首页 > 最新文献

Rambam Maimonides Medical Journal最新文献

英文 中文
Letter to the Editor: Delayed Presentation of Non-COVID-19 Patients During the COVID-19 Pandemic Is Not Limited to Children. 致编辑的信:COVID-19大流行期间非COVID-19患者的延迟就诊不仅限于儿童。
IF 1.5 Q2 Medicine Pub Date : 2021-07-20 DOI: 10.5041/RMMJ.10447
Klaus Rose, Oishi Tanjinatus, Jane Grant-Kels, Earl B Ettienne, Pasquale Striano
We read with interest the report about four minors who were diagnosed late with non-COVID-19 diseases during the COVID-19 pandemic. We would like to emphasize that, firstly, such delays are not limited to minors, and secondly, that also in minors should we distinguish the administrative and the physiological meanings of the term “child” and hence distinguish administratively defined “children” who bodily are already mature from those young patients who bodily are indeed still children. The 16-year-old patient that was presented to the emergency room with endocarditis was bodily no longer a child, although administratively and probably also psychologically, due to his Down syndrome, he was still a child. Two of the other patients, one with hemolytic anemia (2.5 years old) and one with Ewing sarcoma (4 years old), were still pre-pubertal children, while the 13-year-old minor with a septic hip was already adolescent. The author of the cited paper works in a pediatric department and reports those patients that he has seen during his work. However, in our view there is nothing specifically pediatric in his observations. Several recent papers discuss delays of diagnosis and treatment of non-COVID-19 diseases during the pandemic, including head and neck cancer, appendicitis, heart failure and septicemia, pulmonary thromboembolism,6 pyelonephritis, and cancer in general.8 Some patients in these papers are administratively still “children,” some are adults, and appendicitis is discussed in both.3,4 The delay the COVID-19 pandemic has caused in the timely diagnosis of various diseases is not a “pediatric” challenge, but a challenge for medicine in general.
{"title":"Letter to the Editor: Delayed Presentation of Non-COVID-19 Patients During the COVID-19 Pandemic Is Not Limited to Children.","authors":"Klaus Rose, Oishi Tanjinatus, Jane Grant-Kels, Earl B Ettienne, Pasquale Striano","doi":"10.5041/RMMJ.10447","DOIUrl":"https://doi.org/10.5041/RMMJ.10447","url":null,"abstract":"We read with interest the report about four minors who were diagnosed late with non-COVID-19 diseases during the COVID-19 pandemic. We would like to emphasize that, firstly, such delays are not limited to minors, and secondly, that also in minors should we distinguish the administrative and the physiological meanings of the term “child” and hence distinguish administratively defined “children” who bodily are already mature from those young patients who bodily are indeed still children. The 16-year-old patient that was presented to the emergency room with endocarditis was bodily no longer a child, although administratively and probably also psychologically, due to his Down syndrome, he was still a child. Two of the other patients, one with hemolytic anemia (2.5 years old) and one with Ewing sarcoma (4 years old), were still pre-pubertal children, while the 13-year-old minor with a septic hip was already adolescent. The author of the cited paper works in a pediatric department and reports those patients that he has seen during his work. However, in our view there is nothing specifically pediatric in his observations. Several recent papers discuss delays of diagnosis and treatment of non-COVID-19 diseases during the pandemic, including head and neck cancer, appendicitis, heart failure and septicemia, pulmonary thromboembolism,6 pyelonephritis, and cancer in general.8 Some patients in these papers are administratively still “children,” some are adults, and appendicitis is discussed in both.3,4 The delay the COVID-19 pandemic has caused in the timely diagnosis of various diseases is not a “pediatric” challenge, but a challenge for medicine in general.","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39191786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Jewish Values in Medical Decision-making for Unrepresented Patients: A Ritualized Approach. 犹太价值观在医疗决策为无代表的病人:仪式化的方法。
IF 1.5 Q2 Medicine Pub Date : 2021-07-20 DOI: 10.5041/RMMJ.10441
Jason Weiner

Determining appropriate care for patients who cannot speak for themselves is one of the most challenging issues in contemporary healthcare and medical decision-making. While there has been much discussion relating to patients who left some sort of instructions, such as an advance directive, or have someone to speak on their behalf, less has been written on caring for patients who have nobody at all available to speak for them. It is thus crucial to develop clear and rigorous guidelines to properly care for these patients. The Jewish tradition offers an important perspective on caring for unrepresented patients and determining approaches to guide care providers. This article develops an understanding of fundamental Jewish principles that can provide clear guidance in navigating this challenge. It applies those values to a specific set of suggested behaviors, one of which adds a novel ritualized component to what has been recommended by bioethicists in the past.

