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Hjorth M, Svanberg A, LoMartire R, Kaminsky E, Rorsman F. Patient perceived quality of cirrhosis care- adjunctive nurse-based care versus standard medical care: a pragmatic multicentre randomised controlled study. BMC Nurs 2024; 23:251. [PMID: 38637755 PMCID: PMC11027520 DOI: 10.1186/s12912-024-01934-9] [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: 12/06/2023] [Accepted: 04/12/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Cirrhosis treatment implies prevention and alleviation of serious disease events. Healthcare providers may, however, fail to meet patients' expectations of collaboration and specific needs of information and support. Individualised nursing care could meet patients' needs. The aim was thus to measure patient-perceived quality of care after adjunctive registered nurse-based intervention Quality Liver Nursing Care Model (QLiNCaM) compared with standard medical care. METHODS This pragmatic multicentre study consecutively randomised patients to either adjunctive registered nurse-based care, or standard medical care for 24 months (ClinicalTrials.gov NCT02957253). Patients were allocated to either group at an equal ratio, at six Swedish outpatient clinics during 2016-2022. Using the questionnaire 'Quality of care from the patient's perspective', patients rated their perceived lack of quality for the adjunctive registered nurse-based intervention compared with the control group at 12 and 24 months, respectively. RESULTS In total, 167 patients were recruited. Seven out of 22 items in the questionnaire supported the finding that 'lacking quality' decreased with adjunctive registered nurse-based care (p < 0.05) at 12 months follow-up; however, these differences could not be established at 24 months. CONCLUSION Additional structured registered nurse-based visits in the cirrhosis outpatient team provided support for improved patient-perceived quality of care during the first 12 months. Registered nurses increase patient involvement and present easy access to cirrhosis outpatient care. Patients express appreciation for personalised information. This study reinforces registered nurses' role in the outpatient cirrhosis team, optimising patient care in compensated and decompensated cirrhosis. TRIAL REGISTRATION Registered at Clinical Trials 18th of October 2016, [ https://www. CLINICALTRIALS gov ], registration number: NCT02957253.
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Affiliation(s)
- Maria Hjorth
- Centre for Clinical Research in Dalarna, Uppsala University, Falun, Sweden.
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | | | - Riccardo LoMartire
- Centre for Clinical Research in Dalarna, Uppsala University, Falun, Sweden
- School of Health and Wellfare, Dalarna University, Falun, Sweden
| | - Elenor Kaminsky
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Fredrik Rorsman
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Piazza M, Squizzato F, Pratesi G, Parlani G, Simonte G, Giudice R, Mansour W, Veraldi GF, Gennai S, Antonello M. Outcomes of Off the Shelf Outer Branched Versus Inner Branched Endografts in the Treatment of Thoraco-abdominal Aortic Aneurysm in the B.R.I.O. (BRanched Inner - Outer) Study Group. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00341-1. [PMID: 38636923 DOI: 10.1016/j.ejvs.2024.04.005] [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] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/25/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE This study aimed to compare two commercially available off the shelf branched endografts for thoraco-abdominal aortic aneurysm (TAAA) repair, namely the E-nside (Artivion) and Zenith t-Branch (Cook Medical) devices. METHODS This multicentre retrospective study (2020 - 2023) included patients treated by branched endovascular aortic repair (BEVAR) for TAAA using the inner branched E-nside or the outer branched t-Branch. Endpoints were 30 day technical success and major adverse events (MAEs) as well as 1 year freedom from target vessel instability and main endograft instability. RESULTS The study included 163 patients: 79 (307 target vessels) treated with E-nside and 84 (325 target vessels) with t-branch. Aneurysm extent was I - III in 91 patients (55.8%; 47% of E-nside and 66% of t-Branch) and IV in 72 patients (44.2%; 53% of E-nside and 34% of t-Branch) (p = .011). An adjunctive proximal thoracic endograft was used in 43% of E-nside vs. 69% of t-Branch (p < .001), with less frequent thoracic endografting (14% vs. 76%; p < .001) and shorter length of coverage (p = .024) in extent IV TAAA treated by E-nside. E-nside cases had shorter bridging length of renal arteries (66 ± 17 mm vs. 76 ± 20 mm; p < .010) and less frequent use of a distal bifurcated endograft (53% vs. 80%; p < .001). Comparing 30 day results, mortality was 1% vs. 2% (p = .62), any MAE occurred in 18% vs. 21% (p = .55), the stroke rate was 3% vs. 0% (p = .23), and the elective spinal cord ischaemia rate was 5% vs. 8% (p = .40) for E-nside and t-Branch, respectively. At 1 year, freedom from target vessel instability was 96 ± 3% for E-nside and 95 ± 3% for t-Branch (p = .58), and freedom from endograft instability was 98 ± 2% vs. 97 ± 3% (p = .46) respectively. CONCLUSION Both off the shelf devices provided excellent early and 1 year results. The E-nside may require shorter thoracic aorta coverage and bridging length for the renal arteries, and less frequent implantation of concomitant proximal thoracic or distal abdominal bifurcated endograft. However, these aspects did not determine significant differences in clinical outcomes.
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Affiliation(s)
- Michele Piazza
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Francesco Squizzato
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giovanni Pratesi
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Gianbattista Parlani
- Unit of Vascular and Endovascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Gioele Simonte
- Unit of Vascular and Endovascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Rocco Giudice
- Vascular and Endovascular Surgery Unit, San Giovanni Addolorata Hospital, Rome, Italy
| | - Wassim Mansour
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I -"La Sapienza" University of Rome, Rome, Italy
| | | | - Stefano Gennai
- Division of Vascular Surgery, University Hospital of Modena and Reggio Emilia, Baggiovara (MO), Italy
| | - Michele Antonello
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Hata S, Okada H, Minamida M, Hironaka J, Hasegawa Y, Kondo Y, Nakajima H, Kitagawa N, Okamura T, Hashimoto Y, Osaka T, Kitagawa N, Majima S, Senmaru T, Ushigome E, Nakanishi N, Asano M, Hamaguchi M, Fukui M. Associations between thyroid hormones and appendicular skeletal muscle index, and hand grip strength in people with diabetes: The KAMOGAWA-A study. Diabetes Res Clin Pract 2024; 209:111573. [PMID: 38346590 DOI: 10.1016/j.diabres.2024.111573] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
AIM To assess the effects of thyroid hormones on appendicular skeletal muscle index (SMI) and hand grip strength (HGS) in people with diabetes. METHODS This cross-sectional cohort included 1,135 participants with diabetes admitted to 3 hospitals in Japan. Multiple regression analysis was performed to determine the associations among thyroid hormone levels, SMI, and HGS. RESULTS Of the 1,135 participants, 480 were female. Their median (interquartile range) age, body mass index, durations of diabetes, and glycated haemoglobin levels were 68 years, 24.3 kg/m2, 10 years, and 7.6 %, respectively. The median (interquartile range) SMI (kg/m2) and hand grip strength of the cohort were 7.1 kg/m2 and 28.2 kg, respectively. Positive correlations between FT3 and the FT3/FT4 ratio with SMI and HGS was observed after adjusting for covariates in males. A negative correlation was found between the FT3/FT4 ratio and sarcopenia as a result of low SMI and low HGS in the male participants but not in females (p for interaction = 0.02). CONCLUSIONS FT3/FT4 ratios may impact skeletal muscles in people with diabetes-particularly in males. Assessments of FT3/FT4 ratios may represent key indicators of muscle mass and strength in males.
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Affiliation(s)
- Shinnosuke Hata
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan; Department of Endocrinology and Metabolism, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Hiroshi Okada
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan; Department of Diabetes and Endocrinology, Matsushita Memorial Hospital, Moriguchi, Japan.
| | - Megumi Minamida
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Junya Hironaka
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yuka Hasegawa
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yuriko Kondo
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Hanako Nakajima
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Nobuko Kitagawa
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Takuro Okamura
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan; Department of Diabetes and Endocrinology, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Takafumi Osaka
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan; Department of Diabetology, Kameoka Municipal Hospital, Kameoka, Japan
| | - Noriyuki Kitagawa
- Department of Endocrinology and Diabetology, Ayabe City Hospital, Ayabe, Japan
| | - Saori Majima
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Takafumi Senmaru
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Naoko Nakanishi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Mai Asano
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan; Division of Metabolism and Rheumatology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan; Department of Endocrinology and Diabetology, Ayabe City Hospital, Ayabe, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Bicalho MAC, Aliberti MJR, Delfino-Pereira P, Chagas VS, Rosa PMDS, Pires MC, Ramos LEF, Bezerra AFB, de Castro Feres AB, Dos Reis Gomes AG, Bhering AR, Pessoa BP, Silva CTCAD, Cimini CCR, Suemoto CK, Dias CAC, Carazai DDR, Ponce D, Rios DRA, Manenti E, Anschau F, Batista JDL, Alvarenga JCD, Viguini JA, Zanellato JM, Rugolo JM, Ruschel KB, do Nascimento L, Menezes LSM, Oliveira LMCD, Castro LCD, Nasi LA, Carneiro M, Ferreira MAP, Godoy MFD, Guimarães-Júnior MH, Oliveira NRD, Ziegelmann PK, Porto PF, Mendes PM, Paraíso PG, Reis PPD, Francisco SC, Araújo SF, Avelino-Silva TJ, Marcolino MS. Clinical characteristics and outcomes of COVID-19 patients with preexisting dementia: a large multicenter propensity-matched Brazilian cohort study. BMC Geriatr 2024; 24:25. [PMID: 38182982 PMCID: PMC10770897 DOI: 10.1186/s12877-023-04494-w] [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] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/17/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We examined the clinical presentations and outcomes of COVID-19 in a multicentre cohort of in-hospital patients, comparing those with and without dementia. METHODS This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥ 60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year, and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events. RESULTS Among 1,556 patients included in the study, 405 (4.5%) had a diagnosis of dementia and 1,151 were matched controls. When compared to matched controls, patients with dementia had a lower frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia; and higher frequency of fever and delirium. They also had a lower frequency of ICU admission (32.7% vs. 47.1%, p < 0.001) and shorter ICU length of stay (7 vs. 9 days, p < 0.026), and a lower frequency of sepsis (17% vs. 24%, p = 0.005), KRT (6.4% vs. 13%, p < 0.001), and IVM (4.6% vs. 9.8%, p = 0.002). There were no differences in hospital mortality between groups. CONCLUSION Clinical manifestations of COVID-19 differ between older inpatients with and without dementia. We observed that dementia alone could not explain the higher short-term mortality following severe COVID-19. Therefore, clinicians should consider other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of older adults with dementia hospitalised with COVID-19.
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Affiliation(s)
- Maria Aparecida Camargos Bicalho
- Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Sala 246, Santa Efigênia, Belo Horizonte, Brazil.
- Cologne University, Albertus-Magnus-Platz, Cologne, 50923, Allemagne.
| | - Márlon Juliano Romero Aliberti
- Laboratório de Investigação Médica Em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Research Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Polianna Delfino-Pereira
- Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Sala 246, Santa Efigênia, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
| | - Victor Schulthais Chagas
- Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
- Medical School, Universidade Federal de Viçosa, Av. Peter Henry Rolfs, S/N, Viçosa, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Belo Horizonte, Brazil
| | - Patryk Marques da Silva Rosa
- Medical School, Centro Universitário de Belo Horizonte, Av. Professor Mário Werneck, 1685, Belo Horizonte, Brazil
| | - Magda Carvalho Pires
- Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Lucas Emanuel Ferreira Ramos
- Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | | | | | | | | | - Bruno Porto Pessoa
- Hospital Júlia Kubitschek, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
| | | | - Christiane Corrêa Rodrigues Cimini
- Hospital Santa Rosália, R. Do Cruzeiro, 01, Teófilo Otoni, Brazil
- Mucuri Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, R. Cruzeiro, 01, Teófilo Otoni, Brazil
| | - Claudia Kimie Suemoto
- Laboratório de Investigação Médica Em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Daniela Dos Reis Carazai
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | - Daniela Ponce
- Botucatu Medical School, Universidade Estadual Paulista "Júlio de Mesquita Filho", Av. Prof. Mário Rubens Guimarães Montenegro, Botucatu, Brazil
| | | | - Euler Manenti
- Hospital Mãe de Deus, R. José de Alencar, 286, Porto Alegre, Brazil
| | - Fernando Anschau
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | - Joanna d'Arc Lyra Batista
- Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
- Universidade Federal da Fronteira Sul, Rod. SC-459, Km 02, Fronteira Sul, Chapecó, Brazil
- Hospital Regional do Oeste, Hospital Regional do Oeste, Florianópolis street, Brazil
| | | | - Julia Avancini Viguini
- Mucuri Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, R. Cruzeiro, 01, Teófilo Otoni, Brazil
| | | | - Juliana Machado Rugolo
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | - Karen Brasil Ruschel
- Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
- Hospital Universitário Canoas, Av. Farroupilha, 8001, Canoas, Brazil
| | | | - Luanna Silva Monteiro Menezes
- Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil
- Hospital Luxemburgo, R. Gentios, 1350, Belo Horizonte, Brazil
| | | | | | - Luiz Antônio Nasi
- Hospital Moinhos de Vento, R. Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Marcelo Carneiro
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz Do Sul, Brazil
| | | | | | | | | | | | - Paula Fonseca Porto
- Medical School, Centro Universitário de Belo Horizonte, Av. Professor Mário Werneck, 1685, Belo Horizonte, Brazil
| | | | - Pedro Gibson Paraíso
- Orizonti - Instituto Oncomed de Saúde e Longevidade, Av. José Do Patrocínio Pontes, 1355, Belo Horizonte, Brazil
| | | | | | | | - Thiago Junqueira Avelino-Silva
- Laboratório de Investigação Médica Em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Global Brain Health Institute, University of California, Av, Raja Gabaglia, San Francisco, Estoril, USA
| | - Milena Soriano Marcolino
- Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Sala 246, Santa Efigênia, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Belo Horizonte, Brazil
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Chen Y, Zhu J, Zhu F, Feng C, Luo C, Song C. Predictive Factors for Dysphagia After Anterior Cervical Spine Surgery: A Prospective Multicenter Study. World Neurosurg 2023; 178:e533-e539. [PMID: 37516144 DOI: 10.1016/j.wneu.2023.07.115] [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: 05/01/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE To identify the incidence and predictors of postoperative dysphagia in patients who undergo anterior cervical spine surgery (ACSS) by utilizing the Eating Assessment Tool (EAT-10). METHODS A multicenter prospective study was undertaken at three hospitals to evaluate patients undergoing ACSS between January 2021 and January 2023. Included patients were aged 18-80 years and were undergoing primary or revision ACSS. Dysphagia was assessed using the validated EAT-10 questionnaire. Patients with dysphagia were included in the observation group, and those without dysphagia were included in the control group. RESULTS Of the 343 patients enrolled, 50 patients (14.6%) had EAT-10 scores of 3 or more at the 6-month follow-up. In the univariate analysis, patients with dysphagia at 7 days had a longer operative time, were current smokers, had involvement of vertebral bodies at C4 and above, and underwent intraoperative neurophysiological monitoring. Patients with dysphagia at 6 months had involvement of vertebral bodies at C4 and above and underwent intraoperative neurophysiological monitoring. In the multivariate analysis to determine associations with prolonged dysphagia, only the involvement of vertebral bodies at C4 and above (odds ratio 3.883, 95% confidence interval 1.847-8.165, P = 0.001) and intraoperative neurophysiological monitoring (odds ratio 0.273, 95% confidence interval 0.080-0.931, P = 0.038) remained significant. CONCLUSIONS Dysphagia is common after ACSS, affecting more than 67.5% of patients at 7 days postoperatively, but over time, the incidence of dysphagia gradually decreases. Involvement of the vertebral bodies at C4 and above is a risk factor for dysphagia after ACSS, and intraoperative neurophysiological monitoring is a protective factor.
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Affiliation(s)
- Yu Chen
- Army Medical University, Chongqing, China
| | - Jingzhen Zhu
- Department of Urology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Fengzhao Zhu
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chencheng Feng
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chunmei Luo
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Caiping Song
- Department of Office of the Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China.
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Taprogge J, Vergara-Gil A, Leek F, Abreu C, Vávrová L, Carnegie-Peake L, Schumann S, Eberlein U, Lassmann M, Schurrat T, Luster M, Verburg FA, Vallot D, Vija L, Courbon F, Newbold K, Bardiès M, Flux G. Normal organ dosimetry for thyroid cancer patients treated with radioiodine as part of the multi-centre multi-national Horizon 2020 MEDIRAD project. Eur J Nucl Med Mol Imaging 2023; 50:3225-3234. [PMID: 37300572 PMCID: PMC10256579 DOI: 10.1007/s00259-023-06295-0] [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] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Dosimetry is rarely performed for the treatment of differentiated thyroid cancer patients with Na[131I]I (radioiodine), and information regarding absorbed doses delivered is limited. Collection of dosimetry data in a multi-centre setting requires standardised quantitative imaging and dosimetry. A multi-national, multi-centre clinical study was performed to assess absorbed doses delivered to normal organs for differentiated thyroid cancer patients treated with Na[131I]I. METHODS Patients were enrolled in four centres and administered fixed activities of 1.1 or 3.7 GBq of Na[131I]I using rhTSH stimulation or under thyroid hormone withdrawal according to local protocols. Patients were imaged using SPECT(/CT) at variable imaging time-points following standardised acquisition and reconstruction protocols. Whole-body retention data were collected. Dosimetry for normal organs was performed at two dosimetry centres and results collated. RESULTS One hundred and five patients were recruited. Median absorbed doses per unit administered activity of 0.44, 0.14, 0.05 and 0.16 mGy/MBq were determined for the salivary glands of patients treated at centre 1, 2, 3 and 4, respectively. Median whole-body absorbed doses for 1.1 and 3.7 GBq were 0.05 Gy and 0.16 Gy, respectively. Median whole-body absorbed doses per unit administered activity of 0.04, 0.05, 0.04 and 0.04 mGy/MBq were calculated for centre 1, 2, 3 and 4, respectively. CONCLUSIONS A wide range of normal organ doses were observed for differentiated thyroid cancer patients treated with Na[131I]I, highlighting the necessity for individualised dosimetry. The results show that data may be collated from multiple centres if minimum standards for the acquisition and dosimetry protocols can be achieved.
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Affiliation(s)
- Jan Taprogge
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK.
