34,131 results on '"Statistical significance"'
Search Results
2. Phonation Resistance Training Exercises (PhoRTE) With and Without Expiratory Muscle Strength Training (EMST) For Patients With Presbyphonia: A Noninferiority Randomized Clinical Trial
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Edie R. Hapner, Michael A. Belsky, Scott D. Rothenberger, Sandeep Shelly, Aaron Ziegler, Amanda I. Gillespie, Jackie Gartner-Schmidt, and Bari Hoffman
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medicine.medical_specialty ,business.industry ,Voice therapy ,Resistance training ,Repeated measures design ,Expiratory Muscle Strength Training ,LPN and LVN ,law.invention ,030507 speech-language pathology & audiology ,03 medical and health sciences ,Speech and Hearing ,0302 clinical medicine ,Otorhinolaryngology ,Quality of life ,Randomized controlled trial ,law ,Statistical significance ,Physical therapy ,Medicine ,Phonation ,030223 otorhinolaryngology ,0305 other medical science ,business - Abstract
Presbyphonia negatively impacts quality of life in patients with age-related voice changes. A proof-of-concept study showed promise for high vocal intensity exercise to treat presbyphonia, which became the basis for a novel intervention for age-related voice changes known as Phonation Resistance Training Exercises (PhoRTE). Expiratory Muscle Strength Training (EMST) has also been proposed as an additional intervention to target and strengthen the aging respiratory system; however, EMST has undergone limited evaluation as an adjunct treatment for elderly patients undergoing voice therapy for presbyphonia. This study determined if the addition of EMST to PhoRTE voice therapy (PhoRTE + EMST) is at least as effective at voice improvement as PhoRTE alone.Prospective, randomized, controlled, single-blinded, non-inferiority.Participants aged 55 years or older with a diagnosis of vocal fold atrophy were randomized to complete PhoRTE therapy or PhoRTE + EMST. The primary outcome was change in Voice Handicap Index-10 (VHI-10). Secondary outcomes included the Aging Voice Index, maximum expiratory pressure, and acoustic and aerodynamic measures of voice. Repeated measures linear mixed models were constructed to analyze outcomes at a significance level of α = 0.10.Twenty-six participants were recruited for the study, and 24 participants were randomized to either treatment arm. Sixteen participants completed the entire study. Both treatment arms showed statistically significant and clinically meaningful improvements in VHI-10 (PhoRTE mean [M] = -8.20, P0.001; PhoRTE + EMST M = -9.58, P0.001), and PhoRTE + EMST was noninferior to PhoRTE alone (P = 0.069). Both groups experienced a statistically significant pre-post treatment decrease (improvement) in AVI scores (PhoRTE M = -18.40, P = 0.004; PhoRTE + EMST M = -16.28, P = 0.005). PhoRTE+EMST had statistically significantly greater changes in maximum expiratory pressure compared to PhoRTE alone (PhoRTE M = 8.24 cm HThis study demonstrates that voice therapy targeting high vocal intensity exercise (eg, PhoRTE) and EMST can play a role in improving voice outcomes for patients with presbyphonia.
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- 2023
3. HIV And HCV adherence and treatment outcomes among people who inject drugs receiving opioid agonist therapy
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Alain H. Litwin, Julia H. Arnsten, Hadi J Minhas, Moonseong Heo, Matthew J. Akiyama, and Brianna L. Norton
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medicine.medical_specialty ,Health (social science) ,Social Psychology ,Treatment outcome ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Antiviral Agents ,Drug Users ,Alcohol intoxication ,Opioid Agonist ,Statistical significance ,Internal medicine ,Medicine ,Humans ,Hiv treatment ,Substance Abuse, Intravenous ,business.industry ,Public Health, Environmental and Occupational Health ,virus diseases ,Opioid use disorder ,Hepatitis C, Chronic ,medicine.disease ,digestive system diseases ,Analgesics, Opioid ,Treatment Outcome ,Anti-Retroviral Agents ,business ,Viral load - Abstract
Among people who inject drugs (PWID), 60% have HCV and 50-90% of HIV-infected PWID are co-infected with HCV. Data comparing adherence to direct-acting antiviral (DAA) therapy among HCV mono-infected and HIV/HCV co-infected PWID is limited. The impact of HCV treatment initiation on HIV antiretroviral therapy (ART) adherence is also poorly understood. We assessed DAA adherence in HCV mono-infected and HIV/HCV co-infected PWID and examined changes in ART adherence and HIV outcomes following HCV treatment. Study was conducted in three Medication for Opioid use Disorder (MOUD) programs in Bronx, New York. HCV treatment adherence was measured using electronic blister packs. 2-week DAA adherence rates were compared and controlled for study arm, psychiatric illness and alcohol intoxication within the past 30 days. ART adherence was measured using participant self-report and dichotomized to "excellent" or "other". ART adherence, CD4 count, and HIV viral load were identified six months prior to, during, and six months after HCV treatment. Statistical significance was assessed with mixed-effects regression linear or logistic models. Overall DAA adherence rates among HCV mono-infected and HIV/HCV co-infected PWID were 74% (95% CI=71-78%) and 76% (95%CI=70-83%), respectively (p=.55). There were no significant changes in ART adherence, CD4 counts, or HIV viral loads prior to, during, or after HCV treatment. This is the first study assessing the impact of DAA therapy on ART adherence and HIV treatment outcomes among PWID. It is one of the first to compare DAA adherence among HCV and HIV/HCV co-infected PWID. Our data demonstrate no significant difference in DAA adherence and no significant impact of HCV treatment on ART adherence or HIV outcomes.
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- 2023
4. The Comparison of Narrow Band Imaging, White Light Laryngoscopy and Videolaryngostroboscopy in the Evaluation of Benign Vocal Fold Lesions
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Yetkin Zeki Yilmaz, H. Ozdogan, Ahmet Ataş, Begum Bahar Yilmaz, Müge Ugurlar, Züleyha Dilek Gülmez, and Aysegul Batioglu-Karaaltin
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medicine.medical_specialty ,medicine.diagnostic_test ,Fold (higher-order function) ,business.industry ,Laryngoscopy ,Sulcus ,LPN and LVN ,medicine.disease ,Endoscopy ,030507 speech-language pathology & audiology ,03 medical and health sciences ,Speech and Hearing ,0302 clinical medicine ,medicine.anatomical_structure ,Otorhinolaryngology ,Statistical significance ,medicine ,White light ,Radiology ,030223 otorhinolaryngology ,0305 other medical science ,business ,Phoniatrics ,Vocal-fold cyst - Abstract
The aim of the study was comparing the diagnostic role of the white light (WL) endoscopy, video laryngostroboscopy (VLS), and narrow-band imaging (NBI) in the evaluation of the benign vocal fold lesions.From March 2018 to June 2019, a total of 118 cases were enrolled in this study. Ninety-eight patients were suspected with vocal fold nodules, cysts, polyps, and sulcus vocalis and 20 patients without a history of dysphonia. Each patient was examined by WL, VLS, and NBI endoscopy. Recorded images and videos were analyzed and scored by three otorhinolaryngologists who had at least 3 years of experience in phoniatrics field. The evaluation results were compared between the methods and the physicians.A total of 118 cases were grouped by their confirmed diagnosis, vocal fold nodules (n = 28), vocal fold cyst (n = 24), vocal fold polyp (n = 9), and sulcus vocalis (n = 37). When the correct diagnosis rates of the physicians were compared, the statistical significance was found between the physicians in the WL and VLS method (P= 0.014, P= 0.027). No statistically significant difference was found among physicians in NBI method (P = 0.368). The difference between the diagnostic methods was found to be statistically significant in reaching the accurate diagnosis for benign vocal fold lesions (P0.001). While the difference between NBI-WL and VLS-WL was statistically significant (P0.001 and P0.001). The difference between NBI-VLS was not statistically significant while evaluating the vocal fold nodules, cysts, and sulcus vocalis separately (P= 0.102, P = 0.026, P = 0.157). Otherwise, it was statistically significant (P= 0.002) while evaluating total benign lesions in the study. The difference between NBI-VLS combination and VLS, NBI-VLS combination and VLS-WL combination were statistically significant (P0.001 and P= 0.001).This study showed that NBI assessments have similar accuracy and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to VLS and have a higher value than WL endoscopy in reaching the diagnosis for benign vocal fold lesions. Therefore, NBI can be accepted as a promising approach to identify benign laryngeal lesions due to its optical properties.
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- 2023
5. Predictive factors for return to work or study and satisfaction in traumatic brachial plexus injury individuals undergoing rehabilitation: A retrospective follow-up study of 101 cases
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Roberta Temporal Soares, Márcio de Mendonça Cardoso, Ana Lúcia Lima Cabral, Andreia Gushikem, Jesiniana Rodrigues Silva, Herilckmans Belnis Tonha Moreira Isidro, Juliana Barnetche Kauer, and Camila Sodré Mendes Barros
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medicine.medical_specialty ,Rehabilitation ,business.industry ,medicine.medical_treatment ,Follow up studies ,Physical Therapy, Sports Therapy and Rehabilitation ,Retrospective cohort study ,Return to work ,medicine.disease ,Patient satisfaction ,Brachial plexus injury ,Statistical significance ,Physical therapy ,Medicine ,business ,Rehabilitation interventions - Abstract
Background An important focus of rehabilitation is thereturn to the meningful occupations which may include work and school activities. Purpose The aim of this study is to investigate predictive factors for return to work/study in traumatic brachial plexus injury patients undergoing rehabilitation and to investigate the level of satisfaction with treatment. Study Design Retrospective observational study with at least 1 year of follow-up. Methods One hundred and one individuals with traumatic brachial plexus injury enrolled in this study. Primary outcomes were return to work/study and satisfaction with treatment. A secondary outcome was the self-perception of what influenced return to work. Sociodemographic and related to injury data, rehabilitation interventions, muscle strength, and disability were analyzed as predictors. Associations were investigated using univariable and discriminant analysis and considered a level of significance of P Results Return to work/study occurred in 55% of the patients who participated in this study. Muscle strength discerned those who returned to work. Time interval between trauma and surgery and age were lower in those who returned to work. Thirty-one patients answered the question regarding self-perception of what influenced return to work. They indicated “necessity”, “rehabilitation”, “my desire” and “not become depressed”. Satisfaction was graded between 8.9 and 9.5 in 95% of the cases. Conclusions Return to work/study was related to muscle strength improvement and those who returned were younger and had less time elapsed from trauma. Individual factors and rehabilitation were pointed out as helpful in aiding return to work. Satisfaction with treatment was high. These findings can help to optimize goals in the rehabilitation environment.
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- 2023
6. Foramen tympanicum prevalence in the population of Southeast Brazil: a morphological study in computed tomography scans
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Ana Cláudia Rossi, Alexandre Rodrigues Freire, Paulo Roberto Botacin, Felippe Bevilacqua Prado, T M C Ribeiro, and E Daruge Júnior
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Adult ,Male ,Histology ,Adolescent ,Population ,Computed tomography ,Young Adult ,Statistical significance ,Prevalence ,Foramen ,Humans ,Medicine ,Child ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,Temporomandibular Joint ,medicine.diagnostic_test ,business.industry ,Skull ,Anatomy ,Middle Aged ,Sagittal plane ,Temporomandibular joint ,Exact test ,medicine.anatomical_structure ,Coronal plane ,Female ,Tomography, X-Ray Computed ,business ,Ear Canal - Abstract
Background: The foramen tympanicum is located on the anteroinferior region of the external acoustic meatus and posteromedial to the temporomandibular joint in children between the first and the fifth year of life. It is considered an anatomical variation when it persists in adults. The aim of this study was to verify the prevalence as well as to characterize the foramen tympanicum in CT scans of the population from southeastern Brazil. Materials and methods: A total of 78 CT scans of dry human skulls were used, which were selected randomly regarding the ages, ranged from 15 to 100 years, and composed a total of 20 female and 58 males. The foramen tympanicum was identified in the images of the axial plane and confirmed in the images of the coronal and sagittal planes. The largest diameter (in mm) was obtained. The descriptive statistics (in %), Fisher's test and chi-square test (χ2) were performed to compare the prevalence of foramen tympanicum between sexes and sides. The probability value ≤ 0.05 was defined as a level of significance. Descriptive statistics were performed to verify the mean diameter of the foramen on the right and left sides of the skulls. Results: The prevalence of foramen tympanicum was higher in females (P = 0.0070), bilaterally, as the absolute values of females were lower in relation to males. Fisher's exact test showed that the prevalence of foramen tympanicum was significantly higher in females (45%) than in males (15.52%). On the right side, the mean axial diameter was 2.23 mm (range 0.93–3.75 mm). On the left side, the mean axial diameter was 2.22 mm (range 0.9–3.61 mm). Conclusions: The knowledge of anatomical variations is extremally valuable for an accurate diagnosis, treatment plan and prognosis and a thorough preoperative assessment.