为不能为自己说话的患者确定适当的护理是当代医疗保健和医疗决策中最具挑战性的问题之一。虽然有很多关于病人留下某种指示的讨论,比如预先指示,或者有人代表他们说话,但很少有人写关于照顾那些根本没有人可以为他们说话的病人的文章。因此,制定明确和严格的指导方针来妥善照顾这些患者是至关重要的。犹太传统提供了一个重要的角度来照顾没有代表的病人和确定方法来指导护理提供者。本文发展了对犹太基本原则的理解,可以为应对这一挑战提供明确的指导。它将这些价值观应用于一组特定的建议行为,其中之一是在过去生物伦理学家推荐的基础上增加了一种新的仪式化成分。
{"title":"Jewish Values in Medical Decision-making for Unrepresented Patients: A Ritualized Approach.","authors":"Jason Weiner","doi":"10.5041/RMMJ.10441","DOIUrl":"https://doi.org/10.5041/RMMJ.10441","url":null,"abstract":"<p><p>Determining appropriate care for patients who cannot speak for themselves is one of the most challenging issues in contemporary healthcare and medical decision-making. While there has been much discussion relating to patients who left some sort of instructions, such as an advance directive, or have someone to speak on their behalf, less has been written on caring for patients who have nobody at all available to speak for them. It is thus crucial to develop clear and rigorous guidelines to properly care for these patients. The Jewish tradition offers an important perspective on caring for unrepresented patients and determining approaches to guide care providers. This article develops an understanding of fundamental Jewish principles that can provide clear guidance in navigating this challenge. It applies those values to a specific set of suggested behaviors, one of which adds a novel ritualized component to what has been recommended by bioethicists in the past.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39239726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
First Admission Neutrophil-Lymphocyte Ratio May Indicate Acute Prognosis of Ischemic Stroke. 初次入院中性粒细胞与淋巴细胞比值可能预示缺血性脑卒中的急性预后。
IF 1.5 Q2 Medicine Pub Date : 2021-07-20 DOI: 10.5041/RMMJ.10440
Murat Alpua, Bahar Say, Ilknur Yardimci, Ufuk Ergün, Ucler Kisa, Ozlem Doğan Ceylan

Objectives: Our study aimed to determine the relationship between serum periostin levels, and the neutrophil-lymphocyte ratio (NLR) with ischemic stroke subtypes, clinical stroke scales, and acute prognosis in patients with acute ischemic stroke.

Materials and methods: Forty-two ischemic stroke patients and 39 age- and sex-matched healthy volunteers were included in our study. Demographic characteristics including age and gender were recorded. Blood serum periostin and NLR values were evaluated in the first 24 hours after admission. Serum periostin levels were compared with healthy controls of similar age and sex. Lesion localization was determined by cranial CT or diffusion MRI of the patients. Stroke scales were recorded on days 1 and 7 of hospitalization in the study group.

Results: The mean serum periostin levels were higher than in the control group, but no statistically significant difference was found. There was no correlation between serum periostin levels and prognosis of stroke. First admission NLRs were statistically higher than in the control group. The first admission NLRs were positively correlated with the first admission National Institute of Health Stroke Scale score and the day 7 modified Rankin score.

Conclusion: Our study is the first study to evaluate both NLR and serum periostin levels in all types of acute ischemic stroke. While our study did not show that first admission serum periostin levels can be used as a biomarker in ischemic stroke, it did indicate that the first admission NLR can be used for acute prognosis of ischemic stroke.

目的:本研究旨在探讨急性缺血性脑卒中患者血清骨膜蛋白水平、中性粒细胞淋巴细胞比(NLR)与缺血性脑卒中亚型、临床脑卒中规模及急性预后的关系。材料与方法:选取42例缺血性脑卒中患者和39例年龄、性别匹配的健康志愿者为研究对象。记录人口统计学特征,包括年龄和性别。入院后24小时测定血清骨膜素和NLR值。比较年龄、性别相近的健康对照者血清骨膜素水平。病变定位由患者头颅CT或弥散性MRI确定。在研究组住院第1天和第7天记录卒中量表。结果:两组患者血清骨膜素水平均高于对照组,但差异无统计学意义。血清骨膜素水平与脑卒中预后无相关性。首次入院nlr显著高于对照组。首次入院nlr与首次入院美国国立卫生研究院卒中量表评分和第7天修正Rankin评分呈正相关。结论:我们的研究是第一个评估所有类型急性缺血性脑卒中患者NLR和血清骨膜蛋白水平的研究。虽然我们的研究没有显示首次入院血清骨膜蛋白水平可以作为缺血性卒中的生物标志物,但它确实表明首次入院NLR可以用于缺血性卒中的急性预后。
{"title":"First Admission Neutrophil-Lymphocyte Ratio May Indicate Acute Prognosis of Ischemic Stroke.","authors":"Murat Alpua,&nbsp;Bahar Say,&nbsp;Ilknur Yardimci,&nbsp;Ufuk Ergün,&nbsp;Ucler Kisa,&nbsp;Ozlem Doğan Ceylan","doi":"10.5041/RMMJ.10440","DOIUrl":"https://doi.org/10.5041/RMMJ.10440","url":null,"abstract":"<p><strong>Objectives: </strong>Our study aimed to determine the relationship between serum periostin levels, and the neutrophil-lymphocyte ratio (NLR) with ischemic stroke subtypes, clinical stroke scales, and acute prognosis in patients with acute ischemic stroke.</p><p><strong>Materials and methods: </strong>Forty-two ischemic stroke patients and 39 age- and sex-matched healthy volunteers were included in our study. Demographic characteristics including age and gender were recorded. Blood serum periostin and NLR values were evaluated in the first 24 hours after admission. Serum periostin levels were compared with healthy controls of similar age and sex. Lesion localization was determined by cranial CT or diffusion MRI of the patients. Stroke scales were recorded on days 1 and 7 of hospitalization in the study group.</p><p><strong>Results: </strong>The mean serum periostin levels were higher than in the control group, but no statistically significant difference was found. There was no correlation between serum periostin levels and prognosis of stroke. First admission NLRs were statistically higher than in the control group. The first admission NLRs were positively correlated with the first admission National Institute of Health Stroke Scale score and the day 7 modified Rankin score.</p><p><strong>Conclusion: </strong>Our study is the first study to evaluate both NLR and serum periostin levels in all types of acute ischemic stroke. While our study did not show that first admission serum periostin levels can be used as a biomarker in ischemic stroke, it did indicate that the first admission NLR can be used for acute prognosis of ischemic stroke.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39241230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Clinical Characteristics and Prognosis of Idiopathic Acute Pancreatitis. 特发性急性胰腺炎的临床特点及预后。
IF 1.5 Q2 Medicine Pub Date : 2021-07-20 DOI: 10.5041/RMMJ.10442
Tzvika Porges, Tali Shafat, Iftach Sagy, Dan Schwarzfuchs, Ilan Rahmani Tzvi-Ran, Alan Jotkowitz, Leonid Barski

Objective: Acute pancreatitis is a serious diagnosis with an increasing incidence in the Western world. In this study we sought to investigate the incidence of idiopathic AP and to compare clinical and prognostic characteristics of idiopathic cases with cases of AP with known etiology.

