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1.
Int. j. morphol ; 38(2): 367-373, abr. 2020. tab, graf
Artigo em Inglês | LILACS (Américas) | ID: biblio-1056449

RESUMO

Sexual dimorphism in Homo-sapiens is a phenomenon of a direct product of evolution by natural selection where evolutionary forces acted separately on the sexes which brought about the differences in appearance between male and female such as in shape and size. Advances in morphometrics have skyrocketed the rate of research on sex differences in human and other species. However, the current challenges facing 3D in the acquisition of facial data such as lack of homology, insufficient landmarks to characterize the facial shape and complex computational process for facial point digitization require further study in the domain of sex dimorphism. This study investigates sexual dimorphism in the human face with the application of Automatic Homologous Multi-points Warping (AHMW) for 3D facial landmark by building a template mesh as a reference object which is thereby applied to each of the target mesh on Stirling/ESRC dataset containing 101 subjects (male = 47, female = 54). The semi-landmarks are subjected to sliding along tangents to the curves and surfaces until the bending energy between a template and a target form is minimal. Principal Component Analysis (PCA) is used for feature selection and the features are classified using Linear Discriminant Analysis (LDA) with an accuracy of 99.01 % which demonstrates that the method is robust.


El dimorfismo sexual en el Homo-sapiens es un fenómeno directo de la evolución por selección natural, donde las fuerzas evolutivas actuaron por separado en los sexos, lo que provocó las diferencias en la apariencia entre hombres y mujeres, tal como la forma y tamaño. Los avances en el área de la morfometría, han generado un aumento significativo de las investigaciones en las diferencias de sexo en humanos y otras especies. Sin embargo, los desafíos actuales que enfrenta el 3D en el análisis de datos faciales, como la falta de homología, puntos de referencia insuficientes para caracterizar la forma facial y la complejidad del proceso computacional para la digitalización de puntos faciales, requiere un estudio adicional en el área del dimorfismo sexual. Este estudio investiga el dimorfismo sexual en el rostro humano con la aplicación de la deformación automática de múltiples puntos homólogos para el hito facial 3D, mediante la elaboración de una malla de plantilla como objeto de referencia, y se aplica en cada una de las mallas objetivas en el conjunto de datos Stirling / ESRC que contiene 101 sujetos (hombre = 47, mujer = 54). Los semi-puntos de referencia se deslizan a lo largo de las tangentes a las curvas y superficies hasta que la energía de flexión entre una plantilla y una forma objetivo es mínima. El análisis de componentes principales (PCA) se utiliza para la selección de características y las características se clasifican mediante el análisis discriminante lineal (ADL) con una precisión del 99,01 %, lo que demuestra la validez del método.


Assuntos
Humanos , Masculino , Feminino , Caracteres Sexuais , Tecido Conjuntivo/anatomia & histologia , Face/anatomia & histologia , Análise Discriminante , Análise Multivariada , Tecido Conjuntivo/diagnóstico por imagem , Imageamento Tridimensional , Face/diagnóstico por imagem , Pontos de Referência Anatômicos
2.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 18-23, Jan.-Mar. 2020. tab, graf
Artigo em Inglês | LILACS (Américas) | ID: biblio-1090550

RESUMO

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.


Assuntos
Humanos , Criança , Adolescente , Adulto , Neoplasias da Orelha/cirurgia , Colesteatoma da Orelha Média/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Fatores de Tempo , Modelos de Riscos Proporcionais , Análise de Sobrevida , Registros Médicos , Análise Multivariada , Estudos Retrospectivos , Cirurgia de Second-Look , Dinamarca , Mastoidectomia/métodos
3.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 42(1): 54-62, Jan.-Feb. 2020. tab, graf
Artigo em Inglês | LILACS (Américas) | ID: biblio-1055351

RESUMO

Objective: Although studies have shown an association between poor sleep and chronotype with psychiatric problems in young adults, few have focused on identifying multiple concomitant risk factors. Methods: We assessed depressive symptoms (Beck Depression Inventory [BDI]), circadian typology (Morningness-Eveningness Questionnaire [MEQ]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), perceived stress (Perceived Stress Scale [PSS]), social rhythm (Social Rhythm Metrics [SRM]), and salivary cortisol (morning, evening and night, n=37) in 236 men (all 18 years old). Separate analyses were conducted to understand how each PSQI domain was associated with depressive symptoms. Results: Depressive symptoms were more prevalent in individuals with higher perceived stress (prevalence ratio [PR] = 6.429, p < 0.001), evening types (PR = 2.58, p < 0.001) and poor sleepers (PR = 1.808, p = 0.046). Multivariate modeling showed that these three variables were independently associated with depressive symptoms (all p < 0.05). The PSQI items subjective sleep quality and sleep disturbances were significantly more prevalent in individuals with depressive symptoms (PR = 2.210, p = 0.009 and PR = 2.198, p = 0.008). Lower levels of morning cortisol were significantly associated with higher depressive scores (r = -0.335; p = 0.043). Conclusion: It is important to evaluate multiple factors related to sleep and chronotype in youth depression studies, since this can provide important tools for comprehending and managing mental health problems.