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- 2022
7. Efficacy of Transcutaneous Electrical Nerve Stimulation and Interferential Current on Tactile Acuity of Individuals With Nonspecific Chronic Low Back Pain
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Saturday Nicholas Oghumu, Bosede Abidemi Tella, and Caleb Ademola Gbiri
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medicine.medical_specialty ,Electric Stimulation Therapy ,Transcutaneous electrical nerve stimulation ,law.invention ,law ,Statistical significance ,medicine ,Humans ,Pain Management ,Pain Measurement ,business.industry ,General Medicine ,Anthropometry ,Tactile acuity ,Low back pain ,Chronic low back pain ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Neurology ,Transcutaneous Electric Nerve Stimulation ,Physical therapy ,Neurology (clinical) ,Analysis of variance ,medicine.symptom ,business ,Low Back Pain ,Body mass index - Abstract
OBJECTIVES Transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) are pain electrotherapies with questioned efficacy. Studies of their effects on tactile acuity of individuals with nonspecific chronic low back pain (NSCLBP) are limited, hence, this study. MATERIALS AND METHODS Thirty-three individuals with NSCLBP randomly allocated into three groups completed this study. Data collected from participants included age, gender, and anthropometric characteristics of height, weight, body mass index, and percentage body fat measured with standard instruments. Also, participants' tactile acuity, pain intensity, and disability were assessed before and after interventions with digital caliper, numerical pain rating scale, and Roland-Morris Disability Questionnaire, respectively. Interventions consisted of stretching, strengthening, and stabilization exercises to all three groups in addition of TENS to group 1 and IFC to group 2, respectively, for five weeks. Descriptive statistics of mean and standard deviation summarized the data. Inferential statistics of paired t-test, independent t-test, and analysis of variance tested the level of significance among variables at p ≤ 0.05. RESULTS Tactile acuity was significantly (p
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- 2022
8. Effect of applying head-shaking maneuver before Epley maneuver in BPPV
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Engin Cekin, Selin Güleryüz, Eyup Baz, Evren Erkul, and Suphi Bulğurcu
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medicine.medical_specialty ,Benign paroxysmal positional vertigo ,medicine.medical_treatment ,Canalolithiasis ,Epley maneuver ,Dizziness ,Otolith ,Utricle ,Statistical significance ,Vertigo ,otorhinolaryngologic diseases ,Humans ,Medicine ,Benign Paroxysmal Positional Vertigo ,Physical Therapy Modalities ,biology ,business.industry ,Posterior Semicircular Canal ,medicine.disease ,biology.organism_classification ,Semicircular Canals ,Head shaking ,Treatment Outcome ,Otorhinolaryngology ,Berg Balance Scale ,Physical therapy ,sense organs ,medicine.symptom ,business ,Balance problems - Abstract
Introduction The Epley maneuver is applied in the treatment of benign paroxysmal positional vertigo, the BPPV. However, dizziness and balance problems do not improve immediately after the treatment. Objective In this study, the effectiveness of the head-shaking maneuver before the Epley maneuver was investigated in the treatment of BPPV. Methods Between March 2020 and August 2020, ninety-six patients with posterior semicircular canal BPPV were analyzed prospectively. The patients were divided into two groups: patients who underwent the Epley maneuver only in the treatment (Group 1) and patients who underwent the Epley maneuver after the head-shaking maneuver (Group 2). The results of the Berg balance scale and dizziness handicap index were evaluated before the treatment and at the first week after the treatment. Results The improvement in functional, emotional, and physical dizziness handicap index and Berg balance scale values after the treatment was found to be statistically significant in both groups. It was determined that the change in functional and physical dizziness handicap index and Berg balance scale values of the patients in Group 2 was statistically higher than those in Group 1. Although, the change in emotional dizziness handicap index values in Group 2 was higher than those in Group 1, no statistical significance was found between the groups. Conclusion As a result of our hypothesis, we think that in the treatment of posterior semicircular canal BPPV, the otoliths adhered to the canal can be mobilized by the head-shaking maneuver, and this will contribute to the increase of the effectiveness of the Epley maneuver.
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- 2022
9. Correlation and agreement of olfactory perception assessed by the Connecticut Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test
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Fernando Augusto Lima Marson, Fernanda Rodrigues Cunha, Marcello Bailarini Aniteli, and Eulalia Sakano
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Olfactory perception ,medicine.medical_specialty ,Intraclass correlation ,Olfaction ,Audiology ,Correlation ,Olfaction Disorders ,03 medical and health sciences ,0302 clinical medicine ,Statistical significance ,Humans ,Medicine ,UPSIT ,030223 otorhinolaryngology ,business.industry ,Olfactory Perception ,B-SIT ,Test (assessment) ,Smell ,Connecticut ,Clinical research ,Otorhinolaryngology ,Odorants ,Mann–Whitney U test ,business ,030217 neurology & neurosurgery - Abstract
Introduction Assessing olfactory perception in olfactory disorders is of utmost importance in therapy management. However, the University of Pennsylvania Smell Identification Test and the Sniffin’ Sticks are the only tests validated in Brazil. Objectives To evaluate the correlation and agreement between the Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test – University of Pennsylvania Smell Identification Test – in healthy participants and in participants with olfactory disorders based on the results and technical aspects of both tests. Methods Fifty participants without olfactory complaints and 50 participants with olfactory disorders who underwent the Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test were included. The following tests were used for statistical analysis: Mann-Whitney U test, Spearman’s correlation, intraclass correlation coefficient and Bland-Altman plot. An alpha error (significance level) of 0.05 was considered in the statistical analysis. Results Both tests were effective in distinguishing the groups without the presence of overlapping values for the measured markers. Additionally, there was a strong correlation between Spearman’s correlation and intraclass correlation coefficient between the tests and for both nostrils. However, the correlations were lower when the groups were individually evaluated. The Bland-Altman plot showed no bias when all participants were simultaneously evaluated. Conclusions The tests to assess olfactory perception presented a high level of agreement. In our sample, we could infer that the Connecticut Chemosensory Clinical Research Center olfactory test is similar to the Brief-Smell Identification Test and can be used in the routine diagnosis of patients with complaints of olfactory disorders, considering the advantage of its low cost.
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- 2022
10. Effect of orthodontic maxillary posterior en masse intrusion anchored with miniplates on maxillary sinuses volume. Retrospective CBCT study
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Mauricio de Almeida Cardoso, Ertty Ertty, Maila Izabela Pêsso Portes, Fernanda Meloti, Tien-Li An, and Ana Cláudia de Castro Ferrreira Conti
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Adult ,Male ,Orthodontics ,Cone beam computed tomography ,Maxillary sinus ,Intraclass correlation ,business.industry ,Spiral Cone-Beam Computed Tomography ,Cone-Beam Computed Tomography ,Maxillary Sinus ,Volume change ,Intrusion ,medicine.anatomical_structure ,Otorhinolaryngology ,Statistical significance ,Maxilla ,medicine ,Humans ,Female ,Surgery ,Oral Surgery ,business ,Sinus (anatomy) ,Retrospective Studies ,Volume (compression) - Abstract
Objective : To evaluate, by means of cone beam computed tomography (CBCT), the volume change of maxillary sinuses in patients that underwent orthodontic maxillary posterior en masse intrusion anchored with miniplates. Materials and Methods : The sample consisted of pretreatment (T1) and posttreatment (T2) CBCT scans obtained from 14 patients (4 male and 10 female), with a mean age of 32.4 years, that underwent orthodontic maxillary posterior en masse intrusion anchored with miniplates in the zygomatic crest. The mean treatment duration was 20 months and the mean intrusion movement was 2.4 mm. Maxillary sinus volume was measured by means of the software ITK SNAP (version 3.8.0) in T1 and T2 CBCT scans. The changes in sinuses volume were calculated by T1-T2 values. Data were analyzed statistically with Wilcoxon test at 5% of level of significance and the method error was analyzed with Wilcoxon test, intraclass correlation and Dahlberg's formula. Results : The mean difference (T1-T2) was -242.85 mm³ (p = 0.396) for the right sinus and -32.5 mm³ (p = 0.875) for the left sinus. A slight increase in the volume of the sinuses was shown although these results were not statistically significant. Conclusion : The orthodontic maxillary posterior en masse intrusion anchored with miniplates did not influence significantly the maxillary sinus volume.
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- 2022
11. Nonsupercharged Retrosternal Roux-en-Y Esophagojejunostomy for Distal Esophageal Reconstruction
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Madhuri V. Rao, Amit Bhargava, Rafael S. Andrade, Jesse E. Doyle, Qi Wang, Ilitch Diaz-Gutierrez, and Kaustav Majumder
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Pulmonary and Respiratory Medicine ,Leak ,medicine.medical_specialty ,Anastomotic Leak ,Constriction, Pathologic ,Anastomosis ,Jejunum ,Postoperative Complications ,Gastrectomy ,Stomach Neoplasms ,Statistical significance ,medicine ,Humans ,Retrospective Studies ,business.industry ,Stomach ,Anastomosis, Surgical ,Anastomosis, Roux-en-Y ,Perioperative ,Roux-en-Y anastomosis ,Surgery ,Exact test ,medicine.anatomical_structure ,Laparoscopy ,Cardiology and Cardiovascular Medicine ,business - Abstract
Delayed distal esophageal reconstruction with nonsupercharged jejunum is an option when gastric conduit is not available. This study aimed to describe a single-center experience with distal esophageal reconstruction with retrosternal Roux-en-Y esophagojejunostomy (RYEJ) and compare perioperative outcomes with retrosternal gastric pull-up (GP).An Institutional Review Board-exempt retrospective chart review was conducted of patients who underwent esophagostomy closure by the retrosternal route at the University of Minnesota Medical Center (Minneapolis, MN) from January 2009 to July 2019. Patients with colonic conduits were excluded. The study compared patients with RYEJ with a contemporary cohort of patients who underwent GP. The anatomic criteria for RYEJ were the absence of a gastric conduit and an esophageal remnant that reached the sternomanubrial joint. Patient characteristics, anastomotic leak and stricture rate, postoperative complications, hospital length of stay, 30-day readmission, and 90-day mortality were recorded. Statistical analysis was performed using the Fisher exact test and the Wilcoxon rank-sum test with a significance level at P ≤.05.A total of 9 patients underwent RYEJ, and 10 patients had GP. Previous esophageal adenocarcinoma was more common in the RYEJ group (n = 5) compared with the GP group (n = 0) (P = .01). Patient demographics and comorbidities were comparable between the groups. No differences were found in all end points, including operating time, estimated blood loss, anastomotic leak or stricture rate, Clavien-Dindo class III to IV complications, hospital length of stay, or mortality.Retrosternal RYEJ without microvascular augmentation is a safe alternative for esophagostomy closure in patients with adequate esophageal length when the stomach is not available. The nonsupercharged jejunum can safely reach the level of the sternomanubrial joint.
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- 2022
12. Can high b-value 3.0 T biparametric MRI with the Simplified Prostate Image Reporting and Data System (S-PI-RADS) be used in biopsy-naïve men?
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Zegu Chen, Guang Yang, Haixia Xu, Jing Chen, Guoren Wang, Gang Yu, Gang Wang, and Zhiming Bai
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Image-Guided Biopsy ,Male ,medicine.medical_specialty ,Prostate biopsy ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Biopsy ,Prostate ,Prostatic Neoplasms ,Magnetic resonance imaging ,medicine.disease ,Magnetic Resonance Imaging ,PI-RADS ,Prostate cancer ,medicine.anatomical_structure ,Statistical significance ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Retrospective Studies - Abstract
Objective To analyze the clinical value of high b-value 3.0 T biparametric magnetic resonance with the Simplified Prostate Image Reporting and Data System (S-PI-RADS) in biopsy-naive men. Methods A retrospective analysis of the data of 224 patients who underwent prostate biopsy (cognitive fusion targeted biopsy combined with systematic biopsy) after a high b-value 3.0 T magnetic resonance examination at Haikou Hospital from July 2018 to July 2020 was performed. Two radiologists performed multi-parameter magnetic resonance imaging (mp-MRI) with the prostate imaging report and data system version 2 (PI-RADS v2) and biparametric magnetic resonance imaging (bp-MRI) with the simplified prostate image reporting and data system (S-PI-RADS). The detection efficacy of the two regimens was evaluated by classifying prostate cancer (PCa) and clinically significant prostate cancer (csPCa) according to pathology, and the statistical significance of the differences between the two regimens was determined by Z-test. Results The area under the receiver operating curve (AUC) values of mp-MRI based on PI-RADS v2 and bp-MRI based on S-PI-RADS to detect PCa were 0.905 and 0.892, respectively, while the AUC values for the detection of csPCa were 0.919 and 0.906, respectively. There was no statistically significant difference between the two tests (Z values were 0.909 and 1.145, p > 0.05). Conclusion There was no significant difference in the detection efficacy of high b-value bp-MRI based on the S-PI-RADS score for prostate cancer and clinically significant prostate cancer compared with the standard PI-RADS v2 score with mp-MRI protocols, which can be applied clinically.
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- 2022
13. Acupuncture for dysmenorrhea of adenomyosis: A randomized controlled trial 针刺治疗子宫腺肌病痛经:随机对照试验
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Xiao-man Cheng, Ting Nie, Zi-xia Cheng, and Li-ying Tian
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Visual analogue scale ,business.industry ,Therapeutic effect ,Endometriosis ,Ibuprofen ,medicine.disease ,Complementary and alternative medicine ,Oral administration ,Anesthesia ,Statistical significance ,medicine ,Acupuncture ,Adenomyosis ,business ,medicine.drug - Abstract
Objective: To compare the difference in the clinical therapeutic effect on dysmenorrhea in the patients with adenomyosis between acupuncture and ibuprofen sustained release capsules. Methods: A total of 40 patients were randomized into an acupuncture group and an ibuprofen group, 20 cases in each one. The treatment was given consecutively for 3 menstrual cycles and the follow-up lasted for 2 menstrual cycles. The score of visual analogue scale (VAS) at the most painful time during menstruation, menstrual flow, the score of COX menstrual symptom scale (CMSS) and the score of endometriosis health profile-5 (EHP-5), as well as the patients’ satisfaction and acceptance were compared between the two groups. Results: Three menstrual cycles after treatment, the VAS score at the most painful time, menstrual flow, CMSS score and EHP-5 score were all lower than those before treatment in either group, with statistical significance (all P 0.05), the menstrual flow was lower (P > 0.05), CMSS score was higher (P 0.05). The score of the patients’ satisfaction and acceptance in the acupuncture group were all higher than the ibuprofen group (both P Conclusion: Acupuncture is effective for analgesia and symptom-relief and the long-term effect is superior to the oral administration of ibuprofen.