Methods: In this retrospective study of adult hospitalized patients diagnosed with acute pancreatitis between 2012 and 2015, a comparison was made between admissions of patients with known etiology and those for whom no cause was found. Primary outcome was defined as composite outcome of 30-day mortality and complications.

Results: Among 560 admissions of 437 patients with a primary diagnosis of acute pancreatitis, the main factors identified were gallstones (51.2%) and idiopathic pancreatitis (35.9%), with alcohol ranked third at only 4.8%. Mortality rate within 30 days of hospitalization was 2.9% and within one year was 7.1%. Use of lipid-lowering, anti-hypertensive, and anti-diabetic medications was more frequent among patients with "idiopathic" disease (70%, 68%, and 33% versus 59%, 56%, and 27%, respectively). Patients admitted with idiopathic AP, in comparison to patients with known AP etiology, had milder disease with shorter hospital stay (3 days versus 4, respectively), and less re-admission in 30 days (7.5% versus 21.2%). Idiopathic AP patients had better prognosis in terms of 30-day death and complication (HR 0.33, 95% CI 0.08-0.40, P<0.001).

Conclusion: Idiopathic disease is common among acute pancreatitis patients; the two study groups differed in severity of disease and prognosis. Common use of medications with doubtful value suggests possible under-diagnosis of drug-induced acute idiopathic pancreatitis.

目的:急性胰腺炎是一种严重的诊断,在西方世界发病率越来越高。在这项研究中,我们试图调查特发性AP的发病率,并比较特发性病例与已知病因的AP的临床和预后特征。方法:回顾性研究2012 - 2015年诊断为急性胰腺炎的成人住院患者,比较已知病因与未发现病因的住院患者。主要转归定义为30天死亡率和并发症的综合转归。结果:在560,437例初诊急性胰腺炎患者中,确定的主要因素是胆结石(51.2%)和特发性胰腺炎(35.9%),酒精排在第三位,仅为4.8%。住院30天内死亡率为2.9%,1年内死亡率为7.1%。在“特发性”疾病患者中,使用降脂、降压和抗糖尿病药物的频率更高(分别为70%、68%和33%,而不是59%、56%和27%)。与已知AP病因的患者相比,特发性AP患者病情较轻,住院时间较短(分别为3天和4天),30天内再入院率较低(7.5%对21.2%)。特发性AP患者在30天死亡和并发症方面预后较好(HR 0.33, 95% CI 0.08-0.40, p)。两个研究组在疾病严重程度和预后方面存在差异。普遍使用的药物价值可疑提示可能对药物性急性特发性胰腺炎诊断不足。
{"title":"Clinical Characteristics and Prognosis of Idiopathic Acute Pancreatitis.","authors":"Tzvika Porges,&nbsp;Tali Shafat,&nbsp;Iftach Sagy,&nbsp;Dan Schwarzfuchs,&nbsp;Ilan Rahmani Tzvi-Ran,&nbsp;Alan Jotkowitz,&nbsp;Leonid Barski","doi":"10.5041/RMMJ.10442","DOIUrl":"https://doi.org/10.5041/RMMJ.10442","url":null,"abstract":"<p><strong>Objective: </strong>Acute pancreatitis is a serious diagnosis with an increasing incidence in the Western world. In this study we sought to investigate the incidence of idiopathic AP and to compare clinical and prognostic characteristics of idiopathic cases with cases of AP with known etiology.</p><p><strong>Methods: </strong>In this retrospective study of adult hospitalized patients diagnosed with acute pancreatitis between 2012 and 2015, a comparison was made between admissions of patients with known etiology and those for whom no cause was found. Primary outcome was defined as composite outcome of 30-day mortality and complications.</p><p><strong>Results: </strong>Among 560 admissions of 437 patients with a primary diagnosis of acute pancreatitis, the main factors identified were gallstones (51.2%) and idiopathic pancreatitis (35.9%), with alcohol ranked third at only 4.8%. Mortality rate within 30 days of hospitalization was 2.9% and within one year was 7.1%. Use of lipid-lowering, anti-hypertensive, and anti-diabetic medications was more frequent among patients with \"idiopathic\" disease (70%, 68%, and 33% versus 59%, 56%, and 27%, respectively). Patients admitted with idiopathic AP, in comparison to patients with known AP etiology, had milder disease with shorter hospital stay (3 days versus 4, respectively), and less re-admission in 30 days (7.5% versus 21.2%). Idiopathic AP patients had better prognosis in terms of 30-day death and complication (HR 0.33, 95% CI 0.08-0.40, P<0.001).</p><p><strong>Conclusion: </strong>Idiopathic disease is common among acute pancreatitis patients; the two study groups differed in severity of disease and prognosis. Common use of medications with doubtful value suggests possible under-diagnosis of drug-induced acute idiopathic pancreatitis.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39191343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Response to Letter to the Editor: Delayed Presentation of Non-COVID-19 Patients During the COVID-19 Pandemic Is Not Limited to Children. 对致编辑的信的回复:在COVID-19大流行期间,非COVID-19患者的延迟就诊不仅限于儿童。
IF 1.5 Q2 Medicine Pub Date : 2021-07-20 DOI: 10.5041/RMMJ.10448
Yonatan Yeshayahu
I read with interest the letter by Klaus Rose et al. regarding the article about delayed diagnosis of severe medical conditions during the coronavirus disease 2019 (COVID-19) pandemic.1 The authors stressed the importance of recognizing that delayed presentation of patients, during the COVID-19 pandemic, was not limited to the pediatric population. I agree with this important point, and the article does not claim otherwise. The presented cases are pediatric, given that they took place in a pediatric department, but it is reasonable to assume that adults have faced the same challenges.
{"title":"Response to Letter to the Editor: Delayed Presentation of Non-COVID-19 Patients During the COVID-19 Pandemic Is Not Limited to Children.","authors":"Yonatan Yeshayahu","doi":"10.5041/RMMJ.10448","DOIUrl":"https://doi.org/10.5041/RMMJ.10448","url":null,"abstract":"I read with interest the letter by Klaus Rose et al. regarding the article about delayed diagnosis of severe medical conditions during the coronavirus disease 2019 (COVID-19) pandemic.1 The authors stressed the importance of recognizing that delayed presentation of patients, during the COVID-19 pandemic, was not limited to the pediatric population. I agree with this important point, and the article does not claim otherwise. The presented cases are pediatric, given that they took place in a pediatric department, but it is reasonable to assume that adults have faced the same challenges.","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39191787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Circulating Proprotein Convertase Subtilisin/Kexin Type 9 Levels Predict Future Cardiovascular Event Risks in Hemodialyzed Black African Patients. 循环蛋白转化酶枯草杆菌素/可辛9型水平预测血液透析黑人患者未来心血管事件风险
IF 1.5 Q2 Medicine Pub Date : 2021-07-20 DOI: 10.5041/RMMJ.10443
François-Pantaléon Musungayi Kajingulu, François Bompeka Lepira, Aliocha Natuhoyila Nkodila, Jean-Robert Rissassy Makulo, Vieux Momeme Mokoli, Pepe Mfutu Ekulu, Justine Busanga Bukabau, Yannick Mayamba Nlandu, Augustin Luzayadio Longo, Nazaire Mangani Nseka, Ernest Kiswaya Sumaili

