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1.
Serge Perrot Anne-Priscille Trouvin Virginie Rondeau Isabelle Chartier Rosine Arnaud Jean-Yves Milon Denis Pouchain 《Joint, bone, spine : revue du rhumatisme》2018,85(1):101-107
Introduction
Physical therapy (PT) represents a major approach in musculoskeletal (MSK) pain. This study aimed to assess kinesiophobia, its impact and management, in patients with MSK pain treated by PT.Methods
A national multicenter, prospective study was conducted in France in patients with MSK pain referred to PT. Kinesiophobia was scored with the Tampa Scale of Kinesiophobia (TSK). Pain, satisfaction, analgesic intake and acceptability were assessed at the initial visit, at the 5th PT session, and at the end of PT.Results
A total of 700 consecutive outpatients with MSK pain, 54.5% female, referred to PT were recruited by 186 GPs: 501 had significant levels of kinesiophobia (TSK score > 40). Patients with kinesiophobia were significantly older, with less physical activity, more pain and less acceptability. Patients from GPs presenting with kinesiophobia had both higher pain and kinesiophobia levels. After 5 PT sessions, global satisfaction was significantly higher in patients without kinesiophobia. A significant increase of PT satisfaction was observed in patients who had been given preventive analgesics before PT sessions, in 25.6% of patients. Independent predictors for specific management of PT-induced pain were: patient's kinesiophobia (OR = 2.02 [1.07–3.82]), current analgesics treatment (OR = 2.05 [1.16–3.63]), GP with postgraduate course on pain (OR = 2.65 [1.29–5.43]), GP's independent practice (OR = 1.88 [1.01–3.48]).Conclusion
Kinesiophobia is frequent in patients with MSK pain, is associated to GPs’ kinesiophobia and decreases satisfaction of physical therapy. Preventive analgesic treatment before PT sessions improves patients’ satisfaction and should be proposed to improve MSK pain management. 相似文献2.
Keiko Uemura Satoki Inoue Masahiko Kawaguchi 《Brazilian Journal of Anesthesiology》2018,68(4):336-343
Background and objectives
Perioperative physicians occasionally encounter situations where central venous catheters placed preoperatively turn out to be unnecessary. The purpose of this retrospective study is to identify the unnecessary application of central venous catheter placement and determine the factors associated with the unnecessary application of central venous catheter placement.Methods
Using data from institutional perioperative central venous catheter surveillance, we analysed data from 1,141 patients who underwent central venous catheter placement. We reviewed the central venous catheter registry and medical charts and allocated registered patients into those with the proper or with unnecessary application of central venous catheter according to standard indications. Multivariate analysis was used to identify factors associated with the unnecessary application of central venous catheter placement.Results
In 107 patients, representing 9.38% of the overall population, we identified the unnecessary application of central venous catheter placement. Multivariate analysis identified emergencies at night or on holidays (odds ratio [OR] 2.109, 95% confidence interval [95% CI] 1.021–4.359), low surgical risk (OR = 1.729, 95% CI 1.038–2.881), short duration of anesthesia (OR = 0.961/10 min increase, 95% CI 0.945–0.979), and postoperative care outside of the intensive care unit (OR = 2.197, 95% CI 1.402–3.441) all to be independently associated with the unnecessary application of catheterization. Complications related to central venous catheter placement when the procedure consequently turned out to be unnecessary were frequently observed (9/107) compared with when the procedure was necessary (40/1034) (p = 0.032, OR = 2.282, 95% CI 1.076–4.842). However, the subsequent multivariate logistic model did not hold this significant difference (p = 0.0536, OR = 2.115, 95% CI 0.988–4.526).Conclusions
More careful consideration for the application of central venous catheter is required in cases of emergency surgery at night or on holidays, during low risk surgery, with a short duration of anesthesia, or in cases that do not require postoperative intensive care. 相似文献3.
Zhao-Kai Low Wai-Yee Ng Stephanie Fook-Chong Bien-Keem Tan Si-Jack Chong Jolie Hwee Sook-Muay Tay 《Burns : journal of the International Society for Burn Injuries》2017,43(2):436-444
Objective
Diabetic burns patients may be at risk of worse clinical outcomes. This study aims to further investigate the impact of diabetes mellitus on clinical outcomes in burns patients in Singapore.Methods
A 3-year retrospective review was performed at the Singapore General Hospital Burns Centre (2011–2013). Pure inhalational burns were excluded. Diabetic (N = 53) and non-diabetic (N = 533) patients were compared, and the impact of diabetes on clinical outcomes, adjusting for confounders, was investigated using multivariate logistic regression.Results
The diabetic group had a significantly higher incidence of wound infection and severe renal impairment, as well as a longer length of stay, higher number of operations and higher rate of unplanned readmission. ICU admission was significantly associated with hyperglycaemia (OR 5.44 [2.61–11.35], p < 0.001) and a higher total body surface area of burn (OR per 1% TBSA 1.07 [1.05–1.09], p < 0.001). Unplanned readmission was significantly associated with wound infection (OR 4.29 [1.70–10.83], p = 0.002), and mortality associated with a higher TBSA (OR per 1% TBSA 1.1 [1.07–1.14], p < 0.001). After adjusting for confounders, diabetes mellitus was not significantly associated with unplanned readmission or mortality.Conclusions
Diabetic burns patients have an increased risk of worse clinical outcomes, including wound infections, renal impairment and longer length of stay. 相似文献4.