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- 2022
14. Effects of Voiced Gargling on the Electrical Activity of Extrinsic Laryngeal Muscles and Vocal Self-assessment
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Geová Oliveira de Amorim, Patricia Maria Mendes Balata, Amabelle Ayssa Santos da Rocha Albuquerque, Leandro de Araújo Pernambuco, Hilton Justino da Silva, and Ana Clara Amorim Sarmento Vieira
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Adult ,Male ,Larynx ,Self-Assessment ,medicine.medical_specialty ,Voice Quality ,Electromyography ,Audiology ,Glissando ,030507 speech-language pathology & audiology ,03 medical and health sciences ,Speech and Hearing ,0302 clinical medicine ,Phonation ,Statistical significance ,medicine ,Humans ,Gargling ,030223 otorhinolaryngology ,medicine.diagnostic_test ,business.industry ,LPN and LVN ,Voice Training ,medicine.anatomical_structure ,Otorhinolaryngology ,Laryngeal Muscle ,Female ,Laryngeal Muscles ,0305 other medical science ,business - Abstract
Summary Objective To verify the immediate effects of voiced gargling on the electrical activity of extrinsic laryngeal muscles and vocal self-assessment. Methods A sample of 20 individuals of both sexes, mean age of 31.95 (±11.57) years, were equally divided in two groups according to the presence or absence of vocal complaint. Both groups were evaluated by surface electromyography of the suprahyoid (SH) and infrahyoid (IH) muscle areas during rest, phonation of the sustained vowel [Ɛ] in habitual and strong intensities; phonation of rising and falling glissando; and counting from 1 to 10. Surface electromyography was assessed before and after the voiced gargling exercise, which lasted 1 minute. All participants self-rated their voice and phonatory comfort after the exercise. Wilcoxon and Mann-Whitney tests were applied, as well as Fisher's exact test and linear-to-linear test. The level of significance was 5%. Results The percentage of electrical activity of the SH muscle area decreased in the glissando and counting tasks in the group with vocal complaint, as well as in phonation of sustained vowel in strong intensity in the group without complaint. Decrease was also observed in the right IH muscle area at rest and during sustained vowel phonation at habitual and strong intensities. Percentage of muscular electrical activity was lower in the group with complaint in the following situations: IH muscle area on both sides, at rest and during habitual phonation of sustained vowel and glissando before and after the exercise; right IH muscle area, during counting and strong phonation of sustained vowel before and after exercise; left IH muscle area, in the counting task, just after intervention. Most participants noticed improvement in voice (70%) and phonatory comfort (65%). Conclusions Voiced gargling during 1 minute promotes immediate effects on the electrical activity of the extrinsic laryngeal muscles in individuals with or without vocal complaint. Most individuals reported improved voice and phonatory comfort after exercise.
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- 2022
15. Final adult height in childhood-onset inflammatory bowel disease
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Gabriele Cont, Egidio Barbi, Andrea Taddio, Luca Ronfani, Marcella Montico, Alessandro Ventura, Eva Da Dalt, P. Salierno, and Matteo Bramuzzo
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medicine.medical_specialty ,business.industry ,Retrospective cohort study ,Disease ,medicine.disease ,Ulcerative colitis ,Inflammatory bowel disease ,Adult height ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,030225 pediatrics ,Internal medicine ,Statistical significance ,Cohort ,Pediatrics, Perinatology and Child Health ,medicine ,In patient ,business - Abstract
Background Long term growth may be compromised in patients with Inflammatory Bowel Disease (IBD). The aims of the study were to evaluate the final height in a cohort of patients with pediatric-onset IBD with respect to genetic target and to determine factors influencing long-term growth. Methods This is a monocentric retrospective cohort study. All patients with diagnosed prepubertal onset IBD were enrolled. Patients were classified into two groups on the basis of the achievement of target height at time of the last follow-up. Clinical parameters were also recorded. Results 82 patients were identified: 42 with Crohn's Disease (CD) and 40 with Ulcerative Colitis (UC). The mean age at diagnosis was 11.0 (SD 4.0) years. Eighty-nine percent of patients achieved final target height. Mean difference between final and target height was -1.2 cm (SD: 5,4). No statistical significance was detected between CD and UC patients final height (p=0.16). Growth failure at the diagnosis and disease severity were the only factors associated with final height achievement failure (p=0.001 and p=0.01 respectively). Conclusions Most part of CD and UC patients achieve the target final height. Disease severity and low height at diagnosis seem to be the two best predictive factors for low final height.
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- 2023
16. Principled Subpopulation Analysis of the BetterBirth Study and the Impact of WHO’s Safe Childbirth Checklist Intervention
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Girmaw Abebe Tadesse, Victor Akinwande, Megan Marx Delaney, William Ogallo, Katherine Semrau, Skyler Speakman, and Claire-Helene Mershon
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History ,medicine.medical_specialty ,education.field_of_study ,Polymers and Plastics ,business.industry ,Public health ,Population ,Declaration ,Articles ,Industrial and Manufacturing Engineering ,Checklist ,Family medicine ,Intervention (counseling) ,Statistical significance ,medicine ,Global health ,Childbirth ,Business and International Management ,education ,business - Abstract
Background: World Health Organization (WHO) developed the Safe Childbirth Checklist as an intervention to improve care and outcomes in maternal and newborn health. In the primary BetterBirth traditional trial analysis, the intervention did not significantly improve . However, a novel subgroup-based analysis could identify subpopulations that benefited from the intervention. Methods: In this work, we employ data-driven analysis methods to identify differentiated subgroups with unexpected characteristics compared to the average population. Specifically, we aim to identify: 1) vulnerable subgroups and 2) subpopulation in the intervention arm with significantly reduced outcome. The method utilizes the existing subset scanning literature that searches over a combination of features to identify the differentiated groups. Findings: We found that low birthweight (
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- 2023
17. Prevalence and predictors of cognitive impairment among the elderly in Bangladesh
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Hasan Ali, Nahian Fyrose Fahim, Mizanur Khondoker, Zakir Hossain, and Jiban Kanai Das
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medicine.medical_specialty ,Physical disability ,business.industry ,030503 health policy & services ,Public health ,Public Health, Environmental and Occupational Health ,Odds ratio ,medicine.disease ,Logistic regression ,03 medical and health sciences ,0302 clinical medicine ,Statistical significance ,Epidemiology ,medicine ,Dementia ,030212 general & internal medicine ,0305 other medical science ,business ,Cognitive impairment ,Demography - Abstract
Aim: To investigate the prevalence of cognitive impairment and its predictors among the elderly in Bangladesh. Subject and Methods: We use a cross-sectional survey of 1015 older people (≥60 years) in Bangladesh collected jointly by the Sir William Beveridge Foundation (SWBF) and Aging Support Forum (ASF), Bangladesh. The Mini-Mental State Examination (MMSE) scale, adapted to the Bengali language, was used for assessing cognitive impairment, which was available for 111 participants. Logistic regression analysis was used to identify predictors of cognitive impairment. Multiple imputation under the missing-at-random (MAR) mechanism was used to deal with missing data. Results: Overall, 31 out of 111 (27.9%) participants had mild, moderate or severe cognitive impairment, with a higher proportion among women (33.3%, 17 out of 51) than men (23.3%, 14 out of 60). More precisely, 24 out of 111 (21.6%) and 7 out of 111 (6.3%) had mild/moderate and severe cognitive impairment, respectively, with a higher percentage among women (mild/moderate: 25.5%, severe: 7.8%) than men (mild/moderate: 18.3%, severe: 5.0%). Age (odds ratio, OR = 1.06, p = 0.046, 95% CI: 1.001 to 1.119) and social engagement (OR = 0.25, p = 0.033, 95% CI: 0.072 to 0.898) were found to be statistically significant predictors of cognitive impairment in this group of people. The effect of physical disability fell short of statistical significance at the 5% level but was significant at the 10% level (OR = 2.89, p = 0.099, 90% CI: 0.999 to 8.370). Conclusion: The prevalence of cognitive impairment in Bangladesh is alarming and is comparatively higher among elderly women, which seems to increase with age and the presence of any physical disability. Also, prevalence appears to be lower in people who are more socially engaged or active.
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- 2023
18. Postoperative Ovarian Morphology on Ultrasound after Ovarian Torsion—Effect of Immediate Surgery: A Retrospective Cohort Study
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Sari Kives, Dana Elborno, Lisa Allen, and Niamh C Murphy
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Torsion Abnormality ,medicine.medical_specialty ,Ovarian surgery ,Adolescent ,Ovarian Torsion ,endocrine system diseases ,medicine.medical_treatment ,Ovary ,Cystectomy ,Statistical significance ,medicine ,Humans ,Ovarian Diseases ,Child ,Retrospective Studies ,Ultrasonography ,business.industry ,Ultrasound ,Ovarian torsion ,Obstetrics and Gynecology ,Retrospective cohort study ,General Medicine ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Ovarian morphology ,Female ,business - Abstract
Study Objective Our objective was to determine if ovarian surgery at the time of ovarian detorsion is associated with impaired short-term ovarian function, as indicated by ovarian morphology on ultrasound when compared to detorsion alone. Design Retrospective cohort study Setting The Hospital for Sick Children, Toronto Participants Confirmed ovarian torsion in patients ≤ 18 years from 1/1/2004 to 31/12/2018 with ovarian sparing surgery. Main Outcome Measures Data was collected on demographics, procedure, intraoperative findings and post-operative ultrasound. To determine ovarian function, we compared morphology on post-operative ultrasound between those with surgery to the ovary compared to those without surgery to the ovary at the time of detorsion. We also compared ovarian volume of affected and contralateral ovaries after detorsion and surgery to the affected ovary. Results 119 patients met inclusion criteria- 67 (56%) had detorsion with surgery to the ovary and 52 (44%) had detorsion alone. There was no statistically significant difference in appearance on post-operative ultrasound between these groups (p=0.446). There was also no statistically significant difference on post-operative ultrasound of affected and contralateral ovarian volumes after detorsion and surgery to the affected ovary (p=0.69). Patients that underwent surgery to the ovary experienced a lower rate of recurrence, however, this did not reach statistical significance with a p-value of 0.080. Conclusion Our study demonstrates that surgery e.g. cystectomy to the ovary at the time of ovarian detorsion does not appear to impact ovarian function when compared to detorsion alone, as indicated on postoperative imaging. There was also no difference in volume of the affected and contralateral ovaries in those cases that underwent surgery at the time of initial detorsion. This evidence would support that immediate cystectomy at the time of initial ovarian detorsion is not associated with impaired ovarian function thus avoiding the need for an interval cystectomy.
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- 2022
19. Implementation of Best Practice Guidelines as an Effort in Reducing Hospital Readmission following Coronary Artery Bypass Surgery
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Natasa Paunic, Miodrag Peric, Andja Cirkovic, Milovan Bojić, Petar Otasevic, Dragana Dinic, Milan Milojevic, and Cardiothoracic Surgery
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medicine.medical_specialty ,Patient Readmission ,03 medical and health sciences ,Coronary artery bypass surgery ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Statistical significance ,Internal medicine ,Surgical site ,medicine ,Humans ,Antibiotic prophylaxis ,Coronary Artery Bypass ,Retrospective Studies ,Hospital readmission ,business.industry ,Incidence (epidemiology) ,Evidence-based medicine ,Patient Discharge ,3. Good health ,030220 oncology & carcinogenesis ,Propensity score matching ,030211 gastroenterology & hepatology ,Surgery ,business - Abstract
Objectives: The present study aimed to identify significant causes of readmission within 30 days following coronary artery bypass graft (CABG) surgery and compare readmission incidence related to surgical site infections (SSIs) before and after implementing international recommendations for antibiotic prophylaxis. Methods: We analyzed 2,225 CABG patients who received either guideline-directed antibiotic prophylaxis (GDAP = 568) or institutional antibiotic prophylaxis (non-GDAP = 1,657) between January 2017 and December 2019. The primary outcome was a composite of sternal wound infection (SWI) or harvest SWI. Secondary outcomes consisted of the individual components of composite end point, the incidence of in-hospital SSIs, and prolonged postoperative length of hospital stay (LOS) (>7 days). Propensity matching was used to select pairs for final comparison. Results: Before implementing GDAP, the most frequent reason for readmission were SSIs, causing 58.2% of all readmissions within 30 days. Of 429 matched pairs, 48 patients in the GDAP group and 67 patients in the non-GDAP group were readmitted to a hospital within 30 days for any cause (11.2 vs. 15.6%, p = 0.048). We found a decreased readmission incidence for reasons related to SSIs, although these differences did not reach statistical significance (7.4 vs. 10.0%, p = 0.069). Adherence to GDAP was associated with reduced in-hospital risks of SSIs and prolonged postoperative LOS (19.6 vs. 26.6%, p = 0.015). Conclusions: In this contemporary clinical practice study, the adherence to GDAP was an insufficient measure to decrease rehospitalization due to SSIs. The present findings warrant further investigation on factors that may contribute to SSIs development after hospital discharge.