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.
| | - Alex Vergara-Gil
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, INSERM Université Paul Sabatier, Toulouse, France
| | - Francesca Leek
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Carla Abreu
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Lenka Vávrová
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Lily Carnegie-Peake
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Sarah Schumann
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Uta Eberlein
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Tino Schurrat
- Department of Nuclear Medicine, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Markus Luster
- Department of Nuclear Medicine, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Frederik A Verburg
- Department of Nuclear Medicine, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Delphine Vallot
- IUCT Oncopole, Av. Irène Joliot-Curie, 31100, Toulouse, France
| | - Lavinia Vija
- IUCT Oncopole, Av. Irène Joliot-Curie, 31100, Toulouse, France
| | | | - Kate Newbold
- Thyroid Unit, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Manuel Bardiès
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, INSERM Université Paul Sabatier, Toulouse, France
- Institut de Recherches en Cancérologie de Montpellier, UMR 1194, INSERM Université de Montpellier, 34298, Montpellier, France
| | - Glenn Flux
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
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Akiyama T, Miyamoto Y, Matsuda A, Tokunaga R, Ogawa K, Iwatsuki M, Iwagami S, Baba Y, Yoshida N, Sonoda H, Yamada T, Yoshida H, Baba H. The colon inflammatory index score can predict the survival outcome after resection of colorectal cancer: a retrospective multicentre study. J Cancer Res Clin Oncol 2023; 149:7887-7894. [PMID: 37058251 DOI: 10.1007/s00432-023-04770-7] [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: 04/03/2023] [Accepted: 04/08/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE Many systemic inflammatory markers have been identified to be prognostic factors in various diseases, including colorectal cancer (CRC). The Colon Inflammatory Index (CII), which is based on the lactate dehydrogenase (LDH) level and the neutrophil-to-lymphocyte ratio (NLR), is reportedly a predictor of the outcome of chemotherapy in patients with metastatic CRC. This retrospective review study aimed to determine whether CII can predict the prognosis after surgical resection of CRC. METHODS A total of 1,273 patients who underwent CRC resection were enrolled and divided into a training cohort (n = 799) and a validation cohort (n = 474). The impact of the preoperative CII score on overall survival (OS) and recurrence-free survival (RFS) was assessed. RESULTS In the training cohort, the CII score was good in 569 patients (71.2%), intermediate in 209 (26.2%), and poor in 21 (2.6%). There were significant between-group differences in body mass index, American Society of Anaesthesiologists physical status, and preoperative tumour markers. The 5-year OS rate was significantly lower in patients with an intermediate or poor CII score (CII risk) than in those with no CII risk (73.8% vs. 84.2%; p < 0.001, log-rank test). In multivariate analysis, CII risk remained a significant independent predictor of poor OS (hazard ratio 1.75; 95% confidence interval 1.18-2.60; p = 0.006). In the validation cohort, the 5-year OS rate was significantly lower in patients with CII risk than in those with no CII risk (82.8% vs. 88.4%; p = 0.046, log-rank test). CONCLUSION These findings indicate that the CII can predict OS after resection of CRC.
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Affiliation(s)
- Takahiko Akiyama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Ryuma Tokunaga
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Katsuhiro Ogawa
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hiromichi Sonoda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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Zheng J, Hu Y, Xu H, Lei Y, Zhang J, Zheng Q, Li L, Tu W, Chen R, Guo Q, Zang X, You Q, Xu Z, Zhou Q, Wu X. Normal-weight visceral obesity promotes a higher 10-year atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus-a multicenter study in China. Cardiovasc Diabetol 2023; 22:137. [PMID: 37308932 DOI: 10.1186/s12933-023-01876-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Visceral obesity is associated with high cardiovascular events risk in type 2 diabetes mellitus (T2DM). Whether normal-weight visceral obesity will pose a higher atherosclerotic cardiovascular disease (ASCVD) risk than body mass index (BMI)-defined overweight or obese counterparts with or without visceral obesity remains unclear. We aimed to explore the relationship between general obesity and visceral obesity and 10-year ASCVD risk in patients with T2DM. METHODS Patients with T2DM (6997) who satisfied the requirements for inclusion were enrolled. Patients were considered to have normal weight when 18.5 kg/m2 ≤ BMI < 24 kg/m2; overweight when 24 kg/m2 ≤ BMI < 28 kg/m2; and obesity when BMI ≥ 28 kg/m2. Visceral obesity was defined as a visceral fat area (VFA) ≥ 100 cm2. Patients were separated into six groups based on BMI and VFA. The odd ratios (OR) for a high 10-year ASCVD risk for different combinations of BMI and VFA were analysed using stepwise logistic regression. Receiver operating characteristic (ROC) curves for diagnosing the high 10-year ASCVD risk were constructed, and areas under the ROC curves were estimated. Potential non-linear relationships between VFA levels and high 10-year ASCVD risk were examined using restricted cubic splines (knot = 4). Multilinear regression was used to identify factors affecting VFA in patients with T2DM. RESULTS In patients with T2DM, subjects with normal-weight visceral obesity had the highest 10-year ASCVD risk among the six groups, which had more than a 2-fold or 3-fold higher OR than those who were overweight or obese according to BMI but did not have visceral obesity (all P < 0.05). The VFA threshold for high 10-year ASCVD risk was 90 cm2. Multilinear regression showed significant differences in the effect of age, hypertension, drinking, fasting serum insulin, fasting plasma glucose, 2 h postprandial C-peptide, triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol on VFA in patients with T2DM (all P < 0.05). CONCLUSIONS T2DM patients with normal-weight visceral obesity had a higher 10-year ASCVD risk than BMI-defined overweight or obese counterparts with or without visceral obesity, which should initiate standardised management for ASCVD primary prevention.
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Affiliation(s)
- Jia Zheng
- Geriatric Medicine Center, Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Department of Endocrinology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Ye Hu
- Geriatric Medicine Center, Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Department of Endocrinology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Hanwen Xu
- Geriatric Medicine Center, Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Department of Endocrinology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Yu Lei
- Geriatric Medicine Center, Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Department of Endocrinology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Jieji Zhang
- Department of Endocrinology, Fenghua District Traditional Chinese Medicine Hospital of Ningbo, Ningbo, 315500, China
| | - Qidong Zheng
- Department of Endocrinology, Yuhuan Second People's Hospital, Taizhou, 317605, China
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, 315000, China
| | - Weiping Tu
- Department of Endocrinology, Shaoxing Shangyu People's Hospital, Shaoxing, 312300, China
| | - Riqiu Chen
- Department of Endocrinology, Lishui People's Hospital, Lishui, 323000, China
| | - Qiongyao Guo
- Department of Endocrinology, The People's Hospital of Putuo Zhoushan, Zhoushan, 316100, China
| | - Xunxiong Zang
- Department of Endocrinology, Yueqing People's Hospital, Wenzhou, 325600, China
| | - Qiaoying You
- Department of Endocrine and Metabolism, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Zhiyong Xu
- Department of Endocrinology, Xianju people's hospital, Taizhou, 317300, China
| | - Qiang Zhou
- Department of Endocrinology, The First Hospital of Jiaxing, Jiaxing, 314000, China
| | - Xiaohong Wu
- Geriatric Medicine Center, Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Department of Endocrinology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, People's Republic of China.
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Piazza M, Squizzato F, Pratesi G, Tshomba Y, Gaggiano A, Gatta E, Simonte G, Piffaretti G, Frigatti P, Veraldi GF, Silingardi R, Antonello M. Editor's Choice - Early Outcomes of a Novel Off the Shelf Preloaded Inner Branch Endograft for the Treatment of Complex Aortic Pathologies in the ItaliaN Branched Registry of E-nside EnDograft (INBREED). Eur J Vasc Endovasc Surg 2023; 65:811-817. [PMID: 36871927 DOI: 10.1016/j.ejvs.2023.02.076] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/02/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the early outcomes of a novel off the shelf pre-loaded inner branched thoraco-abdominal endograft (E-nside) in the treatment of aortic pathologies. METHODS Data from a physician initiated national multicentre registry on patients treated with the E-nside endograft, were prospectively collected and analysed. Pre-operative clinical and anatomical characteristics, procedural data, and early outcomes (90 days) were recorded in a dedicated electronic data capture system. The primary endpoint was technical success. Secondary endpoints were early mortality (90 days), procedural metrics, target vessel patency, endoleak rate, and major adverse events (MAEs) at 90 days. RESULTS In total, 116 patients from 31 Italian centres were included. Mean ± standard deviation (SD) patient age was 73 ± 8 years and 76 (65.5%) were male. Aortic pathologies included degenerative aneurysm in 98 (84.5%), post-dissection aneurysm in five (4.3%), pseudoaneurysm in six (5.2%), penetrating aortic ulcer or intramural haematoma in four (3.4%), and subacute dissection in three (2.6%). Mean ± SD aneurysm diameter was 66 ± 17 mm; aneurysm extent was Crawford I - III in 55 (50.4%), IV in 21 (19.2%), pararenal in 29 (26.7%), and juxtarenal in four (3.7%). The procedure setting was urgent in 25 (21.5%) patients. Median procedural time was 240 minutes (interquartile range [IQR] 195, 303), with a median contrast volume of 175 mL (IQR 120, 235). The endograft's technical success rate was 98.2% and the 90 day mortality rate was 5.2% (n = 6; 2.1% for elective repair and 16% for urgent repair). The 90-days cumulative MAE rate was 24.1% (n = 28). At 90 days, there were 10 (2.3%) target vessel related events (nine occlusions and one type IC endoleak) and one type 1A endoleak requiring re-intervention. CONCLUSION In this real life, non-sponsored registry, the E-nside endograft was used for the treatment of a broad spectrum of aortic pathologies, including urgent cases and different anatomies. The results showed excellent technical implantation safety and efficacy, as well as early outcomes. Longer term follow up is needed to better define the clinical role of this novel endograft.
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Affiliation(s)
- Michele Piazza
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Francesco Squizzato
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giovanni Pratesi
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli I.R.C.C.S., Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Gaggiano
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Emanuele Gatta
- Vascular and Endovascular Surgery Unit, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Gioele Simonte
- Unit of Vascular and Endovascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Paolo Frigatti
- Division of Vascular Surgery, Azienda Sanitaria Universitaria Friuli Centrale, S. Maria della Misericordia University Hospital of Udine, Udine, Italy
| | | | - Roberto Silingardi
- Division of Vascular Surgery, University Hospital of Modena and Reggio Emilia, Baggiovara (MO), Italy
| | - Michele Antonello
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Kim C, Yang Z, Park SH, Hwang SH, Oh YW, Kang EY, Yong HS. Multicentre external validation of a commercial artificial intelligence software to analyse chest radiographs in health screening environments with low disease prevalence. Eur Radiol 2023; 33:3501-3509. [PMID: 36624227 DOI: 10.1007/s00330-022-09315-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 03/28/2022] [Revised: 10/13/2022] [Accepted: 11/22/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To externally validate the performance of a commercial AI software program for interpreting CXRs in a large, consecutive, real-world cohort from primary healthcare centres. METHODS A total of 3047 CXRs were collected from two primary healthcare centres, characterised by low disease prevalence, between January and December 2018. All CXRs were labelled as normal or abnormal according to CT findings. Four radiology residents read all CXRs twice with and without AI assistance. The performances of the AI and readers with and without AI assistance were measured in terms of area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. RESULTS The prevalence of clinically significant lesions was 2.2% (68 of 3047). The AUROC, sensitivity, and specificity of the AI were 0.648 (95% confidence interval [CI] 0.630-0.665), 35.3% (CI, 24.7-47.8), and 94.2% (CI, 93.3-95.0), respectively. AI detected 12 of 41 pneumonia, 3 of 5 tuberculosis, and 9 of 22 tumours. AI-undetected lesions tended to be smaller than true-positive lesions. The readers' AUROCs ranged from 0.534-0.676 without AI and 0.571-0.688 with AI (all p values < 0.05). For all readers, the mean reading time was 2.96-10.27 s longer with AI assistance (all p values < 0.05). CONCLUSIONS The performance of commercial AI in these high-volume, low-prevalence settings was poorer than expected, although it modestly boosted the performance of less-experienced readers. The technical prowess of AI demonstrated in experimental settings and approved by regulatory bodies may not directly translate to real-world practice, especially where the demand for AI assistance is highest. KEY POINTS • This study shows the limited applicability of commercial AI software for detecting abnormalities in CXRs in a health screening population. • When using AI software in a specific clinical setting that differs from the training setting, it is necessary to adjust the threshold or perform additional training with such data that reflects this environment well. • Prospective test accuracy studies, randomised controlled trials, or cohort studies are needed to examine AI software to be implemented in real clinical practice.
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Affiliation(s)
- Cherry Kim
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi, 15355, South Korea
| | - Zepa Yang
- Biomedical Research Center, Guro Hospital, Korea University College of Medicine, Seoul, 08308, South Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Sung Ho Hwang
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, 02841, South Korea
| | - Yu-Whan Oh
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, 02841, South Korea
| | - Eun-Young Kang
- Department of Radiology, Guro Hospital, Korea University College of Medicine, 33-41, Gurodong-ro 28-gil, Guro-gu, Seoul, 08308, South Korea
| | - Hwan Seok Yong
- Department of Radiology, Guro Hospital, Korea University College of Medicine, 33-41, Gurodong-ro 28-gil, Guro-gu, Seoul, 08308, South Korea.
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Kuwahara Y, Takegami Y, Mitsuya S, Tokutake K, Yamauchi K, Imagama S. Locked Tension Band Wiring for Mayo IIA Olecranon Fractures: Modified Surgical Technique and Retrospective Comparative Study of Clinical Outcomes and Cost-effectiveness with Locking Plate. J Hand Surg Asian Pac Vol 2023; 28:205-213. [PMID: 37120308 DOI: 10.1142/s2424835523500224] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Background: Tension band wiring (TBW) has traditionally been used for simple olecranon fractures, but due to its many complications, locking plate (LP) is increasingly being employed. To reduce the complications, we developed a modified technique for olecranon fracture repair, locked TBW (LTBW). The study aimed to compare (1) the frequency of complications and re-operations between LP and LTBW techniques, (2) clinical outcomes and the cost efficacy. Methods: We retrospectively evaluated data of 336 patients who underwent surgical treatment for simple and displaced olecranon fractures (Mayo Type ⅡA) in the hospitals of a trauma research group. We excluded open fractures and polytrauma. We investigated complication and re-operation rates as primary outcomes. As secondary outcomes, Mayo Elbow Performance Index (MEPI) and the total cost, including surgery, outpatients and re-operation, were examined between the two groups. Results: We identified 34 patients in the LP group and 29 patients in the LTBW group. The mean follow-up period was 14.2 ± 3.9 months. The complication rate in the LTBW group was comparable to that in the LP group (10.3% vs. 17.6%; p = 0.49). Re-operation and removal rates were not significantly different between the groups (6.9% vs. 8.8%; p = 1.000 and 41.4% vs. 58.8%; p = 1.00, respectively). Mean MEPI at 3 months was significantly lower in the LTBW group (69.7 vs. 82.6; p < 0.01), but mean MEPI at 6 and 12 months were not significantly different (90.6 vs. 85.2; p = 0.06, 93.9 vs. 95.2; p = 0.51, respectively). The mean cost/patient of the total cost in the LTBW group were significantly lower than those in the LP group ($5,249 vs. $6,138; p < 0.001). Conclusions: This study showed that LTBW achieved clinical outcomes equivalent to those of LP and was significantly more cost effective than LP in the retrospective cohort. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Yutaro Kuwahara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - So Mitsuya
- Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Yamauchi
- Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Mangas-Sánchez C, Garriga-García M, Serrano-Nieto MJ, Garcia-Romero R, Álvarez Beltrán M, Crehuá-Gaudiza E, Vicente-Santamaría S, Martínez-Costa C, Díaz-Martín JJ, Bousoño-García C, González-Jiménez D. Safety and efficacy of a new supplementation protocol in patients with cystic fibrosis and vitamin D deficiency. An Pediatr (Barc) 2023; 98:257-266. [PMID: 36932016 DOI: 10.1016/j.anpede.2023.02.015] [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] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/23/2022] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES Based on the European and American Cystic Fibrosis (CF) consensus recommendations, an increase in vitamin D (VD) supplementation in patients with CF and insufficient or defficient levels was proposed. The objective of our study was to determine the safety and efficacy of this new protocol. MATERIAL AND METHODS Multicentre nonrandomized uncontrolled experimental study. Patients with insufficient levels (<30 ng/mL) received increasing doses of VD (between 800 and 10 000 IU/day). Patients were followed up for 12 months, during which their vitamin and nutritional status, pulmonary function and calcium and phosphate metabolism were assessed. STATISTICAL ANALYSIS t test for paired data and multivariate logistic regression analysis. RESULTS Thirty patients aged 1-39 years (median, 9.1) completed the follow-up. Two patients were dropped from the study on account of 25-OH VD levels greater than 100 ng/mL at 3 months without clinical or laboratory signs of hypercalcaemia. At 12 months, we observed an increase of 7.6 ng/mL (95% CI, 4.6-10 ng/mL) in the mean 25-OH VD level and an improvement in vitamin status: 37% achieved levels of 30 ng/mL or greater, 50% levels between 20 and 30 ng/mL and 13% remained with levels of less than 20 ng/mL. We found no association between improved VD levels and pulmonary function. CONCLUSIONS The proposed protocol achieved an increase in serum VD levels and a decrease in the percentage of patients with VD insufficiency, although it was still far from reaching the percentages of sufficiency recommended for this entity.
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Affiliation(s)
- Carmen Mangas-Sánchez
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Central de Asturias, Oviedo, Spain.
| | | | | | - Ruth Garcia-Romero
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Miguel Servet, Zaragoza, Spain
| | - Marina Álvarez Beltrán
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Vall d'Hebron. Barcelona, Spain
| | - Elena Crehuá-Gaudiza
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Cecilia Martínez-Costa
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Juan José Díaz-Martín
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Central de Asturias, Oviedo, Spain
| | - Carlos Bousoño-García
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Central de Asturias, Oviedo, Spain
| | - David González-Jiménez
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Central de Asturias, Oviedo, Spain
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13
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Liu R, Luo K, Chen X, Ma K, Zhang H, Li S. Can an operation provide superior outcomes for corrected transposition of the great arteries with left ventricular outflow tract obstruction? A multi-institutional study. Eur J Cardiothorac Surg 2023; 63:7058929. [PMID: 36847457 DOI: 10.1093/ejcts/ezad051] [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: 09/07/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVES Our goal was to evaluate the risk-adjusted effects of operative and non-operative repair on long-term outcomes in patients with congenitally corrected transposition of the great arteries and left ventricular outflow tract obstruction (CCTGA/LVOTO). METHODS We retrospectively reviewed 391 patients with CCTGA/LVOTO from 2001 to 2020 (operative group, 282; non-operative group, 109) in 3 centres in China. The operative group included 73 patients who underwent anatomical repair and 209 patients who underwent non-anatomical repair. The median follow-up time was 8.5 years. The inverse probability of treatment weighted-adjusted Cox regression and a Kaplan-Meier analysis were used to evaluate long-term outcomes. RESULTS Operative repair did not reduce the hazard ratio (HR) of death, tricuspid regurgitation or New York Heart Association functional class III/IV, but a significantly increased HR was observed for pulmonary valve regurgitation [HR, 2.84; 95% confidence interval (CI), 1.10-7.33; P = 0.031]. Compared with that in the non-operative group, anatomical repair resulted in significantly increased HRs for death (HR, 2.94; 95% CI, 1.10-7.87; P = 0.032) and pulmonary valve regurgitation (HR, 9.71; 95% CI, 3.66-25.77; P < 0.001). Subgroup analysis showed that in patients with CCTGA/LVOTO with moderate or worse tricuspid regurgitation (≥ moderate), anatomical repair significantly reduced the HR of death. An inverse probability of treatment weighting-adjusted Kaplan-Meier analysis showed that the survival rates at 5 and 10 days postoperatively were 88.2 ± 4.0% and 79.0 ± 7.9%, respectively, in the anatomical repair group; these rates were significantly lower than the rates in the non-operative group (95.4 ± 2.0% and 91.8 ± 2.8%; P = 0.032). CONCLUSIONS For patients with CCTGA/LVOTO, operative repair does not provide superior long-term outcomes, and anatomical repair results in a higher incidence of death. However, in patients with CCTGA/LVOTO with tricuspid regurgitation ≥ moderate, anatomical repair can reduce the risk of death in the long term.