Pedro Videira Reis Gabriela Sousa Ana Martins Lopes Ana Vera Costa Alice Santos Fernando José Abelha 《Brazilian Journal of Anesthesiology》2018,68(3):244-253
Background
Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non‐cardiac surgery.Methods
Adult patients admitted at our surgical intensive care unit between January 2006 and July 2013 was included. Univariate analysis was carried using Mann–Whitney, Chi‐square or Fisher's exact test. Logistic regression was performed to assess independent factors with calculation of odds ratio and 95% confidence interval (95% CI).Results
4398 patients were included. Mortality was 1.4% in surgical intensive care unit and 7.4% during hospital stay. Independent predictors of mortality in surgical intensive care unit were APACHE II (OR = 1.24); emergent surgery (OR = 4.10), serum sodium (OR = 1.06) and FiO2 at admission (OR = 14.31). Serum bicarbonate at admission (OR = 0.89) was considered a protective factor. Independent predictors of hospital mortality were age (OR = 1.02), APACHE II (OR = 1.09), emergency surgery (OR = 1.82), high‐risk surgery (OR = 1.61), FiO2 at admission (OR = 1.02), postoperative acute renal failure (OR = 1.96), heart rate (OR = 1.01) and serum sodium (OR = 1.04). Dying patients had higher scores in severity of disease scoring systems and longer surgical intensive care unit stay.Conclusion
Some factors influenced both surgical intensive care unit and hospital mortality. 相似文献5.
Bimal Bhindi Ross J. Mason Mustafa M. Haddad Stephen A. Boorjian Bradley C. Leibovich Thomas D. Atwell Adam J. Weisbrod Grant D. Schmit R. Houston Thompson 《European urology》2018,73(2):254-259
Background
While partial nephrectomy (PN) is considered the standard approach for a tumor in a solitary kidney, percutaneous cryoablation (PCA) is emerging as an alternative nephron-sparing option.Objective
To compare outcomes between PCA and PN for tumors in a solitary kidney.Design, setting, and participants
Patients who underwent PCA or PN between 2005 and 2015 for a single primary renal tumor in a solitary kidney were identified using Mayo Clinic Registries. Exclusion criteria were inherited tumor syndromes and salvage procedures.Intervention
PCA and PN.Outcome measurements and statistical analysis
To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. The risk of having a post-treatment complication and percent drop in estimated glomerular filtration rate (eGFR), as well as the risks of local/ipsilateral recurrence, distant metastasis, and cancer-specific mortality, were compared between groups using logistic, linear, and Fine-and-Gray competing risk regression models.Results and limitations
The cohort included 118 patients (PCA: 54; PN: 64) with a median follow-up of 47 mo (interquartile range 18, 74). In unadjusted analyses, PCA was associated with a lower risk of complications (15% vs 31%; odds ratio [OR] = 0.38; 95% confidence interval [CI] 0.15, 0.96; p = 0.04). However, upon accounting for baseline differences with IPTW adjustment, there was no longer a significant difference in the risk of complications (28% vs 29%; OR = 0.95; 95% CI 0.53, 1.69; p = 0.9). There were no significant differences between PCA and PN in percentage drop in eGFR at discharge (mean: 11% vs 16%; β = –5%; 95% CI –13, 3; p = 0.2) or at 3 mo (12% vs 9%; β = 3%; 95% CI –3, 10; p = 0.3). Likewise, no significant differences were noted in local recurrence (HR = 0.87; 95% CI 0.38, 1.98; p = 0.7), distant metastases (HR = 0.60; 95% CI 0.30, 1.20; p = 0.2), or cancer-specific mortality (HR = 1.13; 95% CI 0.32, 3.98; p = 0.8). Limitations include the sample size, given the relative rarity of renal masses in solitary kidneys.Conclusions
Our study found no significant difference in complications, renal function outcomes, and oncologic outcomes between PN and PCA for patients with a tumor in a solitary kidney. Validation in a larger multi-institutional analysis may be warranted.Patient summary
Partial nephrectomy (surgery) and percutaneous cryoablation are both options for treating a kidney tumor while preserving the normal portion of the kidney. In patients with a tumor in their only kidney, we found no difference in the risk of complications, kidney function outcomes, or cancer control outcomes between these two approaches. 相似文献6.