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- 2022
20. Social Determinants of Health and After-Hours Electronic Health Record Documentation: A National Survey of US Physicians
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Kea Turner, Young-Rock Hong, Amir Alishahi Tabriz, Lee Revere, and Oliver T Nguyen
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Male ,medicine.medical_specialty ,Social Determinants of Health ,Leadership and Management ,Specialty ,Documentation ,Primary care ,symbols.namesake ,Electronic health record ,Physicians ,Statistical significance ,medicine ,Electronic Health Records ,Humans ,Social determinants of health ,Poisson regression ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Confidence interval ,Cross-Sectional Studies ,Family medicine ,symbols ,Female ,business - Abstract
Identifying patients' social determinants of health (SDoH) can improve patient outcomes but may increase clinicians' documentation time. However, there is limited evidence of how many physicians document SDoH and the associated burden. To address this gap, this study examines documentation of SDoH and after-hours electronic health record (EHR) work among a nationally representative sample of US office-based physicians. This was a cross-sectional analysis of the 2018-2019 National Electronic Health Records Survey. A survey design-adjusted bivariate analysis was used to estimate the prevalence of SDoH documentation and compare this activity between physicians' and practices' characteristics. A modified multivariable Poisson model was used to estimate prevalence ratios of SDoH documentation and after-hours work. The study sample included a weighted sample of 303,389 US physicians (31.5%, female; 72.5%, aged ≥50 years; 48.8% primary care specialty). Of those, 84.3% reported documenting patients' SDoH information. Physicians documenting patients' SDoH tend to be younger (
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- 2022
21. Effectiveness of high-intensity laser therapy in patients with myogenic temporomandibular joint disorder: A double-blind, placebo-controlled study
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Ömer Ekici, Murat Büyükbosna, and Ümit Dündar
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Orofacial pain ,medicine.medical_specialty ,Placebo-controlled study ,Pain ,Placebo ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Statistical significance ,Temporomandibular Joint Disorder ,medicine ,Humans ,Prospective Studies ,030223 otorhinolaryngology ,Pain Measurement ,business.industry ,030206 dentistry ,Temporomandibular Joint Disorders ,Treatment Outcome ,Otorhinolaryngology ,Quality of Life ,Oral and maxillofacial surgery ,Physical therapy ,Surgery ,Laser Therapy ,Oral Surgery ,medicine.symptom ,Range of motion ,business - Abstract
The aim of the study is to evaluate the effectiveness of high-intensity laser therapy (HILT) in the short and long term in the treatment of patients with the myogenic temporomandibular joint disorder(TMD).This prospective, double-blind, controlled clinical study was conducted on patients with myogenic TMD at a university's oral and maxillofacial surgery clinic. Seventy-six patients were randomized into two groups (HILT, and control group), including 38 patients in one group. The patients were evaluated for pain, the range of motion of the jaw, disability, and quality of life. Assessments were performed before therapy (week 0) and after therapy (weeks 4 and 12). Data were evaluated using SPSS-20 and the level of significance was set at p0.05.There was no significant difference between the groups in terms of socio-demographic characteristics of the groups at the beginning of the study. In the 4th week, the VAS pain score was significantly decreased in the HILT group (47%) compared to the placebo HILT group (4%) (p0.001). The maximum mouth opening was significantly increased in the HILT group (27%) compared to the placebo HILT group (4%) at week 12 (p0.001). The HILT group showed a significant improvement in Jaw Functional Limitation Scale 20 (JFLS-20) and Oral Health Impact Profile (OHIP-14) compared to the placebo HILT group (p0.001 and p0.005 respectively).As a result of the study, it was concluded that HILT is a highly effective, non-invasive therapeutic method for patients with myogenic TMD.
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- 2022
22. Prediction of Reduced Gait Speed Using 5-Time Sit-to-Stand Test in Healthy Older Adults
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Daniela Cristina Carvalho de Abreu, Jaqueline Mello Porto, Renato Campos Freire Júnior, Roberta de Matos Brunelli Braghin, and Patricia Silva Tofani
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Male ,medicine.medical_specialty ,Walking ,Correlation ,Gait (human) ,Physical medicine and rehabilitation ,Statistical significance ,medicine ,Humans ,Cutoff ,Gait ,Physical Therapy Modalities ,General Nursing ,Aged ,Receiver operating characteristic ,business.industry ,Health Policy ,Area under the curve ,General Medicine ,Walking Speed ,Gait speed ,Preferred walking speed ,Cross-Sectional Studies ,Female ,Independent Living ,Geriatrics and Gerontology ,business ,human activities - Abstract
OBJECTIVES To determine the accuracy of the 5-time stand-to-sit (5TSTS) test for the identification of older adults with reduced gait speed. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 559 community-dwelling older adults were included in the study, divided into groups of women (n=465) and men (n=94). METHODS 5TSTS and gait speed were assessed. Multiple linear regression analysis with adjustment was performed in order to determine the association between 5TSTS and gait speed, followed by the receiver operating characteristic (ROC) curve for the identification of the usefulness of 5TSTS to discriminate older adults with reduced gait speed. Based on the ROC curve, we identified the area under the curve, the sensitivity, specificity, and cutoff points of the 5TSST. Statistical analyses were made using the SPSS software (version 25.0), and a significance level of 5% (P ≤ .05) was adopted. RESULTS The 5TSTS showed correlation with gait speed. Additionally, 5TSTS was able to discriminate reduced gait speed with moderate accuracy (P < .05; AUC between 0.7 and 0.8). For women, the cutoff scores for 5TSTS to identify gait speed
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- 2022
23. Relationship between apparent diffusion coefficient value of the bone marrow and cortical width of the mandible in the healthy patients
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Takumi Kondo, Takashi Kaneda, Kotaro Ito, Shungo Ichiki, Hirotaka Muraoka, Shunya Okada, and Naohisa Hirahara
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Correlation coefficient ,business.industry ,Significant difference ,Mandible ,Retrospective cohort study ,Pathology and Forensic Medicine ,body regions ,medicine.anatomical_structure ,Otorhinolaryngology ,Statistical significance ,Mann–Whitney U test ,Effective diffusion coefficient ,Medicine ,Surgery ,Bone marrow ,Oral Surgery ,business ,Nuclear medicine - Abstract
Objectives Diffusion-weighted imaging (DWI) is a technique reflecting motion of water proton within the tissue. Studies have investigated the apparent diffusion coefficient (ADC) of bone marrow in musculoskeletal lesions. This study assessed the correlation between the ADC of bone marrow in the mandible and the mandibular cortical width (MCW) in the healthy patients. Methods This research was a retrospective cohort study. The patient underwent echo planar (EPI)-DWI and panoramic X-ray at the Nihon University School of Dentistry between April 2020 and October 2020. The predictor variable was mean MCW. The primary outcome variable was the mean ADC of mandibular bone marrow. The other variable was age. Data were analyzed using a Mann-Whitney U test, Spearman’s correlation coefficient. Statistical significance was set at p Results We analyzed the records of 18 men (mean age, 44.94, age range 20–73 years) and 40 women (mean age, 47.98, age range 21–78 years). There was not significant difference between sex and mean ADC value, mean MCW (p = 0.853 and p= 0.43, respectively). There was a significant positive correlation between MCW and the ADC of the mandibular bone marrow (r = .493, p Conclusions This suggests that in addition to evaluating the MCW, which is currently used for bone quality evaluation, measuring the ADC of bone marrow in the mandible could contribute toward the examination of bone quality and diseases.
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- 2022
24. What executives get wrong about statistics: Moving from statistical significance to effect sizes and practical impact
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Brian S. Anderson
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Marketing ,Phrase ,business.industry ,Computer science ,05 social sciences ,Big data ,Arbiter ,Context (language use) ,Statistical model ,Data science ,Analytics ,Statistical significance ,0502 economics and business ,Discernment ,050211 marketing ,Business and International Management ,business ,050203 business & management - Abstract
Statistical significance functions as an arbiter of sorts for data analysis purporting to show a relationship between two or more variables. Unfortunately, in far too many situations, statistical significance may lead decision-makers relying on data and analytics to improve business decisions astray, particularly in the context of big data. In this article, I outline reasons why executives should develop a healthy discernment when seeing the phrase statistically significant in media outlets, internal analyses, consulting reports, and other sources. To overcome the limitations of focusing on statistical significance, I propose executives shift their attention towards the effect size reported from a statistical model. While not without limitation, effect sizes are more useful to decision-makers, highlight the practical implication of analyses, and help in quantifying the uncertainty inherent to working with data.
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- 2022
25. Long-term use of valproic acid reduced mortality in bipolar disorder patients in a Taiwanese population: An association analysis using the national health insurance research database (NHIRD)
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Lawrence Shih-Hsin Wu, Tsung-Cheng Hsieh, and Cheng-Chia Lin
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Male ,medicine.medical_specialty ,Bipolar Disorder ,National Health Programs ,Lithium (medication) ,Population ,Lithium ,Internal medicine ,Statistical significance ,medicine ,Risk of mortality ,Humans ,Bipolar disorder ,education ,Biological Psychiatry ,Valproic Acid ,education.field_of_study ,Epilepsy ,business.industry ,Hazard ratio ,medicine.disease ,Confidence interval ,Psychiatry and Mental health ,lipids (amino acids, peptides, and proteins) ,business ,medicine.drug - Abstract
OBJECTIVE Valproic acid (VPA) is used for the treatment of epilepsy and bipolar disorder (BD). The aims of this study was to examine that long-term VPA use affects mortality in BD patients. METHODS Association analysis was conducted using the National Health Insurance Research Database (NHIRD) of Taiwan. The long-term VPA use group was selected as patients treated with VPA for BD who used VPA only. The control group consisted of BD patients who were not treated with VPA or lithium. The lithium use group consisted by BD patients used lithium only was also joined the analysis. The cofactors included age (>65 years), sex and the Charlson Comorbidity Index. RESULTS The hazard ratio (HR) of mortality for the VPA group was 0.83 (95% confidence interval (CI), (0.70-0.99); P = 0.04) and the result of lithium group did not reach statistical significance. Furthermore only the duration> 3 years subgroup had a significantly lower incidence of mortality than the control group, with an HR of 0.54 (95% CI, (0.42-0.70); P
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- 2022
26. Factors that affect heart rate variability following acute resistance exercise: A systematic review and meta-analysis
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Sajith U. Marasingha-Arachchige, Pedro E. Alcaraz, Jacobo Á. Rubio-Arias, and Linda H. Chung
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medicine.medical_specialty ,business.industry ,Rest ,Resistance Training ,Physical Therapy, Sports Therapy and Rehabilitation ,Autonomic Nervous System ,Intensity (physics) ,Autonomic nervous system ,Physical medicine and rehabilitation ,Systematic review ,Heart Rate ,Meta-analysis ,Statistical significance ,medicine ,Exercise intensity ,Humans ,Heart rate variability ,Orthopedics and Sports Medicine ,business ,Exercise ,Body mass index - Abstract
There is controversial evidence regarding the effect of acute resistance exercise (ARE) on heart rate variability (HRV) parameters, which indicates the activities of the cardiac autonomic nervous system. The aim of this study was to perform a systematic review and meta-analysis of the literature on the effect of ARE on HRV parameters and identify its possible moderating factors.The PubMed-Medline, Web of Science, SPORTDiscus, and Cochrane Library databases were searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration was followed, and the methodological quality of the studies was evaluated. The level of significance was set at p ≤ 0.05. Twenty-six studies met the inclusion criteria. Main effect analyses between pre- and post-test interventions demonstrated an increase in normalized units low frequency (p0.001; standardized mean difference (SMD) = 0.78; 95% confidence interval (95%CI): 0.46‒1.11) and low frequency/high frequency ratio (p0.001; SMD = 0.82; 95%CI: 0.64‒0.99) and a decrease in standard deviation of the normal-to-normal (NN) interval (p0.001; SMD = -0.58; 95%CI: -0.85 to -0.30), root mean square of the successive differences (p0.001; SMD = -1.01; 95%CI: -1.29 to -0.74), and normalized units high frequency (p0.001; SMD: -1.08; 95%CI: -1.43 to -0.73) following ARE in healthy individuals range: 15 ± 1 to 48 ± 2 years; mean ± SD).There were differences between the subgroups in the number of sets used in an exercise (p = 0.05) for root mean square of the successive differences, as well as for exercise intensity (p = 0.01) and rest between sets (p = 0.05) for normalized units high frequency. Interestingly, there were differences between the subgroups in training volume for root mean square of the successive differences (p = 0.01), normalized units high frequency (p = 0.003) and normalized units low frequency (p = 0.02).Overall, there was a withdrawal of cardiac parasympathetic and activation of cardiac sympathetic modulations following ARE, and these changes were greater with higher training volume ∼30 min after ARE in healthy individuals. Furthermore, the number of sets, intensity, and rest between sets affected HRV parameters. However, gender, body mass index, and training status did not influence the changes in HRV parameters as a response to ARE.
