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Impact of the COVID-19 Pandemic on Blood Transfusion among Hospitalized Patients with Chronic Kidney Disease COVID-19 大流行对慢性肾病住院患者输血的影响
Q4 Medicine Pub Date : 2024-09-17 DOI: 10.3390/medicina60091512
Sevigean Ali, Mihaela Botnarciuc, Iulia-Andreea Badea, Andreea Alexandru, Liliana-Ana Tuta, Lavinia Carmen Daba, Leonard Gurgas, Sergiu Ioachim Chirila
Background and Objectives: Hematological disorders, especially chronic anemia and coagulation disorders, are common in patients with chronic kidney disease (CKD). Severe anemia is associated with increased cardiovascular morbidity and mortality in this special group of patients and is also responsible for decreased hope and quality of life. Despite the use of appropriate iron therapy and erythropoietin-stimulating agents, red blood cell transfusion is occasionally required, usually in the setting of acute bleeding or for correction of perioperative anemia. The COVID-19 pandemic has accelerated the progression of chronic diseases and worsened the outcomes for patients with nephrological conditions. As a precautionary measure against infections, patients’ access to hospitalization for their procedures has been reduced and their chronic complications, including hematological abnormalities, have gotten out of control. Materials and Methods: Our retrospective observational study was designed to evaluate the impact of the COVID-19 pandemic on blood transfusion for the patients with chronic kidney disease hospitalized in our emergency county medical unit, over a period of four years (2019–2022) who were admitted or at least referred for evaluation to the Nephrology department. We also followed the measures adopted to ensure the necessary blood products during this time. Results: Between 2190–2022, a total of 24,096 hospitalized patients were transfused at the Emergency County Clinical Hospital in Constanta, Romania. Meanwhile, in the nephrology and other medical or surgical wards of our medical unit, 1590 CKD patients were transfused with different blood derivatives. During the pandemic years, as expected, the number of transfused patients and transfused blood units decreased by 4% and 7%, respectively, in comparison with the pre-pandemic year, 2019. Unlike the general trend of transfusion activity, more patients with CKD transfused in 2022 (580) than before the pandemic (414 in 2019), and the number of blood units was higher in 2022 than in 2019 for red blood products and plasma. Between 2020–2022, from the total number of transfused patients in our study, 254 with CKD patients (16%) and 798 non-CKD (4%) died in-hospital. Conclusions: The adaptive strategies implemented to ensure the necessary blood products in the hospital during the COVID-19 pandemic mainly included restrictive transfusion and limitation of elective surgical procedures. The subject matter of the article is important as blood shortages are a problem that healthcare workers may encounter in future pandemics.
背景和目的:血液病,尤其是慢性贫血和凝血功能障碍,是慢性肾脏病(CKD)患者的常见病。在这一特殊群体中,严重贫血与心血管疾病发病率和死亡率的增加有关,也是希望和生活质量下降的原因之一。尽管使用了适当的铁剂治疗和促红细胞生成素刺激剂,但偶尔仍需要输注红细胞,通常是在急性出血或纠正围手术期贫血的情况下。COVID-19 大流行加速了慢性疾病的发展,并使肾病患者的预后恶化。作为预防感染的措施,患者住院接受手术的机会减少了,而他们的慢性并发症,包括血液学异常,也失去了控制。材料和方法:我们的回顾性观察研究旨在评估 COVID-19 大流行对四年内(2019-2022 年)在我县急诊科住院的慢性肾病患者输血的影响,这些患者都是肾内科收治的或至少是转诊到肾内科进行评估的。我们还跟踪了在此期间为确保必要的血液制品而采取的措施。结果:2190-2022 年间,罗马尼亚康斯坦察县临床急诊医院共为 24096 名住院患者输血。同时,在我们医疗单位的肾内科和其他内科或外科病房,1590 名慢性肾脏病患者接受了不同血液衍生物的输血。正如预期的那样,与大流行前的 2019 年相比,大流行期间的输血患者人数和输血单位分别减少了 4% 和 7%。与输血活动的总体趋势不同,2022 年输血的慢性肾脏病患者(580 人)多于大流行前(2019 年为 414 人),2022 年红血制品和血浆的输血单位数也高于 2019 年。2020-2022 年间,在我们研究的所有输血患者中,有 254 名慢性肾脏病患者(16%)和 798 名非慢性肾脏病患者(4%)在院内死亡。结论在 COVID-19 大流行期间,为确保医院有必要的血液制品而实施的适应性策略主要包括限制性输血和限制择期手术。这篇文章的主题非常重要,因为血液短缺是医护人员在未来大流行中可能会遇到的问题。
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引用次数: 0
Increased Dose in Spine Stereotactic Radiosurgery for Metastatic Disease: Are We Underestimating the Risks? 增加脊柱立体定向放射手术治疗转移性疾病的剂量:我们是否低估了风险?
