简介:DuringGHtherapyfor2.3-9.6years,maleadult-onsetGH-deficientpatientswithadiagnosisofanonfunctioningadenomahavenoincreasedall-causemortality.However,womenwithadult-onsetGHdeficiency(GHD)arestillatslightlyhigherrisk.Thisgeneralimprovementinmortalityisduetoamorecontemporaryregimenofcardiovasculardrugs,arefinementofsurgicalprocedures,besidestheintroductionofGHtherapyimprovedhormonereplacementregimenswithloweredglucocorticoidreplacement,updatedapproachesofsexsteroidsforwomen,andlessuseofcranialradiotherapy.Theunderlyingdiseaseisthemostimportantpredictorformortality:eg,acraniopharyngioma,malignantcausesofhypopituitarism,previousCushing'sdisease,andthepresenceofdiabetesinsipidus/
简介:OBJECT:Optimummanagementforelderlypatientswithnewlydiagnosedglioblastoma(GBM)inthetemozolomide(TMZ)eraisnotwelldefined.Theobjectofthisstudywastoclarifyoutcomesinthispopulation.METHODS:Theauthorsretrospectivelyreviewed105consecutivecasesinvolvingelderlypatients(age≥65years)withnewlydiagnosedGBMwhoweretreatedattheMayoClinicbetween2003and2008.RESULTS:Thepatients'medianagewas74years(range66-87years),andthemedianKarnofskyPerformanceStatus(KPS)scorewas80(range40-90).Halfofthepatientsunderwentbiopsyandhalfunderwentresection.Patientswithdeep-seatedlesions(19patients[18%])ormultifocallesions(34patients[32%])weremorelikelytohavebiopsythanresection(p=0.0001and0.0009,respectively).Newpersistentneurologicaldeficitsdevelopedin7patients(6.7%).Postoperativehemorrhageoccurredin6patients(5.7%),allofwhomunderwentbiopsy.Completefollow-updataregardingadjuvanttreatmentwasavailablein84patients.Forty-one(49%)weretreatedwithchemotherapy(mostlyTMZ)andradiationtherapy(RT),and23(27%)withRTalone.Nineteen(23%)receivedonlypalliativecareaftersurgery(morecommonwithbiopsy,p=0.03).Chemotherapycomplicationsoccurredin28.6%(Grade3or4hematologicalcomplicationsin11.9%).Themedianvaluesforprogression-freesurvival(PFS)andoverallsurvival(OS)were3.5and5.5months.Inamultivariateanalysis,youngerage(p=0.03,riskratio[RR]0.34,95%CI0.13-0.89),singlelesion(p=0.02,RR0.51,95%CI0.30-0.89),resection(p=0.04,RR0.54,95%CI0.31-0.94),andadjuvanttreatment(p=0.0001,RR0.24,95%CI0.11-0.49)wereassociatedwithbetterOS.OnlyadjuvanttreatmentwassignificantlyassociatedwithprolongedPFS(p=0.0007,RR0.27,95%CI0.13-0.57).Withcombinedtherapywithresection,RT,andchemotherapy,themedianPFSandOSwere8and12.5months,respectively.CONCLUSIONS:TheprognosisforGBMworsenswithincreasingageinelderlypatients.Withimportantrisks,resectionandadjuvanttreatmen
简介:Asubstantialproportionofpatientswithirritablebowelsyndrome(IBS)associatetheirsymptomswiththeingestionofspecificfoods.Therefore,inrecentyears,scientificresearchhasincreasinglyfocusedontheroleofdietinIBSanddietarymanagementisnowconsideredanimportanttoolinIBStreatment.ThisarticlereviewsthemaindietaryapproachesinIBSemphasizingevidencefromexperimentalandobservationalstudiesandsummarizingthemaindietandlifestylerecommendationsprovidedbydietaryguidelinesandscientificliterature.Despitethelimitedevidenceforabeneficialrole,generaladviceonhealthyeatingandlifestyleisrecommendedasthefirst-lineapproachinthedietarymanagementofIBS.Standardrecommendationsincludeadheringtoaregularmealpattern,reducingintakeofinsolublefibers,alcohol,caffeine,spicyfoods,andfat,aswellasperformingregularphysicalactivityandensuringagoodhydration.Second-linedietaryapproachshouldbeconsideredwhereIBSsymptomspersistandrecommendationsincludefollowingalowFODMAPdiet,tobedeliveredonlybyahealthcareprofessionalwithexpertiseindietarymanagement.Theefficacyofthisdietissupportedbyagrowingbodyofevidence.Incontrast,theroleoflactoseorglutendietaryrestrictioninthetreatmentofIBSremainssubjecttoongoingresearchwithalackofhigh-qualityevidence.Likewise,furtherclinicaltrialsareneededtoconcludetheefficacyofprobioticsonIBSsymptoms.