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- 2022
27. Relationship Between Physical Activity Participation and Recovery Outcomes in College-Aged Adults With a Concussion
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Kyle M. Petit, Christopher Kuenze, Nathan Fitton, Mathew Saffarian, Tracey Covassin, and Karin A. Pfeiffer
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Universities ,Concussion ,Symptom reporting ,Physical activity ,Physical Therapy, Sports Therapy and Rehabilitation ,Context (language use) ,Young Adult ,Statistical significance ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Prospective Studies ,Prospective cohort study ,Exercise ,Brain Concussion ,Not evaluated ,business.industry ,Outcome measures ,General Medicine ,medicine.disease ,Athletic Injuries ,Physical therapy ,Female ,business - Abstract
Context Previously, the most common treatment for a concussion was prolonged physical and cognitive rest. Recently, researchers have suggested that earlier physical activity (PA) may be better at promoting recovery. Researchers have not evaluated the relationship between free-living PA (eg, walking) and symptom reporting or recovery duration. Objective To assess the relationship between free-living PA participation and 2 recovery outcomes in college-aged adults with a concussion. Design Prospective cohort. Setting National Collegiate Athletic Association Division I and III universities. Patients or Other Participants Thirty-two college-aged adults (68.8% female, age = 19.8 ± 1.4 years) with a concussion. Main Outcome Measure(s) Participants completed a postconcussion symptom evaluation at visits 1 ( Results Participants averaged 2446 ± 441 counts per minute and spent 12.1% ± 4.2% of their PA performing MVPA. Participants yielded median (interquartile) symptom severities of 28 (24) and 2 (8) for visit 1 and 2, respectively. Average recovery time was 14.7 ± 7.5 days. Total PA did not significantly contribute to the model for visit 2 symptom severity (P = .122) or recovery time (P = .301). Similarly, %MVPA had little contribution to the model for visit 2 symptom severity (P = .358) or recovery time (P = .276). Conclusions We suggest that free-living PA may not be enough to reduce symptoms or shorten recovery. Thus, clinicians may need to provide patients with more structured PA protocols mimicking findings from previous researchers.
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- 2022
28. Definitions of Central Tumors in Radiologically Node-Negative, Early-Stage Lung Cancer for Preoperative Mediastinal Lymph Node Staging
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Jin Mo Goo, Kyung Hee Lee, Chang Min Park, Hyewon Choi, Young Tae Kim, Hyungjin Kim, and Sukki Cho
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Odds ratio ,Critical Care and Intensive Care Medicine ,medicine.disease ,Occult ,Confidence interval ,Interquartile range ,Mediastinal lymph node ,Statistical significance ,Medicine ,Radiology ,Stage (cooking) ,Cardiology and Cardiovascular Medicine ,business ,Lung cancer - Abstract
Background Definitions for central lung cancer have been ambiguous in guidelines, causing difficulty in selecting candidates for invasive mediastinal staging among patients with radiologically node-negative, early-stage lung cancer. Research Question What is the optimal definition for central lung cancer, which is robust to inter-reader and institutional variation, to select candidates for invasive mediastinal staging among those with clinical T1N0M0 lung cancer? Study Design and Methods Two retrospective cohorts were evaluated for the associations of central lung cancer according to 13 definitions based on chest CT with occult nodal metastasis. Univariable and multivariable ordinal logistic regression analyses were performed with the pathological N category as an ordinal outcome. Robust definitions, which retained statistical significance across multi-reader, dual-institutional datasets, were identified. For these definitions, binary diagnostic performance and inter-reader agreement were investigated. Results In the two cohorts, 807 patients (median age, 63 years; interquartile range, 56-71 years; 410 women; 33 pN1, 48 pN2, and 1 pN3) and 510 patients (median age, 65 years; interquartile range, 58-71 years; 267 women; 33 pN1, 20 pN2, and no pN3) were included, respectively. Three definitions robust to inter-reader variation and dataset heterogeneity were identified: definition 7 (concentric lines arising from the midline, inner one-third, medial margin; adjusted odds ratio [OR], 2.01; 95% confidence interval [CI], 1.13-3.51; P=0.02), definition 10 (location index-based inner one-third, center; adjusted OR, 3.60; 95% CI, 1.49-8.25; P=0.003), and definition 12 (location index-based inner one-third, medial margin; adjusted OR, 3.57; 95% CI, 1.91-6.52; P Interpretation Three definitions exhibited robust associations with occult nodal metastasis. However, selecting candidates for invasive mediastinal staging solely based on a central tumor location would be suboptimal.
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- 2022
29. Improved outcomes with implementation of an Enhanced Recovery After Surgery pathway for patients undergoing elective colorectal surgery in the Philippines
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Rosielyn T Apellido, Marie Dione P Sacdalan, Mayou Martin T Tampo, Marc Paul J. Lopez, Ma Concepcion L Cruz, Hermogenes Iii J. Monroy, and Mark Augustine S. Onglao
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medicine.medical_specialty ,business.industry ,Mortality rate ,Gastroenterology ,Colorectal surgery ,Surgery ,Stoma ,Statistical significance ,Clinical endpoint ,Medicine ,Rectal resection ,business ,Prospective cohort study ,Enhanced recovery after surgery - Abstract
Purpose: This study aims to evaluate surgical outcomes (i.e. length of stay [LOS], 30-day morbidity, mortality, reoperation, and readmission rates) with the use of the Enhanced Recovery After Surgery (ERAS) pathway, and determine its association with the rate of compliance to the different ERAS components.Methods: This was a prospective cohort of patients, who underwent the following elective procedures: stoma reversal (SR), colon resection (CR), and rectal resection (RR). The primary endpoint was to determine the association of compliance to an ERAS pathway and surgical outcomes. These were then retrospectively compared to outcomes prior to the implementation of ERAS.Results: A total of 267 patients were included in the study. The overall compliance to the ERAS component was 92.0% (SR, 91.8%; CR, 93.1%; RR, 90.7%). There was an associated decrease in morbidity rates across all types of surgery, as compliance to ERAS increased. The average total LOS decreased in all groups but was only found to have statistical significance in SR (12.1±6.7 days vs. 10.0±5.4 days, P=0.002) and RR (19.9±11.4 days vs. 16.9±10.5 days, P=0.04) groups. Decreased postoperative LOS was noted in all groups. Morbidity rates were significantly higher after ERAS implementation, but reoperation and mortality rates were found to be similar.Conclusion: Increased compliance to ERAS protocol is associated with a decrease in morbidity across all surgery types. The implementation of an ERAS protocol significantly decreased mean hospital LOS, without any increase in major surgical complications. Having your own hospital ERAS pathway improves documentation and accuracy of reporting surgical complications.
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- 2022
30. The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery
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Nabi, Vugar, Ayhan, Selim, Yuksel, Selcen, Adhikari, Prashant, Vila-Casademunt, Alba, Pellise, Ferran, Perez-Grueso, Francisco Sanchez, Alanay, Ahmet, Obeid, Ibrahim, Kleinstueck, Frank, Acaroglu, Emre, Grp, European Spine Study, Acibadem University Dspace, Institut Català de la Salut, [Nabi V] Department of Orthopaedics and Traumatology, Antalya Research and Education Hospital, Ministry of Health, University of Health Science, Antalya, Turkey. [Ayhan S] Department of Neurosurgery, Baskent University Hospital, Ankara, Turkey. [Yuksel S] Department of Biostatistics, Yildirim Beyazit University, Ankara, Turkey. [Adhikari P] ARTES Spine Center, Acibadem Ankara Hospital, Ankara, Turkey. [Vila-Casademunt A, Pellise F] Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
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medicine.medical_specialty ,Blood management ,Anemia ,Health-related quality of life ,sistema musculoesquelético::esqueleto::huesos::columna vertebral [ANATOMÍA] ,Adult spine deformity ,Scoliosis ,Quality of life ,Statistical significance ,medicine ,Columna vertebral - Malformacions - Cirurgia ,Orthopedics and Sports Medicine ,Patient outcome assessment ,Hospitals - Ingressos i altes ,Hospital readmission ,business.industry ,diagnóstico::pronóstico::resultado del tratamiento [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Otros calificadores::Otros calificadores::/cirugía [Otros calificadores] ,Retrospective cohort study ,Diagnosis::Prognosis::Treatment Outcome [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,medicine.disease ,Other subheadings::Other subheadings::/surgery [Other subheadings] ,Surgery ,Therapeutics::Patient Care::Hospitalization::Patient Readmission [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,Avaluació de resultats (Assistència sanitària) ,terapéutica::asistencia al paciente::hospitalización::reingreso de pacientes [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Hemoglobin ,business ,Musculoskeletal System::Skeleton::Bone and Bones::Spine [ANATOMY] - Abstract
Adult spine deformity; Anemia; Patient outcome assessment Deformidad de la columna en adultos; Anemia; Evaluación del resultado del paciente Deformitat de la columna en adults; Anèmia; Avaluació dels resultats del pacient Study Design Retrospective cohort. Purpose This study aims to evaluate the impact of anemia on functional outcomes, health-related quality of life (HRQoL), and early hospital readmission (EHR) rates after adult spinal deformity (ASD) surgery at the time of discharge from the hospital. Overview of Literature Concerns with risks of transfusion, insufficient evidence for its benefits, and the possibility of associated adverse outcomes have led to restrictive transfusion practices. Therefore, patients are discharged according to patient blood management programs that are implemented in hospitals nationwide to reduce unnecessary blood transfusions. However, not many comprehensive kinds of studies exist on the effect of postoperative anemia on functional life and complications. Methods Anemia severity was defined following the 2011 World Health Organization guidelines. All patients had HRQoL tests as well as complete blood counts pre- and postoperatively. EHR is the admission within 30 days of discharge and was used as the dependent parameter. Results This study comprised 225 surgically treated ASD patients with a median age of 62.0 years, predominantly women (80%). Of the 225 patients, 82, 137, and six had mild, moderate, and severe anemia at the time of discharge, respectively. Seventeen of the patients (mild [11, 64.7%]; moderate [5, 29.4%]; severe [1, 5.9%]) were readmitted within 30 days. The mean hemoglobin values were higher in readmitted patients (p=0.071). Infection was the leading cause of readmission (n=12), but a low hemoglobin level was not observed in any of these patients at the time of discharge. Except for Scoliosis Research Society-22 questionnaire, HRQoL improvements did not reach statistical significance in early readmitted patients in the first year after surgery. Conclusions The results of this study demonstrated that the occurrence and the severity of postoperative anemia are not associated with EHR in surgically treated patients with ASD. The findings of the current research suggested that clinical awareness of the parameters other than postoperative anemia may be crucial. Thus, improvements in HRQoL scores were poor in early readmitted patients 1 year after surgery. European Spine Study Group is a clinical research group funded by a research grant from DePuy-Synthes.
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- 2022
31. Cardiac Surgery Outcomes: A Case for Increased Screening and Treatment of Obstructive Sleep Apnea
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Niveditta Ramkumar, Tessa C. Cattermole, Seth Wolf, Cathy S. Ross, Hannah J. Rando, Daniel J. Gelb, Bruce J. Leavitt, Walter F. DeNino, Benjamin M. Westbrook, Candice Wolf, Bethany Bourcier, and Alexander Iribarne
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Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Disease ,Postoperative Complications ,Risk Factors ,Statistical significance ,Humans ,Medicine ,Cardiac Surgical Procedures ,Coronary Artery Bypass ,Risk factor ,Retrospective Studies ,Sleep Apnea, Obstructive ,business.industry ,Atrial fibrillation ,medicine.disease ,respiratory tract diseases ,Cardiac surgery ,Obstructive sleep apnea ,Emergency medicine ,Cohort ,Propensity score matching ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Because of the limited published information on complications that obstructive sleep apnea (OSA) patients experience during and after cardiac surgery, we investigated OSA as a risk factor for postoperative outcomes.This project used the Northern New England Cardiovascular Disease Study Group's data collected between 2011 and 2017 based on The Society of Thoracic Surgeons Adult Cardiac Surgery Database Data Collections form. A retrospective analysis of 1555 patients with OSA and 10,450 patients without OSA across 5 medical centers undergoing isolated coronary artery bypass grafting, isolated valve surgery, and combined coronary artery bypass grafting valve surgery was conducted. We used 1:1 nearest-neighbor propensity score matching with no replacement to balance characteristics among patients with and without OSA.There was a statistically significant increased risk of postoperative pneumonia, increased length of total and postoperative stay, and time to initial extubation. Two outcomes trended toward significance: intra- and postoperative intraaortic balloon pump use. Outcomes that failed to show statistical significance were surgical site infection, atrial fibrillation, cerebrovascular accident, permanent pacemaker placement, and blood products given. A chart review conducted on a subset of the study cohort revealed that more than 40% of OSA patients did not receive continuous positive airway pressure or bilevel positive airway pressure therapy postoperatively during their hospitalization.Our study aligns with the literature in concluding that OSA has deleterious effects on postoperative outcomes of cardiac surgery patients. Further research to better stratify OSA patients by severity are still needed. Additionally heightened awareness of the need to screen, diagnose, and properly treat patients for OSA is needed.
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- 2022
32. Long-term Outcomes of Children Operated on for Anomalous Left Coronary Artery From the Pulmonary Artery
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Jeffrey M. Vinocur, Alice Chan, Amanda S. Thomas, Lazaros Kochilas, and Bahaaldin Alsoufi
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Coronary Vessel Anomalies ,Pulmonary Artery ,National Death Index ,Article ,Ventricular Dysfunction, Left ,Left coronary artery ,medicine.artery ,Mitral valve ,Statistical significance ,Internal medicine ,Bland White Garland Syndrome ,medicine ,Humans ,Hospital Mortality ,Child ,Retrospective Studies ,Mitral regurgitation ,business.industry ,Infant ,Mitral Valve Insufficiency ,Anomalous Left Coronary Artery ,Transplantation ,Treatment Outcome ,medicine.anatomical_structure ,Pulmonary artery ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
We examined the outcomes of children (18 years) operated on for anomalous left coronary artery from the pulmonary artery (ALCAPA).We linked patients undergoing ALCAPA repair between 1982 and 2003 in the Pediatric Cardiac Care Consortium with the National Death Index and the Organ Procurement and Transplantation Network to examine their outcomes through 2019.We identified 228 children (median age, 6.0 months) operated on for ALCAPA. At the time of repair, 38.6% had severe mitral regurgitation (MR), and 71.4% had severe left ventricular (LV) dysfunction. Repair included primarily coronary reimplantation in 173 and the Takeuchi procedure in 34; concurrently, 18 underwent mitral valve (MV) operation. In-hospital death occurred in 31 (13.6%) and was not associated with MR severity (P = .846); however, among patients with moderate or severe MR, risk of death was 28% lower when undergoing MV operation (P = .033). After adjustment for other risk factors, only infant operation reached statistical significance for in-hospital death (adjusted odds ratio, 12.99; 95% CI, 1.61-104.59; P = .016). Among those discharged alive with long-term data available (n = 155), the 30-year transplant-free survival reached 95.5% (95% CI, 92.3%-98.8%) and was not associated with the degree of preoperative MR or LV dysfunction. Coronary reimplantation was associated with better long-term survival compared with other surgical techniques (adjusted odds ratio, 0.11; 95% CI, 0.02-0.74; P = .023).Favorable long-term outcomes can be expected after coronary artery reimplantation for ALCAPA, even in patients with severe LV dysfunction at presentation. MV operation predicted decreased risk for in-hospital mortality in patients with moderate/severe MR, but MR severity predicted neither in-hospital nor longer-term outcomes.