Q4 Medicine Pub Date : 2024-09-17 DOI: 10.3390/medicina60091514
Gil Kimchi, Maya Nulman, Saeda Haj, Idan Bar-Orian, Ory Haisraely, Ran Harel
Background and Objectives: The recently published Spine Stereotactic Radiosurgery (SSRS) ESTRO guidelines advise against treating spinal metastatic disease with a single dose equal to or smaller than 18 Gy, prioritizing local control over the potential for complications. This study aims to assess the necessity and validity of these higher dose recommendations by evaluating the outcomes and experiences with lower radiation doses. Materials and Methods: A retrospective evaluation of SSRS patients treated at a single institute was conducted. The outcomes and complications of this cohort were compared to the current literature and the data supporting the new ESTRO guidelines. Results: A total of 149 treatment sessions involving 242 spinal levels were evaluated. The overall local control rate was 91.2%. The mean radiation dose for the local control group compared to the local failure group was similar (17.5 vs. 17.6 Gy, not significant). The overall complication rate was 6%. These results are consistent with previous publications evaluating SSRS for metastatic spinal disease. Conclusions: SSRS dose escalation may increase local control efficacy but comes with a higher risk of complications. The evidence supporting the strong recommendations in the recent ESTRO guidelines is not robust enough to justify a universal application. Given the palliative nature of treatment for metastatic patients, dose determination should be individualized based on patient conditions and preferences, with a detailed discussion about the risk–benefit ratio of increased doses and the level of evidence supporting these recommendations.
背景与目的:最近发布的脊柱立体定向放射外科(SSRS)ESTRO指南建议不要用等于或小于18 Gy的单次剂量治疗脊柱转移性疾病,因为局部控制优先于潜在的并发症。本研究旨在通过评估较低放射剂量的疗效和经验,评估这些较高剂量建议的必要性和有效性。材料与方法:对在一家研究所接受治疗的 SSRS 患者进行了回顾性评估。将该组患者的疗效和并发症与现有文献和支持 ESTRO 新指南的数据进行比较。结果:共评估了涉及 242 个脊柱水平的 149 次治疗。总体局部控制率为 91.2%。局部控制组与局部失败组的平均放射剂量相似(17.5 vs. 17.6 Gy,差异不显著)。总体并发症发生率为 6%。这些结果与之前评估SSRS治疗转移性脊柱疾病的出版物一致。结论:SSRS剂量升级可提高局部控制疗效,但并发症风险较高。支持最近 ESTRO 指南中强烈建议的证据还不够有力,不足以证明可以普遍应用。鉴于转移性患者治疗的姑息性质,剂量的确定应根据患者的病情和偏好进行个体化,并详细讨论增加剂量的风险效益比以及支持这些建议的证据水平。
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引用次数: 0
Exercise Barriers in Older Individuals with Alzheimer’s Disease: A Cross-Sectional Study 老年痴呆症患者的运动障碍:一项横断面研究
Q4 Medicine Pub Date : 2024-09-16 DOI: 10.3390/medicina60091510
İsmail Uysal, Fatih Özden, Mehmet Özkeskin, Zehra Benzer, Emir İbrahim Işık
Background and Objectives: Defining the exercise habits of individuals with Alzheimer’s Disease (AD) may help to determine optimal rehabilitation programs. This study aimed to investigate the physical and psychological parameters associated with exercise barriers in older individuals with AD, with the goal of informing more effective rehabilitation programs. Materials and Methods: A cross-sectional prospective study was conducted with 50 individuals with AD. The individuals were evaluated with the Exercise Benefit/Barriers Scale (EBBS), the Mini-Mental State Examination (MMSE), the Five Times Sit to Stand Test (FTSTS), the Barthel Index (BI), the Tampa Scale for Kinesiophobia (TSK), and the Hospital Anxiety and Depression Scale (HADS). Results: There was a significant positive correlation between age with EBBS-Exercise Barriers (r = 0.308; p = 0.029) and EBBS-Total Score (r = 0.295; p = 0.038). There were significant negative correlations between the time of diagnosis with EBBS-Exercise Benefits (r = −0.569; p = 0.000), EBBS-Exercise Barriers (r = −0.324; p = 0.022), and EBBS-Total Score (r = −0.508; p = 0.000). There was a positive correlation between MMSE and EBBS-Exercise Benefits (r = 0.465; p = 0.001), EBBS-Exercise Barriers (r = 0.471; p = 0.001) and EBBS-Total Score (r = 0.519; p = 0.000). There were significant positive correlations between FTSTS and EBBS-Exercise Barriers (r = 0.340; p = 0.016), and EBBS-Total Score (r = 0.280; p = 0.049). There were positive correlations between BI and EBBS-Exercise Benefits (r = 0.362; p = 0.010), EBBS-Exercise Barriers (r = 0.377; p = 0.007), and EBBS-Total Score (r = 0.405; p = 0.004). Conclusions: Exercise barriers/benefits were associated with cognition and post-diagnosis duration in individuals with AD. Individuals with lower physical function had lower exercise perception. In addition, living with relatives or caregivers led to better exercise benefit scores.