Assuntos
Humanos , Masculino , Adolescente , Transtornos do Sono-Vigília/psicologia , Estresse Psicológico/psicologia , Hidrocortisona/análise , Transtornos Cronobiológicos/psicologia , Depressão/etiologia , Militares/psicologia , Escalas de Graduação Psiquiátrica , Valores de Referência , Saliva/metabolismo , Sono/fisiologia , Fatores de Tempo , Análise Multivariada , Fatores de Risco , Análise de Variância , Estatísticas não Paramétricas , Depressão/metabolismo , Autorrelato
4.
Korean Circulation Journal ; : 133-144, 2020.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-786225

RESUMO

BACKGROUND AND OBJECTIVES: The relationship between operator volume and outcomes of percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) has not been fully investigated. We aimed to investigate the relationship between operator PCI volume and in-hospital outcomes after primary PCI for STEMI.METHODS: Among the total of 44,967 consecutive cases of PCI enrolled in the Korean nationwide, retrospective registry (K-PCI registry), 8,282 patients treated with PCI for STEMI by 373 operators were analyzed. PCI volumes above the 75th percentile (>30 cases/year), between the 75th and 25th percentile (10–30 cases/year), and below the 25th percentile (<10 cases/year) were defined as high, moderate, and low-volume operators, respectively. In-hospital outcomes including mortality, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and urgent repeat PCI were analyzed.RESULTS: The average number of primary PCI cases performed by 373 operators was 22.2 in a year. In-hospital mortality after PCI for STEMI was 571 cases (6.9%). In-hospital outcomes by operator volume showed no significant differences in the death rate, cardiac death, non-fatal MI, and stent thrombosis. However, the rate of urgent repeat PCI tended to be lower in the high-volume operator (0.6%) than in the moderate-(0.7%)/low-(1.5%) volume operator groups (p=0.095). The adjusted odds ratios for adverse in-hospital outcomes were similar in the 3 groups. Multivariate analysis also showed that operator volume was not a predictor for adverse in-hospital outcomes.CONCLUSIONS: In-hospital outcomes after primary PCI for STEMI were not associated with operator volume in the K-PCI registry.


Assuntos
Estudos de Coortes , Morte , Mortalidade Hospitalar , Humanos , Mortalidade , Análise Multivariada , Infarto do Miocárdio , Razão de Chances , Intervenção Coronária Percutânea , Estudos Retrospectivos , Stents , Acidente Vascular Cerebral , Trombose , Resultado do Tratamento
5.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-785435

RESUMO

PURPOSE: The risk of posthepatectomy liver failure (PHLF) after right hepatectomy remains substantial. Additional parameters such as computed tomography volumetry, liver stiffness measurement by FibroScan, indocyanine green retention rate at 15 minutes, and platelet count used to properly assess future liver remnant volume quality and quantity are of the utmost importance. Thus, we compared the usefulness of these modalities for predicting PHLF among patients with hepatocellular carcinoma after right hepatectomy.METHODS: We retrospectively reviewed patients who underwent right hepatectomy for hepatocellular carcinoma between 2007 and 2013. PHLF was determined according to International Study Group of Liver Surgery consensus definition and severity grading. Grades B and C were defined as clinically relevant posthepatectomy liver failure (CRPHLF). The results were internally validated using a cohort of 97 patients.RESULTS: Among the 90 included patients, 15 (16.7%) had CRPHLF. Multivariate analysis confirmed that platelet count < 140 (109/L) (hazard ratio [HR], 24.231; 95% confidence interval [CI], 3.623–161.693; P = 0.001) and remnant liver volume-to-body weight (RVL/BW) ratio < 0.55 (HR, 25.600; 95% CI, 4.185–156.590; P < 0.001) were independent predictors of CRPHLF. Among the 12 patients with a platelet count < 140 (109/L) and RLV/BW ratio < 0.55, 9 (75%) had CRPHLF. Likewise, 5 of 38 (13.2%) with only one risk factor developed CRPHL versus 1 of 40 (2.5%) with no risk factors. These findings were confirmed by the validation cohort.CONCLUSION: RLV/BW ratio and platelet count are more important than the conventional RLV/TFLV, indocyanine green retention rate at 15 minutes, and liver stiffness measurement in the preoperative risk assessment for CRPHLF.