Context and objective: Cardiovascular diseases are the leading cause of mortality in patients. In this context, proprotein convertase subtilisin/kexin type 9 (PCSK9) appears to be the new biomarker identified as interfering in lipid homeostasis. This study aimed to investigate the association between PCSK9, dyslipidemia, and future risk of cardiovascular events in a population of black Africans.

Methods: A cross-sectional study was conducted between August 2016 and July 2020 in six hemodialysis centers in the city of Kinshasa, Democratic Republic of the Congo. Serum PCSK9 was measured by ELISA; lipid levels of 251 chronic kidney disease grade 5 (CKD G5) hemodialysis patients and the Framingham predictive instrument were used for predicting cardiac events.

Results: Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) were significantly increased in the tertile with the highest PCSK9. By contrast, high-density lipoprotein cholesterol (HDL-c) was significantly decreased in the same tertile. A strong positive and significant correlation was found between PCSK9 and TC, TG, and LDL-c. Negative and significant correlation was observed between PCSK9 and HDL-c. The levels of PCSK9, smoking, overweight, and atherogenic dyslipidemia were associated with future risks for cardiovascular events in univariate analysis. After adjustment, all these variables persisted as independent determinants of future risk for cardiovascular events. The probability of having a cardiovascular event in this population was independently associated with PCSK9 levels. Compared to the patients in the lowest PCSK9 tertile, patients with PCSK9 levels in the middle (aOR 5.9, 95% CI 2.06-17.3, P<0.001) and highest tertiles (aOR 8.9, 95% CI 3.02-25.08, P<0.001) presented a greater risk of cardiac event.

Conclusion: Increased PCSK9 serum levels are associated with higher levels of TC, LDL-c, and TG and lower levels of HDL-c in black African hemodialysis patients. Serum PCSK9 levels in these patients predict increased risk of cardiovascular events, independent of traditional potential confounders.