Jeffrey J. Leow Alexander P. Cole Thomas Seisen Joaquim Bellmunt Matthew Mossanen Mani Menon Mark A. Preston Toni K. Choueiri Adam S. Kibel Benjamin I. Chung Maxine Sun Steven L. Chang Quoc-Dien Trinh 《European urology》2018,73(3):374-382
Background
Radical cystectomy (RC) for muscle-invasive bladder cancer (BCa) has potential for serious complications, prolonged length of stay and readmissions—all of which may increase costs. Although variations in outcomes are well described, less is known about determinants driving variation in costs.Objective
To assess surgeon- and hospital-level variations in costs and predictors of high- and low-cost RC.Design, setting, and participants
Cohort study of 23 173 patients who underwent RC for BCa in 208 hospitals in the USA from 2003 to 2015 in the Premier Healthcare Database.Outcome measurements and statistical analysis
Ninety-day direct hospital costs; multilevel hierarchal linear models were constructed to evaluate contributions of each variable to costs.Results and limitations
Mean 90-d direct hospital costs per RC was $39 651 (standard deviation $34 427), of which index hospitalization accounted for 87.8% ($34 803) and postdischarge readmission(s) accounted for 12.2% ($4847). Postoperative complications contributed most to cost variations (84.5%), followed by patient (49.8%; eg, Charlson Comorbidity Index [CCI], 40.5%), surgical (33.2%; eg, year of surgery [25.0%]), and hospital characteristics (8.0%). Patients who suffered minor complications (odds ratio [OR] 2.63, 95% confidence interval [CI]: 2.03–3.40), nonfatal major complications (OR 12.7, 95% CI: 9.63–16.8), and mortality (OR 13.5, 95% CI: 9.35–19.4, all p < 0.001) were significantly associated with high costs. As for low-cost surgery, sicker patients (CCI = 2: OR 0.41, 95% CI: 0.29–0.59; CCI = 1: OR 0.58, 95% CI: 0.46–0.75, both p < 0.001), those who underwent continent diversion (vs incontinent diversion: OR 0.29, 95% CI: 0.16–0.53, p < 0.001), and earlier period of surgery were inversely associated with low costs.Conclusions
This study provides insight into the determinants of costs for RC. Postoperative morbidity, patient comorbidities, and year of surgery contributed most to observed variations in costs, while other hospital- and surgical-related characteristics such as volume, use of robot assistance, and type of urinary diversion contribute less to outlier costs.Patient summary
Efforts to address high surgical cost must be tailored to specific determinants of high and low costs for each operation. In contrast to robot-assisted radical prostatectomy where surgeon factors predominate, high costs in radical cystectomy were primarily determined by postoperative complication and patient comorbidities. 相似文献7.
8.
A. Suarez-de-la-Rica C. Castro-Arias J. Latorre F. Gilsanz E. Maseda 《Revista espa?ola de anestesiología y reanimación》2018,65(3):143-148
Objectives
to evaluate mortality of patients ≥ 80 years admitted to the Surgical Intensive Care Unit (SICU), global hospital mortality and factors related to it.Material and methods
observational retrospective study of patients ≥ 80 years admitted to SICU between June 2012 and June 2015.Results
a total of 299 patients were included, 54 of them died in the SICU (18.1%) and 80 patients (26.8%) died during their hospital stay. SICU mortality was independently related to age (OR = 1.125; 95%CI: 1.042-1.215; P = .003), SAPS II (OR = 1.026; 95% CI: 1.008-1.044; P = .004), need for renal replacement therapy (RRT) (OR = 1.960; 95%CI: 1.046-3.671; P = .036) and need for mechanical ventilation for more than 24 hours (OR = 2.834; 95%CI: 1.244-6.456; P = .013). Factors independently related to hospital mortality were age (OR = 1.125; 95%CI: 1.054-1.192; P < .001), SOFA score (OR = 1.154; 95% CI: 1.079-1.235; P < .001), need for RRT (OR = 1.924; 95%CI: 1.121-3.302; p = 0.018) and need for mechanical ventilation for more than 24 hours (OR = 3.144; 95% CI: 1.771-5.584; P < .001).Conclusions
In critically ill patients over 80 years hospital mortality was independently related to age, SOFA score, RRT need and need for mechanical ventilation for more than 24 hours. Our results raise important issues about end-of-life care and life-sustaining interventions in elderly, critically ill patients. 相似文献9.
