Young Min
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Min Kim
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Dae Woo Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jeong-Whun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Jin Kook Kim
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Konkuk University, Seoul, Korea
| | - Ji-Hun Mo
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Dankook University, College of Medicine, Cheonan, Korea
| | - Jae-Min Shin
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Korea University, Seoul, Korea
| | - Kyu-Sup Cho
- Department of Otolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Sanggyu Kwak
- Department of Medical Statistics, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Seung-Heon Shin
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu, Korea.
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Duarte-Batista P, Farinha NC, Marques R, Pinheiro JP, Silva J, Tuna R, Reis JH, Antunes C, Machado MJ, Lemos SS, Branco J, Roque D, Simão D, Simas N, Teixeira W, Felício C, Ferreira M, Cunha E, Rocha L, Figueiredo G, Noronha C, Pinto V, Silva F, Ferreira A, Sousa O. HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan. ACTA MEDICA PORT 2021; 34:413-419. [PMID: 34715948 DOI: 10.20344/amp.13770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/24/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Our national protocol for traumatic brain injury dictates that hypocoagulated patients with mild trauma and initial tomography scan with no intracranial traumatic changes must be hospitalized for 24 hours and do a post-surveillance tomography scan. The main goal of this study was to evaluate the clinical relevance of these measures. MATERIAL AND METHODS A prospective observational study was undertaken in four hospitals. Adult hypocoagulated traumatic brain injury patients with a normal tomography scan were included. The main outcomes evaluated were rate of delayed intracranial hemorrhage, rate of admission in a neurosurgical department, rate of complications related with surveillance and rate of prolonged hospitalization due to complications. An analysis combining data from a previously published report was also done. RESULTS A total of 178 patients were included. Four patients (2.3%) had a delayed hemorrhage and three (1.7%) were hospitalized in a neurosurgery ward. No cases of symptomatic hemorrhage were identified. No surgery was needed, and all patients had their anticoagulation stopped. Complications during surveillance were reported in seven patients (3.9%), of which two required prolonged hospitalization. DISCUSSION The rate of complications related with surveillance was higher than the rate of delayed hemorrhages. The initial period of in-hospital surveillance did not convey any advantage since the management of patients was never dictated by neurological changes. Post-surveillance tomography played a role in deciding about anticoagulation suspension and prolongation of hospitalization. CONCLUSION Delayed hemorrhage is a rare event and the need for surgery even rarer. The need for in-hospital surveillance should be reassessed.
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Affiliation(s)
- Pedro Duarte-Batista
- Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Nuno Cubas Farinha
- Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Renata Marques
- Serviço de Neurocirurgia. Hospital De Braga. Braga. Portugal
| | - João Páscoa Pinheiro
- Serviço de Neurocirurgia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - João Silva
- Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto. Portugal
| | - Rui Tuna
- Serviço de Neurocirurgia. Centro Hospitalar de São João. Porto. Portugal
| | - José Hipólito Reis
- Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | | | | | - Samuel Sequeira Lemos
- Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Jessica Branco
- Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Diogo Roque
- Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Diogo Simão
- Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Nuno Simas
- Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Wilson Teixeira
- Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Cátia Felício
- Serviço de Cirurgia Geral. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Miguel Ferreira
- Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto. Portugal
| | - Eduardo Cunha
- Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto. Portugal
| | - Luís Rocha
- Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto. Portugal
| | | | - Carolina Noronha
- Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto. Portugal
| | - Vasco Pinto
- Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto. Portugal
| | - Filipe Silva
- Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto. Portugal
| | - Ana Ferreira
- Serviço de Neurocirurgia. Centro Hospitalar de São João. Porto. Portugal
| | - Osvaldo Sousa
- Serviço de Neurocirurgia. Centro Hospitalar de São João. Porto. Portugal
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Seward MW, Antonelli BJ, Giunta N, Iorio R, Fitz W, Lange JK, Shah VM, Chen AF. Weight loss before total joint arthroplasty using a remote dietitian and mobile app: study protocol for a multicenter randomized, controlled trial. J Orthop Surg Res 2020; 15:531. [PMID: 33187535 PMCID: PMC7662734 DOI: 10.1186/s13018-020-02059-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/02/2020] [Indexed: 12/23/2022] Open