背景和目的:心血管疾病是患者死亡的主要原因。在这种情况下,蛋白转化酶枯草素/酮蛋白9型(PCSK9)似乎是被鉴定为干扰脂质稳态的新生物标志物。本研究旨在调查非洲黑人人群中PCSK9、血脂异常和未来心血管事件风险之间的关系。方法:2016年8月至2020年7月,在刚果民主共和国金沙萨市的六个血液透析中心进行了一项横断面研究。ELISA法检测血清PCSK9;251例慢性肾脏疾病5级(CKD G5)血液透析患者的血脂水平和Framingham预测仪用于预测心脏事件。结果:总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-c)和甘油三酯(TG)在PCSK9最高的小鼠中显著升高。相比之下,同一品种的高密度脂蛋白胆固醇(HDL-c)显著降低。PCSK9与TC、TG、LDL-c呈显著正相关。PCSK9与HDL-c呈显著负相关。在单变量分析中,PCSK9水平、吸烟、超重和动脉粥样硬化性血脂异常与心血管事件的未来风险相关。调整后,所有这些变量仍然是未来心血管事件风险的独立决定因素。该人群发生心血管事件的概率与PCSK9水平独立相关。与PCSK9水平最低的患者相比,PCSK9水平处于中等水平的患者(aOR 5.9, 95% CI 2.06-17.3)。结论:在非洲黑人血液透析患者中,PCSK9血清水平升高与TC、LDL-c和TG水平升高以及HDL-c水平降低相关。这些患者的血清PCSK9水平预测心血管事件风险增加,独立于传统的潜在混杂因素。
{"title":"Circulating Proprotein Convertase Subtilisin/Kexin Type 9 Levels Predict Future Cardiovascular Event Risks in Hemodialyzed Black African Patients.","authors":"François-Pantaléon Musungayi Kajingulu,&nbsp;François Bompeka Lepira,&nbsp;Aliocha Natuhoyila Nkodila,&nbsp;Jean-Robert Rissassy Makulo,&nbsp;Vieux Momeme Mokoli,&nbsp;Pepe Mfutu Ekulu,&nbsp;Justine Busanga Bukabau,&nbsp;Yannick Mayamba Nlandu,&nbsp;Augustin Luzayadio Longo,&nbsp;Nazaire Mangani Nseka,&nbsp;Ernest Kiswaya Sumaili","doi":"10.5041/RMMJ.10443","DOIUrl":"https://doi.org/10.5041/RMMJ.10443","url":null,"abstract":"<p><strong>Context and objective: </strong>Cardiovascular diseases are the leading cause of mortality in patients. In this context, proprotein convertase subtilisin/kexin type 9 (PCSK9) appears to be the new biomarker identified as interfering in lipid homeostasis. This study aimed to investigate the association between PCSK9, dyslipidemia, and future risk of cardiovascular events in a population of black Africans.</p><p><strong>Methods: </strong>A cross-sectional study was conducted between August 2016 and July 2020 in six hemodialysis centers in the city of Kinshasa, Democratic Republic of the Congo. Serum PCSK9 was measured by ELISA; lipid levels of 251 chronic kidney disease grade 5 (CKD G5) hemodialysis patients and the Framingham predictive instrument were used for predicting cardiac events.</p><p><strong>Results: </strong>Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) were significantly increased in the tertile with the highest PCSK9. By contrast, high-density lipoprotein cholesterol (HDL-c) was significantly decreased in the same tertile. A strong positive and significant correlation was found between PCSK9 and TC, TG, and LDL-c. Negative and significant correlation was observed between PCSK9 and HDL-c. The levels of PCSK9, smoking, overweight, and atherogenic dyslipidemia were associated with future risks for cardiovascular events in univariate analysis. After adjustment, all these variables persisted as independent determinants of future risk for cardiovascular events. The probability of having a cardiovascular event in this population was independently associated with PCSK9 levels. Compared to the patients in the lowest PCSK9 tertile, patients with PCSK9 levels in the middle (aOR 5.9, 95% CI 2.06-17.3, P<0.001) and highest tertiles (aOR 8.9, 95% CI 3.02-25.08, P<0.001) presented a greater risk of cardiac event.</p><p><strong>Conclusion: </strong>Increased PCSK9 serum levels are associated with higher levels of TC, LDL-c, and TG and lower levels of HDL-c in black African hemodialysis patients. Serum PCSK9 levels in these patients predict increased risk of cardiovascular events, independent of traditional potential confounders.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39191344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Incidence of Cardiac Manifestations in Children with Dengue Fever: A Cross-sectional Study. 登革热患儿心脏表现的发生率:一项横断面研究。
IF 1.5 Q2 Medicine Pub Date : 2021-04-29 DOI: 10.5041/RMMJ.10436
Janakiraman Abhinayaa, Saji James, Rathinasamy Jebaraj, Ponnurangam Nagarajan Vinoth

Objective: The aim of our study was to explore the incidence of cardiac involvement in children with dengue infection admitted in a tertiary care hospital and to evaluate the features of cardiac involvement with the severity of dengue fever.

Methods: This was a cross-sectional study conducted from September 2014 to August 2016. A total of 130 patients with confirmed dengue NS1 antigen or IgM antibody positivity between the ages of 1 month and 18 years were evaluated. On the third day of admission, blood samples for cardiac markers were collected, and electrocardiograms (ECG) and echocardiograms were performed for each patient.

Results: Of the 130 dengue patients in the study, 60 (46.2%) were males and 70 (53.8%) were females (male to female ratio, 1:1.16). Cardiac involvement was present in 60 (46.2%) children and was more prominent in children with severe dengue (72.7%), followed by dengue with warning symptoms (53.8%) and dengue fever (28.6%). There was no significant correlation between cardiac involvement and primary/secondary dengue. Both ECG and echocardiography changes were significantly correlated with dengue severity, as opposed to cardiac markers.

Conclusions: Cardiac involvement was present in children with dengue. Evaluation with ECG, echocardiography, and cardiac markers such as creatine phosphokinase-myocardial band (CPK-MB) are required for the management of cardiac complications in children with dengue. Our study showed an association between cardiac involvement and the severity of dengue. Further studies should be framed, and follow-up of dengue patients with cardiac involvement is necessary for therapeutic management.