Assuntos
Carcinoma Hepatocelular , Estudos de Coortes , Consenso , Hepatectomia , Humanos , Verde de Indocianina , Falência Hepática , Fígado , Análise Multivariada , Contagem de Plaquetas , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
6.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-785434

RESUMO

PURPOSE: The International Study Group on Pancreatic Fistula's definition of postoperative pancreatic fistula (POPF) has recently been updated. This study aimed to identify risk factors for POPF in patients having pancreaticoduodenectomy (PD) and to generate a nomogram to predict POPF.METHODS: Data on 298 patients who underwent PD from March 2012 to October 2017 was retrospectively reviewed and POPF statuses were redefined. A nomogram was constructed using data from 220 patients and validated using the remaining 78 patients. Independent risk factors for POPF were identified using univariate and multivariate analyses. A predictive nomogram was established based on the independent risk factors and was compared with existing models.RESULTS: Texture of the pancreas, size of the main pancreatic duct, portal vein invasion, and definitive pathology were the identified risk factors. The nomogram had a C-index of 0.793 and was internally validated. The nomogram performed better (C-index of 0.816) than the other most cited models (C-indexes of 0.728 and 0.735) in the validation cohort. In addition, the nomogram can assign patients into low- (less than 10%), intermediate- (10% to 30%), and high-risk (equal or higher than 30%) groups to facilitate personalized management.CONCLUSION: The nomogram accurately predicted POPF in patients having PD.


Assuntos
Estudos de Coortes , Humanos , Análise Multivariada , Nomogramas , Pâncreas , Ductos Pancreáticos , Fístula Pancreática , Pancreaticoduodenectomia , Patologia , Veia Porta , Estudos Retrospectivos , Fatores de Risco
7.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-811200

RESUMO

PURPOSE: Phosphorylated ribosomal S6 kinase 1 (pS6K1) is a major downstream regulator of the mammalian target of rapamycin (mTOR) pathway. Recent studies have addressed the role of S6K1 in adipogenesis. pS6K1 may affect the outcome of estrogen depletion therapy in patients with hormone-sensitive breast cancer due to its association with adipogenesis and increased local estrogen levels. This study aimed to investigate the potential of pS6K1 as a predictive marker of adjuvant aromatase inhibitor (AI) therapy outcome in postmenopausal or ovarian function-suppressed patients with hormone-sensitive breast cancer.METHODS: Medical records were retrospectively reviewed in postmenopausal or ovarian function-suppressed patients with estrogen receptor-positive and node-positive primary breast cancer. pS6K1 expression status was scored on a scale from 0 (negative) to 3+ (positive) based on immunohistochemical analysis.RESULTS: A total of 428 patients were eligible. The median follow-up duration was 44 months (range, 1–90). In patients with positive pS6K1 expression, AIs significantly improved disease-free survival (DFS) compared to selective estrogen receptor modulators (SERMs) (5 year-DFS: 83.5% vs. 50.7%, p = 0.016). However, there was no benefit of AIs on DFS in the pS6K1 negative group (5 year-DFS 87.6% vs. 91.4%, p = 0.630). On multivariate analysis, AI therapy remained a significant predictor for DFS in the pS6K1 positive group (hazard ratio, 0.39; 95% confidence interval, 0.16–0.96; p = 0.041). pS6K1 was more effective in predicting the benefit of AI therapy in patients with ages < 50 (p = 0.021) compared to those with ages ≥ 50 (p = 0.188).CONCLUSION: pS6K1 expression may predict AI therapy outcomes and serve as a potential predictive marker for adjuvant endocrine therapy in postmenopausal and ovarian function-suppressed patients with hormone-sensitive breast cancer. AIs may be more effective in patients with pS6K1 positive tumors, while SERM could be considered an alternative option for patients with pS6K1 negative tumors.