Abstract
Background The months prior to elective surgery may present an opportunity for patients to initiate behavior changes that will simultaneously ready them for surgery and improve their overall health status. An upcoming elective total joint arthroplasty (TJA) may serve as motivation for patients with severe obesity (body mass index [BMI]> 40 kg/m2) to lose weight, as it may optimize clinical outcomes following TJA and help them become eligible for TJA since some surgeons use a BMI of 40 kg/m2 as a cut-off for offering surgery in an effort to optimize outcomes. Methods The purpose of this multicenter randomized, controlled trial is to assess the feasibility and efficacy of a 12-week remote dietitian (RD) supervised dietary and physical activity weight loss intervention and mobile app for 60 patients with severe obesity prior to undergoing TJA. Intervention participants will receive access to a smartphone app and connect with an RD who will contact these participants weekly or bi-weekly via video calls for up to nine video calls. Together, participants and RDs will set goals for lifestyle modifications, and RDs will check on progress towards achieving these goals using in-app tools such as food logs and text messages between video calls. All patients will be encouraged to lose at least 20 pounds with a goal BMI < 40 kg/m2 after 12 weeks. Individuals randomized to the control group will receive clinical standard of care, such as nutritionist and/or physical therapy referrals. Outcome and demographic data will be collected from blood serology, chart review, mobile app user data, pre- and postintervention surveys, and phone interviews. The primary outcome measure will be weight change from baseline. Secondary outcome measures will include percentage of patients eligible to undergo TJA, number of sessions completed with dietitians, self-reported global health status (PROMIS Global Health scale), self-reported joint-specific pain and function (Knee injury and Osteoarthritis Outcome Score (KOOS) or Hip disability and Osteoarthritis Outcome Score (HOOS)), and serologies such as hemoglobin A1c, total lymphocyte count, albumin, and transferrin. Qualitative responses transcribed from phone interviews about the intervention will also be analyzed. Discussion This will be the first study to assess pre-operative weight loss in patients with severe obesity anticipating orthopaedic surgery using an RD and mobile app intervention aimed at helping patients become eligible for TJA. Trial registration Registered on 1 April 2020 at Clincialtrials.gov. Trial number is NCT04330391.
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Affiliation(s)
- Michael W Seward
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | - Brielle J Antonelli
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Nancy Giunta
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Richard Iorio
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Wolfgang Fitz
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Jeffrey K Lange
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Vivek M Shah
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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Radmard AR, Gholamrezanezhad A, Montazeri SA, Kasaeian A, Nematollahy N, Molaee Langrudi R, Javad Rashid R, Dehghan A, Hekmatnia A, Shakourirad A, Pezeshki Rad M, Nafisi Moghadam R, Sharifian H, Enhesari A, Aalinezhad M, Jamalipour Soufi G, Shakibafard A, Mohammadzadeh M, Jalli R, Bakhshayeshkaram M, Faghihi Langroudi T, Raoufi M, Abrishami A, Dehghan P, Bahrami-Motlagh H, Hashemi H, Sanei Taheri M. A Multicenter Survey on the Trend of Chest CT Scan Utilization: Tracing the First Footsteps of COVID-19 in Iran. Arch Iran Med 2020; 23:787-793. [PMID: 33220698 DOI: 10.34172/aim.2020.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/06/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Chest computed tomography (CT) scan has been used widely to diagnose COVID-19 in Iran. OBJECTIVES To trace the footsteps of COVID-19 in Iran by exploring the trend in using chest CT scans and its economic impact on radiology departments. Methods: In this cross-sectional study, the number of imaging examinations from 33 tertiary radiology departments in 9 large cities of Iran was collected from September 23, 2019 to March 20, 2020 (Months 1 to 6) and the corresponding months in 2018-2019. RESULTS A 50.2% increase was noted in the chest CT scan utilization in 2019-2020 compared to 2018-2019. This increase was +15%, +15%, +27%, +2%, +1% in Months 1-5 of 2019-2020, respectively. In Month 6 of 2019-2020, a 251% increase in the acquisition of chest CT scans was observed compared to the Month 6 of 2018-2019. Following negative balance of revenue from Month 1 to 5 with respect to the inflation rate, the total income in Month 6 was further 1.5% less than the same Month in 2018-19. CONCLUSION The observed peak in chest CT utilization in Month 3 prior to the surge in Month 6 could be explained by the seasonal influenza. However, unawareness about an emerging viral disease, i.e. COVID-19, might have underutilized chest CT in Months 4 and 5 before the official announcement in Month 6. The unbalanced increase in the workload of radiology departments in the shortage of cardiothoracic radiologists with the simultaneous decrease in income initiated a vicious cycle that worsened the economic repercussions of the pandemic.