简介:PURPOSE:Todeterminethesafetyandefficacyofgefitinib,anepidermalgrowthfactorreceptor(EGFR)tyrosinekinaseinhibitor,incombinationwithradiationfornewlydiagnosedglioblastoma(GBM)patients.METHODSANDMATERIALS:BetweenMarch21,2002,andMay3,2004,RadiationTherapyOncologyGroup(RTOG)0211enrolled31and147GBMpatientsinthephase1and2arms,respectively.Treatmentconsistedofdailyoralgefinitnibstartedatthetimeofconventionalcranialradiationtherapy(RT)andcontinuedpostRTfor18monthsoruntilprogression.Tissuemicroarraysfrom68caseswereanalyzedforEGFRexpression.RESULTS:Themaximumtolerateddose(MTD)ofgefitinibwasdeterminedtobe500mginpatientsonnon-enzyme-inducinganticonvulsantdrugs(non-EIAEDs).Allpatientsinthephase2componentweretreatedatagefitinibdoseof500mg;patientsreceivingEIADSscouldbeescalatedto750mg.Themostcommonsideeffectsofgefitinibincombinationwithradiationweredermatologicandgastrointestinal.Mediansurvivalwas11.5monthsforpatientstreatedperprotocol.Therewasnooverallsurvivalbenefitforpatientstreatedwithgefitinib+RTwhencomparedwithahistoricalcohortofpatientstreatedwithRTalone,matchedbyRTOGrecursivepartitioninganalysis(RPA)classdistribution.Youngeragewassignificantlyassociatedwithbetteroutcome.Perprotocolstratification,EGFRexpressionwasnotfoundtobeofprognosticvalueforgefitinib+RT-treatedpatients.CONCLUSIONS:TheadditionofgefitinibtoRTiswelltolerated.MediansurvivalofRTOG0211patientstreatedwithRTwithconcurrentandadjuvantgefitinibwassimilartothatinahistoricalcontrolcohorttreatedwithradiationalone.
简介:AbstractTraditional radiotherapy and chemotherapy often cause irreversible damage to the fertility and endocrine function of cancer patients. The current methods of fertility preservation include freezing the sperms of adult and adolescent males after puberty; freezing the embryos, oocytes, and ovarian tissue of females; and drug intervention and fertility preservation surgery. This article reviews fertility preservation in cancer patients with respect to current methods, indications, and some more recently developed methods that remain under investigation.
简介:AbstractFractures of the acetabulum in elderly patients were often caused by low energy trauma. Fractures involving anterior column are more common and often associated with impaction and comminution. Osteoporosis further complicates the management. Percutaneous fracture fixation has low morbidity but it is a technically demanding procedure. Open reduction and fracture fixation is done with or without simultaneous total hip replacement. Delayed total hip replacement is considered in posttraumatic arthritis patients. Patients with minimal displaced fractures, associated both-column fractures with secondary congruence of joint and patients who are medically unfit for surgery can be managed non-operatively. Whatever be the method of management, these elderly patients should be mobilised as early as possible.
简介:与多重损伤在病人为错误诊断探索特征,治疗结果和原因的目的,以便减少错误诊断的发生。从1997年8月被同意进入我们的部门到2008年8月的有多重损伤的3163个病人全部的方法A,回顾地被学习比较诊断和治疗的特征。有2117男性(66.93%),有平均数的1046女性(33.07%)36.46年变老(范围,14-80年)。象一般地位,创伤的条件,诊断和治疗状况,预后和死亡那样的参数被分析。错误诊断组和正确诊断组之间的差别以阐明的损害,复杂并发症和治疗结果的严厉被比较错误诊断的原因和预防。结果在这研究的多重损伤的错误诊断率是16.19%。误诊的主要解剖地点是手足和骨盆(299个位置,39.50%),腹的区域和骨盆的机关(148个位置,19.55%),并且胸的区域(109个位置,14.40%)。在错误诊断组,ISS,一些医院停留,知觉的骚乱的率,批评盒子和吃惊,盒子是33.78吗?
