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1.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 18-23, Jan.-Mar. 2020. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1090550

ABSTRACT

Abstract Introduction Cholesteatomas are benign tumors consisting of skin, and growing inside a retraction pocket in the tympanic membrane. Cholesteatomas can occupy the entirety of the middle ear, and are known for their osteolytic capabilities. Surgery is the only curative treatment for cholesteatomas. Objective To describe the risk of recurrence after first-time surgically-treated middle- ear cholesteatoma (STMEC1) on the island of Funen from 1983 to 2015. Methods Cases of STMEC1 were identified in the Danish National Hospital Register. The medical records were reviewed. Time-to-event analyses were applied. The ears were followed from STMEC1 to a secondary cholesteatoma, emigration, death, or end of follow-up. Results Records from 1,006 patients with STMEC1 were reviewed. A total of 54 patients were submitted to surgery on both ears. The total sample consisted of 1,060 ears with STMEC1; 300 were children's (< 16 years) ears, and 760 were adult's ears. The total observation time was of 12,049 years. The overall estimated proportion with recurrence 5 years after surgery was of 37% in children and of 15% in adults. The older the child was at the first surgery, the risk decreased by 7% per year. In children, canal wall up (CWU) mastoidectomy without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% confidence interval [95%CI]: 1.2-3.0) compared with CWU with obliteration. Conclusion Compared with adults, children were had 2.6 times more risk of recurrence. Procedures performed without mastoidectomy had the lowest risk of recurrence. In children, obliteration was associated with a significantly lower risk of recurrence. However, patients were not randomized regarding the surgical approach; thus, the association between approach and risk of recurrence was likely influenced by confounding factors.


Subject(s)
Humans , Child , Adolescent , Adult , Ear Neoplasms/surgery , Cholesteatoma, Middle Ear/surgery , Neoplasm Recurrence, Local/epidemiology , Time Factors , Proportional Hazards Models , Survival Analysis , Medical Records , Multivariate Analysis , Retrospective Studies , Second-Look Surgery , Denmark , Mastoidectomy/methods
2.
Rev. habanera cienc. méd ; 19(1): 167-179, ene.-feb. 2020. tab, graf
Article in Spanish | LILACS (Americas), CUMED | ID: biblio-1099154

ABSTRACT

Introducción: El análisis de riesgo en la gestión de la calidad y seguridad permite la mejora continua de los servicios médicos en Cuba. En Medicina Nuclear Terapéutica es requisito regulador que permite la continuidad de estos servicios a la población. Objetivo: Analizar los riesgos radiológicos con enfoque integrador dirigido a causas básicas de fallo en la práctica citada. Material y métodos: Se revisó y adaptó el modelo genérico de riesgo para cada caso de estudio. Los métodos prospectivos de matriz de riesgo y análisis de modos y efectos de fallo y reactivo de aprendizaje de las lecciones de sucesos registrados fueron utilizados con el código cubano SECURE MR-FMEA versión 3.0. Se determinó el riesgo inherente, su tratamiento y el riesgo residual por práctica. Se identificaron las etapas del proceso, las medidas y las causas básicas más contribuyentes. Resultados: No se obtuvo riesgo superior al del nivel alto. La radiosinoviortesis y el tratamiento radiactivo de la policitemia vera tuvieron la mayor cantidad de modificaciones al modelo genérico. Las etapas más significativas son prescripción clínica, preparación del radiofármaco y administración. Las medidas preventivas de mayor importancia son mantener una carga de trabajo moderada para el personal, las capacitaciones de los médicos nucleares y del técnico que realiza la administración. Conclusiones: Existe una no uniformidad en el nivel de calidad y seguridad entre los servicios analizados. Para el cambio, la adopción de decisiones se ve beneficiada en su eficacia y eficiencia, al integrarse los métodos prospectivos y reactivos de análisis de riesgo(AU)


Introduction: Risk assessment in quality and safety management allows the continuous improvement of the medical services in Cuba. In Therapeutic Nuclear Medicine, it is a regulatory requirement which allows the continuity of these services to the population. Objective: To assess radiological risks with an integrated approach focused on underlying causes of failure in the mentioned practice. Material and Methods: The generic risk model was reviewed and adapted for each case study. The prospective methods of risk assessment matrix of failure modes and effects and incident learning lessons from the events registered were used applying the Cuban code SECURE MR-FMEA version 3.0. The inherent risk, treatment, and residual risk in the practice were determined. The stages of the process, measurements, and the main contributing causes were identified. Results: There was no risk higher than the high level. Radiosynoviorthesis and the radioactive treatment of the Polycythemia Vera had the greatest amount of modifications to the generic model. The most significant stages are clinical prescription, preparation of the radiopharmaceutical formulation and administration. The most important preventive measures are to maintain a moderate workload for the personnel, and the training of the nuclear physicians and the technician who performs the administration. Conclusions: There is a non-uniformity in the level of quality and safety among the NTM services in Cuba. For change, decision-making is benefited in terms of effectiveness and efficiency by integrating prospective and reactive risk assessment methods(AU)


Subject(s)
Humans , Male , Female , Quality of Health Care/standards , Radiation Risks , Nuclear Medicine/methods , Proportional Hazards Models , Cuba
3.
Article in English | WPRIM (Western Pacific) | ID: wprim-811212