Assuntos
Adipogenia , Inibidores da Aromatase , Aromatase , Biomarcadores Tumorais , Neoplasias da Mama , Mama , Intervalo Livre de Doença , Estrogênios , Seguimentos , Humanos , Registros Médicos , Análise Multivariada , Estudos Retrospectivos , Proteínas Quinases S6 Ribossômicas , Moduladores Seletivos de Receptor Estrogênico , Sirolimo , Tamoxifeno
8.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-811114

RESUMO

BACKGROUND: Spontaneous disease stabilization of desmoid-type fibromatosis (DF) has been demonstrated in many reports, and the watchful waiting approach without any frontline treatment is becoming popular as an initial management strategy. In this study, we aimed to assess the disease stabilization rate and identify predictive factors for disease stabilization of DF in patients with conservative treatment.METHODS: We reviewed 76 patients with sporadic extra-abdominal DF who were managed with frontline conservative treatment in our institute. The minimum follow-up was 12 months. Stabilization was defined as radiological evidence of no change or continuous decrease in size of the tumor for six months or more. The primary endpoint was stabilization of DF. Possible patient-, disease-, and treatment-related factors predictive of disease stabilization were analyzed with multivariate analysis.RESULTS: At final follow-up, 54 of the 76 tumors (71%) were stable, and mean time to stabilization was 30.4 months (range, 7 to 112 months). On Kaplan-Meier survival analysis, the spontaneous stabilization rate was 25.4% at one year, 52.7% at two years, and 70.9% at three years. The mean time to spontaneous stabilization was longer in patients with ≤ 40 years of age (p = 0.022) or recurrence (p = 0.041). On multivariate analysis with the Cox proportional hazard method, recurrence (hazard ratio [HR], 1.79; p = 0.041) and younger age (HR, 2.04; p = 0.022) were identified as independent prognostic factors for longer time to disease stabilization.CONCLUSIONS: Frontline conservative treatment seems to be the optimal treatment for most patients with DF. Younger patients or those with recurrence may require longer time to spontaneous disease stabilization.


Assuntos
Fibroma , Fibromatose Agressiva , Seguimentos , Humanos , Métodos , Análise Multivariada , Recidiva , Conduta Expectante
9.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-811110

RESUMO

PURPOSE: Hepatic resection is considered as the optimal treatment for intrahepatic cholangiocarcinoma (IHCC); however, the survival rate after resection is low and the analysis of long-term (≥10 years) survivors is rare. This study aims to analyze the clinicopathological factors affecting the long-term survival of patients with IHCC.METHODS: Between January 2003 and December 2012, a single-institution cohort of 429 patients who underwent hepatic resection for IHCC were reviewed retrospectively. Surgical results, recurrence, and survival rates were investigated, and multivariate analyses were performed to identify prognostic factors.RESULTS: The overall 1- , 3- , 5- and 10-year survival rates of patients were 76.5%, 44.1%, 33.3%, and 25.1%, respectively. Multivariate analysis showed that the serum CA 19-9 level (≥38 U/mL) (P < 0.001), lymph node (LN) metastasis (P = 0.001), and lymphovascular invasion (LVI) (P = 0.012) were independent factors associated with overall survival. In particular, CA 19-9 level and histologic type were determined to be independent factors affecting survival for more than 10 years.CONCLUSION: CA 19-9 (≥38 U/mL), LN metastasis, and LVI were identified as independent risk factors for survival after resection of IHCC. CA 19-9 (<38 U/mL) and histologic type were independent factors predicting survival for more than 10 years.


Assuntos
Ductos Biliares , Colangiocarcinoma , Estudos de Coortes , Humanos , Linfonodos , Análise Multivariada , Metástase Neoplásica , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida , Sobreviventes
10.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-811109

RESUMO

PURPOSE: Appendiceal tumoral lesions can occur as benign, malignant, or borderline disease. Determination of the extent of surgery through accurate diagnosis is important in these tumoral lesions. In this study, we assessed the accuracy of preoperative CT and identified the factors affecting diagnosis.METHODS: Patients diagnosed or strongly suspected from July 2016 to June 2019 with appendiceal mucocele or mucinous neoplasm using abdominal CT were included in the study. All the patients underwent single-incision laparoscopic cecectomy with the margin of cecum secured at least 2 cm from the appendiceal base. To compare blood test results and CT findings, the patients were divided into a mucinous and a nonmucinous group according to pathology.RESULTS: The total number of patients included in this study was 54 and biopsy confirmed appendiceal mucinous neoplasms in 39 of them. With CT, the accuracy of diagnosis was 89.7%. The mean age of the mucinous group was greater than that of the nonmucinous group (P = 0.035). CT showed that the maximum diameter of appendiceal tumor in the mucinous group was greater than that in the nonmucinous group (P < 0.001). Calcification was found only in the appendix of patients in the mucinous group (P = 0.012). Multivariate analysis revealed that lager tumor diameter was a factor of diagnosis for appendiceal mucinous neoplasm.CONCLUSION: The accuracy of preoperative diagnosis of appendiceal mucinous neoplasms in this study was 89.7%. Blood test results did not provide differential diagnosis, and the larger the diameter of appendiceal tumor on CT, the more accurate the diagnosis.