背景和目的:确定阿尔茨海默病(AD)患者的运动习惯有助于确定最佳康复计划。本研究旨在调查与老年痴呆症患者运动障碍相关的生理和心理参数,从而为制定更有效的康复计划提供依据。材料与方法:对 50 名注意力缺失症患者进行了横断面前瞻性研究。研究人员使用运动受益/障碍量表(EBBS)、迷你精神状态检查(MMSE)、五次坐立测试(FTSTS)、巴特尔指数(BI)、坦帕运动恐惧症量表(TSK)和医院焦虑抑郁量表(HADS)对这些患者进行了评估。结果显示年龄与 EBBS-运动障碍(r = 0.308; p = 0.029)和 EBBS-总分(r = 0.295; p = 0.038)之间存在明显的正相关。诊断时间与 EBBS-运动受益(r = -0.569;p = 0.000)、EBBS-运动障碍(r = -0.324;p = 0.022)和 EBBS-总分(r = -0.508;p = 0.000)之间存在明显的负相关。MMSE 与 EBBS-运动受益(r = 0.465;p = 0.001)、EBBS-运动障碍(r = 0.471;p = 0.001)和 EBBS-总分(r = 0.519;p = 0.000)之间呈正相关。FTSTS 与 EBBS-运动障碍(r = 0.340;p = 0.016)和 EBBS-总分(r = 0.280;p = 0.049)之间存在明显的正相关。BI与EBBS-运动益处(r = 0.362; p = 0.010)、EBBS-运动障碍(r = 0.377; p = 0.007)和EBBS-总分(r = 0.405; p = 0.004)之间呈正相关。结论运动障碍/益处与注意力缺失症患者的认知能力和诊断后持续时间有关。身体机能较差的人对运动的认知度较低。此外,与亲属或照顾者同住会提高运动受益评分。
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引用次数: 0
Analysis of Dental Prosthetic Treatment in Patients with Cancer Aged 65 Years and Older after Expanded Health Insurance Coverage: A Retrospective Clinical Study 医疗保险覆盖范围扩大后 65 岁及以上癌症患者的牙科修复治疗分析:回顾性临床研究
Q4 Medicine Pub Date : 2024-09-16 DOI: 10.3390/medicina60091509
Hyo-Jung Kim, Iel-Yong Sung
Background and Objectives: With increases in cancer incidence and the number of cancer survivors, the demand for cancer management is growing. However, studies on dental prosthetic treatment for patients with cancer are rare. We aim to investigate the dental prosthetic treatment in patients with cancer aged ≥65 years after expanded health insurance coverage. Materials and Methods: This retrospective study included patients who were treated with implants and removable dentures at Ulsan University Hospital in South Korea between June 2015 and June 2023. Data on age, sex, cancer location, comorbid systemic diseases, number of remaining teeth, dental prosthetic treatment history, type of dental prosthetic treatment, and insurance coverage status were extracted from patient medical records and panoramic radiographs. The influence of multiple variables on dental prosthetic treatment was analyzed using the Chi-square and Fisher’s exact tests. Results: The study included 61 patients with cancer (32 men, 29 women; average age: 70.9 years). Among them, 56 (91.8%) had insurance coverage benefits, and 34 (55.7%) received treatments such as implants, removable partial dentures, or complete dentures for the first time. Treatment types included 37 (60.7%) cases of implant prostheses and 24 (39.3%) conventional removable dentures. No statistical differences were observed in the type of dental prosthetic treatment according to sex, age, cancer location, number of systemic diseases, and dental prosthetic treatment history (p > 0.05). Patients with <10 remaining teeth received treatment with conventional removable dentures, which was statistically significant (p < 0.001). Conclusions: Of the 61 patients, 56 (91.8%) received insurance benefits, and 34 (55.7%) underwent dental prosthetic treatment for the first time. Within the limitations of this retrospective study, the expanded health insurance coverage alleviated the unmet demand for dental prosthetic treatment. As cancer prevalence continues to increase, expanding customized health insurance coverage is crucial to meet this demand.
背景和目标:随着癌症发病率和癌症幸存者人数的增加,对癌症治疗的需求也在不断增长。然而,针对癌症患者的牙科修复治疗研究却很少见。我们旨在调查医疗保险覆盖范围扩大后,年龄≥65 岁癌症患者的牙科修复治疗情况。材料和方法:这项回顾性研究纳入了 2015 年 6 月至 2023 年 6 月期间在韩国蔚山大学医院接受种植体和活动义齿治疗的患者。研究人员从患者病历和全景X光片中提取了患者的年龄、性别、患癌部位、合并全身性疾病、剩余牙齿数量、牙科修复治疗史、牙科修复治疗类型以及保险情况等数据。采用卡方检验(Chi-square)和费雪精确检验(Fisher's exact)分析了多个变量对义齿修复治疗的影响。研究结果研究包括 61 名癌症患者(32 名男性,29 名女性;平均年龄:70.9 岁)。其中,56 人(91.8%)享有保险福利,34 人(55.7%)首次接受种植体、可摘局部义齿或全口义齿等治疗。治疗类型包括 37 例(60.7%)种植义齿和 24 例(39.3%)传统活动义齿。根据性别、年龄、患癌部位、全身性疾病数量和牙科修复治疗史,在牙科修复治疗类型方面未发现统计学差异(P > 0.05)。剩余牙齿少于 10 颗的患者接受了传统活动义齿治疗,这在统计学上有显著意义(P < 0.001)。结论在 61 名患者中,56 人(91.8%)获得了保险福利,34 人(55.7%)首次接受了牙科修复治疗。在这项回顾性研究的局限性范围内,医疗保险覆盖面的扩大缓解了牙科修复治疗需求得不到满足的问题。随着癌症发病率的不断上升,扩大定制化医疗保险的覆盖范围对于满足这一需求至关重要。