ABSTRACT

OBJECTIVE: To compare the efficacy and toxicity of dose-dense weekly paclitaxel and 3-weekly carboplatin (ddPC) as neoadjuvant chemotherapy (NAC) with the standard 3-weekly regimen.METHODS: A retrospective study of patients diagnosed with stage IIIc and IV ovarian cancer who received at least one cycle of NAC followed by interval debulking surgery between August 2015 and January 2018 was conducted. Patient characteristics, clinical and pathological response to NAC, surgical and survival outcome, and adverse event were compared.RESULTS: A total of 23 patients in the ddPC group and 50 patients in the standard group received a median of 3 cycles of NAC. Rate of grade ≥3 neutropenia was significantly higher in the ddPC group than the standard (82.6% vs. 22.0%, p<0.001). Patients in the ddPC group underwent dose-reduction more frequently (34.8% vs. 4.00%, p=0.001). Normalization of cancer antigen-125 post-NAC occurred more frequently in the ddPC group (73.9% vs. 46.0%, p=0.030). No residual disease rate (43.5% vs. 60.0%, p=0.188) and chemotherapy response score of 3 (34.8% vs. 26.0%, p=0.441) were not statistically different between two groups. There was no statistical difference in progression free survival (PFS) at 2 years (36.3% vs. 28.4%, p=0.454). Cox proportional hazard model showed that ddPC was not a significant determinant of PFS (p=0.816).CONCLUSION: There was no difference between both regimens in terms of NAC response and survival outcomes. However, ddPC group showed higher hematologic toxicity requiring dose reduction.


Subject(s)
Carboplatin , Disease-Free Survival , Drug Therapy , Humans , Neoadjuvant Therapy , Neutropenia , Ovarian Neoplasms , Paclitaxel , Proportional Hazards Models , Retrospective Studies , Treatment Outcome
4.
Article in English | WPRIM (Western Pacific) | ID: wprim-782489

ABSTRACT

BACKGROUND: The purposes of this study were 1) to investigate the incidence of pneumonia during hospitalization in elderly hip fracture patients, 2) to evaluate the effect of pneumonia on 30 day to 1 year mortality and 3) to analyze the impact of age and gender on the mortality rate in the pneumonia patients using a nationwide cohort of Korea.METHODS: The Korean National Health Insurance Service (NHIS) database included approximately 5.5 million Korean enrollees > 60 years of age. A total of 588,147 participants were randomly selected for senior cohort using 10% simple random sampling. We identified senile (> 65 years old) patients who underwent hip fracture surgery from January 2005 to December 2014 and those who developed pneumonia during hospitalization from the NHIS-Senior cohort. The index date of hip fracture occurrence was defined as the date of admission to the acute care hospital. The last date of follow-up was defined as the date of death or 31 December 2015, whichever came first. A multivariable-adjusted Cox proportional hazards model was used to investigate the effects of pneumonia on all-cause mortality.RESULTS: During the enrollment period, a total of 14,736 patients, who were older than 65 years, underwent hip fracture surgeries. Among them, 1,629 patients (11.05%) developed pneumonia during the hospitalization. The pneumonia incidence was 16.39% (601/3,666) in men patients and 9.29% (1,028/10,042) in women patients. Compared to 13,107 non-pneumonia patients, adjusted relative risk (aRR) of death in pneumonia patients was 2.69 (95% confidence interval [CI], 2.14–3.38; P < 0.001) within postoperative 30-day, 3.40 (95% CI, 3.01–3.83; P < 0.001) within postoperative 90-day, 2.86 (95% CI, 2.61–3.15; P < 0.001) within postoperative 180-day and 2.31 (95% CI, 2.14–2.50; P < 0.001) within postoperative 1-year. According to patient's age, the aRR of death in pneumonia patients was 5.75 (95% CI, 2.89–11.43) in adults aged < 70 years, 5.14 (95% CI, 4.08–6.46) in those aged 70–79 years, 3.29 (95% CI, 2.81–3.86) in those aged 80–89 years and 2.02 (95% CI, 1.52–2.69) in those aged ≥ 90 years. The aRR was 3.63 (95% CI, 3.01–4.38) in men pneumonia patients, and 3.27 (95% CI, 2.80–3.83) in women pneumonia patients.CONCLUSION: The prevalence of pneumonia in elderly hip fracture patients was 11.05%. Men had higher incidence (16.39%) than women (9.29%). Compared to non-pneumonia patients, the pneumonia patients had higher 30-day to 1-year mortalities with aRR of 2.31 to 3.40. They had increased mortality in all age groups older than 65 years with aRR of 1.52 to 4.08. Both genders of pneumonia patients had higher risk of mortality (aRR, 3.63 in men and 3.27 in women) compared to non-pneumonia patients.