Céline Vidal Cédric Lukas Bernard Combe Francis Berenbaum Yves Marie Pers Christian Jorgensen Jérémie Sellam Jacques Morel 《Joint, bone, spine : revue du rhumatisme》2018,85(4):461-468
Objective
To compare BASDAI 50 response rate to TNFi in axial spondyloarthritis (axSpA) depending on the presence or not of objective signs of axSpA and to look for predictive factors of TNFi efficacy.Methods
Patients diagnosed with axSpA according to ASAS criteria “clinical arm” and treated between January 2001 and September 2015 with TNFi were included. First group included patients with at least one objective sign such as arthritis, dactylitis, enthesitis, uveitis, inflammatory bowel disease, elevated C-reactive protein or radiological sacroiliitis, and second group included non-radiographic axSpA (nr-axSpA) patients without any objective sign corresponding to patients with inflammatory back pain and either a good response to NSAID or a SpA family history. The primary outcome was the TNFi efficacy, defined as an achievement of BASDAI 50 at 3 months. The secondary outcomes were BASDAI 50 achievement over 1 year and analysis of predictive factors of TNFi response.Results
We included 84 nr-axSpA patients without any objective signs and 84 axSpA patients with objective signs (48.2% r-axSpA and 52.8% nr-axSpA). BASDAI 50 achievement rates were significantly higher in patients with objective signs than in patients without, at 3 months (45.1% versus 13.7%, P < 0.0001) and at any of the visit-time points over the first year (61.9% versus 21.4%, P < 0.0001). In multivariate analysis, overweight/obesity and sacroiliitis on MRI were respectively negative and positive predictive factors of TNFi efficacy in the total population at 3 months (OR = 0.32, 95%CI [0.11, 0.96], P = 0.041 and OR = 6.92, 95% CI (2.41, 19.8), P < 0.0001, respectively).Conclusion
TNFi should be used with caution in axSpA when objective signs are absent as only 13.7% of these patients were BASDAI 50 responders at 3 months. 相似文献10.
Boris Gershman Holly K. Van Houten Jeph Herrin Daniel M. Moreira Simon P. Kim Nilay D. Shah R. Jeffrey Karnes 《European urology》2017,71(1):55-65
Background
Prostate biopsy and postbiopsy complications represent important risks of prostate-specific antigen (PSA) screening. Although landmark randomized trials and updated guidelines have challenged routine PSA screening, it is unclear whether these publications have affected rates of biopsy or postbiopsy complications.Objective
To evaluate whether publication of the 2008 and 2012 US Preventive Services Task Force (USPSTF) recommendations, the 2009 European Randomized Study of Screening for Prostate Cancer and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, or the 2013 American Urological Association (AUA) guidelines was associated with changes in rates of biopsy or postbiopsy complications, and to identify predictors of postbiopsy complications.Design, setting, and participants
This quasiexperimental study used administrative claims of 5 279 315 commercially insured US men aged ≥40 yr from 2005 to 2014, of whom 104 584 underwent biopsy.Interventions
Publications on PSA screening.Outcome measurements and statistical analysis
Interrupted time-series analysis was used to evaluate the association of publications with rates of biopsy and 30-d complications. Logistic regression was performed to identify predictors of complications.Results and limitations
From 2005 to 2014, biopsy rates fell 33% from 64.1 to 42.8 per 100 000 person-months, with immediate reductions following the 2008 USPSTF recommendations (?10.1; 95% confidence interval [CI], ?17.1 to ?3.0; p < 0.001), 2012 USPSTF recommendations (?13.8; 95% CI, ?21.0 to ?6.7; p < 0 .001), and 2013 AUA guidelines (?8.8; 95% CI, ?16.7 to ?0.92; p = 0.03). Concurrently, complication rates decreased 10% from 8.7 to 7.8 per 100 000 person-months, with a reduction following the 2012 USPSTF recommendations (?2.5; 95% CI, ?4.5 to ?0.45; p = 0.02). However, the proportion of men undergoing biopsy who experienced complications increased from 14% to 18%, driven by nonsepsis infectious complications (p < 0.001). Predictors of complications included prior fluoroquinolone use (odds ratio [OR]: 1.27; 95% CI, 1.22–1.32; p < 0.001), anticoagulant use (OR: 1.14; 95% CI, 1.04–1.25; p = 0.004), and age ≥70 yr (OR: 1.25; 95% CI, 1.15–1.36; p < 0.001). Limitations included the retrospective design.Conclusions
Although there has been an absolute reduction in rates of biopsy and 30-d complications, the relative morbidity of biopsy continues to increase. These observations suggest a need to reduce the morbidity of biopsy.Patient summary
Absolute rates of biopsy and postbiopsy complications have decreased following landmark publications about prostate-specific antigen screening; however, the relative morbidity of biopsy continues to increase. 相似文献11.
