Factores asociados al fracaso terapéutico en personas viviendo con VIH con tratamiento antirretroviral: una revisión panorámica de la literatura / Associated factors of treatment failure in people living with HIV taking antiretroviral treatment: a scooping review

Introducción: Se estima que en 2019 vivían 38 millones de personas con el virus de la inmunodeficiencia humana (VIH), para quienes es fundamental el tratamiento antirretroviral (TAR); sin embargo, no siempre funciona. El fracaso terapéutico del TAR sucede cuando existe una progresión de la enfermedad en parámetros clínicos, virológicos o inmunológicos con un peor pronóstico. Objetivo: Identificar los factores asociados al fracaso terapéutico del TAR en personas viviendo con VIH. Métodos: Se siguieron los lineamientos para revisiones sistemáticas de PRISMA-SCR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews), modificados por Tricco y otros. Los artículos sobre el fracaso terapéutico en población adulta en primera línea de TAR se hallaron en PubMed y la Biblioteca Virtual de Salud. Información, análisis y síntesis: La definición de fracaso terapéutico utilizada en ocho artículos corresponde con los criterios de la OMS; el resto emplea el criterio virológico con distintos puntos de corte. Se describen factores asociados con el fracaso terapéutico con significación estadística, agrupados en factores sociodemográficos (sexo, edad, edad inicio del TAR, compartir estatus de VIH, empleo de drogas inyectables y nivel educativo) y factores clínicos (niveles de linfocitos T CD4+ al inicio del TAR, nivel de adherencia, cambio de régimen, estadio de la OMS al inicio del TAR y coinfección por tuberculosis). Conclusiones: Dos factores fundamentales en el fracaso terapéutico son los sociodemográficos y los clínicos que dependen de la accesibilidad al tratamiento, el sistema de salud y las características intrínsecas de los individuos, incluyendo las conductas en relación con su enfermedad(AU)

Introduction: It is estimated that by 2019 there are 38 million people living with the human immunodeficiency virus (HIV), for whom antiretroviral treatment is essential. Treatment failure occurs when there is a progression of the disease in clinical, virological, or immunological parameters that lead to a change in treatment and a worse prognosis of the disease. The objective of this panoramic review is to answer the following question: What are the factors associated with the therapeutic failure of antiretroviral treatment in people living with HIV? Methods: A panoramic review was carried out following the guidelines for systematic reviews suggested by PRISMA-SCR (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes extension for Scoping Reviews) and modified by Tricco et al. The articles on therapeutic failure in the adult population on the first line of ART were rescued from PubMed and the Virtual Health Library (VHL). The search was limited to a period from 2010 to 2020 and articles whose population was children or pregnant women and articles not available in English or Spanish were excluded. Information, Analysis and Synthesis: The definition of therapeutic failure used corresponds to the WHO criteria in eight articles, while the rest use the virological criterion in variable reference points. Regarding the factors associated with treatment failure, those with statistical significance grouped into sociodemographic factors (sex, age, age of ART onset, shared HIV status, injection drug use, and educational level) and clinical factors (T CD4+ levels are described at the start of ART, level of adherence, change of regimen, WHO stage at the start of ART, and tuberculosis coinfection). Conclusions: Two fundamental factors in therapeutic failure are sociodemographic and clinical, which in turn depend on accessibility to treatment, the health system and intrinsic characteristics of the individuals and the behaviors they adopt in relation to their disease(AU)

Impact of metabolic syndrome and clinical features on functioning in patients with bipolar disorder: a cross-sectional study

Objective: The metabolic syndrome (MS) is highly prevalent among patients with bipolar disorder (BD), and may affect progression, functioning, and comorbid conditions in BD. The aim of this study was to investigate the effect of clinical variables and MS on overall functioning and specific areas of functioning in patients with BD. Methods: A total of 210 participants (140 participants with BD I and BD II in remission and 70 non-psychiatric control subjects) were included. The investigators administered the Young Mania Rating Scale (YMRS), the Bipolar Depression Rating Scale (BDRS), the Global Assessment of Functioning Scale (GAF), and the Bipolar Disorder Functioning Scale (BDFS). The participants completed the Beck Depression Scale (BDS) and the Beck Anxiety Scale (BAS). MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Hierarchical regression analysis was used to investigate potential correlations of comorbid MS with clinical variables and level of functioning. Results: Level of functioning did not differ between patients with and without MS. However, there were significant correlations between the level of functioning subscales and the number of depressive episodes (p = 0.033), level of general functioning (p = 0.012), duration of illness (p = 0.012), BDS (p = 0.005), BDRS (p = 0.021), BAS total scores (p = 0.021), number of hypomanic episodes (p = 0.022), number of hospitalizations (p = 0.003), employment status (p = 0.032), and diagnosis of BD I (p = 0.007) and BD II (p = 0.044). Conclusion: Our findings suggest that clinical variables had a greater effect on functioning than MS in BD patients.