Subject(s)
Adult , Aged , Cohort Studies , Female , Follow-Up Studies , Hip , Hospitalization , Humans , Incidence , Korea , Male , Mortality , National Health Programs , Pneumonia , Prevalence , Proportional Hazards Models
5.
Yonsei Medical Journal ; : 145-153, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-782197

ABSTRACT

PURPOSE: This study investigated multidrug-resistant (MDR) pathogens and antibiotic strategies of culture-positive spontaneous ascitic infection (SAI) in patients with acute decompensated cirrhosis.MATERIALS AND METHODS: We retrospectively analyzed 432 acute decompensated cirrhotic patients with culture-positive SAI from 11 teaching hospitals in China (January 2012 to May 2018). A Cox proportional hazards model analysis was conducted to identify independent predictors of 28-day mortality.RESULTS: A total of 455 strains were isolated from 432 ascitic culture samples. Gram-negative bacteria (GNB), gram-positive bacteria (GPB), and fungi caused 52.3, 45.5, and 2.2% of all SAI episodes, respectively. Episodes were classified as nosocomial (41.2%), healthcare-related (34.7%), and community-acquired (24.1%). Escherichia coli (13.4%) and Klebsiella pneumoniae (2.4%) were extended-spectrum β-lactamase producing isolates. The prevalence of methicillin-resistant Staphylococcus aureus was 1.1%. Ceftazidime, cefepime, aztreonam, and amikacin were recommended as first-line antibiotics agents for non-MDR GNB infections; piperacillin/tazobactam and carbapenems for MDR GNB in community-acquired and healthcare-related or nosocomial infections, respectively; and vancomycin or linezolid for GPB infections, regardless of drug-resistance status. Multivariate analysis revealed days of hospital stay before SAI, upper gastrointestinal bleeding, white blood cell count, alanine aminotransferase, serum creatinine concentration, total bilirubin, and international normalized ratio as key independent predictors of 28-day mortality.CONCLUSION: MDR pathogens and antibiotic strategies were identified in patients with acute decompensated cirrhosis with culture-positive SAI, which may help optimize therapy and improve clinical outcomes.


Subject(s)
Alanine Transaminase , Amikacin , Anti-Bacterial Agents , Aztreonam , Bilirubin , Carbapenems , Ceftazidime , China , Creatinine , Cross Infection , Escherichia coli , Fibrosis , Fungi , Gram-Negative Bacteria , Gram-Positive Bacteria , Hemorrhage , Hospitals, Teaching , Humans , International Normalized Ratio , Klebsiella pneumoniae , Length of Stay , Leukocyte Count , Linezolid , Methicillin-Resistant Staphylococcus aureus , Mortality , Multivariate Analysis , Prevalence , Proportional Hazards Models , Retrospective Studies , Risk Factors , Vancomycin
6.
Article in English | WPRIM (Western Pacific) | ID: wprim-782094

ABSTRACT

OBJECTIVE: The purpose of this study was to analyze the impact of surgery of primary sites on stage IVB cervical cancer patients from a population-based database, the Surveillance, Epidemiology and End Results (SEER).METHODS: Propensity score matching was performed to minimize heterogeneity in patient between with-surgery group and without-surgery group. Clinicopathological characteristics were compared using the χ² or Fisher's exact test. Survival analysis included the Kaplan-Meier method, log-rank test, and Cox proportional hazards model.RESULTS: Between 2010-2015, a total of 1,139 International Federation of Gynecology and Obstetrics (FIGO) stage IVB cervical cancer patients receiving chemoradiotherapy (CRT) were included in this retrospective study. Within post-matching cohort, the median duration of overall survival (OS) in stage IVB cervical cancer patients receiving CRT was 22 months. The overall 5-year survival rate was 25.7%. The increasing American Joint Committee on Cancer T stage (T1 vs. T2, p=0.033, hazard ratio [HR]=1.79, 95% confidence interval [CI]=1.05–3.05; T1 vs. T3, p=0.003, HR=2.20, 95% CI=1.31–3.67; T1 vs. T4, p=0.037, HR=2.75, 95% CI=1.06–7.12) and visceral metastasis (with vs. without, p=0.038, HR=1.60, 95% CI=1.03–2.49) was reported as independent risk factors of OS. Surgery of primary sites combined with CRT tended to prolong the survival of stage IVB cervical cancer patients (p<0.001, HR=0.36, 95% CI=0.21–0.61) compared with CRT, especially for patients without visceral metastasis (p=0.005, HR=0.31, 95% CI=0.14–0.70).CONCLUSIONS: In conclusion, patients with stage IVB cervical cancer may achieve their best outcomes through CRT combined with surgery of primary sites. However, it deserves large scale prospective clinical trials to confirm.


Subject(s)
Chemoradiotherapy , Cohort Studies , Epidemiology , Gynecology , Humans , Joints , Methods , Neoplasm Metastasis , Obstetrics , Population Characteristics , Propensity Score , Proportional Hazards Models , Prospective Studies , Retrospective Studies , Risk Factors , Survival Rate , Uterine Cervical Neoplasms
7.
Article in English | WPRIM (Western Pacific) | ID: wprim-782092