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- 2022
33. Cost comparison and complication profiles of superior capsular reconstruction, lower trapezius transfer, and reverse shoulder arthroplasty for irreparable rotator cuff tears
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Erick M. Marigi, Quinn J. Johnson, John W. Sperling, Bijan J. Borah, Ruchita Dholakia, and Joaquin Sanchez-Sotelo
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medicine.medical_specialty ,Shoulder surgery ,medicine.medical_treatment ,Rotator Cuff Injuries ,Arthroscopy ,Tendon transfer ,Statistical significance ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Rotator cuff ,Range of Motion, Articular ,Average cost ,Shoulder Joint ,business.industry ,General Medicine ,Arthroplasty ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Arthroplasty, Replacement, Shoulder ,Costs and Cost Analysis ,Superficial Back Muscles ,Tears ,business ,Complication - Abstract
BACKGROUND Irreparable rotator cuff tears (IRCTs) pose treatment challenges both clinically and financially. As cost-effectiveness initiatives are prioritized, value-based health care delivery models are becoming increasingly common. The purpose of this study was to perform a comprehensive analysis of the cost, complications, and readmission rates of 3 common surgical treatment options for IRCTs: superior capsular reconstruction (SCR), arthroscopically assisted lower trapezius tendon transfer (LTTT), and reverse shoulder arthroplasty (RSA). METHODS Between 2018 and 2020, 155 patients who underwent shoulder surgery at a single institution for IRCT with minimal to no arthritis were identified. Procedures performed included 20 SCRs, 47 LTTTs, and 88 RSAs. A cost analysis was designed to include a period of 60 days preoperatively, the index surgical hospitalization, and 90 days postoperatively, including costs of any readmission or reoperation. RESULTS Mean standardized costs were as follows: preoperative evaluation SCR $507, LTTT $507, and RSA $730; index surgical hospitalization SCR $19,675, LTTT $15,722, and RSA $16,077; and postoperative care SCR $655, LTTT $686, and RSA $404. Significant differences were observed in the index surgical costs (P < .001), with SCR incurring an additional average cost of $3953 and $3598 compared with LTTT and RSA, respectively. The 90-day complication, reoperation, and readmission rates were 0%, 0%, and 0% in the SCR group; 2.1%, 0%, and 0% in the LTTT group; and 3.4%, 0%, and 1.1% in the RSA group, respectively. With the numbers available, differences among the 3 surgical procedures with respect to complication (P = .223), reoperation (P = .999), and readmission rates (P = .568) did not reach statistical significance. CONCLUSIONS The mean standardized costs for the treatment of 3 common IRCT procedures inclusive of 60-day workup and 90-day postoperative recovery were $16,915, $17,210, and $20,837 for LTTT, RSA (average added cost $295), and SCR (average added cost $3922), respectively. This information may provide surgeons and institutions with cost-related information that will become increasingly relevant with the expansion of value-based surgical reimbursements.
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- 2022
34. A combined training program's effect on anthropometry, body composition, physical fitness and blood pressure in elite police
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Duarte Henriques-Neto, Mário Sá, Teresa Santos, José Afonso, Miguel Peralta, Adilson Marques, and Repositório da Universidade de Lisboa
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Adult ,Gerontology ,medicine.medical_specialty ,education.field_of_study ,Anthropometry ,business.industry ,Public health ,Population ,Physical fitness ,Blood Pressure ,Physical Therapy, Sports Therapy and Rehabilitation ,Body composition ,Police ,Blood pressure ,Statistical significance ,Exercise Test ,medicine ,Lean body mass ,Humans ,Orthopedics and Sports Medicine ,education ,business ,Aerobic capacity - Abstract
Copyright © 2021 EDIZIONI MINERVA MEDICA, Background: Combined training (CT) simultaneously associates aerobic and strength exercises. Worldwide, studies on CT´s on Police officers' physical fitness are scarce. This study aims to measure a 4-month CT program's impact in the Close Protection Unit of the Portuguese Elite Police. Methods: A pre-and post-test study included 32 participants (mean age 30.1±2.7 years old). Anthropometry, body composition, physical fitness, and blood pressure assessments were collected. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS, 26.0) with a significance level at p≤0.05. Results: The main results showed an improvement in anthropometrics; aerobic capacity, strength, muscular endurance, and systolic blood pressure. However, a lean mass decrease, a fat mass increase, and worse results in other bioimpedance measures were observed. Conclusions: In this study, the poor body composition results may imply a closer look for health concerns, although physical fitness has improved. Thus, it might be suggested that a CT program is helpful to increase physical fitness in elite police officers. Yet, improvements for its future application can be suggested, namely to include and address hydration level, nutrition, and rest/sleep moments. Moreover, because a high physical fitness level is needed in these population throughout their lifespan, ministerial policies should develop specific training programs, that can reduce morbidity and premature mortality, and have a major cos-teffectiveness impact on public health.
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- 2022
35. Effect of Wendler glottoplasty on voice and quality of life of transgender women
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Adriana de Oliveira Camargo Gomes, Jonia Alves Lucena, Daniela de Vasconcelos, Bruno Teixeira de Moraes, and Mateus Morais Aires
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Trans woman ,medicine.medical_specialty ,Range (music) ,business.industry ,Transgender persons ,Glottoplasty ,Maximum phonation time ,Audiology ,Transgender women ,film.subject ,Formant ,Otorhinolaryngology ,Quality of life ,film ,Sex reassignment procedures ,Statistical significance ,Cohort ,Voice ,Medicine ,Surgery ,business - Abstract
Objective To investigate the effect of Wendler glottoplasty on voice feminization, voice quality and voice-related quality of life. Methods Prospective interventional cohort of transgender women submitted to Wendler glottoplasty. Acoustic analysis of the voice included assessment of fundamental frequency, maximum phonation time formant frequencies (F1 and F2), frequency range, jitter and shimmer. Voice quality was blindly assessed through GRBAS scale. Voice-related quality of life was measured using the Trans Woman Voice Questionnaire and the self-perceived femininity of the voice. Results A total of 7 patients were included. The mean age was 35.4 years, and the mean postoperative follow-up time was 13.7 months. There was a mean increase of 47.9 ± 46.6 Hz (p = 0.023) in sustained/e/F0 and a mean increase of 24.6 ± 27.5 Hz (p = 0.029) in speaking F0 after glottoplasty. There was no statistical significance in the pre- and postoperative comparison of maximum phonation time, formant frequencies, frequency range, jitter, shimmer, and grade, roughness, breathiness, asthenia, and strain scale. Trans Woman Voice Questionnaire decreased following surgery from 98.3 ± 9.2 to 54.1 ± 25.0 (p = 0.007) and mean self-perceived femininity of the voice increased from 2.8 ± 1.8 to 7.7 ± 2.4 (p = 0.008). One patient (14%) presented a postoperative granuloma and there was 1 (14%) premature suture dehiscence. Conclusion Glottoplasty is safe and effective for feminizing the voice of transgender women. There was an increase in fundamental frequency, without aggravating other acoustic parameters or voice quality. Voice-related quality of life improved after surgery.
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- 2023
36. CT-based Abdominal Adipose Tissue Area Changes in Patients Undergoing Adrenalectomy Due to Cushing's Syndrome and Non-functioning Adenomas
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Elif Gündoğdu and Emre Emekli
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Adenoma ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Urology ,Adipose tissue ,Computed tomography ,Intra-Abdominal Fat ,Adrenocortical adenoma ,Endocrinology ,Statistical significance ,parasitic diseases ,Internal Medicine ,medicine ,Humans ,Adrenal adenoma ,In patient ,Cushing Syndrome ,Retrospective Studies ,S syndrome ,medicine.diagnostic_test ,business.industry ,Adrenalectomy ,nutritional and metabolic diseases ,General Medicine ,medicine.disease ,Adipose Tissue ,Adrenocortical Adenoma ,Tomography, X-Ray Computed ,business ,human activities ,tissues - Abstract
Background The majority of Cushing’s syndrome (CS) cases constitute patients with functional adrenal adenomas. In adrenal CS, visceral adipose tissue (VAT) area, VAT/subcutaneous adipose tissue (SAT), and VAT/total adipose tissue (TAT) ratios are expected to decrease in response to adrenalectomy, although no change is expected in non-functioning adrenal adenomas (NFA). Objective To evaluate the changes in VAT, SAT, TAT areas and VAT/SAT, VAT/TAT ratios using computed tomography (CT) in patients who underwent adrenalectomy due to adenomas. Methods Preoperative and postoperative CT of 32 patients (16 with CS and 16 with NFA) were retrospectively evaluated. The VAT, SAT, TAT areas were obtained from CT at the level of L1–2 intervertebral disc space, and the VAT/SAT, VAT/TAT ratios were calculated. The postoperative parameter changes in both groups were evaluated compared to the preoperative values. The level of statistical significance was considered as p Results The time interval between preoperative and postoperative CT measurements were 10.37 months (6–17) in CS and 9.75 months (7–15) in NFA groups (p=073). Preoperative CT indicated that the patients with CS had larger VAT and TAT areas (p=0.03, p=0.02) but SAT remained unchanged (p=0.08). However, postoperative CT revealed that there was no difference between the two groups in terms of VAT, TAT, and SAT areas (p=0.87, p=0.36, p=0.14). Postoperatively, in patients with CS, there was a decrease in VAT and TAT areas (p=0.01 for both) and VAT/SAT and VAT/TAT ratios (p=0.03, p=0.02) but SAT remained unchanged (p=0.10). In patients with NFA, no change was detected in the postoperative SAT, TAT, and VAT areas (p=0.12, p=0.40, p=0.99) or the VAT/SAT and VAT/TAT ratios (p=0.38, p=0.62). Conclusions Adrenalectomy is an effective treatment method leading to a decrease in the VAT, TAT areas, and VAT/SAT and VAT/TAT ratios in patients with cortisol producing adrenocortical adenoma. Thus, CT facilitates quantitative demonstration of the changes while evaluating the response of these patients to treatment.
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- 2023
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37. Analysis of echocardiographic characteristics in patients with acute intracerebral hemorrhage
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Ling Xu, Fenglin Jiang, Umut Ocak, and Pinar Eser Ocak
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Intracerebral hemorrhage ,medicine.medical_specialty ,business.industry ,Neuroscience (miscellaneous) ,Diastole ,medicine.disease ,medicine.anatomical_structure ,Neurology ,Internal medicine ,Statistical significance ,Mitral valve ,Basal ganglia ,Cohort ,medicine ,Cardiology ,Surgery ,In patient ,Neurology (clinical) ,Interventricular septum ,business - Abstract
Purpose The aim of this article is to evaluate the effect of basal ganglia hemorrhage on cardiac functions in the acute stage using transthoracic echocardiography. Methods Based on the data regarding computerize tomography and echocardiography data on the PACS imaging system of a single comprehensive medical center, a total of 110 cases with acute basal ganglia hemorrhage were analyzed retrospectively. The patients were further divided into four groups depending on the localization and extension of the hemorrhage as right basal ganglia hemorrhage (group 1), left basal ganglia hemorrhage (group 2), right basal ganglia hemorrhage with expansion into the ventricles (group 3) and left basal ganglia hemorrhage with expansion into the ventricles (group 4). Cardiac functions based on echocardiography findings were compared between groups. Results There were 70 males (63.6%) and 40 females (36.7%) in this cohort with average an age of 59.45 ± 10.26 years. The thickness of the diastolic interventricular septum was less than 11 mm. The difference in the amount of bleeding was significantly different between group 3 compared with group 1 (p = 0.041). The end systolic left ventricular diameter (LVDS) was significantly different between group 4 compared with group 1 (p = 0.030). The blood loss correlated with Pearson peak of mitral valve e′ (p = 0.034), and with Pearson peak of mitral annulus e′ (p = 0.037). There was no statistical significance in other echocardiographic parameters. Conclusion Acute intracerebral hemorrhage in basal ganglia is associated with left ventricular diastolic dysfunction.