目的:本研究的目的是探讨三级医院收治的登革热感染儿童心脏受累的发生率,并评估登革热严重程度的心脏受累特征。方法:于2014年9月至2016年8月进行横断面研究。对130例年龄在1个月至18岁之间确诊登革热NS1抗原或IgM抗体阳性的患者进行评估。入院第3天采血检测心脏标志物,并行心电图、超声心动图检查。结果:130例登革热患者中,男性60例(46.2%),女性70例(53.8%),男女比例为1:1.16。60例(46.2%)患儿心脏受累,重症登革热患儿心脏受累更为突出(72.7%),其次是有警告症状的登革热(53.8%)和登革热(28.6%)。心脏受累与原发性/继发性登革热之间没有显著相关性。与心脏标志物相反,心电图和超声心动图变化与登革热严重程度显著相关。结论:登革热患儿存在心脏受累。评估心电图、超声心动图和心脏标志物,如肌酸磷酸激酶-心肌带(CPK-MB)是处理登革热儿童心脏并发症的必要条件。我们的研究表明,心脏受累与登革热的严重程度之间存在关联。进一步的研究应该框架,并随访登革患者的心脏累及是必要的治疗管理。
{"title":"Incidence of Cardiac Manifestations in Children with Dengue Fever: A Cross-sectional Study.","authors":"Janakiraman Abhinayaa,&nbsp;Saji James,&nbsp;Rathinasamy Jebaraj,&nbsp;Ponnurangam Nagarajan Vinoth","doi":"10.5041/RMMJ.10436","DOIUrl":"https://doi.org/10.5041/RMMJ.10436","url":null,"abstract":"<p><strong>Objective: </strong>The aim of our study was to explore the incidence of cardiac involvement in children with dengue infection admitted in a tertiary care hospital and to evaluate the features of cardiac involvement with the severity of dengue fever.</p><p><strong>Methods: </strong>This was a cross-sectional study conducted from September 2014 to August 2016. A total of 130 patients with confirmed dengue NS1 antigen or IgM antibody positivity between the ages of 1 month and 18 years were evaluated. On the third day of admission, blood samples for cardiac markers were collected, and electrocardiograms (ECG) and echocardiograms were performed for each patient.</p><p><strong>Results: </strong>Of the 130 dengue patients in the study, 60 (46.2%) were males and 70 (53.8%) were females (male to female ratio, 1:1.16). Cardiac involvement was present in 60 (46.2%) children and was more prominent in children with severe dengue (72.7%), followed by dengue with warning symptoms (53.8%) and dengue fever (28.6%). There was no significant correlation between cardiac involvement and primary/secondary dengue. Both ECG and echocardiography changes were significantly correlated with dengue severity, as opposed to cardiac markers.</p><p><strong>Conclusions: </strong>Cardiac involvement was present in children with dengue. Evaluation with ECG, echocardiography, and cardiac markers such as creatine phosphokinase-myocardial band (CPK-MB) are required for the management of cardiac complications in children with dengue. Our study showed an association between cardiac involvement and the severity of dengue. Further studies should be framed, and follow-up of dengue patients with cardiac involvement is necessary for therapeutic management.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38862320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Salivary Biomarker Levels and Oral Health Status of Children with Cerebral Palsy and Their Healthy Siblings: A Comparative Study. 脑瘫儿童及其健康兄弟姐妹唾液生物标志物水平与口腔健康状况的比较研究
IF 1.5 Q2 Medicine Pub Date : 2021-04-29 DOI: 10.5041/RMMJ.10437
Palanichamy Anjugam, Veerabadhran Mahesh Mathian, Murugesan Gawthaman, Selvaraj Vinod, Easwaramurthy Yamuna Devi

Background: The dental needs of cerebral palsy children are an area of study much in need of attention. The neglect of this aspect should be rectified, and simpler diagnostic methodologies should be established and used to serve this purpose.

Aim: This study aimed to determine oral health status and salivary biomarkers (salivary flow rate, pH, buffering capacity) among children with cerebral palsy (CP), to compare their data with that of their healthy siblings, and to evaluate the relationship between salivary biomarkers and dental caries.

Methods: A total of 30 CP children (study group) and 30 normal healthy siblings (controls) were selected between the ages of 5 and 12 years. Salivary biomarkers were assessed, and oral health status was examined.

Statistical analysis: Chi-square test was used for comparison of oral health status. Unpaired t test was used to compare caries indexes (decay/filled teeth-primary dentition [dft] and decay/missing/filled teeth-permanent dentition [DMFT]) and salivary biomarkers between the groups. Pearson correlation was used to find the correlation between salivary biomarkers and caries.

Results: The dft scores were significantly higher in the study group (P<0.05). The pH values and salivary flow rates were significantly lower in the study group (P<0.05 and P<0.001, respectively). There was a significant correlation between DMFT scores and salivary flow rate in the study group (P<0.05).

Conclusion: Low pH and low salivary flow rate might be risk factors for dental caries in CP populations; moreover, the significant correlation between DMFT score and salivary flow rate suggests that salivary flow rate could be used as a screening tool for assessing at-risk subjects in such populations.