ABSTRACT

OBJECTIVES: Two randomized, controlled studies comparing outcomes in patients treated with direct oral anticoagulants or low-molecular weight heparin for cancer-associated venous thromboembolism (VTE) have previously been performed. However, gynecologic cancers accounted for approximately 10% of the study populations. We compared the outcomes of patients with primary gynecological cancers who were treated for cancer-associated VTE with either rivaroxaban or dalteparin.METHODS: The 162 eligible patients with gynecologic cancers who were treated with either dalteparin (n=60) or rivaroxaban (n=102) were reviewed. The primary outcome was a composite event, which included recurrence or clinically relevant bleeding events during the therapeutic period. Secondary outcomes were recurrence, clinically relevant bleeding events, and mortality.RESULTS: During the therapeutic period, there were no significant differences between the groups in the proportion of composite events, recurrence, or clinically relevant bleeding. Multivariate analysis using the Cox proportional hazards model also showed no significant difference in the number of composite events and clinically relevant bleeding between the groups. In the rivaroxaban group, 44.0% of patients experienced gastrointestinal bleeding and 24.0% experienced urinary tract bleeding. In the dalteparin group, bleeding was most common in the urinary tract (44.4%) and at the injection site (22.2%).CONCLUSION: In this study, although there were no significant differences in effectiveness or safety between the rivaroxaban and dalteparin groups, rivaroxaban use was associated with a higher rate of clinically relevant bleeding than dalteparin. Therefore, caution should be taken when prescribing rivaroxaban for gynecologic cancer-associated VTE and bleeding events should be carefully monitored.


Subject(s)
Anticoagulants , Dalteparin , Hemorrhage , Heparin , Humans , Mortality , Multivariate Analysis , Proportional Hazards Models , Recurrence , Rivaroxaban , Urinary Tract , Venous Thromboembolism
8.
Article in English | WPRIM (Western Pacific) | ID: wprim-782091

ABSTRACT

OBJECTIVE: Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) confers similar outcomes as primary debulking surgery and chemotherapy. Little is known about patients who receive NACT but do not undergo debulking surgery. Our aim was to characterize these patients.METHODS: We prospectively identified patients with newly diagnosed stage III/IV ovarian cancer treated with NACT from 7/1/15–12/1/17. Fisher exact and Wilcoxon rank-sum tests were used to compare clinical characteristics by surgical status. The Kaplan-Meier method was used to estimate survival outcomes. Log-rank test and Cox proportional hazards model were applied to assess the relationship of covariates to outcome, and time-dependent covariates were applied to variables collected after diagnosis.RESULTS: Of 224 women who received NACT, 162 (72%) underwent IDS and 62 (28%) did not undergo surgery. The non-surgical group was older (p<0.001), had higher Charlson comorbidity index (CCI; p<0.001), lower albumin levels (p=0.007), lower Karnofsky performance scores (p<0.001), and were more likely to have dose reductions in NACT (p<0.001). Reasons for no surgery included poor response to NACT (39%), death (15%), comorbidities (24%), patient preference (16%), and loss to follow-up (6%). The no surgery group had significantly worse overall survival (OS) than the surgery group (hazard ratio=3.34; 95% confidence interval=1.66–6.72; p<0.001), after adjustment for age, CCI, and dose reductions.CONCLUSIONS: A significant proportion of women treated with NACT do not undergo IDS, and these women are older, frailer, and have worse OS. More studies are needed to find optimal therapies to maximize outcomes in this high-risk, elderly population.


Subject(s)
Aged , Comorbidity , Cytoreduction Surgical Procedures , Diagnosis , Drug Therapy , Female , Follow-Up Studies , Humans , Methods , Neoadjuvant Therapy , Ovarian Neoplasms , Patient Preference , Proportional Hazards Models , Prospective Studies
9.
Chinese Medical Journal ; (24): 525-533, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-774810

ABSTRACT

BACKGROUND@#Serum antinuclear antibodies (ANAs) are positive in some patients with chronic lymphocytic leukemia (CLL), but the prognostic value of ANAs remains unknown. The aim of this study was to evaluate the role of ANAs as a prognostic factor in CLL.@*METHODS@#This study retrospectively analyzed clinical data from 216 newly diagnosed CLL subjects with ANAs test from 2007 to 2017. Multivariate Cox regression analyses were used to screen the independent prognostic factors related to time to first treatment (TTFT), progression free survival (PFS) and overall survival (OS). Receiver operator characteristic curves and area under the curve (AUC) were utilized to assess the predictive accuracy of ANAs together with other independent factors for OS.@*RESULTS@#The incidence of ANAs abnormality at diagnosis was 13.9%. ANAs positivity and TP53 disruption were independent prognostic indicators for OS. The AUC of positive ANAs together with TP53 disruption was 0.766 (95% confidence interval [CI]: 0.697-0.826), which was significantly larger than that of either TP53 disruption (AUC: 0.706, 95% CI: 0.634-0.772, P = 0.034) or positive ANAs (AUC: 0.595, 95% CI: 0.520-0.668, P < 0.001) in OS prediction. Besides, serum positive ANAs as one additional parameter to CLL-international prognostic index (IPI) obtained superior AUCs in predicting CLL OS than CLL-IPI alone.@*CONCLUSION@#This study identified ANAs as an independent prognostic factor for CLL, and further investigations are needed to validate this finding.