Relationship between SUVmax in 18F-FDG PET/CT and PD-L1 expression in invasive lung adenocarcinoma / 中国胸心血管外科临床杂志

@#Objective    To investigate the relationship between the expression of programmed cell death ligand-1 (PD-L1) and the maximal standardized uptake value (SUVmax) in 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and the correlation of clinical factors between SUVmax values and PD-L1. Methods    The clinical data of 84 patients with invasive lung adenocarcinoma diagnosed pathologically in West China Hospital, Sichuan University from August 2016 to November 2018 were analyzed retrospectively, including 38 males and 46 females, aged 60 (32-85) years. The tumor was acinar-predominant in 37 patients, papillary in 20, lepidic in 19, solid in 5 and micropapillary in 3. Multivariate analysis of the relationship between SUVmax value and other clinicopathological features was performed by linear regression. Logistic regression analysis was used to analyze the relationship between PD-L1 protein expression and other pathological features. Results    The SUVmax of the PD-L1 expression group was significantly higher than that of the non-PD-L1 expression group in the whole invasive lung adenocarcinoma group (P=0.002) and intermediate-grade histologic subtype (P=0.016). The SUVmax cut-off value of PD-L1 expression in the whole invasive lung adenocarcinoma group and intermediate-grade histologic subtype was 5.34 (AUC: 0.732, P=0.002) and 5.34 (AUC: 0.720, P=0.017), respectively. Multivariate analysis showed that pleura involvement, vascular tumor thrombus and the increase of tumor diameter could cause the increase of the SUVmax value, while the SUVmax value decreased in the moderately differentiated tumor compared with the poorly differentiated tumor. The SUVmax cut-off value between low-grade histologic subtype and intermediate-grade histologic subtype, intermediate-grade histologic subtype and high-grade histologic subtypes was 1.54 (AUC: 0.854, P<0.001) and 5.79 (AUC: 0.889, P<0.001), respectively. Multivariate analysis of PD-L1 expression showed pleura involvement (P=0.021, OR=0.022, 95%CI 0.001 to 0.558) and moderate differentiation (opposite to poor differentiation) (P=0.004, OR=0.053, 95%CI 0.007 to 0.042) decreased the expression of PD-L1. Conclusion    The SUVmax of the PD-L1 expression group is significantly higher than that of the non-PD-L1 expression group in the whole invasive lung adenocarcinoma group and intermediate-grade histologic subtype. The level of SUVmax and the expression of PD-L1 in invasive lung adenocarcinoma are related to many clinical factors.

A Study of Correlation of Clinical Variables with Presenting Stage and Type of Endometrial Cancer at a Tertiary Care Hospital - A Retrospective Study

Introduction: The prevalence of gynecological cancers has been increasing in the Asian population. With the recent changingtrend in lifestyle and reproductive profile of women, the number of cases being diagnosed with endometrial cancer is increasing.Aim: The aim of this study is to evaluate the correlation of various clinical risk factors of endometrial carcinoma on thehistopathology and presenting stage of the disease.Materials and Methods: A hospital-based, retrospective study included 100 patients of endometrial carcinoma presented atthe Institute of Obstetrics and Gynaecology, Chennai, India, between January 2016 and June 2019. The correlation of age(≤40 years and >40 years), parity status (parous and nulliparous), menstrual status (premenopause and postmenopause),diabetes, hypertension, duration of complaint (≤6 months and >6 months), and body mass index (BMI) with the stage of thedisease (clinical/radiological and pathological stages) and histological class was analyzed.Results: The mean age of patients was 56.4 ± 11.3 years. Among the 100 patients, a total of 62 (63.6%) patients had presentedwith clinical/radiological stage-I, of which 6 patients had defaulted for treatment and 6 patients had the stage-IV disease. Of the88 patients who underwent staging laparotomy, 59 (67%) patients had pathological stage-I carcinoma and 3, 18, and 8 patientspresented in stage II, III, and IV disease, respectively. Histopathological evaluation revealed endometrioid adenocarcinomaas the most common type, in 79 patients (79%). No significant correlation of any of the risk factors on clinical/radiological,pathological as well as on histopathology was observed.Conclusion: The study did not state the statistically significant association of age, parity status, menopause, diabetes,hypertension, BMI, and the duration of complaints with the histological class of endometrial carcinoma and presenting clinicaland pathological stages of endometrial carcinoma.