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简介:Epithelialovariancancerisprimarilyadiseaseofolderwomen.Advancedageisriskfactorfordecreasedsurvival.Optimalsurgeryandthesafeandeffectiveadministrationofchemotherapyareessentialforprolongedprogression-freeandoverallsurvival(OS).Inthisarticle,theavailableregimensinboththeprimarytreatmentandrelapsedsettingarereviewed.
简介:BackgroundThisarticlesummarizedtheexperienceofatrioventricularvalvereplacementoperationforfunctionalsingleventriclepatientswhoseatrioventricularvalvewasinsufficiency.Thefollow-uptimeofoperationwasarrangedfromearly-tomedium-term.MethodsFromJuly2009toJuly2015,therewere40patientsoffunctionalsingleventriclereceivingtheoperationofatrioventricularvalvereplacement,including23maleand17femalepatients.TheageatA-Vvalvereplacementwasrangedfrom6daysto32years(themediumageof9years),andthebodyweightrangedfrom2.7to57kg(themediumbodyweightof21.5kg).Moreover,theatrioventricularvalvereplacementwasperformedonallpatientsunderextracorporealcirculation.ResultsAtrioventricularvalvereplacementwasperformedon40patientswithfunctionsingleventricleinhospital,ofwhicheight(20.0%)diedinhospitalincludingtwoneonateandinfant(agerange:6days-2yearsold)accountingfor25%(2/8),Amongthem,sevenpatientsdiedoflowcardiacoutputsyndrometwopatientswithrepeatedhypoxemiaconcurrentinfectionafteroperation,andonewithbilateraldiaphragmaticparalysisandmalignantarrhythmia.Forthepatientssufferingthesevereperivalvularleakage,therewasareoperation,andthecardiacfunctionbeforethefirstoperationwasclassⅣ.OnepatientreceivedhearttransplantationfinallyforsevereheartfailureafterAVvalvereplacement.Fortherestofpatients,theircardiacfunctionrecoveredtoclassⅠ-Ⅱafteroperation.ConclusionsForfunctionsingleventriclepatientswithatrioventricularvalveregurgitation,themortalityrateofatrioventricularvalvereplacementcanbeacceptediftheoperationwasindicated.Forpatientswithsevereatrioventricularvalueregurgitation,theresultoftheoperationintheearlyandmediumtermwassatisfying.Thus,theatrioventricularvalvereplacementservedasausefultreatmentforpatientsdiagnosedofA-Vvalveregurgitationandfunctionalsingleventricle.
简介:Treated50casesofrenalcolicwithelectroacupunctureandcomparedtheresultswiththoseintwocontrolgroups.Totaleffectiverateinthetreatmentgroup,controlgroupⅠandcontrolgroupⅡwas98.0%,90.0%and92.0%respectively.
简介:AbstractObjective:To measure the prevalence of depression in patients with psoriasis and to evaluate the relationship between the severity of psoriasis and depression and its effect on patients’ quality of life.Methods:A total of 154 patients with a confirmed diagnosis of psoriasis were assessed to determine the severity of psoriasis based on the psoriasis area and severity index score, presence, and severity of depression using the patient health questionnaire 9, and quality of life using the dermatology life quality index 10. Pearson correlation coefficient was used to demonstrate the relationship between continuous variables with 95% confidence intervals (CIs); P < 0.00001 was taken to indicate statistical significance.Results:The severity of psoriasis was mild in 36.36% of patients, moderate in 25.97%, severe in 32.47%, and very severe in 5.20%. Of the 154 patients, 139 (90.3%) had depression; the severity of depression was mild in most affected patients (46.7%) and severe in 2.6% of patients. Psoriasis had a moderate effect on the quality of life in 37.01% of patients and a very large effect in 33.77% of patients. The severity of psoriasis was positively correlated with depression (Pearson correlation coefficient, r= 0.42, P < 0.00001, 95% CI: 0.28-0.54) and quality of life (r= 0.43, P < 0.00001, 95% CI: 0.29-0.55).Conclusion:Depression is a common comorbidity in patients with psoriasis. The severity of psoriasis is positively correlated with the severity of depression and is associated with poor quality of life.