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Affiliation(s)
- Rui Liu
- Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 Beilishi Road, Xicheng District, Beijing, China
| | - Kai Luo
- Department of Cardiothoracic Surgery, School of Medicine, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, Dongfang Road 1678, Shanghai, China
| | - Xinxin Chen
- Department of Cardiac Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China
| | - Kai Ma
- Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 Beilishi Road, Xicheng District, Beijing, China
| | - Hao Zhang
- Department of Cardiothoracic Surgery, School of Medicine, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, Dongfang Road 1678, Shanghai, China
| | - Shoujun Li
- Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 Beilishi Road, Xicheng District, Beijing, China
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Vande Velde F, Hektoen L, Phythian CJ, Rinaldi L, Bosco A, Hinney B, Gehringer M, Strube C, May K, Knubben-Schweizer G, Martins OM, Mateus TL, Simion VE, Charlier J, Bartley DJ, Claerebout E. Understanding the uptake of diagnostics for sustainable gastrointestinal nematode control by European dairy cattle farmers: a multi-country cross-sectional study. Parasite 2023; 30:4. [PMID: 36762941 PMCID: PMC9912928 DOI: 10.1051/parasite/2023002] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/06/2023] [Indexed: 02/11/2023] Open
Abstract
To mitigate emerging anthelmintic resistance (AR) in cattle, sustainable gastrointestinal nematode control strategies should be adopted. A multi-centre study was set up to understand the factors affecting European dairy cattle farmers' adoption of diagnostics and to gauge for differences between regions. The data were collected through a multi-lingual survey by participating countries of the European Co-operation in Science and Technology (COST) action COMbatting Anthelmintic Resistance in ruminants (COMBAR). Four countries provided sufficient data to be included in the data analysis: Norway, Italy, Germany and Austria. Three models were estimated and validated through structural equation modelling. Norway, along with Germany and Austria (pooled dataset) showed similar trends that align with previous studies. AR risk perception had no influence on the adoption intention of diagnostics, a positive influence was found for attitude towards diagnostics and subjective norms (i.e., perceived opinion of others), and a negative influence of attitudes towards anthelminthics. Additionally, routine (i.e., perception of the current treatment) had an indirect effect on adoption intention through attitudes. Italy's data deviated from these findings, presenting a positive effect of the perceived severity of AR, and perceived behavioural control (i.e., perceived ability to perform a specific behaviour) on adoption intention of diagnostics. Finally, Norway's data set allowed for inclusion of a measurement of current behaviour in the model, identifying a direct positive effect of the perceived actual behaviour of other farmers on their own behaviour.
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Affiliation(s)
- Fiona Vande Velde
- Laboratory for Parasitology, Faculty of Veterinary Medicine, Ghent University Salisburylaan 133 9820 Merelbeke Belgium,Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences Fredrik A. Dahls vei 15 1430 Ås Norway
| | - Lisbeth Hektoen
- Department of Production Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, 1 Veterinærbygningen Elizabeth Stephansens vei 15 1430 Ås Norway
| | - Claire J. Phythian
- Department of Production Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, 1 Veterinærbygningen Elizabeth Stephansens vei 15 1430 Ås Norway
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, CREMOPAR Via Federico Delpino 1 80137 Naples Italy
| | - Antonio Bosco
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, CREMOPAR Via Federico Delpino 1 80137 Naples Italy
| | - Barbara Hinney
- Institute of Parasitology, Department of Pathobiology, Vetmeduni Veterinärplatz 1 1210 Vienna Austria
| | - Martin Gehringer
- LKV Lower Austria Pater Werner Deibl-Straße 4 3910 Zwettl Austria
| | - Christina Strube
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover Buenteweg 17 30559 Hanover Germany
| | - Katharina May
- Institute of Animal Breeding and Genetics, Justus-Liebig-University of Gießen Frankfurter Str. 94 35392 Giessen Germany
| | - Gabriela Knubben-Schweizer
- Clinic for Ruminants with Ambulatory and Herd Health Services, Ludwig-Maximilians Universität München Sonnenstrasse 16 85764 Oberschleissheim Germany
| | - Oliva M.D. Martins
- Instituto Politécnico de Bragança, Campus de Santa Apolónia 5300-253 Bragança Portugal
| | - Teresa L. Mateus
- CISAS - Center for Research and Development in Agrifood Systems and Sustainability, Escola Superior Agrária, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Àlvares 4900-347 Viana do Castelo Portugal,Veterinary and Animal Research Centre (CECAV), UTAD, Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS) Quinta de Prados 5000-801 Vila Real Portugal
| | - Violeta-Elena Simion
- Faculty of Veterinary Medicine, Spiru Haret University Bdul Basarabia 256, Sector 3 030352 Romania
| | | | - David J. Bartley
- The Moredun Research Institute, Pentlands Science Park Penicuik EH26 0PZ United Kingdom
| | - Edwin Claerebout
- Laboratory for Parasitology, Faculty of Veterinary Medicine, Ghent University Salisburylaan 133 9820 Merelbeke Belgium
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15
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Grosso TM, Hernández-Sánchez D, Dragovic G, Vasylyev M, Saumoy M, Blanco JR, García D, Koval T, Loste C, Westerhof T, Clotet B, Sued O, Cahn P, Negredo E. Identifying the needs of older people living with HIV (≥ 50 years old) from multiple centres over the world: a descriptive analysis. AIDS Res Ther 2023; 20:10. [PMID: 36782210 PMCID: PMC9924192 DOI: 10.1186/s12981-022-00488-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/01/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Older People Living with HIV (OPWH) combine both aging and HIV-infection features, resulting in ageism, stigma, social isolation, and low quality of life. This context brings up new challenges for healthcare professionals, who now must aid patients with a significant comorbidity burden and polypharmacy treatments. OPWH opinion on their health management is hardly ever considered as a variable to study, though it would help to understand their needs on dissimilar settings. METHODS We performed a cross-sectional, comparative study including patients living with HIV aged ≥50 years old from multiple centers worldwide and gave them a survey addressing their perception on overall health issues, psychological problems, social activities, geriatric conditions, and opinions on healthcare. Data was analyzed through Chisquared tests sorting by geographical regions, age groups, or both. RESULTS We organized 680 participants data by location (Center and South America [CSA], Western Europe [WE], Africa, Eastern Europe and Israel [EEI]) and by age groups (50- 55, 56-65, 66-75, >75). In EEI, HIV serostatus socializing and reaching undetectable viral load were the main problems. CSA participants are the least satisfied regarding their healthcare, and a great part of them are not retired. Africans show the best health perception, have financial problems, and fancy their HIV doctors. WE is the most developed region studied and their participants report the best scores. Moreover, older age groups tend to live alone, have a lower perception of psychological problems, and reduced social life. CONCLUSIONS Patients' opinions outline region- and age-specific unmet needs. In EEI, socializing HIV and reaching undetectable viral load were the main concerns. CSA low satisfaction outcomes might reflect high expectations or profound inequities in the region. African participants results mirror a system where general health is hard to achieve, but HIV clinics are much more appealing to them. WE is the most satisfied region about their healthcare. In this context, age-specific information, education and counseling programs (i.e. Patient Reported Outcomes, Patient Centered Care, multidisciplinary teams) are needed to promote physical and mental health among older adults living with HIV/AIDS. This is crucial for improving health-related quality of life and patient's satisfaction.
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Affiliation(s)
- Tomás Martín Grosso
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina ,grid.26089.350000 0001 2228 6538Laboratorio de Inmunología, Universidad Nacional de Luján, Buenos Aires, Argentina
| | - Diana Hernández-Sánchez
- grid.411438.b0000 0004 1767 6330Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gordana Dragovic
- grid.7149.b0000 0001 2166 9385Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - María Saumoy
- grid.411129.e0000 0000 8836 0780HIV and STD Unit, Hospital de Bellvitge, Barcelona, Spain
| | - José Ramón Blanco
- grid.428104.bInfectious Disease Department, Hospital Universitario San Pedro - CIBIR, Logroño, Spain
| | - Diego García
- Adhara HIV/AIDS Association, Sevilla Checkpoint, Seville, Spain
| | - Tetiana Koval
- grid.513024.1Department of Infectious Diseases, Poltava State Medical University, Poltava, Ukraine
| | - Cora Loste
- grid.411438.b0000 0004 1767 6330Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tendayi Westerhof
- grid.411438.b0000 0004 1767 6330AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Bonaventura Clotet
- grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain ,grid.440820.aUniversitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain
| | - Omar Sued
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina
| | - Pedro Cahn
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina
| | - Eugènia Negredo
- Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. .,Universitat Autònoma de Barcelona, Barcelona, Spain. .,Universitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain.
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16
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Zhang R, Huang J, Shan J, Chen Y, Xia H. Peripheral blood CD177 + cells as an early diagnostic marker for biliary atresia: A prospective multicentre study in pediatric patients with cholestasis. J Hepatol 2022; 77:1714-1716. [PMID: 35995126 DOI: 10.1016/j.jhep.2022.08.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Ruizhong Zhang
- Provincial Key Laboratory of Research in Structure Birth Defect Disease and Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China; Department of Pediatric Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Junyu Huang
- Provincial Key Laboratory of Research in Structure Birth Defect Disease and Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Jiarou Shan
- Provincial Key Laboratory of Research in Structure Birth Defect Disease and Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
| | - Yan Chen
- Faculty of Medicine, Macau University of Science and Technology, Macau, 999078, China; Provincial Key Laboratory of Research in Structure Birth Defect Disease and Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China.
| | - Huimin Xia
- Provincial Key Laboratory of Research in Structure Birth Defect Disease and Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China.
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17
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Acevedo-Nuevo M, Martín-Arribas MC, González-Gil MT, Solís-Muñoz M, Arias-Rivera S, Royuela-Vicente A. The use of mechanical restraint in critical care units: Characterisation, application standards and related factors. Results of a multicentre study. Enferm Intensiva (Engl Ed) 2022; 33:212-224. [PMID: 36369124 DOI: 10.1016/j.enfie.2021.12.003] [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] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement. METHOD Multicentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96 h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals). RESULTS A total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (P < .001) and with the provision of training for professionals (P = .020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r = -.431) and in the subgroup of patients with ETT (r = -.521). CONCLUSIONS Restraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who may not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.
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Affiliation(s)
- M Acevedo-Nuevo
- Organización Nacional de Trasplantes, Madrid, Spain; Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain.
| | - M C Martín-Arribas
- Subdirección General de Investigación en Terapia Celular y Medicina Regenerativa, Instituto de Salud Carlos III, Madrid, Spain
| | - M T González-Gil
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain
| | - M Solís-Muñoz
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain; Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | - S Arias-Rivera
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - A Royuela-Vicente
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain; Unidad de Bioestadística, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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18
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Mikola K, Rebane K, Arnstad ED, Berntson L, Fasth A, Glerup M, Herlin T, Kautiainen H, Nielsen S, Nordal E, Peltoniemi S, Rygg M, Rypdal V, Zak M, Aalto K. Transitioning patients with juvenile idiopathic arthritis to adult care: the Nordic experience. Pediatr Rheumatol Online J 2022; 20:84. [PMID: 36182898 PMCID: PMC9526898 DOI: 10.1186/s12969-022-00742-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/06/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With juvenile idiopathic arthritis (JIA), there are several protocols and practices used worldwide for the transition from paediatric to adult care. In this study, we examined the transferral rates and disease activity after transition, as well as the disease- and health-related outcomes. We also introduce the transition practices employed in the Nordic countries. METHODS The study population comprised 408 participants with a disease onset from 1997 to 2000 who attended an 18-year follow-up visit in this population-based Nordic JIA cohort study. The patients were retrospectively divided into three subgroups: Patients transferred directly from paediatric care to adult rheumatology care, patients referred there later, and patients never transferred during the 18-year follow-up period. RESULTS One hundred and sixty-three (40%) JIA patients had been directly transferred to an adult clinic. The cumulative transition rate was 52%, but there were significant differences between the participating centres. Fifty patients had later been referred to an adult clinic. Among the 195 patients who had never been transferred, 39% were found to have disease activity at the study visit. CONCLUSION This study highlights the need to reconsider transition practices to avoid our undesirable finding of patients with disease activity in JIA, but no appropriate health care follow-up.
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Affiliation(s)
- Katriina Mikola
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, 00290, Helsinki, Finland.
| | - Katariina Rebane
- grid.15485.3d0000 0000 9950 5666New Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, 00290 Helsinki, Finland
| | - Ellen Dalen Arnstad
- grid.414625.00000 0004 0627 3093Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway ,grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Lillemor Berntson
- grid.8993.b0000 0004 1936 9457Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Anders Fasth
- grid.8761.80000 0000 9919 9582Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mia Glerup
- grid.154185.c0000 0004 0512 597XDepartment of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Herlin
- grid.154185.c0000 0004 0512 597XDepartment of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Hannu Kautiainen
- grid.410705.70000 0004 0628 207XKuopio University Hospital, Primary Health Care Unit Kuopio, Pohjois-Savo, Finland ,grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Helsinki, Finland
| | - Susan Nielsen
- grid.475435.4Department of Pediatrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Ellen Nordal
- grid.412244.50000 0004 4689 5540Department of Pediatrics, University Hospital of North Norway and Pediatric Research Group, Tromsø, Norway ,grid.10919.300000000122595234Department of Clinical Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - Suvi Peltoniemi
- grid.15485.3d0000 0000 9950 5666Helsinki University Central Hospital, HUS Inflammation Center, Rheumatology and University of Helsinki, Helsinki, Finland
| | - Marite Rygg
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Pediatrics, St. Olavs University Hospital, Trondheim, Norway
| | - Veronika Rypdal
- grid.412244.50000 0004 4689 5540Department of Pediatrics, University Hospital of North Norway and Pediatric Research Group, Tromsø, Norway
| | - Marek Zak
- grid.475435.4Department of Pediatrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristiina Aalto
- grid.15485.3d0000 0000 9950 5666New Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, 00290 Helsinki, Finland
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19
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Liu W, Xiong H, Wang W, Chen S, Li F, Liu J, Yan H, Zhang J, Qian Y, Fan C. Effectiveness and safety of a less-invasive MCL reconstruction technique for contracted or ossified ligaments in patients with elbow stiffness: An open-label, non-randomised, prospective, multicentre trial in China. EClinicalMedicine 2022; 52:101616. [PMID: 36016695 PMCID: PMC9396044 DOI: 10.1016/j.eclinm.2022.101616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/08/2022] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The elbow joint is sensitive to trauma from accidents, sports injuries, and surgical trauma. Some patients develop ossification or contracture of the medial collateral ligament (MCL) after elbow trauma. A less invasive reconstruction of the MCL can be performed after resection of diseased MCL. The biomechanical characteristics of this technique have been demonstrated and validated. However, its clinical effectiveness and safety require further confirmation in clinical practice. METHODS This open-label, non-randomised, prospective, multicentre trial included consecutive patients with elbow stiffness from five orthopaedic centres in China. Patients willing to participate in the study, with elbow stiffness caused by traumatic injury, who had reached skeletal maturity, and who had a range of motion of <100° were eligible for inclusion. Patients with immunological or metabolic causes of elbow stiffness, burns, or central nervous system injuries were excluded. In addition, patients who did not require MCL release and reconstruction after intraoperative release of other structures were also excluded. All patients underwent resection of the diseased MCL part in an open arthrolysis. Medial stability of the elbow was reconstructed using a less invasive MCL reconstruction technique that uses fascia and tendon patches. In this study, the primary outcomes, including stability, Mayo Elbow Performance Score (MEPS), Amadio score, were used to comprehensively evaluate this technique. Outcomes were assessed at 6 weeks, 6 months, and 1 year postoperatively and annually thereafter. This study reports the results of one arm of the trial that has been registered with the Chinese Clinical Trial Registry (chictr.org.cn), ChiCTR-INC-16010019. FINDINGS Between January 1, 2017 and March 1, 2020, 104 eligible patients were enrolled. The mean follow-up time was 43·47 (95% CI, 41·45 - 45·49) months. Among all 104 patients, 100 (96%) patients who underwent MCL reconstruction retained medial stability at the last follow-up. All outcomes from the last follow-up were used for comparison with the preoperative outcomes. No differences in preoperative and postoperative stability scores were observed (P = 0·7820). Extension, flexion, pronation, and supination of the injured elbow improved significantly (P < 0·0001, P < 0·0001, P < 0·0001, P < 0·0001). The mean range of motion (ROM) and forearm rotational range of motion (FRR) increased by 71·25° (152%) (P < 0·0001) and 30·83° (25%) (P < 0·0001), respectively. Additionally, the Mayo Elbow Performance Score (MEPS) and muscle strength had increased after evaluation at follow-ups (P < 0·0001, P < 0·0001). Drastic pain relief and nerve symptom reduction were observed, as evaluated using VAS scores and Amadio scores, respectively (P < 0·0001, P < 0·0001). Seventeen (16%) patients experienced a recurrence of elbow stiffness of varying severity, but only two patients had poor or fair results. Several common and non-severe complications, including infection in one (1%) patient, new nerve symptoms in seven (7%) patients, new pain in one (1%) patient, fracture in one (1%) patient, and valgus instability in four (4%) patients, were observed and properly treated in this study. INTERPRETATION The less invasive MCL reconstruction technique using fascia and tendon patches is an effective method for restoring medial stability in patients with elbow stiffness after complete arthrolysis with certain safety. The technique shows prospects for elbow MCL reconstruction in clinical practice. FUNDING The study was supported by the National Key Research and Development Program of China (No. 2021YFC2400805), National Natural Science Foundation of China (No. 81830076), Young Elite Scientist Sponsorship Program by Cast (No. YESS20200153), Shanghai Sailing Program (No. 20YF1436000), Shanghai Municipal Science and Technology Commission Foundation (No.19ZR1439200), Municipal Hospital Newly-developing Cutting-edge Technologies Joint Research Program of Shanghai Shenkang Hospital Development Centre (No. SHDC12018130).
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Affiliation(s)
- Wenjun Liu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai Fengxian District Central Hospital, Shanghai, PR China
| | - Hao Xiong
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
- Shanghai Engineering Research Centre for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, PR China
| | - Wei Wang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
- Shanghai Engineering Research Centre for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, PR China
| | - Shuai Chen
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
- Shanghai Engineering Research Centre for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, PR China
| | - Fengfeng Li
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, PR China
| | - Junjian Liu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Hede Yan
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Jingwei Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai Fengxian District Central Hospital, Shanghai, PR China
- Corresponding authors.
| | - Yun Qian
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
- Shanghai Engineering Research Centre for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, PR China
- Corresponding authors.
| | - Cunyi Fan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
- Shanghai Engineering Research Centre for Orthopaedic Material Innovation and Tissue Regeneration, Shanghai, PR China
- Corresponding authors.
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20
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Chen M, Chen Y, Fang X, Wang Z, Pu X, Liang C, Guo H, Li Q, Pan F, Hong H, Huang H, Li J, Lin T. Clinical features and treatment outcome of lymphoepithelioma-like carcinoma from multiple primary sites: a population-based, multicentre, real-world study. BMC Pulm Med 2022; 22:360. [PMID: 36138362 PMCID: PMC9494884 DOI: 10.1186/s12890-022-02097-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphoepithelioma-like carcinoma (LELC) is a rare and unique subtype of cancer that histologically resembles undifferentiated nasopharyngeal carcinoma (NPC). The population-based analysis of LELC and the optimal treatment remains unclear. MATERIALS AND METHODS This real-world, retrospective study investigated 770 patients with LELC for primary site, treatment, and survival outcomes from 2005 to 2019 from five cancer centres in China. The overall survival (OS) of different subgroups was appraised by log-rank tests and Kaplan-Meier analysis. RESULTS Primary sites LELC included the lung (597 cases, 77.5%), salivary gland (115 cases, 14.9%), and others. The median progression-free survival (PFS) of LELC patients was 47.4 months. The median overall survival (OS) was not reached. The 5-year survival rate for LELC patients was 77.8%. Most patients in stages I and II received surgery. The majority of patients in stage III received surgery and radiotherapy. More than half of the patients in stage IV received chemotherapy. Among relapsed or metastatic cases receiving chemotherapy, patients who received immunotherapy at any time presented with a superior OS than those without immunotherapy (P < 0.0001, HR = 0.39, 95% CI 0.25-0.63). Compared with the SEER database, patients with LELC had a better prognosis than NPC, with a 5-year overall survival of 77.3% vs. 56.8% (P < 0.001). CONCLUSION Our data provide treatment patterns and outcomes for LELC from various primary sites. Randomized controlled studies are necessary to further define the standard of care for patients with LELC. Trial registration This clinical trial was registered at ClinicalTrials.gov (No. NCT04614818).