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Affiliation(s)
- Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Gholamrezanezhad
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Amir Kasaeian
- Department of Biostatistics and Epidemiology, Hematology-Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nemat Nematollahy
- Department of Radiology, 5 Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Roghieh Molaee Langrudi
- Diagnostic Radiology Department, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Reza Javad Rashid
- Department of Radiology, Imam Reza hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Dehghan
- Department of Radiology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Hekmatnia
- Radiology Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Shakourirad
- Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Pezeshki Rad
- Department of Radiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Nafisi Moghadam
- Department of Radiology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hashem Sharifian
- Department of Radiology, Amir A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Enhesari
- Clinical Research Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Marzieh Aalinezhad
- Radiology Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Maryam Mohammadzadeh
- Department of Radiology, Amir A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Jalli
- Department of Radiology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Bakhshayeshkaram
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taraneh Faghihi Langroudi
- Department of Radiology, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoomeh Raoufi
- Department of Radiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Abrishami
- Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pooneh Dehghan
- Department of Radiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hooman Bahrami-Motlagh
- Department of Radiology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Sanei Taheri
- Department of Radiology, Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Tang Y, Wang LX, Xie WG, Shen ZA, Guo GH, Chen JJ, Han CM, Ren LC, Chu ZG, Yin MF, Wang Y, Zhang DX, Huang YS, Zhang JP. [Multicenter epidemiological investigation of hospitalized elderly, young and middle-aged patients with severe burn]. Zhonghua Shao Shang Za Zhi 2019; 33:537-544. [PMID: 28926874 DOI: 10.3760/cma.j.issn.1009-2587.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compare and analyze the epidemiological characteristics of hospitalized elderly, young and middle-aged patients with severe burn in recent years, so as to provide reference for the prevention and treatment of elderly patients with severe burn. Methods: Relying on the entry system of epidemiological case data and biological sample of severe burn from multicenter in clinic, medical records of patients with severe burn, aged above 18, hospitalized in 8 burn wards from January 2012 to December 2015 were collected. Six hundred and fifteen patients who were more than 18 years old and less than or equal to 65 years old were included in young and middle-aged group (YM). Eighty-two patients aged more than 65 years old were included in elderly group (E). Data of age, gender, residence, education level, cause of injury, location of injury, season of injury, total burn area, occurrence and area of full-thickness burn injury, wound site, inhalation injury incidence and severity, post burn admission time, proportion of delayed resuscitation, proportion of escharectomy or tangential excision and skin grafting, preinjury systemic disease, system complication during hospitalization, length of hospital stay, outcome of treatment, and reason of abandoning treatment of patients were analyzed. Data were processed with chi-square test and Mann-Whitney U test. The odds ratios of preinjury systemic disease, system complication during hospitalization, and adverse outcome of patients in group YM were compared with those in group E. Results: (1) The majority of patients in the two groups were male, but the proportion of male patients in group YM was higher. There was statistically significant difference in gender distribution of patients between the two groups (χ(2)=18.727, P<0.001). The majority of patients in the two groups were from rural areas, but the proportion of rural patients in group E was higher. There was statistically significant difference in residence distribution of patients between the two groups (χ(2)=9.306, P=0.002). Patients in group YM mainly had secondary education, while patients in group E mainly had primary education. There was statistically significant difference in distribution of education level of patients between the two groups (χ(2)=146.797, P<0.001). (2) The most common causes of injury of patients in the two groups were both flame, but the proportion of patients with flame burn injury in group E was higher. There was statistically significant difference in distribution of cause of injury of patients between the two groups (χ(2)=25.063, P<0.001). The main locations of injury of patients in groups YM and E were respectively public place and private residence. There was statistically significant difference in location distribution of injury of patients between the two groups (χ(2)=46.313, P<0.001). The main seasons of injury of patients in groups YM and E were respectively summer and winter. There was statistically significant difference in season distribution of patients between the two groups (χ(2)=23.143, P<0.001). There was statistically significant difference in distribution of total burn area of patients between the two groups (χ(2)=25.799, P=0.002). The occurrences of full-thickness burn injury of patients in the two groups were similar (χ(2)=2.685, P=0.101), while there was statistically significant difference in area of full-thickness burn injury of patients between the two groups (χ(2)=26.702, P=0.002). There was no statistically significant difference in distribution of wound site of patients between the two groups (χ(2)=3.954, P=0.785). There were no statistically significant differences in incidence and severity distribution of inhalation injury of patients between the two groups (with χ(2) values respectively 0.425 and 0.672, P values above 0.05). (3) There was statistically significant difference in distribution of admission time of patients between the two