Subject(s)
ADP-ribosyl Cyclase 1 , Blood , Adolescent , Adult , Aged , Aged, 80 and over , Antibodies, Antinuclear , Blood , Autoimmunity , Physiology , Female , Humans , Kaplan-Meier Estimate , Leukemia, Lymphocytic, Chronic, B-Cell , Blood , Mortality , Male , Middle Aged , Multivariate Analysis , Mutation , Genetics , Proportional Hazards Models , Retrospective Studies , Survival Analysis , Tumor Suppressor Protein p53 , Blood , Young Adult , ZAP-70 Protein-Tyrosine Kinase , Blood
10.
Chinese Medical Journal ; (24): 1028-1036, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-774786

ABSTRACT

BACKGROUND@#The mortality of cardiovascular disease is constantly rising, and novel biomarkers help us predict residual risk. This study aimed to evaluate the predictive value of serum homocysteine (HCY) levels on prognosis in patients with ST-segment elevation myocardial infarction (STEMI).@*METHODS@#The 419 consecutive patients with STEMI, treated at one medical center, from March 2010 to December 2015 were retrospectively investigated. Peripheral blood samples were obtained within 24 h of admission and HCY concentrations were measured using an enzymatic cycling assay. The patients were divided into high HCY level (H-HCY) and low HCY level (L-HCY) groups. Short- and long-term outcomes were compared, as were age-based subgroups (patients aged 60 years and younger vs. those older than 60 years). Statistical analyses were mainly conducted by Student t-test, Chi-squared test, logistic regression, and Cox proportional-hazards regression.@*RESULTS@#The H-HCY group had more males (84.6% vs. 75.4%, P = 0.018), and a lower prevalence of diabetes (20.2% vs. 35.5%, P < 0.001), compared with the L-HCY group. During hospitalization, there were seven mortalities in the L-HCY group and 10 in the H-HCY group (3.3% vs. 4.8%, P = 0.440). During the median follow-up period of 35.8 (26.9-46.1) months, 33 (16.2%) patients in the L-HCY group and 48 (24.2%) in the H-HCY group experienced major adverse cardiovascular and cerebrovascular events (MACCE) (P = 0.120). History of hypertension (hazard ratio [HR]: 1.881, 95% confidence interval [CI]: 1.178-3.005, P = 0.008) and higher Killip class (HR: 1.923, 95% CI: 1.419-2.607, P < 0.001), but not HCY levels (HR: 1.007, 95% CI: 0.987-1.027, P = 0.507), were significantly associated with long-term outcomes. However, the subgroup analysis indicated that in older patients, HCY levels were significantly associated with long-term outcomes (HR: 1.036, 95% CI: 1.011-1.062, P = 0.005).@*CONCLUSION@#Serum HCY levels did not independently predict in-hospital or long-term outcomes in patients with STEMI; however, among elderly patients with STEMI, this study revealed a risk profile for late outcomes that incorporated HCY level.


Subject(s)
Aged , Chi-Square Distribution , Coronary Angiography , Female , Homocysteine , Blood , Humans , Kaplan-Meier Estimate , Logistic Models , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction , Blood , Proportional Hazards Models , Retrospective Studies , ST Elevation Myocardial Infarction , Blood , Pathology
11.
Yonsei Medical Journal ; : 611-618, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-762100

ABSTRACT

PURPOSE: Family with sequence similarity 83 member H (FAM83H) plays key roles in tumorigenesis. However, the specific roles of FAM83H in cervical cancer (CC) have not been well studied. MATERIALS AND METHODS: The RNA-seq data of 306 CC tissues and three normal samples downloaded from The Cancer Genome Atlas were used to analyze the expression of FAM83H. The Kaplan-Meier method was used to draw survival curves. Associations between FAM83H expression and clinicopathological factors were analyzed by chi-square test. Cox proportional hazards model was used to analyze prognostic factors. Loss-of-function assays were conducted to discover the biological functions of FAM83H in cell proliferation, colony formation, invasion, and migration. Real-time Quantitative Reverse Transcription PCR (qRT-PCR) and Western blotting were used to measure the expression levels of FAM83H in CC cell lines. RESULTS: Our results demonstrated that FAM83H is overexpressed in CC tissues and that high FAM83H expression is associated with worse overall survival (OS). High FAM83H expression in CC was associated with clinical stage, pathologic tumor, and pathologic node. Univariate analysis suggested that FAM83H expression was significantly related to the OS of CC patients. Although multivariate analysis showed that FAM83H expression was not an independent prognostic factor for the OS of CC patients, the effects of FAM83H on CC cell growth and motility was significant. Loss-of-function experiments demonstrated that knockdown of FAM83H inhibited proliferation, colony formation, migration, and invasion of CC cells by inactivating PI3K/AKT pathway. CONCLUSION: FAM83H might play a crucial role in CC progression and could act as a novel therapeutic target in CC.


Subject(s)
Blotting, Western , Carcinogenesis , Cell Line , Cell Proliferation , Genome , Humans , Methods , Multivariate Analysis , Neoplasm Metastasis , Polymerase Chain Reaction , Prognosis , Proportional Hazards Models , Reverse Transcription , Uterine Cervical Neoplasms
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-740191