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Affiliation(s)
- Meiting Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, 510060, China
| | - Yungchang Chen
- Senior Ward/ Phase I Clinical Trial Ward, Sichuan Cancer Hospital & Institue, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Xiaojie Fang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, 510060, China
| | - Zhao Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, 510060, China
| | - Xingxiang Pu
- Department of Thoracic Medical Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Yuelu District, 283 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Chaoyong Liang
- Department of Medical Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Hongqiang Guo
- The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Qian Li
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, 510060, China
| | - Fei Pan
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, 510060, China
| | - Huangming Hong
- Senior Ward/ Phase I Clinical Trial Ward, Sichuan Cancer Hospital & Institue, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - He Huang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, 510060, China.
| | - Jiman Li
- Department of Pathology, Sichuan Cancer Hospital & Institue, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China.
| | - Tongyu Lin
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, 510060, China. .,Senior Ward/ Phase I Clinical Trial Ward, Sichuan Cancer Hospital & Institue, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China.
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21
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Zarbo C, Agosta S, Casiraghi L, De Novellis A, Leuci E, Paulillo G, Rocchetti M, Starace F, Zamparini M, de Girolamo G. Assessing adherence to and usability of Experience Sampling Method (ESM) and actigraph in patients with Schizophrenia Spectrum Disorder: A mixed-method study. Psychiatry Res 2022; 314:114675. [PMID: 35751998 DOI: 10.1016/j.psychres.2022.114675] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 10/12/2021] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 10/18/2022]
Abstract
The application of innovative technologies in psychiatry is promising, but the debate about its feasibility is not settled. Our aim was to investigate and compare adherence to and usability of 7-day monitoring with an Experience Sampling Method (ESM) and Actigraphy among a sample of individuals with a diagnosis of Schizophrenia Spectrum Disorders (SSD) and paired healthy controls. Twenty-two patients living in residential facilities (RFs), 20 outpatients and 26 controls were enrolled in this study as part of the DiAPAson project. Participants wore an actigraph and were evaluated for daily time use and mood with a smartphone-based ESM. Then, they completed questionnaires to assess the usability of the devices and were interviewed. Adherence was assessed as the percentage of time spent wearing actigraph and answering ESM notifications. Residential patients, compared to controls, showed significantly higher usability of the actigraph and lower adherence to both the actigraph and ESM. From the qualitative interviews, four high-order themes emerged: effects of monitoring, adherence and usability, emotions and mental states, and advice. Findings are promising for the application of these methodologies in such populations. The role of multidisciplinary staff in RFs is crucial for guaranteeing the realization of such projects.
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Affiliation(s)
- Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - Sara Agosta
- Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Letizia Casiraghi
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | | | | | | | - Matteo Rocchetti
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Fabrizio Starace
- Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Manuel Zamparini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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22
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Li Y, Yang Y, Zhao A, Luo N, Niu M, Kang W, Xie A, Lu H, Chen L, Liu J. Parkinson's disease peripheral immune biomarker profile: a multicentre, cross-sectional and longitudinal study. J Neuroinflammation 2022; 19:116. [PMID: 35610646 PMCID: PMC9131564 DOI: 10.1186/s12974-022-02481-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 11/14/2021] [Accepted: 05/15/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Inflammations play crucial role in the pathogenesis of Parkinson's disease (PD), however, their possible value in the diagnosis or tracking of the progress of PD is still limited, because of discordant results in the literature and a lack of information regarding its reproducibility. Thus, overall longitudinal and cross-sectional studies are needed. This multicentre study was designed to investigate the association between multiple peripheral immune biomarkers and the development and progression of PD. METHODS This was a longitudinal and multicentre study. First, we measured the levels of five typical cytokines and five focused chemokines in 76 PD patients and 76 healthy controls (HCs) in a discovery cohort. Then, a validation cohort of 80 PD and 80 HC participants was recruited from four multicentre locations. In addition, a prospective follow-up of early-stage PD patients was performed with significant biomarkers. Finally, we performed further verification in an exploratory set of patients with idiopathic REM sleep behaviour disorder (iRBD). RESULTS In the discovery set, CXCL12, CX3CL1 and IL-8 levels were significantly higher in PD patients than in HCs (p < 0.05). The receiver-operating characteristic (ROC) curve for a combination of these three biomarkers produced a high area under the curve (AUC) of 0.89 (p < 0.001). Moreover, four biomarkers (the previous three and CCL15) were significantly associated with PD in the discovery and validation cohorts. Furthermore, in the prospective follow-up cohort, CX3CL1 levels were associated with motor progression after a mean interval of 43 months. In addition, CX3CL1 and IL-8 levels were higher in iRBD patients than in HCs. CONCLUSION We showed a correlation between a profile of four peripheral immune biomarkers and PD development and progression. Our findings may provide a basis whereby PD patients with abnormal inflammatory profiles can be identified and receive timely therapeutic interventions.
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Affiliation(s)
- Yuanyuan Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Yan Yang
- Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining, 272000, China
| | - Aonan Zhao
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Ningdi Luo
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Mengyue Niu
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Wenyan Kang
- Department of Neurology, Ruijin Hospital North Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Anmu Xie
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Hong Lu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Lei Chen
- Department of Neurology, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, 300350, China.
| | - Jun Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China. .,CAS Center for Excellence in Brain Science and Intelligence Technology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
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23
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Gupta AK, Joshi S, Kafle B, Thapa R, Chapagai M, Nepal S, Niraula A, Paudyal S, Sapkota P, Poudel R, Gurung BS, Pokhrel P, Jha R, Pandit S, Thapaliya S, Shrestha S, Volpe U, Sartorius N. Pathways to mental health care in Nepal: a 14-center nationwide study. Int J Ment Health Syst 2021; 15:85. [PMID: 34930398 PMCID: PMC8685796 DOI: 10.1186/s13033-021-00509-4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pathways to care studies are feasible and tested means of finding the actual routes taken by patients before reaching proper care. In view of the predominance of nonprofessional service providers and the lack of previous large studies on pathways in Nepal, this multicenter study is needed. The aim of the study was to trace the various pathways and carers involved in mental health care; assess clinical variables such as the duration of untreated illness, clinical presentation and treatment; and compare geographically and culturally diverse landscapes. METHODS This was a cross-sectional, convenience sampling study performed at 14 centers where new cases were being taken. The World Health Organization Study of the Pathways-to-Care Schedule was applied. The Nepali version of the encounter form was used. The data were collected between 17 September and 16 October 2020 and were analyzed using the Statistical Package for the Social Sciences (SPSS). Additionally, perspectives from local investigators were collected and discussed. RESULTS Most of the first carers were native/religious faith healers (28.2%), followed by psychiatrists (26%). The median duration for the first psychiatric consultation was 3 weeks. The duration of untreated illness was 30.72 ± 80.34 (median: 4) weeks, and the time taken for this journey was 94.99 ± 274.58 (median: 30) min. The longest delay from the onset of illness to psychiatric care was for epilepsy {90.0 ± 199.0 (median: 25.5)} weeks, followed by neurotic illness {22.89 ± 73.45 (median: 2)} and psychotic illness {10.54 ± 18.28 (median: 2)} weeks. Overall, most patients with severe mental illnesses (SMIs) had their first contact with faithhealers (49%), then met with medical doctors (13%) or psychiatrists (28%). Marked differences in clinical presentation surfaced when hilly centers were compared with the Terai belt. CONCLUSIONS Faith healers, general practitioners and hospital doctors are major carers, and the means of educating them for proper referral can be considered. The investigators see several hindrances and opportunities in the studied pathways. The employment of more mental health professionals and better mental health advocacy, public awareness programs and school education are suggested strategies to improve proper mental health care.
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Affiliation(s)
| | - Sulochana Joshi
- Department of Psychiatry, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Bikram Kafle
- Department of Psychiatry, Devdaha Medical College, Devdaha, Nepal
| | - Ranjan Thapa
- Neuro Cardio and Multi-Specialty Hospital, Biratnagar, Nepal
| | - Manisha Chapagai
- Department of Psychiatry, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Suraj Nepal
- Department of Psychiatry, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Abhash Niraula
- P.T. Birta City Hospital and Research Centre, Birtamode, Nepal
| | - Sreya Paudyal
- Universal College of Medical Sciences, Siddharthanagar, Nepal
| | | | - Reet Poudel
- Department of Psychiatry, Nepalgunj Medical College, Kohalpur, Nepal
| | | | - Prabhakar Pokhrel
- Department of Psychiatry, KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal
| | - Robin Jha
- Department of Psychiatry, Janakpur Provincial Hospital, Janakpur, Nepal
| | - Sanjib Pandit
- Present Address: Department of Psychiatry, Rapti Academy of Health Sciences, Ghorahi, Nepal
- Department of Psychiatry, Karnali Academy of Health Sciences, Jumla, Nepal
| | - Suresh Thapaliya
- Department of Psychiatry, National Medical College, Birgunj, Nepal
- Present Address: Kent and Medway NHS and Social Care Partnership Trust, Kent, UK
| | - Shuva Shrestha
- Department of Psychiatry, National Medical College, Birgunj, Nepal
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Head, Department of Clinical Neurosciences/DIMSC, School of Medicine, Università Politecnica Delle Marche, Via Tronto 10/A, 60126 Ancona, Italy
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), 20 chemin Colladon, 1209 Geneva, Switzerland
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24
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Sakata Y, Sakata S, Oya Y, Tamiya M, Suzuki H, Shibaki R, Okada A, Kobe H, Matsumoto H, Yokoi T, Sato Y, Uenami T, Saito G, Tsukita Y, Inaba M, Ikeda H, Arai D, Maruyama H, Hara S, Tsumura S, Morinaga J, Sakagami T. Osimertinib as first-line treatment for advanced epidermal growth factor receptor mutation-positive non-small-cell lung cancer in a real-world setting (OSI-FACT). Eur J Cancer 2021; 159:144-53. [PMID: 34749119 DOI: 10.1016/j.ejca.2021.09.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/31/2021] [Accepted: 09/25/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Osimertinib is the standard of care in the initial treatment for advanced epidermal growth factor receptor (EGFR) mutation-positive lung cancer. However, clinical data and reliable prognostic biomarkers are insufficient. METHODS We performed a retrospective multicentre cohort study for 538 EGFR mutation-positive patients, who received osimertinib as the initial treatment between August 2018 and December 2019. The main outcome was progression-free survival (PFS). RESULTS The median observation period was 14.7 months (interquartile range 11.4-20.0). The median PFS was 20.5 months (95% confidence interval [CI] 18.6-not reached). Multivariate analysis showed that sex (male) (hazard ratio [HR] 1.99, 95% CI 1.35-2.93, P = 0.001), malignant effusions (HR 1.51, 95% CI 1.11-2.04, P = 0.008), liver metastasis (HR 1.55, 95% CI 1.03-2.33, P = 0.037), advanced unresectable cases (HR 1.71, 95% CI, 1.04-2.82, P = 0.036), mutation type and programmed cell death-ligand 1 (PD-L1) expression were associated with PFS. The L858R (HR 1.55, 95% CI 1.01-2.38, P = 0.043) and uncommon mutations (HR 3.15, 95% CI 1.70-5.83, P < 0.001) were associated with PFS. PD-L1 expression of 1-49% (HR 1.66, 95% CI 1.05-2.63, P = 0.029), ≥50% (HR 2.24, 95% CI 1.17-4.30, P = 0.015) and unknown (HR 1.53, 95% CI 1.05-2.22, P = 0.026) was associated with PFS. The main reasons for treatment discontinuation among 219 patients were disease progression (44.3%), pneumonitis (25.5%) and other adverse events (16.0%). CONCLUSION During initial treatment with osimertinib, PD-L1 expression is significantly related to PFS. Adverse events are a noteworthy reason for discontinuation.
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Hattori A, Takamochi K, Shiono S, Tsuboi M, Maniwa Y, Suzuki K, Suzuki K. Multicentre prospective observational study for pulmonary vein stump thrombus after anatomical lung resections. Eur J Cardiothorac Surg 2021; 61:92-99. [PMID: 34363655 DOI: 10.1093/ejcts/ezab370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/12/2021] [Revised: 04/13/2021] [Accepted: 07/01/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our goal was to evaluate the incidence and frequent sites of pulmonary vein stump thrombus (PVST) formation after pulmonary resection. METHODS This is a prospective multicentre observational study conducted by 14 institutions in Japan. Enrolled patients underwent anatomical pulmonary resection including lobectomy, bilobectomy, pneumonectomy, left upper trisegmentectomy or lingular segmentectomy. Postoperative contrast-enhanced computed tomography was performed in the early period after the pulmonary resection to evaluate the incidence of PVST. Furthermore, univariable and multivariable analyses were performed to assess the risk factors associated with PVST using a logistic regression model. RESULTS The status of PVST based on postoperative contrast-enhanced computed tomography scans was prospectively evaluated for 1040 patients. Postoperative computed tomography evaluation was performed for 3 (range: 1-84) days on average after the pulmonary resection. PVST was found in 127 (12.2%) patients with left-sided (23.3%) predominance compared to the right side (4.9%) (P < 0.001). Furthermore, left upper lobectomy was the most frequent operative procedure (30.8%). Multivariable analyses demonstrated that left upper lobectomy (P = 0.001) and left-sided pulmonary resection (P < 0.001) were independent significant predictors of PVST. Cerebral infarction was observed in 9 (0.87%) patients during this period and included 6 (1.46%) in whom it developed after the operation was performed on the left side. Especially in the early postoperative phase, left pulmonary resection was significantly associated with the incidence of cerebral infarction (0.16% vs 1.21%; P = 0.028). CONCLUSIONS PVST is an early postoperative event that is frequently observed in patients undergoing left anatomical pulmonary resection, especially a left upper lobectomy. IRB NUMBER 16-205, Clinical trial registry: UMIN000027118.
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Affiliation(s)
- Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Kazuhiro Suzuki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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26
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van Houdt PJ, Saeed H, Thorwarth D, Fuller CD, Hall WA, McDonald BA, Shukla-Dave A, Kooreman ES, Philippens MEP, van Lier ALHMW, Keesman R, Mahmood F, Coolens C, Stanescu T, Wang J, Tyagi N, Wetscherek A, van der Heide UA. Integration of quantitative imaging biomarkers in clinical trials for MR-guided radiotherapy: Conceptual guidance for multicentre studies from the MR-Linac Consortium Imaging Biomarker Working Group. Eur J Cancer 2021; 153:64-71. [PMID: 34144436 PMCID: PMC8340311 DOI: 10.1016/j.ejca.2021.04.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 12/14/2022]
Abstract
Quantitative imaging biomarkers (QIBs) derived from MRI techniques have the potential to be used for the personalised treatment of cancer patients. However, large-scale data are missing to validate their added value in clinical practice. Integrated MRI-guided radiotherapy (MRIgRT) systems, such as hybrid MRI-linear accelerators, have the unique advantage that MR images can be acquired during every treatment session. This means that high-frequency imaging of QIBs becomes feasible with reduced patient burden, logistical challenges, and costs compared to extra scan sessions. A wealth of valuable data will be collected before and during treatment, creating new opportunities to advance QIB research at large. The aim of this paper is to present a roadmap towards the clinical use of QIBs on MRIgRT systems. The most important need is to gather and understand how the QIBs collected during MRIgRT correlate with clinical outcomes. As the integrated MRI scanner differs from traditional MRI scanners, technical validation is an important aspect of this roadmap. We propose to integrate technical validation with clinical trials by the addition of a quality assurance procedure at the start of a trial, the acquisition of in vivo test-retest data to assess the repeatability, as well as a comparison between QIBs from MRIgRT systems and diagnostic MRI systems to assess the reproducibility. These data can be collected with limited extra time for the patient. With integration of technical validation in clinical trials, the results of these trials derived on MRIgRT systems will also be applicable for measurements on other MRI systems.
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Affiliation(s)
- Petra J van Houdt
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 102, Amsterdam, 1066CX, the Netherlands.
| | - Hina Saeed
- Department of Radiation Oncology, Medical College of Wisconsin, 9200 W Wisconsin Av, Milwaukee, WI, 53226, USA.
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany.
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0097, Houston, TX, 77030, USA.
| | - William A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, 9200 W Wisconsin Av, Milwaukee, WI, 53226, USA.
| | - Brigid A McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0097, Houston, TX, 77030, USA.
| | - Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Ernst S Kooreman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 102, Amsterdam, 1066CX, the Netherlands.
| | - Marielle E P Philippens
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Astrid L H M W van Lier
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Rick Keesman
- Department of Radiation Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 32, Nijmegen, 6525GA, the Netherlands.
| | - Faisal Mahmood
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Kløvervænget 19, Odense C, 5000, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19.3, Odense C, 5000, Denmark.
| | - Catherine Coolens
- Department of Medical Physics, Princess Margaret Cancer Centre and University Health Network, 700 University Avenue, Toronto, Ontario, M5M 1G7, Canada.
| | - Teodor Stanescu
- Department of Medical Physics, Princess Margaret Cancer Centre and University Health Network, 700 University Avenue, Toronto, Ontario, M5M 1G7, Canada; Department of Radiation Oncology, University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada.
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0097, Houston, TX, 77030, USA.
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Andreas Wetscherek
- Joint Department of Physics, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, 15 Cotswold Road, London, SM2 5NG, United Kingdom.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 102, Amsterdam, 1066CX, the Netherlands.