Sam J. Egger Ross J. Calopedos Dianne L. O’Connell Suzanne K. Chambers Henry H. Woo David P. Smith 《European urology》2018,73(6):859-867
Background
Long-term psychological well-being and quality-of-life are important considerations when deciding whether to undergo active treatment for low-risk localised prostate cancer.Objective
To assess the long-term effects of active surveillance (AS) and/or watchful waiting (WW) on psychological and quality-of-life outcomes for low-risk localised prostate cancer patients.Design, setting, and participants
The Prostate Cancer Care and Outcome Study is a population-based prospective cohort study in New South Wales, Australia. Participants for these analyses were low-risk localised prostate cancer patients aged <70 yr at diagnosis and participated in the 10-yr follow-up.Outcome measurements and statistical analysis
Validated instruments assessed outcomes relating to six health-related quality-of-life and nine psychological domains relevant to prostate cancer patients. Adjusted mean differences (AMDs) in outcome scores between prostate cancer treatment groups were estimated using linear regression.Results and limitations
At 9–11 yr after diagnosis, patients who started AS/WW initially had (1) higher levels of distress and hyperarousal than initial radiation/high-dose-rate brachytherapy patients (AMD = 5.9; 95% confidence interval or CI [0.5, 11.3] and AMD = 5.4; 95% CI [0.2, 10.5], respectively), (2) higher levels of distress and avoidance than initial low-dose-rate brachytherapy patients (AMD = 5.3; 95% CI [0.2, 10.3] and AMD = 7.0; 95% CI [0.5, 13.5], respectively), (3) better urinary incontinence scores than initial radical prostatectomy patients (AMD = –9.1; 95% CI [–16.3, –2.0]), and (4) less bowel bother than initial radiation/high-dose-rate brachytherapy patients (AMD = –16.8; 95% CI [–27.6, –6.0]). No other significant differences were found. Limitations include participant attrition, inability to assess urinary voiding and storage symptoms, and nonrandom treatment allocation.Conclusions
Notwithstanding some long-term differences between AS/WW and various active treatment groups in terms of distress, hyperarousal, avoidance, urinary incontinence, and bowel bother, most long-term outcomes were similar between these groups.Patient summary
This study assessed the long-term psychological and quality-of-life impacts of initially monitoring rather than actively treating low-risk prostate cancer. The results suggest that initial monitoring rather than active treatment has only a minor impact on subsequent long-term psychological and quality-of-life outcomes. 相似文献12.
Seyda Efsun Ozgunay Derya Karasu Seyhan Dulger Canan Yilmaz Zeynep Tabur 《Brazilian Journal of Anesthesiology》2018,68(5):462-471
Background
The purpose of the current study was to determine the effects of preoperative cigarette smoking and the carbon monoxide level in the exhaled breath on perioperative respiratory complications in patients undergoing elective laparoscopic cholecystectomies.Methods
One hundred and fifty two patients (smokers, Group S and non‐smokers, Group NS), who underwent laparoscopic cholecystectomies under general anesthesia, were studied. Patients completed the Fagerstrom Test for Nicotine Dependence. The preoperative carbon monoxide level in the exhaled breath levels were determined using the piCO + Smokerlyzer 12 h before surgery. Respiratory complications were recorded during induction of anesthesia, intraoperatively, during extubation, and in the recovery room.Results
Statistically significant increases were noted in group S with respect to the incidence of hypoxia during induction of anesthesia, intraoperative bronchospasm, bronchodilator treatment intraoperatively, and bronchospasm during extubation. The carbon monoxide level in the exhaled breath and the Fagerstrom Test for Nicotine Dependence, and number of cigarettes smoked 12 h preoperatively were designated as covariates in the regression model. Logistic regression analysis of anesthetic induction showed that a 1 unit increase in the carbon monoxide level in the exhaled breath level was associated with a 1.16 fold increase in the risk of hypoxia (OR = 1.16; 95% CI 1.01–1.34; p = 0.038). Logistic regression analysis of the intraoperative course showed that a 1 unit increase in the number of cigarettes smoked 12 h preoperatively was associated with a 1.16 fold increase in the risk of bronchospasm (OR = 1.16; 95% CI 1.04–1.30; p = 0.007). While in the recovery room, a 1 unit increase in the Fagerstrom Test for Nicotine Dependence score resulted in a 1.73 fold increase in the risk of bronchospasm (OR = 1.73; 95% CI 1.04–2.88; p = 0.036).Conclusions
Cigarette smoking was shown to increase the incidence of intraoperative respiratory complications while under general anesthesia. Moreover, the estimated preoperative carbon monoxide level in the exhaled breath level may serve as an indicator of the potential risk of perioperative respiratory complications. 相似文献13.