ABSTRACT

OBJECTIVE: Human papillomavirus (HPV) infection is the most important risk factor for cervical cancer, which progresses from precursor lesions with no symptom if left untreated. We compared the risk of cervical dysplasia among HPV-positive Korean women based on HPV types and infection patterns. METHODS: We observed participants of a 5-year multicenter prospective cohort study, comprising HPV-positive women with either atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion of the cervix at their enrollment. Follow-ups, comprising cytology and HPV DNA testing results, were included in the final analysis. Incidence was calculated for each infection pattern (persistent infection, incidental infection, and clearance). To investigate cervical dysplasia risk, we used Cox proportional hazard models adjusted for variables that were significantly different among infection patterns. From April 2010 to September 2017, 71 of 1,027 subjects developed cervical dysplasia more severe than high-grade squamous intraepithelial lesion of the cervix. RESULTS: Of these 71 subjects, persistent infection, incidental infection, and clearance were noted in 30, 39, and 2 individuals, respectively. Based on changes in DNA results during follow-up, cumulative incidence was 27.2%, 10.4%, and 0.5% for persistent infection, incidental infection, and clearance, respectively. Compared to clearance, the adjusted hazard ratios for cervical dysplasia were 51.6 and 24.1 for persistent and incidental infections, respectively (p < 0.001). CONCLUSION: Individuals persistently infected with the same HPV types during the follow-up period had the highest risk of severe cervical dysplasia. Hence, it is necessary to monitor HPV types and infection patterns to prevent severe cervical precancerous lesions.


Subject(s)
Atypical Squamous Cells of the Cervix , Cervix Uteri , Cohort Studies , DNA , Female , Follow-Up Studies , Human Papillomavirus DNA Tests , Humans , Incidence , Korea , Papillomavirus Infections , Proportional Hazards Models , Prospective Studies , Republic of Korea , Risk Factors , Squamous Intraepithelial Lesions of the Cervix , Uterine Cervical Dysplasia , Uterine Cervical Neoplasms
13.
Chinese Medical Journal ; (24): 914-921, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-772176

ABSTRACT

BACKGROUND@#It is currently unclear if fibrinogen is a risk factor for adverse events in patients receiving percutaneous coronary intervention (PCI) or merely serves as a marker of pre-existing comorbidities and other causal factors. We therefore investigated the association between fibrinogen levels and 2-year all-cause mortality, and compared the additional predictive value of adding fibrinogen to a basic model including traditional risk factors in patients receiving contemporary PCI.@*METHODS@#A total of 6293 patients undergoing PCI with measured baseline fibrinogen levels were enrolled from January to December 2013 in Fuwai Hospital. Patients were divided into three groups according to tertiles of baseline fibrinogen levels: low fibrinogen, <2.98 g/L; medium fibrinogen, 2.98 to 3.58 g/L; and high fibrinogen, ≥3.58 g/L. Independent predictors of 2-year clinical outcomes were determined by multivariate Cox proportional hazards regression modeling. The increased discriminative value of fibrinogen for predicting all-cause mortality was assessed using the C-statistic and integrated discrimination improvement (IDI).@*RESULTS@#The 2-year all-cause mortality rate was 1.2%. It was significantly higher in the high fibrinogen compared with the low and medium fibrinogen groups according to Kaplan-Meier analyses (1.7% vs. 0.9% and 1.7% vs. 1.0%, respectively; log-rank, P = 0.022). Fibrinogen was significantly associated with all-cause mortality according to multivariate Cox regression (hazard ratio 1.339, 95% confidence interval: 1.109-1.763, P = 0.005), together with traditional risk factors including age, sex, diabetes mellitus, left ventricular ejection fraction, creatinine clearance, and low-density lipoprotein cholesterol. The area under the curve for all-cause mortality in the basic model including traditional risk factors was 0.776, and this value increased to 0.787 when fibrinogen was added to the model (IDI = 0.003, Z = 0.140, P = 0.889).@*CONCLUSIONS@#Fibrinogen is associated with 2-year all-cause mortality in patients receiving PCI, but provides no additional information over a model including traditional risk factors.


Subject(s)
Acute Coronary Syndrome , Blood , Therapeutics , Aged , Fasting , Blood , Female , Fibrinogen , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Multivariate Analysis , Percutaneous Coronary Intervention , Proportional Hazards Models , Risk Factors
14.
Chinese Medical Journal ; (24): 1023-1027, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-772142

ABSTRACT

BACKGROUND@#It is important to determine prognostic factors for the outcome of amyotrophic lateral sclerosis (ALS) at an early stage. The time taken for symptoms to spread from spinal or bulbar regions to both (time to generalization; TTG) is considered a strong predictor of survival; however, this has rarely been studied in Asian populations. The aim of this retrospective study was to evaluate potential factors affecting prognosis in Chinese patients with sporadic ALS, with a focus on the association between TTG and overall survival.@*METHODS@#Seventy-one patients with sporadic ALS who were hospitalized at Chinese PLA General Hospital from 2009 to 2016 were followed up until December 2017. Survival analysis was performed using univariate Kaplan-Meier log-rank and multivariate Cox proportional hazards models. The clinical data of the patients were recorded and analyzed. Variables studied were age at symptom onset, sex, site of symptom onset, diagnostic latency, TTG, diagnostic category, ALS Functional Rating Scale-revised score, percent predicted forced vital capacity (FVC%), and disease progression rate (DPR) at diagnosis.@*RESULTS@#The mean age at onset was 54 (SD = 10.2) years, and the median survival time from symptom onset was 41 months (95% confidence interval: 34-47). By univariate analysis, factors independently affecting survival were age at symptom onset (Log rank = 15.652, P < 0.0001), TTG (Log rank = 14.728, P < 0.0001), diagnostic latency (Log rank = 11.997, P = 0.001), and DPR (Log rank = 6.50, P = 0.011). In the Cox multivariate model, TTG had the strongest impact on survival time (hazard ratio = 0.926, P = 0.01).@*CONCLUSIONS@#TTG can be used as an effective indicator of prognosis in patients with sporadic ALS.