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Gao Z, Zhao J, Liu X, Li S, Wang M, Gao Y. Portal vein thrombosis associated with high 14-day and 6-week rebleeding in patients after oesophageal variceal band ligation: a retrospective, multicentre, nested case-control study. Hepatol Int 2021; 15:1183-1195. [PMID: 34292507 DOI: 10.1007/s12072-021-10224-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The association between prognosis of variceal bleeding and portal vein thrombosis (PVT) is unclear. In this multicentre study, we determined the effect of PVT on rebleeding and mortality in patients with acute variceal bleeding (AVB) after oesophageal variceal band ligation (EVL). METHODS Cirrhotic patients with AVB who had undergone EVL were included. The patients were allocated to either the PVT group or the control cirrhotic group (CCG) based on the presence or absence of PVT. One-year rebleeding episodes and mortality after EVL were recorded. RESULTS A total of 218 cirrhotic patients with AVB from 3 centres were included. Patients with PVT had a higher rate of 14-day and 6-week rebleeding than those without PVT (14-day: 8.26% vs. 1.83%, p = 0.03; 6-week: 11.92% vs. 1.83%, p = 0.003). The rates of 5-day failure (3.67% vs. 0.92%, p = 0.175), 1-year rebleeding (21.10% vs. 20.18%, p = 0.867), and 14-day, 6-week, and 1-year mortality were similar between the groups (14-day: 3.67% vs. 0.92%, p = 0.175; 6-week: 3.67% vs. 0.92%, p = 0.175; 1-year: 3.67% vs. 1.83%, p = 0.408). The Child-Pugh class [p = 0.022, hazard ratio (HR): 1.453; 95% confidence interval (CI) 1.056-1.998], PVT (p = 0.050, HR: 4.622, 95% CI 0.999-21.395), albumin < 30 g/L (p = 0.023, HR: 5.886, 95% CI 1.272-27.245), and number of bands (p = 0.010, HR: 1.207, 95% CI 1.046-1.393) were identified as the predictors for 14-day rebleeding; the multivariate analysis revealed only the number of bands (p = 0.009, HR: 1.247, 95% CI 1.056-1.473) as the independent factor. PVT (p = 0.012, HR: 6.732, 95% CI 1.519-29.835) and albumin < 30 g/L (p = 0.027, HR: 3.643, 95% CI 1.160-11.441) were identified as predictors for 6-week rebleeding; however, only PVT (p = 0.015, HR: 6.380, 95% CI 1.427-28.515) was found to be the independent factor in the multivariate analysis. Further analysis showed that superior mesenteric vein (SMV) thrombosis is the only risk factor predicting 6-week rebleeding in patients with PVT (p = 0.032, HR: 3.405, 95% CI 1.112-10.429). CONCLUSIONS PVT was associated with high 14-day and 6-week rebleeding in patients after EVL. SMV thrombosis was the only risk factor for 6-week rebleeding in patients with PVT. High albumin levels may serve as a protective factor for the 14-day and 6-week rebleeding risk. PVT was not responsible for mortality after EVL during 1-year follow-up.
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Affiliation(s)
- Zhanjuan Gao
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, People's Republic of China
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, Shandong Province, People's Republic of China
| | - Jingrun Zhao
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, Shandong Province, People's Republic of China
| | - Xiaofeng Liu
- Department of Gastroenterology, Chinese People's Liberation Army No.960 Hospital, Jinan, Shandong Province, People's Republic of China
| | - Senlin Li
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, Shandong Province, People's Republic of China
| | - Minghui Wang
- Department of Gastroenterology, Chinese People's Liberation Army No.960 Hospital, Jinan, Shandong Province, People's Republic of China
| | - Yanjing Gao
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, People's Republic of China.
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Creta A, Elliott P, Earley MJ, Dhinoja M, Finlay M, Sporton S, Chow A, Hunter RJ, Papageorgiou N, Lowe M, Mohiddin SA, Boveda S, Adragao P, Jebberi Z, Matos D, Schilling RJ, Lambiase PD, Providência R. Catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: a European observational multicentre study. Europace 2021; 23:1409-1417. [PMID: 33930121 DOI: 10.1093/europace/euab022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/13/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM). Data on the efficacy of catheter ablation of AF in HCM patients are sparse. METHODS AND RESULTS Observational multicentre study in 137 HCM patients (mean age 55.0 ± 13.4, 29.1% female; 225 ablation procedures). We investigated (i) the efficacy of catheter ablation for AF beyond the initial 12 months; (ii) the available risk scores, stratification schemes and genotype as potential predictors of arrhythmia relapse, and (iii) the impact of cryoballoon vs. radiofrequency in procedural outcomes. Mean follow-up was 43.8 ± 37.0 months. Recurrences after the initial 12-month period post-ablation were frequent, and 24 months after the index procedure, nearly all patients with persistent AF had relapsed, and only 40% of those with paroxysmal AF remained free from arrhythmia recurrence. The APPLE score demonstrated a modest discriminative capacity for AF relapse post-ablation (c-statistic 0.63, 95% CI 0.52-0.75; P = 0.022), while the risk stratification schemes for sudden death did not. On multivariable analysis, left atrium diameter and LV apical aneurysm were independent predictors of recurrence. Fifty-eight patients were genotyped; arrhythmia-free survival was similar among subjects with different gene mutations. Rate of procedural complications was high (9.3%), although reducing over time. Outcome for cryoballoon and radiofrequency ablation was comparable. CONCLUSION Very late AF relapses post-ablation is common in HCM patients, especially in those with persistent AF. Left atrium size, LV apical aneurysm, and the APPLE score might contribute to identify subjects at higher risk of arrhythmia recurrence. First-time cryoballoon is comparable with radiofrequency ablation.
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Affiliation(s)
- Antonio Creta
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.,Research Doctorate Programme, Campus Bio-Medico University of Rome, Rome, Italy
| | - Perry Elliott
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.,Institute for Cardiovascular Sciences, University College London, London, UK
| | - Mark J Earley
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Mehul Dhinoja
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Malcolm Finlay
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Simon Sporton
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Anthony Chow
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Ross J Hunter
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Nikolaos Papageorgiou
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Martin Lowe
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Saidi A Mohiddin
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Serge Boveda
- Cardiology Department, Clinique Pasteur, Toulouse, France
| | - Pedro Adragao
- Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | - Zeynab Jebberi
- Cardiology Department, Clinique Pasteur, Toulouse, France
| | - Daniel Matos
- Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | - Richard J Schilling
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Pier D Lambiase
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Rui Providência
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.,Institute of Health Informatics Research, University College of London, London, UK
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29
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Koppel CJ, Driesen BW, de Winter RJ, van den Bosch AE, van Kimmenade R, Wagenaar LJ, Jukema JW, Hazekamp MG, van der Kley F, Jongbloed MRM, Kiès P, Egorova AD, Verheijen DBH, Damman P, Schoof PH, Wilschut J, Stoel M, Speekenbrink RGH, Voskuil M, Vliegen HW. The first multicentre study on coronary anomalies in the Netherlands: MuSCAT. Neth Heart J 2021; 29:311-317. [PMID: 33683666 PMCID: PMC8160042 DOI: 10.1007/s12471-021-01556-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Accepted: 02/17/2021] [Indexed: 01/16/2023] Open
Abstract
Background Current guidelines on coronary anomalies are primarily based on expert consensus and a limited number of trials. A gold standard for diagnosis and a consensus on the treatment strategy in this patient group are lacking, especially for patients with an anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) with an interarterial course. Aim To provide evidence-substantiated recommendations for diagnostic work-up, treatment and follow-up of patients with anomalous coronary arteries. Methods A clinical care pathway for patients with ACAOS was established by six Dutch centres. Prospectively included patients undergo work-up according to protocol using computed tomography (CT) angiography, ischaemia detection, echocardiography and coronary angiography with intracoronary measurements to assess anatomical and physiological characteristics of the ACAOS. Surgical and functional follow-up results are evaluated by CT angiography, ischaemia detection and a quality-of-life questionnaire. Patient inclusion for the first multicentre study on coronary anomalies in the Netherlands started in 2020 and will continue for at least 3 years with a minimum of 2 years of follow-up. For patients with a right or left coronary artery originating from the pulmonary artery and coronary arteriovenous fistulas a registry is maintained. Results Primary outcomes are: (cardiac) death, myocardial ischaemia attributable to the ACAOS, re-intervention after surgery and intervention after initially conservative treatment. The influence of work-up examinations on treatment choice is also evaluated. Conclusions Structural evidence for the appropriate management of patients with coronary anomalies, especially (interarterial) ACAOS, is lacking. By means of a structured care pathway in a multicentre setting, we aim to provide an evidence-based strategy for the diagnostic evaluation and treatment of this patient group. Supplementary Information The online version of this article (10.1007/s12471-021-01556-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C J Koppel
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - B W Driesen
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R J de Winter
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Amsterdam University Medical Centres, location AMC, Amsterdam Zuidoost, The Netherlands
| | - A E van den Bosch
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - R van Kimmenade
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L J Wagenaar
- Thorax Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - J W Jukema
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - M G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - F van der Kley
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - M R M Jongbloed
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Centre, Leiden, The Netherlands
| | - P Kiès
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - A D Egorova
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - D B H Verheijen
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - P Damman
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - P H Schoof
- Department of Cardiothoracic Surgery, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - J Wilschut
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M Stoel
- Thorax Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R G H Speekenbrink
- Thorax Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - M Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H W Vliegen
- Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands.
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30
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Zhang L, Weng TP, Wang HY, Sun F, Liu YY, Lin K, Zhou Z, Chen YY, Li YG, Chen JW, Han LJ, Liu HM, Huang FL, Cai C, Yu HY, Tang W, Huang ZH, Wang LZ, Bao L, Ren PF, Deng GF, Lv JN, Pu YL, Xia F, Li T, Deng Q, He GQ, Li Y, Zhang WH. Patient pathway analysis of tuberculosis diagnostic delay: a multicentre retrospective cohort study in China. Clin Microbiol Infect 2021; 27:1000-1006. [PMID: 33421578 DOI: 10.1016/j.cmi.2020.12.031] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/13/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Delay in diagnosis of tuberculosis (TB) is an important but under-appreciated problem. Our study aimed to analyse the patient pathway and possible risk factors of long diagnostic delay (LDD). METHODS We enrolled 400 new bacteriologically diagnosed patients with pulmonary TB from 20 hospitals across China. LDD was defined as an interval between the initial care visit and the confirmation of diagnosis exceeding 14 days. Its potential risk factors were investigated by multivariate logistic regression and multilevel logistic regression. Hospitals in China were classified by increasing size, from level 0 to level 3. TB laboratory equipment in hospitals was also evaluated. RESULTS The median diagnostic delay was 20 days (IQR: 7-72 days), and 229 of 400 patients (57.3%, 95%CI 52.4-62.1) had LDD; 15% of participants were diagnosed at the initial care visit. Compared to level 0 facilities, choosing level 2 (OR 0.27, 95%CI 0.12-0.62, p 0.002) and level 3 facilities (OR 0.34, 95%CI 0.14-0.84, p 0.019) for the initial care visit was independently associated with shorter LDD. Equipping with smear, culture, and Xpert at initial care visit simultaneously also helped to avoid LDD (OR 0.28, 95%CI 0.09-0.82, p 0.020). The multilevel logistic regression yielded similar results. Availability of smear, culture, and Xpert was lower in level 0-1 facilities than in level 2-3 facilities (p < 0.001, respectively). CONCLUSIONS Most patients failed to be diagnosed at the initial care visit. Patients who went to low-level facilities initially had a higher risk of LDD. Improvement of TB laboratory equipment, especially at low-level facilities, is urgently needed.
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Affiliation(s)
- Lu Zhang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Tao-Ping Weng
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong-Yu Wang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng Sun
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuan-Yuan Liu
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Ke Lin
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhe Zhou
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuan-Yuan Chen
- Department of Tuberculosis, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Yong-Guo Li
- Department of Infectious Diseases, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Ji-Wang Chen
- Department of Tuberculosis, The Second Hospital of Daqing, Daqing, China
| | - Li-Jun Han
- Department of Tuberculosis, Changchun Hospital of Infectious Diseases, Changchun, China
| | - Hui-Mei Liu
- Department of Tuberculosis, Xuzhou Hospital of Infectious Diseases, Xuzhou, China
| | - Fu-Li Huang
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Cui Cai
- Department of Tuberculosis, Guiyang Public Health Clinical Centre, Guiyang, China
| | - Hong-Ying Yu
- Department of Infectious Diseases, The First People's Hospital of Huaihua, Huaihua, China
| | - Wei Tang
- Provincial Key Laboratory for Respiratory Infectious Diseases in Shandong, Shandong Provincial Chest Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zheng-Hui Huang
- Department of Tuberculosis, Wuhan Jin Yin-Tan Hospital, Wuhan, China
| | - Long-Zhi Wang
- Department of Tuberculosis Xi'an Chest Hospital, Xi'an, China
| | - Lei Bao
- Department of Infectious Diseases, Anhui Provincial Hospital, Anhui, China
| | - Peng-Fei Ren
- Department of Tuberculosis, Henan Province Infectious Diseases Hospital, Zhengzhou, China
| | - Guo-Fang Deng
- Shenzhen Key Laboratory of Infection & Immunity, Shenzhen Third People's Hospital (The Second Affiliated Hospital of Shenzhen University), Shenzhen University School of Medicine, Shenzhen, China
| | - Jian-Nan Lv
- Department of Tuberculosis, Beihai Tuberculosis Hospital, Beihai, China
| | - Yong-Lan Pu
- Department of Infectious Diseases, The First People's Hospital of Taicang, Taicang, China
| | - Fan Xia
- Department of Infectious Diseases, 905th Military Hospital, Naval Medical University, Shanghai, China
| | - Tao Li
- Department of Infectious Diseases, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China
| | - Qun Deng
- Department of Tuberculosis, Jiangxi Chest Hospital, Jiangxi, China
| | - Gui-Qing He
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, China
| | - Yang Li
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
| | - Wen-Hong Zhang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
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31
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Lascarrou JB, Miailhe AF, le Gouge A, Cariou A, Dequin PF, Reignier J, Coupez E, Quenot JP, Legriel S, Pichon N, Thevenin D, Boulain T, Frat JP, Vimeux S, Colin G, Desroys du Roure F. NSE as a predictor of death or poor neurological outcome after non-shockable cardiac arrest due to any cause: Ancillary study of HYPERION trial data. Resuscitation 2020; 158:193-200. [PMID: 33301887 DOI: 10.1016/j.resuscitation.2020.11.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/29/2020] [Revised: 11/14/2020] [Accepted: 11/26/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Prognostication of hypoxic-ischaemic brain injury after resuscitation from cardiac arrest is based on a multimodal approach including biomarker assays. Our goal was to assess whether plasma NSE helps to predict day-90 death or poor neurological outcome in patients resuscitated from cardiac arrest in non-shockable rhythm. METHODS All included patients participated in the randomised multicentre HYPERION trial. Serum blood samples were taken 24, 48, and 72 h after randomisation; pre-treated, aliquoted, and frozen at -80 °C at the study sites; and shipped to a central biology laboratory, where the NSE assays were performed. Primary outcome was neurological status at day 90 assessed by Cerebral Performance Category (1 or 2 versus. 3, 4 or 5). RESULTS NSE was assayed in 235 assessable blood samples from 101 patients. In patients with good versus poor outcomes, median NSE values at 24, 48, and 72 h were 22.6 [95%CI, 14.6;27.3] ng/mL versus 33.6 [20.5;90.0] ng/mL (p < 0.04), 18.1 [11.7;29.7] ng/mL versus 76.8 [21.5;206.6] ng/mL (p < 0.0029), and 9 [6.1;18.6] ng/mL versus 80.5 [22.9;236.1] ng/mL (p < 0.001), respectively. NSE at 48 and 72 h predicted the neurological outcome with areas under the receiver-operating curve of 0.79 [95%CI, 0.69;0.96] and 0.9 [0.81;0.96], respectively. NSE levels did not differ significantly between the groups managed at 33°C and 37°C (p = 0.59). CONCLUSIONS Data from a multicentre trial on cardiac arrest with a non-shockable rhythm due to any cause confirm that NSE values at 72 h are associated with 90-day outcome. NSE levels did not differ significantly according to the targeted temperature. REGISTRATION IDENTIFIER ClinicalTrial NCT02722473.
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Affiliation(s)
- Jean-Baptiste Lascarrou
- Medecine Intensive Reanimation, University Hospital Centre, Nantes, France; Paris Cardiovascular Research Centre, INSERM U970, Paris, France; AfterROSC Network, France.
| | | | | | - Alain Cariou
- Paris Cardiovascular Research Centre, INSERM U970, Paris, France; AfterROSC Network, France; Medecine Intensive Reanimation, University Hospital Centre, Cochin, France
| | - Pierre-François Dequin
- INSERM CIC1415, CHRU de Tours, Tours, France; Medical Intensive Care Unit, University Hospital Centre, Tours, France; Université de Tours, Tours, France
| | - Jean Reignier
- Medecine Intensive Reanimation, University Hospital Centre, Nantes, France
| | - Elisabeth Coupez
- Medical Intensive Care Unit, University Hospital Centre, Clermond-Ferrand, France
| | | | - Stephane Legriel
- AfterROSC Network, France; Medical-Surgical Intensive Care Unit, Versailles Hospital, Versailles, France; University Paris-Saclay, UVSQ, INSERM, CESP, Team «PsyDev», Villejuif, France
| | - Nicolas Pichon
- AfterROSC Network, France; Service de Réanimation Polyvalente, University Hospital Centre, Limoges, France; CIC 1435, University Hospital Centre, Limoges, France
| | - Didier Thevenin
- Medical-Surgical Intensive Care Unit, General Hospital Centre, Lens, France
| | - Thierry Boulain
- Medical Intensive Care Unit, Regional Hospital Centre, Orleans, France
| | - Jean-Pierre Frat
- Medical Intensive Care Unit, University Hospital Centre, Poitiers, France; INSERM, CIC-1402, équipe ALIVE, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers, France
| | - Sylvie Vimeux
- Medical-Surgical Intensive Care Unit, General Hospital Centre, Montauban, France
| | - Gwenhael Colin
- Medical-Surgical Intensive Care Unit, District Hospital Centre, La Roche-sur-Yon, France
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Demizu Y, Imai R, Kiyohara H, Matsunobu A, Okamoto M, Okimoto T, Tsuji H, Ohno T, Shioyama Y, Nemoto K, Nakano T, Kamada T; Japan Carbon-Ion Radiation Oncology Study Group. In response to Liu et al. Radiother Oncol 2021; 155:e18-9. [PMID: 33227354 DOI: 10.1016/j.radonc.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022]
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Embun R, Royo-Crespo I, Recuero Díaz JL, Bolufer S, Call S, Congregado M, Gómez-de Antonio D, Jimenez MF, Moreno-Mata N, Aguinagalde B, Amor-Alonso S, Arrarás MJ, Blanco Orozco AI, Boada M, Cabañero Sánchez A, Cal Vázquez I, Cilleruelo Ramos Á, Crowley Carrasco S, Fernández-Martín E, García-Barajas S, García-Jiménez MD, García-Prim JM, Garcia-Salcedo JA, Gelbenzu-Zazpe JJ, Giraldo-Ospina CF, Gómez Hernández MT, Hernández J, Wolf JDI, Jauregui Abularach A, Jiménez U, López Sanz I, Martínez-Hernández NJ, Martínez-Téllez E, Milla Collado L, Mongil Poce R, Moradiellos-Díez FJ, Moreno-Balsalobre R, Moreno Merino SB, Obiols C, Quero-Valenzuela F, Ramírez-Gil ME, Ramos-Izquierdo R, Rivo E, Rodríguez-Fuster A, Rojo-Marcos R, Sanchez-Lorente D, Sanchez Moreno L, Simón C, Trujillo-Reyes JC, Hernando Trancho F. Spanish Video-Assisted Thoracic Surgery Group: Method, Auditing, and Initial Results From a National Prospective Cohort of Patients Receiving Anatomical Lung Resections. Arch Bronconeumol 2020; 56:718-724. [PMID: 35579917 DOI: 10.1016/j.arbr.2020.01.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/05/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Our study sought to know the current implementation of video-assisted thoracoscopic surgery (VATS) for anatomical lung resections in Spain. We present our initial results and describe the auditing systems developed by the Spanish VATS Group (GEVATS). METHODS We conducted a prospective multicentre cohort study that included patients receiving anatomical lung resections between 12/20/2016 and 03/20/2018. The main quality controls consisted of determining the recruitment rate of each centre and the accuracy of the perioperative data collected based on six key variables. The implications of a low recruitment rate were analysed for "90-day mortality" and "Grade IIIb-V complications". RESULTS The series was composed of 3533 cases (1917 VATS; 54.3%) across 33 departments. The centres' median recruitment rate was 99% (25-75th:76-100%), with an overall recruitment rate of 83% and a data accuracy of 98%. We were unable to demonstrate a significant association between the recruitment rate and the risk of morbidity/mortality, but a trend was found in the unadjusted analysis for those centres with recruitment rates lower than 80% (centres with 95-100% rates as reference): grade IIIb-V OR=0.61 (p=0.081), 90-day mortality OR=0.46 (p=0.051). CONCLUSIONS More than half of the anatomical lung resections in Spain are performed via VATS. According to our results, the centre's recruitment rate and its potential implications due to selection bias, should deserve further attention by the main voluntary multicentre studies of our speciality. The high representativeness as well as the reliability of the GEVATS data constitute a fundamental point of departure for this nationwide cohort.