Description of clinical factors for suicide attempts in a tertiary care hospital of northern part of India

Background: Suicide is the result of an act deliberately initiated and performed by a person in the full knowledge or expectation of its fatal outcome. Suicide attempts are a significant public health problem. The present study aimed to explore the variousclinical characteristics of suicideattempters in a tertiary care hospital of Shimla, Himachal Pradesh, a northern state of India.Methods: We conducted a descriptive study among patients with attempted suicide to the department of Psychiatry, Indira Gandhi Medical College (IGMC) Shimla. A structured, self-designed interview schedule and short-form revised Eyseneck personality questionnaire-Hindi (EPQRS-H) was used for data collection. Data was analyzed using Epi info software v 7.2.0.Results: There were total 77 participants in the study out of which 44 (57.1%) were females. Mean age (Standard deviation) of participants was 30.8 years (9.9 years). Relationship problems were the most common (48.1%) recent life event followed by health events (28.6%). Depression was found to be the most common diagnosis (62.3%). Pesticide consumption was the method of attempting suicide in 72.7% of females compared to 66.7% of males.Conclusions: Recent major life events especially relationship problems may lead to majority of suicide attempts. There is urgent need to focus on patients suffering from depression by health personnel as well as family members. The sale of the pesticides should be regulated to keep in check the misuse of the same.

Analysis of prognostic factors in early cervical adenocarcinoma / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the prognostic factors of early stage adenocarcinoma of uterine cervix.METHODS: Totally 176 cases of early stage adenocarcinoma of uterine cervix who were admitted to Liaoning Cancer Hospital from January 2003 to May 2013 were analyzed retrospectively.RESULTS: The median age of 176 cases was 45(20-73),The 5-year overall survival rate was 81%. The 5-year tumor-free survival rate was 74.0%. The median survival time was 85 months.In univariate analysis,prognostic factors of patients with early cervical adenocarcinoma were clinical stage and lymph node metastasis.The five-year survival rate of ⅠB1,ⅠB2 and ⅡA1 was 86.0%,74.0% and 66.0%,and there were statistical differences(P<0.05).Compared with patients of ⅠB stage,the risk of death inⅡA1 patients was significantly increased(HR=2.92,95%CI 1.37-6.21).Totally 151 cases were pathologically proved with negative lymph node metastasis and 25 cases positive. The 5-year survival rates of them were 87.0% and 32.0% respectively and there were statistical differences between them(P<0.05).Multivariate analysis showed that only lymph node metastasis was an independent factor for survival(HR=5.86,95%CI 2.85-12.05).CONCLUSION: The 5-year survival rate of early-stage adenocarcinoma of uterine cervix is high;lymphnode metastasis is an important prognostic factor of early stage adenocarcinoma of uterine cervix.

Factores de riesgo para la infección del sitio quirúrgico posapendicectomía. Estudio de casos y controles / Risk factors for surgical-site infection in the atlantic state, colombia. A case-control study

Resumen Objetivo: Evaluar la influencia de los determinantes sociodemográficos, clínicos y del servicio de salud sobre el riesgo de infección del sitio quirúrgico en pacientes apendicectomizados, en los hospitales del Atlántico, Colombia. Materiales y métodos: Estudio de casos y controles retrospectivo. Se revisaron los registros quirúrgicos de pacientes apendicectomizados entre 2009 y 2013. Muestra: 80 casos y 272 controles. Factores estudiados: sociodemográficos (edad, género, régimen de afiliación al sistema de salud); clínicos (antecedentes patológicos, hospitalizaciones previas, grado del apéndice); servicios (tiempos de espera, técnica quirúrgica, duración del procedimiento, profilaxis antibiótica, tiempo de estancia hospitalaria). Análisis: bivariable y multivariable. Se calcularon las razones de momios (OR), intervalos de confianza al 95 %, y pruebas de significancia estadística. Resultados: Luego del análisis multivariado, los factores de riesgo independientes fueron: edad mayor de 54 años (OR = 5,37); afiliación al régimen subsidiado del sistema general de seguridad social en salud (OR = 3,49) y el grado histopatológico del apéndice II, que incluye inflamación focal, ulceraciones del epitelio y microabscesos aislados en folículos linfáticos, (OR = 1,98). Conclusión: Este estudio aporta nueva evidencia de la multicausalidad de la infección nosocomial en pacientes sometidos a apendicectomía. Se destaca el rol de la desigualdad en salud como factor de riesgo importante, lo cual merece especial atención.

Abstract Objective: To evaluate sociodemographic, clinical and health-service-related determinants associated to surgical site infections in patients undergoing appendectomy in third level Hospitals, located in the Colombian Northern Region, from 2009 to 2013. Methods: Retrospective data was collected of hospital records from participating hospitals; 80 cases and 272 controls were compared regarding socio-demographic (age, gender, regime of affiliation to the social-security health system), clinical (comorbidity, prior hospitalization, degree of appendix), and healthcare-related variables (diagnostic time, preoperative time, operation duration, prophylaxis with antibiotics and hospital-stay length). Both bivariate and multivariate analysis were conducted. Odds Ratios, 95% confidence intervals were estimated; Besides, both X2-Test and T Student Tests were used to evaluate statistical significance. Results: Socio-demographic (age, affiliation to the subsidized-health-system), clinical (metabolic disease) and health-care related factors such as preoperative waiting time showed to be associated to surgical site infections, in the bivariate analysis. In the final regression model only age above 54 (OR= 5,37); subsidized affiliation to the social security system (3,49) and histopathological grade of appendix, which included focal inflammation, epithelial ulcers, and isolated micro-abscesses in lymphatic's follicles showed to be independent risk factors (OR= 1,98). Conclusion: This study adds new evidence on the multifactorial origin of post-surgery nosocomial infections and spotlights health inequality as a major risk factor that needs to be addressed.