{"title":"Analysis of Dental Prosthetic Treatment in Patients with Cancer Aged 65 Years and Older after Expanded Health Insurance Coverage: A Retrospective Clinical Study","authors":"Hyo-Jung Kim, Iel-Yong Sung","doi":"10.3390/medicina60091509","DOIUrl":"https://doi.org/10.3390/medicina60091509","url":null,"abstract":"Background and Objectives: With increases in cancer incidence and the number of cancer survivors, the demand for cancer management is growing. However, studies on dental prosthetic treatment for patients with cancer are rare. We aim to investigate the dental prosthetic treatment in patients with cancer aged ≥65 years after expanded health insurance coverage. Materials and Methods: This retrospective study included patients who were treated with implants and removable dentures at Ulsan University Hospital in South Korea between June 2015 and June 2023. Data on age, sex, cancer location, comorbid systemic diseases, number of remaining teeth, dental prosthetic treatment history, type of dental prosthetic treatment, and insurance coverage status were extracted from patient medical records and panoramic radiographs. The influence of multiple variables on dental prosthetic treatment was analyzed using the Chi-square and Fisher’s exact tests. Results: The study included 61 patients with cancer (32 men, 29 women; average age: 70.9 years). Among them, 56 (91.8%) had insurance coverage benefits, and 34 (55.7%) received treatments such as implants, removable partial dentures, or complete dentures for the first time. Treatment types included 37 (60.7%) cases of implant prostheses and 24 (39.3%) conventional removable dentures. No statistical differences were observed in the type of dental prosthetic treatment according to sex, age, cancer location, number of systemic diseases, and dental prosthetic treatment history (p > 0.05). Patients with <10 remaining teeth received treatment with conventional removable dentures, which was statistically significant (p < 0.001). Conclusions: Of the 61 patients, 56 (91.8%) received insurance benefits, and 34 (55.7%) underwent dental prosthetic treatment for the first time. Within the limitations of this retrospective study, the expanded health insurance coverage alleviated the unmet demand for dental prosthetic treatment. As cancer prevalence continues to increase, expanding customized health insurance coverage is crucial to meet this demand.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
PREVENT Equation: The Black Sheep among Cardiovascular Risk Scores? A Comparative Agreement Analysis of Nine Prediction Models in High-Risk Lithuanian Women PREVENT 等式:心血管风险评分中的黑羊?九种预测模型在高风险立陶宛妇女中的一致性比较分析
Q4 Medicine Pub Date : 2024-09-16 DOI: 10.3390/medicina60091511
Petras Navickas, Laura Lukavičiūtė, Sigita Glaveckaitė, Arvydas Baranauskas, Agnė Šatrauskienė, Jolita Badarienė, Aleksandras Laucevičius
Background and Objectives: In the context of female cardiovascular risk categorization, we aimed to assess the inter-model agreement between nine risk prediction models (RPM): the novel Predicting Risk of cardiovascular disease EVENTs (PREVENT) equation, assessing cardiovascular risk using SIGN, the Australian CVD risk score, the Framingham Risk Score for Hard Coronary Heart Disease (FRS-hCHD), the Multi-Ethnic Study of Atherosclerosis risk score, the Pooled Cohort Equation (PCE), the QRISK3 cardiovascular risk calculator, the Reynolds Risk Score, and Systematic Coronary Risk Evaluation-2 (SCORE2). Materials and Methods: A cross-sectional study was conducted on 6527 40–65-year-old women with diagnosed metabolic syndrome from a single tertiary university hospital in Lithuania. Cardiovascular risk was calculated using the nine RPMs, and the results were categorized into high-, intermediate-, and low-risk groups. Inter-model agreement was quantified using Cohen’s Kappa coefficients. Results: The study uncovered a significant diversity in risk categorization, with agreement on risk category by all models in only 1.98% of cases. The SCORE2 model primarily classified subjects as high-risk (68.15%), whereas the FRS-hCHD designated the majority as low-risk (94.42%). The range of Cohen’s Kappa coefficients (−0.09–0.64) reflects the spectrum of agreement between models. Notably, the PREVENT model demonstrated significant agreement with QRISK3 (κ = 0.55) and PCE (κ = 0.52) but was completely at odds with the SCORE2 (κ = −0.09). Conclusions: Cardiovascular RPM selection plays a pivotal role in influencing clinical decisions and managing patient care. The PREVENT model revealed balanced results, steering clear of the extremes seen in both SCORE2 and FRS-hCHD. The highest concordance was observed between the PREVENT model and both PCE and QRISK3 RPMs. Conversely, the SCORE2 model demonstrated consistently low or negative agreement with other models, highlighting its unique approach to risk categorization. These findings accentuate the need for additional research to assess the predictive accuracy of these models specifically among the Lithuanian female population.