简介:AbstractBackground:Anorexia nervosa (AN) is a psychological disorder, which is characterized by the misunderstanding of body image, food restriction, and low body weight. An increasing number of studies have reported that the pathophysiological mechanism of AN might be associated with the dysbiosis of gut microbiota. The purpose of our study was to explore the features of gut microbiota in patients with AN, hoping to provide valuable information on its pathogenesis and treatment.Methods:In this cross-sectional study, from August 2020 to June 2021, patients with AN who were admitted into Peking University Third Hospital and Peking University Sixth Hospital (n = 30) were recruited as the AN group, and healthy controls (HC) were recruited from a middle school and a university in Beijing (n = 30). Demographic data, Hamilton Depression Scale (HAMD) scores of the two groups, and length of stay of the AN group were recorded. Microbial diversity analysis of gut microbiota in stool samples from the two groups was analyzed by 16S ribosomal RNA (rRNA) gene sequencing.Results:The weight (AN vs. HC, [39.31 ± 7.90] kg vs. [56.47 ± 8.88] kg, P < 0.001) and body mass index (BMI, AN vs. HC, [14.92 ± 2.54] kg/m2vs. [20.89 ± 2.14] kg/m2, P < 0.001) of patients with AN were statistically significantly lower than those of HC, and HAMD scores in AN group were statistically significantly higher than those of HC. For alpha diversity, there were no statistically significant differences between the two groups; for beta diversity, the two groups differed obviously regarding community composition. Compared to HC, the proportion of Lachnospiraceae in patients with AN was statistically significantly higher (AN vs. HC, 40.50% vs. 31.21%, Z = –1.981, P = 0.048), while that of Ruminococcaceae was lower (AN vs. HC, 12.17% vs. 19.15%, Z = –2.728, P = 0.007); the proportion of Faecalibacterium (AN vs. HC, 3.97% vs. 9.40%, Z = –3.638, P < 0.001) and Subdoligranulum (AN vs. HC, 4.60% vs. 7.02%, Z = –2.369, P = 0.018) were statistically significantly lower, while that of Eubacterium_hallii_group was significantly higher (AN vs. HC, 7.63% vs. 3.43%, Z = –2.115, P = 0.035). Linear discriminant effect (LEfSe) analysis (LDA score >3.5) showed that o_Lachnospirales, f_Lachnospiraceae, and g_Eubacterium_hallii_group (o, f and g represents order, family and genus respectively) were enriched in patients with AN. Microbial function of nutrient transport and metabolism in AN group were more abundant (P > 0.05). In AN group, weight and BMI were significantly negatively correlated with the abundance of Bacteroidota and Bacteroides, while positively correlated with Subdoligranulum. BMI was significantly positively correlated with Firmicutes; HAMD scores were significantly negatively correlated with Faecalibacterium.Conclusions:The composition of gut microbiota in patients with AN was different from that of healthy people. Clinical indicators have correlations with the abundance of gut microbiota in patients with AN.
简介:Objective:Toinvestigatethedepressionstatusofpatientswithsexuallytransmitteddiseases(STDs).Methods:Thedepressionstatusoffifty-onehospitalizedSTDpatientswasevaluatedinarandomizedcontrolstudyusingZung'sQuantitativeTable.18healthycontrolpatientswithsimilardemographicbackgroundswererandomlychosenascontrols.Patientswithscoresaboveorequalto40wereconsideredtobesufferingfromdepression.Results:Theprevalencerateofdepressioninthepatientgroupwasobviouslyhigherthanthatofinthecontrol(X2=16.456,P<0.01).Prevalenceofdepressionwasfoundtobesignificantlyrelatedtooccupation(P<0.05).Thoughtheprevalencewasnotfoundtodiffersignificantlybetweenthosewithatreatmentcourselessthan2monthsandthosewithonelongerorequalto2months(X2=0.041,P>0.05),themeandepressionscoresoftheformergroupweresignificantlyhigherthanthoseofthelatter(P<0.01).Nosignificantdifferenceswerefoundbetweennewversusrelapsingdisease,marriedversusnon-married,maleversusfemale,ordifferingeducationalbackgrounds.