A study to determine patient-related factors that influence length of hospital stay among patients with Schizophrenia admitted at Ward 7 in 2001-2004

Objectives@#This study aimed to examine schizophrenic patient related factors- demographic, psychopathology, social function & premorbid social functioning - that would predict length of hospital stay and determine their relationship. @*Methodology@#One hundred eighty four charts of schizophrenic patients admitted to Ward 7 of UP PGH from 2001- 2004 were reviewed. Data collected were the patient's demographic characteristics, psychopathology, premorbid social functioning and economic support system. Univariate and multivariate analyses were made to identify factors associated with length of hospital stay. @*Results@#Of the 184 charts reviewed, 42 (23%) had a short hospital stay of 1- 14 hospital days while 142 ( 77%) were considered as having a long hospital stay i.e. more than 14 hospital days. Univariate analysis with p< 0.05 revealed that the number of IM medications and number of psychopharmacologic medications had a significant relationship with length of hospital stay. At a p value < 0.20, two additional predictors were identified: absence of heterosexual relationship and age of onset of illness. Multivariate analysis of these four factors revealed that age of onset of illness and number of psychopharmacologic interventions were patient related factors that predicted length of hospital stay.@*Conclusion@#Knowledge concerning patient related factors such as number of medications and age of onset were significant in predicting length of hospitalization for schizophrenic patients, which would be of help in formulating admissions and in patient policies for the hospital.

Non-clinical factors and predictors of self-rating of oral health among young adolescents in a rural Nigerian population

Aim: The aim of the study was to assess the non-clinical determinants and predictors of self-ratings of oral health among young adolescents in a Nigerian rural population. Methods: A cross-sectional survey was conducted among adolescents of 11-13 years old in Igboora, Nigeria. Information on self-rating of oral health, self-assessed satisfaction with oral health condition and tooth appearance, pain history, consultation with the dentist and oral hygiene measures were obtained using structured questionnaires translated to the local language. Data were analysed using SPSS version 23; Chi Square and logistic regression were used to establish associations between variables and predictors with p value < 0.05 statistically significant. Results: A total of 400 respondents participated in the study. Most 346 (86.5%) rated their oral health positively. Those who expressed dissatisfaction with the appearance of their teeth, 17 (44.7%) dissatisfaction with their oral health condition, 25 (45.5%) had toothache in the preceding six months, 44 (19.7%) perceived a need for dental treatment, 43 (16.7%) or cleaned their teeth once daily or less frequently, 37 (20.9%), rated their oral health poorly (p < 0.001, p < 0.001, p = 0.001, p = 0.012, p < 0.001, respectively). The significant predictors of self-ratings of oral health were self-assessed satisfaction with oral health condition, toothache in the preceding six months and frequency of tooth cleaning. Conclusion: Satisfaction with oral health condition, toothache in the preceding six months and frequency of tooth cleaning are factors that predict self-rating of oral health in young adolescents in the rural community studied

Fatores associados à percepção de aliança terapêutica por pacientes em psicoterapia psicanalítica / Factors associated with patient's perception of therapeutic alliance in psychoanalytic psychotherapy

A percepção do paciente sobre a relação com seu psicoterapeuta é determinante para a sua permanência em tratamento e para o sucesso da psicoterapia. Estabelecer preditores de aliança terapêutica pode ter o potencial de auxiliar os psicoterapeutas a utilizar formas de intervenção durante as fases iniciais do tratamento. O objetivo do estudo foi investigar a associação entre fatores sócio-demográficos e clínicos do paciente e do terapeuta e a forma como o paciente percebe a aliança terapêutica. Trata-se de um estudo transversal que avaliou a qualidade da aliança em pacientes adultos atendidos em psicoterapia psicanalítica em um ambulatório de saúde mental. A amostra foi constituída por 118 pacientes que chegaram até a quarta sessão de psicoterapia psicanalítica. Os resultados apontam para a influência da intensidade dos sintomas de psicoticismo e do gênero do paciente na percepção da aliança terapêutica.(AU)