背景和目的:在女性心血管风险分类方面,我们旨在评估九种风险预测模型(RPM)之间的模型间一致性:新颖的心血管疾病 EVENTs 风险预测方程 (PREVENT)、使用 SIGN 评估心血管风险、澳大利亚心血管疾病风险评分、弗拉明汉硬性冠心病风险评分 (FRS-hCHD)、动脉粥样硬化多种族研究风险评分、集合队列方程 (PCE)、QRISK3 心血管风险计算器、雷诺兹风险评分和系统性冠心病风险评估-2 (SCORE2)。材料与方法:一项横断面研究针对立陶宛一家三级大学医院的 6527 名 40-65 岁女性代谢综合征患者。使用九个 RPM 计算心血管风险,并将结果分为高、中、低风险组。模型间的一致性采用科恩卡帕系数进行量化。研究结果研究发现,风险分类存在很大差异,只有 1.98% 的病例所有模型的风险类别一致。SCORE2 模型主要将受试者划分为高风险(68.15%),而 FRS-hCHD 则将大多数受试者划分为低风险(94.42%)。Cohen's Kappa 系数的范围(-0.09-0.64)反映了不同模型之间的一致性。值得注意的是,PREVENT 模型与 QRISK3(κ = 0.55)和 PCE(κ = 0.52)有显著的一致性,但与 SCORE2(κ = -0.09)完全不一致。结论心血管 RPM 选择在影响临床决策和患者护理管理方面发挥着关键作用。PREVENT 模型显示了平衡的结果,避免了 SCORE2 和 FRS-hCHD 中的极端结果。PREVENT 模型与 PCE 和 QRISK3 RPM 之间的一致性最高。相反,SCORE2 模型与其他模型的一致性一直较低或为负值,这突显了其独特的风险分类方法。这些发现突出表明,有必要开展更多的研究,以评估这些模型在立陶宛女性人群中的预测准确性。
{"title":"PREVENT Equation: The Black Sheep among Cardiovascular Risk Scores? A Comparative Agreement Analysis of Nine Prediction Models in High-Risk Lithuanian Women","authors":"Petras Navickas, Laura Lukavičiūtė, Sigita Glaveckaitė, Arvydas Baranauskas, Agnė Šatrauskienė, Jolita Badarienė, Aleksandras Laucevičius","doi":"10.3390/medicina60091511","DOIUrl":"https://doi.org/10.3390/medicina60091511","url":null,"abstract":"Background and Objectives: In the context of female cardiovascular risk categorization, we aimed to assess the inter-model agreement between nine risk prediction models (RPM): the novel Predicting Risk of cardiovascular disease EVENTs (PREVENT) equation, assessing cardiovascular risk using SIGN, the Australian CVD risk score, the Framingham Risk Score for Hard Coronary Heart Disease (FRS-hCHD), the Multi-Ethnic Study of Atherosclerosis risk score, the Pooled Cohort Equation (PCE), the QRISK3 cardiovascular risk calculator, the Reynolds Risk Score, and Systematic Coronary Risk Evaluation-2 (SCORE2). Materials and Methods: A cross-sectional study was conducted on 6527 40–65-year-old women with diagnosed metabolic syndrome from a single tertiary university hospital in Lithuania. Cardiovascular risk was calculated using the nine RPMs, and the results were categorized into high-, intermediate-, and low-risk groups. Inter-model agreement was quantified using Cohen’s Kappa coefficients. Results: The study uncovered a significant diversity in risk categorization, with agreement on risk category by all models in only 1.98% of cases. The SCORE2 model primarily classified subjects as high-risk (68.15%), whereas the FRS-hCHD designated the majority as low-risk (94.42%). The range of Cohen’s Kappa coefficients (−0.09–0.64) reflects the spectrum of agreement between models. Notably, the PREVENT model demonstrated significant agreement with QRISK3 (κ = 0.55) and PCE (κ = 0.52) but was completely at odds with the SCORE2 (κ = −0.09). Conclusions: Cardiovascular RPM selection plays a pivotal role in influencing clinical decisions and managing patient care. The PREVENT model revealed balanced results, steering clear of the extremes seen in both SCORE2 and FRS-hCHD. The highest concordance was observed between the PREVENT model and both PCE and QRISK3 RPMs. Conversely, the SCORE2 model demonstrated consistently low or negative agreement with other models, highlighting its unique approach to risk categorization. These findings accentuate the need for additional research to assess the predictive accuracy of these models specifically among the Lithuanian female population.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Glenohumeral Joint Volume Measurement in Patients with Shoulder Instability: A 3D Volumetric Magnetic Resonance Arthrographic Study 肩关节失稳患者的盂肱关节容积测量:三维容积磁共振关节造影研究
Q4 Medicine Pub Date : 2024-09-16 DOI: 10.3390/medicina60091508
Derya Güçlü, Elif Nisa Ünlü, Mehmet Arıcan, Oğuzhan Acar, Veysel Uludağ, Hayri Oğul
Background and Objectives: This study aimed to compare capsular volume in patients with shoulder instability to that in control subjects without instability using magnetic resonance (MR) arthrography. The objective was to develop a reliable screening method with which to assess shoulder volume. Materials and Methods: In 21 patients with atraumatic shoulder instability and 21 controls, thin-slice 3D volumetric MR arthrography sequences were obtained. MR arthrography images were uploaded to 3D reconstruction, and 3D images were generated. From the 3D reconstructed images, volumetric measurements of rotator interval (RI), anterior and posterior capsular (AC, PC) recesses, biceps tendon sheath (BS), axillary recess (AR), and total glenohumeral joint (TGJ) were performed. Individuals with any extra-articular contrast leakage were also recorded. Results: A retrospective study analyzed a patient group of 21 individuals with shoulder instability (mean age 29.52 ± 12.83 years) and a control group of 21 individuals without instability (mean age 35.71 ± 12.77 years). No statistically significant differences were identified between the groups with regard to age, gender, or side distribution. The mean total joint volume was significantly higher in the instability group (29.85 ± 6.40 cm3) compared to the control group (23.15 ± 3.48 cm3, p = 0.0001). Additionally, the mean volumes of the RI, AC, PC, BS, and AR were all significantly greater in the patient group compared to the control group. Conclusions: 3D volumetric MR arthrographic measurements of the shoulder joint capacity can provide valuable insights for clinical follow-up and guide surgical treatment decisions in cases of atraumatic shoulder instability.