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- 2022
38. The effectiveness of systemic and endovascular intra-arterial thrombectomy protocol for decreasing door-to-recanalization time duration
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Hyungjong Park, Chang-Hyun Kim, Jeong-Ho Hong, Chang-Young Lee, Sung Il Sohn, and Su Chel Kim
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Protocol (science) ,medicine.medical_specialty ,Univariate analysis ,business.industry ,Time duration ,Statistical significance ,Internal medicine ,Intra arterial ,Cardiology ,Medicine ,In patient ,Good outcome ,business ,Acute stroke - Abstract
Objective: Variable treatment strategies and protocols have been applied to reduce time durations in the process of acute stroke management. The aim of this study is to investigate the effectiveness of our intra-arterial thrombectomy (IAT) protocol for decreasing door-to-recanalization time duration and improve successful recanalization.Methods: A systemic and endovascular protocol included door-to-image, image-to-puncture and puncture-to-recanalization. We retrospectively analyzed the patients of pre- (Sep 2012–Apr 2014) and post-IAT protocol (May 2014–Jul 2018). Univariate analysis was used for the statistical significance according to variable factors (age, gender, the location of occluded vessel, successful recanalization TICI 2b-3). Independent t-test was used to compare the time duration.Results: Among all 267 patients with acute stroke of anterior circulation, there were 50 and 217 patients with pre- and post-IAT protocol. Age, gender, and the location of occluded vessel have no statistical significance (p>0.05). In pre- and post-IAT group, successful recanalization was 39 of 50 (78.0%) and 185/217 (85.3%), respectively (p<0.05). Post-IAT (48.8%, 106/217) group had a higher tendency of good outcome than pre-IAT group (36.0%, 18/50) (p>0.05). Pre- and post-IAT group showed 61.7±21.4 vs. 25±16.0 (p<0.05), 102.0±29.8 vs. 82.7±30.4 (min) (p<0.05), and 79.1±47.5 vs. 58.4±75.3 (p<0.05) in three steps, respectively.Conclusions: We suggest that the application of systemic and endovascular IAT protocols showed a significant time reduction for faster recanalization in patients with LVO. To build-up the well-designed IAT protocol through puncture-to-recanalization can be needed to decrease time duration and improve clinical outcome in recanalization therapy in acute stroke patients.
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- 2022
39. Fatores relacionados à cárie dentária em escolares de 15-19 anos de Manaus, Amazonas
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Lays Lara Araújo Muller, Shirley Maria de Araújo Passos, Adriana Beatriz Silveira Pinto, and Ângela Xavier Monteiro
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education.field_of_study ,business.industry ,Population ,Dentistry ,General Medicine ,Oral health ,Irritability ,Dental care ,Oral hygiene ,Statistical significance ,Individual data ,Medicine ,medicine.symptom ,business ,education - Abstract
Objetivo: Avaliar a experiência de cárie dentária e fatores relacionados em adolescentes de 15 a 19 anos de uma escola pública de Manaus-AM. Métodos: O delineamento do estudo foi do tipo transversal, cuja amostra foi constituída por 103 escolares. Para avaliar a cárie dentária foram realizados exames clínicos utilizando o Índice CPO-D (cariados, perdidos, obturados por dente) para avaliar presença de cárie dentária em ficha individual. Também foram aplicados dois questionários referentes aos hábitos de higiene bucal e à percepção da presença de dor dentária nos últimos seis meses e impacto das condições de saúde bucal na vida diária. O Índice Significant Caries Index (SIC) foi utilizado para avaliar a presença da doença cárie dentária em um terço da população com maior CPO-D. Para análise dos dados foram utilizados os programas Microsoft Excel® e Statistical Package for the Social Sciences (SPSS), adotando o nível de significância de 0,05. Para verificar a hipótese de associação entre variáveis foi utilizado o teste Qui-quadrado de Pearson. Resultados: A média do índice CPO-D encontrada foi de 1,2 considerada baixa; sendo o componente cariado (C) o responsável pela maior parte do Índice CPO-D. O Índice SIC foi de 4,4 evidenciando que um terço da amostra apresentava Índice CPO muito superior à média encontrada, mostrando desigualdade na distribuição da doença no grupo estudado. A frequência de escovação por 3 vezes ao dia foi relatada pela maioria dos adolescentes (57,3%). No entanto, sobre a frequência de consulta dos adolescentes ao cirurgião-dentista, constatou-se que 48,6% dos estudantes nunca procuraram atendimento. Houve relação estatisticamente significante entre presença de cárie dentária e irritabilidade causada pelos dentes (p = 0,011) e dificuldade para falar (p = 0,007). Conclusão: Este estudo apontou baixa experiência de cárie dentária, sendo a frequência de escovação por 3 vezes ao dia relatada pela maioria dos adolescentes. Houve relação estatisticamente significante entre presença de cárie dentária e as questões sobre incômodo ao escovar os dentes e dificuldade para falar.
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- 2022
40. Effects of a remote, YouTube-delivered exercise intervention on young adults’ physical activity, sedentary behavior, and sleep during the COVID-19 pandemic: Randomized controlled trial
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Daniel J. McDonough, Wenxi Liu, Zan Gao, and Melina A. Helgeson
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Adult ,medicine.medical_specialty ,Physical Therapy, Sports Therapy and Rehabilitation ,law.invention ,Social media ,Young Adult ,Randomized controlled trial ,Resistance-training ,law ,Statistical significance ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Young adult ,Exercise ,Pandemics ,Self-determination theory ,business.industry ,Public health ,COVID-19 ,Repeated measures design ,Video ,Exercise Therapy ,High-intensity interval training ,Physical therapy ,Original Article ,Female ,Analysis of variance ,Sedentary Behavior ,Sleep ,business - Abstract
Background Public health guidelines have called for innovative and flexible physical activity (PA) intervention strategies to promote PA and health amid the coronavirus disease (COVID-19) pandemic. Therefore, this study's purpose was to examine the effects of a home-based, YouTube-delivered PA intervention grounded in self-determination theory on young adults’ free-living PA, sedentary behavior, and sleep quality (NCT04499547). Methods Sixty-four young adults (48 females; age: 22.8 ± 3.4 years, mean ± SD; body mass index = 23.1 ± 2.6 kg/m2) were randomized (1:1) into the intervention group, which received weekly aerobic and muscle-strengthening PA videos, or control group, which received weekly general health education videos, for 12 weeks. Our primary outcome was free-living moderate-to-vigorous PA (MVPA) and our secondary outcomes were sedentary behavior, light PA, and sleep quality (measured using ActiGraph accelerometers) along with muscle-strengthening PA frequency, self-determination theory-related motivation (non-regulation, external regulation, introjected regulation, identified regulation, integrated regulation, and intrinsic regulation), and perceived PA barriers (assessed using validated questionnaires). Repeated measures analysis of variances (ANOVAs) examined between-group differences at an adjusted significance level of 0.004 and effect sizes as partial eta-squared (ηp2). Results We observed statistically significant interaction effects for MVPA, sleep efficiency, muscle-strengthening PA frequency, non-regulation, integrated regulation, intrinsic regulation, and perceived PA barriers (F(1, 62) = 10.75–77.67, p < 0.001–0.002, ηp2 = 0.15–0.56) with all outcomes favoring the intervention group. We observed no statistically significant differences in either group for sedentary behavior, light PA, sleep duration, or external, introjected, and identified regulations after 12 weeks (F(1, 62) = 1.11–3.64, p = 0.06–0.61). Conclusion With national COVID-19 restrictions still in place and uncertainty regarding post-pandemic PA environments and behaviors, a remote, YouTube-delivered PA intervention may help foster clinically meaningful improvements in young adults’ free-living MVPA, muscle-strengthening PA frequency, sleep efficiency, PA-related intrinsic motivation, and perceived PA barriers., Graphical Abstract Image, graphical abstract
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- 2022
41. Patients with metastatic renal cell carcinoma treated with cabozantinib in the Czech Republic: analysis of four cancer centers
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Alexandr Poprach, Anezka Zemankova, Igor Richter, Bohuslav Melichar, Hana Študentová, Aneta Rozsypalova, Tomas Buchler, Vladimir Samal, Josef Dvorak, Ondrej Brom, and Jiri Bartos
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Oncology ,medicine.medical_specialty ,Cabozantinib ,business.industry ,Proportional hazards model ,Cancer ,030204 cardiovascular system & hematology ,medicine.disease ,General Biochemistry, Genetics and Molecular Biology ,3. Good health ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,chemistry ,Renal cell carcinoma ,030220 oncology & carcinogenesis ,Internal medicine ,Statistical significance ,Cohort ,medicine ,Progression-free survival ,business ,Adverse effect - Abstract
Aim The aim of this study was to retrospectively analyze treatment outcomes and tolerance in patients in whom cabozantinib was used after previous targeted therapy. Patients and methods Cabozantinib was administered in dose 60 mg/day, a subset of patients received initial dose of 40 mg/day. The treatment was administered until to progression or unacceptable toxicity. CT scans were assessed according to the RECIST 1.1 and toxicity of treatment was assessed based on the CTCAE (version 4). Kaplan-Meier analysis was used to calculate progression free survival (PFS) and overall survival (OS). We performed a multivariate analysis of risk factors for treatment outcomes (PFS, OS) by Cox regression analysis. All statistics were evaluated at the significance level alpha = 0.05. Results 54 patients with metastatic renal cell carcinoma (mRCC) were evaluated. Median PFS in all patients treated with cabozantinib was 9.3 months (95% CI 5.3 - 13.3). One-year survival was 85.2% (95% CI 72.9 - 93.4%). Treatment response was observed in 45.9% of cases, including one complete remission. Cox regression analysis demonstrated that presence of subsequent treatment was the only factor with a significant effect on OS (P=0.008). Adverse events occurred in 88.9% of patients, grade 3 - 4 in 46.3%. Conclusion The analysis of our cohort of patients treated with cabozantinib in the second or higher lines of treatment showed that cabozantinib represents an effective and safe therapy and contributes to longer survival of our mRCC patients.
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- 2022
42. Reulceration and Reoperation Incidence After Isolated Partial Fifth Ray Amputations: A Multicenter Study
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Hayden L. Hoffler, Cody D. Blazek, Joni K. Evans, Clark K. Brackney, Nicholas S. Powers, Benjamin J. Honeycutt, and Patrick R. Burns
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Reoperation ,medicine.medical_specialty ,Foot ,business.industry ,Incidence ,Incidence (epidemiology) ,medicine.medical_treatment ,Statistical difference ,Amputation, Surgical ,Diabetic Foot ,Surgery ,Amputation ,Multicenter study ,Statistical significance ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Below knee amputation ,Complication ,business ,Foot (unit) ,Retrospective Studies - Abstract
Ulceration or reulceration is a common complication following partial or total fifth ray amputations. The primary aim of this study was to evaluate the incidence of reulceration following partial fifth ray amputations. This was a multicenter review of 117 consecutive limbs that underwent partial fifth ray amputations at the University of Pittsburgh Medical Center and Wake Forest Baptist Medical Centers. Procedures were performed at various levels along the fifth metatarsal. Incidence of postoperative ulceration was evaluated on the ipsilateral foot. We hypothesized there would be an association between location of resection and development of reulceration. Seventy-one of 117 patients (60.7%) experienced repeat ulceration following a partial fifth ray amputation. Median follow-up time was 19 months. There was no statistical difference based on location of amputation (proximal, middle, distal, isolated base) with regards to reulceration (p = .166), further amputation (p = .271), transmetatarsal amputation (p = .160), or below knee amputation (p = .769). There was statistical significance in the follow up time between study sites (p = .013), fifth ray amputation reoperation rate between study sites (p = .001), and reulceration rates between study sites (p = .017). Partial fifth ray amputations can be a good initial salvage procedure to clear infection and prolong bipedal ambulatory status. The results of the present study put forward that there is not an association between location of amputations of the fifth ray and development of reulceration, transfer lesions or more proximal amputations.
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- 2022
43. Supine versus Prone Percutaneous Nephrolithotomy for Complex Stones: A Multicenter Randomized Controlled Trial
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Fabio C. Vicentini, Fabio Cesar Miranda Torricelli, William C. Nahas, Rodrigo Perrella, David Cohen, Joaquim F.A. Claro, Manoj Monga, Alexandre Danilovic, Guido Giusti, Miguel Srougi, Eliane D. Paro, Daniel B. Ferreira, Claudio Bovolenta Murta, Giovani S. Marchini, Carlos Batagello, Eduardo Mazzucchi, and Priscila Kuriki Vieira Mota
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medicine.medical_specialty ,Supine position ,business.industry ,Urology ,medicine.medical_treatment ,medicine.disease ,law.invention ,Surgery ,Prone position ,Primary outcome ,Randomized controlled trial ,law ,Statistical significance ,medicine ,Operative time ,Kidney stones ,business ,Percutaneous nephrolithotomy - Abstract
PURPOSE High-quality evidence comparing supine to prone percutaneous nephrolithotomy (PCNL) for the treatment of complex stones is lacking. This study aimed to compare the outcomes of supine position (SUP) and prone position (PRO) PCNL. MATERIALS AND METHODS A noninferior randomized controlled trial was performed according to the CONSORT (Consolidated Standards for Reporting Trials) criteria. The inclusion criteria were patients over 18 years of age with complex stones. SUP was performed in the Barts flank-free modified position. Except for positioning, all the surgical parameters were identical. The primary outcome was the difference in the success rate on the first postoperative day (POD1) between groups. The secondary outcome was the difference in the stone-free rate (SFR) on the 90th postoperative day (final SFR). A noninferiority margin of 15% was used. Demographic, operative, and safety variables were compared between the groups. Statistical significance was set at p
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- 2022
44. Complications related to orthognathic surgery: A 10-year experience in oral and maxillofacial training center
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Napat Damrongsirirat, Boosana Kaboosaya, Kiti Siriwatana, Pornchai Jansisyanont, Keskanya Subbalekha, and Atiphan Pimkhaokham
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Orthognathic surgery ,Osteotomy ,Young Adult ,Postoperative Complications ,Bleeding time ,Statistical significance ,medicine ,Humans ,Skeletal deformity ,Postoperative Period ,Adverse effect ,Retrospective Studies ,medicine.diagnostic_test ,Orthognathic Surgical Procedures ,business.industry ,Orthognathic Surgery ,Surgery ,Otorhinolaryngology ,Training center ,Female ,Oral Surgery ,Complication ,business - Abstract
Aim This article aimed to review adverse events and complications to orthognathic surgery based upon 10 years. Material and methods This study was a retrospective investigation between 2009 and 2018. Independent variables such as sex, age, pre-operative conditions, diagnosis, type of surgery, bleeding volume, surgery duration, and hospitalization were recorded. The data regarding orthognathic surgery adverse events and complications were evaluated and statistically analyzed with a significance level of p Results A total of 891 patients were included in this study (male 39.1%, female 60.9%) with a mean age of 26.4 ± 6.09 years. A neurosensory disturbance was found as immediate post-operative sequelae as 93.5%. The four most frequent complications had a relapse (6.4%), post-operative TMD (5.7%), unfavorable osteotomy (5.5%), and infection (4.9%), which seem to be more common in males. An average blood loss was 497 ± 371 ml and the average operative time was 401 ± 109.3 min. Complication rates were statistically affected by bleeding volume (p-value = 0.01), operative time (p-value = 0.03), and type of skeletal deformity (p-value = 0.01). Conclusion Although numerous complications were recorded, no fatal complications were experienced. Bleeding time, operative time, and skeletal classification have significant influence on orthognathic surgery complications. However, a multitude of factors could be modified to reduce the complication rate and improve the result of the treatment. One of the most significant factors was the operative time.