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Affiliation(s)
- Raul Embun
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain.
| | - Iñigo Royo-Crespo
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - José Luis Recuero Díaz
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Sergio Bolufer
- Servicio de Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, Spain
| | - Sergi Call
- Servicio de Cirugía Torácica, Hospital Universitari Mútua Terrasa, Universidad de Barcelona, Terrasa, Barcelona, Spain
| | - Miguel Congregado
- Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - David Gómez-de Antonio
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Marcelo F Jimenez
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Universidad de Salamanca, IBSAL, Salamanca, Spain
| | - Nicolas Moreno-Mata
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Borja Aguinagalde
- Servicio de Cirugía Torácica, Hospital Universitario de Donostia, San Sebastián-Donostia, Spain
| | - Sergio Amor-Alonso
- Servicio de Cirugía Torácica, Hospital Universitario Quironsalud Madrid, Madrid, Spain
| | - Miguel Jesús Arrarás
- Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Marc Boada
- Servicio de Cirugía Torácica, Hospital Clinic de Barcelona, Instituto Respiratorio, Universidad de Barcelona, Barcelona, Spain
| | | | - Isabel Cal Vázquez
- Servicio de Cirugía Torácica, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Silvana Crowley Carrasco
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | | | - Jose María García-Prim
- Servicio de Cirugía Torácica, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | - María Teresa Gómez Hernández
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Universidad de Salamanca, IBSAL, Salamanca, Spain
| | - Jorge Hernández
- Servicio de Cirugía Torácica, Hospital Universitario Sagrat Cor, Barcelona, Spain
| | | | | | - Unai Jiménez
- Servicio de Cirugía Torácica, Hospital Universitario Cruces, Bilbao, Spain
| | - Iker López Sanz
- Servicio de Cirugía Torácica, Hospital Universitario de Donostia, San Sebastián-Donostia, Spain
| | | | - Elisabeth Martínez-Téllez
- Servicio de Cirugía Torácica, Hospital Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Roberto Mongil Poce
- Servicio de Cirugía Torácica, Hospital Regional Universitario, Málaga, Spain
| | | | | | | | - Carme Obiols
- Servicio de Cirugía Torácica, Hospital Universitari Mútua Terrasa, Universidad de Barcelona, Terrasa, Barcelona, Spain
| | | | | | - Ricard Ramos-Izquierdo
- Servicio de Cirugía Torácica, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Eduardo Rivo
- Servicio de Cirugía Torácica, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Rodríguez-Fuster
- Servicio de Cirugía Torácica, Hospital del Mar, Barcelona, Spain; IMIM (Instituto de Investigación Médica Hospital del Mar), Barcelona, Spain
| | - Rafael Rojo-Marcos
- Servicio de Cirugía Torácica, Hospital Universitario Cruces, Bilbao, Spain
| | - David Sanchez-Lorente
- Servicio de Cirugía Torácica, Hospital Clinic de Barcelona, Instituto Respiratorio, Universidad de Barcelona, Barcelona, Spain
| | - Laura Sanchez Moreno
- Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santader, Spain
| | - Carlos Simón
- Servicio de Cirugía Torácica, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Carlos Trujillo-Reyes
- Servicio de Cirugía Torácica, Hospital Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
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Demizu Y, Imai R, Kiyohara H, Matsunobu A, Okamoto M, Okimoto T, Tsuji H, Ohno T, Shioyama Y, Nemoto K, Nakano T, Kamada T. Carbon ion radiotherapy for sacral chordoma: A retrospective nationwide multicentre study in Japan. Radiother Oncol 2020; 154:1-5. [PMID: 32941958 DOI: 10.1016/j.radonc.2020.09.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 08/16/2020] [Accepted: 09/09/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Usefulness of carbon ion radiotherapy (CIRT) for sacral chordoma has been reported from single institutions. We conducted a retrospective nationwide multicentre study to evaluate the clinical outcomes of CIRT for sacral chordoma in Japan. MATERIALS AND METHODS A total of 219 patients who underwent CIRT for sacral chordoma at institutions across Japan between December 2003 and July 2014 were included in this study. RESULTS Median patient age was 67 years (range, 26-87 years). Most patients had no history of surgical resection (96%). The most frequent planning target volume (PTV) range was 100-500 mL (65%). The most frequently used dose-fractionation was 67.2 Gy (relative biological effectiveness) in 16 fractions (65%). The median follow-up was 56 months (range, 7-132 months). The 5-year overall survival (OS), progression-free survival, and local control rates were 84%, 48%, and 72%, respectively. Frequent sites of out-of-field recurrence included bone (9%) and lung (9%) metastases. The Cox proportional hazards model revealed that both younger age (P = 0.004) and smaller PTV (P = 0.001) were associated with significantly better OS. Acute toxicities of ≥Grade 3 occurred in eight patients (4%). Late toxicities of ≥Grade 3 occurred in 13 patients (6%): skin disorders in six patients (3%), pain in three (1%), myositis in three (1%), etc. CONCLUSION: Our retrospective nationwide multicentre study showed that CIRT for sacral chordoma was effective and safe, and replicated the previously reported data from a representative CIRT institution in Japan demonstrating high local control and low toxicity rates.
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Affiliation(s)
- Yusuke Demizu
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, Kobe, Japan; Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Reiko Imai
- QST Hospital, Quantum Medical Science Directorate, National Institute for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Hiroki Kiyohara
- Department of Radiation Oncology, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | | | | | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Hiroshi Tsuji
- QST Hospital, Quantum Medical Science Directorate, National Institute for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | | | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University, Faculty of Medicine, Yamagata, Japan
| | - Takashi Nakano
- National Institute of Radiological Sciences, Quantum Medical Science Directorate, National Institute for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Tadashi Kamada
- Ion-beam Radiation Oncology Center, Kanagawa Cancer Center, Yokohama, Japan.
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Lundström E, Isaksson E, Näsman P, Wester P, Mårtensson B, Norrving B, Wallén H, Borg J, Dennis M, Mead G, Hankey GJ, Hackett ML, Sunnerhagen KS. Update on the EFFECTS study of fluoxetine for stroke recovery: a randomised controlled trial in Sweden. Trials 2020; 21:233. [PMID: 32111264 PMCID: PMC7048055 DOI: 10.1186/s13063-020-4124-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/30/2020] [Indexed: 12/13/2022] Open
Abstract
Studies have suggested that fluoxetine might improve neurological recovery after stroke, but the results remain inconclusive. The EFFECTS (Efficacy oF Fluoxetine - a randomisEd Controlled Trial in Stroke) reached its recruitment target of 1500 patients in June 2019. The purpose of this article is to present all amendments to the protocol and describe how we formed the EFFECTS trial collaboration in Sweden. METHODS In this investigator-led, multicentre, parallel-group, randomised, placebo-controlled trial, we enrolled non-depressed stroke patients aged 18 years or older between 2 and 15 days after stroke onset. The patients had a clinical diagnosis of stroke (ischaemic or intracerebral haemorrhage) with persisting focal neurological deficits. Patients were randomised to fluoxetine 20 mg or matching placebo capsules once daily for 6 months. RESULTS Seven amendments were made and included clarification of drug interaction between fluoxetine and metoprolol and the use of metoprolol for severe heart failure as an exclusion criterion, inclusion of data from central Swedish registries and the Swedish Stroke Register, changes in informed consent from patients, and clarification of design of some sub-studies. EFFECTS recruited 1500 patients at 35 centres in Sweden between 20 October 2014 and 28 June 2019. We plan to unblind the data in January 2020 and report the primary outcome in May 2020. CONCLUSION EFFECTS will provide data on the safety and efficacy of 6 months of treatment with fluoxetine after stroke in a Swedish health system setting. The data from EFFECTS will also contribute to an individual patient data meta-analysis. TRIAL REGISTRATION EudraCT 2011-006130-16. Registered on 8 August 2014. ISRCTN, ISRCTN13020412. Registered on 19 December 2014. ClinicalTrials.gov: NCT02683213. Retrospectively registered on 2 February 2016.
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Affiliation(s)
- Erik Lundström
- Department of Neuroscience, Neurology, Uppsala University, Akademiska Sjukhuset, SE-751 85, Uppsala, Sweden.
| | - Eva Isaksson
- Department of Clinical Neuroscience, Neurology, Karolinska Institutet, Nobels väg 6, SE-171 76, Stockholm, Sweden
| | - Per Näsman
- Centre for Safety Research, KTH Royal Institute of Technology, TR10 B, SE-100 44, Stockholm, Sweden
| | - Per Wester
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88, Stockholm, Sweden
- Department of Public Health & Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Björn Mårtensson
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Bo Norrving
- Department of Clinical Sciences, Lund, Neurology, Skåne University Hospital, Lund University, SE-221 85, Lund, Sweden
| | - Håkan Wallén
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, SE-182 88, Stockholm, Sweden
| | - Jörgen Borg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88, Stockholm, Sweden
| | - Martin Dennis
- Royal Infirmary, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Gillian Mead
- Royal Infirmary, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Graeme J Hankey
- Medical School, The University of Western Australia, Perth, Australia
| | - Maree L Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia
- The University of Central Lancashire, Preston, UK
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Riga Stradins University, Riga, Latvia
- Sunnaas Rehabilitation Hospital, Bjørnemy, Norway
- Rehabilitation Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ercibengoa M, Càmara J, Tubau F, García-Somoza D, Galar A, Martín-Rabadán P, Marin M, Mateu L, García-Olivé I, Prat C, Cilloniz C, Torres A, Pedro-Botet ML, Ardanuy C, Muñoz P, Marimón JM. A multicentre analysis of Nocardia pneumonia in Spain: 2010-2016. Int J Infect Dis 2019; 90:161-166. [PMID: 31693939 DOI: 10.1016/j.ijid.2019.10.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 10/19/2019] [Accepted: 10/23/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To analyse all cases of Nocardia pneumonia occurring between 2010 and 2016 in five Spanish hospitals. METHODS This was a retrospective observational analysis of clinical and microbiological data collected from 55 cases of Nocardia pneumonia. RESULTS There were one to 20 cases per hospital and six to nine cases per year. Chronic obstructive pulmonary disease, bronchiectasis, and asthma were the main predisposing underlying respiratory conditions. Thirty-four patients were receiving systemic and/or inhaled corticosteroids prior to infection, eight had neoplasia, and six had haematological malignancies. Clinical and radiological findings were common to pneumonia of other infectious aetiologies, except for the frequent presence of nodules and cavitation. Overall, the 1-year mortality was high (38.2%), and mortality was directly related to the pulmonary disease in 15 patients (27.3%). The most frequently identified species were N. cyriacigeorgica (n=21), N. abscessus (n=8), and N. farcinica (n=5). All Nocardia isolates were susceptible to linezolid and all but two were susceptible to amikacin and trimethoprim-sulfamethoxazole. CONCLUSIONS Nocardia pneumonia-associated mortality remains high, probably because of the debilitated status of patients in whom this pathogen is able to cause pulmonary infection.
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Affiliation(s)
- Maria Ercibengoa
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain
| | - Jordi Càmara
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Hospital de Bellvitge-IDIBELL, L'Hospitalet de LLobregat, Spain
| | - Fe Tubau
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Hospital de Bellvitge-IDIBELL, L'Hospitalet de LLobregat, Spain
| | - Dolores García-Somoza
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Hospital de Bellvitge-IDIBELL, L'Hospitalet de LLobregat, Spain
| | - Alicia Galar
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
| | - Pablo Martín-Rabadán
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Mercedes Marin
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Lourdes Mateu
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit - Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ignasi García-Olivé
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Department of Pneumology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Cristina Prat
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Microbiology Department - Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Catia Cilloniz
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Department of Pneumology, Hospital Clinic of Barcelona - August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Antonio Torres
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Department of Pneumology, Hospital Clinic of Barcelona - August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria-Luisa Pedro-Botet
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit - Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Carmen Ardanuy
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Hospital de Bellvitge-IDIBELL, L'Hospitalet de LLobregat, Spain; Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- CIBER Enfermedades Respiratorias - CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose María Marimón
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain.
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Horke A. Surgery for anomalous aortic origin of coronary arteries is safe, but is it also effective in the long term? Eur J Cardiothorac Surg 2019; 56:704-705. [PMID: 31343687 DOI: 10.1093/ejcts/ezz110] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander Horke
- Division of Congenital Cardiovascular Surgery, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Germany
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Kissling E, Pozo F, Buda S, Vilcu AM, Rizzo C, Gherasim A, Horváth JK, Brytting M, Domegan L, Meijer A, Paradowska-Stankiewicz I, Machado A, Vučina VV, Lazar M, Johansen K, Dürrwald R, van der Werf S, Bella A, Larrauri A, Ferenczi A, Zakikhany K, O'Donnell J, Dijkstra F, Bogusz J, Guiomar R, Filipović SK, Pitigoi D, Penttinen P, Valenciano M. Effectiveness of influenza vaccine against influenza A in Europe in seasons of different A(H1N1)pdm09 and the same A(H3N2) vaccine components (2016-17 and 2017-18). Vaccine X 2019; 3:100042. [PMID: 31660536 PMCID: PMC6807025 DOI: 10.1016/j.jvacx.2019.100042] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 05/16/2019] [Revised: 09/13/2019] [Accepted: 09/15/2019] [Indexed: 11/09/2022] Open
Abstract
Influenza A(H3N2) circulated in Europe in 2016–17 and 2017–18 and A(H1N1)pdm09 in 2017–18. Changed A(H1N1)pdm09 vaccine component VE was 58% against A(H1N1)pdm09 in 2017–18. A(H3N2) VE was 13% and 28% among all ages in 2016–17 and 2017–18, respectively.
Introduction Influenza A(H3N2) viruses predominated in Europe in 2016–17. In 2017–18 A(H3N2) and A(H1N1)pdm09 viruses co-circulated. The A(H3N2) vaccine component was the same in both seasons; while the A(H1N1)pdm09 component changed in 2017–18. In both seasons, vaccine seed A(H3N2) viruses developed adaptations/alterations during propagation in eggs, impacting antigenicity. Methods We used the test-negative design in a multicentre primary care case-control study in 12 European countries to measure 2016–17 and 2017–18 influenza vaccine effectiveness (VE) against laboratory-confirmed influenza A(H1N1)pdm09 and A(H3N2) overall and by age group. Results During the 2017–18 season, the overall VE against influenza A(H1N1)pdm09 was 59% (95% CI: 47–69). Among those aged 0–14, 15–64 and ≥65 years, VE against A(H1N1)pdm09 was 64% (95% CI: 37–79), 50% (95% CI: 28–66) and 66% (95% CI: 42–80), respectively. Overall VE against influenza A(H3N2) was 28% (95% CI: 17–38) in 2016–17 and 13% (95% CI: −15 to 34) in 2017–18. Among 0–14-year-olds VE against A(H3N2) was 28% (95%CI: −10 to 53) and 29% (95% CI: −87 to 73), among 15–64-year-olds 34% (95% CI: 18–46) and 33% (95% CI: −3 to 56) and among those aged ≥65 years 15% (95% CI: −10 to 34) and −9% (95% CI: −74 to 32) in 2016–17 and 2017–18, respectively. Conclusions Our study suggests the new A(H1N1)pdm09 vaccine component conferred good protection against circulating strains, while VE against A(H3N2) was <35% in 2016–17 and 2017–18. The egg propagation derived antigenic mismatch of the vaccine seed virus with circulating strains may have contributed to this low effectiveness. A(H3N2) seed viruses for vaccines in subsequent seasons may be subject to the same adaptations; in years with lower than expected VE, recommendations of preventive measures other than vaccination should be given in a timely manner.
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Affiliation(s)
- Esther Kissling
- Epidemiology Department, Epiconcept, 47 rue de Charenton, 75012 Paris, France
| | - Francisco Pozo
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain
| | - Silke Buda
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Respiratory Infections Unit, Seestrasse 10, 13353 Berlin, Germany
| | - Ana-Maria Vilcu
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75012, Paris, France
| | - Caterina Rizzo
- Department of Infectious Diseases, National Institute of Health, Rome, Italy.,Bambino Gesù Children's Hospital, Rome, Italy
| | - Alin Gherasim
- National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain
| | | | - Mia Brytting
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1 D01 A4A3, Ireland
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Ausenda Machado
- Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - Mihaela Lazar
- "Cantacuzino" National Medico-Military Institute for Research and Development, Bucharest, Romania
| | - Kari Johansen
- European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73 Solna, Sweden
| | - Ralf Dürrwald
- Robert Koch Institute, National Reference Center for Influenza, Seestrasse 10, 13353 Berlin, Germany
| | - Sylvie van der Werf
- Unité de Génétique Moléculaire des Virus à ARN, Institut Pasteur, CNRS UMR3569, Université Paris Diderot SPC, France.,CNR des Virus des Infections Respiratoires, WHO National Influenza Center, Institut Pasteur, France
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Amparo Larrauri
- National Epidemiology Centre, Institute of Health Carlos III, Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain
| | | | | | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1 D01 A4A3, Ireland
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Joanna Bogusz
- National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Raquel Guiomar
- Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Portugal
| | | | - Daniela Pitigoi
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 169 73 Solna, Sweden
| | - Marta Valenciano
- Epidemiology Department, Epiconcept, 47 rue de Charenton, 75012 Paris, France
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Shiraishi N, Watanabe N, Katsuki F, Sakaguchi H, Akechi T. Effectiveness of the Japanese standard family psychoeducation on the mental health of caregivers of young adults with schizophrenia: a randomised controlled trial. BMC Psychiatry 2019; 19:263. [PMID: 31477061 PMCID: PMC6719377 DOI: 10.1186/s12888-019-2252-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 06/15/2018] [Accepted: 08/22/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study examined the effects of the standard model of family psychoeducation (SM-FPE) in Japan on the mental health of relatives who care for young patients with a psychotic disorder. METHODS Stratified by recent-onset/chronic psychosis, 74 caregivers of outpatients aged 30.1 years (mean) were randomly assigned to receive TAU (treatment as usual) alone or TAU plus SM-FPE. All outcomes were measured at baseline, at the end of the intervention (10 weeks), and 1 month post-intervention (14 weeks). The primary outcome was the trait anxiety of caregivers at 14 weeks. Secondary outcomes included caregivers' state anxiety, psychological distress, care burden, and expressed emotion. Integrating these secondary outcomes, a conceptual framework of caregivers' health state was assessed via structural equation modelling. RESULTS Compared with TAU alone, SM-FPE plus TAU did not significantly improve all caregivers' individual outcomes. Direct effects of the intervention were observed in the caregivers of chronic patients as significant improvements of their overall mental health state at 10 weeks, which indirectly continued until 14 weeks. However, such intervention effects were not observed in the caregivers of recent-onset patients. CONCLUSIONS The lack of effectiveness in the recent-onset stage suggests that the usefulness of the SM-FPE needs to be corroborated by further research. TRIAL REGISTRATION The study protocol was retrospectively registered at ClinicalTrials.gov (registration number: NCT01731977; date of registration: 22 November 2012).