背景和目的:本研究旨在利用磁共振(MR)关节造影术比较肩关节不稳定患者与无不稳定性的对照受试者的关节囊容量。目的是开发一种可靠的筛查方法,用于评估肩关节体积。材料和方法:在 21 名肩关节非创伤性不稳定患者和 21 名对照组患者中获取薄片三维容积磁共振关节造影序列。将磁共振关节造影图像上传到三维重建系统,生成三维图像。根据三维重建图像,对旋转肌间隙(RI)、前后关节囊(AC、PC)凹陷、肱二头肌腱鞘(BS)、腋窝凹陷(AR)和整个盂肱关节(TGJ)进行容积测量。此外,还记录了关节外造影剂渗漏的情况。结果一项回顾性研究分析了 21 名肩关节不稳定患者(平均年龄为 29.52 ± 12.83 岁)和 21 名无肩关节不稳定的对照组患者(平均年龄为 35.71 ± 12.77 岁)。两组患者在年龄、性别或患侧分布方面均无明显统计学差异。与对照组(23.15 ± 3.48 cm3,P = 0.0001)相比,不稳定组的平均关节总体积(29.85 ± 6.40 cm3)明显更高。此外,与对照组相比,患者组的 RI、AC、PC、BS 和 AR 的平均体积均明显增大。结论肩关节容量的三维容积磁共振关节造影测量可为临床随访提供有价值的见解,并指导非创伤性肩关节不稳定病例的手术治疗决策。
{"title":"Glenohumeral Joint Volume Measurement in Patients with Shoulder Instability: A 3D Volumetric Magnetic Resonance Arthrographic Study","authors":"Derya Güçlü, Elif Nisa Ünlü, Mehmet Arıcan, Oğuzhan Acar, Veysel Uludağ, Hayri Oğul","doi":"10.3390/medicina60091508","DOIUrl":"https://doi.org/10.3390/medicina60091508","url":null,"abstract":"Background and Objectives: This study aimed to compare capsular volume in patients with shoulder instability to that in control subjects without instability using magnetic resonance (MR) arthrography. The objective was to develop a reliable screening method with which to assess shoulder volume. Materials and Methods: In 21 patients with atraumatic shoulder instability and 21 controls, thin-slice 3D volumetric MR arthrography sequences were obtained. MR arthrography images were uploaded to 3D reconstruction, and 3D images were generated. From the 3D reconstructed images, volumetric measurements of rotator interval (RI), anterior and posterior capsular (AC, PC) recesses, biceps tendon sheath (BS), axillary recess (AR), and total glenohumeral joint (TGJ) were performed. Individuals with any extra-articular contrast leakage were also recorded. Results: A retrospective study analyzed a patient group of 21 individuals with shoulder instability (mean age 29.52 ± 12.83 years) and a control group of 21 individuals without instability (mean age 35.71 ± 12.77 years). No statistically significant differences were identified between the groups with regard to age, gender, or side distribution. The mean total joint volume was significantly higher in the instability group (29.85 ± 6.40 cm3) compared to the control group (23.15 ± 3.48 cm3, p = 0.0001). Additionally, the mean volumes of the RI, AC, PC, BS, and AR were all significantly greater in the patient group compared to the control group. Conclusions: 3D volumetric MR arthrographic measurements of the shoulder joint capacity can provide valuable insights for clinical follow-up and guide surgical treatment decisions in cases of atraumatic shoulder instability.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Relationship between Cancer and Intention to Leave Work among Older Workers: A Cross-Sectional Internet-Based Study 癌症与老年工人离职意向之间的关系:基于互联网的横断面研究
Q4 Medicine Pub Date : 2024-09-15 DOI: 10.3390/medicina60091506
Ryutaro Matsugaki, Shinya Matsuda, Akira Ogami
Background and Objectives: Limited research has focused on the relationship between cancer, job loss, and factors associated with job loss among older workers. Therefore, in this study, we aimed to examine the relationship between cancer and intention to leave and between physical-health-related issues, mental-health-related issues, and cancer-related symptoms and intention to leave among older workers with cancer. Materials and Methods: This cross-sectional internet-based study included 4498 workers aged 60–75 years. Intention to leave was assessed based on whether individuals considered quitting their current jobs in the near future. Results: A multivariate logistic regression analysis showed a significant association between cancer and intention to leave (adjusted odds ratio [aOR]: 1.42, 95% confidence interval [CI]: 1.01–2.00, p = 0.045). In addition, physical-health-related issues (aOR: 2.33, 95% CI: 1.10–4.92, p = 0.026) and mental-health-related issues (aOR: 4.44, 95% CI: 1.80–10.98, p = 0.001) were significantly associated with the intention to leave. Conclusions: Healthcare providers and employers must address the physical- and mental-health-related issues facing older workers with cancer to help them secure their employment.