groups (χ(2)=6.632, P=0.036), but there was no statistically significant difference in proportion of delayed resuscitation of patients between the two groups (χ(2)=1.261, P=0.261). The proportion of escharectomy or tangential excision and skin grafting of patients in group YM was 72.0% (443/615), which was significantly higher than 35.4% (29/82) of group E (χ(2)=44.498, P<0.001). The incidence of preinjury systemic disease of patients in group YM was 13.2% (81/615), which was significantly lower than 61.0% (50/82) of group E (χ(2)=108.337, P<0.001). The risk of preinjury systemic disease of patients in group E was 10.30 times of that of patients in group YM [with 95% confidence interval (CI) of 6.24-17.01, P<0.001]. During hospitalization, 59.8% (49/82) of patients in group E suffered from system complications, which was significantly higher than 36.6% (225/615) of group YM (χ(2)=16.282, P<0.001). The risk of system complication of patients in group E was 2.57 times of patients in group YM (with 95% CI of 1.61-4.12, P<0.001). The length of hospital stay of patients in group E was significantly shorter than that of group YM (U=36 735, P<0.001). There was statistically significant difference in treatment outcome of patients between the two groups (χ(2)=106.251, P<0.001). The risk of adverse outcome of patients in group E was 7.52 times of group YM (with 95% CI of 4.40-12.88, χ(2)=67.709, P<0.001). The proportion of abandoning treatment of patients in group E was significantly higher than that of group YM (χ(2)=150.670, P<0.001). The risk of abandoning treatment of patients in group E was 15.86 times of that of group YM (with 95% CI of 9.36-26.88, P<0.001). There was no statistically significant difference in distribution of reason of abandoning treatment of patients between the two groups (χ(2)=4.178, P=0.243). Conclusions: There were significant differences in the epidemiological characteristics of patients in groups E and YM. In elderly burn patients, the proportion of rural population was higher and the education level was lower. Flame burn was common and burns mostly occurred in private residences and in winter. The total burn area was slightly lower but the area of full-thickness burn injury was larger. The length of hospital stay was shorter and the proportion of surgical treatment was lower. The incidences of preinjury systemic disease and system complication during hospitalization were higher, and therefore the risks of adverse outcome and abandoning treatment were higher.
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Affiliation(s)
- Y Tang
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, the Third Military Medical University, Chongqing 400038, China
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14
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Kharazifard MJ, Holakouie-Naieni K, Mansournia MA. Application of Multilevel Models in Dentistry. J Dent (Tehran) 2017; 14:352-360. [PMID: 29942330 PMCID: PMC6015589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Multilevel analysis which was primarily introduced to deal with hierarchical data was later applied extensively for research in other fields of science and not only for nested data, but also for repeated measurements or clustered trials. This method of statistical analysis was applied in dental studies in the 1991 for the first time but despite its value for data analysis in dental studies, its application for dental studies remains limited until now. This manuscript reviews the applications of this method in dental studies.
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Affiliation(s)
- Mohammad Javad Kharazifard
- PhD Candidate of Epidemiology, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author: MJ. Kharazifard, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,
| | - Kurosh Holakouie-Naieni
- Professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Assistant Professor, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Touzet S, Occelli P, Schröder C, Manificat S, Gicquel L, Stanciu R, Schaer M, Oreve MJ, Speranza M, Denis A, Zelmar A, Falissard B, Georgieff N, Bahrami S, Geoffray MM. Impact of the Early Start Denver Model on the cognitive level of children with autism spectrum disorder: study protocol for a randomised controlled trial using a two-stage Zelen design. BMJ Open 2017; 7:e014730. [PMID: 28348195 PMCID: PMC5372147 DOI: 10.1136/bmjopen-2016-014730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Early intervention for autism spectrum disorder (ASD) in the European French-speaking countries is heterogeneous and poorly evaluated to date. Early intervention units applying the Early Start Denver Model (ESDM) for toddlers and young children with ASD have been created in France and Belgium to improve this situation. It is essential to evaluate this intervention for the political decision-making process regarding ASD interventions in European French-speaking countries. We will evaluate the effectiveness of 12 hours per week ESDM intervention on the cognitive level of children with ASD, over a 2-year period. METHODS AND ANALYSIS The study will be a multicentre, randomised controlled trial, using a two-stage Zelen design. Children aged 15-36 months, diagnosed with ASD and with a developmental quotient (DQ) of 30 or above on the Mullen Scale of Early Learning (MSEL) will be included. We will use a stratified minimisation randomisation at a ratio 1:2 in favour of the control group. The sample size required is 180 children (120 in the control and 60 in the intervention group). The experimental group will receive 12 hours per week ESDM by trained therapists 10 hours per week in the centre and 2 hours in the toddlers' natural environment (alternatively by the therapist and the parent). The control group will receive care available in the community. The primary outcome will be the change in cognitive level measured with the DQ of the MSEL scored at 2 years. Secondary outcomes will include change in autism symptoms, behavioural adaptation, communicative and productive language level, sensory profile and parents' quality of life. The primary analysis will use the intention-to-treat principle. An economic evaluation will be performed. DISSEMINATION Findings from the study will be disseminated through peer reviewed publications and meetings. TRIAL REGISTRATION NUMBER NCT02608333 (clinicaltrials.gov); Pre-results.