The patient's perception of the relationship with their therapist is determinant for their treatment adherence and for the success of psychotherapy. Establishing predictors of therapeutic alliance may potentially help psychotherapists to use forms of intervention during the early stages of treatment. This study aimed to investigate the association between socio-demographic and clinical factors of both patient and therapist and the way in which the patient perceives the therapeutic alliance. It is a cross-sectional study that evaluated the quality of the alliance in adult patients attended in psychoanalytic psychotherapy in a mental health outpatient clinic. The sample consisted of 118 patients who reached the fourth session of psychoanalytic psychotherapy. The results suggest that the intensity of psychoticism symptoms and patient gender influence the perception of the therapeutic alliance.(AU)

Determinantes sociodemográficos y clínicos asociados a mortalidad fetal intrauterina en el municipio de Pasto, 2010-2012 / Demographic and clinical determinants associated with intrauterine fetal mortality in the municipality of Pasto, 2010-2012

Resumen Introducción: La mortalidad fetal intrauterina (MFIU) es un problema de salud pública por sus elevadas tasas a nivel mundial y en poblaciones de ingresos medios y bajos. Sin embargo, es un evento poco estudiado y carece de visibilidad en las políticas, planes y programas de salud pública. Objetivo: Analizar los determinantes sociodemográficos y clínicos asociados a la MFIU en Pasto-Colombia. Materiales y métodos: Estudio analítico observacional con 88 muertes fetales como casos y 88 nacidos vivos como controles, ocurridas en hospitales de tercer nivel en el municipio de Pasto-Colombia durante 2010-2012, para determinar la relación entre mortalidad fetal, condiciones clínicas (complicaciones del embarazo, edad gestacional, peso al nacer, controles prenatales, antecedentes obstétricos, tóxicos o aborto) y sociodemográficas (edad, etnia, ocupación, estado civil, estrato, zona de residencia, escolaridad, paridad, condición de desplazamiento, embarazo planeado). Resultados: Se identificó que el riesgo de mortalidad fetal es significativamente menor con el incremento de la edad gestacional (OR ajustado=0,76 IC95% 0,62; 0,93) y el peso al nacer (OR ajustado=0,99 IC95% 0,98; 0,99). Otras variables clínicas y sociodemográficas no se asociaron. Conclusión: Los resultados proveen evidencia para la planificación de planes de intervención que prioricen a mujeres cuyo feto tenga un peso inferior al normal y un riesgo de nacimiento prematuro.

Abstract Introduction: Intrauterine fetal mortality (IUFM) is a public health problem because of its high rates worldwide and in low-and middle-income populations. However, it is a little-studied event and lacks visibility in public health policies, plans and programs. Objective: To analyze the sociodemographic and clinical determinants associated with IUFM in Pasto-Colombia. Materials and methods: A study, that includes 88 fetal deaths as cases and 88 live births as controls occurred in third level hospitals in Pasto-Colombia during 2010 and 2012, was carried out to determine the relationship between fetal mortality, clinical conditions (complications of pregnancy, gestational age, birth weight, prenatal controls, pathological and toxic medical history, or abortion) and sociodemographic conditions (age, ethnicity, occupation, marital status, stratum, area of residence , schooling, parity, displacement condition, planned pregnancy). Results: It was identified that the risk of fetal mortality is significantly lower with the increase in gestational age (OR ajustado = 0.76 IC95% 0.62; 0.93) and birth weight (OR ajustado = 0.99 IC95% 0.98; 0.99). Other clinical and sociodemographic variables were not associated. Conclusion: The results provide evidence for planning intervention plans that prioritize women whose fetus has a lower-than-normal weight and a risk of premature birth.

Risk factors for the prognosis of pediatric medulloblastoma: a retrospective analysis of 40 cases

OBJECTIVES: In this study, we evaluated the association of molecular subtypes, clinical characteristics and pathological types with the prognosis of patients with medulloblastoma. METHODS: We analyzed forty patients with medulloblastoma who underwent surgical resection at our center between January 2004 and June 2014. Risk factors associated with survival, disease progression and recurrence were analyzed with a univariate Cox regression analysis, and the identified significant risk factors were further analyzed by Kaplan-Meier survival curves. RESULTS: Factors associated with overall survival included M stage (p=0.014), calcification (p=0.012), postoperative treatment, postoperative Karnofsky Performance Scale (KPS) score (p=0.015), and molecular subtype (p=0.005 for WNT and p=0.008 for SHH). Number of symptoms (p=0.029), M stage (p<0.001), and postoperative radiotherapy (p=0.033) were associated with disease progression. Patients with the WNT or SHH subtype had better survival outcomes than patients with non-WNT/SHH subtypes. Risk factors for disease progression-free survival were symptoms >2 and ≥M1 stage without postoperative radiotherapy. The risk of recurrence increased with advanced M stage. Protective factors for recurrence included M0 stage and a combination of chemotherapy and radiotherapy. CONCLUSION: We identified the risk factors associated with survival, disease progression and recurrence of medulloblastoma patients. This information is helpful for understanding the prognostic factors related to medulloblastoma.