简介:AIM:Toevaluatewhetherthelevelofthrombospondin-1(TSP-1)inaqueoushumorcanpredicttheprognosisoftrabeculectomyinpatientswithprimaryangle-closureglaucoma(PACG).METHODS:Thiscase-controlstudyinvolved26patientswithPACGwhoexperiencedafailedtrabeculectomy(casegroup)and78age-andsex-matchedpatientswithPACGwhounderwentsuccessfultrabeculectomy(controlgroup).AqueoushumorwascollectedatthetimeoftrabeculectomyandtestedforTSP-1andTGF-β2levelswithanenzyme-linkedimmunosorbentassaymethod.Logisticregressionmodelingwasusedtoassesstheriskfactorsforfailedtrabeculectomy.RESULTS:ThemeanTSP-1aqueousconcentrationsweresignificantlyhigherinthecasegroup(20.67±9.79ng/mL)thanthecontrolgroup(5.17±2.29ng/mL)(P<0.001).Thetransforminggrowthfactor-β2(TGF-β2)aqueousconcentrationsweresignificantlydifferentbetweenthecaseandcontrolgroup,at3633.25and1090.24pg/mL,respectively(P<0.001).LogisticregressionanalysisrevealedTSP-1levelasanindependentriskfactorforafailedtrabeculectomy(OR=3.540;95%CI=1.092-11.482).CONCLUSION:TheaqueoushumorTSP-1andTGF-β2levelsarehigherinPACGeyeswithfailedtrabeculectomythanwithsuccessfultrabeculectomyatoneyear.TheaqueoushumorTSP-1levelisanindependentriskfactorassociatedwithfailedtrabeculectomy.
简介:AbstractBackground:Reviving patients with prolonged disorders of consciousness (DOCs) has always been focused and challenging in medical research. Owing to the limited effectiveness of available medicine, recent research has increasingly turned towards neuromodulatory therapies, involving the stimulation of neural circuits. We summarised the progression of research regarding neuromodulatory therapies in the field of DOCs, compared the differences among different studies, in an attempt to explore optimal stimulation patterns and parameters, and analyzed the major limitations of the relevant studies to facilitate future research.Methods:We performed a search in the PubMed database, using the concepts of DOCs and neuromodulation. Inclusion criteria were: articles in English, published after 2002, and reporting clinical trials of neuromodulatory therapies in human patients with DOCs.Results:Overall, 187 published articles met the search criteria, and 60 articles met the inclusion criteria. There are differences among these studies regarding the clinical efficacies of neurostimulation techniques for patients with DOCs, and large-sample studies are still lacking.Conclusions:Neuromodulatory techniques were used as trial therapies for DOCs wherein their curative effects were controversial. The difficulties in detecting residual consciousness, the confounding effect between the natural course of the disease and therapeutic effect, and the heterogeneity across patients are the major limitations. Large-sample, well-designed studies, and innovations for both treatment and assessment are anticipated in future research.
简介:AbstractPurpose:Trauma has been called the neglected disease of modern society. According to WHO, fall is the second major cause of trauma or deaths resulting from unintentional accidents. The aim of this study was to investigate the different types of fall according to International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) in hospitalized patients visiting specialized accident and trauma hospitals of Mashhad, Iran.Methods:This was a cross sectional retrospective study performed between March 20, 2013 and March 20, 2014. The research population consisted of all medical records of patients for fall injuries in three specialized accident and trauma hospitals. ICD-10 was adopted to categorize all types of falls (w00-w19). The results obtained were analyzed by SPSS 16.Results:Altogether 7,448 cases were included. The codes w18 (fall on same level) and w09 (fall involving playground equipment) with the frequencies of 1,856 and 1,303, respectively in both genders had the maximum number of falls. The maximum percentage of mortality has been related to "fall on and from ladder" ," fall from cliff "and "fall on same level involving ice and snow" .Conclusion:As falls can cause irrecoverable injuries including mortality of people, thus health authorities and policymakers should take preventive measures given the causes of falls and the root of this type of injuries, so that the costs resulting from this cause and its injuries can be reduced.