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Affiliation(s)
- Sandrine Touzet
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon F-69003, France
- Laboratoire Health Services and Performance Research, EA 7425 HESPER, Université de Lyon, Lyon F-69008France
| | - Pauline Occelli
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon F-69003, France
- Laboratoire Health Services and Performance Research, EA 7425 HESPER, Université de Lyon, Lyon F-69008France
| | - Carmen Schröder
- Department of Child and Adolescent Psychiatry, Hopitaux universitaires de Strasbourg, Strasbourg F-67000, France
- CNRS UPR 3212—Team 9, Strasbourg University, Strasbourg F-67000, France
| | | | - Ludovic Gicquel
- Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier Spécialisé Henri Laborit, Saint Benoît F-86280, France
- Child and Adolescent Psychiatry Department, Unité de Recherche Clinique, Université de Poitiers, Poitiers F-86000, France
| | - Razvana Stanciu
- Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Bruxelles 1020, Belgium
| | - Marie Schaer
- Office Médico-Pédagogique, University of Geneva, Geneva, Switzerland
| | - Marie-Joelle Oreve
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Le Chesnay F-78150, France
| | - Mario Speranza
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Le Chesnay F-78150, France
- EA 4047 HANDIReSP, Université de Versailles Saint-Quentin-en-Yvelines, Versailles F-78000, France
| | - Angelique Denis
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon F-69003, France
- Laboratoire Health Services and Performance Research, EA 7425 HESPER, Université de Lyon, Lyon F-69008France
| | - Amelie Zelmar
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon F-69003, France
- Laboratoire Health Services and Performance Research, EA 7425 HESPER, Université de Lyon, Lyon F-69008France
| | - Bruno Falissard
- Université Paris-Sud, CESP, INSERM, UVSQ, Université Paris-Saclay, U1178, Maison de Solenn, Paris cedex 14, France
- Department of Public Health, AP-HP, Hôpital Paul Brousse, Villejuif F-94800, France
| | - Nicolas Georgieff
- Department of child and adolescent psychiatry, Centre Hospitalier le Vinatiers, Bron F-69500, France
- Université de Lyon, Lyon F-69008, France
| | - Stephane Bahrami
- EA 4047 HANDIReSP, Université de Versailles Saint-Quentin-en-Yvelines, Versailles F-78000, France
- CIC 1429, INSERM, AP-HP, Hôpital Raymond-Poincare, Garches F-92380, France
| | - Marie-Maude Geoffray
- Department of child and adolescent psychiatry, Centre Hospitalier le Vinatiers, Bron F-69500, France
- Université de Lyon, Lyon F-69008, France
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16
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Vasania VS, Hari A, Tandon R, Shah S, Haldipurkar S, Shah S, Sachan S, Viswanathan C. Transplantation of Autologous Ex Vivo Expanded Human Conjunctival Epithelial Cells for Treatment of Pterygia: A Prospective Open-label Single Arm Multicentric Clinical Trial. J Ophthalmic Vis Res 2015; 9:407-16. [PMID: 25709763 PMCID: PMC4329698 DOI: 10.4103/2008-322x.150800] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 10/12/2013] [Indexed: 11/04/2022] Open
Abstract
Purpose: To establish the efficacy and safety of ex vivo cultured autologous human conjunctival epithelial cell (hCjEC) transplantation for treatment of pterygia. Methods: Twenty-five patients with pterygia were recruited at different centers across the country. Autologous hCjEC grafts were prepared from conjunctival biopsy specimens excised from the healthy eye and cultured ex vivo on human amniotic membrane mounted on inserts using a unique mounting device. The hCjEC grafts were then transported in an in-house designed transport container for transplantation. Post-surgery, the patients were followed up on days 1, 7, 14, 30, 90, and 180 as per the approved study protocol. Clinical outcomes were assessed by slit lamp examination, visual acuity, imprint cytology, fluorescein/rose bengal staining, Schirmer's test, and photographic evaluation three and 6 months post-transplantation. Results: Two patients were lost to follow-up and final analysis included 23 cases. No recurrence of pterygium was observed in 18 (78.3%) patients; all of these eyes showed a smooth conjunctival surface without epithelial defects. Recurrence was observed in 5 (21.7%) patients at 3 months post-treatment. No conjunctival inflammation, secondary infections or other complications were reported. Adequate goblet cells were present in 19 (82.6%) patients at the site of transplantation. Conclusion: We have, for the 1st time, standardized a protocol for preparing autologous hCjEC grafts that can be safely transported to multiple centers across the country for transplantation. The clinical outcome was satisfactory for treating pterygia.