The effects of 4 different clinical factors on endotracheal cuff pressure / 中华护理杂志

Objective To investigate the effects of endotracheal suctioning,turning over,oral caring and swallowingon cuff pressure,so as to provide evidence for the management of the endotracheal cuff.Methods During continuous monitoring of cuff pressure with pressure sensor,the changes of cuff pressure were recorded in the process of endotracheal suctioning,turning over,and oral caring.The data of cuff pressure were recorded including before activity,during activity,after activity for 5 min,15 min and 30 min.In addition,the data of cuff pressure were recorded including before swallowing,during swallowing,after swallowing for 1 min,5 min and 10 min.Results The cuff pressure during endotracheal suctioning and after endotracheal suctioning for 5 min was higher than that before endotracheal suctioning,the difference was statistically significant (P＜0.05);the cuff pressure during turning over and after turning over for 5 min was higher than that before turning over,the difference was statistically significant (P＜0.05);the cuff pressure during the oral caring was higher than that before oral caring,the difference was statistically significant(P＜0.05);the cuff pressure during swallowing was higher than that before swallowing,the difference was statistically significant(P＜0.05).Conclusion These clinical factors would lead to transient increase of cuff pressure including suctioning,turning over,oral caring,and swallowing.The instantaneous cuff pressure will mislead the staff to judge the safey of endotracheal cuff.The cuff pressure should not be blindly adjusted,so as to avoid the risks of leakage and aspiration.

A prospective, multicenter, phase Ⅱ clinical study of concurrent chemotherapy and thoracic three-dimensional radiotherapy for stage IV non-small cell lung cancer -Impact of clinical factors on survival (PPRA-RTOG003) / 中华放射肿瘤学杂志

Objective To investigate the impact of clinical factors on survival in patients receiving concurrent chemotherapy and three?dimensional radiotherapy ( 3DRT) for stage IV non?small cell lung cancer ( NSCLC) . Methods A total of 203 patients were enrolled in a prospective clincial study from 2008 to 2012, and among these patients, 178 patients were eligible for analysis of clinical factors. All patients were treated with platinum?based doublets chemotherapy, with a median number of chemotherapy cycles of 4( 2?6 cycles) and a median dose of 3DRT of 60?3 Gy (36?0?76?5 Gy).The Kaplan?Meier method was used to calculate overall survival ( OS) rates, the log?rank test was used to compare survival rates between groups, and the Cox regression model were used for multivariate analysis. Results The 1?, 2?, and 3?year overall survival rates were 56%, 16%, and 10%, respectively, and the median survival time was 13 months (95% CI=11?500?14?500). The univariate analysis showed that platelet count ≤221×109/L, neutrophil count ≤5.2×109/L, white blood cell count<7×109/L, and improvement in Karnofsky Performance Scale ( KPS) after treatment significantly prolonged OS ( P=0?000,0?022,0?003, and 0?029) , and metastasis to a single organ and hemoglobin≥120 g/L tended to prolong OS (P=0?058 and 0?075). The multivariate analysis showed that white blood cell count<7×109/L, platelet count ≤221×109/L, and improvement in KPS after treatment were beneficial to OS ( all P<0?05) . Conclusions White blood cell count and platelet count before treatment and KPS after treatment are prognostic factors for patients with stage IV NSCLC receiving concurrent chemotherapy and 3DRT. Clinical Trial Registry ClinicalTrials. gov, registration number:ChiCTRTNC10001026.

Analysis of clinical and physical factors for acute bone marrow suppression induced by concurrent chemoradiotherapy in rectal cancer / 中国肿瘤临床

Objective:To analyze the clinical and physical tactors associated with acute bone marrow suppression in concurrent chemo-radiotherapy for rectal cancer and to provide a reference standard for the best clinical treatment plan. Methods:Retrospective analy-sis was performed on 62 patients with rectal cancer who received concurrent radiotherapy and chemotherapy in our department. The pelvis was contoured for each patient in the radiotherapy treatment planning system and divided into three subsites: lumbosacral spine, ilium, and lower pelvis. Prognostic clinical and physical factors were analyzed by univariate and multivariate analyses. Evaluated prognostic clinical factors included sex, age, clinical stage, original hemoglobin levels, and chemotherapy, operation, and radiation modes;physical factors included V5, V10, V15, V20, V25, V30, V35, V40, V45, V50, Dmax, and Dmean of lumbosacral spine, ilium, low-er pelvis, and pelvis. Results:The percentage of patients who developed acute bone marrow suppression (≥2 grade) was 61.3%(38/62).Univariate analysis of related factors revealed statistically significant differences were sex, chemotherapy, lumbosacral spine V45, il-ium V20, and ilium V30. Multivariate logistic regression analysis indicated that chemotherapy and ilium V30 are the risk factors for acute bone marrow suppression. The receiver operating curve showed that the threshold of ilium V30 was 44%. Conclusion:Acute bone marrow suppression is influenced by more than one factor;local control rate of the tumor and acute bone marrow suppression are tradeoffs in rectal cancer treatment. An appropriate chemotherapy method should be selected, and ilium V30 must be maintained below 44%to prevent bone marrow suppression in rectal cancer patients.