Subject(s)
Adult , Amyotrophic Lateral Sclerosis , Pathology , Disease Progression , Female , Humans , Male , Middle Aged , Prognosis , Proportional Hazards Models , Retrospective Studies
15.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-788161

ABSTRACT

PURPOSE: The purpose of this study was to identify the risk factors for falls in tertiary hospital inpatients and to suggest data for developing a nursing intervention program for preventing falls.METHODS: Data were collected between January 1, 2017, to December 31, 2017. Kaplan-Meier estimation was used to measure the survival rate, and the log-rank test was used for the differences between the fall group and the non-fall group. The Cox proportional hazards model was used to identify the risk factors for falls.RESULTS: The incidence rate of falls for the inpatients was 1.2 cases per 1,000 days of hospitalization. The risk factors for falls were more likely to be found among those who were aged ≥81, had not undergone surgery, had poor joint motion, had unsteady gait, needed help or supervision, used assistive devices, had comorbidity, and took at least two drugs.CONCLUSION: For the inpatients, the risk factors for falls included age, surgery, comorbidity, medication that could change mobility, joint motion, and use of patient care equipment. It is necessary to give special attention to inpatients who have any of these risk factors and to develop a falls risk assessment tool.


Subject(s)
Accidental Falls , Comorbidity , Gait Disorders, Neurologic , Hospitalization , Humans , Incidence , Inpatients , Joints , Nursing , Organization and Administration , Patient Care , Proportional Hazards Models , Risk Assessment , Risk Factors , Self-Help Devices , Survival Analysis , Survival Rate , Tertiary Care Centers
16.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-787495

ABSTRACT

BACKGROUND: Grip strength has been found to be closely related to mortality and disease morbidity. In this study, we aimed to evaluate the relationship between grip strength and mortality in middle aged and elderly Koreans.METHODS: Study subjects were selected from the participants of the Korean Longitudinal Study of Ageing from 2006 to 2016. The Cox proportional hazards model was used to analyze the association between grip strength, all-cause mortality, and cause-specific mortality according to age and sex, after adjusting for covariates.RESULTS: The adjusted hazard ratio (HR) for all-cause mortality was decreased in the high grip strength group (male: HR=0.580, 95% confidence interval [CI]=0.478–0.704; female: HR=0.601, 95% CI=0.483–0.747) compared to the low grip strength group in both sexes. In male, cardiovascular mortality (middle group: HR=0.453, 95% CI=0.278–0.738; high group: HR=0.538, 95% CI=0.332–0.871) and cancer mortality (middle group: HR=0.697, 95% CI=0.514–0.945; high group: HR=0.589, 95% CI=0.427–0.812) were significantly lower in the middle and high grip strength groups compared to the low grip strength group. The HR for mortality due to stroke in male decreased significantly according to grip strength, but this became nonsignificant after adjusting for covariates. No association between cause-specific mortality and grip strength was found in female.CONCLUSION: In this study, grip strength was inversely associated with all-cause mortality, with similar effects on cause-specific mortality due to heart disease and cancer in male. Grip strength is a useful predictor of health status, and further studies are needed to evaluate its clinical relevance in Koreans.


Subject(s)
Aged , Female , Hand Strength , Heart Diseases , Humans , Korea , Longitudinal Studies , Male , Middle Aged , Mortality , Proportional Hazards Models , Stroke
17.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-787479

ABSTRACT

BACKGROUND: To investigate the impact of national health screening on all-cause mortality risk, aged over 45.METHODS: Data from Korean Longitudinal Study of Aging 2006–2014 were assessed. A total of 10,254 participants were included at baseline, and survival rate was assessed biennially. Using cox proportional hazards model, the effect of health screening on mortality risk was investigated. Covariates were gender, depression, education, marital status, co-habitants, house income, social engagement, economic satisfaction, private health insurance, residence location, chronic diseases, and health behaviors (smoking, alcohol intake, regular exercise).RESULTS: At baseline 2006, 54.4% of participants didn't undergo health screening. A hazard ratio (HR) for mortality risk of non-participants were 1.36 (95% confidence interval [CI], 1.21–1.53) after adjusting age and gender. Adding marital status and co-habitants to model 1 as covariates, HR was 1.34 (95% CI, 1.18–1.50) (model 2). Adding depression scores and socioeconomic vulnerabilities to model 2, HR was 1.29 s (95% CI, 1.14–1.45) (model 3). Adding chronic diseases to model 3, HR was 1.26 (95% CI, 1.14–1.48) (model 4). Finally, health behaviors have been added to model 4, HR was 1.24 (95% CI, 1.10–1.40) (model 5). In addition, the mortality risk increased as the cumulative number of missing health screenig increased accordingly.CONCLUSION: Health screening was an independent factor to reduce mortality risk. Therefore, active encouragement to participate the health screening should be implemented to reduce all-cause mortality.