Robert J. Motzer Alain Ravaud Jean-Jacques Patard Hardev S. Pandha Daniel J. George Anup Patel Yen-Hwa Chang Bernard Escudier Frede Donskov Ahmed Magheli Giacomo Carteni Brigitte Laguerre Piotr Tomczak Jan Breza Paola Gerletti Mariajose Lechuga Xun Lin Michelle Casey Michael Staehler 《European urology》2018,73(1):62-68
Background
Adjuvant sunitinib significantly improved disease-free survival (DFS) versus placebo in patients with locoregional renal cell carcinoma (RCC) at high risk of recurrence after nephrectomy (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.59–0.98; p = 0.03).Objective
To report the relationship between baseline factors and DFS, pattern of recurrence, and updated overall survival (OS).Design, setting, and participants
Data for 615 patients randomized to sunitinib (n = 309) or placebo (n = 306) in the S-TRAC trial.Outcome measurements and statistical analysis
Subgroup DFS analyses by baseline risk factors were conducted using a Cox proportional hazards model. Baseline risk factors included: modified University of California Los Angeles integrated staging system criteria, age, gender, Eastern Cooperative Oncology Group performance status (ECOG PS), weight, neutrophil-to-lymphocyte ratio (NLR), and Fuhrman grade.Results and limitations
Of 615 patients, 97 and 122 in the sunitinib and placebo arms developed metastatic disease, with the most common sites of distant recurrence being lung (40 and 49), lymph node (21 and 26), and liver (11 and 14), respectively. A benefit of adjuvant sunitinib over placebo was observed across subgroups, including: higher risk (T3, no or undetermined nodal involvement, Fuhrman grade ≥2, ECOG PS ≥1, T4 and/or nodal involvement; hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.55–0.99; p = 0.04), NLR ≤3 (HR 0.72, 95% CI 0.54–0.95; p = 0.02), and Fuhrman grade 3/4 (HR 0.73, 95% CI 0.55–0.98; p = 0.04). All subgroup analyses were exploratory, and no adjustments for multiplicity were made. Median OS was not reached in either arm (HR 0.92, 95% CI 0.66–1.28; p = 0.6); 67 and 74 patients died in the sunitinib and placebo arms, respectively.Conclusions
A benefit of adjuvant sunitinib over placebo was observed across subgroups. The results are consistent with the primary analysis, which showed a benefit for adjuvant sunitinib in patients at high risk of recurrent RCC after nephrectomy.Patient summary
Most subgroups of patients at high risk of recurrent renal cell carcinoma after nephrectomy experienced a clinical benefit with adjuvant sunitinib.14.
A. Gotra C. Doucet P. Delli Fraine A. Bessissow C. Dey B. Gallix L.-M. Boucher D. Valenti 《Diagnostic and interventional imaging》2018,99(10):615-624
Purpose
To compare changes in inferior vena cava (IVC) filter positional parameters from insertion to removal and examine how they affect retrievability amongst various filter types.Materials and methods
A total of 447 patients (260 men, 187 women) with a mean age of 55 years (range: 13–91 years) who underwent IVC filter retrieval between 2007–2014 were retrospectively included. Post-insertion and pre-retrieval angiographic studies were assessed for filter tilt, migration, strut wall penetration and retrieval outcomes. ANCOVA and multiple logistic regression models were used to analyze factors affecting retrieval success. Pairwise comparisons between filter types were performed.Results
Of 488 IVC filter retrieval attempts, 94.1% were ultimately successful. The ALN filter had the highest mean absolute value of tilt (5.6 degrees), the Optease filter demonstrated the largest mean migration (?8.0 mm) and the Bard G2 filter showed highest mean penetration (5.2 mm). Dwell time of 0–90 days (OR, 11.1; P = 0.01) or 90–180 days (OR, 2.6; P = 0.02), net tilt of 10–15 degrees (OR 8.9; P = 0.05), caudal migration of ?10 to 0 mm (OR, 3.46; P = 0.03) and penetration less than 3 mm (OR, 2.6; P = 0.01) were positive predictors of successful retrievability. Higher odds of successful retrieval were obtained for the Bard G2X, Bard G2 and Cook Celect when compared to the ALN and Cordis Optease filters.Conclusion
Shorter dwell time, lower mean tilt, caudal migration and less caval wall penetration are positive predictors of successful IVC filter retrieval. 相似文献15.