Analysis of the results and the influencing factors of intrauterine insemination with husband sperm in 181 cycles / 中国综合临床

Objective To analyze the outcome of patients receiving intrauterine insemination with husband sperm,in order to evaluate the effect of relative factors on pregnancy rate after intrauterine insemination. Methods Ninety-eight infertile couples who received intrauterine insemination in the Affiliated Hospital of Nantong University from March 2013 to May 2014 were selected as our subjects and 181 cycles were included. The information including clinical factors including maternal age,infertile time,infertile causes, ovulation induction protocol,time of insemination and postwash total motitle sperm(TMS)and pregnancy rate were recorded. Results (1)Totally 26 patients received clinical pregnancies,and clinical pregnancy rate(CPR) was 14. 36% per cycle. With age increase pregnancy rate decreased( χ2 = 1. 654 9,P = 0. 647).(2)The pregnancy rate of the patients was the same within the infertile time( χ2 = 1. 588 5,P = 0. 662).(3)The pregnancy rate of the patients with secondary infertility was lower than that of the patients with primary infertility,but there was no significant difference(χ2 = 0. 923 3,P = 0. 337).(4)The pregnancy rate of ovulation induction cycles was lower than that of nature cycles,but there was no significant difference(χ2 = 2. 222 0,P= 0. 136).(5)Postwash TMS was showed the same trend(χ2 = 0. 643 4,P = 0. 422). Conclusion In terms of intrauterine insemination with husband sperm,age,infertile time,infertile types,ovulation induction protocol and posrwash TMS can affect pregnancy rate,and the effects of various factors should be considered comprehensively in the process of therapy.

Clinical Factors That Potentially Affect the Treatment Outcome of Helicobacter pylori Eradication Therapy with using a Standard Triple Regimen in Peptic Ulcer Patients / 대한소화기내시경학회지

BACKGROUND/AIMS: Proton pump inhibitor (PPI) based triple therapy for Helicobacter pylori eradication has an approximately 20% treatment failure rate. The aim of this study is to examine the clinical factors that influence eradication of H. pylori in patients with peptic ulcers. METHODS: We reviewed the medical records of 597 endoscopy-proven peptic ulcer and H. pylori-positive patients who were treated at our hospital between July 2004 and March 2007. The eradication rate and the effect of age, gender, smoking, alcohol drinking, activity and the location of ulcer and the kind of PPIs were examined. RESULTS: 597 patients were treated with one-week triple therapy (PPI, amoxicillin 1 g, clarithromycin 500 mg all twice daily). The overall eradication rate was 80.2%. Eradication was significantly more successful in the patients with an age under 60, and in patients over 60 and who had a duodenal ulcer (83.2% vs 73.2%, respectively, p=0.005) or a gastric ulcer (82.5% vs 73.6%, respectively, p=0.041). There was no statistically significant difference according to gender, smoking, alcohol, the activity of the ulcer and the kind of PPIs. CONCLUSIONS: An age over 60 and gastric ulcer were associated with a lower H. pylori eradication rate in patients with peptic ulcers. Therefore, H. pylori eradication in old age patients and in patients with gastric ulcer should be managed differently and the treatment duration should be extended or a new treatment regime developed to overcome the lower eradication rate.

Factores relacionados con la percepción subjetiva de la calidad de vida de pacientes con diabetes / Factors related to subjective evaluation of quality of life of diabetic patients

Objective. To determine the relationship between some clinical and psychosocial factors and the quality of life of a group of diabetic patients. Method. A cross sectional study was done with diabetic patients attending a primary care unit. Quality of life was evaluated with a verbal global scale. The clinical and psychosocial factors studied were: type of diabetes, duration of the disease, type of treatment, associated diseases, complications, metabolic control (glycosylated hemoglobin), treatment compliance, coping styles, negative attitude to disease, social support, and socioeconómica! level. Results. We interviewed 173 patients, most women (73%), most type 2 (95%). We found that being a woman was a factor negatively related to quality of life. Of clinical variables, only duration of disease was slightly correlated with quality of life (-0.14). Psychological and social variables were significantly correlated with quality of life. We performed a stepwise multiple regression analysis and we found that seven psychosocial variables explained 30% of variance of quality of life. Conclusions. Our results indicate that clinical factors did not correlate with quality of life. It is the way the patient lives with diabetes and not the diabetes by itself what affects the quality of life of diabetic patients. Some psychological and social variables were significantly related to quality of life of these patients.