Subject(s)
Aging , Chronic Disease , Depression , Education , Health Behavior , Insurance, Health , Korea , Longitudinal Studies , Marital Status , Mass Screening , Mortality , Proportional Hazards Models , Survival Rate
18.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-787468

ABSTRACT

BACKGROUND: Fractures should be actively prevented in the elderly because recovery from the damage of fractures is slow and fractures can cause both physical and psychological pain in the elderly. Previous studies have reported that depression is related to falls or low bone mineral density (BMD). This study aimed to evaluate the risk of fracture according to the depression status among the elderly.METHODS: This study used the National Health Insurance Corporation cohort data to examine 96,188 elderly people aged >65 years who were examined in 2007 and 2008. The chi-square test was used to determine the general characteristics and fracture incidence in patients with depression and healthy controls, and the hazard ratio was calculated using the Cox proportional hazards model corrected for general characteristics. The Kaplan-Meier method predicted the risk of fracture in two groups during the observation period.RESULTS: In the depressed group, 23.2% (441 of 1,904) of the patients had a fracture during the 5-year follow-up period; however, in the control group, only 17.5% (16,470 of 94,284) had a fracture (P < 0.001). In addition, multivariate analysis of the adjusted variables showed that the risk of fracture in the depressed group was 1.34 times higher than that in the control group. The risk of fracture in women was 1.71 times higher than that in men, and the risk of fracture increased with age.CONCLUSION: The risk of fracture in the elderly who were depressed was significantly higher than that in the elderly who were not depressed.


Subject(s)
Accidental Falls , Aged , Bone Density , Cohort Studies , Depression , Depressive Disorder , Female , Follow-Up Studies , Humans , Incidence , Male , Methods , Multivariate Analysis , National Health Programs , Proportional Hazards Models
19.
Intestinal Research ; : 94-106, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-740026

ABSTRACT

BACKGROUND/AIMS: Few reports have described the long-term treatment outcomes of the anti-tumor necrosis factor-α antibody for Japanese Crohn’s disease (CD) patients. The aim of this study was to evaluate them and clarify the clinical factors that affect the long-term prognosis of the anti-tumor necrosis factor-α treatments. METHODS: This was a retrospective, observational, single-center cohort study. Japanese CD patients treated with either infliximab or adalimumab as a first-line therapy were analyzed. The cumulative retention rates of the biologics, relapse-free survival, and surgery-free survival were analyzed using Kaplan-Meier methods. The clinical factors associated with the long-term outcomes were estimated by both the log-rank test and Cox proportional hazard model. RESULTS: The cumulative retention rate was significantly higher in the group with a concomitant elemental diet of ≥900 kcal/day, baseline C-reactive protein (CRP) levels < 2.6 mg/dL, and baseline serum albumin levels ≥3.5 g/dL, respectively. The baseline serum albumin levels were also associated with both relapse-free and surgery-free survival. The lack of concomitant use of an elemental diet ≥900 kcal/day was identified as the only independent risk factor for the withdrawal of the biologics. CONCLUSIONS: Baseline CRP levels and serum albumin levels could affect the long-term outcomes in CD patients. Concomitant elemental diet of ≥900 kcal/day could have a positive influence on clinical treatment course.


Subject(s)
Adalimumab , Antibodies , Asian Continental Ancestry Group , Biological Products , C-Reactive Protein , Cohort Studies , Crohn Disease , Food, Formulated , Humans , Infliximab , Necrosis , Prognosis , Proportional Hazards Models , Retrospective Studies , Risk Factors , Serum Albumin
20.
Article in English | WPRIM (Western Pacific) | ID: wprim-739568

ABSTRACT

PURPOSE: To investigate the prognostic influence of Korean public medical insurance system on breast cancer patients. METHODS: Data of 1,068 patients with primary invasive breast cancer were analyzed. Korean public medical insurance status was classified into 2 groups: National Health Insurance and Medical Aid. Kaplan-Meier estimator and Cox proportional hazards model were used for survival analysis. RESULTS: The Medical Aid group showed worse prognoses compared to the National Health Insurance group both in overall survival (P = 0.001) and recurrence-free survival (P = 0.006). The Medical Aid group showed higher proportion of patients with tumor size > 2 cm (P = 0.022), more advanced stage (P = 0.039), age > 50 years (P = 0.003), and low education level (P = 0.003). The Medical Aid group showed higher proportion of patients who received mastectomy (P < 0.001) and those who received no radiation therapy (P = 0.013). The Medical Aid group showed a higher rate of distant recurrence (P = 0.014) and worse prognosis for the triple negative subtype (P = 0.006). Medical insurance status was a significant independent prognostic factor in both univariate analysis and multivariate analysis. CONCLUSION: The Medical Aid group had worse prognosis compared to the National Health Insurance group. Medical insurance status was a strong independent prognostic factor in breast cancer. Unfavorable clinicopathologic features could explain the worse prognosis for the Medical Aid group. Careful consideration should be given to medical insurance status as one of important prognostic factors for breast cancer patients.


Subject(s)
Breast Neoplasms , Breast , Education , Humans , Insurance Coverage , Insurance , Mastectomy , Multivariate Analysis , National Health Programs , Prognosis , Proportional Hazards Models , Recurrence
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