Troy G. Seelhammer Eric M. DeGraff Travis J. Behrens Justin C. Robinson Kristen L. Selleck Darrell R. Schroeder Juraj Sprung Toby N. Weingarten 《Brazilian Journal of Anesthesiology》2018,68(4):329-335
Background and objectives
The primary aim was to determine risk factors for flumazenil administration during postanesthesia recovery. A secondary aim was to describe outcomes among patients who received flumazenil.Methods
Patients admitted to the postanesthesia recovery room at a large, academic, tertiary care facility after surgery under general anesthesia from January 1, 2010, to April 30, 2015, were identified and matched to 2 controls each, by age, sex, and surgical procedure. Flumazenil was administered in the recovery phase immediately after general anesthesia, according to the clinical judgment of the anesthesiologist. Demographic, procedural, and outcome data were extracted from the electronic health record. Conditional logistic regression, accounting for the 1:2 matched‐set case‐control study designs, was used to assess characteristics associated with flumazenil use.Results
The incidence of flumazenil administration in the postanesthesia care unit was 9.9 per 10,000 (95% CI, 8.4–11.6) general anesthetics. History of obstructive sleep apnea (Odds Ratio [OR] = 2.27; 95% CI 1.02–5.09), longer anesthesia (OR = 1.13; 95% CI 1.03–1.24 per 30 minutes), use of total intravenous anesthesia (OR = 6.09; 95% CI 2.60–14.25), and use of benzodiazepines (OR = 8.17; 95% CI 3.71–17.99) were associated with risk for flumazenil administration. Among patients who received midazolam, cases treated with flumazenil received a higher median (interquartile range) dose than controls: 3.5 mg (2.0–4.0 mg) vs. 2.0 mg (2.0–2.0 mg), respectively (p < 0.001). Flumazenil use was correlated with a higher rate of unanticipated noninvasive positive pressure ventilation, longer postanesthesia care unit stay, and increased rate of intensive care unit admissions.Conclusions
Patients who required flumazenil postoperatively had received a higher dosage of benzodiazepines and utilized more postoperative health care resources. More conservative perioperative use of benzodiazepines may improve postoperative recovery and use of health care resources. 相似文献16.
Karl H. Pang Ruth Groves Suresh Venugopal Aidan P. Noon James W.F. Catto 《European urology》2018,73(3):363-371
Background
Multimodal enhanced recovery after surgery (ERAS) regimens have improved outcomes from colorectal surgery.Objective
We report the application of ERAS to patients undergoing radical cystectomy (RC).Design, setting, and participants
Prospective collection of outcomes from consecutive patients undergoing RC at a single institution.Intervention
Twenty-six components including prehabilitation exercise, same day admission, carbohydrate fluid loading, targeted intraoperative fluid resuscitation, regional local anaesthesia, cessation of nasogastric tubes, omitting oral bowel preparation, avoiding drain use, early mobilisation, chewing gum use, and audit.Outcome measurements and statistical analysis
Primary outcomes were length of stay and readmission rate. Secondary outcomes included intraoperative blood loss, transfusion rates, survival, and histopathological findings.Results and limitations
Four hundred and fifty-three consecutive patients underwent RC, including 393 (87%) with ERAS. Length of stay was shorter with ERAS (median [interquartile range]: 8 [6–13] d) than without (18 [13–25], p < 0.001). Patients with ERAS had lower blood loss (ERAS: 600 [383–969] ml vs 1050 [900–1575] ml for non-ERAS, p < 0.001), lower transfusion rates (ERAS: 8.1% vs 25%, chi-square test, p < 0.001), and fewer readmissions (ERAS: 15% vs 25%, chi-square test, p = 0.04) than those without. Histopathological parameters (eg, tumour stage, node count, and margin state) and survival outcomes did not differ with ERAS use (all p > 0.1). Multivariable analysis revealed ERAS use was (p = 0.002) independently associated with length of stay.Conclusions
The use of ERAS pathways was associated with lower intraoperative blood loss and faster discharge for patients undergoing RC. These changes did not increase readmission rates or alter oncological outcomes.Patient summary
Recovery after major bladder surgery can be improved by using enhanced recovery pathways. Patients managed by these pathways have shorter length of stays, lower blood loss, and lower transfusion rates. Their adoption should be encouraged. 相似文献17.
Lidia Blay Javier Louro Teresa Barata Marisa Baré Joana Ferrer Josep Maria Abad Xavier Castells Maria Sala 《Cirugía espa?ola》2019,97(2):89-96
Introduction
Currently, variability in surgical practice is a problem to be solved. The aim of this study is to describe the variability in the surgical treatment of breast cancer and to analyze the factors associated with it.Methods
The study population included 1057 women diagnosed with breast cancer and surgically treated. Our data were from the CaMISS retrospective cohort.Results
The mean age at diagnosis was 59.3 ± 5 years. A total of 732 patients were diagnosed through screening mammograms and 325 patients as interval cancers. The mastectomy surgery was more frequent in the tumors detected between intervals (OR = 2.5; [95%CI: 1.8-3.4]), although this effect disappeared when we adjusted for the rest of the variables.The most important factor associated with performing a mastectomy was TNM: tumors in stage III-IV had an OR of 7.4 [95%CI: 3.9-13.8], increasing in adjusted OR to 21.7 [95%CI: 11.4-41.8].Histologically, infiltrating lobular carcinoma maintains significance in adjusted OR (OR = 2.5; [95%CI: 1.4-4.7]).According to the screening program, there were significant differences in surgical treatment. Program 3 presented an OR of non-conservative surgery of 4.0 [95%CI: 1.8-8.9]. This program coincided with the highest percentage of reconstruction (58.3%).Conclusions
This study shows that, despite taking into account patient and tumor characteristics, there is great variability in the type of surgery depending on the place of diagnosis. 相似文献18.