背景:脑瘫儿童的牙科需求是一个非常需要关注的研究领域。应该纠正对这方面的忽视,应该建立和使用更简单的诊断方法来达到这一目的。目的:本研究旨在测定脑瘫儿童的口腔健康状况和唾液生物标志物(唾液流速、pH值、缓冲能力),并将其与健康兄弟姐妹的数据进行比较,并评估唾液生物标志物与龋病的关系。方法:选取5 ~ 12岁的CP患儿30例(研究组)和正常健康兄弟姐妹30例(对照组)。评估唾液生物标志物,并检查口腔健康状况。统计学分析:口腔健康状况比较采用卡方检验。采用非配对t检验比较各组龋病指数(蛀牙/补牙-初级牙列[dft]和蛀牙/缺牙/补牙-恒牙列[DMFT])和唾液生物标志物。采用Pearson相关性分析唾液生物标志物与龋病的相关性。结论:低pH值和低唾液流率可能是CP人群发生龋病的危险因素;此外,DMFT评分与唾液流率之间的显著相关性表明,唾液流率可以作为评估这些人群中高危受试者的筛查工具。
{"title":"Salivary Biomarker Levels and Oral Health Status of Children with Cerebral Palsy and Their Healthy Siblings: A Comparative Study.","authors":"Palanichamy Anjugam,&nbsp;Veerabadhran Mahesh Mathian,&nbsp;Murugesan Gawthaman,&nbsp;Selvaraj Vinod,&nbsp;Easwaramurthy Yamuna Devi","doi":"10.5041/RMMJ.10437","DOIUrl":"https://doi.org/10.5041/RMMJ.10437","url":null,"abstract":"<p><strong>Background: </strong>The dental needs of cerebral palsy children are an area of study much in need of attention. The neglect of this aspect should be rectified, and simpler diagnostic methodologies should be established and used to serve this purpose.</p><p><strong>Aim: </strong>This study aimed to determine oral health status and salivary biomarkers (salivary flow rate, pH, buffering capacity) among children with cerebral palsy (CP), to compare their data with that of their healthy siblings, and to evaluate the relationship between salivary biomarkers and dental caries.</p><p><strong>Methods: </strong>A total of 30 CP children (study group) and 30 normal healthy siblings (controls) were selected between the ages of 5 and 12 years. Salivary biomarkers were assessed, and oral health status was examined.</p><p><strong>Statistical analysis: </strong>Chi-square test was used for comparison of oral health status. Unpaired t test was used to compare caries indexes (decay/filled teeth-primary dentition [dft] and decay/missing/filled teeth-permanent dentition [DMFT]) and salivary biomarkers between the groups. Pearson correlation was used to find the correlation between salivary biomarkers and caries.</p><p><strong>Results: </strong>The dft scores were significantly higher in the study group (P<0.05). The pH values and salivary flow rates were significantly lower in the study group (P<0.05 and P<0.001, respectively). There was a significant correlation between DMFT scores and salivary flow rate in the study group (P<0.05).</p><p><strong>Conclusion: </strong>Low pH and low salivary flow rate might be risk factors for dental caries in CP populations; moreover, the significant correlation between DMFT score and salivary flow rate suggests that salivary flow rate could be used as a screening tool for assessing at-risk subjects in such populations.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38862321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Delayed Presentation of Children to Healthcare Facilities due to COVID-19 Lockdown, Leading to Severe Complications. 由于COVID-19封锁,儿童延迟到医疗机构就诊,导致严重并发症。
IF 1.5 Q2 Medicine Pub Date : 2021-04-29 DOI: 10.5041/RMMJ.10431
Yonatan Yeshayahu

During the coronavirus disease 2019 (COVID-19) pandemic, the increasing fear of leaving home and entering hospitals, together with guidelines to the public from Israel's Ministry of Health recommending the use of telemedicine rather than physical visits to the doctor, led to delayed diagnoses of non-COVID-19-related medical conditions. This research letter presents a cluster of severe medical conditions that were delayed in diagnosis due to postponed presentation to healthcare facilities during the COVID-19 pandemic. Ewing sarcoma, severe hemolytic anemia, endocarditis requiring surgery, and septic hip requiring surgery are some examples of cases we encountered with delayed diagnoses. This led to the appearance of a rather low burden of disease in the pediatric population during the pandemic, and pediatric hospitals and clinics experienced a very low volume of activity. Given the low burden of COVID-19 in children, and the well-defined separation between infected and non-infected areas within the hospitals, we should consider improving the guidelines and messages conveyed to the public regarding the importance of prompt medical assessment for other medical conditions, even during a pandemic, along with reassurance of the safety of entering medical facilities given the strict isolation procedures being observed. Conclusion: Medical associations should reconsider the messages being sent to the public during future outbreaks, and encourage medical assessment.

在2019年冠状病毒病(COVID-19)大流行期间,人们越来越害怕离开家和进入医院,再加上以色列卫生部向公众发布的指南建议使用远程医疗,而不是亲自去看医生,导致与COVID-19无关的医疗状况的诊断被延误。本研究信函介绍了在COVID-19大流行期间由于推迟向医疗机构就诊而延误诊断的一系列严重疾病。尤因肉瘤、严重溶血性贫血、需要手术的心内膜炎和需要手术的脓毒性髋关节是我们遇到的延迟诊断的一些例子。这导致大流行期间儿科人口的疾病负担相当低,儿科医院和诊所的活动量非常低。鉴于2019冠状病毒病对儿童的负担较低,以及医院内感染区和非感染区有明确的区分,我们应该考虑改进向公众传达的指导方针和信息,即即使在大流行期间,也要对其他医疗状况进行及时医疗评估,同时在遵守严格隔离程序的情况下,确保进入医疗设施的安全性。结论:医学协会应重新考虑在未来疫情期间向公众发送的信息,并鼓励医学评估。
{"title":"Delayed Presentation of Children to Healthcare Facilities due to COVID-19 Lockdown, Leading to Severe Complications.","authors":"Yonatan Yeshayahu","doi":"10.5041/RMMJ.10431","DOIUrl":"https://doi.org/10.5041/RMMJ.10431","url":null,"abstract":"<p><p>During the coronavirus disease 2019 (COVID-19) pandemic, the increasing fear of leaving home and entering hospitals, together with guidelines to the public from Israel's Ministry of Health recommending the use of telemedicine rather than physical visits to the doctor, led to delayed diagnoses of non-COVID-19-related medical conditions. This research letter presents a cluster of severe medical conditions that were delayed in diagnosis due to postponed presentation to healthcare facilities during the COVID-19 pandemic. Ewing sarcoma, severe hemolytic anemia, endocarditis requiring surgery, and septic hip requiring surgery are some examples of cases we encountered with delayed diagnoses. This led to the appearance of a rather low burden of disease in the pediatric population during the pandemic, and pediatric hospitals and clinics experienced a very low volume of activity. Given the low burden of COVID-19 in children, and the well-defined separation between infected and non-infected areas within the hospitals, we should consider improving the guidelines and messages conveyed to the public regarding the importance of prompt medical assessment for other medical conditions, even during a pandemic, along with reassurance of the safety of entering medical facilities given the strict isolation procedures being observed. Conclusion: Medical associations should reconsider the messages being sent to the public during future outbreaks, and encourage medical assessment.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25361357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 6
Retrospective Evaluation of Factors Affecting Lymph Node Retrieval Following Gastrectomies with Oncologic Intent. 有肿瘤目的的胃切除术后影响淋巴结恢复的因素的回顾性评价。
IF 1.5 Q2 Medicine Pub Date : 2021-04-29 DOI: 10.5041/RMMJ.10434
Steven Fuchs, Itamar Ashkenazi

Background: Adequate lymphadenectomy is an important factor affecting survival in gastric cancer patients. Retrieval and examination of at least 15 lymph nodes is recommended in order to properly stage gastric malignancies. The objectives of this study were to evaluate the proportion of patients undergoing inadequate lymphadenectomies and possible risk factors for inadequate surgery.