Assuntos
Apêndice , Biópsia , Ceco , Diagnóstico , Diagnóstico Diferencial , Testes Hematológicos , Humanos , Mucinas , Mucocele , Análise Multivariada , Patologia , Estudos Prospectivos , Tomografia Computadorizada por Raios X
11.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-811107

RESUMO

PURPOSE: Radical lymph node dissection for right-sided colon cancer is technically challenging. No clear guideline is available for surgical resection of clinical stage I right-sided colon cancer. This study was designed to review the pathologic stage of clinical stage I right-sided colon cancer and determine the relevant extent of surgical resection.METHODS: Patients were treated for clinical stage I right-sided colon cancers (cecal, ascending, hepatic flexure, and proximal transverse colon) between July 2006 and December 2014 at a tertiary teaching hospital. Open surgery was not included because laparoscopic surgery is an initial major procedure in the institution.RESULTS: During the study period, 80 patients diagnosed with clinical stage I right-sided colon cancer were classified into 2 groups according to the pathology: stage 0/I and II/III. Tumor sizes were larger in the stage II/III group (P = 0.003). The stage II/III group had higher rates of vascular (P = 0.023) and lymphatic invasion (P = 0.023) and lower rates of well differentiation (P = 0.022). During follow-up, 1 case of local and 4 cases of systemic recurrences were found. Multivariate analysis to confirm odds ratios affecting change from clinical stage I to pathological stage II/III showed that tumor size (P = 0.010) and the number of retrieved lymph nodes (P = 0.046) were risk factors.CONCLUSION: For right-sided colon cancer, even with clinical stage I included, radical lymph node dissection should be performed for exact staging with sufficient number of lymph nodes. This will help determine appropriate adjuvant treatment, especially in large tumor sizes.


Assuntos
Colo , Colo Ascendente , Colo Transverso , Neoplasias do Colo , Seguimentos , Hospitais de Ensino , Humanos , Laparoscopia , Excisão de Linfonodo , Linfonodos , Análise Multivariada , Razão de Chances , Patologia , Recidiva , Estudos Retrospectivos , Fatores de Risco
12.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-811064

RESUMO

PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.


Assuntos
Corticosteroides , Asma , China , Comorbidade , Progressão da Doença , Educação , Feminino , Hipersensibilidade Alimentar , Hospitalização , Humanos , Hipertensão , Pacientes Internados , Adesão à Medicação , Mortalidade , Análise Multivariada , Doença Pulmonar Obstrutiva Crônica , Estudos Retrospectivos , Fatores de Risco , Estações do Ano , Autocuidado , Fumaça , Fumar
13.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-811063

RESUMO

PURPOSE: Anaphylaxis is an immediate allergic reaction characterized by potentially life-threatening, severe, systemic manifestations. While studies have evaluated links between serious illness and posttraumatic stress disorder (PTSD), few have investigated PTSD after anaphylaxis in adults. We sought to investigate the psychosocial burden of recent anaphylaxis in Korean adults.METHODS: A total of 203 (mean age of 44 years, 120 females) patients with anaphylaxis were recruited from 15 university hospitals in Korea. Questionnaires, including the Impact of Event Scale-Revised-Korean version (IES-R-K), the Korean version of the Beck Anxiety Inventory (K-BAI), and the Korean version of the Beck Depression Inventory (K-BDI), were administered. Demographic characteristics, causes and clinical features of anaphylaxis, and serum inflammatory markers, including tryptase, platelet-activating factor, interleukin-6, tumor necrosis factor-α, and C-reactive protein, were evaluated.RESULTS: PTSD (IES-R-K ≥ 25) was noted in 84 (41.4%) patients with anaphylaxis. Of them, 56.0% had severe PTSD (IES-R-K ≥ 40). Additionally, 23.2% and 28.1% of the patients had anxiety (K-BAI ≥ 22) and depression (K-BDI ≥ 17), respectively. IES-R-K was significantly correlated with both K-BAI (r = 0.609, P < 0.0001) and K-BDI (r = 0.550, P < 0.0001). Among the inflammatory mediators, tryptase levels were lower in patients exhibiting PTSD; meanwhile, platelet-activating factor levels were lower in patients exhibiting anxiety and depression while recovering from anaphylaxis. In multivariate analysis, K-BAI and K-BDI were identified as major predictive variables of PTSD in patients with anaphylaxis.CONCLUSIONS: In patients with anaphylaxis, we found a remarkably high prevalence of PTSD and associated psychological distresses, including anxiety and depression. Physicians ought to be aware of the potential for psychological distress in anaphylactic patients and to consider psychological evaluation.