Joaquin Mateo Heather H. Cheng Himisha Beltran David Dolling Wen Xu Colin C. Pritchard Helen Mossop Pasquale Rescigno Raquel Perez-Lopez Verena Sailer Michael Kolinsky Ada Balasopoulou Claudia Bertan David M. Nanus Scott T. Tagawa Heather Thorne Bruce Montgomery Suzanne Carreira Johann S. de Bono 《European urology》2018,73(5):687-693
Background
Germline DNA damage repair gene mutation (gDDRm) is found in >10% of metastatic prostate cancer (mPC). Their prognostic and predictive impact relating to standard therapies is unclear.Objective
To determine whether gDDRm status impacts benefit from established therapies in mPC.Design, setting, and participants
This is a retrospective, international, observational study. Medical records were reviewed for 390 mPC patients with known gDDRm status. All 372 patients from Royal Marsden (UK), Weill-Cornell (NY), and University of Washington (WA) were previously included in a prevalence study (Pritchard, NEJM 2016); the remaining 18 were gBRCA1/2m carriers, from the kConFab consortium, Australia.Outcome measurements and statistical analysis
Response rate (RR), progression-free survival (PFS), and overall survival (OS) data were collected. To account for potential differences between cohorts, a mixed-effect model (Weibull distribution) with random intercept per cohort was used.Results and limitations
The gDDRm status was known for all 390 patients (60 carriers of gDDRm [gDDRm+], including 37 gBRCA2m, and 330 cases not found to carry gDDRm [gDDRm–]); 74% and 69% were treated with docetaxel and abiraterone/enzalutamide, respectively, and 36% received PARP inhibitors (PARPi) and/or platinum. Median OS from castration resistance was similar among groups (3.2 vs 3.0 yr, p = 0.73). Median docetaxel PFS for gDDRm+ (6.8 mo) was not significantly different from that for gDDRm– (5.1 mo), and RRs were similar (gDDRm+ = 61%; gDDRm– = 54%). There were no significant differences in median PFS and RR on first-line abiraterone/enzalutamide (gDDRm+ = 8.3 mo, gDDRm– = 8.3 mo; gDDRm+ = 46%, gDDRm– = 56%). Interaction test for PARPi/platinum and gDDRm+ resulted in an OS adjusted hazard ratio of 0.59 (95% confidence interval 0.28–1.25; p = 0.17). Results are limited by the retrospective nature of the analysis.Conclusions
mPC patients with gDDRm appeared to benefit from standard therapies similarly to the overall population; prospective studies are ongoing to investigate the impact of PARPi/platinum.Patient summary
Patients with inherited DNA repair mutations benefit from standard therapies similarly to other metastatic prostate cancer patients. 相似文献19.
Antonio Anzueto Peter M.A. Calverley Achim Mueller Norbert Metzdorf Michaela Haensel José R. Jardim Emilio Pizzichini Horacio Giraldo Alejandra Ramirez-Venegas Eduardo R. Giugno 《Archivos de bronconeumologia》2018,54(3):140-148
Introduction
Geographical variations may impact outcomes in chronic obstructive pulmonary disease (COPD). We evaluated differences in baseline characteristics and outcomes between patients enrolled in Latin America compared with the rest of the world (RoW) in the TIOtropium Safety and Performance In Respimat® (TIOSPIR®) trial.Methods
TIOSPIR®, a 2–3-year, randomized, double-blind trial (n = 17 116; treated set), compared safety and efficacy of once-daily tiotropium Respimat® 5 and 2.5 μg with tiotropium HandiHaler® 18 μg. This post-hoc analysis pooled data from all treatment arms to assess mortality, exacerbations, cardiac events, and serious adverse events (SAEs) between both regions.Results
At baseline, patients enrolled in Latin America (n = 1000) versus RoW (n = 16 116) were older, with higher pack-years of smoking history and more exacerbations, but less cardiac history. In this analysis, patients in Latin America versus RoW had an increased risk of death (hazard ratio [HR] [95% confidence interval (CI)]: 1.52 [1.24–1.86]; P < .0001) or moderate-to-severe exacerbation (HR [95% CI]: 1.29 [1.18–1.41]; P < .0001), but a lower risk of severe exacerbation (HR [95% CI]: 0.82 [0.68–0.98]; P = .0333). SAE rates in Latin America were lower versus RoW (incidence rate ratio [IRR] [95% CI]: 0.82 [0.72–0.92]), including cardiac disorders (IRR [95% CI]: 0.68 [0.48–0.97]). Risk of major adverse cardiovascular events were similar (HR [95% CI]: 0.99 [0.71–1.40]; P = .9677).Conclusions
TIOSPIR® patients in Latin America had a higher risk of death or moderate-to-severe exacerbation, but a lower risk of severe exacerbation than those in RoW. Geographical differences may impact outcomes in COPD trials. 相似文献20.