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Affiliation(s)
- Nao Shiraishi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Norio Watanabe
- 0000 0004 0372 2033grid.258799.8Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Fujika Katsuki
- 0000 0001 0728 1069grid.260433.0Department of Psychiatric and Mental Health Nursing, Nagoya City University School of Nursing, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601 Japan
| | - Hajime Sakaguchi
- Midorino Kaze Minamichita Hospital, Magohazama-86 Toyooka, Minamichita, Aichi, Chita District 470-3411 Japan
| | - Tatsuo Akechi
- 0000 0001 0728 1069grid.260433.0Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601 Japan
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Schmitz D, Vogl T, Nour-Eldin NEA, Radeleff B, Kröger JC, Mahnken AH, Ittrich H, Gehl HB, Plessow B, Böttcher J, Tacke J, Wispler M, Rosien U, Schorr W, Joerdens M, Glaser N, Fuchs ES, Tal A, Friesenhahn-Ochs B, Leimbach T, Höpner L, Weber M, Gölder S, Böhmig M, Hetjens S, Rudi J, Schegerer A. Patient radiation dose in percutaneous biliary interventions: recommendations for DRLs on the basis of a multicentre study. Eur Radiol 2019; 29:3390-3400. [PMID: 31016441 DOI: 10.1007/s00330-019-06208-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 10/10/2018] [Revised: 03/20/2019] [Accepted: 03/27/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Percutaneous biliary interventions (PBIs) can be associated with a high patient radiation dose, which can be reduced when national diagnostic reference levels (DRLs) are kept in mind. The aim of this multicentre study was to investigate patient radiation exposure in different percutaneous biliary interventions, in order to recommend national DRLs. METHODS A questionnaire asking for the dose area product (DAP) and the fluoroscopy time (FT) in different PBIs with ultrasound- or fluoroscopy-guided bile duct punctures was sent to 200 advanced care hospitals. Recommended national DRLs are set at the 75th percentile of all DAPs. RESULTS Twenty-three facilities (9 interventional radiology depts. and 14 gastroenterology depts.) returned the questionnaire (12%). Five hundred sixty-five PBIs with 19 different interventions were included in the analysis. DAPs (range 4-21,510 cGy·cm2) and FTs (range 0.07-180.33 min) varied substantially depending on the centre and type of PBI. The DAPs of initial PBIs were significantly (p < 0.0001) higher (median 2162 cGy·cm2) than those of follow-up PBIs (median 464 cGy·cm2). There was no significant difference between initial PBIs with ultrasound-guided bile duct puncture (2162 cGy·cm2) and initial PBIs with fluoroscopy-guided bile duct puncture (2132 cGy·cm2) (p = 0.85). FT varied substantially (0.07-180.33 min). CONCLUSIONS DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. PBI with US-guided bile duct puncture did not reduce DAP, when compared to PBI with fluoroscopy-guided bile duct puncture. National DRLs of 4300 cGy·cm2 for initial PBIs and 1400 cGy·cm2 for follow-up PBIs are recommended. KEY POINTS • DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. • PBI with US-guided bile duct puncture did not reduce DAP when compared to PBI with fluoroscopy-guided bile duct puncture. • DRLs of 4300 cGy·cm2for initial PBIs (establishing a transhepatic tract) and 1400 cGy·cm2for follow-up PBIs (transhepatic tract already established) are recommended.
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Affiliation(s)
- Daniel Schmitz
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus and St. Hedwig Hospital, Academic Teaching Hospital of Heidelberg University, Bassermannstr.1, 68165, Mannheim, Germany.
| | - Thomas Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Boris Radeleff
- Department for Diagnostic and Interventional Radiology, Sana Municipal Hospital Hof, Hof, Germany
| | - Jens-Christian Kröger
- Institute for Diagnostic and Interventional Radiology, University Medicine Rostock, Rostock, Germany
| | - Andreas H Mahnken
- Institute for Diagnostic and Interventional Radiology, University Hospital Marburg, Marburg, Germany
| | - Harald Ittrich
- Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg, Hamburg, Germany
| | - Hans-Björn Gehl
- Institute for Diagnostic Radiology, Municipal Hospital Bielefeld, Bielefeld, Germany
| | - Bernd Plessow
- Radiological Institute, University Medicine Greifswald, Greifswald, Germany
| | - Joachim Böttcher
- Institute for Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera, Gera, Germany
| | - Josef Tacke
- Institute for Diagnostic and Interventional Radiology/Neuroradiology, Municipal Hospital Passau, Passau, Germany
| | - Markus Wispler
- Community Hospital Havelhöhe, Gastroenterology, Berlin, Germany
| | - Ulrich Rosien
- Medical Clinic, Israelite Hospital Hamburg, Hamburg, Germany
| | - Wolfgang Schorr
- Department of Gastroenterology and Interventional Endoscopy, Barmherzige Brüder Hospital Regensburg, Regensburg, Germany
| | - Markus Joerdens
- Department of Gastroenterology, Oncology and Infectiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nicolas Glaser
- Clinic for Internal Medicine II: Gastroenterology, Oncology, Endocrinology and Infectiology, University Hospital Freiburg, Freiburg, Germany
| | - Erik-Sebastian Fuchs
- Department of Gastroenterology, Infectiology, Diabetology and Gastrointestinal Oncology (Medical Clinic C), Ludwigshafen Municipal Hospital, Ludwigshafen, Germany
| | - Andrea Tal
- Medical Clinic I: Gastroenterology and Hepatology, Pneumology and Allergology, Endocrinology and Diabetology as Nutritional Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Bettina Friesenhahn-Ochs
- Clinic for Internal Medicine II: Gastroenterology, Hepatology, Endocrinology, Diabetology and Nutritional Medicine, Saarland University Hospital, Homburg, Germany
| | - Thomas Leimbach
- Clinic for Gastroenterology, Hepatology, Gastrointestinal Oncology, Municipal Hospital Bogenhausen Munich, Munich, Germany
| | - Lars Höpner
- Clinic for Gastrointestinal Diseases/Medical Clinic I, Municipal Clinic of Braunschweig, Braunschweig, Germany
| | - Marko Weber
- Clinic for Internal Medicine IV: Gastroenterology, Hepatology, Infectiology, Interdisciplinary Endoscopy, University Hospital Jena, Jena, Germany
| | - Stefan Gölder
- Medical Clinic III - Gastroenterology, Municipal Hospital Augsburg, Augsburg, Germany
| | - Michael Böhmig
- Medical Clinic I (Gastroenterology, Hepatology, Oncology, Infectiology), Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | - Svetlana Hetjens
- Department of Medical Statistics and Biomathematics of Mannheim University Hospital, Heidelberg University-Hospital, Heidelberg, Germany
| | - Jochen Rudi
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus and St. Hedwig Hospital, Academic Teaching Hospital of Heidelberg University, Bassermannstr.1, 68165, Mannheim, Germany
| | - Alexander Schegerer
- Department for Radiation Protection and Health, Federal Office of Radiation Protection, Salzgitter, Germany
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Lambrecht ML, Eaton DJ, Sonke JJ, Nestle U, Peulen H, Weber DC, Verheij M, Hurkmans CW. Results of a multicentre dosimetry audit using a respiratory phantom within the EORTC LungTech trial. Radiother Oncol 2019; 138:106-113. [PMID: 31252291 DOI: 10.1016/j.radonc.2019.06.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The EORTC 22113-08113 LungTech trial assesses the safety and efficacy of SBRT for centrally located NSCLC. To insure protocol compliance an extensive RTQA procedure was implemented. METHODS Twelve centres were audited using a CIRS008A phantom. The phantom was scanned using target inserts of 7.5 mm and 12.5 mm radius in static condition. For the 7.5 mm insert a 4DCT was acquired while moving according to a cos6 function. Treatment plans were measured using film and an ionization chamber. Wilcoxon's signed-rank tests were performed to compare the three plans across institutions. A Spearman correlation was calculated to evaluate the influence of factors such as PTV, slice thickness and total number of monitor units on the dosimetric results. RESULTS The reference output dose median [min, max] variation was 0.5% [-1.1, +1.5]. The median deviations between chamber doses and point-planned doses were 1.8% [-0.1; 6.7] for the 7.5 mm and 1.1% [-2.8; 5.0] for the 12.5 mm sphere in static situation and 3.2% [-3.2; 15.7] for the dynamic situation. Film gamma median pass rates were 92.0% [68.0, 99.0] for 7.5 mm static, 96.2% [73.0, 99.0] for 12.5 mm static and 71.0% [40.0, 99.0] for 7.5 mm dynamic. Wilcoxon's signed-rank tests showed that the dynamic irradiations resulted in significantly lower gamma pass rates compared to the 12.5 mm static plan (p = 0.001). The total number of MUs per plan was correlated to both film and IC results. CONCLUSION An end-to-end audit was successfully performed, revealing important variations between institutions especially in dynamic irradiations. This shows the importance of dosimetry audits and the potentials for further technique and methodology improvements.
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Affiliation(s)
- Marie Lara Lambrecht
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - David J Eaton
- Radiotherapy Trials QA Group, Mount Vernon Hospital, Northwood, United Kingdom
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherland Cancer Institute, Amsterdam, The Netherlands
| | - Ursula Nestle
- Department of Radiation Oncology, KlinikenMaria Hilf, Mönchengladbach, Germany
| | - Heike Peulen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Marcel Verheij
- Department of Radiation Oncology, The Netherland Cancer Institute, Amsterdam, The Netherlands
| | - Coen W Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands.
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Chapron A, Pelé F, Andres É, Fiquet L, Laforest C, Veislinger A, Fougerou C, Turmel V, Fouchard J, Yourish B, Oumari S, Allory E, Banâtre A, Schweyer FX, Pommier J, Brinchault G, Guillot S, Laviolle B, Jouneau S. [Targeted screening of COPD in primary care: Feasibility and effectiveness]. Rev Mal Respir 2019; 36:162-170. [PMID: 30686560 DOI: 10.1016/j.rmr.2018.08.023] [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] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/14/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a common but under-diagnosed pathology in primary care. The objective was to study the feasibility of a randomized controlled trial in general practice to detect new cases of COPD at an earlier stage. METHODS A cluster randomized, controlled, multicenter intervention study comparing, according to a 2×2 factorial plan, two case finding strategies: a systematic GOLD-HAS hetero-questionnaire and coordination of the patient's path to facilitate access to spirometry. The PIL-DISCO pilot study took place in 2017. Patients between 40 and 80 years old, with no previous history of COPD, consulting their GP on a given day regardless of the reason, were included. RESULTS 176 patients were included in 1.5 days. Spirometry was performed in none of the control arm, in 13 (29.5%) of the questionnaire arm, in 22 (50%) in the coordination arm and in 32 (72.7%) with the combination of the two strategies. Two cases of stage 2 COPD and thirteen other respiratory diseases were diagnosed. CONCLUSIONS This study confirms the feasibility of the protocol in primary care in terms of speed of inclusion and acceptability. An extension phase aiming to include 3200 patients will assess the diagnostic value of the two strategies tested in general practice.
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Affiliation(s)
- A Chapron
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France; Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France; Université Rennes, CNRS, ARENES - UMR 6051, 35000 Rennes, France.
| | - F Pelé
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France; Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France; Irset, institut de recherche en santé, environnement et travail, université Rennes, UMR_S 1085, 35000 Rennes, France
| | - É Andres
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France
| | - L Fiquet
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France; Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - C Laforest
- Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - A Veislinger
- Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - C Fougerou
- Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - V Turmel
- Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - J Fouchard
- Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - B Yourish
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France
| | - S Oumari
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France
| | - E Allory
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France; Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - A Banâtre
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France; Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - F-X Schweyer
- EHESP, école des hautes études en santé publique, université Rennes, 35000 Rennes, France
| | - J Pommier
- Université Rennes, CNRS, ARENES - UMR 6051, 35000 Rennes, France; EHESP, école des hautes études en santé publique, université Rennes, 35000 Rennes, France
| | - G Brinchault
- Services de pneumologie et explorations fonctionnelles respiratoires, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - S Guillot
- Services de pneumologie et explorations fonctionnelles respiratoires, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - B Laviolle
- Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - S Jouneau
- Irset, institut de recherche en santé, environnement et travail, université Rennes, UMR_S 1085, 35000 Rennes, France; Services de pneumologie et explorations fonctionnelles respiratoires, université Rennes, CHU de Rennes, 35000 Rennes, France
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Lai WV, Lebas L, Barnes TA, Milia J, Ni A, Gautschi O, Peters S, Ferrara R, Plodkowski AJ, Kavanagh J, Sabari JK, Clarke SJ, Pavlakis N, Drilon A, Rudin CM, Arcila ME, Leighl NB, Shepherd FA, Kris MG, Mazières J, Li BT. Afatinib in patients with metastatic or recurrent HER2-mutant lung cancers: a retrospective international multicentre study. Eur J Cancer 2019; 109:28-35. [PMID: 30685684 DOI: 10.1016/j.ejca.2018.11.030] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/19/2018] [Accepted: 11/23/2018] [Indexed: 01/26/2023]
Abstract
INTRODUCTION HER2 mutations occur in 1-3% of lung adenocarcinomas. With increasing use of next-generation sequencing at diagnosis, more patients with HER2-mutant tumours present for treatment. Few data are available to describe the clinical course and outcomes of these patients when treated with afatinib, a pan-HER inhibitor. METHODS We identified patients with metastatic or recurrent HER2-mutant lung adenocarcinomas treated with afatinib among seven institutions across Europe, Australia, and North America between 2009 and 2017. We determined the partial response rate to afatinib, types of HER2 mutations, duration of response, time on treatment, and survival. RESULTS We collected information on 27 patients with stage IV or recurrent HER2-mutant lung adenocarcinomas treated with afatinib. Of 23 patients evaluable for response, three partial responses were noted (13%, 95% confidence interval [CI] 4-33%). In addition, 57% of patients (13/23) had stable disease, and 30% (7/23) had progressive disease. We documented partial responses in patients with HER2 exon 20 insertions, including two with YVMA insertion and one with VAG insertion. Two patients with partial responses were previously treated with trastuzumab and pertuzumab. Median duration of response to afatinib was 6 months (range 5-10); median time on treatment was 3 months (range 1-30) and median overall survival from the date of diagnosis of metastatic or recurrent disease was 23 months (95% CI 18-53 months). CONCLUSIONS Afatinib is modestly active in patients with HER2-mutant lung adenocarcinomas, including responses after progression on prior HER2-targeted therapies. However, investigations into the biology of HER2-mutant lung adenocarcinomas and development of better HER2-directed therapies are warranted.
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Affiliation(s)
- W Victoria Lai
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Tristan A Barnes
- Princess Margaret Cancer Centre, Toronto, Canada(2); Northern Beaches Cancer Service, Manly NSW Australia(3)
| | - Julie Milia
- Toulouse University Hospital, Toulouse, France
| | - Ai Ni
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Kavanagh
- Toronto General Hospital, University Health Network and University of Toronto, Toronto, Canada
| | - Joshua K Sabari
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, New York, NY, USA(3)
| | - Stephen J Clarke
- Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Nick Pavlakis
- Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Alexander Drilon
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles M Rudin
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria E Arcila
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Mark G Kris
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Bob T Li
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Nicolas-Chanoine MH, Vigan M, Laouénan C, Robert J. Risk factors for carbapenem-resistant Enterobacteriaceae infections: a French case-control-control study. Eur J Clin Microbiol Infect Dis 2018; 38:383-393. [PMID: 30488368 DOI: 10.1007/s10096-018-3438-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/19/2018] [Indexed: 12/01/2022]
Abstract
This study aimed to assess characteristics associated with infections due to carbapenem-resistant Enterobacteriaceae (CRE), producing (CPE) or not producing (non-CPE) carbapenemase, among hospitalised patients in 2014-2016 in France. Case-patients with CRE were compared to two control populations. In multivariate analysis comparing 160 CRE cases to 160 controls C1 (patients with a clinical sample positive for carbapenem-susceptible Enterobacteriaceae), five characteristics were linked to CRE: male gender (OR = 1.9; 95% CI = 1.3-3.4), travel in Asia (OR = 10.0; 95% CI = 1.1-91.2) and hospitalisation in (OR = 2.4; 95% CI = 1.3-4.4) or out of (OR = 4.4; 95% CI = 0.8-24.1) France in the preceding 12 months, infection in the preceding 3 months (OR = 3.0; 95% CI = 1.5-5.9), and antibiotic receipt between admission and inclusion (OR = 1.9; 95% CI = 1.0-3.3). In multivariate analysis comparing 148 CRE cases to 148 controls C2 [patients with culture-negative sample(s)], four characteristics were identified: prior infection (OR = 3.3; 95% CI = 1.6-6.8), urine drainage (OR = 3.0; 95% CI = 1.5-6.1) and mechanical ventilation (OR = 3.7; 95% CI = 1.1-13.0) during the current hospitalisation, and antibiotic receipt between admission and inclusion (OR = 6.6; 95% CI = 2.8-15.5). Univariate analyses comparing separately CPE cases to controls (39 CPE vs C1 and 36 CPE vs C2) and non-CPE cases to controls (121 non-CPE vs C1 and 112 non-CPE vs C2), concomitantly with comparison of CPE to non-CPE cases showed that only CPE cases were at risk of previous travel and hospitalisation abroad. This study shows that, among CRE, risk factors are different for CPE and non-CPE infection, and suggests that question patients about their medical history and lifestyle should help for early identification of patients at risk of CPE among patients with CRE.