Assuntos
Adulto , Anafilaxia , Ansiedade , Proteína C-Reativa , Depressão , Hospitais Universitários , Humanos , Hipersensibilidade , Interleucina-6 , Coreia (Geográfico) , Análise Multivariada , Necrose , Prevalência , Estudos Prospectivos , Transtornos de Estresse Pós-Traumáticos , Triptases
14.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-810982

RESUMO

OBJECTIVE: To retrospectively evaluate the safety and efficacy of percutaneous radiofrequency ablation (RFA) in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma who had previously received curative surgery.MATERIALS AND METHODS: Between 2002 and 2017, percutaneous RFA was performed on 94 metachronous hepatic metastases (median diameter, 1.5 cm) arising from pancreatic cancer in 60 patients (mean age, 60.5 years). Patients were included if they had fewer than five metastases, a maximum tumor diameter of ≤ 5 cm, and disease confined to the liver or stable extrahepatic disease. For comparisons during the same period, we included 66 patients who received chemotherapy only and met the same eligibility criteria described.RESULTS: Technical success was achieved in all hepatic metastasis without any procedure-related mortality. During follow-up, local tumor progression of treated lesions was observed in 38.3% of the tumors. Overall median survival and 3-year survival rates were 12 months and 0%, respectively from initial RFA, and 14.7 months and 2.1%, respectively from the first diagnosis of liver metastasis. Multivariate analysis showed that a large tumor diameter of > 1.5 cm, a late TNM stage (≥ IIB) before curative surgery, a time from surgery to recurrence of < 1 year, and the presence of extrahepatic metastasis, were all prognostic of reduced overall survival after RFA. Median overall (12 months vs. 9.1 months, p = 0.094) and progression-free survival (5 months vs. 3.3 months, p = 0.068) were higher in the RFA group than in the chemotherapy group with borderline statistical difference.CONCLUSION: RFA is safe and may offer successful local tumor control in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma. Patients with a small diameter tumor, early TNM stage before curative surgery, late hepatic recurrence, and liver-only metastasis benefit most from RFA treatment. RFA provided better survival outcomes than chemotherapy for this specific group with borderline statistical difference.


Assuntos
Adenocarcinoma , Ablação por Cateter , Diagnóstico , Intervalo Livre de Doença , Tratamento Farmacológico , Seguimentos , Humanos , Fígado , Mortalidade , Análise Multivariada , Metástase Neoplásica , Neoplasias Pancreáticas , Recidiva , Estudos Retrospectivos , Taxa de Sobrevida
15.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-810980

RESUMO

OBJECTIVE: We aimed to investigate the ability of readout-segmented echo-planar imaging (rs-EPI)-based diffusion tensor imaging (DTI) in assessing the microstructural change of extraocular muscles (EOMs) and optic nerves in patients with thyroid-associated orbitopathy (TAO) as well as in evaluating disease activity.MATERIALS AND METHODS: We enrolled 35 TAO patients and 22 healthy controls (HCs) who underwent pre-treatment rs-EPI-based DTI. Mean, axial, and radial diffusivity (MD, AD, and RD) and fractional anisotropy (FA) of the medial and lateral EOMs and optic nerve for each orbit were calculated and compared between TAO and HC groups and between active and inactive TAO groups. Factors such as age, sex, disease duration, mediation, and smoking history between groups were also compared. Logistic regression analysis was used to evaluate the predictive value of significant variables for disease activity.RESULTS: Disease duration was significantly shorter in active TAOs than in inactive ones (p < 0.001). TAO patients showed significantly lower FA and higher MD, AD, and RD than HCs for both medial and lateral EOMs (p < 0.001), but not the AD value of lateral EOMs (p = 0.619). Active patients had significantly higher FA, MD, and AD than inactive patients for medial EOMs (p < 0.005), whereas only FA differed significantly in the lateral EOMs (p = 0.018). The MD, AD, and RD of optic nerves were significantly lower in TAO patients than HCs (p < 0.05), except for FA (p = 0.129). Multivariate analysis showed that the MD of medial EOMs and disease duration were significant predictors for disease activity. The combination of these two parameters showed optimal diagnostic efficiency for disease activity (area under the curve, 0.855; sensitivity, 68.4%; specificity, 96.9%).CONCLUSION: rs-EPI-based DTI is promising in assessing microstructural changes of EOMs and optic nerves and can help to indicate the disease activity of TAO, especially through the MD of medial EOMs.