Methods: This was a retrospective study that included patients, 18 years and older, who underwent gastrectomies with oncologic intent in the Hillel Yaffe Medical Center. We analyzed the association of demographic, clinical, and pathological variables with adequate number of lymph nodes.

Results: The retrieval of less than 15 lymph nodes was reported in 51% (53/104) patients undergoing gastrectomies with oncologic intent. The extent of surgery was the only variable associated with inadequate lymphadenectomy on univariate analysis: subtotal/proximal versus total gastrectomy (P=0.047). Differences observed for previous surgery (P=0.193), T stage (P=0.053), N stage (P=0.051), and lymphovascular invasion (P=0.14) did not reach significance. Subtotal/proximal gastrectomy resulted in inadequate resection of lymph nodes in 56% of the patients, while this occurred in only 30% of the patients undergoing total gastrectomy (relative risk 1.865; 95% CI 0.93, 3.741). Logistic regression confirmed that only subtotal/proximal versus total gastrectomy was associated with inadequate number of lymph nodes resected (P=0.043).

Discussion and conclusion: In this study we analyzed the association of patient, tumor, and surgery-related factors on adequate lymphadenectomy in patients undergoing gastrectomies for possible gastric cancer. Larger extent of the surgery (total, rather than subtotal/proximal gastrectomy) was revealed to be the only indicator positively associated with adequate lymphadenectomy.

背景:充分的淋巴结切除术是影响胃癌患者生存的重要因素。为了正确分期胃恶性肿瘤,推荐至少15个淋巴结的恢复和检查。本研究的目的是评估接受不适当淋巴结切除术的患者比例以及不适当手术的可能危险因素。方法:这是一项回顾性研究,包括18岁及以上在Hillel Yaffe医学中心接受肿瘤目的胃切除术的患者。我们分析了人口统计学、临床和病理变量与淋巴结数量充足的关系。结果:51%(53/104)有肿瘤目的的胃切除术患者的淋巴结切除少于15个。在单因素分析中,手术范围是与淋巴结切除不充分相关的唯一变量:胃次全切除术/近端切除术与全胃切除术(P=0.047)。既往手术(P=0.193)、T期(P=0.053)、N期(P=0.051)、淋巴血管侵犯(P=0.14)差异均无统计学意义。胃大部/近端切除术导致56%的患者未完全切除淋巴结,而在全胃切除术患者中仅30%出现这种情况(相对风险为1.865;95% ci 0.93, 3.741)。Logistic回归证实,只有次全/近端胃切除术与全胃切除术与淋巴结切除数量不足相关(P=0.043)。讨论与结论:在本研究中,我们分析了患者、肿瘤和手术相关因素与可能发生胃癌的胃切除术患者充分切除淋巴结的关系。更大的手术范围(全胃切除术,而不是胃次全切除术/近端切除术)是与充分的淋巴结切除术呈正相关的唯一指标。
{"title":"Retrospective Evaluation of Factors Affecting Lymph Node Retrieval Following Gastrectomies with Oncologic Intent.","authors":"Steven Fuchs,&nbsp;Itamar Ashkenazi","doi":"10.5041/RMMJ.10434","DOIUrl":"https://doi.org/10.5041/RMMJ.10434","url":null,"abstract":"<p><strong>Background: </strong>Adequate lymphadenectomy is an important factor affecting survival in gastric cancer patients. Retrieval and examination of at least 15 lymph nodes is recommended in order to properly stage gastric malignancies. The objectives of this study were to evaluate the proportion of patients undergoing inadequate lymphadenectomies and possible risk factors for inadequate surgery.</p><p><strong>Methods: </strong>This was a retrospective study that included patients, 18 years and older, who underwent gastrectomies with oncologic intent in the Hillel Yaffe Medical Center. We analyzed the association of demographic, clinical, and pathological variables with adequate number of lymph nodes.</p><p><strong>Results: </strong>The retrieval of less than 15 lymph nodes was reported in 51% (53/104) patients undergoing gastrectomies with oncologic intent. The extent of surgery was the only variable associated with inadequate lymphadenectomy on univariate analysis: subtotal/proximal versus total gastrectomy (P=0.047). Differences observed for previous surgery (P=0.193), T stage (P=0.053), N stage (P=0.051), and lymphovascular invasion (P=0.14) did not reach significance. Subtotal/proximal gastrectomy resulted in inadequate resection of lymph nodes in 56% of the patients, while this occurred in only 30% of the patients undergoing total gastrectomy (relative risk 1.865; 95% CI 0.93, 3.741). Logistic regression confirmed that only subtotal/proximal versus total gastrectomy was associated with inadequate number of lymph nodes resected (P=0.043).</p><p><strong>Discussion and conclusion: </strong>In this study we analyzed the association of patient, tumor, and surgery-related factors on adequate lymphadenectomy in patients undergoing gastrectomies for possible gastric cancer. Larger extent of the surgery (total, rather than subtotal/proximal gastrectomy) was revealed to be the only indicator positively associated with adequate lymphadenectomy.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38942472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
期刊
Rambam Maimonides Medical Journal
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1