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Affiliation(s)
- Viraf Sam Vasania
- Regenerative Medicine Group, Reliance Life Sciences Pvt. Ltd., Navi Mumbai, Maharashtra, India
| | - Aarya Hari
- Regenerative Medicine Group, Reliance Life Sciences Pvt. Ltd., Navi Mumbai, Maharashtra, India
| | - Radhika Tandon
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Shah
- Department of Ophthalmology, King Edward Memorial Hospital, Pune, Maharashtra, India
| | | | - Smitesh Shah
- Dr. Shah's Laser Eye Institute, Kalyan West, Thane, Maharashtra, India
| | - Shailendra Sachan
- Regenerative Medicine Group, Reliance Life Sciences Pvt. Ltd., Navi Mumbai, Maharashtra, India
| | - Chandra Viswanathan
- Regenerative Medicine Group, Reliance Life Sciences Pvt. Ltd., Navi Mumbai, Maharashtra, India
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17
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Gangemi M, Cavallo LM, Di Somma A, Mazzucco GM, Bono PS, Ghetti G, Zambon G. Hydrocephalus onset after microsurgical or endovascular treatment for acute subarachnoid hemorrhage. Retrospective italian multicenter study. Transl Med UniSa 2014; 9:50-5. [PMID: 24809036 PMCID: PMC4012376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 03/24/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic shunt-dependent hydrocephalus is a complication of aneurysmal subarachnoid hemorrhage (aSAH). Its incidence and risk factors have been described while the hydrocephalus onset in terms of days after treatment (microsurgical or endovascular) has not been yet analyzed. MATERIALS AND METHODS 45 patients, treated for aSAH in 4 Italian Neurosurgical Departments, were retrospectively analyzed. It was calculated the time that elapses between treatment and hydrocephalus onset in 36 patients. RESULTS Of the 45 shunted patients, 15 (33.3%) were included in the microsurgical group (group A) and 30 (66.6%) were in the endovascular one (group B). There was no difference of the hydrocephalus onset between the two groups (24,1 days, group A vs. 27,7 days, group B). The presence of intracerebral hematoma (ICH) caused a delay in the hydrocephalus onset after endovascular treatment in terms of 11,5 days compared to microsurgical group as well the absence of vasospasm determined a delay of 13,7 days (not statistically significant). CONCLUSION No difference in terms of hydrocephalus onset after microsurgical or endovascular treatment has been demonstrated. Only the presence of ICH or the absence of vasospasm can cause a slight delay in the time of hydrocephalus onset in the endovascular series (not statistically significant). Long-term follow-up studies involving higher numbers of subjects are needed to better demonstrate this issue.
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Affiliation(s)
- Michelangelo Gangemi
- Department of Neurosciences and Reproductive and Odontostomatological Sciences Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Luigi Maria Cavallo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Alberto Di Somma
- Department of Neurosciences and Reproductive and Odontostomatological Sciences Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy,
| | - Grazia Marina Mazzucco
- Department of Neurosurgery, Treviso Regional Hospital-University of Padova, Treviso, Italy
| | - Paolo Sebastiano Bono
- Department of Human Pathology and Oncology, University of Florence, Units of Neurosurgery Careggi Hospital, Florence, Italy
| | - Giovanni Ghetti
- Ospedale S. Maria della Misericordia- S. Andrea delle Fratte, Università degli Studi di Perugia, Perugia, Italy
| | - Giampaolo Zambon
- Department of Neuroscience and Neurosurgery, San Bortolo Hospital, Vicenza, Italy
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