Assuntos
Anisotropia , Imagem de Tensor de Difusão , Difusão , Imagem Ecoplanar , Humanos , Modelos Logísticos , Análise Multivariada , Músculos , Negociação , Nervo Óptico , Órbita , Sensibilidade e Especificidade , Fumaça , Fumar , Troleandomicina
16.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-810968

RESUMO

BACKGROUND: This study described and analysed the features of powered mobility device (PMD)-related injuries and compared elderly and younger adult injuries.METHODS: Data from Korea Emergency Department-based Injury In-depth Surveillance (EDIIS) database involving eight emergency departments in 2011–2016 were analysed. The inclusion criteria were injuries sustained during the use of PMDs. The variables were compared between adults aged ≥ 65 years and younger adults. Primary and secondary outcomes were severe trauma and poor clinical course accordingly. The logistic regression analysis was used to identify risk factors for study outcomes.RESULTS: A total of 231 adults were enrolled, of whom 150 were ≥ 65 years of age. The total number of PMD-related injuries and the proportion of elderly injured patients increased annually, and most injuries occurred on the roadway and did not involve crash opponents. By multivariate analysis, patients aged ≥ 65 years had a higher injury severity score (adjusted odds ratio [AOR], 2.78; 95% confidence interval [CI], 1.50–5.40) and had a higher incidence of intensive care unit admissions, surgery, and death (AOR, 2.42; 95% CI, 1.16–5.28).CONCLUSION: Given the higher number and severity of injuries sustained among elderly adults ≥ 65 years of age shown in this study, we recommend that safety educations, such as the use of protective equipment and the safe driving on the roadway, are considered for PMD users ≥ 65 years of age.


Assuntos
Adulto , Idoso , Emergências , Serviço Hospitalar de Emergência , Epidemiologia , Humanos , Incidência , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva , Coreia (Geográfico) , Modelos Logísticos , Análise Multivariada , Razão de Chances , Fatores de Risco , Cadeiras de Rodas
17.
Blood Research ; : 17-26, 2020.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-820807

RESUMO

BACKGROUND: DNMT3A mutations occur in approximately 20% of AML cases and are associated with changes in DNA methylation. CDKN2B plays an important role in the regulation of hematopoietic progenitor cells and DNMT3A mutation is associated with CDKN2B promoter methylation. We analyzed the characteristics of DNMT3A mutations including their clinical significance in AML and their influence on promoter methylation and CDKN2B expression.METHODS: A total of 142 adults, recently diagnosed with de novo AML, were enrolled in the study. Mutations in DNMT3A, CEBPA, and NPM1 were analyzed by bidirectional Sanger sequencing. We evaluated CDKN2B promoter methylation and expression using pyrosequencing and RT-qPCR.RESULTS: We identified DNMT3A mutations in 19.7% (N=28) of enrolled patients with AML, which increased to 29.5% when analysis was restricted to cytogenetically normal-AML. Mutations were located on exons from 8–23, and the majority, including R882, were found to be present on exon 23. We also identified a novel frameshift mutation, c.1590delC, in AML with biallelic mutation of CEBPA. There was no significant difference in CDKN2B promoter methylation according to the presence or type of DNMT3A mutations. CDKN2B expression inversely correlated with CDKN2B promoter methylation and was significantly higher in AML with R882H mutation in DNMT3A. We demonstrated that DNMT3A mutation was associated with poor AML outcomes, especially in cytogenetically normal-AML. The DNMT3A mutation remained as the independent unfavorable prognostic factor after multivariate analysis.CONCLUSION: We characterized DNMT3A mutations in AML and revealed the association between the DNMT3A mutation and CDKN2B expression and clinical outcome.


Assuntos
Adulto , Metilação de DNA , Éxons , Mutação da Fase de Leitura , Células-Tronco Hematopoéticas , Humanos , Leucemia Mieloide Aguda , Metilação , Análise Multivariada
18.
Blood Research ; : 49-56, 2020.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-820803

RESUMO

BACKGROUND: Human immunodeficiency virus (HIV)-negative plasmablastic lymphoma (PBL) is a rare entity of diffuse large B-cell lymphoma (DLBCL). The clinicopathological features of and optimal treatment for HIV-negative PBL remain largely unknown.METHODS: To gain insight into this distinct lymphoma, we summarized the clinicopathologic characteristics of 8 unpublished HIV-negative PBLs and performed a comprehensive review of 394 published cases.RESULTS: Of the 8 unpublished PBLs, the median patient age was 53.0 years. Four patients presented with stage IV disease. All 8 patients showed a plasma cell-like immunophenotype. Of the six patients who received anthracycline-based chemotherapy, including two who received bortezomib, three patients achieved a continuous complete response, two patients died due to disease progression, and one patient was lost to follow-up. The other two patients achieved continuous complete response after receiving chemotherapy combined with radiotherapy and surgery. Of the 402 patients, the majority were male, with a mean age of 58.0 years. EBV infection was detected in 55.7% of the patients. The median survival times of the patients who received CHOP or CHOP-like regimens and intensive regimens were not reached and 23.0 months, respectively, and the intensive regimen did not improve the survival outcome (P=0.981). Multivariate analysis showed that EBER remained the only independent factor affecting overall survival (OS).CONCLUSION: HIV-negative PBL is a distinct entity with a predilection for elderly and immunosuppressed individuals. Intensive chemotherapy had no apparent survival benefits over the CHOP regimen in terms of OS; the prognosis of this disease is poor with current chemotherapy methods, and treatment remains a challenge.