背景和目标:有关老年工人中癌症、失业以及失业相关因素之间关系的研究十分有限。因此,本研究旨在探讨癌症与离职意向之间的关系,以及身体健康相关问题、心理健康相关问题、癌症相关症状与老年癌症患者离职意向之间的关系。材料和方法:这项基于互联网的横断面研究包括 4498 名年龄在 60-75 岁之间的工人。离职意向的评估基于个人是否考虑在不久的将来辞去目前的工作。研究结果多变量逻辑回归分析表明,癌症与离职意向之间存在显著关联(调整后赔率 [aOR]:1.42,95% 置信区间):1.42,95% 置信区间 [CI]:1.01-2.00, p = 0.045).此外,与身体健康相关的问题(aOR:2.33,95% 置信区间:1.10-4.92,p = 0.026)和与精神健康相关的问题(aOR:4.44,95% 置信区间:1.80-10.98,p = 0.001)也与离职意向显著相关。结论医疗服务提供者和雇主必须解决老年癌症患者面临的身体和心理健康相关问题,以帮助他们确保就业。
{"title":"Relationship between Cancer and Intention to Leave Work among Older Workers: A Cross-Sectional Internet-Based Study","authors":"Ryutaro Matsugaki, Shinya Matsuda, Akira Ogami","doi":"10.3390/medicina60091506","DOIUrl":"https://doi.org/10.3390/medicina60091506","url":null,"abstract":"Background and Objectives: Limited research has focused on the relationship between cancer, job loss, and factors associated with job loss among older workers. Therefore, in this study, we aimed to examine the relationship between cancer and intention to leave and between physical-health-related issues, mental-health-related issues, and cancer-related symptoms and intention to leave among older workers with cancer. Materials and Methods: This cross-sectional internet-based study included 4498 workers aged 60–75 years. Intention to leave was assessed based on whether individuals considered quitting their current jobs in the near future. Results: A multivariate logistic regression analysis showed a significant association between cancer and intention to leave (adjusted odds ratio [aOR]: 1.42, 95% confidence interval [CI]: 1.01–2.00, p = 0.045). In addition, physical-health-related issues (aOR: 2.33, 95% CI: 1.10–4.92, p = 0.026) and mental-health-related issues (aOR: 4.44, 95% CI: 1.80–10.98, p = 0.001) were significantly associated with the intention to leave. Conclusions: Healthcare providers and employers must address the physical- and mental-health-related issues facing older workers with cancer to help them secure their employment.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Novel Models for Assessing and Pathophysiology of Hepatic Ischemia–Reperfusion Injury Mechanisms 评估肝缺血再灌注损伤机制和病理生理学的新型模型
Q4 Medicine Pub Date : 2024-09-15 DOI: 10.3390/medicina60091507
Connor Whalen, Arun Verma, Kento Kurashima, Jasmine Carter, Hala Nazzal, Ajay Jain
Hepatic ischemia–reperfusion injury (IRI) is a major cause of postoperative hepatic dysfunction and liver failure involving cellular damage to previously ischemic tissues to which blood flow is restored. The reestablishment of blood flow is essential for salvaging ischemic tissues. The reperfusion itself, however, can paradoxically lead to further cellular damage, which involves a multi-factorial process resulting in extensive tissue damage, which can threaten the function and viability of the liver and other organ systems. The following review outlines multiple models for in-lab analysis of the various hepatic IRI mechanisms, including murine, porcine, cell lines, and machine perfusion models.
肝脏缺血再灌注损伤(IRI)是导致术后肝功能障碍和肝衰竭的一个主要原因,它涉及到先前缺血组织的细胞损伤,而血流恢复则会对缺血组织造成损伤。重建血流对挽救缺血组织至关重要。然而,再灌注本身可能会导致进一步的细胞损伤,这涉及一个多因素过程,导致广泛的组织损伤,从而威胁到肝脏和其他器官系统的功能和存活能力。以下综述概述了用于实验室分析各种肝脏 IRI 机制的多种模型,包括小鼠、猪、细胞系和机器灌注模型。
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引用次数: 0
Prevalence, Management, and Outcomes of Atrial Fibrillation in Paediatric Patients: Insights from a Tertiary Cardiology Centre 儿童患者心房颤动的患病率、管理和疗效:来自三级心脏病学中心的启示
Q4 Medicine Pub Date : 2024-09-15 DOI: 10.3390/medicina60091505
Andreia Duarte Constante, Joana Suarez, Guilherme Lourenço, Guilherme Portugal, Pedro Silva Cunha, Mário Martins Oliveira, Conceição Trigo, Fátima F. Pinto, Sérgio Laranjo
Background and Objectives: Atrial fibrillation (AF) is increasingly recognised in paediatric patients, presenting unique challenges in management due to its association with various underlying heart conditions. This study aimed to evaluate the prevalence, management strategies, and outcomes of AF in this population. Materials and Methods: A retrospective analysis was conducted at a tertiary paediatric cardiology centre, including patients aged ≤18 years diagnosed with AF between January 2015 and December 2023. The study focused on demographic details, clinical presentations, treatments, and outcomes. Descriptive statistics were employed to assess treatment efficacy, recurrence rates, and complications. Results: The study included 36 paediatric patients (median age: 15 years, IQR: 13–17; 58% male). Of these, 52.8% had acquired heart disease, 16.7% had congenital heart anomalies, and 16.7% presented with lone AF. The initial management strategies involved electrical cardioversion in 53.3% of patients and pharmacological conversion with amiodarone in 46.7%. Rhythm control therapy was administered to over 80% of the cohort, and 63.9% were placed on oral anticoagulation, predominantly for rheumatic and congenital heart diseases. The overall success rate of rhythm control was 96.2%, with an AF recurrence rate of 3.8%. Ischemic stroke was the most common complication, occurring in three patients, all with underlying rheumatic heart disease. Conclusions: AF in paediatric patients is predominantly associated with rheumatic and congenital heart diseases, though a significant proportion of patients present with lone AF. Despite effective rhythm control in most cases, neurological complications, particularly ischemic strokes in patients with underlying heart disease, remain a critical concern. These findings underscore the need for more comprehensive studies to better understand the aetiology, risk factors, and optimal management strategies for paediatric AF.