Objetivo. Determinar la relación de algunos factores clínicos y psicosociales con la percepción global de la calidad de vida de pacientes con diabetes. Material y métodos. Se realizó un escrutinio transversal, de pacientes con diabetes en una clínica de medicina familiar del Seguro Social. La calidad de vida se evaluó con una escala global verbal. Se evaluaron las siguientes variables clínicas: tipo de diabetes, tiempo de evolución, tipo de tratamiento, enfermedades asociadas, complicaciones y el control metabólico. Las variables psicosociales estudiadas fueron: el conocimiento de la enfermedad, el apego al tratamiento, las formas de contender con la enfermedad, el impacto emocional producido por la misma y el apoyo social. Los pacientes fueron entrevistados con instrumentos previamente validados. Se determinó la hemoglobina glucosilada. Resultados. Fueron entrevistados 173 pacientes (73% mujeres), con un promedio de edad de 50.5 años para las mujeres y 51.5 para los hombres. La mayoría (95%) tenía diabetes tipo 2. Se determinó la relación entre las variables estudiadas y la calidad de vida. En el análisis bivariado se encontró que las mujeres tenían significativamente una menor calidad de vida (62.8 vs. 69.5). De los factores sociales, el nivel socioeconómico, el apoyo social y tener una pareja, correlacionaron positivamente con la calidad de vida. De los factores psicológicos, las formas de contención (evitación y resignación), el rechazo a la enfermedad y el impacto emocional correlacionaron negativamente con la calidad de vida. De las variables clínicas, sólo el tiempo de evolución tuvo una correlación discreta (r = - 0.14). En el análisis multivariado, siete variables psicosociales explicaron 30% de la varianza en la calidad de vida. Conclusiones. Nuestros resultados indican que aparentemente los factores clínicos influyen poco sobre la calidad de vida. Consideramos que la calidad de vida, medida de forma global, subjetiva, depende en un gran porcentaje de la forma en la que los pacientes viven la enfermedad más que de las características de la misma.

The Factors Associated with the Success of Ahmed Glaucoma Valve Implantation

PURPOSE: To evaluate the factors associated with the success of Ahmed glaucoma valve implantation in refractory glaucoma. METHODS: The medical records of 45 eyes of 45 patients that underwent Ahmed implant surgery for the treatment of refractory glaucoma were reviewed retrospectively. The success criterion was a stable postoperative intraocular pressure (IOP) between 6 and 21 mmHg with or without antiglaucoma medications during the study period. Failure was defined as an abnormal IOP outside of the above range on two consecutive visits, and cases that needed additional surgery to control IOP or to treat devastating surgical complications. We compared the differences in various clinical factors before surgery between the success and failure groups. RESULTS: The Kaplan-Meier cumulative success rate was 71.1% at 12 months. Among the various clinical factors age, gender, right or left eye, phakia or pseudophakia, systemic disease such as diabetes and hypertension, preoperative IOP, preoperative number of antiglaucoma medications, and the number of previous glaucoma or other ocular surgeries were not significantly different between the success and failure groups. Implantation at the superotemporal site and steroid non-responsders of the fellow eye showed a significantly greater success rate than the superonasal site and steroid responders, respectively, after Ahmed glaucoma valve implantation. CONCLUSIONS: The efficacy of lowering the IOP of an Ahmed glaucoma valve would be expected to be greater if the patient is a steroid non-responder. Given the same conditions in the superotemporal and superonasal areas, implanting the Ahmed glaucoma valve in the superotemporal quadrant showed an ito increased success rate.

Clinical Factors Associated with Functional Status at Discharge in Stroke Patients

OBJECTIVE: To investigate the clinical characteristics, risk factors and complications of stroke patients and their effect on the patient's functional outcomes at discharge. METHOD: We performed a prospective study during hospitalization on 1, 250 consecutive acute stroke patients discharged from Dong-Eui Hospital from June 2001 to May 2002. Glasgow outcome scale, status of upper extremity involved and status of ambulation were used to evaluate functional status. RESULTS: The variables of clinical characteristics identified as significant in functional status at discharge were the presence of occupation, interval between onset and visit to hospital arrival, type of first treatment after stroke, type of caregiver, type of stroke and location of infarction and intracranial hemorrhage. Positive functional outcomes were significantly related to a younger age, male, small amount of hemorrhage and short length of hospital stay. Among risk factors of stroke, abnormal ECG findings at admission and presence of previous stroke were negative prognostic factors. The complications influencing stroke outcome negatively were pneumonia, depression, urinary tract infection, myocardial infarction and recurrence of stroke in hospitalization. CONCLUSION: The results of this study should be considered during acute management and rehabilitation of stroke patients and are valuable as basic data of functional outcome after stroke.