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Affiliation(s)
- Marie-Hélène Nicolas-Chanoine
- Service de Microbiologie, Hôpital Beaujon, AP-HP, F-92110, Clichy, France. .,INSERM and University Paris Diderot, IAME, UMR 1137, 16 rue Henri Huchard, F-75018, Paris, France.
| | - Marie Vigan
- Department of Epidemiology, Biostatistic and Clinical Research, Bichat Hospital, AP-HP, F-75018, Paris, France.,INSERM, CIC-EC 1425, Bichat Hospital, AP-HP, F-75018, Paris, France
| | - Cédric Laouénan
- INSERM and University Paris Diderot, IAME, UMR 1137, 16 rue Henri Huchard, F-75018, Paris, France.,Department of Epidemiology, Biostatistic and Clinical Research, Bichat Hospital, AP-HP, F-75018, Paris, France.,INSERM, CIC-EC 1425, Bichat Hospital, AP-HP, F-75018, Paris, France
| | - Jérôme Robert
- Centre d'Immunologie et des Maladies Infectieuses, CIMI-Paris, Team E13 (Bacteriology), CR7, INSERM, U1135, Sorbonne Université, F-75013, Paris, France.,Bacteriology and Hygiene, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, F-75013, Paris, France
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Hatch R, Young D, Barber V, Griffiths J, Harrison DA, Watkinson P. Anxiety, Depression and Post Traumatic Stress Disorder after critical illness: a UK-wide prospective cohort study. Crit Care 2018; 22:310. [PMID: 30466485 PMCID: PMC6251214 DOI: 10.1186/s13054-018-2223-6] [Citation(s) in RCA: 223] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
Abstract
Background Survivors of intensive care are known to be at increased risk of developing longer-term psychopathology issues. We present a large UK multicentre study assessing the anxiety, depression and post-traumatic stress disorder (PTSD) caseness in the first year following discharge from an intensive care unit (ICU). Methods Design: prospective multicentre follow-up study of survivors of ICU in the UK. Setting: patients from 26 ICUs in the UK. Inclusion criteria: patients who had received at least 24 h of level 3 ICU care and were 16 years of age or older. Interventions: postal follow up: Hospital Anxiety and Depression Score (HADS) and the Post-Traumatic Stress Disorder (PTSD) Check List-Civilian (PCL-C) at 3 and 12 months following discharge from ICU. Main outcome measure: caseness of anxiety, depression and PTSD, 2-year survival. Results In total, 21,633 patients admitted to ICU were included in the study. Postal questionnaires were sent to 13,155 survivors; of these 38% (4943/13155) responded and 55% (2731/4943) of respondents passed thresholds for one or more condition at 3 or 12 months following discharge. Caseness prevalence was 46%, 40% and 22% for anxiety, depression and PTSD respectively; 18% (870/4943 patients) met the caseness threshold for all three psychological conditions. Patients with symptoms of depression were 47% more likely to die during the first 2 years after discharge from ICU than those without (HR 1.47, CI 1.19–1.80). Conclusions Over half of those who respond to postal questionnaire following treatment on ICU in the UK reported significant symptoms of anxiety, depression or PTSD. When symptoms of one psychological disorder are present, there is a 65% chance they will co-occur with symptoms of one of the other two disorders. Depression following critical illness is associated with an increased mortality risk in the first 2 years following discharge from ICU. Trial registration ISRCTN Registry, ISRCTN69112866. Registered on 2 May 2006. Electronic supplementary material The online version of this article (10.1186/s13054-018-2223-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert Hatch
- NIHR Academic Clinical Fellow in Intensive Care Medicine, Oxford Deanery, Oxford, UK.,Kadoorie Centre for Critical Care Research and Education, University of Oxford, Level 3, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Duncan Young
- Professor of Intensive Care Medicine, University of Oxford, Oxford, UK.,Kadoorie Centre for Critical Care Research and Education, University of Oxford, Level 3, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Vicki Barber
- OCTRU Hub Manager, University of Oxford, Oxford, UK
| | - John Griffiths
- Consultant in Intensive Care Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David A Harrison
- Head Statistician, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Peter Watkinson
- Associate Professor of Intensive Care Medicine, Oxford University Hospitals NHS Trust, Oxford, UK. .,Kadoorie Centre for Critical Care Research and Education, University of Oxford, Level 3, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
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Tsutsui Y, Daisaki H, Akamatsu G, Umeda T, Ogawa M, Kajiwara H, Kawase S, Sakurai M, Nishida H, Magota K, Mori K, Sasaki M. Multicentre analysis of PET SUV using vendor-neutral software: the Japanese Harmonization Technology (J-Hart) study. EJNMMI Res 2018; 8:83. [PMID: 30128776 PMCID: PMC6102169 DOI: 10.1186/s13550-018-0438-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 04/10/2018] [Accepted: 08/09/2018] [Indexed: 01/16/2023] Open
Abstract
Background Recent developments in hardware and software for PET technologies have resulted in wide variations in basic performance. Multicentre studies require a standard imaging protocol and SUV harmonization to reduce inter- and intra-scanner variability in the SUV. The Japanese standardised uptake value (SUV) Harmonization Technology (J-Hart) study aimed to determine the applicability of vendor-neutral software on the SUV derived from positron emission tomography (PET) images. The effects of SUV harmonization were evaluated based on the reproducibility of several scanners and the repeatability of an individual scanner. Images were acquired from 12 PET scanners at nine institutions. PET images were acquired over a period of 30 min from a National Electrical Manufacturers Association (NEMA) International Electrotechnical Commission (IEC) body phantom containing six spheres of different diameters and an 18F solution with a background activity of 2.65 kBq/mL and a sphere-to-background ratio of 4. The images were reconstructed to determine parameters for harmonization and to evaluate reproducibility. PET images with 2-min acquisition × 15 contiguous frames were reconstructed to evaluate repeatability. Various Gaussian filters (GFs) with full-width at half maximum (FWHM) values ranging from 1 to 15 mm in 1-mm increments were also applied using vendor-neutral software. The SUVmax of spheres was compared with the reference range proposed by the Japanese Society of Nuclear Medicine (JSNM) and the digital reference object (DRO) of the NEMA phantom. The coefficient of variation (CV) of the SUVmax determined using 12 PET scanners (CVrepro) was measured to evaluate reproducibility. The CV of the SUVmax determined from 15 frames (CVrepeat) per PET scanner was measured to determine repeatability. Results Three PET scanners did not require an additional GF for harmonization, whereas the other nine required additional FWHM values of GF ranging from 5 to 9 mm. The pre- and post-harmonization CVrepro of six spheres were (means ± SD) 9.45% ± 4.69% (range, 3.83–15.3%) and 6.05% ± 3.61% (range, 2.30–10.7%), respectively. Harmonization significantly improved reproducibility of PET SUVmax (P = 0.0055). The pre- and post-harmonization CVrepeat of nine scanners were (means ± SD) 6.59% ± 1.29% (range, 5.00–8.98%) and 4.88% ± 1.64% (range, 2.65–6.72%), respectively. Harmonization also significantly improved the repeatability of PET SUVmax (P < 0.0001). Conclusions Harmonizing SUV using vendor-neutral software produced SUVmax for 12 scanners that fell within the JSNM reference range of a NEMA body phantom and improved SUVmax reproducibility and repeatability.
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Affiliation(s)
- Yuji Tsutsui
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiromitsu Daisaki
- Gunma Prefectural College of Health Sciences, 323-1 Kamioki-machi, Maebashi-shi, 371-0052, Japan
| | - Go Akamatsu
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba-shi, 263-8555, Japan.,Department of Molecular Imaging, Institute of Biomedical Research and Innovation, 2-2, Minatojima Minamimachi, Chuo-ku, Tokyo, 28 650-0047, Japan
| | - Takuro Umeda
- Department of Nuclear Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Matsuyoshi Ogawa
- Department of Radiology, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hironori Kajiwara
- Department of Radiology, Center Hospital of National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Shigeto Kawase
- Department of Radiology, Kyoto University Hospital, 54 Kawaharacho, Syogoin, Sakyo-ku, Kyoto City, 606-8507, Japan
| | - Minoru Sakurai
- Clinical Imaging Center for Healthcare, Nippon Medical School, 1-12-15 Sendagi, Bunkyo-ku, Tokyo, 113-0022, Japan
| | - Hiroyuki Nishida
- Department of Molecular Imaging, Institute of Biomedical Research and Innovation, 2-2, Minatojima Minamimachi, Chuo-ku, Tokyo, 28 650-0047, Japan
| | - Keiichi Magota
- Division of Medical Imaging and Technology, Hokkaido University Hospital, Kita 14-jo Nishi 5-chome, Kita-ku, Sapporo-shi, Hokkaido, 060-8648, Japan
| | - Kazuaki Mori
- Department of Radiology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Masayuki Sasaki
- Department of Health Science, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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47
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Gallo A, Capaccio P, Benazzo M, De Campora L, De Vincentiis M, Farneti P, Fusconi M, Gaffuri M, Lo Russo F, Martellucci S, Ottaviani F, Pagliuca G, Paludetti G, Pasquini E, Pignataro L, Puxeddu R, Rigante M, Scarano E, Sionis S, Speciale R, Canzi P. Outcomes of interventional sialendoscopy for obstructive salivary gland disorders: an Italian multicentre study. Acta Otorhinolaryngol Ital 2018; 36:479-485. [PMID: 28177330 PMCID: PMC5317126 DOI: 10.14639/0392-100x-1221] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/19/2016] [Indexed: 12/18/2022]
Abstract
Interventional sialendoscopy has become the predominant therapeutic procedure for the management of obstructive salivary disorders, but only a few multicentre studies of large series of patients with a long-term follow-up have been published. This Italian multicentre study involved 1152 patients (553 females; mean age 50 years) who, after at least a clinical and ultrasonographic evaluation, underwent a total of 1342 diagnostic and interventional sialendoscopies, 44.6% of which involved the parotid gland. 12% (n = 138) of patients underwent multiple treatments. The procedure was successful in 1309 cases. In 33 cases (2.4%) the procedure could not be concluded mainly because of complete duct stenosis (21 cases). Salivary stones were the main cause of obstruction (55%), followed by ductal stenosis and anomalies (16%), mucous plugs (14.5%) and sialodochitis (4.7%). Complete therapeutic success was obtained in 92.5% of patients after one or more procedures, and was ineffective in < 8%. Untoward effects (peri and postoperative complications) were observed in 5.4% of cases. Sialendoscopy proved to be an effective, valid and safe procedure in the diagnostic and therapeutic management of non-neoplastic obstructive salivary gland diseases.
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Affiliation(s)
- A Gallo
- Department of Medico-surgical sciences and biotechnologies, ENT Section, Sapienza University of Rome, Italy
| | - P Capaccio
- Department of Biomedical, Surgical and Dental Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - M Benazzo
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico "S. Matteo" Foundation, Pavia, Italy
| | - L De Campora
- Department of Otorhinolaryngology, "Fatebenefratelli" Hospital, Roma, Italy
| | - M De Vincentiis
- Department of Sense Organs, ENT Section, Policlinico "Umberto I", Sapienza University of Rome, Italy
| | - P Farneti
- Department of Experimental, Diagnostic and Specialty Medicine, Dimes, Bologna University Medical School, Ear, Nose and Throat Unit of "Sant'Orsola-Malpighi" Hospital, Bologna, Italy
| | - M Fusconi
- Department of Sense Organs, ENT Section, Policlinico "Umberto I", Sapienza University of Rome, Italy
| | - M Gaffuri
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - F Lo Russo
- Department Experimental biomedicine and clinical neurosciences, Otorhinolaryngology Unit, University of Palermo; Italy
| | - S Martellucci
- Department of Medico-surgical sciences and biotechnologies, ENT Section, Sapienza University of Rome, Italy
| | - F Ottaviani
- Department of Clinical Sciences and Community Health, San Giuseppe Hospital, Università degli Studi di Milano, Milan, Italy
| | - G Pagliuca
- Department of Medico-surgical sciences and biotechnologies, ENT Section, Sapienza University of Rome, Italy
| | - G Paludetti
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Italy
| | - E Pasquini
- Ear, Nose and Throat Metropolitan Unit, Surgical Department, AUSL Bologna, Italy
| | - L Pignataro
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - R Puxeddu
- Department of Otorhinolaryngology, AOU, PO "S. Giovanni di Dio", University of Cagliari, Italy
| | - M Rigante
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Italy
| | - E Scarano
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Italy
| | - S Sionis
- Department of Otorhinolaryngology, AOU, PO "S. Giovanni di Dio", University of Cagliari, Italy
| | - R Speciale
- Department Experimental biomedicine and clinical neurosciences, Otorhinolaryngology Unit, University of Palermo; Italy
| | - P Canzi
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico "S. Matteo" Foundation, Pavia, Italy
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Bhadada SK, Arya AK, Mukhopadhyay S, Khadgawat R, Sukumar S, Lodha S, Singh DN, Sathya A, Singh P, Bhansali A. Primary hyperparathyroidism: insights from the Indian PHPT registry. J Bone Miner Metab 2018; 36:238-245. [PMID: 28364324 DOI: 10.1007/s00774-017-0833-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/03/2017] [Indexed: 02/05/2023]
Abstract
The presentation of primary hyperparathyroidism (PHPT) is variable throughout the world. The present study explored retrospective data submitted to the Indian PHPT registry ( http://www.indianphptregistry.com ) between July 2005 and June 2015 from 5 centres covering four different geographical regions. The clinical, biochemical, radiological and histopathological characteristics of PHPT patients across India were analysed for similarity and variability across the centres. A total of 464 subjects (137 men and 327 women) with histopathologically proven PHPT were analysed. The mean age was 41 ± 14 years with a female:male ratio of 2.4:1. The majority (95%) of patients were symptomatic. Common clinical manifestations among all the centres were weakness and fatigability (58.7%), bone pain (56%), renal stone disease (31%), pancreatitis (12.3%) and gallstone disease (11%). Mean serum calcium, parathyroid hormone and inorganic phosphorus levels were 11.9 ± 1.6 mg/dL, 752.4 ± 735.2 pg/mL and 2.8 ± 0.9 mg/dL, respectively. Sestamibi scanning had better sensitivity than ultrasonography in the localisation of parathyroid adenoma; however, when these two modalities were combined, 93% of the cases were correctly localised. Mean parathyroid adenoma weight was 5.6 ± 6.5 g (0.1-54 g). It was concluded that the majority of PHPT patients within India are still mainly symptomatic with >50% of patients presenting with bone disease and one-third with renal impairment. Compared to Western countries, Indian patients with PHPT are younger, biochemical abnormalities are more severe, and adenoma weight is higher. As our observation is largely derived from a tertiary care hospital (no routine screening of serum calcium level), the results do not reflect racial differences in susceptibility to PHPT.
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Affiliation(s)
- Sanjay Kumar Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Ashutosh Kumar Arya
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Postgraduate Medical Education and Research (IPGMER), Kolkata, India
| | - Rajesh Khadgawat
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Suja Sukumar
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Sailesh Lodha
- Department of Endocrinology, Fortis Hospital, Jaipur, India
| | | | - Anjali Sathya
- Vijaya Hospital/MMM Hospital, Chennai, Tamilnadu, India
| | - Priyanka Singh
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Pinquié F, Goupil F, Oster JP, Dixmier A, Renault PA, Lévy A, Mathieu JP, Paillot N, Goutorbe FC, Masson P, Molinier O, Debieuvre D, Grivaux M. [Therapeutic strategies in patients undergoing surgery for non-small cell lung cancer. Results of the ESCAP-2011-CPHG study, promoted by the French College of General Hospital Respiratory Physicians (CPHG)]. Rev Mal Respir 2017; 34:976-990. [PMID: 29150179 DOI: 10.1016/j.rmr.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of ESCAP-2011-CPHG, promoted by the French College of General Hospital Respiratory Physicians, was to describe therapeutic strategies in lung cancer in the first 2 years after diagnosis, in a real-life setting. This article focuses on patients undergoing surgical management of a non-small cell lung cancer (NSCLC). METHODS A prospective multicentre study was conducted in 53 French general hospitals. For each patient with lung cancer diagnosed in 2010, a standardised form was completed following each change in treatment strategy up to 2 years after diagnosis. RESULTS Overall, 3418 of the 3943 included patients had NSCLC. 741 patients (21.7%) underwent curative surgery (stage 0-II, IIIA, IIIB, and IV: 65%, 27%, 3% and 5%, respectively). The therapeutic strategy changed less often in surgical than non-surgical patients and average follow-up time was longer: 23.3 months (SD: 9.3) versus 10.4 months (SD: 9.5) for non-surgical patients. Among patients with a surgical first strategy (92.6% of surgical patients as a whole), 56.9% did not receive any other treatment, 34.7% received chemotherapy, 5.9% radio-chemotherapy, 2.6% radiotherapy. At the end of follow-up, 55.8% were still alive without any other strategy, 13.1% had died, and 31.1% had received at least one more strategy. Among patients with a surgical second strategy, 63% had received chemotherapy alone during the first strategy. CONCLUSIONS ESCAP -2011- CPHG assessed everyday professional practice in the surgical management of NSCLC in general hospitals. It pointed out the discrepancies between current guidelines and the therapeutic strategies applied in real life conditions.
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Affiliation(s)
- F Pinquié
- Service de pneumologie, centre hospitalier du Mans, 72000 Le Mans, France
| | - F Goupil
- Service de pneumologie, centre hospitalier du Mans, 72000 Le Mans, France.
| | - J-P Oster
- Service de pneumologie, hôpitaux civils de Colmar, hôpital Pasteur, 68000 Colmar, France
| | - A Dixmier
- Service de pneumologie, centre hospitalier d'Orléans, hôpital de la Source, 45000 Orléans, France
| | - P-A Renault
- Service de pneumologie, centre hospitalier général de Pau, 64000 Pau, France
| | - A Lévy
- Service de pneumologie, centre hospitalier Jacques-Cœur, 18000 Bourges, France
| | - J-P Mathieu
- Service de pneumologie, centre hospitalier de la Côte-Basque, 64100 Bayonne, France
| | - N Paillot
- Service de pneumologie, centre hospitalier régional de Metz-Thionville, 57000 Metz, France
| | - F C Goutorbe
- Service de pneumologie, centre hospitalier général de Béziers, 34500 Béziers, France
| | - P Masson
- Service de pneumologie, centre hospitalier de Cholet, 49280 Cholet, France
| | - O Molinier
- Service de pneumologie, centre hospitalier du Mans, 72000 Le Mans, France
| | - D Debieuvre
- Service de pneumologie, hôpital Émile-Muller, GHRMSA, 68100 Mulhouse, France
| | - M Grivaux
- Service de pneumologie, centre hospitalier de Meaux, 77100 Meaux, France
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Shigemura K, Kitagawa K, Osawa K, Yamamichi F, Tokimatsu I, Nomi M, Takaba K, Fujisawa M. Comparison of antibiotics use, urinary tract infection (UTI)-causative bacteria and their antibiotic susceptibilities among 4 hospitals with different backgrounds and regions in Japan. J Chemother 2017; 30:31-36. [PMID: 28956738 DOI: 10.1080/1120009x.2017.1376817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this study, we compared the antibiotic use, urinary tract infection-causative bacteria and their antibiotic susceptibilities among four hospitals with different backgrounds and regions in Japan in 2014. Frequency of antibiotic use (antibiotic use density: AUD/all AUD) were: ampicillin: 0.21-20.3 (median: 1.6) and cefazolin: 0.8-34.2 (2.5), representatively. The antibiotic resistant rates of Escherichia coli were ampicillin: 1.1-52.3% (median: 51.8%), piperacillin: 47.9-49.1% (48.0%), cefazolin: 23.2-34.1% (28.9%), levofloxacin: 36.6-43.8% (40.2%).We found that there were significant correlations (1) between antibiotic resistance of E. coli and annual total amount of antibiotic use (p = 0.017), annual number of days of antibiotic use (p = 0.002) and days of therapy (DOT, p = 0.002), and (2) between antibiotic resistance of extended-spectrum β-lactamase-producing bacteria and annual number of days of antibiotic use (p = 0.004) and DOT (p = 0.004) in a rehabilitation hospital. These results suggested that more antibiotic uses could lead to antibiotic resistances. Further analyses with more number of data are being undertaken.
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Affiliation(s)
- Katsumi Shigemura
- a Department of Urology , Kobe University Graduate School of Medicine , Kobe , Japan.,b Infection Control and Prevention , Kobe University Graduate School of Medicine , Kobe , Japan.,c Division of Infectious Diseases, Department of International Health Science , Kobe University Graduate School of Health Science , Kobe , Japan
| | - Koichi Kitagawa
- d Division of Translational Research for Biologics, Department of Internal Related , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Kayo Osawa
- b Infection Control and Prevention , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Fukashi Yamamichi
- e Department of Urology , Hyogo Prefectural Amagasaki General Medical Center , Amagasaki , Hyogo , Japan
| | - Issei Tokimatsu
- b Infection Control and Prevention , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Masashi Nomi
- f Infection control and prevention , Hyogo Prefectural Rehabilitation Central Hospital , Kobe , Japan
| | - Kei Takaba
- g Infection control and prevention , Mie Prefectural General Medical Center , Mie , Japan
| | - Masato Fujisawa
- a Department of Urology , Kobe University Graduate School of Medicine , Kobe , Japan
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