背景和目的:房颤(AF)在儿科患者中的发病率越来越高,由于其与各种潜在的心脏疾病相关,因此在管理上面临着独特的挑战。本研究旨在评估房颤在这一人群中的患病率、管理策略和治疗效果。材料和方法:在一家三级儿科心脏病学中心进行了一项回顾性分析,研究对象包括 2015 年 1 月至 2023 年 12 月期间确诊为房颤的 18 岁以下患者。研究侧重于人口统计学细节、临床表现、治疗和结果。研究采用描述性统计来评估治疗效果、复发率和并发症。研究结果研究共纳入 36 名儿童患者(中位年龄:15 岁,IQR:13-17 岁;58% 为男性)。其中,52.8%患有后天性心脏病,16.7%患有先天性心脏畸形,16.7%为单发房颤。53.3%的患者采用电复律治疗,46.7%的患者采用胺碘酮药物治疗。超过80%的患者接受了节律控制治疗,63.9%的患者接受了口服抗凝治疗,主要用于治疗风湿性和先天性心脏病。心律控制的总体成功率为 96.2%,房颤复发率为 3.8%。缺血性中风是最常见的并发症,有三名患者发生了这种并发症,他们都患有潜在的风湿性心脏病。结论儿科房颤主要与风湿性心脏病和先天性心脏病有关,但也有相当一部分患者表现为单独房颤。尽管大多数病例都能有效控制心律,但神经系统并发症,尤其是有潜在心脏病的患者发生缺血性中风,仍然是一个令人严重关切的问题。这些发现强调了进行更全面研究的必要性,以便更好地了解小儿房颤的病因、风险因素和最佳管理策略。
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引用次数: 0
Morphology and Prevalence of the Inferior Transverse Scapular Ligament: Systematic Review, Meta-Analysis, and Proposal for Classification 肩胛下横韧带的形态和患病率:系统回顾、元分析和分类建议
Q4 Medicine Pub Date : 2024-09-14 DOI: 10.3390/medicina60091504
Ioannis Antonopoulos, Evmorfia Pechlivanidou, Łukasz Hubert Olewnik, Nicol Zielinska, Dimosthenis Chrysikos, Alexandros Samolis, George Tsikouris, Theodore Troupis
Background/Objectives: The suprascapular nerve is most vulnerable to entrapment at the suprascapular and spinoglenoid notches, causing neuropathy. Numerous studies have examined the suprascapular notch and ligament and its relationship with suprascapular nerve entrapment, but few have examined the spinoglenoid notch and the inferior transverse scapular ligament (ITSL). This study summarizes all existing ITSL morphology studies and presents a simple and comprehensive classification system for different ITSL subtypes. Methods: A systematic review of the literature was conducted according to the PRISMA guidelines, searching the online databases PubMed and Embase. The references of each relevant article were further screened to find more eligible studies. The Anatomical Quality Assessment tool was used in order to further evaluate the quality of the records extracted. STATA MP 14 was used for the analysis in this study. Results: In total, 14 studies (995 scapulae; minimum: 1 and maximum: 268) were included in the present study. The overall ITSL prevalence was 5.8 (95% CI: 4.5–7.1) and the estimated odds for ligamentous vs. membranous type was 0.5 (95% CI: 0.3–0.7). The basic different morphological subtypes of the ITSL reported in the included studies are the band-like ligament, the fan-shaped ligament, the membranous ITSL, and the perforated membranous types. Conclusions: The ITSL represents an anatomical structure of mostly ligamentous nature. A single ITSL definition and standardization of its basic morphological subtypes along with an easy-to-remember and thus widely used classification system could greatly facilitate the comprehensive description, identification, and proper handling of this element across many surgical procedures.
背景/目的:肩胛上神经最容易在肩胛上切迹和蝶骨切迹处发生卡压,导致神经病变。许多研究都对肩胛上切迹和韧带及其与肩胛上神经卡压的关系进行了研究,但很少有研究对椎骨切迹和肩胛下横韧带(ITSL)进行研究。本研究总结了所有现有的 ITSL 形态学研究,并针对不同的 ITSL 亚型提出了一个简单而全面的分类系统。研究方法根据PRISMA指南,在PubMed和Embase在线数据库中搜索文献,进行系统性综述。进一步筛选了每篇相关文章的参考文献,以找到更多符合条件的研究。为了进一步评估所提取记录的质量,使用了解剖质量评估工具。本研究使用 STATA MP 14 进行分析。结果本研究共纳入了 14 项研究(995 个肩胛骨;最少:1 个,最多:268 个)。ITSL的总发病率为5.8(95% CI:4.5-7.1),韧带型与膜型的估计几率为0.5(95% CI:0.3-0.7)。纳入研究报告的 ITSL 基本形态亚型包括带状韧带、扇形韧带、膜性 ITSL 和穿孔膜性类型。结论ITSL 是一种主要由韧带构成的解剖结构。单一的 ITSL 定义、其基本形态亚型的标准化以及易于记忆并因此被广泛使用的分类系统,可极大地促进许多外科手术中对这一要素的全面描述、识别和正确处理。
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引用次数: 0
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