Assuntos
Idoso , Bortezomib , Progressão da Doença , Tratamento Farmacológico , Infecções por Vírus Epstein-Barr , HIV , Humanos , Perda de Seguimento , Linfoma , Linfoma de Células B , Masculino , Análise Multivariada , Plasma , Linfoma Plasmablástico , Prognóstico , Radioterapia
19.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-816623

RESUMO

BACKGROUND: Studies on the relationship between thyroid function and anemia in the euthyroid range are scarce. We aimed to evaluate the association between anemia and serum free thyroxine (fT4) and thyrotropin (TSH) in euthyroid adults.METHODS: Data on 5,352 participants aged ≥19 years were obtained from the Korea National Health and Nutrition Examination Survey VI (2013 to 2015). Anemia was defined as hemoglobin (Hb) <13 and <12 g/dL for men and women, respectively.RESULTS: Overall, 6.1% of participants had anemia, and more women (9.9%) had anemia than men (2.8%, P<0.001). In multivariate analysis, serum fT4 levels, but not TSH, were positively associated with serum Hb levels in both sexes (P<0.001, each). Serum Hb levels linearly reduced across decreasing serum fT4 quartile groups in both sexes (P<0.001, each). After adjusting for potential confounding factors, participants with low-normal fT4 had 4.4 (P=0.003) and 2.8 times (P<0.001) higher risk for anemia than those with high-normal fT4 among men and women, respectively. When participants were divided into two groups at 50 years of age, in younger participants, men and women with the first quartile were at higher risk of anemia than men with the second quartile (odds ratio [OR], 3.3; P=0.029) and women with the forth quartile (OR, 3.2; P<0.001), respectively. This association was not observed in older participants.CONCLUSION: These results suggest that a low-normal level of serum fT4 was associated with a lower serum Hb level and a higher risk of anemia in euthyroid adults, especially in younger participants.


Assuntos
Adulto , Anemia , Feminino , Humanos , Coreia (Geográfico) , Masculino , Análise Multivariada , Inquéritos Nutricionais , Testes de Função Tireóidea , Glândula Tireoide , Tireotropina , Tiroxina
20.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-782488

RESUMO

BACKGROUND: The chronic obstructive pulmonary disease (COPD) assessment test (CAT) is a validated, eight-item questionnaire used to quantify the health status of patients. The aim of this study was to evaluate the usefulness of the CAT questionnaire as a tool to assess the response to treatment in acute exacerbations of COPD in an outpatient setting.METHODS: A multicenter, phase 3 randomized controlled trial was conducted previously to examine the efficacy and safety of oral zabofloxacin for the treatment of COPD exacerbations. In the present post hoc analysis of the original study, patients with COPD exacerbation were categorized as responders or non-responders according to the respiratory symptoms persisting on day 10 (visit 3) of treatment. The CAT questionnaire was completed daily by patients at home from the initial visit to the second visit on day 5. Subsequently, the questionnaire was completed in the presence of a physician on days 10 (visit 3) and 36 (visit 4). Multivariate regression analysis was performed to determine the association between CAT scores and the therapeutic response.RESULTS: The CAT scores decreased more rapidly in responders compared to non-responders during the first 5 days (23.3–20.4 vs. 23.5–22). Among responders, patients with higher severity of illness also revealed higher CAT scores on the first day of an exacerbation (mild, 19.8; moderate, 21.4; severe, 23.8; very severe, 28.6). Multivariate analysis revealed that a change in the CAT score during the first 3 days influenced the therapeutic response. A significant decrease in scores in the domains of sputum production, chest tightness, and activities of daily living was seen among responders.CONCLUSION: Early improvement in CAT scores may be associated with a more favorable response to the treatment of COPD exacerbations.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01658020TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0000532


Assuntos
Atividades Cotidianas , Animais , Gatos , Humanos , Serviços de Informação , Análise Multivariada , Pacientes Ambulatoriais , Doença Pulmonar Obstrutiva Crônica , Escarro , Tórax
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