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- 2022
45. Utilization of reverse shoulder arthroplasty for the treatment of glenohumeral arthritis among American Board of Orthopaedic Surgery (ABOS) Part II candidates, 2008-2019
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Brendan M. Patterson, Trevor R. Gulbrandsen, Olivia C. O'Reilly, Mary Kate Skalitzky, and Molly A. Day
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Reverse shoulder ,Evidence-based medicine ,medicine.disease ,Arthroplasty ,Surgery ,medicine.anatomical_structure ,Glenohumeral arthritis ,Statistical significance ,Arthropathy ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,Rotator cuff ,business - Abstract
Background Despite advances in shoulder arthroplasty, treatment options for advanced glenohumeral osteoarthritis (GHOA) remain limited. Surgical management includes total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RSA), and hemiarthroplasty. The rates of TSA and RSA for the treatment of GHOA in the United States has increased in recent years. Trends in shoulder arthroplasty in recently trained surgeons have not been explored. The purpose of the study was to examine the trends in arthroplasty use (TSA, RSA, and hemiarthroplasty) for primary GHOA among American Board of Orthopedic Surgeons (ABOS) Part II examinees, and to identify patterns based on geographic region or fellowship training. Methods ABOS Part II examinees with at least 1 shoulder arthroplasty in the examination years 2008-2019 were collected. Hemiarthroplasty, TSA, and RSA performed from 2007-2018 for a diagnosis of primary GHOA were included. Arthroplasty for primary or secondary diagnoses of fracture, infection, tumor, rotator cuff arthropathy or tear, revision, and non-arthroplasty procedures were excluded. Proportion and volume of cases were evaluated, with sub-analyses of geographic region and fellowship training. Univariate logistic regression determined statistical significance (P Results A total of 946,946 cases from 8609 ABOS Part II examinees were submitted, with 8733 shoulder arthroplasties performed. Overall, 3923 arthroplasties for primary GHOA were included (44.9% of all shoulder arthroplasties). TSA was used in 50.9% of cases. The proportion of RSA performed for primary GHOA has increased over the past 11 years, with RSA surpassing TSA as the most common procedure for primary GHOA over the last 4 years (P Conclusion Utilization of RSA for treatment of primary GHOA by ABOS Part II examinees has increased significantly over the past twelve years. Among ABOS Part II examinees, RSA has recently surpassed TSA as the most common arthroplasty utilized for treatment of primary GHOA. Examination of early-career surgical practice allows for consideration of training influence in treatment of GHOA. As volume of shoulder arthroplasty continues to increase, trends and procedure volume have implications for clinical practice and patient outcomes. Level of evidence: Level III
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- 2022
46. Adopting robotic thoracic surgery impacts hospital overall lung resection case volume
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Lucian Lozonschi, Paul C. Kuo, Haroon Janjua, Michael P. Rogers, Emanuel Eguia, and Eric M. Toloza
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medicine.medical_specialty ,Lung Neoplasms ,Health administration ,Hospital volume ,Robotic Surgical Procedures ,Statistical significance ,medicine ,Humans ,Lung surgery ,Pneumonectomy ,Lung ,Retrospective Studies ,Case volume ,Thoracic Surgery, Video-Assisted ,business.industry ,General surgery ,technology, industry, and agriculture ,Thoracic Surgery ,General Medicine ,Length of Stay ,Hospitals ,body regions ,medicine.anatomical_structure ,Cardiothoracic surgery ,Surgery ,Lung resection ,business ,human activities - Abstract
We sought to evaluate the role of robotic-assisted lung surgery on hospital volume using difference in difference (DID). We propose hospital adoption of robotic thoracic technology increases total volume of specific procedures as compared to non-robotic hospitals.The 2010-2015 Florida Agency for Health Care Administration dataset was queried for open, video-assisted thoracoscopic, and robotic-assisted thoracic surgeries. Incident Rate Ratios (IRR) from DID analysis determined the significance of robotic technology. For each technique, length of stay and elements of charges were compared to determine statistical significance.A total of 28,484 lung resection procedures performed at 162 hospitals, 65 of which had robotic capabilities were included. Robotic hospitals experienced an 85% increase in total lung surgical volume (IRR 1.85, p-value0.001). This increase in volume was consistent for each lung resection procedure separately.Hospital adoption of robotic technology significantly increases the overall lung surgical volume for select lung resection procedures.
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- 2022
47. Anti-dense fine speckled (DFS) antibody: its staining pattern in indirect immunofluorescence and its clinical relevance
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Samet Karahan, Şerife Emre, and Hatice T. Hörmet-Öz
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0301 basic medicine ,Pathology ,medicine.medical_specialty ,Anti-nuclear antibody ,Extractable nuclear antigens ,Autoimmune Diseases ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Statistical significance ,Humans ,Medicine ,Clinical significance ,Fluorescent Antibody Technique, Indirect ,Adaptor Proteins, Signal Transducing ,Retrospective Studies ,030203 arthritis & rheumatology ,Staining and Labeling ,biology ,business.industry ,medicine.disease ,Connective tissue disease ,Staining ,030104 developmental biology ,Antibodies, Antinuclear ,biology.protein ,CTD ,Antibody ,business ,psychological phenomena and processes ,Transcription Factors - Abstract
Background: Dense fine speckled (DFS) pattern is defined by very intense, heterogeneous speckled staining of nucleoplasms of interphase HEp-2 cells and chromosomal areas of metaphase cells. The association of Anti-DFS70 and rheumatologic signs, symptoms, and diagnosis were evaluated. Methods: One-hundred-eight anti-DFS70 positives who got consecutively admitted to the Rheumatology clinic between January and June 2020 were analyzed. The clinical and laboratory findings of positives for anti-DFS70 antibody were compared with those with DFS pattern ANA IFA staining rates. Also, anti-DFS70 positivity rates and their correlation with the DFS staining pattern were analyzed retrospectively in 1016 CTD patients. Results: The most common complaint was joint pain seen in 77 (71.3%) and the most common laboratory abnormality was RF-positivity observed in 10/108 (9.3%) who had anti-DFS70 positivity. The most common ANA staining pattern was DFS (72/108; 66.7%); one-third had other than DFS. No statistical significance was found for the association of any of the rheumatological complaints and laboratory findings with the DFS staining pattern. ANA analysis was performed in a total of 964/1016 (94.88%) CTD patients and 44 (4.56%) of these positive for anti-DFS70. The correlation coefficient showed good correlations between the DFS pattern staining and anti-DFS70 antibody positivity (r=+0.773, p Conclusions: Anti-DFS70-positives have a low rate of CTD. A low anti-DFS70 positivity rate was observed in patients with CTD. As such, it can be considered that anti-DFS70 does not predict CTD or even excludes it.
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- 2022
48. Retrospective Clinical Study of Minimally Invasive Full-Mouth Rehabilitations of Patients with Erosions and/or Abrasions Following the 3-Step Technique. Part 1: 6-year Survival Rates and Technical Outcomes of the Restorations
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Arek Torosyan, Deborah Sierra, Philippe Mojon, Francesca Vailati, and Irena Sailer
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Male ,Dentistry ,Composite Resins ,Retrospective data ,Medium term ,stomatognathic system ,Statistical significance ,medicine ,Humans ,Attrition ,In patient ,Dental Restoration Failure ,Mouth Rehabilitation ,Dental Restoration, Permanent ,Survival analysis ,Retrospective Studies ,business.industry ,Treatment options ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,ddc:617.6 ,Survival Rate ,stomatognathic diseases ,Inlays ,Female ,Oral Surgery ,business - Abstract
Purpose To evaluate the survival rates and technical outcomes of minimally invasive full-mouth rehabilitations in patients affected by dental erosion and attrition. Materials and methods For this retrospective study, 28 subjects (8 women, 20 men; mean age: 45.6 years) who suffered from generalized erosions and attrition and who were treated according to the 3-step technique were invited to participate. The patient records were reviewed, and the restorations were clinically and radiographically examined. This part of the study (part 1) evaluated restoration survival and technical outcomes using the modified United States Public Health Service criteria (mUSPHS). Survival analysis was performed using Kaplan-Meier survival statistics, and comparison between subgroups was made using log-rank test. For all other comparisons, cross-tabulations of occurrence were performed, and significance was tested using Pearson chi-square test. The level of statistical significance was set at P Results A total of 19 patients (3 women, 16 men; mean age: 45.6 years) agreed to participate. In these patients, 406 restorations (149 direct composites, 110 onlays, 147 veneers) supported by 365 teeth were examined. The mean time in service was 71.8 ± 28.6 months. Six failed restorations were identified; all were direct composites. The 6-year survival rates were 97.3% for direct composites, 98.2% for onlays, and 100% for veneers (P > .05). No differences were found among materials and locations of the restorations. Nineteen technical complications included 14 partial fractures, 3 fissures, 1 wear, and 1 decementation. The mUSPHS evaluation showed good technical outcomes. Presence or absence of a nightguard influenced restoration survival (P = .003). Conclusion Minimally invasive rehabilitations of patients with erosions/attrition with the 3-step technique are a reliable treatment option in the medium term. Protective nightguards are recommended.
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- 2022
49. A randomised placebo-controlled clinical trial on the efficacy of local lidocaine injections and oral citalopram for the treatment of complex regional pain syndrome
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Rahul Padmanabhan, Nefer Fallico, A M Spagnoli, Francesco Somma, and Shakeel Rahman
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medicine.medical_specialty ,Lidocaine ,medicine.drug_class ,Citalopram ,Placebo ,Double-Blind Method ,health services administration ,Statistical significance ,medicine ,Humans ,Anesthetics, Local ,Local anesthetic ,business.industry ,medicine.disease ,Surgery ,Clinical trial ,Complex regional pain syndrome ,Anesthesia ,Neuropathic pain ,Neuralgia ,business ,human activities ,Complex Regional Pain Syndromes ,medicine.drug - Abstract
Background Complex Regional Pain Syndrome (CRPS) is a neuropathic pain condition with no universally recognised treatment. The study evaluates the efficacy of a therapeutic protocol consisting of oral citalopram and lidocaine injections in patients affected by CRPS. Methods Between January 2010 and December 2014, 150 consecutive patients with CRPS were enrolled in the study and randomly assigned into three groups: group one - lidocaine injection and oral citalopram, group two - lidocaine injection and oral placebo, group three - injective and oral placebo. The Impairment Sum Score (ISS) was used to assess the severity of CRPS before, as well as at regular intervals after treatment commenced. Statistical significance (p Results The combined treatment proved to be more effective (ISS 47.6 to 12.6) than local anesthetic alone (ISS 47.5 to 21.5) and to placebo (ISS 47.2 to 29.9). Conclusion This study indicates that CRPS may be managed with well-tolerated association of oral citalopram and lidocaine injections.
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- 2022
50. Lessons Learned From Treating 114 Inferior Vena Cava Injuries at a Limited Resources Environment - A Single Center Experience
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Simone de Campos Vieira Abib, Adenauer Marinho de Oliveira Góes Junior, Ismari Perini Furlaneto, and Karlene Thayane Barros da Silva
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Vena Cava, Inferior ,Wounds, Penetrating ,Abdominal Injuries ,Single Center ,Inferior vena cava ,Fasciotomy ,Postoperative Complications ,Statistical significance ,medicine ,Humans ,cardiovascular diseases ,Child ,Retrospective Studies ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,Vascular System Injuries ,Surgery ,medicine.vein ,Shock (circulatory) ,Concomitant ,cardiovascular system ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Ligation ,business ,Brazil - Abstract
BACKGROUND The inferior vena cava is the most frequently injured vascular structure in penetrating abdominal trauma. We aimed to review inferior vena cava injury cases treated at a limited resources facility and to discuss the surgical management for such injures. METHODS This was a retrospective study of patients with inferior vena cava injuries who were treated at a single center between January 2011 and January 2020. Data pertaining to the following were assessed: demographic parameters, hypovolemic shock at admission, the distance that the patient had to be transported to reach the hospital, affected anatomical segment, treatment, concomitant injuries, complications, and mortality. Non-parametric data were analyzed using Fisher's exact, Chi-square, Mann-Whitney, or Kruskal-Wallis test, as applicable. The Student's t-test was used to assess parametric data. Moreover, multiple logistic regression analyses (including data of possible death-related variables) were performed. Statistical significance was set at P
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- 2022
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